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1.
Int J Mol Sci ; 22(10)2021 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-34067977

RESUMO

Testicular cancer (TC) is the most frequent tumor in young males. In the vast majority of cases, it is a curable disease; therefore, very often patients experience a long survival, also due to their young age at diagnosis. In the last decades, the role of the vitamin D deficiency related to orchiectomy has become an increasingly debated topic. Indeed, vitamin D is essential in bone metabolism and many other metabolic pathways, so its deficiency could lead to various metabolic disorders especially in long-term TC survivors. In our article, we report data from studies that evaluated the incidence of hypovitaminosis D in TC survivors compared with cohorts of healthy peers and we discuss molecular mechanisms and clinical implications.


Assuntos
Sobreviventes de Câncer/estatística & dados numéricos , Neoplasias Testiculares/complicações , Deficiência de Vitamina D/etiologia , Humanos , Masculino , Deficiência de Vitamina D/patologia
2.
Front Endocrinol (Lausanne) ; 12: 674039, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33967965

RESUMO

Background: In a recently published retrospective case series, Temozolomide was found active as second line approach in advanced ACC patients. The disease control rate obtained, however, was short-lived. We report here an ACC patient with extensive metastatic disease who obtained a remarkable long lasting response with this alkylating agent. Case Presentation: a 22-year-old female patient with ACC presented at our Medical Oncology Department in poor general condition due the presence of extensive metastatic pulmonary involvement. The disease had progressed to etoposide, doxorubicin and cisplatin plus mitotane therapy. Second line temozolomide therapy was prescribed leading to a progressive improvement of patient general conditions. The disease restaging after 12 cycles revealed a complete response of lung lesions and the patient was free from progression for 14+ months. Conclusion: Temozolomide therapy could be exceptionally efficacious in the management of ACC patients. The molecular mechanisms of sensitivity and resistance to this drug should be carefully studied, in order to select the patients destined to obtain a significant clinical benefit to the drug.


Assuntos
Neoplasias do Córtex Suprarrenal/tratamento farmacológico , Carcinoma Adrenocortical/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Córtex Suprarrenal/patologia , Carcinoma Adrenocortical/secundário , Adulto , Cisplatino/administração & dosagem , Doxorrubicina/administração & dosagem , Etoposídeo/administração & dosagem , Feminino , Humanos , Mitotano/administração & dosagem , Prognóstico , Indução de Remissão , Temozolomida/administração & dosagem , Adulto Jovem
3.
Crit Rev Oncol Hematol ; 159: 103224, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33493632

RESUMO

Germ cell tumors (GCTs) represent the best and the only example of solid tumors curable in the large majority of patients. GCTs are one of the few malignancies for which specific biochemical markers have been identified: human chorionic gonadotropin (HCG) and alfa-fetoprotein (AFP). Due to their specificity and sensitivity they constitute formidable tools in the diagnosis and monitoring of treatment for GCTs. As a tumor mass marker, lactate dehydrogenase (LDH) is also considered. Tumor markers are expressed in 15-20% of seminoma and 60-80% of non-seminoma. With the aim to increase sensitivity and specificity, recent studies have proposed miRNAs as serum biomarkers. This review will focus on role of serum tumor markers in diagnosis, staging, prognosis, monitoring of response, and finally follow-up of GCTs.


Assuntos
Neoplasias Embrionárias de Células Germinativas , Seminoma , Neoplasias Testiculares , Biomarcadores Tumorais , Humanos , Masculino , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias Embrionárias de Células Germinativas/terapia , Prognóstico , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/terapia
5.
Nutrients ; 12(10)2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33081215

RESUMO

Improvements in Clinical Oncology, due to earlier diagnoses and more efficient therapeutic strategies, have led to increased numbers of long-term survivors, albeit many with chronic diseases. Dealing with the complex care needs of these survivors is now an important part of Medical Oncology. Suitable diet and physical activity regimes will be important in maintaining their health. This paper will review what we know and what we can do in the near future for these patients.


