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2.
JAMA Netw Open ; 4(10): e2128667, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34648011

RESUMO

Importance: Many patients with cancer who would benefit from psychosocial care do not receive it. Implementation strategies may favor the integration of psychosocial care into practice and improve patient outcomes. Objective: To evaluate the effectiveness of the Humanization in Cancer Care (HuCare) Quality Improvement Strategy vs standard care as improvement of at least 1 of 2 domains (emotional or social function) of patient health-related quality of life at baseline and 3 months. A key secondary aim included investigation of the long-term effect. Design, Setting, and Participants: HuCare2 was a multicenter, incomplete, stepped-wedge cluster randomized clinical trial, conducted from May 30, 2016, to August 28, 2019, in three 5-center clusters of cancer centers representative of hospital size and geographic location in Italy. The study was divided into 5 equally spaced epochs. Implementation sequence was defined by a blinded statistician; the nature of the intervention precluded blinding for clinical staff. Participants included consecutive adult outpatients with newly diagnosed cancer of any type and stage starting medical cancer treatment. Interventions: The HuCare Quality Improvement Strategy comprised (1) clinician communication training, (2) on-site visits for context analysis and problem-solving, and (3) implementation of 6 evidence-based recommendations. Main Outcomes and Measures: The primary outcome was the difference between the means of changes of individual scores in emotional or social functions of health-related quality of life detected at baseline and 3-month follow-up (within each group) and during the postintervention epoch compared with control periods (between groups). Long-term effect of the intervention (at 12 months) was assessed as a secondary outcome. Intention-to-treat analysis was used. Results: A total of 762 patients (475 [62.3%] women) were enrolled (400 HuCare Quality Improvement Strategy and 362 usual care); mean (SD) age was 61.4 (13.1) years. The HuCare Quality Improvement Strategy significantly improved emotional function during treatment (odds ratio [OR], 1.13; 95% CI, 1.04-1.22; P = .008) but not social function (OR, 0.99; 95% CI, 0.89-1.09; P = .80). Effect on emotional function persisted at 12 months (OR, 1.05; 95% CI, 1.00-1.10; P = .04). Conclusions and Relevance: In this trial, the HuCare Quality Improvement Strategy significantly improved the emotional function aspect of health-related quality of life during cancer treatment and at 12 months, indicating a change in clinician behavior and in ward organization. These findings support the need for strategies to introduce psychosocial care; however, more research is needed on factors that may maximize the effects. Trial Registration: ClinicalTrials.gov Identifier: NCT03008993.


Assuntos
Neoplasias/terapia , Reabilitação Psiquiátrica/normas , Melhoria de Qualidade , Idoso , Análise por Conglomerados , Estudos Transversais , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/psicologia , Reabilitação Psiquiátrica/métodos , Reabilitação Psiquiátrica/estatística & dados numéricos , Qualidade de Vida/psicologia
3.
Clin Neurol Neurosurg ; 208: 106887, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34418708

RESUMO

We report a case of Guillain-Barré syndrome (GBS) following the first dose of Oxford/AstraZeneca COVID-19 vaccine with papilledema as atypical onset. As the COVID-19 vaccination campaign progresses worldwide, GBSs vaccine-related have been increasingly reported. After reviewing the available literature, considering the annual incidence of GBS, in this historical moment, the public health systems cannot afford an unjustified distrust in vaccines, caused by misinterpretation of epidemiological data. Nonetheless, it is important for clinicians to promptly recognize neurological complications potentially associated with COVID-19 vaccinations and report them to pharmacovigilance agencies.


