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1.
Zhonghua Bing Li Xue Za Zhi ; 49(11): 1169-1173, 2020 Nov 08.
Artículo en Chino | MEDLINE | ID: mdl-33152824

RESUMEN

Objective: To explore the relationship between the expression of human epidermal growth factor receptor 2 (HER2) in core needle biopsy (CNB) specimens before neoadjuvant chemotherapy (NAC) and post NAC Residual Cancer Burden (RCB) classification in breast cancer. Methods: This retrospective study included 150 patients with CNB proven invasive breast carcinoma in the Fourth Hospital of Hebei Medical University from January 2013 to January 2014. Immunohistochemistry (IHC) or fluorescence in situ hybridization (FISH) was used to detect the expression of HER2 in the CNB specimens. RCB was used to assess the chemotherapy response of patients. SPSS 21.00 and GraphPad Prism 8.0.1 were used for data statistics; Chi square test and Fisher's exact test for correlation analysis, and Cox regression for survival analysis. P<0.05 was considered statistically significant. Results: Among the 150 patients, there were 38 RCB-0, 12 RCB-Ⅰ, 61 RCB-Ⅱ and 39 RCB-Ⅲ post NAC. RCB-0 meant pathological complete response (PCR). Statistical analysis found that the pre NAC HER2 expression was related to PCR and RCB classification after surgery (r1=‒0.217,r2=‒0.282;P<0.05). Further analysis demonstrated that in the HER2-positive group, PCR was associated with prolonged OS and DFS (HR=2.939, 2.359; P<0.05); the differences of OS and DFS in RCB classifications were more significant (P<0.05) in the HER2 positive than HER2 negative groups. Conclusion: There is a correlation between pre NAC HER2 expression and PCR and RCB classification after treatment. In HER2-positive patients, the prognostic stratification of RCB classification is more obvious, suggesting that pre NAC HER2 overexpression combined with RCB classification after surgery can more accurately predict the prognosis.


Asunto(s)
Neoplasias de la Mama , Terapia Neoadyuvante , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/genética , Neoplasias de la Mama/cirugía , Humanos , Hibridación Fluorescente in Situ , Neoplasia Residual , Pronóstico , Receptor ErbB-2/genética , Estudios Retrospectivos , Resultado del Tratamiento
2.
Gan To Kagaku Ryoho ; 47(9): 1331-1335, 2020 Sep.
Artículo en Japonés | MEDLINE | ID: mdl-33130694

RESUMEN

The treatment outcomes of unresectable pancreatic cancer(URPC)have improved due to the advent of gemcitabine with nab-paclitaxel(GnP)and FOLFIRINOX as first-line therapy. There have been increasing reports of URPC responding to chemotherapy or chemoradiation and that conversion surgery(CS)can help to achieve long-term survival. This study aims to assess the treatment outcomes of URPC in our department and consider CS adaptation. Thirty-six patients with URPC who were treated with GnP or FOLFIRINOX between 2015 and 2018 were included in this retrospective analysis. Thirty-five patients had GnP, while 1 patient had FOLFIRINOX. The median age of the patients was 68.0 years and included 17 males and 19 females. Twenty-eight of the tumors were located in the pancreas head and 8 in the body-tail. Twenty-one cases were locally advanced(UR-LA), and 15 cases had distant metastases(UR-M). CS was performed in 9 cases(25.0%). The 2-year survival rate for patients that underwent CS was 53.3%, and 34.1% for patients that did not undergo CS. The prognosis of patients who underwent CS tended to be better, but there was no significant difference(p=0.141). In the patients that underwent CS, there were cases of early recurrence in which the period of preoperative chemotherapy was short, and the tumor markers were not normalized. Therefore, it is thought that prolonging preoperative treatment could help to select more suitable patients for CS.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias Pancreáticas , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioradioterapia , Femenino , Humanos , Masculino , Neoplasias Pancreáticas/tratamiento farmacológico , Estudios Retrospectivos , Resultado del Tratamiento
4.
Gan To Kagaku Ryoho ; 47(9): 1383-1385, 2020 Sep.
Artículo en Japonés | MEDLINE | ID: mdl-33130706

RESUMEN

A 70-year-old male with defecation difficulties was referred to our hospital. A colonoscopy and computed tomography revealed multiple advanced rectal cancers in the rectosigmoid and lower rectum with swollen lymph nodes. After 6 courses of neoadjuvant capecitabine and oxaliplatin and bevacizumab without radiotherapy(CapeOX plus BV therapy), a colonoscopy revealed that the tumors had significantly reduced. A low anterior laparoscopic resection with diverting ileostomy was performed. Histopathological examination showed no residual tumor cells or lymph node metastasis. A final diagnosis of pathological complete response was made. The patient has currently survived 1-year disease-free. Neoadjuvant CapeOX plus BV therapy can be a promising therapeutic option for locally advanced rectal cancer.


