Irinotecan-cetuximab-bevacizumab as a salvage treatment in heavily pretreated metastatic colorectal cancer patients: a retrospective observational study.

BACKGROUND: The objective was to evaluate the efficacy of irinotecan-cetuximab-bevacizumab in combination as a salvage treatment for heavily pretreated metastatic colorectal cancer patients. METHODS: A total of 39 patients resistant to both oxaliplatin and irinotecan were included in this retrospective study. Treatment consisted of irinotecan 180/m(2) every 14 days, weekly cetuximab standard dose and bevacizumab 5 mg/kg every 14 days. RESULTS: Partial response was observed in 8 patients (20%), stable disease in 24 (61%) and progressive disease in 7 (18%). Overall response rate in KRAS wild type was 6/22 (27%) and in mutated KRAS it was 2/15 (13%). Median time to progression was 8 months (6.4-9.4) and median overall survival 12 months (10.1-13.8). Overall, grade 3-4 adverse events were observed in 24 patients (62%). CONCLUSIONS: This regimen is active and moderately well tolerated in heavily pretreated advanced colorectal patients. However, caution is advisable when interpreting these results, because they run against the findings of two large phase III trials.

Prognostic value of carcinoembryonic antigen level in rectal cancer treated with neoadjuvant chemoradiotherapy.

BACKGROUND: The purpose of this study was to identify clinical and pathological parameters to improve prediction of disease-free survival (DFS) and overall survival (OS) in patients treated with neoadjuvant chemoradiotherapy for rectal cancer. METHODS: Between July 1995 and May 2007, 148 patients with primary rectal adenocarcinoma received neoadjuvant chemoradiotherapy followed by mesorectal excision. Preoperative treatment included various protocols, UFT and leucovorin (28%) and oxaliplatin-based chemotherapy (72%). Clinical and pathological variables were evaluated in relation to patient outcomes. RESULTS: Thirteen percent of patients achieved a complete pathologic response. No response or minimal response as defined by Dworak (Tumor Regression Grade 0/1) was observed in 30 patients (20%). At a median follow-up of 37 months, the 3-year DFS and OS were 64% and 83%, respectively. Pre-treatment serum carcinoembryonic antigen (CEA) level

Idiopathic and recurrent thromboembolic phenomena in cancer patients

BACKGROUND: Venous thromboembolism (VTE) is one of the most common complications in cancer patients. It is not only associated with both reduced survival and a high number of recurrences, but an idiopathic VTE also increases the likelihood of a cancer diagnosis. METHODS: Between January 2000 and October 2005 we reviewed the medical history of 88 patients who were admitted to a tertiary hospital and presented both a diagnosis of VTE and any type of tumour. The information collected included the type of tumour, the temporal association between tumour diagnosis and VTE, anticoagulation treatment applied and percentage of recurrences. RESULTS: Ten patients (11.4%) presented the VTE prior to the cancer diagnosis; only half of them underwent a posterior tumour screening routine. Fifteen patients (17%) were diagnosed simultaneously and 71% presented the VTE after the tumour was detected. In 47 patients (53.4%) no risk factors for VTEs were detected. Twenty-nine patients (31.7%) presented a recurrent VTE, mainly during chemotherapy treatment (66%). Less than half of the patients (47.57%) were receiving treatment with low-molecular- weight heparins (LMWH). CONCLUSIONS: Idiopathic VTEs may be the first manifestation of an occult neoplasia, but tumour screening is scheduled in only a few patients. Regarding the high incidence of recurrent VTE in cancer populations, a high percentage is attributed to the underuse of LMWH, whose efficacy in preventing recurrent phenomena is superior to oral dicumarinics (AU)

No disponible

Employment in a cohort of breast cancer patients.

BACKGROUND: Breast cancer survivors can have problems in returning to work. However, the importance of work to cancer survivors has until recently received little attention. AIMS: To investigate employment- and work-related disability in a cohort of breast cancer patients to identify possible discrimination and other obstacles to remaining in work. METHODS: Questionnaire study of breast cancer patients employed at diagnosis and where diagnosis had been confirmed at least 6 months before the interview. Participants completed a questionnaire concerning cancer-related symptoms and work-related factors and clinical details were obtained from their medical records. RESULTS: The study included 96 consecutive patients with breast cancer aged between 18 and 65 years. In total, 80% of patients were unable to work after diagnosis, but 56% returned to work at the end of treatment. The sequelae of the disease or its treatment and the stage of disease were independently associated with the ability to work after the end of treatment. Only one patient did not tell his/her employers and coworkers about his/her disease. In total, 29% noticed changes in their relation with co-workers and managers, usually in the sense that they tried to be helpful. None reported job discrimination. CONCLUSION: Breast cancer survivors in this study encountered some problems in returning to work, mainly linked to the sequelae of their disease and its treatment rather than to discrimination by employers or colleagues.

