Objectives: To summarize evidence-based cognitive-behavioral therapy (CBT) treatment and propose clinical interventions for adult patients with obsessive-compulsive disorder (OCD). Methods: The literature on CBT interventions for adult OCD, including BT and exposure and response prevention, was systematically reviewed to develop updated clinical guidelines for clinicians, providing comprehensive details about the necessary procedures for the CBT protocol. We searched the literature from 2013-2020 in five databases (PubMed, Cochrane, Embase, PsycINFO, and Lilacs) regarding study design, primary outcome measures, publication type, and language. Selected articles were assessed for quality with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association. Results: We examined 44 new studies used to update the 2013 American Psychiatric Association guidelines. High-quality evidence supports CBT with exposure and response prevention techniques as a first-line treatment for OCD. Protocols for Internet-delivered CBT have also proven efficacious for adults with OCD. Conclusion: High-quality scientific evidence supports the use of CBT with exposure and response prevention to treat adults with OCD.

ResumoO câncer de pulmão é a principal causa de mortes por câncer no mundo. Recentemente, novas estratégias promissoras de tratamento foram criadas a partir do desenvolvimento de terapias de alvo molecular, particularmente aquelas que interferem em vias de transdução de sinais em células neoplásicas. Uma das vias de transdução de sinais mais estudadas é aquela ativada a partir do EGFR, que leva a perda do controle da proliferação celular, aumento da angiogênese celular e aumento da capacidade de invasão celular. Mutações ativadoras no EGFR (deleções no éxon 19 e mutação L858R no éxon 21), primeiramente descritas em 2004, foram detectadas em aproximadamente 10% dos pacientes com carcinoma de pulmão de células não pequenas (CPCNP) não escamoso em países ocidentais e são os fatores preditivos mais importantes de resposta aos tyrosine-kinase inhibitors (inibidores de tirosina quinase) do EGFR (EGFR-TKIs). Estudos de tratamento de primeira linha com esses EGFR-TKIs (gefitinibe, erlotinibe e afatinibe) em pacientes sem tratamento sistêmico prévio, em comparação com regimes baseados em platinas, têm demonstrado que os EGFR-TKIs resultam em ganhos em sobrevida livre de progressão e taxas globais de resposta, embora somente em pacientes cujos tumores alberguem mutações ativadoras no EGFR. Ensaios clínicos também mostraram a efetividade dos EGFR-TKIs como tratamentos de segunda e terceira linha de CPCNP avançado. Neste artigo, revisamos os principais aspectos da ativação da via do EGFR em CPCNP, reforçamos a importância da identificação correta das mutações ativadoras no EGFR e discutimos os principais resultados do tratamento do CPCNP com EGFR-TKIs.

AbstractLung cancer is the leading cause of cancer-related deaths worldwide. Promising new therapies have recently emerged from the development of molecular targeted drugs; particularly promising are those blocking the signal transduction machinery of cancer cells. One of the most widely studied cell signaling pathways is that of EGFR, which leads to uncontrolled cell proliferation, increased cell angiogenesis, and greater cell invasiveness. Activating mutations in the EGFR gene (deletions in exon 19 and mutation L858R in exon 21), first described in 2004, have been detected in approximately 10% of all non-squamous non-small cell lung cancer (NSCLC) patients in Western countries and are the most important predictors of a response to EGFR tyrosine-kinase inhibitors (EGFR-TKIs). Studies of the EGFR-TKIs gefitinib, erlotinib, and afatinib, in comparison with platinum-based regimens, as first-line treatments in chemotherapy-naïve patients have shown that the EGFR-TKIs produce gains in progression-free survival and overall response rates, although only in patients whose tumors harbor activating mutations in the EGFR gene. Clinical trials have also shown EGFR-TKIs to be effective as second- and third-line therapies in advanced NSCLC. Here, we review the main aspects of EGFR pathway activation in NSCLC, underscore the importance of correctly identifying activating mutations in the EGFR gene, and discuss the main outcomes of EGFR-TKI treatment in NSCLC.