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An. bras. dermatol ; 96(6): 712-716, Nov.-Dec. 2021. tab
Article in English | LILACS | ID: biblio-1355629


Abstract Background: The treatment of advanced periocular basal cell carcinomas becomes a challenge as surgery may involve highly mutilating procedures. Vismodegib is the first selective hedgehog inhibitor approved for the treatment of locally advanced tumors or metastatic disease. Objective: Analyze the results of treatment with vismodegib for advanced periocular basal cell carcinomas in a real-life setting of a reference center between 2014 and 2020. Methods: Retrospective longitudinal study. The patient's demographic profile, comorbidities, tumor characteristics, and treatment outcomes were analyzed. Results: A total of 13 patients were included. Median follow-up and treatment duration were 15.9 and 10.5 months, respectively. Objective clinical response rate was 76.9%: 30.8% had a complete response and 46.2% a partial response. The median duration of response was 13 months. Progressive disease was observed in 38.5% of cases, with a median of 19 months after the beginning of treatment. Eighty-four percent of the patients had at least one adverse event, and 61.54% needed to interrupt treatment temporarily or permanently to increase tolerability. Study limitations: Being a retrospective study in a real-life setting, the evaluation of objective clinical response was subjective to physician appreciation. Conclusion: Vismodegib is a safe and effective treatment for locally advanced basal cell carcinoma. To prevent recurrences, the drug should be used continually when tolerated. The role of neoadjuvant vismodegib before surgery is being investigated and might add an important step in searching for a definitive treatment for these cases.

Humans , Carcinoma, Basal Cell/drug therapy , Neoplasms/drug therapy , Pyridines , Retrospective Studies , Longitudinal Studies , Hedgehog Proteins , Anilides , Neoplasm Recurrence, Local/drug therapy
Medicina (B.Aires) ; 81(5): 767-773, oct. 2021. graf
Article in Spanish | LILACS | ID: biblio-1351049


Resumen El tumor de células gigantes óseo es una neoplasia de agresividad local intermedia, que raramente metastatiza. En los últimos años el denosumab, anticuerpo monoclonal humano, surgió como una alternativa de tratamiento para esta enfermedad, al bloquear el comportamiento lítico tumoral. El objetivo de este trabajo fue determinar sus indicaciones y efectos adversos, analizando también los resultados oncológicos, y las tasas de recurrencia local en pacientes con diagnóstico de tumor de células gigantes óseo que recibieron denosumab como tratamiento neoadyuvante. Entre 2010 y 2018 se analizaron 80 pacientes con tumor de células gigantes, de los cuales 14 recibieron denosumab como tratamiento neoadyuvante. El seguimiento mínimo fue 12 meses. En 8 pacientes se trató de un tumor primario, mientras que 6 fueron pacientes con recidiva tumoral. En todos los casos se evidenció una mejoría clínica. Trece presentaron cambios radiográficos, y 11 respuesta histológica completa. En 6 de 14 pacientes se evidenció una recurrencia local y en 7 se identificó al menos un efecto adverso relacionado con el denosumab (incluyendo una malignización tumoral). A pesar de ser una herramienta útil para el tratamiento del tumor de células gigantes, el uso de denosumab está asociado a mayor tasa de recurrencias locales y no está exento de efectos adversos.

Abstract Giant cell tumor of bone is an intermediate, locally aggressive and rarely metastasiz ing, primary bone neoplasia. In recent years denosumab emerged as a treatment alternative for this pathology. The objective of this work was to analyze its indications as well as the clinical outcomes, side effects and local recurrence rates in patients diagnosed with giant cell tumor of bone, who received denosumab as neoadjuvant treatment. Between 2010 and 2018, 80 patients with giant cell tumor were analyzed, of whom 14 received deno sumab as a neoadjuvant treatment. The minimum follow-up was 12 months. In 8 patients it was a primary tumor, while 6 showed tumor recurrence. In all cases, clinical improvement was evident. Thirteen patients presented radiographic changes, and 11 showed complete histological response. A local recurrence was evidenced in 6 of 14 patients, and at least one adverse effect related to denosumab (including tumor malignancy) was identified in 7. Despite being a useful tool for treating giant cell tumor, the use of denosumab is associated with a higher rate of local recurrences and is not free of adverse effects.

Humans , Bone Neoplasms/drug therapy , Bone Neoplasms/diagnostic imaging , Giant Cell Tumor of Bone/drug therapy , Giant Cell Tumor of Bone/diagnostic imaging , Bone Density Conservation Agents/adverse effects , Denosumab/adverse effects , Neoplasm Recurrence, Local/drug therapy
Rev. bras. ginecol. obstet ; 43(3): 185-189, Mar. 2021. tab
Article in English | LILACS | ID: biblio-1251295


Abstract Objective The objective of the present study was to analyze the reasons that led to hormone therapies (HTs) regimen changes in women with breast cancer. Methods This was a retrospective cross-sectional study from a single-institution Brazilian cancer center with patient records diagnosed with breast cancer between January 2012 and January 2017. Results From 1,555 women who were in treatment with HT, 213 (13.7%) women had HT switched, either tamoxifen to anastrozole or vice-versa. Most women included in the present study who switched HT were > 50 years old, postmenopausal, Caucasian, and had at least one comorbidity. From the group with therapy change, 'disease progression' was reason of change in 124 (58.2%) cases, and in 65 (30.5%) patients, 'presence of side effects' was the reason. From those women who suffered with side effects, 24 (36.9%) had comorbidities. Conclusion The present study demonstrated a low rate of HT switch of tamoxifen to anastrozole. Among the reasons for changing therapy, the most common was disease progression, which includes cancer recurrence, metastasis or increased tumor. Side effects were second; furthermore, age and comorbidities are risk factors for side effects.