Assuntos
Sobreviventes de Câncer , Suplementos Nutricionais , Ingestão de Alimentos/fisiologia , Terapia Nutricional/métodos , Fenômenos Fisiológicos da Nutrição/fisiologia , Estado Nutricional , Assistência ao Paciente/métodos , Manutenção do Peso Corporal , Carboidratos da Dieta/administração & dosagem , Fibras na Dieta/administração & dosagem , Proteínas na Dieta/administração & dosagem , Estilo de Vida Saudável , Humanos , Minerais/administração & dosagem , Terapia Nutricional/tendências , Assistência ao Paciente/tendências , Vitaminas/administração & dosagem
8.
Front Oncol ; 10: 564346, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33520693

RESUMO

Testicular cancer (TC) is the most frequent solid tumor diagnosed in young adult males. Although it is a curable tumor, it is frequently associated with considerable short-term and long-term morbidity. Both biological and psychological stress experienced during cancer therapy may be responsible for stimulating molecular processes that induce premature aging and deterioration of immune system (immunosenescence) in TC survivors, leading to an increased susceptibility to infections, cancer, and autoimmune diseases. Immunosenescence is a remodeling of immune cell populations with inversion of the CD4:CD8 ratio, accumulation of highly differentiated memory cells, shrinkage of telomeres, shift of T-cell response to Th2 type, and release of pro-inflammatory signals. TC survivors exposed to chemotherapy show features of immunological aging, including an increase in memory T-cells (CD4+ and CD8+) and high expression of the senescence biomarker p16INK4a in CD3+ lymphocytes. However, the plethora of factors involved in the premature aging of TC survivors make the situation more complex if we also take into account the psychological stress and hormonal changes experienced by patients, as well as the high-dose chemotherapy and hematopoietic stem cell transplantation that some individuals may be required to undergo. The relatively young age and the long life expectancy of TC patients bear witness to the importance of improving quality of life and of alleviating long-term side-effects of cancer treatments. Within this context, the present review takes an in-depth look at the molecular mechanisms of immunosenescence, describing experimental evidence of cancer survivor aging and highlighting the interconnected relationship between the many factors modulating the aging of the immune system of TC survivors.

9.
Semin Oncol ; 46(2): 107-111, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31076171

RESUMO

BACKGROUD: Germ cell tumors (GCTs) are a group of neoplasms usually arising in the gonads, and very rarely in sites outside the gonads, mainly in the retroperitoneum, the anterior mediastinum, and pineal gland or the coccyx (mainly in childhood). The prognosis of nonseminoma primary mediastinal GCTs (PMGCTs), is considered to be poorer compared to its retroperitoneal or gonadal counterparts and, according to the International Germ Cell Cancer Collaborative Group, it is considered by definition as a "poor risk" disease. MATERIAL AND METHODS: Our review highlights the clinical features, prognostic factors, and therapeutic strategies in PMGCTs, as described in medical literature. So far available data were obtained through a Medline search of English-language papers. RESULTS: Due to the rarity of the disease, there are no prospective studies comparing different treatment strategies. For this reason, oncology societies recommend treating PMGCTs like other GCTs, according to general risk categories. CONCLUSION: Because of the rarity of the disease, poor categorization, and the lack of novel therapeutic strategies, an International database is required to obtain more information on these tumors. Additional efforts should be done, with the aims to find effective novel therapeutic agents.


