ABSTRACT
New cases of the novel coronavirus disease 2019 (COVID-19), also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continue to rise worldwide following the declaration of a pandemic by the World Health Organization (WHO). The current pandemic has completely altered the workflow of health services worldwide. However, even during this critical period, patients with other diseases, like cancer, need to be properly treated. A few reports have shown that mortality due to SARS-CoV-2 is higher in elderly patients and those with other active comorbidities, including cancer. Patients with lung cancer are at risk of pulmonary complications from COVID-19, and as such, the risk/benefit ratio of local and systemic anticancer treatment has to be considered. For each patient, several factors, including age, comorbidities, and immunosuppression, as well as the number of hospital visits for treatment, can influence this risk. The number of cases is rising exponentially in Brazil, and it is important to consider the local characteristics when approaching the pandemic. In this regard, the Brazilian Thoracic Oncology Group has developed recommendations to guide decisions in lung cancer treatment during the SARS-CoV-2 pandemic. Due to the scarcity of relevant data, discussions based on disease stage, evaluation of surgical treatment, radiotherapy techniques, systemic therapy, follow-up, and supportive care were carried out, and specific suggestions issued. All recommendations seek to reduce contagion risk by decreasing the number of medical visits and hospitalization, and in the case of immunosuppression, by adapting treatment schemes when possible. This statement should be adjusted according to the reality of each service, and can be revised as new data become available.
Subject(s)
Humans , Aged , Pneumonia, Viral/prevention & control , Coronavirus Infections/prevention & control , Coronavirus , Pandemics/prevention & control , Patient Care/standards , Lung Neoplasms/therapy , Pneumonia, Viral/transmission , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Societies, Medical , Brazil , Practice Guidelines as Topic , Coronavirus Infections/transmission , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Resource Allocation/economics , Resource Allocation/organization & administration , Betacoronavirus , SARS-CoV-2 , COVID-19 , Lung Neoplasms/complicationsABSTRACT
ABSTRACT Objective: Follicular and mantle cell lymphoma are low-grade B-cell malignancies that lack good responses to chemoimmunotherapy. This study aimed to assess retrospectively clinicopathological features and to determine independent prognostic factors for follicular and mantle cell lymphoma patients treated at two Brazilian medical centers: the Hematology and Hemotherapy Center of the Universidade Estadual de Campinas (Unicamp), a public university hospital, and AC. Camargo Cancer Center, a specialized cancer center. Methods: Two hundred and twenty-seven follicular and 112 mantle cell lymphoma cases were diagnosed between 1999 and 2016. Archived paraffin blocks were retrieved and reviewed. Corresponding demographics and clinical data were recovered from medical charts. Outcome analyses considered both overall and event-free survival. Results: For follicular lymphoma treated with the R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, prednisone) and R-CVP (rituximab, cyclophosphamide, vincristine sulfate, prednisone) regimens, both B-symptoms (p-value < 0.01 for overall and event-free survival) and high-risk Follicular Lymphoma International Prognostic Index (p-value < 0.01 for overall survival) were independently associated to worse prognosis. Maintenance with rituximab improved the prognosis (p-value < 0.01 for overall survival). For mantle cell lymphoma, B-symptoms (p-value = 0.03 for overall survival and event-free survival) and bone marrow infiltration (p-value = 0.01 for overall survival) independently predicted reduced survival, and rituximab at induction increased both event-free and overall survival (p-value < 0.01 in both analyses). Combinations of these deleterious features could identify extremely poor prognostic subgroups. The administration of rituximab was more frequent in the AC. Camargo Cancer Center, which was the institution associated with better overall survival for both neoplasias. Conclusion: This study represents the largest cohort of follicular and mantle cell lymphoma in South America thus far. Some easily assessable clinical variables were able to predict prognosis and should be considered in low-income centers. In addition, the underuse of rituximab in the Brazilian public health system should be reconsidered in future health policies.
Subject(s)
Humans , Prognosis , Lymphoma, Follicular , Lymphoma, Mantle-CellABSTRACT
ABSTRACT Lung cancer is one of the most incident types of cancer and a leading cause of cancer mortality in Brazil. We reviewed the current status of lung cancer by searching relevant data on prevention, diagnosis, and treatment in the country. This review highlights several issues that need to be addressed, including smoking control, patient lack of awareness, late diagnosis, and disparities in the access to cancer health care facilities in Brazil. We propose strategies to help overcome these limitations and challenge health care providers, as well as the society and governmental representatives, to work together and to take a step forward in fighting lung cancer.
RESUMO O câncer de pulmão é um dos tipos de câncer com maior incidência e uma das principais causas de mortalidade por câncer no Brasil. Revisamos a situação atual do câncer de pulmão por meio de pesquisa de dados relevantes a respeito de prevenção, diagnóstico e tratamento no país. Esta revisão mostra várias questões que precisam de atenção, tais como controle do tabagismo, educação dos pacientes, desconhecimento por parte dos pacientes, diagnóstico tardio e desigualdade de acesso ao tratamento de câncer no Brasil. Propomos estratégias para ajudar a superar essas limitações e desafiamos os profissionais de saúde, a sociedade e os representantes do governo a trabalhar em conjunto e dar um passo à frente na luta contra o câncer de pulmão.
