Trabalhos Científicos

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.

Body image is of paramount importance to quality of life, particularly for oncology patients who experience various invasive modifications as a result of their disease or its treatment. These modifications may include alopecia, weight changes, surgical scars, among others. Monitoring the patient’s relationship with their body image is essential for identifying individuals who may require specialized care. The objective of this study is to evaluate body image perceptions using the Body Image Scale (BIS) questionnaire among patients with malignant neoplasms receiving care at a public hospital in the state of Goiás. This cross-sectional study assessed body image among cancer patients through the administration of the BIS questionnaire. The BIS is a validated instrument in Brazil that focuses on capturing affective dimensions related to body image and is widely employed in the context of various other diseases. The study sample consisted of 302 oncology patients undergoing treatment or follow-up at the Clinical Oncology Service of a public healthcare facility in Goiás. The sample included adults of both sexes, aged 18 years and older, who were attending the service during the study period. Patients who were physically or psychologically unable to respond, those under 18 years of age, and those who declined to participate were excluded from the study. Data collection was conducted in person at the oncology service during routine consultations, hospitalizations, or chemotherapy sessions. Of the 302 patients, 196 (65%) were female and 106 (35%) were male, with a mean age of 58 years. Patients with neoplasms in 25 distinct anatomical sites were evaluated, with breast cancer being the most prevalent, representing 144 (48%) of the participants. Preliminary analysis revealed a higher incidence of negative body image perception among female patients and those experiencing permanent bodily alterations due to the disease or its treatment. In conclusion, the quality of life of oncology patients is a critical factor in the effectiveness of their treatment. Therefore, body image assessment is essential and should be incorporated into patient evaluations, as cancer treatment is invasive and can significantly alter body image perception. When not addressed, these alterations may lead to psychological distress and a deterioration in overall health, thereby impacting treatment outcomes.

The influences exerted by the environment in which an individual lives, as well as the circumstances they experience, particularly regarding their health, have a significant impact on their well-being. Adverse circumstances can generate a negative impact on the quality of life, affecting it in a general sense. Malignant neoplasms create such adversity in the patient’s life, suddenly leading them to face situations of pain, fear, depression, and the loss of femininity/masculinity and sexuality. Women, in particular, are socially constructed to play the role of caregivers and supporters within the family. When they are unable to assume these daily functions due to the frailties imposed by the disease, the physical-psychic-social balance is disrupted, affecting the family and social nucleus. Men, on the other hand, experience a compromise of their masculinity, with a reduction in muscle mass, gynecomastia, and hot flashes, leading to feelings of aversion, reduced self-esteem, and a sense of emasculation. Thus, understanding na individual’s perception of their lived experiences is important and necessary for maintaining their well-being, which will influence their treatment. In this context, the present study aims to apply the shortened version of the PANAS scale (Positive and Negative Affect Schedule) by Iolanda et al. (2014) in patients diagnosed with cancer, to assess the individuals’ emotions and what these may represent in their quality of life and the treatment adopted. The construct is composed of 10 items that assess subjective well-being, encompassing daily affective experiences related to life satisfaction and consisting of three main elements judgments about one’s life satisfaction, the experience of positive affects, and the experience of negative affects. The instrument was applied to 200 patients undergoing treatment in a public hospital in the state of Goiás, of which 130 (65%) were women and 70 (35%) were men. The preliminary analysis of the results showed a decrease in positive affects in patients who were recently diagnosed and in those with sequelae from the disease or treatment, while, in patients undergoing ongoing oncology follow-up, negative affects diminished over time. It is concluded that the shortened version of the PANAS scale can be used to assist healthcare professionals in better understanding suffering and, consequently, in improving pre- and post-treatment counseling, providing emotional and physical support when necessary.

