[A case of osteonecrosis of the lower jaw due to bisphosphonates in a breast cancer patient with bone metastasis].

Recently, osteonecrosis of the jaw (ONJ) with bisphosphonates is frequently reported. ONJ due to bisphosphonate is an adverse event in the treatment of breast cancer with bone metastasis. We report a case of ONJ due to bisphosphonates. A 66-year-old woman was admitted to our hospital due to right advanced breast cancer with bone metastasis. She received neo-adjuvant chemotherapy consisting of paclitaxel 70 mg/m2, qw, trastuzumab 2 mg/m2, qw. After chemotherapy, we performed modified mastectomy for local control. Postoperative adjuvant chemotherapy was added with bisphosphonate for bone metastasis of breast cancer. After bisphosphonate was used 14 times, she had a pain and pus-discharge in her lower jaw. The dentists' diagnosis was ONJ. We treated her with antibiotics and local minor curettage. The inflammatory symptoms almost disappeared. In this case, the administration of bisphosphonates was thought to be a major risk factor for ONJ. We think that special precautions for ONJ should be taken in patients administered bisphosphonates for bone metastasis of breast cancer.

Neoadjuvant paclitaxel for operable breast cancer: multicenter phase II trial with clinical outcomes.

AIM: To determine the efficacy of preoperative weekly paclitaxel for patients with operable breast cancer tumors greater than 3 cm. PATIENTS AND METHODS: Paclitaxel 80 mg/m2 weekly x 3 times every 4 weeks for 3 cycles was administered to 53 patients. Twenty-two patients were stage 11, 26 stage III, 5 stage IV Median age (range) was 53 (24-73) years, and 32 patients were negative for estrogen receptor. Thirteen patients showed HER2 overexpression. RESULTS: Eligible cases composed of 53 patients for evaluation of response. Seven patients had a clinical complete response and 29 patients had a partial response. The overall response rate was 67.9%, including three patients with a pathological complete response. In 18 patients with HER2 overexpression, a clinical complete response was observed in 5, a partial response was observed in 9, and stable disease was found in 4. No treatment, related to grade 3 neutropenia, was given for 1 patient (2%). Other hematological and non-hematological toxicity was found in only 1 patient with fatigue. CONCLUSION: Preoperative weekly paclitaxel induced a high clinical response rate with a high safety profile. HER2-overepressing tumors had a higher clinical response rate than non-HER2-overepxressing tumors (91% vs. 50%, respectively). Further studies are needed to determine whether an increase in the cycles of paclitaxel and/or adding anthracyclines may lead to higher pathological complete response and breast-conservation rates in the neoadjuvant setting.

Case of breast cancer with endocrine differentiation.

An 89-year-old woman presented with a chief complaint of induration in the left breast persisting for 1 month. Core needle biopsy of the lesion showed invasive breast cancer. Therefore, we diagnosed the lesion as left breast cancer and performed a modified mastectomy. On the immunohistochemical study, the tumor was positive for synaptophysin and positive in part for chromogranin-A and carcinoembryonic antigen. Therefore, we diagnosed the lesion as breast cancer with endocrine differentiation. We report the clinical and pathological features of this disease herein.

[Two cases with have a complication in cardiac function during chemotherapy with trastuzumab].

The most fatal complication in trastuzumab therapy for breast cancer is cardiac disfunction. It can be classified two patterns, early onset type and late onset type. This complication often becomes severe, but it is reversible if appropriate steps are taken. In treating patients with trastuzumab, their cardiac function must be checked by echocardiogram every three months.