Breast Cancer In Remission Research Articles

A RARE CASE OF PRIMARY TRACHEOBRONCHIAL AMYLOIDOSIS PRESENTING AS LARGE UNILATERAL PLEURAL EFFUSION

SESSION TITLE: Pulmonary Manifestations of Systemic Diesase SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: The incidence of recurrent pleural effusions is 1-2% in patients with systemic amyloidosis. Tracheobronchial amyloidosis (TBA) is a rare condition that primarily involves large airways. Patients usually present with dyspnea and wheezing. Pleural effusion is not a common manifestation of TBA. Herein, we present a rare case of primary TBA presenting as a recurrent unilateral pleural effusion. CASE PRESENTATON: An 81-year-old non-smoker female with a significant history of recent hip surgery, breast cancer in remission for 10 years, hypertension and coronary artery disease presented to the hospital with a one-day history of insidious onset of dyspnea and dry cough. She appeared to be in mild distress and had decreased air entry on the left chest along with expiratory wheezing on auscultation. The rest of her exam was unremarkable. Her chest x-ray showed a new large left-sided pleural effusion. She underwent thoracentesis; drained 1500 ml of yellow serous fluid. The pleural fluid analysis was predominantly lymphocytic, exudative, with negative cultures and cytology. A post-thoracentesis chest CT scan showed left lower lobe consolidation and a segmental collapse of the left upper lobe (LUL). On Bronchoscopy, an endobronchial lesion with near total obstruction of LUL bronchus was visualized. Subsequently, an endobronchial biopsy was performed. Pathology of the lesion was consistent with amyloid deposition confirmed by Congo Red staining. Further workup to rule out systemic amyloidosis was negative. The patient’s clinical, imaging, and pathology findings were consistent with primary light chain TBA with post-obstructive atelectasis and pleural effusion. The patient was not a candidate for Melphalan secondary to her poor functional status and she declined treatment with Rituximab. Accordingly, she underwent external beam radiation therapy and was started on methylprednisolone 40 mg intravenously for five days, followed by a two-week course of a tapered regimen of oral prednisone. Subsequent follow-up a month after discharge showed complete resolution of left-sided pleural effusion. DISCUSSION: Pleural effusion is common in systemic amyloidosis, especially in the setting of amyloid cardiomyopathy, and interstitial deposition of amyloid protein. The presence of pleural effusion in systemic amyloidosis is associated with an expected survival of 1.8 months. In the absence of systemic amyloidosis, it is unknown whether pleural effusion is a manifestation of isolated TBA. In TBA, almost half of chest X-rays are normal. A common finding includes lobar collapse, but not pleural effusion. To our knowledge, this is the first case of primary TBA associated pleural effusion which is responsive to both steroids and radiotherapy. CONCLUSIONS: In the absence systemic amyloidosis, amyloid cardiomyopathy, or pulmonary parenchymal amyloidosis, pleural effusion may also be a clinical manifestation of localized TBA. Reference #1: Tada, L., Anjum, H., Linville, W.K. and Surani, S. (2015). Recurrent pleural effusions occurring in association with primary pulmonary amyloidosis. Case reports in pulmonology, 2015. Reference #2: L Berk, John & O'Regan, Anthony & Skinner, Martha. (2002). Pulmonary and Tracheobronchial Amyloidosis. Seminars in respiratory and critical care medicine. 23. 155-65. 10.1055/s-2002-25304. DISCLOSURES: No relevant relationships by Thamer Sartawi, source=Web Response No relevant relationships by Mingchen Song, source=Web Response No relevant relationships by Rajagopal Sreedhar, source=Web Response

Abstract 1330: Role of epigenetic remodeling in sensitizing triple-negative breast cancer cells to treatment through enhanced chemotherapy-induced autophagy

