Overall survival prediction in metastatic castration-resistant prostate cancer treated with radium-223.

OBJECTIVE: Radium-223(223Ra) is indicated for patients (p) with metastatic castration resistant prostate cancer (mCRCP). OBJECTIVES: The aim of this study was to evaluate the role of baseline clinical variables associated with overall survival (OS) and toxicity of 223Ra. Its purpose was to identify the factors that can predict a better response to treatment and provide information regarding the most appropriate time for the application of 223Ra. MATERIALS AND METHODS: Prospective study in 40p with mCRPC treated with 223Ra. End points were OS, progression-free survival and time to progression. The follow-up parameters were: doses received, hemoglobin (Hb), absolute neutrophil count (ANC), platelet count (PC), prostate specific antigen (PSA), alkaline phosphatase (ALP), Visual Analogue Scale for pain, Eastern Cooperative Oncology Group (ECOG) and WHO's Cancer Pain Ladder. The use of other treatments was also evaluated. RESULTS: Median OS was 17.1 months(mo) (CI95%6.5-27.7); 26/40p received complete treatment of 223Ra, without reaching a median OS and 14p received incomplete treatment with a median OS 13.6mo(CI95%1.6-25.6). Median follow-up was 11.2mo (range:1.3-45.2). The univariate analysis showed that factors as VAS, ECOG, Hb and ALP values were independently associated with OS. First line treatment with 223Ra was started in 11/40p, while 19p had been heavily pre-treated and 13p received concomitant treatment. CONCLUSIONS: 223Ra therapy require an adequate selection of patients to obtain the greatest clinical benefit. Low basal Hb, hight basal ALP, bone marrow involvement and an altered ECOG were the main factors that decreased OS in our patients. 223Ra should be considered relatively early in the course of treatment. Available at. https://www.intbrazjurol.com.br/pdf/aop/2019-0343OA.pdf.

Overall survival prediction in metastatic castration-resistant prostate cancer treated with radium-223

ABSTRACT Objective Radium-223(223Ra) is indicated for patients (p) with metastatic castration resistant prostate cancer (mCRCP). Objectives The aim of this study was to evaluate the role of baseline clinical variables associated with overall survival (OS) and toxicity of 223Ra. Its purpose was to identify the factors that can predict a better response to treatment and provide information regarding the most appropriate time for the application of 223Ra. Materials and Methods Prospective study in 40p with mCRPC treated with 223Ra. End points were OS, progression-free survival and time to progression. The follow-up parameters were: doses received, hemoglobin (Hb), absolute neutrophil count (ANC), platelet count (PC), prostate specific antigen (PSA), alkaline phosphatase (ALP), Visual Analogue Scale for pain, Eastern Cooperative Oncology Group (ECOG) and WHO's Cancer Pain Ladder. The use of other treatments was also evaluated. Results Median OS was 17.1 months(mo) (CI95%6.5-27.7); 26/40p received complete treatment of 223Ra, without reaching a median OS and 14p received incomplete treatment with a median OS 13.6mo(CI95%1.6-25.6). Median follow-up was 11.2mo (range:1.3-45.2). The univariate analysis showed that factors as VAS, ECOG, Hb and ALP values were independently associated with OS. First line treatment with 223Ra was started in 11/40p, while 19p had been heavily pre-treated and 13p received concomitant treatment. Conclusions 223Ra therapy require an adequate selection of patients to obtain the greatest clinical benefit. Low basal Hb, hight basal ALP, bone marrow involvement and an altered ECOG were the main factors that decreased OS in our patients. 223Ra should be considered relatively early in the course of treatment.

Lupus eritematoso sistémico con anticuerpos antinucleares negativos y anemia hemolítica / Systemic lupus erythematosus with negative antinuclear antibodies and hemolytic anemia

El lupus eritematoso sistémico (LES) es una enfermedad autoinmune multisistémica, con exacerbaciones y remisiones o con actividad perenne, que conlleva al desarrollo de daño orgánico. Debido a las múltiples formas de presentación y la variedad de órganos que pueden estar comprometidos, el diagnóstico del LES siempre ha sido un reto. A continuación presentamos el caso de una paciente con diagnóstico de LES, en quien su principal manifestación de la enfermedad fue hematológica y los anticuerpos antinucleares (ANA) son negativos y los anticuerpos anti-Ro son positivos. Los ANA han sido utilizado como marcadores de LES y hacen parte de los criterios de clasificación propuestos por el American College of Rheumatology (ACR) para el diagnóstico de la enfermedad. Existe, sin embargo, controversia de si algunos pacientes que cumplen criterios ACR, pero con ANA negativos, si puedan ser rotulados como LES. Existen pocos reportes de caso al respecto (Acta Med Colomb 2010; 35: 179-182).

Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease, with exacerbations and remissions or perennial activity wich in time develops organ damage. Because of the multiple forms of presentation and the variety of organs that may be involved, the diagnosis of SLE has always been a challenge. We present the case of a patient with lupus in whom the main manifestation of the disease was hematologic, and antinuclear antibodies (ANA) were negative. ANA have been used as markers of SLE and are part of the classification criteria proposed by the American College of Rheumatology (ACR) for the diagnosis of the disease. There is, however, controversy over whether some patients who met ACR criteria, but had negative ANAs, can be labeled as SLE. There are few case reports in this regard (Acta Med Colomb 2010; 35: 179-182).