Acquired cellular resistance to traditional chemotherapeutics is a common obstacle in the treatment of most cancer cell types. This resistance occurs as a result of changes in the underlying molecular mechanisms of disease progression. The development of novel chemotherapeutic approaches designed to enhance the efficacy of protypical anti-cancer drugs is important in order to overcome this issue. Such approaches will aid in understanding the biomolecular phenomena responsible for drug resistance and disease progression. Combining signaling pathway inhibitors has become an effective strategy for enhancing tumor cell death by targeting multiple pathways known to regulate cell survival. Pemetrexed, an FDA-approved anti-folate drug, targets thymidylate synthase (TS) and a secondary folate-dependent enzyme, 5’ aminoimidazole-carboximide ribonucleotide formyltransferase (AICART); both important for DNA synthesis. Studies performed by our collaborator demonstrated that TS inhibition causes intracellular accumulation of ZMP+ and activation of AMPK which is known to induce autophagy in mammalian cells. Previous studies from our lab and others showed that sorafenib, a multi-kinase inhibitor of Raf-1 and class III receptor tyrosine kinases, was able to induce a cytotoxic form of autophagy in a variety of tumor cell types. Combination treatment using pemetrexed and sorafenib in these cancer cells resulted in an enhancement of autophagy and cell lethality beyond that of individual drugs alone. Inhibition of autophagy suppressed the toxic interactions of these drugs in all cell types examined. Pemetrexed/sorafenib cotherapy also proved to be an effective treatment for triple negative breast cancer cells having advanced to a stage of estrogen independence. Fulvestrant-resistant MCF7 cells were more sensitive to the drug combination than parental, estrogen-dependent MCF7 cells. Breast cancer cells cotreated with pemetrexed and sorafenib exhibited enhanced MEK/ERK signaling, Src activation that was dependent on platelet-derived growth factor β (PDGFRβ) downregulation, elevated protein phosphatase 2A (PP2A) activity, and increased de novo ceramide synthesis. Studies using a mouse model of experimentally-induced breast cancer validated drug combination effectiveness through inhibition of tumor growth, while no deleterious effects on normal tissues were observed. The data presented demonstrates that pemetrexed/sorafenib cotreatment augments chemosensitivity in both in vitro and in vivo systems. Based upon these findings, a Phase I clinical trial involving pemetrexed and sorafenib in breast cancer patients with solid, recurrent tumors was begun in 2011. In conclusion, this work strongly supports a promising therapeutic utility for the pemetrexed/sorafenib combination in treatment of various cancer cell types.

<p>Mnogi lekovi registrovani za razne druge indikacije mogu da deluju selektivno na tumorske receptore, signalne puteve, metaboličke procese, bioenergetske faktore, enzime, proteine, gene koji reguli&scaron;u proliferaciju, apoptozu i neoangiogenezu tumora ne pogađajući ove procese kod zdravih ćelija. Uvođenje novih lekova je izrazito dug, složen i skup proces istraživanja. Kori&scaron;ćenjem principa otkrivanja antikancerskog efekta kod već registrovanih lekova za druge indikacije, direktno se utiče na skraćivanje vremena i tro&scaron;kova istraživanja. Eksperimentalno je ispitana efikasnost antitumorskog delovanja mebendazola, metformina, itrakonazola, diklofenaka, nitroglicerina i deoksiholne kiseline na fibrosarkom hrčka izazvan BHK21/C13 tumorskom ćelijskom linijom praćenjem veličine i histologije lečenih tumora. Eksperimentalno je ispitana mogućnost primene deoksiholne kiseline, nitroglicerina, kofeina i itrakonazola kao adjuvansa u kombinaciji sa pojedinim ispitivanim lekovima (metformin, itrakonazol, diklofenak) za lečenje fibrosarkoma hrčka. Kako je ispitivanje vr&scaron;eno na mladuncima imladim hrčkovima i kako su sarkomi najče&scaron;ći u dečijem uzrastu, definisanje potencijalne antikancerske uloge ispitivanih lekova se odnosi prvenstveno na njihovu primenu u pedijatriji. Pokazano je da metformin, kombinacije metformina sa kofeinom, metformina sa itrakonazolom i metformina sa nitroglicerinom deluju u pogledu svih ispitivanih parametara tumora antitumorski na fibrosarkom hrčka. Kofein, itrakonazol i nitroglicerin pojačavaju antitumorsko dejstvo metformina na fibrosarkom hrčka. Tokom svih eksperimenata realizovanih u okviru ove disertacije, pokazalo se da nije bilo delotvornog tretmana, koji ne sadrži metformin.