Reproductive and hormonal characteristics (breastfeeding, parity, age at first full-term birth, hormone replacement therapy) were associated with luminal subtype, compared to non-luminal breast cancer, as consistent with previous studies. Obesity and overweight increased the risk of triple negative subtype, particularly in premenopausal women. Older age and use of hormone replacement therapy were related to the risk of HER-2 overexpressing breast cancer. Our data suggest a significant heterogeneity in association of traditional breast cancer risk factors and tumor subtypes.

The trials of T-DM1 as a single agent and in combination with other chemotherapies have shown clinical activity and a favorable safety profile in patients with HER2-positive metastatic breast cancer. There are ongoing studies of T-DM1 showing an increasing tendency towards moving the study of these agents to earlier stages of HER2-positive breast cancer.

Lapatinib is a dual tyrosine kinase inhibitor (TKI) that has a considerable efficacy in ErbB2-positive metastatic breast cancer (MBC). Previous studies revealed that TKIs caused cardiotoxicity in approximately 10 % of the patients. This study assessed the cardiac safety of lapatinib in women with ErbB2-positive MBC. In this observational single center study, all patients with ErbB2-positive MBC who were previously treated with anthracycline, taxanes, and trastuzumab in the adjuvant and/or metastatic setting were assigned to receive lapatinib at a dose of 1,250 mg per day continuously plus capecitabine at a dose of 2,000 mg/m(2) in two divided doses on days 1 through 14 of a 21-day cycle. Cardiac toxicity was assessed with symptoms, transthoracic echocardiography, electrocardiography and biochemical markers (brain natriuretic peptide (BNP), creatine kinase (CK) and creatine kinase-MB) at baseline and every 9 weeks until disease progression. Twenty-six patients were treated with lapatinib and capecitabine therapy for a median of 18 (range 3-60) weeks. The median age was 48 (range 28-83) years. All patients had ErbB2-positive MBC. Among 25 eligible patients, 5 (19.2 %) patients experienced new cardiac events compared with baseline findings. Of these 5 patients, 1 (3.8 %) had T wave negativity, 1 (3.8 %) had sinus tachycardia, 1 (3.8 %) had grade 1 (453 ms) QT prolongation, and 2 (7.7 %) had decreased LVEF below the critical level. Among eligible 21 patients, 2 (7.7 %) had increased BNP, 1 (3.8 %) had increased CK, and 1 (3.8 %) had increased CK-MB level compared with baseline. No serious cardiac events that required monitorization or medication occurred. There was no statistically significant relationship between the duration of lapatinib administration and LVEF changes, QT prolongation, BNP, CK, and CK-MB level. According to our findings, lapatinib was safe and well tolerated and has a low incidence of cardiac side effects. Therefore, it seemed that cardiotoxicity was not a class effect of TKIs. However, despite the absence of clinically significant adverse cardiac effects under lapatinib therapy, the incidence of cardiotoxicity reported in our study was higher than previous lapatinib studies.

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The risk of specific breast cancer subtypes may not be associated with BMI in pre- and postmenopausal breast cancer. However, obesity might be related to an increased risk of premenopausal hormone receptor-negative breast cancer. Further studies are needed for clarification of the probable mechanisms in the pathogenesis of premenopausal hormone receptor-negative breast cancer.

The present study showed that increased Hb levels after tyrosine kinase inhibitor therapy could be a predictive marker of RCC.

A ntineoplastic agents have been shown to cause easily identifiable pigmentary changes involving the skin, mucosa, and appendages in literature. Supravenous hyperpigmentation is a rare complication of chemotherapy administration, easily differentiated from other forms of pigmentations, by its characteristic appearance following the course of the vessels, the antineoplastic agent is administered to. Here, we describe a case of supravenous hyperpigmentation induced by the vinca alkaloid, vinorelbine.The patient is a 51-year-old female, who presented in with a mass in the right breast. A biopsy was performed in May 2005 which revealed estrogen receptor positive (ER+), progesteron receptor positive (PR+), Cerb-B2 1+ infiltrative carcinoma. A thoracic spinal magnetic resonance imaging was conducted, which revealed metastasis in T10, L1, and L5. A thoracic computer tomography (CT) was taken which revealed a mass in the upper right quadrant of the right breast, laterally smaller dispersed nodules and right axillary lymphadenopathy. In September 2007, a bone scintigraphy was performed which demonstrated findings consistent with disseminated bone metastasis. Also, an upper and lower abdominal CT was performed which revealed masses in the liver and bones, originating from the malignancy. Afterward a right mastectomy was performed; the specimen was grade 2 ER, PR+ cerb 2 1+ mixed infiltrative carcinoma. Following chemotherapy, follow-up thoracic, and abdominal CT imaging was performed to evaluate the progress, which showed that the disseminated sclerotic bone metastasis had not regressed whereas the liver metastasis had lessened in size. In the thorax CT performed in July 2011, lung metastasis was also identified. 160 mg of megestrol acetate, twice daily was recommended. Last, the patient was prescribed six cycles of vinorelbine.During the first half hour of the administration of vinorelbine, the patient developed hyperpigmented lesions in the left anterior part of the forearm. With each administration of vinorelbine, the pigmentation got darker in color. (Fig. 1) A biopsy was requested but denied. Following a detailed physical examination, a literature review was performed to identify other cases with similar characteristics. The patient was diagnosed with persistent serpentine supravenous hyperpigmentation due to the administration of vinorelbine; and was asked to return for follow-up after her regimen was completed. During follow-up, in time, the hyperpigmented areas around the course of the veins, with which the chemotherapeutic agent was administered, faded, as also observed by other cases present in literature.

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