ACFT therapy using adriamycin, cyclophosphamide, tegafur and tamoxifen against progressive breast cancer

Multiconcomitant therapy using adriamycin, cyclophosphamide, tegafur and tamoxifen was employed as chemo-endocrine therapy against progressive breast cancer, and the effects, toxicity and prognosis associated with this regimen were studied. This therapy was performed in 24 cases of both inoperable progressive breast cancer and postoperatively recurrent breast cancer. Efficacy was noted in 14 cases, including 4 cases of complete remission, giving an efficacy rate of 58%. Ten patients among the total of 24 are presently alive. The median survival time for all cases was 19.5 months, versus 34.0 months for effective cases and 12.5 months for ineffective cases. The main side effects noted were hematological toxicity, gastrointestinal symptoms and alopecia, but none of these symptoms were serious. Symptoms of heart failure occurred in one patient due to cardiotoxicity of adriamycin, but were not fatal. It can be concluded that ACFT therapy for the treatment of progressive breast cancer results in a good efficacy rate and longer survival time.     

Esophageal metastasis of breast carcinoma

Esophageal metastasis from primary breast cancer is an unusual manifestation. We recently treated a patient with dysphagia, whose breast cancer had been treated in the distant past. A 70-year-old woman had been followed regularly in our outpatient clinic for 14 years after her primary breast cancer treatment, with no apparent tumor recurrence. After 2 years absence, she consulted our clinic with progressive dysphagia. Contrast esophagography and endoscopic examination with ultrasonography revealed a protruding submucosal tumor that was histopathologically diagnosed as esophageal metastasis of breast cancer. Radiation therapy involving a total of 60 Gy in combination with aromatase inhibitor was given. The patient’s dysphagia was greatly relieved, concomitant with marked improvement of the stenotic lesion on imaging. Since treatment for recurrent breast cancer is generally palliative, systemic (chemo- and/or endocrine-) therapy in combination with radiotherapy is the first-line option for esophageal metastasis of breast cancer.     

Neoadjuvant Therapy in Early Breast Cancer: Treatment Considerations and Common Debates in Practice

Neoadjuvant treatment offers a number of benefits for patients with early breast cancer, and is an important option for consideration by multidisciplinary teams. Despite literature showing its efficacy, the use of neoadjuvant therapy varies widely. Here we discuss the clinical evidence supporting the use of neoadjuvant therapy in early stage breast cancer, including patient selection, monitoring response, surgery and radiotherapy considerations, with the aim of assisting multidisciplinary teams to determine patient suitability for neoadjuvant treatment.     

Bromocriptine in chemotherapy-resistant, metastatic breast cancer. Results of the GO-MC-BROMO 2/82 AIO Study

In a case report a patient with metastatic breast cancer, who had chemotherapy resistance and hyperprolactinemia, showed a tumor remission following suppression of elevated prolactin levels with bromocriptine. Based on this observation, 18 patients with progressive metastatic breast cancer, chemotherapy resistance and hyperprolactinemia were treated with 10 mg bromocriptine/day in a prospective study. This treatment was in addition to chemotherapy, which was continued for 8 weeks in spite of progressive disease. In all patients, elevated prolactin levels (arithmetic mean 1388 +/- 201 mU/l before treatment) were suppressed to values under 100 mU/l. A partial remission was observed in one single patient which was not clearly attributed to suppression of plasma prolactin levels, but to delayed tumor remission. Side effects, mainly gastrointestinal disorders, were observed in all patients during therapy. In 6/18 patients treatment had to be stopped before end of study due to intolerable nausea and vomiting. It is concluded that suppression of elevated prolactin levels in progressive metastatic breast cancer patients is not effective in restoring tumor sensitivity to chemotherapy.     

A case of an elderly breast cancer patient achieving partial response with toremifene without efficacy of letrozole as a preoperative primary endocrine therapy

A 91-year-old woman was diagnosed as having ER-positive breast cancer, and was treated with primary endocrine therapy because she refused to undergo surgery under general anesthesia. The patient was treated with letrozole as the initial endocrine therapy, but was judged to have progressive disease after 11 months. During letrozole treatment, the patient could not achieve an effect greater than stable disease. Thereafter, she received toremifene treatment (40 mg/day). After three months of this treatment, the patient achieved a partial response. The response was maintained for 12 months, and the patient then underwent lumpectomy under local anesthesia. In conclusion, toremifene could be an effective preoperative primary endocrine regimen for elderly breast cancer patients.     

