Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.343
Filtrar
1.
Rev. venez. oncol ; 33(1): 46-59, mar. 2021. tab
Artigo em Espanhol | LILACS, LIVECS | ID: biblio-1147479

RESUMO

El cáncer de mama Triple Negativo es un subtipo molecular que se caracteriza por ausencia de expresión de receptores de estrógeno, progesterona y proteína HER2. Representa el 10 % a 15 % de todos los subtipos de cáncer de mama con impacto en el pronóstico y en las líneas de tratamiento; siendo negativo para receptores hormonales y HER2, la terapéutica hormonal y anti-HER2 no cuentan para su manejo. Aún no se dispone de productos dirigidos a blancos específicos para esta categoría.(AU)


The Triple Negative breast cancer is a molecular subtype characterized by no expression of the estrogen, the progesterone and the HER2 protein receptors. They represents 10 % to 15 % of all the breast cancer subtypes with an impact on the prognosis and in the treatment lines; is negative for the hormone receptors and for the HER2, hormonal and the anti-HER2 therapeutics do not count for the management of them. The products targeting specific to this category are not yet available(AU)


Assuntos
Humanos , Feminino , Biomarcadores Tumorais , Antraciclinas/uso terapêutico , Taxoides/uso terapêutico , Neoplasias de Mama Triplo Negativas/patologia , Neoplasias de Mama Triplo Negativas/epidemiologia , Mamografia , Tratamento Farmacológico , Oncologia
2.
Anticancer Res ; 41(2): 1063-1068, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517316

RESUMO

BACKGROUND/AIM: We evaluated the impact of the relative dose intensity (RDI) of neoadjuvant chemotherapy (NAC) on the survival of patients with breast cancer (BC). PATIENTS AND METHODS: This randomized phase II trial included 188 patients with human epidermal growth factor receptor 2 (HER2)-negative BC treated with anthracycline followed by paclitaxel as NAC. We grouped patients using a relative dose intensity (RDI) threshold of 85% and evaluated clinicopathological features and clinical outcomes. RESULTS: The 5-year overall survival rate was 91.2% and 76.3%, when RDI ≥85% and <85%, respectively (p=0.015). Age, tumor, and node status, and the RDI were significantly different on univariate analysis, but not on multivariate analysis. An exploratory subgroup analysis revealed that a low RDI was associated with low overall survival of patients with obesity, T1/2 disease, and lymph node metastases. CONCLUSION: Maintaining the RDI of NAC is crucial for achieving the survival benefit in selected patients with HER2-negative BC.


Assuntos
Antraciclinas/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias da Mama/tratamento farmacológico , Paclitaxel/administração & dosagem , Receptor ErbB-2/metabolismo , Adulto , Idoso , Antraciclinas/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/metabolismo , Neoplasias da Mama/mortalidade , Esquema de Medicação , Cálculos da Dosagem de Medicamento , Feminino , Humanos , Pessoa de Meia-Idade , Terapia Neoadjuvante , Paclitaxel/uso terapêutico , Análise de Sobrevida , Resultado do Tratamento
3.
Zhonghua Wai Ke Za Zhi ; 59(2): 101-103, 2021 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-33378800

RESUMO

Triple negative breast cancer (TNBC) is a special type of breast cancer. At present, the major treatment for TNBC is chemotherapy. Neoadjuvant therapy and obtained pathology completed response could bring the TNBC patients better prognosis. The most used TNBC chemotherapy protocols are established on the basis of anthracycline and taxane. Through the thorough knowledge of molecular mechanism of TNBC, neoadjuvant therapy protocols have optimized, including the use of platinum, immune checkpoint inhibitors and poly-ADP-ribose polymerase inhibitors, and assumed positive outcome for TNBC patients.


Assuntos
Terapia Neoadjuvante , Neoplasias de Mama Triplo Negativas , Antraciclinas/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica , Hidrocarbonetos Aromáticos com Pontes/uso terapêutico , Humanos , Compostos de Platina/uso terapêutico , Prognóstico , Taxoides/uso terapêutico , Neoplasias de Mama Triplo Negativas/tratamento farmacológico
4.
J Cancer Res Ther ; 16(4): 764-770, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32930116

RESUMO

Background: The benefits of second-line chemotherapy on the overall survival (OS) of small-cell lung cancer (SCLC) patients might be confounded by subsequent therapies. In this study, we aimed to determine the influence of progression-free survival (PFS) and postprogression survival (PPS) on OS after second-line chemotherapy in patients with refractory SCLC treated with amrubicin monotherapy. Materials and Methods: We analyzed the data of 35 patients with refractory SCLC who were treated with amrubicin monotherapy as second-line chemotherapy between July 2005 and December 2015. The correlations of PFS and PPS with OS were statistically analyzed at the individual level using Spearman's rank correlation and linear regression analyses. Results: The correlation between PPS and OS was strong (r = 0.88, P < 0.05, R2 = 0.87), while that between PFS and OS was weak (r = 0.60, P < 0.05, R2 = 0.15). The number of regimens administered after disease progression postsecond-line chemotherapy was significantly associated with PPS (P = 0.003). Conclusions: OS is more strongly linked to PPS than to PFS in refractory SCLC patients who undergo amrubicin monotherapy as a second-line treatment. These results suggest that treatments administered after second-line chemotherapy affect the OS of refractory SCLC patients treated with amrubicin monotherapy.


