101
|
Macarulla T, Carrato A, Díaz R, García A, Laquente B, Sastre J, Álvarez R, Muñoz A, Hidalgo M. Management and supportive treatment of frail patients with metastatic pancreatic cancer. J Geriatr Oncol 2018; 10:398-404. [PMID: 30005980 DOI: 10.1016/j.jgo.2018.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/03/2018] [Accepted: 06/18/2018] [Indexed: 12/18/2022]
Abstract
Data regarding management of frail patients with pancreatic ductal adenocarcinoma practice is currently very scarce. Randomized clinical trials usually exclude these subgroup of patients and the majority of the publications only consider chronological age and ECOG performance status for their classification. Therefore, the current available data do not reflect daily clinical practice. Only data from a phase two study (FRAGANCE study), designed to select a tolerable dose-schedule of nab-placitaxel + gemcitabine (Phase one) and to evaluate the efficacy of the selected regimen (Phase two) in patients with ECOG-2 and previously untreated advanced PDAC, are currently available. Management of these particular patients is exceedingly complex and requires collaboration of multidisciplinary teams and intensive support treatment. This article reviews the literature available regarding the management of the so-called frail patients and provide guidance for chemotherapy as well as supportive care treatments.
Collapse
|
102
|
Domingo JS, Huertas RM, García AB, de la Fuente EC, Serrano CS, Delgado MV, Saez OM, Muñoz FL, Olmos VP, Garrote MR, Vaz M, Puertas PR, Fuentes R, Carrato A, Monteagudo RF. Analysis of classical high risk factors in stage III colon cancer: Experience at University Hospital Ramon y Cajal (UHRyC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
103
|
Serrano CS, Delgado MV, de la Fuente EC, García AB, Domingo JS, Huertas RM, Saez OM, Muñoz FL, Puertas PR, Olmos VP, Garrote MR, Vaz M, Fuentes R, Carrato A, Monteagudo RF. Analysis of the benefit of the adjuvant chemotherapy in stage II colon cancer according to the presence of classic poor risk factors: Our experience in Ramon y Cajal Hospital. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
104
|
de la Fuente EC, Serrano CS, Delgado MV, García AB, Huertas RM, Domingo JS, Saez OM, Olmos VP, Garrote MR, Muñoz FL, Puertas PR, Guillén-Ponce C, Carrato A, Monteagudo RF. Benefit of the addition of oxaliplatin to 5-FU/leucovorin or capecitabine in adjuvant therapy for stage II/III colorectal cancer in elderly patients: Experience in Ramon y Cajal University Hospital. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
105
|
Huertas RM, Domingo JS, de la Fuente EC, García AB, Delgado MV, Serrano CS, Saez OM, Muñoz FL, Olmos VP, Garrote MR, Vaz M, Carrato A, Puertas PR, Fuentes R, Monteagudo RF. Impact of adding oxaliplatin to fluoropyrimidines in the adjuvant therapy in stage II in colon cancer: Experience in Ramon y Cajal Universitary Hospital. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
106
|
Pacheco-Barcia V, Solís RM, Saez OM, Muñoz FL, Bermejo E, Monteagudo JM, Marin C, Correa A, Maqueda R, Rogado J, de Paredes AG, de Santiago ER, Olmos VP, Monteagudo RF, Garrote MR, Carrato A, Donnay O, Martin E, Santander C, Colomer R. Safety of self-expandable metal stents (SEMS) or emergency surgery for acute colonic obstruction in metastatic colon cancer patients treated with bevacizumab. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy150.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
107
|
García AB, Domingo JS, Serrano CS, Artahona VA, Delgado MV, Saez OM, Cerrillo JM, Huertas RM, de la Fuente EC, Monteagudo RF, Garrote MR, Olmos VP, Vaz M, Puertas PR, Guillén-Ponce C, Carrato A, Muñoz FL. Analysis of global factors associated with survival in esophageal squamous cell carcinoma: Our experience at Ramon y Cajal Hospital. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
108
|
Serrano CS, Puertas PR, Saez OM, Muñoz FL, García AB, Artahona VA, Delgado MV, Cerrillo JM, de la Fuente EC, Huertas RM, Domingo JS, Olmos VP, Monteagudo RF, Garrote MR, Vaz M, Fuentes R, Guillén-Ponce C, Carrato A. Predictive factors for early relapse and survival in resected pancreatic cancer: A single institution experience. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
