Pinto Joseph A, Saravia César H, Flores Claudio, Araujo Jhajaira M, Martínez David, Schwarz Luis J, Casas Alberto, Bravo Leny, Zavaleta Jenny, Chuima Brigitte, Alvarado Hober, Fujita Ricardo, Gómez Henry L
Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima 15036, Perú.
Departamento de Radioterapia, Oncosalud-AUNA, Lima 15036, Perú.
Ecancermedicalscience. 2019 Jan 22;13:896. doi: 10.3332/ecancer.2019.896. eCollection 2019.
Advances in high-throughput technologies and their involvement in the 'omics' of cancer have made possible the identification of hundreds of biomarkers and the development of predictive and prognostic platforms that model the management of cancer from evidence-based medicine to precision medicine. Latin America (LATAM) is a region characterised by fragmented healthcare, high rates of poverty and disparities to access to a basic standard of care not only for cancer but also for other complex diseases. Patients from the public setting cannot afford targeted therapy, the facilities offering genomic platforms are scarce and the use of high-precision radiotherapy is limited to few facilities. Despite the fact that LATAM oncologists are well-trained in the use of genomic platforms and constantly participate in genomic projects, a medical practice based in precision oncology is a great challenge and frequently limited to private practice. In breast cancer, we are waiting for the results of large basket trials to incorporate the detection of actionable mutations to select targeted treatments, in a similar way to the management of lung cancer. On the other hand and paradoxically, in the 'one fit is not for all' era, clinical and genomic studies continue grouping our patients under the single label 'Latin American' or 'Hispanic' despite the different ancestries and genomic backgrounds seen in the region. More regional cancer genomic initiatives and public availability of this data are needed in order to develop more precise oncology in locally advanced breast cancer.
高通量技术的进步及其在癌症“组学”中的应用，使得识别数百种生物标志物以及开发预测和预后平台成为可能，这些平台将癌症管理模式从循证医学转变为精准医学。拉丁美洲（LATAM）地区的医疗保健体系分散，贫困率高，不仅在癌症治疗方面，在获取其他复杂疾病基本医疗标准方面也存在差异。公立医疗机构的患者负担不起靶向治疗，提供基因组平台的设施稀缺，高精度放疗的使用也仅限于少数机构。尽管拉丁美洲的肿瘤学家在基因组平台的使用方面训练有素，并经常参与基因组项目，但基于精准肿瘤学的医疗实践仍是一项巨大挑战，且通常仅限于私立医疗机构。在乳腺癌方面，我们正在等待大型综合试验的结果，以便纳入可操作突变的检测，从而像肺癌治疗那样选择靶向治疗。另一方面，矛盾的是，在“一刀切并不适用于所有人”的时代，临床和基因组研究仍继续将我们的患者统一归类为“拉丁美洲人”或“西班牙裔”，尽管该地区存在不同的祖先和基因组背景。为了在局部晚期乳腺癌中发展更精准的肿瘤学，需要更多的区域癌症基因组计划以及这些数据的公开可用性。
