Neoadjuvant Therapy with Weekly Nanoparticle Albumin-Bound Paclitaxel for Luminal Early Breast Cancer Patients: Results from the NABRAX Study (GEICAM/2011-02), a Multicenter, Non-Randomized, Phase II Trial, with a Companion Biomarker Analysis.

BACKGROUND: Nanoparticle albumin-bound paclitaxel (nab-Paclitaxel) is an alternative to standard taxanes for breast cancer (BC) treatment. We evaluated nab-Paclitaxel efficacy as neoadjuvant treatment for early estrogen receptor-positive (ER+), human epidermal growth factor receptor 2-negative (HER2-) disease. MATERIALS AND METHODS: Women with ER+, HER2-, stage II-III BC were treated preoperatively with four cycles of weekly nab-Paclitaxel (150 mg/m2), 3 weeks on and 1 week off. We hypothesized that poor pathological response rate (residual cancer burden [RCB] III; Symmans criteria) would be ≤16%. RESULTS: Eighty-one patients with a median age of 47 years were treated; 64.2% were premenopausal, and 69% of tumors were stage II. Residual cancer burden III rate was 28.4% (95% confidence interval [CI]: 18.6%-38.2%), RCB 0+I (good response) rate was 24.7% (95% CI: 15.3%-34.1%) and RCB 0 (complete response) rate was 7.4% (95% CI: 1.7%-13.1%). Objective response rate by magnetic resonance imaging was 76.5% and rate of conversion to breast conserving surgery was 40.0%. The most frequent grade 3 and 4 toxicity was neutropenia (12.3% and 3.7% of patients, respectively), without any febrile neutropenia. Sensory neuropathy grade 2 and 3 were seen in 25.9% and 2.5% of patients, respectively. Tumor secreted protein, acidic, cysteine-rich (SPARC) overexpression was significantly associated with RCB 0 (odds ratio: 0.079; 95% CI: 0.009-0.689; p = .0216). CONCLUSION: Despite failing to confirm an RCB III rate ≤16% in nab-Paclitaxel-treated patients, the RCB 0+I rate indicates a significant drug antitumor activity with low rates of grade 3-4 toxicity. Our exploratory biomarker analysis suggests a potential predictive role of complete response for SPARC. Confirmatory analyses are warranted, adapting dose and schedule to decrease peripheral neurotoxicity. (Trial registration: European Clinical Trials Database study number: 2011-004476-10; ClinicalTrials.gov: NCT01565499). IMPLICATIONS FOR PRACTICE: The pathological response rate (residual cancer burden [RCB]; Symmans criteria) of nanoparticle albumin-bound paclitaxel administered as neoadjuvant treatment for early estrogen receptor-positive, human epidermal growth factor receptor 2-negative disease was evaluated. Whereas poor response (RCB III) was 24.7%, similar to that for docetaxel, good response (RCB 0+I) reached 23.0%, far superior to the 13% for docetaxel, while keeping toxicity low. Exploratory biomarker analysis suggests secreted protein, acidic, cysteine-rich overexpression in tumor cells as a potential predictor of complete response (RCB 0). Findings point to an encouraging single-agent neoadjuvant treatment with low toxicity, which warrants future research and development.

Obesity and survival in operable breast cancer patients treated with adjuvant anthracyclines and taxanes according to pathological subtypes: a pooled analysis.

INTRODUCTION: Obesity is an unfavorable prognostic factor in breast cancer (BC) patients regardless of menopausal status and treatment received. However, the association between obesity and survival outcome by pathological subtype requires further clarification. METHODS: We performed a retrospective analysis including 5,683 operable BC patients enrolled in four randomized clinical trials (GEICAM/9906, GEICAM/9805, GEICAM/2003-02, and BCIRG 001) evaluating anthracyclines and taxanes as adjuvant treatments. Our primary aim was to assess the prognostic effect of body mass index (BMI) on disease recurrence, breast cancer mortality (BCM), and overall mortality (OM). A secondary aim was to detect differences of such prognostic effects by subtype. RESULTS: Multivariate survival analyses adjusting for age, tumor size, nodal status, menopausal status, surgery type, histological grade, hormone receptor status, human epidermal growth factor receptor 2 (HER2) status, chemotherapy regimen, and under-treatment showed that obese patients (BMI 30.0 to 34.9) had similar prognoses to that of patients with a BMI < 25 (reference group) in terms of recurrence (Hazard Ratio [HR] = 1.08, 95% Confidence Interval [CI] = 0.90 to 1.30), BCM (HR = 1.02, 0.81 to 1.29), and OM (HR = 0.97, 0.78 to 1.19). Patients with severe obesity (BMI ≥ 35) had a significantly increased risk of recurrence (HR = 1.26, 1.00 to 1.59, P = 0.048), BCM (HR = 1.32, 1.00 to 1.74, P = 0.050), and OM (HR = 1.35, 1.06 to 1.71, P = 0.016) compared to our reference group. The prognostic effect of severe obesity did not vary by subtype. CONCLUSIONS: Severely obese patients treated with anthracyclines and taxanes present a worse prognosis regarding recurrence, BCM, and OM than patients with BMI < 25. The magnitude of the harmful effect of BMI on survival-related outcomes was similar across subtypes.

