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Browsing by Author "Acevedo, Francisco"

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A Molecular Stratification of Chilean Gastric Cancer Patients with Potential Clinical Applicability
(2020) Pinto Paganini, Mauricio Arturo; Bravo Castillo, Maria Loreto; Sánchez Rojel, César Giovanni; Acevedo, Francisco; Mondaca Contreras, Sebastián Patricio; Ibañez, Carolina; Galindo A., Héctor; Madrid Arenas, Jorge; Nervi Nattero, Bruno; Peña Durán, José Esteban; Torres Montes, Paula Javiera; Owen, Gareth Ivor; Corvalán R., Alejandro; Garrido S., Marcelo; Córdova Delgado, M.; Retamal, I. N.; Muñoz Medel, M.; Durán, D.; Villanueva, F.; Koch, E.; Armisen, R.
A simple method to assess estrogen receptor gene (ESR1) amplification in paired biopsies from primary tumor and recurrence in breast cancer patients receiving endocrine therapy
(2020) Maiz, Cristóbal; Oddó, David; Alfaro, Francisca; Villarroel, Alejandra; Acevedo, Francisco; Pérez Sepulveda, Alejandra; Muñiz, Sabrina; Silva, Fernando; Valdivia, Andrés; Merino, Tomas; Pinto, Mauricio P.; Sánchez, César
Globally, Breast Cancer (BC) is the leading cause of cancer death among women. About 75% of patients are diagnosed with hormone-dependent tumors and are set to receive Endocrine Therapy (ET) targeting the estrogen receptor. Unfortunately, a significant proportion of these patients develops ET resistance. Still controversial, studies have proposed that Estrogen Receptor-Alpha Gene (ESR1) alterations may underlie ET resistance. Here, we describe the use of a Chromogenic in Situ Hybridization (CISH) assay for the assessment of ESR1 amplification in primary tumors and recurrences. This assay could be a useful clinical tool with therapeutic implications for estrogen receptor positive BC patients.
Abstract PS6-37: Clinical stage is the only predictor of survival in breast cancer patients with a complete pathological response
(2021) Acevedo, Francisco; Walbaum, Benjamin; Merino, Tomas; Petric, Militza; Sanchez, Cesar
INTRODUCTION In breast cancer (BC) patients, achieving a complete pathological response (pCR) after neoadjuvant chemotherapy (NCT) is associated with better prognosis. Despite this, some of these patients will experience recurrences of the disease and will eventually die of BC. We identified clinical factors that can affect recurrence and survival in BC patients who achieve pCR.METHODSRetrospective analysis of a Chilean BC database including patients treated in public and private hospitals in Santiago, Chile from 2010 to 2019. pCR was defined as the absence of residual invasive disease in the breast and in the axillary lymph nodes (ypT0/is N0) at the completion of the NCT. Invasive Disease-Free Survival (IDFS), Distant Disease-Free Survival (DDFS) and BC-specific survival (BCS) was measured from the time of diagnosis to the event or lost to follow-up. We performed Cox regression analysis to identify factors associated with prognosis.RESULTSFrom 855 patients who received NCT, 195 (22.8%) achieved pCR and were included in this study. Clinical characteristics are shown in table 1. 76 (37.9%) patients had hormone receptor positive (HR+) and 113 (57.4%) had Human epidermal growth factor 2 (HER2) positive tumors. 88.7% were treated with a regimen that included anthracyclines and taxanes. With a median follow-up of 36 months, three-year IDFS, DDFS and BCS and their 95% confidence intervals were 90.9% (84.7 - 94.6), 91.8% (86.0 - 95.3) and 93.8% (87.8 - 97.5); respectively. The stage at diagnosis was the only predictor associated with IDFS (Hazard ratio (HR) = 5.6; p = 0.02), DDFS (HR = 4.1, p = 0.07), and BCS (HR = 8.3, p = 0.04). Body mass index (BMI), age, hospital, HR or HER2 status, lymph node involvement, or the presence of an in-situ component, were not associated with prognosis in the multivariate analysis.CONCLUSIONThe clinical stage at diagnosis was the only predictor of survival in patients who achieved pCR after NCT. Short follow-up and few events may have affected these results. This data is consistent with previously published work. Table 1. Tumor and patient characteristicsMedian age49 (24 – 78)HospitalPublic57.4%Private43.6%BMIMedian27.2 (18.5 – 44.7)Overweight38.0%Obese31.9%Receptor StatusRH+/HER2-16.4%RH+/HER2+21.5%RH-/HER2+35.9%RH-/HER2-26.2%Clinical StageI2.1%II47.4%III50.5%Lymph Node +69.7%ypT0/N078.1%ChemotherapyAnthracycline5.1%Taxane6.2%Anthracycline-Taxane88.7% Citation Format: Francisco Acevedo, Benjamin Walbaum, Tomas Merino, Militza Petric, Cesar Sanchez. Clinical stage is the only predictor of survival in breast cancer patients with a complete pathological response [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-37.
