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Pernas S, Villagrasa P, Vivancos A, Scaltriti M, Rodón J, Burgués O, Nuciforo P, Canes J, Paré L, Dueñas M, Vidal M, Cejalvo JM, Perelló A, Llommbard-Cussac A, Dorca J, Montaño A, Pascual T, Oliveira M, Ribas G, Rapado I, Prat A, Ciruelos E. First Nationwide Molecular Screening Program in Spain for Patients With Advanced Breast Cancer: Results From the AGATA SOLTI-1301 Study. Front Oncol 2021; 11:744112. [PMID: 34804931 PMCID: PMC8600133 DOI: 10.3389/fonc.2021.744112] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background The SOLTI-1301 AGATA study aimed to assess the feasibility of a multi-institutional molecular screening program to better characterize the genomic landscape of advanced breast cancer (ABC) and to facilitate patient access to matched-targeted therapies in Spain. Methods DNA sequencing of 74 cancer-related genes was performed using FFPE tumor samples in three different laboratories with three different gene panels. A multidisciplinary advisory board prospectively recommended potential targeted treatments. The primary objective was to determine the success of matching somatic DNA alteration to an experimental drug/drug class. Results Between September 2014 and July 2017, 305 patients with ABC from 10 institutions were enrolled. Tumor sequencing was successful in 260 (85.3%) patients. Median age was 54 (29-80); most tumors were hormone receptor-positive/HER2-negative (74%), followed by triple-negative (14.5%) and HER2-positive (11.5%). Ninety-seven (37%) tumor samples analyzed proceeded from metastatic sites. Somatic mutations were identified in 163 (62.7%) patients, mostly in PIK3CA (34%), TP53 (22%), AKT1 (5%), ESR1 (3%), and ERBB2 (3%) genes. Significant enrichment of AKT1 mutation was observed in metastatic versus primary samples (9% vs. 2%; p=0.01). Genome-driven cancer therapy was recommended in 45% (n=116) of successfully screened patients, 11% (n=13) of whom finally received it. Among these patients, 46.2% had a PFS of ≥6 months on matched therapy. Conclusions AGATA is the first nationwide molecular screening program carried out in Spain and we proved that implementing molecular data in the management of ABC is feasible. Although these results are promising, only 11% of the patients with genome-driven cancer therapy received it.
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Affiliation(s)
- Sonia Pernas
- Catalan Institute of Oncology (ICO)- Institut d'Investigació Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,SOLTI Breast Cancer Research Group, Barcelona, Spain
| | | | - Ana Vivancos
- Cancer Genomics Laboratory, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Maurizio Scaltriti
- Memorial Sloan Kettering Cancer Center, Memorial Hospital, New York, NY, United States
| | - Jordi Rodón
- Oncology Department, Monroe Dunaway (MD) Anderson Cancer Center, Houston, TX, United States.,Oncology Department, Vall d'Hebron University Hospital/Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Octavio Burgués
- Pathology Department, Hospital Clínico Universitario Valencia, Valencia, Spain
| | - Paolo Nuciforo
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Jordi Canes
- SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - Laia Paré
- SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - Marta Dueñas
- Molecular Oncology Unit, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain.,Institute of Biomedical Research, University Hospital "12 de Octubre", Madrid, Spain
| | - Maria Vidal
- SOLTI Breast Cancer Research Group, Barcelona, Spain.,Oncology Department, Hospital Clínic de Barcelona, Barcelona, Spain.,Translational Genomics and Targeted Therapeutics in Solid Tumors, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Juan Miguel Cejalvo
- Pathology Department, Hospital Clínico Universitario Valencia, Valencia, Spain.,Breast Cancer Biology, Instituto de Investigación Sanitaria (INCLIVA) Biomedical Research Institute, Valencia, Spain.,Center for Biomedical Network Research on Cancer (CIBERONC), Valencia, Spain
| | - Antonia Perelló
- Oncology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Antonio Llommbard-Cussac
- Oncology Department, Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO) - Hospital Arnau de Vilanova, Valencia, Spain
| | - Joan Dorca
- Oncology Department, Catalan Institute of Oncology (ICO), Girona, Spain
| | - Alvaro Montaño
- Oncology Department, Hospital Virgen del Rocío, Sevilla, Spain
| | - Tomás Pascual
- SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - Mafalda Oliveira
- SOLTI Breast Cancer Research Group, Barcelona, Spain.,Oncology Department, Vall d'Hebron University Hospital/Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Gloria Ribas
- Breast Cancer Biology, Instituto de Investigación Sanitaria (INCLIVA) Biomedical Research Institute, Valencia, Spain.,Center for Biomedical Network Research on Cancer (CIBERONC), Valencia, Spain
| | - Inmaculada Rapado
- Institute of Biomedical Research, University Hospital "12 de Octubre", Madrid, Spain
| | - Aleix Prat
- SOLTI Breast Cancer Research Group, Barcelona, Spain.,Oncology Department, Hospital Clínic de Barcelona, Barcelona, Spain.,Translational Genomics and Targeted Therapeutics in Solid Tumors, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,School of Medicine, University of Barcelona, Barcelona, Spain
| | - Eva Ciruelos
- SOLTI Breast Cancer Research Group, Barcelona, Spain.,Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
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Robles-Pérez A, Luburich P, Bolivar S, Dorca J, Nolla JM, Molina-Molina M, Narváez J. A prospective study of lung disease in a cohort of early rheumatoid arthritis patients. Sci Rep 2020; 10:15640. [PMID: 32973236 PMCID: PMC7515904 DOI: 10.1038/s41598-020-72768-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 09/02/2020] [Indexed: 01/26/2023] Open
Abstract
Lung disease is common in patients with rheumatoid arthritis (RA). The onset of lung involvement in RA is not well known. The objective is to describe the features and evolution of lung involvement in early RA, its relationship with disease activity parameters, smoking and treatments. Consecutive patients with early RA without respiratory symptoms were included and tracked for 5 years. Lung assessment included clinical, radiological and pulmonary function tests at diagnosis and during follow-up. Peripheral blood parameters (erythrocyte sedimentation rate, C reactive protein, rheumatoid factor and anti-citrullinated peptide autoantibodies) and scales of articular involvement, such as DAS28-CRP, were evaluated. 40 patients were included and 32 completed the 5-year follow up. 13 patients presented lung involvement in the initial 5 years after RA diagnosis, 3 of them interstitial lung disease. Significant decrease of diffusion lung transfer capacity of carbon monoxide over time was observed in six patients, 2 of them developed interstitial lung disease. DLCO decrease was correlated with higher values of CRP and ESR at diagnosis. Methotrexate was not associated with DLCO deterioration or lung disease development. Subclinical progressive lung disease correlates with RA activity parameters. Smoking status and methotrexate were not associated with development or progression of lung disease.
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Affiliation(s)
- A Robles-Pérez
- ILD Unit, Department of Pneumology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Feixa Llarga S/N, 08907, Barcelona, Spain
| | - P Luburich
- Servei de Diagnòstic Per La Imatge El Prat (SDPI El Prat), Department of Radiology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - S Bolivar
- Servei de Diagnòstic Per La Imatge El Prat (SDPI El Prat), Department of Radiology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - J Dorca
- ILD Unit, Department of Pneumology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Feixa Llarga S/N, 08907, Barcelona, Spain
| | - J M Nolla
- Department of Rheumatology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - M Molina-Molina
- ILD Unit, Department of Pneumology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Feixa Llarga S/N, 08907, Barcelona, Spain.
| | - J Narváez
- Department of Rheumatology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
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Cuyàs E, Fernández-Arroyo S, Buxó M, Pernas S, Dorca J, Álvarez I, Martínez S, Pérez-Garcia JM, Batista-López N, Rodríguez-Sánchez CA, Amillano K, Domínguez S, Luque M, Morilla I, Stradella A, Viñas G, Cortés J, Verdura S, Brunet J, López-Bonet E, Garcia M, Saidani S, Joven J, Martin-Castillo B, Menendez JA. Metformin induces a fasting- and antifolate-mimicking modification of systemic host metabolism in breast cancer patients. Aging (Albany NY) 2020; 11:2874-2888. [PMID: 31076561 PMCID: PMC6535060 DOI: 10.18632/aging.101960] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 04/01/2019] [Accepted: 05/04/2019] [Indexed: 01/01/2023]
Abstract
Certain dietary interventions might improve the therapeutic index of cancer treatments. An alternative to the “drug plus diet” approach is the pharmacological reproduction of the metabolic traits of such diets. Here we explored the impact of adding metformin to an established therapeutic regimen on the systemic host metabolism of cancer patients. A panel of 11 serum metabolites including markers of mitochondrial function and intermediates/products of folate-dependent one-carbon metabolism were measured in paired baseline and post-treatment sera obtained from HER2-positive breast cancer patients randomized to receive either metformin combined with neoadjuvant chemotherapy and trastuzumab or an equivalent regimen without metformin. Metabolite profiles revealed a significant increase of the ketone body β-hydroxybutyrate and of the TCA intermediate α-ketoglutarate in the metformin-containing arm. A significant relationship was found between the follow-up levels of homocysteine and the ability of treatment arms to achieve a pathological complete response (pCR). In the metformin-containing arm, patients with significant elevations of homocysteine tended to have a higher probability of pCR. The addition of metformin to an established anti-cancer therapeutic regimen causes a fasting-mimicking modification of systemic host metabolism. Circulating homocysteine could be explored as a clinical pharmacodynamic biomarker linking the antifolate-like activity of metformin and biological tumor response.
