Dor crônica em pacientes com câncer

Revisão sobre dor oncológica publicada agora no Lancet:

O manejo adequado da dor em pacientes com câncer produz alívio satisfatório para a maioria. No entanto, estima-se que 43% dos pacientes com câncer recebe cuidados inadequados para a sua dor. A base do tratamento na terapia farmacológica da dor oncológica são os opiáceos e todos os médicos devem tentar otimizar os resultados positivos dessas drogas, minimizando os riscos.

Quando a terapêutica opióide não é suficiente, a adição de um AINE no tratamento com opióides pode ser útil, especialmente em algumas situações dolorosas, mas o risco gastrointestinal, cardiovascular e renal destes fármacos devem ser pesados ​​contra os benefícios em cada caso. Outros medicamentos, como corticosteróides, antidepressivos e anticonvulsivantes, também podem ser úteis.

Os tratamentos não medicamentosos também podem ser usados ​​para melhorar o controle da dor.

Os benefícios da integração dos cuidados paliativos no tratamento da dor oncológica são aplicados durante todo o curso da doença e incluem intervenções para manter a qualidade de vida, aliviar o sofrimento e melhorar a sobrevivência e adaptação.

Leia a revisão na Lancet: http://bit.ly/nTk3Wo

Papel de células tronco gliais na angiogênese tumoral

Muitas evidências apoiam a hipótese de que células-tronco gliais estão intimamente relacionadas com o início da angiogênese, o fenômeno da hipóxia e da rede microvascular intratumoral neoplásicas.

Este trabalho, publicado na Revista de Neurología, analisou o papel das células-tronco gliais em relação ao processo de angiogênese, bem como alguns resultados que se relacionam com o aparecimento dessas células durante a angiogênese em modelo de glioma experimental em rato.

As células foram caracterizadas através de anticorpos contra os antígenos CD133, nestina e fator de crescimento endotelial (VEGF). Células nestina (+) foram encontradas em todas as fases do desenvolvimento do tumor, enquanto CD133 (+) estavam presentes apenas nos estados intermediários correspondentes à superexpressão de VEGF. Este momento é conhecido como "ativação da angiogênese (angiogenic switch).

Algumas das células CD133 (+) co-expressaram nestina. Células-tronco gliais neste modelo de glioma experimental, mimetrizando o glioblastoma multiforme humano, formam nichos em áreas hipóxicas e perivasculares intratumorais.

Link: http://bit.ly/qisCmh

Temozolomida melhora estado funcional de idosos com glioblastoma

Temozolomida melhora a sobrevida e melhora a função e qualidade de vida em pacientes idosos com glioblastoma multiforme (GBM) recentemente diagnosticado, de acordo com resultados obtidos em um ensaio fase II publicado no Journal of Clinical Oncology.

Um terço dos pacientes no estudo experimentaram melhorias no status funcional e um quarto deles tinham capacidade de cuidar de si mesmos após o tratamento com temozolomida, se administrada antes que eles mostrassem progressão da doença.

Os pesquisadores recrutaram 70 pacientes com idade acima de 70 anos que foram diagnosticados com GBM. Cada um recebeu 150-200 temozolomida mg/m2/dia por cinco dias a cada quatro semanas até progressão da doença. Treze por cento dos pacientes desenvolveram neutropenia grau 3 ou 4, enquanto 14% desenvolveram trombocitopenia de grau 3 ou 4. A sobrevida livre de progressão mediana foi de 16 semanas e a sobrevida global mediana foi de 25 semanas.

Link para o trabalho: http://bit.ly/qgx9t7

Vaccine design at atomic level

Scientists from Novartis Italy-based facilities have reported in this month on Science Translational Medicine how they have probed an even deeper scale in the design of a new vaccine. Searching for a useful vaccine against meningococcus B, they combined conventional immunogen design, genomics and atomic structural information that led to a novel level of design refinement. Meningococcus is a well-known causal agent to meningitis, a life-threatening infection. Although there exists vaccines for most strains of meningococcus, serotype B (composed of more than 300 strains) has no such vaccine. Although this new vaccine is far from final development stage, this new accomplishment represents a further advance in the general process of vaccine development. In the future, new and safer vaccines may be designed this way. Read more: http://bit.ly/oNMnbV and http://bit.ly/qPl4Fh

