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Poniżej zaprezentowano zalecenia European Society of Medical Oncology dotyczące oceny kardiologicznej u chorych poddanych terapii antracyklinami oraz przeciwciałami monoklonalnymi.

Podczas San Antonio Breast Cancer Symposium zaprezentowano wyniki badania III fazy oceniającego skuteczność terapii pierwszej linii anastrozolem skojarzonym z fulwestrantem, u kobiet po menopauzie chorych na przerzutowego raka piersi wykazującego ekspresję receptorów hormonalnych.

Poniżej przedstawiono uzupełnienie wcześniej zamieszczonej listy leków zatwierdzonych w Europie do leczenia nowotworów złośliwych.

Aim of the study : The objective of the study was to determine the body composition (BC) changes in women with breast cancer after endocrine therapy, and the influence of aerobic training on the parameters under discussion. Material and methods : 41 women aged 32-48 (mean ± SD 44.1 ±4.4) with breast cancer during endocrine therapy (ET). This was a nonrandomized, prospective trial. The following examinations were conducted in patients according to the schedule: I before the beginning of ET; II after 6 months of the ET; III after 12 months of ET and after 6-month aerobic training. Body composition was evaluated using dual X-ray absorptiometry (DEXA) with respect to free fatty mass, lean, fat and the percentage location of android and gynoid fat. The body build was evaluated with respect to body height, body weight and selected anthropometric parameters BMI and WHR. Results : During the first six months of ET without regular physical activity the following was reported: a significant increase of body weight, BMI, the amount of fatty tissue, including android fat distribution (p < 0.05); the lack of any significant change in the amount of gynoid fatty tissue (p > 0.05). At that time muscle (p < 0.05) and free fatty mass (p > 0.05) reductions were reported. After the six-month aerobic workout no significant body weight or BMI increase was observed. However, there was a significant reduction in WHR (p < 0.05), which correlated with the decrease of android fatty tissue (p < 0.05). The other elements evaluated in the DEXA underwent statistically insignificant changes. Conclusions : The outcome analysis allows us to conclude that during breast cancer ET the patients are reported to have negative changes in BC and phy­sique. Therefore, this patient group is advised to receive regular rehabilitation with the aim of reducing the side effects of the treatment. However, aerobic train­ing seems to be insufficient in order to fully reduce the side effects of this form of cancer therapy.

Background : HER2 consists of an extracellular domain (the target for trastuzumab), a transmembrane domain, and an intracellular domain, which is recognized by an antibody used in the immunohistochemical assessment of HER2 overexpression. The study consisted of 31 patients with metastatic breast cancer treated with trastuzumab. The aim of the study was to evaluate retrospectively expression of extracellular and intracellular HER2 domains in primary breast cancers treated with surgery and to assess their correlation with biological features of tumours, disease-free survival, overall survival, as well as progression-free survival and survival since the start of trastuzumab treatment. Material and methods : All these patients relapsed and were treated with tras­tuzumab because of metastatic disease – none of them received trastuzumab in an adjuvant setting. Two kinds of antibodies were used in immunohistochemical evaluation: against extracellular and intracellular domains of the HER2. Results : A significant correlation between different patterns of HER2 domain overexpression and disease-free survival was found. Disease-free survival (the time from the primary operation to relapse – prior to the start of any palliative treatment) was the shortest in patients with overexpression of both domains compared to patients without overexpression of both domains and the group with intracellular domain overexpression combined with absence of extracellular domain overexpression (median 13.2 vs. 24.3 vs. 52.4 months, p = 0.01). There was no significant difference between these 3 groups of patients in aspects of biological features of tumours, overall survival, progression-free survival and survival since the start of trastuzumab treatment. Conclusion: Concurrent assessment of extracellular and intracellular domains of HER2 may have prognostic value for HER2-positive patients.

Podczas San Antonio Breast Cancer Symposium przedstawiono wyniki badania III fazy (CLEOPATRA), opublikowane tego samego dnia w New England Journal of Medicine. W badaniu oceniano efektywność pertuzumabu z trastuzumabem i docetakselem u kobiet chorych na zaawansowanego/przerzutowego raka piersi, których guzy prezentowały nadekspresję HER2.

Podczas San Antonio Breast Cancer Symposium zaprezentowano zaktualizowane wyniki badania BOLERO-2, w którym oceniano skuteczność ewerolimusu skojarzonego z eksemestanem u kobiet po menopuazie chorych na zaawansowanego raka piersi, których guzy prezentowały obecność receptorów hormonalnych i u których doszło do niepowodzenia wcześniejszej terapii.

Amerykańska Agencja ds. Żywności i Leków (U.S. FDA – Food and Drug Administration) zarejestrowała 10 leków stosowanych w leczeniu nowotworów litych.

EMA (European Medicines Agency) zarejestrowała sześć nowych leków oraz rozszerzyła wskazania pięciu leków stosowanych w leczeniu nowotworów litych.

