Complete response in advanced breast cancer patient treated with a combination of capecitabine, oral vinorelbine and dasatinib

Background

Currently, there are no data available on the best choice of treatment in heavily pretreated patients with advanced breast cancer. However, the combination of oral vinorelbine and capecitabine has been demonstrated to be effective and safe in patients with advanced breast cancer pretreated with anthracycline. Furthermore, some studies assessed the activity of dasatinib, an oral tyrosine kinase inhibitor that inhibits five oncogenic tyrosine kinase families, alone or in combination with different chemotherapy in patients affected with advanced breast cancer.

Case presentation

A patient with metastatic breast cancer, hormone receptor positive and human epidermal grow factor receptor 2 negative, pretreated with epirubicine, taxanes and nab-paclitaxel, was submitted to third line chemotherapy with vinorelbine 60 mg/m² on day 1, 8 plus capecitabine 1000 mg/m² twice daily from day 1 to day 14 every 21 days. The patient was taking also dasatinib 100 mg once daily for chronic myeloid leukemia. The treatment was well tolerated and, after 15 months, computed tomography scan showed a complete response of liver metastases and bone stable disease. After another 28 months, a 18-fluorodeoxyglucose positron emission tomography scan showed a metabolic response of bone metastases without other site of disease.

Conclusions

This is the first case in literature about activity of dasatinib in combination with a chemotherapy schedule of oral vinorelbine and capecitabine in advanced breast cancer. This treatment showed both good tolerability and great activity with a long progression free survival of 54 months.

Effects of isoproterenol on distribution of perfusion in embolized dog lungs

In 19 mechanically venilated, anesthetized dogs, autologous venous thrombi were formed in the inferior vena cava and subsequently released. Serial perfusion lung scintigrams revealed the postembolic distribution of pulmonary blood flow before, during, and after the infusion of isoproterenol at 2.2 micrograms/min. Isoproterenol failed to restore perfusion to embolically occluded regions. When reperfusion occurred it was attributable to clot resolution. Gas exchange and hemodynamic measurements obtained in seven thromboembolized animals showed no scan evidence of reperfusion during the isoproterenol infusion. After embolization, cardiac output increased from 1.7 to 2.6 liter/min (p less than 0.05), and PvO2 from 38.0 to 45.3 mm Hg (p less than 0.05). Shunt fraction remained unchanged. The postembolic infusion of isoproterenol was associated with a further increase in cardiac output to 3.6 liter/min (p less than 0.01), an elevation in PvO2 to 50.7 mm Hg, along with a decrease in pulmonary vascular resistance from the postembolic mean of 448 to 246 dynes.sec.cm-5 (p less than 0.05). Perfusion defects following acute pulmonary thromboembolization are not altered by the infusion of the potent pulmonary vasodilator, isoproterenol. Infusion of this drug following thromboembolization may have potential therapeutic benefit by reducing pulmonary vascular resistance, increasing cardiac output, and elevating the mixed-venous oxygen tension.

Changes in ventilation and perfusion in anesthetized dogs following lobar lavage with saline solution

The therapeutic application of endobronchial lavage has been inhibited by concern regarding alterations in the exchange of gases, particularly hypoxemia, and by the technical complexity of the procedure. Using a cuffed fiberoptic bronchoscope with which lavage could be restricted to one lobe, we studied the sequence of alterations in the exchange of gases after lavage and the attendant disturbances in ventilation and perfusion in ten mongrel dogs following lobar lavage with 1,850 ml of physiologic saline solution. Sequential scintiphotographs of ventilation and perfusion and sequential measurements of arterial blood gas levels were obtained. Linkage of the computer to the scintillation camera allowed quantification of data on ventilation and perfusion from the lobar area of interest. Lavage induced a reduction in regional ventilation and perfusion in all dogs. The decline in ventilation preceded that in perfusion, and the computed ratio of ventilation over perfusion reached its lowest point during the first 30 minutes after lavage. The arterial oxygen pressure (PaO2) declined in all dogs from a mean baseline value of 87 mm Hg to a mean value of 76 mm Hg at 30 minutes after lavage and gradually returned to a mean of 85 mm Hg by six hours after lavage. The lowest value for PaO2 occurred after balloon occlusion prior to lavage. Calculations of shunt showed a minimal increment in the intrapulmonary shunt (Qs/Qt). In the normal dog, lobar lavage induces mild hypoxemia due to an imbalance of ventilation and perfusion that resolves within six hours.

Biologic half-life and organ distribution of radiolabeled human PiM and PiZ alpha-1-antitrypsin in the dog

Highly purified A-1-A.T., prepared from blood obtained from donors of known PiZZ and PiMM phenotype, was radiolabeled with 125I or 131I and injected intravenously into dogs. The radiolabeled proteins retained their prelabel electrophoretic and trypsin-inhibitory characteristics. The biologic t1/2 of both M and Z protein in the circulation were similar, averaging 71 hr for M protein and 80 hr for Z protein. The label was shown to remain tightly bound in vivo for 2 days after injection. The material was nonpyrogenic in rabbit and dog. No arteriovenous differences in radioactivity could be detected at 2 or 20 min after injection. However, surface scanning disclosed substantial pulmonary deposition of radioactivity for the first 9 hr after injection. At 48 hr, intense radioactivity was present in the spleen, but not in the liver. These studies indicate the feasibility of similar studies in man, including noninvasive assessment of body distribution of M and Z protein by surface scanning techniques.