Neoadjuvant therapy for breast cancer treatment: an expert panel recommendation from the Brazilian Society of Breast Surgeons 2018.

PURPOSE: Breast cancer neoadjuvant chemotherapy (NAC) consists of the administration of cytotoxic and targeted drugs prior to breast surgery, with the objective of reducing the tumor burden to allow breast conservation. NAC also aims to improve long-term treatment outcomes such as disease-free and overall survival. To optimize clinical practice with the best available evidence for breast cancer patients in the setting of neoadjuvant treatment, the Brazilian Society of Breast Surgeons (Sociedade Brasileira de Mastologia-SBM) held a consensus conference to develop this guideline. METHODS: Twenty-two questions addressing relevant breast cancer neoadjuvant treatment were previously formulated. The voting panel comprised 25 specialists from the SBM. A consensus was established if there was 75% agreement. If there was less concordance, after discussion, the consensus was determined by a 51% concordance. RESULTS: The recommendations were based on the best level of scientific evidence and the opinion from breast cancer experts, when no such research data were available. CONCLUSION: This manuscript provides updated guidance according to the views of the SBM's experts for the clinical practice of breast cancer surgeons. This manuscript depicts the summarized recommendations for NAC treatment.

Role of gemcitabine as second-line therapy after progression on FOLFIRINOX in advanced pancreatic cancer: a retrospective analysis.

BACKGROUND: Cancer of the exocrine pancreas is a highly lethal malignancy. Surgical resection is the only potentially curative treatment. Unfortunately, because of the late presentation, the majority have either locally advanced cancer at initial diagnosis. Systemic chemotherapy provides benefit to patients with advanced pancreatic cancer, improving disease-related symptoms and survival when compared to best supportive care alone. Based on fase III study, FOLFIRINOX regimen became the standard first-line treatment. But, the optimal management strategy for patients who fail initial FOLFIRINOX is undefined. Despite the lack of clinical trials that report the real benefit of gemcitabine in patients with advanced exocrine pancreatic cancer as second line treatment. We aim at reporting our experience with this regimen. METHODS: Patients with advanced exocrine pancreatic cancer who received gemcitabine (1.000 mg/m(2) on days 1, 8 and 15 every 4 weeks) until disease progression, as second-line therapy at our institution were retrospectively evaluated. Progression-free survival (PFS) and overall survival (OS) were estimated by the Kaplan-Meier method. RESULTS: A total of 20 patients were reviewed. Median age was 57 years (range, 43-74 years), and 55% were older than 60 years. Most patients were male (80%), had metastatic disease (60%), and ECOG performance status of 0 or 1 (65%). PFS and OS were 2.0 (95% CI, 1.2-2.8) and 5.7 months (95% CI, 3.9-7.4), respectively. There were no deaths due to the treatment. CONCLUSIONS: In this study, gemcitabine was a reasonable second-line treatment option for patients with advanced pancreatic adenocarcinoma and good ECOG performance status. Phase III trials are urgently needed comparing gemcitabine versus best supportive of care (BSC) can evaluate the real benefit of this chemotherapy after progression on FOLFIRINOX.

Antitumor effects of electrochemical treatment.

Electrochemical treatment is an alternative modality for tumor treatment based on the application of a low intensity direct electric current to the tumor tissue through two or more platinum electrodes placed within the tumor zone or in the surrounding areas. This treatment is noted for its great effectiveness, minimal invasiveness and local effect. Several studies have been conducted worldwide to evaluate the antitumoral effect of this therapy. In all these studies a variety of biochemical and physiological responses of tumors to the applied treatment have been obtained. By this reason, researchers have suggested various mechanisms to explain how direct electric current destroys tumor cells. Although, it is generally accepted this treatment induces electrolysis, electroosmosis and electroporation in tumoral tissues. However, action mechanism of this alternative modality on the tumor tissue is not well understood. Although the principle of Electrochemical treatment is simple, a standardized method is not yet available. The mechanism by which Electrochemical treatment affects tumor growth and survival may represent more complex process. The present work analyzes the latest and most important research done on the electrochemical treatment of tumors. We conclude with our point of view about the destruction mechanism features of this alternative therapy. Also, we suggest some mechanisms and strategies from the thermodynamic point of view for this therapy. In the area of Electrochemical treatment of cancer this tool has been exploited very little and much work remains to be done. Electrochemical treatment constitutes a good therapeutic option for patients that have failed the conventional oncology methods.