Resumo Objetivo O objetivo do presente estudo foi analisar os motivos que levaram às mudanças no esquema hormonioterápico (HT) em mulheres com câncer de mama. Métodos Estudo transversal retrospectivo realizado no Hospital da Mulher de Campinas e consequente pesquisa de prontuários de mulheres diagnosticados com câncer de mama entre janeiro de 2012 e janeiro de 2017. Resultados De 1.555 mulheres em tratamento com HT, 213 (13,7%) mulheres tiveram HT alterado, tamoxifeno para anastrozol ou vice-versa. A maioria das mulheres incluídas no presente estudo que tiveram mudança de HT tinha > 50 anos, estava na pós-menopausa, era caucasiana e tinha pelo menos uma comorbidade. Os principais motivos de troca de HT foram devido a 'progressão da doença', ocorrendo em 124 (58,2%) casos e a 'presença de efeitos colaterais' (n = 65; 30,5%). Das mulheres que sofreram efeitos colaterais, 24 (36,9%) apresentaram comorbidades. Conclusão O presente estudo demonstrou uma baixa taxa na alteração de tamoxifeno para anastrozol. Entre as razõesmais comuns para alterar a HT estava a progressão da doença, que inclui recorrência do câncer, metástase ou aumento do tumor. Os efeitos colaterais foram a segunda causa e, além disso, a idade e as comorbidades foram fatores de risco para efeitos colaterais.

Breast Neoplasms/drug therapy , Antineoplastic Agents, Hormonal/therapeutic use , Neoplasm Recurrence, Local/drug therapy , Patient Participation , Tamoxifen/administration & dosage , Tamoxifen/adverse effects , Tamoxifen/therapeutic use , Medical Records , Cross-Sectional Studies , Retrospective Studies , Disease Progression , Antineoplastic Agents, Hormonal/administration & dosage , Antineoplastic Agents, Hormonal/adverse effects , Anastrozole/administration & dosage , Anastrozole/analogs & derivatives , Anastrozole/therapeutic use
Chinese Journal of Oncology ; (12): 1027-1033, 2021.
Article in Chinese | WPRIM | ID: wpr-920984


Bladder cancer is one of the common malignant tumors in China, with 75% of bladder cancer being non-muscle invasion with a high recurrence rate after surgery. Intravesical therapy is an useful methods to either directly kill tumor cells by infusing cytotoxic drugs into the bladder or directly or indirectly induce local immune responses of the body through infusing immune agents, such as bacillus calmette guerin, and thus reduce the risk of tumor recurrence and progression. In 2019, the Urological Chinese Oncology Group issued the "Expert consensus on intravesical therapy on non-muscle invasive bladder cancer" . Recently, great progress in the clinical diagnosis and treatment of non-muscle invasive bladder cancer has been achieved domestically and abroad, including the risk assessment of non-muscle invasive bladder cancer, the therapeutic choice of intravesical drugs, the adverse reactions and treatment experience of intravesical therapy, and clinical research on new types of intravesical drugs. This consensus is made according to domestic and overseas evidence-based medicine in combination with current clinical practice and experience of intravesical therapy for non-muscle invasive bladder cancer in China. It is an update of the 2019 expert consensus, with the wish to provide a guidance for domestic clinical standardized intravesical therapy for non-muscle invasive bladder cancer.

Adjuvants, Immunologic/therapeutic use , Administration, Intravesical , Consensus , Humans , Neoplasm Invasiveness , Neoplasm Recurrence, Local/drug therapy , Urinary Bladder Neoplasms/drug therapy
Journal of Experimental Hematology ; (6): 1141-1147, 2021.
Article in Chinese | WPRIM | ID: wpr-888530


OBJECTIVE@#To evaluate the safety and efficacy of C-CAR011 in the treatment of relapsed or refractory B-cell non-Hodgkin lymphoma (R/R B-NHL) patients.@*METHODS@#B-NHL patients treated with C-CAR011 infusion following lympho-depletion were enrolled. All the patients were followed up for 1 year after C-CAR011 treatment(5.0×10@*RESULTS@#The ratio of the male and female of 6 patients was 1∶1, and the patients were treated with C-CAR011 at a dose of 5.0×10@*CONCLUSION@#C-CAR011 is a safe treatment option for R/R B-NHL; some patients could achieve long-term sustained responses after C-CAR011 infusion( number, NCT03483688).

