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Introduction: Breast cancer is the most common type of cancer and the leading cause of death by cancer in women in Colombia. Approximately 15 to 20% of breast cancers overexpress HER2. Objective: To analyze the relationship between multiple clinical and histological variables and pathological complete response in patients with HER2-positive breast cancer undergoing neoadjuvant therapy in a specialized cancer center in Colombia. Materials and methods: We performed a retrospective analysis of non-metastatic HER2-positive breast cancer patients who received neoadjuvant therapy between 2007 and 2020 at the Instituto de Cancerología Las Americas Auna (Medellín, Colombia). Assessed parameters were tumor grade, proliferation index, estrogen receptor, progesterone receptor, HER2 status, type of neoadjuvant therapy, pathologic complete response rates, and overall survival. Results: Variables associated with low pathologic complete response rates were tumor grades 1-2 (OR = 0.55; 95% CI = 0.37-0.81; p = 0.03), estrogen receptor positivity (OR =0.65; 95%; CI = 0.43-0.97; p=0.04), and progesterone receptor positivity (OR = 0.44; 95% CI = 0.29-0.65; p = 0.0001). HER2 strong positivity (score 3+) was associated with high pathological complete response rates (OR = 3.3; 95% CI = 1.3-8.35; p=0.013). Five-year overall survival was 91.5% (95% CI = 82.6-95.9) in patients with pathological complete response and 73.6% (95% CI = 66.4-79.6) in patients who did not achieve pathological complete response (p = 0.001). Additionally, the pathological complete response rate was three times higher in patients receiving combined neoadjuvant chemotherapy with anti-HER2 therapy than in those with chemotherapy alone (48% versus 16%). Conclusions: In patients with HER2-positive breast cancer, tumor grade 3, estrogen receptor negativity, progesterone receptor negativity, strong HER2 positivity (score 3+), and the use of the neoadjuvant trastuzumab are associated with higher pathological complete response rates.

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OBJECTIVE: The aim of this study was to investigate the predictive importance of the previously validated log(ER)*log(PgR)/Ki-67 predictive model in a larger patient population. METHODS: Patients with hormone receptor positive/HER-2 negative and clinical node positive before chemotherapy were included. Log(ER)*log(PgR)/Ki-67 values of the patients were determined, and the ideal cutoff value was calculated using a receiver operating characteristic curve analysis. It was analyzed with a logistic regression model along with other clinical and pathological characteristics. RESULTS: A total of 181 patients were included in the study. The ideal cutoff value for pathological response was 0.12 (area under the curve=0.585, p=0.032). In the univariate analysis, no statistical correlation was observed between luminal subtype (p=0.294), histological type (p=0.238), clinical t-stage (p=0.927), progesterone receptor level (p=0.261), Ki-67 cutoff value (p=0.425), and pathological complete response. There was a positive relationship between numerical increase in age and residual disease. As the grade of the patients increased, the probability of residual disease decreased. Patients with log(ER)*log(PgR)/Ki-67 above 0.12 had an approximately threefold increased risk of residual disease when compared to patients with 0.12 and below (odds ratio: 3.17, 95% confidence interval: 1.48-6.75, p=0.003). When age, grade, and logarithmic formula were assessed together, the logarithmic formula maintained its statistical significance (odds ratio: 2.47, 95% confidence interval: 1.07-5.69, p=0.034). CONCLUSION: In hormone receptor-positive breast cancer patients receiving neoadjuvant chemotherapy, the logarithmic model has been shown in a larger patient population to be an inexpensive, easy, and rapidly applicable predictive marker that can be used to predict response.

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OBJECTIVE: Glucose transporter-1 is a marker involved in energy transport in cancer cells. It has been shown to be a poor prognostic factor in many cancer types, including breast cancer. However, there is no satisfactory parameter predicting treatment in breast cancer patients receiving neoadjuvant therapy. This study investigated the effect of glucose transporter-1 in predicting the treatment response of patients receiving neoadjuvant therapy. METHODS: In this study, glucose transporter-1 immunohistochemistry was applied to tru-cut biopsy of patients who were diagnosed with breast cancer and received neoadjuvant therapy between 2010 and 2021. A built-in scoring system was used to evaluate both the pattern and intensity of glucose transporter-1 immunohistochemistry staining. The relationship between glucose transporter-1 immunohistochemistry staining and other clinicopathological parameters was examined. In addition, the relationship of glucose transporter-1 with response to treatment was investigated. RESULTS: A relationship was found between high glucose transporter-1 expression and other clinicopathological parameters (such as estrogen and progesterone receptor negativity, high Ki-67, triple-negative, and Her2 status). Cases with high glucose transporter-1 expression had either a complete or a partial pathologic response. The result was statistically significant. CONCLUSION: Glucose transporter-1 has the potential to be a biomarker that can be evaluated more objectively as an alternative to Ki-67 labeling index in evaluating the response to treatment in patients receiving neoadjuvant therapy.

