Determining personalized treatment by gene expression profiling in metastatic breast carcinoma patients: a pilot study

Purpose: The present study evaluates the massive study of gene expression in metastatic breast carcinoma (MBC) patients using microarray gene expression profiling (MAGE) complemented with conventional sequencing, immunohistochemistry (IHC) and fluorescent "in situ" hybridization (FISH), seeking to optimize the treatment in a subset of heavily pretreated patients and with limited life expectancy. Patients, material and methods: MBC patients in hormone therapy progression with survival expectancy of at least 3 months (m) have been included. The MAGE contains gene probes representing genes known to potentially interact with available drugs as cited in the literature. Results: Thirty-nine procedures were performed from October 2010 to April 2016. Within the 30 evaluable procedures, considering all hormonal manipulations as a single line, the patients had received a median of 4 treatment lines prior to MAGE (range 1-7). Progression was observed in 6 cases, stable disease (SD) in 7 cases and partial response (PR) in 16 cases, which implies a clinical benefit rate (SD + PR) of 76%. Actuarial median progression-free survival (PFS) was 6 m (95% CI 2.5-9.5) in patients with clinical benefit. The median overall survival (OS) for the entire series was 11 m (95% CI 2.2-19.8). Conclusion: Data presented here indicate that the use of MAGE provides relevant information to establish personalized treatment in frail patients with limited life expectancy in which therapeutic futility is a particularly difficult burden to assume

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Solitary focus in the liver in a thyroid cancer patient after a whole body scan with 131 iodine

A 51-year-old woman diagnosed with follicular variant of papillary thyroid carcinoma underwent a total thyroidectomy followed four weeks later by an ablative dose of 3.7 GBq of 131I. A whole body scan 5 days after ablation showed an intense uptake within the thyroid bed and a focal uptake located in the right lung base or liver dome. Computed tomography examination revealed a hypodense hepatic node in segment VII resembling a liver metastasis. Histological examination after ultrasound-guided fine-needle aspiration characterized the lesion as a liver abscess. The abscess regressed after antibiotic therapy. Liver metastases from papillary thyroid carcinoma are uncommon. On the other hand, false positive findings of 131I whole body scans have been described. A focal hepatic uptake might represent a metastasis (rare in papillary carcinomas) or be related to other causes (cysts, inflammation or infection, non-thyroidal neoplasms, etc.)

Se presenta el caso de una mujer de 51 añosdiagnosticada de carcinoma papilar de tiroides, variante folicular, sometida a tiroidectomía total seguida 4 semanas después por una dosis ablativa de 3,7 GBq de 131I. El rastreo corporal total a los 5 días mostró una intensa captación en el lecho tiroideo, y una captación focal localizada en la base del pulmón derecho o la cúpula hepática. La tomografía axial computarizadasubsecuente reveló un nódulo hipodenso en el segmentoVII hepático, sugestivo de metástasis. El estudio patológico del material obtenido mediante punción-aspiración con aguja fina (PAAF) lo caracterizó como absceso hepático. Tras tratamiento antibiótico se objetivó regresión del mismo. Las metástasishepáticas de carcinoma papilar de tiroides son infrecuentes y, por otro lado, se han descrito con anterioridad falsos positivos del rastreo con 131I. Una captación focal hepática podría representar una metástasis (rara en carcinomas papilares) o estar relacionada con otras causas (quistes, inflamación o infección, tumores no tiroideos, etc.) (AU)