Instituto Nacional De Cancerologia Research Articles

Abstract PS09-06: Tumor infiltrating lymphocytes as a predictor of pathologic complete response to neoadjuvant therapy in HER2 positive breast cancer

Abstract Background The presence of tumor infiltrating lymphocytes (TILs) has shown positive prognostic relevance for certain subtypes of breast cancer, although its value as a predictive biomarker is still uncertain. The purpose of this study was to study the association between TILs expression with the pathologic complete response (pCR) following neoadjuvant therapy in Mexican patients with HER2+ breast cancer. Methods Retrospective cohort of patients with stage I-III HER2+ breast cancer who received neoadjuvant therapy between 2017 and 2020 at Instituto Nacional de Cancerología (INCan). We collected demographic and clinico-pathological characteristics. Stage was assigned using AJCC 7th criteria; hormone receptor (HR) and HER2 status were determined according to ASCO-CAP guidelines. Quantification of TILs was made by microscopy and stained with hematoxylin-eosin. TIL levels were defined as low (1-10%) intermediate (11-40%) and high ( >40%). Complete pathologic response was defined as the absence of invasive disease in breast and axilla (ypT0/is N0). pCR rates were compared using X2 and Fisher's exact tests according to demographic and clinicopathologic characteristics. Univariate logistic regression analysis was performed to estimate the probability of pCR according to relevant characteristics. Those parameters with p ≤0.10 on univariate analysis were included in a multivariate logistic regression model. A p< 0.05 was considered as statistically significant. Results We included 164 patients (mean age 51.0 years, SD 11.4). 86 patients (54.1%) were postmenopausal, 75 patients (47.2%) had T3-T4 tumors, 129 patients (81.1%) had positive lymph nodes, 133 patients (83.6%) presented Ki67 ≥30%, 59 patients (37.1%) had negative hormone receptors, 136 patients (85.5%) were treated with anthracyclines and 20 patients (12.6%) received dual anti-HER2 therapy with trastuzumab/pertuzumab. TIL expression was low in 84 patients (52.8%), intermediate in 47 (29.6%), and high in 28 patients (17.6%). The pathologic complete response (pCR) rate in the overall population was 50.9%. pCR rates according to the demographic and clinico-pathological features are listed in Table 1. In patients with intermediate-high TILs, pCR rates were 73.1% with trastuzumab, and 75.0% with dual HER2 blockade (p=0.91). Among patients with low TILs, pCR rates were 23.6% and 75.0%, respectively (p < 0.001). On univariate analysis, intermediate TILs (OR 3.59; 95% C.I 1.70-7.59; p= < 0.001), high TILs (OR 29.00; 95% C.I 6.40-131.37; p= < 0.001), Ki67 ≥30% (OR 2.73, 95% C.I 1.11-6.73; p=0.02), and dual anti-HER2 therapy (OR 3.31; 95% C.I 1.14-9.63 p= 0.021) were associated with a higher probability of pCR. T3/T4 tumor size (OR 0.43; 95% C.I 0.22-0.81; p = 0.009) was associated with a lower probability of pCR. Positive lymph nodes, HR status , and use of anthracyclines were not significantly associated. On multivariate analysis, intermediate TILs (OR 3.28; 95% C.I 1.46-7.32 p=.004), high TILs (OR 32.37; 95% C.I 6.84-153.04 p= < 0.001), and dual anti-HER2 therapy (OR 6.58; 95% CI 2.01-21.47 p= .002) remained significantly associated with pCR. Conclusions Intermediate/high TIL expression was significantly associated with pCR. Our results suggest that TIL expression could help select patients with locally advanced HER2+ breast cancer for treatment intensification with dual HER2 blockade in resource-limited settings. However, these findings require confirmation in larger, prospective studies before implementation into routine practice. TABLE 1. Pathologic complete response (pCR) rates according to demographic and clinical pathological features (n=164). Citation Format: Alberto Monroy Chargoy, Haydee Cristina Verduzco-Aguirre, Javier Monroy Chargoy, Jose Rodrigo Espinosa-Fernandez, Jesus Antonio Martinez Ojeda, Paula Cabrera-Galeana. Tumor infiltrating lymphocytes as a predictor of pathologic complete response to neoadjuvant therapy in HER2 positive breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PS09-06.

