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Garcia-Torralba E, Pérez Ramos M, Ivars Rubio A, Navarro Manzano E, Blaya Boluda N, Lloret Gil M, Aller A, de la Morena Barrio P, García Garre E, Martínez Díaz F, García Molina F, Chaves Benito A, García-Martínez E, Ayala de la Peña F. Deconstructing neutrophil to lymphocyte ratio (NLR) in early breast cancer: lack of prognostic utility and biological correlates across tumor subtypes. Breast Cancer Res Treat 2024; 205:475-485. [PMID: 38453782 DOI: 10.1007/s10549-024-07286-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/07/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE The prognostic utility and biological correlates of neutrophil to lymphocyte ratio (NLR), a potential biomarker of the balance between immune response and the inflammatory status, are still uncertain in breast cancer (BC). METHODS We analysed a cohort of 959 women with early breast cancer, mostly treated with neoadjuvant or adjuvant chemotherapy. Clinical and pathological data, survival, NLR (continuous and categorical) and stromal tumor infiltrating lymphocytes (sTIL) were evaluated. RESULTS NLR was only weakly associated with Ki67, while no association was found for grade, histology, immunohistochemical subtype or stage. Lymphocyte infiltration of the tumor did not correlate with NLR (Rho: 0.05, p = 0.30). These results were similar in the whole group and across the different BC subtypes, with no differences in triple negative BC. Relapse free interval (RFI), breast cancer specific survival (BCSS) and overall survival (OS) changed according to pre-treatment NLR neither in the univariate nor in the multivariate Cox models (RFI: HR 0.948, p = 0.61; BCSS: HR 0.920, p = 0.57; OS: HR 0.96, p = 0.59). CONCLUSION These results question the utility of NLR as a prognostic biomarker in early breast cancer and suggest the lack of correlation of NLR with tumor microenvironment immune response.
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Affiliation(s)
- Esmeralda Garcia-Torralba
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, Murcia, 30008, Spain
- Department of Medicine, Medical School, University of Murcia, Murcia, 30001, Spain
- Instituto Murciano de Investigación Biosanitaria, IMIB, Murcia, 30120, Spain
| | - Miguel Pérez Ramos
- Department of Pathology, Hospital Universitario Morales Meseguer, Murcia, 30008, Spain
| | - Alejandra Ivars Rubio
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, Murcia, 30008, Spain
- Department of Medicine, Medical School, University of Murcia, Murcia, 30001, Spain
- Instituto Murciano de Investigación Biosanitaria, IMIB, Murcia, 30120, Spain
| | - Esther Navarro Manzano
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, Murcia, 30008, Spain
- Instituto Murciano de Investigación Biosanitaria, IMIB, Murcia, 30120, Spain
- Centro Regional de Hemodonación, Murcia, 30003, Spain
| | - Noel Blaya Boluda
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, Murcia, 30008, Spain
- Department of Medicine, Medical School, University of Murcia, Murcia, 30001, Spain
- Instituto Murciano de Investigación Biosanitaria, IMIB, Murcia, 30120, Spain
| | - Miguel Lloret Gil
- Department of Medicine, Medical School, University of Murcia, Murcia, 30001, Spain
| | - Alberto Aller
- Department of Medicine, Medical School, University of Murcia, Murcia, 30001, Spain
| | - Pilar de la Morena Barrio
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, Murcia, 30008, Spain
- Instituto Murciano de Investigación Biosanitaria, IMIB, Murcia, 30120, Spain
| | - Elisa García Garre
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, Murcia, 30008, Spain
- Instituto Murciano de Investigación Biosanitaria, IMIB, Murcia, 30120, Spain
| | - Francisco Martínez Díaz
- Instituto Murciano de Investigación Biosanitaria, IMIB, Murcia, 30120, Spain
- Department of Pathology, Hospital Universitario Reina Sofía, Murcia, 30003, Spain
- Department of Pathology, Medical School, University of Murcia, Murcia, 30001, Spain
| | - Francisco García Molina
- Department of Pathology, Hospital Universitario Reina Sofía, Murcia, 30003, Spain
- Department of Pathology, Medical School, University of Murcia, Murcia, 30001, Spain
| | - Asunción Chaves Benito
- Department of Pathology, Hospital Universitario Morales Meseguer, Murcia, 30008, Spain
- Department of Pathology, Medical School, University of Murcia, Murcia, 30001, Spain
| | - Elena García-Martínez
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, Murcia, 30008, Spain
- Instituto Murciano de Investigación Biosanitaria, IMIB, Murcia, 30120, Spain
- Medical School, Universidad Católica San Antonio, Murcia, 30107, Spain
| | - Francisco Ayala de la Peña
- Department of Medical Oncology, School of Medicine, Hospital Universitario Morales Meseguer, University of Murcia, Avda. Marqués de los Vélez, s/n, Murcia, 30008, Spain.
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Ayala de la Peña F, Antolín Novoa S, Gavilá Gregori J, González Cortijo L, Henao Carrasco F, Martínez Martínez MT, Morales Estévez C, Stradella A, Vidal Losada MJ, Ciruelos E. Correction: SEOM-GEICAM-SOLTI clinical guidelines for early-stage breast cancer (2022). Clin Transl Oncol 2024; 26:555-556. [PMID: 37902930 PMCID: PMC10810952 DOI: 10.1007/s12094-023-03334-y] [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] [Indexed: 11/01/2023]
Affiliation(s)
- Francisco Ayala de la Peña
- Department of Medical Oncology, Hospital G. Universitario Morales Meseguer, University of Murcia, Av. Marqués de los Vélez, s/n, 30008, Murcia, Spain.
| | - Silvia Antolín Novoa
- Department of Medical Oncology, Complexo Hospitalario Universitario, A Coruña (CHUAC), Coruña, Spain
| | | | | | | | - María Teresa Martínez Martínez
- Medical Oncology Department, INCLIVA Biomedical Research Institute, Hospital Clínico of Valencia, University of Valencia, 46010, Valencia, Spain
| | | | - Agostina Stradella
- Medical Oncology Department, Institut Català d'Oncologia. L'Hospitalet,, Barcelona, Spain
| | | | - Eva Ciruelos
- Medical Oncology Department, Breast Cancer Unit, University Hospital 12 de Octubre, Madrid, Spain and HM Hospitales, Madrid, Spain
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Ayala de la Peña F, Antolín Novoa S, Gavilá Gregori J, González Cortijo L, Henao Carrasco F, Martínez Martínez MT, Morales Estévez C, Stradella A, Vidal Losada MJ, Ciruelos E. SEOM-GEICAM-SOLTI clinical guidelines for early-stage breast cancer (2022). Clin Transl Oncol 2023; 25:2647-2664. [PMID: 37326826 PMCID: PMC10425528 DOI: 10.1007/s12094-023-03215-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 06/17/2023]
Abstract
Breast cancer is the leading cause of cancer in women in Spain and its annual incidence is rapidly increasing. Thanks to the screening programs in place, nearly 90% of breast cancer cases are detected in early and potentially curable stages, despite the COVID-19 pandemic possibly having impacted these numbers (not yet quantified). In recent years, locoregional and systemic therapies are increasingly being directed by new diagnostic tools that have improved the balance between toxicity and clinical benefit. New therapeutic strategies, such as immunotherapy, targeted drugs, and antibody-drug conjugates have also improved outcomes in some patient subgroups. This clinical practice guideline is based on a systematic review of relevant studies and on the consensus of experts from GEICAM, SOLTI, and SEOM.
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Affiliation(s)
- Francisco Ayala de la Peña
- Department of Medical Oncology, Hospital G. Universitario Morales Meseguer, University of Murcia, Av. Marqués de los Vélez, s/n, 30008, Murcia, Spain.
| | - Silvia Antolín Novoa
- Department of Medical Oncology, Complexo Hospitalario Universitario, A Coruña (CHUAC), Coruña, Spain
| | | | | | | | - María Teresa Martínez Martínez
- Medical Oncology Department, INCLIVA Biomedical Research Institute, Hospital Clínico of Valencia, University of Valencia, 46010, Valencia, Spain
| | | | - Agostina Stradella
- Medical Oncology Department, Institut Català d'Oncologia. L'Hospitalet,, Barcelona, Spain
| | | | - Eva Ciruelos
- Medical Oncology Department, Breast Cancer Unit, University Hospital 12 de Octubre, Madrid, Spain and HM Hospitales, Madrid, Spain
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Bueno-Muiño C, Echavarría I, López-Tarruella S, Roche-Molina M, del Monte-Millán M, Massarrah T, Jerez Y, Ayala de la Peña F, García-Sáenz JÁ, Moreno F, Rodríguez-Lescure Á, Malón-Giménez D, Ballesteros García AI, Marín-Aguilera M, Galván P, Brasó-Maristany F, Waks AG, Tolaney SM, Mittendorf EA, Vivancos A, Villagrasa P, Parker JS, Perou CM, Paré L, Villacampa G, Prat A, Martín M. Assessment of a Genomic Assay in Patients With ERBB2-Positive Breast Cancer Following Neoadjuvant Trastuzumab-Based Chemotherapy With or Without Pertuzumab. JAMA Oncol 2023; 9:841-846. [PMID: 37103916 PMCID: PMC10141274 DOI: 10.1001/jamaoncol.2023.0187] [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] [Received: 09/14/2022] [Accepted: 12/22/2022] [Indexed: 04/28/2023]
Abstract
Importance Biomarkers to guide the use of pertuzumab in the treatment of early-stage ERBB2 (formerly HER2)-positive breast cancer beyond simple ERBB2 status are needed. Objective To determine if use of the HER2DX genomic assay (Reveal Genomics) in pretreatment baseline tissue samples of patients with ERBB2-positive breast cancer is associated with response to neoadjuvant trastuzumab-based chemotherapy with or without pertuzumab. Design, Setting, and Participants This is a retrospective diagnostic/prognostic analysis of a multicenter academic observational study in Spain performed during 2018 to 2022 (GOM-HGUGM-2018-05). In addition, a combined analysis with 2 previously reported trials of neoadjuvant cohorts with results from the assay (DAPHNe and I-SPY2) was performed. All patients had stage I to III ERBB2-positive breast cancer, signed informed consent, and had available formalin-fixed paraffin-embedded tumor specimens obtained prior to starting therapy. Exposures Patients received intravenous trastuzumab, 8 mg/kg, loading dose, followed by 6 mg/kg every 3 weeks in combination with intravenous docetaxel, 75 mg/m2, every 3 weeks and intravenous carboplatin area under the curve of 6 every 3 weeks for 6 cycles, or this regimen plus intravenous pertuzumab, 840 mg, loading dose, followed by an intravenous 420-mg dose every 3 weeks for 6 cycles. Main Outcome and Measures Association of baseline assay-reported pathologic complete response (pCR) score with pCR in the breast and axilla, as well as association of baseline assay-reported pCR score with response to pertuzumab. Results The assay was evaluated in 155 patients with ERBB2-positive breast cancer (mean [range] age, 50.3 [26-78] years). Clinical T1 to T2 and node-positive disease was present in 113 (72.9%) and 99 (63.9%) patients, respectively, and 105 (67.7%) tumors were hormone receptor positive. The overall pCR rate was 57.4% (95% CI, 49.2%-65.2%). The proportion of patients in the assay-reported pCR-low, pCR-medium, and pCR-high groups was 53 (34.2%), 54 (34.8%), and 48 (31.0%), respectively. In the multivariable analysis, the assay-reported pCR score (as a continuous variable from 0-100) showed a statistically significant association with pCR (odds ratio [OR] per 10-unit increase, 1.43; 95% CI, 1.22-1.70; P < .001). The pCR rates in the assay-reported pCR-high and pCR-low groups were 75.0% and 28.3%, respectively (OR, 7.85; 95% CI, 2.67-24.91; P < .001). In the combined analysis (n = 282), an increase in pCR rate due to pertuzumab was found in the assay-reported pCR-high tumors (OR, 5.36; 95% CI, 1.89-15.20; P < .001) but not in the assay-reported pCR-low tumors (OR, 0.86; 95% CI, 0.30-2.46; P = .77). A statistically significant interaction between the assay-reported pCR score and the effect of pertuzumab in pCR was observed. Conclusions and Relevance This diagnostic/prognostic study demonstrated that the genomic assay predicted pCR following neoadjuvant trastuzumab-based chemotherapy with or without pertuzumab. This assay could guide therapeutic decisions regarding the use of neoadjuvant pertuzumab.
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Affiliation(s)
- Coralia Bueno-Muiño
- Medical Oncology Department, Hospital Infanta Cristina (Parla), Fundación de Investigación Biomédica del H.U. Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Isabel Echavarría
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - Sara López-Tarruella
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Geicam, Universidad Complutense, Madrid, Spain
| | - Marta Roche-Molina
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - María del Monte-Millán
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - Tatiana Massarrah
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - Yolanda Jerez
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | | | - José Ángel García-Sáenz
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, CIBERONC, Madrid, Spain
| | - Fernando Moreno
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, CIBERONC, Madrid, Spain
| | | | | | | | | | - Patricia Galván
- Translational Genomics and Targeted Therapies in Solid Tumors, Department of Medical Oncology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Fara Brasó-Maristany
- Translational Genomics and Targeted Therapies in Solid Tumors, Department of Medical Oncology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Adrienne G. Waks
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Sara M. Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Elizabeth A. Mittendorf
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Ana Vivancos
- Cancer Genomics Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | | | - Joel. S. Parker
- Department of Genetics, Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill
| | - Charles M. Perou
- Department of Genetics, Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill
| | | | | | - Aleix Prat
- Reveal Genomics, Barcelona, Spain
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
- Department of Medical Oncology, Hospital Clinic of Barcelona, Spain
- Institute of Oncology-Quirón, Barcelona, Spain
| | - Miguel Martín
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Geicam, Universidad Complutense, Madrid, Spain
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García-Torralba E, Navarro Manzano E, Luengo-Gil G, De la Morena Barrio P, Chaves Benito A, Pérez-Ramos M, Álvarez-Abril B, Ivars Rubio A, García-Garre E, Ayala de la Peña F, García-Martínez E. A new prognostic model including immune biomarkers, genomic proliferation tumor markers ( AURKA and MYBL2) and clinical-pathological features optimizes prognosis in neoadjuvant breast cancer patients. Front Oncol 2023; 13:1182725. [PMID: 37313470 PMCID: PMC10258327 DOI: 10.3389/fonc.2023.1182725] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/17/2023] [Indexed: 06/15/2023] Open
Abstract
Background Up to 30% of breast cancer (BC) patients treated with neoadjuvant chemotherapy (NCT) will relapse. Our objective was to analyze the predictive capacity of several markers associated with immune response and cell proliferation combined with clinical parameters. Methods This was a single-center, retrospective cohort study of BC patients treated with NCT (2001-2010), in whom pretreatment biomarkers were analyzed: neutrophil-to-lymphocyte ratio (NLR) in peripheral blood, CD3+ tumor-infiltrating lymphocytes (TILs), and gene expression of AURKA, MYBL2 and MKI67 using qRT-PCR. Results A total of 121 patients were included. Median followup was 12 years. In a univariate analysis, NLR, TILs, AURKA, and MYBL2 showed prognostic value for overall survival. In multivariate analyses, including hormone receptor, HER2 status, and response to NCT, NLR (HR 1.23, 95% CI 1.01-1.75), TILs (HR 0.84, 95% CI 0.73-0.93), AURKA (HR 1.05, 95% CI 1.00-1.11) and MYBL2 (HR 1.19, 95% CI 1.05-1.35) remained as independent predictor variables. Conclusion Consecutive addition of these biomarkers to a regression model progressively increased its discriminatory capacity for survival. Should independent cohort studies validate these findings, management of early BC patients may well be changed.
