Lung cancer in Brazil

Araujo, Luiz Henrique; Baldotto, Clarissa; Castro Jr, Gilberto de; Katz, Artur; Ferreira, Carlos Gil; Mathias, Clarissa; Mascarenhas, Eldsamira; Lopes, Gilberto de Lima; Carvalho, Heloisa; Tabacof, Jaques; Martínez-Mesa, Jeovany; Viana, Luciano de Souza; Cruz, Marcelo de Souza; Zukin, Mauro; Marchi, Pedro De; Terra, Ricardo Mingarini; Ribeiro, Ronaldo Albuquerque; Lima, Vladmir Cláudio Cordeiro de; Werutsky, Gustavo; Barrios, Carlos Henrique; ,

doi:10.1590/S1806-37562017000000135

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Jornal Brasileiro de Pneumologia

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Sumário

REVIEW ARTICLE • J. bras. pneumol. 44 (01) • Jan-Feb 2018 • https://doi.org/10.1590/S1806-37562017000000135 copy

Lung cancer in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Lung cancer is one of the most incident types of cancer and a leading cause of cancer mortality in Brazil. We reviewed the current status of lung cancer by searching relevant data on prevention, diagnosis, and treatment in the country. This review highlights several issues that need to be addressed, including smoking control, patient lack of awareness, late diagnosis, and disparities in the access to cancer health care facilities in Brazil. We propose strategies to help overcome these limitations and challenge health care providers, as well as the society and governmental representatives, to work together and to take a step forward in fighting lung cancer.

Keywords:
Lung neoplasms/epidemiology; Lung neoplasms/therapy; Lung neoplasms/diagnosis; Biomarkers; Brazil

Author	N	Type of facility	NSCLC, %	SCC/Ad ratio	III-IV, %
Ismael et al.⁽¹⁸18 Ismael GF, Coradazzi AL, Neto FA, Abdalla KC, Milhomem PM, Oliveira JS, et al. Aspectos clínicos e histopatológicos em câncer de pulmão: análise dos dados de uma instituição no interior paulista entre 1997 e 2008. J Bras Oncol Clin. 2010;7(22):72-8.⁾	1,887	Public	89	0.93	71
Younes et al.⁽¹⁹19 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):119-27. https://doi.org/10.1590/S0041-87812004000300005 https://doi.org/10.1590/S0041-8781200400... ⁾	737	Public	100^a	1.20	74
Westphal et al.⁽²⁰20 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):157-63. https://doi.org/10.1590/S1806-37132009000200009 https://doi.org/10.1590/S1806-3713200900... ⁾	352	Public	91	2.54	66
Barros et al.⁽²¹21 Barros JA, Valladares G, Faria AR, Fugita EM, Ruiz AP, Vianna AG, et al. Early diagnosis of lung cancer: the great challenge. Epidemiological variables, clinical variables, staging and treatment. J Bras Pneumol. 2006;32(3):221-7. https://doi.org/10.1590/S1806-37132006000300008 https://doi.org/10.1590/S1806-3713200600... ⁾	263	Public	87	1.96	94
Novaes et al.⁽²²22 Novaes FT, Cataneo DC, Ruiz Junior RL, Defaveri J, Michelin OC, Cataneo AJ. Lung cancer: histology, staging, treatment and survival. J Bras Pneumol. 2008;34(8):595-600. https://doi.org/10.1590/S1806-37132008000800009 https://doi.org/10.1590/S1806-3713200800... ⁾	240	Public	80	1.25	72
Araujo et al.⁽²³23 Araujo LH, Baldotto CS, Zukin M, Vieira FM, Victorino AP, Rocha VR, 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):1001-14. https://doi.org/10.1590/1809-4503201400040017 https://doi.org/10.1590/1809-45032014000... ⁾	566	Private	100^a	0.33	80
Caires-Lima et al.⁽²⁶26 Caires-Lima R, Takahashi TK, Mak MP, Roiteberg FS, Teixeira CH, Mesquita CS, et al. Referral of lung cancer patients to specialized clinical oncology care: Instituto do Câncer do Estado de São Paulo 2010-2011. J Thorac Oncol. 2012;7(7):S111.⁾	232	Public	92	0.48	93
Mascarenhas et al.⁽²⁴24 Mascarenhas E, Lessa G. Perfil clínico e sócio-demográfico de pacientes com câncer de pulmão não-pequenas células atendidos num serviço privado. J Bras Oncol Clin. 2010;7(22):49-54.⁾	338	Private	83	0.38	78
Freitas et al.⁽²⁵25 Freitas ED. Aspectos epidemiológicos do câncer de pulmão em uma instituição privada. J Bras Oncol Clin. 2010;7:(22):55-9.⁾	93	Private	100^a	0.33	88