Assuntos
Antraciclinas/uso terapêutico , Neoplasias Pulmonares/tratamento farmacológico , Carcinoma de Pequenas Células do Pulmão/tratamento farmacológico , Idoso , Antineoplásicos/uso terapêutico , Progressão da Doença , Resistencia a Medicamentos Antineoplásicos , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Estudos Prospectivos , Estudos Retrospectivos , Carcinoma de Pequenas Células do Pulmão/mortalidade , Carcinoma de Pequenas Células do Pulmão/patologia , Taxa de Sobrevida
5.
Gan To Kagaku Ryoho ; 47(8): 1205-1208, 2020 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-32829355

RESUMO

Standard regimens for extrapulmonary neuroendocrine carcinomas(EPNEC)are not established. Treatment used for small cell lung cancer is also used for EPNECs. Amrubicin(AMR) monotherapy is used as salvage therapy for small cell lung cancer, but its efficacy in EPNEC is not clear. The aim of this study was to estimate the efficacy of AMR monotherapy in EPNEC. We retrospectively investigated patients with EPNEC who received first-line platinum-based chemotherapy between April 2007 and March 2019. The time to treatment failure(TTF)and the efficacy and toxicity was analyzed in the patients who received AMR monotherapy. Among 43 patients with EPNEC, 14(13 males, one female; median age, 58 years)received AMR monotherapy. Primary site included the pancreas(n=3), stomach(n=3), rectum(n=1), anal canal(n=1), salivary glands(n= 1), urothelial(n=1), bladder(n=1), prostate(n=1), and 2 patients had primary unknown cancer. Pathological type included small cell(n=4), large cell(n=2), and other types(n=8). Prior chemotherapy comprised CDDP plus CPT-11(n =5), CDDP plus ETP(n=2), and CBDCA plus ETP(n=6). The median TTF was 49(20-61)days. One patient had a partial response and the disease control rate was 33%. The common adverse events of >Grade 3 were leukopenia(69%), neutropenia(62%), and febrile neutropenia(23%). AMR monotherapy was clinically effective and safe for EPNEC.


Assuntos
Antraciclinas/uso terapêutico , Carcinoma Neuroendócrino , Antineoplásicos , Protocolos de Quimioterapia Combinada Antineoplásica , Carcinoma Neuroendócrino/tratamento farmacológico , Feminino , Humanos , Neoplasias Pulmonares , Masculino , Pessoa de Meia-Idade , Platina , Estudos Retrospectivos , Resultado do Tratamento
6.
Medicine (Baltimore) ; 99(25): e20454, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569168

RESUMO

BACKGROUND: The aim of this study is to examine the efficacy of weekly amrubicin (WA) for treating refractory or relapsed non-small cell lung cancer (RRNSCLC). METHODS: The literature search will be performed using the Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycINFO, Scopus, Chinese Biomedical Literature Database, WANGFANG, VIP database, and China National Knowledge Infrastructure from inception onwards up to the March 1, 2020. No language limitation will be implemented. Randomized controlled trials that examined the efficacy and safety of WA for the treatment of RRNSCLC will be included. Literature selection, data extraction, and methodological quality assessment will be handled by 2 independent authors. We will invite a third author to disentangle any divergences between 2 authors. We will carry out statistical analysis using RevMan 5.3 software. RESULTS: This study will summarize current evidence to assess the efficacy and safety of WA for the treatment of RRNSCLC. CONCLUSIONS: The findings of this study will provide helpful evidence for the clinician, and will promote further studies, as well as clarify the direction of research on WA for the management of RRNSCLC.Study registration number: INPLASY202040168.


Assuntos
Antraciclinas/uso terapêutico , Antineoplásicos/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Recidiva Local de Neoplasia/tratamento farmacológico , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto
7.
Cancer Sci ; 111(7): 2579-2587, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32378780

RESUMO

We performed a genome-wide association study to investigate the association between single nucleotide polymorphisms and anthracycline-induced cardiotoxicity (ACT) in patients diagnosed with early breast cancer. From January 2000 to December 2015, 8490 patients underwent breast surgery at the National Cancer Center in Korea. Patients who received doxorubicin (cumulative dose 240 mg/m2 -300 mg/m2 ) with or without trastuzumab as a neoadjuvant/adjuvant therapy were included in our cohort. Sixty-seven patients in our cohort were diagnosed with ACT. Clinical data, including age, body weight, height, cancer stage, trastuzumab treatment, comorbidities, and concomitant medications, were collected retrospectively. Patients were classified as having either persistent or transient ACT based on their clinical course. In total, 346 946 single nucleotide polymorphisms in 42 cases and 215 controls were tested in this study. Body mass index (BMI) ≥25 kg/m2 [odds ratio (OR) = 2.45, 95% confidence interval (CI), 1.23-4.88, P = .011] and trastuzumab use (OR = 2.40, 95% CI, 1.11-5.17, P = .026) were identified as significant risk factors. We found 7 genetic variants for ACT including rs17530621 (SHISA3, P = 3.10E-06), rs11894115 (MPP4, P = 4.71E-06), rs58328254 (RPL7, P = 6.09E-06), and rs117299725 (PRUNE2, P = 8.53E-06), although none of these variants reached the Bonferroni-corrected significance level when adjusted for BMI and trastuzumab use ( = α1.44E-07 based on 0.05/346 946). rs117299725 was a common variant when only the persistent ACT group was analyzed separately. It is meaningful that our study analyzed comprehensively the influence of genetic variation on ACT, along with some clinical factors in Asian breast cancer patients who received anthracycline with or without trastuzumab. Further research will be needed on candidate genetic variants found in this study.


