An observational study in Non-Small Cell Lung Cancer, Dysgeusia and Taste Disorders, sponsored by Instituto Nacional de Cancerologia de Mexico. Completed at 1 site in Mexico. Open to participants aged 18 Years to 90 Years. Per ClinicalTrials.gov, last updated 2024-02-28.
Sponsored by Instituto Nacional de Cancerologia de Mexico · Observational
One of the most widely used treatments for non-small cell lung cancer (NSCLC) is the combination of paclitaxel-cisplatin. These drugs may contribute to taste alterations like dysgeusia. Which alters the feeding of cancer patients, contributing to the anorexia, weight loss and malnutrition, which leads to a prognostic impact in a lower patient response to chemotherapy, radiotherapy and surgical treatment as well as increased toxic effects, impacting treatment discontinuation and therefore, morbidity and survival of patients. The objective of this study is to describe the threshold of perception and recognition of basic tastes in patients with NSCLC before treatment with platin and paclitaxel-based chemotherapy and after the second cycle, and analyze the effect in the developement of dysgeusia, as well as the association between these and the nutritional status and quality of life.
Lung cancer is the leading cause of death from malignancies in our country. It was recently reported to induce 11.5% of cancer deaths in Mexico, with a rate of 6.5 per 100 000 people.
Non-Small Cell Lung Cancer (NSCLC) accounts for 80% of all lung cancer cases. Less than 20% has resectable disease and in the National Cancer Institute of Mexico exclusively less than 2%, representing chemotherapy the standard of care in these patients.
One of the most widely used drug combinations is paclitaxel-cisplatin. It has been reported a prevalence of malnutrition in 60 to 79% in this type of cancer, being the major contributor to morbidity and mortality. The etiology resides both in the systemic effects of the tumor and toxic effects of treatment as low levels hematologic, nausea, vomiting, mucositis, anorexia, dysgeusia, among others.
Weight loss has a strong impact on the response to chemotherapy, radiotherapy and surgery, as well as increased toxic effects impacting the discontinuation of treatment and is considered an independent predictor of survival for most patients with NSCLC. Is estimated that over 20% of cancer patients the cause of death are inanition effects.
Among the most frequent symptoms in advanced unresectable cancer or its treatment that may affect food intake and hence nutritional status, are the early satiety and dysgeusia (61% and 46% respectively). As are difficult to change early satiety, dysgeusia is a field for selecting strategies in its management.
The dysgeusia is defined as a change in taste that can manifest as a distortion of taste, lack of taste (ageusia), decreased sensitivity of perception (hypogeusia) or increased sensitivity to some or all flavors (hypergeusia).
The development of dysgeusia have clinical significance in the etiology of cancer anorexia because it can affect eating habits and contribute to weight loss or malnutrition and consequently affect the quality of life.
The chemotherapy may contribute to dysgeusia. It has reported a prevalence of 56.3% of Dysgeusia in cancer patients under this type of treatment. As well, zinc deficiency has been associated with the hypogeusia, this metal to be involved at various levels in the physiology of the role of taste at various levels of cell several organization.
Several studies have linked consumption dysgeusia with energy and macronutrients, weight loss, lack of appetite and early satiety.
The type of tumor, stage, chemotherapy regimen and serum zinc levels are associated with dysgeusia, but the exact mechanism underlining these disturbances are not known at totality. No known if chemotherapy or before this is presented dysgeusia. In addition there are few studies in this area and with methodological weaknesses, among which include heterogeneous population (patients with a diagnosis of malignancy of breast, lung, prostate, multiple myeloma and lymphoma), different patterns of treatment(different chemotherapy drugs, radiotherapy schedules and combination of both forms of measurement of dysgeusia, besides the absence of dysgeusia baseline evaluation before chemotherapy to establish a causal association between chemotherapy and taste alteration.
Also, is unknown if dysgeusia impact on body composition determined by bioelectrical impedance, phase angle in and consumption of micronutrients (iron, sodium, zinc, B6, B12).
