Trabalhos Científicos

INTRODUCTION: Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide. Lesions caused by some HPV subtypes increase the likelihood of cervical neoplasia. In 2023, the forecast was for 17,010 new cases, representing a rate of 13.25 cases per 100,000 Brazilian women. This article proposes a review of the literature and the collection of statistical data from the Datasus System (Department of Informatics of the Unified Health System) to perform an epidemiological analysis of HPV-induced lesions after the ten-year anniversary of the implementation of the quadrivalent vaccine in primary care. METHODOLOGY: The study is classified as a retrospective ecological study and employs a time-series and census approach, covering the period between 2013 and 2024. Quantitative variables were tabulated and presented as absolute data; when necessary, percentages were also calculated using the same program. Additionally, a non-systematic literature review was conducted to investigate the effects of HPV vaccination in Brazil and other countries. RESULTS: The results show that HPV vaccination has reduced genital warts by 90%. Another point observed from the collected data was a significant increase in cervical lesion screening in Brazil; the number of cytopathological exams performed increased by 5663% between 2013 and 2023. This increase was accompanied by a rise in the detection of adenocarcinoma in situ and high-grade pre-neoplastic lesions. However, since the vaccinated population has not yet reached the peak age for incidence (i.e., between 30 and 50 years), the full impact of the vaccination is not yet entirely visible. Additionally, a meta-analysis of seven studies conducted worldwide on the prevalence of HPV found a 68% reduction in HPV types 16 and 18 infections in countries with at least 50% vaccination coverage. CONCLUSION: HPV vaccination has demonstrated a significant reduction in infections with types 16 and 18, with a decrease in cervical lesions in countries with high vaccination coverage. In Brazil, the increase in the number of cytopathological exams reflects greater screening and detection of early lesions, although a complete assessment of the impact of vaccination on cervical lesions still requires more time and additional studies.

Early-stage patients with non-small cell lung cancer (NSCLC) are mostly eligible for curative treaments, including both surgery and adjuvant chemotherapy. However, not all patients benefit from adjuvant treatment. Currently, there are no specific criteria to define who will benefit from adjuvant chemotherapy (ACT). We aimed to assess the prognostic and predictive potential of a 12-gene expression panel for ACT benefit in patients with surgically resected NSCLC patients. This is a retrospective multicentric study that included resectable NSCLC cases from different centers (n=209). Tumor RNA was isolated from routinelly collected samples (FFPE). From 100ng of RNA, gene expression of the 12 genes (ATP8A1, AURKA, C1orf116, COL4A3, DOCK9, HOPX, HSD17B6, IFT57, MBIP, NKX2-1, RRM2, and TTC37) was assessed using the Custom nCounter® Elements XT panel. Raw counts were normalized by 7 housekeeping genes, and superpc survival-based model was applied to predict prognosis and ACT benefit. Results: Patients were stratified into two groups: high-risk (unfavorable prognosis; ACT benefit), and low-risk (favorable prognosis; ACT non-benefit). Cases classified as high-risk presented decreased overall (HR=4.16; CI=2.06-8.43; p<0.001) and event-free survival (HR=3.40; CI=1.88-6.16; p<0.001) compared with those classified as low-risk. High-risk patients who received ACT showed increased event-free survival (HR=1.98; CI=1.02-3.84; p=0.04) compared with those high-risk who did not receive ACT. Low-risk patients who received ACT and those who did not received ACT exhibited similar survival rates – overall and event-free survival (p=0.88 and p=0.3, respectively). Conclusion: The 12-gene expression panel succesfully stratified NSCLC patients with distintive outcomes and shows a promising predictive value for identifying high-risk patients who will benefit from ACT. Our 12-gene panel might be a promising predictive tool for guiding adjuvant treatment in resectable NSCLC cases.

The Department of Oncogenetics at AC Camargo Cancer Center is the oldest oncogenetics service in Brazil. It officially began its activities in November 1999, offering integrative care that includes risk assessment and genetic counseling provided by a multidisciplinary team of clinical oncologists, clinical geneticists, nurses, and biomedical professionals. The main research focuses include Hereditary Breast and Ovarian Cancer Syndromes (HBOC), Li-Fraumeni Syndrome, Lynch Syndrome, von Hippel-Lindau (VHL), and Neurofibromatosis type 1, among others. For 14 years, consultation information was considered confidential, and genetic information was safeguarded and protected in OG files attached to physical medical records, remaining under the care of the hospital archive to this day. Recently, over 5,000 OG files up to 2014 were digitized, and the Family files were reviewed to historically characterize the evolution of care and oncogenetic investigation, which was still limited to genes of interest in specific research projects at the time. Today, the Department of Oncogenetics consists of six oncogenetic physicians who work directly in the Reference Centers at AC Camargo, with over 7,000 consultations per year. During its 25 years of existence, AC Camargo's OG has promoted the training of doctors and nurses who are now leading figures in oncogenetics in Brazil and continues to be the country's largest reference in OG, disseminating knowledge to over 100 residents and interns who attend clinics at AC Camargo units throughout the year. The review of the Department of Oncogenetics' archives has historical academic relevance and is of great strategic value for policies concerning high-risk populations, considering the oncological outcomes of this population to date.

