RESUMEN
Thyroid cancer is an uncommon cancer. Molecular biology plays a vital role in its development. Chemotherapy showed unsatisfactory results in advanced stages where surgery and iodine therapy are not appropriate. These last ten years have been marked by a major advance in understanding the molecular features of this cancer and therapeutic correlations, moreover, clinical trials have focused on the treatment of this disease on metastatic stages and led to a significant therapeutic panel targeting angiogenesis, mutations frequently found in cervical cancer: RET, BRAF, RAS... these are the motesanib, axitinib, sunitinib, pazopanib, vandetanib, cabozotinib and sorafenib. The last three molecules have already the autorisation of FDA and EMA. In this review, we will put the item on oncogenetic characteristics of thyroid carcinoma as well as new targeted therapies in patients refractory to conventional treatment.
Asunto(s)
Terapia Molecular Dirigida , Medicina de Precisión/tendencias , Neoplasias de la Tiroides/terapia , Inhibidores de la Angiogénesis/uso terapéutico , Antineoplásicos/uso terapéutico , Transformación Celular Neoplásica/genética , Humanos , Terapia Molecular Dirigida/métodos , Terapia Molecular Dirigida/tendencias , Neovascularización Patológica/tratamiento farmacológico , Medicina de Precisión/métodos , Inhibidores de Proteínas Quinasas/uso terapéutico , Proteínas Proto-Oncogénicas c-ret/antagonistas & inhibidores , Proteínas Proto-Oncogénicas c-ret/genética , Neoplasias de la Tiroides/epidemiología , Neoplasias de la Tiroides/genéticaRESUMEN
We report the demonstration (for the first time to our knowledge) of a cholecysto-colonic fistula using Primovist® enhanced MRCP in a 74-year-old patient. We discuss the advantage of this newly emerged technique over traditional T2-weighted MRCP in this indication.
RESUMEN
Targeted therapies have an increasing importance in digestive oncology. These new treatments have been authorized in colon cancer, gastric cancer, pancreatic cancer, endocrine cancer and gastrointestinal stromal tumors. The oncologist should develop high abilities to use these therapies especially concerning the indications, response's biomarkers, toxicities and evaluation methods.
Asunto(s)
Antineoplásicos/uso terapéutico , Neoplasias del Sistema Digestivo/tratamiento farmacológico , Receptores ErbB/antagonistas & inhibidores , Terapia Molecular Dirigida , Inhibidores de la Angiogénesis/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Anticuerpos Monoclonales Humanizados/toxicidad , Neoplasias Colorrectales/tratamiento farmacológico , Tumores del Estroma Gastrointestinal/tratamiento farmacológico , Humanos , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Pancreáticas/tratamiento farmacológico , Neoplasias Gástricas/tratamiento farmacológicoRESUMEN
OBJECTIVES: Anthracyclines chemotherapy remains primordial and impossible to circumvent in the treatment of breast cancer, in the adjuvant, metastatic and neoadjuvant setting. But some breast invasive tumors are resistant to anthracyclines. The neoadjuvant model is ideal to test the chemosensibility by selecting the well-responder patients and identifying the predictive factors of this response. PATIENTS AND METHODS: We report a retrospective study of 126 patients treated at our institute during 2 years (January 2003-December 2004) for a breast cancer with primary chemotherapy. All the patients received anthracyclines according to protocol AC60 (doxorubicine plus cyclophosphamide). RESULTS: The clinical objective response rate (RO) was 67 % with a complete clinical response (RC) of 11 %. We found a pathological complete response (pCR) in seven patients (5,6 %) of the 126 cases. The statistical study identifies only two clinical factors as predictive of RC and pCR: tumoral size T2-T3 and clinical nodal status N0-N1, while the SBR grading and the hormonal receptors were not correlated. DISCUSSION AND CONCLUSION: Some clinical and histological factors are recognized as predictive for the benefit of anthracyclines neoadjuvant chemotherapy, and correlated to the pCR; we discuss our results through those of the literature, by exposing the current data.
