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1.
Clin. transl. oncol. (Print) ; 23(8): 1520-1528, ago. 2021. tab
Artículo en Inglés | IBECS | ID: ibc-222150

RESUMEN

Colorectal cancer is the second leading cause of cancer-related death worldwide. For metastatic colorectal cancer (mCRC) patients, it is recommended, as first-line treatment, chemotherapy (CT) based on doublet cytotoxic combinations of fluorouracil, leucovorin, and irinotecan (FOLFIRI) and fluorouracil, leucovorin, and oxaliplatin (FOLFOX). In addition to CT, biological (targeted agents) are indicated in the first-line treatment, unless contraindicated. In this context, most of mCRC patients are likely to progress and to change from first line to second line treatment when they develop resistance to first-line treatment options. It is in this second line setting where Aflibercept offers an alternative and effective therapeutic option, thought its specific mechanism of action for different patient’s profile: RAS mutant, RAS wild-type (wt), BRAF mutant, potentially resectable and elderly patients. In this paper, a panel of experienced oncologists specialized in the management of mCRC experts have reviewed and selected scientific evidence focused on Aflibercept as an alternative treatment (AU)


Asunto(s)
Humanos , Inhibidores de la Angiogénesis/uso terapéutico , Antineoplásicos Inmunológicos/uso terapéutico , Neoplasias Colorrectales/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica , Bevacizumab/uso terapéutico , Ensayos Clínicos Fase III como Asunto , Neoplasias Colorrectales/genética , Neoplasias Colorrectales/patología , Fluorouracilo/uso terapéutico , Leucovorina/uso terapéutico , Factores de Edad
2.
ESMO Open ; 6(2): 100062, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33711671

RESUMEN

BACKGROUND: We explored the influence of BRAF and PIK3CA mutational status on the efficacy of bevacizumab or cetuximab plus 5-fluorouracil/leucovorin and irinotecan (FOLFIRI) as first-line therapy in patients with RAS wild-type metastatic colorectal cancer (mCRC). PATIENTS AND METHODS: VISNÚ-2 was a multicentre, randomised, phase II study. Patients with RAS wild-type mCRC and <3 circulating tumour cells/7.5 ml blood were stratified by BRAF/PIK3CA status (wild-type versus mutated) and number of affected organs (1 versus >1), and allocated to bevacizumab (5 mg/kg every 2 weeks) or cetuximab (400 mg/m2 then 250 mg/m2 weekly) plus FOLFIRI [irinotecan 180 mg/m2, leucovorin 400 mg/m2, 5-fluorouracil 400 mg/m2 (bolus) then 2400 mg/m2 (46-h continuous infusion) every 2 weeks]. The primary endpoint was progression-free survival (PFS). All analyses were exploratory. RESULTS: Two hundred and forty patients with BRAF/PIK3CA wild-type (n = 196) or BRAF- and/or PIK3CA-mutated tumours (n = 44) were enrolled. Median PFS was 12.7 and 8.8 months in patients with BRAF/PIK3CA wild-type and BRAF/PIK3CA-mutated tumours, respectively [hazard ratio (HR) = 1.22; 95% confidence interval (CI) 0.80-1.85; P = 0.3602]. In the BRAF- and/or PIK3CA-mutated cohort, median PFS was 2.8, 8.8 and 15.0 months in patients with BRAF/PI3KCA-mutated (n = 8), BRAF-mutated/PI3KCA wild-type (n = 16) and BRAF wild-type/PI3KCA-mutated (n = 20) tumours, respectively (P = 0.0002). PFS was similar with bevacizumab plus FOLFIRI versus cetuximab plus FOLFIRI in BRAF/PIK3CA wild-type (HR = 0.99; 95% CI 0.67-1.45; P = 0.9486) and BRAF/PIK3CA-mutated tumours (HR = 1.11; 95% CI 0.53-2.35; P = 0.7820). The most common grade 3/4 treatment-related adverse events were neutropenia, diarrhoea and asthenia in both treatment groups. CONCLUSIONS: BRAF/PIK3CA status influences outcomes in patients with RAS wild-type mCRC but does not appear to assist with the selection of first-line targeted therapy.


