LEONARDO GOMES DA FONSECA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/07 - Laboratório de Gastroenterologia Clínica e Experimental, Hospital das Clínicas, Faculdade de Medicina
LIM/07 - Laboratório de Gastroenterologia Clínica e Experimental, Hospital das Clínicas, Faculdade de Medicina
8 resultados
Resultados de Busca
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- Safety and efficacy of sorafenib in patients with Child-Pugh B advanced hepatocellular carcinoma(2015) FONSECA, Leonardo Gomes Da; BARROSO-SOUSA, Romualdo; BENTO, Afonso Da Silva Alves; BLANCO, Bruna Paccola; VALENTE, Gabriel Luis; PFIFFER, Tulio Eduardo Flesch; HOFF, Paulo Marcelo; SABBAGA, JorgeSorafenib demonstrated a survival benefit in the treatment of advanced hepatocellular carcinoma (HCC) in phase III trials. However, almost all the patients included in those trials exhibited well-preserved liver function (Child-Pugh A). The aim of this study was to describe our experience with sorafenib in Child-Pugh B HCC patients. A database of patients with advanced HCC treated with sorafenib was retrospectively evaluated. The median overall survival of Child-Pugh B patients (n=20) was 2.53 months [95% confidence interval (CI): 0.33-5.92 months] and of Child-Pugh A patients (n=100) 9.71 months (95% CI: 6.22-13.04). Child-Pugh B patients had a significantly poorer survival compared to Child-Pugh A patients (P=0.002). The toxicities were similar between the two groups. Metastasis, vascular invasion and alpha-fetoprotein level >1,030 ng/ml were not associated with survival among Child-Pugh B patients (P=0.281, 0.189 and 0.996, respectively). Although the survival outcomes were worse in Child-Pugh B patients treated with sorafenib, the toxicity profile was manageable. Therefore, there remains the question of whether to treat this subgroup of patients and more data are required to define the role of sorafenib in the context of liver dysfunction.
conferenceObject Does cytotoxic chemotherapy (CT) have a role in palliative treatment of hepatocellular carcinoma (HCC)?(2018) MARTA, Guilherme Nader; FONSECA, Leonardo Gomes da; BRAGHIROLI, Maria Ignez Freitas Melro; HOFF, Paulo Marcelo; SABBAGA, JorgeconferenceObject Irinotecan combined with Panitumumab or cetuximab as third-line treatment for metastatic colorectal cancer.(2022) BRAGHIROLI, Maria Ignez; VICENTINI, Maria Fernanda Batistuzzo; FONSECA, Leonardo Gomes da; SOUZA, Karla Teixeira; BONADIO, Renata Colombo; BRAGHIROLI, Oddone Freitas Melro; MATHIAS, Maria Cecilia Machado; TALANS, Aley; MENDOZA, Maria Elizabeth Zambrano; MARTINS, Juliana Goes; SABAGGA, Jorge; MONIZ, Camila Venchiarutti Motta Venchiarutti; HOFF, Paulo MarceloconferenceObject Pretreatment neutrophil to lymphocyte ratio and prognosis of patients with advanced hepatocelullar carcinoma treated with sorafenib.(2014) FONSECA, Leonardo Gomes; BARROSO-SOUSA, Romualdo; BLANCO, Bruna Paccola; VALENTE, Gabriel Luls; BRAGHLROLL, Maria Ignez Freltas Melro; PFIFFER, Tullo Eduardo Flesch; SABBAGA, Jorge; HOFF, Paulo MarceloconferenceObject Prospective results of perioperative chemotherapy (PCT) with cisplatin and irinotecan for locally advanced gastric cancer.(2016) PEREIRA, Guilherme Luiz Stelko; FONSECA, Leonardo Gomes da; RAMOS, Marcus Fernando Kodama Pertille; RIBEIRO, Ulysses; PEREIRA, Gabriel; PEREIRA, Marina Alessandra; MELLO, Evandro Sobroza de; SABBAGA, Jorge; HOFF, Paulo Marcelo- Safety and efficacy of cytotoxic chemotherapy in hepatocellular carcinoma after first-line treatment with sorafenib(2018) FONSECA, Leonardo Gomes da; MARTA, Guilherme Nader; BRAGHIROLI, Maria Ignez Freitas Melro; CHAGAS, Aline Lopes; CARRILHO, Flair Jose; HOFF, Paulo Marcelo; SABBAGA, JorgeBackgroundBefore the targeted therapies era, cytotoxic chemotherapy (CCT) was an option for advanced hepatocellular carcinoma (HCC), even with the lack of supporting evidence. Since the last decade, sorafenib has been established as the first-line therapy. Although new agents are being incorporated, CCT is still considered in regions where new drugs are not available or for patients who progressed through the approved therapies and remain in good clinical condition. We aimed to describe our experience regarding the use of CCT as second-line treatment after sorafenib.MethodsA database of 273 patients was evaluated. Patients that received CCT after sorafenib progression were selected for the analysis. Descriptive statistics was used for categorical and continue variables. Median survival was estimated with Kaplan-Meier curves. Variables were found to be significant if the two-sided p value was 0.05 on multivariate testing using the Cox regression model.ResultsForty-five patients received CCT; 33 (73.3%) had Child-Pugh classification A, and 34 (75.6%) had stage C according to the Barcelona Clinic Liver Cancer (BCLC) staging system. The most used regimen was doxorubicin in 25 patients (55.6%). Median overall survival (OS) was 8.05 months (95% confidence interval [CI] 2.73 - 9.88 months). The 6-month and 1-year survival probability was 52.4% and 27.36%, respectively. Eastern Cooperative Oncology Group performance status (ECOG PS) 0-1 and disease control with sorafenib was independently associated with better OS in patients treated with CCT. Any-grade toxicities were observed in 82.2% and grade 3-4 in 44.4% of the patients.ConclusionIn accordance with previous studies, CCT had a notable rate of adverse events. The poor prognosis of this cohort suggests that CCT may not alter the natural history of HCC after sorafenib progression.