Antigens, CD19/therapeutic use , Antineoplastic Combined Chemotherapy Protocols , B-Lymphocytes , Female , Humans , Lymphoma, Follicular , Lymphoma, Large B-Cell, Diffuse , Male , Middle Aged , Neoplasm Recurrence, Local/drug therapy , Treatment Outcome
Chinese Medical Journal ; (24): 1299-1309, 2021.
Article in English | WPRIM | ID: wpr-878164


BACKGROUND@#Bendamustine was approved in China on May 26th, 2019 by the National Medical Product Administration for the treatment of indolent B-cell non-Hodgkin lymphoma (NHL). The current study was the registration trial and the first reported evaluation of the efficacy, safety, and pharmacokinetics of bendamustine in Chinese adult patients with indolent B-cell NHL following relapse after chemotherapy and rituximab treatment.@*METHODS@#This was a prospective, multicenter, open-label, single-arm, phase 3 study (NCT01596621; C18083/3076) with a 2-year follow-up period. Eligible patients received bendamustine hydrochloride 120 mg/m2 infused intravenously on days 1 and 2 of each 21-day treatment cycle for at least six planned cycles (and up to eight cycles). The primary endpoint was the overall response rate (ORR); and secondary endpoints were duration of response (DoR), progression-free survival (PFS), safety, and pharmacokinetics. Patients were classified according to their best overall response after initiation of therapy. Proportions of patients in each response category (complete response [CR], partial response [PR], stable disease, or progressive disease) were summarized along with a two-sided binomial exact 95% confidence intervals (CIs) for the ORR.@*RESULTS@#A total of 102 patients were enrolled from 20 centers between August 6th, 2012, and June 18th, 2015. At the time of the primary analysis, the ORR was 73% (95% CI: 63%-81%) per Independent Review Committee (IRC) including 19% CR and 54% PR. With the follow-up period, the median DoR was 16.2 months by IRC and 13.4 months by investigator assessment; the median PFS was 18.6 months and 15.3 months, respectively. The most common non-hematologic adverse events (AEs) were gastrointestinal toxicity, pyrexia, and rash. Grade 3/4 neutropenia was reported in 76% of patients. Serious AEs were reported in 29 patients and five patients died during the study. Pharmacokinetic analysis indicated that the characteristics of bendamustine and its metabolites M3 and M4 were generally consistent with those reported for other ethnicities.@*CONCLUSION@#Bendamustine is an active and effective therapy in Chinese patients with relapsed, indolent B-cell NHL, with a comparable risk/benefit relationship to that reported in North American patients.@*CLINICAL TRIAL, No. NCT01596621;

Adult , Antineoplastic Combined Chemotherapy Protocols , Bendamustine Hydrochloride/therapeutic use , China , Humans , Lymphoma, Non-Hodgkin/drug therapy , Neoplasm Recurrence, Local/drug therapy , Prospective Studies , Rituximab/therapeutic use
Frontiers of Medicine ; (4): 551-561, 2021.
Article in English | WPRIM | ID: wpr-888745


Glioma is the most common lethal tumor of the human brain. The median survival of patients with primary World Health Organization grade IV glioma is only 14.6 months. The World Health Organization classification of tumors of the central nervous system categorized gliomas into lower-grade gliomas and glioblastomas. Unlike primary glioblastoma that usually develop de novo in the elderly, secondary glioblastoma enriched with an isocitrate dehydrogenase mutant typically progresses from lower-grade glioma within 5-10 years from the time of diagnosis. Based on various evolutional trajectories brought on by clonal and subclonal alterations, the evolution patterns of glioma vary according to different theories. Some important features distinguish the normal brain from other tissues, e.g., the composition of the microenvironment around the tumor cells, the presence of the blood-brain barrier, and others. The underlying mechanism of glioma recurrence and evolution patterns of glioma are different from those of other types of cancer. Several studies correlated tumor recurrence with tumor heterogeneity and the immune microenvironment. However, the detailed reasons for the progression and recurrence of glioma remain controversial. In this review, we introduce the different mechanisms involved in glioma progression, including tumor heterogeneity, the tumor microenvironment and drug resistance, and their pre-clinical implements in clinical trials. This review aimed to provide new insights into further clinical strategies for the treatment of patients with recurrent and secondary glioma.

Aged , Brain Neoplasms/genetics , Drug Resistance , Glioblastoma , Glioma/genetics , Humans , Mutation , Neoplasm Recurrence, Local/drug therapy , Tumor Microenvironment
Rev. bras. ginecol. obstet ; 41(3): 176-182, Mar. 2019. tab
Article in English | LILACS | ID: biblio-1003547


Abstract Objective The aim of the present study was to describe and analyze data of 57 women with borderline ovarian tumors (BOTs) regarding histological characteristics, clinical features and treatment management at the Department of Obstetrics and Gynecology of the Universidade Estadual de Campinas (Unicamp, in the Portuguese acronym). Methods The present retrospective study analyzed data obtained from clinical and histopathological reports of women with BOTs treated in a single cancer center between 2010 and 2018. Results A total of 57 women were included, with a mean age of 48.42 years old (15.43- 80.77), of which 30 (52.63%) were postmenopausal, and 18 (31.58%) were < 40 years old. All of the women underwent surgery. A total of 37 women (64.91%) were submitted to complete surgical staging for BOT, and none (0/57) were submitted to pelvic or paraortic lymphadenectomy. Chemotherapy was administered for two patients who recurred. The final histological diagnoses were: serous in 20 (35.09%) cases, mucinous in 26 (45.61%), seromucinous in 10 (17.54%), and endometrioid in 1 (1.75%) case. Intraoperative analyses of frozen sections were obtained in 42 (73.68%) women, of which 28 (66.67%) matched with the final diagnosis. The mean follow-up was of 42.79 months (range: 2.03-104.87 months). Regard ingthe current status of the women, 45(78.95%) are alive without disease, 2(3.51%) arealive with disease, 9 (15.79%) had their last follow-up visit > 1 year beforethe performanceof the present study but arealive, and 1 patient(1.75%) died of another cause. Conclusion Women in the present study were treated according to the current guidelines and only two patients recurred.

