Vicente Alberola Candel

Old and New Insights in the Treatment of Thyroid Carcinoma

Thyroid cancer is the endocrine tumor that bears the highest incidence with 33 550 new cases per year. It bears an excellent prognosis with a mortality of 1530 patients per year (Jemal et al.; 2007). We have been treating patients with thyroid carcinoma during many years without many innovations. Recently, we have assisted to the development of new agents for the treatment of this disease with unexpected good results. Here we present a review with the old and new methods for the treatment of this disease.Thyroid cancer is the endocrine tumor that bears the highest incidence with 33 550 new cases per year. It bears an excellent prognosis with a mortality of 1530 patients per year (Jemal et al.; 2007). We have been treating patients with thyroid carcinoma during many years without many innovations. Recently, we have assisted to the development of new agents for the treatment of this disease with unexpected good results. Here we present a review with the old and new methods for the treatment of this disease.

Management of platinum-resistant ovarian cancer with the combination of pemetrexed and gemcitabine.

IntroductionPlatinum resistant ovarian cancer is a current challenge in Oncology. Current approved therapies offer no more of a 20% of response. New therapeutic options are urgently needed.Patients and MethodsPatients were treated with the combination of Pemetrexed 500 mg/m2 d1 and Gemcitabine 1000 mg/m2 d1, 8 in a 21 days basis.Results10 platinum-resistant ovarian cancer patients were treated under compassionate use. Mean previous chemotherapy lines were 3.3. Mean administered cycles were 4. Mean CA 125 decrease was on average of 47%, with one patient experiencing a 95% decrease in her CA 125 level. 1 patient had a complete clinical remission, and 2, had partial radiological responses. Mean Progression free survival was 16.5 weeks, and Overall Survival was 21.2 weeks. Treatment was well tolerated.ConclusionsDeemd to the observed activity, the combination of Pemetrexed and Gemcitabine deserves deeper investigation in platinum-resistant ovarian cancer patients.

Melanoma: from darkness to promise.

Metastatic melanoma is one of the most resistant tumors to standard chemotherapy approaches. The median overall survival of patients diagnosed with metastatic melanoma is lower than 9 months. Current approved treatments offer only marginal survival advantages. New immunotherapeutic targets have appeared recently trying to modulate the host immune response against the tumor. New targeted agents have changed the standard of care of other solid tumor types like breast cancer. Here, we discuss the new advances and achievements in the treatment of this highly resistant disease.Metastatic melanoma is one of the most resistant tumors to standard chemotherapy approaches. The median overall survival of patients diagnosed with metastatic melanoma is lower than 9 months. Current approved treatments offer only marginal survival advantages. New immunotherapeutic targets have appeared recently trying to modulate the host immune response against the tumor. New targeted agents have changed the standard of care of other solid tumor types like breast cancer. Here, we discuss the new advances and achievements in the treatment of this highly resistant disease.

Durable Complete Remission of a Brainstem Glioma Treated with a Combination of Bevacizumab and Cetuximab

Treatment of a relapsed glioma is a clinical challenge nowadays. New active treatments are required to treat these difficult diseases. Here we present a durable complete remission of a relapsed glioblastoma that has achieved a complete radiologic response with the combination of cetuximab and bevacizumab, in a third-line setting, that has offered a progression-free survival of 20 months. We consider here both potential mechanisms for the explanation of this result. First, the potential target of the cancer stem cells (CSCs) with these two antibodies, and second, the potential recruitment of the immune system to directly pursue the CSCs.

Cell-cell fusion as a potential target in cancer therapy

In the fight against cancer, new and more specific targets are needed. Here, we offer an example of a potential target that has not been widely studied, namely the syncytin protein. Syncytin is expressed mainly in the human placenta and is implicated in placental syncytiotrophoblast cell fusion. Not much is known about the role of syncytin in cancer, but the existing data call for more intense research. Its retroviral origin and particular tissue distribution make syncytin an interesting potential target in cancer therapy.

PSA Decrease with Fulvestrant Acetate in a Hormone-Resistant Metastatic Prostate Cancer Patient