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Progesterone receptors (PR) play a pivotal role in many female reproductive tissues such as the uterus, the ovary, and the mammary gland (MG). Moreover, PR play a key role in breast cancer growth and progression. This has led to the development and study of different progestins and antiprogestins, many of which are currently being tested in clinical trials for cancer treatment. Recent reviews have addressed the role of PR in MG development, carcinogenesis, and breast cancer growth. Thus, in this review, in addition to making an overview on PR action in normal and tumor breast, the focus has been put on highlighting the still unresolved topics on hormone treatment involving PR isoforms and breast cancer prognosis.

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CONTEXTO CLÍNICO: Los miomas uterinos son los tumores benignos más comunes del tracto reproductivo femenino. Se los conoce también como fibroleiomiomatosis, leiomiomatosis, fibromiomatosis o fibromas uterinos. Se producen por una mutación de los miocitos uterinos ante la estimulación de los receptores de estrógenos que producen factores de crecimiento y de los receptores de progesterona que inducen mitosis e inhiben la apoptosis en miocitos de miomas. Se clasifican en miomas intramurales, submucosos, subserosos y cervicales. TECNOLOGÍA: El acetato de ulipristal es un modulador selectivo de los receptores de progesterona de las células del mioma, inhibiendo la proliferación celular y de la matriz extracelular a través de la inducción de apoptosis. También reduce la expresión de citoquinas proinflamatorias. Produce cambios celulares del endometrio miomatoso sin afectar el resto del endometrio ni los vasos sanguíneos. OBJETIVO: El objetivo del presente informe es evaluar la evidencia disponible acerca de la eficacia, seguridad y aspectos relacionados a las políticas de cobertura del uso de ulipristal en miomatosis uterina. MÉTODOS: Se realizó una búsqueda en las principales bases de datos bibliográficas, en buscadores genéricos de internet, y financiadores de salud. Se priorizó la inclusión de revisiones sistemáticas (RS), ensayos clínicos controlados aleatorizados (ECAs), evaluaciones de tecnologías sanitarias (ETS), evaluaciones económicas, guías de práctica clínica (GPC) y políticas de cobertura de diferentes sistemas de salud. RESULTADOS: Se incluyeron dos revisiones narrativas, cuatro GPC, cuatro evaluaciones económicas, y seis informes de políticas de cobertura para el acetato de ulipristal en miomatosis uterina. No se encontraron estudios que comparen el uso de acetato de ulipristal versus miomectomía o histerectomía. CONCLUSIONES: Evidencia de alta calidad sugiere que el uso de acetato de ulipristal en mujeres de edad fértil con miomatosis uterina sintomática, sería más efectivo y más seguro que los análogos de hormona liberadora de gonadotrofina controlando las metrorragias moderadas y severas, y reduciendo el tamaño tumoral a corto plazo. No se encontraron estudios que evalúen la reducción de tasas de miomectomía o histerectomía. Las guías de práctica clínica de Latinoamérica, Europa y Canadá consideran al ulipristal como uma alternativa válida a los análogos de hormona liberadora de gonadotrofina en mujeres en edad fértil con metrorragias severas, anemia sintomática, miomas mayores a 3 cm y necesidad de preservar el útero. La mayoría de los financiadores de salud europeos dan cobertura a este tratamiento. No es cubierta por financiadores estadounidenses por no tener aprobación por la agencia regulatória estadounidense para esta indicación. No se encontraron políticas de salud en Latinoamérica.

