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Cancer patients can experience flares of pain, called breakthrough pain (BTcP), despite treatment with painkillers. Although BTcP can be excruciating, its intensity and other characteristics depend on several factors, including its treatment. However, even if treated, BTcP can impair quality of life for cancer patients. We assessed quality of life in 118 patients with advanced cancer and BTcP treated in 13 medical oncology departments across Spain. We treated BTcP with individualized therapy, taking into account both pain-related and patient-related factors. We also measured quality of life using a specific, widely-used questionnaire at the study visits: at onset of individualized pain therapy and after 3, 15 and 30 days’ treatment. At each visit, flare-up pain therapy was adjusted or maintained as necessary. Throughout the study, quality of life and sleep quality improved for all participants. Furthermore, there was a greater reduction in intensity, duration and frequency of BTcP. The most common treatments for flare-ups were low doses of rapid-onset opioids (fentanyl given by sublingual, buccal or nasal administration), which were much better tolerated than high-dose opioids. Overall, the study showed that quality of life in patients with advanced cancer and BTcP increased after individualized pain therapy, mainly with low doses of rapid-onset opioids.

Lenvatinib; Thyroid cancer Lenvatinib; Càncer de tiroide Lenvatinib; Cáncer de tiroide Thyroid cancer is the most frequent endocrine tumor. In locally advanced or metastatic disease there are only two types of treatment available: radioactive iodine (RAI) while the disease is RAI-sensitive and multikinase inhibitors, lenvatinib and sorafenib, when the disease becomes RAI-refractory. The objective of this publication is to review the current knowledge on the use of targeted therapy and the specific practical considerations concerning lenvatinib in the treatment of patients with differentiated thyroid cancer under special circumstances. The authors received honoraria payment from Eisai Farmacéutica SA in line with ICMJE guidelines.

Introduction: Tyrosine kinase inhibitors have been a breakthrough in the treatment of advanced medullary thyroid cancer (MTC), and they can prolong progression-free survival (PFS). Case Presentation: A patient with MTC and metastatic spread to the lymph nodes, lungs, bones, breast, and cerebellum started treatment with vandetanib. During treatment, she developed secondary adrenal insufficiency and hypogonadotropic hypogonadism. After 9 years of vandetanib therapy, the disease has not progressed and the patient maintains a complete response of the breast metastases and a partial response of the other metastatic lesions. Conclusion: To our knowledge, this is the first reported case of secondary adrenal insufficiency and hypogonadotropic hypogonadism related to therapy with vandetanib. Moreover, the prolonged PFS and the complete disappearance of some of the metastatic lesions in this patient are truly unusual.

BACKGROUND: Previous studies have shown prolonged overall survival (OS) in patients with metastatic breast cancer (MBC) treated with eribulin, without a clear improvement in progression-free survival (PFS), which might indicate an eribulin-mediated suppression of further spread of metastasis. In addition, it was shown that 44.1% of patients with luminal B-like tumors who received neoadjuvant eribulin converted to the luminal A-like subtype, which might be associated to a more endocrine-sensitive behavior. The aim of this trial is to explore the efficacy of eribulin in combination with the same drug administered in the last endocrine therapy (ET) regimen in hormone receptor (HR)-positive (+) / human epidermal growth factor receptor 2 (HER2)-negative (-), locally-recurrent or MBC patients who had previously shown progression while on an aromatase inhibitor (AI)-containing regimen in the metastatic setting or within six months from their last AI dose in the adjuvant setting. TRIAL DESIGN: This is an open-label, randomized, multicenter phase II trial. Patients will be randomized 1:1 to receive either eribulin alone (Arm A) or eribulin in combination with the last AI administered either in the metastatic or adjuvant setting (Arm B). Patients will receive eribulin intravenously on days 1 and 8 of every 21-day cycle, alone or in combination with exemestane, letrozole, or anastrozole, until disease progression or unacceptable toxicity. Main selection criteria are: (1) Pre- or post-menopausal women, who received an AI +/- gonadotropin-releasing hormone analogue in the last ET regimen; (2) HR+ / HER2-, unresectable locally advanced or MBC; (3) Measurable disease according to the Response Evaluation Criteria In Solid Tumors (RECIST) criteria v. 1.1; (4) At least one taxane or anthracycline regimen in either the neoadjuvant or adjuvant setting; (5) Patients with no prior line of chemotherapy in the metastatic setting; (6) At least 1 and up to 3 prior lines of ET in the metastatic setting. The primary objective of the study is to assess the overall response rate (ORR) in treatment Arm B, defined as the proportion of patients with confirmed complete or partial response according to the RECIST criteria v.1.1. Secondary objectives include: (1) PFS, PFS-2, OS, clinical benefit rate, duration of response, change in maximum tumor shrinkage in both arms, and ORR in Arm A; (2) Safety-related outcome as per Common Terminology Criteria for Adverse Events v. 5.0. Patients will be accrued in a Simon’s two-stage admissible design. In stage I, the accrual goal will be a total of 22 patients. If there are at least 2 responders out of 11 in Arm B, accrual will continue to stage II until completion. Assuming an ORR of 10% in Arm A and 30% in Arm B, a sample size of 60 subjects will provide the necessary statistical precision for the observed differences between treatment arms. ClinicalTrials.gov identifier: NCT03795012.First patient enrolled on June 24th, 2019. Citation Format: José Manuel Pérez-García, Alfonso Cortés Salgado, Elena López Miranda, Antonio Antón, Pedro Sánchez Rovira, Beatriz Castelo Fernández, Ana López González, Isabel Garau, Alejandro Martínez, Miguel Corbellas Aparicio, Sonia Del Barco, Miguel Sampayo, François Riva, Andrea Malfettone, Antonio Llombart-Cussac, Javier Cortés. A multicenter, randomized, phase II trial evaluating the efficacy of eribulin monotherapy and eribulin plus endocrine therapy in locally-recurrent or metastatic breast cancer patients after progression on endocrine therapy (REVERT study) [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr OT2-09-01.

