SEOM SOGUG clinical guideline for treatment of kidney cancer (2022).

Renal cancer is the seventh most common cancer in men and the tenth in women. The aim of this article is to review the diagnosis, treatment, and follow-up of renal carcinoma accompanied by recommendations with new evidence and treatment algorithms. A new pathologic classification of RCC by the World Health Organization (WHO) was published in 2022 and this classification would be considered a "bridge" to a future molecular classification. For patients with localized disease, surgery is the treatment of choice with nephron-sparing surgery recommended when feasible. Adjuvant treatment with pembrolizumab is an option for intermediate-or high-risk cases, as well as patients after complete resection of metastatic disease. More data are needed in the future, including positive overall survival data. Clinical prognostic classification, preferably IMDC, should be used for treatment decision making in mRCC. Cytoreductive nephrectomy should not be deemed mandatory in individuals with intermediate-poor IMDC/MSKCC risk who require systemic therapy. Metastasectomy can be contemplated in selected subjects with a limited number of metastases or long metachronous disease-free interval. For the population of patients with metastatic ccRCC as a whole, the combination of pembrolizumab-axitinib, nivolumab-cabozantinib, or pembrolizumab-lenvatinib can be considered as the first option based on the benefit obtained in OS versus sunitinib. In cases that have an intermediate IMDC and poor prognosis, the combination of ipilimumab and nivolumab has demonstrated superior OS compared to sunitinib. As for individuals with advanced RCC previously treated with one or two antiangiogenic tyrosine-kinase inhibitors, nivolumab and cabozantinib are the options of choice. When there is progression following initial immunotherapy-based treatment, we recommend treatment with an antiangiogenic tyrosine-kinase inhibitor. While no clear sequence can be advocated, medical oncologists and patients should be aware of the recent advances and new strategies that improve survival and quality of life in the setting of metastatic RC.

SEOM-SOGUG clinical guideline for localized muscle invasive and advanced bladder cancer (2021).

Most muscle-invasive bladder cancer (BC) are urothelial carcinomas (UC) of transitional origin, although histological variants of UC have been recognized. Smoking is the most important risk factor in developed countries, and the basis for prevention. UC harbors high number of genomic aberrations that make possible targeted therapies. Based on molecular features, a consensus classification identified six different MIBC subtypes. Hematuria and irritative bladder symptoms, CT scan, cystoscopy and transurethral resection are the basis for diagnosis. Radical cystectomy with pelvic lymphadenectomy is the standard approach for muscle-invasive BC, although bladder preservation is an option for selected patients who wish to avoid or cannot tolerate surgery. Perioperative cisplatin-based neoadjuvant chemotherapy is recommended for cT2-4aN0M0 tumors, or as adjuvant in patients with pT3/4 and or pN + after radical cystectomy. Follow-up is particularly important after the availability of new salvage therapies. It should be individualized and adapted to the risk of recurrence. Cisplatin-gemcitabine is considered the standard first line for metastatic tumors. Carboplatin should replace cisplatin in cisplatin-ineligible patients. According to the EMA label, pembrolizumab or atezolizumab could be an option in cisplatin-ineligible patients with high PD-L1 expression. For patients whose disease respond or did not progress after first-line platinum chemotherapy, maintenance with avelumab prolongs survival with respect to the best supportive care. Pembrolizumab also increases survival versus vinflunine or taxanes in patients with progression after chemotherapy who have not received avelumab, as well as enfortumab vedotin in those progressing to first-line chemotherapy followed by an antiPDL1/PD1. Erdafitinib may be considered in this setting in patients with FGFR alterations. An early onset of supportive and palliative care is always strongly recommended.

Observational real world data with palbociclib associated to hormone therapy for advanced breast carcinoma.

OBJECTIVE: Cyclin-dependent kinase 4/6 inhibitors have a synergistic effect  in combination with endocrine therapy. This combination is used as first and  subsequent-line treatment for advanced luminal breast carcinoma because it  increases progression-free survival. We analysed clinical course and toxicity  in patients treated with palbociclib in our hospital and determined potential  associations between these variables and clinicopathological variables. METHOD: Observational retrospective study including patients with advanced  or metastatic breast cancer treated with palbociclib plus endocrine therapy at  the Hospital Universitario de Cabueñes between 2017 and 2020. We  analysed clinicopathological variables, toxicity, and survival. Results: In total, 72 women and 1 man (median age: 63 years) received palbociclib plus an  aromatase inhibitor or fulvestrant. When used as firstline treatment,  progression-free survival was 22 months, and as second and subsequent-line treatment, progression-free survival was 13 months. Adverse effects (mainly haematological) were experienced by nearly all any patient, although delays  and dose adjustments were common (61.7% and 42.7%, respectively).  Performance status alone had a significant impact on progression-free  survival (22 months in patients with ECOG 0 vs 12 months in patients with  ECOG ≥ 1; P = 0.021). CONCLUSIONS: Disease stage, age, and performance status do not limit the  use of treatment with palbociclib, nor its combination with aromatase inhibitors or fulvestrant for first or subsequent-line treatment.  Toxicity is easily managed. Real-world results are equivalent to those  published to date.

