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de Jesus VHF, Peixoto RD, Ribeiro HSDC, Pinheiro RN, Oliveira AF, Anghinoni M, Torres SM, Boff MF, Weschenfelder R, Prolla G, Riechelmann RP. Current clinical practice in the management of Brazilian patients with potentially resectable pancreatic ductal adenocarcinoma (PDAC). J Surg Oncol 2023. [PMID: 37795658 DOI: 10.1002/jso.27453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND AND OBJECTIVES We aimed to describe the routine clinical practice of physicians involved in the treatment of patients with localized pancreatic ductal adenocarcinoma (PDAC) in Brazil. METHODS Physicians were invited through email and text messages to participate in an electronic survey sponsored by the Brazilian Gastrointestinal Tumor Group (GTG) and the Brazilian Society of Surgical Oncology (SBCO). We evaluated the relationship between variable categories numerically with false discovery rate-adjusted Fisher's exact test p values and graphically with Multiple Correspondence Analysis. RESULTS Overall, 255 physicians answered the survey. Most (52.5%) were medical oncologists, treated patients predominantly in the private setting (71.0%), and had access to multidisciplinary tumor boards (MTDTB; 76.1%). Medical oncologists were more likely to describe neoadjuvant therapy as beneficial in the resectable setting and surgeons in the borderline resectable setting. Most physicians would use information on risk factors for early recurrence, frailty, and type of surgery to decide treatment strategy. Doctors working predominantly in public institutions were less likely to have access to MTDTB and to consider FOLFIRINOX the most adequate regimen in the neoadjuvant setting. CONCLUSIONS Considerable differences exist in the management of localized PDAC, some of them possibly explained by the medical specialty, but also by the funding source of health care.
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Affiliation(s)
- Victor Hugo Fonseca de Jesus
- Medical Oncology Unit, Grupo Oncolínicas Florianópolis, Florianópolis, Santa Catarina, Brazil
- Medical Oncology Department, Centro de Pesquisas Oncológicas (CEPON), Florianópolis, Santa Catarina, Brazil
- Post-Graduate Program, A.C. Camargo Cancer, São Paulo, Sao Paulo, Brazil
| | - Renata D'Alpino Peixoto
- Medical Oncology Unit, Grupo Oncoclínicas/Centro Paulista de Oncologia, São Paulo, São Paulo, Brazil
| | | | | | | | - Marciano Anghinoni
- Surgical Oncology Unit, Centro de Oncologia do Paraná (Oncoville), Curitiba, Paraná, Brazil
| | - Silvio Melo Torres
- Department of Abdominal Surgery, A.C. Camargo Cancer, São Paulo, São Paulo, Brazil
| | - Márcio Fernando Boff
- Surgical Oncology Unit, Hospital Mãe de Deus, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rui Weschenfelder
- Department of Medical Oncology, Hospital Moinho de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gabriel Prolla
- Grupo Oncoclínicas Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rachel P Riechelmann
- Department of Medical Oncology, A.C. Camargo Cancer, São Paulo, São Paulo, Brazil
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Peixoto RD, Coutinho AK, Prolla G, Weschenfelder RF, Riechelmann R. Unresectable metastatic colorectal cancer in fit patients - a practical algorithm of treatment sequencing from the Brazilian Group of Gastrointestinal Tumours (GTG). Ecancermedicalscience 2023; 17:1544. [PMID: 37377686 PMCID: PMC10292853 DOI: 10.3332/ecancer.2023.1544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Indexed: 06/29/2023] Open
Abstract
Recent advances in biomarker-driven therapies have changed the landscape of unresectable metastatic colorectal cancer (mCRC) and brought not only access issues but also difficulties for the treating physician (especially generalist oncologists) in choosing the most suitable treatment for each individual patient. This manuscript proposes an algorithm developed by The Brazilian Group of Gastrointestinal Tumours with the aim of bringing easy-to-follow steps in the management of unresectable mCRC. The algorithm is based on evidence for fit patients to facilitate therapeutic decisions in the clinical practice and assumes that there are no access and resource limitations.
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Gil M, Peixoto RD, Passarini T, Mathias MC, Moraes EDD, Canedo JA, Pereira S, Amorim L, Prolla G, Freitas L, Costa e Silva M, Ferreira CGM, Ferrari BL, Garicochea B, Dienstmann R, Gil RA, Jácome AA. Triplets versus doublets in the treatment of right-sided metastatic colorectal cancer in real-world setting: A propensity-score weighting analysis. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
55 Background: Right-sided metastatic colorectal cancer (mCRC) has a worse prognosis and the best first-line treatment is still uncertain. The aim of this study was to analyze progression-free survival (PFS) and overall survival (OS) comparing triplet versus doublet backbone chemotherapy in first-line setting for right-sided mCRC. Methods: Retrospective study evaluating 510 patients with mCRC who were treated in a private institution in Brazil from January 2011 to December 2019. Information of 118 patients with right-sided primary tumor was analyzed in this study. Demographic and clinical data were retrieved from electronic medical records. PFS and OS were calculated in months (m) using propensity-score weighting analysis (PSWA) due to expected disparity between the number of patients treated with triplet and doublet regimens. Variables used to balance patient groups were age; metastasectomy; primary tumor resection; bevacizumab use; BRAF and RAS mutation status. Results: The median follow-up was 31 months. Our population was mostly composed of elderly (64%) and female (52%) patients. First-line treatment with triplet backbone chemotherapy was done in 16 patients (14%). Primary tumor resection was done in 14% of the cases, 55% underwent metastasectomy, and 57% received anti-VEGF treatment. BRAF mutation was found in 9% of the patients and RAS mutation in 46%. After PSWA we found a significant better median PFS among patients treated with triplet regimen: 12.7m versus 8.9m compared to those receiving doublet backbone chemotherapy, with a hazard ratio of 0.64 (CI 95%: 0.42 – 0.97); p-value: 0.037. No significant difference was found in OS (29.8m versus 45.5m) between triplet and doublet therapy groups, respectively. Conclusions: In our study we found a significantly better PFS with triplet backbone chemotherapy in first-line setting for right-sided mCRC, encouraging the use of this regimen in treatment-naive selected patients. However, no difference in OS was found, probably due to subsequent treatments. PSWA is an acceptable and needed tool to enable retrospective real world studies involving treatments with expected uneven distribution. More studies are needed to answer the best strategy to target right-sided mCRC, which remains a challenge for oncologists, with unmet needs.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Rodrigo Dienstmann
- Oncoclínicas Precision Medicine, Oncoclínicas Group, São Paulo, Brazil & Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
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Riechelmann R, Kruschewsky Coutinho Araujo A, dos Santos Fernandes G, Weschenfelder R, Rocha Filho D, Schlittler L, Rego J, Prolla G, de Jesus R, Gössling G, D'Alpino Peixoto R. 435P Cisplatin versus mitomycin plus fluoropyrimidine and radiation for localized squamous cell carcinoma of the anus (SCCA): Final results of GTG-LACOG 1318 real-world data study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Jácome AA, Peixoto RD, Gil MV, Ominelli J, Prolla G, Dienstmann R, Eng C. Biologics in rectal cancer. Expert Opin Biol Ther 2022; 22:1245-1257. [PMID: 35912589 DOI: 10.1080/14712598.2022.2108700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Despite the use of multimodality therapy, locally advanced rectal cancer (LARC) still presents high rates of disease recurrence. Fluoropyrimidine-based chemotherapy concurrently with radiation therapy (RT) remains the cornerstone of neoadjuvant therapy of LARC, and novel therapies are urgently needed in order to improve the clinical outcomes. AREAS COVERED We aim to summarize data from completed and ongoing clinical trials addressing the role of biological therapies, including monoclonal antibodies, immune checkpoint inhibitors (ICIs), antibody-drug conjugates, bispecific antibodies, and gene therapies in the systemic therapy of rectal cancer. EXPERT OPINION Deeper understanding of the molecular biology of colorectal cancer (CRC) has allowed meaningful advances in the systemic therapy of metastatic disease in the past few years. The larger applicability of biological therapy in CRC, including genome-guided targeted therapy, antiangiogenics, and immunotherapy, gives us optimism for the personalized management of rectal cancer. Microsatellite instability (MSI) tumors have demonstrated high sensitivity to ICIs, and preliminary findings in the neoadjuvant setting of rectal cancer are promising. To date, antiangiogenic and anti-EGFR therapies in LARC have not demonstrated the same benefit seen in metastatic disease. The outstanding results accomplished by biomarker-guided therapy in metastatic CRC will guide future developments of biological therapy in LARC.