Assuntos
Neoplasias do Mediastino/terapia , Neoplasias Embrionárias de Células Germinativas/terapia , Neoplasias Testiculares/terapia , Gônadas/patologia , Humanos , Neoplasias do Mediastino/patologia , Mediastino/patologia , Neoplasias Embrionárias de Células Germinativas/patologia , Prognóstico , Fatores de Risco , Neoplasias Testiculares/patologia
10.
Crit Rev Oncol Hematol ; 137: 154-164, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31014511

RESUMO

BACKGROUND: No compelling evidence is available about surveillance and follow-up of patients with testicular germ cell tumour (TGCT). METHODS: In the light of the best clinical evidence, the Italian Germ cell cancer Group (IGG) and the Associazione Italiana di Oncologia Medica (AIOM) set up a multidisciplinary national consensus conference, involving 42 leading experts and 3 TGCT survivors. A minimum of 50% of votes was required in order to achieve a consensus recommendation on 29 questions. RESULTS: Recommendations have been summarized in three tables, divided by stage I seminoma, stage I nonseminoma and the advanced disease, which may be useful for clinicians to appropriately choose the clinical investigation and its timing during the surveillance and follow-up of TGCT patients based on an accurate estimation of their risk of disease relapse. CONCLUSIONS: The IGG-AIOM consensus recommendations may help clinicians to choose appropriate clinical investigations for the surveillance and follow-up of TGCT patients.


Assuntos
Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias Testiculares/diagnóstico , Consenso , Seguimentos , Humanos , Masculino , Guias de Prática Clínica como Assunto , Seminoma/diagnóstico
11.
Artigo em Inglês | MEDLINE | ID: mdl-30858829

RESUMO

Testicular cancer is the most frequent tumor in young males aged 15-39 years. As cure rates are currently around 90%, the prevalence of survivors is increasing. However, a disease-free condition does not necessarily correspond to a life free of physical and psychosocial health problems. The aim of this review was to explore psychosocial morbidity among testicular cancer survivors. A literature search was conducted in three electronic databases (PubMed, Medline, and Embase). The results of the search on cancer survivors were then combined with those of the search on psychosocial concerns and work performance. Eighty-four publications met the inclusion criteria. Physical, psychological, work-related problems and changing perspectives about work and life in general influenced life and career decisions among testicular cancer survivors. Individual health, sexual relationships and work problems, affect several important aspects of survival and significantly influence the QoL of long-term survivors.

12.
Future Oncol ; 15(12): 1347-1352, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30880465

RESUMO

Germ cell tumors represent 11% of the cancers diagnosed in adolescent males and are the most common solid tumors in adult men between the ages of 20 and 35. Pure seminoma accounts for around 50% of all testicular germ cell tumors. The prognostic classification of the International Germ Cell Cancer Collaborative Group for good-prognosis seminoma includes both nodal disease and pulmonary visceral metastases. In this article, we analyzed recent data on prognosis and outcome of good-prognosis seminoma to revise the traditional classification of the disease and improve tailored treatment.


Assuntos
Biomarcadores Tumorais/análise , Neoplasias Pulmonares/mortalidade , Seminoma/classificação , Neoplasias Testiculares/classificação , Intervalo Livre de Doença , Humanos , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/terapia , Masculino , Estadiamento de Neoplasias , Prognóstico , Medição de Risco , Seminoma/mortalidade , Seminoma/secundário , Seminoma/terapia , Neoplasias Testiculares/mortalidade , Neoplasias Testiculares/secundário , Neoplasias Testiculares/terapia , Testículo/patologia
14.
Bone Marrow Transplant ; 53(6): 722-728, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29367713

RESUMO

We aimed to assess the incidence and risk factors of secondary malignancy (SM) in the young adult patients who received high-dose chemotherapy (HDCT) for germ cell tumors (GCT). The EBMT database was interrogated. Criteria for patient selection included adult male GCT and HDCT administered in any line of therapy. Cumulative incidence methods were used to estimate the time-to-SM diagnosis. Univariable Fine and Gray proportional hazard regression evaluated risk factors of SM occurrence. From 1981 to 2015, 9153 autografts were identified. Among 5295 patients, 59 cases of SM, developed after a median follow-up of 3.8 years, were registered. Of these patients, 23 (39%) developed hematologic SM, 34 (57.6%) solid SM (two patients had uncoded SM). Twenty-year cumulative incidence of solid versus hematologic SM was 4.17% (95% CI: 1.78-6.57) versus 1.37% (95% CI: 0.47-2.27). Median overall survival after SM was significantly shorter for patients who developed hematologic SM versus solid SM (8.6 versus 34.4 months, p = 0.003). Age older than 40 years at the time of HDCT was significantly associated with hematologic, but not solid, SM development (p = 0.004 versus p = 0.234). SM occurrence post-HDCT showed different patterns of incidence and mortality in GCT. These data may be important to optimize patient selection, counseling and follow-up after HDCT.


