Novos Fármacos no tratamento das dislipidemias / New Drugs in the Treatment of Dyslipidemias

O papel da dislipidemia na deflagração da aterosclerose coronária está bem estabelecido. A aterosclerose é um processo dinâmico, evolutivo, a partir de dano endotelial. A doença aterosclerótica é a principal causa de morte no Brasil. Em especial, níveis elevados de colesterol total e colesterol ligado à lipoproteína de baixa densidade, reduzidos níveis de colesterol de alta densidade e aumento de níveis de triglicerídios podem induzir à doença coronária...

Pulmonary metastasectomy: a multivariate analysis of 440 patients undergoing complete resection.

Surgical resection is currently a standard approach for isolated lung metastases from different primary tumours. The aim of the present analysis is to evaluate the outcome of patients submitted to complete resection of pulmonary metastases and to determine prognostic factors for long-term survival. A group of 440 consecutive patients previously diagnosed with primary malignant solid tumours and submitted to complete surgical resection of lung nodules with suspected or diagnosed metastatic lesion were retrospectively reviewed. The average follow-up time was 43.2 months (range: 0-192) and the 60-month O.S. was 43.7%. Univariate analysis: patients with adenocarcinoma presented the highest 5-year survival rates (53.4%, P = 0.0001); DFI >36 months (P < 0.0001), number of nodules on CT scan (P = 0.0052), number of malignant nodules resected (P = 0.0252) and the size of the largest resected nodule (P < 0.0001) were also significant. Multivariate analysis: number of malignant nodules resected (P = 0.01), size of the largest nodule resected (P = 0.001), DFI >36 months (P < 0.001) and histology of the primary tumour (P = 0.017) had significant impact on survival. The benefit of such an aggressive surgical approach is only limited to selected subgroups of patients. The decision to consider a patient for resection of metastastic disease should include factors beyond the feasibility of complete removal.

Chemotherapy beyond first-line in stage IV metastatic non-small cell lung cancer / Quimioterapia em câncer de pulmão não pequenas células metastático estádio IV: além da primeira linha

OBJECTIVE: Platinum-based doublet chemotherapy is considered the standard of care for advanced non-small cell lung cancer (NSCLC). However, prognosis after recurrent or progressive disease following first-line chemotherapy is usually poor. Maintenance chemotherapy, second line treatment and even third line chemotherapy are available for patients with advanced NSCLC. Unfortunately, few patients are candidates for chemotherapy beyond first line. The present study evaluated characteristics of patients with NSCLC and outcomes of the treatment of their metastatic disease, with emphasis on second and third-line chemotherapy. METHODS: This was a retrospective observational study of 2,673 patients with metastatic, stage IV, non-small cell lung cancer admitted for treatment in two São Paulo institutions. First-line chemotherapy was defined as the first chemotherapeutic approach administered to the patient. Second and third-line chemotherapy were defined as the systemic treatment administered after discontinuing first-line chemotherapy, either for intolerance or for progressive or recurrent disease. RESULTS: Most patients (57.9 percent) received first-line chemotherapy, and approximately 23.4 percent received second-line and 8 percent third-line regimens. Only 2.5 percent received fourth-line chemotherapy. Median overall survival (OS) was 8 months (95 percent CI: 8-9 months). At univariate analyses, gender (p < 0.05), histology, first-line chemotherapy, objective response to first-line chemotherapy and second-line chemotherapy (p < 0.01) were prognostic factors related to overall survival. At multivariate analysis, only performance status (p = 0.04), receiving any second-line chemotherapy (p < 0.01) and response to first-line chemotherapy (p < 0.01) were independent predictors of overall survival. CONCLUSION: Second-line chemotherapy is a therapeutic strategy that should be considered for a selected group of patients. Performance status and response to first-line chemotherapy could be determinant characteristics to select patients who might be treated beyond first-line chemotherapy.

