[Key Points of Examination after Breast Augmentation and Our Clinic's Algorithm of Immediate Reconstruction Using Silicone Implant for Breast Cancer Patient after Breast Augmentation]

Recently, the cases of breast augmentation for cosmetic purposes are rapidly increasing, there are more opportunities to examine for patient with breast augmentation history than before. In some cases, breast cancer screening is difficult due to the effects of breast augmentation. At our clinic, even in cases diagnosed with breast cancer after breast augmentation, we actively perform immediate breast reconstruction using silicone implant. However, it is necessary to consider the condition and type of breast augmentation at the time of diagnosis and also treatment. We will share our algorithm for immediate breast reconstruction using silicone implant for breast cancer after augmentation mammaplasty.

Droplet duos on water display pairing, autonomous motion, and periodic eruption

Under non-equilibrium conditions, liquid droplets dynamically couple with their milieu through the continuous flux of matter and energy, forming active systems capable of self-organizing functions reminiscent of those of living organisms. Among the various dynamic behaviors demonstrated by cells, the pairing of heterogeneous cell units is necessary to enable collective activity and cell fusion (to reprogram somatic cells). Furthermore, the cyclic occurrence of eruptive events such as necroptosis or explosive cell lysis is necessary to maintain cell functions. However, unlike the self-propulsion behavior of cells, cyclic cellular behavior involving pairing and eruption has not been successfully modeled using artificial systems. Here, we show that a simple droplet system based on quasi-immiscible hydrophobic oils (perfluorodecalin and decane) deposited on water, mimics such complex cellular dynamics. Perfluorodecalin and decane droplet duos form autonomously moving Janus or coaxial structures, depending on their volumes. Notably, the system with a coaxial structure demonstrates cyclic behavior, alternating between autonomous motion and eruption. Despite their complexity, the dynamic behaviors of the system are consistently explained in terms of the spreading properties of perfluorodecalin/decane duplex interfacial films.

Formation and evolution of carbonaceous asteroid Ryugu: Direct evidence from returned samples

Samples of the carbonaceous asteroid Ryugu were brought to Earth by the Hayabusa2 spacecraft. We analyzed 17 Ryugu samples measuring 1 to 8 millimeters. Carbon dioxide-bearing water inclusions are present within a pyrrhotite crystal, indicating that Ryugu's parent asteroid formed in the outer Solar System. The samples contain low abundances of materials that formed at high temperatures, such as chondrules and calcium- and aluminum-rich inclusions. The samples are rich in phyllosilicates and carbonates, which formed through aqueous alteration reactions at low temperature, high pH, and water/rock ratios of <1 (by mass). Less altered fragments contain olivine, pyroxene, amorphous silicates, calcite, and phosphide. Numerical simulations, based on the mineralogical and physical properties of the samples, indicate that Ryugu's parent body formed ~2 million years after the beginning of Solar System formation.

Star-Shaped Peptide-Polymer Hybrids as Fast pH-Responsive Supramolecular Hydrogels

Significant challenges have gone into the design of smart hydrogels, with numerous potential applications in the industrial, cosmetic, and biomedical fields. Herein, we report the synthesis of novel 4-arm self-assembling peptide-polyethylene glycol (PEG) hybrid star-shaped polymers and their comprehensive hydrogel properties. β-sheet-forming oligopeptides with alternating hydrophobic Leu/ionizable Glu repeats and Cys residues were successfully conjugated to 4-arm PEG via a thiol-maleimide click reaction. The hybrid star-shaped polymers demonstrated good cytocompatibility and reversible β-sheet (lightly acidic pH)-to-random coil (neutral and basic pH) transition in dilute aqueous solutions. At increasing polymer concentrations up to 0.5 wt %, the star-shaped polymers formed transparent hydrogels with shear-thinning and self-healing behaviors via β-sheet self-assembly, as well as a conformation-dependent gel-sol transition. Interestingly, the star-shaped polymers responded rapidly to pH changes, causing gelation to occur rapidly within a few seconds from the change in pH. Hydrogel characteristics could be modulated by manipulating the length and net charge of the peptide blocks. Furthermore, these star-shaped polymers served as satisfactory network scaffolds that could respond to dynamic environmental changes in the pH-oscillation system, owing to their excellent gelation capability and pH sensitivity. As such, they are highly favorable for diverse applications, such as pH-responsive controlled release.