Assuntos
Vacinas contra COVID-19/efeitos adversos , COVID-19/prevenção & controle , Síndrome de Guillain-Barré/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2
4.
Ther Adv Neurol Disord ; 14: 17562864211019574, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34104220

RESUMO

BACKGROUND AND AIMS: No consensus exists on how aggressively to treat relapsing-remitting multiple sclerosis (RRMS) nor on the timing of the treatment. The objective of this study was to evaluate disability trajectories in RRMS patients treated with an early intensive treatment (EIT) or with a moderate-efficacy treatment followed by escalation to higher-efficacy disease modifying therapy (ESC). METHODS: RRMS patients with ⩾5-year follow-up and ⩾3 visits after disease modifying therapy (DMT) start were selected from the Italian MS Registry. EIT group included patients who received as first DMT fingolimod, natalizumab, mitoxantrone, alemtuzumab, ocrelizumab, cladribine. ESC group patients received the high efficacy DMT after ⩾1 year of glatiramer acetate, interferons, azathioprine, teriflunomide or dimethylfumarate treatment. Patients were 1:1 propensity score (PS) matched for characteristics at the first DMT. The disability trajectories were evaluated by applying a longitudinal model for repeated measures. The effect of early versus late start of high-efficacy DMT was assessed by the mean annual Expanded Disability Status Scale (EDSS) changes compared with baseline values (delta-EDSS) in EIT and ESC groups. RESULTS: The study cohort included 2702 RRMS patients. The PS matching procedure produced 363 pairs, followed for a median (interquartile range) of 8.5 (6.5-11.7) years. Mean annual delta-EDSS values were all significantly (p < 0.02) higher in the ESC group compared with the EIT group. In particular, the mean delta-EDSS differences between the two groups tended to increase from 0.1 (0.01-0.19, p = 0.03) at 1 year to 0.30 (0.07-0.53, p = 0.009) at 5 years and to 0.67 (0.31-1.03, p = 0.0003) at 10 years. CONCLUSION: Our results indicate that EIT strategy is more effective than ESC strategy in controlling disability progression over time.

5.
Neurol Sci ; 42(11): 4647-4655, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33677753

RESUMO

BACKGROUND: Comparative effectiveness of natalizumab and fingolimod over a follow-up longer than 2 years has been not addressed yet. OBJECTIVES: To compare the effect on no evidence of disease activity (NEDA-3) in relapsing-remitting multiple sclerosis (RRMS) patients treated with natalizumab or fingolimod for at least 4 years. METHODS: We included RRMS patients switched from first-line agents to natalizumab or fingolimod. Patients were propensity score (PS)-matched on a 1-to-1 basis. Percentages of patients reaching NEDA-3 status at 2 and 4 years of follow-up were compared using the chi-square test. The risk of not achieving NEDA-3 at 4 years was explored in matched samples by Cox regression models. RESULTS: We evaluated 174 PS-matched patients. Patients receiving natalizumab reached a NEDA-3 status at 2 and 4 years more frequently than those exposed to fingolimod (63% vs 44%, p=0.037; 45.7% vs 25.8%, p=0.015, respectively). Patients receiving natalizumab were at a significant lower risk of not achieving the NEDA-3 status at 4 years compared to those exposed to fingolimod (hazard ratio (95% confidence interval): 0.54 (0.36-0.80), p=0.002). CONCLUSIONS: Although both medications were effective in patients non-responding to first-line agents, natalizumab seems to be superior to fingolimod in RRMS in obtaining NEDA-3 status at 4 years.


Assuntos
Esclerose Múltipla Recidivante-Remitente , Esclerose Múltipla , Cloridrato de Fingolimode/uso terapêutico , Humanos , Fatores Imunológicos/uso terapêutico , Imunossupressores/uso terapêutico , Esclerose Múltipla/tratamento farmacológico , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Natalizumab/uso terapêutico , Resultado do Tratamento
6.
Brain Behav ; 11(1): e01930, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33325640

