[Treatment patterns in advanced breast cancer with anthracycline and taxanes and their costs in three public hospitals of Mexico]. / Patrones de tratamiento y costo de atención del cáncer de mama avanzado con falla a antraciclinas y taxanos en 3 hospitales públicos de México.

OBJECTIVES: In Mexico, breast cancer is the second leading cause of cancer mortality among females. For patients with advanced breast cancer (ABC) resistant to anthracyclines and taxanes (AT), there are limited treatment options. There is a scarcity of data regarding clinical management of this population and treatment costs at this stage of the disease. The objective of this study was to describe the treatment patterns of care for metastatic breast cancer after AT and the associated cost from the point-of-view of the Mexican Public Health Care Sector. METHODS: Between January 1, 2004 and December 31, 2007, a retrospective cohort of adult female ABC patients resistant to AT was developed by reviewing and extracting key data from medical charts. We conducted a retrospective, transversal and descriptive analysis of the patient data. Target population data files were obtained from 414 patients from 3 public hospitals in México. RESULTS: Capecitabine, vinorelbine and cyclophosphamide were the most commonly prescribed agents, however clinical drug therapy management of the disease was different within and among the three hospitals included in the study. This difference translated into a disparity of prescription costs, ranging from an average of $122.22 pesos/patient/month (cyclophosphamide, IC 95% $94.43-$150.01) to $37,835.53 pesos/patient/month (capecitabine+trastuzumab IC 95% $34,953.18-$40,717.88) for the first treatment after AT. CONCLUSIONS: The results highlight a lack of standardized care for patients and suggest that differences in treatment patterns are not only a reflection of scarcity of scientific data and diversity of prescription preferences among physicians but also of economic restrictions. Ultimately, there is a clear unmet medical need to be addressed through evidence-based medicine alternatives that support efficacy and cost effectiveness treatments.

[Current therapeutic advances in the treatment of non-Hodgkin lymphoma]. / Actualidades terapéuticas en el tratamiento de linfoma no Hodgkin.

Lymphoma is a lymphoid cell cancer that originates in lymphoid tissues. Non Hodgkin (NHL) type represents 90% of cases. In Mexico, NHL constitutes the third most common cancer in males and the sixth among females. NHL treatment has achieved significant advances in the last decade and NHL is currently becoming a disease with a high probability of cure. Rituximab has become an alternative for the treatment of NHL. Rituximab is a monoclonal antibody that targets the CD20 antigen expressed in the mature malignant B cells. It induces NHL B cells destruction by complement-mediated citotoxicity, apoptosis and sensitization to the toxic effect of chemotherapy. Rituximab has revolutionized treatment results by offering patients with aggressive NHL a higher possibility of cure and in the case of the intractable forms of NHL it increases the disease free period. The standard treatment for a patient with NHL is rituximab-CHOP (immunotherapy). In addition, rituximab has pharmacoeconomic advantages as shown in various cost-utility and cost-effectiveness studies.

Actualidades terapéuticas en el tratamiento de linfoma no Hodgkin / Current therapeutic advances in the treatment of non-Hodgkin lymphoma

El linfoma es un cáncer de las células linfoides originado en los tejidos linfoides. El tipo no Hodgkin (LNH) representa 90% de los casos. En México, el linfoma no Hodgkin constituye el tercer cáncer más común en el sexo masculino y el sexto en el femenino. El tratamiento del linfoma ha tenido un avance muy significativo en la última década, pasando a ser una neoplasia con alta probabilidad de curación. Actualmente se dispone de rituximab, un anticuerpo monoclonal dirigido contra el antígeno CD20 expresado en las células malignas B maduras, que induce la destrucción de las células del linfoma no Hodgkin tipo B a través de citotoxicidad mediada por complemento, apoptosis y sensibilización al efecto tóxico de la quimioterapia. Rituximab ha revolucionado los resultados del tratamiento al poder ofrecer a los pacientes con linfomas agresivos una mayor posibilidad de curación, y en los linfomas indolentes aumenta el periodo sin enfermedad. El tratamiento estándar actual en pacientes con linfoma no Hodgkin agresivo es rituximab-CHOP (inmunoquimioterapia). La adición de rituximab al tratamiento del linfoma no Hodgkin tiene ventajas fármaco-económicas, demostradas en estudios de costo-utilidad y costo-efectividad.

