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Hecht JR, Raman SS, Chan A, Kalinsky K, Baurain JF, Jimenez MM, Garcia MM, Berger MD, Lauer UM, Khattak A, Carrato A, Zhang Y, Liu K, Cha E, Keegan A, Bhatta S, Strassburg CP, Roohullah A. Phase Ib study of talimogene laherparepvec in combination with atezolizumab in patients with triple negative breast cancer and colorectal cancer with liver metastases. ESMO Open 2023; 8:100884. [PMID: 36863095 PMCID: PMC10163149 DOI: 10.1016/j.esmoop.2023.100884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 12/01/2022] [Accepted: 01/21/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Talimogene laherparepvec (T-VEC), a first-in-class oncolytic viral immunotherapy, enhances tumor-specific immune activation. T-VEC combined with atezolizumab, which blocks inhibitor T-cell checkpoints, could provide greater benefit than either agent alone. Safety/efficacy of the combination was explored in patients with triple negative breast cancer (TNBC) or colorectal cancer (CRC) with liver metastases. METHODS In this phase Ib, multicenter, open-label, parallel cohort study of adults with TNBC or CRC with liver metastases, T-VEC (106 then 108 PFU/ml; ≤4 ml) was administered into hepatic lesions via image-guided injection every 21 (±3) days. Atezolizumab 1200 mg was given on day 1 and every 21 (±3) days thereafter. Treatment continued until patients experienced dose-limiting toxicity (DLT), had complete response, progressive disease, needed alternative anticancer treatment, or withdrew due to an adverse event (AE). The primary endpoint was DLT incidence, and secondary endpoints included efficacy and AEs. RESULTS Between 19 March 2018 and 6 November 2020, 11 patients with TNBC were enrolled (safety analysis set: n = 10); between 19 March 2018 and 16 October 2019, 25 patients with CRC were enrolled (safety analysis set: n = 24). For the 5 patients in the TNBC DLT analysis set, no patient had DLT; for the 18 patients in the CRC DLT analysis set, 3 (17%) had DLT, all serious AEs. AEs were reported by 9 (90%) TNBC and 23 (96%) CRC patients, the majority with grade ≥3 [TNBC, 7 (70%); CRC, 13 (54%)], and 1 was fatal [CRC, 1 (4%)]. Evidence of efficacy was limited. Overall response rate was 10% (95% confidence interval 0.3-44.5) for TNBC; one (10%) patient had a partial response. For CRC, no patients had a response; 14 (58%) were unassessable. CONCLUSIONS The safety profile reflected known risks with T-VEC including risks of intrahepatic injection; no unexpected safety findings from addition of atezolizumab to T-VEC were observed. Limited evidence of antitumor activity was observed.
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Affiliation(s)
- J R Hecht
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Santa Monica, USA.
| | - S S Raman
- Department of Radiology, David Geffen School of Medicine at UCLA, Santa Monica, USA
| | - A Chan
- Breast Cancer Research Centre - WA & Curtin University, Perth Breast Cancer Institute Hollywood Consulting Centre, Nedlands, Australia
| | - K Kalinsky
- Emory Winship Cancer Institute, Atlanta, USA
| | - J-F Baurain
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - M M Jimenez
- Hospital General Universitario Gregorio Marañon, Universidad Complutense, CIBERONC, Madrid, Spain
| | - M M Garcia
- Department of Medical Oncology, Hospital del Mar, CIOCC Barcelona, CIBERONC, Barcelona, Spain
| | - M D Berger
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - U M Lauer
- Department of Medical Oncology and Pneumology, Virotherapy Center Tübingen, University Hospital Tübingen, Tübingen, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), partner site Tübingen, Tübingen, Germany
| | - A Khattak
- Fiona Stanley Hospital & Edith Cowan University, Perth, Australia
| | - A Carrato
- Medical Oncology Department, Ramon y Cajal University Hospital, Alcala University, IRYCIS, CIBERONC, Madrid, Spain; Pancreatic Cancer Europe Chairman, Brussels, Belgium
| | - Y Zhang
- Virginia Oncology Associates, Norfolk, USA
| | - K Liu
- Amgen Inc., Thousand Oaks, USA
| | - E Cha
- Genentech, South San Francisco, USA
| | | | | | - C P Strassburg
- Department of Medicine I, University Hospital Bonn, Medical Clinic and Polyclinic I, Bonn, Germany
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Rosato V, Gómez-Rubio P, Molina-Montes E, Márquez M, Löhr M, O'Rorke M, Michalski CW, Molero X, Farré A, Perea J, Kleeff J, Crnogorac-Jurcevic T, Greenhalf W, Ilzarbe L, Tardón A, Gress T, Barberá VM, Domínguez-Muñoz E, Muñoz-Bellvís L, Balsells J, Costello E, Iglesias M, Kong B, Mora J, O'Driscoll D, Poves I, Scarpa A, Ye W, Hidalgo M, Sharp L, Carrato A, Real FX, La Vecchia C, Malats N. Gallbladder disease and pancreatic cancer risk: a multicentric case-control European study. Eur J Cancer Prev 2021; 30:423-430. [PMID: 34545020 DOI: 10.1097/cej.0000000000000588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS The overall evidence on the association between gallbladder conditions (GBC: gallstones and cholecystectomy) and pancreatic cancer (PC) is inconsistent. To our knowledge, no previous investigations considered the role of tumour characteristics on this association. Thus, we aimed to assess the association between self-reported GBC and PC risk, by focussing on timing to PC diagnosis and tumour features (stage, location, and resection). METHODS Data derived from a European case-control study conducted between 2009 and 2014 including 1431 PC cases and 1090 controls. We used unconditional logistic regression models to estimate odds ratios (ORs) and corresponding 95% confidence intervals (CIs) adjusted for recognized confounders. RESULTS Overall, 298 (20.8%) cases and 127 (11.6%) controls reported to have had GBC, corresponding to an OR of 1.70 (95% CI 1.33-2.16). The ORs were 4.84 (95% CI 2.96-7.89) for GBC diagnosed <3 years before PC and 1.06 (95% CI 0.79-1.41) for ≥3 years. The risk was slightly higher for stage I/II (OR = 1.71, 95% CI 1.15-2.55) vs. stage III/IV tumours (OR = 1.23, 95% CI 0.87-1.76); for tumours sited in the head of the pancreas (OR = 1.59, 95% CI 1.13-2.24) vs. tumours located at the body/tail (OR = 1.02, 95% CI 0.62-1.68); and for tumours surgically resected (OR = 1.69, 95% CI 1.14-2.51) vs. non-resected tumours (OR = 1.25, 95% CI 0.88-1.78). The corresponding ORs for GBC diagnosed ≥3 years prior PC were close to unity. CONCLUSION Our study supports the association between GBC and PC. Given the time-risk pattern observed, however, this relationship may be non-causal and, partly or largely, due to diagnostic attention and/or reverse causation.
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Affiliation(s)
- V Rosato
- Unit of Medical Statistics and Biometry, National Cancer Institute, IRCCS Foundation, Milan, Italy
| | - P Gómez-Rubio
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid
- CIBERONC, Spain
| | - E Molina-Montes
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid
- CIBERONC, Spain
| | - M Márquez
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid
- CIBERONC, Spain
| | - M Löhr
- Gastrocentrum, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - M O'Rorke
- Centre for Public Health, Belfast, Queen's University Belfast, Belfast, UK
| | - C W Michalski
- Department of Surgery, Technical University of Munich, Munich
- Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - X Molero
- Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Barcelona, Universitat Autònoma de Barcelona, Barcelona
- CIBEREHD
| | - A Farré
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona
| | - J Perea
- Department of Surgery, University Hospital 12 de Octubre
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - J Kleeff
- Department of Surgery, Technical University of Munich, Munich
- Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - T Crnogorac-Jurcevic
- Barts Cancer Institute, Centre for Molecular Oncology, Queen Mary University of London, John Vane Science Centre, London
| | - W Greenhalf
- Department of Molecular and Clinical Cancer Medicine, The Royal Liverpool University Hospital, Liverpool, UK
| | - L Ilzarbe
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid
- Hospital del Mar-Parc de Salut Mar, Barcelona
| | - A Tardón
- Department of Medicine, Instituto Universitario de Oncología del Principado de Asturias, Oviedo
- CIBERESP, Spain
| | - T Gress
- Department of Gastroenterology, University Hospital of Giessen and Marburg, Marburg, Germany
| | - V M Barberá
- Molecular Genetics Laboratory, General University Hospital of Elche
| | - E Domínguez-Muñoz
- Department of Gastroenterology, University Clinical Hospital of Santiago de Compostela
| | - L Muñoz-Bellvís
- General and Digestive Surgery Department, Salamanca University Hospital, Elche, Santiago de Compostela, and Salamanca, Spain
| | - J Balsells
- Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Barcelona, Universitat Autònoma de Barcelona, Barcelona
- CIBEREHD
| | - E Costello
- Department of Molecular and Clinical Cancer Medicine, The Royal Liverpool University Hospital, Liverpool, UK
| | - M Iglesias
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid
- Hospital del Mar-Parc de Salut Mar, Barcelona
| | - Bo Kong
- Department of Surgery, Technical University of Munich, Munich
| | - J Mora
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona
| | - D O'Driscoll
- National Cancer Registry Ireland and HRB Clinical Research Facility, University College Cork, Cork, Ireland
| | - I Poves
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid
- Hospital del Mar-Parc de Salut Mar, Barcelona
| | - A Scarpa
- ARC-Net centre for Applied Research on Cancer and Department of Pathology and Diagnostics, University and Hospital trust of Verona, Verona, Italy
| | - W Ye
- Gastrocentrum, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - M Hidalgo
- Madrid-Norte-Sanchinarro Hospital, Madrid, Spain
| | - L Sharp
- National Cancer Registry Ireland and HRB Clinical Research Facility, University College Cork, Cork, Ireland
- Newcastle University, Institute of Health & Society, Newcastle, UK
| | - A Carrato
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid
- Department of Oncology, Ramón y Cajal University Hospital, IRYCIS, Alcala University
| | - F X Real
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid
- Epithelial Carcinogenesis Group
- Spanish National Cancer Research Centre (CNIO), Madrid
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - C La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - N Malats
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid
- CIBERONC, Spain
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Gómez-España MA, Montes AF, Garcia-Carbonero R, Mercadé TM, Maurel J, Martín AM, Pazo-Cid R, Vera R, Carrato A, Feliu J. SEOM clinical guidelines for pancreatic and biliary tract cancer (2020). Clin Transl Oncol 2021; 23:988-1000. [PMID: 33660222 PMCID: PMC8058005 DOI: 10.1007/s12094-021-02573-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 11/10/2022]
Abstract
Pancreatic cancer (PC) and biliary tract cancer (BTC) are both aggressive and highly fatal malignancies. Nowadays we have a profound knowledge about the molecular landscape of these neoplasms and this has allowed new therapeutic options. Surgery is the only potentially curative therapy in both cancers, but disease recurrence is frequent. In PC, adjuvant treatment with mFOLFIRINOX has improved overall survival (OS) and in BTC adjuvant treatment with capecitabine seems to improve OS and relapse-free survival. Concomitant radio-chemotherapy could also be considered following R1 surgery in both neoplasms. Neoadjuvant treatment represents the best option for achieving an R0 resection in borderline PC. Upfront systemic chemotherapy is the treatment of choice in unresectable locally advanced PC and BTC; then locoregional therapy could be considered after an initial period of at least 3-4 months of systemic chemotherapy. In metastatic PC, FOLFIRINOX or Gemcitabine plus nab-paclitaxel have improved OS compared with gemcitabine alone. In metastatic BTC, cisplatin plus gemcitabine constitute the standard treatment. Progress in the knowledge of molecular biology has enabled the identification of new targets for therapy with encouraging results that could in the future improve the survival and quality of life of patients with PC and BTC.
