Advanced renal cell carcinoma management: the Latin American Cooperative Oncology Group (LACOG) and the Latin American Renal Cancer Group (LARCG) consensus update.

PURPOSE: Renal cell carcinoma is an aggressive disease with a high mortality rate. Management has drastically changed with the new era of immunotherapy, and novel strategies are being developed; however, identifying systemic treatments is still challenging. This paper presents an update of the expert panel consensus from the Latin American Cooperative Oncology Group and the Latin American Renal Cancer Group on advanced renal cell carcinoma management in Brazil. METHODS: A panel of 34 oncologists and experts in renal cell carcinoma discussed and voted on the best options for managing advanced disease in Brazil, including systemic treatment of early and metastatic renal cell carcinoma as well as nonclear cell tumours. The results were compared with the literature and graded according to the level of evidence. RESULTS: Adjuvant treatments benefit patients with a high risk of recurrence after surgery, and the agents used are pembrolizumab and sunitinib, with a preference for pembrolizumab. Neoadjuvant treatment is exceptional, even in initially unresectable cases. First-line treatment is mainly based on tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs); the choice of treatment is based on the International Metastatic Database Consortium (IMCD) risk score. Patients at favourable risk receive ICIs in combination with TKIs. Patients classified as intermediate or poor risk receive ICIs, without preference for ICI + ICIs or ICI + TKIs. Data on nonclear cell renal cancer treatment are limited. Active surveillance has a place in treating favourable-risk patients. Either denosumab or zoledronic acid can be used for treating metastatic bone disease. CONCLUSION: Immunotherapy and targeted therapy are the standards of care for advanced disease. The utilization and sequencing of these therapeutic agents hinge upon individual risk scores and responses to previous treatments. This consensus reflects a commitment to informed decision-making, drawn from professional expertise and evidence in the medical literature.

Treatment of Localized and Locally Advanced, High-Risk Prostate Cancer: A Report From the First Prostate Cancer Consensus Conference for Developing Countries.

PURPOSE: To generate and present survey results on important issues relevant to treatment and follow-up of localized and locally advanced, high-risk prostate cancer (PCa) focusing on developing countries. METHODS: A panel of 99 PCa experts developed more than 300 survey questions of which 67 questions concern the main areas of interest of this article: treatment and follow-up of localized and locally advanced, high-risk PCa in developing countries. A larger panel of 99 international multidisciplinary cancer experts voted on these questions to create the recommendations for treatment and follow-up of localized and locally advanced, high-risk PCa in areas of limited resources discussed in this article. RESULTS: The panel voted publicly but anonymously on the predefined questions. Each question was deemed consensus if 75% or more of the full panel had selected a particular answer. These answers are based on panelist opinion and not on a literature review or meta-analysis. For questions that refer to an area of limited resources, the recommendations considered cost-effectiveness as well as the possible therapies with easier and greater access. Each question had five to seven relevant answers including two nonanswers. Results were tabulated in real time. CONCLUSION: The voting results and recommendations presented in this article can guide physicians managing localized and locally advanced, high-risk PCa in areas of limited resources. Individual clinical decision making should be supported by available data; however, as guidelines for treatment of localized and locally advanced, high-risk PCa in developing countries have not been defined, this article will serve as a point of reference when confronted with this disease.

Consensus on Prostate Cancer Treatment of Localized Disease With Very Low, Low, and Intermediate Risk: A Report From the First Prostate Cancer Consensus Conference for Developing Countries (PCCCDC).

PURPOSE: A group of international urology and medical oncology experts developed and completed a survey on prostate cancer (PCa) in developing countries. The results are reviewed and summarized, and recommendations on consensus statements for very low-, low-, and intermediate-risk PCa focused on developing countries were developed. METHODS: A panel of experts developed more than 300 survey questions of which 66 questions concern the principal areas of interest of this paper: very low, low, and intermediate risk of PCa in developing countries. A larger panel of 99 international multidisciplinary cancer experts voted on these questions to create the recommendations for treatment and follow-up for very low-, low-, and intermediate-risk PCa in areas of limited resources discussed in this manuscript. RESULTS: The panel voted publicly but anonymously on the predefined questions. Each question was deemed consensus if 75% or more of the full panel had selected a particular answer. These answers are based on panelist opinion not a literature review or meta-analysis. For questions that refer to an area of limited resources, the recommendations consider cost-effectiveness and the possible therapies with easier and greater access. Each question had five to seven relevant answers including two nonanswers. The results were tabulated in real time. CONCLUSION: The voting results and recommendations presented in this document can be used by physicians to support management for very low, low, and intermediate risk of PCa in areas of limited resources. Individual clinical decision making should be supported by available data; however, as guidelines for treatment for very low, low, and intermediate risk of PCa in developing countries have not been developed, this document will serve as a point of reference when confronted with this disease.

Comparison between Oncotype DX test and standard prognostic criteria in estrogen receptor positive early-stage breast cancer.

OBJECTIVE: To compare the prognosis estimated by standard prognostic criteria versus the prognosis estimated by the Oncotype DX. METHODS: A retrospective study was performed on 22 patients with positive estrogen receptor, early-stage breast cancer who had an Oncotype DX recurrence score available. RESULTS: Kappa value between Oncotype DX and standard prognostic criteria was: Adjuvant! (K = 0.091), Adjuvant! (Transbig) (K = 0.182) and National Comprehensive Cancer Network (K = 0.091). The Fisher's exact test did not show correlation between Oncotype and standard prognostic criteria. CONCLUSION: Standard prognostic criteria showed no correlation with Oncotype DX.

Comparação entre o teste Oncotype DX e critérios prognósticos padronizados em câncer de mama receptor de estrogênio positivo em estágio inicial / Comparison between Oncotype DX test and standard prognostic criteria in estrogen receptor positive early-stage breast cancer

Objective: To compare the prognosis estimated by standard prognostic criteria versus the prognosis estimated by the Oncotype DX. Methods: A retrospective study was performed on 22 patients with positive estrogen receptor, early-stage breast cancer who had an Oncotype DX recurrence score available. Results: Kappa value between Oncotype DX and standard prognostic criteria was: Adjuvant! (K = 0.091), Adjuvant! (Transbig) (K = 0.182) and National Comprehensive Cancer Network (K = 0.091). The Fisher's exact test did not show correlation between Oncotype and standard prognostic criteria. Conclusion: Standard prognostic criteria showed no correlation with Oncotype DX.

Objetivo: Comparar o prognóstico estimado por critérios prognósticos padronizados e o prognóstico estimado pelo Oncotype DX. Métodos: Foi realizado um estudo retrospectivo envolvendo 22 pacientes com receptor de estrogênio positivo, portadoras de câncer de mama em estágio inicial que possuíam uma pontuação disponível avaliada pelo teste Oncotype DX. Resultados: O valor Kappa entre o teste Oncotype DX e os critérios prognósticos padrão foi: Adjuvant! (K = 0,091), Adjuvant! (Transbig) (K = 0,182) e National Comprehensive Cancer Network (K = 0,091). O teste exato de Fisher não mostrou correlação entre Oncotype DX e os critérios prognósticos padronizados. Conclusão: Os critérios prognósticos padronizados não mostraram correlação com o teste Oncotype DX.