Subject(s)
Humans , Male , Female , Lung Neoplasms/diagnosis , Lung Neoplasms/therapy , Time Factors , Brazil/epidemiology , Risk Factors , Sex Distribution , Health Services Accessibility , Lung Neoplasms/epidemiologyABSTRACT
Background: Colorectal cancer (CRC) is a neoplasia with high incidence and mortality rates. It had been suggested that the inflammatory response is an important CRC prognostic factor. The disordered and accelerated proliferation of neoplastic cells decreases the oxygen and nutrient supply, generating a microenvironment characterized by hypoxia, necrosis and inflammation. This study aimed to evaluate the impact of factors associated with hypoxia, such as HIF1A (hypoxia-inducible factor 1-alpha) and VEGF (vascular endothelial growth factor), and with lipid metabolism, including PPARG (peroxisome proliferator-activated receptor-gamma), LXRA (liver X receptor-alpha) and LXRB (liver X receptor-beta), on the overall survival (OS) of CRC patients. Methods: This was a cohort study of 101 patients with high-risk stage II-III (TNM) CRC located above the peritoneal reflection. They were treated between 1990 and 2004 at the AC Camargo Cancer Center. Immunohistochemical analyses of HIF1A, VEGF, PPARG, LXRA and LXRB protein expression were performed using tissue microarrays (TMAs). Results: There was an association between the presence of vascular invasion and the lack of VEGF expression (p = 0. 028) as well as with positive HIF1A expression and lymphatic invasion (p = 0.045). The 5-year and 10-year OS rates were 76.6% and 60.2%, respectively. Patients with PPARG-positive tumors had a higher OS (p = 0.018). There were no correlations between the positive expression of VEGF, HIF1A, LXRA or LXRB and OS. The Cox regression model demonstrated that the risk of death was 2.72-fold higher in patients with PPARG-negative tumors (95% CI = 1.086.85). Conclusion: The PPARG expression was an independent prognostic factor for CRC tumors and might be used for risk stratification to stage II and stage III CRC patients (AU)
Subject(s)
Humans , Male , Female , Prognosis , Immunohistochemistry , Colorectal Neoplasms , Survival Analysis , Cohort Studies , Lipid Metabolism , HypoxiaABSTRACT
OBJECTIVE: To determine the prevalence of hyperglycemia during induction therapy in adult patients with acute leukemia and its effect on complicated infections and mortality during the first 30 days of treatment. METHODS: An analysis was performed in a retrospective cohort of 280 adult patients aged 18 to 60 years with previously untreated acute leukemia who received induction chemotherapy from January 2000 to December 2009 at the Hemocentro de Pernambuco (HEMOPE), Brazil. Hyperglycemia was defined as the finding of at least one fasting glucose measurement > 100 mg/dL observed one week prior to induction therapy until 30 days after. The association between hyperglycemia and complicated infections, mortality and complete remission was evaluated using the Chi-square or Fisher's exact tests by the Statistical Package for Social Sciences (SPSS) in the R software package version 2.9.0. RESULTS: One hundred and eighty-eight patients (67.1%) presented hyperglycemia at some moment during induction therapy. Eighty-two patients (29.3%) developed complicated infections. Infection-related mortality during the neutropenia period was 20.7% (58 patients). Mortality from other causes during the first 30 days after induction was 2.8%. Hyperglycemia increased the risk of complicated infections (OR 3.97; 95% confidence interval: 2.08 - 7.57; p-value < 0.001) and death (OR 3.55; 95% confidence interval: 1.77-7.12; p-value < 0.001) but did not increase the risk of fungal infections or decrease the probability of achieving complete remission. CONCLUSION: This study demonstrates an association between the presence of hyperglycemia and the development of complicated infections and death in adult patients during induction therapy for acute leukemia.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Leukemia , Mortality , Fever , Hyperglycemia , Infections , NeutropeniaABSTRACT
Targeted monoclonal antibodies have become an important therapeutic option for patients with cancer. Cetuximab, a chimeric mouse-human (30:70) immunoglobulin G1 monoclonal antibody against epidermal growth factor receptor, has been approved by the US Food and Drug Administration for the treatment of head and neck and metastatic colorectal cancer (mCRC). Severe (grade 3/4) hypersensitivity-infusion reactions (HIRs) occur in 2-3% of the patients, with fatal outcomes in 0.1%. It is recommended that patients showing severe HIRs to cetuximab should avoid further exposure to it, but in some cases there is no alternative treatment. Two options are currently available for patients with HIRs to cetuximab: desensitization protocol and panitumumab. We describe here two patients with mCRC who successfully underwent a cetuximab desensitization protocol following a severe HIR to cetuximab.