</p> / <p>Many drugs registered for various other indications can act selectively to tumor receptors, signaling pathways, metabolic processes, bioenergetic factors, enzymes, proteins, genes that regulate proliferation, apoptosis, and neoangiogenesis of the tumor without affecting these processes in the healthy cells. The introduction of new drugs is a very long, complex and expensive process of research. Using the principle of detecting the anticancer effect in already registered drugs for other indications, directly affects the reduction of time and cost of research. The efficacy of mebendazole, metformin, itraconazole, diclofenac, nitroglycerin and deoxycholic acid antitumor activity on hamster fibrosarcinoma induced experimentally by the BHK21/C13 tumor cell line was tested by monitoring the size and histology of the treated tumors. The possibility of using deoxycholic acid, nitroglycerin, caffeine and itraconazole as an adjuvant in combination with investigated drugs (metformin, itraconazole, diclofenac) for the treatment of hamster fibrosarcoma has been experimentally tested. As the examination was carried out on young cubs and young hamsters and that sarcomas are the most common in childhood, defining the potential anti-cancer role of the investigated drugs relates primarily to their application in pediatrics. Metformin, combinations of metformin with caffeine, metformin with itraconazole and metformin with nitroglycerin have shown antitumor action on the hamster fibrosarcoma in terms of all tested tumor parameters. Caffeine, itraconazole and nitroglycerin increase the antitumor effect of metformin on the hamster fibrosarcoma. During all the experiments carried out within this dissertation, there has been no effective treatment, which does not contain metformin.</p>

A leucemia linfóide aguda nos adultos apresenta prognóstico reservado. Os objetivos deste estudo são descrição e análise de parâmetros clínicos, laboratoriais e fatores prognósticos em 102 pacientes tratados com diferentes protocolos de quimioterapia no período de 1990 a 2005, no Serviço de Hematologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Em estudo de coorte retrospectivo, com exclusão de LLA subtipo L3 (FAB) ou B-IV (EGIL), foram analisadas a taxa de remissão completa (RC), sobrevida global (SG) e sobrevida livre de doença (SLD) para a população geral e para os dois principais protocolos de tratamento. A análise estatística foi feita pelo programa SPSS 10.0. Associação entre variáveis, fatores prognósticos e resposta foram observados através do teste ?2 de Person. Curvas de SG e SLD foram construídas pelo método de Kaplan-Meier e as diferenças analisadas pelo teste de log-rank. A idade média foi de 30,6 anos (12 a 82 anos) e predominou o sexo masculino (55,9%). Ao diagnóstico, os achados clínicos foram: fadiga (58,2%), esplenomegalia (59,7%), hepatomegalia (54,6%), linfadenopatia (52,6), febre (38,8%), dor óssea(28,6%), sangramento (27,5%) e cefaléia (15,3%). Envolvimento do sistema nervoso central (SNC) foi detectado em 11 (11,8%) pacientes, enquanto envolvimento testicular acometeu um paciente. O valor médio de hemoglobina, leucócitos e plaquetas foram 8,5g/dl, 84.341/mm3 e 76.275/mm3, respectivamente. 98,7% dos pacientes apresentaram linfoblastos no sangue periférico. A classificação FAB foi igualmente observada entre os tipos L1 e L2. As LLA B e T foram observadas em 69,7% e 30,2%, respectivamente. O cariótipo foi realizado em 40 pacientes, e t (9;22) foi identificada em 20% (8/40) dos casos. Os pacientes foram tratados com quatro diferentes protocolos: BFM 86 modificado (BFM 86M) em 47,15% (48/102), Linker et al em 39,2% (40/102), Lister et al em 5,9% (6/102) e CHOP em 7,8% (8/102). Na análise para a população geral, na fase de indução, 70,6% (65/92) dos pacientes entraram em RC. Idade inferior a 18 anos e ausência de infiltração de SNC foram fatores preditores positivos de resposta em análise multivariada (p=0,03). Com mediana de seguimento de 49 meses, observamos taxa de 30,5% e 27% para SG e SLD em 4 anos. Ausência de sangramento e hepatomegalia, ao diagnóstico, e idade < 35 anos estiveram associados à maior SG através de análise multivariada (p=0,01). Os dois protocolos com maior número de pacientes, apresentaram distribuição semelhante de parâmetros clínicos e laboratoriais, a exceção da variável FAB. RC foi obtida em 76,7% e 63,9% dos pacientes tratados respectivamente com os protocolos BFM 86M e Linker (p=0,21). A SG foi de 49,5% com o BFM 86M em 4 anos Vs 16% com o protocolo Linker (p=0,004). Observou-se que o protocolo BFM86M teve melhor SG para pacientes com idade <35 anos (p=0,01), sem sangramento e hepatomegalia ao diagnóstico (p=0,03 e p=0,01) e sem leucocitose (B <30.000mm3 e T <100.000mm) (p=0,04); enquanto que pacientes com LLA T tratados com o protocolo Linker apresentaram SG inferior (p=0,05). A diferença de SLD entre os dois protocolos não foi significativa (p=0,58), entretanto na faixa etária entre 21-35 anos, o protocolo BFM se mostrou superior (p=0,03). Verificamos que o BFM 86M é superior ao Linker et al, sendo um bom protocolo para tratamento de LLA em pacientes adolescentes e adultos jovens sem fatores de risco. / Acute lymphoblastic leukemia in adults has a poor outcome. The aim of this study is to describe and evaluate clinical, laboratory and prognostic factors in 102 patients reated with different protocols of chemotherapy from 1990 to 2005. Adult ALLsubtype L3 (FAB) or B-IV (EGIL) was excluded. We evaluated complete remission (CR), overall survival (OS) and disease free survival (DFS) rates for the whole population and for the two principal treatment protocols. This