109
|
Melisi D, Westphalen B, àMellbring, Carrato A, Taieb J, Prager G, Macarulla Mercadé T, Esquermes ND, Ferreras A, de Jong F. Symptoms reported at initial diagnosis of (metastatic) pancreatic adenocarcinoma ([m]PAC) in routine clinical practice and variation in frequencies across Europe. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
110
|
Delgado MV, Serrano CS, de la Fuente EC, García AB, Saez OM, Huertas RM, Domingo JS, Cerrillo JM, Muñoz FL, Olmos VP, Garrote MR, Puertas PR, Vaz M, Carrato A, Monteagudo RF. Efficacy of adjuvant chemotherapy for elderly patients with colon cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
111
|
Prager G, Mercadé TM, àMellbring, Taieb J, Carrato A, Melisi D, Westphalen B, Esquermes ND, Ferreras A, de Jong F. Baseline characteristics and second-line treatment for metastatic pancreatic adenocarcinoma (mPAC) patients receiving first-line FOLFIRINOX, gemcitabine+nab-paclitaxel or gemcitabine-monotherapy in routine clinical practice across Europe. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy150.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
112
|
Maravic Z, Wyrwicz L, Karczmarek-Borowska B, Basany EE, Carrato A, Horvath A, àBenedict, Kapitány Z. Understanding of metastatic colorectal cancer (mCRC) in the real world: Initial results from a European survey on the unmet needs of patients living with metastatic colorectal cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
113
|
Vidal J, Dalmeses A, Vivas CS, Garcia-Carbonero R, García-Alfonso P, Carrato A, Elez E, Ortiz M, Losa F, Massutí B, Valladares-Ayerbes M, Manzano J, de Prado JV, Gallego J, Grávalos C, Varela M, Azuara D, Tabernero J, Salazar R, Aranda E, Bellosillo B, Montagut C. Ultra-selection of metastatic colorectal cancer patients using next generation sequencing platform to improve clinical efficacy of anti-EGFR therapy. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy149.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
114
|
Guillem V, Bofill S, Feyjoo M, Anton A, Aranda E, Camps C, Carrato A, Constenla M, Cruz-Hernández JJ, Diaz Rubio E, Garcia-Foncillas J, Gascon P, Lopez R, Soler B, Escobar Y. Clinical practice evaluation of opioids induced constipation management in oncologic patients: The EIO-50 project. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e22175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
115
|
Guillem Porta V, Anton A, Aranda E, Carrato A, Constenla M, Cruz-Hernández JJ, Diaz Rubio E, Garcia-Foncillas J, Gascon P, Lopez R, Caballero F, Monge D, Garcia de Leonardo C, Campos FJ, Camps C. The future of precision medicine, strengths and weaknesses: An expert position paper. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
116
|
Pacheco-Barcia V, Mondejar R, Martinez Saez O, Longo F, Bermejo E, Moreno Monteagudo JA, Marin C, Correa A, Maqueda R, Rogado Revuelta J, Garcia de Paredes A, Rodriguez de Santiago E, Pachon V, Ferreiro Monteagudo R, Rodríguez Garrote M, Carrato A, Donnay O, Martin E, Santander C, Colomer R. Safety of self-expandable metal stents (SEMS) or emergency surgery for acute malignant colonic obstruction in patients treated with bevacizumab. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e15505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
117
|
Lopez R, Reina JJ, Monge D, Caballero F, Guillem V, Aranda E, Carrato A, Diaz Rubio E, Garcia-Foncillas J, Feyjoo M, Camps C. Assessment and treatment of breakthrough cancer pain in Spain: A self-audit study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
118
|
Martín AM, Hidalgo M, Alvarez R, Arrazubi V, Martínez-Galán J, Salgado M, Macarulla T, Carrato A. From First Line to Sequential Treatment in the Management of Metastatic Pancreatic Cancer. J Cancer 2018; 9:1978-1988. [PMID: 29896283 PMCID: PMC5995948 DOI: 10.7150/jca.23716] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/14/2018] [Indexed: 12/13/2022] Open
