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1.
Artigo em Inglês | MEDLINE | ID: mdl-31918305

RESUMO

A simple, sensitive HPLC-MS/MS method was developed and validated for the determination of lidocaine in skin and plasma of rats. The methods were established and validated assessing lower limit of quantitation (LLOQ), linearity, intra and inter-day precision and accuracy, selectivity, recovery and matrix effect. Chromatography was done on a Gemini column embedded with C18 stationary phase (50 mm × 2.0 mm, 5 µm particle size), using a gradient with mobile phases consisting of 0.1% HCOOH in bidistilled water and 0.1% HCOOH in acetonitrile. The mass spectrometer worked with electrospray ionization in positive ion mode and selected reaction monitoring, using target ions m/z 235.10 for lidocaine and m/z 245.10 for lidocaine-d10, used as internal standard. RESULTS: The linearity of the method was in the ranges of lidocaine concentrations 10.0-200.0 ng/mL for skin homogenate (accuracy 94.1-105.5%; R2 ≥ 0.998) and 0.025-2 ng/mL for plasma (accuracy 96.2-104.8%; R2 ≥ 0.996). The intra- and inter-day precision and accuracy determined on three quality control samples (20, 75 and 170 ng/mL for skin and 0.075, 0.4 and 1.5 ng/mL for plasma) were ≤4.2% and 103.8-108.2% for skin and ≤12.4% and 95.5-101.4% for plasma. The LLOQ was 10 ng/mL in skin homogenate and 0.025 ng/mL in plasma. The applicability of the method was demonstrated by measuring lidocaine in skin and plasma after exposure to medicated patches containing 5% lidocaine.


Assuntos
Cromatografia Líquida de Alta Pressão/métodos , Lidocaína/análise , Espectrometria de Massas em Tandem/métodos , Adesivo Transdérmico , Animais , Estabilidade de Medicamentos , Lidocaína/administração & dosagem , Lidocaína/farmacocinética , Limite de Detecção , Modelos Lineares , Masculino , Ratos , Reprodutibilidade dos Testes , Pele/química
2.
Eur J Cancer ; 76: 84-92, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28284173

RESUMO

BACKGROUND: Preclinical models that mimic pathological and molecular features of solitary fibrous tumour (SFT) represent an important tool to select effective regimes and novel compounds to be tested in the clinic. This study was aimed at developing two preclinical models of SFT, assessing their predictive value in the clinic and selecting potential novel effective treatments. MATERIAL AND METHODS: Two dedifferentiated-SFT (D-SFT) models obtained from patients' biopsies were grown in immunodeficient mice. The antitumour activity on these models of doxorubicin, dacarbazine (DTIC), ifosfamide (monotherapy or combination), trabectedin and eribulin was tested. Twelve SFT patients were treated with doxorubicin and DTIC. Response by RECIST, progression-free survival and overall survival were retrospectively evaluated, distinguishing malignant-SFT (M-SFT) and D-SFT. RESULTS: Two D-SFT patient-derived xenografts (PDXs) that represent the first available preclinical in vivo models of SFT were developed and characterised. Doxorubicin/DTIC, DTIC/ifosfamide, doxorubicin/ifosfamide combinations consistently induced better antitumour activity than the single-agents. Particularly, doxorubicin/DTIC combination caused a max tumour volume inhibition >80% in both models. Doxorubicin/DTIC combo showed activity also in the case-series. Best RECIST responses were: 6 responses (M-SFT = 2 of 7, D-SFT = 4 of 5), 1 stable disease, 5 progressions, with a 6-month median progression-free survival (M-SFT = 6, D-SFT = 10 months). The PDXs were very sensitive to trabectedin and eribulin. CONCLUSION: Doxorubicin plus DTIC combination was effective in our two D-SFT mice models and appeared to be active also in the clinic, especially in high-grade D-SFT patients. Among additional drugs tested in the PDXs, trabectedin and eribulin were highly effective, providing a rational to test these drugs in D-SFT patients.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Cerebelares/tratamento farmacológico , Neoplasias Renais/tratamento farmacológico , Neoplasias Meníngeas/tratamento farmacológico , Neoplasias Pleurais/tratamento farmacológico , Neoplasias Retroperitoneais/tratamento farmacológico , Neoplasias de Tecidos Moles/tratamento farmacológico , Tumores Fibrosos Solitários/tratamento farmacológico , Adulto , Idoso , Animais , Western Blotting , Neoplasias Cerebelares/mortalidade , Dacarbazina/administração & dosagem , Dioxóis/administração & dosagem , Intervalo Livre de Doença , Doxorrubicina/administração & dosagem , Feminino , Furanos/administração & dosagem , Humanos , Ifosfamida/administração & dosagem , Cetonas/administração & dosagem , Neoplasias Renais/mortalidade , Masculino , Neoplasias Meníngeas/mortalidade , Camundongos SCID , Pessoa de Meia-Idade , Neoplasias Pleurais/mortalidade , Critérios de Avaliação de Resposta em Tumores Sólidos , Neoplasias Retroperitoneais/mortalidade , Estudos Retrospectivos , Neoplasias de Tecidos Moles/mortalidade , Tumores Fibrosos Solitários/mortalidade , Taxa de Sobrevida , Tetra-Hidroisoquinolinas/administração & dosagem , Trabectedina , Ensaios Antitumorais Modelo de Xenoenxerto
3.
Sci Rep ; 6: 37027, 2016 11 14.
Artigo em Inglês | MEDLINE | ID: mdl-27841316