Resumo Objetivo O objetivo do presente estudo foi descrever uma série de 57 mulheres com tumores borderline de ovário (TBO) em relação às características histológicas, clínicas, e ao manejo do tratamento realizado no Departamento de Obstetrícia e Ginecologia da Universidade Estadual de Campinas (Unicamp). Métodos O presente estudo retrospectivo analisou dados obtidos dos registros clínicos e histopatológicos de mulheres com TBO tratadas em um único centro oncológico de 2010 a 2018. Resultados Um total de 57 mulheres foram incluídas, com uma média de idade de 48,42 anos (15,43-80,77), das quais 30 (52,63%) eram menopausadas, e 18 (31,58%) tinham < 40 anos. Todas as mulheres foram operadas. Um total de 37 mulheres (64,91%) foram submetidas a cirurgia de estadiamento completo para TBO, e nenhuma foi submetida a linfadenectomia pélvica ou paraórtica. O tratamento com quimioterapia foi administrado em duas pacientes que recidivaram. Os diagnósticos histológicos finais foram: seroso em 20 mulheres (35,09%), mucinoso em 26 (45,61%), seromucinoso em 10 (17,54%) e endometrióide em 1 (1,75%). A avaliação histológica intraoperatória foi realizada em 42 (73,68%) das mulheres, das quais 28 (66,67%) foram compatíveis com os diagnósticos finais. O tempo médio de seguimento foi de 42,79 meses (variando de 2,03 a 104,87 meses). Em relação ao status atual das mulheres, 45 (78.95%) estão vivas sem doença, 2 (3,51%) estão vivas com doença, 9 (15.79%) tiveram a última consulta de seguimento há > 1 ano antes da realização do presente estudo, mas estão vivas, e 1 paciente faleceu por outra causa. Conclusão As mulheres do presente estudo foram tratadas de acordo com as recomendações atuais e apenas duas mulheres apresentaram recorrência.

Humans , Female , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Ovarian Neoplasms/pathology , Precancerous Conditions/pathology , Ovarian Neoplasms/surgery , Ovarian Neoplasms/drug therapy , Precancerous Conditions/surgery , Precancerous Conditions/drug therapy , Brazil , Cancer Care Facilities/statistics & numerical data , Menopause/physiology , Retrospective Studies , Treatment Outcome , Age Distribution , Organ Sparing Treatments/statistics & numerical data , Salpingo-oophorectomy/statistics & numerical data , Hysterectomy/statistics & numerical data , Middle Aged , Neoplasm Recurrence, Local/etiology , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/drug therapy , Antineoplastic Agents/therapeutic use
Lima; s.n; jul. 2016. tab.
Non-conventional in Spanish | LILACS, BRISA | ID: biblio-847613


INTRODUCCIÓN: Antecedentes: El presente dictamen expone la evaluación de tecnología de la eficacia y seguridad de Bortezomib para su uso en pacientes con mieloma múltiple recidivante y/o refractario a uno o más tratamientos previos. Como antecedente relevante, existe un dictamen emitido por IETSI-ESSALUD sobre el uso de Bortezomib como primera línea de tratamiento en pacientes con mieloma múltiple. Generalidades: El mieloma múltiple es una neoplasia hematológica caracterizada por la proliferación de células plasmáticas que producen inmunoglobulinas monoclonales. Estas células, proliferan en la medula ósea y suelen producir destrucción ósea masiva manifestada por lesiones osteolíticas, osteopenia e incluso fracturas patológicas. Clínicamente suele presentarse con dolor óseo y lesiones líticas, proteínas séricas totales incrementadas, proteínas monoclonales incrementadas en suero u orina, anemia de origen incierto, hipercalcemia e incluso insuficiencia renal aguda o síndrome nefrótico por amiloidosis primaria concurrente. Tecnología Sanitaria de Interés: sobre Bortezomib: Bortezomib es un inhibidor de proteosomas, el primero de su clase, que actúa en la homeostasis proteica celular bloqueando específicamente el proteosoma 26. Este proteosoma 26 es una enzima que se encarga normalmente de catalizar todas las proteínas anormales que son generadas usualmente en el metabolismo. La inhibición de este proteosoma conlleva a apoptosis celular y es por lo tanto un blanco interesante en terapia del cáncer. Estrategia de Busqueda: Se realizó una estrategia de búsqueda sistemática de la evidencia científica con respecto al uso de bortezomib en pacientes con mieloma múltiple recidivante y/o refractario a uno o más tratamientos previos. Las siguientes fuentes han sido revisadas y consultadas: Medline/Pubmed, Trip Database, The Cochrane Library, The National Institute for Health and Care Excellence (NICE) del Reino Unido, The Scottish Intercollegiate Guidelines Network (SIGN) de Escocia, The National Guideline Clearinghouse (NCG) de los Estados Unidos, The American Society of Clinical Oncology (ASCO) de los Estados Unidos, The National Comprehensive Cancer Network (NCCN) de los Estados Unidos. RESULTADOS: Sinopsis de la Evidencia: Se realizó la búsqueda y revisión de la evidencia científica actual para la evaluación de la eficacia y seguridad de Bortezomib en pacientes con mieloma múltiple recidivante y/o refractario a uno o más tratamientos previos. Se presenta la información encontrada de acuerdo al tipo de evidencia revisada: Guías de Práctica Clínica (GPC): Se describió la GPC de la Evaluaciones de Tecnologías Sanitarias (ETS): Se encontró una evaluación de tecnología elaborada por la NICE del Reino Unido del año 2007 (Documento TA 129 de la NICE).NCCN Versión 3 del año 2016; Revisiones Sistemáticas (RS) o Meta-análisis: Se encontró la RS de Scott et al., 2016 del grupo colaborativo Cochrane; Estudios Primarios: Se consideraron tres ensayos clínicos pertenecientes a Richardson, et al., 2005, Garderet et al., 2012, Hjorth et al., 2012. CONCLUSIONES: El objetivo del presente dictamen fue evaluar la eficacia y seguridad de Bortezomib para su uso en pacientes con mieloma múltiple recidivante y/o refractario a uno o más tratamientos previos. Esta indicación actualmente no está contemplada en el petitorio de medicamentos. En la bibliografía identificada, existen recomendaciones vigentes para el uso de Bortezomib como tratamiento, o parte del tratamiento, farmacológico para pacientes con mieloma múltiple que han recibido tratamiento (esquemas) previos. Sin embargo la cantidad de evidencia es mucho menor con respecto al uso de este mismo fármaco como primera línea de tratamiento. Se identificó una revisión sistemática Cochrane, la misma que incluyó 3 estudios clínicos aleatorizados cuya población fue compatible con la pregunta PICO del presente dictamen, en donde el sub-análisis de sobrevida global y sobrevida libre de progresión favoreció a bortezomib sobre otros esquemas sin bortezomib. De los 3 estudios identificados solamente un estudio reportó calidad de vida y esta no fue diferente entre los dos grupos de estudio. Por lo expuesto, el Instituto de Evaluación de Tecnologías en Salud e Investigación ­ IETSI, aprueba el uso de Bortezomib en pacientes con mieloma múltiple recidivante y/o refractario a uno o más tratamientos previos. La vigencia del presente dictamen preliminar es de dos años.

