RESUMEN
Epithelial ovarian cancer (EOC) is the deadliest gynecological malignancy worldwide. Brain metastasis (BM) is quite an uncommon presentation. However, the likelihood of central nervous system (CNS) metastasization should be considered in the context of disseminated disease. The therapeutic management of BMs is an unmet clinical need, to date. We identified, across different cancer centers, six cases of both BRCA wild-type and BRCA-mutated EOCs spreading to the CNS. They presented either with a single brain lesion or with multiple lesions and most of them had intracranial-only disease. All cases received Poly-ADP ribose polymerase inhibitor (PARPi) maintenance, as per clinical practice, for a long time within a multimodal treatment approach. We also provide an insight into the available body of work regarding the management of this intriguing disease setting, with a glimpse of future therapeutic challenges. Despite the lack of unanimous guidelines, multimodal care pathways should be encouraged for the optimal disease control of this unfortunate patient subset. Albeit not being directly investigated in BM patients, PARPi maintenance is deemed to have a valuable role in this setting. Prospective research, aimed to implement worthwhile strategies in the multimodal patient journey of BMs from EOC, is eagerly awaited.
Asunto(s)
Neoplasias Encefálicas , Carcinoma Epitelial de Ovario , Neoplasias Ováricas , Inhibidores de Poli(ADP-Ribosa) Polimerasas , Anciano , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Encefálicas/secundario , Neoplasias Encefálicas/tratamiento farmacológico , Carcinoma Epitelial de Ovario/tratamiento farmacológico , Carcinoma Epitelial de Ovario/patología , Carcinoma Epitelial de Ovario/genética , Terapia Combinada , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/patología , Neoplasias Ováricas/genética , Inhibidores de Poli(ADP-Ribosa) Polimerasas/uso terapéuticoRESUMEN
To evaluate the rate of early breast cancer (EBC) patients treated with neoadjuvant systemic therapy (NAT) in Italy, criteria of patient selection and types of therapies delivered, an analysis of 1276 patients with stage I-II-III was conducted out of 1633 patients enrolled in the multicenter prospective observational BRIDE study. A total of 177 patients (13.9%) were treated with NAT and 1099 (85.9%) with surgery; in multivariate analysis, menopausal status, cT, cN, grade, HER2-positive and Triple negative (TN) subgroups were significantly associated with the decision to administer NAT. The type of NAT delivered was influenced by EBC subtype. NAT was administered to 53.2% of HER2+/HR-negative, 27.9% of HER2+/HR+, 7.1% of HER2-negative/HR+ and 30.3% of TN EBC patients. The pCR rates were similar to the ones reported in the literature: 74.2% in HER2+/HR-negative, 52.3% in HER2+/HR+, 17.2% in HER2-negative/HR+ and 37.9% in TN. In clinical practice, patient and tumor characteristics influenced oncologists in the decision to administer NAT in EBC and in the choice of the type of systemic therapy, according to ESMO and AIOM Guidelines. Currently, it is recommended always to evaluate the use of NAT in EBC, mainly in HER2+ and TN patients, considering that pCR is associated with significantly better survival of the patient and that effective therapies are now available for residual disease.
RESUMEN
OBJECTIVE: Around 15% of epithelial ovarian cancer (EOC) patients (pts) harbor a germline BRCA1 or 2 mutation, showing different features than BRCA wild-type pts. The clinical and pathological features of an Italian BRCA mutated EOC cohort were described. METHODS: We retrospectively analyzed clinical, pathological and mutational data from a cohort of Italian BRCA mutated EOC pts. treated in 15 MITO centers between 1995 and 2017. RESULTS: Three-hundred thirty-one pts. were recorded. Two-hundred forty (72%) and 91 (27.5%) pts. harbored a BRCA1 and BRCA2 mutation, respectively. Median age at diagnosis was 52 years. The most frequent diagnosis was a high grade serous FIGO III or IV EOC and platinum doublet in first-line was administered to almost all pts. Fifty-three % of them had no residual disease (R = 0) at surgery. Median progression-free-survival (mPFS) after first-line chemotherapy was 29 months. Expected percentage of pts. alive at 5 years was 72.5% (CI 60.2-80.8%) and R = 0 predicted a significantly longer overall survival (OS). Sixty-six pts. (19,9%) had both an EOC and a breast cancer (BC) diagnosis. The first diagnosis was BC in 81,8% of cases with a mean interval between the two diagnoses (IBTDs) of 132.4 months. Mutational data show that the founder mutation c.5266dupC in BRCA1 was the most frequently recorded. CONCLUSIONS: This is the largest Italian BRCA mutEOC cohort. The only predictor of longer OS was R = 0. EOC pts. that developed subsequently a BC are long-term survivors.
