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Conte B, Brasó-Maristany F, Hernández AR, Pascual T, Villacampa G, Schettini F, Vidal Losada MJ, Seguí E, Angelats L, Garcia-Fructuoso I, Gómez-Bravo R, Lorman-Carbó N, Paré L, Marín-Aguilera M, Martínez-Sáez O, Adamo B, Sanfeliu E, Fratini B, Falato C, Chic N, Vivancos A, Villagrasa P, Staaf J, Parker JS, Perou CM, Prat A. A 14-gene B-cell immune signature in early-stage triple-negative breast cancer (TNBC): a pooled analysis of seven studies. EBioMedicine 2024; 102:105043. [PMID: 38447275 PMCID: PMC10924177 DOI: 10.1016/j.ebiom.2024.105043] [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: 09/09/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Early-stage triple-negative breast cancer (TNBC) displays clinical and biological diversity. From a biological standpoint, immune infiltration plays a crucial role in TNBC prognosis. Currently, there is a lack of genomic tools aiding in treatment decisions for TNBC. This study aims to assess the effectiveness of a B-cell/immunoglobulin signature (IGG) alone, or in combination with tumor burden, in predicting prognosis and treatment response in patients with TNBC. METHODS Genomic and clinical data were retrieved from 7 cohorts: SCAN-B (N = 874), BrighTNess (n = 482), CALGB-40603 (n = 389), METABRIC (n = 267), TCGA (n = 118), GSE58812 (n = 107), GSE21653 (n = 67). IGG and a risk score integrating IGG with tumor/nodal staging (IGG-Clin) were assessed for event-free survival (EFS) and overall survival (OS) in each cohort. Random effects model was used to derive pooled effect sizes. Association of IGG with pathological complete response (pCR) was assessed in CALGB-40603 and BrighTNess. Immune significance of IGG was estimated through CIBERSORTx and EcoTyper. FINDINGS IGG was associated with improved EFS (pooled HR = 0.77, [95% CI = 0.70-0.85], I2 = 18%) and OS (pooled HR = 0.79, [0.73-0.85], I2 = 0%) across cohorts, and was predictive of pCR in CALGB-40603 (OR 1.25, [1.10-1.50]) and BrighTNess (OR 1.57 [1.25-1.98]). IGG-Clin was predictive of recurrence (pooled HR = 2.11, [1.75-2.55], I2 = 0%) and death (pooled HR = 1.99, 95% [0.84-4.73], I2 = 79%) across cohorts. IGG was associated with adaptive immune response at CIBERSORTx and EcoTyper analysis. INTERPRETATION IGG is linked to improved prognosis and pCR in early-stage TNBC. The integration of IGG alongside tumor and nodal staging holds promise as an approach to identify patients benefitting from intensified or de-intensified treatments. FUNDING This study received funding from: Associació Beca Marta Santamaria, European Union's Horizon 2020 research and innovation and Marie Skłodowska-Curie Actions programs, Fundación FERO, Fundación CRIS contra el cáncer, Agència de Gestó d'Ajuts Universitaris i de Recerca, Instituto de Salud Carlos III, Fundación Contigo, Asociación Cáncer de Mama Metastásico IV, Breast Cancer Research Foundation, RESCUER, Fundación científica AECC and FSEOM.
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Affiliation(s)
- Benedetta Conte
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Cancer Institute and Blood Diseases, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Fara Brasó-Maristany
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Cancer Institute and Blood Diseases, Hospital Clinic de Barcelona, Barcelona, Spain; Reveal Genomics, Barcelona, Spain
| | - Adela Rodríguez Hernández
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Cancer Institute and Blood Diseases, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Tomás Pascual
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Cancer Institute and Blood Diseases, Hospital Clinic de Barcelona, Barcelona, Spain; SOLTI Cooperative Group, Barcelona, Spain
| | - Guillermo Villacampa
- Reveal Genomics, Barcelona, Spain; SOLTI Cooperative Group, Barcelona, Spain; Oncology Data Science, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Francesco Schettini
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Cancer Institute and Blood Diseases, Hospital Clinic de Barcelona, Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Maria J Vidal Losada
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Cancer Institute and Blood Diseases, Hospital Clinic de Barcelona, Barcelona, Spain; SOLTI Cooperative Group, Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain; Institute of Oncology (IOB)-Hospital QuirónSalud, Barcelona, Spain
| | - Elia Seguí
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Cancer Institute and Blood Diseases, Hospital Clinic de Barcelona, Barcelona, Spain; SOLTI Cooperative Group, Barcelona, Spain
| | - Laura Angelats
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Cancer Institute and Blood Diseases, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Isabel Garcia-Fructuoso
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Cancer Institute and Blood Diseases, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Raquel Gómez-Bravo
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Cancer Institute and Blood Diseases, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Natàlia Lorman-Carbó
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | | | - Olga Martínez-Sáez
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Cancer Institute and Blood Diseases, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Barbara Adamo
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Cancer Institute and Blood Diseases, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Esther Sanfeliu
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Pathology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Beatrice Fratini
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Claudette Falato
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; SOLTI Cooperative Group, Barcelona, Spain
| | - Núria Chic
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Cancer Institute and Blood Diseases, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Ana Vivancos
- Reveal Genomics, Barcelona, Spain; Vall d'Hebron Institute of Oncology (VHIO), Cancer Genomics Group, Barcelona, Spain
| | | | - Johan Staaf
- Division of Translational Cancer Research, Department of Laboratory Medicine, Lund University, Sweden
| | - Joel S Parker
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - Charles M Perou
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Aleix Prat
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Cancer Institute and Blood Diseases, Hospital Clinic de Barcelona, Barcelona, Spain; Reveal Genomics, Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain; Institute of Oncology (IOB)-Hospital QuirónSalud, Barcelona, Spain.
