RESUMO
Background: Prostate cancer (PC) has a serious public health impact, and its incidence is rising due to the aging population. There is limited evidence and consensus to guide the management of PC in Southeast Asia (SEA). We present real-world data on clinical practice patterns in SEA for advanced PC care. Method: A paper-based survey was used to identify clinical practice patterns and obtain consensus among the panelists. The survey included the demographics of the panelists, the use of clinical guidelines, and clinical practice patterns in the management of advanced PC in SEA. Results: Most panelists (81%) voted prostate-specific antigen (PSA) as the most effective test for early PC diagnosis and risk stratification. Nearly 44% of panelists agreed that prostate-specific membrane antigen positron emission tomography-computed tomography imaging for PC diagnostic and staging information aids local and systemic therapy decisions. The majority of the panel preferred abiraterone acetate (67%) or docetaxel (44%) as first-line therapy for symptomatic mCRPC patients. Abiraterone acetate (50%) is preferred over docetaxel as a first-line treatment in metastatic castration-sensitive prostate cancer patients with high-volume disease. However, the panel did not support the use of abiraterone acetate in non-metastatic castration-resistant prostate cancer (nmCRPC) patients. Apalutamide (75%) is the preferred treatment option for patients with nmCRPC. The cost and availability of modern treatments and technologies are important factors influencing therapeutic decisions. All panelists supported the use of generic versions of approved therapies. Conclusion: The survey results reflect real-world management of advanced PC in a SEA country. These findings could be used to guide local clinical practices and highlight the financial challenges of modern healthcare.
RESUMO
BACKGROUND: Breast cancer is one of the leading cancers among females of Brunei Darussalam. There are four subtypes of breast cancer, including human epidermal growth factor receptor 2 (HER-2) positive breast cancer, which is known to be more aggressive and have a poor prognosis. AIM: This study aims to assess the proportion of HER-2 positive cases and the association of HER-2 positivity with patients' epidemiological and clinicopathological factors in Brunei Darussalam. METHODS AND RESULTS: A total of 146 breast cancer cases that were sent for fluorescence in situ hybridisation (FISH) analysis from 1 January 2012 to 31 December 2016 were obtained from The Brunei Cancer Centre, Brunei Darussalam. Data analysis was done with regards to age at diagnosis, ethnicity, stage at diagnosis and HER-2 results by immunohistochemistry (IHC) and FISH. Majority of the study population were diagnosed before the age of 50 years and the median age was 52.0 years. 58.2% (n = 85) cases were reported as IHC 3+, followed by 23.3% (n = 34) IHC 2+ cases and 18.5% (n = 27) negative cases. The proportion of true HER-2 positive cases in total by FISH analysis was 34.9% (n = 51). Majority of Stage IV HER-2 positive cases had metastases to the liver or bones. CONCLUSIONS: Age at diagnosis is significant in determining HER-2 status of tumours by FISH (P = .045). Tumour size (P < .001) and lymph node (P = .006) are significant in metastases of tumours. The proportion of HER-2 positive cases is consistent with findings from the Asian region but higher than that of Western countries. Determining false-positive and false-negative results by IHC test is important to ensure adequate treatment for patients with breast cancer.
