ABSTRACT
Most patients diagnosed with luminal metastatic breast cancer (MBC) who are seen in oncology consultations are elderly. MBC in elderly patients is characterized by a higher percentage of hormone receptor (HR) expression and a lower expression of human epidermal growth factor receptor 2 (HER2). The decision regarding which treatment to administer to these patients is complex due to the lack of solid evidence to support the decision-making process. The objective of this paper is to review the scientific evidence on the treatment of elderly patients with luminal MBC. For this purpose, the Oncogeriatrics Section of the Spanish Society of Medical Oncology (SEOM), the Spanish Breast Cancer Research Group (GEICAM) and the SOLTI Group appointed a group of experts who have worked together to establish consensus recommendations to optimize the treatment of this population. It was concluded that the chronological age of the patient alone should not guide therapeutic decisions and that a Comprehensive Geriatric Assessment (CGA) should be performed whenever possible before establishing treatment. Treatment selection for the elderly population should consider the patients baseline status, the expected benefit and toxicity of each treatment, and the impact of treatment toxicity on the patients quality of life and functionality.
Subject(s)
Humans , Male , Female , Breast/pathology , Unilateral Breast Neoplasms/drug therapy , Unilateral Breast Neoplasms/metabolism , Geriatric Assessment , Receptor, ErbB-2 , Age Factors , Quality of LifeABSTRACT
Most patients diagnosed with luminal metastatic breast cancer (MBC) who are seen in oncology consultations are elderly. MBC in elderly patients is characterized by a higher percentage of hormone receptor (HR) expression and a lower expression of human epidermal growth factor receptor 2 (HER2). The decision regarding which treatment to administer to these patients is complex due to the lack of solid evidence to support the decision-making process. The objective of this paper is to review the scientific evidence on the treatment of elderly patients with luminal MBC. For this purpose, the Oncogeriatrics Section of the Spanish Society of Medical Oncology (SEOM), the Spanish Breast Cancer Research Group (GEICAM) and the SOLTI Group appointed a group of experts who have worked together to establish consensus recommendations to optimize the treatment of this population. It was concluded that the chronological age of the patient alone should not guide therapeutic decisions and that a Comprehensive Geriatric Assessment (CGA) should be performed whenever possible before establishing treatment. Treatment selection for the elderly population should consider the patient's baseline status, the expected benefit and toxicity of each treatment, and the impact of treatment toxicity on the patient's quality of life and functionality.
Subject(s)
Breast Neoplasms , Age Factors , Aged , Breast/pathology , Breast Neoplasms/drug therapy , Breast Neoplasms/metabolism , Consensus , Female , Geriatric Assessment , Humans , Quality of Life , Receptor, ErbB-2ABSTRACT
Population aging is associated with greater numbers of older people with cancer. Thanks to treatment advances, not only are more seniors diagnosed with cancer, but there are also more and more older cancer survivors. This upward trend will continue. Given the heterogeneity of aging, managing older patients with cancer poses a significant challenge for Medical Oncology. In Spain, a Geriatric Oncology Task Force has been set up within the framework of the Spanish Society for Medical Oncology (SEOM). With the aim of generating evidence and raising awareness, as well as helping medical oncologists in their training with respect to seniors with cancer, we have put together a series of basic management recommendations for this population. Many of the patients who are assessed in routine clinical practice in Oncology are older. CGA is the basic tool by means of which to evaluate older people with cancer and to understand their needs. Training and the correct use of recommendations regarding treatment for comorbidities and geriatric syndromes, support care, and drug-drug interactions and toxicities, including those of antineoplastic agents, as detailed in this article, will ensure that this population is properly managed
No disponible
Subject(s)
Humans , Aged , Neoplasms/therapy , Geriatric Assessment/methods , Neoplasms/epidemiology , Health of the Elderly , Multiple Chronic Conditions/epidemiology , Polypharmacy , Drug-Related Side Effects and Adverse Reactions/prevention & control , Granulocyte Colony-Stimulating Factor/therapeutic use , Erythropoietin/therapeutic useABSTRACT
Population aging is associated with greater numbers of older people with cancer. Thanks to treatment advances, not only are more seniors diagnosed with cancer, but there are also more and more older cancer survivors. This upward trend will continue. Given the heterogeneity of aging, managing older patients with cancer poses a significant challenge for Medical Oncology. In Spain, a Geriatric Oncology Task Force has been set up within the framework of the Spanish Society for Medical Oncology (SEOM). With the aim of generating evidence and raising awareness, as well as helping medical oncologists in their training with respect to seniors with cancer, we have put together a series of basic management recommendations for this population. Many of the patients who are assessed in routine clinical practice in Oncology are older. CGA is the basic tool by means of which to evaluate older people with cancer and to understand their needs. Training and the correct use of recommendations regarding treatment for comorbidities and geriatric syndromes, support care, and drug-drug interactions and toxicities, including those of antineoplastic agents, as detailed in this article, will ensure that this population is properly managed.
