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Arias Ron D, Areses Manrique MC, Mosquera Martínez J, García González J, Afonso Afonso FJ, Lázaro Quintela M, Fernández Núñez N, Azpitarte Raposeiras C, Amenedo Gancedo M, Santomé Couto L, García Campelo MR, Muñoz Iglesias J, Ruiz Bañobre J, Vilchez Simo R, Casal Rubio J, Campos Balea B, Carou Frieiro I, Alonso-Jaudenes Curbera G, Anido Herranz U, García Mata J, Fírvida Pérez JL. Efficacy and safety of Nivolumab in older patients with pretreated lung cancer: A subgroup analysis of the Galician lung cancer group. J Geriatr Oncol 2020; 12:410-415. [PMID: 33357975 DOI: 10.1016/j.jgo.2020.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/14/2020] [Accepted: 11/30/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Nivolumab is an anti PD1 immunotherapy drug approved for advanced Non-Small Cell Lung Cancer (NSCLC) patients who previously received at least one prior line of treatment. Older patients are often not represented in clinical trials and drugs with acceptable safety profiles are necessary. We aim to report the efficacy and safety profile of Nivolumab in the real-world older subgroup of the Galician lung cancer group study. PATIENTS AND METHODS We retrospectively reviewed 188 advanced NSCLC patients treated with at least one prior therapy. We collected data from patients who were ≥70 years old treated with Nivolumab in second or subsequent lines. Patient characteristics, treatment efficacy (overall survival, progression-free survival, and response rate), and safety profile were reported. RESULTS Thirty-eight patients aged ≥70 years were included in the subgroup analysis. The median age was 74.5 years, a high percentage of patients were males (95%), most had a Performance Status of 1 (79%) and only 13% were non-smokers. The predominant histology was adenocarcinoma (53%), and 18% of patients received 2 or more lines. The median Progression-Free Survival was 7.53 months (CI 4.3-17.3, p = 0.15) and the median Overall Survival was 14.85 months (CI 10.5-20.7, p = 0.44). The objective response rate was 42%. No new adverse events were reported in comparison to a global population. CONCLUSIONS The efficacy and safety profile of Nivolumab in advanced NSCLC patients treated with at least one prior therapy and age ≥70 years old can be overlapped to a global population. Further prospective trials are needed to define and confirm these results.
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Affiliation(s)
- David Arias Ron
- Medical Oncology Department, University Hospital Complex of Ourense, Ourense, Spain.
| | | | | | - Jorge García González
- Medical Oncology Department, Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS), Santiago de Compostela 15706, Spain
| | | | | | | | | | | | | | | | - Jose Muñoz Iglesias
- Medical Oncology Department, University Hospital Complex of Ourense, Ourense, Spain
| | - Juan Ruiz Bañobre
- Medical Oncology Department, Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS), Santiago de Compostela 15706, Spain
| | - Rocío Vilchez Simo
- Medical Oncology Department, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | | | - Begoña Campos Balea
- Medical Oncology Department, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Iria Carou Frieiro
- Medical Oncology Department, Complejo Hospitalario de Pontevedra, Pontevedra, Spain
| | | | - Urbano Anido Herranz
- Medical Oncology Department, Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS), Santiago de Compostela 15706, Spain
| | - Jesús García Mata
- Medical Oncology Department, University Hospital Complex of Ourense, Ourense, Spain
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Afonso Afonso FJ, Fernández Núñez N, Vilchez Simo R, Firvida JL, De Dios Alvarez N, Campos Balea B, Ruiz Bañobre J, Areses Manrique MC, Agraso Busto S, Carmona Campos M, De Paz Árias LM, Cameselle Garcia S, Pereiro Corbacho D, Vázquez Estévez S, García Mata J, Casal Rubio J, Constenla M. Third and successive–lines of chemotherapy in NSCLC patients without therapeutic targets: Experience of the Grupo Gallego de Cáncer de Pulmón. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e20579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20579 Background: The current treatment of advanced non-small cell lung cancer (NSCLC) is conditioned by the presence of molecular and immunohistochemical biomarkers. In the absence of these, the therapeutic option is the use of chemotherapy with or without antiangiogenic agents. The efficacy of non-target systemic treatments is not proven, beyond a second-line and the experiences in their use are limited to retrospective analyzes. We present the experience of the Grupo Gallego de Cáncer de Pulmón in patients with advanced NSCLC treated exclusively with three or more lines of chemotherapy. Methods: Retrospective analysis of patients with advanced NSCLC, treated with three or more lines of chemotherapy in standard regimen, with or without antiangiogenic agents, in Galicia´s hospitals, Spain. Results: We included 168 patients (134 male and 34 female) treated with three or more chemotherapy lines, with a median age at the time of receiving the first-line, of 60.84 years (41-83). Of these, 51 (30,35%) received a fourth-line and 18 (10,74%) a fifth-line of treatment. None received antitarget therapy or immunotherapy. The median overall survival (OS) was 18.1 months. The median OS after the third line was 6.1 months, with 73% of patients alive at three months and 44% six months after the start of that therapeutic line. We did not appreciate differences in OS between those who received three lines and those who received the largest number of subsequent treatments. Our multivariate analysis (age, gender, histology, performance status at initiation of each teatment-line, response to previous treatments) identified that the individuals who benefited the most were those under the age of 60 years, PS-ECOG 0-1 at diagnosis and those with a more durable response to the first-line. Conclusions: The third-line of chemotherapy can benefit those patients with advanced NSCLC, under 60 years of age at the time of diagnosis, with good performance status and with long-lasting responses to the first line of treatment. We did not see benefit in adding fourth or fifth-line of chemotherapy. All data will be presented in the 2019 ASCO annual meeting.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Manuel Constenla
- Servicio de Oncología Médica, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
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Areses Manrique MC, Mosquera Martínez J, García González J, Afonso Afonso FJ, Lázaro Quintela M, Fernández Núñez N, Azpitarte Raposeiras C, Amenedo Gancedo M, Santomé Couto L, García Campelo MR, Muñoz Iglesias J, Cortegoso Mosquera A, Vilchez Simo R, Casal Rubio J, Campos Balea B, Carou Frieiro I, Alonso-Jaudenes Curbera G, Anido Herranz U, García Mata J, Fírvida Pérez JL. Real world data of nivolumab for previously treated non-small cell lung cancer patients: a Galician lung cancer group clinical experience. Transl Lung Cancer Res 2018; 7:404-415. [PMID: 30050778 DOI: 10.21037/tlcr.2018.04.03] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Recently, immunotherapy has changed the standard of treatment in non-small cell lung cancer (NSCLC). Outside clinical trials, data of real life is lacking. This is an observational study that represents the real world experience with nivolumab in pretreated NSCLC. Methods Eligibility criteria included, histologically confirmed NSCLC, stage IIIB and IV, evaluable disease and at least one prior therapy. Patients received nivolumab until progressive disease (PD) or unacceptable toxicity. The main aim of the study was to report the efficacy and safety profile of Nivolumab in pretreated patients with advanced NSCLC of our everyday clinical practice. The secondary aim was to perform subgroup analysis by clinical features. Results From August of 2015 to January of 2017, 188 patients were enrolled. The patients demographics were: median age 58 years, 144 male; 17 never smoker and 171 former/current smoker; 112 adenocarcinoma, 66 squamous-cell carcinoma and 10 not otherwise specified (NOS); 61 stage IIIB and 127 stage IV; 15 performance status (PS) 0, 154 PS 1 and 19 PS 2; 5 epidermal growth factor receptor (EGFR) and 1 anaplastic lymphoma kinase (ALK); 42 with central nervous system (CNS) metastases; and 71 received 2 or more prior therapy lines. Of the 188 patients enrolled, 25 (13.3%) were not evaluated, 3 (1.6%) had complete response (CR), 45 (23.9%) partial response (PR), 48 (25.5%) disease stabilization (DS) and 67 (35.6%) PD. The median of progression-free survival (PFS) was 4.83 months (95% CI, 3.6-5.9) and overall survival (OS) was 12.85 months (95% CI, 9.07-16.62). The subgroup analysis revealed statistical significance in OS for patients with CNS metastases 14.8 months (95% CI, 11.5-17.3) vs. 5.09 months (95% CI, 0.3-9.8) and also PS 0 [not reached (NR)] vs. PS 1 11.7 months vs. PS 2 3.4 months (95% CI, 2.3-4.4). The safety profile was in accordance with the literature data. Conclusions This study represents the real word experience with nivolumab and the results are consistent with previously reported in clinical trials. PS 2 and the presence of CNS metastases are associated with poor prognosis.
