Novel Therapies in the Treatment of Hodgkin Lymphoma.

OPINION STATEMENT: Patients with Hodgkin lymphoma (HL) can achieve excellent response and survival rates following frontline combination chemo- and radiation therapy. However, about 10-15% of patients will experience disease relapse which is associated with poor outcomes. Recent breakthroughs in understanding the mechanisms of oncogenicity and interactions within the tumor microenvironment have resulted in development of novel drugs for treatment of patients with HL. Utilizing this information, treatment of newly diagnosed and relapsed HL has become a rapidly evolving field with multiple clinical trials evaluating novel treatment approaches incorporating targeted immunotherapy. In the frontline setting, the use of novel drugs may allow for de-escalation of therapy to avoid long-term complications associated with bleomycin and consolidation radiation therapy. Patients with early-stage, non-bulky disease are candidates for omitting radiation therapy using treatment combinations that include upfront use of brentuximab vedotin or nivolumab. In patients with advanced disease, the addition of brentuximab vedotin to a chemotherapy backbone is currently the standard of care in our practice, particularly in patients with a contraindication for receiving bleomycin. Future investigations in patients with advanced-stage HL will focus on establishing a new standard of care by comparing brentuximab vedotin and nivolumab in combination with chemotherapy (BV-AVD vs. N-AVD) and decreasing the risk of relapse by exploring consolidation therapy in patients with high-risk disease. In patients who have relapsed or are refractory to first-line therapy, salvage treatment has incorporated brentuximab vedotin or PD-1 checkpoint inhibitors to improve response rates of cytotoxic chemotherapy thereby improving the probability of a successful stem cell transplant. Post-transplant consolidation with brentuximab is currently standard of care in patients with high-risk disease. Patients who relapse following autologous stem cell transplant now have an expanded armamentarium of chemo- and immunotherapy options. However, the challenge is to determine the sequence of therapy after prior brentuximab or checkpoint inhibitor exposure.

Outcomes of COVID-19 in Patients With Cancer: A Closer Look at Pre-Emptive Routine Screening Strategies.

PURPOSE: The benefit of routine pre-emptive screening for severe acute respiratory syndrome coronavirus 2 infections in patients with cancer before cancer-directed therapies is unclear. Herein, we characterize the outcomes of a cohort of patients with cancer who were diagnosed with COVID-19 by routine screening (RS) in comparison with those diagnosed on the basis of clinical suspicion or exposure history (nonroutine screening [NRS]). METHODS: A multisite prospective observational study was conducted at three major and five satellite campuses of the Mayo Clinic Cancer Center between March 18 and July 31, 2020. The primary outcome was COVID-19-related hospital admission. Secondary outcomes included intensive care unit admissions and all-cause mortality. RESULTS: Five thousand four hundred fifty-two patients underwent RS in the outpatient setting only, and 44 (0.81%) were diagnosed with COVID-19. RS detected 19 additional patients from the scheduled inpatient admissions for surgical or interventional procedures or inpatient chemotherapy. One hundred sixty-one patients were diagnosed with COVID-19 on the basis of NRS. COVID-19-related hospitalization rate (17.5% v 26.7%; P = .14), intensive care unit admission (1.6% v 5.6%; P = .19), and mortality (4.8% v 3.7%; P = .72) were not significantly different between the RS and NRS groups. In the multivariable analysis, age ≥ 60 years (odds ratio, 4.4; P = .023) and an absolute lymphocyte count ≤ 1.4 × 109/L (odds ratio, 9.2; P = .002) were independent predictors of COVID-19-related hospital admission. CONCLUSION: The COVID-19 positivity rate was low on the basis of RS. Comparing the hospital admission and mortality outcomes with the NRS cohort, there were no significant differences. The value of routine pre-emptive screening of asymptomatic patients with cancer for COVID-19 remains low.

Cardiac complications of chemotherapy: role of prevention.

OPINION STATEMENT: With recent novel therapies, cancer survival has improved and chemotherapy-induced cardiac toxicity including left ventricular dysfunction and heart failure has a greater potential impact on long-term outcomes. Hence, the prevention of cardiotoxicity should be an important objective when planning the therapy of cancer patients. Different pharmacologic and nonpharmacologic approaches have been shown to be effective in small trials, most of them in patients treated with anthracyclines. Treatment of cardiovascular risk factors, the implementation of a healthy lifestyle, and changes in the administration of anthracyclines have been shown to be effective to prevent cardiotoxicity, as is the administration of antioxidants such as dexrazoxane, and some cardiovascular drugs such as ACE-inhibitors and beta-blockers. Ongoing studies are analyzing the effects of these drugs on anthracycline- and trastuzumab-induced cardiotoxicity. Nevertheless, the future of the prevention of cardiac toxicity should include the study of the exact mechanism of toxicity of each cardiotoxic drug and the genetic individual susceptibility of each patient. With this information, correct risk stratification could be performed when planning the initial therapy and new drugs with less cardiotoxicity could be developed. Also, the diagnostic and prognostic value of different cardiac biomarkers and of imaging techniques for each cardiotoxic drug should be established. Finally, further large randomized studies are needed to confirm the results of prior pilot studies on the effects of cardioprotective drugs.

Caracterización clínica y citogenética del retraso mental y del desarrollo psicomotor en pacientes atendidos en el servicio de consulta externa de genética médica del hospital Roberto Gilbert Elizalde, Guayaquil – Ecuador / Clinical and cytogenetical description of mental retardation and psicomotor development in patients treated in the medical genetics outpatient service of the Roberto Gilbert Elizalde hospital, Guayaquil – Ecuador

Estudio retrospectivo, descriptivo, analítico, horizontal. Objetivo: conocer las causas genéticas más frecuentes de retraso mental y su caracterización clínica. Metodología: recolección de datos de los registros del hospital. Criterios de inclusión: pacientes con diagnóstico de retraso mental o retraso del desarrollo psicomotor que acudieron al servicio de genética médica del hospital “Roberto Gilbert” de Guayaquil durante el período comprendido entre el 1 de abril al 31 de diciembre de 2006, en quienes se ha descartado previamente causas peri o posnatales. Criterios de exclusión: pacientes con diagnóstico de retraso mental o retraso del desarrollo psicomotor de etiología peri o posnatal. Resultados: la relación hombre mujer fue de 1,3:1. Las causas genéticas correspondieron al 77 de los casos; de ellas 61 (66) correspondieron a cromosomopatías, 30 (33) a enfermedades monogénicas y 1 (1) etiología multifactorial. Las patologías asociadas más frecuentemente fueron las cardiopatías congénitas, seguida del hipotiroidismo, con 60 y 22 respectivamente. La edad a la cual los pacientes con Síndrome del X Frágil alcanzaron lenguaje hablado fue significativamente mayor a la encontrada en los grupos síndrome de Down (p=0,007) y otras causas de RDPM (p=0,03). Conclusiones: este estudio contribuye a la atención primaria de salud para una detección e intervención temprana y mejoramiento de la calidad de vida del paciente con RM incluida su familia.