Epidemiological Data on the Nutritional Status of Cancer Patients Receiving Treatment with Concomitant Chemoradiotherapy, Radiotherapy or Sequential Chemoradiotherapy to the Abdominopelvic Area.

Cancer patients are particularly susceptible to undernourishment so associated weight loss is frequent. Approximately 15% of patients lose >10% of their usual body weight, 40-80% become undernourished, and about 20% die as a result. Well-nourished patients have a higher survival rate when compared with patients at risk of undernourishment (19.9 vs. 3.7 months); hence, nutritional intervention is pivotal. Undernourishment negatively influences the patient's prognosis, and its prevalence depends on the tumor type and location, disease stage, treatment, and the applied nutritional evaluation tool. During abdominopelvic radiotherapy, up to 90% of patients experience symptoms of varying severity; weight loss during radiotherapy is an early indicator of nutritional deterioration, and he the use of radiation is associated with a higher likelihood of undernourishment. In patients with gynecological malignancies, 12.5-54% are malnourished before receiving oncological treatment, worsening after treatment in 35.8-82% of cases. There is also deterioration of the nutritional status in patients with colorectal cancer once pelvic radiotherapy is initiated, whereby 50% of cases are malnourished at the beginning of treatment, and 66.7% are so when it ends. Although there are notable differences in the impact of radiotherapy on weight according to the radiated region, 88% patients receiving abdominal radiotherapy were found to lose weight compared to 38% of patients whose treatment was limited to the pelvis.

Epidemiological Profile, Gastrointestinal Toxicity, and Treatment of Pelvic Cancers in Patients Managed with Radiotherapy to the Abdominal Pelvic Area.

Mexico has seen an increase in cancer prevalence in its entire population as well as particular age ranges, predominantly the older segment. The most frequently reported pelvic cancers in Mexico are cervical, endometrial, bladder, prostate, rectum, and anal canal. Approximately 80% of the population diagnosed with pelvic cancers present with locally advanced tumors and require concomitant chemoradiotherapy, sequential chemoradiotherapy, or radiotherapy alone. The toxicity of any of these treatment modalities may be manifested as intestinal injury, a significant problem that can compromise the response to treatment, the patient's nutritional state, quality of life, and survival. In this article, we will approach key aspects in nutrition as well as the epidemiological characteristics and toxicities in patients affected by these pelvic tumors.

Central nervous system metastasis from osteosarcoma: Case report and literature review.

Osteosarcoma is the most common primary malignancy of bone in children and young adults, the highest incidence peak is during adolescence and doesn't have any gender predominance. The main site of metastasis are the lungs and extrapulmonary cases are occasional. The incidence of metastasis in the Central Nervous System (CNS) is 2-6.5%, increase to 10-15% in patients with pulmonary metastases. Therefore, metastatic disease of the CNS is rare and the information on such patients is limited. Here, we describe a case of a 20-year old patient diagnosed with osteosarcoma in the left distal femur stage IIB, he developed pulmonary disease, during palliative chemotherapy experienced relapse to the brain classified as recursive partitioning analysis (RPA) class II, and was treated with external radiotherapy (30 Gy in 10 fractions) and later he had a poor evolution and died.

Advanced Squamous Cell Carcinoma of the Head and Neck: The Current Role of Cetuximab.

We review clinical trials of squamous cell carcinoma of the head and neck (SCCHN) to address the current and potential uses of cetuximab (CTX). PubMed was reviewed to identify papers published between 2010 and 2016. The search terms used were "cetuximab" and "head and neck cancer." A total of 634 articles were identified. Phase II or III studies with CTX in patients with advanced SCCHN without treatment or with recurrent/metastatic tumors were selected. Forty-six registries were obtained. Information was critically reviewed and relevant information presented. As definitive treatment of advanced squamous cells carcinomas and as palliative treatment of recurrent/metastatic disease, CTX alone or associated with chemotherapy and/or radiotherapy is an alternative to chemoradiotherapy because of its distinct and favorable toxicity profile.

