Day 1 :
I.M. Sechenov First Moscow State Medical University, Russia
Keynote: Analysis of the all Russia observational studies: Reduxine (Sibutramine) safety monitoring in patients with alimentary obesity and comorbidities
Time : 10:00 am-10:30 am
Tatiana Romantsova is currently working as a Professor at Department of Endocrinology in Sechenov University, Moscow. He is the author of 215 scientific articles.
As in many other developed nations, the problem of obesity is acute in Russia, where it’s prevalent in 24.1% of the population (28 million people). In Russia, Sibutramine (Reduxine) and a combination of Sibutramine and Metformin (ReduxineMet) are authorized to reduce weight in patients with obesity and type-2 diabetes mellitus or prediabetes. Since the administration of central-acting drugs as pharmacotherapy of obesity is the most pathogenetically justified treatment, the issue of safety of Sibutramine therapy is very important. In order to implement the principles of active monitoring of the efficacy and safety of Sibutramine in the current clinical practice and to develop an algorithm of it’s reasonable prescribing the observation studies “Vesna”, “Primavera” and “Aurora” were conducted in 2011-2017 under the auspices of Endocrinology Research Centre and the Russian Association of Endocrinologists. The programs were attended by 4,874 doctors of various specialties and 139.305 patients. In “Vesna” study it was shown that Sibutramine therapy is effective in weight loss, changing eating behavior and promotes positive changes in LDL, HDL, TG and fasting glucose. In the “Primavera” study the body mass reducing dynamics during 3, 6, 12 months was 9.5±4.28 kg, 15.0±6.22 kg, 20.0±8.62 kg respectively. Moreover, it was shown that Reduxine therapy under the supervision of a physician was associated with decreased levels of systolic and diastolic blood pressure and had no effect on heart rate. Reduxine® Met in “Aurora” study was being added to the diabetes therapy, that was chosen by the attending physician, prior to the patient's participation in the program. The average fasting plasma glucose and HbA1c reduction were 2±1.6 mmol/l and 1.2±1.1% respectively. Current studies show, that Sibutramine therapy of obesity according to approved indications is safe and effective for long-term treatment in regards to weight loss, regulation of lipemic index, glucose profile and quality of life.
MRCCC Siloam Hospitals, Indonesia
Dr. Jeffry Beta Tenggara has 8 years’ experience in treating oncology patients. He currently works in MRCCC Siloam Hospital Jakarta, a cancer hospital, as a medical oncologist and a member of Internal Medicine Department.In addition to his medical practice, he is a member of the Indonesian Society of Internal Medicine, Indonesian Society of Oncology, and Indonesian Medical Association.
Introduction: Docetaxel was frequently used to treat solid tumors, primarily breast cancer by disrupting microtubule function to inhibit cell division. Although this agent was known to cause myalgia, arthralgia and neuropathy, there are few reports since 2005 that published the myositis complication of this agent. We presented a case report of necrotizing fasciitis as a continuing myositis condition that happened after Docetaxel treatment.
Case Report: A 44 years old female diagnosed with stage-IIIB ductal invasive breast carcinoma (ER/PR+ HER-). She underwent chemotherapy with Docetaxel and Doxorubicin following the surgical treatment. After 6th chemotherapy cycle, the patient had pain at both thighs especially the left side. The symptom progressed until blisters seen on the skin and ulcer developed. Physical examination showed normal vital signs, ulceration at posterior left thigh with minimal purulent discharge, stiff and tender on palpation. Laboratory result showed elevated CRP and ESR with no elevated WBC and shifting of differential count. Doppler ultrasound showed soft tissue edema with no sign of DVT or thrombus, contrast MRI showed thickening and edema of the thigh muscle, enhancement of adductor brevis, semitendinosus, gluteus maximus and lateral vastus muscle, which consistent with myositis necroticans. PET- CT revealed necrotic irregular pattern on subcutaneous tissue including muscles at both posterior thigh compartment, with left domination. The result was different than previous PET- CT study which conducted before administration of Docetaxel. She was suspected with myositis complicated with secondary infection and planned to undergone surgical debridement. At intraoperative procedure, the surgeon found necrotic muscular tissue with no sign of primary infection. The tissues were sent for pathology examination. Pathology examination revealed necrotic tissues with gas inclusion, inflammatory cells (PMN and lymphocyte) and necrotic vascular tissues, these findings consistent with necrotizing fasciitis. In 1990s, reports of Docetaxel side effect began to revealed myopathy condition with unexplained pathophysiology. Documented cases of acute inflammatory myositis in patients treated with Docetaxel began to publish since 2005. Until 2015 there are less than 10 cases reported the myositis side effect of Docetaxel. The proposed theory linking this effect were direct myotoxicity, systemic leakage of protein in the interstitial space, increased cytokine levels (primarily IL-6, IL-8, IL-10), indirect muscle damage through hypocalcaemia and hyperthermia and accumulation of acid phosphatase in muscle lysosome. Although Docetaxel induced myositis was an exclusion diagnosis, this rare side effect must be considered to prevent further deteriorating condition.