Better overall survival in patients who achieve pathological complete response after neoadjuvant chemotherapy for breast cancer in a Chilean public hospital
(2021) Acevedo, Francisco; Petric, Militza; Walbaum, Benjamin; Robin, Julieta; Legorburu, Luisa; Murature, Geraldine; Guerra, Constanza; Navarro, Marisel; Canovas, María José; Sanchez, Cesar; Vargas, Lorena; Manzor, Manuel; Peña, José; Muñiz, Sabrina; Veglia, Paulina; Cartes, Raúl; Martinez, Raúl
Introduction: There is extensive evidence associating the response to neoadjuvant chemotherapy (NeoCT) with breast cancer (BC) survival. However, to the author’s knowledge, there is no published data in Chile. The objective of the study is to evaluate whether achieving pathological complete response (pCR) after NeoCT is associated with greater survival and lower risk of recurrence in a Chilean Public Health Service. Methods: Retrospective analysis of a database. Patients with a diagnosis of Stages I–III BC who received NeoCT between 2009 and 2019 were included. Clinical and pathological information were extracted from the clinical records. BC subtypes were defined using hormone receptor (HR) information (HR: oestrogen and/or progesterone) and epidermal growth factor type 2 (HER2), being divided into four groups: HR /HER2−, HR /HER2 , HR−/HER2 , HR-/HER2−. pCR was defined as the absence of invasive cancer in the breast and axilla (ypT0/is N0) after NeoCT. Results: Of 3,092 patients, 17.2% received NeoCT. Of these, 40.2% corresponded to HR /HER2−, 20.9% HR /HER2 , 18.2% HR−/HER2 and 20.7% HR−/HER2−. Overall, 24.8% achieved pCR, being the lowest for HR /HER2− (10.3%) and the highest for HR−/HER2 (53.2%). In the multivariable analysis, family history, HER2 and type of chemotherapy were associated with a greater probability of pCR. With a median follow-up of 40 months, the overall survival and metastasis-free survival (MFS) at 3 years were greater for the group with pCR compared to that which did not achieve it (90.5% versus 76.7%, p = 0.03 and 88.5% versus 71.4%, p = 0.003, respectively). The multivariable analysis confirmed this finding. Brain MFS was similar in both groups. Conclusion: NeoCT is associated with greater pCR in aggressive BC subtypes. In those, achieving pCR was associated with better survival in our study. To the author’s knowledge, this is the first study which evaluates the relation between pCR and BC subtypes in a Chilean public hospital.
Cancer survivorship in Latin America: current status and opportunities
(2021) Anampa-Guzmán, Andrea; Acevedo, Francisco; Partridge, Ann H.; Alfano, Catherine M.; Nekhlyudov, Larissa
Purpose: The number of cancer survivors is increasing globally although the status of cancer survivorship care provision and research in developing countries is limited. This study aimed to review published literature and available guidelines and/or recommendations to inform cancer survivorship care in Latin America. Methods: Embase, Web of Science, Scopus, PubMed, and SciELO were systematically searched for articles and guidelines and/or recommendations published through December 31, 2020. Our search terms included cancer, survivors, neoplasm, cancer, survivorship, survivor, follow-up studies, and the name of the countries. We categorized the articles by country, year, cancer type(s), language, and domain of cancer survivorship care. We also searched governmental health agencies websites in all Latin American countries. Results: Our literature review found 664 articles for inclusion. The number of publications increased over time. Brazil had most of the survivorship research (n = 483, 72.7%). The most common topics included surveillance and management of psychosocial effects (n = 237, 35.7%) and physical effects (n = 230, 34.6%). Prevention and surveillance for recurrences and health promotion and disease prevention were each addressed by about 10% (n = 71) of the publications. Although close to half of the publications included more than one cancer, 28.9% (n = 192) focused solely on breast cancer. We found no guidelines and/or recommendations explicitly focusing on Latin America in the reviews of the literature or the national governmental institutions' websites. Conclusion: We found a growing body of cancer survivorship publications, mainly focusing on psychosocial and physical effects, although no cancer survivorship guidance and/or recommendations focused on Latin America were identified. Expanding research across Latin American countries and covering a broader spectrum of cancer survivorship care is needed. Development of guidelines may further promote provision of quality care for this growing population of cancer survivors.
