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Đokić S, Gazić B, Grčar Kuzmanov B, Blazina J, Miceska S, Čugura T, Grašič Kuhar C, Jeruc J. Clinical and Analytical Validation of Two Methods for Ki-67 Scoring in Formalin Fixed and Paraffin Embedded Tissue Sections of Early Breast Cancer. Cancers (Basel) 2024; 16:1405. [PMID: 38611083 PMCID: PMC11011015 DOI: 10.3390/cancers16071405] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/29/2024] [Accepted: 03/31/2024] [Indexed: 04/14/2024] Open
Abstract
Proliferation determined by Ki-67 immunohistochemistry has been proposed as a useful prognostic and predictive marker in breast cancer. However, the clinical validity of Ki-67 is questionable. In this study, Ki-67 was retrospectively evaluated by three pathologists using two methods: a visual assessment of the entire slide and a quantitative assessment of the tumour margin in 411 early-stage breast cancer patients with a median follow-up of 26.8 years. We found excellent agreement between the three pathologists for both methods. The risk of recurrence for Ki-67 was time-dependent, as the high proliferation group (Ki-67 ≥ 30%) had a higher risk of recurrence initially, but after 4.5 years the risk was higher in the low proliferation group. In estrogen receptor (ER)-positive patients, the intermediate Ki-67 group initially followed the high Ki-67 group, but eventually followed the low Ki-67 group. ER-positive pN0-1 patients with intermediate Ki-67 treated with endocrine therapy alone had a similar outcome to patients treated with chemotherapy. A cut-off value of 20% appeared to be most appropriate for distinguishing between the high and low Ki-67 groups. To summarize, a simple visual whole slide Ki-67 assessment turned out to be a reliable method for clinical decision-making in early breast cancer patients. We confirmed Ki-67 as an important prognostic and predictive biomarker.
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Affiliation(s)
- Snežana Đokić
- Department of Pathology, Institute of Oncology, 1000 Ljubljana, Slovenia; (S.Đ.); (B.G.)
- Faculty of Medicine Ljubljana, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Barbara Gazić
- Department of Pathology, Institute of Oncology, 1000 Ljubljana, Slovenia; (S.Đ.); (B.G.)
| | - Biljana Grčar Kuzmanov
- Department of Pathology, Institute of Oncology, 1000 Ljubljana, Slovenia; (S.Đ.); (B.G.)
| | - Jerca Blazina
- Department of Pathology, Institute of Oncology, 1000 Ljubljana, Slovenia; (S.Đ.); (B.G.)
| | - Simona Miceska
- Faculty of Medicine Ljubljana, University of Ljubljana, 1000 Ljubljana, Slovenia;
- Department of Cytopathology, Institute of Oncology, 1000 Ljubljana, Slovenia
| | - Tanja Čugura
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Cvetka Grašič Kuhar
- Faculty of Medicine Ljubljana, University of Ljubljana, 1000 Ljubljana, Slovenia;
- Department of Medical Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
| | - Jera Jeruc
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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Grašič Kuhar C, Geiger J, Schwab FD, Heinzelmann-Schwartz V, Vetter M, Weber WP, Kurzeder C. Prognostic Importance of Axillary Lymph Node Response to Neoadjuvant Systemic Therapy on Axillary Surgery in Breast Cancer-A Single Center Experience. Cancers (Basel) 2024; 16:1306. [PMID: 38610984 PMCID: PMC11010874 DOI: 10.3390/cancers16071306] [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: 02/11/2024] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Neoadjuvant systemic treatment (NST) is the standard treatment for HER2+, triple-negative (TN), and highly proliferative luminal HER2- early breast cancer. Pathologic complete response (pCR) after NST is associated with improved outcomes. We evaluated the predictive factors for axillary-pCR (AXpCR) and its impact on the extent of axillary node surgery. This retrospective study included 92 patients (median age of 50.4 years) with an initially node-positive disease. Patients were treated with molecular subtype-specific NST (4.3% were luminal A-like, 28.3% luminal HER2-, 26.1% luminal HER2+, 18.5% HER2+ non-luminal, and 22.8% TN). Axillary-, breast- and total-pCR were achieved in 52.2%, 48.9%, and 38% of patients, respectively. In a binary logistic regression model for the whole population, the only independent factor significantly associated with AXpCR was breast-pCR (OR 7.4; 95% CI 2.6-20.9; p < 0.001). In patients who achieved breast-pCR, aggressive subtypes (HER2+ and TN; OR 11.24) and clinical tumor stage (OR 0.10) had a significant impact on achieving AXpCR. Axillary lymph node dissection was avoided in 53.3% of patients. In conclusion, in node-positive patients with HER2+ and TN subtypes, who achieved breast-pCR after NST, de-escalation of axillary surgery could be considered in most cases.
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Affiliation(s)
- Cvetka Grašič Kuhar
- Department of Medical Oncology, Institute of Oncology, 1000 Ljubljana, Slovenia
- Faculty of Medicine Ljubljana, University of Ljubljana, 1000 Ljubljana, Slovenia
- Breast Cancer Center, University Hospital Basel, University of Basel, 4001 Basel, Switzerland; (J.G.); (F.D.S.); (W.P.W.); (C.K.)
| | - James Geiger
- Breast Cancer Center, University Hospital Basel, University of Basel, 4001 Basel, Switzerland; (J.G.); (F.D.S.); (W.P.W.); (C.K.)
| | - Fabienne Dominique Schwab
- Breast Cancer Center, University Hospital Basel, University of Basel, 4001 Basel, Switzerland; (J.G.); (F.D.S.); (W.P.W.); (C.K.)
