Resistencia a la insulina y Enfermedad de Alzheimer prodrómica en la Comunidad de La Rioja: primeras impresiones

Trabajo presentado en la XLIII Reunión de la Sociedad de Neurología del País Vasco, celebrada en Vitoria (España), el 6 de mayo de 202

Estudio descriptivo del patrón de dieta y adherencia a la Dieta Mediterránea en pacientes con Enfermedad de Alzheimer prodrómica en La Rioja

Trabajo presentado en la Reunión Anual de la Sociedad de Neurología del País Vasco, celebrada en San Sebastián (España), los días 3 y 4 de marzo de 202

Valoración de la Calidad de sueño, actividad física y estado cognitivo en una serie de pacientes con Enfermedad de Alzheimer (EA) prodrómica: Estudio descriptivo

Resumen del trabajo presentado en la LXXIII Reunión Anual de la Sociedad Española de Neurología, celebrada de forma virtual del 22 de noviembre al 2 de diciembre de 2021Objetivo: Describir la calidad de sueño, actividad física y estado cognitivo en pacientes con Enfermedad de Alzheimer prodrómica (EA). Analizar los problemas de sueño y ejercicio físico en función de la presencia o no de factores de riesgo cardiovascular. Material y Métodos: Estudio descriptivo de variables sociodemográficas, clínicas, factores de riesgo cardiovascular (FRV), antecedentes familiares de enfermedades neurodegenerativas (AF), MMSE y biomarcadores. Se emplearon los cuestionarios de Pittsburg (PSQI), de actividad física (ClassAF) y el Minimental state examination (MMSE) para evaluar la calidad de sueño, la actividad física y el estado cognitivo respectivamente. El análisis estadístico fue llevado a cabo con el programa SPSS. Resultados: Revisados 23 casos con EA prodrómica con edad inferior a 75 años y PET-amiloide positivo 100%. Mujeres 69,56%. Estudios primarios 47,82%. FRV 52,17%. AF 56,52%. MMSE 26.91(±1.47). Problemas en calidad de sueño 52,17%. No se encontraron diferencias estadísticamente significativas en la calidad de sueño entre los que presentaron FRV y los que no (50% vs. 54,54% respectivamente). Actividad física: laboral o doméstica: 86,95% (moderada); ejercicio físico y/o deporte: 78,26% (ligero); frecuencia semanal de ejercicio físico y/o deporte: 78,26% (diariamente), sin diferencias en función del FRV. Conclusiones: En nuestra serie, más de la mitad de los pacientes presentan problemas de sueño. Sin embargo, no se encuentran diferencias en la calidad del sueño entre los pacientes que presentan o no factores de riesgo cardiovascular. No hay diferencias en la actividad física en relación con la presencia o no de factores de riesgo cardiovascular en pacientes con EA prodrómica. Limitaciones: tamaño muestral.Peer reviewe

Bone sarcomas: ESMO–EURACAN–GENTURIS–ERN PaedCan Clinical Practice Guideline for diagnosis, treatment and follow-up

Production costs have been covered by ESMO from central funds

Dietary pattern focused on macro and micronutrients intake and its association with body mass and waist circumference index in patients with prodromal Alzheimer's disease in La Rioja

