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Tiscoski KA, Giacomazzi J, Rocha MS, Gössling G, Werutsky G. Real-world data on triple-negative breast cancer in Latin America and the Caribbean. Ecancermedicalscience 2023; 17:1635. [PMID: 38414969 PMCID: PMC10898885 DOI: 10.3332/ecancer.2023.1635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Indexed: 02/29/2024] Open
Abstract
Breast cancer (BC) is the most prevalent cancer in women in Latin America and the Caribbean. We compiled real-world data (RWD) on the epidemiology, diagnosis, treatment, and patient outcomes of triple-negative breast cancer (TNBC), addressing the main barriers to optimal care in Latin America. The prevalence of TNBC varies between 11% and 38.5% of all BC cases diagnosed in the region, and TNBC primarily affects young patients. Delays in BC diagnosis, with consequent advanced disease stages and barriers to access efficient therapies, particularly due to high costs, negatively impact patient outcomes. Cancer clinical trials are an opportunity to access standard and novel therapies for patients with this aggressive BC subtype and thus must be prioritised. Finally, generating RWD and cost-effectiveness studies in a region with limited resources is critical for decision-makers to define the incorporation of new technologies for the treatment of BC.
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Affiliation(s)
- Katsuki Arima Tiscoski
- Santa Casa de Misericórdia de Porto Alegre, Rua Professor Annes Dias, Porto Alegre 90020-090, Brazil
- https://orcid.org/0000-0003-0074-4272
| | - Juliana Giacomazzi
- Latin American Cooperative Oncology Group (LACOG), Av Ipiranga, Porto Alegre 90619-900, Brazil
- https://orcid.org/0000-0001-5811-5140
| | - Matheus Soares Rocha
- Latin American Cooperative Oncology Group (LACOG), Av Ipiranga, Porto Alegre 90619-900, Brazil
- https://orcid.org/0000-0001-8972-7449
| | - Gustavo Gössling
- Latin American Cooperative Oncology Group (LACOG), Av Ipiranga, Porto Alegre 90619-900, Brazil
- https://orcid.org/0000-0002-4361-2889
| | - Gustavo Werutsky
- Latin American Cooperative Oncology Group (LACOG), Av Ipiranga, Porto Alegre 90619-900, Brazil
- https://orcid.org/0000-0001-6271-105X
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2
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Giacomazzi J, Ziegelmann PK, da Costa S, Bittar CM, Obst FM, Rosset C, Macedo GS, Bock H, Canal T, Paese MI, Benvenuti JL, Buj MC, Ashton-Prolla P, Goldim JR, Pozza R. Cancer Risk Factors in Southern Brazil: Report of a Comprehensive, Matched Case-Control Study. JCO Glob Oncol 2023; 9:e2300006. [PMID: 38060977 PMCID: PMC10723862 DOI: 10.1200/go.23.00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 06/26/2023] [Accepted: 10/02/2023] [Indexed: 12/17/2023] Open
Abstract
PURPOSE To evaluate cancer risk factors among cancer cases and controls from Southern Brazil, to analyze a multigene hereditary panel testing (MGPT, 26 genes) for breast cancer (BC) and colorectal cancer (CCR) cases diagnosed age younger than 50 years and to characterize them for hereditary cancer syndrome (HCS) phenotypes. METHODS A case-control (matched by age group and sex) study was conducted on regional cancer. Data on exposure factors and first-/second-degree family history of cancer (1/2FHC) were collected. The MGPT was performed using Illumina next-generation sequencing technology. RESULTS A total of 1,007 cases and 1,007 controls were included. The most frequent cancers were BC (n = 311), CCR (n = 147), prostate (n = 132), and lung cancers (n = 89). It was independently associated with cancer, 1/2FHC, tobacco consumption (TC), pesticide exposure (PE), solvent/glue exposure, and BMI <24. BC was associated with 1/2FHC, TC, and hormone replacement therapy use; CCR with 1/2FHC, TC, and BMI <24; prostate cancer with 1/2FHC, TC, and alcohol consumption; and lung cancer with 1/2FHC, TC, PE, and BMI <24. MGPT identified pathogenic/likely pathogenic mutations in 24 (32%) women with BC and in three (18%) women and four (24%) men diagnosed with CCR at under 50 years. Among the tested patients under 50 years with diagnosed BC and CCR, 98.6% and 97% present criteria for HCS, respectively. CONCLUSION This study confirmed the association of several factors associated with BC, CCR, prostate, and lung cancers and reinforced the importance of evaluating FHC and genetic testing, especially for patients under 50 years with diagnosed BC or CCR. A better understanding of population-specific cancer risk factors builds on sustainable data for developing prevention strategies. These efforts increase the commitment to early detection and surveillance.
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Affiliation(s)
- Juliana Giacomazzi
- Instituto Tacchini de Pesquisa em Saúde/Hospital Tacchini, Tacchini Sistema de Saúde, Bento Gonçalves, Brazil
- Programa de Pós-graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
- Hayde Health, Porto Alegre and Bento Gonçalves, Brazil
| | - Patricia Klarmann Ziegelmann
- Programa de Pós-graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil
- Departamento de Estatística, UFRGS, Porto Alegre, Brazil
| | - Samanta da Costa
- Instituto Tacchini de Pesquisa em Saúde/Hospital Tacchini, Tacchini Sistema de Saúde, Bento Gonçalves, Brazil
| | - Camila Matzenbacher Bittar
- Instituto Tacchini de Pesquisa em Saúde/Hospital Tacchini, Tacchini Sistema de Saúde, Bento Gonçalves, Brazil
| | - Fernando Mariano Obst
- Instituto do Câncer, Hospital Tacchini, Tacchini Sistema de Saúde, Bento Gonçalves, Brazil
- Oncoclínicas Porto Alegre, Porto Alegre, Brazil
- Hospital São Lucas da Pontifícia Universidade Católica de Porto Alegre, PUCRS, Porto Alegre, Brazil
| | - Clévia Rosset
- Laboratório de Medicina Genômica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Unidade de Pesquisa Laboratorial, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Gabriel S. Macedo
- Laboratório de Medicina Genômica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Hugo Bock
- Unidade de Pesquisa Laboratorial, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Thais Canal
- Instituto Tacchini de Pesquisa em Saúde/Hospital Tacchini, Tacchini Sistema de Saúde, Bento Gonçalves, Brazil
| | - Mari Ines Paese
- Instituto Tacchini de Pesquisa em Saúde/Hospital Tacchini, Tacchini Sistema de Saúde, Bento Gonçalves, Brazil
| | - Jean Lucas Benvenuti
- Instituto Tacchini de Pesquisa em Saúde/Hospital Tacchini, Tacchini Sistema de Saúde, Bento Gonçalves, Brazil
| | - Maria Carolina Buj
- Instituto Tacchini de Pesquisa em Saúde/Hospital Tacchini, Tacchini Sistema de Saúde, Bento Gonçalves, Brazil
- Hayde Health, Porto Alegre and Bento Gonçalves, Brazil
| | - Patricia Ashton-Prolla
- Laboratório de Medicina Genômica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Departamento de Genética, UFRGS, Porto Alegre, Brazil
| | - José Roberto Goldim
- Serviço de Bioética, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Faculdade de Medicina, PUCRS, Porto Alegre, Brazil
| | - Roberta Pozza
- Instituto Tacchini de Pesquisa em Saúde/Hospital Tacchini, Tacchini Sistema de Saúde, Bento Gonçalves, Brazil
- Hayde Health, Porto Alegre and Bento Gonçalves, Brazil
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3
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Moriguchi-Jeckel CM, Madke RR, Radaelli G, Viana A, Nabinger P, Fernandes B, Gössling G, Berdichevski EH, Vilas E, Giacomazzi J, Rocha MS, Borges JA, Hoffmann E, Greggio S, Venturin GT, Barrios CH, Zaffaroni F, Werutsky G, da Costa JC. Clinical validation and diagnostic accuracy of 99mTc-EDDA/HYNIC-TOC compared to 111In-DTPA-octreotide in patients with neuroendocrine tumours: the LACOG 0214 study. Ecancermedicalscience 2023; 17:1582. [PMID: 37533941 PMCID: PMC10393301 DOI: 10.3332/ecancer.2023.1582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Indexed: 08/04/2023] Open
Abstract
99mTc-EDDA/HYNIC-TOC is an easily available and cheaper radionuclide that could be used for somatostatin-receptor-based imaging of neuroendocrine tumours (NETs). We aimed to evaluate the diagnostic performance of 99mTc-EDDA/HYNIC-TOC compared to111In-DTPA-octreotide in patients (pts) with NETs. We performed a prospective diagnostic study including pts with biopsy-confirmed NET and at least one visible lesion at conventional imaging. Two independent nuclear medicine physicians evaluated pts who underwent 99mTc and 111In scans and images. The primary outcome was comparative diagnostic accuracy of 99mTc and 111In. Secondary outcomes include safety. Nine pts were included and performed 14 paired scans. Overall, 126 lesions were identified. 99mTc demonstrated superior sensitivity both when all images were analysed (93.7, 95% CI 88.1% - 96.8% versus 74.8%, 95% CI 66.6 - 81.6%, p < 0.001) and when liver-specific images were analysed (97.8%, 95% CI 92.7% - 99.5% versus 85.1%, 95% CI 76.6% - 91.0%, p < 0.001). 99mTc was also associated with a lower negative likelihood ratio (LR) (0.002, 95% CI 0.009 - 0.1 versus 0.19, 95% CI 0.12 - 0.42, p = 0.009) when evaluating hepatic lesions. Adverse events happened in 3 pts after 111In and in 2 pts after 99mTc, all grade 1. The 99mTc demonstrated a higher sensitivity overall and a better negative LR in liver-specific images compared to 111In in pts with NETs. Our findings suggest that 99mTc is an alternative to 111In and is especially useful in ruling out liver metastases. NCT02691078.
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Affiliation(s)
- Cristina M Moriguchi-Jeckel
- Instituto do Cérebro do Rio Grande do Sul – Brain Institute (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Av Ipiranga, Porto Alegre 90619-900, Brazil
- Escola de Ciências da Saúde e da Vida (PUCRS), Av Ipiranga, Porto Alegre 90619-900, Brazil
| | | | - Graciane Radaelli
- Instituto do Cérebro do Rio Grande do Sul – Brain Institute (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Av Ipiranga, Porto Alegre 90619-900, Brazil
| | - Alice Viana
- Grupo RPH, Av Ipiranga, Porto Alegre 90619-900, Brazil
| | | | | | - Gustavo Gössling
- Latin American Cooperative Oncology Group (LACOG), Av Ipiranga, Porto Alegre 90619-900, Brazil
| | | | - Eduardo Vilas
- Hospital São Lucas da PUCRS, Av Ipiranga, Porto Alegre 90610-001, Brazil
| | - Juliana Giacomazzi
- Latin American Cooperative Oncology Group (LACOG), Av Ipiranga, Porto Alegre 90619-900, Brazil
| | - Matheus Soares Rocha
- Latin American Cooperative Oncology Group (LACOG), Av Ipiranga, Porto Alegre 90619-900, Brazil
| | | | - Elias Hoffmann
- P3DMED, Rua Gomes Jardim, 201 Sala 1109A, Porto Alegre 90620-130, Brazil
- Núcleo de Imagens Médicas (Nimed), P96A do Tecnopuc – PUCRS, Porto Alegre, Brazil
| | - Samuel Greggio
- Instituto do Cérebro do Rio Grande do Sul – Brain Institute (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Av Ipiranga, Porto Alegre 90619-900, Brazil
- Escola de Ciências da Saúde e da Vida (PUCRS), Av Ipiranga, Porto Alegre 90619-900, Brazil
| | - Gianina T Venturin
- Instituto do Cérebro do Rio Grande do Sul – Brain Institute (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Av Ipiranga, Porto Alegre 90619-900, Brazil
| | - Carlos H Barrios
- Latin American Cooperative Oncology Group (LACOG), Av Ipiranga, Porto Alegre 90619-900, Brazil
| | - Facundo Zaffaroni
- Latin American Cooperative Oncology Group (LACOG), Av Ipiranga, Porto Alegre 90619-900, Brazil
| | - Gustavo Werutsky
- Latin American Cooperative Oncology Group (LACOG), Av Ipiranga, Porto Alegre 90619-900, Brazil
| | - Jaderson C da Costa
- Instituto do Cérebro do Rio Grande do Sul – Brain Institute (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Av Ipiranga, Porto Alegre 90619-900, Brazil
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Gössling G, Rebelatto TF, Villarreal-Garza C, Ferrigno AS, Bretel D, Sala R, Giacomazzi J, William WN, Werutsky G. Current Scenario of Clinical Cancer Research in Latin America and the Caribbean. Curr Oncol 2023; 30:653-662. [PMID: 36661699 PMCID: PMC9858272 DOI: 10.3390/curroncol30010050] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/22/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023] Open
Abstract
In Latin America and the Caribbean (LAC), progress has been made in some national and regional cancer control initiatives, which have proved useful in reducing diagnostic and treatment initiation delays. However, there are still significant gaps, including a lack of oncology clinical trials. In this article, we will introduce the current status of the region's clinical research in cancer, with a special focus on academic cancer research groups and investigator-initiated research (IIR) initiatives. Investigators in LAC have strived to improve cancer research despite drawbacks and difficulties in funding, regulatory timelines, and a skilled workforce. Progress has been observed in the representation of this region in clinical trial development and conduct, as well as in scientific productivity. However, most oncology trials in the region have been sponsored by pharmaceutical companies, highlighting the need for increased funding from governments and private foundations. Improvements in obtaining and/or strengthening the LAC cancer research group's financing will provide opportunities to address cancer therapies and management shortcomings specific to the region. Furthermore, by including this large, ethnic, and genetically diverse population in the world's research agenda, one may bridge the gap in knowledge regarding the applicability of results of clinical trials now mainly conducted in populations from the Northern Hemisphere.
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Affiliation(s)
- Gustavo Gössling
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre 90619-900, RS, Brazil
| | - Taiane F. Rebelatto
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre 90619-900, RS, Brazil
| | - Cynthia Villarreal-Garza
- Breast Cancer Center Hospital Zambrano Hellion TecSalud—Tecnologico de Monterrey, Monterrey 66278, NL, Mexico
| | - Ana S. Ferrigno
- Breast Cancer Center Hospital Zambrano Hellion TecSalud—Tecnologico de Monterrey, Monterrey 66278, NL, Mexico
| | - Denisse Bretel
- Grupo de Estudios Clínicos Oncológicos del Perú (GECO PERU), Lima 15038, Peru
| | - Raul Sala
- Grupo Argentino de Investigación Clínica en Oncología (GAICO), Rosario S2124KBO, Argentina
| | - Juliana Giacomazzi
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre 90619-900, RS, Brazil
| | - William N. William
- Hospital BP—Beneficência Portuguesa de São Paulo, São Paulo 01323-001, SP, Brazil
| | - Gustavo Werutsky
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre 90619-900, RS, Brazil
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5
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Dos Santos RP, Silva D, Menezes A, Lukasewicz S, Dalmora CH, Carvalho O, Giacomazzi J, Golin N, Pozza R, Vaz TA. Automated healthcare-associated infection surveillance using an artificial intelligence algorithm. Infect Prev Pract 2021; 3:100167. [PMID: 34471868 PMCID: PMC8387762 DOI: 10.1016/j.infpip.2021.100167] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022] Open
Abstract
Healthcare-associated infections (HAIs) are among the most common adverse events in hospitals. We used artificial intelligence (AI) algorithms for infection surveillance in a cohort study. The model correctly detected 67 out of 73 patients with HAIs. The final model used a multilayer perceptron neural network achieving an area under receiver operating curve (AUROC) of 90.27%; specificity of 78.86%; sensitivity of 88.57%. Respiratory infections had the best results (AUROC ≥93.47%). The AI algorithm could identify most HAIs. AI is a feasible method for HAI surveillance, has the potential to save time, promote accurate hospital-wide surveillance, and improve infection prevention performance.
