SEOM-GEINO clinical guideline of systemic therapy and management of brain central nervous system metastases (2021)

Central nervous system (CNS) dissemination is a severe complication in cancer and a leading cause of cancer-related mortality. Brain metastases (BMs) are the most common types of malignant intracranial tumors and are reported in approximately 25% of patients with metastatic cancers. The recent increase in incidence of BMs is due to several factors including better diagnostic assessments and the development of improved systemic therapies that have lower activity on the CNS. However, newer systemic therapies are being developed that can cross the blood–brain barrier giving us additional tools to treat BMs. The guidelines presented here focus on the efficacy of new targeted systemic therapies and immunotherapies on CNS BMs from breast, melanoma, and lung cancers.

SEOM-GEINO clinical guideline of systemic therapy and management of brain central nervous system metastases (2021).

Central nervous system (CNS) dissemination is a severe complication in cancer and a leading cause of cancer-related mortality. Brain metastases (BMs) are the most common types of malignant intracranial tumors and are reported in approximately 25% of patients with metastatic cancers. The recent increase in incidence of BMs is due to several factors including better diagnostic assessments and the development of improved systemic therapies that have lower activity on the CNS. However, newer systemic therapies are being developed that can cross the blood-brain barrier giving us additional tools to treat BMs. The guidelines presented here focus on the efficacy of new targeted systemic therapies and immunotherapies on CNS BMs from breast, melanoma, and lung cancers.

Neumonía organizada asociada a tratamiento con trastuzumab / Organizing Pneumonia Associated with the Use of Trastuzumab

La neumonía organizada es una entidad clinicohistológica que suele manifestarse de forma subaguda con clínica respiratoria e infiltrados pulmonares. Puede ser de causa desconocida (criptogenética) o estar asociada a distintas enfermedades, infecciones o fármacos. Presentamos el caso de una paciente de 60 años con antecedentes de una neoplasia de mama, motivo por el cual seguía tratamiento con trastuzumab, un anticuerpo monoclonal anti-HER2, a quien se detectó de forma casual un infiltrado pulmonar, cuya biopsia transbronquial fue diagnóstica de neumonía organizada. Tras la retirada del fármaco desapareció el infiltrado pulmonar. Debido a la creciente utilización de la terapia biológica en diferentes campos de la clínica, nos parece de interés comunicar esta forma de afectación pulmonar atribuible al anticuerpo monoclonal trastuzumab(AU)

Organizing pneumonia is a clinical and histological condition in which the onset is usually subacute with respiratory symptoms and pulmonary infiltrates. It may be unknown origin (cryptogenic) or associated with other illnesses, infectious diseases or drugs. We present a 60 year-old female patient with a previous history of breast cancer, who was being treated with trastuzumab, an antiHER2 monoclonal antibody. She was diagnosed with casual pulmonary infiltrates that had histological changes compatible with organizing pneumonia. The pulmonary infiltrates disappeared on withdrawing trastuzumab treatment. Due to the increasing use of biological therapies in different medical areas, we believe it is of interest to report this pulmonary involvement attributed to the monoclonal antibody trastuzumab(AU)

[Organizing pneumonia associated with the use of trastuzumab]. / Neumonía organizada asociada a tratamiento con trastuzumab.

Organizing pneumonia is a clinical and histological condition in which the onset is usually subacute with respiratory symptoms and pulmonary infiltrates. It may be unknown origin (cryptogenic) or associated with other illnesses, infectious diseases or drugs. We present a 60 year-old female patient with a previous history of breast cancer, who was being treated with trastuzumab, an antiHER2 monoclonal antibody. She was diagnosed with casual pulmonary infiltrates that had histological changes compatible with organizing pneumonia. The pulmonary infiltrates disappeared on withdrawing trastuzumab treatment. Due to the increasing use of biological therapies in different medical areas, we believe it is of interest to report this pulmonary involvement attributed to the monoclonal antibody trastuzumab.

Prevention of irinotecan associated diarrhea by intestinal alkalization. A pilot study in gastrointestinal cancer patients.

AIM AND BACKGROUND: Intestinal alkalization could prevent irinotecan associated diarrhea modulating some chemical equilibria between irinotecan metabolites. The aim of this study was to evaluate the efficacy of this procedure in advanced gastrointestinal cancer patients (GICP). MATERIALS AND METHOD: In this prospective study advanced GICP, receiving irinotecan based chemotherapy regimens, were well trained to add sodium bicarbonate to the water intake in order to accomplish intestinal alkalization. RESULTS: A total of twenty four advanced GICP were enrolled. Grade III-IV diarrhea has been observed in four patients (16%), some of whom had several risk factors for diarrhea. Only one out of seventeen colorectal cancer patients, receiving the irinotecan combination as first line therapy, had grade III-IV diarrhea. No side effects of the procedure have been appreciated. CONCLUSIONS: Intestinal alkalization may be effective as a preventive treatment for irinotecan associated diarrhea in chemotherapy regimens used in GICP. This procedure deserves further investigation.

Prevention of irinotecan associated diarrhea by intestinal alkalization. A pilot study in gastrointestinal cancer patients

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Aim and background. Intestinal alkalization couldprevent irinotecan associated diarrhea modulatingsome chemical equilibria between irinotecan metabolites.The aim of this study was to evaluate the efficacyof this procedure in advanced gastrointestinalcancer patients (GICP).Materials and method. In this prospective studyadvanced GICP, receiving irinotecan based chemotherapyregimens, were well trained to add sodiumbicarbonate to the water intake in order to accomplishintestinal alkalization.Results. A total of twenty four advanced GICP wereenrolled. Grade III-IV diarrhea has been observedin four patients (16%), some of whom had severalrisk factors for diarrhea. Only one out of seventeencolorectal cancer patients, receiving the irinotecancombination as first line therapy, had grade III-IVdiarrhea. No side effects of the procedure have beenappreciated.Conclusions. Intestinal alkalization may be effectiveas a preventive treatment for irinotecan associateddiarrhea in chemotherapy regimens used in GICP.This procedure deserves further investigation