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Meri-Abad M, Moreno-Manuel A, García SG, Calabuig-Fariñas S, Pérez RS, Herrero CC, Jantus-Lewintre E. Clinical and technical insights of tumour mutational burden in non-small cell lung cancer. Crit Rev Oncol Hematol 2023; 182:103891. [PMID: 36565893 DOI: 10.1016/j.critrevonc.2022.103891] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Despite the durable responses provided by the introduction of checkpoint inhibitors in advanced Non-Small Cell Lung Cancer (NSCLC) without actionable targets in a subset of patients, a large proportion of them will progress after immunotherapy. Programmed Death Ligand 1 (PD-L1) was the first biomarker approved for immunotherapy, although it has multiple limitations, thus the development of novel biomarkers is an urgent need. Tumour Mutational Burden (TMB) is an emerging biomarker defined as the total number of mutations per coding area of tumour genome. Targeted gene panels have emerged as a cost-effective approach to estimate TMB. However, there is still an unmet need to fully standardize sample requirements, panel size, and bioinformatic pipelines to ensure that TMB is calculated appropriately. In addition, researchers are also evaluating TMB calculation in liquid biopsy. In this work, we summarize the relevant advances and the clinical utility of TMB in NSCLC.
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Affiliation(s)
- Marina Meri-Abad
- Medical Oncology Department, General University Hospital of Valencia, Valencia, Spain
| | - Andrea Moreno-Manuel
- Mixed Unit TRIAL (Príncipe Felipe Research Centre & Fundación para la Investigación del Hospital General Universitario de Valencia), Valencia, Spain; CIBERONC, Valencia, Spain
| | - Sandra Gallach García
- Mixed Unit TRIAL (Príncipe Felipe Research Centre & Fundación para la Investigación del Hospital General Universitario de Valencia), Valencia, Spain; CIBERONC, Valencia, Spain
| | - Silvia Calabuig-Fariñas
- Mixed Unit TRIAL (Príncipe Felipe Research Centre & Fundación para la Investigación del Hospital General Universitario de Valencia), Valencia, Spain; CIBERONC, Valencia, Spain; Pathology Department, Universitat de València, Valencia, Spain
| | - Rafael Sirera Pérez
- CIBERONC, Valencia, Spain; Biotechnology Department, Universitat Politècnica de València, Valencia, Spain; Mixed Unit Nanomedicine, Centro Investigación Príncipe Felipe-Universitat Politècnica de Valencia, 46022 Valencia, Spain
| | - Carlos Camps Herrero
- Medical Oncology Department, General University Hospital of Valencia, Valencia, Spain; Mixed Unit TRIAL (Príncipe Felipe Research Centre & Fundación para la Investigación del Hospital General Universitario de Valencia), Valencia, Spain; CIBERONC, Valencia, Spain; Department of Medicine, Universitat de València, Valencia, Spain
| | - Eloisa Jantus-Lewintre
- Mixed Unit TRIAL (Príncipe Felipe Research Centre & Fundación para la Investigación del Hospital General Universitario de Valencia), Valencia, Spain; CIBERONC, Valencia, Spain; Biotechnology Department, Universitat Politècnica de València, Valencia, Spain; Mixed Unit Nanomedicine, Centro Investigación Príncipe Felipe-Universitat Politècnica de Valencia, 46022 Valencia, Spain.
