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1.
Ecancermedicalscience ; 14: 1044, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32565897

RESUMO

Introduction: The world is living through an outbreak of an acute respiratory syndrome caused by a new betacoronavirus known as coronavirus 2 (SARS CoV-2), which has been declared an international public health emergency by the World Health Organisation. Cancer patients are a very special population in this setting since they are more susceptible to viral infections than the general population. Several recommendations have been made on this issue, most of them based on expert opinion and institutional experience. It is essential to gather the evidence available for decision making. Objective: To review the evidence available in order to create a multi-institutional position from the perspective of scientific societies in Argentina involved in the management of cancer patients. Methodology: The review included two phases: 1) search and systematic revision of the medical literature; 2) consensus and revision of the document drafted by national scientific societies involved in the management and care of cancer patients using the modified Delphi method. The final results were presented at a videoconference with all the participants. Also, additional comment and recommendations were discussed. The final document was revised and approved for publication by the members of the panel. Results: The consensus panel included 18 representatives from scientific societies from Argentina who assessed the evidence and then made recommendations for the management of cancer patients in our country. International guidelines (CDC; ASCO, NCCN and ESMO) were considered as a background for analysis, as well as institutional guidelines and an open ad hoc survey administered to 114 healthcare professionals from the scientific societies involved in this study.The recommendations are grouped as follows: 1) general care interventions-training of the personnel, cleaning and disinfection of the hospital premises and patient scheduling; 2) treatment decisions-patient care, surgeries, immunosuppressive therapy, radiotherapy and screening; 3) ethical considerations-optimisation of resources, end-of-life care for critically-ill patients; 4) management of hospitalised patients; and 5) wellbeing of the healthcare team.The general recommendation arising from the study is that the management of cancer patients must adapt to the exceptional pandemic status quo without disregarding treatment or cure options. Moreover, healthcare professional accompaniment of all patients should not be neglected. All healthcare professionals must make a significant joint effort to create multidisciplinary teams to discuss the most appropriate measures for each particular situation. Conclusions: The scientific evidence available on this topic worldwide is in progress. This together with the epidemiologically shifting scenario poses unprecedented challenges in the management of cancer amidst this global pandemic. Furthermore, the key role of the healthcare structural organisation appears evident, such as the drafting of clear guidelines for all the stakeholders, adaptability to constant change and an interdisciplinary shared vision through consensus to provide adequate care to our cancer patients in the light of uncertainty and fast-paced change.

2.
Artigo em Espanhol | BINACIS | ID: biblio-1053489

RESUMO

INTRODUCCIÓN: El cáncer de mama es la primera causa de muerte de la mujer en la Argentina, con una incidencia estimada de más de 19.000 casos nuevos por año. Dentro de estos, el tipo de cáncer hereditario más común es el de mama/ovario hereditario, provocado por mutaciones en los genes BRCA 1(Breast cáncer) y BRCA 2. A su vez el cáncer colorrectal es la segunda causa de muerte en Argentina, con una incidencia estimada de más de 11.000 casos nuevos por año. OBJETIVO: de la presente investigación es evaluar la utilidad de la realización de los estudios genéticos en personas con cáncer hereditario en el contexto del consejo genético, con un asesoramiento antes y después de realizarse la prueba genética POBLACIÓN Y MÉTODOS: Se estudiaron 34 mujeres con diagnóstico de cáncer de mama/ovario y 31 pacientes de ambos sexos con diagnóstico de cáncer colorrectal (CCR). En las mujeres se analizaron los genes BRCA 1 y 2 por secuenciación de próxima generación (NSG) y grandes rearreglos de los genes BRCA 1 y 2 por amplificación de sonda dependiente de la ligadura multiplex (MLPA). En las personas de ambos sexos se determinó la Inestabilidad de Microsatelites(IMS), el análisis de mismatch repair (MMR) por MLPA y la mutación del gen BRAF (Protooncogen B-Raf) RESULTADOS: Los resultados mostraron que las pacientes con cáncer de mama / ovario con antecedentes familiares tienen un alto porcentaje de BRCA negativo. En cuanto a los cambios fenotípicos, el más predominante en este estudio, fue el subtipo triple negativo y la paciente con BRCA 2 positivo presentó este fenotipo. Con respecto al estudio del cáncer de colon detectamos cuatro pacientes con IMS-alta y mutación del V600E del gen BRAF. Cuando se les realizó el análisis de MLPA en los genes MSH6, MLH1, MSH2 y PMS2 a los efectos de establecer la diferencia entre CCR y síndrome de Lynch, los resultados fueron negativos, por lo tanto, estos pacientes fueron diagnosticados como CCR esporádico. CONCLUSIONES: Como lo demuestra este trabajo, para el consejo genético, el estudio de vías moleculares en pacientes con cáncer hereditario es un instrumento de ayuda para la valoración del riesgo génico. (AU)