Lymphoma is a lymphoid cell cancer that originates in lymphoid tissues. Non Hodgkin (NHL) type represents 90% of cases. In Mexico, NHL constitutes the third most common cancer in males and the sixth among females. NHL treatment has achieved significant advances in the last decade and NHL is currently becoming a disease with a high probability of cure. Rituximab has become an alternative for the treatment of NHL. Rituximab is a monoclonal antibody that targets the CD20 antigen expressed in the mature malignant B cells. It induces NHL B cells destruction by complement-mediated citotoxicity, apoptosis and sensitization to the toxic effect of chemotherapy. Rituximab has revolutionized treatment results by offering patients with aggressive NHL a higher possibility of cure and in the case of the intractable forms of NHL it increases the disease free period. The standard treatment for a patient with NHL is rituximab-CHOP (immunotherapy). In addition, rituximab has pharmacoeconomic advantages as shown in various cost-utility and cost-effectiveness studies.

Prevalence of iron, folate, and vitamin B12 deficiency anemia after laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: One of the most common bariatric operations is the laparoscopic Roux-en-Y gastric bypass (LRYGBP) in which the gastric capacity is restricted and the absorption by the small intestine is reduced. The objective of this study was to evaluate the incidence of iron, folate, and vitamin B12 deficiency anemia in patients undergoing LRYGBP. PATIENTS AND METHODS: Clinical records of 30 patients who underwent LRYGBP between July 2003 and January 2005 and had a minimum follow up of 24 months at our outpatient clinic were included. Multivitamin supplementation was prescribed to all patients. The complete blood cell count, plasma iron, total iron-binding capacity, transferrin saturation, serum folate, and cobalamin levels before surgery, 6 months, 1, 2, and 3 years after the surgery were analyzed. RESULTS: There were 25 women (83.4%) and five men (16.6%) with ages from 21 to 56 years. Before surgery, two patients (6.6%) presented ferropenic anemia. Iron deficiency was seen in 40 and 54.5% 2 and 3 years after surgery, respectively. Cobalamin deficiency was observed in 33.3% at 2 years and in 27.2% at 3 years. At 2-year follow-up, 46.6% of the patients had already developed anemia and 63.6% at 3 years. Folate deficiency was not observed in any patient. CONCLUSION: Our routine scheme of vitamin supplementation is not sufficient to prevent iron and vitamin B12 deficiencies in most patients.

Tratamiento de pacientes con linfomas no Hodgkin asociados a SIDA: experiencia del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán / Treatment of non-Hodgkin's lymphoma associated with acquired immnodeficiency syndrome (AIDS) at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

Antecedentes: La supervivencia de los pacientes con linfomas no Hodgkin asociados al Síndrome de Inmunodeficiencia Adquirida (SIDA) ha mejorado con el uso de antirretrovirales y de quimioterapia menos tóxica. Material y métodos: El objetivo del estudio fue mostrar los resultados del tratamiento de los pacientes con linfomas no Hodgkin y SIDA. Se estudiaron nueve pacientes de manera retrospectiva. Se analizó la supervivencia global y libre de enfermedad mediante curvas de Kaplan-Meier; además de sus características generales. Resultados: El tratamiento recibido fue a base de etopósido, prednisona, vincristina, doxorrubicina y ciclofosfamida (DA-EPOCH). Los pacientes tuvieron supervivencia global de 18 meses, una supervivencia libre de enfermedad de 13 meses, una mediana de seguimiento de 16 meses con respuestas completas en ocho de nueve pacientes. Conclusiones: Se observó una adecuada repuesta a tratamiento en este grupo de enfermos reflejada en una mayor supervivencia global.

BACKGROUND: Survival in patients with acquired immunodeficiency syndrome (AIDS) related non-Hodgkin's Lymphoma has improved with the use of High Active Antiretroviral Therapy (HAART) and less toxic chemotherapy. MATERIAL AND METHODS: Clinical characteristics and outcome among patients treated for AIDS related non-Hodgkin's Lymphoma are described. Nine patients were studied retrospectively. Overall survival (OS) and Free Disease Survival (FDS) using a Kaplan-Meier model were analyzed. RESULTS: Patients received (DA-EPOCH) etoposide, prednisone, vincristine, doxorubicin and cyclophosphamide. The overall Survival was 18 months and 13 month Free Disease Survival with a median follow-up of 16 months showing full response in 8/9 patients was observed. CONCLUSIONS: A very satisfactory treatment response in this group of patients expressed as an increased Overall Survival was noted.

