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1.
Arch. argent. pediatr ; 119(5): e536-e539, oct. 2021. tab, ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1292788

ABSTRACT

El melanoma es la forma más grave de cáncer de piel. La morbimortalidad es variable, ya que se relaciona con las medidas de prevención implementadas, la detección temprana y el acceso al tratamiento temprano. La incidencia ha aumentado en los últimos años a pesar de la mayor concientización con respecto a la exposición a la luz solar y la utilización de cremas protectoras. A su vez, el rango etario se ha ampliado, y esta enfermedad afecta a individuos cada vez más jóvenes. Se estima que del 1 % al 4 % de todos los casos de melanoma ocurren en menores de 20 años.Se presentan dos casos pediátricos, con evolución prolongada y diagnóstico inicial erróneo. Es fundamental para el pediatra general, primer contacto del paciente con el sistema de salud, conocer las características de estas lesiones. Un alto índice de sospecha permitiría la derivación al especialista de forma temprana.


Melanoma is the most serious skin cancer. Morbimortality is variable as it is related to the preventive measures, early detection, and access to early treatment. The incidence has increased in recent years, despite the raise in awareness of avoiding sun exposure and the use of sunscreen. What is more, the disease age range has expanded, affecting increasingly younger individuals. It is estimated that 1 to 4 % of all melanoma cases occurred in people younger than twenty years old.We present two pediatric cases with prolonged evolution and wrong initial diagnosis. Since the general pediatrician is the patient's first contact with the health system, it is extremely important to know the characteristics of these lesions. A high index of suspicion would allow an early referral to the specialist.


Subject(s)
Humans , Child, Preschool , Child , Melanoma/drug therapy , Melanoma/therapy , Skin Diseases/diagnosis , Skin Diseases/drug therapy , Sunscreening Agents/therapeutic use , Incidence
2.
Rev. bras. cir. cardiovasc ; 36(1): 112-115, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1155784

ABSTRACT

Abstract A 71 year-old male with a history of multiple excisions of an initial Clark's level V melanoma of the breast followed by combined radiation and interferon treatment, as well as a recurrence, 3 years later, of a BRAF-positive tumor of the shoulder, with subsequent therapy with dabrafenib and trametinib, presented again with progressive intracardiac masses causing significant right ventricular outflow obstruction. Additionally, the patient complained of dyspnea and fatigue on exertion, thus he was scheduled for surgical resection.


Subject(s)
Humans , Male , Aged , Skin Neoplasms/surgery , Heart Neoplasms/surgery , Heart Neoplasms/diagnostic imaging , Melanoma/surgery , Melanoma/drug therapy , Mutation , Neoplasm Recurrence, Local
3.
Medwave ; 20(7): e8010, 2020.
Article in English, Spanish | LILACS | ID: biblio-1122665

ABSTRACT

Las terapias target constituyen hoy en día una alternativa terapéutica cada vez más utilizada para el manejo de pacientes con melanoma metastásico. Sin embargo, se han descrito múltiples efectos farmacológicos adversos asociados a su uso, siendo los cutáneos los de mayor prevalencia. Se presenta el caso de un hombre de 55 años con diagnóstico de melanoma cutáneo metastásico etapa IV, BRAFV600E mutado, en tratamiento con dabrafenib/trametinib que consultó por desarrollo de lesiones nodulares eritematosas sensibles en extremidades superiores e inferiores, asociadas a sensación febril durante el curso del tratamiento. Se descartó alguna infección sobreagregada. Se realizó una biopsia de las lesiones cutáneas, con confirmación diagnóstica histopatológica de una paniculitis mixta de predominio septal, granulomatosa y con vasculitis leucocitoclástica. La paniculitis asociada a esta terapia ha sido descrita en la literatura y se ha considerado un efecto farmacológico inmunomediado adverso, relacionándose a un mejor pronóstico para el melanoma metastásico en tratamiento. Por lo tanto, así como en el caso presentado, se evita la suspensión del fármaco y se asocia terapia sintomática en caso de mayores molestias del paciente. Es de alta relevancia para el dermatólogo conocer e interpretar adecuadamente este efecto adverso farmacológico, y así indicar el manejo más adecuado para el paciente.


Target therapies are currently a therapeutic option increasingly used for the management of patients with metastatic melanoma. However, there are multiple adverse pharmacological effects associated with their use that have been described. Cutaneous adverse reactions are the most frequent. We report the case of a 55-year-old man with a diagnosis of stage IV BRAFV600E-mutated metastatic cutaneous melanoma undergoing treatment with dabrafenib/trametinib, who consulted due to the development of erythematous nodular lesions in the upper and lower limbs associated with febrile sensation during the course of treatment. Infection was ruled out and a biopsy of the skin lesions was done, which provided the histopathological confirmation of a predominantly septal, granulomatous with leukocytoclastic vasculitis, mixed panniculitis. Panniculitis associated with this therapy has been described in the literature and has been considered an immune-mediated pharmacological adverse effect. It is considered to be related to a better prognosis in the treatment of metastatic melanoma. Consequently, as shown in this case report, target therapy should not be discontinued and symptomatic medication should be given to alleviate patient discomfort. The dermatologist should know and properly interpret this adverse effect and prescribe the most appropriate management for the patient.


Subject(s)
Humans , Male , Middle Aged , Panniculitis/chemically induced , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Molecular Targeted Therapy/methods , Oximes/administration & dosage , Pyridones/administration & dosage , Pyrimidinones/administration & dosage , Skin Neoplasms/drug therapy , Panniculitis/diagnosis , Panniculitis/therapy , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Molecular Targeted Therapy/adverse effects , Dermatologists , Imidazoles/administration & dosage , Melanoma/drug therapy
4.
Rev. Hosp. Ital. B. Aires (2004) ; 39(4): 146-148, dic. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1099838

ABSTRACT

Los anticuerpos monoclonales que inhiben los puntos de control PD-1 y CTLA-4 se usan actualmente en el tratamiento del melanoma y cáncer metastásico de pulmón de células no pequeñas, entre otros. Se refiere el caso de una paciente con cáncer de pulmón en tratamiento con pembrolizumab. La paciente se presentó con edema facial y parálisis facial periférica. En el laboratorio se observó la hormona tirotrofina (TSH) elevada y se llegó al diagnóstico de hipotiroidismo por pembrolizumab. Inició tratamiento con levotiroxina con mejoría clínica. Se presenta este caso por el importante papel del dermatólogo en el manejo multidisciplinario del paciente oncológico. (AU)


