Cuidados Paliativos en una paciente con Mesotelioma Peritoneal. Revisión de la literatura

Introducción: Los mesoteliomas peritoneales se origina de las células que recubren la serosa de las cavidades del cuerpo, el 15% se originan del peritoneo. Su incidencia de es 0.2 a 3 casos por millones de personal al año. Son tumores raros y su supervivencia global se limita hasta 12 meses. El objetivo de esta presentación de caso es describir una presentación atípica de esta entidad y realizar una revisión de la literatura. Materiales y métodos: Se realizó una descripción de un caso en la consulta externa de oncología diagnosticada con Mesotelioma papilar bien diferenciado de primario de peritoneo diagnosticada en el 2012 quien en el 2022 mantiene 10 años de supervivencia global y se realizó una revisión de la literatura en base al caso clínico. Resultados:  Se define los tipos de mesotelioma peritoneal, sus características clínicas, el manejo del Mesotelioma Peritoneal según el Consenso de Chicago, los principios en cuidados de soporte como la ascitis peritoneal, el dolor, náuseas y vómitos, distrés psicosocial, así como la discusión del caso. Conclusión: El mesotelioma peritoneal es una enfermedad rara que puede ser rápidamente progresiva con una carga de enfermedad importante y pronóstico limitado. La instauración temprana de cuidados paliativos en pacientes con neoplasia incurable como el mesotelioma peritoneal permite el abordaje una mejor calidad de vida del paciente, así como de cumplir objetivos acordes a la situación clínica de cada paciente. (provisto por Infomedic International)

Introduction: Peritoneal mesotheliomas originate from the cells lining the serosa of the body cavities, 15% originate from the peritoneum. Their incidence is 0.2 to 3 cases per million personnel per year. They are rare tumors and their overall survival is limited to 12 months. The aim of this case report is to describe an atypical presentation of this entity and to review the literature. Materials and methods: A description of a case was made in the oncology outpatient clinic diagnosed with well-differentiated papillary mesothelioma of primary peritoneum diagnosed in 2012 who in 2022 maintains 10 years of overall survival and a review of the literature was performed based on the clinical case. Results: We define the types of peritoneal mesothelioma, its clinical features, the management of peritoneal mesothelioma according to the Chicago Consensus, the principles in supportive care such as peritoneal ascites, pain, nausea and vomiting, psychosocial distress, as well as the discussion of the case. Conclusion: Peritoneal mesothelioma is a rare disease that can be rapidly progressive with a significant disease burden and limited prognosis. The early establishment of palliative care in patients with incurable neoplasm such as peritoneal mesothelioma allows the approach to a better quality of life of the patient, as well as to meet objectives according to the clinical situation of each patient. (provided by Infomedic International)

HOLA COVID-19 Study: Evaluating the Impact of Caring for Patients With COVID-19 on Cancer Care Delivery in Latin America.

PURPOSE: The HOLA COVID-19 study sought to evaluate the impact of COVID-19 on oncology practices across Latin America (LATAM), challenges faced by physicians, and how practices and physicians adapted while delivering care to patients with cancer. METHODS: This international cross-sectional study of oncology physicians in LATAM included a 43-item anonymous online survey to evaluate changes and adaptations to clinical practice. Multivariable logistic regression analyses were used to evaluate the association of caring for patients with COVID-19 and changes to clinical practice. RESULTS: A total of 704 oncology physicians from 19 countries completed the survey. Among respondents, the most common specialty was general oncology (34%) and 56% of physicians had cared for patients with COVID-19. The majority of physicians (70%) noted a decrease in the number of new patients evaluated during the COVID-19 pandemic when compared with prepandemic, and 73% reported adopting the use of telemedicine in their practice. More than half (58%) of physicians reported making changes to the treatments that they offered to patients with cancer. In adjusted models, physicians who had cared for patients with COVID-19 had higher odds of changing the type of chemotherapy or treatments that they offered (adjusted odds ratio 1.81; 95% CI, 1.30 to 2.53) and of delaying chemotherapy start (adjusted odds ratio 2.05; 95% CI, 1.49 to 2.81). Physicians identified significant delays in access to radiation and surgical services, diagnostic tests, and supportive care. CONCLUSION: The COVID-19 pandemic has significantly disrupted global cancer care. Although changes to health care delivery are a necessary response to this global crisis, our study highlights the significant disruption and changes to the treatment plans of patients with cancer in LATAM resulting from the COVID-19 health care crisis.

Parotid Myoepithelial Carcinoma in a Pediatric Patient with Multiple Recurrences: Case Report.