W New England Journal of Medicine opublikowano wyniki badania III fazy, w którym porównano skuteczność uzupełniającej chemioterapii składającej się z docetakselu i karboplatyny połączonych z trastuzumabem (TCH) do schematu zawierającego antracyklinę i docetaksel oraz trastuzumab (AC – T + Tr) u kobiet chorych na raka piersi z nadekspresją lub amplifikacją HER2.

Podczas konferencji European Society of Medical Oncology zaprezentowano wyniki badania BOLERO-2, w którym oceniano skuteczność ewerolimusu skojarzonego z eksemestanem u kobiet po menopuazie chorych na zaawansowanego raka piersi, których guzy prezentowały obecność receptorów hormonalnych i u których doszło do niepowodzenia wcześniejszej terapii.

Podczas konferencji European Society of Medical Oncology, która odbyła się w Sztockholmie w dniach 23-27 września 2011 zaprezentowano wyniki randomizowanego badania II fazy porównujące skuteczność T-DM1 z trastuzumabem skojarzonym z docetakselem u chorych na raka piersi z przerzutami z nadekspresją receptora HER2.

Amerykańską Agencję ds. Żywności i Leków (US Food and Drug Administration – FDA) zarejestrowała denosumab (Prolia) do leczenia utraty masy kostnej u kobiet po menopauzie leczonych uzupełniająco inhibitorami aromatazy w przebiegu raka piersi.

W Journal of Clinical Oncology opublikowano zalecenia Cancer Care Ontario (CCO) zatwierdzone przez panel ekspertów Amerykańskiego Towarzystwa Onkologii Klinicznej (ASCO – American Society of Clinical Oncology). Zalecenia dotyczą uzupełniającej hormonalnej blokady czynności jajników u kobiet przed menopauzą po pierwotnej operacji z powodu inwazyjnego raka piersi.

Każdego roku American Cancer Society publikuje wartości szacunkowe nowych przypadków zachorowania i zgonów z powodu nowotworów złośliwych spodziewanych w Stanach Zjednoczonych w bieżącym roku.

W Journal of the American Medical Association (JAMA) opublikowano wyniki badania klinicznego, w którym kobietom chorym na raka piersi przed i w trakcie neoadiuwantowej lub uzupełniającej chemioterapii podawano analog GnRH. Miało to zapobiec objawom wczesnej menopauzy.

To evaluate the impact of different types of physical activity on life satisfaction, acceptance of illness and adaptation to breast cancer among women after treatment. Women after treatment of breast cancer had high awareness of the impact of physical activity on recovery. The study subgroup of women who were most active had a better strategy of fighting spirit. Among many types of physical activity, tourist trips and dance were the most important for quality of life. Physical activity seemed to be profitable also for the subgroup outside the Breast Cancer Survivors’ Club.

In the course of radiation therapy different types of adverse reactions of the skin are observed in approximately 95% of patients. Among the various complications encountered after radiotherapy, radiation recall dermatitis (RRD) deserves special attention. Radiation dermatitis is a form of delayed hypersensitivity of irradiated skin, and the direct trigger factors are medicines – most chemotherapeutics. The reaction is an inflammatory dermatosis. It is limited to previously irradiated skin and appears a number of months after radiotherapy. The aetiology of RRD is still unclear. Its clinical presentation may vary from mild erythema to necrosis and ulceration. The article presents the case of a 50-year-old patient, who after radiotherapy for breast cancer, during the hormonal therapy (tamoxifen), developed RRD type skin reactions after skin application of Amol. The article presents a detailed differential diagnosis of skin changes of RRD type, and discusses the principles of treatment and prevention.

Palmar-plantar erythrodysesthesia (PPE), also called hand-foot syndrome (HFS), is a distinctive and relatively frequent dermatological toxic reaction associated with certain chemotherapeutic agents: pegylated liposomal doxorubicin, capecitabine, a long-circulating formulation of doxorubicin, cytosine arabinoside, interleukin 2. HFS typically presents with dysaesthesia and tingling in the hands and feet. Dysaesthesias and erythema may occur on several other body surfaces, especially in areas where pressure or increased warmth occurs, such as on the buttocks, groin, under pendulous breasts, and in the axillae. We present the case of a 56-year-old woman with HFS in the axillae, inguen and on the skin of the back and abdomen during treatment with pegylated liposomal doxorubicin for metastatic breast cancer. After four cycles of chemotherapy, treatment was interrupted due to HFS (G3 according to NCI CTC). Palmar-plantar erythrodysaesthesia is an oppressive complication after chemotherapy; it often makes normal daily activity impossible, deteriorates the patient’s quality of life and frequently limits chances of effective treatment.

ASCO 2011: Naukowcy zaprezentowali wyniki badania II fazy (CHEM-LOB trial), w którym oceniali skuteczność skojarzenia neoadiuwantowej chemioterapii składającej się z paklitakselu połączonego ze schematem FEC (fluourouracyl, epirubicyna, cyklofosfamid) i terapią anty-HER2 – trastuzumabem i lapatynibem.