Guías antieméticas: ¿hemos incorporado los cambios referentes a carboplatino y antraciclinas? / Antiemetic guidelines: Have we incorporated the changes concerning carboplatin and anthracyclines?

Objetivo: en 2016 se publicaron las guías de la MASCC/ESMO que incorporaron los esquemas de antraciclinas como quimioterapia altamente emetógena (QAE) proponiendo la triple terapia antiemética, así como para los esquemas de carboplatino. Los objetivos fueron analizar el nivel de concordancia entre las guías y la profilaxis antiemética utilizada en el hospital de día de hematooncología, evaluar su efectividad y determinar el ahorro de la inclusión de netupitant/palonosetrón (NEPA) oral con dexametasona intravenosa (NEPAd) respecto a fosaprepitant con ondansetrón y dexametasona (FOD intravenosa). Método estudio observacional prospectivo registrando variables demográficas, esquema de quimioterapia recibido, localización tumoral, riesgo emetógeno del paciente, pauta antiemética prescrita, concordancia con guía MASCC/ESMO y su efectividad, utilización de medicación de rescate y registro de visitas a urgencias o ingresos por emesis.Se llevó a cabo un estudio farmacoeconómico de minimización de costes. Resultados se incluyeron 61 pacientes, 70% mujeres, mediana edad 60,5.Los esquemas de platino fueron más frecuentes en el periodo 1, siendo el 87,5% respecto al 67,6% en el periodo 2. Los esquemas con antraciclinas fueron del 21,6 y 10% respectivamente en cada periodo. Un 21,1% de las pautas antieméticas no coincidían con las recomendaciones MASCC/ESMO, siendo en su totalidad en el periodo 1. La puntuación de los cuestionarios de efectividad fue de protección total en el 90,9% en las náuseas agudas, del 100% en los vómitos agudos y en las náuseas retardadas, y del 72,7% en los vómitos retardados. La frecuencia de uso de medicación de rescate fue del 18,7% en el periodo 1 y no fue necesaria en el periodo 2.No se detectaron visitas a urgencias ni ingresos en ninguno de los periodos. El uso de NEPAd comportó una reducción del 28% de los costes con respecto al empleo de FOD. Conclusiones: ... (AU)

Objective: Latest MASCC/ESMO guidelines of the recommendations for the prophylaxis of acute and delayed emesis induced by moderately emetogenic chemotherapy was published in 2016 incorporating anthracycline schemes as highly emetogenic chemotherapy (HEC), proposing triple antiemetic therapy to control nausea and vomiting. Likewise, they recommend triple therapy for carboplatin. The objectives of this study were to analyze the degree of concordance between guidelines and antiemetic prophylaxis used in the Chemotherapy Outpatient Unit in patients undergoing treatment with HEC and carboplatin, to evaluate its effectiveness and to determine the savings due to the use of netupitant/palonosetron (NEPA) oral (or) with intravenous (iv) dexamethasone (NEPAd) compared to iv Fosaprepitant with ondansetron and dexamethasone (FOD iv).MethodsProspective observational study recording demographic variables, chemotherapy protocol, tumor location, patient emetogenic risk, antiemetic regimen prescribed, concordance with the MASCC/ESMO guideline, and effectiveness, evaluated by MASCC survey, use of rescue medication and visits to the Emergency Department or hospitalization due to emesis.A cost minimization pharmacoeconomic study was carried out. Results 61 patients were included; 70% women; median age 60.5. Platinum schemes were more frequent in period 1, being 87.5% compared to 67.6% in period 2. Anthracycline schemes were 21.6% and 10% respectively in each period.A 21.1% of the antiemetic regimens did not coincide with the MASCC/ESMO recommendations, being entirely in period 1. The score of the effectiveness questionnaires was total protection in 90.9% in acute nausea, from 100% in acute vomiting and delayed nausea, and 72.7% in delayed vomiting.The frequency of use of rescue medication was 18.7% in period 1 and was not necessary in period 2.No visits to the emergency room or admissions were detected in any of the periods. Conclusions: ...(AU)

Antiemetic guidelines: Have we incorporated the changes concerning carboplatin and anthracyclines? / Guías antieméticas: ¿hemos incorporado los cambios referentes a carboplatino y antraciclinas?

OBJECTIVE: Latest MASCC/ESMO guidelines of the recommendations for the prophylaxis of acute and delayed emesis induced by moderately emetogenic chemotherapy was published in 2016 incorporating anthracycline schemes as highly emetogenic chemotherapy (HEC), proposing triple antiemetic therapy to control nausea and vomiting. Likewise, they recommend triple therapy for carboplatin. The objectives of this study were to analyze the degree of concordance between guidelines and antiemetic prophylaxis used in the Chemotherapy Outpatient Unit in patients undergoing treatment with HEC and carboplatin, to evaluate its effectiveness and to determine the savings due to the use of netupitant/palonosetron (NEPA) oral (or) with intravenous (iv) dexamethasone (NEPAd) compared to iv Fosaprepitant with ondansetron and dexamethasone (FOD iv). METHODS: Prospective observational study recording demographic variables, chemotherapy protocol, tumor location, patient emetogenic risk, antiemetic regimen prescribed, concordance with the MASCC/ESMO guideline, and effectiveness, evaluated by MASCC survey, use of rescue medication and visits to the Emergency Department or hospitalization due to emesis. A cost minimization pharmacoeconomic study was carried out. RESULTS: 61 patients were included; 70% women; median age 60.5. Platinum schemes were more frequent in period 1, being 87.5% compared to 67.6% in period 2. Anthracycline schemes were 21.6% and 10% respectively in each period. A 21.1% of the antiemetic regimens did not coincide with the MASCC/ESMO recommendations, being entirely in period 1. The score of the effectiveness questionnaires was total protection in 90.9% in acute nausea, from 100% in acute vomiting and delayed nausea, and 72.7% in delayed vomiting. The frequency of use of rescue medication was 18.7% in period 1 and was not necessary in period 2. No visits to the emergency room or admissions were detected in any of the periods. CONCLUSIONS: Use of NEPAd led to a 28% reduction in costs with respect to the use of FOD. A high level of concordance was obtained in both periods between the latest published guideline and healthcare practice in our field. Surveys carried out on patients seem to suggest that both antiemetic therapies have similar effectiveness in clinical practice. The inclusion of NEPAd has led to a reduction in costs, positioning itself as an efficient option.

