Immune checkpoint inhibitors in endometrial cancer.

The incidence of endometrial cancer (EC) is increasing worldwide. The prognosis for patients diagnosed with early-stage remains good, whereas for patients with recurrent or metastatic disease, the prognosis is poor and treatment options, until recently, were limited. In 2017, pembrolizumab was approved by the US Food and Drug Administration (FDA) for those patients with mistmach repair deficiency (MMRd) or high microsatellite instability (MSI-H) tumors. However, only 20-30 % of EC have MSI, and just over half of these patients benefit from treatment. In 2019, the FDA granted breakthrough therapy designation to lenvatinib in combination with pembrolizumab for the potential treatment of patients with advanced microsatellite stable EC that has progressed after treatment with at least one previous systemic therapy. It appears clear that immune check-point inhibitors will have a definite place in the management of EC, both as single agent or in combination with other targeted agents. In this review, we summarize the current evidence of immune check point blockade and the identification of potential biomarkers, beyond MSI-H or MMRd, that could help to predict response to this agents in correlation with the genomic EC subtypes.

MYH polyposis syndrome: clinical findings, genetics issues and management

Colorectal cancer (CRC) is one of the most frequent cancer in first world. Two hereditary CCR syndrome have been described: familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer. A recently described biallelic mutation of MYH, is responsible for adenomatous polyposis with an increased risk of CRC and is responsible for 30-40 % of adenomatous polyposis cases in which an APC mutation cannot be found. However, there is no clear consensus in the literature as whether a monoallelic mutation increases the risk for colorectal cancer. In addition, some authors have indicated that the spectrum of extracolonic lesions in MYH associated polyposis (MAP) might be far different from that observed in FAP and could be more similar to Lynch syndrome spectrum. In this review we are going to describe some general and specific aspects of MAP, including genetic topics, clinical features, different phenotypes and strategies to reduce CCR risk (AU)

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MYH polyposis syndrome: clinical findings, genetics issues and management.

Colorectal cancer (CRC) is one of the most frequent cancer in first world. Two hereditary CCR syndrome have been described: familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer. A recently described biallelic mutation of MYH, is responsible for adenomatous polyposis with an increased risk of CRC and is responsible for 30-40 % of adenomatous polyposis cases in which an APC mutation cannot be found. However, there is no clear consensus in the literature as whether a monoallelic mutation increases the risk for colorectal cancer. In addition, some authors have indicated that the spectrum of extracolonic lesions in MYH associated polyposis (MAP) might be far different from that observed in FAP and could be more similar to Lynch syndrome spectrum. In this review we are going to describe some general and specific aspects of MAP, including genetic topics, clinical features, different phenotypes and strategies to reduce CCR risk.

SEOM Clinical guidelines for the treatment of advanced colorectal cancer 2013

Colorectal cancer (CRC) is the most common malignant tumor in Western countries. Despite efforts made to implement screening programmes for early detection and treatment, still half of the patients present or will eventually develop distant metastasis. Management of advanced CRC should be discussed within an experienced multidisciplinary team, to adequately select the most appropriate systemic therapeutic option, as well as the optimal way to integrate it with surgical procedures when indicated. Disease localization and extent, resectability of primary and metastatic disease, tumor biology and dynamics, clinical symptoms, personal preferences and patient's ability to tolerate intensive chemotherapy or extensive surgical procedures are the key factors to properly design a customized treatment plan. The aim of the current manuscript is to provide synthetic practical guidelines regarding therapeutic options for advanced CRC (AU)

SEOM clinical guidelines for the treatment of advanced colorectal cancer 2013.

Colorectal cancer (CRC) is the most common malignant tumor in Western countries. Despite efforts made to implement screening programmes for early detection and treatment, still half of the patients present or will eventually develop distant metastasis. Management of advanced CRC should be discussed within an experienced multidisciplinary team, to adequately select the most appropriate systemic therapeutic option, as well as the optimal way to integrate it with surgical procedures when indicated. Disease localization and extent, resectability of primary and metastatic disease, tumor biology and dynamics, clinical symptoms, personal preferences and patient's ability to tolerate intensive chemotherapy or extensive surgical procedures are the key factors to properly design a customized treatment plan. The aim of the current manuscript is to provide synthetic practical guidelines regarding therapeutic options for advanced CRC.

