Trabalhos Científicos

Introduction: Breast cancer (BC) is a leading cause of cancer-related morbidity and mortality in women globally. The HER2+ and triple-negative (TN) subtypes exhibit distinct biological behaviors and treatment outcomes. With rising obesity rates, it is crucial to understand how obesity affects treatment responses in these hormone-negative subtypes to improve patient management. Objective: This study aims to compare demographic characteristics, tumor features, and treatment outcomes between HER2+ and TNBC patients, focusing on the impact of obesity on treatment efficacy. Methods: This retrospective analysis included women with histological diagnoses of BC treated at a SUS hospital in São Paulo from June 2016 to June 2023. Participants aged 18 or older, diagnosed with TNBC or HER2+ who received neoadjuvant chemotherapy were included. Data were collected from electronic medical records with approval from the Research Ethics Committee. A total of 76 HER2+ and 160 TN patients were included. Clinical and histopathological data included menopausal status, age, ethnicity, tobacco and alcohol consumption, number of births, and body mass index (BMI ≥ 30). The analysis assessed surgery type (mastectomy vs. quadrantectomy), radiotherapy (yes/no), and chemotherapy response (complete pathologic response [PCR] vs. residual disease), along with tumor stage, nodal stage, presence of metastases, histological type, and Ki67 expression. Results: The HER2+ group demonstrated a higher PCR rate of 44.7% compared to 33.1% in the TN group (p = 0.0075). Mastectomy was performed in 57.9% of HER2+ patients and 45.6% of TN patients (p = 0.6288). Among obese patients, those with HER2+ (n=27) had a higher mastectomy rate (63.0%) than TN patients (n=54) at 40.7% (p = 0.0979). Significant differences in radiotherapy were noted, with 74.1% of obese HER2+ receiving it versus 96.3% of TN patients (p = 0.0053). PCR in obese HER2+ patients was 66.7%, higher than 35.2% in obese TN patients (p = 0.0096). Conclusion: This study reveals significant differences in treatment responses and surgical decisions between HER2+ and TNBC patients, especially regarding obesity. Understanding the impact of obesity on treatment outcomes in these hormone-negative subtypes is vital for tailoring individualized treatment plans. Future research is needed to explore the relationship between obesity and treatment efficacy in these BC subtypes.

Introduction: Chemotherapy is a cornerstone in cancer treatment, yet its systemic and nonspecific nature often leads to significant adverse reactions. Objective: This study aimed to characterize immediate adverse reactions to chemotherapy infusion and to understand patient perceptions of these events. Method: From June 2023 to March 2024, adult outpatients receiving intravenous chemotherapy who experienced immediate adverse reactions to chemotherapy infusion were recruited (Ethics committee approval CAAE 69885623.3.0000.5153). Data were collected via structured patient interviews using a specific form, with reactions classified by severity (CTCAE) and causality (Naranjo algorithm). Follow-up interviews assessed patients' perceptions during subsequent treatment sessions. Results: A total of 71 immediate adverse reactions to chemotherapy infusion episodes were documented among 67 patients, predominantly female (85%), with an incidence of 0.19%. The primary diagnoses were breast (37.31%) and colon cancer (13.43%). Oxaliplatin (23%) and paclitaxel (21%) were the most frequently associated chemotherapeutic agents. Cardiovascular (30%) and respiratory (23%) symptoms were most common. Reaction severity ranged from mild (42.2%) to moderate (28.2%), necessitating corrective measures in all cases. According to the Naranjo algorithm, 79% of reactions were possibly linked to chemotherapeutic agents. A significant association was found between patient skin color and reaction severity (p=0.021), as well as between the chemotherapeutic agent classes and the number of signs and symptoms (p=0.015). Notably, 57% of patients expressed fear of future immediate adverse reactions to chemotherapy infusion episodes. Conclusion: In conclusion, while immediate adverse reactions to chemotherapy infusion to infusion were rare and typically mild to moderate, cardiovascular and respiratory symptoms were most prevalent. The patients' reported fear of future immediate adverse reactions to chemotherapy infusion episodes highlights the importance of improving communication and providing psychological support during treatment.

Increased leukocyte infiltration in the tumor microenvironment (TME) is significantly associated with improved prognosis and response to treatment in Head and Neck Squamous Cell Carcinoma (HNSCC). There is evidence that the association with prognosis depends not only on the number of infiltrating cells, but also on the cell type and phenotype. Infiltration of leukocytes in the TME is largely dependent on the chemokines and chemokine receptors expressed by neoplastic/stromal cells and leukocytes, respectively. Increased CCR4/CCL17 interactions are associated with greater infiltration of pro-tumoral M2-like macrophages, Tregs and Th2 cells and worse prognosis and poor response to treatment. The CCR5/CCL5 interaction is involved in the anti-tumoral response, as CCL5 can be secreted by M1-like (anti-tumoral) macrophages and attract Th1 and NK cells. In this study we assess the expression of selected chemokines and chemokine receptors in the TME of HNSCC and verify its association with tumor aggressiveness according to clinical TNM staging. Expression of CCL2, CCR2, CCL4, CCR4, CCL5, CCR5, CCL17, and CCL20 was determined by RT-qPCR in 47 cases of HNSCC treated at the Santa Casa of Araraquara Hospital (CONEP CAAE 53343421.0.0000.5416 ): 42 men, 7 women, 82,97% smokers, T1/T2=26, T3/T4=21, Nx/N0=18 and N1/N2/N3=29. Total RNA was extracted from surgical specimens and used for cDNA synthesis. The cDNA was used in qPCR reactions using the SYBR Green system and specific primers, with HRPT1 as the normalization gene. Expression of CCL2 (p=0.02) and CCR2 (p=0.03) was increased in tumors without nodal invasion, possibly indicating reduced aggressiveness. CCR4 expression was greater (p=0.0232) in smaller tumors, but there was difference regarding the presence of nodal invasion (p=0.2069). Expression of CCL20, CCL4, CCL5 and CCR5 were not significantly different when tumors were grouped by size or by presence of nodal invasion. There was a tendency for lower CCL17 expression, which may attract Treg cells, in more aggressive tumors with nodal invasion (p=0.0914). This data will be subsequently explored with the prevalence of infiltrating M1, M2 macrophages, as well as CD8+, CD4+ T and FOXP3+ Treg cells, but it supports the relevance of chemokines and chemokine receptors in shaping leukocyte infiltration in HNSCC tumor microenvironment. The data indicates that increased expression of CCL2 and CCR2 are associated with less aggressive HNSCC in this cohort of HNSCC patients.