RESUMO

Mass Spectrometry Imaging (MSI) is a widespread technique used to qualitatively describe in two dimensions the distribution of endogenous or exogenous compounds within tissue sections. Absolute quantification of drugs using MSI is a recent challenge that just in the last years has started to be addressed. Starting from a two dimensional MSI protocol, we developed a three-dimensional pipeline to study drug penetration in tumors and to develop a new drug quantification method by MALDI MSI. Paclitaxel distribution and concentration in different tumors were measured in a 3D model of Malignant Pleural Mesothelioma (MPM), which is known to be a very heterogeneous neoplasm, highly resistant to different drugs. The 3D computational reconstruction allows an accurate description of tumor PTX penetration, adding information about the heterogeneity of tumor drug distribution due to the complex microenvironment. The use of an internal standard, homogenously sprayed on tissue slices, ensures quantitative results that are similar to those obtained using HPLC. The 3D model gives important information about the drug concentration in different tumor sub-volumes and shows that the great part of each tumor is not reached by the drug, suggesting the concept of pseudo-resistance as a further explanation for ineffective therapies and tumors relapse.


Assuntos
Antineoplásicos Fitogênicos/análise , Neoplasias/diagnóstico por imagem , Paclitaxel/análise , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Animais , Antineoplásicos Fitogênicos/metabolismo , Antineoplásicos Fitogênicos/uso terapêutico , Linhagem Celular Tumoral , Cromatografia Líquida de Alta Pressão , Feminino , Humanos , Imageamento Tridimensional , Mesotelioma/química , Mesotelioma/diagnóstico por imagem , Mesotelioma/tratamento farmacológico , Mesotelioma/patologia , Nanopartículas Metálicas/química , Camundongos , Camundongos Nus , Neoplasias/química , Neoplasias/tratamento farmacológico , Neoplasias/patologia , Paclitaxel/metabolismo , Paclitaxel/uso terapêutico , Titânio/química , Transplante Heterólogo
4.
Br J Cancer ; 113(12): 1687-93, 2015 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-26633559

