Introduction: Breast cancer (BC) is the most frequently diagnosed cancer and the leading cause of cancer-related mortality in women. Advances in screening and treatment have improved survival but have also increased morbidity and mortality due to treatment side effects, particularly cardiotoxicity. Late cardiotoxicity generally develops several years after treatment. The risk of cardiotoxicity post BC treatment is increased by cardiovascular (CV) risk factors and previous cardiac disease. Nevertheless, limited data is available about the long-term effects of cardiotoxic treatment in women without CV risk factors before BC diagnosis. Aims: To assess prevalence and long-term effects of late cardiotoxicity in a low-risk group of BC survivors. Methods: This prospective study evaluated women aged between 18–65 years, diagnosed with non-metastatic BC and treated between 2011–2016 at a single institution The echocardiographic parameters were compared to an age-matched control group of women recently diagnosed with BC who have not been submitted to anticancer therapy. Results: Among the 40 recruited women, 32.5% displayed left ventricular systolic dysfunction (LVSD) and 10% fulfilled criteria for late cardiotoxicity based on their previously recorded imaging parameters. There was a significant difference in left ventricular ejection fraction (LVEF) between time points (p < .001). The study group had significant lower LVEF compared to the control group, (p < .001). Additionally, there was a significant reduction in Global Longitudinal Strain in the study group when compared to controls, (p < .001). Conclusions: In conclusion, this study demonstrated that cancer therapy related cardiac disease is a common side effect in BC survivors. Given this finding, even women without previous CV risk factors should be carefully monitored years after the end of treatment.

Background Despite the widespread use of anthracyclines (ANT) and anti-HER2 antibodies as trastuzumab (TZB) in chemotherapy schemes, it is known the potential cardiotoxic effects that can limit its use. Aim To study the benefit of drugs commonly used to treat heart failure with reduced ejection fraction or drugs known for an antioxidative effect on the prevention of ANT and TZB induced cardiotoxicity. Methods an extensive search was made in PubMed, Embase and Cochrane trials since inception to November 2020. Randomized controlled trials in which the drugs mentioned were given to adult patients treated with ANT and/or TZB were included. The outcomes of interest were left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), E/A ratio, E/e’ ratio, left atrium diameter, BNP/NT-pro-BNP and Troponin I levels. Subgroup analysis were made accounting for combinations of exposure to ANT and/or TZB Results 24 randomized controlled trials were included with a total of 3159 participants (94% were women). A meta-analysis showed betablockers to lower E/A ratio (combined effect of 0,12 decrease (95% CI:[0,05; 0,19], I2 = 11%), and did not show any effect on LVEF, except perhaps for nebivolol, which in one study demonstrated a mean difference of 6,30% [3,32; 9,28] (p < 0,05) between groups. Angiotensin Conversion Enzyme Inhibitors and Angiotensin Receptor Antagonists did not show any protective effect. Dexrazoxane also showed to reduce the incidence of cardiac events with a combined risk ratio of 0,28 (95% CI: [0,16; 0,47], I2 = 9%). Rosuvastatin also showed to preserve LVEF and left atrium diameter and spironolactone showed to preserve LVEF, E/A and E/e’ ratio, however with only one trial each. Conclusions Prophylactic administration of either beta-blockers or dexrazoxane may prevent the development of ANT and TZB cardiotoxicity and therefore allow for fewer treatment interruptions and a better long-term prognosis of cancer patients.

Background: In advanced and incurable cancer disease, chemotherapy may be recommended if it improves the quality of life, even if it does not increase survival. However, in an end-of-life setting, the use of chemotherapy is controversial, with less clear indications and more individualized decisions. This study aimed to evaluate patients who received chemotherapy within the last three months of life, an indicator of the quality of care provided. Methods: We analyzed data from patients receiving chemotherapy in the last 3 months of life and who died from January 2018 to December 2020, in our Oncology Department. Results: It was found that 391 patients received chemotherapy in the last 3 months of life. Most had metastatic disease at diagnosis (71%, n=276) and were treated in a first-line setting. A more detailed analysis revealed that 50% (n=193) underwent treatment in the last month and 22% (n=42) in the last week of life. Most patients died due to disease progression, with 79% of deaths occurring in the hospital. Conclusions: This work puts into figures the reality of an Oncology Centre, revealing the investment made in fighting the disease and providing greater longevity to patients, with quality of life.

À luz dos conhecimentos atuais, o tratamento de imunoterapia no cancro do pulmão de não pequenas células doença avançada apresenta os melhores resultados nos doentes com expressão de programmed death ligand 1 (PD-L1) positiva.Apresentamos dois casos clínicos diferentes, ambos de sucesso: o primeiro referente a um doente do sexo masculino, 91 anos, com expressão de PD-L1 de 90% e com elevada taxa de resposta ao tratamento de imunoterapia com pembrolizumab na dose de 200 mg, a cada 3 semanas; no segundo caso trata-se de uma doente do sexo feminino, de 47 anos, com expressão de PD-L1 negativa e em que a imunoterapia foi usada como segunda linha, após se verificar progressão sob tratamento com quimioterapia, tendo-se verificado também neste caso uma resposta completa com o uso de atezolizumab, na dose de 1200 mg, a cada 3 semanas.

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