ABSTRACT
Infections are still a major cause of morbi-mortality in patients with cancer. Some of these infections are preventable through specific measures, such as vaccination or prophylaxis. This guideline aims to summarize the evidence and recommendations for the prevention of infections in cancer patients, devoting special attention to the most prevalent preventable infectious disease. All the evidences will be graded according to The Infectious Diseases Society of America grading system.
Subject(s)
Neoplasms/complications , Neoplasms/drug therapy , Antibiotic Prophylaxis , Immunosuppression Therapy , Drug Therapy , VaccinationABSTRACT
Infections are still a major cause of morbi-mortality in patients with cancer. Some of these infections are preventable through specific measures, such as vaccination or prophylaxis. This guideline aims to summarize the evidence and recommendations for the prevention of infections in cancer patients, devoting special attention to the most prevalent preventable infectious disease. All the evidences will be graded according to The Infectious Diseases Society of America grading system.
Subject(s)
Communicable Diseases , Neoplasms , Humans , Neoplasms/complications , Neoplasms/drug therapyABSTRACT
Breast cancer constitutes the most common malignant neoplasm in women around the world. Approximately 12% of patients are diagnosed with metastatic stage, and between 5 and 30% of early or locally advanced BC patients will relapse, making it an incurable disease. PD-L1 ligation is an immune inhibitory molecule of the activation of T cells, playing a relevant role in numerous types of malignant tumors, including BC. The objective of the present review is to analyze the role of PD-L1 as a biomarker in the different BC subtypes, adding clinical trials with immune checkpoint inhibitors and their applicable results. Diverse trials using immunotherapy with anti-PD-1/PD-L1 in BC, as well as prospective or retrospective cohort studies about PD-L1 in BC, were included. Despite divergent results in the reviewed studies, PD-L1 seems to be correlated with worse prognosis in the hormone receptor positive subtype. Immune checkpoints inhibitors targeting the PD-1/PD-L1 axis have achieved great response rates in TNBC patients, especially in combination with chemotherapy, making immunotherapy a new treatment option in this scenario. However, the utility of PD-L1 as a predictive biomarker in the rest of BC subtypes remains unclear. In addition, predictive differences have been found in response to immunotherapy depending on the stage of the tumor disease. Therefore, a better understanding of tumor microenvironment, as well as identifying new potential biomarkers or combined index scores, is necessary in order to make a better selection of the subgroups of BC patients who will derive benefit from immune checkpoint inhibitors.
ABSTRACT
Triple negative breast cancer (TNBC) is a heterogeneous disease representing about 15% of all breast cancers. TNBC are usually high-grade histological tumors, and are generally more aggressive and difficult to treat due to the lack of targeted therapies available, and chemotherapy remains the standard treatment. There is a close relationship between pathological complete response after chemotherapy treatment and higher rates of disease-free survival and overall survival. In this review of systemic treatment in early triple negative breast cancer, our purpose is to analyze and compare different therapies, as well as to highlight the novelties of treatment in this breast cancer subtype.
ABSTRACT
CONTEXT: Resection of pancreatic cancer with vascular invasion is a controversial issue, especially when the arterial trunks, such as the celiac axis, are involved. The modified Appleby procedure deals with the problem of encasement of the celiac trunk. CASE REPORT: Two patients with locally advanced pancreatic cancer are reviewed: a 65-year-old female and a 78-year-old male with pancreatic cancer and involvement of the celiac trunk and hepatic artery. The male patient received neoadjuvant chemoradiation. The former underwent an extended pancreatectomy with en-bloc resection of the hepatic artery, celiac trunk, gastric serosa and adrenal gland. Liberation of arterial trunk involvement in the second patient was performed. The margins were microscopically clear of tumor (R0) in both patients. The second patient died from cholecystitis owing to arterial insufficiency. CONCLUSIONS: CT vascular encasement is not always synonymous with real tumoral vascular invasion. Improvement in the quality of anesthesiological and surgical techniques has allowed vascular resections with lower morbidity. A cholecystectomy should always be performed using the modified Appleby procedure.