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Affiliation(s)
- Esmeralda García-Torralba
- Department of Haematology and Medical Oncology, University Hospital Morales Meseguer, Murcia, Spain
- Department of Medicine, Medical School, University of Murcia, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Esther Navarro Manzano
- Department of Medicine, Medical School, University of Murcia, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Gines Luengo-Gil
- Department of Haematology and Medical Oncology, University Hospital Morales Meseguer, Murcia, Spain
- Department of Medicine, Medical School, University of Murcia, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Pilar De la Morena Barrio
- Department of Haematology and Medical Oncology, University Hospital Morales Meseguer, Murcia, Spain
- Department of Medicine, Medical School, University of Murcia, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | | | - Miguel Pérez-Ramos
- Department of Pathology, University Hospital Morales Meseguer, Murcia, Spain
| | - Beatriz Álvarez-Abril
- Department of Haematology and Medical Oncology, University Hospital Morales Meseguer, Murcia, Spain
- Department of Medicine, Medical School, University of Murcia, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Alejandra Ivars Rubio
- Department of Haematology and Medical Oncology, University Hospital Morales Meseguer, Murcia, Spain
- Department of Medicine, Medical School, University of Murcia, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Elisa García-Garre
- Department of Haematology and Medical Oncology, University Hospital Morales Meseguer, Murcia, Spain
- Department of Medicine, Medical School, University of Murcia, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Francisco Ayala de la Peña
- Department of Haematology and Medical Oncology, University Hospital Morales Meseguer, Murcia, Spain
- Department of Medicine, Medical School, University of Murcia, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Elena García-Martínez
- Department of Haematology and Medical Oncology, University Hospital Morales Meseguer, Murcia, Spain
- Department of Medicine, Medical School, University of Murcia, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
- Medical School, Catholic University of Murcia, Murcia, Spain
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García-Torralba E, Pérez Ramos M, Ivars Rubio A, Navarro-Manzano E, Blaya Boluda N, de la Morena Barrio P, García-Garre E, Martínez Díaz F, Chaves-Benito A, García-Martínez E, Ayala de la Peña F. Clinical Meaning of Stromal Tumor Infiltrating Lymphocytes (sTIL) in Early Luminal B Breast Cancer. Cancers (Basel) 2023; 15:2846. [PMID: 37345183 DOI: 10.3390/cancers15102846] [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: 04/14/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 06/23/2023] Open
Abstract
Luminal breast cancer (BC) is associated with less immune activation, and the significance of stromal lymphocytic infiltration (sTIL) is more uncertain than in other BC subtypes. The aim of this study was to investigate the predictive and prognostic value of sTIL in early luminal BC. The study was performed with an observational design in a prospective cohort of 345 patients with predominantly high-risk luminal (hormone receptor positive, HER2 negative) BC and with luminal B features (n = 286), in which the presence of sTIL was analyzed with validated methods. Median sTIL infiltration was 5% (Q1-Q3 range (IQR), 0-10). We found that sTIL were associated with characteristics of higher biological and clinical aggressiveness (tumor and lymph node proliferation and stage, among others) and that the percentage of sTIL was predictive of pathologic complete response in patients treated with neoadjuvant chemotherapy (OR: 1.05, 95%CI 1.02-1.09, p < 0.001). The inclusion of sTIL (any level of lymphocytic infiltration: sTIL > 0%) in Cox regression multivariable prognostic models was associated with a shorter relapse-free interval (HR: 4.85, 95%CI 1.33-17.65, p = 0.016) and significantly improved its performance. The prognostic impact of sTIL was independent of other clinical and pathological variables and was mainly driven by its relevance in luminal B BC.
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Affiliation(s)
- Esmeralda García-Torralba
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, 30008 Murcia, Spain
- Department of Medicine, Medical School, University of Murcia, 30001 Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria, IMIB, 30120 Murcia, Spain
| | - Miguel Pérez Ramos
- Department of Pathology, Hospital Universitario Morales Meseguer, 30008 Murcia, Spain
| | - Alejandra Ivars Rubio
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, 30008 Murcia, Spain
- Department of Medicine, Medical School, University of Murcia, 30001 Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria, IMIB, 30120 Murcia, Spain
| | - Esther Navarro-Manzano
- Department of Medicine, Medical School, University of Murcia, 30001 Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria, IMIB, 30120 Murcia, Spain
- Centro Regional de Hemodonación, 30003 Murcia, Spain
| | - Noel Blaya Boluda
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, 30008 Murcia, Spain
- Department of Medicine, Medical School, University of Murcia, 30001 Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria, IMIB, 30120 Murcia, Spain
| | - Pilar de la Morena Barrio
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, 30008 Murcia, Spain
- Department of Medicine, Medical School, University of Murcia, 30001 Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria, IMIB, 30120 Murcia, Spain
| | - Elisa García-Garre
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, 30008 Murcia, Spain
- Department of Medicine, Medical School, University of Murcia, 30001 Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria, IMIB, 30120 Murcia, Spain
| | - Francisco Martínez Díaz
- Department of Pathology, Hospital Universitario Reina Sofía, 30003 Murcia, Spain
- Department of Pathology, Medical School, University of Murcia, 30001 Murcia, Spain
| | - Asunción Chaves-Benito
- Department of Pathology, Hospital Universitario Morales Meseguer, 30008 Murcia, Spain
- Department of Pathology, Medical School, University of Murcia, 30001 Murcia, Spain
| | - Elena García-Martínez
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, 30008 Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria, IMIB, 30120 Murcia, Spain
- Medical School, Universidad Católica San Antonio, 30107 Murcia, Spain
| | - Francisco Ayala de la Peña
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, 30008 Murcia, Spain
- Department of Medicine, Medical School, University of Murcia, 30001 Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria, IMIB, 30120 Murcia, Spain
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Martínez-Jáñez N, Ezquerra MB, Henao F, Manso L, Antón A, Zamora P, Murillo SM, Tolosa P, Andrés R, Calvo L, Galve E, Lopez R, de la Peña FA, López-Tarruella S, Boronat L, Martos T, Chacón JI, Álvarez I, de la Haba-Rodríguez J, Antón FM. Abstract P4-01-28: PALBOSPAIN: OBSERVATIONAL ANALYSIS OF FIRST-LINE THERAPY WITH PALBOCICLIB IN PATIENTS WITH HR+/HER2- METASTATIC BREAST CANCER (MBC) IN REAL-LIFE CONDITIONS. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p4-01-28] [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: 03/06/2023]
Abstract
Abstract
INTRODUCTION AND OBJECTIVES Palbociclib associated with hormone therapy (HT) has shown significant benefit in progression-free survival (PFS) and response rate versus HT alone in patients with HR+, HER2- MBC. The PALBOSPAIN study evaluates the efficacy and safety of palbociclib treatment under real-life conditions. The main objective of the study was to assess PFS, and secondary objectives were overall survival (OS), response rate, time to next line of treatment, percentage of dose reduction and safety.
MATERIAL AND METHODS This is an observational, ambispective, multicenter, nation-wide study. Patients diagnosed with HR+/HER2- MBC who had started first-line treatment with palbociclib between November 2017 and November 2019 were included. Patients treated within a clinical trial were excluded, as were those who had received any previous systemic treatment for advanced disease.
RESULTS 762 patients from 35 centers were included. 79% (n=600) were postmenopausal, 54.9% (n=418) had visceral disease, and 30.6% (n=233) had de-novo metastatic disease. Palbocliclib was combined with an aromatase inhibitor in 69.6% of patients and fulvestrant in 30.2% Four groups were established to assess efficacy (table 1): overall population; patients with de-novo metastatic disease (cohort A); patients relapsing >12 months after the end of adjuvant hormonal therapy (cohort B); and patients relapsing within 12 months after the end of adjuvant hormonal therapy (cohort C). Median PFS was 24 months (CI 95%; 25-27) overall and 28 (IC 95%; 23-39), 29 (IC 95%;25-35) and 14 months (IC 95%;11-17) for cohorts a, B and C, respectively. Median overall survival was 42 months (40-NA). The most common side effects were neutropenia (71.3%, grade 3-4 in 52.5%, no episodes of febrile neutropenia), fatigue (38.6%), leucopenia (29.8%), anemia (28.9%), articular pain (19%), and thrombocytopenia (2,2%). 49% (n=385) of patients required dose reduction of palbociclib (one level in 27.6% and two levels in 21.4%).
CONCLUSION In the first two years after its approval in Spain, palbociclib in first line of HR+/HER2- MBC in real-life conditions yielded PFS and safety results comparable to those of PALOMA 2 and PALOMA 3 clinical trials. OS results were poorer, although the population included in this retrospective study is heterogeneous and median survival values have not been reached in some subgroups.
Table 1. Efficay results of palbociclib in real world
Citation Format: Noelia Martínez-Jáñez, Meritxell Bellet Ezquerra, Fernando Henao, Luis Manso, Antonio Antón, Pilar Zamora, Serafin Morales Murillo, Pablo Tolosa, Raquel Andrés, Lourdes Calvo, Elena Galve, Rafael Lopez, Francisco Ayala de la Peña, Sara López-Tarruella, Laia Boronat, Tamara Martos, J. Ignacio Chacón, Isabel Álvarez, Juan de la Haba-Rodríguez, Fernando Moreno Antón. PALBOSPAIN: OBSERVATIONAL ANALYSIS OF FIRST-LINE THERAPY WITH PALBOCICLIB IN PATIENTS WITH HR+/HER2- METASTATIC BREAST CANCER (MBC) IN REAL-LIFE CONDITIONS [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-01-28.
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Affiliation(s)
- Noelia Martínez-Jáñez
- 1Medical Oncology Hospital Universitario Ramón y Cajal. Madrid. Spain. GEICAM Spanish Breast Cancer Group., TRES CANTOS, Madrid, Spain
| | - Meritxell Bellet Ezquerra
- 2Vall d’Hebron Institute of Oncology (VHIO) and Vall d’Hebron University Hospital, and SOLTI Group, Barcelona, Spain
| | - Fernando Henao
- 3Medical Oncology Hospital Virgen de la Macarena. Sevilla. Spain
| | - Luis Manso
- 4Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Antonio Antón
- 5Hospital Universitario Miguel Servet. GEICAM Spanish Breast Cancer Group., Spain
| | - Pilar Zamora
- 6Hospital Universitario de La Paz, Madrid, Spain
| | | | - Pablo Tolosa
- 8SOLTI Cancer Research Group, Barcelona, Spain/Medical Oncology Department, Hospital 12 de Octubre, Madrid., Madrid, Spain
| | - Raquel Andrés
- 9Hospital Clínico Universitario Lozano Blesa. GEICAM Spanish Breast Cancer Group., Spain
| | - Lourdes Calvo
- 10Oncology Department-Universitary Hospital A Coruña, A Coruña, Galicia, Spain
| | | | - Rafael Lopez
- 12Medical Oncology Hospital Clínico Universitario de Santiago CHUS. La Coruña Spain
| | | | - Sara López-Tarruella
- 14Hospital Universitario Gregorio Marañón. CIBERONC-ISCIII. GEICAM Spanish Breast Cancer Group., Spain
| | - Laia Boronat
- 15Medical Oncology Hospital de la Santa Creu i Sant Pau. Barcelona. Spain
| | - Tamara Martos
- 16Medical Oncology. Hospital del Mar. Barcelona. Spain
| | - J. Ignacio Chacón
- 17Hospital Universitario de Toledo. GEICAM Spanish Breast Cancer Group., Spain
| | - Isabel Álvarez
- 18Hospital Universitario Donostia-BioDonostia. GEICAM Spanish Breast Cancer Group., Spain
| | - Juan de la Haba-Rodríguez
- 19Instituto Maimonides de Investigacion Biomedica, Hospital Reina Sofia, Universidad de Córdoba. GEICAM Spanish Breast Cancer Group., Spain
| | - Fernando Moreno Antón
- 20Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), CIBERONC, Madrid, Spain
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Bueno-Muiño C, Echavarria I, López-Tarruella S, Marta RM, del Monte-Millán M, Massarrah T, Gilarranz YJ, Herrero B, Gámez S, Márquez-Rodas I, Cebollero-Presmanes M, Manuel NS, de la Morena Barrio P, de la Peña FA, García-Sáenz JÁ, Antón FM, Rodríguez Lescure Á, Quintanar T, Malón-Giménez D, Rodriguez-Lajusticia L, García AIB, Torres DB, Villarejo L, Lobato N, Arias A, Ocaña I, Álvarez E, Paré L, Marín-Aguilera M, Galván P, Brasó-Maristany F, Vivancos A, Villagrasa P, Parker JS, Perou CM, Prat A, Martín M. Abstract P6-01-46: Independent validation of the HER2DX genomic test in HER2-positive breast cancer treated with neoadjuvant docetaxel, carboplatin, trastuzumab +/- pertuzumab (TCH/TCHP): a correlative analysis from a multicenter academic study. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p6-01-46] [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: 03/06/2023]
Abstract
Abstract
Background: HER2DX (Prat et al. EBiomedicine 2022) is a 27-gene prognostic (risk-score) and predictive (pathological complete response [pCR]-score) assay in early-stage HER2+ breast cancer based on clinical data and the expression of 4 gene signatures (immune, proliferation, luminal differentiation and HER2 amplicon). Here, we aim to evaluate, for the first time, the ability of HER2DX to predict pCR following neoadjuvant TCH or TCHP in HER2+ disease. Methods: Standardized HER2DX was performed in a central lab on baseline pre-treatment FFPE tumor biopsies from the GOM-HGUGM-2018-05 study in Spain, a consecutive retrospective series of patients (pts) with newly diagnosed stage I-III HER2+ breast cancer eligible for neoadjuvant therapy. Pts received standard 6 cycles of docetaxel, carboplatin and trastuzumab (TCH) or TCH with pertuzumab (TCHP) regimens. Primary aim was to test the ability of HER2DX pCR score to predict pCR (ypT0/is ypN0). Secondary objectives were to test the ability of HER2DX pCR score to predict pCR independently of clinical-pathological variables and the PAM50 subtype (HER2-enriched versus not), and to evaluate the association of HER2DX pCR score with the HER2DX risk-score. Logistic regression and receiver-operator curve (ROC) analysis were assessed. Statistical analyses were performed in R code 4.0.5. Results: HER2DX was evaluated in 155 pts (97%) enrolled in the study with available RNA (as of June 2022). Mean age of pts was 50 (range 22-74) and 55.2% of pts (n=85) were pre-menopausal. Clinical T2-4 disease represented 77.4% of cases (n=120), clinical node-positive disease (cN1-3) represented 63.9% of cases (n=99), and 68.0% of tumors (n=105) were hormone receptor-positive. The overall pCR rate was 57.4% (95% confidence interval [CI] 50-65): 52.2% (95% CI 40-64) with TCH (n=67) and 61.4% (95% CI 50-72) with TCHP (n=88). The proportion of HER2DX low-, medium- and high-pCR groups was 34.2%, 34.8% and 31.0%, respectively. HER2DX pCR score (as a continuous variable from 0 to 100) was significantly associated with pCR (odd ratio [OR]=1.03, p=5.91e-07). The pCR rates in HER2DX pCR-high and pCR-low groups were 75.0% and 28.0% (OR=7.6, 95% CI 3.2-19.1, p=7.14e-06), respectively. In pts treated with TCHP, the pCR rates in HER2DX pCR-high and pCR-low groups were 85.7% and 27.3% (OR=16.0, 95% CI 4.3-59.01, p=3.2e-05), respectively. The AUC ROC of HER2DX pCR score (as a continuous variable) and pCR status was 0.746 (in all pts) and 0.812 (in pts treated with TCHP). HER2DX pCR score was significantly associated with pCR independently of hormone receptor status, Ki67, age, menopausal status, pertuzumab use, clinical stage and PAM50 HER2-enriched subtype. The proportion of HER2DX low- and high-risk of relapse disease was 32.0% and 68.0%, respectively. The correlation of HER2DX pCR score and HER2DX risk-score was weak (coefficient=-0.17), as previously described. Proportion of cases according to both HER2DX scores and absolute difference of pCR rates between TCHP and TCH in each combined group is shown in Table. Conclusion: The HER2DX genomic test predicts pCR following neoadjuvant TCH or TCHP regimens independently of clinical-pathological variables and intrinsic subtype. The combination of both HER2DX scores might help better tailor systemic therapy in patients with newly diagnosed stage I-III HER2+ breast cancer.
