ANA AMELIA FIALHO DE OLIVEIRA HOFF
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
8 resultados
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Agora exibindo 1 - 8 de 8
- Endocrine side effects of cancer immunotherapy(2017) CUKIER, Priscilla; SANTINI, Fernando C.; SCARANTI, Mariana; HOFF, Ana O.Immune checkpoint inhibitors have recently become a cornerstone for the treatment of different advanced cancers. These drugs, represented mainly by monoclonal antibodies anti-cytotoxic T-lymphocyte antigen 4 (CTLA-4), anti-programmed cell death protein-1 (PD-1) and anti-PD-1 ligand molecules (PD-L1 and L2), have the ability to reactivate the immune system against tumor cells, but can also trigger a myriad of autoimmune side effects, termed immune-related adverse events (irAEs). In particular, there are a number of endocrine-related irAEs. Current data from clinical trials show increased incidence of hypophysitis with CTLA4 inhibition and thyroid dysfunction with PD-(L) 1 blockade. In addition, a few cases of type 1 diabetes mellitus and primary adrenal insufficiency have been reported. We discuss the incidence, clinical manifestations, diagnosis and management of immune-related endocrinopathies in this highly complex context of oncological patients in need of immunotherapies.
- HOW TO IDENTIFY CERVICAL TRAUMATIC NEUROMAS IN THE POST-OPERATIVE NECK DISSECTION: BRIEF REVIEW OF THE CERVICAL PLEXUS ULTRASOUND(2022) MARCOS, Vincius neves; KULCSAR, Marco aurelio vamondes; HOFF, Ana oliveira; CHAMMAS, Maria cristina; FREITAS, Ricardo miguel costa DEtraumatic neuromas (CTNs) are a non-neoplastic hyperplasia of damaged nerves and may be misinterpreted as metastatic lymph nodes during cervical ultrasound of patients with thyroid cancer after lateral neck dissection, resulting in unnecessary and painful fin-needle aspiration biopsy. The anatomy of the cervical plexus is challenging, and the correct identification and recognition of its neural roots and branches on ultrasound are key to the correct CTN diagnosis. This review outlines the US technique used to characterize CTNs in 10 standardized steps and describes the sonographic features of the cervical plexus, to assist the radiologist in the recognition of CTNs and their differentiation from lymph node metastases. (E-mail: viniciusnevesm@gmail. com) (c) 2022 World Federation for Ultrasound in Medicine & Biology. All rights reserved.
- 5th International ACC Symposium: Future and Current Therapeutic Trials in Adrenocortical Carcinoma(2016) HOFF, Ana O.; BERRUTI, AlfredoAdrenocortical carcinoma (ACC) is a rare and complex disease associated with a high mortality rate. Despite intensive translational and clinical research, prognosis remains poor. Over the past decade, a significant effort has been made to develop multinational, collaborative studies to better understand the pathogenesis and clinical features of this rare disease in attempt to improve the therapeutic strategies and patient outcome. The results of both standard and newer treatments are discussed in this review as well as the recent discovery of pathways involved in ACC pathogenesis that provide the rationale to introduce new molecular target therapies. Finally, remaining issues regarding how to improve available therapies in adjuvant setting are raised and addressed.