Complete response to immunotherapy plus chemotherapy after an unusual clinical response to afatinib and stereotactic radiosurgery in a patient with metastatic EGFR-mutant non–small-cell lung cancer
(2020) Pizarro, Gonzalo; Pinto, Mauricio P.; Muñoz-Medel, Matías; Cordova-Delgado, Miguel; Bravo, M. Loreto; Nervi, Bruno; Sánchez, César; Ibañez, Carolina; Peña, José; Walbaum, Benjamín; Madrid, Jorge; Briones, Juan; Koch, Erica; Valbuena, Jose; Gonzalez, Sergio; Gejman, Roger; Acevedo, Francisco; Mondaca, Sebastian; Garrido, Marcelo; Vines, Eugenio; Galindo, Hector
Contrast-enhanced mammography predicts pathological response after neoadjuvant chemotherapy in locally advanced breast cancer
(2022) Canteros, Daniel; Walbaum, Benjamin; Córdova-Delgado, Miguel; Torrealba, Andrés; Reyes, Constanza; Navarro, María Elena; Razmilic, Dravna; Camus, Mauricio; Dominguez, Francisco; Navarrete, Orieta; Pinto, Mauricio P.; Pizarro, Gonzalo; Acevedo, Francisco; Sánchez, César
Introduction: Recently, contrast-enhanced mammography (CEM) has emerged as a reliable alternative to breast magnetic resonance imaging (MRI) for the assessment of pathological response in breast cancer patients. Our study sought to determine the diagnostic accuracy of CEM to predict pathological complete response (pCR) in patients who received neoadjuvant chemotherapy (NACT). Methods: We retrieved the medical records of patients who underwent NACT at our institution. Using post-surgery pCR, morphological evidence and CEM enhancement tumours were classified as follows: 1) radiologic complete response (rCR); 2) functional radiological complete response (frCR); and 3) non-complete response. Initially, we used multivariate analyses adjusted by clinical variables and frCR or rCR to determine which variables affected pathological response. Then, CEM diagnostic accuracy to discriminate pCR was assessed using receiver operating characteristic curves in univariate and multivariate models including either frCR or rCR. Results: A total of 48 patients were included in our study. Most patients (68.7%) were hormone receptor (HR)+ and 41.6% (20) of the patients achieved pCR. Using univariate logistic regression analyses we found that HR status, HER2 status, rCR and frCR had a significant impact on CEM diagnostic accuracy. Exploratory analyses found that CEM sensitivity was higher for HR− tumours. Multivariate logistic regression analyses found 60% sensitivity, 92.9% specificity and 79.2% accuracy in a model that included clinical variables and rCR. Conclusion: CEM is a reliable alternative to high-cost, time-consuming breast MRI that predicts pCR in patients undergoing NACT; CEM diagnostic accuracy was higher among patients who harboured HR− tumours.
