Consensus on the Treatment and Follow-Up for Metastatic Castration-Resistant Prostate Cancer: A Report From the First Global Prostate Cancer Consensus Conference for Developing Countries (PCCCDC).

PURPOSE: To present a summary of the recommendations for the treatment and follow-up for metastatic castration-resistant prostate cancer (mCRPC) as acquired through a questionnaire administered to 99 physicians working in the field of prostate cancer in developing countries who attended the Prostate Cancer Consensus Conference for Developing Countries. METHODS: A total of 106 questions out of more than 300 questions addressed the use of imaging in staging mCRPC, treatment recommendations across availability and response to prior drug treatments, appropriate drug treatments, and follow-up, and those same scenarios when limited resources needed to be considered. Responses were compiled and the percentages were presented by clinicians to support each response. Most questions had five to seven relevant options for response including abstain and/or unqualified to answer, or in the case of yes or no questions, the option to abstain was offered. RESULTS: Most of the recommendations from this panel were in line with prior consensus, including the preference of a new antiandrogen for first-line therapy of mCRPC. Important aspects highlighted in the scenario of limited resources included the option of docetaxel as treatment preference as first-line treatment in several scenarios, docetaxel retreatment, consideration for reduced doses of abiraterone, and alternative schedules of an osteoclast-targeted therapy. CONCLUSION: There was wide-ranging consensus in the treatment for men with mCRPC in both optimal and limited resource settings.

Correlação entre o perfil de expressão protéica e fatores prognósticos em portadores de carcinoma pulmonar não pequenas células avançado loco-regionalmente / Correlation between the profile of protein expression and prognostic factors in carriers of locally advanced non small cell lung cancer

O Câncer de Pulmão é a causa mais comum de morte por neoplasia em todo o mundo e sua incidência vem aumentando desde a década de 50. No Brasil, foram diagnosticados aproximadamente 27.170 novos casos em 2006. Em nosso meio cerca de 80% dos Carcinomas Pulmonares Não Pequenas Células (CPNPC) apresentam-se como doença avançada localmente ou com metástase à distância. O prognóstico neste grupo de pacientes é ruim, com taxas de sobrevida a 5 anos variando de 10 a 15% nos pacientes com estadio clinico IIIA e de 2-5% em pacientes com estágio clínico IIIB. Para a grande maioria dos autores, os principais fatores prognósticos em CPNPC são: desempenho clinico (índice de Karnofsky), extensão da doença, tipo histológico, raça, sexo, idade e estado nutricional. Através de analise retrospectiva de 64 pacientes com CPNPC estadio clinico (EC) III, tratados com quimioterapia e radioterapia combinadas, correlacionamos variáveis clínicas com a análise da expressão dos marcadores protéicos relacionados ao ciclo celular (p53, pRb, p21 e p27), além dos oncogenes (EGFR, c-erbB2) utilizando-se a imunoistoquímica. Vários estudos tem demonstrado o valor destes marcadores como fator de prognóstico em Câncer de Pulmão. Em nosso estudo, a sobrevida global a 3 anos foi de 22,7% e a 5 anos de 8,3%, com mediana de 16 meses. Entre as variáveis clínicas analisadas, tais como: gênero, idade, histologia, estadio clínico e modalidade de tratamento, apenas o estadio clínico alcançou significância estatística, com sobrevida a 3 anos de 47% para o IIIA e 14,1% para o IIIB, com p=0,01. Em relação aos anticorpos estudados, a perda de expressão do p21 correlacionou-se com uma maior sobrevida global a 3 anos (34,6% versus 11%; p=0,01). A expressão dos demais marcadores protéicos não mostrou correlação signficativa com a sobrevida global. Foi demonstrado, em análise multivariada, que o estadio clínico e a expressão da p21 comportaram-se como variáveis independentes de pior prognóstico em nosso estudo. Em conclusão, entre os marcadores moleculares estudados, apenas a expressão do p21 determinou piora da sobrevida. O EC e a expressão do p21 obtiveram valor prognostico independente na determinação da sobrevida global. Em virtude da complexidade das interações protéicas presentes no ciclo celular das células neoplásicas, a interpretação desses resultados, deve ser vista de maneira cuidadosa, devido principalmente a nossa casuística limitada, a seleção dos pacientes e o número limitado de marcadores realizados neste estudo.

Lung cancer is the most common cause of death for neoplasia in the whole world and its incidence comes increasing since the decade of 50. In Brazil, 27,170 new cases in 2006 were diagnosed, being 80% of them is presented as advanced local illness or with distant metastasis. The prognosis in this group of patients is bad, with a 5 years survival rate varying of 10-15% in the patients with clinical stage (CS) IIIA and of 2-5% in patients with CS IIIB. For the great majority of the authors, the main prognostic factors in non small cell lung cancer (NSCLC) are: performance-status (Karnofsky index), CS, histological subtype, race, gender, age, and nutritional state. Through a data base of 64 patients diagnosed with NSCLC CS III, treated exclusively with chemoradiotherapy or radiotherapy alone, we correlate clinical parameters with the analysis of the expression of the molecular markers related to cellular cycle (p53, pRb, p21 and p27) and expression of oncogenes (EGFR, c-erbB2) using immunohistochemical method. Various studies have demonstrated the value of these molecular markers as prognostic factor in lung cancer. In our study, the 3 and 5 survival rates was of 22,7% and of 8,3%, respectively. In respect of the clinical parameters analyzed, such as: gender, age, histologic subtype, CS and type of treatment, only the CS reached statistical significance, with a 3 years survival rate of 47% for CS IIIA and 14.1% for the IIIB, with p=0,01. In relation to studied antibodies, the loss of expression of p21 was correlated with a greater survival (34.6% versus 11%; p=0,01). The expression of the EGFR, cerb-B2, p53, pRb and p27 did not correlated statistically with survival. It was demonstrated, in a multivariate analysis that the CS and the expression of p21 has behaved as independent variable of worse prognostic in our study. In conclusion, the CS and expression of p21 had independent prognosis in determination of overall survival. Due to complexity of the protein interactions in the cellular cycle of the neoplasic cells, the interpretation of these results, due casuistic limitation, patient selection and limited numbers of markers, these data must carefully be analysed, mainly if analyzed of isolated form.