Beneficios de la quimioterapia adyuvante en los resultados de supervivencia del cáncer de mama triple negativo pT1N0M0
Authors:   Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru, Morante Zaida , Ferreira Yomali ,   Departamento de Bioingeniería e Ingeniería Química, Universidad de Ingeniería y Tecnología, Lima, Peru, Valdiviezo Natalia ,   Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru, Castañeda Carlos ,   Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru, Vidaurre Tatiana ,   Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru, Valencia Guillermo , Otoya Iris ,   Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru, Fuentes Hugo ,   Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru, Neciosup Silvia ,   Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru, Gomez Henry L. ,   Instituto de Investigaciones en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Peru Oncosalud, Auna Ideas, Lima, Peru
Published: November 2024

Introduction Collaborative health research has proven to be an effective approach to addressing regional and international challenges in the diagnosis, treatment, and management of diseases (1–4). In Latin America, a region characterized by geographic, socioeconomic, and epidemiological diversity, the creation of research networks is essential to unify efforts and generate knowledge applicable locally and internationally (1–4). In this context, the Latin American Lymphoma Study Group (GELL) emerges as a key player in lymphoma research—a family of hematologic cancers with high clinical and molecular heterogeneity. Origins and Structure of GELL Founded in 2018, GELL is a collaborative research network comprising 14 Latin American countries, supported by prestigious international institutions such as the Dana Farber Institute, MD Anderson Cancer Center, and Tampa General Hospital. The group’s primary objective is to conduct multicenter studies that provide high-quality epidemiological, clinical, and molecular data on various lymphoma subtypes. Introduction: Triple-negative breast cancer (TNBC) is notably an aggressive breast cancer (BC) subtype, leading to early relapse and poor prognosis. Effects of adjuvant chemotherapy among early-stage TNBC (pT1N0M0) patients remain unclear in different populations. Objectives: Our study aimed to determine the impact of adjuvant chemotherapy on overall survival (OS) and progression-free survival (PFS) within the specific subset of Peruvian pT1N0M0 TNBC patients (pT1a/b vs. pT1c). Methods: We retrospectively analyzed 2007 TNBC cases diagnosed between 2000-2014 at the Instituto Nacional de Enfermedades Neoplásicas (Lima, Peru). We included only non-metastatic TNBC cases and classified them as pT1N0M0 after surgery. TNBC patients who underwent neoadjuvant chemotherapy were excluded. We describe our population according to the tumor size from the residue disease (pT1a/b vs. pT1c). We used the Kaplan-Meier method test to determine differences in survival curves for OS and PFS. A Univariate Cox proportional hazards model was used to identify risk factors for PFS. Results: Our study cohort included 124 TNBC patients. Around 65.3% (n=81) were undergoing adjuvant chemotherapy. Notably, among pT1c patients, this treatment was more prevalent compared to pT1a/b (72.1% vs. 50.0%). Survival analysis showed no significant OS benefit from chemotherapy (HR:2.46,95%CI:0.74-8.13,p=0.13). However, a marked improvement in PFS was noted exclusively in the pT1c subgroup, with patients not treated with chemotherapy offering a prognostic risk (HR:20.10,95% CI:5.54-73.10,p<0.0001). pT1a/b patients demonstrated no benefit from chemotherapy regarding progression (HR:3.07,95% CI:0.27-34.50,p=0.34). Conclusion: Our study highlights that adjuvant chemotherapy significantly improves PFS in pT1cN0M0 TNBC patients but shows no clear benefit for smaller tumors (pT1a/bN0M0). Future research should focus on personalized chemotherapy strategies in early-stage TNBC to identify predictive markers for survival. Objectives and Achievements of GELL One of GELL's main objectives is to determine the epidemiology of different lymphoma subtypes in Latin America, including diffuse large B-cell lymphoma (DLBCL), follicular lymphoma, nasal-type T/NK-cell lymphoma, and Epstein-Barr virus (EBV)-associated lymphoma. The group also aims to develop retrospective and prospective studies on inflammatory biomarkers and novel prognostic scores (5–7). These studies help identify risk factors and clinical parameters that predict treatment response and prognosis in lymphoma patients. To date, GELL has collected data on more than 6,400 patients in retrospective studies, including: 1,500 patients with DLBCL (6,8). 1,000 patients with peripheral T-cell lymphoma (PTCL-NOS) (9). 800 patients with follicular lymphoma (10). 2,000 patients with adult T-cell leukemia/lymphoma (ATLL) (11). These retrospective studies are crucial for generating hypotheses that guide future prospective studies, contributing to a better understanding of lymphomas in the region. Scientific Production and Knowledge Dissemination GELL has achieved remarkable scientific output, contributing 37 works that include: 6 articles published in high-impact journals. 30 posters presented at international conferences such as ASH, EHA, and the World HTLV-1 Congress. 4 oral sessions at international scientific events. Among its most significant scientific achievements is the multicenter validation of the prognostic value of the neutrophil-to-lymphocyte ratio in DLBCL patients (12), published in collaboration with other international institutions. Additionally, GELL has developed consensus on relevant topics such as the management of patients with unspecified peripheral T-cell lymphoma (PTCL-NOS), which is in the process of publication, and the impact of COVID-19 on lymphoma patients (13). The impact of GELL's scientific production is measured not only in terms of publications and presentations but also in its ability to influence clinical practice at the regional level. The creation of consensuses and participation in clinical trials ensure that GELL's findings are immediately applicable to patient care in Latin America. Future Projects and GELL's Expansion GELL is not content with its achievements and continues to expand its horizons towards new research projects. One of the most ambitious projects underway is a molecular study on the genetic profile of DLBCL in Latin America, which will analyze over 400 genes using the Foundation One–Heme platform. This will be the first study of its kind in the region, providing a detailed understanding of the genetic alterations characterizing lymphomas in Latin American patients. Another significant project involves conducting prospective clinical trials on nasal-type T/NK-cell lymphoma and a meta-analysis on inflammatory biomarkers in lymphomas. These studies not only contribute to advancing scientific knowledge but also allow patients access to innovative treatments through clinical trials, promoting equity in access to advanced therapies. International Collaboration GELL has established collaborations with research groups from Japan, Brazil, and Italy, enabling it to build one of the largest global databases on T-cell lymphomas and EBV-associated DLBCL. These collaborations reflect the growing relevance of studies conducted in Latin America and position GELL as a global leader in lymphoma research. Conclusion The Latin American Lymphoma Study Group (GELL) has demonstrated that scientific collaboration in Latin America can generate valuable knowledge applicable globally. Its efforts to unify data from multiple countries, conduct prospective and retrospective studies, and promote participation in clinical trials have significantly improved the care of lymphoma patients in the region. With ambitious projects on the horizon, such as the molecular analysis of DLBCL and new clinical trials, GELL is well-positioned to continue leading lymphoma research in Latin America and beyond.