- Department of Gynecologic Oncology, University Hospital Basel, 4031 Basel, Switzerland;
| | | | - Marcus Vetter
- Medical Faculty, University of Basel, 4001 Basel, Switzerland;
- Department of Hematology and Oncology, Cantonal Hospital Basel-Land, 4410 Liestal, Switzerland
| | - Walter Paul Weber
- Breast Cancer Center, University Hospital Basel, University of Basel, 4001 Basel, Switzerland; (J.G.); (F.D.S.); (W.P.W.); (C.K.)
| | - Christian Kurzeder
- Breast Cancer Center, University Hospital Basel, University of Basel, 4001 Basel, Switzerland; (J.G.); (F.D.S.); (W.P.W.); (C.K.)
- Department of Gynecologic Oncology, University Hospital Basel, 4031 Basel, Switzerland;
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Chiru ED, Oseledchyk A, Schoetzau A, Kurzeder C, Mosimann R, Vetter M, Grašič Kuhar C. Application of a 21-Gene Recurrence Score in a Swiss Single-Center Breast Cancer Population: A Comparative Analysis of Treatment Administration before and after TAILORx. Diagnostics (Basel) 2023; 14:97. [PMID: 38201405 PMCID: PMC10795714 DOI: 10.3390/diagnostics14010097] [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: 11/03/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024] Open
Abstract
In patients with hormone receptor positive, human epidermal receptor 2 negative (HR+/HER2-) negative breast cancer (BC), the TAILORx study showed the benefit of adding chemotherapy (CHT) to endocrine therapy (ET) in a subgroup of patients under 50 years with an intermediate Oncotype DX recurrence score (RS 11-25). The aim of the present study was to determine if the TAILORx findings, including the changes in the RS categories, impacted CHT use in the intermediate RS (11-25) group in daily practice, as well as to identify the main factors for CHT decisions. We conducted a retrospective study on 326 BC patients (59% node-negative), of which 165 had a BC diagnosis before TAILORx (Cohort A) and 161 after TAILORx publication (Cohort B). Changes in the RS categories led to shifts in patient population distribution, thereby leading to a 40% drop in the low RS (from 60% to 20%), which represented a doubling in the intermediate RS (from 30% to 60%) and an increase of 5% in the high RS (from 8-10% to 15%). The overall CHT recommendation and application did not differ significantly between cohort B when compared with A (19% vs. 22%, resp., p = 0.763). In the intermediate RS (11-25), CHT use decreased by 5%, while in the high-risk RS category (>25), there was an increase of 13%. The tumor board recommended CHT for 90% of the patients according to the new RS guidelines in cohort A and for 85% in cohort B. The decision for CHT recommendation was based on age (OR 0.93, 95% CI 0.08-0.97, p = 0.001), nodal stage (OR 4.77, 95% CI 2.03-11.22, p < 0.001), and RS categories (RS 11-25 vs. RS 0-10: OR 0.06 (95% CI 0.02-0.17), p < 0.001; RS > 26 vs. RS 11-25: OR 618.18 95% CI 91.64-4169.91, p < 0.001), but did not depend on the cohort. In conclusion, while the tumor board recommendation for CHT decreased in the intermediate RS category, there was an increase being reported in the high RS category, thus leading to overall minor changes in CHT application. As expected, among the younger women with intermediate RS and unfavorable histopathological factors, CHT use increased.
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Affiliation(s)
- Elena Diana Chiru
- Medical Oncology, Basel University Hospital, 4051 Basel, Switzerland; (A.O.); (M.V.)
- Center of Oncology and Hematology, Cantonal Hospital Baselland, 4410 Liestal, Switzerland
| | - Anton Oseledchyk
- Medical Oncology, Basel University Hospital, 4051 Basel, Switzerland; (A.O.); (M.V.)
| | - Andreas Schoetzau
- Department of Biomedicine, Basel University, 4051 Basel, Switzerland;
| | | | - Raphael Mosimann
- Faculty of Medicine, Basel Medical University, 4051 Basel, Switzerland;
| | - Marcus Vetter
- Medical Oncology, Basel University Hospital, 4051 Basel, Switzerland; (A.O.); (M.V.)
- Center of Oncology and Hematology, Cantonal Hospital Baselland, 4410 Liestal, Switzerland
- Department of Gynecologic Oncology, Basel University Hospital, 4051 Basel, Switzerland;
| | - Cvetka Grašič Kuhar
- Department of Gynecologic Oncology, Basel University Hospital, 4051 Basel, Switzerland;
- Medical Oncology Department, Institute of Oncology Ljubljana, SI-1000 Ljubljana, Slovenia
- Faculty of Medicine Ljubljana, Korytkova 2, SI-1000 Ljubljana, Slovenia
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Geršak K, Geršak BM, Gazić B, Klevišar Ivančič A, Drev P, Ružić Gorenjec N, Grašič Kuhar C. The Possible Role of Anti- and Protumor-Infiltrating Lymphocytes in Pathologic Complete Response in Early Breast Cancer Patients Treated with Neoadjuvant Systemic Therapy. Cancers (Basel) 2023; 15:4794. [PMID: 37835488 PMCID: PMC10571934 DOI: 10.3390/cancers15194794] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/20/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
The tumor microenvironment, composed of pro- and antitumor immune cells, affects cancer cell behavior. We aimed to evaluate whether tumor-infiltrating lymphocyte (TIL) density and TIL subtypes in core biopsies at the diagnosis of breast cancer patients could predict a pathologic complete response (pCR; ypT0/is ypN0) from neoadjuvant systemic therapy (NST). The TIL subtypes were determined based on the proportions of presumably antitumor (CD8+, CXCL13+) and protumor (PD-1+, FOXP3+) immune cells. A prospective, noninterventional study, including 171 participants undergoing NST, was performed. The median TIL density for the entire cohort was 10% (IQR: 3.5-23.8), and 59 (35%) patients achieved pCR. TIL density was positively associated with pCR (univariately and multivariably). In the multivariable logistic regression model, TIL density was an independent predictor of pCR (p = 0.012, OR 1.27; 95% CI 1.05-1.54) when controlled for age (p = 0.232), Ki-67 (p = 0.001), node-negative status (p = 0.024), and HER2+/triple negative vs. luminal B-like subtype (p < 0.001). In our sample, higher proportions of PD-1+ TILs and FOXP3+ TILs were associated with a higher probability of pCR but the association was not statistically significant and we could not make any conclusions on the direction of associations in the model with all four biomarkers. In the exploratory multivariable analysis, we showed that only higher CD8+ TILs were associated with pCR. In conclusion, TIL density and its subtypes are associated with pCR.
