Ramucirumab in the treatment of non-small cell lung cancer.

INTRODUCTION: Therapeutic options for treating Non-Small Cell Lung Cancer (NSCLC) have recently increased. Ramucirumab (Cyramza), an anti-angionenic agent was approved in 2014 for treatment of several malignancies, including second-line treatment of patients with NSCLC with disease progression on or after platinum-based chemotherapy. Areas covered: We performed a comprehensive search of the literature focused on clinical trials with use of ramucirumab, targeting its evolution in the treatment of NSCLC. This review summarizes the results regarding its safety and efficacy. Expert opinion: Angiogenesis has been widely recognized as a quintessential feature in cancer, intrinsically mediating tumor survival and progression. Ramucirumab, an anti-VEGFR2 agent, combined with docetaxel, was FDA-approved for NSCLC patients. Results from a phase III trial have demonstrated the usefulness of this combination, with benefits in progression free survival and overall survival for NSCLC patients. A greater magnitude of benefit is seen in patients with aggressive tumor behavior. Treatment with ramucirumab is generally tolerable, however, there is potential for severe toxicity. Adverse events reported with this combination include neutropenia, febrile neutropenia and hypertension. Also, there is the intrinsic risk of bleeding resulting from the mechanism of action. As such, adverse events should be identified timely, so drug-related complications can be prevented.

Proposals for the prevention of lung cancer in the health system of Mexico.

The management of lung cancer is challenging. However, nowadays the main goal is to achieve a significant overall survival accompanied by a good quality of life. Because smoking is associated with up to 71% of cancer deaths, the first policy that should be established is one that promotes strategies for healthy lifestyles by providing information about lung cancer, risk factors, protection factors, and precautionary data. Furthermore, an effective screening method that would allow early diagnosis should be established. Following diagnosis, the patient should be genotyped to identify predisposing mutations to give personalized medicine to the patient. The health system policies should include information that affects the health of the population and simultaneously allows for early diagnoses, resulting in a higher survival rate.

Diagnostic efficacy of electron microscopy and pleural effusion cytology for the distinction of pleural mesothelioma and lung adenocarcinoma.

The diagnosis of malignant pleural mesothelioma (MPM) is challenging and requires immunohistochemistry or electron microscopy assays to specifically differentiate MPM from lung adenocarcinoma. An ultrastructural study of fresh tissue is considered to be the "gold standard." In most cases, the first diagnostic approach is performed on pleural effusion, and in some patients, this is the only available sample for diagnosis. The aim of the present study is to evaluate if an examination of pleural effusion samples based on electron microscopy (EMpe) is a useful tool for the differential diagnosis of MPM and lung adenocarcinoma. An EMpe study was performed in 25 pleural effusion samples. Histological and immunohistochemical markers confirmed the diagnosis of either mesothelioma (5) or adenocarcinoma (20). Of the five cases that were diagnosed with mesothelioma, two samples (40%) showed cells with "bushy" microvilli, which are characteristic of mesothelioma, by EMpe, and three were acellular (60%). Of the 20 cases of adenocarcinoma, EMpe showed cells with short microvilli in 9 (45%), and 11 were acellular (55%). EMpe identifies unequivocal morphological changes that are useful for the differential diagnosis of MPM or adenocarcinoma when the pleural effusion sample contains evaluable tumor cells.

Immunological Evasion in Glioblastoma.

Glioblastoma is the most aggressive tumor in Central Nervous System in adults. Among its features, modulation of immune system stands out. Although immune system is capable of detecting and eliminating tumor cells mainly by cytotoxic T and NK cells, tumor microenvironment suppresses an effective response through recruitment of modulator cells such as regulatory T cells, monocyte-derived suppressor cells, M2 macrophages, and microglia as well as secretion of immunomodulators including IL-6, IL-10, CSF-1, TGF-ß, and CCL2. Other mechanisms that induce immunosuppression include enzymes as indolamine 2,3-dioxygenase. For this reason it is important to develop new therapies that avoid this immune evasion to promote an effective response against glioblastoma.