Introduction: Cancer is one of the leading causes of global mortality, highlighting the need for early diagnosis to improve clinical outcomes. Artificial intelligence (AI) has emerged as a promising tool that offers precise interventions in medical practice. In recent years, AI has established itself as a significant innovation, such as in mammography and tomosynthesis devices, revolutionizing medical diagnosis through advances in detailed and predictive analyses. Objective: Analyze AI interventions in cancer diagnosis and contribute to early screenings. Method: Articles from the PubMed database were reviewed, the inclusion criteria being: topics related to the use of AI in cancer diagnosis from 2019 to 2023, in English and Portuguese. The search terms used were “artificial intelligence”, “cancer”, and “diagnosis”. Results: Among the 33 articles analyzed, 21 showed that AI is essential in the early diagnosis of cancer, due to its precision and lower failure rates, as well as its ability to direct and reduce treatment costs. AI handles large amounts of data, aiding in the prediction of potential protein interactions and gene expression. This tool facilitates the discovery of new drugs at lower costs and in less time. For example, the smartphone app based on the Skinvision algorithm enables patients to receive a quicker diagnosis, as this technology evaluates skin lesions in 30 seconds and detects 95% of skin cancer at an early stage - although medical intervention is still necessary afterward. Nine articles indicated that AI is promising, but lacks concrete evidence compared to specialized doctors. Finally, three articles did not conclude that AI is superior for cancer diagnosis. Conclusion: The use of AI in oncology has proven promising for diagnosing and monitoring cellular changes, given its ease, precision and safety in healthcare. This has already been demonstrated in robotic and nanorobotic surgeries, drugs administration and the identification of abnormalities in radiological images, showing a high sensitivity compared to conventional technologies. Therefore, although AI does not replace human intelligence or interaction, it is a valuable ally in medical practice, working across various areas of oncology such as screening, early diagnosis and treatment.

INTRODUCTION: ChatGPT consists of a LLM - Large Language Model, and is capable of producing responses on a wide range of topics in natural language. In this context, a new way of patient contact with health information is emerging. OBJECTIVE: Evaluate and quantify the reliability, accuracy, and quality of LLM's cancer information in the context of non medical internet users. Analyze discrepancies between ChatGPT answers and medical source of information. Identify the emotional approach in the responses provided by the Artificial Intelligence. METHODOLOGY: To analyze the reliability and accuracy of information provided by ChatGPT, 100 questions were developed based on three sources of information: INCA’s website FAQ section on cancer, queries of the most trending topics using Google Trends tool, and personal experiences of group members based on common patient inquiries in hospitals and primary care settings. Both formal and informal language, non-technical terms, and subjective words were used to test ChatGPT's ability to handle various question formulations. Each question was prompted in the platform, with a new ChatGPT instance created for each message to prevent previous responses from influencing the next. This process was conducted for both 3.5 and 4.0 versions of ChatGPT. The responses from both models were recorded in a Google Sheets table, separated, and individually sent to each member of the evaluation committee, consisting of four group members. For the analysis, the committee members, supervised by an oncologist, were divided into pairs, each in charge with half of the responses. The criterias used for the evaluation were: correct, complete, empathetic, comprehensible, and if it incentivises the user to seek a health professional. For each criteria, one point was given if the condition was met, and zero if not, with no decimal values allowed. To make the final evaluation, it was considered the average score from both pairs. RESULTS Statistical evaluations revealed that although both models had similar accuracy rates, 87% GPT 3.5 versus 91% GPT 4.0, the latter version is usually more complete: 28% vs 74%, respectively. Neither 3.5 nor 4.0 versions address emotional aspects in most answers (5% vs 14%, respectively), but they do answer in a patient-friendly language (92% vs 95%, respectively). In conclusion, it is possible that LLM's may be used in the future as a tool for patient education.

Introduction: TNBC is a subtype of breast cancer that does not express hormone receptors and HER-2 protein, making it more aggressive. TROP2 is a transmembrane protein that may be expressed in TNBC and has been associated with more aggressive tumors and worse survival outcomes. Objectives: This study aimed to examine the expression of TROP2 in early and locally advanced TNBC, as well as its potential relationship with clinicopathological characteristics, response to neoadjuvant treatment, and survival outcomes. Methods: This cross-sectional, retrospective study included 54 patients with TNBC Stages I, II, or III from January 2012 to December 2020. Data were collected from electronic medical records and biopsy specimens of the primary tumors. TROP2 expression was evaluated by immunohistochemistry and immunofluorescence. Ethics committee approval: 5.614.936. Results: The average age of the patients was 51 years. Lymphovascular invasion (LVI) was present in 46.2% of patients, while perineural invasion (PNI) was present in 18.5%. Regarding clinical staging at diagnosis, 50% of patients were diagnosed with Stage III, 40.7% with Stage II, and 9.2% with Stage I. When examining TROP2 expression using immunohistochemical evaluation, it was found that most cases showed membranous positivity of variable intensity throughout the tumor, with staining exclusively in tumor cells. The immunofluorescence data were subjected to a ROC curve to estimate the cutoff point, using pathological response to determine the cutoff. The defined cutoff point was >37.5. Of the 54 patients, 72.2% had low TROP2 expression, and 27.8% had high expression. Overall, 90.7% of patients showed some level of TROP2 expression. High TROP2 expression was significantly associated with LVI, tumor size, and higher staging. Additionally, among the 26 patients who underwent neoadjuvant chemotherapy, those with high TROP2 expression had a higher rate of complete pathological response. Conclusions: TROP2 expression was associated with clinicopathological factors and contributed to a more significant response to chemotherapy in patients with triple-negative breast cancer.