INTRODUCTION: Breast cancer is the leading cause of death of women in Argentina, with a estimated incidence of more than 19,000 new cases per year. Among these, the most common type of inherited cancer is the breast /ovarian caused by mutations in the BRCA1 and BRCA 2 genes. At the same time, the cancer colorrectal is the second cause of death in Argentina, with an estimated incidence of more than 11,000 new cases per year. OBJECTIVE: of the present investigation is to evaluate the usefulness of the realization of the genetic studies in people with hereditary cancer in the context of genetic counseling, with a advice before and after the genetic test. POPULATIONS AND METHODS: We studied 34 women diagnosed with breast / ovarian cancer and 31 patients of both sexes with diagnosis of colorectal cancer (CRC). In women, the BRCA 1 and 2 genes by next generation sequencing (NSG) and large rearrangements of BRCA 1 and 2 genes by probe amplification dependent on multiplex ligation(MLPA). The instability of microsatellites (IMS) was determined in people of both sexes, the analysis of mismatchrepair (MMR) by MLPA and the mutation of the BRAF gene. RESULTS: There results showed that patients with breast / ovarian cancer with a history family members have a high percentage of negative BRCA. As for the changes phenotypic, the most predominant in this study, was the triple negative subtype and the patient with positive BRCA 2 presented this phenotype. With respect to the study of colon cancer detected four patients with IMS-high and mutation of the V600E of the BRAF gene. When the MLPA analysis was performed on the MSH6, MLH1, MSH2 genes and PMS2, in order to established difference between CRC and Lynch syndrome, the results were negative and therefore these patients were diagnosed as sporadic CRC. CONCLUSIONS: As this work demonstrates, for him genetic counseling, the study of pathways molecules in patients with hereditary cancer is a helpful instrument for risk assessment. (AU)


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Genes BRCA1 , Predisposição Genética para Doença , Genes BRCA2 , Síndrome Hereditária de Câncer de Mama e Ovário , Neoplasias Ovarianas , Argentina , Neoplasias da Mama , Neoplasias Colorretais , Testes Genéticos , Estudos de Associação Genética
3.
Artigo em Espanhol | BINACIS | ID: biblio-1096267