Introduction: Targeted therapies have transformed lung cancer treatment, markedly enhancing overall survival rates. Gene fusions involving ALK, RET, ROS1, and NTRK1,2, and 3, as well as METex∆14 alterations, have proven to be effective therapeutic targets. However, there is a paucity of data on these genetic alterations in admixed populations, such as those in Brazil. Aim: We aimed to evaluate the frequency and clinical impact of gene fusions and METex∆14 in Brazilian lung cancer patients. Methodology: We evaluated 414 patients diagnosed with lung cancer at Barretos Cancer Hospital between 2022 and 2023. Gene fusions (ALK, RET, ROS1, NTRK1,2 and 3) and METex∆14 alterations were assessed using RNA-based methodologies, including nCounter, Idylla, and Next-Generation Sequencing (NGS). Statistical analyses were conducted to evaluate the associations of the molecular profile with PDL-1 expression and survival outcomes. Results: Among the 414 patients, 61.4% were from the Southeast region, the median age of diagnosis was 64 years, most of them were male (56.5%), former or current smokers (72.7%), diagnosed with lung adenocarcinoma (73.9%), and had advanced disease (64.3%). The median overall survival for all patients was 13.7 months (10.6 – 16.7). Overall, fusions were present in 12.0% (52/414) of patients, with ALK the most frequent alterated gene in 9.6% (39/414) of cases, followed by RET, 1.4% (6/414), ROS1, 1.2% (5/414), and NTRK1,2,3, 0.5% (2/414). Alteration of METex∆14 was found in 3.9% (16/414). All alterations were mutually exclusive. The presence of gene fusions was associated with younger patients (p<0.0001), never-smokers (p<0.0001), adenocarcinomas (p=0.005), and PD-L1 expression (p=0.004). We observed that METex∆14 (3.9%; 16/414) was associated with older patients (p=0.014), never-smokers (p=0.010), and high PD-L1 expression (p<0.0001). Importantly, 40% (21/52) of patients harboring fusions were treated with Tyrosine Kinase Inhibitors (TKIs) and showed better 5-year overall survival than those not treated with TKIs (p<0.0001; median not reached and 7.6 months, respectively). Conclusion: Gene fusions and METex∆14 alterations are present in approximately 16% of Brazilian NSCLC patients. Treatment with TKIs showed significantly better overall survival in patients with fusions, underscoring the need for molecular testing to guide patient’s treatment.

Introduction: Patient Journey Maps are an emerging concept that visually maps the patients’ care path as they navigate the care continuum. This approach, when combined with Process Mining techniques, can early reveal bottlenecks in the patient’s treatment flow, which can be very useful for patient navigation management and for optimization of care services in an oncology center. The goal of this study is to present a patient journey system based on process mining able to identify bottlenecks in the treatment workflow, aiming to improve the patient’s care path. Methods: A Patient journey system embedded with process mining was deployed in a private oncology center. The system allows the evaluation of the patient's journey on two levels: their path throughout the care continuum (activities) and their workflow tasks within the oncology center to receiving care services. Patient journeys from 2022 to 2024 were analyzed, which includes 2906 cases. Two kinds of delays were assessed: the time elapsed between the patient's initial evaluation and the beginning of treatment (level 1), and the waiting time to start the care workflow tasks, since the patient registration (level 2). The system uses a traffic light chart to show bottlenecks, whose limit target times were set at 30 days for the beginning of treatment and 30 minutes for waiting time of a care task. Results: Considering the time of beginning the treatment, the average is 32.78 days, where 69.27% of patients start before 30 days, 11.82% between 30 and 45, and 6.38% after 90. The average time for the most prevalent cancers, respectively breast and prostate, is 27.1 and 33.2 days. The system also pointed out variations according to different health insurances; 54.12 days for the longest, and 22.3 for the shortest. Regarding the workflow care tasks, the average waiting times measured were 22.71, 17.19 and 20.84 minutes, respectively, for Encounters, Chemo, and Radio. Encounter was the task with the highest percentage of bottlenecks: 31.26%, where 60.03% of those occurring in the morning shift. There is also a variation according to the day of the week; Monday has the highest occurrence (34.88%) while Thursday has the lowest (27.61%). Conclusions: Results show that process mining can be applied in a patient journey system to identify bottlenecks in the treatment workflow. Thus, this system can provide useful information for improving the patients' care path in an oncology center.

Background: Systemic treatment is recommended for patients with unresectable hepatocellular carcinoma (HCC), but outcomes vary according to baseline features. As the treatment of HCC evolves with the incorporation of immunotherapy (IT), prognostic evaluation gains relevance for clinical counseling and risk stratification in clinical trials. We aim to describe the prognostic role of a score based on parameters used in the daily routine. Methods: Clinical and laboratorial data from patients treated between 2009-2024 were evaluated, divided into first-line sorafenib-(SOR)cohort and IT-cohort, according to the treatment received. Survival was estimated using the Kaplan-Meier method and hazard ratios (HR) were estimated using a Cox regression model. A score based on baseline ALBI grade, neutrophil-to-lymphocyte ratio (NLR) and alpha-fetoprotein (AFP) was tested in the SOR-cohort and validated in the IT-cohort. Results: We evaluated 440 patients in the SOR-cohort and 32 patients in the IT-cohort. Median age was 63 years, 73.4% were male, 83.8% were Child-Pugh A and 72.5% were BCLC-C. The following factors were independently associated with worse survival in the SOR-cohort: AFP ≥ 200 ng/ml (p<0.01), ALBI score ≥ 2 (p<0.01) and NLR ≥3 (p<0.01). Patients were assigned 1 point for each factor. Survival was longer for patients with 0-1 point, intermediate for 2 points and worse for 3 points, both in SOR- and IT-cohorts (Table). The score based on AFP, NLR and ALBI was able to significantly distinguish the outcomes of patients with 0-1 vs 2-3 points in SOR-cohort (HR 2.2; 95%CI 1.8-2.7; p<0.01) and IT-cohort (HR 2.2; 95%CI 1.1-4.9; p 0.04). Conclusion: A score with routine clinical parameters can predict outcomes of HCC patients, irrespective of the type of systemic treatment. Identifying prognostic factors can support the rationale for exploring a risk-based allocation and optimize decision making.

