Abstract
Introduction: Breast cancer represents the most frequently neoplasm diagnosed in women. Early breast cancer (EBC) occurs in 36-50% of cases, with recurrence rates of more than 20% at 10 ...years in our country. Adjuvant chemotherapy reduces recurrence rates in high-risk patients. Oncotype Dx® values the expression of 21 genes associated with recurrence. This study describes the characteristics of a third-level center population and its association with the risk of recurrence over a period of 10 years.
Methods: A retrospective review of medical records of patients with early stage IA-IIB, hormone receptors (HR +) and HER2- breast cancer treated in our institution from January 2008 to December 2018 was conducted. Clinicopathological characteristics and Oncotype Dx® recurrence score (RS) were collected and a descriptive statistical analysis of the general variables was performed.
Results: We included 136 patients with EBA clinical stage (IA-IIB), HR +/ HER2-, N0-1. Median age at diagnosis was 55.03 years (30-80), the most frequent histology in the general population was invasive ductal carcinoma (88.23%), 68.38% presented in stage IA. Patients were classified into recurrence risks according to the original description of the 21-gen expression test, 72 patients (53%) were classified as low risk (LR), 49 patients (36%) at intermediate risk (IR) and 15 (11%) patients at high risk (HR) of recurrence.
For LR patients, mean age at diagnosis was 55.5 years (30-80), for HR patients the mean age was 51.9 years (32-79). Estrogen receptors (ER) were present in all patients. Progesterone receptors were positive in 97.2% of patients with LR and only in 69% in HR. 32% of LR patients expressed Ki-67 levels greater than 15% compared to HR (80%). Lymph node status was positive in 11.1% of LR patients, 30.6% for IR and 20% for RH, tumor size was >20mm (T2) in 18% of LR patients and 26.6% in the HR group. Lymphovascular invasion (LVI) was present in 25% of LR patients while for HR it was positive in 60%, similar findings were found for perineural invasion (PNI) with 20.8% present in LR and 33.3% in the HR group. Nuclear grade was higher in the HR group (20% grade 3) compared to that of LR (5.5%).
When reclassifying the risk categories using the cut-off values in TAILORx trial, the population distribution was modified, with a notable increase in the population in IR with 86 (63.2%) patients in this group, 28 patients in the LR group (20.5%) and 22 patients (16.1%) in HR.
Conclusions: We reported the clinicopathological characteristics of a Mexican population and its distribution according to Oncotype Dx® risk groups. A higher rate of proliferation was observed by Ki-67 in the HR group, as well as a lower age of presentation, higher rates of LVI and PNI, and a higher nuclear grade. This findings agree with those reported in the literature. The update in the cut-off values for the risk categories in TAILORx resulted in an increase in the proportion of patients at intermediate and high risk.
Citation Format: Geovani Amador-García, Elina Alexandra Rodriguez-Meléndez, José Fabián Martínez-Herrera, Raúl Alejandro Andrade-Moreno, Eduardo Reyes-Sánchez, Daniela Vázquez-Juárez, Lorena López-Zepeda, Álvaro Padilla-Rodríguez, Guillermo Manuel Olivares-Beltrán, Alberto Villalobos-Prieto, Álvaro Aguayo-González, Fernando Pérez-Zincer, Christian Patricio Camacho-Limas, José Miguel Lázaro-León, Juan Alberto Serrano-Olvera, Raquel Gerson-Cwilich. Correlation between clinicopathological characteristics and oncotype Dx recurrence score (RS) in early breast cancer. Experience in a Mexican population abstract. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-07-12.
Immune checkpoint inhibitors (ICI) are a group of drugs that have been used in recent years for the treatment of advanced malignancies such as melanoma, non-small cell lung cancer and other tumors, ...significantly increasing survival. However, the use of ICI has been associated with an increased risk of autoimmune diseases, with endocrine organs, specifically the thyroid, being highly susceptible to this phenomenon.
To describe the incidence and clinical characteristics of patients treated with ICI who develop thyroid disease.
