Somatic Mutations in Latin American Breast Cancer Patients: A Systematic Review and Meta-Analysis

(1) Background: Somatic mutations may be connected to the exposome, potentially playing a role in breast cancer's development and clinical outcomes. There needs to be information regarding Latin American women specifically, as they are underrepresented in clinical trials and have limited access to somatic analysis in their countries. This study aims to systematically investigate somatic mutations in breast cancer patients from Latin America to gain a better understanding of tumor biology in the region. (2) Methods: We realize a systematic review of studies on breast cancer in 21 Latin American countries using various databases such as PubMed, Google Scholar, Web of Science, RedAlyc, Dianlet, and Biblioteca Virtual en Salud. Of 392 articles that fit the criteria, 10 studies have clinical data which can be used to create a database containing clinical and genetic information. We compared mutation frequencies across different breast cancer subtypes using statistical analyses and meta-analyses of proportions. Furthermore, we identified overexpressed biological processes and canonical pathways through functional enrichment analysis. (3) Results: 342 mutations were found in six Latin American countries, with the TP53 and PIK3CA genes being the most studied mutations. The most common PIK3CA mutation was H1047R. Functional analysis provided insights into tumor biology and potential therapies. (4) Conclusion: evaluating specific somatic mutations in the Latin American population is crucial for understanding tumor biology and determining appropriate treatment options. Combining targeted therapies may improve clinical outcomes in breast cancer. Moreover, implementing healthy lifestyle strategies in Latin America could enhance therapy effectiveness and clinical outcomes.

Clinical trial: pharmacodynamics and pharmacokinetics of re-treatment with fixed-dose induction of peginterferon alpha-2a in hepatitis C virus genotype 1 true non-responder patients

BACKGROUND

Patients infected with hepatitis C virus genotype 1 who are true non-responders to previous therapy suffer from a very difficult-to-cure disease. New approaches to treatment are necessary.

AIM

To explore the efficacy, pharmacokinetics and safety of fixed-dose induction with peginterferon alpha-2a and ribavirin in this difficult-to-cure population.

METHODS

Seventy-five hepatitis C virus genotype 1 true non-responder patients to a previous interferon-based combination regimen were randomised to receive peginterferon alpha-2a 360, 270 or 180 microg/week for 12 weeks, followed by 180 microg/week for 36 weeks, in combination with ribavirin (1000/1200 mg/day). Peginterferon alpha-2a concentration was measured throughout the study.

RESULTS

Sustained virological response rates were 38%, 30% and 18%, in the 360, 270 and 180 microg/week groups, respectively (relapse rates: 25%, 50% and 64%, respectively). The area under the serum concentration-time curve of peginterferon alpha-2a from 0-12 weeks increased in a dose-dependent manner (P < 0.0001) and was associated with the sustained virological response (odds ratio: 1.35; 95% CI: 0.89, 2.06). The three regimens were equally well tolerated.

CONCLUSION

Fixed-dose induction of peginterferon alpha-2a resulted in increased drug exposure and improved the likelihood of achieving a cure, without compromising safety in hepatitis C virus genotype 1 true non-responder patients.

Treatment of chronic he1patitis C genotype 1 with peginterferon-alpha2a (40 kDa) plus ribavirin under routine clinical practice in Spain: early prediction of sustained virological response rate

BACKGROUND

Sustained virological response rates of up to 52% have been obtained with peginterferon alpha2a (40 kDa) plus ribavirin in patients suffering from chronic hepatitis C genotype 1 in randomized-controlled trials.

AIM

To assess early virological response and its clinical utility in predicting an sustained virological response in patients suffering from chronic hepatitis C genotype 1 in routine clinical practice in Spain.

METHODS

Treatment-naïve patients received pegylated interferon alpha2a (40 kDa) 180 microg/week plus ribavirin 1000/1200 mg/day for 48 weeks, and were followed for a further 24 weeks. Overall, 475 patients received at least one dose of medication and were included in the efficacy population.

RESULTS

The overall sustained virological response rate was 48%. Of those with week 12 virological data, 83% had an early virological response. The negative predictive value of an early virological response was 93%.

CONCLUSION

If sustained virological response is the goal, a treatment-decision based on a 12-week evaluation during routine clinical practice is feasible.

Treatment of chronic he1patitis C genotype 1 with peginterferon-alpha2a (40 kDa) plus ribavirin under routine clinical practice in Spain: early prediction of sustained virological response rate

BACKGROUND

Sustained virological response rates of up to 52% have been obtained with peginterferon alpha2a (40 kDa) plus ribavirin in patients suffering from chronic hepatitis C genotype 1 in randomized-controlled trials.

AIM

To assess early virological response and its clinical utility in predicting an sustained virological response in patients suffering from chronic hepatitis C genotype 1 in routine clinical practice in Spain.

METHODS

Treatment-naïve patients received pegylated interferon alpha2a (40 kDa) 180 microg/week plus ribavirin 1000/1200 mg/day for 48 weeks, and were followed for a further 24 weeks. Overall, 475 patients received at least one dose of medication and were included in the efficacy population.

RESULTS

The overall sustained virological response rate was 48%. Of those with week 12 virological data, 83% had an early virological response. The negative predictive value of an early virological response was 93%.

CONCLUSION

If sustained virological response is the goal, a treatment-decision based on a 12-week evaluation during routine clinical practice is feasible.

Rationale and design of TeraViC-4 study: a phase III, randomized clinical trial to evaluate the effects of treatment duration with peginterferon alfa-2a (40-kDa) and ribavirin in naïve patients with chronic hepatitis C virus infection without early virological response at week 4

Several studies are available on the efficacy and safety of 40 kDa branched peginterferon alfa-2a (40-kDa) combined with ribavirin in the treatment of chronic hepatitis C patients. The TeraViC-4 study is a phase III, randomized, parallel group, multicenter study that includes two additional open arms. The main objective is to investigate if extended therapy over 72 weeks increases the rate of sustained virological response induced by a standard 48-week treatment period in naïve patients with chronic hepatitis C who do not show an early virological response. All patients will be treated with peginterferon alfa-2a (40-kDa), 180 micrograms subcutaneous (s.c.) once-weekly, and ribavirin, 400 mg b.i.d. Virological response will be assessed by a hepatitis C virus ribonucleic acid (HCV-RNA) qualitative polymerase chain reaction (PCR) test. Non-early responders (HCV-RNA still detectable after 4 weeks of therapy) will be randomly separated to receive combination therapy for 44 or 68 additional weeks. Early responders (undetectable HCV-RNA at week 4) will be allocated into two open arms according to HCV genotype and basal viral load, and they will be treated for 20 or 44 additional weeks. All patients will be followed for 24 weeks on no therapy. A total of 504 patients are planned to be included in the study in order to reach the required sample size in the two randomized groups. Efficacy of treatment will be assessed by determination of HCV-RNA and the primary efficacy variable is the rate of sustained virological response (after 24 weeks of treatment-free follow-up) in patients without early virological response. Secondary efficacy variables are the rate of sustained biochemical response, the rate of response in function of HCV genotype, viral load and treatment duration. Safety data will also be recorded and analyzed.