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Schettini F, Martínez-Sáez O, Falato C, De Santo I, Conte B, Garcia-Fructuoso I, Gomez-Bravo R, Seguí E, Chic N, Brasó-Maristany F, Paré L, Vidal M, Adamo B, Muñoz M, Pascual T, Ciruelos E, Perou CM, Carey LA, Prat A. Prognostic value of intrinsic subtypes in hormone-receptor-positive metastatic breast cancer: systematic review and meta-analysis. ESMO Open 2023; 8:101214. [PMID: 37075698 PMCID: PMC10373919 DOI: 10.1016/j.esmoop.2023.101214] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND In hormone receptor-positive (HoR+) breast cancer (BC), gene expression analysis identifies luminal A (LumA), luminal B (LumB), human epidermal growth factor receptor 2 (HER2)-enriched (HER2-E), basal-like (BL) intrinsic subtypes and a normal-like group. This classification has an established prognostic value in early-stage HoR+ BC. Here, we carried out a trial-level meta-analysis to determine the prognostic ability of subtypes in metastatic BC (MBC). MATERIALS AND METHODS We systematically reviewed all the available prospective phase II/III trials in HoR+ MBC where subtype was assessed. The primary endpoint was progression-free survival (PFS)/time to progression (TTP) of the LumA subtype compared to non-LumA. Secondary endpoints were PFS/TTP of each individual subtype, according to treatment, menopausal and HER2 status and overall survival (OS). The random-effect model was applied, and heterogeneity assessed through Cochran's Q and I2. Threshold for significance was set at P < 0.05. The study was registered in PROSPERO (ID: CRD42021255769). RESULTS Seven studies were included (2536 patients). Non-LumA represented 55.2% and was associated with worse PFS/TTP than LumA [hazard ratio (HR) 1.77, P < 0.001, I2 = 61%], independently of clinical HER2 status [Psubgroup difference (Psub) = 0.16], systemic treatment (Psub = 0.96) and menopausal status (Psub = 0.12). Non-LumA tumors also showed worse OS (HR 2.00, P < 0.001, I2 = 65%), with significantly different outcomes for LumB (PFS/TTP HR 1.46; OS HR 1.41), HER2-E (PFS/TTP HR 2.39; OS HR 2.08) and BL (PFS/TTP HR 2.67; OS HR 3.26), separately (PFS/TTP Psub = 0.01; OS Psub = 0.005). Sensitivity analyses supported the main result. No publication bias was observed. CONCLUSIONS In HoR+ MBC, non-LumA disease is associated with poorer PFS/TTP and OS than LumA, independently of HER2, treatment and menopausal status. Future trials in HoR+ MBC should consider this clinically relevant biological classification.
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Affiliation(s)
- F Schettini
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona; Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Facultat de Medicina i Ciéncies de la Salut, Universitat de Barcelona, Barcelona, Spain.
| | - O Martínez-Sáez
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona; Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Facultat de Medicina i Ciéncies de la Salut, Universitat de Barcelona, Barcelona, Spain; Breast Oncology Program, Dana-Farber Cancer Institute, Boston, USA
| | - C Falato
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; SOLTI Breast Cancer Research Group, Barcelona, Spain; Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | - I De Santo
- Medical Oncology Unit, San Carlo Hospital, Potenza, Italy
| | - B Conte
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona; Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona
| | - I Garcia-Fructuoso
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona; Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona
| | - R Gomez-Bravo
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona
| | - E Seguí
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona; Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - N Chic
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - F Brasó-Maristany
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona
| | - L Paré
- Reveal Genomics, Barcelona
| | - M Vidal
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona; Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Facultat de Medicina i Ciéncies de la Salut, Universitat de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - B Adamo
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona; Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona
| | - M Muñoz
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona; Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Facultat de Medicina i Ciéncies de la Salut, Universitat de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - T Pascual
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona; Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - E Ciruelos
- SOLTI Breast Cancer Research Group, Barcelona, Spain; Medical Oncology Department, Hospital 12 de Octubre, Madrid, Spain
| | - C M Perou
- UNC Lineberger Comprehensive Cancer Center, UNC Chapel Hill, Chapel Hill; Departments of Genetics, UNC Chapel Hill, Chapel Hill, USA
| | - L A Carey
- UNC Lineberger Comprehensive Cancer Center, UNC Chapel Hill, Chapel Hill; Departments of Medicine, UNC Chapel Hill, Chapel Hill, USA
| | - A Prat
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona; Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Facultat de Medicina i Ciéncies de la Salut, Universitat de Barcelona, Barcelona, Spain; Reveal Genomics, Barcelona; Institute of Oncology (IOB)-Hospital Quirónsalud, Barcelona, Spain.
