Patient profiles as an aim to optimize selection in the second line setting: the role of aflibercept

Colorectal cancer is the second leading cause of cancer-related death worldwide. For metastatic colorectal cancer (mCRC) patients, it is recommended, as first-line treatment, chemotherapy (CT) based on doublet cytotoxic combinations of fluorouracil, leucovorin, and irinotecan (FOLFIRI) and fluorouracil, leucovorin, and oxaliplatin (FOLFOX). In addition to CT, biological (targeted agents) are indicated in the first-line treatment, unless contraindicated. In this context, most of mCRC patients are likely to progress and to change from first line to second line treatment when they develop resistance to first-line treatment options. It is in this second line setting where Aflibercept offers an alternative and effective therapeutic option, thought its specific mechanism of action for different patient’s profile: RAS mutant, RAS wild-type (wt), BRAF mutant, potentially resectable and elderly patients. In this paper, a panel of experienced oncologists specialized in the management of mCRC experts have reviewed and selected scientific evidence focused on Aflibercept as an alternative treatment (AU)

Patient profiles as an aim to optimize selection in the second line setting: the role of aflibercept.

Colorectal cancer is the second leading cause of cancer-related death worldwide. For metastatic colorectal cancer (mCRC) patients, it is recommended, as first-line treatment, chemotherapy (CT) based on doublet cytotoxic combinations of fluorouracil, leucovorin, and irinotecan (FOLFIRI) and fluorouracil, leucovorin, and oxaliplatin (FOLFOX). In addition to CT, biological (targeted agents) are indicated in the first-line treatment, unless contraindicated. In this context, most of mCRC patients are likely to progress and to change from first line to second line treatment when they develop resistance to first-line treatment options. It is in this second line setting where Aflibercept offers an alternative and effective therapeutic option, thought its specific mechanism of action for different patient's profile: RAS mutant, RAS wild-type (wt), BRAF mutant, potentially resectable and elderly patients. In this paper, a panel of experienced oncologists specialized in the management of mCRC experts have reviewed and selected scientific evidence focused on Aflibercept as an alternative treatment.

SEOM clinical guideline in nasopharynx cancer (2017)

Nasopharyngeal carcinoma (NPC) is distinct from other cancers of the head and neck in biology, epidemiology, histology, natural history, and response to treatment. Radiation therapy is an essential component of curative-intent of non-disseminated disease and the association of chemotherapy improves the rates of survival. In the case of metastatic disease stages, treatment requires platinum/gemcitabine-based chemotherapy and patients may achieve a long survival time (AU)

No disponible

SEOM clinical guideline in nasopharynx cancer (2017).

Nasopharyngeal carcinoma (NPC) is distinct from other cancers of the head and neck in biology, epidemiology, histology, natural history, and response to treatment. Radiation therapy is an essential component of curative-intent of non-disseminated disease and the association of chemotherapy improves the rates of survival. In the case of metastatic disease stages, treatment requires platinum/gemcitabine-based chemotherapy and patients may achieve a long survival time.

Asociación entre Presencia de Levaduras del Género Candida y Factores del Paciente Adulto Mayor con y sin Estomatitis Protésica / Association between Presence of Candida Yeasts and Elderly Patient Factors with and without Denture Stomatitis

La estomatitis protésica (ESP) es una alteración de la mucosa de soporte de diverso grado de severidad, que puede complicarse clínicamente con la presencia de levaduras del género Candida (LGC). Factores del individuo, del ambiente oral y del microorganismo favorecen la infección, que de no tratarse oportunamente puede evolucionar hacia lesiones hiperplásicas. Los objetivos fueron establecer relación clínico ­ microbiológica entre especies de LGC y ESP, asociar condiciones sistémicas (CS) prevalentes de pacientes portadores de prótesis con presencia y cantidad de LGC y efecto en la severidad de ESP; y asociar factores locales: uso continuo de prótesis y antigüedad protésica, con prevalencia de LGC y severidad de ESP. Un estudio observacional analítico fue realizado en 93 pacientes, edad promedio 67 años, 26% hombres y 74% mujeres, atendidos en el área de Prótesis Removible (Facultad de Odontología, Universidad de Chile), seleccionados de acuerdo a criterios de inclusión y firma del consentimiento informado. La recolección muestral de saliva no estimulada y mucosa oral se realizó considerando las variables del estudio. Estas muestras fueron procesadas de acuerdo a protocolos preestablecidos. El análisis microscópico permitió verificar desarrollo de colonias macromorfológicamente compatibles con LGC. Para el análisis estadístico se utilizaron test ANOVA y Kruskall Wallis. Existe relación clínica microbiológica entre presencia de LGC y ESP. El aumento de LGC se relaciona con severidad de ESP. La especie dominante es Candida albicans sobre no albicans. La presencia de ambas se asocia con aumento de la severidad de ESP. Al asociar las CS se observa asociación con depresión, no así con hipertensión arterial y diabetes mellitus. En relación a los factores locales protésico continuo y antigüedad protésica, existe relación entre antigüedad y presencia de LGC en pacientes con ESP, sin diferencias estadísticas entre presencia de LGC y uso protésico continuo en pacientes con ESP.

