Browsing by Author "Soria, Tannia"

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    Characteristics and outcomes of thymomas in Latin America: Results from over 10 years of experience (CLICaP-LATimus)
    (Thorac Cancer, 2021) Martín, Claudio; Enrico, Diego; Mas, Luis; Patane, Ana Karina; Arrieta, Oscar; Soria, Tannia; Cardona, Andres F.; Ruiz-Patiño, A.; Ruiz, Rossana; Rioja, Patricia; Lozano, Sophia; Zatarain-Barrón Zyanya Lucia; Barrón, Feliciano; Puparelli, Carmen; Tsou Florencia; Corassa, Marcelo P.; Freitas, Helano C.; Cordeiro de Lima, Vladmir Cláudio; Rojas, Leonardo; Ordóñez-Reyes, Camila; Corrales, Luis; Sotelo, Carolina; Rodríguez, July; Ricaurte, Luisa; Ávila, Jenny; Archila, Pilar; Rosell, Rafael; Cuello, Mauricio; Remon, Jordi
    Background: Thymomas are a group of rare neoplasms of the anterior mediastinum. The objective of this study was to describe the demographics, clinical characteristics and treatment approaches in Latin America. Methods: This was a retrospective multicenter cohort study including patients with histologically proven thymomas diagnosed between 1997 and 2018. Demographics, clinicopathological characteristics and therapeutic outcomes were collected locally and analyzed in a centralized manner. Results: A total of 135 patients were included. Median age at diagnosis was 53 years old (19-84), 53.3% (n = 72) of patients were female and 87.4% had an ECOG performance score ranging from 0-1. A total of 47 patients (34.8%) had metastatic disease at diagnosis. Concurrent myasthenia gravis occurred in 21.5% of patients. Surgery was performed in 74 patients (54.8%), comprising 27 (20%) tumorectomies and 47 (34.8%) thymectomies. According to the Masaoka-Koga system, overall survival (OS) at five-years was 73.4%, 63.8% and 51%, at stages I-II, III-IVA and IVB, respectively (p = 0.005). Furthermore, patients with low lactate dehydrogenase (LDH) (≤373 IU/L) at baseline and myasthenia gravis concurrence showed significantly better OS (p = 0.001 and p = 0.008, respectively). In multivariate analysis, high LDH levels (HR 2.8 [95% confidence interval [CI]: 1.1-7.8]; p = 0.036) at baseline and not performing a surgical resection (HR 4.1 [95% CI: 1.3-12.7]; p = 0.016) were significantly associated with increased risk of death. Conclusions: Our data provides the largest insight into the clinical characteristics and outcomes of patients with thymomas in Latin America. Survival in patients with thymomas continues to be very favorable, especially when subjected to adequate local control. Keywords: Latin America; cohort studies; medical oncology; thymoma.
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    Conocimientos y percepciones de los Oncólogos ecuatorianos sobre manejo y acceso a medicamentos en cáncer renal metastásico
    (Rev Virtual la Soc Paraguaya Med Interna. 2017, 2017) Torres Toala, Fausto Gady; Soria, Tannia; Moreno, Andrea; Ruilova, Erika; Irigoyen, Paulina
    Introducción: el cáncer renal es una patología que, al igual que otras neoplasias, si se diagnostica tempranamente puede tener un mejor pronóstico. La variabilidad clínica es un factor que puede afectar su diagnóstico. Objetivo: evaluar el nivel de conocimientos y las percepciones de los médicos oncólogos clínicos ecuatorianos sobre el cáncer renal metastásico. Metodología: se realizó un estudio de corte transversal. La información fue recolectada a través de una encuesta diseñada para esta investigación. Resultados: la variabilidad de conocimientos de los profesionales fue baja, la experiencia en su práctica asistencial con medicamentos complejos es amplia, principalmente con sunitinib, la decisión de manejo sistémico del cáncer metastásico se consigue a partir de grupos de pares o multidisciplinarios, pero siempre se priorizan criterios clínicos antes que administrativos. Conclusiones: los oncólogos tienen baja variabilidad en los conocimientos y amplia experiencia en el uso de medicamentos complejos, sin embargo, la situación de acceso a medicamentos de alto costo es un factor presente en la mayoría Palabras claves: neoplasias renales, conocimientos, actitudes y práctica en salud
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    Evaluación de los conocimientos generales de los profesionales de la salud ecuatorianos acerca del cáncer renal
    (Práctica Fam Rural, 2018) Torres, Fausto Gady; Soria, Tannia; Moreno, Andrea; Ruilova, Erika; Irigoyen Paulina
    Introducción: el cáncer renal, como toda patología oncológica, tiene un mejor pronostico si es diagnosticada tempranamente, de manera general los médicos especialistas no son la puerta de entrada de esta enfermedad al sistema de salud, por lo que es indispensable tener ciertos indicios clínicos en médicos no especialistas o de diferentes especialidades. Objetivo: Evaluar el nivel de conocimientos de los Médicos Ecuatorianos sobre el Cáncer Renal. Metodología: Se realizó un estudio de corte transversal, la información fue recolectada a través de una encuesta diseñada para esta investigación. se calcula la muestra en base a prevalencias de conocimientos regionales con un nivel de confianza de 95%. Resultados: en general los aciertos a las preguntas de conocimientos fueron elevados (61%), el puntaje fue más alto en especialidades directamente relacionadas. El componente más afectado fue el de tratamiento (38%). El 78% de los médicos percibe que no existe medicación adecuada en el mercado ecuatoriano y más de la mitad piensa que la tecnología es aún insuficiente. Un 15% de profesionales aún cree que el manejo de Cáncer Renal debe hacerse exclusivamente por un médico oncólogo. Conclusiones: Existen vacíos de conocimiento en los profesionales de la salud, éstos se dan en todos los componentes evaluados, es necesario fortalecer los esfuerzos de Educación continua para evitar retrasos en el diagnóstico de patologías cuyo pronóstico depende de un manejo temprano.
