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Papers by HEZIO FERNANDES

Journal of Medical Residency Review, Feb 14, 2024

Research, Society and Development, Nov 11, 2022

Benefícios promovidos pela utilização de um nutracêutico produzido por fermentação altamente biod... more Benefícios promovidos pela utilização de um nutracêutico produzido por fermentação altamente biodisponível, rico em β-glucanas e aminoácidos, para pacientes oncológicos tratados com quimioterapias e radioterapias Benefits promoted by the use of a highly bioavailable fermentation-produced nutraceutical, rich in β-glucans and amino acids, for cancer patients treated with chemotherapy and radiotherapy Beneficios promovidos por el uso de un nutracéutico producido por fermentación de alta biodisponibilidad, rico en β-glucanos y aminoácidos, para pacientes con cáncer tratados con quimioterapia y radioterapia

The Journal of Clinical Endocrinology & Metabolism, 2018

Peptide receptor radionuclide therapy (PRRT) with the radiolabeled somatostatin analogue [Lutetiu... more Peptide receptor radionuclide therapy (PRRT) with the radiolabeled somatostatin analogue [Lutetium-177-DOTA 0-Tyr 3 ]octreotate (177 Lu-DOTATATE) is widely applied for inoperable metastatic small intestinal and nonfunctioning pancreatic neuroendocrine tumors (pNETs). The aim of this study is to describe the safety and efficacy of the treatment of functioning pNETs. Methods: Patients were treated with up to four cycles of 177 Lu-DOTATATE with an intended dose of 7.4 Gbq per cycle. Radiological (Response Evaluation Criteria in Solid Tumors 1.1), symptomatic, and biochemical response were analyzed retrospectively for all patients with a functioning pNET (insulinoma, gastrinoma, VIPoma, and glucagonoma) treated with 177 Lu-DOTATATE. Quality of life (QOL) was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core Module questionnaire. Results: Thirty-four patients with a metastatic functioning pNET (European Neuroendocrine Tumor Society grade 1 or 2) were included: 14 insulinomas, 5 VIPomas, 7 gastrinomas, and 8 glucagonomas. Subacute hematological toxicity, grade 3 or 4 occurred in 4 patients (12%) and a hormonal crisis in 3 patients (9%). PRRT resulted in partial or complete response in 59% of patients and the disease control rate was 78% in patients with baseline progression. 71% of patients with uncontrolled symptoms had a reduction of symptoms and a more than 80% decrease of circulating hormone levels was measured during follow-up. After PRRT, median progression-free survival was 18.1 months (interquartile range: 3.3 to 35.7) with a concurrent increase in QOL. Conclusion: Treatment with 177 Lu-DOTATATE is a safe and effective therapy resulting in radiological, symptomatic and biochemical response in a high percentage of patients with metastatic functioning pNETs. Hormonal crises occur relatively frequent and preventive therapy should be considered before and/or during PRRT.

Journal of Clinical Oncology, 2017

e21631 Background: Bone metastasis occurs in more than 65-90% patients with hormone-dependent sol... more e21631 Background: Bone metastasis occurs in more than 65-90% patients with hormone-dependent solid tumors, as breast and prostate cancer, with slow evolution, being not responsive to standard chemotherapeutic agents, which restricts treatment options. Previously, we have shown that lipid nanoparticles resembling LDL-cholesterol-like are uptake in malignant tissues and capable of delivery anti-cancer drugs, after intravenous injection. The delivery of drug drastically reduced toxicity. The objective of this study was to evaluate the clinical responses to treatment with paclitaxel associated to nanoparticles, laboratory toxicity and pain scale in patients with breast and prostate carcinoma, previously treated with conventional schemes chemotherapy and not eligible for subsequent treatment. Methods: We included six patients with prostate carcinoma, and ten patients with breast carcinoma (age 68 ± 4 and 55 ± 7 years, respectively). All patients had advanced clinical staging IV at diagn...

