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5th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 5)
(Elsevier Ltd., 2020) Cardoso, F; Paluch-Shimon, S; Senkus, E; Curigliano, G; Aapro, MS; André, F; Barrios, CH; Bergh, J; Bhattacharyya, GS; Biganzoli, L; Boyle, F; Cardoso, MJ; Carey, LA; Cortés, J; El Saghir, NS; Elzayat, M; Eniu, A; Fallowfield, L; Francis, PA; Gelmon, K; Gligorov, J; Haidinger, R; Harbeck, N; Hu, X; Kaufman, B; Kaur, R; Kiely, BE; Kim, SB; Lin, NU; Mertz, SA; Neciosup, SO; ffersen, BV; Ohno, S; Pagani, O; Prat, A; Penault-Llorca, F; Rugo, HS; Sledge, GW; Thomssen, C; Vorobiof, DA; Wiseman ,T; Xu, B; Norton, L; Costa, A; Winer, EP
This ESO-ESMO ABC 5 Clinical Practice Guideline provides key recommendations for managing advanced breast cancer patients. It provides updates on managing patients with all breast cancer subtypes, LABC, follow-up, palliative and supportive care. Updated diagnostic and treatment algorithms are also provided. All recommendations were compiled by a multidisciplinary group of international experts. Recommendations are based on available clinical evidence and the collective expert opinion of the authors.
A biomarker study in Peruvian males with breast cancer
(Baishideng Publishing Group, 2021) Castaneda, Carlos; Castillo, Miluska; Bernabe, LA; Sanchez, J; Torres, E; Suarez, N; Tello, K; Fuentes, H; Dunstan, J; De La Cruz, M; Cotrina, JM; Abugattas, J; Guerra, H; Gomez, HL
AIM:To investigate clinicopathological features and biomarkers of BC tumors in males and their prognostic value in Peruvian population. METHODS: This study looked at a single-institution series of 54 Peruvian males with invasive BC who were diagnosed from Jan 2004 to June 2018. Standard pathological features, TIL levels, MMR proteins, AR immunohistochemistry staining, and PIK3CA gene mutations were prospectively evaluated in cases with available paraffin material. Percentage of AR and estrogen receptor (ER) positive cells was additionally calculated by software after slide scanning. Statistical analyses included association tests, intraclass correlation test and Kaplan Meier overall survival curves. RESULTS: The median age was 63 years and most cases were ER-positive (85.7%), HER2 negative (87.2%), Luminal-A phenotype (60%) and clinical stage II (41.5%) among our male breast tumors. Median TIL was 10% and higher levels tended to be associated with Luminal-B phenotype and higher grade. AR-positive was found in 85.3% and was correlated with ER (intraclass index of 0.835, P < 0.001). Loss of MMR proteins was found in 15.4% and PIK3CA mutation (H1047R) in 14.3% (belonged to the Luminal-A phenotype). Loss of MMR proteins was associated with AR-negative (P = 0.018) but not with ER (P = 0.43) or TIL (P = 0.84). Early stages (P < 0.001) and lower grade (P = 0.006) were associated with longer overall survival. ER status, phenotype, AR status, TIL level, MMR protein loss nor PIK3CA mutation was not associated with survival (P > 0.05). CONCLUSION: Male BC is usually ER and AR positive, and Luminal-A. MMR loss and PIK3CA mutations are infrequent. Stage and grade predicted overall survival in our South American country population.