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Muñoz-Carrillo FJ, Paré L, Conte B, Rodríguez A, Galván P, Sanfeliu E, González-Farré B, Falato C, Garcia-Fructuoso I, Adamo B, Chic N, Martínez-Sáez O, Pascual T, Moreno R, Muñoz M, Brasó-Maristany F, Prat A, Schettini F, Vidal M. Abstract P2-23-16: Clinico-Pathological and Molecular Characterization of HER2-Enriched Breast Tumors Independently of HER2 Status. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p2-23-16] [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: Breast cancer (BC) is a highly prevalent and heterogeneous disease, entailing different so-called intrinsic subtypes (IS) according to gene expression, namely Luminal A, Luminal B, HER2-Enriched (HER2E) and Basal-like, as well as a normal breast-like group. The HER2E is still a poorly understood entity, which needs further biologic characterization to improve therapeutic management.
MATERIAL AND METHODS: Patients (pts) treated at Hospital Clinic (Barcelona, Spain) over 18 years with a diagnosis of metastatic BC, with available matched primary and metastatic tumor samples for gene expression analyses were retrospectively recruited. Using the nCounter® Breast Cancer 360 panel, we studied the expression of 776 genes pertaining to different tumor and immune pathway-related signatures, with a focus on HER2E vs. non-HER2E tumors. Significant changes were considered at a false discovery rate (FDR) < 5%. Main clinicopathological features were also compared. IS changes from primary to metastatic disease were assessed.
RESULTS: Ninety-one pts with paired tumor samples were included. Briefly, primary tumors were 67.0% hormone receptor-positive (HR+)/HER2-negative (HER2-), 14.8% were HER2-positive (HER2+) and 18.2% were triple-negative (TNBC). IS distribution in primary tumors was the following: 25 Luminal A (28%), 22 Luminal B (24%), 24 HER2E (26%), 12 Basal-like (13%), and 8 Normal-like (9%). In contrast, IS distribution in metastatic tumors was the following: 13 Luminal A (14%), 22 Luminal B (24%), 34 HER2-E (37%), 16 Basal-like (18%), and 6 Normal-like (7%). The HER2E disease proved to be a relatively stable subtype, with 16 (66.7%) tumors not changing IS in the transition to metastatic disease (p=0.078). Particularly, within HR+/HER2-, HER2+ and TNBC, 8/12 (66.7%), 8/10 (80.0%) and 1/2 (50.0%) tumors remained HER2E. Conversely, an overall significant switch from Luminal to non-Luminal tumors at the metastatic progression was observed (p=0.031), with 14/19 (73.7%) new non-Luminal BC being HER2E. When considering all primary and metastatic tumors, HER2E were observed to be less frequently estrogen receptor (ER) positive than non-HER2E tumors (55.8% vs. 78.7%; p=0.002), with lower mean progesterone receptor (PR) levels (15.3% vs. 25.8%; p=0.027). Compared to the other subtypes (as a group), the PAM50 risk of recurrence score (ROR-P) was higher for HER2E tumors (59.1 vs. 41.7; p < 0.001), which were also more frequently HER2+ (36.5% vs. 5.8%) and less likely HR+/HER2- (50.0% vs. 73.6%) and TNBC (13.5% vs. 20.7%), compared to non-HER2E (p < 0.001). No significant differences in grade, TILs, Ki67 and histotype were observed. Overall, 140/776 genes were significantly downregulated in HER2E vs. non-HER2E tumors, including genes related to cell adhesion, migration, DNA damage repair, apoptosis, estrogen signalling pathway, senescence. Conversely, 178/776 genes were significantly upregulated, including the tyrosine-kinase receptor FGFR4, genes involved in nuclear activity, DNA transcription regulation, MAP-kinase signaling pathways, proliferation, cytokine response, epithelial-to-mesenchymal transition (EMT), cell cycle progression, and immune-related genes such as CD274 (PD-L1 gene).
DISCUSSION: A switch towards more aggressive IS from primary to advanced disease was observed, with an increase in HER2E prevalence. HER2E tumors, which tend to maintain their IS at the metastatic disease, showed upregulation of genes related to proliferation, survival and EMT, coherently with their well-known worse prognosis. FGFR4 and CD274 upregulation, along with downregulation of genes involved in DNA damage repair suggest these tumors might benefit from targeted therapeutic approaches. Genomic higher risk was not convoyed by consistent clinicopathological features, except for lower PR levels and HER2 overexpression at IHC. Further characterization according to primary/metastatic and HR status is ongoing.