Asunto(s)
Terapia Neoadyuvante , Neoplasias del Recto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Capecitabina/uso terapéutico , Humanos , Masculino , Neoplasias del Recto/tratamiento farmacológico , Neoplasias del Recto/cirugía , Recto
5.
Gan To Kagaku Ryoho ; 47(10): 1449-1455, 2020 Oct.
Artículo en Japonés | MEDLINE | ID: mdl-33130739

RESUMEN

We investigated factors related to the recurrence and prognosis of patients with triple-negative breast cancer (TNBC)after neoadjuvant chemotherapy(NAC). Of the 545 patients who underwent surgery after NAC between January 2013 and December 2016, 131 patients had TNBC. An analysis of each TNBC case indicated that the presence or absence of clinical lymph node metastasis(cN)before treatment might be a predictive factor of prognosis. There were 57(43.5%)pathological complete response(pCR)(ypT0 or ypTis/N0)cases after NAC. Overall survival(OS)and disease free survival(DFS) were significantly better in pCR cases than in non-pCR cases. However, recurrence was observed in 8 of 57(14%)pCR cases and 29 of 74(39%)non-pCR cases. The factors defining DFS from the univariate analysis of the non-pCR group were cN, ypT, ypN, and vascular invasion. The multivariate analysis of these factors suggested that residual cN and vascular invasion might be independent factors predicting DFS. Residual vascular invasion was found to predict OS, and was considered to be a poor prognostic factor.


Asunto(s)
Neoplasias de la Mama , Neoplasias de la Mama Triple Negativas , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Supervivencia sin Enfermedad , Humanos , Terapia Neoadyuvante , Recurrencia Local de Neoplasia , Pronóstico , Neoplasias de la Mama Triple Negativas/tratamiento farmacológico
6.
Gan To Kagaku Ryoho ; 47(10): 1501-1504, 2020 Oct.
Artículo en Japonés | MEDLINE | ID: mdl-33130750

RESUMEN

We present the case of a 66-year-old female diagnosed with gallbladder cancer that was initially discovered with contrast enhanced computed tomography. The primary gall bladder tumor displayed heterogeneous enhancement. The patient underwent cholecystectomy with full-thickness excision of the gallbladder cancer. After 3 rounds of adjuvant chemotherapy with the oral fluoropyrimidine derivative, S-1(administered for 4 weeks at 120 mg/day and then stopped for 2 weeks), a metastasis measuring 15 mm in diameter emerged within hepatic segment 5. The chemotherapy regimen was altered to include 6 months of combination therapy with gemcitabine(1,000 mg/m2)and cisplatin(25 mg/m2)given once every week for 2 weeks and then stopped for 1 week. The hepatic metastasis decreased in size to 8 mm in diameter, and a partial liver resection was performed. After hepatectomy, the patient remains alive and without disease recurrence.


Asunto(s)
Neoplasias de la Vesícula Biliar , Neoplasias Hepáticas , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioterapia Adyuvante , Femenino , Neoplasias de la Vesícula Biliar/tratamiento farmacológico , Neoplasias de la Vesícula Biliar/cirugía , Hepatectomía , Humanos , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/cirugía , Recurrencia Local de Neoplasia
7.
Gan To Kagaku Ryoho ; 47(10): 1505-1507, 2020 Oct.
Artículo en Japonés | MEDLINE | ID: mdl-33130751

RESUMEN

Case 1: A 68-year-old woman was diagnosed with advanced HER2-positive breast cancer(T2N2aM0, cStage ⅢA). She was treated with 4 courses of preoperative chemotherapy with pertuzumab, trastuzumab, and docetaxel. She was diagnosed to have achieved partial remission(PR), and subsequently underwent a mastectomy and axillary dissection. Pathological examination revealed smaller than 1 mm(Grade 2b). Case 2: A 59-year-old woman was diagnosed with advanced HER2-positive breast cancer(T4bN1M0, cStage ⅢB). She was treated with 4 courses of preoperative chemotherapy with pertuzumab, trastuzumab, and docetaxel. She was diagnosed to have achieved PR(primary lesion: complete remission), and subsequently underwent a mastectomy and axillary dissection. Pathological examination revealed complete pathological response(Grade 3). Combination therapy with pertuzumab, trastuzumab, and docetaxel appears to be a useful preoperative chemotherapy regimen for locally advanced HER2-positive breast cancer.