Abstract PO4-12-01: Navigation program for timely needs assessment and referral to appropriate services among young breast cancer patients in Mexico

Abstract Background: International guidelines on young women with breast cancer (YWBC) endorse patient navigation (PN) and education interventions to reduce barriers that hinder early access to information and healthcare. In Mexico, the first PN program for YWBC was created by Joven & Fuerte in 2020 for the systematic identification of patients’ medical and support needs and their referral to the appropriate services. This study aims to evaluate whether the PN program facilitates referral and timely access to specialty or supportive care services, to identify the associated barriers, and to assess patients’ satisfaction. Methods: This prospective cohort included women ≤40 years, recently diagnosed with BC (≤3 months [m]), treated at Instituto Nacional de Cancerologia from Nov-20 to Jun-23. Participants were exposed to a PN program in which a series of target questions and validated surveys were applied at baseline, 3 m and 6 m to systematically identify their needs. At each timepoint, the navigator had an in-person or remote meeting with each patient to provide general BC information, share the detected needs, and provide referral to the required services. Patients’ attendance to referrals and related barriers at baseline and 3 m were assessed at 3 m and 6 m, respectively. Results: 207 patients had completed baseline navigation at the time of the analysis, while 138 (67%) and 123 (59%) had completed 3 m and 6 m navigation, respectively. Median age at diagnosis was 36 years (21-40). Most patients had ≥high school education (57%), were unemployed (67%), were single/divorced (52%), had ≥1 child (72%), and had public (79%) or no (21%) health insurance. The services patients were referred to according to their needs and their rates of attendance are detailed in the Table. The most mentioned barriers for attendance to referrals at both baseline and 3 m were patient-physician miscommunication (n=36 and n=32), personal decision not to attend (n=18 and n=8), and forgetfulness (n=6 and n=8). Moreover, attendance to referrals made in 2022-2023 was significantly higher than in 2020-2021, when COVID-19 restrictions were in place (72% vs 48%; p< .001). Feedback on the PN program was provided in 172/207 (83%), 96/138 (70%), and 123/123 (100%) cases at baseline, 3 m and 6 m, respectively. At all timepoints, nearly all patients were very satisfied/satisfied with the program (98-99%); believed the needs detection survey had explored aspects they deemed relevant at the moment (91-98%); affirmed the program had eased their referral to all (73-80%) or some (19-27%) of the services they believed they needed; and stated the program aided them to better cope with their illness (97-99%). Most (82-88%) rated their satisfaction with the information provided by the program ≥90/100. Conclusion: The main needs observed in this YWBC cohort comprised access to support groups, nutritional counseling, psychological care, and wig providers. The vast majority of patients were highly satisfied with the information and guidance provided by the PN program. Although PN timely identified patients’ health needs and informed them on their individual referral recommendations, attendance rates to the required services were suboptimal in most cases. Factors for non-attendance included possibly the COVID-19 pandemic, as well as personal and health system aspects, which should be further explored to effectively address them and increase timely access to comprehensive, patient-centered care. Table. Patients’ referral and attendance to specialty and supportive care services Citation Format: Fernanda Mesa-Chavez, Lucero Labra, Ana Rodriguez, Alan Fonseca, Marlid Cruz-Ramos, Alejandra Platas, Paula Cabrera-Galeana, Cynthia Villarreal-Garza. Navigation program for timely needs assessment and referral to appropriate services among young breast cancer patients in Mexico [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-12-01.

Early Incorporation to Palliative Care (EPC) in Patients With Advanced Non-Small Cell Lung Cancer: The PACO Randomized Clinical Trial.

Patients with non-small cell lung cancer (NSCLC) experience a considerable disease burden, evident in symptomatic and psychological spheres. Advanced cancer represents a complex scenario for patients and the healthcare team. Early palliative care (EPC) has been proven as a clinically meaningful strategy in this context by several randomized trials but not in a resource-limited setting. This study aimed to evaluate the effect of EPC compared with standard oncological care (SOC) in patients with metastatic NSCLC in Mexico. A prospective, randomized clinical trial was conducted at Instituto Nacional de Cancerologia in Mexico. All patients had histologically confirmed metastatic NSCLC without previous treatment. Patients were randomly assigned (1:1) to receive SOC or SOC + EPC. The EPC group was introduced to the palliative care team at baseline after randomization, which was integrated by psychologists, bachelor's in nutrition, specialized nurses, and physicians. Patients randomized to this arm had programmed visits to meet with the team at baseline and through the 2nd, 4th-, and 6th cycles thereafter. The primary endpoint was overall survival (OS); secondary outcomes included quality of life (QoL), anxiety and depression, and symptom intensity. They were assessed using the instruments EORTC QLQ-C30 questionnaire, Edmonton Symptom Assessment Scale (ESAS), and the Hospital Anxiety and Depression Scale (HADS) (clinicaltrials.gov [NCT01631565]). Questionnaires were completed at baseline, at 2nd, 4th, and 6th cycles of treatment. Between March 2012 and June 2015, 201 patients were assessed for eligibility and 146 were enrolled and allocated to receive EPC (73) or SOC (73). Median OS for patients in the EPC vs SOC arm was 18.1 months (95% CI, 7.9-28.4) and 10.5 months (95% CI, 4.7-16.2) (P = .029). Having a poor performance status (HR 1.7 [1.2-2.5]; P = .004) and allocation to the control group (HR 1.5 [1.03-2.3]; P = .034) were independently associated with a worse OS. Those patients with a global QoL > 70 at baseline had a better OS if they were In the EPC arm (38.7 months (95% CI, 9.9-67.6) vs SOC 21.4 months (95% CI, 12.4-30.3)). Mean QoL had a numerical improvement in patients allocated to EPC after 6 cycles of follow-up, nonetheless this difference was not statistically significant (55.1 ± 23.7 vs 56.9 ± 25.3; P = .753). There were no significant differences in anxiety and depression at all study points. EPC is associated with a significant improvement in OS, although, we observed that the greatest benefit of providing EPC was observed in those with a global QoL > 70 at baseline. This study did not identify significant changes in terms of QoL or symptom burden between the study groups after follow-up. Evidence robustly suggests that EPC should be considered part of the multidisciplinary treatment of metastatic NSCLC patients since diagnosis. According to our study, EPC can be implemented in low- or middle-income countries (LMIC).

