Application of Comprehensive Genomic Profiling-Based Next-Generation Sequencing Assay to Improve Cancer Care in a Developing Country.

PURPOSE: Identifying actionable oncogenic mutations have changed the therapeutic landscape in different types of tumors. This study investigated the utility of comprehensive genomic profiling (CGP), a hybrid capture-based next-generation sequencing (NGS) assay, in clinical practice in a developing country. METHODS: In this retrospective cohort study, CGP was performed on clinical samples from patients with different solid tumors recruited between December 2016 and November 2020, using hybrid capture-based genomic profiling, at the individual treating physicians' request in the clinical care for therapy decisions. Kaplan-Meier survival curves were estimated to characterize the time-to-event variables. RESULTS: Patients median age was 61 years (range: 14-87 years), and 64.7% were female. The most common histological diagnosis was lung primary tumors, with 90 patients corresponding to 52.9% of the samples (95% CI 45.4-60.4%). Actionable mutations with FDA-approved medications for specific alterations correspondent to tumoral histology were identified in 58 cases (46.4%), whereas other alterations were detected in 47 different samples (37.6%). The median overall survival was 15.5 months (95% CI 11.7 months-NR). Patients who were subjected to genomic evaluation at diagnosis reached a median overall survival of 18.3 months (95% CI 14.9 months-NR) compared to 14.1 months (95% CI 11.1 months-NR) in patients who obtained genomic evaluation after tumor progression and during standard treatment (P = .7). CONCLUSION: CGP of different types of tumors identifies clinically relevant genomic alterations that have benefited from targeted therapy and improve cancer care in a developing country to guide personalized treatment to beneficial outcomes of cancer patients.

Rash associated with the use of pegylated filgrastim in a patient with advanced pancreatic cancer.

Filgrastim and pegfilgrastim are granulocyte colony-stimulating factor (G-CSF) products, which have been part of the supportive treatment of cancer patients for years to increase the white blood cell count and absolute neutrophil count with the primary objective of preventing the appearance of neutropenic fever in patients at risk because of the very toxic chemotherapy. Pegfilgrastim is a glycosylated form of filgrastim with a prolonged duration of effect, a reduced renal clearance, and relatively fewer side effects. Rash in particular has been described rarely (less than 3.7% of cases). Various dermatologic complications have been associated with G-CSF therapy, with filgastrim more than pegfilgrastim. These complications include local skin reactions, folliculitis, vasculitis, and pyoderma gangrenosum as well as the more classic generalized allergic rash associated both with and without anaphylaxis. We present a patient with pancreatic cancer who developed facial rash related to the use of pegfilgrastim that led to discontinuation of the agent and we review the literature on this topic.

Chemoimmunotherapy and withdrawal of immunosuppression for monomorphic posttransplant lymphoproliferative disorders.

BACKGROUND: Monomorphic PTLDs are the most aggressive type of PTLD occurring after SOT. Current guidelines for treatment suggest a stepwise approach that includes a reduction of immunosuppression (RIS) with or without rituximab, followed by chemotherapy if there is no response. Nevertheless, recommendations regarding the extent and duration of RIS are nonstandardized and RIS as an initial strategy might be associated with an unacceptably high frequency of graft loss and disease progression. PATIENTS AND METHODS: We reviewed the outcome of a combination program of aggressive chemoimmunotherapy and complete withdrawal of immunosuppression in treating 22 patients with monomorphic PTLD between January 1995 and August 2012. RESULTS: Twelve of 22 patients (55%) received CHOP-R (cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab) every 2 weeks (dose-dense CHOP-R) and 10 patients received other doxorubicin-based regimens. There was no treatment-related mortality. Complete response was seen in 91% of patients. Median OS was 9.61 years (95% confidence interval (CI), 5.21-10.74). Median progression-free survival was 5.39 years (95% CI, 2.10-10.74). The graft rejection rate was 18% (95% CI, 0.03-0.34). CONCLUSION: The use of aggressive chemoimmunotherapy in combination with the withdrawal of immunosuppression approach yields excellent results and should be prospectively studied in a multi-institutional setting.

Beneficios del ejercicio físico sistemático en pacientes diabáticos no insulinodependientes / Benefits of systeatic physical exercises in non-insulin-dependent diabetics

Se trataron 14 diabéticos no insulinodependientes, con dieta e hipoglicemiantes orales y fueron sometidos a un régimen de ejercicios físicos durante 12 meses. Al finalizar el tercer mes, los enfermos no necesitaron ingerir más la glibenclamida. A los 6 meses de entrenamiento hubo un descenso significativo sólo en el colesterol y la fracción LDL-C. Al concluir la investigación hubo una respuesta favorable, estadísticamente, en todos los indicadores humorales: colesterol, triglicéridos, HDL-C, LDL-C, HDL-C/colesterol y HDL-C/LDL-C. El ejrcicio físico facilitó el descenso en el peso corporal de los pacientes, y los mantuvo además con un control metabólico óptimo

Nefropatía incipiente: factores relacionados con la excreción de albúmina urinaria en pacientes diabéticos insulinodependientes / Incipient nephropathy: factor related to urinary albumin excretion in insulin-dependent diabetic patients

Se evaluó la excreción de albúmina urinaria (EAU) a 54 pacientes diabéticos insulino-dependientes, quienes no presentaban proteinuria (>0,5 g/24 horas). La microalbuminuria persistente (nefropatía incipiente) se halló en el 31,5 por ciento de la muestra estudiada. Los pacientes diabéticos (sexo masculino) con nefropatía incipiente presentaron la presión sanguínea (sistólica, media y diastólica) superior significativamente, comparada con la de aquéllos con normoproteinuria. La edad promedio del diagnóstico, los añños de evolución y la presión sistólica, fueron las variables asociadas con la EUA. En el sexo femenino sólo la presión sistólica se relacionó con la EUA. En el análisis de regresión múltiple, la presión sistólica, solamente en el sexo masculino, fué el factor más relevante asociado con la microalbuminuria