Background: Pancreatic adenocarcinoma (PDAC) treatment remains a challenging problem. Although adjuvant chemotherapy is the gold standard in resectable disease, neoadjuvant have been investigated in recent trials. Also, it is known that 6-months of treatment is used in most adjuvant trials. However, it is a debate concerning the best strategy. This study aimed to assess the association of chemotherapy duration, treatment strategy (neoadjuvant vs adjuvant) in resected PDAC patients. Methods: This was a retrospective chart review of non-metastatic PDAC patients that were treated with surgery and received chemotherapy (neoadjuvant or adjuvant ) from January 1, 2019 through December 31, 2023 at AC Camargo Cancer Center. We analyzed the treatment duration (≤3 vs >3 months), treatment strategy (neo vs adjuvant) and others clinical-treatment features (ECOG, resectability classification, initial Ca19-9 levels). The primary endpoint was overall survival (OS). Cox regression multivariable analyses for OS was performed to adjust for prognostic variables in PDAC. Results: We included 86 patients in the study, in which 77.9% were classified as resectable, 24.1% had Ca19-9 levels>500 and 33.8% were ECOG 1/2. Chemotherapy duration ≤3 months occurred in 15.1%, FOLFIRINOXm was used in 74.4%. Concerning treatment strategy, patients received neoadjuvant (47.8%), adjuvant (37.5%) and perioperative (14.7%). Median follow-up time was 32.5 months. Overall survival was 39 months (95% CI: 31.9-46.1). Patients who received less than 3 months of chemotherapy had inferior survival (29.0 vs 48.0 months, P=0.01) compared to >3 months. Regarding FOLFIRINOX chemotherapy, patients who received neoadjuvant treatment had inferior prognosis compared to adjuvant FOLFIRINOX (37.0 vs 65.0, P=0.02). Neoadjuvant therapy was not associated with positive margins or post-operative complications. In Cox multivariate analysis (adjusted for ECOG, resectability classification, Ca19-9 levels), adjuvant FOLFIRINOX compared to neoadjuvant FOLFIRINOX was associated with 69% reduction in risk of death (95% CI: 0.09-0.95); regarding chemotherapy duration, patients who performed > 3 months had 88% reduction in risk of death (95% CI: 0.08-0.73). Conclusions: In this retrospective unicentric analysis in non-metastatic PDAC patients who were submitted to surgery the duration of total chemotherapy ≤3 months and neoadjuvant FOLFIRINOX were associated with worst survival.

Introduction: In recent years, there have been significant advances in cancer treatment with the discovery of new drugs and therapies that improve the prognosis of cancer patients. However, despite the benefits, cardiovascular diseases have emerged as one of the main adverse effects of antineoplastic therapy, contributing to patient morbidity and mortality. Although chemotherapy plays an important role in the outcomes of cancer patients, the use of some classes of chemotherapy has resulted in increasing cases of side effects and cardiovascular complications, the most common occurrence being the development of chemotherapy-induced cardiotoxicity, which extends after treatment. Objective: To identify and describe the factors that characterize cardiovascular toxicity in a sample of cancer patients undergoing outpatient chemotherapy. Methods: Descriptive observational study conducted with adult patients with stage I, II or III cancer, with indication for outpatient chemotherapy in a hospital in southeastern Brazil. Sociodemographic data and tumor characterization were obtained through medical records and a semi-structured questionnaire. Electrocardiogram assessment and blood collection for biomarker analysis were collected before the infusion of the first chemotherapy in the patient. Descriptive analyses were conducted in the R software. Results: The most prevalent chemotherapy protocols in the study were Docetaxel® associated with cyclophosphamide® (22.62%) followed by Adriamycin® associated with Cyclophosphamide® (17.85%). The mean C-reactive protein was 6.83 mg/l with 30 participants presenting high cardiovascular risk. In contrast, only 1 participant had elevated troponin 1. Prolongation of the QT interval was identified in 11.90% of the sample. Conclusion: Cancer patients undergoing chemotherapy protocols, mainly anthracyclines® and taxanes®, associated with some previous risk factor, have an increased risk of chemotherapy-induced cardiotoxicity. In addition, C-reactive protein levels were increased in a large part of the sample. The findings draw attention to the cardiovascular risk of these patients.

