RESUMO
INTRODUCTION: Prostate cancer (PCa) is the most common cancer amongst men in 2018 in Europe. The issue of PCa screening in the general population has been debated following the publication of international European (ERSPC) and North American (PLCO) studies. There is currently no organised PCa screening. The objective of this analysis was to evaluate the practice of PCa screening in the French population with no history of cancer between 2005 and 2016. METHODS: Since 2005, the EDIFICE surveys have focused on the knowledge and behaviour of French people with regard to cancer screening. The practice of screening was evaluated according to the answer to the question: "Have you ever done PCa screening?" Responses were analysed according to age, socio-professional category and level of social precariousness. RESULTS: After a strong increase between 2005 and 2008 (from 36% to 49%, P≤0.01), a significant decrease in the reported PCa screening rate was observed between 2014 (49%) and 2016 (42%; P=0.02). This decrease was mainly reflected in the socially advantaged categories and in the youngest age group (50-54 years). Screening practices remain the same in older men. CONCLUSION: The perception of the effectiveness of PCa screening could explain the changes of behavior in the French population. This decrease in participation in PCa screening requires monitoring to avoid a general loss of confidence in cancer screening. LEVEL OF EVIDENCE: 3.
Assuntos
Detecção Precoce de Câncer , Conhecimentos, Atitudes e Prática em Saúde , Neoplasias da Próstata/diagnóstico , Idoso , França , Comportamentos Relacionados com a Saúde , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: The incidence of skin cancers, melanoma in particular, is increasing rapidly. Consequently, specific recommendations for sun-protection measures now exist. This survey set out to assess the compliance of the general population with these guidelines. METHODS: The French nationwide observational survey, EDIFICE Melanoma, was conducted (28 September to 20 October 2011) through phone interviews of a representative sample of 1502 subjects aged ≥ 18 years, using the quota method. Sun-protection was defined as frequent or systematic use of clothes or sunscreen. The group of individuals who declared exposure to the sun (N = 1172) was subdivided: risk-takers (N = 442), and those who used sun protection (N = 730). RESULTS: Risk-takers were significantly more often male (62% vs. 44%, P < 0.01), had a lower level of education (40% vs. 26%, P < 0.01), lower incomes (2587 euros vs. 2948 euros/month) and were more often smokers (42% vs. 31%, P < 0.01). In contrast, age, marital status and use of sunbeds were not significantly different between the two groups. Interestingly, risk-takers had less risk factors for melanoma. However, they were less well-informed about high-risk exposure and optimal use of sunscreen. Sun-protection measures for their children were less stringent than those of the group who used sun protection: systematic/frequent use of sunglasses (42% vs. 59%, P < 0.01), systematic use of sunscreen (77% vs. 86%, P < 0.01), and frequent renewal (69% vs. 82%, P < 0.01), high sun protection factors (SPF) (46% vs. 56%, P < 0.01), use of clothing (84% vs. 92%, P < 0.01) and hats (88% vs. 94%, P < 0.01). CONCLUSIONS: Risk-takers are characterized by a lesser understanding of sun-protection measures and behaviours. Their children benefit less from protective measures than those of people who use sun protection themselves. Improved understanding may well improve behaviours; one can therefore legitimately predict a considerable impact on parents' attitude to their own protection and that of their children.
Assuntos
Pai , Melanoma/epidemiologia , Neoplasias Cutâneas/epidemiologia , Adolescente , Criança , Óculos , França/epidemiologia , Humanos , Masculino , Melanoma/prevenção & controle , Roupa de Proteção , Fatores de Risco , Neoplasias Cutâneas/prevenção & controle , Protetores SolaresRESUMO
Incidence of colorectal cancers (CRCs) increases with age. The surgical and medical management of elderly patients needs to be improved. Until recently, these patients were not included into controlled clinical trials. Between 2004 and 2007, 88 patients (median age 79) had surgery for CRC in our hospital. In half the cases, patients had an emergency surgery (40/88). Twenty patients had dementia, with no relationships between dementia and emergency surgery (50% vs. 45% for patients without dementia), nor between dementia and median length of hospital stay (16 days vs. 22 days). In metastatic setting (20 patients), chemotherapy was omitted in 10 cases, usually patients with dementia (5 patients; p = 0.002) Standard therapy was hardly applicable because many patients were frail. In the future, usefulness of participation to the staffs of a geriatrist will be assessed prospectively.
