SEOM clinical guidelines for diagnosis and treatment of metastatic colorectal cancer 2015

Colorectal cancer (CRC) is the second leading cause of cancer dead in Spain. About half the patients will eventually develop distant metastases. However, as treatment options are expanding, prognosis has steadily improved over the last decades. Management of advanced CRC should be discussed within an experienced multidisciplinary team to select the most appropriate systemic treatment (chemotherapy and targeted agents) and to integrate surgical or ablative procedures when indicated. Disease site and extent, resectability, tumor biology and gene mutations, clinical presentation, patient preferences, and comorbidities are key factors to design a customized treatment plan. The aim of these guidelines is to provide synthetic recommendations for managing advanced CRC patients (AU)

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Gemcitabine plus capecitabine (Gem–Cape) biweekly in chemorefractory metastatic colorectal cancer

Purpose: A proportion of patients with metastatic colorectal cancer (mCRC) are still able to continue with active therapy after their progression to fluoropyrimidines, oxaliplatin, and irinotecan regimens. Studies suggest that gemcitabine and fluoropyrimidines are synergic antimetabolites. The purpose was to evaluate gemcitabine–capecitabine (Gem–Cape) in heavily pretreated mCRC and to thus assess possible predictive factors for progression-free survival (PFS) and overall survival (OS). Patients and methods: This analysis was performed on 119 evaluable patients pretreated with fluoropyrimidines, oxaliplatin, irinotecan, and biological agents between June 2001 and July 2011. Patients received gemcitabine 1,000 mg/m2 day 1 and capecitabine 1,000 mg/m2 bid for 7 days every 2 weeks. Results: The general characteristics were ECOG 0–1, 89 %; male, 68 %, and median age 63 years. In total, 61 % had received two chemotherapy lines, while 39 % had received three or more. Objective response rates and stable disease rates at 3 months were 6.72 and 37.81 %, equalling a clinical benefit of 44.53 %. The median PFS and OS were 2.87 months [95 % confidence interval (CI) 2.53–3.17 months] and 6.53 months (95 % CI 5.33–8.77), respectively. The most frequent toxicities were grades 1–2, anemia (22 %), thrombocytopenia (10 %), and hand–foot syndrome (9 %); grade ≥3, diarrhea (2 %), with no treatment-related discontinuations. No treatment-related deaths were reported. Statistical significance was obtained by subgroups, assessing clinical benefits and objective responses for PFS and OS. Moreover, patients under 65 tended to have a better PFS. Conclusion: These data suggest that Gem–Cape is a tolerable and feasible regimen, associated with clinical benefit in non-selected, heavily pretreated, mCRC patients (AU)

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Erratum to: Gemcitabine plus capecitabine (Gem–Cape) biweekly in chemorefractory metastatic colorectal cancer

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Recommendations and expert opinion on the adjuvant treatment of colon cancer in Spain

Adjuvant chemotherapy is the current standard in the management of patients with localised colon cancer (CC) following curative resection. The use of oxaliplatin plus 5 fluorouracil/leucovorin (FOLFOX) or oxaliplatin plus capecitabine-based (XELOX) regimens, both approved in Europe as adjuvant treatment for stage III CC, has improved prognosis in this stage, but questions on their usefulness in high-risk stage II or elderly CC patients and on the role of some prognostic biomarkers are still pending. In April 2010, a consensus meeting on adjuvant CC treatment based on a revision of the most recent literature was held in Spain. The panel considered the use of adjuvant chemotherapy for high-risk stage II CC patients to be justified. Additionally, the more convenient administration of oral fluoropyrimidines vs. IV continuous infusion 5-FU would make XELOX a more suitable alternative for the patient. A more cautious decision should be taken when prescribing oxaliplatin treatment in patients aged ≥70 (AU)

Impact of the incorporation of tyrosine kinase inhibitor agents on the treatment of patients with a diagnosis of advanced renal cell carcinoma: study based on experience at the Hospital Universitario Central de Asturias

