Observational study of HR+/HER2− metastatic breast cancer patients treated with abemaciclib in Spain in the Named Patient Use Program (AbemusS)

Introduction/objectives To describe abemaciclib use in patients with hormone receptor-positive, human epidermal growth factor receptor-negative (HR+/HER2−) metastatic breast cancer (mBC) who participated in the Named Patient Use program (NPU) in Spain.Material and methods This retrospective study was based on medical record review of patients across 20 centers during 2018/2019. Patients were followed up until death, enrolment in a clinical trial, loss of follow-up or study end. Clinical and demographic characteristics, treatment patterns and abemaciclib effectiveness were analyzed; time-to-event and median times were estimated using the Kaplan–Meier (KM) method. Results The study included 69 female patients with mBC (mean age 60.4 ± 12.4 years), 86% of whom had an initial diagnosis of early BC and 20% had an ECOG ≥ 2. Median follow-up was 23 months (range 16–28). Metastases were frequently observed in bone (79%) and visceral tissue (65%), with 47% having metastases in > 2 sites. Median number of treatment lines before abemaciclib was 6 (range 1–10). Abemaciclib monotherapy was received by 72% of patients and combination therapy with endocrine therapy by 28% of patients; 54% of patients required dose adjustments, with a median time to first adjustment of 1.8 months. Abemaciclib was discontinued in 86% of patients after a median of 7.7 months (13.2 months for combination therapy and 7.0 months for monotherapy) mainly due to disease progression (69%). Conclusion These results suggest that abemaciclib is effective, as monotherapy and in combination, for patients with heavily pretreated mBC, consistent with clinical trial results (AU)

Observational study of HR+/HER2- metastatic breast cancer patients treated with abemaciclib in Spain in the Named Patient Use Program (AbemusS).

INTRODUCTION/OBJECTIVES: To describe abemaciclib use in patients with hormone receptor-positive, human epidermal growth factor receptor-negative (HR+/HER2-) metastatic breast cancer (mBC) who participated in the Named Patient Use program (NPU) in Spain. MATERIAL AND METHODS: This retrospective study was based on medical record review of patients across 20 centers during 2018/2019. Patients were followed up until death, enrolment in a clinical trial, loss of follow-up or study end. Clinical and demographic characteristics, treatment patterns and abemaciclib effectiveness were analyzed; time-to-event and median times were estimated using the Kaplan-Meier (KM) method. RESULTS: The study included 69 female patients with mBC (mean age 60.4 ± 12.4 years), 86% of whom had an initial diagnosis of early BC and 20% had an ECOG ≥ 2. Median follow-up was 23 months (range 16-28). Metastases were frequently observed in bone (79%) and visceral tissue (65%), with 47% having metastases in > 2 sites. Median number of treatment lines before abemaciclib was 6 (range 1-10). Abemaciclib monotherapy was received by 72% of patients and combination therapy with endocrine therapy by 28% of patients; 54% of patients required dose adjustments, with a median time to first adjustment of 1.8 months. Abemaciclib was discontinued in 86% of patients after a median of 7.7 months (13.2 months for combination therapy and 7.0 months for monotherapy) mainly due to disease progression (69%). CONCLUSION: These results suggest that abemaciclib is effective, as monotherapy and in combination, for patients with heavily pretreated mBC, consistent with clinical trial results.

Sobre la gestación por sustitución. Otra vuelta de tuerca / Sobre la gestació per substitució. Una altra volta de rosca / On Surrogacy. Another turn of phrase

El autor vuelve a insistir, a propósito de una reciente sentencia del Tribunal Supremo español, en tres tesis sobre la gestación por sustitución que ya había defendido en otras ocasiones: no se trata de una práctica prohibida en nuestro Derecho (la nulidad no es lo mismo que la ilicitud); no atenta, en sí misma considerada, contra la dignidad humana, de la mujer gestante o del niño; y su regulación no tiene por qué exigir la gratuidad por parte de la mujer gestante, si bien la remuneración que esta pudiera recibir no debe quedar librada a las leyes del mercado.(AU)

L'autor torna a insistir, a propòsit d'una recent sentència del TribunalSuprem espanyol, en tres tesis sobre la gestació per substitució que ja havia defensat en altres ocasions: no es tracta d'una pràctica prohibida en el nostre Dret (la nul·litat no és el mateix que la il·licitud); no atempta, en si mateixa considerada, contra la dignitat humana, de la dona gestant o del nen; i la seva regulació no té per què exigir la gratuïtat per part de la dona gestant, si bé la remuneració que aquesta pogués rebre no ha de quedar lliurada a les lleis del mercat.(AU)

The author insists, with regard to a recent Spanish Supreme Court ruling, on three theses on surrogacy that he has already defended: it is not a practice prohibited in our law (nullity is not the same as illegality); it is not, in itself considered, against the human dignity of the pregnant woman or the child; and its regulation does not necessarily have to require the pregnant woman to do it for free, although the remuneration that she may receive should not be left to the laws of the market.(AU)

Endocytosis mediated by an atypical CUBAM complex modulates slit diaphragm dynamics in nephrocytes.