[National consensus of diagnosis and treatment of non-small cell lung cancer]. / Consenso nacional de diagnóstico y tratamiento del cáncer de pulmón de células no pequeñas.

Mexican specialists in oncology, oncologic surgery, thoracic surgery, pneumology, pathology, molecular biology, anesthesiology, algology, psychology, nutrition, and rehabilitation (all of them experts in lung cancer treatment) in order to develop the National Consensus on Lung Cancer. The consensus has been developed as an answer to the need of updated Mexican guidelines for the optimal treatment of the disease, as well as to the requirements that such guidelines be established by multidisciplinary panel, depicting the current attention given to cancer lung cases in Mexico. Thus, this paper analyses the epidemiological review, screening, diagnosis, staging, pathology, translational medicine, and the suitable therapies for early, locally advanced, and metastatic disease in the first, second, and third lines of management, as well as rehabilitation and palliative measures.

[Third National Ovarian Consensus. 2011. Grupo de Investigación en Cáncer de Ovario y Tumores Ginecológicos de México "GICOM"]. / Tercer Consenso Nacional de Cáncer de Ovario 2011. Grupo de Investigación en Cáncer de Ovario y Tumores Ginecológicos de México "GICOM".

INTRODUCTION: Ovarian cancer (OC) is the third most common gynecologic malignancy worldwide. Most of cases it is of epithelial origin. At the present time there is not a standardized screening method, which makes difficult the early diagnosis. The 5-year survival is 90% for early stages, however most cases present at advanced stages, which have a 5-year survival of only 5-20%. GICOM collaborative group, under the auspice of different institutions, have made the following consensus in order to make recommendations for the diagnosis and management regarding to this neoplasia. MATERIAL AND METHODS: The following recommendations were made by independent professionals in the field of Gynecologic Oncology, questions and statements were based on a comprehensive and systematic review of literature. It took place in the context of a meeting of two days in which a debate was held. These statements are the conclusions reached by agreement of the participant members. RESULTS: No screening method is recommended at the time for the detection of early lesions of ovarian cancer in general population. Staging is surgical, according to FIGO. In regards to the pre-surgery evaluation of the patient, it is recommended to perform chest radiography and CT scan of abdomen and pelvis with IV contrast. According to the histopathology of the tumor, in order to consider it as borderline, the minimum percentage of proliferative component must be 10% of tumor's surface. The recommended standardized treatment includes primary surgery for diagnosis, staging and cytoreduction, followed by adjuvant chemotherapy Surgery must be performed by an Oncologist Gynecologist or an Oncologist Surgeon because inadequate surgery performed by another specialist has been reported in 75% of cases. In regards to surgery it is recommended to perform total omentectomy since subclinic metastasis have been documented in 10-30% of all cases, and systematic limphadenectomy, necessary to be able to obtain an adequate surgical staging. Fertility-sparing surgery will be performed in certain cases, the procedure should include a detailed inspection of the contralateral ovary and also negative for malignancy omentum and ovary biopsy. Until now, laparoscopy for diagnostic-staging surgery is not well known as a recommended method. The recommended chemotherapy is based on platin and taxanes for 6 cycles, except in Stage IA, IB and grade 1, which have a good prognosis. In advanced stages, primary cytoreduction is recommended as initial treatment. Minimal invasion surgery is not a recommended procedure for the treatment of advanced ovarian cancer. Radiotherapy can be used to palliate symptoms. Follow up of the patients every 2-4 months for 2 years, every 3-6 months for 3 years and anually after the 5th year is recommended. Evaluation of quality of life of the patient must be done periodically. CONCLUSIONS: In the present, there is not a standardized screening method. Diagnosis in early stages means a better survival. Standardized treatment includes primary surgery with the objective to perform an optimal cytoreduction followed by chemotherapy Treatment must be individualized according to each patient. Radiotherapy can be indicated to palliate symptoms.

