Parc Tauli Sabadell Hospital Universitari

Barcelona, Spain

Parc Tauli Sabadell Hospital Universitari

Barcelona, Spain
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Gallardo E.,Parc Tauli Sabadell Hospital Universitari | Arranz J.T.,Hospital General Universitario Gregorio Maranon | Maroto J.P.,Hospital Of La Santa Creu I Sant Pau | Leon L.T.,Hospital Clinico Universitario | Bellmunt J.,Hospital del Mar IMAS
Critical Reviews in Oncology/Hematology | Year: 2013

The term castration-resistant prostate cancer (CRPC) encompasses a wide variety of patients with different prognoses. The combination of docetaxel and prednisone is considered as the standard first-line chemotherapy. For years, patients progressing on docetaxel have been managed with second- and third-line hormone therapies, re-treatment with docetaxel, or combined mitoxantrone and prednisone. Recently published results of four studies using different drugs: cabazitaxel (CBZ), abiraterone (AA), enzalutamide (ENZ), and radium 223, showed an increased survival in such patients. In this article, authors make some considerations about criteria guiding the choice of a second-line chemotherapy after docetaxel in patients with metastatic CRPC, and propose an algorithm based on scientific evidence and consensus for rational use of cabazitaxel in this scenario. © 2013 Elsevier Ireland Ltd.


PubMed | Hospital Vall dHebron, Hospital Universitario La Paz, Complejo Hospitalario Ourense Hospital Santa Maria Nai, Hospital Universitario Clinico Virgen Of La Victoria and 33 more.
Type: | Journal: BMC cancer | Year: 2016

The impact of such recommendations after their implementation of guidelines has not usually been evaluated. Herein, we assessed the impact and compliance with the Spanish Oncology Genitourinary Group (SOGUG) Guidelines for toxicity management of targeted therapies in metastatic renal cell carcinoma (mRCC) in daily clinical practice.Data on 407 mRCC patients who initiated first-line targeted therapy during the year before and the year after publication and implementation of the SOGUG guideline program were available from 34 Spanish Hospitals. Adherence to SOGUG Guidelines was assessed in every cycle.Adverse event (AE) management was consistent with the Guidelines as a whole for 28.7% out of 966 post-implementation cycles compared with 23.1% out of 892 pre-implementation cycles (p = 0.006). Analysis of adherence by AE in non-compliant cycles showed significant changes in appropriate management of hypertension (33% pre-implementation vs. 44.5% post-implementation cycles; p < 0.0001), diarrhea (74.0% vs. 80.5%; p = 0.011) and dyslipemia (25.0% vs. 44.6%; p < 0.001).Slight but significant improvements in AE management were detected following the implementation of SOGUG recommendations. However, room for improvement in the management of AEs due to targeted agents still remains and could be the focus for further programs in this direction.


PubMed | Hospital Of Basurto, Hospital Universitario Of Salamanca, Hospital General Universitario Gregorio Maranon, Instituto Valenciano Of Oncologia and 3 more.
Type: | Journal: Critical reviews in oncology/hematology | Year: 2016

Treatment of metastatic castration-resistant prostate cancer (mCRPC) has been revolutionized in recent years. It is well known that androgen receptor is still active in most patients with disease progression and serum testosterone levels <50 ng/dL. Moreover, further hormonal maneuvers, either through decreasing androgen levels (abiraterone) or by targeting the androgen receptor (AR) pathway (enzalutamide), prolong survival. In addition, a new cytostatic able to overcome docetaxel resistance, cabazitaxel, and the radioisotope radium 223 have been incorporated to the armamentarium of mCRPC. mCRPC is not only a heterogeneous tumor, it changes over time developing neuroendocrine features or selection of clones resistant to hormonal maneuvers. In addition, the multiplicity of current treatments, make it necessary to design algorithms that help the specialist to choose the most appropriate treatment for a particular patient. The lack of randomized trials comparing face to face the different available options limit the scope of this review. In this article, the authors describe the prognostic factors for first line therapy in patients with mCRPC, and propose a treatment algorithm for mCRPC based on the levels of scientific evidence available and, if not available, on the consensus between medical professionals. Finally, the panel discuss how to define progressive disease in the setting of mCRPC and treatment with targeted therapies.


Araujo J.C.,University of Houston | Trudel G.C.,Bristol Myers Squibb | Saad F.,Center Hospitalier Of Luniversite Of Montreal | Armstrong A.J.,Duke University | And 22 more authors.
The Lancet Oncology | Year: 2013

