Oncología Clínica

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Real world prevalence of biomarkers for treatment of advanced gastric cancer or gastroesophageal junction cancer in a cohort of Colombian patients
(Journal of Clinical Oncology, 2024-01-22) Molina Pimienta, Luisana; Ballen, Diego-Felipe
Background: Gastric cancer (GC) is the leading cause of cancer-related deaths in Colombia, GLOBOCAN estimated 6.451 deaths in 2022. Development of immune checkpoint inhibitors and HER2 target therapy with chemotherapy had improved overall survival in advanced setting, but we do not have data about the prevalence of biomarkers used for selection of these patients in Colombia or Latin-America. Our aim is to describe the prevalence of biomarkers used currently for selection of treatment in a real-world multicenter cohort of advanced gastric and gastroesophageal junction (GEJ) cancer. Methods: We did a retrospective observational multicenter study of patients with advanced GC/GEJ cancer treated at three reference cancer centers in Bogota, Colombia between January 1, 2023 and July 31, 2023. We reviewed medical history and pathology reports looking for the prevalence of biomarkers used for selection of first line systemic therapy. Ventana 4B5 for HER2 IHQ evaluation and Dako 22C3 for PDL1 expression by CPS were used. MMR proteins were evaluated by IHQ nuclear expression. Results: 101 patients with advanced GC/GEJ were included. The median age was 61 years (range 18-83), 53,5% of patients were men, 92.1% were gastric cancer and 87,1% were de novo stage IV. Signet ring cells were found in 40%, peritoneal carcinomatosis was documented in 59% and 75,2% were distal tumors (no cardias or GEJ involvement). PDL1 positivity, defined as CPS $1 was found in 30.6%, using CPS > 5 cutoff just 22.7% of them were positive. HER2 positivity and MMR deficiency were found in the same proportion of patients 5%. Among young patients (, 50 years) 80% had diffuse histology, 30% were CPS > 5. HER2 status and PDL1 testing was unknown in 21% and 29% respectively. Conclusions: Among these real-world patients, both HER2 and PDL1 positivity was lower than reported in other regions. Higher incidence of distal tumors, signet ring cells and diffuse histology could explain this difference. Correlation of PDL1 positivity between 22C3 and 28.8 was unknown in our population. Our study remarks the high medical need for investigation of biomarkers and developing of prospective studies for correlation and other targets like Claudins and FGFR2b. R
Caracterización clínica, patológica y supervivencia global de neoplasias neuroendocrinas gastroenteropancreáticas de un centro de referencia, Bogotá - Colombia (2008-2020)
(2024-02-26) Molina Pimienta, Luisana; Cuéllar Cuéllar, Andres; Tapiero Garcia, Mireya; Romero Rojas, Alfredo
Introducción: Las neoplasias neuroendocrinas (NEN) son tumores raros y heterogéneos originados en el sistema neuroendocrino difuso, con comportamiento biológico y clínico variable. Representan el 0,5% de todas neoplasias recién diagnosticadas. Los tumores neuroendocrinos gastroenteropancreáticos (GEP-NEN) representan una proporción significativa de los NEN. Nuestro objetivo es establecer los factores clínicos y patológicos asociados a supervivencia de los pacientes con diagnóstico de GEP-NEN. Métodos: Observacional analítico tipo cohorte retrospectivo. Se incluyeron pacientes atendidos entre el 1 de enero de 20 y el 1 de enero de 2020 en el Instituto Nacional de Cancerología en Bogotá, Colombia. Resultados: Un total de 204 pacientes fueron incluidos. La mediana de edad fue de 55 años (rango: 46-64) y el 61,3% de los pacientes eran mujeres. La mayoría de los pacientes (95,6%) tenían tumores neuroendocrinos (TNE) gastroenteropancreáticos y el 55,9% tenía enfermedad en estadio IV. Además, el 30,9% tenía un tumor funcional. La mediana de seguimiento fue de 8,7 años (rango: 5,5 a 11,6 años). Aún no se ha alcanzado la mediana de supervivencia general. Se encontró una diferencia estadísticamente significativa en la supervivencia según la puntuación de Krenning (p = 0,023), el compromiso metastásico (p < 0,0001), el grado del tumor (p = 00093) y entre los pacientes sometidos a cirugía y los que no (p<0,0001). Conclusiones: En esta cohorte, los resultados de supervivencia fueron mayores que los informados anteriormente en México. Este estudio proporciona información valiosa sobre las GEP-NEN en un entorno de un país de ingresos medianos.
