Complete response in advanced breast cancer patient treated with a combination of capecitabine, oral vinorelbine and dasatinib.

BACKGROUND: Currently, there are no data available on the best choice of treatment in heavily pretreated patients with advanced breast cancer. However, the combination of oral vinorelbine and capecitabine has been demonstrated to be effective and safe in patients with advanced breast cancer pretreated with anthracycline. Furthermore, some studies assessed the activity of dasatinib, an oral tyrosine kinase inhibitor that inhibits five oncogenic tyrosine kinase families, alone or in combination with different chemotherapy in patients affected with advanced breast cancer. CASE PRESENTATION: A patient with metastatic breast cancer, hormone receptor positive and human epidermal grow factor receptor 2 negative, pretreated with epirubicine, taxanes and nab-paclitaxel, was submitted to third line chemotherapy with vinorelbine 60 mg/m2 on day 1, 8 plus capecitabine 1000 mg/m2 twice daily from day 1 to day 14 every 21 days. The patient was taking also dasatinib 100 mg once daily for chronic myeloid leukemia. The treatment was well tolerated and, after 15 months, computed tomography scan showed a complete response of liver metastases and bone stable disease. After another 28 months, a 18-fluorodeoxyglucose positron emission tomography scan showed a metabolic response of bone metastases without other site of disease. CONCLUSIONS: This is the first case in literature about activity of dasatinib in combination with a chemotherapy schedule of oral vinorelbine and capecitabine in advanced breast cancer. This treatment showed both good tolerability and great activity with a long progression free survival of 54 months.

[Computed tomography features after cystectomy]. / Aspetti con tomografia computerizzata dopo interventi di cistectomia.

Continent urinary diversions are most often performed in the patients who underwent cystectomy for malignancy, typically an invasive bladder carcinoma. There is no ideal surgical technique suitable to every case to reconstruct the lower urinary tract because many factors affect patients selection--e.g., tumor stage, patient's age and overall condition, and so on. Since radiologists play an important role in following up these patients, they must be familiar with postoperative anatomy to detect complications promptly. From 1985 to 1991, forty-two patients underwent radical cystectomy and urinary diversion; four different kinds of diversion were performed: ureterocutaneostomy, ureteroileocutaneostomy, ureterosigmoidostomy and total bladder replacement with ileal or ileocecal segments. The patients were examined with CT six months after surgery and then every year. The usual postoperative CT findings are reported. In the patients who underwent radical cystectomy, a loop of sigmoid colon fills the space left empty by surgery; less frequently, a loop of ileum or of both ileum and sigmoid colon occupies the bladder fossa. The CT findings in the four different kinds of diversion were different enough to be easily distinguished: ureters joined to skin, to an ileal loop or to sigmoid colon are found in ureterocutaneostomy, ureteroileocutaneostomy and ureterosigmoidostomy, respectively. Also the two examined kinds of neobladder (Lebag and "Padovana" techniques) exhibited different volumes and shapes. The anastomosis between ureters and intestinal segment could not be identified in all cases. Nonetheless, CT is the imaging method of choice after cystectomy, as it allows the thorough evaluation of the genitourinary apparatus.