First-line endocrine therapy for advanced breast cancer. A real-world study at a Latin American university health institution
(TAYLOR & FRANCIS LTD, 2020) Walbaum, Benjamin; Acevedo, Francisco; Medina, Lidia; Bravo, M. Loreto; Merino, Tomas; Camus, Mauricio; Dominguez, Francisco; Mondaca, Sebastian; Galindo, Hector; Nervi, Bruno; Ibanez, Carolina; Madrid, Jorge; Pena, Jose; Koch, Erica; Garrido, Marcelo; Pinto, Mauricio P.; Sanchez, Cesar
Objective: Clinical guidelines recommend the use of endocrine therapy (ET) in advanced hormone receptor positive (HR+) human epidermal growth factor receptor type 2 negative (HER2-) breast cancer (BC) patients in the absence of visceral disease or ET resistance. Furthermore, studies indicate similar response and survival rates using ET or cytotoxic chemotherapy (CT). Methods: Herein, we assessed clinical characteristics, type of systemic therapy and survival rates of advanced HR + HER2-BC patients in our database. Results: A total of 172 advanced HR + HER2-BC patients were treated at our institution between 1997 and 2019. Sixty percent received first-line ET (4% received combined ET). Median age of this subset was 55 years (range: 30-86). Similarly, the median age of patients that received CT was 54 years (range: 21-83). Over time, 30% of patients received ET in the 2000-2005 period; this increased to 70% in the 2016-2019 period (p = .045). Overall survival (OS) was 97 months and 51 months for patients treated with ET or CT, respectively (p = .002). Conclusions: To the best of our knowledge this is the first study assessing the use of ET in Chilean advanced HR + HER2-BC patients. Several patients in our institution receive CT without indication. The increase in ET usage over time can be attributed to better and faster immunohistochemical detection methods for Estrogen Receptor (ER), changes in educational and government policies, and a wider variety of ET options. Finally, clinical trials have failed to demonstrate a substantial benefit of CT over ET in this setting.
Longitudinal study of wound healing status and bacterial colonisation of Staphylococcus aureus and Corynebacterium diphtheriae in epidermolysis bullosa patients
(2022) Fuentes, Ignacia; Yubero, María Joao; Morandé, Pilar; Varela, Carmen; Oróstica, Karen; Acevedo, Francisco; Rebolledo‐Jaramillo, Boris; Arancibia, Esteban; Porte, Lorena; Palisson, Francis
Epidermolysis bullosa (EB) is an inherited disorder characterised by skin fragility and the appearance of blisters and wounds. Patient wounds are often colonised or infected with bacteria, leading to impaired healing, pain and high risk of death by sepsis. Little is known about the impact of bacterial composition and susceptibility in wound resolution, and there is a need for longitudinal studies to understand healing outcomes with different types of bacterial colonisation. A prospective longitudinal study of 70 wounds from 15 severe EB patients (Junctional and Recessive Dystrophic EB) from Chile. Wounds were selected independently of their infected status. Wound cultures, including bacterial species identification, composition and Staphylococcus aureus (SA) antibiotic susceptibility were registered. Wounds were separated into categories according to their healing capacity, recognising chronic, and healing wounds. Hundred-one of the 102 wound cultures were positive for bacterial growth. From these, 100 were SA-positive; 31 were resistant to Ciprofloxacin (31%) and only seven were methicillin-resistant SA (7%). Ciprofloxacin-resistant SA was found significantly predominant in chronic wounds (**P < .01). Interestingly, atoxigenic Corynebacterium diphtheriae (CD) was identified and found to be the second most abundant recovered bacteria (31/101), present almost always in combination with SA (30/31). CD was only found in Recessive Dystrophic EB patients and not related to wound chronicity. Other less frequent bacterial species found included Pseudomonas aeruginosa, Streptococus spp. and Proteus spp. Infection was negatively associated with the healing status of wounds.
Machine learning analysis of a Chilean breast cancer registry
(2021) Acevedo, Francisco; Causa, Leonardo; Bravo, Sebastián; García, Pablo; Cuevas, Ricardo; Bravo, Maria Loreto; Avellaira, Carla; Muñiz, Sabrina; Petric, Militza; Martinez, Raúl; Guerra, Constanza; Navarro, Marisel; Taramasco, Carla; Sanchez, Cesar
In recent years, artificial intelligence (AI) and machine learning (a form of AI) have offered valuable tools for medicine by applying and training algorithms in order to make predictions. Herein, we applied a machine learning algorithm to analyze data from a >20 year breast cancer (BC) registry elaborated in two Chilean health institutions (a public hospital and a private center) that includes a total of 4838 patients and their basic clinicalpathological characteristics. Preliminary results suggest that this cohort of patients can be subdivided into five clusters according to key variables that also correlate with overall survival and disease-free survival rates. To our knowledge this is the first Latin American report of its kind. Our laboratory is currently expanding these analyses.