That's why is necessary to continue studying this phenomenon to develop a better understanding of the nature, frequency, severity and duration of dysgeusia in patients with advanced lung cancer, the role that zinc exerts in its development and its impact on consumption food, anthropometric parameters and quality of life in such patients before and after chemotherapy in the same regimen of chemotherapy.
7,620 studies on the registry are indexed under Carcinoma, Non-Small-Cell Lung; 1,838 are open to participants now.
This study's enrollment of 40 is below the median of 160 across 1,148 observational studies indexed under Carcinoma, Non-Small-Cell Lung.
Browse Carcinoma, Non-Small-Cell Lung studies →Instituto Nacional de Cancerologia de Mexico is the lead sponsor of 41 studies on the registry; 13 are open to participants now.
Counted across the registry records on this site, refreshed daily.
Outpatients from National Cancer Institute with stage III and IV NSCLC candidates for 1 st line chemotherapy paclitaxel-cisplatin based agreeing to participate in the study.
Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
A scale of how much an illness limits everyday activity. For people being assessed to join a study, scores run from 0 (fully active) to 4; lower is more active.
Studies most often ask for 0–1 or 0–2. Your doctor gives the score; the WHO scale uses the same steps. The full scale also has 5, which records death.
A line of therapy is one course of treatment, which may combine several drugs. First-line is the first course given; second-line follows when that stops working or is not tolerated.
“Two prior lines” means two courses that count separately under the study’s rules — not simply two drugs. Ask the study team if you are unsure how yours are counted.
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
ECOG performance status
A scale of how much an illness limits everyday activity. For people being assessed to join a study, scores run from 0 (fully active) to 4; lower is more active.
Studies most often ask for 0–1 or 0–2. Your doctor gives the score; the WHO scale uses the same steps. The full scale also has 5, which records death.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Line of therapy
A line of therapy is one course of treatment, which may combine several drugs. First-line is the first course given; second-line follows when that stops working or is not tolerated.
“Two prior lines” means two courses that count separately under the study’s rules — not simply two drugs. Ask the study team if you are unsure how yours are counted.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Outpatients from National Cancer Institute with stage III and IV NSCLC candidates for 1 st line chemotherapy paclitaxel-cisplatin based agreeing to participate in the study
Dysgeusia (UMAMI Perception)
Describe the threshold of perception and recognition (PT and RT, respectively) umami) with 5 dilutions with different concentrations. The patients were instructed to taste each 5 ml dilution in ascending order and to rinse the dilution around the entire oral cavity. After each rinse, the patients were asked whether the sample they took tasted different from water to identify their PT, which was assigned to the lowest concentration at which the subject perceived a difference in taste from water. If so, then the patients were asked to identify the taste to define their RT, which was assigned to the lowest concentration at which the subject identified the taste.
Time frame: Change from Baseline in threshold of perception at 6 weeks
Dysgeusia (UMAMI Recognition)
Describe the threshold recognition (RT) of umami with 5 dilutions with different concentrations. The patients were instructed to taste each 5 ml dilution in ascending order and to rinse the dilution around the entire oral cavity. After each rinse, the patients were asked whether the sample they took tasted different from water to identify their PT, which was assigned to the lowest concentration at which the subject perceived a difference in taste from water. If so, then the patients were asked to identify the taste to define their RT, which was assigned to the lowest concentration at which the subject identified the taste.
Time frame: Change from Baseline in threshold of perception at 6 weeks
Dysgeusia (SWEET Perception)
Describe the threshold perception (PT) of sweet taste with 5 dilutions with different concentrations. The patients were instructed to taste each 5 ml dilution in ascending order and to rinse the dilution around the entire oral cavity. After each rinse, the patients were asked whether the sample they took tasted different from water to identify their PT, which was assigned to the lowest concentration at which the subject perceived a difference in taste from water. If so, then the patients were asked to identify the taste to define their RT, which was assigned to the lowest concentration at which the subject identified the taste.
