Abstract
Trastuzumab has improved the prognosis of HER2 positive breast cancer, but cardiotoxicity remains a concern. We aimed to identify risk factors for trastuzumab-induced cardiotoxicity, with an ...emphasis on the HER2 Ile655Val single nucleotide polymorphism. This single-center case–control study included 1056 patients with early-stage HER2 positive breast cancer that received adjuvant trastuzumab. Cardiotoxicity was defined as a decline in left ventricular ejection fraction (LVEF) > 15% in patients without previous cardiomyopathy, or > 10% in patients with baseline LVEF of < 50%. Patient characteristics and cardiac parameters were compared in 78 (7.38%) cases and 99 randomly assigned controls, and the polymorphism was genotyped using real-time polymerase chain reaction. Cardiotoxicity was independently associated with advanced age (
P
= 0.024), lower body mass index (
P
= 0.023), left breast involvement (
P
= 0.001), N3 status (
P
= 0.004), diabetes (
P
= 0.016), and a family history of coronary artery disease (
P
= 0.019). Genotype distribution was as follows: A/A (Ile/Ile) was found in 111 (62.7%) patients, A/G (Ile/Val) in 60 (33.9%) patients, and G/G (Val/Val) in 6 (3.4%) patients. The genotype was not associated with cardiotoxicity or the severity of heart failure, reversibility, and recovery time. We found no association between the HER2 Ile655Val polymorphism and trastuzumab-induced cardiotoxicity; therefore, we do not recommend routine cardiotoxicity-risk stratification using this polymorphism.
Body composition has been studied relatively recently as part of oncology trials in different types of tumors. There are numerous studies that define the impact of chemotherapy side effects on the ...quality of life (QoL) of breast cancer patients, however, there are few studies that analyze the impact of body composition on the QoL of premenopausal patients in the course of cytotoxic treatment. The study was performed on a sample of premenopausal patients treated with neoadjuvant or adjuvant AC chemotherapy for early-stage breast cancer at Day Hospital of the Department of Medical Oncology, University Hospital for Tumors in Zagreb. The study included 68 patients, median age 46.6 years. Analysis of the QoL questionnaires and their association with body composition indicated several interesting results. At the beginning of treatment, most pronounced was the connection between body composition and physical and sexual functioning and hair loss, while in subsequent treatment cycles the effect on other QoL subdomains, in particular fatigue and diarrhea, was more pronounced. In conclusion, we found body composition to have a significant impact on certain QoL subdomains during treatment.
Triple-negative breast cancer (TNBC) occurs in around one-sixth of all breast cancer (BC) patients, with the most aggressive behavior and worst prognosis of all BC subtypes. It is a heterogeneous ...disease, with specific molecular characteristics and natural dynamics of early recurrence and fast progression. Due to the lack of biomarkers or any valid treatment targets, it can only be treated with classic cytotoxic chemotherapy. We analyzed a cohort of 152 patients, median age 58 years, diagnosed with and treated for early stage TNBC at the university Hospital for Tumors, Sestre milosrdnice university Hospital Centre, Zagreb, Croatia, during the 2009-2012 period. Patients were treated with primary surgical approach, adjuvant chemotherapy and adjuvant irradiation. We observed a relatively large proportion of locally advanced TNBC at diagnosis, with large tumor size and nodal involvement, with high grade and high proliferation index Ki67. Patient age, tumor size and lymph node involvement, as expected, were significant and clinically most important prognostic factors for 5-year disease-free survival (67%; 95% CI 60%-75%) and overall absolute survival rate (74%; 95% CI 66%-81%). Key words: Triple negative breast cancer; Early disease; Adjuvant treatment; Tumor size; Lymph node; Disease free survival; Overall survival; Prognostic factor
Invasive ductal carcinoma is the most common type of breast cancer and accounts for about 70-85% of all invasive breast carcinomas. It primarily metastasizes to the bone, lungs, regional lymph nodes, ...liver and brain. Most of breast cancer recurrence occurs within the first 5 years of diagnosis, particularly for ER negative disease. Gastrointestinal tract involvement is very rare and is detected in only 10% of all the cases, and it usually derives from lobular breast cancer rather than the much more common cell type of ductal breast cancer. Early diagnosis is very important because it enables prompt and adequate choice of treatment and improves patient’s long-term prognosis. In this report we describe an unusual case of obstructive jaundice caused by metastases from invasive ductal breast cancer to the lymph nodes of the hepatoduodenal ligament with extramural compression of the distal common bile duct and tumor invasion to the lumen of the duct. Our goal is to emphasize possible diagnostic pitfalls and increase the clinical awareness and the importance of intensive follow-up in patients with breast cancer, even years after the initial diagnosis.
