Kazumi Kawase

Primary Rhabdomyosarcoma of the Breast in a 13-Year-Old Girl: Report of a Case

We report a case of primary alveolar rhabdomyosarcoma of the breast in a 13-year-old Japanese girl. The patient initially presented with a 13 × 8-cm mass in her left breast, which was diagnosed as alveolar rhabdomyosarcoma after an excisional biopsy. Genetic expression of the tumor revealed t(2;13)(q35–37;q14). She underwent modified radical mastectomy (Bt + Ax) and nine lymph nodes were found to be involved. Systemic examinations showed multiple bone and lung metastases 2 weeks after her operation. Despite chemotherapy with doxorubicin, ifosfamide, and actinomycin D, which resulted in remission for 6 months, she died of the disease 8 months after surgery.

Successful Combination Therapy with Trastuzumab and Paclitaxel for Adriamycin- and Docetaxel-Resistant Inflammatory Breast Cancer

We present a case of adriamycin-and docetaxel-resistant inflammatory breast cancer (IBC) in which partial response was achieved with combination therapy using trastuzumab and paclitaxel. A 48-year old woman noticed a lump in her right breast. She was diagnosed with IBC and the disease was staged as T4d N1 M0, stage IIIB. The patient was started on neoadjuvant chemotherapy with adriamycin (50 mg/m2) and docetaxel (60 mg/m2) administered every three weeks. Six courses were performed and the response was evaluated as no change. After one month, contralateral breast swelling indicated bilateral IBC. Bilateral mastectomy using the Halsted method was performed. The immunohistochemical results of the Hercep Test™ was strongly positive (3+). After the mastectomy, right pleural effusion appeared, and cytological examination revealed the cells to be class V (adenocarcinoma).To treat the clinically advanced breast cancer, combination therapy with trastuzumab (initially 4 mg/kg followed by two or more cycles of 2 mg/kg) and paclitaxel (80 mg/m2) were given intravenously every week for eight cycles and then every two weeks thereafter. A total of 32 courses of therapy were performed, the pleural effusion completely disappeared and partial response was maintained for a duration of 482 days. The adverse reactions were mild, and it was possible for her to be treated as an outpatient with high quality of life. This report suggests that weekly combination therapy of trastuzumab and paclitaxel was useful for treatment of adriamycin-and docetaxel-resistant metastatic breast cancer.

The predictive value of PgR and HER-2 for response to primary systemic chemotherapy in inflammatory breast cancer.

BackgroundInflammatory breast cancer (IBC) is the most aggressive form of primary breast cancer. We examined the relationship between clinicopathological factors and clinical response to primary systemic chemotherapy (PSC) and outcome.MethodsTwenty-five patients with IBC were examined. Twelve patients received an anthracycline-based regimen, and 13 patients received an anthracycline-and a taxane-containing regimen as PSC. The expression of hormone receptors and human epidermal growth factor receptor-2 (HER-2) was determined by immunohistochemistry.ResultsThe overall clinical response rate was 64.0%. Clinical response to PSC was higher in patients with progesterone receptor (PgR)-positive (P = 0.01) and HER-2-negative (P = 0.03) tumors. Patients with fewer than ten involved axillary lymph nodes (P = 0.01 and P = 0.02, respectively) and with a clinical response to PSC (P = 0.02 and P = 0.01, respectively) showed better distant disease-free survival and overall survival.ConclusionIn patients with IBC, PgR-positive and HER-2-negative tumors are more sensitive to anthracycline-based PSC. Patients with extensive residual tumor (ten or more lymph-nodes involved, no response to PSC) after PSC had unfavorable prognoses.

