{"version":1,"generado":"2026-09-28T10:06:22","actualizado":"2026-09-24","enfermedad_medible":{"recist":[{"fecha":"2026-07-13","suma_mm":68,"rol":{"es":"basal","en":"baseline"},"dianas":[{"lesion":{"es":"Hígado s.II","en":"Liver s.II"},"mm":18},{"lesion":{"es":"Hígado s.IVb","en":"Liver s.IVb"},"mm":15},{"lesion":{"es":"Mama derecha CSE","en":"Right breast upper outer quadrant"},"mm":14},{"lesion":{"es":"Vértebra dorsal (D11 en hoja RECIST / D12 en RM)","en":"Thoracic vertebra (D11 on RECIST sheet / D12 on MRI)"},"mm":21}],"fuente":"puesta_al_dia","sello":"verificado"},{"fecha":"2026-09-08","suma_mm":74,"rol":{"es":"control 1 (+8,8 %, sin lesiones nuevas → SD por RECIST 1.1; PD clínica declarada por el investigador)","en":"follow-up 1 (+8.8 %, no new lesions → RECIST 1.1 SD; clinical PD declared by the investigator)"},"dianas":[{"lesion":{"es":"Hígado s.II","en":"Liver s.II"},"mm":20},{"lesion":{"es":"Hígado s.IVb","en":"Liver s.IVb"},"mm":19},{"lesion":{"es":"Mama derecha CSE","en":"Right breast upper outer quadrant"},"mm":15},{"lesion":{"es":"Vértebra dorsal (D11 en hoja RECIST / D12 en RM)","en":"Thoracic vertebra (D11 on RECIST sheet / D12 on MRI)"},"mm":20}],"fuente":"puesta_al_dia","sello":"verificado"}],"volumen":[{"fecha":"2026-07-13","ml":2.8,"n_lesiones":9,"fuente":"carga_tumoral","sello":"verificado"},{"fecha":"2026-09-08","ml":11.9,"n_lesiones":20,"fuente":"carga_tumoral","sello":"verificado"}],"lesiones":[{"id":"L1 · seg VII · no vista en el TC previo","segmento":"VII","estudios":[{"fecha":"2026-09-08","diametro_mm":16.7,"volumen_ml":1.99,"densidad_uh":137,"suvmax":2.16}],"fuente":"ficha_json","sello":"verificado"},{"id":"L2 · seg II · diana RECIST (radiólogo 18→20 mm) · crece (+47,5 % diámetro, +309 % volumen vs 13-jul según el modelo) · SUV 8-sep por debajo de la media hepática pese a crecer: pregunta abierta para radiología","segmento":"II","estudios":[{"fecha":"2026-07-10","diametro_mm":null,"volumen_ml":null,"densidad_uh":null,"suvmax":2.39},{"fecha":"2026-09-08","diametro_mm":18.0,"volumen_ml":1.8,"densidad_uh":113,"suvmax":1.29}],"fuente":"ficha_json","sello":"verificado"},{"id":"L3 · seg IV (IVb) · diana RECIST (radiólogo 15→19 mm) · crece (+24,3 % diámetro, +60,5 % volumen vs 13-jul) · la más activa en PET (informe 4,5)","segmento":"IVb","estudios":[{"fecha":"2026-07-10","diametro_mm":null,"volumen_ml":null,"densidad_uh":null,"suvmax":2.58},{"fecha":"2026-09-08","diametro_mm":13.8,"volumen_ml":1.22,"densidad_uh":122,"suvmax":4.22}],"fuente":"ficha_json","sello":"verificado"},{"id":"L4 · seg V · crece (+91,5 % diámetro, +245 % volumen vs 13-jul)","segmento":"V","estudios":[{"fecha":"2026-07-10","diametro_mm":null,"volumen_ml":null,"densidad_uh":null,"suvmax":1.62},{"fecha":"2026-09-08","diametro_mm":13.6,"volumen_ml":1.07,"densidad_uh":123,"suvmax":1.17}],"fuente":"ficha_json","sello":"verificado"},{"id":"L5 · seg VII · crece (+132,7 % diámetro, +791 % volumen vs 13-jul)","segmento":"VII","estudios":[{"fecha":"2026-07-10","diametro_mm":null,"volumen_ml":null,"densidad_uh":null,"suvmax":1.69},{"fecha":"2026-09-08","diametro_mm":12.8,"volumen_ml":0.98,"densidad_uh":103,"suvmax":1.99}],"fuente":"ficha_json","sello":"verificado"},{"id":"L6 · seg VIII · crece (+43,4 % diámetro, +171 % volumen vs 13-jul)","segmento":"VIII","estudios":[{"fecha":"2026-07-10","diametro_mm":null,"volumen_ml":null,"densidad_uh":null,"suvmax":1.79},{"fecha":"2026-09-08","diametro_mm":11.9,"volumen_ml":0.84,"densidad_uh":113,"suvmax":1.89}],"fuente":"ficha_json","sello":"verificado"},{"id":"L7 · seg VI · crece (+62,9 % diámetro, +250 % volumen vs 13-jul)","segmento":"VI","estudios":[{"fecha":"2026-07-10","diametro_mm":null,"volumen_ml":null,"densidad_uh":null,"suvmax":1.37},{"fecha":"2026-09-08","diametro_mm":11.4,"volumen_ml":0.7,"densidad_uh":110,"suvmax":2.1}],"fuente":"ficha_json","sello":"verificado"},{"id":"L8 · seg VIII · no vista en el TC previo","segmento":"VIII","estudios":[{"fecha":"2026-09-08","diametro_mm":11.4,"volumen_ml":0.64,"densidad_uh":104,"suvmax":2.12}],"fuente":"ficha_json","sello":"verificado"},{"id":"L9 · seg VI · no vista en el TC previo","segmento":"VI","estudios":[{"fecha":"2026-09-08","diametro_mm":10.6,"volumen_ml":0.57,"densidad_uh":116,"suvmax":1.93}],"fuente":"ficha_json","sello":"verificado"},{"id":"L10 · seg V · estable (+6,7 % diámetro, −16,1 % volumen vs 13-jul)","segmento":"V","estudios":[{"fecha":"2026-07-10","diametro_mm":null,"volumen_ml":null,"densidad_uh":null,"suvmax":2.05},{"fecha":"2026-09-08","diametro_mm":11.1,"volumen_ml":0.47,"densidad_uh":106,"suvmax":2.38}],"fuente":"ficha_json","sello":"verificado"},{"id":"L11 · seg III · no vista en el TC previo · SUV sobre fondo","segmento":"III","estudios":[{"fecha":"2026-09-08","diametro_mm":10.4,"volumen_ml":0.47,"densidad_uh":115,"suvmax":3.07}],"fuente":"ficha_json","sello":"verificado"},{"id":"L12 · seg III · no vista en el TC previo · <10 mm","segmento":"III","estudios":[{"fecha":"2026-09-08","diametro_mm":8.4,"volumen_ml":0.31,"densidad_uh":107,"suvmax":1.66}],"fuente":"ficha_json","sello":"verificado"},{"id":"L13 · seg VI · no vista en el TC previo · <10 mm","segmento":"VI","estudios":[{"fecha":"2026-09-08","diametro_mm":7.9,"volumen_ml":0.24,"densidad_uh":121,"suvmax":2.09}],"fuente":"ficha_json","sello":"verificado"},{"id":"L14 · seg VI · no vista