Abstract Dysregulation of the epigenome is implicated in initiation and progression of variety of cancers and their acquired resistance to chemotherapy. As such targeting epigenetic regulators has the potential to modulate cancer cell biology and their sensitivity to chemotherapy and/or radiation. Our studies demonstrates that silencing of the epigenetic regulator Nucleosome Remodeling Factor (NURF) sensitizes breast tumor cells to chemotherapy and enhances the anti-tumor immune response. A screen of a variety of chemotherapeutic agents shows that NURF KD cells are selectively sensitized to Topo II inhibitors, which includes doxorubicin. NURF KD increases DNA damage (gamma H2AX staining) and autophagy (acridine orange staining) in breast tumor cells exposed to doxorubicin (Dox) and enhances growth inhibition as well as suppressing the ability of the cells to recover proliferative capacity. Increased autophagy as well as breast tumor sensitization to doxorubicin were observed using a small molecule inhibitor of NURF, suggesting that NURF can also be targeted pharmacologically. Our studies suggest that enhanced autophagy may be a primary contributor to chemo sensitivity in NURF KD cells. Studies are currently underway to confirm the role of autophagy in chemosensitization in- vitro and enhanced immune response in-vivo using autophagy deficient cells (through ATG silencing). Doxorubicin produces profound DNA damage and promotes immunogenic cell death enhanced by NURF KD. Increased cell autonomous antitumor effects by doxorubicin in concert with increased cell non-autonomous antigenicity could help to achieve tumor regression, reduce metastasis, and possibly promote long term remission in breast cancer. Citation Format: Liliya Tyutyunyk, Joseph Landry, David Gewirtz, Nga Dao. Role of epigenetic remodeling in sensitizing triple-negative breast cancer cells to treatment through enhanced chemotherapy-induced autophagy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1330.

Abstract 377: Time-restricted feeding: A dietary intervention to treat breast cancer in postmenopausal obese mice

Abstract Background: Abundant evidence indicates that obesity increases risk for breast cancer and the incidence further increases by 40% in obese postmenopausal women. Therefore it is envisioned by diverse research groups that the risk of breast cancer in obese postmenopausal women is an ever-increasing menace that needs to be curbed soon with effective practical strategies that could have a far-reaching impact. In this setting, time-restricted feeding (TRF), the practice of consuming ad libitum energy during the normal active phase, has been demonstrated to reinforce normal metabolic regulation, thereby attenuating obesity-driven metabolic deregulation. Although studies have assessed the effect of TRF on metabolism, no investigations have been carried out in human or mouse exploring TRF in cancer remission. Therefore, the present work is to understand the efficacy of TRF for improved breast cancer remission in postmenopausal obese female mice. Further, the work explores the mechanistic link of TRF for reduced tumor growth. Methods: Ovariectomized and 4-vinylcyclohexene diepoxide (VCD) treated mice were used as a postmenopausal model. Both ovariectomized and VCD mice were made obese by feeding them with 60% high-fat diet (HFD) and then grouped into ad libitum group (24 h access to food) and TRF group (8 hr access to food at night) to assess metabolic and tumor growth effect of TRF. To develop breast tumor, mice were injected with py230 breast cancer cell line into the mammary fat pad. The metabolic effect of TRF was assessed by glucose tolerance test, insulin tolerance test, body weight measurement, food intake, lipid accumulation in liver by HE staining and measurement of different tissue weight. Measuring the tumor volume over time and tumor weight assessed TRF effect on tumor growth. Performing a tumor growth study in mice fed with HFD and HFD containing diazoxide assessed insulin dependency of tumor growth in ad libitum group. Insulin-dependent tumor growth was validated by tumor growth study in normal chow-fed mice implanted with insulin pump or without pump (control). Results: The preliminary studies in ovariectomized and VCD-treated postmenopausal mice suggest that restricting access to Western-style HFD in active night phase improves insulin resistance, glucose tolerance, and hepatic steatosis. Further, TRF exhibited reduced tumor growth compared to ad libitum group. More importantly, the results from tumor growth study in mice fed with HFD with/without diazoxide or normal chow mice with/without insulin pump, suggest that the tumor growth is insulin dependent and TRF may be acting through attenuating insulin signaling. Conclusion: Experimental and animal model data corroborate that TRF improves metabolic deregulation and reduces breast tumor growth in HFD-fed obese mice. The results suggest putative application of such therapeutic intervention for breast cancer therapy. Citation Format: Manasi Das, Emilie Gross, Deepak Kumar, Consuelo Sauceda, Hyun-Tae Park, Dorothy D. Sears, Lesley Ellies, Nicholas Webster. Time-restricted feeding: A dietary intervention to treat breast cancer in postmenopausal obese mice [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 377.