Time frame: Change from Baseline in threshold of perception at 6 weeks
Dysgeusia (SWEET Recognition)
Describe the recognition threshold (RT) of sweet taste with 5 dilutions with different concentrations. The patients were instructed to taste each 5 ml dilution in ascending order and to rinse the dilution around the entire oral cavity. After each rinse, the patients were asked whether the sample they took tasted different from water to identify their PT, which was assigned to the lowest concentration at which the subject perceived a difference in taste from water. If so, then the patients were asked to identify the taste to define their RT, which was assigned to the lowest concentration at which the subject identified the taste.
Time frame: Change from Baseline in threshold of perception at 6 weeks
Dysgeusia (BITTER Perception)
Describe the perception threshold (PT) of bitter taste with 5 dilutions with different concentrations. The patients were instructed to taste each 5 ml dilution in ascending order and to rinse the dilution around the entire oral cavity. After each rinse, the patients were asked whether the sample they took tasted different from water to identify their PT, which was assigned to the lowest concentration at which the subject perceived a difference in taste from water. If so, then the patients were asked to identify the taste to define their RT, which was assigned to the lowest concentration at which the subject identified the taste.
Time frame: Change from Baseline in threshold of perception at 6 weeks
Dysgeusia (BITTER Recognition)
Describe the recognition threshold (RT) of bitter taste with 5 dilutions with different concentrations. The patients were instructed to taste each 5 ml dilution in ascending order and to rinse the dilution around the entire oral cavity. After each rinse, the patients were asked whether the sample they took tasted different from water to identify their PT, which was assigned to the lowest concentration at which the subject perceived a difference in taste from water. If so, then the patients were asked to identify the taste to define their RT, which was assigned to the lowest concentration at which the subject identified the taste.
Time frame: Change from Baseline in threshold of perception at 6 weeks
Dysgeusia (UMAMI Dilutions Dichotomized)
We divide dilutions in two groups and dichotomized the patients into high and low sensibility to umami taste. (perception)
Time frame: pre - post chemotherapy (6 weeks)
Dysgeusia (SWEET Dilutions Dichotomized)
We divide dilutions in two groups and dichotomized the patients into high and low sensibility to sweet taste.
Time frame: pre - post chemotherapy (6 weeks)
Dysgeusia (BITTER Dilutions Dichotomized)
We divide dilutions in two groups and dichotomized the patients into high and low sensibility to umami, bitter and sweet tastes
Time frame: pre - post chemotherapy (6 weeks)
BODY COMPOSITION
fat mass and lean body mass pre-post chemotherapy
Time frame: Change from Baseline in perception and recognition thresholds at 6 weeks
Body Mass Index
Body mass index, using the formula kg/m\^2
Time frame: Change from Baseline in threshold of perception and recognition at 6 weeks
Subjective Global Assessment
validated questionnaire to identify patients with malnutrition or risk of malnutrition Subjective global assessment (PG-SGA) was used to assess and classify patients as having severe or moderate malnourishment (B or C) or as being well nourished (A).
Time frame: descriptive values before chemotherapy
PROTEIN AND FAT Consumption
energy and nutrimental consumption was estimated by questionnaire SNUT difference between ≥ Sweet perception thresholds vs \< Sweet perception thresholds after chemotherapy
Time frame: participants were evaluated baseline and after 2 cycles of chemotherapy, an average of 6 weeks
IRON Consumption
IRON consumption was estimated by questionnaire SNUT difference between ≥ Sweet perception thresholds vs \< Sweet perception thresholds after chemotherapy
Time frame: participants were evaluated baseline and after 2 cycles of chemotherapy, an average of 6 weeks
Quality o f Life
The HRQL evaluation was assessed using the validated Mexican-Spanish version of the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaires specific for cancer and for LC (EORTC-QLQ-C30 and QLQ-LC13). \[18, 19\] Scores for the multi-item functional or symptom scales and the single items scales were calculated using a linear transformation of raw scores to produce a range from 0 to 100, as described by EORTC. A score of 100 represents the best score for the global health status and functional scales of QoL or 0 in the symptom rating.
