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1.
Bone ; 44(1): 173-5, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18849018

RESUMO

We report on the potential association of suspected bisphosphonate-associated osteonecrosis of the jaw (BRONJ) recurrence with the use of the novel antiangiogenic drug sunitinib. A 59 year-old patient affected by metastatic renal cell carcinoma (RCC) and established BRONJ experienced consecutive episodes of painful jaw infection with cutaneous fistula and bone sequestration which occurred during active treatment with sunitinib, improved after discontinuation and antibiotic therapy, then rapidly worsened with resumption of sunitinib. We hypothesize that the potent antiangiogenic activity of sunitinib may amplify the inhibition of bone remodeling exerted by aminobisphosphonates entrapped within the osteonecrotic mineral matrix, antagonize mucosal healing and expose to infections during treatment. This supports the emerging role of soft-tissue damage in the pathogenesis of osteonecrosis of the jaw.


Assuntos
Carcinoma de Células Renais/tratamento farmacológico , Indóis/efeitos adversos , Indóis/uso terapêutico , Doenças Maxilomandibulares/induzido quimicamente , Neoplasias Renais/tratamento farmacológico , Neoplasias Pulmonares/secundário , Osteonecrose/induzido quimicamente , Pirróis/efeitos adversos , Pirróis/uso terapêutico , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/patologia , Fístula Dentária/induzido quimicamente , Fístula Dentária/complicações , Humanos , Doenças Maxilomandibulares/complicações , Neoplasias Renais/complicações , Neoplasias Renais/patologia , Neoplasias Pulmonares/complicações , Masculino , Pessoa de Meia-Idade , Osteonecrose/complicações , Sunitinibe
2.
Crit Rev Oncol Hematol ; 66(2): 163-70, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18243726

RESUMO

PURPOSE: To evaluate management and outcome of patients >or=70 years admitted to our Medical Oncology ward and evaluated by Multidimensional Geriatric Assessment before treatment with standard or "elderly-friendly" chemotherapy regimens, a list of which was developed within our Geriatric Oncology Program based on published clinical trials and personal experience. PATIENTS AND METHODS: Charts of patients treated from January 2004 to January 2006 were reviewed for choice of treatment, tumor response, toxicities and survival. RESULTS: 117 patients (median age 75 years) were divided into Frail (F) (34.2%) and Not-Frail patients (NF: 33.3% Fit plus 32.5% Vulnerable). The two groups did not differ according to the use of "elderly-friendly"chemotherapy regimens (40% of F pts and 39% of NF pts), dose reductions >or=25% (37.5% vs. 31.2%) and grade 3-4 toxicities (52.5% vs. 58.4%). Early interruption of treatment due to toxicity or patient's refusal (42.5 vs. 15.6, p=0.001) and deaths within 30 days from last chemotherapy administration (22.5% vs. 3.9%, p=0.003) were significantly different. F patients showed clinical or radiological response in 21.2% of cases, and subjective improvement in 22.6%. After a median follow-up of 19 months, median survival of F patients (6.4 months) is shorter compared to NF group (16.9 months, p=0.012). CONCLUSIONS: The use of "elderly-friendly"chemotherapy regimens was limited to less than a half of cases. F patients may respond to chemotherapy but display higher rates of premature withdrawal and early deaths compared to NF patients, with a shorter survival. Clinical trials particularly aimed at frail patients are urgently needed.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Idoso Fragilizado , Avaliação Geriátrica , Serviços de Saúde para Idosos , Oncologia , Neoplasias/tratamento farmacológico , Avaliação de Processos e Resultados em Cuidados de Saúde , Seleção de Pacientes , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Feminino , Hospitais , Humanos , Itália , Estimativa de Kaplan-Meier , Masculino , Neoplasias/mortalidade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
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