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Affiliation(s)
- Alexandre A Jácome
- Department of Gastrointestinal Medical Oncology, Oncoclínicas, Belo Horizonte, Brazil
| | | | - Mariana V Gil
- Department of Gastrointestinal Medical Oncology, Oncoclínicas, Rio de Janeiro, Brazil
| | - Juliana Ominelli
- Department of Gastrointestinal Medical Oncology, Oncoclínicas, Rio de Janeiro, Brazil
| | - Gabriel Prolla
- Department of Gastrointestinal Medical Oncology, Oncoclínicas, Porto Alegre, Brazil
| | | | - Cathy Eng
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
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Peixoto RD, Oliveira LJDC, Passarini TDM, Andrade AC, Diniz PH, Prolla G, Amorim LC, Gil M, Lino F, Garicochea B, Jácome A, Ng K. Vitamin D and colorectal cancer - A practical review of the literature. Cancer Treat Res Commun 2022; 32:100616. [PMID: 35940119 DOI: 10.1016/j.ctarc.2022.100616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/01/2022] [Accepted: 07/27/2022] [Indexed: 06/15/2023]
Abstract
Colorectal cancer (CRC) is the third leading cause of cancer-related mortality in the United States and the second cause worldwide. Its incidence rates have been decreasing in the overall population in the US in the past few decades, but with increasing rates in the population younger than 50 years old. Environmental factors are supposed to be involved in the development of the disease, with strong evidence favoring an influence of the diet and lifestyle. A diet high in red meat and calories, and low in fiber, fruits and vegetables increases the risk of CRC, as well as physical inactivity. The influence of low calcium intake and low levels of vitamin D on the risk of the disease and on the clinical outcomes of CRC patients has also been investigated. Hypovitaminosis D has been highly prevalent worldwide and associated with several chronic diseases, including malignancies. Vitamin D is a steroid hormone with the main function of regulating bone metabolism, but with many other physiological functions, such as anti-inflammatory, immunomodulatory, and antiangiogenic effects, potentially acting as a carcinogenesis inhibitor. In this review, we aim to describe the relation of vitamin D with malignant diseases, mainly CRC, as well as to highlight the results of the studies which addressed the potential role of vitamin D in the development and progression of the disease. In addition, we will present the results of the pivotal randomized clinical trials that evaluated the impact of vitamin D supplementation on the clinical outcomes of patients with CRC.
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Affiliation(s)
- Renata D'Alpino Peixoto
- Department of Gastrointestinal Medical Oncology, Centro Paulista de Oncologia, Oncoclinicas, Av. Brigadeiro Faria Lima 4300, São Paulo, SP 04538-132, Brazil.
| | - Leandro Jonata de Carvalho Oliveira
- Department of Gastrointestinal Medical Oncology, Centro Paulista de Oncologia, Oncoclinicas, Av. Brigadeiro Faria Lima 4300, São Paulo, SP 04538-132, Brazil
| | | | - Aline Chaves Andrade
- Department of Gastrointestinal Medical Oncology, Oncoclinicas, Belo Horizonte, Brazil
| | - Paulo Henrique Diniz
- Department of Gastrointestinal Medical Oncology, Oncoclinicas, Belo Horizonte, Brazil
| | - Gabriel Prolla
- Department of Gastrointestinal Medical Oncology, Oncoclinicas, Porto Alegre, Brazil
| | - Larissa Costa Amorim
- Department of Gastrointestinal Medical Oncology, Centro Paulista de Oncologia, Oncoclinicas, Av. Brigadeiro Faria Lima 4300, São Paulo, SP 04538-132, Brazil
| | - Mariana Gil
- Department of Gastrointestinal Medical Oncology, Oncoclinicas, Rio de Janeiro, Brazil
| | - Flora Lino
- Department of Gastrointestinal Medical Oncology, Oncoclinicas, Rio de Janeiro, Brazil
| | - Bernardo Garicochea
- Department of Gastrointestinal Medical Oncology, Centro Paulista de Oncologia, Oncoclinicas, Av. Brigadeiro Faria Lima 4300, São Paulo, SP 04538-132, Brazil
| | - Alexandre Jácome
- Department of Gastrointestinal Medical Oncology, Oncoclinicas, Belo Horizonte, Brazil
| | - Kimmie Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
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Jácome AA, Gil RA, Moraes EDD, Peixoto RD, Canedo JA, Passarini T, Gil M, Pereira S, Amorim L, Prolla G, Freitas L, Coelho F, Paiva I, Paes R, Cruz H, Costa e Silva M, Ferreira CG, Ferrari BL, Garicochea B, Dienstmann R. Treatment patterns and outcomes of patients with metastatic colorectal cancer in third-line and beyond systemic therapy: Real-world data from a setting with limited resources. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
58 Background: Regorafenib and trifluridine/tipiracil (TAS-102) are the only therapeutic options for patients with chemorefractory metastatic colorectal cancer (mCRC) with demonstrated benefit in overall survival (OS). However, they are not accessible worldwide. In Brazil, they have been recently approved, but they have not yet been provided by public health system or private health insurances. We aimed to describe the treatment patterns and clinical outcomes of that population in a setting with limited access to those drugs. Methods: Retrospective study evaluating 510 patients with mCRC who were treated at five Oncoclinicas centers in Brazil from January 2011 to December 2019. Demographic and clinical data were retrieved from electronic medical records. The median OS was calculated by Kaplan-Meier method and prognostic factors were evaluated via multivariable Cox Regression, calculating the Hazard Ratio (HR) and the confidence interval (CI95%). Results: A total of 163 patients (33% of the overall population) received third-line and 73 (15%) fourth-line systemic therapy. Median age was 62 years, 59% were male. Tumors were right-sided in 19%, RAS mutated 44%, BRAF mutated 3%, and high-frequency microsatellite instability 3%. Metastasectomy prior to third-line was performed in 62% of the patients. From the start of third-line therapy, median follow-up was 9.0 months, with 67% of deaths, and median OS was 13.7 months (CI95% 11.8m–20.0m). Most adopted regimens in third-and fourth-line were (1) rechallenge with oxaliplatin-based therapy (39% and 26%, respectively); (2) rechallenge with irinotecan-based therapy (32% and 34%); (3) rechallenge with anti-EGFR monoclonal antibodies (20% and 29%); (4) regorafenib (13% and 25%); and (5) TAS-102 (2% and 4%). In multivariable model including clinical and molecular variables, prior metastasectomy was the only significant prognostic factor for OS (HR 0.51, CI95% 0.31–0.83, p=0.007). Conclusions: In real-world, a meaningful proportion of patients with mCRC are eligible for third and later lines of therapy. Rechallenge with chemotherapy and anti-EGFR agents is overused in a setting of limited access to therapies with demonstrated OS benefit, such as regorafenib and TAS-102. Barriers to drug access impair the adoption of the best evidence-based continuum of care and strategies to overcome them are urgently needed. Refractory patients in later lines of therapy derive survival benefit from prior metastasectomy.
