1
|
Andrade MDO, Bonadio RRDCC, Diz MDPE, Testa L. Visceral crisis in metastatic breast cancer: an old concept with new perspectives. Clinics (Sao Paulo) 2024; 79:100362. [PMID: 38754225 DOI: 10.1016/j.clinsp.2024.100362] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/12/2024] [Accepted: 04/02/2024] [Indexed: 05/18/2024] Open
Abstract
Visceral Crisis (VC) in breast cancer is a critical scenario when the burden of metastatic disease results in rapid deterioration of organ functions. There are no widely accepted objective clinical criteria for the definition of VC, and different studies have reported diverse clinical conditions such as visceral crises. Diagnosis of VC is associated with a dismal prognosis and the management of this condition is currently based on limited retrospective evidence and expert opinions. International guidelines have recommended cytotoxic polychemotherapy in the management of VC, to achieve rapid symptomatic control and preserve organ function. Nevertheless, in the case of hormone receptor-positive breast cancer, the role of chemotherapy as the treatment of choice for VC has been recently questioned, since endocrine therapy plus CDK4/6 inhibitors yielded similar response rates, with better quality of life. For HER2-positive and triple-negative breast cancer, combined chemotherapy (plus HER2-directed therapy for HER2-positive) remains a standard option for VC, but novel effective drugs such as antibody-drug conjugates are emerging and their role in the VC context shall soon be elucidated. This review aims to critically discuss the definition, prognosis, management, and future directions regarding the visceral crisis in metastatic breast cancer.
Collapse
Affiliation(s)
- Matheus de Oliveira Andrade
- Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | | | - Maria Del Pilar Estevez Diz
- Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Laura Testa
- Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| |
Collapse
|
2
|
Harada G, Bonadio RRDCC, de Araújo FCC, Victor CR, Sallum RAA, Junior UR, Cecconello I, Takeda FR, de Castria TB. Induction Chemotherapy for Locally Advanced Esophageal Cancer. J Gastrointest Cancer 2021; 51:498-505. [PMID: 31240598 DOI: 10.1007/s12029-019-00266-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Concurrent chemoradiotherapy followed by surgery is the standard treatment for locally advanced esophageal cancer (EC), and the role of induction chemotherapy (IC) remains unclear. We aimed to study if the addition of IC to standard treatment increases the rate of pathologic complete response (pCR). METHODS We assembled a retrospective analysis of patients (pts) diagnosed with locally advanced EC and treated with preoperative chemoradiotherapy followed by esophagectomy (CRT+S), preceded or not by IC, between 2009 and 2017. Patients' characteristics, tumor variables, and treatment outcomes were evaluated. The Kaplan-Meier method was used to estimate overall survival and the Cox proportional hazard model to evaluate prognostic factors. RESULTS One hundred and three patients were studied, with a median age of 62 years (range 37-84). Seventy-five patients (73%) were male, 67 (65%) had squamous cell carcinoma, and 31 (30%) had adenocarcinoma. Forty-three patients (41.7%) received IC followed by CRT+S (IC+CRT+S). The most frequent IC consisted of paclitaxel and platinum chemotherapy (90%), and the median number of cycles was 2. All patients received CRT+S. Concurrent chemotherapy was a combination of paclitaxel and platinum in 94 patients (91%). There was no statistically significant difference in pCR between the IC group and the standard CRT+S group. The pCR was 41.9% and 46.7% in the IC+CRT+S and CRT+S groups (p = 0.628), respectively. In the multivariate analysis, pCR was an independent prognostic factor for time to treatment failure (TTF) (HR 0.35, p = 0.021), but not for overall survival (OS) (p = 0.863). The factor that significantly affected OS in the multivariate analysis was positive lymph node (HR 5.9, 95%, p = 0.026). CONCLUSIONS Our data suggest that the addition of IC to standard CRT + S does not increase the pCR rate in locally advanced EC. No difference in OS was observed between pts. that received or not IC. Regardless of the treatment received, pts. achieving a pCR presented improved TTF.