Humans , Multiple Myeloma/drug therapy , Neoplasm Recurrence, Local/drug therapy , Bortezomib/administration & dosage , Drug Therapy, Combination , Peru , Technology Assessment, Biomedical , Treatment Outcome
Article in English | WPRIM | ID: wpr-216440


OBJECTIVE: Bevacizumab was recently approved by the US Food and Drug Administration for use in recurrent platinum resistant epithelial ovarian cancer (EOC), fallopian tube cancer (FTC), or primary peritoneal cancer (PPC) when no more than two prior cytotoxic regimens have been used; due to concerns for gastrointestinal perforation. We sought to determine bevacizumab-related toxicities in heavily pretreated recurrent EOC. METHODS: We performed a retrospective chart review of patients with recurrent EOC, FTC, and PPC from 2001 to 2011. Patients who received at least two prior chemotherapy regimens before bevacizumab were included. Medical records were reviewed for bevacizumab associated toxicities. The Wilcoxon-Mann-Whitney test was used to compare quantitative variables. Survival was estimated with the Kaplan-Meier method. RESULTS: Sixty patients met inclusion criteria. At the start of bevacizumab treatment, the median age was 60 years and the median body mass index was 26.5 kg/m². More than 50% of patients received bevacizumab after three prior cytotoxic regimens. Grade 3 or higher bevacizumab associated toxicity events occurred in four patients, including one patient who developed a rectovaginal fistula. The median overall survival from the start of bevacizumab treatment was 21.05 months (95% CI, 18.23 to 32.67; range, 1.9 to 110 months). The number of cytotoxic regimens prior to bevacizumab treatment did not differ in those that experienced a toxicity versus those that did not (p=0.66). CONCLUSION: The use of bevacizumab in heavily pretreated EOC, FTC, or PPC is worth consideration.

Adult , Aged , Aged, 80 and over , Angiogenesis Inhibitors/therapeutic use , Bevacizumab/adverse effects , Fallopian Tube Neoplasms/drug therapy , Female , Humans , Intestinal Perforation/chemically induced , Middle Aged , Neoplasm Recurrence, Local/drug therapy , Neoplasms, Glandular and Epithelial/drug therapy , Ovarian Neoplasms/drug therapy , Peritoneal Neoplasms/drug therapy , Retrospective Studies
Article in English | WPRIM | ID: wpr-27941


OBJECTIVE: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been recently reported with favorable oncological outcomes as treatment of advanced epithelial ovarian cancer (EOC). The aim of this study was to demonstrate the feasibility of CRS+HIPEC with cisplatin and paclitaxel for the treatment of advanced EOC. METHODS: This is a prospective observational study of 54 patients, from April 2007 to October 2013, with primary or recurrent peritoneal carcinomatosis due to EOC. The mean age was 54.51+/-9.34. Thirty patients (59%) had primary EOC, and 24 patients (41%) had recurrent disease. RESULTS: Mean peritoneal cancer index was 10.11 (range, 0 to 28), complete cytoreduction (CC0) was achieved for 47 patients (87%), CC1 for seven patients (13%). Patients with suboptimal cytoreduction (CC2 and CC3) were not included in the study. The mean stay in intensive care unit was 4.73+/-5.51 days and the mean hospitalization time was 24.0+/-10.03 days. We did not observe any intraoperative death. Seven patients (13%) required additional operations. Three patients (5.6%) died within 30 days from the procedure. Severe complications were seen in 19 patients (35.2%). During the follow-up period, disease recurred in 33 patients (61.1%); the median disease-free survival time was 12.46 months and the median overall survival time was 32.91 months. CONCLUSION: CRS+HIPEC with cisplatin and paclitaxel for advanced EOC is feasible with acceptable morbidity and mortality. Additional follow-up and further studies are needed to determine the effects of HIPEC on long term survival.