Asunto(s)
Neoplasias de la Mama , Anciano , Anticuerpos Monoclonales Humanizados , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Docetaxel , Femenino , Humanos , Mastectomía , Persona de Mediana Edad , Estadificación de Neoplasias , Receptor ErbB-2 , Trastuzumab/uso terapéutico
8.
Gan To Kagaku Ryoho ; 47(10): 1509-1512, 2020 Oct.
Artículo en Japonés | MEDLINE | ID: mdl-33130752

RESUMEN

A 69-year-old woman presented with persistent nauseous, underwent upper gastrointestinal endoscopy, and was diagnosed with type 2 advanced gastric cancer at the antrum. Abdominal contrast CT image data revealed that there was a large, swollen, pancreatic superior lymph node invading the common hepatic artery. We determined that the tumor was unresectable and systemic chemotherapy was performed using S-1 plus oxaliplatin(SOX)therapy. After 5 courses of chemotherapy, the abdominal contrast CT image data indicated reduction of both the primary lesion and lymph node metastasis. A laparotomy was performed. As the No. 8a lymph node was forming hard scar tissue, we could not dissected clearly it from the common hepatic artery wall. We strongly suspected that cancer tissue remained at the artery wall. A distal gastrectomy and Roux-en-Y reconstruction were performed. Histologically, the resected specimen was determined to be Grade 3, with a pathological complete response(pCR). The patient was administered S-1 for 6 months after the operation and has enjoyed 2.5 years of recurrence-free survival. SOX therapy for unresectable gastric cancer and surgical intervention as conversion surgery were effective. This case demonstrated the possibility of life prolongation using these therapies.


Asunto(s)
Neoplasias Gástricas , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Femenino , Gastrectomía , Humanos , Metástasis Linfática , Oxaliplatino , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/cirugía
9.
Gan To Kagaku Ryoho ; 47(10): 1517-1520, 2020 Oct.
Artículo en Japonés | MEDLINE | ID: mdl-33130754

RESUMEN

A 66-year-old male diagnosed with transverse colon cancer was admitted to our hospital. Computed tomography, colonoscopy, and esophagogastroduodenoscopy revealed locally advanced cancer with invasion of the gastric antrum. We staged the disease as cT4a, cN2, cM0, Stage ⅢB, with wild-type RAS expression. We performed an ileostomy prior to administering chemotherapy. The patient received 4 courses of modified FOLFOXIRI plus bevacizumab and 2 courses of FOLFIRI. The size of the tumor noticeably decreased after chemotherapy. The patient experienced grade 3 neutropenia, anorexia, and oral mucositis during chemotherapy. We performed a right hemicolectomy(D3), partial gastrectomy and ileum resection after administering neoadjuvant chemotherapy. The pathological stage of the disease was ypT2, ypN0, ypM0, ypStageⅠ, and the effect of the chemotherapy was Grade 1b. After the resection, he received mFOLFOX6 and CapeOX for 3 months as adjuvant chemotherapy. He remained cancer-free for 1 year and 3 months after the surgery. This result suggests that preoperative modified FOLFOXIRI plus bevacizumab chemotherapy is a useful regimen for the treatment of locally advanced colon cancer.


Asunto(s)
Colon Transverso , Neoplasias del Colon , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bevacizumab/uso terapéutico , Camptotecina/análogos & derivados , Neoplasias del Colon/tratamiento farmacológico , Neoplasias del Colon/cirugía , Fluorouracilo/uso terapéutico , Humanos , Leucovorina , Masculino , Terapia Neoadyuvante , Compuestos Organoplatinos , Antro Pilórico
10.
Medicine (Baltimore) ; 99(45): e23040, 2020 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-33157956

