RACHEL SIMOES PIMENTA RIECHELMANN
Projetos de Pesquisa
Unidades Organizacionais
LIM/24 - Laboratório de Oncologia Experimental, Hospital das Clínicas, Faculdade de Medicina
10 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 10
- Treatment of patients with metastatic colorectal cancer and poor performance status: current evidence and challenges(2018) ROCHA, Lucila Soares da Silva; RIECHELMANN, Rachel P.Patients with unresectable metastatic colorectal cancer live for a median of three years when treated with standard therapies. While the evidence guiding cancer-directed treatment of this disease comes from phase III trials that have mostly enrolled patients with good performance status, some patients present with poor clinical conditions. The best treatment for these patients remains to be determined. We performed a systematic review of the treatment outcomes of patients with metastatic colorectal cancer and poor performance status, defined as Eastern Cooperative Oncology Group performance status >= 2. Eligible articles were prospective or retrospective studies or case reports published in English, Portuguese or Spanish. We searched PubMed, EMBASE, LILACS and the Cochrane Library from onset until October 2017 using specific keywords for each search. We found a total of 18 publications, mostly case reports and retrospective studies (14 articles). One was an uncontrolled prospective trial, two were observational studies and one was an individual patient meta-analysis. Although some studies suggested benefits in terms of symptomatic response with standard chemotherapy, with good safety profiles when dose-reduced regimens were administered, a true survival gain could not be demonstrated. The scientific evidence for treating metastatic colorectal cancer patients with poor performance status is scarce, and more studies evaluating treatment for this population are necessary since this condition is not uncommon in clinical practice, particularly in the public healthcare system and developing countries and among destitute populations.
- High tumour burden, delayed diagnosis and history of cardiovascular disease may be associated with carcinoid heart disease(2018) ALVES, Carolina; MESQUITA, Marcella; SILVA, Carolina; SOEIRO, Maria; HAJJAR, Ludhmila; RIECHELMANN, Rachel P.Background: Patients with carcinoid syndrome (CS) may present carcinoid heart disease (CHD) but prognostic factors are not entirely understood. Patients and Methods: Retrospective study of patients with metastatic neuroendocrine tumours (NETs) and CS and/or abnormal 24-hour-urinary 5-hydroxiindolacetic acid. CHD was defined as moderate to severe tricuspid or pulmonary regurgitation in the echocardiogram. Results: The frequency of CHD among 42 patients was 38% (95% confidence interval [CI]: 23%-54%). CHD was associated with higher volume of liver metastases (odds ratio [OR] 13.86, 95% CI: 2.57-74.68, p = 0.002). Time from CS symptoms to NET diagnosis was borderline significant (p = 0.08). When CHD was defined as at least mild tricuspide regurgitation, the frequency of CHD was 45% and it was associated with cardiovascular comorbidities (OR: 6.58, 95% CI: 1.09; 39.78, p = 0.040). Conclusion: CHD was frequent among patients with CS, significantly associated with high liver tumour burden, and likely linked to the history of cardiovascular disease and longer time of CS.
