carcinoma (mRCC). The purpose of this study was to assess the budget impact of including sunitinib as first-line therapy (1L) option for mRCC patients, within a 3 year time horizon from the payer perspective in Argentina. METHODS: An excelbased budget impact model (BIM) was adapted to the context of Argentina to determine the incremental cost of introducing sunitinib in the 1L for patients with mRCC. The analysis was conducted with 2 comparators based on Argentina treatment pattern: pazopanib and sunitinib. Epidemiology data of mRCC was obtained from the literature. The drugs costs were obtained from ANMAT's National Drug Vademecum. The costs of drug administration and patient monitoring, and adverse events costs were estimated through a microcosting approach, based on published data and expert opinion, and were based on tariffs from healthcare institutions (social security and private sector) of Argentina. The market share of the different drugs was based on market studies and assumptions. The budget impact is reported in terms of annual budget impact, per-member per-year (PMPY) and per-patient per-year (PPPY). RESULTS: In Argentina assuming a population of 1 million people, patients eligible for 1L treatment were estimated at 27. The net budget impact estimated for the introduction of sunitinib was -$9,250.08 each year. The cumulative net budget impact was -$27,750.24, representing an impact of -1.94% compared to a scenario without sunitinib. The incremental cost PMPY was -$0.01, and the incremental cost PPPY was -$338.48. In one-way sensitivity analysis the price of sunitinib was the only one that showed a significant influence on the results. CONCLUSIONS: Our results suggest that the inclusion of sunitinib as a therapeutic option in patients with mRCC could generate budgetary savings compared to treatment with pazopanib.

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Introduction: Breast cancer is one of the neoplasms that most cause death in women. Among these, there are some subtypes of greater biological aggressiveness, such as triple negative and HER overexpressed, which are associated with greater recurrence and mortality. Adenoid cystic carcinoma (ACC), salivary gland type, represents less than 0.1% of primary breast carcinomas and has indolent biological behavior and favorable prognosis compared with nonspecial triplenegative types. Case Report: A 51-year-old woman diagnosed with locally advanced ACC in the right breast, with negative immunohistochemistry for hormone receptors and HER2, underwent quadrantectomy with upfront axillary dissection, followed by adjuvant radiotherapy. After 12 years of diagnosis, she presented significant back pain, with magnetic resonance imaging scan evidencing bone lesion without medullary involvement in D7 and L1 suggestive of the secondary implant. Anatomopathology revealed the same histology as the primary tumor. Re-evaluation of chest tomography showed progression of pulmonary disease, 5 months after diagnosis of the first metastasis, underwent segmentectomy, with descriptive pathology identical to the initial lesion. Due to the oligoprogression and tumor type, somatic genetic research of the lung material was requested, which revealed a mutation in the NTRK gene, patient is still waiting for Larotrectinib in court. Discussion: The tumor has an unusual histological type, rare occurrence, slow progression course, and the absence of lymph node metastasis; the average incidence is around age 60. In this case, a young patient presented an ACC tumor with lung and bone metastasis. Due to the rarity, there is no definitive consensus regarding the ideal treatment, with the literature referring to the choice of mastectomy. Conclusions: Although malignant breast neoplasms and nonspecial subtypes, such as ductal and triple negative, have a poor prognosis, breast carcinoma of this aforementioned type has a favorable prognosis. The search for driver mutations in cancers of special types, together with the advances in genetic medicine, allows satisfactory results with target-specific treatments.

Introduction: Progression-free survival in patients with HER2-positive breast cancer was significantly improved after administering dual block (DB) associated with docetaxel when compared with trastuzumab and docetaxel. This case report is about a patient with malignant breast cancer — HER2 positive — and metastatic lung and liver disease. Objective: The aim of this study is to report the positive response to the oncologic treatment. Case Report: A 43-year-old woman was diagnosed in 2011 with malignant breast cancer in early stage, i.e., cT1N0M0, with acute liver lesion not detected by tomography. She underwent upfront surgery, adjuvant chemotherapy with AC-TH schedule plus 1 year of Herceptin, and adjuvant radiotherapy. The tumor was developed again in 2015 through physical examinations, revealing metastatic lung and liver disease. She underwent first-line chemotherapy with docetaxel, Herceptin, and pertuzumab with DB maintenance. After additional physical examination, she presented an excellent response to treatment, remaining on maintenance with DB since October 2015 with an exceptional response to oncologic therapy. Discussion: It was observed an excellent response to treatment. Despite the poor prognosis, the patient presented a complete clinical improvement, and the treatment ensured much longer than average survival and an outstanding quality of life. Conclusion: Using docetaxel, Herceptin, and pertuzumab in patients with breast cancer, HER2 positivity improved the median overall survival of the patient; this confirms, albeit as an isolated case, the data from the Cleopatra study.