Application of Comprehensive Genomic Profiling-Based Next-Generation Sequencing Assay to Improve Cancer Care in a Developing Country.

PURPOSE: Identifying actionable oncogenic mutations have changed the therapeutic landscape in different types of tumors. This study investigated the utility of comprehensive genomic profiling (CGP), a hybrid capture-based next-generation sequencing (NGS) assay, in clinical practice in a developing country. METHODS: In this retrospective cohort study, CGP was performed on clinical samples from patients with different solid tumors recruited between December 2016 and November 2020, using hybrid capture-based genomic profiling, at the individual treating physicians' request in the clinical care for therapy decisions. Kaplan-Meier survival curves were estimated to characterize the time-to-event variables. RESULTS: Patients median age was 61 years (range: 14-87 years), and 64.7% were female. The most common histological diagnosis was lung primary tumors, with 90 patients corresponding to 52.9% of the samples (95% CI 45.4-60.4%). Actionable mutations with FDA-approved medications for specific alterations correspondent to tumoral histology were identified in 58 cases (46.4%), whereas other alterations were detected in 47 different samples (37.6%). The median overall survival was 15.5 months (95% CI 11.7 months-NR). Patients who were subjected to genomic evaluation at diagnosis reached a median overall survival of 18.3 months (95% CI 14.9 months-NR) compared to 14.1 months (95% CI 11.1 months-NR) in patients who obtained genomic evaluation after tumor progression and during standard treatment (P = .7). CONCLUSION: CGP of different types of tumors identifies clinically relevant genomic alterations that have benefited from targeted therapy and improve cancer care in a developing country to guide personalized treatment to beneficial outcomes of cancer patients.

Impact of COVID-19 Infection on Patients with Cancer: Experience in a Latin American Country: The ACHOCC-19 Study.

INTRODUCTION: The ACHOCC-19 study was performed to characterize COVID-19 infection in a Colombian oncological population. METHODOLOGY: Analytical cohort study of patients with cancer and COVID-19 infection in Colombia. From April 1 to October 31, 2020. Demographic and clinical variables related to cancer and COVID-19 infection were collected. The primary outcome was 30-day mortality from all causes. The association between the outcome and the prognostic variables was analyzed using logistic regression models and survival analysis with Cox regression. RESULTS: The study included 742 patients; 72% were >51 years. The most prevalent neoplasms were breast (132, 17.77%), colorectal (92, 12.34%), and prostate (81, 10.9%). Two hundred twenty (29.6%) patients were asymptomatic and 96 (26.3%) died. In the bivariate descriptive analysis, higher mortality occurred in patients who were >70 years, patients with lung cancer, ≥2 comorbidities, former smokers, receiving antibiotics, corticosteroids, and anticoagulants, residents of rural areas, low socioeconomic status, and increased acute-phase reactants. In the logistic regression analysis, higher mortality was associated with Eastern Cooperative Oncology Group performance status (ECOG PS) 3 (odds ratio [OR] 28.67; 95% confidence interval [CI], 8.2-99.6); ECOG PS 4 (OR 20.89; 95% CI, 3.36-129.7); two complications from COVID-19 (OR 5.3; 95% CI, 1.50-18.1); and cancer in progression (OR 2.08; 95% CI, 1.01-4.27). In the Cox regression analysis, the statistically significant hazard ratios (HR) were metastatic disease (HR 1.58; 95% CI, 1.16-2.16), cancer in progression (HR 1.08; 95% CI, 1.24-2.61) cancer in partial response (HR 0.31; 95% CI, 0.11-0.88), use of steroids (HR 1.44; 95% CI, 1.01-2.06), and use of antibiotics (HR 2.11; 95% CI, 1.47-2.95). CONCLUSION: In our study, patients with cancer have higher mortality due to COVID-19 infection if they have active cancer, metastatic or progressive cancer, ECOG PS >2, and low socioeconomic status. IMPLICATIONS FOR PRACTICE: This study's findings raise the need to carefully evaluate patients with metastatic cancer, in progression, and with impaired Eastern Cooperative Oncology Group status to define the relevance of cancer treatment during the pandemic, consider the risk/benefit of the interventions, and establish clear and complete communication with the patients and their families about the risk of complications. There is also the importance of offering additional support to patients with low income and residence in rural areas so that they can have more support during cancer treatment.