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Affiliation(s)
- Mª A. Gómez-España
- Medical Oncology Department, Hospital Universitario Reina Sofía, IMIBIC, CIBERONC, Córdoba, Spain
| | - A. F. Montes
- Medical Oncology Department, Complexo Hospitalario Universitario de Ourense (CHUO), Orense, Spain
| | - R. Garcia-Carbonero
- Medical Oncology Department, Hospital Universitario, UCM, CNIO, CIBERONC, 12 de Octubre, IIS imas12, Madrid, Spain
| | - T. M. Mercadé
- Medical Oncology Department, Hospital Universitari Vall D´Hebron, Barcelona, Spain
| | - J. Maurel
- Medical Oncology Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - A. M. Martín
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - R. Pazo-Cid
- Medical Oncology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - R. Vera
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - A. Carrato
- Medical Oncology Department, Hospital Universitario Ramón Y Cajal, Alcala University, IRYCIS, CIBERONC, Madrid, Spain
| | - J. Feliu
- Medical Oncology Department, Hospital Universitario La Paz, CIBERONC, IDIPAZ, Madrid, Spain
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Gil M, Rodríguez DR, Fuente ECDL, Huertas RM, Sanz L, Pozas J, Ballesteros P, Fernandez VA, Perez JC, Vaz M, Delgado MV, Fuentes R, Olmos VP, Puertas PR, Garrote MR, Monteagudo RF, Carrato A, Longo F, Domingo JS. P-187 Impact on survival of local complications in pancreatic cancer: Experience at the Ramón y Cajal University Hospital (HURyC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Aranda E, Polo E, Camps C, Carrato A, Díaz-Rubio E, Guillem V, López R, Antón A. Treatment patterns for metastatic colorectal cancer in Spain. Clin Transl Oncol 2020; 22:1455-1462. [PMID: 31974819 PMCID: PMC7381444 DOI: 10.1007/s12094-019-02279-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 12/19/2019] [Indexed: 11/27/2022]
Abstract
Purpose The primary aim of this retrospective study was to describe the treatment patterns according to the type of treatment received by patients with metastatic colorectal cancer (mCRC) in Spain. Methods This was a retrospective, observational, multicenter study performed by 33 sites throughout Spain that included consecutive patients aged 18 years or older who had received or were receiving treatment for mCRC. Results At the time of inclusion, of the 873 evaluable patients, 507 (58%) had received two lines, 235 (27%) had received three lines, 106 (12%) had received four lines, and the remaining patients had received up to ten lines. The most frequent chemotherapy schemes were the FOLFOX or CAPOX regimens (66%) for first-line treatment, FOLFOX, CAPOX or FOLFIRI (70%) for second-line treatment, and FOLFOX, FOLFIRI or other fluoropyrimidine-based regimens for third- and fourth-line (over 60%) treatment. Sixty percent of patients received targeted therapy as part of their first-line treatment, and this proportion increased up to approximately 70% of patients as part of the second-line of treatment. A relevant proportion of patients were treated with unknown KRAS, and especially the BRAF, mutation statuses. Conclusions This study reveals inconsistencies regarding adherence to the recommendations of the ESMO guidelines for the management of mCRC in Spain. Improved adherence to the standard practice described in such guidelines for the determination of RAS and BRAF mutation statuses and the use of targeted therapies in first-line treatment should be considered to guarantee that patients can benefit from the best therapeutic approaches available.
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Affiliation(s)
- E Aranda
- Oncology Department, Maimonides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, Córdoba, Spain. .,CIBERONC, Instituto de Salud Carlos III, Madrid, Spain. .,Oncology Dapartment, Hospital Universitario Reina Sofía, Av. Menendez Pidal, s/n, 14004, Córdoba, Spain.
| | - E Polo
- Medical Oncology Department, Miguel Servet University Hospital, IIS Aragón, Zaragoza, Spain
| | - C Camps
- Molecular Oncology Laboratory, Fundación Investigación Hospital General Universitario de Valencia, Valencia, Spain.,CIBERONC, Valencia, Spain.,Department of Medical Oncology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.,Department of Medicine, Universitat de Valencia, Valencia, Spain
| | - A Carrato
- CIBERONC, Instituto de Salud Carlos III, Madrid, Spain.,Medical Oncology, Ramón y Cajal Universtity Hospital, IRYCIS, Alcalá University, Madrid, Spain
| | - E Díaz-Rubio
- CIBERONC, Instituto de Salud Carlos III, Madrid, Spain.,Medical Oncology, Hospital Clínico San Carlos, Madrid, Spain
| | - V Guillem
- Medical Oncology Department, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - R López
- CIBERONC, Instituto de Salud Carlos III, Madrid, Spain.,Servicio de Oncología Médica y Grupo de Oncología Médica Traslacional (Oncomet), Hospital Clínico Universitario e Instituto de Investigación Sanitaria (IDIS) de Santiago, Santiago de Compostela, Spain
| | - A Antón
- Medical Oncology Department, Miguel Servet University Hospital, IIS Aragón, Zaragoza, Spain
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Serrano Domingo J, Martín Huertas R, Corral de la Fuente E, Barquín García A, Saavedra Serrano C, Albarrán Artahona V, Reguera Puertas P, Fuentes R, Ferreiro Monteagudo R, Olmos VP, Vaz M, Villamayor Delgado M, Rodriguez Garrote M, Carrato A, Longo Muñoz F. Impact on survival of local complications in Pancreatic Cancer: experience at the Ramón y Cajal University Hospital (HURyC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Martín Huertas R, Longo Muñoz F, Serrano Domingo J, Corral de la Fuente E, Pachón Olmos V, Rodriguez Garrote M, Fuentes R, Ferreiro Monteagudo R, Vaz M, Carrato A. Locally advanced unresectable or metastatic pancreatic adenocarcinoma in patients under 65 years with good performance status (PS) at Ramón y Cajal University Hospital in Madrid. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Longo Muñoz F, Castillo Trujillo O, Serrano Domingo J, Martín Huertas R, Corral de la Fuente E, San Juan A, Portela J, Cano J, Reguera Puertas P, Rodriguez Garrote M, Izquierdo Manuel M, Jimenez Fonseca P, Carrato A, Aranda E. FOLFIRINOX versus Nab-paclitaxel plus gemcitabine in the first-line chemotherapy for patients with advanced pancreatic ductal adenocarcinoma: a multivariate analysis of prognostic factors in a national cohort (Comunica-TTD working group). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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9
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Carrato A, Benavides M, Massutí B, Ferreiro-Monteagudo R, García Alfonso P, Falcó E, Reboredo M, Cano T, Gallego J, Viéitez JM, Layos L, Salud A, Polo E, Dotor E, Durán-Ogalla G, Rodriguez-Garrote M, Calvo A, Grande E, Aranda E. First-line single-agent regorafenib in frail patients with metastatic colorectal cancer: a pilot phase II study of the Spanish Cooperative Group for the Treatment of Digestive Tumours (TTD). BMC Cancer 2019; 19:533. [PMID: 31159765 PMCID: PMC6547483 DOI: 10.1186/s12885-019-5753-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 05/27/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Treatment of frail patients with advanced colorectal cancer (CRC) is controversial. This pilot phase II trial aimed to assess the efficacy and safety of regorafenib when administered in first-line to frail patients with advanced CRC. METHODS Frail patients without prior advanced colorectal cancer treatment were included in the study. Definition of frailty was defined per protocol based on dependency criteria, presence of chronic comorbid pathologies and/or geriatric features. MAIN OBJECTIVE to assess progression-free survival (PFS) rate at 6 months. Treatment consisted of 28-day cycles of orally administered regorafenib 160 mg/day (3 weeks followed by 1 week rest). RESULTS Forty-seven patients were included in the study. Median age was 81 years (range 63-89). Frailty criteria: dependency was observed in 26 patients (55%), comorbidities in 27 (57%) and geriatric features in 18 (38%). PFS rate at 6 months was 45% (95% confidence interval [CI] 30-60]. Median PFS was 5.6 months (95%CI 2.7-8.4). Median overall survival (OS) was 16 months (95%CI 7.8-24). Complete response, partial response and stable disease were observed in one, two and 21 patients respectively (objective response rate 6.4%; disease control rate 51%). Thirty-nine patients (83%) experienced grade 3-4 adverse events (AEs). The most common grade 3-4 AEs were hypertension (15 patients; 32%), asthenia (14; 30%), hypophosphatemia (6; 13%); diarrhea (4; 8%), hand-foot-skin reaction (4; 8%). There were two toxic deaths (4.2%) (grade 5 rectal bleeding and death not further specified). Dose reduction was required in 26 patients (55%) and dose-delays in 13 patients (28%). CONCLUSIONS The study did not meet the pre-specified boundary of 55% PFS rate at 6 months. Toxicity observed (83% patients experienced grade 3 and 4 AEs) preclude its current use in clinical practice on this setting. Disease control rate and overall survival results are interesting and might warrant further investigation to identify those who benefit from this approach. TRIAL REGISTRATION This trial was prospectively registered at EudraCT ( 2013-000236-94 ). Date of trial registration: April 9th, 2013.
