Navegando por Palavras-chave "lung cancer"

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    Bronchioloalveolar carcinoma arising in a congenital pulmonary airway malformation in a child: case report with an update of this association
    (Elsevier B.V., 2007-05-01) Ramos, Simone G.; Barbosa, Gustavo H.; Tavora, Fabio Rocha Fernandes [UNIFESP]; Jeudy, Jean; Torres, Lidia A. G. M.; Tone, Luiz Gonzaga; Trad, Clovis S.; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Univ Maryland
    An 9-year-old girl was evaluated for a mass in the left pulmonary lobe. Her clinical history was remarkable for an intermittent dry cough since the age of 2, with recurrent episodes of purulent sputum and fever. She underwent left lower lobectomy, which was found to be a bronchioloalveolar carcinoma arising in a type 1 congenital pulmonary airway malformation at pathologic examination. No additional therapies were undertaken. Two years after resection, imaging studies showed 5 contralateral pulmonary nodules suggestive of disseminated disease with a poor outcome. A review of presentation, treatment, and outcome of this association was made. (C) 2007 Elsevier Inc. All rights reserved.
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    The effect of PD-L1 testing on the cost-effectiveness and economic impact of immune checkpoint inhibitors for the second-line treatment of NSCLC
    (Oxford Univ Press, 2017) Aguiar, P. N., Jr.; Perry, L. A.; Penny-Dimri, J.; Babiker, H.; Tadokoro, H. [UNIFESP]; de Mello, R. A.; Lopes, G. L., Jr.
    Background: Immune checkpoint inhibitors improve outcomes compared with chemotherapy in lung cancer. Tumor PD-L1 receptor expression is being studied as a predictive biomarker. The objective of this study was to assess the cost-effectiveness and economic impact of second-line treatment with nivolumab, pembrolizumab, and atezolizumab with and without the use of PD-L1 testing for patient selection. Design: We developed a decision-analytic model to determine the cost-effectiveness of PD-L1 assessment and second-line immunotherapy versus docetaxel. The model used outcomes data from randomized clinical trials (RCTs) and drug acquisition costs from the United States. Thereafter, we used epidemiologic data to estimate the economic impact of the treatment. Results: We included four RCTs (2 with nivolumab, 1 with pembrolizumab, and 1 with atezolizumab). The incremental quality-adjusted life year (QALY) for nivolumab was 0.417 among squamous tumors and 0.287 among non-squamous tumors and the incremental cost-effectiveness ratio (ICER) were $155 605 and $187 685, respectively. The QALY gain in the base case for atezolizumab was 0.354 and the ICER was $215 802. Compared with treating all patients, the selection of patients by PD-L1 expression improved incremental QALY by up to 183% and decreased the ICER by up to 65%. Pembrolizumab was studied only in patients whose tumors expressed PD-L1. The QALY gain was 0.346 and the ICER was $98 421. Patient selection also reduced the budget impact of immunotherapy. Conclusion: The use of PD-L1 expression as a biomarker increases cost-effectiveness of immunotherapy but also diminishes the number of potential life-years saved.
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    The effect of PD-L1 testing on the cost-effectiveness and economic impact of immune checkpoint inhibitors for the second-line treatment of NSCLC (vol 28, pg 2256, 2017)
    (Oxford Univ Press, 2017) Aguiar Jr., P. N.; Perry, L. A.; Penny-Dimri, J.; Babiker, H.; Tadokoro, H. [UNIFESP]; Mello, R. A. de; Lopes Jr., G. L.
    Background: Immune checkpoint inhibitors improve outcomes compared with chemotherapy in lung cancer. Tumor PD-L1 receptor expression is being studied as a predictive biomarker. The objective of this study was to assess the cost-effectiveness and economic impact of second-line treatment with nivolumab, pembrolizumab, and atezolizumab with and without the use of PD-L1 testing for patient selection. Design: We developed a decision-analytic model to determine the cost-effectiveness of PD-L1 assessment and second-line immunotherapy versus docetaxel. The model used outcomes data from randomized clinical trials (RCTs) and drug acquisition costs from the United States. Thereafter, we used epidemiologic data to estimate the economic impact of the treatment. Results: We included four RCTs (2 with nivolumab, 1 with pembrolizumab, and 1 with atezolizumab). The incremental quality-adjusted life year (QALY) for nivolumab was 0.417 among squamous tumors and 0.287 among non-squamous tumors and the incremental cost-effectiveness ratio (ICER) were $155 605 and $187 685, respectively. The QALY gain in the base case for atezolizumab was 0.354 and the ICER was $215 802. Compared with treating all patients, the selection of patients by PD-L1 expression improved incremental QALY by up to 183% and decreased the ICER by up to 65%. Pembrolizumab was studied only in patients whose tumors expressed PD-L1. The QALY gain was 0.346 and the ICER was $98 421. Patient selection also reduced the budget impact of immunotherapy. Conclusion: The use of PD-L1 expression as a biomarker increases cost-effectiveness of immunotherapy but also diminishes the number of potential life-years saved.
