PAULO MARCELO GEHM HOFF
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Radiologia, Faculdade de Medicina - Docente
LIM/24 - Laboratório de Oncologia Experimental, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/24 - Laboratório de Oncologia Experimental, Hospital das Clínicas, Faculdade de Medicina - Líder
19 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 19
- Return to work after breast cancer diagnosis: An observational prospective study in Brazil(2018) LANDEIRO, Luciana C. G.; GAGLIATO, Debora M.; FEDE, Angelo B.; FRAILE, Natalia M.; LOPEZ, Rossana M.; FONSECA, Leonardo G. da; PETRY, Vanessa; TESTA, Laura; HOFF, Paulo M.; MANO, Max S.Background In North America and Europe, return-to-work (RTW) rates vary among breast cancer (BC) survivors, from 24% to 66% and from 53% to 82% at 6 and 36 months after diagnosis, respectively. To date, there is a lack of data on RTW rates after BC diagnosis in Latin America. Therefore, the primary objectives of this study were to define RTW rates at 12 and 24 months after BC diagnosis and to identify the factors associated with RTW in this population. Methods In total, 125 employed women from a single institution with newly diagnosed BC were interviewed by telephone at 6, 12, and 24 months after diagnosis. Those who had inoperable or metastatic disease were excluded. Results Overall, RTW rates were 30.3% and 60.4% at 12 and 24 months after BC diagnosis, respectively. Most women reported that they received support from their employer, but only 29.1% reported having been offered work adjustments. In multivariate analysis, the factors associated with positive RTW outcomes included higher household income (odds ratio [OR], 17.76; 95% confidence interval [CI], 3.33-94.75; P = .001), breast-conserving surgery (OR, 9.77; 95% CI, 2.03-47.05; P = .004), and work adjustments (OR, 37.62; 95% CI, 2.03-47.05; P = .004). The factors associated with negative RTW outcomes included adjuvant endocrine therapy (OR, 0.11; 95% CI, 0.02-0.74; P = .023), and depression diagnosed after BC (OR, 0.07; 95% CI, 0.01-0.63; P = .017). Conclusions RTW rates in the current study were lower than those observed in developed countries but similar to the rates among low-income Americans. Workplace adjustments, higher income, breast-conserving surgery, endocrine therapy, and depression after BC played an important role in the RTW decision. Cancer 2018;124:4700-4710. (C) 2018 American Cancer Society.
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, Jorge- The Addition of Bevacizumab to Oxaliplatin-Based Chemotherapy: Impact Upon Hepatic Sinusoidal Injury and Thrombocytopenia(2018) OVERMAN, Michael J.; FERRAROTTO, Renata; RAGHAV, Kanwal; GEORGE, Binsah; QIAO, Wei; MACHADO, Karime K.; SALTZ, Leonard B.; MAZARD, Thibault; VAUTHEY, J. N.; HOFF, Paulo M.; HOBBS, Brian; LOYER, Evelyn M.; KOPETZ, ScottBackground: Oxaliplatin-based chemotherapy can cause hepatic sinusoidal injury (HSI), portal hypertension, and splenic sequestration of platelets. Evidence suggests that bevacizumab may protect against HSI. Methods: Two cohorts of metastatic colorectal cancer (CRC) were analyzed: a nonrandomized exploratory cohort of 184 patients treated at a single institution from 2003 to 2010 and a confirmatory cohort of 200 patients from a multi-institutional randomized trial (NO16966). All patients were treated with frontline fluoropyrimidine and oxaliplatin with or without bevacizumab. Changes in splenic volumes and platelet counts were compared by treatment, two-sided log-rank test. Results: In the exploratory cohort, the bevacizumab-treated patients (n = 138) compared with the nonbevacizumab-treated patients (n - 46) demonstrated a longer median time to splenic enlargement (>= 30%, P - .02) and reduced rate of thrombocytopenia (<150000/mm(3), P = .04). In the confirmatory cohort (106 bevacizumab arm and 94 placebo arm), the median time to a spleen enlargement of 30% or more was 7.6 vs 5.4 (P = .01), and six-month cumulative incidence of thrombocytopenia (platelets < 100000/mm(3)) was 19% vs 51% (P < .001) for bevacizumab compared with placebo. The development of an increasing spleen size was associated with the risk of either grade 1 or grade 2 thrombocytopenia (P < .001). The cumulative rate of grade 1 or grade 2 thrombocytopenia was statistically less in the bevacizumab arm, with six-month grade 2 thrombocytopenia rates of 4% vs 23% (P < .001). Patients with a large spleen prior to chemotherapy initiation appeared to be at highest risk of this toxicity. Conclusion: In metastatic CRC, the addition of bevacizumab to oxaliplatin-based chemotherapy reduces the frequency of splenic enlargement and the rate of thrombocytopenia.
