Laserterapia transcutânea para efeitos adversos hematopoiéticos de quimioterápicos antineoplásicos: Ensaio clínico randomizado / Terapia con láser transcutáneo para los efectos adversos hematopoyéticos de la quimioterapia antineoplásica: Ensayo clínico aleatorizado / Transcutaneous laser therapy for hematopoietic adverse effects of antineoplastic chemotherapeutics: Randomized clinical trial

Objetivo. Avaliar a eficácia dos protocolos de aplicação transcutânea do Intravenous Laser Irradiation of Blood 30' e 60', sobre os efeitos adversos no tecido hematopoiético por agentes quimioterápicos antineoplásicos endovenosos em adultos. Método. Ensaio clínico, randomizado e unicego, realizado em serviço ambulatorial de quimioterapia de hospital público do estado de São Paulo realizado de abril de 2018 a março de 2019. A amostra constituiu de 55 pacientes com tumores sólidos, a partir do segundo ciclo de tratamento com fármacos endovenosos citotóxicos para o tecido hematopoiético. O comprimento de onda utilizado foi de 660 nm, por via transcutânea, sob artéria radial. Resultado. Comparado ao tipo de hemocomponente, obtivemos, respectivamente aos protocolos do Intravenous Laser Irradiation of Blood 30' e 60': hemoglobina (85%; 86%), plaquetas (100%; 100%) e neutrófilos (95%; 92%). Conclusão. Considerou-se ambos os protocolos eficazes e, portanto, sugere-se implantá-los em unidades de quimioterapia(AU)

Objective: To evaluate the effectiveness of the protocols for transcutaneous application of the Intravenous Laser Irradiation of Blood 30' and 60', on the adverse effects on hematopoietic tissue by intravenous antineoplastic chemotherapeutic agents in adults. Method. Clinical, randomized and single-blind trial, carried out in an outpatient chemotherapy service of a public hospital in the state of São Paulo, carried out from April 2018 to March 2019. The sample consisted of 55 patients with solid tumors, from the second cycle of treatment with cytotoxic intravenous drugs for hematopoietic tissue. The wavelength used was 660 nm, transcutaneously, under the radial artery. Result. Compared to the type of blood component, we obtained, respectively from the Intravenous Laser Irradiation of Blood 30' and 60' protocols: hemoglobin (85%; 86%), platelets (100%; 100%) and neutrophils (95%; 92%). Conclusion. Both protocols were considered effective and, therefore, it is suggested to implant them in chemotherapy units.(AU)

Objetivo. Evaluar la efectividad de los protocolos de aplicación transcutánea de Irradiación Láser Intravenosa de Sangre 30' y 60', sobre los efectos adversos sobre el tejido hematopoyético por agentes quimioterápicos antineoplásicos intravenosos en adultos. Método. Ensayo clínico, aleatorizado y simple ciego, realizado en un servicio de quimioterapia ambulatoria de un hospital público del estado de São Paulo, realizado de abril de 2018 a marzo de 2019. La muestra estuvo compuesta por 55 pacientes con tumores sólidos, del segundo ciclo. del tratamiento con fármacos intravenosos citotóxicos para el tejido hematopoyético. La longitud de onda utilizada fue de 660 nm, por vía transcutánea, bajo la arteria radial. Resultado. En comparación con el tipo de componente sanguíneo, obtuvimos, respectivamente, de los protocolos de Irradiación Intravenosa con Láser de Sangre 30' y 60': hemoglobina (85%; 86%), plaquetas (100%; 100%) y neutrófilos (95%; 92%). %). Conclusión. Ambos os protocolos se consideraron efectivos, por lo que se sugiere implantarlos en las unidades de quimioterapia(AU)

Subclinical Systolic Dysfunction during Chemotherapy for Breast Cancer

Abstract Background Cardiotoxicity is the main complication related to cancer therapy. Studies indicate that global longitudinal strain is an early detector of subclinical dysfunction of the left ventricle, preceding the decline in ejection fraction (EF). However, the reproducibility of such methodology has not been tested outside specialized centers. Objectives To assess the frequency of subclinical cardiotoxicity and to compare global longitudinal strain and EF measurements during the clinical course of patients undergoing chemotherapy for breast cancer. Methods This was an observational prospective study of 78 adult women who underwent serial echocardiograms (baseline and 1, 3, and 6 months after the beginning of chemotherapy), to evaluate biplane and 3D EF and global longitudinal strain. Cardiotoxicity and subclinical dysfunction were defined according to American Society of Echocardiography/European Association of Cardiovascular Imaging criteria. Statistical significance was set at p < 0.05. Results The mean age of the patients was 50.1 ± 11.48 years. The frequency of subclinical cardiotoxicity (defined by global longitudinal strain) was 14.9% after 30 days of chemotherapy, 16.7% after 3 months, and 19.7% after 6 months, compared to 4.5%, 3%, and 6.6%, respectively, when clinical cardiotoxicity was determined according to EF. The group that developed subclinical cardiotoxicity by 30 days (group A) had a higher frequency of clinical cardiotoxicity at 3 months (p=0.028) and a lower mean biplane EF after 30 days (p= 0.036) than the group that showed no evidence of subclinical cardiotoxicity (group B). Conclusion Subclinical cardiotoxicity was frequent and began early, being associated with a drop in EF during the clinical course.

Cutaneous adverse events to systemic antineoplastic therapies: a retrospective study in a public oncologic hospital

Abstract Background: Mucocutaneous adverse events are common during anticancer treatment, with variable consequences for the patient and their therapeutic regimen. Objective: To evaluate the most common adverse events, as well as the drugs associated with their appearance and the consequences for cancer treatment. Methods: A retrospective study was carried out through the analysis of patients treated at the Clinical Dermatology Unit of a public oncologic hospital. Results: A total of 138 patients with 200 adverse events were evaluated. The most commonly identified adverse events were nail and periungual changes (20%), papulopustular eruptions (13%), acneiform eruptions (12%), hand-foot syndrome (6.5%), hand-foot skin reaction (6%), and xerosis (6%). The most frequently associated antineoplastic treatment groups were classical chemotherapy (46.2%), target therapy (32.3%), and other non-antineoplastic drugs used in neoplasia protocols (16.5%). Of the total number of patients, 17.4% had their treatment suspended or changed due to a dermatological adverse event. Study limitations: Retrospective study and analysis of patients who were referred for specialized dermatological examination only, not allowing the assessment of the actual incidence of adverse events. Conclusion: A wide variety of dermatological manifestations are secondary to antineoplastic treatment with several different drugs resulting, not rarely, in the interruption or modification of therapeutic regimens.

