Oncologic emergencies have been extensively described and clearly defined. In oncology daily practice, cancer patients seek non-scheduled medical care in situations they perceive as a medical emergency, but which may not be a true emergency. The aim of the study was to identify the main symptoms leading to a non-scheduled consultation (NSC) and their relationship to the type of cancer, and to evaluate whether the diagnosis at discharge of patients admitted as result of a NSC correlates with a true oncologic emergency. This was a prospective observational study. Between July 2002 and April 2003, 365 NSCs were recorded. The most frequent baseline diseases were breast cancer (70), lung cancer (67), gastrointestinal cancer (52), lymphoma (42) and ovarian cancer (22). The most common symptoms for consultation were: fever (84), pain (81), cutaneous manifestations (26), dyspnea (23), bleeding (16) and abdominal distention (16). Overall, 114 of 365 NSCs (31%) resulted in admission. The most frequent symptoms resulting in admission were fever (42), pain (16), dyspnea (11), vomiting (9), neurologic manifestations (7), abdominal distention (6) and anuria (6). At discharge, only 30 patients (26%) admitted after a NSC were diagnosed with a defined oncologic emergency: febrile neutropenia (13), intestinal occlusion (12), obstructive uropathy (4) and abdominal perforation (1). True emergencies were not the most frequent causes of NSC at our institution.
PURPOSE In recent years, unprecedented benefits have been observed with the development of cyclin-dependent kinase (CDK) 4 and 6 inhibitors for the treatment of hormone receptor–positive/human epidermal growth factor receptor 2–negative metastatic breast cancer. However, there is scarce evidence of their value in specific populations, such as patients carrying germline pathogenic variants in DNA repair–related genes. PATIENTS AND METHODS We retrospectively studied the efficacy of CDK 4/6 inhibitors plus endocrine therapy in patients with hormone receptor–positive/human epidermal growth factor receptor 2–negative advanced breast cancer. Three cohorts were compared, including patients harboring germline pathogenic variants in DNA repair–related genes (g BRCA1/2- ATM- CHEK2 mutated), those tested without these mutations (wild type [WT]), and the nontested subgroup. Relevant prognostic factors including age, metastatic site (visceral v nonvisceral), Eastern Cooperative Oncology Group, and prior treatment with CDK 4/6 inhibitors were stratified by univariate and multivariate Cox regression models. RESULTS Among the total population (n = 217), 15 (6.9%) patients carried g BRCA1/2 (n = 10)- ATM (n = 4)- CHEK2 (n = 1) pathogenic variants, 45 (20.7%) were WT, and 157 (72.4%) were nontested. Gene pathogenic variant carriers were younger ( P < .001). Most patients (164, 75.6%) had not received prior endocrine therapy in the advanced setting. Median progression-free survival was shorter in patients with evaluated germline pathogenic variants (10.2 months [95% CI, 5.7 to 14.7]), compared with WT and nontested patients (15.6 months [95% CI, 7.8 to 23.4], and (17.6 months [95% CI, 12.9 to 22.2]; P = .002). Consistently, a worse median overall survival was observed in the subgroup with germline pathogenic variants than in the WT group ( P = .006). Multivariable analysis showed that mutation status was an independent prognostic factor of progression-free survival ( P = .020) and overall survival ( P = .012). CONCLUSION In this retrospective real-world study, g BRCA1/ 2- ATM-CHEK2 pathogenic variants were independently associated with poor outcomes in patients with advanced breast cancer treated with CDK4/6 inhibitors.
El cáncer de mama es una de las enfermedades más frecuentes en todo el mundo. La amplificación del proto-oncogén HER2 se presenta en 20-25% de los tumores de mama. TDM-1 es un conjugado anticuerpo-quimioterápico. Se realizó en forma retrospectiva, observacional y descriptiva un análisis de los datos de pacientes con diagnóstico de cáncer de mama metastásico HER2 positivo, que realizaban y/o habían realizado tratamiento con dicho fármaco. Se evaluaron 27 mujeres. La indicación de TDM-1 fue en 7.4% (2) en primera línea, 37% (10) en segunda línea, y 55.5% (15) en líneas posteriores, con un tiempo a la progresión de 7.44 meses (IC: 4.33-NC) para el global de pacientes, tasa de respuesta objetiva de 44% y se constataron 7 (26%) toxicidades G3-4.
El cáncer de mama es una enfermedad frecuente en todo el mundo. Un 20-25% de estos tumores tienen sobre-expresión/amplificación de HER2. El desarrollo de anticuerpos conjugados con drogas citotóxicas no sólo maximiza el potencial de la eficacia antitumoral de la droga, sino que además minimiza la toxicidad de los tejidos normales, mejorando así el índice terapéutico. Trastuzumab emtansina (T-DM1) es un conjugado anticuerpo-quimioterápico que incorpora las propiedades anti-HER2 del trastuzumab y la actividad citotóxica del inhibidor de microtúbulos DM1 (derivado de la maytansina). Los resultados de los estudios clínicos con trastuzumab emtansina demuestran su utilidad en el tratamiento del cáncer de mama HER2 positivo, prolongando la supervivencia libre de progresión y la supervivencia global en pacientes con enfermedad metastásica previamente tratadas con trastuzumab y taxanos, con un perfil de toxicidad favorable. Los distintos estudios en curso definirán el rol de esta droga en otras líneas de cáncer de mama y posiblemente de otros tumores.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.