RESUMO

BACKGROUND AND AIMS: Interferon beta (IFNß) is a well-established first-line therapy for relapsing-remitting multiple sclerosis (RRMS) patients and remains the most widely prescribed agent. Atypical hemolytic uremic syndrome (aHUS) represents a rare but severe adverse effect (AE) that could occur even after many years from the beginning of IFNß therapy. Eculizumab is currently approved for treatment of aHUS and recently for neuromyelitis optica spectrum disorder (NMOSD) with aquaporin-4 antibodies (AQP4-IgG). In this article, we report the case of the latest onset of IFNß-related aHUS experienced by an MS patient and we briefly review the literature on this topic. METHODS: We performed a systematic review of the literature using PubMed, and we performed a retrospective analysis of RRMS patients that received IFNß-1a in our center and developed thrombotic microangiopathy (TMA). From this search, we identified only one patient. RESULTS: In the published literature, we identified 24 MS patients who received IFNß as disease-modifying treatment (DMT) and then developed thrombotic microangiopathy with kidney injury. The aHUS has been diagnosed in 6, all received IFNß-1a and the latest onset was after 15 years. We report a case of a 39-year-old man affected by RRMS who assumed IFNß-1a since 1999. In July 2018, he developed an IFNß-related aHUS. After the failure of plasma exchange, he underwent eculizumab, with an improvement of glomerular filtration rate and without new signs of MS activity. CONCLUSION: To our knowledge, this case represents the latest onset of IFNß-related aHUS in MS patients. Up to now, there are not literary reports about the possibility to reintroduce a DMT as add-on therapy to eculizumab.


Assuntos
Síndrome Hemolítico-Urêmica Atípica , Esclerose Múltipla Recidivante-Remitente , Esclerose Múltipla , Adulto , Humanos , Interferon beta/efeitos adversos , Masculino , Esclerose Múltipla/tratamento farmacológico , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Estudos Retrospectivos
7.
J Immunother Cancer ; 8(2)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33060148

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has overwhelmed the health systems worldwide. Data regarding the impact of COVID-19 on cancer patients (CPs) undergoing or candidate for immune checkpoint inhibitors (ICIs) are lacking. We depicted the practice and adaptations in the management of patients with solid tumors eligible or receiving ICIs during the COVID-19 pandemic, with a special focus on Campania region. METHODS: This survey (25 questions), promoted by the young section of SCITO (Società Campana di ImmunoTerapia Oncologica) Group, was circulated among Italian young oncologists practicing in regions variously affected by the pandemic: high (group 1), medium (group 2) and low (group 3) prevalence of SARS-CoV-2-positive patients. For Campania region, the physician responders were split into those working in cancer centers (CC), university hospitals (UH) and general hospitals (GH). Percentages of agreement, among High (H) versus Medium (M) and versus Low (L) group for Italy and among CC, UH and GH for Campania region, were compared by using Fisher's exact tests for dichotomous answers and χ2 test for trends relative to the questions with 3 or more options. RESULTS: This is the first Italian study to investigate the COVID-19 impact on cancer immunotherapy, unique in its type and very clear in the results. The COVID-19 pandemic seemed not to affect the standard practice in the prescription and delivery of ICIs in Italy. Telemedicine was widely used. There was high consensus to interrupt immunotherapy in SARS-CoV-2-positive patients and to adopt ICIs with longer schedule interval. The majority of the responders tended not to delay the start of ICIs; there were no changes in supportive treatments, but some of the physicians opted for delaying surgeries (if part of patients' planned treatment approach). The results from responders in Campania did not differ significantly from the national ones. CONCLUSION: Our study highlights the efforts of Italian oncologists to maintain high standards of care for CPs treated with ICIs, regardless the regional prevalence of COVID-19, suggesting the adoption of similar solutions. Research on patients treated with ICIs and experiencing COVID-19 will clarify the safety profile to continue the treatments, thus informing on the most appropriate clinical conducts.


