The effect of prognostic factors at baseline on the efficacy of trifluridine/tipiracil in patients with metastatic colorectal cancer: A Portuguese exploratory analysis.

BACKGROUND: The RECOURSE trial supported trifluridine/tipiracil as a treatment option in metastatic colorectal cancer (mCRC). Subsequent analysis demonstrated that low tumour burden and indolent disease are good prognosis factors improving progression-free survival (PFS) and overall survival (OS). This study aimed to evaluate the impact of prognosis group in the OS, PFS and safety of trifluridine/tipiracil in patients with mCRC. METHODS: Single-centre, retrospective, and observational study of patients with mCRC who started trifluridine/tipiracil between February 2018 and July 2019. Patients were divided into good prognosis characteristics (GPC) [low tumour burden (less than 3 metastasis site) and indolent disease (≥18 months from first metastasis diagnosis)] and poor prognostic characteristics (PPC) group [high tumour burden (3 or more metastasis sites) and/or aggressive disease (<18 months since the first metastasis diagnosis)]. RESULTS: Median age was 67 years (48-82), 67.3% of the patients were male, and 65.3% had stage IV disease at baseline. Overall, median OS was 7.5 months (95%CI:5.7-9.3). Twenty-two patients (44.9%) presented GPC and 29 (59.1%) had PPC. GPC patients had longer median OS [11.4 (95%CI:6.2-16.7)] versus 3.9 months [(95%CI: 3.3-4.6),p < 0.0001] and PFS [4.9 (95%CI:3.0-6.9) versus 2.6 months (95%CI:2.2-2.8),p < 0.0001]. These differences were more pronounced in GPC patients with no liver metastasis. Grade ≥3 adverse events incidence didn't vary between GPC and PPC subgroups. CONCLUSION: Our study validates the improved trifluridine/tipiracil efficacy in patients with GPC in comparison with PPC while maintaining a well-tolerated safety profile. Indolent disease, low tumour burden and the absence of liver metastasis were shown to be good prognosis factors influencing sustained response to trifluridine/tipiracil.

Immunotherapy and predictive immunologic profile: the tip of the iceberg.

The interplay between cancer and the immune system has been under investigation for more than a century. Immune checkpoint inhibitors have changed the outcome of several tumors; however, there is a significant percentage of patients presenting resistance to immunotherapy. Besides the action mechanism, it is essential to unravel this complex interplay between host immune system and tumorigenesis to determine an immune profile as a predictive factor to immune checkpoint blockade agents. Tumor expression of programmed death-ligand 1 (PD-L1), tumor mutational burden, or mismatch repair deficiency are recognized predictive biomarkers to immunotherapy but are insufficient to explain the response rates and heterogeneity across tumor sites. Therefore, it is crucial to explore the role of the tumor microenvironment in the diversity and clonality of tumor-infiltrating immune cells since different checkpoint molecules play an influential role in cytotoxic T cell activation. Moreover, cytokines, chemokines, and growth factors regulated by epigenetic factors play a complex part. Peripheral immune cells expressing PD-1/PD-L1 and the biologic roles of soluble immune checkpoint molecules are the subject of new lines of investigation. This article addresses some of the new molecules and mechanisms studied as possible predictive biomarkers to immunotherapy, linked with the concept of immune dynamics monitoring.

Giant Metastatic Breast Phyllodes Tumour with an Elusive Diagnosis: A Case Report and Literature Review.

BACKGROUND: The term phyllodes tumours, which account for less than 1% of breast neoplasms, describes a spectrum of heterogenous tumours with different clinical behaviours. Less than 30% present as metastatic disease. Complete surgical resection is the standard of care so that recurrence rates are reduced. The role of adjuvant chemotherapy or radiation therapy is controversial. Patients with metastatic disease have a median overall survival of around 30 months. CASE DESCRIPTION: The authors present the case of a 57-year-old woman with an exuberant left malignant phyllodes tumour with bilateral involvement, as well as lung and axillar metastasis. The patient underwent haemostatic radiation therapy and started palliative chemotherapy with doxorubicin, achieving partial response with significant improvement in quality of life. A posterior simple mastectomy revealed a small residual tumour. DISCUSSION: Metastatic malignant phyllodes tumours are rare, so therapeutic strategies rely on small retrospective studies and guidelines for soft tissue sarcoma. Palliative chemotherapy protocols include anthracycline-based regimens, either as monotherapy with doxorubicin or doxorubicin together with ifosfamide. With few treatment options, management of these patients must rely on a continuum of care. LEARNING POINTS: Phyllodes tumours are a rare type of breast neoplasm.The differential diagnosis of breast cancer should include phyllodes tumours.Accurate and rapid diagnosis is required.