- Malignancy-Related Hypercalcemia in Advanced Solid Tumors: Survival Outcomes(2017) RAMOS, Ricardo Emanuel de Oliveira; MAK, Milena Perez; ALVES, Michel Fabiano Silva; PIOTTO, Gustavo Henrique Munhoz; TAKAHASHI, Tiago Kenji; FONSECA, Leonardo Gomes da; SILVINO, Marina Cavalcanti Maroja; HOFF, Paulo Marcelo; CASTRO JR., Gilberto dePurpose Malignancy-related hypercalcemia (MRH) is associated with a dismal prognosis. The widespread use of bisphosphonates (BPs), availability of more effective drugs in cancer treatment, and improvement in supportive care might have attenuated its impact. Patients and Methods To assess overall survival (OS) of patients with MRH in a contemporary setting, we conducted a retrospective analysis of 306 patients with solid cancer hospitalized for symptomatic hypercalcemia. A multivariable Cox proportional hazards regression model was performed to evaluate possible prognostic factors associated with MRH. Results All patients had serum ionized calcium > 5.5 mg/dL or total Ca > 10.5 mg/dL. Median age was 57 years, and the majority had squamous cell carcinoma (62%) and Eastern Cooperative Oncology Group performance status > 1 (96%). Head and neck was the most frequent primary site (28%). Forty-five percent had no previous chemotherapy (CT), and subsequent CT was administered to 32%. Eighty-three percent received BP with no survival gain. Median OS was 40 (95% CI, 33 to 47) days. Patients with a performance status > 2, altered mental status, C-reactive protein > 30 mg/L, albumin < 2.5 g/dL, or bodymass index < 18 kg/m(2) had significantly poorer survival in a univariable analysis, and longer OS was related to treatment-naive patients, subsequent CT, and breast primary site. In the multivariable analysis, subsequent CT led to a median OS improvement of 144 versus 25 days (hazard ratio, 0.24; 95% CI, 0.14 to 0.40; P <.001). Conclusion In a contemporary setting, MRH remains a marker of poor prognosis. Patients treated with CT had better survival, which suggests that appropriate treatment of selected patients might alter the course of this syndrome. (C) 2017 by American Society of Clinical Oncology Licensed under the Creative Commons Attribution 4.0 License
- Pre-treatment neutrophil-to-lymphocyte ratio affects survival in patients with advanced hepatocellular carcinoma treated with sorafenib(2014) FONSECA, Leonardo Gomes da; BARROSO-SOUSA, Romulado; BENTO, Afonso da Silva Alves; BLANCO, Bruna Paccola; VALENTE, Gabriel Luis; PFIFFER, Tulio Eduardo Flesch; HOFF, Paulo Marcelo; SABBAGA, JorgeSorafenib is the first systemic therapy to demonstrate survival benefit in advanced hepatocellular carcinoma (HCC) in randomized controlled trials with rigorous patient selection. Neutrophil-to-lymphocyte ratio (NLR) has been shown to be associated with poor survival in various solid tumors. Our aim is to evaluate the prognostic role of NLR in HCC patients treated with sorafenib. A total of 105 advanced HCC patients treated with sorafenib were retrospectively reviewed, and relevant data from the clinical records were collected. Univariate and multivariate analysis were carried out to identify factors associated with survival. The median age of the cohort was 59.7 years, and 84.8 % were Child-Pugh class A, and 86.7 % had ECOG performance status 0 or 1. Median duration of sorafenib treatment was 100 days. Median overall survival (OS) of the entire cohort was 8.03 months. Median OSwas 5.23 months (95 % CI 2.96-7.50 months) and 10.05 months (95 % IC 2.52-18.47 months) for patients with NLR>3.5 and NLR <= 3.5, respectively (p = 0.002). Alpha-fetoprotein [1,030 ng/mL and serum albumin B3.8 g/dL were also associated with worse prognosis (p = 0.006 and p = 0.042, respectively). The subgroup of patients with high alpha-fetoprotein, low albumin and NLR>3.5 had median OS of 1.7 months, whereas the subgroup with none of these parameters had median OS of 16.5 months (p< 0.001). NLR affects survival in advanced HCC patients treated with sorafenib. Selecting HCC patients based on the laboratorial features may improve the therapeutic effectiveness of sorafenib.