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Current Trends in Biotechnology and Pharmacy Vol. 6 (2) 119-144 April 2012, ISSN 0973-8916 (Print), 2230-7303 (Online) Table 3. Relative likelihood of death from specific types of cancer among specific age groups in less developed countries compared to developed countries. Raw data taken from IARC (16) and comparisons were performed using the GLOBOCAN Online Analysis - Age- Specific Tables tools, using Population as Less Developed or More Developed; Sex as Both Sexes, or Male or Female for sex-specific cancers (breast, cervix uteri, corpus uteri, prostate and testis); Data Type as Incidence or Mortality; and Statistic as Numbers. Age groups Cancer type Total 0-14 15-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+ All cancers excl. non-melanoma skin cancer 1.37 3.07 2.45 1.89 1.71 1.59 1.56 1.65 1.60 1.60 1.36 Bladder 1.49 5.57 2.12 1.79 1.95 1.95 1.97 1.99 1.87 1.86 1.58 Brain, nervous system 1.05 2.06 1.40 1.05 1.08 1.03 0.99 1.06 1.05 1.10 1.16 Breast 1.42 2.95 1.86 1.81 1.85 1.96 1.88 2.04 1.91 1.71 1.49 Cervix uteri 1.24 3.25 1.78 1.41 1.41 1.30 1.23 1.28 1.29 1.40 1.18 Colorectum 0.32 4.13 1.80 1.50 1.50 1.41 1.35 1.43 1.43 1.50 1.47 Corpus uteri 1.25 - 2.04 2.21 1.92 1.84 1.86 1.94 1.77 1.75 1.65 Gallbladder 1.05 3.85 1.80 1.46 1.42 1.22 1.04 1.11 1.16 1.18 1.14 Hodgkin lymphoma 2.63 15.26 4.36 3.59 2.90 2.84 2.57 2.38 2.19 2.05 1.61 Kaposi sarcoma - - - - - - - - - - - Kidney 1.37 6.12 3.29 1.91 2.00 1.70 1.43 1.50 1.52 1.47 1.30 Larynx 1.33 0.68 2.10 1.94 1.46 1.27 1.25 1.36 1.24 1.49 1.48 Leukaemia 1.31 3.72 1.85 1.76 1.87 1.92 1.70 1.63 1.45 1.36 1.12 Lip, oral cavity 1.68 2.97 2.03 2.16 1.73 1.63 1.61 1.73 1.84 2.01 1.97 Liver 0.99 2.12 1.28 1.37 1.23 1.10 1.06 1.09 1.06 1.07 0.98 Lung 1.06 1.32 1.30 1.09 1.08 1.06 1.04 1.10 1.10 1.16 1.10 Melanoma of skin 2.61 5.16 4.32 3.42 3.05 3.18 2.63 2.71 2.31 2.69 2.20 Multiple myeloma 1.30 18.98 3.73 2.54 2.33 1.83 1.73 1.63 1.49 1.44 1.16 Nasopharynx 1.35 12.00 1.72 1.79 1.44 1.46 1.20 1.35 1.54 1.72 1.65 Non-Hodgkin lymphoma 1.73 7.41 3.25 3.12 2.95 2.58 2.46 2.28 1.98 1.85 1.44 Oesophagus 1.02 - 1.39 1.02 0.96 0.91 0.91 1.00 1.07 1.18 1.12 Other pharynx 1.60 5.96 3.95 2.80 2.00 1.65 1.51 1.49 1.40 1.67 1.39 Pancreas 0.95 6.17 1.13 0.92 1.01 0.99 0.96 0.97 0.97 1.00 0.97 Prostate 2.26 15.68 16.58 7.85 4.93 5.36 4.33 4.49 3.49 2.74 1.50 Stomach 1.18 2.41 1.18 1.08 1.08 1.09 1.14 1.28 1.24 1.35 1.32 Testis 4.53 5.86 6.31 4.89 3.55 3.42 2.42 2.34 1.22 1.20 1.39 Thyroid 2.27 59.44 8.03 7.82 6.07 4.28 4.79 4.07 3.13 2.56 1.67 Rebecca E. Smith and Juan Miguel Pascale 124
Current Trends in Biotechnology and Pharmacy Vol. 6 (2) 119-144 April 2012, ISSN 0973-8916 (Print), 2230-7303 (Online) which are well-established will be reviewed and their value to low- and middle-income countries discussed in the following section. Three cancers of importance in the developing world will be considered: lung, colorectal and breast cancer. These cancers share some similarity in the biochemical dysfunctions at their foundations, which will assist in rationalizing technical resources for genetic testing and analysis in developing world laboratories. Gastrointestinal stromal tumors, of special interest in Panama, will also be reviewed. Relatively simple genotyping tests which enhance risk assessment, prognosis or pharmaceutical choice in the management of these cancers will be referenced and their implementation in low- and middle-income countries will be evaluated. It should be noted that well-established options for personalized medicine for those cancers with higher relative morbidity and mortality in the developing world, such as lymphoma, multiple myeloma and cancers of the thyroid, prostate and testis are lacking at this time. Nonetheless, with the recent and complete sequencing of prostate cancers reported by Berger et al. (17), there are new insights into the molecular mechanisms giving rise to this group of cancers (18), the potential of targeting these pathways with new therapeutics (19) and of using their components as prognostic markers of clinical outcome, important in identifying men with aggressive forms of the disease who will benefit most from therapy (18, 20). The third criterion is beyond the scope of this review, but rationalizes applications of personalized medicine that are sustainably affordable for developing world economies. The genetic tests used in personalized medicine and the chemo- and biologic therapies indicated by the results of these tests are expensive. Tests and therapies will either be strictly limited for specific cancers or patient groups, or innovative models of funding for personalized medicine will need to be developed. Lung and bronchial cancer : Lung cancers are the leading cause of cancer death worldwide Developing world personalized cancer medicine 125 (Table 3; 16), with five-year survival rates of only 10% in most countries (21), a consequence of the advanced stage at which many are diagnosed (22). There is little difference in the likelihood of survival between patients in developed and developing nations (Table 3). Lung cancers are classified morphologically according to the 2004 WHO scheme which identifies four major types: small-cell carcinoma, and the non-small cell carcinomas (NSCLCs), which are classified further into squamous cell carcinoma, large-cell carcinoma and adenocarcinoma, the predominant histological type in women and patients of Asian descent (21). NSCLCs comprise about 80% of lung cancers and patient age, gender and smoking history influence tumor histology (21, 23). Molecular classification confirms morphological classification and describes subtypes, especially for adenocarcinomas, although heterogeneity among the four major groups exists and cellular transitions between subtypes are observed, making absolute classification difficult (15, 24). There are two well-defined applications of personalized medicine in managing lung cancer. The first application is genetic typing of EGFR (also known as Her1 and erb-b1) in lung cancers to identify patients who will respond to tyrosine kinase inhibitors (TKIs), which act on EGFR, and which are demonstrated to prolong disease-free survival for some patients with advanced lung cancer. EGFR is a cell membrane receptor responsible for relaying, via phosphorylation cascades, gene activation signals which mobilize cells, progress cell cycle progression and angiogenesis. Several cancer types, including 43 to 83% of NSCLCs (25), show somatic EGFR mutations which result in constitutive activation of the receptor, downstream phosphorylation events and uninhibited cell proliferation as a consequence. Activating EGFR mutations are observed in about 10% of all lung cancers. More than 18 mutations of phenotypic significance are found
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6th Annual Convention of Associatio
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