Qualidade de Vida e Saúde Bucal em Crianças submetidas à Terapia Antineoplásica / Quality of Life and Oral Health in Children undergoing Antineoplastic Therapy / Calidad de Vida y salud Oral de los Niños sometidos a Terapia Antineoplásica

Introdução: O câncer é uma doença grave cujo protocolo de tratamento pode produzir severos efeitos colaterais de ordem psicossocial e física. Os principais efeitos do tratamento antineoplásico podem acometer a cavidade oral, especialmente em crianças, comprometendo a sua qualidade de vida e a do núcleo familiar. Objetivo: Identificar e descrever as lesões bucais relacionadas aos efeitos colaterais produzidos pelo tratamento antineoplásico e avaliar seu impacto sobre a qualidade de vida da criança e da sua família. Método: Estudo qualitativo e transversal, com a participação de 117 crianças pré-escolares atendidas em hospital de referência (Paraíba), por meio do questionário B-ECOHIS, de exames clínicos odontológicos e de prontuários médicos. O tratamento estatístico fundamentou-se na análise descritiva e regressão de Poisson com variância robusta no método (p<0,05). Resultados: As manifestações mais observadas foram mucosite e xerostomia (66,7% e 54,7%, respectivamente). Relativo ao impacto na qualidade de vida da criança, o domínio de maior média foi limitação funcional 3,0 (±1,8) e, na família, função familiar 1,0 (±1,0). Conclusão: O impacto na qualidade de vida das crianças se revelou fraco e, no núcleo familiar, não foi significativo

Introduction: Cancer is a burdensome disease whose treatment protocol can produce severe psychosocial and physical side effects. The main effects of antineoplastic treatment may affect the oral cavity, especially in children, compromising theirs and their family quality-of-life. Objective: To identify and describe side effects-related antineoplastic treatment and to assess its impact on the children's and their families' quality-of-life. Method: Qualitative and cross-sectional study, with the participation of 117 children, preschoolers, consulted at a referral hospital in the State of Paraíba, through the B-Ecohis questionnaire, dental clinical exams and medical records. The statistical treatment was based on descriptive analysis and Poisson Regression with robust variance in the Stepwise method (p<0.05). Results: The most common manifestations were mucositis and xerostomia (66.7% and 54.7% respectively). The impact on the children's quality-of-life affected mostly the domain of functional limitation with mean of 3.0 (±1.8) and 1.0 (±1.0) for the family function in the family. Conclusion: The impact on the quality-of life in children was weak and not significant in the family

Introducción: El cáncer es una enfermedad grave cuyo protocolo de tratamiento puede producir efectos secundarios psicosociales y físicos graves. Entre los principales efectos del tratamiento antineoplásico, algunos afectan la cavidad bucal, especialmente en los niños, comprometiendo su calidad de vida y el núcleo familiar. Objetivo: Identificar los efectos secundarios producidos por el tratamiento antineoplásico y evaluar su impacto en la calidad de vida del niño y su familia. Método: Estudio cualitativo y transversal, con la participación de 117 niños, preescolares, atendidos en un hospital de referencia (Paraíba), mediante el cuestionario B-Ecohis, exámenes clínicos dentales y registros médicos. El tratamiento estadístico se basó en análisis descriptivo y Regresión de Poisson con varianza robusta en el método Stepwise (p<0,05). Resultados: Las manifestaciones más observadas fueron mucositis y xerostomía (66,7% y 54,7% respectivamente). En cuanto al impacto en la calidad de vida del niño, el dominio con mayor promedio fue la limitación funcional 3,0 (±1,8) y la función familiar 1,0 (±1,0) en la familia. Conclusión: El impacto en la calidad de vida de los niños fue débil y en la familia no significativo

Chinese expert consensus on the diagnosis and treatment of chemotherapy-induced peripheral neuropathy (2022 edition) / 中华肿瘤杂志

Chemotherapy-induced peripheral neuropathy (CIPN) is a serious clinical problem and challenging for oncologists. CIPN is often a persistent adverse consequence of certain chemotherapeutic agents and more cancer survivors will experience CIPN leading to chronic pain and worsening quality of life. However, the available and effective strategies for clinical treatment of CIPN are very limited. Oncologists are frequently obliged to decrease or stop neurotoxic anticancer drugs, with a possible deleterious impact on the oncological prognostic. The challenges faced by CIPN include further study on the pathological mechanism, dose threshold, incidence, risk factors and clinical characteristics of CIPN; lack of diagnostic criteria and tools of CIPN; lack of effective and standardized CIPN prevention and treatment programs. The current update of research results on these challenging issues of CIPN will provide more decision-making evidence for oncologists to diagnose and treat CIPN. Therefore, Committee of Neoplastic Supportive-Care of China Anti-Cancer Association and Cancer Clinical Chemotherapy Committee of China Anti-Cancer Association convenes some experts to summarize the recent literatures and discuss to reach the consensus about recommendations for the definition, pathophysiological mechanism, assessment, prevention, and treatment of CIPN.

Efficacy of Wen-Luo-Tong on Peripheral Neuropathy Induced by Chemotherapy or Target Therapy: A Randomized, Double-Blinded, Placebo-Controlled Trial / 中国结合医学杂志

OBJECTIVE@#To evaluate the efficacy of Wen-Luo-Tong Granules (WLT) local administration in the treatment of patients with peripheral neuropathy (PN) induced by chemotherapy or target therapy.@*METHODS@#This study is a randomized, double-blinded, and placebo-controlled trial. Seventy-eight patients with PN induced by chemotherapy or target therapy were enrolled from China-Japan Friendship Hospital between July 2019 and January 2020. They were randomly assigned to WLT (39 cases) and control groups (39 cases) using a block randomization method. The WLT group received WLT (hand and foot bath) plus oral Mecobalamin for 1 week, while the control group received placebo plus oral Mecobalamin. The primary endpoint was PN grade evaluated by the National Cancer Institute-Common Toxicity Criteria for Adverse Events (NCI-CTCAE). The secondary endpoints included quantitative touch-detection threshold, neuropathy symptoms, Quality of Life Questionnaire-Chemotherapy Induced Peripheral Neuropathy (QLQ-CIPN20), and Quality of Life Questionnaire-Core30 (QLQ-C30).@*RESULTS@#After treatment, the PN grade in the WLT group was significantly lower than that in the control group (1.00 ± 0.29 vs. 1.75 ± 0.68, P<0.01). The total effective rate in the WLT group was significantly higher than that in the control group (82.05% vs. 51.28%, P<0.01). Compared with the control group, the touch-detection thresholds at fingertips, neuropathy symptom score, QLQ-CIPN 20 (sensory scale, motor scale, autonomic scale, and sum score), and QLQ-C30 (physical functioning, role functioning, emotional functioning, and global health) in the WLT group significantly improved after treatment (P<0.01 or P<0.05).@*CONCLUSION@#WLT local administration was significantly effective in the treatment of patients with PN induced by chemotherapy or target therapy. (Trial registration No. ChiCTR1900023862).

Expert consensus on the diagnosis and treatment of anticancer drug-induced interstitial lung disease / 中华肿瘤杂志

Drug-induced interstitial lung disease (DILD) is the most common pulmonary adverse events caused by anti-cancer treatment. In recent years, with the development of clinical oncology, a large amount of novel anti-cancer drugs have been approved and widely used in clinical practice, and the incidence of anti-cancer drug related DILD is gradually increasing. DILD lacks specific clinical manifestations or diagnostic criteria. If not treated properly, it may leads to interruption or discontinuation of anti-cancer treatment, or even become life threat in severe cases. Therefore, the Anti-cancer Drug-induced Interstitial Lung Disease Management Group have reached a consensus on the diagnosis and management of anti-cancer DILD after several rounds of discussion. This consensus aims to improve clinicians' awareness of anti-cancer drug related-DILD and proposes an algorithm for the diagnosis and treatment of this disease, and to improve patients' prognosis and quality of life.