A Structural Model for Adjustment to Aging among Older Women in Breast Cancer Remission

This study aims to build a structural model to explore the predictors of adjustment to aging (AtA) reported by older women in breast cancer remission. A community-dwelling sample of 771 older women in breast cancer remission aged between 75 and 98 years answered a questionnaire to determine socio-demographic (age, income, marital status, education, household, and living setting), and health-related characteristics (self-reported functional limitations and disabilities, time since remission, other type of cancer, breast reconstruction, perceived health, recent disease and medication). Several measures were employed to assess AtA, sense of coherence and subjective well-being. Structural equation modeling was used to explore a structural model of the self-reported AtA, encompassing all variables. Significant predictors of AtA are self-reported disability (β = .404; p < .001), time since remission (β = .371; p < .001), perceived health (β = .257; p < .001), other type of cancer (β = .231; p < .001), breast reconstruction (β = .153; p = .008), marital status (β = .141; p < .001), sense of coherence (β = .140; p < .001), and living setting (β = .139; p = .006). These variables accounted for 84.3% of the variability of AtA. Self-reported disability and time since remission were the strongest predictors of AtA. Our findings suggest that health care interventions with older women in breast cancer remission still living in the community may benefit from clearly including these predictors of AtA, as they are relevant for promoting older women’ s aging well.

Is Breast Surgery Necessary for Breast Carcinoma in Complete Remission Following Neoadjuvant Chemotherapy?

The likelihood of pathological complete remission (pCR) of breast cancer following neoadjuvant chemotherapy (NACT) is increasing; most of all in the triple negative and HER2 positive tumour subgroups. The question thus arises whether or not breast surgery is necessary when there is complete remission after NACT, and whether it provides any improvement of the oncological treatment result when tumour is no longer detectable. Avoiding surgery and possibly even radiotherapy would only be conceivable on the basis of a reliable diagnosis of pCR without operating. Current imaging does not achieve the necessary sensitivity and specificity to assure the diagnosis of pathological complete remission. Further studies are therefore required to determine which methods are best able to evaluate tumour response to NACT. Studies on image-guided, minimally invasive biopsies after NACT have delivered first promising results towards diagnosing pCR before surgery and could provide the basis for further studies on the possibility of avoiding surgery in this specific patient collective.

Leczenie żywieniowe u chorych na nowotwory piersi

In women, breast cancer is the most common malignancy whilst its morbidity rates are the second most frequent after lung cancer. Rearrangements of developmental changes in mammary gland tissue that occur many times throughout life (eg. during puberty, pregnancy), create a specific environment as demonstrated by an enhanced immune response but suppressed inflammatory status; these being most likely conducive to carcinogenesis. Contributing factors to breast cancer development include: endocrine disruption, genetic predisposition and environmental determinants such as overweight and low levels of physical activity. Hitherto, nutritional guidelines in cases of breast cancer remission are lacking, nevertheless specialists state that they should be based on primary prevention. The presence of cancer confers changes to dietary requirements, whilst the side effects of treatment are gastro-intestinal disorders and anorexia which lead to malnourishment. A modified diet may thus beneficially impact upon women’s quality of life during breast cancer remission, together with potentially improving their survival prognoses.

Critical Considerations in Anticancer Drug Development and Dosing Strategies: The Past, Present, and Future.

Critical Considerations in Anticancer Drug Development and Dosing Strategies: The Past, Present, and Future.