Abstract P2-12-14: The effect of low intensity exercise for mental status and quality of life of Japanese early breast cancer patients

Objective: Breast cancer is one of the most common cancers, and it accounts for 20% of malignant tumors of women. Psychological damage of the breast cancer patient is serious. In our institution, approximately 30% of the early breast cancer patients diagnosed as depressed mental status before operation. Breast cancer patients have to receive hormone therapy, chemotherapy, and radiation therapy for a long term after operation. Depressed mental status affects execution of the treatment, and the interruption of the treatment brings the risk of cancer recurrence. As a treatment for depressed mental status of cancer patients, medication and psychotherapy are common, but some previous reports showed exercise is effective. Exercises provided in these reports were various kinds and strength, and the standard prescription is not established. We investigate the effect of walking program as a mild aerobic exercise, whether it improves the depressed mental status and quality of life (QOL) of breast cancer patients. Methods: 25 early breast cancer patients were recruited. Depressed mental status and QOL were assessed by Center for Epidemiologic Studies Depression Scale (CES-D) and Medical Outcomes Study 36-item Short Form Health Survey (SF-36). Physical activity was measured by accelerometer (Lifecorder PLUS, Suzuken), and estimated using metabolic equivalent foe task (MET). Participants mounted accelerometer after discharge, and baseline physical activity was recorded till 1 month after operation. After recording baseline physical activity, we instructed to perform walking or mild aerobic exercise. Scores of CES-D and SF-36, and physical activity data were measured again after two months. Results: Physical activity after intervention was significantly increased as compared to baseline (8.5±5.5 vs 12.3±6.9 MET.h/week, p=0.02 ). At pre-operation phase, nine patients (36%) regarded as depressed mental status by CES-D, and depressed patients decreased to five at the time of 3 months after operation. A subscale of SF-36 ( mental health ) reduced significantly compared with pre-operation and 3 months after operation ( p Conclusion: This study demonstrated the possibility that walking program as a mild exercise improves mental status and QOL of perioperative breast cancer patients. It is necessary to examine in more detail for clinical application. Citation Format: Makiko Kamio, Kazumi Kawase, Hiroko Nogi, Ken Uchida, Hiroshi Takeyama. The effect of low intensity exercise for mental status and quality of life of Japanese early breast cancer patients [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-12-14.

The Impact of CD44+CD24- Cells on Non-Sentinel Axillary Lymph Node Metastases in Sentinel Node-Positive Breast Cancer.

Background: Although completion axillary lymph node dissection (CALND) is the standard for evaluating axillary status after identification of a positive sentinel lymph node (SLN) in breast cancer, approximately 30-60% of SLN-positive patients have negative non-SLN. It has been recently demonstrated that the putative breast cancer stem cells with CD44+CD24low/- phenotype are associated with self-renewal and tumorigenic potential. In this study, in order to explore such putative breast cancer stem cells in the SLN, we intended to retrospectively analyze expression of CD44+CD24low/- on metastatic tumor cells within SLN as a predictive factor for positive non-SLN (NSLN).Methods: We tested 271 patients for the SLNs by using serial sectioning and cytokeratin immunohistochemistry (IHC) and hematoxylin-eosin, and identified 67 patients who had a positive SLN biopsy and CALND. CD44 and CD24 expression was detected using IHC. Immunostaining for CD44 and CD24 interpreted as positive if at least 1% of tumor cells show distinct membranous staining. Univariate logistic regression techniques were used to assess significant associations.Results: Twenty-seven patients out of 67 patients (40%) had positive NSLN metastases. Six positive SLNs with micrometastases were not available for evaluation of CD24 and CD44 expression. Out of the 61 patients, 22 (36%), 47 (77%) and 28 (62%) patients had CD24-positive, CD44-positive and CD44+/CD24low/- metastatic tumor cells in SLN, respectively. Positive NSLN metastase was significantly associated with primary tumor size (P=0.004), negative CD24 expression (P=0.04), positive CD44 expression (P=0.04) and CD44+/CD24low/- (P=0.03).Conclusion: This is the first evidence for the existence of the putative stem-like phenotype within the SLN, which is significantly associated with positive NSLN, in early breast cancer patients. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1160.