Equity in local health: participatory tool to assess physical and socioeconomic settings in Spain

To address local health with a focus on equity and social determinants in a participative way, an intersectoral health analysis must be within reach, with the participation of citizens in every step of the process, as well as the support and commitment of policy-makers. Tools that allow collective evaluation of the people's places and organized data collection are also required.

In June of 2019, the translation and transcultural adaptation of the Place Standard Tool, as well as its validation in two municipalities was launched to have available a Spanish tool to evaluate places focusing on equity and social determinants, including equity in all the phases of the assessment process of the territory, promote and facilitate participation of vulnerable populations in every step, analyze results and interventions taking into account axes of inequality, build capacity at different levels, and address the resulting health necessities with an intersectoral focus on social determinants.

A Spanish participatory tool with a focus on social determinants was validated. Equity was addressed through focus groups consisting of vulnerable people, analyzing the results by axes of inequality. The participation of citizens was included in the place assessment, and in the prioritization of actions to be developed in the areas with the worst evaluation. An intersectoral group is currently working on the planning of the proposed actions. The first action is a plan to foster the use of bicycles and a mobility analysis to improve urban transportation.

The tool allows the participatory place assessment, and facilitates the connection of results and interventions to social determinants of health. It offers organized results which facilitates the intersectoral approach of derived interventions. The support of policy-makers is essential to carry out actions that impact social determinants of health, and to avoid creating false expectations among the citizens.

Outcomes of single versus double hormone receptor-positive breast cancer. A GEICAM/9906 sub-study

BACKGROUND

Retrospective data suggest better outcomes for patients with double hormonal receptor (oestrogen [ER] and progesterone receptor [PgR])-positive (dHR+) early breast cancer, compared with single hormonal receptor-positive, sHR+, (ER+/PgR- or ER-/PgR+) disease. Here, we evaluate the classification according to intrinsic subtypes and clinical outcomes of sHR+ versus dHR+ in HER2-negative breast cancer patients enrolled in GEICAM/9906 study (NCT00129922).

METHODS

Archival tumours were retrieved retrospectively for the analysis of ER, PgR and HER2 status and classified into intrinsic subtypes using the PAM50 gene expression assay. Disease-free survival (DFS) and overall survival (OS) were explored using a Cox proportional hazard analysis.

RESULTS

Data on intrinsic subtypes were available in 571 (50%) patients with ER+ and/or PR+, and HER2-negative primary tumours. The incidence of luminal A and luminal B subtypes were 52%/36% in dHR+ tumours (ER+/PgR+), and 15%/58% in ER+/PgR-tumours. ER-/PgR+ tumours were mainly luminal A (52%). Compared with ER+/PgR+ patients, DFS was similar in ER-/PgR+ (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.57-2.34, p = 0.70) but worse in ER+/PgR- patients (HR 1.60, 95% CI 1.12-2.28, p < 0.01). Similar results were observed for OS (HR 1.50, p = 0.30 and HR 1.86, p < 0.01, respectively).

CONCLUSIONS

The ER+/PgR- group is characterised by higher proliferation and worse outcomes. In spite of the ER-/PgR+ subgroup resembles ER+/PgR+ disease in terms of molecular subtypes and outcomes, the small number of patients in this subgroup prevents from drawing any conclusions.

TRIAL REGISTRATION

EudraCT: 2005-003108-12 (retrospectively registered 28/06/2005). CLINICALTRIALS.

GOV IDENTIFIER

NCT00129922 (retrospectively registered 10/08/2005).

Abstract P4-20-01: Implications of financial modeling in breast cancer clinical research from 1990 to 2010

SUMMARY: Over the past two decades significant progress has been made in breast cancer treatment resulting in a substantial improvement in patients' outcome. But we have to think about who promotes all this research and the consequences of the type of fundingThis project aims to evaluate the implication of finance in clinical research and the variance according to the type of funding.

OBJETIVES: To evaluate the financial evolvement of breast cancer clinical trials in the past two decades, regarding the phase of development design of the studies, the collaboration between Academy (Acad) and Industry (Ind), the sample size, the study results and the statistical analyses conducted.