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Affiliation(s)
| | - D Silva
- Qualis Soluções em Infectologia, Brazil
| | - A Menezes
- Qualis Soluções em Infectologia, Brazil
| | | | | | | | | | | | | | - T A Vaz
- Qualis Soluções em Infectologia, Brazil
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6
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Vianna FSL, Giacomazzi J, Oliveira Netto CB, Nunes LN, Caleffi M, Ashton-Prolla P, Camey SA. Performance of the Gail and Tyrer-Cuzick breast cancer risk assessment models in women screened in a primary care setting with the FHS-7 questionnaire. Genet Mol Biol 2019; 42:232-237. [PMID: 31170278 PMCID: PMC6687344 DOI: 10.1590/1678-4685-gmb-2018-0110] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 11/12/2018] [Indexed: 12/21/2022] Open
Abstract
Breast cancer (BC) risk assessment models base their estimations on different aspects of a woman's personal and familial history. The Gail and Tyrer-Cuzick models are the most commonly used, and BC risks assigned by them vary considerably especially concerning familial history. In this study, our aim was to compare the Gail and Tyrer-Cuzick models after initial screening for familial history of cancer in primary care using the FHS-7 questionnaire. We compared 846 unrelated women with at least one positive answer to any of the seven FHS-7 questions (positive group) and 892 unrelated women that answered negatively (negative group). Concordance between BC risk estimates was compared by Bland-Altman graphics. Mean BC risk estimates were higher using the Tyrer-Cuzick Model in women from the positive group, while women from the negative group had higher BC risk estimates using the Gail model. With increasing estimates, discordance also increased, mainly in the FHS-7 positive group. Our results show that in women with a familial history of cancer, the Gail model underestimates risk and the Tyrer-Cuzick seems to be more appropriate. FHS-7 can be a useful tool for the identification of women with higher breast cancer risks in the primary care setting.
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Affiliation(s)
- Fernanda Sales Luiz Vianna
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Laboratório de Medicina Genômica, Centro de Pesquisa Experimental do Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | | | - Luciana Neves Nunes
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Maira Caleffi
- Associação Hospitalar Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Patricia Ashton-Prolla
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Laboratório de Medicina Genômica, Centro de Pesquisa Experimental do Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Suzi Alves Camey
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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7
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Albuquerque C, Debiasi M, Werutsky G, Uema D, Cronenberger E, Cordeiro de Lima VC, de Sant'ana RO, Bines J, Santi PX, Goés RS, Liedke P, Batista MLM, Dybal V, Nerón YV, Beato CA, Borges G, Giacomazzi J, dos Santos LV, Ismael G, Rosa DD, Azambuja A, Andrade D, Martinez-Mesa J, Zaffaroni F, Barrios CH. Abstract P1-17-10: Survival outcomes related to health care coverage in breast cancer patients with brain metastases in Brazil: A sub-analysis from the LACOG-0312 study. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-17-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
The incidence of brain metastases among women with metastatic breast cancer (MBC) ranges from 10 to 30% depending of breast cancer (BC) subtype. Inequities in the access to optimal treatment and shorter survival of BC by type of health care coverage were previously reported in an observational study in Brazil. The present analysis aims to analyze the impact of the type of health care coverage on survival outcomes of patients with MBC and brain involvement.
Methods
LACOG-0312 is a retrospective cohort study that enrolled patients with metastatic or locally advanced/recurrent unresectable BC diagnosed during 2012 in Brazil. Overall survival (OS) was defined as the time from the diagnosis of brain metastases and death from any cause. Comparisons were made using the Kaplan-Meier method based on the type of health care coverage (public vs. private) among patients who developed brain metastases. Cox regression analysis was performed for identification of independent prognostic factors associated with survival after brain metastases diagnosis.
Results
Among the 690 MBC patients included in the LACOG-0312 study, 145 (21%) were diagnosed with brain metastases. Of them, 94 (71,75%) were covered by the Brazilian public health care and 37 (28,25%) had private coverage. Baseline characteristics such as age at MBC diagnosis, stage IV at diagnosis and tumor subtypes were similar between both groups.
Median time to develop brain metastases after diagnosis of MBC was 14 months in the whole population with no differences between public and private patients (13 vs. 17 months p=0.172).
Median OS from the date of brain metastases diagnosis was similar for both groups: 10.0 months in private and 9.0 months in public health insured patients (HR 0.92 – 95%CI 0.55-1.51; p=0.729). In a multivariable analysis including type of health care coverage, only the triple negative BC subtype was associated with a worse survival post brain metastases diagnosis.
Conclusion
Our study indicates that health care coverage is not associated with survival outcomes in patients with MBC and brain metastases. Potential differences in the access to optimal care such as radiotherapy, surgery and systemic treatments may not play a significant role in the survival of theses patients possibly due to small clinical benefit of the current treatment options for brain metastases in breast cancer.
Citation Format: Albuquerque C, Debiasi M, Werutsky G, Uema D, Cronenberger E, Cordeiro de Lima VC, de Sant'ana RO, Bines J, Santi PX, Goés RS, Liedke P, Batista MLM, Dybal V, Nerón YV, Beato CA, Borges G, Giacomazzi J, dos Santos LV, Ismael G, Rosa DD, Azambuja A, Andrade D, Martinez-Mesa J, Zaffaroni F, Barrios CH. Survival outcomes related to health care coverage in breast cancer patients with brain metastases in Brazil: A sub-analysis from the LACOG-0312 study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-17-10.
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Affiliation(s)
- C Albuquerque
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - M Debiasi
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - G Werutsky
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - D Uema
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - E Cronenberger
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - VC Cordeiro de Lima
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - RO de Sant'ana
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - J Bines
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - PX Santi
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - RS Goés
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - P Liedke
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - MLM Batista
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - V Dybal
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - YV Nerón
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - CA Beato
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - G Borges
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - J Giacomazzi
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - LV dos Santos
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - G Ismael
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - DD Rosa
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - A Azambuja
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - D Andrade
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - J Martinez-Mesa
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - F Zaffaroni
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
| | - CH Barrios
- Hospital São Lucas Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centros de Novos Tratamentos Itajaí, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e
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Werutsky G, Zaffaroni F, Uema D, Cronenberger E, Cordeiro de Lima VC, de Sant'ana RO, Bines J, Santi PX, Goés RS, Liedke P, Batista MLM, Dybal V, Nerón YV, Beato CA, Borges G, Giacomazzi J, dos Santos LV, Ismael G, Rosa DD, Azambuja A, Andrade D, Martinez-Mesa J, Debiasi M, Barrios CH. Abstract P4-10-17: Survival outcomes related to health care coverage in metastatic breast cancer in Brazil: A sub-analysis from the LACOG-0312 study. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-10-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Metastatic breast cancer (MBC) is an incurable disease in which latest therapies have evolving and improving patients survival. Inequities in the access to optimal treatment and shorter survival of BC by type of health care coverage were previously reported in an observational study in Brazil. In Brazil patients with private health coverage have access to the most recent therapies, however the public health system does not provide several therapies approved for the treatment of MBC such as everolimus, trastuzuman, eribulin, TDM-1, pertuzumab among others. The present analysis aims to analyze the impact of the type of health care coverage on survival outcomes of patients with MBC.
Methods
LACOG-0312 is a retrospective cohort study that enrolled patients with metastatic or locally advanced/recurrent unresectable BC diagnosed during 2012 in Brazil. Overall survival was defined as the time from the diagnosis of MBC and death from any cause. Comparisons were made using the Kaplan-Meier method based on the type of health care coverage (public vs. private). Cox regression analysis was performed for identification of independent prognostic factors associated with overall survival.
Results
A total of 634 patients with MBC were included in the study. Baseline characteristics by type of health care coverage was similar for visceral disease (43% in public and 44% in private, p=0.78), age at MBC diagnosis (median 62 years in public and 64 years in private, p=0.25), BC subtype (p=0.89), however more patients public insured were metastatic at diagnosis (42% vs. 33%) and had performance status >= 2 (12% vs. 3%).
The proportion of patients that received any first-line systemic therapy was similar in both groups (95.2% in public and 95.5% in private, p=1.0), however more patients with private insurance received second (82% vs. 71.6%, p=0.013) and third line (56% vs. 45%, p=0.024) therapy compared to public health covered patients.
OS from the date of MBC diagnosis in whole population was 36 months. There was no difference in terms of OS between private (42 months) and public (35 months) health insured patients (p=0.65). OS by BC subtype was 15 months for triple negative, 23 months in HER2 positive, 44 and 42 months for Luminal A and B respectively. There was no difference in OS by type of health insurance coverage in any BC subtypes.
In a multivariate analysis type of health care coverage did not associate with survival, only triple negative (HR (95% CI) – 3.495 (2.448 - 4.989); p <0.001), HER2 positive (HR (95% CI) - 2.287 (1.394 - 3.572); p = 0.001) BC subtypes and visceral metastases (HR (95% CI) – 1.413 (1.075 - 1.858); p <0.013) were correlated with a worse survival.
Conclusion
Our study suggestes that health care coverage is not associated with survival outcomes in patients with MBC. Potential differences in the access to optimal systemic treatments may not play a significant role in the survival of these patients. Real-world studies addressing the impact of new cancer therapies for different BC subtypes in MBC are needed.
Citation Format: Werutsky G, Zaffaroni F, Uema D, Cronenberger E, Cordeiro de Lima VC, de Sant'ana RO, Bines J, Santi PX, Goés RS, Liedke P, Batista MLM, Dybal V, Nerón YV, Beato CA, Borges G, Giacomazzi J, dos Santos LV, Ismael G, Rosa DD, Azambuja A, Andrade D, Martinez-Mesa J, Debiasi M, Barrios CH. Survival outcomes related to health care coverage in metastatic breast cancer in Brazil: A sub-analysis from the LACOG-0312 study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-17.
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Affiliation(s)
- G Werutsky
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - F Zaffaroni
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - D Uema
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - E Cronenberger
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - VC Cordeiro de Lima
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - RO de Sant'ana
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - J Bines
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - PX Santi
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - RS Goés
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - P Liedke
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - MLM Batista
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - V Dybal
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - YV Nerón
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - CA Beato
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - G Borges
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - J Giacomazzi
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - LV dos Santos
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - G Ismael
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - DD Rosa
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - A Azambuja
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - D Andrade
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - J Martinez-Mesa
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - M Debiasi
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
| | - CH Barrios
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; A.C. Camargo Cancer Center, São Paulo, Brazil; Hospital do Câncer do Ceará -ICC, Fortaleza, Brazil; Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Centro de Estudos e Pesquisa de Hematologia (CEPHO), Santo André, Brazil; Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil; Clínica AMO, Salvador, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, Brazil; Hospital Amaral Carvalho, Jaú, Brazil; Centro de Novos Tratamentos Itajaí - Clínica de Neoplasias Litoral, Itajaí, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, Brazil; Ho
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Barrios CH, Uema D, Cronenberger E, Lima V, Bines J, de Sant'ana RO, Batista ML, Dybal V, Liedke P, Beato C, Nerón YV, Giacomazzi J, dos Santos L, Ismael G, Azambuja A, Andrade D, Rosa DD, Borges G, Mano M, Martinez-Mesa J, Zaffaroni F, Werutsky G. Abstract P6-16-04: Real World data and patterns of care of metastatic breast cancer (MBC) in Brazil: First results of LACOG 0312 retrospective study. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-16-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Randomised clinical trials (RCT) are considered a gold standard generating efficacy and safety data supporting drug approval. However, real world data (RWD) reflecting health care delivery is becoming increasingly important. RWD on patient profiles and patterns of care in MBC are scarce in developing countries. As an example, observational studies suggest that despite guideline recommendations clearly indicating ET for hormone receptor positive MBC, a considerable proportion of patients in clinical practice begin chemotherapy in early lines of therapy. This pragmatic information addresses the uptake and applicability of the RCT results and should be able to help informing health care planning complementing RCT generated data. The objective of this study is to describe patient characteristics and evaluate actual physician-reported treatments for MBC in Brazil.
Methods
This analysis addresses the first 362 patients included in LACOG-0312, a retrospective study planning to recruit over 700 patients (cut-off date April 30th 2016) with recurrent locally advanced or MBC diagnosed in 2012 in 18 institutions across Brazil. Patient characteristics, type of health insurance coverage, treatment and survival outcome were analysed.
Results
Median age at BC diagnosis was 53 years and 37% were premenopausal. Regarding the educational level, 63.2% had completed elementary (primary) schooling, 75.7% were covered by the public health system while 24.3% had some form of private coverage. 70% of patients had hormone receptor positive (HR+) and 18% had HER2 positive tumors. Median disease free survival time from surgery was 29 months. Interestingly, 30% of patients underwent a biopsy of a metastatic site. Of the 362 patients, 349 (96.9%) received some form of palliative systemic therapy. Median time from diagnosis of metastatic disease to first-line therapy initiation was 46 days but a significant difference was noted between patients with public versus private health insurance (50 vs. 33 days p=0.012). Half of the patients received at least 3 lines of therapy (chemo or endocrine) to a maximum of 9 lines. In patients with HR+ tumors, endocrine therapy was administered in 47% in first, 65% in second and 61% in third-line, respectively. Median overall survival (OS) from diagnosis of metastatic disease was 34 months (CI 95%: 25.7-44.3) and no differences in OS were observed between patients with public or private coverage (34 months vs. 35 months p=0.808). Causes of death were cancer in 85.2% of patients and treatment toxicity in 3.6%.
Conclusion
Our study included a population with predominantly low educational level and mostly public health insurance. This likely corresponds to the majority of cases and reflects cancer care patterns in Brazil and many developing countries. A considerable proportion of patients were premenopausal at MBC diagnosis. More than half of HR+ patients received at least 3 lines of endocrine therapy although 54% of them had chemotherapy as the first systemic treatment. Patients from the public health system experienced a delay in starting first-line therapy but this didn't seem to jeopardize cancer outcomes in this setting.
Citation Format: Barrios CH, Uema D, Cronenberger E, Lima V, Bines J, de Sant'ana RO, Batista ML, Dybal V, Liedke P, Beato C, Nerón YV, Giacomazzi J, dos Santos L, Ismael G, Azambuja A, Andrade D, Rosa DD, Borges G, Mano M, Martinez-Mesa J, Zaffaroni F, Werutsky G. Real World data and patterns of care of metastatic breast cancer (MBC) in Brazil: First results of LACOG 0312 retrospective study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-16-04.
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Affiliation(s)
- CH Barrios
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - D Uema
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - E Cronenberger
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - V Lima
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - J Bines
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - RO de Sant'ana
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - ML Batista
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - V Dybal
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - P Liedke
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - C Beato
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - YV Nerón
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - J Giacomazzi
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - L dos Santos
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - G Ismael
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - A Azambuja
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - D Andrade
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - DD Rosa
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - G Borges
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - M Mano
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - J Martinez-Mesa
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - F Zaffaroni
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
| | - G Werutsky
- PUCRS Scholl of Medicine - Centro de Pesquisa em Oncologia, Porto Alegre, RS, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, CE, Brazil; A.C. Camargo Cancer Center, São Paulo, SP, Brazil; Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil; Hospital Haroldo Juaçaba - Instituto do Câncer do Ceará, Fortaleza, CE, Brazil; Núcleo de Oncologia da Bahia (NOB), Salvador, BA, Brazil; Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Hospital Amaral Carvalho, Jaú, SP, Brazil; Centro de Pesquisa Clínica – CEPON, Florianópolis, SC, Brazil; Hospital Tacchini, Bento Gonçalves, RS, Brazil; Instituto de Ensino e Pesquisa São Lucas, São Paulo, SP, Brazil; Centro de Hematologia e Oncologia de Rio Claro, Rio Claro, SP, Brazil; Instituto do Câncer Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Instituto Oncológico de Ribeir
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10
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Villacis RAR, Basso TR, Canto LM, Pinheiro M, Santiago KM, Giacomazzi J, de Paula CAA, Carraro DM, Ashton-Prolla P, Achatz MI, Rogatto SR. Rare germline alterations in cancer-related genes associated with the risk of multiple primary tumor development. J Mol Med (Berl) 2017; 95:523-533. [PMID: 28093616 DOI: 10.1007/s00109-017-1507-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 12/07/2016] [Accepted: 01/06/2017] [Indexed: 12/13/2022]
Abstract
Multiple primary tumors (MPT) have been described in carriers of inherited cancer predisposition genes. However, the genetic etiology of a large proportion of MPT cases remains unclear. We reviewed 267 patients with hereditary cancer predisposition syndromes (HCPS) that underwent genetic counseling and selected 22 patients with MPT to perform genomic analysis (CytoScan HD Array, Affymetrix) aiming to identify new alterations related to a high risk of developing MPT. Twenty patients had a positive family history of cancer and 11 met phenotypic criteria for HCPS. Genetic testing for each of the genes associated with these syndromes revealed negative results for pathogenic mutations. Seventeen rare germline copy number variations (CNVs) covering 40 genes were identified in 11 patients, including an EPCAM/MSH2 deletion in one Lynch syndrome patient. An enrichment analysis revealed a significant number of genes (where the CNVs are mapped) associated with carcinogenesis and/or related to functions implicated with tumor development, such as proliferation and cell survival. An interaction network analysis highlighted the importance of TP53 pathway in cancer emergence. A high number of germline copy-neutral loss of heterozygosity (cnLOH) was identified in nine cases, particularly in two patients. Eighteen genes were covered by both rare CNVs and cnLOH, including 14 related to tumorigenesis and seven genes (ABCC1, KDM4C, KIAA0430, MYH11, NDE1, PIWIL2, and ULK2) specifically associated with cellular growth and proliferation. Overall, we identified 14 cases with rare CNVs and/or cnLOH that may contribute to the risk of MPT development. KEY MESSAGE CNVs may explain the risk of hereditary cancer syndromes in MPT patients. CNVs affecting genes related to cancer are candidates to be involved in MPT risk. EPCAM/MSH2 deletions should be investigated in patients suspected to have LS. Gene enrichment related to the TP53 network is associated with MPT development. cnLOH and CNVs contribute to the risk of MPT development.