Surgery for breast cancer -- from radical mastectomy to breast-conserving surgery

Treatment for breast cancer requires a multidisciplinary approach. The role of surgical treatment for breast cancer has changed over the past several decades, while the paradigm shift in the understanding of the natural history of breast cancer has gone from local disease theory to systemic disease theory. Under these circumstances, surgical procedure has become less aggressive and less invasive. Also, the introduction of primary systemic therapy for breast cancer could modify local treatment. On the other hand, the significance of local control on long-term survival has emerged from meta-analysis. We should understand surgical treatment as part of the multidisciplinary treatment. In this review, we introduce a change in surgical strategy for patients with breast cancer, and discuss the role of surgical treatment with in the recent multidisciplinary treatment.     

Effective salvage chemotherapy with S-1 alone in a patient with lung metastasis of breast cancer

A patient with lung metastasis of breast cancer was reported. The patient underwent surgery in December, 1999. Her breast cancer then recurred in December, 2000. After treatment failure with anthracycline and taxane antitumor drugs,she participated in a phase II study of S-1, a fluorinated pyrimidine anticancer drug, which was given orally at 80 mg/m2/day (2 doses). After completion of 4 courses of treatment,the target lesions of the lung metastasis markedly shrunk by 47.5% as compared with the pretreatment. Because salvage therapy with S-1 alone showed good antitumor efficacy and beneficial tolerability when the standard dosage was maintained, it was considered that this home therapy was effective for advanced/recurrent breast cancer that was resistant to anthracycline and taxane antitumor drugs.     

Evaluating the organization and delivery of breast cancer services: use of performance measures to identify knowledge gaps

Objectives This paper identifies gaps in our knowledge about the quality of breast cancer care in Canada to understand where programs and resources are required to enhance health services and research capacity. Methods A modified Delphi approach was employed involving a 15-member multidisciplinary panel of health professionals and two rounds of rating followed by deliberation to develop evidence- and consensus-based performance measures. A literature search for Canadian health services research in breast cancer was conducted based on the indicator topics. Eligible articles were identified in indexed databases of medical literature and funded research from 1995 to 2006. Results The multidisciplinary panel selected 34 indicators spanning access to services, patient outcomes, diagnosis and staging, surgery, adjuvant therapy, pathology, and follow-up care. A total of 78 articles (66 quantitative; 12 exploratory) on these topics were reviewed. Apart from two aspects of care (communication of treatment options, supportive care), the yield of Canadian breast cancer health services research did not increase subsequent to a review conducted 10 years ago which recommended greater efforts in this area. Conclusions Research involving quantitative and qualitative methods is needed to increase our understanding about the organization and delivery of services for breast cancer diagnosis, treatment and follow-up care. Since it is unclear how to balance competing research demands, innovative strategies are required to assemble resources for health services research on breast cancer. This could include the promotion of partnerships between researchers and policy-makers across jurisdictions, and the pooling of resources between organizations, regions or networks.     

初诊Ⅳ期老年乳腺癌MDT诊治报道

本文介绍1例初诊Ⅳ期老年乳腺癌病例的多学科专家组(multidisciplinary team,MDT)诊治过程.该病例初诊时78岁,右乳腺巨大肿物破溃,伴随多发骨转移、肺转移和淋巴结转移,疾病分期为Ⅳ期老年乳腺癌.经MDT讨论后患者接受紫杉醇联合卡培他滨化疗,疗效不显著,再次MDT讨论后,接受右乳腺癌改良根治术.术后行内分泌药物(来曲唑)治疗,实现疾病控制和生活质量提高.治疗10个月,疾病进展,更换内分泌治疗(氟维司群),获得长期获益.唑来膦酸治疗20个月后,患者出现左侧下颌骨病变,因无法明确是下颌骨坏死还是骨转移进展,经MDT讨论并尊重患者意愿,行姑息治疗9个月后死亡,总生存期32个月.该诊治过程说明,MDT诊治对转移性乳腺癌治疗可提供重要支持;老年乳腺癌因不同的疾病特点且缺乏前瞻性临床研究数据,尤其需要MDT模式指导治疗,全面评估风险与获益,予以个体化治疗方式.     

A case of effective combination therapy with docetaxel, cyclophosphamide and trastuzumab as primary systemic therapy for locally advanced HER2-positive breast cancer

We experienced a case of locally advanced breast cancer achieving a significant improvement by using a combination of docetaxel(DOC), cyclophosphamide(CPA)and trastuzumab as a primary systemic therapy.The patient was a 54-year-old woman suffering from a right breast mass, who was referred to our hospital and diagnosed with HER2-positive breast cancer with subclavicular lymph nodes metastases.The combination therapy of DOC(75 mg/m / 2), CPA(600 mg/m2)and trastuzumab(loading dose 8 mg/kg, then 6 mg/kg)for 6 courses at q3 week intervals, was started as the primary systemic therapy. After 6 courses of treatment, a right modified radical mastectomy was performed.There were a little breast cancer cells in the breast, and no axillary lymph node metastases.The combination chemotherapeutic regime with DOC, CPA and trastuzumab seems to be useful for treatment of HER2-positive breast cancer.     