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Os autores fizeram uma revisão de literatura acerca da análise doplervelocimétrica como ferramenta ultrassonográfica do comportamento biológico da vasculatura uterina e do leiomioma uterino, e procuraram averiguar, por meio de revisão da literatura, se o Doppler poderia diferenciar o leiomioma do leiomiossarcoma e avaliar a resposta ao tratamento clínico com agonistas do GnRH, moduladores seletivos de receptores de progesterona e procedimentos minimamente invasivos destes tumores. Outros tipos de tratamento não foram avaliados. Apesar do restrito número de estudos e da baixa casuística de cada pesquisa isoladamente, observou-se que há uma mudança no índice de resistência dos parâmetros doplervelocimétricos após o tratamento farmacológico e/ou minimamente invasivo do leiomioma uterino; as demais variáveis se comportam de forma variável. Concluiu-se, portanto, que a doplervelocimetria parece não se constituir ainda um parâmetro confiável para diferenciar o leiomioma do leiomiossarcoma e de avaliação de resposta ao tratamento clínico

The authors performed a literature review about Doppler velocimetry as the ultrasonographic tool of the biological behavior from uterine and leiomioma vascularization. They also tried to ascertain through literature review if Doppler could differ between leiomioma to leiomyossarcoma and assess response to clinical treatment with GnRH agonists, selective modulators of progesterone receptors and minimally invasive procedures of these tumors. Other types of treatment were not evaluated. Despite the restrict number of studies and low sampling of each research, there was a change on resistant index from Doppler velocimetry patterns after pharmacological and/or minimally invasive treatment of uterine leiomioma; other indices behaved diversely. Therefore, we concluded that Doppler velocimetry does not constitute a good pattern to differ uterine leiomioma from leiomyossarcoma and of response assessment to clinical treatment

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La expresión de receptores de estrógeno (RE) y de progesterona (RP) constituyen una variable de valor pronóstico en el cáncer de mama, donde la respuesta a la terapia endocrina ser  más favorable en tumores con estos receptores positivos. El objetivo del presente trabajo fue determinar la expresión de RE y de RP y su asociación con las variables pronósticas: edad, presencia de ganglios linfáticos axilares con metástasis, tamaño del tumor, grado histológico, grado nuclear, estadio clínico, tiempo libre de enfermedad y sobrevida. Se estudiaron 53 pacientes con carcinoma de mama, con edades comprendidas entre 29 y 77 años, diagnósticadas en el Instituto Oncológico "Dr. Miguel P‚rez Carreño" que no habían recibido quimioterapia. Los cortes de biopsias se analizaron por inmunohistoquímica, utilizando el método de estreptavidina-biotina-peroxidasa. En los resultados obtenidos se observó un 22,6 por ciento de expresión de RE y un 18,8 por ciento de RP con una asociación significativa entre ambos receptores (p< 0,005). Se evidenció relación significativa entre los RE y la edad de las pacientes (p<0,005), el porcentaje de negativos fue mayor en los pacientes hasta los 50 años y el porcentaje de positivos mayor en el grupo de más de 50 años. Las pacientes con RE y RP positivos presentaron mayor tiempo libre de enfermedad y mayor sobrevida aunque sin significación estadística. No se observó asociación significativa entre el estatus de los receptores de estrogeno y progesterona con las demás variables en estudio

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Se estudió el contenido de receptores a estradiol y progesterona en el tejido mamario de pacientes con mastopatía fíbroquística (MFQ). Se formaron 4 grupos diferentes de acuerdo al tipo de receptor que se encontró: (R-E+, R-Pg+); (R-E+, R-Pg-); (R-E-, R-Pg-).El 7 por ciento de las MQF fueron positivos para ambos receptores, mientras que el 75 por ciento fueron negativos tanto para el receptor a estraqdiol como para el de progesterona. El 10 por ciento presentan el (R-E+) y el 80 por ciento fueron (R-Pg+). El número de unión específica encontrada en este tipo de patología considerados "Receptor positivo" de este estudio, estuvieron en el rango de 6.1-80 fmol/mg. de proteína. receptor negativo se consideró cuando la unión específica fue menos de 6 fmol/mg. de proteínas. No se encontró correlación significativa entre la concentración de estos receptores y la edad de la paciente. Con los datos así obtenidos, se discute la presencia y tipo de estos receptores como criterio para ampliar el campo de acción para la elección de la teraía endócrina en este tipo de enfermedad benigna de la mama.

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