ABSTRACT
INTRODUCTION: Stage III non-small-cell lung cancer (NSCLC) management is challenging given the heterogeneous nature of the disease. The LATAM subset of the real-world, global KINDLE study reported the treatment patterns and clinical outcomes for LATAM from the pre-immuno-oncology era. METHODS: The study was conducted in seven countries (Argentina, Chile, Colombia, Dominican Republic, Mexico, Peru and Uruguay) in stage III NSCLC (American Joint Committee on Cancer, 7th edition) diagnosed between January 2013 and December 2017. Retrospective data from patients' medical records (index date to the end of follow-up) were collected. Summary statistics, Kaplan-Meier survival estimates and a two-sided 95% confidence interval (CI) were provided. Cox proportional hazard model was used for univariate and multi-variate analyses. RESULTS: A total of 231 patients was enrolled, the median age was 65.0 years (range 21.0-89.0), 60.6% were males, 76.6% had smoking history, 64.0% had adenocarcinoma and 28.7% underwent curative resection. Multiple treatment regimens (>25) were used; chemotherapy alone was the most common (24.8%). The overall median progression-free survival (mPFS) and median overall survival (mOS) were 14.8 months (95% CI, 12.1-18.6) and 48.6 months (95% CI, 34.7 to not calculable). Significantly better mPFS and mOS were observed for stage IIIA with curative surgery and resectable tumours and stage IIIB with an Eastern Cooperative Oncology Group score of 0/1, female gender, resectable tumours, adenocarcinoma and curative surgery (p < 0.05). CONCLUSION: Results show diversity in treatment practices and the corresponding clinical outcomes in stage III NSCLC. There is a need to streamline treatment selection and sequencing to decrease relapse rates after initial therapy.
Subject(s)
Adenocarcinoma , Carcinoma, Non-Small-Cell Lung , Lung Neoplasms , Male , Humans , Female , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Carcinoma, Non-Small-Cell Lung/drug therapy , Lung Neoplasms/drug therapy , Latin America , Retrospective Studies , Neoplasm Recurrence, Local/pathology , Adenocarcinoma/pathology , Neoplasm StagingABSTRACT
OBJECTIVE: Latin American countries are heterogeneous in terms of lung cancer incidence and exposure to potential carcinogens. We evaluated the frequency and clinical characteristics of ALK rearrangements (ALKr) in Latin America. METHODS: A total of 5,130 lung cancer patients from 10 Latin American countries were screened for inclusion. ALKr detection was performed by fluorescence in situ hybridization (FISH), immunohistochemistry (IHC), and real-time reverse transcriptase-polymerase chain reaction (RT-PCR) to assess method variability. Demographic and clinicopathologic characteristics were analyzed. RESULTS: Among the 5,130 patients screened, 8.4% (n = 433) had nonevaluable FISH tests. Evaluable FISH analyses revealed positive ALKr in 6.8% (320/4,697) of the study population, which included patients from 9 countries. ALKr distribution for each country was: Mexico 7.6% (79/1,034), Colombia 4.1% (10/242), Argentina 6.0% (153/2,534), Costa Rica 9.5% (13/137), Panama 4.4% (5/114), Uruguay 5.4% (2/37), Chile 8.6% (16/185), Venezuela 8.9% (13/146), and Peru 10.8% (29/268). RT-PCR showed high positive (83.6%) and negative (99.7%) predictive values when compared to the gold standard FISH. In contrast, IHC only showed a high negative predictive value (94.6%). CONCLUSIONS: Although there is a clear country and continental variability in terms of ALKr frequency, this difference is not significant and the overall incidence of ALKr in Latin America does not differ from the rest of the world.