Asunto(s)
Proteína BRCA1/genética , Carcinoma Epitelial de Ovario/genética , Predisposición Genética a la Enfermedad , Neoplasias Ováricas/genética , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Epitelial de Ovario/mortalidad , Carcinoma Epitelial de Ovario/patología , Demografía , Femenino , Humanos , Italia , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Ováricas/mortalidad , Neoplasias Ováricas/patología , Supervivencia sin Progresión , Estudios RetrospectivosRESUMEN
The MITO 15 was a prospective, single-arm trial, evaluating trabectedin monotherapy in patients with recurrent ovarian cancer (OC) who were BRCA mutation-carriers or had a BRCAness phenotype. It is largely reported that trabectedin may induce nausea and vomiting but the real emetogenic potential of the drug, in the different schedules, has never been fully described; furthermore, OC patients are known to have an enhanced risk of developing nausea and vomiting due to female gender, abdominal spreading of the disease, and major surgery experienced by most of them. We thought to carry on a sub-study in the MITO 15 context focused on chemotherapy-induced nausea and vomiting (CINV) associated with trabectedin single agent. For all patients enrolled in the trial, we evaluated the antiemetic regimen at the first cycle, acute and delayed CINV, any rescue therapy, any change in the prophylactic antiemetic regimen, and the potential relationship between dexamethasone dosage and incidence of CINV. Overall, our findings were consistent with literature and confirmed that trabectedin can be classified as moderately emetogenic. We observed slightly higher rates of both nausea and vomiting compared to previous experiences with trabectedin monotherapy, probably due to intrinsic features of our population: all females and suffering from ovarian cancer. It seems that in preventing acute CINV, the combination of three drugs was more effective than the doublet; however, the difference did not reach statistical significance; further studies are required to verify such hypothesis. Given the extreme heterogeneity of the antiemetic regimens used, it appears that a standard antiemetic protocol does not exist and more specific guidelines for clinicians are needed.
Asunto(s)
Antieméticos/uso terapéutico , Antineoplásicos/efectos adversos , Dioxoles/efectos adversos , Náusea/inducido químicamente , Neoplasias Ováricas/tratamiento farmacológico , Tetrahidroisoquinolinas/efectos adversos , Vómitos/inducido químicamente , Adulto , Estudios de Cohortes , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/patología , Estudios Prospectivos , TrabectedinaRESUMEN
BACKGROUND: Uterine leiomyosarcoma (LMS) is a rare malignancy of mesenchymal tissues and in advanced stages its prognosis is very poor. Surgery followed by radiotherapy and/or chemotherapy is the treatment of choice for advanced disease. Cardiac metastases are very uncommon and only a few cases have been described to date. CASE: A 55-year-old woman was referred to our center for a uterine LMS with lung metastases at diagnosis. After 3 lines of chemotherapy for persistent lung disease, CT scan showed suspected thrombosis in the right pulmonary vein, along with disease progression in the lungs. The patient started treatment with low-molecular-weight heparin and a fourth line of chemotherapy. After 3 months of therapy, a new CT scan showed a larger thrombus and she underwent a cardiology visit that revealed an intracardiac mass. Submitting the patient to palliative surgery or radiation therapy was not possible because of the aggressiveness of the lung metastases, so she continued chemotherapy, resulting in disease stabilization. CONCLUSIONS: Surgery is the best option for intracardiac dissemination of uterine LMS, but when this is not possible based on the performance status of the patient and spread of the disease, the combination of chemotherapy and radiotherapy seems to be the best option according to the literature. In our case we treated the patient only with chemotherapy.
