Determination of essential biomarkers in lung cancer: a real-world data study in Spain with demographic, clinical, epidemiological and pathological characteristics.

BACKGROUND: The survival of patients with lung cancer has substantially increased in the last decade by about 15%. This increase is, basically, due to targeted therapies available for advanced stages and the emergence of immunotherapy itself. This work aims to study the situation of biomarker testing in Spain. PATIENTS AND METHODS: The Thoracic Tumours Registry (TTR) is an observational, prospective, registry-based study that included patients diagnosed with lung cancer and other thoracic tumours, from September 2016 to 2020. This TTR study was sponsored by the Spanish Lung Cancer Group (GECP) Foundation, an independent, scientific, multidisciplinary oncology society that coordinates more than 550 experts and 182 hospitals across the Spanish territory. RESULTS: Nine thousand two hundred thirty-nine patients diagnosed with stage IV non-small cell lung cancer (NSCLC) between 2106 and 2020 were analysed. 7,467 (80.8%) were non-squamous and 1,772 (19.2%) were squamous. Tumour marker testing was performed in 85.0% of patients with non-squamous tumours vs 56.3% in those with squamous tumours (p-value < 0.001). The global testing of EGFR, ALK, and ROS1 was 78.9, 64.7, 35.6% respectively, in non-squamous histology. PDL1 was determined globally in the same period (46.9%), although if we focus on the last 3 years it exceeds 85%. There has been a significant increase in the last few years of all determinations and there are even close to 10% of molecular determinations that do not yet have targeted drug approval but will have it in the near future. 4,115 cases had a positive result (44.5%) for either EGFR, ALK, KRAS, BRAF, ROS1, or high PDL1. CONCLUSIONS: Despite the lack of a national project and standard protocol in Spain that regulates the determination of biomarkers, the situation is similar to other European countries. Given the growing number of different determinations and their high positivity, national strategies are urgently needed to implement next-generation sequencing (NGS) in an integrated and cost-effective way in lung cancer.

Impact of an osteoporosis specialized unit on bone health in breast cancer survivals treated with aromatase inhibitors.

OBJECTIVE: Considering the increased fracture risk in early breast cancer patients treated with aromatase inhibitors (AI), we assessed the impact of a preventive intervention conducted by a specialized osteoporosis unit on bone health at AI treatment start. MATERIAL AND METHODS: Retrospective cohort of postmenopausal women who started treatment with AI after breast cancer surgical/chemotherapy treatment and were referred to the osteoporosis unit for a comprehensive assessment of bone health. Bone densitometry and fracture screening by plain X-ray were performed at the baseline visit and once a year for 5 years. RESULTS: The final record included 130 patients. At AI treatment start, 49% had at least one high-risk factor for fractures, 55% had osteopenia, and 39% osteoporosis. Based on the baseline assessment, 79% of patients initiated treatment with bisphosphonates, 88% with calcium, and 79% with vitamin D. After a median of 65 (50-77) months, 4% developed osteopenia or osteoporosis, and 14% improved their densitometric diagnosis. Fifteen fractures were recorded in 11 (8.5%) patients, all of them receiving preventive treatment (10 with bisphosphonates). During the follow-up period, patients with one or more high-risk factors for fracture showed a greater frequency of fractures (15% vs. 3%) and experienced the first fracture earlier than those without high-risk factors (mean of 99 and 102 months, respectively; P=0.023). CONCLUSIONS: The preventive intervention of a specialized unit at the start of AI treatment in breast cancer survivors allows the identification of patients with high fracture risk and may contribute to preventing bone events in these patients.

Impact of an osteoporosis specialized unit on bone health in breast cancer survivals treated with aromatase inhibitors / Impacto de una unidad de osteoporosis en la salud ósea de pacientes con cáncer de mama en tratamiento con inhibidores de la aromatasa

Objective: Considering the increased fracture risk in early breast cancer patients treated with aromatase inhibitors (AI), we assessed the impact of a preventive intervention conducted by a specialized osteoporosis unit on bone health at AI treatment start. Material and methods: Retrospective cohort of postmenopausal women who started treatment with AI after breast cancer surgical/chemotherapy treatment and were referred to the osteoporosis unit for a comprehensive assessment of bone health. Bone densitometry and fracture screening by plain X-ray were performed at the baseline visit and once a year for 5 years. Results: The final record included 130 patients. At AI treatment start, 49% had at least one high-risk factor for fractures, 55% had osteopenia, and 39% osteoporosis. Based on the baseline assessment, 79% of patients initiated treatment with bisphosphonates, 88% with calcium, and 79% with vitamin D. After a median of 65 (50-77) months, 4% developed osteopenia or osteoporosis, and 14% improved their densitometric diagnosis. Fifteen fractures were recorded in 11 (8.5%) patients, all of them receiving preventive treatment (10 with bisphosphonates). During the follow-up period, patients with one or more high-risk factors for fracture showed a greater frequency of fractures (15% vs. 3%) and experienced the first fracture earlier than those without high-risk factors (mean of 99 and 102 months, respectively; P=0.023). Conclusions: The preventive intervention of a specialized unit at the start of AI treatment in breast cancer survivors allows the identification of patients with high fracture risk and may contribute to preventing bone events in these patients