Citation Format: Coralia Bueno-Muiño, Isabel Echavarria, Sara López-Tarruella, Roche-Molina Marta, María del Monte-Millán, Tatiana Massarrah, Yolanda Jerez Gilarranz, Blanca Herrero, Salvador Gámez, Iván Márquez-Rodas, María Cebollero-Presmanes, Nevado Santos Manuel, Pilar de la Morena Barrio, Francisco Ayala de la Peña, José Ángel García-Sáenz, Fernando Moreno Antón, Álvaro Rodríguez Lescure, Teresa Quintanar, Diego Malón-Giménez, Laura Rodriguez-Lajusticia, Ana Isabel Ballesteros García, Dulce Bañón Torres, Lucía Villarejo, Nerea Lobato, Ainhoa Arias, Inmaculada Ocaña, Enrique Álvarez, Laia Paré, Mercedes Marín-Aguilera, Patricia Galván, Fara Brasó-Maristany, Ana Vivancos, Patricia Villagrasa, Joel S Parker, Charles M. Perou, Aleix Prat, Miguel Martín. Independent validation of the HER2DX genomic test in HER2-positive breast cancer treated with neoadjuvant docetaxel, carboplatin, trastuzumab +/- pertuzumab (TCH/TCHP): a correlative analysis from a multicenter academic study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-01-46.
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Affiliation(s)
- Coralia Bueno-Muiño
- 1Medical Oncology Department, Hospital Infanta Cristina (Parla), Fundación de Investigación Biomédica del H.U. Puerta de Hierro, Majadahonda, 28009 Madrid, spail, Madrid, Spain
| | - Isabel Echavarria
- 2Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain
| | - Sara López-Tarruella
- 3Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain, Madrid, Spain
| | - Roche-Molina Marta
- 4Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain, Madrid, Spain
| | - María del Monte-Millán
- 5Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain, Madrid, Spain
| | - Tatiana Massarrah
- 6Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain, Madrid, Spain
| | | | - Blanca Herrero
- 8Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain, Madrid, Spain
| | - Salvador Gámez
- 9Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain, Madrid, Spain
| | - Iván Márquez-Rodas
- 10Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain, Madrid, Spain
| | | | - Nevado Santos Manuel
- 12Pathology Service, Hospital Universitario Infanta Cristina, Parla, Madrid, Spain, Madrid, Spain
| | - Pilar de la Morena Barrio
- 13Hematology and Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain., Murcia, Spain
| | - Francisco Ayala de la Peña
- 14Hematology and Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain., Murcia, Spain
| | | | - Fernando Moreno Antón
- 16Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), CIBERONC, Madrid, Spain, Madrid, Spain
| | | | - Teresa Quintanar
- 18Medical Oncology Department, General Universitario de Elche, Alicante, Spain., Andalucia, Spain
| | | | | | | | - Dulce Bañón Torres
- 22Department of Medical Oncology, Hospital Universitario de La Princesa, Madrid, Spain, Madrid, Spain
| | - Lucía Villarejo
- 23Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain, Madrid, Spain
| | - Nerea Lobato
- 24Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain, Madrid, Spain
| | - Ainhoa Arias
- 25Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain, Madrid, Spain
| | - Inmaculada Ocaña
- 26Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain, Madrid, Spain
| | - Enrique Álvarez
- 27Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain, Madrid, Spain
| | | | | | - Patricia Galván
- 30Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain, Catalonia, Spain
| | - Fara Brasó-Maristany
- 31Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS)
| | - Ana Vivancos
- 32Cancer Genomics Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain., Barcelona, Spain
| | | | - Joel S Parker
- 34Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Charles M. Perou
- 35Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Miguel Martín
- 37Hospital General Universitario Gregorio Marañón, Madrid, Spain, Spain
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Vera R, Juan-Vidal O, Safont-Aguilera MJ, de la Peña FA, Del Alba AG. Sex differences in the diagnosis, treatment and prognosis of cancer: the rationale for an individualised approach. Clin Transl Oncol 2023:10.1007/s12094-023-03112-w. [PMID: 36802013 DOI: 10.1007/s12094-023-03112-w] [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: 01/16/2023] [Accepted: 02/02/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND Precision medicine in oncology aims to identify the most beneficial interventions based on a patient's individual features and disease. However, disparities exist when providing cancer care to patients based on an individual's sex. OBJECTIVE To discuss how sex differences impact the epidemiology, pathophysiology, clinical manifestations, disease progression, and response to treatment, with a focus on data from Spain. RESULTS Genetic and environmental factors (social or economic inequalities, power imbalances, and discrimination) that contribute to these differences adversely affect cancer patient health outcomes. Increased health professional awareness of sex differences is essential to the success of translational research and clinical oncological care. CONCLUSIONS The Sociedad Española de Oncología Médica created a Task Force group to raise oncologists' awareness and to implement measures to address sex differences in cancer patient management in Spain. This is a necessary and fundamental step towards optimizing precision medicine that will benefit all individuals equally and equitably.
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Affiliation(s)
- Ruth Vera
- Department of Medical Oncology, University Hospital of Navarra, Pamplona. IdiSNA, Navarra's Health Research Institute, Irunlarrea 3, 31190, Pamplona, Spain.
| | - Oscar Juan-Vidal
- Department of Medical Oncology, University Hospital La Fe, Valencia, Spain
| | - María José Safont-Aguilera
- Department of Medical Oncology, University General Hospital of Valencia, Valencia University, Valencia. CIBERONC, Valencia, Spain
| | - Francisco Ayala de la Peña
- Medical Oncology, Department of Haematology and Oncology, University General Hospital Morales Meseguer, Murcia, Spain
| | - Aránzazu González Del Alba
- Genitourinary Tumour Unit, Department of Medical Oncology, University Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
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Sánchez-Cánovas M, Jimenez-Fonseca P, Fernández Garay D, Cejuela Solís M, Casado Elía D, Coma Salvans E, de la Haba Vacas I, Gómez Sánchez D, Fernández Montés A, Morales Giménez R, Biosca Gómez de Tejada M, Arrazubi Arrula V, Sequero López S, Otero Candelera R, Sánchez Cendra C, Justo de la Peña M, Moreno Muñoz D, Orillo Sarmiento M, Martínez de Castro E, García Escobar I, Bernal Vidal A, Ortega Moran L, Muñoz Martín AJ, Sánchez Bayona R, Martínez Ortiz MJ, Ayala de la Peña F, Vicente V, Carmona-Bayonas A. Prediction of serious complications in patients with pulmonary thromboembolism and solid cancer: Validation of the EPIPHANY Index in a prospective cohort of patients from the PERSEO study. PLoS One 2023; 18:e0266305. [PMID: 37159465 PMCID: PMC10168567 DOI: 10.1371/journal.pone.0266305] [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] [Received: 03/16/2022] [Accepted: 04/11/2023] [Indexed: 05/11/2023] Open
Abstract
INTRODUCTION There is currently no validated score capable of classifying cancer-associated pulmonary embolism (PE) in its full spectrum of severity. This study has validated the EPIPHANY Index, a new tool to predict serious complications in cancer patients with suspected or unsuspected PE. METHOD The PERSEO Study prospectively recruited individuals with PE and active cancer or receiving antineoplastic therapy from 22 Spanish hospitals. The estimation of the relative frequency θ of complications based on the EPIPHANY Index categories was made using the Bayesian alternative for the binomial test. RESULTS A total of 900 patients, who were diagnosed with PE between October 2017 and January 2020, were enrolled. The rate of serious complications at 15 days was 11.8%, 95% highest density interval [HDI], 9.8-14.1%. Of the EPIPHANY low-risk patients, 2.4% (95% HDI, 0.8-4.6%) had serious complications, as did 5.5% (95% HDI, 2.9-8.7%) of the moderate-risk participants and 21.0% (95% HDI, 17.0-24.0%) of those with high-risk episodes. The EPIPHANY Index was associated with overall survival (OS) in patients with different risk levels: median OS was 16.5, 14.4, and 4.4 months for those at low, intermediate, and high risk, respectively. Both the EPIPHANY Index and the Hestia criteria exhibited greater negative predictive value and a lower negative likelihood ratio than the remaining models. The incidence of bleeding at 6 months was 6.2% (95% HDI, 2.9-9.5%) in low/moderate-risk vs 12.7% (95% HDI, 10.1-15.4%) in high-risk (p-value = 0.037) episodes. Of the outpatients, serious complications at 15 days were recorded in 2.1% (95% HDI, 0.7-4.0%) of the cases with EPIPHANY low/intermediate-risk vs 5.3% (95% HDI, 1.7-11.8%) in high-risk cases. CONCLUSION We have validated the EPIPHANY Index in patients with incidental or symptomatic cancer-related PE. This model can contribute to standardize decision-making in a scenario lacking quality evidence.
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Affiliation(s)
- Manuel Sánchez-Cánovas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Paula Jimenez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | | | - Mónica Cejuela Solís
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Diego Casado Elía
- Medical Oncology Department, Complejo Hospitalario de Salamanca, Salamanca, Spain
| | - Eva Coma Salvans
- Medical Oncology Department, Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain
| | - Irma de la Haba Vacas
- Medical Oncology Department, Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain
| | - David Gómez Sánchez
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Ana Fernández Montés
- Medical Oncology Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | | | | | | | | | | | | | | | | | | | - Eva Martínez de Castro
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Ignacio García Escobar
- Medical Oncology Department, Hospital General Universitario Virgen de las Nieves, Granada, Spain
| | - Alejandro Bernal Vidal
- Medical Oncology Department, Hospital Universitario San Juan de Alicante, Sant Joan d'Alacant, Spain
| | - Laura Ortega Moran
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Andrés J Muñoz Martín
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | | | | | | | - Vicente Vicente
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Alberto Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
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Navarro-Manzano E, Luengo-Gil G, González-Conejero R, García-Garre E, García-Martínez E, García-Torralba E, Chaves-Benito A, Vicente V, Ayala de la Peña F. Prognostic and Predictive Effects of Tumor and Plasma miR-200c-3p in Locally Advanced and Metastatic Breast Cancer. Cancers (Basel) 2022; 14:cancers14102390. [PMID: 35625994 PMCID: PMC9139340 DOI: 10.3390/cancers14102390] [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: 04/23/2022] [Revised: 05/07/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022] Open
Abstract
While the role of miR-200c in cancer progression has been established, its expression and prognostic role in breast cancer is not completely understood. The predictive role of miR-200c in response to chemotherapy has also been suggested by some studies, but only limited clinical evidence is available. The purpose of this study was to investigate miR-200c-3p in the plasma and primary tumor of BC patients. The study design included two cohorts involving women with locally advanced (LABC) and metastatic breast cancer. Tumor and plasma samples were obtained before and after treatment. We found that miR-200c-3p was significantly higher in the plasma of BC patients compared with the controls. No correlation of age with plasma miR-200c-3p was found for controls or for BC patients. MiR-200c-3p tumor expression was also associated with poor overall survival in LABC patients treated with neoadjuvant chemotherapy, independently of pathological complete response or clinical stage. Our findings suggest that plasmatic miR-200c-3p levels could be useful for BC staging, while the tumor expression of miR-200c-3p might provide further prognostic information beyond residual disease in BC treated with neoadjuvant chemotherapy.
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Affiliation(s)
- Esther Navarro-Manzano
- Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer, 30008 Murcia, Spain; (E.N.-M.); (G.L.-G.); (R.G.-C.); (E.G.-G.); (E.G.-M.); (E.G.-T.); (V.V.)
- Centro Regional de Hemodonación, 30003 Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria, IMIB, 30120 Murcia, Spain
- Department of Medicine, Medical School, University of Murcia, 30001 Murcia, Spain;
| | - Ginés Luengo-Gil
- Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer, 30008 Murcia, Spain; (E.N.-M.); (G.L.-G.); (R.G.-C.); (E.G.-G.); (E.G.-M.); (E.G.-T.); (V.V.)
- Centro Regional de Hemodonación, 30003 Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria, IMIB, 30120 Murcia, Spain
- Department of Medicine, Medical School, University of Murcia, 30001 Murcia, Spain;
| | - Rocío González-Conejero
- Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer, 30008 Murcia, Spain; (E.N.-M.); (G.L.-G.); (R.G.-C.); (E.G.-G.); (E.G.-M.); (E.G.-T.); (V.V.)
- Centro Regional de Hemodonación, 30003 Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria, IMIB, 30120 Murcia, Spain
- Department of Medicine, Medical School, University of Murcia, 30001 Murcia, Spain;
| | - Elisa García-Garre
- Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer, 30008 Murcia, Spain; (E.N.-M.); (G.L.-G.); (R.G.-C.); (E.G.-G.); (E.G.-M.); (E.G.-T.); (V.V.)
- Instituto Murciano de Investigación Biosanitaria, IMIB, 30120 Murcia, Spain
| | - Elena García-Martínez
- Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer, 30008 Murcia, Spain; (E.N.-M.); (G.L.-G.); (R.G.-C.); (E.G.-G.); (E.G.-M.); (E.G.-T.); (V.V.)
- Instituto Murciano de Investigación Biosanitaria, IMIB, 30120 Murcia, Spain
- Medical School, Universidad Católica San Antonio, 30107 Murcia, Spain
| | - Esmeralda García-Torralba
- Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer, 30008 Murcia, Spain; (E.N.-M.); (G.L.-G.); (R.G.-C.); (E.G.-G.); (E.G.-M.); (E.G.-T.); (V.V.)
- Instituto Murciano de Investigación Biosanitaria, IMIB, 30120 Murcia, Spain
| | - Asunción Chaves-Benito
- Department of Medicine, Medical School, University of Murcia, 30001 Murcia, Spain;
- Department of Pathology, Hospital Universitario Morales Meseguer, 30008 Murcia, Spain
| | - Vicente Vicente
- Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer, 30008 Murcia, Spain; (E.N.-M.); (G.L.-G.); (R.G.-C.); (E.G.-G.); (E.G.-M.); (E.G.-T.); (V.V.)
- Centro Regional de Hemodonación, 30003 Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria, IMIB, 30120 Murcia, Spain
- Department of Medicine, Medical School, University of Murcia, 30001 Murcia, Spain;
| | - Francisco Ayala de la Peña
- Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer, 30008 Murcia, Spain; (E.N.-M.); (G.L.-G.); (R.G.-C.); (E.G.-G.); (E.G.-M.); (E.G.-T.); (V.V.)