Asunto(s)
Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/secundario , Leiomiosarcoma/patología , Neoplasias Uterinas/patología , Terapia Combinada , Ecocardiografía , Femenino , Neoplasias Cardíacas/tratamiento farmacológico , Humanos , Leiomiosarcoma/diagnóstico , Imagen por Resonancia Magnética , Persona de Mediana Edad , Estadificación de Neoplasias , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/terapiaRESUMEN
Uterine carcinosarcoma (UCS) is an aggressive malignancy. With an incidence of 2/100,000 females and a 5 years Survival at stage IV of 0%, it is an uncommon type of cancer with a very poor prognosis. Histologically, UCS is a biphasic neoplasm consisting of a mixture of malignant epithelial and mesenchymal components but there is now enough clinical-pathological evidence to consider UCS as metaplastic carcinoma in which the mesenchymal part retains epithelial features. The principal treatment in early/locally-advanced UCS is surgery; because of its aggressiveness, it generally presents distant metastases at diagnosis. Adjuvant radiotherapy and chemotherapy have uncertain effect. Chemotherapy alone or associated with radiotherapy seems to improve disease free survival (DFS) and overall survival (OS) in stage III and IV UCS. No advantages in OS and DFS have been shown with radiotherapy alone. The present review summarizes and analyzes the most important news about this type of gynaecological cancer.
Asunto(s)
Carcinosarcoma/diagnóstico , Carcinosarcoma/terapia , Enfermedades Raras , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/terapia , Carcinosarcoma/mortalidad , Femenino , Humanos , Clasificación del Tumor , Estadificación de Neoplasias , Pronóstico , Neoplasias Uterinas/mortalidadRESUMEN
Gynecologic cancers represent a major global healthcare problem since they are associated with a significant mortality and morbidity. Over the last decade, considerable efforts have been spent in the development and optimization of novel diagnostic modalities to achieve an early diagnosis, aid in choosing appropriate treatment, improving long term surveillance, with the ultimate goal of increasing survival of gynecologic cancer patients. A growing body of evidence defines PET/CT as one of the most powerful tools for tumor, nodal and metastasis (TNM) cancer staging both in pre-treatment and in post treatment follow-up settings. At any phase of cancer evaluation, detection of metastasis represents one of the most critical impediments to the cure of tumor; traditional diagnostic imaging modalities, such as computed tomography (CT), are frequently found to inadequately stage the tumor, based on subsequent outcomes. As a consequence, patients may undergo pointless surgery for disease that could be treated with local medical therapies. In the setting of restaging, the ability to describe primary lesion, lymph nodes, possible metastases to peritoneum, bone, liver, lungs and brain renders PET/CT a potential alternative for a series of tests, including bone scanning, MRI or ultrasound, diagnostic CT, lymph node surgical sampling, that need to be used in combination in order to obtain a level of clinical confidence. In this review, we describe, the theoretical advantage and prognostic implications of PET/CT in the management of gynecologic cancer patients.
