Management of patients with recurrent/metastatic endometrial cancer: Consensus recommendations from an expert panel from Brazil.

Background: Endometrial cancer is of increasing concern in several countries, including Brazil, in part because of an ageing population, declines in fertility, and the increasing prevalence of obesity. Although endometrial tumors had lagged behind other cancer types in terms of treatment improvements, molecular characterization of these tumors is paving the way for novel therapies and an expansion of the therapeutic arsenal. We aimed to help medical oncologists who manage patients with recurrent or metastatic endometrial cancer in the Brazilian healthcare setting. Methods: The panel, composed of 20 medical oncologists, convened in November 2021 to address 50 multiple-choice questions on molecular testing and treatment choices. We classified the level of agreement among panelists as (1) consensus (≥75% choosing the same answer), (2) majority vote (50% to <75%), or (3) less than majority vote (<50%). Results: Consensus was present for 25 of the 50 questions, whereas majority vote was present for an additional 23 questions. Key recommendations include molecular testing for every patient with recurrent/metastatic endometrial cancer; choice of first-line treatment according to microsatellite instability and HER2, with the addition of programmed death ligand 1 (PD-L1) and hormone receptors (HRs) for second-line therapy; carboplatin and paclitaxel as the preferred option in first-line treatment of HER2-negative disease, with the addition of trastuzumab in HER2-positive disease; pembrolizumab plus lenvatinib as a key option in second line, regardless of HER2, PD-L1 or HRs; and various recommendations regarding treatment choice for patients with distinct comorbidities. Conclusion: Despite the existing gaps in the current literature, the vast majority of issues addressed by the panel provided a level of agreement sufficient to inform clinical practice in Brazil and in other countries with similar healthcare environments.

Breast cancer neoadjuvant endocrine therapy and COVID-19: a renewed breath with future perspectives

In 2020, the COVID-19 pandemic is the major healthcare concern around the world. The infection is especially severe to those with immune system suppression, including patients with cancer. In order to mitigate the negative effects of COVID-19, guidelines have been developed by societies worldwide to review oncology care during this pandemic time. Neoadjuvant endocrine therapy (NET) is a well-stablished option for hormone positive (HR) HER2 negative breast cancer and showed a positive response in breast conservative surgery with substantially less toxicity. Compared to chemotherapy, the NET cost is lower, and its administration is easier, due to less medical visits. Even with remarkable advantages, NET remains taking less place in treatments than it might have. Periods of humanity crisis, such as World Wars and other pandemics, boosted the development of science and established many treatments, which are currently practiced. New data generated during the COVID-19 outbreak can inspire more trials comparing chemotherapy to endocrine therapy within the neoadjuvant setting. The purpose of this letter is to suggest NET as a safe low toxicity treatment strategy for breast cancer, not only to postpone breast cancer surgery during the pandemic, but also to become a standard therapy, a flame kept burning crossing the COVID-19 border.

Perioperative chemotherapy in locally advanced gastric cancer.

Gastric cancer is one of the most common cancers and a main cause of cancer-related death worldwide, since the majority of patients suffering of this malignancy are usually faced with a poor prognosis due to diagnosis at later stages. In order to improve treatment outcomes, the association of surgery with chemo and/or radiotherapy (multimodal therapy) has become the standard treatment for locally advanced stages. However, despite several treatment options currently available for management of these tumors, perioperative chemotherapy has been mainly accepted for the comprehensive therapeutic strategy including an appropriated D2-gastrectomy. This manuscript presents a (nonsystematic) critical review about the use of perioperative chemotherapy, with a special focus on the drugs delivery.

Perioperative ceemotherapy in locally advanced gastric cancer / Quimioterapia peri-operatoria no tratamento do cancer gastrico localmente avancado

Gastric cancer is one of the most common cancers and a main cause of cancer-related death worldwide, since the majority of patients suffering of this malignancy are usually faced with a poor prognosis due to diagnosis at later stages. In order to improve treatment outcomes, the association of surgery with chemo and/or radiotherapy (multimodal therapy) has become the standard treatment for locally advanced stages. However, despite several treatment options currently available for management of these tumors, perioperative chemotherapy has been mainly accepted for the comprehensive therapeutic strategy including an appropriated D2-gastrectomy. This manuscript presents a (nonsystematic) critical review about the use of perioperative chemotherapy, with a special focus on the drugs delivery.

O câncer gástrico representa um dos cânceres mais comuns em todo o mundo e uma importante causa de óbito por causas oncológicas, uma vez que a maioria dos pacientes com esta neoplasia malígna é confrontada com um prognóstico muito ruim em decorrência do diagnóstico comumente tardio. Com o intuito de melhorar os resultados do tratamento, a associação de cirurgia com quimioterapia e/ou radioterapia (terapia multidisciplinar), tornou-se o tratamento padrão para os casos em estádios localmente avançados. Por outro lado, embora diversos regimes de tratamento estejam atualmente disponíveis para o manejo desses tumores, a quimioterapia perioperatória tem recebido maior atenção como estratégia terapêutica quando a abordagem cirúrgica utilizada inclui a dissecção D2 dos linfonodos regionais. Apresenta-se uma revisão crítica (não-sistemática) sobre o uso de quimioterapia perioperatória no tratamento do câncer gástrico localmente avançado.