Browsing by Author "Sanchez, Cesar"
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- ItemAbstract PS6-37: Clinical stage is the only predictor of survival in breast cancer patients with a complete pathological response(2021) Acevedo, Francisco; Walbaum, Benjamin; Merino, Tomas; Petric, Militza; Sanchez, CesarINTRODUCTION In breast cancer (BC) patients, achieving a complete pathological response (pCR) after neoadjuvant chemotherapy (NCT) is associated with better prognosis. Despite this, some of these patients will experience recurrences of the disease and will eventually die of BC. We identified clinical factors that can affect recurrence and survival in BC patients who achieve pCR.METHODSRetrospective analysis of a Chilean BC database including patients treated in public and private hospitals in Santiago, Chile from 2010 to 2019. pCR was defined as the absence of residual invasive disease in the breast and in the axillary lymph nodes (ypT0/is N0) at the completion of the NCT. Invasive Disease-Free Survival (IDFS), Distant Disease-Free Survival (DDFS) and BC-specific survival (BCS) was measured from the time of diagnosis to the event or lost to follow-up. We performed Cox regression analysis to identify factors associated with prognosis.RESULTSFrom 855 patients who received NCT, 195 (22.8%) achieved pCR and were included in this study. Clinical characteristics are shown in table 1. 76 (37.9%) patients had hormone receptor positive (HR+) and 113 (57.4%) had Human epidermal growth factor 2 (HER2) positive tumors. 88.7% were treated with a regimen that included anthracyclines and taxanes. With a median follow-up of 36 months, three-year IDFS, DDFS and BCS and their 95% confidence intervals were 90.9% (84.7 - 94.6), 91.8% (86.0 - 95.3) and 93.8% (87.8 - 97.5); respectively. The stage at diagnosis was the only predictor associated with IDFS (Hazard ratio (HR) = 5.6; p = 0.02), DDFS (HR = 4.1, p = 0.07), and BCS (HR = 8.3, p = 0.04). Body mass index (BMI), age, hospital, HR or HER2 status, lymph node involvement, or the presence of an in-situ component, were not associated with prognosis in the multivariate analysis.CONCLUSIONThe clinical stage at diagnosis was the only predictor of survival in patients who achieved pCR after NCT. Short follow-up and few events may have affected these results. This data is consistent with previously published work. Table 1. Tumor and patient characteristicsMedian age49 (24 – 78)HospitalPublic57.4%Private43.6%BMIMedian27.2 (18.5 – 44.7)Overweight38.0%Obese31.9%Receptor StatusRH+/HER2-16.4%RH+/HER2+21.5%RH-/HER2+35.9%RH-/HER2-26.2%Clinical StageI2.1%II47.4%III50.5%Lymph Node +69.7%ypT0/N078.1%ChemotherapyAnthracycline5.1%Taxane6.2%Anthracycline-Taxane88.7% Citation Format: Francisco Acevedo, Benjamin Walbaum, Tomas Merino, Militza Petric, Cesar Sanchez. Clinical stage is the only predictor of survival in breast cancer patients with a complete pathological response [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-37.
- ItemAn approximate dynamic programming approach to network-based scheduling of chemotherapy treatment sessions(2024) Wenzel, Arturo; Saure, Antoine; Cataldo, Alejandro; Rey, Pablo A.; Sanchez, CesarA solution approach is proposed for the interday problem of assigning chemotherapy sessions at a network of treatment centres with the goal of increasing the cost-efficiency of system-wide capacity use. This network-based scheduling procedure is subject to the condition that both the first and last sessions of a patient's treatment protocol are administered at the same centre the patient is referred to by their oncologist. All intermediate sessions may be administered at other centres. It provides a systematic way of identifying effective multi-appointment scheduling policies that exploit the total capacity of a networked system, allowing patients to be treated at centres other than their home centre. The problem is modelled as a Markov decision process which is then solved approximately using techniques of approximate dynamic programming. The benefits of the approach are evaluated and compared through simulation with the existing manual scheduling procedures at two treatment centres in Santiago, Chile. The results suggest that the approach would obtain a 20% reduction in operating costs for the whole system and cut existing first-session waiting times by half. A key conclusion, however, is that a network-based scheduling procedure brings no real benefits if it is not implemented in conjunction with a proactive assignment policy like the one proposed in this paper.