Evidence-Based Practice Guideline for the Management of Lymphedema Proposed by the Japanese Lymphedema Society

Background: Secondary lymphedema mostly occurs as an aftereffect of cancer treatment, and it is estimated that 100,000-150,000 patients are affected in Japan. An estimated 3500 patients, develop lymphedema of the lower and upper extremities each year secondary to uterine and breast cancer treatment. Medical reimbursement was first instituted in April 2008 by the Ministry of Health, Labour and Welfare in Japan. Since 2008, we have developed guidelines regarding treatment options for patients with lymphedema based on scientific evidence. This is the third edition of the guidelines established by the Japanese Lymphedema Society (JLES), published in 2018. The JLES Practice Guideline-Making Committee (PGMC) developed 21 clinical questions (CQs). Methods and Results: A review of these 15 CQs was performed in accordance with the methodology for establishing clinical guidelines. The 15 recommendations for each of these CQs were developed and discussed until consensus by the PGMC was reached. Moreover, outside members who had no involvement in these guidelines evaluated the contents using the Appraisal of Guidelines for Research and Evaluation (AGREE) II reporting checklist. Conclusion: These guidelines have been produced for the adequate management of lymphedema by doctors and other medical staff on the lymphedema management team of medical institutes, including nurses, physical technicians, and occupational therapists.

Mode Bifurcation on Contact Line Dynamics at Oil/Water Interface Depending on the Contact Line Length

The motion of the contact line at the oil/water interface caused by chemical reactions is well known as a typical example of artificial active matter in the field of nonlinear science. When water (containing trimethylstearylammonium chloride) and nitrobenzene (containing iodide anion) phases are in contact, the regulated traveling-wave patterns appear along the inner wall of the glass container. In this study, we demonstrate a new dynamical mode of the contact line, an up-and-down motion, which becomes dominant with the decrease in the size of a glass tube, and the probability of occurrence is extremely high when the diameter of the glass tube is below 1 mm. A physicochemical model of the contact line motion that incorporates the spatiotemporal variation of the surfactant concentration on a glass surface is proposed, and its effect on the wettability of oil/water phases on the walls of the glass tubes is studied. The present model can reproduce the mode bifurcation of the dynamical motion depending on the inner diameter of the glass tubes.

[The Treatment of Olaparib for BRCA Positive-Metastatic Breast Cancer Patient]

Breast cancer patient(invasive ductal carcinoma, ER[+], PgR[+], HER2[3+], Ki-67: 30%)had neoadjuvant chemotherapy( FEC followed by docetaxel plus trastuzumab). After surgical operation(mastectomy and Ax)was performed and she received trastuzumab plus hormone therapy. After 2 years later, she had liver metastasis that showed IDC, ER(+), PgR (+), HER2(-). In addition, BRCA positive was shown. Therefore, the patient received olaparib tablets(300 mg twice daily). After 2 months later, liver metastasis reduced dramatically.

[Palbociclib in a Postmenopausal Metastatic Breast Cancer Patient]

The purpose of our study was to test the efficacy and toxicity of palbociclib therapy for breast cancer treatment. Ten patients diagnosed with breast carcinoma were selected for this retrospective study between 2017 and 2018. After the patients had previously been administered palbociclib, they received either capecitabine or eribulin. As a result, the median PFS of capecitabine and eribulin were 6.4 months(3-10)and 5.8 months(4-7), respectively. Therefore, the treatment administered after palbociclib therapy may be useful for breast cancer patients.

[A Case of Pulmonary Tumor Thrombotic Microangiopathy(PTTM)Diagnosed During Chemotherapy for Metastatic Breast Cancer]

A 46-year-old woman with metastatic breast cancer developed dyspnea that progressed relatively rapidly during chemotherapy. Chest-abdominal CT revealed wedge-shaped infiltration shadow, and cardiac catheterization revealed elevated pulmonary artery pressure. Aspiration cytology of pulmonary arterial blood was performed and malignant cells were confirmed. Chemotherapy was difficult to continue because of deterioration in general condition, and she died 7 days after diagnosis. This time, we report a case of PTTM for which pulmonary arterial blood cytology was useful for diagnosis.