Monoclonal antibodies that inhibit PD-1 and CTLA-4 control points are currently used in the treatment of melanoma and metastatic non-small cell lung cancer, among others. The case of a patient, with lung cancer being treated with Pembrolizumab. The patient was presented with facial edema and peripheral facial paralysis and in the laboratory the elevated hormone Tyrotrophin (TSH) was observed, the diagnosis of pembrolizumab hypothyroidism was reached. She started treatment with levothyroxine with clinical improvement. This case is presented by the important role of the dermatologist in the multidisciplinary management of the cancer patient. (AU)


Subject(s)
Humans , Female , Middle Aged , M Phase Cell Cycle Checkpoints/drug effects , Immunotherapy/adverse effects , Antibodies, Monoclonal/adverse effects , Thyroxine/therapeutic use , Brain Neoplasms/complications , Brain Neoplasms/drug therapy , Thyrotropin/analysis , Carboplatin/administration & dosage , Carcinoma, Non-Small-Cell Lung/complications , Carcinoma, Non-Small-Cell Lung/drug therapy , Tumor Suppressor Proteins/drug effects , Dermatology , Facial Injuries , Facial Paralysis , CTLA-4 Antigen/drug effects , CTLA-4 Antigen/physiology , Programmed Cell Death 1 Receptor/drug effects , Programmed Cell Death 1 Receptor/physiology , Pemetrexed/administration & dosage , Melanoma/complications , Melanoma/drug therapy , Antibodies, Monoclonal/administration & dosage , Antibodies, Monoclonal/therapeutic use , Neoplasm Metastasis/drug therapy
5.
An. bras. dermatol ; 94(6): 721-723, Nov.-Dec. 2019. graf
Article in English | LILACS | ID: biblio-1054886

ABSTRACT

Abstract Primary male genital melanomas are very rare; they are associated with high mortality and late detection. Scrotal melanoma is the least common presentation and only 23 cases have been reported. Herein, the authors present a 30-year-old patient with stage IIIC (T4b, N2a, M0) scrotal melanoma in order to report the characteristics, treatment, and outcome, as well as to emphasize the importance of examination of the genitals, education of patients about self-examination and destigmatizing genital lesions to increase the likelihood of earlier detection.


Subject(s)
Humans , Male , Adult , Scrotum/pathology , Skin Neoplasms/pathology , Genital Neoplasms, Male/pathology , Melanoma/pathology , Skin Neoplasms/drug therapy , Biopsy , Interferon alpha-2/administration & dosage , Genital Neoplasms, Male/drug therapy , Melanoma/drug therapy , Neoplasm Staging , Antineoplastic Agents/administration & dosage
6.
Arq. bras. oftalmol ; 82(1): 38-44, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-973869

ABSTRACT

ABSTRACT Purpose: To evaluate the effects of ranibizumab and amfenac in human uveal melanoma cell lines and to explore the ability of these compounds to sensitize uveal melanoma cells to radiation therapy. Methods: The 92.1 human uveal melanoma cell line was cultured and subjected to the proposed treatment (ranibizumab, amfenac, and a combination of both). Proliferation, migration, and invasion assays of the 92.1 uveal melanoma cell line were assessed after pretreatment with ranibizumab (125 mg/mL), amfenac (150 nM), or a combination of both. In addition, proliferation rates were assessed after treatment with ranibizumab and amfenac, and the cells were subsequently exposed to various radiation doses (0, 4, and 8 Gy). Results: Proliferation assay: cells treated with a combination of ranibizumab and amfenac had lower proliferation rates than controls (p=0.016) and than those treated with only ranibizumab (p=0.033). Migration assay: a significantly lower migration rate was observed in cells treated with amfenac than the control (p=0.014) and than those treated with ranibizumab (p=0.044). Invasion assay: there were no significant differences among the studied groups. Irradiation exposure: in the 4 Gy dose group, there were no significant differences among any groups. In the 8 Gy dose group, treatment with ranibizumab, amfenac, and their combination prior to application of the 8 Gy radiation led to a marked reduction in proliferation rates (p=0.009, p=0.01, and p=0.034, respectively) compared with controls. Conclusion: Combination of ranibizumab and amfenac reduced the proliferation rate of uveal melanoma cells; however, only amfenac monotherapy significantly decreased cell migration. The radiosensitivity of the 92.1 uveal melanoma cell line increased following the administration of ranibizumab, amfenac, and their combination. Further investigation is warranted to determine if this is a viable pretreatment strategy to render large tumors amenable to radiotherapy.


RESUMO Objetivo: Avaliar os efeitos do ranibizumabe em associação com o amfenac nas células de melanoma uveal humano e explorar a capacidade desses compostos em sensibilizar as células de melanoma uveal à radioterapia. Métodos: Células de melanoma uveal humano do tipo 92.1 foram cultivadas e submetidas ao tratamento proposto (ranibizumabe, amfenac e a combinação de ambos). Ensaios de proliferação, migração e invasão com as células de melanoma uveal do tipo 92.1 foram avaliados após tratamento com ranibizumabe (125 mg/ml), amfenac (150 nM) e a combinação de ambos. Além disso, as taxas de proliferação foram avaliadas após tratamento com ranibizumabe e amfenac com subsequente exposição das células a diferentes doses de radiação (0 Gy, 4 Gy e 8 Gy). Resultados: Ensaio de proliferação: células tratadas com ranibizumabe e amfenac combinados apresentaram taxas de proliferação inferiores em comparação ao grupo controle (p=0,016), do que as tratadas apenas com ranibizumabe (p=0,033). Ensaio de migração: foi observada uma taxa de migração significativamente mais baixa nas células tratadas com amfenac do que no grupo controle (p=0,014) e do que nas tratadas com ranibizumabe (p=0,044). Ensaio de invasão: não houve diferenças significativas entre os grupos estudados. Exposição à irradiação: no grupo da dose de 4 Gy, não houve diferença significante entre os grupos. No grupo da dose de 8 Gy, o tratamento com ranibizumabe, afenac e sua combinação antes da aplicação da radiação de 8 Gy levou a uma redução acentuada nas taxas de proliferação (p=0,009, p=0,01 e p=0,034, respectivamente) em comparação aos grupos controle. Conclusão: A combinação de ranibizumabe e amfenac reduziu a taxa de proliferação das células de melanoma uveal; no entanto, apenas o amfenac diminuiu significativamente a migração celular. A radiossensibilidade das células de melanoma uveal do tipo 92.1 aumentou após a administração de ranibizumabe, amfenac e sua combinação. Mais investigações são necessárias para determinar se esta é uma estratégia de pré-tratamento viável para tornar grandes tumores passíveis de radioterapia.


