Jiang Zefei

Remarkable response with pembrolizumab plus albumin-bound paclitaxel in 2 cases of HER2-positive metastatic breast cancer who have failed to multi-anti-HER2 targeted therapy

ABSTRACT In clinical practice, one subgroup patients of breast cancer might have developed resistance to multi-anti-HER2 targeted drugs(trastuzumab, lapatinib and/or T-DM1) and can not benefit from the anti-HER2 targeted therapy continuously. We attempt to change the next therapic way for these patients. Two patients with metastatic breast cancer who have failed to multi-anti-HER2 targeted therapy were treated with pembrolizumab (2 mg/Kg, day1) plus albumin-bound paclitaxel (125 mg/m2, day1,8) every 3 weeks. CT evaluation and HER2 ECD test were performed every 2 cycles. Both of the two patients achieved remarkable response with Partial Remission (PR), meanwhile serum HER2 ECD levels (the upper normal limit is 15 ng/ml) showed a remarkable decreases(compared to the base line decreases 75% and 60% respectively). The results indicate that regimen of pembrolizumab combination with albumin-bound paclitaxel might produce response in patients with HER2-positive metastatic breast cancer who have failed to multi-anti-HER2 targeted therapy.

Progestin as an alternative treatment option for multi-treated recurrent triple-negative breast cancer

OBJECTIVE Patients with recurrent triple-negative breast cancer (TNBC) currently have no established treatment option other than chemotherapy. However, long-term chemotherapy is often difficult due to adverse effects. A previous study documented a 10%-30% response rate of progestins in oestrogen receptor-negative breast cancer. The aim of this study was to investigate the effect of medroxyprogesterone/megestrol acetate (MPA/MA) in patients with recurrent TNBC. METHODS This retrospective observational analysis included 51 patients with recurrent TNBC; 17 were treated with MPA/MA and 34 underwent chemotherapy. The two groups were matched at a 1:2 ratio according to age, metastatic sites, and salvage treatment lines. Efficacy was compared using the χ2 and rank-sum tests. Progression-free survival (PFS) was calculated using the Kaplan-Meier method, and the two groups were compared using the log-rank test. RESULTS The two groups were well balanced in terms of age, disease-free survival, number of metastases, and salvage therapy lines. Clinical benefit rates in the MPA/MA and chemotherapy groups were 52.94% and 73.53%, respectively (χ2 test, p = 0.208), and median PFS was comparable between groups (log-rank test, p = 0.135). Median PFS of 1st-6th-line salvage treatments was shorter in the MPA/MA group than in the chemotherapy group (log-rank test, p = 0.036), but median PFS of ≥7th-line salvage treatments was comparable (log-rank test, p = 0.139). Eight patients discontinued chemotherapy due to adverse effects, and one patient withdrew from MPA treatment because of weight gain. CONCLUSIONS Progestins (MPA/MA) are an alternative treatment option for multi-treated recurrent TNBC.

Treatment with everolimus for a patient with systemic metastatic breast cancer results in severe pulmonary injury: a case report.

Everolimus has been used in patients with hormone receptor-positive breast cancer. This study reports that treatment with everolimus alone induced severe pulmonary injury in a patient with systemic metastatic breast cancer. A 58-yearold woman with systemic metastatic breast cancer was treated with everolimus alone for 4 weeks and developed severe cough and dyspnea. Computed tomography (CT) scan of the chest showed a progressive lung tumor accompanied by bilateral pulmonary homogeneous ground-glass opacity, especially in the inferior lobe of the left lung. Laboratory examinations revealed a high frequency of monocytes, higher levels of serum alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and C-reactive protein as well as mild hypoxemia and hypocarbia. However, she had no evidence of infection with mycoplasma pneumoniae, chlamydia, pneumocystis, tuberculosis, influenza A virus, and was negative for serum galactomannan (GM) antigen assay. She was suspected to have drug-induced interstitial pneumonia. Everolimus treatment was stopped, and treated with methylprednisolone and empiric antibiotic therapy for 7 days. She received further corticosteroid treatment and felt much better, accompanied by clearance of lung inflammation; she was discharged from hospital. Our experience suggests that treatment with everolimus alone may cause severe pulmonary injury and should be considered carefully in cases of patients with systemic metastatic breast cancer.

Clinical Trial of Letrozole （femara） versus Aminoglutethimide in Postmenopausal Women with Advanced Breast Cancer

AbstractObjective: To compare the response and adverse reactions of aminoglutethimide with that of femara, an oral aromatase inhibitor, in postmenopausal women with advanced breast cancer. Methods: Fifty patients were randomly assigned to femara 2.5 mg once daily (n=26) or aminoglutethimide (n=24) 125 mg twice daily in the first week, 250 mg twice daily in the second week, 250 mg three times daily in the third week and 250 mg four times daily in the fourth week, 30 days for one cycle for both groups. Results: Overall objective response rate (complete+partial) of 26.9% for femara was 12.5% higher than that of aminoglutethimide, but there was no significant difference (P=0.294). The percentages of stable disease were 53.8% and 50.0% respectively in both treatment groups and that of progressive disease of two groups were 19.2% and 37.5%. There was no significant difference between two arms in the receptor status, disease-free intervals, sites of disease and stages of treatment. Femara-related adverse events were fatigue (15.4%), anorexia (11.5%), dizziness (7.7%), nausea (3.8%) and somnolence (3.8%). However, incidence of nausea (25.0%) and vomiting (16.7%) in aminoglutethimide group was obviously higher and severer than that in femara group (P=0.045 and P=0.046). Compared to femara group, frequency in dizziness (25.0%), fatigue (20.8%), anorexia (16.7%), somnolence (12.5%) and cutaneous pruritus (12.5%) was higher in aminoglutethimide group. Allergic rash occurred in aminoglutethimide group. Conclusion: Femara was more effective and well tolerated than aminoglutethimide with respect to side effects in the treatment of postmenopausal women with advanced breast cancer.