retrospective cohort was done in hematology department of the FMUSP. Statistical analysis was done by SPSS 10.0. The association of features and prognosis was assessed by Person\'s chi-square. OS and DFS curves were constructed by Kaplan-Meier method and the differences were calculated by the log-rank test. Mean age was 30,6 (12 to 82) years and 55,9% was male. Clinical findings, at diagnosis, were fatigue (58,2%), splenomegaly (59,7%), hepatomegaly (54,6%), ymphadenopathy (52,6%), fever (38,8%), bone pain (28,6%), bleeding (27,5%) and headache (15,3%). Involvement of central nervous system (CNS) was detected in 11 (11,8%) patients and testicular involvement was observed in one patient. Mean blood values were 8,5g/dl, 84.341/mm3 and 76.275/mm3 for hemoglobin, leucocytes and platelets respectively. 98,7% of the patients presented with lymphoblasts in peripheral blood. FAB classification was equally observed between L1 and L2. B and T ALL was noted in 69,7% and 30,2% respectively. Karyotype analysis was performed in 40 cases, where Philadelphia chromosome (ph) was identified in 20% (8/40) of them. Patients were treated with four different protocols: BFM 86 modified (BFM 86M) in 47,1% (48/102), Linker et al in 39,2% (40/102), Lister et al in 5,9% (6/102) and CHOP in 7,8% (8/102) of the patients. In the judgment for the entire population, in induction treatment, 70,6% (65/92) of the patients had CR. Age below 18 years and no infiltration in CNS were positive factors for CR in multivariate analyses (p=0,03). In a median follow up of 49 months, we have observed a 4 years OS and DFS of 30,5% and 27% respectively. No bleeding and hepatomegaly, at diagnosis, and age less than 35 years were factors associated a better OS in multivariate analyses (p=0, 01). Protocols with highest number of patients (BFM and Linker) showed the same distribution of clinical and laboratory factors; exception FAB classification. CR were seen in 76,7% and 63,9% of the patients treated with BFM 86M and Linker respectively. (p=0,21). OS was 49,5% with BFM protocol in 4 years Vs 16% with Linker (p=0,004). We observed a better OS for patients with age below 35 years (p=0,01), no bleeding and no hepatomegaly at diagnosis (p=0,03 ; p=0,01) and no leucocytosis ( B < 30000/mm3 and T < 100000/mm3) treated with BFM 86M; however ALL - T treated with Linker protocols had inferior OS (p=0,05). DFS between protocols wasn\'t significant (p=0,58), but with age between 21 and 35 years BFM was better (p=0,03). We conclude that BFM 86M is superior than Linker et al and it is a good treatment for childhood / young adults without risk factors

A toxicidade vestibular pode ser definida como danos que uma substância química causa sobre a estrutura e a função vestibular. Entre as drogas que podem causar a vestibulotoxicidade estão os agentes antineoplásicos como os derivados da platina. OBJETIVO: Identificar a frequência de ocorrência de alteração vestibular em pacientes oncológicos tratados com derivados da platina, os sinais e sintomas vestibulares nestes pacientes, e se a alteração vestibular pré-existente exacerba os sintomas eméticos durante a quimioterapia com derivados da platina. METODOLOGIA: Amostra foi composta por pacientes adultos com câncer que realizaram tratamento com drogas derivadas da platina. O protocolo para o monitoramento vestibular foi composto pelo questionário Dizziness Handicap Inventory (DHI) Brasileiro, Testes da Função Vestibular (manobra de Dix-Hallpike e vecto-eletronistagmografia) e pela descrição de sintomas eméticos e tontura durante a quimioterapia e avaliação vestibular. RESULTADOS: Quarenta e oito pacientes realizaram a avaliação vestibular pré-quimioterapia, sendo que 23 (48%) apresentaram avaliação vestibular dentro da normalidade. Dezesseis pacientes submeteram-se ao monitoramento vestibular com avaliação antes e após tratamento, sendo que após o tratamento dois pacientes (12,5%) apresentaram avaliação vestibular dentro da normalidade e 14 (87,5%) apresentaram algum tipo de alteração vestibular, evidenciada somente pela prova calórica. Nenhum paciente referiu queixas vestibulares ao DHI na avaliação pré-tratamento, assim como quase todos os pacientes, exceto um, na avaliação pós tratamento. Apenas um (6,3%) com avaliação vestibular alterada pós-tratamento apresentou grau leve no DHI. A dose de cisplatina entre os pacientes que mostraram piora do quadro vestibular variou entre 160 e 400 mg/m² e dois pacientes foram tratados com carboplatina com dose de 2306 mg/m² e 1801 mg/m². Não houve diferença de manifestação dos sintomas eméticos/tontura durante a avaliação vestibular ou após quimioterapia entre os pacientes com e sem alteração vestibular prévia. Entretanto, os pacientes que referiram sintomas eméticos durante os ciclos de quimioterapia foram aqueles que manifestaram maior desconforto na PC, independente da dose de quimioterapia ou da alteração vestibular. CONCLUSÃO: Alteração vestibular ou a modificação do quadro vestibular ocorreu em 50% dos pacientes com câncer tratados com derivados da platina. O sinal mais frequente de alteração nos testes vestibulares