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Affiliation(s)
- Rolando A R Villacis
- International Center for Research (CIPE), A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Tatiane R Basso
- International Center for Research (CIPE), A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Luisa M Canto
- International Center for Research (CIPE), A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Maísa Pinheiro
- International Center for Research (CIPE), A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Karina M Santiago
- Department of Oncogenetics, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Juliana Giacomazzi
- Department of Genetics, Federal University of Rio Grande do Sul (UFRGS) and Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Cláudia A A de Paula
- International Center for Research (CIPE), A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Dirce M Carraro
- International Center for Research (CIPE), A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Patrícia Ashton-Prolla
- Department of Genetics, Federal University of Rio Grande do Sul (UFRGS) and Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Maria I Achatz
- Department of Oncogenetics, A.C. Camargo Cancer Center, São Paulo, SP, Brazil.,Division of Cancer Epidemiology and Genetics, National Cancer Institute (NCI)/National Institutes of Health (NIH), Bethesda, MD, USA
| | - Silvia R Rogatto
- International Center for Research (CIPE), A.C. Camargo Cancer Center, São Paulo, SP, Brazil. .,Department of Clinical Genetics, Vejle Sygehus, Kabbeltoft 25, 7100, Vejle, Denmark. .,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
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11
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Fitarelli-Kiehl M, Macedo GS, Schlatter RP, Koehler-Santos P, Matte UDS, Ashton-Prolla P, Giacomazzi J. Comparison of multiple genotyping methods for the identification of the cancer predisposing founder mutation p.R337H in TP53. Genet Mol Biol 2016; 39:203-9. [PMID: 27275664 PMCID: PMC4910550 DOI: 10.1590/1678-4685-gmb-2014-0351] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 09/22/2015] [Indexed: 01/04/2023] Open
Abstract
Germline mutations in the TP53 gene are associated with Li-Fraumeni and Li-Fraumeni-Like Syndromes, characterized by increased predisposition to early-onset cancers. In Brazil, the prevalence of the TP53-p.R337H germline mutation is exceedingly high in the general population and in cancer-affected patients, probably as result of a founder effect. Several genotyping methods are used for the molecular diagnosis of LFS/LFL, however Sanger sequencing is still considered the gold standard. We compared performance, cost and turnaround time of Sanger sequencing, PCR-RFLP, TaqMan-PCR and HRM in the p.R337H genotyping. The performance was determined by analysis of 95 genomic DNA samples and results were 100% concordant for all methods. Sequencing was the most expensive method followed by TaqMan-PCR, PCR-RFLP and HRM. The overall cost of HRM increased with the prevalence of positive samples, since confirmatory sequencing must be performed when a sample shows an abnormal melting profile, but remained lower than all other methods when the mutation prevalence was less than 2.5%. Sequencing had the highest throughput and the longest turnaround time, while TaqMan-PCR showed the lowest turnaround and hands-on times. All methodologies studied are suitable for the detection of p.R337H and the choice will depend on the application and clinical scenario.
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Affiliation(s)
- Mariana Fitarelli-Kiehl
- Programa de Pós-Graduação em Genética e Biologia Molecular,
Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Laboratório de Medicina Genômica, Centro de Pesquisa Experimental,
Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Gabriel S. Macedo
- Programa de Pós-Graduação em Genética e Biologia Molecular,
Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Laboratório de Medicina Genômica, Centro de Pesquisa Experimental,
Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Rosane Paixão Schlatter
- Grupo de Pesquisa e Pós-Graduação (GPPG), Hospital de Clínicas de
Porto Alegre, and Programa de Pós Graduação em Cardiologia, UFRGS Porto Alegre, RS,
Brazil
| | - Patricia Koehler-Santos
- Unidade de Análises Moleculares e de Proteínas (UAMP), Centro de
Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS,
Brazil
| | - Ursula da Silveira Matte
- Programa de Pós-Graduação em Genética e Biologia Molecular,
Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Unidade de Análises Moleculares e de Proteínas (UAMP), Centro de
Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS,
Brazil
- Departamento de Genética, Universidade Federal do Rio Grande do Sul
(UFRGS), Porto Alegre, RS, Brazil
| | - Patricia Ashton-Prolla
- Programa de Pós-Graduação em Genética e Biologia Molecular,
Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Laboratório de Medicina Genômica, Centro de Pesquisa Experimental,
Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
- Departamento de Genética, Universidade Federal do Rio Grande do Sul
(UFRGS), Porto Alegre, RS, Brazil
| | - Juliana Giacomazzi
- Laboratório de Medicina Genômica, Centro de Pesquisa Experimental,
Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
- Departamento de Genética, Universidade Federal do Rio Grande do Sul
(UFRGS), Porto Alegre, RS, Brazil
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12
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Fitarelli-Kiehl M, Giacomazzi J, Santos-Silva P, Graudenz MS, Palmero EI, Michelli RAD, Achatz MI, de Toledo Osório CAB, de Faria Ferraz VE, Picanço CG, Ashton-Prolla P. The breast cancer immunophenotype of TP53-p.R337H carriers is different from that observed among other pathogenic TP53 mutation carriers. Fam Cancer 2016; 14:333-6. [PMID: 25564201 DOI: 10.1007/s10689-015-9779-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Germline TP53 mutations are associated with Li-Fraumeni syndrome, an autosomal dominant disorder characterized by a predisposition to multiple early-onset cancers including breast cancer (BC), the most prevalent tumor among women. The majority of germline TP53 mutations are clustered within the DNA-binding domain of the gene, disrupting the structure and function of the protein. A specific germline mutation in the tetramerization domain of p53, p.R337H, was reported at a high frequency in Southern and Southeastern Brazil. This mutation appears to result in a more subtle defect in the protein, which becomes functionally deficient only under particular conditions. Recent studies show that the BC phenotype in TP53 mutation carriers is often HER2 positive (63-83%). Considering that the immunophenotype of BC among p.R337H carriers has not been reported, we reviewed immunohistochemistry data of 66 p.R337H carriers in comparison with 12 patients with other non-functional TP53 germline mutation. Although 75% of carriers of these mutations showed significant HER2 overexpression (3+), corroborating previous studies, only 22.7% of p.R337H patients had BC overexpressing HER2. These results reinforce the notion that different germline mutations in TP53 may predispose to BC via different mechanisms.
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Affiliation(s)
- Mariana Fitarelli-Kiehl
- Post-Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil,
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13
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Giacomazzi J, Baethgen L, Carneiro LC, Millington MA, Denning DW, Colombo AL, Pasqualotto AC. The burden of serious human fungal infections in Brazil. Mycoses 2015; 59:145-50. [PMID: 26691607 DOI: 10.1111/myc.12427] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2015] [Indexed: 01/07/2023]
Abstract
In Brazil, human fungal infections are prevalent, however, these conditions are not officially reportable diseases. To estimate the burden of serious fungal diseases in 1 year in Brazil, based on available data and published literature. Historical official data from fungal diseases were collected from Brazilian Unified Health System Informatics Department (DATASUS). For fungal diseases for which no official data were available, assumptions of frequencies were made by estimating based on published literature. The incidence (/1000) of hospital admissions for coccidioidomycosis was 7.12; for histoplasmosis, 2.19; and for paracoccidioidomycosis, 7.99. The estimated number of cryptococcal meningoencephalitis cases was 6832. Also, there were 4115 cases of Pneumocystis pneumonia in AIDS patients per year, 1 010 465 aspergillosis and 2 981 416 cases of serious Candida infections, including invasive and non-invasive diseases. In this study, we demonstrate that more than 3.8 million individuals in Brazil may be suffering from serious fungal infections, mostly patients with malignant cancers, transplant recipients, asthma, previous tuberculosis, HIV infection and those living in endemic areas for truly pathogenic fungi. The scientific community and the governmental agencies should work in close collaboration in order to reduce the burden of such complex, difficult-to-diagnose and hard to treat diseases.
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Affiliation(s)
- Juliana Giacomazzi
- Postgraduation Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFSCPA), Porto Alegre, Brazil
| | - Ludmila Baethgen
- Postgraduation Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFSCPA), Porto Alegre, Brazil
| | - Lilian C Carneiro
- Postgraduation Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFSCPA), Porto Alegre, Brazil
| | - Maria Adelaide Millington
- Department of Epidemiological Vigilance, Ministry of Health, Secretary of Health Vigilance, Brasília, Brazil
| | - David W Denning
- Education and Research Centre - University Hospital of South Manchester, Manchester, UK
| | - Arnaldo L Colombo
- Departament of Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Alessandro C Pasqualotto
- Postgraduation Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFSCPA), Porto Alegre, Brazil.,Molecular Biology Laboratory, Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Hospital Dom Vicente Scherer (HDVS), Porto Alegre, Brazil
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14
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Paskulin DD, Giacomazzi J, Achatz MI, Costa S, Reis RM, Hainaut P, dos Santos SEB, Ashton-Prolla P. Ancestry of the Brazilian TP53 c.1010G>A (p.Arg337His, R337H) Founder Mutation: Clues from Haplotyping of Short Tandem Repeats on Chromosome 17p. PLoS One 2015; 10:e0143262. [PMID: 26618902 PMCID: PMC4664269 DOI: 10.1371/journal.pone.0143262] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 11/01/2015] [Indexed: 11/22/2022] Open
Abstract
Rare germline mutations in TP53 (17p13.1) cause a highly penetrant predisposition to a specific spectrum of early cancers, defining the Li-Fraumeni Syndrome (LFS). A germline mutation at codon 337 (p.Arg337His, c1010G>A) is found in about 0.3% of the population of Southern Brazil. This mutation is associated with partially penetrant LFS traits and is found in the germline of patients with early cancers of the LFS spectrum unselected for familial history. To characterize the extended haplotypes carrying the mutation, we have genotyped 9 short tandem repeats on chromosome 17p in 12 trios of Brazilian p.Arg337His carriers. Results confirm that all share a common ancestor haplotype of Caucasian/Portuguese-Iberic origin, distant in about 72–84 generations (2000 years assuming a 25 years intergenerational distance) and thus pre-dating European migration to Brazil. So far, the founder p.Arg337His haplotype has not been detected outside Brazil, with the exception of two residents of Portugal, one of them of Brazilian origin. On the other hand, increased meiotic recombination in p.Arg337His carriers may account for higher than expected haplotype diversity. Further studies comparing haplotypes in populations of Brazil and of other areas of Portuguese migration are needed to understand the historical context of this mutation in Brazil.
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Affiliation(s)
- Diego Davila Paskulin
- Post-Graduate Program, Genetics and Molecular Biology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Genomic Medicine Laboratory, Experimental Research Center, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
- * E-mail:
| | - Juliana Giacomazzi
- Post-Graduate Program, Genetics and Molecular Biology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Genomic Medicine Laboratory, Experimental Research Center, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Sandra Costa
- Life and Health Sciences Research Institute, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rui Manoel Reis
- Life and Health Sciences Research Institute, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Pierre Hainaut
- International Prevention Research Institute, Lyon and Institut Albert Bonniot/INSERM 823, Grenoble, France
| | | | - Patricia Ashton-Prolla
- Post-Graduate Program, Genetics and Molecular Biology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Genomic Medicine Laboratory, Experimental Research Center, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
- Medical Genetics Service), Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
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15
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Giacomazzi CR, Giacomazzi J, Netto CB, Santos-Silva P, Selistre SG, Maia AL, Oliveira VZD, Camey SA, Goldim JR, Ashton-Prolla P. Pediatric cancer and Li-Fraumeni/Li-Fraumeni-like syndromes: a review for the pediatrician. Rev Assoc Med Bras (1992) 2015; 61:282-9. [DOI: 10.1590/1806-9282.61.03.282] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 10/17/2014] [Indexed: 11/21/2022] Open
Abstract
Summary Introduction: cancer is the second leading cause of death in children between the ages of 0 and 14 years, corresponding to approximately 3% of all cases diagnosed in Brazil. A significant percentage (5-10%) of pediatric cancers are associated with hereditary cancer syndromes, including Li-Fraumeni/Li-Fraumeni-like syndromes (LFS/LFL), both of which are caused by TP53 germline mutations. Recent studies have shown that a specific TP53 mutation, known as p.R337H, is present in 1 in 300 newborns in Southern and Southeast Brazil. In addition, a significant percentage of children with LFS/LFL spectrum tumors in the region have a family history compatible with LFS/LFL. Objective: to review clinical relevant aspects of LFS/LFL by our multidisciplinary team with focus on pediatric cancer. Methods: the NCBI (PubMed) and SciELO databases were consulted using the keywords Li-Fraumeni syndrome, Li-Fraumeni-like syndrome and pediatric cancer; and all manuscripts published between 1990 and 2014 using these keywords were retrieved and reviewed. Conclusion: although LFS/LFL is considered a rare disease, it appears to be substantially more common in certain geographic regions. Recognition of population- specific risks for the syndrome is important for adequate management of hereditary cancer patients and families. In Southern and Southeastern Brazil, LFS/ LFL should be considered in the differential diagnosis of children with cancer, especially if within the spectrum of the syndrome. Due to the complexities of these syndromes, a multidisciplinary approach should be sought for the counseling, diagnosis and management of patients and families affected by these disorders. Pediatricians and pediatric oncologists in areas with high prevalence of hereditary cancer syndromes have a central role in the recognition and proper referral of patients and families to genetic cancer risk evaluation and management programs.
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Giacomazzi J, Hartmann CR, Paskulin DD, Rivero LF, Caleffi M, Pasqualotto AC, Graudenz MS, Rosa DD. Abstract P4-15-22: The ASCO/CAP guideline update for HER2 testing increases the number of breast cancer patients eligible for HER2-targeted therapy. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p4-15-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) published, in Nov/2013, the interpretive guidelines for HER2 testing of breast cancer patients. This aimed to improve the accuracy of HER2 testing and its utility as a predictive marker in invasive breast cancer. The former version of these criteria was written in 2007. Objectives: to compare the HER2 immunohistochemical (IHC) analysis using the 2007 versus 2013 algorithms in a cohort of breast cancer cases diagnosed in a single institution in Southern Brazil. The cases were previously classified as HER2 1+ or 2+, using the 2007 criteria. Methods: the sample included 100 invasive breast cancer cases. The HercepTest (Dako, Denmark) was used for determination of HER2 expression. The HER2 testing was analyzed independently by two pathologists. The FISH analysis was done using a HER2/D17Z1 probe set. Preliminary Results: The HER2 IHC interpretation changed in 11/69 (15.9%) cases: 8.7% negative or equivocal cases by the 2007 guidelines were positive by the 2013 classification and 7.2% of HER2 1+ cases became equivocal (p<0.001; x2 test). The FISH analyses are ongoing. Conclusion: The 2013 ASCO/CAP guidelines resulted in less negative cases and in more equivocal (requiring reflex testing) and positive tests. Applying the ASCO/CAP 2013 guidelines resulted in a significantly increase of breast cancer patients eligible for HER2-targeted therapies.