Significance of Pathologic Response in Patients With Early and Locally Advanced Breast Cancer Treated With Neoadjuvant Chemotherapy in a Middle-Income Country. A Real-World Historical Cohort
(JCO Global Oncology, 2024-07-11) Mantilla, William; Gonzalez Blanco, Mariafernanda; Rojas, Sebastian; Guerra, Joaquin Hernando; Munevar, Isabel
PURPOSE Breast cancer (BC) is the most frequent neoplasm in women in Colombia and is associated with a higher mortality rate than in other countries and regions. Neoadjuvant chemotherapy (NACT) has become a standard treatment in locally advanced BC and provides an opportunity to improve clinical outcomes in BC. This study aims to describe characteristics, treatment patterns, and outcomes after NACT in a cohort of Colombian patients with BC. METHODS We performed a retrospective cohort study. We included adult patients with BC treated with NACT. Clinical charts were retrospectively reviewed. Descriptive statistics and time to event for overall survival analyses were performed. Recursive partitioning was performed for survival curves to assess the complex relationship between survival times and other variables. RESULTS Three hundred and fourteen patients were included for analysis. The pathologic complete response after neoadjuvant chemotherapy (ypCR) rate was 34.4%, with a higher ypCR in triple-negative BC (TNBC; 46.9%) and human epidermal growth factor receptor 2–positive BC (72.7%). Thosewho did not achieve ypCR had a higher percentage of death and relapse.Themedian follow-up was 4.9 years, with an 88.2% 5-year overall survival (OS). CONCLUSION A total of 62.6% of the total patients identified were not treated with NACT, indicating a low utilization. Our global ypCR rate was higher when compared with similar studies in Colombia, likely because of differences in the NACT treatment regimens. ypCR was only associated with OS in the TNBC subgroup, emphasizing the importance of pursuing ypCR in these patients. We consider the use of NACT a valuable opportunity to implement innovative treatment approaches that improve outcomes in Colombian patients with BC.
Factores clínicos de los pacientes en cáncer renal de células claras manejado con inmunoterapia en primera línea en el Instituto Nacional de Cancerología entre 2018 y 2023, Bogotá – Colombia
(en revision, 2024-10-07) Zapata, Martin Ignacio; Gonzalez Blanco, Mariafernanda
Resumen Introducción: El cáncer renal de células claras (CRCC) es una de las malignidades más comunes del sistema urinario. Hasta el 30% se presenta con metástasis local o a distancia mientras que el 20% de los que reciben diagnóstico inicial de enfermedad localizada desarrollaran metástasis durante el seguimiento. La evaluación del riesgo y la elección del tratamiento adecuado son cruciales para su manejo. Este estudio pretende disminuir la brecha de información en Colombia y Latino América. Métodos: Se realizó un estudio observacional de corte transversal, incluyendo pacientes atendidos entre el 1 de enero de 2018 y el 31 de diciembre de 2023 en el Instituto Nacional de Cancerología en Bogotá, Colombia. Resultados: Se incluyeron 27 pacientes con una mediana de edad de 54 años, la mayoría hombres (78%), fumadores (48.1%) con una buena condición funcional (karnofsky superior a 80% : 85.5%). El 59.3% presentaba sobrepeso con un IMC superior a 25 y el 22.2% se encontraba en rango de obesidad superando un IMC de 30. El 66.7% de los pacientes debuto con enfermedad metastásica con compromiso principalmente a nivel pulmonar (48.1%) y óseo (40.7%). El 18.5 % de la población tenía riesgo favorable, el 48.1% riesgo intermedio y el 33.3% riesgo desfavorable (International Metastatic RCC Database Consortium IMDC). Los esquemas de tratamiento más utilizados como primera línea fueron nivolumab + ipilimumab (63%), pembrolizumab + axitinib (18,5%) y pembrolizumab + lenvatinib (14,8%). Al realizar un seguimiento mínimo de 6 meses 40,7% de los pacientes presento progresión de su enfermedad requiriendo cambio de línea de tratamiento a inhibidor de tirosin kinasa (TKI), el mas utilizado fue cabozantinib (18,5%). Conclusiones: Nuestros resultados contribuyen a la comprensión del manejo del cáncer renal de células claras metastásico en Colombia, destacando la importancia de la inmunoterapia como opción terapéutica. Mostrando similitudes con la literatura publicada previamente. Se necesitan más estudios para optimizar el tratamiento y mejorar los resultados. Palabras clave: Carcinoma de Células Renales; Neoplasias Renales; Inmunoterapia; Nefrectomía; América Latina;
Clear Cell Renal Cell Carcinoma With Brain Metastases Treated With Complementary Ketogenic Metabolic Therapy: A Case Report
(2025-05-28) Alfredo Acevedo Ramos; Martin Zapata Laguado