foi a hiporreflexia à prova calórica, sem sintomas vestibulares relatados na vida diária destes pacientes. As alterações vestibulares pré-existentes não exacerbaram os sintomas eméticos durante a quimioterapia / Vestibular toxicity may be defined as a damage that chemical substances cause on the structure and the function of the vestibular system. Among the drugs that may cause vestibulotoxicity there are antineoplastic agents, such as those derived from platinum. OBJECTIVE: To identify the frequency of occurrence of vestibular alterations in cancer patients treated with platinum-based chemotherapy; the vestibular signs and symptoms in these patients, and whether the pre-existing vestibular alterations exacerbate emetic symptoms during chemotherapy with platinum-based drugs. METHODS: The sample was composed of adults who were treated of the cancer with platinum-based chemotherapy. The vestibular monitoring protocol involved the Brazilian Dizziness Handicap Inventory (DHI), Vestibular Function Tests (positioning nystagmus with Dix-Hallpike maneuver and vectoelectronystagmography) and the description of emetic symptoms and dizziness during chemotherapy and vestibular evaluation. RESULTS: Forty-eight subjects performed the pre-treatment vestibular evaluation, and 23 of them (48%) presented vestibular assessment within the normal range. Sixteen patients underwent the vestibular monitoring evaluation before and after treatment: after the treatment two patients (12.5%) showed normal vestibular assessment while 14 (87.5%) showed a vestibular disorder, basically in the caloric tests, but the alteration was considered a modification in their baseline stage in eight patients (50%). None of the patients reported complaints in the pre-treatment assessment, with a DHI scores within the normal range, as well as all the patients, except one, in the post treatment assessment (81,3%). Only one patient (6.3%) had a score above normal (mild complaint) with altered vestibular evaluation in the post treatment assessment. The dose of cisplatin among these patients who had a modification in the vestibular function varied from 160 to 400 mg/m² and two patients were treated with carboplatin with do of 2306 mg/m² and 1801 mg/m². There was no difference of emetic symptoms/dizziness during the chemotherapy or the vestibular evaluation among patients with or without previous vestibular alterations. However, patients who reported more emetic symptoms during chemotherapy cycles were those who showed greater discomfort in the caloric test, regardless of the dosage of chemotherapy or vestibular alteration. CONCLUSION: Vestibular alterations or modification of the baseline alteration were found in 50% of cancer patients treated with platinum-based chemotherapy. The most common sign of vestibular alteration in the vestibular tests was the hiporeflexia at the caloric test with no reported symptoms in their daily life. The preexisting vestibular alterations did not exacerbate emetic symptoms during chemotherapy

INTRODUÇÃO: A cirurgia associada à radioterapia proporciona altas taxas de preservação de membros e de controle local em sarcomas de partes moles de extremidade de adultos, mas ainda apresenta elevadas taxas de complicações locais e de metástases à distância. O valor da quimioterapia adjuvante ou neoadjuvante ainda é controverso e objeto de investigações clínicas. A identificação de fatores moleculares preditivos de resposta à quimioterapia pode selecionar pacientes que se beneficiem ou não da sua aplicação. OBJETIVOS: identificar perfis de expressão gênica capazes de diferenciar tumores respondedores e não respondedores a quimioterapia neoadjuvante em sarcomas de partes moles. Analisar os resultados preliminares relativos à efetividade de um esquema de quimioterapia neoadjuvante em sarcomas de partes moles. MÉTODOS: amostras foram coletadas a partir de um ensaio clínico fase II não controlado que testa um esquema de quimioterapia neoadjuvante com doxorrubicina e ifosfamida em sarcomas de alto grau histológico, localizados em extremidades de pacientes adultos. O perfil de expressão gênica foi determinado pela análise de cDNA microarrays. RESULTADOS: 14 pacientes foram incluídos no estudo clínico e 6 amostras foram utilizadas para análise molecular. 222 seqüências diferentemente expressas entre respondedores e não respondedores foram identificadas. Entre os genes com maior diferença de expressão, foram observados genes envolvidos com via de sinalização de TGF, genes envolvidos com angiogênese, com degradação de matriz extracelular e com desenvolvimento. A taxa de resposta objetiva à quimioterapia neoadjuvante foi de 28,6%, a taxa de amputação foi de 7,1% e taxa de complicações relacionadas à ferida operatória foi de 23%. Complicações graus 3 e 4 ocorreram em 50% dos pacientes e nenhum deles faleceu ou teve a proposta cirúrgica suspensa em decorrência de complicações da quimioterapia. CONCLUSÕES: tumores respondedores a quimioterapia neoadjuvante com doxorrubicina e ifosfamida apresentaram um perfil de expressão gênica diferente dos não respondedores, particularmente em