Resultados do tratamento do carcinoma espinocelular anal e do seu precursor em doentes HIV-positivos

Nadal, Sidney Roberto; Horta, Sérgio Henrique Couto; Calore, Edenilson Eduardo; Manzione, Carmen Ruth

doi:10.1590/s0104-42302007000400025

Cited by 3 publications

(3 citation statements)

References 34 publications

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“…The results from a series of epidemiologic studies conclude that HPV infection is central to anal cancer development as well [2, 14]. In fact, the presence of HPV DNA in SCCAs is so high (ranging in the literature 35–60%) [15], it suggests that HPV presence may be a necessary cause for squamous cell carcinomas of the anal canal [16].…”

Section: Current Understanding Of Sccamentioning

confidence: 99%

“…It also is likely that variations in the E6 gene sequence may allow evasion from the host immune system, which would result in increased viral persistence [28]. A mechanistic possibility is that HPV induces high‐grade dysplasia by integrating into host DNA and/or inhibiting the p53 protein, possibly through the interaction of E6 proteins with host factor E6AP ubiquitin ligase, binding p53 and causing its degradation [15]. The p53 gene is frequently wild‐type in HPV‐related cervical cancers, and the same is likely in SCCA.…”

Section: Current Understanding Of Sccamentioning

confidence: 99%

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Current Understanding and Potential Immunotherapy for HIV‐Associated Squamous Cell Carcinoma of the Anus (SCCA)

Marín-Müller

Chen

et al. 2008

World j. surg.

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Squamous cell carcinoma of the anus (SCCA) is a rare disease in the average population, but is of increasing concern among immuncompromised individuals such as the HIV seropositive. Coinfection with human papillomavirus (HPV) in this population is common. HPV infection is difficult to clear with a compromised immune system, which results in a greater risk of tumor development and a more aggressive progression of the disease. The recent approval of a prophylactic HPV vaccine for cervical cancer has sparked an interest in a search for improved immunotherapeutic multimodality therapies to combat anogenital tumors associated with the virus. In this review, we discuss the known mechanisms of action of HIV-associated SCCA, examine the current treatments for the disease, and focus on the potential of an immunotherapeutic vaccine approach for both prophylactic and therapeutic application.

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Section: Current Understanding Of Sccamentioning

confidence: 99%

Section: Current Understanding Of Sccamentioning

confidence: 99%

Current Understanding and Potential Immunotherapy for HIV‐Associated Squamous Cell Carcinoma of the Anus (SCCA)

Marín-Müller

Chen

et al. 2008

World j. surg.

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“…15 Atualmente, doentes HIV-positivo que apresentam CD4 superior a esse nível e carga viral sérica indetectável não são considerados imunodeprimidos graves e são tratados da mesma forma que os soronegativos. [16][17][18] Há autores que não observaram diferenças com esse tratamento nessa população quando comparada à dos soronegativos para o HIV, 18,19 embora outros tenham referido aumento da toxicidade do esquema nos doentes soropositivos. 5,[11][12][13] Estudos comparando doentes imunodeprimidos e imunocompetentes vêm mostrado, respectivamente, envolvimento linfonodal em 60% e 17%, recidivas em 75% e 6%, boa resposta à radio e quimioterapia em 62% e 85%, toxicidade a esse tratamento em 80% e 30%, e sobrevivência global de 1,4 e 5,3 anos.…”

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Seguimento dos doentes soropositivos e soronegativos para o HIV com carcinoma espinocelular do canal anal

Nadal

Cruz²

2009

Rev bras. colo-proctol.

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RESUMO: A incidência do carcinoma espinocelular (CEC) anal e das neoplasias intra-epiteliais anais (NIA) é maior nos pacientes infectados pelo papilomavírus humano (HPV), e está relacionada à imunidade e à infecção pelo vírus da imunodeficiência humana (HIV). A associação com viroses de transmissão sexual indica que seja tumor sexualmente transmitido. A infecção pelo HIV mudou o perfil dos portadores do CEC anal. A doença que anteriormente acometia mulheres na 6 a década de vida, hoje atinge preferencialmente homens na 3ª e 4 a décadas. Nos Estados Unidos, a expectativa de diagnóstico desse tumor aumentou de 19/ 100.000, na época pré-HAART (1992-1995), para 48,3/100.000 no período pós-HAART imediato (1996-1999) e para 78,2/100.000 pessoas por ano, nos anos mais recentes (2000-2003). O tratamento do CEC anal, descrito por Nigro em 1974, combina radio e quimioterapia. Operações de resgate estão indicadas caso haja persistência ou recidiva da doença. Estudos comparando, respectivamente, doentes imunodeprimidos e imunocompetentes vêm mostrado envolvimento linfonodal em 60% e 17%, recidivas em 75% e 6%, boa resposta à radio e quimioterapia em 62% e 85%, toxicidade a esse tratamento em 80% e 30%, e sobrevivên-cia global de 1,4 e 5,3 anos. A contagem sérica baixa de linfócitos T CD4 prediz mau prognóstico. Quando acima de 200/mm 3 , os resultados são comparáveis aos observados entre os imunocompetentes.

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Treatment outcomes of patients with localized anal squamous cell carcinoma according to HIV infection: systematic review and meta-analysis

Camandaroba

Araújo

Silva

et al. 2018

J. Gastrointest. Oncol

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Background: Definitive chemoradiation (CRT) is the standard treatment for localized squamous cell carcinoma of the anus (SCCA). Because most phase III trials in SCCA have excluded patients with HIV, the evidence on treatment outcomes of these patients is lacking. We performed a systematic review and metaanalysis on the efficacy and toxicity profiles of HIV-positive SCCA patients treated with definitive CRT. Methods: The systematic search was conducted Embase, Medline, Cochrane Libary, Scopus, Lilacs and Opengrey, from inception until September 2017. Eligible studies were clinical trials, prospective or retrospective cohort studies. The main outcome variables were 3-year disease-free survival (DFS) and overall survival (OS) rates and frequency of grade 3 or 4 (G3/4) treatment-related toxicities, according to HIV status. Meta-analyses using pooled risk ratios were performed for binary outcomes from comparative studies from the antiretroviral therapy (HAART) era with the fixed effects model. Results: Out of 3,951 studies, 40 were deemed eligible, with a total of 3,720 patients. One third (N=1,298; 34%) were HIV-positive and their median pre CRT CD4 count was 347 μm/L. HIV-positive patients presented higher risk of G3/4 cutaneous toxicities [risk ratio (RR) =1.34; 95% CI, 1.10-1.64; P=0.004; I 2 =77.7%], worse 3-year DFS rate (RR =1.32; 95% CI, 1.01-1.74; P=0.043; I 2 =52.19%), and 3-year OS rate (RR =1.77; 95% CI, 1.35-2.32; P<0.001; I 2 =6%). Conclusions: Patients with localized SCCA and HIV infection treated with CRT tend to experience higher risk of toxicities and worse DFS and OS rates. Our findings suggest that future trials should be tailored to HIV-positive patients.

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Resultados do tratamento do carcinoma espinocelular anal e do seu precursor em doentes HIV-positivos

Cited by 3 publications

References 34 publications

Current Understanding and Potential Immunotherapy for HIV‐Associated Squamous Cell Carcinoma of the Anus (SCCA)

Current Understanding and Potential Immunotherapy for HIV‐Associated Squamous Cell Carcinoma of the Anus (SCCA)

Seguimento dos doentes soropositivos e soronegativos para o HIV com carcinoma espinocelular do canal anal

Treatment outcomes of patients with localized anal squamous cell carcinoma according to HIV infection: systematic review and meta-analysis

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