A 65-year-old woman was first diagnosed in 2011 with stage III clear cell renal cell carcinoma (pT3aNxM0) of the left kidney, managed successfully with radical nephrectomy. She remained disease-free for three years. In 2014, she developed a metachronous stage III papillary thyroid carcinoma (T1N1M0), treated with total thyroidectomy, nodal dissection, and adjuvant radioactive iodine therapy (100 mCi). In 2019, two pulmonary lesions were detected in the left upper lobe. Biopsy confirmed metastatic clear cell carcinoma. Due to intolerance to sunitinib, the patient was treated with pazopanib. By September 2022, she developed four intracranial metastatic lesions, predominantly in the right frontal lobe and bilateral mesial temporal lobes. A neurosurgeon performed a biopsy, confirming metastatic clear cell carcinoma. The patient underwent whole-brain radiotherapy over five sessions and began treatment with nivolumab. After receiving five cycles of immunotherapy, the patient experienced a seizure associated with edema around the dominant lesion and neurological decline. She was treated with anticonvulsants and a short steroid course, leading to functional recovery. We used this treatment for around 10 days and continued immunotherapy and anticonvulsant therapy. In January 2023, ketogenic metabolic therapy (KMT) was initiated using a 3:1 ratio ketogenic supplement (KetoVie). Ketone levels and neurological status were closely monitored. Upon confirmation of ketones in the urine or blood, therapy adjustments were made to optimize adherence. By July 2023, the patient no longer required assistance for medical appointments, discontinued anticonvulsant therapy, and retained full cognitive function. In January 2024, the patient maintained a partial response, and dietary supplementation was stopped. This case highlights the potential role of KMT as a safe and complementary approach in advanced clear cell renal cell carcinoma. KMT may enhance the efficacy of immunotherapy and radiotherapy, contributing to improved progression-free survival and neurological function without increasing toxicity.
Desenlaces oncológicos y seguridad del tratamiento neoadyuvante con y sin antraciclinas en cáncer de mama temprano y localmente avanzado HER-2 positivo en el Instituto Nacional de Cancerología.
(2025-07-21) Alfredo Acevedo Ramos, Andrea Zuluaga Liberato, Sandra Diaz Casas
Introduction: Recent clinical trials have shown similar effectiveness between anthracycline-containing and non-anthracycline regimens in neoadjuvant treatment of early and locally advanced breast cancer with respect to pathological complete response (pCR) rates and event-free survival. This has motivated a trend toward progressive withdrawal of anthracyclines in this clinical setting, seeking to reduce adverse effects such as cardiotoxicity and myelotoxicity. However, there are no comparative studies between the two most currently used regimens, derived from the BERENICE and TRAIN-2 studies. Methods: An analytical retrospective observational study was conducted with patients diagnosed with early, locally advanced HER-2 positive breast cancer who started neoadjuvant chemotherapy with anthracyclines (Doxorubicin, Cyclophosphamide x 4, Taxane, Trastuzumab and Pertuzumab x 4 = AC-THP) and without anthracyclines (Carboplatin, Paclitaxel weekly, Trastuzumab and Pertuzumab for 6-9 cycles = TCbHP) treated at the National Cancer Institute between April 2020 and December 2024. Complete pathological response, as well as cardiac toxicity and neurotoxicity in both treatment arms, were evaluated in the initial analysis. Results: A total of 111 patients were included in whom neoadjuvant treatment with chemotherapy plus pertuzumab and trastuzumab were defined. 51 patients received AC-THP and 60 received TCbHP (89.6% received 6 cycles). There was no statistically significant difference in pCR between patients operated on in each arm. 58.3% received ACHTP and 60.4% in TCbHP (OR 1.08 95% CI 0.49-2.36 p = 0.84). A descriptive analysis showed a trend toward higher pCR in T3-T4, N+, and ER-positive patients compared to patients who received the anthracycline arm. The incidence of LVEF decline >10% with an absolute value <50% during the neoadjuvant phase was 9.8% and 3.3% in ACTHP vs TCbHP. Grade 2 neuropathy events were reported in 9.8% vs. 23.3% of patients receiving TCbHP, respectively. Conclusions: Despite using fewer cycles than those administered in the TRAIN-2 study (6 vs 9 cycles) in most patients, we found similar pCR rates between the anthracycline-free regimen and the anthracycline-containing regimen. It is perhaps still pertinent to discuss the risk-benefit of using an anthracycline-containing regimen in patients with HR+, T3-4, and N+, in addition to the usual considerations of cardiovascular risk factors. Cardiotoxicity events in the anthracycline arm were similar to those in the BERENICE study. We recorded fewer cases of grade 2 or higher neuropathy than in the TRAIN-2 study, possibly due to the reduced number of cycles received.

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