RESUMEN

BACKGROUND: There search of PARP inhibitors has made great breakthroughs and progress. Become a new type of medicine for cancer treatment,bringing hope to more advanced cancer patients.The purpose of this systematic review is to evaluate the clinical efficacy and adverse effects of PARP inhibitorscombined with chemotherapy and chemotherapy alone in the treatment of cancer patients. METHODS: We searched the following 4 databases, including: PubMed, EMBASE, Web of Science, and Cochrane Library. The search will also be conducted at the clinical trial centers: ClinicalTrials.gov, ISRCTN Registry, WHO International Clinical Trials Registration Platform. The search date is as of September 22, 2020. There is no language restriction during this search, and the latest documents are kept updated through settings. The subject search terms were identified as "PARP Inhibitor", "Neoplasms" and "Dug therapy". The Phase 2 and Phase 3 clinical trials comparing PARP inhibitor combined with chemotherapy and chemotherapy alone were included. The results include overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and adverse events. Two researchers separately completed the article inclusion, data extraction and quality evaluation of this study. The assessment of the risk of bias and data will be conducted using Review Manager. ETHICS AND DISSEMINATION: All articles are published and do not require the approval of the ethics committee and the signed informed consent form. The results of this systematic review will be published through peer-reviewed publications. REGISTERED: Registered on INPLASY and the registration number is INPLASY202090087.


Asunto(s)
Antineoplásicos/efectos adversos , Neoplasias/tratamiento farmacológico , Inhibidores de Poli(ADP-Ribosa) Polimerasas/efectos adversos , Adulto , Anciano , Antineoplásicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Ensayos Clínicos Fase II como Asunto , Ensayos Clínicos Fase III como Asunto , Manejo de Datos , Supervivencia sin Enfermedad , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/mortalidad , Inhibidores de Poli(ADP-Ribosa) Polimerasas/uso terapéutico , Supervivencia sin Progresión , Resultado del Tratamiento
11.
Medicine (Baltimore) ; 99(45): e22950, 2020 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-33157935

RESUMEN

INTRODUCTION: Cervical cancer is the second largest tumor disease threatening female reproductive tract health. AS2O3 is a multi-directional and multi-target anti-cervical cancer drug. It can be combined with platinum drugs to treat cervical cancer. The literatures of AS2O3 combined with platinum drugs related to cervical cancer have shown inconsistent results, and there is currently no high quality of systematic review to evaluate the effects of AS2O3 combined with platinum drugs in cervical cancer patients. METHODS AND ANALYSIS: English and Chinese literature about AS2O3 combined with platinum drugs treatment for cervical cancer published before August 31, 2020 will be systematic searched in PubMed, Embase, Web of Science, Cochrane Library, Open Grey, Clinicaltrials.gov, Chinese Clinical Trial Registry, WANFANG, VIP Chinese Science and Technology Journal Database, CNKI, Chinese biomedical document service system (SinoMed). Only randomized controlled trials (RCTs) of patients with cervical cancer will be included. Literature screening, data extraction, and the assessment of risk of bias will be independently conducted by 2 reviewers, and the 3rd reviewer will be consulted if any different opinions existed. Clinical total effective rate, adverse events, SCCAg, CYFRA21-1, quality of life, and immune function will be evaluated. Systematic review and meta-analysis will be produced by RevMan 5.3 and Stata 14.0. This protocol reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) statement, and we will report the systematic review by following the PRISMA statement. RESULTS: The current study is a protocol for systematic review and meta-analysis without results, and data analysis will be carried out after the protocol. We will share our findings in the fourth quarter of 2021. CONCLUSION: Efficacy and safety of AS2O3 combined with platinum drugs in the treatment of cervical cancer will be assessed. The results will be published in a public issue journal to provide evidence-based medical evidence for Obstetrician and Gynecologists to make clinical decisions. ETHICS AND DISSEMINATION: Ethical approval is not required as the review is a secondary study based on published literature. The results of the study will be published in peer-reviewed publications and disseminated electronically or in print. PROTOCOL REGISTRATION NUMBER: INPLASY202080130.


Asunto(s)
Trióxido de Arsénico/administración & dosificación , Compuestos de Platino/administración & dosificación , Neoplasias del Cuello Uterino/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Femenino , Humanos , Metaanálisis como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación , Revisiones Sistemáticas como Asunto
12.
Medicine (Baltimore) ; 99(42): e22802, 2020 Oct 16.
Artículo en Inglés | MEDLINE | ID: mdl-33080754