genes envolvidos na via de sinalização de TGF. O esquema terapêutico testado mostrou-se efetivo e seguro para ser investigado em um estudo fase III / INTRODUCTION: Surgery combined with adjuvant radiotherapy provides high rates of limb sparing and local control for adult extremity soft tissue sarcomas, but is still associated with high rates of local morbidity and distant recurrences. The role of adjuvant or neoadjuvant chemotherapy is still controversy and target of clinical investigations. The identification of molecular predictive factors of response to chemotherapy could select patients who have benefits or not with its use. OBJECTIVES: to identify gene expression profiles that discriminate tumors with respect to response to neoadjuvant chemotherapy. Analyze the preliminary results of a protocol of neoadjuvant chemotherapy in soft tissue sarcomas. METHODS: samples were collected from subjects of a single-arm prospective clinical trial that investigates the effectiveness of a neoadjuvant doxorubicin and ifosphamide-based chemotherapy regimen in high grade extremity soft tissue sarcomas in adults. Gene expression profiles were determined by the analysis of cDNA microarrays. RESULTS: 14 patients were included in the clinical trial and six samples were used in the molecular study. 222 sequences differentially expressed between responders and non responders were identified. Among the genes with higher differences in expression, we have identified genes involved with TGF signaling pathway, angiogenesis, extracelular matrix degradation and development. The objective response rate to neoadjuvant chemotherapy was 28,6%, the amputation rate was 7,1%, and the wound complication rate was 23%. Grades 3 and 4 complications have occurred in 50 % of the cases, but no deaths or modifications on surgical intent related to chemotherapy complications have occurred. CONCLUSIONS: tumors considered responders to neoadjuvant chemotherapy showed a gene expression profile significantly different from non responders, especially with respect to the TGF signaling pathway. The neoadjuvant regimen tested has showed to be effective and safe to be considering for a phase III clinical trial

Infusões prolongadas de 5-fluorouracil são mais seguras e potencialmente mais efetivas no tratamento do câncer de cólon metastático do que infusões rápidas da mesma medicação. No entanto, infusões prolongadas requerem a disponibilidade de um acesso venoso central, bem como de bombas de infusão dispendiosas. O desenvolvimento de fluoropirimidinas orais permitiu que pacientes fossem expostos ao 5-fluorouracil por longo tempo, com maior conveniência. UFT e leucovorin administrados três vezes ao dia demonstraram previamente uma eficácia equivalente, com menor toxicidade, quando comparados a um regime convencional de infusão rápida de 5- fluorouracil e leucovorin. Este estudo com 98 pacientes foi desenhado e conduzido com objetivo de demonstrar equivalência no tempo de progressão com o uso de UFT e leucovorin administrados duas vezes ao dia, com o uso da mesma combinação administrada três vezes ao dia. Objetivos secundários incluíram análise de toxicidade, resposta objetiva e sobrevida global. O tempo mediano de progressão foi de 3,8 meses, comparado com 3,5 meses observados com o uso da medicação três vezes ao dia e a taxa de resposta foi de 11%, com uma sobrevida mediana de 12,8 meses, sendo comparável aos resultados de 12% e 12,4 meses obtidas com o uso da combinação três vezes ao dia. A incidência de diarréia com graus 3 e 4 foi de 30% no regime de administração duas vezes ao dia, e 21% no de três vezes ao dia. Esses resultados sugerem que o uso de UFT e leucovorin duas vezes ao dia tem eficácia e toxicidade similares àquelas obtidas com o uso da mesma medicação três vezes ao dia. / Prolonged infusions have been shown to be safer and potentially more effective than bolus regimens of 5- fluorouracil as treatment for advanced colorectal cancer. However, infusional 5- fluorouracil requires central venous access and costly infusion pumps. Development of oral fluoropyrimidines has allowed longer exposures to 5-fluorouracil with increased convenience. UFT and leucovorin given thrice daily showed improved safety and no significant difference in survival or response rate compared with bolus 5- fluorouracil and leucovorin. This study with 98 patients was conducted to evaluate whether UFT and leucovorin given twice daily provided comparable time to progression (TTP) to the same combination administered three times a day. Secondary objectives included evaluation of toxicity, overall tumor response rate, and survival. Median time to progression was 3.8 months, compared with 3.5 months observed with the thrice-daily regimen. The twice-daily regimen had a response rate of 11% and median survival of 12.8 months, comparable to the 12% and 12.4 months seen with the thrice-daily regimen. The incidence of grade 3-4 drug-related diarrhea was 30% on the twice-daily and 21% on the thrice-daily schedule. Results suggest that the twice-daily schedule has similar safety and efficacy to the thrice-daily schedule.