Objetivo: Evaluar el impacto de la intervención preventiva de una unidad de osteoporosis en supervivientes de cáncer de mama que inician un tratamiento con inhibidores de la aromatasa (IA). Material y métodos: Estudio retrospectivo en mujeres posmenopáusicas con cáncer de mama precoz que iniciaron un tratamiento con IA tras la cirugía y/o quimioterapia, derivadas a la unidad de osteoporosis para una evaluación de la salud ósea, incluyendo densitometrías óseas y búsqueda sistemática de fracturas mediante Rx al inicio del tratamiento y anualmente durante 5 años. Resultados: Se incluyeron 130 pacientes. Al inicio del tratamiento con IA el 49% tenía al menos un factor de riesgo alto para fracturas, el 55% osteopenia y el 39% osteoporosis. Tras la evaluación inicial, el 79% de las pacientes inició un tratamiento con bifosfonatos, el 88% con calcio y el 79% con vitamina D. Tras una mediana de 65 (50-77) meses, el 4% desarrolló osteopenia u osteoporosis y el 14% mejoró el diagnóstico densitométrico. Se registraron 15 fracturas en 11 (8,5%) pacientes, todas ellas en tratamiento preventivo. Durante el seguimiento, las pacientes con ≥1 factores de riesgo altos registraron una mayor frecuencia de fracturas (15 vs. 3%) y un menor tiempo hasta la primera fractura (media de 99 vs. 102 meses; p=0,023). Conclusiones: La intervención preventiva de una unidad de osteoporosis al inicio del tratamiento con IA en supervivientes de cáncer de mama permite identificar pacientes con un elevado riesgo de fracturas y puede contribuir a la prevención de eventos óseos en estas pacientes

La anemia como factor de riesgo quirúrgico / Anemia as a surgical risk factor

La anemia perioperatoria es frecuente en los pacientes quirúrgicos y se asocia a un aumento de la morbimortalidad y disminución de la calidad de vida. Las causas principales de anemia en el contexto perioperatorio son el déficit de hierro y la inflamación crónica. En el postoperatorio, la anemia puede ser agravada por la pérdida sanguínea del intraoperatorio siendo la transfusión alogénica el método más habitual de tratamiento. Por otro lado, la transfusión de sangre no está exenta de riesgos, aumentando de nuevo la morbilidad y mortalidad de los pacientes. Dada la preocupación que esto genera, nos proponemos revisar la fisiopatología de estas anemias en el entorno quirúrgico así como su tratamiento mediante la ingesta de alimentos ricos en hierro, terapia con hierro oral e intravenoso (hierro sacarosa y carboximaltosa de hierro). En la anemia de tipo inflamatorio crónico utilizamos agentes estimulantes de la eritropoyesis (eritropoyetina alfa) y en casos de anemias mixtas la combinación de ambos tratamientos. El objetivo siempre es reducir la necesidad de la transfusión perioperatoria y acelerar la recuperación de la anemia postoperatoria así como disminuir la tasa de morbimortalidad de los pacientes (AU)

Perioperative anemia is common in patients undergoing surgery and is associated with increased morbidity and mortality and a decreased quality of life. The main causes of anemia in the perioperative context are iron deficiency and chronic inflammation. Anemia can be aggravated by blood loss during surgery, and is most commonly treated with allogeneic transfusion. Moreover, blood transfusions are not without risks, once again increasing patient morbidity and mortality. Given these concerns, we propose to review the pathophysiology of anemia in the surgical environment, as well as its treatment through the consumption of iron-rich foods and by oral or intravenous iron therapy (iron sucrose and iron carboxymaltose). In chronic inflammatory anemia, we use erythropoiesis-stimulating agents (erythropoietin alpha) and, in cases of mixed anemia, the combination of both treatments. The objective is always to reduce the need for perioperative transfusions and speed the recovery from postoperative anemia, as well as decrease the patient morbidity and mortality rate (AU)