Introduction: The expression of the Ki67 protein assessed by immunohistochemistry (IHC) can be used as a prognostic biomarker to stratify breast cancer patients who harbor a high risk of disease relapse and can benefit more from chemotherapy. However, the prognostic and predictive value of Ki67 for HER2-positive breast cancer is not clearly understood. This study aimed to test the relationship between Ki67 expression and the pathological response in HER2-positive breast cancer. Materials and Methods: We included 260 patients with HER2-positive breast cancer treated with neoadjuvant chemotherapy plus anti-HER2 therapy at A. C. Camargo Cancer Center, Brazil, from January 2010 to December 2022. Information regarding demographics, comorbidities, immunohistochemical features, treatment, clinical staging, and toxicity was collected from patients’ electronic medical records. Ki67 expression information was collected from pathological reports and categorized as <30% or >30%. Descriptive statistics were used to summarize data. Survival curves were calculated using the Kaplan-Meier method and compared with the log-rank test. Multivariate analysis using Cox’s regression models was performed to integrate factors associated with pathological complete response(pCR). Results: The number of stage II and III patients was 154 (58.3%) and 93 (35.2%), respectively. Histological grade II and III were observed in 136 (51.5%) and 121 (45.8%) tumors. Ki67 >30% was seen in 185 (70%) tumors, and 172 (65.2%) had hormonal receptor expression. The median follow-up was 41 months (37.13-44.87). One-hundred and forty-four (55.4%) patients achieved pCR. The Ki67 <30% was significantly associated with a lower rate of pCR, 33 patients (42.3%) compared to 111 patients (61%) in the group with Ki67>30% (p=0.002). On the multivariate analysis, after adjustment for the use of neoadjuvant trastuzumab plus pertuzumab, use of neoadjuvant anthracyclines, and HER2 score + 3 on IHC (vs. HER2 amplified by FISH/ISH), Ki67 remained as an independent factor associated with pCR. Conclusion: Tumors with Ki67 <30 were associated with a lower rate of pCR after completing neoadjuvant treatment. Ki67 was kept as an independent predictor for pCR regardless of the use of neoadjuvant antracycline or trastuzumab plus pertuzumab, and HER2 score as evaluated by IHC. In the future, PAM 50 or another multigenic test may better fit these patients into different prognostic subgroups and help to de-escalate treatment.

Introduction: Chemotherapy-induced nausea and vomiting (CINV) is the most frequent and troubling adverse event during chemotherapy, significantly interfering with patient compliance and quality of life. Therefore, effective prophylactic measures are crucial for proper care. The THRIVE (Training to Help Reduce CINV ratEs) program, through a comprehensive multinational and multicenter personal practice assessment (PPA), evaluated the awareness and adherence of medical oncologists to established CINV management guidelines. Here, we report results from Brazilian practice. Objective: To evaluate medical oncologists' awareness of CINV and their adherence to CINV management guidelines. Methods: Twenty Brazilian clinical oncologists anonymously answered a survey about their own practice during a patient consultation. The PPA surveys were developed by four expert clinical oncologists from Argentina, Brazil and Canada. Results: Ninety percent (90%) of respondents declared adherence to international guidelines for determining CINV management protocols. However, 55% misclassified the emetogenic potential of highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC) regimens. Assessment of personal risk factors is essential to establish the best management of CINV; nevertheless, respondents did not discuss these factors with 56% of their patients. Additionally, there was a divergence between risk factors described in guidelines and those considered by respondents (i.e. only 25% of respondents consider gender as a risk factor). The assessment of these factors is particularly relevant for CINV prophylaxis in patients under treatment with MEC - although it is recommended to include a Neurokinin 1 receptor antagonist (NK-1 RA) in the regimen of patients with additional factors, only 60% of respondents actually use this strategy. Conclusion: There are significant disparities between clinical practices and guideline recommendations for CINV management in Brazil. Misclassification of emetogenic potential and inadequate assessment of personal risk factors highlight the need for continuous medical education to ensure optimal CINV management practices.