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Jácome AA, Castro ACG, Vasconcelos JPS, Silva MHCR, Lessa MAO, Moraes ED, Andrade AC, Lima FMT, Farias JPF, Gil RA, Prolla G, Garicochea B. Efficacy and Safety Associated With Immune Checkpoint Inhibitors in Unresectable Hepatocellular Carcinoma: A Meta-analysis. JAMA Netw Open 2021; 4:e2136128. [PMID: 34870682 PMCID: PMC8649834 DOI: 10.1001/jamanetworkopen.2021.36128] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE Immune checkpoint inhibitors (ICIs) have yielded conflicting results in hepatocellular carcinoma (HCC). The overall effect of ICIs compared with standard therapies in unresectable HCC requires more research. OBJECTIVE To estimate the efficacy and safety associated with ICIs compared with standard therapies in patients with unresectable HCC. DATA SOURCES PubMed, Cochrane Library, Web of Science, Latin American and Caribbean Health Sciences Literature, and American Society of Clinical Oncology and European Society of Medical Oncology meeting proceedings were systematically searched. Reference lists from studies selected by electronic searching were manually searched to identify additional relevant studies. The search included literature published or presented from February 2010 to February 2020. STUDY SELECTION From December 2019 to February 2020, independent reviewers evaluated each database, scanning the title, abstract, and keywords of every record retrieved. Full articles were further assessed if the information given suggested that the study was a randomized clinical trial (RCT) comparing ICIs vs standard therapies in the treatment of unresectable HCC. DATA EXTRACTION AND SYNTHESIS The full text of the resulting studies and extracted data were reviewed independently according to PRISMA guidelines. Summary hazard ratios (HRs) of overall survival (OS) and progression-free survival (PFS) were calculated by a random-effects model. The likelihood of ICIs being associated with overall response rate (ORR) and treatment-related adverse events (TRAEs) was expressed by odds ratios (ORs) using a random-effects model. MAIN OUTCOMES AND MEASURES The main outcomes were OS, PFS, ORR, and TRAEs. RESULTS Of 1836 studies yielded by the search, 3 were retained, totaling 1657 patients (985 treated with ICIs vs 672 receiving standard treatment). Two studies evaluated ICIs as monotherapy, and 1 study investigated the combination of ICIs with bevacizumab. Compared with standard therapies (sorafenib in first-line therapy or placebo in second-line therapy), ICIs were associated with significantly improved OS (HR, 0.75; 95% CI, 0.62-0.92; P = .006), PFS (HR, 0.74; 95% CI, 0.56-0.97; P = .03), and ORR (OR, 2.82; 95% CI 2.02-3.93; P < .001). The probability of grade 3 or 4 TRAEs was lower with ICIs than with sorafenib (OR, 0.44; 95% CI, 0.20-0.96; P = .04). CONCLUSIONS AND RELEVANCE This meta-analysis found superior efficacy and safety associated with ICIs compared with standard therapies and highlights the survival benefit associated with the combination of antiangiogenic therapy with ICIs in first-line systemic therapy of unresectable HCC.
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Affiliation(s)
- Alexandre A. Jácome
- Department of Gastrointestinal Medical Oncology, Oncoclínicas, Belo Horizonte, Brazil
| | | | | | | | | | | | - Aline C. Andrade
- Department of Gastrointestinal Medical Oncology, Oncoclínicas, Belo Horizonte, Brazil
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Peixoto RD, Coutinho AK, Weschenfelder RF, Prolla G, Rocha D, Andrade AC, Rego JF, Fernandes GDS, Crosara M, Hoff PM, Dienstmann R, Costa E Silva M, Riechelmann RP. Fluorouracil Bolus Use in Infusional Regimens Among Oncologists-A Survey by Brazilian Group of Gastrointestinal Tumors. JCO Glob Oncol 2021; 7:1270-1275. [PMID: 34383598 PMCID: PMC8389882 DOI: 10.1200/go.21.00167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The utility of administering fluorouracil (5-FU) in bolus in regimens of infusional 5-FU has been questioned. We aimed to quantify the use of 5-FU bolus in infusional regimens for gastrointestinal malignancies among Brazilian oncologists. METHODS This was a cross-sectional electronic survey composed of eight multiple-choice questions sent to Brazilian oncologists during 14 days in February 2021. The survey instrument collected demographic data of participants and assessed practices in terms of 5-FU bolus use. We evaluated the association of demographic variables and 5-FU prescribing patterns with Fisher’s exact test (odds ratio [OR]). RESULTS The survey was completed by 332 medical oncologists. Overall, 37% were experienced oncologists and 32% were gastrointestinal specialists. In the first-line metastatic and in the adjuvant settings, 40% and 67% of oncologists always prescribe 5-FU bolus in infusional regimens, respectively. Experienced oncologists more frequently omit 5-FU bolus when compared with early-career oncologists, both in the metastatic (41% v 26%; OR, 1.98; P = .005) and adjuvant settings (28% v 14%; OR, 2.32; P = .003). In addition, more GI specialists remove 5-FU bolus when compared with generalists, but only in the metastatic setting (44% v 25%; OR, 2.33; P = .001). GI specialists are more likely to consider that treatment efficacy is not affected by 5-FU bolus withdrawal than are generalists (89% v 75%; OR, 2.65; P = .003). Most respondents (67%) keep leucovorin at the same doses when omitting 5-FU bolus, and only 16% always recommend dihydropyrimidine dehydrogenase testing. CONCLUSION Our survey indicates that experience in oncology practice and percentage of time dedicated to treat GI cancers influence the prescription of 5-FU bolus in Brazil, with more frequent omission of it among experienced gastrointestinal specialists, particularly in the metastatic setting.
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Affiliation(s)
| | - Anelisa K Coutinho
- Clínica AMO: GEM Assistencia Medica Especializada Sociedade Simples Ltda, Salvador, Brazil
| | | | - Gabriel Prolla
- PUCRS: Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Juliana Florinda Rego
- Onofre Lopes University Hospital: Hospital Universitario Onofre Lopes, Natal, Brazil
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Peixoto R, Coutinho A, Weschenfelder R, Prolla G, da Rocha Filho D, Andrade A, Rego J, Dos Santos Fernandes G, Crosara Teixeira M, Hoff P, Costa e Silva M, Dienstmann R, Riechelmann R. P-47 5-fluorouracil bolus use in infusional regimens among oncologists: A survey by Brazilian Group of Gastrointestinal Tumors. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Rocha-Filho DR, Peixoto RD, Weschenfelder RF, Rego JFM, Riechelmann R, Coutinho AK, Fernandes GS, Jacome AA, Andrade AC, Murad AM, Mello CAL, Miguel DSCG, Gomes DBD, Racy DJ, Moraes ED, Akaishi EH, Carvalho ES, Mello ES, Filho FM, Coimbra FJF, Capareli FC, Arruda FF, Vieira FMAC, Takeda FR, Cotti GCC, Pereira GLS, Paulo GA, Ribeiro HSC, Lourenco LG, Crosara M, Toneto MG, Oliveira MB, de Lourdes Oliveira M, Begnami MD, Forones NM, Yagi O, Ashton-Prolla P, Aguillar PB, Amaral PCG, Hoff PM, Araujo RLC, Di Paula Filho RP, Gansl RC, Gil RA, Pfiffer TEF, Souza T, Ribeiro U, Jesus VHF, Costa WL, Prolla G. Brazilian Group of Gastrointestinal Tumours' consensus guidelines for the management of oesophageal cancer. Ecancermedicalscience 2021; 15:1195. [PMID: 33889204 PMCID: PMC8043684 DOI: 10.3332/ecancer.2021.1195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Indexed: 11/28/2022] Open
Abstract
Oesophageal cancer is among the ten most common types of cancer worldwide. More than 80% of the cases and deaths related to the disease occur in developing countries. Local socio-economic, epidemiologic and healthcare particularities led us to create a Brazilian guideline for the management of oesophageal and oesophagogastric junction (OGJ) carcinomas. The Brazilian Group of Gastrointestinal Tumours invited 50 physicians with different backgrounds, including radiology, pathology, endoscopy, nuclear medicine, genetics, oncological surgery, radiotherapy and clinical oncology, to collaborate. This document was prepared based on an extensive review of topics related to heredity, diagnosis, staging, pathology, endoscopy, surgery, radiation, systemic therapy (including checkpoint inhibitors) and follow-up, which was followed by presentation, discussion and voting by the panel members. It provides updated evidence-based recommendations to guide clinical management of oesophageal and OGJ carcinomas in several scenarios and clinical settings.