Beta bloqueadores e o tratamento do câncer

Recentemente, 2 artigos publicados no Journal of Clinical Oncology (link 1 e 2) relataram que pacientes com câncer de mama que usam beta bloqueadores (como o propranolol), uma classe de drogas largamente utilizada para tratar hipertensão, têm menos recorrência tumoral e maior sobrevida livre de doença, e também que pacientes usando estas drogas apresentam um risco menor de desenvolver câncer de mama avançado. Estes estudos vêm se somar a evidências pré-clínicas e um estudo anterior que havia demonstrado um possível efeito protetor dos betabloqueadores contra câncer de qualquer tipo. Enquanto uma nova onda de euforia ligada aos beta bloqueadores vai se formando (desde o advento do tratamento dos hemangiomas com propranolol), especialistas advertem contra o uso destas drogas antes que ensaios clínicos bem controlados demonstrem seu papel no tratamento anticâncer. O Dr. Des Powe, do Queen's Medical Centre publicou um outro estudo no jornal Oncotarget, onde relata uma redução de 71% da mortalidade em pacientes com câncer de mama usando beta bloqueadores. Ele diz que "está encorajado por estes resultados iniciais, os quais demonstraram que, usando uma droga bem estabelecida, segura e barata, poderemos conseguir um avanço na terapia alvo contra o câncer de mama."
Veja um vídeo sobre o assunto:

The Running Mice

Researchers of the University of Pennsylvania and his colleagues genetically engineered mice to lack the IL-15Rα gene, and the modified mice ran six times farther than normal mice each night. Previous studies had suggested that IL-15Rα is important for muscle strength. The genetically-modified mice seemed to lack fast-twitch muscles - muscles that allow more precise movements but tire faster - and to have only slow-twitch muscles - which have more endurance but do not allow fine movements. This could explain why the mice did not tire, but the cause of their behavioral changing was not clear. Why they wanted to run for hours every night? The scientists argue that human resistance to fatigue could be affected by this same gene and that this could be a possible target for human diseases.
Read more:

Missing Gene Helps Mice Run for Hours - ScienceNOW

First effective immunotherapy for high-risk neuroblastoma

A team led by San Diego medical researcher Alice Yu published in New England Journal of Medicine their break-through results of the first ever immunotherapy proved to be effective for high-risk neuroblastoma patients. This new treatment was first announced in the 2009 edition of ASCO meeting (see previous post). Children with this disease normally have a grim prognosis. Yu's group treated children after standard high-dose chemotherapy and stem cell rescue with a monoclonal antibody against a surface molecule commonly found in neuroblastomas - the disialoganglioside GD2. Anti-GD2 therapy along with isotretinoin and IL-2 boosted patients' disease-free survival by 20% (44 to 64% 2 years after diagnosis). This result is superior to conventional treatment. The only drawback was the high amount of toxicity in immunotherapy-treated patients. Read the article here.

Intermediate-risk neuroblastoma has good prognosis

Neuroblastoma, a tumor that affects mostly young children and has a very high mortality rate when advanced, has been shown in a study published in 2010 that can have good prognosis with reduced chemotherapy. The study, announced for the first time in 2007 (see this previous post) was led by a team from Perth, Australia and endorsed by Childrens Oncology Group. They used the COG risk stratification system that uses clinical and tumor biological data to assign children to one of 3 risk groups: low, intermediate and high. Only intermediate-risk patients were included in this study. Results have shown that a short, reduced chemotherapy made up of 4 or 8 cycles and lower doses than previous treatment regimens yielded high survival rates. This regimen reduced toxicity as well, while maintaining a very good result. In this present study, 100% of INSS stage 3 patients achieved prolonged cure. Read the complete article here.

High-dose chemotherapy and stem cell transplant for advanced neuroblastoma

Results from a french pilot trial testing very high dose chemotherapy followed by autologous transplantation in children with advanced neuroblastoma were not different from previous trials with other approaches. Survival in this group of patients remained between 30-40% in 5 years. New treatments are needed for kids with advanced neuroblastoma.

A dose-intensive approach (NB96) for induction therapy utilizing sequential high-dose chemotherapy and stem cell rescue in high-risk neuroblastoma in children over 1 year of age - Monnereau-Laborde - 2011 - Pediatric Blood & Cancer - Wiley Online Library

Advanced neuroblastoma treated with 131I-MIBG and combined chemotherapy

A group from Italy has just published results from a trial using Radio-iodine MIBG to treat kids with advanced neuroblastoma. They report better results with association to chemotherapy. This initial report may yield new clinical trials using this combination to test it's efficacy against this grim disease.

Treatment of advanced neuroblastoma in children over 1 year of age: The critical role of 131I-metaiodobenzylguanidine combined with chemotherapy in a rapid induction regimen - Mastrangelo - 2011 - Pediatric Blood & Cancer - Wiley Online Library

Bacteria Flash Like Christmas Lights - ScienceNOW

Cool blinking bacteria allow scientists to discover a whole new electrophysiological phenomenon. Bacteria can depolarize like neurons do, a group of scientists who were studying neurons discovered by chance. See the cool video showing flashing live bacteria in Science web page.

