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de Andrade DAP, Guimarães APG, de Melo AC, Nogueira-Rodrigues A, Gomes LM, Scaranti M, Maia JML, Morelle AM, Santos CADAL, Souza CDP, de Freitas D, Callegaro Filho D, Paulino E, Júnior EWA, Pimenta JM, dos Santos MB, de Almeida MS, Souza RP, Cabral S, Maluf FC. Management of patients with recurrent/metastatic endometrial cancer: Consensus recommendations from an expert panel from Brazil. Front Oncol 2023; 13:1133277. [PMID: 36969061 PMCID: PMC10033867 DOI: 10.3389/fonc.2023.1133277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/23/2023] [Indexed: 03/11/2023] Open
Abstract
BackgroundEndometrial cancer is of increasing concern in several countries, including Brazil, in part because of an ageing population, declines in fertility, and the increasing prevalence of obesity. Although endometrial tumors had lagged behind other cancer types in terms of treatment improvements, molecular characterization of these tumors is paving the way for novel therapies and an expansion of the therapeutic arsenal. We aimed to help medical oncologists who manage patients with recurrent or metastatic endometrial cancer in the Brazilian healthcare setting.MethodsThe panel, composed of 20 medical oncologists, convened in November 2021 to address 50 multiple-choice questions on molecular testing and treatment choices. We classified the level of agreement among panelists as (1) consensus (≥75% choosing the same answer), (2) majority vote (50% to <75%), or (3) less than majority vote (<50%).ResultsConsensus was present for 25 of the 50 questions, whereas majority vote was present for an additional 23 questions. Key recommendations include molecular testing for every patient with recurrent/metastatic endometrial cancer; choice of first-line treatment according to microsatellite instability and HER2, with the addition of programmed death ligand 1 (PD-L1) and hormone receptors (HRs) for second-line therapy; carboplatin and paclitaxel as the preferred option in first-line treatment of HER2-negative disease, with the addition of trastuzumab in HER2-positive disease; pembrolizumab plus lenvatinib as a key option in second line, regardless of HER2, PD-L1 or HRs; and various recommendations regarding treatment choice for patients with distinct comorbidities.ConclusionDespite the existing gaps in the current literature, the vast majority of issues addressed by the panel provided a level of agreement sufficient to inform clinical practice in Brazil and in other countries with similar healthcare environments.
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Affiliation(s)
- Diocésio Alves Pinto de Andrade
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- InORP Oncoclínicas Group, Ribeirão Preto, Brazil
- *Correspondence: Diocésio Alves Pinto de Andrade,
| | | | - Andréia Cristina de Melo
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- Brazilian Nacional Cancer Institute – INCA, Rio de Janeiro, Brazil
| | - Angélica Nogueira-Rodrigues
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Larissa Müller Gomes
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- CPO Oncoclínicas Group, São Paulo, Brazil
| | - Mariana Scaranti
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- DASA – Hospital 9 de Julho, São Paulo, Brazil
| | - Joyce Maria Lisboa Maia
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- Cancer Treatment Center, MedRadius –, Maceió, Brazil
| | - Alessandra Menezes Morelle
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | - Cristiano de Pádua Souza
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- Barretos Cancer Hospital, Barretos, Brazil
| | - Daniela de Freitas
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- Hospital Sírio-Libanês, São Paulo, Brazil
| | - Donato Callegaro Filho
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Eduardo Paulino
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- Brazilian Nacional Cancer Institute – INCA, Rio de Janeiro, Brazil
| | | | - Juliana Martins Pimenta
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- Hospital Beneficiência Portuguesa de São Paulo, São Paulo, Brazil
| | | | - Michelle Samora de Almeida
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- Hospital do Coração HCOR Oncologia, São Paulo, Brazil
| | - Ronaldo Pereira Souza
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- AC Camargo Cancer Center, São Paulo, Brazil
| | - Samantha Cabral
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- Universidade de São Paulo, São Paulo, Brazil
| | - Fernando Cotait Maluf
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- Hospital Beneficiência Portuguesa de São Paulo, São Paulo, Brazil
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Paulino E, de Melo AC, de Andrade DAP, de Almeida MS. Systemic therapy for advanced cervical cancer: Leveraging the historical threshold of overall survival. Crit Rev Oncol Hematol 2023; 183:103925. [PMID: 36696932 DOI: 10.1016/j.critrevonc.2023.103925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 12/27/2022] [Accepted: 01/20/2023] [Indexed: 01/23/2023] Open
Abstract
Cervical cancer (CC) is a worldwide problem, especially in low- and middle-income countries, where patients are often diagnosed with locally advanced disease. Until recently, all chemotherapy drugs achieved low ORR and 12-month overall survival (12- month OS) for advanced CC after failure for platinum compounds. Advances in systemic therapy with immunotherapy, targeted therapy, and antibody-drug conjugates (ADC) have leveraged the 12-month OS limit. Recently, immunotherapy (pembrolizumab) has become the standard of care in first-line advanced CC combined with platinum and taxane and in second-line after platinum doublet failure.