Author	N	EGFR mutation, %	NS, %	Female, %	non-SCC, %	Setting
Pontes et al.⁽⁴⁰40 Pontes LB, Bacchi CE, Queiroga EM, Piha T, Miranda PA, Freire S, et al. EGFR mutation screening in non-small cell lung cancer: results from an access program in Brazil. J Clin Oncol. 32:15 Suppl:1526.⁾	3,371	25	NR	58	100	Clinical
Yen et al.⁽⁴⁵45 Yen C, Bitton RC, De Lima LGCA, Amadio AV, Takahashi TK, Marini AM, et al. Characterization of EGFR activating mutations in Brazilian patients with pulmonary adenocarcinoma. Proceedings of the 16th World Conference on Lung Cancer; 2015 Sep 6-9; Denver: USA. Aurora (USA): IASLC; 2015. P2.04-041.⁾	417	25	34	57	100	Clinical
Saito et al.⁽⁴⁶46 Saito A, Lima VCC, Dettino ALA, Macedo MP, Cunha IW, Dal Molin GZ, et al. Patterns of EGFR mutations in a cohort of 395 patients from a single institution in Brazil. Proceedings of the 16th World Conference on Lung Cancer; 2015 Sep 6-9; Denver: USA. Aurora (USA): IASLC; 2015. P2.04-033.⁾	395	26	27	51	91	Clinical
Domingues et al.⁽⁴³43 Domingues PM, Montella T, Zukin M, Baldotto C, Ferreira C. Epidemiology and clinical outcomes of epidermal growth factor receptor (EGFR) mutant patients at the Brazilian National Cancer Institute (INCA). Proceedings of the 16th World Conference on Lung Cancer; 2015 Sep 6-9; Denver: USA. Aurora (USA): IASLC; 2015. P2.04-032.⁾	288	27	26	56	95	Clinical
Bacchi et al.⁽⁴¹41 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 (Sao Paulo). 2012;67(5):419-24. https://doi.org/10.6061/clinics/2012(05)03 https://doi.org/10.6061/clinics/2012(05)... ⁾	207	30	54	58	82	Clinical
Gomes et al.⁽⁴⁸48 Gomes JR, Amarante MP, D'Alpino RD, Moreira RB, Souza TT, Lino AR, et al. Mutation profile in non-small cell lung cancer: analysis of a Brazilian population. J Clin Oncol. 2015; 33,15 Suppl:e19115.⁾	162	33	32	48	100	Clinical
Melo et al.⁽⁴²42 Melo AC, Inada HK, Barros M, Terra SB, Ligorio C, Sugawara E, et al. Non-small cell lung cancer genotyping in a Brazilian cohort. Proceedings of the 14th World Conference on Lung Cancer; 2011 Jul 3-7; Amsterdam: The Netherlands. Aurora (USA): IASLC; 2011. P2.123.⁾	157	22	15	47	68	Research
De Sa et al.⁽⁴⁴44 De Sa VK, Nascimento EC, Meireles SI, Capelozzi VL. Epidermal growth factor receptor mutations in primary and metastatic adenocarcinomas from a tertiary hospital in São Paulo, Brazil. Proceedings of the 16th World Conference on Lung Cancer; 2015 Sep 6-9; Denver: USA. Aurora (USA): IASLC; 2015. P1.18-002.⁾	100	28	NR	NR	100	Clinical