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    Global Cancer Institute multidisciplinary tumor boards as a tool to improve patterns of clinical practice for breast and gynecologic cancer in resource-limited settings.
    (J Clin Oncol [Internet], 2017) Louis, Jessica St.; Bukowski, Alexandra; Rodrigues, Angelica Noguelra; Moreno, Joel; Ferreyra, Mayra; Lopes, Andre; De La Serna, Frances; Tindwa, Chakou Halfani; Baki Mollah, Obayedullah; Villarreal-Garza, Cynthia; Duarte, Carlos; Hambardzumyan, Vahagn; Salman, Pamela; Soria, Tannia; Goss, Paul E.
    Background: Multidisciplinary tumor boards (MTBs) are commonly practiced in high-income countries (HICs) to ensure adherence to guidelines through a team approach to patient care. The Global Cancer Institute (GCI) established online MTBs in 2012 to facilitate live telemedicine discussions of breast and gynecologic case scenarios between specialists in low- and middle-income countries (LMICs) and expert specialists in HICs. GCI MTBs aim to improve clinical knowledge and patterns of practice for specialists in LMICs through an interactive online forum. Methods: In each monthly MTB, three patient case scenarios are presented by specialists in LMICs for live discussion with an expert panel of specialists based in HICs. Guideline or clinical trial-based discussions are held for each case scenario. Best practices for clinical care in limited resource settings are also discussed. Links to clinical practice guidelines, clinical trials, and resources are provided to all MTB attendees. For educational purposes, each MTB is live streamed and uploaded to a private YouTube channel for viewing by community oncologists and trainees worldwide. Results: The GCI MTBs program has recruited over 500 LMIC participants from 48 hospitals in 24 countries across Latin America, Eastern Europe, Africa, and Asia. 17 expert breast cancer specialists and 13 expert gynecologic cancer specialists provide multidisciplinary guidance. To date, 130 breast cancer case scenarios and 80 gynecologic cancer case scenarios have been presented. For breast MTBs, 73% of case scenarios were invasive ductal carcinomas. Common subtypes presented were ER/PR+ (63%), HER2+ (30%), and triple negative disease (28%). 56 cases involved advanced disease management (43%). For gynecologic MTBs, common gynecologic cancer case scenarios were cervical (74%) and ovarian (15%). 37 cases involved advanced disease management (46%). Conclusions: GCI MTBs are a useful educational tool for specialists in LMICs to improve patterns of clinical practice and engage in multidisciplinary discussions. GCI continues to expand its MTBs to cancer facilities in LMICs.