- HER-2 overexpression in gastroesophageal junction (EGJ) adenocarcinoma as a predictor of prognosis in patients treated with perioperative chemotherapy.(2018) FELISMINO, Tiago; OLIVEIRA, Audrey; ALVES, Ana Caroline; JESUS, Victor Hugo Fonseca; COSTA JR., Wilson L.; COIMBRA, Felipe Jose Fernandez; SILVA, Milton Jose De Barros E.; RIECHELMANN, Rachel Pimenta; BEGNAMI, Maria Dirlei; RODRIGUES, Newton Augusto Ferreira; MELLO, Celso Lopes
- Current approaches to immunotherapy in noncolorectal gastrointestinal malignancies(2018) JESUS, Victor Hugo Fonseca de; FELISMINO, Tiago Cordeiro; SILVA, Milton Jose de Barros e; SILVA, Virgi Prime Lio de Souza e; RIECHELMANN, Rachel P.Noncolorectal gastrointestinal (GI) malignancies are among the most frequently diagnosed cancers. Despite the undeniable progress in systemic treatments in recent decades, further improvements using cytotoxic chemotherapy seem unlikely. In this setting, recent discoveries regarding the mechanism underlying immune evasion have prompted the study of molecules capable of inducing strong antitumor responses. Thus, according to early data, immunotherapy is a very promising tool for the treatment of patients with GI malignancies. Noncolorectal GI cancers are a major public health problem worldwide. Traditional treatment options, such as chemotherapy, surgery, radiation therapy, monoclonal antibodies and antiangiogenic agents, have been the backbone of treatment for various stages of GI cancers, but overall mortality remains a major problem. Thus, there is a substantial unmet need for new drugs and therapies to further improve the outcomes of treatment for noncolorectal GI malignancies. ""Next-generation'' immunotherapy is emerging as an effective and promising treatment option in several types of cancers. Therefore, encouraged by this recent success, many clinical trials evaluating the efficacy of immune checkpoint inhibitors and other strategies in treating noncolorectal GI malignancies are ongoing. This review will summarize the current clinical progress of modern immunotherapy in the field of noncolorectal GI tumors.
conferenceObject Palliative chemotherapy for patient with advanced tumor and poor performance status: Are oncologists' hopes of benefit justified?(2018) VASCONCELLOS, V. F.; BONADIO, R. R. C. C.; AVANCO, G.; NEGRAO, M. V.; RIECHELMANN, R.conferenceObject High prevalence of TSC2 germline missense mutations in nontuberous sclerosis patients with gastroenteropancreatic neuroendocrine neoplasia.(2018) LINCK, Rudinei Diogo Marques; ASPRINO, Paula Fontes; CESAR, Jonatas Eduardo da Silva; FREITAS, Florencio Porto; KOYAMA, Fernanda Christtanini; RIECHELMANN, Rachel Simoes Pimenta; GALANTE, Pedro Alexandre Favoretto; COSTA, Frederico Perego; HOFF, Paulo Marcelo Gehm; MEYER, Diogo; CAMARGO, Anamaria Aranha; SABBAGA, Jorge- 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
- 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.
- Carcinoid syndrome: update on the pathophysiology and treatment(2018) FERRARI, Anezka C. Rubin de Celis; GLASBERG, Joao; RIECHELMANN, Rachel P.Approximately 30-40% of patients with well-differentiated neuroendocrine tumors present with carcinoid syndrome, which is a paraneoplastic syndrome associated with the secretion of several humoral factors. Carcinoid syndrome significantly and negatively affects patients' quality of life; increases costs compared with the costs of nonfunctioning neuroendocrine tumors; and results in changes in patients' lifestyle, such as diet, work, physical activity and social life. For several decades, patients with neuroendocrine tumors and carcinoid syndrome have been treated with somatostatin analogues as the first-line treatment. While these agents provide significant relief from carcinoid syndrome symptoms, there is inevitable clinical progression, and new therapeutic interventions are needed. More than 40 substances have been identified as being potentially related to carcinoid syndrome; however, their individual contributions in triggering different carcinoid symptoms or complications, such as carcinoid heart disease, remain unclear. These substances include serotonin (5-HT), which appears to be the primary marker associated with the syndrome, as well as histamine, kallikrein, prostaglandins, and tachykinins. Given the complexity involving the origin, diagnosis and management of patients with carcinoid syndrome, we have undertaken a comprehensive review to update information about the pathophysiology, diagnostic tools and treatment sequence of this syndrome, which currently comprises a multidisciplinary approach.
- TSC2 rare germline variants in non-tuberous sclerosis patients with neuroendocrine neoplasias(2018) ASPRINO, Paula Fontes; LINCK, Rudinei Diogo Marques; CESAR, Jonatas; FREITAS, Florencio Porto; KOYAMA, Fernanda Christtanini; RIECHELMANN, Rachel Simoes Pimenta; COSTA, Frederico Perego; HOFF, Paulo Marcelo Gehm; GALANTE, Pedro Alexandre Favoretto; MEYER, Diogo; CAMARGO, Anamaria Aranha; SABBAGA, Jorge