RESUMEN
BACKGROUND: In Asia, large-scale studies on anti-HER2 treatment in HER2-positive breast cancer patients with brain metastases are limited. We studied the treatment patterns of these patients in Asia to evaluate the impact of anti-HER2 treatment on the time to occurrence of brain metastases (TTBM) and survival after brain metastasis (BM). METHODS: A retrospective study of HER2-positive breast cancer patients diagnosed with BM between January 2006 and December 2008 in six Asian countries was conducted. Demographics, tumour characteristics, treatment details, and events dates were collected from medical records. RESULTS: Data from 280 patients were analysed. Before BM, 63% received anti-HER2 treatment. These patients had significantly longer TTBM than those without anti-HER2 treatment (median 33 vs 19 months; P<0.002). After BM, 93% received radiotherapy, 57% received chemotherapy, and 41% received anti-HER2 treatment (trastuzumab and/or lapatinib). Use of both anti-HER2 agents, primarily sequentially, after BM demonstrated the longest survival after BM and was associated with a significant survival benefit over no anti-HER2 treatment (median 26 vs 6 months; hazard ratio 0.37; 95% CI 0.19-0.72). CONCLUSION: Anti-HER2 treatment before BM was associated with longer TTBM. Anti-HER2 treatment after BM was associated with a survival benefit, especially when both trastuzumab and lapatinib were utilised.
Asunto(s)
Antineoplásicos/uso terapéutico , Neoplasias Encefálicas/tratamiento farmacológico , Neoplasias Encefálicas/secundario , Neoplasias de la Mama/tratamiento farmacológico , Inhibidores de Proteínas Quinasas/uso terapéutico , Receptor ErbB-2/antagonistas & inhibidores , Adulto , Anciano , Anticuerpos Monoclonales Humanizados/uso terapéutico , Neoplasias Encefálicas/enzimología , Neoplasias Encefálicas/patología , Neoplasias de la Mama/enzimología , Neoplasias de la Mama/patología , Femenino , Humanos , Lapatinib , Persona de Mediana Edad , Quinazolinas/uso terapéutico , Receptor ErbB-2/biosíntesis , Estudios Retrospectivos , Trastuzumab , Adulto JovenRESUMEN
OBJECTIVES: To create a fetal size nomogram for use in sub-Saharan Africa and compare the derived centiles with reference intervals from developed countries. METHODS: Fetal biometric measurements were obtained at entry to antenatal care (11-22 weeks' gestation) and thereafter at 4-week intervals from pregnant women enrolled in a longitudinal ultrasound study in Kinshasa, Democratic Republic of Congo. The study population comprised 144 singleton gestations with ultrasound-derived gestational age within 14 days of the menstrual estimate. A total of 755 monthly ultrasound scans were included with a mean +/- SD of 5 +/- 1 (range, 2-8) scans per woman. Estimated fetal weight (EFW) was calculated at each ultrasound examination using the Hadlock algorithm. A general mixed-effects linear regression model that incorporated random effects for both the intercept and slope was fitted to log-transformed EFW to account for both mean growth and within-fetus variability in growth. Reference centiles (5(th), 10(th), 50(th), 90(th) and 95(th) centiles) were derived from this model. RESULTS: Nomograms derived from developed populations consistently overestimated the 50(th) centile EFW value for Congolese fetuses by roughly 5-12%. Differences observed in the 10(th) and 90(th) centiles were inconsistent between nomograms, but generally followed a pattern of overestimation that decreased with advancing gestational age. CONCLUSIONS: In low-resource settings, endemic malaria and maternal nutritional factors, including low prepregnancy weight and pregnancy weight gain, probably lead to lower fetal weight and utilization of nomograms derived from developed populations is not appropriate. This customized nomogram could provide more applicable reference intervals for diagnosis of intrauterine growth restriction in sub-Saharan African populations.
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Retardo del Crecimiento Fetal/diagnóstico por imagen , Nomogramas , Atención Prenatal/métodos , Ultrasonografía Prenatal/métodos , Adolescente , Adulto , África del Sur del Sahara , Tamaño Corporal , Femenino , Retardo del Crecimiento Fetal/epidemiología , Edad Gestacional , Humanos , Estudios Longitudinales , Embarazo , Valores de Referencia , Adulto JovenRESUMEN
Maternal malaria and under-nutrition are established risk factors for small-for-gestational-age (SGA) births; however, whether malaria is associated with intrauterine growth restriction (IUGR) is unknown. We investigated IUGR risk among 177 HIV-negative pregnant women enrolled in a longitudinal ultrasound study conducted in Democratic Republic of Congo from May 2005 to May 2006. Malaria infection, maternal anthropometrics, and ultrasound estimated fetal weight were measured monthly. All positive malaria cases were treated and intermittent presumptive therapy (IPTp) provided. Log-binomial regression models for IUGR were fitted using generalized estimating equations to account for statistical clustering of repeat IUGR measurements. Twenty-nine percent of fetuses experienced an episode of IUGR with the majority occurring in the third trimester. The risk of IUGR associated with malaria was greatest after three or more cumulative infections (RR 3.3, 95% CI 1.3-8.2) and was two- to eight-fold higher among women with evidence of under-nutrition. Receiving antimalarial treatment in the previous month (for IPTp or treatment) was significantly protective against IUGR (RR 0.5, 95% CI 0.3-0.7). The interaction observed between malaria and under-nutrition suggests that antenatal programmes in malaria endemic areas should incorporate nutritional screening and supplementation in addition to IPTp.
Asunto(s)
Retardo del Crecimiento Fetal/diagnóstico por imagen , Malaria/complicaciones , Desnutrición/complicaciones , Complicaciones del Embarazo , Adolescente , Adulto , República Democrática del Congo , Femenino , Humanos , Estudios Longitudinales , Malaria/tratamiento farmacológico , Embarazo , Factores de Riesgo , Ultrasonografía , Adulto JovenRESUMEN
The Surveillance Research Program of the American Cancer Society's Department of Epidemiology and Surveillance Research reports its 33rd annual compilation of cancer frequency, incidence, mortality, and survival data for the United States.
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Neoplasias/epidemiología , Adolescente , Negro o Afroamericano/estadística & datos numéricos , Anciano , American Cancer Society , Población Negra , Niño , Preescolar , Etnicidad/estadística & datos numéricos , Femenino , Predicción , Humanos , Incidencia , Lactante , Masculino , Neoplasias/mortalidad , Programa de VERF , Tasa de Supervivencia , Estados Unidos/epidemiología , Población Blanca/estadística & datos numéricosRESUMEN
The Surveillance Research Program of the American Cancer Society's Department of Epidemiology and Surveillance reports its 32nd annual compilation of cancer incidence, mortality, and survival data for the United States and around the world.