Citation Format: Juliana Giacomazzi, Carolina R Hartmann, Diego D Paskulin, Luis Fernando Rivero, Maira Caleffi, Alessandro C Pasqualotto, Marcia S Graudenz, Daniela D Rosa. The ASCO/CAP guideline update for HER2 testing increases the number of breast cancer patients eligible for HER2-targeted therapy [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P4-15-22.
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Affiliation(s)
- Juliana Giacomazzi
- 1Universidade Federal de Ciencias da Saude de Porto Alegre (UFCSPA)
- 2Irmandade da Santa Casa de Misericordia de Porto Alegre (ISCMPA)
| | | | - Diego D Paskulin
- 2Irmandade da Santa Casa de Misericordia de Porto Alegre (ISCMPA)
| | | | | | - Alessandro C Pasqualotto
- 1Universidade Federal de Ciencias da Saude de Porto Alegre (UFCSPA)
- 2Irmandade da Santa Casa de Misericordia de Porto Alegre (ISCMPA)
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17
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Canto LMD, Basso TR, Villacis RR, Giacomazzi J, Ashton-Prolla P, Achatz MW, Rogatto S. Genomic Alterations in Patients Showing Multiple Primary Tumors and Family History of Cancer. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu332.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Giacomazzi J, Correia RL, Palmero EI, Gaspar JF, Almeida M, Portela C, Camey SA, Monteiro A, Pinheiro M, Peixoto A, Teixeira MR, Reis RM, Ashton-Prolla P. The Brazilian founder mutation TP53 p.R337H is uncommon in Portuguese women diagnosed with breast cancer. Breast J 2014; 20:534-6. [PMID: 25052705 DOI: 10.1111/tbj.12308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Since the first studies reporting the TP53 p.R337H mutation as founder mutation in Southern and Southeastern Brazil, there has been controversy on its origin. Preliminary analysis of a small subset of Brazilian mutation carriers revealed that the haplotype incided on a Caucasian background. The vast majority of carriers identified today reside in Brazil or, if identified in other countries, are Brazilian immigrants. To our knowledge, the only two exceptions of carriers without a recognizable link with Brazil are two European families, from Portugal and Germany. Haplotype analysis in the Portuguese family revealed the same haplotype identified in Brazilian individuals, but in the German family, a distinct haplotype was found. Knowing that a significant proportion of women with breast cancer (BC) in Southern Brazil are p.R337H carriers, we analyzed p.R337H in a Portuguese cohort of women diagnosed with this disease. Median age at diagnosis among the first 573 patients tested was 60 years and 100 (17.4%) patients had been diagnosed at or under the age of 45 years. Mutation screening failed to identify the mutation in the 573 patients tested. These results are in contrast with the mutation frequency observed in a study including 815 BC-affected women from Brazil, in which carrier frequencies of 12.1 and 5.1% in pre- and postmenopausal women were observed, respectively. These findings suggest that the Brazilian founder mutation p.R337H, the most frequent germline TP53 mutation reported to date, is not a common germline alteration in Portuguese women diagnosed with BC.
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Affiliation(s)
- Juliana Giacomazzi
- Genomic Medicine Laboratory, Experimental Research Centre, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Genetics Department, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Hospital Tacchini, Bento Gonçalves, Brazil
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19
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Falavigna M, Lima KM, Giacomazzi J, Paskulin DD, Hammes LS, Ribeiro RA, Rosa DD. Effects of lifestyle modification after breast cancer treatment: a systematic review protocol. Syst Rev 2014; 3:72. [PMID: 24997590 PMCID: PMC4107599 DOI: 10.1186/2046-4053-3-72] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 06/17/2014] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND There is no consensus in the literature regarding the effectiveness of lifestyle modification interventions, including recommendations about specific diet or exercise program for patients with breast cancer. Diet interventions and regular physical activity may reduce the risk of breast cancer and its recurrence. The primary aim of our study is to evaluate the effects of different lifestyle modification interventions (diet and physical activity) in the survival of patients with stages I to III breast cancer after treatment. METHODS/DESIGN This review will be conducted according to the Cochrane Handbook for Systematic Reviews of Intervention and will be reported following the PRISMA statement recommendations. CENTRAL, MEDLINE and EMBASE databases will be searched for peer-reviewed literature. Randomized controlled trials of diet, exercise, or both, compared with usual care, after treatment of breast cancer stage I to III will be included in the systematic review. Two authors will independently screen titles and abstracts of studies for potential eligibility. Data will be combined using random-effect meta-analysis models with restricted maximum-likelihood as variance estimator, and will be presented as relative risk or standardized mean difference with 95% CI. The quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework and summary of findings tables will be presented for patient important outcomes. DISCUSSION Our study may improve the current understanding of the role that lifestyle-modifiable factors can play in saving or prolonging the lives of women who have been treated for breast cancer, and also on modifying their quality of life. SYSTEMATIC REVIEW REGISTRATION The review has been registered with PROSPERO (registration number CRD42014008743).
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Affiliation(s)
| | | | | | | | | | | | - Daniela Dornelles Rosa
- Institute for Education and Research, Hospital Moinhos de Vento, Rua Ramiro Barcellos 910, Porto Alegre 90035-001, Brazil.
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20
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Giacomazzi J, Graudenz MS, Osorio CABT, Koehler-Santos P, Palmero EI, Zagonel-Oliveira M, Michelli RAD, Scapulatempo Neto C, Fernandes GC, Achatz MIWS, Martel-Planche G, Soares FA, Caleffi M, Goldim JR, Hainaut P, Camey SA, Ashton-Prolla P. Prevalence of the TP53 p.R337H mutation in breast cancer patients in Brazil. PLoS One 2014; 9:e99893. [PMID: 24936644 PMCID: PMC4061038 DOI: 10.1371/journal.pone.0099893] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 05/20/2014] [Indexed: 02/04/2023] Open
Abstract
Germline TP53 mutations predispose individuals to multiple cancers and are associated with Li-Fraumeni/Li-Fraumeni-Like Syndromes (LFS/LFL). The founder mutation TP53 p.R337H is detected in 0.3% of the general population in southern Brazil. This mutation is associated with an increased risk of childhood adrenal cortical carcinoma (ACC) but is also common in Brazilian LFS/LFL families. Breast Cancer (BC) is one of the most common cancers diagnosed in TP53 mutation carriers. We have assessed the prevalence of p.R337H in two groups: (1) 59 BC affected women with a familial history (FH) suggestive of hereditary cancer syndrome but no LFS/LFL features; (2) 815 BC affected women unselected for cancer FH, diagnosed with BC at or before age 45 or at age 55 or older. Among group 1 and group 2 patients, 2/59 (3.4%, CI95%: 0.4%-11.7%) and 70/815 (8.6%, CI95%: 6.8%-10.7%), respectively, were p.R337H carriers in the germline. The prevalence of p.R337H was higher in women diagnosed with BC at or before age 45 (12.1%, CI95%: 9.1%-15.8%) than at age 55 or older (5.1%, CI95%: 3.2%-7.7%), p<0.001). The Brazilian founder p.R337H haplotype was detected in all carriers analysed. These results suggest that inheritance of p.R337H may significantly contribute to the high incidence of BC in Brazil, in addition to its recently demonstrated impact on the risk of childhood ACC.
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Affiliation(s)
- Juliana Giacomazzi
- Genomic Medicine Laboratory, Experimental Research Centre, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Post-Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Marcia S Graudenz
- Post-Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil; Pathology Service, HCPA, Porto Alegre, Rio Grande do Sul, Brazil and Instituto de Patologia, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cynthia A B T Osorio
- Pathology Service, Hospital do Câncer AC Camargo (HCACC), São Paulo, São Paulo, Brazil
| | - Patricia Koehler-Santos
- Protein and Molecular Analysis Laboratory, Experimental Research Centre, HCPA, Porto Alegre, Rio Grande do Sul, Brazil
| | - Edenir I Palmero
- Molecular Oncology Research Centre, Hospital do Câncer de Barretos, Barretos, São Paulo, Brazil
| | - Marcelo Zagonel-Oliveira
- National Institute of Populational Medical Genetics (INAGEMP), UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rodrigo A D Michelli
- Molecular Oncology Research Centre, Hospital do Câncer de Barretos, Barretos, São Paulo, Brazil
| | | | - Gabriela C Fernandes
- Molecular Oncology Research Centre, Hospital do Câncer de Barretos, Barretos, São Paulo, Brazil
| | | | | | - Fernando A Soares
- Pathology Service, Hospital do Câncer AC Camargo (HCACC), São Paulo, São Paulo, Brazil
| | - Maira Caleffi
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - José Roberto Goldim
- Bioethics Research Laboratory, HCPA, Porto Alegre, Rio Grande do Sul, Brazil
| | - Pierre Hainaut
- International Agency for Research on Cancer (IARC), Lyon, Rhone, France; International Prevention Research Institute, Lyon, Rhone, France
| | - Suzi A Camey
- Department of Statistics, Institute of Mathematics, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Patricia Ashton-Prolla
- Genomic Medicine Laboratory, Experimental Research Centre, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Post-Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil; National Institute of Populational Medical Genetics (INAGEMP), UFRGS, Porto Alegre, Rio Grande do Sul, Brazil; Post-Graduate Program in Genetics and Molecular Biology, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
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21
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Izetti P, Hautefeuille A, Abujamra AL, de Farias CB, Giacomazzi J, Alemar B, Lenz G, Roesler R, Schwartsmann G, Osvaldt AB, Hainaut P, Ashton-Prolla P. PRIMA-1, a mutant p53 reactivator, induces apoptosis and enhances chemotherapeutic cytotoxicity in pancreatic cancer cell lines. Invest New Drugs 2014; 32:783-94. [PMID: 24838627 DOI: 10.1007/s10637-014-0090-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 03/13/2014] [Indexed: 01/05/2023]
Abstract
TP53 mutation is a common event in many cancers, including pancreatic adenocarcinoma, where it occurs in 50-70 % of cases. In an effort to reactivate mutant p53 protein, several new drugs are being developed, including PRIMA-1 and PRIMA-1(Met)/APR-246 (p53 reactivation and induction of massive apoptosis). PRIMA-1 has been shown to induce apoptosis in tumor cells by reactivating p53 mutants, but its effect in pancreatic cancer remains unclear. Here we investigated the effects of PRIMA-1 on cell viability, cell cycle and expression of p53-regulated proteins in PANC-1 and BxPC-3 (mutant TP53), and CAPAN-2 (wild-type TP53) pancreatic cell lines. Treatment with PRIMA-1 selectively induced apoptosis and cell cycle arrest in p53 mutant cells compared to CAPAN-2 cells. The growth suppressive effect of PRIMA-1 was markedly reduced in p53 mutant cell lines transfected with p53 siRNA, supporting the role of mutant p53 in PRIMA-1 induced cell death. Moreover, treatment with the thiol group donor N-acetylcysteine completely blocked PRIMA-1-induced apoptosis and reinforced the hypothesis that thiol modifications are important for PRIMA-1 biological activity. In combination treatments, PRIMA-1 enhanced the anti-tumor activity of several chemotherapic drugs against pancreatic cancer cells and also exhibited a pronounced synergistic effect in association with the Mdm2 inhibitor Nutlin-3. Taken together, our data indicate that PRIMA-1 induces apoptosis in p53 mutant pancreatic cancer cells by promoting the re-activation of p53 and inducing proapoptotic signaling pathways, providing in vitro evidence for a potential therapeutic approach in pancreatic cancer.
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Affiliation(s)
- Patricia Izetti
- Laboratório de Medicina Genômica, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, RS, Brazil, 90035-003,
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22
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Macedo GDS, Araujo Vieira I, Cortez-Paixão V, Giacomazzi J, Santiago KM, Achatz MIW, Ashton-Prolla P. Identification of a rare germ-line variant in the TP53 3’UTR in individuals with the Li-Fraumeni-like phenotype: A new mechanism of cancer predisposition? J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.11106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Gabriel de Souza Macedo
- Universidade Federal do Rio Grande do Sul/ Hospital de Clínicas de Porto Alegre/CPE-Laboratório de Medicina Genômica, Porto Alegre, Brazil
| | | | | | | | | | | | - Patricia Ashton-Prolla
- Departamento de Genética, UFRGS; Laboratório de Medicina Genômica, Centro de Pesquisa Experimental, HCPA e Serviço de Genética Médica, HCPA, Porto Alegre, Brazil
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Affiliation(s)
| | | | | | | | - Patricia Ashton-Prolla
- Departamento de Genética, UFRGS; Laboratório de Medicina Genômica, Centro de Pesquisa Experimental, HCPA e Serviço de Genética Médica, HCPA, Porto Alegre, Brazil
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24
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Giacomazzi J, Schmidt AV, Palmero EI, Roth FL, Caleffi M, Camey SA, Ashton-Prolla P. Evaluation of the knowledge about breast cancer in Brazilian women seeking assistance in basic health care units. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e20573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | - Suzi Alves Camey
- Departamento de Estatística, Instituto de Matemática, UFRGS e Grupo de Pesquisa e Pós Graduação, HCPA, Porto Alegre, Brazil
| | - Patricia Ashton-Prolla
- Departamento de Genética, UFRGS; Laboratório de Medicina Genômica, Centro de Pesquisa Experimental, HCPA e Serviço de Genética Médica, HCPA, Porto Alegre, Brazil
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25
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Fitarelli-Kiehl M, Giacomazzi J, Santos-Silva P, Ashton-Prolla P. Abstract P2-07-04: HER2 overexpressing breast cancers are more frequent in carriers of TP53 DNA-binding domain mutations than in carriers of oligomerization-site mutations. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p2-07-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Germline TP53 mutations are associated with Li-Fraumeni Syndrome (LFS), an autosomal dominant disorder characterized by predisposition to multiple early-onset cancers including breast cancer (BC), the most prevalent tumor among women. The majority of germline TP53 mutations are missense substitutions clustered within the DNA-binding domain of the gene that disrupt the structure and function of the protein. Recently, the germline mutation p.R337H (c.1010G>A), lying in the oligomerization domain of p53, was reported at a high frequency in Southern and Southeastern Brazil. This mutation appears to result in a more subtle defect in the protein, which becomes functionally deficient only under particular conditions and specific tissues. Recent reports suggest that BC are HER2-postive in a high proportion (63-83%) of TP53 mutation carriers. Histopathologic features of breast cancers among carriers of oligomerization domain mutations have not been reported. Our objective was to analize HER2 status in breast cancers from carriers of germline TP53 mutations, both in the DNA-binding and oligomerization domains. We retrospectively reviewed the immunohistochemistry data of breast cancers from 64 carriers of TP53 p.R337H and 6 carriers of nonfunctional germline TP53 mutations (p.G245S, p.R273H, p.G244D or c.672+1G>T). All patients were recruited from the cancer genetics clinic at Hospital de Clínicas de Porto Alegre, Brazil. Germline TP53 mutations were identified by Sanger sequencing of the entire coding sequence and flanking intronic regions. Immunohistochemistry (IHC) was performed using standard procedures. HER2 expression was assessed using a 0 to 3+ scale according the ASCO-CAP Guidelines. All of the six patients with nonfunctional TP53 mutations showed strong (3+) HER2 staining by IHC in their breast tumors. In the group of p.R337H carriers, 23.4% showed significant HER2 overexpression (3+), 21.9% presented ambiguous HER2 results (2+), and 54.7% showed weak or no HER2 expression (1+ or 0). Thus, HER2 overexpressing breast cancers were more frequent in carriers of TP53 nonfunctional (DNA binding domain) mutations (p≤0.001) than in those carrying the oligomerization domain mutation. Preliminary results from this study suggest that germline mutations in different domains of the TP53 gene may predispose to breast cancer through different mechanisms.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-07-04.