Pancreatitis Can Present Like Cancer: Lymphoplasmacytic Sclerosing Pancreatitis in a Patient with a History of Gastric Carcinoma.

Autoimmune pancreatitis has been associated with many syndromes in the presence of increased immunoglobulin levels. IgG4 antibodies are elevated in the context of lymphoplasmacytic sclerosing pancreatitis associated with IgG4-related disease. We present the case of a 74-year-old man diagnosed with autoimmune pancreatitis on a cancer background. Awareness of this condition in the cancer patient is crucial for timely diagnosis. Infectious complications might have implications for the choice of immunosuppressant. LEARNING POINTS: Autoimmune pancreatitis can mimic pancreatic cancer, thus delaying diagnosis in patients with cancer.It is important to rule out malignancy and distinguish autoimmune pancreatitis from pancreatic cancer, but obtaining a sample of pancreatic tissue can be difficult.Steroids are the mainstay of initial treatment, but there is growing evidence for the use of other immunomodulators, such as rituximab, for induction and maintenance or as an option for patients at high risk of relapse.

Association between bevacizumab-related hypertension and response to treatment in patients with metastatic colorectal cancer.

BACKGROUND: Bevacizumab has become standard of care as first-line treatment of metastatic colorectal cancer (mCRC), after proving increased response rates and improvement in survival outcomes. Hypertension (HTN) is a common complication of the treatment with bevacizumab and, owing to its close relation with antiangiogenic mechanism, may represent a clinical biomarker to predict the efficacy of the treatment. The aim of this study was to retrospectively evaluate if HTN grades 2 to 3 were correlated with response to treatment with bevacizumab in first line, as well as with improved progression-free survival (PFS) and overall survival (OS), in a series of patients with mCRC. METHODS: Retrospective evaluation of clinical records of patients with histologically proven mCRC, treated with bevacizumab as first-line treatment, between January 2008 and December 2013. RESULTS: 79 patients were evaluated. 51.9% of patients developed HTN G2-G3 during chemotherapy-bevacizumab treatment. In the group of patients who developed bevacizumab-related HTN, 73.2% showed response to treatment (complete response (CR)+ partial response (PR)) and 97.6% achieved disease control (CR, PR or stable disease) compared to 18.4% of patients with response and 63.2% with disease control in the group that did not (OR 12.08; 95% CI 4.13 to 35.29; p<0.001 responders vs non-responders; OR 20.8; 95% CI 2.56 to 168.91; p 0.005 controlled vs non controlled disease). The median OS was 28 months (22.7-33.3). Significant statistical difference was obtained in PFS between the two groups (p<0.001). In the group that developed bevacizumab-related HTN, the median OS was 33 months (25.7-40.3), and in the group that did not, it was 21 months (16.5-25.5) with no significant statistical difference between the two groups (p 0.114). CONCLUSIONS: In this subset of patients, HTN G2-3 was predictive of response to treatment with bevacizumab and of PFS but not of OS.

Intervenção nutricional integrada à prática de Lian Gong em usuários hipertensos de uma unidade básica de saúde de Belo Horizonte, Minas Gerais / Nutritional intervention integrated with the practice of Lian Gong among hypertensive users of a primary healthcare unit in Belo Horizonte, Minas Gerais