RESUMO

BACKGROUND: In order to investigate the mechanisms of acquired resistance to trabectedin, trabectedin-resistant human myxoid liposarcoma (402-91/T) and ovarian carcinoma (A2780/T) cell lines were derived and characterised in vitro and in vivo. METHODS: Resistant cell lines were obtained by repeated exposures to trabectedin. Characterisation was performed by evaluating drug sensitivity, cell cycle perturbations, DNA damage and DNA repair protein expression. In vivo experiments were performed on A2780 and A2780/T xenografts. RESULTS: 402-91/T and A2780/T cells were six-fold resistant to trabectedin compared with parental cells. Resistant cells were found to be hypersensitive to UV light and did not express specific proteins involved in the nucleotide excision repair (NER) pathway: XPF and ERCC1 in 402-91/T and XPG in A2780/T. NER deficiency in trabectedin-resistant cells was associated with the absence of a G2/M arrest induced by trabectedin and with enhanced sensitivity (two-fold) to platinum drugs. In A2780/T, this collateral sensitivity, confirmed in vivo, was associated with an increased formation of DNA interstrand crosslinks. CONCLUSIONS: Our finding that resistance to trabectedin is associated with the loss of NER function, with a consequent increased sensitivity to platinum drugs, provides the rational for sequential use of these drugs in patients who have acquired resistance to trabectedin.


Assuntos
Antineoplásicos/farmacologia , Dioxóis/farmacologia , Compostos Organoplatínicos/farmacologia , Tetra-Hidroisoquinolinas/farmacologia , Animais , Ciclo Celular/efeitos dos fármacos , Linhagem Celular Tumoral , Dano ao DNA , Resistencia a Medicamentos Antineoplásicos , Feminino , Histonas/metabolismo , Humanos , Camundongos , Camundongos Nus , Trabectedina , Ensaios Antitumorais Modelo de Xenoenxerto
5.
Nanotechnology ; 25(33): 335706, 2014 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-25074670

RESUMO

One of the major drawbacks that limits the clinical application of nanoparticles is the lack of preliminary investigations related to their biocompatibility, biodegradability and biodistribution. In this work, biodegradable PEGylated polymer nanoparticles (NPs) have been synthesized by using macromonomers based on poly(ε-caprolaconte) oligomers. More in detail, NPs have been produced by adopting a surfactant-free semibatch emulsion polymerization process using PEG chains as a stabilizing agent. The NPs were also labeled with rhodamine B covalently bound to the NPs to quantitatively study their biodistribution in vivo. NPs were investigated in both in vitro and in vivo preclinical systems to study their biodistribution in mice bearing B16/F10 melanoma, as well as their biocompatibility and biodegradability. The NP concentration was evaluated in different tissues at several times after intravenous injection. The disappearance of the NPs from the plasma was biphasic, with distribution and elimination half-lives of 30 min and 15 h, respectively. NPs were retained in tumors and in filter organs for a long time, were still detectable after 7 d and maintained a steady concentration in the tumor for 120 h. 48 h after injection, 70 ± 15% of the inoculated NPs were excreted in the feces. The favorable tumor uptake, fast excretion and absence of cytotoxicity foster the further development of produced NPs as drug delivery carriers.


Assuntos
Sistemas de Liberação de Medicamentos , Nanopartículas/química , Polietilenoglicóis/química , Polietilenoglicóis/farmacocinética , Animais , Linhagem Celular Tumoral , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Feminino , Melanoma Experimental , Camundongos , Camundongos Endogâmicos C57BL , Tamanho da Partícula , Polímeros , Rodaminas/química , Rodaminas/farmacocinética , Distribuição Tecidual
6.
Oncogene ; 33(44): 5201-10, 2014 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-24213580

RESUMO

To elucidate the mechanisms behind the high sensitivity of myxoid/round cell liposarcoma (MRCL) to trabectedin and the suggested selectivity for specific subtypes, we have developed and characterized three MRCL xenografts, namely ML017, ML015 and ML004 differing for the break point of the fusion gene FUS-CHOP, respectively of type I, II and III. FUS-CHOP binding to the promoters of some target genes such as Pentraxin 3 or Fibronectin 1, assessed by chromatin immunoprecipitation, was strongly reduced in the tumor 24 h after the first or the third weekly dose of trabectedin, indicating that the drug at therapeutic doses causes a detachment of the FUS-CHOP chimera from its target promoters as previously shown in vitro. Moreover, the higher sensitivity of MRCL types I and II appears to be related to a more prolonged block of the transactivating activity of the fusion protein. Doxorubicin did not affect the binding of FUS-CHOP to target promoters. Histologically, the response to trabectedin in ML017 and ML015 was associated with a marked depletion of non-lipogenic tumoral cells and vascular component, as well as lipidic maturation as confirmed by PPARγ2 expression in western Blot. By contrast, in ML004 no major changes either in the cellularity or in the amount of mature were found, and consistently PPARγ2 was null. In conclusion, the data support the view that the selective mechanism of action of trabectedin in MRCL is specific and related to its ability to cause a functional inactivation of the oncogenic chimera with consequent derepression of the adypocytic differentiation.