Neutrophil/lymphocyte ratio in complete blood count as a mortality predictor in breast cancer
(SOC MEDICA SANTIAGO, 2016) Mimica, Ximena; Acevedo, Francisco; Oddo, David; Ibanez, Carolina; Medina, Lidia; Kalergis, Alexis; Camus, Mauricio; Sanchez, Cesar
Background: The white blood cell count is one of the most sensitive markers associated with inflammation. The neutrophil/lymphocyte count ratio may be an independent factor for breast cancer mortality. Aim: To assess the predictive value of the neutrophil/lymphocyte ratio for mortality in breast cancer. Material and Methods: Review of the database of a cancer center of a University hospital. Patients with infiltrating breast cancer treated between 1997 and 2012 were selected. The pathology type and lymph node involvement were obtained from the pathology report. The expression of estrogen, progesterone and Human Epidermal Growth Factor Receptor 2 (HER2) was determined by immunohistochemistry or in situ fluorescent hybridization (FISH). The absolute peripheral neutrophil and lymphocyte counts were obtained from a complete blood count obtained at least three months before treatment. Patients were followed for a median of 61 months (range 1-171). Results: From 323 eligible patients, after excluding those in stage IV and those without an available complete blood count, 131 patients were analyzed (81 with negative receptors and 117 HER2 enriched). The neutrophil/lymphocyte ratio was similar in both types of tumors (2.1 and 1.91 respectively). Twenty two patients died during follow-up. Surviving patients with HER2 enriched tumors had a lower neutrophil/lymphocyte ratio than those who died (1.79 and 3.21 respectively, p < 0.01). In a multivariate analysis, including age, tumor stage and lymph node involvement as confounding factors, the neutrophil/lymphocyte ratio was still significantly associated with a risk of death with a hazard ratio of 2.56. Conclusions: A high neutrophil/lymphocyte ratio in the complete blood count can be a predictor of death in breast cancer.
Oncological benefit versus cardiovascular risk in breast cancer patients treated with modern radiotherapy
(2022) Acevedo, Francisco; Ip, Teresa; Orellana, María; Martínez, Gonzalo; Gabrielli, Luigi; Andia, Marcelo; Besa, Cecilia; Pinto, Mauricio P.; Sánchez, Cesar; Merino, Tomas
Radiotherapy (RT) is an essential part of breast cancer (BC) treatments. Unfortunately, heart exposure to radiation can also impair the long-term survival of patients. Our study aimed to quantify the oncological benefit and the cardiovascular (CV) risk associated with modern RT in a real-world cohort of BC patients. Our descriptive study enrolled BC patients who received adjuvant RT. Ten-year overall survival (OS) was estimated using Predict® version 2.1 (National Health Service, London, UK). The basal risk of CV events was estimated using the American Heart Association (ACC/AHA) CV score. Treatment volumes and mean cardiac doses were obtained from RT treatment plan records. The increased risk of CV events due to RT was estimated using a model proposed by Darby. The risk of acute myocardial infarction or stroke mortality was estimated using HeartScore® (European Society of Cardiology, Brussels, Belgium). A total of 256 BC patients were included in the study. The average age of patients was 57 years old (range: 25–91); 49.6% had left BC. The mean cardiac dose was 166 cGy (interquartile range (IQR) 94–273); the estimated hazard ratio (HR) for CV disease was HR 1.12 (confidence interval (CI) 1.04–1.24). The estimated baseline 10-year CV risk was 5.6% (0.2 to 51.2); CV risk increased by 0.9% (range 0.02–35.47%) after RT. The absolute risk of 10-year mortality from CV disease was 2.5% (0.1–9); RT was associated with an estimated 4.9% survival benefit (3.73–6.07) against BC death and a 0.23% (0.17–0.29) estimated increase in CV mortality. Modern RT decreased 10-year BC mortality by 4% but increased CV mortality by 0.2% in this cohort. Our findings encourage the implementation of personalized adjuvant RT treatments that balance risks and benefits to improve long-term BC patient survival.