METHODS: A systematic review was performed using MEDLINE to identify breast cancer randomized clinical trials published between January1990 and December2010. Studies that involved chemotherapy, endocrine and/or targeted therapies, wherethe primary endpoint was considered adequate to support a drug approval in oncology according to the FDA and EMA (U.S. Food and Drug Administration and European Medicines Agency, respectively), were included.

RESULTS:Data were evaluated 2,211 and 472 met selection criteria comprised in the methodology During the first decade the Acad was the main breast cancer research promoter being replaced by the Inv. throughout the second decade (p &lt;0.0001). Thirty nine percent of the studies evaluated were phase III (39% Acad, 61% Ind), 15% were phase II (30% Acad, 70% Ind) and the remaining 47% were not classified by authors (65% Acad 35% Ind). As for the primary endpoint, 25% of the phase III trials evaluated progression free survival, 15% overall response rate, 1% time to progression and only 5% examined overall survival. Sixty five percent of the trials were national (60% Acad 40% Ind) and 35% international (25% Acad 75% Ind). Single-center studies accounted for 11% of the trial (65% Acad 35% Ind). Most of the national trials were developed by the US. Fifty four percent of the studies were conducted by research groups (67% supported by Ind. and 33% Acad.). The Ind sponsored 26% of the studies in the first decade and 50% during the second. The median number of patients enrolled by research groups was 892 in contrast with 409 included by other organizations. The primary endpoint was achieved in 19% of the Acad trials and 21% of the Ind trials. Only 53% of the studies declared intention to treat based analysis in their statistical workout.

RESULTS  ACADEMY(%)INDUSTRY (%)PPROMOTION OF THE STUDY1990-2000121(26)68(14)0,0001 2001-2010105(22)178(38)0,0001STUDY DESIGNUNICENTRIC TRIALS34(7)18(4)0,007 MULTICENTRIC TRIALS191(40)228(48)  NATIONAL TRIALS183(39)122(26)0,0001 INTERNATIONAL TRIALS42(9)124(26)  COOPERATIVE GROUP95(20)160(34)  NOT COOPERATIVE GROUP130(28)86(18) STATISTICAL ANALYSISINTENT OF TREAT86(18)163(35)  NOT DECLARATED140(30)83(18) 

CONCLUSIONS:There is a significant tendency towards the promotion of research by the pharmaceutical industries during the last two decades, leading a change in the clinical trials design and the endpoints.

Citation Format: Jerez Y, Lopez-Tarruella S, Marquez-Rodas I, Perez S, Ocaña A, Echavarria I, Lobo M, Gallego I, Torres G, Ortega L, Garcia G, Palomero I, Gonzalez Del Val R, Massarrah T, Esteban M, Del Monte-Millan M, Martin M. Implications of financial modeling in breast cancer clinical research from 1990 to 2010 [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-20-01.

Abstract OT3-01-02: A phase I-II trial of dasatinib in combination with trastuzumab (T) and paclitaxel in the first line treatment of HER2 positive metastatic breast cancer (MBC) patients: GEICAM/2010-04

Background: Resistance to targeted-therapies is a current problem in our clinical practice. In HER2 overexpressing tumors, resistance to trastuzumab-based therapies is widely observed. Expression of SRC has been pre-clinically linked to trastuzumab resistance and the addition of the multi-tyrosine kinase inhibitor dasatinib to trastuzumab increases its antitumor activity (Seoane S, et al. J Natl Cancer Inst. 2010). On previous studies, Dasatinib showed a good toxicity profile, with low grade 3-4 toxicity rates (E. Mayer, et al. J Clin Oncol 2009). We have designed a phase I-II trial combining dasatinib with standard trastuzumab/paclitaxel. (ClinicalTrials.gov Identifier: NCT01306942). In this abstract we report the description of the phase II part of the trial which is ongoing.