Análisis de las patologías con mayor prevalencia en las Unidades Móviles de Rehabilitación y Fisioterapia de la provincia de Almería / Analysis of the most prevalent disorders in home-rehabilitation and physiotherapy units in the province of Almería (Spain)

Objetivos Describir las patologías de mayor prevalencia en 1753 pacientes derivados a las Unidades Móviles de Rehabilitación y Fisioterapia. Método Estudio descriptivo transversal. Las variables analizadas fueron la edad, el sexo, el diagnóstico principal, la capacidad funcional (Índice de Barthel), los objetivos fisioterapéuticos, las técnicas de tratamiento y el número de sesiones realizadas. Resultados Los diagnósticos principales fueron secuelas por inmovilización (29%), fracturas de cadera (16,5%), accidente vascular cerebral (13,7%), prótesis de rodilla (11,9%) y cadera (4,7%), enfermedad pulmonar obstructiva crónica (2,6%) y enfermedad de Alzheimer (2,4%). Los Índices de Barthel iniciales más bajos se obtuvieron en Alzheimer, accidente vascular cerebral y secuelas por inmovilización; el más alto se obtuvo en los pacientes intervenidos de prótesis de rodilla. El proceso que necesitó mayor número de sesiones para su recuperación fue el accidente vascular cerebral. Conclusiones Se confirman ganancias positivas entre el Índice de Barthel inicial y el final tras el tratamiento rehabilitador para cada proceso descrito, con una mayor independencia funcional del paciente (AU)

Objectives To describe the most prevalent disorders in 1753 patients referred to home rehabilitation and home physiotherapy units. Method We carried out a cross-sectional descriptive study. The variables analyzed were age, gender, main diagnosis, functional capacity (Barthel Index), physiotherapeutic objectives, the treatment applied and the number of sessions. Results The main diagnoses were immobilization effects (29%), hip fracture (16.5%), stroke (13.7%), knee replacement (11.9%), hip replacement (4.7%), chronic obstructive pulmonary disease (2.6%), and Alzheimer's disease (2.4%). The lowest Barthel Index was obtained in Alzheimer's disease, stroke and immobilization effects and the highest in patients with knee replacement. The process requiring the highest number of sessions for complete recovery was stroke. Conclusions Significant improvements were confirmed in pre- and post- Barthel Index scores for each of the above-mentioned diagnoses, demonstrating greater functional independence among patients (AU)

[Analysis of the most prevalent disorders in home-rehabilitation and physiotherapy units in the province of Almería (Spain)]. / Análisis de las patologías con mayor prevalencia en las Unidades Móviles de Rehabilitación y Fisioterapia de la provincia de Almería.

OBJECTIVES: To describe the most prevalent disorders in 1753 patients referred to home rehabilitation and home physiotherapy units. METHOD: We carried out a cross-sectional descriptive study. The variables analyzed were age, gender, main diagnosis, functional capacity (Barthel Index), physiotherapeutic objectives, the treatment applied and the number of sessions. RESULTS: The main diagnoses were immobilization effects (29%), hip fracture (16.5%), stroke (13.7%), knee replacement (11.9%), hip replacement (4.7%), chronic obstructive pulmonary disease (2.6%), and Alzheimer's disease (2.4%). The lowest Barthel Index was obtained in Alzheimer's disease, stroke and immobilization effects and the highest in patients with knee replacement. The process requiring the highest number of sessions for complete recovery was stroke. CONCLUSIONS: Significant improvements were confirmed in pre- and post- Barthel Index scores for each of the above-mentioned diagnoses, demonstrating greater functional independence among patients.

