Purpose To assess the activity, safety and treatment patterns of sunitinib in patients with poor-risk metastatic renal cell carcinoma (mRCC). Materials and Methods We retrospectively reviewed the charts of poor risk patients treated with sunitinib from October 2006 to July 2013 who met the eligibility criteria. The primary endpoint was overall survival (OS). Tumor radiological response was measured according to RECIST 1.1 and adverse events (AEs) were assessed through standard criteria. Results Median OS was 8.16 months (95% CI, 5.73-10.59). Of the 53 patients included in this analysis, 9 (17.0%) achieved partial response, 12 (22.6%) had stable disease. Median treatment duration was 3.30 months (95% CI: 1.96-4.63) and 26.4% of patients discontinued treatment due to toxicity. Grade 3 or higher AEs occurred in 39.6% of patients, the most common being fatigue (15.1%), neutropenia (9.5%), nausea, vomiting and diarrhea (7.5% each). Discussion Sunitinib may benefit some unselected poor-risk patients, although the rates of AEs and drug discontinuation suggest a need for careful patient monitoring.

CONTEXTO E OBJETIVO: A administração de um agonista do hormônio liberador das gonadotropinas no momento pré-ovulatório é uma opção para desencadear a ovulação nos ciclos de reprodução assistida. O objetivo deste trabalho é investigar o padrão da secreção de prolactina após a administração de dose única de agonista no momento pré-ovulatório. TIPO DE ESTUDO E LOCAL: Estudo descritivo realizado em um centro de referência terciário. PARTICIPANTES: 15 pacientes normo-ovulatórias submetidas a indução da ovulação para inseminação intra-uterina. MÉTODOS: A estimulação ovariana foi realizada com gonadotropinas da mulher menopausada (75 UI por via intramuscular diariamente). Na presença de pelo menos um folículo de 17 mm (observado por ultra-sonografia), administrou-se 0,5 mg de acetato de buserelina. Foram colhidas amostras de sangue para determinação dos níveis de prolactina no momento da injeção do agonista e 4, 8, 12, 24 e 48 horas depois. RESULTADOS: Observou-se aumento significante nas concentrações séricas de prolactina 4, 8 e 12 horas após a administração do análogo, com um pico após 8 horas. CONCLUSÃO: A administração de uma dose única de análogo agonista no momento pré-ovulatório de pacientes estimuladas com gonadotropinas da mulher menopausada promove aumento significante nas concentrações séricas de prolactina.

CONTEXT AND OBJECTIVE: Administration of a gonadotropin-releasing hormone (GnRH) agonist at the preovulatory phase is an option for triggering ovulation in assisted reproductive technology cycles. The aim of this work was to investigate the pattern of prolactin secretion after the administration of a single dose of GnRH-agonist at the preovulatory phase. DESIGN AND SETTING: Descriptive study at a tertiary referral center. PARTICIPANTS: Fifteen normally ovulating patients undergoing ovarian stimulation for intrauterine insemination were studied. METHODS: Ovarian stimulation was carried out using human menopausal gonadotropin (intramuscular 75 IU daily). When at least one follicle reached 17 mm (observed echographically), 0.5 mg of buserelin acetate was administered. Blood samples were taken to determine prolactin concentrations, at the time of agonist injection and 4, 8, 12, 24 and 48 hours later. RESULTS: A statistically significant increase in serum levels of prolactin was observed 4, 8 and 12 hours after GnRH-agonist administration, with a peak at 8 hours. CONCLUSION: The administration of a single dose of GnRH-agonist at the preovulatory phase in patients undergoing ovarian stimulation performed with human menopausal gonadotropin causes a significant increase in serum prolactin levels.

Relatamos o caso de um homem de 20 anos, com diagnóstico de tumor de células germinativas, que apresentou acidente vascular cerebral isquêmico durante quimioterapia com cisplatina, etoposide e bleomicina. Os casos relatados na literatura foram revisados, bem como os diferentes mecanismos fisiopatológicos implicados na toxicidade vascular deste esquema quimioterápico.

A 20-year-old man with a germ cell tumor who experienced an ischemic stroke as a complication of cisplatin/etoposide/bleomycin based chemotherapy is reported. The previously reported cases are reviewed as well as the different physiopathologic mechanisms associated with vascular toxicity of this regimen.