Defining the optimal sequence for the systemic treatment of metastatic breast cancer

Metastatic breast cancer is a heterogeneous disease that presents in varying forms, and a growing number of therapeutic options makes it difficult to determine the best choice in each particular situation. When selecting a systemic treatment, it is important to consider the medication administered in the previous stages, such as acquired resistance, type of progression, time to relapse, tumor aggressiveness, age, comorbidities, pre- and post-menopausal status, and patient preferences. Moreover, tumor genomic signatures can identify different subtypes, which can be used to create patient profiles and design specific therapies. However, there is no consensus regarding the best treatment sequence for each subgroup of patients. During the SABCC Congress of 2014, specialized breast cancer oncologists from referral hospitals in Europe met to define patient profiles and to determine specific treatment sequences for each one. Conclusions were then debated in a final meeting in which a relative degree of consensus for each treatment sequence was established. Four patient profiles were defined according to established breast cancer phenotypes: pre-menopausal patients with luminal subtype, post-menopausal patients with luminal subtype, patients with triple-negative subtype, and patients with HER2-positive subtype. A treatment sequence was then defined, consisting of hormonal therapy with tamoxifen, aromatase inhibitors, fulvestrant, and mTOR inhibitors for pre- and post-menopausal patien ts; a chemotherapy sequence for the first, second, and further lines for luminal and triple-negative patients; and an optimal sequence for treatment with new antiHER2 therapies. Finally, a document detailing all treatment sequences, that had the agreement of all the oncologists, was drawn up as a guideline and advocacy tool for professionals treating patients with this disease (AU)

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SEOM clinical guidelines for the treatment of early breast cancer

The incidence is increasing due to mammographic screening and an ageing population. In some countries the mortality rate has decreased especially in middleaged and younger groups because of improved treatment and possibly earlier detection. However, breast cancer is still the leading cause of cancer-related death in European women. The purpose of this work was to elaborate a Spanish Society of Medical Oncology guideline on pharmacologic interventions for early breast cancer (BC). We have compiled the latest advances in the management of this pathology either in the adjuvant and neoadjuvant setting, cytostatic and hormonal treatment, so that in a simple way could be useful to oncologist, residents and other related specialties (AU)

Coriocarcinoma mediastínico primario con metástasis pulmonares, cerebrales y hepáticas / Primary mediastinal choriocarcinoma with lung, brain and liver metastases

Entre el 1 y el 4 por ciento de los tumores germinales (TG) pueden originarse en el mediastino, siendo esta su localización extragonadal más frecuente. De ellos, los tumores germinales mediastínicos (TGM) no seminomatosos como el coriocarcinoma son menos habituales, más agresivos y de peor pronóstico. Presentamos el caso de un paciente varón de 34 años, diagnosticado de inicio en Febrero del 2000 de un coriocarcinoma mediastínico primario con metástasis pulmonares bilaterales, hepáticas y cerebrales, aprovechando la ocasión para revisar algunas características de estos tumores, de su historia natural, diagnóstico y tratamiento (AU)

Necrólisis epidérmica tóxica postradioterapia / Toxic epidermal necrolysis post-radiotherapy

Propósito: Presentamos un caso de Necrolisis Epidérmica Tóxica ocurrido después de radioterapia en un paciente diagnosticado de carcinoma epidermoide de lengua. Material y método: Varón de 62 años, en tratamiento con Omeprazol y Finasteride por UIcus péptico e Hipertrofia benigna de próstata, que tras serle aplicado un protocolo de quimioterapia en régimen Al-Sarraf por el carcinoma de lengua previamente descrito y radioterapia en sesiones de manera fraccionada, 21 días después de la última sesión de radioterapia, desarrolla un cuadro compatible clínicamente con Necrolisis Epidérmica Tóxica que ocasiona el éxitus del mismo. Resultados: La necrolisis epidérmica tóxica (NET) es una dermatosis ampollosa de etiopatogenia desconocida, en la que han sido implicados múltiples agente causales, entre ellos la aplicación de radioterapia, y que dada la gravedad de la misma, así como las complicaciones que de ella se pueden derivar, requiere estrecha vigilancia. Conclusiones: Incidimos en la relación causa-efecto existente entre radioterapia y NET, así como el tratamiento de la misma basado en medidas de soporte evitando la administración de corticoides sistémicos (AU)