Abstract 3314: Synergistic effects of chemotherapy-induced autophagy and epigenetic remodeling

Abstract Cytotoxic chemotherapy has been shown to enhance tumor cell immunogenicity by promoting the secretion of damage-associated molecular pattern (DAMP) molecules which, in turn, stimulates the immune response. These effects can be further stimulated by combining chemotherapy with an immunotherapy designed to enhance effector cell (CD8 T cell or NK cell) anti-tumor activity. Our studies demonstrate that knockdown of the epigenetic regulator NURF increases DNA damage (gamma H2AX staining) and autophagy (acridine orange staining) in breast tumor cells exposed to doxorubicin and enhances growth inhibition as well as suppressing the capacity of the cells to recover and proliferate. Similar increases in autophagy were observed using a small molecule inhibitor of NURF, suggesting that NURF can be targeted therapeutically. Sensitization was not observed with ionizing radiation or cisplatin. Studies are in progress to assess the nature of autophagy in the NURF KD and NURF WT cells, distinguishing between the cytoprotective, cytotoxic, cytostatic and nonprotective forms. How NURF regulates doxorubicin induced DNA damage is being investigated by mapping sites of damage genome wide. It is anticipated that enhanced cell autonomous tumor cell sensitivity in concert with improvements in tumor cell antigenicity (cell non-autonomous sensitization) achieved by NURF depletion could improve anti-tumor immunogenicity, achieve tumor regression, reduce metastasis, and possibly achieve long term remission in breast cancer. Citation Format: Liliya Tyutyunyk, Joseph Landry, Tareq Saleh, David Gewirtz. Synergistic effects of chemotherapy-induced autophagy and epigenetic remodeling [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3314. doi:10.1158/1538-7445.AM2017-3314

Complete remission in metastatic breast cancer: expecting the unexpected-results of a cross-sectional study.

Complete response (CR) in metastatic breast cancer (MBC) is rare. This study aims at analyzing the characteristics and outcome of MBC patients achieving CR. We performed a cross-sectional analysis of clinical data from a consecutive series of MBC patients admitted at the Division of Medical Oncology of Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy, achieving CR following treatment for systemic disease and with at least 2years of follow-up. Seventy-six MBC patients with CR were identified during a calendar year. 47 patients (61.8%) achieved CR more than once, for a total of 123 cases. Median age at MBC diagnosis was 56years (range 30-76). 52 patients (68.4%) presented with recurrent disease, 24 (31.6%) with de novo metastatic disease. The majority of patients (80.3%) had hormone receptor (HR) positive and 26 (34.2%) had HER2 overexpressing MBC. 54 patients (71.1%) had only one site of metastatic disease. 33 patients (43.4%) received a local approach as part of their treatment and 67 (54.5%) achieved CR during maintenance therapy. CRs were durable, as after a median follow-up of 8.3years (interquartile range 5.8-11.0years) 42 patients (55.3%) were alive with no evidence of disease. Durable CRs can occur after systemic therapy alone or after combined systemic and local treatments. Most cases presented CR in the presence of limited disease spreading, not necessarily on first-line therapy. Our study highlights the crucial role of multidisciplinary approach to MBC and the benefit of maintenance treatment.

French women's representations and experiences of the post-treatment management of breast cancer and their perception of the general practitioner's role in follow-up care: A qualitative study.

BackgroundIn France, the Cancer Plan II 2009‐2013 was launched to improve post‐cancer management and promote greater involvement of general practitioners (GPs) in follow‐up care.ObjectivesWe investigated how women experienced the post‐treatment management of breast cancer and perceived the role of the GP in follow‐up care.DesignWe conducted a qualitative study based on semi‐structured interviews with women with breast cancer in remission. The interviews were transcribed and analysed in accordance with the principles of thematic analysis.Setting and participantsWe interviewed 21 patients aged between 30 and 86. Eighteen breast cancer survivors were recruited from GP practices and five from a patients’ association.ResultsFour themes emerged from the thematic analysis: that breast cancer is a life‐changing event; how patients managed the effects of treatment; how patients viewed the future; and patients’ expectations of their GP.Discussion and conclusionFrench survivors of breast cancer perceived the physical changes caused by their illness to impact their womanhood, leading to difficulties with sexual relations, a diminished sense of self and fears for the future. They felt abandoned at the end of treatment and desired support. They appreciated the ease of contacting their GP but considered follow‐up care outside their remit. They agreed to be followed up by their GP, provided that they co‐operated closely with a cancer specialist. This is in accordance with the French Cancer Plan II 2009‐2013, which recommends greater involvement of GPs in a monitoring protocol shared with cancer specialists.