Obstrução lacrimal pós-tratamento oncológico: revisão de literatura / Lacrimal drainage system obstruction after cancer treatment: a literature review

RESUMO A obstrução de via lacrimal é uma possível complicação decorrente de tratamentos oncológicos sistêmicos e locais. A epífora crônica gera grande impacto na qualidade de vida desses pacientes, e, como a fibrose terminal da via lacrimal pode necessitar de procedimentos complexos para sua resolução, é importante estarmos atentos a esse efeito adverso, com o objetivo de reconhecê-lo e tratá-lo precocemente, ou mesmo preveni-lo. Nesta revisão da literatura, os autores analisam todos os agentes quimioterápicos e radioterápicos associados à obstrução lacrimal e descrevem os mecanismos, a frequência, os tratamentos e a profilaxia. Os tratamentos oncológicos associados à obstrução lacrimal foram: radioterapia em cabeça e pescoço (dosagem acima de 45 a 75Gy), radioiodoterapia (dosagem acima de 150mCi) e quimioterapia com 5-FU, S-1, capecitabine e docetaxel. A obstrução lacrimal pode ser irreversível, e a intubação profilática das vias lacrimais é uma possibilidade descrita de tratamento profilático em casos de radioterapia e uso do 5-FU, S-1 e docetaxel. O tratamento cirúrgico de todos os casos é a dacriocistorrinostomia.

ABSTRACT Lacrimal duct obstruction can be a side effect of systemic and/or local cancer treatments. Chronic epiphora has a great impact on the quality of life of oncological patients. Since terminal fibrosis of the lacrimal system may require complex procedures, it is important to be aware of this adverse effect in order to recognize and treat it, or even prevent it. A literature review was performed to identify all types of systemic cancer treatment associated with lacrimal obstruction and to describe the mechanisms, frequency, treatment, and prophylaxis. The oncological treatments associated with lacrimal obstruction were head and neck radiotherapy (dosage above 45-75 Gy), radioiodine therapy (dosage above 150 mCi), and chemotherapy with 5-FU, S-1, Capecitabine and Docetaxel. Depending on the dose, this complication may be irreversible. Prophylactic intubation of the lacrimal system is an option for prophylaxis in cases of radiotherapy, use of 5-FU, S-1, and Docetaxel. Final surgical treatment is dacryocystorhinostomy.

Investigation of teratogenic effects of letrozole on fetal bone development / Investigación de los efectos teratogénicos de letrozol en el desarrollo óseo fetal

SUMMARY: Letrozole is mainly used for the treatment of unexplained infertility, breast cancer and polycystic ovarian syndrome, with secondary use in ovarian stimulation. In cases of unexpected or unknown pregnancy during the use of letrozole, letrozole may cause a teratogenic effect on the fetus. In this reason, in this study, we aimed to determine the effect of letrozole on fetal bone development. In this study, 32 pregnant Wistar albino rats were used. The rats were divided into four groups: Control (saline) and high; 0.3 mg/kg, medium; 0.03 mg/kg, low; 0.003 mg/ kg letrozole. Saline and letrozole were administered in 100 mL solutions by intraperitonaly from day 11 to day 15 of pregnancy. The skeletal system development of fetuses was examined with double skeletal staining, immunohistochemical staining methods and mineral density scanning electron microscopy. A total of 100 fetuses from female rats, 25 in each group, were included in the study. As a result of that, ossification rates were observed to decrease depending on the dose of letrozole in the forelimb limb (scapula, humerus, radius, ulna) and hindlimb (femur, tibia, fibula) limb bones. As a result of the statistical analysis, a statistically significant decrease was found in the ossification rates of all bones between the control group and low, medium, high letrozole groups (p<0.001). Exposure to letrozole during pregnancy adversely affected ossification and bone growth. However, the teratogenic effects of letrozole are unclear. Therefore, it needs to be investigated more extensively.

RESUMEN: Letrozol se usa principalmente para el tratamiento de la infertilidad inexplicable, el cáncer de mama y el síndrome de ovario poliquístico, con estimulación ovárica de uso secundario. En casos de embarazo inesperado o desconocido durante el uso de letrozol, puede causar un efecto teratogénico en el feto. Por esta razón, en este estudio, nuestro objetivo fue determinar el efecto de letrozol en el desarrollo óseo fetal. Se utilizaron 32 ratas albinas Wistar preñadas las cuales se distribuyeron en cuatro grupos: Control (solución salina) y alta; 0,3 mg/kg, medio; 0,03 mg/kg, bajo; 0,003 mg/kg de letrozol. Se administró solución salina y letrozol en soluciones de 100 mL por vía intraperitoneal desde el día 11 hasta el día 15 de la preñez. El desarrollo del sistema esquelético de los fetos se examinó con tinción esquelética doble, métodos de tinción inmunohistoquímica y microscopía electrónica de barrido de densidad mineral. Se incluyeron en el estudio un total de 100 fetos de ratas hembra, 25 en cada grupo. Como resultado, se observó que las tasas de osificación disminuían dependiendo de la dosis de letrozol en los huesos de los miembros torácicos (escápula, húmero, radio, ulna) y de las miembros pélvicos (fémur, tibia, fíbula). Se encontró una disminución estadísticamente significativa en las tasas de osificación de todos los huesos entre el grupo control y los grupos de letrozol bajo, medio y alto (p<0,001). La exposición a letrozol durante la preñez afectó negativamente la osificación y el crecimiento óseo. Sin embargo, los efectos teratogénicos del letrozol no están claros por lo que debe ser investigado más extensamente.

Principais implicações terapêuticas à qualidade de vida de pacientes com câncer de colo uterino: uma revisão narrativa / Therapeutic implications to the quality of life of cervical cancer's patients: a narrative review

O câncer de colo uterino é o quarto tipo mais incidente e fatal entre as mulheres no Brasil e no mundo, o que representa mundialmente em torno de 600 mil novos casos e mais de 300 mil mortes a cada ano. Assim como o diagnóstico, o tratamento da doença pode impactar de forma significativa a qualidade de vida dessas pacientes. A aplicação de questionários que avaliem os diferentes aspectos da qualidade de vida das mulheres afetadas por esse câncer é uma ferramenta relevante, pois auxilia na compreensão e identificação dos principais danos relacionados ao tratamento. Este trabalho visa analisar a literatura atual que investiga e relata os principais efeitos à qualidade de vida de mulheres com câncer de colo uterino associados a diferentes modalidades terapêuticas e, desse modo, contribuir nas escolhas de tratamento e manejo clínico que resultem em menores impactos à qualidade de vida dessas mulheres.(AU)

Cervical cancer is the fourth most incident and fatal cancer type among women in Brazil and worldwide. This data represents around 600 thousand new cases worldwide each year and more than 300 thousand lives lost. Both diagnosis and treatment can significantly impact the quality of life of cervical cancer patients. The application of questionnaires that assess the different aspects of the quality of life of women affected by this cancer is a relevant tool, as it helps to understand and identify the main damages related to the treatment. This article aims to analyze the current literature that reports the main effects on the quality of life of women with cervical cancer associated with different therapeutic modalities. In this way, the review could assist in the treatment choices that imply less impact on the quality of life of these women.(AU)

Taxane-induced scleroderma: report of two cases / Esclerodermia inducida por taxanos: informe de dos casos

ABSTRACT Taxanes are a class of chemotherapeutic agents with common associated dermatologic adverse events, such as skin hyperpigmentation, hand-foot skin syndrome, paronychia and onycholysis. Taxane-induced scleroderma is rare. Few cases with skin findings resembling systemic sclerosis, have been reported after the administration of these agents. We report two cases with stage IV breast cancer, aged 66 and 71 years, who developed sclerodermic skin lesions in their extremities after starting treatment with placlitaxel and nabplaclitaxel respectively.