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Affiliation(s)
- Klara Geršak
- Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, 1000 Ljubljana, Slovenia (B.G.); (A.K.I.); (C.G.K.)
- Division of Medical Oncology, Institute of Oncology Ljubljana, Zaloška Cesta 2, 1000 Ljubljana, Slovenia
| | - Blaž Matija Geršak
- Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, 1000 Ljubljana, Slovenia (B.G.); (A.K.I.); (C.G.K.)
| | - Barbara Gazić
- Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, 1000 Ljubljana, Slovenia (B.G.); (A.K.I.); (C.G.K.)
- Department of Pathology, Institute of Oncology Ljubljana, Zaloška Cesta 2, 1000 Ljubljana, Slovenia;
| | - Andreja Klevišar Ivančič
- Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, 1000 Ljubljana, Slovenia (B.G.); (A.K.I.); (C.G.K.)
- Department of Pathology, Institute of Oncology Ljubljana, Zaloška Cesta 2, 1000 Ljubljana, Slovenia;
| | - Primož Drev
- Department of Pathology, Institute of Oncology Ljubljana, Zaloška Cesta 2, 1000 Ljubljana, Slovenia;
| | - Nina Ružić Gorenjec
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, 1000 Ljubljana, Slovenia;
| | - Cvetka Grašič Kuhar
- Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, 1000 Ljubljana, Slovenia (B.G.); (A.K.I.); (C.G.K.)
- Division of Medical Oncology, Institute of Oncology Ljubljana, Zaloška Cesta 2, 1000 Ljubljana, Slovenia
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Grašič Kuhar C, Silvester J, Mencinger M, Ovčariček T, Čemažar M, Miceska S, Modic Ž, Kuhar A, Jesenko T, Kloboves Prevodnik V. Association of Circulating Tumor Cells, Megakaryocytes and a High Immune-Inflammatory Environment in Metastatic Breast Cancer. Cancers (Basel) 2023; 15:3397. [PMID: 37444507 DOI: 10.3390/cancers15133397] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Liquid biopsy is becoming an important source of new biomarkers during the treatment of metastatic cancer patients. Using size-based microfluid technology, we isolated circulating tumor cells (CTCs) from metastatic breast cancer patients to evaluate their presence and cluster formation, as well as the presence of megakaryocytes and immune-inflammatory blood cells, and to correlate their presence with clinicopathological data and overall survival (OS). In total, 59 patients (median age 60.4 years) were included in the study: 62.7% luminal A/B-like, 20.3% HER2-positive, and 17% triple-negative. Our results showed that at least one CTC was present in 79.7% and ≥5 CTCs in 35.2% of the patients. CTC clusters were present in patients with ≥5 CTCs only (in 19.2% of them), and megakaryocytes were present in 52% of all patients. The presence of CTC clusters and megakaryocytes was positively associated with the CTC count. Patients with low pan-inflammatory value (PIV), low systemic immune-inflammatory index (SII), and low relative change from baseline (ΔPIV%, ΔSII%) were associated with significantly higher OS than their counterparts. ΔPIV%, the presence of infection in the last month, and a long duration of metastatic disease were identified as independent prognostic factors for OS. The interplay of CTCs, CTC clusters, megakaryocytes, and PIV needs to be further explored.
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Affiliation(s)
- Cvetka Grašič Kuhar
- Department Medical Oncology, Institute of Oncology, 1000 Ljubljana, Slovenia
- Faculty of Medicine Ljubljana, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Jernej Silvester
- Faculty of Medicine Ljubljana, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Marina Mencinger
- Department Medical Oncology, Institute of Oncology, 1000 Ljubljana, Slovenia
| | - Tanja Ovčariček
- Department Medical Oncology, Institute of Oncology, 1000 Ljubljana, Slovenia
| | - Maja Čemažar
- Department of Experimental Oncology, Institute of Oncology, 1000 Ljubljana, Slovenia
- Faculty of Health Sciences, University of Primorska, 6000 Izola, Slovenia
| | - Simona Miceska
- Faculty of Medicine Ljubljana, University of Ljubljana, 1000 Ljubljana, Slovenia
- Department of Cytopathology, Institute of Oncology, 1000 Ljubljana, Slovenia
| | - Živa Modic
- Faculty of Medicine Ljubljana, University of Ljubljana, 1000 Ljubljana, Slovenia
- Department of Experimental Oncology, Institute of Oncology, 1000 Ljubljana, Slovenia
| | - Anamarija Kuhar
- Department of Cytopathology, Institute of Oncology, 1000 Ljubljana, Slovenia
| | - Tanja Jesenko
- Faculty of Medicine Ljubljana, University of Ljubljana, 1000 Ljubljana, Slovenia
- Department of Experimental Oncology, Institute of Oncology, 1000 Ljubljana, Slovenia
| | - Veronika Kloboves Prevodnik
- Department of Cytopathology, Institute of Oncology, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Maribor, 2000 Ljubljana, Slovenia
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Kuhar CG, Borštnar S, Gazić B, Matos E. Complete response in the axilla and the non-triple negative subtype are favourable prognostic factors for survival outcomes in inflammatory breast cancer. Breast 2023:S0960-9776(23)00011-5. [PMID: 36740512 DOI: 10.1016/j.breast.2023.01.011] [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: 04/08/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 01/26/2023] Open