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Affiliation(s)
- A. Carrato
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERONC, Alcala University, Ctra. De Colmenar Viejo, km 9,100, 28034 Madrid, Spain
| | - M. Benavides
- Hospital Regional Universitario Virgen de la Victoria, Málaga, Spain
| | - B. Massutí
- Hospital General Universitario de Alicante, Alicante, Spain
| | - R. Ferreiro-Monteagudo
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERONC, Alcala University, Ctra. De Colmenar Viejo, km 9,100, 28034 Madrid, Spain
| | | | - E. Falcó
- Hospital Son Llatzer, Mallorca, Spain
| | - M. Reboredo
- Complejo Hospitalario Universitario A Coruña, La Coruña, Spain
| | - T. Cano
- Hospital Universitario Reina Sofia, IMIBIC, University of Córdoba, CIBERONC, Instituto de Salud Carlos III, Córdoba, Spain
| | - J. Gallego
- Hospital General Universitario de Elche, Alicante, Spain
| | - J. M. Viéitez
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - L. Layos
- Hospital Germans Trias i Pujol, ICO, Badalona, Spain
| | - A. Salud
- Hospital de Lleida Arnau de Vilanova, Lérida, Spain
| | - E. Polo
- Hospital Miguel Servet, Zaragoza, Spain
| | - E. Dotor
- Corporació Sanitària Parc Taulí, Barcelona, Spain
| | - G. Durán-Ogalla
- Hospital Regional Universitario Virgen de la Victoria, Málaga, Spain
| | - M. Rodriguez-Garrote
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERONC, Alcala University, Ctra. De Colmenar Viejo, km 9,100, 28034 Madrid, Spain
| | - A. Calvo
- Hospital Gregorio Marañón, Madrid, Spain
| | - E. Grande
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERONC, Alcala University, Ctra. De Colmenar Viejo, km 9,100, 28034 Madrid, Spain
| | - E. Aranda
- Hospital Universitario Reina Sofia, IMIBIC, University of Córdoba, CIBERONC, Instituto de Salud Carlos III, Córdoba, Spain
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Vidal J, Bellosillo B, Santos Vivas C, García-Alfonso P, Carrato A, Cano MT, García-Carbonero R, Élez E, Losa F, Massutí B, Valladares-Ayerbes M, Viéitez JM, Manzano JL, Azuara D, Gallego J, Pairet S, Capellá G, Salazar R, Tabernero J, Aranda E, Montagut C. Ultra-selection of metastatic colorectal cancer patients using next-generation sequencing to improve clinical efficacy of anti-EGFR therapy. Ann Oncol 2019; 30:439-446. [PMID: 30689692 DOI: 10.1093/annonc/mdz005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Extended RAS analysis is mandatory in metastatic colorectal cancer (mCRC) patients. The optimal threshold of RAS mutated subclones to identify patients most likely to benefit from antiepidermal growth factor receptor (EGFR) therapy is controversial. Our aim was to assess the clinical impact of detecting mutations in RAS, BRAF, PIK3CA and EGFRS492R in basal tissue tumour samples by using a highly sensitive next-generation sequencing (NGS) technology in mCRC patients treated with chemotherapy plus anti-EGFR or anti-vascular endothelial growth factor. PATIENTS AND METHODS Five hundred and eighty-one tumour samples from untreated mCRC patients from 7 clinical studies were collected. Mutational analysis was carried out by standard-of-care (therascreen pyro) with a sensitivity detection of 5% mutant allele fraction (MAF), and compared with NGS technology using 454GS Junior platform (Roche Applied Science, Germany) with a sensitivity of 1%. Molecular results were correlated with clinical outcomes. RESULTS After quality assessment, 380 samples were evaluable for molecular analysis. Standard-of-care mutational analysis detected RAS, BRAFV600E or PIK3CA mutations in 56.05% of samples compared with 69.21% by NGS (P = 0.00018). NGS identified coexistence of multiple low-frequency mutant alleles in 96 of the 263 mutated cases (36.5%; range 2-7). Response rate (RR), progression-free survival (PFS) and overall survival (OS) were increasingly improved in patients with RAS wild-type, RAS/BRAF wild-type or quadruple (KRAS/NRAS/BRAF/PIK3CA) wild-type tumours treated with anti-EGFR, assessed by standard-of-care. No additional benefit in RR, PFS or OS was observed by increasing the detection threshold to 1% by NGS. An inverse correlation between the MAF of the most prevalent mutation detected by NGS and anti-EGFR response was observed (P = 0.039). EGFRS492Rmutation was not detected in untreated samples. CONCLUSIONS No improvement in the selection of patients for anti-EGFR therapy was obtained by adjusting the mutation detection threshold in tissue samples from 5% to 1% MAF. Response to anti-EGFR was significantly better in patients with quadruple wild-type tumours.
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Affiliation(s)
- J Vidal
- Medical Oncology Department, Hospital del Mar-IMIM, CIBERONC Instituto de Salud Carlos III, Barcelona
| | - B Bellosillo
- Pathology Department, Hospital del Mar, Barcelona
| | - C Santos Vivas
- Translational Research Laboratory, Medical Oncology Department, Catalan Institute of Oncology (ICO), ICO-Bellvitge Biomedical Research Institute (IDIBELL)-CIBERONC Instituto de Salud Carlos III, L'Hospitalet de Llobregat, Barcelona
| | | | - A Carrato
- Medical Oncology Department, Hospital Ramón y Cajal, IRYCIS, CIBERONC Instituto de Salud Carlos III, Alcala University, Madrid
| | - M T Cano
- Medical Oncology Department, IMIBIC, Reina Sofía Hospital, University of Cordoba, CIBERONC Instituto de Salud Carlos III
| | - R García-Carbonero
- Oncology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre, (imas12), UCM, CNIO, CIBERONC Instituto de Salud Carlos III, Madrid
| | - E Élez
- Medical Oncology Department, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), CIBERONC Instituto de Salud Carlos III, Universitat Autònoma de Barcelona, Barcelona
| | - F Losa
- Medical Oncology Department, Hospital Sant Joan Despí - Moisés Broggi, Barcelona
| | - B Massutí
- Medical Oncology Department, Hospital General Universitario, Alicante
| | - M Valladares-Ayerbes
- Medical Oncology Department, Complejo Hospitalario Universitario de A Coruña, A Coruña
| | - J M Viéitez
- Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo
| | - J L Manzano
- Medical Oncology Department, ICO, Badalona, Barcelona
| | - D Azuara
- Translational Research Laboratory, Medical Oncology Department, Catalan Institute of Oncology (ICO), ICO-Bellvitge Biomedical Research Institute (IDIBELL)-CIBERONC Instituto de Salud Carlos III, L'Hospitalet de Llobregat, Barcelona
| | - J Gallego
- Medical Oncology Department, Hospital General Universitario de Elche, Alicante
| | - S Pairet
- Pathology Department, Hospital del Mar, Barcelona
| | - G Capellá
- Faculty of Medicine, Department of Clinical Sciences, Translational Research Laboratory, ICO-IDIBELL, L'Hospitalet de Llobregat, University of Barcelona, CIBERONC Instituto de Salud Carlos III, Barcelona, Spain
| | - R Salazar
- Translational Research Laboratory, Medical Oncology Department, Catalan Institute of Oncology (ICO), ICO-Bellvitge Biomedical Research Institute (IDIBELL)-CIBERONC Instituto de Salud Carlos III, L'Hospitalet de Llobregat, Barcelona
| | - J Tabernero
- Medical Oncology Department, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), CIBERONC Instituto de Salud Carlos III, Universitat Autònoma de Barcelona, Barcelona
| | - E Aranda
- Medical Oncology Department, IMIBIC, Reina Sofía Hospital, University of Cordoba, CIBERONC Instituto de Salud Carlos III
| | - C Montagut
- Medical Oncology Department, Hospital del Mar-IMIM, CIBERONC Instituto de Salud Carlos III, Barcelona.
