RESUMO
Cancer incidence reported by The Global Cancer Observatory (GLOBOCAN) is an estimate based on the registries available in each country. Their validity in regions such as Latin America is affected by the lack of reliable data and less access to healthcare among the population. Studying the geographic distribution of the incidence of malignant tumors facilitates the search for risk factors and allows prioritizing health resources. Aim: To estimate the incidence of the main malignant tumors in Chilean people with access to a private healthcare insurance at an oncological institute, and to know its geographical distribution. Material and Methods: Incident cancer cases during 2017 and 2018 were obtained from the institution's Tumor Registry. The incidence was adjusted by age and sex of the Chilean population obtained from the 2017 Census. Cancer rates were calculatedfor each of the 16 administrative regions in Chile. Results: Overall, the incidence of breast, lung, colon and thyroid cancers in the studied population was significantly higher than estimates for Chile reported by GLOBOCANfor 2020, especiallyfor thyroid cancer. There is a higher incidence of breast cancer in Greater Santiago and of lung cancer in men in the Antofagasta Region. Conclusions: The regional differences observed are explained by known risk factors. However the high incidence of lung and colon cancer in the Los Ríos Region requires further studies.
RESUMO
Introduction The incidence of cutaneous melanoma has increased worldwide over the years, and an incidence of 3 cases per 100,000 men and women is estimated in Chile. Though most of the patients are diagnosed at an early stage of the disease and have a good prognosis, advanced melanoma has poor survival results. For the treatment of melanoma, the combination of dabrafenib plus trametinib has been demonstrated to improve the outcome versus dabrafenib alone, but only indirect evidence is available for its efficacy and safety compared with immunotherapy, like nivolumab. The aim of this study is to review the available evidence to report results of efficacy and safety of dabrafenib plus trametinib in comparison with nivolumab in metastatic melanoma. Methods We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews selected, reanalyzed data of primary studies, and generated a summary of the findings table using the GRADE approach. Results and conclusions We identified five systematic reviews, including seven studies overall that included one intervention of our interest, of which all were randomized trials. We only found indirect evidence comparing dabrafenib plus trametinib versus nivolumab that came from Network Meta-Analyses. We concluded that it is not possible to decide if dabrafenib plus trametinib is a better strategy for advanced melanoma treatment than nivolumab because the certainty of the evidence is very low for efficacy and safety outcomes.
Introducción La incidencia de melanoma cutáneo ha aumentado a nivel mundial con el paso de los años, estimándose en Chile una incidencia de 3 casos por 100.000 hombres y mujeres. Aunque la mayoría de los pacientes son diagnosticados en etapas tempranas de la enfermedad y tienen un buen pronóstico, el melanoma avanzado tiene malos resultados de sobrevida. Para el tratamiento del melanoma, se ha demostrado que la combinación de dabrafenib más trametinib mejora el resultado frente a dabrafenib solo, pero sólo se dispone de evidencia indirecta sobre su eficacia y seguridad en comparación con la inmunoterapia, como nivolumab. Métodos Se realizaron búsquedas en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, que se mantiene mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Se extrajeron los datos de las revisiones sistemáticas seleccionadas, se reanalizaron los datos de los estudios primarios y se generó una tabla de resumen de los hallazgos utilizando el enfoque GRADE. Resultados y conclusiones Se identificaron cinco revisiones sistemáticas, incluyendo siete estudios en total que incluían una intervención de nuestro interés, de los cuales todos eran ensayos aleatorizados. Se concluyó que no es posible decidir si dabrafenib más trametinib es una mejor estrategia para el tratamiento del melanoma avanzado que nivolumab porque la certeza de las pruebas es muy baja para los resultados de eficacia y seguridad.