ABSTRACT
El carcinoma de próstata resistente a castración (CPRC) se define como la progresión tumoral a pesar de unos niveles eficaces de castración. (testosterona sérica < 50 ng/dL). La progresión bioquímica requiere al menos dos incrementos sucesivos en la cifra de antígeno prostático específico (PSA), separados al menos una semana, y con un valor mínimo de 2 ng/mL. In pacientes con bloqueo androgénico completo, se debe suspender al antiandrógeno antes del diagnóstico de CPRC. El CPRC es una entidad heterogénea. El valor basal de PSA y la velocidad de PSA parecen ser los factores pronósticos más importantes en pacientes con recidiva bioquímica como única manifestación del CPRC. Algunos de estos pacientes pueden ser seguidos sin tratamiento hasta la progresión de la enfermedad. Debido a que un gran porcentaje de tumores que progresan a pesar de la castración siguen siendo hormonodependientes, el empleo de otras terapias hormonales ha sido el tratamiento preferido para la mayoría de estos pacientes. Junto con los inhibidores de la esteroidogénesis suprarrenal, se están investigando actualmente otros enfoques más novedosos para inhibir el efecto del receptor androgénico activado sobre la célula tumoral. Recientemente, ha habido un importante desarrollo de la inmunoterapia, que ha demostrado incrementar la supervivencia en pacientes con CPRC oligosintomáticos. La quimioterapia de primera y segunda línea en CPRC se asocia con incremento de supervivencia, pero generalmente se recomienda para pacientes con metástasis. Hasta que estén disponibles los resultados de ensayos clínicos actualmente en marcha, el tipo y secuencia de tratamientos para los pacientes con CPRC y recaída bioquímica debe realizarse de forma individualizada(AU)
Castration resistant prostatic carcinoma (CRPC) is defined as tumor progression despite an effective castration (serum testosterone levels < 50 ng/dL). Biochemical progression requires at least two successive increases from the previous lowest value of serum prostate-specific antigen (PSA) spaced at least a week, and with a minimum value of 2 ng/mL. In patients receiving complete androgen blockade, antiandrogen should be discontinued prior to diagnosis of CRPC. CPRC is a heterogeneous entity. Baseline PSA and PSA velocity seem to be the most important prognostic factors in patients with biochemical relapse as the only manifestation of CRPC. Some of these patients can be followed without treatment until disease progression. Because of a large proportion of tumors progressing under androgen deprivation therapy remain hormone-dependent, the use of other hormonal therapies has been the preferred treatment for the majority of these patients. Besides inhibitors of adrenal steroidogenesis, other novel hormonal approaches are currently under investigation to avoid the effect of the activated androgenic receptor on the tumor cell. In recent years there has been an important development of immunotherapy, which has demonstrated to increase survival in CRPC oligosymptomatic patients. First and second line chemotherapy in CRPC are associated with an increase in overall survival, but they are usually recommended for patients with metastases. Until the results of ongoing trials are available, the type and timing of the treatment for patients with CRPC and biochemical recurrence should be individualized(AU)
Subject(s)
Humans , Male , Carcinoma/complications , Carcinoma/diagnosis , Carcinoma/surgery , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/therapy , Prostate-Specific Antigen/administration & dosage , Neoplasm Metastasis/diagnosis , Neoplasm Metastasis/drug therapy , Orchiectomy/methods , Prostate-Specific Antigen/analysis , Oligosymptomatic Diseases/methods , Oligosymptomatic Diseases/trendsABSTRACT
Diffuse large B-cell non-Hodgkin's lymphoma (LDCGB) is one of the best examples of chemotherapy curable malignant diseases. This "Oncoguía SEOM" summarizes the basic directions of staging and recommended treatment options. The staging study should be thorough and includes clinical, laboratory, diagnostic imaging and nuclear medicine. Treatment depends on patient characteristics and comorbidity and on disease extension and prognostic factors. In localized cases, chemoimmunotherapy (CHOP-R) of short duration, followed by involved-field irradiation is the preferred option. In advanced stages, the association of CHOP-like chemotherapy and Rituximab has been a major breakthrough in terms of cure rate. It is important do not forget the supportive treatment in these patients.
Subject(s)
Lymphoma, Large B-Cell, Diffuse/therapy , Medical Oncology/methods , Practice Guidelines as Topic , Algorithms , Humans , Medical Oncology/trends , Societies, Medical , SpainABSTRACT
An 80-year-old man was admitted to hospital with low-grade fever, weight loss, asthenia and anorexia. Physical examination revealed generalised ichthyosis with palmoplantar hyperkeratosis. CT scan showed retroperitoneal and inguinal lymph node enlargement. An inguinal lymph node biopsy revealed Hodgkin's disease (nodular-sclerosing subtype). The patient received chemotherapy, showing a clear improvement of both skin lesions and lymph nodes.
