ObjetivosEvaluar mediante un metaanálisis los efectos de la reperfusión tardía en el IAM (hipótesis de la arteria abierta) sobre la morbimortalidad y la fracción de eyección (Fey). Material y métodosSe incluyeron estudios aleatorizados controlados (EAC) que compararan angioplastia (ATC) con tratamiento médico (TM) en pacientes con infarto agudo de miocardio (IAM) que permanecieran con la arteria ocluida > 12 horas, con un seguimiento > 3 meses. Se realizaron búsquedas electrónicas y en listas de referencias. ResultadosOcho EAC, que sumaron 2.972 pacientes, cumplieron los criterios de inclusión; los estudios incluyeron entre 30 y 2.166 pacientes (media: 77). El intervalo entre el IAM y la ATC fue de 25 horas a 26,3 días (media: 8,3 días). En forma global se detectó una tendencia a la reducción del riesgo de muerte [RR 0,73 (IC 95% 0,46-1,16)] y al incremento del riesgo de IAM [RR 1,15 (IC 95% 0,76-1,72)]. Hubo una tendencia a la reducción en las internaciones por IC con la ATC con un RR de 0,56 (0,26-1,21) y una reducción significativa de procedimientos de revascularización con un RR de 0,82 (0,70-0,97). La Fey en el seguimiento fue 2,39 puntos mayor en el grupo ATC (-0,06-4,84). Sin embargo, la evaluación de los datos según la calidad de los estudios demuestra que el beneficio sobre la mortalidad se concentra en los EAC de menor calidad [0,50 (0,25-0,99)], mientras que no existe tal beneficio en los EAC de mayor calidad [0,89 (0,53-1,51)]. No hubo heterogeneidad significativa, excepto en los efectos sobre la fracción de eyección (p de heterogeneidad = 0,03); el nivel de inconsistencia general fue moderado. Existen evidencias de sesgo de publicación. Conclusiones Sobre la base de estos resultados, el metaanálisis indica que efectuar una angioplastia tar- día en vasos ocluidos en el infarto no aporta beneficios sobre la morbimortalidad. Los resultados entusiastas de los primeros ensayos de pequeñas dimensiones pueden ser atribuidos a sesgos de publicación y a déficits en el diseño. Se registra un discreto incremento en la Fey con la intervención que no se tradujo en beneficios clínicos en esta población de bajo riesgo, aunque sería interesante su estudio en pacientes con compromiso significativo de la función ventricular.
Existen numerosos casos comunicados sobre la disfunción ventricular izquierda reversible precipitada por estrés emocional, pero su mecanismo no se conoce. En esta presentación se describe la evaluación de dos pacientes que consultaron con un cuadro clínico típico de síndrome de Tako-Tsubo, dolor precordial luego de un estrés emocional, disfunción ventricular izquierda transitoria y arterias coronarias angiográficamente normales. Con el objetivo de profundizar el conocimiento de las arterias coronarias y la fisiopatología de esta enfermedad, a ambas se les realizó una tomografía multislice, en la que se evidenciaron lesiones coronarias similares a las halladas en accidentes de placa responsables de síndromes coronarios agudos. Si bien estos hallazgos deben completarse con estudios posteriores con un número mayor de pacientes, sugieren que al menos un subgrupo de pacientes con síndrome de Tako-Tsubo tiene un sustrato fisiopatológico similar a los síndromes coronarios agudos.