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Taieb J, Carrato A, Westphalen B, Melisi D, Prager G, Macarulla Mercade T, Mellbring ÅB, d'Esquermes N, Ferreras A, de Jong F. First-line (1L) full dose (f) and modified (m) FOLFIRINOX and gemcitabine+nab-paclitaxel (GN) treatment (tx) for metastatic pancreatic adenocarcinoma (mPAC) patients (pts) in routine clinical practice across Europe. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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12
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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Affiliation(s)
- T Macarulla
- Dpt. Medical Oncology, Hospital Vall d'Hebrón, Barcelona, Spain.
| | - A Carrato
- Dpt. Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - R Díaz
- Dpt. Medical Oncology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - A García
- Dpt. Medical Oncology, Instituto Catalán de Oncología, de Girona, Spain
| | - B Laquente
- Dpt. Medical Oncology, Instituto Catalán de Oncología, L'Hospitalet de Llobregat, Barcelona, Spain
| | - J Sastre
- Dpt. Medical Oncology, Hospital Clínico Universitario San Carlos, Spain
| | - R Álvarez
- Dpt. Medical Oncology, Centro Integral Oncológico Clara Campal, Hospital Universitario Sanchinarro, Madrid, Spain
| | - A Muñoz
- Dpt. Medical Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M Hidalgo
- Dpt. Medical Oncology, Beth Israel Deaconess Medical Center, Boston, USA
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13
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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15
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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17
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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19
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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25
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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Affiliation(s)
- E Molina-Montes
- Spanish National Cancer Research Center (CNIO), Genetic and Molecular Epidemiology Group, Madrid, and CIBERONC, Spain
| | - P Gomez-Rubio
- Spanish National Cancer Research Center (CNIO), Genetic and Molecular Epidemiology Group, Madrid, and CIBERONC, Spain
| | - M Márquez
- Spanish National Cancer Research Center (CNIO), Genetic and Molecular Epidemiology Group, Madrid, and CIBERONC, Spain
| | - M Rava
- Spanish National Cancer Research Center (CNIO), Genetic and Molecular Epidemiology Group, Madrid, and CIBERONC, Spain
| | - M Löhr
- Karolinska Institutet and University Hospital, Gastrocentrum, Stockholm, Sweden
| | - C W Michalski
- Technical University of Munich, Department of Surgery, Munich, Germany
- University of Heidelberg, Department of Surgery, Heidelberg, Germany
| | - X Molero
- Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, and CIBEREHD, Spain
| | - A Farré
- Hospital de la Santa Creu i Sant Pau, Department of Gastroenterology, Barcelona, Spain
| | - J Perea
- University Hospital 12 de Octubre, Department of Surgery, Madrid, Spain
| | - W Greenhalf
- Royal Liverpool University Hospital, Department of Molecular and Clinical Cancer Medicine, Liverpool, UK
| | - L Ilzarbe
- Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | - M O'Rorke
- Queen's University Belfast, Centre for Public Health, Belfast, UK
| | - A Tardón
- Instituto Universitario de Oncología del Principado de Asturias, Department of Medicine, Oviedo, and CIBERESP, Spain
| | - T Gress
- University Hospital of Giessen and Marburg, Department of Gastroenterology, Marburg, Germany
| | - V M Barberà
- General University Hospital of Elche, Molecular Genetics Laboratory, Elche, Spain
| | - T Crnogorac-Jurcevic
- Barts Cancer Institute, Centre for Molecular Oncology, Queen Mary University of London, London, UK
| | - E Domínguez-Muñoz
- University Clinical Hospital of Santiago de Compostela, Department of Gastroenterology, Santiago de Compostela, Spain
| | - L Muñoz-Bellvís
- Salamanca University Hospital, General and Digestive Surgery Department, Salamanca, Spain
| | - J Balsells
- Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, and CIBEREHD, Spain
| | - E Costello
- Royal Liverpool University Hospital, Department of Molecular and Clinical Cancer Medicine, Liverpool, UK
| | - J Huang
- Karolinska Institutet and University Hospital, Gastrocentrum, Stockholm, Sweden
| | - M Iglesias
- Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | - J Kleeff
- Technical University of Munich, Department of Surgery, Munich, Germany
- Martin-Luther-University Halle-Wittenberg, Department of Visceral, Vascular and Endocrine Surgery, Halle (Saale), Germany
| | - Bo Kong
- Technical University of Munich, Department of Surgery, Munich, Germany
| | - J Mora
- Hospital de la Santa Creu i Sant Pau, Department of Gastroenterology, Barcelona, Spain
| | - L Murray
- Queen's University Belfast, Centre for Public Health, Belfast, UK
| | - D O'Driscoll
- National Cancer Registry Ireland and HRB Clinical Research Facility, University College Cork, Cork, Ireland
| | - I Poves
- Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | - A Scarpa
- ARC-Net Centre for Applied Research on Cancer and Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - W Ye
- Karolinska Institutet and University Hospital, Gastrocentrum, Stockholm, Sweden
| | - M Hidalgo
- Madrid-Norte-Sanchinarro Hospital, Madrid, Spain
| | - L Sharp
- National Cancer Registry Ireland and HRB Clinical Research Facility, University College Cork, Cork, Ireland
- Newcastle University, Institute of Health and Society, Newcastle upon Tyne, UK
| | - A Carrato
- Ramón y Cajal University Hospital, Department of Oncology, IRYCIS, Alcala University, Madrid, and CIBERONC, Spain
| | - F X Real
- Spanish National Cancer Research Centre (CNIO), Epithelial Carcinogenesis Group, Madrid, Universitat Pompeu Fabra, Departament de Ciències Experimentals i de la Salut, Barcelona, and CIBERONC, Spain
| | - N Malats
- Spanish National Cancer Research Center (CNIO), Genetic and Molecular Epidemiology Group, Madrid, and CIBERONC, Spain
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Gallego J, López C, Pazo-Cid R, López-Ríos F, Carrato A. Biomarkers in pancreatic ductal adenocarcinoma. Clin Transl Oncol 2017; 19:1430-1437. [PMID: 28616721 DOI: 10.1007/s12094-017-1691-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 05/24/2017] [Indexed: 12/18/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is currently the third most frequent form of malignancy. The role of biomarkers in the diagnostic and therapeutic strategy of cancer is constantly expanding. Translational research is already changing paradigms in tumours encompassing from early diagnosis to precision medicine in advanced disease. Nomenclature for molecular subtypes of tumours is gradually gaining acceptance and there are growing expectations it will further go from the bench to the bedside. However, the clinical relevance of biomarkers in PDAC is still far behind the relevance of biomarkers in other solid tumours. This article is part of a wider project (GALLgo) involving over forty specialists devoted to the multidisciplinary management of PDAC which concluded in recommendations based on scientific evidence. The aim of the present article is to review the diagnostic, prognostic and predictive biomarkers, either in localised or advanced disease, which have been lately subjected to study and analysis and others currently available for PDAC in order to give strength-graded recommendations linked to quality of evidence that can be used as guidelines in routine clinical practice.
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Affiliation(s)
- J Gallego
- Department of Medical Oncology, University Hospital of Elche, Camí de l'Almazara, 11, Elche, 03203, Alicante, Spain.
| | - C López
- Department of Medical Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - R Pazo-Cid
- Department of Medical Oncology, Hospital Universitario Miguel Servet, Saragossa, Spain
| | - F López-Ríos
- Department of Pathology, Laboratorio de Dianas Terapéuticas, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - A Carrato
- Department of Medical Oncology, Madrid, Spain
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Benavides M, Abad A, Carrato A, Gravalos C, Fernández-Montes A, Falcó E, González-Flores E, Garcia Garcia T, Martin-Valades J, Gallego Plazas J, Valladares-Ayerbes M, García-Girón C, Dueñas R, García-Tapiador A, Pericay C, Losa F, Viudez A, García-Teijido P, Diaz Rubio E, Aranda Aguilar E. Benefits of upfront primary tumour resection (UPTR) according to sidedness in mCRC: Retrospective analyses of TTD MACRO-2 and PLANET randomised trials. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Benavides M, Carrato A, Abad A, Guillen-Ponce C, Garcia-Alfonso P, Gil S, Cano Osuna M, Safont M, Gravalos C, Manzano-Mozo J, Sanchez A, Alcaide-Garcia J, López R, Massuti Sureda B, Sastre J, Martinez de Castro E, Escudero P, Méndez-Ureña M, Diaz Rubio E, Aranda Aguilar E. Impact of tumor location on the efficacy of first-line anti-EGFR monoclonal antibody plus chemotherapy in patients (pts) with metastatic colorectal cancer (mCRC): Retrospective analyses of the randomized MACRO-2 and PLANET trials from TTD Group. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Aranda E, Camps Herrero C, Khosravi P, Feyjoo M, Anton Torres A, Gascon P, Garcia Foncillas J, Diaz Rubio E, Guillem Porta V, Carrato A, Constenla Figueiras M, Cruz Hernandez J, López R. How do Spanish medical oncologists manage breakthrough pain? A national study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx388.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gomez-Rubio P, Rosato V, Márquez M, Bosetti C, Molina-Montes E, Rava M, Piñero J, Michalski CW, Farré A, Molero X, Löhr M, Ilzarbe L, Perea J, Greenhalf W, O'Rorke M, Tardón A, Gress T, Barberá VM, Crnogorac-Jurcevic T, Muñoz-Bellvís L, Domínguez-Muñoz E, Gutiérrez-Sacristán A, Balsells J, Costello E, Guillén-Ponce C, Huang J, Iglesias M, Kleeff J, Kong B, Mora J, Murray L, O'Driscoll D, Peláez P, Poves I, Lawlor RT, Carrato A, Hidalgo M, Scarpa A, Sharp L, Furlong LI, Real FX, La Vecchia C, Malats N. A systems approach identifies time-dependent associations of multimorbidities with pancreatic cancer risk. Ann Oncol 2017; 28:1618-1624. [PMID: 28383714 DOI: 10.1093/annonc/mdx167] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) is usually diagnosed in late adulthood; therefore, many patients suffer or have suffered from other diseases. Identifying disease patterns associated with PDAC risk may enable a better characterization of high-risk patients. METHODS Multimorbidity patterns (MPs) were assessed from 17 self-reported conditions using hierarchical clustering, principal component, and factor analyses in 1705 PDAC cases and 1084 controls from a European population. Their association with PDAC was evaluated using adjusted logistic regression models. Time since diagnosis of morbidities to PDAC diagnosis/recruitment was stratified into recent (<3 years) and long term (≥3 years). The MPs and PDAC genetic networks were explored with DisGeNET bioinformatics-tool which focuses on gene-diseases associations available in curated databases. RESULTS Three MPs were observed: gastric (heartburn, acid regurgitation, Helicobacter pylori infection, and ulcer), metabolic syndrome (obesity, type-2 diabetes, hypercholesterolemia, and hypertension), and atopic (nasal allergies, skin allergies, and asthma). Strong associations with PDAC were observed for ≥2 recently diagnosed gastric conditions [odds ratio (OR), 6.13; 95% confidence interval CI 3.01-12.5)] and for ≥3 recently diagnosed metabolic syndrome conditions (OR, 1.61; 95% CI 1.11-2.35). Atopic conditions were negatively associated with PDAC (high adherence score OR for tertile III, 0.45; 95% CI, 0.36-0.55). Combining type-2 diabetes with gastric MP resulted in higher PDAC risk for recent (OR, 7.89; 95% CI 3.9-16.1) and long-term diagnosed conditions (OR, 1.86; 95% CI 1.29-2.67). A common genetic basis between MPs and PDAC was observed in the bioinformatics analysis. CONCLUSIONS Specific multimorbidities aggregate and associate with PDAC in a time-dependent manner. A better characterization of a high-risk population for PDAC may help in the early diagnosis of this cancer. The common genetic basis between MP and PDAC points to a mechanistic link between these conditions.
