Enrique Espinosa Arranz

Role of anti-Her-2 therapy in bladder carcinoma

Bladder cancer, in its advanced stage, has very few therapeutic strategies with proven efficacy. Platinum-combination chemotherapy can be considered a standard for first-line therapy, but after progression there is no standard therapy, and the prognosis is very poor. The development of targeted therapies in the last few years has significantly changed the prognosis of a wide variety of tumors. In bladder cancer, there is no targeted therapy currently approved for its use in advanced disease. There is evidence that Her-2 amplification and/or overexpression is seen in bladder cancer, and may influence prognosis. Anti-Her-2 drugs, such as trastuzumab or lapatinib, are under investigation in urothelial neoplasms, but there is no phase III trial that has evaluated their use in bladder cancer. We review the published evidence about Her-2 determination, its influence on bladder carcinoma prognosis, the clinical development of anti-Her-2-targeted therapies, and the possible future research directions involving this pathway in bladder cancer.

Adjuvant chemotherapy for breast cancer and cognitive impairment.

Complaints of loss of memory and lack of concentration have been reported by long-term survivors of breast cancer. This mild cognitive impairment (MCI), also called “chemobrain” or “chemofog,” has been the subject of a number of studies in the last few years. This cognitive impairment, although usually mild, must be studied to define possible risk factors for its development, and for future research into a preventive or therapeutic treatment approach. Long-term survivors of breast cancer must be followed to detect possible treatment sequelae as soon as possible. Since the number of these long-term survivors has increased in the last years, in part because of more active adjuvant treatments, our knowledge about the long-term side effects of these therapies has also grown.

mTOR pathway inhibition in renal cell carcinoma

Renal cell carcinoma therapy has changed in a very significant way in the last few years. Up to 5 new agents have been developed, improving the results previously achieved with cytokine therapy. Bevacizumab, sorafenib, sunitinib, temsirolimus, and everolimus are now part of the therapeutic arsenal for this illness. Particularly, this has been the first tumoral type in which inhibition of mammalian target of rapamycin (mTOR) has proved its efficacy in phase III trials, either as first-line therapy for poor prognosis patients (temsirolimus, CCI-779) or as second-line therapy after failure of tyrosine-kinase inhibitors (everolimus, RAD001). In this paper, we review the basis for mTOR inhibition in RCC, and discuss the results of the trials involving temsirolimus and everolimus for the treatment of this disease.

Tratamiento de soporte en el enfermo con cáncer. Algunas propuestas basadas en nuestra experiencia

ResumenEl oncólogo médico, en general, se ha centrado durante mucho tiempo en los resultados de la quimioterapia antineoplásica y se ha olvidado con mucha frecuencia de una parte muy importante de la asistencia integral del enfermo con cáncer: el tratamiento de soporte. Afortunadamente esto ya no es así en la actualidad y el control de signos y síntomas ha recuperado su primacía en la estrategía terapéutica oncológica.Aportamos en esta breve revisión nuestra pequeña experiencia en el tratamiento de los enfermos neoplásicos con respecto al dolor, anorexia, anemia, neutropenia febril y apoyo psicológico.AbstractThe medical oncologist has focused much of the time on the results of chemotherapy, and has forgotten a main issue in the global care of the patients with cancer: supportive care. Fortunatelly, things have evolved and today the management of signs and symptoms is a cornerstone in the therapeutic oncology approaches.Here we report our experience in the treatment of cancer patients regarding the management of pain, anorexia, anemia, febrile neutropenia and psychological care.

Perspectivas del uso de la eritropoyetina en Oncología

ResumenLa anemia del cáncer está relacionada con la calidad de vida, con el pronóstico de la enfermedad y con la probabilidad de responder a la radioterapia. Las transfusiones no pueden servir para mejorar estos parámetros de forma rutinaria. La eritropoyetina, por su parte, permite alcanzar y mantener niveles de hemoglobina suficientes para que la radioterapia consiga resultados óptimos. Esto se ha demostrado en tumores de cabeza y cuello y de cérvix. La relación entre el uso de la eritropoyetina y la supervivencia todavía no está demostrada.AbstractAnemia in cancer patients is related to quality of life, prognosis and the response to radiotherapy. These factors cannot be improved routinely with blood transfusions. Erythropoietin may achieve and maintain hemoglobin levels so that optimal results can be obtained with radiotherapy. This has been demonstrated in tumors of the head and neck and cervix. The relation between erythropoietin and sur-vival has not been demonstrated yet.

Intra-abdominal desmoplastic small round cell tumour in a 39-year-old man

Desmoplastic small round cell tumor is a very rare neoplasm, that usually appears in children and young adolescents. There is no standard therapy, and responses to chemotherapy are infrequent. Surgery is still the main treatment for this disease. We report the case of a 39 year-old man and briefly summarize the evidence about this tumor.

Biología Molecular de los cánceres de cabeza y cuello

ResumenSe ha visto que los cánceres de cabeza y cuello tienen múltiples anomalías genéticas que influyen en el desarrollo y comportamiento del tumor y pueden ser útiles para la creación de nuevas terapias.En este trabajo se describen una serie de anomalías citogenéticas y moleculares relacionadas con la susceptibilidad, cancerización y pronóstico de los tumores de cabeza y cuello.Esta revisión expondrá algunos avances en el tratamiento de pacientes con cáncer de cabeza y cuello; enfatizando en la forma en la que la Biología Molecular probablemente influya en el desarrollo de futuras terapias.AbstractHead and neck cancers have multiple genetic abnormalities that influence tumor behavior and may be useful in developing new therapies.This review presents a large number of cytogenic and molecular abnormalities involved in head and neck cancer susceptibility, field cancerization, and prognosis.This review will highlight some important advances in the treatment of patients with head and neck cancer and emphasize the ways in which Molecular Biology is likely to affect the development of future therapies.