Objetivo: Los inhibidores de quinasas dependientes de ciclina CDK4 y CDK6  poseen efecto sinérgico al asociarse con hormonoterapia. Su uso está  extendido en primera y sucesivas líneas de carcinoma de mama avanzado  tipo luminal por mejorar la supervivencia libre de progresión. Los objetivos  de nuestro estudio se basaron en analizar la evolución clínica y la toxicidad  presentada en las pacientes tratadas en nuestro centro con palbociclib, así  como relacionar la evolución con las diferentes variables clínico-patológicas.Método: El estudio, de tipo observacional y retrospectivo, recogió datos de  pacientes con cáncer de mama avanzado o metastásico tratados con hormonoterapia y palbociclib en el Hospital Universitario de Cabueñes  entre los años 2017 y 2020. Se analizaron diferentes variables  clínicopatológicas, así como información sobre toxicidad y supervivencia. Resultados: Un total de 72 mujeres y 1 varón con una mediana de edad de  63 años recibieron palbociclib asociado a inhibidor de aromatasa o  fulvestrant. En primera línea la supervivencia libre de progresión fue de 22  meses, y en segunda o sucesivas líneas de 13 meses. El 95,9% de Abstract las pacientes presentaron algún tipo de efecto adverso, principalmente hematológico. No se produjo ningún abandono por toxicidad, aunque los  retrasos y los ajustes de dosis fueron frecuentes (61,7% y 42,7%,  respectivamente). Solo la situación funcional al inicio del tratamiento influyó de manera significativa en la supervivencia libre de progresión (22 meses en  ECOG 0 versus 12 meses en ECOG ≥ 1; p = 0,021).Conclusiones: La extensión de la enfermedad, edad o status menopáusico no impiden el tratamiento con palbociclib, ya se administre con inhibidores de aromatasa o fulvestrant y en una u otra línea  metastásica. La toxicidad del fármaco es manejable, y los resultados de vida  real obtenidos son superponibles a los de los ensayos publicados hasta la actualidad.

[Metastasis of breast carcinoma in the ureter. Presentation of a clinical case.] / Metástasis de carcinoma de mama en uréter. Presentación de un caso clínico.

OBJECTIVE: To assess the importance of long-term close follow-up in patients with breast carcinoma. MATERIALS AND METHODS: To present a case report. RESULTS: A case of a 55-year-old woman with history of lobular carcinoma of the breast is presented. She received neoadjuvant treatment, surgery and complementary chemotherapy and radiotherapy. In radiologic imaging studies, multiple bone metastases were diagnosed. The patient consulted for left lumbar pain. Radiologic studies revealed left hydronephrosis secondary to soft tissue lesion in pyeloureteral junction with renal functional impairment. A biopsyperformed using an endoscopic approach (ureteroscopy), diagnosed a metastasis of breast carcinoma in the ureter. CONCLUSION: Metastatic lesions in the ureter are extremely rare, even less frequent the ones with breast origin with around ten cases published worldwide. With the previous diagnosis of breast carcinoma, the probable ureteral compromise should be considered especially in patients with clinical and radiological symptoms of urinary tract obstruction. A well-timed and proper diagnosis may influence in prognosis and survival.

OBJETIVO: Resaltar la importancia del seguimiento estrecho a largo plazo de pacientes con antecedente de carcinoma de mama.MATERIALES Y MÉTODOS: Presentación de un caso clínico. RESULTADOS: Se presenta el caso de una mujer de 55 años de edad con antecedente de carcinoma lobulillar de mama. Recibió tratamiento neoadyuvante, cirugía y quimioterapia y radioterapia posterior. En estudio de imagen de control se diagnosticó de metástasis óseas múltiples. La paciente consultó por dolor lumbar izquierdo de varios meses de evolución, en estudio de imagen se observó hidronefrosis izquierda secundaria a lesión de partes blandas en unión pieloureteral con alteración funcional renal. En biopsia realizada mediante abordaje endoscópico (ureteroscopia) se diagnosticó de metástasis de carcinoma de mama en uréter.CONCLUSIÓN: Las lesiones metastásicas en uréter son extremadamente infrecuentes siendo aún menos frecuentes las de origen mamario con alrededor de diez casos publicados mundialmente. Con el diagnóstico previo de carcinomade mama, el probable compromiso ureteral debe ser tomado en cuenta especialmente en pacientes con síntomas clínicos y radiológicos de obstrucción de la vía urinaria. Un diagnóstico oportuno es posible que influya en el pronóstico y supervivencia posterior.