Myoepithelial carcinoma of the salivary glands is a rare entity, with scarce amount of case reports in the literature. Due to its infrequency, its diagnosis is usually difficult and uncertain. Although there are reports of locoregional recurrences and distant metastases, its low incidence and varied biological behavior limits the clinical evidence that can be used to predict the prognosis and determine the course of treatment. We present a 23-year-old female patient without past medical history with an initial 1-year history of volume increase in the right parotid region of tumor aspect and painful on palpation. As a malignancy was suspected, a total parotidectomy was performed, reporting in the deep lobe a parotid myoepithelial carcinoma with vascular and neural invasion, negative borders, and 3-9 negative regional nodes. During her 16-year clinical evolution, she presented approximately every 2 years and a total of 9 locoregional recurrences and hepatic metastases, including cervical lymphoid nodules, temporal bone, frontal bone, and temporal fossa. Those recurrences have been treated with coordinated efforts between repeated external radiotherapy, chemotherapy, and multiple surgical resections. Myoepithelial tumors represent only 1.0-1.5% of all salivary gland tumors. The literature reports suggest a high incidence of locoregional recurrences and distant metastases in de novo myoepithelial carcinomas. Due to its rarity, treatment continues to be based on the experience of medical staff.

Costes informales: definición, obtención y análisis. La importancia de su incorporación en las evaluaciones económicas en salud / Informal costs: definition, obtaining and analysis. The importance of its incorporation in economic evaluations in health

Introducción: Los costes informales derivan de cuidados informales que es la atención prestada a un enfermo o discapacitado por parte de personas que no son profesionales socio sanitarios y que no reciben una remuneración económica. El objetivo del trabajo es explicar los costes informales en salud, su definición, su obtención, análisis y el im­ pacto en su incorporación en las evaluaciones económicas en salud. Materiales y métodos: Se realizó una búsqueda del tema sobre costes informales en la base de datos de Medline­Pubmed y en la búsqueda de la biblioteca de la Universidad Carlos III Madrid vía internet a través de varias bases de datos como EconLit y ABI/IN­ FORM collection. Resultados: Se define los cuidados informales, los métodos para su medición en tiempo, en preferencias reveladas, preferencias establecidos fijados, otros métodos, la importan­ cia de incorporar los costos informales en las evaluaciones económicas en salud. Conclusión: La evaluación económica a nivel de la perspectiva de la sociedad se debe incluir, pero muchas veces se realiza según el pagador por lo difícil que puede ser su medición.

Introduction: Informal costs derive from informal care, which is the care provided to a sick or disabled person by people who are not socio­health professionals and who do not receive financial compensation. The objective of the work is to explain the informal costs in health, its definition, its obtaining, analysis and the impact on its incorporation in the economic health evaluations. Material and methods: A search of the topic on informal costs was carried out in the Medli­ ne­Pubmed database and in the search of the Carlos III Madrid University library via the In­ ternet through several databases such as EconLit and ABI / INFORM collection. Results: Informal care is defined, the methods for its measurement in time, in revealed preferences, established preferences, other methods, the importance of incorporating informal costs in economic health evaluations. Conclusion: The economic evaluation at the level of the society perspective must be in­ cluded, but many times it is carried out according to the payer because of how difficult its measurement can be done

Cancer immunotherapy-associated hypophysitis.

The advances in cancer therapy have included the development of drugs that inhibit immune checkpoint ligands. Two types of immune checkpoint inhibitors, both antibodies that target CTLA-4 and PD-1, have been approved for its use in NSCLC and melanoma as first-line or second-line therapy. Sadly, not desirable consequences of immunotherapy are immune-related adverse events. immune-related hypophysitis is the most common endocrine adverse event after thyroid disfunction. The particularity of endocrine immune-related adverse events is their non-reversibility, with incidence and prevalence destined to increase in the coming years, particularly if this form of therapy is used in the future for earlier stages of cancer. Therefore, hypophysitis represents a challenge for the physician, sometimes occurring without specific symptomatology and which should be considered for clinical management. In this review, we describe the current data regarding the pathophysiology and management for immune-related hypophysitis.

An international epidemiological analysis of young patients with non-small cell lung cancer (AduJov-CLICaP).

BACKGROUND: A proportion of patients with NSCLC is diagnosed at 40 years or younger. These patients tend to be never-smokers, usually present with stage IV adenocarcinoma, and have somatic genomic alterations. Few studies have documented and analyzed epidemiological characteristics of this population. MATERIALS AND METHODS: We performed an international epidemiological analysis of 389 young patients with NSCLC. Data was collected from centers participating in the Latin American Consortium for Lung Cancer Research (AduJov-CLICaP). Patients were identified and data was retrospectively collected from different Latin American countries and Canada (Argentina=6, Canada=19, Colombia=29, Costa Rica=9, Mexico=219, Nicaragua=2, Panama=19, Perú=76 and Venezuela=10). The period of study was from 2012 to 2017. Inclusion criteria were: age 40 years or less and a histologically confirmed NSCLC. Clinical data was obtained, and EGFR mutation status and EML4-ALK translocation were collected. RESULTS: NSCLC patients aged 40 years or less accounted for approximately 4% of the total NSCLC population. Female patients accounted for 54.5%, while median age was of 37 years. Adenocarcinoma accounted for 86.1% (n=335/389), 72.5% (n=282/389; unknown=5) of patients were non-smokers, and 90.3% (n=351/389) had stage IV disease. Site of metastasis was obtained from 260/351 (unknown=91) stage IV patients (lung metastasis=40.0%, CNS metastasis=35.7%, and bone metastasis=31.5%). OS for the total population was 17.3 months (95%CI=13.9-20.7). OS for EGFRm(+)=31.4months (95%CI=11.6-51.3), EGFRm(-)=14.5months (95%CI=11.0-17.9) (p=0.005). OS for alk(+)=9.8months (95%CI=3.1-16.5) and alk(-)=5.6months (95%CI=3.9-7.3) (p=0.315). CONCLUSIONS: Patients aged 40 years or less account for a small but important proportion of NSCLC cases. Younger patients may have different characteristics compared to the older population. EGFRm and EML4-alk translocation frequency is higher than that of the general population.

