Giuliana Caprio

A phase II trial of a biweekly combination of paclitaxel and gemcitabine in metastatic breast cancer

BackgroundMany emerging new drugs have recently been trialled for treatment of early and advanced breast cancer. Among these new agents paclitaxel and gemcitabine play a crucial role, mostly in patients with relapsed and metastatic disease after failure of chemotherapy with antracyclines.MethodsA phase II study was started in order to evaluate the activity and toxicity of a combination of paclitaxel and gemcitabine in a biweekly schedule on metastatic breast cancer patients previously treated with antracyclines.ResultsTwenty-five patients received paclitaxel (150 mg/mq) by 3-hours infusion, followed by gemcitabine (2000 mg/mq) given as a 60 min i.v. infusion (day 1–14) for a maximum of eight cycles. In all patients treatment was evaluated for toxicity and efficacy; four patients (16%) achieved a complete response, 12 (48%) a partial response giving an overall objective response rate of 64%. Stable disease was documented in 5 patients (20%) and progressive disease occurred in 4 patients (16%).ConclusionThe schedule of treatment was safe and tolerable from a haematological and non-haematological point of view. These data confirm that the combination of gemcitabine and paclitaxel on a biweekly basis is an effective and well-tolerated regimen in breast cancer patients with prior therapeutic exposure to antracyclines.

Use of Core Needle Biopsy rather than Fine-Needle Aspiration Cytology in the Diagnostic Approach of Breast Cancer

Background and Aims: In the following study case, we reviewed breast ultrasound-guided core needle biopsy (CNB), using Mammotome (vacuum-assisted breast biopsy) and Tru-cut, carried out on palpable and nonpalpable uncertain breast lumps or malignant large lesions to be submitted to neoadjuvant chemotherapy. Material and Methods: Examinations were conducted during a 4-year period of clinical activity in a highly specialized center, from December 2009 to December 2013, in 712 patients previously subjected to fine-needle aspiration cytology (FNAC). Results: The results demonstrated that among the 712 breast biopsies, in many cases FNAC was not conclusive, and therefore we proceeded with the echo-guided biopsy, through which we were able to collect sufficient material for the histological examination in order to direct patients to surgery or follow-up. Conclusions: CNB is far superior to FNAC, especially in cases of uncertainty, where it is preferable to proceed directly with CNB, which may also determine additional prognostic and predictive markers. Initially FNAC is less expensive, but the actual costs involved tend to be higher for FNAC as it is less accurate and a CNB is often required. In accordance with recent publications, we can confirm the full validity of CNB in the diagnostic approach of breast lesions.

Matrix-producing carcinoma of the breast: a case report.

Matrix-producing breast cancer (MPC) is a subtype of metaplastic carcinoma of the breast. It is a very rare tumor, which constitutes less than 1% of all malignant mammary tumors. The origin of this tumor is still unclear: there are molecular studies that suggest an origin from myoepithelial cells, whereas other studies underline the neoplastic transformation of a multipotent stem cell. Even the differential diagnosis of MPC and other breast neoplasms (phyllodes tumors and real sarcomas of the breast) is not always easy. In the literature, a certain chemoresistance has been demonstrated, and a standard treatment of this tumor does not exist at this time. We report the case of a 44-year-old, premenopausal, female patient with a 6-cm breast lump. Neither imaging nor fine needle aspiration biopsy was crucial in achieving a diagnosis. The patient underwent a simple mastectomy. In consideration of the negative lymph node status, the patient was not subjected to radiotherapy or adjuvant chemotherapy. Moreover, since the receptor status was negative, hormone therapy was not necessary. The patient has been disease free for 4 years now.

Urokinase expression in course of benign and malignant mammary lesions: Comparison between nodular and healthy tissues

PurposeIncreased expression of urokinase (uPA), a member of the serine protease family, is an effector of metastatic cascade and has been reported in various malignancies, including breast cancer. uPA overexpression in cancer tissues was correlated with a more aggressive phenotype and it is considered a strong and independent unfavorable prognostic factor in breast cancer.MethodsUsing real-time PCR assay, we analyzed uPA expression of malignant and benign breast nodular lesions versus healthy tissues (normal breast and lymphocytes).ResultsWe found that besides breast cancer nodule, normal mammary gland and lymphocytes overexpressed uPA too. Tissues obtained from women with benign lesions expressed homogeneous and lower uPA.ConclusionsIn conclusion, although uPA overexpression is typical of cancer tissues, it could be considered as a feature of the whole organism affected by cancer. On the basis of these first results, uPA could be considered for further studies as a possible useful therapeutic target in breast cancer.

Multidisciplinary breast unit: the activity of the past 15 years.

To the Editor: The knowledge and interest regarding breast lesions have rapidly grown during the past 20 years and presently constitute a primary issue. Each year in our country approximately 30,000 new cases of cancer are reported (1), approximately 250,000 patients need a regular followup, more than 2 million diagnostic examinations are performed, with a total yearly cost of approximately

One-day surgery in a series of 150 breast cancer patients: efficacy and cost-benefit analysis.

150 billion; furthermore, a remarkable number of biopsies are performed for benign lesions (which could be reduced by improving diagnostics). The Service of Prevention, Diagnosis, and Therapy of Tumors, in the Surgery Department “Pietro Valdoni” of Rome University “La Sapienza,” has considered the importance of establishing a multidisciplinary unit of senology, with the aim of fighting cancer in an efficient manner. The objectives it has set include anticipated diagnostics by integrating clinical-instrumental investigations; a correct and rapid diagnosis exclusively performed through cooperation between highly specialized professionals who work together (2); and a therapeutic strategy suitable for the necessities of single patients, with particular concern for the psychological aspect. In this structure it is possible to perform, beside diagnostics, medical and surgical therapy as well as postoperational follow-up, and both symptomatic and nonsymptomatic women are attended. We report our experience regarding the past 15 years of activities. The Service of Prevention, Diagnosis, and Therapy of Tumors provides health care in accordance with the National Security Service, and patients are seen Monday through Friday from 9 a . m . to 2 p . m ., without an appointment, by bringing an order for a specialized examination written by the doctor in charge of the patient. The center was created with the aim of attending mainly symptomatic women, who need examinations performed within in a short period of time, but who would usually be obliged to undergo instrumental diagnostic tests in different centers, with long delays. Obviously nonsymptomatic women who require yearly monitoring screenings are also attended. The service is divided into several areas: wait, acceptance, clinic, diagnosis by images, day surgery, nuclear medicine, and laboratories. The various areas are arranged so that an obliged course must be followed. An average of 20 persons are seen daily and the time required for a monitoring screening includes the visit, mammography and/or echography, as well as a discussion with the doctor regarding the results of the examinations, which requires 1 to 3 hours. In the case of a follow-up patient, the time is extended because of the greater number of tests that must be performed. Patients are divided into three age ranges: less than 25 years, between 25 and 40 years, and more than 40 years. Women who are not yet 25 years of age have only a clinical examination. If an abnormality is detected, echography and possibly a needle aspiration (Fig. 1) are performed. Women between 25 and 40 years of age have echography performed, and whenever the breast shows an adipose involution, mammography (Fig. 2) is performed. Women who are more than 40 years of age have a mammogram