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Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/cirurgia , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante , Estudos de Coortes , Neoplasias Colorretais/tratamento farmacológico , Feminino , Humanos , Masculino , Complicações Pós-Operatórias , Estudos RetrospectivosRESUMO
INTRODUCTION: Dermatological effects are among the most frequent side-effects in patients receiving erlotinib (Tarceva). However, there no official recommendations on the preventive or curative management of those erlotinib-related skin effects (ERSE). The "Prise En Charge des Effets Dermatologiques sous Erlotinib" (PRECEDE) study was designed to study how ERSE are being managed in France. MATERIAL AND METHODS: The PRECEDE study is an observational retrospective study which included every nonsmall cell lung cancer patients treated with erlotinib in seven cancer centers in France from January 2005 to December 2007. Data related to preventive or curative treatment of ERSE were collected from the medical files of the patients. RESULTS: Two hundred and thirty-four patients were included; 48.7% of them had been delivered information on the potential occurrence of ERSE and 15.8% of those 234 patients had had prescription of drugs to be taken in case of ERSE, while 65.0% presented with ERSE which resolved in the majority of cases (86.2% of the patients), either spontaneously or under treatment. In the 85 patients in whom treatment was successful, 178 drug prescriptions comprising 35 different drugs were recorded. CONCLUSION: ERSE are frequent but regress in most cases, spontaneously or under treatment. However, there is still a wide variety of drugs used. This demonstrates that there is a need for recommendations on the management of ERSE in order to prevent and treat this erlotinib-related effect.
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Toxidermias/etiologia , Inibidores de Proteínas Quinases/efeitos adversos , Quinazolinas/efeitos adversos , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Cloridrato de Erlotinib , Feminino , França , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Inibidores de Proteínas Quinases/administração & dosagem , Quinazolinas/administração & dosagemRESUMO
INTRODUCTION: The practices of screening and the parameters influencing these practices are not well known in France. The objectives of the Edifice study were to analyze a large cohort of patients and doctors in order to further characterize these parameters. PATIENTS AND METHODS: The study was performed by the Institute TNS Healthcare-SOFRES, and included 2 parallel studies: 1) on 1 609 healthy persons representative of the global French population and aged 40 to 75 years (N = 1 509), with an over representation of patients aged 50 to 74 years living in the 22 pilot French departments pilots; 2) on 600 generalist practitioners. Data were collected and analyzed by the expert panel... RESULTS: Ninety-three, 25, 36 and 6% of the patients in the general population declared to have performed at least one a screening exam for breast, colon, prostate, and lung carcinoma respectively. Seventy, 20, 60 and 4% of GP declare to propose systematically to a 40-75-year-old patient a screening test for breast, colon, prostate, or lung cancer. For breast cancer screening the adhesion of the GP is independent of the date of implementation of a general screening in their own regions, while for colorectal screening, 34 and 20% of the patients living in the pilot versus other departments were screened. Overall, prostate cancer screening is recommended by the GP panel for 77.1% of patients aged 50 to 75 years. CONCLUSIONS: This study shows a good adhesion of screening procedures for GP and patients, shows that screening is improved by general screening policy in colorectal cancer, but that prostate cancer screening practices exceed what is recommended according to evidence based medicine.
Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias do Colo/diagnóstico , Medicina de Família e Comunidade , Neoplasias Pulmonares/diagnóstico , Neoplasias da Próstata/diagnóstico , Neoplasias Retais/diagnóstico , Adulto , Fatores Etários , Idoso , Neoplasias da Mama/epidemiologia , Neoplasias do Colo/epidemiologia , Feminino , França/epidemiologia , Humanos , Neoplasias Pulmonares/epidemiologia , Masculino , Mamografia/normas , Mamografia/estatística & dados numéricos , Pessoa de Meia-Idade , Neoplasias da Próstata/epidemiologia , Neoplasias Retais/epidemiologia , Fatores SexuaisRESUMO
Erythopoietin (EPO) treatment of anemia during cancer has dramatically improved the tolerance of chemotherapy and quality of life of patients at all stages of the disease. Several surveys have demonstrated a high prevalence and a high incidence of anemia in lung cancer patients. The guidelines updates concerning EPO treatment for these patients are described. They take into account the debate concerning the potential harm of these molecules on the neoplastic disease and the possible role of EPO receptors expressed by several tumors, including non small cell lung cancer.