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Affiliation(s)
- Elisabet Cuyàs
- Program Against Cancer Therapeutic Resistance (ProCURE), Metabolism and Cancer Group, Catalan Institute of Oncology, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Salvador Fernández-Arroyo
- Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, IISPV, Rovira i Virgili University, Reus, Spain
| | - Maria Buxó
- Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Sonia Pernas
- Department of Medical Oncology, Breast Unit, Catalan Institute of Oncology-Hospital Universitari de Bellvitge-Bellvitge Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Joan Dorca
- Medical Oncology, Catalan Institute of Oncology, Girona, Spain
| | - Isabel Álvarez
- Medical Oncology Service, Hospital Universitario Donostia, Donostia-San Sebastián, Spain.,Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
| | - Susana Martínez
- Medical Oncology Department, Hospital de Mataró, Mataró, Barcelona, Spain
| | | | - Norberto Batista-López
- Medical Oncology Service, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
| | - César A Rodríguez-Sánchez
- Medical Oncology Service, Hospital Universitario de Salamanca, Salamanca, Spain.,Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Kepa Amillano
- Medical Oncology, Hospital Universitari Sant Joan, Reus, Spain
| | - Severina Domínguez
- Medical Oncology Service, Hospital Universitario Araba, Vitoria-Gasteiz, Spain
| | - Maria Luque
- Department of Medical Oncology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Idoia Morilla
- Department of Medical Oncology, Breast Unit, Catalan Institute of Oncology-Hospital Universitari de Bellvitge-Bellvitge Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Agostina Stradella
- Department of Medical Oncology, Breast Unit, Catalan Institute of Oncology-Hospital Universitari de Bellvitge-Bellvitge Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Gemma Viñas
- Medical Oncology, Catalan Institute of Oncology, Girona, Spain
| | - Javier Cortés
- IOB Institute of Oncology, Hospital Quirónsalud, Madrid and Barcelona, Spain.,Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Sara Verdura
- Program Against Cancer Therapeutic Resistance (ProCURE), Metabolism and Cancer Group, Catalan Institute of Oncology, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Joan Brunet
- Medical Oncology, Catalan Institute of Oncology, Girona, Spain.,Hereditary Cancer Programme, Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Spain.,Hereditary Cancer Programme, Catalan Institute of Oncology (ICO), Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Eugeni López-Bonet
- Department of Anatomical Pathology, Dr. Josep Trueta Hospital of Girona, Girona, Spain
| | - Margarita Garcia
- Clinical Research Unit, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Samiha Saidani
- Unit of Clinical Research, Catalan Institute of Oncology, Girona, Spain
| | - Jorge Joven
- Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, IISPV, Rovira i Virgili University, Reus, Spain
| | | | - Javier A Menendez
- Program Against Cancer Therapeutic Resistance (ProCURE), Metabolism and Cancer Group, Catalan Institute of Oncology, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), Girona, Spain
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López-Padrós C, Rodríguez C, Salord N, Alves C, Vilarrasa N, Gasa M, Planas R, Montserrat M, Virgili M, Pérez-Ramos S, López-Cadena E, Ramos M, Dorca J, Monasterio C. Effectiveness of an intensive weight-loss program for severe obstructive sleep apnea syndrome (OSA) in patients undergoing CPAP treatment: a randomized controlled trial. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.907] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Recalde S, Quiroga V, del Barco S, Falo C, Dorca J, Margeli M, Stradella A, Soler T, Te García IR, Viñas G, Fernandez A, Vázquez RV, Vethencourt A, Marin MR, Gil-Gil M. Influence of age on the indication of adjuvant chemotherapy in early breast cancer using Oncotype DX. An analysis of 240 patients treated in the Institut Catala d’Oncologia (ICO) hospitals. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.034] [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: 11/13/2022] Open
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Cuyàs E, Buxó M, Ferri Iglesias MJ, Verdura S, Pernas S, Dorca J, Álvarez I, Martínez S, Pérez-Garcia JM, Batista-López N, Rodríguez-Sánchez CA, Amillano K, Domínguez S, Luque M, Morilla I, Stradella A, Viñas G, Cortés J, Joven J, Brunet J, López-Bonet E, Garcia M, Saidani S, Queralt Moles X, Martin-Castillo B, Menendez JA. The C Allele of ATM rs11212617 Associates With Higher Pathological Complete Remission Rate in Breast Cancer Patients Treated With Neoadjuvant Metformin. Front Oncol 2019; 9:193. [PMID: 30984619 PMCID: PMC6447648 DOI: 10.3389/fonc.2019.00193] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 12/18/2018] [Accepted: 03/06/2019] [Indexed: 12/21/2022] Open
Abstract
Background: The minor allele (C) of the single-nucleotide polymorphism (SNP) rs11212617, located near the ataxia telangiectasia mutated (ATM) gene, has been associated with an increased likelihood of treatment success with metformin in type 2 diabetes. We herein investigated whether the same SNP would predict clinical response to neoadjuvant metformin in women with early breast cancer (BC). Methods: DNA was collected from 79 patients included in the intention-to-treat population of the METTEN study, a phase 2 clinical trial of HER2-positive BC patients randomized to receive either metformin combined with anthracycline/taxane-based chemotherapy and trastuzumab or equivalent regimen without metformin, before surgery. SNP rs11212617 genotyping was assessed using allelic discrimination by quantitative polymerase chain reaction. Results: Logistic regression analyses revealed a significant relationship between the rs11212617 genotype and the ability of treatment arms to achieve a pathological complete response (pCR) in patients (odds ratio [OR]genotype×arm = 10.33, 95% confidence interval [CI]: 1.29-82.89, p = 0.028). In the metformin-containing arm, patients bearing the rs11212617 C allele had a significantly higher probability of pCR (OR A/C,C/C = 7.94, 95%CI: 1.60-39.42, p = 0.011). Conversely, no association was found between rs11212617 and clinical response in the reference arm (OR A/C,C/C = 0.77, 95%CI: 0.20-2.92, p = 0.700). After controlling for tumor size and hormone receptor status, the rs11212617 C allele remained a significant predictor of pCR solely in the metformin-containing arm. Conclusions: If reproducible, the rs11212617 C allele might warrant consideration as a predictive clinical biomarker to inform the personalized use of metformin in BC patients. Trial Registration: EU Clinical Trials Register, EudraCT number 2011-000490-30. Registered 28 February 2011, https://www.clinicaltrialsregister.eu/ctr-search/trial/2011-000490-30/ES.