Intrinsic subtype distribution across primary and metastatic breast tumors
Citation Format: Francisco Javier Muñoz-Carrillo, Laia Paré, Benedetta Conte, Adela Rodríguez, Patricia Galván, Esther Sanfeliu, Blanca González-Farré, Claudette Falato, Isabel Garcia-Fructuoso, Barbara Adamo, Nuria Chic, Olga Martínez-Sáez, Tomás Pascual, Reinaldo Moreno, Montserrat Muñoz, Fara Brasó-Maristany, Aleix Prat, Francesco Schettini, Maria Vidal. Clinico-Pathological and Molecular Characterization of HER2-Enriched Breast Tumors Independently of HER2 Status [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 P2-23-16.
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Affiliation(s)
| | - Laia Paré
- 2Reveal Genomics, Barcelona, Catalonia, Spain
| | - Benedetta Conte
- 3Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Adela Rodríguez
- 4Medical Oncology Department, Hospital Clínic of Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain
| | - Patricia Galván
- 5Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute, Barcelona, Catalonia, Spain
| | - Esther Sanfeliu
- 6SOLTI Breast Cancer Research Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Faculty of Medicine and Pathology Department, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - Blanca González-Farré
- 7Pathology Department, Hospital Clínic of Barcelona, Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Claudette Falato
- 8Reveal Genomics, Barcelona, Spain; SOLTI cooperative group, Barcelona; Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | | | - Barbara Adamo
- 10Medical Oncology Department, Hospital Clínic de Barcelona; Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute, Barcelona, Catalonia, Spain
| | - Nuria Chic
- 11Hospital Clínic of Barcelona, Barcelona, Spain; August Pi I Sunyer Biomedical Research Institute, Barcelona, Catalonia, Spain
| | - Olga Martínez-Sáez
- 12Medical Oncology Department, Hospital Clínic of Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Tomás Pascual
- 13Medical Oncology Department, Hospital Clínic of Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Catalonia, Spain
| | - Reinaldo Moreno
- 14Medical Oncology Department, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Montserrat Muñoz
- 15SOLTI Breast Cancer Research Group, Hospital Clínic of Barcelona, Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain
| | - Fara Brasó-Maristany
- 16Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS)
| | | | - Francesco Schettini
- 18Medical Oncology Department, Hospital Clínic of Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Maria Vidal
- 19Medical Oncology Department, Hospital Clínic of Barcelona; Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain; SOLTI Breast Cancer Research Group; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain
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Abstract
PURPOSE OF REVIEW Oral SERDs are under extensive development to overcome fulvestrant main limitations, including intramuscular-only formulation and poor performance in early-stage hormone receptor-positive (HR+)/HER2-negative breast cancer. This review summarizes the most relevant evidence published so far and envisions the potential integration of oral SERDs in the therapeutic algorithm of HR+/HER2-negative metastatic breast cancer (MBC). RECENT FINDINGS Amcenestrant and giredestrant, two of the most promising oral SERDs, recently failed to show a significant improvement in progression-free survival (PFS) in pivotal trials. Conversely, elacestrant demonstrated significant PFS superiority over standard-of-care endocrine therapy (aromatase inhibitors or fulvestrant) in MBC. Additionally, it did not show unusual side effects observed with other oral SERDs, like bradycardia, hematotoxicity and vision impairment, and proved to be effective also in case of ESR1 -mutant endocrine-resistant breast cancer. Combination trials of oral SERDs with target agents, such as CDK4/6-inhibitors, are ongoing. Finally, some window-of-opportunity trials showed promising on-target activity in early-stage for this drug class. SUMMARY Promising results from early-phase trials are not translating into sufficient clinical benefit in pivotal trials of main oral SERDs in monotherapy, except for elacestrant. Whether oral SERDs might become the backbone for combination strategies in MBC or the preferred (neo)adjuvant endocrine agents is under evaluation.