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Núñez Abad M, Calabuig-Fariñas S, Lobo de Mena M, Torres-Martínez S, García González C, García García JÁ, Iranzo González-Cruz V, Camps Herrero C. Programmed Death-Ligand 1 (PD-L1) as Immunotherapy Biomarker in Breast Cancer. Cancers (Basel) 2022; 14:307. [PMID: 35053471 PMCID: PMC8773553 DOI: 10.3390/cancers14020307] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 11/05/2021] [Revised: 12/22/2021] [Accepted: 01/05/2022] [Indexed: 12/21/2022] Open
Abstract
Breast cancer constitutes the most common malignant neoplasm in women around the world. Approximately 12% of patients are diagnosed with metastatic stage, and between 5 and 30% of early or locally advanced BC patients will relapse, making it an incurable disease. PD-L1 ligation is an immune inhibitory molecule of the activation of T cells, playing a relevant role in numerous types of malignant tumors, including BC. The objective of the present review is to analyze the role of PD-L1 as a biomarker in the different BC subtypes, adding clinical trials with immune checkpoint inhibitors and their applicable results. Diverse trials using immunotherapy with anti-PD-1/PD-L1 in BC, as well as prospective or retrospective cohort studies about PD-L1 in BC, were included. Despite divergent results in the reviewed studies, PD-L1 seems to be correlated with worse prognosis in the hormone receptor positive subtype. Immune checkpoints inhibitors targeting the PD-1/PD-L1 axis have achieved great response rates in TNBC patients, especially in combination with chemotherapy, making immunotherapy a new treatment option in this scenario. However, the utility of PD-L1 as a predictive biomarker in the rest of BC subtypes remains unclear. In addition, predictive differences have been found in response to immunotherapy depending on the stage of the tumor disease. Therefore, a better understanding of tumor microenvironment, as well as identifying new potential biomarkers or combined index scores, is necessary in order to make a better selection of the subgroups of BC patients who will derive benefit from immune checkpoint inhibitors.
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Affiliation(s)
- Martín Núñez Abad
- Department of Medical Oncology, Hospital General Universitario de Valencia, 46014 Valencia, Spain; (M.L.d.M.); (C.G.G.); (C.C.H.)
| | - Silvia Calabuig-Fariñas
- Molecular Oncology Laboratory, Fundación Investigación, Hospital General Universitario de Valencia, 46014 Valencia, Spain; (S.C.-F.); (S.T.-M.)
- Unidad Mixta TRIAL, Centro Investigación Príncipe Felipe-Fundación Investigación, Hospital General Universitario de Valencia, 46014 Valencia, Spain
- Centro de Investigación Biomédica en Red Cáncer, CIBERONC, 28029 Madrid, Spain
- Department of Pathology, Universitat de València, 46010 Valencia, Spain
| | - Miriam Lobo de Mena
- Department of Medical Oncology, Hospital General Universitario de Valencia, 46014 Valencia, Spain; (M.L.d.M.); (C.G.G.); (C.C.H.)
| | - Susana Torres-Martínez
- Molecular Oncology Laboratory, Fundación Investigación, Hospital General Universitario de Valencia, 46014 Valencia, Spain; (S.C.-F.); (S.T.-M.)
- Unidad Mixta TRIAL, Centro Investigación Príncipe Felipe-Fundación Investigación, Hospital General Universitario de Valencia, 46014 Valencia, Spain
- Centro de Investigación Biomédica en Red Cáncer, CIBERONC, 28029 Madrid, Spain
| | - Clara García González
- Department of Medical Oncology, Hospital General Universitario de Valencia, 46014 Valencia, Spain; (M.L.d.M.); (C.G.G.); (C.C.H.)
| | | | - Vega Iranzo González-Cruz
- Department of Medical Oncology, Hospital General Universitario de Valencia, 46014 Valencia, Spain; (M.L.d.M.); (C.G.G.); (C.C.H.)
- Centro de Investigación Biomédica en Red Cáncer, CIBERONC, 28029 Madrid, Spain
- Department of Medicine, Universitat de València, 46010 Valencia, Spain
| | - Carlos Camps Herrero
- Department of Medical Oncology, Hospital General Universitario de Valencia, 46014 Valencia, Spain; (M.L.d.M.); (C.G.G.); (C.C.H.)
- Molecular Oncology Laboratory, Fundación Investigación, Hospital General Universitario de Valencia, 46014 Valencia, Spain; (S.C.-F.); (S.T.-M.)
