2006 - UZ Leuven

NEVEN P., PARIDAENS R., AMANT F., WILDIERS H., BERTELOOT P.,LEUNEN K., SMEETS A., WELTENS C., VAN DEN BOGAERT W., VANLIMBERGEN E., CHRISTIAENS M.R., VERGOTE I.: Adjuvant therapy forpostmenopausal ER-positive breast cancer. Why tamoxifen still has afuture? The Leuven point of view. Int. J. Gynecol. Cancer, 2006; 16(2):505-510.Currently, the value of predictive markers when choosing between anAI and tamoxifen such as levels of steroid receptors, an absent PR,HER-2 overexpression, gene profiles, molecular markers, andCYP2D6 polymorphisms have not prospectively been tested in largeclinical trials. Therefore, the choice between an AI and tamoxifen cancurrently only be based on “good old prognostic markers” as tumorgrade, size, and lymph node status. Retrospective analysis doessuggest a potential role for an absent PR when choosing betweentamoxifen and an AI, but data are inconsistent.Based on available results from published/presented trials, all threeAIs show great promise over tamoxifen in further increasing diseasefreesurvival from breast cancer whether they substitute for tamoxifenor whether they are given for 2-3 years after completion of tamoxifenfor 2-3 years. High-risk groups seem to benefit the most. However,survival differences of AIs over 5 years tamoxifen are unclear.Tamoxifen for 5 years therefore continues to play an important role inlow-risk patients with an endocrine-responsive tumor (PR present,HER-2 absent). Long-term serious side effects to tamoxifen likeendometrial cancer and thrombo-embolic events are rare andprobably preventable (clean uterus at baseline and there are riskfactors for deep vein thrombosis). Efficacy of AIs over tamoxifenshould be balanced against the tolerability profile of AIs, osteoporoticfractures, and cardiovascular risk. Bearing QOL data in mind, patientpreference for treatment should also be considered when choosingbetween efficacy and side effects to obtain the highest compliancepossible.RISHA A., SMEETS A., CHRISTIAENS M.R.: Aspergilloma of the breastin a lung transplantation patient: a case report. Acta Chir. Belg., 2006;106(6): 730-731.Discussion: Aspergillus is an ubiquitous saprophyte fungus found innature, commonly isolated from soil, plant debris and indoor airenvironment. Immune suppression is the major factor predisposing toopportunistic infections in man. The fungus affects essentially the lungof immune depressed patients. Extrapulmonary involvement is veryrare though almost any organ or system in the human body can beinvolved. Infections of the breast are mostly described in patients with37