Uwe Güth

1034 Background: Anthracycline- and taxane-based adjuvant chemotherapy is the common systemic treatment in TNBC to date. Addition of platinum derivatives in the neo-adjuvant setting showed improved pathological complete response. In the advanced/metastatic setting, complete and partial responses were improved in patients with BRCA1/2 mutations but not in an unselected population. Data on platinum-derivatives in the adjuvant setting are limited. Our study evaluated the role of carboplatinum in addition to standard adjuvant therapy in early TNBC patients after primary surgery. Methods: We conducted a retrospective, single-center study in a Swiss cohort. All patients with stage I – III TNBC who underwent primary breast surgery and axillary staging between 2003 and 2014 were included. Patients with neoadjuvant or palliative treatment were excluded. Two cohorts were identified: Cohort A with standard chemotherapy (anthracyclines and taxanes), cohort B with additional carboplatinum-treatment. Results: Eighty-three patients with TNBC post breast surgery and axillary staging with subsequent adjuvant chemotherapy were identified. Stage and grade were well balanced between cohorts. Patients in cohort A (N = 54) were treated with anthracycline- and taxane-based regimes while patients in cohort B (N = 29) additionally received carboplatin. Most commonly, patients received 4 cycles of epirubicin/cyclophosphamide, followed by 4 cycles of docetaxel/carboplatin. There was no significant difference in relapse free (distant or local) survival (p = 0.755). Mean relapse free survival was 100 vs. 98 months. There was also no difference in overall survival between the two cohorts (p = 0.208). Mean survival was 98 vs. 91 months. In cohort A, 43.47% had 6 or more cycles of treatment vs. 89.7% in cohort B (p < 0.001). Conclusions: In an unselected cohort of early TNBC, addition of carboplatin in an adjuvant setting was not beneficial. The sample is too small to define subgroups of patient, which might benefit from carboplatin therapy. Further prospective trials to evaluate the addition of platinum in the adjuvant setting are warranted.

Introduction Pyoderma gangrenosum (PG) is a rare ulcerative skin disease characterized by a wide variety in its clinical presentation and outcome. The etiology is unknown and the pathogenesis is poorly understood, but autoimmune mechanisms have been suggested. Gynecological reports about PG are particularly scarce. As gynecologists rarely encounter this disorder, the correct diagnosis can easily be missed. Patients and Methods This paper presents the first case to our knowledge of an idiopathic PG of the vaginal vault as a late complication after vaginal hysterectomy. Conclusion We demonstrate how PG, a rare disorder, might be misdiagnosed and how only the correct diagnosis and treatment involving systemic glucocorticoids and wound care can spare the patients from long-term morbidity.

Nonoperative but systemic therapy as first-line management is offered to some patients with breast cancer (BC) who have assumed limited life expectancy, such as older women or those who have distant metastases at initial presentation. We evaluated rates of and predicting factors for success and failure of this therapy approach. Seventy-five patients who were initially treated only systemically, and cases in which local control while avoiding surgery was the intended long-term therapy goal were analyzed. Additionally, two stage-dependent subgroups were distinguished (A: stage I-III, n = 31; B: stage IV, n = 44). Failure of therapy was defined as when secondary surgery had to be performed due to locoregional progression or in case of no surgery when severe locoregional clinical signs/symptoms were observed during the further course. Patients in group A were older than those in group B (81 vs. 67.5 years; P < 0.001) and showed an increased survival (5-year rates: 40.2% vs. 24.3%). In 24 patients of the entire cohort (32%), secondary surgery had to be performed; surgery was performed more often in group A (58.1% vs. 13.6%). In the cases in which no surgery was performed (n = 51), 11 women (21.6%) suffered from severe locoregional symptoms in the palliative situation (A: n = 1; B: n = 10). Although the presence of stage IV was a significant factor for therapy success (odds ratio (OR), 2.59; 95% confidence interval (CI), 0.95–7.05; P = 0.039), skin involvement was associated with failure of therapy (OR, 3.57; 95% CI, 1.16–11.11; P = 0.031). Nonoperative treatment may be offered to selected patients with BC who have assumed limited life expectancy. These women must be openly informed that this approach is not successful in nearly half of the cases.

