Review of pharmacokinetic monitoring of 5-Fluorouracil as a tool to increase efficacy and safety [Revisión del monitoreo farmacocinético del 5-fluorouracilo como herramienta para incrementar eficacia y seguridad]
Matus-Santos J.A.,Servicio de Oncologia Medica
Revista medica del Instituto Mexicano del Seguro Social | Year: 2016
Recent progress in medical knowledge has indicated that both clinical and biological markers will determine the response to different medical treatments: age, gender and genetics will determine the success of treatment. Genetic variability in this respect is fundamental and determines efficiency and safety of drugs, as well as susceptibility and illness' development. Fortunately, personalized medicine now offers individually tailored treatment strategies for each patient's needs. This is of outmost importance in oncology, since treatment is per se toxic and the commonly found low serum drug concentrations result in low treatment efficacy. Personalized medicine will allow a better approach to this, until now, a poorly managed disease. In this review we intent to raise awareness of personalized medicine and of clinical pharmacologic monitoring, with the aim to achieve adequate levels of efficacy and safety in the use of the cytotoxic drug 5-Fluorouracil (5-FU). Additionally, the importance of pharmacogenomics for the use of 5-FU is discussed. We designed this discussion towards medical practitioners challenged with treatment decisions every day, together with their patients.Los pacientes bajo tratamiento con alopurinol pueden presentar reacciones adversas potencialmente mortales, particularmente al inicio del tratamiento. Las reacciones cutáneas adversas por alopurinol tienen una prevalencia aproximada del 2 %. Presentamos dos casos de síndrome de hipersensibilidad por alopurinol en pacientes mexicanos en quienes la hiperuricemia asintomática fue la indicación para su uso. El médico general y el especialista deben estar alerta ante este síndrome que ocasiona alta morbilidad y mortalidad.
Ales Martinez J.E.,Servicio de Oncologia Medica
Revisiones en Cancer | Year: 2015
In Spain there are 25,000 new breast cancer patients every year and 6,000 women die annually of this disease. Breast cancer prevention by inhibiting estrogenic function has been repeatedly demonstrated. Recently, The British National Institute for Health and Care Excellence (NICE) has included tamoxifen and raloxifene as preventive agents for high risk populations. However, side effects associated with each of these drugs require an individualized risk evaluation and prevent their indiscriminate use. More recent chemoprevention trials with aromatase inhibitors have shown definitely that exemestane and anastrozole improve the risk/benefit ratio of pharmacological breast cancer prevention. This has led to the updated guidelines of the American Association of Clinical Oncology (ASCO) to add exemestane as a new breast cancer preventive agent. However, there is still considerable lack of information and insight into the cause and ways to prevent hormone receptor negative breast cancer. New findings into the mechanisms underlying breast cancer carcinogenesis, the discovery of new molecular targets and development of even better-tolerated drugs are needed to make additional progress in this area. Copyright © 2015 ARAN EDICIONES, S.L.
Garcia R.V.,Servicio de Oncologia Medica |
Dorronsoro M.G.,Complejo Hospitalario Of Navarra
Cancer and Chemotherapy Reviews | Year: 2012
Perioperative chemotherapy improves outcome in resectable colorectal liver metastases and turns unresectable metastases into a resectable disease. This review discusses the advances in pre-operative neoadjuvant therapy with bevacizumab in patients with colorectal cancer liver metastases, focused in the measurement of histological changes after treatment. Several grading systems have been used to evaluate pathological response, a microscopic measure of the residual tumor cells in the liver metastases after treatment. Rubbia-Brandt published the first description of pathological response quantification in resected colorectal liver metastases after chemotherapy treatment by adapting the scheme previously described by Mandard and based in the proportion between residual cancer cells and fibrosis. Blazer assessed the response with a semiquantitative system by estimating the proportion of residual cells in relation to the total tumor area. Such pathological response has emerged as a strong predictive factor, with prognostic impact on survival after hepatectomy, and the addition of bevacizumab to chemotherapy has shown an improvement in the histological response to neoadjuvant therapy. Moreover, addition of bevacizumab reduces the incidence and severity of sinusoidal dilation compared with chemotherapy alone. The correlation of radiological information on residual neoplastic disease after neoadjuvant treatment plus bevacizumab is poor when radiological response is determined on the basis of RECIST criteria. Recent reports have shown an improvement in progression-free and overall survival with the addition of bevacizumab to chemotherapy, regardless of objective tumor response monitored with the RECIST criteria. That is why new criteria have been described by Chun, et al. They reported a median overall survival of 31 months for patients with optimal morphologic response compared with 19 months with incomplete or no response.
