RESUMEN
Survival for glioblastoma (GBM) patients with an unmethyated MGMT promoter in their tumor is generally worse than methylated MGMT tumors, as temozolomide (TMZ) response is limited. How to better treat patients with unmethylated MGMT is unknown. We performed a trial combining erlotinib and bevacizumab in unmethylated GBM patients after completion of radiation (RT) and TMZ. GBM patients with an unmethylated MGMT promoter were trial eligible. Patient received standard RT (60 Gy) and TMZ (75 mg/m2 × 6 weeks) after surgical resection of their tumor. After completion of RT they started erlotinib 150 mg daily and bevacizumab 10 mg/kg every 2 weeks until progression. Imaging evaluations occurred every 8 weeks. The primary endpoint was overall survival. Of the 48 unmethylated patients enrolled, 46 were evaluable (29 men and 17 women); median age was 55.5 years (29-75) and median KPS was 90 (70-100). All patients completed RT with TMZ. The median number of cycles (1 cycle was 4 weeks) was 8 (2-47). Forty-one patients either progressed or died with a median progression free survival of 9.2 months. At a follow up of 33 months the median overall survival was 13.2 months. There were no unexpected toxicities and most observed toxicities were categorized as CTC grade 1 or 2. The combination of erlotinib and bevacizumab is tolerable but did not meet our primary endpoint of increasing survival. Importantly, more trials are needed to find better therapies for GBM patients with an unmethylated MGMT promoter.
Asunto(s)
Antineoplásicos/uso terapéutico , Bevacizumab/uso terapéutico , Neoplasias Encefálicas/tratamiento farmacológico , Clorhidrato de Erlotinib/uso terapéutico , Glioblastoma/tratamiento farmacológico , Radioterapia/efectos adversos , Adulto , Metilación de ADN , Metilasas de Modificación del ADN/genética , Dacarbazina/efectos adversos , Dacarbazina/análogos & derivados , Supervivencia sin Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Temozolomida , Resultado del Tratamiento , Adulto JovenRESUMEN
The paper presents an informatic system offering the acupuncturist, herbalist and acupressurist a rich source of clinical information. It adapts the theory of Chinese Medicine to Western medical practice and is solidly based on the ancient Chinese classics. The system provides an orientative diagnosis starting from the clinical picture of the patient consisting in syndrome differentiation. Based on the Yin-Yang and 5 Elements theory the remedy associated with the energetic imbalance is determinated. Then the tastes, nature and tropism implied by the principle of treatment are used to prescribe the herbal treatment. The treatment variants through acupuncture and acupressure are also indicated. The system is also useful in teaching Chinese Medicine.
Asunto(s)
Toma de Decisiones Asistida por Computador , Sistemas Especialistas , Medicina Tradicional China , Acupresión/métodos , Terapia por Acupuntura/métodos , Medicamentos Herbarios Chinos/uso terapéutico , Humanos , RumaníaRESUMEN
The paper presents a system developed for the assistance of diagnosis and treatment in alternative medicine, based on traditional Chinese methods. The system named CompAc, is a result of an interdisciplinary cooperation and is designed for the physician, specialist in acupuncture. The Compac system allows the determination of the type of energetic imbalance starting from the clinical picture of the patient and establishing whether an organ or any of the viscera are affected. It allows also the indication of different variants of treatment. The diagnosis proposed by the system has to be confirmed by the physician and can be modified by him. The system is also useful for medical training.