Browsing by Author "Ferreyra, Y"

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Beneficios de la quimioterapia adyuvante en los resultados de supervivencia en cáncer de mama triple negativo PT1N0M0
(Universidad Ricardo Palma, Instituto de Investigaciones en Ciencias Biomedicas, Facultad de Medicina Humana, 2024) Morante, Z; Ferreyra, Y; Valdivieso, N; Castañeda, C; Vidaurre, T; Valencia, G; Otoya, I; Fuentes, H; Neciosup, S; Gomez, HL
Introduction: Triple-negative breast cancer (TNBC) is notably an aggressive breast cancer (BC) subtype, leading to early relapse and poor prognosis. Effects of adjuvant chemotherapy among early-stage TNBC (pT1N0M0) patients remain unclear in different populations. Objectives: Our study aimed to determine the impact of adjuvant chemotherapy on overall survival (OS) and progression-free survival (PFS) within the specific subset of Peruvian pT1N0M0 TNBC patients (pT1a/b vs. pT1c). Methods: We retrospectively analyzed 2007 TNBC cases diagnosed between 2000-2014 at the Instituto Nacional de Enfermedades Neoplásicas (Lima, Peru). We included only non-metastatic TNBC cases and classified them as pT1N0M0 after surgery. TNBC patients who underwent neoadjuvant chemotherapy were excluded. We describe our population according to the tumor size from the residue disease (pT1a/b vs. pT1c). We used the Kaplan-Meier method test to determine differences in survival curves for OS and PFS. A Univariate Cox proportional hazards model was used to identify risk factors for PFS. Results: Our study cohort included 124 TNBC patients. Around 65.3% (n=81) were undergoing adjuvant chemotherapy. Notably, among pT1c patients, this treatment was more prevalent compared to pT1a/b (72.1% vs. 50.0%). Survival analysis showed no significant OS benefit from chemotherapy (HR:2.46,95%CI:0.74-8.13,p=0.13). However, a marked improvement in PFS was noted exclusively in the pT1c subgroup, with patients not treated with chemotherapy offering a prognostic risk (HR:20.10,95% CI:5.54-73.10,p<0.0001). pT1a/b patients demonstrated no benefit from chemotherapy regarding progression (HR:3.07,95% CI:0.27-34.50,p=0.34). Conclusion: Our study highlights that adjuvant chemotherapy significantly improves PFS in pT1cN0M0 TNBC patients but shows no clear benefit for smaller tumors (pT1a/bN0M0). Future research should focus on personalized chemotherapy strategies in early-stage TNBC to identify predictive markers for survival.
Subcutaneous Trastuzumab: An Observational Study of Safety and Tolerability in Patients with Early HER2-Positive Breast Cancer
(Hindawi Limited, 2024) Otoya, I; Valdiviezo, N; Morante, Z; Calle, C; Ferreyra, Y; Huarcaya-Chombo, N; Polo-Mendoza, G; Castañeda, C; Vidaurre, T; Neciosup, SP; Calderón, MJ; Gomez, HL
Purpose: In Peru, breast cancer (BC) stands as the most predominant malignancy neoplasm among women. Trastuzumab has marked a significant milestone in the management of this disease. It has been shown to improve prognosis in human epidermal growth factor receptor 2 (HER2)-expressing female patients, but its repercussions and efficacy are yet to be analyzed in a context with limited resources. Methods: The study population is made of woman patients aged 18 years and older diagnosed with HER2-positive BC at Instituto Nacional de Enfermedades Neoplásicas (INEN, Lima, Peru) during 2019-2021 and treated with at least one dose of subcutaneous trastuzumab. We reviewed medical records to register treatment characteristics, adverse events (AEs), disease progression, and survival status. We considered a median follow-up time of 36 and 45 months for progression and survival status. Results: The majority of patients were over 50 years old (54.29%). Tumor size averaged 19.7±16.1 mm. Lymph nodes were present in 44.78% of patients. Most patients received adjuvant chemotherapy (63.8%) as first-line treatment. Descriptive analyses of treatment outcomes revealed a 30% toxicity rate, primarily attributed to arthralgia (47.62%), followed by diarrhea, fatigue, and injection site reactions, with relatively lower discontinuation rates compared to larger scale studies. Differences in demographic, clinical, and treatment characteristics were not statistically significant concerning the emergence of AEs (p>0.05). Progression appeared in nine patients, and the overall survival (OS) rate stood at 98.6% and 92.8%, respectively, during a median follow-up of 36 and 45 months. Conclusion: The research suggests that subcutaneous trastuzumab is comparable in effectiveness and safety to the intravenous administration. Regional-specific studies may provide valuable insights into demographic factors influencing treatment outcomes in Peru or other countries. Furthermore, it could represent a more accessible alternative, potentially enhancing patient adherence and optimizing healthcare resource logistics. © 2024 Iris Otoya et al.
Subpopulation treatment effect pattern plot analysis: a prognostic model for distant recurrence-free survival to estimate delayed adjuvant chemotherapy initiation effect in triple-negative breast cancer
(Frontiers Media SA, 2023) Morante, Z; Ferreyra, Y; Pinto, JA; Valdivieso, N; Castañeda, C; Vidaurre, T; Valencia, G; Rioja, P; Fuentes, H; Cotrina, JM; Neciosup, S; Gomez, HL
Introduction: Triple-negative breast cancer (TNBC) is a heterogeneous disease associated with a poor prognosis. Delaying in time to start adjuvant chemotherapy (TTC) has been related to an increased risk of distant recurrence-free survival (DRFS). We aimed to develop a prognostic model to estimate the effects of delayed TTC among TNBC risk subgroups. Materials and methods: We analyzed 687 TNBC patients who received adjuvant chemotherapy at the Instituto Nacional de Enfermedades Neoplasicas (Lima, Peru). Database was randomly divided to create a discovery set (n=344) and a validation set (n=343). Univariate and multivariate Cox regression models were performed to identify prognostic factors for DRFS. Risk stratification was implemented through two models developed based on proportional hazard ratios from significant clinicopathological characteristics. Subpopulation treatment effect pattern plot (STEPP) analysis was performed to determine the best prognostic cut-off points for stratifying TNBC subgroups according to risk scores and estimate Kaplan-Meier differences in 10-year DRFS comparing TTC (≤30 vs.>30 days). Results: In univariate analysis, patients aged ≥70 years (HR=4.65; 95% CI: 2.32-9.34; p=<0.001), those at stages pT3-T4 (HR=3.28; 95% CI: 1.57-6.83; p=0.002), and pN2-N3 (HR=3.00; 95% CI: 1.90-4.76; p=<0.001) were notably associated with higher risk. STEPP analysis defined three risk subgroups for each model. Model N°01 categorized patients into low (score: 0–31), intermediate (score:32–64), and high-risk (score: 65–100) cohorts; meanwhile, Model N°02: low (score: 0–26), intermediate (score: 27–55), and high (score: 56–100). Kaplan-Meier plots showed that in the discovery set, patients with TTC>30 days experienced a 17.5% decrease in 10-year DRFS rate (95%CI=6.7-28.3), and the impact was more remarkable in patients who belong to the high-risk subgroup (53.3% decrease in 10 years-DRFS rate). Similar results were found in the validation set. Conclusions: We developed two prognostic models based on age, pT, and pN to select the best one to classify TNBC. For Model N°02, delayed adjuvant chemotherapy conferred a higher risk of relapse in patients ≥70 years and who were characterized by pT3/T4 and pN2/N3. Thus, more efforts should be considered to avoid delayed TTC in TNBC patients, especially those in high-risk subgroups.