Survival Outcomes of Metastatic Non-small Cell Lung Cancer Patients With Limited Access to Immunotherapy and Targeted Therapy in a Cancer Center of a Low- and Middle-Income Country.

OBJECTIVE: To describe the survival outcomes of metastatic non-small cell lung cancer patients with limited access to immunotherapy and targeted therapy in a cancer reference center in Colombia. METHODS: A retrospective analysis of metastatic non-small cell lung cancer patients treated between 2013 and 2018 was performed, majority diagnosed with adenocarcinoma. It was carried out in a public cancer reference center that provides care to patients of low and middle socioeconomic status. Overall survival and progression-free survival were evaluated by Kaplan-Meier analysis and log-rank test. A Cox regression model was performed for univariate and multivariate analysis. RESULTS: 209 patients were included with majority of adenocarcinoma (79.5%). First-line treatment was cytotoxic chemotherapy (50.2%), EGFR-targeted therapy (14.8%), chemoimmunotherapy (1.9%), and ALK-targeted therapy (1.4%). 31.6% received best supportive care. Median time of follow-up was 13 months, median overall survival was 11.2 months (95% CI, 7.9-14.4), 13 months for adenocarcinoma (95% CI, 8.1-17.9), and 2.5 months for squamous cell carcinoma (95% CI, 0.6-4.4) (P < .001). Median progression-free survival was 9.3 months (95% CI, 7.9-10.7) without differences according to the type of first-line therapy. Median time-to-treatment was 55 days and only 54% of patients with a tested actionable mutation in EGFR received an EGFR-targeted therapy as the first-line treatment. Multivariate analysis showed that squamous cell carcinoma histology and receiving best supportive care were independent factors for worse overall survival ((HR:1.8, 95% CI, 1.076-3.082, P=.026) and (HR:14.6, 95% CI, 8.921-24.049, P < .001), respectively). Meanwhile, squamous cell carcinoma histology was an independent factor for worse progression-free survival (HR:3.4, 95% CI, 1.540-7.464, P=.002). CONCLUSIONS: Despite advances in precision medicine, during the study period, cytotoxic chemotherapy was the most used treatment in our patients. Furthermore, about a third of them received best supportive care. The use of targeted therapies has been restricted by access to molecular diagnosis and remained low until 2018. Access to immunotherapy should be prioritized.

Características de los pacientes con cáncer de pulmón de célula no pequeña en el Instituto Nacional de Cancerología de Colombia / Characteristics of patients with non-small cell lung cancer at the National Cancer Institute of Colombia

Resumen Objetivos: Describir las características demográficas, histopatológicas, biología molecular tumoral y estadificación de los pacientes con cáncer de pulmón de célula no pequeña atendidos entre diciembre de 2013 y diciembre de 2018 en el Instituto Nacional de Cancerología de Colombia. Métodos: Estudio descriptivo de corte transversal. Resultados: Se incluyeron 392 pacientes con cáncer de pulmón de célula no pequeña, la mediana de edad fue 65.9 años (rango, 28,9 a 88,9 años). 198 (50,5%) pacientes fueron mujeres, obteniendo una relación hombre mujer 1:1. El 90.6% de los casos eran mayores de 50 años. Antecedente de tabaquismo se presentó en 211 (53,8%) pacientes, 75.8% de la población masculina y 32,3% de la población femenina eran fumadores. El adenocarcinoma se encontró en 293 (74,7%) pacientes y el carcinoma escamocelular en 73 (18,6%) pacientes. La estadificación patológica fue: estadio I en 22 (5,6%) pacientes, estadio II en 18 (4,6%), estadio III en 40 (10,2%) pacientes, estadio IV en 311 (79,3%) pacientes y no hubo dato en un solo paciente. Se detectó la mutación del EGFR en 21,2% de los pacientes. Los reordenamientos de ALK se identificaron en 4,6% de los pacientes y el PDL 1 solo se midió en el 9% de la población. Conclusiones: este estudio nos muestra el panorama general del cáncer de pulmón de célula no pequeña en la población colombiana, en donde la mayoría de los pacientes se diagnostican en estadios avanzados de la enfermedad y nos expone la necesidad de nuevas estrategias para la detección temprana y el acceso oportuno de los pacientes con cáncer de pulmón.