Los taxanos son agentes quimioterapéuticos cuyo uso se asocia a problemas dermatológicos tales como hiperpigmentación, síndrome manos-pies, paroniquia y onicolisis. La esclerodermia inducida por taxanos es rara, con pocos casos informados en la literatura. Informamos los casos de dos pacientes con cáncer de mama en estado IV, de 66 y 71 años, que desarrollaron lesiones esclerodérmicas en las extremidades después de ser tratadas con placlitaxel y nabplaclitaxel, respectivamente.

Recomendaciones para el manejo de la cardiotoxicidad relacionada con el tratamiento del cáncer. Primera parte / Recommendations for the management of cardiotoxicity related to cancer treatment. Part one / Recomendações para a gestão de cardiotoxicidade relacionada com o tratamento do câncer. Primeira parte

Las nuevas terapias oncológicas han logrado aumentar la sobrevida del paciente con cáncer, observando, sin embargo, un incremento de la morbilidad y mortalidad vinculadas a sus efectos secundarios. El desarrollo de eventos cardiovasculares adversos impacta negativamente en el pronóstico durante el tratamiento del cáncer, pero también en los supervivientes al cáncer, donde las enfermedades cardiovasculares (ECV) y las segundas neoplasias son la principal causa de muerte1-5. La cardiotoxicidad inducida por el tratamiento del cáncer se define como el conjunto de ECV derivadas de los tratamientos oncológicos. Su manifestación es variada e incluye el desarrollo de disfunción ventricular, insuficiencia cardíaca (IC), isquemia miocárdica, hipertensión arterial y arritmias, entre otras. Puede ser consecuencia tanto del efecto directo del tratamiento sobre la estructura y función cardíacas, como del desarrollo acelerado de ECV6-9. Frecuentemente se utiliza el término cardiotoxicidad como sinónimo de disfunción ventricular por quimioterapia (DV-QT). Dado que la cardiotoxicidad abarca un espectro más amplio de afectación cardiovascular, creemos conveniente hablar de DV-QT para referirnos a la afectación de la función sistólica del ventrículo izquierdo. La DV-QT y el desarrollo de IC representan una de las complicaciones más temidas por su impacto pronóstico en la esfera cardiovascular y oncológica, dado que limitan el arsenal terapéutico para el tratamiento del cáncer5,10. Han sido creadas diversas sociedades de cardio-onco-hematología con el fin de generar recomendaciones de práctica clínica y formar profesionales capacitados para el manejo de las complicaciones cardiovasculares del tratamiento del cáncer11. La cardio-oncología es una disciplina en creciente y continuo desarrollo. Creemos que es fundamental realizar tareas de formación médica continua, así como también estimular el trabajo conjunto de diversas especialidades para brindar una mejor asistencia. Este texto es el resultado del trabajo de un equipo multidisciplinario que incluye cardiólogos, hematólogos y oncólogos, y pretende brindar información a los integrantes del equipo de salud involucrados en la asistencia de pacientes oncológicos. Debido a su extensión, hemos decidido fraccionar el contenido en tres partes para facilitar su publicación.

New oncological therapies have been successful in increasing cancer patient survival, but they have also led to an increase in morbidity and mortality linked to their side effects. During cancer treatment, the development of cardiovascular side effects has a negative impact in prognosis, but also in cancer survivors, in whom cardiovascular diseases and secondary malignancies are the main cause of death. Cancer related cardiotoxicity is defined as the development of cardiovascular diseases related to cancer treatment. Clinical presentation is broad involving ventricular dysfunction, heart failure, myocardial ischemia, arterial hypertension and arrhythmias among others. This may result from the direct cardiovascular effect of a cancer treatment or accelerated development of cardiovascular diseases. Frequently, in the literature cardiotoxicity and chemotherapy related ventricular dysfunction are used as synonyms. However, cardiotoxicity includes a broad spectrum of cardiovascular manifestations, thus in this text we refer to chemotherapy related ventricular dysfunction as the presence of left ventricular systolic impairment. Chemotherapy related ventricular dysfunction and heart failure are two of the most feared complications of cancer treatment due to its impact on cardiovascular and oncological prognosis, affecting treatment options. Numerous worldwide cardio-onco-hematology societies have emerged to generate clinical practice guidelines and improve the diagnosis and evaluation of cardiovascular cancer treatment side effects. Cardio-Oncology is a discipline in continuous growth and development. We strongly believe that continuum medical education and a multidisciplinary approach is necessary to provide a quality health care. This text is the result of a multidisciplinary work involving cardiologists, hematologists and oncologists. It is our goal to provide information to the health care team involved in the assistance of cancer patients. Due to its extension, it will be published in three parts.

O desenvolvimento de novas terapias oncológicas levou a um aumento na sobrevida dos pacientes, mas ao mesmo tempo traz consigo morbidades relacionadas aos tratamentos. O desenvolvimento de efeitos cardiovasculares adversos tem um impacto negativo no prognóstico dos pacientes em tratamento, bem como nos pacientes considerados curados, nos quais doença cardiovascular e malignidades secundárias são as principais causas de morte. Cardiotoxicidade relacionada ao câncer é definida como o desenvolvimento de doença cardiovascular secundária ao tratamento. A gama de apresentações clínicas é ampla, podendo se manifestar como disfunção ventricular, insuficiência cardíaca, isquemia miocárdica, hipertensão arterial, arritmias, entre outras. Isto pode ser resultante de desenvolvimento e progressão acelerados de doença cardiovascular ou por efeito direto das terapias. Frequentemente é dito na literatura que cardiotoxicidade e disfunção ventricular relacionada à quimioterapia são sinônimos. Entretanto, cardiotoxicidade engloba um amplo espectro de manifestações cardiovasculares. Neste texto, portanto, nos referimos à disfunção ventricular causada por quimioterápicos exclusivamente como a presença de disfunção sistólica ventricular esquerda. Disfunção ventricular relacionada à quimioterapia e insuficiência cardíaca são duas das mais temidas complicações do tratamento oncológico devido ao seu impacto no prognóstico cardiovascular e oncológico, podendo afetar ainda a escolha e manutenção das opções terapêuticas. Diversas sociedades cardio-onco-hematológicas surgiram ao redor do mundo com o objetivo de gerar diretriz clínicas práticas e melhorar o diagnóstico e tratamento das complicações cardiovasculares resultantes das terapias oncológicas. A cardio-oncologia é uma disciplina em contínuo crescimento e desenvolvimento. Nós acreditamos fortemente que educação médica continuada e uma abordagem multidisciplinar são necessárias para um cuidado médico de qualidade. Este texto é o resultado de um trabalho multidisciplinar envolvendo cardiologistas, hematologistas e oncologistas. Nosso objetivo é de oferecer informação à equipe de cuidados em saúde envolvido na assistência destes pacientes. Devido à sua extensão, este texto será publicado em três partes.