Asunto(s)
Biomarcadores de Tumor/metabolismo , Antígeno Ca-125/metabolismo , Fluorodesoxiglucosa F18 , Neoplasias de los Genitales Femeninos/diagnóstico por imagen , Ganglios Linfáticos/diagnóstico por imagen , Proteínas de la Membrana/metabolismo , Imagen Multimodal/estadística & datos numéricos , Tomografía de Emisión de Positrones , Radiofármacos , Tomografía Computarizada por Rayos X , Antineoplásicos/administración & dosificación , Antineoplásicos/uso terapéutico , Femenino , Neoplasias de los Genitales Femeninos/tratamiento farmacológico , Neoplasias de los Genitales Femeninos/mortalidad , Neoplasias de los Genitales Femeninos/cirugía , Humanos , Ganglios Linfáticos/patología , Metástasis Linfática , Estadificación de Neoplasias , Recurrencia , Estudios Retrospectivos , Tasa de Supervivencia , Carga TumoralRESUMEN
Epithelial ovarian cancer (EOC) patients with BRCA mutations (BRCA +) benefit from platinum-based treatment more than noncarriers. Impaired ability to repair DNA by homologous recombination increases their chemosensitivity. We investigated whether BRCA + predicts for improved outcome following pegylated liposomal doxorubicin (PLD) for recurrence. Recurrent EOC patients receiving second- or third-line PLD from 1998 to 2009 in 4 institutions (Tel Aviv, New York, Padua, and Jerusalem) were subjected to retrospective comparisons between 40 (25.8%) patients who were BRCA +, and 115 (74.2%) deemed nonhereditary (NH). Median age was 59 years (range 31-83); 111 (72%) had a platinum-free interval more than 6 months [PLD alone (n = 65) and PLD plus platinum (n = 90)]; 104 received PLD in second-line and 51 in third-line. BRCA + versus NH comparisons: median time to treatment failure (TTF) 15.8 months [95% confidence interval (CI): 11.4-21.6] versus 8.1 months (95% CI: 6.1-10.3; P = 0.009); overall survival (OS) 56.8 months (95% CI: 32.5-indeterminate) versus 22.6 months (95% CI: 17.0-34.1; P = 0.002). In multivariate Cox models BRCA status was significantly associated with TTF (HR = 1.66; 95% CI: 1.08-2.55; P = 0.02) and OS (adjusted HR 2.07; 95% CI: 1.18-3.60; P = 0.01). Adjusted HR relating platinum sensitivity to OS was 1.58 (95% CI: 0.93-2.68; P = 0.09); no significant association found with age at diagnosis, line of PLD or combinations, or institution. In this retrospective analysis, recurrent EOC BRCA mutation carriers treated with PLD had an improved outcome, and this result seemed to be independent of platinum sensitivity. Tumors arising in a background of defective BRCA function are more sensitive than other EOCs to DNA-damaging agents such as PLD, even after acquiring platinum resistance.
Asunto(s)
Antineoplásicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Doxorrubicina/análogos & derivados , Genes BRCA1 , Genes BRCA2 , Neoplasias Glandulares y Epiteliales/tratamiento farmacológico , Neoplasias Glandulares y Epiteliales/genética , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/genética , Polietilenglicoles/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/administración & dosificación , Carcinoma Epitelial de Ovario , Doxorrubicina/administración & dosificación , Doxorrubicina/uso terapéutico , Femenino , Mutación de Línea Germinal , Humanos , Persona de Mediana Edad , Compuestos Organoplatinos/administración & dosificación , Polietilenglicoles/administración & dosificación , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Intestinal-type adenocarcinoma of the nasal cavities and paranasal sinuses is a relatively rare tumor. Standard therapeutic modalities include surgery followed by radiotherapy, sometimes with chemotherapy treatment. Despite these treatments, the outcome is poor due to frequent local recurrences constituting the main cause of death among patients; leptomeningeal carcinomatosis is not a frequent event, and its presence indicates short expected survival. The therapy of neoplastic meningitis includes cranial irradiation, intrathecal chemotherapy and high-dose systemic chemotherapy. However, these approaches report important side effects with only modest efficacy. Thus, it is important to discover better treatment for this cancer complication. We present, for the first time, a case of leptomeningeal carcinomatosis from invasive intestinal-type adenocarcinoma treated with temozolomide and cisplatin chemotherapy obtaining a prolonged reduction and stabilization of the lesion improving the clinical condition of the patient.