en el TC previo · <10 mm","segmento":"VI","estudios":[{"fecha":"2026-09-08","diametro_mm":6.6,"volumen_ml":0.16,"densidad_uh":95,"suvmax":2.01}],"fuente":"ficha_json","sello":"verificado"},{"id":"L15 · seg IV · no vista en el TC previo · <10 mm · borde contaminado","segmento":"IV","estudios":[{"fecha":"2026-09-08","diametro_mm":6.3,"volumen_ml":0.15,"densidad_uh":108,"suvmax":2.43}],"fuente":"ficha_json","sello":"verificado"},{"id":"L16 · seg VI · no vista en el TC previo · <10 mm","segmento":"VI","estudios":[{"fecha":"2026-09-08","diametro_mm":5.7,"volumen_ml":0.11,"densidad_uh":109,"suvmax":1.91}],"fuente":"ficha_json","sello":"verificado"},{"id":"L17 · seg IV · no vista en el TC previo · <10 mm · borde contaminado","segmento":"IV","estudios":[{"fecha":"2026-09-08","diametro_mm":5.3,"volumen_ml":0.1,"densidad_uh":120,"suvmax":2.03}],"fuente":"ficha_json","sello":"verificado"},{"id":"L18 · seg VII · no vista en el TC previo · <10 mm · PET no evaluable","segmento":"VII","estudios":[{"fecha":"2026-09-08","diametro_mm":4.1,"volumen_ml":0.05,"densidad_uh":116,"suvmax":null}],"fuente":"ficha_json","sello":"verificado"},{"id":"L19 · seg VIII · no vista en el TC previo · <10 mm · PET no evaluable","segmento":"VIII","estudios":[{"fecha":"2026-09-08","diametro_mm":5.3,"volumen_ml":0.05,"densidad_uh":114,"suvmax":null}],"fuente":"ficha_json","sello":"verificado"},{"id":"L20 · seg V · no vista en el TC previo · <10 mm · PET no evaluable","segmento":"V","estudios":[{"fecha":"2026-09-08","diametro_mm":2.2,"volumen_ml":0.02,"densidad_uh":103,"suvmax":null}],"fuente":"ficha_json","sello":"verificado"},{"id":"Focos PET 8-sep sin lesión en el TC a <10 mm: seg VII (SUVmax 3,77), seg VIII (3,6; el informe lo destaca), seg IV (3,41). Dos lesiones de julio en seg I (4,4 y 2,2 mm) no reencontradas","segmento":"VII / VIII / IV","estudios":[{"fecha":"2026-09-08","diametro_mm":null,"volumen_ml":null,"densidad_uh":null,"suvmax":3.77}],"fuente":"ficha_json","sello":"verificado"}],"pet":[{"fecha":"2026-03-24","resumen":{"es":"PET-TC 18F-FDG: sugestivo de progresión ósea. Persiste hipermetabolismo en D11 (SUVmax 7,61, previo 10,19), L5, ala sacra derecha, ilíaco derecho supracetabular, femoral derecho (SUVmax 9,43, previo 6), pedículo izquierdo de L1 (6,84, previo 4,67); focos nuevos en D1 e ilíaco izquierdo supracetabular","en":"18F-FDG PET-CT: suggestive of bone progression. Persistent hypermetabolism in D11 (SUVmax 7.61, previously 10.19), L5, right sacral ala, right supra-acetabular iliac, right femur (SUVmax 9.43, previously 6), left pedicle of L1 (6.84, previously 4.67); new foci in D1 and left supra-acetabular iliac"},"fuente":"pet_2026_03_24","sello":"verificado"},{"fecha":"2026-05-26","resumen":{"es":"PET 68Ga-DOTATOC: sobreexpresión SSTR en múltiples metástasis óseas blásticas (SUVmax hasta 13,27 en D11, 12,1 en L5), pero heterogénea: varias lesiones sin captación y el pedículo izquierdo de L1 FDG+ / Ga−. Captación focal en cola de mama derecha, SUVmax 2,64, «a valorar en estudio dirigido» (el informe no la llama primario). El hígado aún no tenía lesiones: su estado SSTR es desconocido. Sin escala Krenning en el informe","en":"68Ga-DOTATOC PET: SSTR overexpression in multiple blastic bone metastases (SUVmax up to 13.27 in D11, 12.1 in L5), but heterogeneous: several lesions without uptake and the left pedicle of L1 FDG+ / Ga−. Focal uptake in the tail of the right breast, SUVmax 2.64, “to be assessed with a targeted study” (the report does not call it the primary). The liver had no lesions yet: its SSTR status is unknown. No Krenning score in the report"},"fuente":"estado_actual","sello":"verificado"},{"fecha":"2026-07-10","resumen":{"es":"PET-TC 18F-FDG (cribado del ensayo BG-75202): primeras lesiones hepáticas; hígado s.IVb SUVmax 2,6 y s.II 2,2 según el informe","en":"18F-FDG PET-CT (BG-75202 trial screening): first liver lesions; liver s.IVb SUVmax 2.6 and s.II 2.2 according to the report"},"fuente":"ficha_lesiones","sello":"verificado"},{"fecha":"2026-09-08","resumen":{"es":"PET-TC 18F-FDG (informe firmado el 9-sep): «Progresión hepática y ósea, por aparición de nuevas lesiones activas» (columna, escápula derecha, costillas, pelvis, fémures). Hígado s.IVb SUVmax 4,5 y s.VIII 3,6. El TC del mismo día informa «estabilidad de la afectación M1 ósea»","en":"18F-FDG PET-CT (report signed on 9 Sep): “Hepatic and bone progression, due to the appearance of new active lesions” (spine, right scapula, ribs, pelvis, femurs). Liver s.IVb SUVmax 4.5 and s.VIII 3.6. The same-day CT reports “stability of the M1 bone involvement”"},"fuente":"estado_actual","sello":"verificado"}]},"ficha":{"diagnostico":{"valor":{"es":"Carcinoma de mama infiltrante NST con diferenciación neuroendocrina, HR+/HER2 IHC 0, estadio IV de novo (metástasis óseas múltiples al debut, presentación como compresión medular en L3)","en":"Invasive breast carcinoma NST with neuroendocrine differentiation, HR+/HER2 IHC 0, de novo stage IV (multiple bone metastases at presentation, presenting as spinal cord compression at L3)"},"fuente":"consulta_2024_01_25","sello":"verificado"},"fecha_diagnostico":{"valor":{"es":"2024-01-16","en":"2024-01-16"},"fuente":"tabla_molecular","sello":"verificado"},"edad_diagnostico":{"valor":33,"fuente":"consulta_2024_01_25","sello":"inferido"},"estadio":{"valor":{"es":"IV