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Affiliation(s)
- P Gomez-Rubio
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid, and CIBERONC, Spain
| | - V Rosato
- Branch of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro," Department of Clinical Sciences and Community Health, University of Milan, Milan
- Unit of Medical Statistics, Biometry and Bioinformatics, National Cancer Institute, IRCCS Foundation, Milan
| | - M Márquez
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid, and CIBERONC, Spain
| | - C Bosetti
- Department of Epidemiology, Mario Negri Institute for Pharmacological Research-IRCCS, Milan, Italy
| | - E Molina-Montes
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid, and CIBERONC, Spain
| | - M Rava
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid, and CIBERONC, Spain
| | - J Piñero
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute (IMIM), Pompeu Fabra Univeristy (UPF), Barcelona, Spain
| | - C W Michalski
- Department of Surgery, Technical University of Munich, Munich
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - A Farré
- Department of Gastroenterology, Santa Creu i Sant Pau Hospital, Barcelona
| | - X Molero
- Exocrine Pancreas Research Unit and Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona
- Network of Biomedical Research Centres (CIBER), Hepatic and Digestive Diseases and Epidemiology and Public Health, Madrid, Spain
| | - M Löhr
- Gastrocentrum, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - L Ilzarbe
- Department of Gastroenterology, Parc de Salut Mar University Hospital, Barcelona
| | - J Perea
- Department of Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | - W Greenhalf
- Department of Molecular and Clinical Cancer Medicine, The Royal Liverpool University Hospital, Liverpool
| | - M O'Rorke
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - A Tardón
- Network of Biomedical Research Centres (CIBER), Hepatic and Digestive Diseases and Epidemiology and Public Health, Madrid, Spain
- Department of Medicine, University Institute of Oncology of Asturias, Oviedo, Spain
| | - T Gress
- Department of Gastroenterology, University Hospital of Giessen and Marburg, Marburg, Germany
| | - V M Barberá
- Molecular Genetics Laboratory, General University Hospital of Elche, Elche, Spain
| | - T Crnogorac-Jurcevic
- Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, John Vane Science Centre, London, UK
| | - L Muñoz-Bellvís
- General and Digestive Surgery Department, Salamanca University Hospital, Salamanca
| | - E Domínguez-Muñoz
- Department of Gastroenterology, Clinical University Hospital of Santiago de Compostela, Santiago de Compostela
| | - A Gutiérrez-Sacristán
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute (IMIM), Pompeu Fabra Univeristy (UPF), Barcelona, Spain
| | - J Balsells
- Exocrine Pancreas Research Unit and Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona
- Network of Biomedical Research Centres (CIBER), Hepatic and Digestive Diseases and Epidemiology and Public Health, Madrid, Spain
| | - E Costello
- Department of Molecular and Clinical Cancer Medicine, The Royal Liverpool University Hospital, Liverpool
| | - C Guillén-Ponce
- Department of Oncology, Ramón y Cajal Hospital, Madrid, and CIBERONC, Spain
| | - J Huang
- Gastrocentrum, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - M Iglesias
- Department of Gastroenterology, Parc de Salut Mar University Hospital, Barcelona
| | - J Kleeff
- Department of Surgery, Technical University of Munich, Munich
- Department of Molecular and Clinical Cancer Medicine, The Royal Liverpool University Hospital, Liverpool
| | - B Kong
- Department of Surgery, Technical University of Munich, Munich
| | - J Mora
- Department of Gastroenterology, Santa Creu i Sant Pau Hospital, Barcelona
| | - L Murray
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - D O'Driscoll
- Research Programme, National Cancer Registry Ireland
| | - P Peláez
- Department of Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | - I Poves
- Department of Gastroenterology, Parc de Salut Mar University Hospital, Barcelona
| | - R T Lawlor
- ARC-Net Centre for Applied Research on Cancer and Department of Pathology and Diagnostics, University and Hospital trust of Verona, Verona, Italy
| | - A Carrato
- Department of Oncology, Ramón y Cajal Hospital, Madrid, and CIBERONC, Spain
| | - M Hidalgo
- Clara Campal Integrated Oncological Centre, Sanchinarro Hospital, Madrid, Spain
| | - A Scarpa
- ARC-Net Centre for Applied Research on Cancer and Department of Pathology and Diagnostics, University and Hospital trust of Verona, Verona, Italy
| | - L Sharp
- Research Programme, National Cancer Registry Ireland
- Institute of Health & Society, Newcastle University, UK
| | - L I Furlong
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute (IMIM), Pompeu Fabra Univeristy (UPF), Barcelona, Spain
| | - F X Real
- Epithelial Carcinogenesis Group, Spanish National Cancer Research Centre (CNIO), Madrid, and CIBERONC
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - C La Vecchia
- Branch of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro," Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - N Malats
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid, and CIBERONC, Spain
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Guillem V, Camps C, Carrato A, Díaz-Rubio E, Gascón P. European edition of the NCCN clinical practice guidelines: relevance of the translation and adaptation into Spanish. Clin Transl Oncol 2017; 19:288-290. [DOI: 10.1007/s12094-016-1545-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 08/18/2016] [Indexed: 11/28/2022]
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Azuara D, Garcia-Carbonero R, Alfonso PG, Santos-Vivas C, Navarro V, Varela M, Carrato A, Elez E, Cano M, Losa F, Montagut C, Sureda BM, Manzano J, Vieitez J, Valladares-Ayerbes M, Sanjuan X, Capellá G, Tabernero J, Aranda E, Salazar R. Extended genotyping of RAS/BRAF for improved selection of metastatic CRC patients to anti-EGFR therapy: Comparison of three platforms. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw363.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gravalos C, Carrato A, Tobeña M, Pulido EG, Soler G, Vieitez J, Robles L, Valladares-Ayerbes M, Polo E, Limon M, Safont M, Lopez C, Alfonso PG, Aranda E. Phase II clinical trial with axitinib as maintenance therapy in patients (p) with metastatic colorectal carcinoma (CRC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Martin-Richard M, Custodio A, García-Girón C, Grávalos C, Gomez C, Jimenez-Fonseca P, Manzano JL, Pericay C, Rivera F, Carrato A. Erratum to: SEOM guidelines for the treatment of gastric cancer 2015. Clin Transl Oncol 2016; 18:426. [PMID: 26867938 PMCID: PMC4969810 DOI: 10.1007/s12094-016-1491-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- M Martin-Richard
- Medical Oncology Department, Hospital de la Santa Creu I, Sant Pau, 167, 08025, Barcelona, Spain.
| | - A Custodio
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - C García-Girón
- Medical Oncology Department, Hospital Universitario de Burgos, Burgos, Spain
| | - C Grávalos
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - C Gomez
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Jimenez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | - J L Manzano
- Medical Oncology Department, Hospital Universitari Germans Trias I Pujol de Badalona, Barcelona, Spain
| | - C Pericay
- Medical Oncology Department, Hospital de Sabadell-Consorcio Sanitario Parc Taulì, Barcelona, Spain
| | - F Rivera
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - A Carrato
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Bartsch DK, Slater EP, Carrato A, Ibrahim IS, Guillen-Ponce C, Vasen HFA, Matthäi E, Earl J, Jendryschek FS, Figiel J, Steinkamp M, Ramaswamy A, Vázquez-Sequeiros E, Muñoz-Beltran M, Montans J, Mocci E, Bonsing BA, Wasser M, Klöppel G, Langer P, Fendrich V, Gress TM. Refinement of screening for familial pancreatic cancer. Gut 2016; 65:1314-21. [PMID: 27222532 DOI: 10.1136/gutjnl-2015-311098] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 05/01/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic ductal adenocarcinoma, PDAC). However, the age to begin screening and the optimal screening protocol remain to be determined. METHODS IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective screening programmes at three tertiary referral centres. The diagnostic yield according to age and different screening protocols was analysed. RESULTS 253 IAR with a median age of 48 (25-81) years underwent screening with a median of 3 (1-11) screening visits during a median follow-up of 28 (1-152) months. 134 (53%) IAR revealed pancreatic lesions on imaging, mostly cystic (94%), on baseline or follow-up screening. Lesions were significantly more often identified in IAR above the age of 45 years (p<0.0001). In 21 IAR who underwent surgery, no significant lesions (PDAC, pancreatic intraepithelial neoplasia (PanIN) 3 lesions, high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years. Potentially relevant lesions (multifocal PanIN2 lesions, low/moderate-grade branch-duct IPMNs) occurred also significantly more often after the age of 50 years (13 vs 2, p<0.0004). The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS (n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at ≥24 months intervals (n=30). CONCLUSIONS It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years. MRI-based screening supplemented by EUS at baseline and every 3rd year or when changes in MRI occur appears to be efficient.