Subject(s)
Adenocarcinoma of Lung/epidemiology , Adenocarcinoma of Lung/genetics , Anaplastic Lymphoma Kinase/genetics , Biomarkers, Tumor/genetics , Gene Rearrangement , Adenocarcinoma of Lung/diagnosis , Aged , Female , Genetic Predisposition to Disease , Humans , Immunohistochemistry , In Situ Hybridization, Fluorescence , Incidence , Latin America/epidemiology , Male , Middle Aged , Molecular Epidemiology , Prevalence , Real-Time Polymerase Chain Reaction , Retrospective Studies , Reverse Transcriptase Polymerase Chain ReactionABSTRACT
Pancreatic cancer is a malignancy of great impact in developed countries and is having an increasing impact in Latin America. Incidence and mortality rates are similar for this cancer. This is an important reason to offer to the patients the best treatments available. During the Latin American Symposium of Gastroenterology Oncology (SLAGO) held in Viña del Mar, Chile, in April 2015, a multidisciplinary group of specialists in the field met to discuss about this disease. The main conclusions of this meeting, where practitioners from most of Latin American countries participated, are listed in this consensus that seek to serve as a guide for better decision making for patients with pancreatic cancer in Latin America.
Subject(s)
Humans , Pancreatic Neoplasms/therapy , Adenocarcinoma/therapy , Practice Guidelines as Topic , Disease Management , Consensus Development Conferences as Topic , Deoxycytidine/analogs & derivatives , Deoxycytidine/therapeutic use , Chemoradiotherapy , Latin America , Antimetabolites, Antineoplastic/therapeutic useABSTRACT
Pancreatic cancer is a malignancy of great impact in developed countries and is having an increasing impact in Latin America. Incidence and mortality rates are similar for this cancer. This is an important reason to offer to the patients the best treatments available. During the Latin American Symposium of Gastroenterology Oncology (SLAGO) held in Viña del Mar, Chile, in April 2015, a multidisciplinary group of specialists in the field met to discuss about this disease. The main conclusions of this meeting, where practitioners from most of Latin American countries participated, are listed in this consensus that seek to serve as a guide for better decision making for patients with pancreatic cancer in Latin America.
Subject(s)
Adenocarcinoma/therapy , Disease Management , Pancreatic Neoplasms/therapy , Practice Guidelines as Topic , Antimetabolites, Antineoplastic/therapeutic use , Chemoradiotherapy , Consensus Development Conferences as Topic , Deoxycytidine/analogs & derivatives , Deoxycytidine/therapeutic use , Humans , Latin America , GemcitabineABSTRACT
INTRODUCTION: Previously, we reported the frequency of epidermal growth factor receptor (EGFR) and KRAS mutations in nonsmall-cell lung cancer (NSCLC) patients in Latin America. The EGFR mutation frequency was found between Asian (40%) and Caucasian (15%) populations. Here, we report the updated distribution of NSCLC mutations. METHODS: A total of 5738 samples from NSCLC patients from Argentina (1713), Mexico (1417), Colombia (1939), Peru (393), Panama (174), and Costa Rica (102) were genotyped for EGFR and KRAS. RESULTS: The median patient age was 62.2 ± 12.3 years; 53.5% were women, 46.7% had a history of smoking, and 95.2% had adenocarcinoma histology. The frequency of EGFR mutations was 26.0% (95% confidence interval [CI], 24.9-27.1; Argentina, 14.4% [12.8-15.6]; México, 34.3% [31.9-36.7]; Colombia, 24.7% [22.8-26.6]; Peru, 51.1% [46.2-55.9]; Panamá, 27.3 [20.7-33.9]; and Costa Rica, 31.4% [22.4-40.4]). The frequency of KRAS mutations was 14.0% (9.1-18.9). In patients with adenocarcinoma, EGFR mutations were independently associated with gender (30.7% females vs. 18.4% males; p < 0.001), nonsmoker status (27.4% vs. 17.1%, p < 0.001), ethnicity (mestizo/indigenous, 35.3% vs. Caucasian, 13.7%, p < 0.001), and the absence of KRAS mutation (38.1% vs. 4.7%; p < 0.001). The overall response rate to EGFR tyrosine kinase inhibitors was 60.6% (95% CI, 52-69), with a median progression-free survival and overall survival of 15.9 (95% CI, 12.420.6) and 32 months (95% CI, 26.5-37.6), respectively. CONCLUSION: Our findings support the genetic heterogeneity of NSCLC in Latin America, confirming that the frequency of EGFR mutations is intermediate between that observed in the Asian and Caucasian populations.