Subject(s)
Aged , Medical Oncology/standards , Neoplasms/therapy , Geriatric Assessment/methods , Humans , Medical Oncology/methodsABSTRACT
PURPOSE: Our goal was to describe the clinical, histological, and epidemiological characteristics of lung cancer diagnoses in people ≥70 years of age. MATERIALS AND METHODS: Information on patients diagnosed with lung cancer from January 2006 to February 2008 was prospectively collected from the outpatient oncology department at a regional hospital. A total of 83 patients (97.6% men; mean age 77 years) were studied. There was a higher ratio of men to women than that reported in younger populations. Mean age was higher than that reported for randomized studies: 65.1% were ≥75 years old. Patients >80 years constituted 28.9% of the study population. Most patients (96.4%) had a history of smoking; they were predominantly former smokers (72.5% vs. 27.5%). RESULTS: The most common histological types were squamous cell (61.3%) and small cell (14.5%) carcinoma. Metastasis was present in 36.1% of patients. Stage was significantly associated with survival (logrank p < 0.001). There was no association between age and survival. Squamous cell lung cancer was associated with a better survival (p = 0.003). CONCLUSIONS: Elderly lung cancer patients who attended clinical practice were older than those included in prospective studies. The predominance of men and squamous cell carcinoma is associated with a smoking history. The epidemiological and histological patterns of younger patients have changed, possibly in relation to changes in smoking habits. The translation of these changes to elderly patients will be evidenced in the future. Only prospective epidemiologic studies will determine whether smoking habits are changing epidemiology in elderly lung cancer patients (AU)
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/etiology , Lung Neoplasms/epidemiology , Lung Neoplasms/etiology , Small Cell Lung Carcinoma/epidemiology , Smoking/adverse effects , Smoking/epidemiology , Carcinoma, Squamous Cell/epidemiology , Carcinoma, Squamous Cell/pathology , Lung Neoplasms/pathology , Incidence , Neoplasm Staging , Small Cell Lung Carcinoma/etiology , Small Cell Lung Carcinoma/pathologyABSTRACT
Non-small-cell lung cancer (NSCLC) ranks among the neoplasms with the worst prognoses and the highest mortality rates. Several factors, mainly clinical, are known that provide a predictive value on the course of the disease. In the era in which we live, the molecular basis of cancer is studied in depth and several molecular markers have been described that could play a prognostic role or that could predict the probability of responding to the different treatments used. Moreover, some mechanisms have been proposed that could explain primary or acquired resistance to treatment with chemotherapy and to targeted therapies. Knowing all these pathways is very important, as it allows the development of selective therapeutic strategies that minimise toxicity and optimise treatment effectiveness. However, the data obtained yield results that are at times contradictory, prospective studies with biomarkers thus being necessary so that their role can be established with the necessary evidence (AU)
Subject(s)
Humans , Male , Female , Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinoma, Non-Small-Cell Lung/drug therapy , Lung Neoplasms/diagnosis , Lung Neoplasms/drug therapy , Biomarkers, Tumor/analysis , Biomarkers, Tumor/genetics , Angiogenesis Inhibitors/therapeutic use , Biomarkers, Pharmacological/analysis , Carcinoma, Non-Small-Cell Lung/genetics , Drug Resistance, Neoplasm/genetics , Genes, erbB-1 , Genes, ras , Genetic Markers/physiology , Lung Neoplasms/genetics , Mutation/physiology , PrognosisABSTRACT
PATIENTS AND METHOD: We studied patients with acquired human immunodeficiency virus (HIV) infection that developed non-Hodgkin's lymphoma (NHL) from January 1985 to October 2001. RESULTS: 44 patients (36 men, 8 women; median age 34 years) were included. Burkitt's lymphoma was diagnosed in 34%, and diffuse large cell B lymphoma in 29.5%. A history of AIDS diagnosis was detected in 20 cases (45%). International prognostic index (IPI) was 0-1 in 19 patients (43%), 2 in 12 (27%) and higher than 3 in 13 (30%). Chemotherapy was used in 64% of the patients, radiation therapy in 2% and both in 11%. Criteria for partial response were reached in 13 patients (29%), for complete remission in 2 (4%) and for stabilization in 1 (2%). Nine (20%) patients are alive (5 without disease), 22 (50%) died because of NHL, 5 (11%) died because of treatment associated toxicity and 8 died because of other causes. Median survival were 3 months, with a 1-year survival estimate of 24% and a 2-year survival estimate of 14%. In the univariate analysis of prognostic factors, IPI = 0-1 in comparison with IPI = 2-5 (p = 0.000), physical status (PS) < or = 2 (p = 0.021) and absence of B symptoms (p = 0.012) were significant. In the multivariate analysis, IPI = 0-1 was also significant (p = 0.000). CONCLUSIONS: Patients with HIV and NHL has multiple factors of poor prognosis. The survival is limited and chemotherapy toxicity is high. Patients with low IPI are a subgroup with better prognosis.