Body composition has been studied relatively recently as part of oncology trials in different types of tumors. There are numerous studies that define the impact of chemotherapy side effects on the ...quality of life (QoL) of breast cancer patients, however, there are few studies that analyze the impact of body composition on the QoL of premenopausal patients in the course of cytotoxic treatment. The study was performed on a sample of premenopausal patients treated with neoadjuvant or adjuvant AC chemotherapy for early-stage breast cancer at Day Hospital of the Department of Medical Oncology, University Hospital forTumors in Zagreb. The study included 68 patients, median age 46.6 years. Analysis of the QoL questionnaires and their association with body composition indicated several interesting results. At the beginning of treatment, most pronounced was the connection between body composition and physical and sexual functioning and hair loss, while in subsequent treatment cycles the effect on other QoL subdomains, in particular fatigue and diarrhea, was more pronounced. In conclusion, we found body composition to have a significant impact on certain QoL subdomains during treatment. Key words: Body composition; Quality of life; Breast cancer; Premenopausal women; Chemotherapy M. Pavlovic Mavic, R. ?eparovic, Lj. Vazdar, A. Tecic Vuger i M. Banovic Sastav tijela se poceo proucavati relativno nedavno u sklopu onkolo?kih ispitivanja u razlicitim vrstama tumora. Postoje brojne studije koje definiraju utjecaj nuspojava kemoterapije na kvalitetu ?ivota bolesnika oboljelih od raka dojke, medutim, malo je studija koje su analizirale utjecaj sastava tijela na kvalitetu ?ivota premenopauzalnih bolesnica tijekom citotoksicnog lijecenja. Studija je provedena na uzorku premenopauzalnih bolesnica lijecenih neoadjuvantnom ili adjuvantnom kemoterapijom po protokolu AC za rani stadij raka dojke u Dnevnoj bolnici Zavoda za internisticku onkologiju Klinike za tumore u Zagrebu. U istra?ivanju je sudjelovalo 68 bolesnica, medijan dobi od 52,6 godina. Analiza upitnika kvalitete ?ivota i njihova povezanost sa sastavom tijela ukazali su na nekoliko zanimljivih rezultata. Na pocetku lijecenja najizra?enija je bila veza izmedu sastava tijela i fizickog i seksualnog funkcioniranja te gubitka kose, dok je u kasnijim ciklusima lijecenja utjecaj na druge poddomene kvalitete ?ivota, osobito umor i proljev, bio vi?e izra?en. Zakljucno, sastav tijela ima znacajan utjecaj na odredene poddomene kvalitete ?ivota u tijeku kemoterapijskog lijecenja. Kljucne rijeci: Sastav tijela; Kvaliteta ?ivota; Rak dojke; Premenopauzalne ?ene; Kemoterapija
Tumor stimulira specifične urođene i stečene imunološke mehanizme. Glavni nositelji imunološkog odgovora tijela na tumor su T limfociti, a glavni mehanizam je ubijanje tumorskih stanica citotoksičnim ...T limfocitima CD8 +. U nekim slučajevima imunološki sustav također može imati protumorsku ulogu, što je paradoks, s obzirom na to da je poznato da upalno stanje potiče rast tumora. Jedna od glavnih karakteristika tumora je izbjegavanje imunološkog odgovora, posebno mehanizmima inhibicije aktivnog antitumorskog imunološkog odgovora putem dva glavna fiziološka inhibitorna signala, CTLA-4 i PD1 / PDL1. Blokada ovih kontrolnih točaka, koji su mehanizmi inhibicije T stanica, nedavno je dala najbolje rezultate u imunoterapijskom pristupu liječenju karcinoma. Imuni infiltrat u tumoru, kao dokaz postojanja aktivnog unutarnjeg odgovora organizma, je heterogen, a sastav se često razlikuje između različitih tumora i tumorskih stanica i uglavnom se dijeli na dvije glavne stanične linije: limfoidnu i mijeloidnu. O vrsti staničnih linija u imunološkom infiltratu i njihovoj aktivaciji i orijentaciji ovisi klinički odgovor kod različitih tumora. Dobro je poznato da imuni infiltrat, posebno limfociti koji infiltriraju tumor (TIL), mogu predvidjeti odgovor na terapiju i imati prognostičku ulogu. Kod nekih solidnih tumora oni su dobar znak, dok kod nekih signaliziraju lošiju prognozu. Brojne studije procjenjivale su ulogu limfocitnog infiltrata u raku dojke (BC), a na temelju tog znanja uspostavljen je prvi koncenzus o standardizaciji procjene TIL u solidnim tumorima na BC modelu. Prognostičkoj ulozi TIL u trostruko negativnom raku dojke posvećeno je najviše pažnje.
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