Effectiveness of daily versus non-daily granulocyte colony-stimulating factors in patients with solid tumours undergoing chemotherapy: a multivariate analysis of data from current practice.

We conducted a multicentre, retrospective, observational study including patients with solid tumours (excluding breast cancer) that received granulocyte colony-stimulating factors (G-CSF) and chemotherapy. We investigated the effectiveness of daily vs. non-daily G-CSFs (pegfilgrastim) adjusting by potential confounders. The study included 391 patients (211 daily G-CSF; 180 pegfilgrastim), from whom 47.3% received primary prophylaxis (PP) (57.8% pegfilgrastim), 26.3% secondary prophylaxis (SP: initiation after cycle 1 and no reactive treatment in any cycle) (51.5% pegfilgrastim) and 26.3% reactive treatment (19.4% pegfilgrastim). Only 42.2% of patients with daily G-CSF and 46.2% with pegfilgrastim initiated prophylaxis within 72 h after chemotherapy, and only 10.5% of patients with daily G-CSF received it for ≥ 7 days. In the multivariate models, daily G-CSF was associated with higher risk of grade 3-4 neutropenia (G3-4N) vs. pegfilgrastim [odds ratio (OR): 1.73, 95% confidence interval (CI): 1.004-2.97]. Relative to SP, PP protected against G3-4N (OR for SP vs. PP: 6.0, 95%CI: 3.2-11.4) and febrile neutropenia (OR: 3.1, 95%CI: 1.1-8.8), and was associated to less chemotherapy dose delays and reductions (OR for relative dose intensity <85% for SP vs. PP: 3.1, 95%CI: 1.7-5.4) and higher response rate (OR: 2.1, 95%CI: 1.2-3.7). Data suggest that pegfilgrastim, compared with a daily G-CSF, and PP, compared with SP, could be more effective in preventing neutropenia and its related events in the clinical practice.

Concurrencia de síndromes paraneoplásicos neurológicos, en paciente afecta de cáncer de mama y metástasis cerebral: revisión de la literatura / Concurrence of neurologic paraneroplastic syndromes in a woman with brain metastatic breast cancer: review of the literature

Los Síndromes paraneoplásicos neurológicos sonentidades complejas, de difícil diagnóstico, y quepueden afectar a cualquier parte del sistemanervioso. El descubrimiento de nuevos antígenosonconeuronales y su relación con las alteracionesinmunológicas asociadas están ayudando a undiagnóstico precoz. La asociación con el carcinomade mama es infrecuente. Presentamos el caso de unapaciente de 62 años, diagnosticada de carcinoma demama izquierda, mastectomizada y tratada conquimioterapia adyuvante. Presentó recidiva, conmetástasis cerebelosa resecada quirúrgicamente ytratada con radioterapia. Se complicó con cuadromiasteniforme de tipo Lambert-Eaton, disfunciónautonómica y posterior encefalítis límbica con comairreversible. La aplicación de los nuevos criteriosdiagnósticos, los descubrimientos moleculares y larealización de ensayos clínicos terapeúticos,podrían mejorar las expectativas en estas pacientes

Neurological paraneoplastic syndromes arecomplex entities of difficult diagnosis. They canlocate in any part of the nervous system producingimportant neurological dysfunctions. The discoveryof new specific anti-neuronal antibodies and theirrelation with the associated immunologicalalterations help to make an early diagnosis.Association with breast cancer is not frequent. Wepresent the case of a 62-year old patient with leftbreast carcinoma that had been treated bymastectomy and adjuvant chemotherapy one yearbefore. She relapsed with cerebellum metastasesand was treated by surgery and radiotherapy. Thepicture was complicated with a Lambert-Eaton-likemyasthenic syndrome, neuroplastic sensoryneuronopathy, limbic encephalitis and irreversiblecoma. The application of new diagnostic criteria,the molecular discoveries and the performance oftherapeutic clinical trials could better the lifeexpectancy of these patients

HER2 y carcinoma de próstata: ¿una relación de utilidad clínica? / HER2 and prostate carcinoma: is there any relation with clinical utility?

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