Multiple rebound-associated vertebral fractures after denosumab discontinuation: is prompt antiresorptive therapy always recommended, even when the risk of fracture seems low? A case report

2021 ◽  
Vol 21 ◽  
Author(s):  
Giangiacomo Osella ◽  
Soraya Puglisi ◽  
Anna Alì ◽  
Giuseppe Reimondo ◽  
Massimo Terzolo
Keyword(s):  
Breast Cancer ◽  
Case Report ◽  
Vertebral Fractures ◽  
Absolute Risk ◽  
Antiresorptive Therapy ◽  
Mineral Density ◽  
Strong Recommendation ◽  
Case Presentation ◽  
Risk Of Fracture ◽  
Antiresorptive Drug

Background: Non-osteoporotic patients with endocrine-sensitive breast cancer are often treated with denosumab only during the anti-aromatase treatment, and when the anti-aromatase therapy is discontinued, no antiresorptive drug is prescribed. This case report clearly shows how even a patient with a low risk of fractures could have multiple rebound vertebral fractures after denosumab discontinuation. Case Presentation: We report the case of a 60-year-old woman who suffered from multiple vertebral fractures only seven months after discontinuation of denosumab that had been administered to prevent bone loss related to three years of aromatase inhibitors as adjuvant therapy for breast cancer. No antiresorptive therapy was prescribed at the time of denosumab discontinuation, assuming that the patient had a low absolute risk of fracture after the withdrawal of the aromatase inhibitor. Conclusion: This case underlines the relative irrelevance of bone mineral density and clinical algorithms in predicting the risk of rebound-associated vertebral fractures after denosumab discontinuation and the strong recommendation to always switch to another antiresorptive therapy (such as zoledronic acid) immediately at the time of denosumab discontinuation.

Risk factors for fractures in patients on hormonal therapies for breast cancer and DCIS.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19627-e19627
Author(s):  
Abdullah Ladha ◽  
Josy Mathew
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Bone Mineral Density ◽  
Aromatase Inhibitors ◽  
Hormonal Therapy ◽  
Mineral Density ◽  
Risk Of Fracture ◽  
Increased Risk ◽  
Hormonal Therapies ◽  
Positive Breast Cancer

e19627 Background: Hormonal therapy with aromatase inhibitors (AI) or tamoxifen (TAM) is standard of care for hormone receptor positive breast cancer and DCIS. Fractures are a complication of treatment with AI due to accelerated bone loss. Risk factors for fracture in patients on hormonal therapy (HT) for breast cancer and DCIS are poorly defined. Methods: All 71 patients with breast cancer or DCIS seen in the bone and mineral clinic of our institution from 2000 to 2010 were analyzed. Data on demographics, pathology, type and duration of HT, bone mineral density studies (BMD), number and site of fractures were collected. Statistical analysis: t test, chi square test and Fisher’s exact test for categorical data. Results: The age of the patients ranged 40 to 97 years. 65 patients had ER positive breast cancer, 6 patients had DCIS. 9 patients had fractures.41 patients were on an AI alone, 8 were on TAM alone and 14 were on both sequentially. Fractures involved: vertebral compression, femur, hip, distal radioulnar, rib, hand and feet bones. Patients who had osteoporosis at the femur, osteoporosis or osteopenia in the lumbar spine or forearm in the initial BMD study were found to have an increased risk of fracture (P<0.05). Patients who were on TAM and AI sequentially had an increased risk of fracture (P<0.05) compared AI alone. The use of bisphosphonates and the duration of use were significantly associated with fracture (P<0.05) as these patients already had osteoporosis. The age, race, duration of AI use and the use of calcium and vitamin D were not found to be significantly different in patients who had fractures compared to those who did not. In the 24 patients who had two BMD studies, there was no significant change in the BMD overall. Conclusions: Patients with osteoporosis or osteopenia at baseline have an increased risk of fracture with the use of hormonal therapies for breast cancer and DCIS. This risk was not eliminated by the use of bisphosphonates. Sequential use of tamoxifen and aromatase inhibitors increase the risk of fractures. Bone mineral density studies done prior to the initiation of hormonal therapy for breast cancer maybe useful estimating the risk of fracture while on treatment.