What predicts adjustment to aging among older women in breast cancer remission? The influence of subjective well-being, sense of coherence, and socio-demographic, lifestyle and health-related factors

ObjectivesTo build a structural model to explore the predictors of adjustment to aging (AtA) reported by older women in breast cancer remission.MethodsOlder women in breast cancer remission (n = 214) aged between 75 and 94 years participated in this study. A questionnaire to determine socio-demographic (age, income, professional and marital status, education, household, living setting and self-reported spirituality), lifestyle and health-related characteristics (physical activity, leisure, perceived health, recent disease and medication), and measures to assess AtA, sense of coherence and subjective well-being, were employed. Structural equation modeling was used to explore a structural model of the self-reported AtA, encompassing all variables.ResultsPreliminary results indicated that self-reported spirituality (β = .397; P &lt; .001), leisure (β = .383; P &lt; .001), physical activity (β = .267; P &lt; .001), perceived health (β = .211; P &lt; .001), marital status (β = .173; P &lt; .001), professional status (β = .156; P = .009), sense of coherence (β = .138; P &lt; .001), and living setting (β = .129; P = .007), predicted AtA. The variables accounted for 79.2% of the variability of AtA.ConclusionSelf-reported spirituality and leisure were the strongest predictors of AtA. Our preliminary findings suggest that health care interventions with older women in breast cancer remission still living in the community may benefit from clearly including predictors of AtA, as these are essential for promoting older women’ s aging well.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Abstract A33: The association between breast cancer treatment decisions, fertility and emotional well-being among premenopausal women: An original data collection

Abstract Women in their reproductive years, ages 14 through 44, account for 15% of all breast cancer cases in the United States (Tomao et al, 2010). The 5-year survival rate for women diagnosed during these years is on average 85% (“Cancer Survival by Age”, 2014). Breast cancer treatment often leads to infertility (Tomao et al, 2010). Therefore, many survivors will become infertile without reaching their desired family size. Unfortunately, prior studies reveal low patient awareness of the infertility risks associated with cancer treatment until after they have completed treatment (Crawshaw et al, 2009). This suggests a potential decrease in quality of life once they enter remission. This paper outlines the process of developing a survey for original data collection among women in Pennsylvania who are registered as breast cancer survivors and who were diagnosed during their reproductive years. The central focus of the study is whether breast cancer treatment and remission is associated with a change in family size expectations among pre-menopausal women and if this is associated with the information a woman receives before she begins treatment. Additionally, we will be asking if the change in family size expectations pre and post-treatment are associated with feelings of regret, satisfaction or depression. Questions are taken largely from surveys focused on medical decision making. An original conceptual model is developed. Citation Format: Angela Gale Campbell, Marianne Hillemeier, Roger Anderson. The association between breast cancer treatment decisions, fertility and emotional well-being among premenopausal women: An original data collection. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A33.

Emotional specificities of autobiographical memory after breast cancer diagnosis.

Cancer involves stressful events. One aspect of cognition that is impacted by stress is episodic autobiographical memory (EAM). EAM is intimately linked to self-representation. Some studies have revealed impairment of EAM in patients with breast cancer in remission. Yet, these studies failed to differentiate between the influence of adjuvant treatments and that of psychosocial factors. We therefore assessed the psychological impact of breast cancer diagnosis on EAM and self-representation profiles prior to any adjuvant treatment. Patients newly diagnosed with breast cancer (n=31) and women without any history of cancer (n=49) were compared on state anxiety, EAM and its emotional characteristics, and self-representations. The most anxious patients retrieved fewer emotional details for memories than the controls, and had lower self-representation scores than the least anxious patients, who had no deficits in emotional detail retrieval. Our results revealed distinct EAM profiles for patients, reflecting two contrasting modes of coping with breast cancer.

