Dr. Thiago Bueno was announced as the winner during the 2019 Best of ASCO® Annual Meeting, promoted by LACOG on June 14th and 15th, at the Transamerica Hotel in the city of São Paulo, state of São Paulo.

Thiago Bueno de Oliveira is a PhD in Oncology by the Antônio Prudente Foundation; Head Physician at the Department of Clinic Oncology; Leader of the Clinic Oncology at the Referral Center for Head and Neck-Centro de Referência em Cabeça e Pescoço at the AC Camargo Cancer Center; and Member of the Brazilian Group for Head and Neck Cancer.

Check the report of Dr. Thiago regarding his research:

My study, which has been already concluded and was my PhD thesis; it addressed the assessment of Circulating Tumor Cells (CTCs) analyzed in blood samples collected before and after the treatment of patients bearing locally advanced head and neck cancer.

The study included, on a prospective basis, 83 patients bearing epidermioid carcinoma of oral cavity, oropharynx, pharynx and hypopharynx, with locally advanced disease and candidates to a curative treatment. The study detedted CTCs in 94{46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391} of patients before the onset of treatment and the number of CTCs was significantilly correlated with the survival and response to treatment. For every increment of 1 CTC/mL before the treatment there was a sigfnificant increase of 18{46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391} for death risk, 16{46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391} for relapse risk or progression of disease and a 26{46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391} reduction in the probability of a complete answer to the treatment. Additionally, the study addressed the expression of biomarkers at the CTCs, some of them bearing prognostic and predictive potential. The counting of CTCs before the treatment has also proven to be a potential predictor of benefit for using chemotherapy before the radiotherapy (induction). High counting of CTCs after the treatment and a non-favorable kinetic (significant increases of CTCs considering the counting before and after the treatment) were also correlated to the worst survival rate.

The importance of such results consists in identifying patients with increased risk of death or disease relapse, for potential intensification of treatments to improve those outcomes. Consequently, the research of CTCs and biomarkers before and after the treatment enables the planning of individual treatments, aiming at the maximization of probabilities of cure and minimization of treatment-related sequels, thus improving the survival with quality of life.

Here is a technical summary of the study and its results:

Prognostic impact of circulating tumoral cells and their potential predicing role for response to treatment of locally advanced epidermioid head and neck carcinoma. São Paulo; 2019. [Tese de Doutorado-Fundação Antônio Prudente].

Introduction:
The prognostic role of circulating tumor cells (CTCs) in locally advanced head and neck cancer has not been determined to date due to conflicting results in previous studies, most of them using cytokeratine-dependant tecniques for identification and couting of CTCs. The primary objective of such study consists in determing the maximum rate of detection using the ISET method, the prognostic role and the potential predictive role of CTCs in locally advanced head and neck cancer.

Methodology:
Prospective analysis of blood samples of patients bearing non-metastastic, stages III/IV locally advanced head and neck cancer (CCPLA) for CTCs before and after the treatment, in two scenarios: initial curative surgery and radiotherapy (RT) and candidates to non-surgical strategies (unresectable or preservation of organ) with RT simultaneous to chemotherapy (QT) or cetuximabe, preceded or not by induction-chemotherapy (QTI).

Results:
A total of 83 patients were included, while the baseline detection rate of CTCs was 94{46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391} (78/83). The CTC couting was significantly correlated with survival, with relative increase of 18{46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391} for risk of death (HR=1,18; CI95{46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391}: 1,06-1,31; p<0,001), 16{46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391} for risk of pogression (HR=1,16; CI95{46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391}: 1,04-1,28; p=0,004) and a 26{46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391} reduction for the probability of complete answer to the tratamento (OR=0.74; CI95{46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391}: 0.58-0.95; p=0.022) for every increase of one CTC. Patients with CTCs < 6,5/mL presented an estimate global survival (SG) in two years corresponding to 85,6{46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391} x 22,9{46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391} for CTCs ≥ 6.5/mL (HR=0,18; CI95{46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391}: 0,06-0,49; P<0,0001), while patients with CTCs ≤ 3.8/mL presented an estimate of free-progression survival (SLP) in two years corresponding to 71,8{46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391} x 37{46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391} for CTCs > 3.8/mL (HR=0,32; CI95{46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391}:0,15-0,67; p=0,001). After the treatment, high countings of e CTCs (cut point 6,6/mL) were significantly correlated with a worse global survival (HR=0,12; CI95{46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391}: 0,06-0,40; p<0,001) and SLP survival (HR=0,19; CI95{46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391}: 0,06-0,59; p=0,001). In the subgroup of non-surgical treatment (n=67), the presence of microemboli (ME) was significantly correlated with a worse SG (HR=3,01; CI95{46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391}: 1,06-8,52; p=0,020) and SLP (HR=3,84; CI95{46cf1a6c7461ff493d31bdca70d45967bd1ce7048f85e123712b94daa5b61391}: 1,62-9,11; p<0,001). In such subgroup, high CTCs (>3,8/mL) and ME were identified as potential predictors for the benefit of QTI. The expression of MRP-7 in baseline ME was correlated to a worse 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), while the expression of TFGβRI at CTCs after the treatment was correlated to a worse SG (HR=3,60; 1,03-12,59; p=0,032). The expression of β-tubulin III at CTCs was correlated to a worse SG in patients receiving QTI (p=0.012). Patients with favorable kinetics of CTCs presented better SG (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:
The counting of baseline CTCs was correlated to survival and response to treatment and, in conjunction with ME, are potential predictive factors for the benefit of QTI. High countings of CTCs after the treatment and non-favobrable kinetics were also prognostic. The expression of biomarkers in CTCs and ME has a prognostic and predictive in locally advanced head and neck cancer (CCPLA).