Long survival of a patient from Matanzas with lung cancer and brain metastasis. Case report

El cáncer de pulmón constituye la primera causa de muerte por tumores malignos y el de células no pequeñas es el más frecuente. Este se caracteriza por una tendencia a metatizar órganos importantes como el sistema nervioso central para lo cual se estima una supervivencia media de tres a seis meses después de tratado con radiación. Se presenta el caso de una paciente de 55 años, no fumadora, que fue atendida en el servicio de Oncología, donde se le realizaron estudios, observándose imagen nodular en el lóbulo inferior del pulmón derecho; se tomó muestra que informó carcinoma epidermoide, en estadio T2aN0M0 Etapa Ib. Se implementaron varios esquemas de tratamiento, incluida intervención quirúrgica. En noviembre de 2018 fallece. Se trata de una paciente con diagnóstico de carcinoma epidermoide de pulmón con metástasis cerebral y ósea que logró una supervivencia global de seis años, superando la media establecida hasta la actualidadLung cancer is the leading cause of death from malignant tumors, with non-small cell cancer being the most common. This ischaracterized by a tendency to metatize important organs such as the central nervous system, for which an average survivalof three to six months is estimated after being treated with radiation. We present the case of a 55-year-old patient, non-smoker, who was studied in the Oncology service, where studies were carried out, observing a nodular image in the lower lobe of the right lung; sample was taken that she reported squamous cell carcinoma, stage T2aN0M0 Stage Ib. Several treatment schemeswere implemented, including surgical intervention. In November 2018 she passes away. She is a patient with a diagnosis ofsquamous cell carcinoma of the lung with brain and bone metastases who achieved an overall survival of six years, exceeding the average established to date

Estado actual de largos supervivientes con cáncer de pulmón tratados con inmunoterapia

Introduction: Non-small cell lung cancer (NSCLC) is one of the leading causes of death in the world, however, the application of immunotherapy has improved the quality of life and overall survival. Objective: To characterize the current health status of patients with long-survival NSCLC treated with active Cuban immunotherapy in the province of Matanzas. Methodology: A descriptive, retrospective study was conducted in 24 patients with a cytohistological diagnosis of NSCLC treated with active Cuban immunotherapy, in the Provincial Oncology Service of Matanzas, from January 2010 to July 2021. The data were obtained through the medical records and reports of the Department of Pathological Anatomy of the "Faustino Pérez" Hospital. Results and discussion: Patients with long-survival NSCLC were mostly men, with a white complexion, older than 60 years, with a diagnosis of squamous cell carcinoma, stage IIIB-IV, with first-line treatment with chemotherapy and radiotherapy, followed by active immunotherapy with Vaxira and CIMAvax-EGF, associated with a survival of 5 to 15 years and low lethality. Conclusions: Patients treated with active immunotherapy presented long survival associated with a better quality of life.Introducción: El cáncer de pulmón de células no pequeñas (CPCNP) constituye una de las principales causas de muerte en el mundo, sin embargo, la aplicación de inmunoterapia ha mejorado la calidad de vida y supervivencia global. Objetivo: Caracterizar el estado de salud actual de los pacientes con CPCNP de larga supervivencia tratados con inmunoterapia activa cubana en la provincia de Matanzas. Metodología: Se realizó un estudio descriptivo, retrospectivo, en 24 pacientes con diagnóstico citohistológico de CPCNP tratados con inmunoterapia activa cubana, en el Servicio de Oncología Provincial de Matanzas, desde enero del 2010 hasta julio del 2021. Los datos se obtuvieron a través de las historias clínicas y de los informes del departamento de Anatomía Patológica del Hospital “Faustino Pérez”. Resultados y discusión: Los pacientes con CPCNP de larga supervivencia fueron en su mayoría hombres, de tez blanca, mayores de 60 años, con diagnóstico de carcinoma epidermoide, en etapa IIIB-IV, con tratamiento de primera línea con quimioterapia y radioterapia, seguido de inmunoterapia activa con Vaxira y CIMAvax-EGF, asociado a una supervivencia de 5 a 15 años y baja letalidad. Conclusiones: Los pacientes tratados con inmunoterapia activa presentaron larga supervivencia asociada a una mejor calidad de vida

