Browsing by Author "Sánchez Rojel, César Giovanni"

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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.
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    Access disparities and underutilization of germline genetic testing in Chilean breast cancer patients
    (2023) Acevedo Claros, Francisco Nicolás; Walbaum García, Benjamín Vicente; Camus Appuhn, Mauricio Gonzalo; Manzor Véliz, Manuel; Muñiz Muñoz, María Sabrina; Medina Araya, Lidia; Petric Guajardo, Militza Paulina; Reyes, Paula; Domínguez, Francisco; Puschel Illanes, Klaus; Merino Lara, Tomás Rodrigo; Bravo, M. Loreto; Pinto, Mauricio P.; Ibáñez, Carolina; Hughes, Kevin; Sánchez Rojel, César Giovanni
    Purpose Latin American reports on genetic cancer risk assessments are scarce. In Chile, current breast cancer (BC) guidelines do not define strategies for germline genetic testing. Our study sought to quantify the disparities in access to genetic testing in Chilean BC patients, according to international standards and their clinical characteristics to explore improvement strategies.Methods Retrospective analysis of invasive BC databases including patients treated in a Public Hospital (PH) and in an Academic Private Center (AC) in Santiago, Chile between 2012 and 2021.Results Of 5438 BC patients, 3955 had enough data for National Comprehensive Cancer Network (NCCN) categorization. From these, 1911 (48.3%) fulfilled NCCN criteria for germline testing, of whom, 300 were tested for germline mutations and 268 with multigene panels. A total of 65 pathogenic variants were found in this subset. As expected, BRCA1/2 mutations were the most frequent (17.7%). Access to genetic testing was higher in AC versus PH (19.6% vs. 10.3%, p = 0.0001). Other variables associated with germline genetic testing were BC diagnosis after 2018, being 45 years old or younger at diagnosis, BC family history (FH), FH of ovarian cancer, non-metastatic disease, and triple-negative subtype.Conclusion In our cohort, 15% of BC patients who met NCCN criteria for germline testing were effectively tested. This percentage was even lower at the PH. Current recommendations encourage universal genetic testing for BC patients; however, our findings suggest that Chile is far from reaching such a goal and national guidelines in this regard are urgently needed. To our knowledge, this is the first study of its kind in Chile and Latin America.
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    Axillary web syndrome among Chilean women with breast cancer : incidence and possible predisposing factors
    (2020) Ramírez Parada, Karol Lilia; Garay-Acevedo, D.; Mella Abarca, Williams Andrés; Petric Guajardo, Militza Paulina; Sánchez Rojel, César Giovanni; McNeely, M. L.; Leao-Ribeiro, I.; Fernández Verdejo, Rodrigo
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    Breast cancer at extreme ages - A comparative analysis in Chile
    (2015) Acevedo Claros, Francisco Nicolás; Camus Appuhn, Mauricio Gonzalo; Sánchez Rojel, César Giovanni
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    Calorie Restriction and Time-Restricted Feeding: Effective Interventions in Overweight or Obese Patients Undergoing Radiotherapy Treatment with Curative Intent for Cancer
    (2024) Vega Huerta, Carmen Natalia; Barnafi Wittwer, Esteban Andrés; Sánchez Rojel, César Giovanni; Acevedo Claros, Francisco Nicolás; Walbaum García, Benjamín Vicente; Parada Daza, Alejandra Cristina; Rivas Segura, Nicolás Eduardo; Merino Lara, Tomás Rodrigo
    This study assesses the feasibility of calorie restriction (CR) and time-restricted feeding (TRF) in overweight and obese cancer patients who realized little to no physical activity undergoing curative radiotherapy, structured as a prospective, interventional, non-randomized open-label clinical trial. Of the 27 participants initially enrolled, 21 patients with breast cancer were selected for analysis. The participants self-selected into two dietary interventions: TRF, comprising a sugar and saturated fat-free diet calibrated to individual energy needs consumed within an 8 h eating window followed by a 16 h fast, or CR, involving a 25% reduction in total caloric intake from energy expenditure distributed across 4 meals and 1 snack with 55% carbohydrates, 15% protein, and 30% fats, excluding sugars and saturated fats. The primary goal was to evaluate the feasibility of these diets in the specific patient group. The results indicate that both interventions are effective and statistically significant for weight loss and reducing one’s waist circumference, with TRF showing a potentially stronger impact and better adherence. Changes in the LDL, HDL, total cholesterol, triglycerides, glucose and insulin were not statistically significant.
