Metástases ósseas: opções de tratamento sistêmico

As metástases ósseas podem ser um dos primeiros indicativos de doença disseminada nos pacientes com câncer, principalmente de mama, pulmão e próstata. Embora a maior parte desses pacientes tenha sua sobrevida diminuída após o diagnóstico de doença metastática, uma proporção considerável sobreviverá por um período de tempo suficientemente grande para que a doença óssea provoque sintomas significativos, causando dor e afetando a qualidade de vida do indivíduo. Alternativas de tratamento vêm sendo pesquisadas para esses pacientes, em tentativas de interferência no processo fisiopatológico da doença óssea. Radioisótopos e agentes sem atividade citotóxica têm se destacado neste aspecto, e este artigo sobrepassa as diversas alternativas terapêuticas em investigação clínica para esse grupo de pacientes

Comparison of hormonal receptor expression and HER2 status between circulating tumor cells and breast cancer metastases

OBJECTIVES: Breast cancer (BC) is the most common neoplasm in women. Biopsy of metastatic lesions is recommended to confirm estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status as there are discrepancies in these patterns between primary tumors and metastases in up to 40% of the cases. Circulating tumor cells (CTCs) are related to BC outcomes and could potentially be an alternative to the invasive procedures of metastasis rebiopsy. ISET(R) technology is not currently employed to detect CTCs in patients with BC. Emerging data support that the characterization of CTC protein expression can refine its prognostic value. Transforming growth factor (TGF)-B plays a role in BC progression and invasiveness. Thus, in this study, we aimed to compare ER, PR, and HER2 expression in primary tumors, CTCs, and metastases and evaluate TGF-B type 1 receptor (TGF-B RI) expression in CTCs as prognostic factor for progression free survival (PFS) and overall survival (OS). METHODS: This prospective study was conducted at the A.C. Camargo Cancer Center, Brazil. Blood samples were processed in ISET(R) (Isolation by SizE of Tumors, Rarecells, France) before computed tomography–guided biopsy of suspected metastatic lesions. Protein expression levels in CTCs were compared to those in primary tumors/ metastases (medical records). RESULTS: Of the 39 patients initially included, 27 underwent both biopsies of metastases and blood collection and were considered for analysis. The concordance rates for ER, PR, and HER2 expression between primary tumors and metastases were high. No loss of HER2 expression at any metastasis site and retention of the same pattern of protein expression in all triple-negative (TN) tumors (92.5%, 81.5% and 96.2% respectively) (p<0.0001) was observed. When metastases/CTCs were classified as TN/non–TN, CTCs showed high specificity (93%), accuracy (84.2%), and negative predictive value (88%). The median OS of patients without TGF-B RI expression in CTCs was 42.6 versus 20.8 months for TGF-B RI expression-positive ones (p>0.05). CONCLUSION: The role of CTCs detected by ISET has not yet been established in BC. Here, we suggest that this methodology may be useful to evaluate metastasis in non–TN cases as well as TGF-B RI expression in CTCs, which may impact patient survival. Due to sample limitations, future studies must focus on specific BC subtypes and an expansion of the cohort

Treinamento concorrente como método de desenvolvimento de força e motricidade global em um paciente autista / Concurrent training as a method of strength and global motricity development in an autistic patient

O estudo descreve o treinamento concorrente (TC) no desenvolvimento da força e motricidade global, a partir da sua prática por um paciente com autismo clássico, pois o sujeito com autismo pode desenvolver déficits na motricidade global, além de apresentar problemas de coordenação neuromuscular. O objetivo foi analisar através do treinamento os níveis de força e motricidade global de um paciente autista clássico no espaço terapêutico Amira Figueiras (ARIMA). O estudo foi desenvolvido por meio de uma analise documental dos prontuários e relatórios semestrais disponibilizados pelo Espaço. Foram analisados os avanços do mesmo de modo gradativo ao longo das sessões terapêuticas de treinamento, apresentando seus resultados por meio de gráfico e quadro, onde é possível identificar grandes níveis de evolução no desenvolvimento das capacidades objetivadas na pesquisa. Por fim, é preciso compreender que as dificuldades encontradas perante as observações da escassez de conteúdo bibliográfico e a prática do treinamento concorrente para este grupo o tornam um tema delicado, porém para que resultados eficazes sejam alcançados é necessária a mediação adequada do professor de Educação Física capacitado para o desenvolvimento desta prática

