Oncologic patients with covid 19: A mexican endeavor Daniela Shveid-Gerson; Alejandro Noguez-Ramos; Diana A. Villegas-Osorno ...
Revista medica del hospital general de mexico s.s.a,
10/2021, Letnik:
84, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Introduction: The coronavirus disease 2019 (COVID-19) pandemic is a worldwide challenge. There are few reports regarding its behavior in cancer patients. Materials and methods: Retrospective study ...including cancer patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the ABC Medical Center in Mexico City. We include general and oncological variables. We analyzed clinical features and treatment of COVID-19 and its outcomes such as hospitalization and death. Results: We report 86 patients with cancer and SARS-CoV-2 infection. The vast majority of patients 80 (93.1%) had a solid tumor while the most frequent primary tumor was breast 40 (46.5%) and lung 8 (9.3%). The clinical stage of patients was I in 22.1%, II in 16.3%, III in 31.4%, and IV in 24.4%. Antibiotics were used in 37 patients (43%) and corticosteroids in 32 (37.2%). Discussion: During disease evolution, 11 (12.8%) patients were hospitalized and 6 (7.0%) died. Variables of significant association with hospitalization include gender (men, odds ratio OR 5.6), previous cardiac disease (OR 25.1), and hematologic malignancy (OR 8.1). Associations with higher mortality rates were gender (men, OR 15), clinical Stage III/IV cancer (OR 11.3), type 2 diabetes mellitus (OR 14.7), previous cardiac disease (OR 19.2), and targeted therapy (OR 9.0). Conclusions: We found lower hospitalization and mortality rates compared to what had been previously reported both in Mexico around the globe. Men and patients with previous cardiac disease had a significant higher risk of hospitalization and death. Hematologic malignancies (lymphoma) were associated with higher hospitalization. Clinical Stage III/IV, targeted therapy, and type 2 diabetes mellitus showed a statistically significant association with mortality risk.
Introduction: The Coronavirus disease (COVID-19) pandemic is a worldwide challenge. There are few useful tools to predict patient outcomes. Identification of biomarkers able to predict progression of ...the disease could improve the treatment of these patients. Objective: The objective of the study was to identify biomarkers of disease progression among patients with severe COVID-19 pneumonia. Materials and methods: A retrospective cohort study was conducted among severe COVID-19 pneumonia patients hospitalized in the American British Cowdray Medical Center in Mexico City. Disease progression was defined as use of vasoactive amines, need of non-invasive or invasive mechanical ventilation or death. Studied biomarkers included neutrophil/lymphocyte index, lymphocyte/platelet Ratio, C reactive protein, procalcitonin, D Dimer, lactic dehydrogenase (LDH), ferritin, 25–OH–Vitamin D, and interleukin 6. Results: We report 46 patients with severe COVID-19 pneumonia. Mean age was 51 years, the majority of whom 30 (65%) male. Median hospitalization was 9 days. 23 (50%) of patients presented disease progression. Ferritin and LDH were strongly associated with disease progression among our cohort. In addition, age was associated with worst prognosis with a relative risk 4.5 (1.2-16.9, p = 0.003). Conclusions: Age, ferritin, and LDH were associated with disease progression among patients with severe COVID-19 pneumonia.