Adult , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Cisplatin/administration & dosage , Combined Modality Therapy , Cytoreduction Surgical Procedures/adverse effects , Feasibility Studies , Female , Humans , Hyperthermia, Induced/adverse effects , Infusions, Parenteral , Kaplan-Meier Estimate , Middle Aged , Neoplasm Recurrence, Local/drug therapy , Ovarian Neoplasms/drug therapy , Paclitaxel/administration & dosage , Prospective Studies , Treatment Outcome
Article in English | WPRIM | ID: wpr-39278


OBJECTIVE: The concept of platinum sensitivity and cross-resistance among platinum agents are widely known in the management of recurrent ovarian cancer. The aim of this study was to evaluate two hypotheses regarding the validity of the concept of platinum sensitivity and non-cross-resistance of cisplatin analogue with cisplatin in recurrent cervical cancer. METHODS: In this retrospective study, the clinical data of patients with recurrent cervical cancer, who had a history of receiving cisplatin based chemotherapy (including concurrent chemoradiotherapy [CCRT] with cisplatin) and who received second-line chemotherapy at the time of recurrence between April 2004 and July 2012 were reviewed. RESULTS: In total, 49 patients-34 squamous cell carcinomas (69.4%) and 15 non-squamous cell carcinomas (30.6%)-were enrolled. The median age was 53 years (range, 26 to 79 years). Univariate and multivariate analysis showed that a platinum free interval (PFI) of 12 months has a strong relationship with the response rate to second-line chemotherapy. Upon multivariate analysis of survival after second-line platinum-based chemotherapy, a PFI of 12 months significantly influenced both progression-free survival (hazard ratio [HR], 0.349; 95% confidence interval [CI], 0.140 to 0.871; p=0.024) and overall survival (HR, 0.322; 95% CI, 0.123 to 0.842; p=0.021). In patients with a PFI of less than 6 months, the difference of progression-free survival between patients with re-administration of cisplatin (3.0 months) and administration of cisplatin analogue (7.2 months) as second-line chemotherapy was statistically significant (p=0.049, log-rank test). CONCLUSION: The concept of platinum sensitivity could be applied to recurrent cervical cancer and there is a possibility of noncross-resistance of cisplatin analogue with cisplatin.

Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carboplatin/administration & dosage , Carcinoma, Squamous Cell/drug therapy , Cisplatin/administration & dosage , Drug Resistance, Neoplasm , Female , Humans , Kaplan-Meier Estimate , Middle Aged , Neoplasm Recurrence, Local/drug therapy , Organoplatinum Compounds/administration & dosage , Retreatment , Retrospective Studies , Treatment Outcome , Uterine Cervical Neoplasms/drug therapy
Rev. latinoam. enferm ; 22(6): 994-1000, 16/12/2014. tab
Article in English | LILACS, BDENF | ID: lil-732944


OBJECTIVES: to assess the quality of life of people living with HIV/AIDS and verify its association with clinical characteristics and treatment adherence. METHOD: cross-sectional study conducted in a hospital in the state of Paraíba, Brazil. A questionnaire was used to collect socio-demographic and clinical data. The quality of life scale proposed by the World Health Organization and a questionnaire to measure treatment adherence were used. RESULTS: of the 314 interviewees, 190 (60.5%) were male, aged 43 years on average, 121 (38.5%) had attended up to five years of schooling, 108 (34.4%) received up to two times the minimum wage, and 112 (35.7%) were on sick leave. In regard to clinical variables, individuals with an undetectable viral load scored higher in all the domains concerning quality of life, with statistically significant differences in three domains. Regarding treatment adherence, 235 (73.8%) presented poor adherence and those who strictly adhered to treatment obtained better scores in quality of life. The results show that quality of life is better among individuals adherent to ART. Supporting people to adhere to the antiretroviral treatment should be a persistent task of healthcare workers and other people participating in the treatment, such as family members and friends. .

OBJETIVOS: avaliar a qualidade de vida das pessoas vivendo com o vírus da imunodeficiência humana/síndrome da imunodeficiência adquirida e suas associações com características clínicas e adesão ao tratamento. MÉTODO: estudo transversal, realizado em um hospital do Estado da Paraíba. Utilizou-se questionário para caracterização sociodemográfica e clínica, escala de qualidade de vida (proposta pela Organização Mundial da Saúde) e escala de adesão ao tratamento (Questionário para Avaliação da Adesão ao Tratamento Antirretroviral). RESULTADOS: dos 314 entrevistados, 190 (60,5%) eram do sexo masculino, idade média de 43 anos, 121(38,5%) contavam com até cinco anos de estudo, 108 (34,4%) recebiam até dois salários-mínimos e 112 (35,7%) estavam afastados das atividades laborais. Quanto às variáveis clínicas, identificou-se que os indivíduos com carga viral indetectável apresentaram maiores escores em todos os domínios de qualidade de vida, com diferença estatisticamente significante em três domínios. Sobre a adesão ao tratamento, 235 (73,8%) apresentaram adesão insuficiente, os que apresentaram adesão estrita obtiveram melhores escores de qualidade de vida. Os resultados mostraram que a qualidade de vida é melhor para os aderentes ao tratamento antirretroviral. Apoiar as pessoas em tratamento para melhorar a adesão aos antirretrovirais deve ser tarefa constante dos profissionais de saúde e de outras pessoas que participam do tratamento, como familiares e amigos. .