High-dose interleukin-2 in patients with metastatic melanoma whose disease progressed after biochemotherapy.

The objective of this study was to report our experience with 38 consecutive patients with metastatic melanoma treated with high-dose (HD) bolus interleukin (IL)-2 after disease progression on or after biochemotherapy as the only earlier treatment for metastatic disease. We conducted a retrospective review of all patients with metastatic melanoma treated with HD IL-2 at the Oncology Center of Hospital Sirio-Libanes between October 2000 and December 2009. The treatment consisted of IL-2, of 600,000 U/kg every 8 h for up to 14 doses, followed by 1-week rest and readmission for the second cycle. Responders received up to four additional cycles. Median follow-up was 9 months. The overall response rate was 23.6%, and we found no correlation between earlier response to biochemotherapy and response to HD IL-2. The median survival was 9.5 months for all patients and 36.1 months for the responders. The most frequent grade 3 or 4 adverse events were hypotension, diarrhea, and respiratory distress, and one patient died from septic shock. We concluded that HD IL-2 has clinically meaningful antitumor activity in patients with metastatic melanoma whose disease has progressed after biochemotherapy. This is a treatment alternative in patients with no central nervous system involvement and who are fit enough to tolerate it, regardless of the initial response to biochemotherapy.

Peritonectomy for peritoneal carcinomatosis: long-term outcomes from a single Brazilian institution.

BACKGROUND: The objective of this study was to evaluate the long-term outcomes of a single institution, Hospital Sírio-Libanes in São Paulo, Brazil, regarding the treatment of peritoneal carcinomatosis. METHODS: Between October 2002 and October 2006, 46 consecutive patients were treated with radical cytoreduction and hyperthermic peritoneal chemotherapy. There were 21 patients with peritoneal surface malignancy (PSM) from colorectal origin (among whom 8 had an appendiceal primary), 15 with ovarian carcinomas, 2 with primary peritoneal mesotheliomas, and 8 with other cancers. The median age was 49 years (range 18-77 years). All patients were followed for a median of 20 months. Demographic data, tumor histology, the peritoneal carcinomatosis index (PCI), operative procedures (extension of resection, lymphadenectomy), and hyperthermic intraperitoneal chemotherapy (HIPEC) characteristics (drugs, temperature, duration) were prospectively recorded. Perioperative mortality and morbidity and the long-term outcome were assessed. RESULTS: Complete cytoreduction was achieved in 45 patients. The median PCI was 11, and the mean operating time was 17 h. There were no procedure-related deaths, but major morbidity was observed in 52% and included fistulas, abscesses, and hematologic complications. The overall Kaplan-Meier 4-year estimated survival was 56%. Among patients with PSM from colorectal carcinoma, the estimated 3-year survival was 70%. Nine (42%) patients had a recurrence, three with peritoneal disease. The median disease-free-interval was 16 months. The ovarian cancer patients had an estimated 4-year survival rate of 75% and median disease-free survival duration of 21 months. CONCLUSIONS: Cytoreductive surgery with HIPEC may improve survival of selected patients with peritoneal carcinomatosis, with acceptable morbidity.

Breast cancer in Latin America: results of the Latin American and Caribbean Society of Medical Oncology/Breast Cancer Research Foundation expert survey.

The incidence of breast cancer in Latin American countries is lower than that in more developed countries, whereas the mortality rate is higher. These differences probably are related to differences in screening strategies and access to treatment. Population-based data are needed to make informed decisions. A 65-question telephone survey that included 100 breast cancer experts from 12 Latin American countries was conducted in 2006 as an exploratory analysis of the current state of breast cancer treatment in these regions at both at the country level and at the center level. Greater than 90% of countries had no national law or guideline for mammography screening. The access rate to mammography was 66.3% at the country level and 47% at the center level. Variation in care based on level (country vs center) was indicated for the timing of treatment after diagnosis, timing from initial diagnosis to treatment, and the time from surgery to initial chemotherapy. However, the more sophisticated diagnostic testing for hormone receptors and biomarkers were available at most centers (>80%), and, overall, nearly 80% of patients started treatment within 3 months of diagnosis. Variation in care between breast cancer care at the center level versus the country level indicated a need for national cancer care programs. Alternative data collection strategies for understanding the state of breast cancer control programs in developing countries can help identify areas of improvement.