Collapse
Affiliation(s)
- Guilherme Harada
- Instituto do Câncer do Estado de São Paulo, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
- Centro de Oncologia, Hospital Sírio-Libanês, Sao Paulo, Brazil.
| | | | | | - Carolina Ribeiro Victor
- Instituto do Câncer do Estado de São Paulo, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Rubens Antonio Aissar Sallum
- Instituto do Câncer do Estado de São Paulo, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
- Division of Digestive Surgery - Department of Gastroenterology, São Paulo State Cancer Institute - ICESP-HCFMUSP, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Ulysses Ribeiro Junior
- Instituto do Câncer do Estado de São Paulo, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
- Division of Digestive Surgery - Department of Gastroenterology, São Paulo State Cancer Institute - ICESP-HCFMUSP, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Ivan Cecconello
- Instituto do Câncer do Estado de São Paulo, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
- Division of Digestive Surgery - Department of Gastroenterology, São Paulo State Cancer Institute - ICESP-HCFMUSP, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Flávio Roberto Takeda
- Instituto do Câncer do Estado de São Paulo, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
- Division of Digestive Surgery - Department of Gastroenterology, São Paulo State Cancer Institute - ICESP-HCFMUSP, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Tiago Biachi de Castria
- Instituto do Câncer do Estado de São Paulo, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
- Centro de Oncologia, Hospital Sírio-Libanês, Sao Paulo, Brazil
| |
Collapse
|
3
|
Silva M, Bonadio RRDCC, Matos G, Camargo V. Treatment outcomes for adult patients with localized osteosarcoma treated with chemotherapy without methotrexate. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz283.025] [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] [Indexed: 11/14/2022] Open
|
4
|
de Carvalho CSA, Moniz C, Watarai G, Crespo J, Nogueira PVDS, Martinez J, Moraes PMGD, Bonadio RRDCC, Braghiroli MIFM, Sabbaga J, Hoff P. Real world data on adjuvant chemotherapy for high-risk stage II colorectal cancer: The role of tumour side. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.037] [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] [Indexed: 11/12/2022] Open
|
5
|
Rodrigues da Cunha Colombo Bonadio R, Gondim Meira Velame Azevedo R, Harada G, Cabral Severino da Costa S, Costa Miranda V, de Freitas D, Abdo Filho E, Alves de Oliveira Ferreira P, Gabrielli F, Del Pilar Estevez Diz M. Adjuvant Carboplatin and Paclitaxel Chemotherapy Followed by Radiotherapy in High-Risk Endometrial Cancer: A Retrospective Analysis. J Glob Oncol 2018; 4:1-8. [PMID: 30241227 PMCID: PMC6223436 DOI: 10.1200/jgo.17.00146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/20/2022] Open
Abstract
PURPOSE The best adjuvant treatment in high-risk endometrial cancer remains unclear. Although adjuvant chemotherapy seems to improve overall survival (OS) in locally advanced disease, the role of adding radiotherapy is not certain. We evaluated the outcomes of patients with high-risk endometrial cancer treated with adjuvant chemotherapy followed by radiotherapy. PATIENTS AND METHODS We performed a retrospective analysis of patients with high-risk endometrial cancer (endometrioid histology stages III to IVA or carcinosarcoma, clear cell, or serous histology stages I to IVA) treated with adjuvant carboplatin and paclitaxel, followed by radiotherapy, from 2010 to 2017 at a Brazilian cancer center. The Kaplan-Meier method was used for survival analysis, and prognostic factors were analyzed using the Cox proportional hazards model. RESULTS One hundred forty-six consecutive patients were evaluated. The OS rates were 86.2% at 3 years and 75.4% at 5 years. OS was significantly affected by pelvic lymphadenectomy ( P = .001) and positive peritoneal cytology ( P < .001). Three- and 5-year disease-free survival (DFS) rates were 78.3% and 69.5%, respectively. The initial site of recurrence was limited to the pelvis in 4.1% of patients, within the abdomen in 1.3%, and extra-abdominal in 11.6%. Patients with grade 1 or 2 endometrioid carcinoma had better prognosis than patients with endometrioid carcinoma grade 3 or nonendometrioid histology (3-year DFS, 93.67% v 68.5%, respectively; P = .0017). CONCLUSION Adjuvant carboplatin and paclitaxel, followed by radiotherapy, is effective in high-risk endometrial cancer and associated with low rates of pelvic recurrence, which might be explained by the addition of radiotherapy. The high-risk group is heterogeneous, and the benefit of adjuvant treatment in patients with grade 1 or 2 endometrioid carcinoma is less clear.