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Affiliation(s)
| | | | - Francesco Schettini
- Department of Medical Oncology, Hospital Clinic of Barcelona
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi I Sunyer Biomedical Research Institute (IDIBAPS)
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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Soosaipillai G, Wu A, Dettorre GM, Diamantis N, Chester J, Moss C, Aguilar-Company J, Bower M, Sng CCT, Salazar R, Brunet J, Jones E, Mesia R, Jackson A, Mukherjee U, Sita-Lumsden A, Seguí E, Ottaviani D, Carbó A, Benafif S, Würstlein R, Carmona C, Chopra N, Cruz CA, Swallow J, Saoudi N, Felip E, Galazi M, Garcia-Fructuoso I, Lee AJX, Newsom-Davis T, Wong YNS, Sureda A, Maluquer C, Ruiz-Camps I, Cabirta A, Prat A, Loizidou A, Gennari A, Ferrante D, Tabernero J, Russell B, Van Hemelrijck M, Dolly S, Hulbert-Williams NJ, Pinato DJ. Specialist palliative and end-of-life care for patients with cancer and SARS-CoV-2 infection: a European perspective. Ther Adv Med Oncol 2021; 13:17588359211042224. [PMID: 34497669 PMCID: PMC8419540 DOI: 10.1177/17588359211042224] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 08/09/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Specialist palliative care team (SPCT) involvement has been shown to improve symptom control and end-of-life care for patients with cancer, but little is known as to how these have been impacted by the COVID-19 pandemic. Here, we report SPCT involvement during the first wave of the pandemic and compare outcomes for patients with cancer who received and did not receive SPCT input from multiple European cancer centres. METHODS From the OnCovid repository (N = 1318), we analysed cancer patients aged ⩾18 diagnosed with COVID-19 between 26 February and 22 June 2020 who had complete specialist palliative care team data (SPCT+ referred; SPCT- not referred). RESULTS Of 555 eligible patients, 317 were male (57.1%), with a median age of 70 years (IQR 20). At COVID-19 diagnosis, 44.7% were on anti-cancer therapy and 53.3% had ⩾1 co-morbidity. Two hundred and six patients received SPCT input for symptom control (80.1%), psychological support (54.4%) and/or advance care planning (51%). SPCT+ patients had more 'Do not attempt cardio-pulmonary resuscitation' orders completed prior to (12.6% versus 3.7%) and during admission (50% versus 22.1%, p < 0.001), with more SPCT+ patients deemed suitable for treatment escalation (50% versus 22.1%, p < 0.001). SPCT involvement was associated with higher discharge rates from hospital for end-of-life care (9.7% versus 0%, p < 0.001). End-of-life anticipatory prescribing was higher in SPCT+ patients, with opioids (96.3% versus 47.1%) and benzodiazepines (82.9% versus 41.2%) being used frequently for symptom control. CONCLUSION SPCT referral facilitated symptom control, emergency care and discharge planning, as well as high rates of referral for psychological support than previously reported. Our study highlighted the critical need of SPCTs for patients with cancer during the pandemic and should inform service planning for this population.
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Affiliation(s)
| | - Anjui Wu
- Cancer Division, University College London Hospitals, London, UK
- UCL Cancer Institute, Fitzrovia, London, UK
| | - Gino M Dettorre
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | | | - John Chester
- Medical Oncology, School of Medicine, Cardiff University, Cardiff, UK
- Medical Oncology, Velindre Cancer Centre, Cardiff, UK
| | - Charlotte Moss
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - Juan Aguilar-Company
- Medical Oncology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
- Infectious Diseases, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Mark Bower
- Department of Oncology and National Centre for HIV Malignancy, Chelsea & Westminster Hospital, London, UK
| | | | - Ramon Salazar
- Department of Medical Oncology, ICO L’Hospitalet, Oncobell Program (IDIBELL), CIBERONC. Hospitalet de Llobregat, Spain
| | - Joan Brunet
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Eleanor Jones
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, UK
| | - Ricard Mesia
- Department of Medical Oncology, Catalan Institute of Oncology, Badalona, Spain
| | | | - Uma Mukherjee
- Medical Oncology, Barts Health NHS Trust, London, UK
| | - Ailsa Sita-Lumsden
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, UK
| | - Elia Seguí
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | - Diego Ottaviani
- Cancer Division, University College London Hospitals, London, UK
| | - Anna Carbó
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Sarah Benafif
- Cancer Division, University College London Hospitals, London, UK
| | - Rachel Würstlein
- Department of Gynaecology and Obstetrics, Breast Centre and Gynaecological Cancer Centre and CCC Munich, University Hospital Munich, Munich, Germany
| | - Carme Carmona
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Neha Chopra
- Cancer Division, University College London Hospitals, London, UK
| | | | - Judith Swallow
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Nadia Saoudi
- Medical Oncology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Eudald Felip
- Department of Medical Oncology, Catalan Institute of Oncology, Badalona, Spain
| | - Myria Galazi
- Cancer Division, University College London Hospitals, London, UK
| | - Isabel Garcia-Fructuoso
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Alvin J. X. Lee