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Affiliation(s)
- M Fitarelli-Kiehl
- Genomic Medicine Laboratory, Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Post-Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Post-Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - J Giacomazzi
- Genomic Medicine Laboratory, Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Post-Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Post-Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - P Santos-Silva
- Genomic Medicine Laboratory, Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Post-Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Post-Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - P Ashton-Prolla
- Genomic Medicine Laboratory, Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Post-Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Post-Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Giacomazzi J, Correia RL, Palmero EI, Gaspar JF, Almeida M, Portela C, Camey SA, Reis RM, Ashton-Prolla P. Abstract P2-13-01: The Brazilian founder TP53 p.R337H mutation is uncommon in Portuguese women diagnosed with breast cancer. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p2-13-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Since the first studies reporting the TP53 p.R337H mutation as founder mutation in Southern and Southeastern regions of Brazil, both in the general population and in patients from high risk breast cancer families with adrenocortical, choroid plexus and breast carcinomas, there has been controversy on the origin of this mutation. Preliminary analysis of the small subset of Brazilian mutation carriers that defined the founder haplotype using 29 tag SNPs revealed that the haplotype incided on a Caucasian background. The vast majority of carriers identified today reside in Brazil or, if identified in other countries, are Brazilian immigrants. To our knowledge, the only two exceptions of carriers without a recognizable link with Brazil are two European families (one Portuguese and one German) (Chompret et al., 2000; Herrmann et al. 2012). Haplotype analysis in the Portuguese family revealed the same haplotype identified in Brazilian individuals, but in the German family, a distinct haplotype was found. Knowing that a significant proportion of women with breast cancer in Southern Brazil are p.R337H carriers, we initiated TP53 genotyping in a Portuguese cohort of women with breast cancer recruited from the cities of Lisboa and Braga. Median age at diagnosis of breast cancer among the first 573 patients tested was 60 years and 100 (17.4%) patients had been diagnosed at or under the age of 45 years. Mutation screening was performed using Real-Time PCR (taqman assays), and failed to identify the mutation in the 573 patients tested. These results are in contrast with the mutation frequency observed in a study of 815 breast cancer-affected women from Southern and Southeastern Brazil, which has reached frequencies of 12.1 and 5.1% in pre- and post-menopausal women, respectively (Ashton-Prolla et al. 2012; ASCO Annual Meeting, ref 1522). We conclude that there is a significant difference in mutation frequency observed between the two cohorts (p<0.001). These findings suggest that TP53 p.R337H is not a common molecular alteration in Portuguese breast cancer-affected patients.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-13-01.
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Affiliation(s)
- J Giacomazzi
- Hospital de Clinicas de Porto Alegre, Brazil; Hospital de Câncer de Barretos, Brazil; Faculdade de Ciências Médicas UNL, Portugal; Braga Hospital, Portugal
| | - RL Correia
- Hospital de Clinicas de Porto Alegre, Brazil; Hospital de Câncer de Barretos, Brazil; Faculdade de Ciências Médicas UNL, Portugal; Braga Hospital, Portugal
| | - EI Palmero
- Hospital de Clinicas de Porto Alegre, Brazil; Hospital de Câncer de Barretos, Brazil; Faculdade de Ciências Médicas UNL, Portugal; Braga Hospital, Portugal
| | - JF Gaspar
- Hospital de Clinicas de Porto Alegre, Brazil; Hospital de Câncer de Barretos, Brazil; Faculdade de Ciências Médicas UNL, Portugal; Braga Hospital, Portugal
| | - M Almeida
- Hospital de Clinicas de Porto Alegre, Brazil; Hospital de Câncer de Barretos, Brazil; Faculdade de Ciências Médicas UNL, Portugal; Braga Hospital, Portugal
| | - C Portela
- Hospital de Clinicas de Porto Alegre, Brazil; Hospital de Câncer de Barretos, Brazil; Faculdade de Ciências Médicas UNL, Portugal; Braga Hospital, Portugal
| | - SA Camey
- Hospital de Clinicas de Porto Alegre, Brazil; Hospital de Câncer de Barretos, Brazil; Faculdade de Ciências Médicas UNL, Portugal; Braga Hospital, Portugal
| | - RM Reis
- Hospital de Clinicas de Porto Alegre, Brazil; Hospital de Câncer de Barretos, Brazil; Faculdade de Ciências Médicas UNL, Portugal; Braga Hospital, Portugal
| | - P Ashton-Prolla
- Hospital de Clinicas de Porto Alegre, Brazil; Hospital de Câncer de Barretos, Brazil; Faculdade de Ciências Médicas UNL, Portugal; Braga Hospital, Portugal
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Giacomazzi J, Selistre SG, Rossi C, Alemar B, Santos-Silva P, Pereira FS, Netto CB, Cossio SL, Roth DE, Brunetto AL, Zagonel-Oliveira M, Martel-Planche G, Goldim JR, Hainaut P, Camey SA, Ashton-Prolla P. Li-Fraumeni and Li-Fraumeni-like syndrome among children diagnosed with pediatric cancer in Southern Brazil. Cancer 2013; 119:4341-9. [DOI: 10.1002/cncr.28346] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 06/10/2013] [Accepted: 07/22/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Juliana Giacomazzi
- Laboratorio de Medicina Genomica; Experimental Research Center; Hospital de Clinicas de Porto Alegre; Porto Alegre Brazil
- Post-Graduate Program in Medicine; Medical Sciences; Universidade Federal do Rio Grande do Sul (UFRGS); Porto Alegre Brazil
- Genetics Department; UFRGS; Porto Alegre Brazil
| | - Simone G. Selistre
- Post-Graduate Program in Medicine; Medical Sciences; Universidade Federal do Rio Grande do Sul (UFRGS); Porto Alegre Brazil
- Pediatric Oncology Service; Hospital de Clinicas de Porto Alegre; Porto Alegre Brazil
| | - Cristina Rossi
- Laboratorio de Medicina Genomica; Experimental Research Center; Hospital de Clinicas de Porto Alegre; Porto Alegre Brazil
- School of Medicine; UFRGS; Porto Alegre Brazil
| | - Barbara Alemar
- Laboratorio de Medicina Genomica; Experimental Research Center; Hospital de Clinicas de Porto Alegre; Porto Alegre Brazil
- Post-Graduate Program in Genetics and Molecular Biology; UFRGS; Porto Alegre Brazil
| | - Patricia Santos-Silva
- Laboratorio de Medicina Genomica; Experimental Research Center; Hospital de Clinicas de Porto Alegre; Porto Alegre Brazil
- Post-Graduate Program in Medicine; Medical Sciences; Universidade Federal do Rio Grande do Sul (UFRGS); Porto Alegre Brazil
| | - Fernando S. Pereira
- Laboratorio de Medicina Genomica; Experimental Research Center; Hospital de Clinicas de Porto Alegre; Porto Alegre Brazil
- School of Medicine; UFRGS; Porto Alegre Brazil
| | - Cristina B. Netto
- Medical Genetics Service; Hospital de Clinicas de Porto Alegre; Porto Alegre Brazil
| | - Silvia L. Cossio
- Laboratorio de Medicina Genomica; Experimental Research Center; Hospital de Clinicas de Porto Alegre; Porto Alegre Brazil
- Post-Graduate Program in Medicine; Medical Sciences; Universidade Federal do Rio Grande do Sul (UFRGS); Porto Alegre Brazil
| | - Daniela E. Roth
- Pediatric Oncology Service; Hospital de Clinicas de Porto Alegre; Porto Alegre Brazil
| | - Algemir L. Brunetto
- Pediatric Oncology Service; Hospital de Clinicas de Porto Alegre; Porto Alegre Brazil
| | | | | | - Jose R. Goldim
- Bioethics Research Laboratory; Hospital de Clinicas de Porto Alegre; Porto Alegre Brazil
| | - Pierre Hainaut
- International Prevention Research Institute; Lyon France
| | - Suzi A. Camey
- Department of Statistics, Institute of Mathematics; UFRGS; Porto Alegre Brazil
| | - Patricia Ashton-Prolla
- Laboratorio de Medicina Genomica; Experimental Research Center; Hospital de Clinicas de Porto Alegre; Porto Alegre Brazil
- Post-Graduate Program in Medicine; Medical Sciences; Universidade Federal do Rio Grande do Sul (UFRGS); Porto Alegre Brazil
- Genetics Department; UFRGS; Porto Alegre Brazil
- Post-Graduate Program in Genetics and Molecular Biology; UFRGS; Porto Alegre Brazil
- Medical Genetics Service; Hospital de Clinicas de Porto Alegre; Porto Alegre Brazil
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Giacomazzi J, Koehler-Santos P, Palmero EI, Graudenz MS, Rivero LF, Lima E, Pütten ACK, Hainaut P, Camey SA, Michelli RD, Neto CS, Fitarelli-Kiehl M, Geyer G, Meurer L, Geiger A, Azevedo MB, da Silva VD, Ashton-Prolla P. A TP53 founder mutation, p.R337H, is associated with phyllodes breast tumors in Brazil. Virchows Arch 2013; 463:17-22. [DOI: 10.1007/s00428-013-1439-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 04/24/2013] [Accepted: 06/03/2013] [Indexed: 10/26/2022]
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29
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Giacomazzi J, Graudenz MS, Osorio CABT, Koehler-Santos P, Palmero EI, Michelli RAD, Fernandes GC, Scapulatempo Neto C, Achatz MIW, Martel-Planche G, Soares FA, Caleffi M, Goldim JR, Hainaut P, Camey SA, Ashton-Prolla P. Association between the founder brazilian TP53 p.R337H mutation and HER2-positive status. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e22154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e22154 Background: Recent studies in North American and British series have suggested an association between germline TP53 mutations and early onset HER2-positive breast cancer (BC). Mutations in the TP53 gene are estimated to occur in 1:2,000-1:5,000 individuals of the general population. Among women with BC who are unselected for family history they occur in up to 0.25%. In women with early-onset BC (<30 years) they occur in up to 7%. A specific germline TP53 mutation (c.1010G>A; p.R337H) has been encountered in 0.3% of the general population, in 13.3% of Li-Fraumeni-like families and in 0.5-2.4% of BC-affected women in Brazil. In an exploratory approach, the aim of this study was to investigate, in our series, if there is an association between human epidermal growth factor receptor 2 (HER2) amplification and the germline TP53 p.R337H mutation in a series of BC-affected women. Methods: A series of 718 Brazilian BC-affected women was genotyped in our previous study and 64 (8.9%) were mutation carriers. These cases were recruited from 3 centers and HER2 analysis was performed by immunohistochemistry (IHC) in each center according to validated protocols. Statistical analysis was done using SPSS software. Results: In 47 of 64 mutation carriers (73.5%), BC showed HER expression (either 1+, 2+ or 3+) while among 654 non-carriers, this immunophenotype was observed in 320 (48.9%) (p<0.001). This pattern was still observed after stratification of groups according to age at diagnosis (≤45 and ≥55 years) (p<0.001 and 0.03, respectively) and was independent of recruiting center. Conclusions: These results indicate that BC developing on a background of the founder Brazilian TP53 p.R337H mutation shows more frequently some amplification of HER2, consistent with recent studies showing an association between germline TP53 mutations and BC with HER2 hyperexpression. These findings should be confirmed in larger series to understand the significance of the association. If confirmed, this finding may justify germline TP53 p.R337H mutation testing in all HER2-positive Brazilian BC patients and would have a significant impact on patient and family counseling as well as on treatment.
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Affiliation(s)
- Juliana Giacomazzi
- Universidade Federal do Rio Grande do Sul/Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Marcia S. Graudenz
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas of Porto Alegre, Porto Alegre, Brazil
| | | | | | | | | | | | | | | | | | | | | | - Jose Roberto Goldim
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas of Porto Alegre, Porto Alegre, Brazil
| | - Pierre Hainaut
- International Prevention Research Institute, Lyon, France
| | - Suzi Alves Camey
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas of Porto Alegre, Porto Alegre, Brazil
| | - Patricia Ashton-Prolla
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas of Porto Alegre, Porto Alegre, Brazil
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Giacomazzi J, Selistre S, Duarte J, Ribeiro JP, Vieira PJC, de Souza Macedo G, Rossi C, Czepielewski M, Netto CBO, Hainaut P, Ashton-Prolla P. TP53 p.R337H is a conditional cancer-predisposing mutation: further evidence from a homozygous patient. BMC Cancer 2013; 13:187. [PMID: 23570263 PMCID: PMC3637265 DOI: 10.1186/1471-2407-13-187] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Accepted: 03/12/2013] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Adrenocortical carcinomas (ACCs) are among the most common childhood cancers occurring in infants affected with the Li-Fraumeni and Li- Fraumeni-like (LFS/LFL) syndromes, which are caused by dominant germline mutations in the TP53 gene. In Brazil, a particular mutation, occurring in the tetramerisation domain of the gene, p.R337H, is exceedingly common due to a founder effect and is strongly associated with ACC. In this report, we describe the phenotype and long-term clinical follow-up of a female child diagnosed with ACC and homozygous for the TP53 p.R337H founder mutation. CASE PRESENTATION At age 11 months, the patient was diagnosed with a virilising anaplastic adrenal cortical tumour, which was completely excised without disturbing the adrenal capsule. Family history was consistent with an LFL tumour pattern, and genotyping identified the TP53 p.R337H mutation in both alleles in genomic DNA from lymphocytes and fibroblasts. Haplotype analysis confirmed the occurrence of the mutation in the same founder haplotype previously described in other Brazilian patients. No other germline or somatic TP53 mutations or rearrangements were identified. At age 9 years, the child was asymptomatic and had no evidence of endocrine derangements. Full body and brain magnetic resonance imaging (MRI) failed to detect any suspicious proliferative lesions, and cardiopulmonary exercise testing results were within the normal reference for the child's age, ruling out a major exercise capacity deficiency. CONCLUSION This is the first clinical and aerobic functional capacity documentation of a patient who carries two mutant TP53 alleles and no wild-type allele. Our results support the hypothesis that TP53 p.R337H, the most common TP53 mutation ever described in any population, is a conditional mutant. Furthermore, our observations over a long period of clinical follow-up suggest that TP53 p.R337H homozygotes do not have a more severe disease phenotype than do heterozygote carriers of the same mutation. Patients with the homozygous TP53 p.R337H genotype will require careful surveillance for lifetime cancer risk and for effects on metabolic capacity later in life.
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Affiliation(s)
- Juliana Giacomazzi
- Genomic Medicine Laboratory, Experimental Research Center, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Post-Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Simone Selistre
- Post-Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Pediatric Oncology Service, HCPA, Porto Alegre, Brazil
| | | | - Jorge Pinto Ribeiro
- Exercise Pathophysiology Research Laboratory and Cardiology Division, HCPA, Porto Alegre, Brazil
- Post-Graduate Program in Genetics and Molecular Biology, UFRGS, Porto Alegre, Brazil
| | - Paulo JC Vieira
- Exercise Pathophysiology Research Laboratory and Cardiology Division, HCPA, Porto Alegre, Brazil
| | - Gabriel de Souza Macedo
- Genomic Medicine Laboratory, Experimental Research Center, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Post-Graduate Program in Genetics and Molecular Biology, UFRGS, Porto Alegre, Brazil
| | - Cristina Rossi
- Genomic Medicine Laboratory, Experimental Research Center, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- School of Medicine, UFRGS, Porto Alegre, Brazil
| | - Mauro Czepielewski
- Department of Internal Medicine, Faculty of Medicine, UFRGS, Porto Alegre, Brazil
- Service of Endocrinology, HCPA, Porto Alegre, Brazil
| | | | - Pierre Hainaut
- International Prevention Research Institute, Lyon, France
| | - Patricia Ashton-Prolla
- Genomic Medicine Laboratory, Experimental Research Center, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Post-Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Post-Graduate Program in Genetics and Molecular Biology, UFRGS, Porto Alegre, Brazil
- Service of Medical Genetics, HCPA, Porto Alegre, Brazil
- Departamento de Genética, UFRGS e Serviço de Genética Médica e Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, 90035-903 Porto Alegre, RS, Brazil
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31
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Isoppo de Souza C, Rosa DD, Ettrich B, Cibeira GH, Giacomazzi J, Tusset P, Ashton-Prolla P, Medeiros LR, Caleffi M, Neto EC, Moriguchi EH, Graudenz MS. Association of adipokines and adhesion molecules with indicators of obesity in women undergoing mammography screening. Nutr Metab (Lond) 2012; 9:97. [PMID: 23113882 PMCID: PMC3541161 DOI: 10.1186/1743-7075-9-97] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 10/08/2012] [Indexed: 12/22/2022] Open
Abstract
UNLABELLED BACKGROUND The soluble cell adhesion molecules and adipokines are elevated in patients with obesity, hypertension, type 2 diabetes mellitus, breast cancer and atherosclerosis. OBJECTIVE To investigate the relationship between anthropometric profile, dietary intake, lipid profile and fasting glycemia with serum levels of adipokines (adiponectin and PAI-1) and adhesion molecules (ICAM-1 and VCAM-1) in women without breast cancer undergoing routine mammographic screening. DESIGN Transversal study. SUBJECTS One hundred and forty-five women over 40-years old participated in this study. RESULTS In 39.3% of cases the BMI was above 30 kg/m2; 46.9% had hypertension, 14.5% had type 2 Diabetes Mellitus, 31.7% had dyslipidemia and 88.3% presented a waist-to-hip ratio ≥ 0.8. A linear correlation was found between serum levels of PAI-1 and triglycerides, between serum levels of PAI-1 and WHR and between serum levels of VCAM-1 and BMI. CONCLUSION We found a high prevalence of obesity and metabolic syndrome. PAI-1 and VCAM-1 levels were correlated with clinical indicators of obesity and overweight.
