10 research outputs found
Disección septal tras infarto de miocardio inferior
Background
Septal dissection and rupture are a possible cause of ventricular septal defect after acute myocardial infarction. This presentation reports the case of a 68 year-old man with inferior acute myocardial infarction, who was satisfactorily operated of a septal pseudoaneurysm diagnosed intraoperatively.La disección del septum interventricular y su rotura constituyen una posible causa de la
comunicación interventricular luego de un infarto de miocardio. En esta presentación se
describe el caso de un varón de 68 años con un infarto agudo de miocardio inferior que fue
intervenido en forma satisfactoria de un seudoaneurisma septal diagnosticado intraoperatoriamente
El intervencionismo coronario percutáneo previo no aumenta la mortalidad hospitalaria en cirugÃa coronaria: análisis de una serie de 63.420 casos
Introducción
En diversas publicaciones de los últimos años se señala una mortalidad hospitalaria mayor de
la cirugÃa de revascularización miocárdica en pacientes con antecedente de intervencionismo
coronario percutáneo previo exitoso; por su parte, los modelos de riesgo de mortalidad en cirugÃa
cardÃaca publicados hasta la actualidad no han incluido este antecedente como factor de riesgo.
Objetivo
Analizar si el intervencionismo coronario percutáneo previo es un factor de riesgo de mortalidad
hospitalaria en la cirugÃa de revascularización coronaria.
Material y métodos
Entre enero de 1997 y diciembre de 2007 se analizaron un total de 78.794 pacientes sometidos
a cirugÃa coronaria, recogidos en la base de datos del Ministerio de Sanidad de España. Tras
aplicar los criterios de exclusión, el estudio se realizó sobre un total de 63.420 pacientes, de
los que 2.942 (4,6%) tenÃan intervencionismo coronario percutáneo previo. Las variables
continuas se compararon con las pruebas de U de Mann-Whitney o de la t de Student y las
variables categóricas, mediante chi cuadrado. Se realizó un análisis de regresión logÃstica
univariado y multivariado y un análisis multivariado que incluÃa un Ãndice de propensión.
Resultados
El intervencionismo coronario percutáneo previo no fue un predictor independiente de mortalidad
hospitalaria en el análisis multivariado (odds ratio 0,88; intervalo de confianza del
95% 0,72-1,07; p = 0,20) ni en el modelo que incluÃa un Ãndice de propensión (odds ratio 0,9;
intervalo de confianza 95% 0,75-1,08; p = 0,27).
Conclusión
El intervencionismo coronario percutáneo previo parece no ser un factor de riesgo independiente
de mortalidad hospitalaria en pacientes con intervención quirúrgica coronaria
Association of BRAF V600E/K Mutation Status and Prior BRAF/MEK Inhibition With Pembrolizumab Outcomes in Advanced Melanoma: Pooled Analysis of 3 Clinical Trials.
Importance: The optimal sequencing of immune checkpoint inhibitors and targeted therapy for BRAF V600E/K-mutant melanoma is not well established.
Objective: To assess the association of BRAF wild-type (WT) or BRAF V600E/K-mutant status and BRAF inhibitor (BRAFi) with or without MEK inhibitor (MEKi) therapy with response to pembrolizumab.
Design, Setting, and Participants: This study is a post hoc subgroup analysis of pooled data from 3 multinational, multisite studies: KEYNOTE-001 (data cutoff September 1, 2017), KEYNOTE-002 (data cutoff May 30, 2018), and KEYNOTE-006 (data cutoff December 4, 2017). Patients included in this analysis were adults with advanced melanoma and known BRAF V600E/K tumor status who had received pembrolizumab.
Interventions: Patients received pembrolizumab in dosages of 2 mg/kg every 3 weeks, 10 mg/kg every 2 weeks, or 10 mg/kg every 3 weeks.
Main Outcomes and Measures: End points were objective response rate (ORR) and progression-free survival (PFS) assessed by Response Evaluation Criteria in Solid Tumors, version 1.1, and overall survival (OS). Objective response rates, 4-year PFS, and OS rates were compared in the following patient subgroups: BRAF WT vs BRAF V600E/K-mutant melanoma and BRAF V600E/K-mutant melanoma with vs without previous treatment with BRAFi with or without MEKi therapy.
Results: The overall study population (N = 1558) included 944 men (60.6%) and 614 women (39.4%). The mean (SD) age was 60.0 years (14.0). The ORR was 38.3% (596/1558), 4-year PFS rate was 22.0%, and 4-year OS rate was 36.9%. For patients with BRAF WT (n = 1124) and BRAF V600E/K-mutant melanoma (n = 434), ORR was 39.8% (n = 447) and 34.3% (n = 149), 4-year PFS rate was 22.9% and 19.8%, and 4-year OS rate was 37.5% and 35.1%, respectively. Patients with BRAF V600E/K-mutant melanoma who had (n = 271) vs had not (n = 163) previously received BRAFi with or without MEKi therapy had baseline characteristics with worse prognosis; ORR was 28.4% (n = 77) and 44.2% (n = 72), 4-year PFS rate was 15.2% and 27.8%, and 4-year OS rate was 26.9% and 49.3%, respectively.
Conclusions and Relevance: Results of this subgroup analysis support the use of pembrolizumab for treatment of advanced melanoma regardless of BRAF V600E/K mutation status or receipt of prior BRAFi with or without MEKi therapy
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Adjuvant Pembrolizumab versus IFNα2b or Ipilimumab in Resected High-Risk MelanomaAdjuvant Pembrolizumab in High-Risk Melanoma
We conducted a randomized phase III trial to evaluate whether adjuvant pembrolizumab for one year (647 patients) improved recurrence-free survival (RFS) or overall survival (OS) in comparison with high-dose IFNα-2b for one year or ipilimumab for up to three years (654 patients), the approved standard-of-care adjuvant immunotherapies at the time of enrollment for patients with high-risk resected melanoma. At a median follow-up of 47.5 months, pembrolizumab was associated with significantly longer RFS than prior standard-of-care adjuvant immunotherapies [HR, 0.77; 99.62% confidence interval (CI), 0.59-0.99; P = 0.002]. There was no statistically significant association with OS among all patients (HR, 0.82; 96.3% CI, 0.61-1.09; P = 0.15). Proportions of treatment-related adverse events of grades 3 to 5 were 19.5% with pembrolizumab, 71.2% with IFNα-2b, and 49.2% with ipilimumab. Therefore, adjuvant pembrolizumab significantly improved RFS but not OS compared with the prior standard-of-care immunotherapies for patients with high-risk resected melanoma.SignificanceAdjuvant PD-1 blockade therapy decreases the rates of recurrence, but not survival, in patients with surgically resectable melanoma, substituting the prior standard-of-care immunotherapies for this cancer. See related commentary by Smithy and Shoushtari, p. 599. This article is highlighted in the In This Issue feature, p. 587
Therapeutic vaccines for cancer: an overview of clinical trials
Item does not contain fulltextThe therapeutic potential of host-specific and tumour-specific immune responses is well recognized and, after many years, active immunotherapies directed at inducing or augmenting these responses are entering clinical practice. Antitumour immunization is a complex, multi-component task, and the optimal combinations of antigens, adjuvants, delivery vehicles and routes of administration are not yet identified. Active immunotherapy must also address the immunosuppressive and tolerogenic mechanisms deployed by tumours. This Review provides an overview of new results from clinical studies of therapeutic cancer vaccines directed against tumour-associated antigens and discusses their implications for the use of active immunotherapy