OBJETIVO: A quimioterapia dupla com base em platina consiste no tratamento padrão para o câncer de pulmão não pequenas células (CPNPC) avançado. Contudo, o prognóstico dos pacientes com doença recorrente ou em progressão após a quimioterapia de primeira linha é ruim. Quimioterapia de manutenção, de segunda linha e até de terceira linha são tratamentos válidos para pacientes com CPNPC de estádio avançado. Infelizmente, poucos pacientes são candidatos para o tratamento quimioterápico além daquele de primeira linha. O presente estudo avalia as características de pacientes com CPNPC e os resultados do tratamento da doença metastática, com ênfase na quimioterapia de segunda e de terceira linha. MÉTODOS: Este é um estudo observacional e retrospectivo de 2.673 pacientes com CPNPC metastático, estádio IV, admitidos para tratamento em duas instituições de São Paulo, SP. A quimioterapia de primeira linha foi definida como a primeira abordagem quimioterápica administrada ao paciente. Quimioterapias de segunda e de terceira linha foram definidas como tratamento sistêmico administrado após a interrupção da quimioterapia de primeira linha, seja por intolerância ou por doença em progressão ou recorrente. RESULTADOS: A maioria dos pacientes (57,9 por cento) foi submetida à quimioterapia de primeira linha; aproximadamente 23,4 por cento receberam quimioterapia de segunda linha e 8 por cento de terceira. Apenas 2,5 por cento foram submetidos ao regime de quarta linha. A sobrevida global mediana (OS) foi de 8 meses (IC 95 por cento: 8-9 meses). Na análise univariada, sexo (p < 0,05), histologia, quimioterapia de primeira linha, resposta imparcial à quimioterapia de primeira linha e quimioterapia de segunda linha (p < 0,01) foram fatores prognósticos relacionados com a sobrevida global. Na análise multivariada, status de performance (p = 0,04), submissão do paciente a qualquer tipo de quimioterapia de segunda linha (p < 0,01) e resposta à quimioterapia de primeira linha (p < 0,01) foram os únicos fatores independentes preditivos de maior sobrevida. CONCLUSÃO: A quimioterapia de segunda linha é uma estratégia terapêutica a ser considerada em seletos grupos de pacientes. O status de performance e a resposta à quimioterapia de primeira linha poderiam ser alguns dos fatores determinantes durante o processo de seleção dos pacientes que deverão ser submetidos a regimes quimioterápicos além da primeira linha.

Chemotherapy beyond first-line in stage IV metastatic non-small cell lung cancer.

OBJECTIVE: Platinum-based doublet chemotherapy is considered the standard of care for advanced non-small cell lung cancer (NSCLC). However, prognosis after recurrent or progressive disease following first-line chemotherapy is usually poor. Maintenance chemotherapy, second line treatment and even third line chemotherapy are available for patients with advanced NSCLC. Unfortunately, few patients are candidates for chemotherapy beyond first line. The present study evaluated characteristics of patients with NSCLC and outcomes of the treatment of their metastatic disease, with emphasis on second and third-line chemotherapy. METHODS: This was a retrospective observational study of 2,673 patients with metastatic, stage IV, non-small cell lung cancer admitted for treatment in two São Paulo institutions. First-line chemotherapy was defined as the first chemotherapeutic approach administered to the patient. Second and third-line chemotherapy were defined as the systemic treatment administered after discontinuing first-line chemotherapy, either for intolerance or for progressive or recurrent disease. RESULTS: Most patients (57.9%) received first-line chemotherapy, and approximately 23.4% received second-line and 8% third-line regimens. Only 2.5% received fourth-line chemotherapy. Median overall survival (OS) was 8 months (95% CI: 8-9 months). At univariate analyses, gender (p < 0.05), histology, first-line chemotherapy, objective response to first-line chemotherapy and second-line chemotherapy (p < 0.01) were prognostic factors related to overall survival. At multivariate analysis, only performance status (p = 0.04), receiving any second-line chemotherapy (p < 0.01) and response to first-line chemotherapy (p < 0.01) were independent predictors of overall survival. CONCLUSION: Second-line chemotherapy is a therapeutic strategy that should be considered for a selected group of patients. Performance status and response to first-line chemotherapy could be determinant characteristics to select patients who might be treated beyond first-line chemotherapy.