Review of concepts in therapeutic decision-making in HER2-negative luminal metastatic breast cancer.

PURPOSE: Hormone receptor (HR)-positive, Human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (MBC) requires a therapeutic approach that takes into account multiple factors, with treatment being based on anti-estrogen hormone therapy (HT). As consensus documents are valuable tools that assist in the decision-making process for establishing clinical strategies and optimize the delivery of health services, this consensus document has been created with the aim of developing recommendations on cretiera for hormone sensitivity and resistance in HER2-negative luminal MBC and facilitating clinical decision-making. METHODS: This consensus document was generated using a modification of the RAND/UCLA methodology, which included the definition of the project and identification of issues of interest, a non-exhaustive systematic review of the literature, an analysis and synthesis of the scientific evidence, preparation of recommendations, and external evaluation with a panel of 64 medical oncologists specializing in breast cancer. RESULTS: A Spanish panel of experts reached consensus on 32 of the 32 recommendations/conclusions presented in the first round and were accepted with an approval rate of 100% about definition of metastatic disease not susceptible to local curative treatment, definition of hormone sensitivity and hormone resistance in metastatic luminal disease and therapeutic decision-making. CONCLUSION: We have developed a consensus document with recommendations on the treatment of patients with HER2-negative luminal MBC that will help to improve therapeutic benefits.

Carcinoma de mama triple negativo. Heterogeneidad inmunofenotípica y en el comportamiento farmacocinético / Triple-negative breast carcinoma: heterogeneity in immunophenotypes and pharmacokinetic behavior

Objetivos. Valorar, mediante resonancia magnética (RM), las características morfocinéticas, farmacocinéticas y de difusión de las neoplasias de mama con fenotipo triple negativo y analizar si hay relación entre estos parámetros y el tiempo hasta la progresión. Material y métodos. Estudio retrospectivo y observacional de una serie consecutiva de 100 pacientes con diagnóstico histológico de cáncer de mama, fenotipo triple negativo, entre enero de 2005 y diciembre de 2010 en nuestro centro. Se revisaron los estudios de RM de extensión locorregional y se recogieron las características anatomopatológicas y el seguimiento de las pacientes hasta agosto de 2014. Resultados. Las características más frecuentes por RM de estos tumores fueron: lesiones tipo masa de morfología redondeada (47,3%), bordes bien delimitados (53,7%), patrón de captación 'en anillo' (46,2%), curvas de tipo 3 (50,5%), hiperintensidad de señal intratumoral en las secuencias potenciadas en T2, valores altos de ADC (coeficiente de difusión aparente) (1,04 × 10−3 mm2/s) y una permeabilidad capilar aumentada (Kep) (0,94 min−1). No se evidenció ninguna relación estadísticamente significativa entre las características morfocinéticas o farmacocinéticas y el tiempo hasta la progresión. Se halló elevada presencia del componente in situ en las piezas quirúrgicas, aunque su representación era baja. En el seguimiento, un 25% presentaron metástasis, con predilección por órganos viscerales y baja supervivencia. Conclusión. Las neoplasias con fenotipo triple negativo mostraron mayoritariamente en la RM lesiones de tipo masa, de morfología redondeada, bordes bien delimitados y patrón de captación "en anillo". No se evidenció ninguna relación estadísticamente significativa entre las características morfocinéticas o farmacocinéticas y el tiempo hasta la progresión (AU)

Objectives. To evaluate the morphokinetic, pharmacokinetic, and diffusion characteristics of triple-negative breast cancers on magnetic resonance (MR) imaging and to analyze whether there is a relation between these parameters and the time to progression. Material and methods. This was a retrospective observational study of a consecutive series of 100 patients with histologically confirmed triple-negative breast cancer studied at our center between January 2005 and December 2010. We reviewed the findings on MR locoregional extension studies, the histological findings, and the follow-up of patients until August 2014. Results. The most common MR findings for these tumors were a rounded mass (47.3%), well-defined borders (53.7%), ring enhancement (46.2%), type 3 curves (50.5%), hyperintensity within the tumor on T2-weighted sequences, high ADC values (1.04 × 10-3 mm2/s), and increased capillary permeability (Kep) (0.94 min-1). No significant association was observed between the morphokinetic or pharmacokinetic characteristics and the time to progression. The in situ component in the surgical specimens was high, although its expression was low. During follow-up, 25% of patients had metastases, with a predilection for the visceral organs, and survival was low. Conclusion. Tumors with the triple-negative phenotype mostly presented in MR as rounded tumors with well-defined borders and ring enhancement. We found no significant association between the morphokinetic or pharmacokinetic characteristics and the time to progression (AU)

Triple-negative breast carcinoma: heterogeneity in immunophenotypes and pharmacokinetic behavior.

OBJECTIVES: To evaluate the morphokinetic, pharmacokinetic, and diffusion characteristics of triple-negative breast cancers on magnetic resonance (MR) imaging and to analyze whether there is a relation between these parameters and the time to progression. MATERIAL AND METHODS: This was a retrospective observational study of a consecutive series of 100 patients with histologically confirmed triple-negative breast cancer studied at our center between January 2005 and December 2010. We reviewed the findings on MR locoregional extension studies, the histological findings, and the follow-up of patients until August 2014. RESULTS: The most common MR findings for these tumors were a rounded mass (47.3%), well-defined borders (53.7%), ring enhancement (46.2%), type 3 curves (50.5%), hyperintensity within the tumor on T2-weighted sequences, high ADC values (1.04 × 10(-3) mm2/s), and increased capillary permeability (Kep) (0.94 min(-1)). No significant association was observed between the morphokinetic or pharmacokinetic characteristics and the time to progression. The in situ component in the surgical specimens was high, although its expression was low. During follow-up, 25% of patients had metastases, with a predilection for the visceral organs, and survival was low. CONCLUSION: Tumors with the triple-negative phenotype mostly presented in MR as rounded tumors with well-defined borders and ring enhancement. We found no significant association between the morphokinetic or pharmacokinetic characteristics and the time to progression.

Haemolytic uraemic syndrome associated with gemcitabine

Haemolytic uraemic syndrome (HUS) is a rare thromboembolic complication observed in patients with cancer. It is characterised by the clinical triad of acute renal failure, microangiopathic haemolytic anaemia and thrombocytopaenia. It may be associated with a variety of aetiologies, including chemotherapeutic agents such as mitomycin, cisplatin, bleomycin, 5-fluorouracil and, most recently, gemcitabine. We report a 70-year-old patient treated with gemcitabine who developed haemolytic uraemic syndrome (AU)