Neuroendocrine tumors can be found in different locations with specific presentations. Although these tumors are rare, their occurrence has significantly increased and advanced therapeutic approaches are essential for improving patient outcomes.This study aims to explore and analyze the latest treatment approaches for neuroendocrine tumors, focusing on advanced diagnostic methods to improve quality of life.A narrative review was conducted using scientific articles published between 2016 and 2024, indexed in Medline via PubMed to answer the clinical question: “In patients diagnosed with neuroendocrine tumors, how do advanced and personalized therapeutic approaches compare to conventional treatments in terms of clinical outcomes, survival rates, and significant therapeutic efficacy?”. Comparing imaging methods, Ga-DOTATATE was found to have higher sensitivity than indium-111 pentetreotide, planar imaging or planar imaging plus SPECT. For treatment, capecitabine/temozolomide extended a median progression-free survival from 14.4 months for temozolomide to 22.7 months, with a median overall survival of 53.8 months for temozolomide and 58.8 months for capecitabine/temozolomide. Lu-DOTATATE is a theranostic practice, demonstrating tumor regression, symptom relief, increased progression-free survival in patients with advanced-stage disease and a reduction in hormone hypersecretion. Additionally, Hsp90 protein inhibitors and an Aurora kinase inhibitor, ZM447439, were shown to inhibit NET cell proliferation. In breast cancer, CXCR2 inhibitors prevent neutrophil mobilization, which are able to create extracellular traps and acquire the ability to regulate tumor progression, improving the efficacy of chemotherapy particularly in the metastatic disease. New diagnostic and therapeutic techniques for NET’s show superior outcomes. Lu-DOTATATE therapy has proven to be highly effective. The combination of therapies has proven effective in cases involving Ga-DOTATATE PET/CT paired with FDG PET/CT for diagnosis, and Capecitabine plus Temozolomide for medical treatment. Somatostatin analogs are potential antiproliferative agents and can induce sustained stabilization in grade 1–2 NET’s. Radiopharmaceuticals hold both diagnostic and therapeutic potential. Strategies such as passive targeting, active targeting, and stimulus-responsive delivery systems have proven to be safe. Conversely, dual-targeting therapy demonstrated increased toxicity and side effects.

INTRODUCTION: Daratumumab is a monoclonal antibody used in the treatment of multiple myeloma, which binds to CD38 proteins, causing the death of cancer cells. It can be used alone or in combination with bortezomib, lenalidomide, or dexamethasone, and its administration can be subcutaneous or intravenous. Despite being a modern and revolutionary treatment, infusion-related reactions have been reported in approximately half of all patients receiving this therapy, mostly during the first infusion and generally of mild to moderate severity. Studies suggest that common symptoms may include respiratory symptoms such as nasal congestion, cough, and throat irritation, as well as chills, vomiting, and nausea. Therefore, administration in escalated doses is used to avoid such side effects. OBJECTIVE: To describe the adverse effects related to the infusion reactions of intravenous daratumumab and the measures taken in a chemotherapy outpatient clinic in the Zona da Mata region of Minas Gerais, Brazil. METHOD: This is a quantitative, retrospective, observational, and descriptive cohort study of patients exposed to intravenous daratumumab in 2023 in a chemotherapy outpatient clinic. The study was single-center and involved the analysis of medical records and reports generated for adverse events. RESULTS: Fifteen people participated in this study, eight men and seven women, with an average age of 65 years. Of these patients, nine received their first infusion in 2023, and six had subsequent sessions, totaling 204 infusions throughout the year. Four patients (44%) experienced adverse reactions, all of mild to moderate severity, during the first infusion. Reported reactions included nasal congestion (25%), tremors (25%), throat itching (12.5%), cough (12.5%), headache (12.5%), facial flushing (12.5%), and limb stiffness (12.5%). None of the patients needed to pause treatment due to these reactions, and they were treated at the time of the reaction with hydrocortisone following medical evaluation. CONCLUSION: The study corroborates existing literature and highlights the need for continuous monitoring of daratumumab infusions, particularly in first-time patients. Moreover, the creation of a protocol for adverse reactions to chemotherapeutic agents ensures that the entire team can promptly attend to the patient, ensuring safety, prognosis, and quality of treatment.

Introduction: Vaccination against Human Papillomavirus (HPV) is an essential strategy recommended by the World Health Organization (WHO) to prevent cervical cancer and other neoplasms associated with the virus. The WHO recommends prioritizing vaccination for girls aged 9 to 14 years, before they become sexually active, due to its proven efficacy in reducing the risk of infection. In Brazil, the vaccine was introduced in 2014, but vaccination coverage remains low, reflecting challenges in implementation. Objective: The objective of this article is to analyze the efficacy of HPV vaccination and its adherence in Brazil to prevent cervical cancer. Methods: This study is based on a systematic review involving the investigation of retrospective data on the number of HPV vaccine doses administered, comparing vaccine adherence with databases of reported cases of HPV-related cancer, with a particular focus on cervical cancer. Data were collected from the Vaccination Panel of the Brazilian Ministry of Health (MS) and WHO databases, followed by an analytical examination of the correlations found in other studies. Results: A survey conducted on the MS portal evaluated the percentage of the population vaccinated against HPV. The data showed that in 2022, approximately 75.8% of adolescent females were vaccinated against HPV, representing a decrease of just over 11% compared to the previous survey conducted by the Unified Health System (SUS) in 2019, when the percentage of vaccinated girls was about 87.1%. Additionally, according to the MS, HPV infection affects at least 54% of the female population and 41% of the male population who have initiated sexual activity. Moreover, according to the Pan American Health Organization, in 2018 alone, around 311,000 deaths due to complications from cervical cancer were recorded in low- and middle-income countries, where there is a low incidence of HPV vaccination. Conclusion: Based on the systematic review, low adherence to the HPV vaccine in Brazil compromises the effectiveness of the preventive strategy against cervical cancer. The link between insufficient vaccination coverage and persistent high incidence rates highlights the need for stronger public health policies, educational campaigns, and greater accessibility to vaccination. National studies, such as those by Malta et al. and Silva et al., underscore the urgency of integrated actions to increase adherence, reducing morbidity and mortality associated with HPV.

