Background In resource-constrained settings, data regarding breast cancer patients' adherence to endocrine therapy (ET) and physicians’ prescribing practices is limited. This study aims to decrease this knowledge gap in a real-world clinical practice. Methods Premenopausal women with stage 0-III hormone-sensitive breast cancer and receiving adjuvant ET during the past 1–5 years were identified in three Mexican referral centers. Participants' self-reported ET compliance, clinicopathologic characteristics, ET-related knowledge and beliefs, experienced adverse effects, social support, and patient-physician relationships were evaluated. Physician ET prescribing practices were compared with the gold standard according to international and national guidelines to assess clinicians’ adherence to standard-of-care prescription. Results In total, 95/132 (72%) and 35/132 (27%) participants reported complete and acceptable adherence, respectively. Incomplete adherence was mainly attributed to forgetfulness, adverse effects, and unwillingness to take ET. Being employed/studying ( p = 0.042), worrying about long-term ET use ( p = 0.031), and experiencing >7 ET-related symptoms ( p = 0.018) were associated with incomplete adherence. Guideline-endorsed regimens were prescribed in 84/132 (64%) patients, while the rest should have undergone ovarian function suppression (OFS) but instead received tamoxifen monotherapy. Conclusions Premenopausal Mexican women self-report remarkably high rates of adequate ET adherence. However, a considerable proportion misses ≥1 doses/month, usually because of forgetfulness. Notably, only 64% receive standard-of-care ET due to suboptimal prescription of OFS. Interventions that remind patients to take their ET, refine physicians’ knowledge on the importance of OFS in high-risk patients, and increase access to OFS could prove pivotal to enhance optimal ET implementation and adherence, which could translate into improved patient outcomes.

Osteosarcoma is the most common primary malignancy of bone in children and young adults, the highest incidence peak is during adolescence and doesn't have any gender predominance. The main site of metastasis are the lungs and extrapulmonary cases are occasional. The incidence of metastasis in the Central Nervous System (CNS) is 2-6.5%, increase to 10-15% in patients with pulmonary metastases. Therefore, metastatic disease of the CNS is rare and the information on such patients is limited. Here, we describe a case of a 20-year old patient diagnosed with osteosarcoma in the left distal femur stage IIB, he developed pulmonary disease, during palliative chemotherapy experienced relapse to the brain classified as (RPA) class II, and was treated with external radiotherapy (30 Gy in 10 fractions) and later he had a poor evolution and died.

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BACKGROUND. Breast cancer is the most frequent neoplasm worldwide, as reported by GLOBOCAN 2020, there were 2.2 million new cases per year and 680,000 deaths. In Mexico, it represents the leading cause of death from cancer in women, and therefore represents a public health problem in our country. The standard treatment for patients with hormone receptor-positive, her2-negative breast cancer is endocrine tehrapy with an aromatase inhibitor plus a CDK4/6 inhibitor (CDK4/6i+AI), however access to these therapies is difficult and limited resources in developing countries, lead to treatment strategies such as aromatase inhibitors alone (AI) or chemotherapy (ChT) still being used. However, management with ChT involves an increase in the use of reosurces due to cost per infusión, use of premedication and granulocyte colony-stimulating agents. OBJECTIVE The aim of this study was to provide an economic evaluation of CDK4/6i+AI compared with AI alone or ChT as a first line in MBC to better understand its value from the healthcare point of view in a developing country. METHODS. We designed a retrospective cost-effectiveness analysis of three different therapies CDK4/6i+AI, AI alone and ChT administered as first-line therapy for patients with MBC. RESULTS. A cost-effectiveness analysis was performed on a retrospective cohort of 150 MBC patients (march 2011 to April 2020) with a follow-up of al least 2 years. The median age at diagnosis was 55 years old. The utilization of health care resources was retrieved from clinical charts. Only direct costs associated with pre-progression, progression, and management of adverse events were considered and expressed on current USD. Seventy-six percent were diagnosed with de novo stage IV disease, 66% were postmenopausal and 76% had ductal histology. The most common sites of metastasis were visceral 55% and 29% had only bone metastases. We identified 3 treatment groups: (1) CDK4/6i+AI, 18.66% (28/150), (2) AI, 48.66% (73/150) and (3) ChT, 32.66% (49/150). The median PFS of iCDK4/6 + TH was 32.10 months compared with 18.87 (95%CI: 16.4, 28.7) months for the AI group and 6.57 months for chemotherapy. The HR of iCDK4/6+TH vs HT was 0.357 (95%CI: 0.18-0.72) and that of iCDK4/6+TH vs chemotherapy was 0.09 (95%CI: 0.04-0.22). Median OS survival was not reached in any arm. The most frequent adverse events grade 3 were fatigue 10.71%, neutropenia 32.14%, diarrhea 7.14%, myalgias 3.57% and arthralgias 3.57% in the CDK4/6i +AI group, fatigue 2.74% and arthralgias 4.11% in AI group and fatigue 20.41%, neutropenia 18.37%, nausea 10.2%, diarrhea 6.12%, myalgias 2.4% and headache 2.4% with chemotherapy. PFS was used as the outcome for the cost-effectiveness analysis, with 5 years of follow-up, CDK4/6i+AI offer an incremental efficacy of 1.4 years in PFS compared with AI and 2.43 years with ChT, they are related to an incremental cost of $28,151.61 and $26,720.47 concerning AI and ChT, respectively. The ICER for CDK4/6i+AI compared to AI is $20,108.29 and $10,996.07 compared to chemotherapy. CONCLUSION. CDK4/6i+AI increase years of life gained when compared to AI and chemotherapy. Is a cost-effective tratment in our institution because it is less than two GDP per capita. CDK4/6i+AI is the standar treatment around the world even in develop countries like Mexico. PFS 3 arms PFS 3 arms Citation Format: Maritza Ramos-Ramírez, Silvia Guzman-vazquez, Vanessa Dominguez-Esquivel, Jose Rodrigo Espinosa-Fernandez, Sandy Ruiz-Cruz, Paula Cabrera-Galeana, Alexandra Garcilazo, Luis Antonio Cabrera-Miranda, Claudia Haydee Arce Salinas. Cost-effectiveness of CDK4/6 inhibitors as a First line Therapy for Metastatic Breast Cancer. A Mexican Cohort. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-36.