Nasopharyngeal carcinoma (NPC) is distinct from other cancers of the head and neck in biology, epidemiology, histology, natural history, and response to treatment. Radiotherapy (RT) is the cornerstone of locoregional treatment of non-disseminated disease and the association of chemotherapy improves the rates of survival. In the case of metastatic disease stages, treatment requires platinum/gemcitabine-based chemotherapy and patients may achieve a long survival time.

Background: Luminal advanced breast cancer (ABC) patients eventually progress on endocrine therapy. REVERT aimed to explore whether eribulin could restore endocrine sensitivity in a randomized, non-comparative phase II trial. Methods: Aromatase inhibitor (AI)-resistant patients with luminal ABC were randomized 1:1 to receive eribulin +/− AI. Patients were stratified by prior cyclin-dependent kinases 4/6 inhibitor (CDK4/6i) treatment. The primary endpoint was an investigator-assessed overall response rate (ORR) according to RECIST version 1.1 in the eribulin + AI arm. An interim analysis was planned with 11 evaluable patients according to a two-stage Simon design. Results: Twenty-two patients were enrolled (15 eribulin + AI arm; 7 eribulin arm). The trial was terminated early in March 2021, with eight (36.4%) patients still on treatment. ORR was 26.7% in the eribulin + AI arm (95% CI, 7.8–55.1%; p = 0.0541). In the eribulin arm, two (28.6%) patients had an objective response (95% CI, 3.7–71.0%). The difference between the study arms was not significant (p = 0.918). The addition of AI to eribulin also failed to show improvement in other efficacy endpoints. A significant interaction between the treatment arm and previous CDK4/6i treatment was observed for ORR (p = 0.018) and progression-free survival (p = 0.084). Overall, the toxicity profile was consistent with the known safety profile of eribulin. No treatment-related deaths were reported. Conclusion: Eribulin + AI does not seem to improve outcomes compared with eribulin monotherapy in patients with AI-resistant luminal ABC. This chemo–endocrine approach deserves further investigation after progression to CDK4/6i-based therapy.

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.

Se ha visto que los canceres de cabeza y cuello tienen multiples anomalias geneticas que influyen en el desarrollo y comportamiento del tumor y pueden ser utiles para la creacion de nuevas terapias.

La cistitis hemorragica se define como un sangrado vesical difuso agudo o insidioso. Las causas potenciales de hemorragia vesical son numerosas; incluyen toxicos quimicos (agentes al quilantes como las oxazofosforinas, el busulfan, tiotepa, derivados de toloudina y de anilinas como los insecticidas y drogas de diseno), agentes immunes (penicilinas, el danazol), radioterapia externa o intersticial, virus (adenovirus tipo 11, virus BK y virus deInfluenza A), asi como diversas etiologias idiopaticas (amiloidosis en la artritis reumatoide). El diagnostico y tratamiento de esta complicacion a menudo resulta problematico. Por otro lado, la hemorragia vesical secundaria a infecciones bacterianas, fungicas y parasitarias no esta directamente recogida en esta revision. Por tanto nos centraremos en las causas de cistitis hemorragica no debidas a infecciones de origen tumoral.

Hepatic toxicity of breast cancer therapy is well known, usually consisting of elevation in the serum levels of hepatic enzymes or fatty infiltration of the liver. The chemotherapeutic agents most commonly linked to hepatotoxic effects are methotrexate, anthracyclines, taxanes and cyclophosphamide. There are few reports of patients with liver metastasis having radiological findings mimicking cirrhosis, both in the presence or the absence of prior systemic chemotherapy. Hepatotoxicity of antineoplastic drugs and cellular necrosis induced by response of liver metastases to chemotherapy may play a critical role in its physiopathology.This article reports a series of ten women with breast cancer (nine with liver metastasis) treated with chemotherapy or hormonotherapy.They had low risk factors for hepatic disease, but developed a cirrhosis-like appearance in the computed tomography scan. The patient without liver metastasis is the second of this kind described in the literature. Relatively few reports have documented clinical sequelae of portal hypertension. In our series, three patients had oesophageal bleeding varices needing be hospitalised. To our knowledge, these are the first cases reported in the literature.This suggests that some manifestations of portal hypertension may develop in association with the cirrhosis- like pattern induced by breast cancer therapy.