Trabalhos Científicos

Introduction: The KRAS gene is a proto-oncogene that encodes a protein involved in the RAS/MAPK signaling pathway, regulating cellular processes such as growth, proliferation, and survival. It plays a crucial role in the oncogenesis of various types of cancer, including colorectal cancer. Furthermore, colorectal cancer is the third cause of mortality worldwide between all cancers. Objective: This study aimed to analyze the frequency of mutations in KRAS gene and different subtypes of colorectal cancer. Method: This is a descriptive retrospective observational study to measure the frequency of KRAS gene mutations in colorectal cancer. We searched in the National Cancer Institute database the following search terms "KRAS gene","colorectal", and "mutation". Results: A total of 412 KRAS mutations were found in 2936 cases of colorectal cancer , 53.4% in male and 46.6% in female . Most cases (399 patients) were also tested for Simple Somatic Mutations, the most frequent mutations found were in the G12D (n=81, 20.3%), G12V (n=66, 16.5%), and G13D (n=47, 11.8%) proteins, all due a missense substitution. For the G12V mutation, 83.9% of cases were adenomas and adenocarcinomas (17.6% in the rectum, 1.5% in the rectosigmoid junction, and 80.9% in the colon); 14.8% were cysts and mucinous/serous neoplasms (16.7% in the rectum and 83.3% in the colon); and 1.2% were complex epithelial neoplasms in the colon. In G12V, 90.9% had adenomas and adenocarcinomas (16.7% in the rectum, 8.3% in the rectosigmoid junction, and 75% in the colon); 9.1% cyst and mucinous/serous neoplasm (16.7% in the rectum; 83.3% in the colon); and 1.5% neoplasm in the colon. For G13D, 89.4% of the cases were adenomas and adenocarcinomas (7.1% in the rectum, 14.3% in the rectosigmoid junction, and 78.6% in the colon); 8.5% cysts and mucinous/serous neoplasm (100% in the colon); and 2.1% neoplasm in the colon. The average lifespan for patients with the G12D, G12V, and G13D mutations were: 592, 485, and 320 days, respectively. Conclusion: The KRAS gene mutations showed a higher prevalence of adenomas, adenocarcinomas, and mucinous/serous neoplasms in the colon. G13D, although less common, showed more adenomas in the rectosigmoid junction and a worse prognosis. These variations highlight the need to consider each mutation differently in the management of colorectal cancer.

INTRODUCTION: Leukemia is the most common type of cancer in children and adolescents. Understanding its epidemiological profile is crucial for the promotion of targeted early identification measures, which are essential for better therapeutic outcomes and prognosis of the cases. OBJECTIVE: To analyze the morbidity and mortality of leukemia in pediatric patients in Brazil over the last 5 years, in order to gain a deeper understanding of the scenario and support the planning of effective interventions. METHODS: This is a cross-sectional, quantitative, and descriptive study on hospital admissions, deaths, and hospital stays related to leukemia in the pediatric age group between January 2019 and December 2023. The research was conducted using data from the Informatics Department of the Brazilian Unified Health System (DATASUS), through the TABNET tool. Information was collected regarding hospital admissions, deaths, mortality rate, and average hospital stay according to the variables: sex, race/color, age group, year, type of care, and region. RESULTS: There were 87,227 hospital admissions during the analyzed period, with an average hospital stay of 6.9 days and 1,527 deaths. Of the total admissions, 50,628 occurred in males and 36,599 in females, with a predominance of mixed-race individuals (48%). The age group with the highest percentage of hospital admissions was 1 to 4 years (36.2%), followed by 5 to 9 years (35.9%), 10 to 14 years (26.1%), and under 1 year (1.8%). When relating deaths to age, the age group with the highest number was from 10 to 14 years (33,3%), and the one with less deaths was the “under 1 year” group (5.2%). Additionally, 2022 had the highest number of admissions, with 18,117 cases (20.8%), compared to 2019, which had 1,143 admissions (1.3%). Moreover, the Southeast region led in the number of admissions, totaling 31,975, followed by the Northeast (25,944) and the South (15,715). However, among the 1,527 deaths, the Northeast exceeded the Southeast, with approximately 40% compared to 30% of the total, respectively. CONCLUSION: The research highlights the importance of focused strategies for this pathology and its most affected individuals, with a readiness of the health system for diagnosis and management of the cases, specially in the regions with a higher number of cases and deaths, in order to improve quality of life and survival rate among these children.