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Affiliation(s)
- Eduardo Paulino
- Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Oncologia D'or, Rio de Janeiro, Brazil.
| | - Andreia Cristina de Melo
- Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Grupo Oncoclínicas, Rio de Janeiro, Brazil
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Nogueira-Rodrigues A, Flores MG, Macedo Neto AO, Braga LAC, Vieira CM, de Sousa-Lima RM, de Andrade DAP, Machado KK, Guimarães APG. HPV vaccination in Latin America: Coverage status, implementation challenges and strategies to overcome it. Front Oncol 2022; 12:984449. [PMID: 36387151 PMCID: PMC9645205 DOI: 10.3389/fonc.2022.984449] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/10/2022] [Indexed: 12/24/2022] Open
Abstract
Cervical cancer remains a leading cause of morbidity and mortality amongst females in Latin America (LATAM). Cervical cancer is a preventable disease and HPV vaccination is a main key strategy towards its elimination. This study analyzes HPV vaccine implementation current status and the main barriers to achieve adequate coverage in the region. Data from the nineteen sovereign states of LATAM (comprised of all Portuguese and Spanish-speaking nations located south of the United States) were collected, including year of HPV vaccine implementation, gender and age targets, the number of doses included in the public program and coverage by dose. Sixteen out of the 19 evaluated countries have already implemented HPV vaccination programs. However, despite its proven efficacy and safety, HPV vaccine uptake in LATAM has been lower than expected. There is an evident decline in adhesion, mainly regarding the second dose. Several reasons are probably involved, of note: limited knowledge of HPV and HPV vaccine, misguided safety concerns, high cost, cultural barriers, and the Covid19 pandemic. Proper strategies to overcome these barriers are needed to ensure successful uptake. Effective policies are: adopting the one dose schedule, delivering the vaccine on both health center and schools, and advising health professionals to recommend the vaccine. Further research regarding HPV vaccine hesitancy in Latin America is needed.
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Affiliation(s)
- Angélica Nogueira-Rodrigues
- Department of Internal Medicine, Federal University of Minas Gerais, Belo Horizontel, Brazil
- *Correspondence: Angélica Nogueira-Rodrigues,
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Alves Pinto de Andrade D, Duval da Silva V, Baiocchi G, de Macedo Matsushita G, Alves de Lima M, Paula Carvalho J, Batista Sandre L, De Brot L, Manuel Reis R, dos Reis R. Reassessment of low- and intermediate-risk endometrial cancer reports by gynecological pathologists increases risk classification without impacting outcome. Eur J Obstet Gynecol Reprod Biol 2022; 278:172-176. [DOI: 10.1016/j.ejogrb.2022.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/14/2022] [Accepted: 09/26/2022] [Indexed: 11/24/2022]
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de Andrade DAP, da Silva LS, Laus AC, de Lima MA, Berardinelli GN, da Silva VD, Matsushita GDM, Bonatelli M, da Silva ALV, Evangelista AF, Carvalho JP, Reis RM, Dos Reis R. A 4-Gene Signature Associated With Recurrence in Low- and Intermediate-Risk Endometrial Cancer. Front Oncol 2021; 11:729219. [PMID: 34485158 PMCID: PMC8416164 DOI: 10.3389/fonc.2021.729219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/30/2021] [Indexed: 12/28/2022] Open
Abstract
Background The molecular profile of endometrial cancer has become an important tool in determining patient prognosis and their optimal adjuvant treatment. In addition to The Cancer Genome Atlas (TCGA), simpler tools have been developed, such as the Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE). We attempted to determine a genetic signature to build a recurrence risk score in patients diagnosed with low- and intermediate-risk endometrial cancer. Methods A case-control study was conducted. The eligible patients were women diagnosed with recurrence low- and intermediate-risk endometrial cancer between January 2009 and December 2014 at a single institution; the recurrence patients were matched to two