Subject(s)
Humans , Antibodies, Monoclonal , Immunoglobulin G , Neoplasm Metastasis , Colorectal NeoplasmsABSTRACT
ILP (Perfusão Isolada de Membro) com melphalan (MEL) é uma obordagem alternativa no tratamento de melanomas cutâneos avançados, não-ressecáveis, de extremidades, poupando o membro da amputação. ... O objetivo do nosso estudo foi determinar o perfil de expressão gênica do melanoma e sua modificação após tratamento com TNF, MEL ou TMF+MEL. .... Os perfis de expressão gênica das células e dos tumores foram determinados através da estratégia de microarray, empregando um biochip contendo 16.128 oligonucleotídeos. O tratamento das células de melanoma com MEL durante 48h esteve associado com uma maior taxa de morte celular. O TNF não exerceu nenhuma atividade citotóxica sobre as células de melanoma in vitro. A administração de melfalano promoveu uma menor velocidade de crescimento tumoral (p<0,001), efeito este que não foi modificado pela co-administração de TNF. Entretanto, tumores tratados com TNF apenas ou em combinação com MEL apresentaram mais necrose (p=0,017 e p=0,014, respectivamente) e menos mitoses (p=0,001). Um número menor de mitoses também foi observado em resposta a MEL. O tratamento com MEL ou MEL+TNF esteve associado com aumento da sobrevida livre de progressão. ... Um grupo de genes grande teve sua expressão modulada pelo tratamento in vitro. Entre estes, nós identificamos Aff1, um regulador do ciclo celular, positivamente regulado por MEL. O mesmo efeito foi observado in vivo para este gene em especial. Da comparação entre os perfis de expressão gênica dos tumores por ANOVA, nós identificamos 118 genes diferencialmente expressos com p<0,05. Entre os elementos diferencialmente expressos estão genes que codificam proteínas envolvidas em adesão celular (Pecam1, Pard3, Dlg5), apoptose (Bcl11l), vias de sinalização (Arhgef6, Flt-1), regulação de transcrição (Tcfe3, Ifi202b, Irak1bp1, Fabp4,Trp73, Trim24), ciclo celular (Cdc7, Aff1), metabolismo de drogas (Akr1b7), potencial metastático (Trpm1, Mib2) e várias outras funções biológicas...
ILP (Isolated Limb Perfusion) with melphalan (MEL) is an alternative approach in the treatment of non-resectable locally advanced cutaneous melanomas of extremity, sparing the limb from amputation. ILP is a locoregional procedure to deliver high doses of drugs to a limb with minimal systemic and mild local toxicity. The association with the Tumor Necrosis Factor (TNF) improves total complete response rates from 40-50% to 70-90%. The molecular mechanisms underlining this synergistic effect are poorly understood. The aim of our study was to determine the gene expression profile of melanoma and its alterations after the treatment with TNF, MEL and TNF+MEL. To reach this objective B16F1 and B16F10 cells were exposed to MEL (36,9µM), TNF (10ng/ml) or both during 3 hours for microarray assays or for 24h, 48h and 72h for citoxicity assays. At same time, 6-8 weeks-old male C57BL6 mice were injected subcutaneously, on both flanks, with 5,0x105 of B16F10 and B16F1 melanoma cells. Animals bearing tumors of 1,0±0,3cm2 (n=9-10 mice/group) received an intravenous injection of TNF (0,05µg/Kg), MEL (12mg/Kg), TNF+MEL or saline (control). One of the tumors was surgically removed 3h after for RNA extraction and histology and the other one was left for growth measurements. Gene expression profiles from cells and tumors were determined by microarray strategy using a biochip containing 16.128 oligonucleotides. Treatment of melanoma cells with MEL for 48h was associated with a significantly higher cell death rate. TNF exerted no cytotoxic effects on melanoma cells in vitro. The administration of melphalan led to slower tumor growth rate (p<0,001), effect that was not modified by the TNF co-administration. Nevertheless, tumors treated with TNF alone or in combination with MEL presented more necrosis (p=0,017 and p=0,014, respectively) and less mitosis (p=0,001). Less mitosis was also observed in response to MEL alone. Treatment with MEL or MEL+TNF was associated with a longer progression free survival. Three-hourtreatment with MEL or TNF did not affect vascular density. A whole set of genes had its expression modulated by treatment in vitro. Amongst them, we identified Aff1, a regulator of cell proliferation, as positively regulated by MEL. The same effect was observed in vivo for this specific gene. From the comparison between the gene expression profile by ANOVA, we identified 118 genes differentially expressed with p<0,05. Among the differentially expressed elements are genes coding for proteins involved in cell adhesion (Pecam1, Pard3, Dlg5), apoptosis (Bcl11l), signaling pathways (Arhgef6, Flt-1), regulation of transcription (Tcfe3, Ifi202b, Irak1bp1, Fabp4,Trp73, Trim24), cell cycle (Cdc7, Aff1), drug metabolism (Akr1b7), metastatic potential (Trpm1, Mib2) and many other diverse biological functions. Supported by: FAPESP (AU)
Subject(s)
Oligonucleotide Array Sequence Analysis , Gene Expression , Tumor Necrosis Factors , Melanoma , MuridaeABSTRACT
Os autores fazem revisäo e atualizaçäo dos radicais livres e sua influência na fisiologia e patologia humana