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1.
Rev Med Suisse ; 15(660): 1512-1515, 2019 Aug 28.
Artigo em Francês | MEDLINE | ID: mdl-31496176

RESUMO

The emergence of immunotherapy has generated great enthusiasm in oncology improving the prognosis of pathologies such as melanoma, lung cancer, kidney cancer, bladder and head and neck cancers. This enthusiasm concerns also older patients in view of the good tolerance of immunotherapy in young people. However, advanced age is linked to changes in the immune system, called immunosenescence, which could have a negative impact on the efficacy and toxicity of immunotherapy treatment. Knowledge in terms of efficacy and tolerance is limited for geriatric patients, few being included in clinical studies. This article summarizes the experience of immunotherapy in large clinical trials. It appears that the immune checkpoint inhibitors are effective and well tolerated in the elderly.


Assuntos
Imunoterapia , Neoplasias , Fatores Etários , Humanos , Tolerância Imunológica , Imunossenescência , Oncologia/tendências , Neoplasias/terapia
2.
Presse Med ; 48(7-8 Pt 1): 825-831, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31447337

RESUMO

Diagnosis criteria have been revised in 2014 and allow the treatment of some asymptomatic patients. Since 2015, a new prognostic score includes tumor plasma cells chromosomal abnormalities. It helps in the distinction between "standard risk" and "high risk" myelomas. Scanner, MRI and Pet Scan are the radiological reference exams to evaluate bone involvement. Alkylating agents, immunomodulators, proteasome inhibitors, and monoclonal antibodies became the most important antitumoral treatments. Risk notion will become more and more important for therapeutic choices. These choices will depend on residual disease evaluation. The next decade will be the immunotherapies development decade.


Assuntos
Detecção Precoce de Câncer/tendências , Oncologia/tendências , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/terapia , Terapias em Estudo/tendências , Anticorpos Monoclonais/uso terapêutico , Terapia Combinada/tendências , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/normas , Humanos , Fatores Imunológicos/uso terapêutico , Imunoterapia/métodos , Imunoterapia/tendências , Oncologia/métodos , Oncologia/normas , Mieloma Múltiplo/patologia , Guias de Prática Clínica como Assunto , Prognóstico , Terapias em Estudo/métodos
3.
Presse Med ; 48(7-8 Pt 2): e251-e256, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31447338

RESUMO

Cancer patients quite commonly will report different types of pain associated with the disease substrate. Systemic analgesia and radiotherapy provide only partial pain relief in the majority of these patients. Interventional Oncology techniques for pain management and mobility improvement in cancer patients include percutaneous techniques such as neurolysis, ablation and augmentation (both in the spine and peripheral skeleton) as well as trans-arterial embolization. Percutaneous neurolysis acts indirectly providing regional anesthesia whilst the rest of the aforementioned techniques act directly upon the tumor either by inhibiting local growth or by providing stability and skeletal augmentation. Whenever possible, techniques such as ablation and trans-arterial embolization apart from pure palliation may add to the principle of local tumor control. The aim of this review is to provide details concerning the Interventional Oncology techniques used for cancer pain management and to address the necessity for a tailored-based approach applying different techniques or combinations of them in different cases and locations.


Assuntos
Dor do Câncer/terapia , Oncologia/métodos , Neoplasias/terapia , Manejo da Dor/métodos , Cuidados Paliativos/métodos , Anestesia por Condução , Osso e Ossos/cirurgia , Ablação por Cateter/métodos , Embolização Terapêutica/métodos , Humanos , Oncologia/tendências , Neoplasias/complicações , Bloqueio Nervoso/métodos , Cuidados Paliativos/tendências , Coluna Vertebral/patologia , Coluna Vertebral/cirurgia , Vertebroplastia/métodos
4.
Biochim Biophys Acta Rev Cancer ; 1872(1): 138-148, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31348975