nonrecurrence patients with the same diagnosis by age and surgical staging. Following RNA isolation of 51 cases, 17 recurrence and 34 nonrecurrence patients, the expression profile was determined using the nCounter® PanCancer Pathways Panel, which contains 770 genes. Results The expression profile was successfully characterized in 49/51 (96.1%) cases. We identified 12 genes differentially expressed between the recurrence and nonrecurrence groups. The ROC curve for each gene was generated, and all had AUCs higher than 0.7. After backward stepwise logistic regression, four genes were highlighted: FN1, DUSP4, LEF1, and SMAD9. The recurrence risk score was calculated, leading to a ROC curve of the 4-gene model with an AUC of 0.93, sensitivity of 100%, and specificity of 72.7%. Conclusion We identified a four-gene signature that may be associated with recurrence in patients with low- and intermediate-risk endometrial cancer. This finding suggests a new prognostic factor in this poorly explored group of patients with endometrial cancer.
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Affiliation(s)
- Diocésio Alves Pinto de Andrade
- InORP ONCOCLÍNICAS Group, Oncology Institute of Ribeirão Preto, Ribeirão Preto, Brazil.,Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
| | | | - Ana Carolina Laus
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
| | - Marcos Alves de Lima
- Epidemiology and Biostatistics Nucleus, Barretos Cancer Hospital, Barretos, Brazil
| | | | | | | | - Murilo Bonatelli
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
| | | | | | - Jesus Paula Carvalho
- Discipline of Gynecology, Instituto do Cancer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Rui Manuel Reis
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ricardo Dos Reis
- Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, Brazil
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Franzoi MA, Rosa DD, Zaffaroni F, Werutsky G, Simon S, Bines J, Barrios C, Cronemberger E, Queiroz GS, Cordeiro de Lima V, Júnior RF, Couto J, Emerenciano K, Resende H, Crocamo S, Reinert T, Van Eyli B, Nerón Y, Dybal V, Lazaretti N, de Cassia Costamillan R, Pinto de Andrade DA, Mathias C, Vacaro GZ, Borges G, Morelle A, Filho CAS, Mano M, Liedke PER. Advanced Stage at Diagnosis and Worse Clinicopathologic Features in Young Women with Breast Cancer in Brazil: A Subanalysis of the AMAZONA III Study (GBECAM 0115). J Glob Oncol 2020; 5:1-10. [PMID: 31730380 PMCID: PMC6882517 DOI: 10.1200/jgo.19.00263] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Breast cancer (BC) in young women is uncommon and tends to present with more aggressive characteristics. To better understand and characterize this scenario in Brazil through real-world data, we performed a subanalysis of AMAZONA III study (ClinicalTrials.gov identifier: NCT02663973). METHODS The AMAZONA III study (GBECAM 0115) is a prospective registry that included 2,950 women newly diagnosed with invasive BC in Brazil from January 2016 until March 2018 at 22 sites. Valid data were obtained from 2,888 patients regarding age at diagnosis and complete baseline information. To compare epidemiologic and clinicopathological features at the time of diagnosis, patients with BC were divided into two groups according to age: ≤ 40 years and > 40 years. Quantitative variables were described as means, and categorical variables were described as frequencies and percentages and compared using the Pearson’s χ2 test. RESULTS Of 2,888 women diagnosed with BC, 486 (17%) were ≤ 40 years old. Young women had higher educational level, most were employed and a significant number were married (P < .001 for all associations). Younger patients were more symptomatic at BC diagnosis (P < .001), and they also presented more frequently with stage III, T3/T4, grade 3 tumors, HER-2–positive, luminal B, and triple-negative subtypes. CONCLUSION Brazilian women younger than age 40 years have unfavorable clinicopathological features of BC at diagnosis, with more aggressive subtypes and advanced stage when compared with older women. These differences are not explained by socioeconomic or ethnic imbalances. The causes of a higher prevalence of BC among young women in Brazil deserve additional investigation.
