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Manejo de las toxicidades inmunomediadas por fármacos anti-PD-1/PD-L1 抗PD-1/PD-L1药物免疫介导毒性的管理
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-03-01 DOI: 10.1016/j.med.2025.03.007
A. Barrill, J.C. Calvo, M.E. Olmedo, V. Alía, S. Roa, G. González, M. García-Pardo, Y. Lage, P. Garrido, J. Chamorro
{"title":"Manejo de las toxicidades inmunomediadas por fármacos anti-PD-1/PD-L1","authors":"A. Barrill,&nbsp;J.C. Calvo,&nbsp;M.E. Olmedo,&nbsp;V. Alía,&nbsp;S. Roa,&nbsp;G. González,&nbsp;M. García-Pardo,&nbsp;Y. Lage,&nbsp;P. Garrido,&nbsp;J. Chamorro","doi":"10.1016/j.med.2025.03.007","DOIUrl":"10.1016/j.med.2025.03.007","url":null,"abstract":"<div><div>The era of immunotherapy has changed the prognosis and quality of life of a large number of patients with lung neoplasms. In general, the treatment of choice has become immunotherapy associated with chemotherapy in multiple scenarios. However, with their emergence, new toxicities have arisen that require rapid identification to achieve optimal control because, although infrequent, they can be life-threatening. Usually, starting treatment with oral or intravenous corticotherapy will be proposed and, depending on the severity of the symptoms, hospitalization and the temporary or definitive suspension of immunotherapy will be considered. In refractory cases, the use of immunomodulatory drugs may be necessary. This protocol aims to summarize the characteristics and general management of these adverse effects.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 27","pages":"Pages 1618-1621"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143591723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Biomarcadores predictivos en el cáncer de pulmón. Implicaciones terapéuticas 肺癌的预测生物标志物。治疗意义
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-03-01 DOI: 10.1016/j.med.2025.03.005
M.E. Olmedo, Y. Lage, M. García-Pardo, S. Roa, J.C. Calvo, V. Alía, A. Barril, G. González, P. Garrido y J. Chamorro
{"title":"Biomarcadores predictivos en el cáncer de pulmón. Implicaciones terapéuticas","authors":"M.E. Olmedo,&nbsp;Y. Lage,&nbsp;M. García-Pardo,&nbsp;S. Roa,&nbsp;J.C. Calvo,&nbsp;V. Alía,&nbsp;A. Barril,&nbsp;G. González,&nbsp;P. Garrido y J. Chamorro","doi":"10.1016/j.med.2025.03.005","DOIUrl":"10.1016/j.med.2025.03.005","url":null,"abstract":"<div><div>Targeted and immune checkpoint inhibitor therapies have changed the prognosis and quality of life for subgroups of lung cancer patients. The 2004 discovery of epidermal growth factor receptor (EGFR) mutations followed by rearrangements in the anaplastic lymphoma kinase (ALK) gene facilitated the development of targeted drugs for patients with advanced non-small cell lung cancer (NSCLC). In recent years, other therapeutic targets have been identified in patients with adenocarcinoma that are being incorporated into clinical practice. To date, the only predictive biomarker of immunotherapy efficacy approved in patients with NSCLC is the immunohistochemical (IHC) determination of PD-L1 (Programmed death-ligand-1) in the tumor. This protocol aims to summarize the predictive biomarkers of treatment efficacy used in routine clinical practice.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 27","pages":"Pages 1610-1613"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143591721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cáncer de cabeza y cuello 头颈部癌症
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-03-01 DOI: 10.1016/j.med.2025.03.004
S. Roa, V. Alía, A. Barrill, Y. Lage, M. García-Pardo, M.E. Olmedo, J.C. Calvo, G. González, P. Garrido y J. Chamorro
{"title":"Cáncer de cabeza y cuello","authors":"S. Roa,&nbsp;V. Alía,&nbsp;A. Barrill,&nbsp;Y. Lage,&nbsp;M. García-Pardo,&nbsp;M.E. Olmedo,&nbsp;J.C. Calvo,&nbsp;G. González,&nbsp;P. Garrido y J. Chamorro","doi":"10.1016/j.med.2025.03.004","DOIUrl":"10.1016/j.med.2025.03.004","url":null,"abstract":"<div><div>Head and neck tumors encompass neoplasms of the upper aerodigestive tract, including the salivary glands. They are rare tumors with a very heterogeneous population and geographic distribution. Its location in an anatomically complex area conditions the different therapeutic strategies aimed at minimizing comorbidities and optimizing patients’ organ functionality and quality of life. Multiple environmental (toxic, dietary, viral infections, etc.) and genetic risk factors related to the disease have been described; some are prognostic factors of the disease. A systematic study of the neck should be performed through a physical examination, fibroendoscopy, imaging test, and biopsy. A molecular study on the sample should be ordered in order to determine possible therapeutic targets. Likewise, a multidisciplinary approach must also be proposed in order to individualize and establish the best treatment option in each case: surgery, radiotherapy, or systemic treatment (chemotherapy, immunotherapy, targeted therapy).</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 27","pages":"Pages 1603-1609"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143591724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Funciones efectoras de los linfocitos T T淋巴细胞效应功能
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-03-01 DOI: 10.1016/j.med.2025.03.011
D. Díaz Martín , A. Prieto Martín , L. Muñoz Zamarrón , M. Álvarez-Mon
{"title":"Funciones efectoras de los linfocitos T","authors":"D. Díaz Martín ,&nbsp;A. Prieto Martín ,&nbsp;L. Muñoz Zamarrón ,&nbsp;M. Álvarez-Mon","doi":"10.1016/j.med.2025.03.011","DOIUrl":"10.1016/j.med.2025.03.011","url":null,"abstract":"<div><div>T lymphocytes are an essential part of the antigen-specific adaptive immune response. This update will explore the concept, functions, and main characteristics of these lymphocytes, the particularities of their receptor, and subpopulations based on their receptor. It will analyze the functional states based on the antigenic encounter, what signals are necessary for their activation, and how they differentiate after encountering an antigen. Attention will be paid to the effector functions of helper and cytotoxic T cells, as well as their differentiation into subpopulations such as Th1, Th2, Th17, and Treg. In addition, it will examine other polarizations described for T lymphocytes, including Tfh, Th9, and Th22. It will also address the study of Tγδ lymphocytes, NKT cells, and cytotoxic CD4 T cells, as well as tissue-resident memory T cells. Lastly, it will analyze how the immunological memory of T lymphocytes is generated and how their exhaustion occurs.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 28","pages":"Pages 1643-1659"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143739989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Indicación de vacunación-inmunoterapia en las enfermedades alérgicas 过敏性疾病的疫苗接种-免疫治疗指南
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-03-01 DOI: 10.1016/j.med.2025.04.006
P. Méndez Brea , I. Roibás Veiga , T. González Vidal , C. Vidal Pan
{"title":"Indicación de vacunación-inmunoterapia en las enfermedades alérgicas","authors":"P. Méndez Brea ,&nbsp;I. Roibás Veiga ,&nbsp;T. González Vidal ,&nbsp;C. Vidal Pan","doi":"10.1016/j.med.2025.04.006","DOIUrl":"10.1016/j.med.2025.04.006","url":null,"abstract":"<div><div>Allergen immunotherapy or vaccination is the only etiological treatment for allergic diseases such as rhinitis, asthma, and allergy to hymenoptera venoms. Its efficacy has been fully demonstrated in double-blind, placebo-controlled studies and in meta-analyses. Immunotherapy should only be used in diseases in which an IgE-mediated allergy mechanism has been shown to be central to its pathogenesis. Vaccination consists of the administration of repeated doses of an allergenic extract to which the patient is sensitized in order to improve the symptoms associated with subsequent exposure to that allergen. The main indications and contraindications for specific immunotherapy with allergens and the most frequently used routes of administration are described.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 29","pages":"Pages 1763-1768"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143817297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo diagnóstico y terapéutico de la anafilaxia 过敏症的诊断和治疗方案
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-03-01 DOI: 10.1016/j.med.2025.04.007
I. Roibás Veiga , P. Méndez Brea , T. González Vidal , C. Vidal Pan
{"title":"Protocolo diagnóstico y terapéutico de la anafilaxia","authors":"I. Roibás Veiga ,&nbsp;P. Méndez Brea ,&nbsp;T. González Vidal ,&nbsp;C. Vidal Pan","doi":"10.1016/j.med.2025.04.007","DOIUrl":"10.1016/j.med.2025.04.007","url":null,"abstract":"<div><div>Anaphylaxis is the most severe allergic reaction. Early diagnosis and urgent administration of the treatment of choice are crucial in order to save the lives of affected patients. The anaphylaxis code implemented by the Galician Health Service is the best approach to the diagnosis and treatment of this disease. It ensures a rapid care pathway for patients with an anaphylactic reaction.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 29","pages":"Pages 1769-1774"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143817298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Asma bronquial Asma bronquial
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-03-01 DOI: 10.1016/j.med.2025.04.002
P. Méndez Brea , I. Roibás Veiga , T. González Vidal , C. Vidal Pan
