Successful Retreatment of Metastatic Triple-negative Breast Cancer With Immune Checkpoint Inhibitors and Chemotherapy.

BACKGROUND/AIM: The efficacy of retreatment with immune checkpoint inhibitors (ICIs) in programmed death-ligand 1 (PD-L1) positive metastatic or recurrent triple-negative breast cancer (mTNBC) remains unknown. We report a case of a patient with recurrent triple-negative breast cancer who was successfully treated with two different ICIs in combination with chemotherapy. CASE REPORT: A 60-year-old female patient was treated with neoadjuvant chemotherapy consisting of epirubicin + cyclophosphamide (EC) followed by docetaxel (DTX). The tumor shrank with EC, but progressed with DTX. One year after the surgery, the patient presented with multiple lung metastases. The patient received combination therapy with atezolizumab and nab-paclitaxel and achieved a partial response (PR). However, the disease progressed after 6 months. She received eribulin as second-line chemotherapy for 4.5 months, and her treatment was changed to pembrolizumab, carboplatin, and gemcitabine as third-line chemotherapy. The tumor immediately reduced and disappeared after three cycles of this treatment and achieved PR. CONCLUSION: This case illustrated that retreatment with ICIs was effective.

[Chemotherapy-Resistant Breast Cancer and Carcinomatous Pleuritis Successfully Treated with Abemaciclib plus Letrozole Therapy].

A 78-year-old woman was examined in the outpatient department with a chief complaint of swelling of the left breast. Examination confirmed a 10 cm mass in the left breast as along with edema and redness of the skin, following which a diagnosis of invasive micropapillary carcinoma was made after biopsy. The CT imaging showed left chest wall invasion, multiple axillary lymph node metastases, and left carcinomatous pleuritis. Since this a case of advanced breast cancer, we initiated treatment with bevacizumab plus paclitaxel. After 8 months, her medication was changed to eribulin, owing to progression of the cancer, which continued even up to 4 months. We then initiated abemaciclib plus letrozole therapy as the third treatment. We observed tumor reduction and clearing of pleural effusion with no serious adverse events, and continued her therapy for 11 months before the cancer progressed. We report a case of chemotherapy-resistant breast cancer and carcinomatous pleuritis in an older adult patient for which abemaciclib plus letrozole therapy was effective.

[A Case of Lung Metastasis of the Breast Cancer with a Remarkable Response to Stereotactic Body Radiation Therapy(SBRT)].

A 69-year-old woman admitted to our hospital with the lump in the left breast. Further examination was performed for the lesion, and it was diagnosed as invasive ductal carcinoma. Partial resection and sentinel lymph node biopsy were performed. Pathological diagnosis was metaplastic carcinoma with squamous metaplasia. As the adjuvant treatment, docetaxel and cyclophosphamide(TC)therapy and radiotherapy was performed. Following the treatment of those, tegafur-uracil was administered for 2 years. Three years after the surgery, an isolated lung metastasis was revealed by CT. Capecitabine and cyclophosphamide(XC)therapy was administered, but not effective. Stereotactic body radiation therapy(SBRT)was performed for the lesion. As a result, the metastatic lesion was obscured. Drug therapy was stopped due to adverse events, and she is observed by no medication. Thirty-six months after SBRT and 78 months after the surgery, the patient is alive without recurrence. SBRT could be an effective treatment strategy for the oligometastais of the lung.

[Combination of trastuzumab, aromatase inhibitor and anti-cancer drugs obtained a good prognosis for an inoperable stage III B breast cancer patient with giant skin ulceration].

A 68-year-old woman who had an inoperable, ER-positive, PgR-positive and HER2-positive advanced breast cancer with giant skin ulceration has been treated with the combination of trastuzumab, aromatase inhibitor and anti-cancer drugs. She was thus well-controll for over 9 years. Trastuzumab was administered more than 400 times, but no cardiac toxicity has been observed. The synergistic efficacy of the combination of trastuzumab and anti-cancer drugs was already proven, but it has recently been reported that concurrent treatment of trastuzumab and endocrine therapy improves the prognoses of triple positive breast cancer patients.

The relationship between NY-ESO-1 mRNA expression and clinicopathological features in non-small cell lung cancer.

Tumor-associated antigens recognized by cellular or humoral effectors of the immune system are potential targets for antigen-specific cancer immunotherapy. NY-ESO-1 is one of the most immunogenic cancer/testis (CT) antigens and emerges as the potential candidate for specific immunotherapy. We studied mRNA expression status of NY-ESO-1 in 63 cases of NSCLCs using the real-time reverse transcription PCR to examine the relationship between its expression and clinicopathological features. NY-ESO-1 expression was present in 20 (32%) of 63 NSCLC cases and significantly increased with the advancement of disease stage in TNM classification (P=0.013), especially related to lymph node metastasis (P=0.020). Moreover, frequency of NY-ESO-1 expression was related to the degree of pathological differentiation (P=0.035). The quantity of NY-ESO-1 expression by real-time RT-PCR was not correlated with any clinicopathological factor. Our results demonstrate that the NY-ESO-1 expression was frequently present in primary NSCLC, especially advanced cases with lymph node metastasis. In addition, the high incidence of NY-ESO-1 expression in NSCLC suggests the possibility of a specific immunotherapy for NSCLC.

Generation of mature dendritic cells fully capable of T helper type 1 polarization using OK-432 combined with prostaglandin E(2).

Dendritic cell (DC) administration appears to be a very promising approach for the immunotherapy of cancer. The results of clinical studies have suggested that the nature and the magnitude of antitumor immune responses are critically affected by DC functions, including production of T helper type 1 (Th1)-inducing cytokines, activation of T cell subsets and natural killer (NK) cells, and migration from peripheral tissues to the T cell area of the draining lymph nodes. Administration of immature DCs could fail to fully stimulate antigen-specific immune responses and might induce tolerance under some conditions. In this study, we developed a method to obtain fully mature DCs, and we compared in detail the DCs thus obtained with those obtained using a maturation stimulus termed monocyte-derived medium (MCM)-mimic, which is a mixture of recombinant cytokines and prostaglandin E(2) (PGE(2)) mimicking the components of monocyte-conditioned medium. Using DCs derived from monocytes of advanced cancer patients in this study, we found that DCs stimulated with OK-432 alone showed phenotypes similar to those of mature DCs induced using MCM-mimic, though with better secretion of IL-6 and IL-12. However, these DCs were found to have poor migratory capacity associated with the marginal expression of CCR7. When OK-432 was combined with PGE(2), the CCR7 expression and migratory capacity of DCs were significantly improved without impairing other immuno-stimulatory functions. These results suggest that stimulation with the combination of OK-432 and PGE(2) could be applicable as an alternative to MCM-mimic in clinical trials which require fully matured DCs to induce Th1-type immune responses against tumor cells even in patients with advanced cancer.