Pembrolizumab response in stage IV luminal-type breast cancer with high microsatellite instability: a case report.

BACKGROUND: Pembrolizumab (PEM), an immune checkpoint inhibitor (ICI), is often used for triple-negative breast cancer, but can also be used to treat solid tumors that exhibit high microsatellite instability (MSI-High). However, patients with breast cancer rarely have MSI-High, the use of PEM in such cases in clinical practice is uncertain due to lack of sufficient supporting data. Here, we report the case of a premenopausal woman in who received PEM for MSI-High luminal-type breast cancer. CASE PRESENTATION: A 40-year-old premenopausal Asian woman was diagnosed with stage IIA (T2N0M0) breast cancer and had an Oncotype DX recurrence score of 38. After surgery, she received 4 courses of chemotherapy with docetaxel and cyclophosphamide. After 3 months of tamoxifen therapy, the patient complained of abdominal pain due to right iliac metastasis, and biopsy of the metastatic lesion showed of luminal type; she was sequentially treated with fulvestrant, a CDK4/6 inhibitor, and an anticancer drug (TS1), but over the next year, metastasis to the bone and para-aortic lymph nodes increased. Tumor was MSI-High; PEM was started, and after three courses, bone metastases were reduced, para-aortic lymph node metastases resolved, opioids were discontinued, and the patient returned to society; PEM was administered for 1 year with no worsening of bone metastases on imaging. Asymptomatic brain metastasis less than 1 cm was detected and gamma knife was performed. Six months after completion of PEM, the patient is working with no new lesions. CONCLUSION: We report a case of luminal-type breast cancer with bone metastases and MSI-High, which was treated with PEM and showed a rapid therapeutic response.

A Case of Radiation-Associated Vertebral Compression Fracture Mimicking Solitary Bone Metastasis of Lung Cancer.

Radiation therapy plays an important role in the treatment of lung cancer. Although adverse effects of radiation are well known, they are sometimes difficult to be diagnosed. We report a case of a radiation-associated vertebral compression fracture which mimicked bone metastasis of lung cancer. The patient was a 57-year-old man diagnosed with lung squamous cell carcinoma (cT1aN2M0, c-stage IIIA). He received concurrent chemoradiotherapy (CRT) in combination with 6 weeks of weekly carboplatin plus paclitaxel and thoracic radiation of 60 Gy/30 fractions, followed by bi-weekly durvalumab for 12 months. On the last day of the 12-month durvalumab regimen, he complained of backache. Magnetic resonance imaging showed compression fracture of the seventh thoracic vertebra with the spinal cord compressed, and fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography demonstrated weak focal uptake only at the seventh thoracic vertebra. Although the fracture had been suspected to be bone metastasis, surgical biopsy revealed no evidence of malignancy. Since the seventh thoracic vertebra was included in the irradiation area, the patient was diagnosed with a radiation-associated fracture. Dual-energy X-ray absorptiometry of the lumbar vertebrae (L2 - 4) after the surgery revealed osteopenia. In conclusion, we successfully diagnosed the radiation-associated vertebral fracture caused by radical CRT. The fracture mimicked bone metastasis in preoperative imaging tests. Thus, surgical biopsy was useful for diagnosis.

[Study on job support programs for drug addicts in japan: results of a nationwide survey on drug addiction rehabilitation centers (DARC)].

In Japan, many drug addiction rehabilitation centers (DARC) provide various types of recovery programs for drug addiction. The purpose of this study was to clarify the attitudes of DARC staff and users regarding job support programs. A nationwide questionnaire survey was conducted in 2009. The staff of 46 facilities and 606 users returned questionnaires. The results indicated that many (92.1%) users had work experience before entering the recovery programs provided by DARC and about half (49.3%) of the users reported being motivated to work. Although many DARC have established various job support programs, the users faced various levels of anxieties to get employed and 60.4% of the users expected to learn more detailed and concrete methods for finding a job. Through the DARC programs, the users gradually realize the significance of basic daily living skills such as maintaining their rhythm of life or neat and presentable appearance. And the more they get recovered the more they understand the significance of "self-care" and "interpersonal relationship skills". These findings indicate that job support programs for drug addicts should also focus on these recovery processes. More extensive job supports dealing with more practical issues and covering a wide variety of anxieties would be imperative.

Homogeneity of GAFCHROMIC EBT2 film among different lot numbers.

EBT2 film is widely used for quality assurance in radiation therapy. The purpose of this study was to investigate the homogeneity of EBT2 film among various lots, and the dose dependence of heterogeneity. EBT2 film was positioned in the center of a flatbed scanner and scanned in transmission mode at 75 dpi. Homogeneity was investigated by evaluating gray value and net optical density (netOD) with the red color channel. The dose dependence of heterogeneity in a single sheet from five lots was investigated at 0.5, 2, and 3 Gy. Maximum coefficient of variation as evaluated by netOD in a single film was 3.0% in one lot, but no higher than 0.5% in other lots. Dose dependence of heterogeneity was observed on evaluation by gray value but not on evaluation by netOD. These results suggest that EBT2 should be examined in each lot number before clinical use, and that the dose calibration curve should be constructed using netOD.