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Affiliation(s)
- Maria Alice Franzoi
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Jules Bordet Institut, Brussels, Belgium.,Latin American Cooperative Oncology Group, Porto Alegre, Brazil
| | - Daniela D Rosa
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil.,Grupo Brasileiro de Estudos em Câncer de Mama, Porto Alegre, Brazil.,Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | - Gustavo Werutsky
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil.,Grupo Brasileiro de Estudos em Câncer de Mama, Porto Alegre, Brazil
| | - Sérgio Simon
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil.,Grupo Brasileiro de Estudos em Câncer de Mama, Porto Alegre, Brazil
| | - José Bines
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil.,Grupo Brasileiro de Estudos em Câncer de Mama, Porto Alegre, Brazil.,Instituto Nacional do Cancer, Rio de Janeiro, Brazil
| | - Carlos Barrios
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil.,Grupo Brasileiro de Estudos em Câncer de Mama, Porto Alegre, Brazil
| | | | | | | | | | - José Couto
- Hospital do Câncer de Londrina, Londrina, Brazil
| | | | | | | | - Tomás Reinert
- Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caxias do Sul, Brazil
| | | | - Yeni Nerón
- Centro de Pesquisas em Oncologia, Florianópolis, Brazil
| | - Vanessa Dybal
- Clínica Assistência Multidisciplinar em Oncologia, Salvador, Brazil
| | | | | | | | | | | | | | | | | | - Max Mano
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Pedro E R Liedke
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Latin American Cooperative Oncology Group, Porto Alegre, Brazil.,Grupo Brasileiro de Estudos em Câncer de Mama, Porto Alegre, Brazil
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Castro BGR, Souza CDP, Andrade CEMDC, Vieira MDA, Andrade DAPD, Reis RD. Ovarian Sertoli-Leydig Cell Tumors: Epidemiological, Clinical and Prognostic Factors. Rev Bras Ginecol Obstet 2019; 41:440-448. [PMID: 31344718 PMCID: PMC10309283 DOI: 10.1055/s-0039-1693056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Objective To describe a series of cases of ovarian Sertoli-Leydig cell tumors (SLCTs).
Methods Retrospective review of 12 cases of SLCT treated at the Hospital do Câncer de Barretos, Barretos, state of São Paulo, Brazil, between October 2009 and August 2017.
Results The median age of the patients was 31 years old (15–71 years old). A total of 9 patients (75.0%) presented symptoms: 8 (66.7%) presented with abdominal pain, 5 (41.7%) presented with abdominal enlargement, 2 (16.7%) presented with virilizing signs, 2 (16.7%) presented with abnormal uterine bleeding, 1 (8.3%) presented with dyspareunia, and 1 (8.3%) presented with weight loss. The median preoperative lactate dehydrogenase (LDH) was 504.5 U/L (138–569 U/L), alpha-fetoprotein (AFP) was 2.0 ng/ml (1.1–11.3 ng/ml), human chorionic gonadotropin (β-hCG) was 0.6 mUI/ml (0.0–2.3 mUI/ml), carcinoembryonic antigen (CEA) was 0.9 ng/ml (0.7–3.4 ng/ml), and cancer antigen 125 (CA-125) was 26.0 U/ml (19.1–147.0 U/ml). All of the tumors were unilateral and surgically treated. Lymphadenectomy was performed in 3 (25.0%) patients, but none of the three patients submitted to lymphadenectomy presented lymph node involvement. In the anatomopathological exam, 1 (8.3%) tumor was well-differentiated, 8 (66.7%) were moderately differentiated, and 3 (25.0%) were poorly differentiated. A total of 5 (55.6%) tumors were solid-cystic, 2 (22.2%) were purely cystic, 1 (11.1%) was cystic with vegetations, and 1 (11.1%) was purely solid, but for 3 patients this information was not available. The median lesion size was 14.2 cm (3.2–23.5 cm). All of the tumors were at stage IA of the 2014 classification of the International Federation of Gynecology and Obstetrics (FIGO). A total of 2 (16.7%) patients received adjuvant treatment; 1 of them underwent 3 cycles of paclitaxel and carboplatin every 21 days, and the other underwent 4 cycles of ifosfamide, cisplatin and etoposide every 21 days. None of all of the patients had recurrence, and one death related to complications after surgical staging occurred.