Assuntos
Antraciclinas/efeitos adversos , Neoplasias da Mama/complicações , Neoplasias da Mama/genética , Cardiotoxicidade/etiologia , Predisposição Genética para Doença , Variação Genética , Estudo de Associação Genômica Ampla , Antraciclinas/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/epidemiologia , Cardiotoxicidade/diagnóstico , Cardiotoxicidade/epidemiologia , Estudos de Casos e Controles , Comorbidade , Feminino , Estudos de Associação Genética/métodos , Humanos , Razão de Chances , Polimorfismo de Nucleotídeo Único , Vigilância da População , República da Coreia
8.
Am J Cardiol ; 127: 163-168, 2020 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-32444028

RESUMO

Anthracycline-induced cardiotoxicity can lead to clinical and subclinical heart failure. Decrease of global longitudinal strain is a predictor for heart failure. Early detection of subclinical cardiotoxicity is crucial for timely intervention and prevention of further progression. Cardiac function of 41 survivors of childhood acute lymphoblastic leukemia (ALL) was assessed. Values of cardiac troponin T, N-terminal-pro-brain natriuretic peptide, conventional and myocardial 2D strain echocardiography were measured before (T = 0), during (T = 1, cumulative dose of 120 mg/m2), shortly after (T = 2) and long after anthracycline treatment (T = 3, ≥5 years after anthracycline exposure). Cardiac function of survivors at the latest follow up was compared with 70 healthy age-matched controls. None of the survivors showed clinical signs of cardiac failure at T = 3. Strain values decreased during anthracycline treatment and an ongoing reduction was seen at the latest follow-up (T = 3) with preserved cardiac function (normal ejection fraction and shortening fraction). At T = 1, a relative reduction in longitudinal strain (≥10% compared with baseline) was observed in 38% of the survivors, which increased to 54% at T=3. ALL survivors showed significantly lower conventional and myocardial 2D strain values, especially strain rate, compared with healthy age-matched controls. At T = 3, we did not find any abnormal cardiac troponin T levels. Six percent of the survivors showed abnormal N-terminal-pro-brain natriuretic peptide levels. This prospective study showed an ongoing reduction of 2D myocardial strain and strain rate, with preserved left ventricular ejection fraction (≤10% decrease compared with baseline) in asymptomatic ALL survivors at late follow-up.


Assuntos
Antraciclinas/uso terapêutico , Ecocardiografia/métodos , Eletrocardiografia , Cardiopatias/fisiopatologia , Contração Miocárdica/fisiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Cardiopatias/diagnóstico , Cardiopatias/etiologia , Humanos , Masculino , Países Baixos/epidemiologia , Projetos Piloto , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Fatores de Tempo
9.
PLoS One ; 15(5): e0233037, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32401825

RESUMO

Tumor-infiltrating lymphocyte (TIL) levels have prognostic and predictive values in treatment-naïve breast cancers. However, there have been controversies regarding TIL subset changes and their clinical implications in post-treatment breast cancers. This study aimed to explore change and prognostic significance of TIL subset infiltration after primary systemic therapy (PST) in breast cancer. One-hundred-fifty-five patients who had residual disease after anthracycline- or anthracycline plus taxane-based PST were included. The quantities of intratumoral and stromal TIL subsets (CD8+, CD4+, and FOXP3+ TILs) in pre- and post-PST breast cancer samples, as well as changes between them, were analyzed along with their correlations with clinicopathologic features and outcome of patients. As a whole, intratumoral CD8+ and CD4+ TILs increased after PST while stromal TILs decreased. Both intratumoral and stromal FOXP3+ TILs decreased after PST. The chemo-sensitive group [residual cancer burden (RCB) class I and II] showed the same pattern of change in intratumoral CD8+ TILs as the whole group, whereas the chemo-resistant group (RCB class III) showed no significant change in intratumoral CD8+ TIL infiltration after PST. Survival analyses for each TIL subset as well as their ratios revealed that high levels of intratumoral, stromal, and total CD8+ TIL infiltration after PST were independent predictors of longer patient survival. In subgroup analyses, CD8+ TIL infiltration after PST revealed prognostic significance in the chemo-resistant group but not in the chemo-sensitive group. In conclusion, infiltration of CD8+, CD4+, and FOXP3+ TIL changed after PST in the intratumoral and stromal compartments. Especially, increase of intratumoral CD8+ TILs was associated with chemo-responsiveness. Moreover, CD8+ TIL status in residual tumors after PST may be used as a potential prognostic marker in breast cancer patients who receive PST and provide additional prognostic information to chemo-resistant group.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Antígenos CD4/metabolismo , Antígenos CD8/metabolismo , Fatores de Transcrição Forkhead/metabolismo , Linfócitos do Interstício Tumoral/imunologia , Adulto , Idoso , Antraciclinas/uso terapêutico , Neoplasias da Mama/imunologia , Neoplasias da Mama/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasia Residual , Prognóstico , Análise de Sobrevida , Taxoides/uso terapêutico , Resultado do Tratamento
10.
Am J Cardiol ; 125(12): 1906-1912, 2020 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-32331711