Background: Young women with breast cancer (YWBC) may experience bone mineral density (BMD) loss due to the effects of cancer treatment on estrogen levels. Studies assessing BMD in breast cancer (BC) patients have had a limited representation of young women. This study aimed to analyze the frequency of low BMD and its associated factors in this specific age group. Methods: This retrospective, multicenter study included women ≤40 years diagnosed with stage 0-III BC, treated with chemotherapy (CT) and/or endocrine therapy (ET) between 2010-2020, and with no documented bone metastases during follow-up. The protocol was conducted in 5 BC referral centers in Mexico. Demographic, clinical and treatment data were collected, as well as bone dual-energy X-ray absorptiometry (DEXA) results. Low BMD was defined as T-score <-1.0 or Z-score ≤-2.0 at the lumbar spine (L1-L4) or femoral neck. The frequency of low BMD was analyzed with descriptive statistics. Binary logistic regression using complete case analysis was conducted to calculate odds ratios (OR) and 95% confidence intervals (95%CI) of experiencing low BMD according to demographic, clinical and therapeutic factors. Results: In total, 716 YWBC met inclusion criteria. Median age at BC diagnosis was 36 years (21-40); 708 (99%) women were premenopausal at diagnosis. Most were married (355; 50%), had higher education (381; 53%), were unemployed (433; 61%), and were non-smokers (552; 77%). Body mass index (BMI) was < 18.5 kg/m2 (underweight) and ≥25.0 kg/m2 (overweight/obese) in 14 (2%) and 392 (58%) cases, respectively. The most common BC subtype was hormone receptor (HR) positive/HER2 negative (371; 52%), followed by triple negative (168; 24%), HR positive/HER2 positive (122; 17%) and HR negative/HER2 positive (55; 8%). Patients were mostly diagnosed with stage II (346; 48%) or III (276; 39%) disease. As for treatment, CT in 667 (93%), ET in 468 (65%), anti-HER2 therapy in 168 (24%), and radiotherapy was administered in 562 (79%) cases. DEXA scans were documented in 213/716 (30%) patients. In total, 286 DEXA results were available. The time elapsed from the start of the first systemic treatment to the DEXA result was 0-12 months in 42 cases (15%); 13-36 months in 103 (36%); 37-60 months in 72 (25%); and >60 months in 69 (24%). Overall, 133/213 patients (62%; 95%CI 56-69%) had at least one low BMD report after the start of CT or ET. T-scores and Z-scores in each period are detailed in the Table. No fractures were recorded in any case after BC diagnosis. The only variable associated with at least one low BMD result was BMI ≥25.0 kg/m2 (OR, 1.88; 95%CI, 1.04-3.40). The described demographic, clinical and treatment factors were not significantly associated with low BMD. Conclusion: This study showed a suboptimal frequency of bone DEXA monitoring in YWBC. A considerable proportion of YWBC experienced low BMD after initiation of CT and/or ET; and a significant association was found between obesity/overweight at BC diagnosis and subsequent low BMD. These data reflect the importance of requesting DEXA scans in young patients on a regular basis and promoting the maintenance of an adequate body weight, in line with international recommendations. Further studies evaluating the degree of BMD loss and its determinants would contribute to establish the optimal periodicity to monitor BMD in relation to BC therapy, allow timely offering of interventions to reduce bone morbidity, as well as improve the quality and life and survivorship of this young group of patients. Table. DEXA T-scores and Z-scores. Citation Format: Fernanda Mesa-Chavez, Yanin Chavarri-Guerra, Sandy Ruiz-Cruz, Paula Cabrera-Galeana, Christopher Jesus del Rio-Martinez, Carmen Guadalupe Bermudez-Barrientos, Brizio Moreno-Jaime, Abigail Samayoa-Mateos, David Vega-Morales, Cynthia Villarreal-Garza. Frequency of low bone mineral density in young women with breast cancer and associated factors [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-08-13.