A high number of co-occurring genomic alterations detected by NGS is associated with worse clinical outcomes in advanced EGFR-mutant lung adenocarcinoma: Data from LATAM population
(Elsevier Ireland Ltd, 2022) Heredia, D; Mas, L; Cardona, AF; Oyervides, V; Motta-Guerrero, R; Galvez-Nino, M; Lara-Mejía, L; Aliaga-Macha, C; Carracedo, C; Varela-Santoyo, E; Ramos-Ramírez, M; Davila-Dupont, D; Martínez, J; Cruz-Rico, G; Remon, J; Arrieta, O
Background: Co-occurring genomic alterations identified downstream main oncogenic drivers have become more evident since the introduction of next-generation sequencing (NGS) analyses at diagnosis and progression. Emerging evidence has stated that co-occurring genomic alterations at diagnosis might represent de novo and primary resistance mechanisms to tyrosine kinase inhibitors (TKIs) in advanced EGFR-mutant (EGFRm) non-small lung cancer (NSCLC). In this study, we assessed the prognostic role of co-occurring genomic alterations in advanced EGFRm NSCLC. Methods: A cohort of 111 patients with advanced NSCLC harboring EGFR-sensitive mutations detected by PCR was analyzed in 5 Latin American oncological centers from January 2019 to December 2020. All eligible patients received upfront therapy with EGFR-TKI. Co-occurring genomic alterations were determined at diagnosis in every patient by the NGS (FoundationOneCDx) comprehensive platform, which evaluates 324 known cancer-related genes. Results: EGFR exon19 deletion was the most frequent oncogenic driver mutation (60.4 %) detected by NGS. According to the NGS assay, 31 % and 68.3 % of patients had 1–2 and ≥ 3 co-occurring genomic alterations, respectively. The most frequent co-occurring genomic alterations were TP53 mutations (64.9 %) followed by CDKN2AB alterations (13.6 %), BRCA2 (13.6 %), and PTEN (12.7 %) mutations. Baseline central nervous system disease was present in 42.7 % of patients. First- or second-generation EGFR TKIs (gefitinib, afatinib, or erlotinib) were the most common treatment in 67.5 % of patients, while osimertinib was administered in 27.9 % of cases. The median PFS in all evaluated patients was 13.63 months (95 %CI: 11.79–15.52). Using ≥ 3 co-occurring alterations as the cut-off point, patients with ≥ 3 co-occurring genomic alterations showed a median PFS, of 12.7 months (95 %CI: 9.92–15.5) vs 21.3 months (95 %CI: 13.93-NR) in patients with 2 or less co-occurring genomic alterations [HR 3.06, (95 %CI: 1.55–5.48) p = 0.0001]. Also, patients with a TP53 mutation had a shorter PFS, 13.6 (95 %CI: 10.7–15.5) vs 19.2 months (95 %CI: 12.8-NR) in wild type TP53 [HR 2.01 (95 %CI: 1.18–3.74) p = 0.12]. In the multivariate analysis, the number (≥3) of concurrent genomic alterations and ECOG PS of 2 or more were related to a significant risk factor for progression [HR 2.79 (95 %CI: 1.49–5.23) p = 0.001 and HR 2.42 (95 %CI: 1.22–4.80) p = 0.011 respectively]. Conclusion: EGFR-mutant NSCLC is not a single oncogene-driven disease in the majority of cases, harboring a higher number of co-occurring genomic alterations. This study finds the number of co-occurring genomic alterations and the presence of TP53 mutations as negative prognostic biomarkers, which confers potentially earlier resistance mechanisms to target therapy.
A Novel Splicing Mutation in the ACVRL1/ALK1 Gene as a Cause of HHT2
(MDPI, 2022) Errasti-Díaz, S; Peñalva, M; Recio-Poveda, L; Vilches, S; Casado-Vela, J; Pérez Pérez, J; Botella, LM; Albiñana, V; Cuesta, AM
Hereditary Hemorrhagic Telangiectasia (HHT) is a rare disorder of vascular develop-ment. Common manifestations include epistaxis, telangiectasias and arteriovenous malformations in multiple organs. Different deletions or nonsense mutations have been described in the ENG (HHT1) or ACVRL1/ALK1 (HHT2) genes, all affecting endothelial homeostasis. A novel mutation in ACVRL1/ALK1 has been identified in a Peruvian family with a clinical history compatible to HHT. Subsequently, 23 DNA samples from oral exchanges (buccal swaps) of the immediate family members were analyzed together with their clinical histories. A routine cDNA PCR followed by comparative DNA sequencing between the founder and another healthy family member showed the presence of the aforementioned specific mutation. The single mutation detected (c.525 + 1G > T) affects the consensus splice junction immediately after exon 4, provokes anomalous splicing and leads to the inclusion of intron IV between exons 4 and 5 in the ACVRL1/ALK1 mRNA and, therefore, to ALK1 haploinsufficiency. Complete sequencing determined that 10 of the 25 family members analyzed were affected by the same mutation. Notably, the approach described in this report could be used as a diagnostic technique, easily incorporated in clinical practice in developing countries and easily extrapolated to other patients carrying such a mutation.