Prognostic Factors Associated with Tumor Recurrence and Overall Survival in Soft Tissue Sarcomas of the Extremities in a Colombian Reference Cancer Center.

Introduction: Soft tissue sarcomas (STS) are low-incidence tumors whose clinical and histopathological factors are associated with adverse oncological outcomes. This study evaluated prognostic factors (PF) associated with tumor recurrence and overall survival (OS) in patients diagnosed with STS of the extremities, treated at the Instituto Nacional de Cancerología (INC), Bogotá, Colombia. Materials and Methods: An analytical observational study of a historical cohort was carried out, including patients diagnosed with STS and managed surgically in the Functional Unit for Breast and Soft Tissue Tumors of the INC from January 2008 to December 2018. Results: A total of 227 patients were included; 74.5% had tumors greater than 5 cm. Most patients (29.1%) were in stage IIIB at diagnosis. Age was associated with higher mortality (HR = 1.01; CI95%: 1-1.02; p = 0.048). Tumor persistence at admission to the INC (HR = 2.34; CI95%: 1.25-4.35; p = 0.007) and histologic grade III (HR = 5.36; CI95%: 2.29-12.56; p = <0.001) showed statistical significance in the multivariate analysis for recurrence of any type, as did the PFs associated with a higher risk of local recurrence (HR = 2.85; CI95%: 1.23-6.57; p = 0.014 and HR = 6.09; CI95%: 2.03-18.2; p = 0.001), respectively. Tumor size (HR = 1.03; CI95%: 1-1.06; p = 0.015) and histologic grade III (HR = 4.53; CI95%: 1.42-14.49; p = 0.011) were associated with a higher risk of distant recurrence. Conclusions: This cohort showed that in addition to histologic grade and tumor size, tumor persistence at the time of admission has an impact on disease recurrence, so STS should be managed by a multidisciplinary team with experience in this pathology in high-volume reference centers.

Sociodemographic characteristics and their association with survival in women with cervical cancer

BackgroundIn 2020, the highest incidence and mortality from cervical cancer (CC) were detected in low and middle-income countries. CC remains a health problem for women living in them. In Mexico, CC ranks second in cancer incidence and mortality in women. The main characteristics of this population are low income, low educational level, and inadequate medical coverage. The present study characterized the Mexican population by CC, and the sociodemographic variables that impacted overall survival (OS) were identified.MethodsA retrospective study that included a cohort of patients with a confirmed diagnosis of CC at the Instituto Nacional de Cancerologia between 2003 and 2016. Information was collected on sociodemographic variables related to the disease and OS.ResultsFour thousand six hundred thirty-one patients were included. The median age was 51 years, 78.5% were unemployed, 44.4% lived in a rural/suburban area, 50.8% had a partner when collecting this information, and 74.3% were classified as having low socioeconomic status. Age, living in a rural/suburban area, more advanced stages of the disease, and not receiving cancer treatment were associated with lower OS.ConclusionCC continues to affect mainly women with minimal resources, low educational levels, and living in marginalized areas. These characteristics influence the OS. Prevention and timely detection programs, education, and training focused on this population and with broader coverage are required to identify patients with CC at earlier stages.