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Affiliation(s)
- Caroline Isoppo de Souza
- Programa de Pós Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Rio Grande do Sul, Brasil
| | - Daniela Dornelles Rosa
- Programa de Pós Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Rio Grande do Sul, Brasil
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brasil
- Grupo Brasileiro de Estudos do Câncer de Mama (GBECAM), São Paulo, Brasil
| | - Betina Ettrich
- Programa de Pós Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Rio Grande do Sul, Brasil
| | - Gabriela Hermann Cibeira
- Programa de Pós Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Rio Grande do Sul, Brasil
- Programa de Pós Graduação em Cardiologia e Ciências Cardiovasculares, Universidade Federal do Rio Grande do Sul (UFRGS), Rio Grande do Sul, Brasil
| | - Juliana Giacomazzi
- Programa de Pós Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Rio Grande do Sul, Brasil
- Laboratório de Medicina Genômica do Hospital de Clínicas de Porto Alegre (HCPA), Rio Grande do Sul, Brasil
| | - Paloma Tusset
- Programa de Pós Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Rio Grande do Sul, Brasil
| | - Patrícia Ashton-Prolla
- Programa de Pós Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Rio Grande do Sul, Brasil
- Laboratório de Medicina Genômica do Hospital de Clínicas de Porto Alegre (HCPA), Rio Grande do Sul, Brasil
- Instituto Nacional de Genética Médica Populacional (INAGEMP), Porto Alegre, Brasil
- Departamento de Genética, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brasil
| | - Lidia Rosi Medeiros
- Programa de Pós Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Rio Grande do Sul, Brasil
| | - Maira Caleffi
- Grupo Brasileiro de Estudos do Câncer de Mama (GBECAM), São Paulo, Brasil
- Programa de Pós Graduação em Cardiologia e Ciências Cardiovasculares, Universidade Federal do Rio Grande do Sul (UFRGS), Rio Grande do Sul, Brasil
- Núcleo Mama Porto Alegre (NMPOA), Rio Grande do Sul, Brasil
| | | | - Emilio Hideyuki Moriguchi
- Programa de Pós Graduação em Cardiologia e Ciências Cardiovasculares, Universidade Federal do Rio Grande do Sul (UFRGS), Rio Grande do Sul, Brasil
| | - Marcia Silveira Graudenz
- Programa de Pós Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Rio Grande do Sul, Brasil
- Departamento de Patologia, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brasil
- Hospital de Clinicas de Porto Alegre (HCPA), , Rio Grande do Sul, Brazil
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Macedo GS, Lisbôa da Motta L, Giacomazzi J, Netto CBO, Manfredini V, S.Vanzin C, Vargas CR, Hainaut P, Klamt F, Ashton-Prolla P. Increased oxidative damage in carriers of the germline TP53 p.R337H mutation. PLoS One 2012; 7:e47010. [PMID: 23056559 PMCID: PMC3467233 DOI: 10.1371/journal.pone.0047010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 09/11/2012] [Indexed: 11/18/2022] Open
Abstract
Germline mutations in TP53 are the underlying defect of Li-Fraumeni Syndrome (LFS) and Li-Fraumeni-like (LFL) Syndrome, autosomal dominant disorders characterized by predisposition to multiple early onset cancers. In Brazil, a variant form of LFS/LFL is commonly detected because of the high prevalence of a founder mutation at codon 337 in TP53 (p.R337H). The p53 protein exerts multiple roles in the regulation of oxidative metabolism and cellular anti-oxidant defense systems. Herein, we analyzed the redox parameters in blood samples from p.R337H mutation carriers (C, n = 17) and non-carriers (NC, n = 17). We identified a significant increase in erythrocyte GPx activity and in plasma carbonyl content,an indicator of protein oxidative damage, in mutation carriers compared to non-carriers (P = 0.048 and P = 0.035, respectively). Mutation carriers also showed a four-fold increase in plasma malondialdehyde levels, indicating increased lipid peroxidation (NC = 40.20±0.71, C = 160.5±0.88, P<0.0001). Finally, carriers showed increased total antioxidant status but a decrease in plasma ascorbic acid content. The observed imbalance could be associated with deregulated cell bioenergetics and/or with increased inflammatory stress, two effects that may result from loss of wild-type p53 function. These findings provide the first evidence that oxidative damage occurs in carriers of a germline TP53 mutation, and these may have important implications regarding our understanding of the mechanisms responsible for germline TP53 p.R337H mutation-associated carcinogenesis.
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Affiliation(s)
- Gabriel S. Macedo
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Laboratório de Medicina Genômica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Leonardo Lisbôa da Motta
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, UFRGS, Porto Alegre, Brazil
- Institutos Nacionais de Ciência e Tecnologia - Translacional em Medicina (MCT/CNPq INCT-TM), Porto Alegre, RS, Brazil
- Rede Gaúcha de Estresse Oxidativo e Sinalização Celular (FAPERGS), Porto Alegre, RS, Brazil
| | - Juliana Giacomazzi
- Laboratório de Medicina Genômica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Programa de Pós-Graduação em Ciências Médicas: Medicina, UFRGS, Porto Alegre, Brazil
| | | | - Vanusa Manfredini
- Universidade Federal do Pampa (UNIPAMPA), Campus Uruguaiana-RS, Brazil
| | - Camila S.Vanzin
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, UFRGS, Porto Alegre, Brazil
- Serviço de Genética Médica, HCPA, Porto Alegre, Brazil
| | - Carmen Regla Vargas
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, UFRGS, Porto Alegre, Brazil
- Serviço de Genética Médica, HCPA, Porto Alegre, Brazil
| | - Pierre Hainaut
- International Prevention Research Institute, Lyon, France
| | - Fábio Klamt
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, UFRGS, Porto Alegre, Brazil
- Institutos Nacionais de Ciência e Tecnologia - Translacional em Medicina (MCT/CNPq INCT-TM), Porto Alegre, RS, Brazil
- Rede Gaúcha de Estresse Oxidativo e Sinalização Celular (FAPERGS), Porto Alegre, RS, Brazil
- Programa de Pós-Graduação em Ciências Médicas: Medicina, UFRGS, Porto Alegre, Brazil
| | - Patricia Ashton-Prolla
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Laboratório de Medicina Genômica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Programa de Pós-Graduação em Ciências Médicas: Medicina, UFRGS, Porto Alegre, Brazil
- Serviço de Genética Médica, HCPA, Porto Alegre, Brazil
- * E-mail:
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33
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Aguiar ESD, Giacomazzi J, Schmidt AV, Bock H, Saraiva-Pereira ML, Schuler-Faccini L, Duarte Filho D, Santos PACD, Giugliani R, Caleffi M, Camey SA, Ashton-Prolla P. GSTM1, GSTT1, and GSTP1 polymorphisms, breast cancer risk factors and mammographic density in women submitted to breast cancer screening. Rev bras epidemiol 2012; 15:246-55. [DOI: 10.1590/s1415-790x2012000200002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 05/27/2012] [Indexed: 01/07/2023] Open
Abstract
Genetic polymorphisms in genes related to the metabolism of xenobiotics, such as genes of the glutathione S-transferases (GSTM1, GSTT1, and GSTP1) superfamily have been associated with an increased risk for breast cancer (BC). Considering the high incidence of BC in the city of Porto Alegre in southern Brazil, the purpose of this study was to characterize genotypic and allelic frequencies of polymorphisms in GSTM1, GSTT1, and GSTP1, and correlate these molecular findings with established risk factors for breast cancer including mammographic density, in a sample of 750 asymptomatic women undergoing mammographic screening. Molecular tests were performed using the multiplex polymerase chain reaction (PCR) for GSTM1 and GSTT1, and quantitative PCR for GSTP1 polymorphisms. Overall, the frequencies of GSTM1 and GSTT1 null genotypes were 45% and 21%, respectively. For GSTP1 polymorphism, genotypic frequencies were 44% for the Ile/Ile genotype, 44% for the Ile/Val genotype, and 12% for Val/Val genotype, with an allelic frequency of 66% for the wild type allele in this population, similar to results of previous international publications. There was a statistically significant association between the combined GSTM1 and GSTT1 null genotypes (M-/T-) and mammographic density in post menopausal women (p = 0.031). When the GSTT1 null (T-) genotype was analyzed isolated, the association with mammographic density in post menopausal women and in the overall sample was also statistically significant (p = 0.023 and p = 0.027, respectively). These findings suggest an association of GSTM1 and GSTT1 null genotypes with mammographic density.
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Affiliation(s)
| | - Juliana Giacomazzi
- Universidade Federal do Rio Grande do Sul, Brazil; Hospital de Clínicas de Porto Alegre, Brazil; Associação Hospitalar Moinhos de Vento, Brazil
| | | | - Hugo Bock
- Hospital de Clínicas de Porto Alegre, Brazil; Universidade Federal do Rio Grande do Sul, Brazil
| | - Maria Luiza Saraiva-Pereira
- Hospital de Clínicas de Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Brazil; Universidade Federal do Rio Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul, Brazil
| | - Lavínia Schuler-Faccini
- Hospital de Clínicas de Porto Alegre, Brazil; Universidade Federal do Rio Grande do Sul, Brazil
| | | | | | - Roberto Giugliani
- Universidade Federal do Rio Grande do Sul, Brazil; Hospital de Clínicas de Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Brazil; Universidade Federal do Rio Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul, Brazil
| | | | | | - Patrícia Ashton-Prolla
- Universidade Federal do Rio Grande do Sul, Brazil; Associação Hospitalar Moinhos de Vento, Brazil; Hospital de Clínicas de Porto Alegre, Brazil; Universidade Federal do Rio Grande do Sul, Brazil
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34
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Giacomazzi J, Rossi C, Selistre SG, Alemar B, Roth D, Brunetto AL, Netto C, Goldim JR, Hainaut P, Camey SA, Ashton-Prolla P. Prevalence of TP53 p.R337H mutation in children with cancer from a public hospital in southern Brazil. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.10593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10593 Background: Childhood cancers are a common feature in Li-Fraumeni/Li Fraumeni-Like Syndromes (LFS/LFL), associated with the inheritance of a germline TP53 mutation. Recently, a specific germline mutation in exon 10 of the TP53 gene, p.R337H, has been reported at a high prevalence in Southeastern Brazil. Initial studies on this mutation claimed that the main, if not exclusive, cancer risk in carriers is childhood adrenocortical carcinoma (ADR). However, others recent reports identified p.R377H carriers among LFL families and among a larger spectrum of tumors, such as choroid plexus carcinoma (CPC) and osteosarcoma. The aim of this study was to assess the frequency of the p.R337H mutation in children diagnosed with tumors of the LFS/LFL spectrum: ADR, sarcoma, central nervous system tumors, leukemia, germline cell tumors and Wilm’s tumor) at the Children’s Cancer Institute of Rio Grande do Sul (Brazil) between 1998 and 2011. Methods: Family history (FH) was recorded in pedigrees, and DNA was extracted from peripheral blood and FFPE samples by standard methods. Screening for the p.R337H mutation was performed by allelic discrimination (TaqMan assay) and by TP53 exon 10 sequencing. Results: Analysis of 295 children diagnosed with tumors of the LFS/LFL spectrum identified the p.R337H mutation in 9/11 (81,8%) children with ADR (including a homozygous p.R337H individual) and in 2/2 (100%) children with CPC. All individuals had loss of heterozygosity in the tumor and in all cases the mutant allele occurred on the same founder haplotype. One hundred fourth-six (49,5%) patients had a cancer FH in first or second degree relatives, 47 (16,0%) had a FH of breast cancer and 49 (16,6%) had FH of LFL consistent with Chompret and/or Birch criteria. Conclusions: These results confirm the strong association of p.R337H with ADR and CPC. A FH consistent with LFL syndrome is present in a high proportion of children diagnosed with tumors of the LFS/LFL spectrum in Southern Brazil. Financial support: FIPE-HCPA, CAPES, FAPERGS and Glaxo Smith Kline.
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Affiliation(s)
- Juliana Giacomazzi
- Programa de Pós Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS) e Laboratório de Medicina Genômica, Centro de Pesquisa Experimental, Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Cristina Rossi
- Faculdade de Medicina, UFRGS e Laboratorio de Medicina Genômica, Centro de Pesquisa Experimental, HCPA, Porto Alegre, Brazil
| | - Simone Geiger Selistre
- Pós Graduação em Medicina: Ciências Médicas, UFRGS e Serviço de Oncologia Pediátrica, HCPA, Porto Alegre, Brazil
| | - Barbara Alemar
- Programa de Pós Graduação em Genética e Biologia Molecular, UFRGS e Laboratório de Medicina Genômica, Centro de Pesquisa Experimental, UFRGS, Porto Alegre, Brazil
| | - Daniela Roth
- Serviço de Oncologia Pediátrica, HCPA, Porto Alegre, Brazil
| | | | | | - Jose Roberto Goldim
- Serviço de Bioética, HCPA e Grupo de Pesquisa e Pós Graduação, HCPA, Porto Alegre, Brazil
| | - Pierre Hainaut
- International Centre for Research and Training - Centro Internacionale de Pesquisa e Ensino, Sao Paulo, Brazil
| | - Suzi Alves Camey
- Departamento de Estatística, Instituto de Matemática, UFRGS e Grupo de Pesquisa e Pós Graduação, HCPA, Porto Alegre, Brazil
| | - Patricia Ashton-Prolla
- Departamento de Genética, UFRGS; Laboratório de Medicina Genômica, Centro de Pesquisa Experimental, HCPA e Serviço de Genética Médica, HCPA, Porto Alegre, Brazil
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Ashton-Prolla P, Osorio CABT, Koehler-Santos P, Graudenz MS, Palmero EI, Fernandes G, Micheli R, Martel-Planche G, Achatz MI, Soares FA, Goldim JR, Caleffi M, Hainaut P, Camey SA, Giacomazzi J. Contribution of TP53 p.R337H mutation to breast cancer prevalence in Brazil. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.1522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1522 Background: The exact contribution of TP53 germline mutations, associated with Li Fraumeni Syndrome, to the overall burden of cancer is still only partially known. Studies in Southern and Southeastern Brazil have shown that a specific germline mutation at codon 337 (c.1010G>A; p.R337H), has incomplete penetrance and may be present in a significant number of subjects (estimated frequency at the populational level of 1:300 individuals). In an exploratory approach, the aim of the study is to assess the frequency of the p.R337H mutation in women from different Brazilian regions, diagnosed with breast cancer (BC) before 46 and after 55 years of age, and unselected for family history of cancer. Methods: Formalin-fixed paraffin-embedded (FFPE) non-tumoral tissue (lymph nodes or normal breast) of women diagnosed with BC between 2000 and 2010 in 3 pathology laboratories from the Brazilian cities of Porto Alegre, São Paulo and Barretos were obtained retrospectively and analyzed after anonimization. Genomic DNA was isolated with standard methods and genotyping performed in duplicates by qPCR (TaqMan assay). Confirmation of all mutation-positive and a sample of mutation-negative cases were done by TP53 exon 10 sequencing or by a second independent qPCR analysis. Results: Analysis of 515 BC-affected women identified the p.R337H mutation in the germline of 70 (8,6%) cases: 49/403 (12,1%) diagnosed before 46 years and 21/412 (5,1%) diagnosed after 55 years. BC occurred earlier in p.R337H mutation carriers than in non-carriers (p=0.001). Conclusions: Preliminary analysis in a sample of women with BC indicates that p.R337H founder mutation is present in a high proportion of cases, especially those diagnosed at a young age. Regional genetic background and recruitment strategies may account for the different mutation frequencies observed in the centers of study. The occurrence of this mutation at such a high frequency in a particular geographic region has important implications for disease management and cancer risk counseling for these patients and families. This mutation likely contributes to a significant proportion of the health burden associated with BC in Brazil. Financial support: FIPE-HCPA, CAPES, FAPERGS and Glaxo Smith Kline.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Jose Roberto Goldim
- Serviço de Bioética, HCPA e Grupo de Pesquisa e Pós Graduação, HCPA, Porto Alegre, Brazil
| | - Maira Caleffi
- Núcleo Mama, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Pierre Hainaut
- International Centre for Research and Training - Centro Internacionale de Pesquisa e Ensino, Sao Paulo, Brazil
| | - Suzi Alves Camey
- Departamento de Estatística, Instituto de Matemática, UFRGS e Grupo de Pesquisa e Pós Graduação, HCPA, Porto Alegre, Brazil
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Macedo GDS, Giacomazzi J, Netto C, Motta L, Klamt F, Ashton-Prolla P. Antioxidants and oxidative stress in patients with Li-Fraumeni-like syndrome and TP53 p.R337H mutation carriers. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e21042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21042 Background: Germline mutations in the TP53 gene are the underlying genetic defect of Li-Fraumeni Syndrome (LFS) and its variant, Li-Fraumeni-like (LFL) Syndrome, autosomal dominant disorders characterized by predisposition to multiple early-onset cancers. More recently, p53 is emerging as an important player in redox metabolism and important enzymes involved in defenses against oxidative stress have shown to be regulated by p53, including glutathione peroxidase 1 (GPX1) and mitochondrial superoxide dismutase 2 (SOD2). The aim of the present study was to investigate the redox profile parameters in blood of p.R337H mutation carriers and non-carriers individuals. Methods: A total of 34 individuals were included in the study and they were divided in two groups: mutation carriers (n=17) and non-carriers (n=17). Antioxidant enzyme activities (SOD, CAT, GPx) and oxidative stress parameters (Protein carbonyl content, Sulfhydryl content and TBARS) were measured in plasma, erythrocytes, leukocytes and serum. Results: Erythrocyte SOD and GPx activities, two first-line players in enzimatic antioxidant defense, differed significantly between mutation carriers and non-carriers, with an increased activity in the latter (p>0,05). Plasma Carbonyl content, an indicative of protein damage related to ROS overgeneration, was also increased in carriers (p=0,015). There was no significant difference between groups in all other parameters evaluated. Conclusions: Our findings suggest that TP53 p.R337H mutation carriers present different antioxidant enzyme activities and oxidative stress parameters when compared to non-carriers.
