Immune manifestations with checkpoint inhibitors in a single Brazilian center: experience and literature review.

OBJECTIVES: The presence of autoimmune events were recorded in patients receiving immune checkpoint inhibitors. MATERIALS & METHODS: Retrospective study in patients receiving immune checkpoint inhibitors (ICIs) during the period of 2012-2019. RESULTS: A total of 554 patients received ICIs of which 123 developed an immune related adverse event. Twenty one (17%) with toxicity were identified as having a pre-existing autoimmune disease and 88 required treatment with corticosteroids or hormone replacement. Thirty two (26%) out of 123 had to temporarily discontinue ICIs due to autoimmune manifestations. Endocrine and skin manifestations were the most prevalent immune disorders in our cohort. In melanoma better efficacy was seen in patients with immune toxicity. CONCLUSION: Autoimmune diseases appear in patients receiving ICIs in this real world experience. Our results differ from other series on the frequency of autoimmunity. Complete discontinuation of ICIs due to autoimmunity was rare.

Risk of fatigue and anemia in patients with advanced cancer treated with olaparib: A meta-analysis of randomized controlled trials.

INTRODUCTION: PARP inhibitors are a new class of drugs that are currently being studied in several malignancies. Olaparib is FDA-approved for advanced breast cancer and advanced ovarian cancer patients. Fatigue and anemia are among the most common cancer and treatment-related symptoms. Therefore, we conducted a meta-analysis of randomized controlled trials (RCT) to characterize the incidence and relative risks (RRs) of fatigue and anemia associated with olaparib. METHODS: PubMed, Cohrane, Embase and abstracts presented at the annual meeting of the American Society of Clinical Oncology (ASCO) were searched for articles published from 2000 to June 2018. The eligible studies were phase II and III RCT of olaparib. Safety profile from each selected study was evaluated for all-grade and high-grade fatigue and anemia adverse events. Summary incidences and the RR, with 95% confidence intervals, of all-grade and high-grade events were calculated using random-effects or fixed-effects model based on the heterogeneity of selected studies. RESULTS: A total of 9 trials were selected, and included 2074 patients with advanced ovarian, gastric, prostate, lung or breast cancer. 908 patients received placebo/control treatments and 1166 received olaparib alone or combination with other active cancer treatments. The RR of all-grade and high fatigue was 1.24 (95% CI, 1.10-1.39) and 1.71 (95% CI, 1.06-2.77), respectively. The RR of all-grade and high-grade anemia was 2.10 (95% CI, 1.48-2.98) and 3.15 (95% CI, 1.73-5.71), respectively. CONCLUSION: Our findings suggest that the olaparib treatment is associated with an increased risk of fatigue and anemia. Since fatigue and anemia are very common treatment related adverse events, and both can impair the quality of life of patients, it is important to identify them early and manage it accordingly in order to optimize the overall treatment.

Conversion treatment of hepatic metastases of colon adenocarcinoma by bevacizumab and FOLFOX.

A patient is described who presented with an obstructive adenocarcinoma in the ascending colon and two liver metastases. She underwent right hemicolectomy with concurrent lymphadenectomy. As one of the liver metastases was considered irresectable, she received bevacizumab-containing chemotherapy. The disease responded well to treatment and after 4 months the largest lesion was subjected to radiofrequency ablation and the smaller could be removed. Eventually, systemic treatment was discontinued. At a later time-point the patient developed a new metastasis in the hilum of the liver. Bevacizumab-containing treatment was again successful; the patient experienced a complete response. Currently, she feels well. The only sign of disease is a slightly elevated carcino-embryonic antigen level at 36 months after diagnosis of metastatic colon cancer.

Avaliaçäo do intervalo de tempo e custo médio para a obtençäo do eutiroidismo na doença de Graves tratada com drogas antitiroidianas em um hospital geral / Evaluation of time interval middle cost for obtention of euthyroidism in Grave's disease treated with antithyroid drugs in a geral hospital

Os pacientes com doença de Graves tornam-se eutiróideos usualmente 6 a 12 semanas após iniciar os antitiroidíanos. Aderência à medicaçäo é vital para o sucesso da terapêutica. Com os objetivos de avaliar retrospectivamente o tempo necessário para a obtençäo do eutiroidismo clínico e laboratorial e o custo da terapêutica clínica, analisamos 82 pacientes com doença de Graves atendidos entre fevereiro/96 e novembro/97 e acompanhados até julho/99. Destes, 49 (59,8 por cento) foram acompanhados até o eutiroidismo, ocorrido em 24,8 semanas. Apenas 11 alcançaram o eutiroidismo em 12 semanas. Dezesseis pacientes näo aderentes despenderam tempo significantemente maior até o eutiroidísmo que os aderentes (37,3 vs. 18,7 semanas). O abandono do tratamento ocorreu em 36,6 por cento dos pacientes. O custo do tratamento em 24,8 semanas somou R$248,72, contra R$151,68 em 12 semanas. Assim, nossos pacientes demoram mais tempo para alcançar o eutiroidísmo que o usualmente descrito, implicando em um custo 64 por cento maior. A falta de aderência é a justificativa mais importante para este atraso na compensaçäo da tirotoxicose.

Pé diabético: avaliaçäo da evoluçäo e custo hospitalar de pacientes internados no Conjunto Hospitalar de Sorocaba / Diabetic foot: evaluation of evolution and hospital cost of hospitalized patients in Conjunto Hospitalar de Sorocaba

O pé diabético é uma dos principais complicaçöes do diabetes mellitus (DM), sendo causa freqüente de internaçöes hospitalares. Os custos destas internaçöes e o ônus social constituem um grave problema de saúde. Com o objetivo de avaliar diabéticos portadores de lesöes podais internados, estudamos 23 pacientes (14M, 9F; 39-80 anos de idade), no período de abril a novembro de 1999. Todos tinham DM tipo 2 e 48 por cento deles foram internados com glicemia <200mg/dL. As lesöes estavam assim distribuídas (segundo classificaçäo de Wagner): grau 1:26 por cento; grau 2:17 por cento; grau 3:13 por cento; grau 4:35 por cento; grau 5: 9 por cento. Evoluíram para amputaçäo 65 por cento dos pacientes, sendo 30 por cento de coxa. O tempo mediano de internaçäo foi de 14 dias. O custo mediano das internaçöes foi de R$1.004,59 e em 24 por cento delas foi superior a R$2.000,00. Somado ao custo médio de próteses (R$1.900,00), totaliza-se um ônus próximo a R$3.000,00. Na amostra, 9 pacientes estavam na faixa etária economicamente ativa. Os pacientes portadores de lesöes nos pés säo responsáveis por internaçöes prolongadas e de custo elevado, o que näo é compatível com o sistema público de saúde do nosso país. Assim, a prevençäo é um dos pontos fundamentais para melhorar o prognóstico desta patologia.