- Instituto Murciano de Investigación Biosanitaria, IMIB, 30120 Murcia, Spain
- Department of Medicine, Medical School, University of Murcia, 30001 Murcia, Spain;
- Correspondence: ; Tel.: +34-968360900
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Garcia-Torralba E, Álvarez-Abril B, Bravo-Pérez C, Manzano EN, de la Morena Barrio P, Rubio AI, García-Garre E, Zafra GM, de la Peña FA, García-Martínez E. Abstract P4-07-11: Prognostic significance of changes in tumor infiltrating lymphocytes and neutrophil-to-lymphocyte ratio after neoadjuvant chemotherapy in early breast cancer patients. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p4-07-11] [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: 11/16/2022]
Abstract
Abstract
Introduction. There are still 30-40% of patients with early breast cancer (BC) that relapse after neoadjuvant chemotherapy (NAC). New prognostic biomarkers are needed. Current evidence shows that both markers of antitumor local and systemic immune response, such as tumor infiltrating lymphocytes (TIL) and neutrophil-to-lymphocyte ratio (NLR) have prognostic value in early BC. Most works have evaluated baseline levels, but their variation after NAC might be related to treatment resistance and should be explored.The aim of this study was to simultaneously investigate the prognostic significance of the pre-post-NAC variation of TIL and NLR in patients with early BC.Methods. Retrospective, single-center cohort of 121 patients with early BC treated with NAC between 2001 and 2010. Pre- and post-NAC TIL (CD3+) were assessed by tumor tissue microarrays performed in both diagnostic core-needle biopsy and surgical excision specimens, respectively. Pre- and post-NAC NLR were calculated based on blood tests collected within 1 month of cancer diagnosis and at the moment of surgery, respectively. The change on TIL and NLR after NAC was estimated by calculating the absolute difference of post- and pre- values of these parameters (Δpost-pre). We examined the association between the absolute difference of TIL and NLR (both divided into deciles) and survival outcomes by Cox regression. To represent in Kaplan-Meier curves the combined effect of the change of TIL and NLR in OS, we divided patients into 4 groups, depending on the sign of Δpost-pre values of TIL and NLR: 1) no TIL nor NLR increment after NAC (ΔTIL & ΔNRLpost-pre≤0); 2) no TIL but NLR increment (ΔTILpost-pre≤0, ΔNRLpost-pre>0); 3) TIL but no NLR increment (ΔTILpost-pre>0, ΔNRLpost-pre≤0); and 4) TIL and NLR increment following NAC (ΔTIL & ΔNRLpost-pre>0).Results. 47 (40%) out of 121 patients had pre- and post-NAC values of both NLR and TIL. Patients’ baseline characteristics are shown in Table 1. The median follow-up of this group was 11.5 years (IQR: 10.5 - 12.5 years). At the final follow-up date, overall survival (OS) was 87.2 %. In the univariable analysis, the increase in TIL and NLR after NAC among deciles showed a negative prognostic value for OS (TIL: HR 1.54, 95%CI 1.05-2.26, p=0.026; HR 1.32 95%CI 0.98-1.79, p=0.070). In the multivariable analysis, adjusted by cancer staging after NAC, both the increase of TIL and NLR after NAC among deciles add independent predictive value (TIL: HR 1.53, 95%CI 1.00-2.34, p=0.049; RNL: HR 1.42 95%CI 0.95-2.12, p=0.09).The subpopulation of patients with no TIL increment after NAC (Groups 1&2, N=23) showed the best prognosis, with no deaths at 10 years. Among patients with TIL increment (Groups 3&4, N=22), those with no NLR increment (Group 3, N=5) showed an intermediate prognosis (20% deaths at 10 years), whereas patients with concurrent NLR increment (Group 4, N=17) had the lowest OS (29.4% deaths at 10 years). Differences observed between groups were statistically significant (Log Rank p=0.042).Conclusion. The integrated characterization of TIL and NLR variations after NAC identifies different prognostic subgroups in early BC patients. In our cohort, both the increment of TIL and/or NLR after NAC are associated to a worse prognosis. Future validation of these findings in large, multicenter cohorts might allow treatment optimization by means of new strategies such as immunotherapy.
Table 1.Patients’ baseline characteristicsN=47Age (median, range)56 (21, 78)Menstrual statusPostmenopausal25 (53,2%)Premenopausal22 (46,8%)Histologic subtypeInvasive ductal carcinoma42 (91,5%)Other subtypes4 (8,5%)Histologic gradeGrade 12 (4,3%)Grade 218 (38,3%)Grade 323 (48,9%)Unknown4 (8,6%)cTcT221 (44,7%)cT324 (51,1%)cT4a-d2 (4,2%)cNcN018 (38,3%)cN114 (29,8%)cN26 (12,8%)cN39 (19,1%)Molecular subtypeHR+ HER2-22 (46,8%)HER2+ HR+8 (17,0%)HER2+ HR-6 (12,8%)Triple negative10 (21,3%)Breast surgeryConservative26 (55,3%)Mastectomy21 (44,7%)Axillary surgerySentinel lymph node biopsy12 (25,5%)Axillary lymph node dissection35 (74,5%)Relapse typeMetastasis7 (14,9%)Local/contralateral1 (0,83%)Deaths6 (12,8%)
Citation Format: Esmeralda Garcia-Torralba, Beatriz Álvarez-Abril, Carlos Bravo-Pérez, Esther Navarro Manzano, Pilar de la Morena Barrio, Alejandra Ivars Rubio, Elisa García-Garre, Gema Marín Zafra, Francisco Ayala de la Peña, Elena García-Martínez. Prognostic significance of changes in tumor infiltrating lymphocytes and neutrophil-to-lymphocyte ratio after neoadjuvant chemotherapy in early breast cancer patients [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-07-11.
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Garcia-Torralba E, Álvarez-Abril B, Bravo-Pérez C, Manzano EN, de la Morena Barrio P, Rubio AI, García-Garre E, Zafra GM, de la Peña FA, García-Martínez E. Abstract P4-07-03: Development of prognostic models based on clinical, immune-related and proliferation factors in early breast cancer patients treated with neoadjuvant chemotherapy. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p4-07-03] [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: 11/16/2022]
Abstract
Abstract
Introduction and objectives Up to 30% of early breast cancer (BC) patients treated with neoadjuvant chemotherapy will have systemic relapse during the follow-up. The integration of clinical, analytical and molecular parameters associated to tumor biology or host immune response could help to better stratify the prognosis of these patients. The aim of this study was to analyze the prognostic ability of immune-related and proliferation markers in combination with clinical parameters in patients with early BC treated with neoadjuvant chemotherapy. Methods and materials Retrospective and single-center cohort of BC patients treated with neoadjuvant chemotherapy between 2001 and 2010. We analyzed the following pre-treatment biological markers: neutrophil-to-lymphocyte ratio (NLR) in peripheral blood and CD3+-tumor-infiltrating lymphocytes (TIL), interferon-gamma and interleukin-10 in tumor samples by using a tissue microarray. Gene expression of AURKA, MYBL2, MKI67 and CTNNB1 in RNA from tumor samples was also evaluated by quantitative real-time polymerase chain reaction (qRT-PCR). Survival analysis was performed using Cox regression. The predictive capacity of the regression models was evaluated using AIC (Akaike Information Criterion) index, ROC curves and Harrell's C statistics. Results A total of 121 patients were included. Median age: 56 years. Cancer stage at diagnosis: 16% IIA, 28% IIB, 33% IIIA, 7% IIIB and 16% IIIC. Molecular subtype: 64% hormone receptor-positive (12% HER2-positive), 11% HER2-positive and 22% triple-negative. Pathological complete response (pCR): 16.5%. Median follow-up: 12 years. In the univariate analysis, NLR (HR 1.23, 95% CI 1.11-1.36; p<0.001), TIL (HR 0.89, CI95% 0.81-0.98; p=0, 02), AURKA (HR 1.02, 95% CI 1.01-1.04; p<0.001) and MYBL2 (HR 1.10, 95% CI 1.03-1.19; p=0.007) showed prognostic value for overall survival (OS). In the multivariate analysis, including staging after neoadjuvant therapy (HR 6.54, 95% CI 1.36-31.49; p=0.02), NLR (HR 1.33, 95% CI 1.08-1.64; p=0.008), TIL (HR 0.84, 95% CI 0.73-0.97; p=0.21), AURKA (HR 1.05, 95% CI 0.99-1.10; p=0.055) and MYBL2 (HR 1.14, 95% CI 1.00-1.31; p=0.04) remained as independent predictive variables in a regression analysis. Consecutive addition of these biomarkers to a regression model based on staging after neoadjuvant treatment progressively increased the discrimination accuracy of the models. These differences were more marked for the predictive model that included the four biological parameters identified in the multivariate analysis: NLR, TIL, AURKA and MYBL2 (Table 1). Conclusion In our cohort, the creation of a prognostic model integrated by clinical factors together with proliferation and both tissue and circulating immune biomarkers demonstrated high predictive capacity for OS. The validation of these findings in independent cohorts could impact in patient’s management.
Table 1.Analysis of prognostic capacity with the consecutive addition of biomarkersAICAUC ROC (95% CI)pHarrell's C-index (95% CI)pModel 1: ypTN2740,76 (0,58-0,94)Ref*0,74 (0,57-0,91)Ref*Model 2: ypTN + NLR1870,78 (0,61-0,95)0,830,80 (0,67-0,93)0,53Model 3: ypTN + NLR + TIL850,85 (0,73-0,98)0,300,83 (0,73-0,94)0,30Model 4: ypTN + NLR + TIL + + AURKA + MYBL2570,91 (0,80-1)0,110,89 (0,81-0,97)0,13*Ref: model 1 was the reference category that was used for comparison of AUC and C-index.AIC: Akaike Information Criterion. AUC ROC: Area Under the ROC Curve. ROC: Receiver Operating Characteristic.
Citation Format: Esmeralda Garcia-Torralba, Beatriz Álvarez-Abril, Carlos Bravo-Pérez, Esther Navarro Manzano, Pilar de la Morena Barrio, Alejandra Ivars Rubio, Elisa García-Garre, Gema Marín Zafra, Francisco Ayala de la Peña, Elena García-Martínez. Development of prognostic models based on clinical, immune-related and proliferation factors in early breast cancer patients treated with neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-07-03.
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Carmona-Bayonas A, Calderón C, Hernández R, Fernández Montes A, Castelo B, Ciria-Suarez L, Antoñanzas M, Rogado J, Pacheco-Barcia V, Asensio Martínez E, Ivars A, Ayala de la Peña F, Jimenez-Fonseca P. Prediction of quality of life in early breast cancer upon completion of adjuvant chemotherapy. NPJ Breast Cancer 2021; 7:92. [PMID: 34257315 PMCID: PMC8277774 DOI: 10.1038/s41523-021-00296-8] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 06/09/2021] [Indexed: 01/05/2023] Open
Abstract
Quality of life (QoL) is a complex, ordinal endpoint with multiple conditioning factors. A predictive model of QoL after adjuvant chemotherapy can support decision making or the communication of information about the range of treatment options available. Patients with localized breast cancer (n = 219) were prospectively recruited at 17 centers. Participants completed the EORTC QLQ-C30 questionnaire. The primary aim was to predict health status upon completion of adjuvant chemotherapy adjusted for multiple covariates. We developed a Bayesian model with six covariates (chemotherapy regimen, TNM stage, axillary lymph node dissection, perceived risk of recurrence, age, type of surgery, and baseline EORTC scores). This model allows both prediction and causal inference. The patients with mastectomy reported a discrete decline on all QoL scores. The effect of surgery depended on the interaction with age. Women with ages on either end of the range displayed worse scores, especially with mastectomy. The perceived risk of recurrence had a striking effect on health status. In conclusion, we have developed a predictive model of health status in patients with early breast cancer based on the individual's profile.
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Affiliation(s)
- Alberto Carmona-Bayonas
- Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer, University of Murcia, IMIB, Murcia, Spain.
| | - Caterina Calderón
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, University of Pais Vasco, Pais Vasco, Spain
| | - Raquel Hernández
- Department of Medical Oncology, Hospital Universitario de Canarias, Tenerife, Spain
| | - Ana Fernández Montes
- Department of Medical Oncology, Complejo Hospitalario Universitario de Orense, Orense, Spain
| | - Beatriz Castelo
- Department of Medical Oncology, Hospital Universitario La Paz, Madrid, Spain
| | - Laura Ciria-Suarez
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Mónica Antoñanzas
- Department of Medical Oncology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Jacobo Rogado
- Department of Medical Oncology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Vilma Pacheco-Barcia
- Department of Medical Oncology, Hospital Central de la Defensa Gomez Ulla, Madrid, Spain
| | | | - Alejandra Ivars
- Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer, University of Murcia, IMIB, Murcia, Spain
| | - Francisco Ayala de la Peña
- Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer, University of Murcia, IMIB, Murcia, Spain
| | - Paula Jimenez-Fonseca
- Department of Medical Oncology, Hospital Universitario Central of Asturias, ISPA Oviedo University of Pais Vasco, Pais Vasco, Spain
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Martín García A, Mitroi C, Mazón Ramos P, García Sanz R, Virizuela JA, Arenas M, Egocheaga Cabello I, Albert D, Anguita Sánchez M, Arrarte Esteban VI, Ayala de la Peña F, Bonanand Lozano C, Castro A, Castro Fernández A, Córdoba R, Cosín-Sales J, Chaparro-Muñoz M, Dalmau R, Drak Hernández Y, Deiros Bronte L, Díez-Villanueva P, Escobar Cervantes C, Fernández Redondo C, García Rodríguez E, Lozano T, Marco Vera P, Martínez Monzonis A, Mesa D, Oristrell G, Palma Gámiz JL, Pedreira M, Reinoso-Barbero L, Rodríguez I, Serrano Antolín JM, Toral B, Torres Royo L, Velasco Del Castillo S, Vicente-Herrero T, Zatarain-Nicolás E, Tamargo J, López Fernández T. Stratification and management of cardiovascular risk in cancer patients. A consensus document of the SEC, FEC, SEOM, SEOR, SEHH, SEMG, AEEMT, AEEC, and AECC. ACTA ACUST UNITED AC 2021; 74:438-448. [PMID: 33712348 DOI: 10.1016/j.rec.2020.11.020] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022]
Abstract
Both cancer treatment and survival have significantly improved, but these advances have highlighted the deleterious effects of vascular complications associated with anticancer therapy. This consensus document aims to provide a coordinated, multidisciplinary and practical approach to the stratification, monitoring and treatment of cardiovascular risk in cancer patients. The document is promoted by the Working Group on Cardio Oncology of the Spanish Society of Cardiology (SEC) and was drafted in collaboration with experts from distinct areas of expertise of the SEC and the Spanish Society of Hematology and Hemotherapy (SEHH), the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Radiation Oncology (SEOR), the Spanish Society of General and Family Physicians (SEMG), the Spanish Association of Specialists in Occupational Medicine (AEEMT), the Spanish Association of Cardiovascular Nursing (AEEC), the Spanish Heart Foundation (FEC), and the Spanish Cancer Association (AECC).