RESUMO

According to the most recent epidemiological studies, breast cancer shows the highest incidence and the second leading cause of death in women. Cancer progression and metastasis are the main events related to poor survival of breast cancer patients. This can be explained by the presence of highly resistant to chemo- and radiotherapy stem cells in many breast tumor tissues. In this context, numerous studies highlighted the possible involvement of epithelial to mesenchymal transition phenomenon as biological program to generate cancer stem cells, and thus participate to both metastatic and drug resistance process. Therefore, the comprehension of mechanisms (both cellular and molecular) involved in breast cancer occurrence and progression can lay the foundation for the development of new diagnostic and therapeutical protocols. In this review, we reported the most important findings in the field of breast cancer highlighting the most recent data concerning breast tumor biology, diagnosis and therapy.


Assuntos
Biomarcadores Tumorais/genética , Neoplasias da Mama/genética , Resistencia a Medicamentos Antineoplásicos/genética , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Progressão da Doença , Transição Epitelial-Mesenquimal/genética , Feminino , Humanos , Oncologia/tendências , Metástase Neoplásica
5.
Oncology ; 97(4): 191-201, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31266042

RESUMO

Endoscopic decompression of bile duct stenosis in unresectable cholangiocarcinoma (CC) may be difficult due to localization of the tumor, but it is important for pursuing oncologic treatment afterwards. Besides the initial diagnosis, jaundice and cholangitis are the most important indications for immediate endoscopic treatment. Endoscopic retrograde cholangiopancreatography is the favored approach for biliary access and stent placement. Hilar tumors are more difficult to treat and sometimes need higher endoscopic or radiologic expertise. In general, biliary decompression is accompanied by antibiotic treatment. Oncologic treatment of CC remains difficult, as it has to be interrupted when -infectious complications occur. For chemotherapy, a gemcitabine/cisplatin-based regime is favored. A validated -second-line treatment does not exist. Several therapeutic options are therefore offered to patients, including photodynamic therapy, selective internal radiotherapy, and high-dose radiotherapy. Exact treatment recommendations do not exist due to tumor rarity and lack of randomized controlled trials. In the present article, we take a look at current endoscopic, medical, and oncologic challenges from the endoscopist's point of view.


Assuntos
Neoplasias dos Ductos Biliares/terapia , Colangiocarcinoma/terapia , Endoscopia , Oncologia/tendências , Antibacterianos/uso terapêutico , Antineoplásicos/farmacologia , Colangiopancreatografia Retrógrada Endoscópica , Colangite/terapia , Constrição Patológica , Humanos , Fotoquimioterapia , Radioterapia
6.
Oncology ; 97(4): 202-205, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31288226

RESUMO

Based on the results of several phase 3 randomized trials, "maintenance therapy" (prolonged treatment after an initial response to cytotoxic chemotherapy) has assumed a critical role in the routine care of advanced epithelial ovarian cancer. While earlier data had provided support for this therapeutic concept in disease management (e.g., multiple cycles of single-agent paclitaxel following a clinical complete response to a platinum/paclitaxel regimen), more recent data has revealed both the efficacy and safety of the anti-angiogenesis agent, bevacizumab, and several PARP inhibitors when employed in this clinical setting.


Assuntos
Tratamento Farmacológico/métodos , Oncologia/tendências , Neoplasias Ovarianas/tratamento farmacológico , Bevacizumab/administração & dosagem , Feminino , Humanos , Neoplasias Ovarianas/imunologia , Paclitaxel/administração & dosagem , Platina/administração & dosagem , Inibidores de Poli(ADP-Ribose) Polimerases/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
7.
Crit Rev Oncol Hematol ; 141: 36-42, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31212145