Assuntos
Anemia/tratamento farmacológico , Eritropoetina/uso terapêutico , Neoplasias Pulmonares/fisiopatologia , Anemia/induzido quimicamente , Anemia/psicologia , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Progressão da Doença , Relação Dose-Resposta a Droga , Esquema de Medicação , Eritropoetina/efeitos adversos , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/psicologia , Guias de Prática Clínica como Assunto , Qualidade de Vida/psicologia , Proteínas Recombinantes , Fatores de RiscoRESUMO
BACKGROUND: The EDIFICE survey aimed to investigate the compliance of the general population to the screening tests available in France for the 4 most common cancers: breast, colorectal, prostate and lung. Implementation of breast cancer screening has been generalized in France since 2003: women aged between 50 and 74 years are systematically invited to perform a mammography every second year. Results pertaining to breast cancer are reported hereafter. METHODS: This nationwide observational survey was carried out in France from 18 January to 2 February 2005 among representative samples of 773 women aged between 40 and 75 years and 600 general practitioners (GPs). Information collected included socio-demographic characteristics, attitude towards cancer screening and actual experience of cancer screening, as well as GPs' practice regarding screening. The precision of the results is +/- 4.3% for a 95% confidence interval. RESULTS: Among the 507 participating women aged between 50 and 74 years, 92.5% (469/507) had undergone at least one mammography: 54.6% (256/469) underwent this test on their own initiative and 44.6% (209/469) of women performed it in the framework of a systematic screening plan. Most women participating in the systematic screening (89.0% i.e. 186/209) had a mammography within the last dating from less than 2 years versus 73.8% (189/256) of those who performed it outside the screening program (Chi(2) test; p<0.01). Interestingly, 422 women (61.9% i.e. 422/682 women aged between 40-75 years with at least one mammography) had performed a mammography before the recommended age for screening. There was a significant correlation (p = 0.009) between the existence of a first mammography before 50 years of age and subsequent screening on women's own initiative (54.6% of 469 screened women). Main reasons for not performing the screening test every second year (77 women aged between 50-74 years) included: feeling unconcerned and/or unmotivated (p = 0.0001), no cancer anxiety (p = 0.020) and no recommendation by the GP (p = 0.015); Of the 600 participating GPs, 68.6% (412/600) systematically recommended a mammography to their patients. GPs' perceptions of the reasons for women's avoidance of the screening test were unwillingness to be aware of mammography results (44.4% - 266/600) and the belief that mammography was painful (52.5% - 315/600). CONCLUSION: The main result of the EDIFICE survey is the high rate of women's attendance at mammography screening. The EDIFICE survey pointed out that systematic and organized screening played a major role in the regularity of screening tests for breast cancer every second year. GPs and gynaecologist are key actors in heightening public awareness.
Assuntos
Neoplasias da Mama/diagnóstico , Programas de Rastreamento/métodos , Adulto , Idoso , Atitude Frente a Saúde , Feminino , França , Ginecologia/métodos , Humanos , Mamografia/métodos , Oncologia/métodos , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Distribuição TecidualRESUMO
AIMS: The Epidermal Growth Factor-Receptor (EGF-R) is frequently overexpressed in colorectal carcinoma (CRC) and patients can benefit from anti-EGF-R therapy. Yet, the relationship, within tumours, between EGF-R and the activity of downstream effectors such as the non-receptor tyrosine kinase p60c-src and the signal transducer and activator of transcription 3 (STAT3) has not been extensively analyzed. METHODS AND RESULTS: We evaluated EGF-R, tyrosine 416-phosphorylated p60c-src (P-p60c-src), STAT3 and tyrosine 705-phosphorylated STAT3 (P-STAT3) on Tissue Micro Array (TMA) from 126 patients with CRC. Composite immunohistochemistry scores based on the intensity of labelling and the percentage of positive cells were determined on TMA for EGF-R, P-p60c-src, STAT3 and P- STAT3. A high score was found in 56%, 61%, 62% and 27% of the cases for EGF-R, P-p60c-src, STAT3 and P-STAT3 respectively. There was a significant correlation between EGF-R and P-p60c-src (p=0.006) and between P-p60c-src and P-STAT3 (p=0.0009). STAT3 was significantly correlated with vascular emboli (p=0.03) and perineural invasion (p=0.02). CONCLUSIONS: The correlations between EGF-R, P-p60-src and P-STAT3 and some stage-related pathological features point to a critical role for a EGF-R-connected p60c-src-kinase-mediated pathway involving STAT3 and contributing to cell survival and proliferation within CRC tumours.
