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Jimenez Gordo AM, Colmenarejo G, Baena Espinar J, Aguado C, Mielgo X, Pertejo A, Alvarez Alvarez RM, Sanchez A, Lopez JL, Molina R, López-Alfonso A, Hernandez B, Chara Velarde LE, Martin AM, Lopez A, Dorta M, Lorduy AC, Zambrana F, Casado E, Sereno M. A multicenter analysis of the outcome of cancer patients with neutropenia and COVID-19 infection optionally treated with granulocyte colony-stimulating factor (G-CSF). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.12105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12105 Background: Infection by SARS-CoV-2 can turn into an acute respiratory infection. Approximately 15% of patients will develop a distress syndrome responsible in most cases of mortality. A host hyperinflammatory response induced by a cytokine storm, is the main cause of this severe complication. Chemotherapy myelosuppression is associated with higher risk of infections and mortality in cancer patients. There have been no previous reports about the clinical management of patients with neutropenia and concomitant COVID-19. Herein, we present a multicenter experience in several hospitals during COVID-19 outbreak in neutropenic cancer patients infected by SARS-Cov-2. Methods: Retrospective clinical data were collected from clinical reports. Protocol was approved by a Clinical Research Ethics Committee (HULP: PI-4194). Inclusion criteria were cancer patients with neutropenia (<1500 cells/mm3) and concomitant COVID-19 infection. Comorbidities, tumor type and stage, treatment, neutropenia severity, filgrastim (G-CSF), COVID-19 parameters and mortality were analyzed. Exploratory analysis included a description of all data collected and bivariate analyses among different pairs of variables, including their impact in mortality in this cohort. In addition, multivariable logistic regression was used to predict respiratory failure and death as a function of multiple variables. Results: Among 943 patients with cancer screened in 14 hospitals in Spain, eighty-three patients (8%) had a febrile neutropenia and COVID-19 infection. Lung (26%), breast (22%), colorectal (13%) and digestive non-colorectal (17%) cancers were the main locations and most patients had advanced disease (67%). Fifty-three (63%) of patients included died because respiratory failure. Neumonia was presented in 76% of patients, bilateral in 47% and 12% of all patients had thrombotic events. The median of neutrophils was 650cls/mm3 and 49% received G-CSF with a median of days on treatment around 4,5 days. Among all variables related with mortality in neutropenic cancer patients with COVID-19 infection, we found that the number of days with G-CSF showed a significant trend toward worse outcome and higher mortality. In particular, a logistic regression model was developed to predict respiratory failure, as a function of the number of days of G-CSF treatment. As adjusting covariates, sex, age, treatment purpose (palliative vs curative, to adjust for patient status), tumor type, and the lowest level of neutrophils in the patient (to adjust for neutropenic status) were used. A significant effect was obtained for the days of G-CSF treatment (OR = 1.4, 95% CI [1.03, 1.92], p-value = 0.01). Conclusions: Our findings suggest that a prolonged G-CSF treatment could be disadvantageous for these cancer patients with COVID-19, with a higher probability of worse outcome.
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Affiliation(s)
- Ana M. Jimenez Gordo
- Medical Oncology Department, Hospital Universitario Infanta Sofía, San Sebastián De Los Reyes, Spain
| | - Gonzalo Colmenarejo
- Biostatistics and Bioinformatics Unit, IMDEA-Food Institute, CEI UAM, CSIC, Madrid, Spain
| | | | | | | | - Ana Pertejo
- Hospital Universitario La Paz, Madrid, Spain
| | | | - Ana Sanchez
- Hospital Universitario de Getafe, Madrid, Spain
| | | | - Raquel Molina
- Medical Oncology Department, Hospital Universitario Príncipe de Asturias, Alcala De Henares, Spain
| | - Ana López-Alfonso
- Medical Oncology Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | | | | | - Ana Lopez
- Hospital Universitario Severo Ochoa, Madrid, Spain
| | | | | | - Francisco Zambrana
- Medical Oncology Department, Infanta Sofía University Hospital, Madrid, Spain
| | - Enrique Casado
- Medical Oncology Department, Infanta Sofía University Hospital, Madrid, Spain
| | - Maria Sereno
- Medical Oncology Department, Infanta Sofía University Hospital, Madrid, Spain
