Interstitial lung disease associated with adjuvant and neoadjuvant chemotherapy in early breast cancer

Trastuzumab-Induced Interstitial Pneumonitis

Trastuzumab is a recombinant immunoglobulin G1 monoclonal antibody used to treat human epidermal growth factor receptor 2 (HER2) cancers. Trastuzumab-induced interstitial pneumonitis is a rare adverse effect reported in a few patients. Interstitial pneumonitis presents as symptoms of dyspnea, hypoxia, cough, and fever. If the patient is treated early, corticosteroids can slow or reverse the disease progression. A 41-year-old woman presented with dyspnea and a dry cough three weeks after her third cycle of trastuzumab therapy for breast cancer. A diagnosis of trastuzumab-induced interstitial pneumonitis was made after multiple other disease processes were ruled out. The patient was started on methylprednisolone while inpatient and transitioned to prednisone for outpatient therapy. The patient was maintained on 2-3L of oxygen throughout her hospital stay and was discharged on 3L of oxygen through nasal cannula. Trastuzumab was never restarted after discharge. There have been many trials evaluating the safety, efficacy, and optimal treatment regimen of trastuzumab, but there are only a few reports of interstitial pneumonitis adverse reaction. The lack of correlation and limited cases make this adverse effect very difficult to diagnose and monitor. New trials and case reports can bring an insight into contributing factors, symptoms at onset, and treatment for future patients. With the increase in use of trastuzumab therapy, physicians should be aware of how to diagnose and treat the rare adverse reaction of trastuzumab-induced interstitial pneumonitis.

Long-term follow-up results of pediatric and adolescent patients with localized Ewing sarcoma treated based on stratified modalities

BACKGROUND

Compared with other pediatric tumors, little advances were achieved in studies on the stratified treatment in localized Ewing sarcoma. Most pediatric oncology groups treated Ewing sarcoma according to whether there was an existing metastasis, without involving more prognostic factors. In this study, patients with localized Ewing sarcoma were divided into resectable and unresectable groups at diagnosis and received chemotherapy with different intensity, for the purpose of achieving good efficacy, avoiding overtreatment and reducing unnecessary toxicity.

METHODS

A total of 143 patients with a median age of 10 years old diagnosed with localized Ewing sarcoma in this retrospective study were divided into two cohorts (Cohort 1, n = 42; Cohort 2, n = 101) and patients in Cohort 2 received chemotherapy with different intensity (Regimen 1, n = 52; Regimen 2, n = 49). Outcomes were analyzed using the Kaplan-Meier method to estimate event-free survival (EFS) and overall survival (OS), and the curves were compared using the log-rank test.

RESULTS

The 5-year EFS and 5-year OS for all the patients were 69.0% and 77.5%. The 5-year EFS for Cohort 1 and Cohort 2 were 76.0% and 66.1% (p = 0.31), and the 5-year OS were 83.0% and 75.1% (p = 0.30), respectively. In Cohort 2, the 5-year EFS rate of patients treated with Regimen 2 was significantly higher than that of patients treated with Regimen 1 (74.5% vs. 58.3%, p = 0.03).

CONCLUSIONS

According to whether a grossly complete resection was received at the time of diagnosis, localized Ewing sarcoma patients in this study were stratified into two groups and received different intensities of chemotherapy, which achieved good efficacy and avoided overtreatment and reduced unnecessary toxicity.

Effects of the Combination of Continuous Nursing Care and Breathing Exercises on Respiratory Function, Self-Efficacy, and Sleep Disorders in Patients with Lung Cancer Discharged from Hospital

The purpose of this study was to explore the effect of respiratory function and self-efficacy of patients with lung cancer after surgery by the combination of continuing nursing care and breathing exercises and to assess its clinical value in improving the quality of patients' sleep. 120 cases of lung cancer patients were divided into the control group (n = 60 cases) and the experimental group (n = 60 cases) randomly. The control group used conventional care methods for postoperative lung cancer patients, while the experimental group used continuous care combined with a respiratory exercise care model on the basis of conventional care, comparing the differences in the recovery of lung function, self-efficacy, sleep quality, incidence of sleep disorders, and other indicators between the two groups. The average indicator of recovery condition in patients of experimental groups FEV1 (L), FEV1% pred (%), and FEV1/FVC (%) was higher than patients in control groups with lower symptom scores and complication rates (P < 0.05). The self-efficacy score of patients in the experimental group was higher than that in the control group (P < 0.05) during sixty days of follow-up. The sleeping time of the experimental group was significantly shorter than that of the control group (P < 0.05) and the sleep time was longer than that of the control group (P < 0.05), but the incidence of sleep disorders and drug use rate were lower than that of the control group (P < 0.05) before discharge. Continuous nursing care combined with respiratory exercises can significantly accelerate the recovery of lung function and respiratory function reconstruction in patients with lung cancer after surgery, improve the self-efficacy score of patients, improve the sleep quality of patients, and be conducive to postoperative rehabilitation of patients.

Pneumocystis jirovecii Pneumonia in Three Patients With Breast Cancer Receiving Neoadjuvant Dose-Dense Chemotherapy

We report three cases of Pneumocystis jirovecii pneumonia (PJP) during dose-dense neoadjuvant chemotherapy for breast cancer. All patients presented with symptoms (e.g., fever), and computed tomography showed diffuse ground-glass shadows. Bronchoalveolar lavage was performed, and the diagnosis was confirmed by polymerase chain reaction for Pneumocystis jirovecii. All patients had completed three or four courses of dose-dense epirubicin-cyclophosphamide chemotherapy and received prednisolone for preventing chemo-induced nausea and vomiting. Moreover, lymphocytopenia was observed in all patients. Since the onset of PJP in preoperative neoadjuvant chemotherapy can be life-threatening and leads to delayed surgery, careful consideration of prophylaxis for PJP is required.