Prospective Cohort Real-World Study on Neuroendocrine Tumor Patient's Quality of Life During Peptide Receptor Radionuclide Therapy With 177Lu-DOTATATE.

OBJECTIVE: The aim of this study was to report lutetium-177 (177Lu)-DOTATATE radionuclide therapy from a patient perspective and their health-related quality of life. METHODS: This prospective cohort study, including adult patients treated with 177Lu-DOTATATE. At the beginning of the follow-up (T1), socioeconomic and clinical information was collected, and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires C30-v3 and GI.NET21 were applied. Follow-up was performed at the third cycle (T2) and 3 months after the end of treatment (T3). Student t test for paired samples was used to compare quality of life at T1, T2, and T3. RESULTS: Thirty-eight patients with stage IV disease and mean age of 52.54 (standard deviation, 12.49) years were included. The most prevalent site was the gastrointestinal tract (39.7%). Global health improved between T2 and T3 (P = 0.022) and T1 and T3 (P = 0.038). Functional scales did not indicate significant changes between the periods. Regarding symptoms, significant improvements in nausea and vomiting and gastrointestinal symptoms were observed between T2 and T3 (P = 0.012 and 0.029) and T1 and T3 (P = 0.012 and 0.011), respectively. CONCLUSIONS: 177Lu-DOTATATE therapy improved global health and reduced disease-related symptoms in NET patients, positively impacting health-related quality of life.

Neutrophil to lymphocyte ratio as a prognosis biomarker of PRRT in NET patients.

PURPOSE: Peptide Receptor Radionuclide Therapy (PRRT) with 177Lu-DOTATATE is a palliative therapeutic option for advanced Neuroendocrine Tumors (NETs). Prognostic factors can predict long-term outcomes and determine response to therapy. Among those already explored, biomarkers from full blood count, including neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) has shown value for other solid tumors and for NETs patients submitted to other forms of therapy. However, its relation to PRRT response and patients' prognosis is still to be determined. METHODS: Medical records from 96 patients submitted to PRRT between 2010 and 2017 were reviewed, median NLR and PLR were calculated from baseline flood blood count and dichotomized as high or low. Progression-free survival (PFS) and Overall Survival (OS) were calculated. RESULTS: NLR and PLR median values were 1.8 and 123, respectively. Patients with low NLR had a significantly longer OS (estimated median of 77.5 months, 95% CI: 27.3-127.7) when compared to patients with high NLR (estimated median of 47.7 months, 95% CI: 34.7-60.8); p = 0.04. Patients with low NLR had a trend toward a longer median PFS when compared to patients with high NLR [estimated medians of 77 months (95% CI: 27.3-127.7), and 47.7 months, (95% CI: 34.7-60.7)], respectively, p = 0.08. CONCLUSION: Patients with advanced-stage NET with NLR higher than 1.8 have worse long term clinical outcomes after PPRT. Larger studies are needed to validate the optimal cutoff for this biomarker.

Declínio cognitivo e uso de medicamentos na população de idosos institucionalizados de uma cidade do interior de Minas Gerais, Brasil / Neurocognitive disorders and medication used by the institutionalized elderly population of the interior of Minas Gerais, Brazil

Resumo Introdução Idosos institucionalizados possuem maiores riscos para a prescrição de cinco ou mais medicamentos, ou polifarmácia, e, por consequência, de eventos adversos, por apresentarem problemas de saúde limitantes, fragilidade e baixa funcionalidade. Esse risco é ainda maior quanto maior o declínio cognitivo. Objetivo Determinar a prevalência de declínio cognitivo (DC) e a relação com o uso de medicamentos em idosos institucionalizados. Método Estudo transversal descritivo realizado por análise de prontuários dos idosos institucionalizados portadores ou não de DC, conforme resultados de testes validados. Foram levantados os medicamentos utilizados e os medicamentos potencialmente inadequados (MPI) por meio dos Critérios de Beers (2015). Resultados Foram avaliados 88 idosos, com idade média de 77,6 (9,2) anos. A prevalência de DC foi de 75%, sendo maior no sexo feminino (82,5%, p = 0,01) e em idosos acima de 80 anos (85%, p = 0,04). Antieméticos e inibidores de bomba de prótons foram significativamente mais utilizados nos idosos com DC. A prevalência de polifarmácia foi de 69,3%, e 71 idosos (80,68%) utilizavam pelo menos um MPI, com maior prevalência do uso de MPI na faixa etária de 60 a 79 anos (p = 0,004). Os idosos que utilizavam pelo menos um MPI também usavam maior número de medicamentos (p = 0,014). Conclusão A presença de DC teve relação com a maior utilização de antieméticos e inibidores de bomba de prótons, mas não com o maior uso de MPI. Além disso, foi observada elevada prevalência de polifarmácia e MPI em prescrições dos idosos institucionalizados.