Abstract
AIM To assess real-world outcomes and prognostic factors of non-metastatic inflammatory breast cancer according to immunohistochemistry (IHC)-based subtype and treatment regimen. METHODS An institutional retrospective analysis of patients treated with neoadjuvant systemic treatment (NAST) for stage III inflammatory breast cancer diagnosed between 2001 and 2018 was performed. The survival outcomes in relation to patient characteristics, tumour characteristics, treatment modality and response to NAST were analyzed. RESULTS 225 patients fulfilled the inclusion criteria, 90% of patients were node-positive. IHC-based subtypes: 39.1% were HR+/HER2-, 19.1% HR+/HER2+, 23.1% HR-/HER2+ and 18.7% HR-/HER2-. Treatment was multimodal: NAST (100%), surgery (94.2%) and radiotherapy (94.2%). 53.3% of patients received adjuvant endocrine therapy, 34.3% (neo)adjuvant trastuzumab. Tri-modality therapy was applied in 89.3% of patients. Following NAST, a pathologic complete remission (pCR) in the breast was found in 16.9%, in the axilla in 29.7% and in both the breast and axilla in 10.3% of patients. The axillary pCR rate was significantly higher in HR- subtypes. Median overall survival (OS) was 8.9, 7.2, 5.8 and 2.3 years (p < 0.001) for HR+/HER2-, HR+/HER2+, HR-/HER2+ and HR-/HER2- subtype, respectively. On multivariate analysis, IHC-based subtype, age and axillary pCR were found as independent prognostic factors for RFS and OS. pCR rate and median OS improved over time, 5.8% vs 14.7% and 4.7 vs 10.0 years (2001-2009 vs. 2010-2018), respectively. CONCLUSIONS Axillary pCR and the non-triple-negative IHC-based subtype are favourable prognostic factors for RFS and OS in inflammatory breast cancer. Introduction of taxanes and antiHER2 drugs contributed to improved pCR rate and OS.
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Affiliation(s)
- Cvetka Grašič Kuhar
- Institute of Oncology Ljubljana, Department of Medical Oncology, Zaloška 2, 1000, Ljubljana, Slovenia; Faculty of Medicine Ljubljana, Vrazov Trg 2, 1000, Ljubljana, Slovenia
| | - Simona Borštnar
- Institute of Oncology Ljubljana, Department of Medical Oncology, Zaloška 2, 1000, Ljubljana, Slovenia; Faculty of Medicine Ljubljana, Vrazov Trg 2, 1000, Ljubljana, Slovenia
| | - Barbara Gazić
- Faculty of Medicine Ljubljana, Vrazov Trg 2, 1000, Ljubljana, Slovenia; Institute of Oncology Ljubljana, Department of Pathology, Zaloška 2, 1000, Ljubljana, Slovenia
| | - Erika Matos
- Institute of Oncology Ljubljana, Department of Medical Oncology, Zaloška 2, 1000, Ljubljana, Slovenia; Faculty of Medicine Ljubljana, Vrazov Trg 2, 1000, Ljubljana, Slovenia.
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Mauri D, Kamposioras K, Tsali L, Dambrosio M, De Bari B, Hindi N, Salembier C, Nixon J, Dimitrios T, Alongi F, Hameed H, Valachis A, Papadimitriou K, Corradini S, Popovic L, Kopecky J, Rodriguez A, Antunac K, Yi J, Lovey J, Strojan P, Saraireh H, Røtterud R, Chojnacka M, Olalla SC, Chilingirova N, De Mello RA, Araujo Amaral G, Arbabi F, Vidra R, Rapushi E, Takeuchi D, Christopoulos C, Ivanova I, Djan I, Petricevic B, Cellini F, Mihaylova I, Dedic Plavetic N, Grašič Kuhar C, Takeuchi E, Kountourakis P, Ntellas P, Gazouli I, Gkoura S, Yuce S, ER Ö, Yasmina C, Kumaran G, Spahiu O, Yusuf A, Gono P, Apostolidis K, Tolia M. COVID-19 Vaccinations: Summary Guidance for Cancer Patients in 28 Languages: Breaking Barriers to Cancer Patient Information. Rev Recent Clin Trials 2022; 17:11-14. [PMID: 34967300 PMCID: PMC9241076 DOI: 10.2174/1574887116666211028145848] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/16/2021] [Accepted: 08/26/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Covid-19 vaccination has started in the majority of the countries at the global level. Cancer patients are at high risk for infection, serious illness, and death from COVID-19 and need vaccination guidance and support. Guidance availability in the English language only is a major limit for recommendations' delivery and their application in the world's population and generates information inequalities across the different populations. METHODS Most of the available COVID-19 vaccination guidance for cancer patients was screened and scrutinized by the European Cancer Patients Coalition (ECPC) and an international oncology panel of 52 physicians from 33 countries. RESULTS A summary guidance was developed and provided in 28 languages in order to reach more than 70 percent of the global population. CONCLUSION Language barrier and e-guidance availability in the native language are the most important barriers when communicating with patients. E-guidance availability in various native languages should be considered a major priority by international medical and health organizations that are communicating with patients at the global level.