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    Ibero-American Expert Consensus on Squamous Cell Carcinoma of the Head and Neck Treatment in Patients Unable to Receive Cisplatin: Recommendations for Clinical Practice
    (Cancer Management and Research, 2021) Falco, Agustín; De Oliveira, Thiago Bueno; Cacicedo Jon; Ospina, Aylen Vanessa; Ticona, Miguel Ángel; Galindo, Héctor; Pereira, Marcos David; Aguilar-Ponce, José Luis; Rueda-Domínguez, Antonio; Soria, Tannia; Taberna, Miren; Iglesias, Lara; Sowley, Taysser; Mesía, Ricard; TTCC group (Spanish Group for the Treatment of the Head and Neck Cancer)
    Abstract: Cisplatin is the standard of treatment for squamous cell carcinoma of the head and neck (SCCHN) that has demonstrated efficacy, either in locally advanced disease when combined with radiotherapy at high doses, or in metastatic/recurrent disease when combined with other agents. However, the usual toxicities related to cisplatin, such as neurotoxicity, nephrotoxicity, ototoxicity, and hematologic toxicities, especially when high doses have been administered, have important implications in the patients’ quality of life. The decision to administer cisplatin depends on several patient factors, such as age, performance status, weight loss, comorbidities, previous toxicities, chronic viral infection, or even the current SARS-CoV-2 pandemic. In order to establish recommendations for the management of patients with SCCHN, a group of experts in medical and radiation oncology from Spain and Latin-American discussed how to identify patients who are not candidates for cisplatin to offer them the most suitable therapeutic alternative. Keywords: age, cisplatin, comorbidities, contraindication, frailty, toxicity
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    Lung cancer: EGFR-ALK mutation in the high lands
    (Journal of Clinical Oncology, 2018) Villacrés, Leonardo David; Villarroel, Nelson; Moreno, Pablo; Carrasco, Edison A.; Castillo, José; Muñoz, María José; Caballero, Henry; Soria, Tannia
    Background: It has been shown that oxygen is a driver of damage forming free radicals, at higher areas of altitude the risk of developing lung cancer decreases, the primary endpoint was to identify the incidence of EGFR-ALK mutation in the high lands and as a secondary endpoint was to determine the relationship among a pulmonary lobe location, EGFR-ALK mutation and tobacco use. Methods: All patients with lung cancer living at an altitude between 2500( meters above sea level) masl to 3000 masl treated at the Hospital Solon Espinosa Ayala "Quito-Ecuador" between the year 2010 and 2015. The characteristics of the patients included in this study were: living in the high lands for more than 30 years, to have a EGFR and ALK mutation reported. All this data were collected from the electronic medical records. A descriptive analysis of the EGFR and ALK mutation were performed in our city, the Fisher test was used to compare the mutation of EGFR with the location of a pulmonary lobe in a physiological way, whether the tumor is located in superior or inferior lobe and also with tobacco use. Results: Among 191 individuals, 154 individuals were excluded as the did not meet the inclusion criteria, with a total of 37 individuals, with an EGFR mutation in 48.6% (18/37) and an ALK mutation in 3% ( 1/37) of patients. Although 50% of the EGFR mutations belonged to a superior lobe location, this was not significant statistically OR = 2.25 IC 95% (0.61 - 8.18); p = 0.15, the EGFR mutation was not affected by tobacco consumption in our data, presented in the non-smoker individuals OR = 1.47 IC 95% (0.80 - 2.71); p = 0.21. Conclusions: The incidence of EGFR mutation is high, practically presenting a 1: 1 ratio, while the incidence of ALK mutation was very low; Although the EGFR mutation was higher in the upper lobe tumor location, it was not significant, and it was a finding that tobacco consumption was not related to the EGFR mutation present.
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    Personalizing Precision Oncology Clinical Trials in Latin America: An Expert Panel on Challenges and Opportunities
    (The Oncologist, 2019) Arai, Roberto Jun; Guindalini, Rodrigo Santa Cruz; Llera, Andrea Sabina; O'Connor, Juan Manoel; Muller, Bettina; Lema, Mauricio; Freitas, Helano C.; Soria, Tannia; Delgado, Lucía; Landaverde, Denis; Montenegro, Paola; Riechelmann, Rachel P.
    Abstract The participation of patients in precision oncology trials needs to fulfill molecular-based selection criteria. This strongly limits accrual, and as a consequence, screening successes have decreased, costs have increased, and fewer subjects are enrolled. To achieve narrowed targets, studies have been forced to be multicenter and multinational to reach a larger pool of candidates. However, this globalization faces many challenges, as, for example, in the case of precision oncology trials. These trials have a complex structure that is dependent upon a high-tech infrastructure and knowledge in a dynamic environment. Given the movement of precision clinical cancer research to regions other than Europe and the U.S., it is important to evaluate the feasibility of performing such trials in lower-middle- and low-income countries. Here we critically discuss the advantages of conducting precision oncology clinical trials in Latin America and make suggestions on how to overcome the main challenges involved. IMPLICATIONS FOR PRACTICE: Precision clinical trials in oncology are studies that require candidates to have tumors with specific molecular alterations, which are considered the target for the trial experimental therapy. Because many molecular alterations are rare, fewer patients are enrolled. This has led to trials being forced to be multicenter and multinational, including trials in Latin America. This article discusses the challenges and opportunities to conduct precision oncology trials in Latin America, aiming to help sponsors and investigators to solve complex issues that ultimately lead to more of such trials being run in the region, potentially benefiting more Latin American patients with cancer. Keywords: Cancer; Clinical trials; Global oncology; Precision oncology.