Subject(s)
Humans , Phenylacetates/pharmacology , Angiogenesis Inhibitors/pharmacology , Cyclooxygenase 2 Inhibitors/pharmacology , Ranibizumab/pharmacology , Melanoma/drug therapy , Melanoma/radiotherapy , Radiation Tolerance , Uveal Neoplasms/drug therapy , Uveal Neoplasms/radiotherapy , Antineoplastic Combined Chemotherapy Protocols , Cell Movement/drug effects , Cell Movement/radiation effects , Reproducibility of Results , Cell Line, Tumor , Cell Proliferation/drug effects , Cell Proliferation/radiation effects , Dose-Response Relationship, Radiation
7.
Rev. chil. dermatol ; 35(2): 63-67, 2019. tab, ilus
Article in Spanish | LILACS | ID: biblio-1103483

ABSTRACT

El Vemurafenib es un inhibidor de la enzima serina/treonina quinasa BRAF utilizado en el tratamiento de pacientes con melanoma con diseminación loco-rregional y enfermedad metastásica, portadores de la mutación V600E del gen BRAF. Se ha asociado a múltiples efectos adversos cutáneos de los cuales se destaca la posibilidad de generar cambios en los nevos melanocíticos, aparición de nuevos nevos e incluso de segundos melanomas. El seguimiento digital dermatoscópico con mapeo corporal, ha demostrado utilidad en el diagnóstico precoz de melanoma.Presentamos dos casos clínicos de pacientes con ante-cedentes de melanoma en tratamiento con inhibido-res de BRAF (BRAFi) e inhibidores de BRAF y MEK (MEKi) en quienes se realizó seguimiento digital der-matoscópico con mapeo corporal. Se detectaron cambios en nevos melanocíticos preexistentes, aparición segundos melanomas y metástasis cutáneas.El grupo de pacientes con antecedentes de melanoma y en tratamiento con BRAFi o combinación de BRA-Fi y MEKi se beneficia especialmente del control der-matológico con seguimiento digital dermatoscópico y mapeo corporal.


Vemurafenib is an inhibitor of the serine / threonine kinase BRAF enzyme currently used in the treatment of patients with locoregional spread and metastatic melanoma carriers of the mutationV600E of the BRAF gene. It has been associated with multiple cu-taneous adverse effects including changes in melanocytic nevi, appearance of new nevi and even second melanomas. Dermoscopic digital follow-up with total body mapping has proven useful in the early diagnosis of melanoma.We present two cases of patients with a history of me-lanoma in treatment with BRAF inhibitors (BRAFi) and inhibitors of BRAF and MEK (MEKi) in whom a digital dermoscopic follow-up was performed with body mapping. Changes in preexisting melanocytic nevi, second melanomas and cutaneous metastases were detected.The group of patients with a history of melanoma and in treatment with BRAFi or a combination of BRAFi and MEKi especially benefits from dermato-logical surveillance with digital dermoscopic follow-up and total body mapping.


Subject(s)
Humans , Middle Aged , Skin Neoplasms/drug therapy , Vemurafenib/therapeutic use , Melanoma/drug therapy , Antineoplastic Agents/therapeutic use , Skin Neoplasms/pathology , Follow-Up Studies , Dermoscopy , Melanoma/pathology
8.
Epidemiol. serv. saúde ; 28(2): e2018325, 2019. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1012074

ABSTRACT

Objetivo: estimar o impacto orçamentário incremental da terapia-alvo para tratamento de primeira linha do melanoma avançado não cirúrgico e metastático, em comparação à dacarbazina. Métodos: análise de impacto orçamentário na perspectiva do Sistema Único de Saúde (SUS) do Brasil; a partir de dados demográficos e estimativas da incidência, foi delimitada a população no horizonte temporal de três anos (2018-2020) e estimados os custos diretos médicos; foi considerado cenário de referência o tratamento com dacarbazina, e como cenários alternativos a terapia-alvo com vemurafenibe, dabrafenibe, vemurafenibe + cobimetinibe e dabrafenibe + trametinibe; a avaliação das incertezas foi conduzida mediante análise por cenários. Resultados: o impacto orçamentário incremental variou de R$ 451.867.881,00 a R$ 768.860.968,00, representando 0,70 a 1,53% dos gastos anuais totais com medicamentos ambulatoriais no SUS; no melhor e no pior cenário, os resultados variaram de R$ 289.160.835,00 a R$ 1.107.081.926,00. Conclusão: a terapia-alvo, comparada à dacarbazina, implica impacto excessivo no orçamento, desfavorecendo eventual incorporação.


Objetivo: estimar el impacto presupuestario incremental de la terapia dirigida para tratamiento de primera línea del melanoma avanzado no quirúrgico y metastásico comparado con la dacarbazina. Métodos: análisis de impacto presupuestario, en la perspectiva del Sistema Único de Salud (SUS) de Brasil; a partir de datos demográficos y estimaciones de incidencia se delimitó la población en un horizonte temporal de tres años (2018-2020) y se estimaron los costos directos médicos. El escenario de referencia fue el tratamiento con dacarbazina y los escenarios alternativos la terapia dirigida con vemurafenib, dabrafenib, vemurafenib + cobimetinib y dabrafenib + trametinib; la evaluación de incertidumbre se llevó a cabo mediante análisis por escenarios. Resultados: el impacto presupuestario incremental varió de R$ 451.867.881,00 a R$ 768.860.968,00, representando 0,70 a 1,53% de gastos anuales totales con medicamentos de ambulatorios en el SUS; en el mejor y el peor escenario los resultados variaron de R$ 289.160.835,00 a R$ 1.107.081.926,00. Conclusión: el uso de terapia dirigida comparado a la dacarbazina implica en impacto excesivo en el presupuesto, desfavoreciendo una eventual incorporación.


