RESUMO O câncer de pulmão é um dos tipos de câncer com maior incidência e uma das principais causas de mortalidade por câncer no Brasil. Revisamos a situação atual do câncer de pulmão por meio de pesquisa de dados relevantes a respeito de prevenção, diagnóstico e tratamento no país. Esta revisão mostra várias questões que precisam de atenção, tais como controle do tabagismo, educação dos pacientes, desconhecimento por parte dos pacientes, diagnóstico tardio e desigualdade de acesso ao tratamento de câncer no Brasil. Propomos estratégias para ajudar a superar essas limitações e desafiamos os profissionais de saúde, a sociedade e os representantes do governo a trabalhar em conjunto e dar um passo à frente na luta contra o câncer de pulmão.

ABSTRACT Lung cancer is one of the most incident types of cancer and a leading cause of cancer mortality in Brazil. We reviewed the current status of lung cancer by searching relevant data on prevention, diagnosis, and treatment in the country. This review highlights several issues that need to be addressed, including smoking control, patient lack of awareness, late diagnosis, and disparities in the access to cancer health care facilities in Brazil. We propose strategies to help overcome these limitations and challenge health care providers, as well as the society and governmental representatives, to work together and to take a step forward in fighting lung cancer.

OBJECTIVES: With the development of next-generation sequencing (NGS) technologies, DNA sequencing has been increasingly utilized in clinical practice. Our goal was to investigate the impact of genomic evaluation on treatment decisions for heavily pretreated patients with metastatic cancer. METHODS: We analyzed metastatic cancer patients from a single institution whose cancers had progressed after all available standard-of-care therapies and whose tumors underwent next-generation sequencing analysis. We determined the percentage of patients who received any therapy directed by the test, and its efficacy. RESULTS: From July 2013 to December 2015, 185 consecutive patients were tested using a commercially available next-generation sequencing-based test, and 157 patients were eligible. Sixty-six patients (42.0%) were female, and 91 (58.0%) were male. The mean age at diagnosis was 52.2 years, and the mean number of pre-test lines of systemic treatment was 2.7. One hundred and seventy-seven patients (95.6%) had at least one identified gene alteration. Twenty-four patients (15.2%) underwent systemic treatment directed by the test result. Of these, one patient had a complete response, four (16.7%) had partial responses, two (8.3%) had stable disease, and 17 (70.8%) had disease progression as the best result. The median progression-free survival time with matched therapy was 1.6 months, and the median overall survival was 10 months. CONCLUSION: We identified a high prevalence of gene alterations using an next-generation sequencing test. Although some benefit was associated with the matched therapy, most of the patients had disease progression as the best response, indicating the limited biological potential and unclear clinical relevance of this practice.

O desenvolvimento de anemia é bastante frequente nos pacientes com câncer. Geralmente é decorrente de diversos fatores, sendo a deficiência de ferro um importante mecanismo. Ela pode ser absoluta, decorrente de perdas do estoque de ferro, ou funcional, devido à redução na absorção e disponibilização do ferro. Além de sintomas ligados à diminuição dos níveis de hemoglobina, como dispneia, palpitação e tonturas, a anemia impacta negativamente na sobrevida e acentua a fadiga relacionada ao câncer. Todos os pacientes com câncer e anemia devem ter seus parâmetros de ferro medidos e a investigação diagnóstica é guiada pelo tipo de tumor e sinais e sintomas do paciente. A deficiência funcional do ferro também está relacionada a menor resposta durante o tratamento com agentes estimuladores da eritropoese e já existem subsídios na literatura para o uso de suplementação de ferro endovenoso para melhorar a resposta hematopoética.

Anemia is common in cancer patients. A variety of factors contribute to anemia in the cancer patient with iron deficiency being an important mechanism. It can be secondary to a reduction in iron deposits or a functional deficiency with impaired iron absorption in the small intestine and decreased iron availability. Apart from symptoms related to low levels of hemoglobin such as dyspnoea, palpitations and dizziness, anemia negatively impacts survival and accentuates fatigue in cancer patients. Every oncologic patient with anemia should have their iron parameters assessed; the diagnostic investigation should be determined by the type of tumor and the signs and symptoms exhibited by the patient. Functional iron deficiency is also related to response failure during treatment using erythropoietin-stimulating agents in cancer patients and nowadays there is scientific support for the use of intravenous iron supplementation in order to improve hematopoiesis.