카페시타빈과 통합의학 프로그램 치료 병용을 통해 호전된 진행성 유방암 1례

Abstract Case of Remission of Progressive Breast Cancer Treated by Capecitabine with Integrative Medicine Therapy Yong Jae Jin, Kwang Soon Shin, Jee Yong Ha Jnagdeuk Korean Medicine Hospital Received 28 Nobember 2014, revised 19 December 2014, accepted 20 December 2014 This report is aimed to investigate the effect of Integrative Medicine Therapy (IMT) in treating breast cancer metastasized to several portion. A 55-year-old woman who was diagnosed breast cancer and treated by breast conservation surgery (BCS) IN 2002. (pT2M0N0), adjuvant chemotherapy and radiotherapy till Jan. in 2013. But cancer had metastasized to sacrum (2009), liver (2012) and ribs (2013). Finally cause of several side effects of Xeloda(neuralgia and vommiting), she gave up to be treated by Xeloda and started to receive IMT including Abnoba Viscum, Vitamin C therapy Xeloda again, Korean herbal medicine and pharmacopuncture from Jul. in 2013. The effect was evaluated with Positron Emission Tomography and Computed Tomography (PET-CT) and Abdomen Computed Tomography (CT). The metastatic tumor in liver was disappeared and cancers to ribs, their size decreased after 12 months and pain of sacrum maintained VAS 2 continually. These results suggest that IMT is a therapeutic method to treat metastatic tumor originated from breast cancer.

Positive and cost-effectiveness effect of spa therapy on the resumption of occupational and non-occupational activities in women in breast cancer remission: A French multicentre randomised controlled trial

Purpose of the researchThe main aim was to assess the effects of a spa treatment on the resumption of occupational and non-occupational activities and the abilities of women in breast cancer remission. A cost-effectiveness analysis (CEA) was also performed. Methods and sampleA multicentre randomised controlled trial was carried out between 2008 and 2010 in the University Hospital of Auvergne and two private hospitals in Clermont-Ferrand, France. Eligible patients were women in complete breast cancer remission without contraindication for physical activities or cognitive disorders and a body mass index between 18.5 and 40 kg/m2. The intervention group underwent spa treatment combined with consultation with dietician whereas the control underwent consultations with the dietician only. Of the 181 patients randomised, 92 and 89 were included in the intervention and the control groups, respectively. The CEA involved 90 patients, 42 from the intervention group and 48 from the control group. Key resultsThe main results showed a higher rate of resumption of occupational activities in the intervention group (p = 0.0025) and a positive effect of the intervention on the women's ability to perform occupational activities 12 months after the beginning of the study (p = 0.0014), and on their ability to perform family activities (p = 0.033). The stay in a thermal centre was cost-effective at 12 months. ConclusionsSpa treatment is a cost-effective strategy to improve resumption of occupational and non-occupational activities and the abilities of women in breast cancer remission.

BEM-ESTAR SUBJETIVO EM IDOSAS COM E SEM CANCRO DA MAMA EM REMISSÃO

The exponential growth of older population, along with the incidence of breast cancer on older women, is a worldwide concern. Objectives: To analyze significant differences among two groups of older women with and without breast cancer, regarding subjective well-being (SWB) and its affective and cognitive dimensions. Method: We recruited 387 non-institutionalized women aged 75 years or older (M = 85.27; SD = 6.59; range 75-100), who were allocated in two groups (with and without breast cancer). Measures were completed including demographics, the Satisfaction with Life Scale and the Positive and Negative Affect Schedule. Results: The group with breast cancer in remission presented a higher SWB score, particularly the positive affect score. These differences were statistically significant. Conclusions: Although breast cancer represents an important threat to older women's SWB, those participants presented a significantly high score, in comparison to the other participants.