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Affiliation(s)
- Elisabet Cuyàs
- Program Against Cancer Therapeutic Resistance (ProCURE), Metabolism and Cancer Group, Catalan Institute of Oncology, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Maria Buxó
- Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | | | - Sara Verdura
- Program Against Cancer Therapeutic Resistance (ProCURE), Metabolism and Cancer Group, Catalan Institute of Oncology, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Sonia Pernas
- Breast Unit, Department of Medical Oncology, Catalan Institute of Oncology-Hospital Universitari de Bellvitge-Bellvitge Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Joan Dorca
- Medical Oncology, Catalan Institute of Oncology, Girona, Spain
| | - Isabel Álvarez
- Medical Oncology Service, Hospital Universitario Donostia, Donostia-San Sebastián, Spain.,Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
| | - Susana Martínez
- Medical Oncology Department, Hospital de Mataró, Mataró, Barcelona, Spain
| | | | - Norberto Batista-López
- Medical Oncology Service, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Spain
| | - César A Rodríguez-Sánchez
- Medical Oncology Service, Hospital Universitario de Salamanca, Salamanca, Spain.,Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Kepa Amillano
- Medical Oncology, Hospital Universitari Sant Joan, Reus, Spain
| | - Severina Domínguez
- Medical Oncology Service, Hospital Universitario Araba, Vitoria-Gasteiz, Spain
| | - Maria Luque
- Department of Medical Oncology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Idoia Morilla
- Breast Unit, Department of Medical Oncology, Catalan Institute of Oncology-Hospital Universitari de Bellvitge-Bellvitge Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Agostina Stradella
- Breast Unit, Department of Medical Oncology, Catalan Institute of Oncology-Hospital Universitari de Bellvitge-Bellvitge Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Gemma Viñas
- Medical Oncology, Catalan Institute of Oncology, Girona, Spain
| | - Javier Cortés
- Department of Medical Oncology, Ramón y Cajal University Hospital, Madrid, Spain
| | - Jorge Joven
- Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, IISPV, Rovira i Virgili University, Reus, Spain
| | - Joan Brunet
- Medical Oncology, Catalan Institute of Oncology, Girona, Spain.,Hereditary Cancer Programme, Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Spain.,Hereditary Cancer Programme, Catalan Institute of Oncology (ICO), Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Eugeni López-Bonet
- Department of Anatomical Pathology, Dr. Josep Trueta Hospital of Girona, Girona, Spain
| | - Margarita Garcia
- Clinical Research Unit, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Samiha Saidani
- Unit of Clinical Research, Catalan Institute of Oncology, Girona, Spain
| | | | | | - Javier A Menendez
- Program Against Cancer Therapeutic Resistance (ProCURE), Metabolism and Cancer Group, Catalan Institute of Oncology, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), Girona, Spain
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Pernas S, Villagrasa P, Nuciforo PG, Vivancos A, Scaltriti M, Rodón J, Burgués O, Canes J, Dueñas M, Cecchi F, Vidal M, Lluch A, Perelló A, Llombart A, Dorca J, Montaño A, Oliveira M, Ribas G, Rapado I, Paré L, Prat A, Ciruelos E. Abstract P6-18-02: Primary and secondary results of the first nationwide molecular screening program in Spain for patients with advanced breast cancer (AGATA SOLTI-1301 study). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-18-02] [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: Metastatic breast cancer is the second leading cause of death among women globally. A better understanding of tumor biology, and the availability of high-throughput technologies, have enabled the emergence of precision medicine bringing new expectations and giving rise to molecular screening programs (MSP). SOLTI, as a collaborative Spanish network, designed AGATA, the first multi-institutional MSP ever implemented in this country. Here, we report both the primary and some of the secondary results of the pilot study.
Methods: A total of 10 sites within SOLTI network in Spain participated. DNA-sequencing of 56 cancer related genes was performed using FFPE tumor samples (primary or metastatic). Each clinical case was reviewed by a multidisciplinary advisory board (MAB), which recommended, in a prospective manner, potential experimental treatments, mainly in the context of clinical trials. The primary objective was to determine the success rate of matching a DNA alteration to an experimental drug or drug class. Secondary objectives included a comprehensive molecular characterization of tumor samples by PAM50 subtyping and quantification of protein expression levels by MASS-SPEC (70 proteins panel).
Results: 305 patients (pts) were screened from September 2014 to July 2017 and 260 (85.3%) were finally evaluated by the MAB. Pts characteristics were: mean age 54 years (29-80), ER+/HER2- (n=192; 74%), HER2+ (n=30; 11.5%) and TNBC (n=38; 14.5%). 163 primary tumors and 97 metastatic samples were profiled. Regarding the primary objective, 116 pts (45%) presented at least one mutation (range 1-6) that could be matched to a drug or drug class. Of these, 13 pts (11.2%) received therapy matched to their molecular profile according to the MAB recommendation and their follow-up is still on-going. No mutation was detected in 97 (37%) pts (WT), and 47 patients (18.1%) presented a mutation but no match was possible. The most common mutations were PIK3CA (34%), TP53 (22%), AKT1 (5%), ESR1 (3%) and ERBB2 (3%). Intrinsic subtype distribution in 177 samples was as follows: 34% Luminal A (n=60); 21% Luminal B (n=36); 13% HER2E (n=22); 19% Basal-like (n=34) and 13% Normal-like (n=23). Compared to primary tumors (n=110), the proportion of HER2-enriched disease in metastatic tumors (n=63) was significantly higher (6% vs 20%; p=0.005). Protein expression analysis was performed in 146 samples (94 primary and 57 metastasis). In 19 cases (13%), the outlier expression of some targetable proteins (FGFR1 [n=4, 2.7%], IGF1R [n=4, 2.7%], EGFR [n=1, 0.7%], CEACAM5 [n=6, 4.1%], IDO1 [n=2, 1.37%], TROP2 [n=2, 1.37%]) were identified. Of note, HER2 overexpression (>740 amol/μg) was observed in 4 HER2- cases. Finally, among WT tumors, 21% presented a potential drug-matched protein target.
Conclusions: Nationwide molecular screening in Spain is feasible. Nearly half of patients had tumors with mutation(s), mostly PIK3CA, that could be matched to a potential drug or drug class. PAM50 profile might be helpful to navigate towards a therapeutic decision making, although the MAB could not make any targeted-driven recommendation yet with this data. More clinical evidence is needed to use MASS-SPEC as a diagnostic tool.
Citation Format: Pernas S, Villagrasa P, Nuciforo PG, Vivancos A, Scaltriti M, Rodón J, Burgués O, Canes J, Dueñas M, Cecchi F, Vidal M, Lluch A, Perelló A, Llombart A, Dorca J, Montaño A, Oliveira M, Ribas G, Rapado I, Paré L, Prat A, Ciruelos E. Primary and secondary results of the first nationwide molecular screening program in Spain for patients with advanced breast cancer (AGATA SOLTI-1301 study) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-18-02.
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Affiliation(s)
- S Pernas
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - P Villagrasa
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - PG Nuciforo
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - A Vivancos
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - M Scaltriti
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - J Rodón
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - O Burgués
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - J Canes
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - M Dueñas
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - F Cecchi
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - M Vidal
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - A Lluch
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - A Perelló
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - A Llombart
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - J Dorca
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - A Montaño
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - M Oliveira
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - G Ribas
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - I Rapado
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - L Paré
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - A Prat
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - E Ciruelos
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
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Martin-Castillo B, Pernas S, Dorca J, Álvarez I, Martínez S, Pérez-Garcia JM, Batista-López N, Rodríguez-Sánchez CA, Amillano K, Domínguez S, Luque M, Stradella A, Morilla I, Viñas G, Cortés J, Cuyàs E, Verdura S, Fernández-Ochoa Á, Fernández-Arroyo S, Segura-Carretero A, Joven J, Pérez E, Bosch N, Garcia M, López-Bonet E, Saidani S, Buxó M, Menendez JA. A phase 2 trial of neoadjuvant metformin in combination with trastuzumab and chemotherapy in women with early HER2-positive breast cancer: the METTEN study. Oncotarget 2018; 9:35687-35704. [PMID: 30479698 PMCID: PMC6235018 DOI: 10.18632/oncotarget.26286] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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: 08/29/2018] [Accepted: 10/21/2018] [Indexed: 12/12/2022] Open
Abstract
The METTEN study assessed the efficacy, tolerability, and safety of adding metformin to neoadjuvant chemotherapy plus trastuzumab in early HER2-positive breast cancer (BC). Women with primary, non-metastatic HER2-positive BC were randomized (1:1) to receive metformin (850 mg twice-daily) for 24 weeks concurrently with 12 cycles of weekly paclitaxel plus trastuzumab, followed by four cycles of 3-weekly FE75C plus trastuzumab (arm A), or equivalent regimen without metformin (arm B), followed by surgery. Primary endpoint was the rate of pathological complete response (pCR) in the per-protocol efficacy population. pCR rate was numerically higher in the metformin-containing arm A (19 of 29 patients [65.5%, 95% CI: 47.3-80.1]) than in arm B (17 of 29 patients [58.6%, 95% CI: 40.7-74.5]; OR 1.34 [95% CI: 0.46-3.89], P = 0.589). The rate of breast-conserving surgery was 79.3% and 58.6% in arm A and B (P = 0.089), respectively. Blood metformin concentrations (6.2 μmol/L, 95% CI: 3.6-8.8) were within the therapeutic range. Seventy-six percent of patients completed the metformin-containing regimen; 13% of patients in arm A dropped out because of metformin-related gastrointestinal symptoms. The most common adverse events (AEs) of grade ≥3 were neutropenia in both arms and diarrhea in arm A. None of the serious AEs was deemed to be metformin-related. Addition of anti-diabetic doses of metformin to a complex neoadjuvant regimen was well tolerated and safe. Because the study was underpowered relative to its primary endpoint, the efficacy data should be interpreted with caution.