O objetivo do estudo foi estudar a expressão de timidilato sintase (TS) como fator preditivo para eficácia de quimioterapia adjuvante com 5-fluorouracil (5-FU) e como fator prognóstico para sobrevida em pacientes portadores de câncer colorretal. Trata-se de estudo retrospectivo em uma série de 114 pacientes com carcinoma colorretal estádios II ou III, distribuídos em dois grupos: 1)cirurgia exclusiva (n=61); 2)cirurgia seguida de quimioterapia com 5-FU (n=53). A expressão de TS foi determinada por imunoistoquímica. Observou-se que a expressão intratumoral de TS foi capaz de selecionar pacientes que se beneficiaram com emprego de quimioterapia adjuvante, mas não se mostrou como variável independente para risco de recidiva ou óbito / The purpose of this study was trying to assess the value of TS expression as a predictive factor in the efficacy of adjuvant chemotherapy in colorectal cancer, as well as its independent prognostic value for survival. It deals with a retrospective study that assesses a series of 114 individuals with high risk colorectal cancer, distributed into two different groups: 1)surgery alone (n=61); 2)surgery and 5-FU-based chemotherapy (n=53). TS expression was determined by immunohistochemistry. We observed that TS expression may select patients that benefit from adjuvant chemotherapy, but it was not shown as an independent variable for the risk of recurrence or death

OBJETIVOS: Evidências consistentes sugerem que a quimioterapia (QT) sistêmica para o tratamento do câncer pode apresentar efeitos deletérios na cognição levando a prejuízos de memória, atenção, velocidade de processamento e função executiva. A maioria dos estudos anteriores, entretanto, foi realizada em mulheres com câncer de mama, o que levanta a possibilidade de que o déficit possa ter sido causado por alterações hormonais e/ou menopausa precoce induzidas pela QT. Pouco se sabe sobre a toxicidade da QT na cognição de pacientes portadores de câncer coloretal (CCR). O objetivo do estudo foi avaliar os efeitos cognitivos da QT adjuvante baseada em fluorouracil (5FU) associado ou não a oxaliplatina (FLOX) em pacientes portadores de CCR estádios II e III , em comparação a indivíduos com câncer de cólon estádio II de baixo risco não submetidos à QT. METODOLOGIA: Estudo de coorte prospectivo, não intervencionista, unicêntrico, onde os pacientes com CCR foram submetidos a uma avaliação neuropsicológica detalhada, além da avaliação de queixas subjetivas de memória e de sintomas depressivos antes do início da quimioterapia (t1) e após 12 meses de seguimento (t2). Avaliamos ainda o papel da apoliproteína E como preditor de risco para disfunção cognitiva e a presença de lesão de substância branca por ressonância magnética (RM) de crânio. RESULTADOS: Num período de 2 anos, de dezembro de 2012 a dezembro de 2014, 85 pacientes foram recrutados e completaram a avaliação inicial (t1): 26 no grupo controle (sem quimioterapia= QT-) e 59 no grupo casos (quimioterapia= QT+). Dentre os 85 pacientes que participaram da avaliação inicial, 16 foram excluídos da análise do desfecho principal. A maioria dos pacientes era do sexo masculino (60,3%), idosos com idade média de 62,5 anos (DP 9,4) e escolaridade média de 7,6 anos (DP 3,7). Considerando o desfecho primário do escore composto global e também os domínios cognitivos de memória e atenção, não econtramos diferença significativa de desempenho no t1 e t2 entre os grupos. Com relação a função executiva, os pacientes que realizaram QT apresentaram melhor desempenho no t1, entretanto, evoluíram com maior declínio e pior desempenho que os controles no t2 após ajuste para idade, sexo, escolaridade e sintomas depressivos no baseline (beta -1,80; 95%CI -3,50; -0,11, p=0,04). Um subgrupo de 32 pacientes foram submetidos a RM de crânio que não mostrou alterações significativas de substância branca pela técnica de imagem de tensor de difusão (DTI) no seguimento. A presença do alelo ?4 da apolipoproteína E não foi diferente entre os grupos. CONCLUSÃO: Pacientes portadores de câncer colorretal que receberam quimioterapia adjuvante com esquema FLOX apresentaram declínio no desempenho cognitivo no domínio função executiva em comparação a pacientes com doença localizada que não receberam QT após 12 meses de seguimento / PURPOSE: Cognitive dysfunction may occur after chemotherapy in cancer survivors, especially in those that received chemotherapy for breast cancer. The frequency and to which extent such toxicity develops in colorectal cancer (CRC) survivors is unknown. This prospective study evaluated the effects of adjuvant chemotherapy on the cognitive performance of patients with localized CRC in comparison with a control group who did not receive chemotherapy. METHODS: Consecutive patients with localized stages II and III CRC completed neuropsychological assessments, self-reported cognitive complaints