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1.
Medicine (Baltimore) ; 99(40): e22620, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019484

RESUMO

RATIONALE: Low-dose mitotane has been widely used for many decades in patients with advanced adrenocortical carcinoma (ACC), which exhibited good safety profiles compared with the high-dose regimen. The clinical efficacy and toxicity of mitotane are closely related to its plasma concentration, and therapeutic drug monitoring (TDM) is recommended. Until now, no severe adverse drug reaction (ADR) related to the toxic plasma level after a short-term treatment of low-dose mitotane has been published. PATIENT CONCERNS: A 50-year-old Chinese female presented with severe neurological adverse events related to a toxic plasma levels of 42.8 mg/L after 4 months treatment of low-dose mitotane. DIAGNOSES: During the course of therapy, no other medication could cause neurological adverse events. Therefore, we suspected a high sensitivity to the side effect of mitotane related to a toxic plasma level. INTERVENTIONS: Treatment of mitotane was stopped. OUTCOMES: The trough plasma concentration of mitotane decreased to 18.7 mg/mL after one and a half months, and the neurological symptoms gradually improved after drug discontinuance. LESSONS: The present case provides the first report of severe neurological adverse events induced by the short-term use of low-dose mitotane for adjuvant treatment in a patient with ACC, indicating that potentially severe ADR can also occur when using low-dose regimen in the early stage of treatment. TDM and early recognition could result in a favorable outcome.


Assuntos
Neoplasias do Córtex Suprarrenal/patologia , Carcinoma Adrenocortical/tratamento farmacológico , Antineoplásicos Hormonais/toxicidade , Mitotano/toxicidade , Doenças do Sistema Nervoso/induzido quimicamente , Antineoplásicos Hormonais/sangue , Antineoplásicos Hormonais/uso terapêutico , Grupo com Ancestrais do Continente Asiático/etnologia , Monitoramento de Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Feminino , Humanos , Pessoa de Meia-Idade , Mitotano/sangue , Mitotano/uso terapêutico , Síndromes Neurotóxicas , Resultado do Tratamento , Suspensão de Tratamento
2.
Medicine (Baltimore) ; 99(35): e21721, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871890

RESUMO

The aim of this study was to provide an innovative nomogram to predict the risk of >2 positive nodes in patients fulfilling the Z0011 criteria with 1-2 sentinel lymph nodes (SLNs) only retrieved.From 2007 to 2017, at the Breast Unit of ICS Maugeri Hospital 271 patients with 1-2 macrometastatic SLNs, fulfilling the Z0011 criteria, underwent axillary dissection and were retrospectively reviewed.A mean of 1.5 SLNs per patient were identified and retrieved. One hundred eighty-seven (69.0%) had 1-2 positive nodes, and 84 (31.0%) had >2 metastatic nodes. Independent predictors of axillary status were: positive SLNs/retrieved SLNs ratio (odds ratio [OR] 10.95, P = .001), extranodal extension (OR 5.51, P = .0002), and multifocal disease (OR 2.9, P = .003). A nomogram based on these variables was constructed (area under curve after bootstrap = 0.74).The proposed nomogram might select those patients fulfilling the Z0011 criteria, with 1-2 SLNs harvested, in whom a high axillary tumor burden is expected, aiding to guide adjuvant treatments.


Assuntos
Neoplasias da Mama/patologia , Neoplasias Primárias Múltiplas/patologia , Nomogramas , Linfonodo Sentinela/patologia , Idoso , Antineoplásicos Hormonais/uso terapêutico , Área Sob a Curva , Axila , Neoplasias da Mama/terapia , Quimioterapia Adjuvante , Feminino , Humanos , Metástase Linfática , Mastectomia Segmentar , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Radioterapia Adjuvante , Carga Tumoral
3.
Womens Health (Lond) ; 16: 1745506520952003, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32833600