Background: Src kinase-mediated interactions between prostate cancer cells and osteoclasts might promote bone metastasis. Dasatinib inhibits tyrosine kinases, including Src kinases. Data suggests that dasatinib kinase inhibition leads to antitumour activity, affects osteoclasts, and has synergy with docetaxel, a first-line chemotherapy for metastatic castration-resistant prostate cancer. We assessed whether dasatinib plus docetaxel in chemotherapy-naive men with metastatic castration-resistant prostate cancer led to greater efficacy than with docetaxel alone. Methods: In this double-blind, randomised, placebo-controlled phase 3 study, we enrolled men of 18 years or older with chemotherapy-naive, metastatic, castration-resistant prostate cancer, and adequate organ function from 186 centres across 25 countries. Eligible patients were randomly assigned (1:1) via an interactive voice response system to receive docetaxel (75 mg/m2 intravenously every 3 weeks, plus oral prednisone 5 mg twice daily), plus either dasatinib (100 mg orally once daily) or placebo until disease progression or unacceptable toxicity. Randomisation was stratified by Eastern Cooperative Oncology Group performance status (0-1 vs 2), bisphosphonate use (yes vs no), and urinary N-telopeptide (uNTx) value (<60 μmol/mol creatinine vs ≥60 μmol/mol creatinine). All patients, investigators, and personnel involved in study conduct and data analyses were blinded to treatment allocation. The primary endpoint was overall survival, analysed by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT00744497. Findings: Between Oct 30, 2008, and April 11, 2011, 1522 eligible patients were randomly assigned to treatment; 762 patients were assigned to dasatinib and 760 to placebo. At final analysis, median follow-up was 19·0 months (IQR 11·2-25·1) and 914 patients had died. Median overall survival was 21·5 months (95% CI 20·3-22·8) in the dasatinib group and 21·2 months (20·0-23·4) in the placebo group (stratified hazard ratio [HR] 0·99, 95·5% CI 0·87-1·13; p=0·90). The most common grade 3-4 adverse events included diarrhoea (58 [8%] patients in the dasatinib group vs 27 [4%] patients in the placebo group), fatigue (62 [8%] vs 42 [6%]), and asthenia (40 [5%] vs 23 [3%]); grade 3-4 pleural effusions were uncommon (ten [1%] vs three [<1%]). Interpretation: The addition of dasatinib to docetaxel did not improve overall survival for chemotherapy-naive men with metastatic castration-resistant prostate cancer. This study does not support the combination of dasatinib and docetaxel in this population of patients. Funding: Bristol-Myers Squibb. © 2013 Elsevier Ltd.


Cabanas-Valdes R.,International University of Catalonia | Bagur-Calafat C.,International University of Catalonia | Girabent-Farres M.,International University of Catalonia | Caballero-Gomez F.M.,Parc Tauli Sabadell Hospital Universitari | And 2 more authors.
Clinical Rehabilitation | Year: 2016

Objective: To examine the effect of core stability exercises on trunk control, dynamic sitting and standing balance, gait, and activities of daily living in subacute stroke patients. Design: A randomized controlled trial. Setting: Inpatient rehabilitation hospital in two centres. Subjects: Eighty patients (mean of 23.25 (±16.7) days post-stroke) were randomly assigned to an experimental group and a control group. Interventions: Both groups underwent conventional therapy for five days/week for five weeks and the experimental group performed core stability exercises for 15 min/day. The patients were assessed before and after intervention. Main measures: The Trunk Impairment Scale (Spanish-Version) and Function in Sitting Test were used to measure the primary outcome of dynamic sitting balance. Secondary outcome measures were standing balance and gait as evaluated via Berg Balance Scale, Tinetti Test, Brunel Balance Assessment, Postural Assessment Scale for Stroke (Spanish-Version), and activities of daily living using Barthel Index. Results: The experimental group showed statistically significant differences for all of the total scale scores (P<0.05), except for the sitting section of the Brunel Balance Assessment. The mean (SD) difference between groups in Trunk Impairment Scale total score was 3.40 (±4.12) points, and its subscale dynamic sitting balance was 2.28 (±3.29). The Berg Balance Scale was 14.54 (±18.19) points, and the Barthel Index was 13.17 (±25.27) points. Collectively, these results were in favour of the experimental group. Conclusions: Core stability exercises in addition to conventional therapy improves trunk control, dynamic sitting balance, standing balance, gait and activities of daily living in subacute post-stroke patients. © The Author(s) 2015.


PubMed | Parc Tauli Sabadell Hospital Universitari, University Pompeu Fabra and University of Barcelona
Type: Clinical Trial, Phase I | Journal: The oncologist | Year: 2014

The combination of gemcitabine plus capecitabine and sunitinib (GCS) shows activity in metastatic renal cell carcinoma (mRCC). We tested the multitargeted chemo-switch regimen as first-line treatment in patients with mRCC.We assessed the maximum tolerated dose and antitumor activity of GCS in treatment-nave, advanced mRCC patients. Treatment consisted of intravenous gemcitabine on days 1 and 8, oral capecitabine twice daily on days 1-14, and oral sunitinib daily for six 21-day cycles, followed by sunitinib monotherapy at the investigators discretion. Dose level 0 (DL0) was gemcitabine 1,000 mg/m(2) per day plus capecitabine 650 mg/m(2) per 12 hours plus sunitinib 37.5 mg/day; DL1 was gemcitabine 1,000 mg/m(2) per day plus capecitabine 850 mg/m(2) per 12 hours plus sunitinib 37.5 mg/day.Sixteen patients were enrolled. At DL1, two of four patients had dose-limiting toxicity (DLT; grade 3 diarrhea and grade 4 thrombocytopenia). The dose was reduced to DL0 when only 1 of 12 patients experienced DLT (grade 3 diarrhea, grade 3 mucositis, and grade 3 thrombocytopenia). Dose reductions were frequent (58% of patients), and only seven patients were able to receive the three drugs for more than three cycles. One patient achieved a complete response, three had partial responses, and the best response for four was stable disease.The safety profile of the combination does not seem manageable in this patient population. No further development of the combination is recommended.


