Influence of BRAF and PIK3CA mutations on the efficacy of FOLFIRI plus bevacizumab or cetuximab as first-line therapy in patients with RAS wild-type metastatic colorectal carcinoma and <3 baseline circulating tumour cells: the randomised phase II VISNÚ-2 study.

BACKGROUND: We explored the influence of BRAF and PIK3CA mutational status on the efficacy of bevacizumab or cetuximab plus 5-fluorouracil/leucovorin and irinotecan (FOLFIRI) as first-line therapy in patients with RAS wild-type metastatic colorectal cancer (mCRC). PATIENTS AND METHODS: VISNÚ-2 was a multicentre, randomised, phase II study. Patients with RAS wild-type mCRC and <3 circulating tumour cells/7.5 ml blood were stratified by BRAF/PIK3CA status (wild-type versus mutated) and number of affected organs (1 versus >1), and allocated to bevacizumab (5 mg/kg every 2 weeks) or cetuximab (400 mg/m2 then 250 mg/m2 weekly) plus FOLFIRI [irinotecan 180 mg/m2, leucovorin 400 mg/m2, 5-fluorouracil 400 mg/m2 (bolus) then 2400 mg/m2 (46-h continuous infusion) every 2 weeks]. The primary endpoint was progression-free survival (PFS). All analyses were exploratory. RESULTS: Two hundred and forty patients with BRAF/PIK3CA wild-type (n = 196) or BRAF- and/or PIK3CA-mutated tumours (n = 44) were enrolled. Median PFS was 12.7 and 8.8 months in patients with BRAF/PIK3CA wild-type and BRAF/PIK3CA-mutated tumours, respectively [hazard ratio (HR) = 1.22; 95% confidence interval (CI) 0.80-1.85; P = 0.3602]. In the BRAF- and/or PIK3CA-mutated cohort, median PFS was 2.8, 8.8 and 15.0 months in patients with BRAF/PI3KCA-mutated (n = 8), BRAF-mutated/PI3KCA wild-type (n = 16) and BRAF wild-type/PI3KCA-mutated (n = 20) tumours, respectively (P = 0.0002). PFS was similar with bevacizumab plus FOLFIRI versus cetuximab plus FOLFIRI in BRAF/PIK3CA wild-type (HR = 0.99; 95% CI 0.67-1.45; P = 0.9486) and BRAF/PIK3CA-mutated tumours (HR = 1.11; 95% CI 0.53-2.35; P = 0.7820). The most common grade 3/4 treatment-related adverse events were neutropenia, diarrhoea and asthenia in both treatment groups. CONCLUSIONS: BRAF/PIK3CA status influences outcomes in patients with RAS wild-type mCRC but does not appear to assist with the selection of first-line targeted therapy.

Active study: undetected prevalence and clinical inertia in the treatment of breakthrough cancer pain (BTcP).

AIMS: To prove if there is clinical inertia in the identification and treatment of episodes of breakthrough cancer pain (BTcP), comparing actual results from clinical practice with clinical oncologists' prior perception. DESIGN: Observational and descriptive study, using information collected by practising medical oncologists, at three moments: (a) questionnaire regarding their professional judgement of the handling of patients with BTcP in their practice, (b) cross-sectional clinical screening, to detect possible existing cases of BTcP in a representative sample of their patients, (c) retrospective self-audit of clinical case histories of patients diagnosed with BTcP to find out about how it has been handled. PARTICIPANTS AND STUDY PERIOD: A random sample on a state level of 108 specialists in medical oncology. 540 patients who suffer some type of cancer pain on the designated study date for each specialist (July-December 2016). RESULTS: The global prevalence of BTcP in the study sample covered 91.3% of the patients who were suffering some type of cancer pain. Barely 2% of the doctors surveyed suspected figures around this mark. 40.9% of the cases had not been previously detected as BTcP by their doctors. Although 90% of the patients who had previously been diagnosed with BTcP received a specific analgesic treatment for the symptoms, 42% of those patients with known BTcP were not able to control their episodes of pain. CONCLUSIONS: Clinical inertia is a serious problem in the handling of BTcP in medical oncology services, where it is the subject of a significantly low level of detection and treatment, despite the contrasting perception of specialists.

Quimioterapia basada en el perfil genético en el cáncer de pulmón: Nuevos tratamientos para nuevas dianas / No disponible

No disponible

[Effectiveness and safety of imatinib in seven gastrointestinal stromal tumor cases]. / Efectividad y seguridad de imatinib en siete casos de tumores del estroma gastrointestinal.