BACKGROUND: Immune checkpoint blockade (ICB) has changed the natural history of advanced melanoma (MA) . Different studies suggested that the elevated serum concentration of lactate dehydrogenase (LDH) was associated with poor prognosis of melanoma. OBJECTIVES: O gather real data from patients with advanced melanoma treated at a skin tumor reference center. Our objective is to evaluate the prognostic impact of elevated DHL in patients with MA treated with ICB. METHODS: We performed a retrospective observational analysis of MA patients treated with ICB at a referral center. We analyzed the impact of increasing DHL on progression-free (PFS) and overall survival (OS) using the Kaplan Meier method, log-rank test and time-dependent COX regression model. RESULTS: 170 AM patients treated with anti-PD1 (79%) or anti-PD1 + anti-CTLA4 (21%) between September 2013 and December 2019 were analyzed. Fifty-five percent in first-line, 22.4% second-line and the remaining in third or more lines of therapy. Ninety- four were male (55.3%), median age of 60.5 years (24.8 to 88.3) and 61 (35.9%) pts had BRAF mutation. Among patients in stage IV (94%), 52 (32.4%) were M1c, 36 (22.4%) M1d and 56 (33%) had elevated LDH, 45 (25.87%) with up to 2 times the upper limit of normal and 11 (7.13%) %) 2 times above the normal value. At a median follow-up of 23.6 months (95% CI: 18.0-29.1), the median PFS and OS for patients with and without elevated LDH was 3.5 x 18.8 months (p 0.001) and 7.7 months x not achieved (p 0.001), respectively. In a multivariate analysis for survival, elevated LDH was an independent adverse prognostic factor (LDH-HR: 3.87; 95% CI: 2.33-6.42; p:0.001). CONCLUSIONS: In this analysis of real-life data, the presence of elevated LDH appears to be a poor independent prognostic factor for OS and PFS in patients with advanced melanoma treated with ICB.

Introduction: Laryngo-tracheo-bronchial papillomatosis is a benign pathology that usually affects children and adolescents. It is caused by human papillomavirus (HPV) infection in the aerodigestive tract. In children, vertical transmission is the main cause and can occur during childbirth or intrauterine. Papillomas appear as single or multiple, exophytic, sessile or pedunculated nodules, usually limited to the larynx. They are usually lesions that recur frequently. Despite being a benign disease, dysplasia and malignant transformation can occur. The incidence of malignant transformation of papillomas to squamous cell carcinoma is estimated to occur in 3-7% of adults, usually in patients with previous dissemination to the tracheobronchial tree. After the malignant transformation of papillomas to squamous cell carcinoma, the usual oncological treatment for lung neoplasms is carried out according to their histological subtype, oncodrives and oncological stage. There are no reports in the literature of a different treatment for this lung neoplasm of this type of etiology. Objective: To report the experience of a patient with recurrent laryngeal papillomatosis malignancy in adulthood. Case report: GGC, 45 years old, with upper airway papillomatosis since childhood with several surgical approaches to papillomatous lesions in the upper airway. At a routine check-up, she was diagnosed on 03/05/2021 with squamous cell carcinoma (SCC) of the lung (pT1bN2-single chain 7 = stage III), treated with left lower lobectomy and mediastinal lymphadenectomy followed by adjuvant chemotherapy with carboplatin and paclitaxel (03/31/2024- 07/15/2021). During the follow-up, a suspicious contralateral nodule was observed growing and a re-biopsy was chosen. Pathological anatomy confirmed a recurrence of the disease (lung SCC) whose PDL1 analysis showed 40% on 27/07/2021. In a decision shared with the patient, who refused to undergo chemotherapy again, first-line immunotherapy with pembrolizumab alone was started, with good disease control and no signs of relapse to date. The patient is not a carrier of genetic mutations that justify the higher risk of developing neoplasms (p53 analysis 28/02/2022-VUS). Conclusion: We should advise patients with airway papillomatosis it is necessary to check with an otorhinolaryngologist and pulmonologist. This will help us to better monitor the complications of this underlying pathology, such as neoplasia or necrotizi

