Prediction of severe toxicity in adult patients under treatment with 5-fluorouracil: a prospective cohort study.

5-Fluorouracil (5-FU) has long been used for the treatment of gastrointestinal tumors harboring interindividual variability in both the pharmacokinetic and the pharmacogenetic profiles, which in turn may lead to life-threatening toxicities. We carried out a prospective cohort study of adult patients initiating treatment with 5-FU between 2013 and 2015. Primary exposures of interest were the methylenetetrahydrofolate reductase single nucleotide polymorphism in exons 4 and 7 and 5'-untranslated region-thymidylate synthase VNTR genotypes, in addition to baseline clinical and demographic variables. The primary outcome was the time to the occurrence of severe toxicity. We used a Cox regression model to evaluate patients' survival and toxicity experience and its association with baseline characteristics and a priori determined genetic polymorphisms. A total of 197 patients were included, 40.1% developed severe toxicity during follow-up. Variables that were significantly associated with developing severe toxicity were the European Organization for Research and Treatment of Cancer functional score [hazard ratio (HR): 0.98; 95% confidence interval (CI): 0.97-0.99]; type of tumor [anus (HR: 2.50; 95% CI: 1.07-5.82), head and neck/esophagus/stomach (HR: 2.95; 95% CI: 1.64-5.33)] and 5-FU continuous infusion regimens over 4-5 days (HR: 9.35; 95% CI: 2.68-32.59). We found a significant association between baseline functional status, type of tumor and continuous infusion regimens and the occurrence of severe toxicity during the follow-up of patients receiving 5-FU. No association was found with the genotypic variants evaluated. Future validation and modeling of an everyday easy-to-use score to predict toxicity among these subgroup of patients remains warranted.

Whole-brain radiation therapy plus concomitant temozolomide for the treatment of brain metastases from non-small-cell lung cancer: a randomized, open-label phase II study.

BACKGROUND: A previously published study of temozolomide concurrent with whole-brain radiation therapy (WBRT) reported significant improvement in response rates and a nonsignificant trend toward improved overall survival compared with WBRT alone in patients with brain metastases primarily from lung cancer. This study sought to confirm the benefit of adding temozolomide to WBRT in patients with non-small-cell lung cancer (NSCLC) with brain metastases. PATIENTS AND METHODS: This planned phase III study (target = 380 events) was converted to a phase II study (target = 70 events) because of poor enrollment. Patients with NSCLC and > or = 1 newly diagnosed brain lesion were randomized to WBRT (30 Gy in 10 fractions) alone or combined with temozolomide (75 mg/m2/day) for 21 or 28 days. Endpoints included overall survival and time to central nervous system (CNS) progression. RESULTS: Median overall survival and median time to CNS progression was 4.4 and 3.1 months in the WBRT + temozolomide arm (n = 47) versus 5.7 and 3.8 months in the WBRT arm (n = 48). However, there were imbalances in the percentages of patients receiving previous chemotherapy and with synchronous brain metastases. Adding temozolomide to WBRT increased the frequency of nausea, vomiting, alopecia, fatigue, anorexia, and constipation. Most adverse events were mild to moderate. CONCLUSION: The benefit of adding temozolomide to WBRT was not confirmed; however, the accrual goal for the planned phase III trial was not reached, and the study regimen differed from regimens used previously. Therefore, the role of temozolomide in treating brain metastases remains unresolved.

PKC Delta (PKCdelta) promotes tumoral progression of human ductal pancreatic cancer.

OBJECTIVE: Our objective was to study the role of protein kinase C delta (PKCdelta) in the progression of human pancreatic carcinoma. METHODS: Protein kinase C delta expression in human ductal carcinoma (n = 22) was studied by immunohistochemistry. We analyzed the effect of PKCdelta overexpression on in vivo and in vitro properties of human ductal carcinoma cell line PANC1. RESULTS: Human ductal carcinomas showed PKCdelta overexpression compared with normal counterparts. In addition, in vitro PKCdelta-PANC1 cells showed increased anchorage-independent growth and higher resistance to serum starvation and to treatment with cytotoxic drugs. Using pharmacological inhibitors, we determined that phosphatidylinositol-3-kinase and extracellular receptor kinase pathways were involved in the proliferation of PKCdelta-PANC1. Interestingly, PKCdelta-PANC1 cells showed a less in vitro invasive ability and an impairment in their ability to migrate and to secrete the proteolytic enzyme matrix metalloproteinase-2. In vivo experiments indicated that PKCdelta-PANC1 cells were more tumorigenic, as they developed tumors with a significantly lower latency and a higher growth rate with respect to the tumors generated with control cells. Besides, only PKCdelta-PANC1 cells developed lung metastasis. CONCLUSION: Our results showed that the overexpression of PKCdelta in PANC1 cells induced a more malignant phenotype in vivo, probably through the modulation of cell proliferation and survival, involving phosphatidylinositol-3-kinase and extracellular receptor kinase signaling pathways.