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Affiliation(s)
- D K Bartsch
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Marburg, Germany
| | - E P Slater
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Marburg, Germany
| | - A Carrato
- Department of Medical Oncology, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - I S Ibrahim
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - C Guillen-Ponce
- Department of Medical Oncology, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - H F A Vasen
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - E Matthäi
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Marburg, Germany
| | - J Earl
- Department of Medical Oncology, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - F S Jendryschek
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Marburg, Germany
| | - J Figiel
- Department of Radiology, Philipps University Marburg, Marburg, Germany
| | - M Steinkamp
- Department of Gastroenterology and Endocrinology, Philipps University Marburg, Marburg, Germany
| | - A Ramaswamy
- Department of Pathology, Philipps University Marburg, Marburg, Germany
| | - E Vázquez-Sequeiros
- Department of Gastroenterology, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - M Muñoz-Beltran
- Department of Radiology, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - J Montans
- Department of Pathology, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - E Mocci
- Department of Medical Oncology, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - B A Bonsing
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - M Wasser
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - G Klöppel
- Department of Pathology, Consultation Centre for Pancreatic Tumors, Technical University Munich, Munich, Germany
| | - P Langer
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Marburg, Germany Department of General Surgery, Klinikum Hanau GmbH, Hanau, Germany
| | - V Fendrich
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Marburg, Germany
| | - T M Gress
- Department of Gastroenterology and Endocrinology, Philipps University Marburg, Marburg, Germany
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López de Maturana E, Picornell A, Masson-Lecomte A, Kogevinas M, Márquez M, Carrato A, Tardón A, Lloreta J, García-Closas M, Silverman D, Rothman N, Chanock S, Real FX, Goddard ME, Malats N. Prediction of non-muscle invasive bladder cancer outcomes assessed by innovative multimarker prognostic models. BMC Cancer 2016; 16:351. [PMID: 27259534 PMCID: PMC4893282 DOI: 10.1186/s12885-016-2361-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 05/12/2016] [Indexed: 01/28/2023] Open
Abstract
Background We adapted Bayesian statistical learning strategies to the prognosis field to investigate if genome-wide common SNP improve the prediction ability of clinico-pathological prognosticators and applied it to non-muscle invasive bladder cancer (NMIBC) patients. Methods Adapted Bayesian sequential threshold models in combination with LASSO were applied to consider the time-to-event and the censoring nature of data. We studied 822 NMIBC patients followed-up >10 years. The study outcomes were time-to-first-recurrence and time-to-progression. The predictive ability of the models including up to 171,304 SNP and/or 6 clinico-pathological prognosticators was evaluated using AUC-ROC and determination coefficient. Results Clinico-pathological prognosticators explained a larger proportion of the time-to-first-recurrence (3.1 %) and time-to-progression (5.4 %) phenotypic variances than SNPs (1 and 0.01 %, respectively). Adding SNPs to the clinico-pathological-parameters model slightly improved the prediction of time-to-first-recurrence (up to 4 %). The prediction of time-to-progression using both clinico-pathological prognosticators and SNP did not improve. Heritability (ĥ2) of both outcomes was <1 % in NMIBC. Conclusions We adapted a Bayesian statistical learning method to deal with a large number of parameters in prognostic studies. Common SNPs showed a limited role in predicting NMIBC outcomes yielding a very low heritability for both outcomes. We report for the first time a heritability estimate for a disease outcome. Our method can be extended to other disease models. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2361-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- E López de Maturana
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), C/Melchor Fernández, Almagro, 3, 28029, Madrid, Spain
| | - A Picornell
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), C/Melchor Fernández, Almagro, 3, 28029, Madrid, Spain
| | - A Masson-Lecomte
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), C/Melchor Fernández, Almagro, 3, 28029, Madrid, Spain
| | - M Kogevinas
- Centre for Research in Environmental Epidemiology (CREAL), Parc de Salut Mar, Barcelona, Spain.,CIBERESP, Madrid, Spain
| | - M Márquez
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), C/Melchor Fernández, Almagro, 3, 28029, Madrid, Spain
| | - A Carrato
- Servicio de Oncología, Hospital Universitario Ramon y Cajal, Madrid, and Servicio de Oncología, Hospital Universitario de Elche, Elche, Spain
| | - A Tardón
- Department of Preventive Medicine Universidad de Oviedo, Oviedo, Spain.,CIBERESP, Madrid, Spain
| | - J Lloreta
- Parc de Salut Mar and Departament of Pathology, Hospital del Mar - IMAS, Barcelona, Spain
| | - M García-Closas
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - D Silverman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, Bethesda, Maryland, USA
| | - N Rothman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, Bethesda, Maryland, USA
| | - S Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, Bethesda, Maryland, USA
| | - F X Real
- Epithelial Carcinogenesis Group, Spanish National Cancer Research Centre (CNIO), Madrid, and Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - M E Goddard
- Biosciences Research Division, Department of Environment and Primary Industries, Agribio, and Department of Food and Agricultural Systems, University of Melbourne, Melbourne, Australia
| | - N Malats
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), C/Melchor Fernández, Almagro, 3, 28029, Madrid, Spain.
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Longo Muñoz F, Earl J, Martinez Avila J, Rodriguez Garrote M, Guerrero C, Galindo J, Priego P, Rodriguez G, García-Moreno F, Lopez F, Hervás A, Caminoa A, García I, Soteras C, Vázquez-Sequeiros E, Botella J, Pachón Olmos V, Ferreiro Monteagudo R, Vaz M, Gómez A, Guillén-Ponce C, Carrato A. P-016 Circulating mRNA expression of CD133, SNAIL, ZEB1 and ZHX as biomarkers in gastric and esophageal cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw199.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Carrato A, Falcone A, Ducreux M, Valle JW, Parnaby A, Djazouli K, Alnwick-Allu K, Hutchings A, Palaska C, Parthenaki I. A Systematic Review of the Burden of Pancreatic Cancer in Europe: Real-World Impact on Survival, Quality of Life and Costs. J Gastrointest Cancer 2016; 46:201-11. [PMID: 25972062 PMCID: PMC4519613 DOI: 10.1007/s12029-015-9724-1] [Citation(s) in RCA: 176] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of this study was to assess the overall burden of pancreatic cancer in Europe, with a focus on survival time in a real-world setting, and the overall healthy life lost to the disease. METHODS Real-world data were retrieved from peer-reviewed, observational studies identified by an electronic search. We performed two de novo analyses: a proportional shortfall analysis to quantify the proportion of healthy life lost to pancreatic cancer and an estimation of the aggregate life-years lost annually in Europe. RESULTS Ninety-one studies were included. The median, age-standardised incidence of pancreatic cancer per 100,000 was 7.6 in men and 4.9 in women. Overall median survival from diagnosis was 4.6 months; median survival was 2.8-5.7 months in patients with metastatic disease. The proportional shortfall analysis showed that pancreatic cancer results in a 98 % loss of healthy life, with a life expectancy at diagnosis of 4.6 months compared to 15.1 years for an age-matched healthy population. Annually, 610,000-915,000 quality-adjusted life-years (QALYs) are lost to pancreatic cancer in Europe. Patients had significantly lower scores on validated health-related quality of life instruments versus population norms. CONCLUSIONS To the best of our knowledge, this is the first study to systematically review real-world overall survival and patient outcomes of pancreatic cancer patients in Europe outside the context of clinical trials. Our findings confirm the poor prognosis and short survival reported by national studies. Pancreatic cancer is a substantial burden in Europe, with nearly a million aggregate life-years lost annually and almost complete loss of healthy life in affected individuals.
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Affiliation(s)
- A. Carrato
- />Medical Oncology Department, Ramon y Cajal University Hospital, Ctra. Colmenar Viejo Km. 9,100, Madrid, Spain
| | - A. Falcone
- />Unit of Medical Oncology, Pisa University Hospital, Via Roma 67, Pisa, 56126 Italy
| | - M. Ducreux
- />Gastrointestinal Unit, Gustave Roussy Institute, 114 Rue Edouard-Vaillant, 94805 Villejuif, France
| | - J. W. Valle
- />Department of Medical Oncology, University of Manchester and Christie NHS Foundation Trust, Wilmslow Rd, Manchester, M20 4BX UK
| | - A. Parnaby
- />Celgene Corporation, Route de Perreux 1, 2017 Boudry, Switzerland
| | - K. Djazouli
- />Celgene Corporation, Route de Perreux 1, 2017 Boudry, Switzerland
| | | | - A. Hutchings
- />Dolon Ltd, 175-185 Grays Inn Road, London, WC1X 8UE UK
| | - C. Palaska
- />Dolon Ltd, 175-185 Grays Inn Road, London, WC1X 8UE UK
| | - I. Parthenaki
- />Dolon Ltd, 175-185 Grays Inn Road, London, WC1X 8UE UK
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Martin-Richard M, Custodio A, García-Girón C, Grávalos C, Gomez C, Jimenez-Fonseca P, Manzano JL, Pericay C, Rivera F, Carrato A. Seom guidelines for the treatment of gastric cancer 2015. Clin Transl Oncol 2015; 17:996-1004. [PMID: 26691658 PMCID: PMC4689778 DOI: 10.1007/s12094-015-1456-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 11/13/2015] [Indexed: 02/06/2023]
Abstract
Gastric cancer is the fourth cause of death by cancer in Spain and a significant medical problem. Molecular biology results evidence that gastroesophageal junction tumors and gastric cancer should be considered as two independent entities with a different prognosis and treatment approach. Endoscopic resection in very early tumors is feasible. Neoadjuvant and adjuvant therapy in locally advanced resectable tumor increase overall survival and should be considered standard treatments. In stage IV tumors, platinum–fluoropyrimidine-based schedule, with trastuzumab in HER2-overexpressed tumors, is the first-line treatment. Different therapies in second line have demonstrated in randomized studies their clear benefit in survival improvement.