[Radiation-Induced Breast Angiosarcoma after Conservative Surgery for Breast Cancer]

We present the case of an 88-year-old woman who had undergone breast conserving surgery for left breast cancer 8 years ago.She received postoperative radiotherapy(total dose of 60 G/30 Fr)to the residual breast together with endocrine therapy.She underwent skin biopsy after having had a red skin tumor in the left breast.Angiosarcoma was diagnosed and chemotherapy and radiotherapy were initiated.The patient is alive without recurrence 8 months after chemotherapy.

[The Approach of Breast Reconstruction for Breast Cancer in Our Hospital]

The demand for breast reconstruction is expected to increase with the currently observed increase in the number of breast cancer patients. Among the 70 patients included in the study, 59 received tissue expanders, 1 received implant, and 10 received deep inferior epigastric perforator flaps. Complications were noted in is 11 patients who received tissue expanders. In this study, age>50 years and smoking were associated with higher rates of complication. Choosing an appropriate method for breast reconstruction is important. In addition with plastic surgery, an approach to reduce complications will be necessary in future.

[A Case of Ductal Carcinoma In Situ(DCIS)Diagnosed by Excisional Biopsy with Benign Cytology Findings of Fine-Needle Aspiration]

Nipple discharge is a common symptom and frequently results from benign tumors. However, there is a 5-30% risk of malignancy. A 65-year-old woman presented at the hospital because of bloody nipple discharge in her right breast. She had noticed an abnormal nipple discharge for several months. Mammography showed focal asymmetric densities without calcification in the middle outer quadrant of her right breast. Ultrasonography indicated a 1.5×1.1 cm sized cyst with fluid-fluid level. Breast MRI showed a simple cyst with a benign contrast enhancement pattern. No malignant cells were observed by fine-needle aspiration. Considering the low sensitivity of mammography and breast MRI to DCIS, we performed an excisional biopsy. Histological examination revealed that the lesion was DCIS. The patient underwent right total mastectomy and was diagnosed with low grade DCIS(ER-positive, PgR-positive, HER2-negative). She continues endocrine therapy with an aromatase inhibitor.

Ionic Tuning of Droplet Motion on Water Surface

Herein, the oscillation of an oil droplet on the surface of water is studied. The droplet contains an anionic surfactant that can react with the cations present in water. The oscillation starts after a random motion, and the oscillation pattern apparently depends on the cation species in the water phase. However, a common pattern is included. The cation species only affects the amplitude and frequency and sometimes perturbs the regular pattern owing to the instability at the oil/water interface. This common pattern is explained by a simple model that incorporates the surfactant transport from the droplet to the surrounding water surface. The dependency of the amplitude and frequency on cation species is expressed quantitatively by a single parameter, the product of the amplitude and square of frequency. This parameter depends on the cationic species and can be understood in terms of the spreading coefficient. The simple model successfully explains this dependency.

Autonomous Movement System Induced by Synergy between pH Oscillation and a pH-Responsive Oil Droplet

A sustainable droplet motion that is driven by pH oscillation was obtained. The pH oscillation is only of a single pulse in a batch reactor. However, it shows continuous oscillation around the moving droplet, as the motion itself controls the diffusion flux in an asymmetric manner. Various types of motions that are spontaneous in nature may be obtained by a single-pulse oscillation coupled with mass transport.

[Temporary Home Management of a Refractory Pleural Effusion with an Indwelling Catheter]

BACKGROUND

Pleurocentesis and pleurodesis are the common treatments for pleural effusion. However, most home-visit physicians usually hesitate to perform these treatments for patients confined at home.

CASE

A 51-year-old woman developed breast cancer(ER+, HER2-)at the age of 39 years. She underwent a partial mastectomy of the right breast. Nine years later, metastatictumors in the lungs, and hilar and mediastinal lymph nodes were found. The patient was admitted to our hospital because of the progression of pleural effusion and dyspnea. On the day of admission, the aspiration catheter was placed in the left lung with continuous suction, but pleurodesis could not be performed as the left lung did not re-expand enough. As the patient requested to go home as soon as possible, she was discharged with the catheter in place. Three days after the discharge, the home-visit physician drained 340 mL of fluid through the catheter. Six days after the discharge, the patient was readmitted to the hospital with malaise and dyspnea, but no signs of complications associated with the indwelling catheter use were observed. The patient died 4 days after the readmission.

CONCLUSION

This case suggests that draining fluid using an indwelling pleural catheter as a home-based healthcare measure is one of the simplest and safest options.

