VANESSA DA COSTA MIRANDA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
26 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 26
conferenceObject Neoadjuvant chemotherapy with six cycles of carboplatin and paclitaxel in advanced ovarian cancer patients not candidates for optimal primary surgery: Safety and effectivenes(2013) MIRANDA, Vanessa Costa; FEDE, Angelo Bezerra de Sousa; ANJOS, Carlos Henrique Dos; SILVA, Juliana Ribeiro da; SANCHEZ, Fernando Barbosa; BESSA, Lyvia Rodrigues da Silva; CARVALHO, Jesus Paula; ABDO FILHO, Elias; FREITAS, Daniela; BARROS, Laryssa Almeida Borges de; SILVA, Samantha Cabral Severino da; ESTEVEZ-DIZ, Maria Del Pilar- Carboplatin-based chemoradiotherapy in advanced cervical cancer: an alternative to cisplatin-based regimen?(2016) SEBASTIAO, Ana Morais; ROCHA, Lucila Soares da Silva; GIMENEZ, Rodrigo Darouche; BARROS, Laryssa Almeida Borges de; FUKUSHIMA, Julia Tizuko; SILVA, Samantha Cabral Severino da; MIRANDA, Vanessa da Costa; CAIRES, Inacelli Queiros de Souza; FREITAS, Daniela de; ABDO FILHO, Elias; DIZ, Maria Del Pilar EstevezObjective: To evaluate the results of treatment with cisplatin or carboplatin concomitant with radiotherapy (RT) in cases of locally advanced cervical cancer (CC). Methods: This study is a retrospective analysis of medical records of 184 patients with cervical cancer stage IIB-IVA who were treated at Instituto do Cancer do Estado de Sao Paulo from May 2008 to December 2012. All patients received complete pelvic region external-beam RT with weekly cisplatin (cis-RT, 40 mg/m(2); n = 159) or carboplatin (carbo-RT, AUC 2; n = 25), followed by high-dose-rate intracavitary brachytherapy (HDR-ICBT). Primary endpoint was progression free survival; secondary endpoints were overall survival and overall response rate, which includes complete and partial responses. Results: Five or more chemotherapy cycles were administered to 87.3% and 84% of the cis-RT- and carbo-RT- treated patients, respectively (p = 0.749). Estimated 3-years progression free survival was 59% in the cis-RT group vs 40% in the carbo-RT group (p = 0.249). Estimated 3-years overall survival was 70% in the cis-RT group vs 68% in the carbo-RT group (p = 0.298). Overall response rate (95.3% cis-RT vs 95.4% carbo-RT; p = 0.911) and grade >= 3 toxic effects (8.5% cis-RT vs 11.8% carbo-RT; p = 0.757) were similar. In multivariate analysis, only the overall response rate was a significant predictor of survival. Conclusions: Patients with advanced cervical cancer who are treated with carbo-RT have similar 3-years overall survival, progression free survival, overall response rate, and toxic effects when compared to cis-RT-treated patients. Carbo-RT may be an alternative treatment in patients that cannot receive cisplatin.
conferenceObject A phase II trial of metformin and fluorouracil (MetFU) for patients (pts) with metastatic colorectal cancer (mCRC) refractory to standard treatment(2014) MIRANDA, Vanessa Costa; FARIA, Luiza Dib; BRAGHIROLI, Maria Ignez Freitas Melro; JACOBS, Monica; SABBAGA, Jorge; HOFF, Paulo Marcelo; RIECHELMANN, Rachel Pimenta- EXPLORING THE ROLE OF METFORMIN IN ANTICANCER TREATMENTS: A SYSTEMATIC REVIEW(2014) MIRANDA, V. C.; BARROSO-SOUSA, R.; GLASBERG, J.; RIECHELMANN, R. P.Many clinical and preclinical studies suggest that metformin has antitumor activity. There are two main mechanisms that justify this effect: its ability to activate AMPK, preventing the gluconeogenesis in the liver and stimulating glucose uptake in muscle (insulin-independent), and its potential to negatively regulate mTOR activity (insulin-dependent). Thus, numerous studies have evaluated its role in cancer risk, prognosis and as an antitumor therapy in different malignancies. The following is a systematic review on the clinical evidence about the effects of metformin in cancer. Uncontrolled studies suggest that metformin is associated with reduced risk of different types of cancers among patients with hyperinsulinemia conditions, such as diabetes and obesity. However, among cancer patients, the literature is conflicting about the real impact of metformin on survival and outcomes of cancer treatments. The effects of metformin in nondiabetic patients remain unknown. Ongoing randomized trials are awaited to prove the true antineoplastic activity of metformin.