Resumen del trabajo presentado en la 19th Conference on Trans Pyrenean Investigations in Obesity and Diabetes (CTPIOD), celebrada en Aragón (España), los días 17 y 18 de octubre de 2022Functional decline (dementia) during aging results in the deterioration of physical and cognitive capacities. The most common form of dementia is Alzheimer's disease that accounts for 60% of all patients with dementia. Unfortunately, there are no effective or preventive treatments for this disease [1]. Addressing modifiable risk factors is considered to be the most promising strategy to prevent or delay Alzheimer's disease. In this regard, diet is a modifiable environmental factor that has been associated with many non-communicable diseases with connections to dementia [2]. A large body of scientific evidence, mostly observational studies, suggests a direct role for dietetic habits nutrition on clinical measures of cognitive status in older adults. Due to the complex biological interactions between different components of the diet, it has been proposed that the use of a whole-diet approach, through the study of dietary patterns rather than individual nutrients or food groups, might help to understand the role of diet in Alzheimer¿s disease and related dementia [3]. Thus, the aim of the study was to establish the connections between dietetic habits, body mass and waist index in the protection against Alzheimer's disease in an environment of other multiple lifestyle factors. To achieve this goal, a retrospective observational study of cases and controls has been carried out. For this, 95 volunteers have been studied: 46 were included in the Alzheimer group (mean age 70.4) and 49 in the control group (mean age 65.0). For the diet and nutritional evaluation, the Food Frequency Questionnaire (FFQ) and the Three-Day Record (3-DR) were used. FFQ includes 115 foods structured in 9 groups [4] and, based on these data, the level of adherence to the Mediterranean Diet was also calculated. In addition, the 3-DR is a prospective method in an open format which collects information on the foods and beverages consumed in a previously specified period of time [5]. From this, the analysis of the average daily intake of energy, macro- and micronutrients was carried out using the PCN Pro food composition database [6]. The results showed that the controls have a statistically higher body mass index (BMI) than the Alzheimer cases (27.6 vs 25.7 p=0.0137). No statistically significant differences were observed with respect to the waist index. In the analysis of the dietary pattern, the levels of adherence to the Mediterranean Diet suggests a slightly higher adherence in the control group (score 9.24/14) compared to the Alzheimer¿s disease group (score 8.83/14), although this difference was not statistically significant. The analysis of macro and micronutrients showed that the control participants daily ingested higher amounts of polyunsaturated fatty acids (p=0.032), iron (p=0.040), folic acid (p=0.009), vitamin C (p=0.030) and vegetal proteins (p=0.021). In contrast, patients with Alzheimer's disease daily ingested statistically higher amounts of phosphorus (p=0.025) and animal proteins (p=0.025). The dietary data contrast with the BMI and waist index observed in the two groups. More studies are needed to understand such lack of associations among dietary intake and BMI in our cohort.This study was supported by Ministerio de Ciencia, Innovación y Universidades (MCIN/AEI/10.13039/5011000 11033) (Spanish Goverment) throught the project PID2019-108851RB-C22 and the Margarita Salas postdoctoral grant (funded by the European Union – NextGenerationEU)

Nivolumab and sunitinib combination in advanced soft tissue sarcomas: a multicenter, single-arm, phase Ib/II trial

[Background] Sarcomas exhibit low expression of factors related to immune response, which could explain the modest activity of PD-1 inhibitors. A potential strategy to convert a cold into an inflamed microenvironment lies on a combination therapy. As tumor angiogenesis promotes immunosuppression, we designed a phase Ib/II trial to test the double inhibition of angiogenesis (sunitinib) and PD-1/PD-L1 axis (nivolumab).[Methods] This single-arm, phase Ib/II trial enrolled adult patients with selected subtypes of sarcoma. Phase Ib established two dose levels: level 0 with sunitinib 37.5 mg daily from day 1, plus nivolumab 3 mg/kg intravenously on day 15, and then every 2 weeks; and level −1 with sunitinib 37.5 mg on the first 14 days (induction) and then 25 mg per day plus nivolumab on the same schedule. The primary endpoint was to determine the recommended dose for phase II (phase I) and the 6-month progression-free survival rate, according to Response Evaluation Criteria in Solid Tumors 1.1 (phase II).[Results] From May 2017 to April 2019, 68 patients were enrolled: 16 in phase Ib and 52 in phase II. The recommended dose of sunitinib for phase II was 37.5 mg as induction and then 25 mg in combination with nivolumab. After a median follow-up of 17 months (4–26), the 6-month progression-free survival rate was 48% (95% CI 41% to 55%). The most common grade 3–4 adverse events included transaminitis (17.3%) and neutropenia (11.5%).[Conclusions] Sunitinib plus nivolumab is an active scheme with manageable toxicity in the treatment of selected patients with advanced soft tissue sarcoma, with almost half of patients free of progression at 6 months.[Trial registration number] NCT03277924.This work was supported by GEIS and ISG. BMS and Pfizer provided drug supply and partial funding for shipping. Translational studies were partially funded by Beca Buesa from the GEIS group

Pazopanib for treatment of typical solitary fibrous tumours: a multicentre, single-arm, phase 2 trial

[Background] Solitary fibrous tumour is an ultra-rare sarcoma, which encompasses different clinicopathological subgroups. The dedifferentiated subgroup shows an aggressive course with resistance to pazopanib, whereas in the malignant subgroup, pazopanib shows higher activity than in previous studies with chemotherapy. We designed a trial to test pazopanib activity in two different cohorts of solitary fibrous tumour: the malignant-dedifferentiated cohort, which was previously published, and the typical cohort, which is presented here.[Methods] In this single-arm, phase 2 trial, adult patients (aged ≥18 years) diagnosed with confirmed metastatic or unresectable typical solitary fibrous tumour of any location, who had progressed in the previous 6 months (by Choi criteria or Response Evaluation Criteria in Solid Tumors [RECIST]) and an Eastern Cooperative Oncology Group (ECOG) performance status of 0–2 were enrolled at 11 tertiary hospitals in Italy, France, and Spain. Patients received pazopanib 800 mg once daily, taken orally, until progression, unacceptable toxicity, withdrawal of consent, non-compliance, or a delay in pazopanib administration of longer than 3 weeks. The primary endpoint was proportion of patients achieving an overall response measured by Choi criteria in patients who received at least 1 month of treatment with at least one radiological assessment. All patients who received at least one dose of the study drug were included in the safety analyses. This study is registered in ClinicalTrials.gov, NCT02066285, and with the European Clinical Trials Database, EudraCT 2013-005456-15.[Findings] From June 26, 2014, to Dec 13, 2018, of 40 patients who were assessed, 34 patients were enrolled and 31 patients were included in the response analysis. Median follow-up was 18 months (IQR 14–34), and 18 (58%) of 31 patients had a partial response, 12 (39%) had stable disease, and one (3%) showed progressive disease according to Choi criteria and central review. The proportion of overall response based on Choi criteria was 58% (95% CI 34–69). There were no deaths caused by toxicity, and the most frequent adverse events were diarrhoea (18 [53%] of 34 patients), fatigue (17 [50%]), and hypertension (17 [50%]).[Interpretation] To our knowledge, this is the first prospective trial of pazopanib for advanced typical solitary fibrous tumour. The manageable toxicity and activity shown by pazopanib in this cohort suggest that this drug could be considered as first-line treatment for advanced typical solitary fibrous tumour.Spanish Group for Research on Sarcomas (GEIS), Italian Sarcoma Group (ISG), French Sarcoma Group (FSG), GlaxoSmithKline, and Novartis

Gastrointestinal stromal tumours: ESMO-EURACAN-GENTURIS Clinical Practice Guidelines for diagnosis, treatment and follow-up

Gastrointestinal stromal tumours (GISTs) are malignant mesenchymal tumours with a variable clinical behaviour, marked by differentiation towards the interstitial cells of Cajal.1 GISTs belong to the family of soft tissue sarcomas (STSs) but are treated separately due to their peculiar histogenesis, clinical behaviour and specific therapy. This European Society for Medical Oncology (ESMO)–European Reference Network for Rare Adult Solid Cancers (EURACAN)–European Reference Network for Genetic Tumour Risk Syndromes (GENTURIS) Clinical Practice Guideline (CPG) will cover GISTs while other STSs are covered in the ESMO–EURACAN–European Reference Network for Paediatric Oncology (ERN PaedCan)–GENTURIS STS CPG.Peer reviewe