RESUMO

Reducing primary tumor volume is the main role of neoadjuvant chemotherapy for breast cancer. We evaluated the benefit of adding docetaxel to anthracyclin as neoadjuvant therapy. This study is a retrospective cohort analysis comparing the efficacy of neoadjuvant chemotherapy in patients subjected to docetaxel and epirubicin or 5-fluoruracil, epirubicin and cyclophosphamide combinations (DE and FEC group, respectively). The mean number of chemotherapy delivered was similar in both groups (P = 0.8). A total of 316 patients were treated (151 in FEC group and 165 in DE group). Primary endpoint was the clinical and pathological response to therapy. Breast conserving surgery rate was compared. In T1/2 staged patients, the complete clinical response rate was 7.5% in FEC group and 32% in DE group (P = 0.002), and the breast conserving surgery rate was 72 and 73% in FEC and DE groups, respectively (P = 0.9). In the subset of patients staged as T3 and T4a-c, objective response was higher in DE group (P < 0.0001 and P = 0.008, respectively). Breast conserving surgery rate was 38 and 63% in FEC and DE groups, respectively, in T3 staged patients and, 20.5 and 37% in T4a-c staged patients (P = 0.003 and 0.08). Despite the similar number of chemotherapy cycles delivered in both groups, the presence of microscopic axillary lymph node involvement after chemotherapy was less frequent in DE group. Neoadjuvant chemotherapy with DE combination is more effective in terms of clinical and pathological response propitiating higher breast conserving surgery rate than FEC combination in stage II and III breast cancer.

Assuntos

RESUMO

Primary fallopian tube carcinoma (PFTC) is a rare gynecologic neoplasm and is usually diagnosed late and presents classically with a characteristic group of symptoms. We describe a case of a 76-year-old woman who underwent TVS requested by the family physician due to unspecific pelvic pain. An adnexal mass was found with morphology associated with high levels of CA125 suggestive of a malignant tumor. During laparotomy, a mass located in the left tube was found. Histopathology confirmed PFTC. Total hysterectomy, salpingo-oophorectomy and adjuvant chemotherapy with carboplatin/paclitaxel were performed. The patient has not yet presented any signs of recurrence.

Assuntos

RESUMO

The proliferative response of lymphocytes to mitogens is known to be decreased in cancer patients; this phenomenon is thought to play an important role in disease progression, but it has not been studied as a prognostic factor in cervical cancer patients receiving treatment. Fourteen patients with advanced cervical cancer submitted to chemotherapy with cis-platinum (100 mg/m2/cycle) and bleomycin (30 mg/cycle) over three cycles every 4 weeks were evaluated. Mean follow-up time was 30 months. The following laboratory tests carried out on peripheral blood lymphocytes collected before and at the end of chemotherapy were used as prognostic factors: proliferative response of lymphocytes to phytohemagglutinin (PHA) and stimulated with interleukin 12 (IL-12), capacity of gamma interferon production (IFN-gamma), and variations in memory T cell (CD45-RO) and naive T cell (CD45-RA) subsets. A clear correlation was obtained between response to treatment, survival rates, and PHA-induced proliferative response. A significant difference was observed in the number of CD45-RO lymphocyte at the pre-chemotherapy period and IFN-gamma production at the post-chemotherapy period in the group of good responders to treatment. The use of IL-12 produced a leveling in both groups for lymphocyte proliferation, i.e., a recovery from the deficiency presented by the lymphocyte of the poor responders group. The parameters of immunologic assays, especially proliferative response, appears to be correlated with prognosis and survival rates and therefore are good discriminating factors for the selection of groups of patients that will benefit from this type of treatment. IL-12 seems to play an important role in the regulation of the antitumor immune response and should be considered for therapeutic use.

RESUMO

Patients with advanced cervical cancer have deficient natural killer (NK) cell activity, usually as a consequence of tumor invasion, which results in tumor NK cell sequestration. The reason for the occurrence of such alterations in patients under chemotherapy is unknown. We evaluated the activity and number of NK cells and T cell subpopulations in ten patients before and three weeks after neoadjuvant chemotherapy (CT). The schedule used was cis-platinum (100 Mg/M2 per cycle) and bleomycin (15 mg/cycle), repeated every 28 days. Although there were similar levels of NK cells before and after CT in both groups, we observed greater cytotoxicity of peripheral blood lymphocytes and increased levels of CD4+ and CD8+ T cells (P<0.01) in five patients who presented a good clinical response when compared to the group with a poor response. IL- 12, known to increase NK cell activity when added to peripheral blood lymphocyte cultures, markedly increased lytic activity before and after CT only in the group with a good clinical response. These results suggest that NK cells from the poorly responding patient group express less lytic activity per NK cell and are insensitive to IL- 12 stimulation, probably as a result of reduced IL-12 receptor expression or a defective intracellular transduction mechanism. The present findings may be useful as a prognostic factor in clinical practice and also provide support for human clinical trials of IL- 12 and neoadjuvant CT for the treatment of malignant cervical tumors.

Assuntos