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Affiliation(s)
- Duilio R Rocha-Filho
- Hospital Universitário Walter Cantídio, 60430-372 Fortaleza, Brazil
- Grupo Oncologia D’Or, 04535-110 São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | - Diogo B D Gomes
- Hospital Israelita Albert Einstein, 05652-900, São Paulo, Brazil
| | - Douglas J Racy
- Hospital Beneficência Portuguesa de São Paulo, 01323-001 São Paulo, Brazil
| | | | - Eduardo H Akaishi
- Faculdade de Medicina da Universidade de São Paulo, 01246903 São Paulo, Brazil
| | | | - Evandro S Mello
- Faculdade de Medicina da Universidade de São Paulo, 01246903 São Paulo, Brazil
| | - Fauze Maluf Filho
- Faculdade de Medicina da Universidade de São Paulo, 01246903 São Paulo, Brazil
| | | | | | | | | | - Flavio R Takeda
- Faculdade de Medicina da Universidade de São Paulo, 01246903 São Paulo, Brazil
| | | | | | - Gustavo A Paulo
- Universidade Federal de São Paulo, 04040-003 São Paulo, Brazil
| | | | | | | | | | - Marcos B Oliveira
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, 01238-010 São Paulo, Brazil
| | | | | | - Nora M Forones
- Universidade Federal de São Paulo, 04040-003 São Paulo, Brazil
| | - Osmar Yagi
- Faculdade de Medicina da Universidade de São Paulo, 01246903 São Paulo, Brazil
| | | | | | | | - Paulo M Hoff
- Grupo Oncologia D’Or, 04535-110 São Paulo, Brazil
| | | | | | | | | | | | - Tulio Souza
- Hospital Aliança de Salvador, 41920-900 Salvador, Brazil
| | - Ulysses Ribeiro
- Faculdade de Medicina da Universidade de São Paulo, 01246903 São Paulo, Brazil
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Reis LB, Konzen D, Netto CBO, Braghini PMB, Prolla G, Ashton-Prolla P. Tuberous Sclerosis Complex with rare associated findings in the gastrointestinal system: a case report and review of the literature. BMC Gastroenterol 2020; 20:394. [PMID: 33225890 PMCID: PMC7682061 DOI: 10.1186/s12876-020-01481-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/01/2020] [Indexed: 11/17/2022] Open
Abstract
Background Tuberous Sclerosis Complex (TSC) is a complex and heterogeneous genetic disease that has well-established clinical diagnostic criteria. These criteria do not include gastrointestinal tumors. Case presentation We report a 45-year-old patient with a clinical and molecular diagnosis of TSC and a family history of cancer, presenting two rare associated findings: gastrointestinal polyposis and pancreatic neuroendocrine tumor. This patient was subjected to a genetic test with 80 cancer predisposing genes. The genetic panel revealed the presence of a large pathogenic deletion in the TSC2 gene, covering exons 2 to 16 and including the initiation codon. No changes were identified in the colorectal cancer and colorectal polyposis genes. Discussion and conclusions We describe a case of TSC that presented tumors of the gastro intestinal tract that are commonly unrelated to the disease. The patient described here emphasizes the importance of considering polyposis of the gastrointestinal tract and low grade neuroendocrine tumor as part of the TSC syndromic phenotype.
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Affiliation(s)
- Larissa Brussa Reis
- Laboratório de Medicina Genômica - Centro de Pesquisa Experimental - Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil.,Programa de Pós-graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Daniele Konzen
- Hospital Mãe de Deus, Porto Alegre, Rio Grande do Sul, Brazil.,Hospital São Lucas, Escola de Medicina da Pontifícia Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Cristina Brinckmann Oliveira Netto
- Serviço de Genética Médica, Hospital de Clinicas de Porto Alegre (HCPA), Rua Ramiro Barcelos 2350, Porto Alegre, RS, CEP: 90035-903, Brazil
| | | | - Gabriel Prolla
- Hospital São Lucas, Escola de Medicina da Pontifícia Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Patricia Ashton-Prolla
- Laboratório de Medicina Genômica - Centro de Pesquisa Experimental - Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil. .,Programa de Pós-graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil. .,Serviço de Genética Médica, Hospital de Clinicas de Porto Alegre (HCPA), Rua Ramiro Barcelos 2350, Porto Alegre, RS, CEP: 90035-903, Brazil.
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13
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Peixoto RD, Rocha-Filho DR, Weschenfelder RF, Rego JFM, Riechelmann R, Coutinho AK, Fernandes GS, Jacome AA, Andrade AC, Murad AM, Mello CAL, Miguel DSCG, Gomes DBD, Racy DJ, Moraes ED, Akaishi EH, Carvalho ES, Mello ES, Filho FM, Coimbra FJF, Capareli FC, Arruda FF, Vieira FMAC, Takeda FR, Cotti GCC, Pereira GLS, Paulo GA, Ribeiro HSC, Lourenco LG, Crosara M, Toneto MG, Oliveira MB, de Lourdes Oliveira M, Begnami MD, Forones NM, Yagi O, Ashton-Prolla P, Aguillar PB, Amaral PCG, Hoff PM, Araujo RLC, Filho RPDP, Gansl RC, Gil RA, Pfiffer TEF, Souza T, Jr. UR, Jesus VHF, Jr WLC, Prolla G. Brazilian Group of Gastrointestinal Tumours' consensus guidelines for the management of gastric cancer. Ecancermedicalscience 2020; 14:1126. [PMID: 33209117 PMCID: PMC7652540 DOI: 10.3332/ecancer.2020.1126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Indexed: 12/23/2022] Open
Abstract
Gastric cancer is among the ten most common types of cancer worldwide. Most cases and deaths related to the disease occur in developing countries. Local socio-economic, epidemiologic and healthcare particularities led us to create a Brazilian guideline for the management of gastric carcinomas. The Brazilian Group of Gastrointestinal Tumors (GTG) invited 50 physicians with different backgrounds, including radiology, pathology, endoscopy, nuclear medicine, genetics, oncological surgery, radiotherapy and clinical oncology, to collaborate. This document was prepared based on an extensive review of topics related to heredity, diagnosis, staging, pathology, endoscopy, surgery, radiation, systemic therapy and follow-up, which was followed by presentation, discussion, and voting by the panel members. It provides updated evidence-based recommendations to guide clinical management of gastric carcinomas in several scenarios and clinical settings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Diogo B D Gomes
- Hospital Israelita Albert Einstein, São Paulo. Brazil, 05652- 900
| | - Douglas J Racy
- Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil, 01323-001
| | | | - Eduardo H Akaishi
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 01246903
| | | | - Evandro S Mello
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 01246903
| | - Fauze Maluf Filho
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 01246903
| | | | | | | | | | - Flavio R Takeda
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 01246903
| | | | | | - Gustavo A Paulo
- Universidade Federal de São Paulo, São Paulo, Brazil, 04040-003
| | | | | | | | | | - Marcos B Oliveira
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Sâo Paulo, Brazil, 01238-010
| | | | | | - Nora M Forones
- Universidade Federal de São Paulo, São Paulo, Brazil, 04040-003
| | - Osmar Yagi
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 01246903
| | | | | | | | | | | | | | | | | | | | - Tulio Souza
- Hospital Aliança de Salvador, Salvador, Brazil, 41920-900
| | - Ulysses Ribeiro Jr.