- Unidad Mixta TRIAL, Centro Investigación Príncipe Felipe-Fundación Investigación, Hospital General Universitario de Valencia, 46014 Valencia, Spain
- Centro de Investigación Biomédica en Red Cáncer, CIBERONC, 28029 Madrid, Spain
- Department of Medicine, Universitat de València, 46010 Valencia, Spain
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Meri-Abad M, Blasco Cordellat A, Camps Herrero C. Capillary and cutaneous hypopigmentation secondary to pazopanib. Med Clin (Barc) 2021; 158:246-247. [PMID: 34226060 DOI: 10.1016/j.medcli.2021.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Marina Meri-Abad
- Servicio de Oncología Médica, Consorcio Hospital General Universitario Valencia, Valencia, España.
| | - Ana Blasco Cordellat
- Servicio de Oncología Médica, Consorcio Hospital General Universitario Valencia, Valencia, España; CIBERONC, Madrid, España
| | - Carlos Camps Herrero
- Servicio de Oncología Médica, Consorcio Hospital General Universitario Valencia, Valencia, España; CIBERONC, Madrid, España; Departamento de Medicina, Universidad de Valencia, Valencia, España
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Núñez Abad M, Calabuig-Fariñas S, Lobo de Mena M, José Godes Sanz de Bremond M, García González C, Torres Martínez S, García-García JÁ, Iranzo González-Cruz V, Camps Herrero C. Update on systemic treatment in early triple negative breast cancer. Ther Adv Med Oncol 2021; 13:1758835920986749. [PMID: 33613695 PMCID: PMC7871289 DOI: 10.1177/1758835920986749] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/18/2020] [Indexed: 12/21/2022] Open
Abstract
Triple negative breast cancer (TNBC) is a heterogeneous disease representing about 15% of all breast cancers. TNBC are usually high-grade histological tumors, and are generally more aggressive and difficult to treat due to the lack of targeted therapies available, and chemotherapy remains the standard treatment. There is a close relationship between pathological complete response after chemotherapy treatment and higher rates of disease-free survival and overall survival. In this review of systemic treatment in early triple negative breast cancer, our purpose is to analyze and compare different therapies, as well as to highlight the novelties of treatment in this breast cancer subtype.
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Affiliation(s)
- Martín Núñez Abad
- Department of Medical Oncology, University
General Hospital of Valencia, Valencia, Spain
| | - Silvia Calabuig-Fariñas
- Molecular Oncology Laboratory, General
University Hospital Research Foundation, University General Hospital of
Valencia, Valencia, Spain
- CIBERONC, Madrid, Spain
- Department of Pathology, Universitat de
València, Valencia, Spain
- Mixed Unit TRIAL, Príncipe Felipe Research
Center & General University Hospital of Valencia Research Foundation,
Spain
| | - Miriam Lobo de Mena
- Department of Medical Oncology, University
General Hospital of Valencia, Valencia, Spain
| | | | - Clara García González
- Department of Medical Oncology, University
General Hospital of Valencia, Valencia, Spain
| | - Susana Torres Martínez
- Molecular Oncology Laboratory, General
University Hospital Research Foundation, University General Hospital of
Valencia, Valencia, Spain
- CIBERONC, Madrid, Spain
| | | | - Vega Iranzo González-Cruz
- Department of Medical Oncology, University
General Hospital of Valencia, Tres Cruces, 2, Valencia, 46014, Spain
- CIBERONC
- Department of Medicine, Universitat de
València, Valencia, Spain
| | - Carlos Camps Herrero
- Department of Medical Oncology, University
General Hospital of Valencia, Valencia, Spain
- Molecular Oncology Laboratory, General
University Hospital Research Foundation, University General Hospital of
Valencia, Valencia, Spain
- CIBERONC, Madrid, Spain
- Department of Medicine, Universitat de
València, Valencia, Spain
- Mixed Unit TRIAL, Príncipe Felipe Research
Center & General University Hospital of Valencia Research Foundation,
Spain
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Gil-Raga M, Meri-Abad M, Safont Aguilera MJ, Hernández Machancoses A, Lobo M, Calabuig-Fariñas S, López Torrecilla J, Herreros Pomares A, Camps Herrero C. Long term control stereotactic body radiotherapy (SBRT) for oligometastatic colorectal cancer: a single center study. Chin Clin Oncol 2020; 9:13. [PMID: 32192350 DOI: 10.21037/cco.2020.01.10] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/14/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND To evaluate survival after stereotactic body radiotherapy (SBRT) as radical treatment for metastases of colorectal cancer (CRC) and to identify prognostic factors after treatment. METHODS Patients with metastatic CRC treated with SBRT on metastatic lesions were retrospectively analyzed between February 2012 and August 2016 at the General University Hospital of Valencia. The follow-up was carried out until July 15, 2018. The data have been collected in a database. Patients