- Management of radioiodine refractory differentiated thyroid cancer: the Latin American perspective(2024) PITOIA, Fabian; SCHEFFEL, Rafael Selbach; CALIFANO, Ines; GAUNA, Alicia; TALA, Hernan; VAISMAN, Fernanda; GONZALEZ, Alejandro Roman; HOFF, Ana Oliveira; MAIA, Ana LuizaRadioiodine (RAI) refractory differentiated thyroid cancer is an uncommon and challenging situation that requires a multidisciplinary approach to therapeutic strategies. The definition of RAI-refractoriness is usually a clear situation in specialized centers. However, the right moment for initiation of multikinase inhibitors (MKI), the time and availability for genomic testing, and the possibility of prescribing MKI and selective kinase inhibitors differ worldwide.Latin America (LA) refers to the territories of the world that stretch across two regions: North America (including Central America and the Caribbean) and South America, containing 8.5% of the world's population. In this manuscript, we critically review the current standard approach recommended for patients with RAI refractory differentiated thyroid cancer, emphasizing the challenges faced in LA. To achieve this objective, the Latin American Thyroid Society (LATS) convened a panel of experts from Brazil, Argentina, Chile, and Colombia. Access to MKI compounds continues to be a challenge in all LA countries. This is true not only for MKI but also for the new selective tyrosine kinase inhibitor, which will also require genomic testing, that is not widely available. Thus, as precision medicine advances, significant disparities will be made more evident, and despite efforts to improve coverage and reimbursement, molecular-based precision medicine remains inaccessible to most of the LA population. Efforts should be undertaken to alleviate the discrepancies between the current state-of-the-art care for RAI-refractory differentiated thyroid cancer and the present situation in Latin America.
- Diagnosis and Management of Tropomyosin Receptor Kinase Fusion-Positive Thyroid Carcinomas A Review(2023) HADDAD, Robert; ELISEI, Rossella; HOFF, Ana O.; LIU, Zhiyan; PITOIA, Fabian; PRUNERI, Giancarlo; SADOW, Peter M.; SOARES, Fernando; TURK, Andrew; WILLIAMS, Michelle D.; WIRTH, Lori J.; CABANILLAS, Maria E.IMPORTANCE Thyroid epithelial malignant neoplasms include differentiated thyroid carcinomas (papillary, follicular, and oncocytic), follicular-derived high-grade thyroid carcinomas, and anaplastic and medullary thyroid carcinomas, with additional rarer subtypes. The discovery of neurotrophic tyrosine receptor kinase (NTRK) gene fusions has fostered developments in precision oncology, with the approval of tropomyosin receptor kinase inhibitors (larotrectinib and entrectinib) for patients with solid tumors, including advanced thyroid carcinomas, harboring NTRK gene fusions. OBSERVATIONS The relative rarity and diagnostic complexity of NTRK gene fusion events in thyroid carcinoma present several challenges for clinicians, including variable access to robust methodologies for comprehensive NTRK fusion testing and poorly defined algorithms of when to test for such molecular alterations. To address these issues in thyroid carcinoma, 3 consensus meetings of expert oncologists and pathologists were convened to discuss diagnostic challenges and propose a rational diagnostic algorithm. Per the proposed diagnostic algorithm, NTRK gene fusion testing should be considered as part of the initial workup for patients with unresectable, advanced, or high-risk disease as well as following the development of radioiodine-refractory ormetastatic disease; testing by DNA or RNA next-generation sequencing is recommended. Detecting the presence of NTRK gene fusions is important to identify patients eligible to receive tropomyosin receptor kinase inhibitor therapy. CONCLUSIONS AND RELEVANCE This review provides practical guidance for optimal integration of gene fusion testing, including NTRK gene fusion testing, to inform the clinical management in patients with thyroid carcinoma.
- Vitamin D and cancer: does it really matter?(2016) SCARANTI, Mariana; CASTRO JUNIOR, Gilberto de; HOFF, Ana OliveiraPurpose of reviewThis article provides a background for an evidence-based decision regarding the prescription of vitamin D for cancer prevention and improvement of outcomes in oncology.Recent findingsIn 2014, Feldman and colleagues published a review suggesting a beneficial role for vitamin D in cancer development. In the same year, a Cochrane meta-analysis that included 18 randomized clinical trials comparing vitamin D administration versus no intervention in healthy population found no difference regarding cancer incidence between the groups. One year later, a phase III trial published in the New England Journal of Medicine did not show any protective effect of vitamin D against adenoma development.SummaryVitamin D is well known for its importance in calcium and phosphate homeostasis, being essential for bone mineralization. However, calcitriol, or 1,25-dyhydroxy-vitamin D3, is a multifunctional steroid hormone with many extra skeletal actions and may regulate signaling pathways related to cancer development and progression. In preclinical studies, it was shown that vitamin D can promote cell differentiation and inhibit proliferation, angiogenesis, and cell migration. Inconsistent results are found in epidemiological studies and early trials regarding clinical effects of vitamin D supplementation and cancer in terms of prevention and impact in cancer-related mortality.