Actividad laboral en una cohorte de pacientes con linfoma no Hodgkin / No disponible

Introducción: La actividad laboral en el cáncer es un aspecto psicosocial que ha recibido poca atención hasta el momento actual, a pesar de considerarse una dimensión de la calidad de vida para estos pacientes. Objetivos: La reinserción y adaptación al entorno laboral fueron investigados en una cohorte de pacientes con linfoma no Hodgkin para describir los factores que influyen en la vuelta al trabajo de estos enfermos. Pacientes y métodos: El estudio incluyó 37 pacientes consecutivos diagnosticados de un linfoma no Hodgkin y empleados en el momento del diagnóstico. El cuestionario incluyó aspectos epidemiológicos, clínicos y laborales (32 variables en total). El estudio fue aprobado por el Comité Ético y de Investigación Cínica del Hospital La Paz. Todos los pacientes dieron su consentimiento para participar en el estudio y para la utilización de los datos de su historia clínica. Resultados: El 86,5% de los pacientes pasaron a inactivos tras comenzar el tratamiento de la enfermedad y un 32,5% lo seguían estando tras éste. No hubo diferencias en la influencia de las distintas variables analizadas con respecto a la actividad laboral tras el diagnóstico. Sin embargo, el realizar un trabajo predominantemente físico y la presencia de secuelas derivadas del tumor o del tratamiento de éste, sí influyeron en la reinserción laboral una vez finalizado el tratamiento específico. La mayoría de los pacientes no creían que el tener la enfermedad les perjudicaría en su puesto de trabajo y, en casi todos los casos, tanto sus compañeros como sus jefes conocían que tenían un tumor. Conclusiones: Éste es el primer estudio exploratorio en nuestro país acerca de la reinserción laboral de los pacientes diagnosticados de un linfoma. Son necesarios más trabajos para establecer las dificultades que tienen este tipo de enfermos en la reinserción laboral y establecer las medidas adecuadas para la mejora de este proceso

Background: Cancer affects many dimensions determining quality of life, including work. However, the importance of work to cancer survivors has received little attention. Aim. Employment and work-related disability were investigated in a cohort of non-Hodgkin's lymphoma patients to describe a possible discrimination and other work issues. Patients and Methods: The study included consecutively 37 non-Hodgkin's lymphoma patients who were employed at diagnosis. The questionnaire included cancer related symptoms and work-related factors. Clinical details were obtained from the medical record. Patients were interviewed face to face and 32 variables were recorded. The study was approved by the Ethical Committee of Hospital La Paz. All patients gave consent to participate. Results: Eighty-six per cent of patients were unable to work after diagnosis, but 68% returned to work at the end of treatment. The type of worker and the sequelae of the disease or its treatment were independently associated with the ability to work after the end of treatment. Almost all patients told their employers and co-workers about their disease. None reported job discrimination. Conclusions: This is the first exploratory study in Spain about labour reintegration in non-Hodgkin's lymphomas. Further studies are necessary

EGFR and colon cancer: a clinical view.

Signalling pathways that emerge from EGFR activation are critical in colon cancer (CC) biology. Its targeting with specific drugs has opened a new window in the treatment of this disease. In this regard, monoclonal antibodies (mAb) have evidenced a high degree of efficiency opposed to the uselessness of tyrosine-kinase inhibitors. Cetuximab is the mAb that has evidenced most activity in CC. After its initial approval as an irinotecan-resistance reversal agent, cetuximab has demonstrated its efficiency from the first line to heavily pretreated patients. In the first line, its addition may increase response rate to chemotherapy, improving liver metastases resection rate. Another promising approach has been suggested from combination schedules with bevacizumab. Panitumumab has been recently approved for CC. Although there is limited clinical experience, the latest data have confirmed its activity in heavily pretreated patients resulting in a clinical benefit vs. best support care. In spite of the clinical benefits, adverse events and the high sanitary cost derived from these drugs force the selection of patients with the highest probability of benefit. At the moment, when EGFR expression evidenced by immunohistochemistry has no value, skin toxicity and, fundamentally, K-Ras mutations may hint at critical information for confirmatory prospective studies.

