INOR. 50 Aniversary August 13 th th Cutaneous Lymphoma Symposium. Mycosis Fungoides/Sezary Syndrome in Cuba. Epidemiology, Therapy and Outcomes

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1 6th Cutaneous Lymphoma Symposium Mycosis Fungoides/Sezary Syndrome in Cuba. Epidemiology, Therapy and Outcomes INOR 50 Aniversary August 13 th 2016 Elías A. Gracia Medina MD Head of Medical Oncology Department National Institute of Oncology and Radiobiology

2 Cuba an island in the Caribbean Sea Area Km 2 Cuban population exceeds the 11.2 million inhabitants at the end of Health care services. Universal Covering, accessibility, free of charge Cancer Control Program since

3 Population-Based Cancer Registry 1964 was created the National Cancer Registry Collecting data on every person with cancer in Cuba. demography, tumour features, treatment evaluate the impact of the cancer control actions (incidence, prevalence, survival, mortality). identify possible cancer causes in a population

4 Cancer Burden in Cuba

5 Mortality by main cause of death. Cuba Source: National Statistic Office. MINSAP

6 Disability-Adjusted Life Years per 1000 inhabitants from 1 to 74 years old. Cuba Source: National Statistic Office. MINSAP

7 Cancer Mortality all sites by sex. Cuba , , ASR: age standardize rates to world population x Fuente: Series tipificadas de mortalidad. DNE. MINSAP

8 Cancer mortality by sex and main sites. Cuba, 2014 number of cases, crude and adjusted rates. MALE FEMALE Site no CR ASR Site no TC TAM Lung Lung Prostate Breast Colon Colon Larynx Cervix Esophagus Pancreas Lip-oral and pharynx Uterine corpus Stomach Liver and biliary track Urinary Bladder Stomach Pancreas Brain Liver and biliary track Ovary All sites All sites Anuario estadístico MINSAP

9 Cancer incidence by sex Cuba Note: Prognostic: segmented lineal regresion Source: National Cancer Registry

10 Cuba is facing an aging population Expectancy of life has reached years for male and 81.2 for female. In 2015, the 19.3 % of the total population are people 60 years and more. It s shall increase to 29% by 2030

11 Cancer burden as a health problem Relationship between the increment of population and cancer cases in group of 60 year-old and more.

12 Cancer incidence by sex and main sites. Cuba 2012 number of cases, crude and adjusted rates. MALE FEMALE No CR ASR No. CR ASR Skin Skin Prostate Breast Lung Lung Lip-Oral cavity-farynx Cervix Larynx Colon Colon Uterine corpus Urinary Bladder Ovary Esophagus Lymphomas Lymphomas Non Hodgkin Non Hodgkin Hodgkin Hodgkin Other non specified Other non specified Thyroid Stomach Pancreas All sites All sites Source. Anuario estadístico MINSAP

13 Non Hodgkin s Lymphomas in Cuba

14 Non Hodgkin s lymphoma Incidence. Cuba Source: National Cancer Registry of Cuba

15 Number of new cases of non Hodgkin s lymphoma by years. Cuba

16 Geographic distribution of non Hodgkin s Lymphomas incidence in Cuba The distribution is not homogeneous across the country. Source. National Cancer Registry

17 Non Hodgkin s Lymphoma distribution by cell subtype. Cuba (n=5081) Source. National Cancer Registry

18 Improvement of diagnostic of Non Hodgkin s Lymphoma 2004 Introduction of CD20 immunohistochemestry analysis 2007 Introduction of fully lymphoma characterization by immunophenotype analysis 2014 Centralized diagnostic of lymphoma in 2 Institution. INOR and HHA. Modified from Meyerson HJ. Et al. Mod Pathol.2013;26:32 43

19 Population-based survival of non Hodgkin s lymphomas Number of patients eligible for analysis and relative survival, for adults (15-99 years) diagnosed with non Hodgkin s lymphoma in Cuba during Period Total of cases Excluded (DCO) Included Relative Survival Median (years) (4.6%) (8.3%)

20 Relative survival for non Hodgkin s Lymphoma has been improved in the last decade, this results are still below of those reported in North America and Europe. Comparison of Cuba 5-year relative survival (95% IC) of HL and NHL with the relative survival reported by SEER and EUROCARE study Cuba SEER 1 [ ] EUROCARE -4 1 [ ] No Hodgkin s Lymphoma 52.5 [48-55%] [ %] [ %] 1 Verdecchia A. Lancet Oncology 2007;

21 Mycosis Fungoides in Cuba

22 T-Cell Lymphomas Reported to the National Cancer Registry. Cuba (n=198)

23 New cases of MF/SS reported to the National Cancer Registry by year of diagnosis. Cuba (n=118) *preliminary data

24 Main characteristic of Mycosis Fungoides cases reported to the National Cancer Registry of Cuba (n=118) Characteristic N % Age (median, range) 64 years (20-91) Sex Race 60 years < 60 years Male Female Caucasian Afro Mixed Time between first symptoms and diagnosis (median, Range) 9.7 month (3-50)

25 MF/SS. Clinical stage at diagnostic. Cases reported to the Nacional Cancer Registry of Cuba TNM N % T T T T3 8 6,8 T Unknown N Nx N N N N Unknown M N % Mx M M Unknown Stage N % Stage I Stage II Stage III Stage IV Unknonw

26 Available treatment in Cuba for Mycosis Fungoides Topic treatment (steroid) Immunotherapy (interferon alpha 2B) Radiotherapy Chemotherapy Combination of the above therapies

27 Firts line therapy Mycosis Fungoide. Cuba Type of treatment No % Chemotherapy (alkylant-based) Immunotherapy Topic steroids Radiotherapy + Chemotherapy Chemotherapy + Immunotherapy Chemotherapy + topic therapy Unknown Total

28 Overall Survival. MF/SS Patients reported to the National Cancer Registry (n=118) Median IC 95% 1 year 3 year 5 year NR % 81.4% 75.3%

29 Overall Survival by Clinical Stage. MF/SS patients reported to the National Cancer Registry (n=96) P=0.013 Stage I Stage II Stage III Stage IV

30 Summary Non Hodgkin s lymphomas are included among the tens main cancer causes in Cuba The incidence of lymphomas has been increased in the last years T-Cell lymphomas represent the 4% of all new cases of NHL reported to the NCR MF/SS is a very rare subtype of lymphoma in Cuba, with an average of 16 new cases per years. Nevertheless MF is the most frequent TCL reported. Most of the cases are treated with chemotherapy agents and topic therapy Five years Population based Survival is 75.3%

31 MSc Yaima Galan Alvarez Head of National Cancer Registry of Cuba

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