Long-term complete remission of metastatic breast cancer induced by a steroidal aromatase inhibitor after failure of a non-steroidal aromatase inhibitor

Patient: Female, 56Final Diagnosis: Breast cancerSymptoms: Solid mass in the right breastMedication: ExemestaneClinical Procedure: —Specialty: OncologyObjective:Unusual clinical courseBackground:The efficacy of third-generation aromatase inhibitors for hormone receptor-positive postmenopausal metastatic breast cancer is well established. Although several clinical trials have reported incomplete cross-resistance between different aromatase inhibitors, few cases of complete responses of recurrent metastatic breast cancer occurring after substituting a second aromatase inhibitor have been reported. We here present a rare case of non-steroidal aromatase inhibitor-tolerant metastatic breast cancer with long-term complete remission following substitution of a steroidal aromatase inhibitor.Case Report:We present the case of a 56-year-old Japanese woman who underwent right breast-conserving surgery for breast cancer, TNM staging T1, N0, M0, Stage I. She received adjuvant chemotherapy with 6 cycles of FEC100 and radiation therapy, and then began hormonal therapy with anastrozole. Twelve months postoperatively, computed tomography (CT) revealed multiple lung metastases. Exemestane was substituted for anastrozole. After 3 months of exemestane, CT showed that all lung metastases had completely resolved. Her complete response was maintained for 5 years: she died during a tsunami 6 years after the initial surgery.Conclusions:Substitution of a steroidal for a non-steroidal aromatase inhibitor produced a sustained complete remission in a patient with hormonal receptor-positive postmenopausal recurrent breast cancer.Achieving complete response after switching from a non-steroidal to a steroidal aromatase inhibitor in a hormonal receptor-positive postmenopausal recurrent breast cancer contributed to a higher quality of life for the patient. Further investigation is needed to identify the predictors of long-term remission following such a switch.

Case of Complete Remission of Breast Cancer Metastasized to Lung Treated by Traditional Korean Therapy

This report is aimed to investigate the effect of Traditional Korean Therapy (TKT) in treating recurred breast cancer metastasized to lung. A 53-year-old woman who was diagnosed as left breast cancer and underwent surgery, adjuvant chemotherapy and radiotherapy in early 2009 was admitted for the treatment of recurred, metastatic lung cancer in late 2012. She was treated with TKT including acupuncture, moxibustion and pharmacopuncture. The effect was evaluated with positron emission tomogram and computed tomogram (PET-CT). The metastatic tumors in both lungs were disappeared after the treatment for about 2 months. These results suggest that TKT is a therapeutic method to treat metastatic lung cancer originated from breast cancer.

Abstract OT3-3-02: Phase IIB randomized double-blind placebo-controlled biomarker modulation study of high dose vitamin D in premenopausal women at high-risk for breast cancer: SWOG S0812

