유방암의 호르몬 치료

이수이 대한내과학회 2023 대한내과학회지 Vol.98 No.6

Hormone receptor-positive breast cancer accounts for 60-70% of all breast cancers and has a better prognosis than human epidermal growth factor receptor-2 (HER2)-positive or triple-negative breast cancer. Hormone treatment for breast cancer is an important treatment method that is effective and has few side effects for hormone receptor-positive breast cancer. Hormone therapy is performed as adjuvant therapy in early breast cancer and as palliative therapy in metastatic breast cancer. In the past decade, molecularly targeted agents against intracellular targets such as mammalian target of rapamycin (everolimus), cyclin-dependent kinase 4 and 6 (palbociclib, ribociclib, abemaciclib), and phosphatidylinositol 3-kinase (alpelisib) has offered patients effective therapeutic options, and combination of hormone treatment with the molecular agents have continued to improve the outcome of breast cancer.

Identification of genes underlying different methylation profiles in refractory anemia with excess blast and refractory cytopenia with multilineage dysplasia in myelodysplastic syndrome

이수이,권혁찬,김성현,오성용,Ji Hyun Lee,이연수,Daekwan Seo,한진영,김효진 대한혈액학회 2012 Blood Research Vol.47 No.3

Background Myelodysplastic syndrome (MDS) is a preleukemic condition that transforms into acute myeloid leukemia. However, the genetic events underlying this transformation remain poorly understood. Aberrant DNA methylation may play a causative role in the disease and its prognosis. Thus, we compared the DNA methylation profiles in refractory anemia with excess blast (RAEB) to those in refractory cytopenia with multilineage dysplasia (RCMD). Methods Bone marrow samples were collected from 20 patients with primary MDS (9 with RAEB and 11 with RCMD), and peripheral blood samples were collected from 4 healthy controls. These samples were assessed using a commercial whole genome-wide methylation assay. Methylation-specific polymerase chain reaction (PCR) was used to detect the methylation of candidate gene promoters in RAEB and RCMD. Results Microarray data revealed significant hypermethylation in 69 genes within RAEB but not RCMD. Candidate genes were mapped to 5 different networks, and network 1 had the highest score due to its involvement in gene expression, cancer, and cell cycle. Five genes (GSTM5, BIK, CENPH, RERG, and ANGPTL2) were associated with malignant disease progression. Among them, the methylated promoter pairs of GSTM5 (55.5% and 20%), BIK (20% and 0%), and ANGPTL2 (44.4% and 10%) were observed more frequently in RAEB. Conclusion DNA methylation of GSTM5, BIK, and ANGPTL2 may induce epigenetic silencing and contribute to the increasing blasts and resulting MDS progression; however, the functions of these genes were not determined. Further study focusing on epigenetic silencing using various detection modalities is required.

우심방 허탈 및 빈맥을 초래한 다량의 늑막 삼출

이수이,박태호,박선이,구정모,차광수,김무현,김영대,양두경 한국심초음파학회 2006 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.14 No.2

Malignant Adenomyoepithelioma of the Breast and Responsiveness to Eribulin

이수이,오성용,김성현,이지현,김대철,조세헌,이미리,김효진 한국유방암학회 2015 Journal of breast cancer Vol.18 No.4

Adenomyoepithelioma (AME) of the breast is an uncommon tumor characterized by its dual differentiation into luminal cells and myoepithelial cells. In most cases these tumors have a benign clinical course, but distant metastases have been reported. We present the case of a 51-year-old woman diagnosed with malignant AME. The patient underwent a right modified radical mastectomy, and pathological examination confirmed the diagnosis of malignant AME. Ten months after the operation, multiple hepatic, pleural, and abdominal wall metastases were detected. A number of palliative chemotherapeutic agents were tried, including anthracycline and taxanes. However, the disease continued to progress, and superior vena cava syndrome developed as a result of direct tumor invasion. The patient received salvage eribulin monotherapy. After two cycles of this treatment, her clinical symptoms were ameliorated, and a computed tomography scan showed a partial response. Eribulin chemotherapy was thus effective in treating malignant AME in this case.