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Affiliation(s)
- Davide Mauri
- Address correspondence to this author at the Department Medical Oncology, EMEKEN, University Hospital of Ioannina, Ioannina, Greece; Tel: +302651099394; E-mail:
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Mauri D, Kamposioras K, Matthaios D, Tolia M, Nixon I, Dambrosio M, Zarkavelis G, Papadimitriou K, Petricevic B, Kountourakis P, Kopecky J, Grašič Kuhar C, Popovic L, Chilingirova NP, De Mello RA, Dedić Plavetić N, Katsanos K, Mostert B, Alongi F, de Bari B, Corradini S, Kampletsas E, Gazouli I, Gkoura S, Amylidi AL, Valachis A. Next Generation Sequencing of Circulating Tumor DNA Can Optimize Second Line Treatment in RAS Wild Type Metastatic Colorectal Cancer after Progression on Anti-EGFR Therapy: Time to Rethink Our Approach. Oncol Res Treat 2022; 45:216-221. [PMID: 34999585 DOI: 10.1159/000521845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 08/31/2021] [Accepted: 01/05/2022] [Indexed: 11/19/2022]
Abstract
Background Management of Raswild-type colorectal cancer (CRC) patients upon disease progression after the successful use of targeted treatment with anti-EGFR monoclonal antibodies and backbone chemotherapy remains a clinical challenge. Development of treatment resistance with prevalence of pre-existing RAS mutated clones, RAS mutation conversion, truncation of extracellular receptor domains as well as HER2 and MET amplification are molecular events that can be difficult to follow without the use of sophisticated laboratory techniques. Summary The clinical hurdle of re-biopsy and tumor heterogeneity can be overcome by the implementation Next Generation Sequencing (NGS) to analyze circulating tumor DNA (ctDNA) and identify drugable mutations or recovery of RAS-wildness. In this opinion paper we summarize with critical thinking the clinical approach to be followed after the failure of first line treatment in Ras wild-type CRC tumors with the use of NGS. Key Messages Rechallenge with anti-EGFR inhibitors, in case of persistent or recovery of Ras wildness, and targeted approach of specific mutations (BRAF inhibitors) amplifications (anti-Her2 treatment) or fusion proteins (NTRK inhibitors) can by guided by the use of NGS. The use of NGS platforms for serial analysis of ctDNA is an important step to better understand the molecular landscape of metastatic colorectal cancer and guide clinical decisions. NGS should be considered a mainstay in clinical practice for the management of CRC patients and health authorities should consider reimbursing its use in the appropriate clinical settings.
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Affiliation(s)
- Davide Mauri
- Department of Medical Oncology, University of Ιoannina, Ιoannina, Greece
| | | | | | - Maria Tolia
- Department of Radiotherapy/Radiation Oncology, Faculty of Medicine, University of Crete, Heraklion, Greece,
| | - Ioanna Nixon
- Scottish Sarcoma Network (SSN) UK Chair NCRI HN Epidemiology and Survivorship Subgroup, The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Mario Dambrosio
- Department of Medical Oncology, Clinica San Carlo, Paderno Dugnano, Italy
| | | | | | - Branka Petricevic
- Department of Hematology and Oncology, Klinik Ottakring, Vienna, Austria
| | | | - Jindrich Kopecky
- Department of Clinical Oncology and Radiotherapy, University Hospital Hradec Kralove, Hradec Kralove, Czechia
| | - Cvetka Grašič Kuhar
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Lazar Popovic
- Medical Oncology Department, Oncology Institute of Vojvodina, University of Novi Sad, Novi Sad, Serbia
| | - Nataliya P Chilingirova
- Medical Oncology Clinic at Specialized Hospital for Active Treatment in Oncology, University Pleven, Sofia, Bulgaria
| | - Ramon Andrade De Mello
- Department of Biomedical Sciences & Medicine, University of Algarve, Faro, Portugal
- Precision Oncology Group, Federal University of São Paulo (UNIFESP), & Nine of July University (UNINOVE), São Paulo, Brazil
| | - Natalija Dedić Plavetić
- Department of Oncology, University Hospital Centre Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia
| | | | - Bianca Mostert
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Verona, Italy
- University of Brescia, Brescia, Italy
| | | | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | | | - Ioanna Gazouli
- Department of Medical Oncology, University of Ιoannina, Ιoannina, Greece
| | - Stefania Gkoura
- Department of Medical Oncology, University of Ιoannina, Ιoannina, Greece
| | - Anna-Lea Amylidi
- Department of Medical Oncology, University of Ιoannina, Ιoannina, Greece
| | - Antonios Valachis
- Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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9
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Zupančič T, Zakotnik B, Kuhar CG. Outcome of patients with recurrent/metastatic squamous cell head and neck cancer treated with platinum-based chemotherapy with or without cetuximab in real-world practice. Mol Clin Oncol 2021; 15:190. [PMID: 34349990 DOI: 10.3892/mco.2021.2352] [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: 09/02/2020] [Accepted: 04/07/2021] [Indexed: 11/06/2022] Open
Abstract
Patients with recurrent or metastatic squamous cell head and neck cancer (R/M SCHNC) exhibit a poor prognosis with a median overall survival (OS) time of <1 year. Platinum-based chemotherapy with or without cetuximab has been the standard of care in the last decade. The aim of the current retrospective study was to evaluate the outcome and tolerability of treatment in patients with R/M SCHNC receiving platinum/5-fluorouracil/cetuximab (PFE) chemotherapy compared with platinum/5-fluorouracil (PF) chemotherapy in daily clinical practice. A retrospective analysis was performed using the data of patients treated at the Institute of Oncology Ljubljana between April 2008 and May 2018. Progression-free survival (PFS) and OS were calculated with the Kaplan-Meier method and compared with the log-rank test. Multivariate regression Cox analysis was used to determine independent prognostic factors. A total of 67 patients were treated at the aforementioned Institute: 34 patients received the PF and 33 the PFE regimen. The mean age of patients was 54.6 years and 91% of patients were male. Median PFS time was 6.6 vs. 7.1 months for the PF vs. PFE groups, respectively (P=0.852). Median OS time was 9.6 vs. 11.5 months for the PF vs. PFE groups, respectively (P=0.029). The prognostic factor for PFS was partial remission [hazard ratio (HR), 0.32; 95% CI, 0.15-0.70; P=0.004]. Prognostic factors for OS were partial remission (HR, 0.15; 95% CI, 0.06-0.38; P<0.001) or stable disease (HR, 0.28; 95% CI, 0.13-0.64; P=0.002), and a subsequent line of treatment upon progression (HR, 0.28; 95% CI, 0.15-0.52; P<0.001). In the PFE group, 15.4% of patients had a grade >2 infusion reaction to cetuximab and 27.3% had grade 3 skin rash. There were no differences in diarrhoea, hypomagnesaemia, infections and febrile neutropenia; however, the mortality on active treatment was high (13.4%). In conclusion, patients treated with PFE had similar PFS, but improved OS compared with patients treated with the PF protocol. The proportion of patients who died under treatment due to disease progression and toxicity was high in both treatment arms. A thorough selection of patients for this treatment is crucial.