OBJETIVOS: evaluar la calidad de vida de las personas viviendo con VIH/Sida y sus asociaciones con características clínicas y adhesión al tratamiento. MÉTODO: estudio transversal, realizado en un hospital del estado de Paraíba. Se utilizó un cuestionario para caracterización sociodemográfica y clínica, la Escala de Calidad de Vida (propuesta por la Organización Mundial de la Salud) y la Escala de Adhesión al Tratamiento (Cuestionario para Evaluación de la Adhesión al Tratamiento Antirretroviral). RESULTADOS: de los 314 entrevistados, 190 (60,5%) eran del sexo masculino, edad promedio de 43 años, 121(38,5%) contaban con hasta cinco años de estudio, 108 (34,4%) recibían hasta dos salarios mínimos y 112 (35,7%) no realizaban actividades laborales. En cuanto a las variables clínicas, se identificó que los individuos con carga viral indetectable presentaron mayores puntajes en todos los dominios de calidad de vida, con diferencia estadísticamente significativa en tres dominios. Sobre la adhesión al tratamiento, 235 (73,8%) presentaron adhesión insuficiente, los que presentaron adhesión estricta obtuvieron mejores puntajes de calidad de vida. Los resultados mostraron que la calidad de vida es mejor para los adherentes a la TARV. Apoyar a personas en tratamiento para mejorar la adhesión a los antirretrovirales debe ser una tarea constante de los profesionales de la salud y de otras personas que participan del tratamiento, como familiares y amigos. .

Humans , Female , Adult , Middle Aged , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/drug therapy , Neoplasm Recurrence, Local/drug therapy , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Floxuridine/administration & dosage , Medroxyprogesterone Acetate , Medroxyprogesterone/administration & dosage , Medroxyprogesterone/analogs & derivatives
Clinics ; 69(11): 758-762, 11/2014. tab, graf
Article in English | LILACS | ID: lil-731105


OBJECTIVES: Despite its rising popularity, reports on the use of preoperative imatinib mesylate (IM) in patients with advanced gastrointestinal stromal tumor (GIST) are limited. This study aims to explore the clinical efficacy of preoperative IM in patients with primarily unresectable or metastatic/recurrent GIST. METHODS: Between September 2009 and February 2014, patients with primarily unresectable or metastatic/recurrent GIST treated by a single medical team were recruited and considered for preoperative IM therapy. Re-examination was conducted regularly and abdominal enhanced CT data, blood biochemistry and responses to IM were recorded. RESULTS: A total of 18 patients were enrolled, including 13 with a primary tumor (7 stomach, 3 small bowel, 2 rectal and 1 pelvic tumor) and 5 with recurrent or metastatic GIST (2 with liver metastasis, 2 with anastomotic recurrence and 1 with pelvic GIST). The median follow-up time was 9.5 months (range of 3-63). The median tumor sizes before and after initiation of IM treatment were 9.1 cm and 6.0 cm (p = 0.003) based on the CT findings, respectively. All patients showed a decrease in tumor burden and the median tumor size reduction was 35%. Sixteen of the 18 patients showed a partial response to IM and two possessed stable disease. Nine of the 18 patients (50%) underwent surgical resection of primary or metastatic/recurrent tumors, with a median of 7 months of IM therapy. One case each of multivisceral resection and tumor recurrence were noted. CONCLUSIONS: IM as a preoperative therapy is feasible and safe for unresectable or metastatic/recurrent GIST that can effectively decrease tumor size, facilitating resection. .

Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Antineoplastic Agents/therapeutic use , Benzamides/therapeutic use , Gastrointestinal Neoplasms/drug therapy , Gastrointestinal Stromal Tumors/drug therapy , Neoplasm Recurrence, Local/drug therapy , Piperazines/therapeutic use , Pyrimidines/therapeutic use , Gastrointestinal Neoplasms/pathology , Gastrointestinal Neoplasms/surgery , Gastrointestinal Stromal Tumors/pathology , Gastrointestinal Stromal Tumors/secondary , Gastrointestinal Stromal Tumors/surgery , Liver Neoplasms/secondary , Neoadjuvant Therapy , Neoplasm Metastasis/drug therapy , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/surgery , Preoperative Care , Preoperative Period , Reproducibility of Results , Time Factors , Tomography, X-Ray Computed , Treatment Outcome , Tumor Burden
Yonsei Medical Journal ; : 1664-1671, 2014.
Article in English | WPRIM | ID: wpr-180228


PURPOSE: To investigate chemosensitivity with an adenosine triphosphate-based chemotherapy response assay in patients with epithelial ovarian or peritoneal cancer according to tumor histology, grade, and disease status. MATERIALS AND METHODS: One hundred specimens were collected during primary or secondary debulking from 67 patients with primary ovarian cancer, 24 patients with recurrent ovarian cancer, 5 patients with primary peritoneal cancer, and 4 patients with recurrent peritoneal cancer; samples were collected between August 2006 and June 2009. Tumor cells were isolated and cultured for 48 hours in media containing chemotherapy. The chemosensitivity index (CI) was calculated as 300 minus the sum of the cell death rate at 0.2x, 1x, and 5x drug concentrations, and the CI values were compared. RESULTS: CI values were obtained from 93 of 100 patients. The most active agents against primary disease were ifosfamide and paclitaxel. For primary serous adenocarcinoma, paclitaxel and irinotecan were the most active, followed by ifosfamide. For clear cell carcinoma, ifosfamide was the most active, followed by paclitaxel and irinotecan. Although not statistically significant, the CIs of cisplatin, carboplatin, paclitaxel, and docetaxel decreased as tumor grade increased. In 14 cases of recurrent disease, paclitaxel was the most active, followed by ifosfamide and cisplatin. CONCLUSION: Ifosfamide and paclitaxel were the most active drugs for primary and recurrent disease. Therefore, we recommend further clinical studies to confirm the efficacy of paclitaxel, ifosfamide, and cisplatin combination chemotherapy for recurrent and primary ovarian cancer.