scholarly journals Docetaxel Retinopathy: A Case Report

2017 ◽  
Vol 8 (1) ◽  
pp. 21-25 ◽  
Author(s):  
Sylvia Nghiem-Buffet ◽  
Salomon Yves Cohen ◽  
Audrey Giocanti-Auregan
Keyword(s):  
Breast Cancer ◽  
Optical Coherence Tomography ◽  
Case Report ◽  
Visual Loss ◽  
Inner Retina ◽  
Case Presentation ◽  
Spectral Domain Oct ◽  
Combined Use ◽  
En Face Oct ◽  
En Face

Background: To report the use of En-face optical coherence tomography (OCT) in a patient treated with docetaxel and tamoxifen for breast cancer for the detection of macular edema (ME) without evidence of leakage on fluorescein angiography (FA). Case Presentation: A 52-year-old woman treated for breast cancer presented with bilateral visual loss for 2 months. FA showed no significant leakage while spectral-domain OCT scans of both eyes showed foveolar and parafoveolar cystic spaces in a moderately thickened macula. En-face OCT segmented at the inner retina showed the petaloid arrangement of cystic cavities, comparable to a cystoid ME. Conclusions: The combined use of tamoxifen could have potentiated the toxic effect of docetaxel on the macula. En-face OCT images may reveal a petaloid aspect of the macula due to cysts in the inner retina segmentation, when FA shows no leakage.

scholarly journals New Drugs, Old Toxicities: Pneumonitis Related to Palbociclib – A Case Report

Breast Care ◽  
2019 ◽  
Vol 15 (5) ◽  
pp. 548-552 ◽  
Author(s):  
Eudald Felip ◽  
Laia Llobera ◽  
Clara Perez-Mañá ◽  
David Quintela ◽  
Ignacio Guasch ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Case Report ◽  
Specific Inhibitor ◽  
Metastatic Breast ◽  
New Drugs ◽  
Cyclin Dependent Kinase ◽  
Breast Cancer Patients ◽  
Case Presentation ◽  
Cyclin Dependent Kinases ◽  
Main Adverse Effect

Background: Palbociclib is a specific inhibitor of cyclin-dependent kinases 4 and 6 that is approved for the treatment of advanced or metastatic breast cancer patients. Despite a good toxicity profile in pivotal trials, where asymptomatic neutropenia was the main adverse effect, its wider use in clinical practice may show less prevalent but serious toxicities. Case Presentation: Here, we describe a case of pneumonitis due to palbocicblib. A 57-year-old female with breast cancer with bone metastasis presented dyspnea at rest 3 months after beginning treatment with palbociclib and letrozole. Palbociclib-induced pneumonitis was considered the most probable cause after ruling out all alternatives, and the patient was successfully treated with steroids and showed complete remission. Conclusions: In summary, we present a well-documented case report of pneumonitis related to palbociclib. However, the mechanism of toxicity is still unknown, and there are as yet no reliable biomarkers to predict toxicity with cyclin-dependent kinase 4/6 inhibitors. In this case report, we alert physicians about new drugs that can provoke old toxicities.

scholarly journals Raloxifene: Mechanism of Action, Effects on Bone Tissue, and Applicability in Clinical Traumatology Practice

2009 ◽  
Vol 3 (1) ◽  
pp. 14-21 ◽  
Author(s):  
Jose R. Caeiro Rey ◽  
Eduardo Vaquero Cervino ◽  
Maria Luz Rentero ◽  
Emilio Calvo Crespo ◽  
Angel Oteo Álvaro ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Postmenopausal Osteoporosis ◽  
Vertebral Fractures ◽  
Negative Effects ◽  
Mineral Density ◽  
Beneficial Effects ◽  
Estrogen Receptor Modulators ◽  
Prevention And Treatment ◽  
Low Incidence ◽  
Receptor Modulators

Raloxifene, a member of the class of selective estrogen receptor modulators (SERM), reproduces the beneficial effects of estrogens on the skeletal systems, without the negative effects estrogens on breast and endometrium. This is a review article summarizing its mechanism, effects on bone and its applicability in traumatology clinical practice. In postmenopausal osteoporosis, this drug has been proven to decrease accelerated bone turnover, increase bone mineral density (BMD), and to structurally recover bone, decreasing the risk of vertebral fractures and the risk of non-vertebral fractures in patients with previous, severe vertebral fractures. Moreover, raloxifene appears to lower the risk of invasive breast cancer. Raloxifene would be efficacious in the prevention and treatment of postmenopausal osteoporosis. We can therefore conclude that raloxifene would be efficacious in the prevention and treatment of postmenopausal osteoporosis, while reducing the risk of breast cancer when used at the indicated dose of 60 mg/day and with a low incidence of side effects.