Inibidores de Desmetilase Lisina-Específica 1 (LSD1) como candidatos a agentes antineoplásicos / Lysine-Specif Demethylase 1 (LSD1) inhibitors as candidates for antineoplastic agents

O câncer é uma das principais causas de morte no mundo sendo, atualmente, a segunda principal causa de morte, perdendo apenas para as doenças cardiovasculares, tornando-se um grande desafio para as autoridades de saúde pública. No Brasil são estimados 625000 novos casos desta enfermidade para o triênio de 2020-2022. Nesse cenário, vários alvos epigenéticos são considerados alternativas no desenvolvimento de inibidores para a terapia do câncer devido serem identificados e relacionados com a carcinogênese, incluindo modificações no perfil de metilação do DNA e modificações de histonas como a metilação, acetilação e fosforilação. Dentre estas modificações, a metilação de histonas é regulada reversivelmente por histonas metiltransferases e desmetilases. A enzima desmetilase lisina-específica 1 (LSD1) foi a primeira histona desmetilase caracterizada e catalisa a remoção de grupos metila das lisinas 4 e 9 da histona H3 (H3K4 e H3K9), utilizando o FAD como cofator. Superexpressa em vários tumores de alto risco e tendo seus níveis correlacionados com a reincidência do tumor durante o tratamento, a LSD1 apresenta papel fundamental na tumorgênese. Portanto, tem sido considerado um alvo biológico promissor no desenvolvimento de novos fármacos para terapêutica contra o câncer. Sendo assim, neste trabalho, a partir de dados de triagem virtual baseado neste alvo biológico, selecionou-se um hit, o qual foi utilizado como protótipo para o planejamento de análogos visando melhorar as características farmacológicas, pois possuem grupos químicos passíveis das mesmas interações com o alvo. Foram sintetizadas 16 moléculas, sendo 7 compostos finais inéditos derivados carboxamídicos e 9 derivados sulfonamídicos. Todos os compostos foram caracterizados por RMN (1H e 13C), espectrometria de massas de alta resolução, espectroscopia de infravermelho, ponto de fusão, polarímetro e a pureza dos compostos foi avaliada por CLAE. Os compostos finais foram submetidos ao ensaio enzimático frente à LSD1, acoplado a Enzima Horseradish Peroxidase (EHP), mostrando que apenas o composto 4g apresentou atividade inibitória de 64% e 57% em 50 µM e 500 µM respectivamente. No ensaio de viabilidade celular na linhagem HEL (linhagem leucêmica) os 16 compostos (4a- 4g, 5a-5d e 6a-6d) apresentaram-se ativos com valores de CI50 na faixa de 5,3 µM a 20,25 µM. Os compostos mais potentes foram os 4e (CI50 = 6,9 µM), 5d (CI50 =5,30 µM) e 6ª (CI50 =6,61 µM), evidenciando que os compostos possuem elevada potência, tornando-se moléculas promissoras em linhagens leucêmicas. Os estudos de ancoramento molecular com a LSD1 sugeriram que a mudança de orientação do composto 4g, permitiu que o grupo benzila da porção benzilamida faça interação com os resíduos PHE560 e TYR807 no bolso hidrofóbico, o que possivelmente acarretou um bloqueio na entrada da cavidade, permitindo a inibição pelo composto

Cancer is one of the leading causes of death in the world and is currently the second leading cause of death, second only to cardiovascular disease, making it a major challenge for public health authorities. In Brazil, approximately, 625000 new cases of this disease are estimated for the 2020-2022 period. In this scenario, several epigentic targets are considered alternatives in the development of inhibitors in cancer therapy, since they are identified and related to carcinogenesis, including changes in the DNA methylation profile and changes in histones such as methylation, acetylation and phosphorylation. Among these modifications, histone methylation is reversibly regulated by histones methyltransferases and demethylases. Lysine-specific demethylase1 (LSD1) was the first histone demethylase characterized and catalyzes the removal of methyl groups from lysines 4 and 9 of histone H3 (H3K4 and H3K9), using FAD as a cofactor. LSD1 has been found to be overexpressed in several high-risk tumors and these levels are correlated with tumor recurrence during treatment. Therefore, it has been considered a promising biological target in the development of new drugs with therapeutic potential against cancer. Thus, in this work, the virtual screening technique based on the biological target was used to discover LSD1 interactions, and then based on the hit found, we propose to synthesize compounds that have chemical groups susceptible to such interactions, seeking to evaluate the enzymatic activity in LSD1 enzyme. Were synthesized 16 molecules, 7 of which are unpublished final compound derived from carboxamides and 9 sulfonamide derivatives. All compounds were characterized by NMR (1H and 13C), high resolution mass spectrometry, infrared spectroscopy, melting point, polarimeter and the purity of the compounds was assessed by CLAE. The final compounds were subjected to enzymatic assays Against LSD1, coupled with enzime Horseradish Peroxidase (HRP), showing that only the 4g compound showed 64% and 57% inhibitory activity in 50 µM and 500 µM respectively. In the cell viability assay in the HEL line (Leukemic line) the 16 compounds (4a-4g, 5a-5d and 6a-6d) were active with IC 50 values in the range of 5.3 µM to 20.25 µM. The most potent compounds were 4e (CI50 = 6.9 µM), 5d (CI50 = 5.30 µM) and 6a (CI50 = 6.61 µM), showing that the compounds have high potency, becoming promising molecules in leukemic lines. Docking studies with LSD1 suggested, that the change in orientation of the 4g compound allows the benzyl group of the benzylamide portion to interact with the PHE560 and TYR807 residues in the hydrophobic pocket, which possibly cause a block in the entrance of the cavity, allowing the inhibition by the compound. Thus, the results obtained indicate that the class of compounds described is likely to continue to be investigated, both in the search for new LSD1 inhibitory hits based on the structure of the 4g compound, how to deepen the studies with 16 compounds of the present work in the performance of more specific tests in leukemic cells, in order to unravel the mechanism of action and possible targets

Systematic review and Meta-analysis on chemotherapy-induced bone marrow suppression treated with acupuncture / 中国针灸

OBJECTIVE@#To review systematically the effectiveness of acupuncture in treatment of chemotherapy-induced bone marrow suppression.@*METHODS@#From the date of database establishment to April 1, 2020, the articles on randomized controlled trials of chemotherapy-induced bone marrow suppression were retrieved by computer from the following databases, i.e. PubMed, Cochrane central register of controlled trials (CENTRAL), EMbase, cumulative index to nursing & allied health literature (CINAHL), JBI database of systematic reviews and implementation reports, CNKI, Wanfang, VIP and SinoMed. Using RevMan5.3, Meta-analysis was conducted. With GRADEpro GDT, the evidence quality was evaluated.@*RESULTS@#A total of 12 articles were included, 10 articles of which were analyzed by quantitative Meta-analysis. Compared with the control group, the improvements in the decrease of post-chemotherapy leukocyte (@*CONCLUSION@#Acupuncture alleviates the decrease of leukocyte, platelet, neutrophile granulocyte and erythrocyte counts and improves the survival quality of patients with chemotherapy-induced bone marrow suppression.