RESUMO

To determine the impact of radiation therapy (XRT) in addition to trastuzumab (TZB) adjuvant chemotherapy for HER2+ breast cancer on left ventricular systolic function, we assessed demographics, oncologic treatment history including XRT exposure, and serial measurements of left ventricular ejection fraction (LVEF) in 135 consecutively identified women receiving TZB for treatment of adjuvant breast cancer. Longitudinal mixed effects models were fit to identify baseline to treatment changes in LVEF among those receiving TZB with or without concomitant anthracycline or XRT. Women averaged 53 ± 3 years in age, 77% were white, 62% patients had 1 or more cardiovascular risk factors at baseline, and mean duration of TZB was 11 ± 5 months. Seventy-seven women were treated with XRT and received between 4000 and 5500 cGy of radiation. The LVEF declined by an average of 3.4% after 1 year for those in the study. Relative to baseline upon completion of adjuvant TZB, LVEF remained reduced for those receiving anthracycline with or without XRT (p=0.002 for both), or XRT alone (p=0.002), but not in those without these therapies. Amongst patients treated only with XRT and TZB, LVEF declined 3.1% on average in those with left-sided disease and 6.9% on average in those with right-sided disease (p= 0.06, p= 0.008 respectively). Among women receiving TZB for adjuvant treatment of HER-2 positive breast cancer, the administration of XRT, anthracycline, or the combination of the 2 is associated with a persistent post-treatment as opposed to a temporary treatment related decline in LVEF.


Assuntos
Antraciclinas/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/radioterapia , Doenças Cardiovasculares/etiologia , Volume Sistólico , Trastuzumab/uso terapêutico , Quimioterapia Adjuvante , Feminino , Humanos , Pessoa de Meia-Idade , Receptor ErbB-2 , Fatores de Risco , Volume Sistólico/efeitos dos fármacos , Volume Sistólico/efeitos da radiação
11.
Sci Rep ; 10(1): 5839, 2020 04 03.
Artigo em Inglês | MEDLINE | ID: mdl-32246106

RESUMO

Anthracycline chemotherapy is commonly used to treat breast cancer yet may increase the level of matrix metalloproteinases (MMP) -2 and -9, which increase the risk of atherosclerosis. While exercise has been shown to reduce the level of MMP in patients with diabetes, high intensity interval training (HIIT) has not been utilized to improve level of MMP in women with breast cancer receiving anthracycline chemotherapy. Thirty women were randomized to either 8-week HIIT or control (CON) group. The CON group was offered the HIIT intervention after 8 weeks. MMP-1, -2 -7, -9, tissue inhibitor of MMP (TIMP) -1, and-2 were measured at baseline and post-intervention. Repeated measures ANCOVA and paired t-test were performed to assess changes in MMP and TIMP. Post-intervention, no significant between-group differences were observed for MMP and TIMP. However, within-group decrease in MMP-9 was observed in the HIIT group [104.3(51.9) to 65.2(69.1); P = 0.01]. MMP-9 in the CON group was not significantly changed [115.5(47.2) to 90.4(67.9);]. MMP-2 significantly increased in both the HIIT group [76.6(11.2) to 83.2(13.1); P = 0.007) and the CON group [69.0(8.9) to 77.6(11.1) P = 0.003). It is unclear whether an 8-week HIIT intervention influences MMP-9 in breast cancer patients undergoing anthracycline chemotherapy. Additional investigations are required to understand the exercise-induced changes in MMP-2 and -9 in women undergoing anthracycline chemotherapy.


Assuntos
Antraciclinas/uso terapêutico , Antineoplásicos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Treinamento Intervalado de Alta Intensidade , Metaloproteinases da Matriz/sangue , Adulto , Antraciclinas/efeitos adversos , Antineoplásicos/efeitos adversos , Neoplasias da Mama/enzimologia , Neoplasias da Mama/terapia , Feminino , Treinamento Intervalado de Alta Intensidade/métodos , Humanos , Metaloproteinase 1 da Matriz/sangue , Metaloproteinase 10 da Matriz/sangue , Metaloproteinase 2 da Matriz/sangue , Metaloproteinase 7 da Matriz/sangue , Metaloproteinase 9 da Matriz/sangue , Inibidor Tecidual de Metaloproteinase-1/sangue , Inibidor Tecidual de Metaloproteinase-2/sangue
12.
Anticancer Res ; 40(3): 1571-1578, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32132059

RESUMO

BACKGROUND/AIM: The efficacy of the combination of amrubicin and bevacizumab against advanced non small-cell lung cancer (NSCLC), as a second or third-line treatment, was evaluated. PATIENTS AND METHODS: Amrubicin was administered for 3 days to patients with previously treated advanced NSCLC, whereas bevacizumab was administered on day 1 of each cycle; this regimen was repeated every 3 weeks. RESULTS: Among the 16 patients, an overall response rate of 12.5% (for two patients) was achieved, and the overall disease control rate was 93.7%. Progression free survival and overall survival were 8.5 and 16.6 months, respectively. Grade 3 or 4 haematological toxicities were leukopenia, neutropenia, and febrile neutropenia. Grade 3 proteinuria and infection were the non haematological adverse events. CONCLUSION: The combination of amrubicin and bevacizumab is a promising regimen in the second or third-line treatment for advanced non-squamous NSCLC; however, physicians must recognise the risk of proteinuria related with this regimen.


