Lung cancer in Brazil: epidemiology and treatment challenges

Vanessa Karen de Sá, Juliano C Coelho, Vera Luiza Capelozzi, Sergio Jobim de Azevedo, Vanessa Karen de Sá, Juliano C Coelho, Vera Luiza Capelozzi, Sergio Jobim de Azevedo

Abstract

Lung cancer persists throughout the world as a major cause of death. In 2014, data from the Brazilian National Cancer Institute (INCA) estimated 16.400 new cases of lung cancer among men (second most common) and 10.930 new cases among women (fourth most common). These data are consistent for all Brazilian regions and reflect the trends of cancer in the country over the last decade. Brazil is a continental country, the largest in Latin America and fifth in the world, with an estimated population of >200 million. Although the discrepancy in the national income between rich and poor has diminished in the last 2 decades, it is still huge. More than 75% of the Brazilian population do not have private health insurance and rely on the national health care system, where differences in standard of cancer care are evident. It is possible to point out differences from the recommendations of international guidelines in every step of the lung cancer care, from the diagnosis to the treatment of advanced disease. This review aims to describe and recognize these differences as a way to offer a real discussion for future modifications and action points toward delivery of better oncology care in our country.

Keywords: Brazilian scenario; NSCLC; diagnosis; drivers mutations; screening.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

