The benefit of palliative chemotherapy (PC) in patients with advanced solid tumors and poor performance status (ECOG-PS) has not been prospectively validated, which makes treatment decision challenging. We aimed to evaluate the overall survival, factors associated with early mortality, and adoption of additional procedures in hospitalized patients with advanced cancer and poor ECOG-PS treated with PC. We analyzed a retrospective cohort of patients with advanced cancer treated with PC during hospitalization at an academic cancer center in Brazil from 2014 to 2016. Eligibility criteria included: ECOG-PS 3–4 and start of first-line PC; or ECOG-PS ≥ 2 and start of second or subsequent lines. Primary endpoint was 30-day survival from start of PC. Kaplan-Meier method was used for survival estimates and Cox regression for factors associated with 30-day mortality. Two hundred twenty-eight patients were eligible. 21.9, 66.7 and 11.4% of patients had ECOG-PS 2, 3 and 4, respectively. 49.6% had gastrointestinal tumors. Median follow-up was 49 days (range 1–507). 98.2% of patients had died, 32% during the index hospitalization. The 30-day and 60-day survival rates were 55.7 and 38.5%, respectively. 30% of patients were admitted to the intensive care unit. In a multivariable analysis, ECOG-PS 3/4 (HR 2.01; P = 0.016), hypercalcemia (HR 2.19; P = 0.005), and elevated bilirubin (HR 3.17; P < 0.001) were significantly associated with 30-day mortality. Patients with advanced cancer and poor ECOG-PS had short survival after treatment with inpatient PC. Inpatient PC was associated with aggressive end-of-life care. Prognostic markers such as ECOG-PS, hypercalcemia and elevated bilirubin can contribute to the decision-making process for these patients.

It is encouraging to witness the recent price reduction and expanded access to next generation sequencing platforms, the increasing number of investments and publications on new targets and respective targeted drugs, as well as the worldwide excitement with anti-cancer personalised therapies. This editorial aims to highlight the limitations regarding the small proportion of solid cancers potentially eligible for the use of molecular-based targeted drugs until now. It also covers the expected clinical benefits in refractory patients treated by matched therapies, and detailed cost-effectiveness analysis of the use of DNA sequencing analysis oncology practice in an academic and large-scale community.

High-grade neuroendocrine carcinoma of the urinary bladder comprehends small-cell and large-cell variants. It is a rare and aggressive neoplasm, mostly diagnosed in advanced stages. It is more frequently encountered among Caucasian men in the sixth decade of life. Urinary symptoms are the most common clinical presentation. Diagnosis is generally not troublesome once the lesions are easily detectable by imaging exams and cystoscopy. This neoplasia is associated with tobacco smoking, and is frequently associated with other carcinomatous components such as urothelial carcinoma, adenocarcinoma, and sarcomatoid carcinoma. The authors report a case of an apparently healthy female patient who presented cervical lymph node enlargement not accompanied by systemic symptoms. The supraclavicular lymph node biopsy revealed metastatic small cell carcinoma. The computed tomography scan showed a bladder wall nodular thickening, enlarged lymph nodes along the iliac, periaortic, mediastinal, cervical and supraclavicular chains, as well as an insufflating lytic bone lesion in the right iliac wing. The positron emission tomography-fluorodeoxyglucose (PET-FDG) added to these findings, the presence of a paraesophageal lymph node, lymphadenomegaly in the gluteal region and a vertebral lytic lesion in T10. Resected specimen of the bladder tumor revealed a high-grade neuroendocrine carcinoma with small-cell and large-cell features.