Benefits of a multidisciplinary approach to breast care

The University of Michigan Breast Care Center (BCC) was established in 1985 to provide comprehensive, multidisciplinary diagnosis and treatment of benign and malignant breast disease. This work presents an overview of our experience in the BCC and assesses the clinical, academic, financial, and educational effectiveness of the program. A database was used to generate a list of all patients seen in the BCC between February 1, 1985 and December 31, 1991. Participating departments provided information regarding outpatient, inpatient, clinical and consultative activities, and referral patterns attributable to BCC endeavors. BCC educational and academic activities were reviewed and profiled. Clinical information was culled from the BCC database, hospital records, and the hospital tumor registry. The BCC has resulted in a fivefold increase in breast care related activity at the University of Michigan Medical Center. Over half of the patients treated in the BCC with primary operable breast cancer receive breast-conserving therapy. The BCC performs a unique educational function, providing the primary breast care experience for house staff as well as one third of the third year medical school class. The BCC supports over 20 clinical research protocols, and patient enrollment in clinical trials has increased dramatically since 1985. The BCC also provides support to basic science researchers receiving over 2.5 million dollars in peer reviewed direct cost support. These data suggest that a multidisciplinary approach to patient care as embodied by the BCC can be clinically, financially, and academically superior and productive. This model warrants further investigation not only in the field of breast care, but also in other clinical situations that require multidisciplinary input and therapy. © 1993 Wiley-Liss, Inc.     

A case of adriamycin and methotrexate-resistant recurrent breast cancer treated with doxifluridine and mitomycin C]

A 49-year-old woman was diagnosed with local recurrence and cervical lymph node and bone metastases 55 months after surgery for breast cancer. She was treated with goserelin acetate and tamoxifen but the disease was assessed as progressive after 8 months. Five courses of CMF therapy were performed but lung, pleural and mediastinal lymph node metastases were detected. Then, five courses of CAF therapy were carried out, but a contralateral breast metastasis was detected and the patient complained of shortness of breath. The CAF therapy was assessed as PD. We attempted administration of doxifluridine (5'-DFUR) and mitomycin C (MMC) on an outpatient basis. After 6 months, no progressive disease was detected and she was relieved of her shortness of breath. The combination therapy was assessed as long NC. Combination therapy with 5'-DFUR and MMC is thus a useful treatment for adriamycin- and methotrexate-resistant breast cancer, especially in terms of quality of life.     

A case of recurrent breast cancer with multiple lung metastases responding to anastrozole monotherapy

A 51-year-old postmenopausal woman was referred to our hospital for treatment of ER-positive recurrent breast cancer. The patient had lung and pleural metastases with pleural effusion from breast cancer. She was treated with anastrozole, a 3rd-generation aromatiase inhibitor. The efficacy of the treatment was definite: the multiple metastatic lung lesions showed a partial response after 5 months' treatment, and reached a complete response after 14 months' treatment. The patient experienced no adverse effects with this therapy. Anastrozole therapy is a useful treatment for postmenopausal woman with ER-positive recurrent breast cancer.     

洛铂联合长春瑞滨治疗46例晚期乳腺癌的临床观察

目的：观察长春瑞滨（NVB）联合洛铂（LBP）的NL方案治疗晚期乳腺癌的近期疗效和不良反应。方法：从2009年2月至2011年6月,采用NVB加LBP的联合化疗方案治疗晚期乳腺癌46例,LBP 30mg/m2,第1天,静脉滴注3小时;NVB 25mg/m2,第1、8天,静脉滴注30分钟,21天为1周期。结果：46例患者中,CR 2例,PR 16例,SD 17例,PD 11例,RR为39.1%,DCR（CR＋PR＋SD）为76.1%。主要不良反应为骨髓抑制,白细胞下降（Ⅲ＋Ⅳ度）发生率45.7%,血小板下降（Ⅲ＋Ⅳ度）发生率8.7%。,非血液学毒性轻微,可以耐受。结论：LBP联合NVB治疗晚期乳腺癌疗效较好,不良反应可以耐受,可以作为晚期乳腺癌的二线治疗方案或解救方案。     

A paclitaxel-resistant case of recurrent breast cancer responded to combination therapy of capecitabine and trastuzumab

The patient was a 72-year-old female. Under the supervision of her former doctor, this patient had an operation and adjuvant chemotherapy for progressive breast cancer. During the following period, local recurrence of breast cancer and pulmonary lymphopathia developed. Although medication with paclitaxel was attempted, the focus was resistant to this treatment, and metastasis to the brain was also observed. Due to the dyscrasia above, the patient had difficulty breathing and became bedridden. Subsequently, combination treatment of capecitabine and trastuzumab was attempted. As a result,metastasis in the brain and pulmonary lymphopathia were improved. The patient recovered enough to be discharged at one time. However, his condition took a turn for the worse after the interruption of the combination treatment by a side effect. In conclusion, the combination treatment of capecitabine and trastuzumab is thought to be effective for non-responders to paclitaxel.     

