Percorrer por autor "Costa, Diogo Alpuim"
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- Exploring the clinical benefits of genomic profiling for advanced solid tumors in Portugal.Publication . Tavares, Nuno; Damaso, Sara; Brás, Raquel Lopes; Guedes, Helena; Simões, Pedro; Rodrigues, Tania; Costa, Diogo Alpuim; Bonito, Nuno Antunes; Pratas, Edgar; Macedo, Daniela; Filipe, Frederico Ferreira; Martins Cavaco, Ana Cláudia; Pavanello, Marina; Costa, LuisBackground: Comprehensive genomic profiling (CGP) plays a significant role in precision oncology by pairing genomic alterations from different tumor types with molecularly targeted therapies. However, the evaluation of its real-world impact, clinical utility, and effects on quality of life remain unexplored. The FRONTAL study (Foundation medicine Real wOrld evideNce in porTugAL) is an ongoing multicentric academic study that aims to establish a national registry of portuguese patients with solid tumors that underwent CGP through Foundation Medicine tests (FoundationOne CDx, Liquid CDx, and Heme). Methods: The study enrolled portuguese patients diagnosed with advanced solid tumors who were not eligible for curative treatment at the time of recruitment. Patients who had previously done CGP evaluation could be included if the test was conducted within one year before the start of the study. CGP data was retrieved from the Foundation Medicine reports and clinical data from the medical records. Actionable genomic findings were reported if associated to therapies for the patient’s tumor type or with proven clinical benefit in other tumor types based on the NCCN Categories of Evidence and Consensus. In addition, quality of life questionnaires (QLQ-C30) were collected for a subset of patients. The primary outcome was a binary endpoint of disease control at 16 weeks of treatment, defined by the absence of progression at that timepoint. Results: Genomic and real-world clinical data were collected and analyzed for 146 patients ( . 70% of the cohort), from 10 different sites in Portugal. Several cancer types were included, with colorectal tumors being the most common (19%), followed by sarcomas (18%) and pancreatic tumors (12%). According to the Foundation Medicine reports, actionable molecular alterations were described in 52% of the cohort. Twenty-three percent of the patients had their therapeutic decision changed due to the CGP result. The most frequent alterations among these patients included high tumor mutational burden (TMB) and/or microsatellite instability (MSI) (35%), as well as pathogenic mutations in PIK3CA (15%) and ATM (12%). Forty-three percent of patients with changed therapy were reported to have achieved disease control at 16 weeks of treatment. Half of the patients with disease control had either high TMB, MSI, or BRAF mutations, reinforcing that evaluating actionable alterations with tissue-agnostic FDA approvals benefit oncology patients. Conclusions: The FRONTAL study highlights the clinical utility of CGP in advanced solid tumors. We identified actionable alterations in 52% of patients, leading to changes in treatment for 23% of the cohort. These findings support the value of CGP in guiding personalized therapies and emphasize the need for further research into its impact on patient outcomes and quality of life. Research Sponsor: None.
- The impact on productivity costs of reducing unemployment in patients with advanced breast cancer: A model estimation based on a portuguese nationwide observational studyPublication . Matos, Leonor Vasconcelos de; Borges, Margarida; Oliveira, Ana Teresa; Bulhosa, Carolina; Miguel, Luís Silva; Freitas, Tiago Fidalgo de; Cunha, Renato; Mendes, Ana Duarte; Arede, Ana Júlia; Marques, Cristiana; Costa, Diogo Alpuim; Correia, Jorge Alves; Brito, Margarida; Sousa, Mário Fontes e; Guimarães, Teresa; Cardoso, FatimaThis study aimed to characterize the employment status and work-related conditions of patients with advanced breast cancer (ABC) in Portugal and quantify the productivity costs of premature abandonment of the work market while evaluating strategies to promote employment. The analysis was based on a cumulative incidence model for estimation of ABC prevalence and on a cross-sectional study characterizing the employment status of patients with ABC. This study was conducted in Portuguese hospitals, between Nov2021-Dec2022 and included patients diagnosed with ABC for at least 6 months, aged 66 or less and consenting for a self-answered questionnaire regarding work status. A total of 2151 working-aged women were estimated to have ABC in 2019 in Portugal, with productivity costs amounting to 28,676,754 over 2019-2021. 112 patients from 9 hospitals were included in the study, average age was 52yr, 48 % had a postsecondary educational degree level and 87 % reported having a paid job at the time of diagnosis, mostly full-time. At the time of the study, only 38 % of the patients maintained the job status. The remaining were unemployed (51 %), on medical leave (25 %) or retired (24 %). Stop working was a personal choice for only 5 %. A subsidized part-time employment regimen, despite increased government costs, would allow a reduction in productivity costs, leading to a positive balance of 2,431,329 over the same period. This study suggests that the majority of patients with ABC abandon the labor market before the age of retirement. Flexible work arrangements would benefit the patient, the government and the society.
- New perspectives on the conservative management of osteoradionecrosis of the mandible: A literature reviewPublication . Costa, Diogo Alpuim; Costa, Tiago Porfírio; Netto, Eduardo Carlinhos; Joaquim, Natércia; Ventura, Isabel; Pratas, Ana Cristina; Winckler, Patricia; Silva, Inês Pires; Pinho, Ana Catarina; Sargento, Isabel Goulão; Guerreiro, Francisco Gamito; Moreira, António RitaOver the last decades, several therapeutic options were considered in the treatment of the osteoradionecrosis (ORN) of the mandible, including supportive measures, ultrasound therapy, corticosteroids, hyperbaric oxygen, surgical resection with reconstruction, and, more recently, drugs capable of reversing the fibroatrophic process. Once established, the ORN does not spontaneously disappear and a standard treatment has not yet been defined. The clear clinical effectiveness of hyperbaric oxygen therapy (HBOT) varies according to the literature and there are some economic/logistic issues to be considered; the triplet tocopherol/pentoxifylline/clodronate demands greater evidence from randomized clinical trials and also resilience from the patient, given the long treatment duration and its possible side effects. Controversy around the ideal treatment of the initial stage ORN of the mandible persists. More rigorous randomized prospective trials are essential. The purpose of this article was to review the relevant literature on the physiopathology of ORN of the mandible and discuss the new perspectives of its conservative treatment. (C) 2016 Wiley Periodicals, Inc.