Assuntos
Antineoplásicos Alquilantes/farmacologia , Dioxóis/farmacologia , Lipossarcoma Mixoide/tratamento farmacológico , Proteínas de Fusão Oncogênica/genética , Proteína FUS de Ligação a RNA/genética , Tetra-Hidroisoquinolinas/farmacologia , Fator de Transcrição CHOP/genética , Adulto , Animais , Biópsia , Diferenciação Celular/efeitos dos fármacos , Diferenciação Celular/genética , Doxorrubicina/farmacologia , Feminino , Humanos , Lipossarcoma Mixoide/genética , Camundongos Nus , Proteínas de Fusão Oncogênica/metabolismo , Proteína FUS de Ligação a RNA/metabolismo , Trabectedina , Fator de Transcrição CHOP/metabolismo , Ensaios Antitumorais Modelo de Xenoenxerto
7.
Br J Cancer ; 97(7): 888-94, 2007 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-17848949

RESUMO

The clinical success of small-molecule vascular disrupting agents (VDAs) depends on their combination with conventional therapies. Scheduling and sequencing remain key issues in the design of VDA-chemotherapy combination treatments. This study examined the antitumour activity of ZD6126, a microtubule destabilising VDA, in combination with paclitaxel (PTX), a microtubule-stabilising cytotoxic drug, and the influence of schedule and sequence on the efficacy of the combination. Nude mice bearing MDA-MB-435 xenografts received weekly cycles of ZD6126 (200 mg kg(-1) i.p.) administered at different times before or after PTX (10, 20, and 40 mg kg(-1) i.v.). ZD6126 given 2 or 24 h after PTX showed no significant benefit, a result that was attributed to a protective effect of PTX against ZD6126-induced vascular damage and tumour necrosis, a hallmark of VDA activity. Paclitaxel counteracting activity was reduced by distancing drug administrations, and ZD6126 given 72 h after PTX potentiated the VDA's antitumour activity. Schedules with ZD6126 given before PTX improved therapeutic activity, which was paralleled by a VDA-induced increase in cell proliferation in the viable tumour tissue. Paclitaxel given 72 h after ZD6126 yielded the best response (50% tumours regressing). A single treatment with ZD6126 followed by weekly administration of PTX was sufficient to achieve a similar response (57% remissions). These findings show that schedule, sequence and timing are crucial in determining the antitumour efficacy of PTX in combination with ZD6126. Induction of tumour necrosis and increased proliferation in the remaining viable tumour tissue could be exploited as readouts to optimise schedules and maximise therapeutic efficacy.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Antineoplásicos Fitogênicos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Compostos Organofosforados/uso terapêutico , Paclitaxel/uso terapêutico , Animais , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Sinergismo Farmacológico , Quimioterapia Combinada , Feminino , Humanos , Camundongos , Camundongos Nus , Mitose/efeitos dos fármacos , Necrose , Neovascularização Patológica , Taxa de Sobrevida , Resultado do Tratamento , Ensaios Antitumorais Modelo de Xenoenxerto
8.
Drug Metab Dispos ; 34(12): 2028-35, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16963486