Asunto(s)
Neoplasias Colorrectales , Células Neoplásicas Circulantes , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Bevacizumab/uso terapéutico , Camptotecina/efectos adversos , Cetuximab/uso terapéutico , Fosfatidilinositol 3-Quinasa Clase I/genética , Fosfatidilinositol 3-Quinasa Clase I/uso terapéutico , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/genética , Humanos , Proteínas Proto-Oncogénicas B-raf/genética
3.
Clin Transl Oncol ; 23(8): 1520-1528, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-33630242

RESUMEN

Colorectal cancer is the second leading cause of cancer-related death worldwide. For metastatic colorectal cancer (mCRC) patients, it is recommended, as first-line treatment, chemotherapy (CT) based on doublet cytotoxic combinations of fluorouracil, leucovorin, and irinotecan (FOLFIRI) and fluorouracil, leucovorin, and oxaliplatin (FOLFOX). In addition to CT, biological (targeted agents) are indicated in the first-line treatment, unless contraindicated. In this context, most of mCRC patients are likely to progress and to change from first line to second line treatment when they develop resistance to first-line treatment options. It is in this second line setting where Aflibercept offers an alternative and effective therapeutic option, thought its specific mechanism of action for different patient's profile: RAS mutant, RAS wild-type (wt), BRAF mutant, potentially resectable and elderly patients. In this paper, a panel of experienced oncologists specialized in the management of mCRC experts have reviewed and selected scientific evidence focused on Aflibercept as an alternative treatment.


Asunto(s)
Inhibidores de la Angiogénesis/uso terapéutico , Neoplasias Colorrectales/tratamiento farmacológico , Sustitución de Medicamentos , Receptores de Factores de Crecimiento Endotelial Vascular/uso terapéutico , Proteínas Recombinantes de Fusión/uso terapéutico , Factores de Edad , Antineoplásicos Inmunológicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bevacizumab/uso terapéutico , Camptotecina/análogos & derivados , Camptotecina/uso terapéutico , Ensayos Clínicos Fase III como Asunto , Neoplasias Colorrectales/genética , Neoplasias Colorrectales/patología , Fluorouracilo/uso terapéutico , Genes ras , Humanos , Leucovorina/uso terapéutico , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/cirugía , Mutación , Neovascularización Patológica/tratamiento farmacológico , Compuestos Organoplatinos/uso terapéutico , Proteínas Proto-Oncogénicas B-raf/genética , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores
4.
Clin. transl. oncol. (Print) ; 15(11): 959-964, nov. 2013.
Artículo en Inglés | IBECS | ID: ibc-127681

RESUMEN

PURPOSE: Advanced non-small cell lung cancer (NSCLC) is a common and lethal malignancy that has rarely benefited from chemotherapy. Erlotinib is highly effective in NSCLC patients selected by clinical characteristics and/or the presence of epidermal growth factor receptor-sensitizing mutations. However, the way to delay or bypass erlotinib resistance is not systematically addressed. Different erlotinib-failure modes have been reported in NSCLC, and strategies to prolong erlotinib efficacy are perhaps adaptable to them. We report the feasibility and efficacy of continued erlotinib maintenance and local salvage radiation to overcome erlotinib resistances in selected NSCLC patients. PATIENTS AND METHODS: Thirty of 52 consecutive erlotinib-treated advanced NSCLC from the NYU Langone Medical Center and the Arnau de Vilanova Hospital of Lleida responded initially to erlotinib. Twenty-six patients eventually showed a generalized-progression to erlotinib, and four progressed in solitary tumor sites. These four patients were treated with continued erlotinib maintenance and local salvage radiation. RESULTS: The progression-free survival (PFS) was statistically similar in patients with oligo or generalized-progression to erlotinib. However, all four cases with solitary-progression did benefit from continued erlotinib maintenance and salvage radiation with 41-140 % prolongation of PFS. It was reflected in an improved overall survival when they were compared with patients with generalized-progression (76.4 vs. 19.9 months; p = 0.018). CONCLUSION: Continued erlotinib maintenance and local salvage radiation is feasible and could contribute to a better outcome in selected NSCLC patients with solitary-progression to erlotinib. Prospective randomized trials of this strategy are warranted (AU)