- Cancer Division, University College London Hospitals, London, UK
| | - Thomas Newsom-Davis
- Department of Oncology and National Centre for HIV Malignancy, Chelsea & Westminster Hospital, London, UK
| | | | - Anna Sureda
- Haematology Department, ICO Hospitalet, Hospitalet de Llobregat, IDIBELL, Universitat de Barcelona, Spain
| | - Clara Maluquer
- Haematology Department, ICO Hospitalet, Hospitalet de Llobregat, IDIBELL, Universitat de Barcelona, Spain
| | - Isabel Ruiz-Camps
- Infectious Diseases, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Alba Cabirta
- Department of Haematology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
- Translational Genomics and Targeted Therapies in Solid Tumours, IDIBAPS, Barcelona, Spain
| | - Angela Loizidou
- Department of Infectious Diseases, Internal Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Alessandra Gennari
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy
| | - Daniela Ferrante
- Department of Translational Medicine, Unit of Cancer Epidemiology, CPO-Piemonte, University of Eastern Piedmont, Novara, Italy
| | - Josep Tabernero
- Medical Oncology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Beth Russell
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, UK
| | - Saoirse Dolly
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, UK
| | - Nicholas J Hulbert-Williams
- Professor of Behavioural Medicine, Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chritchley Building, Parkgate Road, Chester, Cheshire, CH1 4BJ, UK
| | - David J Pinato
- Department of Surgery and Cancer, Clinical Senior Lecturer and Consultant Medical Oncologist, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
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Castillo Manzano C, Guillén P, Vidal JB, Lazaro C, Ruffinelli J, Santos Vivas C, Torrent F, Lleuger R, Garcia-Fructuoso I, Teule A. 1115P Beyond classic hereditary neuroendocrine tumors (NET) syndromes. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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7
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Pinato DJ, Zambelli A, Aguilar-Company J, Bower M, Sng C, Salazar R, Bertuzzi A, Brunet J, Mesia R, Segui E, Biello F, Generali D, Grisanti S, Rizzo G, Libertini M, Maconi A, Harbeck N, Vincenzi B, Bertulli R, Ottaviani D, Carbo A, Bruna R, Benafif S, Marrari A, Wuerstlein R, Carmona-Garcia MC, Chopra N, Tondini C, Mirallas O, Tovazzi V, Betti M, Provenzano S, Fotia V, Cruz CA, Dalla Pria A, D'Avanzo F, Evans JS, Saoudi-Gonzalez N, Felip E, Galazi M, Garcia-Fructuoso I, Lee AJX, Newsom-Davis T, Patriarca A, Garcia-Illescas D, Reyes R, Dileo P, Sharkey R, Wong YNS, Ferrante D, Marco-Hernandez J, Sureda A, Maluquer C, Ruiz-Camps I, Gaidano G, Rimassa L, Chiudinelli L, Izuzquiza M, Cabirta A, Franchi M, Santoro A, Prat A, Tabernero J, Gennari A. Clinical portrait of the SARS-CoV-2 epidemic in European cancer patients. Cancer Discov 2020; 10:CD-20-0773. [PMID: 32737082 PMCID: PMC7668225 DOI: 10.1158/2159-8290.cd-20-0773] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/22/2020] [Accepted: 07/28/2020] [Indexed: 02/06/2023]
Abstract
The SARS-Cov-2 pandemic significantly impacted on oncology practice across the globe. There is uncertainty as to the contribution of patients' demographics and oncological features on severity and mortality from Covid-19 and little guidance as to the role of anti-cancer and anti-Covid-19 therapy in this population. In a multi-center study of 890 cancer patients with confirmed Covid-19 we demonstrated a worsening gradient of mortality from breast cancer to haematological malignancies and showed that male gender, older age, and number of co-morbidities identifies a subset of patients with significantly worse mortality rates from Covid-19. Provision of chemotherapy, targeted therapy and immunotherapy did not worsen mortality. Exposure to antimalarials was associated with improved mortality rates independent of baseline prognostic factors. This study highlights the clinical utility of demographic factors for individualized risk-stratification of patients and support further research into emerging anti-Covid-19 therapeutics in SARS-Cov-2 infected cancer patients.
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Affiliation(s)
| | | | | | - Mark Bower
- National Centre for HIV Malignancy, Chelsea and Westminster Hospital, UK
| | - Christopher Sng
- Cancer Division, University College London Hospitals NHS Foundation Trust
| | - Ramon Salazar
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), Traslational Research Laboratory, ICO-Bellvitge Biomedical Research Institute (IDIBELL)-CIBERONC, L'Hospitalet de Llobregat
| | | | - Joan Brunet
- Medical Oncology, Catalan Institute of Oncology Hospital Josep Trueta
| | - Ricard Mesia
- Institut Catala d'Oncologia - L'Hospitalet, Universitat de Barcelona, IDIBELL
| | | | | | - Daniele Generali
- US Terapia Molecolare e Farmacogenomica, Az Istituti Ospitalieri di Cremona
| | | | | | | | - Antonio Maconi
- Research Education Innovation Infrastrucure, Ospedale Antonio e Biagio e Cesare Arrigo, Alessandria
| | | | | | - Rossella Bertulli
- Medical Oncology Unit 2 - Adult mesenchymal tumour and rare cancer network, Cancer Medicine department, Istituto Nazionale dei Tumori
| | | | - Anna Carbo
- Medical Oncology, Catalan Institute of Oncology, Girona
| | - Riccardo Bruna
- Department of Translational Medicine, Universita del Piemonte Orientale
| | | | | | | | - M Carmen Carmona-Garcia