Denture stomatitis (DS) is a change of the support mucous of diverse severity that can get clinically complex with the presence of yeasts of the Candida genus (YCG). Individual's factors of the oral and microorganism environment favor the infection, which can evolve to hyperplasic lesions if not treated early. The aims were to establish clinical-microbiological relationship between YCG and DS species, associate systematic conditions (SC) prevalent of patients using prosthesis with presence and quantity of YCG and effect on DS severity; and associate local factors: continuous use of prosthesis and age of the prosthesis (AP), with YCG prevalence and DS severity. An analytical observational study was performed in 93 patients, average age 67 years old, 26% male and 74% female, treated at the Removable Prosthesis Area (Facultad de Odontología, Universidad de Chile), selected according to inclusion criteria and signature of informed consent. The unstimulated saliva and oral mucous sample recollection was performed considering the study's variables. The microscopic analysis allowed to check macro morphologically YCG compatible colonies development. For the statistical analysis, ANOVA and Kruskall Wallis tests were used. There is a microbiological clinical relationship between the presence of YCG and DS. The increase of YCG is related to the severity of DS. The dominant species is Candida albicans over not albicans. The presence of both is associated with the increase of DS severity. By associating the SC, a relation with depression is observed, but not with arterial hypertension and mellitus diabetes. As for the continuous local prosthetic factors and AP, a relationship exists between AP and presence of YCG in patients with DS, without statistical differences between YCG and continuous prosthetic use in patients with DS.

Biochemotherapy in the treatment of metastatic melanoma in selected patients

INTRODUCTION: Bioimmunochemotherapy (BCT) is a combination of biological agents and cytostatics that has shown an increase in response rate (RR) in metastatic melanoma patients. The aim of the study is to evaluate RR, progression- free survival (PFS), overall survival (OS) and treatment toxicity. MATERIALS AND METHODS: Retrospective analysis of 11 metastatic melanoma patients treated from January 2002 to June 2008 with cisplatin 20 mg/m(2) i.v. days 1.4, dacarbazine 800 mg/m(2) i.v. day 1, vinblastine 1.5 mg/m(2) i.v. days 1.4, interleukin (IL)-2 9 MIU/m(2) s.c. 5.8 days and interferon (IFN)-alpha-2b 5 MIU/m2 s.c. days 5.9, 11, 13 and 15, with the support of granulocyte colony-stimulating factor (G-CSF) and antibiotics. Patients with ECOG 0, age < or = 65 years and with measurable disease were included. The planned number of courses was 4. RR was measured by Revised Evaluation Criteria in Solid Tumour (RECIST) criteria (computed tomography [CT]+/-proton emission tomography [PET]). Toxicity was measured according to the National Cancer Institute (NCI) common toxicity criteria. RESULTS: Observed RRs were 18% complete response (CR), 27% partial response (PR), 9% stable disease (SD) and 46% disease progression. The median PFS was 4 months (95% CI, 0.10 m), with a 23% one-year PFS. Median OS was 4.6 months (95% CI, 0.9.19 m), with a 29% one-year OS. Eighty-three percent of patients experienced grade 3-4 toxicity, mainly due to neutropenia, thrombocytopenia and flu-like syndrome. CONCLUSIONS: Treatment with BCT shows an increase in RR, some achieving durable CR; nevertheless it cannot be considered a standard treatment and should be employed only in selected patients (AU)

[External quality control of the parasitological diagnosis of Cryptosporidium parvum]. / Control de calidad externo en el diagnóstico parasitológico de Cryptosporidium parvum.

Between 1991 and 1994, eight external quality assessments of Cryptosporidium parvum infection diagnosis were performed. Stool specimens were sent to 74 laboratories, to be stained and examined. In 40 laboratories (54.1%), the diagnosis was correct in all evaluations, whereas in 34 (46%), the diagnosis disagreed with the parasitology reference laboratory in one occasion or more. The mean correlation of diagnoses with the reference laboratory was 88% (range 79-96%). Ninety-three percent of negative samples and 87% of positive samples were correctly diagnosed. These figures are similar to those obtained abroad. These results lead to the development of a quality control network for the diagnosis of Cryptosporidium parvum infections along the country, aiming to improve its reliability.

