Incidence of interstitial lung disease and cardiotoxicity with trastuzumab deruxtecan in breast cancer patients: a systematic review and single-arm meta-analysis.

BACKGROUND: Trastuzumab deruxtecan (T-DXd) has been shown to benefit progression-free survival and overall survival in patients with metastatic breast cancer (mBC) after progression on ≥1 human epidermal growth factor receptor 2 (HER2)-targeted therapies. However, interstitial lung disease (ILD) and cardiotoxicity are the most significant toxicities associated with T-DXd. Therefore, we conducted a systematic review and meta-analysis to assess the incidence and severity of these toxicities in mBC patients treated with T-DXd. MATERIALS AND METHODS: We searched PubMed, Cochrane, and Scopus databases, and conferences websites for randomized clinical trials and nonrandomized studies of intervention including HER2-low or HER2-positive mBC patients who received at least one dose of T-DXd. Statistical analysis was carried out using R software. RESULTS: We included 15 studies comprising 1970 patients with a mean follow-up of 13.3 months. Median age ranged from 53 to 59 years, 61.9% were non-Asian, and 67.4% had hormone receptor-positive mBC. In a pooled analysis, the incidence of ILD was 11.7% [222 patients; 95% confidence interval (CI) 9.1% to 15.0%]. Patients receiving T-DXd dose of 6.4 mg/kg developed a significantly higher rate of ILD (22.7%) compared to those receiving a dose of 5.4 mg/kg (9.3%) (P < 0.01). Most cases of ILD (80.2%; 174/217 patients) were mild (grade 1 or 2). Grade 3 or 4 ILD was reported in 29 patients (13.4%), and grade 5 in 14 patients (6.4%). The incidence of decreased left ventricular ejection fraction (LVEF) was 1.95% (95% CI 0.65% to 3.73%), and the QT interval (QTi) prolongation was 7.77% (95% CI 2.74% to 20.11%). Most patients were asymptomatic, but four had LV dysfunction and heart failure (0.26%). CONCLUSIONS: In this meta-analysis of 1970 patients with mBC, treatment with T-DXd was associated with a 11.7% incidence of ILD, 7.7% incidence of prolonged QTi, and 1.9% incidence of reduced LVEF. Early detection and management of T-DXd-related toxicity by a multidisciplinary team may ultimately improve patient outcomes.

Effects of Rest Interval on Strength Recovery in Breast Cancer Survivors.

The purpose of this study was to compare the acute effect of 2 different resting intervals (RI) between sets of isokinetic knee extension exercise on peak torque (PT) and total work (TW) in breast cancer survivors (BCS) and control group (CNT). 16 BCS (52±4 years) and 14 CNT (53±6 years) performed 3 sets of 10 unilateral isokinetic knee extension repetitions at 60°.s(- 1) on 2 separate days with 2 different RI between sets (1 and 2 min). There was a significant interaction between groups vs. exercise sets (p=0.03) and RI vs. exercise sets (p<0.001) for PT. PT was greater in CNT at 1(st) and 2(nd) sets compared to BCS group (CNT, 133.4±20.8 and BCS 107.6±19.9 Nm, p=0.012 and CNT, 118.9±19.6 and BCS, 97.1±15.9 Nm, p=0.045, respectively). The TW of the knee extensor was significant greater in CNT than BCS group for all 3 knee extension exercise sets. In conclusion, the present study suggests that Breast Cancer Survivors women may need a longer rest interval (longer than 2 min) to be able to fully recover during a 3 sets of isokinetic knee extension exercise training session.

Flow cytometry in breast cancer: cell yield using two different fine needle aspiration devices.