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    Cáncer de mama avanzado receptor de estrógeno positivo: Manejo sistémico actual
    (2018) Sánchez Rojel, César Giovanni; Valenzuela Velasquez, Yasna Daniela; Pérez-Sepúlveda, Alejandra; Villarroel Pérez, María Alejandra; Medina Araya, Lidia; Camus Appuhn, Mauricio Gonzalo; Acevedo Claros, Francisco Nicolás
    El cáncer de mama es la primera causa de muerte por cáncer en mujeres chilenas. Mientras la mayoría de las personas logra curarse de esta enfermedad, un 5% de los casos se presenta inicialmente con enfermedad avanzada y hasta un 20-30% de pacientes con enfermedad localizada pueden sufrir recurrencias sistémicas. La mayoría de las neoplasias mamarias son dependientes del estímulo estrogénico, de allí que la deprivación de estrógenos es la principal estrategia terapéutica. Recientemente, el uso de terapias molecularmente dirigidas en combinación con la terapia endocrina ha logrado mejorar los resultados de sobrevida del cáncer de mama avanzado, con menos efectos colaterales que aquellos producidos por la quimioterapia convencional. El conocimiento de los mecanismos de acción de estas nuevas terapias, sus toxicidades, vías de resistencia y selección de pacientes para lograr los mejores beneficios terapéuticos son aspectos relevantes en el manejo de la enfermedad. Presentamos una revisión del estado actual del manejo del cáncer de mama metastásico hormonodependiente con enfásis en el uso de terapias endocrinas combinadas con terapias moleculares.
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    Cáncer de mama en mujeres adultas mayores, características clínicas e histopatológicas y resultados del tratamiento con intención curativa
    (2013) Sánchez Rojel, César Giovanni; Bakal, Federico L.; Camus Appuhn, Mauricio Gonzalo; Besa de C., Pelayo
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    Características clínico-patológicas y sobrevida de pacientes con cáncer de mama bilateral sincrónico
    (2014) Sánchez Rojel, César Giovanni; Acevedo Claros, Francisco Nicolás; Petric, M.; Domínguez Covarrubias, Francisco José; León Ramírez, Augusto; Razmilic Valdés, Dravna Nichi; Ceballos, C.; Espinoza, F.; Navarro Ortega, María Elena; Oddo Benavides, David; Camus, M.
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    Clinical characteristics, risk factors, and outcomes in Chilean triple negative breast cancer patients: a real-world study
    (2023) Acevedo Claros, Francisco Nicolás; Walbaum, Benjamin; Medina, Lidia; Merino Lara, Tomás Rodrigo; Camus Appuhn, Mauricio Gonzalo; Puschel Illanes, Klaus; Ramírez Parada, Karol Lilia; Manzor, Manuel; Veglia, Paulina; Martinez, Raul; Guerra, Constanza; Navarro, Marisel; Bauerle, Catherine; Domínguez Covarrubias, Francisco José; Sánchez Rojel, César Giovanni
    Background Latin American (LA) studies on triple-negative breast cancer (TNBC) and their characteristics are scarce. This forces physicians to make clinical decisions based on data obtained from studies that include non-Hispanic patients. Our study sought to obtain local epidemiological data, including risk factors and clinical outcomes from a Chilean BC registry. Methods This was a retrospective population-cohort study that included patients treated at a community hospital (mid-low income) or an academic private center (high income), in the 2010-2021 period. Univariate and multivariate analyses were performed to identify prognostic factors associated with survival. Results 647 out of 5,806 BC patients (11.1%) were TNBC. These patients were younger (p = 0.0001) and displayed lower rates of screening-detected cases (p = 0.0001) compared to non-TNBC counterparts. Among TNBC patients, lower income (i. e., receiving treatment at a community hospital) was associated with poorer overall survival (HR: 1.53; p = 0.0001) and poorer BC specific survival (HR: 1.29; p = 0.004). Other risk factors showed no significant differences between TNBC and non-TNBC. As expected, 5-year OS was significantly shorter on TNBC versus non-TNBC patients (p = 0.00001). In our multivariate analyses TNBC subtype (HR: 2.30), locally advanced stage (HR: 7.04 for stage III), lower income (HR: 1.64), or non-screening detected BC (HR: 1.32) were associated with poorer OS. Conclusion To the best of our knowledge, this is the largest LA cohort of TNBC patients. Interestingly, the proportion of TNBC among Chileans was smaller compared to similar studies within LA. As expected, TNBC patients had poorer survival and higher risk for early recurrence versus non-TNBC. Other relevant findings include a higher proportion of premenopausal patients among TNBC. Also, mid/low-income patients that received medical attention at a community hospital displayed lower survival versus private health center counterparts.
