Metronomic chemotherapy in the neoadjuvant setting: results of two parallel feasibility trials (TraQme and TAME) in patients with HER2+ and HER2− locally advanced breast cancer

Neoadjuvant chemotherapy has practical and theoretical advantages over adjuvant chemotherapy strategy in breast cancer (BC) management. Moreover, metronomic delivery has a more favorable toxicity profile. The present study examined the feasibility of neoadjuvant metronomic chemotherapy in two cohorts [HER2+ (TraQme) and HER2− (TAME)] of locally advanced BC. Twenty patients were prospectively enrolled (TraQme, n=9; TAME, n=11). Both cohorts received weekly paclitaxel at 100 mg/m2 during 8 weeks followed by weekly doxorubicin at 24 mg/m2 for 9 weeks in combination with oral cyclophosphamide at 100 mg/day (fixed dose). The HER2+ cohort received weekly trastuzumab. The study was interrupted because of safety issues. Thirty-six percent of patients in the TAME cohort and all patients from the TraQme cohort had stage III BC. Of note, 33% from the TraQme cohort and 66% from the TAME cohort displayed hormone receptor positivity in tumor tissue. The pathological complete response rates were 55% and 18% among patients enrolled in the TraQme and TAME cohorts, respectively. Patients in the TraQme cohort had more advanced BC stages at diagnosis, higher-grade pathological classification, and more tumors lacking hormone receptor expression, compared to the TAME cohort. The toxicity profile was also different. Two patients in the TraQme cohort developed pneumonitis, and in the TAME cohort we observed more hematological toxicity and hand-foot syndrome. The neoadjuvant metronomic chemotherapy regimen evaluated in this trial was highly effective in achieving a tumor response, especially in the HER2+ cohort. Pneumonitis was a serious, unexpected adverse event observed in this group. Further larger and randomized trials are warranted to evaluate the association between metronomic chemotherapy and trastuzumab treatment.

Prevalencia de la litiasis biliar en la diabetes mellitus / Prevalence of biliary lithiasis in diabetes mellitus

Para analizar la prevalencia de la litiasis biliar en pacientes portadores de diabetes mellitus en una población uruguaya, fueron estudiados prospectivamente mediante ecografía abdominal 177 diabéticos y comparados sus resultados con los de un grupo control de 708 pacientes no diabéticos. Se demostró que la prevalencia de la litiasis biliar en diabéticos de este medio es elevada (34,4 por ciento), siendo significativamente mayor que la del grupo control (25,4 por ciento; p < 0,015). Cuando se discriminó por sexo y edad, la diferencia fue estadísticamente significativa en las mujeres consideradas en su totalidad (diabéticas 40,7 por ciento versus controles 24,6 por ciento; p < 0,005), mientras que en el sexo masculino sólo lo fue en el grupo comprendido entre 40 y 59 años, no ocurriendo lo mismo con los de mayor edad. No existió diferencia estadísticamente significativa entre la prevalencia de la litiasis biliar en diabéticos no insulino dependientes y en los insulino dependientes. 65 por ciento de los casos de litiasis biliar del total de diabéticos de la serie resultaron asintomáticos, mientras 14,7 por ciento se presentó con complicaciones

Obstruçäo do íleo terminal por mucosa gástrica heterotópica: relato de caso / Terminal ileum from obstruction owing to heterotopic gastric mucosa: case report

A mucosa gástrica ectópica localizada no intestino delgado, distal ao ligamento de Treitz é muito rara, excetuando-se a encontrada habitualmente no divertículo de Meckel e na duplicaçao intestinal. Existem formas congênita e adquirida, sendo esta última secundária à processos inflamatórios intestinais. As diferenças entre estas formas sao basicamente histológicas, determinando no entanto aspectos fisiopatológicos distintos. Apresentamos caso de mucosa gástrica ectópica em paciente de 34 anos de idade, manifestada por obstruçao do íleo terminal. Submetido a duas enterectomias e anastomoses primárias, apresentou boa evoluçao pós-operatória. O aspecto histopatológico, típico da forma adquirida com mucosa antral e intensa fibrose, foi provavelmente relacionado à quadro recente de tuberculose intestinal, porém nao confirmada histologicamente. O antecedente de tuberculose pulmonar recente na família, aliado à linfoadenomegalia mesentérica encontrada a operaçao, sustentam tal suspeita. Este é fato inédito na literatura dentre as outras 28 publicaçoes de heterotopia gástrica no jejuno e íleo.