Papers by Deolinda S Pereira
Value in Health, Dec 1, 2020
Ovarian cancer, Oct 1, 2021
Conclusion* Ovarian cancer in premenopausal women is a threatening condition, diagnosed in most c... more Conclusion* Ovarian cancer in premenopausal women is a threatening condition, diagnosed in most cases in advanced stages, that needs a combination of quemotherapy and surgery. Surgical approach must be aggressive in order to achieve a complete resection of the tumor.
Ovarian cancer, Oct 1, 2021
Current Problems in Cancer, Dec 1, 2022
Background: The presence of brain metastases at the time of initial breast cancer diagnosis (BMIB... more Background: The presence of brain metastases at the time of initial breast cancer diagnosis (BMIBCD) is uncommon. Hence, the prognostic assessment and management of these patients is very challenging. The aim of this study was to analyse the influence of tumour subtype compared with other prognostic factors in the survival of patients with BMIBCD. Methods: We evaluated women with BMIBCD, reported to Surveillance, Epidemiology and End Results program from 2010 to 2013. Patients with other primary malignancy were excluded. Univariate and multivariate analyses were performed to determine the effects of each variable on overall survival (OS). Results: We included 740 patients. Median OS for the whole population was 10 months, and 20.7% of patients were alive at 36 months. Tumour subtype distribution was: 46.6% hormone receptor (HR)þ/HER2À, 17% HRþ/HER2þ, 14.1% HRÀ/HER2þ and 22.3% triplenegative. Univariate analysis showed that the presence of liver metastases, lung metastases and triple-negative patients (median OS 6 months) had worse prognosis. The HRþ/HER2þ subtype had the longest OS with a median of 22 months. In multivariate analysis, older age (hazard ratio 1.8), lobular histology (hazard ratio 2.08), triple-negative subtype (hazard ratio 2.25), liver metastases (hazard ratio 1.6) and unmarried patients (hazard ratio 1.39) had significantly shorter OS.
Gynecologic oncology reports, Apr 1, 2022
Highlights • LGSOC is characterized scarce therapeutic options in the advanced setting.• BRAF mut... more Highlights • LGSOC is characterized scarce therapeutic options in the advanced setting.• BRAF mutations are frequent on these types of tumours.• Dabrafenib/trametinib yield impressive responses in patients with BRAF mutations.
Background The addition of carboplatin to an anthracycline/taxane-based chemotherapy(CT) in neoad... more Background The addition of carboplatin to an anthracycline/taxane-based chemotherapy(CT) in neoadjuvant setting has been suggested to improve pathological complete response(pCR) in TNBC. However, the impact of pCR in prognosis is unknown. We aim to study the value and feasibility of the addition of carboplatin in neoadjuvant setting. Methods Demographic and clinical data of TNBC patients treated with neoadjuvant CT in a comprehensive cancer center between 2010-2018 were retrospectively collected. Two cohorts were defined: one treated with Carboplatin/Paclitaxel followed by dose-dense Doxorrubicin/Cyclophosphamide(CP-AC) and other with AC followed by Docetaxel(AC-D). Median follow-up time was 3.1 and 6.9 years, respectively. pCR was defined as absence of residual invasive tumor in breast/axilla. Survival analysis using Kaplan-Meier method and Cox proportional-hazards model were applied. Statistical significance was set at p<0.05. Results One-hundred and sixty patients were enrolled: 78 CP-AC and 38 AC-D. Groups were balanced regarding patients and tumor characteristics with exception of pre-menopausal status, more frequent in CP-AC(68% vs 47%;p=.04). Age at diagnosis was 47(28-76)years, the majority had ECOG 0(92%) ductal carcinomas(82%), clinicalT2/3 stages(76%), grade 3(81%) with lymph node involvement(N+)(57%). 14% had Inflammatory breast cancer(IBC)(CP-AC 14%;AC-D 13%; p=.9). Neutropenia was the most prevalent adverse event(G3/4: CP-AC 61%;AC-D 16%;p=.02), 12% and 16% of febrile neutropenia(p=.8). G3/4 thrombocytopenia occurred only in CP-AC(6%). Hypersensitivity reactions were more prevalent in CP-AC(19% vs 2.7%;p=.02), majority to paclitaxel, all G1/2. Hospital admission occurred in 12%(CP-AC 13%;AC-D 9%; p=.8). There were no treatment-related deaths. Treatment schedule was complete in 89%(CP-AC 87%;AC-D 92%;p=.5), with 20% dose reductions(CP-AC 25%;AC-D 11%;p=0.9). pCR was achieved in 42%(CP-AC 50%;AC-D 28%;p=.03). 1- and 3-year disease-free survival(DFS) was 94%/85% for CP-AC and 72%/58% for AC-D(p=.3). Risk of recurrence was higher in IBC(HR 25.1;CI95% 7.7-81.3;p<.0001), N+ disease(HR 3.6;CI95% 1.2-10.5;p=.02) and non-pCR(HR 10.9;CI95% 2.3-52.3,p=.003). N+ disease was associated with higher recurrence only in AC-D(HR 11.7;CI95% 1.3-104;p=.03). Cancer-related deaths were 20%(CP-AC 10%;AC-D 40%;p=.001). 