RESUMO

Administration of Dienogest prior to hysteroscopic polypectomy is empirically performed, but the physiological effects of Dienogest on endometrial polyps are unclear. We aimed to investigate the effects of Dienogest on the proliferation and inflammation of endometrial polyps. We conducted a retrospective case study on 40 menstruating women who underwent hysteroscopic polypectomy at our hospital. We collected clinical data, and the polyps were divided by morphological appearance. The specimens obtained were immunostained for Ki67 as a marker of cellar proliferation and CD138 as a marker of plasmacytes, which are a hallmark of chronic endometritis. Dienogest significantly suppressed the proliferation status of EPs because Dienogest treatment prior to the operation significantly reduced the Ki67 index (41.25 ± 16.85 vs 7.18 ± 9.82, p < 0.01). We found that sessile-type polyps showed a significantly lower Ki67 index than the pedunculated type (12.28 ± 11.12 vs 2.09 ± 2.73, p = 0.026). The presence of CD138-positive cells was more pronounced in sessile-type polyps than in pedunculated polyps (p = 0.018). However, Dienogest treatment showed no apparent effect on inflammation status, as detected by CD138-positive cells. We revealed that Dienogest suppressed cellular proliferation, and morphological classification of endometrial polyps could be used to predict the responsiveness to Dienogest. However, Dienogest might not affect cellular inflammation.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Proliferação de Células/efeitos dos fármacos , Endométrio/efeitos dos fármacos , Nandrolona/análogos & derivados , Pólipos/tratamento farmacológico , Adulto , Endométrio/patologia , Feminino , Humanos , Histeroscopia , Pessoa de Meia-Idade , Nandrolona/uso terapêutico , Estudos Retrospectivos , Doenças Uterinas/patologia
4.
Commun Biol ; 3(1): 374, 2020 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-32641750

RESUMO

The recent outbreak of infections and the pandemic caused by SARS-CoV-2 represent one of the most severe threats to human health in more than a century. Emerging data from the United States and elsewhere suggest that the disease is more severe in men. Knowledge gained, and lessons learned, from studies of the biological interactions and molecular links that may explain the reasons for the greater severity of disease in men, and specifically in the age group at risk for prostate cancer, will lead to better management of COVID-19 in prostate cancer patients. Such information will be indispensable in the current and post-pandemic scenarios.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Neoplasias da Próstata/epidemiologia , Distribuição por Sexo , Antineoplásicos Hormonais/uso terapêutico , Antivirais/uso terapêutico , Betacoronavirus/fisiologia , Betacoronavirus/ultraestrutura , Comorbidade , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/imunologia , Suscetibilidade a Doenças , Reposicionamento de Medicamentos , Feminino , Previsões , Hormônios Esteroides Gonadais/fisiologia , Humanos , Masculino , Proteínas de Neoplasias/antagonistas & inibidores , Proteínas de Neoplasias/biossíntese , Proteínas de Neoplasias/fisiologia , Peptidil Dipeptidase A/fisiologia , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/imunologia , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/metabolismo , Inibidores de Proteases/uso terapêutico , Receptores Virais/efeitos dos fármacos , Receptores Virais/fisiologia , Fatores de Risco , Serina Endopeptidases/biossíntese , Serina Endopeptidases/fisiologia , Estados Unidos/epidemiologia , Internalização do Vírus
5.
Medicine (Baltimore) ; 99(29): e20821, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702824

RESUMO

This study was to investigate the efficacy and safety of fulvestrant 500 mg for the treatment of hormone receptor positive advanced postmenopausal women, including ovarian ablation and investigated factors associated with prolonged time-to-treatment failure.Data from 60 women with metastatic breast cancer who were treated at Zhejiang Cancer Hospital. Patients received 500 mg (n = 60) between December 2011 and November 2012 were followed until November 2017. Main outcomes were clinical responses to fulvestrant, including best response, progressive disease, partial response, and stable disease lasting 12 months or more. Time to progression and time to progression-free-survival were also analyzed.Among the included 60 patients (mean age 47.18 years), 51 (85.0%) had received prior adjuvant therapy. During follow-up after fulvestrant treatment, the median PFS for the best response was derived as 7.0 months (inter-quartile = 4, 13.8 months). The observed median progression-free-survival time for best response was represented longer when fulvestrant was first-line treatment than when patients received prior endocrine and/or chemotherapy. Univariate analysis revealed that receiving either endocrine therapy only or endocrine therapy plus chemotherapy prior to fulvestrant treatment may be associated with median progression-free survival time to best response (P = .002, .026, .007, respectively).Fulvestrant treatment is safe and well-tolerated in women with hormone-sensitive advanced breast cancer, and first-line fulvestrant therapy increases progression-free-survival time, especially in patients without prior adjuvant treatment.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Antagonistas do Receptor de Estrogênio/uso terapêutico , Fulvestranto/uso terapêutico , Metástase Neoplásica/tratamento farmacológico , Pós-Menopausa/efeitos dos fármacos , Adulto , Antineoplásicos Hormonais/uso terapêutico , Grupo com Ancestrais do Continente Asiático/etnologia , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Quimioterapia Adjuvante/métodos , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Metástase Neoplásica/patologia , Intervalo Livre de Progressão , Estudos Retrospectivos , Segurança , Tempo para o Tratamento , Resultado do Tratamento
6.
Prog Urol ; 30(10): 484-487, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32620366

RESUMO

COVID-19 is the pandemic that hit the world starting December 2019. Recent studies and international statistics have shown an increased prevalence, morbidity as well as mortality of this disease in male patients compared to female patients. The aim of this brief communication is to describe the pathophysiology of this sex-discrepancy, based on the infectivity mechanism of the coronavirus including the Angiotensin-Converting Enzyme 2 (ACE2), the Type II transmembrane Serine Protease (TMPRSS2), and the androgen receptor. This could help understand the susceptibility of urological patients, especially those receiving androgen deprivation therapy for prostate cancer, and testosterone replacement therapy.