Time frame: participants were evaluated baseline and after 2 cycles of chemotherapy, an average of 6 weeks
Change From Baseline in Albumin After 2 Cycles of Chemotherapy
comparison of patients who increased or decreased their sensibility to the PT of umami taste
Time frame: participants were evaluated baseline and after 2 cycles of chemotherapy, an average of 6 weeks
Peripheral Neuropathy (QLQ-C30 Version 3, EORTC)
comparison of peripheral neuropathy patients who increased or decreased their sensibility to the PT of umami taste The HRQL evaluation was assessed using the validated Mexican-Spanish version of the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaires specific for cancer and for LC (EORTC-QLQ-C30 and QLQ-LC13). Scores for the multi-item functional or symptom scales and the single items scales were calculated using a linear transformation of raw scores to produce a range from 0 to 100, as described by EORTC. A score of 100 represents the best score for the global health status and functional scales of QoL or 0 in the symptom rating.
Time frame: participants were followed for the duration of 2 cycles of chemotherapy, an average of 6 weeks
Global Status of Quality of Life (C-30,LC13 EORTC)
differences in global status of QoL scale (C-30,LC13 EORTC) between those with more or less sensibility to recognize the umami taste. score of scale 0-100, a higher score represents better overall state.
Time frame: time between baseline and before 2 cycles of chemotherapy, an average of 6 weeks
We recruit patients since September 2010 to July 2012
| Milestone | Pre-chemotherapy Patientes =40 |
|---|---|
| Started | 40 |
| Completed | 40 |
| Not completed | 0 |
Describe the threshold of perception and recognition (PT and RT, respectively) umami) with 5 dilutions with different concentrations. The patients were instructed to taste each 5 ml dilution in ascending order and to rinse the dilution around the entire oral cavity. After each rinse, the patients were asked whether the sample they took tasted different from water to identify their PT, which was assigned to the lowest concentration at which the subject perceived a difference in taste from water. If so, then the patients were asked to identify the taste to define their RT, which was assigned to the lowest concentration at which the subject identified the taste.
| μmol/ml | Pre-chemotherapy Patientes | Post-chemotherapy Patients |
|---|---|---|
| Dysgeusia (UMAMI Perception) | .3 (.3 to 3.3) | .3 (.3 to 2.7) |
fat mass and lean body mass pre-post chemotherapy
| kg | Pre-chemotherapy Patientes | Post-chemotherapy Patients |
|---|---|---|
| FAT MASS (kg) | 20.09 ± 7.7 | 19.67 ± 6.5 |
| LEAN BODY MASS (kg) | 41.79 ± 13 | 41.26 ± 11.9 |
Body mass index, using the formula kg/m\^2
| kg/m^2 | Pre-chemotherapy Patientes | Post-chemotherapy Patients |
|---|---|---|
| Body Mass Index | 24.5 ± 4 | 24.1 ± 4 |
validated questionnaire to identify patients with malnutrition or risk of malnutrition Subjective global assessment (PG-SGA) was used to assess and classify patients as having severe or moderate malnourishment (B or C) or as being well nourished (A).
| participants | Pre-chemotherapy Patientes | Post-chemotherapy Patientes |
|---|---|---|
| SGA A | 26 | 23 |
| SGA B & C | 14 | 17 |
energy and nutrimental consumption was estimated by questionnaire SNUT difference between ≥ Sweet perception thresholds vs \< Sweet perception thresholds after chemotherapy
| gr | ≥ Sweet Perception Thresholds After Chemotherapy | < Sweet Perception Thresholds After Chemotherapy |
|---|---|---|
| proteins | 59.12 ± 32.7 | 91.07 ± 33.1 |
| animal proteins | 28.2 ± 14 | 49.29 ± 18.5 |
| fat | 60.1 ± 26.2 | 91.77 ± 31.6 |
IRON consumption was estimated by questionnaire SNUT difference between ≥ Sweet perception thresholds vs \< Sweet perception thresholds after chemotherapy
| mg | ≥ Sweet Perception Thresholds After Chemotherapy | < Sweet Perception Thresholds After Chemotherapy |
|---|---|---|
| IRON Consumption | 10.8 ± 7.5 | 16.11 ± 6.3 |
Describe the threshold recognition (RT) of umami with 5 dilutions with different concentrations. The patients were instructed to taste each 5 ml dilution in ascending order and to rinse the dilution around the entire oral cavity. After each rinse, the patients were asked whether the sample they took tasted different from water to identify their PT, which was assigned to the lowest concentration at which the subject perceived a difference in taste from water. If so, then the patients were asked to identify the taste to define their RT, which was assigned to the lowest concentration at which the subject identified the taste.