Introduction: Unresectable colorectal liver metastases (CRLM) still have poor outcomes despite the many treatment options available. Until recently, the most common therapeutic approach for unresectable CRLM was palliative chemotherapy, which is associated with a 5-year Overall Survival (OS) rate of less than 10%. Liver transplantation (LT) has emerged as a promising intervention for unresectable CRLM. According to the 2018 Annual Report from the European Liver Transplant Registry, over the past 15 years, LT has reached a 5-year survival of 61%. However, the efficacy of LT for unresectable CRLM remains a subject of debate. Objectives: This study aims to perform a systematic review and meta-analysis to evaluate the outcomes of using liver transplantation for patients with unresectable CRLM. Methods: We searched PubMed, Embase, and Cochrane Central for studies analyzing LT for unresectable CRLM. The outcomes of interest were overall survival (OS) and disease-free survival (DFS). We performed a Systematic Review and single-arm meta-analysis. Statistical analysis was performed using R statistical software 4.3.2. We considered as significant p values < 0.05. Results: We included 235 patients from 11 studies. The total follow-up period ranged from 7 to 168 months. The mean age of the patients undergoing liver transplant ranged from 28.7 to 73. The mean 1-, 2-, 3-, 4-, and 5-year OS was 93% (CI 0.88-0.97), 78% (CI 0.63-0.92), 68% (CI 0.59-0.76), 59% (CI 0.49-0.7) and 48% (CI 0.37-0.59), respectively. Only in the 2-years OS analysis there was a high heterogeneity (P = 0.07; I² = 55%). The mean DFS was 59% (CI 0.44-0.75), 41% (CI 0.22-0.59), 37% (CI 0.17-0.58), 21% (CI 0.11-0.31) and 21% (CI 0.11-0.31) at 1, 2, 3, 4 and 5 years. The prevalence of recurrence was 43.4% (95% CI 15.32 - 73.78). Conclusion: Our analysis showed that LT for unresectable CRLM results in higher OS and DFS compared to standard treatment with palliative chemotherapy, based on available literature. Additionally, the recurrence rate is acceptable, suggesting that LT may be a valid treatment option for patients with unresectable CRLM.

Background: Abiraterone acetate (AA) is an antiandrogen agent indicated for the treatment of metastatic castration-resistant prostate cancer, category 1, at dosage of 1,000 mg once a day. It must be taken on an empty stomach, 1 hour before or 2 hours after meals. Research highlights the possibility of an alternative dose of AA at a reduced dose (250mg per day) after low-fat eating, that suggests similar PSA control in relation to the usual dose. Objective: The primary aim was to compare, between group LOW AA (250 mg with a low-fat meal) with the STD AA dose (1,000 mg fasting), the PSA decline after 12 weeks of medication use. Secondary aims were to access progression-free survival, overall survival, PSA response rate, duration of response, safety, and quality of life. Methods: Clinical trial, randomized, conducted in the state of Rio Grande do Norte/Brazil. Enrolled participants were randomized in a 1:1 ratio to receive AA 1000 mg on an empty stomach or 250 mg with a low-fat meal (LOW). Eligible patients are over 18 years of age with CRPC, ECOG ≤1, with disease biochemical or radiological progression. Patients must have progressed on ADT and docetaxel, treated or not with local therapy (prostatectomy or local radiotherapy). Castration can be biochemical or surgical. Results: 38 patients were accrued: 18 in the STD AA arm and 20 in the LOW AA arm. Bone metastasis was reported in 88.9% and 75% of the patients in the STD AA and LOW AA arms, respectively. At 4 weeks (T1), there was a greater effect on PSA in the LOW arm (69.54) compared with the STD arm (66.02), and non-inferiority of the LOW arm was established according to predefined criteria. A significant difference was found between PSA values at T0 and T1 within the LOW group (p-value: 0.0210). There is a difference between the means at T0 and T1 in the following items of the EORTC QLQ-PR25 questionnaire: urinary symptoms, incontinence assistance, bowel symptoms, symptoms related to hormonal treatment, sexual activity, and sexual functioning; however, these differences are not statistically significant. Conclusion: The reduction in PSA observed in preliminary analysis suggests that LOW AA is promising, especially in low-resource settings where financial resources are limited. However, the data are preliminary, and the final analysis must have statistical significance with the pre-specified time points (T0, T1, T2, T3) to assess the non-inferiority of the 250 mg dose combined with a low-fat diet.