Assuntos
Betacoronavirus , Infecções por Coronavirus/etiologia , Pandemias , Peptidil Dipeptidase A/fisiologia , Pneumonia Viral/etiologia , Receptores Androgênicos/fisiologia , Receptores Virais/fisiologia , Serina Endopeptidases/fisiologia , Antagonistas de Androgênios/uso terapêutico , Androgênios/fisiologia , Antineoplásicos Hormonais/uso terapêutico , Betacoronavirus/isolamento & purificação , Betacoronavirus/patogenicidade , Betacoronavirus/fisiologia , Infecções por Coronavirus/epidemiologia , Suscetibilidade a Doenças , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Masculino , Especificidade de Órgãos , Peptidil Dipeptidase A/biossíntese , Peptidil Dipeptidase A/genética , Pneumonia Viral/epidemiologia , Neoplasias da Próstata/fisiopatologia , Sistema Renina-Angiotensina/fisiologia , Sêmen/virologia , Serina Endopeptidases/biossíntese , Serina Endopeptidases/genética , Distribuição por Sexo , Glicoproteína da Espícula de Coronavírus/fisiologia , Internalização do Vírus
7.
Toxicol Appl Pharmacol ; 401: 115118, 2020 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-32619553

RESUMO

Glucocorticoid receptor (GR) modulates extensive biological and pathological processes including tumor progression through diverse mechanisms. The regulatory effects of dexamethasone (DEX), a synthetic glucocorticoid, as well as its interaction with GR have been recognized beyond hematologic cancers. In the present study, we investigated the anti-cancer efficacy of DEX and the correlation with GR in pancreatic cancer, a most aggressive malignancy threatening human health. The differential levels of GR expression were examined in two human pancreatic cancer cell lines, PANC-1 and SW1990, as well as in xenografts and patient tumor tissues. DEX significantly inhibited colony formation, migration, and tumor growth of PANC-1 cells expressing abundant GR. The underlying mechanisms involved suppression of nuclear factor κB (NF-κB) phosphorylation and down-regulation of epithelial-to-mesenchymal transition (EMT), interleukin 6 (IL-6) and vascular endothelial growth factor (VEGF). The anti-cancer effects of DEX were partially reversed by GR silencing or combinational administration of GR antagonist, RU486. The dose-dependent efficacy of DEX in tumor growth inhibition was also demonstrated in a GR-positive patient-derived xenograft model along with safety in mice. DEX was less potent, however, in SW1990 cells with poor GR expression. Our findings suggest that DEX effectively inhibits pancreatic tumor growth partially through GR activation. The potential correlation between GR expression and anti-cancer efficacy of DEX may have some clinical implications.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Dexametasona/uso terapêutico , Neoplasias Pancreáticas/metabolismo , Receptores de Glucocorticoides/metabolismo , Carga Tumoral/efeitos dos fármacos , Ensaios Antitumorais Modelo de Xenoenxerto/métodos , Células A549 , Animais , Antineoplásicos Hormonais/farmacologia , Dexametasona/farmacologia , Relação Dose-Resposta a Droga , Feminino , Glucocorticoides/farmacologia , Glucocorticoides/uso terapêutico , Humanos , Células MCF-7 , Camundongos Endogâmicos BALB C , Camundongos Nus , Neoplasias Pancreáticas/tratamento farmacológico , Carga Tumoral/fisiologia
8.
PLoS One ; 15(7): e0236506, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32730287