may have received prior systemic therapy and/or resection of metastatic disease. Endpoints were timed from end of SBRT and included overall survival (OS) and progression-free survival (PFS). Univariate and multivariate analysis using Cox proportional hazard modeling was used to identify prognostic factors. RESULTS A total of 49 patients were identified. Before SBRT, 77.5% of the patients have received systemic therapy and 65.2% surgery for metastatic disease. Of metastatic lesions treated with SBRT 53.1% were located in the lung, 30.6% in the liver and 16.3% in other locations. Median survival were: PFS after treatment with SBRT was 9.9 months (95% CI: 4.64-15.1) and the median OS was 28.9 months (95% CI: 19.0-38.7). No relapses were observed in 20% of the patients after SBRT. The treatment was well tolerated and no patient had grade 3 or 4 adverse effects. Right colon [HR 16.53 (95% CI: 3.11-87.87), P value 0.001] and higher tumor stage (III-IV) [HR 12.30 (95% CI: 2.10-71.92), P value 0.005] showed a lower OS in a multivariate analysis. CONCLUSIONS SBRT for oligometastatic disease is an effective option for patients with advanced CRC, with encorauging survival outcomes. However, a definitive validation in large randomized studies is required.
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Affiliation(s)
- Mireia Gil-Raga
- Medical Oncology Department, General University Hospital, Valencia, Spain.
| | - Marina Meri-Abad
- Medical Oncology Department, General University Hospital, Valencia, Spain
| | | | | | - Miriam Lobo
- Medical Oncology Department, General University Hospital, Valencia, Spain
| | - Silvia Calabuig-Fariñas
- Molecular Oncology Laboratory, Research Foundation of University General Hospital, Valencia, Spain
| | - Jose López Torrecilla
- Radiotherapy Oncology Department, ERESA, General University Hospital, Valencia, Spain
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Merí Abad M, Aparisi Aparisi FDA, Blasco Cordellat A, Camps Herrero C. A-68-year-old woman with dancing eyes syndrome. Med Clin (Barc) 2019; 153:475. [PMID: 31029373 DOI: 10.1016/j.medcli.2019.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/05/2019] [Accepted: 03/07/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Marina Merí Abad
- Servicio de Oncología Médica, Hospital General Universitario Valencia, Valencia, España.
| | | | - Ana Blasco Cordellat
- Servicio de Oncología Médica, Hospital General Universitario Valencia, Valencia, España; Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, España
| | - Carlos Camps Herrero
- Servicio de Oncología Médica, Hospital General Universitario Valencia, Valencia, España; Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, España; Universidad de Valencia, Valencia, España
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Camps Herrero C, Antón Torres A, Cruz-Hernández JJ, Carrato A, Constenla M, Díaz-Rubio E, Feyjoo Saus M, Garcia-Foncillas J, Gascón P, Guillem V. Working towards a consensus on the oncological approach of breakthrough pain: a Delphi survey of Spanish experts. J Pain Res 2019; 12:2349-2358. [PMID: 31534359 PMCID: PMC6681159 DOI: 10.2147/jpr.s203903] [Citation(s) in RCA: 5] [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: 02/02/2019] [Accepted: 07/02/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose There is a lack of standards for the diagnosis, assessment and management of breakthrough cancer pain (BTcP). La Fundación ECO (the Foundation for Excellence and Quality in Oncology) commissioned a study to establish a consensus and lay the foundations for the appropriate management of BTcP in oncology patients. Patients and methods A modified Delphi survey comprising two rounds was used to gather and analyze data, which was conducted over the Internet. Each statement that reached a consensus with the respondents was defined as a median consensus score (MED) of ≥7, and agreement among panelists as an interquartile range (IQR) of ≤3. Results In total, 69 medical oncologists responded, with a broad consensus that BTcP implied exacerbations of high-intensity pain, as opposed to moderate pain. Furthermore, they concurred that appropriate diagnostic equipment is needed, and that rapid-onset fentanyl formulations should be the preferred treatment for BTcP management. The panelists agreed that a lack of appropriate information and training to attend to patients, as well as limited patient visitation rights, were barriers to effective BTcP management. Regarding gaps in detected knowledge, the panelists were unsure of the measures necessary to assess the burden of the disease on the patient’s quality of life and associated medication costs. Alongside this, there was a lack of awareness of the technical specifics of the different formulations of rapid-onset fentanyl. Conclusion These results represent the current status of BTcP management. They may inform recommendations and provide a framework for future research.