Assuntos
Antraciclinas/uso terapêutico , Antineoplásicos/uso terapêutico , Bevacizumab/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Idoso , Antraciclinas/farmacologia , Antineoplásicos/farmacologia , Bevacizumab/farmacologia , Carcinoma Pulmonar de Células não Pequenas/patologia , Estudos de Viabilidade , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
13.
Klin Lab Diagn ; 65(3): 141-148, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32163687

RESUMO

Anthracyclines are effectively used in many therapeutic regimens for breast cancer (BC). However, the dose-dependent cardiotoxic effect causes certain limitations on their use. Laboratory tests for risk prediction and early diagnosis of anthracycline-induced cardiotoxicity (ACIC) based on measuring the activity and concentration of topoisomerase 2ß, the levels of troponins T and I (TnT и TnI), N-terminal fragment of brain natriuretic peptide progenitor, remain relevant, but complicate the risk stratification with low specificity. Recently, the number of works devoted to the study of new biomarkers ACIC has been growing: galectin-3, soluble ST-2 (sST-2), and myeloperoxidase (MPO). In this review we analyzed current understanding of the classical markers ACIC and the results of recent studies dedicated to new predictors.


Assuntos
Antraciclinas/toxicidade , Neoplasias da Mama/tratamento farmacológico , Cardiotoxicidade , Antraciclinas/uso terapêutico , Biomarcadores , DNA Topoisomerases Tipo II , Detecção Precoce de Câncer , Feminino , Galectina 3 , Humanos , Proteína 1 Semelhante a Receptor de Interleucina-1 , Peptídeo Natriurético Encefálico , Peroxidase , Troponina I , Troponina T
14.
BMC Cancer ; 20(1): 232, 2020 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-32188417

RESUMO

BACKGROUND: NEPA is an oral fixed-dose combination of netupitant, a new highly selective neurokinin-1 receptor antagonist, and palonosetron. This study was conducted to evaluate whether the efficacy of NEPA against chemotherapy-induced nausea and vomiting (CINV) in cycle 1 would be maintained over subsequent chemotherapy cycles in breast cancer patients receiving adjuvant anthracycline plus cyclophosphamide (AC). The study also describes the relationship between efficacy on day 1 through 5 (overall period) and control of CINV on day 6 through 21 (very late period) in each cycle. METHODS: In this multicentre, phase II study, patients received both NEPA and dexamethasone (12 mg intravenously) just before chemotherapy. The primary efficacy endpoint was overall complete response (CR; no emesis and no rescue medication use) in cycle 1. Sustained efficacy was evaluated during the subsequent cycles by calculating the rate of CR in cycles 2-4 and by assessing the probability of sustained CR over multiple cycles. The impact of both overall CR and risk factors for CINV on the control of very late events (vomiting and moderate-to-severe nausea) were also examined. RESULTS: Of the 149 patients enrolled in the study, 139 were evaluable for a total of 552 cycles; 97.8% completed all 4 cycles. The proportion of patients with an overall CR was 70.5% (90% CI, 64.1 to 76.9) in cycle 1, and this was maintained in subsequent cycles. The cumulative percentage of patients with a sustained CR over 4 cycles was 53%. NEPA was well tolerated across cycles. In each cycle, patients with CR experienced a significantly better control of very late CINV events than those who experienced no CR. Among the patients with CR, the only predictor for increased likelihood of developing very late CINV was pre-chemotherapy (anticipatory) nausea (adjusted odds ratio = 0.65-0.50 for no CINV events on cycles 3 and 4). CONCLUSION: The high anti-emetic efficacy seen with the NEPA regimen in the first cycle was maintained over multiple cycles of adjuvant AC for breast cancer. Preliminary evidence also suggests that patients achieving a CR during the overall period gain high protection even against very late CINV events in each chemotherapy cycle. TRIAL REGISTRATION: This trial was retrospectively registered at Clinicaltrials.gov identifier (NCT03862144) on 05/Mar/2019.


Assuntos
Antraciclinas/efeitos adversos , Antieméticos/uso terapêutico , Antineoplásicos Alquilantes/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Ciclofosfamida/efeitos adversos , Dexametasona/uso terapêutico , Antagonistas do Receptor de Neuroquinina-1/uso terapêutico , Palonossetrom/uso terapêutico , Piridinas/uso terapêutico , Vômito/induzido quimicamente , Vômito/prevenção & controle , Adulto , Idoso , Antraciclinas/uso terapêutico , Antieméticos/administração & dosagem , Antineoplásicos Alquilantes/uso terapêutico , Quimioterapia Adjuvante , Ciclofosfamida/uso terapêutico , Dexametasona/administração & dosagem , Combinação de Medicamentos , Feminino , Humanos , Pessoa de Meia-Idade , Antagonistas do Receptor de Neuroquinina-1/administração & dosagem , Palonossetrom/administração & dosagem , Piridinas/administração & dosagem
15.
Ann Afr Med ; 19(1): 1-7, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32174608