[The first Mexican consensus of endometrial cancer. Grupo de Investigación en Cáncer de Ovario y Tumores Ginecológicos de México]. / Primer consenso Mexicano de cancer de endometrio.

INTRODUCTION: Endometrial cancer (EC) is the second most common gynecologic malignancy worldwide in the peri and postmenopausal period. Most often for the endometrioid variety. In early clinical stages long-term survival is greater than 80%, while in advanced stages it is less than 50%. In our country there is not a standard management between institutions. GICOM collaborative group under the auspice of different institutions have made the following consensus in order to make recommendations for the management of patients with this type of neoplasm. MATERIAL AND METHODS: The following recommendations were made by independent professionals in the field of Gynecologic Oncology, questions and statements were based on a comprehensive and systematic review of literature. It took place in the context of a meeting of four days in which a debate was held. These statements are the conclusions reached by agreement of the participant members. RESULTS: Screening should be performed women at high risk (diabetics, family history of inherited colon cancer, Lynch S. type II). Endometrial thickness in postmenopausal patients is best evaluated by transvaginal US, a thickness greater than or equal to 5 mm must be evaluated. Women taking tamoxifen should be monitored using this method. Abnormal bleeding in the usual main symptom, all post menopausal women with vaginal bleeding should be evaluated. Diagnosis is made by histerescopy-guided biopsy. Magnetic resonance is the best image method as preoperative evaluation. Frozen section evaluates histologic grade, myometrial invasion, cervical and adnexal involvement. Total abdominal hysterectomy, bilateral salpingo oophorectomy, pelvic and para-aortic lymphadenectomy should be performed except in endometrial histology grades 1 and 2, less than 50% invasion of the myometrium without evidence of disease out of the uterus. Omentectomy should be done in histologies other than endometriod. Surgery should be always performed by a Gynecologic Oncologist or Surgical Oncologist, laparoscopy is an alternative, especially in patients with hypertension and diabetes for being less morbid. Adjuvant treatment after surgery includes radiation therapy to the pelvis, brachytherapy, and chemotherapy. Patients with Stages III and IV should have surgery with intention to achieve optimal cytoreduction because of the impact on survival (51 m vs. 14 m), the treatment of recurrence can be with surgery depending on the pattern of relapse, systemic chemotherapy or hormonal therapy. Follow-up of patients is basically clinical in a regular basis. CONCLUSIONS: Screening programme is only for high risk patients. Multidisciplinary treatment impacts on survival and local control of the disease, including surgery, radiation therapy and chemotherapy, hormonal treatment is reserved to selected cases of recurrence. This is the first attempt of a Mexican Collaborative Group in Gynecology to give recommendations is a special type of neoplasm.

Staging, response to therapy, and restaging of lymphomas with 18F-FDG PET.

BACKGROUND: We undertook this study to determine the diagnostic accuracy of (18)FDG after three cycles and at the end of chemotherapy in non-Hodgkin's lymphoma (NHL) or Hodgkin's lymphoma (HL). We also evaluated the role of (67)Ga, bone marrow aspiration (BMA), and computed tomography (CT) in monitoring lymphoma treatment. METHODS: (18)FDG, (67)Ga, BMA, and CT were performed before chemotherapy on 40 untreated patients. (18)FDG and CT data were also obtained in 28/40 patients after 3 cycles of chemotherapy and at the end of chemotherapy. Patients had a median follow-up of 18 months, 21 had NHL, 7 had HL. Age range was from 15 to 74 years. Histopathology considered the standard reference at the initial stage. Follow-up was a comparative study of all exam results. RESULTS: Initial staging for PET and CT was as follows: sensitivity (Se) was 100%, specificity (Sp) 100%, positive predictive value (PPV) 100%, negative predictive value (NPV) 0%, and accuracy (Ac) 100%. (67)Ga was Se, 64%; Sp, 0%, PPV, 100%; and Ac, 64%. After the third cycle of chemotherapy and at the end of chemotherapy, Se, Sp, PPV, NPV, and Ac were always higher with PET than with CT. Eighteen patients had complete response, and seven had partial or no response. CONCLUSIONS: (18)FDG had greater prognostic values than CT after the third and last cycle of chemotherapy. PET after three cycles of chemotherapy is predictive of 18-month outcome in patients with intermediate and aggressive NHL and HL and may help in the identification of patients who would benefit from more intensive treatment or from a change in chemotherapy.