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Affiliation(s)
- M Martin-Richard
- Medical Oncology Department, Hospital de la Santa Creu I Sant Pau, 167, 08025, Barcelona, Spain.
| | - A Custodio
- Medical Oncology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - C García-Girón
- Medical Oncology Department, Hospital Universitario de Burgos, Burgos, Spain
| | - C Grávalos
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - C Gomez
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Jimenez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | - J L Manzano
- Medical Oncology Department, Hospital Universitari Germans Trias I Pujol de Badalona, Barcelona, Spain
| | - C Pericay
- Medical Oncology Department, Hospital de Sabadell-Consorcio Sanitario Parc Taulì, Barcelona, Spain
| | - F Rivera
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - A Carrato
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Cortés A, Fernández M, Martínez N, Guerra E, López E, Olmedo M, Longo F, Cortez P, Muñoz J, Gómez A, Roberts E, Reguera P, Gión M, Madariaga A, Molina J, Villamayor M, Martínez O, Mezquita L, Ferreiro R, Carrato A. 1915 Comparison of local clinical subtyping to central molecular classification using microarray-based gene expression test in early breast cancer patients. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30864-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abad A, Massuti B, Gravalos C, Escudero P, Guillen-Ponce C, Manzano J, Ortiz M, Safont M, Gallego J, Sastre J, Pericay C, Duenas R, Rivera F, Losa F, Valladares-Ayerbes M, Gonzalez E, Robles L, Aranda E, Carrato A. 2128 Early tumour shrinkage (ETS) and depth of response (DpR) with first-line panitumumab (P) plus FOLFOX4 (P-FOLFOX4) or FOLFIRI (P-FOLFIRI) in patients (pts) with wild-type (WT) RAS colorectal cancer (CRC) and liver-limited disease (LLD). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31050-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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43
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Earl J, Garcia-Nieto S, Martinez-Avila J, Montans J, Sanjuanbenito A, Rodríguez-Garrote M, Lisa E, Mendia E, Lobo E, Malats N, Carrato A, Guillen C. 428 KRAS mutant circulating free DNA (cfDNA) and circulating tumor cell (CTC) detection in peripheral blood as biomarkers in patients diagnosed with exocrine pancreatic cancer. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30262-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Van Cutsem E, Prenen H, D'Haens G, Bennouna J, Carrato A, Ducreux M, Bouché O, Sobrero A, Latini L, Staines H, Oum'Hamed Z, Dressler H, Studeny M, Capdevila J. A phase I/II, open-label, randomised study of nintedanib plus mFOLFOX6 versus bevacizumab plus mFOLFOX6 in first-line metastatic colorectal cancer patients. Ann Oncol 2015; 26:2085-91. [PMID: 26272806 DOI: 10.1093/annonc/mdv286] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 06/27/2015] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND This randomised, open-label, phase I/II study evaluated the efficacy and safety of nintedanib, an oral, triple angiokinase inhibitor, combined with chemotherapy, relative to bevacizumab plus chemotherapy as first-line therapy in patients with metastatic colorectal cancer (mCRC). PATIENTS AND METHODS Patients with histologically confirmed mCRC (adenocarcinoma), an Eastern Cooperative Oncology Group performance status ≤ 2 and adequate organ function were included. Patients were randomised 2:1 to receive nintedanib 150 mg or 200 mg b.i.d. plus mFOLFOX6 (oxaliplatin 85 mg/m(2), l-leucovorin 200 mg/m(2) or d,l-leucovorin 400 mg/m(2), 5-fluoruracil bolus 400 mg/m(2) followed by 2400 mg/m(2), every 2 weeks) or bevacizumab (5 mg/kg every 2 weeks) plus mFOLFOX6. During phase I, patients underwent a 3 + 3 dose-escalation schema to determine the maximum tolerated dose (MTD) of nintedanib in combination with mFOLFOX6. The primary end point was progression-free survival (PFS) rate at 9 months. Objective response (OR) was a secondary end point. RESULTS The nintedanib recommended phase II dose was 200 mg b.i.d. plus mFOLFOX6 based on safety data from phase I (n = 12). Of 128 patients randomised in the phase II part, 126 received treatment (nintedanib plus mFOLFOX6, n = 85; bevacizumab plus mFOLFOX6, n = 41). PFS at 9 months was 62.1% with nintedanib and 70.2% with bevacizumab [difference: -8.1% (95% confidence interval -27.8 to 11.5)]. Confirmed ORs were recorded in 63.5% and 56.1% of patients in the nintedanib and bevacizumab groups, respectively. The incidence of adverse events (AEs) considered related to treatment was 98.8% with nintedanib and 97.6% with bevacizumab; the incidence of serious AEs was 37.6% with nintedanib and 53.7% with bevacizumab. The pharmacokinetics of nintedanib and the components of mFOLFOX6 were unaffected by their combination. CONCLUSIONS Nintedanib in combination with mFOLFOX6 showed efficacy as first-line therapy in patients with mCRC with a manageable safety profile and further studies in this population are warranted.
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Affiliation(s)
- E Van Cutsem
- Digestive Oncology, University Hospitals Leuven and KULeuven, Leuven, Belgium
| | - H Prenen
- Digestive Oncology, University Hospitals Leuven and KULeuven, Leuven, Belgium
| | - G D'Haens
- Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands Imelda GI Clinical Research Centre, Bonheiden, Belgium
| | - J Bennouna
- Department of Medical Oncology, Centre René Gauducheau, Nantes, France
| | - A Carrato
- Department of Medical Oncology, Ramon y Cajal University Hospital, Madrid, Spain
| | - M Ducreux
- Gustave-Roussy Cancer Campus, Institut Gustave Roussy, Paris University of Paris-Sud, Le Kremlin Bicêtre, Paris
| | - O Bouché
- Department of Digestive Oncology, CHU Reims, Reims, France
| | - A Sobrero
- Department of Medical Oncology, San Martino Hospital, Genoa
| | - L Latini
- Oncology Unit, Macerata Hospital, Macerata, Italy
| | - H Staines
- Medical and Drug Regulatory Affairs, Boehringer Ingelheim France S.A.S., Reims, France
| | - Z Oum'Hamed
- Medical and Drug Regulatory Affairs, Boehringer Ingelheim France S.A.S., Reims, France
| | - H Dressler
- Global Pharmacovigilance, Boehringer Ingelheim, Ingelheim, Germany
| | - M Studeny
- Division of Medicine/Department of Clinical Development, Boehringer Ingelheim, Vienna, Austria
| | - J Capdevila
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
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Mocci E, Guillen-Ponce C, Earl J, Marquez M, Solera J, Salazar-López MT, Calcedo-Arnáiz C, Vázquez-Sequeiros E, Montans J, Muñoz-Beltrán M, Vicente-Bártulos A, González-Gordaliza C, Sanjuanbenito A, Guerrero C, Mendía E, Lisa E, Lobo E, Martínez JC, Real FX, Malats N, Carrato A. PanGen-Fam: Spanish registry of hereditary pancreatic cancer. Eur J Cancer 2015. [PMID: 26212471 DOI: 10.1016/j.ejca.2015.07.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To describe the organisation of the registry and the preliminary results in terms of characteristics of high-risk pancreatic ductal adenocarcinoma (PDAC) families recruited to date and findings of the screening programme. To compare early onset sporadic cases (⩽50 years), sporadic cases (>50 years) and cases with family history of cancer, for PDAC possible risk factors. METHODS/PATIENTS Families with hereditary cancer syndromes predisposing to PDAC were recruited from two main sources: Spanish hospitals participating in PanGenEU, a pan-European multicentre case-control study, and their genetic counseling unit. Individuals at high-risk of PDAC were enrolled into a screening programme, consisting of Endoscopic ultrasound, computerised tomography, magnetic resonance imaging. Genetic testing of candidate genes was offered according to each patient's risk. RESULTS Among 577 consecutive PDAC cases, recruited via PanGenEU, 36 (6%) had ⩾2 first-degree relative with PDAC: Familial pancreatic cancer (FPC). So far PanGen-Fam has recruited 42 high-risk PDAC families; 25 (60%) had FPC. Five index cases with cancer were positive for BRCA2 and one for BRCA1 germline mutations. In the second year of prospective PDAC screening, one neuroendocrine tumour and a high-grade dysplasia lesion suspicious of carcinoma were diagnosed among 41 high-risk individuals. Furthermore EUS detected chronic-pancreatitis-like parenchymal changes in 15 patients. CONCLUDING STATEMENT The identification and recruitment of PDAC high-risk families into the PanGen-Fam registry provides an opportunity to detect early onset cancer and precursor pancreatic cancer lesions at a potentially curative stage and to increase the knowledge of the natural history of the disease.
