An Autoimmune Haemolytic Anaemia Secondary to Ipilimumab Treatment.

BACKGROUND: Melanoma is one of the fastest growing neoplasms worldwide. Treatment of metastatic disease has swiftly shifted in the last decade from generally ineffective chemotherapy regimens to highly effective targeted treatments or immunotherapy, with a range of side effects that differ completely from those of previous treatments for this disease. CASE: We present a case of a 71-year-old man with diagnosis metastatic melanoma. This patient was treated with anti-CTLA-4 antibody ipilimumab. Despite minor skin toxicity, the regimen was well tolerated until he developed hemolytic anemia, an autoimmune side effect of ipilimumab. The treatment was withdrawn and steroids were administered until the issue was resolved. CONCLUSION: Immunotherapy has become the standard of care for many tumors, and its side effects are completely different from those of chemotherapy, meaning that oncologists must be aware of this to avoid a potentially life-threatening situation and arrive at an early diagnosis and implement prompt treatment.Key words: anemia - autoimmune event - anti-CTLA-4.

Sentinel Lymph Node in Melanoma -  a Study Conducted in the South of Brazil.

BACKGROUND: The presence or absence of lymph node metastases is a very important prognostic factor for survival and recurrence in patients with cutaneous melanoma. Controversies remain among specialists about whether it is advisable or not to perform a sentinel lymph node biopsy in patients with melanoma, although it is currently supported by most standard guidelines. We performed this study to identify which patients are more prone to having a positive lymph node test result in a population with high melanoma rates in the south of Brazil. MATERIALS AND METHODS: We performed the study with 62 consecutive patients who underwent sentinel lymph node biopsies from 2003 to the early months of 2015 in the city of Blumenau - Santa Catarina, Brazil. RESULTS: Breslow thickness, ulceration, nodular subtype, and Clark level IV were associated with positive sentinel lymph node group status (p 0.05). DISCUSSION: Although there is still a controversy over whether or not this procedure should be performed, most guidelines still support its application. To lower the economical and physical impact, however, it is worthwhile to determine which patients are more prone to acquiring positive lymph node at presentation and, perhaps, in the future, indicate surgery for this particular group, who could benefit most from further treatment options. KEY WORDS: melanoma - sentinel lymph node biopsy - prognosis.

Forbidden to Drive -  a New Chemotherapy Side Effect.

BACKGROUND: Capecitabine is an oral antineoplastic agent classified as a pyrimidin analogue. It is widely used in different types of cancers. Unfortunately, it does not come without a cost, as the drug may have adverse effects - largely diarrhea, but also hand -foot syndrome and loss of fingerprints in extreme cases. CASE: We report a case of a 47-year-old male, which had been diagnosed with metastatic rectal cancer and received capecitabine, developing a severe hand foot syndrome which led him to lose his fingerprints in spite of complete resolution of the syndrome after stoppage of the drug. CONCLUSION: This case highlights a rare condition that, even though not precisely a disease per se, may hinder patients quality of life and must be recognised by the treating physician as an treatment related side effect.

A rare neoplastic growth on the ear lobe.

We report a case of an 83-year-old previously healthy female patient presenting with a swiftly evolving erythematous violaceous, infiltrative, ulcerated onion like mass with hyperkeratotic surface on the left ear lobe. The lesion was excised and resulted as an atypical fibroxanthoma, an extremely rare neoplastic growth, being a superficial variant of pleomorphic malignant fibrous histiocytoma. A brief review of dia-gnosis, treatment and prognosis is discussed.

Analysis of disease-free survival and overall survival in patients with luminal a breast cancer stratified according to TNM.

BACKGROUND AND AIM: The TNM classification of malignant tumours is the most commonly used system to assess the stage as well as the prognosis of cancer. However, one of the biggest challenges in treatment of breast cancer is the understanding of tumour heterogeneity typical of these carcinomas. The aim of this study was to analyse the disease-free survival and overall survival in patients with luminal A subtype of breast cancer, stratified by TNM staging system. METHODS AND STUDY DESIGN: A total of 363 medical records from January 2001 to May 2006 were evaluated for data collection. There were 136 patients with luminal A breast cancer, selected for the cohort. The main objective was the analysis of disease-free survival (DFS) and overall survival (OS) in patients with luminal A breast cancer, stratified according to the TNM classification. RESULTS: The group of 136 patients with immunohistochemically defined luminal A subtype represented 53% of the 253 patients with breast cancer. There was no significant difference in the number and type of patients as for TNM stage and histological grading among patients treated with chemotherapy and HT in comparison to patients treated with HT alone. CONCLUSION: Our analysis did not prove any significant difference in survival of patients treated with chemotherapy followed by hormone therapy in comparison to patients treated with HT alone. We suggest that the IHC luminal A subtype of breast cancer generally warrants a good prognosis independently on other prognostic factors such as TNM stage. We conclude that patients might not benefit of adding a chemotherapy to hormonal therapy in adjuvant settings.

Bevacizumab as secondline treatment of glioblastoma -  worth the effort?

OBJECTIVE: To evaluate the role of bevacizumab and irinotecan as secondline treatment of glioblastoma in patients with progression after radiotherapy and temozolomide. METHODS: A retrospective analysis of 16 subjects was performed with overall survival and toxicity evaluation as the primary endpoint. RESULTS: The analysis revealed serious toxicity of this highly expensive regimen without proving an improvement in overall survival of patients in comparison to a control group. CONCLUSION: Unless there are robust data from phase III clinical trials, including quality of life assessments or evaluation of predictive bio-markers to guide therapy, bevacizumab and irinotecan regimen should be spared for cautiously selected patients, especially in countries with limited budget for oncological treatment.

Wage -specific assessment of mammography screening in Brazilian women.

OBJECTIVE: Mammography is an inexpensive examination that has become a standard screening method thanks to its cost-effectiveness. Due to an enormous cost escalation of cancer treatment over the last years, the assessment of this method, especially in the settings of an emerging country, is a matter of serious concern. METHODS: A search within the national health database was conducted registering the data with nation- wide coverage. Data collection and analysis was commenced in 2010 with referrence to the year 2008 as the most recently updated period. The obtained information on mammography screening among Brazilian women was evaluated by subdividing the data in four groups according to socioeconomic status of the subjects. The study population was estimated to comprise about 2 million individuals. RESULTS: More than 45% of Brazilian women older than 40 years of age have never undergone a mammography. The figures correlated with the income level, reaching an astonishing number of 62.2% in a group of patients with the lowest income level. CONCLUSION: Mammography has proved effective in early detection of breast cancer in women. This study suggests that the lack of compliance in breast cancer screening in Brazil, pronounced especially in low- income families, may contribute to the increasing mortality rates associated with the disease.