A Retrospective Cohort Study on the Disease-Free Survival and overall survival of patients with Stage I-III Triple-Negative Breast Cancer given adjuvant Chemotherapy in the Makati Medical Center

Background@#Triple-negative breast cancer (TNBC) comprises 15-20% of all breast cancers and is marked by early relapse and poor overall survival. Adjuvant chemotherapy has become the standard of care for these patients albeit to this time there is no consensus on its optimal chemotherapy regimen. This study determined the disease-free-survival (DFS) and overall survival (OS) of patients with stage I-III triple-negative breast cancer given adjuvant chemotherapy in Makati Medical Center from 2000 to 2015.@*Methods@#A single institution (Makati Medical Center), retrospective cohort was conducted involving 157 stage I-III triple-negative breast cancer patients, diagnosed from January 2000 to June 2015, who completed an adjuvant chemotherapy regimen and had at least 3 years of follow up with their medical oncologist. Review of charts of these patients was done, and the demographic, clinical, histopathologic, chemotherapy, recurrence and mortality data were collected and analyzed. The OS and DFS rates were estimated using the Kaplan-Meier method.@*Results@#107 stage I-III triple-negative breast cancer patients who met eligibility criteria were included in the analysis. The most common chemotherapy regimens were sequential anthracycline-taxane (32 patients, 29.09%) and anthracycline-based regimens (32 patients, 29.09%). The 5-year median OS of TNBC patients given adjuvant chemotherapy was 78.94% (95% CI: 69% to 86%) while the 5-year median DFS of TNBC patients was 71.71% (95% CI: 61.68% – 79.5%). There was no significant association between overall survival or disease-free survival and treatment with a particular chemotherapy regimen.@*Conclusions@# Adjuvant chemotherapy with sequential anthracycline-taxane, concurrent anthracycline-taxane, CMF, anthracycline-based and taxane-based regimens among stage I-III triple-negative breast cancer patients in Makati Medical Center resulted in comparable overall survival and disease-free survival. The use of immune checkpoint inhibitors presents a viable option in TNBC as demonstrated in the Impassion 130 and KEYNOTE 119 trials, and should be further evaluated in the Philippine setting.

High-Intensity Focused Ultrasound (HIFU) as salvage therapy for radio-recurrent prostate cancer: predictors of disease response

ABSTRACT Background Some men with localized radio-recurrent prostate cancer may benefit from salvage high-intensity focused ultrasound (HIFU). Herein, we describe oncologic outcomes and predictors of disease response after salvage whole gland HIFU from our prospective cohort. Materials and Methods Patients with localized radio-recurrent prostate cancer were prospectively enrolled from January 2005 to December 2014. Participants had to meet both biochemical and histological definitions of recurrence. Exclusion criteria included the receipt of prior salvage therapy, presence of metastatic disease, and administration of ADT in the 6-months prior to enrollment. Participants were treated with a single session of whole-gland HIFU ablation with the AblathermTM device (EDAP, France). The primary endpoint was recurrence-free survival (RFS), defined as a composite endpoint of PSA progression (Phoenix criteria), receipt of any further salvage therapy, receipt of ADT, clinical progression, or death. Kaplan-Meier survival analysis was used to determine the primary end-point and stratifications were used to determine the significance of 6 pre-specified predictors of improved RFS (TRUS biopsy grade, number of study entry TRUS biopsy cores positive, palpable disease at study enrollment, pre-HIFU PSA, an undetectable post-HIFU PSA nadir, and receipt of prior hormone therapy). Survival analysis was performed on participants with a minimum of 1-year follow-up. Results Twenty-four participants were eligible for study inclusion with a median follow-up of 31.0 months. Median PSA at study entry was 4.02ng/ml. Median time to PSA nadir was 3 months after treatment and median post-HIFU PSA nadir was 0.04ng/ml. Median 2-year and 5-year RFS was 66.3% and 51.6% respectively. Of our 6 prespecified predictors, an undetectable PSA nadir was the only significant predictor of improved RFS (HR 0.07, 95% CI 0.02-0.29, log-rank P<0.001). One participant underwent an intervention for a urethral stricture. No participants developed osteitis pubis or rectourethral fistulae. Conclusions Salvage HIFU allows for disease control in selected patients with localized radio-recurrent prostate cancer. An undetectable PSA nadir serves as an early predictor of disease response.

