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Lung cancer has been the leading cause of cancer-related deaths in both developed and developing countries, with most primary lung cancers being non-small cell lung carcinomas. Treatment for this condition is sometimes individualized. With developments in modern treatment and phase III clinical trial results, epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) and ALK-TKI have proven thier superior effectivity in comparison with the standard platinum-based doublet and are commonly approved as first-line indications in previously untreated advanced non-small cell lung cancer (NSCLC) patients with EGFR or ALK mutations. In the majority of cases, the presence of the ALK rearrangement mutation does not overlap with other mutations in NSCLC. Here, we report a patient with concomitant ALK rearrangement and EGFR mutation treated with a combination of TKIs: osimertinib and ceritinib.
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BACKGROUND: Hereditary cancer syndromes (HCS) are responsible for 5-10% of cancer cases. Genetic testing to identify pathogenic variants associated with cancer predisposition has not been routinely available in Vietnam. Consequently, the prevalence and genetic landscape of HCS remain unknown. METHODS: 1165 Vietnamese individuals enrolled in genetic testing at our laboratory in 2020. We performed analysis of germline mutations in 17 high- and moderate- penetrance genes associated with HCS by next generation sequencing. RESULTS: A total of 41 pathogenic variants in 11 genes were detected in 3.2% individuals. The carrier frequency was 4.2% in people with family or personal history of cancer and 2.6% in those without history. The percentage of mutation carriers for hereditary colorectal cancer syndromes was 1.3% and for hereditary breast and ovarian cancer syndrome was 1.6%. BRCA1 and BRCA2 mutations were the most prevalent with the positive rate of 1.3% in the general cohort and 5.1% in breast or ovarian cancer patients. Most of BRCA1 mutations located at the BRCA C-terminus domains and the top recurrent mutation was NM_007294.3:c.5251C>T (p.Arg1751Ter). One novel variant NM_000038.6(APC):c.6665C>A (p.Pro2222His) was found in a breast cancer patient with a strong family history of cancer. A case study of hereditary cancer syndrome was illustrated to highlight the importance of genetic testing. CONCLUSION: This is the first largest analysis of carrier frequency and mutation spectrum of HCS in Vietnam. The findings demonstrate the clinical significance of multigene panel testing to identify carriers and their at-risk relatives for better cancer surveillance and management strategies.
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PURPOSE: This paper aims to analyze the household financial burden and poverty impacts of cancer treatment in Vietnam. METHODS: Under the "ASEAN CosTs in ONcology" study design, three major specialized cancer hospitals were employed to assemble the Vietnamese data. Factors of socioeconomic, direct, and indirect costs of healthcare were collected prospectively through both individual interviews and hospital financial records. RESULTS: The rates of catastrophic expenditure based on the cut-off points of 20%, 30%, 40%, and 50% of household's income were 82.6%, 73.7%, 64.7%, and 56.9%, respectively. 37.4% of the households with patient were impoverished by the treatment costs for cancer. The statistically significant correlates of the impoverishment problem were higher among older patients (40-60 years: 1.77, 95% CI 1.14-2.73; above 60 years: 1.75, 95% CI 1.03-2.98); poorer patients (less than 100% national income: 29, 95% CI 18.6-45.24; less than 200% national income: 2.89, 95% CI 1.69-4.93); patients who underwent surgery alone (receiving nonsurgery treatment: 2.46, 95% CI 1.32-4.59; receiving multiple treatments: 2.4, 95% CI 1.38-4.17). CONCLUSIONS: Lots of households were pushed into poverty due to their expenditure on cancer care; more actions are urgently needed to improve financial protection to the vulnerable groups.