Asunto(s)
Humanos , Masculino , Femenino , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Supervivencia/psicología
5.
Clin Transl Oncol ; 15(11): 959-64, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-23606352

RESUMEN

PURPOSE: Advanced non-small cell lung cancer (NSCLC) is a common and lethal malignancy that has rarely benefited from chemotherapy. Erlotinib is highly effective in NSCLC patients selected by clinical characteristics and/or the presence of epidermal growth factor receptor-sensitizing mutations. However, the way to delay or bypass erlotinib resistance is not systematically addressed. Different erlotinib-failure modes have been reported in NSCLC, and strategies to prolong erlotinib efficacy are perhaps adaptable to them. We report the feasibility and efficacy of continued erlotinib maintenance and local salvage radiation to overcome erlotinib resistances in selected NSCLC patients. PATIENTS AND METHODS: Thirty of 52 consecutive erlotinib-treated advanced NSCLC from the NYU Langone Medical Center and the Arnau de Vilanova Hospital of Lleida responded initially to erlotinib. Twenty-six patients eventually showed a generalized-progression to erlotinib, and four progressed in solitary tumor sites. These four patients were treated with continued erlotinib maintenance and local salvage radiation. RESULTS: The progression-free survival (PFS) was statistically similar in patients with oligo or generalized-progression to erlotinib. However, all four cases with solitary-progression did benefit from continued erlotinib maintenance and salvage radiation with 41-140 % prolongation of PFS. It was reflected in an improved overall survival when they were compared with patients with generalized-progression (76.4 vs. 19.9 months; p = 0.018). CONCLUSION: Continued erlotinib maintenance and local salvage radiation is feasible and could contribute to a better outcome in selected NSCLC patients with solitary-progression to erlotinib. Prospective randomized trials of this strategy are warranted.


Asunto(s)
Adenocarcinoma Bronquioloalveolar/terapia , Adenocarcinoma/terapia , Carcinoma de Pulmón de Células no Pequeñas/terapia , Quimioradioterapia , Neoplasias Pulmonares/terapia , Inhibidores de Proteínas Quinasas/uso terapéutico , Quinazolinas/uso terapéutico , Adenocarcinoma/mortalidad , Adenocarcinoma/secundario , Adenocarcinoma Bronquioloalveolar/mortalidad , Adenocarcinoma Bronquioloalveolar/secundario , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/secundario , Progresión de la Enfermedad , Clorhidrato de Erlotinib , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Estadificación de Neoplasias , Pronóstico , Dosificación Radioterapéutica , Estudios Retrospectivos , Terapia Recuperativa , Tasa de Supervivencia
6.
Clin. transl. oncol. (Print) ; 14(12): 891-895, dic. 2012.
Artículo en Inglés | IBECS | ID: ibc-127018

RESUMEN

The gamma-delta (γδ) T-cells are a subset of T-lymphocytes characterized by the presence of a surface antigen recognition complex type 2. Those γδ T-cells represent 2-5 % of peripheral T-cells only, but they are common in organs and mucosae, acting as a first defense system in the entries to the organism. The γδ T-cells take part on immune response by direct cytolysis, development of memory phenotypes, and modulation of immune cells, and they have been implied in autoimmune disorders, immune deficiencies, infections, and tumor diseases. We reported the role of γδ T-cells in oncology, focusing in their potential applications for cancer treatment. Experimental designs and clinical trials in the treatment of solid malignancies are extensively reviewed (AU)


Asunto(s)
Humanos , Neoplasias/inmunología , Neoplasias/terapia , Receptores de Antígenos de Linfocitos T gamma-delta/inmunología , Linfocitos T/inmunología , Ensayos Clínicos como Asunto , Inmunoterapia/métodos
7.
Lupus ; 13(3): 159-64, 2004.
Artículo en Inglés | MEDLINE | ID: mdl-15119543

