RU2325920C1 - Method of peget breast cancer treatment - Google Patents

Abstract

FIELD: medicine; carcinology.

SUBSTANCE: can be applied for treatment of Peget breast cancer. Method substance implies that autoblood is sampled from peripheral vein in two bottles with hemo-preserving agent, 100 ml in each bottle. First bottle is added with doxorubicin dosed 50 mg/m, and second one is added with 5-fluorouracil dosed 750 mg/m² , after that both bottles are incubated in thermostat at temperature 37°C during 30 minutes. Content of first bottle is injected with intravenous dropper followed by the second bottle content on the first and the eighth day of treatment course. Additionally from the first to the seventh day of treatment course cyclophosphan dosed 200 mg/m² is injected intramuscularly. Then in 2 weeks after the last injection of chemical agents surgical procedure is performed in radical volume.

EFFECT: reduced tumour mass, provided epithelisation of skin ulcer, prevented by-effect toxicity of chemotherapy and metastases.

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Description

The invention relates to medicine, more specifically to oncology, and can be used in the treatment of central breast cancer of various stages.

There is a method of treating Paget's cancer of the breast in the very initial stages of the disease, when the nipple or sector of the breast is removed operatively ("Paget's disease - breast cancer", Bazhenova AP, Khananashvili GN, M., Medicine, 1975 g.).

However, the authors themselves say that surgical treatment of the mentioned volume cannot be widely used, since often the invasion of cancer goes along the ducts and the surgeon cannot macroscopically establish its prevalence. The latter leads to the spread of the process and rapid metastasis through the lymphatic system.

A known method of treating Paget cancer of the breast, consisting of several stages. The first of these is surgical, which involves a radical mastectomy with preservation of the pectoral muscles. This is followed by radiation and drug therapy with antitumor chemotherapy drugs (“Paget Cancer of the Breast”, Pogodina EM, et al. Mammology Magazine, No. 1, 2006).

However, surgical treatment provides a radical removal of the lesion, and disseminated tumor cells cannot be exposed to it. Postoperative radiation and chemotherapy have a damaging effect on disseminated tumor cells. The use of these additional therapeutic effects leads to severe complications from hemopoiesis and toxic side effects of cytostatics. Strengthening of gastrointestinal syndrome, development of immunosuppression, suppression of division and growth of blood stem cells, up to the development of pancytopenia. This negatively affects the condition of patients and forces them to interrupt treatment and take additional measures to normalize their condition.

The aim of the invention is to reduce the size of the tumor and the prognosis of the disease.

This goal is achieved by the fact that on the first and eighth day of treatment, the patient is administered doxoribucin at a dose of 50 mg / m ² and 5-fluorouracil 750 mg / m ² , combined with 200.0 ml of autologous blood taken from a peripheral vein and incubated in a thermostat at a temperature 37 ° C for 30 minutes; from the first to the seventh day, intramuscular administration of cyclophosphamide at 200 mg / m ^{2 is} carried out daily, and 2 weeks after drug therapy, surgical removal of the lesion site is carried out with determination of the activity of acid protease (cathepsin D) in the tumor tissue and the perifocal zone.

Analysis of known methods of treating Paget's breast cancer and the claimed, allows us to state the presence of novelty of the developed method.

The novelty of the “Method for the treatment of Paget's breast cancer” lies in the possibility of influencing tumor cells of both the lesion itself and disseminated micrometastases in other organs and tissues. Preoperative drug therapy makes it possible to implement this, it involves both intravenous administration of antitumor chemotherapy drugs and intramuscular administration.

In the available sources of open information in Russia, the CIS countries and abroad, a similar method was not found.

A "method for treating Paget's breast cancer" is industrially applicable. It can be reproduced and repeated many times in specialized medical institutions and surgical clinics of a wide profile.

Considering that cathepsin D is a marker of the invasive and metastatic potential of the tumor and is able to change quantitatively depending on the therapeutic measures taken, we found it possible to use this indicator as a prognosis of the further course of the disease. Studies of cathepsin D in 9 patients with Paget's cancer and in patients with benign tumors in the mammary gland revealed the following: in 5 patients this indicator under the influence of therapeutic measures did not change significantly relative to the norm and after 6 months at the next clinical examination a relapse in the postoperative scar was revealed; in 4 patients with breast Paget's cancer, in which the activity index of cathepsin D was close to that in normal tissue, no relapse or metastasis of the disease has been identified to date.

The method is as follows. After cytological verification of the diagnosis in a patient in the treatment room, autologous blood is collected from the peripheral vein in two bottles with a blood preservative of 100 ml each. In the first bottle add doxoribucin at a dose of 50 mg / m ² , previously dissolved in physiological saline; 5-fluorouracil is introduced into the second vial at the rate of 750 mg / m ² , after which both vials are incubated in a thermostat at a temperature of 37 ° C for 30 minutes and the contents of the first and then second vials are intravenously introduced on the first and eighth day of treatment. Additionally, from the first to the seventh day of treatment, the patient is injected intramuscularly with 200 mg / m ^{2 of} cyclophosphamide. Then, 2 weeks after the last administration of chemotherapy, surgery is performed in the amount of radical mastectomy and the activity of acidic proteinase in the tumor tissue and the perifocal zone is determined.

