ABSTRACT
PURPOSE: The incidence of breast cancer in young women (BCYW) has increased in recent decades. Malignant disease in this subset is characterized by its aggressiveness and poor prognosis. Ovarian function suppression (OFS) in these patients improves survival especially in hormone receptor-positive (HR +) cases. The Regan Composite Risk (RCR) is a prognostic tool to identify high-risk HR + BC candidates for OFS. Our study sought to characterize a Chilean cohort of early HR + BCYW assessing the use of OFS and its related prognosis and the utility of RCR in our patients. METHODS: This was a retrospective population cohort study that included ≤ 35-year-old early HR + /human epidermal growth factor receptor 2 -negative (HER2-) BC patients treated between 2001 and 2021. Analysis included clinical-pathological characteristics, treatment strategies, and survival. Also, we evaluated the association between RCR and survival. RESULTS: A total of 143 patients were included into our study, representing 2.9% of all early BC cases in our registry. Median age was 31 years old (range: 19-35). Most patients (93%) received endocrine therapy (ET). Of these, 18% received OFS. No survival differences were observed among treatment strategies. Median RCR score for patients treated with CT plus ET was significantly higher vs. ET alone (2.95 vs. 1.91; p = 0.0001). Conversely, patients treated with tamoxifen alone had significantly lower RCR scores vs. OFS (2.72 vs. 3.14; p = 0.04). Higher RCR scores were associated with poorer overall survival. CONCLUSION: Less than 20% of very young women with early HR + /HER2-BC in our cohort received OFS, in most cases, this involved surgical oophorectomy. RCR score was higher in patients that underwent CT and OFS and was associated with survival, regardless of treatment. We confirm the RCR score as a valuable prognostic tool to identify high-risk BC patients who could benefit from OFS.
Subject(s)
Breast Neoplasms , Female , Humans , Adult , Breast Neoplasms/therapy , Breast Neoplasms/drug therapy , Antineoplastic Agents, Hormonal/therapeutic use , Retrospective Studies , Cohort Studies , Chemotherapy, Adjuvant , Premenopause , Receptor, ErbB-2/metabolismABSTRACT
Major advances in sequencing technologies and targeted therapies have accelerated the incorporation of oncology into the era of precision medicine and "biomarker-driven" treatments. However, the impact of this approach on the everyday clinic has yet to be determined. Most precision oncology reports are based on developed countries and usually involve metastatic, hard-to-treat or incurable cancer patients. Moreover, in many cases race and ethnicity in these studies is commonly unreported and real-world evidence in this topic is scarce. Herein, we report data from a total of 202 Chilean advanced stage refractory cancer patients. Retrospectively, we collected patient data from NGS tests and IHC in order to determine the proportion of patients that would benefit from targeted treatments. Overall >20 tumor types were included in our cohort and 37% of patients (n = 74) displayed potentially actionable alterations, including on-label, off-label and immune checkpoint inhibitor recommendations. Our findings were in-line with previous reports such as the cancer genome atlas (TCGA). To our knowledge, this is the first report of its kind in Latin America delivering real-world evidence to estimate the percentage of refractory tumor patients that might benefit from precision oncology. Although this approach is still in its infancy in Chile, we strongly encourage the implementation of mutational tumor boards in our country in order to provide more therapeutic options for advanced stage refractory patients.
ABSTRACT
El objetivo del siguiente estudio fue el de propiciar en la comunidad de Tiara cambios de actitudes que le permitan, a través de la participación activa, mayor autonomía para generar acciones que conlleven a optimizar la salud comunitaria. La investigación se condujo bajo el enfoque investigación-acción participativa, abarcando cuatro fases, la exploratoria, la organizativa, la de elaboración de estrategías y acciones y la evaluativa. Se obtuvieron alcances significativos no sólo a nivel de los investigadores comunitarios (comunidad propiamente dicha), sino también del equipo coordinador investigador. La conclusión más relevante señala la evidencia de un cambio de actidud de la población manifestada a través de su organización para enfrentar los problemas de salud comunitaria. Entre las recomendaciones se proponen la creación del "Proyecto Tiara" para darle continuidad al trabajo iniciado y garantizar la dotación del ambulatorio según el programa de medicina simplificada.