RESUMO

BACKGROUND: Few studies report the effects of tamoxifen intake and the occurrence of de novo fatty liver and the deterioration of existing fatty liver. The aim of this study was to investigate the effects of tamoxifen on fatty change of liver over time and also the impact of fatty liver on the prognosis of patients with breast cancer. METHODS: This was a single-center, retrospective study of patients who were diagnosed with primary breast cancer from January 2007 to July 2017. 911 consecutive patients were classified into three groups according to treatment method: tamoxifen group, aromatase inhibitor (AI) group, and control group. RESULTS: Median treatment duration was 49 months (interquartile range, IQR; 32-58) and median observational period was 85 months (IQR; 50-118). Long-term use of tamoxifen significantly aggravated fatty liver status compared to AI or control groups [hazard ratio (HR): 1.598, 95% confidence interval (CI): 1.173-2.177, P = 0.003] after adjusting other factors. When analyzed separately depending on pre-existing fatty liver at baseline, tamoxifen was involved in the development of de novo fatty liver [HR: 1.519, 95% CI: 1.100-2.098, P = 0.011) and had greater effect on fatty liver worsening (HR: 2.103, 95% CI: 1.156-3.826, P = 0.015). However, the progression of fatty liver did not significantly affect the mortality of breast cancer patients. CONCLUSIONS: Tamoxifen had a significant effect on the fatty liver status compared to other treatment modalities in breast cancer patients. Although fatty liver did not affect the prognosis of breast cancer, meticulous attention to cardiovascular disease or other metabolic disease should be paid when used for a long time.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Fígado Gorduroso/diagnóstico , Tamoxifeno/efeitos adversos , Adulto , Antineoplásicos Hormonais/efeitos adversos , Inibidores da Aromatase/uso terapêutico , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Estudos de Casos e Controles , Duração da Terapia , Fígado Gorduroso/etiologia , Fígado Gorduroso/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pontuação de Propensão , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Tamoxifeno/uso terapêutico
10.
Breast ; 52: 110-115, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: covidwho-437530

RESUMO

BACKGROUND: Corona Virus Disease 19 (COVID-19) had a worldwide negative impact on healthcare systems, which were not used to coping with such pandemic. Adaptation strategies prioritizing COVID-19 patients included triage of patients and reduction or re-allocation of other services. The aim of our survey was to provide a real time international snapshot of modifications of breast cancer management during the COVID-19 pandemic. METHODS: A survey was developed by a multidisciplinary group on behalf of European Breast Cancer Research Association of Surgical Trialists and distributed via breast cancer societies. One reply per breast unit was requested. RESULTS: In ten days, 377 breast centres from 41 countries completed the questionnaire. RT-PCR testing for SARS-CoV-2 prior to treatment was reported by 44.8% of the institutions. The estimated time interval between diagnosis and treatment initiation increased for about 20% of institutions. Indications for primary systemic therapy were modified in 56% (211/377), with upfront surgery increasing from 39.8% to 50.7% (p < 0.002) and from 33.7% to 42.2% (p < 0.016) in T1cN0 triple-negative and ER-negative/HER2-positive cases, respectively. Sixty-seven percent considered that chemotherapy increases risks for developing COVID-19 complications. Fifty-one percent of the responders reported modifications in chemotherapy protocols. Gene-expression profile used to evaluate the need for adjuvant chemotherapy increased in 18.8%. In luminal-A tumours, a large majority (68%) recommended endocrine treatment to postpone surgery. Postoperative radiation therapy was postponed in 20% of the cases. CONCLUSIONS: Breast cancer management was considerably modified during the COVID-19 pandemic. Our data provide a base to investigate whether these changes impact oncologic outcomes.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Neoplasias da Mama/terapia , Infecções por Coronavirus/epidemiologia , Mastectomia/métodos , Pneumonia Viral/epidemiologia , Radioterapia/métodos , Antineoplásicos/uso terapêutico , Betacoronavirus , Quimioterapia Adjuvante , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Assistência à Saúde/métodos , Gerenciamento Clínico , Europa (Continente)/epidemiologia , Perfilação da Expressão Gênica , Humanos , Programas de Rastreamento , Pandemias , Pneumonia Viral/diagnóstico , Radioterapia Adjuvante , Inquéritos e Questionários , Tempo para o Tratamento/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos
11.
Breast ; 52: 110-115, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32502796