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Affiliation(s)
| | | | - Jorge García González
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Urbano Anido Herranz
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
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Vázquez S, Casal J, Afonso Afonso FJ, Fírvida JL, Santomé L, Barón F, Lázaro M, Pena C, Amenedo M, Abdulkader I, González-Arenas C, Fachal L, Vega A. EGFR testing and clinical management of advanced NSCLC: a Galician Lung Cancer Group study (GGCP 048-10). Cancer Manag Res 2016; 8:11-20. [PMID: 26893581 PMCID: PMC4745839 DOI: 10.2147/cmar.s85173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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] [Indexed: 11/26/2022] Open
Abstract
Purpose This study aimed to assess the incidence of mutations in the epidermal growth factor receptor (EGFR) gene in non-small-cell lung cancer (NSCLC) patients in the Galician region of Spain and the clinical management and outcome of patients carrying EGFR mutations. Patients and methods All newly diagnosed advanced or metastatic NSCLC patients were screened for EGFR mutations in matched tumor samples (tissue or cytology specimens) and serum samples. Results Of 198 patients screened for EGFR mutations in tumor samples, 184 had evaluable data and, of these, 25 (13.6%) had EGFR mutations (84% sensitizing mutations). EGFR mutation was found in serum in 14 (8.1%) patients (of 174 evaluable). Compared to matched tumor tissue, serum EGFR mutation testing specificity and sensitivity were 99% and 52%, respectively. All but two patients received gefitinib. Median progression-free survival and overall survival were 10 (95% confidence interval: 4.8–15.3) months and 17.8 (95% confidence interval: 13.9–21.6) months, respectively, in patients carrying sensitizing mutations. Conclusion The incidence of EGFR mutations in Galicia is consistent with previous data in Spain. Our results also support the feasibility of EGFR testing to guide treatment decision making using tumor tissue or cytology samples, or serum samples if tumor specimens are unavailable. These findings also confirm that first-line gefitinib is an active treatment option in Caucasians with EGFR mutation-positive NSCLC.