Exploring the role of novel agents in the treatment of renal cell carcinoma.

Renal cell carcinoma represents nearly 3% of all cancers, predominantly affecting individuals >or=50 years of age, and until recently, few treatments options were available for metastatic disease. The 5-year median survival for these patients with metastatic renal cell carcinoma has been estimated at <10%. This review explores the data of the most relevant trials focusing on new approaches with novel agents, including sunitinib, sorafenib, bevacizumab, temsirolimus, as well as their combinations with traditional agents. We describe mechanisms of action, activity, and toxicity profile of those agents, as well as administration schedules that have been studied in clinical trials.

Efeito anti-tumoral do campo elétrico potencializando quimioterápicos: estudos no modelo animal / Antitumoral effect of the electrochemical therapy: Study in animal model

Introdução: Com dois experimentos consecutivos, avaliaram-se: (1) o impacto de um campo elétrico na eficiência de quimioterápicos e na resposta proliferativa de linfócitos contra o tumor (ensaio MTT) no modelo murino; e (2) o efeito da eletricidade isolada ou associada à quimioterapia no tratamento de tumores de cabeça e pescoço espontâneos de cães e gatos. Métodos: (1) Cinco milhões de células do tumor ascítico de Ehrlich foram injetadas no dorso de 35 camundongos machos Balb/c. Após sete dias, os camundongos foram divididos em sete grupos, recebendo diferentes combinações de cisplatina ou bleomicina associada ou não a eletricidade. A progressão do tumor foi medida diariamente em cada camundongo e as diferenças entre os grupos foi avaliada por ANOVA. O impacto imunológico do tratamento foi avaliado pela co-cultura de células do tumor de Ehrlich com linfócitos provenientes de camundongos tratados e não tratados, sendo a co-cultura com células alogênicas utilizada como controle. A seguir, foi realizado um estudo seqüencial e não-comparativo (2) onde cães e gatos que apresentavam tumores espontâneos de cabeça e pescoço foram biopsiados, estadiados e tratados com eletricidade isolada ou associada à quimioterapia em um hospital veterinário. Resultados: (1) A área média do tumor (+/- desvio-padrão) dos camundongos que receberam cisplatina ou bleomicina associada à eletricidade foi significativamente menor se comparada aos controles (p<0.05). O ensaio MTT demonstrou que os linfócitos de camundongos tratados com eletricidade promovem a eliminação das células do tumor de Ehrlich na co-cultura. No estudo (2), 28 animais (14 cães e 14 gatos) foram tratados com eletricidade isolada (15 casos) ou combinada à quimioterapia. A carga elétrica média/volume do tumor foi 38,50 C/cm3. Por análise univariada, fatores que influenciaram na sobrevida foram o estádio T (p=0.04) e a carga/volume do tumor (p<0.01). Conclusões: (1) Eletricidade potencializa tanto o efeito de cisplati....

