Rosina Lanza

Metastasis to the Pancreas from Breast Cancer: Difficulties in Diagnosis and Controversies in Treatment

Background: Metastasis to the pancreas originating from malignant tumours is a rare event and, in the literature, we have found only 11 reported cases of solitary pancreatic metastases originating from breast cancer. Case Report: We report a case of a 51-year-old woman with primary breast cancer who developed obstructive jaundice and epigastric pain after 2 years without any symptoms. The pancreatic mass revealed by computed tomography (CT) scan and magnetic resonance imaging (MRI) was not recognised as a metastasis from breast cancer and the patient underwent cephalic pancreaticoduodenectomy. Conclusions: We discuss all aspects of the case management, stressing the importance of a careful evaluation of the clinical history and the primary cancer features and the usefulness of a multi-disciplinary approach. These aspects are of main importance for a correct diagnostic process and an appropriate therapeutic choice when a pancreatic lesion develops in a patient with prior neoplasm.

On and off metronomic oral vinorelbine in elderly women with advanced breast cancer.

Background Elderly patients with metastatic breast cancer (MBC) have more problems receiving chemotherapy than younger patients, especially with the presence of multiple comorbidities, adverse drug events and functional decline. Low-dose oral administration of cytotoxic agents such as vinorelbine, a semisynthetic vinca alkaloid that interferes with microtubule assembly, leading to arrest of cell division, is usually effective and well tolerated. Methods From February 2010 to February 2014, 32 patients with MBC, median age 76 years (range 69-83) were treated with oral vinorelbine 30 mg (total dose), one day on and one day off, until disease progression or unacceptable toxicity levels were reported. Toxicity, quality of life and clinical benefit were evaluated. Matched t-tests were conducted to discern whether quality-of-life indicator (p<0.05 was considered significant) differed before and 6 months after treatment. Statistical analysis was performed using Graph Pad Prism 5.0 (GraphPad Software Inc., San Diego, CA, USA). Results No grade 3 and 4 adverse events were reported. A clinical benefit of 50% was found in our cohort. On and off metronomic vinorelbine oral administration resulted in good tolerability and safe profile in our selected elderly population, and improved patient adherence to therapy. Conclusions The present study demonstrated that metronomic vinorelbine might be a potential treatment in elderly patients by reducing adverse effects and increasing quality of life, setting the stage for future extensive clinical trials.

Circulating neuregulin-1 and galectin-3 can be prognostic markers in breast cancer

Background It is important to identify novel plasmatic biomarkers that can contribute to assessing the prognosis and outcome of breast cancer patients. Neuregulin-1 (NRG1) and galectin-3 (Gal-3) are proteins that are involved in breast cancer development and patient survival; therefore, we studied whether the serum concentration of these 2 proteins can be correlated to breast cancer progression. Methods Plasmatic NRG1 and Gal-3 were evaluated in 25 healthy controls and 50 breast cancer patients at baseline and at 3 and 6 months after treatment with anthracyclines and taxanes, with or without trastuzumab. Results NRG1 and Gal-3 were significantly more elevated in cancer patients than in healthy controls; furthermore, NRG1 and Gal-3 were significantly increased after chemotherapy and were predictive of mortality at 1 year. Conclusions Circulating NRG1 and Gal-3 can be additional biomarkers indicative of prognosis and outcomes for breast cancer patients.

Anthracycline-Free Neoadjuvant Chemotherapy Ensures Higher Rates of Pathologic Complete Response in Breast Cancer

Micro‐Abstract We describe a study of anthracycline‐free taxane/carboplatin‐based neoadjuvant chemotherapy in patients with initially inoperable breast cancer. The primary endpoint of pathologic complete response was 64% with a high tolerability and no grade 4 toxicity. Therefore, we propose this schedule of therapy as the best in terms of efficacy and low toxicity for this kind of patient. Purpose: Neoadjuvant chemotherapy (NCT) is a standard of care for locally advanced and initially inoperable breast cancer. NCT can test chemotherapy efficacy and can be followed by breast‐conserving surgery. Considering taxanes as one of the most effective agents, we analyzed the efficacy of a neoadjuvant schedule without anthracyclines and based only on taxanes and carboplatin, trying to avoid cardiotoxicity, which is the most serious side effect correlated with anthracyclines. Patients and Methods: We enrolled 61 patients with breast cancer, belonging to 4 subgroups, according to molecular phenotypes: 24 triple‐negative/basal‐like, 13 HER2‐like, 20 luminal B, and 4 luminal A. All patients underwent weekly chemotherapy with carboplatin AUC2, paclitaxel 80 mg/m2, with trastuzumab (in case of HER2 positivity) 2 mg/kg, except for luminal A patients, who underwent only hormonal therapy. Among 61 patients, 26 (43%) received modified radical mastectomy and 35 (57%) received breast‐conserving surgery. Results: The patients obtaining pathologic complete response (pCR) were 20 (83%) of 24 triple‐negative/basal‐like, 10 (76%) of 13 HER2‐like, 6 (30%) of 20 luminal B, and 3 (75%) of 4 luminal A. All the patients were evaluated for toxicity: no grade 4 was detected, 5 patients experienced grade 3 neuropathy, then reverted to G2 after chemotherapy discontinuation. At a minimum follow‐up of 5 years, median overall survival was 48 months. Conclusion: Taxane/carboplatin‐based/anthracycline‐free NCT is the best treatment for inoperable breast cancer in terms of efficacy and toxicity, because this approach avoids cardiotoxicity and obtains an optimal rate (64%) of pCR, with an important impact on survival.

Unexpected Vocal Cord Paralysis and Myasthenia Gravis in a Patient with Squamous Cell Lung Cancer

Vocal cord paralysis is a voice disorder that occurs when one or both the vocal cords don’t open or don’t close properly. This often determines difficulty in swallowing and coughing by the patient, because food or liquids slip into the trachea and the lungs. Vocal cord paralysis may be caused by trauma, cancer, surgery, or intubation and it has been sometimes described to follow vinca alkaloid treatment. Myasthenia gravis is an autoimmune disorder that can represent a paraneoplastic syndrome in cancer patients. We report a 55-years-old male with an advanced squamous cell lung carcinoma, presenting a unilateral vocal cord paralysis immediately after the treatment with gemcitabine, and myasthenia gravis one week after. To date, there aren’t any data in the literature describing causal relationship between non small cell lung cancer and myasthenia gravis; here we suggest that myasthenia gravis simultaneous to lung cancer might be a rare form of paraneoplastic syndrome. It is impossible to find a single cause for our patient vocal cord paralysis: it could in fact have a multifactorial pathogenesis, not excluding the possibility of a single rare paraneoplastic syndrome, which includes both myasthenia gravis and vocal cord paralysis.

Over 17-month complete clinical brain response with a well-tolerated lapatinib plus capecitabine combination in a very young patient afflicted by HER2-positive metastatic breast cancer

This report describes a case of ab initio metastatic HER2-positive breast cancer in a very young patient. The onset of breast cancer at such a young age is uncommon and could delay the diagnosis with unquestionable impact on the prognosis. Unfortunately, the patient experienced cerebral progression during first-line treatment. Indeed, brain metastases occur in about one-third of HER2-positive metastatic breast cancer patients during trastuzumab-based treatment. The small molecule lapatinib is active in established cerebral disease, and we report a complete brain response longer than expected, thanks to a well-tolerated, orally administered combination of lapatinib and capecitabine.