{"title":"Asma bronquial","authors":"P. Méndez Brea ,&nbsp;I. Roibás Veiga ,&nbsp;T. González Vidal ,&nbsp;C. Vidal Pan","doi":"10.1016/j.med.2025.04.002","DOIUrl":"10.1016/j.med.2025.04.002","url":null,"abstract":"<div><div>This update addresses asthma from a comprehensive perspective, highlighting its pathophysiology, diagnosis, and treatment. It is a chronic inflammatory disease of the airways characterized by episodes of wheezing, dyspnea, and cough. The importance of an accurate diagnosis that includes an evaluation of symptoms, medical history, and pulmonary function tests is emphasized. It is classified according to severity and control, which helps to personalize treatment. To this end, it is important to identify and avoid triggers as well as to promote the use of long-term control medications, such as inhaled corticosteroids and short-acting bronchodilators for symptom relief. A stepwise approach is recommended, adjusting treatment according to the degree of asthma control. In addition, long-term management strategies and patient education to improve quality of life and reduce exacerbations are described. Management and treatment of severe asthma that is difficult to control is also discussed.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 29","pages":"Pages 1726-1735"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143817294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Carcinoma de pulmón de célula no pequeña 非小细胞肺癌
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-03-01 DOI: 10.1016/j.med.2025.03.002
Y. Lage, M. García-Pardo, M.E. Olmedo, S. Roa, J.C. Calvo, V. Alía, A. Barrill, G. González, P. Garrido, J. Chamorro
{"title":"Carcinoma de pulmón de célula no pequeña","authors":"Y. Lage,&nbsp;M. García-Pardo,&nbsp;M.E. Olmedo,&nbsp;S. Roa,&nbsp;J.C. Calvo,&nbsp;V. Alía,&nbsp;A. Barrill,&nbsp;G. González,&nbsp;P. Garrido,&nbsp;J. Chamorro","doi":"10.1016/j.med.2025.03.002","DOIUrl":"10.1016/j.med.2025.03.002","url":null,"abstract":"<div><div>Non-small cell lung cancer (NSCLC) accounts for approximately 85% of all lung cancer cases. The main risk factor is tobacco, followed by radon. The main histological subtypes are adenocarcinoma and squamous cell carcinoma. In most cases, patients are diagnosed with NSCLC in advanced stages (III-IV), usually after the onset of respiratory and/or constitutional symptoms. The first diagnostic test is usually a chest X-ray in which a pulmonary nodule is observed, after which staging should be completed with a thoracic-abdominal-pelvic computed tomography (CT) scan (and a positron emission tomography (PET-CT) scan in case of localized or locally advanced disease) and a cranial CT scan. The histological diagnosis should be confirmed by performing a biopsy. Enough tissue should be obtained not only for cytomorphological diagnosis (histological subtype), but also for the biomarker study (molecular diagnosis and PD-L1). In the last decade, significant advances have been made in the treatment of patients with NSCLC with the emergence of targeted therapies and immunotherapy, which have achieved a significant improvement in survival. The treatment of choice will depend on the patient's characteristics (general condition, previous diseases, etc.) and preferences as well as on the tumor characteristics, the histological subtype, and whether targeted therapies exist or not (depending on the biomarker results).</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 27","pages":"Pages 1580-1594"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143591717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Dolor pleurítico y astenia en un paciente fumador 吸烟者的胸腔疼痛和衰弱
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-03-01 DOI: 10.1016/j.med.2025.03.009
J.C. Calvo, Y. Lage, M. García-Pardo, J. Chamorro Pérez
{"title":"Dolor pleurítico y astenia en un paciente fumador","authors":"J.C. Calvo,&nbsp;Y. Lage,&nbsp;M. García-Pardo,&nbsp;J. Chamorro Pérez","doi":"10.1016/j.med.2025.03.009","DOIUrl":"10.1016/j.med.2025.03.009","url":null,"abstract":"","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 27","pages":"Pages 1627.e1-1627.e3"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143591719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo de manejo multimodal del cáncer de pulmón: cirugía, radioterapia y tratamiento sistémico. Indicaciones terapéuticas y paliativas de la cirugía y la radioterapia 肺癌多模式管理方案：手术、放疗和全身治疗。手术和放疗的治疗和缓和适应症
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-03-01 DOI: 10.1016/j.med.2025.03.008
J. Chamorro, J.C. Calvo, M. García-Pardo, G. González, S. Roa, Y. Lage, A. Barril, M.E. Olmedo, V. Alía, P. Garrido
{"title":"Protocolo de manejo multimodal del cáncer de pulmón: cirugía, radioterapia y tratamiento sistémico. Indicaciones terapéuticas y paliativas de la cirugía y la radioterapia","authors":"J. Chamorro,&nbsp;J.C. Calvo,&nbsp;M. García-Pardo,&nbsp;G. González,&nbsp;S. Roa,&nbsp;Y. Lage,&nbsp;A. Barril,&nbsp;M.E. Olmedo,&nbsp;V. Alía,&nbsp;P. Garrido","doi":"10.1016/j.med.2025.03.008","DOIUrl":"10.1016/j.med.2025.03.008","url":null,"abstract":"<div><div>Lung cancer requires accurate staging for the best therapeutic approach. Surgery, radiotherapy, and systemic therapies are the mainstays of treatment. The first two are more relevant in early and potentially curative stages. Given the complexity of the cases and the multimodality of the treatments, joint decision making by a multidisciplinary tumor committee is essential in order to choose the best alternative.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 27","pages":"Pages 1622-1626"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143591720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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