Introduction: With two consecutive experiments, we evaluated (1) the impact of electricity on chemotherapy response and on the lymphocyte proliferative response against the tumor (MTT assay) in a murine tumor model and (2) the effect of electricity alone and combined with chemotherapy in the treatment of spontaneous head and neck tumors of cats and dogs. Methods: (1) Five million cells of Ehrlich Ascitic Tumor were injected into the dorsal region of 35 male Balb/c mice. Seven days later, mice were divided into 7 groups, receiving different treatments combining Cisplatin or Bleomycin with electricity. Tumor progression in each mouse was measured daily and differences among the groups were assessed by ANOVA test. The immune impact of treatment was evaluated by the co-culture of lymphoid cells of treated and untreated mice with Ehrlich Tumor cells using co-culture with allogenic cells was used as a control. Following these results, we done a (2) sequential and non comparative study, in which dogs and cats presenting with a malignant neoplasm were clinically evaluated, staged and treated by electrolysis or electrochemotherapy in a veterinary hospital. Results: (1) The mean tumor area (+/- standard deviation) of mice receiving Cisplatin or Bleomycin with electricity were found significantly smaller if compared to that of controls (p<0.05). The co-culture results suggest that lymphocytes from mice treated by electricity promote elimination of Ehrlich Tumor cells in culture. In the study (2) 28 animals (14 dogs and 14 cats) were treated by electricity alone (15 cases) or combined to chemotherapy. The mean electrical charge/tumor volume was 38,50 C/cm3. By univariated analysis, factors impacting on survival were T stage (p=0.04) and charge/tumor volume (p<0.01). Conclusions: (1) Electricity enhanced the effect of both Cisplatin and Bleomycin and probably also stimulated an immune response against the tumor...

História natural do câncer de mama / Natural history of the breast cancer

Ao que tudo indica, a lesão genética iniciadora do câncer de mama ocorre em tecidos precursores da neoplasia. Formando-se o tumor, seu ritmo de crescimento é determinado basicamente pela função de proliferação celular, com desenvolvimento lento. A principal via de disseminação das células neoplásicas da mama é linfática e, após os êmbolos neoplásicos atingirem a circulação sistêmica, podem ser neutralizados pelo sistema de defesa do hospedeiro (resposta imune inata ou adaptativa) ou se multiplicar a distãncia. As assinaturas genéticas de cada tumor relacionam-se com o seu potencial metastatizante e a predileção por certos órgãos-alvo.

Apparently, the genetic lesion initiator of breast cancer occurs in tissues precursors of neoplasia. Forming the tumor, its growth rate is basically determined by the function of cell proliferation, with slow development. The major route of spread of breast cancer cells is lymphatic and after neoplastic emboli reach the systemic circulation, can be neutralized by the system of host defense (innate or adaptive immune response) or multiply the distance. Genetic signatures of each tumor are related to their potential metastasizing and the preference for certain target organs.

Acinar cell carcinoma of the pancreas.

Acinar cell carcinoma of the pancreas is a rare tumor for which the best chemotherapy regimen has not been clearly established. Here, we report on a female patient with an unusually long survival and a remarkable response to weekly paclitaxel. To our knowledge, this is the first time that paclitaxel has been associated with an objective response in this disease. The patient recurred after initial resection and failed multiple prior chemotherapeutic regimens. She received weekly paclitaxel at 80 mg/m2 and responded after eight doses, maintaining controlled disease for a total of 4 mo. We present her case in detail and review the available literature regarding this rare type of tumor.

Arterite de Takayasu: estudo de 16 casos, aspectos clinicos, laboratoriais e revisäo da literatura / Takayasu's arteritis: study of 16 cases, clinical, laboratory aspects and review of the literature

Os autores apresentam um estudo restrospectivo dos aspectos clínicos e laboratoriais de 16 pacientes com arterite de Takayasu, internados no Hospital das Clínicas da FMUSP, no último decênio. Dos 16 pacientes, 14 eram do sexo feminino e as idades variaram de 18 a 45 anos (média de 23 anos). A maioria dos casos procurou o hospital para esclarecimento de hipertensäo arterial (4), síncope (2), cefaléia (2), claudicaçäo intermitente (2) e febre (2). Foi o exame físico, entretanto, devido à presença dos sopros vasculares (87,5%), déficit de pulsos (75,0%) e hipertensäo arterial (37,5%), que levou à suspeita diagnóstica. O exame laboratorial mais freqüentemente alterado foi elevada velocidade de hemossedimentaçäo (93,3%), proteína reativa C positiva (78,5%) e PPD > ou = 10 mm (73,3%). O Rx do tórax e o ECG estavam normais em quase todos os casos. Dois dos 16 apresentavam tuberculose pulmonar ativa (12,5%). A exceçäo de um paciente cujo diagnóstico foi firmado pela biópsia da aorta, todos os outros foram baseados nos achados clínicos, laboratoriais e angiográficos, que se mostraram semelhantes aos verificados em outras séries estudadas