Breast Cancer during Pregnancy: An Interdisciplinary Approach in Our Institution.

BACKGROUND: Breast cancer is the most common cancer diagnosed during pregnancy. CASE REPORT: We report on a case of a 26-year-old woman who was diagnosed with right-sided breast cancer in her 15th week of gestation. We discussed possible treatment scenarios and the patient opted for neoadjuvant therapy with taxanes and anthracyclines during pregnancy, followed by delivery and then followed by surgery, antibody therapy, and radiotherapy. The patient received neoadjuvant chemotherapy with paclitaxel 80 mg/m(2) weekly for 12 cycles, followed by 4 cycles of epirubicin and cyclophosphamide (90/600 mg/m(2)) every 3 weeks. Complete clinical response was seen after preoperative chemotherapy. After delivery of a healthy child at 40 weeks of gestation, she received breast-conserving surgery and axillary dissection. Anti-HER2 antibody treatment with trastuzumab was started concomitantly with adjuvant radiotherapy. Endocrine treatment with a gonadotropin-releasing hormone (GnRH) analog and tamoxifen for 5 years was planned to be started after radiotherapy. CONCLUSION: Treatment of breast cancer during pregnancy requires an interdisciplinary approach and careful consideration of the patient's stage of disease, the gestational age, and the preferences of the patient and her family.

Bendamustine in Metastatic Breast Cancer: An Old Drug in New Design.

The goal of treatment for patients with advanced breast cancer is to prolong survival, control symptoms, and reduce disease-related complications. Despite the introduction of many cytotoxic agents during the past decade, only modest improvement in survival in metastatic breast cancer has been achieved. In order to improve this situation, new cytotoxic drugs as well as molecule-targeted agents are now under investigation. Bendamustine is a bifunctional alkylating agent with cytotoxic activity against several types of solid tumors. In the search for new anthracycline-free combinations, taxanes and alkylating agents might be worth investigating, in order to reduce cardiac toxicity. In this article, we reviewed the latest information regarding antitumor activity, toxicity, pharmacokinetics, and clinical application of bendamustine as a cytotoxic agent in metastatic breast cancer.

Epidermal growth factor receptor (EGFR) mutation does not correlate with platinum resistance in ovarian carcinoma. Results of a prospective pilot study.

BACKGROUND: Different studies have demonstrated epidermal growth factor receptor (EGFR) status as an independent prognostic factor for ovarian cancer (OC). Recent studies in non-small cell lung cancer suggest that the presence of a clinical response to tyrosine kinase inhibitors correlates with somatic mutations in the kinase domain of EGFR, exons 18-21. For patients with OC, data are not available on EGFR gene mutation. MATERIALS AND METHODS: Shock-frozen samples from 32 patients with OC were screened for L858R deletion mutations of EGFR within exon 21 of the kinase domain and 15 bp deletion in exon 19. Additionally, nine commercially available OC cell lines and 32 established OC lines were analysed. RESULTS: In cell lines, as well as in tumor samples, stratified to platinum-free therapy interval, no mutation of the EGFR gene was observed. CONCLUSION: Mutations in the kinase domain of the EGFR, exons 19 and 21, are absent or very infrequent in patients with OC.

The -463G/A polymorphism in myeloperoxidase gene and cervical cancer.

BACKGROUND: Cervical cancer is the leading cause of cancer-related death in women in developing countries. The -463 type G polymorphism of the MPO gene has been correlated with higher MPO expression and increased risk of various types of cancers. Our study was performed in order to evaluate the association between the -463G polymorphism and the prevalence of cervical cancer. MATERIALS AND METHODS: In our prospective study, 149 patients with cervical cancer and 126 patients without any malignancies were enrolled. RESULTS: No significant difference was found between genotype distributions in the cervical cancer patients and the control group. There was also no significant association of the genotype distributions with clinical prognostic factors. However, significantly lower A allele frequency of the -463 polymorphism of the MPO gene was found in our study group in comparison with that of the average Caucasian population. CONCLUSION: The -463 polymorphism of the MPO gene was not associated with susceptibility to cervical cancer.

