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Objetivo. Evaluar la actividad y toxicidad de fluoruracilo en infusión continua y vinorelbina en segunda o tercera línea de tratamiento del cáncer de mama metastásico (CMM). Método y pacientes. En este estudio fase II se incluyeron 24 pacientes que habían recibido doxorrubicina y/o paclitaxel. Se administró 5-fluoruracilo a 1g/m 2 /día en infusión continua por 3 días y vinorelbina a 30 mg/m 2 D1 cada 21 días por 6 ciclos. Resultados. Las respuestas globales observadas fueron del 37,5% (12,5% respuestas completas). El perío-do libre de enfermedad se calculó una media de 6,33 ± 8,12 meses (IC 95% de 3,43 meses). Se observó toxicidad en el 12,5% de las pacientes y no se registró toxicidad grave ni muertes relacionadas a tratamiento. Conclusión. El 5-fluoruracilo/vinorelbina a las dosis administradas es un esquema efectivo en pacientes con CMM multitratadas, con un bajo perfil de toxicidad y costo.Palabras clave: cáncer de mama, metástasis, 5-fluoruracilo, vinorelbina. Efectiveness of 5-fluoruracil and vinorelbine in patients who had received multi-treatments for metastatic breast cancer INTRODUCCIÓNEn México la incidencia de cáncer de mama en el año 2000 fue de 9.998 nuevos casos con una tasa de 19,8/100.000 habitantes con 3.503 defunciones 1 . En los EE.UU. se estiman 5 casos por cada 100.000 en mujeres de 25 años, 150/100.000 a los 50 años y 200/100.000 a los 75 años de edad 2,3 . La quimioterapia desempeña un papel importante en el tratamiento del cáncer de mama metastásico al ofrecer la posibilidad de la paliación y prolongar la supervivencia 4-7 . En el tratamiento del cáncer de mama metastásico, las antraciclinas son fármacos muy activos además del paclitaxel, docetaxel, gemcitabina y vinorelbina; sin embargo cuando los pacientes no responden bien a estos medicamentos, tienen un pobre pronóstico y sólo un pequeño porcentaje alcanza respuestas objetivas con otras líneas de tratamiento 8,9 . Cada uno de ellos con perfiles diferentes de toxicidad, método de aplicación y coste, estos fármacos de segunda línea conducen a respuestas clí-nicas y períodos libres de progresión muy similares, aunque la vinorelbina tiene el menor coste por ciclo de tratamiento 9,10 . Esta última es un fármaco derivado ORIGINAL ARTICLES Efectividad de 5-fluoruracilo y vinorelbina en pacientes multitratadas por cáncer de mama metastásico

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6 Background: Penile cancer is a rare neoplasm (<1%), being more common in underdeveloped countries, 10-20% of male neoplasms, with a mean age at diagnosis of 60 years. The number of annual cases in Mexico is only 660 cases, 0.35% of all neoplasms. Its initial symptomatology as a palpable or ulcerated lesion must be differentiated from infectious processes. From 30 to 60% of cases debut with inguinal lymphadenopathies and distant metastases in 1 to 10%. Methods: Cross-sectional, retrospective cohort study of patients diagnosed with penile cancer, who received medical care at the medical oncology service of the University Cancer Center from January 1, 1999 to December 31, 2019. Results: Of the 103 patients analyzed in this study, the mean age was 55 years (27-91 years), the highest level of schooling obtained was primary in 18.5%, being mostly from the state of Nuevo León in 61.1%. of the cases. The duration of symptoms was 17 months on average, and the time interval between diagnosis and receiving medical or surgical treatment was 97 days. Regarding the pathological characteristics of penile cancer, the average tumor size was 41.4mm, the most frequent histological type was squamous in 91.3%. Regarding the classification by clinical stages, patients in clinical stage I was 8%, II 10.6%, III 26.2% and IV 32%, not being recorded accurately in 23.3% of cases. The initial medical treatment was surgical in 81.5% of the cases, with partial phallectomy being the procedure of choice in 57.2% of the patients, with the presence of positive margins in 9.5% of the patients. Lymph node involvement was 71.2% of the cases and lymph node dissection was only performed in 31% of the patients. Those who received chemotherapy were 27.1% of the patients, the majority, 57.1% in the adjuvant setting, the most commonly used scheme was cisplatin with 5-fluoroacyl in 60.7%. Radiotherapy was used in 25.2% of the patients, being the adjuvant modality in 65.4% and in the palliative context in 34.6%, with an average dose of 46.5 Gy and 8 fractions. Conclusions: A diagnosis at an earlier age was observed in our court, being 55 years old vs 60 years old reported in the literature. A delay in diagnosis of up to 12 months has been reported in 15-50% in the literature, being higher in our population with a mean of 17.7 months. Poor adherence to treatment and clinical follow-up was observed, since one in 4 patients only goes to oncology once and loses follow-up. Penile cancer is a rare, psychologically devastating neoplasm with delayed diagnosis, advanced clinical disease, decreased survival, and high recurrence rates despite bimodal or trimodal treatment. A multidisciplinary team approach should be sought to achieve better oncological results and timely detection of cancer in earlier stages.