Assuntos
Neoplasias Embrionárias de Células Germinativas/complicações , Segunda Neoplasia Primária/etiologia , Adulto , Europa (Continente) , Feminino , Humanos , Masculino , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Embrionárias de Células Germinativas/patologia , Segunda Neoplasia Primária/patologia , Estudos Retrospectivos , Fatores de Tempo
15.
Med Oncol ; 34(8): 133, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28653284

RESUMO

Relapsed germ cell tumor (GCT) is a highly curable cancer with standard-dose platinum-based chemotherapy (CT); however, high-dose CT (HDCT) is seldom used as salvage therapy instead or after conventional CT. We conducted a systematic review of published trials to compare outcomes between standard-dose CT and HDCT in patients with relapsed GCT after first-line therapy for advanced disease. A literature search was carried out in multiple electronic databases (PubMed, Embase, Scopus, Web of Science, and The Cochrane Library), and studies reporting salvage treatment of relapsed GCT with standard-dose or carboplatin-etoposide-based HDCT were selected. Overall response rate, median overall survival (OS), and the 1-, 2-, 3-, and 5-year OS rates were pooled, and the significance of difference between arms was assessed with a Chi-square test. Twenty-nine standard-dose and 31 HD studies were included in the meta-analysis. For standard-dose CT versus HDCT, there was no significant difference in median OS (14.8 months and 24.09 months, respectively; P = 0.09) or in 1-, 2-, 3-, or 5-year survival rate (standard-dose CT, 64.2, 63.6, 45.1, and 43%, respectively; HDCT, 63.7, 51.2, 46.7, and 45%, respectively; P = 0.9, P = 0.4, P = 0.75, and P = 0.06). Conventional dose regimens and HDCT were associated with comparable efficacy when used as salvage therapies in relapsed GCTs as second-line therapy or beyond. However, the selection of ideal candidates for more or less intensive treatments deserves further research in the near future.


Assuntos
Antineoplásicos/administração & dosagem , Terapia de Salvação/métodos , Neoplasias Testiculares/tratamento farmacológico , Relação Dose-Resposta a Droga , Humanos , Masculino , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Embrionárias de Células Germinativas/mortalidade , Taxa de Sobrevida , Neoplasias Testiculares/mortalidade , Resultado do Tratamento
16.
Expert Rev Hematol ; 10(8): 685-695, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28656800

RESUMO

INTRODUCTION: Disorders of iron metabolism are commonly seen in onco-hematological clinical practice. Iron-deficiency anemia and cancer-associated anemia are usually treated with supportive therapies. Optimal management of these conditions are discussed in this perspective paper. Areas covered: A position paper discussing a number of hot topics on anemia in cancer patients is presented. The main areas covered by experts in the field are: definitions, prevalence and consequences of anemia and iron deficiency, incidence of anemia resulting from targeted therapies, importance of anemia diagnosis and monitoring, evaluation of iron status before and during treatment, role of transfusions and erythropoiesis-stimulating agents, management of iron deficiency with or without anemia, parenteral iron supplementation, role of new oral iron formulations, safety and cost issues regarding different iron compounds and administration routes. Expert commentary: Despite the availability of newer therapeutic options for its management, anemia still represents a major complication of treatment in cancer patients (surgery, chemotherapy, radiotherapy, targeted therapies), aggravating physical impairment, and negatively affecting general outcome. The view expressed by the panelists, attendees of the 4th Mediterranean Course on Iron Anemia, summarizes what they consider optimal clinical practice for screening, diagnosis, treatment and monitoring of iron deficiency and anemia in cancer patients.