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Affiliation(s)
- Carlos Camps Herrero
- Jefe de Servicio de Oncología Médica, Consorcio Hospital General Universitario, Valencia, Spain
| | - Antonio Antón Torres
- Jefe del Servicio de Oncología Médica, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Alfredo Carrato
- Jefe del Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Manuel Constenla
- Jefe de Servicio de Oncología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Eduardo Díaz-Rubio
- Jefe del Servicio de Oncología Médica, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Jesus Garcia-Foncillas
- Jefe de Servicio de Oncología Médica, Hospital Universitario "Fundación Jiménez Díaz", Madrid, Spain
| | - Pere Gascón
- Jefe del Servicio de Oncología Médica, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Vicente Guillem
- Jefe del Servicio de Oncología Médica, Instituto Valenciano de Oncología, Valencia, Spain
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Garde Noguera J, Jantus-Lewintre E, Gil-Raga M, Evgenyeva E, Maciá Escalante S, Llombart-Cussac A, Camps Herrero C. Role of RAS mutation status as a prognostic factor for patients with advanced colorectal cancer treated with first-line chemotherapy based on fluoropyrimidines and oxaliplatin, with or without bevavizumab: A retrospective analysis. Mol Clin Oncol 2017; 6:403-408. [PMID: 28451421 DOI: 10.3892/mco.2017.1149] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 12/02/2016] [Indexed: 01/28/2023] Open
Abstract
The role of Kirsten rat sarcoma viral oncogene homolog (KRAS) and neuroblastoma RAS viral oncogene homolog (NRAS) mutations as negative predictors for anti-epidermal growth factor receptor (EGFR) therapies in metastatic colorectal cancer (CRC) has been firmly established. However, whether the RAS mutation status plays a role as a biomarker for anti-vascular endothelial growth factor (VEGF) treatment remains controversial. Data from 93 CRC patients who received first-line cytotoxic chemotherapy with fluoropyrimidines and oxaliplatin, with or without bevacizumab, were analyzed. We investigated the association between the RAS mutation status and clinical outcomes in terms of response rate, progression-free survival (PFS) and overall survival (OS). Mutations in RAS genes were observed in 47 (52.6%) patients (45 KRAS and 2 NRAS mutations). Patients with tumours harbouring RAS mutations were less suitable for primary tumour resection, were more likely to develop lung metastases, and received bevacizumab treatment for a shorter time period compared with those with wild-type tumours. The response rate to chemotherapy did not differ according to the RAS mutation status, and there were no significant differences in PFS [RAS mutation: 12 months, 95% confidence interval (CI): 8.7-15.2 vs. RAS wild-type: 12 months, 95% CI: 9.67-14.32; P=0.857] or OS (RAS mutation: 20 months, 95% CI: 14.3-25.6 vs. RAS wild-type: 24 months, 95% CI: 18.7-29.2; P=0.631). Patients with RAS mutation vs. those with RAS wild-type exhibited a favourable trend in PFS when treated with bevacizumab (13 months, 95% CI: 6.5-19.4 vs. 10 months, 95% CI: 4.2-15.7, respectively; P=0.07) and OS (27 months, 95% CI: 18.5-35.4 vs. 15 months, 95% CI: 12.4-17.5, respectively; P=0.22). In conclusion, RAS mutations are not a prognostic marker for PFS and OS in CRC patients receiving fluoropyrimidine-oxaliplatine treatment, with or without bevacizumab. RAS mutations are not predictive of the lack of efficacy of bevacizumab, and these patients appear to benefit from anti-angiogenic treatment.