Introduction: chRCC is a rare subtype of renal cell carcinoma (RCC) with distinctive histopathological features and generally favorable prognosis. Understanding its clinical outcomes and prognostic factors is essential for optimizing patient care. Objective: To evaluate the clinicopathological features and outcomes of patients with localized or metastatic chRCC at an academic tertiary cancer center. Methods: We conducted a retrospective analysis of patients with chRCC treated at a single cancer center. Survival probabilities were estimated using the Kaplan-Meier method. Prognostic factors were assessed through univariate analyses with the Cox regression model. Results: From 2009 to 2024, 2181 patients with RCC were diagnosed, including 718 with non-clear cell histology. We analyzed 123 patients with chRCC, comprising 20 with advanced disease (metastatic at diagnosis, n=8; relapsed, n=12). The median age was 58 years (IQR 48.5-55.5), 56.9% were females, 69.1% had ECOG performance status 0 and 26.8% ECOG-PS 1. Tumors were staged T1-2 in 61.8% and T3-4 in 34.1%. 23% had a second malignancy, including 6 patients with a second RCC. In the advanced disease cohort, the most prevalent site of metastasis was lymph node (55%), followed by bone (45%). Systemic treatment was administered in 55% (pazopanib, n=6; sunitinib, n=4; sorafenib, n=1), with a 18.2% response rate. Metastasis-directed therapy (MDT) was commonly used (65%; surgery, n=9; radiotherapy, n=2; multiple modalities, n=2). The 5-year overall survival (OS) for the full cohort was 84.9% (95% CI 78.3 - 92.1%) with a median follow-up of 75.1 months. Poor survival was associated with M1 stage at diagnosis (p<0.001). In the advanced disease cohort, the 5-year OS was 21% (95% CI 7.8 - 56.3%). Improved survival was associated with MDT use (HR 0.23, 95% CI 0.07 - 0.75) and favorable International mRCC Database Consortium score (HR 0.08, 95% CI 0.01 - 0.51). For patients with localized disease, the 5-year disease-free survival (DFS) was 85.2% (95% CI 78.3 - 92.7%). In this cohort, no factors were statistically associated with relapse or death, including stage (p=0.1), ECOG-PS (p=0.21) or histological grade (p=0.11). Conclusion: chRCC is associated with good prognosis. Advanced disease associates with shorter survival and response to systemic therapy is disappointing. However, patients treated with MDT showed significantly better outcomes, although this might have occurred due to selection bias.

Introduction: Obesity is a complex disease that can affect almost all organs and systems of the human body, and new efforts must be made due to the high incidence of certain types of cancer in obese patients. This work presents aspects of diagnostic imaging exams, with the proposal of teaching medical students about the correlation of these two diseases. Objective: To integrate clinical and radiological medicine, enhancing the students’ learning process by creating a direct link between clinical findings and imaging and to raise awareness about the correlation between centripetal obesity and radiological malignant and non-malignant lesions. Methods: We organized an event titled “Obesity: Health in the Right Measure” to educate medical students about adiposity. The event consisted of patient activities and presentations of diagnostic imaging exams on adiposity. The event featured interdepartmental integration between Clinical Medicine and Radiology. During the patient activities, Medical Clinic professors guided students in interviewing patients, measuring abdominal and hip circumferences, and providing nutritional guidance using a specially created brochure for the event. During the Radiology Department activity, professors presented ten selected clinical cases involving aspects of adiposity and related diseases, including malignant conditions. They discussed the examinations of each clinical case using the PACS (Picture Archiving and Communication System), covering Radiology, Ultrasound, Mammography, Computed Tomography, and Magnetic Resonance Imaging. Results: Around 40 students participated in the event, and assessments, including interviews and measurements, were conducted on 209 patients. Later, CT, MR, and XR images were used to demonstrate the radiological findings associated with ABCD, both with and without malignant lesions. These clinical and radiological findings were then correlated with the higher risk of cancer development in obese patients. Conclusion: The event integrated Clinical Medicine and Radiology, enhancing student learning by creating a direct link between clinical findings and images from examinations of clinical cases of adiposity. These cases included findings of steatosis, increased mesenteric fat, epicardial fat, subcutaneous adipose tissue, and adiposity-related malignant diseases. We believe that teaching students about clinical and imaging aspects can broaden the vision of future doctors.

Summary - Ependymomas are neoplasms composed of neoplastic ependymal cells, manifesting predominantly in children and young adults. We report the clinical, epidemiological and anatomopathological findings of 32 cases of ependymomas in adults over 18 years of age from a Brazilian Oncology Center. Of the 32 cases analyzed, 12 occurred in male patients and 20 in female patients. Ages ranged from 25 to 72 years old, with an average of 48 years old. Regarding location, 19 cases affected the spinal cord, 6 occurred in the supratentorial location, 6 in the posterior fossa and 1 case with synchronous tumors. The signs and symptoms observed included low back pain (28% of patients), paresis (18% of patients), headache (20% of patients), sensory deficit (21%), seizures (3%), dizziness (3%) and cranial nerve palsy (3%). Thirty-one patients underwent surgical resection, 23 (71%) undergoing total resection and 8 (25%) partial resection, only 1 (3%) patient underwent only local biopsy. Of the 32 total patients, 18 underwent adjuvant radiotherapy. There was a total tumor recurrence rate of 28%. These findings are close to those found in international literature, supporting the understanding of the biological behavior of this tumor.

Introduction: Considering that breast cancer is the most common cancer in women worldwide, it is estimated that there will be approximately 2.3 million new cases and 685,000 deaths in 2020. In Brazil, 73,610 new cases of breast cancer were estimated in 2023, with an estimated risk of 66.54 cases per 100,000 women. Survival analysis is essential to assess the effectiveness of available treatments and identify areas for improvement. Without survival data, it is difficult to measure the impact of current treatments and health policies on patients' longevity and quality of life. Objective: To study the association between clinical factors and survival among women diagnosed with breast cancer in all hospitals that comprise the Oncology Care Network of a state in Southeastern Brazil. Method: An observational retrospective cohort study was conducted using secondary data from the Cancer Hospital Registries and the Mortality Information System of Brazil, with a sample consisting of 12,096 women diagnosed with breast cancer between 2000 and 2016. Kaplan-Meier methods were used to evaluate 5-year survival, and the LogRank test was used for univariate analysis of clinical variables. Multivariate analysis was performed using the Cox proportional hazards model for specific causes. Results: Our hospital cohort identified 12,096 cases of breast cancer. The mean age was 54.67 years. Most women (43.11%) had no previous diagnosis and treatment, and invasive ductal carcinoma was the most common type of cancer (96.49%). Women with initial and in situ stage (OS=0.996; 95% CI: 0.990-1.000) and stage I (OS=0.972; 95% CI: 0.965-0.979) had higher overall survival compared to women with advanced stage IV (OS=0.323; 95% CI: 0.314-0.374; p<0.001). In the multivariate analyses, women from the private healthcare system showed a reduced risk of mortality (HR: 0.837; 95% CI: 0.750-0.934; p=0.001) compared to those referred from the public network. Women with distant metastases had a 49% higher risk of mortality (HR:1.49; 95% CI: 1.143-1.948; p=0.003) compared to women without stage IV disease. Conclusion: Women with advanced stage cancer, tumor bilaterality, and isolated treatments had a higher risk of mortality. Mammography and other screening methods improved prognosis and survival. Urgent public investment is needed for screening, early detection, and timely cancer treatment.