Advances on immune-related adverse events associated with immune checkpoint inhibitors / 医学前沿

Immunotherapy has recently led to a paradigm shift in cancer therapy, in which immune checkpoint inhibitors (ICIs) are the most successful agents approved for multiple advanced malignancies. However, given the nature of the non-specific activation of effector T cells, ICIs are remarkably associated with a substantial risk of immune-related adverse events (irAEs) in almost all organs or systems. Up to 90% of patients who received ICIs combination therapy experienced irAEs, of which majority were low-grade toxicity. Cytotoxic lymphocyte antigen-4 and programmed cell death protein-1/programmed cell death ligand 1 inhibitors usually display distinct features of irAEs. In this review, the mechanisms of action of ICIs and how they may cause irAEs are described. Some unsolved challenges, however really engrossing issues, such as the association between irAEs and cancer treatment response, tumor response to irAEs therapy, and ICIs in challenging populations, are comprehensively summarized.

Xerostomia e câncer de mama / Xerostomia and breast cancer / Xerostomía y cáncer de mama

Objetivo: Identificar os estudos que descrevem a prevalência de xerostomia em pacientes com câncer de mama e em quimioterapia. Método: Revisão integrativa, partindo da questão norteadora << Quais as evidências científicas sobre a prevalência de xerostomia em pacientes com câncer de mama e em quimioterapia? >>. Foi realizada uma busca nas bases de dados: US National Library of Medicine and National Institute of Health, Literatura Latino-Americana e do Caribe em Ciências da Saúde e Scientific Electronic Library Online por meio dos Descritores em Ciências da Saúde. Foram encontrados 63 artigos, analisados por dois pesquisadores seguindo os critérios de inclusão e exclusão. Resultados: A prevalência de xerostomia foi descrita em 10 artigos que utilizaram como método de avaliação escalas, questionários com respostas dicotômicas e sialometria. Conclusão: Identificou-se uma prevalência de 47% a 77,3% de xerostomia durante a quimioterapia

Objective: To identify studies describing the prevalence of xerostomia in breast cancer patients undergoing chemotherapy. Method: Integrative review based on the guiding question << What is the scientific evidence on the prevalence of xerostomia in breast cancer patients undergoing chemotherapy? >>. We searched the US National Library of Medicine and National Institute of Health, Latin American and Caribbean Health Sciences Literature and Scientific Electronic Library Online databases using the Health Sciences Descriptors. We found 63 articles, which were analyzed by two researchers, following the inclusion and exclusion criteria. Results: The prevalence of xerostomia was described in 10 articles that used scales, questionnaires with dichotomous answers, and sialometry as evaluation methods. Conclusion: A prevalence of 47% to 77.3% of xerostomia during chemotherapy was identified

Objetivo: Identificar estudios que describen la prevalencia de xerostomía en pacientes con cáncer de mama y quimioterapia. Método: Revisión integradora, basada en la pregunta guía << ¿Cuál es la evidencia científica sobre la prevalencia de xerostomía en pacientes con cáncer de mama y quimioterapia? >>. Se realizaron búsquedas en las bases de datos US National Library of Medicine and National Institute of Health, Literatura Latino-Americana y del Caribe en Ciencias de la Salud y Scientific Electronic Library Online utilizando los Descriptores de Ciencias de la Salud. Encontramos 63 artículos, que fueron analizados por dos investigadores siguiendo los criterios de inclusión y exclusión. Resultados: La prevalencia de xerostomía se describió en 10 artículos que utilizaron escalas, cuestionarios con respuestas dicotómicas y sialometría como método de evaluación. Conclusión: Se identificó una prevalencia de xerostomía del 47% al 77,3% durante la quimioterapia

Recomendaciones para el manejo de la cardiotoxicidad relacionada con el tratamiento del cáncer. Segunda parte / Recommendations for the management of cardiotoxicity related to cancer treatment. Part two / Recomendações para a gestão de cardiotoxicidade relacionada com o tratamento do câncer. Primeira [i.e. Segunda] parte

Las nuevas terapias oncológicas han logrado aumentar la sobrevida del paciente con cáncer, observando, sin embargo, un incremento de la morbilidad y mortalidad vinculadas a sus efectos secundarios. El desarrollo de eventos cardiovasculares adversos impacta negativamente en el pronóstico durante el tratamiento del cáncer, pero también en los supervivientes al cáncer, donde las enfermedades cardiovasculares (ECV) y las segundas neoplasias son la principal causa de muerte1-5. La cardiotoxicidad inducida por el tratamiento del cáncer se define como el conjunto de ECV derivadas de los tratamientos oncológicos. Su manifestación es variada e incluye el desarrollo de disfunción ventricular, insuficiencia cardíaca (IC), isquemia miocárdica, hipertensión arterial (HTA) y arritmias, entre otras. Puede ser consecuencia tanto del efecto directo del tratamiento sobre la estructura y función cardíacas, como del desarrollo acelerado de enfermedad cardiovascular6-9. Con frecuencia, se utiliza el término cardiotoxicidad como sinónimo de disfunción ventricular por quimioterapia (DV-QT). Dado que la cardiotoxicidad abarca un espectro más amplio de afectación cardiovascular, creemos conveniente hablar de DV-QT para referirnos a la afectación de la función sistólica del ventrículo izquierdo. La DV-QT y el desarrollo de IC representan una de las complicaciones más temidas por su impacto pronóstico en la esfera cardiovascular y oncológica, dado que limitan el arsenal terapéutico para el tratamiento del cáncer5,10. Han sido creadas diversas sociedades de cardio-onco-hematología con el fin de generar recomendaciones de práctica clínica y formar profesionales capacitados para el manejo de las complicaciones CV del tratamiento del cáncer11. La cardio-oncología es una disciplina en creciente y continuo desarrollo. Creemos que es fundamental realizar tareas de formación médica continua, así como también estimular el trabajo conjunto de diversas especialidades para brindar una mejor asistencia. Este texto es el resultado del trabajo de un equipo multidisciplinario que incluye cardiólogos, hematólogos y oncólogos, y pretende brindar información a los integrantes del equipo de salud involucrados en la asistencia de pacientes oncológicos. Debido a la extensión del presente texto, hemos decidido fraccionar el contenido en tres partes para facilitar su difusión.

New oncological therapies have been successful in increasing cancer patient survival, but they have also led to an increase in morbidity and mortality linked to their side effects. During cancer treatment, the development of cardiovascular side effects has a negative impact in prognosis, but also in cancer survivors, in whom cardiovascular diseases and secondary malignancies are the main cause of death. Cancer related cardiotoxicity is defined as the development of cardiovascular diseases related to cancer treatment. Clinical presentation is broad involving ventricular dysfunction, heart failure, myocardial ischemia, arterial hypertension and arrhythmias among others. This may result from the direct cardiovascular effect of a cancer treatment or accelerated development of cardiovascular diseases. Frequently, in the literature cardiotoxicity and chemotherapy related ventricular dysfunction are used as synonyms. However, cardiotoxicity includes a broad spectrum of cardiovascular manifestations, thus in this text we refer to chemotherapy related ventricular dysfunction as the presence of left ventricular systolic impairment. Chemotherapy related ventricular dysfunction and heart failure are two of the most feared complications of cancer treatment due to its impact on cardiovascular and oncological prognosis, affecting treatment options. Numerous worldwide cardio-onco-hematology societies have emerged to generate clinical practice guidelines and improve the diagnosis and evaluation of cardiovascular cancer treatment side effects. Cardio-Oncology is a discipline in continuous growth and development. We strongly believe that continuum medical education and a multidisciplinary approach is necessary to provide a quality health care. This text is the result of a multidisciplinary work involving cardiologists, hematologists and oncologists. It is our goal to provide information to the health care team involved in the assistance of cancer patients. Due to its extension, it will be divided in three parts.

