Implementation of the closed system drug-transfer device for preparing and administering chemotherapy eliminated surface contamination with cytotoxic agents at the ambulatory cancer chemotherapy infusion center.

Metaplastic breast cancer (MBC) is a rare neoplasm accounting for <1% of all breast cancer. We evaluated the clinical characteristics and survival outcomes of MBC. MethodsPatients diagnosed with pathologically proven MBC were reviewed from the institutional breast cancer database from 2000 to 2017. ResultsA total of 136 patients diagnosed with MBC were included in the study. The median age of the diagnosis was 60 years, and 60% of patients were stage II at diagnosis, and 22% were stage III. About two-thirds of the patients were triple-negative; 93% had nuclear grade III, and 25% had a lymphovascular invasion. Squamous differentiation (29%) was the most common histologic subtype, followed by the spindle subtype (21%). The most common distant metastases were lung (22%), followed by bone (13%). Moreover, 60% had a mastectomy, 19% had endocrine therapy, 58% had radiation, 51% received anthracycline-based chemotherapy, 26% had non-anthracycline chemotherapy, and 22% received no chemotherapy. In the entire cohort, the two-year overall survival (OS) and five-year OS were 79% and 69%, respectively, and the twoyear progression-free survival (PFS) and five-year PFS were 72% and 61%, respectively. On multivariable analysis, the stage of MBC (stage III: hazard ratio (HR), 5.065 (95% confidence interval (CI), 1.02-25.27) (p=0.048)), poor functional status (Eastern Cooperative Oncology Group (ECOG) score, 2; HR, 24.736 (95% CI, 1.92-318.73) (p=0.014)), and distant metastasis to the brain (HR, 8.453 (95% CI,) (p=0.005)) and lung (HR, 42.102 (95% CI,) (p<0.001)) were significant predictors of decreased OS. ConclusionsMBC demonstrated early disease progression and poor overall survival. The stage of MBC, decreased performance status, and metastasis to the lung and brain were independent poor prognostic factors.

Brentuximab vedotin is a monoclonal antibody that targets the CD30 antigen. It is indicated for the treatment of Hodgkin lymphoma. Hypersensitivity reactions have occurred during infusions of brentuximab vedotin, ranging from mild to severe. We report a case of a 46-year-old male with stage IV nodular sclerosis Hodgkin lymphoma who developed a hypersensitivity reaction to brentuximab vedotin. He experienced a generalized rash, facial swelling, and mild airway obstruction. In order to continue treatment with brentuximab vedotin, we implemented a desensitization protocol. He was premedicated and a 12-step process was performed in which brentuximab vedotin was titrated over three hours. The protocol was successful, allowing the patient to receive subsequent infusions without hypersensitivity reactions.

There are many novel chemotherapeutic options and targeted therapies available for the treatment of colorectal and pancreatic cancer. Patients with these cancers often have hepatic impairment either from the metastasis to the liver or from the chemotherapy or targeted therapies used to treat the disease. It is important to describe the effects of these agents in patients with hepatic impairment. This article will review the dosage recommendations for the chemotherapy regimens and targeted therapies in colorectal and pancreatic cancer patients in the setting of hepatic impairment.

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