Real-world data of fulvestrant as first-line treatment of postmenopausal women with estrogen receptor-positive metastatic breast cancer.

Goals of endocrine therapy for advanced breast cancer (ABC) include prolonging survival rates, maintaining the quality of life, and delaying the initiation of chemotherapy. We evaluated the effectiveness of fulvestrant as first-line in patients with estrogen receptor (ER)-positive ABC with relapse during or after adjuvant anti-estrogenic therapy in real-world settings. Retrospective, observational study involving 171 postmenopausal women with ER-positive ABC who received fulvestrant as first-line between January 2011 and May 2018 in Spanish hospitals. With a median follow-up of 31.4 months, the progression-free survival (PFS) with fulvestrant was 14.6 months. No differences were seen in the visceral metastatic (14.3 months) versus non-visceral (14.6 months) metastatic subgroup for PFS. Overall response rate and clinical benefit rate were 35.2% and 82.8%. Overall survival was 43.1 months. The duration of the clinical benefit was 19.2 months. Patients with ECOG performance status 0 at the start of treatment showed a significant greater clinical benefit rate and overall survival than with ECOG 1-2. Results in real-world settings are in concordance with randomized clinical trials. Fulvestrant continues to demonstrate clinical benefits in real-world settings and appears be well tolerated as first-line for the treatment of postmenopausal women with ER-positive ABC.

Use of bevacizumab as a first-line treatment for metastatic breast cancer.

OBJECTIVE: During clinical practice, it can be challenging, given the lack of response biomarkers, to identify the patients with metastatic breast cancer (mbca) who would benefit most from the addition of bevacizumab to first-line standard chemotherapy. The aim of the present review was to summarize the relevant scientific evidence and to discuss the experience of a group of experts in using bevacizumab to treat mbca. METHODS: A panel of 17 Spanish oncology experts met to discuss the literature and their experience in the use of bevacizumab as first-line treatment for mbca. During the meeting, discussions focused on three main issues: the profile of the patients who could benefit most from bevacizumab, the optimal bevacizumab treatment duration, and the safety profile of bevacizumab. RESULTS: The subset of mbca patients who would benefit the most from the addition of bevacizumab to first-line standard chemotherapy are those with clinically defined aggressive disease. Treatment with bevacizumab should be maintained until disease progression or the appearance of unacceptable toxicity. In the mbca setting, the toxicity profile of bevacizumab is well known and can be managed in clinical practice after adequate training. CONCLUSIONS: This expert group recommends administering bevacizumab as first-line treatment in patients with clinically aggressive disease.

Un posible caso de hiperalgesia en un pacientee n el que añadir 'más morfina' supuso también encontrar 'más dolor' / No disponible

La hiperalgesia puede relacionarse con casos de dolor insoportable en los que a más analgesia opioide se sigue exacerbación del dolor. Presentamos un varón con linfoepitelioma laríngeo y dolor dorsal con fentanilo 100 mcg/h que ingresa por dolor. Se cambió a morfina s.c. 78 mg/día.Hubo que subir sucesivamente la medicación hasta 220 mg/día más innumerables rescates. Las valoraciones resultaban desconcertantes y las respuesta sa dosis de rescate anárquicas. Se cambió a metadona 30 mg s.c.cada 8 horas, y ketamina (perfusión i.v. 0,5 mg/kg/día) durante 3 días. Siguió una mejoría completa. Se debe pensar en hiperalgesia en casos de dolor imposible, principalmente si se precisan dosis altas de opioides, escalada rápida o tratamiento prolongado. El aumento de opioide no es siempre la respuesta adecuada a un opioide ineficaz. Una cantidad inferior de otro opioide puede conducir a un alivio drástico del dolor usando adyuvantes, un opioide alternativo o antagonistas del receptor NMDA como ketamina y metadona (AU)

Hyperalgesia could explain excruciating pain situations in which more opioid analgesia is followed by more pain within hours or days. We present the case of a patient with head and neck cancer, dorsal pain, and a100 mcg/h fentanyl patch. He was admitted to hospital for pain control and we changed his therapy to subcutaneous morphine at 78 mg/day. Doses had to be increased to 220 mg/day with some immediate relieve and poor control thereafter. The evaluation of the patient was very confusing, and response to rescue medication was anarchic. We switched to 30 mg of subcutaneous methadone every 8 hours and then ketamine in continuous subcutaneous infusion at 0.5 mg/kg/day for 3 days. Pain control was total in the next few days. Clinicians must consider hyperalgesia when pain control seems impossible with increasing doses of opioids, mainly when high doses are being used, long term or there is quick dose escalation. Fewer milligrams of opioids may result in pain relief by switching to an alternative opioid or using an NMDA antagonist such as ketamine or methadone (AU)

Nuevos tratamientos para el carcinoma renal / New treatments for renal carcinoma

El cáncer renal presenta varias características que lo diferencian de otros tumores. El aumento de supervivencia observado en pacientes con carcinoma renal metastásico tras la realización de nefrectomía, rompe un concepto clásico de la oncología según el cual la extirpación del tumor primario en tumores avanzados carece de sentido. Junto con el melanoma, es el único tumor en el que tratamientos inmunomoduladores, como interleukina- 2 producen un beneficio clínico al paciente. El tratamiento del cáncer renal metastásico con interleukina-2 intravenosa a dosis altas ha confirmado en estudios aleatorios que puede producir respuestas completas de muy larga duración, en la práctica equivalentes a la curación. Por último, el cáncer renal está siendo empleado como modelo clínico para demostrar la eficacia de múltiples tratamientos dirigidos frente a nuevas dianas. En la actualidad se están estudiando más de 30 nuevos fármacos como tratamiento del cáncer renal, habiendo sido el primer tumor en el que se ha demostrado el beneficio clínico del tratamiento con inhibidores de la angiogénesis. En este artículo se revisan los aspectos más relevantes sobre el cáncer renal, incluyendo epidemiología, factores pronósticos, presentación clínica; bases moleculares y el estado actual de desarrollo de varios de los múltiples fármacos que se están estudiando en esta enfermedad