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    Occupational risk factors of lung cancer in Sao Paulo, Brazil
    (Scand J Work Env Health, 1998-04-01) Wunsch, Victor; Moncau, José Eduardo Cajado [UNIFESP]; Mirabelli, Dario; Boffetta, Paolo; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Agenzia Reg Protez Piemonte; Int Agcy Res Canc
    Objectives This study estimated the risk of occupational exposure for lung cancer in the metropolitan region of Sao Paulo, the largest urbanized and industrialized area in Brazil.Methods In this hospital-based case-referent study of 398 cases and 860 referents, the cases were matched to referents according to age, gender, and hospital and personally interviewed for information on lifetime job history, smoking habits, passive smoking exposure, cancer in relatives, socioeconomic status, and migratory history. The analysis concerned industrial titles and occupational categories. With the use of a job-exposure matrix, exposure to asbestos, polynuclear aromatic hydrocarbons, arsenic, dust, nickel and chromium was assessed.Results For the men in the 56 industrial and 122 occupational categories examined, an excess risk of lung cancer was found in the machinery industry [odds ratio (OR) 1.62, 95% confidence interval (95% CI) 1.02-2.55). In pottery manufacturing the risk (OR 2.21, 95% CI 1.00-4.87) was increased for workers exposed greater than or equal to 10 years (OR 6.43, 95% CI 1.12-37.01). Textile workers employed for greater than or equal to 10 years with a latency of greater than or equal to 40 years had an elevated risk (OR 21.93, 95% CI 1.96-245.0). In the analysis using the job-exposure matrix no risk was detected for the specific lung cancer carcinogens examined. For the women, no significantly elevated risk was observed.Conclusions The results of this study revealed risks of lung cancer for men in the machinery industry and for pottery and textile workers with long-term exposure.
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    PD-L1 expression as a predictive biomarker in advanced non-small-cell lung cancer: updated survival data
    (Future Medicine Ltd, 2017) Aguiar, Pedro N., Jr. [UNIFESP]; De Mello, Ramon Andrade; Hall, Peter; Tadokoro, Hakaru [UNIFESP]; de Lima, Gilberto
    Aim: The treatment of non-small-cell lung cancer has changed after the development of the immune checkpoint inhibitors. Although the most studied biomarker is the tumor programmed death ligand one (PD-L1) expression, its clinical significance is still debatable. In this article, we show the updated survival analysis of all published data. Methods: We searched in network and conference data sources for relevant clinical studies of immunotherapy for non-small-cell lung cancer that assessed the PD-L1 expression even as an exploratory analysis. The updated survival hazard ratios (HR) were included in the analysis. Results: 14 studies with 2857 patients were included (2019 treated with immunotherapy). The response rate was as higher among PD-L1-positive patients (RR: 2.19, 95% CI: 1.63-2.94). PD-L1 expression was also related to better progression-free survival (HR: 0.69, 95% CI: 0.57-0.85) and better overall survival (HR: 0.77, 95% CI: 0.67-0.89). Conclusion: PD-L1 overexpression predicts activity as well as better survival for patients treated with immune checkpoint inhibitors.