The aim of the study was to compare the quality of breast aspirates obtained by two methods of fine needle aspiration cytology (FNAC): the auto-vacuum device and the syringe pistol holder, using flow cytometry. Both techniques were used in 44 fresh surgical specimens. Subsequently, these specimens were fixed and mounted in paraffin. Both the aspirates and the de-waxed histology material were prepared for flow cytometry using a FACScan. Flow cytometry showed that the means for DNA index and S-phase fraction were similar for aspirates obtained with both techniques. Mean aneuploidy was significantly higher in the auto-vacuum device aspirates than in the surgical specimen (43.4 SD +/- 23 vs. 27.9 SD +/- 17; p = 0.04). Mean DNA index and S-phase fraction were similar in cells from aspirates and surgical specimens. It is concluded that both FNAC methods are of similar efficacy in collecting aspirates for flow cytometry.

Randomized prospective study of local transdermic anesthetic in fine needle aspiration biopsy for breast lumps.

AIM: To evaluate the use of local transdermic anesthetics in fine needle aspiration biopsy (FNAB) in breast lesions. METHODS: Prospective randomized study of 119 patients having breast lesions, all being indicated for FNAB. The patients were divided into three groups: 40 patients entered in the active group (lidocaine + prilocaine); 40 patients underwent the placebo group (aqueous extract of Triticum vulgaris); and a control group of 39 women in whom FNAB was performed without the administration of any substance. Both the anesthetic and placebo were administered an hour before FNAB. Pain was quantified through a visual analogic scale of pain. The type of pain was also classified in terms of occurrence: only during the puncture, only during the movements and both. RESULTS: The visual linear analogic scale of pain showed an average of 3.3 in the active group, 3.5 in the placebo and 4.0 in the control group (NS). Analysis of the type of pain which was referred by the patient showed that 15% of the patients in the active group, 12.5% of those in the placebo group and 5.1% in the control group did not refer to any sensation of pain. Pain, when felt, was similar in all three groups (p < 0.4). CONCLUSIONS: Both the quantification and the type of pain referred to were similar in all three groups. However, there was a tendency of the patient to refer to less pain when the active substance or the placebo were used, when results were compared to the control group.

Granulomatous mastitis caused by sparganum. A case report.

BACKGROUND: Sparganosis is not a common disease, and its rarity makes it difficult to distinguish from others. Close examination of fine needle aspiration biopsy (FNAB) samples, however, can aid in histologic examination of the lesion. CASE: A 64-year-old female, born and raised in a rural area in the state of Goiás, Brazil, presented with a relatively mobile and hard lump in the lower inner quadrant of the right breast. It was initially diagnosed as granulomatous mastitis, but cytologic examination of the surgical specimen revealed a sparganum larva, also revealed by anterior FNAB. CONCLUSION: Sparganum should be considered in the differential diagnosis of granulomatous mastitis, especially among Asians living in other countries.

Fine needle aspiration biopsy of solid tumours by auto-vacuum system: a study in rats.

A fine needle aspiration biopsy (FNAB) device was designed to utilize a steel spring located between the syringe and its plunger, which exerts a constant negative pressure (auto-vacuum). In 43 rats inoculated with breast tumour cells, the technique was compared with the standard procedure of FNAB (21 Sp1 and 22 Walker256 carcinosarcoma). Malignant cells were cytologically confirmed in all cases. Sufficient material was obtained in 95% of FNAB by auto-vacuum system versus 86% by standard technique. The superior results obtained with the auto-vacuum system was seen for both soft and hard tumours.

[Cytologic diagnosis of tuberculous mastitis. Report of a case and review of the literature]. / Diagnóstico citológico de mastite tuberculosa. Relato de caso e revisão da literatura.

A case of breast lump is reported in a 42-year old woman, clinically simulating carcinoma. A fine-neddle aspiration biopsy was performed, the cytology showing granulomatous inflammatory process and Mycobacterium tuberculosis. Review of the literature was undertaken and discussed with regard to incidence, clinical presentation, mode of infection, classification, treatment and diagnosis of tuberculous mastitis, focusing on the fine-needle aspiration biopsy as a diagnosis procedure and the cytologic examination findings in tuberculous mastitis.