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Affiliation(s)
- Gabriel de Souza Macedo
- Universidade Federal do Rio Grande do Sul/ Hospital de Clínicas de Porto Alegre/CPE-Laboratório de Medicina Genômica, Porto Alegre, Brazil
| | - Juliana Giacomazzi
- Programa de Pós Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS) e Laboratório de Medicina Genômica, Centro de Pesquisa Experimental, Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | | | | | - Fábio Klamt
- UFRGS/Departamento de Bioquímica, Porto Alegre, Brazil
| | - Patricia Ashton-Prolla
- Departamento de Genética, UFRGS; Laboratório de Medicina Genômica, Centro de Pesquisa Experimental, HCPA e Serviço de Genética Médica, HCPA, Porto Alegre, Brazil
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Giacomazzi J, Aguiar E, Palmero EI, Schmidt AV, Skonieski G, Filho DD, Bock H, Saraiva-Pereira ML, Ewald IP, Schuler-Faccini L, Camey SA, Caleffi M, Giugliani R, Ashton-Prolla P. Prevalence of ERα-397 PvuII C/T, ERα-351 XbaI A/G and PGR PROGINS polymorphisms in Brazilian breast cancer-unaffected women. Braz J Med Biol Res 2012; 45:891-7. [PMID: 22584640 PMCID: PMC3854186 DOI: 10.1590/s0100-879x2012007500081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 04/18/2012] [Indexed: 05/26/2023] Open
Abstract
Polymorphisms of hormone receptor genes have been linked to modifications in reproductive factors and to an increased risk of breast cancer (BC). In the present study, we have determined the allelic and genotypic frequencies of the ERα-397 PvuII C/T, ERα-351 XbaI A/G and PGR PROGINS polymorphisms and investigated their relationship with mammographic density, body mass index (BMI) and other risk factors for BC. A consecutive and unselected sample of 750 Brazilian BC-unaffected women enrolled in a mammography screening program was recruited. The distribution of PGR PROGINS genotypic frequencies was 72.5, 25.5 and 2.0% for A1A1, A1A2 and A2A2, respectively, which was equivalent to that encountered in other studies with healthy women. The distribution of ERα genotypes was: ERα-397 PvuII C/T: 32.3% TT, 47.5% TC, and 20.2% CC; ERα-351 XbaI A/G: 46.3% AA, 41.7% AG and 12.0% GG. ERα haplotypes were 53.5% PX, 14.3% Px, 0.3% pX, and 32.0% px. These were significantly different from most previously published reports worldwide (P < 0.05). Overall, the PGR PROGINS genotypes A2A2 and A1A2 were associated with fatty and moderately fatty breast tissue. The same genotypes were also associated with a high BMI in postmenopausal women. In addition, the ERα-351 XbaI GG genotype was associated with menarche ≥12 years (P = 0.02). ERα and PGR polymorphisms have a phenotypic effect and may play an important role in BC risk determination. Finally, if confirmed in BC patients, these associations could have important implications for mammographic screening and strategies and may be helpful to identify women at higher risk for the disease.
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Affiliation(s)
- J Giacomazzi
- Programa de Pós-Graduação em Medicina, Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
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38
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Giacomazzi J, Aguiar E, Palmero E, Schmidt A, Skonieski G, Duarte Filho D, Bock H, Saraiva-Pereira M, Schuler-Faccini L, Camey S, Caleffi M, Giugliani R, Ashton-Prolla P. Prevalence of the STK15 F31I polymorphism and its relationship with mammographic density. Braz J Med Biol Res 2011; 44:291-6. [DOI: 10.1590/s0100-879x2011007500029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 02/04/2011] [Indexed: 01/26/2023] Open
Affiliation(s)
- J. Giacomazzi
- Universidade Federal do Rio Grande do Sul, Brasil; Hospital de Clínicas de Porto Alegre; Associação Hospitalar Moinhos de Vento, Brasil
| | - E. Aguiar
- Universidade Federal do Rio Grande do Sul, Brasil; Hospital de Clínicas de Porto Alegre; Associação Hospitalar Moinhos de Vento, Brasil
| | - E.I. Palmero
- Universidade Federal do Rio Grande do Sul, Brasil; Hospital de Clínicas de Porto Alegre; Associação Hospitalar Moinhos de Vento, Brasil
| | - A.V. Schmidt
- Universidade Federal do Rio Grande do Sul, Brasil
| | | | | | - H. Bock
- Hospital de Clínicas de Porto Alegre
| | - M.L. Saraiva-Pereira
- Universidade Federal do Rio Grande do Sul; Hospital de Clínicas de Porto Alegre; Hospital de Clínicas de Porto Alegre, Brasil
| | - L. Schuler-Faccini
- Universidade Federal do Rio Grande do Sul, Brasil; Hospital de Clínicas de Porto Alegre, Brasil
| | - S.A. Camey
- Universidade Federal do Rio Grande do Sul
| | - M. Caleffi
- Associação Hospitalar Moinhos de Vento, Brasil
| | - R. Giugliani
- Universidade Federal do Rio Grande do Sul, Brasil; Universidade Federal do Rio Grande do Sul, Brasil; Hospital de Clínicas de Porto Alegre; Hospital de Clínicas de Porto Alegre, Brasil
| | - P. Ashton-Prolla
- Universidade Federal do Rio Grande do Sul, Brasil; Universidade Federal do Rio Grande do Sul, Brasil; Hospital de Clínicas de Porto Alegre; Hospital de Clínicas de Porto Alegre, Brasil; Associação Hospitalar Moinhos de Vento, Brasil
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Giacomazzi J, Koehler-Santos P, Alemar BB, Ashton-Prolla P, Graudenz MS. Abstract P3-06-02: Prevalence of TP53 p.R337H Mutation in Cases of Breast Phyllodes Tumours in Southern Brazil. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p3-06-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Previous studies in Brazilian patients diagnosed with the core-cancers of Li-Fraumeni syndrome (LFS) and its variants (LFL) indicate that a particular germline mutation, TP53 p.R337H, may be highly prevalent and strongly associated with pediatric adrenocortical tumors in Southern Brazil. However, other tumours types, including breast cancer, have been observed in carriers, raising the possibility that the TP53 p.R337H mutation may also contribute to breast tumorigenesis. Breast phyllodes tumour, a very rare and aggressive breast neoplasia that accounts for less than 1% of all breast cancer cases, may be associated with LFS, and has suggested by some to be particularly frequent in TP53 mutation carriers. Methods: Formalin fixed paraffin-embedded (FFPE) tissue from disease-free lymph nodes of an unselected consecutive series of women diagnosed with benign and malignant phyllodes tumours between 2000 and 2010, was obtained from 7 Pathology Laboratories in Southern Brazil. Genomic DNA was isolated from FFPE with the QIAamp DNA Tissue Kit. Genotyping was performed by qPCR using TaqMan technology and direct bi-directional sequencing for confirmation in mutation-positive cases. Results: Analysis of the first 48 cases included in the study (9 malignant, 3 borderline and 36 benign phyllodes tumors) resulted in identification of the TP53 p.R337H mutation in the germline of a 61 year-old patient with malignant phyllodes and a 38 year-old patient with a benign phyllodes tumor of the breast.
Conclusion: Preliminary analysis of a case series of breast phyllodes tumors indicates that germline the founder mutation TP53 p.R337H may be particularly common in women with these tumors in Southern Brazil. Further analysis of the entire TP53 coding region and evaluation of the founder haplotype in the mutation-positive cases is ongoing. The identification of germline TP53 mutations in patients diagnosed with phyllodes tumors of the breast has important implications for disease management and in cancer risk counseling for these patients and families.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-06-02.
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Affiliation(s)
- J Giacomazzi
- Federal University of Rio Grande do Sul (UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - P Koehler-Santos
- Federal University of Rio Grande do Sul (UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - BB Alemar
- Federal University of Rio Grande do Sul (UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - P Ashton-Prolla
- Federal University of Rio Grande do Sul (UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - MS. Graudenz
- Federal University of Rio Grande do Sul (UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
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Caleffi M, Ribeiro RA, Bedin AJ, Viegas-Butzke JMP, Baldisserotto FDG, Skonieski GP, Giacomazzi J, Camey SA, Ashton-Prolla P. Adherence to a breast cancer screening program and its predictors in underserved women in southern Brazil. Cancer Epidemiol Biomarkers Prev 2010; 19:2673-9. [PMID: 20716620 DOI: 10.1158/1055-9965.epi-10-0338] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Adherence to breast cancer screening is a key element to ensure effectiveness of programs aiming at downstaging of breast cancer. In this study, we evaluated adherence to a screening program and its predictors in underserved women in southern Brazil. METHODS Attendance to the program, which is based on yearly mammogram and clinical examination, was evaluated prospectively. Mean time frames between visits were calculated. Possible predictors of adherence (defined as mean intervals ≤18 mo), such as socioeconomic indicators and health/lifestyle behaviors, were investigated. RESULTS A total of 3,749 women (age 51 ± 8 y, illiteracy rate of 6.8%, 57.4% with parity ≥3) were analyzed. Median time between screening rounds was 16.5 months (interquartile range, 13.1-25.7), and median number of rounds attended was 3 (interquartile range, 2-4); 57.6% had mean intervals ≤18, and 71% ≤24 months. The most important independent predictors of adherence were high genetic risk [relative risk (RR), 1.25; 95% confidence interval (95% CI), 1.11-1.40], illiteracy (RR, 0.77; 95% CI, 0.67-0.90), parity ≥5 (RR, 0.89; 95% CI, 0.83-0.96), and smoking (RR, 0.82; 95% CI, 0.77-0.88). CONCLUSIONS Although the proposed screening interval was 1 year, compliance to biannual screening (accepted in several international programs) was high, especially when considering the low socioeconomic level of the sample. IMPACT This project aims to test a breast cancer screening model for underserved populations in limited-resource countries where adherence is an issue. The identification of worst adherence predictors can point to interventions to improve outcomes of similar public health screening strategies.
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Affiliation(s)
- Maira Caleffi
- Núcleo Mama Porto Alegre, Associação Hospitalar Moinhos de Vento, Brazil.
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Ashton-Prolla P, Giacomazzi J, Schmidt AV, Roth FL, Palmero EI, Kalakun L, Aguiar ES, Moreira SM, Batassini E, Belo-Reyes V, Schuler-Faccini L, Giugliani R, Caleffi M, Camey SA. Development and validation of a simple questionnaire for the identification of hereditary breast cancer in primary care. BMC Cancer 2009; 9:283. [PMID: 19682358 PMCID: PMC2739222 DOI: 10.1186/1471-2407-9-283] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 08/14/2009] [Indexed: 11/10/2022] Open
Abstract
Background Breast cancer is a significant public health problem worldwide and the development of tools to identify individuals at-risk for hereditary breast cancer syndromes, where specific interventions can be proposed to reduce risk, has become increasingly relevant. A previous study in Southern Brazil has shown that a family history suggestive of these syndromes may be prevalent at the primary care level. Development of a simple and sensitive instrument, easily applicable in primary care units, would be particularly helpful in underserved communities in which identification and referral of high-risk individuals is difficult. Methods A simple 7-question instrument about family history of breast, ovarian and colorectal cancer, FHS-7, was developed to screen for individuals with an increased risk for hereditary breast cancer syndromes. FHS-7 was applied to 9218 women during routine visits to primary care units in Southern Brazil. Two consecutive samples of 885 women and 910 women who answered positively to at least one question and negatively to all questions were included, respectively. The sensitivity, specificity and positive and negative predictive values were determined. Results Of the 885 women reporting a positive family history, 211 (23.8%; CI95%: 21.5–26.2) had a pedigree suggestive of a hereditary breast and/or breast and colorectal cancer syndrome. Using as cut point one positive answer, the sensitivity and specificity of the instrument were 87.6% and 56.4%, respectively. Concordance between answers in two different applications was given by a intra-class correlation (ICC) of 0.84 for at least one positive answer. Temporal stability of the instrument was adequate (ICC = 0.65). Conclusion A simple instrument for the identification of the most common hereditary breast cancer syndrome phenotypes, showing good specificity and temporal stability was developed and could be used as a screening tool in primary care to refer at-risk individuals for genetic evaluations.
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Affiliation(s)
- Patricia Ashton-Prolla
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul , Porto Alegre, Brazil.
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Palmero EI, Caleffi M, Schüler-Faccini L, Roth FL, Kalakun L, Netto CBO, Skonieski G, Giacomazzi J, Weber B, Giugliani R, Camey SA, Ashton-Prolla P. Population prevalence of hereditary breast cancer phenotypes and implementation of a genetic cancer risk assessment program in southern Brazil. Genet Mol Biol 2009; 32:447-55. [PMID: 21637504 PMCID: PMC3036062 DOI: 10.1590/s1415-47572009005000058] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Accepted: 12/02/2008] [Indexed: 11/22/2022] Open
Abstract
In 2004, a population-based cohort (the Núcleo Mama Porto Alegre - NMPOA Cohort) was started in Porto Alegre, southern Brazil and within that cohort, a hereditary breast cancer study was initiated, aiming to determine the prevalence of hereditary breast cancer phenotypes and evaluate acceptance of a genetic cancer risk assessment (GCRA) program. Women from that cohort who reported a positive family history of cancer were referred to GCRA. Of the 9218 women enrolled, 1286 (13.9%) reported a family history of cancer. Of the 902 women who attended GCRA, 55 (8%) had an estimated lifetime risk of breast cancer ≥ 20% and 214 (23.7%) had pedigrees suggestive of a breast cancer predisposition syndrome; an unexpectedly high number of these fulfilled criteria for Li-Fraumeni-like syndrome (122 families, 66.7%). The overall prevalence of a hereditary breast cancer phenotype was 6.2% (95%CI: 5.67-6.65). These findings identified a problem of significant magnitude in the region and indicate that genetic cancer risk evaluation should be undertaken in a considerable proportion of the women from this community. The large proportion of women who attended GCRA (72.3%) indicates that the program was well-accepted by the community, regardless of the potential cultural, economic and social barriers.