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Affiliation(s)
- Javier Garde Noguera
- Medical Oncology Department, Hospital Arnau de Vilanova of Valencia, 46015 Valencia, Spain
| | - Eloisa Jantus-Lewintre
- Molecular Oncology Laboratory, University General Hospital of Valencia, Research Foundation, 46014 Valencia, Spain
| | - Mireia Gil-Raga
- Medical Oncology Department, Hospital de Sagunto, 46520 Valencia, Spain
| | - Elena Evgenyeva
- Pathology Department, Hospital Marina-Salud de Denia, 03700 Dénia, Spain
| | | | | | - Carlos Camps Herrero
- Medical Oncology and Molecular Laboratory Department, University General Hospital of Valencia, University of Valencia, 46014 Valencia, Spain
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De Las Peñas R, Ponce S, Henao F, Camps Herrero C, Carcereny E, Escobar Álvarez Y, Rodríguez CA, Virizuela JA, López López R. SIADH-related hyponatremia in hospital day care units: clinical experience and management with tolvaptan. Support Care Cancer 2015; 24:499-507. [PMID: 26431960 PMCID: PMC4669367 DOI: 10.1007/s00520-015-2948-6] [Citation(s) in RCA: 9] [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] [Received: 05/12/2015] [Accepted: 09/14/2015] [Indexed: 01/16/2023]
Abstract
Hyponatremia (Na ˂135 mmol/l) is the most frequent electrolyte disorder in clinical practice, and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the commonest cause of hyponatremia in cancer patients. Correcting hyponatremia in these patients can reduce morbidity and mortality, increase the response to anti-cancer agents, and help reduce hospital length of stay and costs. Tolvaptan is an oral medication used to treat SIADH-related hyponatremia patients that needs to be initiated at hospital so patients can have their serum sodium monitored. If tolvaptan could be initiated in hospital day care units (DCUs), performing the same tests, hospitalization could be avoided, quality of life improved, and costs reduced. This is the first publication where a panel of oncologists are sharing their experience and making some recommendations with the use of tolvaptan to treat SIADH-related hyponatremia in DCU after collecting and examining 35 clinical cases with these type of patients. The conclusion from this retrospective observational analysis is that the use of tolvaptan in DCU is safe and effective in the therapeutic management of SIADH-related hyponatremia.
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Affiliation(s)
- Ramón De Las Peñas
- Medical Oncology Department, Consorcio Hospitalario Provincial de Castellón, Castellón, Spain.
| | - Santiago Ponce
- Medical Oncology Department, Hospital 12 de Octubre, Madrid, Spain
| | - Fernando Henao
- Medical Oncology Department, Hospital Universitario Virgen de la Macarena, Seville, Spain
| | - Carlos Camps Herrero
- Medical Oncology Department, Consorcio Hospital General Universitario de Valencia, University of Valencia, Valencia, Spain
| | - Enric Carcereny
- Medical Oncology Department, Institut Catalàd'Oncologia-Badalona, Hospital Germans Trias i Pujol, Barcelona, Spain
| | | | - César A Rodríguez
- Medical Oncology Department, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Juan Antonio Virizuela
- Medical Oncology Department, Hospital Universitario Virgen de la Macarena, Seville, Spain
| | - Rafael López López
- Medical Oncology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain
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Carulla Torrent J, Jara Sánchez C, Sanz Ortiz J, Batista López N, Camps Herrero C, Cassinello Espinosa J, Lizón Giner J, Montalar Salcedo JN, Fitch Warner K, Gobbo Montoya M, Díaz-Rubio García E. Oncologists’ perceptions of cancer pain management in Spain: The real and the ideal. Eur J Pain 2012; 11:352-9. [PMID: 16815053 DOI: 10.1016/j.ejpain.2006.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Revised: 04/06/2006] [Accepted: 05/14/2006] [Indexed: 11/18/2022]
Abstract
AIM Studies in some countries suggest that cancer pain is often not adequately controlled, but little is known about the situation in Spain. The objective of this study was to identify medical oncologists' perceptions about pain management in their patients. METHODS Two-round Delphi survey of 24 medical oncologists from 22 large, geographically diverse hospitals in Spain. Physicians rated each of 150 statements on a Likert scale (1=strongly disagree; 5=strongly agree). The mean, standard deviation and frequency of replies in three agreement categories were calculated for each item. Statements allowing comparison of oncologists' perceptions of how pain is managed in routine clinical practice with how it should be managed were grouped together and analyzed. RESULTS The most notable discrepancies between the real and the ideal occurred in the failure to provide written information or to confirm that patients understand what they are told, the lack of comprehensive and systematic evaluation of pain, and the lack of use of non-pharmacological treatments (NPTs) for cancer pain. CONCLUSIONS Medical oncologists need to improve their communication skills, providing patients with both written and verbal information about their disease and the plan for pain management. Pain should be evaluated at each patient visit using validated scales, and greater attention should be paid to the possible use of NPTs.