Introduction: Malignant brain neoplasms are a group of central nervous system tumors, the most common solid tumors in children and adolescents. Due to the complexity of the disease, pediatric brain neoplasm hospitalizations often involve emergencies and extended hospital stays. Objective: To describe the epidemiological characteristics of pediatric hospitalizations for malignant brain neoplasms in the Brazilian Northeast region from 2019 to 2023. Methods: This cross-sectional, quantitative, descriptive study evaluates pediatric hospitalizations for malignant brain neoplasms in the Northeast region between January 2019 and December 2023. Data was collected using the Informatics Department of the Brazilian Unified Health System (DATASUS), through the TABNET tool. Information was collected regarding hospital admissions, deaths, and average hospital stay, and the selected variables were “Federative Unit,” “Year of Service,” “Type of Service,” “Age Group,” “Race/Ethnicity,” and “Gender”. The selected data were evaluated using Microsoft Excel software, using the statistical data analysis tool. Results: From 2019 to 2023, there were 3,991 hospitalizations for malignant brain neoplasms in the Northeast, accounting for 26.7% of the national total. Bahia had the highest number, with 995 hospitalizations (24%), while Maranhão had the lowest, with 220 (5.5%). The annual average was 798 hospitalizations, with 2022 being the peak year, with 937 cases. The most affected age group was 5 to 9 years (39.3%), while those under 1 year were the least affected (2.3%). Males accounted for 54.4% of the hospitalizations, and 77.3% were emergency cases. The most common race/skin color was brown, while yellow was the least affected. The average length of stay was 7.2 days, varying significantly by federation unit and type of care, with Ceará, Sergipe, and Rio Grande do Norte showing atypical averages of 13.5, 12.3, and 2.2 days, respectively. Indigenous race/skin color had a longer average stay at 19.5 days. There was a strong correlation between hospitalization numbers and deaths. Conclusion: The results show a prominence of the Northeast region in the national scenario of brain neoplasms in children, which reinforces the need of a preparation, from the health system, to diagnose and manage those cases. The findings also highlight regional and racial disparities, indicating a need for further studies to ensure equity in care.

INTRODUCTION: Based on the incorporation of technologies and studies aimed at breast cancer over the years, it is now possible to identify several subtypes of the disease, which end up influencing the treatment and prognosis of patients. Among these subtypes, the immunohistochemical composition of the triple negative (TN), due to the absence of hormone and HER2 receptors, is a challenge because it has fewer therapeutic targets, in addition to a differentiated natural history and epidemiology. METHODS: The study is observational, cross-sectional, and retrospective, conducted at the Napoleão Laureano Hospital in João Pessoa, Paraíba. The sample consisted of breast cancer patients treated between 2015 and 2020, selected non-probabilistically. Data collected include age, cancer history, tumor markers, and clinical staging. Statistical analysis used non-parametric tests and regression models to assess associations between histological subtypes and clinical factors. RESULTS: 220 patients attended from 2015 to 2020 at the Napoleão Laureano hospital, in Paraíba, were included for the analysis of anatomopathological and epidemiological characteristics. Among them, 25 had the TN subtype. The variables age, KI-67 expression, family history of cancer, lymphocytic tumor infiltrate (TIL) and clinical staging were used to compare the subtype in relation to the others, the latter being divided into stages I and II or III and IV. For the analysis of age at diagnosis, the non-parametric Kruskal-Wallis test was used to compare the mean ranks between the subtypes, with a statistically significant difference (p<0.05) between the TN subtype for older ages. As for the other variables, no differences were observed between the subtypes based on the Odds Ratio analysis and the logistic regression model for risk factors, except for the expression of KI-67, which is higher in the TN subtype compared to the luminal subtypes, which may indicate greater cell proliferation. CONCLUSION: Data collection was affected by the pandemic and issues with physical records. The study found that breast cancer heterogeneity depends on a combination of factors, not isolated ones. Larger studies should be undertaken to better stratify the profile of the neoplasm that most affects women worldwide, especially with the worst prognosis subtype, the triple negative.

von Hippel-Lindau (VHL) syndrome is caused by pathogenic germline variants in the VHL gene, predisposing individuals to retinal and CNS angiomas, renal cancer, neuroendocrine tumors, and other neoplasms. Recently, the HIF2A inhibitor Belzutifan has shown efficacy in treating all tumors associated with VHL. A real-world clinical study on the use of Belzutifan in VHL was recently approved by the institutional ethics committee, and 35 VHL patients with different tumors have been included since October 2023. This subproject aims to assess the main adverse effects of the drug, such as anemia, fatigue, and others. To this end, we have collected baseline (pre-treatment) variables from laboratory tests, such as complete blood counts and plasma erythropoietin (EPO) levels, and we will followed the results monthly for up to 6 months of treatment. Preliminary results indicate that all participants developed grade 1-2 anemia, with fatigue and headache being the primary adverse effects (grade 1-2). In five participants with symptomatic anemia or a significant hemoglobin drop in the first 2 months of treatment, subcutaneous (SC) EPO was supplemented efficiently, with prompt recovery. In conclusion, although guidelines for EPO supplementation are not yet defined, we observed that an initial dose of 4,000 IU per week SC was effective for prompt recovery of acute symptoms and improvement of hemoglobin levels in all cases. Maintenance EPO supplementation is still under discussion in our cohort.

Introduction: Invasive cutaneous melanoma is a malignant neoplasm with heterogeneous characteristics, exhibiting different clinical and biological behaviors. Objective: To analyze the association of classical histopathological risk factors (Clark, Breslow, ulceration, lymphocytic infiltration, and number of mitoses/mm²) with the occurrence of death in patients with invasive melanoma. Method: This is an excerpt from a retrospective cohort study consisting of 221 participants treated at the oncology service (COC Erechim, RS) from 2000 to 2023. Data were obtained from medical records. Inclusion in the cohort was based on the date of the confirmatory histopathological examination of melanoma, with censures being the date of death or the last recorded follow-up date in the medical records. The median follow-up of the cohort was over 13 years. To analyze the association between prognostic variables and the outcome of death, specific hazard ratios were calculated, and statistical significances were determined using the Cox Proportional Hazards method. The research was approved by the Ethics Committee of the Regional Integrated University (URI - Erechim Campus) under CAAE 6.136.573. Results: The median age of the cohort participants was 54 years, with 51.1% women and 48.9% men. There were 27 deaths during the follow-up period. The prognostic variables of interest were analyzed concerning their association with the occurrence of death. The analysis of the lymphocytic infiltration variable did not show statistical significance in the studied relationship. The variables: Clark IV (HR 44.96 (6.01-336.26) p<0.001); Clark V (HR 54.60 (6.71-443.86) p<0.001), Breslow index of 2.26-3.0mm (HR 48.28 (5.80-401.80) p<0.001); Breslow index >3.0mm (HR 62.24 (8.21-472.05) p<0.001), and the number of mitoses above 5/mm² (HR 14.03 (2.34-84.25)) were identified as independent markers of poor prognosis. Conclusions: The Clark classification, Breslow index, analysis of ulceration in the primary lesion, and the number of mitoses by histological analysis are important predictive risk factors related to death in individuals with invasive cutaneous melanoma.