A fim de integrar a prática da atividade física à educação nutricional, foi realizado um estudo de intervenção com usuários hipertensos praticantes de Lian Gong de uma Unidade Básica de Saúde de Belo Horizonte, Minas Gerais. A intervenção contemplou seis encontros, em três meses, com duração de trinta minutos cada. Dos encontros, quatro foram destinados à abordagem educativa no tocante à alimentação, à atividade física e à hipertensão arterial. Já o restante (1º e o último encontro) abrangeu avaliação antropométrica (peso, estatura e circunferências) e alimentar (questionário) dos participantes. Adicionalmente, aplicou-se, ao final da intervenção, um questionário para averiguar mudanças nos modos de vida dos usuários. Quinze usuários participaram do estudo, 73,3% do sexo feminino, com média de idade de 53,3± 10,3 anos. Os participantes adultos (n=11) e 83,2% dos participantes idosos apresentavam excesso de peso. Após intervenção, verificou-se redução de circunferência de cintura (90,38 ± 8,15cm; 89,00 ± 8,26cm; p= 0,001) e da Relação Cintura Quadril (0,89 ± 0,04; 0,87 ± 0,04; p= 0,001) entre os participantes. Observou-se, ainda, aumento significativo do consumo de verduras e legumes (p=0,04) e redução do hábito de trocar almoço/jantar por lanches (p= 0,049). A maioria dos participantes (83,3 %) informou ter realizado alguma alteração no hábito alimentar e apresentado melhoria da qualidade de vida após intervenção. Os achados demonstram que, apesar do curto período, a intervenção nutricional favoreceu a modificação da alimentação e da qualidade de vida dos integrantes do grupo estudado, denotando a importância de ações educativas na atenção primária à saúde.

To integrate physical activity practices with nutritional education, an intervention study was conducted among hypertensive users of a primary healthcare unit in Belo Horizonte, Minas Gerais, who were Lian Gong practitioners. The intervention envisaged six meetings over three months, lasting 30 minutes each. Among these, four provided an educational approach towards diet, physical activity, and arterial hypertension. The other two (first and last meetings) covered anthropometric evaluation (weight, height, and circumferences) and dietary assessment (questionnaire) among the participants. In addition, at the end of the intervention, a questionnaire was applied to check on changes to users? lifestyles. Fifteen users participated in the study: 73.3% were female and the mean age was 53.3 ± 10.3 years. The adult participants (n = 11) and 83.2% of the elderly participants were overweight. After the intervention, reductions in waist circumference (90.38 ± 8.15 cm; 89.00 ± 8.26 cm; p = 0.001) and waist/hip ratio (0.89 ± 0.04; 0.87 ± 0.04; p = 0.001) were seen among the participants. Significantly increased consumption of greens and vegetables (p = 0.04) and reduction in the habit of replacing lunch/dinner with snacks (p = 0.049) were also observed. Most participants (83.3%) said that they had made changes in dietary habits and showed improved quality of life after the intervention. The findings demonstrate that despite its short duration, the nutritional intervention promoted the modification of diet and quality of life among the study group?s members, thus indicating the importance of educational actions within primary healthcare.

Perfil de nutrição e saúde de usuários da atenção primária a saúde / Nutrition and health profile of primary health care users / Perfil de la salud y la nutrición de usuarios de la atención primaria en salud

O objetivo deste trabalho foi caracterizar o perfil nutricional e de saúde de usuários adultos e idosos da atençãoprimária a saúde. Trata-se de um estudo transversal desenvolvido com usuários atendidos em seis unidades básicas desaúde de Belo Horizonte, Minas Gerais. Foram obtidos dados sociodemográficos, econômicos, de saúde e consumoalimentar; realizada avaliação antropométrica (peso, altura e circunferências) durante o primeiro atendimentonutricional do indivíduo. Avaliaram-se 304 usuários, com média de idade de 46,3 ± 13,4 anos, sendo 83,9% mulherese 15,8% idosos. Identificou-se mediana de renda per capita de R$271,40 (IC 95%:R$175,00-R$416,00) e 8 anos deestudo (IC 95%:4,0-11,0). O excesso de peso acometeu 88,1% (n=266) dos usuários e 89,2% apresentaram risco paracomplicações metabólicas associadas à obesidade, segundo a circunferência de cintura. Observou-se ainda elevadaprevalência referida de hipertensão arterial (54,7%) e de inatividade física (70,4%). Quanto aos hábitos alimentares60,7%, 76,0% e 93,8% dos participantes apresentavam consumo excessivo de sal, açúcar e óleo, respectivamente.Adicionalmente, verificou-se baixa frequência de ingestão diária de frutas (51,1%), verduras (40,4%) e legumes(53,0%), bem como elevado consumo diário de frituras (22,4%) e suco em pó (27,5%). O consumo de frutasapresentou incremento com aumento da renda per capita e da idade (p<0,001). Ademais, houve associação positivaentre excesso de peso e baixa frequência de consumo de verduras (p=0,006) e legumes (p=0,014). Conclui-se queo perfil identificado oferece subsídios para o desenvolvimento de futuras estratégias de intervenção nutricional notocante ao tratamento dos usuários e promoção de saúde na Atenção Primária.