RESUMO

BACKGROUND: Corona Virus Disease 19 (COVID-19) had a worldwide negative impact on healthcare systems, which were not used to coping with such pandemic. Adaptation strategies prioritizing COVID-19 patients included triage of patients and reduction or re-allocation of other services. The aim of our survey was to provide a real time international snapshot of modifications of breast cancer management during the COVID-19 pandemic. METHODS: A survey was developed by a multidisciplinary group on behalf of European Breast Cancer Research Association of Surgical Trialists and distributed via breast cancer societies. One reply per breast unit was requested. RESULTS: In ten days, 377 breast centres from 41 countries completed the questionnaire. RT-PCR testing for SARS-CoV-2 prior to treatment was reported by 44.8% of the institutions. The estimated time interval between diagnosis and treatment initiation increased for about 20% of institutions. Indications for primary systemic therapy were modified in 56% (211/377), with upfront surgery increasing from 39.8% to 50.7% (p < 0.002) and from 33.7% to 42.2% (p < 0.016) in T1cN0 triple-negative and ER-negative/HER2-positive cases, respectively. Sixty-seven percent considered that chemotherapy increases risks for developing COVID-19 complications. Fifty-one percent of the responders reported modifications in chemotherapy protocols. Gene-expression profile used to evaluate the need for adjuvant chemotherapy increased in 18.8%. In luminal-A tumours, a large majority (68%) recommended endocrine treatment to postpone surgery. Postoperative radiation therapy was postponed in 20% of the cases. CONCLUSIONS: Breast cancer management was considerably modified during the COVID-19 pandemic. Our data provide a base to investigate whether these changes impact oncologic outcomes.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Neoplasias da Mama/terapia , Infecções por Coronavirus/epidemiologia , Mastectomia/métodos , Pneumonia Viral/epidemiologia , Radioterapia/métodos , Antineoplásicos/uso terapêutico , Betacoronavirus , Quimioterapia Adjuvante , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Assistência à Saúde/métodos , Gerenciamento Clínico , Europa (Continente)/epidemiologia , Perfilação da Expressão Gênica , Humanos , Programas de Rastreamento , Pandemias , Pneumonia Viral/diagnóstico , Radioterapia Adjuvante , Inquéritos e Questionários , Tempo para o Tratamento/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos
12.
Zhonghua Zhong Liu Za Zhi ; 42(5): 408-412, 2020 May 23.
Artigo em Chinês | MEDLINE | ID: mdl-32482031

RESUMO

Objective: To investigate the fertility needs and outcome of pregnancy in patients with young breast cancer in China. Methods: A retrospective cross-sectional investigation was conducted on 374 young breast cancer women from Cancer Hospital, Chinese Academy of Medical Sciences. Young patients with breast cancer were defined as patients who got initial diagnosis of breast cancer at age no more than 40 years old. We conducted a questionnaire survey and collected clinical data from medical chart. Logistic regression model was used to analyze the possible factors influencing patients' fertility intention. Results: 308 young women with breast cancer completed questionnaires, and the response rate was 82.4%. 81 patients (26.3%) had fertility needs after diagnosis. Of them, 6 cases took active measures to preserve fertility. 72 patients (23.4%) received fertility counseling during treatment. 7 patients were successfully pregnant, including four cases who delivered normally. Multivariate logistic regression analysis showed that patients under 35 years old (OR=4.81), bachelor degree or above (OR=3.26), receiving breast-conserving surgery (OR=2.15) and childless patients (OR=3.03) were more likely to have fertility needs after diagnosis of breast cancer (all P<0.05). Conclusions: The fertility needs of young breast cancer women in China are gradually increasing. Healthcare providers associated with tumor patients should actively offer corresponding fertility consultation and individualized diagnosis and therapy plans for patients with fertility needs.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Preservação da Fertilidade , Adulto , Neoplasias da Mama/psicologia , China , Estudos Transversais , Feminino , Fertilidade , Humanos , Gravidez , Estudos Retrospectivos
13.
PLoS One ; 15(6): e0233571, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32497134

RESUMO

PURPOSE: This meta-analysis aimed to assess the efficacy and safety of cyclin-dependent kinase (CDK) 4/6 inhibitors plus endocrine therapy (ET) in hormonal receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (ABC). METHODS: We searched PubMed, Embase, Cochrane, ClinicalTrials.gov., ASCO, ESMO and AACR databases from inception to October 10, 2019 for randomized controlled trials (RCTs) that compared CDK 4/6 inhibitors plus ET to single-agent ET with no treatment-line restriction. The main outcomes analyzed were progression-free survival (PFS), overall survival (OS), objective response rate (ORR), clinical benefit rate (CBR), and adverse events (AEs). RESULTS: Of 938 identified studies, 9 RCTs with 5043 women were eligible and included. Compared with ET alone, CDK 4/6 inhibitors and ET combination improved in PFS (hazard ratio (HR) 0.54, 95% confidence interval (CI) 0.50-0.59, p< 0.00001) and OS (HR 0.77, 95% CI 0.69-0.85, p< 0.00001), regardless of ET strategies (HR 0.54, 95% CI 0.50-0.59 in PFS; HR 0.77, 95% CI 0.69-0.85 in OS), treatment line of advanced disease (HR 0.52, 95% CI 0.46-0.59 in PFS; HR 0.75, 95% CI 0.66-0.85 in OS) and menopausal status (HR 0.54, 95% CI 0.50-0.58 in PFS; HR 0.76, 95% CI 0.68-0.84 in OS). Higher risk of grade 3/4 AEs (RR 2.66, 95% CI 2.44-2.90, p < 0.00001) were observed in the combination group than in the ET group. CONCLUSIONS: Combination therapy with CDK 4/6 inhibitors and ET prolongs survival in HR+/ HER2- ABC. This combination is a better therapeutic strategy than endocrine monotherapy in HR+/HER2- ABC, regardless of treatment line, menopausal status and other individual characteristics.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/metabolismo , Quinase 4 Dependente de Ciclina/antagonistas & inibidores , Quinase 6 Dependente de Ciclina/antagonistas & inibidores , Inibidores de Proteínas Quinases/uso terapêutico , Receptor ErbB-2/metabolismo , Receptores Estrogênicos/metabolismo , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Inibidores de Proteínas Quinases/efeitos adversos
14.
Medicine (Baltimore) ; 99(22): e20367, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481418