Oncological resection, myasthenia gravis and staging as prognostic factors in thymic tumours: a Chilean case series
(2021) Salas, Patricio; Solovera, Maria Eliana; Bannura, Felipe; Muñoz-Medel, Matias; Cordova-Delgado, Miguel; Sanchez, Cesar; Ibañez, Carolina; Garrido, Marcelo; Koch, Erica; Acevedo, Francisco; Mondaca, Sebastian; Nervi, Bruno; Madrid, Jorge; Peña, Jose; Pinto, Mauricio P.; Valbuena, José; Galindo, Hector
Background: Thymic epithelial tumours are rare and highly heterogeneous. Reports from the United States suggest an overall incidence of 0.15 per 100,000/year. In contrast, the incidence of these tumours in Latin America is largely unknown and reports are scarce, somewhat limited to case reports. Methods: Herein, we report a series of 38 thymic tumours from a single institution, retrospectively incorporated into this study. Patient characteristics and outcomes including age, sex, stage, paraneoplastic syndromes, treatment regimens and the date of decease were obtained from medical records. Results: Most cases in our series were females and young age (<50 years old) and early stage by Masaoka-Koga or the Moran staging systems. Also, a 34% of patients had myasthenia gravis (MG). Next, we analysed overall survival rates in our series and found that the quality of surgery (R0, R1 or R2), MG status and staging (Masaoka-Koga, Moran or TNM) were prognostic factors. Finally, we compared our data to larger thymic tumour series. Conclusions: Overall, our study confirms complete surgical resection as the standard, most effective treatment for thymic epithelial tumours. Also, the Masaoka-Koga staging system remains as a reliable prognostic factor but also the Moran staging system should be considered for thymomas.
Pathological complete response to neoadjuvant chemotherapy, but not the addition of carboplatin, is associated with improved survival in Chilean triple negative breast cancer patients: a report of real world data
(2021) Walbaum, Benjamin; Acevedo, Francisco; Median, Lidia; Bravo, M. Loreto; Merino, Tomas; Camus, Mauricio; Dominguez, Francisco; Mondaca, Sebastián; Galindo, Héctor; Nervi, Bruno; Ibañez, Carolina; Madrid, Jorge; Muñiz, Sabrina; Peña, José; Koch, Érica; Garrido, Marcelo; Pinto, Mauricio P.; Sánchez, César
Background: Breast cancer (BC) is the leading cause of cancer death for Chilean women. About 11% of cases are triple-negative (TN) BC. These are characterised by poor prognosis, higher risk of early recurrence and visceral dissemination versus other BC subtypes. Current standard treatment for early-stage non-metastatic TNBC patients consists of neoadjuvant chemotherapy (NACT) followed by surgery and radiotherapy. Pathological complete response (pCR) to NACT is associated with an increase in survival rates. In general, NACT and adjuvant regimens involve similar cytotoxic drugs. Recent studies have postulated that the use of platinum compounds in TNBC would increase response rates. However, their effects on patient survival remain uncertain. Materials and methods: We retrieved and analysed medical records from a total of 156 Chilean stage I–III TNBC female patients that received NACT and compared survival rates using carboplatin (Cb)-containing versus non-Cb-containing regimens at two health cancer centres. Results: Median age was 51 years (range: 24–81); 13.5% (n = 21) received Cb-containing regimens, 80.1% (n = 125) received sequential anthracyclines plus taxanes; 29.5% (n = 46) of the total group achieved pCR, 28% for the standard treatment and 35% (n = 8) for the Cb-containing group (p = 0.59). We confirmed pCR was associated with prolonged overall survival, invasive and distant disease-free survival (Log-rank p = 0.0236). But the addition of Cb was not associated with differences in survival measures (Log-rank p = 0.5216). Conclusions: To the best of authors’ knowledge, this is the first report on real-world data in the Chilean population assessing the effect of Cb-containing NACT in TNBC. The authors’ results suggest no survival benefit by the addition of Cb to standard NACT. However, we confirm an increase in survival associated to pCR regardless of treatment.