Haemolytic uraemic syndrome associated with gemcitabine.

Haemolytic uraemic syndrome (HUS) is a rare thromboembolic complication observed in patients with cancer. It is characterised by the clinical triad of acute renal failure, microangiopathic haemolytic anaemia and thrombocytopaenia. It may be associated with a variety of aetiologies, including chemotherapeutic agents such as mitomycin, cisplatin, bleomycin, 5-fluorouracil and, most recently, gemcitabine. We report a 70-year-old patient treated with gemcitabine who developed haemolytic uraemic syndrome.

Gastrointestinal stromal tumors: experience in 49 patients.

INTRODUCTION: Gastrointestinal stromal tumours (GIST) are mesenchymal tumours of the digestive tract originated in the interstitial cells of Cajal. They express the tyrosine kinase c-kit (CD117) activity receptor. Mutations in this receptor cause neoplastic development. Curative treatment continues to be radical resection of the tumour and is resistant to commonly employed chemotherapy regimens. Imatinib mesilate is a drug that inhibits c-kit activity expressed by GIST and its activity in these tumours has been demonstrated. MATERIAL AND METHODS: Retrospective study of all cases of leiomyoma, leiomyosarcoma, schwannoma, and stromal or mesenchymal tumors from 1989 to July 2004. C-kit and CD34 proteins were detected at immunohistochemical study in addition to the usual markers for mesenchymal tumours. RESULTS: 49 GISTs were diagnosed, 26 males and 23 females (mean age 64.1). Symptoms were digestive tract bleeding (n = 13), abdominal pain (n = 13), intestinal occlusion (n = 4) and others. The lesion was located in small bowel (n = 22), stomach (n = 19), rectum (n = 3), peritoneum (n = 2), esophagus (n = 1), omentum (n = 1), and retroperitoneum (n = 1). Forty-three of the 49 patients underwent surgery; radical resection was performed in 37 (75.5%) and palliative surgery in the other six (16.2%). Two of the patients that did not undergo surgery received chemotherapy. At the time of study, 28 (57.14%) patients remained alive, 23 (46.9%) of whom were disease- free and five (10.2%) were not. Nineteen (38.7%) patients died. CONCLUSIONS: The results of our series are similar to the others published. Before the year 2001, surgery was the only successful option for the GIST. Surgical resection continues being the best treatment to definitively cure this disease. Imatinib is used to treat not only resectable tumours, but even to allow the possibility to make a subsequent rescue surgery. On the other hand, Imatinib is used in the treatment of the metastatic disease.

Gastrointestinal stromal tumors: experience in 49 patients

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Introduction. Gastrointestinal stromal tumours(GIST) are mesenchymal tumours of the digestivetract originated in the interstitial cells of Cajal. Theyexpress the tyrosine kinase c-kit (CD117) activityreceptor. Mutations in this receptor cause neoplasticdevelopment. Curative treatment continues to beradical resection of the tumour and is resistant tocommonly employed chemotherapy regimens. Imatinibmesilate is a drug that inhibits c-kit activityexpressed by GIST and its activity in these tumourshas been demonstrated.Material and methods. Retrospective study of allcases of leiomyoma, leiomyosarcoma, schwannoma,and stromal or mesenchymal tumors from 1989to July 2004. C-kit and CD34 proteins were detectedat immunohistochemical study in addition to theusual markers for mesenchymal tumours.Results. 49 GISTs were diagnosed, 26 males and 23females (mean age 64.1). Symptoms were digestivetractbleeding (n = 13), abdominal pain (n = 13), intestinalocclusion (n = 4) and others. The lesion waslocated in small bowel (n = 22), stomach (n = 19),rectum (n = 3), peritoneum (n = 2), esophagus (n = 1),omentum (n = 1), and retroperitoneum (n = 1).Forty-three of the 49 patients underwent surgery;radical resection was performed in 37 (75.5%) andpalliative surgery in the other six (16.2%). Two ofthe patients that did not undergo surgery receivedchemotherapy. At the time of study, 28 (57.14%) patientsremained alive, 23 (46.9%) of whom were disease-free and five (10.2%) were not. Nineteen (38.7%)patients died.Conclusions. The results of our series are similar tothe others published. Before the year 2001, surgerywas the only successful option for the GIST. Surgicalresection continues being the best treatmentto definitively cure this disease. Imatinib is used totreat not only resectable tumours, but even to allowthe possibility to make a subsequent rescue surgery.On the other hand, Imatinib is used in the treatmentof the metastatic disease