Abstract Background Institutionalized elderly are at greater risk of prescribing five or more medications and consequently of higher occurence of adverse events, as they have limiting health problems, frailty and low functionality. This risk is even greater if they also have cognitive decline. Objective To determine the prevalence of cognitive disorders (CDs) and its association with the medication used by the institutionalized elderly population of the interior of Minas Gerais, Brazil. Method Descriptive cross-sectional study for analysis of medical records of institutionalized elderly with or without CDs, according to validated tests. The medicine used and the potentially inappropriate medications (PIMs) were determined as per the Beers criteria (2015). Results Eighty eight elderly people, with mean age of 77.6 (9.2) years, were included. CD prevalence was 75% higher in females (82.5%, p = 0.01) and in older age groups, with 80 years and above (85%, p = 0.04). Antiemetics and proton pump inhibitors were significantly more used by the elderly with CDs. The prevalence of polypharmacy was 69.3%, 71 elderlies (80.7%) used at least one PIM, and a higher prevalence of PIM use was observed in elderly people of 60 to 79 years old (p = 0.004). The elderly who used at least one PIM was also observed to use a higher number of medications (p = 0.014). Conclusion CDs was found to be related to the higher use of antiemetics and proton pump inhibitors, but not to the use of PIMs in regards to the institutionalized elderlies. Furthermore, a high prevalence of polypharmacy and PIMs were detected in the prescriptions of the institutionalized elderly subjects.

Single-center, retrospective study on changes in pain-relieving therapy after bone metastasis detection by bone scintigraphy in prostate cancer patients

Abstract Whole-body bone scintigraphy (WB-BS) is used for detecting and monitoring metastatic spread of prostate cancer (PCa) and to investigate bone pain episodes. To investigate the impact of a positive WB-BS on pain-relieving medicine prescription in PCa patients, a single-center, retrospective cohort study with PCa patients classified as positive for bone metastases (BM) by WB-BS was conducted. Demographic, clinical, and ambulatory pain-relieving medicine prescription data were evaluated. Pain-relieving medicines were categorized according to the WHO 'Analgesic Ladder'. Regimens adopted before and after WB-BS were compared. Differences were considered significant at p<0.05. A total of 180 PCa patients were diagnosed with BM, 64.4% of whom were ≥65 years of age. Thirty-three patients were prescribed analgesics only after WB-BS, mostly including NSAIDs and weak opioids. Pain-relieving prescription changed after WB-BS in patients with prescriptions before and after WB-BS, with a reduction in NSAIDs and adjuvants and an increase in weak and strong opioids. In addition, 40% of patients with WHO analgesic step 1 drugs and 21.7% of patients with WHO step 2 drugs before WB-BS changed to other WHO steps after WB-BS. Pain-relieving prescriptions changed after a positive WB-BS, providing evidence that it could contribute to clinical management of painful metastatic PCa patients.

Liver Steatosis Secondary to PRRT With 177Lu-DOTATATE: An Unknown Adverse Effect.

PRRT (peptide receptor radionuclide therapy) with Lu-DOTATATE for neuroendocrine tumor has some well-known adverse effects, concerning specially the bone marrow and kidneys. Hepatotoxicity has been rarely reported, and there are no data regarding hepatic steatosis secondary to PRRT. We reviewed upper abdomen CT and MRI and applied radiologic criteria for the diagnosis of hepatic steatosis on 62 patients treated between the years of 2010 and 2017. Two patients already showed radiologic signs of steatosis in the middle of the treatment and through follow-up all patients showed improvement of the steatosis.

Health-related quality of life of thyroid cancer patients undergoing radioiodine therapy: a cohort real-world study in a reference public cancer hospital in Brazil.