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Affiliation(s)
- Ana Martín García
- Servicio de Cardiología, Complejo Asistencial Universitario de Salamanca (CAUSA), IBSAL, USAL, Salamanca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain.
| | - Cristina Mitroi
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Pilar Mazón Ramos
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | - Ramón García Sanz
- Servicio de Hematología, Complejo Asistencial Universitario de Salamanca (CAUSA), IBSAL, Salamanca, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC-ISCIII), Spain
| | | | - Meritxell Arenas
- Servicio de Oncología Radioterápica, Hospital Universitario San Juan de Reus, Universidad Rovira i Virgili, Reus, Tarragona, Spain
| | | | - Dimpna Albert
- Servicio de Cardiología Pediátrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | | | | | - Almudena Castro
- Servicio de Cardiología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | | | - Raúl Córdoba
- Servicio de Hematología, Fundación Jiménez Díaz, Madrid, Spain
| | - Juan Cosín-Sales
- Servicio de Cardiología, Hospital Arnau de Vilanova, Valencia, Spain
| | | | - Regina Dalmau
- Servicio de Cardiología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | | | - Lucía Deiros Bronte
- Servicio de Cardiología Pediátrica, Hospital Universitario La Paz, Madrid, Spain
| | | | - Carlos Escobar Cervantes
- Servicio de Cardiología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | | | | | - Teresa Lozano
- Servicio de Cardiología, Hospital General Universitario de Alicante, ISABIAL, Alicante, Spain
| | - Pascual Marco Vera
- Servicio de Hematología y Hemoterapia, Hospital General Universitario de Alicante, ISABIAL, Alicante, Spain
| | - Amparo Martínez Monzonis
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | - Dolores Mesa
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Gerard Oristrell
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | | | - Milagros Pedreira
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | | | - Isabel Rodríguez
- Servicio de Oncología Radioterápica, Hospital Universitario La Paz, Madrid, Spain
| | | | - Belén Toral
- Servicio de Cardiología Pediátrica, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Laura Torres Royo
- Servicio de Oncología Radioterápica, Hospital Universitario San Juan de Reus, Universidad Rovira i Virgili, Reus, Tarragona, Spain
| | | | | | - Eduardo Zatarain-Nicolás
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | - Juan Tamargo
- Departamento de Farmacología, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | - Teresa López Fernández
- Servicio de Cardiología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
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García-Torralba E, Garcia MEG, de la Morena Barrio P, Rubio AI, Martinez EG, Garre EG, Zafra GM, Abril BA, Manzano EN, Ayala de la Peña F. Abstract PS6-54: Prognostic significance of residual micrometastatic axillary involvement with complete pathologic breast response after neoadjuvant chemotherapy for early breast cancer. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps6-54] [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: 11/16/2022]
Abstract
Abstract
Introduction and objectives Pathologic complete response (pCR, ypT0/Tis ypN0) after neoadjuvant chemotherapy (nCT) in early breast cancer (BC) is associated with higher survival rate. Controversy about the prognostic significance of low-volume or micrometastatic axillary residual disease (ypN1mi-RD) exists. Essentially, it is considered equivalent to high-volume nodal disease (ypN1/ypN2-RD) for the indication of lymphadenectomy after nCT. Clarifying ypN1mi-RD prognostic value would be useful for planning adjuvant therapy. Thus, our objective was to assess the prognostic significance of ypN1mi-RD in the context of primary breast tumor pCR. Material and methodsRetrospective, single-center analysis of a cohort of early BC patients treated with nCT between 2010 and 2018 who achieved breast pCR (ypT0/Tis) combined with axillary pCR (ypN0) or ypN1mi-RD or ypN1/ypN2-RD. Cases with pre-nCT sentinel lymph node biopsy were excluded. 5-year disease-free survival (DFS) and overall survival (OS) were analyzed using Cox regression models.ResultsAmong 470 early BC patients treated with nCT, 134 (28.5%) had in-breast pCR, of whom: 97 (20.6%) were ypN0; 7 (1.5%) were ypN1mic; 10 (2.1%) were ypN1 and 5 (1.1%) were ypN2. Clinicopathological characteristics of the groups are shown in the Table. Median follow-up: 33 months. Eight patients relapsed, 4 of 97 with nodal pCR and 4 of 22 with axillary residual disease: 2/7 ypN1mic; 1/10 ypN1 and 1/5 ypN2. Patients who relapsed predominantly presented pre-nCT clinical lymph node involvement, hormone receptor negativity, ki67<20% and absence of complete clinical response (100%). Globally, patients with axillary residual disease had lower DFS rates (95% vs. 69%, p = 0.03), with no apparent differences between ypN1-RD vs. ypN2-RD in the subgroup analysis (75% vs. 80%, respectively). ypN1mic-RD patients showed the poorest DFS (33%, p <0.01). In the multivariable analysis, ypN1mic-RD had worse DFS than nodal pCR (HR 13.98, 95%CI 1.95-100.24, p = 0.01), but no differences were observed between the low and high-volume residual axillary disease categories (HR 0.24, 95%CI 0.03-1.74, p = 0.16). Due to the low rate of events, no differences in terms of OS were observed (p = 0.77).Conclusion In the context of in-breast pCR after nCT for early BC, ypN1mic-RD not only presented a higher risk of relapse than nodal pCR, but also was not associated with a better prognosis than that observed for ypN1/ypN2-RD. Micrometastatic axillary residual disease behaves as an independent adverse prognostic factor, comparable to high-volume axillary residual disease, and might be considered as a factor for the indication of post-nCT adjuvant treatment.
Table. Clinicopathologic characteristics of the cohort of early BC patients treated with nCT betweenypT0/TisypT0/TisypN1mic-RDypN1/N2-RDpCR(N=7)(N=15)(N=97)Age (median, range)49 (25-83)47 (40-77)47 (25-80)Menstrual statusPostmenopausal3 (42,8%)4 (26,7%)42 (43,3%)Premenopausal4 (57,1%)11 (73,3%)55 (56,7%)ECOGECOG 05 (71,4%)13 (86,7%)78 (80,4%)ECOG 12 (28,5%)2 (13,3%)19 (19,6%)Histologic subtypeInvasive ductal carcinoma7(100,0%)14 (93,3%)95 (97,9%)Other subtypes0 (0,0%)1 (6,7%)2 (2,0%)Histologic gradeGrade 10 (0,0%)0 (0,0%)1 (1,0%)Grade 23 (42,9%)5 (33,3%)17 (17,5%)Grade 34 (57,1%)8 (53,3%)67 (69,1%)Unknown0 (0,0%)2 (13,3%)0 (0,0%)cTcT11 (14,2%)4 (26,7%)8 (8,2%)cT24 (57,1%)5 (33,3%)63 (64,9%)cT32 (28,6%)6 (40,0%)24 (24,7%)cT4a-d0 (0,0%)0 (0,0%)2 (2,1%)cNcN01 (14,3%)0 (0,0%)27 (27,8%)cN13 (42,9%)5 (33,3%)34 (35,1%)cN21 (14,3%)6 (40,0%)24 (24,7%)cN32 (28,6%)4 (26,7%)11 (11,3%)Molecular subtypeHR+ HER2-1 (14,3%)8 (53,3%)11 (11,3%)HR+ HER2+3 (42,9%)1 (6,7%)30 (30,9%)HR- HER2+2 (28,6%)3 (20,0%)21 (21,6%)TNBC1 (14,3%)3 (20,0%)35 (36,1%)Breast surgeryConservative7 (100%)10 (66,7%)67 (69,1%)Mastectomy0 (0,0%)5 (33,3%)30 (30,9%)Nodal surgerySLN biopsy0 (0,0%)0 (0,0%)22 (22,7%)ALND7 (100,0%)15 (100,0%)75 (77,3%)ypTypT05 (71,4%)7 (46,7%)80 (82,5%)ypTis2 (28,6%)8 (53,3%)17 (17,5%)Relapse typeMetastatic2 (28,6%)2 (28,6%)2 (2,1%)Local/contralateral0 (0,0%)0 (0,0%)2 (2,1%)Deaths0 (0,0%)1 (6,7%)1 (1,0%)BC: breast cancer. HR: hormone receptor. nCT: neoadjuvant chemotherapy. pCR: pathologic complete response. SLN: sentinel lymph node. TN: triple negative. ypN1mic-RD: micrometastatic axillary residual disease. ypN1/N2-RD: high-volume axillary residual disease.
Citation Format: Esmeralda García-Torralba, Maria Esperanza Guirao Garcia, Pilar de la Morena Barrio, Alejandra Ivars Rubio, Elena Garcia Martinez, Elisa Garcia Garre, Gema Marin Zafra, Beatriz Alvarez Abril, Esther Navarro Manzano, Francisco Ayala de la Peña. Prognostic significance of residual micrometastatic axillary involvement with complete pathologic breast response after neoadjuvant chemotherapy for early breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-54.
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García-Torralba E, Ayala de la Peña F, Alvarez-Abril B, de la Morena Barrio P, Rubio AI, Garre EG, Zafra GM, Carmona-Bayonas A, Martinez EG. Abstract PS6-45: Prognostic significance of tumor-infiltrating lymphocytes and neutrophil-to-lymphocyte ratio in patients with breast cancer receivingneoadjuvant chemotherapy. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps6-45] [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: 11/16/2022]
Abstract
Abstract
Introduction and objectives: Tumor infiltrating lymphocytes (TILs) and neutrophil-to-lymphocyte ratio (NLR) play a prognostic role in early stage breast cancer (BC). There is no evidence about the combined effect of both factors. Our objective was to evaluate the integrated clinical significance of TILs and NLR in patients with early BC treated with neoadjuvant therapy. Materials and methods: Retrospective, single-center analysis of a cohort of patients with early BC treated with neoadjuvant chemotherapy between 2001-2010. Pre-treatment TILs (CD3+-TIL count) was evaluated using a tumor tissue microarray. NLR was calculated within one month of cancer diagnosis. TILs (logarithmic transformed) and NLR were analyzed as continuous variables. Survival analysis was performed using multivariable Cox regression models. Results:A total of 121 patients were included. Median age: 56 years. Cancer stage at diagnosis: 16% IIA, 28% IIB, 33% IIIA, 7% IIIB and 16% IIIC. Molecular subtype: 64% hormone receptor(HR)-positive (12% HER2-positive), 11% HER2-positive HR-negative and 22% triple-negative. Pathological complete response (pCR): 16.5%. Median follow-up: 12 years. Pre-treatment TIL analysis was available in 71 patients (59%) and NLR in 101 (83%). There was no correlation between both variables (Spearman's Rho: 0.03, p = 0.98). In the univariate analysis, the NLR showed a negative prognostic value for overall survival (OS) (HR 1.23, 95%CI 1.11-1.36; p <0.001, C-index: 0.64 95%CI 0.52-0.77, p = 0.69). The effect was opposite for TILs (HR: 0.76 95%CI 0.61-0.95, p = 0.02; C-index: 0.69 95%CI 0.57-0.81, p = 0.69). The linear approximation was adequate, and there was no suspicion of non-proportionality of the hazards. In the multivariate analysis, including or not cancer staging after neoadjuvant therapy, NLR remained as an independent variable (HR 1.18, 95%CI 1.04-1.33; p = 0.01) and a statistic trend for TILs was also observed (HR 0.83, 95%CI 0.65-1.07; p = 0.16). Given the limited sample size, the multivariate analysis did not provide clear evidence of an additive effect. Nevertheless, the combined analysis of both parameters showed a better fit with respect to the two variables separately (Akaike Information Criterion for the combined model, for TILs and for NLR: 106, 133 and 214, respectively). Conclusion:The integrated characterization of TILs and NLR identifies different prognostic subgroups in early BC patients receiving neoadjuvant chemotherapy. Future validation of these findings in large, multicenter cohorts might allow treatment optimization by means of new strategies such as immunotherapy.
Citation Format: Esmeralda García-Torralba, Francisco Ayala de la Peña, Beatriz Alvarez-Abril, Pilar de la Morena Barrio, Alejandra Ivars Rubio, Elisa Garcia Garre, Gema Marin Zafra, Alberto Carmona-Bayonas, Elena Garcia Martinez. Prognostic significance of tumor-infiltrating lymphocytes and neutrophil-to-lymphocyte ratio in patients with breast cancer receivingneoadjuvant chemotherapy [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-45.
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Yamazaki T, Kirchmair A, Sato A, Buqué A, Rybstein M, Petroni G, Bloy N, Finotello F, Stafford L, Navarro Manzano E, Ayala de la Peña F, García-Martínez E, Formenti SC, Trajanoski Z, Galluzzi L. Mitochondrial DNA drives abscopal responses to radiation that are inhibited by autophagy. Nat Immunol 2020; 21:1160-1171. [PMID: 32747819 DOI: 10.1038/s41590-020-0751-0] [Citation(s) in RCA: 199] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 06/23/2020] [Indexed: 12/18/2022]
Abstract
Autophagy supports both cellular and organismal homeostasis. However, whether autophagy should be inhibited or activated for cancer therapy remains unclear. Deletion of essential autophagy genes increased the sensitivity of mouse mammary carcinoma cells to radiation therapy in vitro and in vivo (in immunocompetent syngeneic hosts). Autophagy-deficient cells secreted increased amounts of type I interferon (IFN), which could be limited by CGAS or STING knockdown, mitochondrial DNA depletion or mitochondrial outer membrane permeabilization blockage via BCL2 overexpression or BAX deletion. In vivo, irradiated autophagy-incompetent mammary tumors elicited robust immunity, leading to improved control of distant nonirradiated lesions via systemic type I IFN signaling. Finally, a genetic signature of autophagy had negative prognostic value in patients with breast cancer, inversely correlating with mitochondrial abundance, type I IFN signaling and effector immunity. As clinically useful autophagy inhibitors are elusive, our findings suggest that mitochondrial outer membrane permeabilization may represent a valid target for boosting radiation therapy immunogenicity in patients with breast cancer.
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Affiliation(s)
- Takahiro Yamazaki
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Alexander Kirchmair
- Biocenter, Institute of Bioinformatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Ai Sato
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Aitziber Buqué
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Marissa Rybstein
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Giulia Petroni
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Norma Bloy
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Francesca Finotello
- Biocenter, Institute of Bioinformatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Lena Stafford
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Esther Navarro Manzano
- Hematology and Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.,Universidad de Murcia, Murcia, Spain
| | - Francisco Ayala de la Peña
- Hematology and Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.,Universidad de Murcia, Murcia, Spain
| | - Elena García-Martínez
- Hematology and Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.,Universidad Católica San Antonio de Murcia, Guadalupe, Spain
| | - Silvia C Formenti
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, USA.,Sandra and Edward Meyer Cancer Center, New York, NY, USA
| | - Zlatko Trajanoski
- Biocenter, Institute of Bioinformatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Lorenzo Galluzzi
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, USA. .,Sandra and Edward Meyer Cancer Center, New York, NY, USA. .,Caryl and Israel Englander Institute for Precision Medicine, New York, NY, USA. .,Department of Dermatology, Yale University School of Medicine, New Haven, CT, USA. .,Université Paris Descartes/Paris V, Paris, France.
