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    • tetracycline hcl Along the same line there is no information

    2019-05-05

    Along the same line, there is no information in the literature on the optimal RT schedule in such cases. Doses ranging from 40 to 45Gy should be adequate and we chose to give 2Gy daily. This schedule was based on clinical and radiological evolution of the patient. RT limits natural evolution of the disease but has not been shown to favor bone regeneration. The presence of osteoclasts in the affected bones in active GSD justifies the use of bisphosphonates. Intravenous bisphosphonates have been extensively used in cancer patients with tumor bone disease and they are now part of the routine management of patients with bone metastases [23,26]. They markedly inhibit osteoclastic activity and decrease the frequency of skeletal-related events. As judged by the suppression of CTX levels in our patient, osteoclast activity was markedly inhibited and it is likely that zoledronic tetracycline hcl contributed to partial bone regeneration [13,29] (Fig. 5). In parallel to the marked clinical improvement, X-Rays and MRI suggested indeed new bone formation. Such bone regeneration is extremely rare in GSD. A bone biopsy after treatment would have probably confirmed decreased osteoclast activity and the progressive replacement of lymphagiomatic and fibrous tissue by a new bone formation but it was not performed because it would not have influenced our therapeutic attitude.
    Conclusion
    Conflict of interest statement
    Introduction Bone is the most common site of metastatic spread of breast cancer, and bone metastases remain incurable [1,2]. Bone metastases are also associated with significant pain, reduced quality of life and skeletal related events (SREs), such as radiotherapy or surgery to the bone, pathological fractures, spinal cord compression, or hypercalcaemia [3,4]. Bone metastases from breast cancer are commonly treated with agents that block bone turnover, such as bisphosphonates or the antibody to the Receptor Activator NF-KB ligand (RANKL), denosumab [5–8]. However, despite statistically significant reductions in SREs with bone-targeted agents, the absolute benefits are modest with no consistent progression free survival (PFS) or overall survival (OS) benefit [5,9,10]. The ability to identify new treatment combinations that prolong survival for patients with bone metastatic breast cancer as well as to identify novel biomarkers of absolute benefits from the use of both bone-targeted therapies and novel anti-cancer agents would be exceedingly valuable. In the context of breast cancer bone metastases, VEGF can act as an osteolytic factor in the presence of RANKL, further promoting osteoclast maturation and activation [11,12]. Increased VEGF serum levels are associated with more extensive bone metastases and reductions in serum VEGF levels in these patients have been shown to correlate with response to bisphosphonates [13,14]. As such, the Zamboney study was designed to assess whether patients with bone predominant metastatic breast cancer could benefit from the addition of the targeted agent vandetanib to standard endocrine therapy with fulvestrant. Vandetanib (aka ZACTIMA or AZD6474) is a tyrosine kinase inhibitor predominantly targeting the vascular endothelial growth factor receptor (VEGFR)-2, the epidermal growth factor receptor (EGFR), and the REarranged during Transfection (RET) kinase. The primary results are reported elsewhere [15], but briefly, the addition of vandetanib to fulvestrant was not shown to enhance PFS, OS or tumor response as measured by circulating levels of urinary N-telopeptide (uNTx) [15]. Interestingly, a statistically non-significant trend was observed of a differential treatment effect based on baseline uNTx, suggesting the possibility of a predictive effect. Specifically, no difference in OS or PFS was observed between vandetanib and placebo treated patients who had normal baseline NTx, however, amongst patients with abnormal NTx (i.e. >65nM BCE/mmol Creatine), those who received vandetanib had improved PFS and OS. A test for interaction was statistically significant (p=0.028) with PFS, but not for OS (p=0.25). Hence, we performed additional biomarker analyzes in order to investigate the possibility of whether particular subgroups of patients derived greater benefit from vandetanib.