Journal of Clinical Oncology, 2017

e21628 Background: Pre-chemotherapy nutritional evaluation is fundamental strategy as predictive ... more e21628 Background: Pre-chemotherapy nutritional evaluation is fundamental strategy as predictive factor for the possibility of response to oncological treatment and treatment-related toxicity. As in the Unified Health System patients usually arrive for evaluation with advanced disease, we believe that medical evaluation of the nutritional parameters is important in the therapeutic decision. Methods: From October 2015 through July 2016, we evaluated 210 patients referred for cancer treatment at the Arnaldo Vieira de Carvalho Cancer Institute in São Paulo (Brazil), which is an Institution that exclusively serves the Unified Health System. We evaluated the clinical parameters of weight and height, for estimation of BMI; evaluation the muscle of the fold of the thumb; and laboratory parameters as hemoglobin, lymphocytes, albumin, PCR (C-reactive protein) levels. We included 54 patients with gastrointestinal tract carcinoma; 32 colorectal carcinoma, 14 gastric carcinoma, 8 esophageal car...

Journal of Clinical Oncology, 2016

e21602Background: The use of phytotherapy as supportive treatment in patients with oncologic dise... more e21602Background: The use of phytotherapy as supportive treatment in patients with oncologic disease has been showed as a usual practice controling symptoms related to chemotherapeutic agents. Spir...

Medical Oncology, 2017

Ovarian cancer is often diagnosed at advanced stages, when poorly responsive to standard treatmen... more Ovarian cancer is often diagnosed at advanced stages, when poorly responsive to standard treatment. Firstline treatment consists in schemes including cytoreductive surgery followed by adjuvant chemotherapy schemes with platinum and taxane derivatives. Second-line regimens are based on gemcitabine and liposomal doxorubicin. Third line is often not worthwhile because of the high toxicity with poor response to treatment. Previously, we showed that paclitaxel (PTX) carried in non-protein lipid core nanoparticles (LDE) resembling the chemical structure of LDL has remarkably reduced toxicity. Here, the hypothesis was tested whether PTX-LDE could safely benefit patients in third-line treatment setting. Fourteen women unresponsive to second-line chemotherapy for ovarian cancer, aged 61 ± 10 years, clinical stage IV and TqNqM1, were included. PTX-LDE was administered at 175 mg/m 2 , 3/3 week dose. Patients were submitted to clinical examinations before each chemotherapy cycle. Serum biochemistry and imaging examinations to monitor disease progression were performed. In total, 74 cycles of chemotherapy were done and, in all cycles, clinical or laboratorial toxicities were not observed. Median progression-free survival (PFS) was 3.0 months (95% CI 2.0-3.9). In four patients, PFS was [6 months and in 2 [ 1 year. The unpreceded, striking absence of toxicity and consistently long PFS, compared to previous results, indicate that at least 4 among 14 patients had tumor arrest by the treatment and clear benefit of PTX-LDE at third-line setting. The absence of observable toxicity allows dose escalating to improve response to treatment, as perspective to be tested in the ensuing studies. Keywords Ovarian cancer treatment Á Solid lipid particles Á Drug delivery and cancer Á Drug targeting and cancer Á LDL receptors

Journal of Medical Oncology and Therapeutics, 2017

Results: Our study analyzed 105 patients, of which 60-69 year olds were the more prevalent age gr... more Results: Our study analyzed 105 patients, of which 60-69 year olds were the more prevalent age group. Of those studied, 50% of the patients were found to be overweight and obese and 47.6% were found to be hyperglycemic. The prevalent weight group of patients were those classified as overweight being between 25 and 29 kg/m 2 showing an incidence of 47.4% of rectal cancer and 52.4% of colon cancer. The hyperglycemic patient group showed a prevalence of 28% with rectal cancer and 72% with colon cancer. Those showing rectal cancer consisted of 57,2% men and 28.5% women. Those showing colon cancer demonstrated a prevalence of 41.6% of men and 5.5% women. However, those patients within the hyperglycemic group had no prior diagnosis of T2DM and were unaware of their condition. Conclusion: Our study emphasizes the importance of metabolic disorders and the necessity of effective preventive health measures in attempt to prevent the development of severe pathology with high rate of mortality.