Abstract
BACKGROUND: Breast cancer (BC) in young women has a behavior and biology associated with an increased risk of recurrence and death. The diagnosis of MC in young women is strongly associated ...with the presence of genetic mutations, mainly in the BRCA gene. However, an association between the presence of inherited genetic mutations and prognosis has not been observed. OBJECTIVE: To describe the prevalence and analyze the clinical-pathological characteristics of women, <50 years with BC, with and without BRCA germline mutation. MATERIAL AND METHODS: A descriptive, observational, cross-sectional study of women <50 years with BC with and without BRCA germline mutation who received treatment at a private third level Medical Center. RESULTS: During the period from January 1, 2015 to June 1, 2020, 807 women with a diagnosis of breast cancer were identified who received systemic treatment under adjuvant, neoadjuvant or palliative indication. Of these, 360 (44.6%) were 50 years old or younger. 53 women with BC <50 years had the result of a genetic panel and are the ones that were included for the analysis. Median age was 40 years (27-50), 55% <40 years old. The immunophenotype, according to the evaluation by immunohistochemistry of the hormonal receptors, Ki-67 and HER2/neu status, was luminal A like in 13 (24.5%) women, luminal B like in 18 (34%), luminal B like with overexpression of HER2/neu in 7 (13.2%), HER2/neu in 3 (5.7%) and in 12 (22.6%) cases it was triple negative. 30/53 women (56.6%), presented some mutation in the genetic panel. BRCA1 and/or BRCA2 9/30 (30%) mutation, all of them were pathogenic variants. Mutations other than BRCA in 21/30 (70%), of these 7/21 (33.3%) pathogenic (P) mutations in the ATM (2), MUTYH (2), TP53 (2) and PALB2 (1) genes. In 14/21 (66.7%) variants of uncertain significance (VUS) were identified. We did not observe an association between the clinicopathological characteristics and the BRCA mutational status or other genetic mutations, except for the high degree of differentiation (p = 0.04), being more frequent in the mutated group. There were no differences in disease-free time between BRCA mutated and non-mutated patients (p = 0.12). CONCLUSIONS: The prevalence of the BRCA germline mutation in women with BC <50 years in our population was 30%. The clinical and biological characteristics and the disease-free time were not different among the group with and without BRCA germline mutation, or other genes.
BRCA GENETIC VARIANTS (n:9)IDGenProtein changeNCBI 1000Clinical risk4BRCA1c.1960A>Tp.Lys654*rs80357355P16BRCA1c.815_824dupAGCCATGTGGp.Thr276Alafs*14rs387906563P38BRCA1c.211 A>Gp.Arg71Glyrs80357382P8BRCA2c.658_659delp.Val220llefs*4rs80359604P25BRCA2c.6024dupGp.Gln2009Alafs*9rs80359554P24BRCA1ex9-12del c.548?PBRCA2c.6413T>Ap.Val2138Asprs80358877VUS40BRCA2c.8988_8990delATAinsTTp.Leu2996Phefsrs397508027P42BRCA2c.5146_5149dep.Tyr1716LysFs*8rs276174854P49BRCA2c.6244delp.Leu2082fsrs1131691125PNO BRCA GENETIC VARIANTS (n:21)IDGENProtein changeNCBI 1000Clinical risk45ATMc.7502A>Gp.Asn2501Serrs531617441VUS48ATMc.3663G>Ap.Trp1221rs864622490P52ATMc.2839-3_2839delinsGATACTArs786202148PAPCc.1895T>Cp.Ile632Thrrs587781360VUS3ATMc.6919C>Tp.Leu2307Phers56009889VUSSMAD4c746_747delinsCCp.Gln249delinsPrors587782209VUS23BAP1c.623G>Ap.Arg208Glnrs867416499VUS32BRIP1c.3088_3096dupp.Ala1030_Ser1032duprs1187782159VUS36CDKN2Ac.146T>Cp.Ile49Thrrs199907548VUS5CHEK2c.1567C>Tp.Arg523Cysrs149501505VUS30DICER1c.1798G>Cp.D600HVUS22FANCMc.5832G>Tp.Leu1944Phers201017015VUS41FHc.1481C>Tp.Ala494Valrs752369363VUSTSC1c.2432G>Ap.Arg811Glnrs761281095VUS11MLH1c.2219T>Cp.Ile740Thrrs1044486319VUS12MUTYHc.1227_1228dupp.Glu4110Glyfs*43rs587780078P16MUTYHc.1227_1228dupp.Glu4110Glyfs*43rs587780078P20PALB2c.509_510delp.Arg17Ilefs*14rs515726123P14PMS2c.865T>Ap.Phe2891lers771787834VUS47POLEc.4150C>TVUS6RAD51Cc.492T>Gp.Phe164Leurs573992101VUS17TP53c.604C>Tp.Arg202Cysrs587780072VUS50TP53c.587G>Cp.Arg196Prors483352697P43TP53c.587G>Cp.Arg196Prors483352697PKDRc.1416A>Tp.Gln472Hisrs1870377VUS
Citation Format: Daniela Vazquez-Juarez, Juan A Serrano-Olvera, Alejandro Noguez-Ramos, Gabriela O Regalado-Porras, Jesus M Lazaro-León, Guillermo Olivares-Beltran, Raquel Gerson-Cwilich. Prevalence of BRCA 1/2 germinal mutation among young women with breast cancer: Experience in a third level private center abstract. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-07-07.