PURPOSE: The purpose of this study was to access changes in health-related quality of life (HRQoL) caused by radioiodine therapy (RAI) in thyroid cancer patients. METHODS: Prospective cohort study at Brazilian National Cancer Institute with patients enrolled between March 2015 and June 2017. RAI was performed by administration of 1.11 to 9.25 GBq of Na131I. EORTC QLQ-C30 v3 and EORTC QLQ-H&N35 questionnaires were applied to determine HRQoL at baseline, 1 week and 3 months after RAI. HRQoL during follow-up was evaluated by calculation of score absolute changes in each domain. Descriptive analysis was performed by measures of central tendency and dispersion. Changes in HRQoL were evaluated by paired t-test. The association between social demographic and clinical data and HRQoL was assessed by univariate linear regression for significantly changed domains, and p < 0.05 was considered significant. RESULTS: An improvement on global HRQoL and social Function post-therapy (p = 0.002 and p < 0.001) and on role (p = 0.038), emotional (p < 0.001), and cognitive function (p = 0.016) during RAI were observed. Nausea and vomiting (p < 0,001), pain (p < 0.001), sensitivity problems (p < 0.001), problems with social contact (p < 0.001), dry mouth (p = 0.007), and sticky saliva (p = 0.001) increased during RAI. Females were more sensible to changes in nausea and vomiting, and patients < 55 years experienced higher changes in sense during RAI. CONCLUSIONS: Although RAI might affect HRQoL negatively, patients experienced an improvement on global HRQoL and symptoms reduction post-therapy.

Imunoterapia em Oncologia em uma Cidade do Interior de Minas Gerais: Análise da Década 2010-2019 / Immunotherapy in Oncology in a Countryside City of Minas Gerais: Analysis of the decade 2010-2019 / Inmunoterapia en Oncología en una Ciudad del Interior de Minas Gerais: Analisis de la Década 2010-2019

Introdução: Nos últimos anos, a terapia sistêmica em oncologia sofreu mudanças substanciais e a imunoterapia destacou-se como forma de tratamento adjuvante. No Brasil, as diferenças do acesso a essa terapêutica podem ser observadas de maneira relevante e ainda não há amplo conhecimento sobre o seu uso nas diferentes Regiões do país. Objetivo: Analisar o panorama da utilização de imunoterapia no tratamento oncológico em Barbacena-MG na última década. Método: Estudo descritivo de centro único. Os pacientes maiores de 18 anos, diagnosticados com câncer e que utilizaram imunoterápicos no período de 2010 a 2019, foram selecionados por meio de consulta ao Registro Hospitalar de Câncer, e as informações constantes nesse sistema, bem como prontuários, foram utilizadas para obtenção de dados sociodemográficos e clínicos. Resultados: A imunoterapia foi utilizada no tratamento de 90 pacientes (4,9%), totalizando 95 tratamentos. Entre os medicamentos utilizados, destacaram-se o Bacillus Calmette-Guérin (BCG), o trastuzumabe e o imatinibe. Observou-se um aumento na utilização de imunoterápicos ao longo da década, bem como uma maior variedade de tratamentos realizados. O imatinibe e o pazopanibe obtiveram maior porcentagem de óbitos durante o tratamento e 77,9% dos medicamentos utilizados foram custeados pelo Sistema Único de Saúde (SUS). O tempo de tratamento da maioria dos pacientes se manteve próximo a dez meses, sendo menor para aqueles que se trataram com BCG. Conclusão: O uso da imunoterapia em oncologia em Barbacena apresentou um avanço no período de 2010 a 2019, tanto no quantitativo quanto na variedade de tratamentos, com incorporação de novos medicamentos.

Introduction: In recent years, systemic therapy in oncology has undergone substantial changes and immunotherapy has spread out as a form of adjuvant treatment. In Brazil, differences of access to this therapy are relevant and there is still no extensive knowledge about the use of immunotherapy in different regions of the country. Objective: To analyze the panorama of immunotherapy in cancer treatment in Barbacena-MG in the last decade.Method: Single-centre descriptive study. Patients over 18 years diagnosed with cancer who used immunotherapies in the period from 2010 to 2019 were selected by reviewing the Hospital Cancer Registry and the information contained in this system, as well as charts, were used to obtain sociodemographic and clinical data. Results: Immunotherapy was used to treat 90 patients (4.9%), totalling 95 treatments. Bacillus Calmette-Guérin (BCG), trastuzumab and imatinib were the drugs most used. There was an increase in the use of immunotherapeutic agents over the decade, as well as in the variety of treatments performed. Imatinib and pazopanib had a higher percentage of deaths during treatment and 77.9% of the drugs used were funded by the Unified Health System (SUS). Treatment duration for most patients remained close to 10 months, being shorter for those who were treated with BCG. Conclusion: The use of immunotherapy in oncology in Barbacena has grown from 2010 to 2019, in number and variety of treatments, with incorporation of new drugs.