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Herrera M, Berral-González A, López-Cade I, Galindo-Pumariño C, Bueno-Fortes S, Martín-Merino M, Carrato A, Ocaña A, De La Pinta C, López-Alfonso A, Peña C, García-Barberán V, De Las Rivas J. Cancer-associated fibroblast-derived gene signatures determine prognosis in colon cancer patients. Mol Cancer 2021; 20:73. [PMID: 33926453 PMCID: PMC8082938 DOI: 10.1186/s12943-021-01367-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/19/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- Mercedes Herrera
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Alberto Berral-González
- Bioinformatics and Functional Genomics Group, Cancer Research Center (CiC-IBMCC, CSIC/USAL), Consejo Superior de Investigaciones Científicas (CSIC) and University of Salamanca (USAL), Salamanca, Spain
| | - Igor López-Cade
- Molecular Oncology Laboratory, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Cristina Galindo-Pumariño
- Medical Oncology Department, Ramón y Cajal University Hospital, IRYCIS, CIBERONC, Alcalá University, Madrid, Spain
| | - Santiago Bueno-Fortes
- Bioinformatics and Functional Genomics Group, Cancer Research Center (CiC-IBMCC, CSIC/USAL), Consejo Superior de Investigaciones Científicas (CSIC) and University of Salamanca (USAL), Salamanca, Spain
| | - Manuel Martín-Merino
- Bioinformatics and Functional Genomics Group, Cancer Research Center (CiC-IBMCC, CSIC/USAL), Consejo Superior de Investigaciones Científicas (CSIC) and University of Salamanca (USAL), Salamanca, Spain.,Facultad de Informática, Universidad Pontificia de Salamanca (UPSA), Salamanca, Spain
| | - Alfredo Carrato
- Medical Oncology Department, Ramón y Cajal University Hospital, IRYCIS, CIBERONC, Alcalá University, Madrid, Spain
| | - Alberto Ocaña
- Experimental Therapeutics Unit, Instituto de Investigación Sanitaria San Carlos (IdISSC) and CIBERONC, Madrid, Spain
| | - Carolina De La Pinta
- Radio-Oncology Department, Ramón y Cajal University Hospital, IRYCIS, Alcalá University, Madrid, Spain
| | | | - Cristina Peña
- Medical Oncology Department, Ramón y Cajal University Hospital, IRYCIS, CIBERONC, Alcalá University, Madrid, Spain.
| | - Vanesa García-Barberán
- Molecular Oncology Laboratory, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain.
| | - Javier De Las Rivas
- Bioinformatics and Functional Genomics Group, Cancer Research Center (CiC-IBMCC, CSIC/USAL), Consejo Superior de Investigaciones Científicas (CSIC) and University of Salamanca (USAL), Salamanca, Spain.
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Franco F, Camara JC, Martín-Valadés JI, López-Alfonso A, Marrupe D, Gutiérrez-Abad D, Martínez-Amores B, León A, Juez I, Pérez M, Royuela A, Ruiz-Casado A. Clinical outcomes of FOLFIRINOX and gemcitabine-nab paclitaxel for metastatic pancreatic cancer in the real world setting. Clin Transl Oncol 2020; 23:812-819. [PMID: 32857340 DOI: 10.1007/s12094-020-02473-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Received: 05/13/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVES The incidence of pancreatic cancer is increasing in developed countries. The incorporation of new therapies, to the first-line treatment of patients with good performance status led to better survival in clinical trials. However, there is a wide variability in their use and some concerns about the treatment of elderly patients who were not included in the clinical trials. METHODS This is a retrospective multicenter study. Data from consecutive patients diagnosed with metastatic pancreatic cancer (mPC) treated with FOLFIRINOX (FFX) or gemcitabine plus nab-paclitaxel (GnP) were analysed to evaluate efficacy (overall survival-OS) and toxicity. RESULTS A total of 119 patients were included. 49.6% were treated with FFX and 50.4% with GNP in first-line. The median OS was 12 months with no statistically significant differences between both regimens (12.7 m for FFX vs 10.2 m for GnP). Elevated Ca 19.9 levels and neutrophil-lymphocyte ratio (NLR) increased the risk of death. Patients who received both regimens in first/second line had a median OS longer than 15 months whichever the sequence. 32 patients (27%) were older than 70-y. 54% patients received a second-line treatment, 56% in the FFX group and 44% in the GnP group. The median OS for patients older than 70 was 9.5 m versus 12.3 m for patients younger than 70. Progression of the disease was the cause of death in 67.6% of the patients. CONCLUSIONS In our setting, the use of FFX and GnP for treating mPC is quite similar, but superiority could not be demonstrated for any of the schemes in the first line. OS was determined by basal levels of Ca 19.9 and NLR. Patients receiving both regimens in first/second line whichever the sequence, exhibited the best survival rates. In our series, elderly patients had poorer survival rates.