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Camps Herrero C, Gavilá Gregori J, Garde Noguera J, Caballero Díaz C, Iranzo González-Cruz V, Juárez Marroquí A, Safont Aguilera MJ, Blasco Cordellat A, Berrocal Jaime A, Sanz de Bremond MG. [Euthanasia in patients with cancer and the continuous-care providers]. Clin Transl Oncol 2005; 7:278-84. [PMID: 16185589 DOI: 10.1007/bf02710266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/22/2022]
Abstract
During the clinical evolution of patients with cancer there are many occasions, or phases of the disease, when there are no specific treatments and, as such, we need to provide maximum comfort following appropriate symptom control; in this stage it is fundamental to respect personal autonomy together with the option to reject futile treatment. With appropriate control of symptoms it is possible to reach the stage where the majority of the patients do not continue to suffer. Continuous-care providers for cancer patients are those who are responsible for providing help to resolve these situations. In palliative medicine there are highly-efficacious procedures to the help in these last hours. Sedation is applied when it is impossible to control symptoms by other means. With appropriate Carer cover, it is not necessary to introduce laws on assisted suicide and/or active voluntary euthanasia, neither because of the magnitude of demand, nor because of the difficulties in achieving appropriate control of symptoms.
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Affiliation(s)
- Carlos Camps Herrero
- Servicio de Oncología Médica, Consorcio Hospital General Universitario de Valencia, España.
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Valentín Maganto V, Camps Herrero C, Carulla Torrent J, Cassinello Espinosa J, Dorta Delgado J, Jara Sánchez C, Moreno Nogueira JA. [Safety and efficacy of oral trans-mucosal fentanyl citrate in the long-term treatment of breakthrough pain in oncology patients: the ECODIR study]. Clin Transl Oncol 2005; 7:205-12. [PMID: 15960932 DOI: 10.1007/bf02712818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/25/2022]
Abstract
INTRODUCTION Oral trans-mucosal fentanyl citrate (OTFC) is the one drug specifically developed for the management of breakthrough pain. This study assesses the long-term safety and efficacy of OTFC standard clinical conditions. Patients and methods. Six-month observational study performed on cancer patients with episodes of breakthrough pain. Safety was assessed by recording the advent of adverse events and efficacy by the evaluating the intensity of breakthrough pain. RESULTS 174 cancer patients were recruited into the study. All adverse reactions reported were mild or moderate. OTFC was significantly faster (time to the commencement of pain relief: 12.7 +/- 11.4 vs 32.7 +/- 18.4 minutes; p < 0.001) and potent (post-treatment pain intensity: 3.4 +/- 1.5 vs 4.3 +/- 1.5; p < 0.001) than the previously-used drugs. CONCLUSIONS This observational study confirms the good safety profile of OTFC as well as its effectiveness over long-term period treatment of breakthrough pain.
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Affiliation(s)
- Vicente Valentín Maganto
- Servicio de Oncología Médica, Hospital Universitario 12 de Octubre, Avenida Cordoba km 4500, 28045 Madrid, Spain.