Testicular cancer in androgen insensitivity syndrome in a Mexican population.

Male pseudohermaphroditism and androgen insensitivity syndrome cases have an increased risk of developing testicular cancer due to many factors such as mutations, hormonal disturbances involving gonadotropins and cryptorchidism. We describe the clinical features, diagnosis and treatment of two cases with partial androgen insensitivity syndrome and testicular cancer development, which were handled at the National Cancer Institute of Mexico.

ECOG is as independent predictor of the response to chemotherapy, overall survival and progression-free survival in carcinoma of unknown primary site.

The aim of the present study was to determine whether age, gender, functional status, histology, tumor location, number of metastases, and levels of the tumor markers, lactate dehydrogenase (LDH) and albumin, are poor prognostic factors for the response to chemotherapy in patients with carcinoma of unknown primary site. A total of 149 patients diagnosed with carcinoma of unknown primary site that was histologically confirmed, and treated with chemotherapy in the Oncology Hospital, National Medical Center, 'Century XXI' IMSS, Mexico City, Mexico during the period between January 2002 to December 2009, were carefully selected for the present study. The analysis of 149 patients diagnosed with carcinoma of unknown primary site revealed that the liver was the organ with the highest frequency of metastases (33.5%). The objective response rates to chemotherapy were ~30.2%. Notably, ECOG was an important predictor of response to chemotherapy (P=0.008). The median progression-free survival was 7.1 months. Upon multivariate analysis, the Eastern Cooperative Oncology Group (ECOG) Scale of Performance Status was observed as an independent predictor of progression (P<0.0001). The median overall survival was 14.2 months. The ECOG was also an independent predictor of mortality (P<0.0001). In conclusion, the data from the present study have demonstrated that ECOG is an independent predictor of a poor response to chemotherapy, lower overall survival and progression-free survival in carcinoma of unknown primary site.

Prognostic, predictive and therapeutic implications of HER2 in invasive epithelial ovarian cancer.

The HER2 oncogene encodes a transmembrane protein partially homologous to epidermal growth factor receptor. This oncogene has been studied mainly in breast cancer where it has prognostic, predictive and therapeutic target value. The expression of HER2 in epithelial ovarian cancer has been less studied. HER2 expression can be determined through IHC, FISH, CISH and ELISA among other tests, with reported positivity frequencies of overexpression varying from 1.8% to 76%. In some studies HER2 overexpression has been associated with advanced stages, poorly differentiated tumors, resistance to chemotherapy and shortened survival. Although trastuzumab is able to produce a low response rate as a single agent in pretreated ovarian cancer patients with overexpression of HER2, its usefulness is limited due to the low frequency of strong expression. To date there is not enough bases for assessment and HER2-based therapies in epithelial ovarian cancer.

Reducing the global breast cancer burden: the importance of patterns of care research.