Author	Design	N	Study period	PS ≥ 2, %	Type of facility	mOS, months
Chemotherapy
Younes et al.⁽⁶⁸68 Younes RN, Pereira JR, Fares AL, Gross JL. Chemotherapy beyond first-line in stage IV metastatic non-small cell lung cancer. Rev Assoc Med Bras (1992). 2011;57(6):686-91. https://doi.org/10.1590/S0104-42302011000600017 https://doi.org/10.1590/S0104-4230201100... ⁾	Re	2,673	1990-2008	49^a	Private	8.0
Naime et al.⁽⁶⁹69 Naime FF, Younes RN, Kersten BG, Anelli A, Beato CA, Andrade RM, et al. Metastatic non-small cell lung cancer in Brazil: treatment heterogeneity in routine clinical practice. Clinics (Sao Paulo). 2007;62(4):397-404. https://doi.org/10.1590/S1807-59322007000400005 https://doi.org/10.1590/S1807-5932200700... ⁾	Re	564	1990-2003	47	Private	8.3
Araujo et al.⁽²³23 Araujo LH, Baldotto CS, Zukin M, Vieira FM, Victorino AP, Rocha VR, 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):1001-14. https://doi.org/10.1590/1809-4503201400040017 https://doi.org/10.1590/1809-45032014000... ⁾	Re	339	1998-2010	11	Private	12.2
Leite et al.⁽⁷⁵75 Leite GM, França MVS, Santana LM, Taveira MC, Zanardo G, Teles LT, et al. Descrição epidemiológica e clínica dos pacientes com câncer de pulmão tratados no Hospital Universitário de Brasília. Proceedings of the XVIII Congresso da Sociedade Brasileira de Oncologia Clínica. Brasília; 2013 Oct 23-26; São Paulo: Sociedade Brasileira de Oncologia Clínica. 606.⁾	Re	163	2006-2013	NA	Public	NA
Zukin et al.⁽⁷⁰70 Zukin M, Barrios CH, Pereira JR, Ribeiro Rde A, Beato CA, do Nascimento YN, 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):2849-53. https://doi.org/10.1200/JCO.2012.48.1911 https://doi.org/10.1200/JCO.2012.48.1911... ⁾	Pro	205	2008-2011	100	Public	5.3/9.3^b
Pereira et al.⁽⁷⁶76 Pereira AA, Martins SJ, Lessa RC, Pinto FA, Gagliato DM, Santos ES, et al. Comparison of bevacizumab versus pemetrexed in combination with platinum-based doublets in first-line treatment of advanced non-small cell lung cancer. J Clin Oncol, 2012. 30;15 Suppl:e18078.⁾	Re	82	2007-2011	NA	Private	26.4/16.4^c
Jardim et al.⁽⁷⁷77 Jardim DL, Gagliato Dde M, Ribeiro KB, Shimada AK, Katz A. Bevacizumab as first-line therapy in advanced non-small-cell lung cancer: a Brazilian center experience. Drugs R D. 2012;12(4):207-16. https://doi.org/10.2165/11636760-000000000-00000 https://doi.org/10.2165/11636760-0000000... ⁾	Re	56	2006-2011	7.2	Private	14.8
Pereira et al.⁽⁷¹71 Pereira JR, Martins SJ, Nikaedo SM, Ikari FK. Chemotherapy with cisplatin and vinorelbine for elderly patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC). BMC Cancer. 2004;4:69. https://doi.org/10.1186/1471-2407-4-69 https://doi.org/10.1186/1471-2407-4-69... ⁾	Pro	44	1996-1998	50^a	Public	7.5^d
EGFR TKI
Caires-Lima et al.⁽⁷²72 Caires-Lima R, et al. Erlotinib in metastatic pulmonary adenocarcinomas harbouring EGFR activating mutations in São Paulo--Brazil. Proceedings of the 15th World Conference on Lung Cancer; 2013 Oct 27-30; Sydney: Australia. Aurora (USA): IASLC; 2015. P2.11-009.⁾	Re	49	2010-2013	NA	Public	NR^e
Domingues et al.⁽⁴³43 Domingues PM, Montella T, Zukin M, Baldotto C, Ferreira C. Epidemiology and clinical outcomes of epidermal growth factor receptor (EGFR) mutant patients at the Brazilian National Cancer Institute (INCA). Proceedings of the 16th World Conference on Lung Cancer; 2015 Sep 6-9; Denver: USA. Aurora (USA): IASLC; 2015. P2.04-032.⁾	Re	32	2011-2014	NA	Public	62.9
Freitas et al.⁽⁷³73 Freitas HC, Saito AO, Santos FN, Cunha IW, Dettino ALA, Macedo MP, et al. Treatment and clinical evolution of a cohort of 105 EGFR mutant patients from a single institution. Proceedings of the 16th World Conference on Lung Cancer; 2015 Sep 6-9; Denver: USA. Aurora (USA): IASLC; 2015. P3.01-019.⁾	Re	61	2010-2014	NA	Private	36.3/NR^f

Current scenario

Action

Lung cancer is a leading cause of cancer death in Brazil.
Smoking-related lung cancer remains a major health burden.
Data on lung cancer diagnosis, staging, therapy, and outcomes are scarce.
There is a deficiency in radiation therapy machines to provide full treatment coverage in the country.
There is a significant delay in the approval of systemic therapies by local regulatory agencies.
Inequities in the access to diagnosis, therapy, and molecular testing between public and private health care systems are remarkable.
A lengthy clinical research approval process limits access to clinical trial opportunities.

Reinforce the role of tobacco control, and stimulate programs directed to the entire population, particularly teenagers.
Collect high-quality data on epidemiology and health economy aiming at describing diagnosis, staging, access to therapy, and outcomes.
Strengthen, bring together, and stimulate productive dialogue among medical societies, advocacy groups, government, pharmaceutical companies, and regulatory agencies.
Propose and implement programs to positively impact on prevention, diagnosis, and access to therapy.
Increase local funding for lung cancer prevention, diagnosis, and treatment research.
Stimulate the development of research units and participation in clinical trials.
Stimulate and implement international collaborations.

Sociedade Brasileira de Pneumologia e Tisiologia SCS Quadra 1, Bl. K salas 203/204, 70398-900 - Brasília - DF - Brasil, Fone/Fax: 0800 61 6218 ramal 211, (55 61)3245-1030/6218 ramal 211 - São Paulo - SP - Brazil
E-mail: jbp@sbpt.org.br

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[1] Correspondence to: Luiz H. Araujo. Instituto Nacional de Câncer (INCA), Rua André Cavalcanti, 37, 5º andar, prédio anexo, Centro, CEP 20231-050, Rio de Janeiro, RJ, Brasil. Tel.: 55 21 3207-6650. Fax: 55 21 3207-6566. E-mail: luiz.lima@inca.gov.br