PhaseⅡStudy of Vinorelbine Plus Ifosfamide in Patients with Taxane-resistant Metastatic Breast Cancer

이수이,오성용,권혁찬,김성현,Kyung A Kwon,Chien Ter Hsing,김대철,이진화,이형식,Mi Ri Lee,조세헌,김효진 한국유방암학회 2009 Journal of breast cancer Vol.12 No.4

Purpose: The patients with metastatic breast cancer are routinely exposed to taxane and anthracycline as neoadjuvant, adjuvant, and palliative chemotherapeutic agents. This study was designed to evaluate the efficacy and safety of using a vinorelbine and ifosfamide (Ⅵ) combination treatment in patients with taxane-resistant metastatic breast cancer. Methods: We evaluated the use of a VI regimen (25 mg/㎡ vinorelbine administered on days 1 and 8 plus 2,000 mg/㎡ ifosfamide administered on day 1-3 every 3 weeks) for breast cancer patients who evidenced tumor progression after palliative taxane treatment. Results: Overall, 35 patients were enrolled in this study: Their median age was 50 years (range, 38-72 years). The overall response rate was 40.0% (14 patients; 95% confidence interval [CI], 23-57%). The median time to progression was 4.5 months (95% CI, 3.5-5.4 months). The median overall survival was 18.3 months (95% CI, 12.9-23.6 months). In the 190 cycle of treatment, the incidence of grade ≥3 neutropenia, anemia, and thrombocytopenia was 29.3%, 4.2%, and 2.0%, respectively. Neutropenic fever was noted in 6 cycles (3.1%). The non-hematological toxicities were not severe: grade 1 or 2 vomiting was observed in 22.8% of the patients. Conclusion: Our results suggest that the use of vinorelbine and ifosfamide (Ⅵ) combination chemotherapy appears to be effective and it showed an acceptable toxicity profile in the patients with taxane-resistant metastatic breast cancer.

증례 : 강직성 척추염에 동반된 재발성 다발성 연골염 1예

이수이 ( Su Ee Lee ),조지훈 ( Ji Hoon Jo ),홍현종 ( Hyun Jong Hong ),김기남 ( Ki Nam Kim ),양두경 ( Doo Gyung Yang ),이성원 ( Sung Won Lee ),정원태 ( Won Tae Chung ) 대한내과학회 2007 대한내과학회지 Vol.72 No.1S

종격동 육종이 동반된 급성골수성백혈병 1예

남영희,이지현,권경아,이수이,오성용,김성현,권혁찬,한진영,홍숙희,김효진 대한혈액학회 2009 Blood Research Vol.44 No.3

골수성육종은 미성숙골수세포로 이루어진 골수외 고형종양으로 급성골수성백혈병에서 골수성육종의 발생률은 3∼8%이다. 림프절은 골수성육종이 가장 흔하게 나타나는 곳이며, 그 외 복부, 중추신경계, 고환, 췌장, 유방 등에 침범된 것이 보고되고 있다. 종격동 골수성육종을 동반한 급성골수성백혈병은 매우 드문 질환으로 복합 세포유전학적 이상이 동반되며 불량한 장기 예후를 보이는 질환이다. 최적의 치료법은 무엇인지 결정되어 있지 않다. 37세 남자로 목에 다발성 림프절과 종격동에 큰 종괴가 있어 내원하여 림프종으로 생각되었으나 왼쪽 상쇄골 림프절 조직검사와 골수검사를 통해 골수성육종을 동반한 급성골수성백혈병 환자로 진단되었다. 항암치료 후 완전관해에 도달하였으며 다발성 림프절과 종격동 종괴도 소실되어 조직적합항원-일치 비혈연간 조혈모세포이식을 받은 증례에 대해 보고하는 바이다.

젊은 환자에서 발생한 리툭시맙으로 인한 간질성 폐렴

이동미,오성용,윤현아,이수이,김성현,권혁찬,이수걸,김효진 대한혈액학회 2007 Blood Research Vol.42 No.4

대부분의 경우, 리툭시맙의 부작용은 경미하지만 고령의 환자에서 드물게 중대한 폐합병증이 보고되었다. 본 증례는 젊은 환자에서 리툭시맙의 치료 후 생긴 간질성 폐질환에 관해 보고하고자 한다. 미만성 대세포 B형 림프종 진단 후 리툭시맙-CHOP 치료를 3주기 시행 받았던 35세 여자 환자로 기침과 호흡곤란을 주소로 내원하였다. 환자는 컴퓨터 단층 촬영상 양측 폐에 미만성의 간유리 음영소견을 보였고 동맥혈 검사상 저산소증을 나타내었으며 폐기능 검사상 제한적 형태의 폐기능 소견을 보였다. 감염의 소견은 발견되지 않았다. 환자는 스테로이드를 사용 후 증상의 호전을 보였고 이후 치료에서는 리툭시맙을 제외한 CHOP 요법으로 치료하였으며 호흡곤란의 소견은 관찰되지 않았다. 이전 보고에서 리툭시맙과 관련된 폐병변의 경우 고령에서 보고되었으나 본 증례를 통해 젊은 환자에서도 발생할 수 있음을 유념해야 하겠다.

