Trastuzumab deruxtecan in human epidermal growth factor receptor 2-positive breast cancer brain metastases: a systematic review and meta-analysis

BACKGROUND

Trastuzumab deruxtecan (T-DXd) has shown promising results in patients with breast cancer brain metastases (BCBMs). We conducted a systematic review and meta-analysis to evaluate the effectiveness and safety of T-DXd in the human epidermal growth factor receptor 2 (HER2)-positive BCBM population.

PATIENTS AND METHODS

We searched PubMed, Embase, and Cochrane Library databases as well as American Society of Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO), and San Antonio Breast Cancer Symposium (SABCS) websites for clinical trials (CTs) and observational studies evaluating T-DXd in patients with HER2-positive BCBM. Heterogeneity was assessed with I2 statistics. Random effects models were used for all statistical analyses, which were carried out using R software (version 4.2.2).

RESULTS

Ten studies were included, six CTs (n = 189) and four observational studies (n = 130), with a total of 319 patients. The median progression-free survival was 15 months [95% confidence interval (CI) 13.9-16.1 months]. The objective response rate (ORR) was 61% (95% CI 52% to 70%), and the intracranial (IC)-ORR was 61% (95% CI 54% to 69%). No significant differences in ORR and IC-ORR were observed between CTs and observational studies (P = 0.31 and 0.58, respectively). The clinical benefit rate (CBR) was 80% (95% CI 52% to 94%), and the IC-CBR was 70% (95% CI 54% to 82%). The ORR was 68% (95% CI 57% to 77%) in the subgroup of patients with stable BMs and 60% (95% CI 48%-72%) in patients with active BM, with no significant difference between groups (P = 0.35).

CONCLUSIONS

Our systematic review and meta-analysis supports the IC activity of T-DXd in patients with stable BM and active BM.

TRIAL REGISTRATION

International Prospective Register of Systematic Reviews (PROSPERO) under the protocol number CRD42023422589.

Participatory ethnobotany: comparison between two quilombos in the Atlantic Forest, Ubatuba, São Paulo, Brazil

Ethnobotanical studies that use the participatory research approach seek to involve the residents of a community in different stages of the study, promoting the registration, dissemination and strengthening of local knowledge, as well as the empowerment of decisions related to the sustainable use and management of resources. Using the participatory methodology, this study recorded and made a comparative analysis on the use of plants in two quilombola communities (Quilombo do Cambury-QC and Quilombo da Fazenda-QF) in the State of São Paulo. After a training on anthropological and botanical methods, local researchers selected and interviewed the local experts, recording their knowledge on plant uses and collecting the indicated plants, to be identified and deposited in herbariums. In addition, participant observation and field diaries were used by the academic researchers, helping to analyze the data. To test the differences in the composition of species known to local community, a Jaccard dissimilarity matrix was created, and a Permanova test was employed. During the 178 days of fieldwork, three local researchers from the QC and two from the QF, selected nine and eight experts on the uses of the plants in each quilombo, respectively, corresponding to 214 plant species, indicated for eight ethnobotanical categories. Our hypothesis has been confirmed, since the traditional knowledge found in both quilombos, regarding plant uses and the number of plant species by category, are distinct, since each community occupies particular plant areas and different phytophysiognomies. Most of the indicated species are native to the Atlantic forest, and no significant differences were observed in the proportion of native species vs. introduced among quilombos for any of the categories of use studied. Furthermore, the innovative methodology used, participatory ethnobotany, contributed to the empowerment of community members with regard to the use of their available resources in the environment in which they live, while retaining the intellectual property rights over their own knowledge.

Breast cancer in very young women-a multicenter 10-year experience

BACKGROUND

Breast cancer (BC) is the most prevalent cancer in adult young women in Europe. Although rare, it is one of the leading causes of death in this age group. The aim of this study is to characterize a cohort of young women regarding tumor stage, biology, treatment and survival.

PATIENTS AND METHODS

We present a multicenter retrospective analysis of women <35 years of age, diagnosed with BC between 2008 and 2017. A total of 207 patients from five Portuguese centers were included, from whom 172 were eligible for analysis. Data were analyzed using IBM SPPSS statistics.