scholarly journals Male Breast Cancer with Ureteral Metastasis: a case report

2020 ◽  
Author(s):  
Yanbo Chen ◽  
Jiannan Wu ◽  
Tingting Hu ◽  
Juanjuan Wang ◽  
Fengxi Su
Keyword(s):  
Breast Cancer ◽  
Case Report ◽  
Male Breast Cancer ◽  
Genetic Test ◽  
Male Breast ◽  
Luminal A ◽  
Case Presentation ◽  
Lymph Nodes Metastasis ◽  
Gene Test ◽  
Special Case

Abstract Background: Breast cancer is rare in men and there is no report of male breast cancer (MBC) with ureteral metastasis. In this study, we report a special case of MBC with ureteral metastasis. Case presentation: A 60-year-old man was diagnosed with breast cancer and lymph nodes metastasis. After surgery, chemotherapy and radiotherapy he was diagnosed with left arm metastasis. Then he received mass dissection and chemotherapy again. He was diagnosed with ureter metastasis because of hematuria. This patient took a Precitype gene test (immune index and PAM50) after several lines of treatment and the result indicated that this was a Luminal A subtype case, which was quite different from his immunohistochemical subtype. We adjusted his therapeutic regimen according to the genetic test but there was no obvious efficacy and he passed away five months later. Conclusions: MBC patients with urinary symptoms should be considered for the possibility of metastasis although urinary metastasis in breast cancer is rare. We still need more research and evidence of treatment recommendations for MBC.

Bone health management in early breast cancer patients: An Italian osteoncology center experience.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12055-e12055
Author(s):  
Federica Recine ◽  
Alberto Bongiovanni ◽  
Valentina Fausti ◽  
Laura Mercatali ◽  
Nada Riva ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Vertebral Fractures ◽  
Bone Health ◽  
Bone Fractures ◽  
Univariate Analysis ◽  
P Value ◽  
Health Evaluation ◽  
Mineral Density ◽  
Increased Risk ◽  
Post Menopausal

e12055 Background: Bone health evaluation is important for the optimal management of early stage breast cancer (BC) both in post and pre-menopausal setting. Adjuvant endocrine therapy (ET), including luteinizing hormone-releasing hormone (LHRH) analogues with tamoxifen (TAM) and aromatase inhibitors (AI), may affect bone health resulting in a reduction of the bone mineral density (BMD), leading to an increased risk of bone fractures. The objective of this observational study performed at an Italian Osteoncology Center was to evaluate the prevalence of vertebral fractures in pre and post women with BC treated with adjuvant ET. Methods: Data on patients (pts) with early BC were collected from 2011 to 2016 in a single Institution. We investigated the prevalence of vertebral fractures in pre and post pts treated with ET and other potential independent risk factors associated to bone fractures. To evaluate association with bone fractures and clinical factors, univariate logistic models were carried out. P-value of less than 0.05 was considered significant. Results: A total of 1,165 women with early pre and post-menopausal BC were evaluated; for 702 (60.2%) pts treated with ET was available a X-Ray of the spine and they were included in the analysis. The median age was 61 year-old (31-86 y). A total of 124 were pre-menopausal and 578 were post-menopausal pts. Frequency of bone fractures was 17.6% in post-menopausal and, among them, the major risk of bone fractures was associated with AI treatment (OR:4.37, p:0.005); in pre-menopausal pts bone fractures incidence was 6.4% and the major risk was associated to LHRH+AI treatment (OR:2.18, p:0.307). Higher risk of bone fractures was associated with presence of back-pain (OR:1.81, p:0.006), a lower BMD (OR:2.91, p: < 0.001 for pts with BMD≤2.5) and lower level of Vitamin D (OR:2.06, p:0.030 for pts with ≤10) in univariate analysis. Further analysis are ongoing. Conclusions: This Italian experience confirms the importance of bone health evaluation in order to prevent bone fractures in the management of pre and post-menopausal early BC treated with ET.

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