O câncer de colo uterino é o segundo câncer feminino mais comum no Brasil. O papilomavírus humano (HPV) é causa necessária para seu desenvolvimento. A vacina surge como uma arma contra a infecção por HPV e, consequentemente, contra o câncer. Mas existem mais de 100 genótipos diferentes de HPV, que são divididos em baixo risco e alto risco, de acordo com o potencial oncogênico. Analisam-se os aspectos epidemiológicos e biomoleculares da infecção por HPV na mucosa genital de mulheres qui-lombolas, verificando a associação os achados citológicos e biomoleculares e observando a frequência do papilomavírus nessa população e de seus tipos, para avaliar a aplicabilidade da vacina na população em estudo. A população deste estudo é de 101 mulheres pertencentes à comunidade quilombola de Ju-çatuba, no estado do Maranhão. Foram coletadas amostras de mucosa genital, submetidas à pesquisa para a presença do HPV pela técnica de PCR Nested. As amostras positivas foram sequenciadas para fins de genotipagem viral. Em uma população predominante de mulheres em idade fértil, com parceiro fixo e baixo nível de escolaridade, verificou-se que 10 amostras da cérvice uterina foram positivas paraHPV, sendo 7 positivas para os tipos de alto risco. Mediante a presença dos tipos virais de alta oncoge-nicidade, observa-se a necessidade de implementação de condutas gestoras para redução do risco de aparecimento de câncer do colo do útero.Palavras-chave: Papilomavírus humano. Câncer. Colo uterino. Reação em cadeia da polimerase.CANCER OF THE CERVIX, GENOTYPING OF HUMAN PAPILLOMAVIRUS (HPV) IN QUILOMBOLA WOMEN IN A BRAZILIAN CITY: ACCEPTABILITY OF THE VACCINE.ABSTRACT: Cervical cancer is the second most common female cancer in Brazil. The human papilloma-virus (HPV) is a need cause for its development. The vaccine appears as a weapon against HPV infection and therefore against cancer. But there are more than 100 different HPV genotypes, which are divided into low risk and high risk according to the oncogenic potential. To analyze the epidemiological and biomolecu-lar aspects of HPV infection in the genital mucosa of women Maroons, verifying the association cytological and molecular biological findings and noting the frequency of this population papillomavirus and its types, to evaluate the applicability of the vaccine in the study population. The study population was 101 women belonging to the maroon community of Juçatuba in the state of Maranhão. Genital mucosa samples were collected and submitted to search for the presence of HPV by PCR Nested. The positive samples were sequenced for the purpose of viral genotyping. In a predominant population of women of childbearing age, with a steady partner, and low level of education, it was found that 10 samples of uterine cervix were positive for HPV, with 7 positive for high-risk types. Through the presence of viral types of high tumorige-nicity, there is a need to implement management practices for reducing the risk of developing cancer of the cervix.KEYWORDS: Human Papillomavirus. Cancer. Cervix. Polymerase Chain Reaction.EL CÁNCER DEL CUELLO UTERINO, LA GENOTIPIFICACIÓN DEL VIRUS DEL PAPILOMA HUMANO (VPH) EN MUJERES QUILOMBOLAS EN UNA CIUDAD BRASILEÑA: LA ACEPTABILIDAD DE LA VACUNA.RESUMEN: El cáncer cervical es el segundo cáncer femenino más común en Brasil. El virus del papiloma humano (VPH) es la causa necesaria para su desarrollo. La vacuna se presenta como un arma contra la infección por VPH y, por tanto, contra el cáncer. Pero hay más de 100 genotipos diferentes de VPH, que se dividen en bajo riesgo y de alto riesgo de acuerdo con el potencial oncogénico. Analizar los aspectos epidemiológicos y biomoleculares de la infección por el VPH en la mucosa genital de la mujer cimarrones, la verificación de la citología asociación y hallazgos de biología molecular y tomando nota de la frecuen-cia de este virus del papiloma de la población y sus tipos, para evaluar la aplicabilidad de la vacuna en la población de estudio. La populación de estudio fue de 101 mujeres pertenecientes a la comunidad marrón de Juçatuba en el Estado de Maranhão. Se recogieron muestras de mucosa genital presentados para buscar la presencia de VPH por PCR anidada. Las muestras positivas se secuenciaron con el propósito de determinación del genotipo viral . RESULTADOS: En una población predominante de las mujeres en edad fértil, con una pareja estable, y el bajo nivel de la educación, se encontró que 10 muestras fueron positivas para el VPH cervical, 7 siendo positivo para los tipos de alto riesgo. A través de la presencia de tipos virales de alta tumorigenicidad, hay una necesidad de aplicar prácticas de gestión para reducir el riesgo de desarrollar cáncer de la cérvix.PALABRAS CLAVE: Virus del papiloma humano. Cáncer. Cérvix. Reacción en Cadena de la Polimerasa.