Access to Cancer Care in LMIC - Navigating Current Challenges

At the Summit on Cancer Health Disparities held in 2023, the session on Access to Cancer Care in Low- and middle- income countries (LMIC) highlighted several efforts globally. The collaborative efforts of Dana Farber Cancer Institute and the Ministry of Health in spearheading the Butaro Cancer Center of Excellence (BCCOE) in Rwanda was one such initiative. They were able to set up the BCCOE to address the unmet need of cancer care in this area and have trained nurses in East Africa to help establish other similar centers. They also serve as the single radiotherapy center for the entire of the country. Another such collaborative effort between Massachusetts General Hospital and the cancer center in Botswana in setting up sexual health education initiatives for women undergoing pelvic radiation was highlighted. They started with a quality improvement project to demonstrate the benefit of sexual health education and proper vaginal dilator use amongst women in this demographic. They were able to demonstrate that 90% of patients were able to complete an in-person 6-week workshop with clear benefits noted on a long-term basis. To highlight examples of best practice examples of equitable partnerships, examples of partnerships between Instituto Nacional de Cancerologia in Mexico City and UCSF was described. It was emphasized that for successful collaborations, equitable bidirectional partnerships are key. The thought leaders in this field also highlighted challenges associated with global oncology and the need for inclusion of minorities in clinical trials to improve cancer care for all globally.

Evaluation of a risk-sharing agreement for atezolizumab treatment in second- and third-line NSCLC patients: A strategy in order to improve access in low income countries.

e18683 Background: A targeted treatment approach using anti-PDL1 agents can maximize clinical benefits. However, this type of treatment is expensive, resulting in barriers to treatment access. PD-L1 expression is a predictor of outcomes for patients treated with immune checkpoint inhibitors. There is extensive evidence about the clinical benefits maintained in patients who respond to immunotherapy treatment. The aim of this study is to evaluate the economic implications of implementing a risk-sharing agreement (RSA) for atezolizumab in non-small cell lung cancer patients (NSCLC). Methods: We developed a prospective cost analysis of a RSA for atezolizumab as a second-line (or above) therapy in patients with advanced NSCLC at the Instituto Nacional de Cancerología (INCan) in México. All patients had an ECOG PS 0-1 and PDL1≥1%. The first 4 cycles were funded by the pharmaceutical company. If patients had response by RECIST or clinical benefit (RP), a special government program in the institution absorbed the cost of treatment until progression. A budget impact estimation was performed based on direct medical costs considering a time horizon of 1 year. Secondary endpoints were estimated for each strategy, expressed as the total amount expended and the average cost per patient with or without risk-sharing agreement. Costs and results are express in USD. Results: In total 30 patients were included for second line (n = 23) and third line (n = 7) therapy. The median PFS in all population was 4.67 months (95% CI 3.4-7.8). After 4 cycles, 47% (n = 14) of patients had a RP and increased PFS up to 9.4 months (p &lt; 0.001). A median OS in all cohort was 7.59 months (95% CI 5.1-17.2), however it was longer in patients with RP; 19 months (95% CI 8.81-NR) (p = 0.03). In addition, 33% of patients had RP and PDL1 ≥ 5% whose median OS was not reached The total cost of treatment was $611,557.64 (average $20,385.25 p/p) without a risk-sharing agreement, compared to an overall cost of $260,165.41 (average of $8,672.18 p/p) implementing a risk-sharing agreement. Regarding risk-sharing, non-parametric test as well as paired t test on transformed costs data showed a statistically significant difference in pharmacological cost between the two strategies in relation to cost per patient (p &lt; 0.001). The implementation of a risk-sharing agreement reduced the therapy cost by US$351,392.24 which represents 1.41% of the annual INCan drug budget. Conclusions: Risk-sharing agreement makes it possible to select those patients who have more benefit, thus ensuring that government resources are invested in the population with longer survival, which translates into saving for the state. In this study, the economic impact of risk-shared accounts for a 57.46% reduction in total cost. This is clearly a resource-efficient and treatable option for more patients, particularly in low-income countries.

Oncoguía de cáncer de pulmón de células pequeñas. Enfermedad limitada y enfermedad extensa 2023

Lung cancer (LC) ranked second place in incidence and first in mortality in 2020 worldwide. In Mexico, it is the fifth most frequent neoplasia. Small cell lung cancer (SCLC) presents in 60 % of cases as an extensive disease and the remaining 40 % as a limited disease. SCLC is a neoplasm with aggressive biological behavior, which gives it a worse prognosis when compared to non - small cell lung cancer (NSCLC). Smoking is the most important risk factor for developing this neoplasm. The treatment of patients with SCLC must be multidisciplinary and include mainly surgery, chemotherapy, radiotherapy, and targeted therapy, as well as immune checkpoint inhibitors. This oncoguía presents the diagnostic, staging, and treatment criteria followed at Instituto Nacional de Cancerología (INCan) in order to guide the reader and standardize the approach criteria.