INTRODUCTION: For nearly the past two decades, cytokines (CKs) have been the only systemic treatment option available for advanced renal cell carcinoma (RCC). In recent years, tyrosine kinase inhibitors (TKIs) have demonstrated clinical activity on this tumour. Our purpose is to describe one centre's experience with the use of CKs and TKIs in the treatment of patients with advanced RCC. MATERIALS AND METHODS: This study was designed as a retrospective chart review of RCC patients who were treated with CKs and/or TKIs in our department between July 1996 and June 2008. Efficacy and toxicity were assessed using World Health Organization (WHO) criteria. The Kaplan-Meier method was used to estimate progression-free (PFS) and overall (OS) survival. RESULTS: Ninety-four patients were classified into three groups depending on the modality of treatment administered: 46 were treated with CKs alone and/or chemotherapy (27 with immunotherapy, one with chemotherapy and 18 with both), 28 with TKIs alone (25 with sunitinib and 13 with sorafenib) and 20 with TKIs in second-line treatment following failure with CKs (17 with sunitinib, eight with sorafenib, four with bevacizumab and one with lapatinib). The median age was 60 years in the CK group and 65 and 62, respectively, in TKI in first and second-line treatment groups. Eighty-five percent of patients treated with CKs and 75% in the TKI group in first-line treatment and 80% in second-line treatment were men. Overall, 89% of patients had favourable risk, and 11% had intermediate risk. All patients were considered evaluable for toxicity. The main grade 3-4 (%) toxicity was asthenia for both groups, (ten in TKIs and 15 in CKs). Other grade 1-2 toxicities were mucositis (39), bleeding (8), hypertension (19), skin toxicity (33) and hypothyroidism (12.5) associated with TKIs; and anaemia (33), cough (29), asthenia (39) and emesis (14) associated with CKs. The objective response rate among 80 patients evaluable for activity was 10.6% with CKs and 46.5% and 35%, respectively, with TKIs in first- and second-line treatments. Disease stabilisation with CKs was recorded at 59% of patients and with TKIs 25% and 50% in first- and second-line treatment groups, respectively. The median progression-free survival (PFS) with CKs was 122 days [95% confidence interval (CI) 82-162] and with TKIs 201 days (65-337) in the first and 346 days (256-436) in second-line treatment groups. The median overall survival (OS) was 229 days (142-316) and 2,074 days (1,152-2,996) for patients treated with CKs and TKIs. CONCLUSIONS: Our results are in line with the activity and survival rates previously reported in the literature regarding the use of TKIs for patients with advanced RCC in first- and second-line treatment, which has demonstrated an acceptable toxicity level (AU)

Tratamiento adyuvante en pacientes diagnosticados de carcinoma no microcítico de pulmón: estado de la evidencia científica / Adjuvant treatment of non-small cell lung cancer patients: state of the scientific evidence

La cirugía representa el tratamiento curativo de elección para los pacientes que son diagnosticadosde carcinoma no microcítico de pulmón en estadio local. Sin embargo, gran parte de ellos experimentanuna recurrencia de su enfermedad lo que ha llevado al empleo de opciones terapéuticas tanto localescomo sistémicas con el ánimo de mejorar las posibilidades de curación. Durante las últimas décadasdiversos estudios comparativos heterogéneos y varios meta-análisis publicados en los años 95 y 97no demostraron de forma significativa una ventaja al asociar la quimioterapia y/o radioterapia adyuvantea la cirugía. Desde entonces y hasta nuestros días otros trabajos realizados con un número mayorde pacientes y empleando una quimioterapia más eficaz basada en combinaciones de platino, coincidenen describir un beneficio con su utilización aunque no de forma unánime. Más recientemente, unnuevo meta-análisis recopilando la mayoría de los estudios antes mencionados ha confirmado de formasignificativa una mejoría absoluta del 4% en la supervivencia global de los pacientes sometidos aquimioterapia adyuvante, especialmente en los estadios patológicos II-III tras cirugía y tratados conregímenes que incluyen cisplatino y vinorelbina. Queda por ser determinado el papel que desempeñanotros agentes como el uracilo/tegafur así como la radioterapia en el contexto adyuvante

Surgery is the current treatment of choice in patients with early-stage non-small cell lung cancer.Based on the high rates of recurrence, additional local and systemic treatments have been developed,aimed at improving the cure rates. The comparative studies about the benefits of post-operativeadjuvant chemotherapy and/or radiotherapy, and the meta-analysis studies made during the lastdecades, reviewed in some articles appeared in 95 and 97, did not confirm a significant improvementof the overall survival. Since then, new comparative trials carried out with a higher number of patientsand with more active and standard chemotherapy seem to show a benefit of the administration ofplatinum-based chemotherapy, although it has not gained general acceptance. More recently, a newmeta-analysis, that included the previous studies, has confirmed an overall increase of 4 % in survivalof patients treated by surgery and adjuvant chemotherapy, especially in stages II-III patients receivingschedules of cisplatin and vinorelbine. Further studies are needed to determine the real therapeuticvalue of other agents, as uracil-tegafur and radiotherapy

Quimioterapia complementaria tras resección de metástasis hepáticas en el carcinoma colorrectal / No disponible

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Taxol, propanolol, cimetidina y parada cardiorespiratoria / Taxol, propanolol, cimetidine and cardiorespiratory arrest

Propósito: Estudiar un caso de parada cardiorespiratoria en una paciente tratada con paclitaxel a la luz de los datos de la literatura. Caso clínico: Paciente de 74 años de edad, sin antecedentes de patología cardiaca y con ingesta crónica de propanolol a causa de un temblor esencial, fue tratada con taxol en segunda línea y presentó a los pocos minutos de iniciarse su infusión una parada cardiorespiratoria, que fue rápidamente reversible al iniciarse las maniobras iniciales de resucitación cardiorespiratoria. Se analiza el caso, considerando la medicación concomitante (propanolol, cimetidina, dexclorferinamina) a la luz de los datos de la literatura. Conclusiones: En el momento del cuadro, tres drogas con efectos sobre el sistema de conducción cardiaco coincidieron en el tiempo. Es aconsejable la discontinuación de B-bloqueantes aunque se estén empleando a dosis bajas y no existan anormalidades en el ECG (AU)