Subject(s)
HIV Infections/complications , HIV-1 , Lymphoma, AIDS-Related/complications , Lymphoma, Non-Hodgkin/complications , Adult , Antineoplastic Agents/therapeutic use , Antiretroviral Therapy, Highly Active , Female , HIV Infections/diagnosis , HIV Infections/drug therapy , Humans , Lymphoma, AIDS-Related/diagnosis , Lymphoma, AIDS-Related/drug therapy , Lymphoma, Non-Hodgkin/diagnosis , Lymphoma, Non-Hodgkin/drug therapy , Male , Neoplasm Staging , Prognosis , Retrospective Studies , Survival Analysis , Treatment OutcomeABSTRACT
Gastric adenocarcinoma is a high-lethality tumour and has a great tendency to recur. Liver and peritoneum are the places where the metastases are most frequently localised. We introduce the case of a woman diagnosed with gastric adenocarcinoma who showed isolated skin metastasis. There were an important number of recurrences (always in the skin). She was treated with radical surgery and later treated with different cytostatic schedules. The patient died 13 years after metastasis were diagnosed. With this case we wanted to pay attention to the role of the biologic prognostic factors of gastric carcinoma. The molecular biology of these tumours can explain the different evolution of the disease. Biologic prognostic factors can separate gastric carcinoma into different kinds of disease.
Subject(s)
Carcinoma, Signet Ring Cell/secondary , Skin Neoplasms/secondary , Stomach Neoplasms/pathology , Survivors , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Signet Ring Cell/drug therapy , Carcinoma, Signet Ring Cell/radiotherapy , Carcinoma, Signet Ring Cell/surgery , Cisplatin/administration & dosage , Cobalt Radioisotopes/therapeutic use , Combined Modality Therapy , Etoposide/administration & dosage , Fatal Outcome , Female , Fluorouracil/administration & dosage , Gastroenterostomy , Humans , Leucovorin/administration & dosage , Middle Aged , Radioisotope Teletherapy , Shoulder , Skin Neoplasms/drug therapy , Skin Neoplasms/radiotherapy , Skin Neoplasms/surgery , Stomach Neoplasms/complications , Stomach Neoplasms/surgery , Stomach Ulcer/etiologyABSTRACT
El adenocarcinoma gástrico es un tumor con elevado porcentaje de recaídas y una alta letalidad. Peritoneo e hígado son las localizaciones más frecuentes de las metástasis. Presentamos el caso de una paciente diagnosticada de adenocarcinoma gástrico que presentó una recaída aislada en piel con sucesivas recaídas a nivel cutáneo tratadas de forma local y con diversos esquemas de citostáticos. La paciente falleció 13 años después del diagnóstico de las metástasis. La evolución de esta paciente sugiere la existencia de factores pronósticos biológicos en el carcinoma gástrico que influyen en el comportamiento de la enfermedad. El conocimiento de la biología tumoral puede aclarar los comportamientos atípicos de enfermedades que con los conocimientos actuales son similares pero cuya evolución es muy diferente (AU)
The gastric adenocarcinoma is a high lethality tumour and has a great tendency to the recurrence. Liver and peritonea are the places where the metastases are most frequently localised. We introduce the case of a woman diagnosed of gastric adenocarcinoma who showed isolated skin metastasis. There were an important number of recurrences (always in the skin). She was treated with radical surgery and later treated with different citostatic schedules. The patient died 13 years after metastasis were diagnosed. With this case we wanted to pay attention about the role of the biologic prognostic factors of the gastric carcinoma. The molecular biology of these tumours can to explain the different evolution of the disease. Biologic prognostic factors can separate the gastric carcinoma into different kind of disease (AU)
Subject(s)
Middle Aged , Female , Humans , Survivors , Shoulder , Fatal Outcome , Radioisotope Teletherapy , Antineoplastic Combined Chemotherapy Protocols , Cobalt Radioisotopes , Cisplatin , Combined Modality Therapy , Leucovorin , Etoposide , Fluorouracil , Gastroenterostomy , Skin Neoplasms , Stomach Ulcer , Stomach Neoplasms , Carcinoma, Signet Ring CellABSTRACT