RESUMO

INTRODUCCION: Alrededor del 10 al 20 % de las mujeres con cáncer de mama tienen uno o más familiares de primer grado que también están afectados por cáncer de mama. Aunque sólo del 5 al 10 % de las mujeres no seleccionadas con cáncer de mama tienen una forma hereditaria, asociado a un gen mutado, deficitario en su función, hasta el 20 % de las mujeres con antecedentes familiares de cáncer de mama tienen una mutación en un gen de predisposición a cáncer de moderada o alta penetrancia. OBJETIVO PRIMARIO: Describir los antecedentes oncológicos personales y familiares de pacientes a los que se les solicitó el estudio de mutaciones BRCA 1 y BRCA 2 y compararlos con los criterios usados en guías nacionales (INC) e internacionales (NCCN) compararlos con los criterios usados en guías nacionales (INC) e internacionales (NCCN). MATERIALES Y MÉTODOS: Diseño: Estudio retrospectivo, descriptivo y observacional.Población: Se analizarán todas las historias clínicas de los pacientes a los cuales se les haya realizado el proceso de asesoramiento genético y solicitado el estudio para mutaciones BRCA 1 y 2 desde: julio 15 hasta julio 2018, en la Clínica Universitaria Reina Fabiola e instituto Oulton. RESULTADOS: Se solicitó el estudio para mutaciones deletéreas de genes BRCA 1 y 2 a 94 individuos. La edad promedio fue de 45 años. De los 94 individuos 61 tenían cáncer de mama (64,89%), 10 cáncer de ovario (10,63%), y 23 (24%) no tenían cancer. Del total de individuos, 30 no se lo realizaron por diferentes motivos: 13 (43%) por motivos personales, 3 (10%) por falta de cobertura de la obra social, 14 (46%) no retornaron a consulta.Todos, excepto dos pacientes a quienes se le solicitó el estudio de mutaciones BRCA 1 y 2 cumplían los criterios de las guías americanas y nacionales para el testeo de la mutación. De los 64 individuos que realizaron el test, 14 (21,87%) tenían mutaciones deletéreas, 1 de significado incierto, y 49 dieron negativos (76,5%). De las 61 pacientes con cáncer de mama estudiadas, 48 (78%) eran menores de 50 años, 24 (39,3%) tenían tumores triple negativos, 19 (31%) ganglios axilares positivos, 13 (21%) tumores luminales, 31 (50%) antecedentes familiares de cáncer relacionado con las mutaciones BRCA 1 y 2, 2 de ellas (3%) eran de origen judío askenazi. Dentro los 14 pacientes con mutaciones BRCA, 10 (71%) presentaban mutación BRCA 1 y 4 (28%) en el gen BRCA 2. De los mismos, 8 (57%) tenían cáncer de mama, 2 (14%) cáncer de ovario, 4 (28%) no tenían cáncer. De las 8 pacientes con BRCA mutado con cáncer de mama: todas eran menor de 50 años.3 tenían tumores triple negativos, ninguna tenía familiares con enfermedad oncológica relacionada, 3 tenían ganglios axilares positivos, 2 eran pacientes con tumores luminales. 1 era her2 positivo. De los pacientes con mutaciones positivas con cáncer de ovario, ambas pacientes tenían más de 65 años, tumores serosos y ninguna tenía antecedentes familiares de cáncer. CONCLUSIONES: Podemos concluir que la población estudiada en nuestra serie, coincide con los factores de riesgo para screening de mutaciones BRCA según NCCN en cuanto a: edad menor de 50 años, factores de riesgo heredofamiliares, la variedad de los tumores de mama, el tipo histológico de los tumores de ovario. (AU)