Venous thromboembolic disease in patients with lung cancer

Introducción: La enfermedad tromboembólica engloba dos grandes entidades que son la trombosis venosa profunda y el tromboembolismo pulmonar, en conjunto constituyen la segunda causa de mortalidad en los pacientes con cáncer y en ocasiones la primera manifestación de una neoplasia oculta subyacente. Se presenta más frecuentemente en tumores de estómago, páncreas, ginecológicos, vejiga, testículo y pulmón, localización en la cual aparece hasta en el 14% de los casos y que puede aumentar aún más con el tratamiento. Para su manejo se recomienda evaluar el riesgo y posteriormente el uso de las heparinas de bajo peso molecular, aunque otras opciones pueden ser empleadas. Objetivo: explicar los elementos epidemiológicos, fisiopatológicos y el tratamiento de la enfermedad tromboembólica en pacientes con cáncer de pulmón. Metodología: Se realizó una revisión y análisis de la bibliografía, detallando incidencia, etiología en pacientes oncológicos y principales opciones de manejo. Conclusiones: Su adecuado diagnóstico y oportuno manejo garantizarán para los pacientes una mejor calidad de vida y mayor supervivencia global, y para las instituciones hospitalarias una reducción de gastos significativos.Introduction: Thromboembolic disease encompasses two major entities that are deep vein thrombosis and pulmonary thromboembolism together constitute the second leading cause of death in cancer patients and sometimes the first manifestation of underlying hidden neoplasm. It occurs most frequently in stomach, pancreas, gynecological, bladder, testicle and lung tumors, where it appears in up to 14% of cases and can increase further with treatment. For its management it is recommended to evaluate the risk and subsequently the use of low molecular weight heparins, although other options can be used. Objective: to explain the epidemiological ant pathophysiological elements and the treatment of thromboembolic disease in patients with lung cancer. Methodology: A review and analysis of the bibliography was carried out, detailing incidence, etiology in cancer patients and main management options. Conclusions: Its proper diagnosis and timely management will ensure for patients a better quality of life and greater overall survival, and for hospital institutions a reduction in significant expenditures

Intervención sobre Covid19 en pacientes con cáncer de pulmón y sus familiares

Introduction: COVID 19 is a pandemic disease caused by the SARS-CoV-2 virus, with several groups vulnerable to complications of infection such as patients with lung cancer, associated with immunosuppression due to the oncospecific treatment imposed. Objective: to determine the effectiveness of an educational intervention on Covid-19 in patients with lung cancer and their families. Methodology: A quasi-experimental, before-after study was carried out through an educational intervention during the period from the first of September 2020 to October 31 of that same year, through an applied survey. The intervention was designed in three stages: diagnostic, intervention itself and evaluative. Results: A significant increase in the level of adequate knowledge was observed after the educational intervention on generalities of Covid-19 (84.8%), signs and symptoms of disease (95.7%), complications (82.6%), prevention measures (100%) and susceptibility to Covid-19 (93.5%). Discussion: the educational intervention allows to increase the perception of the risk in those who receive it, guaranteeing a better act in them. Conclusions: the educational intervention increased knowledge about Covid-19 and its effectiveness was demonstrated.Introducción: La COVID 19 es una enfermedad pandémica producida por el virus SARS-CoV-2, con varios grupos vulnerables a las complicaciones de la infección como lo son los pacientes con cáncer de pulmón, asociados a la inmunodepresión por el tratamiento oncoespecífico impuesto. Objetivo: determinar la efectividad de una intervención educativa sobre la Covid-19 en pacientes con cáncer de pulmón y sus familiares. Metodología: Se realizó un estudio cuasi-experimental, tipo antes-después, mediante una intervención educativa durante el período comprendido entre el primero de septiembre del 2020 al 31 de octubre de ese mismo año, a través de una encuesta aplicada. La intervención se diseñó en tres etapas: diagnóstica, de intervención propiamente dicha y evaluativa. Resultados: Se observó un aumento significativo del nivel de conocimiento adecuado después de la intervención educativa sobre generalidades de la Covid-19 (84.8%), los signos y síntomas de enfermedad (95.7%), las complicaciones (82.6%), medidas de prevención (100%) y susceptibilidad a la Covid-19 (93.5%). Discusión: la intervención educativa permite incrementar la percepción del riesgo en quienes la reciben, garantizando un mejor actuar en los mismos. Conclusiones: la intervención educativa incrementó los conocimientos sobre la Covid-19 y se demostró la efectividad de la misma