Is There Still a Role for Axillary Dissection in Breast Cancer Surgery?

The operative management of breast cancer has followed a natural progression toward less invasive techniques over the past century as chemotherapy, hormonal therapy, and radiation therapy have become more effective and used more frequently. Sentinel lymph node (SLN) biopsy in clinically node-negative patients has replaced axillary lymph node dissection (ALND), resulting in improved staging and decreased morbidity. ALND has remained important for patients with clinically involved lymph nodes or positive SLN; however, new evidence from the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial has identified a subset of patients with breast cancer who do not benefit from axillary lymphadenectomy following a positive SLN biopsy. These results are practice changing and need to be analyzed within the context of patient selection and multidisciplinary treatment. Herein, we review the emerging data regarding the benefits and indications for axillary lymphadenectomy in the modern era of multidisciplinary breast cancer management.     

Multidisciplinary approach to cancer treatment: a model for breast cancer treatment at the M.D. Anderson Cancer Center

Despite that fact that a multidisciplinary approach is important for cancer treatment, this approach is not widely used in Japan. The M.D. Anderson Cancer Center (MDACC) is one of the most well-established cancer institutes in the world, and has implemented a unique multidisciplinary team management approach for the treatment of breast cancer. The efforts of MDACC to eliminate cancer have been ongoing for more than 60 years. Here, we describe the multidisciplinary approach used at MDACC for the treatment for breast cancer. We focus on the background of the institute, in terms of establishing its treatment model and educational system, and compare its multidisciplinary approach with the current approach used in Japan, in the hopes of influencing future directions in cancer therapy in Japan.     

Narrowing the focus: Therapeutic cell surface targets for refractory triple-negative breast cancer

Triple-negative breast cancer (TNBC) is defined as a type of breast cancer with lack of expression of estrogen receptor, progesterone receptor and human epidermal growth factor 2 protein. In comparison to other types of breast cancer, TNBC characterizes for its aggressive behavior, more prone to early recurrence and a disease with poor response to molecular target therapy. Although TNBC is identified in only 25%-30% of American breast cancer cases annually, these tumors continue to be a therapeutic challenge for clinicians for several reasons: Tumor heterogeneity, limited and toxic systemic therapy options, and often resistance to current standard therapy, characterized by progressive disease on treatment, residual tumor after cytotoxic chemotherapy, and early recurrence after complete surgical excision. Cell-surface targeted therapies have been successful for breast cancer in general, however there are currently no approved cell-surface targeted therapies specifically indicated for TNBC. Recently, several cell-surface targets have been identified as candidates for treatment of TNBC and associated targeted therapies are in development. The purpose of this work is to review the current clinical challenges posed by TNBC, the therapeutic approaches currently in use, and provide an overview of developing cell surface targeting approaches to improve outcomes for treatment resistant TNBC.     

Cytomegalovirus reactivation and its clinical impact in patients with solid tumors

Cytomegalovirus reactivation can be life threatening. However, little evidence on its incidence in solid cancers is available. Therefore our single center Cytomegalovirus polymerase chain reaction database with altogether 890 CMV positive blood serum samples of mainly hematological and oncological patients was retrospectively analyzed to examine the occurrence of Cytomegalovirus reactivation in patients with solid tumors, resulting in 107 patients tested positive for Cytomegalovirus reactivation. Seventeen patients with solid cancer and a positive CMV-PCR test were identified, of which eight patients had clinically relevant CMV disease and received prompt antiviral treatment. Five patients fully recovered, but despite prompt antiviral treatment three patients died. Among these three patients two had significant co-infections (in one case EBV and in the other case Aspergillus) indicating that that CMV reactivation was at least one factor contributing to sepsis. The patient with the EBV co-infection was treated in an adjuvant therapy setting for breast cancer and died due to Cytomegalovirus and Epstein-Barr virus associated pneumonia despite intensive therapy. The other two patients had progressive disease of an underlying pancreatic cancer at the time of CMV diagnosis. One patient died due to attendant uncontrollable Aspergillus pneumonia, the other patient most likely died independent from CMV disease because of massively progressive underlying disease.Cytomegalovirus reactivation and disease might be underestimated in routine clinical practice. In our retrospective analysis we show that approximately 50 % of our patients suffering from solid cancers with a positive Cytomegalovirus polymerase chain reaction also had clinically relevant Cytomegalovirus disease requiring antiviral therapy.