Una esperanza en el final de la vida / A hope in the end of the life

En aquellas circunstancias en las que una persona estállegando al final de su vida, el objetivo del fisioterapeutaes, por un lado, retrasar el deterioro físico de las funcionesdel sistema músculo-esquelético y nervioso y, porotro, a través del ejercicio, transmitir un deseo de vida ycuración en el paciente, que le aportará un mejor estadode ánimo y bienestar.Se ha llevado a cabo un programa de fisioterapia con pacientesterminales en la Residencia Comarcal de PersonasMayores de Vélez-Rubio (Almería), obteniendograndes beneficios, tanto desde el punto de vista físicocomo desde el psicológico. De ahí el deseo de destacar laimportancia de este profesional que acompaña al enfermoal final de su vida con una caricia(AU)

In those circumstances in which a person is coming at theend of his life, the target of the physiotherapist is of skeletaland nervous muscle delays the physical deterioration of thefunctions of the system and on the other hand, across theexercise, to transmit a desire of life and healing in the patient,who will contribute a better frame of mind and wellbeing.We have carried out a program of physical therapy withterminal patients in the Residencia Comarcal de PersonasMayores, Vélez-Rubio (Almería), obtaining big benefitsboth from the physical point of view and from the psychologicalone and hence emphasizing the importance of thisprofessional, who accompanies the patient at the end of hislife on a caress(AU)

Entrenamiento de las funciones motoras y cognitivas del enfermo de Alzheimer a través de un juego terapéutico en un marco institucional / No disponible

El aumento de la esperanza de vida en las personas mayores no siempre trae consigo un envejecimiento saludable, pero si hace más notable el incremento en las últimas décadas de enfermedades degenerativas como son los diferentes tipos de demencia, entre ellas quizás la más conocida sea la enfermedad de Alzheimer. Es la dependencia que produce esta patología en sus pacientes la que lleva a los familiares a recurrir a centros deatención especializada, como pueden ser los centros de día geriátricos, las residencias de ancianos, etc. La enfermedad de Alzheimer, en su fase inicial se caracteriza por una serie de síntomas que van a ser objeto de nuestra propuesta terapéutica, en el entorno de una residencia geriátrica. Los objetivos principales que se intentan perseguir son estimular la movilidad articular y el esquema corporal, trabajar la percepción del paciente y en general todas las funciones cognitivas que estén mermadas. Se elaborarán una serie de fichas de 50x50 cm., de cartulina en las que se representarán de forma clara diferentes acciones gestuales o de movimiento, en un contraste de blanco y negro o directamente se mostrarán imágenes que reflejen una acción determinada, como expresiones faciales que representen los estados de ánimo, figuras que muestren diferentes movimientos como subir los dos brazos, doblar el cuello hacia un lado, diferentes partes del cuerpo, etc. El paciente debe reconocer la imagen y en su caso saber imitar el gesto o la acción indicada. Los efectos conseguidos se pondrán de manifiesto comparando la valoración inicial que se le hace al anciano, con futuras valoraciones a los 3, 6 y 12 meses de puesta en marcha la actividad. Con este juego terapéutico se trabajan todas las funciones afectadas del enfermo de Alzheimer, de manera que no hacemos un tratamiento analítico sino global del mism (AU)

The increase of the life expectancy in the major persons not always brings with it a healthy aging, but if it makes the increase more notable in the last decades of degenerative illnesses like they are the different types of dementia, between them perhaps the most well-known is Alzheimer’s illness. It is the dependency that produces this pathology in his patients the one that leads to the relatives to resorting to specializing attention centres, since they can be the Geriatric Centres of Day, The Elders’ Residences, etc.The illness of Alzheimer, in his initial phase it is characterized by a series of symptoms that are going to be an object of our therapeutic proposal, in the environment of a geriatric residence.The principal targets that try to be chased are to stimulate the mobility to articulate and the corporal scheme, to work the perception of the patient and in general all the cognitive functions that are reduced. Cm will prepare a series of cards of 50x50., of cardboard in that different actions will be represented of clear gestures or of movement, in a contrast of white and black or directly there will appear images that reflect a certain action, like expressions that represent the frames of mind, figures that show different movements as raising two arms, doubling the neck towards a side, different parts of the body, etc… The patient must recognize the image and in his case be able to imitate the gesture or the stated action. The obtained effects will be made clear comparing the initial evaluation that one does him to the elder, with future evaluations at the age of 3, 6 and 12 months of starting the activity. With this therapeutic game there are worked all the affected functions of Alzheimer’s patient, so that we do not do an analytical but global treatment of the same one (AU)