Interação entre especialidades: miocardiopatia dilatada e neoplasia de mama HER2 positiva

O progresso no conhecimento dos mecanismos da doença e suas potenciais possibilidades de tratamento, têm com o incremento da pesquisa básica, trazido a algumas situações inusitadas. Como quando algo observado em uma situação específica, definida na prática clínica, pode ser transportado para o laboratório, instigando a investigação de uma provável terapêutica em uma doença não relacionada e fazendo o caminho inverso da "bench-to-bedside". Nos últimos anos, o uso de um anticorpo monoclonal, o trastuzumabe, mostrou-se imprescindível no tratamento das neoplasias de mama com amplificação/superexpressão de HER2, com ganho de sobrevida significativo nos contextos adjuvante e terapêutico. A observação da ocorrência de cardiotoxicidade induzida pelo trastuzumabe, assim como a identificação dos mecanismos relacionados a esse efeito colateral, possibilitaram a pesquisa desses mesmos fatores na miocardiopatia dilatada, de uma forma muito interessante

Corporal mass index (cmi) and waist/hip rate (whr) of practicers of moderate aerobical activity

This work aimed to evaluate the Parque do Ingá (a park in the municipality of Maringá, state of Paraná, Brazil) hiking practices profile in relation to corporal mass index (CMI) and waist/hip rate (WHR). Men and women with ages from 20 to 70 years, regular hikers (3 to 5 times a week) which went for their walks between 7:00 to 11:00 a.m. were evaluated. The results showed that 84% of the sample had corporal weight excess, with CMI above 25 kg/m². In most of the age groups the WHR indicated cardiovascular diseases moderate risk for both sexes. This indicates that life quality must be associated with adequate alimentary habits from childhood, together with physical activity and ideal weight maintenance during adult life, avoiding obesity

Cost-effectiveness analysis of Oncotype DX from a Brazilian private medicine perspective: a GBECAM multicenter retrospective study

Background: Oncotype DX (ODX) is a validated assay for the prediction of risk of recurrence and benefit of chemotherapy (CT) in both node negative (N0) and 1–3 positive nodes (N1), hormone receptor positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) early breast cancer (eBC). Due to limited access to genomic assays in Brazil, treatment decisions remain largely driven by traditional clinicopathologic risk factors. ODX has been reported to be cost-effective in different health system, but limited data are available considering the reality of middle-income countries such as Brazil. We aim to evaluate the cost-effectiveness of ODX across strata of clinical risk groups using data from a dataset of patients from Brazilian institutions. Methods: Clinicopathologic and ODX information were analyzed for patients with T1–T3, N0–N1, HR+/HER2− eBC who had an ODX performed between 2005 and 2020. Projections of CT indication by clinicopathologic criteria were based on binary clinical risk categorization based on the Adjuvant! Algorithm. The ODX score was correlated with the indication of CT according to TAILORx and RxPONDER data. Two decision-tree models were developed. In the first model, low and high clinical risk patients were included while in the second, only high clinical risk patients were included. The cost for ODX and CT was based on the Brazilian private medicine perspective. Results: In all, 645 patients were analyzed; 411 patients (63.7%) had low clinical risk and 234 patients (36.3%) had high clinical risk disease. The ODX indicated low (25) risk in 119 (18.4%), 415 (64.3%), and 111 (17.2%) patients, respectively. Among 645 patients analyzed in the first model, ODX was effective (5.6% reduction in CT indication) though with an incremental cost of United States Dollar (US$) 2288.87 per patient. Among 234 patients analyzed in the second model (high clinical risk only), ODX led to a 57.7$ 4350.66 per patient. Conclusions: Our study suggests that ODX is cost-saving for patients with high clinical risk HR+/HER2− eBC and cost-attractive for the overall population in the Brazilian private medicine perspective. Its incorporation into routine practice should be strongly considered by healthcare providers