questionnaires, and depressive symptoms evaluation before starting fluoropyrimidine-based adjuvant chemotherapy (t1) and after 12 months (t2). Control group was assessed at matching intervals. Blood was collected for apolipoprotein E (APOE) genotyping. Clinical and demographic data were also collected. Diffusion tensor imaging (DTI) data was acquired from a subset of participants at both time-points. RESULTS: From December 2012 to December 2014, 137 patients were approached and 85 patients were recruited: 59 received chemotherapy (CTh+) and 26 did not (CTh-), based on standard recommendation for adjuvant therapy for CRC. The mean age was 62.5 years (SD 9.4), 60% were male, and the mean years of education was 7.6 (SD 3.7). No difference was found on global composite score (p=0.38), attention (p= 0.84) or memory (p= 0.97) between the two groups during the followup (mean 375 days, SD 29). However there was a significant difference on executive function domain, after adjustment for age, sex, education, and depressive symptoms at baseline (beta - 1.80; 95%CI -3.50; -0.11, p=0.04), suggesting worse performance for the CTh+ group. In 32 patients who underwent MRI, there was no significant differences for all DTI indices in any white matter regions between CTh+ and CTh- groups during follow-up. APOE polymorphisms were not predictive of cognitive dysfunction. CONCLUSION: After adjusting for confounding factors, patients with CRC who received adjuvant fluorouracil with or without oxaliplatin presented cognitive decline on executive function after 12 months in comparison with patients with localized disease that did not receive chemotherapy

Liu, Pi-chu. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 155-173). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

by Ng Wang Kit. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (leaves 131-139). / Abstracts in English and Chinese. / Acknowledgements --- p.iii / Abstract --- p.v / List of Tables --- p.ix / List of Figures --- p.x / List of Abbreviations --- p.xiii / Table of Contents --- p.xv / Chapter Chapter 1: --- General Introduction --- p.1 / Chapter Chapter 2: --- Literature Review --- p.3 / Chapter 2.1 --- Malaria --- p.3 / Chapter 2.1.1 --- Global picture --- p.3 / Chapter 2.1.2 --- Malaria mechanics --- p.4 / Chapter 2.1.3 --- Life cycle of malaria parasite --- p.4 / Chapter 2.2 --- Treatment of malaria ´ؤ malaria drugs --- p.5 / Chapter 2.2.1 --- Antimalarial drugs --- p.5 / Chapter 2.2.2 --- Drug resistance --- p.6 / Chapter 2.3 --- Treatment of malaria - malarial vaccines --- p.7 / Chapter 2.3.1 --- Malarial vaccine developments --- p.7 / Chapter 2.3.2 --- Transmission blocking vaccines --- p.7 / Chapter 2.3.3 --- Pre-erythrocytic vaccines --- p.9 / Chapter 2.3.4 --- Blood stage vaccines --- p.10 / Chapter 2.4 --- The major merozoite protein - gpl95 --- p.11 / Chapter 2.5 --- Plants as bioreactors --- p.12 / Chapter 2.5.1 --- Products of transgenic plants --- p.13 / Chapter 2.6 --- Transgenic plants for production of subunit vaccines --- p.14 / Chapter 2.6.1 --- Norwalk virus capsid protein production --- p.15 / Chapter 2.6.2 --- Hepatitis B surface antigen production --- p.15 / Chapter 2.7 --- Tobacco and Arabidopsis as model plants --- p.16 / Chapter 2.7.1 --- Arabidopsis --- p.16 / Chapter 2.7.2 --- Tobacco --- p.17 / Chapter 2.8 --- Transformation methods --- p.17 / Chapter 2.8.1 --- Direct DNA uptake --- p.17 / Chapter 2.8.1.1 --- Plant protoplast transformation --- p.17 / Chapter 2.8.1.2 --- Biolistic transformation --- p.18 / Chapter 2.8.2 --- Agrobacterium-mediated transformation --- p.18 / Chapter 2.8.2.1 --- Leaf-disc technique --- p.18 / Chapter 2.8.2.2 --- In planta transformation --- p.19 / Chapter 2.9 --- Phaseolin --- p.20 / Chapter 2.10 --- Detection and purification of recombinant products - Histidine tag --- p.21 / Chapter 2.11 --- Aims of study and hypotheses --- p.22 / Chapter Chapter 3: --- Materials and Methods --- p.24 / Chapter 3.1 --- Introduction --- p.24 / Chapter 3.2 --- Chemicals --- p.24 / Chapter 3.3 --- Expression in tobacco system --- p.24 / Chapter 3.3.1 --- Plant materials --- p.24 / Chapter 3.3.2 --- Bacterial strains --- p.25 / Chapter 3.3.3 --- Chimeric gene construction for tobacco transformation --- p.25 / Chapter 3.3.3.1 --- The cloning of pTZPhasp/flgp42-His/Phast (F1) --- p.26 / Chapter 3.3.3.2 --- The cloning of pBKPhasp-sp/flgp42-His/Phast (P9) --- p.30 / Chapter 3.3.3.3 --- The cloning of pHM2Ubip/flgp42-His/Nost (C2) --- p.30 / Chapter 3.3.4 --- Confirmation of sequence fidelity of chimeric gene by DNA sequencing --- p.33 / Chapter 3.3.5 --- Cloning of chimeric gene into binary vector --- p.34 / Chapter 3.3.6 --- Triparental mating of Agrobacterium tumefaciens LBA4404/pAL4404 --- p.35 / Chapter 3.3.7 --- Tobacco transformation and regeneration --- p.36 / Chapter 3.3.8 --- GUS assay --- p.37 / Chapter 3.3.9 --- Genomic DNA isolation --- p.37 / Chapter 3.3.10 --- PCR amplification and detection of transgene --- p.38 / Chapter 3.3.11 --- Southern blot analysis --- p.38 / Chapter 3.3.12 --- Total seeds RNA isolation --- p.39 / Chapter 3.3.13 --- RT-PCR --- p.39 / Chapter 3.3.14 --- Northern blot analysis --- p.40 / Chapter 3.3.15 --- Protein extraction and SDS-PAGE --- p.40 / Chapter 3.3.16 --- Western blot analysis --- p.41 / Chapter 3.4 --- Expression in Arabidopsis system --- p.42 / Chapter 3.4.1 --- Plant materials --- p.42 / Chapter 3.4.2 --- Bacterial strains --- p.42 / Chapter 3.4.3 --- Chimeric gene construction --- p.42 / Chapter 3.4.3.1 --- The cloning of pBKPhasp-sp/His/EK/p42/Phast (DH) --- p.43 / Chapter 3.4.3.2 --- The cloning of pTZPhaSp/His/EK/p42/Phast (EH) --- p.45 / Chapter 3.4.3.3 --- The cloning of pBKPhasp-sp/His/EK/flgp42/Phast (DHF) and pTZPhasp/His/EK/flgp42/Phast (EHF) --- p.45 / Chapter 3.4.4 --- Confirmation of sequence fidelity of chimeric genes --- p.45 / Chapter 3.4.5 --- Cloning of chimeric gene into Agrobacterium binary vector --- p.49 / Chapter 3.4.6 --- Transformation of Agrobacterium tumefaciens GV3101/pMP90 with chimeric gene constructs --- p.49 / Chapter 3.4.7 --- Arabidopsis Transformation --- p.49 / Chapter 3.4.8 --- Vacuum infiltration transformation --- p.50 / Chapter 3.4.9 --- Selection of successful transformants --- p.51 / Chapter 3.4.10 --- Selection for homozygous plants with single gene insertion --- p.51 / Chapter 3.4.11 --- GUS assay --- p.52 / Chapter 3.4.12 --- Genomic DNA isolation --- p.52 / Chapter 3.4.13 --- PCR amplification and detection of transgenes --- p.52 / Chapter 3.4.14 --- Southern Blot analysis --- p.52 / Chapter 3.4.15 --- Total siliques RNA isolation --- p.53 / Chapter 3.4.16 --- RT-PCR --- p.53 / Chapter 3.4.17 --- Northern blot analysis --- p.53 / Chapter 3.4.17 --- Protein extraction and SDS-PAGE --- p.54 / Chapter 3.4.18 --- Western blot analysis --- p.54 / Chapter 3.5 --- In vitro transcription and translation --- p.54 / Chapter 3.5.1 --- In vitro transcription --- p.54 / Chapter 3.5.2 --- In vitro translation --- p.55 / Chapter 3.6 --- Particle bombardment of GUS fusion gene --- p.56 / Chapter 3.6.1 --- Chimeric gene constructs --- p.56 / Chapter 3.6.2 --- Particle bombardment using snow bean cotyledon --- p.61 / Chapter Chapter 4: --- Results --- p.63 / Chapter 4.1 --- Tobacco system --- p.63 / Chapter 4.1.1 --- Chimeric gene constructs --- p.63 / Chapter 4.1.2 --- Tobacco transformation and regeneration --- p.65 / Chapter 4.1.3 --- GUS activity assay --- p.67 / Chapter 4.1.4 --- Molecular analysis of transgene integration --- p.68 / Chapter 4.1.4.1 --- Genomic DNA extraction and PCR --- p.68 / Chapter 4.1.4.2 --- Southern blot analysis --- p.70 / Chapter 4.1.5 --- Molecular analysis of transgene expression --- p.72 / Chapter 4.1.5.1 --- Total RNA isolation and RT-PCR --- p.72 / Chapter 4.1.5.2 --- Northern blot analysis --- p.75 / Chapter 4.1.6 --- Genomic PCR to confirm whole gene transfer --- p.76 / Chapter 4.1.7 --- Biochemical analysis of transgene expression --- p.78 / Chapter 4.1.7.1 --- Protein extraction and SDS-PAGE --- p.78 / Chapter 4.1.7.2 --- Western blot analysis --- p.78 / Chapter 4.2 --- Arabidopsis system --- p.83 / Chapter 4.2.1 --- Chimeric gene constructs --- p.83 / Chapter 4.2.2 --- Arabidopsis transformation and selection --- p.85 / Chapter 4.2.3 --- Selection of transgenic plants --- p.87 / Chapter 4.2.4 --- Assay of GUS activity --- p.91 / Chapter 4.2.5 --- Molecular analysis of transgene integration --- p.92 / Chapter 4.2.5.1 --- Genomic DNA extraction and PCR --- p.92 / Chapter 4.2.5.2 --- Southern blot analysis --- p.96 / Chapter 4.2.6 --- Molecular analysis of transgene expression --- p.99 / Chapter 4.2.6.1 --- Total RNA isolation and RT-PCR --- p.99 / Chapter 4.2.6.2 --- Northern blot analysis --- p.106 / Chapter 4.2.7 --- Genomic PCR for confirmation of whole gene transfer --- p.107 / Chapter 4.2.8 --- Biochemical analysis of transgene expression --- p.108 / Chapter 4.2.8.1 --- Protein extraction and SDS-PAGE --- p.108 / Chapter 4.2.8.2 --- Western blot analysis --- p.108 / Chapter 4.3 --- In vitro transcription and translation --- p.112 / Chapter 4.4 --- Particle bombardment of p42/ GUS fusion gene --- p.115 / Chapter Chapter 5: --- Discussion and Future perspectives --- p.117 / Chapter 5.1 --- Failure in detecting transgene expression --- p.117 / Chapter 5.2 --- Poor transgene expression --- p.120 / Chapter 5.2.1 --- Bacillus thuringiensis toxin and green fluorescent protein --- p.120 / Chapter 5.2.2 --- AT-richness --- p.121 / Chapter 5.2.3 --- Deleterious sequence - AUUUA --- p.123 / Chapter 5.2.4 --- Presence of AAUAAA or AAUAAA-like motifs --- p.125 / Chapter 5.2.5 --- Codon usage --- p.126 / Chapter 5.3 --- Future perspectives --- p.127 / Chapter Chapter 6: --- Conclusion --- p.129 / References --- p.131