RESULTS

Median age at diagnosis was 31 years. Fifty-one percent of tumors were hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative, 20% HR-positive/HER2-positive, 8% HR-negative/HER2-positive and 20% triple-negative BC. Twenty-two percent of patients were diagnosed in stage I, 26% stage II, 45% stage III and 6% had de novo metastatic cancer. Thirty-nine percent of patients were treated with neoadjuvant chemotherapy. Mean follow-up time was 64.9 months and overall survival at 5 years, of the entire cohort and metastatic patients, was 86.5% and 26%, respectively.

CONCLUSIONS

In our study we found similar population characteristics to other cohorts <35 years of age. To our knowledge, this is one of the largest cohorts in very young women. BC in young women is an important issue and further studies are needed to provide better care and survivorship to patients.

Characterization of lip prints in a Portuguese twins' population

Lip print patterns are referred to as unique to each individual, but controversy exists surrounding twins. In this study, the lip prints of 19 pairs of monozygotic and 47 pairs of dizygotic twins were studied. The left lower lip was photographed and the furrows were classified using Renaud's classification. Results showed the same lip pattern was found only in one monozygotic pair (5.3%) and in 4 dizygotic pairs (8.5%), and no significant statistical differences were found between groups (p > 0.05). In monozygotic twins only type C furrows presence displayed statistical significant differences (p=0.034). As for dizygotic twins, there were statistical significant differences in the frequency of type A (p=0.005) and type G furrows (p=0.018). As for the most common types, both groups displayed a higher prevalence of vertical furrows (type B: 97.4% and 96.8%, type A: 86.8% and 87.2%, in monozygotic and dizygotic, respectively). The least frequent furrow type was type I and type E in monozygotic (2.6% and 5.3%, respectively) and types E, F and I, in dizygotic (6.4%, 7.4%. and 7.4%, respectively). Our results seem to point out that lip print patterns should be useful carefully in twins' identification.

Participatory ethnobotany and conservation: a methodological case study conducted with quilombola communities in Brazil's Atlantic Forest

BACKGROUND

Although multiple studies advocate the advantages of participatory research approaches for ethnoscience, few provide solid contributions from case studies that involve residents in all of the project phases. We present a case study of a participatory approach whose aim is to register ethnobotanical knowledge on the use of plants in two quilombola communities (maroon communities), an important biodiversity hotspot in the Atlantic Forest, Southeast Brazil. Our aim is to provide tools that will empower decision-making related to sustainable use and management among residents.

METHODS

In phase I, the objectives and activities were defined in meetings with residents to carry out ethnobotanical surveys between two quilombola communities-the Quilombo da Fazenda (QF) and Quilombo do Cambury (QC). In phase II, we offered community partners training courses on how to collect plants and ethnobotanical data. In coordination with the university team and using ethnobotanical methods, community partners interviewed specialists on plants and their uses. In phase III, using the participatory mapping method, residents indicated plot locations and collected plants to calculate the Conservation Priority Index for native species recorded in phase II.

RESULTS

In 178 days of fieldwork, two community partners from the QF and three from the QC selected 8 and 11 respondents who reported 175 and 195 plant species, respectively, corresponding to 9 ethnobotanical categories. Based on requests from the local community, booklets and videos with these data were collaboratively produced. A large percentage of species were found to be of great conservation priority-82.1% in the QC and 62.5% in the QF. Virola bicuhyba, Cedrela fissilis, Plinia edulis, and Tabebuia cassinoides are the species most at risk and will be the focus of phase IV, when a participatory management plan will be carried out. Additionally, we present both challenges and opportunities with the hope that others can learn from our successes and failures.

CONCLUSIONS

Our experience shows that it is possible to train community members who wish to document their knowledge to support the process of ensuring that local knowledge is highly regarded, further ensuring its perpetuation. In this context, the project may be of great interest to development programs in promoting community-based management strategies for useful plants.