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Camps Herrero C, Bayo Zaera P, Sirera Pérez R, Sancho Salvador E, Blasco Cordellat A, Safont Aguilera MJ. Análisis de la concentración sérica del ADN tumoral en el cáncer de pulmón no microcítico y avanzado: ¿es útil como factor pronóstico? Clin Transl Oncol 2005; 7:122-6. [PMID: 15899220 DOI: 10.1007/bf02708745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 10/22/2022]
Abstract
INTRODUCTION Presence of circulating DNA in the serum of patients with cancer makes detection of tumour-specific genetic alterations feasible. OBJECTIVE To study serum DNA concentration in patients diagnosed as having advanced Non-Small Cell Lung Cancer (NSCLC) and to evaluate its relationship with age, histology, stage, response, time-to-progression (TTP), and survival. METHODS Serum DNA from 78 patients was purified and spectrophotometrically quantified. RESULTS No significant correlations were found between serum DNA concentration and age, histology, response and survival. There was a significant correlation with respect to stage (IIIB = 408.75 ng/ml; IV = 478.74 ng/ml; p = 0.02). When patients were grouped according to DNA concentration, significant correlation with TTP was found; establishing a cut-off point at 500 ng/ml ([DNA] < 500 ng/ml TTP = 7.25 months, 95%CI: 3.5-5.25; [DNA ] > or = 500 ng/ml TTP = 4.25 months, 95%CI: 2-6.5; p = 0.05). CONCLUSIONS Using the present method, DNA concentration quantification appears to be simple, but with certain deficiencies due to inter-sample variability and low specificity. This is because total DNA concentration is measured without distinguishing as to whether it is tumour-related. We suggest that there is a correlation between DNA concentration and prognosis which enables an analysis of the natural history of the disease.
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Affiliation(s)
- Carlos Camps Herrero
- Servicio de Oncología Médica, Consorcio Hospital General Universitario de Valencia, Av. Tres Cruces s/n, Valencia 46014, Spain.
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Camps C, Martínez EN, Jaime AB, Herrero CC. Second-line treatment with gemcitabine and vinorelbine in non-small-cell lung cancer (NSCLC) cisplatin failures: a pilot study. Lung Cancer 2000; 27:47-53. [PMID: 10672783 DOI: 10.1016/s0169-5002(99)00092-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [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: 11/21/2022]
Abstract
PURPOSE This pilot study was designed to evaluate the efficacy and toxicity of the gemcitabine/vinorelbine combination in non-small-cell lung cancer (NSCLC) patients who had failed cisplatin-based first-line chemotherapy. PATIENTS AND METHODS Eligible patients had refractory or resistant NSCLC, WHO performance status 0-2, adequate hematologic parameters and normal hepatic, renal and cardiac function. Gemcitabine (1200 mg/m2) was administered on days 1, 8 and 15; vinorelbine (25 mg/m2) was administered on days 1 and 8, every 4 weeks until patients experienced disease progression. RESULTS From September 1997 to March 1998, 16 patients were enrolled (six: stage IIIB: ten: stage IV). All 16 patients were assessable for toxicity and evaluated for response. One complete (6.25%) response and no partial responses were observed. Median survival was 25 weeks (95% CI 19-30). A median of 3.31 courses per patient was administered, and the median interval between courses was 28 days. The median delivered dose was 664.85 mg/m2 per week of gemcitabine and 10.71 mg/m2 per week of vinorelbine, corresponding to a relative dose intensity of 0.73 and 0.85, respectively. Grade 2/3 thrombocytopenia occurred in 13 (24.52%) of 53 courses administered. Neutropenia Grade 2/3 occurred in 14 courses (26.41%). There were seven (13.20%) episodes of fever related to the drug administration. Mild asthenia was observed in six (37.5%) patients. Other toxicities were mild to moderate. CONCLUSION These results suggest that this gemcitabine/vinorelbine combination is not an active salvage regimen in patients with refractory NSCLC. The combination merits further evaluation with modified regimens.
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Affiliation(s)
- C Camps
- Hospital General Universitario de Valencia, Spain
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