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Luengo-Gil G, García-Martínez E, Chaves-Benito A, Conesa-Zamora P, Navarro-Manzano E, González-Billalabeitia E, García-Garre E, Martínez-Carrasco A, Vicente V, Ayala de la Peña F. Clinical and biological impact of miR-18a expression in breast cancer after neoadjuvant chemotherapy. Cell Oncol (Dordr) 2019; 42:627-644. [DOI: 10.1007/s13402-019-00450-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2019] [Indexed: 12/19/2022] Open
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Otero MJ, Vera R, González-Pérez C, Ayala de la Peña F, Peñuelas Á, Quer N. Recommendations by the Spanish Society of Hospital Pharmacy, the Spanish Society of Oncology Nursing and the Spanish Society of Medical Oncology for the safe management of antineoplastic medication in cancer patients. Farm Hosp 2018; 42:261-268. [PMID: 30381047 DOI: 10.7399/fh.11132] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVE To define recommendations that permit safe management of antineoplastic medication, minimise medication errors and improve the safety of cancer patients undergoing treatment. METHOD By reviewing the literature and consulting the websites of various health organisations and agencies, an expert committee from the Spanish Society of Hospital Pharmacy and the Spanish Society of Medical Oncology defined a set of safe practices covering all stages of providing cancer therapy to patients. The Spanish Society of Oncology Nursing revised and endorsed the final list. RESULTS In total, 68 recommendations arranged in 5 sections were defined. They include issues concerning the training of health professionals, the technological resources needed, treatment planning, informing the patient and his family, the processes of prescribing, preparing, dispensing and administering cancer therapy (orally, parenterally or intrathecally), assessing patient adherence and treatment toxicity. CONCLUSIONS It is essential for healthcare establishments to implement specific measures designed to prevent medication errors, in order to ensure the safety of cancer patients treated with antineoplastic medication.
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Affiliation(s)
- María José Otero
- Instituto para el Uso Seguro de los Medicamentos (ISMP-España), Servicio de Farmacia Hospitalaria, Hospital Universitario de Salamanca, Salamanca.
| | - Ruth Vera
- Servicio de Oncología Médica, Complejo Hospitalario de Navarra, Pamplona.
| | | | | | - Ángeles Peñuelas
- Coordinadora de Enfermería Oncológica, Hospital Universitari Vall d'Hebron, Vall d'Hebron. Instituto de Oncología, Barcelona.
| | - Nuria Quer
- Servicio de Farmacia Hospitalaria, Instituto Catalán de Oncología, Barcelona.
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21
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Luengo-Gil G, Gonzalez-Billalabeitia E, Perez-Henarejos SA, Navarro Manzano E, Chaves-Benito A, Garcia-Martinez E, Garcia-Garre E, Vicente V, Ayala de la Peña F. Angiogenic role of miR-20a in breast cancer. PLoS One 2018; 13:e0194638. [PMID: 29617404 PMCID: PMC5884522 DOI: 10.1371/journal.pone.0194638] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 03/07/2018] [Indexed: 01/02/2023] Open
Abstract
Background Angiogenesis is a key process for tumor progression and a target for treatment. However, the regulation of breast cancer angiogenesis and its relevance for clinical resistance to antiangiogenic drugs is still incompletely understood. Recent developments on the contribution of microRNA to tumor angiogenesis and on the oncogenic effects of miR-17-92, a miRNA cluster, point to their potential role on breast cancer angiogenesis. The aim of this work was to establish the contribution of miR-20a, a member of miR-17-92 cluster, to tumor angiogenesis in patients with invasive breast carcinoma. Methods Tube-formation in vitro assays with conditioned medium from MCF7 and MDA-MB-231 breast cancer cell lines were performed after transfection with miR-20a and anti-miR20a. For clinical validation of the experimental findings, we performed a retrospective analysis of a series of consecutive breast cancer patients (n = 108) treated with neoadjuvant chemotherapy and with a full characterization of their vessel pattern and expression of angiogenic markers in pre-treatment biopsies. Expression of members of the cluster miR-17-92 and of angiogenic markers was determined by RT-qPCR after RNA purification from FFPE samples. Results In vitro angiogenesis assays with endothelial cells and conditioned media from breast cancer cell lines showed that transfection with anti-miR20a in MDA-MB-231 significantly decreased mean mesh size and total mesh area, while transfection with miR-20a in MCF7 cells increased mean mesh size. MiR-20a angiogenic effects were abrogated by treatment with aflibercept, a VEGF trap. These results were supported by clinical data showing that mir-20a expression was higher in tumors with no estrogen receptor or with more extensive nodal involvement (cN2-3). A higher miR-20a expression was associated with higher mean vessel size (p = 0.015) and with an angiogenic pattern consisting in larger vessels, higher VEGFA expression and presence of glomeruloid microvascular proliferations (p<0.001). This association was independent of tumor subtype and VEGFA expression. Conclusions Transfection of breast cancer cells with miR-20a induces vascular changes in endothelial tube-formation assays. Expression of miR-20a in breast invasive carcinomas is associated with a distinctive angiogenic pattern consisting in large vessels, anomalous glomeruloid microvascular proliferations and high VEGFA expression. Our results suggest a role for miR-20a in the regulation of breast cancer angiogenesis, and raise the possibility of its use as an angiogenic biomarker.
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Affiliation(s)
- Gines Luengo-Gil
- Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer y Centro Regional de Hemodonación, Murcia, Spain
- Department of Internal Medicine, University of Murcia, Murcia, Spain
- IMIB-Arrixaca, Murcia, Spain
| | - Enrique Gonzalez-Billalabeitia
- Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer y Centro Regional de Hemodonación, Murcia, Spain
- IMIB-Arrixaca, Murcia, Spain
- Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain
| | - Sergio Alejo Perez-Henarejos
- Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer y Centro Regional de Hemodonación, Murcia, Spain
- IMIB-Arrixaca, Murcia, Spain
| | - Esther Navarro Manzano
- Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer y Centro Regional de Hemodonación, Murcia, Spain
- IMIB-Arrixaca, Murcia, Spain
| | | | - Elena Garcia-Martinez
- Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer y Centro Regional de Hemodonación, Murcia, Spain
- IMIB-Arrixaca, Murcia, Spain
- Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain
| | - Elisa Garcia-Garre
- Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer y Centro Regional de Hemodonación, Murcia, Spain
- IMIB-Arrixaca, Murcia, Spain
| | - Vicente Vicente
- Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer y Centro Regional de Hemodonación, Murcia, Spain
- Department of Internal Medicine, University of Murcia, Murcia, Spain
- IMIB-Arrixaca, Murcia, Spain
| | - Francisco Ayala de la Peña
- Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer y Centro Regional de Hemodonación, Murcia, Spain
- Department of Internal Medicine, University of Murcia, Murcia, Spain
- IMIB-Arrixaca, Murcia, Spain
- * E-mail:
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García-Martínez E, Smith M, Buqué A, Aranda F, de la Peña FA, Ivars A, Cánovas MS, Conesa MAV, Fucikova J, Spisek R, Zitvogel L, Kroemer G, Galluzzi L. Trial Watch: Immunostimulation with recombinant cytokines for cancer therapy. Oncoimmunology 2018; 7:e1433982. [PMID: 29872569 PMCID: PMC5980390 DOI: 10.1080/2162402x.2018.1433982] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 01/24/2018] [Accepted: 01/24/2018] [Indexed: 12/15/2022] Open
Abstract
Cytokines regulate virtually aspects of innate and adaptive immunity, including the initiation, execution and extinction of tumor-targeting immune responses. Over the past three decades, the possibility of using recombinant cytokines as a means to elicit or boost clinically relevant anticancer immune responses has attracted considerable attention. However, only three cytokines have been approved so far by the US Food and Drug Administration and the European Medicines Agency for use in cancer patients, namely, recombinant interleukin (IL)-2 and two variants of recombinant interferon alpha 2 (IFN-α2a and IFN-α2b). Moreover, the use of these cytokines in the clinics is steadily decreasing, mostly as a consequence of: (1) the elevated pleiotropism of IL-2, IFN-α2a and IFN-α2b, resulting in multiple unwarranted effects; and (2) the development of highly effective immunostimulatory therapeutics, such as immune checkpoint blockers. Despite this and other obstacles, research in the field continues as alternative cytokines with restricted effects on specific cell populations are being evaluated. Here, we summarize research preclinical and clinical developments on the use of recombinant cytokines for immunostimulation in cancer patients.
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Affiliation(s)
- Elena García-Martínez
- Hematology and Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Melody Smith
- Department of Medicine and Immunology Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Aitziber Buqué
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Fernando Aranda
- Immunoreceptors of the Innate and Adaptive System, IDIBAPS, Barcelona, Spain
| | | | - Alejandra Ivars
- Hematology and Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Manuel Sanchez Cánovas
- Hematology and Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | | | - Jitka Fucikova
- Sotio, Prague, Czech Republic
- Dept. of Immunology, 2nd Faculty of Medicine and University Hospital Motol, Charles University, Prague, Czech Republic
| | - Radek Spisek
- Sotio, Prague, Czech Republic
- Dept. of Immunology, 2nd Faculty of Medicine and University Hospital Motol, Charles University, Prague, Czech Republic
| | - Laurence Zitvogel
- Gustave Roussy Comprehensive Cancer Institute, Villejuif, France
- INSERM, U1015, Villejuif, France
- Center of Clinical Investigations in Biotherapies of Cancer (CICBT) 1428, Villejuif, France
- Université Paris Sud/Paris XI, Le Kremlin-Bicêtre, France
| | - Guido Kroemer
- Université Paris Descartes/Paris V, France
- Université Pierre et Marie Curie/Paris VI, Paris
- Equipe 11 labellisée Ligue contre le Cancer, Centre de Recherche des Cordeliers, Paris, France
- INSERM, U1138, Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Comprehensive Cancer Institute, Villejuif, France
- Karolinska Institute, Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden
- Pôle de Biologie, Hopitâl Européen George Pompidou, AP-HP, Paris, France
| | - Lorenzo Galluzzi
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, USA
- Université Paris Descartes/Paris V, France
- Sandra and Edward Meyer Cancer Center, New York, NY, USA
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García Garre E, Luengo Gil G, Montoro García S, Gonzalez Billalabeitia E, Zafra Poves M, García Martinez E, Roldán Schilling V, Navarro Manzano E, Ivars Rubio A, Lip GYH, Ayala de la Peña F. Circulating small-sized endothelial microparticles as predictors of clinical outcome after chemotherapy for breast cancer: an exploratory analysis. Breast Cancer Res Treat 2018; 169:83-92. [PMID: 29340882 DOI: 10.1007/s10549-017-4656-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 12/30/2017] [Indexed: 01/22/2023]
Abstract
PURPOSE Therapeutic exploitation of angiogenesis in breast cancer has been limited by the lack of reliable biomarkers. Circulating small-sized endothelial microparticles (sEMP) are likely to play a significant role as messengers of angiogenesis. Higher levels of EMP have been observed in cancer patients, but their prognostic value in breast cancer is unknown. Our aim was to determine the value of circulating sEMP as a marker of response to chemotherapy in breast cancer. METHODS We included patients with breast cancer treated with neoadjuvant or first-line chemotherapy. Baseline and post-treatment circulating sEMP (CD144+) were quantified using a flow cytometer approach specifically designed for analysis of small-sized particles (0.1-0.5 μm). Small-sized EMP response was defined as a post-treatment decrease of sEMP larger than the median decrease of sEMP after chemotherapy. Baseline and post-chemotherapy VEGFA levels were determined with ELISA. RESULTS Forty-four breast cancer patients were included (19 with metastatic and 25 with locally advanced disease). Median levels of sEMP decreased after chemotherapy (P = 0.005). Response to chemotherapy showed a non-significant trend to associate with sEMP response (P = 0.056). A sEMP response was observed in 51% of patients and was associated with better overall survival (HR 0.18; 95% CI 0.04-0.87; P = 0.02) and progression free survival (HR 0.30; 95% CI 0.09-0.99; P = 0.04) in the group of women with metastatic disease. Post-chemotherapy decrease of VEGFA levels was not associated with breast cancer prognosis. CONCLUSIONS Our results did not support sEMP as a marker of response to chemotherapy. However, our exploratory analysis suggests that in patients with metastatic breast cancer, the decrease of sEMP levels after chemotherapy is associated with better overall and disease free survival and might be superior to VEGFA levels as an angiogenesis-related prognostic marker.
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Affiliation(s)
- Elisa García Garre
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Avda. Marqués de los Velez, s/n, 30008, Murcia, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Ginés Luengo Gil
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Avda. Marqués de los Velez, s/n, 30008, Murcia, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.,Universidad de Murcia, Murcia, Spain
| | - Silvia Montoro García
- Universidad Católica San Antonio de Murcia, Guadalupe, Murcia, Spain.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Enrique Gonzalez Billalabeitia
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Avda. Marqués de los Velez, s/n, 30008, Murcia, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.,Universidad Católica San Antonio de Murcia, Guadalupe, Murcia, Spain
| | - Marta Zafra Poves
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Avda. Marqués de los Velez, s/n, 30008, Murcia, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Elena García Martinez
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Avda. Marqués de los Velez, s/n, 30008, Murcia, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.,Universidad Católica San Antonio de Murcia, Guadalupe, Murcia, Spain
| | - Vanessa Roldán Schilling
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Avda. Marqués de los Velez, s/n, 30008, Murcia, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.,Universidad de Murcia, Murcia, Spain
| | - Esther Navarro Manzano
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Avda. Marqués de los Velez, s/n, 30008, Murcia, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.,Universidad de Murcia, Murcia, Spain
| | - Alejandra Ivars Rubio
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Avda. Marqués de los Velez, s/n, 30008, Murcia, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Francisco Ayala de la Peña
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Avda. Marqués de los Velez, s/n, 30008, Murcia, Spain. .,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain. .,Universidad de Murcia, Murcia, Spain.
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24
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González-Martín A, Alba E, Ciruelos E, Cortés J, Llombart A, Lluch A, Andrés R, Álvarez I, Aramendía JM, de la Peña FA, Barnadas A, Batista N, Calvo L, Galve E, García-Palomo A, García-Sáenz JÁ, de la Haba J, López R, López-Vivanco G, Martínez-Jáñez N, de Dueñas EM, Plazaola A, Rodríguez-Lescure Á, Ruiz M, Sánchez-Rovira P, Santaballa A, Seguí MÁ, Tusquets I, Zamora P, Martín M. Nab-Paclitaxel in Metastatic Breast Cancer: Defining the Best Patient Profile. Curr Cancer Drug Targets 2017; 16:415-28. [PMID: 26278712 DOI: 10.2174/1568009615666150817121731] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 05/10/2015] [Accepted: 08/12/2015] [Indexed: 11/22/2022]
Abstract
Around 40% of patients with breast cancer will present with a recurrence of the disease. Chemotherapy is recommended for patients with recurrent hormone-independent or hormone-refractory breast cancer and almost all patients with metastatic breast cancer (MBC) receive chemotherapy during their medical history. Nanoparticle albuminbound (nab)-paclitaxel is a solvent-free, 130-nanometer particle formulation of paclitaxel. Nab-paclitaxel can be administered to all patients for whom the treatment choice is a taxane. In this review, 6 patient profiles for which nabpaclitaxel may be particularly useful are described and analyzed: (i) as first-line treatment of MBC, (ii) as second-line treatment of MBC after oral chemotherapy, (iii) after a standard taxane, (iv) as third-line treatment after a standard taxane and oral chemotherapy, (v) for patients with HER2-positive MBC and (vi) for patients with intolerance to standard taxanes. Nab-paclitaxel is a rational treatment choice for patients with MBC in different settings, as well as for those with prior exposure to a standard taxane.
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Affiliation(s)
- Antonio González-Martín
- Medical Oncology Department, MD Anderson Cancer Center, Madrid, C/ Arturo Soria, 270, 28033 - Madrid. Spain.