Objective: to estimate the incremental budget impact of target therapy for first-line treatment of advanced non-surgical and metastatic melanoma compared to dacarbazine treatment. Methods: budget impact analysis, from the Brazilian National Health System (SUS) perspective; based on demographic data and incidence estimates, the population over a three-year time horizon (2018-2020) was delimited and the direct medical costs were estimated; the reference scenario was treatment with dacarbazine, and the alternative scenarios were target therapy with vemurafenib, dabrafenib, vemurafenib + cobimetinib and dabrafenib + trametinib; uncertainty assessment was conducted through scenario analysis. Results: the incremental budget impact ranged from R$ 451,867,881.00 to R$ 768,860,968.00, representing 0.70 to 1.53% of total SUS annual outpatient drugs expenditure; in best and worst scenario, results ranged from R$ 289,160,835.00 to R$ 1,107,081,926.00. Conclusion: the use of target therapy compared to dacarbazine implies an excessive impact on the budget, this bring unfovorable to its possible incorporation.


Subject(s)
Humans , Costs and Cost Analysis/trends , Dacarbazine/administration & dosage , Dacarbazine/therapeutic use , Molecular Targeted Therapy/methods , Molecular Targeted Therapy/trends , Melanoma/drug therapy , Melanoma/epidemiology , Skin Neoplasms/drug therapy , Unified Health System , Public Health/trends , Health Care Costs/trends , Neoplasm Metastasis/drug therapy , Antineoplastic Agents/economics
9.
An. bras. dermatol ; 93(2): 299-301, Mar.-Apr. 2018. graf
Article in English | LILACS | ID: biblio-1038267

ABSTRACT

Abstract: Diphencyprone has been reported as a local immunotherapy for cutaneous melanoma metastases. We aim to report cases of melanoma patients treated with diphencyprone in a single Brazilian institution and highlight their outcomes. Since 2012, we have treated 16 melanoma patients with cutaneous metastases with topical diphencyprone. To date, we have had 37.5% of complete response, 25% of partial responses, and 31.25% patients without any response. Treatment was well tolerated and local toxicity was easily controlled. We believe topical diphencyprone is a feasible treatment that can be another option for treating melanoma patients, especially in cases of in-transit or extensive disease.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Skin Neoplasms/drug therapy , Cyclopropanes/therapeutic use , Melanoma/drug therapy , Melanoma/secondary , Antineoplastic Agents/therapeutic use , Skin Neoplasms/pathology , Skin Neoplasms/secondary , Biopsy , Administration, Cutaneous , Brazil , Treatment Outcome , Melanoma/pathology
10.
Rev. Assoc. Med. Bras. (1992) ; 63(9): 814-823, 2017. tab, graf
Article in English | LILACS | ID: biblio-896397

ABSTRACT

Summary Following decades of relative ostracism, advances in the treatment of melanoma have brought a new reality for patients, physicians and researchers. While antibodies targeting molecules involved in the modulation of the interaction between melanoma and immune cells changed the meaning of the term "cancer immunotherapy," a better characterization of the molecular aberrations involved in melanoma carcinogenesis prompted the development of inhibitors of the mitogen-activated protein kinase pathway (MAPK) that also led to significant improvements both in response rates and survival. As a result, new drugs have been approved for clinical use in the United States and Europe, including the immune-checkpoint blockers ipilmumab, pembrolizumab and nivolumab, the oncolytic herpesvirus talimogene laherparepvec, and the targeted-agents vemurafenib, dabrafenib, cobimetinib and trametinib. In this article, we review the results of studies that brought new approaches to the bedside and discuss how these developments are being incorporated into the care of patients in Brazil.


Resumo Após décadas de ostracismo, os recentes avanços no tratamento do melanoma trouxeram uma nova realidade para pacientes, médicos e pesquisadores. Enquanto anticorpos monoclonais voltados a moléculas envolvidas na modulação da interação entre células do melanoma e do sistema imune consolidaram o uso da "imunoterapia", um melhor conhecimento acerca das aberrações genômicas envolvidas na carcinogênese do melanoma viabilizaram o desenvolvimento de inibidores da via mitogen-activated protein kinase pathway (MAPK), o que também resultou em ganhos significativos em taxas de resposta e sobrevida. Consequentemente, novas modalidades de tratamento foram aprovadas para uso clínico nos Estados Unidos e na Europa, incluindo os bloqueadores de correceptores imunes ipilimumabe, nivolumabe e pembrolizumabe, o herpesvírus oncolítico talimogene laherparepvec (T-VEC), e os agentes-alvo vemurafenibe, dabrafenibe, cobimetinibe e trametinibe. Nesse artigo, revisamos os resultados que trouxeram novas alternativas para a prática clínica e discutimos a incorporação desses avanços ao cuidado de pacientes no Brasil.


Subject(s)
Humans , Proto-Oncogene Proteins B-raf/antagonists & inhibitors , Protein Kinase Inhibitors/administration & dosage , Immunotherapy/methods , Melanoma/drug therapy , Antineoplastic Agents/administration & dosage , Proto-Oncogene Proteins B-raf/administration & dosage
11.
Acta cir. bras ; 32(12): 1006-1012, Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-886195

ABSTRACT

Abstract Purpose: To evaluate the efficacy of nivolumab and comparison with dacarbazine (DTIC) on peritoneal carcinomatosis of malignant melanoma in mouse model. Methods: Mouse skin melanoma cells was injected under the capsule of the peritoneal surface in the left side of the abdomen. On postoperative day ten, mouses randomised into three groups. Group 1: Control, Group 2: HIPEC (Hyperthermic intraperitoneal chemotherapy) with DTIC and Group 3: HIPEC with Nivolumab. After the sacrification on postoperative day fifteen, peritoneum evaluated macroscopically and histopathologically by using peritoneal regression grading score (PRGS). Results: In the 15th day exploration, all animals developed extensive intraperitoneal tumor growth in Group 1. In Group 2 and Group 3 median tumor size was 0.7±0.3cm and 0.3±0.2cm respectively (p: 0.023). Peritoneal carcinomatosis index (PCI) were significantly lower in Group 3 than other groups (p: 0.019). The lowest total tumor nodules in group 3 was 4 ± 2. The PGRS score was found significantly lower in Group 3 than other groups (p: 0.03). Lymphocytic response rate was found higher in the Group 3. Conclusions: It has been found that nivolumab significantly better than DTIC on peritoneal metastases of malign melanoma in mouse models. Nivolumab treatment gives promising results with pathological evidence in the treatment of metastatic disease of malignant melanoma.


