More than 50 % of patients with colorectal cancer develop liver metastases. Surgical resection is the only available treatment that improves survival in patients with colorectal liver metastases (CRLM). New antiangiogenic targeted therapies, such as bevacizumab, aflibercept, and regorafenib, in combination with neoadjuvant and conversion chemotherapy may lead to improved response rates in this population of patients and increase the proportion of patients eligible for surgical resection. The present review discusses the available data for antiangiogenic targeted agents in this setting. One of these therapies, bevacizumab, which targets the vascular endothelial growth factor (VEGF) has demonstrated good results in this setting. In patients with initially unresectable CRLM, the combination of 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) plus bevacizumab has led to high response and resection rates. This combination is also effective for patients with unresectable CRLM. Moreover, the addition of bevacizumab to chemotherapy in the neoadjuvant setting of liver metastasis has a higher impact on pathological response rate. This drug also has a manageable safety profile, and according to recent data, bevacizumab may protect against the sinusoidal dilation provoked in the liver by certain cytotoxic agents. In phase II trials, antiangiogenic therapy has demonstrated benefits in the presurgical treatment of CRLM and may represent a new treatment pathway for these patients.
Treatment with FCM results in responses rates of 60% in relapsed or refractory CLL patients. Against this background, we started a trial of FCM in untreated patients diagnosed with CLL younger than 65 yrs. FCM consisted of fludarabine 25 mg/m2 i.v. on days 1 to 3, cyclophosphamide 200 mg/m2 on days 1 to 3, and mitoxantrone 6 mg/m2 i.v. on day 1, given at a 4-week intervals up to six courses. Patients received support with G-CSF and prophylaxis with cotrimoxazole. Response was assessed two months after treatment and included bone marrow and minimal residual disease (MRD) analysis by four-color flow cytometry and PCR. Out the 64 evaluable patients (74% male, median age 58 years), 83% were in advanced (B and C) Binet’s clinical stage and 62% had increased (>20%) ZAP-70 expression. FISH analysis disclosed del(13q) in 25%, +12 in 22%, del(17p) in 10% of cases and del(11q) in 23%. Eighty-three per cent of the patients received the entire planed treatment. Overall response rate was of 88%. MRD-negative CR was obtained in 24%, MRD-positive CR in 23%, nPR 22% and PR 11%. Two out of 14 nPR cases were MRD-negative. Duration of response was 55% at 36 months. Initial parameters associated with CR achievement were the presence of del(17p) (p=0.003), increased serum LDH (P=0.014), and splenomegaly (p=0.04). Hematological toxicity was mild, with grade III-IV neutropenia in 8% of the cases, and moderate infections in 12%. Two patients developed fulminant B hepatitis, one of them dying as a direct consequence of it. In conclusion, in untreated CLL patients, FCM induces a high CR rate, including an important number of MRD negative CR. This places FCM among the most effective regimens for CLL and serves to build up a new immunochemotherapy regimen for CLL (R-FCM) currently under investigation.
RT-PCR for tyrosinase mRNA and S-100 are significant prognostic factors for progression-free survival and OS in melanoma. S-100 has higher sensitivity and specificity than tyrosinase.
Summary : Toxoplasma go n d ii: F reeze-preservation in cell CULTUREFor a better preservation and identification of Toxoplasma gondii isolates, w e propose a new method of freezing of toxoplasma grown in THP-1 cell culture. A cystogenic strain isolated from foetal blood has been grown in these cells and frozen in liquid nitrogen. After thawing, toxoplasma recover the same growth rate and morphology in vitro and the same capacity to form brain cysts into mice compared to the initial strains. The freezing of the cell suspension provides a simple and appropriate method for preservation of Toxoplasma gondii within in « bank » isolates.
ResumenLos avances de las últimas décadas tanto en el diagnóstico como en tratamiento del cáncer han conseguido aumentar la supervivencia, lo que ha conllevado un aumento de las complicaciones neurológicas. Estas complicaciones pueden ser debidas tanto al propio cáncer como al tratamiento y en ocasiones son la primera manifestación de la enfermedad oncológica. Algunas de estas complicaciones son potencialmente reversibles por ello el diagnóstico precoz y su tratamiento correcto pueden mejorar los síntomas neurológicos y la calidad de vida de estos pacientes. En el presente artículo haremos una revisión de las principales complicaciones neurológicas del paciente con cáncer con una orientación diagnóstica y terapéutica.Palabras clave: Cáncer, complicación, neurología, síndrome, paraneoplásico, quimioterapia, radioterapia. AbstractThe advances of recent decades in the diagnosis and treatment of cancer have managed to increase survival, but this has produced an increase in neurological complications. These complications can be caused by cancer and its treatment and sometimes can be the first manifestation of cancer disease. Some of these complications are potentially reversible so that early diagnosis and proper treatment can improve the neurological symptoms and quality of life of these patients. In this article we will review major neurological complications of cancer patients and also do a diagnostic and therapeutic orientation.
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