Unexpected "Lazarus response" to single-agent bevacizumab in heavily pretreated patients with HER2-positive breast cancer

Early clinical trials aimed to halt cancer progression by inhibiting the growth of new blood vessels in tumors through single-agent targeted therapy with bevacizumab. These trials largely proved unsuccessful. However, bevacizumab turned out to be efficient when administered in combination with other anticancer drugs. The efficacy of this approach is explained by the ability of bevacizumab to eliminate immature blood vessels thus normalizing intratumoral blood flow and improving the delivery of cytotoxic or targeted agents. This report describes four cases of heavily pretreated patients with metastatic HER2-positive breast cancer, who had no meaningful treatment options left, and who received single-agent bevacizumab as an empirical last-resort therapy. Three of these patients had severe complaints, and they demonstrated striking symptomatic relief within the first day of this treatment. In addition to the observed "Lazarus response", which was likely attributed to the bevacizumab-driven resolution of edema, some evidence of a direct antitumor effect was observed. These data may call for the reconsideration of bevacizumab monotherapy in patients with HER2-associated breast cancer, and perhaps in some other categories of cancer patients.

Rapid Improvement of the Performance Status and Reduction of the Tumor Size in KRAS-Mutated Colorectal Cancer Patient Receiving Binimetinib, Hydroxychloroquine, and Bevacizumab

Activating RAS mutations occur in more than a half of colorectal cancers (CRCs). RAS-mutated CRCs are notoriously difficult to treat given that they are characterized by the aggressive disease course and the lack of appropriate targeted therapies. Recent preclinical studies demonstrated that RAS-mutated cells escape from therapeutic MEK inhibition by the development of autophagy, and this escape may be prevented by the administration of an antimalarial drug, hydroxychloroquine. The available clinical data are limited to a single case observation involving a patient with KRAS-mutated pancreatic cancer. Here, we report a woman with KRAS G12D-mutated CRC, whose tumor did not respond to conventional therapy. The combination of binimetinib, hydroxychloroquine, and bevacizumab was administered as a last-hope option. The patient experienced rapid improvement of the performance status. The tumor lumps demonstrated 17% reduction in the size within the first 6 weeks of the therapy. This report calls for evaluation of the efficacy of a combination of MEK inhibitors and hydroxychloroquine, possibly with the addition of bevacizumab, in chemotherapy-resistant patients with RAS-mutated cancers.

[The current state of radiologic diagnosis in pancreatic cancer]

The article discusses the role of modalities of radiation imaging in the detection and differential diagnosis of pancreatic cancer. There is presented the problem of diagnosis of pancreatic cancer at the early stages and possible ways of its solving. Analysis of literature finds out that the detection and differential diagnosis of small formations of the pancreas are difficult and require a multimodal approach. None of the modern methods could be considered as the "gold standard" for detection and differential diagnosis of pancreatic cancer.

Ultrastructural and biosynthetic changes in epitheliocytes of renal tubules during the development of chronic renal failure

Structural and functional studies of changes in the tubular compartment during progressive renal dysfunction showed that the major types of damage to tubular cells include dystrophy, degeneration, and atrophy. These changes were associated with inhibition of biosynthetic processes in the tubular epithelium, progressive interstitial fibrosis, and disturbances in the structure and function of peritubular microvessels.