Background Disease presentation, prognostic factors, and treatment patterns for breast cancer patients with leptomeningeal metastasis are not well-characterized. In this study, we examined patient characteristics and prognostic factors for survival after a diagnosis of leptomeningeal metastasis. Patients and Methods 318 consecutive breast cancer patients diagnosed with leptomeningeal metastasis from January 1998 to December 2013 at Memorial Sloan Kettering Cancer Center were identified. Clinico-pathologic and treatment information were obtained by retrospective review. Associations with time from leptomeningeal diagnosis to death were evaluated by Kaplan-Meier curves, log-rank tests, and Cox proportional hazard models. Results Of the 318 patients, 44% were HR+HER2−,18% HR+HER2+, 8.5% HR−HER2+, and 25.5% triple negative; 4% had missing information. The median survival was 3.5 months (95% CI: 3.0, 4.0) with 63 patients (20%) surviving greater than 1 year. Recent diagnosis (after 2006), HER2+ subtype, higher performance status, cranial only involvement, and no evidence of non-central nervous system disease were independently associated with improved survival in multivariate analysis. Conclusions Despite the improvement noted with more recent year of diagnosis, survival following a diagnosis of leptomeningeal metastasis remains poor. Similar to patients with parenchymal brain metastasis only, the survival differs among difference receptor subtypes. A closer examination to identify factors, such as introduction of new systemic therapies that may contribute to longer-term survival may provide insight to improve management of these patients. In addition, factors we identified that are associated with survival may be considered as stratification variables in the design of future randomized clinical trials in this population.

To provide dermatologists and oncologists with a foundation for practical understanding and uses of 5α-reductase inhibitors and spironolactone for breast cancer patients and survivors receiving endocrine therapies, including the effect of these treatments on sex hormone levels, any reported drug interactions, and any risk of malignancy.Methods: All published studies from January 1978 through April 2018 were considered, using databases such as PubMed, Google Scholar, and Science Direct. 47 studies were included in this review.Results: There is no evidence of interactions between 5α-reductase inhibitors and spironolactone with endocrine therapies used in breast cancer. Sex hormone alteration with 5α-reductase inhibitor or spironolactone use is variable. 3 randomized controlled trials, 1 case control study, and 6 retrospective cohort studies, including 284 female patients, studied 5α-reductase inhibitors' effects on serum estrogen levels. Levels were increased in 97 of 284 (34%) patients, decreased in 15 of 284 (5.3%) patients, and unchanged in 162 of 284 (57%) patients. 4 retrospective cohort studies, 1 case study, and 1 double-blinded crossover study, including 95 female patients, assessed spironolactone's effect on estrogen levels. Levels were increased in 25 of 95 (26%) patients, decreased in 6 of 95 (6.3%) patients, and unchanged in 64 of 95 (67%) patients. Ultimately, most patients did not have a significant alteration in the level of estrogen when using 5α-reductase inhibitors or spironolactone. No consistent evidence of increased risk of female breast cancer while on spironolactone was reported in 3 studies including49,298 patients; the risk of breast cancer with the use of 5α-reductase inhibitors has not been studied.

An 87-year-old man presented with altered mental status and ataxia was found to have a neuron-restricted antibody in his cerebrospinal fluid, concerning for a paraneoplastic syndrome of unknown origin. He also exhibited anemia, but otherwise normal electrolytes and liver chemistries. He underwent positron emission tomography/computed tomography which revealed abdominal lymphenopathy. He then underwent push enteroscopy and was found to have a jejunal mass, biopsy proven to be malignant mesothelioma. Malignant mesothelioma is 4–5 times more prevalent in men than women. It is limited to the small bowel, and paraneoplastic syndromes are extremely rare and carry a poor prognosis. The presence of anemia with cerebellar symptoms should trigger a search for a paraneoplastic syndrome-related malignancy.

Attempts to carry out clinical trials to improve the treatment of breast cancers, including chemotherapy and targeted oncologic therapies, often exclude women with baseline cardiovascular compromise, such as low ejection fraction or arrhythmia. Therefore, despite concrete evidence of cardiotoxicity from a select number of chemotherapeutic agents, it has been difficult to better characterize the progression of cardiac dysfunction in women with pre-existing cardiac conditions who receive chemotherapy. Women who have impaired cardiac function should be included in future clinical trials, or at least placed in separate trials with careful monitoring, to better assess this high-risk population. This article will discuss the epidemiology, mechanisms, diagnostic methods, and management of cardiotoxicity from systemic chemotherapy used to treat breast cancer.