RESUMO

IDN 5390 (13-(N-Boc-3-i-butylisoserinoyl)-C-7,8-seco-10-deacetylbaccatin III) is a new taxane, derived from 7,8-C-seco-10-deacetylbaccatin, selected for its ability to inhibit angiogenesis, mainly by acting on endothelial cell motility, and for its selective activity on class III beta-tubulin. In vivo, IDN 5390 shows activity against paclitaxel-sensitive and -resistant tumors when administered on a prolonged, continuous dosage schedule. We studied the pharmacokinetics and bioavailabilty of the drug in mice after single and repeated oral treatment. IDN 5390 was rapidly absorbed after oral administration, with good bioavailability (43%). After intravenous injection, it was extensively distributed in tissue, mainly the liver, kidney, and heart, with low but persistent levels in brain. The kinetics appear dose-dependent with a clearance of 2.6, 1.4, and 0.9 l/kg at, respectively, 60, 90, and 120 mg/kg, and a half-life 24, 36, and 54 min. After prolonged daily oral doses given for 2 weeks, we found that there was a decrease in drug availability; i.e., the area under the concentration-time curve value after p.o. daily administration on day 14 was 2-fold lower than that on day 1. Metabolism plays a major role in elimination of the drug, and at least 12 metabolites were identified in feces and urine. The percentage excreted as metabolites after an oral dose (42%) was higher than that after the i.v. dose (33%), suggesting a first-pass effect. Four metabolites were found in plasma at detectable levels; one of them, with restored taxane scaffold, is a species 3 times more potent than IDN 5390, possibly contributing to the observed anti-tumor activity.


Assuntos
Inibidores da Angiogênese/farmacologia , Inibidores da Angiogênese/farmacocinética , Hidrocarbonetos Aromáticos com Pontes/farmacologia , Hidrocarbonetos Aromáticos com Pontes/farmacocinética , Animais , Antineoplásicos Fitogênicos , Disponibilidade Biológica , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Resistencia a Medicamentos Antineoplásicos , Fezes/química , Feminino , Camundongos , Camundongos Endogâmicos , Microssomos Hepáticos/metabolismo , Paclitaxel , Taxoides/farmacocinética , Taxoides/farmacologia , Distribuição Tecidual
9.
Artigo em Inglês | MEDLINE | ID: mdl-14552822

RESUMO

An isocratic high-performance liquid chromatography (HPLC) method was developed and validated to determine Aloe Emodin (AE) in mouse plasma. The analysis required 0.3 ml of plasma and involves extraction with dichloromethane. The HPLC separation was carried out on Symmetry Shield RP18, a mobile phase of methanol-water-acetic acid (65:35:0.2) and fluorescence detection at lambda(ex)=410 nm and lambda(em)=510 nm. The retention time of AE was 11.7 min. The assay was linear from 10 to 1,000 ng/ml (r2 > or = 0.999), showed intra- and inter-day precision within 7.8 and 4.7%, and accuracy of 87.3-105.7%. Detection limit (LOD) and quantification limit (LOQ) were 4.5 and 5 ng/ml, respectively. The method was applied to determine for the first time the pharmacokinetic of AE in mice.


Assuntos
Cromatografia Líquida de Alta Pressão/métodos , Emodina/sangue , Animais , Antraquinonas , Camundongos , Padrões de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
10.
Br J Cancer ; 88(6): 965-72, 2003 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-12644838

RESUMO

The recognition of the antiangiogenic properties of taxanes provides a basis for novel therapeutic approaches. A prolonged exposure to low drug concentrations has been proposed to be the most suitable approach to exploit the antiangiogenic potential of cytotoxic agents. Such schedule is required to target preferentially slowly dividing endothelial cells. The protracted use of taxanes could benefit from the availability of a taxane endowed with a favourable tolerability profile. Among compounds of a novel series of C-seco taxanes, IDN 5390 was originally selected on the basis of its potent antimotility activity and poor cytotoxicity on endothelial cells. The aim of the study was to investigate the preclinical pharmacologic profile of IDN 5390 in a variety of human tumour xenografts, including ovarian and colon carcinoma and a glioblastoma. IDN 5390, delivered by s.c. injection, daily for 5 days per week, exhibited a high activity against all tumours investigated (tumour growth inhibition was always >85%) in the range of well-tolerated doses. The maximum tolerated dose/injection (MTD), with no signs of systemic or local vesicant toxicity, was 120 mg kg(-1). In contrast, paclitaxel, delivered according to the same schedule, exhibited a variable antitumour efficacy associated with a substantial local toxicity (MTD=10 mg kg(-1)). Considering the remarkable efficacy of IDN 5390 delivered s.c. by protracted treatment schedule, the oral route of administration was further investigated, as the most suitable for daily treatment. Indeed, a good bioavailability of oral IDN 5390 was found. Oral IDN 5390 maintained a substantial efficacy against human tumour xenografts, including paclitaxel-resistant tumours, without loss of potency with respect to s.c. administration. In conclusion, the therapeutic advantages of IDN 5390, over paclitaxel, in protracted daily treatment schedules are represented by the oral efficacy and the high tolerability, which are favourable features to exploit the antiangiogenic potential and to design combinations with other effective agents.