RESUMEN

The agents used in the treatment of acute lymphoblastic leukaemia (ALL) might affect the oral health of cancer patients.The study aims to assess the changes in the levels of immunoglobulin A (IgA) in saliva and blood, during first 22 days of intensive chemotherapy of ALL in children.Saliva and blood samples were taken from 24 patients, including 13 boys and 11 girls (age range: 4 - 17 years) on days 1, 8 and 22 of treatment. The levels of immunoglobulin A and total protein were estimated in samples at each time-point. The distribution of the quantitative variables was assessed using the Shapiro-Wilk test. Non-parametric statistics were used to compare the levels of repeated measurements and post hoc non-parametric analysis was applied for between time-point comparisons.A constant relationship was found between the levels of Ig A in blood and saliva (r = 0.28; P = .031). No change in salivary IgA level was observed in the prednisone-only prephase, but it dropped significantly on day 22 (10.7+/-4.8 vs 9.6+/-6.4 vs 5.7+/-3.9 ng/mL; P = .04), when chemotherapy was given (anthracycline, vincristine, L-asparaginase).In blood, the total protein level decreased significantly between day 1 and 22 (6.2+/-0.4 vs 5.1+/-0.3 g/dL; P = .001). Lymphocyte count (per microliter) also decreased (2.12+/-0.8 vs 0.41+/-0.1 vs 1.08+/-0.5; P = .002). Four children suffered from oral mucositis graded 1 or higher between days 8 and 22.Chemotherapy given during the treatment of childhood ALL is associated with a reduction in the level of salivary immunoglobulin A. Prevention of the drop of salivary IgA may diminish the risk of occurrence of acute mucosal complications.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Glucocorticoides/uso terapéutico , Inmunoglobulina A Secretora/metabolismo , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Saliva/inmunología , Adolescente , Asparaginasa/administración & dosificación , Proteínas Sanguíneas/análisis , Niño , Preescolar , Daunorrubicina/administración & dosificación , Femenino , Humanos , Recuento de Linfocitos , Masculino , Prednisona/uso terapéutico , Proteínas/análisis , Inducción de Remisión , Saliva/química , Estomatitis/inducido químicamente , Vincristina/administración & dosificación
13.
Indian J Cancer ; 57(4): 481-484, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33078758

RESUMEN

Worldwide, hospitals are facing problems in managing cancer patients during the ongoing COVID-19 pandemic. Given the immense cancer burden of oral cancer in India, scheduling surgeries are becoming increasingly difficult. Upfront surgeries are recommended for curative treatment of oral cancers and postponing them raises the fear of progression. Metronomic chemotherapy can be considered during the waiting period given its potential oncological benefits and ease of administration without much toxicity.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Infecciones por Coronavirus/complicaciones , Neoplasias de la Boca/tratamiento farmacológico , Pandemias , Neumonía Viral/complicaciones , Administración Metronómica , Protocolos de Quimioterapia Combinada Antineoplásica/provisión & distribución , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Humanos , India/epidemiología , Neoplasias de la Boca/complicaciones , Neoplasias de la Boca/epidemiología , Neoplasias de la Boca/virología , Procedimientos Quirúrgicos Orales , Neumonía Viral/epidemiología , Neumonía Viral/virología
14.
Medicine (Baltimore) ; 99(43): e22652, 2020 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-33120755

RESUMEN

RATIONALE: Poorly differentiated neuroendocrine carcinoma of the breast is a rare cancer with poor prognosis. There is no standard treatment for the disease. Neoadjuvant therapies and surgery are considered to be the main treatment when the tumor diameter is greater than 5.0 cm. Neoadjuvant therapies include chemotherapy and endocrine therapy. However, the effect of neoadjuvant endocrine therapy is not clear in the disease. PATIENT CONCERNS: In August 2014, a 28-year-old premenopausal woman noted a mass that was approximately 3.0 cm*2.0 cm in size on her right breast with pain. Subsequently, the mass has been always increasing significantly. In August 2015, the mass was approximately 7.0 cm*5.0 cm in size, accompanied by pain, no nipple retraction and discharge, no orange peel-like skin changes, and no dimples. In addition, she had no salient past history. DIAGNOSES: Histopathological examinations by a biopsy with a thick needle (hollow needle) and surgical resection confirmed poorly differentiated neuroendocrine carcinoma of the right breast. INTERVENTIONS: First and remarkably, she underwent 3 months of neoadjuvant endocrine therapy (goserelin once every 28 days, and letrozole 10 mg every day). Then, she underwent surgery - stage I breast reconstruction by using prosthesis. Adjuvant endocrine therapy has been used since the operation. OUTCOMES: According to response evaluation criteria in solid tumors 1.1, the tumor was shrunk by 78.87% after neoadjuvant endocrine therapy. No salient complications were observed. We have followed her for 48 months, and there are no signs of recurrence and metastasis. LESSONS: Poorly differentiated neuroendocrine carcinoma of the breast is rare and has a poor prognosis. Currently, there is no standard treatment for this disease. Studies show estrogen receptor and progesterone receptor of neuroendocrine carcinoma of the breast are often highly expressed. In the case, it can be observed that estrogen receptor and progesterone receptor are highly expressed. Therefore, neoadjuvant endocrine therapy may be considered in neuroendocrine carcinoma of the breast when the mass is large and the patient refuses neoadjuvant chemotherapy. We hope to provide an attractive evidence for neoadjuvant endocrine therapy of neuroendocrine carcinoma of the breast. However, more cases are still being needed for research.