Efficacy of nimotuzumab according to inflammatory indices in patients with advanced non-small cell lung cancer

Introduction: The response to therapies in advanced lung cancer could be related to certain prognostic factors such as inflammatory indices. Objective: To evaluate the efficacy of the humanized monoclonal antibody nimotuzumab in patients with advanced non-small cell lung cancer according to inflammatory indices. Method: A retrospective longitudinal evaluation study was carried out in a universe of 498 patients older than 18 years, with a cytohistological diagnosis of non-small cell lung cancer, in advanced stages, after the first line of oncological therapy, including in multicenter clinical trials promoted by the Center for Molecular Immunology from 2002 to 2018. Descriptive statistics were applied, the x-tile 3.6.1 software was used for the Kaplan Meier test, significant differences were considered when p< 0,05. Results: In the patients analyzed, nimotuzumab showed therapeutic benefit in the group of patients who did not progress to the first line of treatment with chemotherapy or chemoradiotherapy, when they had a lower neutrophil-lymphocyte index (p= 0,017 and p= 0,027) and a lower platelet-lymphocyte index (p= 0,030 and p= 0,009). Conclusion: Selecting a patient with a lower inflammatory index benefits the efficacy of treatment with the humanized mAb nimotuzumab in advanced non-small cell lung cancer, which becomes a predictive tool for response to treatment

Safety and effectiveness of CIMAvax-EGF administered in community polyclinics

In spite of the advances in immunotherapy and targeted therapies, lung cancer continues to be the leading cause of cancer-related death. The epidermal growth factor receptor is an established target for non-small cell lung cancer (NSCLC), and its overactivation by the ligands can induce accelerated proliferation, angiogenesis, and metastasis as well as proinflammatory or immunosuppressive signals. CIMAvax-EGF is an epidermal growth factor (EGF)-depleting immunotherapy that is approved for the treatment of NSCLC patients in Cuba. The study was designed as a phase IV trial to characterize the safety and effectiveness of CIMAvax-EGF in advanced NSCLC patients treated in 119 community polyclinics and 24 hospitals. CIMAvax-EGF treatment consisted of four bi-weekly doses followed by monthly boosters. Overall, 741 NSCLC patients ineligible for further cancer-specific treatment were enrolled. CIMAvax-EGF was safe, and the most common adverse events consisted of mild-to-moderate injection site reactions, fever, chills, tremors, and headache. For patients completing the loading doses, the median survival was 9.9 months. For individuals achieving at least stable disease to the frontline and completing vaccination induction, the median survival was 12 months. Most of the functional activities and symptoms evaluated through the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire improved over time. In conclusion, this real-world trial demonstrated that CIMAvax-EGF was safe and effective in patients who were vaccinated in the maintenance scenario. A larger effect was seen in subjects with poor prognosis like those with squamous tumors and high EGF levels. Remarkably, this community-based intervention was very important because it demonstrated the feasibility of treating advanced lung cancer patients with active immunotherapy in primary care institutions. In addition to CIMAvax-EGF, patients received supportive care at the community clinic. Vaccine administration by the family doctors at the polyclinics reduced the patients’ burden on the medical oncology services that continued providing chemotherapy and other complex therapies. We conclude that community polyclinics constitute the optimal scenario for administering those cancer vaccines that are safe and require prolonged maintenance in patients with advanced cancer, despite the continuous deterioration of their general condition.Clinical trial registrationhttps://rpcec.sld.cu/trials/RPCEC00000205-En, identifier RPCEC00000205