Is it possible to increase pCR in the neoadjuvant treatment with a dose-dense/sequential combination?: results from a phase II Trial combining epirubicin and cyclophosphamide followed by paclitaxel and gemcitabine ± trastuzumab in stage II and III breast cancer patients.

PURPOSE: To evaluate the pathologic complete response (pCR) rate of a combination of epirubicin (E) and cyclophosphamide (C) followed by paclitaxel (P) and gemcitabine (G) (+ trastuzumab[T]) in Her2+ patients) in a sequential and dose-dense schedule as neoadjuvant chemotherapy for stages II and III patients with breast cancer. Secondary endpoints: clinical response rate, disease free survival, safety and correlation between pCR and biologic markers. PATIENTS AND METHODS: Eligible patients were treated with E (90 mg/m²) and C (600 mg/m²) for 3 cycles (first sequence) followed by P (150 mg/m²) and G (2500 mg/m²) (second sequence) for 6 cycles. All drugs were administered on day 1, every 2 weeks, with prophylactic growth factor support. Weekly T (2 mg/kg [4 mg/kg first infusion]) was administered concomitantly with P and G in Her2+ patients. A core biopsy was performed before treatment for biologic markers assessment. Patients underwent surgery, radiotherapy, and adjuvant hormonal therapy according to institutional practice. RESULTS: Seventy-three patients were treated. A pCR was achieved in 27 (37%) patients (32.1%, Her2- and 50%, Her2+). pCR was significantly higher in tumors that were hormonal receptor negative, poorly differentiated and positive for Ki67 and p53. Breast-conserving surgery was performed in 47 patients (64.4%). Most frequent grade 3/4 hematologic and nonhematological toxicities included neutropenia (12%), nausea/vomiting (17%), and transient liver enzymes elevation (7%). One patient suffered an asymptomatic and reversible decrease in left ventricular ejection fraction. CONCLUSIONS: These results show a highly effective regimen in terms of pCR with a good toxicity profile in the neoadjuvant treatment of patients with breast cancer. The addition of trastuzumab increased pCR rate in Her2+ tumors.

Tumour molecular subtyping according to hormone receptors and HER2 status defines different pathological complete response to neoadjuvant chemotherapy in patients with locally advanced breast cancer

PURPOSE: To study the role of breast cancer molecular subtypes according to hormone receptors and HER2 status as a predictive factor for pathological complete response (pCR) to neoadjuvant chemotherapy. PATIENTS AND METHODS: Eligible patients received one of the two chemotherapy schedules every two weeks with prophylactic growth factor support; schedule A: epirubicin 90 mg/m2-cyclophosphamide 600 mg/m2 d1 for 3 cycles followed by a second sequence with paclitaxel (P) 150 mg/ m2-gemcitabine (G) 2500 mg/m2 d1+/-trastuzumab (T) 2 mg/kg/week according to HER2 status (n=73); schedule B: adriamycin (40 mg/m2) d1 plus P (150 mg/m2)-G (2000 mg/m2) d2 for 6 cycles (n=54). Subsequently, patients underwent surgery, radiotherapy and/or adjuvant hormonal therapy according to standard practice. RESULTS: A total of 127 patients were evaluated. Forty-three patients (33.9%) achieved a pCR (50% in patients with HER2+tumours treated with T). Patients treated with che - motherapy alone (n=107, 18 HER2+) had a pCR of 32% (p=0.068). The pCR rate for patients with triple negative (HR and HER2-) cancers was 58.3%, 39.5% for HER2+ and 5.4% for ER/PR+ and HER2- (p<0.001). No differences in disease-free survival (DFS) were noted as a function of pCR, HER2 and HR status or treatment received (+/-T). However, statistical differences in DFS were observed as a function of whether patients had + or - axillar lymph nodes. Patients with + lymph node disease did worse (3 years DFS of 53.7% vs. 81.5%, p=0.025). Breast-conserving surgery was performed in 77 patients (60.6%). CONCLUSION: Tumour molecular subtyping defines different pCR to neoadjuvant chemotherapy (NC) but has no impact over DFS in patients with LABC. Although no significant correlation between HER2 status and trastuzumab therapy with pCR was found, probably due to the small number of patients, a favourable trend was observed in the group of HER2+ tumours treated with T (AU)

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Nódulos pulmonares múltiples de reciente aparición en mujer diagnosticada de metástasis pleurales de un carcinoma de mama / Multiple lung nodules of recent appearance in a woman with diagnosis of breast cancer pleural metastases

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Treatment and prophylaxis of ifosfamide-induced encephalopathy with intravenous methylene blue

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Dermatitis por radiation recall inducida por gemcitabina / Gemcitabine-induced recall radiation dermatitis

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Limitaciones al uso de los marcadores tumorales séricos en la práctica oncológica / Limitations of the use of serum tumor markers in oncologic practice

Los marcadores tumorales séricos (MTS) son utilizados de manera habitual en la monitorización de la respuestay en el seguimiento de los pacientes oncológicos tras las diversas terapias administradas.Presentamos tres casos clínicos con falsas elevaciones de MTS, como son CA 15-3, CA 12-5 y CA 19-9, enpacientes diagnosticados y tratados de carcinoma de mama, carcinoma de ovario y carcinoma colorrectal respectivamente,durante su seguimiento.A continuación se discuten las limitaciones de su uso en la práctica oncológica como consecuencia de susproblemas de sensibilidad y especificidad, y cual es su utilidad en el pronóstico, supervivencia y calidad de vidade los pacientes

Serum tumor markers are often used for the evaluation of the response and follow-up of oncologic patietsafter different dispensed therapies.We report three clinicl cases of false elevation of CA 15-3, CA 12-5 and CA 19-9 serum tumor markersduring the follow-up of patients diagnosed and treated for breast cancer, ovarian cancer and colorectal cancerrespectively.The limitations to their use in oncologic practice are discussed in relation with sensitivity and specificityproblems, as well as their usefulness in the prognosis, survival and quality of life considerations of the patients

Dermatomiositis en el diagnóstico del cáncer: carcinoma de mama y de vesícula biliar / Dermatomyositis in cancer diagnosis: breast and gallbladder carcinomas

La dermatomiositis (DM) es un raro síndrome paraneoplásico que se asocia al diagnóstico de diferentes tumores.Puede preceder a la enfermedad oncológica, cursar simultáneamente o incluso aparecer meses o añosdespués de la misma. Presentamos dos casos de pacientes con DM asociada a carcinoma de mama y de vesículabiliar, describiéndose los principales puntos de interés que esta entidad clínico-patológica pueda tener para eloncólogo

Dermatomyositis (DM) is a rare paraneoplastic syndrome associated with different tumors. It can precedethe tumor appearance or go on simultaneously or even appear years after the tumor is diagnosed. We reporttwo cases of patients with DM associated with breast cancer and gallbladder cancer, and make a review of themain interesting points for oncologists