[Usefulness of bone marrow microscopic examination in HIV-infected patients with pancytopenia]. / Utilidad del estudio microscópico de medula ósea en pacientes con infección por VIH y pancitopenia.

INTRODUCTION: The role of bone marrow examination in the diagnosis of prolongedfever in HIV infected patients, has been well established, but the importance of the morphological and etiological analysis, obtained in patients with coexisting pancytopenia, has not been adequately described. MATERIALS AND METHODS: In a prospective study, we recruited 31 HIV-infected patients with coexisting pancytopenia, with or withoutfever. Bone marrow examination was performed in all cases. Other studies were done to confirm diagnosis. RESULTS: Parvovirus infection was observed in 5 patients, Histoplasma capsulatum in 4, Mycobacterium tuberculosis in 2, Mycobacterium avium complex in 3, HIV in 3, Salmonella typhi in 2, pneumonia and an unknown agent in 2 and intestinal infection and an unknown agent in 2. Only one patient was included in the following diagnostic etiologies: cytomegalovirus, trimethoprim sulfamethoxazole, Hodgkin's disease, hypersplenism, acinetobacter, appendicitis with an unknown agent, E. coli, and hemophagocytic syndrome. We obtained a probable diagnosis in 12 out of 31 patients (38.7), using bone marrow examination. CONCLUSION: In this subgroup of patients, the microscopic analysis of bone marrow is an important clinical approach that can lead to an early diagnosis of patients with and without fever.

Utilidad del estudio microscópico de medula ósea en pacientes con infección por VIH y pancitopenia / Usefulness of bone marrow microscopic examination in HIV-infected patients with pancytopenia

Introducción: El papel del examen de la medula ósea, en el diagnóstico de fiebre prolongada en pacientes con infección por VIH, ha sido bien establecido, pero aún no está bien estudiada la importancia de la información morfológica y etiológica obtenida en el subgrupo de pacientes con pancitopenia coexistente. Material y métodos: En un estudio prospectivo reclutamos 31 pacientes con infección por VIH, con pancitopenia coexistente, con o sin fiebre. Se llevó a cabo en todos los casos el exámen microscópico de la médula ósea, además de otros estudios para concretar un diagnóstico específico. Resultados: La infección por Parvovirus correspondió a cinco casos, Histoplasma capsulatum cuatro casos, Mycobacterium tuberculosis dos casos, complejo Mycobacterium avium tres casos, VIH en tres casos, Salmonella typhi dos casos, sin agente aislado y neumonía en dos casos, sin agente aislado e infección intestinal en dos casos. Hubo un solo caso de cada una de las siguientes etiologías: Citomegalovirus, trimetoprim-sulfametoxazol, Enfermedad de Hodgkin, hiperesplenismo, Acinetobacter, sin agente aislado y apendicitis por Escherichia coli, y síndrome hemofagocítico. Se logró el diagnóstico más probable mediante el análisis microscópico de la medula ósea en 12 de 31 pacientes (38.7%). Conclusión: En este subgrupo de pacientes, el análisis microscópico de la medula ósea es un procedimiento apropiado, que permite además, un diagnóstico temprano en pacientes con y sin episodios febriles.

INTRODUCTION: The role of bone marrow examination in the diagnosis of prolongedfever in HIV infected patients, has been well established, but the importance of the morphological and etiological analysis, obtained in patients with coexisting pancytopenia, has not been adequately described. MATERIALS AND METHODS: In a prospective study, we recruited 31 HIV-infected patients with coexisting pancytopenia, with or withoutfever. Bone marrow examination was performed in all cases. Other studies were done to confirm diagnosis. RESULTS: Parvovirus infection was observed in 5 patients, Histoplasma capsulatum in 4, Mycobacterium tuberculosis in 2, Mycobacterium avium complex in 3, HIV in 3, Salmonella typhi in 2, pneumonia and an unknown agent in 2 and intestinal infection and an unknown agent in 2. Only one patient was included in the following diagnostic etiologies: cytomegalovirus, trimethoprim sulfamethoxazole, Hodgkin's disease, hypersplenism, acinetobacter, appendicitis with an unknown agent, E. coli, and hemophagocytic syndrome. We obtained a probable diagnosis in 12 out of 31 patients (38.7), using bone marrow examination. CONCLUSION: In this subgroup of patients, the microscopic analysis of bone marrow is an important clinical approach that can lead to an early diagnosis of patients with and without fever.