O desenvolvimento de novas terapias oncológicas levou a um aumento na sobrevida dos pacientes, mas ao mesmo tempo traz consigo morbidades relacionadas aos tratamentos. O desenvolvimento de efeitos cardiovasculares adversos tem um impacto negativo no prognóstico dos pacientes em tratamento, bem como nos pacientes considerados curados, nos quais doença cardiovascular e malignidades secundárias são as principais causas de morte. Cardiotoxicidade relacionada ao câncer é definida como o desenvolvimento de doença cardiovascular secundária ao tratamento. A gama de apresentações clínicas é ampla, podendo se manifestar como disfunção ventricular, insuficiência cardíaca, isquemia miocárdica, hipertensão arterial, arritmias, entre outras. Isto pode ser resultante de desenvolvimento e progressão acelerados de doença cardiovascular ou por efeito direto das terapias. Frequentemente é dito na literatura que cardiotoxicidade e disfunção ventricular relacionada à quimioterapia são sinônimos. Entretanto, cardiotoxicidade engloba um amplo espectro de manifestações cardiovasculares. Neste texto, portanto, nos referimos à disfunção ventricular causada por quimioterápicos exclusivamente como a presença de disfunção sistólica ventricular esquerda. Disfunção ventricular relacionada à quimioterapia e insuficiência cardíaca são duas das mais temidas complicações do tratamento oncológico devido ao seu impacto no prognóstico cardiovascular e oncológico, podendo afetar ainda a escolha e manutenção das opções terapêuticas. Diversas sociedades cardio-onco-hematológicas surgiram ao redor do mundo com o objetivo de gerar diretriz clínicas práticas e melhorar o diagnóstico e tratamento das complicações cardiovasculares resultantes das terapias oncológicas. A cardio-oncologia é uma disciplina em contínuo crescimento e desenvolvimento. Nós acreditamos fortemente que educação médica continuada e uma abordagem multidisciplinar são necessárias para um cuidado médico de qualidade. Este texto é o resultado de um trabalho multidisciplinar envolvendo cardiologistas, hematologistas e oncologistas. Nosso objetivo é de oferecer informação à equipe de cuidados em saúde envolvido na assistência destes pacientes. Devido à sua extensão, este texto será dividido em três partes.

Estado Nutricional e Sintomas Gastrointestinais em Pacientes Oncológicos Submetidos à Quimioterapia / Nutritional Status and Gastrointestinal Symptoms in Oncology Patients Receiving Chemotherapy / Estado Nutricional y Síntomas Gastrointestinales en Pacientes con Cáncer Sometidos a Quimioterapia

Introdução: O estado nutricional do paciente oncológico apresenta grande variação ao longo da doença, além de efeitos adversos relacionados ao trato gastrointestinal serem comuns durante o tratamento quimioterápico. Objetivo: Avaliar o estado nutricional e a presença de sintomas gastrointestinais em pacientes oncológicos submetidos à quimioterapia. Método: Estudo transversal com pacientes em tratamento no setor de Quimioterapia do Hospital Escola da Universidade Federal de Pelotas (UFPel), RS, no período de abril a julho de 2019. Dados sociodemográficos e questões relacionadas à doença foram obtidos por meio de um questionário. Para avaliação do estado nutricional e dos sintomas gastrointestinais, utilizou-se a avaliação subjetiva global produzida pelo paciente. A análise dos dados foi realizada por meio de análise descritiva, e a associação entre variáveis categóricas, verificada pelo teste qui-quadrado de Pearson (p<0,05). Resultados:Foram avaliados 101 pacientes, com média de idade de 58,6 anos e maior prevalência de indivíduos do sexo feminino (58,4%), de cor branca (77,2%), casados (53,0%), pertencentes à classe C (50,4%). Encontrou-se maior prevalência dos cânceres do trato gastrointestinal (34,6%) e mama (27,8%). A maioria dos pacientes foi classificada como bem nutrido (66,3%), enquanto saciedade precoce (56,0%), xerostomia (54,0%), inapetência (42,0%) e náusea (37,0%) foram os sintomas mais citados. Não foi encontrada associação estatística entre o estado nutricional e qualquer um dos sintomas gastrointestinais. Conclusão: O estado nutricional da maioria dos pacientes foi classificado como bem nutrido, mas necessitando de atenção para a ocorrência dos sintomas gastrointestinais.

Introduction: The nutritional status of oncologic patients varies greatly throughout the disease, further to gastrointestinal tract related adverse effects that are common during chemotherapy treatment. Objective: Evaluate the nutritional status and the presence of gastrointestinal symptoms in oncologic patients undergoing chemotherapy. Method: Cross-sectional study with patients in treatment in the Chemotherapy Unit of the Hospital School of Pelotas Federal University (UFPel), RS, from April to July 2019. Sociodemographic data and questions related to the disease were obtained through a questionnaire. To assess the nutritional status and gastrointestinal symptoms the Patient-Generated Subjective Global Assessment was utilized. Data analysis was performed through descriptive analysis, and the association between categorical variables was verified by Pearson's chi-square test (p<0.05). Results: A total of one hundred one patients was evaluated, mean age of 58.6 years, with higher prevalence of females (58.4%), Caucasian (77.2%), married (53.0%), belonging to class C (50.4%). Higher prevalence of gastrointestinal tract (34.6%) and breast (27.8%) cancer was found. Most patients were classified as well-nourished (66.3%), while early satiety (56.0%), xerostomia (54.0%), loss of apetite (42.0%), and nausea (37.0%) were the symptoms most cited. No statistical association was encountered between nutritional status and any of the gastrointestinal symptoms. Conclusion: The nutritional status of most patients was classified as well nourished, but attention is needed for the occurrence of gastrointestinal symptoms.