Assuntos
Neoplasias Colorretais/metabolismo , Receptores ErbB/metabolismo , Proteínas Proto-Oncogênicas pp60(c-src)/metabolismo , Fator de Transcrição STAT3/metabolismo , Transdução de Sinais/fisiologia , Idoso , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Humanos , Imuno-Histoquímica , Estadiamento de Neoplasias , Fosforilação , Prognóstico , Análise Serial de Tecidos , Tirosina/metabolismoAssuntos
Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/radioterapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Junção Esofagogástrica , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/radioterapia , Adulto , Camptotecina/análogos & derivados , Camptotecina/uso terapêutico , Quimioterapia Adjuvante , Fluoruracila/uso terapêutico , Humanos , Leucovorina/uso terapêutico , Pessoa de Meia-IdadeRESUMO
Patients with poor performance status (PS) and advanced lung cancer have been underrepresented in clinical trials. As a consequence, the management of these patients in clinical practice is often empirical. Recent data indicate that patients with advanced non-small cell lung cancer (NSCLC) and a PS of 2 tend to benefit from first line chemotherapy with respect to symptom improvement and perhaps overall survival. Whether single-agent or combination chemotherapy is preferable remains debatable. In previously treated patients with NSCLC, EGFR tyrosine kinase inhibitors produced a substantial rate of clinical benefit and led to an improvement in survival compared with placebo in studies that included a significant percentage of patients with poor PS.
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Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/patologia , Humanos , Neoplasias Pulmonares/patologia , Estadiamento de Neoplasias , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Carcinomatous meningitis is a major complication in Non Small Cell Lung Cancer (NSCLC). Despite treatment with radiotherapy alone or in combination with intrathecal and systemic chemotherapy, its prognosis remains poor. OBSERVATION: We report a case of a female non-smoker with adenocarcinoma with bronchoalveolar features presenting with carcinomatous meningitis three years after the diagnosis of her primary tumour. Gefitinib treatment was proposed because of the persistence of meningitic symptoms despite cranial irradiation. Clinical response was observed within 3 weeks and lasted for 9 months. CONCLUSION: Gefitinib may be effective in treating carcinomatous meningitis complicating NSCLC and should be considered in this situation given the absence of effective alternatives.
Assuntos
Adenocarcinoma Bronquioloalveolar/tratamento farmacológico , Antineoplásicos/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Quimioterapia Adjuvante , Neoplasias Pulmonares/patologia , Meningite/tratamento farmacológico , Inibidores de Proteínas Quinases/uso terapêutico , Quinazolinas/uso terapêutico , Adenocarcinoma Bronquioloalveolar/patologia , Adenocarcinoma Bronquioloalveolar/radioterapia , Carboplatina/administração & dosagem , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Cisplatino/administração & dosagem , Terapia Combinada , Irradiação Craniana , Receptores ErbB/antagonistas & inibidores , Feminino , Gefitinibe , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/cirurgia , Meningite/radioterapia , Pessoa de Meia-Idade , Proteínas de Neoplasias/antagonistas & inibidores , Paclitaxel/administração & dosagem , Cuidados Paliativos , Pneumonectomia , Vimblastina/administração & dosagem , Vimblastina/análogos & derivados , VinorelbinaRESUMO
We performed a meta-analysis of all published studies relating intratumoural microvessel density (MVD) (45 studies) or vascular endothelial growth factor (VEGF) expression (27 studies), both reflecting angiogenesis, to relapse free (RFS) and overall survival (OS) in colorectal cancer (CRC). For each study, MVD impact was measured by risk ratio between the two survival distributions with median MVD as cutoff. Eleven studies did not mention survival data or fit inclusion criteria, six were multiple publications of same series, leaving 32 independent studies for MVD (3496 patients) and 18 for VEGF (2050 patients). Microvessel density was assessed by immunohistochemistry, using antibodies against factor VIII (16 studies), CD31 (10 studies) or CD34 (seven studies). Vascular endothelial growth factor expression was mostly assessed by immunohistochemistry. Statistics were performed for MVD in 22 studies (the others lacking survival statistics) including nine studies (n = 957) for RFS and 18 for OS (n = 2383) and for VEGF in 17 studies, including nine studies for RFS (n = 1064) and 10 for OS (n = 1301). High MVD significantly predicted poor RFS (RR = 2.32 95% CI: 1.39-3.90; P < 0.001) and OS (RR = 1.44; 95% CI: 1.08-1.92; P = 0.01). Using CD31 or CD34, MVD was inversely related to survival, whereas it was not using factor VIII. Vascular endothelial growth factor expression significantly predicted poor RFS (RR = 2.84; 95% CI: 1.95-4.16) and OS (RR=1.65; 95% CI: 1.27-2.14). To strengthen our findings, future prospective studies should explore the relation between MVD or VEGF expression and survival or response to therapy (e.g. antiangiogenic therapy). Assessment of these angiogenic markers should be better standardised in future studies.
