Medical oncology care amidst the COVID-19 pandemic at the National University Hospital in the Philippines.

COVID-19 has abruptly and radically changed the landscape of cancer care delivery throughout the world, including the Philippines. The Philippine General Hospital is the academic hospital of the University of the Philippines. Its cancer centre is a primary referral centre that takes care of Filipinos-many resource-constrained-that are burdened by malignancy. As the global pandemic challenges healthcare delivery, centres are forced to rethink how to care for their patients. This paper discusses how a national, academic, referral cancer institute in a low-middle income country is trying to meet the challenges of COVID-19.

Changing the Landscape of Medical Oncology Training at the National University Hospital in the Philippines during the Coronavirus Disease 2019 (COVID-19) Pandemic.

Serving as one of the few training institutions of medical oncology in the Philippines, the University of the Philippines-Philippine General Hospital was faced with challenges brought by the coronavirus 2019 disease (COVID-19) pandemic. With the dismantling of routines and practices in the hospital, training activities such as daily rounds, conferences, and examinations were temporarily put on hold. Recognizing that the strength of any clinical training program is its wealth of patients, the immediate resumption of patient services, albeit limited at first, had been instrumental in ensuring the continuation of training in our institution. Opportunistic teaching-learning strategies between the faculty and fellows were devised. Innovative approaches to learning such as the use of online meeting platforms for division conferences, webinars, examinations, and other learning activities were initiated. Emphasis was given on the important considerations in the management of cancer patients during the COVID-19 pandemic. The emotional and psychological well-being of the faculty and fellows during this crisis were considered and a mental health assessment was conducted prior to the resumption of training activities.

Anaplastic large cell lymphoma in a pregnant Filipino woman successfully treated with prepartum and postpartum chemotherapy.

Diagnosis of a malignancy during pregnancy presents a dilemma regarding the work-up and treatment of the patient. This report presents a 42-year-old woman on her 23rd week of pregnancy with multiple enlarging fungating violaceous skin masses. Biopsy of the dominant mass revealed anaplastic large cell lymphoma. Due to the progressive enlargement and increase in number of the masses, the patient was given two cycles of chemotherapy (doxorubicin, vincristine, cyclophosphamide and prednisone) before delivering a live baby boy via spontaneous vaginal delivery, Apgar 9.9, at 37 4/7 weeks. After delivery, she completed four more cycles of treatment. A full-body positron emission tomography scan done 2 months after the last chemotherapy showed no evidence of disease. The patient is doing well with no evidence of disease 9 months after treatment. Her baby is thriving and has no gross deformities and no developmental delays.

Randomized, placebo-controlled, phase II study of sequential erlotinib and chemotherapy as first-line treatment for advanced non-small-cell lung cancer.

PURPOSE: This study investigated whether sequential administration of erlotinib and chemotherapy improves clinical outcomes versus chemotherapy alone in unselected, chemotherapy-naïve patients with advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Previously untreated patients (n = 154) with stage IIIB or IV NSCLC and Eastern Cooperative Oncology Group performance status of 0 or 1 were randomly assigned to receive erlotinib (150 mg/d) or placebo on days 15 to 28 of a 4-week cycle that included gemcitabine (1,250 mg/m(2) days 1 and 8) and either cisplatin (75 mg/m(2) day 1) or carboplatin (5 x area under the serum concentration-time curve, day 1). The primary end point was nonprogression rate (NPR) at 8 weeks. Secondary end points included tumor response rate, NPR at 16 weeks, duration of response, progression-free survival (PFS), overall survival (OS), and safety. RESULTS: The NPR at 8 weeks was 80.3% in the gemcitabine plus cisplatin or carboplatin (GC)-erlotinib arm (n = 76) and 76.9% in the GC-placebo arm (n = 78). At 16 weeks, the NPR was 64.5% for GC-erlotinib versus 53.8% for GC-placebo. The response rate was 35.5% for GC-erlotinib versus 24.4% for GC-placebo. PFS was significantly longer with GC-erlotinib than with GC-placebo (adjusted hazard ratio, 0.47; log-rank P = .0002; median, 29.4 v 23.4 weeks); this benefit was consistent across all clinical subgroups. There was no significant difference in OS. The addition of erlotinib to chemotherapy was well tolerated, with no increase in hematologic toxicity, and no treatment-related interstitial lung disease. CONCLUSION: Sequential administration of erlotinib following gemcitabine/platinum chemotherapy led to a significant improvement in PFS. This treatment approach warrants further investigation in a phase III study.