Updated Frequency of EGFR and KRAS Mutations in NonSmall-Cell Lung Cancer in Latin America: The Latin-American Consortium for the Investigation of Lung Cancer (CLICaP).

INTRODUCTION: Previously, we reported the frequency of epidermal growth factor receptor (EGFR) and KRAS mutations in nonsmall-cell lung cancer (NSCLC) patients in Latin America. The EGFR mutation frequency was found between Asian (40%) and Caucasian (15%) populations. Here, we report the updated distribution of NSCLC mutations. METHODS: A total of 5738 samples from NSCLC patients from Argentina (1713), Mexico (1417), Colombia (1939), Peru (393), Panama (174), and Costa Rica (102) were genotyped for EGFR and KRAS. RESULTS: The median patient age was 62.2 ± 12.3 years; 53.5% were women, 46.7% had a history of smoking, and 95.2% had adenocarcinoma histology. The frequency of EGFR mutations was 26.0% (95% confidence interval [CI], 24.9-27.1; Argentina, 14.4% [12.8-15.6]; México, 34.3% [31.9-36.7]; Colombia, 24.7% [22.8-26.6]; Peru, 51.1% [46.2-55.9]; Panamá, 27.3 [20.7-33.9]; and Costa Rica, 31.4% [22.4-40.4]). The frequency of KRAS mutations was 14.0% (9.1-18.9). In patients with adenocarcinoma, EGFR mutations were independently associated with gender (30.7% females vs. 18.4% males; p < 0.001), nonsmoker status (27.4% vs. 17.1%, p < 0.001), ethnicity (mestizo/indigenous, 35.3% vs. Caucasian, 13.7%, p < 0.001), and the absence of KRAS mutation (38.1% vs. 4.7%; p < 0.001). The overall response rate to EGFR tyrosine kinase inhibitors was 60.6% (95% CI, 52-69), with a median progression-free survival and overall survival of 15.9 (95% CI, 12.420.6) and 32 months (95% CI, 26.5-37.6), respectively. CONCLUSION: Our findings support the genetic heterogeneity of NSCLC in Latin America, confirming that the frequency of EGFR mutations is intermediate between that observed in the Asian and Caucasian populations.

Methylenetetrahydrofolate reductase polymorphism (677 C>T) predicts long time to progression in metastatic colon cancer treated with 5-fluorouracil and folinic acid.

BACKGROUND AND AIMS: Fluoropyrimidine-based chemotherapy is the most common treatment for unresectable metastatic colorectal cancer (m-CRC). Therapy with 5-FU/folinic acid (FA) continues to be a standard treatment in developing countries. Pharmacogenomics allows the tailoring of cancer therapy to the patient. The polymorphism 677C>T of the methylenetetrahydrofolate reductase (MTHFR) gene seems to influence the effectiveness of treatment with 5-FU. We undertook this study to evaluate the frequency of MTHFR 677C>T polymorphism and its relationship to the time to progression (TTP) and overall survival (OS) in m-CRC treated with 5-FU/FA. METHODS: The MTHFR 677C>T polymorphism was determined using PCR and allele-specific digestion. The clinical variables, TTP and OS, were analyzed in each case and compared between wild-type and variant polymorphic groups. RESULTS: Among 34 patients (12 males and 22 females), we detected eight wild-type homozygous patients (CC; 24%), nine variant homozygous (TT; 26%), and 17 heterozygous (CT; 50%) individuals. The median TTP in patients with the MTHFR 677 CC, CT, and TT genotypes was 3.43, 4.77, and 4.80 months, respectively (p = 0.047, log rank). A longer TTP was observed in patients with polymorphic variant (CT and TT) compared with the wild-type homozygous patients (4.80 vs. 3.43 months; p = 0.031, log rank). CONCLUSIONS: In this study, the frequency of the MTHFR 677C>T polymorphism is 50% among m-CRC Mexican patients. The results of this study appear to show that the presence of the MTHFR 677C>T polymorphism is associated with longer TTP and OS in m-CRC treated with 5-FU/FA.