The role of immunohistochemistry in breast cancer patients treated with neoadjuvant chemotherapy: an old tool with an enduring prognostic value.

BACKGROUND: To assess the molecular subtypes determined by hormonal receptors (HR) and human epidermal growth factor receptor 2 (HER2) status and the role of proliferation measured by the Ki-67 marker as predictive and prognostic factors in breast cancer patients treated with neoadjuvant chemotherapy. METHODS: A total of 127 breast cancer patients were treated with neoadjuvant chemotherapy every 2 weeks as part of 2 studies. Study A consisted of the administration of Adriamycin (40 mg/m(2)) on day 1 plus paclitaxel (150 mg/m(2)) and gemcitabine 2000 mg/m(2)) on day 2 for 6 cycles (n = 54). Study B consisted of the administration of epirubicin (90 mg/m(2)), cyclophosphamide (600 mg/m(2)) on day 1 for 3 cycles, followed by the administration of paclitaxel (150 mg/m(2)) and gemcitabine 2500 (mg/m(2)) on day 1 with or without trastuzumab according to HER2 status (n = 73). In study A, patients did not receive trastuzumab regardless of HER2 status. The molecular subtypes of the patients with breast cancer were classified as 49% HR(+)/HER2(-), 17.5% HR(+)/HER2(+), 13.5% HR(-)/HER2(+), and 20% HR(-)/HER2(-). RESULTS: Pathologic complete response (pCR), defined as the absence of invasive cells in the breast and the lymph nodes, was achieved in 35 (28%) patients. The pCR rate was significantly different between the molecular subtypes of breast cancer, with 9% in HR(+)/HER2(-), 23% in HR(+)/HER2(+), 50% in HR(-)/HER2(+), and 56% in HR(-)/HER2(-) tumors (P < .001). The pCR rate was significantly higher in tumors that had high Ki-67 (≥20%) expression and were HR(-). HER2(+) was associated with a higher trend of pCR but did not reach statistical significance. The median follow-up was 81 months (r = 15-150 months). Patients who achieved a pCR had a significantly lower recurrence (P = .01) and higher overall survival (P = .02) compared with those who did not achieve pCR. A multivariate analysis revealed that pCR (hazard ratio 0.24 [95% CI, 0.07-0.7]; P = .019), the molecular subtype (hazard ratio 0.3 [95% CI, 0.1-0.8]; P = .02), and the Ki-67 index (hazard ratio 3.2 [95% CI, 1.4-7.1]; P = .004) were significant independent predictors of disease-free survival. Similar results were obtained for overall survival, in which the pCR rate (hazard ratio 0.119 [95% CI, 0.028-0.5]; P = .004), the molecular subtype (hazard ratio 0.17 [95% CI, 0.03-0.86]; P = .02), and the Ki-67 index (hazard ratio 3.6 [95% CI, 1.3-9.7]; P = .01) also displayed a significant influence on survival. CONCLUSIONS: Molecular subtypes and Ki-67 index were independent prognostic factors for disease-free survival and overall survival in breast cancer patients treated with neoadjuvant chemotherapy. A high rate of Ki-67 and HR(-) expression were predictors of pCR.

SEOM clinical guidelines for the adjuvant treatment of colorectal cancer.

Colorectal cancer is the third most common malignant neoplasm and the second cause of death by cancer in western countries. In this manuscript, the clinical guidelines of the Spanish Society of Medical Oncology (SEOM) for diagnosis and adjuvant treatment of colon cancer and rectal cancer are reported.

SEOM clinical guidelines for the treatment of advanced colorectal cancer.

Colorectal cancer is the first cause of cancer diagnosis in Spain. Over half of the patients are diagnosed with or will eventually develop distant metastasis. The current manuscript aims to provide synthetic practical guidelines for the therapeutic approaches in advanced disease. Available systemic therapeutic options, and integration and sequencing of chemotherapy with surgical procedures are discussed. Extent of disease, treatment objective, tumor kras mutation status, as well as patient's functional and comorbid conditions shall be considered to properly design the most adequate therapeutic strategy.

[Testicular germ cell tumours: descriptive study of 13 years of experience in the health care area of Badajoz]. / Estudio descriptivo de los tumores testiculares germinales: 13 años de experiencia en el area de salud de Badajoz.