- ItemBetter overall survival in patients who achieve pathological complete response after neoadjuvant chemotherapy for breast cancer in a Chilean public hospital(2021) Acevedo, Francisco; Petric, Militza; Walbaum, Benjamin; Robin, Julieta; Legorburu, Luisa; Murature, Geraldine; Guerra, Constanza; Navarro, Marisel; Canovas, María José; Sanchez, Cesar; Vargas, Lorena; Manzor, Manuel; Peña, José; Muñiz, Sabrina; Veglia, Paulina; Cartes, Raúl; Martinez, RaúlIntroduction: There is extensive evidence associating the response to neoadjuvant chemotherapy (NeoCT) with breast cancer (BC) survival. However, to the author’s knowledge, there is no published data in Chile. The objective of the study is to evaluate whether achieving pathological complete response (pCR) after NeoCT is associated with greater survival and lower risk of recurrence in a Chilean Public Health Service. Methods: Retrospective analysis of a database. Patients with a diagnosis of Stages I–III BC who received NeoCT between 2009 and 2019 were included. Clinical and pathological information were extracted from the clinical records. BC subtypes were defined using hormone receptor (HR) information (HR: oestrogen and/or progesterone) and epidermal growth factor type 2 (HER2), being divided into four groups: HR /HER2−, HR /HER2 , HR−/HER2 , HR-/HER2−. pCR was defined as the absence of invasive cancer in the breast and axilla (ypT0/is N0) after NeoCT. Results: Of 3,092 patients, 17.2% received NeoCT. Of these, 40.2% corresponded to HR /HER2−, 20.9% HR /HER2 , 18.2% HR−/HER2 and 20.7% HR−/HER2−. Overall, 24.8% achieved pCR, being the lowest for HR /HER2− (10.3%) and the highest for HR−/HER2 (53.2%). In the multivariable analysis, family history, HER2 and type of chemotherapy were associated with a greater probability of pCR. With a median follow-up of 40 months, the overall survival and metastasis-free survival (MFS) at 3 years were greater for the group with pCR compared to that which did not achieve it (90.5% versus 76.7%, p = 0.03 and 88.5% versus 71.4%, p = 0.003, respectively). The multivariable analysis confirmed this finding. Brain MFS was similar in both groups. Conclusion: NeoCT is associated with greater pCR in aggressive BC subtypes. In those, achieving pCR was associated with better survival in our study. To the author’s knowledge, this is the first study which evaluates the relation between pCR and BC subtypes in a Chilean public hospital.
- ItemBreast lesions with atypia in percutaneous biopsies, managed with surgery in the last 10 years(2019) Carrillo, Mitzy; Maturana, Gregorio; Maiz, Cristobal; Romero, Diego; Dominguez, Francisco; Oddo, David; Villarroel, Alejandra; Razmilic, Dravna; Elena Navarro, Maria; Leon, Augusto; Sanchez, Cesar; Camus, MauricioIntroduction: The optimal management of breast lesions with atypia (BLA), detected in percutaneous biopsies after screening mammograms, is a controversial issue. The aim of this paper is to compare histological diagnosis by percutaneous biopsy with the results of the surgical biopsy of these lesions and to analyse the changes to clinical approach this would imply.
- ItemCo-design of a Mobile App for Engaging Breast Cancer Patients in Reporting Health Experiences: Qualitative Case Study(2023) Taramasco, Carla; Rimassa, Carla; Noel, Rene; Storm, Maria Loreto Bravo; Sanchez, CesarBackground: The World Health Organization recommends incorporating patient-reported experience measures and patient-reported outcome measures to ensure care processes. New technologies, such as mobile apps, could help report and monitor patients' adverse effects and doubts during treatment. However, engaging patients in the daily use of mobile apps is a challenge that must be addressed in accordance with the needs of people.
- ItemFirst-line endocrine therapy for advanced breast cancer. A real-world study at a Latin American university health institution(TAYLOR & FRANCIS LTD, 2020) Walbaum, Benjamin; Acevedo, Francisco; Medina, Lidia; Bravo, M. Loreto; Merino, Tomas; Camus, Mauricio; Dominguez, Francisco; Mondaca, Sebastian; Galindo, Hector; Nervi, Bruno; Ibanez, Carolina; Madrid, Jorge; Pena, Jose; Koch, Erica; Garrido, Marcelo; Pinto, Mauricio P.; Sanchez, CesarObjective: Clinical guidelines recommend the use of endocrine therapy (ET) in advanced hormone receptor positive (HR+) human epidermal growth factor receptor type 2 negative (HER2-) breast cancer (BC) patients in the absence of visceral disease or ET resistance. Furthermore, studies indicate similar response and survival rates using ET or cytotoxic chemotherapy (CT). Methods: Herein, we assessed clinical characteristics, type of systemic therapy and survival rates of advanced HR + HER2-BC patients in our database. Results: A total of 172 advanced HR + HER2-BC patients were treated at our institution between 1997 and 2019. Sixty percent received first-line ET (4% received combined ET). Median age of this subset was 55 years (range: 30-86). Similarly, the median age of patients that received CT was 54 years (range: 21-83). Over time, 30% of patients received ET in the 2000-2005 period; this increased to 70% in the 2016-2019 period (p = .045). Overall survival (OS) was 97 months and 51 months for patients treated with ET or CT, respectively (p = .002). Conclusions: To the best of our knowledge this is the first study assessing the use of ET in Chilean advanced HR + HER2-BC patients. Several patients in our institution receive CT without indication. The increase in ET usage over time can be attributed to better and faster immunohistochemical detection methods for Estrogen Receptor (ER), changes in educational and government policies, and a wider variety of ET options. Finally, clinical trials have failed to demonstrate a substantial benefit of CT over ET in this setting.
