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SummaryIn the past 12 months a plethora of relevant novel data for the treatment of metastatic HER2 positive breast cancer were published. To bring this new evidence into a clinical perspective, a group of Austrian breast cancer specialists updated their previously published treatment algorithm for those patients. For this consensus paper a total of eight scenarios were developed in which treatment strategies appropriate for specific patient profiles were evaluated. Consensus was established by detailed discussions of each scenario and by reaching full consensus.

The incorporation of [14C]adenosine into various metabolites was studied in a hippocampal slice preparation in order to assess the extent of adenosine metabolism via synthesis of S-adenosylhomocysteine, a potent inhibitor of transmethylation reactions. Highest incorporation of 14C occurred into nucleotides, with only a few percent being recovered in inosine + hypoxanthine, S-adenosylhomocysteine, and the free adenosine pool. Labeling of S-adenosylhomocysteine did not significantly increase with higher concentrations of added adenosine despite greater accumulation of free [14C]adenosine in the tissue. Addition of L-homocysteine significantly increased the labelling of S-adenosylhomocysteine. The results indicate that S-adenosylhomocysteine synthesis is a minor pathway of adenosine metabolism in brain tissue under steady-state conditions. Further, changes in adenosine concentration, without a concomitant change in L-homocysteine availability, are unlikely to lead to a significant accumulation of S-adenosylhomocysteine. S-Adenosylhomocysteine is therefore not likely to play a significant role in mediating the biological effects of adenosine in the CNS via inhibition of transmethylations.