RESUMO

Liquid biopsy can quantify and qualify cell-free (cfDNA) and tumour-derived (ctDNA) DNA fragments in the bloodstream. CfDNA quantification and mutation analysis can be applied to diagnosis, follow-up and therapeutic management as novel oncologic biomarkers. However, some tumor-types release a low amount of DNA into the bloodstream, hampering diagnosis through standard liquid biopsy procedures. Several tumors, as such as brain, kidney, prostate, and thyroid cancer, are in direct contact with other body fluids and may be alternative sources for cfDNA and ctDNA. Non-blood sources of cfDNA/ctDNA useful as novel oncologic biomarkers include cerebrospinal fluids, urine, sputum, saliva, pleural effusion, stool and seminal fluid. Seminal plasma cfDNA, which can be analyzed with cost-effective procedures, may provide powerful information capable to revolutionize prostate cancer (PCa) patient diagnosis and management. In the near future, cfDNA analysis from non-blood biological liquids will become routine clinical practice for cancer patient diagnosis and management.


Assuntos
Biomarcadores Tumorais/genética , Ácidos Nucleicos Livres/isolamento & purificação , Perfilação da Expressão Gênica/métodos , Oncologia/métodos , Neoplasias/diagnóstico , Patologia Clínica/métodos , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/isolamento & purificação , Ácidos Nucleicos Livres/análise , DNA Tumoral Circulante/análise , DNA Tumoral Circulante/isolamento & purificação , DNA Tumoral Circulante/urina , Análise Mutacional de DNA/métodos , Fezes/química , Feminino , Humanos , Biópsia Líquida , Masculino , Oncologia/tendências , Neoplasias/genética , Neoplasias/patologia , Neoplasias/urina , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/metabolismo , Neoplasias da Próstata/terapia , Urinálise/métodos
8.
Anticancer Res ; 39(6): 3137-3140, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177159

RESUMO

BACKGROUND/AIM: Because aggressive oncological management just prior to death constitutes a substantial proportion of end-of-life (EOL) costs, we investigated patterns of EOL oncologic care for stage IV non-small cell lung cancer (NSCLC) in USA to better determine at which point in the patient's management new treatments were being initiated. MATERIALS AND METHODS: The National Cancer Database was queried for stage IV NSCLC patients who received any cancer-directed therapy with known timing thereof. RESULTS: A total of 281,990 stage IV NSCLC patients were analyzed. Of all patients, 10.8% commenced any first-course cancer therapy within four weeks of death, and 24.5% within eight weeks of death. CONCLUSION: 10-15% of stage IV NSCLC patients start cancer therapy within four weeks of death, and 25-30% within eight weeks. This represents a population for whom cancer therapy may not be required, which has implications on reducing EOL healthcare costs.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/terapia , Neoplasias Pulmonares/terapia , Oncologia/tendências , Oncologistas/tendências , Avaliação de Processos e Resultados (Cuidados de Saúde)/tendências , Cuidados Paliativos/tendências , Padrões de Prática Médica/tendências , Assistência Terminal/tendências , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/economia , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , Bases de Dados Factuais , Feminino , Custos de Cuidados de Saúde/tendências , Humanos , Neoplasias Pulmonares/economia , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Oncologia/economia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Oncologistas/economia , Avaliação de Processos e Resultados (Cuidados de Saúde)/economia , Cuidados Paliativos/economia , Padrões de Prática Médica/economia , Assistência Terminal/economia , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
9.
Z Evid Fortbild Qual Gesundhwes ; 143: 35-42, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31080152