The estimated incidence of trachea, bronchus, and lung cancer in Brazil for each year of the 2023-2025 triennium corresponds to an estimated risk of 17.06 new cases per 100,000 men and 13.15 per 100,000 women. Lung cancer diagnosis is generally late, as initial symptoms are nonspecific, which contributes to the increased risk of death in this population. This study aimed to determine the histopathological profile and staging of patients with lung and pleural cancer who enter an Oncology Service of the Unified Health System (SUS) in Rio de Janeiro, as well as to estimate the percentage of deaths occurring during the evaluated period. The study included patients with histopathology and immunohistochemistry-confirmed diagnoses of lung and pleural cancer from January 2022 to September 2023. Data for all patients were recorded in Microsoft Excel spreadsheets and later analyzed for the frequency of observed variables. As of February 2024, the percentage of deaths during the period was recorded. A total of 115 patients with confirmed histopathological diagnoses of lung and pleural cancer were included in the study. The majority were female (54.8%) with an average age of 65 years. Non-small cell lung cancer was the most common histopathological type (83.5%), followed by small cell lung cancer (15.5%) and pleural mesothelioma (1%). Among non-small cell lung cancer subtypes, adenocarcinomas were the most common (63.5%), followed by squamous cell carcinomas (30.2%). For small cell lung cancer subtypes, the majority were small cell carcinomas (77.7%), with the remainder being high-grade neuroendocrine carcinomas (22.3%). Most patients entering the specialized clinical oncology service were at stage IV (67%), followed by stage III (22.6%), stage II (8.7%), and stage I (1.7%). All patients in stages I and II were alive at the time of survival assessment; however, the majority of patients with stage III (61.5%) and stage IV (64.9%) had died. The high mortality rate found in this study is a warning sign for the country's public health system. The advanced staging at which patients arrive at specialized health services significantly impacts the mortality rate, indicating the urgent need for public policies that promote prevention, facilitate the diagnosis of lung cancer, and improve access for patients with confirmed disease to specialized health services.

Lung cancer is a complex and heterogeneous disease that profoundly impacts global public health and remains the leading cause of cancer-related mortality worldwide. Understanding the epidemiological nature and temporal trends of lung cancer is crucial for effective management. Accordingly, this study aims to evaluate the temporal trends in lung cancer mortality in Brazil and its geographic regions between 2000 and 2020. Data on deaths due to malignant neoplasms of the bronchus and lung (ICD-10: C34) were analyzed using official data from the Brazilian Ministry of Health, alongside population statistics. Temporal and geographic patterns were assessed using agestandardized mortality rates and analyzed using a segmented regression model. The national mortality rate attributed to bronchus and lung cancers remained stable, with an average annual percent change (AAPC) of 0.0 (95% CI: -0.6 to 0.6) over the study period. However, significant increases were noted among women (AAPC: 1.8; 95% CI: 1.2 to 2.5) and decreases among men (AAPC: -0.9; 95% CI: -1.2 to -0.5). Regional analysis revealed heterogeneity, with declines observed in the Southeast (AAPC: -0.8; 95% CI: -1.4 to -0.2), South (AAPC: -0.8; 95% CI: -1.1 to -0.2), and Central-West (AAPC: -0.5; 95% CI: -1.1 to 0.0) regions. In contrast, increases were observed in the Northeast (AAPC: 3.2; 95% CI: 2.5 to 3.9) and North (AAPC: 0.5; 95% CI: 0.0 to 1.1) regions. The assessment of lung cancer mortality in Brazil reveals significant discrepancies between sexes and regions, highlighting the need for personalized health policies. Understanding this information can support the implementation of more effective health strategies that address the specific demands of each population group.

INTRODUCTION: Melanoma is the most lethal skin cancer worldwide and the incidence keeps increasing. It can appear in any skin area, including the eyes and mucous membranes, and is most common in areas exposed to the sun. To identify risk populations for melanoma it is needed to analyze epidemiology data, and to our knowledge, none in Paraíba, a Brazilian northeast state. OBJECTIVE: This study aims to survey epidemiology data of melanoma in the state of Paraíba. MATERIALS AND METHODS: We performed a retrospective analysis using DATASUS, the largest publicly available healthcare database in Brazil, to analyze the prevalence of melanoma. We collected data from the state of Paraíba, between 2013 and 2024, for the following data points: gender, race, and age group. RESULTS: A total of 58,822 cases of malignant neoplasms were recorded in Paraíba, encompassing 434 melanoma. The older population were the most affected, with the following distribution: 103 cases for 60 to 69 years old; 94 cases for 70 to 79 years old; 89 cases for 50 to 59 years old. These three groups together were responsible for 65.89% of all cases. For gender, most were male (244 cases, 56,22%). CONCLUSION: We found that in Paraíba men and the older population are the most affected by melanoma, showing the need for strengthening the health care policies for these population groups.