INTRODUCTION: About 10 to 20% of women with breast cancer have one or more first degree relatives who are also affected by breast cancer. Although only 5 to 10% of women not selected with breast cancer have a hereditary form, associated with a mutated gene, deficient in their function, up to 20% of women with a family history of breast cancer have a mutation in a predisposition gene for cancer of moderate or high penetrance . PRIMARY OBJECTIVE: To describe the personal and family oncological history of patients who were asked to study BRCA 1 and BRCA 2 mutations and compare them with the criteria used in national (INC) and international (NCCN) guidelines Design: Retrospective, descriptive and observational study. Population: All the clinical histories of the patients who have undergone the genetic counseling process and the study for BRCA 1 and 2 mutations from July 2015 to July 2018, at the Reina Fabiola University Clinic and Oulton, will be analyzed. RESULTS: The study was requested for deleterious mutations of BRCA 1 and 2 genes in 94 individuals. The average age was 45 years. Of the 94 individuals, 61 had breast cancer (64.89%), 10 ovarian cancer (10.63%), and 23 (24%) had no cancer Of the total number of individuals, 30 were not carried out for different reasons: 13 (43%) for personal reasons, 3 (10%) for lack of social work coverage, 14 (46%) did not return to consultation All but two patients who were asked to study BRCA 1 and 2 mutations met the criteria of the American and national guidelines for mutation testing. Of the 64 individuals who performed the test, 14 (21.87%) had deleterious mutations, 1 of uncertain significance, and 49 were negative (76.5%). Of the 61 patients with breast cancer studied, 48 (78%) were younger than 50 years old, 24 (39.3%) had triple negative tumors, 19 (31%) positive axillary lymph nodes, 13 (21%) luminal tumors, 31 (50%) family history of cancer related to BRCA 1 and 2 mutations, 2 of them (3%) were of Ashkenazi Jewish origin. Within the 14 patients with BRCA mutations, 10 (71%) had a BRCA 1 and 4 (28%) mutation in the BRCA 2 gene. Of these, 8 (57%) had breast cancer, 2 (14%) cancer ovary, 4 (28%) did not have cancer. Of the 8 patients with BRCA mutated with breast cancer: all were younger than 50 years 3 had triple negative tumors, none had relatives with related oncological disease, 3 had positive axillary nodes, 2 were patients with luminal tumors 1 was her2 positive.Of the patients with positive mutations with ovarian cancer, both patients were over 65 years old, had serous tumors and none had a family history of cancer. CONCLUSIONS: We can conclude that the population studied in our series coincides with the risk factors for screening BRCA mutations according to NCCN in terms of: age under 50 years, heredity-familial risk factors, the variety of breast tumors, the histological type of Ovarian tumors. (AU)


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias Ovarianas/genética , Neoplasias da Mama/genética , Genes BRCA1 , Genes BRCA2 , Mutação
4.
Med Oncol ; 35(4): 56, 2018 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-29556815

RESUMO

Prostate cancer is a significant burden and cause of mortality in Latin America. This article reviews the treatment options for patients with metastatic castration-resistant prostate cancer (mCRPC) and provides consensus recommendations to assist Latin American prostate cancer specialists with clinical decision making. A multidisciplinary expert panel from Latin America reviewed the available data and their individual experience to develop clinical consensus opinions for the use of life-prolonging agents in mCRPC, with consideration given to factors influencing patient selection and treatment monitoring. There is a lack of level 1 evidence for the best treatment sequence or combinations in mCRPC. In this context, consensus recommendations were provided for the use of taxane-based chemotherapies, androgen receptor axis-targeted agents and targeted alpha therapy, for patients in Latin America. Prostate-specific antigen (PSA) changes alone, during treatment, should be treated with caution; PSA may not be a suitable biomarker for radium-223. Bone scans and computed tomography are the standard imaging modalities in Latin America. Imaging should be prompted during treatment where symptomatic decline and/or significant worsening of laboratory evaluations are reported, or where a course of therapy has been completed and another antineoplastic agent is under consideration. Recommendations and guidance for treatment options in Latin America are provided in the context of country-level variable access to approved agents and technologies for treatment monitoring. Patients should be treated with the purpose of prolonging overall survival and preserving quality of life through increasing the opportunity to administer all available life-prolonging therapies when appropriate.


Assuntos
Neoplasias de Próstata Resistentes à Castração/terapia , Tomada de Decisão Clínica , Consenso , Humanos , América Latina/epidemiologia , Masculino , Metástase Neoplásica , Neoplasias de Próstata Resistentes à Castração/mortalidade , Neoplasias de Próstata Resistentes à Castração/patologia
6.
Rev. argent. neurocir ; 25(2): 71-77, abr.-jun. 2011. ilus
Artigo em Espanhol | LILACS | ID: lil-605494