Breast cancer (BC) remains the most common type of cancer among women. Disease control must implement strategies that improve screening and predictive factors for response. Over recent years, several therapies have emerged in BC; however, many patients still do not respond, probability due to BC's heterogeneity, involving genetic, immune, and environmental factors. Thus, characterizing the components involved in the tumor microenvironment can provide insights to improve available therapies and identify potential predictive targets for treatment. Our goal was to evaluate clinical, pathological, and immunological profiles of invasive luminal BC in patients at various stages before treatment. In this study, 32 patients were recruited between 2017 and 2022, and initial (I+II, n=15) and advanced (III+IV, n=17) tumor stages were compared. Hematoxylin and eosin slides were analyzed to determine low, intermediate, or high tumor-infiltrating lymphocyte (TIL) percentages. Paraffin block sections from surgical or core biopsies were subjected to immunohistochemistry for CD8+, CD4+, CD68+, PD-1+, PD-L1+, and PD-L2+ immune markers. High expression of estrogen and progesterone receptors was associated with I+II stages. Additionally, higher expression of TILs was associated with a worse prognosis and was present in more advanced and aggressive tumors. Survival analysis showed better survival in initial-stage tumors (p=0.06; 95% CI 0.02-1.10). Advanced-stage patients exhibited higher numbers of CD8+, CD4+, CD68+, PD-1+, PD-L1+, and PD-L2+ immune cells (p<0.001) compared to initial tumor stages. Furthermore, the number of CD8+ and CD4+ TILs was positively correlated with CD68+, PD-1+, PD-L1+, and PD-L2+ immune cells. Nevertheless, CD68+ did not correlate with these immune checkpoints, indicating an altered immune response between initial and advanced tumor stages. TILs are recognized as predictive and prognostic factors for chemotherapy across various BC molecular subtypes; however, their role in luminal subtypes remains controversial. Therefore, accurately characterizing TILs is essential for clinical practice.

INTRODUCTION: Immune checkpoint inhibitors targeting the PD-1/PD-L1 axis have transformed first-line treatments for patients with advanced non-small cell lung cancer (NSCLC). PD-1 inhibitors are the standard of care for patients with PD-L1 expression ≥ 50% and also, alone or combined with chemotherapy when PD-L1 expression is < 50%. The PD-L1 inhibitor has also been approved for use in combination with chemotherapy and anti-angiogenic antibody in the first-line treatment of NSCLC despite PD-L1 expression. The combination of first-line PD-1/PD-L1 inhibitors with anti-CTLA-4 antibodies has also shown increased survival in patients with NSCLC. OBJECTIVES: To compare the efficacy of immune checkpoint inhibitors (ICIs) and chemotherapy in patients with advanced non-small cell lung cancer. Overall survival, progression-free survival, and objective response rates, as well as safety profiles and adverse events associated with each treatment, were analyzed. METHODOLOGY: Observational and retrospective study. Of the 97 articles identified, 12 were selected from the PubMed platform and a descriptive analysis of the collected data was performed. RESULTS: In the CheckMate 063 study, patients with advanced squamous cell lung cancer received Nivolumab, an immune checkpoint inhibitor. In 117 patients, the response rate was 14.5% and the disease stabilization rate was 26%.Two-year survival was observed in 27% of patients. A phase 3 study (CheckMate 017) compared Nivolumab with Docetaxel, a chemotherapeutic agent, with 272 patients randomized to receive Nivolumab 3mg/kg every 2 weeks or Docetaxel 75mg/m² every 3 weeks. The 1-year survival rate was 41% with Nivolumab and 24% with Docetaxel.CONCLUSION: In patients with advanced NSCLC, the use of immune checkpoint inhibitors, such as the PD-1 inhibitor nivolumab, showed higher response rates, stabilization, and 2-year survival. When compared to chemotherapy treatment in a phase 3 study, ICIs demonstrated a 17% increase in 1-year survival rate compared to the chemotherapeutic agent Docetaxel. These findings highlight the choice of ICIs for the treatment of advanced non-small cell lung cancer,considering the high mortality rate of this disease.

In situ vaccination for cancer immunotherapy uses intratumoral administration of small molecules, proteins, nanoparticles, or viruses that activate pathogen recognition receptors (PRRs) to reprogram the tumor microenvironment and prime systemic antitumor immunity. Cowpea Severe Mosaic Virus (CPSMV) is one of the isometric plant viruses belonging to the order Picornavirales, the family Secoviridae and the genus Comoviridae that naturally infects Cowpea (Vigna unguiculata L.) and is commonly found in Brazil. The most studied member of this family is Cowpea Mosaic Virus (CPMV), which, although not infectious to mammals, activates mammalian PRRs. Application of CPMV as an in situ vaccine results in potent and durable efficacy in tumor-bearing mouse models as well as in canine models. In this work, we performed homology analysis between the CPMV coat proteins and a CPSMV isolate from the Northeast Region of Brazil. The complete genomic sequence of the Brazilian CPSMV isolate (MW392574.1), obtained from cowpea plants, was compared with a CPMV sequence (NC_003550.1), both deposited in GenBank, using the BLAST algorithm. Amino acid sequences were aligned and pairwise comparisons between capsid protein sequences were performed. The general organization of the CPSMV genome follows that of the CPMV genome, with both viruses having a bipartite positive-sense RNA genome. RNA-1 encodes proteins involved in replication, while RNA-2 encodes structural proteins. Regarding capsid proteins, both CPMV and CPSMV have capsids with pseudo-T symmetry (pT = 3) composed of proteins S (small) and L (large), which are repeated 60 times to form the capsid. Homology analysis revealed that there is significant similarity between the capsid proteins of the two viruses. Specifically, the S proteins of CPMV (180 aa) and CPSMV (181 aa) present 37.22% of identities, while the L proteins of CPMV (369 aa) and CPSMV (366 aa) present 48.09% of identities. . These data indicate that, although the two viruses are distinct, they are strongly related. Given the therapeutic potential already demonstrated by CPMV, CPSMV may also have therapeutic potential against cancer, justifying further investigation into its use in immunotherapy.