A significant proportion of locally-advanced esophago-gastric adenocarcinoma (EGA) is diagnosed in patients ≥70 years old (y.o.) who are commonly underrepresented in clinical trials.
The PubMed ...database was searched for phase 2/3 clinical trials enrolling patients ≥70 y.o and reporting efficacy/safety information of chemotherapy for resectable EGA. The main outcomes were overall survival (OS) and recurrence-free survival (RFS).
Among 6,128 records, only seven studies reported these outcomes (three peri-operative, three adjuvant, and one neoadjuvant), including 1004 older patients, <20% of the overall population. No significant benefit in terms of OS and RFS was observed for perioperative or adjuvant chemotherapy vs surgery alone. No trial reported safety endpoints in this subgroup.
This work did not show any significant benefit in OS or RFS for chemotherapy vs surgery alone or conventional vs de-escalated chemotherapy in the curative setting of EGA in ≥70 y.o patients. Specific ad hoc trials should be performed to derive reliable data.
Cancer treatment during the COVID-19 pandemic represents a challenge. Hospital visits to receive treatment and interaction with health care workers (HCW) represent potential contagious events. We ...aimed to determine SARS-CoV-2 infection rate among patients with cancer and HCW of a chemoradiotherapy unit localized in a center designated as a COVID-19 priority facility in Mexico City. We also determined the diagnostic performance of a clinical questionnaire (CQ) as a screening tool and anti-SARS-CoV-2 antibody seroconversion rate.
HCW and patients with solid tumors attending the chemoradiotherapy unit signed informed consent. To determine SARS-CoV-2 infection rate prospectively, a nasopharyngeal swab for SARS-CoV-2 real-time quantitative reverse transcriptase polymerase chain reaction (RT-qPCR) was performed every 2 weeks in asymptomatics. An electronic CQ interrogating COVID-19-related symptoms was sent daily. Anti-SARS-CoV-2 immunoglobulin G (IgG) antibodies were measured at baseline and at the end of the study period.
From June to September 2020, we included 130 asymptomatic participants, 44.6% HCW and 55.4% patients with cancer. During a median follow-up of 85 days, 634 nasopharyngeal swabs were performed. Average SARS-CoV-2 monthly incidence was 4.6% (3.15%-7.47%), and cumulative infection rate was 13.8% (18 of 130). Cases were mostly asymptomatic (66%), and no hospitalizations or deaths were recorded. The CQ as a screening tool provided a sensitivity of 27.7%, a positive predictive value of 26.3%, and a positive likelihood ratio of 12. SARS-CoV-2 IgG seroconversion rate was 27.7% among those with a positive RT-PCR.
Patients with cancer on treatment can have uncomplicated COVID-19 outcomes. Biweekly RT-qPCR testing detects asymptomatic infections, prevents transmission, and should be implemented in units to increase patient safety. CQ increase RT-qPCR diagnostic yield and may prioritize testing in resource-deprived settings. Post-infection IgG seroconversion is unreliable.