Garcia-Foncillas J.,Servicio de Oncologia Medica
Clinical and Translational Oncology | Year: 2010
The prognosis of metastatic colorectal cancer remains poor despite advances made in recent years, particularly with new treatments directed towards molecular targets. Cetuximab, a chimeric immunoglobulin (Ig)G1 monoclonal antibody that targets the ligand-binding domain of the epidermal growth factor receptor (EGFR), is active in metastatic colorectal cancer. As an IgG1 antibody, cetuximab may exert its antitumour efficacy through both EGFR antagonism and antibody-dependent cell-mediated cytotoxicity. The benefits of cetuximab in metastatic colorectal cancer are well documented in clinical trials and are acknowledged in the approval and licensing of this agent. There is evidence of the role of cetuximab not only in irinotecan-refractory or heavily pretreated patients, but also of the efficacy and safety of the addition of this agent to FOLFIRI (irinotecan/5-fluorouracil/leucovorin) in first-line metastatic colorectal cancer, with an enhanced effect in 5-fluorouracil patients with Kirsten rat sarcoma (KRAS) wild-type tumours. In these patients, a recent meta-analysis of the pooled Cetuximab Combined with Irinotecan in First-Line Therapy for Metastatic Colorectal Cancer (CRYSTAL) and Oxaliplatin and Cetuximab in First-Line Treatment of mCRC (OPUS) patient populations confirms that the addition of cetuximab to first-line chemotherapy achieves a statistically significant improvement in the best overall response, overall survival time, and progression-free survival (PSF) compared with chemotherapy alone. In nonresectable colorectal liver metastases, cetuximab plus FOLFOX-6 (oxaliplatin/5-fluorouracil/leucovorin) or cetuximab plus FOLFIRI increased significantly resectability of liver metastases, including R0 resections. Also, preliminary data indicate that cetuximab can be administered in a more convenient 2-week schedule in combination with standard chemotherapy. Cetuximab is generally well tolerated. Acne-form rash is the most frequent toxicity. Up to the present time, the results obtained with targeted therapy combinations are not as encouraging as initially expected. The identification of biomarkers associated with disease control, including KRAS and BRAF mutation status in patients treated with cetuximab, is changing the current management of metastatic colorectal cancer. Clinical and molecular predictive markers of response are under active evaluation in order to better select patients who could benefit from cetuximab treatment, with the aim of both optimising patient outcomes and avoiding unnecessary toxicities. © 2010 Feseo.
Servitja Tormo S.,Servicio de Oncologia Medica
Ginecologia y Obstetricia Clinica | Year: 2010
The monoclonal antibody against Her2 Trastuzumab is used in Her2-positive breast cancer. We well known the acute cardiac toxicity but we don't know its effect at larger follow up and its effects in fetal development. We present a case report about a young woman with breast cancer who became pregnant during adjuvant trastuzumab treatment. With an accurate obstetric control, monitoring the developing of anhidramnios, it is possible to maintain the trastuzumab treatment without important problems for the fetus.
Perez Gomez M.,Servicio de Oncologia Medica |
Pedroza Melendez A.,Servicio de Alergia |
Huerta Lopez J.G.,Jefe del Servicio de Alergia
Revista Alergia Mexico | Year: 2010
All chemotherapeutic agents have the potential to induce hypersensitivity reactions and the repeated administration of such drugs during a cancer treatment enhances specific sensitization. Epipodophyllotoxins (etoposide and teniposide) are commonly used to treat lung, testicular, central nervous system and hematologic cancers. Hypersensitivity reactions to epipodophyllotoxins are not the most common but they have been reported. We present a case of an eight-year old male patient, diagnosed with high risk acute lymphoblastic leukemia who received treatment with etoposide among other drugs (St. Jude XIIIB). During the first course of treatment he needed premedication to etoposide administration because of mild hypersensitivity reactions. At the beginning of a second treatment the patient presented two severe hypersensitivity reactions (acute urticaria, angioedema and hypotension) despite the use of premedication and slow infusion. We initiated a twelve steps desensitization protocol for etoposide with success in the second round allowing the administration of further doses in an ambulatory unit without hypersensitivity reactions.