[Abnormal Nipple Discharge]

BACKGROUND

Breast carcinoma and precancer are thought to start in the lining of the milk duct or lobule. Ductography and fiberoptic ductoscopy have beenadvocated as the mainprocedures inpatien ts with nipple discharge.

METHODS

We investigated the usefulness of microdochectomy(MD)by using indocyanine green(ICG)fluorescence imaging. ICG and indigo carmine were injected into the mammary duct. A periareolar incision was made, and a fluorescence image of the demarcated mammary duct segment was obtained.

CONCLUSION

MD using indocyanine green fluorescence imaging is a useful procedure in guiding subsequent breast surgery in the treatment of nipple discharge.

[Evaluation of the Small Excision Using a Sonographically Visible Breast Biopsy Marker(HydroMARK®)]

In case an operation is necessary after an ST-VAB for microcalcification, a wide excision needs to be performed because of the loss of marking. The HydroMARK®breast biopsy marker can be visualized using an ultrasound or mammography and facilitates a small excision. Six months after the deployment, all markers were visualized using an ultrasound. Thus, Hydro MARK®can decrease the sample size(11 g)in open biopsies and correctly diagnose ADH. However, no HydroMARK®cases were diagnosed with ADH in large samples(44 g, 32 g). Five malignant histology cases underwent mastectomy, and the distance between the HydroMARK®and tumor was 300 mm. HydroMARK®appears to be a safe and effective marker after a stereotactic biopsy for calcification, which facilitates an exact small excision of lesion surgically.

[Radiotherapy and Eribulin Mesylate for Mediastinal Node Metastasis from Breast Cancer-A Case Report]

A69 -year-old woman was diagnosed as having local advanced breast cancer. She was treated with neoadjuvant chemotherapy( AC followed by paclitaxel)and followed up with left total mastectomy with axillary lymphadenectomy for breast cancer(pT3N1aM0, Stage ⅢA, ER positive, PgR positive, and HER2 negative). She received adjuvant therapy with chest wall irradiation and an aromatase inhibitor. Two years after the mastectomy, mediastinal lymph node and rib metastases and dissemination appeared. We changed the regimen to capecitabine. She continued the capecitabine therapy for 7 years and was found to have multiple lung metastasis. Therefore, we chose eribulin mesylate therapy. Ten days after eribulin mesylate (1.0mg/body)was first administered, she suddenly had difficulty breathing, and chest CT revealed left low lobe atelectasis. The superior mediastinal lymph node had grown rapidly and compressed the left main bronchus and superior vena cava. To reduce the lymph node size, we started radiotherapy(50 Gy/25 Fr)for the superior mediastinal area in addition to the eribulin mesylate therapy. After the radiotherapy, chest CT revealed a remarkable reduction of lymph node size and full pulmonary reexpansion. One year after the radiotherapy, she is continuing treatment without systemic progression.

[A Successful Treatment of Locally Advanced Breast Cancer with Using Mohs' Paste and Chemotherapy - A Case Report]

Foul smell and large amounts ofexudate, bleeding are the most common and serious symptoms with locally advanced breast cancer(LABC). Mohs' paste is made ofa mixture ofzinc chloride and used for treatment ofmalignant skin tumors. Recently some reports show that Mohs' paste is useful for treatment of malignant tumor including unresectable breast cancer and skin metastasis ofcancer. Mohs' paste is useful for reducing symptoms such as foul smell and exudate, Bleeding. We report a successful case of treatment for LABC with using Mohs' paste and chemotherapy and surgery.

[Local Control by Mastectomy in Advanced Breast Cancer with Liver Metastasis after Chemotherapy, Radiotherapy, and Hyperthermia - A Case Report]

Advanced breast cancer has a poor prognosis compared to early breast cancer; however, quality of life and radical operation can be improved in some case by using multidisciplinary treatment. A 54-year-old woman was examined at the hospital because of an enlarging tumor in the left breast. She was aware of a lump for 3 years. Results of the initial examination indicated invasive ductal carcinoma with liver metastasis. She first received chemotherapy(AC followed by weekly paclitaxel). After 4 courses of weekly paclitaxel, computed tomography revealed axillary lymph nodes involved in the axillary vein. Operation was difficult and conversion therapy was administered. The patient underwent radiotherapy, hyperthermia, and hormone therapy. After 1 year from the start of hormone therapy, the metastasis had disappeared and the patient underwent operation in our unit. Eight months after operation, no recurrence was observed.