A Novel Variant in SQSTM1 Gene Causing Neurodegeneration with Ataxia, Dystonia, and Gaze Palsy in a Peruvian Family
(John Wiley and Sons Inc, 2024) Chacaltana-Vinas, C; Ramirez-Pajares, P; Manrique-Palomino, A; Clause, AR; Chawla, A; Thorpe, E; Taft, R; Rivera-Valdivia, A; Sarapura-Castro, E; Bazalar-Montoya, J; Cornejo-Olivas, M
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A phased approach to implementing the Breast Imaging Reporting and Data System (BI-RADS) in low-income and middle-income countries
(John Wiley and Sons Inc., 2020) Lam, DL; Entezari, P; Duggan, C; Muyinda, Z; Vasquez, A; Huayanay, J; Anderson, BO; Scheel, JR
Background: Successful breast cancer detection programs rely on standardized reporting and interpreting systems, such as the Breast Imaging Reporting and Data System (BI-RADS), to improve system performance. In low-income and middle-income countries, evolving diagnostic programs have insufficient resources to either fully implement BI-RADS or to periodically evaluate the program's performance, which is a necessary component of BI-RADS. This leads to inconsistent breast ultrasound interpretation and a failure to improve performance. Methods: The authors applied the Breast Health Global Initiative's phased implementation strategy to implement diagnostic ultrasound and BI-RADS within the context of a limited-resource setting. Results: The authors recommended starting with triage ultrasound to distinguish suspicious masses from normal breast tissue and benign masses such as cysts because the majority of health workers performing ultrasounds at this level have minimal breast imaging experience. Transitioning to full diagnostic ultrasound with condensed or full BI-RADS should occur after performance and quality metrics have been met. Conclusions: Transitioning through these phases across facilities likely will occur at different times, particularly in rural versus urban settings.
A plain language summary of the CAPItello-291 study: Capivasertib in hormone receptor-positive advanced breast cancer
(Taylor and Francis Ltd., 2024) Turner, NC; Oliveira, M; Howell, SJ; Dalenc, F; Cortés, J; Gomez, HL; Hu, X; Jhaveri, K; Krivorotko, P; Loibl, S; Murillo, SM; Park, YH; Sohn, J-H; Toi, M; Tokunaga, E; Yousef, S; Zhukova, L; de, Bruin, E; Grinsted, L; Schiavon, G; Foxley, A; Rugo, HS
What is this summary about?: This is a summary of the article discussing the results of the CAPItello-291 study. In the study, participants had advanced breast cancer that could not be completely removed with surgery, and that was diagnosed as a type of breast cancer where tumor cells had hormone receptors (HR-positive) but did not have HER2 receptors (HER2-negative). All participants were also required to have previously received treatment with a type of therapy called an aromatase inhibitor (with or without a CDK4/6 inhibitor), but over time their cancer cells had still grown or spread. The CAPItello-291 study researchers wanted to find out if a treatment combination of the medications capivasertib plus fulvestrant worked better than placebo plus fulvestrant. Capivasertib is a drug that blocks the activity of a protein called AKT, which is found inside breast cancer cells. What are the key takeaways?: The main finding was that participants who took capivasertib plus fulvestrant lived longer without their disease getting worse (progressing) compared with those treated with placebo plus fulvestrant. This is called progression-free survival. This result was seen across all participants (median progression-free survival of 7.2 months with capivasertib plus fulvestrant vs 3.6 months with placebo plus fulvestrant). It was also seen in participants whose tumors had detectable genetic alterations in genes called PIK3CA, AKT1, and/ or PTEN (median progression-free survival of 7.3 months with capivasertib plus fulvestrant vs 3.1 months with placebo plus fulvestrant). The most common side effects experienced by participants included diarrhea and different types of rash. These were as expected (given how capivasertib works). The CAPItello-291 study is still ongoing, and more results are expected to be released in the future. What were the main conclusions reported by the researchers?: Results from the CAPItello-291 study showed that capivasertib plus fulvestrant compared with placebo plus fulvestrant improved progression-free survival in participants with HR-positive/ HER2-negative advanced breast cancer whose cancer had grown or spread despite hormone therapy (with/without a CDK4/6 inhibitor). Clinical Trial Registration:NCT04305496 (CAPItello-291) (ClinicalTrials.gov).