Prognostic value of Mdm2, p53 and p16 in patients with astrocytomas.

Surgical cure of gliomas infiltrating into the brain is practically impossible and their clinical course is primarily determined by the biological behavior of the tumor cell. The purpose of this study was to analyze retrospectively prognostic input of p53, Mouse double minute-2 (Mdm2) and p16 in 103 uniformly treated patients with astrocytic tumors. The expression of these molecules was measured by immunohistochemical procedure. Prognostic evaluation was performed with the multivariate proportional hazards model. The follow-up period lasted 19 (5-122) months for the survivors. We observed that 66% of gliomas showed mutated p53, while only 17% overexpressed Mdm2, the p53-regulatory molecule. Besides, almost 50% of gliomas lost p16 immunopositivity. Only p53 labeling showed a positive correlation with the grade of malignancy, according with the WHO classification. The association between mutated p53 and histological grade remained when prognostic variables were considered in a multivariate analysis. No association between p53 status and overall survival was found. On the other hand, Mdm2 overexpression and, unexpectedly, p16 immunopositivity were associated with a shorter survival in an univariate analysis. However, Cox-regression analysis showed that only Mdm2 in female patients was an independent prognostic factor, associated with shorter survival. In conclusion, our results suggest that Mdm2 could be a relevant marker in determining the evolution of glioma patients and could provide a more objective way to classify astrocytomas.

[Predictive response variables to recombinant human erythropoietin treatment in patients with anemia and cancer]. / Variables predictivas de respuesta a la eritropoyetina recombinante humana en pacientes con anemia y cáncer.

The use of human recombinant erythropoietin (rHuEpo) has been approved by the Food and Drug Administration (FDA) in patients with anemia and cancer. Although good results have been obtained, it is too expensive to permit its use massively. For the purpose of evaluating the therapeutic effect of rHuEpo, including toxicity, predictive response variables and quality of life parameters, a prospective trial was carried out in patients with anemia and cancer. Hematimetric parameters, ferritin, Epo, cytokines, transfusions and quality of life were registered. A total of 36 patients were treated in the protocol (34 were evaluable): 16 men and 20 women, with a medium age 56.4 years; 27 patients were treated with chemotherapy (16 with cisplatinum); 15 patients presented medullar infiltration. In 73.5% patients an increase in the level of hemoglobin was registered, and in 64.7% its normalisation was attained. Transfusional requirements were reduced by 50%. The hemoglobin increase greater than 0.5 g/dl at the second week of treatment was the most significant variable of early response. Patients treated with cisplatinum, seric ferritin lower than 1,100 ng/dl and those without medullar tumoral infiltration responded best. Serum Epo, cytokines (IL-1, IL-6 and TNF) and reticulocyte count at the second week did not correlate with response. Quality of life parameters were better in patients with good response to rHuEpo. It can be concluded that good results in the treatment of patients with anemia and cancer are obtained with rHuEpo.

Variables predictivas de respuesta a la eritropoyetina recombinante humana en pacientes con anemia y cáncer. / [Predictive response variables to recombinant human erythropoietin treatment in patients with anemia and cancer]