- ItemMachine learning analysis of a Chilean breast cancer registry(2021) Acevedo, Francisco; Causa, Leonardo; Bravo, Sebastián; García, Pablo; Cuevas, Ricardo; Bravo, Maria Loreto; Avellaira, Carla; Muñiz, Sabrina; Petric, Militza; Martinez, Raúl; Guerra, Constanza; Navarro, Marisel; Taramasco, Carla; Sanchez, CesarIn recent years, artificial intelligence (AI) and machine learning (a form of AI) have offered valuable tools for medicine by applying and training algorithms in order to make predictions. Herein, we applied a machine learning algorithm to analyze data from a >20 year breast cancer (BC) registry elaborated in two Chilean health institutions (a public hospital and a private center) that includes a total of 4838 patients and their basic clinicalpathological characteristics. Preliminary results suggest that this cohort of patients can be subdivided into five clusters according to key variables that also correlate with overall survival and disease-free survival rates. To our knowledge this is the first Latin American report of its kind. Our laboratory is currently expanding these analyses.
- ItemMulti-stage process for chemotherapy scheduling and effective capacity determination(2023) Cataldo, Alejandro; Sufan, Sebastian; Lorca, Alvaro; Andresen, Max; Sanchez, Cesar; Saure, AntoineA novel solution approach is developed for the scheduling of chemotherapy sessions at cancer treatment centers. The problem is divided into two subproblems determining the day (interday scheduling) and the time slots (intraday scheduling), respectively. The interday subproblem is solved by a model that allows for effective treatment center capacity choices while the intraday subproblem is addressed using two optimization models. New patient arrivals and treatment protocols specifying the latest starting date and session spacing are sources of uncertainty. Unlike other existing approaches, the proposed method incorporates the concept of effective treatment capacity which facilitates the interaction between the interday and intraday subproblems allowing them to be solved sequentially and iteratively to thus achieve much more resource-efficient solutions. A case study using real data from a Chilean cancer center to conduct comparative simulations of its manual scheduling methods and the proposed methodology found that the latter almost always performed better, often significantly so, on makespan, resource utilization, overtime, and patient diversion metrics.
- ItemNeeds and satisfaction levels of breast cancer patients(2024) Ramis, Sylvia; Acevedo, Francisco; Bravo, M. Loreto; Pena, Jose; Bravo, Paulina; Medina, Lidia; Muniz, Sabrina; Ibanez, Carolina; Walbaum, Benjamin; Merino, Tomas; Marin-Olivo, Erick; Pinto, Mauricio P.; Sanchez, CesarIntroduction. Knowing and satisfying the needs of breast cancer (BC) patients (P) and their caregivers (CG) during treatment can help to improve their quality of life. This study assessed the needs of BC-P, their CG and health professionals (HP) and their perception before and after an intervention aiming to improve healthcare. Methods. The study included an academic center (AC) and a public hospital (PH). Data were obtained from interviews, focus groups and self-completed surveys. A content analysis was performed using Nvivo software. Due to COVID19 restrictions, educational videos were delivered to HPs describing the identified needs. Finally, satisfaction surveys were applied to P and CG, before and after this intervention. Results. A total of 22 participants were interviewed (7P, 5CG and 10HP). Three main needs were identified: 1) Healthcare related needs, 2) Financial issues and 3) Social support. Subsequently, a satisfaction survey was applied to users (stage I; n=93) and the identified needs were used to design an intervention that consisted of educational videos directed towards HP. Following the intervention a second survey was applied (stage II; n=71). Both surveys revealed high levels of satisfaction among users. Following the second survey, we noticed the emergence of other needs, mainly related to nutrition and the improvement of facilities. Conclusions. This is the first study in Chile assessing BC-P needs from the perspective of P, their CG and HP. All participants indicated that information and social/financial support were the most relevant needs.