Abstract
The current management of patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) is based on systemic chemotherapy. The results of the MPACT and PRODIGE clinical trials have demonstrated that the combination of nab-paclitaxel and gemcitabine (GEM) as well as FOLFIRINOX regimen result in improvement in overall survival when compared to GEM alone. Treatment guidelines now recommend either one of these two regimens as first line treatment for fit patients with mPDAC. Because no head-to-head comparison between the two regimens exists, the selection of one versus the other is based on clinical criteria. The design and eligibility criteria of these two clinical trials are dissimilar, making the results of the MPACT trial more applicable to the general population of patients with mPDAC. In addition, the combination of nab-paclitaxel and GEM is better tolerated and easier to administer in clinical practice than FOLFIRINOX. Furthermore, when the regimens are studied in comparable patient populations the efficacy results are very similar. Nanoliposomal irinotecan plus 5FU has recently demonstrated a significant increase in efficacy rates after a GEM-based treatment. Importantly, treatment of mPDAC should now be considered as a continuum care for patients who are fit, with second and even third line treatments. Different sequential treatment algorithms are proposed based on available data. In retrospective studies, patients who were managed with GEM-based regimens followed by fluoropyrimidine-based regimens appear to have the most favorable outcome.
Collapse
|
119
|
Molina-Montes E, Gomez-Rubio P, Márquez M, Rava M, Löhr M, Michalski CW, Molero X, Farré A, Perea J, Greenhalf W, Ilzarbe L, O'Rorke M, Tardón A, Gress T, Barberà VM, Crnogorac-Jurcevic T, Domínguez-Muñoz E, Muñoz-Bellvís L, Balsells J, Costello E, Huang J, Iglesias M, Kleeff J, Kong B, Mora J, Murray L, O'Driscoll D, Poves I, Scarpa A, Ye W, Hidalgo M, Sharp L, Carrato A, Real FX, Malats N. Risk of pancreatic cancer associated with family history of cancer and other medical conditions by accounting for smoking among relatives. Int J Epidemiol 2018; 47:473-483. [PMID: 29329392 DOI: 10.1093/ije/dyx269] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2018] [Indexed: 12/16/2022] Open
Abstract
Background Family history (FH) of pancreatic cancer (PC) has been associated with an increased risk of PC, but little is known regarding the role of inherited/environmental factors or that of FH of other comorbidities in PC risk. We aimed to address these issues using multiple methodological approaches. Methods Case-control study including 1431 PC cases and 1090 controls and a reconstructed-cohort study (N = 16 747) made up of their first-degree relatives (FDR). Logistic regression was used to evaluate PC risk associated with FH of cancer, diabetes, allergies, asthma, cystic fibrosis and chronic pancreatitis by relative type and number of affected relatives, by smoking status and other potential effect modifiers, and by tumour stage and location. Familial aggregation of cancer was assessed within the cohort using Cox proportional hazard regression. Results FH of PC was associated with an increased PC risk [odds ratio (OR) = 2.68; 95% confidence interval (CI): 2.27-4.06] when compared with cancer-free FH, the risk being greater when ≥ 2 FDRs suffered PC (OR = 3.88; 95% CI: 2.96-9.73) and among current smokers (OR = 3.16; 95% CI: 2.56-5.78, interaction FHPC*smoking P-value = 0.04). PC cumulative risk by age 75 was 2.2% among FDRs of cases and 0.7% in those of controls [hazard ratio (HR) = 2.42; 95% CI: 2.16-2.71]. PC risk was significantly associated with FH of cancer (OR = 1.30; 95% CI: 1.13-1.54) and diabetes (OR = 1.24; 95% CI: 1.01-1.52), but not with FH of other diseases. Conclusions The concordant findings using both approaches strengthen the notion that FH of cancer, PC or diabetes confers a higher PC risk. Smoking notably increases PC risk associated with FH of PC. Further evaluation of these associations should be undertaken to guide PC prevention strategies.