This study aims to characterize the nutritional and health profile of adults and elderly people users of primaryhealthcare. This is a cross-sectional study developed among users attended at six primary healthcare units inBelo Horizonte, Minas Gerais. Data were obtained through socio-demographic, economic, health, dietary andanthropometric assessments were obtained (weight, height and waist circumferences) during each first nutritionalconsultation.The total of 304 users were evaluated, their average age was 46.3 ± 13.4 years; 83.9% were womenand 15.8% were elderly adults. Their per capita income was R$ 271.40 on average (95% CI: 175.00-416.00) and their average schooling level was 8 years (95% CI: 4.0-11.0). Excess weight affected 88.1% (n = 266) of the users and89.2% presented a risk of metabolic complications associated with obesity, according to their waist circumferencemeasurements. It was also seen that there were high prevalence of self-reported arterial hypertension (54.7%) andphysical inactivity (70.4%). Regarding dietary habits, 60.7%, 76.0% and 93.8% of the participants presented excessiveconsumption of salt, sugar and oil, respectively. Furthermore, there were low frequencies of daily intake of fruits(51.1%), greens (40.4%) and vegetables (53.0%); and high daily intake of fried foods (22.4%) and powdered juices(27.5%). The consumption of fruits increased with increasing per capita income and age (p < 0.001). Moreover, therewas a positive association between excess weight and low frequency of intake of greens (p=0.006) and vegetables(p=0.014). It can be concluded from this study that the identified profile provides support for developing futurenutritional intervention strategies relating to treatments and health promotion for primary healthcare users.

El objetivo de este estudio fue caracterizar el perfil nutricional y de salud de los usuarios adultos y mayores dela atención primaria en salud. Estudio de carácter transversal desarrollado con los usuarios atendidos en seisunidades básicas de salud en Belo Horizonte, Minas Gerais. Se obtuvieron datos sociodemográficos, económicos,de salud y consumo de alimentos; se hizo una evaluación antropométrica (peso, talla y circunferencia), duranteel primer atendimiento nutricional del individuo. Se evaluaron 304 usuarios, con edad media de 46,3 ± 13,4anos, siendo 83,9% mujeres y 15,8% mayores. Fue identificado el ingreso medio per cápita de R$ 271,40 (IC 95%:R$175,00- R$ 416, 00), con media de escolaridad de 8 años (IC 95%: 4,0-11,0). El exceso de peso acometió 88,1%(n=266) de los usuarios y 89,2%, de acuerdo con la medidas del perímetro de la cintura, presentaron riesgo decomplicaciones metabólicas asociadas a la obesidad. También se observó alta prevalencia de hipertensión arterial(54,7%) e inactividad física (70,4%). En cuanto a los hábitos alimentarios, la mayoría de los usuarios presentóconsumo excesivo de sal (60,7%), de azúcar (76,0%) y de aceite (93,8%). Además, se verificó baja frecuencia deingestión diaria de frutas (51,1%), hortalizas (40,4%) y vegetales (53,0%); así como un alto consumo de alimentosfritos (22,4%) y jugos en polvo (27,5%). El consumo de frutas aumentó con el aumento de los ingresos per cápitay con la edad (p <0,001). Además, hubo una asociación positiva entre el exceso de peso y la baja frecuencia en elconsumo de verduras (p=0,006) y legumbres (p=0,014). Se concluye que el perfil identificado ofrece subsidios parael desarrollo de futuras estrategias de intervención nutricional en lo que se refiere al tratamiento de los usuarios y lapromoción de la salud en la atención primaria.