The use of human recombinant erythropoietin (rHuEpo) has been approved by the Food and Drug Administration (FDA) in patients with anemia and cancer. Although good results have been obtained, it is too expensive to permit its use massively. For the purpose of evaluating the therapeutic effect of rHuEpo, including toxicity, predictive response variables and quality of life parameters, a prospective trial was carried out in patients with anemia and cancer. Hematimetric parameters, ferritin, Epo, cytokines, transfusions and quality of life were registered. A total of 36 patients were treated in the protocol (34 were evaluable): 16 men and 20 women, with a medium age 56.4 years; 27 patients were treated with chemotherapy (16 with cisplatinum); 15 patients presented medullar infiltration. In 73.5

patients an increase in the level of hemoglobin was registered, and in 64.7

its normalisation was attained. Transfusional requirements were reduced by 50

. The hemoglobin increase greater than 0.5 g/dl at the second week of treatment was the most significant variable of early response. Patients treated with cisplatinum, seric ferritin lower than 1,100 ng/dl and those without medullar tumoral infiltration responded best. Serum Epo, cytokines (IL-1, IL-6 and TNF) and reticulocyte count at the second week did not correlate with response. Quality of life parameters were better in patients with good response to rHuEpo. It can be concluded that good results in the treatment of patients with anemia and cancer are obtained with rHuEpo.

Variables predictivas de respuesta a la eritropoyetina recombinante humana en pacientes con anemia y cancer / Predictive response variables to recombinant human erythropoietin treatment in patients with anemia and cancer

The use of human recombinant erythropoietin (rHuEpo) has been approved by the Food and Drug Administration (FDA) in patients with anemia and cancer. Although good results have been obtained, it is too expensive to permit its use massively. For the purpose of evaluating the therapeutic effect of rHuEpo, including toxicity, predictive response variables and quality of life parameters, a prospective trial was carried out in patients with anemia and cancer. Hematimetric parameters, ferritin, Epo, cytokines, transfusions and quality of life were registered. A total of 36 patients were treated in the protocol (34 were evaluable): 16 men and 20 women, with a medium age 56.4 years; 27 patients were treated with chemotherapy (16 with cisplatinum); 15 patients presented medullar infiltration. In 73.5 percent patients an increase in the level of hemoglobin was registered, and in 64.7 percent its normalisation was attained. Transfusional requirements were reduced by 50 percent. The hemoglobin increase greater than 0.5 g/dl at the second week of treatment was the most significant variable of early response. Patients treated with cisplatinum, seric ferritin lower than 1,100 ng/dl and those without medullar tumoral infiltration responded best. Serum Epo, cytokines (IL-1, IL-6 and TNF) and reticulocyte count at the second week did not correlate with response. Quality of life parameters were better in patients with good response to rHuEpo. It can be concluded that good results in the treatment of patients with anemia and cancer are obtained with rHuEpo. (AU)

Variables predictivas de respuesta a la eritropoyetina recombinante humana en pacientes con anemia y cancer / Predictive response variables to recombinant human erythropoietin treatment in patients with anemia and cancer

The use of human recombinant erythropoietin (rHuEpo) has been approved by the Food and Drug Administration (FDA) in patients with anemia and cancer. Although good results have been obtained, it is too expensive to permit its use massively. For the purpose of evaluating the therapeutic effect of rHuEpo, including toxicity, predictive response variables and quality of life parameters, a prospective trial was carried out in patients with anemia and cancer. Hematimetric parameters, ferritin, Epo, cytokines, transfusions and quality of life were registered. A total of 36 patients were treated in the protocol (34 were evaluable): 16 men and 20 women, with a medium age 56.4 years; 27 patients were treated with chemotherapy (16 with cisplatinum); 15 patients presented medullar infiltration. In 73.5 percent patients an increase in the level of hemoglobin was registered, and in 64.7 percent its normalisation was attained. Transfusional requirements were reduced by 50 percent. The hemoglobin increase greater than 0.5 g/dl at the second week of treatment was the most significant variable of early response. Patients treated with cisplatinum, seric ferritin lower than 1,100 ng/dl and those without medullar tumoral infiltration responded best. Serum Epo, cytokines (IL-1, IL-6 and TNF) and reticulocyte count at the second week did not correlate with response. Quality of life parameters were better in patients with good response to rHuEpo. It can be concluded that good results in the treatment of patients with anemia and cancer are obtained with rHuEpo.