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Affiliation(s)
- Tina Zupančič
- Department of Medical Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia.,Department of Internal Medicine, Dr Franc Derganc General Hospital, Nova Gorica, 5290 Šempeter pri Gorici, Slovenia
| | - Branko Zakotnik
- Department of Medical Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Cvetka Grašič Kuhar
- Department of Medical Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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10
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Kamposioras K, Mauri D, Papadimitriou K, Anthoney A, Hindi N, Petricevic B, Dambrosio M, Valachis A, Kountourakis P, Kopecky J, Kuhar CG, Popovic L, Chilingirova NP, Zarkavelis G, de Mello RA, Plavetić ND, Christopoulos C, Mostert B, Goffin JR, Tzachanis D, Saraireh HH, Ma F, Pavese I, Tolia M. Synthesis of Recommendations From 25 Countries and 31 Oncology Societies: How to Navigate Through Covid-19 Labyrinth. Front Oncol 2020; 10:575148. [PMID: 33330049 PMCID: PMC7711151 DOI: 10.3389/fonc.2020.575148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 06/22/2020] [Accepted: 10/16/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction Pandemic COVID-19 is an unexpected challenge for the oncological community, indicating potential detrimental effects on cancer patients. Our aim was to summarize the converging key points providing a general guidance in order to support decision making, pertaining to the oncologic care in the middle of a global outbreak. Methods We did an international online search in twenty five countries that have managed a surge in cancer patient numbers. We collected the recommendations from thirty one medical oncology societies. Results By synthesizing guidelines for a) oncology service delivery adjustments, b) general and specific treatment adaptations, and c) discrepancies from guidelines comparison, we present a clinical synopsis with the forty more crucial statements. A Covid-19 risk stratification base was also created in order to obtain a quick, objective patient assessment and a risk-benefit evaluation on a case-by-case basis. Conclusions In an attempt to face these complex needs and due to limited understanding of COVID-19, a variability of recommendations based on general epidemiological and infectious disease principles rather than definite cancer-related evidence has evolved. Additionally, the absence of an effective treatment or vaccine requires the development of cancer management guidance, capitalizing on comprehensive COVID-19 oncology experience globally.
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Affiliation(s)
| | - Davide Mauri
- Department of Medical Oncology, University Hospital of Ioannina, Ioannina, Greece
| | | | - Alan Anthoney
- Leeds Institute of Medical Research at St James' Hospital, University of Leeds, Leeds, United Kingdom
| | - Nadia Hindi
- Department of Medical Oncology, University Hospital Virgen del Rocío, Sevilla, Spain.,TERABIS Group, IBiS (Instituto de Biomedicina de Sevilla)/HUVR/CSIC/Universidad deSevilla), Sevilla, Spain
| | - Branka Petricevic
- Medizinische Abteilung, Zentrum für Onkologie und Hämatologie mit Ambulanz und alliativstation Wilhelminenspital, Vienna, Austria
| | - Mario Dambrosio
- Department of Clinical Oncology, Clinica San Carlo, Milan, Italy
| | - Antonis Valachis
- Department of Oncology, Faculty of Medicine & Health, Örebro University, Örebro, Sweden
| | | | - Jindrich Kopecky
- Department of Clinical Oncology, University Hospital, Charles University-Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czechia
| | - Cvetka Grašič Kuhar
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Lazar Popovic
- Oncology Institute of Vojvodina, University of Novi Sad, Novi Sad, Serbia
| | - Nataliya P Chilingirova
- University Specialized Hospital for Active Treatment in Oncology, Medical Oncology Clinic, Sofia, Bulgaria.,Medical University Pleven, Pleven, Bulgaria
| | - George Zarkavelis
- Department of Medical Oncology, University Hospital of Ioannina, Ioannina, Greece
| | - Ramon Andrade de Mello
- Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil.,Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal
| | - Natalija Dedić Plavetić
- University Hospital Centre, Zagreb Department of Oncology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Christos Christopoulos
- Service de Radiothérapie Oncologique, Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France
| | - Bianca Mostert
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - John R Goffin
- Department of Oncology, McMaster University Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Dimitiros Tzachanis
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA, United States
| | | | - Fei Ma
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ida Pavese
- Service d'Oncologie, GHT Grand Paris Nord-Est, Montfermeil, France
| | - Maria Tolia
- Department of Radiotherapy, School of Medicine, University of Crete, Heraklion, Greece
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11
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KovaČ A, Matos E, Kuhar CG, Čakš M, Ovčariček T, Mencinger M, Humar M, Borštnar S. Efficacy and safety of selective cyclin-dependent kinases 4/6 inhibitors in hormone-receptor-positive, HER2-negative advanced breast cancer - results from a real-world setting. Cancer Treat Res Commun 2020; 25:100201. [PMID: 32979704 DOI: 10.1016/j.ctarc.2020.100201] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Selective cyclin-dependent kinases 4/6 inhibitors (CDKi) have become the standard of care in patients with hormone receptor (HR)-positive, HER2-negative advanced breast cancer (ABC). We performed retrospective analysis in patients treated with CDKi in the first year of their routine clinical use in Slovenia. METHODS The primary goals were time-to-treatment failure (TTF) and overall survival (OS), analysed via Kaplan-Meier method, the secondary goals were clinical benefit rate (CBR) and safety. RESULTS Overall, 218 patients' data were evaluated. The median age was 61.8 years (30.6-84.6). The median number of previous ET lines for ABC was 2 (range 0-5). At the time of inclusion, 128 patients (58.7%) had visceral metastases, 45 patients (20.6%) had bone-only disease. At the median follow-up of 15.2 months, disease progressed in 74 patients and 60 patients died. The median TTF was 8.3 months for the whole group, 19.3, 10.3 and 5.5 months for patients treated in the first-, second- and further lines of systemic therapy, respectively. The median OS from the start of CDKi treatment was not reached in any of the groups. CBR was 59.6% for the whole group, 42.7% for further lines of therapy. The most common grade 3/4 adverse event was neutropaenia in 108 patients (49.5%), followed by an increase of hepatic aminotransferases in 13 patients (6.0%). CONCLUSIONS Even in the diverse real-world population treatment with CDKi in combination with ET showed clinical benefit, most prominently in the first- and second lines of systemic therapy.