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Affiliation(s)
- Sergio Vázquez
- Medical Oncology Department, Lucus Augusti University Hospital, Lugo, Spain
| | - Joaquín Casal
- Medical Oncology Department, University Hospital Complex of Vigo, Pontevedra, Spain
| | | | - José Luis Fírvida
- Medical Oncology Department, University Hospital Complex of Ourense, Ourense, Spain
| | - Lucía Santomé
- Medical Oncology Department Povisa Hospital, Vigo, Spain
| | - Francisco Barón
- Medical Oncology Department, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Martín Lázaro
- Medical Oncology Department, Hospital Complex of Pontevedra, Pontevedra, Spain
| | - Carolina Pena
- Medical Oncology Department, Hospital Complex of Pontevedra, Pontevedra, Spain
| | - Margarita Amenedo
- Medical Oncology Department, Oncology Center of Galicia, A Coruña, Spain
| | - Ihab Abdulkader
- Anatomical Pathology Department, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Laura Fachal
- Galician Public Foundation of Genomic Medicine-SERGAS, Santiago de Compostela Clinic Hospital, Santiago de Compostela, Spain
| | - Ana Vega
- Galician Public Foundation of Genomic Medicine-SERGAS, Santiago de Compostela Clinic Hospital, Santiago de Compostela, Spain
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Quintela ML, Mateos LL, Estévez SV, Calvo OF, Herranz UA, Afonso FJA, Santomé L, Aparicio LA. Enzalutamide: a new prostate cancer targeted therapy against the androgen receptor. Cancer Treat Rev 2015; 41:247-53. [PMID: 25638257 DOI: 10.1016/j.ctrv.2014.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 09/22/2014] [Revised: 12/11/2014] [Accepted: 12/12/2014] [Indexed: 10/24/2022]
Abstract
Enzalutamide (MDV3100), an androgen receptor-signalling inhibitor, represents the most recent compound added to the therapeutic armamentarium for the treatment of metastatic castration-resistant prostate cancer (mCRPC) who progressed to docetaxel. The anti-tumour activity and safety of enzalutamide has been demonstrated in a phase III clinical trial, showing a benefit in overall survival, which was the primary endpoint. There are no head-to-head studies comparing the different treatment options in this subset of patients. In this article, most relevant data published in the literature have been reviewed, with special attention to the therapeutic alternatives currently available for postdocexatel mCRPC patients, emphasising the mechanisms of action of the different drugs, efficacy and quality of life-related aspects.
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Affiliation(s)
- Martín Lázaro Quintela
- Oncología Médica, Complexo Hospitalario Universitario de Vigo, C/Pizarro 22, 36204 Vigo, Spain.
| | - Luis León Mateos
- Servicio de Oncología Médica, Complexo Hospitalario Universitario de Pontevedra, Spain.
| | - Sergio Vázquez Estévez
- Servicio de Oncología Médica, Hospital Universitario Lucus Augusti, C/Doutor Ulises Romero, s/n, 27003 Lugo, Spain.
| | - Ovidio Fernández Calvo
- Servicio Oncologia Medica, Complejo Hospitalario Universitario Ourense, C/Ramón Puga 54.32005, Spain.
| | - Urbano Anido Herranz
- Oncología Médica, Complejo Hospitalario Universitario de Santiago de Compostela, c/Choupana s/n, 15706 Santiago de Compostela, A Coruña, Spain.
| | | | - Lucía Santomé
- Servicio de Oncología Médica, Hospital Povisa, C/Salamanca 5, 36211 Vigo, Spain.
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Anido Herranz U, Fernández Calvo O, Afonso Afonso FJ, Rodríguez Martínez de Llano S, Lázaro Quintela M, León Mateos L, Vázquez Estévez S, Antón Aparicio LM. Radium-223 dichloride: a new paradigm in the treatment of prostate cancer. Expert Rev Anticancer Ther 2015; 15:339-48. [PMID: 25555355 DOI: 10.1586/14737140.2015.999045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Radionuclides have been widely used for cancer treatment. Recently, new research about radium-223 dichloride has been conducted in prostate cancer, which reveals that it is the first radiopharmaceutical to demonstrate an improvement in overall survival and time to first symptomatic skeletal event in patients with castration resistant prostate cancer with symptomatic bone metastases. This fact has created a new paradigm in the treatment of prostate cancer landscape, where only chemotherapy and hormone therapy had a role, while β-emitters had been confined exclusively to the role of pain relief with no impact on survival. The aim of this review is to outline current treatment approaches for advanced prostate cancer with a focus on the role of radium-223 dichloride, reviewing patients' profile that make them suitable to therapy and chances for further studies.
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Affiliation(s)
- Urbano Anido Herranz
- Medical Oncology Department, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela 15706, Spain
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Alvarez Díaz H, Aznar MU, Afonso Afonso FJ. Bone lesions simulating multiple myeloma: unusual presentation of esophageal cancer. Eur J Intern Med 2009; 20:e14. [PMID: 19237067 DOI: 10.1016/j.ejim.2008.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Revised: 05/24/2008] [Accepted: 07/07/2008] [Indexed: 12/26/2022]
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