OBJECTIVES: To describe the incidence of germ cell testicular tumors in our Center, their characteristics and therapy results. METHODS: Retrospective study of 66 cases of germ cell testicular tumors diagnosed in the Health Area of Badajoz between 1993 and 2005. RESULTS: Mean age of the time of diagnosis was 32 years (range 16-80 years), presenting a younger age patients with non seminomatous germ cell tumors (NSGCT) (mean age 30 years). 86.5% of the patients did not have risk factors associated with the diagnosis of germ cell testicular tumor. Testicular mass was the most frequent symptom, and a higher proportion of tumors were located in the left testicle (51.5%). Non seminomatous germ cell tumors were the most frequent histological type (64.8%). Stage I (72%) was the most frequent stage in the group of seminomatous tumors, in comparison with 68.5% of non seminomatous tumors. Stages II-III appeared in 34.4% of the NSGCT and 28% of seminomatous, having worse prognosis. 92% of the patients received adjuvant treatment with chemotherapy and/or radiotherapy, and curative surgery was the only treatment in the remainder 8%. Residual mass surgery was undertaken in five patients (stages IIa, IIc and IIIa). Eight of the 66 cases were lost for follow-up. Fifty-three of the 58 patients with follow-up are disease-free, 18 of them with more than five years of follow-up. CONCLUSIONS: An increased incidence of germ cell testicular tumors have been verified over last years, mainly NSGCT Nevertheless, the diagnosis of advanced stages of the disease has diminished in favour of initial stages, which have a better prognosis for the patient. Oncologycal treatment protocols have high cure rates, although a long-term follow-up is needed due to the natural history of these tumors.

Estudio descriptivo de los tumores testiculares germinales: 13 años de experiencia en el área de salud de Badajoz / Testicular germ cell tumours: descriptive study of 13 years of experience in the health care area of Badajoz

Objetivo: Descripción de la incidencia, las características tumorales y los resultados de la terapéutica aplicada en los tumores germinales testiculares diagnosticados en nuestro Centro. Método: Estudio retrospectivo de los 66 casos de tumores germinales diagnosticados en el Área de Salud de Badajoz en el período comprendido entre 1993 y 2005. Resultados: La edad media del diagnóstico de los tumores germinales de testículo (TGT) fue de 32 años (rango 16-80 años), presentando una edad más precoz los pacientes con tumores no seminomatosos (TGNS), media de 30 años. En un 86.5% de los paciente no se encontraron factores de riesgo relacionados con el diagnóstico de TGT. El hallazgo de una masa escrotal fue el síntoma mas frecuente y el tumor se localizó en mayor proporción en el testículo izquierdo (51.5%). Los tumores germinales no seminomatosos fueron la histopatología más común (64.8%). En el grupo de los tumores seminomatosos (TGTS), el estadio I (72%) fué el más diagnosticado frente al 68.5% de los no seminomatosos. Los estadios II-III se dieron en el 34.4% de los TGNS y 28% de los seminomas, conllevando peor pronóstico. El 92% de los pacientes recibió tratamiento adyuvante con quimioterapia y/o radioterapia, y se realizó cirugía curativa como único tratamiento en el 8% restante de los pacientes. Se practicó cirugía de masas residuales en 5 pacientes (estadios IIb, IIc y IIIa). Ocho de los 66 casos se han perdido en el seguimiento. De los 58 pacientes restantes, donde fue posible el control de la evolución, 53 pacientes están libre de enfermedad,18 de ellos con más de 5 años de seguimiento. Conclusiones: En los últimos años se verifica un aumento de la incidencia de TGT, sobre todo a expensa de los TGNS. Sin embargo, ha disminuido el diagnóstico en fase avanzada de la enfermedad en favor de estadios iniciales que confieren un mejor pronóstico para el paciente. Los protocolos de tratamiento oncológicos utilizados proporcionan una alta tasa de curabilidad, aunque debido a la historia natural de tumor, es necesario un seguimiento a largo plazo (AU)

Objectives: To describe the incidence of germ cell testicular tumors in our Center, their characteristics and therapy results. Methods: Retrospective study of 66 cases of germ cell testicular tumors diagnosed in the Health Area of Badajoz between 1993 and 2005. Results: Mean age of the time of diagnosis was 32 years (range 16-80 years), presenting a younger age patients with non seminomatous germ cell tumors (NSGCT) (mean age 30 years). 86.5% of the patients did not have risk factors associated with the diagnosis of germ cell testicular tumor. Testicular mass was the most frequent symptom, and a higher proportion of tumors were located in the left testicle (51.5%). Non seminomatous germ cell tumors were the most frequent histological type (64.8%). Stage I (72%) was the most frequent stage in the group of seminomatous tumors, in comparison with 68.5% of non seminomatous tumors. Stages II-III appeared in 34.4% of the NSGCT and 28% of seminomatous, having worse prognosis. 92% of the patients received adjuvant treatment with chemotherapy and/or radiotherapy, and curative surgery was the only treatment in the remainder 8%. Residual mass surgery was undertaken in five patients (stages IIa, IIc and IIIa). Eight of the 66 cases were lost for follow-up. Fifty-three of the 58 patients with follow-up are disease-free, 18 of them with more than five years of follow-up. Conclusions: An increased incidence of germ cell testicular tumors have been verified over last years, mainly NSGCT. Nevertheless, the diagnosis of advanced stages of the disease has diminished in favour of initial stages, which have a better prognosis for the patient. Oncologycal treatment protocols have high cure rates, although a long-term follow-up is needed due to the natural history of these tumors (AU)