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Affiliation(s)
- Anja KovaČ
- Institute of Oncology Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia; Izola General Hospital, Polje 40, 6310 Izola, Slovenia.
| | - Erika Matos
- Institute of Oncology Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia
| | | | - Marina Čakš
- University Clinical Center Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
| | - Tanja Ovčariček
- Institute of Oncology Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia
| | - Marina Mencinger
- Institute of Oncology Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia
| | - Mojca Humar
- General Hospital "dr. Franc Derganc" Nova Gorica, Ulica padlih borcev 13A, 5290 Šempeter pri Gorici, Slovenia
| | - Simona Borštnar
- Institute of Oncology Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia.
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12
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Grašič Kuhar C, Gortnar Cepeda T, Kovač T, Kukar M, Ružić Gorenjec N. Mobile App for Symptom Management and Associated Quality of Life During Systemic Treatment in Early Stage Breast Cancer: Nonrandomized Controlled Prospective Cohort Study. JMIR Mhealth Uhealth 2020; 8:e17408. [PMID: 32427567 PMCID: PMC7435681 DOI: 10.2196/17408] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/14/2020] [Accepted: 05/14/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Providing patients with cancer who are undergoing systemic therapy with useful information about symptom management is essential to prevent unnecessary deterioration of quality of life. OBJECTIVE The aim was to evaluate whether use of an app for symptom management was associated with any change in patient quality of life or use of health resources. METHODS Outpatients with early stage breast cancer receiving systemic therapy were recruited at the Institute of Oncology in Ljubljana, Slovenia. Patients who received systemic therapy between December 2017 and March 2018 (control group) and between April 2018 and September 2018 (intervention group) were eligible. All patients received standard care, but only those in the intervention group were asked to use mPRO Mamma, an Android-based smartphone app, in addition. The app supported daily tracking of 50 symptoms, allowed users to grade their symptom severity (as mild, moderate, or severe), and also provided in-depth descriptions and recommendations based on reported symptom level. Patient-reported outcomes in both groups were assessed through the European Organisation for Research and Treatment of Cancer (EORTC) core (C-30) and breast cancer (BR-23) questionnaires, as well as a questionnaire about health resources use. The primary outcomes were the difference in the global quality of life between groups and the difference in summary score of the EORTC C-30 questionnaire between groups after 3 time periods (the first week of treatment, the first treatment cycle, and the entire treatment). The secondary outcome was the use of health resources (doctor visits and hospitalizations) in each time period. Other scales were used for exploratory analysis. RESULTS The mean difference between the intervention group (n=46) and the control group (n=45) in global quality of life (adjusted for baseline and type of surgery) after the first week was 10.1 (95% CI 1.8 to 18.5, P=.02). The intervention group summary scores were significantly higher than those of the control group after the first week (adjusted mean difference: 8.9, 95% CI 3.1 to 14.7, P=.003) and at the end of treatment (adjusted mean difference: 10.6, 95% CI 3.9 to 17.3, P=.002). Use of health resources was not statistically significant between the groups in either the first week (P=.12) or the first treatment cycle (P=.13). Exploratory analysis findings demonstrated clinically important improvements (indicated by EORTC C-30 or BR-23 scale scores)-social, physical, role, and cognitive function were improved while pain, appetite loss, and systemic therapy side effects were reduced. CONCLUSIONS Use of the app enabled patients undergoing systemic therapy for early stage breast cancer to better cope with symptoms which was demonstrated by a better global quality of life and summary score after the first week and by a better summary score at the end of treatment in the intervention group compared to those of the control group, but no change in the use of health resources was demonstrated.