Introduction: Measurement instruments (also referred to as questionnaires or scales) are considered "soft-hard" technologies, used to reduce the depersonalization of patients, improve the quality of care, and strengthen the therapeutic relationship between patients and healthcare professionals. Objective: The aim of this study is to identify the scientific production on measurement instruments used by nurses in the clinical practice of palliative oncological care. Methods: An integrative review was conducted, searching for articles in the PUBMED, SCOPUS, CINAHL, and LILACS databases. Descriptors such as "Weights and Measures," "Outcome and Process Assessment, Health Care," "Palliative Care," "Neoplasms," "Carcinoma," "Adenocarcinoma," "Sarcoma," among others, were used according to the controlled vocabularies DeCs (Health Sciences Descriptors) and MeSH (Medical Subject Headings). Filters for date (2013-2023) and language (Portuguese, English, and Spanish) were applied. Results: Of the 400 articles initially identified, 10 met the inclusion and eligibility criteria. All studies were conducted in international contexts (two in Asia, five in Europe, and three in North America) and employed various research strategies, with 40% being reviews. Half of the articles focused on instruments aimed at symptom management, followed by prognostic assessment and quality of life. The most frequently cited instruments were Palliative Performance Scale (PPS), Edmonton Symptom Assessment System (ESAS), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ), applied by nurses or self-administered by patients. Conclusion: A deficit of studies evaluating the main instruments used by nurses in the clinical practice of palliative oncological care was identified, especially from the nursing professionals' perspective. Additionally, a lack of national research on the subject was noted, highlighting the need for further studies in this area. Implications for practice: This study contributes to a situational diagnosis of measurement instruments in palliative oncological care from the perspective of nurses, enabling the identification of research gaps and emphasizing the importance of these instruments in improving oncological care, their benefits, and strategies for their increased use in clinical practice.

Introduction: Non-Hodgkin Lymphoma is characterized by the malignancy of lymphatic cells, and is the most common lymphoma in children and adolescents. Advances in treatment for the pediatric age group have impacted cure rates, leading to changes in the morbidity and mortality profiles associated with the disease. Objective: To analyze the morbidity and mortality profile of pediatric patients with Non-Hodgkin Lymphoma in Brazil over the past five years. Method: This is a cross-sectional, quantitative, and descriptive study that evaluates hospitalizations and deaths for Non-Hodgkin Lymphoma in the pediatric age group from January 2019 to December 2023 in the Northeast region. Data were collected from the Informatics Department of the Brazilian Unified Health System (DATASUS), through the TABNET tool, using variables such as “color/race,” “state,” “year of service,” “type of service,” “age group,” and “sex,” with statistical analysis performed in Microsoft Excel. Results: A total of 18,869 cases of Non-Hodgkin Lymphoma were recorded in the Northeast region, of which 13,779 occurred in pediatric patients, representing 15.84% of the national total. Pernambuco stood out with the highest number of hospitalizations (1,289), and the highest concentration of cases was in the 15 to 19 age group (30.55%). Males predominated in hospitalizations (65%), and most patients were of mixed race (66.64%). The majority of the care was emergency (79.01%), and Ceará recorded the highest number of pediatric deaths (21), with the year 2020 showing the highest number of deaths (24). Conclusion: The research highlights the importance of broadly addressing Non-Hodgkin Lymphoma, considering its significant impact, and the need for public health strategies that encompass the entire population. Additionally, the data presented reinforce the urgency of implementing more robust and innovative early screening campaigns. Those actions are essential to enable early diagnoses and more effective treatments, with the aim of reducing the number of advanced cases and the mortality associated with this pathology.

Introduction: Central Nervous System (CNS) neoplasms, including brain and spinal cord tumors, are significant public health concerns due to their high morbidity and mortality, greatly impacting patients' quality of life. Understanding risk factors is crucial for early detection, proper management, and prevention. In southern Brazil, updated region-specific data is needed to guide health policies and optimize resources. Recent data show gliomas, meningiomas, and brain metastases as the most prevalent CNS tumors in this region.Objectives: This study reviews literature on risk factors and neurogenetic markers associated with CNS tumors, focusing on how these factors influence tumor development and the role of neurogenetic markers in amplifying or mitigating their impact. It aims to contribute to more effective diagnostic and therapeutic approaches by understanding these interactions. Methods:This longitudinal, retrospective, and descriptive study used a quantitative approach based on medical records from patients at the neurosurgery service of a reference hospital in the Northern Plateau of Santa Catarina (years 2018-2023). Approved by the Research Ethics Committee (CEP, CAAE: 73390223.9.0000.0117, favorable opinion number 6.648.635), it analyzed data on age, sex, tumor type, location, previous treatments, and clinical outcomes, comparing them with regional literature to identify incidence and prevalence patterns. Results: The analysis showed that gliomas, meningiomas, and brain metastases were the most common tumors among patients. Gliomas, especially glioblastomas, had high recurrence rates and were aggressive, posing treatment challenges. Meningiomas, often benign, were frequently diagnosed incidentally. Brain metastases were common in patients with primary lung, breast, and melanoma cancers. Advanced sequencing technologies and bioinformatics have been crucial in identifying new biomarkers and understanding CNS cancer's molecular pathways, essential for personalized medicine and targeted therapies. Conclusion: The study highlights the complexity of factors contributing to CNS tumors, including genetic, epigenetic, environmental, and behavioral influences. Understanding these factors is crucial for improving prevention and treatment strategies.In southern Brazil, updated region-specific data is needed to guide health policies and optimize resources. Recent data show gliomas, meningiomas, and brain metastases as the most prevalent CNS tumors in this region.

