Radiofrequency ablation of solid tumors is produced by frictional heating caused when ions in the tissue attempt to follow the changing directions of a high-frequency alternating current. The radiofrequency probe is typically placed under ultrasound guidance, and the ablation is performed with real-time ultrasound monitoring. Radiofrequency ablation has been demonstrated to be effective in the treatment of unresectable hepatic tumors, and promising results have also been obtained in tumors of the lung, bone, brain, kidney, prostate gland, and pancreas. Most recently, radiofrequency ablation has been tested in the treatment of invasive breast tumors. A preliminary study reported that intraoperative radiofrequency ablation causes invasive breast cancer cell death in patients with locally advanced breast cancer. An ongoing study is investigating the use of radiofrequency ablation for the treatment of breast tumors 2 cm or less in diameter.
1133 Background: Epithelial growth factor receptor pathway (EGFR) is expressed in TNBC and may be important in a subset of this heterogeneous disease. We evaluated the efficacy and toxicity of an anti-EGFR antibody (cetuximab) combined with ixabepilone given to the TNBC patients (pts) in the neoadjuvant setting. This study was designed to detect an increase in pathological complete response (pCR) rate, defined as no residual disease in the breast, from 20% to 40% in each arm, using a Simon optimal two stage design, with one-sided alpha=10% and power=80%. At least three responses out of 12 patients were needed to proceed with second stage for each arm. Methods: All pts received 4 cycles of preoperative ixabepilone 40 mg/m2 every 3 weeks. In addition, patients were randomized to receive either 12 infusions of weekly cetuximab (400mg/m2 on week 1, then 250 mg/m2) or not. Race, proliferation rate, and TILs was correlated with pCR. Results: To date, a total of36 pts with stage II-IIIA TNBC were enrolled. Median age was 54 years (range 35-79 years) with median tumor size of 6.1 cm (range 2-18 cm). The median proliferation rate (Ki-67) was 67.2% (range 8%-95%). Pts were Hispanic (36%), White (39%), African-American (19%) and others (6%). In ixabepilone alone arm, pCR was observed in only 14.3%, and this monotherapy arm did not progress to second stage. To date, pCR was observed in 31.3% in ixabepilone/cetuximab arm, with 6 patients still on treatment. Adverse events for the combination arm were modest, mainly grade 1-2 (neutropenia: 4%, skin: 83 %, GI: 50 %, fatigue: 100 %). Grade 3 febrile neutropenia in 3 % were observed. No statistically significant correlation with race, Ki67, and TILs with pCR rate was observed. Conclusions: The addition of cetuximab to ixabepilone may improve the rate of pathological complete response in TNBC pts. There was no association between race or proliferation and response to ixabepilone and cetuximab. Evaluation of EGFR, p-EGFR and EGFR pathway -associated genes, PTEN, mutational analysis of PI3K/mTOR pathway and next generation genomic analysis is underway to evaluate for potential predictive biomarkers of response to EGFR inhibition. Clinical trial information: NCT01097642.
PURPOSE: To evaluate the safety and efficacy of weekly docetaxel plus trastuzumab in women with HER-2–overexpressing metastatic breast cancer. Efficacy was correlated with serum HER-2 extracellular domain (ECD) levels. PATIENTS AND METHODS: Thirty women with metastatic breast cancer were treated with weekly docetaxel and trastuzumab as first- or second-line therapy. Both docetaxel 35 mg/m 2 /wk and trastuzumab 2 mg/kg/wk were delivered in 4-week cycles consisting of three weekly treatments followed by 1 week of rest. A loading dose of trastuzumab 4 mg/kg was administered 1 day before the start of the first cycle. RESULTS: The median delivered dose-intensity of docetaxel was 24 mg/m 2 /wk (range, 18 to 27 mg/m 2 /wk). The intent-to-treat overall response rate (ORR) was 63% (95% confidence interval [CI], 44% to 80%). The ORR in patients whose tumors were HER-2–positive by fluorescence in situ hybridization was 67% (16 of 24 patients; 95% CI, 45% to 84%). In patients with elevated serum HER-2 ECD at baseline, the ORR was 76% (95% CI, 53% to 92%), compared with 33% (95% CI, 7% to 70%) in patients with low HER-2 ECD levels (P = .04). Variations in HER-2 ECD concentrations during treatment correlated with response to treatment. Median time to progression was 9 months. Acute toxicity, including myelosuppression, was mild. Fatigue, fluid retention, and excessive tearing became more common with repetitive dosing. CONCLUSION: Weekly docetaxel and trastuzumab is an active combination for treating patients with HER-2–overexpressing metastatic breast cancer. Serum HER-2 ECD testing may be a promising method for monitoring patients on trastuzumab-based therapy.
In 824 patients who underwent directional vacuum-assisted biopsies (DVABs) of breast microcalcifications, 61 (7.4%) showed atypical ductal hyperplasia (ADH). The 42 who subsequently underwent excision were the subjects of this study. Cases were evaluated for the mammographic characteristics of the lesion, the percentage of lesion removed according to mammography, and histologic findings (including number of large ducts and/or terminal duct-lobular units involved with ADH) in DVAB specimens. Pathologic findings in the surgical specimens in the area of the biopsy site also were recorded. In the DVAB specimens, ADH was confined to an average of 1.5 large ducts or lobular units and was associated with microcalcifications in all of the patients. Surgical specimens showed ADH in 15 cases, no residual lesion in 24 cases, and ductal carcinoma in situ in 3 cases. We found that microcalcifications that contain ADH in less than 3 lobules or ducts and/or that are removed completely by DVAB do not reveal higher-risk lesions on excision; thus, removal is unnecessary. When assessing microcalcifications with ADH, clinicians should consider the percentage of microcalcifications removed by DVAB and the extent of lobular involvement to better assess the need for excision.
To evaluate retrospectively the findings at ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) of masses in breasts that contain a prosthesis.Real-time US-guided FNAB was performed in 22 lesions in 17 patients with breast implants. Pneumocystography was performed in seven of eight cysts. The final diagnosis was based on either histologic findings after surgical excision or a combination of cytologic, imaging, and clinical findings.The lesions had a mean diameter of 15 mm +/- 9 (standard deviation). Fifteen lesions (68%) were not identified on mammograms. In all cases, FNAB was completed without complication. Pneumocystography was successful in seven of seven cysts. Cytologic diagnosis was correct in 21 of 22 lesions (95%). There was one case of inadequate specimen (5%). In 16 cases (73%), the diagnosis was established with a single pass.Real-time US allowed continuous visualization of the needle during insertion and sampling, which resulted in pinpoint accuracy and safety. US-guided FNAB is recommended for needle biopsy in breasts with implants.
During the summer, beach related skin lesions are common reasons for emergency room and dermatology office visits. The authors describe the case of a child with a painful maculopapular rash that resulted after a probable cutaneous exposure to a portuguese-manREFERENCIAS
Abstract: Tumor response to preoperative chemotherapy varies from complete to partial to none. To evaluate pathologic predictors of tumor response to preoperative chemotherapy, we reviewed 287 cases of locally advanced breast carcinoma treated with chemotherapy prior to definitive surgery. The patients ranged in age from 18 to 79 years (mean, 48 years). There were 77 (26.8%) patients with stage II disease, 194 (67.6%) with stage III disease, and 16 (5.6%) with stage IV disease. Following the initial diagnosis of invasive carcinoma (by fine-needle aspirate or cutting needle biopsy), the patients received three to four cycles of both doxorubicin-based and cyclophosphamide-based regimens followed by mastectomy or lumpectomy with axillary dissection. The pathologic parameters that were evaluated included stage, clinical tumor size, and tumor nuclear grade (NG). The latter was performed on fine-needle aspirates using Black's nuclear grading system wherein NG1 was considered well differentiated; NG2, moderately differentiated; and NG3, poorly differentiated. Based on pathologic examination of the resected specimens, tumor responses were categorized into complete response, partial response, no response, or progressive disease. The overall response rate was 71% (12% complete and 59% partial responses). In univariate analyses, tumor size and nuclear grade were significantly related to pathologic tumor response to chemotherapy (p = 0.04 and p = 0.0003, respectively), while disease stage was not (p = 0.17). In multivariate analyses, size remained significant even when NG was present in the equation (p = 0.013). Similarly, when size was included, NG remained significant (p = 0.002). NG3 tumors showed better response than NG2 or NG1 tumors did. While 19.3% of NG3 tumors showed complete response, none of the NG1 tumors completely responded to chemotherapy. Initial tumor size was inversely proportional to degree of tumor response. Our findings indicate that tumor clinical size and nuclear grade are important independent predictors of response to preoperative chemotherapy and that poorly differentiated tumors and small tumors showed the most response.