Plants utilized as medicines by residents of Quilombo da Fazenda, Núcleo Picinguaba, Ubatuba, São Paulo, Brazil: A participatory survey

ETHNOPHARMACOLOGICAL RELEVANCE

Participatory research can help to broaden the understanding of medical systems and beliefs of traditional communities. An ethnopharmacological survey in collaboration with local people focused on plants used in quilombos located in Southeast Region in Brazil identified cultural factors that influence plant and recipe choice.

AIM OF THE STUDY

To investigate the factors related to the therapeutic efficiency of medicinal plants from the perspective of Quilombo da Fazenda residents.

MATERIALS AND METHODS

University researchers collaborated with community residents for both aims and methods of the study. The local partners were trained in the gathering of ethnopharmacological data and then selected and interviewed the residents considered experts on the use of medicinal plants. Data on the use of each species were supported by voucher specimens collected by the local partners and university researchers. Participant observations and field diaries by the university researchers supplemented the data.

RESULTS

Eight interviewees mentioned 92 medicinal species with 60 therapeutic uses, applied in 208 recipes or remedies. Asteraceae (13 species), Lamiaceae (5) and Urticaceae (5) contributed most medicinal plant species. Of the 12 etic categories of use, the circulatory system category had the highest number of plants mentioned. Decoction was the most commonly used preparation method (66.8%), and most remedies were administered orally (76.4%). Eighty-six recipes included more than one plant species and/or the addition of other components, such as sugar, salt or animal products. Several cultural factors influence medicinal plant use. Popular beliefs on the quality of blood or the humoral properties of plants and illnesses, characteristics of the plants and other factors determine which plant is used and why.

CONCLUSIONS

The participatory method identified a large number of factors that influence medicinal plant use: the patient's blood type; the condition of the plant and the disease (hot-cold system); the route of administration and dosage; the preventive uses of the plants; and the influence of other factors, such as the sun, the moon and dew. The participatory approach is useful for gaining insight on the decision processes of medicinal plant use in traditional societies, and also for those communities wanting to document their knowledge with or without the participation of the academy.

Circulating endothelial cell count: a reliable marker of endothelial damage in patients undergoing hematopoietic stem cell transplantation

The physio-pathologic interrelationships between endothelium and GvHD have been better elucidated and have led to definition of the entity 'endothelial GvHD' as an essential early phase prior to the clinical presentation of acute GvHD. Using the CellSearch system, we analyzed circulating endothelial cells (CEC) in 90 allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients at the following time-points: T1 (pre-conditioning), T2 (pre-transplant), T3 (engraftment), T4 (onset of GvHD) and T5 (1 week after steroid treatment). Although CEC changes in allo-HSCT represent a dynamic phenomenon influenced by many variables (that is, conditioning, immunosuppressive treatments, engraftment syndrome and infections), we showed that CEC peaks were constantly seen at onset of acute GvHD and invariably returned to pre-transplant values after treatment response. Since we showed that CEC changes during allo-HSCT has rapid kinetics that may be easily missed if blood samples are drawn at pre-fixed time-points, we rather suggest an 'on demand' evaluation of CEC counts right at onset of GvHD clinical symptoms to possibly help differentiate GvHD from other non-endothelial complications. We confirm that CEC changes are a suitable biomarker to monitor endothelial damage in patients undergoing allo-transplantation and hold the potential to become a useful tool to support GvHD diagnosis (ClinicalTrials.gov NCT02064972).

Thrombosed popliteal aneurysm - first manifestation of bilateral popliteal entrapment syndrome

Popliteal artery entrapment syndrome is a rare and underdiagnosed cause of claudication in the young adult. One of its rare and potentially limb threatening complications is aneurysmal degeneration. We present a case of a fifty years old man with a bilateral popliteal entrapment syndrome admitted with an acutely thrombosed aneurysm at the right inferior limb. An urgent bypass was required. The contralateral limb presented with a type III entrapment and an elective section of a musculotendinous structure was performed. This case suggests that an early diagnosis is mandatory to avoid a dramatic clinical outcome and to limit the surgical treatment to a myotomy.