The medical records of all patients who received ICI treatment within the last three years were retrospectively reviewed, with those who developed thyroid abnormalities being identified.
The prevalence of thyroiditis was 7 %, with an incidence of 21.4 % of patients-month. Median time for the development of thyroiditis was 63 days. Most patients had mild or moderate symptoms and did not require hospitalization, although all but one developed permanent hypothyroidism and required hormone replacement therapy with levothyroxine.
Thyroid dysfunction secondary to immunotherapy is a common entity in our population. Clinical presentation is usually mild and does not require treatment discontinuation; however, due to the high incidence of these adverse events, non-oncology specialists must be familiar with the diagnosis and treatment of these alterations in order to provide multidisciplinary management.
Lung cancer represents a significant global health concern, often diagnosed in its advanced stages. The advent of massive DNA sequencing has revolutionized the landscape of cancer treatment by ...enabling the identification of target mutations and the development of tailored therapeutic approaches. Unfortunately, access to DNA sequencing technology remains limited in many developing countries. In this context, we emphasize the critical importance of integrating this advanced technology into healthcare systems in developing nations to improve treatment outcomes.
We conducted an analysis of electronic clinical records of patients with confirmed advanced non-small cell lung cancer (NSCLC) and a verified negative status for the epidermal growth factor receptor (
) mutation. These patients underwent next-generation sequencing (NGS) for molecular analysis. We performed descriptive statistical analyses for each variable and conducted both univariate and multivariate statistical analyses to assess their impact on progression-free survival (PFS) and overall survival (OS). Additionally, we classified genetic mutations as actionable or non-actionable based on the European Society for Medical Oncology Scale of Clinical Actionability of Molecular Targets (ESCAT) guidelines.
Our study included a total of 127 patients, revealing the presence of twenty-one distinct mutations. The most prevalent mutations were
(18.9%) and Kirsten rat sarcoma viral oncogene homolog (
) (15.7%). Notably, anaplastic lymphoma kinase (
) hazard ratio (HR): 0.258, P<0.001, tumor mutation burden (TMB) (HR: 2.073, P=0.042) and brain magnetic resonance imaging (MRI) (HR: 0.470, P=0.032) demonstrated statistical significance in both the univariate and multivariate analyses with respect to PFS. In terms of OS,
(HR: 0.285, P<0.001) and
(HR: 0.482, P=0.024) exhibited statistical significance in both analyses. Applying the ESCAT classification system, we identified actionable genomic variations (ESCAT level-1), including
,
, breast cancer (
) gene, c-ros oncogene 1 (
), and rearranged during transfection (
) gene, in 32.3% of the patients.
Our findings from massive DNA sequencing underscore that 32.3% of patients who test negative for the
mutation possess other targetable mutations, enabling them to receive personalized, targeted therapies at an earlier stage of their disease. Implementing massive DNA sequencing in developing countries is crucial to enhance survival rates among NSCLC patients and guide more effective treatment strategies.
More than the twenty percent of ovarian cancers are hereditary, and most have BRCA mutations. The 30% of Mexican patients with the BRCA1 mutation have the BRCA1 gene exon 9-12del deletion founder ...mutation (BRCA1 ex9-12del). BRCA-mutated tumors are more sensitive to PARP inhibitors such as olaparib.
To show the clinical experience on the use of olaparib at Instituto Nacional de Cancerología in Mexico.
Ovarian cancer patients treated with olaparib from November 2016 to December 2018 were studied, and their characteristics, clinical response, progression-free survival (PFS) and toxicities were described.
Nineteen patients were assessed, with BRCA1 mutation being found in 78.9%, out of which 21.1% were carriers of the ex9-12del founder mutation. The median of PFS was 12 months; for patients treated on second and third line it was > 15 months, and for those treated with a fourth and subsequent line it was 8.3 months. Patients with the founder mutation had better results. Toxicities were like those reported in previous studies.
Olaparib offers greater PFS benefit as maintenance therapy after a first and second relapse. Patients with founder mutation have had sustained PFS.
PDF