Subject(s)
Animals , Male , Rats , Peritoneal Neoplasms/drug therapy , Peritoneum/pathology , Melanoma/drug therapy , Antibodies, Monoclonal/pharmacology , Antineoplastic Agents/pharmacology , Peritoneal Neoplasms/surgery , Peritoneal Neoplasms/pathology , Peritoneal Neoplasms/secondary , Peritoneum/drug effects , Random Allocation , Regression Analysis , Dacarbazine/therapeutic use , Disease Models, Animal , Drug Evaluation, Preclinical , Neoplasm Grading , Nivolumab , Hyperthermia, Induced , Melanoma/secondary , Antibodies, Monoclonal/therapeutic use , Antineoplastic Agents/therapeutic use
12.
An. bras. dermatol ; 92(6): 830-835, Nov.-Dec. 2017.
Article in English | LILACS | ID: biblio-887132

ABSTRACT

Abstract: The stimulation of the immune system, in order to generate an attack against cancer cells, similarly to that which occurs in infectious disease, has long been matter of interest in oncology; however, only limited success has been achieved, with different treatment strategies tested in recent years. The development of new immune checkpoint inhibitors is currently changing this scenario, and immunotherapy is becoming a real choice among traditional cytotoxic treatments to fight cancer. Recent reports have shown efficacy and safety with the use of pembrolizumab, nivolumab, and ipilimumab for the treatment of different neoplasms, especially melanoma. In this article, we propose a review of the mechanisms of action involved in cancer immunology, the response evaluation of immunotherapies, and its toxicity profile, as well as a summary of the main clinical trials that led to the adoption of these new drugs for melanoma treatment.


Subject(s)
Humans , Antineoplastic Agents, Immunological/therapeutic use , Immunotherapy/methods , Melanoma/immunology , Melanoma/drug therapy , Neoplasms/immunology , Neoplasms/drug therapy , Antineoplastic Combined Chemotherapy Protocols , Treatment Outcome , Antibodies, Monoclonal, Humanized/therapeutic use , CTLA-4 Antigen/antagonists & inhibitors , Programmed Cell Death 1 Receptor/antagonists & inhibitors , Ipilimumab/therapeutic use , Antibodies, Monoclonal/therapeutic use
13.
Autops. Case Rep ; 7(3): 13-19, July.-Sept. 2017. ilus
Article in English | LILACS | ID: biblio-905311

ABSTRACT

BRAF protein is a serine/threonine kinase with 766 amino acids. Approximately 15% of human cancers harbor BRAF mutations as well as other BRAF anomalies (amplifications, fusions). Somatic mutations mainly occur in the catalytic kinase domain (CR3), and the predominant mutation is p.V600E which is the substitution of glutamic acid (E) for valine (V) as result of a mutation at codon 600 of the kinase domain. To our knowledge, the vast majority of the cancers have non-germline BRAF mutations. Here we describe a case of a 60-year-old female with a history of hairy cell leukemia (HCL) who presented with aphasia and forgetfulness. A follow-up Brain CT scan showed three distinct brain lesions which were found to be diagnostic of melanoma (confirmed by immunohistochemistry) with no evidence of a concurrent brain involvement by a B-cell neoplasm. Molecular studies confirmed the same BRAF p.V600E mutation in both malignancies (hairy cell leukemia and melanoma). Thereafter the patient was started on BRAF inhibitor treatment and is now symptom-free after one year of follow up. Having two concurrent malignancies with a shared BRAF mutation is extremely rare and makes this an excellent example of a genomic marker-driven treatment in two histologically and immunophenotypically distinct tumors.


Subject(s)
Humans , Female , Middle Aged , Leukemia, Hairy Cell/drug therapy , Melanoma/drug therapy , Proto-Oncogene Proteins B-raf/therapeutic use , Brain/pathology , Proto-Oncogene Proteins B-raf/antagonists & inhibitors
14.
An. bras. dermatol ; 92(2): 156-166, Mar.-Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-838050

ABSTRACT

Abstract: In the recent past years, many discoveries in the tumor microenvironment have led to changes in the management of melanoma and it is rising up hopes, specially, to those in advanced stages. FDA approved seven new drugs from 2011 to 2014. They are: Vemurafenib, Dabrafenib and Trametinib, kinases inhibitors used for patients that have BRAFV600E mutation; Ipilimumab (anti-CTLA4), Pembrolizumab (anti-PD-1) and Nivolumab (anti-PD-1), monoclonal antibodies that stimulate the immune system; and Peginterferon alfa-2b, an anti-proliferative cytokine used as adjuvant therapy. In this article, we will review the molecular bases for these new metastatic melanoma therapeutic agents cited above and also analyze new molecular discoveries in melanoma study, as Cancer-Testis antigens (CT). They are capable of induce humoral and cellular immune responses in cancer patients and because of this immunogenicity and their restrict expression in normal tissues, they are considered an ideal candidate for vaccine development against cancer. Among CT antigens, NY-ESO-1 is the best characterized in terms of expression patterns and immunogenicity. It is expressed in 20-40% of all melanomas, more in metastatic lesions than in primary ones, and it is very heterogeneous inter and intratumoral. Breslow index is associate with NY-ESO-1 expression in primary cutaneous melanomas, but its relation to patient survival remains controversial.


Subject(s)
Humans , Male , Female , Skin Neoplasms/drug therapy , Antibodies, Monoclonal, Humanized/therapeutic use , Melanoma/genetics , Melanoma/drug therapy , Antibodies, Monoclonal/therapeutic use , Antineoplastic Agents/therapeutic use , Tumor Microenvironment , CTLA-4 Antigen , Ipilimumab , Immunotherapy
15.
Lima; s.n; feb. 2017.
Non-conventional in Spanish | LILACS, BRISA | ID: biblio-848619