RESUMO

OBJECTIVES: Thorough management of patient information is crucial in cancer care in order to avoid errors. Clinicians need complete, up-to-date information to be able to develop an adequate mental model of the patient's situation. The aim of the present study was to identify patient safety hazards coming with the use of health information technology (HIT): patient safety hazards in three outpatient oncology infusion centers were assessed and priority topics identified. Additionally, the number of information sources clinicians have to use in order to get an idea of the patient's situation was systematically assessed. Interviews and observations were conducted with one nurse and one doctor of each ambulatory infusion center. PRINCIPAL RESULTS: Information management-related patient safety hazards were omnipresent in daily care: eleven topics were identified from 125 assessed patient safety hazards. Three of them were particularly relevant to the clinicians' development of an adequate mental model about the patient: patient-related information was not stored in one place but often fragmented in different HIT systems; despite the introduction of HIT, paper documentation remained in place for certain information, making access difficult and increasing the number of relevant sources; the lack of usability of the HIT systems made it difficult to retrieve patient information in a timely manner. Clinicians needed to use between 5 and 11 sources of information to get a more complete picture of a patient's situation. MAJOR CONCLUSIONS: Overall, it has been shown that the design of the HIT systems is not sufficiently adapted to the work processes and does not support clinicians in being fully informed about a patient. The topics identified point to future system design and areas for improvement. In this process, it is very important to align the real work requirements with the design of the HIT and to evaluate and monitor the actual implementation and use of HIT.


Assuntos
Gestão da Informação , Tecnologia da Informação , Segurança do Paciente , Alemanha , Humanos , Oncologia/tendências , Pacientes Ambulatoriais , Estudos Prospectivos
10.
Nervenarzt ; 90(6): 594-600, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31073670

RESUMO

Neuro-oncology is a young and emerging discipline. An interdisciplinary mindset and concerted actions in specialized expert teams are required to meet the challenges, not only in clinical patient care but also in research activities. A close communication network between clinician scientists, medical scientists and data scientists is required to ensure that emerging data from basic, translational and clinical research can be used for improving the sometimes extremely limited and prognostically unsatisfactory treatment options. The continuously developing spectrum of tasks in neuro-oncology includes the classical fields of primary and metastatic tumors of the central nervous system and neurological complications from cancer therapies. It also includes challenges of transition of patients with a disease onset in childhood from pediatric to adult neuro-oncology. This is particularly relevant because the treatment options and the prognosis of primary brain tumors in childhood have improved tremendously. Thus, a close cooperation between pediatric and adult neuro-oncology is necessary to ensure a seamless transition. All these considerations lead to specific challenges for specialized centers of excellence to ensure an innovative, competitive and sustainable framework for modern neuro-oncology.


Assuntos
Oncologia , Neurologia , Neoplasias Encefálicas , Previsões , Humanos , Oncologia/tendências , Neurologia/tendências , Prognóstico
11.
Am Soc Clin Oncol Educ Book ; 39: 88-95, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31099695

RESUMO

Current public health problems such as cancer have an expansive set of lifestyle and social circumstances that affect the cause and course of the disease. In response, over the past 7 years, the National Cancer Institute (NCI) has recognized the important role that cancer centers play in their community and has gradually increased the requirements and stringency of these sections in the Cancer Center Support Grant guidelines to include a plan for community outreach and engagement. Developing sustainable community-academic partnerships is an essential factor for the successful dissemination and implementation of promising interventions and programs aimed at decreasing barriers and improving cancer outcomes. Understanding how best to facilitate linkages and collaboration can expedite translation of research knowledge into practice and allow more evidence-based improvements to be implemented into practice as well as influence research agendas. This article will examine several examples of successful community-academic partnerships focused on cancer prevention and control and explore lessons learned.


Assuntos
Centros Médicos Acadêmicos , Centros Comunitários de Saúde , Oncologia , Prática Associada , Institutos de Câncer , Organização do Financiamento , Guias como Assunto , Humanos , Oncologia/métodos , Oncologia/tendências , National Cancer Institute (U.S.) , Pesquisa , Estados Unidos/epidemiologia
12.
Am Soc Clin Oncol Educ Book ; 39: 176-184, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31099620