Japanese translation and linguistic validation of the US National Cancer Institute's Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE)

BACKGROUND

The US National Cancer Institute (NCI) has developed the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) to capture patients' self-reported symptomatic adverse events in cancer clinical trials. The aim of this study was to develop and linguistically validate a Japanese translation of PRO-CTCAE. Forward- and back-translations were produced, and an independent review was performed by the Japan Clinical Oncology Group (JCOG) Executive Committee and the US NCI. We then conducted cognitive interviews with 21 patients undergoing cancer treatment. Participants were asked to complete the PRO-CTCAE and were interviewed using semi-structured scripts and predetermined probes to investigate whether any items were difficult to understand or answer. The interviews were recorded and transcribed, and a thematic analysis was performed. The data were split into two categories: 1) remarks on the items and 2) remarks on the questionnaire in general.

RESULTS

Twenty-one cancer patients undergoing chemotherapy or hormone therapy were interviewed at the University of Tokyo Hospital and the Kansai Medical University Hirakata Hospital during 2011 and 2012. Thirty-three PRO-CTCAE items were evaluated as "difficult to understand," and 65 items were evaluated as "difficult to answer" by at least one respondent. However, on further investigation, only 24 remarks were categorized as "comprehension difficulties" or "clarity" issues. Most of these remarks concerned patients' difficulties with rating their experience of individual symptomatic events.

CONCLUSIONS

The study provides preliminary evidence supporting the linguistic validity of the Japanese version of PRO-CTCAE. Further cognitive interviewing is warranted for PRO-CTCAE items relating to sexuality and anxiety and for response options on severity attribute items.

[A Case of Shock Due to nabPTX Administration Successfully Treated with Cytokine Adsorption Therapy]

The patient was a 71-year-old woman with ER(+), PgR(-), HER2(3+), and Ki-674 2% breast cancer. After surgery for left breast cancer(Bt+Ax), epirubicin, cyclophosphamide therapy was administered as postoperative adjuvant chemotherapy, and nabPTX plus trastuzumab therapy was started sequentially. The patient was hospitalized due to severe neutrope- nia(neutrophils 0/mm3)from nabPTX, but her condition stabilized after admission. However, the patient suddenly went into shock after 3 days and was thus transferred to the ICU. Her general condition was rapidly improved through cytokine adsorption therapy in the ICU. After 5 days, she was extubated and wheeled back to a general ward. She was discharged without problems in the succeeding months. In this case, FN or cardiovascular diseases was ruled out, and engraftment syndrome was considered given that cytokine adsorption therapy significantly improved the patient's condition. Considering the risk for severe neutropenia in nabPTX administration, clinicians should exercise caution when administering the drug.

[Examination of Stereotactic Mammotome Biopsy for Microcalcification in Our Hospital]

We introduced stereotactic mammotome biopsy(ST-MMT)for the purpose of screening and other institutions. There are many benign cases to be diagnosed by pathological findings, so it is thought to be necessary to examine the adaptation of STMMT again. We examined the performance of ST-MMT in a case of a non-palpating calcification lesion. Between August 2013 and December 2016, ST-MMT biopsies were performed for 247 microcalcified lesions revealed by mammography(in both breasts in 9 patients; twice in the ipsilateral breast in 2 patients). The mean age of all patients was 46 years(range, 24- 89 years). We found 39 cases(15.8%)of breast cancer. A final diagnosis of breast cancer was made in 39 patients, who comprised 0% of those with Category 2, 53.8% of those with Category 3, 35.9% of those with Category 4, and 10.3% of those with Category 5. Regarding the morphology and distribution of microcalcifications, breast cancer accounted for 46.2%, 5.1%, 2.6%, 35.9%, 7.7%, and 2.6% of the cases with small round/clustered, amorphous/clustered, pleomorphic/clus- tered, pleomorphic/linear segmental, and fine linear/clustered patterns, respectively. Also, we examined each of the patients, (1) who underwent mammography for medical examinations, (2) who underwent mammography performed at other institutions, (3) who underwent follow-up for microcalcifications and postoperative follow-up mammography. The proportions of breast cancer diagnoses were (1) 11.4%, (2) 20.6%, and (3) 7.1%. Proportions of Category 3 breast cancer were (1) 10.3%, (2) 38.5%, and (3) 5.1%. Among the cases in which ST-MMT was performed in this study, Category 3 accounted for more than half. However, 10.9%(21/192 lesions)were diagnosed as malignant in Category 3. The diagnosis of breast cancer in pa- tients who underwent mammography performed at other institutions was not observed in 79.4%(104/131 lesions), and among the 104 lesions, as a result of reassessment of calcification in our hospital, Category 2 was also included. Calcification in Category 2 lesions was benign in all cases. It was suggested that the indication for ST-MMT biopsy could be further narrowed down by being careful not to over-diagnose.

