[A Case of Recurrent Breast Cancer with Bone Metastasis Successfully Treated with Everolimus and Exemestane Therapy].

We report a case of a patient treated with everolimus and exemestane combination therapy for bone metastasis after breast surgery.The patient, a 58-year-old woman, consulted our department for back pain in October 2014.S he was diagnosed with left breast cancer when she was 41 years old.She had received Bt+Ax for left breast cancer and administered tamoxifen for 5 years.We decided on everolimus and exemestane combination therapy after observing an abnormal uptake in the 7th to 8th thoracic vertebrae on a PET-CT scan.The pain was controlled using oxycodone and fentanyl orally disintegrating tablet with zoledronic acid.After receiving treatment, the patient experienced pruritus and a Grade 2 rash, but they were managed with antihistamine administration and the treatment was continued.Four months later, the abnormal uptake on the right thoracic vertebrae shrunk; the pain almost disappeared, and oxycodone and fentanyl orally disintegrating tablet were discontinued.Subsequently, exemestane was used alone.Six months later, the range of abnormal uptake on the thoracic vertebrae progressed, and the disease was evaluated as PD.Four months later, everolimus and exemestane combination therapy was resumed, and the abnormal uptake on the thoracic vertebrae almost disappeared as observed on a PET scan.The effectiveness of the treatment was evaluated as CR because other local recurrence and new metastases were not found. Everolimus might exhibit bone resorption inhibiting effects and bone protection effects, but the decision regarding the periods of suitable use and the effects of long-term continuation of treatment are controversial, and further discussion based on experience of increasing use is required.

[Usefulness in predicting parameters for the selection of responders who received immunochemotherapy with PSK in patients with colorectal cancer].

It is very important for immunotherapy to release Th2-dominated immunological conditions in patients with malignant diseases. In the present study, we assessed the intracellular cytokine profiles of CD4 positive cells in peripheral blood in patients with colorectal cancer using a flow cytometric analysis and we investigated whether Th2-dominated immunological conditions could be released by PSK. Peripheral blood samples were collected preoperatively from 57 patients with colorectal cancer before and after the oral administration of PSK (3g/day x 1 week). After the PSK treatment, CD4(+)IL-10(+)T-cell percentages decreased significantly, whereas no significant change occurred in proportions of CD4(+)IL-6(+)T-cells. In the after/ before PSK treatment percentages, the ratio of CD4(+)IL-10(+)T-cells were significantly lower in non-recurrent patients compared with recurrent patients, whereas no significant difference was seen in the ratio of CD4(+)IL-6(+) T-cells. These results suggest that the after/before percentage ratio of CD4(+)IL-10(+)T-cells may be useful predicting parameters for the selection of responders.

Reversed intrapulmonary right-to-left shunt after banding of the patent ductus venosus.

Diffuse pulmonary microvascular arteriovenous communication developed in an 8-year-old girl with a patent ductus venosus. Tc-99m macroaggregated albumin (MAA) pulmonary perfusion scintigraphy with total-body imaging demonstrated multiple lung perfusion deficits and abnormal tracer uptake in systemic organs with hepatic radioactivity greater than the kidneys, suggesting the presence of right-to-left shunt and abnormal hepatic hemodynamics. I-123 iodoamphetamine transrectal portal scintigraphy revealed a large portosystemic venous shunt. The follow-up Tc-99m MAA perfusion scans after banding of the patent ductus venosus revealed partial improvement of the perfusion deficits and right-to-left shunt, indicating the possible reversibility of this pulmonary shunt complication.