Asunto(s)
Antineoplásicos/uso terapéutico , Cisplatino/uso terapéutico , Dacarbazina/análogos & derivados , Carcinomatosis Meníngea/tratamiento farmacológico , Anciano , Dacarbazina/uso terapéutico , Quimioterapia Combinada/métodos , Humanos , Imagen por Resonancia Magnética , Masculino , Carcinomatosis Meníngea/patología , Espacio Subaracnoideo/patología , TemozolomidaRESUMEN
OBJECTIVES: This retrospective analysis aims at describing the safety profile of treatment with pegylated liposomal doxorubicin (PLD) and oxaliplatin in recurrent ovarian cancer patients who experienced myelotoxicity (principally neutropenia) during first line chemotherapy with carboplatin and paclitaxel. METHODS: We reviewed the medical records of patients with relapsed ovarian cancer treated with PLD/Oxaliplatin at the Istituto Oncologico Veneto (IOV)/IRCCS, Padua University between 2002 and 2008. RESULTS: A cohort of 16 patients who developed myelodepression and other toxicities of grade 3 to grade 4 during first line chemotherapy with carboplatin/paclitaxel, were selected for this retrospective study. Patients had developed predominantly grade 3 to grade 4 neutropenia and grade 1 to grade 3 thrombocytopenia as major toxicities during primary chemotherapy with carboplatin and paclitaxel. Following relapse or disease progression, PLD/oxaliplatin chemotherapy was administered at 30 to 35 and 70 mg/m(2), respectively, over 2 day, every 4 weeks. CONCLUSIONS: Complete regression and stabilization of bone marrow suppression and no allergic reactions were seen with PLD/oxaliplatin treatment. The estimated median overall survival was 51.2 months. PLD/oxaliplatin chemotherapy did not show hematological toxicity and was feasible and active in this group of pretreated frail patients.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Ováricas/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Carboplatino/efectos adversos , Progresión de la Enfermedad , Doxorrubicina/administración & dosificación , Doxorrubicina/análogos & derivados , Esquema de Medicación , Femenino , Humanos , Estimación de Kaplan-Meier , Persona de Mediana Edad , Estadificación de Neoplasias , Neutropenia/inducido químicamente , Compuestos Organoplatinos/administración & dosificación , Neoplasias Ováricas/patología , Oxaliplatino , Paclitaxel/efectos adversos , Polietilenglicoles/administración & dosificación , Recurrencia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
AIM: This was a phase II study to assess the activity of a novel neoadjuvant regimen in locally-advanced breast cancer. PATIENTS AND METHODS: Fifty patients with histological confirmation of locally advanced breast cancer received treatment with gemcitabine 1000 mg/m(2) (day 1) followed by gemcitabine 800 mg/m(2) plus docetaxel 75 mg/m(2) plus pegylated liposomal doxorubicin (PLD) 30 mg/m(2) (day 8) every 3 weeks for at least 4 cycles, plus a final 2 additional cycles. Tumour size was T1 (n=2), T2 (n=32), T3 (n=14), T4 (n=2). All 50 patients underwent surgery. RESULTS: Clinical complete, partial and no response were observed in 13 (26%), 24 (48%) and 11 (22%) patients, respectively (overall response rate: 74%). The number of chemotherapy cycles was found to be an independent predictor of a pathologic complete response. CONCLUSION: The combination of gemcitabine-docetaxel-PLD can yield high tumour response rates in patients with locally-advanced breast cancer who undergo a full treatment of 6 cycles.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Terapia Neoadyuvante/métodos , Adulto , Anciano , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Desoxicitidina/administración & dosificación , Desoxicitidina/efectos adversos , Desoxicitidina/análogos & derivados , Docetaxel , Doxorrubicina/administración & dosificación , Doxorrubicina/efectos adversos , Doxorrubicina/análogos & derivados , Femenino , Humanos , Mastectomía , Persona de Mediana Edad , Estadificación de Neoplasias , Polietilenglicoles/administración & dosificación , Polietilenglicoles/efectos adversos , Taxoides/administración & dosificación , Taxoides/efectos adversos , GemcitabinaRESUMEN