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    Correlation between Ki67 and histological grade in breast cancer patients treated with preoperative chemotherapy
    (2014) Petric Guajardo, Militza Paulina; Martínez Riquelme, Santiago Felipe; Acevedo Claros, Francisco Nicolás; Oddo Benavides, David; Artigas Barrenechea, Rocío; Camus Appuhn, Mauricio Gonzalo; Sánchez Rojel, César Giovanni
    Background and Aim: Breast cancer (BC) is a heterogeneous disease and cell proliferation markers may help to identify subtypes of clinical interest. We here analyzed the correlation between cell proliferation determined by Ki67 and HG in BC patients undergoing preoperative chemotherapy (PCT). Materials and Methods: We obtained clinical/pathological data from patients with invasive BC treated at our institution from 1999 until 2012. Expression of estrogen receptor (ER), progesterone receptor (PR), epidermal growth factor receptor type 2 (HER2) and Ki67 were determined by immuno-histochemistry (IHC). Clinicopathological subtypes were defined as: Luminal A, ER and/or PR positive, HER2 negative, HG 1 or 2; Luminal B, ER and/or PR positive, HER2 negative or positive and/or HG 3; triple negative (TN), ER, PR and HER2 negative independent of HG; HER2 positive, ER, PR negative and HER2 positive, independent of HG. By using Ki67, a value of 14% separated Luminal A and B tumors, independently of the histological grade. We analyzed correlations between Ki67 and HG, to define BC subtypes and their predictive value for response to PCT. Results: 1,560 BC patients were treated in the period, 147 receiving PCT (9.5%). Some 57 had sufficient clinicopathological information to be included in the study. Median age was 52 years (26-72), with 87.7% invasive ductal carcinomas (n=50). We performed IHC for Ki67 in 40 core biopsies and 50 surgical biopsies, 37 paired samples with Ki67 before and after chemotherapy being available. There was no significant correlation between Ki67 and HG (p=0.237), both categorizing patients into different subtypes. In most cases Ki67 decreased after PCT (65.8%). Only 3 patients had pathologic complete response (cPR). Conclusions: In our experience we did not find associations between Ki67 and HG. Determination of clinicopathological luminal subtypes differs by using Ki67 or HG.
