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1.
Curr Treat Options Oncol ; 17(9): 49, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27461038

RESUMO

OPINION STATEMENT: At the time of glioblastoma (GBM) recurrence, a sharp analysis of prognostic factors, disease characteristics, response to adjuvant treatment, and clinical conditions should be performed. A prognostic assessment could allow a careful selection between patients that could be proposed to intensified approaches or palliative setting. Participation in clinical trials aims to improve outcome, and should be encouraged due to dismal prognosis of GBM patients after recurrence. Reoperation should be proposed if the tumor is amenable to a complete resection and if prognostic factors suggest that patient could benefit from a second surgery. Second-line chemotherapy should be chosen based on MGMT status, time to disease recurrence, and toxicity profile. If enrollment into a clinical trial is not possible, a nitrosourea-based regimen is the preferred choice, carefully evaluating any previous temozolomide (TMZ)-related toxicity. In MGMT-methylated patients relapsing after TMZ completion, a rechallenge could be proposed. After second progression, the clinical advantage of subsequent lines of chemotherapy still needs to be clarified. However, based on performance status, patients' preference, and disease behavior, a third-line treatment could be considered. Available treatments include nitrosoureas, bevacizumab, or carboplatin plus etoposide. However, more effective therapeutic options are needed.


Assuntos
Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/terapia , Glioblastoma/patologia , Glioblastoma/terapia , Neoplasias Encefálicas/mortalidade , Terapia Combinada/métodos , Glioblastoma/mortalidade , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Retratamento , Resultado do Tratamento
2.
Future Oncol ; 12(8): 1039-44, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26880307

RESUMO

BACKGROUND: The most appropriate management of recurrent glioblastoma is still controversial. In particular, the role of surgery at recurrence remains uncertain. PATIENTS & METHODS: From our Institutional data warehouse we analyzed 270 consecutive patients who received second surgery for recurrent glioblastoma, to assess survival after second surgery, and to evaluate prognostic factors. RESULTS: Complete resection was found in 128 (47.4%) and partial resection in 142 patients (52.6%). Median survival from second surgery was 11.4 months (95% CI: 10.0-12.7). Multivariate analysis showed that age (p = 0.001), MGMT methylation (p = 0.021) and extent of surgery (p < 0.001) are associated with better survival. CONCLUSION: A complete resection should be the goal for second resection and younger age and MGMT methylation status might be considered in the selection of patients.


Assuntos
Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Glioblastoma/patologia , Glioblastoma/cirurgia , Adolescente , Adulto , Idoso , Biomarcadores Tumorais , Neoplasias Encefálicas/mortalidade , Terapia Combinada , Metilação de DNA , Metilases de Modificação do DNA/genética , Enzimas Reparadoras do DNA/genética , Gerenciamento Clínico , Feminino , Glioblastoma/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Prognóstico , Retratamento , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Proteínas Supressoras de Tumor/genética , Adulto Jovem
3.
Oncologist ; 20(2): 166-75, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25568148

RESUMO

Bevacizumab, currently an option for treatment of different types of tumors including glioblastoma, has a peculiar toxicity profile related to its antiangiogenic effect. Because some bevacizumab-related adverse events can be life threatening, it is important to identify risk factors and to establish treatment protocols to minimize treatment-related morbidity and mortality. In glioblastoma patients, the risk of developing certain side effects, such as gastrointestinal perforation, venous thromboembolism, and intracranial hemorrhages, is slightly higher than in patients treated with bevacizumab for other tumor types. We performed a systematic review of the side effects of bevacizumab and their incidence, causal mechanisms, and available treatments. Finally, we identified risk factors and proposed preventive and therapeutic measures for these adverse events.


Assuntos
Bevacizumab/efeitos adversos , Glioblastoma/tratamento farmacológico , Tromboembolia Venosa/patologia , Inibidores da Angiogênese , Bevacizumab/administração & dosagem , Gerenciamento Clínico , Glioblastoma/patologia , Humanos , Tromboembolia Venosa/induzido quimicamente
4.
J Neurooncol ; 121(2): 399-404, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25366365

RESUMO

The optimal end point for phase II studies for recurrent glioblastoma (GBM) is unclear and a matter of debate. Moreover, data about post-progression survival (PPS) after the first disease progression in GBM patients treated according to EORTC 26981/22981/NCIC CE.3 trial are limited. The aim of this study was to evaluate the PPS in GBM patients. The analysis was made with a database on 1,006 GBM patients followed prospectively between 06/2005 and 06/2010. Eligibility criteria for the study were: age ≥ 18 years; PS: 0-2; chemotherapy given at disease progression after RT/TMZ. 232 patients (mean age 52 years, range 18-77 years) were enrolled. The median PFS following second line chemotherapy (PFS2) was 2.5 months (95 % CI 2.1-2.9) and the rate of patients free of progression at 6 months (PFS2-6 mo), was 21.6 % (95 % CI 16.3-26.9 %). The median PPS was 8.6 months (95 % CI 7.4-9.8), PPS rates were: PPS-6: 66 % (95 % CI 60.3-72.9 %), PPS-9: 48.2 % (95 % CI 41.5-54.9 %) and PPS-12: 31.7 % (95 % CI 25.2-38.2 %). PPS in unselected patients treated with alkylating agents is about 8 months. PPS rates could be of interest as an end point in future studies in recurrent GBM.


