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
4 resultados
Resultados de Busca
Agora exibindo 1 - 4 de 4
conferenceObject Young-age onset colorectal cancer: Analysis of incidence, clinical features and outcomes(2017) FUJIKI, F. K.; VICENTINI, M. F. B.; SILVA, A. C. B.; ZAMBRANO, E. M.; FONSECA, L. G.; BRAGHIROLI, M. I.; SABBAGA, J.; HOFF, P. M.conferenceObject CARDIAC SAFETY OF (NEO) ADJUVANT TRASTUZUMAB IN THE BRAZILIAN COMMUNITY SETTING: A SINGLE CENTER EXPERIENCE(2012) FONSECA, L. G.; TAKAHASHI, T. K.; MAK, M. P.; BARROSO-SOUSA, R.; TESTA, L.; HELENA, V. Petry; COSTA, R. De Paula; HOFF, P. M.; MANO, M. S.Background Trastuzumab-associated cardiotoxicity (TAC) has been established in the context of clinical trials. However, when newly registered agents are used in a broader patient population, their safety profile does not always mirror that of the pivotal trials. Trastuzumab (T) only became available in the Brazilian public sector in 2008 and herein we report our off-trial experience so far. Methods Retrospective, single center cohort of HER-2 positive breast cancer patients (pts) treated with (neo)adjuvant chemotherapy and T from July 2008 to March 2012. 95.3% were treated according to local protocol (11.4% TCH; 83.9% AC-TH). Major cardiac event (MCE) was defined as a left ventricular ejection fraction (LVEF) drop of 10% and absolute drop to < 50 % by echocardiogram (ECHO) or as symptomatic heart failure (HF) regardless of the LVEF value or any cardiac event considered clinically meaningful. A multivariable Cox proportional hazards model was used to control for other cardiac risk factors. Results 237 women were identified: median age 53 y (27-83), 99.6% ECOG-PS 0-1, median body mass index 27.4 kg/m2 (17 – 46), 30.4% had hypertension (HTN), 8.8% had diabetes mellitus (DM), 5.9% had previous cardiopathy. 54.8% had ER-positive tumors; 40.7% received neoadjuvant T; most were stage II or III (22.3% and 37.1%). Median number of ECHO assessments was 2.7 (0-6); 136 pts (57.2%) completed T as planned. 20.2% had MCE (13.9% discontinued T). 3.8% discontinued T due to symptomatic HF and 5% for non-cardiac reasons. 41.6% of MCE pts recovered cardiac function. Median initial LVEF was 64.83 ± 1.5 % (no event) vs 64.81 ± 1.5 % (MCE) p = 0.26; median 3-month LFVE was 64.67 ± 4 % (no event) vs 56.12 ± 3 % (MCE) p = 0.0036. HTN, DM, obesity, age, radiotherapy, use of anthracycline and previous cardiopathy were not significantly associated with TAC. Conclusions Our results suggest that TAC in our routine practice is slightly higher than reported in literature (6 to 17%), possibly reflecting selection bias in clinical trials. Symptomatic TAC was as expected for AC-TH (4%). We failed to identify risk factors for TAC, possibly due to the low number of events. Cardiac function must be closely monitored during T treatment and careful pt selection is crucial.conferenceObject ORAL METRONOMIC CYCLOPHOSPHAMIDE IN PATIENTS WITH METASTATIC CASTRATION-RESISTANT PROSTATE CANCER STRATIFIED BY PRIOR DOCETAXEL THERAPY(2012) BARROSO-SOUSA, R.; CHAVES, A. C. R.; FONSECA, L. G.; CASTRO JR., G. De; DZIK, C.; HOFF, P. M.Background: Treatment options remain limited for patients (pts) with metastatic castration-resistant prostate cancer (mCRPC). Here we aimed to investigate the efficacy and safety of low-dose oral cyclophosphamide (CTX), an intermittent metronomic chemotherapy regimen, in pts with mCRPC, previously treated or not with docetaxel. Methods: All pts previously diagnosed with mCRPC and treated with CTX 100mg/ day (3 weeks on and 1 week off, every 28 days) plus prednisone 10mg/day between Oct/2006 and Feb/2012 at our institution were included in this retrospective analysis. The primary efficacy endpoint was prostate-specific antigen (PSA) decrease ≥ 50%. Secondary endpoints were PSA decrease ≥ 30% and toxicity. Kaplan-Meier estimates were calculated and plotted for time to treatment failure (TTF). Single and multivariate Cox proportional hazards modeling was used to estimate hazard ratios with 95% confidence intervals (95% CI). Results: 51 pts with mCRPC were identified, of which 30 (59%) had been already treated with docetaxel. The median age was 72 y.o. (56-86) and 27 pts (53%) were ECOG PS0-1 and 24 pts (47%) PS2-3. Five pts presented with visceral metastasis (10%) and median PSA 525 ng/dL (12-4099) before treatment. Median number of previous cytotoxic lines was 1 (0-2). After a median number of cycles CTX of 3, PSA decrease of ≥ 50% was achieved in 28.6% and 16.7% of docetaxel-naive and docetaxel-pretreated pts, respectively (p= 0.30). Besides, PSA declines of ≥ 30% occurred in 38.1% and 30.0% of docetaxel-naive and docetaxel-pretreated patients, respectively (p= 0.54). Overall, the median TTF was estimated to be 2.4 mo. (95% CI 1.87 – 3.73). Previously treatment with docetaxel was not statistically significant to TTF, and the median TTF was 2.1 mo. (95% CI 1.6 – 3.2) for docetaxel-pretreated and 3.4 mo. (95% CI 1.7 – 5.4) for docetaxel-naïve patients (HR 1.47; 95% CI 0.78 – 2.74; p = 0.22). In general, oral CTX was safe and well tolerated and the most commonly observed G3-4 AE was lymphopenia (29%). Conclusions: Oral metronomic CTX plus prednisone seems to be active and safe in mCRPC, even in pts previously treated with docetaxel. Its convenient oral administration, low cost, and acceptable toxicity profile may justify future investigations of this classic alkylating agent in mCRPC. Disclosure: All authors have declared no conflicts of interest.conferenceObject Efficacy and safety of sorafenib (SFN) in elderly patients with hepatocellular carcinoma (HCC)(2018) FONSECA, L. Gomes Da; MARTA, G. Nader; BRAGHIROLI, M. I.; HOFF, P. M.; SABBAGA, J.