A preoperative nomogram for predicting long-term survival after resection of large hepatocellular carcinoma (>10 cm)
(Elsevier B.V., 2022) Ruiz-Figueroa, E; Pineau, P; Flores, C; Fernández, R; Cano, L; Cerapio, JP; Casavilca-Zambrano, S; Berrospi, F; Chávez, I; Roche, B; Bertani, S
Background: It has previously been demonstrated that a fraction of patients with hepatocellular carcinoma (HCC) > 10 cm can benefit from liver resection. However, there is still a lack of effective decision-making tools to inform intervention in these patients. Methods: We analysed a comprehensive set of clinical data from 234 patients who underwent liver resection for HCC >10 cm at the National Cancer Institute of Peru between 1990 and 2015, monitored their survival, and constructed a nomogram to predict the surgical outcome based on preoperative variables. Results: We identified cirrhosis, multifocality, macroscopic vascular invasion, and spontaneous tumour rupture as independent predictors of survival and integrated them into a nomogram model. The nomogram's ability to forecast survival at 1, 3, and 5 years was subsequently confirmed with high concordance using an internal validation. Through applying this nomogram, we stratified three groups of patients with different survival probabilities. Conclusion: We constructed a preoperative nomogram to predict long-term survival in patients with HCC >10 cm. This nomogram is useful in determining whether a patient with large HCC might truly benefit from liver resection, which is paramount in low- and middle-income countries where HCC is often diagnosed at advanced stages. © 2021 The Author(s)
A preoperative risk score based on early recurrence for estimating outcomes after resection of hepatocellular carcinoma in the non-cirrhotic liver
(Elsevier B.V., 2024) Ruiz, E; Honles, J; Fernández, R; Uribe, K; Cerapio, JP; Cancino, K; Contreras-Mancilla, J; Casavilca-Zambrano, S; Berrospi, F; Pineau, P; Bertani, S
Background: Liver resection is the mainstay treatment option for patients with hepatocellular carcinoma in the non-cirrhotic liver (NCL-HCC), but almost half of these patients will experience a recurrence within five years of surgery. Therefore, we aimed to develop a rationale-based risk evaluation tool to assist surgeons in recurrence-related treatment planning for NCL-HCC. Methods: We analyzed single-center data from 263 patients who underwent liver resection for NCL-HCC. Using machine learning modeling, we first determined an optimal cut-off point to discriminate early versus late relapses based on time to recurrence. We then constructed a risk score based on preoperative variables to forecast outcomes according to recurrence-free survival. Results: We computed an optimal cut-off point for early recurrence at 12 months post-surgery. We identified macroscopic vascular invasion, multifocal tumor, and spontaneous tumor rupture as predictor variables of outcomes associated with early recurrence and integrated them into a scoring system. We thus stratified, with high concordance, three groups of patients on a graduated scale of recurrence-related survival. Conclusion: We constructed a preoperative risk score to estimate outcomes after liver resection in NCL-HCC patients. Hence, this score makes it possible to rationally stratify patients based on recurrence risk assessment for better treatment planning.
A Spectrum of Metastases to the Breast: Radiologic-Pathologic Correlation
(Oxford University Press, 2023-03) Huayanay Espinoza, Jorge L; Mego Ramírez , Fiorela N; Guerra Miller, Henry; Henry Guerra, Miller; Huayanay Santos , Jorge L; Guelfguat, Mark
Metastases to the breast from non-mammary origin are rare. The majority of these lesions appear as secondary manifestations of melanoma and lymphoma, followed by lung carcinomas, gynecological carcinomas, and sarcomas. There has been a steady trend of an increase in diagnosis of intramammary metastases owing to the current advances in imaging technology. Imaging features depend on the type of primary neoplasm and route of dissemination, some of which resemble primary breast cancer and benign breast entities. There are certain imaging features that raise the level of suspicion for metastases in the correct clinical context. However, imaging manifestations of intramammary metastases do not always comply with the known classic patterns. The aim of this review is to clarify these features, emphasizing radiologic-pathologic correlation and a multidisciplinary approach, since most cases are found in patients with advanced disease.