Subject(s)
Hodgkin Disease/diagnosis , Ichthyosis/diagnosis , Paraneoplastic Syndromes/diagnosis , Aged, 80 and over , Hodgkin Disease/drug therapy , Hodgkin Disease/pathology , Humans , Ichthyosis/pathology , Lymph Nodes/pathology , Male , Paraneoplastic Syndromes/pathologyABSTRACT
Primary ovarian Burkitt lymphoma (BL) is a rare neoplasm in adults. We report a 30-year-old woman diagnosed with primary bilateral ovarian BL. She presented features of a twisted ovarian cyst and underwent bilateral salpingo-oophorectomy. The histopathologic evaluation yielded the diagnosis of BL and subsequently she received chemoimmunotherapy with CODOX-M-IVAC plus rituximab (anti-CD20 monoclonal antibody).
Subject(s)
Burkitt Lymphoma/diagnosis , Ovarian Neoplasms/diagnosis , Adult , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Murine-Derived , Antineoplastic Agents/therapeutic use , Burkitt Lymphoma/drug therapy , Female , Humans , Ovarian Neoplasms/drug therapy , RituximabABSTRACT
BACKGROUND AND OBJECTIVE: Multiple myeloma (MM) is a plasm-cell neoplasm characterized by a monoclonal protein in the serum or urine. Thalidomide is effective as second line treatment. PATIENTS AND METHOD: We performed a retrospective study of 36 consecutive patients with refractory MM treated with thalidomide and dexamethasone as second line therapy, with the objective of analyzing the rate of response (primary end point), progression-free survival (PFS) and toxicity profiles (second end points). RESULTS: In our study the overall response rate was 55.6%, with a median of PFS of 12.6 months (95% confidence interval: 4-21 months). PFS at 6, 12 and 18 months was 61.11%, 50% and 22.22% respectively. 30.6% of the patients had neuropathy, 11.11% had rash and 5.55% had deep vein thrombosis. CONCLUSIONS: The combination of thalidomide and dexamethasone is an effective and safe second line treatment for refractory MM, with a manageable toxicity.
Subject(s)
Dexamethasone/therapeutic use , Multiple Myeloma/drug therapy , Thalidomide/therapeutic use , Adult , Aged , Aged, 80 and over , Drug Therapy, Combination , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Fundamento y objetivo: El mieloma múltiple (MM) es una neoplasia de células plasmáticas que se caracteriza por la presencia de una proteína monoclonal en suero u orina. La talidomida es un fármaco eficaz en el tratamiento de segunda línea de esta enfermedad. Pacientes y método: Hemos realizado un estudio retrospectivo de una serie de 36 casos consecutivos con MM pertinaz a los que hemos tratado con talidomida y dexametasona en segunda línea, con el objetivo de analizar la tasa de respuesta (objetivo primario), la supervivencia libre de progresión (SLP) y toxicidad (objetivos secundarios). Resultados: En nuestro estudio hemos encontrado una tasa de respuesta total del 55,6%, una mediana de SLP de 12,6 meses (intervalo de confianza del 95%, 4-21 meses). La SLP a los 6, 12 y 18 meses fue del 61,11, el 50 y el 22,22% respectivamente. El 30,6% de los pacientes presentaron neuropatía; el 11,11%, erupción cutánea y el 5,55%, enfermedad tromboembólica. Conclusiones: La combinación de talidomida y dexametasona es un tratamiento efectivo y seguro en segunda línea para pacientes con MM resistente al tratamiento, con una toxicidad manejable
Background and objective: Multiple myeloma (MM) is a plasm-cell neoplasm characterized by a monoclonal protein in the serum or urine. Thalidomide is effective as second line treatment. Patients and method: We performed a retrospective study of 36 consecutive patients with refractory MM treated with thalidomide and dexamethasone as second line therapy, with the objective of analyzing the rate of response (primary end point), progression-free survival (PFS) and toxicity profiles (second end points). Results: In our study the overall response rate was 55.6%, with a median of PFS of 12.6 months (95% confidence interval: 4-21 months). PFS at 6, 12 and 18 months was 61.11%, 50% and 22.22% respectively. 30.6% of the patients had neuropathy, 11.11% had rash and 5.55% had deep vein thrombosis. Conclusions: The combination of thalidomide and dexamethasone is an effective and safe second line treatment for refractory MM, with a manageable toxicity