Collapse
|
120
|
Grávalos C, Carrato A, Tobeña M, Rodriguez-Garrote M, Soler G, Vieitez JM, Robles L, Valladares-Ayerbes M, Polo E, Limón ML, Safont MJ, Martínez de Castro E, García-Alfonso P, Aranda E. A Randomized Phase II Study of Axitinib as Maintenance Therapy After First-line Treatment for Metastatic Colorectal Cancer. Clin Colorectal Cancer 2018; 17:e323-e329. [PMID: 29551560 DOI: 10.1016/j.clcc.2018.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/12/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the efficacy and safety of maintenance therapy with axitinib versus placebo following induction therapy in patients with metastatic colorectal cancer (mCRC). PATIENTS AND METHODS In this double-blinded, phase II trial, patients with mCRC who had not progressed after 6 to 8 months of first-line chemotherapy were randomized to receive axitinib (5 mg twice a day) (arm A) or placebo (arm B). RESULTS Forty-nine patients were included: 25 in arm A and 24 in arm B. The median follow-up was 26.07 months (95% confidence interval [CI], 18.44-31.73 months). Progression-free survival (PFS) rate at 6 months was 40.00% (95% CI, 21.28%-58.12%) in the axitinib arm versus 8.33% (95% CI, 1.44%-23.30%) in the placebo arm (P = .0141). The median PFS was statistically significantly longer in the axitinib group than in the placebo group (4.96 vs. 3.16 months; hazard ratio, 0.46; 95% CI, 0.25-0.86; P = .0116). Median overall survival was also longer in the axitinib arm but did not reach statistical significance (27.61 vs. 19.99 months; hazard ratio, 0.68; 95% CI, 0.31-1.48; P = .3279). Grade 3 to 4 treatment-related toxicities were experienced by 7 patients (28%) in cohort A and 1 patient (4%) in cohort B (P = .0488). The most frequent grade 3 to 4 treatment-related toxicities were hypertension, diarrhea, and asthenia. There were no toxic deaths. The study was prematurely closed because of slow recruitment. CONCLUSIONS In our study, maintenance treatment with axitinib monotherapy showed a significant increase in PFS and a good safety profile. Axitinib should be further explored as a possible option for first-line chemotherapy maintenance treatment in patients with mCRC.
Collapse
|
121
|
Abad A, Martínez-Balibrea E, Viéitez J, Alonso-Orduña V, García Alfonso P, Manzano J, Massutí B, Benavides M, Carrato A, Zanui M, Gallego J, Grávalos C, Conde V, Provencio M, Valladares-Ayerbes M, Salazar R, Sastre J, Montagut C, Rivera F, Aranda E. Genotype-based selection of treatment of patients with advanced colorectal cancer (SETICC): a pharmacogenetic-based randomized phase II trial. Ann Oncol 2018; 29:439-444. [DOI: 10.1093/annonc/mdx737] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
|
122
|
Barquín García AM, Martinez Saez O, Serrano Domingo JJ, Martín Huertas R, Villamayor Delgado M, Saavedra Serrano C, Corral de la Fuente E, Reguera Puertas P, LONGO FEDERICO, Pachón Olmos V, Rodríguez Garrote M, Guillen C, Carrato A, Ferreiro REYES. Prognostic relevance of primary tumor location in stage III and II colon cancer: Experience at University Hospital Ramon y Cajal (HURyC) Madrid. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
703 Background: Primary tumor location of colon cancer (CC) is emerging as an important prognostic factor owing to distinct biological features. However, this factor still does not represent a prognostic parameter when deciding for adyuvant or palliative chemotherapy. In a meta-analysis of 66 studies including patients with all stages of disease, left-sided primary tumor location was associated with a significantly reduced risk of death and this was independent of other prognostic factors. Methods: We retrospectively included patients with stage II and III CC that underwent surgical resection between 2009 and 2014 HURyC. We performed a multivariate Cox model analysis to estimate if tumor location is an independent prognostic factor for overall survival (OS). The model was further adjusted by including the following confounders: ECOG-PS, number of removed nodes ( < 12 or ≥ 12), perforation, grade, use of adyuvant chemotherapy and age. A covariate was considered a confounder factor if the difference between the adjusted and unadjusted coefficient of chemotherapy varied > 10%. Stata 13.1 was used to analyze the data. Results: 564 patients were identified (267 left sided and 297 right sided). The median follow-up of the entire cohort was 49 months. Globally, right sided CC was not significantly associated with better DFS or OS in comparison with left sided CC (HR: 0.74, p: 0.128; HR: 0.94, p: 0.75, respectively). By stages, stage II right sided CC seemed to show better DFS (HR: 0.45, p: 0.02), although no significant differences were found in OS (HR: 1.004, p: 0.98). Stage III right sided CC was not significantly associated with better DFS or OS in comparison with left sided CC (HR: 0.87, p: 0.585; HR: 0.66, p: 0.19, respectively). Conclusions: The multivariate analysis did not show significant differences in terms of prognostic relevance of primary tumor location in the adyuvant setting.