| μmol/ml | Pre-chemotherapy Patientes | Post-chemotherapy Patients |
|---|---|---|
| Dysgeusia (UMAMI Recognition) | 2.4 (.3 to 3.3) | 1.5 (.3 to 3.3) |
The HRQL evaluation was assessed using the validated Mexican-Spanish version of the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaires specific for cancer and for LC (EORTC-QLQ-C30 and QLQ-LC13). \[18, 19\] Scores for the multi-item functional or symptom scales and the single items scales were calculated using a linear transformation of raw scores to produce a range from 0 to 100, as described by EORTC. A score of 100 represents the best score for the global health status and functional scales of QoL or 0 in the symptom rating.
| Scores on a scale | HRQL Pre-chemotherapy | HRQL Post-chemotherapy |
|---|---|---|
| Global status | 58.33 (0 to 100) | 66.67 (0 to 100) |
| Role functioning | 66.67 (0 to 100) | 83.33 (0 to 100) |
| Emotional functioning | 66.67 (0 to 100) | 91.67 (0 to 100) |
| Fatigue | 38.8 (0 to 100) | 22.22 (0 to 100) |
| Appetite loss | 33.33 (0 to 100) | 0 (0 to 100) |
| Constipation | 33.33 (0 to 100) | 0 (0 to 100) |
comparison of patients who increased or decreased their sensibility to the PT of umami taste
| g/dL | > or = Umami Perception Thresholds | < Umami Perception Thresholds |
|---|---|---|
| Change From Baseline in Albumin After 2 Cycles of Chemotherapy | -0.4 ± 0.11 | 0.28 ± 0.1 |
comparison of peripheral neuropathy patients who increased or decreased their sensibility to the PT of umami taste The HRQL evaluation was assessed using the validated Mexican-Spanish version of the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaires specific for cancer and for LC (EORTC-QLQ-C30 and QLQ-LC13). Scores for the multi-item functional or symptom scales and the single items scales were calculated using a linear transformation of raw scores to produce a range from 0 to 100, as described by EORTC. A score of 100 represents the best score for the global health status and functional scales of QoL or 0 in the symptom rating.
| Units on a scale | > or = Umami Perception Thresholds | < Umami Perception Thresholds |
|---|---|---|
| Peripheral Neuropathy (QLQ-C30 Version 3, EORTC) | 33.33 (0 to 100) | 16.66 (0 to 66.67) |
differences in global status of QoL scale (C-30,LC13 EORTC) between those with more or less sensibility to recognize the umami taste. score of scale 0-100, a higher score represents better overall state.
| units on a scale | < or = Umami Recognition Thresholds | > Umami Recognition Thresholds |
|---|---|---|
| Global Status of Quality of Life (C-30,LC13 EORTC) | 75 (1.66 to 99.58) | 66.67 (8.33 to 100) |
Describe the threshold perception (PT) of sweet taste with 5 dilutions with different concentrations. The patients were instructed to taste each 5 ml dilution in ascending order and to rinse the dilution around the entire oral cavity. After each rinse, the patients were asked whether the sample they took tasted different from water to identify their PT, which was assigned to the lowest concentration at which the subject perceived a difference in taste from water. If so, then the patients were asked to identify the taste to define their RT, which was assigned to the lowest concentration at which the subject identified the taste.