- Regorafenib in antiangiogenic-naive, chemotherapy-refractory advanced colorectal cancer: A phase IIb trial.(2018) RIECHELMANN, Rachel Pimenta; LEITE, Luiz Antonio Senna; GLASBERG, Joao; BARIANI, Giovanni Mendonca; RIVELLI, Thomas Giollo; NEBULONI, Daniela R.; PUTY, Fabiola; KAPPELER, Christian; PEREIRA, Kaline M. C.; QUEIROZ, Marcelo A.; HOFF, Paulo Marcelo
- Change in CEA as an early predictor of progression to first-line systemic therapy in metastatic colorectal cancer.(2018) GULHATI, Pat; YIN, Jun; PEDERSON, Levi; SCHMOLL, Hans-Joachim; HOFF, Paulo Marcelo; DOUILLARD, Jean-Yves
- Serum levels of VEGF and MCSF in HER2+/HER2- breast cancer patients with metronomic neoadjuvant chemotherapy(2018) ARAI, Roberto J.; PETRY, Vanessa; HOFF, Paulo M.; MANO, Max S.Metronomic therapy has been gaining importance in the neoadjuvant setting of breast cancer treatment. Its clinical benefits may involve antiangiogenic machinery. Cancer cells induce angiogenesis to support tumor growth by secreting factors, such as vascular endothelial growth factor (VEGF). In breast cancer, Trastuzumab (TZM) based treatment is of key importance and is believed to reduce diameter and volume of blood vessels as well as vascular permeability. Here in we investigated serum levels of angiogenic factors VEGF and MCSF in patients receiving metronomic neoadjuvant therapy with or without TZM. We observed in HER2+ cohort stable levels of MCSF through treatment, whereas VEGF trend was of decreasing levels. In HER2- cohort we observed increasing levels of MCSF and VEGF trend. Overall, HER2+ patients had better pathological response to treatment. These findings suggest that angiogenic pathway may be involved in TZM anti-tumoral effect in the neoadjuvant setting.
- Evaluation of F-18-FDG PET-CT as a prognostic marker in advanced biliary tract cancer(2018) BRAGHIROLI, Maria I.; MOTA, Jose M.; DUARTE, Paulo S.; MORITA, Tiago O.; BARIANI, Giovanni M.; NEBULONI, Daniela; BUCHPIGUEL, Carlos A.; HOFF, Paulo M.; RIECHELMANN, Rachel P.BackgroundAdvanced biliary tract cancers have a dismal prognosis. Treatment with gemcitabine plus cisplatin has resulted in a significant improvement in survival; however, early assessment of outcomes poses a challenge.ObjectiveWe carried out a prospective study to evaluate the prognostic role of fluorine-18 fluorodeoxyglucose (F-18-FDG) PET-CT scans in patients with advanced biliary tract cancer.Patients and methodsPatients with advanced unresectable or metastatic biliary tract cancer starting first-line chemotherapy with gemcitabine plus cisplatin underwent F-18-FDG PET-CT studies at baseline and after two cycles of therapy. The total lesion glycolysis (TLG) measured at baseline as well as the variation in TLG between the two studies were analyzed as prognostic indicators of overall survival. The survival analyses were carried out using Kaplan-Meier curves and the comparison of survival curves was performed using the Breslow test.ResultsOf the 42 patients included, 37 had the first F-18-FDG PET-CT and 27 had the second F-18-FDG PET-CT. Patients with lower TLG values at baseline or after two cycles of therapy presented a higher median survival than patients with higher baseline TLG values. Patients with a higher decrease in the TLG values between the two studies also had a higher median survival time. However, these results only trended for statistical significance (P values ranging between 0.05 and 0.16).ConclusionLower baseline TLG measured by F-18-FDG PET-CT as well as a decrease in metabolic uptake after chemotherapy were associated with a trend toward longer median survival among patients with advanced biliary cancers.
