Dr. Thiago Bueno was announced the winner during the Best of ASCO® Annual Meeting, organized by LACOG on June 14-15, 2019 at the Hotel Transamérica in São Paulo/SP. Thiago Bueno de Oliveira has a PhD in Oncology from the Antônio Prudente Foundation; Senior Physician in the Department of Clinical Oncology; Leader of Clinical Oncology at the Head and Neck Reference Center of the AC Camargo Cancer Center; and Member of the Brazilian Head and Neck Cancer Group.

Check out Dr. Thiago's report about his research:My work, which has already been completed and was my doctoral thesis, involves the evaluation of circulating tumor cells (CTCs) analyzed in blood samples, before and after treatment in patients with locally advanced head and neck cancer. 83 patients with epidermoid carcinoma of the oral cavity, oropharynx, larynx and hypopharynx, with locally advanced disease and candidates for treatment with curative intent were included prospectively. CTCs were detected in 94 {46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391} of the patients, and the number of CTCs was significantly correlated with survival and response to treatment. For each increase of 1 CTC/ml before treatment, there was a significant increase of 18 {46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391}, 16 {46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391} in the risk of disease recurrence or progression, and a reduction of 26 {46cf1cf1 a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391} in the chance of a complete response to treatment. In addition, the expression of biomarkers in CTCs, some of them with prognostic and predictive potential, was studied. Counting CTCs before treatment was also shown to be a potential predictor of benefit from the use of chemotherapy before (induction) radiation therapy. High CTC counts after treatment and unfavorable kinetics (significant increases in CTCs considering the values before and after treatment) were also correlated with worse survival. The relevance of the results lies in the possibility of identifying patients with a higher risk of death or disease recurrence for potential intensification of treatment to improve these outcomes. Thus, with the search for CTCs and biomarkers before and after treatment, it is possible to personalize the treatment employed to maximize the chances of cure and minimize the sequelae of the treatment, improving survival with quality of life. Below is a technical summary of the work and its results:Prognostic impact of circulating tumor cells and potential predictive role of treatment response in locally advanced epidermoid carcinoma of the head and neck. São Paulo; 2019. [Doctoral Thesis - Antônio Prudente Foundation].Introduction:The prognostic role of circulating tumor cells (CTCs) in locally advanced head and neck cancer (CCPLA) has not yet been determined, due to conflicting results in previous studies, most using cytokeratin-dependent techniques for the identification and counting of CTCs. The primary objective of this study is to determine the detection rate using the ISET method, the prognostic role and potential predictive role of CTCs in CCPLA.Methods:Prospectively, blood samples from patients with non-metastatic CCPLA, stages III/IV, were analyzed for CTCs before and after treatment, in two scenarios: initial curative surgery and adjuvant radiation therapy (RT) and candidates for non-surgical strategies (unresectable or organ preservation) with RT concomitant with chemotherapy (QT) or cetuximab, whether or not preceded by induction QT (QTI).Results:83 patients and the detection rate of CTCs were included. Baseline It was 94 {46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391} (78/83). The CTC count was significantly correlated with survival, with a relative increase of 18 {46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391} (HR=1.18; CI95 {46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391}: 1.06-1.31; p<0.001), 16 {46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391} at risk of progression (HR=1.16; CI95 {46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391}: 1.04-1.28; p=0.004) and a reduction of 26 {46cf1a6c7461493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391} na chance of a complete response to treatment (OR=0.74; CI95 {46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391}: 0.58-0.95; p=0.022) for each increase in a CTC. Patients with CTCs < 6.5/mL had a two-year overall survival (OS) estimate of 85.6 {46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391} x 22.9 {46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e12b94daa5b61391} for CTCs ≥ 6.5/mL (HR=0.18; 95 {46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391}: 0.06-0.49; P<0.0001) and patients with CTCs ≤ 3.8/mL an estimate of progression-free survival (PFS) at two years of 71.8 {46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391} x 37 {46cf1a6c7461ff493d31bdca70d45967bd1 ce7048f85e123712b94daa5b61391} for CTCs > 3.8/mL (HR=0.32; CI95 {46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391} :0.15-0.67; p=0.001). After treatment, high CTC counts (cutoff 6.6/mL) were significantly correlated with worse SG (HR=0.12; CI95 {46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391}: 0.06-0.40; p<0.001) and SLP (HR=0.19; CI95 {46cf1a6c7461ff493d31bdca70d45967bd1ce7048f31bdca70967bd1ce7085f123712b94daa5b61391}: 0.06-0.59; p=0.001). In the non-surgical treatment subgroup (n=67), the presence of microemboli (ME) was significantly correlated with worse OS (HR=3.01; CI95 {46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391}: 1.06-8.52; p=0.020) and SLP (HR=3.84; CI95 {46cf1a6c7461ffce493d31bdca70d9671bdca70d9671bdca70d9671bdca70d967bdca70d967bdca70d967bdca70d967bdca70d967bdca70d967bdca70d967bdca70d967bdca70d967bdca70d967bdca70d967bdca70d967bdca70d967bdca70d967bdca70d967bdca70d967bdca70d967bdca70d967bdca70d9671bdca707048f85e123712b94daa5b61391}: 1.62-9.11; p<0.001). In this subgroup, high CTCs (>3.8/mL) and ME were identified as potential predictors of the QTI benefit. MRP-7 expression in ME Baseline was related to the worst SG (HR=3.49; CI95 {46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391}: 1.01-12.04; p=0.047) and SLP (HR=3.62; CI95 {46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391}: 1.08-12.13; p=0.037) and expression of TFGβRI in CTCs after treatment for the worst OS (HR=3.60; 1.03-12.59; p=0.032). Expression of beta-tubulin III in CTCs was associated with worse OS in patients receiving QTI (p=0.012). Patients with favorable CTC kinetics had better OS (HR=0.22; IC95 {46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391}: 0.07-0.67; p=0.004) and SLP (HR=0.33; CI95 {46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391}: 0.13-0.84; p=0.015).Conclusions:Count of CTCs Baseline were correlated with survival and response to treatment and, together with ME, are potential predictors of the benefit of QTI. High CTC counts after treatment and unfavorable kinetics were also prognostic. Biomarker expression in CTCs and ME plays a prognostic and predictive role in CCPLA.