[Strut Adjusted Volume Implant(SAVI) - An Interim Report of Patient Satisfaction and Outcomes]

BACKGROUND

Strut adjusted volume implant(SAVI)was approved by the Food and Drug Administration(FDA)for the treatment of breast cancer in 2006.

MATERIAL AND METHODS

The phase II study was conducted to investigate the activity and safety of SAVI in breast cancer patients. Criteria for SAVI treatments were N0, T<2 cm, and age≥40. After patients underwent breast-conserving surgery, they received SAVI twice a day×5 days(34 Gy). The primary endpoint are feasibility and safety. Second endpoint are local recurrence rate and cosmesis.

RESULTS

Three patients were enrolled and the median duration of administration is 18.7 days(17-20). Further, the most common treatment-related adverse events were thickening and redness of skin(grade 1/2), while there was no deformity of breast in each case.

CONCLUSION

The current study demonstrated that SAVI is well tolerated treatment in breast cancer patients and may be convenient for use in patient treatment.

Self-Organized Micro-Spiral of Single-Walled Carbon Nanotubes

Single-walled carbon nanotubes (SWCNTs) are reported to spontaneously align in a rotational pattern by drying a liquid droplet of toluene containing polyfluorene as a dispersant. By situating a droplet of an SWCNT solution around a glass bead, spiral patterns are generated. The parallel alignment of SWCNTs along one stripe of such a pattern is confirmed using scanning electron microscopy and polarized optical microscopy. The orientation order increases toward the outer edge of a stripe. The stripe width in the pattern is proportional to the solute concentration, and the width and position of the stripes follow geometric sequences. The growth of the rotational pattern is also observed in real time. The process of spiral pattern formation is visualized, indicating the role of the annihilation of counter-traveling accompanied by continuous depinning. The geometric sequences for the stripe width and position are explained by the near-constant traveling speed and solute enrichment at the droplet periphery.

Gemcitabine and Vinorelbine Combination Chemotherapy in Taxane-Pretreated Patients with Metastatic Breast Cancer: A Phase II Study of the Kinki Multidisciplinary Breast Oncology Group (KMBOG) 1015

Background: This phase II study was conducted to evaluate the efficacy and safety of the chemotherapy combination of gemcitabine and vinorelbine in taxane-pretreated Japanese metastatic breast cancer patients. Methods: In this multicenter, phase II, single-arm study, patients with recurrent or metastatic HER2-negative breast cancer were administered gemcitabine (1,200 mg/m2) and vinorelbine (25 mg/m2) intravenously on days 1 and 8 every 3 weeks. The primary endpoint was the objective response rate, and other endpoints included progression-free survival, overall survival, and safety. Results: A total of 42 patients were enrolled in this study. The objective response rate and clinical benefit rate were 24 and 43%, respectively. The median progression-free survival was 4.0 months. The median overall survival was 11.1 months. Grade 3/4 neutropenia was the most common hematologic toxicity, occurring in 22 patients (54%). Nonhematologic toxicity was moderate and transient, with fatigue (48%) being the most common condition and no severe adverse event reported. Conclusion: The combination of gemcitabine and vinorelbine is an effective and tolerable regimen for HER2-negative, taxane-pretreated, metastatic breast cancer patients in Japan.

Circulating tumor cells as a prognostic marker for efficacy in the randomized phase III JO21095 trial in Japanese patients with HER2-negative metastatic breast cancer

PURPOSE

Prognostic effects of circulating tumor cells (CTCs) have been reported in metastatic breast cancer (MBC). However, few phase III trials have investigated the potential role of CTCs in treatment selection. We explored potential relationships between CTCs, efficacy, and differential treatment effects.

METHODS

Patients with HER2-negative MBC were randomized to receive either concurrent capecitabine plus docetaxel (XT) or sequential single-agent docetaxel followed by single-agent capecitabine at progression (T → X). Blood samples were collected at baseline, on day 1 of cycles 2 and 3, and at progression. CTCs were counted using the CellSearch^® System. The relationship between baseline CTC count and outcomes was investigated using a pre-defined threshold of 2 CTCs/7.5 mL.