Asunto(s)
Antraciclinas/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Terapia Neoadyuvante , Adulto , Anciano , Antraciclinas/administración & dosificación , Neoplasias de la Mama/patología , Ciclofosfamida/administración & dosificación , Doxorrubicina/administración & dosificación , Resistencia a Antineoplásicos , Femenino , Humanos , Ganglios Linfáticos/patología , Persona de Mediana Edad , Invasividad Neoplásica , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Trastuzumab has been a revolution in the treatment of breast cancer overexpressing HER. Its use as an adjuvant for a period of 1 year is currently an international standard. Its major toxicity is cardiac, where the systematic monitoring of the LVEF before and during treatment. To evaluate the cardiac safety for our patients, we conducted this retrospective case-control study. The average in LVEF before the start of trastuzumab was 62.5% (51-80), and at the end of treatment 60.55 (40-77), a decrease in absolute value by 2%. This difference is statistically significant with P<0.001. Eighty-three percent of our patients have completed treatment, of whom 26.4% with a provisional arrest because of a regressive fall in LVEF. A final arrest has been made in 17% cases due to either a nonregressive reduction in LVEF or the appearance of symptomatic heart failure found in two patients. Analysis of risk factors toxicity found in this group of patients with a cardiotoxicity persisting an average age and average number of treatments received anthracyclines higher than the rest of our sample, and diminished baseline LVEF. But all these differences were not statistically significants. During the period of monitoring of these patients, six (67%) had spontaneous recovery of their LFEV 5 months ± 2.01 after discontinuation of trastuzumab. For two cases of symptomatic heart failure, they had a clinical improvement under medical treatment in February but is still less than 40%. The cardiac safety in our study seems comparable with the literature data but located in the upper range of levels of toxicity. The lack of statistical power of our study does not exclude a greater cardiac toxicity of trastuzumab among Moroccan women and should prompt a more cautious use of this drug and the achievement of larger studies that could answer this question.
Asunto(s)
Anticuerpos Monoclonales/efectos adversos , Antineoplásicos/efectos adversos , Neoplasias de la Mama/tratamiento farmacológico , Cardiopatías/epidemiología , Adulto , Anciano , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales Humanizados , Antineoplásicos/uso terapéutico , Quimioterapia Adyuvante , Femenino , Cardiopatías/inducido químicamente , Cardiopatías/fisiopatología , Humanos , Persona de Mediana Edad , Volumen Sistólico , Trastuzumab , Función Ventricular IzquierdaRESUMEN
Nasopharyngeal carcinoma (NPC) is a specific entity different from head and neck carcinoma. Incidence is higher in South-East Asia and North Africa. Prognosis, especially for locally advanced stages (IIB - IVB) and metastasis, remains poor: more than third of cases will present local and/or metastatic recurrence. Overall 5-year survival for all NPC stages ranges from 50% to 70%. The role of chemotherapy in metastasis is well established, and remains an important palliative treatment, although no randomized trial has been reported comparing the different chemotherapy regimens. As 1(st)-line treatment, platin-based regimens seems optimal; in 2(nd) line and after progression under platins, there is no consensus: monotherapy with drugs such as gemcitabine, capecitabine or taxanes has been the most widely tested, with acceptable results. Future trials should integrate targeted therapy, in the light of overexpression of EGFR1 and C-kit in NPC. The present study presents a review of the literature concerning the various studies of metastatic NPC.
Asunto(s)
Antineoplásicos/uso terapéutico , Carcinoma de Células Escamosas/tratamiento farmacológico , Carcinoma de Células Escamosas/patología , Carcinoma/tratamiento farmacológico , Carcinoma/patología , Neoplasias Nasofaríngeas/tratamiento farmacológico , Neoplasias Nasofaríngeas/patología , Antineoplásicos/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma/radioterapia , Carcinoma de Células Escamosas/radioterapia , Ensayos Clínicos como Asunto , Terapia Combinada , Sistemas de Liberación de Medicamentos , Humanos , Neoplasias Nasofaríngeas/radioterapia , Invasividad Neoplásica , Recurrencia Local de Neoplasia/tratamiento farmacológico , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Pronóstico , Radioterapia AdyuvanteAsunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Carcinoma Neuroendocrino/tratamiento farmacológico , Neoplasias de la Mama/patología , Carcinoma Neuroendocrino/patología , Ciclofosfamida/administración & dosificación , Doxorrubicina/administración & dosificación , Resultado Fatal , Femenino , Fluorouracilo/administración & dosificación , Humanos , Inmunohistoquímica , Insuficiencia del TratamientoRESUMEN
CA15-3, a peptide derived from MUC-1, an hormonally-regulated protein, is the most widely used serum marker of breast cancer. CA15-3 level increases at the metastatic phase in 50-80% breast cancer patients. Although rise of CA15-3 precede symptoms of metastasis by a mean time of 2-9 months, current international guidelines do not recommend its routine use for screening for metastases because of moderate sensitivity and absence of clinical impact. We conducted a retrospective study among all patients with metastatic breast cancer seen by three senior breast oncologists during a 4-month period. We evaluated correlation of CA15-3 level at the time of metastatic relapse with ER, PgR and Her2 expressions, tumor type, size and nodal status at initial diagnosis, and sites of metastases. CA15-3 was increased in 168/272 patients (62%) at diagnosis of metastases. ER/PgR positivity was strongly correlated with elevated CA15-3 at this time (P < 0.0001). CA 15-3 was elevated in 69% of the cases of HR+ Her2- primary tumors at time of metastatic relapse. It was elevated in 56% of HR+ Her2+++, 46% of HR- Her2+++ cases and only in 41% of triple-negative cases (P = 0.003). these data confirm that CA 15-3 is very variably elevated at time of metastatic relapse of breast cancer, and this is dependant on HR status.
