Experiencia con un formato simplificado de la herramienta de ayuda en la toma de decisiones Adjuvant Online en pacientes con cáncer de mama / Experience with a simplified format of decision making tool adjuvant Online in breast cancer patients

Fundamento. Adjuvant. Online calcula el riesgo de recidiva y muerte a 10 años y proporciona estimaciones del beneficio del tratamiento adyuvante en pacientes con cáncer de mama. Testamos su aplicabilidad y analizamos únicamente estimaciones de mortalidad. Método. Presentamos las estimaciones de 66 pacientes intervenidas de cáncer de mama unilateral y unicéntrico, sin enfermedad residual ni metástasis. Las variables analizadas fueron edad, comorbilidad, receptores de estrógenos, grado histológico, tamaño tumoral, ganglios metastásicos, tipo de tratamiento hormonal y de quimioterapia. Resultados. La estimación de la mediana de supervivencia fue del 77%, de mortalidad por cáncer fue del 18% y por otras causas fue del 5%. La media de reducción absoluta del riesgo (RAR) de mortalidad con tratamiento hormonal fue del 4%, con quimioterapia fue del 4,5% y con tratamiento combinado fue del 7%. Resultados. Todas las pacientes con algún beneficio decidieron recibir tratamiento hormonal. Cuarenta y tres pacientes (65%) decidieron recibir quimioterapia y 23 pacientes (35%) decidieron no recibirla. La media de reducción del riesgo con quimioterapia fue del 2% en quien decidió no recibir quimioterapia y fue del 8% en quien decidió recibirla. Existe asociación entre la decisión de quimioterapia y la estimación del riesgo de mortalidad por cáncer (p=0,0001), del riesgo de mortalidad por otras causas (p=0,038) y de la RAR (p=0,0001). El 6% de las pacientes con RAR del 1%, el 50% de las que tenían RAR entre el 2–5%, y el 61,8% con RAR entre el 6–10% eligieron la quimioterapia. Conclusiones. Todas las mujeres optan por el tratamiento hormonal independientemente del beneficio. Las razones para elegir la quimioterapia fueron el propio pronóstico vital y la magnitud del beneficio. Algunas pacientes deciden elegir quimioterapia con beneficios mínimos(AU)

Background. Adjuvant. Online estimates 10-year recurrence and mortality outcomes for breast cancer patients and predicts the effect of each type of treatment. Our purpose was to test the applicability by only analysing mortality estimations. Method. We present estimations of 66 women with definitive surgery and axillary staging for unilateral, unicentric, invasive adenocarcinoma, without metastatic or residual disease. Age, co-morbidity, estrogen receptor status, histological grade, tumor size, number of positive nodes, and hormone therapy or chemotherapy option, were the variables required. Results. Median of survival estimations was 77%, cancer mortality 18% and mortality for other reasons 5%. The average of absolute risk reduction (ARR) with hormone therapy was 4%, with chemotherapy 4.5% and with combined treatment 7%. Results. All the patients with some benefit decided to receive hormone therapy. Forty-three patients (65%) decided to receive chemotherapy and 23 (35%) did not. The average risk reduction with chemotherapy was 2% in those who decided not to receive chemotherapy and 8% in those who decided to receive it. There was an association between a chemotherapy decision and the estimation of the risk of breast cancer mortality (P=0.0001), risk of mortality for other reasons (P=0.038), and the ARR (P=0.0001). There were 6% of the patients with an ARR of 1%, 50% between 2–5% and 61.8% between 6–10%, who chose chemotherapy. Conclusions. All women opted for hormone therapy regardless of benefit. The reasons for choosing chemotherapy were the prognosis itself and the magnitude of benefit. Some patients decided to choose chemotherapy even when the benefit was minimal(AU)

[Experience with a simplified format of decision making tool adjuvant! Online in breast cancer patients]. / Experiencia con un formato simplificado de la herramienta de ayuda en la toma de decisiones Adjuvant! Online en pacientes con cáncer de mama.

BACKGROUND: Adjuvant! Online estimates 10-year recurrence and mortality outcomes for breast cancer patients and predicts the effect of each type of treatment. Our purpose was to test the applicability by only analysing mortality estimations. METHOD: We present estimations of 66 women with definitive surgery and axillary staging for unilateral, unicentric, invasive adenocarcinoma, without metastatic or residual disease. Age, co-morbidity, estrogen receptor status, histological grade, tumor size, number of positive nodes, and hormone therapy or chemotherapy option, were the variables required. RESULTS: Median of survival estimations was 77%, cancer mortality 18% and mortality for other reasons 5%. The average of absolute risk reduction (ARR) with hormone therapy was 4%, with chemotherapy 4.5% and with combined treatment 7%. All the patients with some benefit decided to receive hormone therapy. Forty-three patients (65%) decided to receive chemotherapy and 23 (35%) did not. The average risk reduction with chemotherapy was 2% in those who decided not to receive chemotherapy and 8% in those who decided to receive it. There was an association between a chemotherapy decision and the estimation of the risk of breast cancer mortality (P=0.0001), risk of mortality for other reasons (P=0.038), and the ARR (P=0.0001). There were 6% of the patients with an ARR of 1%, 50% between 2-5% and 61.8% between 6-10%, who chose chemotherapy. CONCLUSIONS: All women opted for hormone therapy regardless of benefit. The reasons for choosing chemotherapy were the prognosis itself and the magnitude of benefit. Some patients decided to choose chemotherapy even when the benefit was minimal.

[Treatment with cetuximab in metastatic colorectal cancer patients who do not express the epidermal growth factor receptor]. / Tratamiento con cetuximab en pacientes con cáncer colorrectal metastásico que no expresan el receptor del factor de crecimiento epidérmico.

OBJECTIVE: To evaluate the response to cetuximab, in terms of time passed until disease progression and overall survival, in patients with colorectal cancer (CRC) in which the epidermal growth factor receptor (EGFR) is undetectable. METHOD: Nine EGFR-negative patients (confirmed by an immunohistochemistry study), who were being treated with cetuximab, were selected. Variables collected: demographic data, diagnosis, previous treatments, time since first metastasis to start of treatment with cetuximab, adverse events and tumour markers. The response was monitored using tumour markers and disease progression. Well-being was assessed using the Karnofsky performance status (KPS) or that of the Eastern Cooperative Oncology Group (ECOG). RESULTS: 22% men (2/9) with a median age of 48 (31-63). The median time from being diagnosed with the metastatic disease to the start of treatment with cetuximab was 19 months (12-48). All patients had failed an irinotecan-based regime, 77.77% (7/9) had also failed one which included oxaliplatin. The median number of cycles with cetuximab was 14 (6-32). The main adverse event was the appearance of an acneiform rash in 100% of the cases. The median time until disease progression was 7 months (3-16) and 10.2 months (4-24) for overall survival. The results for well-being showed a KPS of between 80-100% and an ECOG of < 2. The results obtained in the present study for overall survival and time until disease progression are higher than those in the pivotal study (10.2 compared to 8.6 months and 7 compared to 4.1 months respectively). CONCLUSIONS: According to the results obtained, the use of assessing the EGFR expression (by the immunohistochemistry technique at least), as a means of predicting response to treatment with cetuximab may be questioned. This suggests that selecting patients using the routine assessment of this receptor is inappropriate, since it excludes patients who may potentially benefit from the treatment. However, more clinical trials are required in this area in order to confirm these conclusions.