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Affiliation(s)
- F Franco
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain.
| | - J C Camara
- Department of Medical Oncology, Fundación Hospital Alcorcón, Alcorcón, Spain
| | | | - A López-Alfonso
- Department of Medical Oncology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - D Marrupe
- Department of Medical Oncology, Hospital Universitario de Móstoles, Móstoles, Spain
| | - D Gutiérrez-Abad
- Department of Medical Oncology, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | - B Martínez-Amores
- Department of Medical Oncology, Hospital Universitario Rey Juan Carlos, Móstoles, Spain
| | - A León
- Department of Medical Oncology, Fundación Jiménez Díaz, Madrid, Spain
| | - I Juez
- Department of Medical Oncology, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | - M Pérez
- Department of Medical Oncology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - A Royuela
- Department of Biostatistics, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - A Ruiz-Casado
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
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Rogado J, Obispo B, Pangua C, Serrano-Montero G, Martín Marino A, Pérez-Pérez M, López-Alfonso A, Gullón P, Lara MÁ. Covid-19 transmission, outcome and associated risk factors in cancer patients at the first month of the pandemic in a Spanish hospital in Madrid. Clin Transl Oncol 2020; 22:2364-2368. [PMID: 32449128 PMCID: PMC7246222 DOI: 10.1007/s12094-020-02381-z] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [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: 04/28/2020] [Accepted: 05/09/2020] [Indexed: 12/13/2022]
Abstract
Background There are no large reported series determining the Covid-19 cancer patient’s characteristics. We determine whether differences exist in cumulative incidence and mortality of Covid-19 infection between cancer patients and general population in Madrid. Material and methods We reviewed 1069 medical records of all cancer patients admitted at Oncology department between Feb 1 and April 7, 2020. We described Covid-19 cumulative incidence, treatment outcome, mortality, and associated risk factors. Results We detected 45/1069 Covid-19 diagnoses in cancer patients vs 42,450/6,662,000 in total population (p < 0.00001). Mortality rate: 19/45 cancer patients vs 5586/42,450 (p = 0.0001). Mortality was associated with older median age, adjusted by staging and histology (74 vs 63.5 years old, OR 1.06, p = 0.03). Patients who combined hydroxychloroquine and azithromycin presented 3/18 deaths, regardless of age, staging, histology, cancer treatment and comorbidities (OR 0.02, p = 0.03). Conclusion Cancer patients are vulnerable to Covid-19 with an increase in complications. Combined hydroxychloroquine and azithromycin is presented as a good treatment option.
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Affiliation(s)
- J Rogado
- Medical Oncology Department, Hospital Univeristario Infanta Leonor, Gran vía del este, 81, 28031, Madrid, Spain.