A Spectrum of Metastases to the Breast: Radiologic-Pathologic Correlation
(Oxford University Press, 2023) Espinoza, JLH; Ramirez, FNM; Miller, HG; Santos, JLH; Guelfguat, M
Metastases to the breast from non-mammary origin are rare. The majority of these lesions appear as secondary manifestations of melanoma and lymphoma, followed by lung carcinomas, gynecological carcinomas, and sarcomas. There has been a steady trend of an increase in diagnosis of intramammary metastases owing to the current advances in imaging technology. Imaging features depend on the type of primary neoplasm and route of dissemination, some of which resemble primary breast cancer and benign breast entities. There are certain imaging features that raise the level of suspicion for metastases in the correct clinical context. However, imaging manifestations of intramammary metastases do not always comply with the known classic patterns. The aim of this review is to clarify these features, emphasizing radiologic-pathologic correlation and a multidisciplinary approach, since most cases are found in patients with advanced disease. © 2023 Society of Breast Imaging. All rights reserved.
Absceso subretinal por Candida tropicalis en un paciente con leucemia mieloide: reporte de caso
(Elsevier Ltd, 2022) Cruzado-Sánchez, D; Barrios-Borjas, DA; Sapaico-Vicuña, AR; Tellez, WA; Holguín-Ruiz, AM
A 54-year-old female patient with a history of acute myeloid leukaemia and receiving maintenance chemotherapy had a systemic relapse. She also had candidaemia caused by Candida tropicalis. Her blood cultures were negative after receiving antifungal treatment. Later, she had an ophthalmological assessment as part of the protocol, without ocular discomfort. In the fundoscopic examination, a whitish chorioretinal lesion was found in the left eye in relation to subretinal abscess, which correlated with retinal angiography and optical coherence tomography. The patient was treated with systemic antifungals with a favourable resolution of the lesion.
Access to Methotrexate Monitoring in Latin America: A Multicountry Survey of Supportive Care Capacity
(Taylor and Francis Ltd., 2024) Villanueva, G; Lowe, J; Tentoni, N; Taluja, A; Villarroel, M; Narváez, CE; León, SA; Valencia, Libreros, DL; Gonzalez, Suárez, N; Mikkelsen, TS; Howard, SC
High-dose methotrexate (HDMTX) is used to treat a broad spectrum of cancers. Methotrexate (MTX) monitoring and adequate supportive care are critical for safe drug administration; however, MTX level timing is not always possible in low- and middle-income countries. The aim of this study was to evaluate HDMTX supportive care capacity and MTX monitoring practices in Latin America (LATAM) to identify gaps and opportunities for improvement. A multicenter survey was conducted among LATAM pediatric oncologists. Twenty healthcare providers from 20 institutions answered the online questionnaire. HDMTX was used to treat acute lymphoblastic leukemia (ALL; 100%), non-Hodgkin lymphoma (84.2%), diffuse large B-cell lymphoma (47.4%), osteosarcoma (78.9%), and medulloblastoma (31.6%). Delays in starting HDMTX infusion were related to bed shortages (47.4%) and MTX shortages (21.1%). MTX monitoring was performed at an in-hospital laboratory in 52%, at an external/nearby laboratory in 31.6%, and was not available in 10.5%. Median interval between sampling and obtaining MTX levels was ≤ 2 h in 45% and ≥ 6 h in 30%, related to laboratory location. Sites without access to MTX monitoring reduced the MTX dose for patients with high-risk ALL or did not include MTX in the treatment of patients with osteosarcoma. Respondents reported that implementation of point-of-care testing of MTX levels is feasible. In LATAM, highly variable supportive care capacity may affect the safe administration of MTX doses. Improving accessibility of MTX monitoring and the speed of obtaining results should be prioritized to allow delivery of full doses of MTX required by the current protocols.