Third-line docetaxel chemotherapy for recurrent and metastatic gastric cancer

이지현,김성현,오성용,이수이,이호진,이혜정,김효진 대한내과학회 2013 The Korean Journal of Internal Medicine Vol.28 No.3

Background/Aims: To determine the efficacy and toxicity of docetaxel as a thirdline therapy for patients with relapsed gastric cancer who have undergone modified oxaliplatin-fluorouracil (m-FOLFOX)-4 and modified irinotecan-fluorouracil (m-FOLFIRI) regimens. Methods: We analyzed 33 patients who had been histologically diagnosed with adenocarcinoma of the stomach and who had progressed after m-FOLFOX-4 and m-FOLFIRI regimens. Patients were treated with cycles of 75 mg/m2 docetaxel on day 1 every 3 weeks. Results: The median age of the patients was 56.0 years (range, 31.0 to 74.0), and 73% of the patients (24/33) had an Eastern Cooperative Oncology Group performance status of 0 or 1. All patients were evaluated in terms of tumor response:five (15%), nine (27%), and 19 (58%) patients experienced a partial response, stable disease, and progressive disease, respectively. The median time to progression was 2.1 months (95% confidence interval [CI], 1.63 to 2.58), and overall survival was 4.7 months (95% CI, 3.20 to 6.20), from the start of the docetaxel regimen. Assessing patients’ toxicity profiles, the median number of cycles was 2.0 (range, 1.0 to 12.0). The major hematologic toxicities included grade 3 to 4 neutropenia (19/33,58%), grade 3 to 4 thrombocytopenia (2/33, 6%), and grade 3 to 4 anemia (5/33, 15%). Neutropenic fever developed in three patients (3/33, 9%). The nonhematological toxicities were nausea and vomiting (10/33, 30%), abdominal pain (4/33, 12%), skin rash (1/33, 3%), and fluid retention (3/33, 9%). Conclusions: Docetaxel is a feasible third-line therapy regimen for patients with advanced gastric cancer after m-FOLFIRI and m-FOLFOX-4 regimens.

Comparison between Conventional Cytogenetics and Interphase Fluorescence in situ Hybridization (FISH) for Patients with Multiple Myeloma

김성현,김정환,이동미,이수이,오성용,권혁찬,김경은,한진영,김효진 대한혈액학회 2009 Blood Research Vol.44 No.1

Background: For patients with multiple myeloma (MM), different strategies are used to detect chromosomal abnormalities (CA). There have been a few studies that have directly compared FISH with conventional cytogenetics (CC) for the detection of CA. In this study, we employed a combined approach of metaphase cytogenetics and interphase FISH to investigate the genetic basis for the great heterogeneity observed in the clinical behavior of 28 MM patients. Methods: Cytogenetic analysis was performed via traditional metaphase karyotype analysis. The FISH studies were done using DNA probes to detect translocations involving the immunoglobulin heavy chain gene (IGH) at 14q32 and deletions of 17p13.1 and 13q14. Results: CA were detected by CC in 16 patients (57.1%) and by FISH in 14 patients (50.0%) of the 28 patients we studied. 14q32 abnormalities and deletion abnormalities of 13q14 and 17p13.1 were detected by CC in five patients (17.9%), three patients (10.7%) and no patients (0%), respectively and these were detected by FISH in 12 (42.8%), four (14.3%) and five (17.8%), respectively, of the 28 patients we studied. The median follow-up timefor the patients was 23.85 months (range: 0.3∼58.13 months). On the univariate and multivariate analyses, none of the abnormalities detected by cytogenetics and interphase FISH affected survival. Conclusion: On comparing the cytogenetics and interphase FISH results, we can suggest that both studies should be an essential part of the workup for the diagnosis of patients with MM. Also, both studies may complement each other to predict the prognosis.