Exploring disparities in incidence and mortality rates of breast and gynecologic cancers according to the Human Development Index in the Pan-American region.
Martínez-Mesa J, Werutsky G, Stefan M, Pereira Filho CAS, Dueñas-González A, Zarba JJ, Mano M, Villarreal-Garza C, Gómez H, Barrios CH.
OBJECTIVE: To evaluate whether a country's Human Development Index (HDI) can help explain the differences in the country's breast cancer and gynecological cancer incidence and mortality rates in the Pan-American region.
STUDY DESIGN: Ecological analysis.
METHODS: Pan-American region countries with publicly available data both in GLOBOCAN 2012 and the United Nations Development Report 2012 were included (n = 28). Incidence and mortality rates age-standardized per 100,000 were natural log-transformed for breast cancer, ovarian cancer, corpus uteri cancer, and cervical cancer. The mortality-to-incidence ratio (MIR) was calculated for each site. Pearson's correlation test and a simple linear regression were performed.
RESULTS: The HDI showed a positive correlation with breast cancer and ovarian cancer incidence and mortality rates, respectively, and a negative correlation with cervical cancer incidence and mortality rates. The HDI and corpus uteri cancer showed no association. MIR and the HDI showed a negative correlation for all tumor types except ovarian cancer. An increment in 1 HDI unit leads to changes in cancer rates: in breast cancer incidence β = 4.03 (95% confidence interval [CI] 2.61; 5.45) P < 0.001, breast cancer mortality β = 1.76 (95% CI 0.32; 3.21) P = 0.019, and breast cancer-MIR β = -0.705 (95% CI 0.704; 0.706) P < 0.001; in cervical cancer incidence β = -3.28 (95% CI -4.78; -1.78) P < 0.001, cervical cancer mortality β = -4.63 (95% CI -6.10; -3.17) P < 0.001, and cervical cancer-MIR β = -1.35 (95% CI -1.83; -0.87) P < 0.001; in ovarian cancer incidence β = 3.26 (95% CI 1.78; 4.75) P < 0.001, ovarian cancer mortality β = 1.82 (95% CI 0.44; 3.20) P = 0.012, and ovarian cancer-MIR β = 5.10 (95% CI 3.22; 6.97) P < 0.001; in corpus uteri cancer incidence β = 2.37 (95% CI -0.33; 5.06) P = 0.83, corpus uteri cancer mortality β = 0.68 (95% CI -2.68; 2.82) P = 0.96, and corpus uteri cancer-MIR β = -2.30 (95% CI -3.19; -1.40) P < 0.001.
CONCLUSIONS: A country's HDI should be considered to understand disparities in breast cancer and gynecological cancer in the Pan-American region.
Consolidation chemotherapy following concurrent chemoradiation for stage III non-small cell lung cancer: a brazilian multicentric cohort
Vladmir Cordeiro de Lima, Clarissa Baldotto, Carlos Barrios, Eldsamira
Sobrinho, Mauro Zukin, Clarissa Mathias, Facundo Zaffaroni, Rodrigo
Nery, Gabriel Madeira, Alex Amadio, Guilherme Geib, Juliano Coelho, Maria
Fernanda Simões, Gilberto De Castro Jr
January 2017, Volume 12, Issue 1, Supplement, Pages S865-S866
Locally advanced stage III grossly accounts for 25% newly diagnosed non-small cell lng cancer (NSCLC) cases. Albeit some patients (pts) are amenable to surgical resection, most will be treated with concurrent chemoradiation (CRT), whilst the addition of consolidation chemotherapy (CC) is still a debatable topic. We decided to look into the impact of CC in stage III NSCLC Brazilian pts treated in the daily clinical practice
Kathrin Strasser-Weippl, Yanin Chavarri-Guerra, Cynthia Villarreal-Garza, Brittany L Bychkovsky, Marcio Debiasi, Pedro E R Liedke, Enrique Soto-Perez-de-Celis, Don Dizon, Eduardo Cazap, Gilberto de Lima Lopes Jr, Diego Touya, Jo?o Soares Nunes, Jessica St Louis, Caroline Vail, Alexandra Bukowski, Pier Ramos-Elias, Karla Unger-Saldaña, Denise Froes Brandao, Mayra E Ferreyra, Silvana Luciani, Angelica Nogueira-Rodrigues, Aknar Freire de Carvalho Calabrich, Marcela G Del Carmen, Jose Alejandro Rauh-Hain, Kathleen Schmeler, Raúl Sala, Paul E Goss
Lancet Oncol 2015; 16: 1405-38
Cancer is one of the leading causes of mortality worldwide, and an increasing threat in low-income and middleincome countries. Our findings in the 2013 Commission in The Lancet Oncology showed several discrepancies between the cancer landscape in Latin America and more developed countries. We reported that funding for health care was a small percentage of national gross domestic product and the percentage of health-care funds diverted to cancer care was even lower. Funds, insurance coverage, doctors, health-care workers, resources, and equipment were also very inequitably distributed between and within countries. We reported that a scarcity of cancer registries hampered the design of credible cancer plans, including initiatives for primary prevention. When we were commissioned by The Lancet Oncology to write an update to our report, we were sceptical that we would uncover much change. To our surprise and gratification much progress has been made in this short time. We are pleased to highlight structural reforms in health-care systems, new programmes for disenfranchised populations, expansion of cancer registries and cancer plans, and implementation of policies to improve primary cancer prevention.