Breast cancer treatment guidelines are not uniformly followed in clinical practice, with evidence for substantial variations in treatment patterns, quality of care, and patient outcomes among and within countries. The factors that drive treatment decisions are unclear. Furthermore, the impact of different treatment strategies on survival is poorly understood outside the clinical trial setting. Sources of patterns of care information often have limitations in completeness, quality, timeliness of reporting, and relevance to the larger population. Patterns of care studies frequently lack details on cancer stage at diagnosis, tumor biology, and treatment received. It is difficult to compare data between studies and/or track changes over time because of variations in data sources and collection techniques. Thus, the design and implementation of a global registry is sorely needed in order to prospectively evaluate worldwide patterns of care and outcomes in patients with breast cancer. Components of this registry should include random selection of centers of variable practice settings in multiple countries and accurate and rapid data reporting at prestudy and follow-up timepoints. Data collected would include tumor and demographic factors, staging information, treatment rendered, and survival. Variables that influenced the treatment selected would be assessed. This unique international effort would allow the development of strategies to improve diagnostic and treatment-related standards of care and survival outcomes, thus reducing the breast cancer burden worldwide.

The global breast cancer burden: variations in epidemiology and survival.

Breast cancer is the most common type of cancer and the most common cause of cancer-related mortality among women worldwide. However, the burden is not evenly distributed, and, according to the best available data, there are large variations in the incidence, mortality, and survival between different countries and regions and within specific regions. Many complex factors underlie these variations, including population structure (eg, age, race, and ethnicity), lifestyle, environment, socioeconomic status, risk factor prevalence, mammography use, disease stage at diagnosis, and access to high-quality care. We review recent breast cancer incidence and mortality statistics and explore why these vary so greatly across the world. Further research is needed to fully understand the reasons for variations in breast cancer outcomes. This will aid the development of tailored strategies to improve outcomes in general as well as the standard of care for underserved populations and reduce the burden of breast cancer worldwide.

Randomized, open-label trial evaluating the preventive effect of tetracycline on afatinib induced-skin toxicities in non-small cell lung cancer patients.

BACKGROUND: Afatinib has shown long progression free survival and improvement in quality of life in advanced Non-Small Cell Lung Cancer (NSCLC) patients. Although afatinib causes acneiform rash, it can be manageable. Tetracyclines are usually used to treat it; nonetheless, there is no trial that evaluates their prophylactic efficacy on afatinib induced-skin toxicities (AIST). PATIENTS AND METHODS: This open-label, randomized, controlled trial assessed the preventive effect of tetracycline for reducing afatinib-skin toxicities in NSCLC patients receiving afatinib 40 mg/day. Patients were randomly assigned to receive pre-emptive treatment with tetracycline 250 mg every 12h for 4 weeks or not. Reactive treatment in both groups included general dermatological recommendations such as use of skin moisturizers, sunscreen and topical steroids, according to toxicity severity. All patients were blindly monitored for skin toxicities by an expert dermatologist at the start of treatment with afatinib (day 0), weeks 2 and 4 of treatment. The protocol is registered on clinicaltrials.gov (NCT01880515). RESULTS: We included 90 patients, no differences were found in clinical and dermatological baseline characteristics. Rash incidence of any grade, and grade ≥2 was less frequent in the pre-emptive arm vs. the control arm (44.5 vs. 75.6%, RR 0.4 [95% CI 0.17-0.99], p=0.046 and 15.6 vs. 35.6%, RR 0.35 [95% CI, 0.12-0.91], p=0.030, respectively). No difference was found in paronychia, xerosis, mucositis, folliculitis, and skin fissure. No adverse event was associated with tetracycline. Neither rash nor pre-emptive tetracycline impacted on response rate, progression-free or overall survivals. CONCLUSION: Pre-emptive tetracycline was well tolerated and reduced the rash incidence and severity associated with afatinib in more than 60%.

Primary lymphoma of bone.