Assuntos
Antineoplásicos Imunológicos/administração & dosagem , Betacoronavirus/imunologia , Infecções por Coronavirus/epidemiologia , Oncologia/estatística & dados numéricos , Neoplasias/tratamento farmacológico , Pneumonia Viral/epidemiologia , Adulto , Antineoplásicos Imunológicos/efeitos adversos , Antígeno B7-H1/antagonistas & inibidores , Antígeno B7-H1/imunologia , Betacoronavirus/patogenicidade , COVID-19 , Antígeno CTLA-4/antagonistas & inibidores , Antígeno CTLA-4/imunologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Geografia , Humanos , Controle de Infecções/normas , Itália/epidemiologia , Masculino , Oncologia/normas , Neoplasias/imunologia , Oncologistas/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/imunologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Prevalência , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Receptor de Morte Celular Programada 1/imunologia , SARS-CoV-2 , Inquéritos e Questionários/estatística & dados numéricos , Tempo para o Tratamento
9.
Future Oncol ; 11(15 Suppl): 27-30, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26235262

RESUMO

In this short paper, we report our experience with eribulin mesylate in a heavily pretreated breast cancer patient with multiple bone metastases. The patient had been treated with doxorubicin, cyclophosphamide, methotrexate, fluorouracil, tamoxifen, letrozole, LH-RH analogs, fulvestrant, bevacizumab and paclitaxel and liposomal doxorubicin. In November 2013 treatment with eribulin ready to use solution (1.23 mg/m(2) days 1 and 8 of a 21-day cycle) was started and administered for a total of 14 courses. After six cycles of eribulin, evaluation with MRI showed a marked decrease in neoplastic involvement and replacement of osteolytic lesions with osteoblastic ones. No unexpected acute toxicity was observed. Although with all the limitations of any anecdotal report, our experience documents the efficacy and safety of eribulin in this difficult-to-treat patient who had been treated with multiple lines of chemotherapy.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Furanos/uso terapêutico , Cetonas/uso terapêutico , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Terapia Combinada , Feminino , Furanos/administração & dosagem , Furanos/efeitos adversos , Humanos , Cetonas/administração & dosagem , Cetonas/efeitos adversos , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Retratamento , Resultado do Tratamento
10.
Br J Pharmacol ; 169(6): 1228-38, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23594147

RESUMO

BACKGROUND AND PURPOSE: The 5-HT3 receptor is a ligand-gated ion channel that is modulated allosterically by various compounds including colchicine, alcohols and volatile anaesthetics. However the positive allosteric modulators (PAMs) identified to date have low affinity, which hinders investigation because of non-selective effects at pharmacologically active concentrations. The present study identifies 5-chloroindole (Cl-indole) as a potent PAM of the 5-HT3 receptor. EXPERIMENTAL APPROACH: 5-HT3 receptor function was assessed by the increase in intracellular calcium and single-cell electrophysiological recordings in HEK293 cells stably expressing the h5-HT3A receptor and also the mouse native 5-HT3 receptor that increases neuronal contraction of bladder smooth muscle. KEY RESULTS: Cl-indole (1-100 µM) potentiated agonist (5-HT) and particularly partial agonist [(S)-zacopride, DDP733, RR210, quipazine, dopamine, 2-methyl-5-HT, SR57227A, meta chlorophenyl biguanide] induced h5-HT3A receptor-mediated responses. This effect of Cl-indole was also apparent at the mouse native 5-HT3 receptor. Radioligand-binding studies identified that Cl-indole induced a small (≈ twofold) increase in the apparent affinity of 5-HT for the h5-HT3A receptor, whereas there was no effect upon the affinity of the antagonist, tropisetron. Cl-indole was able to reactivate desensitized 5-HT3 receptors. In contrast to its effect on the 5-HT3 receptor, Cl-indole did not alter human nicotinic α7 receptor responses. CONCLUSIONS AND IMPLICATIONS: The present study identifies Cl-indole as a relatively potent and selective PAM of the 5-HT3 receptor; such compounds will aid investigation of the molecular basis for allosteric modulation of the 5-HT3 receptor and may assist the discovery of novel therapeutic drugs targeting this receptor.