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 01246903
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14
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Riechelmann RP, Peixoto RD, Fernandes GDS, Weschenfelder RF, Prolla G, Filho DR, Andrade AC, Crosara M, Rego JFM, Gansl RC, Coimbra F, Aguiar S, Carvalho E, Hoff PM, Coutinho AK. Evidence-based recommendations for gastrointestinal cancers during the COVID-19 pandemic by the Brazilian Gastrointestinal Tumours Group. Ecancermedicalscience 2020; 14:1048. [PMID: 32565901 PMCID: PMC7289615 DOI: 10.3332/ecancer.2020.1048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE As of 2020, the world is facing the great challenge of the COVID-19 (Coronavirus disease 2019) pandemic, caused by the SARS-CoV-2 virus. While the overall mortality is low, the virus is highly virulent and may infect millions of people worldwide. This will consequently burden health systems, particularly by those individuals considered to be at high risk of severe complications from COVID-19. Such risk factors include advanced age, cardiovascular and pulmonary diseases, diabetes and cancer. However, few data on the outcomes of cancer patients infected by SARS CoV-2 exist. Therefore, there is a lack of guidance on how to manage cancer patients during the pandemic. We sought to propose specific recommendations about the management of patients with gastrointestinal malignancies. METHODS The Brazilian Gastrointestinal Tumours Group board of directors and members sought up-to-date scientific literature on each tumour type and discussed all recommendations by virtual meetings to provide evidence-based-and sometimes, expert opinion-recommendation statements. Our objectives were to recommend evidence-based approaches to both treat and minimise the risk of COVID-19 for cancer patients, and simultaneously propose how to decrease the use of hospital resources at a time these resources need to be available to treat COVID-19 patients. RESULTS Overall and tumour-specific recommendations were made by stage (including surgical, locoregional, radiotherapy, systemic treatments and follow-up strategies) for the most common gastrointestinal malignancies: esophagus, gastric, pancreas, bile duct, hepatocellular, colorectal, anal cancer and neuroendocrine tumours. CONCLUSIONS Our recommendations emphasise the importance of treating cancer patients, using the best evidence available, while simultaneously taking into consideration the world-wide health resource hyperutilisation to treat non-cancer COVID-19 patients.
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Affiliation(s)
| | | | | | | | - Gabriel Prolla
- Centro de Oncologia Hospital São Lucas da PUCRS, Porto Alegre, RS 90610-000, Brazil
| | | | | | | | | | - Rene C Gansl
- Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil
| | - Felipe Coimbra
- AC Camargo Cancer Center, Sao Paulo, SP 01509-010, Brazil
| | - Samuel Aguiar
- AC Camargo Cancer Center, Sao Paulo, SP 01509-010, Brazil
| | | | - Paulo M Hoff
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, SP 01246-000, Brazil
| | - Anelisa K Coutinho
- Clinica AMO, Assistência Multidisciplinar em Oncologia, Salvador, BA 41950-640, Brazil
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15
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Jácome AA, De Castro ACG, Solar Vasconcelos JP, Silva MHCR, Lessa MAO, Moraes EDD, Andrade AC, Ferreira BSF, Lima FMT, Bulcao ML, Ferreira AR, Fogacci De Farias JP, Prolla G, Garicochea B. Efficacy and safety of immune checkpoint inhibitors (ICIs) in unresectable hepatocellular carcinoma (HCC): A systematic review and meta-analysis of randomized clinical trials (RCTs). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16631 Background: ICIs have ushered a new era in cancer therapy, but their efficacy in HCC is uncertain. Single-arm phase II studies with sorafenib-refractory patients have suggested clinical activity of nivolumab and pembrolizumab, which have become FDA-approved therapies. Nevertheless, the overall effect of ICIs compared with the standard of care (SOC) in unresectable HCC patients is still unknown. Methods: We systematically searched PubMed, Cochrane Library, Web of Science, LILACS, and ASCO and ESMO Meeting Proceedings in the last 10 years for RCTs that have compared the efficacy of ICIs versus the SOC in the systemic therapy of unresectable HCC. Outcomes of interest included overall survival (OS), progression-free survival (PFS), overall response rate (ORR), and grade 3-4 treatment-related adverse events (TRAEs). A summary hazard ratio (HR) of OS and PFS was calculated using 95% confidence intervals (CI) by fixed-effects model. The likelihood of ICIs being associated with ORR and TRAEs was expressed by odds ratio (OR) and 95% CI using a random-effects model (PROSPERO ID 162599). Results: Of the 2,334 studies yielded by the search, 3 studies were retained (KEYNOTE-240, CheckMate-459, and IMbrave150), totaling 1,657 patients (985 ICIs versus 672 SOC). Two studies compared ICIs versus sorafenib in 1st line setting, and one study compared with placebo in 2nd line. The ICIs studied were pembrolizumab, nivolumab, and atezolizumab. RCTs with anti-CTLA4 have not been reported. Two studies evaluated ICIs as monotherapy, and one study investigated the association with bevacizumab. Compared with the SOC (sorafenib in 1st line or placebo in 2nd line), ICIs significantly improved OS (HR: 0.78, 95% CI 0.68 – 0.89, p = 0.0002), PFS (HR: 0.79, 95% CI 0.71 – 0.89, p < 0.0001), and ORR (OR: 2.82, 95% CI 2.02 – 3.93, p < 0.0001). ICIs were associated with a lower probability of grade 3-4 TRAEs when compared to sorafenib (OR: 0.44, 95% CI 0.20 – 0.96, p = 0.04). No significant heterogeneity was found among studies when OS and ORR were analyzed, but it was found in the analysis of PFS and TRAEs. Conclusions: ICIs demonstrated superior efficacy and safety compared to the standard therapy of patients with unresectable HCC. The analysis of ICIs as monotherapy and combination therapy increased the heterogeneity among studies. The association of anti-angiogenic therapy with ICIs improved the survival benefit of immunotherapy and should become the new SOC in the 1st line systemic therapy of unresectable HCC.