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    A pooled analysis of nivolumab for the treatment of advanced non-small-cell lung cancer and the role of PD-L1 as a predictive biomarker
    (Future Medicine Ltd, 2016) Aguiar, Pedro N., Jr. [UNIFESP]; Santoro, Ilka Lopes [UNIFESP]; Tadokoro, Hakaru [UNIFESP]; Lopes, Gilberto de Lima; Filardi, Bruno Andraus [UNIFESP]; Oliveira, Pedro; Castelo-Branco, Pedro; Mountzios, Giannis; de Mello, Ramon Andrade
    Background: Recent studies with nivolumab (a monoclonal antibody against programmed cell death 1 [PD-1] receptor) have shown promise non-small-cell lung cancer (NSCLC) treatment. Methods: To review available clinical trials data in order to assess nivolumab efficacy and the role of tumoral PDL-1 expression as a biomarker. Results: Nine eligible studies included 2102 patients. In the second line setting, nivolumab achieved a 1-year survival rate of 41%
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    The role of PD-L1 expression as a predictive biomarker in advanced non-small-cell lung cancer: a network meta-analysis
    (Future Medicine Ltd, 2016) Aguiar Junior, Pedro [UNIFESP]; Santoro, Ilka Lopes [UNIFESP]; Tadokoro, Hakaru [UNIFESP]; Lopes, Gilberto de Lima; Filardi, Bruno Andraus [UNIFESP]; Oliveira, Pedro; Mountzios, Giannis; de Mello, Ramon Andrade
    Background: Tumor programmed death ligand one (PD-L1) expression has been studied in several trials in non-small-cell lung cancer. Methods: We assessed the potential role of PD-L1 expression according to Cochrane Collaboration's Guidelines. Results: 13 studies with 1979 patients were included. Among 915 PD-L1 negative patients this rate was 13% (RR 2.08
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    Ventilação não invasiva com pressão positiva para prevenção de complicações após ressecção pulmonar em pacientes com câncer de pulmão: revisão sistemática da literatura
    (Universidade Federal de São Paulo (UNIFESP), 2016-01-27) Torres, Maria Fernanda Santos [UNIFESP]; Riera, Rachel [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: To assess the efficacy and safety of NIPPV for prevention of complications in patients who underwent pulmonary resection for lung cancer. Methods: It was developed a systematic review according to Cochrane Collaboration methodology. We searched the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS and PEDro (last search on 17 March 2015) to identify potentially eligible trials. We did not use any date or language restrictions in the electronic searches for trials. We searched the reference lists of relevant papers and contacted experts in the field for information about additional published and unpublished studies. Additionally we accessed the Register of Controlled Trials (www.controlled-trials.com) and ClinicalTrials.gov (clinicaltrials.gov) to identify ongoing studies. We considered randomised or quasi-randomised clinical trials that compared NIPPV in the immediate postoperative pulmonary resection with no intervention or conventional respiratory therapy. Two authors collected data and assessed trial risk of bias. Where possible, we pooled data from the individual studies using a fixed-effect model (quantitative synthesis) otherwise we tabulated or presented the data in the main text (qualitative synthesis). Where a substantial heterogeneity existed, we applied a random-effects model. Results: From the 155 references retrieved from search strategies, six randomised clinical trials (RCTs) and one quasi-randomised trial fulfilled the eligibility criteria for this review, including a total of 436 patients. There was no statistical difference between the use or not of NIPPV when: (a) pulmonary complications rate (RR 1,03; IC 95% 0,72 to 1,47; five studies), (b) intubation rate (RR 0,55; IC 95% 0,25 to 1,20; three studies), (c) mortality (RR 0,60; 95% CI 0,24 to 1,53; five studies), (d) length of intensive care unit stay (DM-0,75; IC 95% -3,93 to 2,43; two studies), (e) length of hospital stay (DM-0,12; 95% CI -6,15 to 5,90; four studies). None study describe any complications related to NIPPV. Regarding the quality of evidence, four studies were considered "low risk of bias" in all domains evaluated; two were considered 'high risk of bias" to allocation concealment domain where one of those also considered at "high risk of bias" to random sequence generation domain. One study was considered "high risk of bias" because inclusion of participants with more severe clinical conditions compared to participants from other studies. Conclusions: This review demonstrated that there was no additional benefit of using NIPPV in postoperative pulmonary resection for all outcomes analysed (pulmonary complications, rate of intubation, mortality, rate of non-pulmonary complications, postoperative consumption of antibiotics, length of intensive care unit stay, length of hospital stay and adverse effects related to NIPPV). However, the quality of evidence is "very low", "low" and "moderate" since there were few studies, with small sample size and low frequency of outcomes. New welldesigned and well-conducted randomised trials are needed to answer the questions of this review with greater certainty.