Drug-induced vasculitis in a breast cancer patient receiving chemotherapy

Introduction: Drug-induced vasculitis following chemotherapy has been rarely reported. We report such a case of drug-induced vasculitis following chemotherapy in a breast cancer patient

Report of the Case: A 52 year old woman with stage III breast cancer developed pathologically proven vasculitis presenting as bilateral severe erythema, edema and ulceration on both feet 10 days following the 4th cycle of adjuvant chemotherapy. Chemotherapy consisted of docetaxel, doxorubicin, and cyclophosphamide in each cycle that was preceded by premedication including dexamethasone, granisetron, and H1 and H2 blockers. Furthermore, filgrastim [5 micro g/kg] was administered following each cycle of chemotherapy during days 5-9. By discontinuing chemotherapy and starting high-dose intravenous methylprednisolone, vasculitis was resolved. The patient did not experience vasculitis following the re-challenge of chemotherapy excluding docetaxel and filgrastim

Conclusion: This case suggests that docetaxel and filgrastim might be added to the list of agents causing drug-induced vasculitis

Fine needle aspiration diagnosed skin metastasis in a young man with rectal cancer

Introduction: Although colon cancer is one of the most common human cancers, skin metastasis in this disease is rare and necessitates pathological confirmation

Report of the Case: Herein we present a 33 year old man with rectal cancer with ascites. Six cycles of Oxaliplatin based chemotherapy were given. The ascites improved. After three weeks, skin lesions appeared in the upper trunk, both chest wall and back, with extension to the anterior neck Fine Needle Aspiration from the lesions showed malignancy and second line chemotherapy was started. Although the skin lesions showed partial response, unfortunately, the patient died after the fourth chemotherapy injection

Conclusion: Skin metastasis in colorectal cancer, although rare, is a devastating sign, and a careful dermatologic examination should be included in these patients' follow up visits

Combined neoadjuvant chemotherapy and celecoxib in locally advanced breast cancer

Locally advanced breast cancer is a presentation form of cancer with poor prognosis. The optimal method of treatment for these cases remains unclear. In this trial, the role of low dose celecoxib combined with neoadjuvant chemotherapy in locally advanced breast cancer was evaluated. Fifty women with pathologically proven locally advanced breast cancer were enrolled. All patients received preoperative chemotherapy with CAF [Cyclophosphamide 600 mg/m[2], doxorubicin 60 mg/m[2], 5-FU 600 mg/m[2]] regimen. They were randomly assigned into two groups. The first group received oral celecoxib [100mg twice daily] concurrently with chemotherapy and the second group was offered placebo. Chemotherapy was administered every three weeks and celecoxib continued until one week before the surgery. The patients received an average of 3 months treatment. The size of breast mass was measured before each cycle of chemotherapy by a caliper. The pathologic response rate was the primary endpoint of the study. In this trial, 50 patients were eligible, of whom 44 were evaluable. There were 25 patients in the celecoxib group and 25 patients in the placebo arm. Two patients in each group developed metastasis during the treatment course and two patients in group one could not tolerate celecoxib and quit it, so they were excluded from the trial. There was no statistically significant difference in terms of partial or complete response [90.5% vs. 87.0%] between celecoxib and placebo groups. Histological type, grade and hormonal receptor were similar in the two groups. No significant association was observed between menstrual status, size of mass at presentation and response to celecoxib. This study suggests that the use of celecoxib with a dose of 100 mg twice daily combined with neoadjuvant chemotherapy does not improve response rate in locally advanced breast cancer

Effects of cisplatin on olfactory function in cancer patients receiving cisplatin-based chemotherapy

Although ototoxicity and neuropathy are common side effects of cisplatin, there is no evidence of altered olfactory function in cancer patients receiving cisplatin based chemotherapy. The purpose of this study was to investigate the effect of cisplatin on olfactory function. Fifty-eight patients [13 female, and 45 male with a mean age of 54 years] who needed to be treated with cisplatin based chemotherapy at our institution were enrolled in this study. Cisplatin with a dose of 70-100 mg/m2 was administered per cycle in different chemotherapy regimens. Olfactory function and audiometery were tested before beginning chemotherapy [as baseline]. Assessment of olfactory function also was carried out before each cycle of cisplatin and finally olfactory test and audiometery was performed at least 3 weeks after the last course of cisplatin based chemotherapy. of 58 patients enrolled in this study, seven patients died due to their cancer and 51 patients completed the planned chemotherapeutic treatment. The patients received cisplatin at a cumulative dose of 100-700 mg/m2 [mean cumulative dose: 380 mg/m2] during their chemotherapy treatment. Hearing impairment was documented in fourteen patients and four patients developed hyposmia and one patient anosmia that had no hearing loss. The test score changes were not statistically significant but there was a statistically significant correlation between drug dose and hearing loss [P=0.039]. The results of this study showed that cisplatin has no statistically significant effect on the sense of smell at doses which cause hearing impairment