de novo (óseo al diagnóstico; hepático desde jul-2026)","en":"De novo IV (bone at diagnosis; liver since Jul 2026)"},"fuente":"consulta_2024_01_25","sello":"verificado"},"histologia":{"valor":{"es":"Carcinoma infiltrante NST con diferenciación neuroendocrina, grado 2 (Nottingham 3+2+2 en 2024; 3+2+1 en la revisión de 2026); CDIS micropapilar y cribiforme; subtipo IHQ luminal B HER2−","en":"Invasive carcinoma NST with neuroendocrine differentiation, grade 2 (Nottingham 3+2+2 in 2024; 3+2+1 on the 2026 review); micropapillary and cribriform DCIS; IHC subtype luminal B HER2−"},"fuente":"puesta_al_dia","sello":"verificado"},"receptores":[{"marcador":{"es":"RE","en":"ER"},"valor":{"es":"95 / 100 / 85 %","en":"95 / 100 / 85 %"},"detalle":{"es":"3 lecturas del primario (laboratorio de origen 2024; panel externo TSO500 2024; revisión de centro de referencia 2026, intensidad alta, score 225)","en":"3 readings of the primary (originating laboratory 2024; external TSO500 panel 2024; referral center review 2026, high intensity, score 225)"},"fuente":"puesta_al_dia","sello":"verificado"},{"marcador":{"es":"RP","en":"PR"},"valor":{"es":"5 / 100 / 20 %","en":"5 / 100 / 20 %"},"detalle":{"es":"3 lecturas del primario; discordancia entre laboratorios (5 % vs 100 % vs 20 %, intensidad baja, score 25)","en":"3 readings of the primary; inter-laboratory discordance (5 % vs 100 % vs 20 %, low intensity, score 25)"},"fuente":"puesta_al_dia","sello":"verificado"},{"marcador":{"es":"HER2 IHC","en":"HER2 IHC"},"valor":{"es":"0 / 0 / 0","en":"0 / 0 / 0"},"detalle":{"es":"3 lecturas independientes del primario. Una describe «tinción de membrana incompleta y casi imperceptible en <10 %», otra «ausencia de tinción». Ningún informe usa la palabra ultralow. ERBB2 sin alteración en el panel de hueso (F1CDx). HER2 del hígado: negativo según la paciente, informe de AP pendiente","en":"3 independent readings of the primary. One describes “incomplete and barely perceptible membrane staining in <10 %”, another “absence of staining”. No report uses the word ultralow. ERBB2 without alteration in the bone panel (F1CDx). Liver HER2: negative according to the patient, pathology report pending"},"fuente":"estado_actual","sello":"verificado"},{"marcador":{"es":"Ki67","en":"Ki67"},"valor":{"es":"60 % (mama 2024) / 40 % (mama, revisión 2026) / ~15 % (hueso 2026)","en":"60 % (breast 2024) / 40 % (breast, 2026 review) / ~15 % (bone 2026)"},"detalle":{"es":"Tres sitios y momentos distintos; la cifra de hueso arrastra la duda del método de descalcificación (no consta)","en":"Three different sites and time points; the bone figure carries the uncertainty about the decalcification method (not documented)"},"fuente":"hueso_zurich","sello":"verificado"},{"marcador":{"es":"Cromogranina","en":"Chromogranin"},"valor":{"es":"80 % (2024) / positiva focal (2026)","en":"80 % (2024) / focally positive (2026)"},"detalle":{"es":"Primario; no realizada en hueso","en":"Primary; not performed on bone"},"fuente":"puesta_al_dia","sello":"verificado"},{"marcador":{"es":"Sinaptofisina","en":"Synaptophysin"},"valor":{"es":"80 % (2024) / «heterogénea» y «negativa» (2026) / positiva sin porcentaje (hueso 2026)","en":"80 % (2024) / “heterogeneous” and “negative” (2026) / positive without percentage (bone 2026)"},"detalle":{"es":"Contradicción interna en la revisión de 2026: dos entradas en el mismo informe, sin aclarar. Pendiente de aclaración","en":"Internal contradiction in the 2026 review: two entries in the same report, unresolved. Pending clarification"},"fuente":"puesta_al_dia","sello":"verificado"},{"marcador":{"es":"INSM1","en":"INSM1"},"valor":{"es":"positiva, patrón mosaico (2026)","en":"positive, mosaic pattern (2026)"},"detalle":{"es":"Solo en la revisión del primario de 2026","en":"Only in the 2026 review of the primary"},"fuente":"puesta_al_dia","sello":"verificado"},{"marcador":{"es":"CD56","en":"CD56"},"valor":{"es":"negativo (2024)","en":"negative (2024)"},"detalle":{"es":"Primario, laboratorio de origen","en":"Primary, originating laboratory"},"fuente":"puesta_al_dia","sello":"verificado"},{"marcador":{"es":"PD-L1","en":"PD-L1"},"valor":{"es":"CPS 0 %","en":"CPS 0 %"},"detalle":{"es":"Primario 2024 (células tumorales e inmunes); ARN CD274 en percentil 25 (VIGex 2026)","en":"Primary 2024 (tumor and immune cells); CD274 RNA at the 25th percentile (VIGex 2026)"},"fuente":"puesta_al_dia","sello":"verificado"},{"marcador":{"es":"TILs estromales","en":"Stromal TILs"},"valor":{"es":"<5 %","en":"<5 %"},"detalle":{"es":"Revisión del primario 2026; firma VIGex iCold (−0,27)","en":"2026 review of the primary; VIGex iCold signature (−0.27)"},"fuente":"puesta_al_dia","sello":"verificado"},{"marcador":{"es":"CK19 / GATA3 / E-cadherina / p63","en":"CK19 / GATA3 / E-cadherin / p63"},"valor":{"es":"+ / + / no se tiñó / no se tiñó (2024); heterogénea / no se tiñó / + / − (2026)","en":"+ / + / not stained / not stained (2024); heterogeneous / not stained / + / − (2026)"},"detalle":{"es":"Primario, el mismo bloque leído dos veces: GATA3 solo se tiñó en 2024; E-cadherina y p63, solo en la revisión de 2026","en":"Primary, the same block read twice: GATA3 was stained only in 2024; E-cadherin and p63 only in the 2026 review"},"fuente":"puesta_al_dia","sello":"verificado"},{"marcador":{"es":"Umbral NET (WHO >90 % NE)","en":"NET threshold (WHO >90 % NE)"},"valor":{"es":"No alcanzado: diferenciación NE, no NET","en":"Not reached: NE differentiation, not NET"},"detalle":{"es":"80 % en 2024, focal/heterogéneo en 2026. El informe de hueso lo etiqueta como metástasis del «NET clínicamente conocido» porque la petición ya llegaba así; el patólogo avisa de que la gradación no está establecida en biopsias pequeñas","en":"80 % in 2024, focal/heterogeneous in 2026. The bone report labels it as a metastasis of the “clinically known NET” because the request already arrived that way; the pathologist warns that grading is not established in small biopsies"},"fuente":"estado_actual","sello":"inferido"}],"ecog":{"valor":{"es":"0","en":"0"},"fecha":"2026-09-09","fuente":"puesta_al_dia","sello":"verificado"},"sitios":[{"valor":{"es":"Hueso: metástasis incontables blásticas/mixtas/líticas en todo el esqueleto; fracturas patológicas crónicas de L1 y L3; D12 con componente de partes blandas de 20 mm hacia el canal sin contacto medular; PET-FDG 8-sep: lesiones activas nuevas en columna, escápula derecha, costillas, pelvis y fémures","en":"Bone: innumerable blastic/mixed/lytic metastases throughout the skeleton; chronic pathological fractures of L1 and L3; D12 with a 20 mm soft-tissue component extending into the canal without cord contact; FDG-PET 8 Sep: new active lesions in the spine, right scapula, ribs, pelvis and femurs"},"fuente":"estado_actual","sello":"verificado"},{"valor":{"es":"Hígado: múltiples metástasis desde jul-2026, en aumento; dianas s.II 20 mm y s.IVb 19 mm el 8-sep-2026; hígado palpable","en":"Liver: multiple metastases since Jul 2026, increasing; targets s.II 20 mm and s.IVb 19 mm on 8 Sep 2026; palpable liver"},"fuente":"puesta_al_dia","sello":"verificado"},{"valor":{"es":"Mama derecha: primario CSE 15 mm (BI-RADS 6), en aumento leve; axila y mamaria interna libres","en":"Right breast: upper outer quadrant primary 15 mm (BI-RADS 6), slightly increasing; axilla and internal mammary free"},"fuente":"puesta_al_dia","sello":"verificado"},{"valor":{"es":"Sin metástasis pulmonares ni ganglionares RECIST-significativas; sin ascitis ni carcinomatosis; tractos fibrocicatriciales pulmonares bilaterales (secuela de la neumonía de 2024)","en":"No RECIST-significant lung or nodal metastases; no ascites or carcinomatosis; bilateral pulmonary fibrotic scar tracts (sequela of the 2024 pneumonia)"},"fuente":"puesta_al_dia","sello":"verificado"},{"valor":{"es":"SNC: sin imagen cerebral en el archivo y sin clínica registrada (no estudiado, no «negativo»)","en":"CNS: no brain imaging on file and no recorded symptoms (not studied, not “negative”)"},"fuente":"puesta_al_dia","sello":"verificado"}],"estado_actual":{"valor":{"es":"Sin tratamiento antineoplásico desde el 9-sep-2026 (salida del ensayo BG-75202 por progresión clínica hepática, SD por RECIST). En TROPION-Breast06 (Dato-DXd anti-TROP2), VHIO: analítica de cribado del 16-sep dentro de criterios; pruebas previas a la primera dosis (correo de la coordinación, 21-sep); primera dosis prevista en octubre, según Miriam. Goserelina en curso. Anemia hipoproliferativa (Hb 7,8 transfundida el 9-sep; 10,6 el 16-sep). CA15.3 512,8 el 16-sep (509,5 el 8-sep; basal 145). Histología de la biopsia hepática del 18-ago pendiente. El 24-sep el reservorio venoso infunde pero no da retorno de sangre","en":"No anticancer treatment since 9 Sep 2026 (withdrawal from the BG-75202 trial due to clinical hepatic progression, RECIST SD). In TROPION-Breast06 (Dato-DXd anti-TROP2), VHIO: screening labs of 16 Sep within criteria; tests before the first dose (study coordination email, 21 Sep); first dose planned for October, according to Miriam. Goserelin ongoing. Hypoproliferative anemia (Hb 7.8 transfused on 9 Sep; 10.6 on 16 Sep). CA15.3 512.8 on 16 Sep (509.5 on 8 Sep; baseline 145). Histology of the 18 Aug liver biopsy pending. On 24 Sep the venous port infuses but gives no blood return"},"fecha":"2026-09-24","fuente":"plan_tb06","sello":"inferido"}},"lineas":[{"id":"RT-2024","tratamiento":{"es":"Radioterapia paliativa sobre L3 (compresión medular al debut)","en":"Palliative radiotherapy to L3 (spinal cord compression at presentation)"},"inicio":"2024-01-17","fin":"2024-01-27","motivo_fin":{"es":"completada","en":"completed"},"nota":{"es":"Tratamiento inicial, antes de la primera línea sistémica","en":"Initial treatment, before the first systemic line"},"fuente":"consulta_2024_01_25","sello":"verificado"},{"id":"1L","tratamiento":{"es":"Agonista LHRH + letrozol + ribociclib","en":"LHRH agonist + letrozole + ribociclib"},"inicio":"2024-02-02","fin":"2025-01","motivo_fin":{"es":"progresión ósea exclusiva tras 12 meses de agonista LHRH + letrozol","en":"bone-only progression after 12 months of LHRH agonist + letrozole"},"nota":{"es":"Ribociclib solo 15 días: neumonía neutropénica necrotizante con hidroneumotórax e ingreso en UCI (~2 meses); al alta siguió solo con hormonoterapia. Soporte óseo con ácido zoledrónico 4 mg iv mensual desde el inicio","en":"Ribociclib for only 15 days: necrotizing neutropenic pneumonia with hydropneumothorax and ICU admission (~2 months); after discharge she continued on endocrine therapy alone. Bone support with zoledronic acid 4 mg iv monthly from the start"},"fuente":"consulta_2025_02_04","sello":"verificado"},{"id":"2L","tratamiento":{"es":"Fulvestrant 500 mg im c/28 d + abemaciclib 100 mg/12 h (dosis reducida desde el ciclo 1; pautado 150 mg) + agonista LHRH","en":"Fulvestrant 500 mg im every 28 d + abemaciclib 100 mg every 12 h (dose reduced from cycle 1; prescribed 150 mg) + LHRH agonist"},"inicio":"2025-02-04","fin":"2026-05-28","motivo_fin":{"es":"progresión ósea (PET-FDG del 24-mar-2026)","en":"bone progression (FDG-PET of 24 Mar 2026)"},"nota":{"es":"El informe dice «2.