SEOM clinical guidelines for the treatment of advanced colorectal cancer

Colorectal cancer is the first cause of cancer diagnosis in Spain. Over half of the patients are diagnosed with or will eventually develop distant metastasis. The current manuscript aims to provide synthetic practical guidelines for the therapeutic approaches in advanced disease. Available systemic therapeutic options, and integration and sequencing of chemotherapy with surgical procedures are discussed. Extent of disease, treatment objective, tumor kras mutation status, as well as patient's functional and comorbid conditions shall be considered to properly design the most adequate therapeutic strategy (AU)

Chemotherapy-induced peripheral neuropathy: clinical features, diagnosis, prevention and treatment strategies

Chemotherapy-induced peripheral neuropathy (CIN) is a common toxicity of anticancer treatment and its incidence is growing. It significantly affects quality of life and is a dose-limiting factor that interferes with treatment. Its diagnosis can be established in clinical terms but some complementary tests can help when the diagnosis is difficult. There is still no proven method to prevent it that has become a standard of care in spite of the huge amount of investigation carried out in recent years. There are promising strategies that could help reduce the burden of this complication. This review will suggest an approach to the diagnosis of these disorders and provide an update on new therapies (AU)

Idiopathic and recurrent thromboembolic phenomena in cancer patients

BACKGROUND: Venous thromboembolism (VTE) is one of the most common complications in cancer patients. It is not only associated with both reduced survival and a high number of recurrences, but an idiopathic VTE also increases the likelihood of a cancer diagnosis. METHODS: Between January 2000 and October 2005 we reviewed the medical history of 88 patients who were admitted to a tertiary hospital and presented both a diagnosis of VTE and any type of tumour. The information collected included the type of tumour, the temporal association between tumour diagnosis and VTE, anticoagulation treatment applied and percentage of recurrences. RESULTS: Ten patients (11.4%) presented the VTE prior to the cancer diagnosis; only half of them underwent a posterior tumour screening routine. Fifteen patients (17%) were diagnosed simultaneously and 71% presented the VTE after the tumour was detected. In 47 patients (53.4%) no risk factors for VTEs were detected. Twenty-nine patients (31.7%) presented a recurrent VTE, mainly during chemotherapy treatment (66%). Less than half of the patients (47.57%) were receiving treatment with low-molecular- weight heparins (LMWH). CONCLUSIONS: Idiopathic VTEs may be the first manifestation of an occult neoplasia, but tumour screening is scheduled in only a few patients. Regarding the high incidence of recurrent VTE in cancer populations, a high percentage is attributed to the underuse of LMWH, whose efficacy in preventing recurrent phenomena is superior to oral dicumarinics (AU)

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EGFR and colon cancer: a clinical view.

Signalling pathways that emerge from EGFR activation are critical in colon cancer (CC) biology. Its targeting with specific drugs has opened a new window in the treatment of this disease. In this regard, monoclonal antibodies (mAb) have evidenced a high degree of efficiency opposed to the uselessness of tyrosine-kinase inhibitors. Cetuximab is the mAb that has evidenced most activity in CC. After its initial approval as an irinotecan-resistance reversal agent, cetuximab has demonstrated its efficiency from the first line to heavily pretreated patients. In the first line, its addition may increase response rate to chemotherapy, improving liver metastases resection rate. Another promising approach has been suggested from combination schedules with bevacizumab. Panitumumab has been recently approved for CC. Although there is limited clinical experience, the latest data have confirmed its activity in heavily pretreated patients resulting in a clinical benefit vs. best support care. In spite of the clinical benefits, adverse events and the high sanitary cost derived from these drugs force the selection of patients with the highest probability of benefit. At the moment, when EGFR expression evidenced by immunohistochemistry has no value, skin toxicity and, fundamentally, K-Ras mutations may hint at critical information for confirmatory prospective studies.

