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Hughes DJ, Kapiris M, Podvez Nevajda A, McGrath H, Stavraka C, Ahmad S, Taylor B, Cook GJR, Ghosh S, Josephs D, Pintus E, Gennatas S, Bille A, Ryanna K, Santis G, Montes A, Van Hemelrijck M, Karapanagiotou E, Smith D, Spicer J, Georgiou A. Non-Small Cell Lung Cancer (NSCLC) in Young Adults, Age < 50, Is Associated with Late Stage at Presentation and a Very Poor Prognosis in Patients That Do Not Have a Targeted Therapy Option: A Real-World Study. Cancers (Basel) 2022; 14:6056. [PMID: 36551542 PMCID: PMC9776398 DOI: 10.3390/cancers14246056] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022] Open
Abstract
(1) Background: Non-small cell lung cancer (NSCLC) in young patients is uncommon. Real-world evidence on the outcomes of these patients is limited. (2) Methods: We conducted a retrospective cohort study of young NSCLC patients, age < 50 years at diagnosis, who were treated between 2011−2020 in South-East-London cancer centres. Clinicopathological characteristics, treatment and outcomes were analysed. (3) Results: Of 248 NSCLC patients, median age was 46 years, 50% (n = 125) female, 58% (n = 145) white, 18% (n = 45) black and 4% (n = 10) Asian ethnicity. Amongst patients with a documented smoking history, 30% (n = 64) were never-smokers. Most patients had adenocarcinoma (77%, n = 191) and presented with metastatic disease (67%, n = 166). Only 31% (n = 76) had treatment with curative intent. In patients who presented or developed metastatic non-squamous NSCLC (n = 179), EGFR mutation status was known in 88% (n = 157) and mutation present in 19% (n = 34), ALK was known in 66% (n = 118) with a translocation in 10% (n = 18), ROS1 status was known in 57% (n = 102) with a translocation in 4% (n = 8), and KRAS status was known in 66% (n = 119) with a mutation in 12% (n = 22). Overall, 76% (n = 152) patients with metastatic NSCLC received first-line systemic anti-cancer therapy. Median overall survival in metastatic NSCLC was 9.0 months (95% CI 6.5−11.6 months), with superior median overall survival in those with a targeted therapy option (28.7 months) compared to those without (6.6 months; p < 0.001). (4) Conclusion: Young patients contribute a significant proportion of those presenting with lung cancer. They present with advanced stage at diagnosis and have a poor prognosis. Identification of a targeted therapy option is associated with improved survival. However, most patients do not have a known genomic driver, which is in part due to limited testing, particularly in the early years of this study period. These findings highlight the particular importance of rapid-turnaround comprehensive genomic profiling in this age group and the need to identify strategies to facilitate earlier diagnosis in young NSCLC patients.
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Affiliation(s)
- Daniel Johnathan Hughes
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Matthaios Kapiris
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Andreja Podvez Nevajda
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Harriet McGrath
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Chara Stavraka
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
- School of Cancer and Pharmaceutical Sciences, King’s College London, Guy’s Campus, Great Maze Pond, London SE1 1UL, UK
| | - Shahreen Ahmad
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
- King’s College Hospital NHS Foundation Trust, King’s College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Benjamin Taylor
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Gary J. R. Cook
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Sharmistha Ghosh
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
- King’s College Hospital NHS Foundation Trust, King’s College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Debra Josephs
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Elias Pintus
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
- Lewisham and Greenwich NHS Trust, University Hospital Lewisham, High Street, Lewisham, London SE13 6LH, UK
| | - Spyridon Gennatas
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
- Lewisham and Greenwich NHS Trust, University Hospital Lewisham, High Street, Lewisham, London SE13 6LH, UK
| | - Andrea Bille
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
- School of Cancer and Pharmaceutical Sciences, King’s College London, Guy’s Campus, Great Maze Pond, London SE1 1UL, UK
- King’s College Hospital NHS Foundation Trust, King’s College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Kimuli Ryanna
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - George Santis
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
- School of Cancer and Pharmaceutical Sciences, King’s College London, Guy’s Campus, Great Maze Pond, London SE1 1UL, UK
| | - Ana Montes
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Mieke Van Hemelrijck
- School of Cancer and Pharmaceutical Sciences, King’s College London, Guy’s Campus, Great Maze Pond, London SE1 1UL, UK
| | - Eleni Karapanagiotou
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
- School of Cancer and Pharmaceutical Sciences, King’s College London, Guy’s Campus, Great Maze Pond, London SE1 1UL, UK
| | - Daniel Smith
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
