[Pharmacoeconomic aspects of oral cytostatic agents]. / Aspectos farmacoeconómicos de los citostáticos orales.

When validating oral chemotherapy, pharmacists should confirm the suitability and correctness of the prescription, applying the same safety standards as those used for parenteral cytostatic drugs. There are an increasing number of cancers for which orally administered drugs are available, which increases patient satisfaction as these drugs can be taken at home without the need to visit a hospital. As oral cytostatic treatments increase, so does the importance of ensuring optimal treatment compliance. The new oral cytostatic agents are less toxic, reduce indirect costs and imply less loss of time for patients and their families. However, the cost of these agents should be below a threshold acceptable for society. As an aid to decision making, pharmacoeconomic tools should be used.

One year of complete clinical response in a metastatic breast cancer patient treated with a combination of lapatinib and gemcitabine.

The treatment of metastatic breast cancer is challenging. We recently assisted in the development of targeted therapies (in combination with chemotherapy or as monotherapy) that have improved results for selected groups of patients. Lapatinib is a dual tyrosine kinase inhibitor that has shown efficacy in breast cancer. Consequently, its use has been approved, in combination with capecitabine, for the treatment of disease positive for the human epidermal growth factor receptor. Here, we present a case of complete clinical response to a combination of lapatinib and gemcitabine that was maintained for 1 year.

Carcinosarcoma ovárico. A propósito de un caso y revisión de la literatura médica / Carcinosarcoma of the ovary. Apropos of a case and review of the literature

El carcinosarcoma ovárico, también conocido como tumor maligno mixto mesodérmico o tumor mülleriano, es el menos frecuente y el más complejo de tratar. Representa del uno al 4% de todos los tumores ováricos. No hay muchos estudios aleatorizados al respecto, así como tampoco grandes ensayos clínicos. Su tratamiento se basa en publicaciones de casos, estudio de series retrospectivas o extrapolaicones del tratamiento aplicado en otras tumoraciones con un proceso patológico similar en otras localizaciones. A continuación se presenta un caso clínico que los autores de este artículo diagnosticaron y trataron, y que esperan pueda contribuir a ampliar la experiencia en este tipo de tumores (AU)

Carcinosarcoma of the ovary, also known as malignant mixed mesodermal or Müllerian tumors, are the least frequent and most complex ovarian neoplasms to treat. These tumors account for 1–4% of all ovarian masses. There are few randomized studies or large clinical trials. Therefore, management is based on case reports, series of retrospective studies, or extrapolations from neoplasms with similar characteristics in other locations. We present a case of carcinosarcoma of the ovary diagnosed and treated in our department with a view to increasing the experience reported with this type of tumor (AU)

Management of platinum-resistant ovarian cancer with the combination of pemetrexed and gemcitabine.

INTRODUCTION: Platinum resistant ovarian cancer is a current challenge in Oncology. Current approved therapies offer no more of a 20% of response. New therapeutic options are urgently needed. PATIENTS AND METHODS: Patients were treated with the combination of Pemetrexed 500 mg/m(2) d1 and Gemcitabine 1000 mg/m(2) d1,8 in a 21 days basis. RESULTS: 10 platinum-resistant ovarian cancer patients were treated under compassionate use. Mean previous chemotherapy lines were 3.3. Mean administered cycles were 4. Mean CA 125 decrease was on average of 47%, with one patient experiencing a 95% decrease in her CA 125 level. 1 patient had a complete clinical remission, and 2, had partial radiological responses. Mean Progression free survival was 16.5 weeks, and Overall Survival was 21.2 weeks. Treatment was well tolerated. CONCLUSIONS: Deemd to the observed activity, the combination of Pemetrexed and Gemcitabine deserves deeper investigation in platinum-resistant ovarian cancer patients.

Management of platinum-resistant ovarian cancer with the combination of pemetrexed and gemcitabine

INTRODUCTION: Platinum resistant ovarian cancer is a current challenge in Oncology. Current approved therapies offer no more of a 20% of response. New therapeutic options are urgently needed. PATIENTS AND METHODS: Patients were treated with the combination of Pemetrexed 500 mg/m(2) d1 and Gemcitabine 1000 mg/m(2) d1,8 in a 21 days basis. RESULTS: 10 platinum-resistant ovarian cancer patients were treated under compassionate use. Mean previous chemotherapy lines were 3.3. Mean administered cycles were 4. Mean CA 125 decrease was on average of 47%, with one patient experiencing a 95% decrease in her CA 125 level. 1 patient had a complete clinical remission, and 2, had partial radiological responses. Mean Progression free survival was 16.5 weeks, and Overall Survival was 21.2 weeks. Treatment was well tolerated. CONCLUSIONS: Deemd to the observed activity, the combination of Pemetrexed and Gemcitabine deserves deeper investigation in platinum-resistant ovarian cancer patients (AU)

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Young male patient with bilateral synchronous testicular germ cell tumour. Considerations for partial orchiectomy