Oncoguía de cuidados paliativos 2023

Palliative care in oncology focuses on improving patients' quality of life with advanced cancer by controlling physical, psychological, and spiritual symptoms during their illness. It can be started as soon as advanced neoplasia is diagnosed, combined with disease-modifying therapies. This approach also includes the accompaniment of the family members by guiding the patient's care and providing psychological support to relatives of patients. The integration of palliative care in oncology must be flexible according to the type of oncological care provided and adapted to the level of care where it is necessary. In these guidelines, we describe the implementation of palliative medicine at Instituto Nacional de Cancerología (INCan). This gradual process began with the care of patients at the end of life. It is being integrated early into advanced cancer care and psychological attention and adapted to the patient's needs as we did during COVID-19. In the INCan model, the palliative cancer team works with the medical oncologist, surgical oncologist, radio-oncologist, and hemato-oncologist at all levels of care. Oncoguía de cuidados paliativos 2023 also incorporates the experiences and recommendations of teams from different hospitals that care for pediatric, young adults, and geriatric cancer patients in the Mexican Health System. Likewise, referral criteria and pharmacological resources are also included. Its objective is to provide an essential guide and contribute to the standardization of criteria.

Modifying factors of PD-L1 expression on tumor cells in advanced non-small-cell lung cancer.

Programmed death ligand-1 (PD-L1) expression predicts immunotherapy utility in nononcogenic addictive lung adenocarcinoma (ADC). However, its reproducibility and reliability may be compromised outside clinical trials. This study aimed to evaluate factors associated with PD-L1 expression in lung ADC. This observational study assessed 547 tumor samples with advanced lung ADC from January 2016 to December 2020 in a single cancer institution. Tumor samples were stained by at least one approved PD-L1 clone, SP263 (Ventana) or 22C3 (Dako), and stratified in tumor proportion score (TPS) <1%, 1-49%, or ≥50%. Of all the tumor samples, positive PD-L1 staining was higher in poorly differentiated tumors (67.3% vs. 32.7%, p < 0.001). Analytical factors associated with a PD-L1 high expression (TPS ≥ 50%) were the SP263 clone (19.6% vs. 8.2%, p < 0.001), time of archival tumor tissue <12 months (15.3% vs. 3.8%, p=0.024), whenever the analysis was performed in the most recent years (2019-2020) (19.0% vs. 8.3%, p < 0.001), and whenever the analysis was performed by pathologists in the academic setting (Instituto Nacional de Cancerologia, INCan) (19.9% vs. 11.9%, p=0.001). In the molecular analysis, EGFR wild-type tumors had an increased proportion of PD-L1 positive and PD-L1 high cases (60.2% vs. 47.9%, p=0.006 and 17.4% vs.8.5%, p=0.004). A moderate correlation (r=0.69) in the PD-L1 TPS% was observed between the two different settings (INCan vs. external laboratories). Clinicopathological factors were associated with an increased PD-L1 positivity rate. These differences were significant in the PD-L1 high group and associated with the academic setting, the SPS263 clone, time of archival tumor tissue <12 months, and a more recent period in the PD-L1 analysis.

Discharges of Nuclear Medicine Radioisotopes: The Impact of an Abatement System.

Clinical uses of radiopharmaceuticals imply the administration of radioactive substances that are mainly excreted through urine. The Nuclear Medicine Department at the Instituto Nacional de Cancerología (INC-COL) in Bogota, Colombia, administers radiopharmaceuticals for diagnostics and treatment to many patients, resulting in tens of cubic meters of radioactive waste water (WW) every day. As Colombian regulatory limits for liquid radioactive discharges to the sewer system are lower than in other countries, longer WW decay times are required, even when an in-house waste water treatment plant (WWTP) is used. To fulfill the requirements for controlled disposal of radioactive discharges, a complementary abatement system was implemented to retain WW for periods as long as 360 d, and was connected to the hospital´s WWTP. These holding times can cause major changes in the WW physicochemical parameters, reaching levels higher than acceptable. In this study, we evaluate the decontamination and decay efficiency of the retention system using water quality parameters and the amount of radioactivity in the effluents stored in the tanks and the WWTP. According to the results, to maintain the physicochemical parameters below acceptable levels, biological and chemical treatment of decayed WW is necessary before discharging it into urban waste water. Using the principles of dilution, retention, and decay, an integral radioactive WW management system was implemented favoring the quality of discharges and activity levels to the sewer system, with efficiencies close to 100% for WW from discharges in diagnostic procedures ranging from 98% (131I) to 100% (177Lu) for WW from discharges in therapeutic procedures. Activity concentration assessment in medically-derived radionuclides using an in-house waste water treatment plant (WWTP) and a complementary abatement system; an in-house WWTP could be used as an abatement system for short-lived radionuclides; and a tank-based abatement system attached to the in-house WWTP showed higher efficiencies for long-lived radionuclides and adequate physicochemical parameters for the discharge to the city sewage system.