Background: Primary results from COSMIC-313 demonstrated significantly longer progression-free survival (PFS) with first-line cabozantinib plus nivolumab and ipilimumab versus placebo plus nivolumab and ipilimumab in patients with advanced renal cell carcinoma. Final efficacy and safety results, as well as data from exploratory biomarker analyses, are reported here. Patients and methods: The design, participants, and primary-endpoint PFS outcomes have been reported previously for this phase III, double-blind, randomized (1 : 1) study of cabozantinib or placebo plus nivolumab and ipilimumab in adults with previously untreated, advanced clear cell renal cell carcinoma. The secondary endpoint was overall survival (OS) in the intention-to-treat population. Exploratory biomarker analyses investigated the potential association between immune cell types and gene signatures with clinical outcomes. Results: After a median follow-up of 45.0 months, the updated median PFS in the cabozantinib (triplet) arm was longer than in the placebo (doublet) arm (16.6 versus 11.2 months; hazard ratio 0.82, 95% confidence interval 0.69-0.98). There was no significant difference in median OS (hazard ratio 1.02, 95% confidence interval 0.85-1.23, P = 0.84), and the safety profile was consistent with the earlier analysis (grade 3/4 treatment-related adverse events occurred in 75% and 43% of patients in the triplet and doublet arms, respectively). In patients with higher levels of M2-like macrophages, the triplet regimen was associated with significantly improved PFS and OS compared with the doublet regimen. Responders in the triplet arm exhibited elevated angiogenic signatures and reduced immune-related pathways, while responders in the doublet arm had robust immune activation. Conclusions: Long-term results from COSMIC-313 continue to demonstrate a PFS benefit with the addition of cabozantinib to nivolumab and ipilimumab. There was no OS benefit and no new safety signals were observed. Exploratory biomarker analyses suggest adding cabozantinib to nivolumab and ipilimumab improves survival in patients with high levels of M2-like macrophages.
Pembrolizumab combined with neoadjuvant chemotherapy has become the standard of care for most patients with early-stage triple-negative breast cancer (TNBC), typically administered at a dose of 200 mg every three weeks (q3w), as studied in the KEYNOTE-522 trial. A 400 mg every six weeks (q6w) dosing schedule was subsequently approved by regulatory agencies based on pharmacokinetic modeling and exposure-response analyses demonstrating comparable drug exposure and similar expected efficacy and safety to the standard q3w regimen. Although the q6w schedule was not evaluated in prospective neoadjuvant trials, its adoption has increased in real-world practice, particularly in settings with logistical constraints. However, comparative clinical data on the safety and efficacy of q6w versus q3w dosing in early TNBC remain limited. Patients with early TNBC who received neoadjuvant chemotherapy and pembrolizumab within the PETRHA retrospective cohort were included. Pembrolizumab was administered either 200 mg every three weeks (q3w) or 400 mg every six weeks (q6w), based on physicians' choice and local practice. Patients receiving q3w and q6w dosing were compared in terms of treatment completion (defined as receipt of all planned neoadjuvant pembrolizumab cycles), immune-related adverse events (irAEs), and pathologic complete response (pCR) rates, defined as ypT0/is ypN0. Descriptive statistics were used to summarize baseline characteristics. Categorical variables were compared using chi-square or Fisher’s exact tests. A two-sided p-value <0.05 was considered statistically significant. A total of 304 patients were included, of whom 232 (76.3%) received pembrolizumab 200 mg q3w, and 72 (23.7%) received 400 mg q6w. Most patients had stage II (53.9%) or stage III (42.1%) disease, with a similar clinical stage distribution across dosing groups. The use of the q6w schedule was significantly more common in public healthcare settings, with only 0.6% of patients in private institutions receiving pembrolizumab q6w compared to 51.1% in public centers (p<0.001). Treatment completion rates were comparable, with 75.7% of patients in the q3w group and 76.4% in the q6w group completing all planned neoadjuvant pembrolizumab cycles (p=0.60). The pCR rate was higher in the q3w group (62.5%) compared to the q6w group (51.4%), although this difference did not reach statistical significance (p=0.093). irAEs occurred in 37.6% of patients receiving q3w and 25.0% of those receiving q6w dosing (p=0.051), with no statistically significant differences in grade 3 or higher irAEs (12.8% vs. 0%, p=0.205), In this real-world cohort of Hispano-American women with early TNBC, the use of a q6w neoadjuvant pembrolizumab dosing schedule was associated with similar treatment completion rates and a non-significantly lower pCR rate compared to the standard q3w neoadjuvant regimen. The numerically lower incidence and severity of irAEs with q6w dosing suggest a potentially favorable toxicity profile, although the difference was not statistically significant. These findings support the feasibility of q6w neoadjuvant pembrolizumab dosing in clinical practice. A. Aranda-Gutierrez, D. Vazquez-Juarez, Y. Chavarri-Guerra, F. Petracci, O. Peña-Curiel, F. Acevedo, E. Zamudio Lozoya, L. Gonzalez Gonzalez, W. Mantilla, S. Franco, M. Bravo, P. Herrera Ríos, C. Arce Salinas, K. Centelles López, H. Gomez, P. Carreon, E. Aguirre Alvarez, B. Martinez-Cannon, A. Lopez-Galindo, M. Garcia Garces, E. Willars, E. Korbenfeld, A. Benitez-Cruz, M. Lema, C. Lema, C. Villarreal-Garza. Real-world comparison of pembrolizumab dosing schedules (q3w vs q6w) in early TNBC: Insights from the PETRHA cohort [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-07-12.