Introduction: The estimated number of new breast cancer cases in Brazil for each year of the 2023 to 2025 triennium is 73,610. The aging global population has led to an increase in breast cancer cases among the elderly. However, this age group is less likely to receive standard oncological treatment with appropriate protocols, affecting survival rates. Study End Points and Trial Design: This is a retrospective cohort study, designed from the records of 1,160 breast cancer patients aged 75 years or older undergoing treatment for early-stage breast cancer, treated between January 2018 and January 2021 at the Brazilian Institute of Cancer Control (IBCC). The aim of the study was to identify the frequency at which standard adjuvant chemotherapy was administered at this oncological reference center, assess the safety profile. Considering the variables: age at diagnosis, immunohistochemistry, histological grade, and clinical stage, the propensity score matching method made it possible to form pairs with similar characteristics between the chemotherapy (QT) and non-chemotherapy (non-QT) groups and determine the association with disease-free survival and overall survival. Results: A total of 162 patients were eligible and divided into two groups: adjuvant chemotherapy (n=47) and no adjuvant chemotherapy (n=115). The frequency of adjuvant chemotherapy indication was 29%. The preferred regimen was Docetaxel and Cyclophosphamide (TC) in 36.2% of cases. The safety profile was acceptable, with grade 3 and 4 toxicity (Common Terminology Criteria for Adverse Events): hematological toxicity in 6.4%, peripheral neuropathy in 4.9%, no reports of anthracycline-related cardiotoxicity, hospitalization in 8.5%, and no deaths related to adjuvant therapy. After using propensity score matching, 29 balanced pairs were formed, and no association was found between the use of adjuvant chemotherapy and disease-free survival (HR 1; 95% CI 0.25-3.99; p=0.97) or overall survival (HR 0.23; 95% CI 0.03-2.07; p=0.19). Conclusion: The study demonstrates the importance of understanding the profile of elderly breast cancer patients for accurate indication of adjuvant chemotherapy. Additionally, it confirmed with real-world data an acceptable safety profile for standard-of-care protocols. Studies with larger sample sizes and prospective designs may address this gap in the literature: the impact of adjuvant chemotherapy on survival in the elderly population.

Introduction: The standard treatment for clinical stage III colon cancer is surgical treatment followed by adjuvant chemotherapy. There are several treatment regimens based on fluoropyrimidines and oxaliplatin and many patients are unable to complete adjuvant therapy. Objective: evaluate the adjuvant treatment of patients, oncological journey, patients clinical profile, adverse events, treatment toxicities and estimate overall survival (OS) and progression-free survival (PSF) Method: retrospective, observational, unicentric study, with analysis of medical records of patients diagnosed with adenocarcinoma of the colon, rectosigmoid or proximal rectum treated with surgery and adjuvant chemotherapy. Result: Between 2016 and 2021, 167 patients were evaluated with a median age at diagnosis of 59 years, most of them women (52%), median Charlson 3, 59% with low-risk tumors (74% T3 and 69% N1). Regarding the surgical journey, 49% of patients were treated with emergency surgery. The median time between diagnosis and surgery was 16 days and a median of 22 lymph nodes resected. All patients received adjuvant treatment. The median time to start adjuvant therapy was 10 weeks. The most used chemotherapy regimen was CAPOX (Capecitabine and Oxaliplatin) in 65% of cases. Between these patients, 10% discontinued and 73% completed adjuvant treatment. Among those who did not complete the treatment, 65% were due to toxicity and 10% due to disease progression. Among all patients, 24% required dose reduction, with the main toxicity being gastrointestinal (37%) and hematological (32%). Only 7.8% of patients were hospitalized because of treatment complications - main cause was diarrhea (69%) and dehydration (23%). The median follow-up was 46 months. The 5-year overall survival rate was 81.2% and the 5-year progression-free survival rate was 68.1%. Multivariate Cox regression analysis showed that emergency surgery (HR1.81 [CI 0.95-4.43] - p 0.07) and high-risk (HR 1.57 [0.87-2.83] - p 0.01) had a significant impact in OS and PFS. Conclusion: the most part of the population affected by stage III colorrectal adenocarcinoma in this study was young, healthy and had low-risk tumors. There was a high number of emergency surgeries, all of which underwent adjuvant surgery, but with a longer period until adjuvant treatment than recommended. Emergency surgery and high-risk factors had a greater impact on OS and PFS. ​​

Introduction: Pharmacovigilance is crucial for monitoring and preventing adverse drug reactions (ADRs), particularly in oncology, where the therapeutic index is narrow. This study examines the profile of ADRs reported to the Brazilian Health Regulatory Agency (ANVISA) from a private oncology clinic in Salvador, Bahia, during the 2019-2021 triennium. Objective: To analyze the profile of ADR notifications related to oncological treatments in a private clinic in Salvador, focusing on the frequency, severity, causality, age distribution, and the most implicated treatment protocols. Methodology: This retrospective cross-sectional study utilized internal pharmacovigilance data from a single database. Institutional criteria based on ANVISA/SOBRAFO recommendations were applied, with adjustments according to the clinic's protocols. The study was approved by the Research Ethics Committee of Fundação Bahiana de Cardiologia (CAAE: 55159522.1.0000.5027). Data collection included all parenteral oncological protocols for patients of all age groups and both genders, excluding oral chemotherapy due to traceability issues. Results: A total of 10,829 parenteral chemotherapy sessions were conducted, resulting in 441 ADRs reported in 205 patients. Most patients were female (75.6%). The most frequently reported ADRs were hematological, including neutropenia (47.6%), anemia (15.2%), and thrombocytopenia (6.3%). Gastrointestinal toxicities were also common, with diarrhea (5.0%), nausea (2.0%), and mucositis (1.1%) being reported. The causality assessment classified 68.9% of the ADRs as probable, 18.3% as possible, and 12.0% as definite. ADR severity was predominantly Grade 3 (74.6%) and Grade 4 (16.3%). Regarding age distribution, most ADRs were reported in patients aged 60-79 years, with a smaller proportion in patients aged 80 and above. The treatment protocols most frequently associated with ADRs were Paclitaxel (12.2%), Paclitaxel + Carboplatin (9.9%), and Cisplatin + Gemcitabine (8.4%). Conclusion: The ADR profile in this study is consistent with existing literature, with hematological toxicities being the most common. The findings highlight the importance of robust pharmacovigilance systems in oncology to enhance patient safety and inform therapeutic decisions, particularly for older patient populations and commonly used protocols like Paclitaxel and its combinations.