Asunto(s)
Antineoplásicos Hormonales/administración & dosificación , Inhibidores de la Aromatasa/administración & dosificación , Neoplasias de la Mama/tratamiento farmacológico , Carcinoma Neuroendocrino/tratamiento farmacológico , Goserelina/administración & dosificación , Letrozol/administración & dosificación , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/patología , Carcinoma Neuroendocrino/diagnóstico , Carcinoma Neuroendocrino/patología , Femenino , Humanos , Terapia Neoadyuvante/métodos
15.
Lancet Haematol ; 7(11): e838-e850, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33091357

RESUMEN

The integration of rituximab (R) into cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) by Coiffier and colleagues was the first, and last, successful modification of this backbone regimen, which has endured now for almost 20 years. Countless attempts to redefine R-CHOP for patients with diffuse large B-cell lymphoma (DLBCL) have migrated from a focus on dose-intense and dose-dense regimens, to the use of maintenance therapies, and most recently the addition of novel agents. To date, none have changed the basic formula. Although there are many reasons for the absence of success, the incredible molecular heterogeneity of DLBCL is likely to be a major complicating factor. It is clear that as the scientific field's understanding of the genetic heterogeneity of DLBCL deepens, a precision medicine approach should be accounted for and might be one of several paths that could lead to improved outcomes. The rapid identification of poor prognostic groups within the evolving diverse molecular landscape of DLBCL will create new opportunities to produce the next generation of studies with targeted agents against specific pathological drivers. It is conceivable that targeting these driver pathways will require more than one agent, and of course, splitting the pool of patients with DLBCL into smaller groups on the basis of molecular characteristics, will reduce the number of eligible patients for clinical trial investigation. The integration of immunological agents might afford new opportunities to develop treatments agnostic to the complex molecular diversity, while adding minimal toxicity to the regimen. With each of these iterations, the hope is to ultimately shift away from a one-size-fits-all chemotherapy mentality to one predicated on an individualised approach, whether that be through the use of a targeted small molecule or a biological drug. In this Viewpoint, we explore the history of the collective efforts to improve upon R-CHOP, and underscore those lessons that might help to reshape our future plans.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Rituximab/administración & dosificación , Ensayos Clínicos como Asunto , Ciclofosfamida/uso terapéutico , Doxorrubicina/uso terapéutico , Heterogeneidad Genética , Humanos , Lenalidomida/administración & dosificación , Linfoma de Células B Grandes Difuso/patología , Medicina de Precisión , Prednisona/uso terapéutico , Pronóstico , Vincristina/uso terapéutico
16.
Medicine (Baltimore) ; 99(40): e22488, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019444