Proposals for the prevention of lung cancer in the health system of Mexico / Propuestas para la prevención de cáncer de pulmón en el sistema de salud en México

Abstract The management of lung cancer is challenging. However, nowadays the main goal is to achieve a significant overall survival accompanied by a good quality of life. Because smoking is associated with up to 71% of cancer deaths, the first policy that should be established is one that promotes strategies for healthy lifestyles by providing information about lung cancer, risk factors, protection factors, and precautionary data. Furthermore, an effective screening method that would allow early diagnosis should be established. Following diagnosis, the patient should be genotyped to identify predisposing mutations to give personalized medicine to the patient. The health system policies should include information that affects the health of the population and simultaneously allows for early diagnoses, resulting in a higher survival rate.

Resumen El manejo del cáncer de pulmón es un reto que tiene como objetivo una supervivencia global significativa que se vea rodeada de una buena calidad de vida. Si se considera que el tabaquismo está asociado hasta con 71% de las muertes por cáncer, la primera política que debe establecerse es la de proporcionar información sobre el cáncer de pulmón, factores de riesgo, factores de protección y datos de alarma mediante una estrategia de salud de línea de vida, además del establecimiento de un método de tamizaje efectivo que permita un diagnóstico temprano. Después del diagnóstico, debe realizarse una genotipificación para identificar mutaciones sensibles y para proporcionar un tratamiento personalizado al paciente. Las políticas del sistema de salud deben incluir información para que la población incida en su salud y también se puedan realizar diagnósticos tempranos que permitan una mayor supervivencia.

Comparisons of Apparent Diffusion Coefficient Values in Penumbra, Infarct, and Normal Brain Regions in Acute Ischemic Stroke: Confirmatory Data Using Bootstrap Confidence Intervals, Analysis of Variance, and Analysis of Means.

BACKGROUND AND OBJECTIVE: There is no consensus about apparent diffusion coefficient (ADC) values in acute stroke regions that could be used by clinicians in a day-to-day clinical practice; regional measures using confidence intervals (CIs) and a graphic representation of means are scarce in the literature. Our aim in this study was to compare ADC values in infarct, penumbra, and normal brain regions in patients with acute ischemic stroke (AIS). METHODS: This is a retrospective study of 100 magnetic resonance imaging data sets from AIS patients. ADC values were measured in the infarct, penumbra, and normal regions. Three hundred measurements underwent 1-way analysis of variance, analysis of means, and calculation of 95% and 84% CIs. RESULTS: There was a statistically significant difference at the P level less than .025 in ADC values for the 3 regions (F[2, 297] = 168.039, P ≤ .001), with no overlap of the CIs for the means among the regions: normal brain (mean [M] = .847, standard deviation [SD] = .103, 95% CI: .825-.866), infarct (M = .533, SD = .157, 95% CI: .501-.563), and penumbra (M = .764, SD = .110, 95% CI: .740-.787). CONCLUSIONS: ADC values might be used as reference data in acute stroke-specific populations; CIs would provide radiologists and clinicians with additional quantitative tools to evaluate penumbra, infarct, and normal brain tissue and to tailor follow-up and treatment options for selected patients.

Current concepts on magnetic resonance imaging (MRI) perfusion-diffusion assessment in acute ischaemic stroke: a review & an update for the clinicians.

Recently, several medical societies published joint statements about imaging recommendations for acute stroke and transient ischaemic attack patients. In following with these published guidelines, we considered it appropriate to present a brief, practical and updated review of the most relevant concepts on the MRI assessment of acute stroke. Basic principles of the clinical interpretation of diffusion, perfusion, and MRI angiography (as part of a global MRI protocol) are discussed with accompanying images for each sequence. Brief comments on incidence and differential diagnosis are also included, together with limitations of the techniques and levels of evidence. The purpose of this article is to present knowledge that can be applied in day-to-day clinical practice in specialized stroke units or emergency rooms to attend patients with acute ischaemic stroke or transient ischaemic attack according to international standards.