Prospective, multicenter study on the economic and clinical impact of gene-expression assays in early-stage breast cancer from a single region: the PREGECAM registry experience.

INTRODUCTION: The aim of this study is to evaluate the cost-effectiveness and impact of gene-expression assays (GEAs) on treatment decisions in a real-world setting of early-stage breast cancer (ESBC) patients. METHODS: This is a regional, prospective study promoted by the Council Health Authorities in Madrid. Enrolment was offered to women with estrogen receptor-positive, human epidermal growth factor receptor 2-negative, node-negative or micrometastatic, stage I or II breast cancer from 21 hospitals in Madrid. Treatment recommendations were recorded before and after knowledge of tests results. An economic model compared the cost-effectiveness of treatment, guided by GEAs or by common prognostic factors. RESULTS: 907 tests (440 Oncotype DX® and 467 MammaPrint®) were performed between February 2012 and November 2014. Treatment recommendation changed in 42.6% of patients. The shift was predominantly from chemohormonal (CHT) to hormonal therapy (HT) alone, in 30.5% of patients. GEAs increased patients' confidence in treatment decision making. Tumor grade, progesterone receptor positivity and Ki67 expression were associated with the likelihood of change from CHT to HT (P < 0.001) and from HT to CHT (P < 0.001). Compared with current clinical practice genomic testing increased quality-adjusted life years by 0.00787 per patient and was cost-saving from a national health care system (by 13.867€ per patient) and from a societal perspective (by 32.678€ per patient). CONCLUSION: Using GEAs to guide adjuvant therapy in ESBC is cost-effective in Spain and has a significant impact on treatment decisions.

[Acetylation polymorphism in lung cancer]. / Polimorfismo acetilador en el cáncer de pulmón.

The acetylation phenotype was determined, by means of sulfamethazine measurement, in 87 patients (83 male) with confirmed bronchogenic carcinoma and in 93 healthy control patients (41 male) of equal ages. 48 patients and 54 controls were classified as being "slow acetylators" (Ch2 n.s.) When the persons were individually analysed by phenotype, it was confirmed that the patients showed a significantly lower rate of acetylated sulfamethazine than the control group (p less than 0.02), owing to the poor acetylation of patients with small-cell lung cancer. This difference should be confirmed by more detailed pharmacokinetic studies before regarding it as a possible interference of paraneoplasic type. The polymorphism acetylator cannot be considered a genetic marker related to the risk of having lung cancer.

[Carcinoid tumor of the bronchi. An infrequent tumor. Clinical study of 12 cases]. / Carcinoide bronquial. Tumor poco frecuente. Estudio clínico de doce casos.

Twelve patients with a bronchial carcinoid tumor seen over the past 10 years, were retrospectively analyzed. The age, symptoms, smoking habit, previous respiratory conditions, X-ray and extension of the tumor, bronchial endoscopy, treatment and survival were studied. The mean age of these patients was 42.5 years with a male predominance of 2:1. More than half of the patients were smokers (58.3%). The most common symptoms were hemoptysis, costal pain, pneumonia and fever. Two of the patients were asymptomatic (16.6%) and their tumor was detected in a routine health control. Almost half of the patients (41.6%) complained of respiratory symptoms for 3 years previous to diagnosis (mean 7.8 years with a range of 3 to 11 years). 75% of the cases were centrally located. The left lung was most frequently affected (75%). Fiberbronchoscopy was carried out in nine patients; in eight of them the tumor was localized and information was obtained about the segment involved. However, the biopsy was positive in only one case (14.2%). Two patients presented endocrine symptoms with a syndrome similar to the carcinoid. The disease was disseminated with adrenal metastasis in two cases, one of which had also bone and liver metastasis. An immunohistochemical study was performed in eight cases with a positive result for ACTH and calcitonin in one patient. Ten patients were treated with surgery; one with chemotherapy and the other was treated with palliation. Two patients were lost in the follow up period.(ABSTRACT TRUNCATED AT 250 WORDS)