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Background: Currently there are no primary cultures or cell lines derived from patients with breast cancer and obesity. It has been postulated that breast cancer in obese women ...behaves differently as it does in non-obese women, as is composed of distinct biological features, as was generated in a different metabolic environment, as well as pertains to a different prognosis and different response to chemotherapy, lower rates of overall survival and a greater probability of recurrence. By creating a primary breast cancer culture bank of breast cancer tumors from women with obesity (BMI > 30kg/m
2
), we will establish a cell line exclusive to obese women in Mexico, where targeted therapy may be tested and treatment may be individualized depending on the characteristics of the patient. Methods: This study recruited 32 women with breast cancer and a BMI > 30 kg/m
2
, matched by 6 controls with are non-obese women with breast cancer. Elegibility criteria was determined by women with breast cancer confirmed by pathology, who had not been subjected to prior treatment regarding the neoplasm. The breast cancer removing surgeries and the patients were selected from the ABC Medical Center in Mexico City and all procedures were approved by the research and ethics committee of the hospital in question. Results: Through extensive communication a cooperative protocol was established between the departments of surgery, oncology, pathology and nursing to coordinate efforts and be able to take a 2 – 5 mm sample of the breast tumor removed from the patient. To be able to distinguish cancer cells from non-cancer cells (epithelial cells, fibroblasts, adipocytes) the Hayflick limit was be utilized. Once a primary breast cancer culture was established, 12 million cells will be injected into the subscapular area of athymic, nu-nu mice to be able to monitor tumoral growth in vivo and conduct a subsequent cellular analysis, determining it still pertains to the same characteristics of the tumor from which it was obtained. Conclusions: A primary breast cancer culture repository from patients with a BMI > 30 kg/m2 was established. This is the first primary breast cancer culture for both Mexican and obese women with breast cancer, the first in vitro method of analysis of specific characteristics typical of the Mexican population. Translational research may now be conducted on these new tumoral cultures to create individualized therapy for women with the distinct, aforementioned characteristics.
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Background: in Mexico, Colorectal Cancer (CRC) is a leading cause of cancer death, yet population-based screening programs are lacking. In our center, a cohort was created to ...validate a risk calculator to detect advanced colorectal neoplasia, and to understand barriers to implement a CRC screening program. We aimed to determine frequency and reasons associated to rejection of CRC screening in our population. Methods: from August 2019 to March 2020 (early close owing to COVID-19 pandemic) asymptomatic individuals between 50 and 75 years-old with standard-risk for CRC, without previous screening for CRC, from the outpatient internal medicine clinic at a tertiary care center in Mexico City, received standardized information on the importance of CRC screening and were invited to perform both Fecal Immunochemical Test and a screening colonoscopy within a clinical study at no cost. Individuals who rejected participation were given a 10-item questionnaire to select reasons for refusal, as many items as applied. Here we present two groups: 1) individuals who refused to receive information and to perform screening studies, and 2) individuals who refused to participate after receiving information. Results: 162 patients were invited to participate, 77 (47%) refused: 48 rejected immediately (group 1) and provided 51 reasons, and 29 declined after having received standardized information about CRC screening (group 2) and provided 30 reasons. Demographics for 77 patients were: 54 (70.1%) women, median age 66 (IQR 58-71) years. Main reasons for rejection in both groups were: “I do not have time” in 24 (29.6%) times, “I am not interested” in 23 (28.4%) times, and “I am scared” in 14 (17.3%) times (Table). Conclusions: in our cohort, we identified that nearly half of the population invited to participate in a CRC screening program refused. Main reasons were lack of time, lack of interest and fear. This may translate poor understanding on the importance of measures to prevent CRC, and absence of education programs to recall its importance. In order to increment participation in CRC screening, education and awareness campaigns should be implemented.Table: see text