Screening of the Portuguese BRCA2 Founder Mutation in Breast Cancer Patients Unselected for Family History

Background and Objective: The identification of BRCA2 c.156_157insAlu as a founder mutation of Portuguese origin and the optimization of its screening method, allows for fast genetic diagnosis in positive families. Although prevalent in Portuguese families with hereditary breast cancer risk (45% of the families with identified mutations in our Institute are positive for BRCA2 c.156_157insAlu), its prevalence in the general population of Portuguese breast cancer patients unselected for family history is unknown. Our objective was to determine the frequency of c.156_157insAlu in general Portuguese breast cancer (BC) population.Material and methods: After Ethics approval, recruitment started in April 2008.Two centres started the study: the Cancer Institute in Lisbon that observes patients from the Centre and South of the country, and the Hospital of Terceira Island in Azores (patients recruited in Terceira Island were originated from all Azorean Islands). All these patients had the diagnosis of invasive breast cancer, and after counselling a peripheral blood sample was collected and BRCA2 c.156_157insAlu screened by a three-step PCR method (Machado PM et al; J Clin Oncol 25:2027-2034, 2007). Post-test counselling was given at the Breast Cancer Risk Evaluation Clinic, where all patients had their family history analyzed. If at high risk for hereditary cancer, women were advised to enter general screening of BRCA1/2 mutations, when negative for BRCA2 c.156_157insAlu.Results: Three hundred twenty three BC patients (226 from Azores; 97 from the Continent) were recruited for this study and have already been screened. Eighty-three patients from Azores met criteria for familial breast cancer (37%). In the Continent only 10 high-risk patients have been identified so far. Average age at diagnosis was 55.8 yrs; 13 patients had bilateral BC (4%); 18 (6%) patients (all from Azores) had a second cancer diagnosis. Two women (1% of all, and 2% of the patients from the Continent) were positive for the BRCA2 c.156_157insAlu mutation: 1- breast cancer diagnosis at age 45 and a maternal aunt with breast cancer at age 60; 2- bilateral BC (ages 35 and 37), no family history for breast and/or ovarian cancer. The 10 high-risk patients BRCA2 c.156_157insAlu negative accepted to proceed with general BRCA1/2 screening.Patient recruitment is still open.Conclusions: Although we cannot conclude that c.156_157insAlu screening is relevant in the unselected population, one of the positive patients did not meet criteria for counselling outside this study. Our data also suggest that, even for familial BC, c.156_157insAlu may not be as prevalent in the Azorean population.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3061.

Current management of ovarian carcinosarcoma

Ovarian carcinosarcomas (OCS), also known as malignant mixed müllerian tumors, are uncommon malignancies that carry a poor prognosis. The presentation of OCS is usually indistinguishable from that of epithelial ovarian cancer. Due to its low frequency, prospective trials have been difficult to perform, but there is evidence that OCS are sensitive to platinum-based chemotherapy. Recent studies have shown encouraging results with platinum-ifosfamide and platinum-taxane schedules, which are usually considered the treatment of choice. However, poor performance status at presentation is also a common problem, so that many patients may be unsuitable for combination chemotherapy but may still benefit from single-agent platinum or ifosfamide or, occasionally, from nonplatinum schedules such as ifosfamide plus paclitaxel. Aggressive cytoreductive surgery appears to have a positive impact on outcome and should probably be offered to most patients. However, this procedure has been associated with higher rates of complication in OCS and should only be attempted by experienced (gynecological) surgeons in centers with expertise in the management of gynecological malignancies.

Paradoxical coexistence of atopic asthma and Human T-Lymphotropic Virus Type I (HTLV-I) infection: a case report

In this case report, the authors report the presence of two supposedly antagonic immune diseases in the same patient. The patient is a 45-year-old white woman with a history of asthma and allergic rhinitis for the last 10 years. Asthmatic symptoms were present and were triggered after exposure to dust and mold. Her Human T-Lymphotropic Virus Type I (HTLV-I) seropositive status was detected by chance five years ago during a routine screening for blood donation. Skin prick tests were positive for Dermatophagoides pteronyssinus, Dermatophagoides farinae and Blomia tropicalis. Cytokine levels in unstimulated cultures were: IFNgamma= 1195 pg/ ml, TNFalpha = 460 pg/ml, IL5 = 41 pg/ml and IL10 = 265 pg/ml.