Introducción: El estado nutricional del paciente oncológico presenta variacones durante la enfermedad, además de los efectos adversos relacionados con el tracto gastrointestinal comunes durante la quimioterapia. Objetivo: Evaluar el estado nutricional y la presencia de síntomas gastrointestinales en pacientes con cáncer sometidos a quimioterapia. Método: Estudio transversal con pacientes tratados en el sector de quimioterapia del Hospital Escuela de la Universidad Federal de Pelotas (UFPel), RS, de abril a julio de 2019. Se obtuvieron datos sociodemográficos y relacionados con la enfermedad a través de un cuestionario. Para evaluar el estado nutricional y los síntomas gastrointestinales se utilizó la Evaluación Subjetiva Global Producida por el Paciente. Las análisis de los datos se realizó mediante análisis descriptiva, y la asociación entre variables categóricas se verificó mediante la prueba de chi-cuadrado de Pearson (p<0,05). Resultados: Se evaluaron 101 pacientes, con edad media de 58,6 años, mayor prevalencia de mujeres (58,4%), blancos (77,2%), casados (53,0%), pertenecientes a la clase C (50,4%). Se encontró una mayor prevalencia de cánceres del tracto gastrointestinal (34,6%) y de mama (27,8%). La mayoría de los pacientes se clasificó como bien nutrido (66,3%), mientras que saciedad temprana (56,0%), boca seca (54,0%), falta de apetito (42,0%) y náuseas (37,0%) fueron los síntomas más frecuentemente. No se encontró asociación estadística entre el estado nutricional y los síntomas gastrointestinales. Conclusión: El estado nutricional de la mayoría de los pacientes se clasificó como bien nutrido, pero necesita la atención a presencia de síntomas gastrointestinales.

Alterações Dermatológicas Associadas ao Tratamento Oncológico de Mulheres com Câncer de Mama / Dermatological Alterations Associated with Oncological Treatment of Women with Breast Cancer / Alteraciones Dermatológicas Asociadas con el Tratamiento Oncológico de Mujeres con Cáncer de Mama

Introdução: Diversos efeitos colaterais podem acometer a pele e seus anexos durante o tratamento oncológico de mulheres com câncer de mama, comprometendo a terapia. Objetivo: Identificar a ocorrência de alterações dermatológicas durante o tratamento oncológico de mulheres com câncer de mama. Método: Estudo documental e retrospectivo, de cunho quantitativo, com uso de dados secundários obtidos por meio de 190 prontuários clínicos (n=190) de um serviço privado de oncologia. Resultados: As participantes apresentaram média de idade de 53 anos (±11,2), com diagnóstico histopatológico de carcinoma ductal invasivo (85,8%). Todas foram submetidas à quimioterapia, 65,3% à mastectomia radical e 34,2% à radioterapia. As alterações dermatológicas identificadas e as ocorrências verificadas na amostra foram alopecia (94,2%), hiperpigmentação (48,4%), prurido (36,3%), eritema (6,8%), descamação (25,8%) e alterações ungueais (77,9%). Ao todo, foram identificadas 550 alterações dermatológicas, resultando em uma média de 2,9 (±1,3) por paciente. A radioterapia esteve associada a uma maior ocorrência de eritema (p<0,001) e mulheres expostas a taxanos apresentaram maior probabilidade de manifestar de alterações dermatológicas do que as não expostas (p<0,001), bem como fatores sociodemográficos não estiveram associados. Conclusão: A ocorrência de alterações dermatológicas identificadas nas participantes foi significativa, reforçando que essas manifestações podem ser frequentes em mulheres com câncer de mama durante o tratamento oncológico, requerendo medidas de prevenção e tratamento.

Introduction: Several side effects can affect the skin and its attachments during cancer treatment of women with breast cancer, compromising the therapy. Objective: To identify the occurrence of dermatological changes during cancer treatment of women with breast cancer. Method:Quantitative approach, documentary and retrospective study, using secondary data obtained from 190 clinical records (n=190) from a private oncology service. Results: The participants had a mean age of 53 years (±11.2), with histopathological diagnosis of invasive ductal carcinoma (85.8%). All participants were exposed to chemotherapy, 65.3% to radical mastectomy and 34.2% to radiotherapy. The dermatological alterations identified, and the occurrences verified in the sample were alopecia (94.2%), hyperpigmentation (48.4%), pruritus (36.3%), erythema (6.8%), desquamation (25.8%) and nail alterations (77.9%). In all, 550 dermatological alterations were identified, resulting in an average of 2.9 (±1.3) changes per patient. Radiotherapy was associated with a higher occurrence of erythema (p<0.001) and women exposed to taxanes were more likely to manifest dermatological alterations than those unexposed (p<0.001), sociodemographic factors were not associated. Conclusion: The occurrence of dermatological alterations identified in the participants was significant, reinforcing that these manifestations may be frequent in women with breast cancer during oncological treatment, requiring prevention and treatment actions.

Introducción: Varios efectos secundarios pueden afectar la piel y sus uniones durante el tratamiento del cáncer de mujeres con cáncer de mama, comprometiendo la terapia. Objetivo: Identificar la aparición de alteraciones dermatológicas durante el tratamiento del cáncer de mujeres con cáncer de mama. Método: Estudio documental y retrospectivo, de carácter cuantitativo, utilizando datos secundarios obtenidos de 190 registros clínicos (n=190) de un servicio oncológico privado. Resultados: Los participantes tenían una edad media de 53 años (±11,2), con diagnóstico histopatológico de carcinoma ductal invasivo (85,8%). Todas fueran sometidas a quimioterapia, el 65,3% a mastectomía radical y el 34,2% a radioterapia. Las alteraciones dermatológicas identificadas y las ocurrencias verificadas en la muestra fueron alopecia (94,2%), hiperpigmentación (48,4%), prurito (36,3%), eritema (6,8%), descamación (25,8%) y alteraciones en las uñas (77,9%). En total, se identificaron 550 alteraciones dermatológicas, lo que resultó en un promedio de 2,9 (±1,3) por paciente. En total, se identificaron 550 cambios dermatológicos, lo que resultó en un promedio de 2,9 (±1,3) alteraciones por paciente. La radioterapia se asoció con una mayor incidencia de eritema (p<0,001) y las mujeres expuestas a taxanos tienen más probabilidades de manifestar alteraciones dermatológicas que las no expuestas (p<0,001), además de que no se asociaron factores sociodemográficos. Conclusión: La ocurrencia de alteraciones dermatológicas identificadas en las participantes fue significativa, reforzando que estas manifestaciones pueden ser frecuentes en mujeres con cáncer de mama durante el tratamiento oncológico, requiriendo acciones de prevención y tratamiento.

Efficacy and safety of sorafenib in elderly patients with advanced hepatocellular carcinoma

OBJECTIVES: To evaluate the efficacy and safety of sorafenib in elderly patients with advanced hepatocellular carcinoma (HCC). METHODS: We analyzed data from a cohort of patients with advanced HCC treated using systemic treatment according to the local institutional protocol. Patients were divided into two groups, Group A, individuals <70 years of age, and Group B, individuals 70 years of age or older at the time of treatment initiation. Efficacy, measured based on overall survival (OS) and time to treatment failure (TTF), and toxicity were compared between groups. RESULTS: A total of 238 patients with advanced HCC who received sorafenib between 2007 and 2018 were evaluated. The median age for Group A was 59.1 years and that for Group B 73.6 years. The major prognostic characteristics were balanced between the groups. There were no significant differences in OS between Group A (8.0 months, 95%CI 6.34-9.3) and Group B (9.0 months, 95%CI 5.38-12.62), p=0.433, or in TTF between Group A (3.0 months, 95%CI 2.39-3.60) and Group B (3.0 months, 95%CI 1.68-4.32), p=0.936. There were no significant differences between Groups A and B with respect to the incidence of adverse events or treatment discontinuation because of toxicity. CONCLUSION: Efficacy and safety of sorafenib did not differ significantly between younger and older patients with HCC. Our data suggest that age alone should not restrict clinical decision-making for patients with advanced HCC.