Accurate staging of breast cancer (BC) is essential for guiding treatment decisions and estimating prognosis. Current guidelines discourage routine diagnostic imaging in asymptomatic patients. However, adherence is often inconsistent in clinical practice. In Latin America (LATAM), this is further challenged by higher rates of advanced-stage presentations and aggressive tumor subtypes, which may lead to more frequent imaging. Yet, there is a lack of data on real-world imaging patterns in the region. Understanding current staging practices is critical to identifying care gaps, informing context-appropriate guidelines, and promoting efficient diagnostic strategies. We conducted a cross-sectional, anonymous online survey among oncologists and breast surgeons from LATAM countries. The survey included 63 items covering sociodemographic characteristics, imaging use by clinical stage, decision-making criteria, access to diagnostic technologies, turnaround times, and familiarity with guidelines. Descriptive statistics were used for analysis. A total of 269 physicians participated. Respondents included physicians from 18 LATAM countries and Spain; 55.4% were oncologists and 44.6% breast surgeons; 57.3% worked primarily in public settings, and 55.4% had over 10 years of experience. While 43.5% managed more than 50 BC patients per month, only 18.2% were exclusively dedicated to BC care. Guideline awareness was high (NCCN: 89%, ESMO: 71.4%, national: 70.6%), and 89.1% stated that guideline recommendations were important for decision making in clinical practice. Despite this, routine use of diagnostic imaging was reported in 34.2% of asymptomatic patients with stage I disease, 48% in stage II without nodal involvement, 77.7% in stage II with nodal involvement, and 91.1% in stage III. Chest CT (65.9%), abdominal CT (63.2%), and bone scintigraphy (62.7%) were reported as the most frequently used studies, though abdominal ultrasound (US) (42.2%), chest X-ray (40.9%), and PET-CT (23.3%) were also reported. Imaging decisions were primarily influenced by tumor size (78.3%) and biological subtype (65.9%). Chest X-ray and abdominal US reported use decreased from 62.8% in stage I to 24.7% in stage III patients, while thoraco-abdominal CT use increased from 36.2% in stage I to 85.7% in stage III patients. The reported use of imaging did not change based on medical specialty or years of clinical practice. Access to advanced imaging modalities such as PET-CT was more restricted; only 43.9% had consistent availability, and 44.6% reported turnaround times >4 weeks, compared to <3% for chest X-ray or abdominal US, 15.9% for thoraco-abdominal CT, and 27.1% for bone scintigraphy. Most respondents (62.5%) indicated that imaging decisions and turnaround times (82.2%) would differ based on patients' insurance status (public vs private). Overall, the findings highlight a disconnect between guideline-based recommendations and real-world practice, shaped by system-level disparities and resource constraints. Our findings underscore a significant gap between guideline recommendations and real-world diagnostic imaging practices for BC staging across LATAM. Despite high awareness of guidelines, the frequent use of imaging reflects inconsistent adherence to guideline recommendations. Early-stage patients often undergo extensive imaging, with limited access and long delays—particularly for advanced modalities like PET-CT— that may contribute to treatment delays. These findings support the need for regionally adapted staging guidelines and targeted educational strategies to improve guideline-concordant care across LATAM. This work was conducted with the collaboration of LABCA, ACHO, ACM and SVM. W. A. Mantilla, M. A. Bravo, V. Acosta-Marín, A. M. Osorio, C. Villarreal-Garza, A. W. Mushtaq, F. E. Petracci, S. Cervera, G. Santander, A. Reyes-Morales, D. U. Landaverde, J. C. Samamé-Pérez-Vargas, J. Moreno-Rios, L. Gutiérrez, B. Moreno-Jaime, J. J. Caicedo, S. Quintero, A. M. Mejía, H. Carranza, S. X. Franco. Real-world patterns and preferences in the use of diagnostic imaging for breast cancer staging in Hispano-America: A multinational physician survey [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-10-21.