Screen-detected breast cancer is associated with better prognosis and survival compared to self-detected/symptomatic cases in a Chilean cohort of female patients
(2021) Walbaum, Benjamin; Puschel, Klaus; Medina, Lidia; Merino, Tomas; Camus, Mauricio; Razmilic, Dravna; Navarro, Maria Elena; Dominguez, Francisco; Cordova‑Delgado, Miguel; Pinto, Mauricio P.; Acevedo, Francisco; Sánchez, César
Purpose The implementation of national breast cancer (BC) screening programs in Latin America has been rather inconsistent. Instead, most countries have opted for “opportunistic” mammogram screenings on the population at risk. Our study assessed and compared epidemiological, clinical factors, and survival rates associated with BC detected by screening (SDBC) or self-detected/symptomatic (non-SDBC) in Chilean female patients. Methods Registry-based cohort study that included non-metastatic BC (stage I/II/III) patients diagnosed between 1993 and 2020, from a public hospital (PH) and a private university cancer center (PC). Epidemiological and clinical data were obtained from medical records. Results A total of 4559 patients were included. Most patients (55%; n = 2507) came from PH and were diagnosed by signs/ symptoms (non-SDBC; n = 3132, 68.6%); these patients displayed poorer overall (OS) and invasive disease-free survival (iDFS) compared to SDBC. Importantly, the proportion of stage I and “luminal” BC (HR + /HER2 −) were significantly higher in SDBC vs. non-SDBC. Finally, using a stage/subset-stratified age/insurance-adjusted model, we found that nonSDBC cases are at a higher risk of death (HR:1.75; p < 0.001). In contrast, patients with PC health insurance have a lower risk of death (HR: 0.60; p < 0.001). Conclusion We confirm previous studies that report better prognosis/survival on SDBC patients. This is probably due to a higher proportion of stage I and luminal-A cases versus non-SDBC. In turn, the survival benefit observed in patients with PC health insurance might be attributed to a larger proportion of SDBC. Our data support the implementation of a systematic BC screening program in Chile to improve patient prognosis and survival rates.
Terapia personalizada en cáncer de mama precoz. Implicancias prácticas
(2022) Acevedo, Francisco; Sánchez, Cesar; Walbaum, Benjamín
Cáncer de mama es el cáncer más frecuente en Chile y el mundo. El desarrollo de mejores tratamientos sistémicos ha mejorado considerablemente su sobrevida. Desde el descubrimiento del receptor de estrógeno, hace más de 50 años, hasta la fecha mucho se ha avanzado en comprender la heterogeneidad de esta patología. Avances en nuestro entendimiento en proteómica, genómica y biología del cáncer han llevado a una apreciación más profunda de la complejidad y variabilidad de los genes involucrados y su representación fenotípica. Consecuentemente, el tratamiento de estas pacientes se ha vuelto cada vez más individualizado y preciso. Nada ejemplifica esto mejor que el cáncer de mama: el uso de biomarcadores de fácil utilización en clínica con demostrada utilidad pronóstica y predictiva han llevado la pauta de cómo debe ser tratado el cáncer en general. En el siguiente artículo intentaremos describir este camino, mostraremos el significado y las potenciales implicancias de los subgrupos intrínsecos, el uso de plataformas genómicas para definir tratamientos más individualizados y cuál es el futuro de la terapia de precisión en cáncer. El objetivo final es entregar una visión general de como la medicina de precisión ha impactado el manejo del cáncer de mama precoz.
Understanding current therapies in metastatic melanoma
(SOC MEDICA SANTIAGO, 2016) Rodriguez, Rocio; Para, Angela; Gonzalez, Sergio; Molgo, Montserrat; Droppelmann, Nicolas; Acevedo, Francisco; Pena, Jose; Uribe, Pablo
Cutaneous melanoma is a highly aggressive tumor developing from melanocytes, its incidence is increasing, and prognosis in advanced stages is daunting. New therapies have been approved during the recent years with unprecedented results, including inhibitors of MAPK/ERK pathway and immune checkpoint blockade (anti-cytotoxic T lymphocyte antigen- 4 (CTLA-4) as ipilimumab, anti-programmed cell death protein 1 (PD-L1) as pembrolizumab and anti-programmed cell death protein 1 ligand (PD-L1), among many others). The aim of this paper is to review currently available metastatic melanoma therapies focusing mainly on new therapies that have demonstrated effectiveness, after several decades of little progress in the treatment of this disease.

Browsing by Author "Acevedo, Francisco"

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