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16
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Weigert KL, Prolla G, Sperb LM. The Effects of the Bevacizumab on the Jaws: a Case Report. Oral Surg Oral Med Oral Pathol Oral Radiol 2018. [DOI: 10.1016/j.oooo.2018.02.500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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17
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Peixoto R, Riechelmann R, Prolla G, Weschenfelder R, Rego J, Dos Santos Fernandes G, Pereira G, de Oliveira M, da Rocha Filho D, Coutinho A. Treatment choices in metastatic colorectal cancer according to sidedness and RAS/BRAF status: A national survey by the Brazilian Group of Gastrointestinal Tumors (GTG). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Riechelmann R, Coutinho AK, Weschenfelder RF, Andrade DE Paulo G, Fernandes GDS, Gifoni M, Oliveira MDL, Gansl R, Gil R, Luersen G, Lucas L, Reisner M, Vieira FM, Machado MA, Murad A, Osvaldt A, Brandão M, Carvalho E, Souza T, Pfiffer T, Prolla G. GUIDELINE FOR THE MANAGEMENT OF BILE DUCT CANCERS BY THE BRAZILIAN GASTROINTESTINAL TUMOR GROUP. Arq Gastroenterol 2017; 53:5-9. [PMID: 27276097 DOI: 10.1590/s0004-28032016000100003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/22/2015] [Indexed: 02/06/2023]
Abstract
The Brazilian Gastrointestinal Tumor Group developed guidelines for the surgical and clinical management of patients with billiary cancers. The multidisciplinary panel was composed of experts in the field of radiology, medical oncology, surgical oncology, radiotherapy, endoscopy and pathology. The panel utilized the most recent literature to develop a series of evidence-based recommendations on different treatment and diagnostic strategies for cholangiocarcinomas and gallbladder cancers.
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Affiliation(s)
- Rachel Riechelmann
- Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil, Instituto do Câncer do Estado de São Paulo, São Paulo SP , Brasil.,Hospital Sírio Libanês, São Paulo, SP, Brasil, Hospital Sírio-Libanês, Hospital Sírio Libanês, São Paulo SP , Brazil
| | | | - Rui F Weschenfelder
- Hospital Moinhos de Vento, Porto Alegre, RS, Brasil, Hospital Moinhos de Vento, Hospital Moinhos de Vento, Porto Alegre RS , Brazil
| | - Gustavo Andrade DE Paulo
- Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil, Instituto do Câncer do Estado de São Paulo, São Paulo SP , Brasil
| | - Gustavo Dos Santos Fernandes
- Oncologia, Hospital Sírio Libanês, Brasília, DF, Brasil, Hospital Sírio-Libanês, Hospital Sírio Libanês, Brasília DF , Brazil
| | - Markus Gifoni
- Clínica Fujiday Oncologia, Fortaleza, CE, Brasil, Clínica Fujiday Oncologia, Fortaleza CE , Brasil
| | | | - Rene Gansl
- Centro Paulista de Oncologia, São Paulo, SP, Brasil, Centro Paulista de Oncologia, São Paulo SP , Brasil
| | - Roberto Gil
- Instituto Nacional do Câncer, Rio de Janeiro, RJ, Brasil, Instituto Nacional do Câncer, Instituto Nacional do Câncer, Rio de Janeiro RJ , Brazil
| | - Gustavo Luersen
- Hospital Moinhos de Vento, Porto Alegre, RS, Brasil, Hospital Moinhos de Vento, Hospital Moinhos de Vento, Porto Alegre RS , Brazil
| | - Lucio Lucas
- Hospital de Base, Brasília, DF, Brasil, Hospital de Base, Brasília DF , Brasil
| | - Marcio Reisner
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil, Universidade Federal do Rio de Janeiro, Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ , Brazil
| | - Fernando Meton Vieira
- Instituto COI de Pesquisa, Educação e Gestão, Rio de Janeiro, RJ, Brasil, Instituto COI de Pesquisa, Educação e Gestão, Rio de Janeiro RJ , Brasil
| | - Marcel Autran Machado
- Hospital Sírio Libanês, São Paulo, SP, Brasil, Hospital Sírio-Libanês, Hospital Sírio Libanês, São Paulo SP , Brazil
| | - Andre Murad
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil, Universidade Federal de Minas Gerais, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte MG , Brazil
| | - Alessandro Osvaldt
- Hospital de Clínicas, Porto Alegre, RS, Brasil, Hospital de Clínicas, Porto Alegre RS , Brasil
| | - Miguel Brandão
- Clínica AMO, Salvador, BA, Brasil, Clínica AMO, Salvador BA , Brasil
| | - Elisangela Carvalho
- Hospital Português, Salvador, BA, Brasil, Hospital Português, Hospital Português, Salvador BA , Brazil
| | - Tulio Souza
- Hospital Aliança, Salvador, BA, Brasil, Hospital Aliança, Salvador BA , Brasil
| | - Tulio Pfiffer
- Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil, Instituto do Câncer do Estado de São Paulo, São Paulo SP , Brasil
| | - Gabriel Prolla
- Hospital Mãe de Deus, Porto Alegre, RS, Brasil, Hospital Mãe de Deus, Hospital Mãe de Deus, Porto Alegre RS , Brazil
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19
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Coimbra FJF, Ribeiro HSDC, Marques MC, Herman P, Chojniak R, Kalil AN, Wiermann EG, Cavallero SRDA, Coelho FF, Fernandes PHDS, Silvestrini AA, Almeida MFA, de Araújo ALE, Pitombo M, Teixeira HM, Waechter FL, Ferreira FG, Diniz AL, D'Ippolito G, D'Ippolito G, Begnami MDFDS, Prolla G, Balzan SMP, de Oliveira TB, Szultan LA, Lendoire J, Torres OJM. FIRST BRAZILIAN CONSENSUS ON MULTIMODAL TREATMENT OF COLORECTAL LIVER METASTASES. MODULE 1: PRE-TREATMENT EVALUATION. Arq Bras Cir Dig 2016; 28:222-30. [PMID: 26734788 PMCID: PMC4755170 DOI: 10.1590/s0102-6720201500040002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/11/2015] [Indexed: 02/07/2023]
Abstract
Background : Liver metastases of colorectal cancer are frequent and potentially fatal event
in the evolution of patients with these tumors. Aim : In this module, was contextualized the clinical situations and parameterized
epidemiological data and results of the various treatment modalities established.
Method: Was realized deep discussion on detecting and staging metastatic colorectal
cancer, as well as employment of imaging methods in the evaluation of response to
instituted systemic therapy. Results : The next step was based on the definition of which patients would have their
metastases considered resectable and how to expand the amount of patients elegible
for modalities with curative intent. Conclusion : Were presented clinical, pathological and molecular prognostic factors,
validated to be taken into account in clinical practice.
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Affiliation(s)
| | | | | | - Paulo Herman
- American Hepato-Pancreato-Biliary Association, São Paulo, Brazil
| | - Rubens Chojniak
- American Hepato-Pancreato-Biliary Association, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Marcos Pitombo
- American Hepato-Pancreato-Biliary Association, São Paulo, Brazil
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20
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M. Barrios P, Debiasi M, Cauduro C, Herrmann F, Marchese G, Guthmann Pesenatto G, A. Menegat F, Prolla G, Barrios CH, Fay AP. The impact of comprehensive genomic profiling in the management of patients with metastatic solid tumors in a developing country. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e18038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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21
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Prolla G. Is There a Role for Adjuvant Chemotherapy in Rectal Cancer? Curr Colorectal Cancer Rep 2015. [DOI: 10.1007/s11888-015-0261-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Hoff PM, Saad ED, Costa F, Coutinho AK, Caponero R, Prolla G, Gansl RC. Literature review and practical aspects on the management of oxaliplatin-associated toxicity. Clin Colorectal Cancer 2011; 11:93-100. [PMID: 22154408 DOI: 10.1016/j.clcc.2011.10.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 09/24/2011] [Accepted: 10/14/2011] [Indexed: 02/07/2023]
Abstract
Colorectal cancer is currently a public health priority because it is the second leading cause of cancer deaths in Western countries. Combination regimes of oxaliplatin and infusional fluorouracil/leucovorin or capecitabine have emerged as important options in the palliative and adjuvant treatment of colorectal cancer. Although better tolerated than cisplatin, oxaliplatin displays a characteristic profile of adverse events whose recognition and management are essential for physicians who treat patients with colorectal cancer and other malignancies that benefit from the use of oxaliplatin. Peripheral neuropathy is probably the most frequent and clinically relevant adverse event associated with the use of oxaliplatin, and several measures have been proposed to mitigate this toxicity. Temporary interruption of oxaliplatin before limiting neurotoxicity develops during therapy is a potential approach to avoid the problem of oxaliplatin-associated neuropathy in patients with metastatic colorectal cancer. Calcium and magnesium infusions have no effect on chemotherapy efficacy and also constitute a useful approach in clinical practice. Finally, the incidence and severity of chronic peripheral neuropathy in patients treated with oxaliplatin may be reduced by the use of neuroprotective agents, for example, venlafaxine. Other adverse events, such as gastrointestinal and liver toxicity, thrombocytopenia, and hypersensitivity reactions, are also reviewed in this article, and suggestions are made for their management.