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Affiliation(s)
| | - Sonia Pernas
- Department of Medical Oncology, Breast Unit, Catalan Institute of Oncology-Hospital Universitari de Bellvitge-Bellvitge Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Joan Dorca
- Medical Oncology, Catalan Institute of Oncology, Girona, Spain
| | - Isabel Álvarez
- Medical Oncology Service, Hospital Universitario Donostia, Donostia-San Sebastián, Spain
- Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
| | - Susana Martínez
- Medical Oncology Department, Hospital de Mataró, Mataró, Barcelona, Spain
| | | | - Norberto Batista-López
- Medical Oncology Service, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
| | - César A. Rodríguez-Sánchez
- Medical Oncology Service, Hospital Universitario de Salamanca, Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Kepa Amillano
- Medical Oncology, Hospital Universitari Sant Joan, Reus, Spain
| | - Severina Domínguez
- Medical Oncology Service, Hospital Universitario Araba, Vitoria-Gasteiz, Spain
| | - Maria Luque
- Department of Medical Oncology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Agostina Stradella
- Department of Medical Oncology, Breast Unit, Catalan Institute of Oncology-Hospital Universitari de Bellvitge-Bellvitge Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Idoia Morilla
- Department of Medical Oncology, Breast Unit, Catalan Institute of Oncology-Hospital Universitari de Bellvitge-Bellvitge Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Gemma Viñas
- Medical Oncology, Catalan Institute of Oncology, Girona, Spain
| | - Javier Cortés
- Department of Medical Oncology, Ramón y Cajal University Hospital, Madrid, Spain
| | - Elisabet Cuyàs
- Metabolism and Cancer Group, Girona Biomedical Research Institute, Girona, Spain
| | - Sara Verdura
- Metabolism and Cancer Group, Girona Biomedical Research Institute, Girona, Spain
| | - Álvaro Fernández-Ochoa
- Department of Analytical Chemistry, University of Granada, Granada, Spain
- Research and Development of Functional Food Centre (CIDAF), Health Science Technological Park, Granada, Spain
| | - Salvador Fernández-Arroyo
- Unitat de Recerca Biomèdica, Hospital Universitari Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - Antonio Segura-Carretero
- Department of Analytical Chemistry, University of Granada, Granada, Spain
- Research and Development of Functional Food Centre (CIDAF), Health Science Technological Park, Granada, Spain
| | - Jorge Joven
- Unitat de Recerca Biomèdica, Hospital Universitari Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - Elsa Pérez
- Department of Radiology-IDI, Dr. Josep Trueta Hospital of Girona, Girona, Spain
| | - Neus Bosch
- Unit of Clinical Research, Catalan Institute of Oncology, Girona, Spain
- Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Margarita Garcia
- Clinical Research Unit, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Eugeni López-Bonet
- Department of Anatomical Pathology, Dr. Josep Trueta Hospital of Girona, Girona, Spain
| | - Samiha Saidani
- Unit of Clinical Research, Catalan Institute of Oncology, Girona, Spain
- Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Maria Buxó
- Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Javier A. Menendez
- Department of Medical Oncology, Ramón y Cajal University Hospital, Madrid, Spain
- Program Against Cancer Therapeutic Resistance (ProCURE), Metabolism and Cancer Group, Catalan Institute of Oncology, Girona, Spain
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Pernas S, Villagrasa P, Vivancos A, Scaltriti M, Rodon J, Burgues O, Nuciforo P, Canes J, Dueñas M, Vidal M, Lluch A, Perelló A, Llombart A, Dorca J, Montaño Á, Oliveira M, Ribas G, Rapado I, Prat A, Ciruelos E. Primary results of the first nationwide molecular screening program in Spain for patients with advanced breast cancer (AGATA SOLTI-1301 study). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy272.276] [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: 11/13/2022] Open
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10
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Rodríguez-Jiménez P, Mir-Viladrich I, Chicharro P, Solano-López G, López-Longo F, Taxonera C, Sánchez-Martínez P, Martínez-Lacasa X, García-Gasalla M, Dorca J, Arias-Guillén M, García-García J, Dauden E. Consenso multidisciplinar sobre prevención y tratamiento de la tuberculosis en pacientes candidatos a tratamiento biológico. Adaptación al paciente dermatológico. Actas Dermo-Sifiliográficas 2018; 109:584-601. [DOI: 10.1016/j.ad.2018.03.013] [Citation(s) in RCA: 2] [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: 11/04/2017] [Revised: 03/07/2018] [Accepted: 03/19/2018] [Indexed: 02/08/2023] Open
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Rodríguez-Jiménez P, Mir-Viladrich I, Chicharro P, Solano-López G, López-Longo F, Taxonera C, Sánchez-Martínez P, Martínez-Lacasa X, García-Gasalla M, Dorca J, Arias-Guillén M, García-García J, Dauden E. Prevention and treatment of tuberculosis infection in candidates for biologic therapy: A multidisciplinary consensus statement adapted to the dermatology patient. Actas Dermo-Sifiliográficas (English Edition) 2018. [DOI: 10.1016/j.adengl.2018.06.020] [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: 10/28/2022] Open
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12
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Molina-Molina M, Machahua-Huamani C, Vicens-Zygmunt V, Llatjós R, Escobar I, Sala-Llinas E, Luburich-Hernaiz P, Dorca J, Montes-Worboys A. Anti-fibrotic effects of pirfenidone and rapamycin in primary IPF fibroblasts and human alveolar epithelial cells. BMC Pulm Med 2018; 18:63. [PMID: 29703175 PMCID: PMC5922028 DOI: 10.1186/s12890-018-0626-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 04/16/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Pirfenidone, a pleiotropic anti-fibrotic treatment, has been shown to slow down disease progression of idiopathic pulmonary fibrosis (IPF), a fatal and devastating lung disease. Rapamycin, an inhibitor of fibroblast proliferation could be a potential anti-fibrotic drug to improve the effects of pirfenidone. METHODS Primary lung fibroblasts from IPF patients and human alveolar epithelial cells (A549) were treated in vitro with pirfenidone and rapamycin in the presence or absence of transforming growth factor β1 (TGF-β). Extracellular matrix protein and gene expression of markers involved in lung fibrosis (tenascin-c, fibronectin, collagen I [COL1A1], collagen III [COL3A1] and α-smooth muscle actin [α-SMA]) were analyzed. A cell migration assay in pirfenidone, rapamycin and TGF-β-containing media was performed. RESULTS Gene and protein expression of tenascin-c and fibronectin of fibrotic fibroblasts were reduced by pirfenidone or rapamycin treatment. Pirfenidone-rapamycin treatment did not revert the epithelial to mesenchymal transition pathway activated by TGF-β. However, the drug combination significantly abrogated fibroblast to myofibroblast transition. The inhibitory effect of pirfenidone on fibroblast migration in the scratch-wound assay was potentiated by rapamycin combination. CONCLUSIONS These findings indicate that the combination of pirfenidone and rapamycin widen the inhibition range of fibrogenic markers and prevents fibroblast migration. These results would open a new line of research for an anti-fibrotic combination therapeutic approach.