| | - B Obispo
- Medical Oncology Department, Hospital Univeristario Infanta Leonor, Gran vía del este, 81, 28031, Madrid, Spain
| | - C Pangua
- Medical Oncology Department, Hospital Univeristario Infanta Leonor, Gran vía del este, 81, 28031, Madrid, Spain
| | - G Serrano-Montero
- Medical Oncology Department, Hospital Univeristario Infanta Leonor, Gran vía del este, 81, 28031, Madrid, Spain
| | - A Martín Marino
- Medical Oncology Department, Hospital Univeristario Infanta Leonor, Gran vía del este, 81, 28031, Madrid, Spain
| | - M Pérez-Pérez
- Medical Oncology Department, Hospital Univeristario Infanta Leonor, Gran vía del este, 81, 28031, Madrid, Spain
| | - A López-Alfonso
- Medical Oncology Department, Hospital Univeristario Infanta Leonor, Gran vía del este, 81, 28031, Madrid, Spain
| | - P Gullón
- Public Health and Epidemiology Research Group, Universidad de Alcalá, Alcalá de Henares, Spain
| | - M Á Lara
- Medical Oncology Department, Hospital Univeristario Infanta Leonor, Gran vía del este, 81, 28031, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
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Roa S, López-Alfonso A, Toboso del Amo I, Falagan S, Zambrana F, Lopez-Gomez M, Jimenez-Gordo AM, Gomez Raposo C, Merino M, Aguayo C, Casado E, Moreno-Rubio J, Sereno M. Prospective analysis of antinuclear antibodies prevalence in a pan-tumor sample. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e15012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15012 Background: Antinuclear antibodies (ANAs) constitute a spectrum of autoantibodies targeted to nuclear and cytoplasmic components of the cells considered serological markers for different autoimmune disease. However, ANAs are also presented in different types of cancers. Here, we present an exploratory analysis of ANAs patterns detected in patients with a recent cancer diagnosis. Methods: We carried out a prospective analysis of patients recently diagnosed of cancer in two centers. All were tested for ANAs from January to December 2019. Clinical-pathological features were collected from clinical reports. Results: 190 patients were included with different tumors: Lung(56.3%); colon/rectum(16.3%); head-neck(10.5%); pancreas(3.6%); stomach(3.1%); sarcoma(3.1%); urothelial(2.6%) and others( 3.6%). Most of the patients (pts) had stage IV (65.7%) and III (26.8%). Several histologies were included: adenocarcinoma(55.7%); squamous (32.6%) and others (transitional, clear cells, small cell and mesotelial/sarcoma). Chemotherapy was the main treatment (73.6%pts) followed by immunotherapy (11.5%pts), targeted therapy (6.8%pts) and chemo-inmunotherapy (3.1%pts). Among all pts included, only 13 had autoimmune disease: polymyalgia rheumatica (1pt); psoriasis (4pts), bronchial hyperreactivity (2pts) and hypotiroidism (6pts). In this cohort, we found that 60/190, 31.5%pts, showed positive ANAs (+) titers by immunofluorescence analysis. Different patterns were described according to First International Consensus on Standardized Nomenclature of ANAs. The predominant was a speckled pattern presented in 26% pts; secondly, a nucleolar pattern in 16.6% pts and CENP-F AC14 was presented in 8.3%pts. More minoritary patterns were also described. Patients with advanced lung cancer included 56.6% of ANAs (+) cases followed by colorectal cancer (11.6%). Adenocarcinoma (73,3 % pts) and squamous carcinoma (16,6% pts) were the most common histologies among ANAs (+) cases but none of the small cell carcinoma were ANA(+). The majority of ANAs (+) patients were on chemotherapy (73.3 % pts) followed by immunotherapy (16.6% pts). On the other hand, 4/13 of patients with autoimmune diseases presented ANAs(+) titers (CENT-F, scl70 and AC3 patterns). The only patient who developed a severe inmune-related toxicity was ANA negative. Conclusions: In this study, we describe the prevalence of ANAs and their patterns in a cohort of cancer patients. A complementary description of relevant clinical-pathological features in ANAs(+) subgroup is also reported.
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Affiliation(s)
- Silvia Roa
- Medical Oncology Department, Infanta Sofía University Hospital, San Sebastian de los Reyes, Spain
| | - Ana López-Alfonso
- Medical Oncology Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Sandra Falagan
- Medical Oncology Department, Infanta Sofía University Hospital, San Sebastián De Los Reyes, Spain
| | - Francisco Zambrana
- Medical Oncology Department, Infanta Sofía University Hospital, Madrid, Spain
| | | | - Ana M. Jimenez-Gordo
- Medical Oncology Department, Hospital Universitario Infanta Sofía, San Sebastián De Los Reyes, Spain
| | | | - Maria Merino
- Medical Oncology Department, Infanta Sofía University Hospital, Madrid, Spain
| | - Cristina Aguayo
- Medical Oncology Department, Infanta Sofía University Hospital, Madrid, Spain
| | - Enrique Casado
- Medical Oncology Department, Infanta Sofía University Hospital, Madrid, Spain
| | - Juan Moreno-Rubio
- IMDEA, POL, Infanta Sofía University Hospital, SS De Los Reyes, Madrid, Spain
| | - Maria Sereno
- Medical Oncology Department, Infanta Sofía University Hospital, Madrid, Spain
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Gutiérrez Sainz L, Martínez-Recio S, Higuera O, Ghanem I, López-Alfonso A, Pérez M, Jimenez-Gordo AM, Lopez-Gomez M, Molina R, Ibeas P, Feliu J, Rodriguez-Salas N. Efficacy and safety of the combination of aflibercept with fluorouracil, leucovorin, and irinotecan in patients aged 70 years and older with metastatic colorectal cancer previously treated with an oxaliplatin-based regimen in Spain: A retrospective multicenter cohort study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
