ABSTRACT
Los síndromes paraneoplásicos neurológicos son un grupo de trastornos poco frecuentes y heterogéneos que afectan al sistema nervioso y que ocurren en pacientes con una neoplasia maligna, generalmente oculta. Presentamos el caso de una mujer diagnosticada de encefalitis límbica paraneoplásica con presencia de anticuerpos anti-Hu que permitió diagnosticar un cáncer de pulmón oculto (AU)
Paraneoplastic neurologic syndromes are a group of disorders, rare and heterogeneous, affecting the nervous system and usually occur in occult cancer patients. We report the case of a woman diagnosed with paraneoplastic limbic encephalitis and presence of anti-Hu antibodies that allowed to detect occult lung cancer (AU)
Subject(s)
Humans , Female , Middle Aged , Lung Neoplasms/complications , Lung Neoplasms/diagnosis , ELAV Proteins/administration & dosage , ELAV Proteins/analysis , ELAV Proteins/metabolism , Nerve Tissue Proteins/analysis , Nerve Tissue Proteins/metabolism , Diagnosis, Differential , Autoantibodies/analysis , Autoantibodies/blood , Fluorescent Antibody Technique, Indirect/methods , Blotting, Western/methodsABSTRACT
PURPOSE: To study the role of breast cancer molecular subtypes according to hormone receptors and HER2 status as a predictive factor for pathological complete response (pCR) to neoadjuvant chemotherapy. PATIENTS AND METHODS: Eligible patients received one of the two chemotherapy schedules every two weeks with prophylactic growth factor support; schedule A: epirubicin 90 mg/m2-cyclophosphamide 600 mg/m2 d1 for 3 cycles followed by a second sequence with paclitaxel (P) 150 mg/ m2-gemcitabine (G) 2500 mg/m2 d1+/-trastuzumab (T) 2 mg/kg/week according to HER2 status (n=73); schedule B: adriamycin (40 mg/m2) d1 plus P (150 mg/m2)-G (2000 mg/m2) d2 for 6 cycles (n=54). Subsequently, patients underwent surgery, radiotherapy and/or adjuvant hormonal therapy according to standard practice. RESULTS: A total of 127 patients were evaluated. Forty-three patients (33.9%) achieved a pCR (50% in patients with HER2+tumours treated with T). Patients treated with che - motherapy alone (n=107, 18 HER2+) had a pCR of 32% (p=0.068). The pCR rate for patients with triple negative (HR and HER2-) cancers was 58.3%, 39.5% for HER2+ and 5.4% for ER/PR+ and HER2- (p<0.001). No differences in disease-free survival (DFS) were noted as a function of pCR, HER2 and HR status or treatment received (+/-T). However, statistical differences in DFS were observed as a function of whether patients had + or - axillar lymph nodes. Patients with + lymph node disease did worse (3 years DFS of 53.7% vs. 81.5%, p=0.025). Breast-conserving surgery was performed in 77 patients (60.6%). CONCLUSION: Tumour molecular subtyping defines different pCR to neoadjuvant chemotherapy (NC) but has no impact over DFS in patients with LABC. Although no significant correlation between HER2 status and trastuzumab therapy with pCR was found, probably due to the small number of patients, a favourable trend was observed in the group of HER2+ tumours treated with T.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/diagnosis , Breast Neoplasms/drug therapy , Carcinoma, Ductal, Breast/diagnosis , Carcinoma, Ductal, Breast/drug therapy , Genes, erbB-2 , Receptors, Cytoplasmic and Nuclear/genetics , Adult , Aged , Breast Neoplasms/genetics , Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/genetics , Carcinoma, Ductal, Breast/pathology , Disease Progression , Disease-Free Survival , Doxorubicin/administration & dosage , Epirubicin/administration & dosage , Female , Gene Expression Regulation, Neoplastic/physiology , Humans , Middle Aged , Molecular Diagnostic Techniques , Neoadjuvant Therapy , Prognosis , Receptors, Cytoplasmic and Nuclear/analysis , Remission Induction/methodsSubject(s)
Antibodies, Monoclonal/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/drug therapy , Breast Neoplasms/pathology , Genes, erbB-2 , Neoadjuvant Therapy/methods , Adult , Aged , Antibodies, Monoclonal, Humanized , Breast Neoplasms/genetics , Breast Neoplasms/mortality , Cohort Studies , Disease-Free Survival , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Follow-Up Studies , Humans , Mastectomy/methods , Middle Aged , Neoplasm Staging , Radiotherapy, Adjuvant , Risk Assessment , Survival Analysis , Trastuzumab , Treatment OutcomeABSTRACT
A phase II study was conducted to evaluate the safety and efficacy of the combination GIP (gemcitabine, ifosfamide, and cisplatin) for the treatment of patients with advanced non-small-cell lung cancer (NSCLC). Thirty patients with stage III B/IV NSCLC were treated with a combination of GIP. Patients received gemcitabine 1,000 mg/m2 administered intravenously on days 1 and 8, ifosfamide 3,500 mg/m2 on day 2, and cisplatin 80 mg/m2 on day 2, repeated every 21 days. Two of the 30 patients (7%) showed a complete response and 14 patients (46%) showed a partial response. The overall response rate was 53%. The estimated median survival for all patients was 60 weeks. All patients enrolled onto the study were eligible for toxicity assessment. Toxicities were treatable and included World Health Organization grade III or IV leukopenia (29%), thrombocytopenia (18%), anemia (7%) and nausea, and vomiting (6%). Febrile neutropenia occurred in 3 of 30 patients. There were no treatment-related deaths. The combination therapy of GIP is active, well tolerated, and easy to administer on an outpatient basis in advanced NSCLC.