Adenocarcinoma, Clear Cell/drug therapy , Adenosine Triphosphate/metabolism , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Camptothecin/administration & dosage , Carboplatin/therapeutic use , Cisplatin/administration & dosage , Drug Resistance, Neoplasm , Drug Screening Assays, Antitumor/methods , Female , Humans , Ifosfamide/administration & dosage , Middle Aged , Neoplasm Recurrence, Local/drug therapy , Neoplasms, Glandular and Epithelial/drug therapy , Ovarian Neoplasms/drug therapy , Paclitaxel/therapeutic use , Peritoneal Neoplasms/drug therapy , Predictive Value of Tests , Sensitivity and Specificity , Taxoids/administration & dosage
Article in English | WPRIM | ID: wpr-223880


BACKGROUND: Aggressive fibromatosis is a rare but invasive tumor infiltrating widely between fascia and muscle fibers. It has a high tendency to be locally recurrent despite complete resection. Effectiveness of adjuvant treatment for aggressive fibromatosis including radiotherapy, pharmacological agents, hormonal treatments, and chemotherapy have been previously reported. The purpose of this article was to collect and analyze all information regarding the effectiveness and side effects of oral methotrexate in aggressive fibromatosis. METHODS: From 2005 to 2011, eleven patients with aggressive fibromatosis treated with oral methotrexate at our institution were analyzed in this study. Oral methotrexate was administered once per week at 10 mg per week. Authors collected information about effectiveness concerning cases of local recurrence and metastasis. RESULTS: Eleven patients had remission, two patients had local recurrence. Fatal complications or toxicity were not observed. CONCLUSIONS: Oral methotrexate given at this dose and schedule was considered as a useful treatment in primary inoperable fibromatosis and recurrent fibromatosis.

Administration, Oral , Adolescent , Adult , Aged , Antimetabolites, Antineoplastic/administration & dosage , Child , Female , Fibromatosis, Aggressive/drug therapy , Humans , Male , Methotrexate/administration & dosage , Middle Aged , Neoplasm Recurrence, Local/drug therapy , Retrospective Studies , Young Adult
Indian J Cancer ; 2013 Apr-June; 50(2): 122-127
Article in English | IMSEAR | ID: sea-148636


CONTEXT: There are limited effective therapeutic options in the relapsed setting for non-small cell lung cancer (NSCLC) or in the first line for platinum‑ineligible patients. AIM: To evaluate the safety and efficacy of a metronomic schedule of paclitaxel administered weekly in relapsed refractory NSCLC or upfront in patients not eligible for platinum‑based chemotherapy. SETTINGS AND DESIGN: Retrospective analysis of a prospectively collected database from the medical oncology department at Tata Memorial Hospital in Mumbai, India. MATERIALS AND METHODS: Patients with recurrent and treatment-naïve platinum-ineligible advanced NSCLC were treated with weekly paclitaxel at 80 mg/m2 with palliative intent. Restaging scans were obtained every two months. Chemotherapy was continued until progressive disease, intolerable side effects, or decision of the patient. STATISTICAL ANALYSIS USED: SPSS version 16 was used for analysis. Simple percentages were used for descriptive statistics. Progression‑free survival (PFS) was calculated from date of start of paclitaxel till the date of progression, change of therapy due to any reason, or death due to any cause. Overall survival (OS) was calculated from date of start of paclitaxel to death. The Kaplan Meier method was used for estimation of survival. RESULTS: There were 37 patients over eight months. The median age was 59 years, with a male‑to‑female ratio of 5:1. Two patients received paclitaxel in the first line, 18 patients in second line, nine in third line, five in fourth line, and three were in fifth line. 73% patients had received prior platinum and 48.6% patients had Eastern Cooperative Oncology Group performance status (ECOG PS) >2. The median number of weekly cycles delivered was 14. The response rate was 35% [complete remission (CR): 2.7%, partial remission (PR): 32.4%, stable disease (SD): 32.4%, progressive disease (PD): 27%], the median PFS was four months, and the estimated median OS was seven months. Chemotherapy was well tolerated. The most frequent grade 3 toxicities included anemia: 8%, neutropenia: 5.4%, and sensory neuropathy: 8%. There were no grade 4 toxicities and no episodes of febrile neutropenia. CONCLUSIONS: Weekly low‑dose continuous metronomic‑type scheduling of paclitaxel is safe and effective for relapsed refractory NSCLC and in the first line in platinum-ineligible patients.

Administration, Metronomic , Adult , Aged , Carcinoma, Non-Small-Cell Lung/drug therapy , Carcinoma, Non-Small-Cell Lung/pathology , Disease-Free Survival , Drug-Related Side Effects and Adverse Reactions/pathology , Female , Humans , India , Male , Middle Aged , Neoplasm Recurrence, Local/drug therapy , Neoplasm Recurrence, Local/pathology , Neoplasm Staging , Paclitaxel/administration & dosage , Paclitaxel/adverse effects