Quistes y tumores del timo: enfoque multidisciplinario de diagnóstico y tratamiento / Thymic cysts and tumors: multispeciality diagnostic methods and treatment

Objetivo: Analizar los resultados de una serie de tumores de timo. Población: 43 pacientes asistidos en el período de 1977-97, sobre un total de 114 tumores de mediastino (37,7 por ciento). Método: Se analizó específicamente la sintomatología, metodología de diagnóstico, características tumorales locales (grado de invasión en los timomas), tratamiento instituido, mortalidad, supervivencia y causa de muerte. Resultados: Los 43 tumores se presentaron en 25 mujeres y 18 hombres, edad promedio 48 años. El timoma (28 casos) fue la variedad más frecuente (65 por ciento). Quince pacientes no tuvieron síntomas (34,9 por ciento), la Miastenia Gravis (MG) con 10 casos fue la sintomatología más común. La Rx y la TAC de tórax fueron estudios suficientes para la detección y evaluación general de los tumores. En 12 tumores malignos/invasores se obtuvo diagnóstico preoperatorio, 7 por punción percutánea y 5 por mediastinoscopía, mediastinotomía o biopsia cervical. Hubo 12 timomas no invasores y 16 invasores (9 Estadio II, 5 Estadio III y 2 Estadio IV). Se operaron 42 pacientes, el abordaje más frecuente fue la esternotomía mediana (23 casos), todos fueron resecados, 30 con resección simple y 12 ampliadas. Un paciente (linfoma de timo) sólo recibió irradiación y quimioterapia (QMT), 21 recibieron irradiación P.O., 13 timomas, 5 linfomas y 3 carcinomas. Tres pacientes recibieron QTM neoadyuvante con resultados favorables, y 9 adyuvante. Fallecieron 2 pacientes en el P.O. inmediato, ambos portadores de MG, y 6 en el P.O. alejado, 3 por progresión tumoral, los restantes por crisis de MG tromboembolismo pulmonar y complicación de la QMT. La supervivencia actuarial global posoperatoria (P.O.) de los 28 timomas fue a 5 y 10 años del 73 por ciento, 3 de los 5 carcinomas fallecieron por progresión tumoral entre los 2 y 27 meses. Conclusiones: El 34,9 por ciento de los tumores del timo fueron asintomáticos. El timoma fue la variedad más frecuente (65 por ciento), su malignidad se determinó por el grado de invasión, siendo el 43 por ciento no invasivos. Para los tumores invasivos/malignos la punción percutánea fue un método de diagnóstico muy efectivo. El tratamiento de elección de ser la resección quirúrgica con criterio agresivo, y de ser necesaria localmente extendida. La irradiación P.O. fue efectiva en los timomas invasores, la QMT neoadyuvante presentó buen índice de respuesta favorable. Se observó peor evolución P.O. inmediata en los pacientes portadores de M.G... (AU)

Quistes y tumores del timo: enfoque multidisciplinario de diagnóstico y tratamiento / Thymic cysts and tumors: multispeciality diagnostic methods and treatment

Objetivo: Analizar los resultados de una serie de tumores de timo. Población: 43 pacientes asistidos en el período de 1977-97, sobre un total de 114 tumores de mediastino (37,7 por ciento). Método: Se analizó específicamente la sintomatología, metodología de diagnóstico, características tumorales locales (grado de invasión en los timomas), tratamiento instituido, mortalidad, supervivencia y causa de muerte. Resultados: Los 43 tumores se presentaron en 25 mujeres y 18 hombres, edad promedio 48 años. El timoma (28 casos) fue la variedad más frecuente (65 por ciento). Quince pacientes no tuvieron síntomas (34,9 por ciento), la Miastenia Gravis (MG) con 10 casos fue la sintomatología más común. La Rx y la TAC de tórax fueron estudios suficientes para la detección y evaluación general de los tumores. En 12 tumores malignos/invasores se obtuvo diagnóstico preoperatorio, 7 por punción percutánea y 5 por mediastinoscopía, mediastinotomía o biopsia cervical. Hubo 12 timomas no invasores y 16 invasores (9 Estadio II, 5 Estadio III y 2 Estadio IV). Se operaron 42 pacientes, el abordaje más frecuente fue la esternotomía mediana (23 casos), todos fueron resecados, 30 con resección simple y 12 ampliadas. Un paciente (linfoma de timo) sólo recibió irradiación y quimioterapia (QMT), 21 recibieron irradiación P.O., 13 timomas, 5 linfomas y 3 carcinomas. Tres pacientes recibieron QTM neoadyuvante con resultados favorables, y 9 adyuvante. Fallecieron 2 pacientes en el P.O. inmediato, ambos portadores de MG, y 6 en el P.O. alejado, 3 por progresión tumoral, los restantes por crisis de MG tromboembolismo pulmonar y complicación de la QMT. La supervivencia actuarial global posoperatoria (P.O.) de los 28 timomas fue a 5 y 10 años del 73 por ciento, 3 de los 5 carcinomas fallecieron por progresión tumoral entre los 2 y 27 meses. Conclusiones: El 34,9 por ciento de los tumores del timo fueron asintomáticos. El timoma fue la variedad más frecuente (65 por ciento), su malignidad se determinó por el grado de invasión, siendo el 43 por ciento no invasivos. Para los tumores invasivos/malignos la punción percutánea fue un método de diagnóstico muy efectivo. El tratamiento de elección de ser la resección quirúrgica con criterio agresivo, y de ser necesaria localmente extendida. La irradiación P.O. fue efectiva en los timomas invasores, la QMT neoadyuvante presentó buen índice de respuesta favorable. Se observó peor evolución P.O. inmediata en los pacientes portadores de M.G...