Clinical characteristics and outcomes in a cohort of oncologic patients with COVID-19 during the first year of the pandemic in Mexico.

BackgroundLiterature on severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection in cancer patients is scarce in Latin America. This population seems to have a higher risk for adverse outcomes. This study aims to correlate clinical characteristics with outcomes in patients with cancer.MethodsWe included all patients with cancer and confirmed SARS‐CoV‐2 infection from April 19 to December 31, 2020, at the Instituto Nacional de Cancerologia, Mexico. Clinical information was obtained from medical and epidemiological records. For the association between variables and hospitalization, invasive mechanical ventilation (IMV), and mortality, univariate and multivariate logistic regression were performed; odds ratios and 95% confidence intervals were calculated.ResultsFour hundred thirty‐three patients were included; 268 (62%) were female, the median age was 55 years. One hundred thirty‐five (31%), 131 (30%), and 93 (21%) patients had obesity, hypertension, and diabetes mellitus (DM), respectively. Three hundred forty‐one (79%) had solid cancer. One hundred seventy (39%) had advanced cancer. Two hundred (46%) patients were hospitalized. Age (p < 0.01), male gender (p = 0.03), hematological malignancies (HM) (p = 0.04) and advanced cancer (p = 0.03) increased the risk for hospital admission. Forty‐five (10%) patients required IMV. Age (p = 0.02); DM (p = 0.04); high C‐reactive protein (p < 0.01), and lactate dehydrogenase (p = 0.03) were associated with IMV. Mortality within 30 days after diagnosis was 18% (76 cases). Associated characteristics were age (p = 0.04) and low albumin (p < 0.01).ConclusionsIn this study, patients with cancer showed higher mortality, need for hospitalization, and IMV compared with other non‐cancer cohorts. We did not find an increased risk in mortality for HM. Although our cohort was younger than others previously reported, age was a strong predictor of adverse outcomes. Variables associated with IMV and death were similar to those previously described in cancer patients with COVID‐19.

Risk factors and clinical outcomes for Clostridioides difficile infections in a case control study at a large cancer referral center in Mexico

IntroductionClostridioides difficile infection (CDI) is recognized as the leading cause of nosocomial diarrhea. This study describes CDI's clinical characteristics, risk factors, and outcomes in the cancer population. MethodsWe conducted a case-control study on cancer patients from 2015-2018 at the Instituto Nacional de Cancerologia in Mexico. CDI case was defined as diarrhea episode and positive polymerase chain reaction (PCR) for toxigenic strains. Controls were cancer diagnosis-matched patients with diarrhea and negative PCR. Healthcare Facility-Onset (HO-CDI) and Community-Onset, Healthcare Facility-Associated (CO-HCFA-CDI) rates were calculated. For assessing associations, univariate and multivariate logistic regression analyses were conducted. ResultsWe included 148 CDI cases and 148 controls. The CDI rate was 4.1 per 10,000 patient-days and 2.1 per 1,000 patient admissions for HO-CDI and CO-HCFA-CDI episodes, respectively. Clinical characteristics associated with CDI were fever, abdominal pain, and ≥4 episodes of diarrhea/24h. Previous use of proton pump inhibitors (P=.003), fluoroquinolones (P=.016), and cephalosporins (P=.026) increased the risk for CDI acquisition, while higher age (P=.022) and male gender (P=.015) were related to severe episodes. Thirty-day all-cause mortality was higher among CDI patients (18%) than controls (9%). ConclusionThe CDI rate was lower compared to other series. The incidence of CO-HCFA-CDI episodes increased, and HO-CDI cases decreased from 2016 to 2018. Risk factors for acquisition and severe infection were similar to those reported in non-cancer populations.