1- and 2-year overall survival (OS) was 99%/95% for CP-AC and 70%/61% for AC-D(p=.06). N+ disease was associated with higher risk of death in AC-D(HR 6.3;CI95% 1.1-24.6;p=.04). Risk of death was independently associated with IBC(HR 4.1;CI95% 2.1-18.7; p=.001) but not with N+ disease(HR 2.7;CI95% 0.8-9.5;p=.13) or pCR(HR 4.1;CI95% 0.9-19.7;p=.08) although pCR was statistically significant in univariate analysis (1- and 2-year OS 97% vs 92% and 94% vs 86% for pCR and non-PCR;p=.003). Conclusions Carboplatin addition clearly increased pCR with a trend to DFS and OS benefit. This regimen was associated with more, nevertheless manageable, adverse events with most of the patients able to tolerate and complete the full-dose regimen. Though we did not find a subgroup of patients that benefit with carboplatin regimen, we should consider avoiding AC-D at least in N+ disease. Citation Format: Coelho S, Abreu MH, Sales C, Lopes AR, Sousa MF, Couto R, Pousa I, Ferreira A, Ferreira M, Vieira C, Leal C, Castro F, Sousa S, Pereira D. Carboplatin-addition in neoadjuvant treatment of women with triple negative breast cancer (TNBC): Prognostic value in real-world patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-15-19.
Clinical and Translational Oncology
Obesity is a relevant risk factor in breast cancer (BC), but little is known about the effects of... more Obesity is a relevant risk factor in breast cancer (BC), but little is known about the effects of overweight and obesity in surgical outcomes of BC patients. The aim of this study is to analyse surgical options and associated overall survival (OS) in overweight and obese women with BC. In this study, 2143 women diagnosed between 2012 and 2016 at the Portuguese Oncology Institute of Porto (IPO-Porto) were included, and the clinicopathological information was retrieved from the institutional database. Patients were stratified by body mass index (BMI). Statistical analysis included Pearson's chi-squared test with statistical significance set at p < 0.05. Multinomial, binary logistic regression and cox proportional-hazards model were also performed to calculate odd ratios and hazard ratios with 95% confidence intervals for adjusted and non-adjusted models. The results revealed no statistical difference in histological type, topographic localization, tumour stage and receptor stat...
International Journal of Molecular Sciences
Venous thromboembolism (VTE), a common condition in Western countries, is a cardiovascular disord... more Venous thromboembolism (VTE), a common condition in Western countries, is a cardiovascular disorder that arises due to haemostatic irregularities, which lead to thrombus generation inside veins. Even with successful treatment, the resulting disease spectrum of complications considerably affects the patient’s quality of life, potentially leading to death. Cumulative data indicate that long non-coding RNAs (lncRNAs) may have a role in VTE pathogenesis. However, the clinical usefulness of these RNAs as biomarkers and potential therapeutic targets for VTE management is yet unclear. Thus, this article reviewed the emerging evidence on lncRNAs associated with VTE and with the activity of the coagulation system, which has a central role in disease pathogenesis. Until now, ten lncRNAs have been implicated in VTE pathogenesis, among which MALAT1 is the one with more evidence. Meanwhile, five lncRNAs have been reported to affect the expression of TFPI2, an important anticoagulant protein, but...
Breast Cancer Research and Treatment
Introduction Obesity and breast cancer are two major pathologies closely associated with increasi... more Introduction Obesity and breast cancer are two major pathologies closely associated with increasing incidence and mortality rates, especially amongst women. The association between both diseases have been thoroughly discussed but much is still to uncover. Aim The aim of this study is to analyse tumour characteristics and clinical outcomes of overweight and obese women to disclosure potential associations and better understand the impact of obesity in breast cancer. Materials and methods Clinicopathological information of 2246 women were extracted from the institutional database of comprehensive cancer centre in Portugal diagnosed between 2012 and 2016. Women were stratified according to body mass index as normal, overweight, and obese. Patients’ demographic information and tumour features (age, family history, topographic localization, laterality, histological type, and receptor status) were taken as independent variables and overall survival, tumour stage, differentiation grade and...