ª línea desde enero de 2025»; la consulta de C1D1 está fechada el 4-feb-2025. Última dosis de abemaciclib el 30-mar-2026; fulvestrant hasta el 28-may-2026. Duración de abemaciclib ~14 meses","en":"The report says “2nd line since January 2025”; the C1D1 visit is dated 4 Feb 2025. Last abemaciclib dose on 30 Mar 2026; fulvestrant until 28 May 2026. Abemaciclib duration ~14 months"},"fuente":"estado_actual","sello":"verificado"},{"id":"RT-2026","tratamiento":{"es":"SBRT sobre D11, 5 fracciones","en":"SBRT to D11, 5 fractions"},"inicio":"2026-06","fin":"2026-06","motivo_fin":{"es":"completada","en":"completed"},"nota":{"es":"Indicada de urgencia por riesgo de compresión medular tras la RM del 11-jun-2026 (73 días sin tratamiento sistémico). Fechas exactas de las sesiones: no constan en las notas consultadas","en":"Indicated urgently due to risk of spinal cord compression after the MRI of 11 Jun 2026 (73 days without systemic treatment). Exact session dates: not recorded in the notes consulted"},"fuente":"web_timeline","sello":"inferido"},{"id":"3L","tratamiento":{"es":"Fulvestrant + BG-75202 (inhibidor oral de KAT6A/B, ensayo fase 1a/1b NCT07222267, cohorte 1B, Vall d'Hebron)","en":"Fulvestrant + BG-75202 (oral KAT6A/B inhibitor, phase 1a/1b trial NCT07222267, cohort 1B, Vall d'Hebron)"},"inicio":"2026-07-15","fin":"2026-09-09","motivo_fin":{"es":"progresión clínica hepática a las 8 semanas (SD por RECIST +8,8 %, pero crecimiento hepático con empeoramiento de función hepática y CA15.3 ×3,5)","en":"clinical hepatic progression at 8 weeks (RECIST SD +8.8 %, but hepatic growth with worsening liver function and CA15.3 ×3.5)"},"nota":{"es":"Toxicidad atribuida: anemia G2→G3, astenia, disgeusia, anorexia, creatinina G1, CK G2. Transaminasas atribuidas a la enfermedad, no al fármaco","en":"Attributed toxicity: anemia G2→G3, asthenia, dysgeusia, anorexia, creatinine G1, CK G2. Transaminases attributed to the disease, not to the drug"},"fuente":"estado_actual","sello":"verificado"},{"id":"4L","tratamiento":{"es":"Datopotamab deruxtecan (Dato-DXd, anti-TROP2, carga de topoisomerasa I) 6 mg/kg c/3 sem; ensayo fase IIIb de un brazo TROPION-Breast06 (NCT07205822), Vall d'Hebron","en":"Datopotamab deruxtecan (Dato-DXd, anti-TROP2, topoisomerase I payload) 6 mg/kg every 3 weeks; single-arm phase IIIb trial TROPION-Breast06 (NCT07205822), Vall d'Hebron"},"inicio":"2026-10","fin":null,"motivo_fin":null,"nota":{"es":"Participa en el estudio (correo de la coordinación del 21-sep): pruebas previas a la primera dosis. Cribado de laboratorio del 16-sep dentro de criterios (Hb 10,6; AST 59; ALT 38; bilirrubina 1,00; albúmina 4,5; creatinina 0,74). Primera dosis prevista en octubre, según Miriam; la fecha exacta de una cita futura no se publica. El documento de consentimiento no está archivado","en":"Taking part in the study (study coordination email of 21 Sep): tests before the first dose. Laboratory screening of 16 Sep within criteria (Hb 10.6; AST 59; ALT 38; bilirubin 1.00; albumin 4.5; creatinine 0.74). First dose planned for October, according to Miriam; the exact date of a future appointment is not published. The consent document is not on file"},"fuente":"correo_estudio_tb06","sello":"verificado"},{"id":"LHRHa","tratamiento":{"es":"Goserelina 3,6 mg c/28 días (agonista LHRH), autoadministrada","en":"Goserelin 3.6 mg every 28 days (LHRH agonist), self-administered"},"inicio":"2024-02","fin":null,"motivo_fin":null,"nota":{"es":"En curso desde la primera línea. Última dosis 8-sep-2026 según chat, sin documento; cadencia jul-sep no documentada. Último estradiol 35 pg/mL el 26-may-2026 (supresión incompleta; FSH 4,4)","en":"Ongoing since first line. Last dose 8 Sep 2026 according to chat, no document; Jul-Sep cadence not documented. Last estradiol 35 pg/mL on 26 May 2026 (incomplete suppression; FSH 4.4)"},"fuente":"estado_actual","sello":"dicho"},{"id":"Óseo","tratamiento":{"es":"Ácido zoledrónico 4 mg iv (mensual desde 2024, luego trimestral)","en":"Zoledronic acid 4 mg iv (monthly from 2024, then quarterly)"},"inicio":"2024-02","fin":null,"motivo_fin":null,"nota":{"es":"No consta en la medicación concomitante del 9-sep-2026: se desconoce si sigue","en":"Not listed in the concomitant medication of 9 Sep 2026: unknown whether it continues"},"fuente":"puesta_al_dia","sello":"inferido"}],"material":[{"muestra":{"es":"Hueso, cresta ilíaca (biopsia 8-jul-2026, Zúrich): 6 cilindros de 4-11 mm en 4 bloques A-D; por bloque 1 bueno, 1 pobre y 2 inservibles. Parafina, descalcificado (método no consta). Sin fresco ni congelado","en":"Bone, iliac crest (biopsy 8 Jul 2026, Zurich): 6 cores of 4-11 mm in 4 blocks A-D; per block 1 good, 1 poor and 2 unusable. Paraffin, decalcified (method not documented). No fresh or frozen"},"fecha":"2026-07-08","donde":{"es":"Dana-Farber (enviado el 27-ago-2026, recibido