Use of erlotinib throughout pregnancy: a case-report of a patient with metastatic lung adenocarcinoma.

The use of erlotinib throughout pregnancy has not been previously reported. We present the case of a 40 year-old female patient with stage IV lung adenocarcinoma, mediastinal, bone and cerebral metastasis, a EGFR mutation and no smoking history, who had begun first line treatment with erlotinib 150 mg once daily. After two and a half months of treatment a fourteen-week pregnancy was documented, and after informing on fetal risks secondary to erlotinib use and maternal risks secondary to treatment withholding, she decided to continue with treatment under clinical surveillance by both the oncology and obstetrics clinics. At thirty-three weeks gestation a live born 1600 g female was born by caesarean section without evidence of congenital malformations. Imaging assessment after eight months of treatment showed complete bone and central nervous system response and partial lung and mediastinal response. The patient is currently undergoing the 11th month of treatment and is asymptomatic, the baby is 4 months old and is in good health.

Tratamiento oncológico del angiosarcoma cutáneo: revisión de la literatura / Oncologic treatment of cutaneous angiosarcoma: review of the literature

El hemangiosarcoma cutáneo es una enfermedad maligna rara de origen vascular, y corresponde a menos del 1% de todas las malignidades y al 2% de todos los sarcomas de tejidos blandos. Su presentación usual es en el rostro y en la región del cuero cabelludo; al momento de diagnosticarse ya es una enfermedad avanzada. Afecta a menudo al anciano del género masculino y de raza blanca. El tratamiento oncológico se basa en la resección quirúrgica, la radioterapia y la quimioterapia, dado el alto riesgo tanto de recaída local como de diseminación hematológica con intención paliativa. Las tasas de control locorregional a 5 años son, aproximadamente, del 40% al 50%, las tasas de supervivencia libre de metástasis a distancia a 5 años están en el rango del 20% al 40%, y las tasas de supervivencia a 5 años se encuentran entre el 10% y el 30%.

Cutaneous hemangiosarcoma is a rare malignant disease of vascular origin which accounts for less than 1% of all malignancies and 2% of all soft tissue sarcomas. It most frequently affects elderly white males, and is usually found on the face and scalp; at diagnosis it tends to be advanced. Oncologic treatment is based upon surgical resection, radiotherapy and chemotherapy due to the high risk of local relapse as well as to hematologic dissemination with palliative intention. Loco-regional control rates at 5 years range from 40% to 50%, metastasis-free survival rates at 5 years are from 20% to 40%, and survival rates at 5 years from 10% to 30%.

Prolapso genital en el Hospital Universitario de Cartagena / Genital prolapse at the University Hospital of Cartagena

El prolapso genital es una condición frecuente en la práctica clínica, definido como el descenso de las estructuras genitales y/o elementos relacionados con él, por debajo del nivel que normalmente ocupan. La fascia endopélvica une los órganos a las paredes pélvicas, mientras los músculos del piso pélvico, cierran la pelvis y elevando los órganos, evitan la distención de los ligamentos aponeuróticos. 102 pacientes que fueron ingresadas al Hospital Universitario de Cartagena con prolapso genital son estudiadas. Edades: 32-80 años. X=55.8+o- 12.3 años. 74.5 por ciento tenían prolapso Grado III. La paridad promedio fue de 7 partos y ninguna era nulípara. El tipo de prolapso más frecuente fue el cistorectocele, seguido del prolapso genital total. El 30.2 por ciento de las cirugías ginecológicas que se realizan en este Hospital son procedimientos por corrección del prolapso genital. No se presentaron accidentes intraoperatorios y las complicaciones a los 30 días post-quirúrgicas fueron del 11.8 por ciento. La estancia hospitalaria fue de 3-8 días. El origen de los transtornos del piso pélvico se considera multifactorial, dándose gran valor al traumatismo obstétrico y más recientemente a los estados hipoestrogénicos post-menopáusicos. Hacen falta más estudios para precisar la influencia de los estados nutricionales y la tendencia familiar en el prolapso genital