Cancer Research, 2020
Background: During breast cancer follow-up, there is no data suggesting that, besides annual mamm... more Background: During breast cancer follow-up, there is no data suggesting that, besides annual mammography, laboratory and imaging tests in asymptomatic patients lead to survival benefit. However, most available data come from a period of fewer quality of diagnostic procedures and less efficacy of treatment for advanced breast cancer. In our centre, in the absence of disease recurrence after 5 years of follow-up, and when endocrine therapy ends, we transfer the surveillance of breast cancer patients for primary care physicians. Before that, by protocol, we use to request as staging exams a bone scan, a chest x-ray and liver ultrasound, or a thoracoabdominal computed tomography, as well as the quantification of CA15.3, in order to detect asymptomatic cancer recurrence before discharge. This study aimed to evaluate the effectiveness of that strategy in detecting asymptomatic disease and its impact on patients’ outcomes, compared to those who recurred symptomatically during the following...
Cancer Research, 2020
Introduction: Central nervous system (CNS) metastasis are detected in approximately 10-30% of bre... more Introduction: Central nervous system (CNS) metastasis are detected in approximately 10-30% of breast cancer (BC) patients, being associated with poor prognosis despite local and systemic therapeutics available. In the current study, we aimed to evaluate the association between BC subtypes and CNS metastasis development and prognosis. Methods: Retrospective analysis of 258 BC patients’ records with pathological and/or radiological documented CNS metastasis, treated at a Cancer Center between 2003-2019, median follow-up of 61 months (range: 0-351). For analysis purpose, three BC subtypes were considered according to hormone receptor status and HER-2 expression: luminal, HER-2 positive and triple negative. Survival was evaluated by Kaplan-Meier method and groups were compared with log-rank test. Independent prognostic factors were identified using Cox regression model. A p value < 0.05 was considered statistically significant. Results: Ninety four (42%) patients had HER-2 positive, ...
Cervical cancer, 2021
Introduction/Background* Pelvic exenteration is radical enbloc resection of pelvic organs followe... more Introduction/Background* Pelvic exenteration is radical enbloc resection of pelvic organs followed by surgical reconstruction. This is considered a curative treatment in recurrent gynaecological cancers. The present study looked into the long term survival outcome and morbidities associated with pelvic exenterations done in our centre.
Health Economics Review, 2021
Background Breast cancer (BC) is largely prevalent worldwide. HER2-positive BC account for roughl... more Background Breast cancer (BC) is largely prevalent worldwide. HER2-positive BC account for roughly 20–25% of all BC cases and has an overall survival lower than other BC. Innovation on BC therapeutics is a constant, but novel therapies have higher costs. Therefore, cost-effectiveness research is essential to provide healthcare decision-makers with solid foundations for a resource allocation. This study aims to estimate the average direct medical costs/patient and cost-effectiveness of adding pertuzumab in neoadjuvant treatment (NeoT) for HER2-positive breast cancer (BC). Methods Two retrospective real-world consecutive cohorts of ≥18yo female patients diagnosed with HER2-positive BC treated with NeoT at the Breast Clinic of IPO-Porto were studied. The AC-DH regimen (2012–2015) comprised 8 cycles of neoadjuvant therapy (4 cycles of doxorubicin + cyclosphosphamide followed by 4 cycles ofdocetaxel + trastuzumab), while the AC-DHP regimen (2015–2017) included also pertuzumab as NeoT. Ne...
Frontiers in Oncology, 2020
Deleterious variants in the BRCA1/BRCA2 genes and homologous recombination deficiency (HRD) statu... more Deleterious variants in the BRCA1/BRCA2 genes and homologous recombination deficiency (HRD) status are considered strong predictors of response to poly (ADP-ribose) polymerase (PARP) inhibitors (PARPi). The introduction of PARPi in clinical practice for the treatment of patients with advanced ovarian cancer imposed changes in the molecular diagnosis of BRCA1/BRCA2 variants. BRCA1/BRCA2 tumor testing by next-generation sequencing (NGS) can detect simultaneously both somatic and germline variants, allowing the identification of more patients with higher likelihood of benefiting from PARPi. Our main goal was to determine the frequency of somatic and germline BRCA1/BRCA2 variants in a series of non-mucinous OC, and to define the best strategy to be implemented in a routine diagnostic setting for the screening of germline/somatic variants in these genes, including the BRCA2 c.156_157insAlu Portuguese founder variant. We observed a frequency of 19.3% of deleterious variants, 13.3% germline, and 5.9% somatic. A higher prevalence of pathogenic variants was observed in patients diagnosed with high-grade serous ovarian cancer (23.2%). Considering the frequencies of the c.3331_3334del and the c.2037delinsCC BRCA1 variants observed in this study (73% of all BRCA1 pathogenic germline variants identified) and the limitations of NGS to detect the BRCA2 c.156_157insAlu variant, it might be cost-effective to test for these founder variants with a specific test prior to tumor screening of the entire coding regions of BRCA1 and BRCA2 by NGS in patients of Portuguese ancestry.