EGFR and colon cancer: a clinical view

Signalling pathways that emerge from EGFR activation are critical in colon cancer (CC) biology. Its targeting with specific drugs has opened a new window in the treatment of this disease. In this regard, monoclonal antibodies (mAb) have evidenced a high degree of efficiency opposed to the uselessness of tyrosine-kinase inhibitors. Cetuximab is the mAb that has evidenced most activity in CC. After its initial approval as an irinotecan-resistance reversal agent, cetuximab has demonstrated its efficiency from the first line to heavily pretreated patients. In the first line, its addition may increase response rate to chemotherapy, improving liver metastases resection rate. Another promising approach has been suggested from combination schedules with bevacizumab. Panitumumab has been recently approved for CC. Although there is limited clinical experience, the latest data have confirmed its activity in heavily pretreated patients resulting in a clinical benefit vs. best support care. In spite of the clinical benefits, adverse events and the high sanitary cost derived from these drugs force the selection of patients with the highest probability of benefit. At the moment, when EGFR expression evidenced by immunohistochemistry has no value, skin toxicity and, fundamentally, K-Ras mutations may hint at critical information for confirmatory prospective studies (AU)

A modular neural network architecture for step-wise learning of grasping tasks.

This paper proposes a neural network architecture for learning of grasping tasks. The multineural network model presented in this work, allows acquisition of different neural representations of the grasping task through a successive learning over two stages in a strategy that uses already learned representations for the acquisition of the subsequent knowledge. Systematic computer simulations have been carried out in order to test learning and generalization capabilities of the system. The neural activity at different subparts of the artificial neural network during its performance phase, is compared to the activity of populations of real neurons in areas AIP and F5 of the distributed parieto-frontal biological neural network involved in visual guidance of grasping. A more biologically plausible development of the model presented here is also discussed. The proposed model can be also used as a high level controller for a robotic dextrous hand during learning and execution of grasping tasks.

Radioquimioterapia preoperatoria frente a postoperatoria en el carcinoma de recto estadios II-III: estudio comparativo no aleatorizado / Preoperative versus postoperative radiochemotherapy in stages II and III rectal carcinoma: a non-randomized comparative study

Propósito: comparar la eficacia, toxicidad y tasa de complicaciones quirúrgicas del tratamiento adyuvante frente al tratamiento neoadyuvante en el carcinoma de recto.• Material y métodos: 111 pacientes con carcinoma de recto estadios II-III recibieron tratamiento complementario con radioterapia (RT) y quimioterapia (QT). La QT consistió en leucovorin (500 mg/m2) intravenoso el primer día, seguido de lencovorin oral 15 mg/12 horas entre los días 2 y 14 del ciclo, y UFT 390 mg/m2/día entre los días 1 y 14 (350 mg/m2 durante la RT) . En 32 enfermos el tratamiento se realizó de forma neoadyuvante (grupo N), mientras que en los 79 restantes se administró tras la cirugía (grupo A).• Resultados: no hubo diferencias significativas en la supervivencia libre de enfermedad (72 por ciento en el grupo A y 69 por ciento en el grupo N) ni en la supervivencia global a los 3 años (91 por ciento en el grupo A y 95 por ciento en el grupo N). La tasa de complicaciones mayores tras la cirugía fue similar en ambos grupos. La tasa de diarrea grado 3-4 fue del 43 por ciento en los primeros 14 pacientes del grupo N (que recibieron UFT 350 mg/m2), mientras que en el grupo A fue del 18 por ciento (Fisher, p=0.07). En los restantes 18 pacientes del grupo N la dosis de UFT fue reducida a 300 mg/m2. La tasa de cirugía conservadora de esfínter en los tumores situados en los 10 cm últimos del recto fue superior en el grupo N (53 por ciento vs 38 por ciento, p=n.s.).• Conclusiones: el tratamiento neoadyuvante en el cáncer de recto no presenta diferencias significativas con el tratamiento adyuvante en cuanto a tasa de complicaciones quirúrgicas, tasa de recaídas y supervivencia, pero sí aumenta la toxicidad gastrointestinal. (AU)

Reinserción laboral del paciente neoplásico / Reintegration to work of the patients with cancer

Propósito: Analizar la reinserción laboral en los pacientes diagnosticados de cáncer. Material y métodos: Se ha realizado una encuesta a 96 pacientes neoplásicos que desempeñaban un empleo remunerado en el momento del diagnóstico. Resultados: Durante el tratamiento, 8 pacientes (9 por ciento) permanecieron laboralmente activos y 79 (82 por ciento) tuvieron ILT. Tras finalizar éste, 67 enfermos (70 por ciento) desarrollaban alguna actividad laboral y 11 (11 por ciento) continuaban con ILT. Quedaron con secuelas 48 personas (50 por ciento), de las cuales 24 (50 por ciento) pudieron volver al trabajo, frente a 43 (90 por ciento) de las que no presentaron secuelas (p<0,01). Conclusiones: El 70 por ciento de los pacientes que sobreviven al tratamiento de primera línea de una neoplasia logran reinsertarse en el ámbito laboral. Es necesario desarrollar esquemas terapéuticos que, manteniendo la eficacia, reluzcan al mínimo las secuelas (AU)