Subject(s)
Adenocarcinoma/complications , Pancreatectomy/methods , Pancreatic Neoplasms/complications , Adenocarcinoma/surgery , Aged , Celiac Artery/pathology , Celiac Artery/surgery , Cholecystectomy/methods , Constriction, Pathologic/surgery , Female , Hepatic Artery/pathology , Hepatic Artery/surgery , Humans , Male , Pancreatic Neoplasms/surgery , ThinkingABSTRACT
During the clinical evolution of patients with cancer there are many occasions, or phases of the disease, when there are no specific treatments and, as such, we need to provide maximum comfort following appropriate symptom control; in this stage it is fundamental to respect personal autonomy together with the option to reject futile treatment. With appropriate control of symptoms it is possible to reach the stage where the majority of the patients do not continue to suffer. Continuous-care providers for cancer patients are those who are responsible for providing help to resolve these situations. In palliative medicine there are highly-efficacious procedures to the help in these last hours. Sedation is applied when it is impossible to control symptoms by other means. With appropriate Carer cover, it is not necessary to introduce laws on assisted suicide and/or active voluntary euthanasia, neither because of the magnitude of demand, nor because of the difficulties in achieving appropriate control of symptoms.
Subject(s)
Caregivers , Euthanasia , Neoplasms/therapy , Patient Care Team , Terminal Care/methods , Australia , Europe , Euthanasia/legislation & jurisprudence , Euthanasia, Active/ethics , Euthanasia, Active/legislation & jurisprudence , Euthanasia, Active/psychology , Euthanasia, Passive/ethics , Euthanasia, Passive/legislation & jurisprudence , Euthanasia, Passive/psychology , Humans , Japan , Medical Futility , Neoplasms/psychology , Palliative Care , Personal Autonomy , Right to Die/legislation & jurisprudence , Suicide, Assisted/legislation & jurisprudence , Terminal Care/ethics , Terminal Care/legislation & jurisprudence , Terminal Care/psychology , Terminally Ill/psychology , United StatesABSTRACT
La evolución de los enfermos con cáncer conduce en muchas ocasiones a fases de la enfermedad en las que no existen tratamientos específicos y éstos debemos aplicarlos en la consecución del máximo confort a través de un adecuado control sintomático, en esa etapa es fundamental el respeto de la autonomía personal y la posibilidad del rechazo de tratamientos fútiles. Con el adecuado control de síntomas es posible lograr que la mayoría de los enfermos no padezcan sufrimientos. Los cuidados continuos en el paciente oncológico son los responsables de ayudarnos a resolver estas situaciones. En medicina paliativa existe un procedimiento altamente eficaz en la ayuda en las últimas horas, la sedación, aplicable cuando sea imposible el control sintomático con otros medios. Con una cobertura adecuada de cuidados no debería ser necesario introducir leyes de suicidio asistido y/o eutanasia activa voluntaria, ni por la magnitud de la demanda, ni por las dificultades en el adecuado control sintomático
During the clinical evolution of patients with cancer there are many occasions, or phases of the disease, when there are no specific treatments and, as such, we need to provide maximum comfort following appropriate symptom control; in this stage it is fundamental to respect personal autonomy together with the option to reject futile treatment. With appropriate control of symptoms it is possible to reach the stage where the majority of the patients do not continue to suffer. Continuous-care providers for cancer patients are those who are responsible for providing help to resolve these situations. In palliative medicine there are highly-efficacious procedures to the help in these last hours. Sedation is applied when it is impossible to control symptoms by other means. With appropriate Carer cover, it is not necessary to introduce laws on assisted suicide and/or active voluntary euthanasia, neither because of the magnitude of demand, nor because of the difficulties in achieving appropriate control of symptoms