- Lewisham and Greenwich NHS Trust, University Hospital Lewisham, High Street, Lewisham, London SE13 6LH, UK
| | - James Spicer
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
- School of Cancer and Pharmaceutical Sciences, King’s College London, Guy’s Campus, Great Maze Pond, London SE1 1UL, UK
| | - Alexandros Georgiou
- Cancer Centre at Guy’s, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
- School of Cancer and Pharmaceutical Sciences, King’s College London, Guy’s Campus, Great Maze Pond, London SE1 1UL, UK
- King’s College Hospital NHS Foundation Trust, King’s College Hospital, Denmark Hill, London SE5 9RS, UK
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Barbalho D, Sandoval R, Santos E, Pisani J, Quirino C, Garicochea B, Rossi B, Achatz MI. Novel Insights From the Germline Landscape of Breast Cancer in Brazil. Front Oncol 2022; 11:743231. [PMID: 35155181 PMCID: PMC8831886 DOI: 10.3389/fonc.2021.743231] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 12/31/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Breast cancer patients with germline pathogenic variants may benefit from risk-reducing surgeries, intensive screening, and targeted cancer therapies. There is a paucity of data regarding prevalence and distribution of germline pathogenic variants in the Brazilian population. Our primary endpoint was the description of prevalence and distribution of germline pathogenic variants among breast cancer patients who underwent next-generation sequencing (NGS) panel testing. Secondary endpoint was the assessment of predictive factors of a positive test. Methods We analyzed NGS results, personal, and family history data from a prospectively collected cohort of breast cancer patients from August 2013 to May 2019. Exact logistic regression was used to perform multivariable analysis. Results Of 370 breast cancer patients, we found 59 pathogenic variants in 57 (15%) patients. Pathogenic variants were identified in BRCA1 (24%), ATM (14%), BRCA2 (10%), TP53 (8%), PALB2 (8%), CHEK2 (7%), CDH1 (3%), RAD51C (3%), MITF (2%), PMS2 (2%), RAD51D (2%), and TERT (2%). Monoallelic MUTYH pathogenic variants were found in 15%. After multivariable analysis, age of diagnosis (OR 0.89, 95% CI: 0.81–0.95, for each year increase), triple-negative subtype (OR 17.2, 95% CI: 3.74–114.72), and number of breast cancers in the family (OR 2.46, 95% CI 1.57–4.03, for each additional case) were associated with BRCA1 pathogenic variants. In the present study, a quarter of triple-negative breast cancer patients harbored a germline pathogenic variant and two-thirds of those were BRCA1 carriers. Conclusions Prevalence and distribution of germline pathogenic variants in this Brazilian sample of breast cancer patients are mostly similar to other populations. However, there is a trend to an overrepresentation of TP53 pathogenic variants that merits confirmation in further studies. Early-onset breast cancer patients should be offered genetic counseling, particularly those with triple-negative subtype.
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Affiliation(s)
- Daniel Barbalho
- Department of Breast Surgery, Hospital Sirio-Libanês, São Paulo, Brazil
| | - Renata Sandoval
- Department of Oncogenetics, Hospital Sirio-Libanês, São Paulo, Brazil
| | - Erika Santos
- Department of Oncogenetics, Hospital Sirio-Libanês, São Paulo, Brazil
| | - Janina Pisani
- Department of Oncogenetics, Hospital Sirio-Libanês, São Paulo, Brazil
| | - Carla Quirino
- Department of Oncogenetics, Hospital Sirio-Libanês, São Paulo, Brazil
| | - Bernardo Garicochea
- Department of Oncogenetics, Hospital Sirio-Libanês, São Paulo, Brazil.,Centro Paulista de Oncologia, Oncoclinicas, São Paulo, Brazil
| | - Benedito Rossi
- Department of Oncogenetics, Hospital Sirio-Libanês, São Paulo, Brazil
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Freml J, Delate T, Hermosillo-Rodriguez J. Guideline-recommended incorporation of biomarker testing results in metastatic colorectal cancer therapy. Per Med 2020; 17:185-194. [PMID: 32330071 DOI: 10.2217/pme-2019-0107] [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] [Indexed: 11/21/2022]
Abstract
Aim: To describe pharmacogenomic tumor testing among patients with metastatic colorectal cancer. Methods: This was a retrospective study of patients with metastatic colorectal cancer diagnosed between 1 January 2014 and 30 June 2018. Patients were assessed for pharmacogenomic testing and appropriateness of chemotherapy use. Results: Overall, 112/167 (67.1%) patients had at least one of the three recommended pharmacogenomic tests and 41/167 (24.6%) had all tests. Twenty-four patients were treated with cetuximab with 8/167 (4.7%) identified as being treated with a RAS variant (n = 3) or incomplete testing (n = 5); thus, not in accordance with guidelines. Conclusion: Uptake of testing was variable but increased over time; however, a small proportion of patients received cetuximab with a variant or not all recommended tests being performed.
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Affiliation(s)
- Jared Freml
- Pharmacy Department, Kaiser Permanente Colorado, Aurora, CO 80011, USA.,Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO 80453, USA
| | - Thomas Delate
- Pharmacy Department, Kaiser Permanente Colorado, Aurora, CO 80011, USA.,Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO 80453, USA
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