Objetivo: Revisión retrospectiva de nuestra experiencia en el tratamiento del carcinoma de nasofaringe. Material y método: Analizamos 38 pacientes (26 hombres, 12 mujeres). Realizamos análisis de supervivencia mediante el método de Kaplan y Meier. Resultados: La mediana de edad de la serie fue de 44 años (15-78). El 93 por ciento de los pacientes presentaban estadios avanzados al diagnóstico. El tratamiento fue: radioterapia 12 pacientes (32 por ciento), radioterapia y quimioterapia 24 casos (63 por ciento), radioterapia y cirugía 1 paciente (3 por ciento) y cirugía 1 caso (3 por ciento). Tasa de respuesta fue de 87 por ciento (82 por ciento RC, 5 por ciento RP). La tasa de recaída fue del 50 por ciento. La mediana del tiempo hasta la progresión fue de 16.6 meses y la de supervivencia de 54 meses con una supervivencia proyectada a 10 años del 38 por ciento. Conclusiones: El carcinoma de nasofaringe es un tumor diferente al resto de tumores de cabeza y cuello. La radioterapia ha sido clásicamente el tratamiento estándar. Actualmente en tumores no metastáticos la combinación de quimioterapia y radioterapia debe ser el tratamiento estándar. El papel de la quimioterapia como tratamiento adyuvante está por definir. (AU)
Subject(s)
Adolescent , Adult , Aged , Female , Male , Middle Aged , Humans , Nasopharyngeal Neoplasms/therapy , Retrospective Studies , Disease-Free Survival , Disease Progression , Treatment OutcomeABSTRACT
Propósito: Presentamos el caso de un mieloma múltiple de presentación atípica. Caso clínico: Varón de 63 años fumador importante, que debuta con cuadro de dolor torácico osteomuscular y síndrome constitucional. En las exploraciones realizadas se evidenció una condensación en lóbulo superior derecho con múltiples nódulos pulmonares así como imágenes líticas en columna dorsal. Se planteó como diagnóstico inicial la existencia de un carcinoma pulmonar. El estudio anatomopatológico puso de manifiesto que se trataba de un mieloma múltiple que debutó junto a una bronconeumonía bilateral. Discusión: El mieloma múltiple supone una infiltración plasmocitaria de médula ósea. Es frecuente la asociación con procesos infecciosos. La aparición de lesiones cutáneas secundarias a la afectación plasmocitaria y el debut asociado a una bronconeumonía bilateral son dos datos clínicos poco frecuentes. Destacar la necesidad de confirmación anatomopatológica ante cualquier imagen de características tumorales para decidir la actitud terapéutica (AU)
Subject(s)
Male , Middle Aged , Humans , Multiple Myeloma/complications , Multiple Myeloma/diagnosis , Bronchopneumonia/complications , Bronchopneumonia/diagnosis , Lung Neoplasms/diagnosis , Lung Neoplasms/complications , Fatal OutcomeABSTRACT
Introducción: Presentamos un caso de shock séptico en neutropenia causado por Clostridium septicum en un paciente en tratamiento con quimioterapia y radioterapia como tratamiento adyuvante de un cáncer de recto. Presentación del caso: El paciente presentó lesiones cutáneas equimóticas y con crepitación a la exploración, posteriormente la evolución presentó un curso fulminante con foco primario abdominal y desarrollo posterior de gangrena gaseosa en miembros inferiores asociada a shock séptico. A pesar del tratamiento con antibióticos de amplio espectro y el desbridamiento quirúrgico la evolución fue desfavorable. Discusión: La aparición de un shock séptico por Clostridium septicum debe sospecharse en pacientes con enfermedades malignas hematológicas o que afectan al aparato digestivo sobre todo si aparecen lesiones cutáneas que sugieren gangrena gaseosa. Esta infección tiene una alta letalidad y el diagnóstico precoz y el tratamiento antibiótico y quirúrgico debe ser inmediato para lograr un buen control de la enfermedad (AU)
Subject(s)
Aged , Male , Humans , Leg/microbiology , Clostridium Infections/complications , Adenocarcinoma/drug therapy , Gas Gangrene/microbiology , Shock, Septic/microbiology , Rectal Neoplasms/drug therapy , Chemotherapy, Adjuvant , Fatal OutcomeABSTRACT
