Air travel and incidence of pneumothorax in lymphangioleiomyomatosis

BACKGROUND

Pulmonary lymphangioleiomyomatosis (LAM) is a rare disease of women characterized by multiple lung cysts leading to respiratory insufficiency and frequent pneumothorax (PT). Air travel (AT) could increase the risk of PT in LAM through rupture of subpleural cysts induced by atmospheric pressure changes in aircraft cabin. To determine whether AT increases the risk of PT in LAM, we performed a retrospective survey of members of European LAM patient associations. A flight-related PT was defined as occurring ≤30 days after AT.

RESULTS

145 women reported 207 PT. In 128 patients with available data, the annual incidence of PT was 8% since the first symptoms of LAM and 5% since LAM diagnosis, compared to 0.006% in the general female population. Following surgical or chemical pleurodesis, the probability of remaining free of PT recurrence was respectively 82, 68, and 59% after 1, 5 and 10 years, as compared to only 55, 46 and 39% without pleurodesis (p = 0.026). 70 patients with available data performed 178 AT. 6 flight-related PT occurred in 5 patients. PT incidence since first symptoms of LAM was significantly higher ≤30 days after AT as compared to non-flight periods (22 versus 6%, risk ratio 3.58, confidence interval 1.40-7.45).

CONCLUSIONS

The incidence of PT in LAM is about 1000 times higher than in the general female population, and is further increased threefold after AT. Chemical or surgical pleurodesis partly reduces the risk of PT recurrence in LAM.

Salivary miRNA-210 involvement in medication-related osteonecrosis of the jaws

e23052

Background: Improved survival rates from cancer have increased the need to understand the health related problems of cancer treatment. Persistent oral health related problems significantly affect patient's quality of life. Medication-related osteonecrosis of the jaws (MR-ONJ) is an oral complication of antiresorptive medications, denosumab and other medications that target angiogenesis for the management of metastatic bone cancer. The purpose of this pilot study, is to investigate, for the first time, microRNAs expression in MR-ONJ. Recent studies reported the miRNA-210 (a specific angiogenic-related miRNA) demethylation in the Osteonecrosis of the Femoral Head. We hypothesized that MiRNA-210 could also be involved in MR-ONJ development. Primary objective of the study is to investigate the role of miRNA-210 in MR-ONJ pathogenesis. Secondary objective is to investigate the feasibility of salivary miRNAs detection as potential non invasive biomarkers for MR-ONJ. Methods: A case-and-control study has been designed. Inclusion criteria are malignant tumors with ongoing treatment or previous history of anti-resorptive or anti-angiogenic medications. The predictor variable is the presence or absence of MR-ONJ. Oral examination and dental x-ray examinations suggestive of MR-ONJ will be performed. Saliva sample will be collected according to the protocol by Navazesh. The methylation status of miRNA-210 will be investigated using quantitative PCR (Q-PCR). Values will be compared between case and control group. Results: The main expected results are to enroll approximatively twenty patients in case group and sixty patients in control group within a one year recruitment period, validate that saliva is a medium for the identification of biomarkers associated with MR-ONJ and confirm the hypothesis that miRNA-210 is involved in MR-ONJ development. Conclusions: Results acquired within this project would represent a contribute to the understanding of the molecular mechanisms driving to the development of MR-ONJ lesions. MiRNA-210 demethylation could serve as a potential therapeutic target for the treatment of MR-ONJ through stimulation of angiogenesis.

Retrast: Retreatment after adjuvant trastuzumab—Our regional southern Italy experience

e11526

Background: Trastuzumab (T) is the standard of care for pts with HER2+ve BC. Relapse after adj T remains a rare event. Since the large use of T in adj setting, becomes crucial to evaluate advantages of retreatment with T for pts who relapsed after treatment in early stage. There is still lack of clinical evidence and poor data from CT to say that there is a benefit in T re-exposure after relapse following adj T. Methods: Since Jun 2006 and Dec 2011, we reviewed pts with early BC treated with T in adj therapy, relapsed and re-treated with T in first line therapy, in 10 departments of medical oncology in Sicily. We aimed to study feasibility, responses and treatment outcome. Results: 62 pts with HER2+ve fulfilled the criteria for this analysis and 47 were evaluated. Pts had a median age of 53 ys (29-79). ER/PgR-ve cases were 16 (34 %). Ki67 was > 20% in 34 pts (74%). 31 pts (64%) had >3 nodes+ve. All the pts received adj therapy with anthra+/-taxane. 55% of pts had >2 metastatic sites. 12 (25,5%) pts were revalued for HER2: 10 pts confirmed 3+ and two pts 2+ were FISH+. Median time from diagnosis to relapse was 25 mos (7 – 36). Median time from last dose of T to relapse was 10 ms (2 – 35). 33 (70,2%) pts and 14 pts (29,8%) had early (< 12 ms) and late progression (≥ 12 ms) respectively after adj T. First line of therapy was T in combination with mono/polychemotherapy in 42 pts (89,3%) and 5 pts (10,6%) respectively. 27 pts (57,4%) had objective responses (CR 5, PR 22) and 7 pts (14,8%) stable disease. 13 pts (27,6%) had progression: all of these pts had early progressive disease after adj T, 9 pts (69,2%) had Ki67>20%, 5 pts (38,4%) were ER/PgR-ve and 8 pts (61,5%) ER/PgR+ve. Median TTP was 4 mos (range 2-7). Median TTP for early and late relapses pts were respectively 3,7 and 4,8 mos, (p = 0,4). Median OS from relapse to death was 23 mos (r 12 – 37). LVSD G1 (EF < 60-50%) was observed only in 7 pts (14%). Conclusions: Our data confirm the feasibility and safety of treatment with T after adj T therapy and is active for a disease control rate in 72,4% of cases. These results demonstrate that relapses after adj T occurred early (<12 ms) in 70% of pts. However pts with primary resistance (27,6%) should be well categorized using biomolecular markers to receive up-front drugs that overcome the resistance to T.