Background: Immunotherapy (IO) plus chemotherapy (CT) followed by IO has emerged as a new standard first-line treatment for primary advanced or recurrent endometrial cancer (EC) with an unprecedent benefit for deficient DNA mismatch repair (dMMR) patients (pts) and a smaller magnitude of benefit for mismatch repair–proficient (pMMR) disease. We conducted an extracted individual patient data (eIPD) meta-analysis to illustrate the survival curves and provide insights into this new standard. Methods: We searched PubMed, Embase, Cochrane, and oncology meetings up to April 2024 for randomized phase II or III trials (RCTs) investigating IO plus CT as first-line treatment for EC. IPD was reconstructed from reported Kaplan-Meier plots through WebPlotDigitizer and the R package IPDfromKM and then combined. Additionally, we conducted a trial-level meta-analysis using fixed and random effects models. Results: Five RCTs were included (NRG-GY018, RUBY, MITO END-3, AtTEnd/ENGOT-en7, DUO-E). 2436 patients were analyzed for progression-free survival (PFS) and 2317 patients for overall survival (OS). The eIPD underscored the significant benefit of adding IO in dMMR patients, with 3-year absolute gains of 36% in PFS (HR 0.36, 95% CI 0.28-0.45) and 28% in OS (HR 0.41, 95% CI 0.30-0.48) with survival curves showing early separation from treatment initiation, reaching a plateau around 12 months, suggesting sustained benefit. For pMMR, a smaller benefit was observed in PFS, with a 3-year absolute gain of 6% (HR 0.78, 95% CI 0.69-0.88). No difference was observed in OS (HR 0.87, 95% CI 0.74-1.01), although data is immature. Notably, many PFS events occurred early in the pMMR curve, indicating numerous early progressors in both arms. A slight separation of curves began around 10 months, suggesting a subset of pMMR pts may benefit from adding IO to CT. Remarkably, there was a statistically significant benefit for PD-1 inhibitors in the pMMR subgroup (OS PD-1 pMMR: HR 0.78, 95% CI 0.62-0.96) in comparison with PD-L1 inhibitors (OS PD-L1 pMMR HR: 0.93, 95% CI 0.75−1.16). Conclusions: IO should be part of the standard of care in first-line for dMMR EC. For pMMR tumors, only a small subset of pts appears to benefit from adding IO, and longer follow-up is warranted. Molecular classification exploratory analysis may help us to identify who are the pMMR pts that benefit from IO. This analysis suggests different outcomes between PD-1 and PD-L1 inhibition for pMMR EC, favoring PD-1.

Introduction: Cancer is a disease with high worldwide incidence, and chemotherapy is one of the main oncological treatments (INCA, 2022). Oncological nursing plays a crucial role in guiding clinical practice and understanding the impact of cancer and its treatment on patients and their families. The care of oncological patients is based on the application of indicators that allow nurses to assess and improve care processes and outcomes. Objective: This study aims to investigate the causes of absenteeism in oncological patients and assess its impact on the quality of treatment and the efficiency of health services provided. Method: The research was conducted by a nursing team at an outpatient oncology clinic that serves patients with solid and hematological tumors, performing an average of 900 appointments per month. Quantitative and qualitative methods were used for data collection. The sample included patients with different types of cancer who missed at least one treatment session in the last six months. The nursing team collected data on the frequency of absences, the reasons for absenteeism, and the consequences perceived by both patients and the medical team. Results: The results indicated a variation in the percentage of absenteeism over the analyzed months, with peaks in January (18.77%) and February (14.30%). There was a downward trend until June (12.94%). The main causes identified were neutropenia, protocol changes, surgical scheduling, dental issues, and treatment suspension, among others. The increase observed in the first months was mainly attributed to flu syndromes, which impacted the patients' ability to attend treatment sessions. Conclusion: Absenteeism in oncological patients is influenced by a combination of clinical factors. Targeted interventions and improved communication between patients and the healthcare team have the potential to reduce absenteeism rates and improve clinical outcomes. The nursing team plays a central role in identifying and managing these factors, being essential for the effectiveness of interventions and the continuity of oncological treatment.

Introduction: Cancer is the second leading cause of death among children aged 1 to 14 in the United States, and the fourth most common cause of death among adolescents aged 15 to 19. By 2024, 9,620 cases of cancer are expected to be diagnosed in children and 5,290 in adolescents. It is estimated that one in every 257 children and adolescents will be diagnosed with cancer before turning 20. Objective: to analyze the epidemiological profile of childhood cancer in follow-up in the Oncology Care Network of a state in southeastern Brazil. Methods: A descriptive observational study was undertaken, based on tumor registration forms from the Hospital Cancer Registries of the Childhood Cancer Care Network of a Brazilian state between 2007 and 2020. Descriptive and bivariate analyses were conducted in the R software. Results: The number of new cases of childhood cancer was 1,459, with 468 deaths in the series studied. The average age was 7.85 years; the majority were mixed race (53.32%), in the age range of 1-4 years (29.47%) (p=0.008). Leukemia, followed by central nervous system tumors and lymphomas were the most frequent in males (p=0.006) with a significant difference between age groups, with a higher occurrence between 5 and 9 years (p=0.007). The present historical series showed a decreasing trend in the number of new cases (p<0.001). At the end of treatment, complete remission of the disease was observed in 30.57% of cases. Conclusion: Analysis of diagnostic groups by age group revealed unique patterns, with a higher prevalence of leukemia in boys and a higher occurrence of malignant bone tumors and carcinomas in adolescents aged 10-14 years, with a decreasing trend.

