Unraveling the clinicopathological and molecular changes induced by neoadjuvant chemotherapy and endocrine therapy in hormone receptor-positive/HER2-low and HER2-0 breast cancer.

BACKGROUND: The characterization and comparison of gene expression and intrinsic subtype (IS) changes induced by neoadjuvant chemotherapy (NACT) and endocrine therapy in hormone receptor-positive (HR+)/human epidermal growth factor receptor 2 (HER2)-low versus HR+/HER2-0 breast cancer (BC) has not been conducted so far. Most evidence on the association of HER2 status with pathologic responses and prognosis in HR+/HER2-negative BC is controversial and restricted to NACT-treated disease. Similarly, a temporal heterogeneity in HER2 status has been described only with NACT. METHODS: We retrospectively recruited a consecutive cohort of 186 patients with stage I-IIIB HR+/HER2-negative BC treated with neoadjuvant therapy (NAT). Available diagnostic biopsies and surgical samples were characterized for main pathological features, PAM50 IS and ROR-P score, and gene expression. Associations with pathologic complete response, residual cancer burden-0/I, event-free survival (EFS) and overall survival (OS) based on HER2 status were assessed. Pre/post pathologic/molecular changes were analyzed in matched samples. RESULTS: The HER2-low (62.9%) and HER2-0 (37.1%) cohorts did not differ significantly in main baseline features, treatments administered, breast-conserving surgery, pathologic complete response and residual cancer burden-0/I rates, EFS, and OS. NAT induced, regardless of HER2 status, a significant reduction of estrogen receptor/progesterone receptor and Ki67 levels, a down-regulation of PAM50 proliferation- and luminal-related genes/signatures, an up-regulation of selected immune genes, and a shift towards less aggressive IS and lower ROR-P. Moreover, 25% of HER2-0 changed to HER2-low and 34% HER2-low became HER2-0. HER2 shifts were significant after NACT (P < 0.001), not neoadjuvant endocrine therapy (P = 0.063), with consistent ERBB2 mRNA level dynamics. HER2 changes were not associated with EFS/OS. CONCLUSIONS: HER2-low and HER2-0 status change after NAT in ∼30% of cases, mostly after NACT. Targeted adjuvant strategies should be investigated accordingly. Molecular downstaging with current chemo/endocrine agents and immunotherapy should not rely on HER2 immunohistochemical levels in HR+/HER2-negative BC. Instead, HER2-low-targeted approaches should be explored to pursue more effective and/or less toxic dimensional downstaging.

Lung carcinosarcoma.

Lung carcinosarcoma is a neoplasm of high grade composed of epithelial and mesenchymal cells. It is exceptional; and usually affects men who are smokers, between the fifth and eighth decades of life. Medical treatment, chemotherapy and radiotherapy are not active in this kind of tumour, so surgery is the treatment of choice. Prognosis is poor with survival rates at 6 months around 27%. We describe the diagnostic process and the clinical outcome of a patient with lung carcinosarcoma with several paraneoplastic syndromes.

Estudio de viabilidad de un sello de calidad del servicio de atención farmacéutica en una farmacia comunitaria (II): encuesta a farmacéuticos / Feasibility study of a quality seal of the pharmaceutical care service in communitary pharmacy (II). Survey to pharmacists

Un sello de calidad en atención farmacéutica (AF) que garantice que se cumplen unos estándares mínimos en indicación, dispensación y seguimiento fármaco terapéutico sería una herramienta útil para medir la calidad del servicio prestado. Comenzamos por diseñar un cuestionario dirigido a farmacéuticos interesados en prestar servicios de AF que nos proporcionara los indicadores que nos permitieran valorar la aceptabilidad del sello. Éstos se consensuaron en un cuestionario que se distribuyó a través de webs, la Sociedad Española de Farmacia Comunitaria y el Colegio de Farmacéuticos. Se realizó la valoración a partir de los cuestionarios recopilados, con lo que se pudo comprobar que los farmacéuticos estarían «bastante dispuestos a participar» en la elaboración-implantación del sello certificador de calidad. Este sello se considera mayoritariamente imprescindible y/o conveniente (AU)

A quality control on pharmaceutical care that guarantees the compliance of minimum standards as regards instructions, dispensing and pharmaco-therapeutic follow-up would be a useful tool in order to measure the quality of the rendered service. We started designing a questionnaire addressed to pharmacists interested in rendering PC services that will provide us with the indicators that will allow us into assessing the seal acceptance. These reached a consensus through a questionnaire that has been distributed through distributors, web, Sefac and Associations of pharmacists. From the gathered questionnaires the corresponding assessment has been carried out, proving that the pharmacists who had taken part would be «well-disposed to participate» in the elaboration-implementation of the quality certifier seal and this seal is considered by the most like indispensable and/or convenient (AU)

[Study of the influence of arterial pressure response to exertion on cardiac hypertrophy in patients with mild or moderate hypertension]. / Estudio de la influencia de la respuesta de la presión arterial al esfuerzo sobre la hipertrofia cardíaca en hipertensos ligeros y moderados.

In order to study the relationship between tensional response of an hypertensive patient to exercise and its cardiac repercussions, we have studied 42 essential hypertensive patients using echocardiography type M and 2D and exercise test. Patients were divided into two groups according to whether they had (GI) or not (GII) left ventricular hypertrophy. LVH was defined calculating left ventricular mass (LVM) or mean wall thickness (MWT). We have found significant correlations between tensional response and LVH, using only MWT as the index of LVH. This correlation was significant not only with maximum systolic arterial pressure but also with systolic arterial pressure in all intermediate charge stages. Evolution time of arterial hypertension significantly correlated with the degree of LVH according to MWT and less significantly with LVM. We conclude that the correlation between tensional response to exercise and cardiac hypertrophy is always higher when considering MWT as the index of LVH since the calculating the mass some other parameters are also present which hinder its significance and that correlation is established not only in the maximum exercise level.

[Importance of color-coded Doppler in a case of interventricular communication associated with fixed subaortic stenosis]. / Valor del Doppler codificado en color en un caso de comunicación interventricular asociado a estenosis subaórtica fija.

We describe a 10 year old girl with ventricular septal defect in whom bidimensional echocardiogram disclosed a membrane in the outflow tract of the left ventricle. Color Doppler found the presence of fixed subaortic stenosis.