Abstract Objectives: to describe the demographic and histopathologic characteristics, tumor molecular biology and staging of patients with non-small cell lung cancer treated between December 2013 and December 2018 at the National Cancer Institute of Colombia. Methods: a retrospective cohort study based on data from medical records. Results: 392 patients with non-small cell lung cancer were included. The median age was 65.9 years (range: 28.9 to 88.9 years); 198 (50.5%) patients were women, obtaining a 1:1 male-female ratio. 90.6% of the cases were older than 50 years. History of smoking occurred in 211 patients (53.8%), 75.8% of the male population and 32.3% of the female population were smokers. Adenocarcinoma was found in 293 (74.7%) patients, while squamous cell carcinoma was present in 73 (18.6%) patients. The pathological staging was: 22 (5.6%) patients were in stage I, 18 (4.6%) had stage II, 40 (10.2%) patients were in stage III, stage IV was found in 311 (79.3%) patients, and there was no data in one patient. EGFR mutation was detected in 21.2% of patients. ALK rearrangements were identified in 4.6% of patients and PDL-1 was only found in 9% of the population. Conclusions: this study presents a general panorama of non-small cell lung cancer in the Colombian population, where most patients are diagnosed in advanced stages of the disease, and highlights the need for new strategies for early detection and better access for patients with lung cancer.

Primary BRAF Mutant Melanoma of the Lung Treated with Immunotherapy and Pulmonary Bilobectomy: A Case Report.

BACKGROUND Primary melanoma of the lung is a rare tumor that represents 0.01% of primary lung tumors, with only 40 cases reported in the literature. Mucosal melanomas are tumors with a biological and clinical presentation that differs from that of cutaneous melanomas; therefore, the therapeutic approach differs as well. Survival rates of patients with primary melanoma of the lung are much lower than those of patients with cutaneous melanoma, and there are no diagnostic or treatment guidelines for this entity. Radical surgery is the treatment of choice when disease is resectable. The effectiveness of current established treatments for cutaneous melanoma (eg, immunotherapy and targeted therapy) is unknown in this particular subgroup. CASE REPORT We present the case of a patient who presented with cough and hemoptysis. The fiberoptic bronchoscopy revealed an endobronchial mass and the computed tomography images suggested an unresectable mass. The patient was initially diagnosed with an unresectable primary lung melanoma with a clinical stage IIIB (T4N2M0). This lesion achieved partial response after treatment with Pembrolizumab, which allowed radical surgery to be performed, achieving complete resection with negative margins and adequate postoperative evolution. Despite the delays in our health care system, she is currently alive and disease-free more than 24 months after diagnosis. CONCLUSIONS Immunotherapy can reduce the size of mucosal melanoma to the point that it can be resectable and this therapeutic approach increases the survival opportunities of these patients.

[Maternal feeding and social inclusion practices in mexican children with disabilities. Approach with focal groups]. / Prácticas maternas de alimentación e inclusión social de niños mexicanos con discapacidad. Aproximación con grupos focales.

OBJECTIVES: The aim of this study was to identify the maternal feeding practices with children who have some kind of disability and its influence in their social inclusion process. MATERIALS AND METHODS: Three focus groups were carried out with the participation of twelve mothers/caregivers of children with disabilities. RESULTS: The mothers/caregivers are in charge of their children's progress with respect to their physical health and disability. Their feeding practices contribute to their health condition, to the acquisition of nourishing learning, social behavior at the table, domestic collaboration, as well as to the development of language by means of the communicative interactions, and also the tightening of the affective bond between mother and child. CONCLUSIONS: Nourishing practices make possible the cultural transmission of food preferences and aversions and, additionally, generate a context that fosters the development of very diverse learning which, in the case of children with some type of disability, could contribute to the improvement of their pro-social skills and repertoires mediated by their mothers or caregivers.