RESUMO

Increasing enrollment into clinical trials is a top priority across the field of oncology. Because the vast majority of those afflicted with cancer receive their care in the community, creating strong clinical research programs in the community-based setting is important. This article comprehensively outlines the most important elements of creating and sustaining a successful community-based research program. Establishing a clear mission and defining the scope of the research program in collaboration with key physicians and administrative leadership are critical to success. Standard operating procedures should detail operational processes. Ensuring sound financial planning and protected physician time are crucial for a healthy program. Providing mentorship opportunities to investigators and other team members will provide necessary guidance for junior investigators and long-term program stability. Prioritizing provider and patient volunteer engagement through education and awareness will potentially improve enrollment and research ownership. Incorporating administrative and clinical research staff and health care providers, including physicians, advanced practice providers, and pharmacists, will result in a multidisciplinary and unified approach and may also promote research as a routine part of patient care. Regular safety and scientific meetings will reduce regulatory complications and, most importantly, improve patient care. Other keys to a successful program include establishing a diverse trial portfolio, collaboration between different institutions, and ensuring appropriate technological infrastructure. Serial programmatic review provides opportunities to refine suboptimal practices and recognize successful strategies. Community-based research programs are critical to improve access to optimal cancer care. Implementation of successful programs is possible with a collaborative and multidisciplinary approach.


Assuntos
Serviços de Saúde Comunitária , Oncologia , Avaliação de Programas e Projetos de Saúde , Pesquisa , Ensaios Clínicos como Assunto , Assistência à Saúde , Pessoal de Saúde , Humanos , Oncologia/tendências , Prática Associada
13.
Am Soc Clin Oncol Educ Book ; 39: 332-340, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31099640

RESUMO

Multidisciplinary teams (MDTs) have been recommended as a key part of best cancer care for 25 years. Here, we set out the functions and approaches of MDTs and review their impact. Although the literature is patchy in quality, MDTs contribute to improving cancer care and outcomes. They must be well organized, efficient, and well led; work with sound and timely information; and communicate well within the team and with their patients. Patients need carefully prepared information to help them share in the decision-making process. MDTs will be improved by a series of ongoing innovative developments. Increasing information from molecular pathology will increase the precision of their decisions, although the technologies remain expensive and may not be accessible in all countries for some time. New point-of-care testing technologies will improve the quality and timeliness of testing. Good informatics is essential to deliver the information to patients and the MDT. MDTs should be research active, delivering clinical trials, and this should improve outcomes for all of their patients. Patient engagement and empowerment in MDTs should improve patient satisfaction and outcomes. Patient-reported outcome measures will improve MDTs' insights into their patients' problems and symptoms and can improve patient outcomes.


Assuntos
Oncologia , Neoplasias/epidemiologia , Equipe de Assistência ao Paciente , Ensaios Clínicos como Assunto , Gerenciamento Clínico , Humanos , Informática Médica/métodos , Oncologia/métodos , Oncologia/normas , Oncologia/tendências , Técnicas de Diagnóstico Molecular , Neoplasias/diagnóstico , Neoplasias/terapia , Equipe de Assistência ao Paciente/normas , Qualidade da Assistência à Saúde , Pesquisa
15.
Hematol Oncol ; 37(3): 240-252, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31013548

RESUMO

The 60th American Society of Hematology (ASH) held in San Diego in December 2018 was followed by the 13th Post-ASH chronic myeloproliferative neoplasms (MPNs) workshop on December 4 and 5, 2018. This closed annual workshop, first introduced in 2006 by Goldman and Mughal, was organized in collaboration with Alpine Oncology Foundation and allowed experts in preclinical and clinical research in the chronic MPNs to discuss the current scenario, including relevant presentations at ASH, and address pivotal open questions that impact translational research and clinical management. This review is based on the presentations and deliberations at this workshop, and rather than provide a resume of the proceedings, we have selected some of the important translational science and treatment issues that require clarity. We discuss the experimental and observational evidence to support the intimate interaction between aging, inflammation, and clonal evolution of MPNs, the clinical impact of the unfolding mutational landscape on the emerging targets and treatment of MPNs, new methods to detect clonal heterogeneity, the challenges in managing childhood and adolescent MPN, and reflect on the treatment of systemic mastocytosis (SM) following the licensing of midostaurin.


