ABSTRACT
BACKGROUND: The most prevalent subtype of breast cancer (BC) is luminal hormonal-positive breast cancer. The neoadjuvant chemotherapy regimens have side effects, emphasizing the need to identify new startegies. OBJECTIVE: Analyze the complete pathologic response (pCR) rate and overall response in a low-risk hormone-positive subset of patients receiving neoadjuvant hormone treatment (NAHT) with or without Palbociclib (a CDK4/CDK6 inhibitor) to boost NAHT effectiveness. MATERIALS AND METHODS: Based on the upfront 21-gene Oncotype DX or low-risk Breast Recurrence Score assay (RS™), the SAFIA trial is designed as a prospective multicenter international, double-blind neoadjuvant phase-III trial that selects operable with luminal BC patients that are HER2-negative for the induction hormonal therapy with Fulvestrant 500 mg ± Goserelin (F/G) followed by randomization of responding patients to palbociclib versus placebo. The pCR rate served as the study's main outcome, while the secondary endpoint was a clinical benefit. RESULTS: Of the 354 patients enrolled, 253 initially responded and were randomized to either F/G fulvestrant with palbociclib or placebo. Two hundred twenty-nine were eligible for the evaluation of the pathologic response. No statistically significant changes were observed in the pCR rates for the patients treated with the F/G therapy with placebo or palbociclib (7% versus 2%, respectively) per the Chevallier classification (Class1 + Class2) (p = 0.1464) and 3% versus 10% assessed per Sataloff Classification (TA, NA/NB) (p = 0.3108). Palbociclib did not increase the rate of complete pathological response. CONCLUSION: Neoadjuvant hormonal therapy is feasible in a selected population with a low RS score of < 31 CLINICAL TRIAL: NCT03447132.
Subject(s)
Breast Neoplasms , Estradiol , Humans , Female , Fulvestrant/therapeutic use , Neoadjuvant Therapy , Prospective Studies , Disease-Free Survival , Receptor, ErbB-2 , Breast Neoplasms/pathology , Antineoplastic Combined Chemotherapy Protocols/adverse effectsABSTRACT
Histiocytic sarcoma, proliferation araising from immunoregulatory effector system cells, is a very rare and recently recognised tumor. Diagnosis is based on immunohistochemistry and molecular genetic techniques, which allow to distinguish histiocytic sarcoma from lymphocytic proliferation, such as non-Hodgkin's. We report this rare case of multivisceral histiocytic sarcoma revealed by lung localization and for which the evolution was fatal.
Subject(s)
Histiocytic Sarcoma/diagnosis , Lung Neoplasms/diagnosis , Histiocytic Sarcoma/diagnostic imaging , Histiocytic Sarcoma/pathology , Humans , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/pathology , Male , Middle Aged , Radiography, Abdominal , Radiography, ThoracicABSTRACT
During the course of generalised amyloidosis, pulmonary diseases are mainly represented by tracheobronchial involvement and diffuse or nodular parenchymal localizations. The authors report the case of a 61-year-old woman presenting exudative pleural effusion. The diagnosis of generalised amyloidosis in association with multiple myeloma with cardiac and renal involvement was established. A thoracoscopy performed during the investigation of the pleural effusion and the biopsy revealed amyloid deposits in the pleura. The patient died although melphalan/prednisone treatment was initiated. Pleural involvement in amyloidosis is without doubt under-estimated and plays a central role in the creation and persistence of pleural effusion.