INTRODUCTION: Meningioma is the most common primary tumor of the central nervous system (CNS), accounting for approximately one-third of brain and spinal cord tumors. Although most of these tumors are benign, their growth can compress important CNS structures, leading to considerable morbidity and mortality. Since treatment for this condition is complex, access to resources, which is unevenly distributed across regions, may represent a limitation in the appropriate management of the pathology. OBJECTIVE: The present study aims to compare the trend in deaths from meningioma across different regions of the country over an 11-year period. METHOD: This is an aggregated, observational and cross-sectional study, carried out using data obtained from the National Cancer Institute (INCA) Online Mortality Atlas, seeking information on deaths by region, considering all age groups of both sexes, over the 11-year period, between 2012 and 2022. RESULTS: Over the period analyzed, the number of deaths remained relatively stable. Of the 1,734 deaths, 137 were in 2012 and 184 in 2022, with each year in the interval representing a percentage between 7.9% and 10.61%. Regarding spatial distribution, the Southeast region was the one with the most deaths, with 792, as opposed to 80 records in the Brazilian North region. The state of São Paulo alone was responsible for 21.8% of the total deaths in the country, surpassing the entire North and Central-West regions. The latter, despite being the region with the smallest population, was not the one with the lowest number of deaths (116). The distribution by age group showed a predilection for elderly patients, with 60.38% of records in patients over 60 years of age. There was also a clear disparity in terms of gender, with the number of deaths being twice as high in women (1156 versus 578 for men). CONCLUSION: Despite the technical and scientific advances in therapy for CNS tumors, this progress has not been reflected in a reduction in the absolute number of deaths during the study period. This indifference may be due to the unequal distribution of resources among different regions in Brazil, leading to a limitation in timely diagnosis, which underestimates the statistics in poorer regions, such as the North. Another hypothesis is the inefficiency of therapy in cases where the natural course of the disease is more aggressive. Therefore, in order to advance knowledge of this pathology, an optimized distribution of resources is necessa

INTRODUCTION: Meningioma is the most common primary tumor of the central nervous system (CNS), accounting for approximately one-third of brain and spinal cord tumors. Although most of these tumors are benign, their growth can compress important CNS structures, leading to considerable morbidity and mortality. Since treatment for this condition is complex, access to resources, which is unevenly distributed across regions, may represent a limitation in the appropriate management of the pathology. OBJECTIVE:The present study aims to compare the trend in deaths from meningioma across different regions of the country over an 11-year period. METHOD:This is an aggregated, observational and cross-sectional study, carried out using data obtained from the National Cancer Institute (INCA) Online Mortality Atlas, seeking information on deaths by region, considering all age groups of both sexes, over the 11-year period, between 2012 and 2022. RESULTS: Over the period analyzed, the number of deaths remained relatively stable. Of the 1,734 deaths, 137 were in 2012 and 184 in 2022, with each year in the interval representing a percentage between 7.9% and 10.61%. Regarding spatial distribution, the Southeast region was the one with the most deaths, with 792, as opposed to 80 records in the Brazilian North region. The state of São Paulo alone was responsible for 21.8% of the total deaths in the country, surpassing the entire North and Central-West regions. The latter, despite being the region with the smallest population, was not the one with the lowest number of deaths (116). The distribution by age group showed a predilection for elderly patients, with 60.38% of records in patients over 60 years of age. There was also a clear disparity in terms of gender, with the number of deaths being twice as high in women (1156 versus 578 for men).CONCLUSION: Despite the technical and scientific advances in therapy for CNS tumors, this progress has not been reflected in a reduction in the absolute number of deaths during the study period. This indifference may be due to the unequal distribution of resources among different regions in Brazil, leading to a limitation in timely diagnosis, which underestimates the statistics in poorer regions, such as the North. Another hypothesis is the inefficiency of therapy in cases where the natural course of the disease is more aggressive. Therefore, in order to advance knowledge of this pathology, an optimized distribution of resources is necessary.

Introduction: Positron Emission Tomography/Computed Tomography (PET/CT) is currently regarded as the gold standard for lymphoma staging. However, due to its high ionizing radiation exposure, there is increasing interest in non-irradiative diagnostic methods, such as Whole-Body Diffusion-Weighted Imaging/Magnetic Resonance Imaging (WB-DWI/MRI). Although several studies have explored the accuracy of WB-DWI/MRI in lymphoma staging, the conclusions remain inconclusive. Objective: This study aims to evaluate the accuracy of WB-DWI/MRI in detecting nodal and extra-nodal lesions, as well as in staging lymphoma patients, in comparison to the gold standard PET/CT. Material and Methods: Studies were eligible if they directly compared WB-DWI/MRI with PET/CT in lymphoma patients and were observational in nature. Systematic reviews, meta-analyses, conference abstracts, and case reports were excluded. The databases searched included PubMed, EMBASE, and Cochrane, using the keywords: WB-DWI/MRI, PET/CT, lymphoma, and comparison. Pooled staging accuracy, sensitivity, and specificity of WB-DWI/MRI compared to FDG-PET/CT were calculated for both per-lesion diagnosis accuracy and patient staging accuracy. Results: A total of 23 studies comprising 797 patients were included in the analysis. Data from 8 studies were available for calculating nodal lesion diagnosis accuracy, and 6 studies provided data for extra-nodal lesion accuracy. Staging accuracy data was available from 22 studies. The pooled sensitivity and specificity of WB-DWI/MRI for nodal lesion diagnosis were 93.7% (95% CI 89.8-96.4) and 99% (95% CI 97.6-99.8), respectively. For extra-nodal lesion staging, the sensitivity and specificity were 96.3% (95% CI 86.6-99.8) and 99.7% (95% CI 99-100), respectively. The proportion of patients who were under-staged was 1.53% (95% CI 0.38-2.68), while 10.49% (95% CI 2.47-18.52) were over-staged, according to Ann Arbor staging system. Conclusion: WB-DWI/MRI demonstrates high accuracy in diagnosing both nodal and extra-nodal lesions. While the proportion of down-staged patients is minimal, the rate of upstaging is moderate. Therefore, WB-DWI/MRI may be a reliable alternative in settings where PET/CT is unavailable or in populations where exposure to ionizing radiation is particularly concerning, such as in pediatric patients.

