Masahiro Nakano

Kumamoto University, Kumamoto, Kumamoto Prefecture, Japan

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Publications (5)8.93 Total impact

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    ABSTRACT: The patient was 77-year-old woman whose breast cancer had metastasized to the bone and soft tissue 5 years after surgery. Although she had been sequentially treated with endocrine therapies following chemotherapies, new metastatic lesions in the pleura and skin appeared 8 years after recurrence. The biopsied skin tissue showed high positivity for estrogen receptor(ER), was negative for human epidermal growth factor receptor 2(HER2), and had a low Ki-67 labeling index. Following the treatment with exemestane(EXE)for 3months, ethinyl estradiol(EE2)was administered at 3mg/day. After 4 months of treatment, the lymph nodes shrunk to 35% of their size and pleural effusion disappeared. The efficacy of EE2 was observed for 10 months. Subsequently, fulvestrant was administered because the skin lesions showed progressive disease. Adverse events such as nausea and general fatigue were observed at the beginning of EE2 therapy. Pigmentation of the nipple and areola and cystic swelling of the cervical canal were observed after a few months. This therapy can be considered to be effective in patients with ER-positive metastatic breast cancer who have been heavily treated with endocrine therapies and chemotherapies.
    Gan to kagaku ryoho. Cancer & chemotherapy 12/2013; 40(13):2569-2571.
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    ABSTRACT: Breast elastography (EG), which can objectively evaluate tumor stiffness, has been useful for differentiation of benign and malignant breast lesions. However, the value of EG for prediction of response to systemic therapy is poorly understood. The baseline evaluations of EG in 55 patients who received neoadjuvant chemotherapy were reviewed. We investigated the correlation between tumor stiffness and response to neoadjuvant chemotherapy. Tumor stiffness was evaluated by the Tsukuba elasticity scoring system. The mean EG scores were significant lower for the clinical and pathologic complete response (pCR) groups than for the others. When we categorized patients into two groups according to tumor stiffness, 26 patients were assigned to the low EG group (soft, scores from 1 to 3) and 29 patients were assigned to the high EG group (hard, score 4 and 5). The low EG group had significantly higher clinical complete response and pCR rates than the high EG group (clinical complete response, low EG group 38 % vs. high EG group 10 %, P = 0.024; pCR, low EG group 50 % vs. high EG group 14 %, P = 0.003, respectively). Furthermore, multivariate analysis indicated that estrogen receptor, human epidermal growth factor receptor 2, and low EG (odds ratio 13.04, 95 % confidence interval 1.19-458.28, P = 0.035) were independent predictive factors of pCR. Tumor stiffness evaluated by EG bears predictive potential for response to neoadjuvant chemotherapy. Stiffness evaluated by EG may be recognized as a clinically significant tumor characteristic, comparable to other data obtained by functional imaging techniques.
    Annals of Surgical Oncology 04/2012; 19(9):3042-9. · 4.12 Impact Factor
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    ABSTRACT: No clinically useful target molecule has been identified for triple-negative (TN) breast cancer, i.e., estrogen receptor (ER)-negative, progesterone receptor (PgR)-negative, human epidermal growth factor receptor-2 (HER2)-negative phenotype, and its prognosis is poor. Triple-negative cancer consists of two subtypes: basal-like and non-basal-like. The aim of this study is to clarify the clinical and biological characteristics of these two subtypes of TN cancer. We examined, by immunohistochemistry, expression of biological markers cytokeratin (CK) 5/6 and epidermal growth factor receptor (EGFR) in triple-negative breast cancer. Basal-like subtype was defined as CK5/6-positive and/or EGFR-positive, and non-basal-like subtype was defined as no expression of these two markers. We studied the correlation between basal-like subtype and several factors related to tumor progression, along with the prognostic value of basal-like subtype and other biological markers in triple-negative cancer. In the 48 cases of operable triple-negative breast cancer, basal-like subtype was detected in 22 (45.8%) and non-basal-like subtype in 26 (54.2%). Basal-like subtype was significantly correlated with nodal status (P = 0.0475) and nuclear grade (P = 0.0475). Basal-like subtype was also significantly associated with Ki67 labeling index (P = 0.0118), c-kit expression (P = 0.0335), and aurora A expression (P = 0.0020). No association was detected between basal-like cancer and other biological markers. Patients with basal-like subtype of triple-negative cancer showed shorter disease-free survival (P = 0.0049) and overall survival (P = 0.0283) than patients with non-basal-like subtype. No independent prognostic factors were identified among the prognostic factors obtained from univariate analysis. These findings suggest that basal markers can be used to classify triple-negative breast cancer into at least two subtypes with differing prognoses. It is necessary to develop a novel treatment strategy to improve the prognosis of patients with basal-like subtype of triple-negative breast cancer.
    Breast Cancer 09/2009; 16(4):260-7. · 1.33 Impact Factor
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    ABSTRACT: A 57-year-old woman complained of a huge and rapid growing mass with bleeding in the left breast. Breast imaging (CT and MRI)showed a large, irregular and unevenly enhanced tumor with lymph node swelling in the left axilla. Mastectomy and axillary lymph node dissection were performed for control of bleeding from the tumor in the left breast. Pathological diagnosis was spindle cell carcinoma of the breast with transition from papillotubular carcinoma. Although the patient was treated with adjuvant chemotherapy and trastuzumab according to the treatment guideline for conventional breast cancer, she had an early relapse with mediastinal metastasis and died 9 months after operation. The tumor showed metaplastic change from epithelial tumor to spindle cell carcinoma. Because the epithelial part expressed weakly positive estrogen receptor(ER), progesterone receptor(PgR)-negative and HER2-positive, we used trastuzumab for adjuvant therapy. However, part of the spindle cell tumor mainly showed triple-negative, and ER, PgR and HER2 expression were negative, which might explain her poor prognosis for resistance to trastuzumab.
    Gan to kagaku ryoho. Cancer & chemotherapy 07/2009; 36(6):1017-9.
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    ABSTRACT: Estrogen receptor (ER) alpha plays a crucial role in normal breast development and has also been linked to mammary carcinogenesis and clinical outcome in breast cancer patients. However, the molecular mechanisms controlling the expression of ERalpha are as yet not fully understood. Gene amplification is one of the important factors regulating protein expression. Recent studies on the amplification of the ESR1 gene, which encodes ERalpha, have presented conflicting data. Using fluorescence in situ hybridization and real-time quantitative polymerase chain reaction analysis, we examined the ESR1 status in a series of breast cancer tissues and analyzed its clinical importance. ESR1 gene amplification and gain were found in 22.6 and 11.3% of samples, respectively, as determined by three-dimensional fluorescence in situ hybridization assay. Moreover, ESR1 amplification and amplification plus gain were significantly negatively correlated with tumor size, number of positive lymph nodes, negative ERalpha, and positive human epidermal growth factor receptor 2 status. It has also been shown that ESR1 amplification strongly correlates with higher expression levels of ER protein and that patients with ESR1 amplification in their tumors apparently experience longer disease-free survival than those without. Our data suggest that ESR1 amplification might prove to be helpful in selecting patients who may potentially benefit from endocrine therapy.
    Cancer Science 04/2009; 100(6):1012-7. · 3.48 Impact Factor