RESULTS

At screening, 44% of the 148 enrolled patients had positive CTC score. In multivariate analyses of pooled treatment arms, positive baseline CTC and triple-negative disease were strongly associated with worse progression-free survival (PFS) and overall survival (OS). Patients with positive CTC score at the baseline had worse OS, irrespective of change in CTC (decreased versus remaining positive) at cycle 2. The prognostic effect of baseline CTC count on OS appeared slightly less pronounced in XT-treated pts. compared with T → X.

CONCLUSIONS

A baseline CTC count ≥2 CTCs/7.5 mL was associated with worse prognosis. However, some improvement in PFS and OS was shown with concurrent XT, thus baseline CTC could be a predictive marker. As the current trial was not designed to evaluate a change in chemotherapy according to on-treatment CTC changes, prospective investigation is required.

Trapping of excess energy in a nano-layered microenvironment to promote chemical reactions

Nano-layered hybrid compounds composed of a polyfluoroalkyl azobenzene surfactant (abbreviated as C3F-Azo-C6H) and layered inorganic nanosheets undergo three-dimensional morphological changes such as reversible shrinkage and expansion of interlayer spaces, and nanosheet sliding by photo-irradiation. Previously, we have investigated the photoreactivity of C3F-Azo-C6H/clay nano-layered hybrids in various microenvironments and found a remarkable enhancement in the photoreactivity for the cis-trans photo-isomerization reaction (Φ_cis-trans = 1.9). In this paper, nanosecond and microsecond dynamics of trans-C3F-Azo-C6H and its assembly in various microenvironments have been studied by laser flash photolysis to get deeper insight into the extraordinary reactivity of the molecular assembly in the nano-layered microenvironment. In solution, the molecular trans-C3F-Azo-C6H exhibited only a depletion of the trans-form of azobenzene upon the laser pulse excitation. On the other hand, in the case of the C3F-Azo-C6H/clay hybrid film, the depletion of the trans-form was drastically recovered in three steps on nano- and microsecond timescales. This indicates that the once reacted C3F-Azo-C6H molecule (cis-C3F-Azo-C6H) was reverted back to the trans-form after the laser pulse. It is considered that the excess energy provided by the photo-excitation, which is immediately dissipated to the surrounding media through the intermolecular vibrational modes in solution, is trapped in the nano-layered microenvironment to thermally revert the cis-form back to the trans-form. Conversely, in the case of cis-trans isomerization of the C3F-Azo-C6H/clay hybrid film upon photo-irradiation, the reactivity would be much enhanced by the additional contribution of the thermal excess energy efficiently trapped in the nano-layered microenvironment. As compared with the hydrocarbon analogue (C3H-Azo-C6H), the subsequent recovery was very much enhanced in the C3F-Azo-C6H/clay film. The polyfluoroalkyl part of the surfactant layer plays a key role in the retarded dissipation of the excess energy by photo-excitation, which might be coupled with the three-dimensional morphological motion with efficient isomerization reactions.

Efficacy and safety of low-dose capecitabine plus docetaxel versus single-agent docetaxel in patients with anthracycline-pretreated HER2-negative metastatic breast cancer: results from the randomized phase III JO21095 trial

PURPOSE

The randomized phase III JO21095 trial compared the efficacy and safety of low-dose capecitabine plus docetaxel combination therapy (XT) versus single-agent administration of docetaxel in anthracycline-pretreated HER2-negative metastatic breast cancer.

METHODS

Patients were randomized to either low-dose XT (capecitabine 825 mg/m² twice daily, days 1-14; docetaxel 60 mg/m², day 1 every 3 weeks) or docetaxel (70 mg/m², day 1 every 3 weeks). The primary objective was to demonstrate superior progression-free survival (PFS) with low-dose XT versus single-agent docetaxel. Overall survival (OS) and safety were secondary endpoints.