Diet score is associated with plasma homocysteine in a healthy institutionalised elderly population

BACKGROUND AND AIM

Total plasma homocysteine (tHcy) is an independent risk factor for cardiovascular diseases. Among other dietary and non-dietary factors, B vitamins, such as folate, riboflavin and cobalamin, are primary determinants of tHcy in the general population. However, research has concentrated on the relationship of these nutrients with tHcy, and little is known about overall eating patterns and tHcy.

METHODS AND RESULTS

In this study, we analysed whether a diet score based on the consumption of folate-, riboflavin- and cobalamin-rich food groups was associated with tHcy in a sample of 140 institutionalised elderly subjects (59 men and 81 women aged 60-80 years) from Northern Spain. The food groups identified as the major contributors to the intake of the three vitamins were vegetables, fruit, fish, meat and milk and dairy products. The mean tHcy level was 13.3+/-5.1 micromol/L (range: 3.9-30.7 micromol/L). None of the food groups predicted tHcy levels individually, but the overall diet score was inversely associated with tHcy in a multiple linear regression analysis. High tHcy levels (>16 micromol/L) were almost twice as prevalent in the groups scoring less than 7 than in those scoring 7 or more (37.5 vs 19.6%, p=0.021).

CONCLUSIONS

These data suggest that a dietary pattern characterised by high intakes of B vitamin-rich foods is associated with a lower tHcy concentration and a reduced percentage of high tHcy levels in elderly subjects. They also support the use of dietary pattern approaches to evaluate the relationships between diet and health outcomes that go beyond single nutrient analyses.

Hormonal replacement therapy in an animal model with chronic renal failure and ovariectomy: biochemical and densitometric study

BACKGROUND

In spite of estrogen replacement therapy being extensively used in clinical and experimental studies without renal impairment, there are no long-term studies concerning estrogen replacement in chronic renal failure.

METHODS

In this experimental study, six groups of nephrectomized and ovariectomized animals were treated with different doses of 17beta-estradiol, alone or in combination with calcitriol, to evaluate the effect of these treatments on bone metabolism.

RESULTS

Biochemical results showed that estrogen alone did not have any effect neither on calcium nor on PTH serum levels. By contrast, in the groups treated with calcitriol, the levels of serum calcium were significantly higher, and the levels of iPTH were significantly lower than those observed in the control group. Animals receiving the combined treatment with estrogen and calcitriol showed the greater gain in uterus weight and a better bone mineral density at the lumbar site and the proximal and distal tibia sites.

CONCLUSION

The combination of estrogen and calcitriol is the most effective therapy to prevent bone mass loss in animals with chronic renal failure and estrogen deprivation.

Cytokine profile and immunomodulation in asymptomatic human T-lymphotropic virus type 1-infected blood donors

The modulation of the immune response has been used as therapy for clinical disorders associated with human T-lymphotropic virus type 1 (HTLV-1) infection. In this study, the cytokine profile was evaluated in 26 asymptomatic HTLV-1 blood donors. Additionally, both the cell responsible for producing interferon-gamma (IFN-gamma) and the role of exogenous interleukin (IL)-10 in downregulating IFN-gamma production were studied. Cytokine levels were determined in supernatants of unstimulated lymphocyte cultures by enzyme-linked immunosorbent assay. The levels of IFN-gamma, tumor necrosis factor-alpha, IL-5, and IL-10 were higher in supernatants of the lymphocyte cultures taken from HTLV-1-infected donors than in those taken from healthy subjects. Although depletion of CD8+ T cells and natural killer cells did not affect IFN-gamma production, depletion of CD4+ T cells significantly decreased IFN-gamma production. Furthermore, at a concentration of 2 ng/ml, IL-10 had only a minimum effect on IFN-gamma production, although at high concentrations (100 ng/ml), IL-10 decreased IFN-gamma production by 50% in HTLV-1-infected individuals. These data indicate that both T helper 1 and T helper 2 cytokines are elevated in HTLV-1 infection and that IL-10 in high concentrations modulates IFN-gamma production in these patients.