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Affiliation(s)
- M. Molina-Molina
- Department of Pneumology, Bellvitge University Hospital, Barcelona, Spain
- Pneumology Research Group, IDIBELL, University of Barcelona, Barcelona, Spain
- Research Network in Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
| | - C. Machahua-Huamani
- Pneumology Research Group, IDIBELL, University of Barcelona, Barcelona, Spain
| | - V. Vicens-Zygmunt
- Department of Pneumology, Bellvitge University Hospital, Barcelona, Spain
- Pneumology Research Group, IDIBELL, University of Barcelona, Barcelona, Spain
| | - R. Llatjós
- Department of Pathology, Bellvitge University Hospital, Barcelona, Spain
| | - I. Escobar
- Department of Thoracic Surgery, Bellvitge University Hospital, Barcelona, Spain
| | - E. Sala-Llinas
- Research Network in Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
- Department of Penumology, Son Espases University Hospital, Palma de Mallorca, Spain
| | - P. Luburich-Hernaiz
- Servei de Diagnostic per la Imatge El Prat (SDPI El Prat) Department of Radiology, Bellvitge University Hospital, Barcelona, Spain
| | - J. Dorca
- Department of Pneumology, Bellvitge University Hospital, Barcelona, Spain
- Pneumology Research Group, IDIBELL, University of Barcelona, Barcelona, Spain
- Research Network in Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
| | - A. Montes-Worboys
- Department of Pneumology, Bellvitge University Hospital, Barcelona, Spain
- Pneumology Research Group, IDIBELL, University of Barcelona, Barcelona, Spain
- Research Network in Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
- Laboratori de Pneumologia Experimental (Lab. 4126). IDIBELL, Pavelló de Govern. Campus de Bellvitge, Universitat de Barcelona, Hospital de Bellvitge, Carrer de la Feixa Llarga, 08907 L’Hospitalet de Llobregat, Barcelona, Spain
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13
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Ortiz Comino R, Gil D, Minchole E, Diez-Ferrer M, Cubero N, Lopez-Lisbona R, Sanchez C, Ramos O, Esteban A, Dorca J, Rosell A. MA 20.08 Classification of Confocal Endomicroscopy Patterns for Diagnosis of Lung Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Comino RO, Morales A, Minchole E, Diez-Ferrer M, Lopez-Lisbona R, Cubero N, Dorca J, Rosell A. P1.12-009 Experience with Fully Covered Metallic Stents in Patients with Malignant Airway Obstruction. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1007] [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: 11/29/2022]
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15
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Diez-Ferrer M, Torrejon B, Baixeras N, Minchole E, Ortiz R, Cubero N, Lopez-Lisbona R, Dorca J, Rosell A. MA 20.06 Discerning Lung Cancer Cell Patterns with Confocal Endomicroscopy. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.646] [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: 10/18/2022]
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Pernas Simon S, Villagrasa Gonzalez P, Vivancos A, Prat A, Scaltriti M, Burgues O, Rodon J, Canes J, Lluch A, Llombart A, Dorca J, Perelló Martorell A, Oliveira M, Montaño A, Garcia-Estevez L, Nuciforo P, Ribas G, Rapado I, de la Pena L, Ciruelos E. AGATA molecular screening program: Implementing precision medicine in patients with advanced breast cancer in Spain. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx365.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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17
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Alcaide F, Peña MJ, Pérez-Risco D, Camprubi D, Gonzalez-Luquero L, Grijota-Camino MD, Dorca J, Santin M. Increasing isolation of rapidly growing mycobacteria in a low-incidence setting of environmental mycobacteria, 1994-2015. Eur J Clin Microbiol Infect Dis 2017; 36:1425-1432. [PMID: 28321580 DOI: 10.1007/s10096-017-2949-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/23/2017] [Indexed: 11/25/2022]
Abstract
To determine trends in incidence and clinical relevance of rapidly growing mycobacteria (RGM) in a low-prevalence region of non-tuberculous mycobacteria. We retrospectively identified all patients with RGM-positive cultures between January 1994 and December 2015. Trends in incidence, clinical significance, and outcomes were assessed. One hundred and forty patients had RGM-positive cultures (116 respiratory and 24 extra-respiratory sources). The incidence of RGM isolates increased steadily from 2003 (0.34 per 100,000) to 2015 (1.73 per 100,000), with an average annual increase of 8.3%. Thirty-two patients (22.9%) had clinical disease, which trended to cluster in the second half of the study period. A positive acid-fast bacilli smear (odds ratio [OR] 97.7, 95 % CI 13.8-689.4), the presence of extra-respiratory isolates (OR 19.4, 95 % CI 5.2-72.7), and female gender (OR 5.9, 95 % CI 1.9-19.1) were independently associated with clinical disease. Cure rates were 73.3 and 87.5% for pulmonary and extra-pulmonary disease respectively. Although the burden of disease remains low, the presence of RGM isolates is increasing in our geographical setting. Whether this rise will be sustained over time and will coincide with an increase in clinical disease, or whether it is merely a cycle in the poorly understood epidemiological behaviour of environmental mycobacteria, will be seen in the near future.
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Affiliation(s)
- F Alcaide
- Service of Microbiology, Bellvitge University Hospital-IDIBELL, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
- University of Barcelona, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M J Peña
- Service of Microbiology, Bellvitge University Hospital-IDIBELL, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - D Pérez-Risco
- Service of Microbiology, Bellvitge University Hospital-IDIBELL, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - D Camprubi
- Service of Infectious Diseases, Bellvitge University Hospital-IDIBELL, University of Barcelona, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - L Gonzalez-Luquero
- Service of Infectious Diseases, Bellvitge University Hospital-IDIBELL, University of Barcelona, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M D Grijota-Camino
- Service of Infectious Diseases, Bellvitge University Hospital-IDIBELL, University of Barcelona, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - J Dorca
- Service of Pneumology, Bellvitge University Hospital-IDIBELL, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
- University of Barcelona, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Santin
- Service of Infectious Diseases, Bellvitge University Hospital-IDIBELL, University of Barcelona, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
- University of Barcelona, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
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18
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Martin-Castillo B, Lopez-Bonet E, Cuyàs E, Viñas G, Pernas S, Dorca J, Menendez JA. Cancer stem cell-driven efficacy of trastuzumab (Herceptin): towards a reclassification of clinically HER2-positive breast carcinomas. Oncotarget 2016; 6:32317-38. [PMID: 26474458 PMCID: PMC4741696 DOI: 10.18632/oncotarget.6094] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 08/01/2015] [Accepted: 09/24/2015] [Indexed: 12/21/2022] Open
Abstract
Clinically HER2+ (cHER2+) breast cancer (BC) can no longer be considered a single BC disease entity in terms of trastuzumab responsiveness. Here we propose a framework for predicting the response of cHER2+ to trastuzumab that integrates the molecular distinctions of intrinsic BC subtypes with recent knowledge on cancer stem cell (CSC) biology. First, we consider that two interchangeable populations of epithelial-like, aldehyde dehydrogenase (ALDH)-expressing and mesenchymal-like, CD44+CD24-/low CSCs can be found in significantly different proportions across all intrinsic BC subtypes. Second, we overlap all the intrinsic subtypes across cHER2+ BC to obtain a continuum of mixed phenotypes in which one extreme exhibits a high identity with ALDH+ CSCs and the other extreme exhibits a high preponderance of CD44+CD24-/low CSCs. The differential enrichment of trastuzumab-responsive ALDH+ CSCs versus trastuzumab-refractory CD44+CD24-/low CSCs can explain both the clinical behavior and the primary efficacy of trastuzumab in each molecular subtype of cHER2+ (i.e., HER2-enriched/cHER2+, luminal A/cHER2+, luminal B/cHER2+, basal/cHER2+, and claudin-low/cHER2+). The intrinsic plasticity determining the epigenetic ability of cHER2+ tumors to switch between epithelial and mesenchymal CSC states will vary across the continuum of mixed phenotypes, thus dictating their intratumoral heterogeneity and, hence, their evolutionary response to trastuzumab. Because CD44+CD24-/low mesenchymal-like CSCs distinctively possess a highly endocytic activity, the otherwise irrelevant HER2 can open the door to a type of "Trojan horse" approach by employing antibody-drug conjugates such as T-DM1, which will allow a rapid and CSC-targeted delivery of cytotoxic drugs to therapeutically manage trastuzumab-unresponsive basal/cHER2+ BC. Contrary to the current dichotomous model used clinically, our model proposes that a reclassification of cHER2+ tumors based on the spectrum of molecular BC subtypes might inform on their CSC-determined sensitivity to trastuzumab, thus providing a better delineation of the predictive value of cHER2+ in BC by incorporating CSCs-driven intra-tumor heterogeneity into clinical decisions.