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25
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Gonzalez-Billalabeitia E, Castellano D, Sobrevilla N, Guma J, Hervas D, Luengo MI, Aparicio J, Sanchez-Muñoz A, Mellado B, Saenz A, Valverde C, Fernandez A, Margeli M, Duran I, Fernandez S, Sastre J, Ros S, Maroto P, Manneh R, Cerezuela P, Carmona-Bayonas A, Ayala de la Peña F, Luis Aguilar J, Rivera S, García Del Muro X, Germà-Lluch JR. Prognostic Significance of Venous Thromboembolic Events in Disseminated Germ Cell Cancer Patients. J Natl Cancer Inst 2017; 109:2957313. [PMID: 28122896 DOI: 10.1093/jnci/djw265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 08/26/2016] [Accepted: 10/06/2016] [Indexed: 12/29/2022] Open
Abstract
Background Disseminated germ cell cancers are at high risk of developing thromboembolic complications. We evaluated the prognostic value of venous thromboembolic events (VTE) in disseminated germ cell cancer. Methods Patients with germ cell cancer receiving upfront platinum-containing chemotherapy between 2004 and 2014 were pooled from the Spanish Germ Cell Cancer Group (SGCCG) registry and reviewed for the presence of VTE. Results were validated in an independent international group of patients. We used a penalized Cox proportional hazards model including VTE as a time-varying covariate to identify and validate prognostic factors. All statistical tests were two-sided. Results The SGCCG registry identified 416 patients from 14 referral institutions. With a median follow-up of 49 months, VTEs were observed in 9% of patients (n = 38). Events occurred at diagnosis, during chemotherapy, and after chemotherapy in 2.6%, 5.0%, and 1.4% of patients, respectively. VTE was associated with shorter progression-free survival (PFS; hazard ratio [HR] = 2.29, 95% confidence interval [CI] = 1.18 to 4.47, P = .02) and overall survival (OS; HR = 5.14, 95% CI = 2.22 to 11.88, P < .001). In multivariable analysis, the effect was consistent in the intermediate-risk group, both for PFS (HR = 9.52 95% CI = 2.48 to 36.58, P < .001) and OS (HR = 12.84, 95% CI = 2.01 to 82.02, P = .007). VTE at diagnosis is also an adverse prognostic variable for progression-free survival (HR = 4.64, 95% CI = 2.04 to 10.54, P < .001) and for overall survival (HR = 6.28, 95% CI = 1.68 to 17.10, P = .01). These results were validated in an independent international cohort that included 241 patients from four hospitals. Conclusions VTE is an independent adverse prognostic factor in disseminated germ cell cancers, in particular for the intermediate prognostic group of the International Germ Cell Cancer Collaborative Group classification. The presence of VTE at diagnosis has also prognostic significance and should be further explored in future prognostic classifications.
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Affiliation(s)
- Enrique Gonzalez-Billalabeitia
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Daniel Castellano
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Nora Sobrevilla
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Josep Guma
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - David Hervas
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Maria I Luengo
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Jorge Aparicio
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Alfonso Sanchez-Muñoz
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Begoña Mellado
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Alberto Saenz
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Claudia Valverde
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Antonio Fernandez
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Mireia Margeli
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Ignacio Duran
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Sara Fernandez
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Javier Sastre
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Silverio Ros
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Pablo Maroto
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Ray Manneh
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Pablo Cerezuela
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Alberto Carmona-Bayonas
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Francisco Ayala de la Peña
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Jose Luis Aguilar
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Samuel Rivera
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Xavier García Del Muro
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Jose R Germà-Lluch
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
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de la Morena Barrio P, Conesa MÁV, González-Billalabeitia E, Urrego E, García-Garre E, García-Martínez E, Poves MZ, Vicente V, de la Peña FA. Delayed recovery and increased severity of Paclitaxel-induced peripheral neuropathy in patients with diabetes. J Natl Compr Canc Netw 2016; 13:417-23. [PMID: 25870378 DOI: 10.6004/jnccn.2015.0057] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Although diabetes mellitus (DM) is recognized as a risk factor for chemotherapy-induced neurotoxicity, its true impact on intensity and time course of peripheral neuropathy is still unclear. The goal was to analyze the relevance of preexisting DM to weekly paclitaxel-induced peripheral neuropathy (PIPN). METHODS We performed a retrospective case-control study (1:2) including a total of 129 patients with breast cancer (43 with DM and 86 controls) treated with single-agent weekly paclitaxel (wP). RESULTS Compared with controls, patients with DM treated with wP experienced PIPN more frequently (74.4% vs 58.4%; P=.016) and with higher severity (grade 2-3: 51.2% vs 27.7%; P=.014). A significant delay in PIPN resolution was observed in women with DM (P=.001) and, in a multivariate analysis, DM was the only independent predictor for delayed recovery (hazard ratio [HR], 0.16; 95% CI, 0.05-0.55; P=.003). After 2 years, 68.7% of patients with DM (vs 29.2% of women without DM) still experienced PIPN, which was functionally significant (grade 2-3) in 18.2%. CONCLUSIONS Significantly more dose delays and reductions because of PIPN occurred in patients with DM. Preexisting DM associates with long-lasting significant PIPN in patients treated with wP. Benefits and risks of long-term significant PIPN should be carefully balanced in patients with DM before starting wP chemotherapy.
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Affiliation(s)
- Pilar de la Morena Barrio
- From the Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Avda Marques de los Velez, and Centro Regional de Hemodonación, Murcia, Spain
| | - María Ángeles Vicente Conesa
- From the Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Avda Marques de los Velez, and Centro Regional de Hemodonación, Murcia, Spain
| | - Enrique González-Billalabeitia
- From the Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Avda Marques de los Velez, and Centro Regional de Hemodonación, Murcia, Spain
| | - Edgar Urrego
- From the Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Avda Marques de los Velez, and Centro Regional de Hemodonación, Murcia, Spain
| | - Elisa García-Garre
- From the Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Avda Marques de los Velez, and Centro Regional de Hemodonación, Murcia, Spain
| | - Elena García-Martínez
- From the Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Avda Marques de los Velez, and Centro Regional de Hemodonación, Murcia, Spain
| | - Marta Zafra Poves
- From the Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Avda Marques de los Velez, and Centro Regional de Hemodonación, Murcia, Spain
| | - Vicente Vicente
- From the Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Avda Marques de los Velez, and Centro Regional de Hemodonación, Murcia, Spain. From the Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Avda Marques de los Velez, and Centro Regional de Hemodonación, Murcia, Spain
| | - Francisco Ayala de la Peña
- From the Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Avda Marques de los Velez, and Centro Regional de Hemodonación, Murcia, Spain
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Urrego EG, Carmona-Bayonas A, González-Billalabeitia E, Ayala de la Peña F. Should Anticoagulation Therapy Be Withheld in Patients With Active Cancer After 6 Months of Low–Molecular Weight Heparin? J Clin Oncol 2015; 33:1713. [DOI: 10.1200/jco.2014.60.6384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Luengo-Gil G, González-Billalabeitia E, Chaves-Benito A, García Martínez E, García Garre E, Vicente V, Ayala de la Peña F. Effects of conventional neoadjuvant chemotherapy for breast cancer on tumor angiogenesis. Breast Cancer Res Treat 2015; 151:577-87. [PMID: 25967462 DOI: 10.1007/s10549-015-3421-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 05/07/2015] [Indexed: 01/01/2023]
Abstract
The effects of breast cancer conventional chemotherapy on tumor angiogenesis need to be further characterized. Neoadjuvant chemotherapy is an ideal model to evaluate the results of chemotherapy, allowing intra-patient direct comparison of antitumor and antiangiogenic effects. We sought to analyze the effect of neoadjuvant chemotherapy on tumor angiogenesis and its clinical significance in breast cancer. Breast cancer patients (n = 108) treated with neoadjuvant sequential anthracyclines and taxanes were studied. Pre- and post-chemotherapy microvessel density (MVD) and mean vessel size (MVS) were analyzed after CD34 immunohistochemistry and correlated with tumor expression of pro- and antiangiogenic factors (VEGFA, THBS1, HIF1A, CTGF, and PDGFA) by qRT-PCR. Angiogenic measures at diagnosis varied among breast cancer subtypes. Pre-treatment higher MVS was associated with triple-negative subtype and more advanced disease. Higher MVS was correlated with higher VEGFA (p = 0.003), while higher MVD was correlated with lower antiangiogenic factors expression (THBS1, p < 0.0001; CTGF, p = 0.001). Increased angiogenesis at diagnosis (high MVS and glomeruloid microvascular proliferation) and higher VEGFA expression were associated with tumor recurrence (p = 0.048 and 0.009, respectively). Chemotherapy-induced angiogenic response (defined as decreased MVD) was present in 35.2 % of patients. This response correlated with an increase in antiangiogenic factors (THBS1) without changes in VEGFA expression, and it was associated with tumor downstaging, but not with clinical response, pathologic complete response, or prognosis. Global effects of chemotherapy mainly consisted in an increased expression of antiangiogenic factors (THBS1, CTGF), with significant changes neither of tumor VEGFA nor of MVS. Conventionally scheduled neoadjuvant chemotherapy exerts antiangiogenic effects, through an increase in antiangiogenic factors, THBS1 and CTGF, but the expression of VEGFA is maintained after treatment. Better markers of angiogenic response and a better understanding of the cooperation of chemotherapy and antiangiogenic therapy in the neoadjuvant clinical scenario are needed.
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Affiliation(s)
- Ginés Luengo-Gil
- Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Avda. Marqués de los Vélez, s/n, 30008, Murcia, Spain
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Luengo-Gil G, González-Billalabeitia E, González-Conejero R, Chaves-Benito A, García-Martínez E, Soler-Sánchez G, García-Garre E, Velázquez L, Vicente V, Ayala de la Peña F. Abstract P5-09-06: Decrease of tumor F3 expression after neoadjuvant chemotherapy associates to lower survival in breast cancer. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p5-09-06] [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: 11/16/2022]
Abstract
Abstract
Background:
Pathologic complete response (pCR) is the main prognostic factor after neoadjuvant chemotherapy (nCT) for breast cancer (BC). However, in cases without pCR, additional prognostic biomarkers are needed for subsequent prognostic and therapeutic stratification of patients. Tissue factor (F3) is the protease initiator of blood coagulation cascade and is expressed in solid tumors including BC. F3 oncogenic functions derive both from coagulation activation and from its cytoplasmic domain, although they are not well known yet. Prognostic impact of F3 circulating levels and tumor expression seems to be variable, and no studies evaluating F3 expression changes in the residual tumor after nCT are available. Our aim was to evaluate chemotherapy-mediated changes in F3 mRNA levels and their prognostic value in BC treated with nCT.
Methods:
RNA was isolated from FFPE samples of pre- and post-CT tumors. Post-CT F3 levels were analyzed only in patients without primary tumor pCR. Quantification of F3 was performed by RT-qPCR. F3 expression was categorized as no expression or above/below median expression. Change in expression levels (ΔF3), defined as pre-nCT minus post-nCT, was categorized by value of change (positive vs. negative). Association of F3 levels with clinical and pathological characteristics and analysis of paired samples was evaluated with non-parametric tests. Kaplan-Meier curves, log-rank test and Cox proportional hazard regression multivariate models were used for survival analysis. To externally validate our results, we also studied the correlation between F3 and the rest of the set of genes in the TCGA database. The best 150 directly and 150 inversely correlated genes (r >0.3 and <-0.3 respectively) were selected and functional prediction was performed using Genemania software for both groups.
Results:
We included 108 consecutive women with invasive BC, mostly with stages IIB or IIIA-C; Her2+: 25.0%, triple negative: 22.2%. After nCT including anthracyclines and taxanes, pCR rate was 19.4%. nCT significantly increased F3 expression (p<0.000001). Pre-CT F3 levels were not associated with prognostic or predictive variables in our series. Loss or low post-CT F3 levels were associated with poor prognosis only in the univariate analysis. However, a nCT-induced decrease in F3 expression had a negative impact on overall survival in both univariate and multivariate analysis including cN (p=0.001 and 0.013 respectively). Both in our series and in external databases, F3 mRNA levels have an inverse correlation with proliferative genes, and nCT enhances these correlations (pre-CT: MYBL2: r=-0.358, p=0.001; MKI67: r=-0.267, p=0.019; post-CT: MYBL2: r=-0.495, p<0.001; MKI67: r=-0.498, p<0.001). A functional strong inverse correlation between F3 and mitotic functions was also confirmed in TCGA database.
Conclusion:
Our data demonstrate that nCT consistently increases tumor F3 expression. However, those cases with decreased expression of F3 after chemotherapy show poor overall survival rates. Functional analysis in our series and in public databases demonstrate that decreased F3 mRNA expression correlates with an increased mitotic activity, suggesting that low F3 mRNA levels could be a marker of active and resistant to treatment tumors.
Citation Format: Ginés Luengo-Gil, Enrique González-Billalabeitia, Rocío González-Conejero, Asunción Chaves-Benito, Elena García-Martínez, Gloria Soler-Sánchez, Elisa García-Garre, Lorena Velázquez, Vicente Vicente, Francisco Ayala de la Peña. Decrease of tumor F3 expression after neoadjuvant chemotherapy associates to lower survival in breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-09-06.
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Carmona-Bayonas A, Jiménez-Fonseca P, Virizuela Echaburu J, Antonio M, Font C, Biosca M, Ramchandani A, Martínez J, Hernando Cubero J, Espinosa J, Martínez de Castro E, Ghanem I, Beato C, Blasco A, Garrido M, Bonilla Y, Mondéjar R, Arcusa Lanza MÁ, Aragón Manrique I, Manzano A, Sevillano E, Castañón E, Cardona M, Gallardo Martín E, Pérez Armillas Q, Sánchez Lasheras F, Ayala de la Peña F. Prediction of serious complications in patients with seemingly stable febrile neutropenia: validation of the Clinical Index of Stable Febrile Neutropenia in a prospective cohort of patients from the FINITE study. J Clin Oncol 2015; 33:465-71. [PMID: 25559804 DOI: 10.1200/jco.2014.57.2347] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To validate a prognostic score predicting major complications in patients with solid tumors and seemingly stable episodes of febrile neutropenia (FN). The definition of clinical stability implies the absence of organ dysfunction, abnormalities in vital signs, and major infections. PATIENTS AND METHODS We developed the Clinical Index of Stable Febrile Neutropenia (CISNE), with six explanatory variables associated with serious complications: Eastern Cooperative Oncology Group performance status ≥ 2 (2 points), chronic obstructive pulmonary disease (1 point), chronic cardiovascular disease (1 point), mucositis of grade ≥ 2 (National Cancer Institute Common Toxicity Criteria; 1 point), monocytes < 200 per μL (1 point), and stress-induced hyperglycemia (2 points). We integrated these factors into a score ranging from 0 to 8, which classifies patients into three prognostic classes: low (0 points), intermediate (1 to 2 points), and high risk (≥ 3 points). We present a multicenter validation of CISNE. RESULTS We prospectively recruited 1,133 patients with seemingly stable FN from 25 hospitals. Complication rates in the training and validation subsets, respectively, were 1.1% and 1.1% in low-, 6.1% and 6.2% in intermediate-, and 32.5% and 36% in high-risk patients; mortality rates within each class were 0% in low-, 1.6% and 0% in intermediate-, and 4.3% and 3.1% in high-risk patients. Areas under the receiver operating characteristic curves in the validation subset were 0.652 (95% CI, 0.598 to 0.703) for Talcott, 0.721 (95% CI, 0.669 to 0.768) for Multinational Association for Supportive Care in Cancer (MASCC), and 0.868 (95% CI, 0.827 to 0.903) for CISNE (P = .002 for comparison between CISNE and MASCC). CONCLUSION CISNE is a valid model for accurately classifying patients with cancer with seemingly stable FN episodes.