Subject(s)
Adenocarcinoma/genetics , Carcinoma, Non-Small-Cell Lung/genetics , ErbB Receptors/genetics , Lung Neoplasms/genetics , Mutation Rate , Proto-Oncogene Proteins p21(ras)/genetics , Adenocarcinoma/pathology , Aged , American Indian or Alaska Native/genetics , Argentina , Carcinoma, Non-Small-Cell Lung/drug therapy , Carcinoma, Non-Small-Cell Lung/pathology , Colombia , Costa Rica , Disease-Free Survival , ErbB Receptors/antagonists & inhibitors , Female , Genetic Heterogeneity , Humans , Lung Neoplasms/drug therapy , Lung Neoplasms/pathology , Male , Mexico , Middle Aged , Panama , Peru , Protein Kinase Inhibitors/therapeutic use , Sex Factors , Smoking/genetics , Survival Rate , White People/geneticsABSTRACT
Introducción: El cáncer de pulmón tiene altas tasas de incidencia y mortalidad, tanto en el país como en el mundo. El conocimiento de las alteraciones moleculares en esta neoplasia ha permitido desarrollar tratamientos individualizados, observándose resultados terapéuticos muy alentadores. El objetivo de este estudio fue determinar la frecuencia de mutaciones en los exones 19 y 21 en adenocarcinoma de pulmón en nuestra población y realizar una revisión de la evidencia de eficacia de erlotinib en pacientes con cáncer de pulmón de células no pequeñas. Métodos: Se recibieron 133 muestras consecutivas de adenocarcinoma de pulmón entre enero y octubre de 2011. El estado mutacional en el exón 19 de EGFR se realizó por el método de PCR convencional, con la técnica de enriquecimiento del alelo mutado. El estado mutacional en el exón 21 fue determinado mediante el análisis de la curva de desnaturalización por PCR en tiempo real. Resultados: El estado mutacional del exón 19 fue determinado en 122 muestras (11 muestras fueron no evaluables para este análisis, debido a falta de amplificación) y del exón 21 en 104 muestras (29 no fueron evaluables). La frecuencia de mutaciones en cualquiera de los exones fue del 39,3% (48 casos), en el exón 19 fue del 32% (39 casos), en el exón 21 fue de 8,7% (9 casos) y, simultáneamente, en ambos exones, en el 1,9% (2 casos). Conclusiones: Se detectaron una incidencia de mutaciones similares a otras poblaciones latinoamericanas. La evidencia clínica revisada de los estudios OPTIMAL y EURTAC muestra resultados alentadores.
Introduction: Lung cancer has a high incidence and mortality rates in this country as other countries. The knowledge of molecular disruptions in this neoplasm has permitted to develop individual treatments, observing therapeutic results very encouraging. The aim of this study was to establish the frequency of mutations of exons 19 and 21 in lung adenocarcinoma of our population and to make a review of the evidence of erlotinibs efficacy in patients with non-small cell lung cancer. Methods: One hundred and thirty three consecutive samples of lung adenocarcinoma were received between January and October of 2011. The mutate state in the exon 19 of EGFR was made by the PCR conventional method with the enrichment technique of the mutated allele. The mutational state in exon 21 was set through the analysis of the melting curve by PCR in real time. Results: The mutational status of exon 19 was set in 122 samples (11 samples were non-evaluated for this analysis, due to the lack of amplification) and exon 21 in 104 samples (29 were non-evaluated). The frequency of mutations in any of the exons were 39.3% (48 cases), in the exon 19 was 32% (39 cases), in the exon 21 was 8.7% (9 cases) and simultaneity in both exons were 1.9% (2 cases). Conclusions: There was detected an incidence of mutation similar to other Latin American populations. Clinic evidence reviewed of studies Optimal and EURTAC show encouraged results.
Subject(s)
Humans , Antineoplastic Agents , DNA Mutational Analysis , Carcinoma, Non-Small-Cell Lung , Genes, erbB-1 , Lung Neoplasms , Receptor Protein-Tyrosine Kinases , Case ReportsABSTRACT
Los tumores de células germinales son neoplasias potencialmente curables, poco frecuentes y pueden estar relacionadas con disgenesia gonadal. En este artículo se presentan 2 casos de pacientes con tumores germinales de ovario en hermanas de 21 y 22 años de edad con retardo mental.
