Assuntos
Degeneração Macular/induzido quimicamente , Melanoma/tratamento farmacológico , Inibidores de Proteínas Quinases/efeitos adversos , Proteínas Proto-Oncogênicas B-raf/metabolismo , Neoplasias Cutâneas/tratamento farmacológico , Humanos , Melanoma/patologia , Metástase Neoplásica , Inibidores de Proteínas Quinases/uso terapêutico , Neoplasias Cutâneas/patologiaRESUMO
PURPOSE: Intestinal dysbiosis has emerged as a biomarker of response to immune checkpoint inhibitors (ICIs). It can be caused by antibiotics, although it may also result from the use of other drugs that have been studied to a lesser extent. The objective of our study was to analyze the association between the use of potentially dysbiosis-related drugs and survival in patients treated with ICIs in the clinical practice. MATERIALS AND METHODS: A retrospective, multicenter, cohort study was conducted. Clinicopathological variables were collected and the concomitant use of drugs was analyzed. A descriptive analysis of variables and overall survival, estimated by the Kaplan-Meier method, was performed, and association with various independent variables was assessed using Cox regression. RESULTS: We included 253 patients, mainly with non-small cell lung cancer and melanoma. The most commonly used drugs were acid reducers, prescribed to 55.3% of patients, followed by corticosteroids (37.9%), anxiolytic drugs (35.6%), and antibiotics (20.5%). The use of acid reducers (9 vs. 18 months, P < .0001), antibiotics (7 vs. 15 months, P < .017), anxiolytic drugs (8 vs. 16 months, P < .015), and corticosteroids (6 vs. 19 months, P < .00001) was associated with poorer overall survival. Furthermore, the greater the number of drugs used concomitantly with ICIs, the higher the risk of death (1 drug: hazard ratio, 1.88; CI 95%, 1.07-3.30; 4 drugs: hazard ratio, 4.19; CI9 5%, 1.77-9.92; P < .001). CONCLUSION: Response to ICIs may be influenced by the use of drugs that lead to intestinal dysbiosis. Although a confirmatory prospective controlled study is required, our findings should be taken into account when analyzing ICI efficacy.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Disbiose/induzido quimicamente , Inibidores de Checkpoint Imunológico/uso terapêutico , Neoplasias Pulmonares/tratamento farmacológico , Melanoma/tratamento farmacológico , Corticosteroides/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antiácidos/efeitos adversos , Ansiolíticos/efeitos adversos , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Masculino , Melanoma/mortalidade , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Malignant melanoma is one of the most common causes of cancer and cancer deaths in young people. Until few years ago, scarce drugs have proven efficacy in metastatic setting. However, in the recent years, the treatment of metastatic malignant melanoma has undergone the incorporation of effective treatment such as immunotherapy, the use of tyrosine kinase inhibitors and the emergence of other cytostatic compounds, like the nanoparticles. This review aims to propose a standardization to classify the different types of nanoparticles, according to chemical aspects, and update the clinical research with nanoparticles and their use in melanoma field.
Assuntos
Melanoma/terapia , Nanopartículas , Neoplasias Cutâneas/terapia , Ensaios Clínicos como Assunto , HumanosRESUMO
The increase in the therapeutic arsenal in the last 20 years, has given rise to changes in treating colorectal cancer (CRC) with only pyrimidines to combine several cytotoxic drugs. However, the present question is to determine the optimal sequence of this combination. This review presents an update of data on chemical and clinical features of chemotherapy used for colorectal cancer and the mechanisms of cellular resistance and potential predictive and prognostic biomarkers, which may contribute to a better selection of a therapeutic strategy.