124 Background: Colorectal cancer is currently the third most common cancer worldwide. The results of the VELOUR study showed that the addition of aflibercept to Fluorouracil, Leucovorin, and Irinotecan (FOLFIRI) produced an advantage in both progression-free and overall survival (PFS and OS) in patients with metastatic colorectal cancer (mCRC) previously treated with an oxaliplatin-based regimen. The purpose of this study was to evaluate the efficacy and safety of the combination of aflibercept with FOLFIRI in patients aged 70 years and older with mCRC. Methods: We conducted a retrospective multicenter study, which included all patients aged 70 years and older with mCRC treated with Aflibercept plus FOLFIRI between May 2013 and March 2019 in 5 centers in Spain. Data regarding clinical and pathological characteristics, treatment response and survival were collected. Results: We selected 69 patients, of whom the majority (n = 48, 69.6%) were males with a median age of 75 years (range 70 to 84 years). Patients received an average of nine courses of aflibercept with FOLFIRI overall. Regarding response rates, 17 patients (24.6%) achieved a partial response, 37 (53.6%) had stable disease and 15 (21.7%) experienced disease progression. The median PFS was 6.1 months (CI 95%: 4.4–7.8), and the median OS was 13.9 months (CI 95%: 11.1–16.7). Treatment adverse events grade 3 and 4 were reported in 42 patients (60.9%). The most frequently reported treatment adverse events grade 3 and 4 were asthenia (24.6%), diarrhea (18.8%), stomatitis and ulceration (18.8%) and neutropenia (14.5%). Adverse events grade 3 and 4 typically associated with anti-VEGF therapy were infrequent. Adverse events led to permanent discontinuation of treatment in 26.1% of patients. Conclusions: In our sample the combination of aflibercept with FOLFIRI in patients aged 70 years and older with mCRC was effective and safe. Aflibercept plus FOLFIRI is a good therapeutic option for the treatment of mCRC in patients aged 70 years and older previously treated with oxaliplatin.
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Affiliation(s)
| | | | - Oliver Higuera
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Ismael Ghanem
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Ana López-Alfonso
- Medical Oncology Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Mar Pérez
- Medical Oncology Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Ana M. Jimenez-Gordo
- Medical Oncology Department, Hospital Universitario Infanta Sofía, San Sebastián De Los Reyes, Spain
| | - Miriam Lopez-Gomez
- Medical Oncology Department, Hospital Universitario Infanta Sofía, San Sebastián De Los Reyes, Spain
| | - Raquel Molina
- Medical Oncology Department, Hospital Universitario Príncipe de Asturias, Alcala De Henares, Spain
| | - Patricia Ibeas
- Medical Oncology Department, Hospital Universitario Del Henares, Madrid, Spain
| | - Jaime Feliu
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
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Cabezas-Camarero S, García-Barberán V, De la Orden-García V, Mediero-Valeros B, Paz Cabezas M, López-Alfonso A, Sánchez Ruiz AC, Ruiz-Casado A, Díaz-Millán I, Sastre J, Sotelo Lezama M, Diaz-Rubio E. RAS analysis of circulating tumor cells from advanced colorectal cancer using BEAMing technology. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e15151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15151 Background: RAS mutations predict a lack of response to anti-EGFR therapies in metastatic colorectal cancer (mCRC). BEAMing technology is useful for detecting hot-spot mutations in ctDNA in mCRC. Analysis of these mutations in DNA from Circulating Tumor Cells (CTC) may increase the predictive value in mCRC patients (pts). Our aim was to explore the feasibility of studying RAS status using BEAMing in DNA from CTC. Methods: First, spiking experiments (SE) using wild-type (WT) and KRAS-mutated (MUT) cell lines were performed to establish the limit of detection (LOD) for RAS analysis with BEAMing. Second, SE were performed with CTC collected by CellCelector (removes non-CTC background achieving 100% purity of CTC). Finally, BEAMing was used for RAS analysis in ctDNA and in DNA from CTC isolated either with IsoFlux or with CellCelector in 9 mCRC pts with confirmed RAS mutation in primary tumor. Total DNA from CTC was preamplified using RepliG. Results: In SE, 10 and 5 KRAS MUT-cells using different backgrounds of WT-cells (10-0.2% MUT-cells) were detected using BEAMing. However, 3 and 1 MUT-cells (0.009-0%) were not detected. In SE of CTCs collected with CellCelector, BEAMing detected KRAS mutations with 50, 20, 10, 6, 4, 2 and 1 cell (MAF: 23.8%±3.8). A mutation (codon 13) was detected in CTC from one patient positive in tissue and ctDNA (CellCelector; 15 CTCs; MAF: 11.4%). Discordant results were found in 8 patients when CTCs were isolated using Isoflux (min: 0, max: 9 CTCs). CTC from another patient were possibly mutated but WT in ctDNA. Conclusions: This pilot study indicates that RAS mutations can be detected in CTCs using BEAMing. Reducing the non-CTC cellular background may be needed in cases with low CTC number. Molecular information provided by CTC and ctDNA may prove complementary and useful for taking therapeutic decisions in mCRC. These results merit confirmation in larger, prospective studies.