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Affiliation(s)
- Begoña Martin-Castillo
- Unit of Clinical Research, Catalan Institute of Oncology, Girona, Catalonia, Spain.,Molecular Oncology Group, Girona Biomedical Research Institute (IDIBGI), Girona, Catalonia, Spain.,Department of Biochemistry and Molecular Biology II, Faculty of Pharmacy, Complutense University, Madrid, Spain
| | - Eugeni Lopez-Bonet
- Department of Anatomical Pathology, Dr. Josep Trueta Hospital of Girona, Girona, Catalonia, Spain
| | - Elisabet Cuyàs
- Molecular Oncology Group, Girona Biomedical Research Institute (IDIBGI), Girona, Catalonia, Spain.,ProCURE (Program Against Cancer Therapeutic Resistance), Metabolism and Cancer Group, Catalan Institute of Oncology, Girona, Catalonia, Spain
| | - Gemma Viñas
- Molecular Oncology Group, Girona Biomedical Research Institute (IDIBGI), Girona, Catalonia, Spain.,Department of Medical Oncology, Catalan Institute of Oncology, Girona, Catalonia, Spain
| | - Sonia Pernas
- Department of Medical Oncology, Breast Unit, Catalan Institute of Oncology-Hospital Universitari de Bellvitge-Bellvitge Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Joan Dorca
- Molecular Oncology Group, Girona Biomedical Research Institute (IDIBGI), Girona, Catalonia, Spain.,Department of Medical Oncology, Catalan Institute of Oncology, Girona, Catalonia, Spain
| | - Javier A Menendez
- Molecular Oncology Group, Girona Biomedical Research Institute (IDIBGI), Girona, Catalonia, Spain.,ProCURE (Program Against Cancer Therapeutic Resistance), Metabolism and Cancer Group, Catalan Institute of Oncology, Girona, Catalonia, Spain
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19
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Simonetti AF, Garcia-Vidal C, Viasus D, García-Somoza D, Dorca J, Gudiol F, Carratalà J. Declining mortality among hospitalized patients with community-acquired pneumonia. Clin Microbiol Infect 2016; 22:567.e1-7. [PMID: 27021421 DOI: 10.1016/j.cmi.2016.03.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 01/25/2016] [Accepted: 03/13/2016] [Indexed: 11/15/2022]
Abstract
Little information is available on the changes over time in community-acquired pneumonia (CAP) management and their impact on 30-day mortality in hospitalized patients. We performed a prospective, observational study of non-severely immunosuppressed hospitalized adults with CAP from 1995 to 2014. A total of 4558 patients were included. Thirty-day mortality decreased from 9.6% in the first study period (1995-99) to 4.1% in the last period (2010-14); with a progressive downward trend (-0.2% death/year; p for trend = 0.003). Over time, patients were older (p 0.02), had more co-morbidities (p 0.037), more frequently presented severe illness according to the Pneumonia Severity Index (p <0.001) and septic shock (p <0.001), and more often required intensive care unit admission (p <0.001). Combination antibiotic therapy (p <0.001) and fluoroquinolone use (p <0.001) increased. Factors independently associated with 30-day mortality were increasing age (OR 1.04; 95% CI 1.03-1.05), co-morbidities (OR 1.48; 95% CI 1.04-2.11), shock at admission (OR 4.95; 95% CI 3.49-7.00), respiratory failure (OR 1.89; 95% CI 1.42-2.52), bacteraemia (OR 2.16; 95% CI 1.58-2.96), Gram-negative bacilli aetiology (OR 4.79; 95% CI 2.52-9.10) and fluoroquinolone use (OR 0.45; 95% CI 0.29-0.71). When we adjusted for a propensity score to receive fluoroquinolones, the protective effect of fluoroquinolone use was not confirmed. In conclusion, 30-day mortality decreased significantly over time in hospitalized patients with CAP in spite of an upward trend in patient age and other factors associated with poor outcomes. Several changes in the management of CAP and a general improvement in global care over time may have caused the observed outcomes.
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Affiliation(s)
- A F Simonetti
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain
| | - C Garcia-Vidal
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI), Madrid, Spain.
| | - D Viasus
- Division of Health Sciences, Faculty of Medicine, Universidad del Norte, and Hospital Universidad del Norte, Barranquilla, Colombia
| | - D García-Somoza
- Department of Microbiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - J Dorca
- Department of Respiratory Diseases, Hospital Universitari de Bellvitge Barcelona, Spain
| | - F Gudiol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI), Madrid, Spain; Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI), Madrid, Spain; Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
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20
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Rosell A, Rodríguez N, Monsó E, Taron M, Millares L, Ramírez JL, López-Lisbona R, Cubero N, Andreo F, Sanz J, Llatjós M, Llatjós R, Fernández-Figueras MT, Mate JL, Català I, Setó L, Roset M, Díez-Ferrer M, Dorca J. Aberrant gene methylation and bronchial dysplasia in high risk lung cancer patients. Lung Cancer 2016; 94:102-7. [PMID: 26973214 DOI: 10.1016/j.lungcan.2016.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 12/29/2015] [Accepted: 02/02/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The risk for lung cancer is incremented in high degree dysplasia (HGD) and in subjects with hypermethylation of multiple genes. We sought to establish the association between them, as well as to analyze the DNA aberrant methylation in sputum and in bronchial washings (BW). METHODS Cross sectional study of high risk patients for lung cancer in whom induced sputum and autofluorescence bronchoscopy were performed. The molecular analysis was determined on DAPK1, RASSF1A and p16 genes using Methylation-specific PCR. RESULTS A total of 128 patients were enrolled in the study. Dysplasia lesions were found in 79 patients (61.7%) and high grade dysplasia in 20 (15.6%). Ninety eight patients out of 128 underwent molecular analysis. Methylation was observed in bronchial secretions (sputum or BW) in 60 patients (61.2%), 51 of them (52%) for DAPK1, in 20 (20.4%) for p16 and in three (3.1%) for RASSF1A. Methylated genes only found in sputum accounted for 38.3% and only in BW in 41.7%, and in both 20.0%. In the 11.2% of the patients studied, HGD and a hypermethylated gene were present, while for the 55.1% of the sample only one of both was detected and for the rest of the subjects (33.6%), none of the risk factors were observed. CONCLUSIONS Our data determines DNA aberrant methylation panel in bronchial secretions is present in a 61.2% and HGD is found in 15.6%. Although both parameters have previously been identified as risk factors for lung cancer, the current study does not find a significative association between them. The study also highlights the importance of BW as a complementary sample to induced sputum when analyzing gene aberrant methylation.
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Affiliation(s)
- A Rosell
- Department of Respiratory Medicine, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Mallorca, Spain.
| | - N Rodríguez
- Department of Respiratory Medicine, Hospital Comarcal de l'Alt Penedès, Vilafranca, Barcelona, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Mallorca, Spain
| | - E Monsó
- Deparment of Respiratory Medicine, Fundació Parc Taulí, Sabadell, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Mallorca, Spain
| | - M Taron
- Laboratory of Molecular Biology, Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - L Millares
- Fundació Parc Taulí, Sabadell, Barcelona, Spain
| | - J L Ramírez
- Laboratory of Molecular Biology, Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - R López-Lisbona
- Department of Respiratory Medicine, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Mallorca, Spain
| | - N Cubero
- Department of Respiratory Medicine, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Mallorca, Spain
| | - F Andreo
- Department of Respiratory Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Mallorca, Spain
| | - J Sanz
- Department of Respiratory Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Mallorca, Spain
| | - M Llatjós
- Department of Pathology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - R Llatjós
- Department of Pathology, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M T Fernández-Figueras
- Department of Pathology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J L Mate
- Department of Pathology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - I Català
- Department of Pathology, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - L Setó
- Department of Respiratory Medicine, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Roset
- IMS Health, Barcelona, Spain
| | - M Díez-Ferrer
- Department of Respiratory Medicine, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Mallorca, Spain
| | - J Dorca
- Department of Respiratory Medicine, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Mallorca, Spain
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Vogelmeier C, Paggiaro P, Dorca J, Sliwinski P, Mallet M, Kirsten AM, Seoane B, Segarra RM, Leselbaum A, Gil EG. Efficacy of aclidinium/formoterol fixed-dose combination versus salmeterol/fluticasone in COPD. Pneumologie 2016. [DOI: 10.1055/s-0036-1572048] [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: 10/22/2022]
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22
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Martin-Castillo B, Lopez-Bonet E, Buxó M, Dorca J, Tuca-Rodríguez F, Ruano MA, Colomer R, Menendez JA. Cytokeratin 5/6 fingerprinting in HER2-positive tumors identifies a poor prognosis and trastuzumab-resistant basal-HER2 subtype of breast cancer. Oncotarget 2016; 6:7104-22. [PMID: 25742793 PMCID: PMC4466672 DOI: 10.18632/oncotarget.3106] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 12/22/2014] [Accepted: 01/08/2015] [Indexed: 12/19/2022] Open
Abstract
There is an urgent need to refine the prognostic taxonomy of HER2+ breast carcinomas and develop easy-to-use, clinic-based prediction algorithms to distinguish between good- and poor-responders to trastuzumab-based therapy. Building on earlier studies suggesting that HER2+ tumors enriched with molecular and morpho-immunohistochemical features classically ascribed to basal-like tumors are highly aggressive and refractory to trastuzumab, we investigated the prognostic and predictive value of the basal-HER2+ phenotype in HER2-overexpressing tumors. Our retrospective cohort study of a consecutive series of 152 HER2+ primary invasive ductal breast carcinomas first confirmed the existence of a distinct subgroup co-expressing HER2 protein and basal cytokeratin markers CK5/6, the so-called basal-HER2+ phenotype. Basal-HER2+ phenotype (≥10% of cells showing positive CK5/6 staining), but not estrogen receptor status, was significantly associated with inferior overall survival by univariate analysis and predicted worsened disease free survival after accounting for strong prognostic variables such as tumor size at diagnosis in stepwise multivariate analysis. In the sub-cohort of HER2+ patients treated with trastuzumab-based adjuvant/neoadjuvant therapy, basal-HER2+ phenotype was found to be the sole independent prognostic marker for a significantly inferior time to treatment failure in multivariate analysis. A CK5/6-based immunohistochemical fingerprint may provide a simple, rapid, and accurate method for re-classifying women diagnosed with HER2+ breast cancer in a manner that can improve prognosis and therapeutic planning in patients with clinically aggressive basal-HER2+ tumors who are not likely to benefit from trastuzumab-based therapy.