Journal of Medical Residency Review, Feb 14, 2024

Research, Society and Development, Nov 11, 2022

Benefícios promovidos pela utilização de um nutracêutico produzido por fermentação altamente biod... more Benefícios promovidos pela utilização de um nutracêutico produzido por fermentação altamente biodisponível, rico em β-glucanas e aminoácidos, para pacientes oncológicos tratados com quimioterapias e radioterapias Benefits promoted by the use of a highly bioavailable fermentation-produced nutraceutical, rich in β-glucans and amino acids, for cancer patients treated with chemotherapy and radiotherapy Beneficios promovidos por el uso de un nutracéutico producido por fermentación de alta biodisponibilidad, rico en β-glucanos y aminoácidos, para pacientes con cáncer tratados con quimioterapia y radioterapia

The Journal of Clinical Endocrinology & Metabolism, 2018

Peptide receptor radionuclide therapy (PRRT) with the radiolabeled somatostatin analogue [Lutetiu... more Peptide receptor radionuclide therapy (PRRT) with the radiolabeled somatostatin analogue [Lutetium-177-DOTA 0-Tyr 3 ]octreotate (177 Lu-DOTATATE) is widely applied for inoperable metastatic small intestinal and nonfunctioning pancreatic neuroendocrine tumors (pNETs). The aim of this study is to describe the safety and efficacy of the treatment of functioning pNETs. Methods: Patients were treated with up to four cycles of 177 Lu-DOTATATE with an intended dose of 7.4 Gbq per cycle. Radiological (Response Evaluation Criteria in Solid Tumors 1.1), symptomatic, and biochemical response were analyzed retrospectively for all patients with a functioning pNET (insulinoma, gastrinoma, VIPoma, and glucagonoma) treated with 177 Lu-DOTATATE. Quality of life (QOL) was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core Module questionnaire. Results: Thirty-four patients with a metastatic functioning pNET (European Neuroendocrine Tumor Society grade 1 or 2) were included: 14 insulinomas, 5 VIPomas, 7 gastrinomas, and 8 glucagonomas. Subacute hematological toxicity, grade 3 or 4 occurred in 4 patients (12%) and a hormonal crisis in 3 patients (9%). PRRT resulted in partial or complete response in 59% of patients and the disease control rate was 78% in patients with baseline progression. 71% of patients with uncontrolled symptoms had a reduction of symptoms and a more than 80% decrease of circulating hormone levels was measured during follow-up. After PRRT, median progression-free survival was 18.1 months (interquartile range: 3.3 to 35.7) with a concurrent increase in QOL. Conclusion: Treatment with 177 Lu-DOTATATE is a safe and effective therapy resulting in radiological, symptomatic and biochemical response in a high percentage of patients with metastatic functioning pNETs. Hormonal crises occur relatively frequent and preventive therapy should be considered before and/or during PRRT.

Journal of Clinical Oncology, 2017

e21631 Background: Bone metastasis occurs in more than 65-90% patients with hormone-dependent sol... more e21631 Background: Bone metastasis occurs in more than 65-90% patients with hormone-dependent solid tumors, as breast and prostate cancer, with slow evolution, being not responsive to standard chemotherapeutic agents, which restricts treatment options. Previously, we have shown that lipid nanoparticles resembling LDL-cholesterol-like are uptake in malignant tissues and capable of delivery anti-cancer drugs, after intravenous injection. The delivery of drug drastically reduced toxicity. The objective of this study was to evaluate the clinical responses to treatment with paclitaxel associated to nanoparticles, laboratory toxicity and pain scale in patients with breast and prostate carcinoma, previously treated with conventional schemes chemotherapy and not eligible for subsequent treatment. Methods: We included six patients with prostate carcinoma, and ten patients with breast carcinoma (age 68 ± 4 and 55 ± 7 years, respectively). All patients had advanced clinical staging IV at diagn...