ESMO Open, 2020
Background The cost of breast cancer care rises with higher stage at diagnosis; however, there ar... more Background The cost of breast cancer care rises with higher stage at diagnosis; however, there are no real-world data regarding the cost of care according to breast cancer subtypes. This study aimed to estimate direct medical costs for early breast cancer care in the first 3 years after diagnosis according to subtype and stage, using patientlevel data. Methods Women with newly diagnosed stage I-III breast cancer, admitted in 2012 to a Portuguese cancer centre were prospectively followed within the NEON-BC cohort. The use of health resources was obtained from each patient's clinical and administrative records and costs were computed. Tumours were classified into the classic subtypes (hormone receptor-positive (HR+)/HER2−; HER2positive (HER2+); triple-negative breast cancer (TNBC)) and surrogate intrinsic subtypes (luminal Alike ; luminal B-like; HER2 enriched; basal like). Results A total of 703 patients were included: 48.9% had stage I, 35.8% stage II and 15.2% stage III breast cancer; 76.4% had HR+/HER2−, 15.9% HER2+ and 7.7% TNBC. Median cost of care was €9215/patient in stage I, €13 019/patient in stage II and €15 011/patient in stage III and €10 540/patient in HR+/HER2−, €11 224/patient in TNBC and €41 513/patient in HER2+ breast cancer. Systemic therapy accounted for 69.2% of the cost of care among patients with HER2+, 12.0% among HR+/HER2− and 7.5% among TNBC patients. Similar differences were observed across surrogate intrinsic subtypes. Conclusions The cost of early breast cancer care was mainly driven by the tumour subtype and, to a lesser extent, by stage. The median cost of care was fourfold higher among patients with HER2+ tumours compared with those with HR+/HER2− and TNBC. These data provide information for the economic evaluation of innovative treatments for early breast cancer and highlight the weight that targeted systemic therapy might have in the overall cost of care among patients with early breast cancer. How might this impact on clinical practice? ► We demonstrate that the cost of early breast cancer care was mainly driven by tumour subtype. Clinicians and stakeholders must be aware of the weight that targeted systemic therapies may have in the overall cost of care and, given the recent approval of many drugs for the treatment of early breast cancer, that this predominance will probably increase in the future.
Value in Health, 2019
Objectives: A previous analysis showed the economic sustainability of adding liquid biopsy, whene... more Objectives: A previous analysis showed the economic sustainability of adding liquid biopsy, whenever possible, to tissue biopsy for the assessment of epidermal growth factor receptor-positive (EGFR+) mutation in patients with advanced non-small cell lung cancer (mNSCLC). The following analysis evaluated the clinical outcome (progression free survival, PFS) when adopting two different diagnostic strategies in the first-line treatment of patients with EGFR+ mNSCLC. Methods: A previous decisionanalytic model was adopted to compare the two diagnostic strategies: i) tissue strategy and ii) combined strategy (tissue biopsy and, were its outcome unknown, liquid biopsy). We only evaluated the PFS variation between the two diagnostic strategies considered. We assumed that mNSCLC EGFR+ patients were treated with 3 rd generation EGFR-TKI (PFS: 18.9 months), while mNSCLC EGFR Wilde Type (WT) patients were treated with chemotherapy (PFS: 5.7 months). Key variables were tested in the sensitivity analysis. Results: A total of 13,030 patients eligible for tissue biopsy in Italy were considered, of whom 2,463 were assumed to be EGFR+. The combined strategy showed an increase of the number of correctly identified EGFR+ patients (2,293 patients) compared to the tissue strategy (1,691 patients). When considering mNSCLC EGFR+ patients treated with 3 rd generation EGFR-TKI, the PFS would increase from 14.8 months per patient with the tissue strategy to 18.5 months per patient with the combined strategy. When considering mNSCLC EGFR+ patients treated with other 1 st /2 nd generation EGFR-TKI, the PFS would increase from 8.8 months per patient with the tissue strategy to 10.1 months per patient with the combined strategy. Conclusions: The choice of a correct diagnostic strategy is crucial in order to optimize cancer therapies in the first-line treatment of mNSCLC EGFR+. The addition to the diagnostic pathway of the liquid biopsy would correctly identify a greater number of cases, supporting the prescription of a more effective oncological therapy.
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Papers by Deolinda S Pereira