Assuntos
Adenocarcinoma/irrigação sanguínea , Adenocarcinoma/mortalidade , Neoplasias Colorretais/irrigação sanguínea , Neoplasias Colorretais/mortalidade , Neovascularização Patológica , Fator A de Crescimento do Endotélio Vascular/biossíntese , Adenocarcinoma/metabolismo , Idoso , Antígenos CD34/biossíntese , Capilares , Neoplasias Colorretais/metabolismo , Intervalo Livre de Doença , Fator VIII/biossíntese , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Molécula-1 de Adesão Celular Endotelial a Plaquetas/biossíntese , Prognóstico , Análise de Sobrevida , Taxa de SobrevidaRESUMO
BACKGROUND: This multicenter, randomized, phase III study compared the efficacy, including progression-free survival (PFS), and safety of gemcitabine-docetaxel (GD) combination versus cisplatin-vinorelbine (CV) in the treatment of advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Chemonaive patients with stage IIIB or IV NSCLC were treated with GD (gemcitabine 1000 mg/m(2) days 1 and 8 plus docetaxel 85 mg/m(2) day 8, every 3 weeks for eight cycles) or CV (cisplatin 100 mg/m(2) day 1 plus vinorelbine 30 mg/m(2), days 1, 8, 15 and 22, every 4 weeks for six cycles). RESULTS: A total of 311 patients were enrolled (155 GD and 156 CV). Neither PFS nor overall survival differed significantly between the two arms (median PFS 4.2 and 4 months; median survival 11.1 and 9.6 months; 1-year survival 46% and 42%, for GD and CV, respectively). For the GD arm compared with the CV arm, the hazard ratio for PFS was 1.04 [95% confidence interval (CI) 0.83-1.32], and for overall survival, it was 0.90 (95% CI 0.70-1.16). Objective response rates did not differ significantly (31% for GD, 35.9% for CV). Myelosupression, emesis and frequency of febrile neutropenia were less pronounced on the GD arm, whereas fluid retention and pulmonary events were more pronounced. The CV arm experienced a higher number of serious adverse events and a lower compliance with the protocol. There was no quality of life (QoL) difference between arms. Median time to definite impairment of health-related QoL was 153 and 168 days in GD and CV arms, respectively. CONCLUSIONS: There was no advantage in PFS with GD compared with CV; however, the CV regimen had higher rate of toxic events, mainly myelosuppression. The herein, non-platinum-containing regimen could be considered as a rational alternative to the cisplatin-based doublet.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Cisplatino/administração & dosagem , Desoxicitidina/análogos & derivados , Neoplasias Pulmonares/tratamento farmacológico , Vimblastina/análogos & derivados , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carcinoma Pulmonar de Células não Pequenas/secundário , Cisplatino/efeitos adversos , Desoxicitidina/administração & dosagem , Desoxicitidina/efeitos adversos , Docetaxel , Feminino , Doenças Hematológicas/induzido quimicamente , Humanos , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida , Taxoides/administração & dosagem , Taxoides/efeitos adversos , Vimblastina/administração & dosagem , Vimblastina/efeitos adversos , Vinorelbina , GencitabinaRESUMO
BACKGROUND: Epidermal growth factor receptor (EGFR) is overexpressed in many types of cancers, especially colorectal cancer (CRC), and seems to reflect more aggressive histological and clinical behaviors. The aim of this study was to evaluate EGFR immunohistochemical reactivity in CRC biopsies, and to analyze its relationship with various histological and clinical characteristics and survival. PATIENTS AND METHODS: A composite EGFR score, obtained by multiplying the grade (% positive cells) by the intensity of labeling (0-9) was used to define patients with low or high EGFR expression whose clinicopathological features were then compared. Univariate tests and multivariate Cox proportional hazards model were applied for data analysis. RESULTS: Tissue sections from 150 CRC patients with a median follow-up of 40 months were examined. Median patient age at diagnosis was 70 years (range 38-89 years). EGFR reactivity was positive for 143 patients (97%) and high for 118 (80%). According to multivariate analysis, EGFR overexpression was significantly associated with tumor stage, with a higher percentage of EGFR overexpression in T3 than T4 (P=0.003) and not with overall survival. CONCLUSIONS: EGFR was overexpressed in this CRC patient population and was significantly associated with TNM (tumor-node-metastasis) stage T3. In the context of a new therapeutic strategy using EGFR-targeted therapies, although EGFR remains a controversial prognostic factor, this expression-stage association may play a crucial role in a decision to initiate an adjuvant treatment.