INTRODUCTION: Gastric neoplasia is a very aggressive disease and very common in our society. According to global data in 2018, there were 1 million cases worldwide and seven hundred and eighty-three thousand deaths. Gastric cancer is the fifth most common neoplasia in incidence and the third leading cause of death globally. It affects men more frequently. The treatment of gastric neoplasia is multidisciplinary, mainly involving the surgeon, clinical oncologist, and radiation oncologist. The view of curability of this disease has always had surgical resection as its cornerstone. The treatment of gastric cancer involves neoadjuvant or adjuvant therapy. This type of treatment shows an increase in disease-free survival and overall survival. OBJECTIVE: The objective of the study will be to compare outcomes such as overall survival, disease-free survival, and toxicities of our oncology patients at the Hospital de Clínicas UNICAMP, with a diagnosis of gastric neoplasia, who underwent adjuvant therapy with chemotherapy concomitant with radiotherapy versus patients who underwent surgery alone. POPULATION AND SAMPLE: The research had a sample of 465 patients diagnosed with gastric neoplasia who were submitted to the MacDonald protocol for adjuvant therapy at the HC-UNICAMP from 2000 to 2017. RESULT: 465 patients were analyzed in this study, divided into two arms, characterized by patients who underwent adjuvant chemotherapy and radiotherapy (N: 344) and patients who only underwent surgical procedures (N: 121). The median disease-free survival in patients who underwent adjuvant therapy with chemotherapy and concomitant radiotherapy was 28 months versus 14 months in patients who only underwent surgical procedures, with a hazard ratio of 0.60, with P: 0.00, 95% CI 0.47-0.77. The median overall survival in patients who underwent chemotherapy concomitant with adjuvant radiotherapy was 37.2 months versus 16.2 months in patients who only underwent surgical procedures, with a hazard ratio of 0.57, P: 0.00, 95% CI 0.45-0.74. CONCLUSION: After analyzing the data from this retrospective study, we can conclude that HC-UNICAMP patients diagnosed with gastric neoplasia who underwent chemotherapy concomitant with adjuvant radiotherapy have a higher median disease-free survival compared to participants who only underwent surgical procedures, along with similar results to those found in the literature.

Introduction: Cancer (CA) and cardiovascular diseases (CVD) are the two leading causes of death worldwide. Age-adjusted mortality rates for CVD and cancer represented nearly 30% and 20% of all death causes in Brazil in the last 20 years, respectively. Studies show, though, that cancer tends to be the major cause of death in the Brazilian population in the next few years, according to epidemiological trends. Furthermore, as risk factors of these two diseases overlap, it’s expected that mortality rates overlap too. Objective: Compare mortality rates from CVD and CA, with emphasis on breast, prostate, and colon cancer, using infectious and parasitic diseases (IPD) as control, in Brazilian states during the period from 2019 to 2022. Methodology: Ecological study using data from DATASUS and IBGE, evaluating mortality rates for CVD (ICD-10 Chapter IX) and for breast, prostate and colon CA (ICD-10 Chapter II) in the Brazilian federative units for 2019 and 2022. The mortality rate for IPD (ICD-10 Chapter I), within the same time-space frame, was used as a control group. The years 2020 and 2021 were excluded due to potential data contamination from the COVID-19 pandemic. Absolute mortality data were adjusted for population using IBGE estimates. Pearson correlation test was used. Results: All three of the most common cancers in the Brazilian population, respectively, breast, prostate and colorectal adenocarcinoma, have a strong correlation with CVD. After the data collection and analysis through the calculation of Pearson’s correlation coefficient, it was found that, in 2019, there was a very strong correlation (r = 0,75) between the three most common cancer types and CVD in Brazil. As for the correlation between cancer and infectious diseases and CVD and infectious diseases, both had a moderate correlation (r = 0,49 and r = 0,50, respectively). As for 2022, all three Pearson’s correlation coefficients indicated a very strong correlation, be it for cancer/CVD, cancer/infectious diseases and CVD/infectious diseases. Conclusion: The correlation between common cancers and cardiovascular diseases (CVD) in Brazil in 2019 and 2022 indicates a significant overlap in risk factors. Integrated public health strategies could potentially reduce overall mortality by addressing the prevention of common risk factors for both conditions. These findings also highlight the importance of cardio-oncology specialists in improving the health outcomes of the population.