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    Cost-minimization analysis of subcutaneous versus intravenous trastuzumab administration in Chilean patients with HER2-positive early breast cancer
    (2020) Rojas Orellana, Luis; Muniz, S.; Medina Araya, Lidia; Peña Durán, José Esteban; Acevedo Claros, Francisco Nicolás; Pinto Paganini, Mauricio Arturo; Sánchez Rojel, César Giovanni
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    Effect of Supervised Resistance Training on Arm Volume, Quality of Life and Physical Perfomance Among Women at High Risk for Breast Cancer-Related Lymphedema: A Study Protocol for a Randomized Controlled Trial (STRONG-B)
    (Frontiers Media SA, 2022) Ramírez Parada, Karol Lilia; López Garzón, María; Sánchez Rojel, César Giovanni; Petric Guajardo, Militza Paulina; Alfaro Barra, Margarita Eugenia; Fernández Verdejo, Rodrigo; Reyes Ponce, Álvaro Renato; Merino Pereira, Gina Francesca; Cantarero Villanueva, Irene
    Objectives: To determine the preventive effects of supervised resistance training on arms volume, quality of life, physical performance, and handgrip strength in Chilean women at high risk for breast cancer-related lymphedema (BCRL) undergoing chemotherapy. Design: Randomized control trial. Participants: One hundred and six women at high risk for breast cancer-related lymphedema aged 18 to 70 years. Interventions: Participants will be randomized into two groups: [a] intervention, who will receive 12 weeks of supervised resistance training (STRONG-B) during adjuvant chemotherapy; and [b] control, who will receive education to promote lymphatic and venous return, maintain range of motion, and promote physical activity. Main Outcome Measures: The primary outcome will be arms volume measured with an optoelectric device (perometer NT1000). Secondary outcomes will be quality of life, handgrip strength, and physical performance. Primary and secondary outcomes will be measured at baseline, just after the intervention, and 3 and 6 months after. Statistical analysis will be performed following intention-to-treat and per-protocol approaches. The treatment effect will be calculated using linear mixed models. Discussion: The STRONG-B will be a tailored supervised resistance training that attempts to prevent or mitigate BCRL in a population that, due to both intrinsic and extrinsic factors, will commonly suffer from BCRL.
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    Endocrine-Therapy-Resistant ESR1 Variants Revealed by Genomic Characterization of Breast-Cancer-Derived Xenografts
    (2013) Li, Shunqiang; Shen, Dong; Shao, Jieya; Crowder, Robert; Liu, Wenbin; Prat, Aleix; He, Xiaping; Liu, Shuying; Hoog, Jeremy; Sánchez Rojel, César Giovanni; Lu, Charles
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    Epigenetic activation of the prostaglandin receptor EP4 promotes resistance to endocrine therapy for breast cancer
    (2017) Hiken, J.; Mcdonald, J.; Decker, K.; Sánchez Rojel, César Giovanni; Hoog, J.; Vanderkraats, N.; Jung, K.; Akinhanmi M.; Rois, L.; Ellis, M.; Edwards, J.
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    Eribulin-induced radiation recall dermatitis: a case report and brief review of the literature
    (2020) Tran, WT; Ibáñez Cáceres, Carolina.; Pinto, Mauricio P.; Sánchez Rojel, César Giovanni; Czarnota, GJ; Merino Lara, Tomas Rodrigo
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    Factors influencing the implementation of shared decision-making in breast cancer care: protocol for a mixed-methods study
    (2023) Bravo Valenzuela, Paulina Fabiola; Dois C., Angelina M.; Villarroel Del Pino, Luis Antonio; González Aguero, Marcela Margot; Fernandez González, Loreto; Sánchez Rojel, César Giovanni; Martínez, Alejandra; Turen Croquevielle, Valentina; Quezada, Constanza; Guasalaga María, Elisabeth; Härter, Martin
    Chile is committed to actively involving patients in their healthcare. However, little is known about how this is translated into clinical encounters. Breast cancer (BC) is the first cause of cancer-related death in Chilean women. National policy guarantees standard care, and treatment decisions should be made along this process that can have long-term consequences for women. So, BC is a particularly well-suited case study to understand the complexity of patient participation in decision-making.
