Ana Figueiredo

Phase II Study of Celecoxib with Cisplatin Plus Etoposide in Extensive-Stage Small Cell Lung Cancer

We performed a phase II trial to test whether a cyclooxygenase (COX-2) inhibitor, celecoxib, added to standard first-line combination chemotherapy (CT) and as maintenance therapy would improve outcomes in extensive-stage (ES) small-cell lung cancer (SCLC). This was a multicenter trial in CT-naive patients with ES-SCLC. They received standard cisplatin and etoposide (EP) up to 6 cycles and celecoxib 400 mg PO bid continuously until disease progression. Primary end points were response rate (RR), time to progression (TTP), and toxicity. Secondary were overall survival (OS) and quality of life. Of 74 expected patients, only 24 were enrolled and the study stopped earlier because of the published safety concerns about celecoxib. The patients, all male, were between 38 and 74 years. A total of 130 cycles of CT were administered. Toxicity associated with celecoxib was minimal. The RR was 56.5%. Median TTP and OS were 8.6 and 11.3 months, respectively. These data suggest that celecoxib may safely be combined with EP for treatment of ES-SCLC. This combination showed a promising activity and, despite the safety concerns regarding celecoxib, it would be interesting to further evaluate this regimen.

A mulher e o cancro do pulmão

The epidemiology of lung cancer has changed in the last years in several countries all over the world. In the 19th century, the lung cancer was rare but it incidence increase drastically during the 20th century, and the tendency is to continue in the 20th century. Actually the lung cancers incidence and mortality are higher in the developed countries, especially in Europe and Unites States of America, with a increasing in the women incidence. These geographic differences and gender differences are related with smoking habits. Women begin to smoke earlier and have more difficulty to stop, because of problems related with obesity; they have more sensibility to the carcinogens and the risk of lung cancer is 1.5 times higher than the men with the same habits. Adenocarcinoma is the more frequent histological type in young people, in the total of the women and in non-smokers. Many factors since tobacco, home and professional pollution, nutritional, associated diseases even genetic and hormonal factors have been investigated to define its influence in development in women lung cancer. It specificity in women with lung cancer is the common problem for the medical people to treat this disease (pathology).The literature about this problem is not clear, and is necessary to advance with many studies in this area with the objective to clarify this important question.The epidemiology of lung cancer has changed in the last years in several countries all over the world. In the 19th century, the lung cancer was rare but it incidence increase drastically during the 20th century, and the tendency is to continue in the 20th century. Actually the lung cancer’s incidence and mortality are higher in the developed countries, especially in Europe and Unites States of America, with a increasing in the women incidence. These geographic differences and gender differences are related with smoking habits. Women begin to smoke earlier and have more difficulty to stop, because of problems related with obesity; they have more sensibility to the carcinogens and the risk of lung cancer is 1,5 times higher than the men with the same habits. Adenocarcinoma is the more frequent histological type in young people, in the total of the women and in non-smokers. Many factors since tobacco, home and professional pollution, nutritional, associated diseases even genetic and hormonal factors have been investigated to define its influence in development in women lung cancer. It specificity in women with lung cancer is the comum problem for the medical people to treat this disease (pathology).The literature about this problem is not clear, and is necessary to advance with many studies in this arca with the objective to clarify this important question. REV PORT PNEUMOL 2003; IX (3): 225-247

Pneumonia no idoso

RESUMO Com o aumento da esperanca devida tem-se assistido a um envelhecimento da populacao mundial. Preve-se que em 2050 o numero de idosos duplique. Nesta faixa etaria as doencas infecciosas sao a causa mais frequente de hospitalizacao, sendo as infeccoes do tracto respiratorio a quarta causa de morte no idoso e a principal causa de morbilidade. Devido a idade, as multiplas patologias, e ao frequente internamento em lares de 3a idade, a etiologia e a clinica sao substancialmente modificadas, obrigando-nos a atencoes particulares no que concerne o diagnostico e o tratamento. REV PORT PNEUMOL 2001; VII (6): 485-493

Erlotinib e metástases cerebrais

We report two cases of brain metastases in context of non small cell lung cancer (NSCLC). After having progressed to chemotherapy they received erlotinib 150 mg/m2 orally daily, with complete response of brain metastasis and partial response of thoracic lesions. Brain metastases are both prevalent and a major cause of mortality in NSCLC, with few systemic treatment options. Median survival after whole brain radiotherapy is 4-6 months and the role of systemic therapy for brain metastases is limited with the most drugs use to stage IV disease ineffective in this setting. This case demonstrates that brain metastases may be sensitive to erlotinib and give to us growing body of evidence that EGFR-associated tyrosine kinase inhibition is a feasible strategy in the management of NSCLC patients with brain metastases We propose further study into the continued use of this drug in the situation where there is a differential response. Rev Port Pneumol 2008; XIV (Supl 3): S35-S42

Derivação pericardioperitoneal no tratamento de derrames pericárdicos em doentes neoplásicos

Resumo Os derrames pericardicos que surgem num contexto neoplasico sao frequentes e apresentam dificuldades de diagnostico e tratamento. Apesar de surgirem em doentes com neoplasia, 50% destes derrames tem uma etiologia benigna; surgem por mecanismos paralelos, indirectamente relacionados com o tumor. Os restantes (derrames pericardicos neoplasicos – DPN) resultam do atingimento tumoral das estruturas peri ou epicardicas e assumem, por si so, um pior prognostico. As opcoes de tratamento disponiveis sao varias, mas a ausencia de normas orientadoras da sua aplicacao tornam dificil avaliar perfis de rentabilidade, eficacia e seguranca. A derivacao pericardioperitoneal (DPP) e um metodo cirurgico de drenagem da cavidade pericardica que se tem demonstrado muito util em DPN. No CHC, esta tecnica e efectuada com o auxilio de toracoscopia videoassistida (VATS). Nos ultimos 8 anos, foram submetidos a esta modalidade terapeutica 18 doentes com DPN. A tecnica demonstrou ser segura, eficaz e com baixa morbilidade/mortalidade.