Search

BACKGROUNDSunitinib, a vascular endothelial growth factor pathway inhibitor, is an effectivetreatment for metastatic renal-cell carcinoma. We sought to determine the efficacyand safety of sunitinib in patients with locoregional renal-cell carcinoma athigh risk for tumor recurrence after nephrectomy.METHODSIn this randomized, double-blind, phase 3 trial, we assigned 615 patients withlocoregional, high-risk clear-cell renal-cell carcinoma to receive either sunitinib(50 mg per day) or placebo on a 4-weeks-on, 2-weeks-off schedule for 1 year oruntil disease recurrence, unacceptable toxicity, or consent withdrawal. The primaryend point was disease-free survival, according to blinded independent central review.Secondary end points included investigator-assessed disease-free survival,overall survival, and safety.RESULTSThe median duration of disease-free survival was 6.8 years (95% confidence interval[CI], 5.8 to not reached) in the sunitinib group and 5.6 years (95% CI, 3.8 to6.6) in the placebo group (hazard ratio, 0.76; 95% CI, 0.59 to 0.98; P=0.03). Overallsurvival data were not mature at the time of data cutoff. Dose reductions becauseof adverse events were more frequent in the sunitinib group than in theplacebo group (34.3% vs. 2%), as were dose interruptions (46.4% vs. 13.2%) anddiscontinuations (28.1% vs. 5.6%). Grade 3 or 4 adverse events were more frequentin the sunitinib group (48.4% for grade 3 events and 12.1% for grade 4 events)than in the placebo group (15.8% and 3.6%, respectively). There was a similarincidence of serious adverse events in the two groups (21.9% for sunitinib vs.17.1% for placebo); no deaths were attributed to toxic effects.CONCLUSIONSAmong patients with locoregional clear-cell renal-cell carcinoma at high risk fortumor recurrence after nephrectomy, the median duration of disease-free survivalwas significantly longer in the sunitinib group than in the placebo group, at a costof a higher rate of toxic events. (Funded by Pfizer; S-TRAC ClinicalTrials.gov number,NCT00375674.)

Context The aim of the study was to determine risk factors of recurrence in resected pancreatic cancer. Methods We retrospectively analyzed 43 patients who underwent pancreatic resection for ductal adenocarcinoma, from January 2006 to December 2009. Demographic (age, sex), surgical (type of resection), pathological data (grading, TNM stage, lymph node ratio, R status, perineural and vascular invasion) and type of therapy (surgery alone versus surgery plus different adjuvant treatment) were evaluated. Adjuvant chemotherapy was performed in 24 patients with R0 status: 19 received gemcitabine alone (GEM) (1,000 mg/m2 days 1, 8, 15 every 28) and 5 GEM plus cisplatin (CDDP) (75 mg/m2 day 1 every 28). Radiotherapy was performed in 9 patients with R1 status: 6 associated with GEM alone and 3 with GEM plus CDDP. Results Overall survival (OS) and disease free survival (DFS) were (mean±SD) 23.3±3.8 and 12.8±1.2 months, respectively. Recurrence of disease occurred in 31 out of 43 patients (72.1%) with local relapse in 11 (35.5%) and distant metastases in 20 patients (65.5%). Among the prognostic factors evaluated, lymph node ratio and grading were significantly related to recurrence (lymph node ratio P=0.010; G1 vs. G2-G3, P=0.012). Regarding to postoperative treatment there were no significant differences between surgery alone versus surgery plus adjuvant therapy (median DFS: 16.8 versus 11 months; P=0.103). Risk of recurrence was increased in patients treated with chemo-radiotherapy compared those who received chemotherapy or surgery alone (P=0.042 and P=0.09, respectively). Conclusions The risk of recurrence was higher in patients treated with surgery plus chemoradiotherapy if compared to the others, probably because the combination treatment with additional radiotherapy was performed in R1 status patients.

Made available in DSpace on 2016-08-29T15:32:30Z (GMT). No. of bitstreams: 1 tese_2759_DissertacaoMestradoBrunoZanettiMelotti.pdf: 1283815 bytes, checksum: 1948186d38f6639b57cb0387d5eaba2c (MD5) Previous issue date: 2009-11-27 Dado um documento para categorização, um sistema de categorização multi-rótulo de texto tipicamente ordena um conjunto de categorias pré-definido, de acordo com a adequação delas ao documento, e seleciona as categorias do topo do ranking como o conjunto de categorias do documento. Empates no ranking eventualmente existentes podem ser tratados de diferentes maneiras, mas, muito embora isso possa afetar as métricas utilizadas para avaliar o desempenho dos categorizadores multi-rótulo de texto, este problema parece ter sido pouco estudado na literatura. Neste trabalho, analisamos o impacto de diferentes tipos de ranking sobre diversas métricas de avaliação de desempenho de categorizadores multi-rótulo de texto, a saber: one-error, coverage, ranking loss, average precision, R-precision, Hamming loss, exact match, precision, recall, e 1 F . Para isso, reformulamos sua definição de modo a considerar empates de acordo com o tipo de ranking empregado. Utilizamo-las então para avaliar o desempenho das técnicas de categorização multi-rótulo de texto k -vizinhos mais próximos ( k NN), k -vizinhos mais próximos multi-rótulo (ML- k NN), rede neural sem peso do tipo VG-RAM (VG-RAM WNN) e VG-RAM com correlação de dados (VG-RAM WNNCOR) na categorização de duas bases multi-rótulo de texto com grande número de categorias (105 e 692 categorias). Descobrimos que, dependendo do tipo de ranking empregado, os resultados de desempenho são significativamente diferentes para muitas das métricas analisadas, o que sugere que o tipo de ranking deve ser claramente indicado na avaliação de técnicas de categorização multi-rótulo de texto.