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    High linoleic acid levels in red blood cells predict a poor response to neoadjuvant chemotherapy in human epidermal growth factor receptor type 2-positive breast cancer patients
    (2024) Rodrigo Valenzuela; Walbaum García, Benjamín Vicente; Farías Castro, Camila ; Acevedo Claros, Francisco Nicolás; Vargas Añazco, Catalina Andrea; Bennett Lason, José Tomás; Bravo, M. Loreto; Pinto, Mauricio P.; Medina Araya, Lidia Marjorie; Merino Lara, Tomás Rodrigo; Ibáñez Cáceres, Carolina; Parada Daza, Alejandra Cristina; Sánchez Rojel, César Giovanni
    Objective Polyunsaturated fatty acids are categorized as ω-3 or ⍵-6. Previous studies demonstrate that breast cancers display a high expression of fatty acid synthase and high fatty acid levels. Our study sought to determine if changes in plasma or red blood cell membrane fatty acid levels were associated with the response to preoperative (neoadjuvant) chemotherapy in non-metastatic breast cancer patients.MethodsOur prospective study assessed fatty acid levels in plasma and red blood cell membrane. Response to neoadjuvant chemotherapy was evaluated by the presence or absence of pathologic complete response and/or residual cancer burden.ResultsA total of 28 patients were included. First, patients who achieved pathologic complete response had significantly higher neutrophil-to-lymphocyte ratio versus no pathologic complete response (P = 0.003). Second, total red blood cell membrane polyunsaturated fatty acids were higher in the absence of pathologic complete response (P = 0.0028). Third, total red blood cell membrane ⍵-6 polyunsaturated fatty acids were also higher in no pathologic complete response (P < 0.01). Among ⍵-6 polyunsaturated fatty acids, red blood cell membrane linoleic acid was higher in the absence of pathologic complete response (P < 0.01). Notably, plasma polyunsaturated fatty acid, ⍵-6, and linoleic acid levels did not have significant differences. A multivariate analysis confirmed red blood cell membrane linoleic acid was associated with no pathologic complete response; this was further confirmed by receiver operating characteristic analysis (specificity = 92.3%, sensitivity = 76.9%, and area under the curve = 0.855).ConclusionsPending further validation, red blood cell membrane linoleic acid might serve as a predictor biomarker of poorer response to neoadjuvant chemotherapy in non-metastatic human epidermal growth factor receptor type 2–positive breast cancer. Measuring fatty acids in red blood cell membrane could offer a convenient, minimally invasive strategy to identifying patients more likely to respond or those with chemoresistance.
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    Hormone receptor-positive early breast cancer in young women: A comprehensive review
    (2024) Walbaum García, Benjamín Vicente; García-Fructuoso, Isabel; Martínez-Sáez, Olga; Schettini, Francesco; Sánchez Rojel, César Giovanni; Acevedo Claros, Francisco Nicolás; Chic, Nuria; Muñoz-Carrillo, Javier; Adamo, Barbara; Muñoz, Montserrat; Partridge, Ann H.; Bellet, Meritxell; Brasó-Maristany, Fara; Prat, Aleix; Vidal Losada, Maria
    The incidence of breast cancer in ≤ 40 yr-old women (YWBC) has been steadily increasing in recent decades. Although this group of patients represents less than 10 % of all newly diagnosed BC cases it encompasses a significant burden of disease. Usually underrepresented in clinical trials, YWBCs are also characterized by late diagnoses and poorly differentiated, aggressive-subtype disease, partly explaining its poor prognosis along with a high recurrence risk, and high mortality rates. On the other hand, YWBC treatment poses unique challenges such as preservation of fertility, and long-term toxicity and adverse events. Herein, we summarize the current evidence in hormone receptor-positive YWBC including specific risk factors, clinicopathologic and genomic features, and available evidence on response to chemotherapy and endocrine therapy. Overall, we advocate for a more comprehensive multidisciplinary healthcare model to improve the outcomes and the quality of life of this subset of younger patients.
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    Impacto de las metástasis del linfonodo centinela y su tamaño, en el tratamiento del cáncer de mama
    (2014) Escudero, N.; Jans J.; Leon, F.; León Ramírez, Augusto; Domínguez Covarrubias, Francisco José; Goñi Espíldora, Ignacio; Droppelmann, Nicolás; Sánchez Rojel, César Giovanni; Oddo Benavides, David; Camus Appuhn, Mauricio Gonzalo
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    Inmunohistoquímica convencional como predictor de respuesta y sobrevida en pacientes con cáncer de mama tratadas con quimioterapia preoperatoria. Experiencia de un centro
    (2015) Acevedo Claros, Francisco Nicolás; Camus Appuhn, Mauricio Gonzalo; Vial, Catalina; Panay, Sergio; Abarca, Marcelo; Domínguez Covarrubias, Francisco José; Sánchez Rojel, César Giovanni