- Medical Oncology Service, Hospital Universitari de Girona Doctor Josep Trueta- Catalan Insitute of Oncology
| | | | | | - Oriol Mirallas
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona
| | | | - Marta Betti
- Infrastruttura Ricerca Formazione Innovazione, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo
| | - Salvatore Provenzano
- Medical Oncology Unit 2 - Adult mesenchymal tumour and rare cancer network, Cancer Medicine Department, Istituto Nazionale dei Tumori
| | | | | | | | | | | | | | - Eudald Felip
- Medical Oncology Department, Institut Catala d'Oncologia-Badalona, B-ARGO group- IGTP
| | | | | | | | | | - Andrea Patriarca
- Department of Translational Medicine, Universita del Piemonte Orientale
| | | | | | | | | | | | - Daniela Ferrante
- Department of Translational Medicine, Department of Translational Medicine, Unit of Medical Statistics, University of Eastern Piedmont and Cancer Epidemiology, CPO Piemonte, Novara
| | | | - Anna Sureda
- Hospital Duran i Reynals, Institut Catala d'Oncología (ICO)
| | | | | | - Gianluca Gaidano
- Hematology, Division of Hematology, Amedeo Avogadro Univeristy of Eastern Piedmont
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS; Department of Biomedical Sciences, Humanitas University
| | - Lorenzo Chiudinelli
- Dipartimento di Ingegneria Industriale e dell'Informazione, University of Pavia
| | | | - Alba Cabirta
- Hematology, Vall d'Hebron University Hospital, Barcelona
| | - Michela Franchi
- FROM Research Foundation, Ospedale Papa Giovanni XXIII, Bergamo
| | | | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic de Barcelona
| | - Josep Tabernero
- Medical Oncology Department, Vall d'Hebron University Hospital
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8
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Pinato DJ, Lee AJX, Biello F, Seguí E, Aguilar-Company J, Carbó A, Bruna R, Bower M, Rizzo G, Benafif S, Carmona C, Chopra N, Cruz CA, D’Avanzo F, Evans JS, Galazi M, Garcia-Fructuoso I, Dalla Pria A, Newsom-Davis T, Ottaviani D, Patriarca A, Reyes R, Sharkey R, Sng CCT, Wong YNS, Ferrante D, Scotti L, Avanzi GC, Bellan M, Castello LM, Marco-Hernández J, Mollà M, Pirisi M, Ruiz-Camps I, Sainaghi PP, Gaidano G, Brunet J, Tabernero J, Prat A, Gennari A. Presenting Features and Early Mortality from SARS-CoV-2 Infection in Cancer Patients during the Initial Stage of the COVID-19 Pandemic in Europe. Cancers (Basel) 2020; 12:E1841. [PMID: 32650523 PMCID: PMC7408670 DOI: 10.3390/cancers12071841] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 12/19/2022] Open
Abstract
We describe the outcomes in cancer patients during the initial outbreak of the COVID-19 in Europe from the retrospective, multi-center observational OnCovid study. We identified 204 cancer patients from eight centers in the United Kingdom, Italy, and Spain aged > 18 (mean = 69) and diagnosed with COVID-19 between February 26th and April 1st, 2020. A total of 127 (62%) were male, 184 (91%) had a diagnosis of solid malignancy, and 103 (51%) had non-metastatic disease. A total of 161 (79%) had > 1 co-morbidity. A total of 141 (69%) patients had > 1 COVID-19 complication. A total of 36 (19%) were escalated to high-dependency or intensive care. A total of 59 (29%) died, 53 (26%) were discharged, and 92 (45%) were in-hospital survivors. Mortality was higher in patients aged > 65 (36% versus 16%), in those with > 2 co-morbidities (40% versus 18%) and developing > 1 complication from COVID-19 (38% versus 4%, p = 0.004). Multi-variable analyses confirmed age > 65 and > 2 co-morbidities to predict for patient mortality independent of tumor stage, active malignancy, or anticancer therapy. During the early outbreak of SARS-CoV-2 infection in Europe co-morbid burden and advancing age predicted for adverse disease course in cancer patients. The ongoing OnCovid study will allow us to compare risks and outcomes in cancer patients between the initial and later stages of the COVID-19 pandemic.
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Affiliation(s)
- David J. Pinato
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London W12 0HS, UK;
| | - Alvin J. X. Lee
- Department of Oncology, University College London Hospitals, London NW1 2PG, UK; (A.J.X.L.); (S.B.); (N.C.); (M.G.); (D.O.); (C.C.T.S.); (Y.N.S.W.)
| | - Federica Biello
- Department of Translational Medicine, Division of Oncology, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (F.B.); (F.D.); (A.G.)
| | - Elia Seguí
- Department of Medical Oncology, Hospital Clinic, 08036 Barcelona, Spain; (E.S.); (C.A.C.); (R.R.); (A.P.)
| | - Juan Aguilar-Company
- Department of Medical Oncology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), 08035 Barcelona, Spain; (J.A.-C.); (J.T.)
- Department of Infectious Diseases, Vall d’Hebron University Hospital, 08035 Barcelona, Spain;
| | - Anna Carbó
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, 17007 Girona, Spain; (A.C.); (C.C.); (I.G.-F.); (J.B.)
| | - Riccardo Bruna
- Department of Translational Medicine, Division of Haematology, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (R.B.); (A.P.); (R.S.); (G.G.)
| | - Mark Bower
- Department of Oncology and National Centre for HIV Malignancy, Chelsea & Westminster Hospital, London SW109NH, UK; (M.B.); (A.D.P.); (T.N.-D.)
| | - Gianpiero Rizzo
- Department of Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Sarah Benafif
- Department of Oncology, University College London Hospitals, London NW1 2PG, UK; (A.J.X.L.); (S.B.); (N.C.); (M.G.); (D.O.); (C.C.T.S.); (Y.N.S.W.)