Discussion: Myositis and necrotizing fasciitis is a rare side effect of Docetaxel that only few of reports documented since 2005. There are several proposed mechanisms linking this condition. Consideration and early recognition of this condition were needed to prevent further deterioration.
Harvard T H Chan School of Public Health, USA
Michael Retsky has completed his PhD in Experimental Physics from University of Chicago 1974. He is currently working as a Staff at Harvard TH Chan School of Public Health. He has 3 patents pending on methods to prevent late relapses. His over 100 papers in Physics and Oncology have been cited over 2500 times.
Most current cancer research aims to prevent cancer patients from dying from metastatic disease. To solve the problem upstream, i.e., to prevent relapses, with the unexpected observation of bimodal relapse patterns in breast and a number of other cancers. This was not consistent with the current cancer paradigm that has guided early detection and therapy for many years. Our multidisciplinary colleagues include surgeons, medical oncologists, anesthesiologists, biologists and physicists.
After much analysis including computer simulation and input from these medical and scientific specialists, we eventually came to the conclusion that surgery to remove the primary tumor produces systemic inflammation for about one week after the surgery. This systemic inflammation caused dormant single malignant cells and avascular micrometastases to exit from dormancy and result in relapses in the 3 years after surgery. Those relapses comprised the early peak. We have determined that in breast cancer 50 to 80% of relapses (increasing with tumor size and positive nodes) are in the early peak so an effective method to prevent these relapses would be extremely important. It was then determined in a retrospective study that the common inexpensive perioperative NSAID ketorolac can prevent the early relapses. A second retrospective study strongly confirmed this result but a small prospective study found no advantage. The Pangrahy, ovarian and colon papers are very recent and not mentioned in the video to be presented at this conference.
Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Catherine Maurice completed her residency training in Neurology at the University of Montreal in 2013. She then started a 2-year fellowship in neuro-oncology at the Pencer Brain Tumor Centre of Princess Margaret Hospital, Toronto, under the supervision of Dr Warren P. Mason. In 2015, University of Toronto Health Network recruited Dr. Catherine Maurice to work as an attending physician and clinical teacher. She developed a new neuro-oncology clinic focusing on the to assessment of neurologic complications resulting from systemic cancers and novel therapies. She also manages another clinic focused on primary brain tumors and is enrolled in the multidisciplinary Gamma-Knife Clinic of the Krembil Neuroscience Centre. Dr. Maurice is actively involved in teaching, trying to incorporate new technologies and virtual reality into medical education.
It is estimated that thirty to forty percent of all cancers can be prevented by lifestyle and dietary measures alone. The main goal is to potentially interfere with the development of precancerous tumors. Even healthy people have a certain number of latent cancerous cells in their tissues. Spontaneous formation of small tumors happens frequently over a lifetime. However, the growth process is interrupted by our defense mechanisms. Those tumors remain microscopic and harmless, until they vanish. Free radicals, environment or diet-associated chemicals can severely damage DNA, leading ultimately to cancer. Certain fruits and vegetables can neutralize carcinogens, increase their excretion and inhibit tumorigenesis. Food also plays a crucial role on the development and maintenance of the central and peripheral nervous system. This presentation aims to identify key concepts and interesting historical facts related to the impact of food in the field of Neuro-Oncology.