Assessment of the operational characteristics of the National Comprehensive Cancer Network distress management tool, v. 2.2018, in patients seen at the Instituto Nacional de Cancerología, Bogotá

ResumenIntroducción. Los pacientes con cáncer presentan niveles significativos de malestar emocional. La National Comprehensive Cancer Network (NCCN) desarrolló un instrumento (Distress Management) para evaluarlo de forma rápida en pacientes oncológicos. Para su utilización en Colombia, se hizo la adaptación transcultural y se validó.Objetivo.Determinar las características operativas del instrumento de malestar emocional, versión 2.2018, en pacientes atendidos en el Instituto Nacional de Cancerología.Materiales y métodos. Previa autorización de la NCCN, se procedió a la traducción, adaptación transcultural y evaluación de las características operativas del instrumento. Se incluyeron 343 pacientes con diagnóstico de cáncer atendidos en el Instituto Nacional de Cancerología, quienes diligenciaron el instrumento adaptado transculturalmente. Se efectuó un estudio de prueba diagnóstica como patrón de referencia mediante una entrevista semiestructurada.Resultados. Los pacientes tenían una edad promedio de 49,7 años (DE=15) y la mayoría (67 %) eran mujeres. El instrumento tuvo un área bajo la curva ROC de 0,81 (IC95% 0,77- 0,86); el punto de corte óptimo fue de 3,5, el cual se aproximó a 4; la sensibilidad fue de 0,81 (IC95% 0,76-0,85) y la especificidad de 0,69 (IC95% 0,64-0,74). El porcentaje de acuerdo entre el resultado de la entrevista y el instrumento fue de 73 % (kappa=0,64; p<0,001).Conclusiones. El instrumento de malestar emocional permitió detectar el malestar emocional moderado a grave que requiere intervención y manejo. Este instrumento fue adaptado y validado en pacientes con cáncer en Colombia, conservándose el punto de corte en ≥4 como en la versión original.

Oncoguía de cuidados paliativos 2020

Palliative care is focused on achieving the patient's best quality of life, especially by managing multiple symptoms and complications. Its main objectives are detecting, preventing, and treating (often in combination with disease-modifying treatments) the symptoms and needs of the patients and their families. The implementation of palliative care at Instituto Nacional de Cancerología (INCan) has been a priority because late diagnosis is frequent; thus, a high percentage of patients are in advanced stages. Oncoguía de cuidados paliativos 2020 has been written considering the INCan multidisciplinary palliative care group's expertise working with surgeons, oncologists, and radiation oncologist, and based on the published international recommendations. This Oncoguía contains the framework, care processes, an algorithm with the criteria for patients' referral to palliative care, and the pharmacological resources to be used.

Reporte de caso: Presentación clínica e importancia de coinfecciones durante pandemia por COVID-19 en pacientes con neoplasias malignas

El nuevo coronavirus (ahora llamado SARS-CoV2) descubierto en China, se convirtió en pandemia en menos de tres meses. Pacientes infectados por SARS-CoV-2 presentan síntomas de fiebre, disnea, linfopenia, anosmia, disgeusia y cambios radiográficos pulmonares en vidrio esmerilado. La presentación clínica oscila en enfermedad leve a falla respiratoria, choque y disfunción multiorgánica. Se informan los dos primeros casos de pacientes con cáncer y diagnóstico de Covid19 con coinfección en el Instituto Nacional de Cancerología, ESE.

Braquiterapia oftálmica de baja tasa de dosis en el Instituto Nacional de Cancerología, E. S. E.

La braquiterapia de baja tasa de dosis (LDR, por sus siglas en inglés), como opción de tratamiento contra el cáncer en el Instituto Nacional de Cancerología (INC), es una modalidad que usa radiaciones ionizantes para destruir células malignas y reducir el tamaño tumoral. Esta técnica de tratamiento consiste en la aplicación de semillas de iodo 125 (125I), elemento radiactivo que se dispone en una placa metálica de oro que se posiciona quirúrgicamente en la superficie del globo ocular en contacto con el tumor, con el fin de obtener un óptimo control local de los melanomas del cuerpo uveal y los retinoblastomas en pacientes pediátricos, cuando este tipo de neoplasias se encuentran en estadios tempranos, como una terapia alternativa a la enucleación (extirpación completa del globo ocular). En el presente artículo se describe la técnica usada en el INC, que se ha implementado desde el año 2006 empleando el software Plaque Simulator de BEBIG, se hace un barrido de la anatomía del globo ocular, las características físicas del radionúclido de 125I, el procedimiento clínico, la técnica, la planeación dosimétrica y la protección radiológica, dejando finalmente unos tópicos de discusión en las conclusiones.

Verificación funcional de detectores de radiación tipo Geiger-Müller en medicina nuclear y radiofarmacia del Instituto Nacional de Cancerología: una propuesta para el aseguramiento de la calidad de equipos de protección radiológica

Basado en la implementación del plan de aseguramiento de la calidad, el objetivo principal de este estudio es realizar el seguimiento y análisis de las verificaciones funcionales realizadas a los equipos detectores de radiación ionizante del Servicio de Medicina Nuclear y del Servicio de Radiofarmacia del Instituto Nacional de Cancerología E. S. E. (INC). Los equipos de estudio fueron dieciséis detectores tipo Geiger-Müller, fijos y portátiles, con fuentes certificadas selladas tipo gotero y planas para la recolección de mediciones realizadas por un periodo de tres años. Como resultado, se encontraron comportamientos variables siempre en el rango del 20 % del error porcentual existentes entre el valor medido y el valor de referencia de cada equipo. El estudio permite concluir que los detectores muestran un comportamiento esperado dentro de la reproducibilidad propia del detector y las desviaciones propias de los diferentes operadores; sin embargo, y con el fin de minimizar las variaciones, es imprescindible contar con un programa de aseguramiento de la calidad de los equipos detectores de radiación que vele por la idoneidad de las medidas realizadas.