RESUMO

We report three cases of heart failure (HF) associated with the use of cytotoxic drugs such as anthracycline, cyclophosphamide, and 5-fluorouracil in the treatment of breast cancer in Nigerians. The patients had systolic and diastolic HF: HF with reduced ejection fraction and preserved ejection fraction. The prevalence of breast cancer is increasing across Africa, and cytotoxics are some of the most common and best drugs used during management. The cardiotoxicity caused by these drugs limits their use as chemotherapeutic agents. Cytotoxic-induced HF is a preventable and manageable cause of cardiovascular disease (CVD) in Nigeria and Africa. This article discusses the pathophysiology of cytotoxic-induced HF and presents the risk factors that impair cardiovascular function. The importance of proper assessment and the prophylactic and therapeutic measures in the management of cytotoxic-induced HF are emphasized. The peculiar challenges in the management of cytotoxic-induced HF in Nigeria were also discussed. The need for early involvement of cardiologists by oncologists to improve on the chemotherapeutic and cardiovascular outcome in the management of patients with breast cancer was stressed. Perhaps, it is time to birth a new discipline of cardiooncology in Nigeria.


Assuntos
Antraciclinas/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Ciclofosfamida/efeitos adversos , Fluoruracila/efeitos adversos , Insuficiência Cardíaca/induzido quimicamente , Idoso , Antraciclinas/uso terapêutico , Cardiotoxicidade , Ciclofosfamida/uso terapêutico , Feminino , Fluoruracila/uso terapêutico , Humanos , Pessoa de Meia-Idade
16.
J. health med. sci. (Print) ; 6(1): 21-27, ene.-mar. 2020. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-1096529

RESUMO

El cáncer de mama es una de las patologías más frecuentes a nivel mundial y en el Ecuador ocupa un sitio importante dentro de la mortalidad; en pacientes con tumores de estadios avanzados la quimioterapia neodyuvante es el procedimiento indicado para lograr una reducción tumoral satisfactoria. El objetivo fue determinar la respuesta clínica y patológica en pacientes con cáncer de mama tratadas con quimioterapia neoadyuvante según cada subtipo molecular, atendidos en el hospital "Teodoro Maldonado Carbo" en el período 2015 a 2017. Se hizo uso de un diseño no experimental, transversal de tipo correlacional. Pacientes con cáncer de mama que recibieron neoadyuvancia, en su mayoría con quimioterapia basada en antraciclinas y taxanos. Se clasificó a las pacientes por sus subtipos moleculares, los mismos se obtuvieron en base a las características inmunohistoquímicas de los reportes de patología que constan en el sistema AS-400. Se comprobó la respuesta clínica al tratamiento usando los Criterios RECIST 1.1. Como resultado los 171 pacientes fueron analizados. La edad promedio de las pacientes fue 55 13 años de edad; el 25% fueron luminal B (HER+), 24% luminal B (HER-), 22% triple negativo, 18% HER2+ y 12% luminal A; el 52% de las pacientes tuvieron estadio III de la enfermedad; el 75% (129) de las pacientes fue realizada una mastectomía radical modificada. Se pudo concluir que la respuesta patológica completa en pacientes con tratamiento neoadyuvante se relaciona con los subtipos moleculares y esto es estadísticamente significativo. Además, se evidenció las mayores tasas de respuesta patológica completa en los grupos moleculares de HER2+ y triple negativo.


Breast cancer is one of the most frequent pathologies worldwide and in Ecuador it occupies an important place in mortality. In patients with advanced stage tumors, the neo-adjuvant chemotherapy is the indicated procedure to achieve a satisfactory tumor reduction. The aim was to determine the clinical and pathological response in patients with breast cancer treated with neoadjuvant chemotherapy according to each molecular subtype, treated at the "Teodoro Maldonado Carbo" hospital in the period 2015 to 2017. We used a non-experimental, crosssectional type design. Patients with breast cancer who received neoadjuvant, mostly with chemotherapy based on anthracyclines and taxanes. The patients were classified by their molecular subtypes, they were obtained based on the immunohistochemical characteristics of the pathology reports that appear in the AS-400 system. The clinical response to treatment was checked using the RECIST 1.1 Criteria. As a result, a sum of 171 patients were analyzed. The average age of the patients was 55 + 13 years old; 25% were luminal B (Her +), 24% luminal B (Her-), 22% triple negative, 18% Her2 + and 12% luminal A; 52% of the patients had stage III of the disease; 75% (129) of the patients underwent a modified radical mastectomy. As a conclusion, the complete pathological response in patients with neoadjuvant treatment is related to molecular subtypes and this is statistically significant. Also, the highest rates of complete pathological response in the molecular groups of Her2 + and triple negative were evident.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias da Mama/tratamento farmacológico , Quimioterapia Adjuvante , Antraciclinas/uso terapêutico , Taxoides/uso terapêutico , Neoplasias da Mama/classificação , Neoplasias da Mama/patologia , Estudos Transversais , Relação Dose-Resposta a Droga , Quimioterapia Combinada
17.
Rev. cuba. hematol. inmunol. hemoter ; 36(1): e1105, ene.-mar. 2020. graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1126543