UNLABELLED: Primary lymphoma of bone (PLB) is a rare clinical-pathological entity representing less than 1% of all lymphomas. This work was aimed to review the presentation characteristics of PLB at the Instituto Nacional de Cancerología including its management and evolution. MATERIAL AND METHODS: Thirty cases of lymphoma of bone were diagnosed between 1972 and 1999 from a database including 577 patients with lymphoma. Among them, only 8 patients (1.36% of the total lymphomas) met the criteria set out to be diagnosed as primary lymphoma of bone, stage IE. In all patients, diagnosis was histopathologically made through open biopsy, and they were classified in accordance with the former criteria of the Working Formulation (WF). This review applied the current criteria of the World Health Organization (WHO). RESULTS: Three women and five men with a mean age of 40 years (range 20-65) were identified. Mean physical performance (Karnofsky) was 80%. Six patients presented clinically evident disease of the affected region. The most frequent symptom was pain at the site of the lesion in 3 patients, being the cardinal symptom in 1 patient. Histological diagnosis was diffuse large cell lymphoma, and B immunophenotype was confirmed in 5 patients. Five patients received sequential chemotherapy and radiotherapy; 1 patient received chemotherapy; and 2 patients received exclusive radiotherapy. The chemotherapy regimes were based on anthracyclines. Five patients presented complete response and 3 patients showed progressive disease. One patient showing complete response relapse 16 years after the treatment. The mean follow-up in this series was 60 months (range 3-190 months). Tumor localization and functional condition of the patient were the best prognostic factors. Surgery was not therapeutic in any case. CONCLUSIONS: PLB still remains a rare clinical-pathological entity, and represented 1.3% of total lymphomas in this series. Sequential anthracycline-based chemotherapy and radiotherapy are the most important therapeutic choices. Functional condition of patients at diagnosis and tumor localization were the most accurate prognostic factors.

High liposomal doxorubicin tumour tissue distribution, as determined by radiopharmaceutical labelling with (99m)Tc-LD, is associated with the response and survival of patients with unresectable pleural mesothelioma treated with a combination of liposomal doxorubicin and cisplatin.

BACKGROUND: There are currently no available biomarkers for advanced pleural mesothelioma that determine which patients could benefit from a specific chemotherapy regimen. METHODS: Based on the results of a previously published phase II study, we associated the (99m)Technetium-labelled liposomal doxorubicin ((99m)Tc-LD) uptake value (75 % cut-off) with the response rate, progression-free survival and overall survival of patients treated with a combination of liposomal doxorubicin and cisplatin. RESULTS: Patients with tumours exhibiting increased (99m)Tc-LD uptake showed better response rates, progression-free survival and overall survival than those exhibiting lower uptake 73.3 versus 15 % (p < 0.001); 6.9 versus 3.2 months (p = 0.033) and 23 versus 6.6 months (p = 0.001), respectively. CONCLUSION: (99m)Tc-DL uptake in tumour tissue could define a set of patients who would benefit from this chemotherapy regimen.

Morbidity and mortality of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: national cancer institute, Mexico city, Mexico.

Peritoneal carcinomatosis (PC) is generally considered a lethal disease, with a poor prognosis. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as a new approach for peritoneal surface disease. This study investigated the early experience with this combined modality treatment at a single institute. From January 2007 to March 2010, 24 patients were treated After aggressive CS, with HIPEC (cisplatin 25 mg/m(2)/L and mitomycin C 3.3 mg/m(2)/L was administered for 90-minutes at 40.5° C). These data suggest that aggressive CRS with HIPEC for the treatment of PC may result in low mortality and acceptable morbidity. Rigorous patient selection, appropriate and prudent operative procedures were associated with encouraging results in our experience.

Estudio comparativo de granisetron versus metroclopramida/dexametasona en el tratamiento de emesis inducida por cisplatino / Granisetron versus metoclopramide/dexamethasone comparative study in emesis treatment for cisplatin therapy