Germinal cells tumors are neoplasm potentially curable, less frequent and can be related with gonadal dysgenesis. In this article we show 2 cases of patients with germinal tumors of the ovary in sisters of 21 and 22 years old with mental retardation.
Subject(s)
Female , Humans , Adult , Biomarkers, Tumor , Intellectual Disability , Gonadal Dysgenesis , Siblings , Neoplasms, Germ Cell and Embryonal , Ovarian NeoplasmsABSTRACT
Los tumores neuroendocrinos primarios del esófago son raros y difícilmente considerados dentro del diagnóstico diferencial de los tumores esofágicos. En este artículo describimos el caso de un paciente de 76 años portador de un tumor neuroendocrino de células grandes primario del esófago, el cual constituiría el segundo caso reportado a nivel mundial, así como una revisión de la literatura.
Primary neuroendocrine tumors of the esophagus are rare and hardly included in differential diagnoses of esophageal tumors. In this article we describe the case of a 76 years old man with a large cell neuroendocrine carcinoma primary of the oesophagus; this is the second case reported worldwide. A literature review is presented.
Subject(s)
Male , Humans , Aged , Carcinoma, Neuroendocrine , Carcinoma, Large Cell , Esophageal NeoplasmsABSTRACT
El cáncer de pulmón constituye una de las principales causas de muerte de cáncer a nivel mundial. En este artículo se discute el rol de la quimioterapia adyuvante en el tratamiento de esta neoplasia.
Lung cancer in one of the leading causes of death by cancer worldwide. This article discusses the role of adjuvant chemotherapy in the treatment of this malignancy. (AY)
Subject(s)
Humans , Carcinoma, Non-Small-Cell Lung/therapy , Carcinoma, Non-Small-Cell Lung/drug therapy , Lung Neoplasms , Chemotherapy, AdjuvantABSTRACT
Los tumores neuroendocrinos primaros del esófago son raros y difícilmente considerados dentro del diagnóstico diferencial de los tumores primarios del esófago. En este artículo describimos el caso de un paciente de 76 años portador de un tumor neuroendocrino de células grandes primario del esófago, el cual constituiría el segundo caso reportado a nivel mundial, así como una revisión de la literatura.
Primary neuroendocrine tumors of esophagus are rare and hardly included in the differential diagnoses to esophageal tumors. In this article we describe a 76-year-old man with a large cell neuroendocrine carcinoma primary of the esophagus; this would be the second case reported worldwide. A literature review is presented.
Subject(s)
Male , Humans , Aged , Carcinoma, Neuroendocrine , Cells , Esophageal NeoplasmsABSTRACT
El cáncer de pulmón constituye una de las principales causas de muerte por cáncer a nivel mundial. En este artículo se discute el rol de la quimioterapia neoadyuvante en el tratamiento de esta neoplasia.
Lung cancer is one of the main causes of death due to cancer worldwide. This article discusses the role of neoadjuvant chemotherapy in the treatment of this neoplasia.
