Matilde Navarro

Palmar-plantar erythrodysesthesia syndrome associated with short-term continuous infusion (5 days) of 5-fluorouracil.

A case of palmar-plantar erythrodysesthesia syndrome (PPES) observed during a 120-h infusion of 5-fluorouracil (5-FU) is presented. This syndrome has been described in the literature after protracted infusion chemotherapy of over 30 days. The agent most frequently associated with this syndrome was 5-FU. A 53-year-old man was admitted to the hospital with a well-differentiated squamous cell carcinoma of the retromolar trigone. The patient received 100 mg/m2 of cisplatin on day 1 and 120-h continuous infusion of 1000 mg/m2 of 5-FU every 3 weeks. After the second course, the patient developed clinical features consistant with PPES. This side effect has not been previously reported with short-term (5-day or 120-h) continuous infusion of 5-FU. Less frequently, the syndrome has also been described with 10-day continuous infusion. The etiopathogenesis of PPES is unclear, but it seems to be dose-dependent and probably related to cutaneous drug accumulation.

Circulating CA 15.3 levels in breast cancer. Our present experience.

CA 15.3 is an antigen expressed by human breast carcinoma cells, and defined by two monoclonal antibodies, 115D8 and DF3. We used IRMA to determine the circulating serum levels of CA 15.3 in 1178 subjects with breast cancer, non-breast malignancies, benign diseases and controls. A threshold level of 40 U/ml was established with 140 healthy controls and 650 patients with benign diseases (respectively 0% subjects and 1.5% patients had abnormal antigen levels). Elevated CA 15.3 was found in 12 of 184 patients with malignancies different from breast cancer (6.5%), either epithelial carcinomas with distant metastases, mainly in the liver, or primary liver tumors. Breast cancer patients (n=204) were analysed by prior therapy, UICC stage and WHO response to therapy. Eight of 134 (5.9%) patients with stage II or III breast cancer at presentation and no evidence of disease (NED) had elevated CA 15.3. All of 22 patients with stage IV breast cancer not responding to therapy (SD and PD) had antigen levels > 40 U/ml, as did 10 of 34 (29.4%) stage IV patients in objective response (CR+PR). Three of 14 pretreatment patients had abnormal marker levels, and they later proved to have distant metastases. Serum CA 15.3 values were statistically different (p < 0.01) in NED (20.6 ± 11.2 U/ml), CR+PR (33.5 ± 24.0 U/ml), stable disease (98.8 ± 50.4 U/ml) and progressive disease (> 200 U/ml) breast cancer patients. Our results suggest that circulating CA 15.3 antigen levels agree with the stage of breast cancer and with the response to therapy.

Ifosfamide + mitoxantrone in advanced breast cancer previously treated with anthracyclines

SummaryWe treated 19 patients previously exposed to anthracyclines (progression during therapy or after discontinuation of therapy) with ifosfamide (IFO) 2 g/m2 i. v. in a 1-h infusion daily for 3 days with mesna uroprotection and mitoxantrone (MZT) 12 mg/m2 on day 1 of every 3-week cycle. The response rate was assessed after two cycles. A response to treatment was observed in 6 of 15 evaluable patients (40%), with no complete remission and 6 partial remissions. The median duration of response was 6+ months (3+ to 12+). The toxicity was acceptable, with three episodes of grade 3-4 myelosuppression (8%) and one case of congestive heart failure resulting from a fluid overload that responded to medical treatment. The IFOMZT combination is an effective second-line regimen in advanced breast cancer previously treated with anthracyclines.

Addison's disease secondary to prostatic carcinoma. A case report.

Adrenal cortical insufficiency secondary to destruction of the cortex by a metastatic tumor is a rare condition. Addisons disease is usually caused by an autoimmune process or by a tuberculous infection. We report a case of adrenal Insufficiency as the first clinical manifestation of a metastatic prostate carcinoma that occurred simultaneously with an active pulmonary infection by M. tuberculosis.

Serum neuron-specific enolase levels in lung pathologies. Our experience.

we read with interest the recently published work by Fischbach and Jany (1), Even though lately there seems to have been some uncertainty about the role of serum levels of neuron-specific enolase (NSE) as a tumoral marker (2, 3), we agree with Fischbach et al. and other authors (4-7), that measurement of this enzyme still provides the best available marker in the follow-up of small cell lung carcinoma (SCLC), but that as a diagnostic tool for this tumor it is less sensitive. We would like to comment on our experience in assaying this enzyme. Our analysis seems to provide an explanation of the false negatives observed in certain subtypes of SCLC. NSE was measured by radioimmunoassay (Pharmacia A.B.) with double antibody as previously described (7-9). A control group comprised 185healthy, Australia antigen negative blood donors. Enzyme levels were determined in 250 patients with non-malignant lung diseases, 130 patients with non-small cell lung carcinoma (NSCLC) and 63 patients with SCLC (49 before any treatment and 14 being treated; follow-up 2 to 19 months with a mean of 7.2 months).