Propósito: Las primeras pautas eficaces de tratamiento adyuvante para el cáncer colorrectal fueron las combinaciones de 5-fluorouracilo con levamisol (5FU+lev, en el cáncer de colon) y con radioterapia (5FU+RT, en el cáncer de recto). Ambas se emplearon en nuestro centro entre 1992 y 1997. Presentamos aquí sus resultados a largo plazo en términos de toxicidad y supervivencia. Material y métodos: Setenta y cinco pacientes con cáncer de colon (48) y recto (27) resecado con intención curativa en estadios II (36 por ciento) y III (64 por ciento) recibieron quimioterapia basada en la administración de 5FU en bolo (5FU+lev o 5FU+RT en función de la localización primaria). Cincuenta y cinco enfermos (73 por ciento) completaron el tratamiento previsto de un año. La mediana de intensidad de dosis fue del 96 por ciento. La toxicidad fue leve y aceptable, principalmente en forma de diarrea y vómitos. Resultados: Con una mediana de seguimiento de 48 meses (extremos, 29-102), 27 pacientes (36 por ciento) han recaído. La supervivencia global a los 5 años fue de 93 por ciento y 67 por ciento para los enfermos con cáncer de colon en estadios II y III, y de 91 por ciento y 47 por ciento para los pacientes con cáncer de recto en estadios II y III, respectivamente. De los factores pronóstico analizados, sólo la estadificación postquirúrgica (pTNM) se relacionó significativamente con la evolución de los pacientes, mientras que la localización no alcanzó significación estadística. Conclusiones: 5FU+lev y 5FU+RT son tratamientos adyuvantes bien tolerados en el cáncer colorrectal resecado. Sin embargo, el seguimiento a largo plazo refleja la necesidad de mejorar sus resultados, especialmente en aquellos pacientes con estadio III y con tumores primarios rectales (AU)
Subject(s)
Adult , Aged , Female , Male , Middle Aged , Humans , Chemotherapy, Adjuvant , Fluorouracil/therapeutic use , Antimetabolites, Antineoplastic/therapeutic use , Levamisole/therapeutic use , Adjuvants, Immunologic/therapeutic use , Colorectal Neoplasms/therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Follow-Up Studies , Disease-Free Survival , Retrospective Studies , Neoplasm StagingABSTRACT
Propósito: Los tumores de células germinales representan la neoplasia más frecuente en varones jóvenes y constituyen un modelo de cáncer curable. Los casos de agrupación familiar son poco comunes pero su análisis puede ayudar a conocer la etiopatogenia de esta enfermedad. Material y métodos: A raíz de su aparición en dos hermanos tratados en nuestro centro, realizamos una revisión de los casos publicados y de los hipotéticos factores de riesgo que se han propuesto al respecto. Resultados: La incidencia de tumores germinales de aparición familiar en nuestro medio es de 2/180 casos (1.1 por ciento), lo que confirma los datos de la bibliografía. El riesgo de padecer una neoplasia testicular se multiplica por seis en sus familiares de primer grado. Conclusiones: Aunque se desconoce su base molecular, el cáncer de testículo parece originarse de la interacción entre una cierta susceptibilidad genética y el efecto de la exposición intrauterina a algunas sustancias (AU)
Subject(s)
Adult , Male , Humans , Germinoma/genetics , Testicular Neoplasms/genetics , Risk Factors , Genetic Predisposition to Disease , Germinoma/diagnosis , Germinoma/drug therapy , Testicular Neoplasms/diagnosis , Testicular Neoplasms/drug therapyABSTRACT
The rhabdomyosarcoma (RMS) is a tumour derived from the mesenchymal cells that give origin to striate muscle. It appears most frequently at the pediatric age, although some appear in adolescence and in young adulthood. It is a high grade malignancy that metastatisis frequently (most importantly to the lung). There are two principal types: alveolar RMS and embrionary RMS. It can appear in any localization, being the most frequent the periorbitary area and the paranasal sinuses, and the second in frequency the genitourinary system (bladder, prostate and vagina). The therapeutic management is multidisciplinary and local therapies must always be accompanied with polychemotherapy. With combined treatments a curation rate of almost 90% can be reached in good prognosis cases, although it drops to 20% in those with disfavourable prognostic factors. The protocols with higher chemotherapy doses and subsequent rescue with blood-borne progenitor cells have not yet proved their efficiency. We present the case of a fifteen-year old patient with an embrionary rhabdomyosarcoma of the prostate, we analyze the clinical evolution and we revise the present therapeutic management of these neoplasies.