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Affiliation(s)
- Cvetka Grašič Kuhar
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | | | - Timotej Kovač
- Faculty of Computer and Information Science, University of Ljubljana, Ljubljana, Slovenia
| | - Matjaž Kukar
- Faculty of Computer and Information Science, University of Ljubljana, Ljubljana, Slovenia
| | - Nina Ružić Gorenjec
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine Ljubljana, University of Ljubljana, Ljubljana, Slovenia
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13
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Grašič Kuhar C, Strojan P, Zadnik V, Zakotnik B. Importance of magnesium sulfate supplementation in the prevention of hypomagnesemia and hypocalcemia during chemoradiation in head and neck cancer. J Trace Elem Med Biol 2018; 50:327-331. [PMID: 30262299 DOI: 10.1016/j.jtemb.2018.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/28/2018] [Accepted: 07/12/2018] [Indexed: 12/20/2022]
Abstract
In advanced squamous cell carcinoma of the head and neck, concomitant radiotherapy with cisplatin and/or cetuximab is frequently combined with cisplatin-based induction chemotherapy, which can cause severe hypomagnesemia, hypocalcemia, and hypokalemia. The aim of our study was to analyze the effects of magnesium sulfate supplementation on the incidence of hypomagnesemia, hypokalemia, and hypocalcemia during four cycles of TPF (docetaxel, cisplatin, and 5-fluorouracil) induction chemotherapy followed by concomitant radiotherapy (CRT) with cisplatin and cetuximab. Twenty-five patients included in a phase II prospective study received routine magnesium sulfate infusions before each cycle of cisplatin, and additional supplementation based on laboratory findings. During TPF, the incidence of grade 1/2 and grade 3/4 hypomagnesemia was 16% and 4%, respectively; and increased despite magnesium supplementation during CRT to 72% and 8%, respectively. During TPF, a grade 2 and grade 4 hypocalcemia occurred in 8% and 4%, respectively; and during CRT, it reached 36% (grade 1/2). Grade 1 hypokalemia only was observed during TPF (4%) and CRT (8%). The median amounts of supplemented magnesium sulfate during TPF and CRT were 20 mEq and 50 mEq, respectively. It appears that a low incidence of grade 3/4 hypomagnesemia and hypocalcemia in our patients resulted from intensive magnesium supplementation. Thorough measurements of magnesium and calcium during cisplatin-based chemoradiation protocols in patients with head and neck cancer are crucial in preventing the development of grade 3/4 hypomagnesemia and hypocalcemia.
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Affiliation(s)
- Cvetka Grašič Kuhar
- Institute of Oncology Ljubljana, Department of Medical Oncology, Zaloška 2, Ljubljana, Slovenia.
| | - Primož Strojan
- Institute of Oncology Ljubljana, Department of Radiation Oncology, Zaloška 2, Ljubljana, Slovenia
| | - Vesna Zadnik
- Institute of Oncology Ljubljana, Epidemiology and Cancer Registry, Zaloška 2, Ljubljana, Slovenia
| | - Branko Zakotnik
- Institute of Oncology Ljubljana, Department of Medical Oncology, Zaloška 2, Ljubljana, Slovenia
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14
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Kuhar CG, Budihna MV. Effects of mibefradil and verapamil on ischemic-reperfusion in the hearts of guinea pigs with acute renal failure. Pflugers Arch 2016; 440:R141-R142. [DOI: 10.1007/s004240000038] [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: 12/01/2022]
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15
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Strojan P, Kuhar CG, Žumer B, Kadivec M, Karner K, Fajdiga I, Jančar B, Gale N, Poljak M, Kocjan BJ, Zakotnik B. TPF induction chemotherapy and concomitant irradiation with cisplatin and cetuximab in unresectable squamous cell carcinoma of the head and neck. Head Neck 2013; 36:1555-61. [DOI: 10.1002/hed.23506] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 07/10/2013] [Accepted: 09/10/2013] [Indexed: 01/03/2023] Open
Affiliation(s)
- Primož Strojan
- Department of Radiation Oncology; Institute of Oncology; Ljubljana Slovenia
| | | | - Barbara Žumer
- Department of Radiation Oncology; Institute of Oncology; Ljubljana Slovenia
| | | | - Katarina Karner
- Department of Radiation Oncology; Institute of Oncology; Ljubljana Slovenia
| | - Igor Fajdiga
- University Department of Otorhinolaryngology and Cervicofacial Surgery; University Clinical Center; Ljubljana Slovenia
| | - Boris Jančar
- Department of Radiation Oncology; Institute of Oncology; Ljubljana Slovenia
| | - Nina Gale
- Institute of Pathology, Medical Faculty; University of Ljubljana; Slovenia
| | - Mario Poljak
- Institute of Microbiology and Immunology, Medical Faculty; University of Ljubljana; Slovenia
| | - Boštjan J Kocjan
- Institute of Microbiology and Immunology, Medical Faculty; University of Ljubljana; Slovenia
| | - Branko Zakotnik
- Department of Medical Oncology; Institute of Oncology; Ljubljana Slovenia
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16
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Kuhar CG, Bunc M, Drevensek G, Budihna MV, Suput D. Nicardipine dose dependently reduces the effect of equinatoxin II on coronary flow in isolated rat heart. Pflugers Arch 2002; 442:R198-9. [PMID: 11678338 DOI: 10.1007/s004240100023] [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: 10/26/2022]
Abstract
Equinatoxin II (EqT II) decreases coronary flow in guinea-pig and rat heart. It increases cytosolic Ca2+ activity and is supposed to form cation selective membrane pores. In the present study we tried to evaluate the influence of the L-type Ca2+ channel antagonist nicardipine upon the vasoconstrictory effect of EqT II on coronary vessels in isolated heart of the rat. Coronary flow was measured during the experiment. Ten min after bolus injection of EqT II the coronary flow decreased to 17.2 +/- 4.3% in experiments without nicardipine, and to 39.4 +/- 4.5% in the group with 0.1 microM nicardipine (p < 0.05). Our results indicate the possibility that L-type Ca2+ channels could be involved in the effects of EqT II on coronary flow in the rat heart.
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Affiliation(s)
- C G Kuhar
- Department of Pharmacology and Experimental Toxicology, Medical Faculty, Ljubljana, Slovenia
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