http://hdl.handle.net/11422/25236 Thu, 30 Jul 2026 09:13:08 GMT 2026-07-30T09:13:08Z http://hdl.handle.net/11422/29589 Title: Uso de gefitinibe como primeira linha no câncer de pulmão não pequenas células com mutação de EGFR no sistema público de saúde brasileiro: revisão de literatura Author(s)/Inventor(s): Pinheiro, Jaqueline da Silva Costa Advisor: Rodrigues, Carlos Eduardo Nogueira Abstract: Non-small cell lung cancer (NSCLC) remains one of the greatest challenges in modern oncology, particularly within public healthcare systems. Gefitinib, a first-generation tyrosine kinase inhibitor (TKI), was incorporated into the Brazilian Unified Health System (SUS) in 2013 for patients harboring EGFR mutations. However, more than a decade later, effective access to this therapy remains limited. Objective: To review the scientific evidence on the use of gefitinib as first-line treatment for patients with EGFR-mutated NSCLC within the context of the SUS, discussing clinical outcomes and the main barriers to its implementation. Method: A narrative literature review was conducted through searches in the PubMed, SciELO, and LILACS databases, covering publications from 2010 to 2024. Included studies comprised clinical trials, systematic reviews, observational studies, and official documents from the Brazilian Ministry of Health and CONITEC. Results: The literature demonstrates that gefitinib provides significant improvement in progression-free survival (PFS) and presents a more favorable toxicity profile compared with conventional chemotherapy. Nevertheless, the benefit in overall survival (OS) was not consistently observed in pivotal trials, mainly due to the high rate of treatment crossover. Pharmacoeconomic analyses suggest that gefitinib is a cost-effective option in Brazil; however, the SUS reimbursement model, with payments considerably lower than the actual treatment cost, along with the limited availability of molecular testing for EGFR mutations, largely restrict its real-world use. Conclusions: Although gefitinib represents a meaningful advance in personalized oncology, its incorporation into the SUS has not yet translated into equitable access for most patients. This scenario highlights a persistent gap between public health policy and clinical practice, underscoring the need for strategies that ensure the effective implementation of targeted therapies within the Brazilian public healthcare system. Publisher: Universidade Federal do Rio de Janeiro Type: Trabalho de conclusão de especialização Sat, 01 Nov 2025 00:00:00 GMT http://hdl.handle.net/11422/29589 2025-11-01T00:00:00Z http://hdl.handle.net/11422/29582 Title: Rastreio de metástase cerebral em pacientes com câncer de mama metastático assintomáticos: uma revisão narrativa Author(s)/Inventor(s): Silva, Bárbara Lima da Advisor: Nogueira, Carlos Eduardo Abstract: Despite the high incidence of brain metastasis in patients with metastatic breast cancer, imaging-based screening in asymptomatic patients remains controversial and lacks clear consensus across clinical guidelines. Central nervous system involvement varies according to molecular subtype and disease stage, with the risk of brain metastasis estimated to be 2 to 5 times higher in HER2-positive and triple-negative subtypes compared with luminal subtypes. Most cases are diagnosed only after the onset of neurological symptoms, at which point interventions such as radiotherapy, surgery, or systemic therapies are considered. Therefore, this study aims to review the literature in the form of a narrative review in order to summarize and update current knowledge regarding the impact of brain metastasis screening in asymptomatic patients with metastatic breast cancer. Publisher: Universidade Federal do Rio de Janeiro Type: Trabalho de conclusão de especialização Wed, 01 Jan 2025 00:00:00 GMT http://hdl.handle.net/11422/29582 2025-01-01T00:00:00Z http://hdl.handle.net/11422/29245 Title: O papel das platinas no tumor de mama triplo negativo Author(s)/Inventor(s): Souza, Flávia Secco Tavares de Advisor: Rodrigues, Carlos Eduardo Nogueira Abstract: Triple-negative breast cancer is an aggressive subtype characterized by low HER2 expression, with a higher risk of recurrence and a worse prognosis. This study aims to analyze the role of platinum compounds in the treatment of triple-negative breast cancer (TNBC), highlighting their clinical outcomes, impacts on progression-free survival, and toxicity. This is a systematic literature review, without meta-analysis, using PubMed, searching articles published between 2013 and 2025. A total of 19 studies of platinum compounds in the treatment of TNBC were included, 13 of which were randomized clinical trials. In neoadjuvant therapy, the addition of carboplatin increased pCR from 36.9% to 53.2% and event-free survival (EFS) at 4 years (HR 0.57, 95% CI 0.36–0.91; p = 0.02), while pembrolizumab increased pCR to 64.8% and survival to 86.6% at 5 years (p = 0.002). In adjuvant therapy, regimens containing carboplatin showed that disease-free survival (DFS) was up to 93.9% at 3 years, with less toxicity. After neoadjuvant therapy, platinum was inferior to capecitabine, with progression-free survival (PFS of 42% vs 49% at 3 years). In the metastatic setting, the use of platinum increased objective response (81.1% vs. 56.3%) and PFS (9.8 vs. 7.4 months). Experimental studies indicate that new platinum compounds and combined strategies, such as TTFields or melatonin, are more selective and consistent against TNBC. It is concluded that carboplatin improves response and survival in TNBC, being less toxic in adjuvant settings. Capecitabine is superior in residual disease, and platinum has good results in metastatic cancer. Publisher: Universidade Federal do Rio de Janeiro Type: Trabalho de conclusão de especialização Wed, 01 Jan 2025 00:00:00 GMT http://hdl.handle.net/11422/29245 2025-01-01T00:00:00Z http://hdl.handle.net/11422/25439 Title: Leucemia mieloide crônica após tratamento de câncer de mama inicial: uma revisão narrativa Author(s)/Inventor(s): Kremer, Helena de Souza e Mello; Dellatorre, Gabriela Melo Advisor: Bines, Jacques Abstract: Chronic myeloid leukemia (CML) as a secondary neoplasm after treatment of early breast cancer is uncommon, with few reports in the literature. This study aims to research the data available in the form of a narrative review in order to summarize information concerning this diagnosis. Publisher: Universidade Federal do Rio de Janeiro Type: Trabalho de conclusão de especialização Mon, 01 Jan 2024 00:00:00 GMT http://hdl.handle.net/11422/25439 2024-01-01T00:00:00Z