Introduction: Non-melanoma skin cancer (NMSC) is one of the most common tumors worldwide. The main treatment method is surgical removal; however, due to the existence of patients who are not eligible for surgery or those who refuse it, there is the option of radiation therapy (RT). Due to the evolution of the RT techniques, it is necessary to evaluate the pros and cons of other techniques, such as high-dose superficial brachytherapy (HDR). Objectives: The present study aims to understand the relationship between local control of NMSC and epidermal toxicity of patients treated with HDR. Methods:This is a retrospective cohort study in which the medical records of patients treated between 2010 and 2021. The inclusion criteria was: biopsy proven NMSC, no other previous or concomitant malignancy and treatment with HDR. Results: Based on the inclusion criteria, 136 medical records containing 206 tumors were studied. The patient profile had a median age of 81 years (32-101), 81.6% (n=111) had associated comorbidities and females were prevalent (51.5% n=70). Regarding the lesions, the basal cell histological type (67% n=138) was predominant in relation to the squamous cell type (33% n=68). Regarding the location, the face was the most affected site, presenting 76,5% (n=156) of the lesions. Comparing tumor extension, 76.8% (n=129) of the tumors had an extension of 0 to 5 mm. Most treatments had a curative purpose (82.4% n=169), while adjuvant therapies accounted for only 17.6% (n=36) of the cases and no cases of neoadjuvant therapy were recorded. The most applied regimen was a total dose of 48 Gy, in 12 sessions 3 times a week, finding a local control of 90.09% in 3 years of follow-up. Acute epidermal toxicity grade 1 (CTCAE) was present in 71,2% (n=94). Grade 4 toxicity was observed in 6,8% (n=9). Analyzing the statistical tests between toxicity and treatment characteristics, a difference was observed between radiodermatitis G1 and G2 in relation to the total dose applied (p=0.01) in which higher doses presented G2. However, this pattern does not apply to grades G3 and G4, which are not related to the total dose applied. Conclusion: Hypofractionated superficial brachytherapy used in the treatment of non-melanoma skin cancer is an effective method with excellent local control results. The associated expected skin toxicity is a controlled radiodermatitis, in general grade 1.

Introduction: Molecular profiling of non-small cell lung carcinoma (NSCLC), a leading cause of global cancer-related mortality, has significantly improved long-term clinical outcomes. However, understanding resistance mechanisms remains challenging. Mutations like MET, MDM2/4, KRAS/KEAP1, STK11, and KRAS, even in patients with EGFR and ALK genetic alterations, may contribute to resistance to immunotherapy and tyrosine kinase inhibitors (TKIs). Objective: This real-world study aims to investigate associations between resistance mutations, clinical features, and outcomes in a diverse cohort, considering population heterogeneity and socio-economic factors. Methods: This retrospective, cross-sectional study included 39 advanced NSCLC patients from a single oncology center in Belo Horizonte, Brazil. Treatment decisions were based on molecular tumor profiles following local practice. Clinical, histopathological, molecular, and treatment data were analyzed. Cox Regression Model assessed independent associations with progression-free survival (PFS) and overall survival (OS). Significance was set at p < 0.05. Results: The cohort included 39 advanced NSCLC patients (average age 64.1 years, 48% women, 52% men, 98% adenocarcinoma). Common metastasis sites were the CNS (38%) and bones (46%). Platinum-based treatment, often with immunotherapy (46.1%), was prevalent. Among patients with targetable mutations, 41.6% received TKIs upfront. Key findings included 56.4% PD-L1 positivity, 74.3% TMB < 10, 28.2% EGFR mutations, 7.6% ALK mutations, and 64.1% somatic TP53 mutations. PFS was 17.7 months, and OS was 21.6 months. Radiotherapy increased the risk of progression by 5.6 times (p = 0.01), while TMB ≥10 and unusual site metastases were linked to poor OS. TP53 mutation was associated with worse OS (1.8 times, p = 0.11) but was not independently predictive in multivariate analysis. Conclusions and Discussion: TMB ≥10 was associated with worse OS. Somatic TP53 mutations were prevalent in this cohort and linked to poorer clinical outcomes. These findings suggest a potential connection between TP53 mutations and reduced responses to TKIs, but not to immunotherapy, indicating a possible role in resistance mechanisms. Further studies with larger patient groups are ongoing to clarify these associations

INTRODUCTION: In the past decades, there has been an increase in the participation of low-middle-income countries (LMICs), including Brazil, in international multicentric oncology trials. This phenomenon led to significant advancements in LMICs, including access to better treatments. However, there has been substantial criticism of the international community regarding trials offering substandard control arms compared to the standard of care in high-income countries. Herein, we investigate the control arms of trials recruiting in Brazil. OBJECTIVE: To describe the control arm of randomized oncology trials recruiting in Brazil and to rank its appropriateness according to guidelines. METHODS: This is a cross-sectional study including randomized clinical trials recruiting in Brazil on December 4, 2023, per https://clinicaltrials.gov . Data from the studies were abstracted, including the intended number of patients, sponsor, tumor site, phase of study, and control arm. The control arm was ranked as “superior”, “equal”, or “inferior” by NCCN guidelines, supplementary healthcare (supplementary) standards in Brazil, and SUS standards by 2 independent investigators. Brazilian Health Ministry diretrizes diagnosticas e terapêuticas and the ICESP handbook were used to determine SUS standards. Data was summarized in means, medians, and proportions. Fisher’s exact test was used to compare categories. A p<0.05 was considered statistically significant. RESULTS: Ninety-eight studies were included. The median number of intended patients was 555 (54-6000). Most trials were phase 3 (84.7%) and sponsored by pharma (97%). The most frequent tumor types were lung (29.6%) and breast (24.4%). Regarding the line of treatment, 23 (23.5%), 48 (49%), and 27 (27.5%) were (neo)adjuvant, 1 st line, or 2 nd or higher, respectively. In terms of the control arms, 0 studies had its control arms superior to both NCCN or supplementary standards, while 37 (37.8%) were superior to SUS. 79 (80.6%), 81 (82.7%), 56 (57.1%), were equal and 19 (19.4%), 17 (17.3%) and 5 (5.1%), were inferior to NCCN, supplementary and SUS, respectively. Of the 19 control arms considered inferior to NCCN, 3 were ranked as superior, and 16 as equal to SUS. CONCLUSION: A significant number of studies have a control arm inferior to NCCN guidelines. However, the same controls were considered superior or equal to the standards offered in SUS. Such discrepancies may compromise the interpretation of the studies’ findings.