[Cryptosporidium parvum in patients with chronic diarrhea and AIDS: diagnosis by means of indirect immunofluorescence with monoclonal antibodies]. / Cryptosporidium parvum en pacientes con diarrea crónica y SIDA: diagnóstico mediante immunofluorescencia indirecta con anticuerpos monoclonales.

The diagnosis of cryptosporidiosis is difficult when oocyst elimination is poor as occurs in AIDS patients. Aiming to improve the diagnosis, 144 fecal samples coming from AIDS patients with diarrhea, were studied using indirect immunofluorescence with anti-Cryptosporidium monoclonal antibodies. The results were compared with Ziehl Neelsen and safranine stainings. Twenty three samples (15.9%) were positive for Cryptosporidium with at least one of the three methods. Sensitivities were 78.3% for immunofluorescence, 86.9% for Ziehl Neelsen and 91.3 for safranine stainings. The specificity of the three methods was 100%. It is concluded that immunofluorescence does not improve the diagnostic accuracy of cryptosporidiosis and its high cost precludes its use in routine laboratories.

[Indirect immunofluorescence with monoclonal antibodies in the diagnosis of Pneumocystis carinii. Preliminary report]. / Inmunofluorescencia indirecta con anticuerpos monoclonales en el diagnóstico de Pneumocystis carinii. Informe preliminar.

We compared traditional methods based on argentic metamine and toluidine blue staining vs recently introduce techniques based on immunofluorescence for monoclonal antibodies in the diagnosis of P. carinii. Fifty samples were analyzed: 29 (58%) were negative by all method. Of the remaining 21.72% were positive for immunofluorescence, 67% for argentic and 48% for toluidine blue staining. Thus, immunofluorescence techniques represent an improvement in the ability to diagnose infection by P carinii.

[Chagas' disease: an evaluation of serodiagnosis at blood banks in the endemic areas of Chile]. / Enfermedad de Chagas: evaluación del serodiagnóstico en bancos de sangre de zonas endémicas en Chile.

Blood transfusion is one mechanism leading to transmission of Chagas disease. An evaluation of the serologic method used to survey donors in 55 blood banks located in endemic areas was attempted. From 47 responders, 29 (62%) showed complete correlation with the standard used, 16 (34%) showed only 50% correlation and 2 were not possible to evaluate. Most errors were due to an incorrect evaluation of the negative standard serum, whereas the positive one was correctly diagnosed as such in 96% of cases.

[Commercial reagents in the diagnosis of Chagas' disease]. / Reactivos comerciales en el diagnóstico de la enfermedad de Chagas.

The great diversity of commercially available products for the serologic diagnosis of Chagas disease led us to conduct a study of these products in comparison with the indirect immunofluorescence test. Percent agreement between methods ranged from 79 to 100%, the details for each product being given in the text. Better control of commercially available diagnostic products is recommended.

Hydatidosis diagnosis by double diffusion in agar with arc 5 detection.

To further assess the double diffusion arc 5 (DD5) test for human hydatidosis, the test was performed on sera from 45 patients with surgically confirmed hydatidosis and 54 with other pathologies in Santiago, Chile. Combined with tests reported previously, this brought the total number of study subjects with confirmed hydatidosis to 98 and the total with other pathologies to 128. Overall, the test yielded positive results with sera from 55 (56%) of the 98 serologically confirmed cases, the degree of seropositivity among patients with pulmonary hydatidosis (36%) being relatively low. The criteria adopted for a positive result were the presence of arc 5 or, in the absence of arc 5, the presence of three or more bands of precipitate. On the basis of these criteria, no false positive results were detected using sera from the 128 patients with other pathologies. It is concluded that using the DD5 test to diagnose hydatidosis in clinically selected individuals can provide results of high specificity; i.e., positive results can be taken as confirming presence of the infection. On the other hand, a negative DD5 result does not constitute definite proof that no hydatid cysts are present.

Toxoplasmosis en ninos tratados con drogas de efecto inmunodepresor. / Toxoplasmosis in children treated with immunosupressive drugs

La toxoplasmosis puede constituir una infeccion grave e incluso mortal en inmunodeprimidos. Este trabajo analiza la frecuencia de esta infeccion, mediante estudio serologico, en 129 ninos sometidos a tratamiento prolongado con drogas inmunodepresoras, demostrando que es similar a la poblacion infantil normal. Se demuestra que existe un riesgo bajo de 2,3% de reactivacion de la infeccion por T. gondii con el tratamiento inmunodepresor aunque no despreciable dado las consecuencias de esta infeccion. Se aconseja control serologico seriado de estos ninos y eventual tratamiento especifico, si se demuestra infeccion aguda