Renal cell carcinoma presents several unique features, which distinguish it from other tumours. The increase in survival that has been described in patients with renal cell carcinoma following nephrectomy breaks a classical rule of oncology, which states that surgery of the primary tumour has no role in the treatment of patients with advanced disease. Together with melanoma, it is the only tumour in which immunomodulatory treatments with drugs such as interleukin-2 produces a clinical benefit to patients. In randomized trials treatment of metastatic renal cell carcinoma with high dose interleukin-2 has confirmed its ability to induce long-term complete responses, which in practice can be considered equivalent to cure. Lastly, renal cell carcinoma is being used as a clinical model to demonstrate the role of several targeted treatments, with over 30 novel agents under development. It has been the first tumour type in which treatment with angiogenesis inhibitors has shown a clinical benefit. This article reviews the most relevant aspects of renal cell carcinoma, including epidemiology, prognostic factors, clinical presentation, molecular bases and the current status of development of the most relevant novel treatments for this disease

[New treatments for renal carcinoma]. / Nuevos tratamientos para el carcinoma renal.

Renal cell carcinoma presents several unique features, which distinguish it from other tumours. The increase in survival that has been described in patients with renal cell carcinoma following nephrectomy breaks a classical rule of oncology, which states that surgery of the primary tumour has no role in the treatment of patients with advanced disease. Together with melanoma, it is the only tumour in which immunomodulatory treatments with drugs such as interleukin-2 produces a clinical benefit to patients. In randomized trials treatment of metastatic renal cell carcinoma with high dose interleukin-2 has confirmed its ability to induce long-term complete responses, which in practice can be considered equivalent to cure. Lastly, renal cell carcinoma is being used as a clinical model to demonstrate the role of several targeted treatments, with over 30 novel agents under development. It has been the first tumour type in which treatment with angiogenesis inhibitors has shown a clinical benefit. This article reviews the most relevant aspects of renal cell carcinoma, including epidemiology, prognostic factors, clinical presentation, molecular bases and the current status of development of the most relevant novel treatments for this disease.

[Ureteral invagination caused by a fibroepithelial polyp of the ureter. Apropos of a case]. / Invagination urétérale due à un polype fibro-épithélial de l'uretère. A propos d'un cas.

This article reports a new case of intussusception due to a ureteral polyp. The diagnosis was based on the preoperative radiological aspects. The polyp was both invaginated and twisted, and was removed along with a segment of the ureter.

[Ureteral endometriosis. Apropos of a bilateral form]. / Endométriose urétérale. A propos d'une forme bilatérale.

A case of bilateral ureteral endometriosis is reported. The patient presented, on one side, with endometriosis externa, associated with slight renal injury, and, on the other, with adenomyosis leading to uretero-ureteral invagination, and an associated severe renal impairment. A review of the reported cases and pathogenic theories is followed by a discussion of the diagnostic and therapeutic problems raised by ureteral endometriosis. The difficulty of establishing a correct diagnosis and the risk of damage to renal function often lead to surgical removal of the ureteral lesion.

[Role of Chlamydiae in genital infections in man]. / La place des chlamydiae dans les infections génitales chez l'homme.

The importance of the part played by Chlamydia trachomatis in male genital infections has only become apparent in recent years. In man, this bacteria is the main agent responsible for non-gonococcal urethritis and for at least 30% of the cases of acute epididymitis in adults. Although bacteriologically difficult, its identification is of great practical use, because of the hypersensitiveness of Chlamydia to tetracyclines.

[Treatment of non seminomatous testicular tumors (author's transl)]. / Le traitement des tumeurs non séminomateuses du testicule.

Progress in the diagnosis and treatment of NSTT have been registered during the last years. Tumor markers have permitted to lower the percentage of staging error ; nevertheless they have their limits and a return to normal of tumor markers do not mean obligatorily the disparition of a viable tumor. The treatment of NSTT is an emergency : lymphadenectomy is now, for most of authors limited and guided by extemporaneal exploration ; radiotherapy has a complementary target of detecting agent ; chemotherapy (particularly since CDDP was introduced) is very efficient in disseminated forms of disease giving long term remission in 50 to 70 % of cases. Actual results give, for next years, the hope of eradication of NSST in a high number of cases.

[Unilateral implantation of the ureter into the posterior urethra in boys. 5 cases (author's transl)]. / Abouchements unilatéraux de l'uretère dans l'urèthre postérieur chez le garçon. A propos de cinq observations.

The authors report five new cases of unilateral implantation of the ureter into the posterior urethra in boys. Study of these cases confirms the classical data, i.e.: --The chief presenting symptom is infection. There is no urinary incontinence. --The principle examinations useful in diagnosis are the I.V.P. and urethroscopy. --The ectopic termination is in most cases associated with a double ureter, arising from the upper pelvis. However, the ureter may be single (1/5). --In three cases out of five the upper kidney was dysplasic, necessitating partial nephrectomy. In two cases out of five the kidney corresponding to the ectopic ureter was functional, making possible conservatrice surgery with reimplantation of the pathological ureter into the bladder.