Subject(s)
Bone Marrow Neoplasms/secondary , Prostatic Neoplasms/pathology , Rhabdomyosarcoma/secondary , Adolescent , Bone Marrow Neoplasms/therapy , Humans , Male , Prostatic Neoplasms/therapy , Rhabdomyosarcoma/therapyABSTRACT
El rabdomiosarcoma (RMS) es un tumor derivado de las células mesenquimales que dan origen al músculo estriado. Se presenta en edad pediátrica aunque algunos aparecen en adolescentes y adultos jóvenes. Es una neoplasia de alto grado de malignidad que metastatiza de forma frecuente (principal-mente a pulmón). Existen dos tipos fundamentales el RMS alveolar y el RMS embrionario. Pueden aparecer en cualquier localización, el lugar de asiento más frecuente es el área periorbitaria y los senos paranasales, la segunda localización es el aparato genitourinario (vejiga, próstata y vagina).El abordaje terapéutico es multidisciplinar y los tratamientos locales siempre deben acompañarse de poliquimioterapia. Con tratamientos combinados se alcanza un porcentaje de curación cercano al 90 por ciento en los casos de buen pronóstico y sólo de un 20 por ciento en los de pronóstico desfavorable. Las estrategias de incremento de dosis de quimioterapia mediante rescate con células progenitoras no han demostrado todavía su eficacia. Se presenta el caso de un paciente de 15 años con un rabdomiosarcoma embrionario de próstata, analizamos la evolución clínica y revisamos el abordaje terapéutico actual de estas neoplasias (AU)
No disponible
Subject(s)
Adolescent , Male , Humans , Rhabdomyosarcoma , Bone Marrow Neoplasms , Prostatic NeoplasmsABSTRACT
Propósito: La Gemcitabina presenta, como agente único, un índice de respuestas de 20-28 por ciento en el carcinoma no microcítico de pulmón (CPCNP). La asociación Gemcitabina y Cisplatino resulta atractiva para el tratamiento de estas neoplasias. En estudios previos con la combinación se ha objetivado cerca de un 40 por ciento de respuestas. Material y métodos: Ensayo fase II en pacientes afectos de CPCNP, estadios III-B y IV. Esquema de tratamiento: Gemcitabina 1200 mg./m2 (días 1 y 8) y Cisplatino 100 mg/m2 (día 1), cada 21 días. Desde junio 1998 a octubre 1999 se han incluido 26 pacientes, 19 estadios IIIB y 7 estadios IV. Resultados: Se administraron un total de 105 ciclos. La mediana de la intensidad de dosis global fue de 88 por ciento. Efectos secundarios: trombopenia grado 3/4 (37 por ciento de los casos), neutropenia grado 3/4 (31 por ciento) y emesis grado 3 (23 por ciento). Se registraron 14 respuestas parciales (53,8 por ciento, IC 9'5 por ciento: 40 por ciento-80 por ciento). En 18 pacientes (69 por ciento) se administró radioterapia posterior como consolidación. La mediana del tiempo hasta la progresión fue de 5 meses. La supervivencia actuarial a los 18 meses fue de 38 por ciento; mediana de supervivencia de 12 meses. Conclusiones: La combinación es activa en este grupo de pacientes y su toxicidad aceptable (AU)