OBJECTIVE: Imatinib mesylate (IM, Gleevec), a potent PDGF/PDGFR tyrosine kinase inhibitor, affects stroma and vascular endothelial cells. Our study sought to determine the safety and activity of paclitaxel with an intermittent schedule of IM. MATERIALS AND METHODS: rEOC patients previously treated with platinum/paclitaxel and ≤2 regimens for recurrence were enrolled. Paclitaxel 80 mg/m2 was given on days 3, 10, 17 every 28 days and oral IM 300 mg bid on days 1-4, 8-11, and 13-18. RESULTS: Between 2007-2009, 14 patients enrolled, 12 were evaluable. Nine patients were on study at 12 weeks. Objective responses (by RECIST and/or CA125) occurred in 4 patients. There were no grade 4, and only four grade 3 toxic events: diarrhea, edema and 2 cases of neutropenia. Early study closure was due to sufficient safety information with preliminary encouraging efficacy results. CONCLUSION: This weekly paclitaxel regimen with intermittent IM is tolerable with anti-tumor activity, making it suitable as part of future studies.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Recurrencia Local de Neoplasia/tratamiento farmacológico , Neoplasias Glandulares y Epiteliales/tratamiento farmacológico , Neoplasias Ováricas/tratamiento farmacológico , Paclitaxel/uso terapéutico , Piperazinas/uso terapéutico , Pirimidinas/uso terapéutico , Adulto , Anciano , Benzamidas , Supervivencia sin Enfermedad , Femenino , Humanos , Mesilato de Imatinib , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Estadificación de Neoplasias , Neoplasias Glandulares y Epiteliales/mortalidad , Neoplasias Ováricas/mortalidad , Paclitaxel/administración & dosificación , Paclitaxel/efectos adversos , Piperazinas/administración & dosificación , Piperazinas/efectos adversos , Pirimidinas/administración & dosificación , Pirimidinas/efectos adversos , Terapia Recuperativa/métodosRESUMEN
BACKGROUND: The aim of the study was to assess the efficacy of pegylated liposomal doxorubicin (PLD) and oxaliplatin in patients affected by relapsed epithelial ovarian cancer with a family history of BRCA and p53 mutations. METHODS: Seventy-two women received a median of 7.5 courses of PLD at 30 to 35 mg/m2 plus oxaliplatin at 70 mg/m2, and associations between BRCA1/2 and TP53 status and overall survival (OS) were determined. Thirty-eight had a short platinum-free interval (PFI; <12 months), and 34 had a long PFI (> or =12 months). RESULTS: Nine patients had BRCA1 mutations, and 1 had a BRCA2 mutation. Platinum sensitivity was associated with OS (P = 0.0001). At a median follow-up of 9.3 months, objective response rate, median time to progression, and OS were 47.3%, 5.8 months, and 12.9 months, respectively, in short PFI compared with the 76.5%, 11.5 months, and 47.7 months in long PFI. p53 status did not correlate to these parameters. The median time to progression was 11.5 months for high-risk patients versus 6.5 months for patients with sporadic cancer (P = 0.0188), and the median OS from the start of treatment was 48.7 and 16.2 months (P = 0.0032), respectively. Toxicity was mostly grade 1 or 2. CONCLUSIONS: High response rates in the long-PFI patients indicate that this treatment is beneficial and well tolerated. Platinum sensitivity and positive family history and/or a BRCA1/BRCA2 mutation are a useful predictor of response.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma/diagnóstico , Carcinoma/tratamiento farmacológico , Salud de la Familia , Genes p53 , Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/genética , Carcinoma/mortalidad , Doxorrubicina/administración & dosificación , Doxorrubicina/análogos & derivados , Femenino , Genes BRCA1/fisiología , Genes BRCA2/fisiología , Genes p53/fisiología , Humanos , Persona de Mediana Edad , Mutación/fisiología , Compuestos Organoplatinos/administración & dosificación , Neoplasias Ováricas/genética , Neoplasias Ováricas/mortalidad , Oxaliplatino , Polietilenglicoles/administración & dosificación , Pronóstico , Recurrencia , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
Ovarian cancer is typically a disease of elderly women, usually occurring after menopause with a peak incidence in the eighth decade of life. Elderly patients are more likely to suffer the adverse effects of chemotherapy, which may influence successive lines of treatment. We describe the case of an elderly woman with platinum-sensitive ovarian cancer treated with several lines of chemotherapy who developed acute cardiogenic pulmonary edema with her first line of therapy, which included paclitaxel, and her fourth line containing gemcitabine. However, a complete regimen of pegylated liposomal doxorubicin in association with oxaliplatin was well tolerated. Other authors have reported absence of cardiotoxicity with liposomal doxorubicin in their study populations, but no mention was made of patients with a known prior susceptibility to transient heart failure when treated with other chemotherapeutic agents. Our case provides evidence that even in these more difficult-to-treat cases, where cumulative cardiotoxicity may be relatively unpredictable, liposomal doxorubicin does not affect cardiac function.