OBJECTIVE: To measure the effectiveness and safety of imatinib for gstrointestinal stromal tumors (GISTs). METHOD: A retrospective study from 1993 through June 2005 by identifying all patients diagnosed with GIST by the Pathology Department. The medical records of those treated with imatinib were reviewed. Demographic, diagnostic, therapeutic, and outcome-related data were collected. RESULTS: Twenty-five patients were identified, 7 of them treated with imatinib. Total responses were 4/7; 2/7 cases were complete responses, and 2/7 were partial responses. Mean actuarial disease-free survival was 10 months, and overall survival was 44 months. Adverse reactions (ARs) reported included: 33% (5) gastrointestinal events, 40% (6) dermatologic events and/or edema, 14% (2) blood toxicity, and 13% (2) asthenia. In all, 2/7 patients experienced no imatinib-related toxicity. CONCLUSIONS: In our experience, imatinib is an effective, well tolerated therapy for malignant [c-Kit (CD117)-positive], non-resectable and/or metastatic GIST.

Efectividad y seguridad de imatinib en siete casos de tumores del estroma gastrointestinal / Effectiveness and safety of imatinib in seven gastrointestinal stromal tumor cases

Objetivo: Medir la efectividad y seguridad de imatinib en lostumores del estroma gastrointestinal (GIST).Método: Estudio retrospectivo desde el año 1993 hasta juniode 2005 donde se identificaron todos los pacientes diagnosticadosde GIST por anatomía patológica, y se revisaron historias clínicasde los tratados con imatinib. Se recogieron datos demográficos,relativos al diagnóstico, al tratamiento y a la evolución.Resultados: Se identificaron 25 pacientes, 7 tratados conimatinib. La respuesta total fue de 4/7, 2/7 casos fueron respuestascompletas y otros 2/7 respuestas parciales. La mediana actuarialde supervivencia libre de enfermedad alcanzada fue de 10meses y la global 44 meses. Las reacciones adversas (RAM) recogidasfueron: 33% (5) gastrointestinales, 40% (6) dermatológicasy/o edema, 14% (2) toxicidad hematológica y 13% (2) astenia. El2/7 pacientes no experimentaron ningún tipo de toxicidad relacionadacon imatinib.Conclusiones: En nuestra experiencia, imatinib constituye untratamiento efectivo y de buena tolerancia para el GIST maligno[c-Kit (CD117) positivo] no resecable y/o metastásico

Objective: To measure the effectiveness and safety of imatinibfor gstrointestinal stromal tumors (GISTs).Method: A retrospective study from 1993 through June 2005by identifying all patients diagnosed with GIST by the PathologyDepartment. The medical records of those treated with imatinibwere reviewed. Demographic, diagnostic, therapeutic, and outcome-related data were collected.Results: Twenty-five patients were identified, 7 of them treatedwith imatinib. Total responses were 4/7; 2/7 cases were completeresponses, and 2/7 were partial responses. Mean actuarialdisease-free survival was 10 months, and overall survival was 44months. Adverse reactions (ARs) reported included: 33% (5) gastrointestinalevents, 40% (6) dermatologic events and/or edema,14% (2) blood toxicity, and 13% (2) asthenia. In all, 2/7 patientsexperienced no imatinib-related toxicity.Conclusions: In our experience, imatinib is an effective, welltolerated therapy for malignant [c-Kit (CD117)-positive], nonresectableand/or metastatic GIST

[Primary endobronchial non-hodgkins lymphoma: description of a case and review of the literature]. / Linfoma no Hodgkin endobronquial primario: a propósito de un caso y revisión de la literatura.

We report a case of primary endobronchial non-Hodgkin Lymphoma, an unusual extranodal lymphoma, in a 62 year old patient, which begins with malaise, marked respiratory symptoms and empyema. We especially discuss its diagnostic's criteria and its clinicoradiologic manifestations. We argue over its pathologic, immunohistochemical and cytogenetic features according to the REAL classification of lymphomas. On previous experience and the good response of this case, we propose chemotherapy followed radiotherapy may would be a suitable therapeutic approach.

[Acute liver failure as presentation form of small cell carcinoma of the lung]. / Insuficiencia hepática aguda como forma de presentación de un carcinoma microcítico de pulmón.

Metastatic infiltration of the liver is an uncommon cause of acute hepatic failure. We describe the case of a 55-yr-old man who presented with signs and symptoms of liver disease. Diagnostic testing revealed a small cell carcinoma of the lung with massive hepatic metastases.