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    Real World Characterization and Treatment of Patients with Thymic Carcinoma: Lessons from a Latin-American Study (CLICaP-LATimus)
    (J Thorac Oncol, 2019) Mas, L.; Patané, A.; Arrieta, O.G.; Soria, Tannia; Cardona, A.F.; Martin, C.; Ruiz-Patiño, A.; Rojas L.L.; Ruiz, R.; Rioja, P.; Lozano, S.; Zatarain Barrón, Z.L.; Corassa, M.; Freitas, H.; Cordeiro de Lima, V.; Corrales, L.; Sotelo, C.; Rodriguez, J.; Ricaurte, L.; Ávila, J.; Bravo, M.; Mayorga, D.; Archila, P.; Otero, J.; Carranza, H.; Vargas, C.; Rosell, R.; Remon, J.
    Background Thymic carcinoma is a rare tumor that represents a clinical challenge, especially in resource limited settings. The objective of the present study was to characterize patients who presented this disease in Latin-America. Method From 2014 until 2018, a multinational Latin-American cooperative retrospective cohort study was performed. Patients with histologically confirmed thymic carcinoma were included. Clinical, pathological and treatment variables were collected across 7 participating nations. Result A total of 31 patients were included. Median age at diagnosis was 58 years old (34-69), 48% (n=15) of individuals were women with all but 2 patients (6.5%) achieving an ECOG performance score <2. All patients debuted with Stage IV disease; 24 patients (66%, [95%CI 62-92%]) as stage IVa and 7 as stage IVb (33%, [95%CI 7-37%]) with a median LDH level of 396.5 U/L (153-1529 U/L) and a median of 2 metastatic sites. 13 (41.9%, [95%CI 25-59%]) patients received preoperatory treatment consisting of chemotherapy (n=8, 42%) and chemoradiotherapy (n=5, 16%). Among these patients only 4 (12.9%) were subjected to surgery, two of which underwent a tumorectomy and 2 a thymectomy. 28 (90%, [95%CI 79.9-100%]) received palliative chemotherapy either with sunitinib (n=7, 25%) or cytotoxic agents. Median overall survival (OS) was reached at 20.2 months (95%CI 19-NA months). Patients who received preoperative treatment had a significantly prolonged OS (17.6 vs 26 months, HR 2.93 [95%CI 1.04-8.27 months], p = 0.03). Conclusion Thymic carcinoma constitutes an aggressive disease that is often diagnosed in advanced stages. These results suggest that multimodal treatment can be beneficial even in locally advanced cases. Larger clinical trial validating these conclusions are warranted. Keywords Real world data, Latin America, thymic sarcoma
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    Se requieren más médicos especialistas para tratar el cáncer: urge la formación prioritaria y un número suficiente de oncólogos en Ecuador
    (Rev la Fac Ciencias Médicas, 2018) Villacrés, Tatiana; Soria, Tannia; Buizza, Cristiano; González-Andrade, Fabricio
    Contexto: el cáncer ha tomado extrema importancia en la población ecuatoriana, debido al rápido aumento de las tasas de incidencia y de mortalidad; implica que el Sistema Nacional de Salud debe responder a las necesidades de los afectados por cáncer. Es imperioso disponer del talento humano suficiente en lo relacionado a diagnóstico, tratamiento y seguimiento oportu-nos. Con este antecedente, el objetivo del estudio es determinar y estimar la brecha de talento humano especializado en oncología en base a datos de Quito y Guayaquil como ciudades de referencia nacional. Método: las estimaciones se realizaron en dos etapas. La primera basada en el cálculo de las proyecciones de oferta y demanda de los servicios médicos oncológicos en Quito y Guayaquil, en función de la información histórica contenida en bases de datos publicadas por el INEC. La segunda etapa se basó en la transformación de los valores estimados, en base a la capacidad de visitas de los profesionales de salud para la proyección de necesidades. Con estos dos escena-rios se determinó la brecha de talento humano. Resultados: Quito y Guayaquil presentan una brecha importante y creciente de profesionales médicos y del talento humano de apoyo (imagen y laboratorio). Utilizando las proyecciones rea-lizadas, tanto en la tendencia de variación y en la capacidad de visitas, se necesita un aumento importante de personal capacitado en oncología, iniciando con el número de médicos oncólogos. Conclusión: para cubrir la demanda real y potencial de servicios médicos para el tratamien-to del cáncer en Ecuador hasta el 2021, se requiere especializar al menos 3142 médicos para Guayaquil y 4546 para Quito. En relación al número de tecnólogos, auxiliares, nutricionistas, enfermeras y psicólogos por tipo de especialidad, para el 2021 se requiere formar 5232 pro-fesionales para Guayaquil y 8938 para Quito. En ambos casos, la brecha hasta el 2021 será de 7688 especialistas médicos y 14170 profesionales afines. No se ha estimado la brecha para el resto de provincias en Ecuador.Descriptores DeCS: salud pública, tratamiento de cáncer, Ecuador, brecha profesional, médi-cos especialistas