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Neoplasias Colorretais/genética , Neoplasias Colorretais/patologia , Receptores ErbB/biossíntese , Adulto , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisões , Receptores ErbB/análise , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Prognóstico , Valores de Referência , Análise de SobrevidaRESUMO
Treating patients with anthracycline- and taxane-pretreated metastatic breast cancer (MBC) represents a significant challenge to oncologists. The tumour-activated oral fluoropyrimidine, capecitabine, is the only treatment approved for these patients. Our study evaluated the efficacy, safety and impact on quality of life (QOL) of capecitabine in this setting. Patients (n=126) with anthracycline- and taxane-pretreated metastatic breast cancer received capecitabine 1250 mg/m(2) twice daily, days 1-14, followed by a 7-day rest period. Median time to progression was 4.9 months (95% Confidence Interval (CI): 4.0-6.4). Thirty-five patients (28%) achieved an objective response (95% CI: 20-36%), including five (4%) complete responses. Median overall survival was 15.2 months (95% CI: 13.5-19.6 months). Capecitabine demonstrated a favourable safety profile, with a low incidence of treatment-related grade 3/4 adverse events. The most common adverse events were hand-foot syndrome and gastrointestinal effects. QOL assessment showed that capecitabine treatment was associated with an increase in mean Global Health Score. Capecitabine is active, well tolerated and improves the QOL of patients with anthracycline- and taxane-pretreated metastatic breast cancer. Based on the consistently high activity demonstrated in clinical trials, capecitabine has become the reference treatment in this setting.
Assuntos
Antimetabólitos Antineoplásicos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Desoxicitidina/análogos & derivados , Desoxicitidina/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antraciclinas/uso terapêutico , Hidrocarbonetos Aromáticos com Pontes/uso terapêutico , Capecitabina , Intervalo Livre de Doença , Resistencia a Medicamentos Antineoplásicos , Feminino , Fluoruracila/análogos & derivados , Seguimentos , Humanos , Pessoa de Meia-Idade , Metástase Neoplásica , Qualidade de Vida , Taxoides/uso terapêutico , Resultado do TratamentoAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Guanina/análogos & derivados , Mesotelioma/patologia , Mesotelioma/terapia , Cisplatino/administração & dosagem , Terapia Combinada , Glutamatos/administração & dosagem , Guanina/administração & dosagem , Humanos , Incidência , Pemetrexede , PrognósticoRESUMO
Endometrial stromal sarcoma (ESS) is a rare neoplasm, mainly observed in premenopausal women. We describe two women 44 and 34 years old at the time ESS diagnosis, who developed lung metastases 3 and 6 years, respectively, after initial treatment: hysterectomy without (case 1) or with oophorectomy (case 2), followed by hormone replacement therapy (HRT) for the latter. Their estrogen (ER) and progesterone receptors (PR) were analyzed biochemically in metastatic lung tissue, yielding respective concentrations of ER 242 and 184, and PR 910 and 100 fmol/mg of cytosol protein. Both patients started treatment with the aromatase inhibitor aminoglutethimide (500 mg qid) after surgery for the first patient and after stopping HRT for the second. Under aromatase-inhibitor therapy, both patients achieved a complete response, patient 1 remains disease- free with 14+ years of follow-up, and patient 2 with 7+ years. Our data suggest that an aromatase inhibitor may be an effective treatment for ESS. Furthermore, routine ER and PR analyses could be useful to predict the response to hormonal therapy in ESS.