ABSTRACT
Currently, the treatment of malignant melanoma offers the longest and the most studied experience of innovative treatments in malignant pathology. The algorithm of the therapeutic decision in advanced or metastatic melanoma must comprise: the timing of the therapeutic initiation, the sequencing of the specific oncological treatment (radiotherapy and chemotherapy still being therapeutic alternatives in selected cases), the diagnosis and the management of adverse reactions. We present the case of a patient diagnosed with metastatic malignant melanoma in November 2019, who progressed successively under new systemic treatment throughout the 3 years of treatment and experienced skin reactions of various degrees of severity. The comprehensive response to secondary hilar pulmonary lymphatic determinations under subsequent chemotherapy was specific to the presented case. The occurrence of vitiligo secondary to immunotherapy is a favorable prognostic factor, but the occurrence of secondary cerebral determinations is an extremely severe prognostic factor in malignant melanoma and a challenge in making the therapeutic decision. Previous treatment with immune checkpoint inhibitors may trigger a favorable response to systemic chemotherapy. The early and accurate diagnosis of the adverse events of the new therapies requires a multidisciplinary approach, because it can radically change the therapeutic decision.
ABSTRACT
Background: COVID-19 is an infectious disease caused by the new coronavirus, SARS-COV-2. Elderly patients, those with comorbidities such as cardiovascular disease, diabetes, chronic respiratory disease or cancer, are more likely to develop more severe forms of the disease. During COVID-19 pandemic, cancer patients wanted to continue the oncological treatment, this being a priority for them. Material and method: We evaluated the medical records of all patients hospitalized in the Chronic Oncology-Palliative Care Department of the Chronic Diseases Hospital "St. Luke" Bucharest, during a period of 8 weeks of emergency (15.03-8.05, 2020). Between 25.04-8.05, the testing for SARS-CoV-2 was performed, by RT-PCR method, of all the asymptomatic patients hospitalized in the department. Discussion: Delaying oncological treatments, as well as delaying palliative care for cancer patients, can have repercussions on disease progression, overall survival, and quality of life (treatment of symptoms with an increased frequency of cancer, such as pain syndrome, nausea and vomiting, cannot be delayed). However, delaying active cancer treatments cannot be recommended as an option to reduce the risk of pandemic infection. Conclusions: During the COVID-19 global pandemic, between 15.03 and 8.05, 2020, our department ensured the continuity of oncological treatments and palliative care for cancer patients. No patients admitted to our ward were positively diagnosed for SARS-CoV-2 virus infection until May 08, 2020. (English) [ABSTRACT FROM AUTHOR] Introducere: COVID-19 este o boală infecțioasă, cauzată de noul coronavirus, SARS-COV-2. Pacienții vârstnici, cei cu comorbiditati precum boli cardiovasculare, diabet, boli respiratorii cronice sau cancer, sunt mai predispuși să dezvolte forme mai severe ale bolii. În timpul pandemiei COVID-19, pacienții cu cancer au dorit continuarea tratamentului oncologic, acesta fiind prioritar pentru ei. Material și metodă: Am evaluat fișele medicale ale tuturor pacienților internați în Secția Oncologie Cronici-Îngrijiri paliative a Spitalului de boli cronice "Sf. Luca" București, într-o perioadă de 8 săptămâni a stării de urgență (15.03- 08.05.2020). În perioada 25.04-8.05 s-a efectuat și testarea pentru SARS -CoV-2, prin metodă RT-PCR a tuturor pacienților asimptomatici internați în regim de spitalizare continuă. Discuții: Întârzierea tratamentelor oncologice, precum și amânarea îngrijirii paliative a pacienților cu cancer, pot avea repercursiuni asupra progresiei bolii, asupra supraviețuirii generale, și asupra calității vieții (tratarea unor simptomatologii cu frecvență crescută în cancer, precum sindromul algic, greață și vărsăturile, nu pot fi amânate). Totuși, întârzierea tratamentelor oncologice active nu poate fi recomandată ca o alegere pentru reducerea riscului de infectare în perioadă pandemiei Concluzii: În perioadă pandemiei COVID-19, în intervalul 15.03-08.05.2020, Secția Oncologie Cronici-Îngrijiri palliative a Spitalului, a asigurat continuitatea tratamentelor oncologice și a îngrijirii paliative. Niciun pacient internat în secția noastră nu a fost diagnosticat pozitiv pentru infecția cu virusul SARS-CoV-2, până la data de 08.05. 2020. (Romanian) [ABSTRACT FROM AUTHOR] Copyright of Paliatia: Journal of Palliative Care is the property of Media DOM Express and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)