Safety of PARP inhibitors as maintenance therapy in ovarian cancer.

INTRODUCTION: Antiangiogenic agents and poly(ADP-ribose) polymerase inhibitors (PARP-Is) have improved the outcome of patients suffering from ovarian cancer. However, as they are associated with many adverse events (AEs), it is important to be aware of their safety and toxicity profiles. AREAS COVERED: We reviewed PARP-I therapeutical indications, mechanism of action, metabolism, and interactions. We reported on all major and minor AEs that have emerged from clinical trials (SOLO1, PRIMA, PAOLA1, ATHENA, SOLO2, NOVA, ARIEL3, NORA), their follow-ups, meta-analyses, and real-world studies, particularly hematologic toxicities and their management, and secondary malignancies (myelodysplastic syndrome and acute myeloid leukemia). We also addressed gastrointestinal, neurological, respiratory, hepatic, and renal toxicity and the use of PARP-Is in older, pregnant, and lactating patients. No specific research strategy in terms of keywords, inclusive dates and databases was used. EXPERT OPINION: PARP-Is benefits largely outweigh the risks associated with potential AEs. Randomized controlled trials produced strong good, quality data, but they enrolled a selected population and failed to capture rare events. More pharmacovigilance data and real-life studies on a larger and more heterogeneous sample are needed to understand PARP-Is differences and to clarify the incidence of late AEs to balance the risk/benefit ratio.

The role of immunotherapy treatment in non-clear cell renal cell carcinoma: An analysis of the literature.

Non-clear cell renal cell carcinoma (nccRCC) is a heterogeneous group representing 15-30% of renal tumors. They are mostly excluded from immunotherapy trials due to their rarity and worse prognosis. This, alongside nccRCC misdiagnosis/misclassification, lack of immune-biomarker expression rate data, lack of homogeneous data reporting, the retrospective nature of many studies, small sample sizes, and the fact that high-grade evidence only stems from trials mostly addressing the clear cell subtype, result in poorly defined treatments. We thus reviewed available data from several clinical trials, retrospective studies, and meta-analyses on immunotherapy responses and their correlation with histological subtypes and prognostic biomarkers. The papillary and unclassified subtypes are the best candidate for immunotherapy, showing response rates up to ∼35%. Chromophobe cancers, on the other end, have mostly null response rates. Cancers with sarcomatoid features respond very well to immunotherapy, regardless of their histology. Available data for translocation, medullary, collecting duct, and other nccRCCs are inconclusive. Regarding PD-L1, its expression correlates with better responses, but its prognostic value remains to be determined due to small sample sizes hindering direct statistical comparisons. It is necessary to involve a larger number of nccRCC patients and centers in clinical trials and report tumor response rates and PD-(L)1 and other markers' expression rates divided by nccRCC subtypes and not just for the whole cohorts. This will allow us to collect more robust data to best identify patients who can benefit from immunotherapy and ultimately define the standard of treatment. AVAILABILITY OF DATA AND MATERIAL: N/A.

Um estudo sobre os transtornos factícios / A study of the factitious disorders

Os transtornos factícios, mais conhecidos como Síndrome de Münchhausen e Síndrome de Münchhausen por procuração caracterizam o indivíduo que motivado a colocar-se no papel de paciente, pode falsificar, induzir ou produzir sintomas de doenças em si-próprio ou no filho. O objetivo deste trabalho visou a compreensão dos aspectos psicológicos que envolvem esse transtorno. A contribuição desse estudo promove a divulgação de uma patologia que muitos profissionais da saúde desconhecem, mas, que toda a equipe hospitalar é passível de se deparar em sua prática profissional. O contexto hospitalar é o grande norteador para esses sujeitos, que idealizam a figura do médico e são atraídos pelo sentimento de cuidado e acolhimento que esse tipo de ambiente proporciona. A pouca produção científica sobre o tema foi uma das dificuldades encontradas nesta revisão de literatura, a qual se baseou em artigos, livros, teses e documentos elaborados por instituições e associações científicas. Assim, a fim de aprofundar a compreensão do que está contido na primeira parte dessa pesquisa (a descrição dos comportamentos expressos) optou-se em uma discussão de dados que correlacionou este transtorno com a personalidade mais freqüentemente encontrada em tais indivíduos, a borderline. Elementos como um falso self patológico, a intensa carência primitiva, as dificuldades nos relacionamentos interpessoais ajudam a oferecer outro olhar para esses pacientes, vistos como trapaçeadores. O tema implica em questões que ultrapassam o campo da Psiquiatria e Psicologia, abrange aspectos econômicos, sociais, penais, até as profundas mudanças culturais de valores humanos. Pode-se dizer que este transtorno não é tão incomum, como se pensa, e que ele reflete em um grau altíssimo de desespero, a solidão, a insegurança e fragilidade dos vínculos humanos, tornando-o hospital, um dos poucos lugares que oferecem um alívio para as dores não só do corpo, mas, neste caso, para as dores

The factitious disorder, better known as syndrome and syndrome by proxy characterize the individual motivated to put themselves in the role of patient, can falsify, induce or produce symptoms of disease itself, himself or his son. This study aimed at understanding the psychological aspects involved in this disorder The contribution of this study promotes the spread of a disease that many health professionals do not know, but that the whole hospital staff is likely to encounter. The hospital setting is the great guiding for these subjects, which idealize the doctor, and are attracted by the sense of care and welcome that kind of environment is a part. A little scientific literature on the subject was one of the difficulties encountered in this literature review, which was based on articles, books, theses, documents prepared by institutions, scientific societies and associations, largely on international territory. So, in order to deepen the understanding of what is contained in the first part of this research, the description of behaviors expressed, it was decided in a discussion of this data that correlated with the personality disorder most often found in such individuals, the borderline. Elements such as a pathological false self, the severe shortage early, difficulty in interpersonal relationships help provide another look at these patients, seen as cheating. The theme involves issues beyond the field of psychiatry and psychology, covering economic, social, criminal, to the profound cultural changes of human values. You could say that this disorder is not as uncommon as you think, and it reflects in a very high degree of despair, loneliness, insecurity and fragility of human bonds, making the hospital one of the few places that offer a for pain relief not only the body but in this case for psychic pain.