Assuntos
Indóis/farmacologia , Receptores 5-HT3 de Serotonina/metabolismo , Agonistas do Receptor 5-HT3 de Serotonina/farmacologia , Regulação Alostérica , Animais , Sinalização do Cálcio/efeitos dos fármacos , Agonismo Parcial de Drogas , Potenciais Evocados/efeitos dos fármacos , Células HEK293 , Humanos , Técnicas In Vitro , Indóis/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Contração Muscular/efeitos dos fármacos , Proteínas do Tecido Nervoso/agonistas , Proteínas do Tecido Nervoso/antagonistas & inibidores , Proteínas do Tecido Nervoso/genética , Proteínas do Tecido Nervoso/metabolismo , Subunidades Proteicas/agonistas , Subunidades Proteicas/antagonistas & inibidores , Subunidades Proteicas/genética , Subunidades Proteicas/metabolismo , Receptores de Serotonina/química , Receptores de Serotonina/genética , Receptores de Serotonina/metabolismo , Receptores 5-HT3 de Serotonina/química , Receptores 5-HT3 de Serotonina/genética , Proteínas Recombinantes/química , Proteínas Recombinantes/metabolismo , Agonistas do Receptor 5-HT3 de Serotonina/química , Agonistas do Receptor 5-HT3 de Serotonina/metabolismo , Antagonistas do Receptor 5-HT3 de Serotonina/química , Antagonistas do Receptor 5-HT3 de Serotonina/metabolismo , Antagonistas do Receptor 5-HT3 de Serotonina/farmacologia , Bexiga Urinária/efeitos dos fármacos
11.
Int J Environ Health Res ; 19(5): 369-77, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20183198

RESUMO

This study was designed to evaluate the influence of occupational and non-occupational factors on urinary arsenic excretion in workers exposed to iAs (inorganic arsenic) in the dismantlement of a factory which once produced fertilisers. We measured iAs and its methylated metabolites in 108 urinary samples of workers exposed to iAs in July 2006. A total of 13.9% of the samples showed levels higher than the Biological Exposure Index (BEI) of 35 microg/l (mean value 23.9 microg/l). After the improvement of working conditions, in August-October 2006 we collected urinary samples from each of the 108 workers enrolled. We also administrated a questionnaire, in order to investigate the influence of occupational and non-occupational factors on the urinary arsenic excretion. A significant difference was observed in relation with seafood consumption and age stratification. We have found a significant reduction of urinary arsenic excretion between the two phases of biological monitoring, probably due to appropriate hygiene work-related interventions.


Assuntos
Arsênio/urina , Exposição Ambiental/análise , Exposição Ocupacional/análise , Saúde do Trabalhador , Adolescente , Adulto , Fatores Etários , Idoso , Monitoramento Ambiental/métodos , Fertilizantes , Contaminação de Alimentos , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/prevenção & controle , Alimentos Marinhos , Inquéritos e Questionários , Adulto Jovem
12.
Med Lav ; 96(3): 212-21, 2005.
Artigo em Italiano | MEDLINE | ID: mdl-16273839

