What is known and objective Trastuzumab can significantly prolong the survival of patients with human epidermal growth factor receptor‐2 (HER‐2)‐positive breast cancer. Trastuzumab‐induced thrombocytopenia is a rare adverse effect. There have been no reports of acute, grade 4 thrombocytopenia after weekly trastuzumab therapy. The study reports a case of a breast cancer patient with severe thrombocytopenia due to trastuzumab infusion (8 mg/kg). Moreover, the patient experienced recurrence of severe thrombocytopenia after receiving weekly trastuzumab therapy (4 mg/kg). Case summary A 52‐year‐old woman with HER‐2‐positive breast cancer developed diffuse petechial haemorrhages and ecchymosis on the lower limbs and gingival bleeding within 24 hours of trastuzumab infusion (8 mg/kg). She was confirmed to have severe thrombocytopenia, which quickly recovered after corticosteroid therapy and platelet transfusion. When her platelet count recovered, we attempted weekly trastuzumab therapy (4 mg/kg); however, thrombocytopenia recurred within 24 hours. Thus, we did not attempt further treatment with trastuzumab. What is new and conclusion We are the first to attempt weekly trastuzumab therapy after thrombocytopenia induced by its initial administration. Reducing the trastuzumab dose did not prevent trastuzumab‐induced thrombocytopenia. Unlike other reports with administration of high‐dose corticosteroid, we found that a standard dose of corticosteroid combined with platelet transfusion was effective in treating trastuzumab‐induced thrombocytopenia.
Background:To analyze the associated factors that affect the coloration of methylene blue (MB) in axillary lymph node dissection (ALND) of patients with breast cancer and to explore the tracer effect of MB in high axillary lymph node metastasis, to guide surgical treatment.Methods: We recruited 170 patients who underwent ALND, all of them were injected MB before operation. We analyzed the relationships between the clinical factors of age, body mass index (BMI), molecular typing, TNM staging, neoadjuvant chemotherapy, injection time and position and the MB coloration by univariate and multivariate analyses. A total of 84 cases were selected for observation of the application value of MB during intervention involving the lymph nodes upper axillary vein.Results: Of 170 cases, 138 cases (81.17%) were colored. Univariate analysis showed that significant differences were observed between differing BMI's (χ 2 =24.074, P<0.0001) and injection times (χ 2 =41.207, P<0.0001). Multivariate analysis showed that injection time (P=0.016) was the clinical factor associated with MB coloration. More than 60 minutes before surgery and MB injection, the possibility of methylene blue colored was 0.088 times higher than 10 minutes (P=0.010, 95% CI, 0.014, 0.554). MB was used to track the lymph node upper axillary vein with a sensitivity of 12.5%, a specificity of 100%, a false negative rate of 87.50%, and a false positive rate of 0; the kappa coefficient was 0.051 (χ 2 =0.679, P=0.404).Conclusions: Among the clinical factors, MB coloration was worse more than 60 minutes before ALND.Using the technology of MB color, lymph nodes can be clearly identified. It has great guiding value for the doctors who learn the operation initially. However, it is still prudent to use MB for high lymph node dissection.
Background and objectiveChemotherapy is the most common treatment in breast cancer , and neoadjuvant chemotherapy (NAC) is wildly used because of it’s efficiency and safety. To identify significantly differentially expressed genes and select the most suitable breast cancer patients for neoadjuvant chemotherapy (NAC) before treatment. MethodsWe collected a total of 60 breast cancer patient samples before and after NAC. All the samples were subjected to high-throughput RNA sequencing (RNA-seq). Then , we identified AHNAK, CIDEA, ADIPOQ, and AKAP12 as candidate genes related to tumour chemotherapeutic resistance. Next, we analysed the expression levels of AHNAK, CIDEA, ADIPOQ, and AKAP12 by logistic regression and based on the result, we constructed a predictive model visualized by a nomogram. ResultsThe RNA-seq results show that AHNAK, CIDEA, ADIPOQ and AKAP12 are upregulated in residual disease after NAC (P<0.05), and compared with the pathological complete response (pCR) group, the non-pCR group presented high AHNAK, CIDEA, ADIPOQ and AKAP12 expression levels (P<0.05). Logistic analysis showed that high AHNAK, CIDEA, ADIPOQ and AKAP12 expression levels significantly reduced the pCR rate of NAC for breast cancer (P<0.05). In addition, our prediction model , which included AHNAK, CIDEA, ADIPOQ and AKAP12 , showed a good fitting effect with the H1 test (χ2=6.3967, P=0.4945) and the receiver operating characteristic (ROC) curve (area under the curve (AUC) 0.8249, 95% CI 0.722–0.9271). ConclusionHigh expression of AHNAK, CIDEA, ADIPOQ and AKAP12 indicates poor treatment response in breast cancer patients treated with NAC . The efficacy prediction model based on these results is expected to be a new method to select the optimal population of breast cancer patients for NAC.
Background: Trastuzumab can significantly prolong the survival of patients with positive human epidermal growth factor receptor-2 breast cancer. Until now, trastuzumab has been used by millions of people, and trastuzumab-induced thrombocytopenia is rare. There is no report of acute grade 4 thrombocytopenia after weekly trastuzumab therapy. We report a breast cancer patient with severe thrombocytopenia due to trastuzumab (8mg/Kg) who experienced a recurrence of severe thrombocytopenia after attempting weekly trastuzumab therapy (4mg/Kg). Case presentation:A 52-year-old woman with positive human epidermal growth factor receptor-2 breast cancer developed acicular rash with dense skin all over the body and gingival bleeding within 24 hours of trastuzumab infusion (8mg/Kg) and was confirmed to have severe thrombocytopenia, which was quickly recovered after high-dose corticosteroid pulse therapy. When the platelet count recovered, we tried weekly trastuzumab therapy (4mg/kg), Unfortunately, thrombocytopenia recurred within 24 hours. No third trastuzumab treatment was attempted. Conclusion: We are the first report to try weekly trastuzumab therapy after thrombocytopenia induced by first trastuzumab. The patient showed that reducing the dose of trastuzumab was ineffective in preventing trastuzumab-induced thrombocytopenia.
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