PubMed | International University of Catalonia, Biomedical Research Institute Sant Pau, Parc Tauli Sabadell Hospital Universitari and Parc Sanitari Pere Virgili
Type: Journal Article | Journal: Clinical rehabilitation | Year: 2015

To examine the effect of core stability exercises on trunk control, dynamic sitting and standing balance, gait, and activities of daily living in subacute stroke patients.A randomized controlled trial.Inpatient rehabilitation hospital in two centres.Eighty patients (mean of 23.25 (16.7) days post-stroke) were randomly assigned to an experimental group and a control group.Both groups underwent conventional therapy for five days/week for five weeks and the experimental group performed core stability exercises for 15 min/day. The patients were assessed before and after intervention.The Trunk Impairment Scale (Spanish-Version) and Function in Sitting Test were used to measure the primary outcome of dynamic sitting balance. Secondary outcome measures were standing balance and gait as evaluated via Berg Balance Scale, Tinetti Test, Brunel Balance Assessment, Postural Assessment Scale for Stroke (Spanish-Version), and activities of daily living using Barthel Index.The experimental group showed statistically significant differences for all of the total scale scores (P<0.05), except for the sitting section of the Brunel Balance Assessment. The mean (SD) difference between groups in Trunk Impairment Scale total score was 3.40 (4.12) points, and its subscale dynamic sitting balance was 2.28 (3.29). The Berg Balance Scale was 14.54 (18.19) points, and the Barthel Index was 13.17 (25.27) points. Collectively, these results were in favour of the experimental group.Core stability exercises in addition to conventional therapy improves trunk control, dynamic sitting balance, standing balance, gait and activities of daily living in subacute post-stroke patients.


PubMed | Hospital Universitario La Paz, Hospital Alvaro Cunqueiro Complexo Hospitalario Universitario Of Vigo, Hospital Universitario San Carlos, Parc Tauli Sabadell Hospital Universitari and 6 more.
Type: Journal Article | Journal: Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico | Year: 2016

The goal of this article is to provide recommendations for the diagnosis and treatment of muscle-invasive and metastatic bladder cancer. The diagnosis of muscle-invasive bladder cancer is made by pathologic evaluation after transurethral resection. Recently, a molecular classification has been proposed. Staging of muscle-invasive bladder cancer must be done by computed tomography scans of the chest, abdomen and pelvis and classified on the basis of UICC system. Radical cystectomy and lymph node dissection are the treatment of choice. In muscle-invasive bladder cancer, neoadjuvant chemotherapy should be recommended in patients with good performance status and no renal function impairment. Although there is insufficient evidence for use of adjuvant chemotherapy, its use must be considered when neoadjuvant therapy had not been administered in high-risk patients. Multimodality bladder-preserving treatment in localized disease is an alternative in selected and compliant patients for whom cystectomy is not considered for clinical or personal reasons. In metastatic disease, the first-line treatment for patients must be based on cisplatin-containing combination. Vinflunine is the only drug approved for use in second line in Europe. Recently, immunotherapy treatment has demonstrated activity in this setting.


PubMed | Parc Tauli Sabadell Hospital Universitari
Type: Journal Article | Journal: Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva | Year: 2016

Running is popular. Ischemic colitis has been reported in marathon runners. We present a case of an amateur runner who developed ischemic colitis after a relatively short run.


PubMed | Parc Tauli Sabadell Hospital Universitari
Type: Journal Article | Journal: Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva | Year: 2016

Acute pancreatitis is often a relapsing condition, particularly when its triggering factor persists. Our goal is to determine the recurrence rate of acute biliary pancreatitis after an initial episode, and the time to relapse, as well as to identify the risk factors for recurrence.We included all patients admitted for a first acute gallstone pancreatitis event during four years. Primary endpoints included readmission for recurrence and time to relapse.We included 296 patients admitted on a total of 386 occasions. The incidence of acute biliary pancreatitis in our setting is 17.5/100,000 population/year. In all, 19.6% of pancreatitis were severe (22.6% of severe acute pancreatitis for first episodes versus 3.6% for recurring pancreatitis), with an overall mortality of 4.4%. Overall recurrence rate was 15.5%, with a median time to relapse of 82 days. In total, 14.2% of patients relapsed after an acute pancreatitis event without cholecystectomy or endoscopic retrograde cholangio-pancreatography. Severe acute pancreatitis recur in 7.2% of patients, whereas mild cases do so in 16.3%, this being the only risk factor for recurrence thus far identified.Patients admitted for pancreatitis should undergo cholecystectomy as soon as possible or be guaranteed priority on the waiting list. Otherwise, endoscopic retrograde cholangio-pancreatography with sphincterotomy may be an alternative to surgery for selected patients.

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