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8
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Capdevila J, Trigo JM, Aller J, Manzano JL, Adrián SG, Llopis CZ, Reig Ò, Bohn U, Cajal TRY, Duran-Poveda M, Astorga BG, López-Alfonso A, Martínez JM, Porras I, Reina JJ, Palacios N, Grande E, Cillán E, Matos I, Grau JJ. Axitinib treatment in advanced RAI-resistant differentiated thyroid cancer (DTC) and refractory medullary thyroid cancer (MTC). Eur J Endocrinol 2017; 177:309-317. [PMID: 28687563 DOI: 10.1530/eje-17-0243] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/25/2017] [Accepted: 06/29/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Axitinib, an antiangiogenic multikinase inhibitor (MKI), was evaluated in the compassionate use programme (CUP) in Spain (October 2012-November 2014). SUBJECTS AND METHODS 47 patients with advanced radioactive iodine (RAI)-refractory differentiated thyroid cancer (DTC, n = 34) or medullary thyroid cancer (MTC, n = 13) with documented disease progression were treated with axitinib 5 mg b.i.d. The primary efficacy endpoint was objective response rate (ORR) by Response Evaluation Criteria In Solid Tumors (RECIST) v1.1. Progression-free survival (PFS) and adverse events (AEs) were secondary objectives. Regulatory authorities validated the CUP, and all patients signed informed consent form. RESULTS Axitinib was administered as first-line therapy in 17 patients (36.2%), as second-line in 18 patients (38.3%) and as third/fourth-line in 12 patients (25.5%). With a median follow-up of 11.5 months (0-24.3), ORR was 27.7% (DTC: 29.4% and MTC: 23.1%) and median PFS was 8.1 months (95% CI: 4.1-12.2) (DTC: 7.4 months (95% CI: 3.1-11.8) and MTC: 9.4 months (95% CI: 4.8-13.9)). Better outcomes were reported with first-line axitinib, with an ORR of 53% and a median PFS of 13.6 months compared with 16.7% and 10.6 months as second-line treatment. Twelve (25.5%) patients required dose reduction to 3 mg b.i.d. All-grade AEs included asthenia (53.2%), diarrhoea (36.2%), hypertension (31.9%) and mucositis (29.8%); grade 3/4 AEs included anorexia (6.4%), diarrhoea (4.3%) and cardiac toxicity (4.3%). CONCLUSION Axitinib had a tolerable safety profile and clinically meaningful activity in refractory and progressive thyroid cancer regardless of histology as first-line therapy. To our knowledge, this is the first time that cross-resistance between MKIs is suggested in thyroid cancer, highlighting the importance of prospective sequential clinical studies.