Introducción: En las últimas décadas han permitido el desarrollo de nuevas modalidades de tratamientos anticancerosos y la inmunoterapia se ha destacado. En Brasil, el acceso desigual a inmunoterapia es relevante y todavía no hay amplio conocimiento sobre su uso en las distintas regiones del país. Objetivo: Analizar el panorama de la inmunoterapia en el tratamiento anticanceroso en Barbacena-MG en la última década. Método: Estudio descriptivo de centro único, con datos del Registro Hospitalario de Cáncer y registros médicos de los pacientes que usaron inmunoterapéuticos en el tratamiento anticanceroso de 2010 a 2019. Resultados: Se utilizó inmunoterapéuticos para tratar a 90 pacientes (4,9%), totalizando 95 tratamientos. Entre los medicamentos utilizados, se destacaron Bacillus Calmette-Guérin (BCG), trastuzumab e imatinib. Hubo un aumento en el uso de inmunoterapéuticos en la década, así como una mayor variedad de tratamientos realizados. Imatinib y pazopanib tuvieron un mayor porcentaje de muertes durante el tratamiento y 77,9% de los medicamentos utilizados fueron financiados por el Sistema Único de Salud (SUS). El tiempo de tratamiento para la mayoría de los pacientes fue diez meses, siendo más corto para el tratamiento con BCG. Conclusión: El uso de la inmunoterapia en oncología en Barbacena ha avanzado en el período de 2010 a 2019, tanto en cantidad como variedad de tratamientos, con incorporación de nuevos medicamentos.

Perfil sócio demográfico e clínico de pacientes com Câncer Gástrico atendidos em um hospital de referência no interior de Minas Gerais / Socio-demographic and clinical profile of Gastric Cancer patients attended at a reference hospital in the interior of Minas Gerais

Introdução: O câncer gástrico é uma doença multifatorial de grande incidência no Brasil e de índices de mortalidade alarmantes. Por esse motivo, são essenciais as investigações epidemiológicas ao seu respeito para a definição da profilaxia adequada e do rastreio eficaz da doença. Associado a isso, a maior parte dos diagnósticos são feitos em fases avançadas da doença e sabe-se que as taxas de sobrevida em 5 anos são maiores em pacientes nos estágios iniciais. Objetivo: O presente estudo teve como objetivo caracterizar o perfil sócioepidemiográfico dos pacientes com câncer gástrico tratados na região ampliada de saúde do centro sul de Minas Gerais. Métodos: Foi conduzido um estudo de coorte retrospectivo a partir da análise de 456 prontuários de pacientes diagnosticados com câncer gástrico no Hospital Ibiapaba CEBAMS, em Barbacena, MG, no período de 2000 a 2017. Resultados: Os pacientes eram em sua maioria do sexo masculino (73,90%), acima dos 60 anos de idade (68,20%), leucodermos (63,52%), baixo nível educacional (74,19%), com relato de exposição prévia ao tabagismo (55,27%) e não etilistas (61,71%). O tipo histológico mais comum foi o Adenocarcinoma do tipo intestinal de Lauren (49,50%) e o estadiamento mais diagnosticado foi o estágio IV (40,80%). Conclusão: Dessa forma, foi ressaltada no estudo a importância da investigação da neoplasia gástrica na atenção primária, especialmente em pacientes com característica descritas nesse perfil e/ou com outras já descritas pela literatura. (AU)

Introduction: Gastric cancer (GC) is a multifactorial disease of high incidence in Brazil and with alarming mortality rates. For this reason, epidemiological investigations are essential for prophylaxis and effective screening of the disease. In addition, most diagnoses are in advanced stages of the disease and it is known that 5-year survival rates are higher in patients in the early stages. Objectives: The present study aimed to characterize the socio demographic profile of gastric cancer patients treated in the South Center health region of Minas Gerais. Methods: The authors ran a retrospective cohort study based on the analysis of 456 medical records of patients diagnosed with CG at the Ibiapaba CEBAMS Hospital, Barbacena, MG, from 2000 to 2017. Results: The patients were mostly males (73.90 %), above 60 years of age (68.20%), self-identified as white skin (63.52%), low educational level (74.19%), with previous exposure to smoking (55.27%) and non-alcoholic (61.71%). The most common histological type was intestinal adenocarcinoma (49.50%) and the most diagnosed stage was stage IV (40.80%). Conclusion: Accordingly, the study emphasized the importance of primary care investigation of the GC, especially in patients with the described profile or others risk factors already described in the literature. (AU)