RESUMEN

RATIONALE: Some acute myeloid leukemia (AML) patients present with features mimicking the classical hypergranular subtype of acute promyelocytic leukemia (APL) but without the typical promyelocytic leukemia/retinoic acid receptor α (PML/RARα) rearrangement. Herein, we report an AML patient resembling APL but with nucleoporin 98/retinoid acid receptor gamma gene (NUP98/RARG) fusion transcript and Runt-related transcription factor 1 (RUNX1) mutation. PATIENT CONCERNS: An 18-year-old male presented at the hospital with a diagnosis of AML. DIAGNOSES: The patient was diagnosed with bone marrow examination. Bone marrow smear displayed 90.5% promyelocytes. Fluorescence in situ hybridization analysis failed to detect the PML/RARα fusion transcript or RARα amplification. While real-time polymerase chain reaction showed positivity for the NUP98/RARG fusion transcript. G-banding karyotype analysis showed a normal karyotype. INTERVENTIONS: The patient showed resistance to arsenic trioxide and standard 3 + 7 chemotherapy, but eventually achieved complete remission through the Homoharringtonine, Cytarabine, and Aclarubicin chemotherapy. OUTCOMES: These measures resulted in a rapid response and disease control. LESSONS: Acute myeloid leukemia with the NUP98/RARG fusion gene and the RUNX1 mutation may be a special subtype of AML and may benefit from the alkaloid-based regimen.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Leucemia Mieloide Aguda/tratamiento farmacológico , Leucemia Mieloide Aguda/genética , Adolescente , Subunidad alfa 2 del Factor de Unión al Sitio Principal/genética , Diagnóstico Diferencial , Humanos , Leucemia Mieloide Aguda/diagnóstico , Leucemia Promielocítica Aguda/diagnóstico , Masculino , Proteínas de Complejo Poro Nuclear/genética , Receptores de Ácido Retinoico/genética
17.
Medicine (Baltimore) ; 99(44): e22933, 2020 Oct 30.
Artículo en Inglés | MEDLINE | ID: mdl-33126358

RESUMEN

RATIONALE: Increasing evidence has shown that immune checkpoint inhibitors are associated with hyperprogressive disease (HPD). HPD usually resulted in dramatically reduced survival duration, which limited the opportunity to administer other therapies. PATIENT CONCERNS: A heavily pretreated lung adenocarcinoma patient experienced rapid progression of rib metastasis soon after immune checkpoint inhibitor -based combination therapy. DIAGNOSES: On the basis of radiographic and pathological findings, the patient was diagnosed with HPD. INTERVENTIONS: We treated the patient with iodine-125 radioactive particle implantation to the metastatic lesions in the chest wall. OUTCOMES: The metastatic lesions shrank significantly 1 month later. LESSONS: Early detection and adequate treatment are essential for prolonged survival when HPD occurs.


Asunto(s)
Adenocarcinoma del Pulmón/radioterapia , Antineoplásicos Inmunológicos/uso terapéutico , Bevacizumab/uso terapéutico , Inmunoterapia/métodos , Radioisótopos de Yodo/uso terapéutico , Neoplasias Pulmonares/radioterapia , Adenocarcinoma del Pulmón/diagnóstico por imagen , Adenocarcinoma del Pulmón/tratamiento farmacológico , Adenocarcinoma del Pulmón/patología , Antineoplásicos/administración & dosificación , Antineoplásicos/uso terapéutico , Antineoplásicos Inmunológicos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bevacizumab/administración & dosificación , Terapia Combinada , Progresión de la Enfermedad , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X
18.
Medicine (Baltimore) ; 99(43): e22788, 2020 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-33120793

RESUMEN

RATIONALE: The prognosis of patients with aggressive relapsed or refractory (R/R) non-Hodgkin lymphoma (NHL) remains poor. Both immunomodulatory drugs and histone deacetylase inhibitors have demonstrated activity against R/R NHL; yet, the combination of these 2 targeted therapies has rarely been explored. PATIENT CONCERNS: Here, we report 3 cases. Case 1 was a 68-year-old woman who presented to our hospital with dyspnea. Case 2 was a 75-year-old man with massive upper gastrointestinal bleeding. Case 3 was a 62-year-old woman with cough, dyspnea, and lymphadenopathy. DIAGNOSIS: The biopsy results revealed diffuse large B cell lymphoma (DLBCL), DLBCL, and angioimmunoblastic T-cell lymphoma, for Case 1, 2, and 3 respectively. INTERVENTION: All 3 patients experienced relapse after first-line therapy and multiple lines of salvage therapy. Finally, they all received lenalidomide combined with chidamide. OUTCOMES: All 3 patients achieved complete and durable remission. Case 1 relapsed again after 3 months, while the other 2 cases remained in complete remission. LESSONS: To our knowledge, this is the first report of lenalidomide combined with chidamide for the treatment of R/R NHL. Our findings warrant further evaluation of this novel chemo-free therapy in future prospective clinical trials.