RESUMO

BACKGROUND: The incidence of silicosis has decreased today because of a clear improvement of working conditions. According to recent data from Italian National Compensation Agency (INAIL) silicosis represents more than 5% of occupational diseases claimed for annually. Since silicosis is an evolving chronic disease, it has serious consequences on patient health, modifying the quality of life and increasing public costs. Some studies show a relationship between occupational exposure to silica and radiological and functional deterioration, but the results are not satisfactory because of the variety of clinical patterns and the interference of many risk factors. OBJECTIVES: The aim of our investigation was to evaluate silicosis evolution in relation to living habits and to different occupational exposures. METHODS: All admissions from 1980 to 2000 in the Occupational Medicine Unit of the Maugeri Foundation in Cassano Murge (Bari), Southern Italy, with final diagnosis of silicosis were examined. From 586 medical records gathered, subjects with double admissions were selected and their chest radiographs and FVC, FEV1 from lung function test were detected. No industrial hygiene data were available and individual exposure was estimated through calculation of a global exposure index. RESULTS: On the basis of data quality control, 106 consecutive male patients were recruited (age at first admission 51.7 +/- 8.3 years, occupational exposure at second admission 23.8 +/- 9.1 years). More than 50% of the subjects had an estimated high risk exposure at work. The first diagnosis of silicosis was made at first admission in 40% of the cases, 33% of the patients had been suffering from silicosis for 10 years while 27% for more than 10 years. Chest radiographs showed mostly p, q nodular pattern, and over a 4. 7 +/- 3.3 year follow-up period they appeared largely unchanged, although 8 radiographs showed confluent areas, 18 subjects showed pleural thickening, 10 calcified opacities, 17 COPD (Chronic Obstructive Pulmonary Disease) with emphysema, 2 tubercolosis lesions, 4 radiographic abnormalities attributable to cancer (3 lung, 1 oesophageal). CONCLUSIONS: The mainly stationary results of chest radiographs and the slight loss of respiratory function we observed confirm the slow evolution over time of silicosis. Multiple logistic regression analysis of main risk factors showed that subjects with radiographic opacities having a diameter greater than 10 mm or conglomerate shadows at the time of diagnosis seem to have a lower risk of progression of the disease after a relatively short period of follow up, even in mining related exposure.


Assuntos
Silicose/diagnóstico por imagem , Estudos de Coortes , Comorbidade , Progressão da Doença , Feminino , Seguimentos , Volume Expiratório Forçado , Hábitos , Humanos , Itália/epidemiologia , Pulmão/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/epidemiologia , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Radiografia , Estudos Retrospectivos , Fatores de Risco , Silicose/diagnóstico , Silicose/epidemiologia , Silicose/fisiopatologia , Fumar/epidemiologia , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/epidemiologia , Capacidade Vital
13.
Clin Cancer Res ; 11(13): 4741-8, 2005 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-16000569

RESUMO

PURPOSE: Experimental data suggest a complex cross-talk between HER-2 and estrogen receptor, and it has been hypothesized that HER-2-positive tumors may be less responsive to certain endocrine treatments. Clinical data, however, have been conflicting. We have conducted a meta-analysis on the interaction between the response to endocrine treatment and the overexpression of HER-2 in metastatic breast cancer. EXPERIMENTAL DESIGN: Studies have been identified by searching the Medline, Embase, and American Society of Clinical Oncology abstract databases. Selection criteria were (a) metastatic breast cancer, (b) endocrine therapy (any line of treatment), and (c) evaluation of HER-2 expression (any method). For each study, the relative risk for treatment failure for HER-2-positive over HER-2-negative patients with 95% confidence interval was calculated as an estimate of the predictive effect of HER-2. Pooled estimates of the relative risk were computed by the Mantel-Haenszel method. RESULTS: Twelve studies (n = 2,379 patients) were included in the meta-analysis. The overall relative risk was 1.42 (95% confidence interval, 1.32-1.52; P < 0.00001; test for heterogeneity = 0.380). For studies involving tamoxifen, the pooled relative risk was 1.33 (95% confidence interval, 1.20-1.48; P < 0.00001; test for heterogeneity = 0.97); for studies involving other hormonal drugs, a pooled relative risk of 1.49 (95% confidence interval, 1.36-1.64; P < 0.00001; test for heterogeneity = 0.08) was estimated. A second meta-analysis limited to tumors that were either estrogen receptor positive, estrogen receptor unknown, or estrogen receptor negative/progesterone receptor positive yielded comparable results. CONCLUSIONS: HER-2-positive metastatic breast cancer is less responsive to any type of endocrine treatment. This effect holds in the subgroup of patients with positive or unknown steroid receptors.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Receptor ErbB-2/metabolismo , Tamoxifeno/uso terapêutico , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Feminino , Humanos , Receptores de Estrogênio/análise , Receptores de Progesterona/análise , Resultado do Tratamento
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