Lung Cancer in Peru

Ruiz, Rossana; Gálvez-Nino, Marco; Poquioma, Ebert; Limache-García, Abel; Amorín, Edgar; Olivera, Mivael; Valdiviezo, Natalia; Trejo, Juan Miguel Rodríguez; Heredia, Adela; Aguilar, Alfredo; Raez, Luis E.; Neciosup, Silvia P.; Gómez, Henry Leonidas; Payet, Eduardo; López, Luis Alberto Moreno

doi:10.1016/j.jtho.2020.01.018

Cited by 6 publications

(16 citation statements)

References 12 publications

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“…For example, in the Dana Farber cohort, when examining individual mutations within a multivariate model correcting for smoking status, female sex, and Asian race; the association between EGFR mutations and age was no longer significant and the only genotype associated with a younger age at diagnosis was ALK rearrangement ( 10 ). Also, in Peru lung cancer occurs predominantly in never-smokers ( 23 ), which may not be true for other settings in which lung cancer occurs predominantly in smokers with young lung cancer patients representing an etiologically different group (never-smokers). Having said this, due to the small sample size in our study, some statistical differences in genomic alterations could be hid because of the sample size, leading to a high probability of type-2 error.…”

Section: Discussionmentioning

confidence: 95%

“…Because of sample size and the lack of a contemporary comparator group the intention of this study was not to evaluate clinical outcomes or prognosis, therefore the interpretation bias diminishes. Moreover, it was only by 2017 that access to targeted therapy in the subsidized regimen was granted ( 23 ), therefore practically none of the patients had the opportunity to receive this treatment.…”

Section: Discussionmentioning

confidence: 99%

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Genomic landscape of lung cancer in the young

et al. 2022

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BackgroundLung cancer in the young is a rare entity of great interest due to the high frequency of targetable mutations. In this study, we explored the genomic landscape of non-small cell lung cancer (NSCLC) in young patients and compared it with genetic alterations in older patients.MethodsComparative study of the genomic profile of NSCLC young (≤40 years old) vs older patients (>40 years old) from Instituto Nacional de Enfermedades Neoplásicas (INEN) in Lima, Peru. Archival paraffin-embedded tumor samples were profiled with FoundationOne CDx assay to identify short variants alterations (insertions and deletions), copy number variations (CNV), tumor mutational burden and microsatellite instability in 324 driver genes and rearrangements in 28 commonly rearranged genes. A targetable alteration was defined as any alteration in a driver oncogene for which an FDA approved therapy existed at the time of study enrollment.ResultsOverall, 62 tumors were profiled, 32 from young and 30 from older patients. All clinicopathological features (smoking status, clinical stage, and histology) were similar between groups, except for gender (65.6% of females in the younger group vs 40% in the older group, P=0.043). At least one actionable mutation was present in 84.4% and 83.3% in younger and older patients, respectively. Alteration rates in the main genes were: BRAF, 3.1%(n=1) vs 0%; EGFR, 46.9% (n=15) vs 43.3% (n=13); ERBB2, 12.5% (n=4) vs 16.7% (n=5); KRAS, 15.6% (n=5) vs 16.7% (n=5); ALK, 6.3% (n=2) vs 3.3% (n=1); RET, 0.0% vs 3.3% (n=1); ROS1, 3.1% (n=1) vs 3.3% (n=1); NTRK1, 0.0% vs 3.3% (n=1) and MET, 3.1% (n=1) vs 13.3% (n=4). Mean TMB was 4.04 Mut/Mb (SD ± 3.98) for young vs 8.06 Mut/Mb (SD ± 9.84) for older patients (P=0.016). There were not significant differences in CNV, frequency of gene rearrangements, or microsatellites instability.ConclusionNSCLC in the young in our cohort was characterized by a high frequency of actionable genetic aberrations and a low TMB, which was also true for our older patients. The enrichment of actionable mutations in young patients described in other reports might be attributed to differences in the etiology and clinicopathological characteristics between younger and older patients and therefore not be applicable to all populations.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Genomic landscape of lung cancer in the young

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“… 5 , 23 In Peru, targeted therapy against EGFR sensitive mutations was available in the public health system since 2017, which represents a delay in public access of 9 years since National Regulatory Approval and 13 years since Food and Drug Administration approval. 17 …”