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Affiliation(s)
- Begoña Martin-Castillo
- Unit of Clinical Research, Catalan Institute of Oncology, Girona, Catalonia, Spain.,Girona Biomedical Research Institute (IDIBGI), Molecular Oncology Group, Girona, Catalonia, Spain
| | - Eugeni Lopez-Bonet
- Girona Biomedical Research Institute (IDIBGI), Molecular Oncology Group, Girona, Catalonia, Spain.,Department of Anatomical Pathology, Dr. Josep Trueta Hospital of Girona, Girona, Catalonia, Spain
| | - Maria Buxó
- Girona Biomedical Research Institute (IDIBGI), Molecular Oncology Group, Girona, Catalonia, Spain.,Epidemiology Unit and Cancer Registry of Girona (UERCG), Catalan Cancer Plan, Catalan Health Government, Girona, Catalonia, Spain.,Department of Nursing, Universitat de Girona (UdG), Girona, Catalonia, Spain
| | - Joan Dorca
- Medical Oncology Department, Catalan Institute of Oncology, Girona, Catalonia, Spain
| | | | - Miguel Alonso Ruano
- Department of Gynecology, Dr. Josep Trueta Hospital of Girona, Girona, Catalonia, Spain
| | - Ramon Colomer
- Breast Cancer Clinical Research Unit, CNIO-Spanish National Cancer Research Center, Madrid, Spain.,Medical Oncology Department, Hospital La Princesa, Madrid, Spain
| | - Javier A Menendez
- Girona Biomedical Research Institute (IDIBGI), Molecular Oncology Group, Girona, Catalonia, Spain.,Translational Research Laboratory, Catalan Institute of Oncology (ICO), Girona, Catalonia, Spain
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Aparicio J, Maroto P, García del Muro X, Sánchez-Muñoz A, Gumà J, Margelí M, Sáenz A, Sagastibelza N, Castellano D, Arranz J, Hervás D, Bastús R, Fernández-Aramburo A, Sastre J, Terrasa J, López-Brea M, Dorca J, Almenar D, Carles J, Hernández A, Germà J. Prognostic factors for relapse in stage I seminoma: a new nomogram derived from three consecutive, risk-adapted studies from the Spanish Germ Cell Cancer Group (SGCCG). Ann Oncol 2014; 25:2173-2178. [DOI: 10.1093/annonc/mdu437] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Steger G, Dominguez A, Switsers O, Dobrovolskaya N, Giotta F, Glogowska I, Tubiana-Mathieu N, Pecherstorfer M, Ardizzoia A, Bougnoux P, Blasinska-Morawiec M, Veyret C, Garcia S, Dorca J, Marth C, Manikhas A, Benasso M, Protsenko S, Villanova G, Espinosa E. Phase Ii Study Evaluating Oral Vinorelbine As a Single-Agent As First-Line Chemotherapy for Metastatic Breast Cancer Patients with Bone Metastases (Norbreast-228 Trial): First Efficacy Results. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu329.52] [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: 11/14/2022] Open
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25
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Simonetti A, Viasus D, Garcia-Vidal C, Grillo S, Molero L, Dorca J, Carratalà J. Impact of pre-hospital antibiotic use on community-acquired pneumonia. Clin Microbiol Infect 2014; 20:O531-7. [DOI: 10.1111/1469-0691.12524] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 12/02/2013] [Accepted: 12/21/2013] [Indexed: 11/29/2022]
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26
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Cufí S, Corominas-Faja B, Lopez-Bonet E, Bonavia R, Pernas S, López IÁ, Dorca J, Martínez S, López NB, Fernández SD, Cuyàs E, Visa J, Rodríguez-Gallego E, Quirantes-Piné R, Segura-Carretero A, Joven J, Martin-Castillo B, Menendez JA. Dietary restriction-resistant human tumors harboring the PIK3CA-activating mutation H1047R are sensitive to metformin. Oncotarget 2014; 4:1484-95. [PMID: 23986086 PMCID: PMC3824528 DOI: 10.18632/oncotarget.1234] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [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] [Indexed: 12/20/2022] Open
Abstract
Cancer cells expressing constitutively active phosphatidylinositol-3 kinase (PI3K) are proliferative regardless of the absence of insulin, and they form dietary restriction (DR)-resistant tumors in vivo. Because the binding of insulin to its receptors activates the PI3K/AKT/mammalian target of rapamycin (mTOR) signaling cascade, activating mutations in the PIK3CA oncogene may determine tumor response to DR-like pharmacological strategies targeting the insulin and mTOR pathways. The anti-diabetic drug metformin is a stereotypical DR mimetic that exerts its anti-cancer activity through a dual mechanism involving insulin-related (systemic) and mTOR-related (cell-autonomous) effects. However, it remains unclear whether PIK3CA-activating mutations might preclude the anti-cancer activity of metformin in vivo. To model the oncogenic PIK3CA-driven early stages of cancer, we used the clonal breast cancer cell line MCF10DCIS.com, which harbors the gain-of-function H1047R hot-spot mutation in the catalytic domain of the PI3KCA gene and has been shown to form DR-refractory xenotumors. To model PIK3CA-activating mutations in late stages of cancer, we took advantage of the isogenic conversion of a PIK3CA-wild-type tumor into a PIK3CA H1047R-mutated tumor using the highly metastatic colorectal cancer cell line SW48. MCF10DCIS.com xenotumors, although only modestly affected by treatment with oral metformin (approximately 40% tumor growth inhibition), were highly sensitive to the intraperitoneal (i.p.) administration of metformin, the anti-cancer activity of which increased in a time-dependent manner and reached >80% tumor growth inhibition by the end of the treatment. Metformin treatment via the i.p. route significantly reduced the proliferation factor mitotic activity index (MAI) and decreased tumor cellularity in MCF10DCIS.com cancer tissues. Whereas SW48-wild-type (PIK3CA+/+) cells rapidly formed metformin-refractory xenotumors in mice, ad libitum access to water containing metformin significantly reduced the growth of SW48-mutated (PIK3CAH1047R/+) xenotumors by approximately 50%. Thus, metformin can no longer be considered as a bona fide DR mimetic, at least in terms of anti-cancer activity, because tumors harboring the insulin-unresponsive, DR-resistant, PIK3CA-activating mutation H1047R remain sensitive to the anti-tumoral effects of the drug. Given the high prevalence of PIK3CA mutations in human carcinomas and the emerging role of PIK3CA mutation status in the treatment selection process, these findings might have a significant impact on the design of future trials evaluating the potential of combining metformin with targeted therapy.
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Affiliation(s)
- Sílvia Cufí
- Metabolism and Cancer Group, Translational Research Laboratory, Catalan Institute of Oncology, Girona, Catalonia, Spain
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Rojo F, Lluch A, Ruiz A, Ruiz-Borrego M, Barnadas A, Calvo L, Gonzalez S, Margeli M, Rodriguez-Lescure A, Anton A, Seguí MA, Munoz-Mateu M, Dorca J, Lopez-Vega JM, Jara-Sanchez C, Martin N, Casas M, Carrasco EM, Caballero R, Martin M. Subtype analysis from the GEICAM/2003-02 study: High-risk, node-negative breast cancer patients treated with adjuvant fluorouracil, doxorubicin, and cyclophosphamide (FAC) versus FAC followed by weekly paclitaxel. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.11107] [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: 11/20/2022] Open
Affiliation(s)
- Federico Rojo
- Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | - Ana Lluch
- Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Amparo Ruiz
- Instituto Valenciano de Oncología, Valencia, Spain
| | | | | | - Lourdes Calvo
- Complejo Hospitalario Universitario de A Coruña, A Coruna, Spain
| | | | - Mireia Margeli
- Institut Català d'Oncologia - Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Antonio Anton
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | - Joan Dorca
- Institut Catala d'Oncologia Girona, Girona, Spain
| | | | | | | | | | | | | | - Miguel Martin
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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Viñas G, Oliveras G, Perez-Bueno F, Giro A, Blancafort A, Puig-Vives M, Marcos-Gragera R, Dorca J, Brunet J, Puig T. Abstract P4-09-11: Fatty Acid Synthase (FASN) expression in Triple-Negative Breast Cancer. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p4-09-11] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In approximately 15–20% of patients with breast cancer, the tumors do not express estrogen receptor (ER), progesterone receptor (PR) and do not have amplification of HER2. These tumors are called triple-negative breast cancer (TNBC) and patients with these tumors have a poor prognosis. There is no clinically validated, molecularly targeted therapy for TNBC patients and they can be treated only with chemotherapy. Thus, the identification of a novel targeted therapies for TNBC patients would be of great benefit. Fatty acid synthase (FASN) is a multi-enzyme protein that catalyzes fatty acid synthesis. Its main reaction is to synthesize palmitate from acetyl-CoA and malonyl-CoA, in the presence of NADPH, into long-chain saturated fatty acids. Expression levels of FASN are low or undetectable in normal human tissues except for the liver and the adipose tissue. In contrast, high levels of FASN expression have been detected in several human carcinomas. Several reports highlight that FASN overexpression in tumor samples correlates with progression, aggressiveness and metastatic potential of the disease. Previously, our group has shown that FASN activity inhibition induces apoptosis in several human cancer cells. The aim of our study was to evaluate the expression of tumor levels of FASN in triple-negative breast cancer patients.