Introduction: Prostate cancer is one of the most common cancers in the world, being a major cause of premature death in men, and the survival period of this neoplasm has been significantly prolonged worldwide. Here we aim to analyze the risk factors for specific mortality in patients diagnosed with prostate cancer, in a state in southeastern Brazil. Methods: A retrospective cohort study was conducted, using a database of 10,556 patients with prostate cancer diagnosed between 2000 and 2016. Data was extracted from a cancer records database linked to the Mortality Information System of a Brazilian state. The cases were divided into deaths from prostate cancer, deaths from other causes and alive, and we followed them for at least 5 years. Multivariate analysis in the presence of competing risks was performed using the Fine-Gray proportional model. Results: At the end of 2022, the cohort comprised 6,388 individuals still alive, with 1,936 experiencing specific deaths due to prostate cancer and 2,232 deaths resulting from other causes. Regarding the competing risks, age emerged as a specific risk factor for death. For each 10-year increase at the time of diagnosis, patients exhibited an almost 10% higher risk of death from prostate cancer (HR=1.098; 95%CI=1.024-1.176). Patients faced a heightened risk of death from prostate cancer in the presence of distant metastasis (HR=5.315; 95%CI=4.676-6.041). Conversely, there was a decrease in the risk of prostate cancer-specific mortality among patients with a medium or higher level of education (HR=0.767; 95%CI=0.629-0.935) compared to illiterate patients. Additionally, patients who underwent surgery (HR=0.382; 95%CI=0.309-0.471) and radiotherapy (HR=0.477; 95%CI=0.396-0.575) experienced a reduced risk of death from prostate cancer. Conclusion: In conclusion, we found that age, educational level, presence of distant metastasis, surgery, radiotherapy, and hormone therapy were associated with the risk of specific mortality in patients with prostate cancer.

METHODOLOGY: A bibliographic review was conducted on PubMed using the descriptors "Hyperthermic Intraperitoneal Chemotherapy", "Cytoreduction Surgical Procedures" and "Ovarian Neoplasms", with filters for "Meta-analysis", "Randomized Controlled Trial" e "Systematic Review" in the last 6 years, resulting in the selection of 12 articles. OBJECTIVE: The objective of this article is to conduct a critical analysis of the efficacy of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) combined with Cytoreductive Surgery (CRS) in the treatment of Ovarian Cancer. The study aims to assess the effectiveness of this therapeutic approach based on recent and relevant evidence, elucidating both the observed clinical benefits and the limitations and challenges encountered. Through this review, the goal is to achieve a deeper understanding of the topic, offering insights that may inform and guide future research and clinical practices in the management of this malignancy. RESULT: A review of 12 articles addressed various aspects related to the use of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in combination with Cytoreductive Surgery (CRS) for the treatment of Ovarian Cancer. Zivanovic et al. demonstrated that, although well-tolerated, HIPEC with carboplatin did not result in a significant change in median overall survival or superior clinical outcomes, and therefore does not support its use during CRS for the treatment of recurrent ovarian cancer. Wang Y. et al. and Zhang et al., on the other hand, suggest the use of HIPEC in patients with primary ovarian cancer but emphasize the need for further studies to ensure the treatment's efficacy and safety. Other studies have discussed that the implementation of HIPEC in CRS, while not detrimental to the patient's quality of life, also did not show a significant improvement in it, as evidenced by Kim JH et al. and Qi et al. CONCLUSION: The reviewed articles demonstrated a duality regarding the efficacy of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) associated with Cytoreductive Surgery (CRS). Although benefits have been presented in the use of this chemotherapy, there are also studies that indicate indifference and a lack of significant positive results. The paper concludes that, although many promising studies exist, more scientific research is needed to better understand the efficacy and safety of the treatment.

Introduction Intraocular metastases from lung cancer are rare, with prevalence estimates ranging from less than 0.1% in symptomatic cases to 7.1% with systematic screening. Lung cancer, primarily non-small cell lung cancer (NSCLC), ranks as the second most common cause of ocular metastases, after breast cancer. ALK-rearranged NSCLC, which constitutes 2-7% of NSCLC cases, is particularly associated with brain metastases and affects younger, non-smoking patients. Despite its rarity, the prevalence and treatment responses of ocular metastases in ALK-rearranged NSCLC remain underexplored. This study reports three cases of ALK-rearranged NSCLC with ocular metastases treated with ALK TKIs. Case Summaries First Case: A 74-year-old female, initially treated with crizotinib, developed brain and ocular metastases. Transition to alectinib led to a durable response in both primary and metastatic sites. Second Case: A 55-year-old female presented with headaches and vision loss. Initially treated with crizotinib, she experienced ocular metastases and subsequent progression. Treatment with ceritinib and later lorlatinib resulted in significant improvement of visual acuity and disease control. Third Case: A 79-year-old male with advanced NSCLC and ocular involvement was initially treated with chemotherapy and lorlatinib. Lorlatinib proved effective, leading to a positive response in ocular and other metastatic sites. Discussion Ocular metastases are infrequent, often involving the choroid and presenting as unilateral and unifocal. Lung cancer is the second most frequent primary site of ocular metastases. Diagnostic differentiation between primary and metastatic ocular tumors is crucial, and imaging modalities play a significant role in this process. Advances in systemic treatments, particularly TKIs, have improved outcomes for patients with ocular metastases. ALK TKIs, like alectinib and lorlatinib, have shown efficacy in treating ocular metastases, with lorlatinib offering particularly promising results. Conclusion Ocular metastases, though rare, pose significant challenges in oncology. Advances in molecular testing and imaging are enhancing the differentiation of ocular neoplasms and metastases. For ALK-rearranged NSCLC, targeted therapies such as TKIs have improved patient outcomes, highlighting the importance of a multidisciplinary approach for effective management.