El vómito y la náusea inducida por agentes citotóxicos frecuentemente limita la utilización de agentes efectivos pero emetizantes como el cisplatino. Este fue un estudio comparativo de Granisetron versus metoclopramida más dexametasona que evaluó la eficacia y efectos colaterales en las primeras 24 horas en ambos grupos. Se incluyeron 40 pacientes con diagnóstico de cáncer candidatos a recibir cisplatino a una dosis mayor de 49 mg/m2 con hoja de consentimiento informado. Se excluyeron pacientes que hubieran tenido náusea o vómito previo al tratamiento. Se administró Granisetron 40 m g/kg diluido en 20 mL de la solución salina para infusión intravenosa de cinco minutos previo a cisplatino en un grupo y en el otro se administró dexametasona 12 mg diluidos en 50 mL de solución salina para infusión de 30 minutos y metoclopramida 3 mg/kg I.V. en 30 minutos seguido de 4 mg/kg en infusión intravenosa para 8 hrs. Se consideró respuesta completa cuando los pacientes no tuvieron vómito ni náusea o sólo náusea leve. Hubo veintiún pacientes en el grupo de Granisetron y 19 en el grupo de tratamiento estándar. Obtuvimos respuesta completa (RC) del 66.6 por ciento en el grupo de Granisetron vs 73.68 por ciento en el grupo control, se presentó 20 por ciento de extrapiramidalismo de intensidad moderada en el grupo control (p=0.89), mientras que sólo el 9.5 por ciento del grupo de Granisetron presentó cefalea. Granisetron fue tan eficaz como la combinación con metoclopramida con la ventaja de tener muy pocos efectos adversos.

Quimioterapia neoadyuvante en el carcinoma epidermoide de cabeza y cuello. Experiencia en el Instituto Nacional de Cancerología / Neoadyuvant chemotherapy in squamous cell carcinoma of head and neck. Experience in the Instituto Nacional de Cancerologia

Con el objeto de identificar factores pronósticos de respuesta clínica completa en carcinoma epidermoide de cabeza y cuello localmente avanzado, se analziaron retrospectivamente los registros de 72 pacientess tratados en el periodo comprendido de enero de 1986 a diciembre de 1994 con quimioterapia neoadyuvante, utilizando el esquema de 5 FU-cisplatino. Se observó que en los pacientes con cuello clínicamente negativo a metástasis ganglionares y con tumores bien diferenciados fue posible obtener un mayor índice de respuestas clínicas mayores al 50 por ciento después del primer ciclo de quimioterapia. Los pacientes que respondieron a la quimioterapia neoadyuvante también tuvieron mejor respuesta a radioterapia. Concluimos que aquellos pacientes con respuesta parcial después del primer ciclo de quimioterapia deben completar tres ciclos de quimioterapia, ya que esto incrementa los porcentajes de casos con respuesta completa, hecho que mejoran la supervivencia y aumenta la probabilidad de conservar el órgano en donde se origina el tumor, conclusión no validada previamente. Por el contrario, en los casos con porcentajes menores de respuesta posterior al primer ciclo, deberán ser aplicados a otros esquemas de tratamiento con el objeto de ofrecer mejores resultados de los ya conocidos

Bioavailability of etoposide after oral administration of the solution marketed for intravenous use: Therapeutic and pharmacoeconomic perspectives

Background. Oral etoposide administration is a suitable alternative to the intravenous route; therefore, commercial capsules have been developed. Before these capsules were available in Mexico, we studied drug bioavailability after oral administration of the intravenous etoposide solution (IVES). Methods. Eight adult cancer patients received a 50-mg oral etoposide dose as IVES and blood samples were collected over a period of 24 h. plasma etoposide concentration was determined by high-performance liquid chromatography, plasma concentration against time curves were constructed, and biovailability parameters were calculated. Results. Oral IVES yielded an adequate bioavailability profile because Cmax was 2.38 ñ 0.30 µg/mL, AUC was 12.87 ñ 2.02 µg/mL and half-life was 6.72 ñ 0.97 h. Conclusions. Considering that the pharmacokinetic aim is to maintain plasm concentrations between 0.5 and 1.0 µg/mL for several hours while avioding high concentrations, i.e., of 10 µg/mL or higher, oral administration of 50-mg etoposide as IVES appears to be a suitable dosing option. In addition, oral IVES is considerably less expensive than intravenous administration in terms of both drug presentation and administration