Subject(s)
Humans , Cells , Lung Neoplasms/therapy , Radiotherapy , Neoadjuvant TherapyABSTRACT
PURPOSE: Pazopanib and lapatinib are tyrosine kinase inhibitors that target vascular endothelial growth factor receptor, platelet-derived growth factor receptor, and c-Kit or epidermal growth factor receptor (EGFR) and human epidermal growth factor receptor 2 (HER2/neu), respectively. In cervical cancer, EGFR and HER2/neu overexpression and high microvascular density correlate with survival. PATIENTS AND METHODS: Patients with measurable stage IVB persistent/recurrent cervical carcinoma not amenable to curative therapy and at least one prior regimen in the metastatic setting were randomly assigned in a ratio of 1:1:1 to pazopanib at 800 mg once daily, lapatinib at 1,500 mg once daily, or lapatinib plus pazopanib combination therapy (lapatinib at 1,000 mg plus pazopanib at 400 mg once daily or lapatinib at 1,500 mg plus pazopanib at 800 mg once daily). Therapy continued until progression or withdrawal because of adverse events (AEs). Primary end point was progression-free survival (PFS), and secondary end points were overall survival (OS), response rate (RR), and safety. The futility boundary was crossed at the planned interim analysis for combination therapy compared with lapatinib therapy, and the combination was discontinued. RESULTS: Of 230 patients enrolled, 152 were randomly assigned to the monotherapy arms: pazopanib (n = 74) or lapatinib (n = 78). Most patients (62%) had recurrent cancer. Pazopanib improved PFS (hazard ratio [HR], 0.66; 90% CI, 0.48 to 0.91; P = .013) and OS (HR, 0.67; 90% CI, 0.46 to 0.99; P = .045). Median OS was 50.7 weeks and 39.1 weeks and RRs were 9% and 5% for pazopanib and lapatinib, respectively. The only grade 3 AE > 10% was diarrhea (11% pazopanib and 13% lapatinib). Grade 4 AEs were 9% (lapatinib) and 12% (pazopanib). CONCLUSION: This study confirms the activity of antiangiogenesis agents in advanced and recurrent cervical cancer and demonstrates the benefit of pazopanib based on the prolonged PFS and favorable toxicity profile.
Subject(s)
Angiogenesis Inhibitors/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Pyrimidines/administration & dosage , Quinazolines/administration & dosage , Sulfonamides/administration & dosage , Uterine Cervical Neoplasms/drug therapy , Adult , Aged , Aged, 80 and over , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Disease-Free Survival , Drug Delivery Systems , Female , Humans , Indazoles , Lapatinib , Middle Aged , Protein Kinase Inhibitors/therapeutic use , Pyrimidines/adverse effects , Quinazolines/adverse effects , Recurrence , Retreatment , Sulfonamides/adverse effects , Uterine Cervical Neoplasms/mortalityABSTRACT
Objetivo.- Evaluar el comportamiento clínico y los resultados del tratamiento de la ETG en el INEN en el periodo comprendido entre los años 1980 y 2005. Material y métodos.- Estudio retrospectivo realizado en el INEN entre ene-1980 y dic-2005. Se revisaron 595 historias clínicas, recopilando información clínica, tratamientos administrados, toxicidades reportadas, tasa de respuestas y sobrevida global, para los cálculos estadísticos se utilizaron las pruebas de Kaplan-Meier. Resultados.- Entre ene-1980 a dic-2005, fueron admitidas en el INEN 595 pacientes con diagnóstico de ETG: Mola Hidatiforme 254 casos (42.7%), Coriocarcinoma 201 casos (33.8%) y Mola invasiva 41 casos (6.8%) no se reportaron casos de Tumor del sitio de inserción placentaria. Las localizaciones más frecuentes de metástasis fueron: pulmón: 67.3%, vagina: 17.9%, sistema nervioso central: 8.7%, e hígado: 5.1%. Se catalogó las pacientes de acuerdo al Sistema Score de FIGO: Bajo riesgo (score 1-6) 348 pacientes (58.5%) y Alto riesgo (score >6) 247 pacientes (41.5%). El tratamiento fue con monodroga 50.4% y con poliquimioterapia 49.6%. Pacientes de bajo riesgo que recibieron tratamiento con Metotrexate VO obtuvieron respuesta completa en 66.1% de los casos y 97% de sobrevida global a 20 años. Las pacientes de alto riesgo lograron respuesta completa con MAC: 32.5 %, MEC 36.8 %, EMA-CO 50%, BEP 25%. La población de alto riesgo se dividió en dos sub-grupos de acuerdo al score mayor de 12 y menor de 12, hallándose diferencias en la sobrevida global a 20 años de 80% para la población con score menor de 12 y 48% para el grupo con score mayor de 12 quienes presentaron metástasis en hígado y cerebro en 26.5%. Conclusiones.- ETG es una neoplasia altamente curable. Las pacientes de bajo riesgo que recibieron tratamiento con Metotrexate VO, lograron sobrevida global a 20 años de 97%. Existe diferencia en la sobrevida global entre pacientes de alto riesgo con score menor de 12 (80%).