Collapse
Affiliation(s)
| | | | - Guilherme Harada
- All authors: Instituto do Câncer do Estado de São Paulo and Universidade de São Paulo, São Paulo, Brazil
| | | | - Vanessa Costa Miranda
- All authors: Instituto do Câncer do Estado de São Paulo and Universidade de São Paulo, São Paulo, Brazil
| | - Daniela de Freitas
- All authors: Instituto do Câncer do Estado de São Paulo and Universidade de São Paulo, São Paulo, Brazil
| | - Elias Abdo Filho
- All authors: Instituto do Câncer do Estado de São Paulo and Universidade de São Paulo, São Paulo, Brazil
| | | | - Flavia Gabrielli
- All authors: Instituto do Câncer do Estado de São Paulo and Universidade de São Paulo, São Paulo, Brazil
| | | |
Collapse
|
6
|
da Cunha Colombo Bonadio RR, Fogace RN, Miranda VC, Diz MDPE. Homologous recombination deficiency in ovarian cancer: a review of its epidemiology and management. Clinics (Sao Paulo) 2018; 73:e450s. [PMID: 30133561 PMCID: PMC6096977 DOI: 10.6061/clinics/2018/e450s] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 02/05/2018] [Indexed: 11/28/2022] Open
Abstract
Ovarian cancer patients with homologous recombination deficiencies exhibit specific clinical behaviors, and improved responses to treatments, such as platinum-based chemotherapy and poly (ADP-ribose) polymerase (PARP) inhibitors, have been observed. Germline mutations in the BRCA 1/2 genes are the most well-known mechanisms of homologous recombination deficiency. However, other mechanisms, such as germline and somatic mutations in other homologous recombination genes and epigenetic modifications, have also been implicated in homologous recombination deficiency. The epidemiology and implications of these other mechanisms need to be better understood to improve the treatment strategies for these patients. Furthermore, an evaluation of various diagnostic tests to investigate homologous recombination deficiency is essential. Comprehension of the role of homologous recombination deficiency in ovarian cancer also allows the development of therapeutic combinations that can improve the efficacy of treatment. In this review, we discuss the epidemiology and management of homologous recombination deficiency in ovarian cancer patients.
Collapse
Affiliation(s)
- Renata Rodrigues da Cunha Colombo Bonadio
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Rodrigo Nogueira Fogace
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Vanessa Costa Miranda
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Maria del Pilar Estevez Diz
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| |
Collapse
|
7
|
Marta GN, da Cunha Colombo Bonadio RR, Martins RE, Zuppani HB, de Castro G. Cystic brain metastases in ALK-rearranged non-small cell lung cancer. Ecancermedicalscience 2018; 12:818. [PMID: 29662531 PMCID: PMC5880229 DOI: 10.3332/ecancer.2018.818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/04/2018] [Indexed: 11/26/2022] Open
Abstract
The central nervous system (CNS) is a common site of disease progression in patients with non-small-cell lung cancer (NSCLC) with anaplastic lymphoma kinase (ALK)-rearrangement treated with crizotinib. Cystic brain metastases (CBM) have been recently identified as one possible variant of this disease. An illustrative case report is presented along with a literature review performed in order to track relevant papers about CBM in ALK-rearranged NSCLC, including possible pathophysiology, differential diagnosis and treatment options for this condition. Three case reports have been published describing six ALK-rearranged NSCLC patients presenting with CBM, all of which were under treatment with crizotinib by the time of CBM diagnosis. Treatment with CNS-penetrating tyrosine kinase inhibitors (TKIs) resulted in CNS disease control in three of the six cases reported either as single therapy or in combination with radiation therapy (RT). Investigation of differential diagnoses of CBM might be necessary, which include inflammatory and demyelinating disorders, primary brain tumours and infectious diseases, especially neurocysticercosis that might mimic CBM images. Treatment options include RT, CNS-penetrating TKIs and invasive procedures, such as stereotactic drainage. Thus, CBM are associated with ALK-rearranged NSCLC, particularly in patients who use crizotinib and should prompt investigation of differential diagnosis. CNS-penetrating TKIs are effective in the control of solid brain metastases and also seem to be active in CBM as single therapy or in combination with RT.
Collapse
Affiliation(s)
| | | | | | | | - Gilberto de Castro
- Instituto do Câncer do Estado de São Paulo, São Paulo, SP 01246-000, Brazil
| |
Collapse
|