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23
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Xavier MO, Oliveira FDM, Almeida VD, Prolla G, Severo LC. Invasive Aspergillus flavus sinusitis: case report in a patient with biphenotypic acute leukemia. Rev Inst Med Trop Sao Paulo 2009; 51:57-8. [DOI: 10.1590/s0036-46652009000100011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Accepted: 10/06/2008] [Indexed: 11/22/2022] Open
Abstract
Here we report a case of invasive pansinusitis with proptosis of the right eye caused by Aspergillus flavus in an immunocompromised patient with acute biphenotypic leukemia without aggressive therapy response.
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24
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Chilosi M, Chiarle R, Lestani M, Menestrina F, Montagna L, Ambrosetti A, Prolla G, Pizzolo G, Doglioni C, Piva R, Pagano M, Inghirami G. Low expression of p27 and low proliferation index do not correlate in hairy cell leukaemia. Br J Haematol 2008. [DOI: 10.1111/j.1365-2141.2000.02210.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Chilosi M, Chiarle R, Lestani M, Menestrina F, Montagna L, Ambrosetti A, Prolla G, Pizzolo G, Doglioni C, Piva R, Pagano M, Inghirami G. Low expression of p27 and low proliferation index do not correlate in hairy cell leukaemia. Br J Haematol 2000; 111:263-71. [PMID: 11091210 DOI: 10.1046/j.1365-2141.2000.02210.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The molecular basis accounting for the peculiar clinical and biological features of hairy cell leukaemia (HCL) is currently unknown. Deregulation of cell cycle genes plays a significant role in oncogenesis and there is considerable evidence suggesting that Cdk inhibitors (Ckis) function as tumour suppressors. We and others have recently demonstrated low expression of Cki p27 in very aggressive neoplasms and high-grade lymphomas. To investigate whether HCL cases express normal p27 protein, as in other low-grade lymphomas with a low proliferation index, 58 cases of HCL were characterized using a sensitive biotin-streptavidin-immunoperoxidase technique and specific antibodies against p27. All HCL cases showed either no or very weak reactivity, in contrast to other types of low-grade B-cell lymphoma [22 cases of chronic lymphocytic leukaemia (CLL), 12 cases of gastric marginal B-cell lymphoma (MALT), 16 cases of follicular lymphomas and two cases of splenic marginal zone lymphomas]. To investigate the possible mechanism(s) accounting for the low p27 expression observed in hairy cells, multiple approaches were used. According to these molecular studies, low levels of p2 7 are not as a result of (1) increased ubiquitin-mediated degradation, (2) decreased levels of p27 transcription or (3) p27 somatic mutations and/or allelic loss. These findings suggest that low p27 protein expression in HCL may be achieved through post-transcriptional regulation. Finally, our data demonstrate that p27 expression in HCL does not correlate with either cell cycle progression or proliferation index, suggesting that low levels of p27 in hairy cells may be associated with their unique stage of B-cell differentiation and/or the activation of as yet unknown pathways.
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Affiliation(s)
- M Chilosi
- Institute of Anatomic Pathology, University of Verona, Italy
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26
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Liu J, Prolla G, Rostagno A, Chiarle R, Feiner H, Inghirami G. Initiation of translation from a downstream in-frame AUG codon on BRCA1 can generate the novel isoform protein DeltaBRCA1(17aa). Oncogene 2000; 19:2767-73. [PMID: 10851077 DOI: 10.1038/sj.onc.1203599] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Expression of the breast and ovarian cancer gene BRCA1 is regulated at both the transcriptional and post-transcriptional levels. We found that the expression of the BRCA1 protein may also be regulated at the translational level. In addition to an AUG start codon at position 1, BRCA1 mRNA has a second in-frame AUG (+17) that acts as an alternative start codon to generate a novel BRCA1 protein that lacks the first 17 amino acids (DeltaBRCA1(17aa)). We fused cDNAs encoding the second exon of BRCA1 of the wild-type BRCA1 gene (wt-BRCA1) and a mutated BRCA1 gene (mt-BRCA1), in which the first initiation site and its Kozak consensus sequence were abolished, with the nucleophosmin (NPM) reporter gene and used them for in vitro and in vivo translation assays. In both systems, the wt-BRCA1-NPM constructs produced two distinct proteins (18 and 16 kD) begun from the first and second AUGs. The mt-BRCA1-NPM constructs produced only the shorter 16-kD protein lacking the first 17 amino acids of the BRCA1 gene. Next, we analysed the N-terminal protein sequence of purified BRCA1 protein from normal thymocytes and found two different BRCA1 proteins, derived from translation of the first and second in-frame AUGs. Thus, BRCA1 protein expression can be regulated at the translation level in normal cells. Characterization of DeltaBRCA1(17aa) may shed light on the function and regulation of BRCA1 in normal cells as well as the pathogenesis of breast and ovarian cancers. Oncogene (2000).
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Affiliation(s)
- J Liu
- Department of Pathology, New York University Medical Center, New York, NY 10016, USA
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Klein P, Prolla G, Wallach R, Melamed J, Muggia FM. BRCA1 germline mutation presenting as an adenocarcinoma of unknown primary. Cancer J 2000; 6:188-90. [PMID: 10882335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND The work-up of adenocarcinoma of unknown primary usually includes history, physical examination, radiographic imaging, tumor markers, and more recently molecular and genetic information. We report here on how the suggestion by family history of a BRCA1 mutation guided the diagnostic and therapeutic approach in a patient with metastatic carcinoma of unknown primary. METHODS BRCA1 mutation was screened for by polymerase chain reaction (PCR) and single-strand conformational polymorphism analysis. Primers for PCR amplification included selected BRCA1 exons 2, 110, 11L, 13, and 20. The PCR product was cloned into a PCRII vector and sequenced with a Sequenase Version 2.0 Sequencing Kit. RESULTS Single-strand conformational polymorphism analysis suggested a mutation in the region of exon 20 and sequencing confirmed the presence of a germline mutation 5382insC. CONCLUSIONS This case illustrates an unusual presentation of adenocarcinoma of unknown primary in a patient with a germline BRCA1 mutation, the use of a suspected germline mutation to guide the work-up and treatment, and finally the value of positron emission tomography scanning in the work-up of an unknown primary.