RESULTS

In total, 162 patients were treated. Median PFS was 10.5 months with low-dose XT and 9.8 months with single-agent docetaxel (hazard ratio [HR] 0.62 [95% confidence interval (CI) 0.40-0.97]; p = 0.03). The OS HR was 0.89 (95% CI 0.52-1.53; p = 0.68). Grade ≥3 treatment-related toxicities occurred in 74% of XT-treated patients and 76% of docetaxel-treated patients. The main differences in grade ≥3 treatment-related toxicities were hand-foot syndrome (7.3% of XT-treated patients vs 0% receiving docetaxel), fatigue/malaise (2.4 vs 10.0%), and peripheral edema (1.2 vs 7.5%). Dose modifications were required in 100% of low-dose XT and 49% of docetaxel patients. Toxicity-related treatment discontinuations occurred in 18 and 33%, respectively.

CONCLUSION

The improved PFS with low-dose XT versus docetaxel alone is consistent with higher-dose XT phase III experience, but the safety profile was more favorable and manageable.

Osteonecrosis of the jaw associated with everolimus: A case report

Everolimus, a mammalian target of rapamycin inhibitor, has recently been approved for the treatment of metastatic estrogen receptor-positive breast cancer, at a daily dose of 10 mg in combination with exemestane. Osteonecrosis of the jaw (ONJ) is a rare but severe condition, characterized by exposed necrotic bone, and is associated with various drugs that are often used to treat advanced malignancies. We herein report the case of a patient with breast cancer who developed ONJ during treatment with everolimus, which improved after discontinuation of the drug. To the best of our knowledge, this is the first reported case of everolimus-associated ONJ in a patient receiving everolimus for metastatic breast cancer. In 2014, an 80-year-old woman was started on treatment with everolimus and exemestane for stage IIB estrogen receptor-positive breast cancer. Within 2 months, the left side of her face became edematous, with localized heat and tenderness of the left mandibular region and a 3-mm round area of exposed bone. There was purulent discharge and the surrounding gingiva was edematous and erythematous. The left mandible exhibited a low signal intensity area on T1-weighted magnetic resonance imaging. Treatment was discontinued and ONJ showed improvement after 2 months. Therefore, when prescribing everolimus for metastatic breast cancer, oncologists should be aware of the possibility of ONJ as a complication.

[Effectiveness of Postoperative Physical Therapy for Upper-Limb Impairments after Breast Cancer Treatment]

Previous studies have reported the benefits of beginning rehabilitation immediately after breast cancer surgery for improving motor function. However, most studies have not evaluated the long-term struggles patients face after hospital discharge in resuming their previous activities and socialparticipation. Furthermore, the intervention methods and effects of rehabilitation for such activities have not been evaluated. We investigated the effectiveness of postoperative physical therapy for upperlimb impairments after breast cancer treatment. Fifty-four women in the postoperative period of surgery for breast cancer participated in the study. Range of motion in the ipsilateral shoulder was initially limited after surgery and recovered during the study period: shoulder flexion range of motion reached a mean value from 110 to 155 degrees, mean abduction was from 70 to 110 degrees, and mean externalshoul der rotation was from 69 to 85 degrees. Lymphedema was present in 5 women. In conclusion, physical functional disabilities were present in the late postoperative period for breast cancer survivors, and limited range of motion in their shoulders negatively affected their functional capacity and quality of life. Therefore, we need to increase rehabilitation care after breast cancer surgery immediately.

[Serous Carcinoma of the Peritoneum with Metastases to the Breast and Axillary Lymph Nodes]

Metastasis of peritoneal serous carcinoma to the breast and axillary lymph nodes is rare. We present a case of serous carcinoma of the peritoneum with metastases to the breast and axillary lymph nodes. A 72-year-old woman was diagnosed with Stage III peritoneal serous carcinoma in November 2009; she was treated with 6 courses of paclitaxel and carboplatin. In December 2015, she had a palpable mass(2×2 cm)and enlarged axillary lymph nodes. Mammography did not reveal any mass(C1)and ultrasonographic examination demonstrated a partially ill-defined hypoechoic mass with a diameter of 8.7× 7.1 mm. Cytological examination of the axillary lymph node revealed malignancy; breast carcinoma metastasis was suspected and the patient underwent breast-conserving surgery. Histopathological examination of the specimens(breast and axillary lymph nodes)revealed adenocarcinoma, and immunohistochemistry analysis showed that the specimens were CK7(+), CK20(-), CA125(+), PAX8(+), and GCDFP15(-). Taken together, the results indicated peritoneal serous carcinoma metastases to the breast and axillary lymph nodes.

CONCLUSION

We report a case of serous carcinoma of the peritoneum with metastases to the breast and axillary lymph nodes.