RESUMEN
Limited literature is available for bevacizumab exposure-response relationship and there is not a concentration threshold associated with an optimal disease control. This prospective observational study in patients with metastatic colorectal cancer (mCRC) aims to evaluate, in a real-life setting, the relationship between bevacizumab through concentrations at steady state (Ctrough, SS) and disease control. Ctrough, SS were drawn, coinciding with the radiological evaluation of the response (progression or clinical benefit). Generalized estimating equations (GEE) analysis was performed. To test the association between Ctrough, SS in each patient with overall survival (OS) or progression-free survival (PFS), Cox proportional hazard models were developed. Data included 50 bevacizumab Ctrough, SS from 27 patients. The GEE model did not suggest any positive association between bevacizumab Ctrough, SS and clinical benefit (OR 0.99, 95% CI: 0.98-1.02, p = 0.863). The Cox regression showed association between higher median Ctrough, SS with better OS (HR 0.86, 95% CI: 0.73-1.01, p = 0.060), but not with PFS. We cannot confirm a relationship between bevacizumab Ctrough, SS and clinical benefit but this is the first real-world study trying to show a relationship between bevacizumab Ctrough, SS and disease control in mCRC. It was conducted in a small sample size which reduces the level of evidence. Further controlled randomized studies with a sufficient number of patients are required.
Asunto(s)
Antineoplásicos Inmunológicos/uso terapéutico , Bevacizumab/uso terapéutico , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/secundario , Anciano , Inhibidores de la Angiogénesis/uso terapéutico , Antineoplásicos Inmunológicos/farmacocinética , Bevacizumab/farmacocinética , Supervivencia sin Enfermedad , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Masculino , Persona de Mediana Edad , Supervivencia sin Progresión , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
Presentamos un caso de absceso pélvico en mujer de 48 años portadora de un DIU en el que se aisló un microogsnismo poco habitual en estos procesos como es Fusobacterium necrophorum. Aprovechamos el caso para ilustrar a la luz de los nuevos descubrimientos sobre el microbioma endometrial el viejo debate acerca de si el hallazgo en los cultivos de abscesos pélvicos de portadoras de DIUs de microorganismos anaerobios poco comunes indica o no un mayor riesgo de padecer estos procesos en estas mujeres
We present a case of pelvic abscess in a 48-year-old woman with an IUD and an unusual microognism isolated such as Fusobacterium necrophorum. We use it to illustrate on the new discoveries about the endometrial microbiome the old debate about whether the finding in cultures of pelvic abscesses of carriers of IUDs of rare anaerobic microorganisms indicates or not an increased risk of suffering these processes in long term IUD users
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Absceso/diagnóstico , Absceso/microbiología , Enfermedades del Ovario/diagnóstico , Enfermedades del Ovario/microbiología , Dispositivos Intrauterinos , Fusobacterium necrophorum/aislamiento & purificación , Infecciones por Fusobacterium/diagnóstico , Absceso/cirugía , Enfermedades del Ovario/cirugíaRESUMEN
La resistencia a hormonas tiroideas, descrita por Refetoff en 1967, es un desorden genético autosómico dominante. Se caracteriza por una respuesta reducida de los tejidos blandos a la hormona tiroidea con incremento de niveles de tiroxina libre sin inhibición de la hormona tirotropa, como consecuencia de mutaciones presentes en el gen receptor beta de la hormona tiroidea (rTHβ) en el 85% de los casos. Es una entidad poco frecuente y el diagnóstico definitivo se basa en el estudio genético. Presentamos el caso de una probable nueva mutación en el gen rTHβ (AU9
Resistance to thyroid hormone, described by Refetoff in 1967, it is an autosomic dominant genetic disorder. It is characterised by a reduced soft-tissue response to thyroid hormone action, associated with increased free thyroxin (FT4) levels with no thyrotrophic hormone inhibition, as a consequence of mutations present in thyroid hormone receptor beta gen (rTHβ) in 85% of cases. It is a rare disease and the definitive diagnostic is based on a genetic study (AU)