Journal of Clinical Oncology, 2017

e21628 Background: Pre-chemotherapy nutritional evaluation is fundamental strategy as predictive ... more e21628 Background: Pre-chemotherapy nutritional evaluation is fundamental strategy as predictive factor for the possibility of response to oncological treatment and treatment-related toxicity. As in the Unified Health System patients usually arrive for evaluation with advanced disease, we believe that medical evaluation of the nutritional parameters is important in the therapeutic decision. Methods: From October 2015 through July 2016, we evaluated 210 patients referred for cancer treatment at the Arnaldo Vieira de Carvalho Cancer Institute in São Paulo (Brazil), which is an Institution that exclusively serves the Unified Health System. We evaluated the clinical parameters of weight and height, for estimation of BMI; evaluation the muscle of the fold of the thumb; and laboratory parameters as hemoglobin, lymphocytes, albumin, PCR (C-reactive protein) levels. We included 54 patients with gastrointestinal tract carcinoma; 32 colorectal carcinoma, 14 gastric carcinoma, 8 esophageal car...

Journal of Clinical Oncology, 2016

e21602Background: The use of phytotherapy as supportive treatment in patients with oncologic dise... more e21602Background: The use of phytotherapy as supportive treatment in patients with oncologic disease has been showed as a usual practice controling symptoms related to chemotherapeutic agents. Spir...

Medical Oncology, 2017

Ovarian cancer is often diagnosed at advanced stages, when poorly responsive to standard treatmen... more Ovarian cancer is often diagnosed at advanced stages, when poorly responsive to standard treatment. Firstline treatment consists in schemes including cytoreductive surgery followed by adjuvant chemotherapy schemes with platinum and taxane derivatives. Second-line regimens are based on gemcitabine and liposomal doxorubicin. Third line is often not worthwhile because of the high toxicity with poor response to treatment. Previously, we showed that paclitaxel (PTX) carried in non-protein lipid core nanoparticles (LDE) resembling the chemical structure of LDL has remarkably reduced toxicity. Here, the hypothesis was tested whether PTX-LDE could safely benefit patients in third-line treatment setting. Fourteen women unresponsive to second-line chemotherapy for ovarian cancer, aged 61 ± 10 years, clinical stage IV and TqNqM1, were included. PTX-LDE was administered at 175 mg/m 2 , 3/3 week dose. Patients were submitted to clinical examinations before each chemotherapy cycle. Serum biochemistry and imaging examinations to monitor disease progression were performed. In total, 74 cycles of chemotherapy were done and, in all cycles, clinical or laboratorial toxicities were not observed. Median progression-free survival (PFS) was 3.0 months (95% CI 2.0-3.9). In four patients, PFS was [6 months and in 2 [ 1 year. The unpreceded, striking absence of toxicity and consistently long PFS, compared to previous results, indicate that at least 4 among 14 patients had tumor arrest by the treatment and clear benefit of PTX-LDE at third-line setting. The absence of observable toxicity allows dose escalating to improve response to treatment, as perspective to be tested in the ensuing studies. Keywords Ovarian cancer treatment Á Solid lipid particles Á Drug delivery and cancer Á Drug targeting and cancer Á LDL receptors

Journal of Medical Oncology and Therapeutics, 2017

Results: Our study analyzed 105 patients, of which 60-69 year olds were the more prevalent age gr... more Results: Our study analyzed 105 patients, of which 60-69 year olds were the more prevalent age group. Of those studied, 50% of the patients were found to be overweight and obese and 47.6% were found to be hyperglycemic. The prevalent weight group of patients were those classified as overweight being between 25 and 29 kg/m 2 showing an incidence of 47.4% of rectal cancer and 52.4% of colon cancer. The hyperglycemic patient group showed a prevalence of 28% with rectal cancer and 72% with colon cancer. Those showing rectal cancer consisted of 57,2% men and 28.5% women. Those showing colon cancer demonstrated a prevalence of 41.6% of men and 5.5% women. However, those patients within the hyperglycemic group had no prior diagnosis of T2DM and were unaware of their condition. Conclusion: Our study emphasizes the importance of metabolic disorders and the necessity of effective preventive health measures in attempt to prevent the development of severe pathology with high rate of mortality.