OBJECTIVE: Data is lacking about FOLFIRINOX use for advanced pancreatic ductal adeno- carcinoma in emerging countries. The objective of this study was to report outcomes of effi cacy and safety in the setting of a South American institution.
METHODS: Patients treated with FOLFIRINOX for metastatic or locally advanced pancreatic cancer at Instituto do Câncer do Estado de São Paulo (Brazil), between November 2012 and January 2016 were retrospectively reviewed. Baseline characteristics, safety, response and overall survival were analyzed.
RESULTS: Sixty-one patients were enrolled (metastatic disease: 31). Median age was 61 years (range 37-74), and 88.5% had ECOG 0 or 1; 90.2% had T3 or T4 tumors and 36.1% had node-positive disease. FOLFIRINOX was given as the fi rst-line treatment in 88.5% of pa- tients, and was discontinued due to disease progression (55.7%), limiting toxicity (31.1%) or maximum benefi t (13.1%). Median number of cycles was 10 (range 1-32). Dose reductions occurred in 81.9%. Grade 3 or 4 toxicity were found in 60.6% and were mainly hematological (36%), neuropathy (19.6%), fatigue (8.2%) and diarrhea (14.7%). Two patients had febrile neutropenia. Hospitalization during treatment occurred in 31.1% of cases, with three potential treatment-related deaths. Median overall survival was 16.26 in the full cohort; 13.6 in patients with metastatic disease, and 18.7 months in locally advanced disease. The response rate was 39.3% (32.2% in metastatic disease and 43.3% in locally advanced disease).
CONCLUSION: Despite the high prevalence of grade 3 or 4 toxicities, FOLFIRINOX showed effi cacy for the treatment of patients with advanced pancreatic adenocarcinoma, and is an excellent treatment option in emerging countries.
Keywords: Pancreatic neoplasms/drug therapy; FOLFIRINOX; Cohort studies; Brazil
INTRODUCTION: Hepatocellular carcinoma (HCC) corresponds to 90% of primary malignant liver cell carcinomas and is a leading cause of cancer-related death worldwide.
OBJECTIVE: This compilation of cases aimed to identify evidence of correlation between anabolic an- drogen steroids (AAS) abuse for performance improvement by healthy subjects and HCC. Methods: We performed a literature review and identifi ed 935, 1148, 12 and 3 articles in Pubmed, Embase, Scopus and Lilacs, respectively. Only studies, reviews and case reports evaluating the association between androgens and hepatocarcinoma were included with no restrictions in time span or language. Further on, we excluded studies and case reports which patients were receiving therapeutic androgens and collected data only of those re- porting androgen intake to improve physical performance.
RESULTS: Six articles fulfi lled the inclusion criteria, excluding the duplicates. HCC onset after AAS abuse seems to occur at earlier ages than those related to chronic hepatitis B/C, chronic alcohol consumption and nonalcoholic steatohepatitis (NASH). Timeframe ranged from two to seven years in the cases reports presented here. Many AAS subtypes were used by patients depicted in the case reports, so it is diffi cult to conclude if a specifi c AAS is safer or more harmful than the other. Carcinogenic mechanisms are poorly understood, but pre-clinical evidence shows that androgen receptors and oxidative stress may play a pivotal role in its development.
CONCLUSION: The evidence that HCC has been linked to long term AAS abuse for performan- ce improvement is scant but some association is suggested. AAS must be taken only under specialized supervision and the putative correlation with HCC calls for public policies to make high risk populations aware of the risks of misuse and self-administration.
Keywords: Hepatocellular carcinoma; Anabolic androgen steroids; Testosterone congeners
INTRODUCTION: The medullary thyroid carcinoma is a rare neuroendocrine disease that represents about 3 to 10% of all thyroid cancers. However, its early detection and intervention can improve prognosis. Objective: To evaluate the frequency of registered by institutional database of medullary thyroid carcinoma (MTC) in Brazil between 2000 and 2014 and its implications on public health.
METHODS: Descriptive study based on secondary data from the public domain tab module of the Hospital-Based Registry of Cancer (Integrator-HBRC).
RESULTS: In the analyzed period, there were 799 cases of MTC that represents 2.0 % of all HBRC thyroid neoplasms in Brazil. There was a growing trend of registered cases in period 2000-2011, followed by declining trend afterwards.
CONCLUSIONS: The registered percentage of MTC was lower than that cited in medical literature. We can infer four possible reasons: lower incidence of the disease in Brazil, problems in the clinicohistological diagnosis of the disease, gaps in treatment access, or lack of registry (sub-notification). Nonetheless, further studies and practices shall improve screening coverage and qualify record of the disease given that early detection and intervention may modify prognosis of MTC.
Keywords: Thyroid neoplasms/epidemiology; Carcinoma medullary; Multiple endocrine neoplasia; Carcinoma neuroendocrine