el 2-3 de septiembre)","en":"Dana-Farber (shipped 27 Aug 2026, received 2-3 September)"},"estado":{"es":"Escaso: el FoundationOne CDx consumió parte del bloque A. Recepción confirmada al laboratorio según la paciente (24-sep)","en":"Scarce: the FoundationOne CDx consumed part of block A. Receipt confirmed to the laboratory according to the patient (24 Sep)"},"fuente":"hueso_zurich","sello":"verificado"},{"muestra":{"es":"Hígado, segmento IVa (BAG 18-ago-2026, guiada por ecografía, 2 cilindros 16G × 23 mm, lesión de 2,2 cm). Única biopsia hepática. Parafina","en":"Liver, segment IVa (core needle biopsy 18 Aug 2026, ultrasound-guided, 2 cores 16G × 23 mm, 2.2 cm lesion). Only liver biopsy. Paraffin"},"fecha":"2026-08-18","donde":{"es":"Cortes en Dana-Farber (envío 21-sep, recibido 23-sep-2026); bloque original en anatomía patológica del VHIO / Vall d'Hebron","en":"Sections at Dana-Farber (shipped 21 Sep, received 23 Sep 2026); original block at VHIO / Vall d'Hebron pathology"},"estado":{"es":"Limitado: el reparto pedido (2×25 µm para scRNA-seq + 1-2×10 µm para WES) «agotaría prácticamente» el bloque; la combinación cortada y el remanente no constan por escrito. Informe de AP pendiente.","en":"Limited: the requested allocation (2×25 µm for scRNA-seq + 1-2×10 µm for WES) “would practically exhaust” the block; the combination cut and the remainder are not documented in writing. Pathology report pending."},"fuente":"codigos_bloques","sello":"verificado"},{"muestra":{"es":"Mama, primario (BAG 16-ene-2024). Parafina. Pureza tumoral 75 %. Revisado de nuevo en 2026","en":"Breast, primary (core needle biopsy 16 Jan 2024). Paraffin. Tumor purity 75 %. Reviewed again in 2026"},"fecha":"2024-01-16","donde":{"es":"Anatomía patológica de Vall d'Hebron (tras la revisión central)","en":"Vall d'Hebron pathology (after the central review)"},"estado":{"es":"El más abundante. Ubicación del bloque: deducida, no confirmada por escrito","en":"The most abundant. Block location: deduced, not confirmed in writing"},"fuente":"puesta_al_dia","sello":"inferido"},{"muestra":{"es":"Laminillas del primario de mama (H&E, HER2, p63): 3 portaláminas","en":"Slides of the breast primary (H&E, HER2, p63): 3 slide holders"},"fecha":"2024-01","donde":{"es":"Dana-Farber (envío 21-sep, recibido 23-sep-2026)","en":"Dana-Farber (shipped 21 Sep, received 23 Sep 2026)"},"estado":{"es":"Tinción y número por porta según etiqueta; para scRNA-seq desde laminillas hacen falta cortes sin teñir (según el fabricante)","en":"Stain and number per slide according to the label; scRNA-seq from slides requires unstained sections (according to the manufacturer)"},"fuente":"codigos_bloques","sello":"verificado"},{"muestra":{"es":"Hueso, ilíaco derecho (re-biopsia 30-abr-2026, Morales Meseguer): trabéculas óseas y fibras musculoesqueléticas, sin neoplasia. Parafina","en":"Bone, right iliac (re-biopsy 30 Apr 2026, Morales Meseguer): bone trabeculae and musculoskeletal fibers, no neoplasia. Paraffin"},"fecha":"2026-04-30","donde":{"es":"Dana-Farber (envío 21-sep, recibido 23-sep-2026)","en":"Dana-Farber (shipped 21 Sep, received 23 Sep 2026)"},"estado":{"es":"Enviado a propósito por si el tejido sirve, aunque probablemente no tenga tumor","en":"Sent deliberately in case the tissue is useful, although it probably contains no tumor"},"fuente":"codigos_bloques","sello":"verificado"},{"muestra":{"es":"Mama (biopsia 5-jun-2026 para cribado de ensayo): muestra analizable mínima (0,3 mm), insuficiente","en":"Breast (biopsy 5 Jun 2026 for trial screening): minimal analyzable sample (0.3 mm), insufficient"},"fecha":"2026-06-05","donde":{"es":"Anatomía patológica de Vall d'Hebron","en":"Vall d'Hebron pathology"},"estado":{"es":"Insuficiente para diagnóstico; no es material hepático (corrección del 13-sep)","en":"Insufficient for diagnosis; not liver material (correction of 13 Sep)"},"fuente":"estado_actual","sello":"verificado"},{"muestra":{"es":"Plasma: 4 tubos (may-2026)","en":"Plasma: 4 tubes (May 2026)"},"fecha":"2026-05","donde":{"es":"Dana-Farber","en":"Dana-Farber"},"estado":{"es":"Según nota interna del 5-sep-2026, no reabierta","en":"According to an internal note of 5 Sep 2026, not reopened"},"fuente":"puesta_al_dia","sello":"sin_verificar"},{"muestra":{"es":"ADN germinal en líquido, ~500 ng («puede ser con menos»), como normal pareado para el WES","en":"Germline DNA in solution, ~500 ng (“can be with less”), as matched normal for the WES"},"fecha":"2026-09","donde":{"es":"Pendiente de envío a Dana-Farber","en":"Pending shipment to Dana-Farber"},"estado":{"es":"Solo consta en chat (21-sep); confirmación por escrito de que se secuencian tumor y germinal como par: pedida el 24-sep","en":"Recorded only in chat (21 Sep); written confirmation that tumor and germline are sequenced as a pair: requested on 24 Sep"},"fuente":"estado_actual","sello":"dicho"},{"muestra":{"es":"Tejido fresco / congelado / PBMC / buffy coat","en":"Fresh / frozen tissue / PBMC / buffy coat"},"fecha":"2026-09","donde":{"es":"Ninguno en ningún centro","en":"None at any center"},"estado":{"es":"No existe. La única vía sería una biopsia nueva con cilindros extra frescos o congelados sin descalcificar, y sangre antes del primer ciclo (ADN germinal, HLA, PBMC)","en":"Does not exist. The only route would be a new biopsy with extra fresh or