Introduction: Gastric cancer is the third most lethal neoplasm globally, with high incidence and mortality. In Brazil, between 2020 and 2022, 21,230 new cases were registered annually. The etiology is multifactorial, including factors such as age, family history, infections, smoking, and obesity. The gastric microbiota, especially the presence of Helicobacter pylori (HP), plays a crucial role in gastric carcinogenesis, being detected in 75% of gastric cancer cases. Objectives: To study and evaluate the profile of patients with gastric cancer and the efficacy of treatment instituted between January 2019 and December 2023. Methodology: This is a retrospective cross-sectional observational study, based on the analysis of electronic medical records of patients diagnosed with gastric cancer at HU-UFPI. Results: : 73 patients with gastric cancer were included. The median age was 62 years. Approximately 40% of the patients were female and 60% were male. Regarding staging, 63% of the patients were clinical stage IV, 24% stage III, while only 13% of the patients were stage II. In the present cohort, no patients were detected in stage I. Approximately 22% of the patients had previous Helicobacter pylori infection. Regarding the patients undergoing surgical treatment, approximately 36.7% of the patients underwent gastrectomy. Of the patients analyzed, Her-2 testing was performed in 32% of the patients, being positive in 4% of the patients analyzed. Regarding microsatellite instability testing by immunohistochemistry, 20% of the patients underwent it, being positive for instability in 6.6% of the patients analyzed. Smoking was detected in 39% of the patients and alcoholism in 42% of the cases. The median overall survival of patients was 11.2 months. Conclusion: Gastric cancer is a prevalent disease in Brazil. The main associated risk factors were smoking, alcoholism, sedentary lifestyle and previous H. pylori infection. Most patients (63% of cases) in this study were diagnosed at an advanced stage, with no patients in stage I being detected. The delay in accessing health services for testing and allowing early diagnosis may explain these findings. The median overall survival was 11.2 months, which is in line with the expected survival in patients with advanced disease.

Introduction: Prostate cancer (PC) is the second most commonly diagnosed cancer in the male population worldwide, a disease with slow and silent progression that occurs most often in the middle or late stages of life. In addition, it is a disease linked to genetic factors, as studies show that 10 to 12% of cases are associated with hereditary genetic mutations and epigenetics, which favor the growth and survival of tumor cells. Objective: To identify the genetic mutations most frequently associated with prostate cancer. Methodology: The search was conducted using the National Cancer Institute Genomic Data Commons (GDC) database, analyzing information related to the frequency of genetic mutations in 555 cases of prostate cancer. The VEP impact variants were classified as High, Low, Moderate or Modified, according to the gene evaluated. Through PolyPhen Impact, the possible impact resulting from alterations in gene structure was classified as Benign, Possibly Damaging, or Probably Damaging. Subsequently, a more specific search was performed for the 3 genes with the highest number of variants with significant impact, identifying the cancer typology and its statistics regarding the age of diagnosis. Results: 22 genes were evaluated, and of these 555 cases, there were 490 modifications. In this scenario, 3 genes had the highest number of variants with significant impact. The TP53 gene (n = 71, 12.9%) was associated with an average age at diagnosis of 60.75 years. In 25 cases, the variants, according to the VEP, had a high impact, 46 cases had moderate impact and only 14 cases were considered benign regarding the PolyPhen impact. The SPOP (n = 61, 11%) had an average age of onset of around 63 years. Thus, with 2 cases of high impact and 59 cases of moderate impact and 40 cases classified as benign. Finally, the FOXA1 gene (n=39, 7%) was identified on average at 63.2 years of age, with 7 cases considered high impact and 29 cases as moderate. Conclusion: The frequency of genetic alterations occurring among the cases evaluated was high, especially in the TP53, SPOP and FOXA1 genes. Therefore, it is important to track the presence of these mutations, so that the carriers can undergo individualized and preventive monitoring to minimize the risks of developing the disease.

Depression is the most common psychiatric disorder among oncology patients, with a prevalence ranging from 20% to 30% in this population. It affects approximately 9% of patients with breast cancer. Factors such as disease progression and symptoms are directly related to the development of depression, as well as issues related to the finitude of life. Given this context, many patients may require antidepressant medication. This therapy can be essential for the patient's overall health recovery. Given that the coadministration of chemotherapy and antidepressants is a common practice, the aim of this study was to evaluate the interactions between antidepressants and cyclin-dependent kinase inhibitors, which are drugs indicated for patients with locally advanced or metastatic cancer. Micromedex® database was used to screen these interactions. The results showed that the main interactions occurred between tricyclic antidepressants, selective serotonin reuptake inhibitors, and serotonin-norepinephrine reuptake inhibitors with ribociclib (n:15). The involved antidepressants were imipramine, desipramine, amitriptyline, doxepin, clomipramine, citalopram, escitalopram, paroxetine, sertraline, venlafaxine, and levomilnacipran. Pharmacodynamic interactions (n:12) between these classes altered the QT interval on electrocardiograms, being considered serious reactions that discourage coadministration or recommend monitoring the electrocardiogram if replacement is not feasible. Pharmacokinetic interactions (n:3) occurred due to strong inhibition of the CYP3A4 enzyme by Ribociclib, increasing the serum levels of antidepressants, and when coadministered with another strong inhibitor (nefazodone), there was an increase in serum levels of the chemotherapeutic agent. It is concluded that, aiming to maintain antidepressant therapy, the prescriber should prioritize antidepressants that do not present pharmacokinetic or pharmacodynamic interactions, such as nortriptyline, protriptyline, trimipramine, fluoxetine, duloxetine, bupropion, amoxapine, and maprotiline. If the use of other antidepressants is necessary, the electrocardiogram should be monitored or the dose of ribociclib should be reduced.