Aneurysm of the Posterior Meningeal Artery Embedded Within a Dorsal Exophytic Medullary Hemangioblastoma: Surgical Management and Review of Literature

Hemangioblastomas are World Health Organization (WHO) Grade I neoplasms of the hindbrain and spinal cord, whose management can be complicated by preoperative hemorrhage. We report on a case of a young female in extremis with posterior fossa hemorrhage following rupture of a fusiform posterior meningeal artery aneurysm embedded within a medullary hemangioblastoma. We discuss management options, including operative staging and embolization, and review similar cases of hemangioblastoma associated with aneurysm.

MicroRNA-21 in the pathogenesis of acute kidney injury

Acute kidney injury (AKI), associated with significant morbidity and mortality, is widely known to involve epithelial apoptosis, excessive inflammation, and fibrosis in response to ischemia or reperfusion injury, which results in either chronic pathological changes or death. Therefore, it is imperative that investigations are conducted in order to find effective, early diagnoses, and therapeutic targets needed to help prevent and treat AKI. However, the mechanisms modulating the pathogenesis of AKI still remain largely undetermined. MicroRNAs (miRNAs), small non-coding RNA molecules, play an important role in several fundamental biological and pathological processes by a post transcriptional regulatory function of gene expression. MicroRNA-21 (miR-21) is a recently identified, typical miRNA that is functional as a regulator known to be involved in apoptosis as well as inflammatory and fibrotic signaling pathways in AKI. As a result, miR-21 is now considered a novel biomarker when diagnosing and treating AKI. This article reviews the correlative literature and research progress regarding the roles of miR-21 in AKI.

PET imaging in differentiated thyroid cancer: where does it fit and how do we use it?

Positron emission tomography (PET) is a rapidly evolving imaging modality that has gained widespread acceptance in oncology, with several radionuclides applicable to thyroid cancer. Thyroid cancer patients have been studied most commonly using 18F-Fluorodeoxyglucose (FDG)-PET, with perhaps the greatest utility being the potential localization of tumor in differentiated thyroid cancer (DTC) patients who are radioiodine whole body scan (WBS) negative and thyroglobulin (Tg) positive. Also of value is the identification of patients unlikely to benefit from additional 131I therapy and identification of patients at highest risk of disease-specific mortality, which may prompt more aggressive therapy or enrollment in clinical trials. Emerging data suggest that PET/CT fusion studies provide increased accuracy and modify the treatment plan in a significant number of DTC cases when compared to PET images alone. However, studies documenting improvements in survival and tumor recurrence attributable to FDG-PET imaging in thyroid cancer patients are lacking. Specific case examples of thyroid cancer patients who appear to have benefited from FDG-PET imaging do exist, while less data are available in the setting of anaplastic or medullary thyroid carcinoma. This article reviews the utility and limitations of FDG-PET in DTC management, and offers practical recommendations.

Positron emission tomography (PET) é uma modalidade de imagem que vem evoluindo rapidamente e tem ganho ampla aceitação na oncologia em geral e no câncer da tiróide em particular, graças a uma série de radionuclídeos. Pacientes com doenças da tiróide têm sido estudados principalmente com 18F-Fluorodeoxiglicose (FDG)-PET, cuja maior utilidade talvez seja a de poder localizar tumor em pacientes negativos na pesquisa de corpo inteiro e com tireoglobulina positiva. Também é útil na identificação de pacientes que não devem se beneficiar de terapia adicional com 131I e de pacientes de alto risco que podem se beneficiar de terapias mais agressivas ou testes clínicos com drogas alvo-dirigidas. Dados recentes sugerem que a fusão PET/CT aumenta a acurácia e modifica o plano terapêutico de um número significativo de casos de CDT comparada com as imagens de PET apenas. Entretanto, ainda não existem estudos que documentem melhora na sobrevida e na recorrência decorrentes da imagem por FDG-PET em pacientes com câncer da tiróide. Existem exemplos específicos de casos de CDT que aparentemente se beneficiaram do FDG-PET, mas há menos dados relativos ao carcinoma anaplásico ou ao medular. Este artigo revê a utilidade e as limitações do FDG-PET no tratamento do CDT e oferece recomendações práticas.