Collapse
|
123
|
Martinez Saez O, Barquín García AM, Saavedra Serrano C, Corral de la Fuente E, Serrano Domingo JJ, Martín Huertas R, Villamayor Delgado M, LONGO FEDERICO, Reguera Puertas P, Pachon V, Rodríguez Garrote M, Guillen C, Carrato A, Ferreiro Monteagudo R. Benefit of adjuvant treatment in stages II and III colon cancer: Experience at the Ramón y Cajal University Hospital. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
842 Background: The standard adjuvant treatment for patients with stage III colon cancer is 6 months with fluoropyrimidines and oxaliplatin. The Intergroup Trial INT-0035 was the first large-scale study to demonstrate a significant reduction in the risk of death with adjuvant FU plus levamisole in patients with stage III colon cancer. In the MOSAIC study, the addition of oxaliplatin to fluoropyrimidines in patients with resected stage II to III colon cancer showed OS and DFS benefit of oxaliplatin. However, no significant benefit was observed in either DFS or OS in patients with stage II disease, therefore the benefit of adjuvant chemotherapy is still controversial in those patients. Methods: We retrospectively included patients with stages II and III colon cancer that were operated between 2009 and 2014 in the University Ramón y Cajal Hospital from Madrid. We calculate DFS and OS at 48 months and we perform a multivariable Cox model analysis to estimate the benefit of the chemotherapy in each stage. The model was further adjusted by including the following confounders: ECOG-PS, number or removed nodes ( < 12 or ≥ 12), grade and age. A covariate was considered a confounder factor if the difference between the adjusted and unadjusted coefficient of chemotherapy varied > 10%. Stata 13.1 was used to analyze the data. Results: 564 patients were identified (281 stage II and 283 stage III). 259 received chemotherapy and 305 did not. The median follow-up in the entire cohort was 49 months. The median DFS and OS were not reached at the moment of the analysis. DFS and OS at 48 months were both 78.5%. Globally, chemotherapy did not improve DFS (HR 1.05, p: 0.83) but OS was significantly better (HR 0.47, p: 0.001). By stage, chemotherapy did not improve DFS in stage II (HR: 1.6, p: 0.2) nor OS (HR 0.76, p: 0.43). In stage III, chemotherapy showed a trend to improve DSF (HR: 0.61, p: 0.075) and did improve OS (HR: 0.31, p < 0.0001). Conclusions: The multivariable analysis showed a chemotherapy benefit in patients with stage III colon cancer, with a 39% reduction in the risk of recurrence and a 69% in the risk of death; however, in stage II patients these benefits were not found either in DFS or OS.