Trial Design: Eligible patients must be HER2+ (evaluated by central laboratory and assessed by immunohistochemistry and fluorescent in-situ hybridization) MBC and candidates for trastuzumab + chemotherapy as first line treatment. Taxanes and trastuzumab administered in the adjuvant setting are permitted if given &gt;12 months before the inclusion. Patients with CNS involvement are eligible if treated and clinically stable without medication. Treatment consists of trastuzumab 2 mg/kg weekly (following a loading dose of 4 mg/kg in cycle 1), weekly paclitaxel (80 mg/m2, 3 weeks on-one week off) and dasatinib 100 mg once daily (based on the recommended phase II dose from the phase I part, Gil-Martin M, et al. European Breast Cancer Conference 2014, P-041) in a 28-days cycle. Patients are treated until radiologic or symptomatic progression or unacceptable toxicity.

The primary objective for this phase II is efficacy, measured by Objective Response Rate (ORR according to RECIST 1.1). Secondary objectives are: Safety (evaluated using NCI-CTCAE v 4.03), Clinical Benefit Rate, Time to Progression, Progression Free Survival and Response Duration. Pharmacodynamic biomarkers include pAKT, pS6, pSRC, pErk1/2 in tumor tissue samples, mononuclear cells in blood samples and in skin tissue. An additional exploratory objective is to evaluate the correlation between the early presence of lymphocytosis and efficacy. The study will be considered positive if ORR increases 25% from a 50% ORR observed in previous studies with paclitaxel + trastuzumab. We need to include 28 evaluable patients to demonstrate this hypothesis (with an alpha error of 0.05 and a statistical power of 80%), assuming a 10% drop-out rate. Twenty one patients have already been included. Recruitment is expected to finish by the end of 2015.

Citation Format: Ocaña A, Ruiz Borrego M, Gil-Martín M, Antolín S, Guerrero Á, Vidal Boixader L, Martín M, Trigo Pérez JM, Rojo F, Jerez Y, Atienza M, Pernas S, Hernando A, Carrasco E, Benito S, Caballero R, Pandiella A. A phase I-II trial of dasatinib in combination with trastuzumab (T) and paclitaxel in the first line treatment of HER2 positive metastatic breast cancer (MBC) patients: GEICAM/2010-04. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT3-01-02.

Effects of Thyme Extract Oils (from Thymus vulgaris, Thymus zygis, and Thymus hyemalis) on Cytokine Production and Gene Expression of oxLDL-Stimulated THP-1-Macrophages

Properties of thyme extracts from three different species (Thymus vulgaris, Thymus zygis, and Thymus hyemalis) were examined. Two oil fractions from each species were obtained by CO(2) supercritical fluid extraction. Main compounds presented in the supercritical extracts of the three thyme varieties were 1,8 cineole, thymol, camphor, borneol, and carvacrol. As a cellular model of inflammation/atherogenesis, we use human macrophages derived from THP-1 monocytes and activated by oxidized LDLs. These cells were incubated with the thyme fraction oils, and the productions and gene expressions of the inflammatory mediators TNF-α, IL-1B, IL-6, and IL-10 were determined. Thyme extracts significantly reduced production and gene expression of the proinflammatory mediators TNF-α, IL-1B, and IL-6 and highly increased these parameters on the anti-inflammatory IL-10 cytokine. Changes on production and gene expressions were dose dependent and according to the thyme content of each species. Taken together, these results may suggest that thyme extracts could have anti-inflammatory effects.

Synergic antitumoral effect of an IGF-IR inhibitor and trastuzumab on HER2-overexpressing breast cancer cells

BACKGROUND

Receptor tyrosine kinases play an important role in breast cancer. One of them, the type I insulin-like growth factor, has been linked to resistance to trastuzumab (Herceptin), an agent that targets human epidermal growth factor receptor 2. Here, we show that the insulin-like growth factor-I receptor (IGF-IR) antagonist NVP-AEW541 inhibits proliferation of breast cancer cells and synergizes with trastuzumab.

