ABSTRACT
Background: HER2+ breast cancer (BC) subtype overexpresses the Human Epidermal growth factor Receptor type-2 (HER2) and is characterized by its aggressiveness and its high sensitivity to monoclonal antibody-based HER2-targeted therapies. Aim: To assess the prognosis and evaluate the impact of novel anti-HER2 therapies on advanced HER2+ BC patients treated at our institution over the last decades. Material and Methods: Analysis of the patient database at a cancer center of a university hospital. Information about the subtype of cancer was obtained in 2,149 of 2,724 patients in the database. Eighteen percent of the latter were HER2+. We analyzed data of 83 of these patients with advanced disease. Results: Median overall survival (OS) was 24 months. For patients treated between 1997-2006 median OS was 17 months and for those treated in the period 2007-2017 median OS was 32 months (p = 0.09). Conclusions: A non-significant trend towards better survival in the last decade was observed. HER2+ BC overall survival has improved in our center. This can be probably attributed to the use of novel more effective anti-HER2 therapies.
Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Breast Neoplasms/mortality , Breast Neoplasms/chemistry , Receptor, ErbB-2/analysis , Time Factors , Breast Neoplasms/pathology , Breast Neoplasms/drug therapy , Immunohistochemistry , Chile/epidemiology , Retrospective Studies , Receptor, ErbB-2/antagonists & inhibitors , Kaplan-Meier Estimate , Trastuzumab/therapeutic use , Lapatinib/therapeutic use , Neoplasm Recurrence, Local , Antineoplastic Agents/therapeutic useABSTRACT
El cáncer de mama es la primera causa de muerte por cáncer en mujeres chilenas. Mientras la mayoría de las personas logra curarse de esta enfermedad, un 5% de los casos se presenta inicialmente con enfermedad avanzada y hasta un 20-30% de pacientes con enfermedad localizada pueden sufrir recurrencias sistémicas. La mayoría de las neoplasias mamarias son dependientes del estímulo estrogénico, de allí que la deprivación de estrógenos es la principal estrategia terapéutica. Recientemente, el uso de terapias molecularmente dirigidas en combinación con la terapia endocrina ha logrado mejorar los resultados de sobrevida del cáncer de mama avanzado, con menos efectos colaterales que aquellos producidos por la quimioterapia convencional. El conocimiento de los mecanismos de acción de estas nuevas terapias, sus toxicidades, vías de resistencia y selección de pacientes para lograr los mejores beneficios terapéuticos son aspectos relevantes en el manejo de la enfermedad. Presentamos una revisión del estado actual del manejo del cáncer de mama metastásico hormonodependiente con enfásis en el uso de terapias endocrinas combinadas con terapias moleculares.
Breast cancer is the leading cause of cancer death in Chilean women. While most patientes are cured, five percent of cases present with advanced disease initially and up to 20-30% of patients with localized disease may suffer systemic recurrences. The majority of breast neoplasms are dependent on the estrogenic stimulus, hence the deprivation of estrogen is the main therapeutic strategy. Recently, the use of molecular targeted therapies in combination with endocrine therapy has been successful in improving the survival outcomes of advanced breast cancer, with fewer side effects than those produced by conventional chemotherapy. Knowledge of the mechanisms of action of these new therapies, their toxicities, resistance pathways and patient selection to achieve the best therapeutic benefits are relevant aspects in the management of the disease. We present a review of the current state of management of hormone-dependent metastatic breast cancer with emphasis on the use of endocrine therapies combined with molecular therapies.
Subject(s)
Humans , Breast Neoplasms/drug therapy , Antineoplastic Agents, Hormonal/therapeutic use , Antineoplastic Combined Chemotherapy Protocols , Patient Selection , Selective Estrogen Receptor Modulators/therapeutic use , Aromatase Inhibitors/therapeutic use , Cyclin-Dependent Kinase 4/antagonists & inhibitors , Cyclin-Dependent Kinase 6/antagonists & inhibitors , Neoplasm MetastasisABSTRACT
Introduction: Bacterial resistance is a global concern for public health. Reports of antimicrobial resistance, including that against methicillin, have increased in strains of coagulase positive Staphylococcus (CPS) isolated from pets, however in Chile this information is limited. Objectives: To determine the antimicrobial susceptibility profiles and to detect the mecA gene in CPS strains isolated from cats in Chile. Materials and Methods : 134 samples were obtained from healthy cats and cats with skin lesions. These strains were characterized in their coagulase production and identified by BBL Crystal kit. The antimicrobial susceptibility was determined by Kirby Bauer method against 12 antimicrobials, including oxacillin. All strains were subjected to PCR to detect the mecA gene. Results: 72 CPS strains were isolated, including S. aureus and S. intermedius. Antimicrobial resistance against at least one drug was detected in strains from both healthy cats (75%) and from cats with skin lesions (87.5%). The mecA gene was detected in eight methicillin-resistant strains and also in three sensitive strains, being in general multi-resistant. Discussion: These results highlight the role of pets as reservoirs of bacterial resistance, and their potential impact on national public health.