The economic burden of metastatic breast cancer in Spain.

Objectives: The study aimed to estimate the burden of metastatic breast cancer (mBC) in Spain over 5 years. Methods: An incidence-based cost-of-illness model was developed in which a cohort of patients with mBC was followed from the diagnosis of metastatic disease over 5 years or death. Resource use data were collected through a physician survey conducted with 10 clinical experts in Spain. The model distinguished patients according to HER2 and hormonal receptor (HR) status, and followed the patient cohort in monthly cycles. Results: The incident cohort was estimated to be 2,923 patients with mBC, consisting of 1,575 HER2-/HR+, 520 HER2+/HR+, 324 HER2+/HR-, and 503 triple negative patients. The estimated mean survival over the 5-year time period was 2.51 years, on average, with longer survival of 3.36 years for HER2+/HR+, 2.41 years for HER2-/HR+, 2.82 years for HER2+/HR- and shortest mean survival of 1.74 years for triple negative patients. The total costs were €469,92,731 for the overall population, €190,079,787 for the HER2-/HR+, €151,045,260 for the HER2+/HR+, €80,827,171 for the HER2+/HR- and €47,540,512 for the triple negative subgroups over 5 years. Per patient total costs were €160,642 on average, €120,664 for HER2-/HR+, €290,346 for HER2+/HR+, €249,152 for HER2+/HR-and €94,572 for triple negative patients over 5 years. Conclusions: The economic burden of mBC in Spain is significant, but differs by HER2 and HR status. HER2-/HR +patients account for the highest burden due to the prevalence of this category, but HER2+/HR +patients have the highest per patient costs.

Association of Performance Status and Pain in Metastatic Bone Pain Management in the Spanish Clinical Setting.

INTRODUCTION: Bone metastasis is the most common cause of cancer-related pain, and metastatic bone pain (MBP) is not only severe but also progressive in many patients. The aim of this study was to investigate the association between pain management and performance status in patients with metastatic bone cancer in the Spanish clinical setting. METHODS: A 3-month follow-up prospective, epidemiologic, multicenter study was conducted in 579 patients to assess the evolution of their performance, the impact of pain control on sleep and functionality, and the degree of pain control according to analgesic treatment. RESULTS: In patients with MBP, Eastern Cooperative Oncology Group (ECOG) status (1.5 ± 0.7-1.3 ± 0.7 and 1.3 ± 0.8; p < 0.001) and pain (6.5 ± 1.4-2.8 ± 1.9 and 2.1 ± 1.9; p < 0.001) improved significantly from baseline to months 1 and 3, as did functionality and sleep, after a treatment change consisting of increasing the administration of opioids. Evolution of ECOG and pain were closely related. ECOG and pain outcomes were significantly more favorable in patients treated with opioids versus non-opioid treatment, and in patients who did not need rescue medication versus those who did. CONCLUSIONS: MBP is currently poorly managed in Spain. ECOG improvement is closely and directly related to pain management in MBP. Opioid treatment and a lack of requirements for rescue medication are associated with better ECOG and pain outcomes in MBP patients. FUNDING: Mundipharma Pharmaceuticals S.L.

[Impact of anxiety and depression on the physical status and daily routines of cancer patients during chemotherapy]. / Repercusión de la ansiedad y depresión en el estado físico y funcionalidad de enfermos oncológicos durante el tratamiento con quimioterapia.

The evolution of symptoms, emotional state and daily routines in patients with breast cancer and lung cancer during treatment with intravenous chemotherapy (CT) is described and the influence of anxiety and depression on these variables is analyzed. 66 patients, 29 with breast cancer and 37 with lung cancer, were evaluated before starting treatment, and after completing the first, second and last cycle of CT using the Hospital Anxiety and Depression Scale (HADS), rating scales and interview. Less than 30% of the patients showed clinical anxiety or depression according to the HADS. Throughout the treatment, tiredness, fatigue and nausea increased significantly and work and leisure activity decreased. Concern about the future of relatives and insomnia increased significantly over time in patients with breast cancer whereas they decreased in patients with lung cancer. By introducing the HADS scores as covariates, it was found that most differences are due to the time factor and the type of cancer. During treatment with CT, emotional disturbances do not seem to have significant impact on the symptoms and changes in daily life reported by cancer patients.