Assuntos
Neoplasias Encefálicas/tratamento farmacológico , Hidrocarbonetos Aromáticos com Pontes/administração & dosagem , Hidrocarbonetos Aromáticos com Pontes/farmacologia , Carcinoma/tratamento farmacológico , Neoplasias do Colo/tratamento farmacológico , Glioblastoma/tratamento farmacológico , Neoplasias Ovarianas/tratamento farmacológico , Paclitaxel/análogos & derivados , Paclitaxel/administração & dosagem , Paclitaxel/farmacologia , Administração Oral , Animais , Esquema de Medicação , Feminino , Humanos , Injeções Subcutâneas , Camundongos , Camundongos Nus , Neoplasias Experimentais , Taxoides , Transplante Heterólogo
11.
Artigo em Inglês | MEDLINE | ID: mdl-12383484

RESUMO

A HPLC assay was developed to determine IDN 5390, a new paclitaxel analogue, in mouse plasma. The method involves solid-phase extraction from cyano cartridges (recovery >80%), HPLC separation on Symmetry C(18) (4.6 x 150 mm), on isocratic mobile phase of water-acetonitrile-acetic acid (49:50:1) and detection at 227 nm. Retention times of IDN 5390 and IDN 5517 (internal standard, I.S.) were 9.1 and 10.5 min, respectively. The assay was linear from 0.05 to 5 micro g/ml (r(2)>or=0.995), showed intra- and inter-day precision within 1.0 and 6.2%, and accuracy of 94.7-106.8%. LOQ was 0.050 micro g/ml. Using this method IDN 5390 pharmacokinetics was determined in mice.


Assuntos
Hidrocarbonetos Aromáticos com Pontes/sangue , Cromatografia Líquida de Alta Pressão/métodos , Paclitaxel/análogos & derivados , Paclitaxel/sangue , Animais , Hidrocarbonetos Aromáticos com Pontes/farmacocinética , Feminino , Camundongos , Paclitaxel/farmacocinética , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Espectrofotometria Ultravioleta , Taxoides
12.
J Chromatogr B Biomed Sci Appl ; 736(1-2): 135-41, 1999 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-10676993

RESUMO

An HPLC assay was developed to determine the paclitaxel analogue 13-(N-tert.-butoxycarbonyl-beta-isobutylisoserinyl)-14-hydroxyb accatin-1,14-carbonate (IDN5109) and its epimer in mouse plasma. The method involves solid-phase extraction on cyano cartridges (recovery >75%), HPLC separation on symmetry shield column, a mobile phase of NaH2PO4 (10 mM) pH 5.2, acetonitrile (47:53) and detection at 227 nm. Retention times of IDN5109, its epiform and internal standard were 15, 24 and 25.5 min, respectively. The assay was linear from 0.10 to 10 microg/ml (r2 = 0.999), with a C.V. <5% and accuracy in the range of 95-107%. LOQ was 50 ng/ml for both compounds. Using this method IDN5109 pharmacokinetic was determined in mice.


Assuntos
Hidrocarbonetos Aromáticos com Pontes/sangue , Cromatografia Líquida de Alta Pressão/métodos , Paclitaxel/análogos & derivados , Taxoides , Animais , Hidrocarbonetos Aromáticos com Pontes/farmacocinética , Estabilidade de Medicamentos , Feminino , Congelamento , Cinética , Camundongos , Controle de Qualidade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
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