Recommendations for streamlining precision medicine in breast cancer care in Latin America

Alvarado‐Cabrero, Isabel; Doimi, Franco D.; Ortega, Virginia; Lima, Jurema Telles de Oliveira; Torres, Rubén; Torregrosa, Lilián

doi:10.1002/cnr2.1400

Cited by 7 publications

(5 citation statements)

References 58 publications

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“… 12 Other multidisciplinary panels have focused on recommendations for a specific type of cancer, such as breast cancer. 11 Considering the size of the cohort evaluated in this MTB study and the frequency with which clinical management was changed on the basis of genomic function tests in different types of cancer, it can be considered that the scope of this study had a larger impact on the oncology's clinical practice in Colombia, supporting the notion that it is a pioneer study in the practice of precision oncology in Latin America. On a global scale, the real value of this MTB should be weighted at the patient level and beyond a single institution but considering the potential of MTB implementation as part of precision oncology clinical practice 7 —compared with a global scale.…”

Section: Discussionmentioning

confidence: 68%

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Molecular Tumor Board Improves Outcomes for Hispanic Patients With Advanced Solid Tumors

Sotelo-Rodríguez,

Vallejo-Ardila,

Ruiz-Patiño

et al. 2024

JCO Glob Oncol

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PURPOSE Multidisciplinary molecular tumor boards (MTBs) decode complex genomic data into clinical recommendations. Although MTBs are well-established in the oncology practice in developed countries, this strategy needs to be better explored in developing countries. Herein, we describe the possible benefits and limitations of the first MTB established in Colombia. METHODS Demographic, clinical, and genomic information was collected between August 2020 and November 2021. By mid-2020, an MTB strategy was created to discuss clinical cases with one or more genomic alterations identified by next-generation sequencing using an open-access virtual platform. We characterized the patient population as benefiting from the recommended treatment option. We assessed the benefits and access to available targeted therapies that have the potential to change clinical management by making recommendations to treating oncologists on the basis of genomic profiling. However, we did not assess the treatment oncologists' compliance with MTB recommendations because they were not intended to replace clinical judgment/standard of care. RESULTS A total of 146 patients were included in the discussions of the MTB. The median age was 59 years, and 59.6% were women. Genomic results prompting a change in therapeutic decisions were obtained in 53.1% of patients (95% CI, 44.9 to 61.3). The most prevalent malignancy was non–small-cell lung cancer (51%). Other malignancies represented 60%, 50%, and 30% of patients with soft-tissue sarcomas, brain tumors, and breast cancer, respectively. CONCLUSION Using an open-access virtual platform, MTBs were feasible in low- and middle-income countries on the basis of the capability to provide the benefits and access to available targeted therapies that are not standard of care. Furthermore, MTB recommendations were made available to the treating oncologist in different locations across Colombia, providing the option to modify clinical management in most of these patients.

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Section: Discussionmentioning

confidence: 68%

“… 10 Accordingly, some MTBs have been implemented in Latin America mainly for patients not responding to SOC systemic therapies. 11 , 12 Herein, an open-access virtual MTB was implemented using the national cancer network to facilitate the evaluation of cancer and therapeutic approaches for Colombian patients.…”

Section: Introductionmentioning

confidence: 99%

Molecular Tumor Board Improves Outcomes for Hispanic Patients With Advanced Solid Tumors

Sotelo-Rodríguez,

Vallejo-Ardila,

Ruiz-Patiño

et al. 2024

JCO Glob Oncol

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“… 1 In addition to participation barriers, staffing constraints, fragmentation of care, and uneven distribution of resources can pose significant obstacles. 2 , 3 A recent commentary in Communications Medicine emphasized that access to cancer care is dependent on ensuring the presence of staff, stuff, space, systems, and social support , 3 a concept coined by one of the leading architects of improving access, Paul Farmer.…”

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confidence: 99%

Partnering to Strengthen Health Systems and Improve Access to Quality Cancer Care

Israel

2022

JCO Global Oncology

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Access within health care is a universal concern, independent of country income levels or the percentage of gross domestic product investment in health. Addressing the ongoing COVID-19 pandemic has shed light on the hidden access challenges across systems that present barriers to care for many people. These include cultural and language barriers, diminished trust in the health system, and lack of familiarity with negotiating care. 1 Although innovation has addressed certain barriers such as eliminating up-front costs during the pandemic, we still see immense hurdles to care. 1 In addition to participation barriers, staffing constraints, fragmentation of care, and uneven distribution of resources can pose significant obstacles. 2,3 A recent commentary in Communications Medicine emphasized that access to cancer care is dependent on ensuring the presence of staff, stuff, space, systems, and social support, 3 a concept coined by one of the leading architects of improving access, Paul Farmer.For example, screening and diagnosis initiatives for breast cancer are critical to identify cancers in early stages when there is more opportunity to improve outcomes and at lower cost to the health system. 4,5 However, screening programs can only succeed if subsequent diagnosis is confirmed and treatment is initiated within appropriate timelines. 4,6 This cannot occur if the system lacks the capacity in terms of resources, staffing, knowledge, or diagnostic capabilities to confirm diagnosis and refer the patient for care. Another challenge occurs when efforts to address access are implemented with a focus on speed and quantity rather than on quality of care. The Lancet Commission on High Quality Health in the SDG Era has warned that poor quality care is now a bigger barrier to reducing mortality in low-and middle-income countries than insufficient access. 7 Licensed under the Creative Commons Attribution 4.0 License 1

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“…Thus, molecular tumor boards will become as essential as disease-specific ones. [74] The current knowledge of cancer biology and the variety of TT available render incorporating molecular methods in oncology and pathology critical. Expanding access to these methods could be cost-effective and should be considered to allow more precise diagnosis, early detection of cancer, and an effective PM approach.…”

Section: Immunotherapymentioning

confidence: 99%

Adopting Molecular Testing for Solid Tumors in Latin America: Challenges and Opportunities

Araujo¹,

Costa²,

Parra³

et al. 2022

RAS Oncology &Amp; Therapy

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Introduction: The advent of precision medicine, including molecular testing (MT), has revolutionized the cancer care landscape and may provide a path forward in the sustainability of cancer care. Methods: Americas Health Foundation (AHF) identified a panel of seven experts in MT with backgrounds in clinical oncology, molecular pathology, and bioethics from Argentina, Brazil, and Colombia. They convened for a three-day virtual meeting on November 10-12, 2021, to discuss the need for widespread access and adoption of MT for solid tumors in Latin America (LA). Results: The authors identified challenges in MT access in molecular medicine (MM) in LA and proposed suggestions to manage them. Development and implementation of human talent, infrastructure, and policy strategies are essential to provide MT in LA. This review outlines the substantial challenges faced by countries in LA to the widespread adoption of MT in oncology and provides recommendations on overcoming them. Conclusions: Despite the many advantages of MT for solid tumors, the challenges for implementation in LA healthcare systems are sizable and multidimensional. These include regional deficiencies in trained teams, fragmented healthcare systems, and inefficiently distributed budget allocations.

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Recommendations for streamlining precision medicine in breast cancer care in Latin America

Cited by 7 publications

References 58 publications

Molecular Tumor Board Improves Outcomes for Hispanic Patients With Advanced Solid Tumors

Molecular Tumor Board Improves Outcomes for Hispanic Patients With Advanced Solid Tumors

Partnering to Strengthen Health Systems and Improve Access to Quality Cancer Care

Adopting Molecular Testing for Solid Tumors in Latin America: Challenges and Opportunities

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