- AACE/ACE DISEASE STATE CLINICAL REVIEW: PANCREATIC NEUROENDOCRINE INCIDENTALOMAS(2015) HERRERA, Miguel F.; AKERSTROM, Goran; ANGELOS, Peter; GRANT, Clive S.; HOFF, Ana O.; PANTOJA, Juan Pablo; PEREZ-JOHNSTON, Rocio; SAHANI, Dushyant V.; WONG, Richard J.; RANDOLPH, GregoryIncidental detection of pancreatic neuroendocrine tumors (PNETs) has substantially increased over the last decade due to widespread use of advanced imaging studies. Reliable initial imaging-based characterization is crucial for the differential diagnosis from other exocrine neoplasms and to determine the appropriate management plan. Measurements of chromogranin A, pancreatic polypeptide, and calcitonin are recommended for the biochemical evaluation. A thorough medical history needs to be performed to rule out multiple endocrine neoplasia (MEN) type 1. The European Neuroendocrine Tumor Society (ENETS)/Tumor Node Metastasis (TNM) staging system together with a grading based on the Ki-67 proliferation index and mitotic counts has proven to give more appropriate prognostic information than the World Health Organization (WHO)/American Joint Committee on Cancer (AJCC) TNM staging but may still fail to safely differentiate benign from malignant lesions. Poorly differentiated PNETs generally present with metastases and are rarely amenable for resection. Well-or intermediately differentiated tumors >= 2 cm with imaging evidence of malignancy or with a Ki-67 > 2% should be resected. It has been suggested that non-MEN related, nonfunctioning, and asymptomatic PNETs < 2 cm with a Ki-67 index >= 2% carry a low risk of metastasis and may be observed in the absence of clinical or radiologic criteria of malignancy or progression, especially in older patients. However, because metastases may occur with long delay with smaller PNETS, physicians should consider patient age, lesion location, and the risks of operation, and patients not undergoing surgery need to be closely followed closely.
- Recent advances in the molecular pathogenesis and targeted therapies of medullary thyroid carcinoma(2012) ALMEIDA, Madson Q.; HOFF, Ana O.Purpose of review This review will focus on the recent advances in molecular pathogenesis and targeted therapies for medullary thyroid carcinoma (MTC). Unlike hereditary MTC in which rearranged during transfection (RET) mutations are the most important precipitating events, in sporadic MTC the genetic or molecular biomarkers are yet to be established. Recent findings Targeted molecular therapies that inhibit RET and other tyrosine kinase receptors involved in angiogenesis have shown great promise in the treatment of metastatic or locally advanced MTC and are under investigation. In addition, the recent findings of H-RAS mutations in 56% of RET-negative sporadic MTC and the activation of the mammalian target of rapamycin (mTOR) intracellular signaling pathway in hereditary MTC suggests that additional or alternative genetic events are important for MTC pathogenesis. Summary Recently, vandetanib (ZD6474), an inhibitor of vascular endothelial growth factor receptor (VEGFR) 2 and VEGFR 3, RET, and epidermal growth factor receptor (EGFR), was approved for the treatment of adults with symptomatic or progressive MTC. Significant advantages for vandetanib over placebo were seen in terms of response rate, disease control rate, and biochemical response in a phase III study. Furthermore, cabozantinib (XL184), an inhibitor of VEGFR 1 and VEGFR 2, hepatocyte growth factor receptor (MET), and RET, was associated with partial response and stable disease in 29 and 41%, respectively.