- ItemNeutrophil/lymphocyte ratio in complete blood count as a mortality predictor in breast cancer(SOC MEDICA SANTIAGO, 2016) Mimica, Ximena; Acevedo, Francisco; Oddo, David; Ibanez, Carolina; Medina, Lidia; Kalergis, Alexis; Camus, Mauricio; Sanchez, CesarBackground: The white blood cell count is one of the most sensitive markers associated with inflammation. The neutrophil/lymphocyte count ratio may be an independent factor for breast cancer mortality. Aim: To assess the predictive value of the neutrophil/lymphocyte ratio for mortality in breast cancer. Material and Methods: Review of the database of a cancer center of a University hospital. Patients with infiltrating breast cancer treated between 1997 and 2012 were selected. The pathology type and lymph node involvement were obtained from the pathology report. The expression of estrogen, progesterone and Human Epidermal Growth Factor Receptor 2 (HER2) was determined by immunohistochemistry or in situ fluorescent hybridization (FISH). The absolute peripheral neutrophil and lymphocyte counts were obtained from a complete blood count obtained at least three months before treatment. Patients were followed for a median of 61 months (range 1-171). Results: From 323 eligible patients, after excluding those in stage IV and those without an available complete blood count, 131 patients were analyzed (81 with negative receptors and 117 HER2 enriched). The neutrophil/lymphocyte ratio was similar in both types of tumors (2.1 and 1.91 respectively). Twenty two patients died during follow-up. Surviving patients with HER2 enriched tumors had a lower neutrophil/lymphocyte ratio than those who died (1.79 and 3.21 respectively, p < 0.01). In a multivariate analysis, including age, tumor stage and lymph node involvement as confounding factors, the neutrophil/lymphocyte ratio was still significantly associated with a risk of death with a hazard ratio of 2.56. Conclusions: A high neutrophil/lymphocyte ratio in the complete blood count can be a predictor of death in breast cancer.
- ItemPatient-reported outcomes and tolerability in patients receiving ripretinib versus sunitinib after treatment with imatinib in INTRIGUE, a phase 3, open-label study1(2023) Gelderblom, Hans; Jones, Robin L.; Blay, Jean-Yves; George, Suzanne; von Mehren, Margaret; Zalcberg, John R.; Kang, Yoon-Koo; Razak, Albiruni Abdul; Trent, Jonathan; Attia, Steven; Le Cesne, Axel; Siontis, Brittany L.; Goldstein, David; Boye, Kjetil; Sanchez, Cesar; Steeghs, Neeltje; Rutkowski, Piotr; Druta, Mihaela; Serrano, Cesar; Somaiah, Neeta; Chi, Ping; Harrow, Brooke; Becker, Claus; Reichmann, William; Sherman, Matthew L.; Ruiz-Soto, Rodrigo; Heinrich, Michael C.Purpose: In the INTRIGUE trial, ripretinib showed no significant difference versus sunitinib in progression-free survival for patients with advanced gastrointestinal stromal tumour (GIST) previously treated with imatinib. We compared the impact of these treatments on health-related quality of life (HRQoL).Patients and methods: Patients were randomised 1:1 to once-daily ripretinib 150 mg or once daily sunitinib 50 mg (4 weeks on/2 weeks off). Patient-reported outcomes were assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for Cancer-30 (EORTC QLQ-C30) questionnaire at day (D)1, and D29 of all cycles until treatment discontinuation. Change from baseline was calculated. Time without symptoms or toxicity (TWiST) was estimated as the mean number of days without progression, death, or grade & GE;3 treatment-emergent adverse events per patient over 1 year of follow-up.Results: Questionnaire completion at baseline was 88.1% (199/226) for ripretinib and 87.7% (199/227) for sunitinib and remained high for enrolled patients throughout treatment. Patients receiving sunitinib demonstrated within-cycle variation in self-reported HRQoL, corresponding to the on/off dosing regimen. Patients receiving ripretinib reported better HRQoL at D29 assessments than patients receiving sunitinib on all scales except constipation. HRQoL was similar between treatments at D1 assessments, following 2 weeks without treatment for sunitinib patients. TWiST was greater for ripretinib patients (173 versus 126 days).Conclusion: Patients receiving ripretinib experienced better HRQoL than patients receiving sunitinib during the dosing period and similar HRQoL to patients who had not received sunitinib for 2 weeks for all QLQ-C30 domains except constipation. Ripretinib may provide clinically meaningful benefit to patients with advanced GIST previously treated with imatinib.& COPY; 2023 Deciphera Pharmaceuticals LLC. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
- ItemSurgical treatment in oligometastatic breast cancer(2019) Vargas, Catalina; Maiz, Cristobal; Elena Navarro, Maria; Oddo, David; Sanchez, Cesar; Bustos, Marisa; Camus, MauricioMetastatic breast cancer (MBC) management is based on systemic treatment (ST), while the local therapy role remains controversial. We present the case of a 36-year-old woman with a diagnosis of hormone receptor-positive and human epidermal growth factor receptor type 2-positive breast cancer and isolated sternal metastasis, who received neoadjuvant ST with complete remission and later primary tumour surgery. Oligometastatic patients are a subgroup of MBC that can benefit from aggressive local therapies, even with curative intent.