OBJETIVOS: El propósito del estudio fue identificar las prácticas maternas alimentarias con niños que presentan algún tipo de discapacidad y su influencia en el proceso de inclusión social. MATERIALES Y MÉTODOS: Se realizaron tres grupos focales en los que participaron doce madres o cuidadoras de niños con discapacidad. RESULTADOS: Las madres/cuidadoras se ocupan de la mejoría de sus hijos respecto a su salud física y discapacidad. Sus prácticas de crianza alimentaria contribuyen a su estado de salud, al desarrollo de aprendizajes alimentarios, de comportamiento social en la mesa, de colaboración doméstica así como al desarrollo del lenguaje mediante las interacciones comunicativas y a estrechar los lazos afectivos madre-hijo. CONCLUSIONES: Las prácticas de crianza alimentarias posibilitan la transmisión cultural de preferencias y aversiones alimentarias y adicionalmente, generan un contexto que promueve el desarrollo de aprendizajes de muy diversa índole, que para el caso de los niños con algún tipo de discapacidad, podrían coadyuvar a mejorar sus habilidades y repertorios prosociales mediados por las madres o cuidadoras.

Prácticas maternas de alimentación e inclusión social de niños mexicanos con discapacidad. Aproximación con grupos focales / Maternal feeding and social inclusion practices in mexican children with disabilities. Approach with focal groups

RESUMEN Objetivos. El propósito del estudio fue identificar las prácticas maternas alimentarias con niños que presentan algún tipo de discapacidad y su influencia en el proceso de inclusión social. Materiales y métodos. Se realizaron tres grupos focales en los que participaron doce madres o cuidadoras de niños con discapacidad. Resultados. Las madres/cuidadoras se ocupan de la mejoría de sus hijos respecto a su salud física y discapacidad. Sus prácticas de crianza alimentaria contribuyen a su estado de salud, al desarrollo de aprendizajes alimentarios, de comportamiento social en la mesa, de colaboración doméstica así como al desarrollo del lenguaje mediante las interacciones comunicativas y a estrechar los lazos afectivos madre-hijo. Conclusiones. Las prácticas de crianza alimentarias posibilitan la transmisión cultural de preferencias y aversiones alimentarias y adicionalmente, generan un contexto que promueve el desarrollo de aprendizajes de muy diversa índole, que para el caso de los niños con algún tipo de discapacidad, podrían coadyuvar a mejorar sus habilidades y repertorios prosociales mediados por las madres o cuidadoras.

ABSTRACT Objectives. The aim of this study was to identify the maternal feeding practices with children who have some kind of disability and its influence in their social inclusion process. Materials and Methods. Three focus groups were carried out with the participation of twelve mothers/caregivers of children with disabilities. Results. The mothers/caregivers are in charge of their children's progress with respect to their physical health and disability. Their feeding practices contribute to their health condition, to the acquisition of nourishing learning, social behavior at the table, domestic collaboration, as well as to the development of language by means of the communicative interactions, and also the tightening of the affective bond between mother and child. Conclusions. Nourishing practices make possible the cultural transmission of food preferences and aversions and, additionally, generate a context that fosters the development of very diverse learning which, in the case of children with some type of disability, could contribute to the improvement of their pro-social skills and repertoires mediated by their mothers or caregivers.

Asociación entre herpes zóster y recaída o progresión de neoplasias sólidas / Association between herpes zoster and relapse or progression of solid neoplasms