In the western world, cannabis is the most widely used drug of abuse. Cannabinoid hyperemesis syndrome, which seems to be a rare paradoxical reaction in individuals with a particular predisposition, is characterized by cyclic severe nausea and vomiting in long-term cannabis users. While the symptoms are unresponsive to antiemetic drugs, compulsive hot baths result in a considerable symptom relief. We report the first case of cannabinoid hyperemesis syndrome in pregnancy. A 26-year-old patient was admitted to our clinic in the 10th week of gestation. Before undertaking time-consuming and expensive medical examinations to rule out other medical reasons for therapy-resistant hyperemesis in pregnancy, obstetricians should determine whether compulsive bathing or showering provides symptomatic relief and ask specific questions regarding possible/suspected cannabis consumption.

The term "familial male breast cancer" is often misleading, because in the breast cancer families reported in the literature, the vast majority of the patients were women and only a few were men. In this report, we present the rare case of a strictly defined familial male breast cancer (MBC) in which exclusively men were diagnosed with breast cancer. Three of four brothers developed the disease between the age of 46 and 64 years within a period of 21 years whereas all female relatives remained unaffected. The three affected men did not show the typical known clinical and genetic risk factors for MBC. An X-linked recessive inheritance may be possible in these cases. One way to potentially improve the identification of the causes of MBC could be a through a strictly studying families in which the male members were exclusively diagnosed with this malignancy. This approach emphasizes familial MBC as a distinct entity and not only as a variant of female breast cancer.

Purpose The treatment of recurrent ovarian carcinoma (ROC) has become increasingly oriented according to the therapy principles of a chronic disease. We evaluated whether it is justifiable to also apply this concept to the treatment of platinum resistant patients with their known poor prognosis and short overall survival (OS). Methods We analyzed the overall courses of 85 unselected ROC patients and defined the following groups: A, platinum resistant patients (n = 39); subgroup A.1, those who received no or at maximum one line of palliative chemotherapy (n = 15, 38.5%); subgroup A.2, those who received ≥ two therapy lines (n = 24, 61.5%); B, platinum sensitive patients, n = 46. Results Group A had significantly lower OS than group B (median: 16 vs. 25 months; p = 0.019). Group A.1 had significantly worse outcome compared to group A.2 (median: 5 vs. 21.5 months; p < 0.001). The comparison between study group A.2 and group B showed comparable survival rates (p = 0.738). Considering only the patients who had completed treatment courses, the median number of therapy lines administered was higher in group A.2 than in group B (4 vs. 3; p = 0.008). Conclusions There is not only the known dichotomy between platinum sensitive and resistant ROC patients, but rather also within the platinum resistant subgroup itself. There is a considerably large subgroup of platinum resistant patients who will subsequently enter a phase where multiple treatment programs will be considered and administered. These patients have similar survival rates compared to those from the platinum sensitive patient group and the therapy principles of a chronic disease are applicable.

Objective: To depict a clear and coherent picture of the overall course of palliative treatment in an unselected study cohort over the course of time. Methods: We compared therapy type and course of 242 women whose distant metastatic disease was diagnosed from 1990 to 2006 and who ultimately died of the disease. We divided the patients into two subgroups depending on the year of diagnosis of metastases (group A: 1998–2006 vs. group B: 1990–1997). Results: In both subgroups, there were no significant differences in the general type of treatment and the number of administered therapy lines (no systemic therapy: 12.9 vs.13.7%, p = 0.848; endocrine therapy only: 20.4 vs. 25.2%, p = 0.430; chemotherapy only: 18.4 vs.16.9%, p = 0.735; sequential combination regimen including endocrine therapy/chemotherapy/trastuzumab: 46.9 vs. 44.2%, p = 0.694; median: 2 lines). In the cases where chemotherapy was administered, there were no differences between the number of lines among older and younger patients (median: two lines; ≥70 years vs. Conclusion: The number of patients who died from metastatic breast cancer without receiving any antineoplastic therapy was surprisingly high. The use of newer agents and regimens in the treatment of metastatic breast cancer was associated with an improved survival over time. Chemotherapy is a feasible option also among older patients.