Assuntos
Transtornos Mieloproliferativos/terapia , Pesquisa Médica Translacional/métodos , Pesquisa Médica Translacional/tendências , Envelhecimento , Animais , Congressos como Assunto , Análise Mutacional de DNA , Humanos , Inflamação , Leucemia Mielogênica Crônica BCR-ABL Positiva/terapia , Mastocitose/terapia , Oncologia/métodos , Oncologia/tendências , Camundongos , Mutação , Prognóstico , Sociedades Médicas , Estaurosporina/análogos & derivados , Estaurosporina/uso terapêutico , Estados Unidos
16.
Oncology ; 97(1): 1-6, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30939479

RESUMO

BACKGROUND: Triple-negative breast cancer remains a disease with poor prognosis and few treatment options, due to the lack of therapeutic targets. Bevacizumab, the first anti-VEGF agent approved in the treatment of cancer, has demonstrated efficacy in breast cancer in combination with paclitaxel for the first-line treatment of HER2-negative metastatic breast cancer. Despite the fact that the benefit was particularly significant for triple-negative breast cancer with its approval in 2008 by the FDA, this decision was later reversed as there was no improvement in overall survival in addition to significant costs. OBJECTIVES: The scope of the present study is to focus on the role of bevacizumab in triple-negative breast cancer through the analysis of overall survival, progression-free survival, and cost benefit among 45 patients in a French monocentric study and to discuss new paradigms of endpoints. METHODS: All patients diagnosed with metastatic triple-negative breast cancer, for whom first-line treatment was bevacizumab in combination with paclitaxel between January 2011 and April 2018 were included in this single-center retrospective study, and a chart review of all recruited subjects was performed from medical records. RESULTS: In this real-life study among 45 patients with metastatic triple-negative breast cancer, bevacizumab provided a significant benefit for a category of patients, with longer median progression-free survival and the ability of maintenance therapy associated to limited side effects. CONCLUSIONS: Beyond being the phoenix of breast oncology and a magnet of controversy, the case of bevacizumab in metastatic breast cancer highlights one of the greatest challenges in oncology, namely to balance modest clinical benefits with exponential costs. A balance needs to be found between health care affordability, high price of progress, and the best medical decision for the patients, in order to avoid the "unbreathable tipping point" we are actually dealing with.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Bevacizumab/administração & dosagem , Paclitaxel/administração & dosagem , Neoplasias de Mama Triplo Negativas/tratamento farmacológico , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Bevacizumab/efeitos adversos , Pesquisa Biomédica/economia , Análise Custo-Benefício , Feminino , Humanos , Oncologia/tendências , Pessoa de Meia-Idade , Metástase Neoplásica , Paclitaxel/efeitos adversos , Intervalo Livre de Progressão , Receptor ErbB-2/genética , Neoplasias de Mama Triplo Negativas/economia , Neoplasias de Mama Triplo Negativas/genética , Neoplasias de Mama Triplo Negativas/patologia , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Fator A de Crescimento do Endotélio Vascular/genética
20.
Science ; 363(6432): 1175-1181, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30872517

RESUMO

Cancer treatment decisions are increasingly based on the genomic profile of the patient's tumor, a strategy called "precision oncology." Over the past few years, a growing number of clinical trials and case reports have provided evidence that precision oncology is an effective approach for at least some children with cancer. Here, we review key factors influencing pediatric drug development in the era of precision oncology. We describe an emerging regulatory framework that is accelerating the pace of clinical trials in children as well as design challenges that are specific to trials that involve young cancer patients. Last, we discuss new drug development approaches for pediatric cancers whose growth relies on proteins that are difficult to target therapeutically, such as transcription factors.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ensaios Clínicos como Assunto/organização & administração , Desenvolvimento de Medicamentos/métodos , Neoplasias/tratamento farmacológico , Neoplasias/genética , Medicina de Precisão/métodos , Biomarcadores Tumorais/genética , Criança , Humanos , Oncologia/tendências , Terapia de Alvo Molecular , Mutação , Pediatria/tendências
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