References

    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65(1):5–29.
    1. Estimativa . Incidência de Câncer no Brasil [Incidence of Cancer in Brazil] Rio de Janeiro: 2014. [Accessed October 19, 2016]. Available from: . Portuguese.
    1. Souza MC, Vasconcelos AG, Cruz OG. Trends in lung cancer mortality in Brazil from the 1980s into the early 21st century: age-period-cohort analysis. Cad Saude Publica. 2012;28(1):21–30.
    1. Monteiro CA, Cavalcante TM, Moura EC, Claro RM, Szwarcwald CL. Population-based evidence of a strong decline in the prevalence of smokers in Brazil (1989-2003) Bull World Health Organ. 2007;85(7):527–534.
    1. Cancer INd [Accessed October 19, 2016];Global Adults Tobacco Survey Brazil 2008. 2010 Available from: .
    1. Cancer INd Vigescola – Vigilancia de tabagismo em escolares: dados e fatos de 17 cidades brasileiras [Vigescola - smoking surveillance in school: facts and figures of 17 Brazilian cities] 2010. [Accessed September 16, 2016]. Available from: . Portuguese.
    1. National Lung Screening Trial Research Team. Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395–409.
    1. Moyer VA, Force USPST Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160(5):330–338.
    1. de Koning HJ, Meza R, Plevritis SK, et al. Benefits and harms of computed tomography lung cancer screening strategies: a comparative modeling study for the U.S. Preventive Services Task Force. Ann Intern Med. 2014;160(5):311–320.
    1. Ma J, Ward EM, Smith R, Jemal A. Annual number of lung cancer deaths potentially avertable by screening in the United States. Cancer. 2013;119(7):1381–1385.
    1. Takiguchi Y, Sekine I, Iwasawa S. Overdiagnosis in lung cancer screening with low-dose computed tomography. J Thorac Oncol. 2013;8(11):e101–e102.
    1. dos Santos RS, Franceschini JP, Chate RC, et al. Do current lung cancer screening guidelines apply for populations with high prevalence of granulomatous disease? Results from the first Brazilian lung cancer screening trial (BRELT1) Ann Thorac Surg. 2016;101(2):481–486. discussion 487–488.
    1. Ettinger DS, Wood DE, Akerley W, et al. NCCN guidelines insights: non-small cell lung cancer, version 4.2016. J Natl Compr Canc Netw. 2016;14(3):255–264.
    1. Groome PA, Bolejack V, Crowley JJ, et al. The IASLC Lung Cancer Staging Project: validation of the proposals for revision of the T, N, and M descriptors and consequent stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol. 2007;2(8):694–705.
    1. Arriagada R, Bergman B, Dunant A, et al. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med. 2004;350(4):351–360.
    1. Douillard JY, Rosell R, De Lena M, et al. Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB-IIIA non-small-cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]): a randomised controlled trial. Lancet Oncol. 2006;7(9):719–727.
    1. Winton T, Livingston R, Johnson D, et al. Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. N Engl J Med. 2005;352(25):2589–2597.
    1. Trodella L, Granone P, Valente S, et al. Adjuvant radiotherapy in nonsmall cell lung cancer with pathological stage I: definitive results of a phase III randomized trial. Radiother Oncol. 2002;62(1):11–19.
    1. Franca LB, Oliveira MA, Small IA, Zukin M, Araujo LH. Adjuvant therapy for non-small cell lung cancer. J Bras Pneumol. 2011;37(3):354–359.
    1. Araujo LH, Baldotto CS, Zukin M, et al. Survival and prognostic factors in patients with non-small cell lung cancer treated in private health care. Rev Bras Epidemiol. 2014;17(4):1001–1014.
    1. Younes RN, Deutsch F, Badra C, Gross J, Haddad F, Deheinzelin D. Nonsmall cell lung cancer: evaluation of 737 consecutive patients in a single institution. Rev Hosp Clin Fac Med Sao Paulo. 2004;59(3):119–127.
    1. Koshy M, Fedewa SA, Malik R, et al. Improved survival associated with neoadjuvant chemoradiation in patients with clinical stage IIIA(N2) non-small-cell lung cancer. J Thorac Oncol. 2013;8(7):915–922.
    1. Eberhardt WE, Pottgen C, Gauler TC, et al. Phase III study of surgery versus definitive concurrent chemoradiotherapy boost in patients with resectable stage IIIA(N2) and selected IIIB non-small-cell lung cancer after induction chemotherapy and concurrent chemoradiotherapy (ESPATUE) J Clin Oncol. 2015;33(35):4194–4201.
    1. Martins RG, Dienstmann R, de Biasi P, et al. Phase II trial of neoadjuvant chemotherapy using alternating doublets in non-small-cell lung cancer. Clin Lung Cancer. 2007;8(4):257–263.
    1. Curran WJ, Jr, Paulus R, Langer CJ, et al. Sequential vs. concurrent chemoradiation for stage III non-small cell lung cancer: randomized phase III trial RTOG 9410. J Natl Cancer Inst. 2011;103(19):1452–1460.
    1. Schaake-Koning C, van den Bogaert W, Dalesio O, et al. Effects of concomitant cisplatin and radiotherapy on inoperable non-small-cell lung cancer. N Engl J Med. 1992;326(8):524–530.
    1. Albain KS, Crowley JJ, Turrisi AT, 3rd, et al. Concurrent cisplatin, etoposide, and chest radiotherapy in pathologic stage IIIB non-smallcell lung cancer: a Southwest Oncology Group phase II study, SWOG 9019. J Clin Oncol. 2002;20(16):3454–3460.
    1. Belani CP, Choy H, Bonomi P, et al. Combined chemoradiotherapy regimens of paclitaxel and carboplatin for locally advanced non-smallcell lung cancer: a randomized phase II locally advanced multi-modality protocol. J Clin Oncol. 2005;23(25):5883–5891.
    1. Coelho JC, Piroli R, Branco MA, et al. Outcomes of chemoradiotherapy for stage III non-small-cell lung cancer in South of Brazil; World Conference on Lung Cancer; Denver, USA: 2015.