Fecal Immunologic Test Results and Diagnostic Colonoscopy in a Mexican Population at Average Risk for Colorectal Cancer.

Colorectal cancer is preventable and treatable by screening and early detection. Fecal immunochemical tests (FIT) for average risk individuals is an effective strategy for screening. Incidence and mortality in Mexico is increasing and large-scale screening programs do not yet exist. The aim of this study was to evaluate the feasibility of FIT-based colorectal cancer screening program in Mexico City. For more than 15 months, average risk individuals in Mexico City were invited to participate at Mexico's Instituto Nacional de Cancerologia (INCan, Mexico City, Mexico). Participants received an FIT kit for stool collection, results ≥20 ng/mL were referred for high quality colonoscopy. Participants' results were classified according to the most advanced clinical finding as: adenocarcinoma, high-risk adenomas, low-risk adenomas, serrated lesions, hyperplastic polyps, and no polyps. Sequential analyses were performed to assess the positive predictive value (PPV) of FIT. A total of 810 participants were eligible, 737 (91.0%) returned the FIT and 112 (15.2%) had an abnormal result. Of these participants, 87 (77.7%) completed colonoscopy. Clinical findings of participants included: seven (8.1%) adenocarcinomas, 18 (20.7%) high-risk adenomas, 23 (26.4%) low-risk adenomas, one (1.2%) serrated lesions, 14 (16.1%) hyperplasic polyps, and 24 (27.6%) no polyps. The PPV of FIT using the ≥20 ng/mL was 8.1% for cancer and 20.7% for high-risk adenomas. In conclusion, colorectal cancer screening with FIT is feasible at INCan in Mexico City, where resources are available. Further studies are needed to determine feasibility of colorectal cancer screening in other settings, as well as optimal hemoglobin detection cut-off points to maximize the population benefits of colorectal cancer screening with FIT in Mexico.

IBCL-344: Marginal Zone Lymphoma: Epidemiology and Outcomes in a Mexican Center

Context: Marginal zone lymphoma (MZL) is a rare entity, representing 5% of non-Hodgkin lymphomas with straightforward differences in presentation. The treatment is diverse and depends on the location and the medical practice of each center. There is no information in Mexico regarding its presentation and long-term results. Objective: To describe and analyze the epidemiology and the prognostic factors of MZL relating to treatment response and survival. Design: Retrospective observational analytical study. Setting: Instituto Nacional de Cancerologia, a hemato-oncological reference center. Patients: 113 diagnosed with MZL between 2008 and 2019. Interventions: No interventions. Main outcome measures: Descriptive statistics were used. Bivariate risk analysis with X2 and Fisher's exact test were utilized to search for prognostic factors for survival. OS and DFS were assessed with Kaplan Mayer and Log Rank curves. Results: Patients' average age was 57 and predominantly female (57.5%). The median follow-up was 44 months (1–141). MALT was the most common histological WHO variant (87.6%, 99), followed by nodal (8.8%, 10) and splenic (3.5%, 4) ones. For MALT, the most frequent location was conjunctiva and eye attachments (59.6%), followed by stomach (23.2%) and salivary glands (8.1%). H. Pylori was identified in 48% of stomach MALT. DHL was elevated in 8%. Most (108) received treatment: chemotherapy (46.9%) followed by RT (28%). The global response was 76%. The 8-year OS was 75% for the entire group. Regarding MALT, favorable prognostic factors for OS were complete response p = 0.043 (OR 1.4, 95% CI 0.89-2.2) and location of ocular annexes p = 0.009 (OR 0.49 (95% CI 0.32–0.76). The stomach location was the unfavorable one p = 0.01 (OR 1.76, 95% CI 1.09-2.86). The 5-year OS for gastric localization was 57.5%, with a median of 72 months. Other areas did not reach the median (log rank Conclusions: MZL has a heterogeneous presentation. In our series, conjunctival and ocular annexes MALT is found as the main variant–different from that reported in the international literature. The long-term prognosis is favorable, unlike in patients with gastric MALT lymphoma, in which it is less than what is described in other series.