Introduction: The health sector demands assertive decisions made by evidence-based medicine, knowledge derived from clinical research. In oncology, clinical research is necessary to develop new treatments and evaluate their efficacy, safety and toxicity, with the aim of offering patients the best treatment available. Knowing the motivation of cancer patients to participate in a clinical trial facilitates the development of more efficient recruitment strategies. Objective: to evaluate the motivation of cancer patients when participating in a clinical research protocol. Method: prospective, observational study, approved by the Ethics Committee with CAAE 59807422.3.0000.0072, with a randomly selected sample and inclusion of oncology patients, participants in clinical research protocols (in the eligibility phase or undergoing treatment), over 18 years of age, after signing the informed consent form for the current study. These patients answered a questionnaire covering clinical and epidemiological characteristics and an objective question regarding the main reason for participating in the protocol. Analyzes of proportions were carried out with percentages, categorical variables were reported by their frequency distributions and continuous variables as mean and standard deviation. Results: 80 patients with a mean age of 58.8 years were included. The main motivation was the doctor’s recommendation (35% of patients) followed by an altruistic objective: contributing to research to cure cancer and helping other people (25% of patients). Furthermore, 14 patients (17.5%) responded that the main motivation was to have access to medications not available on the market, 11 patients (13.75%) chose the option to increase quality of life and 7 patients (8.75%) to increase time of life. Most patients were women (76.25%), 77.5% of patients had access to healthcare through the Unified Health System (SUS), 68.75% in a metastatic scenario and 60% of patients had already been participating in a clinical research protocol for more than 6 months. Conclusion: The role of the attending physician in referring patients to research protocols is fundamental. The cancer patients evaluated in this study demonstrated doctor’s recommendations as their main motivation, followed by the desire to contribute to the cure of cancer.

Introduction: Palliative care is crucial for enhancing the quality of life for patients with severe, progressive diseases such as cancer. Pereira and Reys (2021) highlight that while palliative care was once seen as separate from disease-modifying treatments, it is now recognized as both complementary and simultaneous. As prognosis deteriorates, palliative care becomes a priority, eventually becoming the sole focus near the end of life. This case study explores the implementation of an oncology navigation program in palliative care, underscoring the importance of this integrated care model. Objective: To report on a pilot project for nursing navigation in palliative care within an outpatient oncology setting. Method: The study was conducted at an outpatient oncology clinic in Fortaleza, Brazil. All patients receiving chemotherapy were evaluated using the Palliative Performance Score (PPS) before infusion. In August 2023, a pilot project was initiated for patients needing priority palliative care, specifically those with a PPS of 50% or lower or a two-level drop on the same scale. Multidisciplinary analysis was performed in weekly meetings with the palliative care and clinical teams. The nurse navigator coordinated physician evaluations, organized meetings with patients and families to discuss palliative care, scheduled appointments with the palliative care physician and team, conducted weekly telemonitoring for patient status updates, contacted families post-death, and served as a liaison between patient needs and the team. Results: In the pilot period, 21 patients were navigated; 14 have passed away, and 7 are under follow-up. Conclusion: Developing nursing navigation within an outpatient oncology palliative care team offers significant benefits for patients, families, and the clinical team. Implications for Practice: Multidisciplinary integration provided extensive support, emphasizing the need for ongoing collaboration in managing complex conditions. Allowing patients to schedule consultations at their discretion promoted autonomy in care, honoring their preferences and needs. Weekly telemonitoring was effective in managing symptoms and facilitating early intervention in emergencies.