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Affiliation(s)
- Jaume Capdevila
- Medical Oncology Department, Gastrointestinal and Endocrine Tumor Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Manuel Trigo
- Medical Oncology Department, University Hospital Virgen de la Victoria, Málaga, Spain
| | - Javier Aller
- Endocrinology Department, University Hospital Puerta de Hierro, Madrid, Spain
| | - José Luís Manzano
- Medical Oncology Department, Catalan Oncology Institute (ICO-Badalona), University Hospital Germans Trias y Pujol, Barcelona, Spain
| | - Silvia García Adrián
- Medical Oncology Department, University Hospital of Móstoles, Móstoles, Madrid, Spain
| | - Carles Zafón Llopis
- Endocrinology and Nutrition Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Òscar Reig
- Medical Oncology Department, Translational Genomics and Targeted Therapeutics in Solid Tumors (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
| | - Uriel Bohn
- Medical Oncology Department, University Hospital of Gran Canaria Doctor Negrín, Las Palmas, Spain
| | - Teresa Ramón Y Cajal
- Medical Oncology Department, University Hospital of Santa Creu i Sant Pau, Barcelona, Spain
| | - Manuel Duran-Poveda
- General and Endocrine Surgery Department, University Hospital Rey Juan Carlos, Madrid, Spain
| | | | - Ana López-Alfonso
- Medical Oncology Department, University Hospital Infanta Leonor, Madrid, Spain
| | | | - Ignacio Porras
- Medical Oncology Department, University Hospital Reina Sofía, Córdoba, Spain
| | - Juan Jose Reina
- Medical Oncology Department, University Hospital Virgen Macarena, Sevilla, Spain
| | - Nuria Palacios
- Endocrinology Department, University Hospital Puerta de Hierro, Madrid, Spain
| | - Enrique Grande
- Medical Oncology Department, University Hospital Ramón y Cajal, Madrid, Spain
| | - Elena Cillán
- Medical Oncology Department, University Hospital of Santa Creu i Sant Pau, Barcelona, Spain
| | - Ignacio Matos
- Medical Oncology Department, Gastrointestinal and Endocrine Tumor Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Jose Grau
- Medical Oncology Department, University of Barcelona, Hospital Clínic of Barcelona, Barcelona, Spain
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9
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Rodríguez M, Silva J, López-Alfonso A, López-Muñiz MB, Peña C, Domínguez G, García JM, López-Gónzalez A, Méndez M, Provencio M, García V, Bonilla F. Different exosome cargo from plasma/bronchoalveolar lavage in non-small-cell lung cancer. Genes Chromosomes Cancer 2014; 53:713-24. [PMID: 24764226 DOI: 10.1002/gcc.22181] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 04/04/2014] [Accepted: 04/08/2014] [Indexed: 12/21/2022] Open
Abstract
Tumor-derived exosomes mediate tumorigenesis by facilitating tumor growth, metastasis, development of drug resistance, and immunosuppression. However, little is known about the exosomes isolated from bronchoalveolar lavage (BAL) in patients with lung neoplasm. Exosomes isolated in plasma and BAL from 30 and 75 patients with tumor and nontumor pathology were quantified by acetylcholinesterase activity and characterized by Western Blot, Electron Microscopy, and Nanoparticle Tracking Analysis. Differences in exosome cargo were analyzed by miRNA quantitative PCR in pooled samples and validated in a second series of patients. More exosomes were detected in plasma than in BAL in both groups (P < 0.001). The most miRNAs evaluated by PCR array were detected in tumor plasma, tumor BAL, and nontumor BAL pools, but only 56% were detected in the nontumor plasma pool. Comparing the top miRNAs with the highest levels detected in each pool, we found close homology only between the BAL samples of the two pathologies. In tumor plasma, we found a higher percentage of miRNAs with increased levels than in tumor BAL or in nontumor plasma. The data reveal differences between BAL and plasma exosome amount and miRNA content.
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Affiliation(s)
- Marta Rodríguez
- Department of Medical Oncology, University Hospital Puerta de Hierro Majadahonda, Madrid, Spain
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10
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Lázaro A, Casinello J, Amorós A, Heredia M, López-Alfonso A. Bilateral inflammatory metachronic ERBB2 (HER2/neu)-positive breast carcinoma: prolonged survival with combined chemotherapy and trastuzumab. Clin Transl Oncol 2008; 10:587-90. [PMID: 18796377 DOI: 10.1007/s12094-008-0255-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A patient with inflammatory breast carcinoma (IBC) diagnosed in the left breast responded to cisplatin and was treated with radical mastectomy and adjuvant therapy. Two years later C-erbB2-positive IBC was diagnosed in the right breast, and was treated with mastectomy and radiotherapy. Two years later skin metastases appeared, and trastuzumab was started initially as monotherapy, and later with paclitaxel and capecitabine. More than 12 years after diagnosis and 7 years after trastuzumab was started, the patient remains in complete clinical remission on trastuzumab and capecitabine.
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Affiliation(s)
- Alicia Lázaro
- Servicio de Farmacia Hospitalaria, Hospital Universitario de Guadalajara, Guadalajara, Spain
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