- Management of Para-aortic Lymph Node Disease in Patients With Cervical Cancer What Is the Best Approach?(2017) NEGRAO, Marcelo Vailati; LIMA, Julianne Maria da Silva; SILVA, Samantha Cabral Severino; DIZ, Maria Del Pilar Estevez; MIRANDA, Vanessa da CostaCervical cancer remains a prevalent and deadly disease in low-income countries, especially among young and otherwise healthy women. Multimodality treatment has led to a significant improvement in outcomes for patients with locally advanced disease, and this is mainly because of the incorporation of platinum-based chemoradiotherapy in current treatment protocols. However, locally advanced tumors are associated with a greater risk for para-aortic lymph node (PALN) involvement, which is an important adverse prognostic factor. Most staging techniques have low accuracy for detection of disease in this area, which could lead to understaging and undertreatment. Meanwhile, patients with PALN disease are underrepresented in trials addressing the treatment of advanced cervical cancer and a few studies have been directed at this population. The aim of this review is to analyze the current data regarding staging and treatment of cervical cancer with PALN disease to determine which strategy is best when managing these patients.
- Neoadjuvant Chemotherapy With Cisplatin and Gemcitabine Followed by Chemoradiation Versus Chemoradiation for Locally Advanced Cervical Cancer: A Randomized Phase II Trial(2019) COSTA, Samantha Cabral S. da; BONADIO, Renata Colombo; GABRIELLI, Flavia Carolina G.; ARANHA, Andrea S.; GENTA, Maria Luiza N. Dias; MIRANDA, Vanessa C.; FREITAS, Daniela de; ABDO FILHO, Elias; FERREIRA, Patricia A. O.; MACHADO, Karime K.; SCARANTI, Mariana; CARVALHO, Heloisa de A.; ESTEVEZ-DIZ, Maria Del PilarPURPOSE Although chemoradiation therapy (CRT) with cisplatin remains the standard treatment of patients with locally advanced cervical cancer (LACC), 40% of patients present with disease recurrence. Additional treatment strategies are required to improve outcomes. We conducted a trial to evaluate the efficacy and safety of neoadjuvant chemotherapy (NAC) with cisplatin and gemcitabine followed by CRT. METHODS In this phase II trial, patients with LACC (International Federation of Gynecology and Obstetrics stage IIB to IVA or with positive lymph nodes) were randomly assigned to three cycles of NAC with cisplatin and gemcitabine followed by standard CRT with weekly cisplatin plus pelvic radiotherapy or to standard CRT alone. The primary end point was 3-year progression-free survival (PFS). Secondary end points were response rate, 3-year locoregional control, 3-year overall survival (OS), safety, and quality of life. RESULTS From 107 patients enrolled in the trial, 55 were randomly assigned to the NAC arm and 52 to the CRT-alone arm. The majority of patients had squamous cell carcinoma (87.8%). After a median follow-up of 31.7 months, NAC was associated with an inferior PFS, with 3-year PFS rates of 40.9% v 60.4% in the CRT arm (hazard ratio, 1.84; 95% CI, 1.04 to 3.26; P = .033). NAC also was associated with a lower OS (3-year OS rate, 60.7% v 