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Background: The phosphoisitol 3-kinase (PI3K) signaling pathway, which promotes cancer cell growth and metabolism, is the most frequently mutated pathway in breast cancer and is associated with chemoresistance and poor prognosis. In this study we present the first analysis in Panamanian and regional population, with precise antations of the PIK3CA mutation, clinicopathological characteristics and prognosis. Methods: Exploratory study, where tumors were prospectively collected from 74 patients with RH+/Her2- metastatic breast cancer from the Instituto Oncológico Nacional between 2022 and 2023. A real-time PCR assay for mutation analysis was performed on DNA extracted from formalin-fixed, paraffin-embedded tumor material to detect mutations in exons 1, 4, 7, 9 and 20 of the PIK3CA gene. Results: The median age of the patients studied was 59 years. The mutation in PIK3CA was found in 33.8% (25/74) of patients with breast cancer, among them 44% were mutations in exon 20, 38% in exon 9, 13% in exon 4 and 5% in exon 1. A significant correlation was observed between the mutation and having history of cancer in the family (P = 0.005), and in postmepausal patients (P = 0.045). We did not found association between the mutation and histologic type, grade, tumor size or axillary status at diagnosis. Median progression-free survival was t reached in both groups and did not show a significant difference. Conclusion: The prevalence of the mutation is relatively high compared to international settings, it may offer an advantage in choosing the best treatment options and should be routinely evaluated during clinical interventions. [ABSTRACT FROM AUTHOR]

Intrathecal infusion therapy is indicated for refractory chronic pain, regardless of its origin (oncologic or not). Morphine and ziconotide are the only drugs approved for use as intrathecal analgesics. The addition of local anesthetics slows the escalation of opioid doses. We present the case of a woman with stage IV breast cancer, with multiple dorsal vertebral metastases, evaluated by the Chronic Pain Unit for severe, disabling pain refractory to conventional measures. An intrathecal pump of morphine and bupivacaine was implanted after a positive intrathecal test dose. Afterward, she had excellent pain control with full functional recovery and no need for adjuvant medication, regardless of disease progression. The use of intrathecal infusion therapy has become a safe and effective tool to consider in cases of refractory oncologic chronic pain. [ABSTRACT FROM AUTHOR]

Metastatic breast cancer is a heterogeneous disease, with little chance of being cured; however, with the advent of new systemic therapies, a substantial improvement in overall survival has been achieved [1-3]. The median overall survival is between two to three years, with ranges ranging from a few months to many years. [4] The selection of therapeutic strategy will depend on both the tumor phenotype and clinical factors. The general idea is to give the treatment as personalized as possible. For the majority of patients with metastatic breast cancer, the bases of treatment are systemic therapy and the best support care; but there are also patients who benefit from local regional control [5-6]. [ABSTRACT FROM AUTHOR]