ABSTRACT
Androgen deprivation treatment was the only treatment available for metastatic prostate cancer until recently, with docetaxel as the only treatment with a proven survival benefit in castration-resistant prostate cancer (CRPC). Several drugs have been approved in the castration-resistant disease (sipuleucel-T, cabazitaxel, abiraterone, enzalutamide, radium-223). More recently, docetaxel and abiraterone have been moved to the hormone-sensitive disease setting, achieving better patient survival. The purpose of this article is to define the state of the art in the treatment of prostate carcinoma (AU)
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Subject(s)
Humans , Male , Prostatic Neoplasms/drug therapy , Prostatic Neoplasms, Castration-Resistant/drug therapy , Androgen Antagonists/therapeutic use , Antineoplastic Agents/therapeutic use , Practice Guidelines as Topic , Neoplasm Metastasis/therapy , Neoplasm Recurrence, Local/drug therapy , Abiraterone Acetate/therapeutic useABSTRACT
Background. The programmed death (PD-1) inhibitor pembrolizumab has been recently approved for the treatment of advanced melanoma. We evaluated the clinical activity of pembrolizumab in melanoma patients treated under the Spanish Expanded Access Program. Methods. Advanced melanoma patients who failed to previous treatment lines were treated with pembrolizumab 2 mg/kg every three weeks. Patients with brain metastases were not excluded if they were asymptomatic. Data were retrospectively collected from 21 centers in the Spanish Melanoma Group. Results. Sixty-seven advanced melanoma patients were analyzed. Most patients were stage M1c (73.1%), had high LDH levels (55.2%) and had ECOG PS 1 or higher (59.7%). For cutaneous melanoma patients, median overall survival was 14.0 months; the 18-month overall survival rate was 47.1%. Overall response rate was 27%, including three patients with complete responses (6.5%). Median response duration was not reached, with 83.3% of responses ongoing (3.5 m+ to 20.4 m+). From ten patients included with brain metastases, four (40%) had an objective response, two (20%) of them achieved a complete response. Significant prognostic factors for overall survival were LDH level, ECOG PS and objective response. There were no serious adverse events. Conclusion. Although this was a heavily pretreated cohort, pembrolizumab activity at the approved dose and schedule was confirmed in the clinical setting with long-term responders, also including patients with brain metastases (AU)
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Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Melanoma/drug therapy , Neoplasm Metastasis/drug therapy , Health Promotion/standards , Neoplasm Staging/methods , Retrospective Studies , Prognosis , Surveys and Questionnaires , Multivariate Analysis , Melanoma/classification , Skin Neoplasms/drug therapy , Uveal Neoplasms/drug therapyABSTRACT
Introducción: Existen pocos estudios sobre recidiva cutánea en el melanoma. Nuestro objetivo fue analizar retrospectivamente las características y el significado pronóstico de los distintos patrones de recidiva cutánea del melanoma. Material y métodos: Los pacientes con melanoma diagnosticados entre 1988-2008 en el Hospital de Bellvitge de Barcelona, con más de dos años de seguimiento, fueron incluidos en el estudio. Se consideró recidiva local a la infiltración cutánea por melanoma en continuidad con la cicatriz de exéresis del tumor primario, metástasis o recidiva regional cuando las lesiones se mantenían en el territorio de drenaje linfático regional y metástasis cutánea a distancia cuando se localizaron fuera de este territorio. Se analizó la relación del patrón de recidiva cutánea con edad, sexo, localización del tumor primario, tipo clinicopatológico, profundidad máxima de invasión y ulceración. Resultados: Ochenta y cinco de 1.080 pacientes desarrollaron recidiva cutánea (7,87%). En 71 de 85 pacientes (83,53%) la recidiva cutánea fue la primera evidencia de recidiva (27 varones y 44 mujeres; edad media: 60,68 años). Treinta y dos pacientes presentaron recidiva local, 32 regional y 7 a distancia. Las curvas de supervivencia mostraron diferencias significativas en tiempo de supervivencia específica desde el diagnóstico del melanoma primario (p=0,044) y desde el diagnóstico de la recidiva cutánea (p<0,001). Conclusiones: Nuestros resultados sugieren que el patrón de recidiva cutánea tiene significado pronóstico y que está relacionado con la localización del tumor primario, puesto que la mayoría de recidivas locales y regionales se producen en las extremidades inferiores y en la cabeza (AU)
Background and objectives: Few studies have addressed cutaneous recurrence of melanoma. The aim of this retrospective study was to analyze the characteristics and prognostic significance of the different patterns of cutaneous recurrence. Material and methods: Patients diagnosed with melanoma between 1988 and 2008 at Hospital de Bellvitge, Barcelona, Spain and for whom data were available for at least 2 years of follow-up were included in the study. Local recurrence was defined as melanoma invasion of the skin adjacent to the scar left by excision of the primary tumor, regional metastasis or recurrence as metastasis restricted to the area drained by a regional lymph node station, and distant cutaneous metastasis as metastasis occurring outside this area. The relationship between cutaneous recurrence pattern and age, sex, primary tumor site, tumor subtype, Breslow depth, and ulceration was assessed. Results: Eighty-five out of 1,080 patients (7.87%) had cutaneous recurrence. In 71 of those patients (83.53%; 27 men and 44 women; mean age, 60.68 years), this was the first indication of melanoma recurrence. Thirty-two patients had local recurrence, 32 regional metastasis, and 7 distant metastasis. Significant differences were observed in survival time from diagnosis of the primary tumor (P=0.044) and from diagnosis of cutaneous recurrence (P<0.001) according to the type of recurrence. Conclusions: Our results suggest that the pattern of cutaneous recurrence is prognostically significant and related to the site of the primary tumor given that the majority of local and regional recurrences occurred in primary tumors located on the lower limbs and head (AU)
Subject(s)
Humans , Melanoma/pathology , Skin Neoplasms/pathology , Neoplasm Recurrence, Local/epidemiology , Lymphatic Metastasis/pathology , Neoplasm Metastasis/pathologyABSTRACT
Cisplatin has been one of the principal chemotherapy agents for the last 30 years and is still used widely in the treatment of testicular, ovarian, lung, head and neck, bladder and several other tumours. Resistance to chemotherapeutic agents is a major obstacle for successful treatment. Treatment effect on germ cell tumours (GCTs) is more successful than in adults suffering from almost any other solid tumour, but resistance still appears in 20% of patients with metastatic disease. However, because of the young age of patients and few data regarding the process of becoming resistant, this situation is still a challenge. In this review we are going to analyse the published literature on cisplatin resistance in GCTs and explain the initiatives that the Spanish Germ Cell Cancer Group (GG) is taking to try to elucidate the molecular mechanisms behind this process (AU)
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