Assuntos
Neoplasias Encefálicas/terapia , Glioblastoma/terapia , Avaliação de Resultados em Cuidados de Saúde/métodos , Adolescente , Adulto , Idoso , Neoplasias Encefálicas/genética , Terapia Combinada , Metilação de DNA , Metilases de Modificação do DNA/genética , Enzimas Reparadoras do DNA/genética , Bases de Dados Factuais , Progressão da Doença , Intervalo Livre de Doença , Determinação de Ponto Final , Feminino , Glioblastoma/genética , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Proteínas Supressoras de Tumor/genética , Adulto Jovem
5.
Future Oncol ; 10(8): 1417-25, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25052752

RESUMO

Angiogenesis is a key process for tumoral growth, which has become a main target for anticancer treatments. A wide number of agents targeting both VEGF and its receptor have recently become standard treatments for different tumor types. Unfortunately, most of the tumors become resistant to these agents after few months of treatment. Different mechanisms of resistance to antiangiogenic drugs have been proposed and investigated; some agents demonstrated to be able to restore sensitivity to antiangiogenic drugs by blocking pathways or molecules involved in the resistance in preclinical models. Biomarkers for the prediction of response or resistance to antiangiogenic agents are under evaluation.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Antineoplásicos/uso terapêutico , Resistencia a Medicamentos Antineoplásicos , Neoplasias/tratamento farmacológico , Biomarcadores , Carcinoma de Células Renais/tratamento farmacológico , Carcinoma de Células Renais/metabolismo , Carcinoma de Células Renais/patologia , Glioblastoma/tratamento farmacológico , Glioblastoma/metabolismo , Glioblastoma/patologia , Humanos , Neoplasias/metabolismo , Neoplasias/patologia , Neovascularização Patológica/tratamento farmacológico , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
6.
Explore (NY) ; 12(1): 42-9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26657031

RESUMO

CONTEXT: Tong Len meditation is an important therapeutic tool in the Tibetan medicine, and it can be used for self-healing and/or to heal others. Currently, in the West, there is no scientific study concerning the efficacy of a Tong Len distant healing effect on psychological disorders in cancer patients. OBJECTIVES: To evaluate a distant healing effect of Tong Len meditation on stress, anxiety, depression, fatigue, and self-perceived quality of life in cancer patients. These psychological objectives were chosen as a consequence of the limited scientific literature of present day. DESIGN: We performed a double-blind randomized controlled trial on 103 cancer patients with tumors. Overall, 12 meditators used Tong Len in aid of 52 patients randomly selected as experimental group, while the remaining 51 patients constituted the control group. Patients and meditators did not know each other. All patients completed profile of mood states (POMS) and European Quality of Life-5 dimensions (EQ-5D) questionnaires before treatment (T0), after two (T1) and three months of treatment (T2), and one month after treatment cessation (T3). RESULTS: With regard to the parameters related to depression, a statistically significant improvement (P = .003) was observed in the treatment group compared to controls. On the other hand, the vigor/activity parameter saw significant improvements in the control group (P = .009). Both groups exhibited significant improvements in the other factors assessed in the POMS and EQ-5D questionnaires. CONCLUSIONS: This study did not provide sufficient evidence supporting an efficacy of Tong Len meditation in distant psychological healing as compared to a control condition. The research highlighted some psychological improvements through Tong Len distant meditation in a group of patients unknown to meditators. Therefore, the enhancement detected in most parameters in both treatment and control groups raises interest on in-depth analysis and evaluation of distant meditation on cancer patients to mitigate psychological problems caused by the disease.


Assuntos
Ansiedade , Depressão , Fadiga , Meditação , Neoplasias/psicologia , Qualidade de Vida , Estresse Psicológico , Afeto , Idoso , Ansiedade/terapia , Depressão/terapia , Método Duplo-Cego , Empatia , Fadiga/terapia , Feminino , Humanos , Intenção , Masculino , Pessoa de Meia-Idade , Estresse Psicológico/terapia , Inquéritos e Questionários , Tibet , Resultado do Tratamento
7.
Expert Rev Anticancer Ther ; 14(1): 93-103, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24308678

RESUMO

For many years, brain metastases (BMs) have been considered as the final stage of a disease course and engendered skepticism about the efficacy of treatments. Local treatments, mainly, whole-brain radiotherapy have been the standard of care, whereas chemotherapy has been considered of limited efficacy due to the potential role of blood-brain barrier.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Encefálicas/terapia , Terapia de Alvo Molecular , Antineoplásicos/administração & dosagem , Antineoplásicos/farmacocinética , Barreira Hematoencefálica/metabolismo , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/secundário , Desenho de Fármacos , Humanos
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