Bilateral synchronous testicular cancer is a rare disease and is usually associated with similar histological findings in each testicle. The standard therapy of bilateral testis cancer is generally considered to be inguinal orchiectomy. We present a case of synchronous bilateral testicular germ cell tumour, with different histology, initially treated with testis-sparing surgery. After pathology review, the margin of the partial orchiectomy was considered affected, and an inguinal orchiectomy was planned. Options for testis-sparing surgery are discussed (AU)

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Options for radiotherapy in the treatment of liver metastases

Technologic advances have provided the means to deliver tumoricidal doses of radiation therapy (RT) to patients with unresectable colorectal liver metastases, while avoiding critical normal tissues, providing the opportunity to use RT for curative intent treatment of metastatic disease. For the current report, the expanded role of RT, with its different techniques in the setting of metastatic colorectal cancer, from palliation to cure was reviewed (AU)

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Circulating tumor cells in breast cancer: methodology and clinical repercussions.

Breast cancer is the most common type of cancer among women, and clinicians have long recognized its heterogeneity. Its detection and treatment in early stages allow for reduction of mortality. Despite the advances and new strategies for combining surgical, radiotherapy, and chemotherapy options, however, the percentage of patients developing metastases and advanced stages remains high. Even though serum tumor markers have been used for the early diagnosis of metastases, their systematic determination has not had an effect on survival. Methods that are more reliable are needed to detect metastases earlier than with the common clinical methods and thus start treatment before overt relapse. Early indicators of response or resistance to treatment are also an issue in clinical practice. Imaging techniques are time consuming, and it is difficult to detect changes that indicate response limited to therapy, and approaches to defining changes in tumor mass are time and resource consuming. In contrast, detection of circulating tumor cells (CTC) could be a useful tool in early detection of relapse and response to systemic chemotherapy. Extremely sensitive techniques are available that are easily applied to peripheral blood samples, which might provide enormous research possibilities in this area.

Clinical case report and literature review: metachronous colorectal splenic metastases.

A 52-year-old woman with a rising carcinoembryonic antigen CEA, no clinical or radiological findings, a negative colonoscopy, and a positron emission tomography (PET) scan that revealed an isolated hypermetabolic lesion in the spleen. The patient underwent splenectomy by laparoscopic surgery. The pathological study confirmed the presence of an isolated metastasis to the spleen. This case reveals the rare occurrence of isolated splenic metastases in the context of colorectal cancer and illustrates the role of PET when a patient shows a rising CEA with negative clinicoradiological studies.

Circulating tumor cells in breast cancer: methodology and clinical repercussions

Breast cancer is the most common type of cancer among women, and clinicians have long recognized its heterogeneity. Its detection and treatment in early stages allow for reduction of mortality. Despite the advances and new strategies for combining surgical, radiotherapy, and chemotherapy options, however, the percentage of patients developing metastases and advanced stages remains high. Even though serum tumor markers have been used for the early diagnosis of metastases, their systematic determination has not had an effect on survival. Methods that are more reliable are needed to detect metastases earlier than with the common clinical methods and thus start treatment before overt relapse. Early indicators of response or resistance to treatment are also an issue in clinical practice. Imaging techniques are time consuming, and it is difficult to detect changes that indicate response limited to therapy, and approaches to defining changes in tumor mass are time and resource consuming. In contrast, detection of circulating tumor cells (CTC) could be a useful tool in early detection of relapse and response to systemic chemotherapy. Extremely sensitive techniques are available that are easily applied to peripheral blood samples, which might provide enormous research possibilities in this area (AU)

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Clinical case report and literature review: metachronous colorectal splenic metastases

A 52-year-old woman with a rising carcinoembryonic antigen CEA, no clinical or radiological findings, a negative colonoscopy, and a positron emission tomography (PET) scan that revealed an isolated hypermetabolic lesion in the spleen. The patient underwent splenectomy by laparoscopic surgery. The pathological study confirmed the presence of an isolated metastasis to the spleen. This case reveals the rare occurrence of isolated splenic metastases in the context of colorectal cancer and illustrates the role of PET when a patient shows a rising CEA with negative clinicoradiological studies (AU)

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Screening and chemoprevention in lung cancer.

Lung cancer is a major health problem due to its incidence and mortality. The risk factors, the existence of a preclinical phase, and the relationship between stage at diagnosis and survival are known. A number of strategies that aim to diagnose lung cancer in its earliest stages, based principally on imaging studies, are therefore being tested. Several drugs aimed at reducing the probability of developing lung cancer in the at-risk population are also under study. At the present time, the results obtained have not been encouraging and we do not have a clear strategy either for early diagnosis or for the use of chemopreventive agents.

Screening and chemoprevention in lung cancer

Lung cancer is a major health problem due to its incidence and mortality. The risk factors, the existence of a preclinical phase, and the relationship between stage at diagnosis and survival are known. A number of strategies that aim to diagnose lung cancer in its earliest stages, based principally on imaging studies, are therefore being tested. Several drugs aimed at reducing the probability of developing lung cancer in the at-risk population are also under study. At the present time, the results obtained have not been encouraging and we do not have a clear strategy either for early diagnosis or for the use of chemopreventive agents (AU)

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