Conclusion Abdominal pain was the most frequent presentation. There was no ultrasonographic pattern. All of the SLCTs were at stage IA, and most of them were moderately differentiated. Relapses did not occur, but one death related to the surgical staging occurred.
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Affiliation(s)
| | | | | | | | | | - Ricardo dos Reis
- Gynecologic Oncology Department, Hospital do Câncer de Barretos, Barretos, SP, Brazil
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Paiva CE, Siquelli FAF, Zaia GR, de Andrade DAP, Borges MA, Jácome AA, Giroldo GASN, Santos HA, Hahn EA, Uemura G, Paiva BSR. Development of a new multimedia instrument to measure cancer-specific quality of life in Portuguese-speaking patients with varying literacy skills. Springerplus 2016; 5:972. [PMID: 27429882 PMCID: PMC4932016 DOI: 10.1186/s40064-016-2675-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 06/26/2016] [Indexed: 12/21/2022]
Abstract
Purpose To develop and validate a new multimedia instrument to measure health-related quality of life (HRQOL) in Portuguese-speaking patients with cancer. Methods A mixed-methods study conducted in a large Brazilian Cancer Hospital. The instrument was developed along the following sequential phases: identification of HRQOL issues through qualitative content analysis of individual interviews, evaluation of the most important items according to the patients, review of the literature, evaluation by an expert committee, and pretesting. In sequence, an exploratory factor analysis was conducted (pilot testing, n = 149) to reduce the number of items and to define domains and scores. The psychometric properties of the IQualiV-OG-21 were measured in a large multicentre Brazilian study (n = 323). A software containing multimedia resources were developed to facilitate self-administration of IQualiV-OG-21; its feasibility and patients’ preferences (“paper and pencil” vs. software) were further tested (n = 54). Results An exploratory factor analysis reduced the 30-item instrument to 21 items. The IQualiV-OG-21 was divided into 6 domains: emotional, physical, existential, interpersonal relationships, functional and financial. The multicentre study confirmed that it was valid and reliable. The electronic multimedia instrument was easy to complete and acceptable to patients. Regarding preferences, 61.1 % of them preferred the electronic format in comparison with the paper and pencil format. Conclusions The IQualiV-OG-21 is a new valid and reliable multimedia HRQOL instrument that is well-understood, even by patients with low literacy skills, and can be answered quickly. It is a useful new tool that can be translated and tested in other cultures and languages. Electronic supplementary material The online version of this article (doi:10.1186/s40064-016-2675-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carlos Eduardo Paiva
- Divisão de Mama e Ginecologia, Departamento de Oncologia Clínica, Barretos Cancer Hospital, Rua Antenor Duarte Vilella, 1331, Bairro Dr Paulo Prata, Barretos, São Paulo CEP: 14784-400 Brazil ; Health-Related Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil ; Center for Research Support - NAP, Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil
| | - Felipe Augusto Ferreira Siquelli
- Health-Related Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil ; Barretos School of Health Sciences, Dr. Paulo Prata - FACISB, Barretos, São Paulo 14785-002 Brazil
| | - Gabriela Rossi Zaia
- Health-Related Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil ; Barretos School of Health Sciences, Dr. Paulo Prata - FACISB, Barretos, São Paulo 14785-002 Brazil
| | | | | | - Alexandre A Jácome
- Department of Clinical Oncology, Mater Dei Hospital, Belo Horizonte, Minas Gerais 30140-093 Brazil
| | | | - Henrique Amorim Santos
- Health-Related Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil ; Barretos School of Health Sciences, Dr. Paulo Prata - FACISB, Barretos, São Paulo 14785-002 Brazil
| | - Elizabeth A Hahn
- Department of Medical Social Sciences and Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL 60611 USA
| | - Gilberto Uemura
- Botucatu Medical School, Universidade Estadual Paulista -UNESP, Botucatu, São Paulo 18618-970 Brazil
| | - Bianca Sakamoto Ribeiro Paiva
- Health-Related Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil ; Center for Research Support - NAP, Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil
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Andrade DAPD, Zucca-Matthes G, Vieira RADC, Andrade CTDAED, Costa AMD, Monteiro AJDC, Dal Lago L, Nunes JS. Neoadjuvant chemotherapy and pathologic response: a retrospective cohort. Einstein (Sao Paulo) 2014; 11:446-50. [PMID: 24488382 PMCID: PMC4880380 DOI: 10.1590/s1679-45082013000400007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 09/28/2013] [Indexed: 11/21/2022] Open
Abstract
Objective: To evaluate the complete pathologic response attained by patients diagnosed with locally advanced breast cancer submitted to neoadjuvant chemotherapy based on the doxorubicin/ cyclophosphamide regimen followed by paclitaxel. Methods: A retrospective cohort of patients with locally advanced breast cancer, admitted to the Hospital de Câncer de Barretos between 2006 and 2008 submitted to the doxorubicin/cyclophosphamide protocol followed by paclitaxel (4 cycles of doxorubicin 60mg/m2 and cyclophosphamide 600mg/m2 every 21 days; 4 cycles of paclitaxel 175mg/m2 every 21 days). The following variables were assessed: age, menopause, performance status, initial clinical staging, anthropometric data, chemotherapy (dose – duration), toxicity profile, post-treatment staging, surgery, pathologic complete response rate, disease-free survival, and pathological characteristics (type and histological degree, hormonal profile and lymph node involvement). Statistical analysis was performed using a 5% level of significance. Results: Of the 434 patients evaluated, 136 were excluded due to error in staging or because they had received another type of chemotherapy. Median age was 50 years, all with performance status 0-1. Median initial clinical size of tumor was 65mm and the median final clinical size of the tumor was 22mm. Fifty-one (17.1%) patients experienced a pathologic complete response. Those with a negative hormonal profile or who were triple-negative (negative Her-2 and hormonal profile) experienced a favorable impact on the pathologic complete response. Conclusion: Neoadjuvant chemotherapy with doxorubicin/ cyclophosphamide followed by paclitaxel provided a pathologic complete response in the population studied in accordance with that observed in the literature. Triple-negative patients had a greater chance of attaining this response.
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Lima JPDSN, de Souza FH, de Andrade DAP, Carvalheira JBC, dos Santos LV. Independent radiologic review in metastatic colorectal cancer: systematic review and meta-analysis. Radiology 2012; 263:86-95. [PMID: 22438443 DOI: 10.1148/radiol.11111111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To perform a meta-analysis addressing evaluation bias in local radiologic assessment (LRA) of lesions when compared with independent radiologic review (IRR) in randomized controlled trials (RCTs) testing chemotherapy for metastatic colorectal cancer (CRC). MATERIALS AND METHODS MEDLINE, EMBASE, ClinicalTrials.gov, the Cochrane Library, and Web sites for major medical meetings were searched for RCTs of chemotherapy for metastatic CRC that reported response evaluation by both LRA and IRR. The risk ratios (RRs) of response in the experimental (RR(exp)) and control (RR(cont)) arms were calculated (response rate in LRA divided by response rate in IRR) for each selected study. The ratio of RR of response was calculated (RR of response of LRA divided by RR of response of IRR). The random-effects model was applied. Meta-regression was used to examine the effect of study characteristics on outcomes. RESULTS LRA and IRR results were concordant (13 studies; 7742 patients; ratio of RR of response = 0.97; 95% confidence interval [95% CI]: 0.90, 1.04; P = .35). However, LRA overestimated tumor response independently of therapy allocation (interaction test, P = .81) both in control (RR(cont), 1.163; 95% CI: 1.086, 1.246; P < .001) and experimental (RR(exp), 1.156; 95% CI: 1.093, 1.222; P < .001) therapies. Meta-regression did not show any effect of trial characteristics on effects. CONCLUSION LRA yields higher response rates in RCTs testing chemotherapy for metastatic CRC, although there was no sign of bias toward experimental therapy. The need for IRR to control evaluation bias must be reappraised.
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