Introducción: La resistencia bacteriana constituye un tema de preocupación para la salud pública mundial. Últimamente han aumentado los reportes de resistencia a antimicrobianos, incluida meticilina, en cepas de Staphylococcus coagulasa positiva (SCP) aisladas desde mascotas. Sin embargo, en Chile esta información es escasa. Objetivos: Determinar el perfil de susceptibilidad antimicrobiana y detectar el gen mecA en cepas de SCP aisladas desde gatos en Chile. Materiales y Métodos: Se obtuvieron 134 muestras desde gatos sanos y con lesiones dermatológicas. Las cepas fueron caracterizadas en su producción de coagulasa e identificadas mediante kit BBL Crystal. La susceptibilidad antimicrobiana se determinó mediante el método de Kirby Bauer ante 12 antimicrobianos, incluida oxacilina. Todas las cepas fueron sometidas a RPC para la detección del gen mecA. Resultados: 72 cepas de SCP fueron aisladas, incluyendo S. aureus y S. intermedius. Se detectó resistencia antimicrobiana a al menos un antimicrobiano en cepas de gatos sanos (75%) y de gatos con lesiones cutáneas (87,5%). El gen mecA fue detectado en ocho cepas resistentes a meticilina y en tres cepas sensibles, siendo en general multi-resistentes. Discusión: Estos resultados destacan el rol de las mascotas como reservorios de resistencia bacteriana y su potencial impacto en la salud pública.
Subject(s)
Animals , Bacterial Proteins/genetics , Cats/microbiology , Polymerase Chain Reaction/veterinary , Penicillin-Binding Proteins/genetics , Methicillin-Resistant Staphylococcus aureus/genetics , Microbial Sensitivity Tests , Chile , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Genes, Bacterial/drug effects , Genes, Bacterial/genetics , Anti-Bacterial Agents/pharmacologyABSTRACT
En el presente artículo se opta por construir una ruta descriptiva de análisis que permitiera poner en consideración el concepto de Pautas de Crianza y su contenido, puesto que para hablar de prácticas de crianza alternas, es decir, de los grupos indígenas y afro, es preciso aclarar que en aras del eurocentrismo se han privilegiado los saberes de la ciencia occidental moderna y se han excluido los saberes creados y reproducidos en el interior de los grupos étnicos mencionados, olvidando que también forman parte del dogma de los saberes válidos. Por lo tanto, para comprender la riqueza de otras formas de conocimiento y/o hacer una decolonialidad del saber, es necesario conocer y respetar las cosmovisiones de las voces acalladas, ya que sus discursos han sido subalternizados y/o mediatizados por otros sin permitirles darlos a conocer desde su propia voz, desde sus lugares epistémicos, éticos y políticos. Entonces, la idea es complementar la episteme occidental con otras epistemes.
In this article, the authors opt for building a descriptive route of analysis dealing with the concept of "Rearing guidelines" and its content, since in order to talk about alternate rearing practices, that is to say, relating to indigenous and afro groups, it is necessary to clarify that in the interest of Eurocentrism, the knowledge of modern Western science has been privileged, and the created and reproduced knowledge by the aforementioned groups has been excluded, forgetting that they are also part of the dogma of valid knowledge. Therefore, in order to understand the wealth of others forms of knowledge and/or decolonization of knowledge, it is necessary to know and to respect the worldviews of the silenced voices, since their speeches have been subordinated and/or mediatized by others without allowing them to make them known from their own voice, from its epistemic, ethical, and political places. Then, the idea is to supplement the Western episteme with other episteme.