Effect of aluminium load on parathyroid hormone synthesis

BACKGROUND

Aluminium overload leads to parathyroid hormone (PTH) suppression. However, it is unclear whether a decrease in synthesis or release of the hormone is mainly involved. The aim of this study was to assess the effect of an acute administration of aluminium on PTH synthesis and release in rats with chronic renal failure and secondary hyperparathyroidism.

METHODS

The study was performed using 100 adult male Wistar rats (body weight 443+/-54 g). 7/8 nephrectomy was performed and the rats were maintained on a high dietary phosphorous intake. Five weeks after surgery, the rats were randomly divided into two groups, one loaded with aluminium (AlCl3) and the other given placebo. Aluminium or placebo were administered i.p. for two consecutive days. The placebo group received saline at the same pH as the aluminium solution. After 2 weeks, serum calcium, phosphorous, creatinine, PTH, and aluminium were measured. The parathyroid glands were removed and PTH messenger RNA (mRNA) was measured by northern blot. Intact PTH was measured by IRMA (Rat PTH, Nichols Institute).

RESULTS

No differences in serum PTH levels were found between the two groups after 5 weeks of renal failure. At the end of the study the rats given aluminium had higher aluminium levels than the placebo group and lower PTH levels. No significant differences were found for calcium, phosphorous, renal function, or body weight. PTH mRNA expression was lower in the aluminium group than in the placebo group.

CONCLUSION

The administration of aluminium in rats with chronic renal failure resulted in reductions in serum PTH and PTH mRNA. Thus far, previous studies had demonstrated that aluminium suppressed PTH release. The present findings suggest that PTH synthesis is also reduced.

Genetic variation in the renin-angiotensin system and athletic performance

The D allele at the angiotensin-I-converting enzyme (ACE)-insertion/deletion polymorphism has been associated with an increased risk of developing several pathological processes, such as coronary heart disease and ventricular hypertrophy. Individuals with the DD genotype show a significantly increased left-ventricular mass in response to physical training, compared to the II genotype (which would be associated with the lowest plasma ACE levels) and the ID genotype. The II genotype has been linked to a greater anabolic response. In accordance with a role for ACE in the response to rigorous physical training, a higher frequency of the I allele has been reported to exist among elite rowers and high-altitude mountaineers. Sixty elite (professional) athletes (25 cyclists, 20 long-distance runners, and 15 handball players), and 400 healthy controls were genotyped for the DNA polymorphisms of the ACE, angiotensinogen (Ang) and angiotensin receptor type 1 (AT1) genes. Plasma ACE levels showed a strong correlation with the I/D genotype in our population. The I-allele occurred at a significantly higher frequency in athletes compared to controls (P = 0.0009). Gene and genotype frequencies for the Ang and AT1 polymorphisms did not differ between athletes and controls. Since the frequency of the ACE I allele was significantly increased among our elite athletes, we conclude that the ACE polymorphism represents a genetic factor that contributes to the development of an elite athlete.

Antiperinuclear factor in psoriatic arthropathy

BACKGROUND

Antiperinuclear factor (APF) is an autoantibody directed against (pro)-filaggrin molecules.

OBJECTIVE

We evaluated whether APF determination is useful for the diagnosis of psoriatic arthritis (PA).

METHODS

We determined APF titers in sera from patients with PA (n = 76), psoriasis vulgaris (n = 38), noninflammatory rheumatic diseases (NIRDs, n = 119), rheumatoid arthritis (RA, n = 159) both with negative (n = 36) and positive (n = 123) rheumatoid factor (RF) tests, as well as from 204 healthy controls. We used an indirect immunofluorescence test on epithelial cells from human buccal mucosa as a substrate.

RESULTS

In patients with PA, 7.9% of the serum samples were APF-positive. The incidence was greater than in healthy controls (1.0%; P < .01), similar to those with uncomplicated psoriasis (2.6%; P = NS) and NIRDs (4.0%; P = NS), and lower than in RF-negative (52.7%; P < .001) and RF-positive (90.2%; P < .001) patients with RA. Three APF-positive patients with PA had symmetric joint involvement and 3 had pustulotic arthroosteitis.

CONCLUSION

The APF test may be useful in differentiating PA from RA, and APF may be specific for two PA subgroups.