Resumen Objetivo: determinar la asociación entre la presencia de herpes zóster y posterior recaída o progresión en pacientes con neoplasias sólidas. Diseño del estudio: estudio de cohorte retrospectiva en adultos con tumores malignos sólidos, tratados en dos centros de oncología de Bucaramanga, entre febrero de 2005 y noviembre de 2011. Se creó una base de datos en EpiInfo 6.04d, se analizó la información en el programa Stata 11. Lugar del estudio: dos centros de oncología de Bucaramanga. Pacientes: adultos con diagnóstico histopatológico de tumor maligno sólido. Mediciones: se determinaron los tiempos libres de progresión y recaída según el tipo de respuesta y exposición, se estimaron los riesgos dados por variables sociodemográficas y clínicas. Se calculó la incidencia de herpes zóster. Resultados: se incluyeron 444 pacientes en el grupo de respuesta parcial y 824 en el grupo derespuesta completa. No hubo asociación entre la presencia de herpes zóster y los dos desenlaces de interés: HR para progresión de 0.94 (IC95% 0.61-1.44), recaída de 0.85 (IC95% 0.46-1.55). La mediana del tiempo libre de recaída fue menor en los individuos que presentaron herpes zóster: 57.1 meses versus 87.4 meses. La incidencia acumulada de herpes zóster fue de 6.02%. Conclusión: la presencia de herpes zóster en pacientes con tumores malignos sólidos no aceleró la recaída ni progresión de la neoplasia. Se observó una tendencia a la recaída en el grupo de pacientes en respuesta completa que presentaron herpes zóster. La incidencia de la infección por herpes zóster en pacientes con tumores sólidos es mayor a la reportada en otros estudios. (Acta Med Colomb 2014; 39: 35-39).

Abstract Objective: to determine the association between the presence of herpes zoster and subsequent relapse or progression in patients with solid tumors Study design: retrospective cohort study in adults with malignant solid tumors, treated at two oncology centers in Bucaramanga between February 2005 and November 2011. A database in EpiInfo 6.04d was created and the information was analyzed in the Stata 11 program. Place of study: two Oncologyc Centers of Bucaramanga. Patients: adults with histopathological diagnosis of malignant solid tumor. Measurements: progression -free and relapse times were determined according to the type of response and exposure. Risks given by sociodemographic and clinical variables were estimated. The incidence of herpes zoster was calculated. Results: 444 patients were included in the partial response group and 824 in the complete response group. There was no association between the presence of herpes zoster and the 2 outcomes of interest: HR for progression of 0.94 (95% CI 0.61 to 1.44), relapse of 0.85 (95% CI 0.46 to 1.55). The mean of the time free of relapse was lower in individuals who had herpes zoster: 57.1 months versus 87.4 months. The cumulative incidence of herpes zoster was 6.02%. Conclusion: the presence of herpes zoster in patients with malignant solid tumors did not accelerate relapse or progression of neoplasia. A tendency to relapse was observed in the group of patients in complete response that had herpes zoster. The incidence of herpes zoster infection in patients with solid tumors is higher than that reported in other studies. (Acta Med Colomb 2014; 39: 35-39).

Characterization of odor-active volatiles in champa (Campomanesia lineatifolia R. and P.).

Volatile extracts from pulp, peels, leaves, and seeds of champa (Campomanesia lineatifolia R. and P.) were obtained by continuous liquid-liquid extraction with pentane/dichloromethane (1:1), and their chemical composition was determined by using HRGC and HRGC-MS. Differences between C. lineatifolia volatile extracts with regard to the identified compounds are presented; however, in all of them the beta-triketones were detected as major constituents (between 50 and 60% of total extract). An odor profile description of volatiles isolated in all of the extracts was obtained by HRGC-O. These analyses showed that beta-triketones contributed to the fruity, floral, and green odor notes in the flavor of fruit. Application of AEDA to pulp volatile extract revealed 2,5-dimethyl-4-methoxy-3(2H)-furanone, 2-phenylethanol, and 2,3-dihydro-5-hydroxy-6,8,8-trimethyl-2-phenyl-4H-1-benzopyran-4,7(8H)-dione (champanone C) to have the highest flavor dilution factors. In a similar way, (E)-cinnamyl alcohol, 2,5-dimethyl-4-methoxy-3(2H)-furanone, and 2,3-dihydro-5-hydroxy-6,8,8-trimethyl-2-phenyl-4H-1-benzopyran-4,7(8H)-dione (champanone C) were identified as key odorant compounds in the fruit peel volatile extract. This is the first time that the volatile composition in champa is reported and also the sensory odor importance of beta-triketones.