Treatment of advanced hormone-sensitive breast cancer in postmenopausal women with exemestane alone or in combination with celecoxib.

PURPOSE: Preclinical data showed that the combination of exemestane and celecoxib has synergistic effects. Therefore, a study was undertaken to explore the efficacy and tolerability of this combination in postmenopausal patients with advanced, hormone-sensitive breast cancer. PATIENTS AND METHODS: A randomized phase II study was conducted in postmenopausal patients with hormone-sensitive breast cancer and measurable disease who had progressive disease after treatment with tamoxifen. Patients were randomly assigned to either exemestane 25 mg daily or the combination of exemestane 25 mg daily with celecoxib 400 mg twice daily. Response Evaluation Criteria in Solid Tumors Group criteria were used to determine antitumor efficacy. Primary end point was the rate of clinical benefit. Secondary end points were tolerability, objective response rate, time to progression (TTP), and duration of clinical benefit. A pharmacodynamic and a pharmacokinetic study were conducted in parallel. RESULTS: One hundred eleven patients (exemestane, n = 55; combination, n = 56) were enrolled in 2002. The demographic characteristics and prognostic factors were similar in both arms. In the assessable population, 24 of 51 patients in the combination arm and 24 of 49 patients in the exemestane arm achieved clinical benefit. TTP was similar in both groups. Duration of clinical benefit was longer in the combination group (median, 96.6 v 49.1 weeks). The addition of celecoxib did not change the tolerability profile of exemestane alone. CONCLUSION: Similar rates of clinical benefit were achieved in both groups.

Transformaçoes na prática psicanalítica / Transformation in the psychoanalytic practics

As autoras refletem sobre mudanças na prática psicanalítica, a nível de relaçäo paciente-terapeuta. Descrevem alguns aspectos da evoluçäo do pensamento freudiano relativos a psicoterapia, desde o uso de hipnose até a prática psicanalítica propriamente dita. Consideram que os aspectos principais da obra de Freud, tais como os referidos na segunda tópica, podem ser apontados como a origem de posteriores desenvolvimentos teóricos, tais como a Teoria das Relaçöes Objetivas de Melanie Klein. O pensamento winnicottiano é destacado devido as contribuiçöes especialmente originais para um novo enfoque da relaçäo paciente-terapeuta. Concluem, considerando que as atuais tendências do pensamento psicanalítico ao enfocarem o self como uma totalidade tendem, conseqüentemente, a valorizar mais intensamente a importância da relaçäo paciente-terapeutica no processo analítico

Transformacoes na pratica psicanalitica

As autores refletem sobre mudancas na pratica psicanalitica, a nivel de relacao paciente-terapeuta. Descrevem-se alguns aspectos da evolucao do pensamento freudiano relativo a psicoterapia, desde o uso de hipnose ate a pratica psicanalitica propriamente dita. Consideram que os aspectos principais da obra de Freud tais como os referidos na segunda topica, podem ser apontados como a origem de posteriores desenvolvimentos teoricos, tais como a Teoria das Relacoes Objetais de Melanie Klein. O pensamento winnicottiano e destacado devido as contribuicoes especialmente originais para um novo enfoque da relacao paciente-terapeuta. Concluem, considerando que as atuais tendencias do pensamento psicanalitico ao enfocarem o self como uma totalidade tendem, consequentemente, a valorizar mais intensamente a importancia da relacao paciente-terapeuta no processo analitico.