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Affiliation(s)
- Alberto Carmona-Bayonas
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile.
| | - Paula Jiménez-Fonseca
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Juan Virizuela Echaburu
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Maite Antonio
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Carme Font
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Mercè Biosca
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Avinash Ramchandani
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Jerónimo Martínez
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Jorge Hernando Cubero
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Javier Espinosa
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Eva Martínez de Castro
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Ismael Ghanem
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Carmen Beato
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Ana Blasco
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Marcelo Garrido
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Yaiza Bonilla
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Rebeca Mondéjar
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - María Ángeles Arcusa Lanza
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Isabel Aragón Manrique
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Aránzazu Manzano
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Elena Sevillano
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Eduardo Castañón
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Mercé Cardona
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Elena Gallardo Martín
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Quionia Pérez Armillas
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Fernando Sánchez Lasheras
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Francisco Ayala de la Peña
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
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García-Martínez E, Gil GL, Benito AC, González-Billalabeitia E, Conesa MAV, García García T, García-Garre E, Vicente V, Ayala de la Peña F. Tumor-infiltrating immune cell profiles and their change after neoadjuvant chemotherapy predict response and prognosis of breast cancer. Breast Cancer Res 2014; 16:488. [PMID: 25432519 PMCID: PMC4303200 DOI: 10.1186/s13058-014-0488-5] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 11/19/2014] [Indexed: 02/07/2023] Open
Abstract
Introduction Tumor microenvironment immunity is associated with breast cancer outcome. A high lymphocytic infiltration has been associated with response to neoadjuvant chemotherapy, but the contribution to response and prognosis of immune cell subpopulations profiles in both pre-treated and post-treatment residual tumor is still unclear. Methods We analyzed pre- and post-treatment tumor-infiltrating immune cells (CD3, CD4, CD8, CD20, CD68, Foxp3) by immunohistochemistry in a series of 121 breast cancer patients homogeneously treated with neoadjuvant chemotherapy. Immune cell profiles were analyzed and correlated with response and survival. Results We identified three tumor-infiltrating immune cell profiles, which were able to predict pathological complete response (pCR) to neoadjuvant chemotherapy (cluster B: 58%, versus clusters A and C: 7%). A higher infiltration by CD4 lymphocytes was the main factor explaining the occurrence of pCR, and this association was validated in six public genomic datasets. A higher chemotherapy effect on lymphocytic infiltration, including an inversion of CD4/CD8 ratio, was associated with pCR and with better prognosis. Analysis of the immune infiltrate in post-chemotherapy residual tumor identified a profile (cluster Y), mainly characterized by high CD3 and CD68 infiltration, with a worse disease free survival. Conclusions Breast cancer immune cell subpopulation profiles, determined by immunohistochemistry-based computerized analysis, identify groups of patients characterized by high response (in the pre-treatment setting) and poor prognosis (in the post-treatment setting). Further understanding of the mechanisms underlying the distribution of immune cells and their changes after chemotherapy may contribute to the development of new immune-targeted therapies for breast cancer. Electronic supplementary material The online version of this article (doi:10.1186/s13058-014-0488-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elena García-Martínez
- Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Murcia, Spain.
| | - Ginés Luengo Gil
- Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Murcia, Spain.
| | | | | | | | - Teresa García García
- Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Murcia, Spain.
| | - Elisa García-Garre
- Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Murcia, Spain.
| | - Vicente Vicente
- Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Murcia, Spain. .,Centro Regional de Hemodonación, Murcia, Spain.
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Dzhugashvili M, Luengo-Gil G, García T, González-Conejero R, Conesa-Zamora P, Escolar PP, Calvo F, Vicente V, Ayala de la Peña F. Role of genetic polymorphisms in NFKB-mediated inflammatory pathways in response to primary chemoradiation therapy for rectal cancer. Int J Radiat Oncol Biol Phys 2014; 90:595-602. [PMID: 25304949 DOI: 10.1016/j.ijrobp.2014.06.060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 05/20/2014] [Accepted: 06/23/2014] [Indexed: 12/20/2022]
Abstract
PURPOSE To investigate whether polymorphisms of genes related to inflammation are associated with pathologic response (primary endpoint) in patients with rectal cancer treated with primary chemoradiation therapy (PCRT). METHODS AND MATERIALS Genomic DNA of 159 patients with locally advanced rectal cancer treated with PCRT was genotyped for polymorphisms rs28362491 (NFKB1), rs1213266/rs5789 (PTGS1), rs5275 (PTGS2), and rs16944/rs1143627 (IL1B) using TaqMan single nucleotide polymorphism genotyping assays. The association between each genotype and pathologic response (poor response vs complete or partial response) was analyzed using logistic regression models. RESULTS The NFKB1 DEL/DEL genotype was associated with pathologic response (odds ratio [OR], 6.39; 95% confidence interval [CI], 0.78-52.65; P=.03) after PCRT. No statistically significant associations between other polymorphisms and response to PCRT were observed. Patients with the NFKB1 DEL/DEL genotype showed a trend for longer disease-free survival (log-rank test, P=.096) and overall survival (P=.049), which was not significant in a multivariate analysis that included pathologic response. Analysis for 6 polymorphisms showed that patients carrying the haplotype rs28362491-DEL/rs1143627-A/rs1213266-G/rs5789-C/rs5275-A/rs16944-G (13.7% of cases) had a higher response rate to PCRT (OR, 8.86; 95% CI, 1.21-64.98; P=.034) than the reference group (rs28362491-INS/rs1143627-A/rs1213266-G/rs5789-C/rs5275-A/rs16944-G). Clinically significant (grade ≥2) acute organ toxicity was also more frequent in patients with that same haplotype (OR, 4.12; 95% CI, 1.11-15.36; P=.037). CONCLUSIONS Our results suggest that genetic variation in NFKB-related inflammatory pathways might influence sensitivity to primary chemoradiation for rectal cancer. If confirmed, an inflammation-related radiogenetic profile might be used to select patients with rectal cancer for preoperative combined-modality treatment.
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Affiliation(s)
- Maia Dzhugashvili
- Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Murcia, Spain; Department of Radiation Oncology, Madrid Oncology Institute (Group IMO), Murcia, Spain
| | - Ginés Luengo-Gil
- Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Murcia, Spain
| | - Teresa García
- Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Murcia, Spain
| | - Rocío González-Conejero
- Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Murcia, Spain
| | | | - Pedro Pablo Escolar
- Department of Radiation Oncology, University Hospital Santa Lucía, Cartagena, Spain
| | - Felipe Calvo
- Department of Radiation Oncology, University General Hospital Gregorio Marañón, Madrid, Spain
| | - Vicente Vicente
- Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Murcia, Spain
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Cascales A, Pastor-Quirante F, Sánchez-Vega B, Luengo-Gil G, Corral J, Ortuño-Pacheco G, Vicente V, de la Peña FA. Association of anthracycline-related cardiac histological lesions with NADPH oxidase functional polymorphisms. Oncologist 2013; 18:446-53. [PMID: 23576480 DOI: 10.1634/theoncologist.2012-0239] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [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: 11/17/2022] Open
Abstract
OBJECTIVE Treatment with anthracyclines may cause cardiac dysfunction, but the sequence of anthracycline-induced heart lesions has been incompletely characterized. NADPH oxidase, a key mediator of oxidative cardiac damage and remodeling, modulates anthracycline clinical cardiotoxicity. Our aim was to determine which cardiac histological lesions are specifically induced by anthracycline treatment and to investigate the role of NADPH functional genetic polymorphisms in their development. PATIENTS AND METHODS Using a retrospective case-control design, we evaluated cardiac histological lesions and NADPH genotype (polymorphisms rs1883112, rs4673, and rs13058338) in 97 consecutive decedents with a cancer diagnosis (48 treated with anthracyclines). RESULTS Myocytolysis (60%), patched myocardial necrosis (19%), and myocardial fibrosis (diffuse and patched; 62% and 23%, respectively) were associated with anthracycline treatment. In patients receiving anthracyclines, NADPH oxidase polymorphism rs4673 protected against focal myocardial necrosis (odds ratio [OR], 0.11; 95% confidence interval [CI], 0.20-0.63) whereas rs1883112 was strongly associated with cardiac fibrosis (OR, 5.11; 95% CI, 1.59-16.43), which was present in all homozygotes. CONCLUSION Anthracyclines induce a cardiac remodeling pattern characterized by interstitial or patched fibrosis. The contribution of the functionally relevant NADPH polymorphisms rs1883112 and rs4673 to anthracycline-related heart lesions provides a plausible explanation for their modulation of cardiotoxicity. If confirmed, these findings may lead to better individualized strategies for early detection and prevention of anthracycline cardiotoxicity.
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Carmona-Bayonas A, Font C, de la Peña FA. Stress-induced hyperglycemia is a valuable biomarker in febrile neutropenia. Rev Bras Hematol Hemoter 2013; 35:12-4. [PMID: 23580876 PMCID: PMC3621627 DOI: 10.5581/1516-8484.20130006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 11/29/2012] [Indexed: 02/06/2023] Open
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Vicente Conesa MA, Garcia-Martinez E, Gonzalez Billalabeitia E, Chaves Benito A, Garcia Garcia T, Vicente Garcia V, Ayala de la Peña F. Predictive value of peripheral blood lymphocyte count in breast cancer patients treated with primary chemotherapy. Breast 2011; 21:468-74. [PMID: 22119767 DOI: 10.1016/j.breast.2011.11.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 09/21/2011] [Accepted: 11/03/2011] [Indexed: 01/30/2023] Open
Abstract
Peripheral blood lymphocyte (PBL) count may reflect the immune status of cancer patients. We retrospectively analyzed the predictive and prognostic impact of baseline and post-chemotherapy PBL counts in a homogeneous group of 103 breast cancer patients treated with neoadjuvant chemotherapy (anthracyclines and taxanes). In univariate analysis, baseline PBL under 1500 × 10(6)/L (p = 0.013; hazard ratio [HR]: 2.80, 95%CI 1.24-6.61), and PBL decrease >200 × 10(6)/L after the first cycle of chemotherapy (p = 0.047; HR: 2.82, 95%CI 1.01-7.86) were significantly related to disease free survival. In multivariate analysis, both baseline PBL count less than 1500 × 10(6)/L (p = 0.034; HR: 3.32, 95%CI 1.09-10.02) and PBL decrease >200 × 10(6)/L after first cycle (p = 0.032; HR: 3.25, 95%CI 1.10-9.56) showed independent prognostic value for worse disease free survival. No effect was observed for overall survival. Our data support the relevance of pre- and post-chemotherapy PBL for breast cancer recurrence after neoadjuvant chemotherapy.
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Ayala de la Peña F, Kanasaki K, Kanasaki M, Tangirala N, Maeda G, Kalluri R. Loss of p53 and acquisition of angiogenic microRNA profile are insufficient to facilitate progression of bladder urothelial carcinoma in situ to invasive carcinoma. J Biol Chem 2011; 286:20778-87. [PMID: 21388952 DOI: 10.1074/jbc.m110.198069] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Activation of oncogenes or inactivation of tumor suppressors in urothelium is considered critical for development of urothelial cancer. Here we report cloning of the urothelium-specific promoter uroplakin-II (UPK II) and generation of transgenic mice in which expression of SV40 large T antigen is driven by UPK II promoter. Inactivation of tumor suppressor p53 and pRb in urothelium by SV40 T antigen resulted in urothelial carcinoma, resembling human high-grade carcinoma in situ. Specific deletion of p53 in urothelial cells using the newly generated UPK II-Cre mice results in normal bladders without any evidence of cancer. The high-grade carcinoma in situ in the UPK II-SV40 mice is associated with significant activation of angiogenic signals consisting of hypoxia-inducible factor-1α (HIF-1α) and VEGF and a down-regulation of thrombospondin-1. Interestingly, such pro-angiogenic activity was not associated with progression to invasive cancer. Analysis of bladder-associated microRNAs in carcinoma in situ lesions reveals a pro-angiogenic profile, with specific overexpression of miR-18a and miR-19a and down-regulation of miR-107. A group of microRNAs (miRs) identified as associated with invasive human urothelial cancer remained unchanged in this mouse model. Collectively, our results support the notion that activation of angiogenesis and loss of p53 are not sufficient for progression to invasive cancer. Our studies identify a new mouse model for bladder cancer that can be used to study factors that determine progression to an invasive phenotype of bladder cancer.
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Affiliation(s)
- Francisco Ayala de la Peña
- 0Division of Matrix Biology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA
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Cascales A, Sánchez-Vega B, Navarro N, Pastor-Quirante F, Corral J, Vicente V, de la Peña FA. Clinical and genetic determinants of anthracycline-induced cardiac iron accumulation. Int J Cardiol 2010; 154:282-6. [PMID: 20974500 DOI: 10.1016/j.ijcard.2010.09.046] [Citation(s) in RCA: 43] [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: 06/02/2010] [Accepted: 09/23/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND The involvement of iron in anthracycline cardiotoxicity is supported by extensive experimental data, and by the preventive efficacy of dexrazoxane, an iron chelator. However, no clinical evidence of anthracycline-induced cardiac iron accumulation is available and the influence of previous iron overload or of genetic factors in human-induced heart disease is largely unknown. Our aim was to test the hypothesis that anthracyclines increase iron heart concentration and that HFE genotype modulates this iron deposit. METHODS We retrospectively evaluated cardiac events, cardiac iron and HFE genotype in 97 consecutive necropsies from patients with solid and hematological neoplasms. Heart and liver iron concentration was determined by atomic absorption spectroscopy. HFE gene mutations (C282Y and H63D) linked to hereditary hemochromatosis were analyzed by Fluorescence Resonance Energy Transfer (FRET) genotyping. RESULTS Heart iron concentration was increased in cases treated with a cumulative doxorubicin dose greater than 200mg/m(2) (490 vs 240 μg/g; p=0.01), independently of liver iron load or transfusion history. HFE mutated haplotypes 282C/63D (p=0.049) and 282Y/63H (p=0.027) were associated to higher cardiac iron deposits. The haplotype C282Y-Y/H63D-H interacted with anthracyclines for increasing cardiac iron load. In a multivariate linear regression analysis both HFE genotypes and anthracyclines contributed to heart iron concentration (R(2)=0.284). CONCLUSIONS Our data support the occurrence of an HFE-modulated heart iron accumulation in individuals treated with anthracyclines, independently of systemic iron load. If prospectively confirmed, iron-related parameters might be useful as predictive factors for anthracycline cardiotoxicity.
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Affiliation(s)
- Almudena Cascales
- Centro Regional de Hemodonación. Ronda de Garay, s/n. 30003, Murcia, Spain
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Vicente E, Zafra M, Garcia-Martinez E, de la Peña FA. Acute rhabdomyolysis as a complication of paclitaxel-gemcitabine chemotherapy for ovarian cancer. Eur J Obstet Gynecol Reprod Biol 2009; 145:226. [PMID: 19481857 DOI: 10.1016/j.ejogrb.2009.04.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 04/03/2009] [Accepted: 04/27/2009] [Indexed: 11/27/2022]
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