Abstract Background: Priorities in breast cancer chemoprevention include developing agents effective against estrogen receptor (ER)-negative breast cancer and validating intermediate biomarkers which correlate with breast cancer risk. Vitamin D is a fat-soluble vitamin which regulates calcium and bone homeostasis, but also has diverse biological effects relevant to breast carcinogenesis. The biologically active form of vitamin D [1,25(OH)D] interacts with the vitamin D receptor (VDR) to modulate cell proliferation, differentiation, apoptosis, and angiogenesis. Epidemiologic data suggests that serum 25(OH)D levels &amp;gt;40-50 ng/ml are associated with a 40-50% reduction in breast cancer risk compared to women with vitamin D deficiency (&amp;lt;20 ng/ml). Given the high prevalence of vitamin D deficiency in the general population, vitamin D3 3000-4000 IU daily would be required to raise 25(OH)D to this putative target level. The central hypothesis of this proposal is that high-dose vitamin D will modulate biomarkers of breast cancer risk. Trial Design: This trial is a phase IIB, randomized, double-blind, placebo-controlled study of oral vitamin D3 (cholecalciferol) 20,000 IU (2 capsules) weekly for one year in 200 premenopausal women at high-risk for breast cancer. Both groups will be supplemented with a standard dose of vitamin D3 600 IU daily. Participants will undergo a mammogram and optional random core breast biopsy timed within 10 days after the start of their menstrual cycle at baseline and 1 year and blood collections at baseline, 6, and 12 months. Participants will be monitored for toxicity, particularly hypercalcemia and hypercalciuria, every 3 months during the 1-year intervention. Main Eligibility Criteria: High-risk is defined as a 5-year Gail risk score ≥1.67% or lifetime risk ≥20%, history of atypical hyperplasia, lobular or ductal carcinoma in situ, germline mutations in BRCA1, BRCA2, p53, or PTEN, history of stage I-II breast cancer in remission for &amp;gt;5 years, or baseline mammographic density &amp;gt;50%. Other eligibility criteria include baseline serum 25(OH)D ≤32 ng/ml, normal serum calcium and urine calcium/creatinine ratio, and no history of kidney stones. Specific Aims: The primary endpoint is change in mammographic density at 12 months compared to baseline between the vitamin D and placebo groups. Secondary exploratory endpoints include breast tissue-based biomarkers (Ki-67, cleaved caspase-3, ER, VDR, and 1α-hydroxylase) and blood-based biomarkers (25(OH)D, 1,25(OH)D, PTH, IGF-1, IGFBP-3, VDR polymorphisms). Statistical Methods: Power calculations are based on a two-sample comparison of normal deviates, using a 2-sided, 0.05-level test. To be conservative, we assume that 15% will have missing breast density data at 12 months and a 2% difference in mammographic density between intervention and control at 12 months with a the standard deviation for each arm of 4%. With 200 women randomized, the study will have 90% power to detect this difference. Target Accrual: 200. Sixty-seven patients accrued as of June 2013. Accrual completion expected December 2014. Contact: Katherine Crew, Columbia University Medical Center, kd59@columbia.edu. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr OT3-3-02.

Hypercalcemia Secondary to Gastrointestinal Stromal Tumors: Parathyroid Hormone-Related Protein Independent Mechanism?

ObjectiveHypercalcemia is a common paraneoplastic manifestation of many malignancies like breast, ovarian, and squamous-cell cancers of head and neck; however, there have been only a few case reports of hypercalcemia associated with gastrointestinal stromal tumors (GISTs). We report a case of GIST presenting with hypercalcemia without any osseous metastasis and provide a literature review regarding the mechanisms of hypercalcemia and therapeutic strategies. MethodsWe present a report of case and a review of the relevant literature. ResultsA 52-year-old woman with history of localized breast cancer in remission and a pelvic 13 × 12 cm GIST with peritoneal, liver, and lung metastases presented with hypercalcemia of 14.3 mg/dL (8.5-10.5 mg/dL). Parathyroid hormone-related protein (PTHrP) was undetectable, intact parathyroid hormone (PTH) was appropriately low at 1 pg/mL (10-65 pg/mL), and 1,25 dihydroxy vitamin D (1,25 OH2 vit D) was elevated at 131 pg/mL (18-78 pg/mL) with normal renal function. Calcium responded transiently to tyrosine kinase inhibitor therapy and bisphosphonates but within a year, she expired due to tumor progression. ConclusionGIST is a rare cause of hypercalcemia. In addition to PTHrP expression, direct tumor production of 1,25(OH)2 vit D or 1-α hydroxylase enzyme resulting in activation of 25-hydroxy vitamin D may be an alternative mechanism in GIST-related hypercalcemia. Therapy with tyrosine kinase inhibitors and bisphosphonates is recommended, though prognosis is poor. Further investigations are needed to characterize the etiology and management of hypercalcemia in these patients. (Endocr. Pract. 2013;19: e158-e162)