ABSTRACT

INTRODUCCIÓN: Antecedentes: El presente dictamen expone la evaluación de tecnología de la eficacia y seguridad del uso de vemurafenib como tratamiento de pacientes con diagnóstico de melanoma maligno, metastásico, irresecable, mutación BRAF V600 y que han progresado al tratamiento de primera línea con nivolumab. Aspectos Generales: El Melanoma es un tumor maligno que se origina en los melanocitos y afecta principalmente a la piel. Los melanomas pueden aparecer también en el ojo (úvea, conjuntiva y el cuerpo ciliar), las meninges o en varias superficies de mucosa. Mientras que los melanomas son causantes de cerca del 90% de las muertes asociadas a tumores cutáneos, incluso los tumores pequeños pueden tener tendencia a la metástasis y por lo tanto tener un pronóstico desfavorable. Tecnología Sanitaria de Interés: Vemurafenib (Zelboraf, Roche) es un inhibidor de la proteína quinasa oncogénica BRAF V600. Este medicamento está autorizado para el tratamiento de pacientes adultos con melanoma irresecable o metastásico con la mutación BRAF V600. METODOLOGÍA: Estrategia de Búsqueda: Se realizó una búsqueda de la literatura con respecto a la eficacia y seguridad de vemurafenib para el tratamiento de los pacientes con melanoma maligno, metastásico, irresecable, con mutación BRAF V600 que han progresado a primera línea con nivolumab. Esta búsqueda se realizó utilizando los meta-buscadores: Translating Research into Practice (TRIPDATABASE), National Library (Pubmed-Medline) y Health Systems Evidence. Adicionalmente, se a amplió la búsqueda revisando la evidencia generada por grupos internacionales que realizan revisiones sistemáticas (RS), evaluación de tecnologías sanitarias (ETS) y guías de práctica clínica (GPC), tales como la Cochrane Group, The National Institute for Health and Care Excellence (NICE), the Agency for Health care Research and Quality (AHRQ), The Canadian Agency for Drugs and Technologies in Health (CADTH) y The Scottish Medicine Consortium (SMC). ESta búsqueda se completó ingresando a la página web www,clinicaltrials.gov, para así pode identificar ensayos clínicos en elaboración o que no hayan sido publicados aún, y así disminuir el riesgo de sesgo de publicación. RESULTADOS: Sinopsis de la Evidencia: Se realizó la búsqueda bibliográfica y de eviencia científica para el sustento del uso de vemurafenib para el tratamiento de los pacientes con melanoma maligno, metastásico, irresecable, con mutación BRAF V600 y que han progresado a la primera línea con nivolumab. Se presenta la evidencia disponible según el tipo de publicación priorizada en los criterios de inclusión. Se incluyeron dos GPC, la guía realizada por la Sociedad Europea de Oncología Médica (ESMO) publicada en el 2015, y la guía del Instituto Nacional para Excelencia en el Cuidado de la Salud (NICE) también pulbicada en el 2015.Se incluyó el estudio BRIM3 que comparó vemurafenib con dacar bazina y en el que se basaron las GPC y la ETS. Aunque la población incluida en este estudio eran pacientes sin tratamiento sistémico previo, se trata del único ensayo clínico aleatorizado de fase III. No se encontraton estudios en progreso o sin publicar que respondan a la pregunta de interés de esta evaluación. Estudios excluidos: el estudio de Sosman et al., 2012 no ha sido incluido porque se trata de un ensayo de fase II sin grupo de comparación y la población no incluye a pacientes que han progresado con nivolumab. CONCLUSIONES: Es posible redefinir los tipos de melanomas en función a la presencia de ciertas mutaciones, las cuales conducen a la activación de proteínas señaladores mutantes que inducen la formación de tumores. Las mutaciones en el gen BRAF están presentes en el 40-70% de los melanomas, condiciendo a una activación de la proliferación celular incontrolada. En EsSalud está disponible el medicamento nivolumab para el tratamiento de primera línea de los pacientes con melanoma metastásico tengan o no la mutación BRAF V600. Frente a esta aprobación los clínicos plantearon la condición clínica de pacientes con melanoma metástasico positivos a la mutación BRAF V600, que progresan a pesar del tratamiento con nivolumab. Esta evaluación se centró en la búsqueda de toda la evidencia respecto a la eficacia de vemurafenib en pacientes que progresaron con nivolumab. Sin embargo, no se ha identificado evidencia respecto a la eficacia de vemurafenib en pacientes con melanoma maligno metastásico irresecable con la mutaciónBRAF V600 y que progresaron al uso de nivolumab. Después de considerar los riesgos de efectos adversos severos con el uso de vemurafenib, los probables costos asociados con el manejo de los mismos y la ausencia de evidencia directa, el balance riesgo beneficio resulta ser claramente de mayor riesgo, mayores inconvenientes para el paciente y probablemente mayores costos frente a un modesto benefício no observado directamente en los pacientes de interés de esta evaluación. En EsSalud está disponible del uso de nivolumad. La dacarbazina se viene usando por más de cuatro décadas y con un perfil de toxicidad conocido y manejable. El Instituto de Evaluación de Tecnologías en Salud e Investigación-IETSI, no aprueba el uso de vemurafenib para el tratamiento de pacientes con MA (irresecable o metastásico) con mutación BRAF V600 después de progresar con nivolumab.


Subject(s)
Humans , Adult , Immunoglobulin G/adverse effects , Melanoma/complications , Melanoma/drug therapy , Mutation , Proto-Oncogene Proteins B-raf/antagonists & inhibitors , Antibodies, Monoclonal , Proto-Oncogene Proteins B-raf , Technology Assessment, Biomedical , Treatment Outcome
16.
Biol. Res ; 50: 36, 2017. graf
Article in English | LILACS | ID: biblio-950884

ABSTRACT

BACKGROUND: Melanoma took top position among the lethal cancers and, despite there have been some great attempts made to increase the natural life of patients with metastatic disease, long-lasting and complete remissions are few. Piceatannol, owns the similar function as resveratrol, has been defined as an anti-cancer agent playing important role in inhibition of proliferation, migration and metastasis in various cancer. Thus, we aim to investigate the anti-cancer effect and mechanisms of piceatannol in melanoma cells. METHODS: Melanoma cell lines WM266-4 and A2058 were treated either with or without piceatannol. Cell viability and cell apoptosis were assessed by using MTT and Annexin V/PI assay, respectively. Cells were transfected with specific miRNA using Lipfectamine 2000. miRNA bingding ability to 3'-UTR region within specific gene was assed by firefly luciferase analysis. Gene and protein expression was eveluated by qRT-PCR and western blot analysis, respectively. RESULTS: Our study showed that piceatannol inhibited WM266-4 and A2058 cells growth and induced apoptosis. Totally, 16 differentially expressed miRNAs were screened out including 8 up-regulated and 8 down-regulated miRNAs. Expression level of miR-181a is significantly higher in piceatannol-treated cells than normal control and is lower in melanoma cancer tissues than its adjacent normal tissues. Bcl-2 is a target gene of miR-181a. Moreover, silencing of miR-181a reverses the decrease of cell viability induced by piceatannol in WM266-4 and A2058 cells. Taken together, present study uncovered the ability of piceatannol to repress melanoma cell growth and clarified the contribution of miR-181a in the anticancer role of piceatannol. CONCLUSION: The present study proposes that piceatannol can be taken into account to be a hopeful anticancer agent for melanoma.