Objective.-To evaluate the clinical behavior and results of treatment of gestational trophoblastic disease at the INEN between 1980 to 2005. Material and methods.- This is a retrospective analysis from January 1980 to December 2005. Evaluation included patient clinical characteristics, treatment, toxicity, response to therapies and survival. Descriptive statistics and Kaplan-Meier for survival analysis was also determined. Results.- 595 patients with GTD were evaluated from January 1980 to December 2005. Hydatidi form mole 254 (42.7%) choriocarcinoma 201 (33.8%) invasive mole 41 (6.8%), no cases with placental insertion trophoblastic tumor (PSTT) were seen. Sites of metastasis were: lung 67.3%, vagina 17.9%, brain 8.7%, liver 5.1%. Among these patients, 247 (41.5%) were categorized by FIGO scoring System as high risk (score >6) and 348 (58.5%) as low risk (score 1-6). The low risk patients whose received treatment with Metotrexate achieved complete remission in 66.1% of cases and the overall survival rate at 20 years was 97%. Patients with high risk who received treatment with: MAC, MEC, EMACO and BEP achieved complete remission in 32.5%, 36.8%, 50% and 25% respectively. High risk populations were divided in two groups according to score > 12 and 12, who developed liver and brain metastasis in 26.5%. The overall survival rate at 20 years, for those with score 12,48%. Conclusions.-Gestational trophoblastic disease is a highly curable neoplasia. Patients with low risk, who received Metotrexate, achieved 97% overall survival rate at 20 years. There are differences inoverall survival rate between patients of high risk those with score 12 (48%) the latter presented brain and liver metastasis. lt is important to define the best treatment for this group of patients.
Subject(s)
Female , Humans , Child , Adolescent , Young Adult , Adult , Middle Aged , Aged , Gestational Trophoblastic Disease , Gestational Trophoblastic Disease/therapy , Epidemiology, Descriptive , Retrospective StudiesABSTRACT
La Doxorrubicina Liposomal Pegilada (liposoma recubierto por polietilenglicol-DLP), es una nueva forma de presentación de la Doxorrubicina que permite que el agente no sea captado por el sistema retículo endotelial, logrando una vida media mayor que la doxorrubicina convencional. Por otro lado, por su tamaño molecular no atraviesa los capilares de los tejidos normales, pero sí las de las neoplasias malignas, permitiendo que se encuentre en altas concentraciones en los tumores malignos, logrando una mayor actividad antitumoral y menor toxicidad. Objetivo: Verificar la eficacia y seguridad del uso de la DLP en diferentes tumores malignos en la práctica clínica habitual. Diseño: Registro y seguimiento de los pacientes con tumores sólidos seleccionados que reciben DLP sola o en combinación, como primera línea o como rescate. Es un estudio de farmacovigilancia donde se verifica las respuestas clínicas (eficacia) y los efectos colaterales (seguridad) que han presentado los pacientes. Materiales y Métodos: Se evaluaron pacientes con diagnóstico de neoplasia maligna que recibieron DLP por indicación de su médico tratante. La dosis de DLP fue variable dependiendo del esquema de QT, siendo la media de dosis 35 mg/m2 los controles se hicieron de acuerdo a la práctica habitual de cada médico y los datos fueron registrados considerando la efectividad y la seguridad de los tratamientos. Resultados: Entre diciembre 2001 a mayo 2003 se incluyeron 58 pacientes, la mediana de edad fue 50 años, del sexo femenino fueron 40, las patologías incluidas: cáncer de mama (20), cáncer de ovario (14), sarcoma de partes blandas (14), linfoma non Hodgkin y mieloma múltiple (4). El 74 por ciento de los pacientes completó 4 a 6 cursos de tratamiento. La tasa de respuesta objetiva según diagnóstico fue: 71 por ciento en sarcoma de partes blandas, 58 por ciento en cáncer de mama, 64 por ciento en cáncer de ovario, 83 por ciento en linfoma non Hodgkin y 67 por ciento en mieloma múltiple...