RESUMO

BACKGROUND: Previous studies have reported that docetaxel combined prednisone (DP) has been used for the treatment of patients with hormone refractory prostate cancer (HRPC). However, its results are still inconsistent. Therefore, this study will synthesize the latest evidence of the efficacy and safety of DP for the treatment of patients with HRPC. METHODS: Cochrane Library, PUBMED, EMBASE, Web of Science, CINAHL, CBM, and CNKI will be searched to identify randomized controlled trials published from their inception to the March 1, 2020, irrespective language and publication time restrictions. We will calculate the pooled effects of dichotomous outcomes as risk ratio and 95% confidence intervals, and that of continuous outcomes as standardized mean difference or mean difference and 95% confidence intervals. Study quality will be assessed using Cochrane risk of bias, and quality of evidence for main outcome will be evaluated using Grading of Recommendations Assessment Development and Evaluation. Statistical analysis will be performed using RevMan 5.3 software. RESULTS: This study will appraise the efficacy and safety of DP for the treatment of patients with HRPC. The primary outcome includes overall survival, and the secondary outcomes comprise of progression-free survival, prostate-specific antigen response rate, duration of prostate-specific antigen response, objective tumor response rate, disease-free survival, quality of life, and adverse events. CONCLUSION: The results of this study may provide helpful evidence of DP for the treatment of patients with HRPC.Systematic review registration: INPLASY202040112.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Antineoplásicos/uso terapêutico , Docetaxel/uso terapêutico , Prednisona/uso terapêutico , Neoplasias da Próstata/tratamento farmacológico , Antineoplásicos/administração & dosagem , Antineoplásicos Hormonais/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Docetaxel/administração & dosagem , Humanos , Masculino , Prednisona/administração & dosagem
15.
Medicine (Baltimore) ; 99(26): e20491, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590732

RESUMO

BACKGROUND: Atypical polypoid adenomyoma (APA) is a rare uterine tumor typically found in fertile age and associated with infertility. Among young nullipara women, conservative treatment is proposed despite the high recurrence rate and the association with endometrial cancer.Our aim was to assess the risk of recurrence with different conservative treatments in fertile ages and the prevalence of malignant or pre-malignant associated lesions to better address an adequate patient counselling when treatment modalities are discussed. METHODS: This study is a systematic review and meta-analysis of case reports and case series about APA management and follow-up. A literature search was carried from Medline and Scopus for studies published from January 1, 1980 to December 31, 2018. RESULTS: We included 46 observational studies and 296 cases in fertile women. The prevalence of APA relapse was 44% (CI.95 33-57%) and was lower in cases treated with operative hysteroscopy (22%; CI.95 11-39%) than in cases treated with blind curettage and polypectomy (38%; CI.95 15-67%). The prevalence of the concomitant or during the follow-up diagnosis of endometrial carcinoma was 16% (CI.95 9-29%). The risk of cancer development during follow-up was significantly less in cases treated with histeroscopy (10.56% new cumulative diagnosis at 5 years follow up; CI.95 0-23.7%) than blind curettage and polypectomy (35.5% new cumulative diagnosis at 5 years; CI.95 11.65-52.92%; P < .05). Medical treatment with medroxyprogesterone acetate after surgery does not reduce APA recurrence. Pregnancy was observed in 79% cases in which the desire was expressed. CONCLUSION: This review suggests that conservative treatment performed by operative hysteroscopy is the optimal choice because it lowers the risk of recurrence, improves the accuracy of concomitant carcinoma or hyperplasia diagnosis, and leaves the possibility of future pregnancies.


