Caracterización clínica y terapéutica del cáncer de mama, en mujeres mayores, atendidas en un centro oncológico de Medellín ­ Colombia / Clinical and therapeutic characterization of breast cancer, in older women, attended in a cancer center in Medellin ­ Colombia

Introducción: El cáncer de mama es el cáncer más frecuente en las mujeres colombianas y más de la mitad de la incidencia la aportan las adultas mayores de 60 años. El objetivo de este estudio fue caracterizar clínicamente a un grupo de pacientes ≥ 65 años, con diagnóstico de cáncer de mama primario. Metodología: Estudio descriptivo de 188 pacientes con edad ≥ 65 años, con cáncer de mama primario, atendidas en la Fundación Colombiana de Cancerología ­ Clínica Vida, entre enero de 2017 y diciembre de 2018. Se realizó un análisis descriptivo de datos sociodemográficos, comorbilidades, características de la enfermedad y tratamiento. Resultados: La población estudiada (188) presentó una edad promedio de 73 años y en el 79.8% de ellas se reportó al menos una comorbilidad. El 76.6% tuvo enfermedad con receptor hormonal positivo. El manejo primario con cirugía se hizo en el 58.5% de las pacientes, y la mayoría fueron procedimientos conservadores de la mama (70.9%). Conclusión: Las mujeres adultas mayores tienen características del cáncer de mama que pueden diferir de las pacientes jóvenes e influir en el tratamiento que se ofrece, impactando en su pronóstico oncológico, en el pronóstico de sus comorbilidades y en la calidad de vida.

Introduction: Breast cancer is the most frequent cancer in Colombian women and more than half of the incidence is contributed by adults over 60 years of age. The objective of this study was to clinically characterize a group of patients ≥ 65 years of age, diagnosed with primary breast cancer. Methodology: Descriptive study of 188 patients aged ≥ 65 years, with primary breast cancer, treated at the Colombian Cancer Foundation - Clínica Vida, between January 2017 and December 2018. A descriptive analysis of sociodemographic data, comorbidities, characteristics of the disease and treatment. Results: The studied population (188) had an average age of 73 years and in 79.8% of them at least one comorbidity was reported. 76.6% had hormone receptor positive disease. The primary manage-ment with surgery was done in 58.5% of the patients, and the majority were breast-conserving proce-dures (70.9%). Conclusion: Older women have characteristics of breast cancer that may differ from young pa-tients. This may influence the treatment offered, impacting on their oncological prognosis, on the prognosis of their comorbidities and on the quality of life.

Response of Leptomeningeal Metastases in EGFR-Mutated Non-Small-Cell Lung Cancer to Afatinib in the Absence of Radiotherapy.

Palliative radiotherapy is currently the medical standard of care for non-small-cell lung cancer (NSCLC) patients with symptomatic CNS and leptomeningeal disease. We report the case of a 62-year-old male patient with EGFR mutation (del19+) NSLC with symptomatic lymph node, bone, CNS, and leptomeningeal metastases. Taking into account on one hand the response to tyrosine kinase inhibitors (TKIs) and on the other hand the short- to medium-term side effects of radiotherapy and the lack of timely availability in our healthcare system, the patient was treated with afatinib (40 mg daily) and exhibited a rapid response with improvement of neurological symptoms. The patient presented partial response of extracranial, CNS, and leptomeningeal lesions at 3, 6, and 12 months of treatment, currently completing 16 months of progression-free survival despite presenting mild dermatological and gastrointestinal toxicities. Afatinib is an effective and safe option in patients with NSLC EGFR mutation del19+ with CNS and leptomeningeal compromise avoiding or delaying radiotherapy and its side effects, especially in countries where there is a lack of access to this kind of therapy.

Platelet-to-lymphocyte ratio as a predictive factor of complete pathologic response to neoadjuvant chemotherapy in breast cancer.

Response to neoadjuvant chemotherapy in breast cancer patients is of prognostic value in determining short- and mid-term outcomes. Inflammatory biomarkers, such as platelet-to-lymphocyte ratio (PLR) and neutrophil to lymphocyte ratio (NLR), have been proposed as predictive factors of response to neoadjuvant chemotherapy. Currently, there are no studies in Colombian patients reporting the role of inflammatory biomarkers as response predictors in patients receiving neoadjuvant chemotherapy. Therefore, in this study we performed a cross-sectional study and analyzed the association between inflammatory biomarkers and pCR (pathological complete response) in patients diagnosed with breast cancer-of different molecular subtypes- and treated with neoadjuvant chemotherapy. A total of 288 patients were included in the study, with a median age of 51 years old. Disease was locally advanced in 83% of the participants, and 77.7% had compromised lymph nodes. In our cohort, the most frequent tumor molecular subtype was luminal B/Her2- (27.8%) followed by triple negative [TN] (21.5%), luminal B/Her2+ (19.8%), Her2-enriched (16%) and luminal A (13.5%). PLR was not associated with age, menopausal status, baseline tumor size, histologic grade, axillary lymph node involvement, disease stage, estrogen receptor status, or Ki67; however, complete pathological response was significantly higher in the low PLR group (PLR<150) compared with the high PLR group (35.1% Vs. 22.2%, p = 0.03). In addition, Her2-enriched tumors achieved the highest pCR rates (65%), followed by TN (34%) tumors. Our results suggest that breast cancer patients with low platelet-to-lymphocyte ratio (PLR <150), treated with neoadjuvant chemotherapy achieve higher complete pathological response, independently of primary tumor molecular subtype.

Obesity and Prognostic Variables in Colombian Breast Cancer Patients: A Cross-Sectional Study.

INTRODUCTION: Obesity is an established risk factor for cancer and cancer-related deaths, including that of the breast. While the prevalence of female obesity has accelerated over the past decade in many developing countries, such as Colombia, the prevalence of overweight and obesity specifically in breast cancer populations has not been fully described. METHODS: A cross-sectional study including 849 women diagnosed with breast cancer between 2009 and 2014. Based on body mass index, prevalence of overweight (BMI ≥ 25 < 30) and obesity (BMI ≥ 30) and associations of BMI with clinical and tumor histopathological features were analyzed. RESULTS: Colombian breast cancer patients had a prevalence of overweight of 34.28% and obesity of 28.15%. Mean BMI was comparable between premenopausal and postmenopausal women (27.2 versus 27.7, resp.). Among premenopausal women, higher BMI was significantly positively associated with hormone receptor negative tumors, as well as with greater lymphovascular invasion. CONCLUSIONS: Colombian breast cancer patients exhibit a significant prevalence of overweight and obesity. Associations of high BMI and poor prognosis variables in the premenopausal population suggest risk of aggressive disease in this population. Future studies to further validate our observations are warranted in order to implement multidisciplinary clinical guidelines.