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Background: Ampullary cancer (AC) represents 0.2% of gastrointestinal cancers. Given the rarity of the disease, information regarding treatment strategies and outcomes derives from ...studies that include the different types of periampullary cancers, which constitute a heterogeneous group. Our aim was to describe the clinical characteristics, treatment modalities and outcomes in patients (pts) with true AC treated at our institution. Methods: A retrospective review of medical records of all consecutive pts with histological diagnosis of AC evaluated at our institution from Jan 2009-Dec 2019. Clinical, pathological and laboratory variables at diagnosis were recorded. Overall survival (OS) was estimated by Kaplan-Meier and compared with the Log-rank test. Statistical significance was determined at P<0.05. Results: 133 pts with AC were included. Median age was 62 yo (IQR 53-70), 51.9% were women. 25% had ampullary adenoma history. Symptoms at diagnosis: 89% jaundice, 63% weight loss and 56% abdominal pain. Median laboratory values were total bilirubin 1.7 mg/dL (0.7-5.1), albumin 3.7 g/dL (3.1-4.2), hemoglobin 12.6 g/dL (10.9-14.2), carbohydrate antigen (CA) 19-9 34.7 U/mL (6.4-113.9) and carcinoembryonic antigen (CEA) 2.6 ng/mL (1.2-4.2). Most tumors were moderately differentiated (59%). Histologic subtypes of adenocarcinoma were available in 84 pts: intestinal 46.4%, pancreaticobiliary 39.3% and mixed 14.3%. Stage at diagnosis was localized (46%), locally advanced N+ (29%) and advanced (25%). For those with localized/locally advanced disease, 91% (91/100) underwent surgical resection, 25.3% (23/91) received adjuvant chemotherapy (ChT), 69.6% (16/23) received single agent and 30.4% (7/23) duplet. Pts who received adjuvant Cht presented N+ in 69.6%, moderate differentiation in 73.9%, intestinal 47.8% and pancreaticobiliary subtype 43.5%. In advanced setting, 63.6% (21/33) received palliative Cht, 66.7% received a duplet regimen. Median OS was 32.8 (22.9-42.8) months (mos). Median OS according to stage was 152.1, 28.1 and 10.2 mos for localized, locally advanced, and advanced, respectively (P<0.001). OS univariate analysis is shown in table. Conclusions: Most of pts presented with localized/locally advanced disease, were eligible to surgical resection and had a better survival. For those with N+ disease it is required to evaluate the role of adjuvant Cht. In the advanced setting, Cht improves prognosis.Table: see text
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Background: there are few reported series n women with breast cancer (BC) and COVID-19, a better prognosis has been observed, with a lower rate of hospitalization and mortality than other ...neoplasms. Methods: We conducted a restrospective, non-experimental, observational, single center, study with a sample of 69 patients with BC who had presented COVID-19, in the period between March 2020 to August 2021. Clinicopathological characteristics of patients with BC were compared between severe and non-severe covid 19 groups, as well as hospitalized and non-hospitalized patients. An analysis of possible risk factors associated with severe disease and hospitalization was performed. Results: 69 cases were reported, median age 52y, mean BMI 25.2, ECOG 0-1: 97%. Smoking history in 24%, diabetes and hypertension were the most frequent comorbidities. The most frequent histology was ductal carcinoma in 80.6%, 73.8% showed ER + and 69.3% PR +, HER2 was overexpressed in 9.2%. The early stages predominated, I 22 (31.3%), II 25 (37.3%), III in 12 (17.9%) and IV in 6 (9%). The most frequents symptoms of COVID-19 were fatigue 70.1%, fever 65.7%, cough 59.7%, headache 56.7%, hyposmia 47.8%, dysgeusia 38.8%. A total of 53 (76.8%) mild cases, 14 (20.3) severe cases and 2 (2.9%) critical cases were registered. The 89.9% (62 patients) were treated as an outpatient basis, while 7 (10.1%) required hospitalization. Active treatment (< 45 days) at the time of COVID-19 was hormonal therapy 36 (50.7%), chemotherapy 11 (16.4%), anti-HER2 in 3 (4.5%), immunotherapy in 1.5%, targeted treatment in 4 (6.0%), surgery in 7 (10.4%) and radiotherapy in 1 (1.5%) patient. When comparing the severe and non-severe groups, as well as hospitalized versus non-hospitalized, we observed no difference between the clinicopathological characteristics. Then, we serch for possible risk factors, in wich, surgery in a period of less than 3 months increases the risk of severity OR 1,297 (95% CI 1,112-1,514), the risk of hospitalization increased in the triple negative subgroup OR 1,143 (95% CI, 1,035- 1,262), surgery less than 3 months OR 1,116 (1,014-1,229) and chemotherapy less than 45 days OR 1,217 (95% CI, 1,024-1,447). Conclusions: In patients with BC, the prevalence of severe or critical COVID-19 was 23% and the hospitalizacion rate 10%. No patient died from this infection. The clinical and pathological characteristics of BC do not appear to increase the risk of severe COVID-19 or the rate of hospitalization. Surgery performed in a period of less than 3 months is marginally associated with an increased risk of severe disease. Chemotherapy, targeted therapy, and immunotherapy do not modify the risk of severe disease; however, higher Ki 67, triple negative subgroup, surgery and chemotherapy showed a slight increase in risk of hospitalization.
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