Introduction: Approximately 10% of breast cancers have a hereditary component, mostly associated with pathogenic variants (PVs) in the BRCA1/2 genes. They typically exhibit genomic instability, but aside from the prioritization of PARP inhibitors and platinum-based therapies, they are treated based on studies of sporadic tumors. Our objective is to describe the tumor characteristics, treatment patterns, and response in patients with BRCA1/2 PVs. Methods: A retrospective observational study was conducted, including patients with breast cancer who carried BRCA1/2 PVs, treated between January 2004 and August 2024 at A.C. Camargo Cancer Center (Brazil). Results: All patients (n=145) were female, with 88 having BRCA1 mutations, 55 having BRCA2 mutations, and 2 patients with mutations in both genes. Mean age: 42 years (±8.67). Ethnicity: White (79%), Brown (11%), Asian (4%), Black (3%), and 3% not reported (NR). Family history of cancer: 54%. 14 patients had synchronous tumors: ovaries n=11; pancreas n=1; stomach n=1. Regarding breast cancer, the predominant histological subtype was NST 88%; CLI 4%; Metaplastic 2%; others: 6%. The majority were high grade (GIII 62%, GII 33%, GI 3%, 2% NR), of the triple-negative subtype 51%; Luminal B: 27%; Luminal B HER-2 low: 8%; Luminal A: 7%; Luminal B HER-2+ 4%; HER-2+: 2%; Basal-like 1%; with up to 20% lymphocytic infiltrate in the tumor (TIL up to 20% n=77; 21-40% n=42; >40% n=9) and diagnosed at early stages EC: (I) n=75; (II) n=41; (III) n=25; (IV) n=4. 82 patients underwent neoadjuvant chemo with ± immunotherapy ± anti-HER2 therapy. Complete response: 34.6%. Adjuvant RT: 86.9%. 82 patients (55%) received adjuvant systemic therapy – AC-T (28%); iPARP (13%); TC (8%); Capecitabine (7%); others: 44%. Adjuvant HT: 6 years (±2.66). Median follow-up of 60 months: 7.8% local recurrence and 20% distant recurrence. Metastasis sites: lung (32%); bone (20%); liver (16%); lymph node (16%); others (16%). 1st line: exclusive chemo (23%); chemo ± targeted therapy or immunotherapy (43%); iPARP (16%). Time to disease progression: 61 months (±39.5). Five-year median survival: 93.1%. Initial surgery: 20% bilateral mastectomy, 50% unilateral, and 30% segmental resection. 129 (89%) patients had prophylactic BSO. Conclusion: We observed a predominance of women in their fourth decade of life, white, with early-stage triple-negative NST, most of whom underwent risk-reducing surgery. 93.1% of patients were alive after 5 years of follow-up.

INTRODUCTION: In Brazil, breast cancer has been the most frequent oncological diagnosis among women, with the exception of non-melanoma skin tumors, with an estimated 73,610 new cases for each year from 2023 to 2025. Therefore, it is important to study the behavior of the disease to understand efficient strategies to increase detection rates. OBJECTIVES: To statistically evaluate the correlation between breast cancer diagnosis rates in the state of Rio de Janeiro, mammogram rates and the percentage of BI-RADS 5 reports among the seven BI-RADS categories, as well as the trend time of these elements. METHODOLOGY: For this ecological study, data were collected from 2014 to 2023 from the Sistema de Informações de Câncer and the Instituto Brasileiro de Geografia e Estatística, via the DATASUS platform. Using the Statistics Kingdom software, Spearman 's test was performed to evaluate the correlation between the variables, and simple linear regression was used to evaluate their temporal trend. The variables are: rate of breast cancer diagnoses per location of diagnosis per 10,000 inhabitants, rate of mammograms performed by place of care per 10,000 inhabitants and percentage of BI-RADS 5 reports. RESULTS: Linear regressions indicated the presence of a positive linear correlation between year and rate of mammograms (p<0.05; R²=0.68), as well as between year and rate of diagnoses (p<0.05; R²=0 .84), with an increase of 1.9 mammograms and 22.2 diagnoses per 10,000 inhabitants per year respectively. This test did not reveal a linear correlation between year and percentage of BI-RADS 5 (p>0.05; R²=0.24). At the same time, the Spearman test indicated that there is a positive correlation (p<0.05; r=0.74) between the rates of mammograms performed and breast cancer diagnoses. CONCLUSION: In view of the above, there is a correlation between the variables mammography rate and diagnosis rate, as well as an increasing trend for both. Unlike them, the percentage of BI-RADS 5 did not show such a trend. These results may suggest that the increase in breast cancer diagnosis rates in the state of Rio de Janeiro is being influenced more by the intensification of screening measures, and not by possible increases in the incidence of the disease. This may also suggest the importance of policies to encourage and facilitate mammograms, such as Outubro Rosa and the Programa Nacional de Controle do Câncer de Mama.

