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Cancer-related anemia adversely affects quality of life and is associated with reduced overall survival. The correction of anemia in cancer patients has the potential to improve treatment efficacy and increase survival. A large number of studies demonstrate that treatment of anemia in cancer patients using erythropoiesis-stimulating agents (ESAs) significantly increases hemoglobin levels, decreases transfusion requirements and improves quality of life, predominantly by reducing fatigue. Some data on the use of ESAs in cancer patients indicate an increased risk of thromboembolic events and a possibly increased risk of mortality. However, there is ample evidence that when ESAs are used within current guidelines, they are valuable and safe drugs for the treatment of anemia in patients receiving radiotherapy and/or chemotherapy. There are increasing data from prospective, randomized trials demonstrating better responses to ESAs with the concurrent use of iron. Blood transfusions are also helpful in the management of anemia in cancer patients, especially when there is a need for immediate increases in hemoglobin levels. In this article, we discuss recent aspects relating to treatment modalities for anemia in cancer patients.

Existem poucos dados na literatura sobre a prevalência da deficiência de ferro em pacientes oncológicos. Um estudo avaliou parâmetros hematológicos em pacientes com câncer que iriam iniciar tratamento com AEE. Dezessete por cento dos casos apresentavam ferritina sérica <100 ng/mL, saturação de transferrina < 20%, e conteúdo de hemoglobina nos reticulócitos (CHbR) < 32 g/dL foi encontrado em 59% e 27%

In this case report, we describe a rare case of a 32-year-old man who presented a highly aggressive, fast growing anaplastic oligodendroglioma five years after being treated with whole brain radiotherapy for a CNS recurrence of a lymphoblastic lymphoma. Initially, the patient was submitted to a surgical intervention and partial tumor resection, which allowed us to establish the pathologic diagnosis and the presence of a 1p deletion. Shortly after the operation the tumor grew back, exerting important mass effect. Since no radiation therapy or surgery could be used and the patient faced a critical condition, chemotherapy was started with a combination of temozolomide and bevacizumab. Immediately after the first cycle a marked clinical and radiological improvement was documented.

Despite the favorable toxicity and safety profiles of pemetrexed (Alimta; Eli Lilly and Company, Indianapolis, IN), several adverse events have been reported, including blood and lymphatic system disorders, gastrointestinal disorders, and general disorders. 1-3 In this letter, we describe a case series consisting of seven patients who developed clinically significant fluid retention, an uncommon adverse effect associated with the use of pemetrexed. All patients have received vitamin supplementation and were pretreated with corticosteroids as indicated in the package insert (Table 1). Other causes of edema were excluded, and all patients had normal echocardiogram, normal levels of B-type natriuretic peptide and albumin, normal renal, hepatic, and thyroid function tests, and no significant proteinuria. Most patients presented with mild-tomoderate edema, mainly in periorbital area, as illustrated in Figure 1 (case 1). Of the seven cases, only one patient (case 4) developed grade 3 refractory edema with symptomatic bilateral effusion. A bilateral thoracocentesis was necessary for symptom relief, and the pleural effusion analysis was consistent with an exudate with no malignant cells and negative cultures. There was complete disappearance of generalized edema and bilateral pleural effusion after discontinuation of pemetrexed treatment. Another patient (case 6) also had complete resolution of the edema after pemetrexed was discontinued because of disease progression. All other cases were managed with observation only or salt restriction and diuretics, with limited control of this side effect. Because

To evaluate the molecular testing and treatment patterns in a retrospective cohort of newly diagnosed treatment-naïve patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC). METHODS: This is an observational retrospective cohort study conducted across 10 cancer centers in Brazil. Treatment-naïve patients with locally advanced or metastatic NSCLC were enrolled from January to December 2014. The following data were collected from the medical records of patients from diagnosis until the last record (death, loss to follow-up, or the end of the maximum follow-up period): demographics; medical history; smoking status; disease characteristics; previous treatments; and molecular testing patterns and results. The overall survival (OS) was also estimated. Results: A total of 391 patients from 8 different Brazilian states were included, with a median age of 64.1 years (23.7-98.7), with most patients being males (60.1%). The smoking status of 74.2% of patients was a 'former' or 'current smoker'. Stage IV NSCLC at diagnosis was observed in 82.4% of patients, with 269 of them (68.8%) presenting adenocarcinoma (ADC). Among the stage IV ADC patients, 54.0% were referred for molecular testing. Among the patients with an available epidermal growth factor receptor (EGFR) mutation status, 31 (24.0%) were EGFR-positive. The first-line treatment was a platinum-based chemotherapy for 98 patients (25.1%), while nonplatinum-based regimens were used in 54 patients (13.8%). OS data were available for 370 patients, with a median OS of 10.8 months. Never smokers had a significantly higher median OS versus current or former smokers (14.6 versus 9.1 months; log-rank p=0.003). Among the patients for whom molecular testing data were available, those with EGFR-positive results had a longer median OS (34.6 versus 12.8 months; log-rank p=0.003). Conclusion: Our findings provide relevant information for prescribers and policy decision-makers by highlighting the unmet needs of patients and the importance of molecular testing in newly diagnosed locally advanced or metastatic lung adenocarcinoma. We also highlight the respective EGFR-tyrosine kinase inhibitor treatment when the result is positive and the areas in which further efforts are required to grant access to effective treatment.

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