The vertebrate endocytic receptor CUBAM, consisting of three cubilin monomers complexed with a single amnionless molecule, plays a major role in protein reabsorption in the renal proximal tubule. Here, we show that Drosophila CUBAM is a tripartite complex composed of Amnionless and two cubilin paralogues, Cubilin and Cubilin2, and that it is required for nephrocyte slit diaphragm (SD) dynamics. Loss of CUBAM-mediated endocytosis induces dramatic morphological changes in nephrocytes and promotes enlarged ingressions of the external membrane and SD mislocalisation. These phenotypes result in part from an imbalance between endocytosis, which is strongly impaired in CUBAM mutants, and exocytosis in these highly active cells. Of note, rescuing receptor-mediated endocytosis by Megalin/LRP2 or Rab5 expression only partially restores SD positioning in CUBAM mutants, suggesting a specific requirement of CUBAM in SD degradation and/or recycling. This finding and the reported expression of CUBAM in podocytes suggest a possible unexpected conserved role for this endocytic receptor in vertebrate SD remodelling.

Abemaciclib, a CDK4 and CDK6 inhibitor for the treatment of metastatic breast cancer.

The addition of CDK4 and 6 inhibitors (abemaciclib, palbociclib or ribociclib) to endocrine therapy, as first-line treatment or following progression after initial endocrine therapy, significantly increased progression-free survival, objective response rates and in some trials overall survival, compared with endocrine therapy alone in HR+ and HER2- breast metastatic breast cancer. These CDK4 and 6 inhibitors are now approved in this context and have become a new standard of care. A hypothesis-generating exploratory analysis suggested that the addition of abemaciclib to endocrine therapy showed the largest effects in subgroups of women with indicators of poor prognosis, although these data require confirmation. This review provides updated clinical trial data for all three drugs in metastatic breast cancer, focusing on abemaciclib, the most recently approved agent.

Fear-of-intimacy-mediated zinc transport controls the function of zinc-finger transcription factors involved in myogenesis.

Zinc is a component of one-tenth of all human proteins. Its cellular concentration is tightly regulated because its dyshomeostasis has catastrophic health consequences. Two families of zinc transporters control zinc homeostasis in organisms, but there is little information about their specific developmental roles. We show that the ZIP transporter Fear-of-intimacy (Foi) is necessary for the formation of Drosophila muscles. In foi mutants, myoblasts segregate normally, but their specification is affected, leading to the formation of a misshapen muscle pattern and distorted midgut. The observed phenotypes could be ascribed to the inactivation of specific zinc-finger transcription factors (ZFTFs), supporting the hypothesis that they are a consequence of intracellular depletion of zinc. Accordingly, foi phenotypes can be rescued by mesodermal expression of other ZIP members with similar subcellular localization. We propose that Foi acts mostly as a transporter to regulate zinc intracellular homeostasis, thereby impacting on the activity of ZFTFs that control specific developmental processes. Our results additionally suggest a possible explanation for the presence of large numbers of zinc transporters in organisms based on differences in ion transport specificity and/or degrees of activity among transporters.

Sobre la nueva Ley de Reproducción Humana Asistida / No disponible

No disponible

An advanced practice nursing program for foreign medical doctors: a practical approach.

AIM: This article articulates lessons learned about an accelerated family nurse practitioner course offered to foreign medical doctors who also held baccalaureate nursing degrees (BSN). BACKGROUND: In the last decade, many physicians in the Philippines returned to school to obtain BSN degrees and licensure as registered nurses (referred to as nurse-medics) to emigrate to the United States in the hope of a better life. Once in the United States, many remain in nursing even though they prefer the practice of medicine. METHOD: This fast-track master's degree program began in fall 2006 at a university in the southwestern United States in collaboration with St. Jude College in the Philippines. By the end of this program (2010), 76 students had graduated. All who sat for the FNP national certification exam passed on the first attempt. RESULTS: Due to a decrease in qualified applicants, the program eventually closed, but a number of important lessons were learned. CONCLUSION: Nursing programs planning to undertake accelerated programs to transition medical doctors to nurse practitioners should consider they retake courses such as physical assessment, pharmacology and pathophysiology.