Leiomyosarcoma (LMS) is a rare malignant neoplasia that affects the uterine corpus. Adjuvant therapies are often applied to avoid recurrences, but their effectiveness is uncertain due to LMS behavior. Affected patients have high rates of metastasis and recurrence. LMS presents diagnostic and therapeutic challenges due to both its histomorphological aspects and complex nature. However, despite the advances in the study of these tumors, limitations persist in understanding their specific molecular aspects. We aimed to evaluate the expression profile of CREBBP and NOTCH2, validate the identified mutations and to examine the methylation profile of these genes. For this, we selected 30 LMS samples of patients and used myometrium (MM) as reference. The genomic DNA of FFPE samples was used to evaluate methylation levels. The RNA from frozen samples underwent real-time PCR (qRT-PCR) gene expression analysis using TaqMan assays. Mutations in CREBBP and NOTCH2 were validated by Sanger sequencing. Statistical tests were performed and significance established at p<0.05. The results showed that patients' age ranged from 32 to 91 years (mean 56 ± SD 11.97). Most of them had postmenopausal bleeding and 80% relapsed and/or had metastases. Significant differences in gene expression were observed, highlighting the reduction of CREBBP (p = 0.004). In cultured cells, a greater reduction in the expression of CREBBP (p=0.2440) and NOTCH2 (p=0.7610). Sanger sequencing revealed significant mutations in the target genes evaluated, with the c.4063G>A mutation being validated in the CREBBP gene. For NOTCH2, at position 78 of the sense sequence alignment, a specific transversion was identified. Hypomethylation was observed in LMS in relation to MM for the CREBBP gene, with the majority of its probes appearing in the gene body region. β values were investigated when comparing LMS and MM, where a highly significant difference between LMS and MM was detected (β: 0,51, p<0.001). In silico analysis revealed gene associations between CREBBP and NOTCH2, where co-expression, genetic interaction, co-localization and signaling pathways were identified. The study contributes to elucidating the molecular mechanisms of these tumors associated with carcinogenesis. Furthermore, the results demonstrated great importance regarding the development of new therapeutic strategies, through the understanding of LMS progression. Thus, the genes represent promising targets for future investigations.

Introduction: Homozygous pathogenic or likely pathogenic variants in the MUTYH gene, are responsible for an autosomal recessive hereditary syndrome called MUTYH-associated polyposis (MAP) that predisposes individuals to attenuated adenomatous polyposis, colorectal cancer and extracolonic tumors such as duodenal cancer. The risk associated with these variants in heterozygous state is quite controversial in literature. Current studies show no significant increase of cancer risk; older studies show that it can be up to 5 times higher than that seen in the general population, depending on the family history of colorectal cancer. The same occurs in relation to other tumors; older studies report an increased risk for stomach, liver, bile duct and endometrial cancer. Objective: To discuss challenges observed in counseling breast cancer patients with heterozygous pathogenic/likely pathogenic variants in the MUTYH gene during genetic cancer risk assessment. Methodology: A retrospective analysis of the medical records of patients with breast cancer was performed from January 2019 to June 2024. Results: Of the 273 breast cancer patients who performed a broad genetic panel for hereditary tumors, 12 (4.39%) had a MUTYH heterozygous pathogenic or likely pathogenic variant. Of these, 10 (83.33%) fulfilled testing criteria for breast and ovarian cancer predisposition syndromes according to the National Comprehensive Cancer Network. All patients were informed about the reproductive risk associated with homozygous variants. Until 2023, patients were advised about the low relative risk of some tumors and colonoscopy was recommended at maximum intervals of 5 years. With new evidence questioning the risks previously stated, counseling of patients who are heterozygous carriers of mutations in this gene was guided by family history and the presence of consanguinity. Conclusion: The MUTYH gene, related to familial polyposis in its recessive form, has been identified in heterozygous state with considerable frequency in breast cancer patients, being most likely an incidental finding whose association with oncogenesis is questionable. These findings should not be used to recommend specific screening and bring challenges to genetic counseling and patient guidance.