Bacteria Flash Like Christmas Lights - ScienceNOW

EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision - Attal - 2010 - European Journal of Neurology - Wiley Online Library

European Federation of Neurological Societies updated guidelines for the management of neuropathic pain. This second EFNS Task Force aimed at updating the existing evidence about the pharmacological treatment of neuropathic pain since 2005. In its conclusions, it declares that there are still too few large-scale comparative studies, and more studies are needed. For future trials, EFNS recommend to assess comorbidities, quality of life, symptoms and signs with standardized tools and attempt to better define responder profiles to specific drug treatments. Read full article:

EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision - Attal - 2010 - European Journal of Neurology - Wiley Online Library

Magnetic Nanoparticles Fry Tumors - ScienceNOW

In a new study, a team from Korea found that injecting mice with tiny magnets and cranking up the heat eliminated tumors from the animals' bodies with no apparent side effects.

The idea of killing cancer with heat isn't new. Like normal cells, cancer cells start to die when body temperature rises above 43˚C. The trick is figuring out how to kill the cancer without harming the body's own cells. One promising idea, known as magnetic hyperthermia, involves injecting minuscule "nanoparticles," basically microscopic lumps of iron oxide or other compounds, into tumors to make them magnetic. The patient is put into a magnetic field that reverses direction thousands of times every second. This therapy has not been tested in humans yet. The magnetic nanoparticles are excited by the applied field and begin to get hot, heating and potentially destroying the surrounding cancer tissue. Read more:

Magnetic Nanoparticles Fry Tumors - ScienceNOW

New Cochrane meta-analysis sparks controversy about bronchiolitis

Bronchiolitis is the most common disease of the lower respiratory tract during the first year of life. Respiratory syncytial virus is the underlying cause of most bronchiolitis and this infection is associated with substantial
morbidity in young children. Research has shown its burden in developed and developing countries and a lack of
clear evidence for its therapeutic management, including
the use of different bronchodilators (β₂ agonists, adrenaline (epinephrine), anticholinergics) and steroids. Several systematic reviews have failed to provide convincing evidence to support any
of these treatments in the acute management of bronchiolitis,
and their routine use is not
recommended by current clinical practice guidelines. Scholars disagree about the use of corticosteroids and common scientific belief is that they are useless and may be even harmful in children with bronchiolitis. Now, a recent meta-analysis published in the British Medical Journal has found evidence that inhaled adrenaline and systemic corticosteroids may indeed have a role in the treatment of bronchiolitis. The study has been criticized by many. One critic say the study is "flawed" and he "read with disappointment the use of a Cochrane review to promote
the use of adrenaline and steroids." Read the study and one of the critics.

Burying Anti-leukotrienes

A recently published meta-analisys from Cochrane Database has reported that anti-leukotriene drugs fare worse than long-acting beta2-adrenergics when treating adults with inhaled-corticosteroid resistant asthma. Although this report coiós not conclude anything for children, anti-leukotrienes are known to have limited value in pediatric asthma. This result makes an even stronger case for the fail that was the anti-leukotriene therapy, once a hype of Big Pharma. Read the abstract here.

What's new this month for 'macrophage activation syndrome' in PubMed

This message contains My NCBI what's new results from the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).

Sender's message: Search: macrophage activation syndrome
Sent on Saturday, 2011 Jul 02
Search macrophage activation syndrome

PubMed Results

1.	Adult-onset Still's disease with macrophage activation syndrome successfully treated with a combination of methotrexate and etanercept.
	Maeshima K, Ishii K, Iwakura M, Akamine M, Hamasaki H, Abe I, Haranaka M, Tatsukawa H, Yoshimatsu H.
	Mod Rheumatol. 2011 Jun 14. [Epub ahead of print]
	PMID: 21670967 [PubMed - as supplied by publisher]
	Related citations

2.	Pathogenesis of systemic juvenile idiopathic arthritis: some answers, more questions.
	Mellins ED, Macaubas C, Grom AA; Medscape.
	Nat Rev Rheumatol. 2011 Jun 7;7(7):416-26. doi: 10.1038/nrrheum.2011.68.
	PMID: 21647204 [PubMed - in process]
	Related citations

3.	Immune mobilization of autologous blood progenitor cells: direct influence on the cellular subsets collected.
	Meehan KR, Talebian L, Wu J, Hill JM, Szczepiorkowski ZM, Sentman CL, Ernstoff MS.
	Cytotherapy. 2010 Dec;12(8):1013-21. Epub 2010 Sep 27.
	PMID: 20873991 [PubMed - indexed for MEDLINE]
	Related citations