Combination of Irinotecan, Oxaliplatin and 5-Fluorouracil as a Rechallenge Regimen for Heavily Pretreated Metastatic Colorectal Cancer Patients.

PURPOSE: Our objective was to evaluate the benefit of re-exposing patients with refractory metastatic colorectal cancer (mCRC) to a combination of oxaliplatin, irinotecan and 5-fluorouracil treatment. METHODS: We retrospectively analysed patients with mCRC who received a combination of oxaliplatin, irinotecan and fluorouracil as a rechallenge regimen after progressing on the same drugs. Both FOLFOXIRI and FOLFIRINOX were used. Toxicity was evaluated for each treatment cycle, and survival analysis was performed using the Kaplan-Meier method. RESULTS: A total of 21 patients who were treated between January 2011 and December 2013 were selected for this study. Most of the patients (95.2%) had an ECOG status of 0-1. The median age at diagnosis was 52.1 years (range 36-77 years), and 14 (66.6%) patients had wild-type KRAS. Thirteen patients received FOLFIRINOX, and eight received FOLFOXIRI. Most patients had previously received at least three regimens, with 80% receiving anti-VEGF and 66% anti-EGFR antibodies. The response rate was 38%, and 24% patients had stable disease. The median time to disease progression was 4.0 months (range 1.0-9.1 months), and the median overall survival duration was 8.6 months (range 6.3-11.5 months). Most patients required dose adjustment and treatment delays. One patient experienced grade 5 neutropenic sepsis. CONCLUSIONS: Both FOLFIRINOX and FOLFOXIRI are active and potentially feasible rechallenge treatment options for heavily pretreated patients with good performance status. With dose reduction and close monitoring for toxicity, the risk of serious adverse events can be minimised.

Rivaroxaban: An Affordable and Effective Alternative in Cancer-Related Thrombosis?

BACKGROUND: Venous thromboembolic events (VTEs) are common and potentially fatal complications in cancer patients, and they are responsible for the second most common cause of death. Low molecular weight heparin (LMWH) is the gold-standard treatment, but the costs involved limit its use, especially in developing countries. Recently, the oral anticoagulant rivaroxaban, which directly inhibits factor Xa, was approved for VTE treatment. METHODS: We conducted a retrospective analysis from January 2009 to February 2014 with patients who had cancer and VTE who were receiving rivaroxaban. We compared the efficacy, safety, and cost of rivaroxaban and low molecular weight heparin (LMWH) alone or followed by vitamin K antagonists. RESULTS: Forty-one patients were identified, with a median age of 62.5 years. The most frequent tumor histology was adenocarcinoma (78%), which was most often found in the colon (26.8%). Most participants had advanced disease and an implanted central venous catheter. Patients' VTE risk-assessment scores were low (12.5%), intermediate (50%), and high (35.5%). Pulmonary thromboembolism was reported in 41.4% of patients, but inferior limb thrombosis was reported only in 14.6%; 43.9% of patients received enoxaparin before starting rivaroxaban. Rivaroxaban was used for a median time of 5.5 months. Nonmajor bleeding was reported in 12.2% of patients, and rethrombosis was reported in 12.2%. In our study, rivaroxaban was as safe and effective as enoxaparin/vitamin K antagonists (P = .54 and P = .25, respectively) or LMWH (P = .46 and P = .29, respectively). CONCLUSION: Although our study was a retrospective analysis, our results suggest that in this cohort of oncologic patients, rivaroxaban was safe and effective. Its oral route and lower cost make it an attractive alternative to LMWH, improving management of patients with cancer in low-income countries. Additional studies are necessary to confirm our data.

A reinserção escolar na área de oncologia infantil: avanços & perspectivas / The scholastic reintegration into the oncology pediatric: advances & perspectives

A proposta deste estudo é um ensaio sobre o tema, mencionando alguns avanços e perspectivas no que tange à reinserção escolar dessas crianças. É importante que a criança com câncer mantenha sua escolaridade, preservando sua vida normal, seu desenvolvimento integral e tenha esperança de cura para construir seu futuro. Porém, sua reinserção escolar tem sido difícil para professores, familiares e para ela própria. Os professores enfrentam dificuldades em como lidar com esta criança frente aos seus colegas de classe e relacionadas à falta de informação sobre a doença. Os familiares sofrem com a preocupação diante da integridade física e emocional da criança, preferindo, muitas vezes, mantê-las em casa. Já as crianças lidam com a desinformação, curiosidade e zombaria, face às mudanças na sua aparência física (perda de peso, queda de cabelo e uso de máscara).

The proposal of this study is an essay on the subject, in which some perspective advances are mentioned and it is extremely important that the children with cancer maintain their schooling, preserving a normal life. It's intellectual and emotional normal life and to have the hope to cure in the determination to construct the future. However, the scholar reintegration of the child in oncologist treatment becomes difficult for the teachers, relatives and for the own ill child. Teachers face the difficulty of how to manage with the child in front of their classmates and with the lack of information about the disease. The relatives suffer with the preoccupation about the physical and emotional integrity of the child. However, the child does not fight with the disinformation, curiosity and deceives, in the face of its physical appearance, (loss of weight, loss of hair and use of masks).

La propuesta de este estudio es un ensayo sobre el tema, mencionando algunos avances y perspectivas.Es de extrema importancia que los niños con cancer mantengan su escolaridad, como forma de preservar su vida normal. Su vida normal intelectual y emocional y tenga la esperanza de curarse en la determinación de construir su futuro. Por eso la restricción, escolar de los niños en tratamiento oncológico se torna difícil para los profesores, familiares y para el propio niño enfermo. Los profesores se enfrentan las dificultad de cómo lidiar con el niño frente a sus compañeros de clase y con la falta información sobre la enfermedad. Los familiares sufren con una preocupación frente a la integridad física y emocional, del niño, prefiriendo muchas veces mantenerlas en casa. Los niños lidian con la desinformación , curiosidad y burla, que hacen los demas niños de su apariencia físico, (pérdida de peso, caida de cabello y uso de cubrebocas).