Introduction: Brain malignant tumors remain to have one of the worst survival rates among all neoplasms. Despite its lower incidence in undeveloped countries, possibly due to scarce resources, Brazil has shown to have one of the highest mortality rates in the world. Magnetic resonance imaging (MRI) is the standard imaging method used for diagnosis and follow up of brain tumors in general, and most recently it has become a potential auxiliary intraoperative tool. Objective: We sought to investigate the trends in brain cancer diagnosis and its relationship with working MRI machines in Brazil from 2014 to 2023. Method: This is an analytical ecological study with data extracted from DataSUS’s Oncology Panel, Resident Population and National Registry of Health Establishments. Data was analyzed through Statskingdom and a linear regression was performed, considering a significance level of 0,05. Incidence was calculated per 100.000 inhabitants. Results: From 2014 to 2023, there were 40.459 new cases of brain malignant tumors, with an incidence increase of 198.6%, demonstrating a very strong positive correlation throughout the period (R=0,891; p<0,001). Furthermore, in the same period, the number of working MRI machines increased 205,4%, and a very strong positive correlation was found between brain cancer diagnosis, showing that for every 100 new working MRI machines, there were 182 new cases of brain cancer diagnosed [R=0,857; β=0,182(0,162-0,202); p<0,001]. Conclusion: The results of this study indicate that there was an increase in the diagnosis of brain malignant tumors in Brazil from 2014 to 2023 accompanied by an increase in the number of working MRI machines. The former could be explained by the latter, demonstrating that there was an improvement in the diagnostic panorama. However, further research needs to be done to confirm these results.

Bladder cancer is a clinically heterogeneous disease stratified into non-muscle-invasive (NMIBC) and invasive (MIBC). In addition to transurethral bladder tumor resection (TURBT) or radical cystectomy, immunotherapy is a treatment options for both cancer types, uncovering the immune system's role in tumor control. We hypothesize that levels of CD8+ and CD3 T-cells infiltrating the tumor (TIL), measured through an adaptation of the Immunoscore for expression data (IS), and T-cell receptor diversity (dTCR), characterized through TCRseq, are potential predictive and prognostic biomarkers. We herein evaluated 3 cohorts: (1) BCG (TIL samples from 23 NMIBC patients who underwent TURBT + adjuvant BCG); (2) BUT (blood, urine, and tumors samples from 6 NMIBC/MIBC patients who underwent TURBT), and (3) ABACUS (84 MIBC patients that underwent neoadjuvant Atezolizumab + cistectomy). We performed TCRseq for (1) and (2) cohorts using DNA from tumor-FFPE (TIL), PBMC, PBMC-derived CD8+, and urine. For cohort (1), we did observe a significant difference in dTCR between BCG responders (n=9) vs. non-responders (n=14, T-test, p=0.35), nor longer recurrence-free survivals in high dTCR (p=0.4, Log-rank test). Just for the small BUT cohort we compared the TCR repertoire similarity of TIL vs. PBMC, CD8+, or urine. We observed a higher similarity between urine and TIL (0.0225, Jaccard index) than PBMC or CD8+ vs. TIL (<0.0025). Under authorized access from the ABACUS study, we used primary tumors’ RNAseq data plus CIBERSORTx to calculate IS (low n=5, intermediate n=59, or high n=20) and correlate with pathological complete response (pCR). We did not observe a significant association between pCR and ISE (p=0.52; Fisher’s Test), but non-responders were depleted from high ISs. Our preliminary results find support on the literature: (i) the greater the CD8+ infiltration, the more pCR in MIBC cases. (ii) TCR repertoire from urine is a proxy for the tumor microenvironment. We are currently recruiting more patients to increase our BUT cohort to validate dTCR from urine as a potential biomarker.