RESUMO

Objetivo: presentar nuestra experiencia en el manejo de gliomas cerebrales de bajo grado (GCBG) en la infancia. Material y método: se incluyeron 30 niños menores de 15 años operados de GCBG entre 1982 y 2008 (17 varones y 13 mujeres). Resultados: las convulsiones fueron la principal manifestación clínica en 24 niños (80%). La IRM fue el método diagnóstico de elección. En 24 pacientes se realizó EEG en el pre-operatorio. Astrocitomas fibrilares y oligodendrogliomas fueron la variedad más frecuente (28/30). Las modalidades terapéuticas fueron: en 19 casos sólo resección tumoral , en 8 exéresis más radioterapia, en 2 casos radiocirugía estereotáctica intersticial con I125 y en un paciente sólo se trato la hidrocefalia. Fallecieron 3 niños (10%); un niño por sepsis (por infección de la derivación del LCR), 6 años y 6 meses después de la cirugía; otro paciente falleció de un infarto de miocardio, 22 años después de la cirugía; y el tercer caso fue un paciente que paso de un ganglioglioma grado II a un glioblastoma multiforme, 10 años y 5 meses después de la primera cirugía. De los 27 niños que viven (90%), 25 (83.3%) están libres de crisis, y 2 (6.6%) tienen convulsions esporádicas con un EEG anormal. El rango de sobrevida fue entre 5 meses y 25 años, con una media de 12 años y 7 meses. Conclusión: la extensión de la resección quirúrgica es el factor pronóstico más importante. Se emplea radioterapia y quimioterapia cuando la exéresis fue incompleta, sobretodo cuando hay recidiva y signos de malignización. La braquiterapia es una buena opción terapéutica.


Assuntos
Astrocitoma , Glioma , Oligodendroglioma
8.
Am J Clin Oncol ; 29(1): 45-51, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16462502

RESUMO

OBJECTIVES: Irinotecan or oxaliplatin combined with 5-fluorouracil (5-FU) +/- folinic acid (FA) has changed the treatment standards for metastatic colorectal cancer (CRC). The oxaliplatin and irinotecan combination has reported consistent activity. The purpose of this phase II study was to assess the efficacy and safety of the simultaneous administration of a triple chemotherapy combination of oxaliplatin, irinotecan, 5-FU bolus, and FA. MATERIALS AND METHODS: Eligible patients had metastatic CRC with no prior oxaliplatin or irinotecan-based chemotherapy. Treatment consisted of oxaliplatin 85 mg/m2 followed by irinotecan 150 mg/m2, repeated every 15 days, with 5-FU 500 mg/m2 bolus and FA 20 mg/m2 on days 1, 8, and 15. An early amendment suppressed the day 8 5-FU/FA. RESULTS: Twenty-six eligible treated patients receiving 253 doses were assessed for toxicity. Myelosuppression was the most frequent toxicity; grade 3 to 4 neutropenia and febrile neutropenia occurred in 50% and 15% of patients, respectively. The treatment schedule modification, omitting the 5-FU dosing on day 8, considerably improved treatment compliance, reducing the incidence of febrile neutropenia, diarrhea, and asthenia. Among the 25 patients evaluable for efficacy, 10 had objective responses including 1 complete response (CR) (4%) and 9 partial responses (PR) (36%), giving an overall response rate of 40%. Median time to progression was 6.20 months [95% confidence interval (CI), 5.44-6.96]. Median overall survival was 12.95 months. CONCLUSIONS: The administration of a triple combination produced promising objective responses with acceptable toxicity but does not seem to produce an evident benefit in time-related parameters.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/patologia , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Camptotecina/administração & dosagem , Camptotecina/análogos & derivados , Diarreia/induzido quimicamente , Feminino , Fluoruracila/administração & dosagem , Humanos , Infusões Intravenosas , Injeções Intravenosas , Irinotecano , Leucovorina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Neutropenia/induzido quimicamente , Compostos Organoplatínicos/administração & dosagem , Oxaliplatina , Resultado do Tratamento
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