PATIENTS AND METHODS

Patient samples and breast cancer cell lines were evaluated for IGF-IR expression or activation by western blotting. 1-(4,5-Dimethylthiazol-2-yl)-3,5-diphenylformazan (MTT) uptake assays and Annexin V staining were used for the analyses of cell proliferation/apoptosis. Biochemical and genomic studies were carried out to gain insights into the mechanism of action of NVP-AEW541.

RESULTS

The IGF-IR was expressed above normal levels in a number of breast cancer samples. Activation of this receptor was inhibited by NVP-AEW541 that also decreased cell proliferation and increased apoptosis. NVP-AEW541 decreased the amount of pAkt and increased the level of p27. Combination studies with several drugs used in the breast cancer clinic showed that NVP-AEW541 synergistically increased the action of trastuzumab.

CONCLUSIONS

Our results show the anti-breast cancer action of NVP-AEW541 and support the clinical development of anti-IGF-IR agents, especially in combination with trastuzumab.

Targeting receptor tyrosine kinases and their signal transduction routes in head and neck cancer

Squamous cell carcinoma of the head and neck (SCCHN) is the sixth most common cancer in the world. At present several therapeutic approaches, including surgical removal, chemotherapy and radiotherapy, are used. Yet a significant number of patients relapse, often with metastases. In an attempt to improve treatment of SCCHN new targeted therapies are emerging. Among them special interest has been devoted to agents that act on the epidermal growth factor receptor (EGFR) and other receptor tyrosine kinases, or the signal transduction routes used by these receptors to induce tumour cell proliferation. Such treatments include monoclonal antibodies and small molecule inhibitors of either the intracellular tyrosine kinase activity of these receptors or relevant signalling intermediates. Here we review the biological bases of these new targeted treatments, with special emphasis on the clinical results that point to an implementation of these drugs into the therapeutic armamentarium against SCCHN.

Feasibility of pegfilgrastim as haematopoietic support for dose-dense every-2-week adjuvant chemotherapy in breast cancer

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Background: Dose-dense sequential chemotherapy has been safety supported with Filgrastim (F). Pegfilgrastim (PEGF) is a pegylated recombinant human granulocyte colony-stimulating factor (G-CSF) that has a long half-life, a fact that facilitates a less frequent dosing. Its safety and efficacy has been established in 21- and 28-days schedules. Methods: We have performed a retrospective analysis of medical records of 2 cohort of patients (n=38) treated at our institution between December 2003 and November 2005. All patients received Adriamicin 60 mg/m2 plus Ciclophosphamide 600 mg/m2 q2w for 4 cycles followed by Paclitaxel 175 mg/m2 q2w for 4 cycles. As G-CSF support, in Cohort A (n=29) PEGF was administered 6 mg on day 2 of each cycle and in Cohort B (n=9) F days 3 to 10 at 5 μg/kg. The primary end point was to explore the feasibility and safety in terms of febrile neutropenia (FN) events, number of treatment delays (TD), incidence of neutropenia grade 3 (NPG3) and 4 (NPG4) and mean absolute neutrophil count (ANC) on day 14 of cycle 1 to 7 for both groups. Indirect comparisons have been performed. Results: Patients characteristics in both cohorts were well balanced, except for age in cohort A compared with cohort B (44,89 versus 52,5, p = 0,02). FN events and TD were increased in cohort B compared with cohort A (22% versus 0%, p=0.051, both comparisons). No statistically significant difference in number of episodes of NPG3 and NPG4 was observed. Median ANC on day 14 for each treatment cycle was significantly greater for Cohort A than Cohort B, except for cycle 6. Conclusions: PEGF is very safe and efficacy in patients treated with dose-dense sequential adjuvant chemotherapy for breast cancer. It could be even more efficient than F in preventing febrile neutropenia events.