Background Early integration of palliative care in oncology practice ("simultaneous care", SC) has been shown to provide better care resulting in improved quality-of-life and also survival. We evaluated the opinions of Italian Association of Medical Oncology (AIOM) members. Patients and methods A 37-item questionnaire was delivered to 1119 AIOM members. Main areas covered were: social, ethical, relational aspects of disease and communication, training, research, organizational and management models in SC. Three open questions explored the definition of Quality of Life, Medical Oncologist and Palliative Care. Results Four hundred and forty-nine (40.1%) medical oncologists returned the questionnaires. Forty-nine percent stated they address non-curability when giving a diagnosis of metastatic tumor, and 43% give the information only to patients who clearly ask for it. Fifty-five percent say the main formative activity in palliative medicine came from attending meetings and 90% agree that specific palliative care training should be part of the core curriculum in oncology. Twenty-two percent stated they consulted guidelines for symptom management, 45% relied upon personal experience and 26% make a referral to a palliative care specialist. Seventy-four percent were in favor of more research in palliative medicine. An integration between Units of Oncology and Palliative Care Services early in the course of advanced disease was advocated by 86%. Diverse and multifaceted definitions were given for the concepts of Quality of Life, Palliative Care and Medical Oncologist. Conclusion SC is felt as an important task, as well as training of medical oncologists in symptom management and research in this field.

We report the case of a young woman who developed metastatic melanoma in the inguinal nodal region, which acquired chondrosarcomatous differentiation and preserved the BRAF mutation found in the primary tumor. The patient was treated with a BRAF/MEK inhibitor combination therapy (dabrafenib/trametinib), which was demonstrated to be effective and well‐tolerated., BRAF‐mutated melanoma with chondrosarcomatoid differentiation and response to targeted therapy.

No abstract available

No abstract available

Background: BRAF (v-raf murine sarcoma viral oncogene homolog B1) and MEK (mitogen activated protein kinase) inhibitors, as well as immunotherapy against cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) and the programmed cell death 1 (PD-1) receptor and its ligand (PD-L1), have shown good results in improving the disease-free survival of patients with metastatic melanoma (MM). The aim of this review is to summarize the main oral adverse events (oAEs) occurring in patients undergoing target or immunotherapy. We proposed two separate sections: oAEs during the treatment with (1) target therapies with BRAF and MEK inhibitors and tyrosine kinase inhibitors (gingival hyperplasia, pigmentation disorders, squamo-proliferative lesions) and (2) immunotherapies with CTLA-4 or PD1 inhibitors (lichenoid reactions, immuno-bullous reactions, xerostomia and other reactions). Adverse events frequently include oAEs, although these are often misdiagnosed and under-reported. Indeed, the oral cavity is not routinely evaluated during clinical practice. The symptomatology related to oAEs is significant since it may represent the first manifestation of a severe systemic reaction, possibly leading to difficulties in nutrition with a consequent impact on patients’ quality of life. A careful examination of the oral cavity is recommended during the evaluation of oncologic patients in order to promptly detect the onset of new manifestations.

Aims: To assess prognostic value of pre-therapy carcinoembryonic antigen (CEA) and cytokeratin-19 fragments (CYFRA 21-1) blood levels in non-small cell lung cancer (NSCLC) patients treated with immune-checkpoint inhibitors (ICIs) and their early change as predictor of benefit. Materials and methods: This is a retrospective cohort study including patients with stage IIIB–IV NSCLC who received anti PD-1/PD-L1 in first or advanced lines of therapy in two institutions. A control cohort of patients treated only with chemotherapy has been enrolled as well. Results: A total of 133 patients treated with nivolumab or atezolizumab were included in the test set, 74 treated with pembrolizumab first line in the validation set and 89 in the chemotherapy only cohort. CYFRA 21-1 >8 ng/mL was correlated with overall survival (OS) in the test set, validation set and in univariate and multivariate analysis (pooled cohort hazard ratio (HR) 1.90, 95% confidence interval (CI) 1.24–2.93, p 0.003). Early 20% reduction after the third cycle was correlated with OS for CEA (HR 0.12; 95% CI 0.04–0.33; p Conclusions: CYFRA 21-1 pre-therapy assessment provides clinicians with relevant prognostic information about patients treated with ICI. CEA and CYFRA 21-1 repeated measures could be useful as an early marker of benefit.