An example of a specific implementation of the method can serve as an extract from the medical history. Patient Y., born in 1974, medical history No. 12156 / x, was admitted on July 11, 2006 to the Department of Tumors of the Breast, Soft Tissues and Bones of the Rostov Cancer Research Institute, complaining of the presence of a non-healing, bleeding ulcer of the left breast.

The patient has a good physique, satisfactory nutritional status. Skin and visible mucous membranes of normal color. The musculoskeletal system without visible signs of pathology. Turgor tissue preserved. The boundaries of the lungs are normal. Percussion clear pulmonary sound, vesicular breathing, no wheezing. The pulse is uniform, satisfactory filling and tension. Heart sounds are clear, rhythmic. Heart rate of 60 per minute. HELL 110/70 mm Hg The tongue is wet, not coated. The abdomen is soft, painless on palpation in all departments. The liver is not enlarged. The symptom of striking is negative on both sides. Physiological administration without features. Concomitant diseases: chronic cholecystitis.

The mammary glands are developed correctly. No nodules were found in the right mammary gland. In the left mammary gland, complete destruction of the nipple-areolar complex, an extensive ulcerative defect of 3.5 × 3.5 cm, is noted, paraareolarly and on the border of the lower quadrants, the tumor is up to 2.0 cm in diameter, dense, round. In the left axillary region, the lymph node is up to 1.5 cm in diameter, soft elastic consistency.

The patient underwent a puncture biopsy of the tumor and scraping of the nipple of the left breast, which detected carcinoma cells, most likely Paget's cancer, cytological analysis No. 15922-25.

On July 13, 2006, a patient in the treatment room received an autoblood from a peripheral vein in two bottles with a blood preservative of 100 ml each. In the first bottle was added doxoribucin at a dose of 50 mg / m ² , previously dissolved in physiological saline; in the second vial of 5-fluorouracil at the rate of 750 mg / m ² , after which both vials were incubated in a thermostat at a temperature of 37 ° C for 30 minutes and the contents of the first and then second vials were intravenously introduced on the first and eighth day of treatment. From July 13 to July 19, 2006, the patient was injected intramuscularly with 200 mg / m ² cyclophosphamide. 2 weeks after the administration of chemotherapy, complete epithelialization of the skin ulcer at the site of the nipple-areolar complex was noted, the paraareolar palpable tumor decreased by 50% from 2.0 to 1.0 cm in diameter. Figure 1, 2.

The introduction of anticancer drugs satisfactorily. No adverse toxic effects were noted. Blood leukocyte counts ranged within normal limits (from 5.0 to 8.2 × 10%).

On August 7, 2006, patient Y. performed a radical left mastectomy. The results of a histopathological study No. 884315-319 - Paget's cancer, focal lymphocytic infiltration, in the deeper parts of the breast - infiltrating ductal cancer with a predominance of ductal component. In the lymph nodes - sinus histiocytosis, focal deposition of homogeneous eosinophilic masses. In fatty tissue - focal hemorrhages.

The indicators of cathepsin D activity from tumor tissue and the perifocal zone were taken for research. The content of cathepsin D in the tumor was 671 nmol / g of tissue, in the perifocal zone - 575 nmol / g of tissue.

The proposed method was carried out treatment of 9 patients with Paget's breast cancer.

None of the patients reported adverse toxic manifestations of chemotherapy drugs. The treatment was carried out in full. All patients underwent surgery; to date, they are under dispensary observation. In 5 patients, there was a need to remove relapse in the postoperative scar and prescribe additional therapeutic measures.

The technical and economic effectiveness of the "Method for the treatment of breast cancer Paget" is the possibility of:

- achieve a decrease in the size of the tumor;

- to achieve complete epithelialization of skin ulcers at the site of the nipple-areolar complex;

- Avoid toxic side effects of chemotherapy;

- prevent the appearance of clinically not manifest micrometastases in organs and tissues.

Claims (1)

A method for treating Paget's cancer of the breast, including drug therapy, surgical removal of a tumor, characterized in that the patient takes autologous blood from a peripheral vein in two bottles with a blood preservative of 100 ml each, doxorubicin at a dose of 50 mg / m is added to the first bottle ^2, the second vial are administered 5-fluorouracil based 750 mg / m ^2, after which both the vial is incubated in a thermostat at 37 ° C for 30 min and intravenously administered contents of the first, the second and then the first vial and an eight th day of treatment, the first to the seventh day of treatment, the patient is injected intramuscularly with 200 mg / m ² cyclophosphamide, then 2 weeks after the last administration of chemotherapy perform surgery in a volume of radical mastectomy.

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