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BACKGROUND: Cyclin-dependent kinase 4/6 (CDK 4/6) inhibitors have been a significant breakthrough in the management of hormone receptor-positive, HER2-negative metastatic breast cancer based on the results of several large phase III randomized trials. The most common reported toxicity is myelosuppression due to disease such as leukopenia, neutropenia, and thrombocytopenia. Other toxicities associated with CDK 4/6 inhibitors include mucositis, fatigue, gastrointestinal side effects, hepatic toxicities, and QTc prolongation. Despite a good toxicity profile in pivotal studies, the increased rates of use in clinical practice may show less prevalent but lethal toxicity such as lung injury. CASE PRESENTATION: Here, we describe a female patient with metastatic hormone receptor-positive/human epidermal growth factor 2-negative breast cancer who developed lung toxicity while on ribociclib. DISCUSSION: Lung injury is a possible side effect of CDK 4/6 inhibitors and there is an increasing need to understand the management of this side effect.
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INTRODUCTION: Human epidermal growth factor receptor 2 (HER-2) targeted therapy regimens can improve tumor response in HER-2-positive metastatic breast cancer (MBC), with overall survival benefits. OBJECTIVE: We evaluated the efficacy of dual HER-2 blockade combined with chemotherapy for HER-2-positive MBC patients as a first-line therapy in our patient population. PATIENTS AND METHODS: We identified 75 patients at King Faisal Specialist Hospital and Research Center that received trastuzumab, pertuzumab, and docetaxel as a first-line therapy in HER-2 positive MBC in 2013-2016. RESULTS: Median age at diagnosis was 45 years; 54.7% were estrogen receptor (ER)-positive. 10% of patients presented with only bone metastasis. The median follow-up time was 36 months with an objective response rate of 74.7% (complete response [CR] 18.7%; partial response [PR] 56%). The 5-year progression-free survival (PFS) and overall survival (OS) were 21% and 71.9% respectively, with a median PFS of 36 months (95% confidence interval [CI] 23.6-48.4). The 5-year OS for ER-negative and ER-positive patients was 93.9% and 59.4% respectively (p = 0.189); 23 patients experienced grade 1/2 toxicity and 2 patients had grade 3/4 toxicity. In terms of OS and PFS, the site of metastasis did not make any significant difference. CONCLUSIONS: First line pertuzumab, trastuzumab, and docetaxel for HER-2-positive MBC patients was found to be an effective and safe therapy in the Saudi population. This finding was consistent with the results seen in the CLEOPATRA trials.
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A multiplex competitive microimmunoassay for the simultaneous determination of gliadin, casein, ß-lactoglobulin, and ovalbumin is presented. The assay in microarray format is performed on a DVD where the allergens are physisorbed on the polycarbonate surface of the disc. The immunointeraction is detected using a mixture of specific gold-labeled antibodies and the signal amplified with the silver enhancement method. The optical density of the precipitate, read by a DVD drive, is related to the concentration of the four allergens in sample. An optimized protocol for the simultaneous extraction of the allergen proteins from food samples is also addressed. The suitability of the method is demonstrated for the simultaneous quantitative extraction and determination of the targeted allergens in spiked baby foods, juices, and beers. The sensitivity (EC50) of the multiplexed assay was 0.04, 0.40, 0.08, and 0.16 mg L-1 for gliadin, casein, ß-lactoglobulin, and ovalbumin, respectively, and the recovery results from the analysis of food samples ranged from 72 to 117%. A portable, easy-to-use, array-based bioanalytical method is developed for quantification of food allergens with a limit of detection below the accepted levels of the international legislations, which allows promotion of food safety and quality. Graphical abstract GLI Gliadin, CAS Casein, ß-LAC ß-lactoglobulin, OVA Ovalbumin.