Estimation of Premature Deaths From Lack of Access to Anti-HER2 Therapy for Advanced Breast Cancer in the Brazilian Public Health System
Márcio Debiasi, Tomás Reinert, Rafael Kaliks, Gilberto Amorim, Maira Caleffi, Carlos Sampaio, Gustavo dos Santos Fernandes and Carlos H. Barrios
J Glob Oncol
Published online before print July 20, 2016
Real World data and patterns of care of metastatic breast cancer (MBC) in Brazil: First results of LACOG 0312 retrospective study
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
Poster presented at the San Antonio Breast Cancer Symposium 2016
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.
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.
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%.
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.
Gustavo Werutsky, Marcio Debiasi, Fernanda H. Sampaio, Paulo R. Nunes Filho, Clarissa Mathias, Mauro Zukin, Facundo Zaffaroni, Gilberto Lopes
Journal of Thoracic Oncology Vol. 11 No. 10S
Epidermal growth factor receptor (EGFR) mutations represent an important predictive factor for response to EGFR inhibitors. This study aims to describe the worldwide epidemiology of EGFR mutations in lung cancer patients.
Pablo Moura Barrios, Marcio Debiasi, Gilberto Lopes, Carlos H. Barrios
October 2016 Volume 11, Issue 10, Supplement, Page S215
Well-established and adequately functional drug approval legislation is indispensable to guarantee a country's population health. Malfunctions and delays in such a crucial process have dire consequences that can be measured. The objective of this study is to evaluate what impact delays in the drug approval process may have in the survival, symptom control and quality of life of NSCLC patients in Brazil. As an example, we used the drug Crizotinib (Xalcori® Pfizer, NY, USA), which had its approval denied by the Brazilian Regulatory Agency, ANVISA in June 2014.
A Phase II Randomized Study of Lapatinib Combined With Capecitabine, Vinorelbine, or Gemcitabine in Patients With HER2-Positive Metastatic Breast Cancer With Progression After a Taxane (Latin American Cooperative Oncology Group 0801 Study)
Henry L. Gómez, Silvia Neciosup, Célia Tosello, Max Mano, José Bines, Gustavo Ismael, Patrícia X. Santi, Hélio Pinczowski, Yeni Nerón, Marcello Fanelli, Luis Fein, Carlos Sampaio, Guillermo Lerzo, Adolfo Capó, Juan J. Zarba, César Blajman, Mirta S. Varela, Jeovany Martínez-Mesa, Gustavo Werutskycorrespondenceemail, Carlos H. Barrios
Incidence and mortality rates of breast and gynecologic cancers and human development index in the pan-American region.
Jeovany Martínez-Mesa, Gustavo Werutsky, Stefan Michiels, Carlos Alberto Sampaio-Filho, Alfonso Duenas, Juan Jose Zarba, Max S. Mano, Cynthia Mayte Villarreal-Garza, Henry Leonidas Gomez, Carlos H. Barrios.
J Clin Oncol 32:5s, 2014 (suppl; abstr 1596)
A phase II randomized study of lapatinib in combination with capecitabine, vinorelbine or gemcitabine as first or second line-therapy in patients with HER2 positive metastatic breast cancer progressing after taxane (LACOG 0801).
Gomez H, Neciosup S, Tosello C, Mano M, Bines J, Ismael G, Santi PX, Pinczowsky H, Neron Y, Fanelli M, Fein L, Sampaio C, Lerzo G, Capo A, Zarba JJ, Blajman C, Varela MS, Martínez-Mesa J, Werutsky G, Barrios CH.
San Antonio Breast Cancer Symposium 2013; Abstract P4-12-26
A randomized, open-label, phase II study of lapatinib / capecitabine, lapatinib / vinorelbine, or lapatinib / gemcitabine in patients with ErbB2-amplified metastatic breast cancer progressing after taxane treatment: Results of an interim analysis (GLICO-0801 / EGF111792).
Henry Leonidas Gomez, Silvia P. Neciosup, Celia Tosello, Patricia Xavier, Yeni Neron do Nascimento, Marcelo Fanelli, Gustavo Ismael, Jose Bines, Carlos Sampaio, Guillermo Luis Lerzo, Adolfo Miguel Capo, Max S. Mano, Luis Fein, Gustavo Werutsky, Carlos H. Barrios
J Clin Oncol 30, 2012 (suppl; abstr e11087)
A randomized open-label, phase II study of lapatinib/capecitabine, lapatinib/vinorelbine, or lapatinib/gemcitabine in patients (pts) with ErbB2-amplified metastatic breast cancer (MBC) progressing after taxane treatment-GLICO-0801.
H. L. Gomez, S. P. Neciosup, Y. Neron do Nascimento, G. Ismael, C. H. Barrios
J Clin Oncol 28:15s, 2010 (suppl; abstr TPS120)