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Pegfilgrastim induces elevation of serum CA 15–3 in breast carcinoma patients after receiving dose-dense adjuvant chemotherapy

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Background: CA 15–3, an epytope related with MUC-1 gene products, is a well known tumour marker to predict early recurrent disease breast cancer. MUC-1 expression can be detected in neutrophil membrane and cytoplasm. It is known that patients with breast cancer who receive adjuvant chemotherapy with G-CSF support may show CA 15–3 false positive elevations Methods: We identified by medical records 76 patients who received adjuvant sequential chemotherapy for breast cancer consisted in Doxorubicin/Ciclophosphamide for 4 cycles followed by Paclitaxel for 4 cycles every-2 (with haematopoietic support with Pegfilgrastim (Cohort A, n=29) or Filgrastim (Cohort B, n=10)) and every-3-weeks without haematopoietic support (cohort C, n=37) between October 2003 and November 2005. Mean values of CA 15–3 recorded at the first follow up (FU) visit after treatment and number of patients with levels above the cut-off value of 40 U/mL were compared between the three patients cohorts. Correlation between CA 15–3 with alkaline phosphatase (AP) levels measured at first FU and with absolute neutrophil count (ANC) mean values measured on day 14 of every cycle were performed for each cohort Results: Patients characteristics between cohorts were well balanced except for age. A statistically significantly difference in median CA 15–3 post-treatment values were observed between Cohort A and C (34.01 versus 22.3, p=0.001), but no between Cohort A and B (34.01 versus 30.53). Eight patients in Cohort A, 2 in B and 1 in C had CA 15–3 levels above 40 UI/mL (27.6% versus 20% versus 2.7%, p=0.009). CA 15–3 decreased to normal values at subsequent visits. CA 15–3, mean ANC (r= 0.272, p= 0.020), and AP (r= 0.361, p= 0.002) were found associated each other when the whole database was analyzed Conclusions: These data provide evidence that Pegfilgrastim induces elevation of CA 15–3 level in comparison with patients treated without G-CSF support. This elevation may be related to the increased neutrophil counts. Physicians should be aware of this fact during the follow up to avoid unnecessary diagnostic workup.

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Effects of salinity on protein and lipopolysaccharide pattern in a salt-tolerant strain of Mesorhizobium ciceri

AIMS

To characterize the physiological and metabolic responses of Mesorhizobium ciceri strain ch-191 to salt stress, investigating the changes induced by salinity in protein and lipopolysaccharide profiles, as well as determining the accumulation of amino acids, glutamate and proline.

METHODS AND RESULTS

Strain ch-191 of M. ciceri was grown with different NaCl concentrations. Protein and lipopolysaccharide patterns were determined by electrophoresis. The strain ch-191 tolerated up to 200 mmol l-1 NaCl, although higher salt dosages limited its growth and induced changes in the protein profile. The most noteworthy change in the LPS-I pattern was the decrease in the slowest band and the appearance of an intermediate mobility band. The accumulation of proline in response to salt stress surpassed that of glutamate.

CONCLUSION

The protein profile showed major alterations at salinity levels which inhibited growth. However, the alterations in the LPS profile and accumulation of compatible solutes were evident from the lowest levels, suggesting that these changes may constitute adaptative responses to salt, allowing normal growth.

SIGNIFICANCE AND IMPACT OF THE STUDY

The selection and characterization of salt-tolerant strains, which also show efficient symbiotic performance under salinity, may constitute a strategy for improving Cicer arietinum-Mesorhizobium ciceri symbiosis in adverse environments.

A new species and new combinations of brevitobrilus tsalolikhin, 1981 (nematoda: tobrilidae) from Spain

A new species of Brevitobrilus Tsalolikhin, Brevitobrilus montanus n. sp., found in high mountain lakes and rivers in Granada, Spain, is described. Additional data on Brevitobrilus granatensis (Ocafia &Zullini, 1988) n. comb. are provided. Brevitobrilus raontanus n. sp. is characterized by moderate size (1.3-1.8 mm), amphid aperture width one-quarter the head width, subterminal seta distance from terminus four times the width of the terminal end of the tail, and supplements S5 and S6 separated. Tobrilus granatensis Ocafia &Zullini, 1988; Tobrilus sardus Vinciguerra &Zullini, 1991; and Tobrilus siculus Vinciguerra &Zullini, 1991 are all transferred to Brevitobrilus. Differences among the 13 species of Brevitobrilus are discussed.