Ferritina urinaria: un nuevo indicador de nefrotoxicidad por cisplatino? / Urinary ferritin: a new marker of cisplatin nephrotoxicity?

Con el objetivo de relacionar las variaciones de ferritina urinaria (FU) con diversos indicadores de nefrotoxicidad por cisplatino (cisP), 26 pacientes recibieron 6 ciclos de quimioterapia que incluían CisP (sin otras drogas nefrotóxicas). El grupo control (CONT, N = 20) fue tratado con seis ciclos de quimioterapia sin drogas nefrotóxicas. Las edades fueron similares en ambos grupos (50,2 ñ 2,6 y 47,7 ñ 2,8 años). En el grupo CisP la FU (ng/mL) basal (B) fue 2,05 ñ 0,19 y luego del 2do ciclo (2C) 50,37 ñ 8,94 (p < 0,001); los valores de ß sub2 microglobulina (ßµG, ng/mL) fueron 248 ñ 10 (B) y 295 ñ 44 (2C; p < 0,01); los de magnesio sérico (MgS, meq/L), 2,03 ñ 0,03 (B) y 1,67 ñ 0,04 (2C; p < 0,001) y los clearances de creatinina (CLCr, mL/min), 109 ñ 3,6 (B) y 94,8 ñ 3,4 (2C; p < 0,001). FU se correlacionó significativamente (p < 0,0001; N = 208) con ßµG (r = 0,550), MgS (r = 0,465) y CLCr (r = 0,375), pero no con la ferritina sérica. En CONT no hubo modificaciones de FU. ßµG, MgS ni CLCr. Los resultados sugieren que el incremento de FU podría ser un indicador de nefrotoxicidad por cisP, cuya utilidad clínica es necesario evaluar

Ferritina urinaria: un nuevo indicador de nefrotoxicidad por cisplatino? / Urinary ferritin: a new marker of cisplatin nephrotoxicity?

Con el objetivo de relacionar las variaciones de ferritina urinaria (FU) con diversos indicadores de nefrotoxicidad por cisplatino (cisP), 26 pacientes recibieron 6 ciclos de quimioterapia que incluían CisP (sin otras drogas nefrotóxicas). El grupo control (CONT, N = 20) fue tratado con seis ciclos de quimioterapia sin drogas nefrotóxicas. Las edades fueron similares en ambos grupos (50,2 ñ 2,6 y 47,7 ñ 2,8 años). En el grupo CisP la FU (ng/mL) basal (B) fue 2,05 ñ 0,19 y luego del 2do ciclo (2C) 50,37 ñ 8,94 (p < 0,001); los valores de ß sub2 microglobulina (ßAG, ng/mL) fueron 248 ñ 10 (B) y 295 ñ 44 (2C; p < 0,01); los de magnesio sérico (MgS, meq/L), 2,03 ñ 0,03 (B) y 1,67 ñ 0,04 (2C; p < 0,001) y los clearances de creatinina (CLCr, mL/min), 109 ñ 3,6 (B) y 94,8 ñ 3,4 (2C; p < 0,001). FU se correlacionó significativamente (p < 0,0001; N = 208) con ßAG (r = 0,550), MgS (r = 0,465) y CLCr (r = 0,375), pero no con la ferritina sérica. En CONT no hubo modificaciones de FU. ßAG, MgS ni CLCr. Los resultados sugieren que el incremento de FU podría ser un indicador de nefrotoxicidad por cisP, cuya utilidad clínica es necesario evaluar (AU)