EGFR and colon cancer: a clinical view

Signalling pathways that emerge from EGFR activation are critical in colon cancer (CC) biology. Its targeting with specific drugs has opened a new window in the treatment of this disease. In this regard, monoclonal antibodies (mAb) have evidenced a high degree of efficiency opposed to the uselessness of tyrosine-kinase inhibitors. Cetuximab is the mAb that has evidenced most activity in CC. After its initial approval as an irinotecan-resistance reversal agent, cetuximab has demonstrated its efficiency from the first line to heavily pretreated patients. In the first line, its addition may increase response rate to chemotherapy, improving liver metastases resection rate. Another promising approach has been suggested from combination schedules with bevacizumab. Panitumumab has been recently approved for CC. Although there is limited clinical experience, the latest data have confirmed its activity in heavily pretreated patients resulting in a clinical benefit vs. best support care. In spite of the clinical benefits, adverse events and the high sanitary cost derived from these drugs force the selection of patients with the highest probability of benefit. At the moment, when EGFR expression evidenced by immunohistochemistry has no value, skin toxicity and, fundamentally, K-Ras mutations may hint at critical information for confirmatory prospective studies (AU)

New screening method for lung cancer by detecting volatile organic compounds in breath.

Lung cancer is a frequent cause of cancer-related deaths in the world. There is no valid screening process and this limits its detection to the late stages, with consequently high mortality rates. Volatile organic compounds (VOC) are chemical compounds (mainly the products of cell catabolism) found as gases in the human breath. Different methods have been developed to analyse VOCs and to compare them in healthy subjects and lung cancer patients. In this review, we summarise the different techniques used to analyse VOC. Many reports have been published with promising results similar to those achieved with accepted screening methods such as mammography. These methods show good perspectives on lung cancer screening.

New screening method for lung cancer by detecting volatile organic compounds in breath

Lung cancer is a frequent cause of cancer-related deaths in the world. There is no valid screening process and this limits its detection to the late stages, with consequently high mortality rates. Volatile organic compounds (VOC) are chemical compounds (mainly the products of cell catabolism) found as gases in the human breath. Different methods have been developed to analyse VOCs and to compare them in healthy subjects and lung cancer patients. In this review, we summarise the different techniques used to analyse VOC. Many reports have been published with promising results similar to those achieved with accepted screening methods such as mammography. These methods show good perspectives on lung cancer screening (AU)

Molecular biology of malignant gliomas

Gliomas are the most common primary brain tumours. In keeping with the degree of aggressiveness, gliomas are divided into four grades, with different biological behaviour. Furthermore, as different gliomas share a predominant histological appearance, the final classification includes both, histological features and degree of malignancy. For example, gliomas of astrocytic origin (astrocytomas) are classified into pilocytic astrocytoma (grade I), astrocytoma (grade II), anaplastic astrocytoma (grade III) and glioblastoma multiforme (GMB) (grade IV). Tumors derived from oligodendrocytes include grade II (oliogodendrogliomas) and grade III neoplasms (oligoastrocytoma). Each subtype has a specific prognosis that dictates the clinical management. In this regard, a patient diagnosed with an oligodendroglioma totally removed has 10-15 years of potential survival. On the opposite site, patients carrying a glioblastoma multiforme usually die within the first year after the diagnosis is made. Therefore, different approaches are needed in each case. Obviously, prognosis and biological behaviour of malignant gliomas are closely related and supported by the different molecular background that possesses each type of glioma. Furthermore, the ability that allows several low-grade gliomas to progress into more aggressive tumors has allowed cancer researchers to elucidate several pathways implicated in molecular biology of these devastating tumors. In this review, we describe classical pathways involved in human malignant gliomas with special focus with recent advances, such as glioma stem-like cells and expression patterns from microarray studies (AU)

Radioquimioterapia preoperatoria frente a postoperatoria en el carcinoma de recto estadios II-III: estudio comparativo no aleatorizado / Preoperative versus postoperative radiochemotherapy in stages II and III rectal carcinoma: a non-randomized comparative study