Acciones preventivas sobre extravasacion por medio de contraste en pacientes
(CINCADER Publishing, 2022) Arias-Osorio, Jovita; Martinez-Miranda, Doris-Haydee; Meneses-la-Riva, Monica-Elisa
Objective: To analyze scientific evidence on prevention measures related to contrast media extravasation in patients. Methodology: A literature review was conducted using 4 databases SciELO, Pubmed, Scopus and Google Scholar in the last ten years, including studies in English, Spanish and Portuguese published in full text indexed journals, carrying a critical analysis of each selected article, reflecting a matrix to sort and categorize. Results: of the 15 scientific articles of the results found show the need to provide the identification of the risk scale (low. mild moderate and high) The affected areas usually present benign lesions characterized by hypervolemia and localized erythema that tend to heal spontaneously without sequelae. However, severe lesions, such as compartment syndrome, can also occur. For these reasons, it is necessary to know the patients at risk, technical characteristics, early diagnosis and timely management of this complication. These are the basic skills that every specialist nursing professional should possess. Conclusions: Extravasation considered an indicator of quality-of-care service in nursing care, with which preventive, corrective and educational measures should be taken in the area where venous accesses are manipulated, an adequate choice of injection site, puncturing thick veins from the elbow crease towards proximal avoiding future complications to reduce the incidence as a zero objective.
Actitud y afrontamiento ante la muerte: Un desafío actual para los profesionales de Enfermería en tiempos de Pandemia
(CINCADER Publishing, 2020) Orihuela-Castro, Alda-Eliana; Meneses-La-Riva, Monica-Elisa; Cosme-Mendoza, Melitta-Fidelia; Soriano-Ramos, Silvia-Ofelia; Levano-Cardenas, Maria-Gioconda; Bazan-Tanchiva, Luis-Javier
Currently the pandemic has caused health systems to collapse due to the high demand of patients with VOC 19 with a high risk of mortality bringing with it pain, suffering and death. Objective: To determine the relationship between a nurse's attitude and coping with the death of a cancer patient with COVID-19 in the Critical Care Unit. Methodology: Quantitative, correlational, cross-sectional and non-experimental design approach. The population is made up of a total of 65 nursing professionals who work in the Critical Care Unit. An instrument was applied on attitudes towards death CAM with 3 dimensions: affective, behavioral and cognitive, with 33 items and the Bugen Scale for facing death with 30 items, both Likert scales. The results show that there is a significant correlation 0.039 between both variables and in the case of the nurse's attitude according to the dimensions: cognitive, behavioral, affective and coping, their correlations are: 0.521, 0.719, 0.015 respectively. It is concluded that the attitude and the coping of the nursing professional in the face of the death of the cancer patient with COVID 19, assume a posture of resilience to offer continuous nursing care to ensure, restore and safeguard the life of the person as a priority in their leading role within the health system based on commitment and social responsibility despite the threats of existing occupational risks. It is suggested to offer psychological protection to diminish the potential risks in the emotional health and quality of work life.
Activation of MAPK pathways due to DUSP4 loss promotes cancer stem cell-like phenotypes in basal-like breast cancer
(American Association for Cancer Research Inc., 2020) Balko, JM; Schwarz, LJ; Bhola, NE; Kurupi, R; Owens, P; Miller, TW; Gómez, H; Cook, RS; Arteaga, CL
Basal-like breast cancer (BLBC) is an aggressive disease that lacks a clinically approved targeted therapy. Traditional chemotherapy is effective in BLBC, but it spares the cancer stem cell (CSC)-like population, which is likely to contribute to cancer recurrence after the initial treatment. Dual specificity phosphatase-4 (DUSP4) is a negative regulator of the mitogen-activated protein kinase (MAPK) pathway that is deficient in highly aggressive BLBCs treated with chemotherapy, leading to aberrant MAPK activation and resistance to taxane-induced apoptosis. Herein, we investigated how DUSP4 regulates the MAP-ERK kinase (MEK) and c-jun-NH2-kinase (JNK) pathways in modifying CSC-like behavior. DUSP4 loss increased mammosphere formation and the expression of the CSC-promoting cytokines interleukin (IL)-6 and IL-8. These effects were caused in part by loss of control of the MEK and JNK pathways and involved downstream activation of the ETS-1 and c-JUN transcription factors. Enforced expression of DUSP4 reduced the CD44(+)/CD24(-) population in multiple BLBC cell lines in a MEK-dependent manner, limiting tumor formation of claudin-low SUM159PT cells in mice. Our findings support the evaluation of MEK and JNK pathway inhibitors as therapeutic agents in BLBC to eliminate the CSC population.