86.8%; hazard ratio, 2.79; 95% CI, 1.29 to 6.01; P = .006). After treatment completion, complete response rates were 56.3% in the NAC arm and 80.3% in the CRT arm (P = .008). Toxicities were similar in both arms, with the exception of hypomagnesemia and neuropathy being more common with NAC. CONCLUSION This study shows that the addition of NAC consisting of cisplatin and gemcitabine to standard CRT is not superior and is possibly inferior to CRT alone for the treatment of LACC. (C) 2019 by American Society of Clinical Oncology
bookPart Etiologia do cancer(2013) MIRANDA, Vanessa da Costa; RIECHELMANN, Rachel- Phase 2 Trial of Metformin Combined With 5-Fluorouracil in Patients With Refractory Metastatic Colorectal Cancer(2016) MIRANDA, Vanessa C.; BRAGHIROLI, Maria Ignez; FARIA, Luiza Dib; BARIANI, Giovanni; ALEX, Alexandra; BEZERRA NETO, Joao Evangelista; CAPARELI, Fernanda C.; SABBAGA, Jorge; SANTOS, Juliana Ferreira Lobo dos; HOFF, Paulo M.; RIECHELMANN, Rachel P.Effects of metformin in colorectal cancer have not been tested in clinical trials. In this phase 2 trial with 50 patients, metformin and 5-fluorouracil (5-FU) showed median progression-free survival of 2 months and overall survival of 7.9 months. However, among patients who experienced stable disease at 8 weeks, disease stabilization lasted for 5.6 months and patients survived for 16 months. Obese patients and those with longer periods off 5-FU seemed to derive more benefit. Background: Observational and preclinical studies have suggested that metformin has antitumor effects in solid tumors, including colorectal cancer (CRC). However, the effects of metformin in CRC have not been tested in clinical trials. Patients and Methods: This was a single-center, single-arm phase 2 clinical trial where histologically confirmed CRC patients with measurable and progressing metastatic disease previously treated with 5-fluorouracil (5-FU), irinotecan, oxaliplatin, and an antieepidermal growth factor receptor (if the tumor was RAS wild type) were enrolled to receive metformin 850 mg orally continuously 2 times a day plus 5-FU 425 mg/m(2) and leucovorin 50 mg intravenously weekly until disease progression, unacceptable toxicity, or withdrawal of consent. The primary end point was disease control rate at 8 weeks. Results: Among 50 patients included, 11 (22%) met the primary end point. The median progression-free survival was 1.8 months and the median overall survival 7.9 months. Analyzing only the 11 patients who experienced disease control at 8 weeks, their median progression-free survival was 5.6 months and their median overall survival was 16.2 months. There was a trend for prolonged median survival for obese patients (12.4 vs. 5.8 months) and those longer off 5-FU. The treatment was well tolerated; the main adverse effects were diarrhea, nausea, vomiting, and myelotoxicity. Conclusion: Metformin and 5-FU showed an overall modest but intriguing activity in patients with refractory CRC in this phase 2 study. Some patients experienced long-term disease control. Further trials are needed to confirm these results, particularly in obese patients with CRC.