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Affiliation(s)
- E Mocci
- Medical Oncology Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - C Guillen-Ponce
- Medical Oncology Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - J Earl
- Medical Oncology Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - M Marquez
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - J Solera
- Molecular Oncogenetics Unit, Institute of Medical and Molecular Genetics, La Paz Hospital, Madrid, Spain
| | - M-T Salazar-López
- Medical Oncology Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - C Calcedo-Arnáiz
- Medical Oncology Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - E Vázquez-Sequeiros
- Digestive Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - J Montans
- Pathology Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - M Muñoz-Beltrán
- Radiology Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - A Vicente-Bártulos
- Radiology Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | | | - A Sanjuanbenito
- Surgery Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - C Guerrero
- Medical Oncology Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - E Mendía
- Surgery Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - E Lisa
- Surgery Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - E Lobo
- Surgery Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - J C Martínez
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - F X Real
- Epithelial Carcinogenesis Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain; Department de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - N Malats
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - A Carrato
- Medical Oncology Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
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Grande E, Capdevila J, Castellano D, Teulé A, Durán I, Fuster J, Sevilla I, Escudero P, Sastre J, García-Donas J, Casanovas O, Earl J, Ortega L, Apellaniz-Ruiz M, Rodriguez-Antona C, Alonso-Gordoa T, Díez JJ, Carrato A, García-Carbonero R. Pazopanib in pretreated advanced neuroendocrine tumors: a phase II, open-label trial of the Spanish Task Force Group for Neuroendocrine Tumors (GETNE). Ann Oncol 2015; 26:1987-1993. [PMID: 26063633 DOI: 10.1093/annonc/mdv252] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 05/26/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The management of advanced neuroendocrine tumors (NETs) has recently changed. We assessed the activity of pazopanib after failure of other systemic treatments in advanced NETs. METHODS This was a multicenter, open-label, phase II study evaluating pazopanib as a single agent in advanced NETs (PAZONET study). The clinical benefit rate (CBR) at 6 months was the primary end point. Translational correlation of radiological response and progression-free survival (PFS) with circulating and tissue biomarkers was also evaluated. RESULTS A total of 44 patients were enrolled. Twenty-five patients (59.5%) were progression-free at 6 months (4 partial responses, 21 stable diseases) with a median PFS of 9.5 months [95% confidence interval (CI) 4.8-14.1]. The CBR varied according to prior therapy received, with 73%, 60% and 25% in patients treated with prior multitarget inhibitors, prior mTOR inhibitors and both agents, respectively. A nonsignificant increase in PFS was observed in patients presenting lower baseline circulating tumor cell (CTC) counts (9.1 versus 5.8 months; P = 0.22) and in those with decreased levels of soluble-vascular endothelial growth factor receptor-2 (sVEGFR-2) (12.6 versus 9.1 months; P = 0.067). A trend toward reduced survival was documented in patients with VEGFR3 rs307821 and rs307826 missense polymorphisms [hazard ratio (HR): 12.3; 95% CI 1.09-139.2; P = 0.042 and HR: 6.9; 95% CI 0.96-49.9; P = 0.055, respectively]. CONCLUSIONS Pazopanib showed clinical activity in patients with advanced NETs regardless of previous treatments. Additionally, CTCs, soluble-s VEFGR-2 and VEGFR3 gene polymorphisms constitute potential biomarkers for selecting patients for pazopanib (NCT01280201). CLINICAL TRIAL NUMBER NCT01280201.
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Affiliation(s)
- E Grande
- Department of Medical Oncology, Ramón y Cajal University Hospital, Madrid.
| | - J Capdevila
- Department of Medical Oncology, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona
| | - D Castellano
- Department of Medical Oncology, I + 12 Research Institute, 12 de Octubre University Hospital, Madrid
| | - A Teulé
- Department of Medical Oncology, IDIBELL, Catalan Institute of Oncology L'Hospitalet, Barcelona
| | - I Durán
- Department of Medical Oncology, Instituto de Biomedicina de Sevilla (IBIS) [HUVR, CSIC, University of Seville], Virgen del Rocío University Hospital, Seville
| | - J Fuster
- Department of Medical Oncology, Son Espases Hospital, Palma de Mallorca
| | - I Sevilla
- Department of Medical Oncology, Virgen de la Victoria University Hospital, Malaga
| | - P Escudero
- Department of Medical Oncology, Clínico Lozano Blesa University Hospital, Zaragoza
| | - J Sastre
- Department of Medical Oncology, Clínico San Carlos Hospital, Madrid
| | - J García-Donas
- Department of Medical Oncology, Centro Integral Oncológico Clara Campal, Madrid
| | - O Casanovas
- Tumor Angiogenesis Group, IDIBELL, Catalan Institute of Oncology L'Hospitalet, Barcelona
| | - J Earl
- Department of Medical Oncology Research Laboratory, Ramón y Cajal University Hospital, Madrid
| | - L Ortega
- Department of Pathology, Clínico San Carlos Hospital, Madrid
| | - M Apellaniz-Ruiz
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Center, ISCIII Center for Biomedical Research on Rare Disease (CIBERER) Madrid, Madrid
| | - C Rodriguez-Antona
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Center, ISCIII Center for Biomedical Research on Rare Disease (CIBERER) Madrid, Madrid
| | - T Alonso-Gordoa
- Department of Medical Oncology, Ramón y Cajal University Hospital, Madrid
| | - J J Díez
- Department of Endocrinology, Ramón y Cajal University Hospital, Madrid, Spain
| | - A Carrato
- Department of Medical Oncology, Ramón y Cajal University Hospital, Madrid
| | - R García-Carbonero
- Department of Medical Oncology, Instituto de Biomedicina de Sevilla (IBIS) [HUVR, CSIC, University of Seville], Virgen del Rocío University Hospital, Seville
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Cortez Castedo S, Gion Cortes M, Longo Munoz F, Ferreiro Monteagudo R, Pachon Olmos V, Rodriguez Garrote M, Alsina M, Munoz del Toro J, Cortes Salgado A, Reguera Puertas P, Madariaga Urrutia A, Villamayor Delgado M, Martinez Saez O, Molina Cerrillo J, Olmedo Garcia M, Grande E, Guillen-Ponce C, Carrato A. P-081 Serum tumor markers as predictors of overall response rate and clinical benefit in patients with advanced esophagogastric adenocarcinoma (EGA) treated with chemotherapy. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv233.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fuchs CS, Azevedo S, Okusaka T, Van Laethem JL, Lipton LR, Riess H, Szczylik C, Moore MJ, Peeters M, Bodoky G, Ikeda M, Melichar B, Nemecek R, Ohkawa S, Świeboda-Sadlej A, Tjulandin SA, Van Cutsem E, Loberg R, Haddad V, Gansert JL, Bach BA, Carrato A. A phase 3 randomized, double-blind, placebo-controlled trial of ganitumab or placebo in combination with gemcitabine as first-line therapy for metastatic adenocarcinoma of the pancreas: the GAMMA trial. Ann Oncol 2015; 26:921-927. [PMID: 25609246 DOI: 10.1093/annonc/mdv027] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 12/30/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This double-blind, phase 3 study assessed the efficacy and safety of ganitumab combined with gemcitabine as first-line treatment of metastatic pancreatic cancer. PATIENTS AND METHODS Patients with previously untreated metastatic pancreatic adenocarcinoma were randomly assigned 2 : 2 : 1 to receive intravenous gemcitabine 1000 mg/m(2) (days 1, 8, and 15 of each 28-day cycle) plus placebo, ganitumab 12 mg/kg, or ganitumab 20 mg/kg (days 1 and 15 of each cycle). The primary end point was overall survival (OS). Secondary end points included progression-free survival (PFS), safety, and efficacy by levels of circulating biomarkers. RESULTS Overall, 322 patients were randomly assigned to placebo, 318 to ganitumab 12 mg/kg, and 160 to ganitumab 20 mg/kg. The study was stopped based on results from a preplanned futility analysis; the final results are reported. Median OS was 7.2 months [95% confidence interval (CI), 6.3-8.2] in the placebo arm, 7.0 months (95% CI, 6.2-8.5) in the ganitumab 12-mg/kg arm [hazard ratio (HR), 1.00; 95% CI, 0.82-1.21; P = 0.494], and 7.1 months (95% CI, 6.4-8.5) in the ganitumab 20-mg/kg arm (HR, 0.97; 95% CI, 0.76-1.23; P = 0.397). Median PFS was 3.7, 3.6 (HR, 1.00; 95% CI, 0.84-1.20; P = 0.520), and 3.7 months (HR, 0.97; 95% CI, 0.77-1.22; P = 0.403), respectively. No unexpected toxicity was observed with ganitumab plus gemcitabine. The circulating biomarkers assessed [insulin-like growth factor-1 (IGF-1), IGF-binding protein-2, and -3] were not associated with a treatment effect on OS or PFS by ganitumab. CONCLUSION Ganitumab combined with gemcitabine had manageable toxicity but did not improve OS, compared with gemcitabine alone in unselected patients with metastatic pancreatic cancer. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT01231347.
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Affiliation(s)
- C S Fuchs
- Department of Medical Oncology/Solid Tumor Oncology, Dana-Farber Cancer Institute, Boston, USA.
| | - S Azevedo
- Oncology Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - T Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - J-L Van Laethem
- Department of Gastroenterology, Erasme University Hospital, Brussels, Belgium
| | - L R Lipton
- Medical Oncology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - H Riess
- Department of Hematology, Oncology, and Tumor Immunology, Charité University, Berlin, Germany
| | - C Szczylik
- Department of Oncology, Military Institute of Health Services, Warsaw, Poland
| | - M J Moore
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - M Peeters
- Department of Oncology, Antwerp University Hospital, Edegum, Belgium
| | - G Bodoky
- Department of Oncology, St László Hospital, Budapest, Hungary
| | - M Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - B Melichar
- Department of Oncology, Palacký University Medical School and Teaching Hospital, Olomouc
| | - R Nemecek
- Department of Oncology, Masaryk University Medical School and Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - S Ohkawa
- Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan
| | - A Świeboda-Sadlej
- Department of Haematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - S A Tjulandin
- Department of Clinical Pharmacology and Chemotherapy, Russian Cancer Research Center, Moscow, Russia
| | - E Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg/Leuven and KU Leuven, Leuven, Belgium
| | - R Loberg
- Medical Sciences, Amgen Inc., Thousand Oaks, USA
| | - V Haddad
- Global Biostatistical Science, Amgen Ltd, Cambridge, UK
| | | | - B A Bach
- Development Oncology Therapeutics, Amgen Inc., Thousand Oaks, USA
| | - A Carrato
- Medical Oncology Department, University Hospital Ramon y Cajal, Madrid, Spain
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Guillen-Ponce C, Lopez R, Macarulla T, Rivera F, Cubillo A, Carrato A, Brozos E, Sauri Nadal T, López C, Hidalgo M. A Phase (Ph) I/II Trial to Evaluate the Efficacy (E) and Safety (S) of Nab-Paclitaxel (Nab-P) in Combination (Co) with Gemcitabine (G) for the Treatment (Tr) of Frail (Fr) Patients (P) with Advanced or Metastatic Pancreatic Cancer (Apc): Safety Results of the Phase I Trial. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.85] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Carrato A, Falcone A, Ducreux M, Valle J, Parnaby A, Djazouli K, Alnwick-Allu K, Hutchings A. Premature Mortality in Pancreatic Cancer: Analysis of Lost Life-Years and Quality-Adjusted Life-Years (Qalys) in Europe. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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