Assuntos
Anemia Ferropriva/etiologia , Anemia Ferropriva/terapia , Neoplasias/complicações , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/epidemiologia , Transfusão de Sangue , Análise Custo-Benefício , Gerenciamento Clínico , Composição de Medicamentos , Custos de Cuidados de Saúde , Humanos , Ferro/administração & dosagem , Ferro/efeitos adversos , Ferro/uso terapêutico , Prevalência
17.
Support Care Cancer ; 25(Suppl 1): 1-2, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28213815
18.
Support Care Cancer ; 25(Suppl 1): 19-20, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28213816
19.
Ther Adv Med Oncol ; 9(1): 22-32, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28203295

RESUMO

BACKGROUND: Many patients with solid tumours or nonmyeloid haematopoietic tumours develop symptomatic anaemia, which has a major impact on quality of life (QoL). The efficacy of erythropoiesis-stimulating agents (ESAs) in improving QoL and reducing blood transfusions has been widely demonstrated. Binocrit® (biosimilar epoetin alfa) is an ESA indicated in the European Union for treating chemotherapy-induced anaemia. The aim of this study was to investigate the effect of Binocrit® on haemoglobin (Hb) levels in anaemic cancer patients in Italian clinical practice. METHODS: The ANEMONE study was a national, longitudinal, retrospective, multicentre observational study. Patients had to be 18 years or older, with a solid tumour or non-Hodgkin's lymphoma, Hodgkin's disease or multiple myeloma, receiving chemotherapy, and treated with Binocrit® to manage chemotherapy-induced anaemia. The primary outcomes were the proportion of patients with a Hb increase ⩾1 g/dl during the first 4 weeks and with a Hb increase ⩾2 g/dl during the first 12 weeks. RESULTS: A total of 245 patients were enrolled and 215 patients were evaluable for statistical analysis. In the first 4 weeks, 49.3% of patients showed an increase in Hb of ⩾1 g/dl: 45.5% in patients with solid tumours and 52.1% in patients with haematological malignancies. In the first 12 weeks, 51.6% of patients showed an increase in Hb of ⩾2 g/dl (48.4% solid tumours, 54.2% haematological diseases). Treatment with Binocrit® was well tolerated. CONCLUSIONS: These results confirm the effectiveness and safety of Binocrit® for chemotherapy-induced anaemia in routine practice in patients with solid tumours, lymphoma and myeloma.

20.
Support Care Cancer ; 25(Suppl 1): 3-6, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28220317

RESUMO

Improving patient-physician communication is an area of medicine that deserves greater attention. Narrative medicine can be considered as one tool that can aid in fostering better communication. Current medical practice is dominated by evidence-based medicine, and dictates what therapies the clinician will offer in a given circumstance, ideally supported by (evidence-based) guidelines. However, when taken alone it tends to decentralize the patient. There are many different approaches that can be used to understand the patient and what he or she is experiencing as a result of their illness. While time constraints are often mentioned as a barrier to improved communication, in reality the time required to listen to patients is not excessive, and all caregivers should reflect on the possibility to give patients greater freedom from time constraints during consultation, and encourage them to narrate their experiences. Moreover, use of narrative-based medicine may be associated with better diagnosis and treatment of pain. Narrative-based medicine is not just for end-of-life care, but something for all caregivers to give greater consideration to in daily practice in order to form a strong frame of alliance.


Assuntos
Medicina Baseada em Evidências/métodos , Relações Médico-Paciente , Assistência Terminal/métodos , Comunicação , Feminino , Cuidados Paliativos na Terminalidade da Vida , Humanos , Masculino
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