Active cancer as the main predictor of mortality for COVID-19 in oncology patients in a specialized center
(Frontiers Media SA, 2023) Villanueva-Cotrina, F; Velarde, J; Rodriguez, R; Bonilla, A; Laura, M; Saavedra, T; Portillo-Alvarez, D; Bustamante, Y; Fernandez, C; Galvez-Nino, M.
Introduction: The role of the type, stage and status of cancer in the outcome of COVID-19 remains unclear. Moreover, the characteristic pathological changes of severe COVID-19 reveled by laboratory and radiological findings are similar to those due to the development of cancer itself and antineoplastic therapies. Objective: To identify potential predictors of mortality of COVID-19 in cancer patients. Materials and methods: A retrospective and cross-sectional study was carried out in patients with clinical suspicion of COVID-19 who were confirmed for COVID-19 diagnosis by RT-PCR testing at the National Institute of Neoplastic Diseases between April and December 2020. Demographic, clinical, laboratory and radiological data were analyzed. Statistical analyses included area under the curve and univariate and multivariate logistic regression analyses. Results: A total of 226 patients had clinical suspicion of COVID-19, the diagnosis was confirmed in 177 (78.3%), and 70/177 (39.5%) died. Age, active cancer, leukocyte count ≥12.8 × 109/L, urea ≥7.4 mmol/L, ferritin ≥1,640, lactate ≥2.0 mmol/L, and lung involvement ≥35% were found to be independent predictors of COVID-19 mortality. Conclusion: Active cancer represents the main prognosis factor of death, while the role of cancer stage and type is unclear. Chest CT is a useful tool in the prognosis of death from COVID-19 in cancer patients. It is a challenge to establish the prognostic utility of laboratory markers as their altered values it could have either oncological or pandemic origins. Copyright © 2023 Villanueva-Cotrina, Velarde, Rodriguez, Bonilla, Laura, Saavedra, Portillo-Alvarez, Bustamante, Fernandez and Galvez-Nino.
Adaptation of international coronavirus disease 2019 and breast cancer guidelines to local context
(Baishideng Publishing Group, 2021) Valencia, GA; Neciosup, S; Gómez, HL; Benites, MDP; Falcón, S; Moron Dveliz, K; Maldonado, M; Auqui, R
Background: The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (a novel coronavirus), which was first identified amid an outbreak of respiratory illness cases in Wuhan, China and declared a global health emergency, is currently considered an additional challenge in the management of patients with breast cancer (BC). Cancer patients are more vulnerable to becoming infected with severe acute respiratory syndrome coronavirus 2 and are more likely to suffer additional complications that can increase mortality. Identifying those BC patients who require more urgent therapy than others in the current situation is essential. These recommendations are based on and have been adapted from those similarly published by international scientific societies for BC management. They are divided mainly by clinical stage (early, advanced), subtype [luminal, human epidermal growth factor receptor 2 (HER2), triple-negative], or type of medical treatment and setting (neoadjuvant, adjuvant, metastatic). Recommendations for HER2 and triple-negative subtypes are similar, whereas in luminal subtype there are various options of management. The objective is to adapt guidelines to local context through relevant decision-makers, avoiding duplication of efforts and optimizing use or resources. We hope that these recommendations will help medical oncologists provide the best quality care to BC patients during the COVID-19 pandemic with information tailored to our healthcare system. Aim: To establish and adapt recommendations from those published by international scientific societies for BC management. Methods: The Peruvian Society of Medical Oncology developed a consensus and propose here a manuscript with recommendations for oncological medical treatment of BC during the COVID-19 pandemic. The Peruvian Society of Medical Oncology invited a panel of experts and opinion leaders on BC working in major health care systems around Peru. Panel experts selected three international clinical practice guidelines (National Comprehensive Cancer Network, European Society for Medical Oncology, Spanish Foundation Research Group in Breast Cancer), considering that these are more representative in COVID-19 management. Also, the panel agreed to include at least one European and American clinical practice guideline. Results: Recommendations about BC management during the COVID-19 pandemic were divided mainly by clinical stage (early, advanced), subtype (luminal, HER2, triple-negative), or type of medical treatment and setting (neoadjuvant, adjuvant, metastatic). Recommendations for HER2 and triple-negative subtypes were similar between clinical practice guidelines, whereas in luminal subtype there were various options of management. One hundred twelve recommendations were reviewed, adapted, and voted. A consensus was made in order to provide best decisions of management, avoid duplication of efforts, and optimize medical resources, considering health care system reality. These recommendations are not intended to replace clinical judgment.Conclusion: Most of recommendations are similar, mainly in high-risk subtypes (HER2, triple-negative). Certain societies adapt them to deal with different situations involving the best decision in the management of BC patients.