No abstract

NEURO-ONCOLOGY • NOVEMBER 2016 expression or amplification and 4 were positive. The median survival of the 16 patients with BM was 15.8 mos. No difference in survival from time of diagnosis was found between HER2 positive (n=4) and Her2 negative group (n=6) (18.5 vs. 14.2 respectively, p=0.67). Median time from diagnosis to development of BM was 13.6 mo. for all the patients, with no difference by HER2 status (pos. 13.1 mo. vs. neg. 14.2 mo.). Median survival from the time of BM diagnosis was 2.4 mos. CONCLUSIONS: BM in GAD are a rare event, found in about 4% of GAD patients. HER2 positivity was slightly more common in the BM group than in the general GAD population. HER2 positivity did not affect survival when compared to the HER2 negative group. Updated results for HER2 status of our series of BM will be presented. BMET-30. TREATMENT OPTIONS OF LONG TERM SURVIVORS WITH LEPTOMENINGEAL METASTASES AND BREAST CANCER

INTRODUCTION: Malignant mesothelioma (MM) is a rare cancer of the serosal membranes, the pleura and peritoneum, and causes significant morbidity and mortality. While implants of the bowel wall are common, only two case reports on intraluminal involvement exist. We present a case of an elderly male with dysdiadochokinesia found to have abdominal lymphadenopathy, and a jejunal mass from peritoneal mesothelioma (PM). CASE DESCRIPTION/METHODS: An 87 year-old male with a family history (FH) of colon cancer in one first-degree relative presented with one month of unintentional weight loss, gait instability, and trouble performing alternating movements. Two months prior to admission, evaluation included a negative MRI of the brain but positive CSF analysis for neuron-restricted autoantibody treated empirically with five days of intravenous immunoglobulin (IVIG) and three days of pulse dose steroids. Physical examination was notable for ataxia and dysdiadochokinesia and a benign abdominal exam. He had normal electrolytes and liver chemistries, but was anemic. PET/CT revealed intensely FDG-avid abdominal and mesenteric lymph nodes, one inseparable from the small bowel (Figures 1 and 2). Lymph nodes were not accessible by IR-guided biopsy, so he underwent push enteroscopy and colonoscopy, in light of his FH, to evaluate for anemia. A large, oozing ulcerated mass was found in the jejunum and biopsied (Figure 3). Immunostaining was positive for cytokeratin, CK7, WT1, and calretinin consistent with PM. His neurologic decline was then linked to PNS secondary to PM. He was discharged with plans for carboplatin therapy. DISCUSSION: MM is strongly associated with asbestos exposure, and is four to five times more prevalent in men than women. PM limited to the small bowel is exceedingly rare. Only one previous case report describes a mass spanning the entire small bowel, identified as mucin-positive epithelial mesothelioma. PNS affects 1 in 10,000 patients with cancer; more than 85% of cases are linked to gynecologic and breast cancers causing cerebellar dysfunction via purkinje cell destruction by anti-Yo antibody (Ab). Two cases of PM associated PNS with anti-Yo Ab in the CSF have been reported; one was treated with IVIG and high dose steroids. The treatment of PM is key to stabilizing neurologic symptoms, such as dysdiadochokinesia. The prognosis of PM and associated PNS remains poor. Anemia with cerebellar symptoms should trigger a search for malignancy and rarer causes such as PM.

INTRODUCTION: Breast cancer (BC) is the most common cancer in women in the developed and developing world. Here we report a patient with treated stage II HER2+ BC presenting with abnormal liver enzymes and jaundice, found to have innumerable hepatic lesions consistent with metastatic BC, with rapid progression to acute liver failure(ALF). CASE DESCRIPTION/METHODS: A 63-year-old female with history of stage II HER2+ BC who underwent six cycles of neoadjuvant chemotherapy, lumpectomy, radiation, letrozole for four years, presented with one week of abdominal distension, dark urine, pale stools, and jaundice. She denied a history of hepatitis, intravenous drug use, or herbal supplement use but used marijuana and was a former smoker and heavy alcohol user. Six years prior to admission, two tubulovillous adenomas, 1.0 × 1.0 × 0.8 cm and 1.5 × 1.5 × 1.2 cm were resected. Surveillance colonoscopy, six months later, revealed a tubular adenoma, 0.2 × 0.2 × 0.2 cm and a tubulovillous adenoma, 1.2 × 1.2 × 1.2 cm. She missed her repeat surveillance colonoscopy. Physical examination was notable for jaundice, scleral icterus, hepatomegaly, and abdominal distension. Workup included negative hepatitis panel, platelet count 121,000/uL, total bilirubin 14.2mg/dL, direct bilirubin 10.7mg/dL, alkaline phosphatase 1367 IU/L, aspartate aminotransferase 621 U/L, alanine aminotransferase 252 U/L, albumin 1.5 g/dL, prothrombin time 14.7 seconds, activated partial thromboplastin time 41.5 seconds, international normal ratio 1.2, CA 15-3 3900 U/mL, CA 19-9 7200 U/mL, and CEA 844 U/mL. CT Abdomen/Pelvis revealed innumerable hepatic metastases, hepatomegaly, and small volume ascites (image 1). She underwent IR-guided biopsy of a hepatic lesion, confirmed as metastatic HER2 equivocal BC. Within one week, she became encephalopathic and died whilst deciding between hospice and systemic chemotherapy. DISCUSSION: BC represents about 30% of all cancer diagnoses in women each year. Of those diagnosed at early stages, 20-30% will relapse with metastatic BC. HER2+ BC has a higher risk of relapse than other subtypes, and is more likely to spread to the brain, liver, bone, and lung. This patient’s hepatic involvement was concerning for metastatic BC or colon cancer, based on past tubulovillous adenomas and missed surveillance colonoscopy. Within three weeks of presentation, she died. This case highlights the fulminant progression of HER2+ BC causing ALF due to tumor infiltration of liver parenchyma with cessation of synthetic capacity.