Cyclin-dependent kinases (CDK) 4/6 inhibitors have significantly improved outcomes for patients with ER+/HER2− breast cancer. Nevertheless, they differ from each other in terms of chemical, biological, and pharmacological features, as well as toxicity profiles. We aim to determine whether QTc prolongation is caused by CDK4/6i in general or if it is associated with ribociclib only. We systematically searched PubMed, Embase, and Cochrane Library for randomized controlled trials (RCTs) comparing the prevalence of QTc prolongation as an adverse event in HR+ breast cancer patients treated with CDK4/6i vs those without CDK4/6i. We pooled relative risk (RR) and mean difference (MD) with 95% confidence interval (CI) for the binary endpoint of QT prolongation. We included 14 RCTs comprising 16 196 patients, of whom 8576 underwent therapy with CDK4/6i. An increased risk of QTc prolongation was associated with the use of CDK4/6i (RR = 2.35, 95% CI = 1.67 to 3.29, P < .001; I² = 44%). Subgroup analyses revealed a significant increase in the QTc interval for the ribociclib and palbociclib cohorts. The ribociclib subgroup showed a relative risk of 3.12 (95% CI = 2.09 to 4.65, P < .001; I² = 12%), whereas the palbociclib subgroup had a relative risk of 1.51 (95% CI = 1.05 to 2.15, P = .025; I² = 0%). Palbociclib was associated with QTc prolongation; however, the relative risk for any grade QTc was quantitively twice with ribociclib. Furthermore, grade 3 QTc prolongations were observed exclusively with ribociclib. These results are important for guiding clinical decision-making and provide reassurance regarding the overall safety profile of this drug class.

A auriculoterapia vem ganhando visibilidade no mundo ocidental como uma técnica inovadora, sendo utilizada como prática integrativa e complementar, aliada às terapias tradicionais, para o enfrentamento do câncer. O presente trabalho objetiva sintetizar as evidências científicas acerca dos benefícios proporcionados pela auriculoterapia na qualidade de vida dos pacientes oncológicos. Trata-se de uma revisão integrativa da literatura, utilizando os descritores dos Descritores em Ciências da Saúde (DeCS) e Medical Subject Headings (MeSH) e estratégias de busca: “Auriculoterapia” AND “Câncer”; “Auriculoterapia” AND “Pacientes oncológicos” AND “Ensaio Clínico”, e suas respectivas variações na língua inglesa. Como critérios de inclusão encontram-se publicações indexadas nas bases 1) ScienceDirect, PubMed, SciELO e Google Acadêmico; 2) nos idiomas inglês e português; 3) presença de ensaios clínicos randomizados com pacientes oncológicos que receberam a intervenção de auriculoterapia; 4) artigos publicados entre 2003 e 2021. Foram excluídos estudos com evidência inferior a três pelos escores de Jadad, artigos em línguas diferentes de inglês ou português e com experimentação animal. Nos resultados, identificou-se que a auriculoterapia permite uma melhora da qualidade de vida dos indivíduos diagnosticados com essa condição, promovendo o controle da ansiedade e dor, além da sintomatologia adversa decorrente da doença e de seu tratamento. Assim, através da análise dos 10 artigos, identificou-se que a auriculoterapia, quando combinada à terapia medicamentosa, é uma técnica segura e de baixo custo capaz de aliviar, de forma eficaz, as dores oncológicas, além de melhorar a qualidade do sono e reduzir a ansiedade, a fadiga e a quantidade de analgésicos utilizados.

Importance: The poly-adenosine diphosphate–ribose polymerase (PARP) enzymes are important for DNA single-strand break repair and PARP inhibitors (PARPi) cause an accumulation of unresolved DNA damage in tumors with BRCA1/2 mutations, resulting in cell death. However, because platinum salts also ultimately cause double-strand DNA breaks and may have overlapping mechanisms of resistance with PARPi, the efficacy of PARPi in patients with prior platinum therapy is unknown. Objective We sought to evaluate the efficacy of PARPi in patients with BRCA1/2-related breast cancer and previous platinum exposure. Data Sources: PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched for papers up to June 26, 2022. Study Selection: We performed a systematic review and meta-analysis of studies that evaluated the efficacy of PARPi in patients with advanced or metastatic breast cancer and germline BRCA1/2 mutations. Two independent investigators identified double-blind, randomized controlled trials (RCTs) that included the subgroup of previous exposure to platinum. Data Extraction and Synthesis: Data extraction from published reports and quality assessment were performed under Cochrane recommendations. The software Review Manager 5.3 was selected for conducting the statistical analyses. Main Outcome(s) and Measure(s): The primary endpoint of interest was progression-free survival (PFS). Hazard ratios (HRs) with a 95% confidence interval (CI) were pooled, and a p-value of < 0.05 was considered statistically significant. Results From 2,069 database results (487 on PubMed; 1,376 on Embase; and 206 on Cochrane), 42 studies were fully reviewed, and 4 RCTs (total of 249 patients) were included in the final investigation. The PARPi included were Olaparib, Talazoparib, Niraparib, and Veliparib. Pooled analysis showed that PARPi improved PFS in breast cancer patients with prior treatment with platinum-based therapy compared to the control group [HR = 0.72; 95% CI, 0.53–0.97; p = 0.03]. For comparison, the population without previous platinum exposure had a similar magnitude of benefit from PARPi [HR = 0.68; 95% CI, 0.52–0.89; p = 0.005]. Conclusions and Relevance: Despite the concerns about cross-resistance between PARPi and platinum agents, patients with advanced breast cancer and previous exposure to platinum therapy have a longer PFS with PARPi when compared to standard chemotherapy.

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The pediatric population constitutes only 2% of COVID-19 cases, however, cases of inflammatory shock, ventricular dysfunction and thrombotic events have been reported. This set of signs is called Multisystem Inflammatory Syndrome (MIS-C), also characterized by hyperpyrexia and generalized organ failure, with a direct relationship with SARS-COV-2 infection. The present work aims to synthesize the evidence of cardiovascular manifestations resulting from the Post COVID-19 Multisystem Inflammatory Syndrome in pediatric age (PMIS-TS). For this Integrative Review, carried out through the PubMed and Science Direct platforms between 2020 and 2022, the descriptors elected were ''Inflammation'', ''Pediatrics'', ''Covid-19'' and ''Cardiology'', associated to the Boolean operator ''AND''. Inclusion criteria consisted of (1) clinical trials, controlled and randomized trials, reviews and meta-analyses; (2) studies on the cardiovascular repercussions of PMIS-TS; (3) studies on pediatric cardiomyopathies resulting from coronavirus infection; (4) articles on management and treatment of PMIS-TS. Exclusion criteria included inadequacies to the topic, assessments of other clinical conditions, in addition to non-specific texts when addressing MIS-C. It was observed that the cases of PMIS-TS had echocardiograms and magnetic resonance imaging predictive of myocarditis, valvulitis and coronary heart disease, findings corroborated by laboratory alterations. The electrocardiograms included premature beats and various arrhythmias. In the analysis of the 54 articles, it was identified that, despite the pediatric age group corresponding to the smallest share of COVID-19 cases, children are susceptible to potentially serious repercussions. Thus, the hyper-inflammatory state can lead to death, and it is essential to conduct new studies with assertive therapeutic options for the aforementioned conditions.