Propósito: comparar la eficacia, toxicidad y tasa de complicaciones quirúrgicas del tratamiento adyuvante frente al tratamiento neoadyuvante en el carcinoma de recto.• Material y métodos: 111 pacientes con carcinoma de recto estadios II-III recibieron tratamiento complementario con radioterapia (RT) y quimioterapia (QT). La QT consistió en leucovorin (500 mg/m2) intravenoso el primer día, seguido de lencovorin oral 15 mg/12 horas entre los días 2 y 14 del ciclo, y UFT 390 mg/m2/día entre los días 1 y 14 (350 mg/m2 durante la RT) . En 32 enfermos el tratamiento se realizó de forma neoadyuvante (grupo N), mientras que en los 79 restantes se administró tras la cirugía (grupo A).• Resultados: no hubo diferencias significativas en la supervivencia libre de enfermedad (72 por ciento en el grupo A y 69 por ciento en el grupo N) ni en la supervivencia global a los 3 años (91 por ciento en el grupo A y 95 por ciento en el grupo N). La tasa de complicaciones mayores tras la cirugía fue similar en ambos grupos. La tasa de diarrea grado 3-4 fue del 43 por ciento en los primeros 14 pacientes del grupo N (que recibieron UFT 350 mg/m2), mientras que en el grupo A fue del 18 por ciento (Fisher, p=0.07). En los restantes 18 pacientes del grupo N la dosis de UFT fue reducida a 300 mg/m2. La tasa de cirugía conservadora de esfínter en los tumores situados en los 10 cm últimos del recto fue superior en el grupo N (53 por ciento vs 38 por ciento, p=n.s.).• Conclusiones: el tratamiento neoadyuvante en el cáncer de recto no presenta diferencias significativas con el tratamiento adyuvante en cuanto a tasa de complicaciones quirúrgicas, tasa de recaídas y supervivencia, pero sí aumenta la toxicidad gastrointestinal. (AU)

[Superior vena cava syndrome: presentation of six cases]. / Síndrome de vena cava superior: presentación de seis casos.

Superior vena cava syndrome is a devastating complication of obstructive lesions compromising the superior vena cava an its branches. Most cases today are caused by malignant tumors. The most frequent are lung carcinoma. The clinical presentation is dyspnea, vuvular enlargement, collateral circulation. Imaging techniques and histological confirmation are used for diagnosis. Early diagnosis and treatment is needed. The following report deals with six patients with superior vena cava syndrome. All entered our hospital through Emergency Department. The description of the principal symptoms and sings, the early diagnosis and the treatment.

Síndrome de vena cava superior: presentación de seis casos / Superior vena cava syndrome: presentation of six cases

El síndrome de vena cava superior (SVCS), es el conjunto de síntomas y signos derivados de la obstrucción parcial o completa de la vena cava superior. Su diagnóstico precoz, es fundamental para un tratamiento eficaz. Las enfermedades malignas son la causa principal, siendo la más frecuente el cáncer de pulmón. La clínica se caracteriza por la disnea y la triada clásica de edema en esclavina, cianosis facial y circulación colateral tóraco-braquial. En el diagnóstico se utilizan técnicas de imagen, siendo preciso para su confirmación, un diagnóstico histológico. El tratamiento ha de ser lo más precoz posible.En el presente trabajo se describen los casos de seis pacientes con SVCS, que ingresaron desde el Servicio de Urgencias de nuestro hospital.Se repasan los principales síntomas y signos, los métodos diagnósticos y el tratamiento empleado, haciendo especial mención a la precocidad en su detención. (AU)

Carboplatino -Tegafur- Leucovorin en el tratamiento del cáncer de mama avanzado / Carboplatin-Tegafur-Leucovorin in the treatment of advanced breast cancer

Propósito: Valorar la eficacia y seguridad del esquema Carboplatino -Tegafur- Leucovorín como tratamiento quimioterápico en el cáncer de mama avanzado. Material y métodos: Entre 1992-97 fueron tratadas con este régimen 19 pacientes (entre 34 y 76 años) con metástasis en distintas localizaciones y que habían recibido ya una o más líneas previas de quimioterapia. Resultados: Se administraron entre 1 y 12 ciclos por paciente. Las principal toxicidad fue: neutropenio, anemia y trombopenia y naúseas y vómitos. No ocurrieron muertes tóxicas. Hubo 1 remisión completa y 4 remisiones parciales. ConcIusiones: El régimen Carboplatino -Tegafur- Leucovorín es moderadamente eficaz como tratamiento de segunda o tercera línea en el cáncer de mama avanzado. La toxicidad, fundamentalmente hematológica, no es demasiado elevada por lo que puede ser una opción más de tratamiento en esos casos (AU)