RESUMO
BACKGROUND: Irinotecan and temozolomide (IT) is a widely used regimen for relapsed Ewing sarcoma (ES), although studies are largely limited to paediatric populations. METHODS: We retrospectively reviewed paediatric (< 18 years) and adult patients (≥ 18 years) treated with salvage IT at two institutions. Haematologic toxicities were graded according to common terminology criteria of adverse events. Survival was estimated by the Kaplan-Meier method and compared by the Log Rank test. RESULTS: Fifty-three patients were treated with IT from Jan, 2010 to Dec, 2018 (n = 16 paediatric; n = 37 adult). IT was given as second-line (n = 34; 64%) or ≥ third-line (n = 19; 36%). There was no difference in ≥ grade 3/4 haematologic toxicity between paediatrics and adults (31% vs. 35% respectively; p = 0.76). The frequency of diarrhoea of any grade was similar (38% in each group). Of 43 patients assessable for response, 12 (28%) had objective response (1 CR, 11 PR), 12 (28%) stable disease and 19 (44%) disease progression. Objective response rate did not differ between the two groups (36% in paediatrics vs. 25% in adults; p = 0.47). Median PFS was superior in paediatrics vs. adults (7.4 vs. 2.2 months, p = 0.039). CONCLUSION: Irinotecan and temozolomide (IT) chemotherapy has activity for relapsed ES, with favourable toxicity and equally observed objective responses in the paediatric and adult populations. The observed superior PFS for the paediatric cohort requires further confirmation in future studies.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Irinotecano/uso terapêutico , Recidiva Local de Neoplasia/tratamento farmacológico , Sarcoma de Ewing/tratamento farmacológico , Temozolomida/uso terapêutico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias Ósseas/mortalidade , Criança , Diarreia/induzido quimicamente , Progressão da Doença , Esquema de Medicação , Humanos , Irinotecano/efeitos adversos , Estimativa de Kaplan-Meier , Recidiva Local de Neoplasia/mortalidade , Intervalo Livre de Progressão , Critérios de Avaliação de Resposta em Tumores Sólidos , Estudos Retrospectivos , Terapia de Salvação , Sarcoma de Ewing/mortalidade , Temozolomida/efeitos adversosRESUMO
1. The nerve-evoked contractions elicited by transmural electrical stimulation of mouse urinary bladders superfused in modified Krebs Ringer buffer containing 1 microM atropine plus 3.4 microM guanethidine were inhibited by adenosine (ADO) and related nucleoside analogues with the following rank order of potency: R-phenylisopropyladenosine (R-PIA) greater than cyclohexyladenosine (CHA) greater than 5'N-ethylcarboxamido adenosine (NECA) greater than ADO greater than S-phenylisopropyladenosine (S-PIA). Tissue preincubation with 8-phenyltheophylline (8-PT) displaced to the right, in a parallel fashion, the NECA concentration-response curve. 2. The contractions elicited by application of exogenous adenosine 5'-triphosphate (ATP) were also inhibited by ADO and related structural analogues. The rank order of potency to reduce the motor response to ATP was: NECA greater than 2-chloroadenosine (CADO) greater than R-PIA greater than ADO greater than CHA greater than S-PIA. 3. The ADO-induced ATP antagonism was of a non-competitive nature and was not specific. Tissue incubation with 10 microM NECA not only reduced the motor responses elicited by ATP, but also 5-hydroxytryptamine, acetylcholine and prostaglandin F2 alpha. The action of NECA was antagonized following tissue preincubation with 8-PT. The inhibitory action of NECA was not mimicked by 10 microM CHA. 4. The maximal bladder ATP contractile response was significantly increased by tissue preincubation with 5-30 microM 8-PT. 5. The 0.15 Hz evoked muscular twitch was significantly increased by 8-PT while dipyridamole consistently reduced the magnitude of the twitch response. These results are consonant with the hypothesis that an endogenous ADO tone modulates the bladder neurotransmission. 6. A working model is proposed suggesting the presence of ADO-Al and A2 receptors in the mouse urinary bladder. The A1 receptor subpopulation is probably of presynaptic origin whereas the smooth muscle membranes contain a population of the A2 receptor subtype.
Assuntos
Adenosina/fisiologia , Sistema Nervoso Autônomo/fisiologia , Receptores Purinérgicos/fisiologia , Transmissão Sináptica/efeitos dos fármacos , Bexiga Urinária/inervação , Adenosina/análogos & derivados , Adenosina/farmacologia , Trifosfato de Adenosina/farmacologia , Adenosina-5'-(N-etilcarboxamida) , Animais , Dipiridamol/farmacologia , Estimulação Elétrica , Camundongos , Contração Muscular/efeitos dos fármacos , Músculo Liso/efeitos dos fármacos , Músculo Liso/fisiologia , Fenilisopropiladenosina/farmacologia , Receptores Purinérgicos/efeitos dos fármacos , Teofilina/análogos & derivados , Teofilina/farmacologia , Bexiga Urinária/efeitos dos fármacos , Bexiga Urinária/fisiologiaRESUMO
The motor activity of the rat bladder elicited by transmural electrical stimulation was abolished in the presence of 200 nM tetrodotoxin but not of 1 microM atropine plus 3.4 microM guanethidine. Tissue preincubation with 20 microM, alpha, beta-methylene ATP reduced but did not obliterate the electrically-induced motor effect. Bradykinin (BK) caused a short-lasting motor response while it potentiated, in a concentration-dependent fashion, the 0.15-5 Hz-induced muscle twitching. The facilitatory action of the peptide lasted for at least 5 min and was blocked by the BK-B2 receptor antagonist D-Arg0 [Hyp3, Thi5,8, D-Phe7]-BK. The motor response caused by the exogenous application of adenosine 5'-triphosphate (ATP) was almost immediate and lasted less than 30 s; it was also potentiated by BK-B2 receptor activation, an effect that was reduced in a concentration-dependent manner by pretreatment with the BK-receptor antagonist.