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Affiliation(s)
- Edenir I. Palmero
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, RSBrazil
| | - Maira Caleffi
- Núcleo Mama Porto Alegre and Associação Hospitalar Moinhos de Vento, Porto Alegre, RSBrazil
| | - Lavínia Schüler-Faccini
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, RSBrazil
| | - Fernanda L. Roth
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, RSBrazil
| | - Luciane Kalakun
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RSBrazil
| | | | - Giovana Skonieski
- Núcleo Mama Porto Alegre and Associação Hospitalar Moinhos de Vento, Porto Alegre, RSBrazil
| | - Juliana Giacomazzi
- Laboratório de Medicina Genômica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RSBrazil
| | - Bernadete Weber
- Núcleo Mama Porto Alegre and Associação Hospitalar Moinhos de Vento, Porto Alegre, RSBrazil
| | - Roberto Giugliani
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, RSBrazil
| | - Suzi A. Camey
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RSBrazil
| | - Patricia Ashton-Prolla
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, RSBrazil
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Caleffi M, Ribeiro RA, Duarte Filho DL, Ashton-Prolla P, Bedin AJ, Skonieski GP, Zignani JM, Giacomazzi J, Franco LR, Graudenz M, Pohlmann P, Fernandes JG, Kivitz P, Weber B. A model to optimize public health care and downstage breast cancer in limited-resource populations in southern Brazil. (Porto Alegre Breast Health Intervention Cohort). BMC Public Health 2009; 9:83. [PMID: 19284670 PMCID: PMC2669067 DOI: 10.1186/1471-2458-9-83] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 03/13/2009] [Indexed: 11/26/2022] Open
Abstract
Background Breast cancer (BC) is a major public health problem, with rising incidence in many regions of the globe. Although mortality has recently dropped in developed countries, death rates are still increasing in some developing countries, as seen in Brazil. Among the reasons for this phenomenon are the lack of structured screening programs, a long waiting period between diagnosis and treatment, and lack of access to health services for a large proportion of the Brazilian population. Methods and design Since 2004, an intervention study in a cohort of women in Southern Brazil, denominated Porto Alegre Breast Health Intervention Cohort, is being conducted in order to test the effectiveness and cost-effectiveness of a model for BC early detection and treatment. In this study, over 4,000 women from underserved communities aged 40 to 69 years are being screened annually with mammography and clinical breast examination performed by a multidisciplinary team, which also involves nutritional counseling and genetic cancer risk assessment. Risk factors for BC development are also being evaluated. Active search of participants by lay community health workers is one of the major features of our program. The accrual of new participants was concluded in 2006 and the study will last for 10 years. The main goal of the study is to demonstrate significant downstaging of BC in an underserved population through proper screening, attaining a higher rate of early-stage BC diagnoses than usually seen in women diagnosed in the Brazilian Public Health System. Preliminary results show a very high BC incidence in this population (117 cases per 100,000 women per year), despite a low prevalence of classical risk factors. Discussion This study will allow us to test a model of BC early diagnosis and treatment and evaluate its cost-effectiveness in a developing country where the mortality associated with this disease is very high. Also, it might contribute to the evaluation of risk factors in a population with a different ethnic background from that studied in developed countries. If our model is proven effective, it may be replicated in other parts of the globe where BC is also a major public health problem.
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Affiliation(s)
- Maira Caleffi
- Associação Hospitalar Moinhos de Vento, Porto Alegre, Brazil.
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Ashton-Prolla P, Giacomazzi J, Schmidt AV, Roth FL, Aguiar E, Moreira SM, Belo-Reyes V, Kalakun L, Caleffi M, Camey SA. Development and validation of a questionnaire for the identification of hereditary breast cancer in primary care. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.22094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Giacomazzi J, Aguiar E, Palmero EI, Kalakun L, Schuler-Faccini L, Duarte Filho D, Bedin A, Caleffi M, Giugliani R, Ashton-Prolla P. Progesterone receptor gene polymorphism (PROGINS) in 701 women from a mammographic breast cancer screening program (NMPOA) in Southern Brazil. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.21048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
21048 Background: Several genetic polymorphisms in hormone receptor genes have been associated with breast cancer (BC) risk. Among these, a 306 base-pair insertion of the Alu subfamily in intron 7 of the progesterone receptor (PR) gene, (PROGINS), has been associated with decreased BC risk in several populations. In Brazil, BC is a significant public health problem, due to its high incidence and mortality rates. In Porto Alegre, Brazil`s southernmost capital, a multidisciplinary Breast Cancer Prevention Project - the Nucleo Mama Porto Alegre Cohort (NMPOA) was started in 2004 and includes a mammographic screening program for women ages 40–69 years. Goal: Determine the allelic and genotypic frequencies of PROGINS in women undergoing annual BC screening and correlate its presence with mammography results and presence of additional BC risk factors (family history of BC, body mass index, estimated BC risk by the Gail model and age) at baseline and after 10 years. Methods: A sample of 701 women from the NMPOA BC screening program was consecutively enrolled in the study from November/2005 until March/2006. Clinical data, mammography results (as BIRADS categories) and BC risk information was obtained by chart review. PROGINS genotyping was performed by polymerase chain reaction (PCR). Results: Of the 701 patients studied, 504 (71,0%) were wild-type homozygous, 184 (26,2%) heterozygous and 13 (1,8%) homozygous for the PROGINS polymorphism. These genotypic frequencies are similar to those of other reports in different populations. Genotype was correlated with 5-year and vital BC risk estimates (Gail model), body mass index, family history of BC and mammography findings. A statistically significant association was found between the presence of PROGINS and a positive family history of BC (p< 0,05). Conclusions: The genotypic and allelic frequencies of the PROGINS polymorphism were not significantly different from those reported previously for other populations. Prospective clinical evaluation of the women followed in this program and correlation of genotype with clinical findings may be important to elucidate additional risks associated with the PROGINS polymorphism. No significant financial relationships to disclose.
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Affiliation(s)
- J. Giacomazzi
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Hospital Moinhos de Vento, Porto Alegre, RS, Brazil; Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - E. Aguiar
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Hospital Moinhos de Vento, Porto Alegre, RS, Brazil; Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - E. I. Palmero
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Hospital Moinhos de Vento, Porto Alegre, RS, Brazil; Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - L. Kalakun
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Hospital Moinhos de Vento, Porto Alegre, RS, Brazil; Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - L. Schuler-Faccini
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Hospital Moinhos de Vento, Porto Alegre, RS, Brazil; Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - D. Duarte Filho
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Hospital Moinhos de Vento, Porto Alegre, RS, Brazil; Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - A. Bedin
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Hospital Moinhos de Vento, Porto Alegre, RS, Brazil; Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - M. Caleffi
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Hospital Moinhos de Vento, Porto Alegre, RS, Brazil; Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - R. Giugliani
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Hospital Moinhos de Vento, Porto Alegre, RS, Brazil; Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - P. Ashton-Prolla
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Hospital Moinhos de Vento, Porto Alegre, RS, Brazil; Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
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Caleffi M, Bedin AJ, Zignani JM, Artico LG, Viegas-Butzke JM, Rutta R, Schmidt A, Giacomazzi J, Ashton-Prolla P, Weber B. Prevalence of breast cancer risk factors in two different cohorts in relation to health care access and preventive programs in southern Brazil. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.1538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1538 Background: Breast cancer (BC) represents a public issue of great impact also in developing countries as Brazil, where BC incidence and mortality rates are continuosly increasing, the latter probably due to late diagnosis and lack of health care programs.Studies are needed to identified BC risk factors in different groups of women in Porto Alegre (POA), where BC incidence is 3-fold higher than other Brazilian cities. Preliminary analysis are presented to enable specialists to design preventive strategies of breast health care models. Methods: The study included a survey of risk factors of two social economic distinct groups of women over 15 years old with different access to health care programs in POA: 1) Núcleo Mama Porto Alegre (NMPOA): underserved women derived from public health care units, and 2) Núcleo Mama Moinhos (NMHMV): women with private insurance. Results: Data of 785 from NMHMV and 8921 from NMPOA are summarized in the table . Obesity and smokers are more frequent in the underserved population whereas a positive familial history is more common in the NMHMV group. Conclusions: Preliminary results showed significant differences among the two studied population demanding distinct strategies of prevention and management. The total number of 15.000 women will be presented together with reproductive factors and the their Gail model access. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- M. Caleffi
- Núcleo Mama Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - A. J. Bedin
- Núcleo Mama Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - J. M. Zignani
- Núcleo Mama Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - L. G. Artico
- Núcleo Mama Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | - R. Rutta
- Núcleo Mama Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - A. Schmidt
- Núcleo Mama Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - J. Giacomazzi
- Núcleo Mama Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | - B. Weber
- Núcleo Mama Hospital Moinhos de Vento, Porto Alegre, Brazil
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Aguiar E, Giacomazzi J, Palmero EI, Kalakun L, Schuler-Faccini L, Duarte Filho D, Skonieski G, Caleffi M, Giugliani R, Ashton-Prolla P. Null allele polymorphisms in the GSTT1 and GSTM1 genes in 705 women from a mammographic breast cancer screening program (NMPOA) in southern Brazil. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.21091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
21091 Background: Several genetic polymorphisms in genes related with metabolism have been associated with breast cancer (BC) risk. Among these, the gluthatione-S-transferase M1 and T1 null genotypes have been associated with slightly increased BC risk in some populations. In Brazil, BC is a significant public health problem, due to its high incidence and mortality rates. In Porto Alegre, Brazil`s southernmost capital, a multidisciplinary BC Prevention Project - the Nucleo Mama Porto Alegre Cohort (NMPOA)- was started in 2004 and includes a mammographic screening program for women ages 40–69 years. Goal:Determine the allelic and genotypic frequencies of GSTM1 and GSTT1 null alleles in women undergoing annual mammographic screening and correlate its presence with mammography results and presence of additional BC risk factors at baseline and after 10 years. Methods: A sample of 705 women from the NMPOA BC screening program was consecutively enrolled from November/2005 until March/2006. Mammography results (BIRADS categories) and BC risk information (5-yr and vital estimates using the Gail model, family history of BC, body mass index) were obtained by chart review. Genotyping was performed by multiplex polymerase chain reaction (PCR). Results: Of the 705 patients studied, 145 (20.6%) and 314 (44.5%) had the GSTT1 and GSTM1 null alleles, respectively. Genotypically, 67 (9,5%) were null homozygous for both genes (GSTM1- and GSTT1- ); 78 (11,1%) were GSTT1- and non-null for GSTM1 (GSTT1- and GSTM1+); 247 (35%) were GSTT1+ and GSTM1- and 313(44,4%) were GSTM+ and GSTT+. There was a statistically significant association of the GSTT1+ allele with low-risk mammographic findings (category BIRADS 1; p<0,05). Conclusions: The genotypic and allelic frequencies of the GSTT1 and GSTM1 null alleles were not significantly different from those reported previously for other populations. The non-null GSTT1 allele was associated with lower category mammographic findings. Prospective clinical evaluation of the women followed in this program and correlation of genotype with clinical findings may elucidate additional risks associated with the presence of these polymorphisms. No significant financial relationships to disclose.
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Affiliation(s)
- E. Aguiar
- Federal University Rio Grande do Sul, Porto Alegre, Brazil; Hospital Moinhos de Vento, Porto Alegre, RS, Brazil; Hospital Moinhos de Vento, Porto Alegre, Brazil; Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - J. Giacomazzi
- Federal University Rio Grande do Sul, Porto Alegre, Brazil; Hospital Moinhos de Vento, Porto Alegre, RS, Brazil; Hospital Moinhos de Vento, Porto Alegre, Brazil; Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - E. I. Palmero
- Federal University Rio Grande do Sul, Porto Alegre, Brazil; Hospital Moinhos de Vento, Porto Alegre, RS, Brazil; Hospital Moinhos de Vento, Porto Alegre, Brazil; Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - L. Kalakun
- Federal University Rio Grande do Sul, Porto Alegre, Brazil; Hospital Moinhos de Vento, Porto Alegre, RS, Brazil; Hospital Moinhos de Vento, Porto Alegre, Brazil; Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - L. Schuler-Faccini
- Federal University Rio Grande do Sul, Porto Alegre, Brazil; Hospital Moinhos de Vento, Porto Alegre, RS, Brazil; Hospital Moinhos de Vento, Porto Alegre, Brazil; Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - D. Duarte Filho
- Federal University Rio Grande do Sul, Porto Alegre, Brazil; Hospital Moinhos de Vento, Porto Alegre, RS, Brazil; Hospital Moinhos de Vento, Porto Alegre, Brazil; Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - G. Skonieski
- Federal University Rio Grande do Sul, Porto Alegre, Brazil; Hospital Moinhos de Vento, Porto Alegre, RS, Brazil; Hospital Moinhos de Vento, Porto Alegre, Brazil; Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - M. Caleffi
- Federal University Rio Grande do Sul, Porto Alegre, Brazil; Hospital Moinhos de Vento, Porto Alegre, RS, Brazil; Hospital Moinhos de Vento, Porto Alegre, Brazil; Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - R. Giugliani
- Federal University Rio Grande do Sul, Porto Alegre, Brazil; Hospital Moinhos de Vento, Porto Alegre, RS, Brazil; Hospital Moinhos de Vento, Porto Alegre, Brazil; Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - P. Ashton-Prolla
- Federal University Rio Grande do Sul, Porto Alegre, Brazil; Hospital Moinhos de Vento, Porto Alegre, RS, Brazil; Hospital Moinhos de Vento, Porto Alegre, Brazil; Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
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Fleck RMM, Rodrigues Junior V, Giacomazzi J, Parissoto D, Dutra-Filho CS, de Souza Wyse AT, Wajner M, Wannmacher CMD. Cysteamine prevents and reverses the inhibition of creatine kinase activity caused by cystine in rat brain cortex. Neurochem Int 2005; 46:391-7. [PMID: 15737437 DOI: 10.1016/j.neuint.2004.11.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2004] [Revised: 11/15/2004] [Accepted: 11/27/2004] [Indexed: 11/15/2022]
Abstract
Cystinosis is a disorder associated with lysosomal cystine accumulation caused by defective cystine efflux. Cystine accumulation provokes a variable degree of symptoms depending on the involved tissues. Adult patients may present brain cortical atrophy. However, the mechanisms by which cystine is toxic to the tissues are not fully understood. Considering that brain damage may be developed by energy deficiency, creatine kinase is a thiolic enzyme crucial for energy homeostasis, and disulfides like cystine may alter thiolic enzymes by thiol/disulfide exchange, the main objective of the present study was to investigate the effect of cystine on creatine kinase activity in total homogenate, cytosolic and mitochondrial fractions of the brain cortex from 21-day-old Wistar rats. We performed kinetic studies and investigated the effects of GSH, a biologically occurring thiol group protector, and cysteamine, the drug used for cystinosis treatment, to better understand the effect of cystine on creatine kinase activity. Results showed that cystine inhibited the enzyme activity non-competitively in a dose- and time-dependent way. GSH partially prevented and reversed CK inhibition caused by cystine and cysteamine fully prevented and reversed this inhibition, suggesting that cystine inhibits creatine kinase activity by interaction with the sulfhydryl groups of the enzyme. Considering that creatine kinase is a crucial enzyme for brain cortex energy homeostasis, these results provide a possible mechanism for cystine toxicity and also a new possible beneficial effect for the use of cysteamine in cystinotic patients.
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Affiliation(s)
- Rochele M Müller Fleck
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2600 - Anexo, CEP 90.035-003 Porto Alegre, RS, Brazil
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