RESUMO

Introducción: La leucemia mieloide aguda es una enfermedad heterogénea caracterizada por la expansión clonal de precursores indiferenciados que provoca un fallo medular. Objetivo: Analizar la supervivencia de los pacientes adultos con leucemia mieloide aguda no promielocítica tratados con altas dosis de antraciclinas en la inducción. Métodos: Se realizó un estudio analítico, retrospectivo y longitudinal en 53 pacientes adultos menores de 60 años, tratados en el Instituto de Hematología e Inmunología, desde septiembre de 2013 hasta diciembre de 2018. Estos pacientes tenían diagnóstico de leucemia mieloide aguda no promielocítica y recibieron altas dosis de antraciclinas (daunorribicina) en el tratamiento de inducción. Resultados: Las probabilidades de supervivencia global a los 12 meses fue mayor para el grupo de 19 a 29 años con 59 por ciento y más baja para el de 40 a 49 años con 21 por ciento. En cuanto a la probabilidad de supervivencia libre de evento fue de 65 por ciento. Esta resultó mayor para los pacientes de los grupos de 19 a 29 años y de 30 a 39 años con 39 por ciento y 40 por ciento, respectivamente. En el grupo de 40-49 años disminuyó hasta 20 por ciento. En relación con la supervivencia global relacionada con los genes reordenados fue mayor para los pacientes que tenían los genes NPM1 y AML1-ETO y menor para los que tenían los genes FLT3 y BCR/ABL. Conclusiones: Los grupos de edades y las alteraciones genéticas no modifican la supervivencia de los pacientes con leucemias mieloide aguda no promielocítica tratados con dosis altas de antraciclinas(AU)


Introduction: Acute myeloid leukemia is a heterogeneous disease characterized by the clonal expansion of undifferentiated precursors that causes bone marrow failure. Objective: To analyze the survival of adult patients with non-promyelocytic acute myeloid leukemia treated with high doses of induced anthracyclines at induction. Methods: An analytical, retrospective and longitudinal study was carried out with 53 adult patients younger than 60 years, treated at the Institute of Hematology and Immunology, from September 2013 to December 2018. These patients had a diagnosis of non-promyelocytic acute myeloid leukemia and received high doses of anthracyclines (daunoribicin) under induction therapy. Results: The probabilities of overall survival at 12 months were higher for the group of 19- 29 years, accounting for 59%, and lower for the group of 40-49 years, accounting for 21 percent. In the age group of 19-29 years, the probability of event-free survival was 65 percent and the probability of disease-free survival was 44 percent. In the group of 40-49 years, it decreased to 27 percent; while in the group of 50-59 it increased, reaching 80 percent. Regarding overall survival associated with the rearranged genes, it was higher for the patients who had the NPM1 and AML1-ETO genes and lower for those who had the FLT3 and BCR/ABL genes. Conclusions: Age groups and genetic alterations do not modify the survival of patients with non-promyelocytic acute myeloid leukemias treated with high doses of anthracyclines(AU)


Assuntos
Humanos , Masculino , Feminino , Leucemia Mieloide Aguda/tratamento farmacológico , Antraciclinas/uso terapêutico , Estudos Retrospectivos , Estudos Longitudinais , Sobrevivência
18.
Am J Cardiol ; 125(8): 1270-1275, 2020 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-32087998

RESUMO

Prolonged trastuzumab therapy is the standard of care for women with metastatic HER2 positive (HER2+) breast cancer. There are limited data on the incidence of cardiotoxicity, its treatment implication, and cardiac care in these patients. We retrospectively identified consecutive women who received >12 months of trastuzumab treatment at Princess Margaret Cancer Centre (Toronto, ON) from 2007 to 2012 for metastatic HER2 positive breast cancer and followed them until death or August 2018. Patients were included if a pretherapy multigated acquisition scan and ≥2 subsequent follow-up scans were available. The Cardiac Review and Evaluation Committee Criteria were used to identify cardiotoxicity. Baseline characteristics and outcomes (final left ventricular ejection fraction, change in LVEF, trastuzumab interruption) were compared in patients with and without cardiotoxicity. Cardiac care and treatment received were recorded. Sixty patients (mean age 52 ± 10.4 years) were included. The median trastuzumab exposure was 37 cycles (interquartile range 23 to 56) over 28 months (interquartile range 19 to 49) and 48% received previous anthracycline therapy. The cumulative incidence of cardiotoxicity was 35% (95% CI 23 to 48) at 3 years. Patients who developed cardiotoxicity were more likely to receive third-line cancer treatments and had lower final LVEF than patients without (54.9% ± 6.3% vs 64% ± 4.9%, p <0.001). Of the 23 patients with cardiotoxicity, 10 (43%) had trastuzumab interrupted for at least 1 cycle, only 7 (30%) patients were seen by a cardiologist and 4 (17%) received cardiac medications. In conclusion, patients with metastatic breast cancer receiving prolonged trastuzumab therapy appear to have high rates of cardiotoxicity. This was associated with high rates of trastuzumab interruption, but low rates of cardiology referral and cardiac treatment, reflecting a potential cardiac care gap.


Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias da Mama/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Trastuzumab/efeitos adversos , Disfunção Ventricular Esquerda/induzido quimicamente , Adulto , Antraciclinas/uso terapêutico , Antineoplásicos Hormonais/uso terapêutico , Neoplasias Ósseas/metabolismo , Neoplasias Ósseas/secundário , Neoplasias Encefálicas/metabolismo , Neoplasias Encefálicas/secundário , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Cardiologia , Cardiotoxicidade , Estudos de Coortes , Feminino , Humanos , Incidência , Neoplasias Hepáticas/metabolismo , Neoplasias Hepáticas/secundário , Neoplasias Pulmonares/metabolismo , Neoplasias Pulmonares/secundário , Pessoa de Meia-Idade , Metástase Neoplásica , Receptor ErbB-2/metabolismo , Encaminhamento e Consulta , Estudos Retrospectivos , Volume Sistólico , Taxoides/uso terapêutico , Disfunção Ventricular Esquerda/epidemiologia , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/terapia
19.
J Surg Res ; 250: 143-147, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32044511

RESUMO

BACKGROUND: A subgroup of triple-negative breast cancer (TNBC) shows impaired BRCA1 function owing to causes other than mutation, which is called "BRCAness." DNA-damaging agents are known to have more efficacy in BRCA1-mutant tumors than mitotic poisons. We conducted a prospective single-arm clinical trial of neoadjuvant chemotherapy (NAC) using an anthracycline-based regimen without taxanes for BRCAness TNBCs. MATERIALS AND METHODS: BRCAness was examined using the multiplex ligation-dependent probe amplification (MLPA) method in TNBC cases. For BRCAness cases, NAC was performed with anthracycline-based regimens without additional taxanes. RESULTS: A total of 30 patients with TNBC were enrolled. MLPA was successfully performed in 25 patients. Eighteen patients (72%) showed BRCAness. Twenty-three patients received NAC as per the protocol. On analysis, the clinical response rate (complete response plus partial response) was 76.4%, and the pathological complete response rate was 35.3%. CONCLUSIONS: The interim analysis revealed that the pathological complete response rate was lower than estimated. Therefore, BRCAness by MLPA was not sufficient to predict the therapeutic response to anthracycline-based regimens in TNBC.


Assuntos
Antraciclinas/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Proteína BRCA1/metabolismo , Terapia Neoadjuvante/métodos , Neoplasias de Mama Triplo Negativas/terapia , Adulto , Idoso , Proteína BRCA1/análise , Quimioterapia Adjuvante/métodos , Ciclofosfamida/uso terapêutico , Docetaxel/uso terapêutico , Epirubicina/uso terapêutico , Feminino , Fluoruracila/uso terapêutico , Humanos , Mastectomia , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Resultado do Tratamento , Neoplasias de Mama Triplo Negativas/patologia
20.
Br J Radiol ; 93(1110): 20190794, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32105502

RESUMO

OBJECTIVE: To investigate the specificity, clinical implication and prognostic value of MRI adipocytic maturation (MAM) in myxoid/round cells liposarcomas (MRC-LPS) treated with neoadjuvant chemotherapy (NAC). METHODS: Of the 89 patients diagnosed with MRC-LPS at our sarcoma reference center between 2008 and 2018, 28 were included as they were treated with NAC, surgery and radiotherapy. All patients underwent contrast-enhanced MRIs at baseline and late evaluation. A control cohort of 13 high-grade pleomorphic and dedifferentiated LPS with same inclusion criteria was used to evaluate the specificity of MAM in MRC-LPS. Two radiologists analyzed the occurrence of MAM, changes in the tumor architecture, shape and surrounding tissues during NAC. Pathological features of tumor samples were reviewed and correlated with MRI. Metastatic relapse-free survival was estimated with Kaplan-Meier curves and Cox models. Associations between prognostic T1-based delta-radiomics features and MAM were investigated with Student t-test. RESULTS: MAM was more frequent in MRC-LPS (p = 0.045) and not specific of any type of chemotherapy (p = 0.7). Regarding MRC-LPS, 14 out of 28 patients (50%) demonstrated MAM. Eight patients showed metastatic relapses. MAM was not associated with metastatic relapse-free survival (p = 0.9). MAM correlated strongly with the percentage of histological adipocytic differentiation on surgical specimen (p < 0.001), which still expressed the tumor marker NY-ESO-1. None of the prognostic T1-based delta-radiomics features was associated with MAM. CONCLUSION: MAM seems a neutral event during NAC. ADVANCES IN KNOWLEDGE: MAM predominated in MRC-LPS and was not specific of a type of chemotherapy. Occurrence of MAM was not associated with better patients' metastasis free survival.


Assuntos
Adipócitos/patologia , Diferenciação Celular , Lipossarcoma Mixoide/diagnóstico por imagem , Lipossarcoma Mixoide/patologia , Imagem por Ressonância Magnética , Adipócitos/efeitos dos fármacos , Adulto , Idoso , Antraciclinas/uso terapêutico , Antineoplásicos/uso terapêutico , Diferenciação Celular/efeitos dos fármacos , Quimioterapia Adjuvante , Meios de Contraste , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Lipossarcoma Mixoide/tratamento farmacológico , Lipossarcoma Mixoide/terapia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Modelos de Riscos Proporcionais , Radioterapia Adjuvante , Estudos Retrospectivos , Sensibilidade e Especificidade , Carga Tumoral
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...