frozen non-decalcified cores, and blood before the first cycle (germline DNA, HLA, PBMC)"},"fuente":"puesta_al_dia","sello":"verificado"}],"se_busca":[{"valor":{"es":"Laboratorios o grupos con capacidad de predecir y validar neoantígenos desde parafina (WES tumor/germinal + scRNA-seq 10x Flex ya en marcha) y de fabricar terapia personalizada (vacuna de neoantígenos, TIL, TCR-T, CAR-T) para un carcinoma de mama HR+/HER2 0 con diferenciación neuroendocrina y metástasis hepáticas","en":"Laboratories or groups able to predict and validate neoantigens from paraffin (tumor/germline WES + 10x Flex scRNA-seq already under way) and to manufacture personalized therapy (neoantigen vaccine, TIL, TCR-T, CAR-T) for an HR+/HER2 0 breast carcinoma with neuroendocrine differentiation and liver metastases"},"fuente":"estado_actual","sello":"inferido"},{"valor":{"es":"Tipaje HLA de clase I/II de alta resolución y estado MHC-I/B2M del tumor: sale de sangre, no gasta tejido, y abre o cierra TCR-T y vacuna","en":"High-resolution HLA class I/II typing and tumor MHC-I/B2M status: comes from blood, uses no tissue, and opens or closes TCR-T and vaccine"},"fuente":"tb06_nota","sello":"inferido"},{"valor":{"es":"IHC de dianas en el tejido hepático (TROP2, Nectin-4, DLL3, SSTR2, B7-H3, CEA) y la histología de la lesión hepática que progresa: es el dato que abre o cierra opciones de ADC, radioligando y terapia celular","en":"Target IHC on the liver tissue (TROP2, Nectin-4, DLL3, SSTR2, B7-H3, CEA) and the histology of the progressing liver lesion: this is the data point that opens or closes ADC, radioligand and cell therapy options"},"fuente":"estado_actual","sello":"verificado"},{"valor":{"es":"Ensayos o programas de acceso (cualquier país) para DESPUÉS de TROPION-Breast06, que admitan: sin quimio previa, HR+/HER2 IHC 0, componente neuroendocrino, metástasis hepáticas, Hb en torno a 9-10 g/dL y un anti-TROP2 previo (el Dato-DXd de TROPION-Breast06). Con cifras ya cotejadas: TB06 no cierra NEXTGEN-TIL (NCT05141474) ni TROPIKANA (NCT06066424); sí cierra otros ADC de topoisomerasa I","en":"Trials or access programs (any country) for AFTER TROPION-Breast06 that accept: no prior chemotherapy, HR+/HER2 IHC 0, a neuroendocrine component, liver metastases, Hb around 9-10 g/dL and a prior anti-TROP2 (the Dato-DXd of TROPION-Breast06). With checked figures: TB06 does not close NEXTGEN-TIL (NCT05141474) or TROPIKANA (NCT06066424); it does close other topoisomerase I ADCs"},"fuente":"tb06_nota","sello":"verificado"},{"valor":{"es":"Radiología: lectura experta del hígado (correspondencia de los 3 focos PET sin lesión TC; diana s.II que crece con SUV bajo; conveniencia de RM hepática con contraste hepatoespecífico o TC multifase para caracterizar las lesiones <10 mm)","en":"Radiology: expert read of the liver (correspondence of the 3 PET foci without a CT lesion; s.II target growing with low SUV; advisability of liver MRI with hepatocyte-specific contrast or multiphase CT to characterize the lesions <10 mm)"},"fuente":"ficha_lesiones","sello":"verificado"},{"valor":{"es":"Interpretación experta del FoundationOne CDx de hueso y del módulo 8p11/11q13 (FGFR1 / CCND1 / FGF3-4-19) como diana: qué evidencia real hay en mama luminal con amplificación alta y componente NE","en":"Expert interpretation of the bone FoundationOne CDx and of the 8p11/11q13 module (FGFR1 / CCND1 / FGF3-4-19) as a target: what real evidence exists in luminal breast cancer with high-level amplification and an NE component"},"fuente":"hueso_zurich","sello":"inferido"},{"valor":{"es":"Contexto de la anemia: hipoproliferativa (reticulocitos bajos, ferritina 370), transfundida el 9-sep-2026; linfocitos 0,7-0,8 basales. Condiciona aféresis, ensayos con umbral de Hb ≥9 y cualquier terapia celular","en":"Anemia context: hypoproliferative (low reticulocytes, ferritin 370), transfused on 9 Sep 2026; baseline lymphocytes 0.7-0.8. Affects apheresis, trials with an Hb threshold ≥9 and any cell therapy"},"fuente":"plan_tb06","sello":"verificado"}],"reservorio":[{"fecha":"2026-03-24","longitud_mm":150.8,"margen_mm":5,"valor":150.8,"fuente":"reservorio_cateter","sello":"verificado"},{"fecha":"2026-07-10","longitud_mm":152.2,"margen_mm":5,"valor":152.2,"fuente":"reservorio_cateter","sello":"verificado"},{"fecha":"2026-09-08","longitud_mm":151.7,"margen_mm":5,"valor":151.7,"fuente":"reservorio_cateter","sello":"verificado"}],"nunca_recibido":{"valor":[{"es":"quimioterapia","en":"chemotherapy"},{"es":"ADC (anticuerpo-fármaco conjugado)","en":"ADC (antibody-drug conjugate)"},{"es":"inmunoterapia (inhibidores de checkpoint)","en":"immunotherapy (checkpoint inhibitors)"},{"es":"radioligandos / PRRT","en":"radioligands / PRRT"},{"es":"terapia celular (CAR-T, TIL, TCR-T)","en":"cell therapy (CAR-T, TIL, TCR-T)"},{"es":"elacestrant (prescrito el 15-may-2026, nunca iniciado)","en":"elacestrant (prescribed on 15 May 2026, never started)"}],"fuente":"estado_actual","sello":"verificado"},"eventos":[{"id":"web-00","fecha_texto":"2021","desde":"2021-01-01","hasta":"2021-12-31","precision":"anio","etiqueta":"Antecedentes","clase":"antecedentes","dibujar":true,"destacado":false,"titulo":{"es":"Un primer aviso que quedó sin respuesta","en":"A first warning that went unanswered"},"enlace":null},{"id":"web-01","fecha_texto":"31 oct 