Adjuvant chemotherapy after curative D2 gastrectomy in Latin American patients with gastric cancer
(ecancer Global Foundation, 2022) Serrano, M; Araujo, JM; Pacheco-Román, C; Macetas, J; Blum, MA; Carrato, A; Ruiz-Figueroa, E; Berrospi-Espinoza, F; Luque Vasquez, C; Chavez-Pasiuri, IK; Payet-Meza, ET; Taxa-Rojas, L; Montenegro, P
Background: Gastric cancer (GC) is the fourth most common cause of cancer deaths around the world and the first cause of cancer deaths in Peru
Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer
(Massachussetts Medical Society, 2018) Sparano, JA; Gray, RJ; Makower, DF; Pritchard, KI; Albain, KS; Hayes, DF; Geyer, CE Jr; Dees, EC; Goetz, MP; Olson, JA Jr; Lively, T; Badve, SS; Saphner, TJ; Wagner, LI; Whelan, TJ; Ellis, MJ; Paik, S; Wood, WC; Ravdin, PM; Keane, MM; Gomez Moreno, HL; Reddy, PS; Goggins, TF; Mayer, IA; Brufsky, AM; Toppmeyer, DL; Kaklamani, VG; Berenberg, JL; Abrams, J; Sledge, GW Jr
Background: The recurrence score based on the 21-gene breast cancer assay predicts chemotherapy benefit if it is high and a low risk of recurrence in the absence of chemotherapy if it is low; however, there is uncertainty about the benefit of chemotherapy for most patients, who have a midrange score. Methods: We performed a prospective trial involving 10,273 women with hormone-receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative, axillary node-negative breast cancer. Of the 9719 eligible patients with follow-up information, 6711 (69%) had a midrange recurrence score of 11 to 25 and were randomly assigned to receive either chemoendocrine therapy or endocrine therapy alone. The trial was designed to show noninferiority of endocrine therapy alone for invasive disease-free survival (defined as freedom from invasive disease recurrence, second primary cancer, or death). Results: Endocrine therapy was noninferior to chemoendocrine therapy in the analysis of invasive disease-free survival (hazard ratio for invasive disease recurrence, second primary cancer, or death [endocrine vs. chemoendocrine therapy], 1.08; 95% confidence interval, 0.94 to 1.24; P=0.26). At 9 years, the two treatment groups had similar rates of invasive disease-free survival (83.3% in the endocrine-therapy group and 84.3% in the chemoendocrine-therapy group), freedom from disease recurrence at a distant site (94.5% and 95.0%) or at a distant or local-regional site (92.2% and 92.9%), and overall survival (93.9% and 93.8%). The chemotherapy benefit for invasive disease-free survival varied with the combination of recurrence score and age (P=0.004), with some benefit of chemotherapy found in women 50 years of age or younger with a recurrence score of 16 to 25. Conclusions: Adjuvant endocrine therapy and chemoendocrine therapy had similar efficacy in women with hormone-receptor-positive, HER2-negative, axillary node-negative breast cancer who had a midrange 21-gene recurrence score, although some benefit of chemotherapy was found in some women 50 years of age or younger. (Funded by the National Cancer Institute and others; TAILORx ClinicalTrials.gov number, NCT00310180 .).

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