Tratamento de tumores neuroendócrinos por medicina nuclear: revisão sistemática da eficácia e segurança do radiofármaco Dotatate-177Lu / Treatment of neuroendocrine tumors by nuclear medicine: a systematic review of efficacy and safety of the radiopharmaceutical 177Lu-Dotatate

O DOTATATE-177Lu é um análogo de somatostatina radiomarcado que guia a radioatividade para tumores neuroendócrinos (NETs) que superexpressam receptores de somatostatina (SSTRs), promovendo o seu tratamento por terapia radionuclídica receptor-específica (PRRT). O objetivo deste trabalho foi avaliar a eficácia e a segurança da PRRT dos NETs com o DOTATATE-177Lu, através de uma revisão sistemática da literatura. A PRRT com o DOTATATE-177Lu foi eficaz no tratamento de NETs metastáticos ou inoperáveis que expressam SSTR tipo 2. Observou-se estabilização ou até regressão da doença em 20 a 50 % dos casos. Já a prevalência de remissão total da doença, apesar de numericamente baixa, foi satisfatória, principalmente levando-se em conta o estágio avançado dos tumores. Os efeitos adversos mais comuns da PRRT foram toxicidade renal e hematológica. Apesar dos estudos evidenciarem a eficácia e a segurança da PRRT com o radiofármaco, essa terapia ainda é considerada em desenvolvimento.

The DOTATATE-177Lu is a radiolabeled somatostatin analogue that guides the radioactivity to neuroendocrine tumors (NETs) that overexpress somatostatin receptors (SSTRs), allowing their treatment by receptor- specific radionuclide therapy (PRRT). The aim of this study was to evaluate the efficacy and safety of PRRT of NETs with DOTATATE-177Lu through a systematic literature review. PRRT with 177Lu - DOTATATE was effective in the treatment of inoperable or metastatic NETs that express SSTR type 2. Stabilization or regression of the disease was observed in 20 to 50% of the cases . The prevalence of total remission, although numerically low, was satisfactory, especially taking into account the advanced tumor stage. The most common adverse events in the PRRT were hematological toxicity and renal failure. Despite studies demonstrate the efficacy and safety of PRRT with the radiotracer , this treatment modality is still considered under development.

Preparation of crotalus venom radiolabeled with technetium-99m as a tool for biodistribution study

Technetium-99m (99mTc) has been the radionuclide of choice for nuclear medicine procedures and experimental research. Because of its optimal nuclear properties, 99mTc is suitable for high efficiency detection with the advantage of reduced radiological waste. Crotalus venom (CV) has been shown to reduce tumors in clinical studies and tissue distribution studies are very important for clinical use. The goal of this work was to obtain CV labeled with 99mTc which preserves its biological activity. After labeling, biological activity was assessed by hemolytic activity evaluation. Labeled and crude venom caused indirect hemolysis provided that the incubation medium contained an exogenous source of lecithin. High yield radiolabeled-CV was obtained and biological activity was preserved. The results suggest that 99mTc-CV can be a useful tool for biodistribution studies.

Tecnécio-99m tem sido o radioisótopo de escolha para procedimentos médicos e pesquisas experimentais. Em decorrência de suas propriedades nucleares, 99mTc é adequado para detecção de alta eficiência com a vantagem do baixo risco radiológico. O veneno de Crotalus (CV) apresentou propriedades antitumorais em estudos clínicos e estudos de biodistribuição são fundamentais em pesquisas clínicas. Esse trabalho teve como objetivo obter um análogo de veneno de Crotalus marcado com 99mTc que preservasse sua atividade biológica. Após a marcação, a atividade biológica foi avaliada através do ensaio de atividade hemolítica. Veneno nativo e marcado apresentaram atividade hemolítica indireta quando incubados em um meio contendo uma fonte exógena de lecitina. Obteve-se um alto rendimento de marcação e a atividade biológica das moléculas foi preservada. Nossos resultados sugerem que 99mTc-CV pode representar uma ferramenta muito útil para estudos de biodistribuição.