- Role of systematic pelvic and para-aortic lymphadenectomy in delayed debulking surgery after six neoadjuvant chemotherapy cycles for high-grade serous ovarian carcinoma(2021) LOPES, Andre; GENTA, Maria L. N. D.; MIRANDA, Vanessa da Costa; ARANHA, Andrea; LOPEZ, Rossana V. M.; PIATO, Dariane S. A. M.; ANTON, Cristina; CARVALHO, Filomena M.; DIZ, Maria del Pilar Esteves; CARVALHO, Jesus P.Introduction We analyzed the role of systematic pelvic and para-aortic lymphadenectomy in delayed debulking surgery after six neoadjuvant chemotherapy (NACT) cycles for advanced high-grade serous ovarian carcinoma. Materials and Methods We retrospectively reviewed patients with advanced ovarian carcinoma who underwent NACT with carboplatin-paclitaxel between 2008 and 2016. Patients were included only if they had FIGO IIIC-IVB high-grade serous carcinoma with clinically negative lymph nodes after six NACT cycles (carboplatin-paclitaxel) and underwent complete or near complete cytoreduction. Patients with partial lymphadenectomy or bulky nodes were excluded. Patients who underwent systematic pelvic and aortic lymphadenectomy and those who did not undergo lymph node dissection were compared. Progression-free and overall survivals were analyzed using the Kaplan-Meier method. Results Totally, 132 patients with FIGO IIIC-IVB epithelial ovarian carcinoma were surgically treated after NACT. Sixty patients were included (39 and 21 in the lymphadenectomy and nonlymphadenectomy group, respectively); 40% had suspicious lymph nodes before NACT. Patient characteristics, blood transfusion numbers, and complication incidence were similar between the groups. In the lymphadenectomy group, 12 patients (30.8%) had histologically positive lymph nodes and the surgical time was longer (229 vs. 164 min). The median overall survival in the lymphadenectomy and nonlymphadenectomy groups, respectively, was 56.7 (95% CI 43.4-70.1) and 61.2 (21.4-101.0) months (p = 0.934); the corresponding disease-free survival was 8.1 (6.2-10.1) and 8.3 (5.1-11.6) months (p = 0.878). Six patients exclusively presented with lymph node recurrence. Conclusions Systematic lymphadenectomy after six NACT cycles may have no influence on survival.
- Adjuvant Carboplatin and Paclitaxel Chemotherapy Followed by Radiotherapy in High-Risk Endometrial Cancer: A Retrospective Analysis(2018) BONADIO, Renata Rodrigues da Cunha Colombo; AZEVEDO, Renata Gondim Meira Velame; HARADA, Guilherme; COSTA, Samantha Cabral Severino da; MIRANDA, Vanessa Costa; FREITAS, Daniela de; ABDO FILHO, Elias; FERREIRA, Patricia Alves de Oliveira; GABRIELLI, Flavia; DIZ, Maria del Pilar EstevezPurpose The best adjuvant treatment in high-risk endometrial cancer remains unclear. Although adjuvant chemotherapy seems to improve overall survival (OS) in locally advanced disease, the role of adding radiotherapy is not certain. We evaluated the outcomes of patients with high-risk endometrial cancer treated with adjuvant chemotherapy followed by radiotherapy. Patients and Methods We performed a retrospective analysis of patients with high-risk endometrial cancer (endometrioid histology stages III to IVA or carcinosarcoma, clear cell, or serous histology stages I to IVA) treated with adjuvant carboplatin and paclitaxel, followed by radiotherapy, from 2010 to 2017 at a Brazilian cancer center. The Kaplan-Meier method was used for survival analysis, and prognostic factors were analyzed using the Cox proportional hazards model. Results One hundred forty-six consecutive patients were evaluated. The OS rates were 86.2% at 3 years and 75.4% at 5 years. OS was significantly affected by pelvic lymphadenectomy (P = .001) and positive peritoneal cytology (P < .001). Three- and 5-year disease-free survival (DFS) rates were 78.3% and 69.5%, respectively. The initial site of recurrence was limited to the pelvis in 4.1% of patients, within the abdomen in 1.3%, and extra-abdominal in 11.6%. Patients with grade 1 or 2 endometrioid carcinoma had better prognosis than patients with endometrioid carcinoma grade 3 or nonendometrioid histology (3-year DFS, 93.67% v 68.5%, respectively; P = .0017). Conclusion Adjuvant carboplatin and paclitaxel, followed by radiotherapy, is effective in high-risk endometrial cancer and associated with low rates of pelvic recurrence, which might be explained by the addition of radiotherapy. The high-risk group is heterogeneous, and the benefit of adjuvant treatment in patients with grade 1 or 2 endometrioid carcinoma is less clear. (C) 2018 by American Society of Clinical Oncology
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