Background: Breast cancer remains highly prevalent among women globally, with a significant burden from metastatic disease. CDK4/6 inhibitors have transformed the treatment landscape for hormone receptor-positive, HER2-negative breast cancer. This study evaluates the cost-effectiveness of palbociclib, ribociclib, and abemaciclib within the Brazilian Unified Health System (SUS), focusing on their financial viability against the backdrop of required price reductions to meet cost-effectiveness thresholds. Objective: To calculate the incremental cost-effectiveness of CDK4/6 inhibitors in both first and second-line settings for patients with metastatic HR+ HER2- breast cancer from the perspective of the Unified Health System (SUS). Methods: Utilizing a Markov model over a 10-year horizon with data from phase 3 randomized trials, this study compares CDK4/6 inhibitors combined with endocrine therapy against endocrine therapy alone. The analysis incorporates life years gained (LYs) and incremental costs, framed within the SUS perspective. Sensitivity analyses were performed to address uncertainties and determine target prices that align with cost-effectiveness thresholds based on three times the Brazilian GDP per capita. Results: The economic analysis revealed that while CDK4/6 inhibitors provide significant clinical benefits for metastatic HR+ HER2- breast cancer, their current pricing far surpasses the SUS's Willingness-To-Pay (WTP) threshold. To align with the established cost-effectiveness thresholds, substantial price reductions are required. Specifically, in the first-line setting, ribociclib would need a 71% discount, and palbociclib would require up to a 94% reduction. In the second-line setting, necessary discounts range from 62% to 65%. These adjustments are essential to achieve the incremental cost-effectiveness ratios proposed, highlighting the need for recalibrated pricing to meet SUS economic standards. Conclusion: While CDK4/6 inhibitors offer significant therapeutic benefits for metastatic breast cancer, their adoption within the SUS at current prices is not economically sustainable. Substantial discounts are crucial to align with the cost-effectiveness criteria, highlighting the urgent need for drug price negotiations. This study provides crucial insights for policymakers, suggesting a strategic approach to pricing that ensures both clinical benefit and economic sustainability, ultimately enhancing patient access to these critical therapies.

Introduction: The 21-gene platform Oncotype DX helps to select women with early ER-positive breast cancer who won’t benefit from adjuvant chemotherapy. This study aimed to assess the cost-effectiveness of using the 21-gene platform for guiding treatment decisions in these patients from the perspective of the Brazilian public health system (SUS). The analysis focused on the costs and outcomes associated with the platform compared to the standard risk factor-based treatment approach. Methods: A cost-effectiveness analysis was conducted over a 6-month time horizon. The analysis was based on standard values payable by SUS for adjuvant hormone therapy and chemotherapy. We measured effectiveness in quality-adjusted life years (QALYs) and performed sensitivity analyses for different hypothetical costs of the 21-gene platform. Results: The decision tree model showed that, when considering all patients, using usual clinical risk factors alone was favored over the 21-gene platform for treatment decisions. However, for patients classified as high risk according to clinical factors, the 21-gene platform was cheaper than the usual clinical risk factors up to a platform cost of US$ 294.75. The incremental cost-effectiveness ratio (ICER) for the platform was lower than the 2022 Brazilian gross domestic product per capita (used as the Willingness to Pay) up to a 21-gene platform cost of US$ 1,505.46. Conclusion: The use of the 21-gene platform can be cost-effective for guiding treatment decisions in early ER-positive breast cancer treated by the SUS for patients at high risk based on clinical factors, if we consider a cost limit of US$ 1,505.46 per test.

Objectives Establish whether CP screening for computed tomography every 2 years is cost-effective in a high-risk population in the perspective of the Brazilian public health scenario Methods For the quantification of the tracked population: smokers and ex-smokers 20 packs/year, aged between 50 and 80 years, it has was used information provided by the IBGE 2020 Demographic Census (Instituto Brasileiro de Geografia e Estatística) and Vigitel 2023 (Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico). Additionally, a non-tracked comparative population was outlined from the FOSP database (Fundação Oncocentro de São Paulo). To define the patient's journey and direct and indirect costs, DATASUS (Departamento de Informática so SUS) bases and information from a expert’s panel to validate assumptions were used. For economic evaluations the models of Markov were used, considering the costs of treatment and outcomes. Results Based on cost- effectiveness analysis (CEA) it was possible to demonstrate that the adoption of a lung cancer (LC) screening strategy with low-dose computed tomography (LDCT) in a previously defined high-risk populations (age between 50 and 80 years and current smokers and former smokers with a smooth load of 20 packs-year) was cost-effective with positive QALY results. Conclusions This study confirmed the premise that the implementation of LC tracking protocol in high-risk populations is cost-effective as early diagnosis and treatment provide medical and social benefits, balancing health costs, higher standards of Overall Survival (OS) and Disease Free Progression (DFP) as well as the possibility of social and family reintegration of the patients, maintaining their productivity.

Ovarian cancer is one of the main causes of mortality among women, often diagnosed in advanced stages with tumors disseminated in the peritoneal cavity. Immunotherapy has shown benefits in solid tumors, including ovarian cancer. Cowpea Mosaic Virus (CPMV) is a promising plant virus for use in immunotherapy due to its immunostimulatory properties and inability to infect humans. This study aimed to review the current literature on the use of CPMV in ovarian cancer models. A search was carried out in the PUBMED database in July 2024 using the descriptors "Ovarian Cancer" and "Cowpea Mosaic Virus". Articles published in the last five years that evaluated the effectiveness of CPMV were included. The results show that weekly intraperitoneal (IP) treatment with the CPMV vaccine in situ significantly delayed tumor growth, improved survival, and prevented recurrence in murine models of ovarian cancer. Injection of CPMV into cancerous tissue induced a potent immune response, converting immunosuppressive neutrophils into pro-inflammatory ones, which killed tumor cells and recruited dendritic cells, T cells, and NK cells to the tumor site. This resulted in the induction of costimulatory molecules in CD11b myeloid cells and the upregulation of interleukin-6 and interferon-γ, in addition to the downregulation of IL-10 and TGF-β, associated with the activation of macrophages and neutrophils to an antitumor phenotype. Conversion of immunosuppressive myeloid cells into potent antigen-presenting cells significantly improved effector and memory CD4+ and CD8+ T cell responses by promoting the cytotoxic activity of systemic tumor-specific CD8+ T cells. Combining in situ vaccination with immune checkpoint therapy generated tumor-specific immune responses and lasting protection against relapse. When CPMV was conjugated to a polymer, prolonged immunological stimulation was observed, likely due to the continued presence of CPMV in the IP space. These findings suggest that the therapeutic effects achieved by in situ CPMV vaccination can be harnessed to potentiate systemic antitumor immunity, providing a robust rationale for CPMV clinical trials.