Page 72 - Genomic Medicine in Emerging Economies

Oncogenetics Unit in the Instituto De Cancerología Las Américas 61

Several laboratories in Colombia are currently offering genetic tests that do
not require very expensive equipment and infrastructure to guide personal-
ized medicine in cancer patients, for example, by using RT-PCR or Sanger
sequencing to study specific mutations or expression patterns of genes in
tumors that confer resistance or sensitivity to certain chemotherapeutic drugs
or targeted therapies. Cardona et al. (2011) reported the results of mutation
screening of the Epidermal Growth Factor Receptor (EGFR) and Kirsten RAt
sarcoma virus (KRAS) genes in 1939 patients with metastatic non-small-
cell lung cancer (NSCLC) patients. They found a positivity rate for EGFR
mutations of 24.7% (479 pts.) and for KRAS mutations of 12.9% (116 pts.).
In another study, they found an EGFR mutation rate of 25.5% in NSCLC
patients, which greatly differed from the mutation rates found in other Latin
American countries, such as Peru (51.1%) or Argentina population (14.4%)
(Arrieta et al., 2015). Another report on personalized therapy for metastatic
colorectal cancer (mCRC ) in Colombia included 202 Colombian patients
with mCRC who were treated at the Fundación Santa Fe de Bogotá (FSFB)
from March 2009 to March 2013 (Vargas et al., 2014). Overall survival (OS)
was analyzed according to KRAS, v-Raf murine sarcoma viral oncogene
homolog B (BRAF) and Phosphatidylinositol-4,5-bisphosphate 3-kinase
(PI3K) mutational profile. They found that 32.7% of the tumors harbored a
KRAS mutation, 10.9% harbored a PIK3CA mutation, and 6.4% harbored a
BRAF mutation. OS for the BRAF wild-type population was 30 months (95%
CI 20.1–41.0), whereas those carrying the BRAF mutation lived 13 months
(95% CI 9.2–17.0; P = .09). They concluded that routine genotyping is neces-
sary to improve patient selection for targeted treatments.
With the rapid evolution in sequencing techniques and the constant decrease
in the price of molecular/genetic testing technologies, hopefully these services
will become more accessible to everyone.

ONCOGENETICS UNIT IN THE INSTITUTO DE
CANCEROLOGÍA LAS AMÉRICAS

The Instituto de Cancerología SA (IDC), an IPS, is a comprehensive cancer cen-
ter that serves a population of 4 million people of the Medellin metropolitan
area and is one of the main referral institutions from other regions of Antio-
quia and the rest of country. The IDC has a multidisciplinary team composed
of oncologists, surgeons, radiotherapists, radiologists, pathologists, palliative
care doctors, nurses, a geneticist, epidemiologists, and a psychologist, who pro-
vide integrated cancer care. One of the main focal points of the IDC is breast
cancer: 800–1000 patients are treated in the IDC every year. The IDC has been
a sister institution of MD Anderson since 2011 and actively participates in the
Global Academic Program run by the MD Anderson.