Zusammenfassung Hintergrund: Das androgen-unabhängige Prostatakarzinom ist schwer zu behandeln. Für Fulvestrant konnte eine hemmende Wirkung auf die Dimerisierung des Östrogenrezeptors nachgewiesen werden, und der Androgenrezeptor kann nachweislich das Wachstum von Prostatakarzinom-Zelllinien stimulieren. Fallbericht: Ein 79-jähriger Patient mit einem metastasierten androgenunabhängigen Prostatakarzinom wurde mit FulvestrantAcetat gemäß einer Loading-Dose-Strategie behandelt. Ohne Auftreten signifikanter Nebenwirkungen konnte 8 Wochen nach Erstbehandlung der Spiegel des prostataspezifischen Antigens (PSA) von 154 ng/ml auf 0.45 ng/ml gesenkt werden. Schlussfolgerung: Mit Fulvestrant konnte der PSA-Spiegel dieses Patienten ohne Toxizität gesenkt werden.BACKGROUND Androgen-independent prostate cancer (AIPCA) is a difficult disease to treat. Fulvestrant has shown activity inhibiting estrogen receptor dimerization, and the androgen receptor has been shown to stimulate growth in prostate cancer cell lines. CASE REPORT A 79-year-old metastatic prostate cancer patient with AIPCA was treated with fulvestrant acetate with a loading dose strategy. Without recording any significant side effects, the prostate-specific antigen (PSA) level decreased from 154 ng/ml to 0.45 ng/ml 8 weeks after the first treatment administration. CONCLUSION Fulvestrant was able to reduce the PSA level in this AIPC patient without any toxicity.

Final Report of the First Refractory Germ Cell Tumor Treated with Sunitinib Malate.

Patients with advanced germ cell tumors can be cured with cisplatin-based chemotherapy, but the outcome remains unsatisfactory for patients with relapsed disease, including those patients with refractory disease after bone marrow transplantation. Targeted therapies have changed the standard of care for many advanced solid tumors. We have identified, in the literature, potential targets for the treatment of refractory germ cell tumors, and applied to a patient with a refractory disease. We chose sunitinib for this purpose. To our knowledge, this is the first case to be treated with sunitinib, and we have found a promising activity.Patients with advanced germ cell tumors can be cured with cisplatin-based chemotherapy, but the outcome remains unsatisfactory for patients with relapsed disease, including those patients with refractory disease after bone marrow transplantation. Targeted therapies have changed the standard of care for many advanced solid tumors. We have identified, in the literature, potential targets for the treatment of refractory germ cell tumors, and applied to a patient with a refractory disease. We chose sunitinib for this purpose. To our knowledge, this is the first case to be treated with sunitinib, and we have found a promising activity.

Young male patient with bilateral synchronous testicular germ cell tumour. Considerations for partial orchiectomy

Bilateral synchronous testicular cancer is a rare disease and is usually associated with similar histological findings in each testicle. The standard therapy of bilateral testis cancer is generally considered to be inguinal orchiectomy. We present a case of synchronous bilateral testicular germ cell tumour, with different histology, initially treated with testis-sparing surgery. After pathology review, the margin of the partial orchiectomy was considered affected, and an inguinal orchiectomy was planned. Options for testis-sparing surgery are discussed.

Carcinoma de ovario: enfermedad tras citorreducción y quimioterapia adyuvante. Importancia e implicaciones terapéuticas

Resumen Las neoplasias de ovario suelen presentarse en estadios avanzados. La citorreduccion primaria completa continua teniendo una importancia clara en el pronostico de las pacientes. Hemos asistido a una progresiva mejoria en el resultado de los tratamientos, desde la aparicion de los taxanos, asi como de la importancia de la via intraperitoneal. Sin embargo, esta ultima no acaba de imponerse como practica clinica habitual dadas las dificultades que presenta. Tras el final de la quimioterapia adyuvante, la mayoria de las pacientes presentara una recaida. La identificacion de las pacientes con mayor riesgo puede permitir el establecimiento de una pauta terapeutica que mejore las perspectivas de este subgrupo de pacientes. La enfermedad residual tras citorreduccion primaria y quimioterapia adyuvante tiene una importancia pronostica y su manejo no responde a pautas estandarizadas.

PSA Decrease with Fulvestrant Acetate in a Hormone-Resistant Metastatic Prostate Cancer Patient: A Case Report

Metastatic prostate cancer is an incurable disease. After a period of hormone sensitivity that allows for the use of antiandrogens, the disease invariably progresses to a situation of androgen-independent growth, which deserves the consideration or the use of chemotherapy. As many of these patients are elderly and fragile, treatment with chemotherapy is challenging. Therefore, new drugs are required. Preclinical evidence supports the role of estrogen receptor (ER) signaling in prostate cancer. In this paper, we report the first published evidence of PSA control in a patient with metastatic prostate cancer treated with fulvestrant acetate.Metastatic prostate cancer is an incurable disease. After a period of hormone sensitivity that allows for the use of antiandrogens, the disease invariably progresses to a situation of androgen-independent growth, which deserves the consideration or the use of chemotherapy. As many of these patients are elderly and fragile, treatment with chemotherapy is challenging. Therefore, new drugs are required. Preclinical evidence supports the role of estrogen receptor (ER) signaling in prostate cancer. In this paper, we report the first published evidence of PSA control in a patient with metastatic prostate cancer treated with fulvestrant acetate.