Asunto(s)
Aminopiridinas/uso terapéutico , Benzamidas/uso terapéutico , Lenalidomida/uso terapéutico , Linfoma no Hodgkin/tratamiento farmacológico , Anciano , Aminopiridinas/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Benzamidas/administración & dosificación , Femenino , Humanos , Lenalidomida/administración & dosificación , Linfoma de Células B Grandes Difuso/patología , Linfoma no Hodgkin/patología , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Terapia Recuperativa
19.
Medicine (Baltimore) ; 99(43): e22789, 2020 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-33120794

RESUMEN

RATIONALE: The advent of high-resolution genome arrays including array comparative genomic hybridization (aCGH) has enabled the detection of cryptic submicroscopic deletions flanking translocation breakpoints in up to 20% of the apparently "balanced" structural chromosomal rearrangements in hematological disorders. However, reports of submicroscopic deletions flanking the breakpoints of t(3;5)(q25;q35) are rare and the clinical significance of submicroscopic deletions in t(3;5) has not been explicitly identified. PATIENT CONCERNS: We present a 47-year-old man with acute myeloid leukemia. G-banding analysis identified t(3;5)(q25;q35). DIAGNOSIS: Array CGH-based detection initially confirmed only the deletion of chromosome 3. Further characterization using fluorescence in situ hybridization identified a cryptic submicroscopic deletion including 5' MLF1-3' NPM1 flanking the breakpoint on the derivative chromosome 3. INTERVENTIONS: The patient started "7+3" induction chemotherapy with cytosine arabinoside and daunorubicin, and subsequently received 2 cycles of high-dose intermittent acronym of cytosine arabinoside or cytarabine. OUTCOMES: The patient did not undergo complete remission and died from an infection due to neutropenia. LESSONS: Haploinsufficiency of NPM1 or other deleted genes, including SSR3, may be responsible for the phenotype of t(3;5)(q25;q35)-positive myeloid neoplasms with submicroscopic deletions.


Asunto(s)
Leucemia Mieloide Aguda/genética , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bandeo Cromosómico , Hibridación Genómica Comparativa , Humanos , Hibridación Fluorescente in Situ , Leucemia Mieloide Aguda/tratamiento farmacológico , Masculino , Persona de Mediana Edad
20.
Medicine (Baltimore) ; 99(43): e22790, 2020 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-33120795

RESUMEN

INTRODUCTION: Children with acute lymphoblastic leukemia (ALL) are at a risk of developing influenza-related complications. Approximately 10% of influenza-infected children with ALL or other types of cancer need intensive care, and 5% of them eventually die. PATIENTS' CONCERNS: We report 2 children with ALL and the swine-origin influenza A virus infection. Diagnosing influenza in them was a challenge. Medical records of these children were reviewed for demographic, clinical, and laboratory data. Patients were hospitalized in the Department of Pediatric Hematology, Oncology, and Transplantology of the Medical University of Lublin, Poland. Case 1 involved a 2-year-old girl who, according to acute lymphoblastic leukemia intercontinental Berlin-Frankfürt-Münster protocol 2009, started chemotherapy in July 2015. She was categorized in the intermediate risk group and received the induction and consolidation phase of the therapy without severe complications. The reinduction therapy was administered in the outpatient department till the 15 day. On the 20 day of this phase, she was admitted to our department with fever, mucositis, tachypnea, abdominal pain, and diarrhea. In September 2009, a 14-year-old boy (case 2) who, according to acute lymphoblastic leukemia intercontinental Berlin-Frankfürt-Münster protocol 2002, was categorized in the high-risk (HR) group, received the induction (Protocol I) phase of therapy without severe complications. On the 7 day of the HR-1 course, he manifested fever and strong, tiring cough, followed by strong mucositis. Chemotherapy had to be interrupted in both children. DIAGNOSIS: Respiratory viral infections, causing pneumonia, occurred in both patients during anticancer treatment. Initially, the real-time polymerase chain reaction test for the swine-origin influenza A was negative in both patients, which delayed the diagnosis. Additionally, bacterial, and fungal complications were also observed. INTERVENTIONS: Both patients received oseltamivir twice a day, a broad-spectrum antibiotic, antifungal drug, and granulocyte colony growth factor. OUTCOMES: The disease progressed quickly, and our patients subsequently died. CONCLUSION: We speculated that early antiviral treatment can help in the better management of patients in the HR group. It is also important to minimize influenza morbidity and mortality by vaccinating family members, using empiric therapy, providing immediate antiviral therapy, and educating parents about hygiene measures.


Asunto(s)
Gripe Humana/complicaciones , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Antivirales/uso terapéutico , Preescolar , Femenino , Humanos , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/tratamiento farmacológico , Masculino , Oseltamivir/uso terapéutico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Factores de Riesgo
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