| | - Carme Carmona
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, 17007 Girona, Spain; (A.C.); (C.C.); (I.G.-F.); (J.B.)
| | - Neha Chopra
- Department of Oncology, University College London Hospitals, London NW1 2PG, UK; (A.J.X.L.); (S.B.); (N.C.); (M.G.); (D.O.); (C.C.T.S.); (Y.N.S.W.)
| | - Claudia Andrea Cruz
- Department of Medical Oncology, Hospital Clinic, 08036 Barcelona, Spain; (E.S.); (C.A.C.); (R.R.); (A.P.)
| | - Francesca D’Avanzo
- Department of Translational Medicine, Division of Oncology, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (F.B.); (F.D.); (A.G.)
| | - Joanne S. Evans
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London W12 0HS, UK;
| | - Myria Galazi
- Department of Oncology, University College London Hospitals, London NW1 2PG, UK; (A.J.X.L.); (S.B.); (N.C.); (M.G.); (D.O.); (C.C.T.S.); (Y.N.S.W.)
| | - Isabel Garcia-Fructuoso
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, 17007 Girona, Spain; (A.C.); (C.C.); (I.G.-F.); (J.B.)
| | - Alessia Dalla Pria
- Department of Oncology and National Centre for HIV Malignancy, Chelsea & Westminster Hospital, London SW109NH, UK; (M.B.); (A.D.P.); (T.N.-D.)
| | - Thomas Newsom-Davis
- Department of Oncology and National Centre for HIV Malignancy, Chelsea & Westminster Hospital, London SW109NH, UK; (M.B.); (A.D.P.); (T.N.-D.)
| | - Diego Ottaviani
- Department of Oncology, University College London Hospitals, London NW1 2PG, UK; (A.J.X.L.); (S.B.); (N.C.); (M.G.); (D.O.); (C.C.T.S.); (Y.N.S.W.)
| | - Andrea Patriarca
- Department of Translational Medicine, Division of Haematology, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (R.B.); (A.P.); (R.S.); (G.G.)
| | - Roxana Reyes
- Department of Medical Oncology, Hospital Clinic, 08036 Barcelona, Spain; (E.S.); (C.A.C.); (R.R.); (A.P.)
| | - Rachel Sharkey
- Department of Translational Medicine, Division of Haematology, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (R.B.); (A.P.); (R.S.); (G.G.)
| | - Christopher C. T. Sng
- Department of Oncology, University College London Hospitals, London NW1 2PG, UK; (A.J.X.L.); (S.B.); (N.C.); (M.G.); (D.O.); (C.C.T.S.); (Y.N.S.W.)
| | - Yien Ning Sophia Wong
- Department of Oncology, University College London Hospitals, London NW1 2PG, UK; (A.J.X.L.); (S.B.); (N.C.); (M.G.); (D.O.); (C.C.T.S.); (Y.N.S.W.)
| | - Daniela Ferrante
- Department of Translational Medicine, Unit of Cancer Epidemiology, CPO-Piemonte, University of Piemonte Orientale, 28100 Novara, Italy;
| | - Lorenza Scotti
- Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy;
| | - Gian Carlo Avanzi
- Department of Translational Medicine, Divisions of Internal and Emergency Medicine, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (G.C.A.); (M.B.); (L.M.C.); (M.P.); (P.P.S.)
| | - Mattia Bellan
- Department of Translational Medicine, Divisions of Internal and Emergency Medicine, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (G.C.A.); (M.B.); (L.M.C.); (M.P.); (P.P.S.)
| | - Luigi Mario Castello
- Department of Translational Medicine, Divisions of Internal and Emergency Medicine, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (G.C.A.); (M.B.); (L.M.C.); (M.P.); (P.P.S.)
| | | | - Meritxell Mollà
- Department of Radiation Oncology, Hospital Clinic, 08035 Barcelona, Spain;
| | - Mario Pirisi
- Department of Translational Medicine, Divisions of Internal and Emergency Medicine, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (G.C.A.); (M.B.); (L.M.C.); (M.P.); (P.P.S.)
| | - Isabel Ruiz-Camps
- Department of Infectious Diseases, Vall d’Hebron University Hospital, 08035 Barcelona, Spain;
| | - Pier Paolo Sainaghi
- Department of Translational Medicine, Divisions of Internal and Emergency Medicine, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (G.C.A.); (M.B.); (L.M.C.); (M.P.); (P.P.S.)
| | - Gianluca Gaidano
- Department of Translational Medicine, Division of Haematology, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (R.B.); (A.P.); (R.S.); (G.G.)
| | - Joan Brunet
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, 17007 Girona, Spain; (A.C.); (C.C.); (I.G.-F.); (J.B.)
| | - Josep Tabernero
- Department of Medical Oncology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), 08035 Barcelona, Spain; (J.A.-C.); (J.T.)
| | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic, 08036 Barcelona, Spain; (E.S.); (C.A.C.); (R.R.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, 08035 Barcelona, Spain
| | - Alessandra Gennari
- Department of Translational Medicine, Division of Oncology, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (F.B.); (F.D.); (A.G.)
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