| μmol/ml | Pre-chemotherapy Patientes | Post-chemotherapy Patients |
|---|---|---|
| Dysgeusia (SWEET Perception) | 3.5 (3.5 to 18.5) | 3.5 (3.5 to 18.5) |
Describe the recognition threshold (RT) of sweet taste with 5 dilutions with different concentrations. The patients were instructed to taste each 5 ml dilution in ascending order and to rinse the dilution around the entire oral cavity. After each rinse, the patients were asked whether the sample they took tasted different from water to identify their PT, which was assigned to the lowest concentration at which the subject perceived a difference in taste from water. If so, then the patients were asked to identify the taste to define their RT, which was assigned to the lowest concentration at which the subject identified the taste.
| μmol/ml | Pre-chemotherapy Patientes | Post-chemotherapy Patients |
|---|---|---|
| Dysgeusia (SWEET Recognition) | 15.5 (3.5 to 18.5) | 12.5 (3.5 to 18.5) |
Describe the perception threshold (PT) of bitter taste with 5 dilutions with different concentrations. The patients were instructed to taste each 5 ml dilution in ascending order and to rinse the dilution around the entire oral cavity. After each rinse, the patients were asked whether the sample they took tasted different from water to identify their PT, which was assigned to the lowest concentration at which the subject perceived a difference in taste from water. If so, then the patients were asked to identify the taste to define their RT, which was assigned to the lowest concentration at which the subject identified the taste.
| μmol/ml | Pre-chemotherapy Patientes | Post-chemotherapy Patients |
|---|---|---|
| Dysgeusia (BITTER Perception) | 97 (91 to 121) | 91 (91 to 121) |
Describe the recognition threshold (RT) of bitter taste with 5 dilutions with different concentrations. The patients were instructed to taste each 5 ml dilution in ascending order and to rinse the dilution around the entire oral cavity. After each rinse, the patients were asked whether the sample they took tasted different from water to identify their PT, which was assigned to the lowest concentration at which the subject perceived a difference in taste from water. If so, then the patients were asked to identify the taste to define their RT, which was assigned to the lowest concentration at which the subject identified the taste.
| μmol/ml | Pre-chemotherapy Patientes | Post-chemotherapy Patients |
|---|---|---|
| Dysgeusia (BITTER Recognition) | 115 (91 to 121) | 109 (91 to 121) |
We divide dilutions in two groups and dichotomized the patients into high and low sensibility to umami taste. (perception)
| participants | Pre-chemotherapy Patientes | Post-chemotherapy Patients |
|---|---|---|
| UMAMI 0.3 - 1.5 μmol/ml | 31 | 36 |
| UMAMI > 1.5 μmol/ml | 9 | 3 |
We divide dilutions in two groups and dichotomized the patients into high and low sensibility to sweet taste.
| participants | Pre-chemotherapy Patientes | Post-chemotherapy Patients |
|---|---|---|
| SWEET 3.5 - 9.5 μmol/ml | 26 | 33 |
| SWEET > 9.5 μmol/ml | 14 | 6 |
We divide dilutions in two groups and dichotomized the patients into high and low sensibility to umami, bitter and sweet tastes
| participants | Pre-chemotherapy Patientes | Post-chemotherapy Patients |
|---|---|---|
| BITTER 91 - 103 μmol/ml | 26 | 35 |
| BITTER > 109 μmol/ml | 14 | 4 |
Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| LUNG CANCER PATIENTS | — | — | — |
We invited to participate 72 patients with NSCLC newly diagnosed, but only 40 patients completed their baseline evaluation and their follow up after two cycles of chemotherapy using paclitaxel (175 mg/m2) and cisplatin (75 mg/m2). The main reason of exclusion was death followed by not returning to the institution.
| Age, Continuous(years) | Pre-chemotherapy Patientes =40 |
|---|---|
| Mean | 55.5 ± 15 |
| Sex: Female, Male(Participants) | Pre-chemotherapy Patientes =40 |
|---|---|
| Female | 20 |
| Male | 20 |
| Region of Enrollment(participants) | Pre-chemotherapy Patientes =40 |
|---|---|
| Mexico | 40 |
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Carcinoma, Non-Small-Cell Lung →
Instituto Nacional de Cancerologia de Mexico