RESUMEN

Our objective was to determine the prevalence of antinuclear antibodies (ANAs) in patients with malignancies and to investigate if their presence might be related with development of musculoskeletal symptoms or paraneoplastic rheumatic syndromes. Antinuclear antibodies were determined by indirect immunofluorescence on Hep-2 cells in 274 neoplastic patients and in a control group of 140 age-adjusted healthy subjects. Antinuclear antibody specificities (anti-DNA and anti-ENA) were investigated in patients with rheumatological symptoms and positive ANA. Antinuclear antibodies were detected in 76 of 274 (27.7%) patients with malignancies and in nine of 140 (6.4%) healthy subjects. Twenty patients reported paraneoplastic rheumatic symptoms or syndromes. Two of them developed clinical symptoms mimicking rheumatoid arthritis (rheumatoid-like arthropathy), one systemic lupus erythematosus (lupus-like syndrome), one dermatomyositis and four cutaneous vasculitides. Musculoskeletal symptoms and paraneoplastic rheumatic symptoms and syndromes were both more frequently observed in patients with positive ANA. Antinuclear antibody specificities were found in only two cases. We can conclude that there is an increased incidence of antinuclear antibodies in malignant conditions. Musculoskeletal symptoms and rheumatic paraneoplastic symptoms and syndromes seem to be more frequent in patients with cancer-related positive ANAs. The failure to find ANA specificities (anti-ENA, anti-DNA) in patients with malignancies and positive ANAs in our study may simply reflect molecular differences between the autoantigens involved in cancer and those characteristically involved in the systemic autoimmune diseases.


Asunto(s)
Anticuerpos Antinucleares/metabolismo , Biomarcadores de Tumor/análisis , Enfermedades del Tejido Conjuntivo/diagnóstico , Neoplasias/diagnóstico , Síndromes Paraneoplásicos/diagnóstico , Enfermedades Reumáticas/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Antinucleares/análisis , Estudios de Cohortes , Enfermedades del Tejido Conjuntivo/sangre , Enfermedades del Tejido Conjuntivo/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/sangre , Neoplasias/epidemiología , Síndromes Paraneoplásicos/sangre , Síndromes Paraneoplásicos/epidemiología , Pronóstico , Enfermedades Reumáticas/sangre , Enfermedades Reumáticas/epidemiología , Sensibilidad y Especificidad
8.
An Med Interna ; 16(7): 354-6, 1999 Jul.
Artículo en Español | MEDLINE | ID: mdl-10481335

RESUMEN

The malignant pleural mesothelioma is a rare neoplastic consequence observed in people with previous exposition to asbestos essentially. The malignant mesothelioma like a term, not only reports to primary malignant extended tumors that are derived of pleural mesothelioma but also, pericardial and peritoneal (about 20%). The exposition of asbestos stands for a sequential cellular reaction with oncogenic potential and with a typical majority clinical presentation. We described the case a patient complaint of malignant pleural mesothelioma with unusual radiology presentation with the result that unilateral calcified pleural plaques with pleural thickening and pleural effusion absence. Definitive diagnostic was achieved by thoracotomy.


Asunto(s)
Mesotelioma/diagnóstico por imagen , Neoplasias Pleurales/diagnóstico por imagen , Calcinosis/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Pleura/diagnóstico por imagen , Enfermedades Pleurales/diagnóstico por imagen , Radiografía Abdominal , Radiografía Torácica , Tomografía Computarizada por Rayos X
9.
An. med. interna (Madr., 1983) ; 16(7): 354-356, jul. 1999.
Artículo en Es | IBECS | ID: ibc-70

RESUMEN

El mesotelioma pleural maligno es una rara entidad neoplásica observada principalmente, en personas con exposición previa al asbesto. El mesotelioma maligno como término, no solo hace referencia a los tumores malignos primarios difusos que derivan del mesotelioma pleural sino también, del pericardio y peritoneo (sobre el 20 porciento). La exposición al asbesto conlleva una reacción celular secuencial con potencial oncógeno y de presentación clínica mayoritaria típica. Describimos el caso de un paciente afectado de mesotelioma pleural maligno con presentación radiológica inusual, en forma de placas pleurales calcificadas unilaterales con engrosamiento pleural y ausencia total de derrame pleural. El diagnóstico definitivo se realizó por toracotomía (AU)


Asunto(s)
Masculino , Persona de Mediana Edad , Humanos , Calcinosis , Mesotelioma , Pleura , Enfermedades Pleurales , Radiografía Abdominal , Radiografía Torácica , Tomografía Computarizada por Rayos X , Neoplasias Pleurales , Mesotelioma , Neoplasias Pleurales
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