Section: Discussionmentioning

confidence: 99%

“…27 However, most of them could not receive osimertinib as a subsequent line of treatment because of limited availability in Peruvian public health system. 17 …”

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confidence: 99%

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Real‐world outcomes of anti‐EGFR therapy in advanced non–small cell lung cancer EGFR mutated in Peru

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Background Despite the advances in the management of advanced non–small cell lung cancer (NSCLC), the access to genetic profiling and target therapies remains a challenge in Latin America, even in countries with a higher rate of targetable mutations. The aim of this study is to evaluate the clinical outcomes of anti‐epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI) treatment in a Peruvian real‐world setting. Methods This is a retrospective study of recurrent or advanced NSCLC EGFR mutated patients diagnosed and treated with anti‐EGFR TKI at Instituto Nacional de Enfermedades Neoplásicas (INEN) between January 1, 2015 to December 31, 2020. The outcomes were objective response rate (ORR), progression free survival (PFS), and overall survival (OS). Results We identify 613 stage IV or recurrent NSCLC patients who were tested for EGFR mutations and found a pathogenic mutation in 39.5% of patients. Only 51.2% of them received anti‐EGFR TKI as institutional treatment. ORR was 58%, after median follow‐up of 32 months, the estimated median PFS was 13.9 months (11.1–16.7 months), and the estimated median OS was 21.7 months (18.5–24.9 months). No differences were found in PFS according to line of treatment or brain metastases at diagnosis ( p = 0.46 and p = 0.07, respectively), respect to OS there were no differences line of treatment ( p = 0.12), significant difference were found in presence of brain metastases ( p = 0.006). Conclusion Our study demonstrates that erlotinib for advanced NSCLC harboring EGFR‐activating mutations is effective even in patients usually excluded from clinical trial, like those previously exposed to one or more lines of chemotherapy or with brain metastases.

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Real‐world KINDLE‐Latin America subset data on treatment patterns and clinical outcomes in patients with stage III non‐small‐cell lung cancer

et al. 2022

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Introduction Stage III non‐small‐cell lung cancer (NSCLC) management is challenging given the heterogeneous nature of the disease. The LATAM subset of the real‐world, global KINDLE study reported the treatment patterns and clinical outcomes for LATAM from the pre‐immuno‐oncology era. Methods The study was conducted in seven countries (Argentina, Chile, Colombia, Dominican Republic, Mexico, Peru and Uruguay) in stage III NSCLC (American Joint Committee on Cancer, 7th edition) diagnosed between January 2013 and December 2017. Retrospective data from patients' medical records (index date to the end of follow‐up) were collected. Summary statistics, Kaplan–Meier survival estimates and a two‐sided 95% confidence interval (CI) were provided. Cox proportional hazard model was used for univariate and multi‐variate analyses. Results A total of 231 patients was enrolled, the median age was 65.0 years (range 21.0–89.0), 60.6% were males, 76.6% had smoking history, 64.0% had adenocarcinoma and 28.7% underwent curative resection. Multiple treatment regimens (>25) were used; chemotherapy alone was the most common (24.8%). The overall median progression‐free survival (mPFS) and median overall survival (mOS) were 14.8 months (95% CI, 12.1–18.6) and 48.6 months (95% CI, 34.7 to not calculable). Significantly better mPFS and mOS were observed for stage IIIA with curative surgery and resectable tumours and stage IIIB with an Eastern Cooperative Oncology Group score of 0/1, female gender, resectable tumours, adenocarcinoma and curative surgery (p < 0.05). Conclusion Results show diversity in treatment practices and the corresponding clinical outcomes in stage III NSCLC. There is a need to streamline treatment selection and sequencing to decrease relapse rates after initial therapy.

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Lung Cancer in Peru

Cited by 6 publications

References 12 publications

Genomic landscape of lung cancer in the young

Genomic landscape of lung cancer in the young

Real‐world outcomes of anti‐EGFR therapy in advanced non–small cell lung cancer EGFR mutated in Peru

Real‐world KINDLE‐Latin America subset data on treatment patterns and clinical outcomes in patients with stage III non‐small‐cell lung cancer

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