529 Background: The combination of gemcitabine-cisplatin (GC) is the current standard of care chemotherapy for metastatic/unresectable biliary tract cancer (BTC). However, the prognosis remains poor. This randomized trial aimed to evaluate the efficacy and safety of irinotecan plus cisplatin (IP) versus GC in advanced or metastatic BTC. Methods: Patients with biopsy-proven, chemo-naïve, unresectable or metastatic BTC, ECOG 0-2, measurable disease per RECIST 1.1, adequate organ function and written informed consent were stratified by ECOG (0 or 1 vs 2) and distant metastases and randomized to receive irinotecan 65 mg/m² IV D1 and D8 plus cisplatin 60 mg/m² D1 repeated every 3 weeks (IP) or gemcitabine 1000 mg/m² IV D1 and D8 plus cisplatin 25 mg/m² IV D1 and D8 repeated every 3 weeks, until disease progression or unacceptable toxicity. The primary endpoint was overall response rate (ORR). Results: Between January 2013 and April 2018, 47 pts were randomized (1:1) to receive IP (N = 24) or GC (N = 23). Overall, groups were well balanced according to prognostic factors. The ORR was 35% (complete response 5%, partial response 30%) and 31.8% in IP and GC arms, respectively. Median progression-free survival were 5.3 vs 7.8 months (HR = 1.165, 95%CI 0.628-2.161, p = 0.628) and median overall survival were 11.9 and 9.8 months (HR = 0.859, 95%CI 0.431 – 1.710, p = 0.665) for IP and GC, respectively. Adverse events were not statistically different between arms, and results were consistent with previous experiences with these regimens. No therapy-related death were reported. Conclusions: Irinotecan-cisplatin combination is active in BTC, with similar ORR, PFS and OS when compared to gemcitabine-cisplatin. Irinotecan-cisplatin were well tolerated, and adverse events were manageable. Irinotecan-cisplatin could be considered as an alternative to gemcitabine-cisplatin. Clinical trial information: NCT01859728.
e17563 Background: Abiraterone acetate (AA) is a potent selective and irreversible inhibitor of CYP17 used as standard treatment for metastatic Castration Resistant Prostate Cancer (mCRPC). In the pivotal trial COU-AA 301, AA 1000 mg/day plus prednisone increased overall survival after docetaxel in patients with mCRPC. A recent trial demonstrated not inferiority with respect to PSA metrics in the reduced dose of 250mg/day AA associated with dietary intake, which is described as AA low dose (AALD). The introduction of generic AA in the Brazilian Pharma Market and after the endorsement of AALD from international guidelines, the use of AA in limited resourced hospitals became feasible. Since december 2018 our institution has incorporated AALD in patients with mCRPC in first or second line therapy, always after chemotherapy with Docetaxel (either in the sensitive or castration scenario). Methods: We retrospectively reviewed 49 patients with mCRPC that received AALD after chemotherapy with Docetaxel from December 2018 to January 2019. The primary end point was PSA response rate (decrease of ≥ 50% in the PSA concentration from pretreatment PSA value). Univariable analysis were performed to explore association between clinical and pathological features. Results: After a median follow-up of 5 months, 25 patients (51%) had PSA response rate ≥ 50%. Median age was 69 years-old and most patients (73.5%) were ECOG 0 and 1. Despite good ECOG, the population had aggressive disease characteristics with 57.1% being ISUP 4 and 5 and 69.4% being clinical stage IV at initial diagnosis. Seventeen patients (34.7%) were exposed to AALD at first line and 32 patients (65.3%) in second line. It was observed that patients in the first line had better PSA response rate them those treated in the second line (70,6% vs 40,6%. p 0.04). Conclusions: Despite the premature data, this retrospective analyses shows PSA response rate in about 50% of patients treated with AALD in the overall population and about 70% in those treated in first line therapy. Serum PSA response rate is known as a surrogate marker for overall survival in those patients. The protocol will for more mature data. AALD might be an alternative dose for treating patients in institutions with limited resources.
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