PURPOSE: Reported treatment outcomes for patients with advanced germ cell tumors (aGCT) are based mainly on series from developed nations. Data from low- and middle-income countries are underrepresented. MATERIAL AND METHODS: From 2000 to 2015, a retrospective analysis identified 300 patients with aGCT treated at our institution. Kaplan-Meier methods were used for analysis of progression-free survival (PFS) and overall survival (OS) according to the International Germ Cell Consensus Classification Group (IGCCCG). RESULTS: Patients’ median age was 28 years. According to the IGCCCG, 57% had good-, 18.3% intermediate-, and 24.7% poor-risk disease. Median α-fetoprotein levels were 2.9, 243, and 3,998 ng/mL, and those of human chorionic gonadotropin were 0.4, 113, and 301.5 mUI/mL in IGCCCG good-, intermediate-, and poor-risk groups, respectively. At a median 46 months of follow-up, 93 PFS events and 45 deaths had occurred and estimated 5-year PFS and OS were 69% and 85%, respectively, including 83% and 95.3% in good-risk, 70.9% and 83.6% in intermediate-risk, and 35.1% and 62.2% in poor-risk patients, respectively. In multivariable analysis, Eastern Cooperative Oncology Group performance status ≥ 2 was a significant independent prognostic factor with a hazard ratio of 2.58 (95% CI, 1.55 to 4.29; P < .001) and 6.20 (95% CI, 2.97 to 12.92; P < .001) for PFS and OS, respectively. CONCLUSION: Brazilian patients with aGCT in this cohort had similar outcomes as patients in the IGCCCG database. In comparison with contemporary series, patients with intermediate- and poor-risk aGCT had slightly inferior PFS and OS, possibly due to a high percentage of patients with poor performance status and less use of high-dose chemotherapy.

10552 Background: The rising incidence of early-onset (EO) cancers (< 45 years) since the 1990s presents a global public health challenge. In Brazil, Hospital-Based Cancer Registries (HCR) provide essential data for understanding cancer epidemiology, encompassing diagnosis, treatment, and outcomes. This study analyzes temporal trends in EO cancer incidence rates (IR) and clinical data in Brazil from 2000 to 2019. Methods: A retrospective cohort study was conducted using data from the Brazilian HCR system (SIS-RHC). Individuals aged 19–44 years, diagnosed with malignant neoplasms (ICD-10) and treated within Brazil’s oncology network, were included. Temporal trends in cancer incidence (2000–2019) were evaluated using the Mann-Kendall test, and bivariate analyses explored associations between demographic and clinical variables. Results: A total of 701,115 individuals were included (mean age: 35 years, SD: 6.62); the cohort was predominantly female (71.9%), non-white (54%), with basic education (49%), and residing in the southeast region (44%). Family history of cancer was reported by 47%, alcohol use by 28%, and smoking by 29%. The Unified Health System (SUS) referred to 79% of cases. Breast (21%) and cervical (21%) cancers were the most prevalent malignancies, followed by non-melanoma skin cancers (8.8%) and thyroid cancer (7.3%). Colon cancer ranked seventh (2.8%). Most cases were diagnosed at localized stages (51.7%), with 28.3% regional and 19.8% metastatic. Localized diagnoses increased significantly over time. Sex differences were observed across age groups and cancer stages (p < 0.001). Annual cancer cases rose significantly from 93,714 cases (2000 to 2004) to 222,301 cases (2015 to 2019) (p < 0.001). Incidence rates (IR) increased with age and over time, rising from 5.65 (ages 19–24) and 46.80 (ages 40–44) in 2000 to 12.28 and 77.11 in 2019. Peaks in IR were observed in 2014 and 2016, reaching 17.41 (ages 19–24) and 111.42 (ages 40–44). Overall, reported cases increased by 219% during the study period. Conclusions: The incidence of EO cancers in Brazil rose by 219% between 2000 and 2019, with breast cancer as the leading malignancy. These findings emphasize the growing cancer burden among younger populations and the need for enhanced cancer registries to guide targeted EO interventions. Future population-based studies are critical to validate and expand upon these results.

The rising global incidence of early-onset cancers (EOCs)—defined as malignancies diagnosed before age 50—represents an urgent and complex publ