Explore the vast range of titles available.

AbstractIntroduction: The treatment landscape of hormone receptor-positive, HER2-negative (HR+/HER2–) metastatic breast cancer (BC) has been transformed with the advent of cyclin-dependent kinase 4/6 inhibitors (CDK4/6i). While myelosuppression is the most common adverse effect, interstitial lung disease (ILD) has emerged as a rare but potentially severe complication in real-world settings. Case Presentation: A 76-year-old woman with metastatic HR+/HER2– BC developed ILD after approximately 20 months of palbociclib therapy. Treatment discontinuation and high-dose corticosteroids resulted in symptomatic and radiological improvement. A concomitant pneumomediastinum was considered a secondary manifestation of ILD. Conclusion: ILD is an underrecognized but clinically significant toxicity of CDK4/6i, requiring early diagnosis and prompt intervention to prevent severe respiratory compromise. A high index of clinical suspicion, prompt diagnosis, and rapid treatment strategies are crucial, particularly in elderly patients, to minimize ILD-associated risks and complications. Further research is needed to establish predictive biomarkers and optimize management guidelines for CDK4/6i-induced ILD.

Background: Real-world safety profiles of immune checkpoint inhibitors (ICIs) in older adults remain insufficiently characterized. Although ICIs are widely used across tumor types, older patients, particularly those with frailty, multimorbidity, or polypharmacy, are consistently under-represented in clinical trials, limiting the external validity of trial-derived toxicity estimates. Robust real-world data are therefore essential to clarify the incidence, seriousness, and age-related patterns of immune-related adverse events (irAEs) in routine practice. Methods: This is a nationwide retrospective study of spontaneous ICI-related ADRs reported in INFARMED’s Portal RAM (2011–2024). We evaluated the frequency, seriousness, fatality, and organ-specific patterns of ICI-related adverse drug reactions (ADRs) reported to the Portuguese National Pharmacovigilance System. The analytic unit was the ADR case. Endpoints included seriousness (primary), fatality, hospitalization, time-to-onset, and System Organ Class. Multivariable logistic regression adjusted for age, sex, regimen, tumor type, polypharmacy, and calendar period; sensitivity analyses using first ADR per patient were concordant. Results: We identified 2300 eligible ICI-related ADRs (corresponding to 925 patients). Median age at the time of ADR was 65 years (IQR not reported); 33.7% occurred in adults aged ≥70 years, and 62.8% of reports involved male patients. PD-1 inhibitors accounted for 77.5% of ADRs, and monotherapy for 72.9%. Overall, 85.8% of ADRs were classified as serious; 17.9% led to hospitalization and 19.1% were fatal. Serious-event reporting was similar in older and younger adults (≥70 vs. <70 years: 84.5% vs. 86.5%, p = 0.22), and the proportion explicitly labeled immune-related did not differ (9.3% vs. 8.7%, p = 0.56). In contrast, fatal outcomes were significantly more common in older adults (25.3% vs. 16.0%; p < 0.001). Age was associated with distinct organ-specific patterns. Adults ≥ 70 years had higher odds of nervous system disorders (aOR 1.75, 95% CI 1.23–2.48) and immune system disorders (aOR 1.42, 95% CI 1.02–1.98), but lower odds of hepatobiliary (aOR 0.52, 95% CI 0.36–0.76; p = 0.001) and blood/lymphatic disorders (aOR 0.50, 95% CI 0.32–0.79). In multivariable models, age ≥ 70 years did not predict seriousness (aOR 0.98, 95% CI 0.76–1.27), whereas combination therapy remained independently associated with increased seriousness (aOR 1.57, 95% CI 1.13–2.18). Conversely, age ≥ 70 years independently predicted fatal outcomes (aOR 1.66, 95% CI 1.31–2.09). Later calendar periods (2017–2024) were associated with substantially lower fatality (aOR 0.16; 95% CI 0.10–0.27). CTLA-4-containing regimens demonstrated a tendency toward higher fatality (aOR 1.50; 95% CI 0.94–2.37). Conclusions: Chronological age does not seem to increase the likelihood of reporting a serious ICI-related ADR, but, once toxicity occurs, older adults experience higher fatality rates. Age-related phenotypic differences and regimen-specific risks highlight the need for early recognition systems and tailored toxicity management in older populations.

Introdução: A maior incidência de cancro em idades jovens, associada ao aumento da sobrevivência, dá origem a um número crescente de doentes oncológicas em idade reprodutiva. A Infertilidade é reconhecida como um efeito a longo prazo do tratamento oncológico, pelo que os médicos devem estar preparados para informar as doentes desta possibilidade e discutir opções disponíveis para Preservação da Fertilidade (PF). A necessidade de reforçar o conhecimento e as competências de comunicação sobre este assunto já foi reconhecida por diversas entidades e, recentemente, foram desenvolvidas, em Portugal, ferramentas informativas e de apoio à tomada de decisão, tais como folhetos informativos, websitese cursos pós-graduados. O principal objetivo deste estudo é avaliar a evolução das práticas dos médicos portugueses que tratam patologia oncológica em relação à PF, comparando os resultados obtidos em 2018 com os de um estudo de 2013-2015.Métodos: Foi aplicado um questionário de auto-resposta a médicos de todas as especialidades que tratam doentes oncológicas. Estes foram recrutados pessoalmente em instituições clínicas portuguesas ou online através da divulgação do link do questionário via e-mail pela Sociedade Portuguesa de Oncologia, a todos os seus membros, e em grupos de médicos do Facebook.Resultados:Em comparação com o estudo anterior, um número maior de médicos refere que “frequentemente ou sempre” informa os seus doentes do sexo feminino sobre o risco de infertilidade relacionada com o cancro e sobre a possibilidade de PF; menos médicos dizem que o fazem “quase nunca” e nenhum dos médicos relatou “nunca” ter informado as suas doentes sobre o risco de infertilidade relacionada com o cancro e sobre PF. Um maior número de clínicos relatou referenciar um maior número de doentes a um médico de medicina reprodutiva. A maioria dos clínicos não reconhece a falta de leis de gestação de substituição como uma barreira às suas práticas de PF, tal como, discorda que deve ser implementada como um método para alcançar uma gravidez após PF.Conclusões:O presente estudo revelou uma melhoria nas práticas globais dos médicos em relação à saúde reprodutiva das doentes oncológicas, comparativamente ao estudo de 2013-2015. Assim, podemos hipotetizar que as estratégias implementadas foram importantes e eficazes, tendo contribuído para aumentar o conhecimento dos clínicos sobre a saúde reprodutiva das doentes oncológicas e para facilitar a comunicação médico-doente.