Subject(s)
Humans , Stilbenes/pharmacology , Gene Expression Regulation, Neoplastic/drug effects , Anticarcinogenic Agents/pharmacology , Apoptosis/drug effects , MicroRNAs/drug effects , Melanoma/drug therapy , Up-Regulation , Cell Survival , MicroRNAs/metabolism , Cell Line, Tumor , Melanoma/metabolism , Melanoma/pathology
17.
Journal of Dentistry-Shiraz University of Medical Sciences. 2017; 18 (3): 219-226
in English | IMEMR | ID: emr-188522

ABSTRACT

Statement of the Problem: Evidence shows thiabendazole has the potential to inhibit angiogenesis in melanoma and fibrosarcoma; however, its effect on oral squamous cell carcinoma has not been previously studied


Purpose: This study sought to assess the cytotoxic effects of thiabendazole on HN5 head and neck squamous carcinoma cell line


Materials and Method: HN5 cell lines were exposed to different concentrations of thiabendazole [prepared from 99% pure powder] for 24, 48 and 72 hours. Cell viability was assessed by the methyl thiazol tetrazolium assay, and IC50 of thiabendazole was calculated. Cells were also exposed to different concentrations of thiabendazole for 48 hours to determine its effect on expression and transcription of vascular endo-thelial growth factor gene. Expression of vascular endothelial growth factor mRNA was assessed by real-time polymerase chain reaction. The vascular endothelial growth factor release was assessed by the enzyme-linked immunosorbent assay test


Results: In all concentrations of thiabendazole except for 200 and 550uM, cell viability was significantly different at different time points [p< 0.05]. At 48 and 72 hours, cell viability at all concentrations of thiabendazole [100-65OuM] significantly decreased compared to the control group [zero concentration]


In addition, cell viability significantly decreased with an increase in thiabendazole concentration. At 48 hours, expression of vascular endothelial growth factor mRNA was significantly lower in presence of 500uM thiabendazole compared to the control group [p< 0.001] and release of vascular endothelial growth factor was inhibited in a dose-dependent manner


Conclusion: Thiabendazole inhibited the proliferation of HN5 cells in a dose-dependent and time-dependent manner. It also inhibited the expression of vascular endothelial growth factor gene


Subject(s)
Humans , Male , Aged , Carcinoma, Squamous Cell/drug therapy , Thiabendazole , Angiogenesis Inhibitors , Fibrosarcoma/drug therapy , Melanoma/drug therapy , Endothelial Growth Factors
18.
Rev. méd. Chile ; 144(11): 1448-1458, nov. 2016. ilus, tab
Article in Spanish | LILACS | ID: biblio-845467

ABSTRACT

Cutaneous melanoma is a highly aggressive tumor developing from melanocytes, its incidence is increasing, and prognosis in advanced stages is daunting. New therapies have been approved during the recent years with unprecedented results, including inhibitors of MAPK/ERK pathway and immune checkpoint blockade (anti-cytotoxic T lymphocyte antigen-4 (CTLA-4) as ipilimumab, anti-programmed cell death protein 1 (PD-L1) as pembrolizumab and anti-programmed cell death protein 1 ligand (PD-L1), among many others). The aim of this paper is to review currently available metastatic melanoma therapies focusing mainly on new therapies that have demonstrated effectiveness, after several decades of little progress in the treatment of this disease.


Subject(s)
Humans , Skin Neoplasms/pathology , Skin Neoplasms/drug therapy , Melanoma/drug therapy , Melanoma/secondary , Antineoplastic Agents/therapeutic use , Skin Neoplasms/genetics , Antineoplastic Combined Chemotherapy Protocols , Mitogen-Activated Protein Kinase Kinases/antagonists & inhibitors , Proto-Oncogene Proteins B-raf/antagonists & inhibitors , Molecular Targeted Therapy , Melanoma/genetics , Antineoplastic Agents/pharmacology
19.
Lima; s.n; sept. 2016.
Non-conventional in Spanish | LILACS, BRISA | ID: biblio-848264

ABSTRACT

INTRODUCCIÓN: Antecedentes: El presente informe expone la evaluación de nivolumab como tratamiento de pacientes con diagnóstico de melanoma maligno (MM), irresecable o metastásico. Aspectos Generales: El Melanoma es un tumor maligno que se origina en los melanocitos y afecta principalmente a la piel. Los melanomas pueden aparecer también en el ojo (úvea, conjuntiva y el cuerpo ciliar), las meninges o en varias superficies de mucosa. ). Mientras que los melanomas son usualmente fuertemente pigmentados, ellos también pueden ser amelanóticos. Los melanomas son causantes de cerca del 90% de las muertes asociadas con los tumores cutáneos, incluso los tumores pequeños pueden tener tendencia a la metástasis y por lo tanto tener un pronóstico desfavorable. Tecnologia Sanitaria de Interés: Nivolumab: Nivolumab (Opdivo, Bristol-Myers Squibb) es un anticuerpo humano monoclonal (inmunoglobulina G4) que bloquea al receptor 1 de la proteína de la muerte celular programada, denominada PD-1. Este receptor es parte de un proceso de control inmunológico; por lo tanto, al bloquear la actividad de la molécula PD-1 expresadas por los linfocitos, se impiden las respuestas inmunes de regulación negativa (down-regulation) y permite que los linfocitos continúen activados facilitando la muerte de las células tumorales. METODOLOGIA: Estrategia de Busqueda: Se realizó una búsqueda de la literatura con respecto a la eficacia y seguridad de nivolumab para el tratamiento de los pacientes con melanoma maligno, irresecable o metastásico. Esta búsqueda se realizó utilizando los meta-buscadores: Translating Research into Practice (TRIPDATABASE), National Library of Medicine (Pubmed-Medline) y Health Systems Evidence. Adicionalmente, se amplió la búsqueda revisando la evidencia generada por grupos internacionales que realizan revisiones sistemáticas (RS), evaluación de tecnologías sanitarias (ETS) y guías de práctica clínica (GPC), tales como la Cochrane Group, The National Institute for Health and Care Excellence (NICE), the Agency for Health care Research and Quality (AHRQ), The Canadian Agency for Drugs and Technologies in Health (CADTH) y The Scottish Medicines Consortium (SMC). Esta búsqueda se completó ingresando a la página web www.clinicaltrials.gov , para así poder identificar ensayos clínicos en elaboración o que no hayan sido publicados aún, y así disminuir el riesgo de sesgo de publicación. RESULTADOS: Sinopsis de la Evidencia: Se realizó la búsqueda bibliográfica y de evidencia científica para el sustento del uso de nivolumab para el tratamiento del MM irresecable o metastásico. Se presenta la evidencia disponible según el tipo de publicación priorizada en los criterios de \r\ninclusión. Se incluyeron dos GPC, la guía realizada por la Sociedad Europea de Oncología Médica (ESMO) publicada en el 2015, y la guía del Instituto Nacional para excelencia en el cuidado y salud (NICE). Se incluyó una ETS realizada por Instituto Nacional para excelencia en el cuidado y salud (NICE). Por corresponder a distintos Sistemas de salud el del Reino Unido y el del Perú, se evaluaron por separado dos ECAs incluidos el ETS realizado por NICE. CONCLUSIONES: El melanoma es un tumor maligno que se origina en los melanocitos cuya incidencia está aumentado en el mundo. La cirugía puede ser curativa cuando la enfermedad es detectada de manera temprana, pero incluso los casos resecados pueden recurrir y progresar con metástasis. El pronóstico del MM permanece siendo muy pobre con una sobrevida global menor al 15% a los 5 años. La evidencia respecto a la eficacia de nivolumab en pacientes con MM respecto a quimioterapia, incluida la dacarbazina, proviene de dos ensayos clínicos aleatorizados (CheckMate-066 y CheckMate-037); sin embargo, debido a la heterogeneidad entre ellos no ha sido posible su análisis conjunto en un metaanálisis. El efecto estimado de nivolumab respecto a dacarbazina en el análisis interino permanece siendo clínicamente relevante considerando la sobreestimación estimada por Bassler. Desde un HR de 0.43 hasta uno de 0.60 si el estudio hubiera continuado. El Instituto de Evaluación de Tecnologías en Salud e \r\nInvestigación-IETSI, aprueba el uso de nivolumab para el tratamiento de pacientes con MM (irresecable o metastásico) según lo establecido en el anexo 1. La vigencia de este dictamen preliminar es de dos años a partir de la fecha de publicación. Se establece que el efecto del uso de este medicamento se evaluará \r\ncon datos de los pacientes que hayan recibido el tratamiento por el tiempo autorizado para determinar su impacto. Esta información servirá para una reevaluación del medicamento, incluyendo una evaluación económica al terminar la vigencia de este dictamen.


