RESUMO
AIM: We aimed to clarify which breast cancer subtypes respond best to docetaxel/cyclophosphamide chemotherapy (TC) as neoadjuvant chemotherapy (NAC). PATIENTS AND METHODS: We analyzed pathological responses, clinicopathological characteristics and biological markers (estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER-2), Ki-67, p53, topoisomerase IIα, class III ß tubulin, cytokeratin 5/6, epidermal growth factor receptor (EGFR)) in specimens from 79 patients who received NAC-TC. RESULTS: Out of 79 patients, 33 (41.8%) achieved quasipathological complete responses (QpCR). Univariate analysis associated negative ER (p<0.001), negative PR (p=0.007), triple-negative subtype (TNBC; p=0.001), high Ki-67 (p=0.022) and low class III ß tubulin (p=0.032) with QpCR. Multivariate analyses associated only negative ER (p=0.050) and low class III ß tubulin (p=0.028) and only non-basal subtype in TNBC with QpCR. CONCLUSION: NAC-TC may be especially effective in ER-breast cancer with low class III ß tubulin or non-basal TNBC.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/metabolismo , Neoplasias de Mama Triplo Negativas/tratamento farmacológico , Tubulina (Proteína)/metabolismo , Quimioterapia Adjuvante , Ciclofosfamida/administração & dosagem , Docetaxel , Feminino , Humanos , Pessoa de Meia-Idade , Taxoides/administração & dosagem , Neoplasias de Mama Triplo Negativas/metabolismoRESUMO
Breast cancer patients who achieve a pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) usually have a favourable prognosis. We report on a patient with early metastases to the brain after achieving pCR. The primary tumour was 7.0 cm in diameter with axillary lymph node metastases, hormone receptor-negative, human epidermal growth factor receptor-2-positive (3+), and histological grade 2 with 60% of cells positive for Ki-67. The patient underwent NAC followed by surgery, and achieved pCR. Five months after surgery, during adjuvant treatment with trastuzumab, she developed headache and dizziness. Brain imaging revealed multiple metastatic brain tumours. She received whole-brain radiotherapy followed by lapatinib and capecitabine therapy. At 7 months after surgery, she remains alive with a persistent mild headache. Physicians should be aware of the possibility of early brain metastases, and consider new treatment strategies to prevent brain metastases in high-risk patients who achieve pCR.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Encefálicas/prevenção & controle , Neoplasias da Mama/tratamento farmacológico , Carcinoma Ductal de Mama/tratamento farmacológico , Terapia Neoadjuvante , Adulto , Anticorpos Monoclonais Humanizados/farmacologia , Neoplasias Encefálicas/induzido quimicamente , Neoplasias Encefálicas/secundário , Neoplasias da Mama/complicações , Neoplasias da Mama/patologia , Capecitabina , Carcinoma Ductal de Mama/complicações , Carcinoma Ductal de Mama/patologia , Quimioterapia Adjuvante , Terapia Combinada , Irradiação Craniana , Desoxicitidina/administração & dosagem , Desoxicitidina/análogos & derivados , Feminino , Fluoruracila/administração & dosagem , Fluoruracila/análogos & derivados , Humanos , Lapatinib , Metástase Linfática , Estadiamento de Neoplasias , Prognóstico , Quinazolinas/administração & dosagem , Receptor ErbB-2/antagonistas & inibidores , Receptor ErbB-2/metabolismo , Indução de Remissão , TrastuzumabRESUMO
The new coupling reaction of phenacylamines with silylstannane and lithium diisopropylamide (LDA) is reported. The treatment of a phenacylamine iodide 1 with (trimethylsilyl)tributylstannane (Me3SiSnBu3) and cesium fluoride (CsF) gave a dimerization product 2 having no iodine atom. Reaction of 1 with LDA afforded a dimerization product 3 with an iodine atom. The products 2 and 3 were separated to the meso and racemic isomers, respectively.