Assuntos
Adenomioma/terapia , Recidiva Local de Neoplasia/patologia , Neoplasias Uterinas/terapia , Adenomioma/patologia , Antineoplásicos Hormonais/uso terapêutico , Quimioterapia Adjuvante , Tratamento Conservador , Curetagem , Hiperplasia Endometrial/patologia , Neoplasias do Endométrio/patologia , Feminino , Humanos , Histeroscopia , Acetato de Medroxiprogesterona/uso terapêutico , Neoplasias Primárias Múltiplas , Gravidez , Taxa de Gravidez , Neoplasias Uterinas/patologia
16.
Medicine (Baltimore) ; 99(24): e20396, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541460

RESUMO

RATIONALE: Patients with, or who develop, metastatic breast cancer have a 5-year relative survival of about 25%. Endocrine therapy clearly improves outcomes in patients with estrogen receptor-positive breast cancer. In the metastatic setting, the primary goal of treatment is to maintain long-term disease control with good quality of life. Rarely, exceptional responders achieve durable disease control, and potential cures cannot be ruled out. PATIENT CONCERNS: We report the case of a 39-year-old woman with primary breast cancer and associated synchronous bone metastases, who experienced a disease response of 12 years with hormonal therapy as maintenance after first line chemotherapy, with a good toxicity profile. DIAGNOSIS: The patient was diagnosed with estrogen receptor + human epidermal growth factor receptor 2 (HER2)- metastatic breast cancer with synchronous bone metastases. INTERVENTIONS: This patient was treated with chemotherapy for 6 cycles as a first-line therapy following by endocrine treatment given as a maintenance therapy. OUTCOMES: Our patient experienced a progression-free survival >12 years with an exceptionally good quality of life. LESSONS: Our anecdotal experience highlights the existence of exceptional responders among patients with hormone receptor-positive metastatic breast cancer, who achieve clinical remission and durable disease control with endocrine therapy. Being able to identify these patients could help in the selection of the best treatment option among the many available.


Assuntos
Neoplasias Ósseas/secundário , Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Adulto , Antineoplásicos/uso terapêutico , Antineoplásicos Hormonais/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/psicologia , Feminino , Humanos , Intervalo Livre de Progressão , Qualidade de Vida , Receptor ErbB-2/genética , Receptores Estrogênicos/genética , Resultado do Tratamento
17.
Artigo em Inglês | MEDLINE | ID: mdl-32570717

RESUMO

In this study, an in-depth analysis of weight management experiences of breast cancer patients treated with tamoxifen is conducted, thereby providing basic data to help develop a multidimensional strategy to reduce recurrence and increase the survival rate of breast cancer patients. Study participants included nine breast cancer patients who were treated with tamoxifen at Kosin University Hospital and Saegyero Hospital in Busan Metropolitan City, Korea. This study employed the photovoice methodology. Participants described the need for family support and cooperation with weight management, provision of personalized weight management programs by medical institutions, provision of information on weight management programs by the community, and financial support for the weight management programs for breast cancer patients at the national level. This study emphasized the importance of weight management for breast cancer patients treated with tamoxifen and collected and analyzed vivid opinions of these patients using photos taken by them.


Assuntos
Antineoplásicos Hormonais , Peso Corporal , Neoplasias da Mama , Tamoxifeno , Antineoplásicos Hormonais/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Quimioterapia Adjuvante , Feminino , Humanos , Mastectomia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , República da Coreia , Tamoxifeno/uso terapêutico
18.
Breast Cancer Res Treat ; 182(3): 515-521, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32529409

RESUMO

PURPOSE: Cryoablation is a minimally-invasive percutaneous procedure that is capable of reducing the psychosocial burden of surgical delay while also decreasing the morbidity of breast cancer therapy. The purpose of this editorial is to discuss the potential role of cryoablation for reducing the psychosocial burden of surgical delay during the COVID-19 pandemic by expediting the management of breast cancer while also lessening demand on limited healthcare resources. METHODS: This editorial critiques current expert opinion recommendations that aim to reduce viral transmission and preserve healthcare resources during the COVID-19 pandemic by advocating delay of elective breast cancer surgery. RESULTS: The editorial summarizes the current state of the evidence that supports the selective use of cryoablation as a definite or stopgap measure in the management of breast cancer during the COVID-19 pandemic or when healthcare resources are limited. CONCLUSIONS: As an office-based procedure performed under local anesthesia, cryoablation eliminates the need for operating room personnel and equipment while also reducing the psychosocial impact of delayed breast cancer surgery. By reducing the number of patient and healthcare provider interactions, cryoablation not only decreases the risk of viral transmission but also the need for personal protective devices during resource-limited times.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Ansiedade/psicologia , Neoplasias da Mama/terapia , Infecções por Coronavirus/epidemiologia , Criocirurgia/métodos , Mastectomia , Terapia Neoadjuvante , Pneumonia Viral/epidemiologia , Tempo para o Tratamento , Procedimentos Cirúrgicos Ambulatórios , Betacoronavirus , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Neoplasias da Mama/psicologia , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Mastectomia Segmentar , Estadiamento de Neoplasias , Pandemias/prevenção & controle , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/prevenção & controle , Medição de Risco
19.
Eur J Endocrinol ; 183(1): G17-G23, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: covidwho-205229