Subject(s)
Humans , Antibodies, Monoclonal/administration & dosage , Melanoma/complications , Melanoma/drug therapy , Neoplasm Metastasis/drug therapy , Cost-Benefit Analysis , Neoplasm Staging , Technology Assessment, Biomedical , Treatment Outcome
20.
Lima; s.n; ago. 2016.
Non-conventional in Spanish | LILACS, BRISA | ID: biblio-848343

ABSTRACT

INTRODUCCIÓN: Antecedentes: El Instituto de Evaluación de Tecnologias en Salud e Investigaciones (IETSI) ha recibido la solicitud de evaluar el uso de pembrolizumab para su uso en pacientes con diagnóstico de melanoma maligno con enfermedad metastásica o irresecable, sin tratamiento sistémico previo, dentro del sistema de EsSalud, indicación actualmente no contemplada en el Petitorio Farmacológico de EsSalud. Generalidades: Los melanomas a nivel mundial representam un problema de salud pública vigente y creciente. De hecho su incidencia no sólo ha aumentado en las últimas décadas sino que también ha aumentado su mortlidad, comparado con otros tipos de cáncer. Tecnología Sanitaria de Interés: Pembrolizumab: Pembrolizumab es un anticuerpo monoclonal humanizado de tipo inmunoglobulina G4 (IgG4) (HuMAb) que actúa sobre la via del receptor de muerte programada 1 (PD-1) bloqueando su interación con PD-L1 y PD-L2. Dado que el receptor PD-1 es un regulador negativo de la actividad de los linfocitos T, al bloquearlo permite la reactivación de la inmunidad anti-tumor. METODOLOGÍA: Estrategia de Búsqueda: El protocolo de esta revisión sistemática y revisado coon el equipo técnico de IETSI. Las siguientes fuentes han sido revisadas y consultadas con la intención de buscar la mejor evidencia disponible: Canadian Agency for Drugs and Technologies in Health (CADTH), Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, European Society for Medical Oncology (ESMO) de Europa, Medline/Pubmed, National Comprehensive Cancer Network (NCCN) de los Estados Unidos, National Guideline Clearinghouse (NCG) de los Estados Unidos, Nationa Institute for Health and Care Excellence (NICE) del Reino Unido, Scopus, Scottish Medicines Consortium (SMC) de Escocia, Sociedad Española de Oncologia Médica (SEOM) de Espanã, Translating Research into Practice (TRIP Database), Web of Science. RESULTADOS: Luego de revisar un total de 77 referencias resultados de nuestra búsqueda bibliográfica, se filtraron 35 estudios, de los cuales sólo seis fueron finalmente seleccionados para nuestro análisis, incluyendo dos ensayos clínicos, tres guías clínicas y uuna evaluación de tecnología. Sinopsis de la Evidencia: Al realizar la búsqueda amplia de guías de prática clínica en Googl Académico así como en las bases de datos revisadas se encontró una gran varidad de guías específicas para el maenejo de pacientes con melanoma maligno. Sin embargo, entre las guías revisadas sólo se encontró tres en las cuales se listó pembrolizumab como una alternativa de tratamiento para el maenjo de pacientes con melanoma maligno irresecable o metastásico, elaboradas respectivamente por SEOM de España, ESMO de Europa y NCCN de los Estados Unidos por lo que a continuación resumiremos lo que plantea esta guía. CONCLUSIONES: A la fecha no se dispone de evidencias que sustenten el uso de pembrolizumab como uma alternativa más eficaz y segura a la quimioterapia con dacarbacina (DTIC) en el tratamiento de los pacientes con diagnóstico de melanoma maligno irresecable o metastásico, sin tratamiento sistémico previo. El Instituto de Evaluación de Tecnologías en Salud e Investigaciones-IETSI, no aprueba el uso de pembrolizumab como tratamiento para los pacientes con diagnóstico de melanoma maligno irresecable o metastásico, sin tratamiento sistémico previo.


Subject(s)
Humans , Immunoglobulin G/administration & dosage , Melanoma/drug therapy , Neoplasm Metastasis/drug therapy , Antibodies, Monoclonal/administration & dosage , Neoplasm Staging , Technology Assessment, Biomedical , Treatment Outcome
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