Medina-Villaamil V.,Institute Investigacion Biomedica |
Martinez-Breijo S.,Servicio de Urologia Medica |
Portela-Pereira P.,Servicio de Urologia Medica |
Quindos-Varela M.,Servicio de Oncologia Medica |
And 4 more authors.
Actas Urologicas Espanolas | Year: 2014
Introduction: MicroRNAs (miRNAs) are small regulatory RNAs that do not code for proteins. Detection of circulating tumor cells (CTC) would provide diagnostic and prognostic information in prostate tumors (PT). Thus, miRNAs could constitute a promising new class of biomarkers for CTC detection. Objectives: To analyze circulating microRNAs in whole blood as non-invasive markers in patients with localized prostate cancer and healthy individuals. Material and methods: A preliminary study including a population of 40 patients with mean age of 71 years and mean PSA of 18, 9ng/ml (range). Regarding the risk group (RG): 33.3% had low risk, 30% intermediate risk and 36.7% high risk. A previous in silico study identified 92 candidates and was followed by another in vivo to verify the findings of the former using array technology by real-time PCR. Results: Statistical analysis of the results revealed 10 microRNAs candidates with statistically significant differential expression between the different risk groups and healthy controls: hsa-miR-337-3p, hsa-miR-330-3p, hsa-miR-339-3p, hsa-miR-124, hsa-miR-218, hsa-miR-128, hsa-miR-10a, hsa-miR-199b-5p, hsa-miR-200b and hsa-miR-15b. Conclusions: Our data suggest that circulating microRNAs can act as biomarkers to identify risk groups in CaP. © 2013 AEU.
PubMed | Servicio de Oncologia Medica
Type: Journal Article | Journal: Revista medica del Instituto Mexicano del Seguro Social | Year: 2016
Recent progress in medical knowledge has indicated that both clinical and biological markers will determine the response to different medical treatments: age, gender and genetics will determine the success of treatment. Genetic variability in this respect is fundamental and determines efficiency and safety of drugs, as well as susceptibility and illness development. Fortunately, personalized medicine now offers individually tailored treatment strategies for each patients needs. This is of outmost importance in oncology, since treatment is per se toxic and the commonly found low serum drug concentrations result in low treatment efficacy. Personalized medicine will allow a better approach to this, until now, a poorly managed disease. In this review we intent to raise awareness of personalized medicine and of clinical pharmacologic monitoring, with the aim to achieve adequate levels of efficacy and safety in the use of the cytotoxic drug 5-Fluorouracil (5-FU). Additionally, the importance of pharmacogenomics for the use of 5-FU is discussed. We designed this discussion towards medical practitioners challenged with treatment decisions every day, together with their patients.
PubMed | Hospital Universitario Basurto, CIBER ISCIII, San Sebastián University, University of Valencia and 6 more.
Type: | Journal: Oncotarget | Year: 2016
A prospective study was performed of patients diagnosed with colorectal cancer (CRC), distinguishing between colonic and rectal location, to determine the factors that may provoke a delay in the first treatment (DFT) provided.2749 patients diagnosed with CRC were studied. The study population was recruited between June 2010 and December 2012. DFT is defined as time elapsed between diagnosis and first treatment exceeding 30 days.Excessive treatment delay was recorded in 65.5% of the cases, and was more prevalent among rectal cancer patients. Independent predictor variables of DFT in colon cancer patients were a low level of education, small tumour, ex-smoker, asymptomatic at diagnosis and following the application of screening. Among rectal cancer patients, the corresponding factors were primary school education and being asymptomatic.We conclude that treatment delay in CRC patients is affected not only by clinicopathological factors, but also by sociocultural ones. Greater attention should be paid by the healthcare provider to social groups with less formal education, in order to optimise treatment attention.
PubMed | Hospital Universitario La Paz, Consorcio Hospital Provincial Of Castellon, Complejo Hospitalario Regional Virgen Macarena Of Seville, Complexo Hospitalario Universitario runa Hospital Juan Canalejo 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
Chemotherapy-induced nausea and vomiting is one of the most worrisome adverse effects of chemotherapy for cancer patients. It can cause severe discomfort and affect the quality of life. In recent years, the incorporation of new drugs has increased the efficacy of antiemetic treatments in the control of emesis associated with chemotherapy. This guideline, in which we give some treatment recommendations with level of evidence and grade of recommendation, provides an update of the previously published guideline of the Spanish Society of Medical Oncology and represents our continued commitment to improving supportive care in cancer patients.