RESUMO

Patients with pituitary tumours, ensuing hormonal abnormalities and mass effects are usually followed in multidisciplinary pituitary clinics and can represent a management challenge even during the times of non-pandemic. The COVID-19 pandemic has put on hold routine medical care for hundreds of millions of patients around the globe, while many pituitary patients' evaluations cannot be delayed for too long. Furthermore, the majority of patients with pituitary tumours have co-morbidities potentially impacting the course and management of COVID-19 (e.g. hypopituitarism, diabetes mellitus, hypertension, obesity and cardiovascular disease). Here, we summarize some of the diagnostic and management dilemmas encountered, and provide guidance on safe and as effective as possible delivery of care in the COVID-19 era. We also attempt to address how pituitary services should be remodelled in the event of similar crises, while maintaining or even improving patient outcomes. Regular review of these recommendations and further adjustments are needed, depending on the evolution of the COVID-19 pandemic status. We consider that the utilization of successful models of pituitary multidisciplinary care implemented during the COVID-19 pandemic should continue after the crisis is over by using the valuable and exceptional experience gained during these challenging times.


Assuntos
Adenoma/terapia , Antineoplásicos Hormonais/uso terapêutico , Infecções por Coronavirus , Agonistas de Dopamina/uso terapêutico , Procedimentos Neurocirúrgicos , Pandemias , Apoplexia Hipofisária/terapia , Neoplasias Hipofisárias/terapia , Pneumonia Viral , Adenoma/diagnóstico , Cabergolina/uso terapêutico , Gerenciamento Clínico , Terapia de Reposição Hormonal , Hormônio do Crescimento Humano/análogos & derivados , Hormônio do Crescimento Humano/uso terapêutico , Humanos , Octreotida/uso terapêutico , Peptídeos Cíclicos/uso terapêutico , Apoplexia Hipofisária/diagnóstico , Neoplasias Hipofisárias/diagnóstico , Guias de Prática Clínica como Assunto , Radioterapia , Somatostatina/análogos & derivados , Somatostatina/uso terapêutico , Telemedicina , Fatores de Tempo , Testes de Campo Visual
20.
J Cancer Res Clin Oncol ; 146(7): 1791-1800, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32405744

RESUMO

AIM: To assess the impact of age, comorbidities and endocrine therapy (ET) in older breast cancer (BC) patients treated with hypofractionated radiotherapy (Hypo-RT). METHODS: From June 2009 to December 2017, we enrolled in this study 735 ER-positive BC patients (stage pT1-T2, pNx-1, M0 and age ≥ 65 years) receiving hypo-RT and followed them until September 2019. Baseline comorbidities included in the hypertension-augmented Charlson Comorbidity Index were retrospectively retrieved. Logistic regression model estimated adjusted-odds ratios (ORs) of ET prescription in relation to baseline patient and tumor characteristics. Competing risk analysis estimated 5-year cumulative incidence function (CIF) of ET discontinuation due to side effects (with BC progression or death as competing events), and its effect on locoregional recurrence (LRR) and distant metastasis (DM) (with death as competing event). RESULTS: ET has been prescribed in 89% patients. In multivariable analysis, the odds of ET prescription was significantly reduced in older patients (≥ 80 years, OR 0.08, 95% CI 0.03-0.20) and significantly increased in patients with moderate comorbidity. Patients ≥ 80 years discontinued the prescribed therapy earlier and more frequently than younger (65-69 years) patients (p = 0.060). Five-year CIF of LLR, DM and death from causes other that BC were 1.7%, 2.2% and 7.5%, respectively. Patients who discontinued ET had higher chance of LRR (p = 0.004). ET use did not impact on OS in any of the analyzed groups. CONCLUSIONS: In older patients, ET did not show a benefit in terms of overall survival. Further studies focusing on tailored treatment approaches are warranted to offer the best care in terms of adjuvant treatment to these patients.


Assuntos
Neoplasias da Mama/epidemiologia , Avaliação Geriátrica , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos Hormonais/administração & dosagem , Antineoplásicos Hormonais/efeitos adversos , Antineoplásicos Hormonais/uso terapêutico , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/mortalidade , Neoplasias da Mama/radioterapia , Terapia Combinada , Comorbidade , Feminino , Humanos , Metástase Neoplásica , Estadiamento de Neoplasias , Cooperação do Paciente , Prognóstico , Hipofracionamento da Dose de Radiação , Radioterapia Adjuvante , Recidiva , Resultado do Tratamento
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