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Chiarle R, Podda A, Prolla G, Podack ER, Thorbecke GJ, Inghirami G. CD30 overexpression enhances negative selection in the thymus and mediates programmed cell death via a Bcl-2-sensitive pathway. J Immunol 1999; 163:194-205. [PMID: 10384116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
The biological function of CD30 in the thymus has been only partially elucidated, although recent data indicate that it may be involved in negative selection. Because CD30 is expressed only by a small subpopulation of medullary thymocytes, we generated transgenic (Tg) mice overexpressing CD30 in T lymphocytes to further address its role in T cell development. CD30 Tg mice have normal thymic size with a normal number and subset distribution of thymocytes. In vitro, in the absence of CD30 ligation, thymocytes of CD30 Tg mice have normal survival and responses to apoptotic stimuli such as radiation, dexamethasone, and Fas. However, in contrast to controls, CD30 Tg thymocytes are induced to undergo programmed cell death (PCD) upon cross-linking of CD30, and the simultaneous engagement of TCR and CD30 results in a synergistic increase in thymic PCD. CD30-mediated PCD requires caspase 1 and caspase 3, is not associated with the activation of NF-kappaB or c-Jun, but is totally prevented by Bcl-2. Furthermore, CD30 overexpression enhances the deletion of CD4+/CD8+ thymocytes induced by staphylococcal enterotoxin B superantigen and specific peptide. These findings suggest that CD30 may act as a costimulatory molecule in thymic negative selection.
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Affiliation(s)
- R Chiarle
- Department of Pathology and Kaplan Comprehensive Cancer Center, New York University Medical Center, New York, NY 10016, USA
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Chiarle R, Podda A, Prolla G, Podack ER, Thorbecke GJ, Inghirami G. CD30 Overexpression Enhances Negative Selection in the Thymus and Mediates Programmed Cell Death Via a Bcl-2-Sensitive Pathway. The Journal of Immunology 1999. [DOI: 10.4049/jimmunol.163.1.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
The biological function of CD30 in the thymus has been only partially elucidated, although recent data indicate that it may be involved in negative selection. Because CD30 is expressed only by a small subpopulation of medullary thymocytes, we generated transgenic (Tg) mice overexpressing CD30 in T lymphocytes to further address its role in T cell development. CD30 Tg mice have normal thymic size with a normal number and subset distribution of thymocytes. In vitro, in the absence of CD30 ligation, thymocytes of CD30 Tg mice have normal survival and responses to apoptotic stimuli such as radiation, dexamethasone, and Fas. However, in contrast to controls, CD30 Tg thymocytes are induced to undergo programmed cell death (PCD) upon cross-linking of CD30, and the simultaneous engagement of TCR and CD30 results in a synergistic increase in thymic PCD. CD30-mediated PCD requires caspase 1 and caspase 3, is not associated with the activation of NF-κB or c-Jun, but is totally prevented by Bcl-2. Furthermore, CD30 overexpression enhances the deletion of CD4+/CD8+ thymocytes induced by staphylococcal enterotoxin B superantigen and specific peptide. These findings suggest that CD30 may act as a costimulatory molecule in thymic negative selection.
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Affiliation(s)
- Roberto Chiarle
- *Department of Pathology and Kaplan Comprehensive Cancer Center, New York University Medical Center, New York, NY 10016
- †Department of Anatomic Pathology, University of Torino, Torino, Italy; Divisions of
| | - Antonello Podda
- *Department of Pathology and Kaplan Comprehensive Cancer Center, New York University Medical Center, New York, NY 10016
- ‡Pediatric Hematology/Oncology and
| | - Gabriel Prolla
- §Hematology/Oncology, Department of Medicine, New York University Medical Center, New York, NY 10016; and
| | | | - G. Jeanette Thorbecke
- *Department of Pathology and Kaplan Comprehensive Cancer Center, New York University Medical Center, New York, NY 10016
| | - Giorgio Inghirami
- *Department of Pathology and Kaplan Comprehensive Cancer Center, New York University Medical Center, New York, NY 10016
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Abstract
In 1982 Stein and coworkers identified a new molecule, CD30 (Ki-1), which is expressed by Reed-Sternberg (RS) cells of Hodgkin's Disease (HD) (1). Although CD30 is not a specific RS cell marker, its characterization has assumed an important role not only in the differential diagnosis of HD, but also in the identification of a morphologically and clinically distinct type of large cell lymphoma, now designated as anaplastic large cell lymphoma (ALCL) (2). The cloning of human and murine CD30 and the utilization of genetically manipulated animal models have rapidly expanded our knowledge on its physiological role in lymphoid development and differentiation. The goal of this review is to present an overview of this rapidly evolving field and discuss the role of CD30 in normal and neoplastic lymphoid cells.
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Affiliation(s)
- R Chiarle
- Department of Pathology and Kaplan Comprehensive Cancer Center, New York University Medical Center, New York, New York 10016, USA
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Schwartsmann G, Sprinz E, Kromfield M, Kalakun L, Sander E, Prolla G, Di Leone L, Gerhardt L, Mans DR. Clinical and pharmacokinetic study of oral etoposide in patients with AIDS-related Kaposi's sarcoma with no prior exposure to cytotoxic therapy. J Clin Oncol 1997; 15:2118-24. [PMID: 9164226 DOI: 10.1200/jco.1997.15.5.2118] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE In this phase II and pharmacokinetic study, chronic, low-dose, oral etoposide was evaluated for its efficacy in patients with AIDS-related Kaposi's sarcoma who were not previously exposed to cytotoxic therapy. PATIENTS AND METHODS Of 28 patients accrued for the study, 25 were assessable for toxicity and response. Twenty-four patients were male (homosexual or bisexual cases) and one patient was female (partner of a bisexual male). All patients were human immunodeficiency virus (HIV)-positive, New York University (NYU) disease stage IIB to IVB, and most exhibiting skin and lymph node and/or visceral disease. Median age was 33 years (range, 21 to 50), and median World Health Organization (WHO) performance status was 2 (range, 0 to 3). The patients received a mean number of six treatment courses (range, four to 27). Prior therapy included local/regional irradiation, immunotherapy (interferon-alpha), local resection, and/or cryotherapy. No prior cytotoxic therapy was allowed. Etoposide was administered at a schedule of 25 mg/m2 orally, twice a day for 7 days, every 2 weeks. Plasma concentrations of the drug were measured in six patients by a high-performance liquid chromatography (HPLC) method, after chloroform extraction using teniposide as internal standard. RESULTS The overall response rate was 32% (two complete and six partial responses), and the median progression-free survival was 8 weeks (range, 4 to 27). Five patients (20%) had stable disease, while 12 cases (48%) did not respond. Patients without a history of opportunistic infections seemed to respond better. The regimen was well tolerated. The main toxic effects consisted of mild to moderate nausea and vomiting in approximately half of the cases, and WHO grodes 3 to 4 leukopenia and thrombocytopenia in eight of 25 (36%) and five of 25 (20%) of cases, respectively. However, only two patients had to discontinue treatment because of prolonged and severe neutropenia. No toxic deaths were documented. The pharmacokinetic analyses revealed the achievement of potentially therapeutic and lowly myelosuppressive plasma etoposide concentrations (2.1 micrograms/mL; range, 1.3 to 2.6) for a significant period of time, ie, for approximately 4.6 hours postdosing. CONCLUSION At the schedule applied, etoposide shows significant objective antitumor activity in advanced AIDS-related Kaposi's sarcoma, and induces acceptable clinical toxicity. This apparent efficacy of the regimen could be a result of the prolonged maintenance of cytotoxic plasma concentrations of etoposide during each treatment course, and the absence of toxic peak levels of the drug. These results, together with the appreciable bioavailability of oral etoposide, make the regimen feasible for outpatient treatment of patients with advanced AIDS-related Kaposi's sarcoma. Further studies using the above-mentioned approach are warranted.
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Affiliation(s)
- G Schwartsmann
- Department of Internal Medicine, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
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Sander E, Prolla G, Marques AR, Zelmanowitz T, Zampese M, Schwartsmann G. Reversal by interleukin-2 of alopecia universalis, mucocutaneous candidiasis, and sexual impotence in a patient with malignant thymoma. J Natl Cancer Inst 1993; 85:673. [PMID: 8468726 DOI: 10.1093/jnci/85.8.673] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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