2023","desde":"2023-10-31","hasta":"2023-10-31","precision":"dia","etiqueta":"Síntomas","clase":"sintomas","dibujar":true,"destacado":false,"titulo":{"es":"Empieza el dolor de espalda","en":"Back pain begins"},"enlace":null},{"id":"web-02","fecha_texto":"11 ene 2024","desde":"2024-01-11","hasta":"2024-01-11","precision":"dia","etiqueta":"Diagnóstico","clase":"diagnostico","dibujar":true,"destacado":true,"titulo":{"es":"El resultado llega por email","en":"The result arrives by email"},"enlace":null},{"id":"web-03","fecha_texto":"ene–feb 2024","desde":"2024-01-01","hasta":"2024-02-29","precision":"mes","etiqueta":"Primera línea","clase":"tratamiento","dibujar":true,"destacado":false,"titulo":{"es":"Empieza el primer tratamiento","en":"The first treatment begins"},"enlace":null},{"id":"web-04","fecha_texto":"feb–abr 2024","desde":"2024-02-01","hasta":"2024-04-30","precision":"mes","etiqueta":"Ingreso urgente","clase":"ingreso","dibujar":true,"destacado":true,"titulo":{"es":"50 días hospitalizada, 10 en UCI","en":"50 days hospitalized, 10 in ICU"},"enlace":null},{"id":"web-05","fecha_texto":"jul 2024","desde":"2024-07-01","hasta":"2024-07-31","precision":"mes","etiqueta":"Molecular","clase":"molecular","dibujar":true,"destacado":true,"titulo":{"es":"El tumor revela su identidad molecular","en":"The tumor reveals its molecular identity"},"enlace":null},{"id":"web-06","fecha_texto":"ene 2025","desde":"2025-01-01","hasta":"2025-01-31","precision":"mes","etiqueta":"Segunda línea","clase":"tratamiento","dibujar":true,"destacado":false,"titulo":{"es":"Un cambio de plan tras la progresión","en":"A change of plan after progression"},"enlace":null},{"id":"web-07","fecha_texto":"mar 2026","desde":"2026-03-01","hasta":"2026-03-31","precision":"mes","etiqueta":"Progresión","clase":"progresion","dibujar":true,"destacado":true,"titulo":{"es":"Progresión ósea","en":"Bone progression"},"enlace":null},{"id":"web-08","fecha_texto":"abr 2026","desde":"2026-04-01","hasta":"2026-04-30","precision":"mes","etiqueta":"Equipo","clase":null,"dibujar":false,"destacado":true,"titulo":{"es":"Se forma el equipo y empieza la búsqueda","en":"The team forms and the search begins"},"enlace":"https://x.com/miriamgonp/status/2041824144484917749"},{"id":"web-09","fecha_texto":"7 abr 2026","desde":"2026-04-07","hasta":"2026-04-07","precision":"dia","etiqueta":"Molecular","clase":"molecular","dibujar":true,"destacado":false,"titulo":{"es":"Leer el tumor sin tocarlo","en":"Reading the tumor without touching it"},"enlace":null},{"id":"web-10","fecha_texto":"8–9 abr 2026","desde":"2026-04-08","hasta":"2026-04-09","precision":"dia","etiqueta":"IA","clase":null,"dibujar":false,"destacado":true,"titulo":{"es":"Poner todo el caso por escrito","en":"Putting the whole case in writing"},"enlace":"https://x.com/javilop/status/2041905341059973294"},{"id":"web-11","fecha_texto":"13 abr 2026","desde":"2026-04-13","hasta":"2026-04-13","precision":"dia","etiqueta":"Molecular","clase":"molecular","dibujar":true,"destacado":false,"titulo":{"es":"Una segunda lectura confirma el perfil","en":"A second reading confirms the profile"},"enlace":null},{"id":"web-12","fecha_texto":"20 abr 2026","desde":"2026-04-20","hasta":"2026-04-20","precision":"dia","etiqueta":"Divulgación","clase":null,"dibujar":false,"destacado":true,"titulo":{"es":"Ponencia en Codemotion Madrid","en":"Talk at Codemotion Madrid"},"enlace":"https://x.com/miriamgonp/status/2046266823209890162"},{"id":"web-13","fecha_texto":"30 abr 2026","desde":"2026-04-30","hasta":"2026-04-30","precision":"dia","etiqueta":"Molecular","clase":"molecular","dibujar":true,"destacado":false,"titulo":{"es":"La aguja no encuentra tumor","en":"The needle finds no tumor"},"enlace":null},{"id":"web-14","fecha_texto":"13 may 2026","desde":"2026-05-13","hasta":"2026-05-13","precision":"dia","etiqueta":"Molecular","clase":"molecular","dibujar":true,"destacado":false,"titulo":{"es":"El tumor sigue cambiando","en":"The tumor keeps changing"},"enlace":null},{"id":"web-15","fecha_texto":"may 2026","desde":"2026-05-01","hasta":"2026-05-31","precision":"mes","etiqueta":"Tercera línea","clase":"tratamiento","dibujar":true,"destacado":false,"titulo":{"es":"Se ofrece la tercera línea","en":"The third line is offered"},"enlace":null},{"id":"web-16","fecha_texto":"17 may 2026","desde":"2026-05-17","hasta":"2026-05-17","precision":"dia","etiqueta":"Divulgación","clase":null,"dibujar":false,"destacado":false,"titulo":{"es":"El problema de los protocolos españoles","en":"The problem with the Spanish protocols"},"enlace":"https://x.com/miriamgonp/status/2055872406858682514"},{"id":"web-17","fecha_texto":"21 may 2026","desde":"2026-05-21","hasta":"2026-05-21","precision":"dia","etiqueta":"Molecular","clase":"molecular","dibujar":true,"destacado":true,"titulo":{"es":"Expertos de varios países revisan el caso","en":"Experts from several countries review the case"},"enlace":null},{"id":"web-18","fecha_texto":"30 may 2026","desde":"2026-05-30","hasta":"2026-05-30","precision":"dia","etiqueta":"Molecular","clase":"molecular","dibujar":true,"destacado":true,"titulo":{"es":"Una nueva imagen abre otra puerta","en":"A new scan opens another door"},"enlace":"https://x.com/miriamgonp/status/2060649242037723567"},{"id":"web-19","fecha_texto":"5 jun 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