Vinorelbine induced perforation of a metastatic gastric lesion

Abstract

BackgroundBreast carcinoma metastasis to the gastrointestinal tract is rare and more frequently associated with lobular than ductal carcinoma (Borst and Ingold, Surg 114(4):637–641 [1]). The purpose of this article is to present a case based review of a unique gastrointestinal metastasis and literature review.MethodsA 46 year old lady with metastatic invasive ductal breast cancer was admitted to A&E with sudden onset of epigastric and left shoulder pain. She completed the first cycle of capecitabine/vinorelbine 1 week previously. Clinical examination revealed a tender epigastrium with rigidity in the upper abdomen. Free air under the diaphragm and a positive Rigler’s sign was radiologically identified. A laparoscopy demonstrated a fibrinous exudate in the left upper quadrant consistent with a walled off lesser curvature gastric perforation. A subsequent oesophagogastroduodenoscopy (OGD) demonstrated a healed gastric ulcer of benign appearance; however the pathology confirmed metastatic breast carcinoma.ResultsLiterature review confirmed no previously reported cases of vinorelbine induced gastric perforation. Four cases of metastatic breast cancer with gastric metastasis presenting with perforation were identified; three of these cases (Fra et al., Presse Med 25(26):1215 (1996) [2], Solis-Caxaj et al., Gastroenterol Clin Biol 28(1):91–92 (2004) [3], Ghosn et al., Bull Cancer 78(11):1071–1073 (1991) [4]), were in the French medical literature, including one male patient (Fra et al., Presse Med 25(26):1215 (1996) [2]) and at least one ductal breast carcinoma (Solis-Caxaj et al., Gastroenterol Clin Biol 28(1):91–92 (2004) [3]). The fourth case (van Geel et al., Ned Tijdschr Geneeskd 144(37):1761–1763 (2000) [5]), was in the Dutch medical literature and a lobular breast carcinoma.ConclusionThis case represents a rare complication of breast cancer chemotherapy, the subsequent significant benefit the patient received from treatment is consistent with the chemosensitivity to therapy that also resulted in gastric perforation. Five years after gastric perforation she resumed palliative chemotherapy after progression on sequential hormonal therapies.

<p>Review of Curcumin Physicochemical Targeting Delivery System</p>

“…After 96 hours, almost 60% of CUR was released at pH 6.4 and 5.0, whereas only 40% CUR was released at pH 7. 4 70 These results proved prodrug delivery nano-systems is an effective way to improve the anticancer action. However, it often suffers from the slow drug release followed by delaying onset of pharmacological action.…”

“…However, the clinical usefulness of chemotherapy drugs are still restricted by severe toxic and side-effects such as myelosuppression, immunologic suppression, gastrointestinal reaction, and peripheral neuropathy. [1][2][3][4][5] Some effective components of plants used in traditional medicine without the serious side-effects, as a supplementary treatment, have been widely studied. 6,7 Among them, Curcumin (CUR), a traditional Chinese medicine monomer, has been extensively studied with broad pharmacological activities, as summarized in Figure 1.…”