Collapse
|
124
|
Rava M, Czachorowski MJ, Silverman D, Márquez M, Kishore S, Tardón A, Serra C, García-Closas M, Garcia-Closas R, Carrato A, Rothman N, Real FX, Kogevinas M, Malats N. Asthma status is associated with decreased risk of aggressive urothelial bladder cancer. Int J Cancer 2018; 142:470-476. [PMID: 28940228 PMCID: PMC6982397 DOI: 10.1002/ijc.31066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/23/2017] [Accepted: 07/31/2017] [Indexed: 12/18/2022]
Abstract
Previous studies suggested an association between atopic conditions and specific cancers. The results on the association with urothelial bladder cancer (UBC) are scarce and inconsistent. To evaluate the association between asthma and risk of UBC, we considered 936 cases and 1,022 controls from the Spanish Bladder Cancer/EPICURO Study (86% males, mean age 65.4 years), a multicenter and hospital-based case-control study conducted during 1998-2001. Participants were asked whether they had asthma and detailed information about occupational exposures, smoking habits, dietary factors, medical conditions and history of medication was collected through face-to-face questionnaires performed by trained interviewers. Since asthma and UBC might share risk factors, association between patients' characteristics and asthma was studied in UBC controls. Association between UBC and asthma was assessed using logistic regression unadjusted and adjusted for potential confounders. The complex interrelationships, direct and mediating effect of asthma on UBC, were appraised using counterfactual mediation models. Asthma was associated with a reduced risk of UBC (odds ratio (OR) = 0.54, 95% confidence interval (CI) 0.37, 0.79) after adjusting for a wide range of confounders. No mediating effect was identified. The reduced risk associated with asthma was restricted to patients with high-risk non-muscle invasive (OR = 0.25, 95%CI 0.10, 0.62) and muscle invasive UBC (OR = 0.32, 95%CI 0.15, 0.69). Our results support that asthma is associated with a decreased risk of UBC, especially among aggressive tumors. Further work on the relationship between asthma and other atopic conditions and cancer risk should shed light on the relationship between immune response mechanisms and bladder carcinogenesis.
Collapse
|
125
|
Martinez Saez O, Barquín García AM, Villamayor Delgado M, Saavedra Serrano C, Corral de la Fuente E, Serrano Domingo JJ, Martín Huertas R, Reguera Puertas P, LONGO FEDERICO, Pachon V, Rodríguez Garrote M, Guillen C, Carrato A, Ferreiro Monteagudo R. Impact of adding oxaliplatin to fluoropyrimidines in the adjuvant colon cancer: Experience in Ramon y Cajal University Hospital. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
815 Background: The addition of oxaliplatin to fluorouracil and leucovorin as adjuvant therapy for patients with stage II and III colon cancer (CC) has been analyzed in two large, randomized trials, MOSAIC and C-07 trials. The updated results of these studies showed that the addition of oxaliplatin enhances overall survival by approximately 5% in patients with stage III disease but has no effect in patients with stage II disease. Methods: We retrospectively included patients with stage II and III CC that were operated between 2009 and 2014 in the Ramón y Cajal University Hospital from Madrid. We perform a multivariable Cox model analysis to estimate the benefit of the chemotherapy stratifying by oxaliplatin in each stage. The model was further adjusted by including the following confounders: ECOG-PS, number of removed nodes, perforation, obstruction, grade and age. Stata 13.1 was used to analyze the data. Results: 564 patients were identified (281 stage II and 283 stage III). 305 did not receive any chemotherapy, 61 received monotherapy with fluoropyrimidines (FP) and 198, FP and oxaliplatin. The median follow-up in the entire cohort was 49 months. Globally, adjuvant chemotherapy (either with FP alone or with the combination with oxaliplatin) showed no benefit in DFS (HR of 1.18 and 0.98, respectively). The benefit in OS was significant either for FP alone (HR: 0.46, p: 0.029) and for the combination treatment (HR: 0.41, p: 0.001). Patients with stage II treated with FP in monotherapy showed no benefit, neither in DFS nor OS (HR for DFS: 2.2, p: 0.1; HR for OS: 0.5, p: 0.22). The benefit was neither seen with the addition of oxaliplatin (HR for DFS: 2, p: 0.11; HR for OS: 0.85, p: 0.7). Stage III patients treated with FP presented a HR for DFS of 0.76 (p: 0.5) and a HR for OS of 0.42 (p: 0.087). The HR for DFS with oxaliplatin was 0.53 (p: 0.07). A significant improvement in OS was observed, with a HR of 0.22 (p < 0.001). Conclusions: The addition of oxaliplatin in the adjuvant treatment of stage III patients showed a trend towards improvement in DFS and a significant benefit in OS compared to not receiving chemotherapy. On the contrary, patients with stage II did not benefit from this treatment, neither in DFS nor OS.
Collapse
|