    1. Besse B, Adjei A, Baas P, et al. 2nd ESMO consensus conference on lung cancer: non-small-cell lung cancer first-line/second and further lines of treatment in advanced disease. Ann Oncol. 2014;25(8):1475–1484.
    1. Anelli A, Lima CA, Younes RN, Gross JL, Fogarolli R. Chemotherapy versus best supportive care in stage IV non-small cell lung cancer, non metastatic to the brain. Rev Hosp Clin Fac Med Sao Paulo. 2001;56(2):53–58.
    1. Naime FF, Younes RN, Kersten BG, et al. Metastatic non-small cell lung cancer in Brazil: treatment heterogeneity in routine clinical practice. Clinics. 2007;62(4):397–404.
    1. Westphal FL, Lima LC, Andrade EO, Lima Netto JC, Silva AS, Carvalho BC. Characteristics of patients with lung cancer in the city of Manaus, Brazil. J Bras Pneumol. 2009;35(2):157–163.
    1. Zukin M, Barrios CH, Pereira JR, et al. Randomized phase III trial of single-agent pemetrexed versus carboplatin and pemetrexed in patients with advanced non-small-cell lung cancer and Eastern Cooperative Oncology Group performance status of 2. J Clin Oncol. 2013;31(23):2849–2853.
    1. Weis LN, Coelh JC, Marks P, et al. Non-small cell lung cancer and brain metastases in Brazil; 7th Latin American Conference on Lung Câncer; Panama. 2016.
    1. Shi Y, Au JS, Thongprasert S, et al. A prospective, molecular epidemiology study of EGFR mutations in Asian patients with advanced non-small-cell lung cancer of adenocarcinoma histology (PIONEER) J Thorac Oncol. 2014;9(2):154–162.
    1. Mok TS, Wu YL, Thongprasert S, et al. Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Engl J Med. 2009;361(10):947–957.
    1. Rosell R, Carcereny E, Gervais R, et al. Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC): a multicentre, open-label, randomised phase 3 trial. Lancet Oncol. 2012;13(3):239–246.
    1. Lee CK, Brown C, Gralla RJ, et al. Impact of EGFR inhibitor in non-small cell lung cancer on progression-free and overall survival: a meta-analysis. J Natl Cancer Inst. 2013;105(9):595–605.
    1. Yang JC, Wu YL, Schuler M, et al. Afatinib versus cisplatin-based chemotherapy for EGFR mutation-positive lung adenocarcinoma (LUX-Lung 3 and LUX-Lung 6): analysis of overall survival data from two randomised, phase 3 trials. Lancet Oncol. 2015;16(2):141–151.
    1. Bacchi CE, Ciol H, Queiroga EM, Benine LC, Silva LH, Ojopi EB. Epidermal growth factor receptor and KRAS mutations in Brazilian lung cancer patients. Clinics. 2012;67(5):419–424.
    1. Arrieta O, Cardona AF, Martin C, et al. Updated frequency of EGFR and KRAS mutations in nonsmall-cell lung cancer in Latin America: the Latin-American consortium for the investigation of lung cancer (CLICaP) J Thorac Oncol. 2015;10(5):838–843.
    1. de Melo AC, de Sá VK, Sternberg C, et al. Mutational Profile and New IASLC/ATS/ERS Classification Provide Additional Prognostic Information about Lung Adenocarcinoma: A Study of 125 Patients from Brazil. Oncology. 2015;89(3):175–86.
    1. Shaw AT, Solomon B. Targeting anaplastic lymphoma kinase in lung cancer. Clin Cancer Res. 2011;17(8):2081–2086.
    1. Bergethon K, Shaw AT, Ou SH, et al. ROS1 rearrangements define a unique molecular class of lung cancers. J Clin Oncol. 2012;30(8):863–870.
    1. Borghaei H, Paz-Ares L, Horn L, et al. Nivolumab versus docetaxel in advanced nonsquamous non-small-cell lung cancer. N Engl J Med. 2015;373(17):1627–1639.
    1. Brahmer J, Reckamp KL, Baas P, et al. Nivolumab versus docetaxel in advanced squamous-cell non-small-cell lung cancer. N Engl J Med. 2015;373(2):123–135.
    1. Herbst RS, Baas P, Kim DW, et al. Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small-cell lung cancer (KEYNOTE-010): a randomised controlled trial. Lancet. 2016;387(10027):1540–1550.
    1. Barrios CH, Debiasi M, Fay AP, Viola LS, Zamprogna L, Mesa JM. Survival analysis of stage IV NSCLC patients treated by the Brazilian public health system compared with patients treated at a research center in the same institution. J Clin Oncol. 2011;29(suppl) abstre16525.
    1. Baerros RPD, Foguel MN, Ulyssea G. Income inequality in Brazil: an analysis of the recent fall. Vol. 1. Brasilia: IPEA; 2006. Portuguese.
    1. Paim J, Travassos C, Almeida C, Bahia L, Macinko J. The Brazilian health system: history, advances, and challenges. Lancet. 2011;377(9779):1778–1797.
    1. Brasil . Protocolos Clínicos e Diretrizes Terapêuticas em Oncologia [Brazil. Clinical Protocols and Therapeutic Guidelines in Oncology] Brasília: Ministério da Saúde; 2014. Portuguese.
    1. Knorst MM, Dienstmann R, Fagundes LP. Retardo no diagnóstico e no tratamento cirúrgico do câncer de pulmão [Delay in the diagnosis and in the surgical treatment of lung cancer] J Pneumol. 2003;29(6):358–364. Portuguese.
    1. Tsao AS, Scagliotti GV, Bunn PA, Jr, et al. Scientific advances in lung cancer 2015. J Thorac Oncol. 2016;11(5):613–638.
    1. Perez CA, Stanley K, Rubin P, et al. A prospective randomized study of various irradiation doses and fractionation schedules in the treatment of inoperable non-oat-cell carcinoma of the lung. Preliminary report by the Radiation Therapy Oncology Group. Cancer. 1980;45(11):2744–2753.
    1. Barrios P, Debiasi M, Lopes G, BARRIOS CX. Impact of regulatory delays in approving oncology drugs in a developing country: mortality associated with lack of access to crizotinib in Brazil; World Conference on Lung Cancer; Denver, Colorado. 2015.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner