Impact of vaccination against COVID-19 on patients with cancer in ACHOC-C19 study: Real world evidence from one Latin American country

Introducción: Durante la pandemia, se ha recomendado que la vacunación contra COVID-19 sea una prioridad para los pacientes con cáncer; sin embargo, estos pacientes no se incluyeron en los estudios iniciales de evaluación de las vacunas disponibles. Objetivo: Definir el impacto de la vacunación contra COVID-19 en la prevención del riesgo de complicaciones asociadas a la infección en una cohorte de pacientes con cáncer en Colombia. Métodos: Se realizó un estudio observacional analítico de cohorte, basado en el registro nacional de pacientes con cáncer e infección por COVID 19 ACHOC-C19. Los datos se recolectaron desde junio de 2021, hasta octubre de 2021. Los criterios de inclusión fueron: Pacientes mayores de 18 años con diagnóstico de cáncer e infección confirmada por COVID-19. Se compararon los datos de las cohortes no vacunadas y vacunadas. Los resultados evaluados incluyeron mortalidad por todas las causas en los 30 días siguientes al diagnóstico de COVID-19, hospitalización y necesidad de ventilación mecánica. La estimación del efecto se realizó mediante el riesgo relativo (RR), la reducción absoluta del riesgo (RRA) y el número necesario a tratar (NNT). El análisis multivariante se realizó mediante modelos lineales generalizados. Resultados: Se incluyeron 896 pacientes, de los cuales 470 eran mayores de 60 años (52,4%) y el 59% eran mujeres (n=530). Se reclutaron 172 pacientes en la cohorte vacunada y 724 en la cohorte no vacunada (ratio: 1 a 4,2). La incidencia acumulada de resultados clínicos entre los pacientes no vacunados frente a los vacunados fue: para hospitalización 42% (IC 95%: 38,7%-46,1%) frente a 29%; (IC 95%: 22,4%-36,5%); para requerimiento de ventilación mecánica invasiva 8,4% (n=61) frente a 4,6% (n=8) y para mortalidad por todas las causas 17% (n=123) frente a 4,65% (n=8). Conclusiones: En nuestra población, los pacientes con cáncer no vacunados tienen un mayor riesgo de complicaciones por infección por COVID -19, como hospitalización, ventilación mecánica y mortalidad. Es muy recomendable promover activamente la vacunación entre esta población. El autor (es). Este es un artículo de acceso abierto distribuido bajo los términos de la Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). Consulte los términos y condicionesIntroduction: During the pandemic, it has been recommended that vaccination against COVID-19 be a priority for patients with cancer; however, these patients were not included in the initial studies evaluating the available vaccines. Objective: To define the impact of vaccination against COVID-19 in preventing the risk of complications associated with the infection in a cohort of patients with cancer in Colombia. Methods: An analytical observational cohort study, based on national registry of patients with cancer and COVID 19 infection ACHOC-C19, was done. The data was collected from June 2021, until October 2021. Inclusion criteria were: Patients older than 18 years with cancer diagnosis and confirmed COVID-19 infection. Data from the unvaccinated and vaccinated cohorts were compared. Outcomes evaluated included all-cause mortality within 30 days of COVID-19 diagnosis, hospitalization, and need for mechanical ventilation. The estimation of the effect was made through the relative risk (RR), the absolute risk reduction (ARR) and the number needed to treat (NNT). Multivariate analysis was performed using generalized linear models. Results: 896 patients were included, of whom 470 were older than 60 years (52.4%) and 59% were women (n=530). 172 patients were recruited in the vaccinated cohort and 724 in the non-vaccinated cohort (ratio: 1 to 4.2). The cumulative incidence of clinical outcomes among the unvaccinated vs vaccinated patients were: for hospitalization 42% (95% CI: 38.7%-46.1%) vs 29%; (95% CI: 22.4%-36.5%); for invasive mechanical ventilation requirement 8.4% (n=61) vs 4.6% (n=8) and for mortality from all causes 17% (n=123) vs 4.65% (n=8). Conclusion: In our population, unvaccinated patients with cancer have an increased risk of complications for COVID -19 infection, as hospitalization, mechanical ventilation, and mortality. It is highly recommended to actively promote the vaccination among this population. © The author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions

Diagnosis in Neuroendocrine Neoplasms: From Molecular Biology to Molecular Imaging

Neuroendocrine neoplasms (NENs) are a heterogeneous group of tumours with a diverse behaviour, biology and prognosis, whose incidence is gradually increasing. Their diagnosis is challenging and a multidisciplinary approach is often required. The combination of pathology, molecular biomarkers, and the use of novel imaging techniques leads to an accurate diagnosis and a better treatment approach. To determine the functionality of the tumour, somatostatin receptor expression, differentiation, and primary tumour origin are the main determining tumour-dependent factors to guide treatment, both in local and metastatic stages. Until recently, little was known about the biological behaviour of these tumours. However, in recent years, many advances have been achieved in the molecular characterization and diagnosis of NENs. The incorporation of novel radiotracer-based imaging techniques, such as 68Gallium-DOTATATE PET-CT, has significantly increased diagnostic sensitivity, while introducing the theragnosis concept, offering new treatment strategies. Here, we will review current knowledge and novelties in the diagnosis of NENs, including molecular biology, pathology, and new radiotracers

Síndrome de Moebius: Genopatía vs efecto teratogénico

esumen El Síndrome de Moebius (MBS) es una enfermedad rara, caracterizada principalmente por parálisis facial y frecuentemente acompañada de alteraciones oculares asociadas al compromiso del VI nervio craneal. Además es frecuente encontrar anomalías orofaciales y de miembros en estos pacientes. En este artículo se presenta un paciente masculino de nueve meses con el cuadro clínico de Síndrome de Moebius en el cual se discuten los aspectos genéticos y medioambientales asociados a esta patología. Desde la introducción del misoprostol y su uso inadecuado como agente abortivo, se ha observado un incremento en la frecuencia de recién nacidos con Síndrome de Moebius asociados al uso de este medicamento. Al día de hoy, tanto el factor genético como el factor medioambiental se encuentran asociados al Síndrome de Moebius. Finalmente, es importante alertar a la comunidad médica y a la población en general acerca del riesgo teratogénico del misoprostol y de la importancia del consejo genético cuando nace un paciente con Síndrome de Moebius. Palabras claves: Síndrome Moebius, parálisis facial, malformación congénita / SALUD UNINORTE. Barranquilla (Col.) 2006; 22 (2): 182-187 Abstract Moebius syndrome is a rare disorder mainly characterized by a facial paralyisis and ocular anomalies involving the sixth craneal nerve. In addition malformations of orofacial structures and limbs are frequently founded. In this case, a nine months old boy with Moebius syndrome is presented, clinical findings are described and genetic or environmental aspects are discussed. Since the use of Misoprostol for abortion without medical indication the number of newborn with Moebius syndrome has increased in the population. Nowadays, either genetic or environmental factors are associated with Moebius syndrome. However, it is necessary to alert general and medical community about the risk of teratogenic effects of Misoprostol drug and about the genetic counselling utility when there is a newborn with Moebius syndrome. Palabras claves: Moebius syndrome, facial paralyisis, congenital malformatio

Immune Checkpoint Inhibitor Combination Therapy versus Sunitinib as First-Line Treatment for Favorable-IMDC-Risk Advanced Renal Cell Carcinoma Patients: A Meta-Analysis of Randomized Clinical Trials

Background: Novel combination therapies have been shown to improve the outcomes of treatment-naive patients with locally advanced or metastatic renal cell carcinoma (aRCC). However, the optimal systemic therapy for aRCC of favorable risk has yet to be clarified. We aimed to evaluate the efficacy and safety of different immunotherapy (IO) combinations, either with another IO (IO–IO) or with an antiangiogenic (IO–TKI), versus sunitinib in the first-line setting in aRCC patients with favorable IMDC risk. Methods: We conducted a systematic search for evidence in PubMed, Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials published up to February 2021. The GRADE approach was used to assess the quality of evidence. Survival hazard ratios were extracted for analysis in the favorable-risk aRCC subgroup (IMDC). A sensitivity analysis was performed excluding trials of combination therapy without TKI. Results: Five randomized controlled phase III trials with a total of 1088 patients were included in the analysis. The studies compared different combinations versus sunitinib monotherapy. All clinical trials reported overall survival (OS), progression-free survival (PFS), and objective response rate (ORR) data. Four out of five trials reported complete response (CR). There was no difference in OS nor PFS between treatment arms in the IMDC favorable-risk subgroup analysis (OS: HR = 1.07, 95% CI = 0.81–1.41; PFS: HR = 0.74, 95% CI = 0.46–1.19). A benefit in ORR and CR was found for combination therapy vs. sunitinib (ORR: HR = 1.89, 95% CI = 1.29–2.76; CR: HR = 3.58, 95% CI = 2.04–6.28). In the sensitivity analysis, including only IO–TKI vs. sunitinib, no difference in OS was found; however, an advantage in PFS was observed (OS: HR = 0.99, 95% CI 0.69–1.43; PFS: HR = 0.60 (0.45–0.81). The safety profile reported is consistent with previous reports. We did not find differences in the incidence of any adverse event (AE) or of grade ≥3 AEs. Conclusion: This meta-analysis shows that combinations of IO–KI as first-line treatment in favorable-IMDC-risk aRCC improve PFS, ORR, and CR, but not OS, versus sunitinib

Well-Differentiated Grade 2, Type 3 Gastrointestinal Neuroendocrine Tumour with Bilateral Metastatic Ovarian Involvement: Report of an Unusual Case

Treatment of metastatic gastric neuroendocrine tumours (NETs) is challenging. In oligometastatic cases, surgical resection is recommended whenever possible. Somatostatin analogues have been used to decrease gastrin levels, and available evidence suggests that these drugs can also reduce recurrences. Here we present a highly unusual case involving a patient with a well-differentiated grade 2, type 3 gastric NET with exclusive metastatic bilateral ovarian involvement. To our knowledge, this is the first such case reported in the literature, as the cause of ovarian involvement is usually due to local invasion rather than metastasis. We believe this case is of interest not only due to the unusual presentation, but also because it makes us consider adjuvant treatment with somatostatin analogues in patients with low-grade tumours and a positive postoperative octreoscan

Androgen Receptor Signaling Inhibition in Advanced Castration Resistance Prostate Cancer: What Is Expected for the Near Future?

The androgen signaling pathway is the cornerstone in the treatment of high risk or advanced prostate cancer patients. However, in recent years, different mechanisms of resistance have been defined in this field, limiting the efficacy of the currently approved antiandrogen drugs. Different therapeutic approaches are under research to assess the role of combination therapies against escape signaling pathways or the development of novel antiandrogen drugs to try to solve the primary or acquired resistance against androgen dependent or independent pathways. The present review aims to summarize the current state of androgen inhibition in the therapeutic algorithm of patients with advanced prostate cancer and the mechanisms of resistance to those available drugs. In addition, this review conducted a comprehensive overview of the main present and future research approaches in the field of androgen receptor inhibition to overcome these resistances and the potential new drugs under research coming into this setting

Latin American Consensus for the Evaluation and Treatment of Patients With Metastatic/Locally Advanced Urothelial Carcinoma

PURPOSEUrothelial cancer accounts for approximately 3% of new cancer cases worldwide, with a high burden of disease in countries with medium and low human development indexes where its incidence and mortality are increasing. The purpose of this consensus is to develop statements on the evaluation and treatment of locally advanced and metastatic urothelial carcinoma that would further guide the clinical practice in Latin America.METHODSA systematic review of the literature was conducted by an independent team of methodologists. Then, a modified Delphi method was developed with clinical specialists from different Latin American countries.RESULTSForty-two consensus statements, based on evidence, were developed to address the staging, the evaluation (suitability for chemotherapy, risk assessment, and biomarkers), and systemic treatment (first-line and subsequent therapies) of locally advanced or metastatic urothelial carcinoma. The statements made in this consensus are suggested practice recommendations in the Latin American context; however, the importance of a complete and individualized patient evaluation as a guide for therapeutic selection is highlighted. The availability and affordability of support tools for the evaluation of the disease, as well as specific therapies, may limit the application of the best practices suggested.RecommendationsTherapeutic decisions need to be tailored to the context-specific clinical setting and availability of resources. Local research is promoted to improve outcomes for patients with this challenging cancer in Latin America