Polymorphism of IL-1alpha, IL-1beta and IL-10 in patients with advanced ovarian cancer: results of a prospective study with 147 patients.

OBJECTIVE: Interleukin 1 (IL-1) and IL-10 are critically involved in tumorigenesis. We investigated polymorphisms of IL-1 and IL-10 genes in patients with ovarian cancer (OC). METHODS: In a prospective, case-control study 147 patients with OC and 129 patients without history of any malignancy (CG) were genotyped for IL-1 gene (IL-1alpha -889 T/C and IL-1beta -511 C/T) and IL-10 gene (IL-10 -1082 G/A, -819 C/T and -592 C/A) using pyrosequencing. RESULTS: IL-10 polymorphisms in -819 and -592 positions correlated with the postoperative residual tumor mass (p=0.036 and p=0.035, respectively). The chance of achieving optimal tumor debulking was 1.49 times greater for patients with the C/C genotype at -819 and -512 positions than for patients with other genotypes. There were no significant associations between allelic frequencies for IL-1alpha and IL-1beta in OC. IL-10 -819 CC and -592 CC genotypes were associated in univariate analysis with a better disease-free and overall survival. CONCLUSIONS: IL-10 promoter polymorphism may be related with the ability to achieve optimal tumor debulking. Polymorphism in IL-10 gene seems to influence the overall and disease-free survival rate. Subsequent multi-institutional studies with high number of patients are warranted to confirm these results.

Expression of IL-10 in patients with ovarian carcinoma.

BACKGROUND: Cytokines are involved in the pathogenesis of different gynecological malignancies. Additionally, they stimulate the spread of cancer cells. Interleukin 10 (IL-10) was described as a pro-inflammatory factor and seems to be implicated in the immune deficiency of patients with cancer. The aim of this study was to determine whether the level of IL-10 in the serum and ascites was associated with the prognosis of advanced ovarian cancer (OC). MATERIALS AND METHODS: In a prospective study from 2001 to 2003, the concentration of IL-10 in the serum and ascites of 117 consecutive patients with advanced OC and 30 women with benign disease who underwent surgery as a control group (CG), was analyzed by the enzyme-linked immunosorbent assay. For statistical analyses, the Chi-square test by Pearson, Fisher's exact test and the Mann-Whitney test were employed. RESULTS: The concentrations of IL-10 were a median of 9.87 pg/ml (range 7.8 to 500 pg/ml) in the serum and a median of 43.70 pg/ml (range 7.8 to 389.4 pg/ml) in the ascites of the OC patients. The IL-10 level in the sera of the CG was a median of 7.80 pg/ml (range 7.8 to 62.8 pg/ml) and 18.34 pg/ml (range 7.8 to 88.72 pg/ml) in the peritoneal fluid. A significant association was observed between the IL-10 serum levels (p = 0.003) and levels in the peritoneal fluid (p = 0.03) in both OC and the CG. IL-10 was significantly more expressed in the ascites of patients with OC than in their sera (p = 0.003). The concentration of IL-10 correlated significantly with proven conventional prognostic factors such as recurrence status (p = 0.005), volume of (ascites, p < 0.001, serum, p = 0.03), histological grading (p = 0.053) and histological type (ascites p = 0.005/ serum p = 0.09). There was no significant correlation between the levels of lL-10 in the ascites and/or serum and FIGO stage, residual tumor mass or age. The cut-off value of 8.0 pg/ml for IL-10 serum levels had a positive predictive value of 84% (95% CI: 76-91) and a negative predictive value of 29% (95% CI: 16-41), with a specificity and sensibility of 47% (95% CI: 29-65) and 70% (95% CI: 62-78), respectively. CONCLUSION: Due to the fact that the levels of IL-10 were significantly higher in the ascites and serum of OC patients than in those of the CG, IL-10 may play an important immunosuppressive role in the pathogenesis of OC. The association between high IL-10 levels in ascites and serum and the histological type of the tumor, as well as between the levels in the peritoneal cavity and grading, suggest that IL-10 could be a prognostic factor in OC.