Introduction: Despite many advances in melanoma treatment, metastatic melanoma still has a poor prognosis, with 5-year overall survival (OS) rates around 10% with palliative chemotherapy. The advent of immunotherapy has increased the 5-year OS to 26-42%. In this context, cancer vaccines have emerged as a potential treatment option for these patients, offering fewer side effects and increased tolerability. However, the effectiveness of these vaccines in combination with standard treatment is not well stablished, especially in the context of metastatic disease. Objective: The objectives of this study were to evaluate the effectiveness of melanoma vaccines as a treatment option for patients with metastatic melanoma and to determine the impact of these vaccines on patients' overall survival. METHODS: We searched Pubmed, Cochrane, and Embase in April 2024 for studies comparing different types of vaccines for the treatment of metastatic melanoma. The vaccines included in the analysis were based on: (1) autologous dendritic cells (DC); (2) irradiated autologous tumor cells (DC+TC); (3) irradiated tumor cells (TC); (4) specific combination of synthetic peptides: UV1 + G or 6 MHP; (5) and with or without adjuvant GM-CSF. We performed a systematic review and single arm metanalysis including only randomized controlled trials. The main outcome was mean overall survival (OS) at 2-, 3-, and 5-years follow-ups, which were pooled using random-effects models with R software version 4.3.2. RoB 2 was used for Risk-of-bias assessment. Results: A total of 285 patients from 4 studies were included in this meta-analysis. Follow-up ranged from 2 to 5 years The mean age of patients was 53.6 years. The mean OS, including DC + TC, TC, DC + G, UV1 + G and 6 MHP vaccines , was 70% at 2 years (95% CI = 58% to 81%; I²= 100%). At 3-years, the mean OS was 59% (95% CI = 46% to 72%; I²= 100%) for DC + TC, TC, DC + G, UV1 + G and 6 MHP. At 5-years of follow-up, the mean OS was 42% (95% CI = 31% to 53%; I²= 100%) with only DC + TC, TC, DC + G vaccines reporting results. Conclusion: Our findings suggest that melanoma vaccines provide a higher mean OS compared to standard, as reported in the literature. Despite the high heterogeneity in the use of different types of melanoma vaccines in the included studies, our results showed an improved mean 5-years OS of 42%, indicating that melanoma vaccines could potentially increase OS in patients with metastatic melanoma.

Up to 20% of luminal (LU) BC patients (pts) will develop disease recurrence in the first ten years. The development of CDK4/6i has changed this paradigm by significantly improving objective response rates and PFS. Despite extensive translational research, no clear predictive biomarker of response to CDK4/6i has been identified. METHODS data from LU BC (HR+/HER2-) pts treated in 1L with the three available iCDK4/6 (abemaciclib, AB, Ribociclib, RIB and Palbociclib, Pb) between December 2016 and June 2024 were retrospectively collected. We aimed to identify variables associated with PFS and overall survival (OS). Survival curves were calculated with the Kaplan-Meier method and compared with log-rank test. Median follow-up time was calculated with inverse Kaplan-Meier. All p values less than 0.05 were deemed significant. RESULTS A total of 378 pts were included; 243 pts (64%) received iCDK4/6 in 1L. The median age was 57 years(y), the majority were females, 33% were pre-menopausal (pm). The majority (N=122) had HER2=0. Ten pts had a BRCAmutation and 96 pts (26%) had a PIK3CA somatic mutation. Most pts had a NST BC (N=175). A total of 152 pts received adjuvant endocrinotherapy (HT), and 29 experienced disease progression during the first 24m. Eighty pts had MTDN, and 116 had visceral MT. Regarding the CDK4/6i used: 70 pts received AB; 83, RIB; 90, Pb. The most used HT associated was aromatase inhibitor (AI) (alone or with goserelin N=166). Eighty-eight pts needed CDKis dose reduction (DR). Median PFS and OS were 32 months (m) and 67 m, respectively. PFS and OS progressively declined in subsequent lines. There was no difference in PFS (p=0.16) or OS (p=0.2) according to the different CDKis (AB, 36 and 52m; RIB, 29 and 51m; PB, 39 and 65m). Median OS has not been reached. 5-y OS rate was 65%. Pts with visceral MT (30 vs. 45m, p=0.005) and MTDN (36 vs. 41m, p=0.02) had worse PFS. Pm women had improved PFS (48 vs. 32m, p=0.049). Pts treated with AI or TMX, with or without goserelin, + CDKi experienced better PFS versus those with fuvestrant + CDKi (44vs27, p=0.005). DR and age (< or ≥ 70 y) had no impact on PFS. When comparing the different CDKi among them, no difference in efficacy was perceived in various scenarios. In the MTD subgroup, the use of AB and IA/TMX combinations were associated with better PFS. CONCLUSION MTDN and visceral MT are predictors of poor PFS in metastatic BC treated with CDKis in 1L. OS data will be presented at the Congress.