Asunto(s)
Biomarcadores de Tumor/sangre , Neoplasias de la Mama/sangre , Mucina-1/sangre , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Óseas/secundario , Neoplasias Encefálicas/secundario , Neoplasias de la Mama/química , Neoplasias de la Mama/patología , Neoplasias de la Mama Masculina/sangre , Neoplasias de la Mama Masculina/patología , Carcinoma Ductal de Mama/sangre , Carcinoma Ductal de Mama/química , Carcinoma Ductal de Mama/secundario , Carcinoma Lobular/sangre , Carcinoma Lobular/química , Carcinoma Lobular/secundario , Proteínas de Unión al ADN , Femenino , Humanos , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/secundario , Masculino , Persona de Mediana Edad , Miembro 1 del Grupo A de la Subfamilia 4 de Receptores Nucleares , Receptor ErbB-2/análisis , Receptores de Estrógenos/análisis , Receptores de Progesterona/análisis , Receptores de Esteroides , Estudios Retrospectivos , Neoplasias Cutáneas/secundario , Carga TumoralRESUMEN
Optimizing the preservative regime for a preparation requires the antimicrobial effectiveness of several preservative combinations to be determined. In this study, three preservatives were tested: benzoic acid, sorbic acid and benzylic alcohol. Their preservative effects were evaluated using the antimicrobial preservative efficacy test (challenge-test) of the European Pharmacopeia (EP). A D-optimal mixture design was used to provide a maximum of information from a limited number of experiments. The results of this study were analysed with the help of the Design Expert software and enabled us to formulate emulsions satisfying both requirements A and B of the EP.
Asunto(s)
Antibacterianos/química , Ácido Benzoico/química , Alcohol Bencilo/química , Emulsiones/química , Conservadores Farmacéuticos/química , Ácido Sórbico/química , Antibacterianos/farmacología , Ácido Benzoico/farmacología , Alcohol Bencilo/farmacología , Pruebas de Sensibilidad Microbiana , Conservadores Farmacéuticos/farmacología , Ácido Sórbico/farmacologíaRESUMEN
In this work, we studied the influence of different parameters controlling cooling stage on biological dispersed system injury. The human red blood cell (RBCs) was chosen as work model. The study examined the influence of two freezing processes on RBCs hemolysis, one process producing big crystals, the other producing small crystals. Using both processes, we examined the effect of freezing temperature, freezing time, and RBCs concentration on injuries to RBCs. Freezing damage was assessed by the hematocrite measure before freezing and after thawing. The process producing a small number of big ice crystals (Pa) seems--in relation to the one producing a large number of small ice crystals (Pb)--to be less traumatic for the RBC, although the two are not statistically different. Freezing temperature and freezing time influence the preservation of RBCs. At 0 and -20 degrees C there were high preservation and total hemolysis, respectively. At -5 degrees C and -10 degrees C, the RBC hemolysis depends on freezing temperature and freezing time. The RBCs hemolysis rates increases when freezing time increases and when freezing temperature decreases. The rates of RBCs preserved decreases with RBCs concentration some with either the freezing process used (Pa or Pb). More, an accentuation of the difference between the two used freezing processes on RBCs hemolysis was retrieved. The analysis of the conductivity evolution within the RBCs suspension frozen showed that the destruction of the RBCs is had essentially to the solution effects. When the crystallization eutectic takes place, the RBCs are already completely destroyed.
Asunto(s)
Conservación de la Sangre , Criopreservación , Eritrocitos , Liofilización , Congelación , Hemólisis , Temperatura , Factores de TiempoRESUMEN
Emulsions of three different size distributions and five oil/water ratios of the finest of these distributions were congealed according to three different congealing processes before the freeze-drying operation. The influence of the various cryoprotective agents added was studied and the size change of the dispersed phase after congealing was examined.