- Combination of Irinotecan, Oxaliplatin and 5-Fluorouracil as a Rechallenge Regimen for Heavily Pretreated Metastatic Colorectal Cancer Patients(2018) FERNANDES, Gustavo Dos Santos; BRAGHIROLI, Maria Ignez; ARTIOLI, Michelle; PATERLINI, Ana Carolina Carvalho Rocha; TEIXEIRA, Marcela Crosara; GUMZ, Brenda Pires; GIRARDI, Daniel da Motta; BRAGHIROLI, Oddone F. M.; COSTA, Frederico Perego; HOFF, Paulo M.PurposeOur objective was to evaluate the benefit of re-exposing patients with refractory metastatic colorectal cancer (mCRC) to a combination of oxaliplatin, irinotecan and 5-fluorouracil treatment.MethodsWe retrospectively analysed patients with mCRC who received a combination of oxaliplatin, irinotecan and fluorouracil as a rechallenge regimen after progressing on the same drugs. Both FOLFOXIRI and FOLFIRINOX were used. Toxicity was evaluated for each treatment cycle, and survival analysis was performed using the Kaplan-Meier method.ResultsA total of 21 patients who were treated between January 2011 and December 2013 were selected for this study. Most of the patients (95.2%) had an ECOG status of 0-1. The median age at diagnosis was 52.1years (range 36-77years), and 14 (66.6%) patients had wild-type KRAS. Thirteen patients received FOLFIRINOX, and eight received FOLFOXIRI. Most patients had previously received at least three regimens, with 80% receiving anti-VEGF and 66% anti-EGFR antibodies. The response rate was 38%, and 24% patients had stable disease. The median time to disease progression was 4.0months (range 1.0-9.1months), and the median overall survival duration was 8.6months (range 6.3-11.5months). Most patients required dose adjustment and treatment delays. One patient experienced grade 5 neutropenic sepsis.ConclusionsBoth FOLFIRINOX and FOLFOXIRI are active and potentially feasible rechallenge treatment options for heavily pretreated patients with good performance status. With dose reduction and close monitoring for toxicity, the risk of serious adverse events can be minimised.
- Personalizing Survival Predictions in Advanced Colorectal Cancer: The ARCAD Nomogram Project(2018) SJOQUIST, Katrin M.; RENFRO, Lindsay A.; SIMES, R. John; TEBBUTT, Niall C.; CLARKE, Stephen; SEYMOUR, Matthew T.; ADAMS, Richard; MAUGHAN, Timothy S.; SALTZ, Leonard; GOLDBERG, Richard M.; SCHMOLL, Hans-Joachim; CUTSEM, Eric Van; DOUILLARD, Jean-Yves; HOFF, Paulo M.; HECHT, Joel Randolph; TOURNIGAND, Christophe; PUNT, Cornelis J. A.; KOOPMAN, Miriam; HURWITZ, Herbert; HEINEMANN, Volker; ZALCBERG, John R.Background: Estimating prognosis on the basis of clinicopathologic factors can inform clinical practice and improve risk stratification for clinical trials. We constructed prognostic nomograms for one-year overall survival and six-month progression-free survival in metastatic colorectal carcinoma by using the ARCAD database. Methods: Data from 22 674 patients in 26 randomized phase III clinical trials since 1997 were used to construct and validate Cox models, stratified by treatment arm within each study. Candidate variables included baseline age, sex, body mass index, performance status, colon vs rectal cancer, prior chemotherapy, number and location of metastatic sites, tumor mutation status (BRAF, KRAS), bilirubin, albumin, white blood cell count, hemoglobin, platelets, absolute neutrophil count, and derived neutrophil-to-lymphocyte ratio. Missing data (<11%) were imputed, continuous variables modeled with splines, and clinically relevant pairwise interactions tested if P values were less than .001. Final models were internally validated via bootstrapping to obtain optimism-corrected calibration and discrimination C-indices, and externally validated on a 10% holdout sample from each trial (n = 2257). Results: In final models, all included variables were associated with overall survival except for lung metastases, and all but total white cell count associated with progression-free survival. No clinically relevant pairwise interactions were identified. Final nomogram calibration was good (C = 0.68 for overall and C = 0.62 for progression-free survival), as was external validity (concordance between predicted >50% vs < 50% probability) and actual (yes/no) survival (72.8% and 68.2% concordance, respectively, for one-year overall and six-month progression-free survival, between predicted (>50% vs < 50% probability] and actual (yes/no] overall and progression-free survival). Median survival predictions fell within the actual 95% Kaplan-Meier confidence intervals. Conclusions: The nomograms are well calibrated and internally and externally valid. They have the potential to aid prognostication and patient-physician communication and balance risk in colorectal cancer trials.
- Pharmacokinetic (PK) and exposure-response (ER) analysis of pertuzumab (P) in patients (pts) with HER2-positive metastatic gastroesophageal junction and gastric cancer (mGEJC/GC).(2018) KIRSCHBROWN, Whitney Paige; WANG, Bei; NIJEM, Ihsan; OHTSU, Atsushi; HOFF, Paulo M.; SHAH, Manish A.