Methods: FASN tumor expression was retrospectively evaluated in 30 paraffin-embedded core-biopsies of 30 patients with TNBC using the Fatty Acid Synthase polyclonal antibody (Assay design, Enzo Life Sciences, Exeter United Kingdom) and the detection kit EnVision™ (DAKO, Glostrup, Denmark). FASN expression levels were determined by immunohistochemistry (IHC) using the AutostainerPlus Link (DAKO). FASN expression was graded from 0 to 3+, meaning 0–1+ normal amounts of FASN protein compared to non-tumor breast tissue, 2+ moderate amounts and 3+ highest levels of FASN expression. In vitro, we have determined the effect of the FASN-inhibitors, EGCG and G28UCM, on cell viability (measured by the MTT assay) and apoptosis [as assessed by cleavage of poly(ADP-ribose) polymerase (PARP)] of two TNBC cell lines, MDA-MB-231 and MDA-MB-468.
Results: From 30 patients with TNBC, 66.6% (20/30) of the patients had a high expression of FASN (FASN 3+) and 33.3% (10/30) had a moderate expression of FASN (FAS 2+). None of the tumors had lack of FASN expression analysed by immunohistochemistry. In vitro, the FASN-inhibitor G28UCM induced apoptosis and showed low IC50 values of citotoxicity in both, MDA-MB-231 and MDA-MB-468 TNBC cell lines.
Conclusions: FASN is overexpressed in triple-negative breast cancer tumors. The absence of target therapies for this breast cancer subtype and its poor prognosis lead to the exploration of FASN as therapeutic target for TNBC patients.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-09-11.
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Affiliation(s)
- G Viñas
- Catalan Institute of Oncology and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; University of Girona and Biomedical Research Institute (IDIBGi), Girona, Spain; Dr. Josep Trueta Hospital and Catalan Institute of Health (ICS), Girona, Spain; Catalan Institute of Oncology, Girona, Spain; University of Girona, Spain
| | - G Oliveras
- Catalan Institute of Oncology and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; University of Girona and Biomedical Research Institute (IDIBGi), Girona, Spain; Dr. Josep Trueta Hospital and Catalan Institute of Health (ICS), Girona, Spain; Catalan Institute of Oncology, Girona, Spain; University of Girona, Spain
| | - F Perez-Bueno
- Catalan Institute of Oncology and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; University of Girona and Biomedical Research Institute (IDIBGi), Girona, Spain; Dr. Josep Trueta Hospital and Catalan Institute of Health (ICS), Girona, Spain; Catalan Institute of Oncology, Girona, Spain; University of Girona, Spain
| | - A Giro
- Catalan Institute of Oncology and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; University of Girona and Biomedical Research Institute (IDIBGi), Girona, Spain; Dr. Josep Trueta Hospital and Catalan Institute of Health (ICS), Girona, Spain; Catalan Institute of Oncology, Girona, Spain; University of Girona, Spain
| | - A Blancafort
- Catalan Institute of Oncology and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; University of Girona and Biomedical Research Institute (IDIBGi), Girona, Spain; Dr. Josep Trueta Hospital and Catalan Institute of Health (ICS), Girona, Spain; Catalan Institute of Oncology, Girona, Spain; University of Girona, Spain
| | - M Puig-Vives
- Catalan Institute of Oncology and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; University of Girona and Biomedical Research Institute (IDIBGi), Girona, Spain; Dr. Josep Trueta Hospital and Catalan Institute of Health (ICS), Girona, Spain; Catalan Institute of Oncology, Girona, Spain; University of Girona, Spain
| | - R Marcos-Gragera
- Catalan Institute of Oncology and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; University of Girona and Biomedical Research Institute (IDIBGi), Girona, Spain; Dr. Josep Trueta Hospital and Catalan Institute of Health (ICS), Girona, Spain; Catalan Institute of Oncology, Girona, Spain; University of Girona, Spain
| | - J Dorca
- Catalan Institute of Oncology and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; University of Girona and Biomedical Research Institute (IDIBGi), Girona, Spain; Dr. Josep Trueta Hospital and Catalan Institute of Health (ICS), Girona, Spain; Catalan Institute of Oncology, Girona, Spain; University of Girona, Spain
| | - J Brunet
- Catalan Institute of Oncology and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; University of Girona and Biomedical Research Institute (IDIBGi), Girona, Spain; Dr. Josep Trueta Hospital and Catalan Institute of Health (ICS), Girona, Spain; Catalan Institute of Oncology, Girona, Spain; University of Girona, Spain
| | - T Puig
- Catalan Institute of Oncology and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; University of Girona and Biomedical Research Institute (IDIBGi), Girona, Spain; Dr. Josep Trueta Hospital and Catalan Institute of Health (ICS), Girona, Spain; Catalan Institute of Oncology, Girona, Spain; University of Girona, Spain
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Puig T, Blancafort A, Casoliva G, Oliveras G, Casas M, Buxo M, Saiz E, Viñas G, Dorca J, Porta R. Abstract P4-09-10: Prospective Analysis of Fatty Acid Synthase (FASN) in Breast Cancer Tissue of Early-Stage Breast Cancer Patients. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p4-09-10] [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: Cancer cells require nutrients to survive in the unfavorable microenvironment of primary solid tumors or metastases before angiogenesis development. Fatty acid synthase (FASN) is a multi-enzyme protein that catalyzes fatty acid synthesis. Expression levels of FASN are low or undetectable in normal human tissues except for the liver and the adipose tissue. In contrast, high levels of FASN expression have been detected in breast cancer tumors and other human carcinomas. Several reports highlight that FASN overexpression in tumor samples correlates with progression, aggressiveness and metastatic potential of the disease. In adition, some studies have suggested the same correlation with serum levels of FASN. Our aim was to analyze the association between the expression of tumor and serum levels of FASN with clinical and pathological prognostic factors in early-stage breast cancer patients.
Methods: Fifty-five patients with early-stage breast cancer treated with surgery and post-operative chemotherapy were included in the study. We prospectively measured the levels of FASN in tumor and serum samples. Clinical data included demographic characteristics, menarche, pregnancy, breast feeding, menopausal status and body mass index (BMI). Pathological and molecular data included: pathological state, histological grade, estrogen and progesterone receptors, HER2 status, p53 mutation and Ki 67 levels. FASN tissue expression levels were determined by IHC and circulating FASN levels were determined by ELISA. FASN expression was graded from 0 to 3+, meaning 0–1+ normal amounts of FASN protein compared to non-tumor breast tissue, 2+ moderate amounts and 3+ the highest levels of FASN expression. Baseline characteristics were summarized descriptively. Categorical variables were compared by c2 or Fisher's exact. For continuous variables, if the data are approximately normal, the two groups were compared using ANOVA. If the normality assumption is not warranted, then the Kruskall-Wallis test has been used.
Results: Median age was 49 (rage 33–77). 51% of the patients were menopausal and median BMI was 24,75. Thirty-four percent of the patients had stage I, 51% stage II and 15% stage III. We observed a statistically significant association between FASN over expression and the lack of progesterone receptors (p = 0.027) in tumor samples. In contrast, we found no relation between FASN and estrogen receptor nor between FASN and HER2 tumor expression in this setting. Menopause and age were strongly related to higher levels of FASN tumor expression (p < 0.001). Patients with higher BMI had higher levels of FASN in tumor tissue although this association was not statistically significant (p = 0.07). Finally, we observed a positive relation between breast cancer stage and the levels of FASN tumor (p = 0.05). In contrast, circulating FASN levels were not associated with any pathological or clinical prognostic factor.
Conclusions: Our study suggests that FASN overexpression is significantly related to age, menopausal status, more advanced stages and lack of progesterone receptor expression in early-stage breast cancer patients. However, no relation between serum levels of FASN and the clinical or molecular prognostic factors have been observed.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-09-10.
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Affiliation(s)
- T Puig
- University of Girona and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; Assistència Sanitària Institute, Girona, Spain; Catalan Institute of Oncology, Girona, Spain; Dr. Josep Trueta Hospital, Girona, Spain; Dr. Josep Trueta Hospital and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; Health Inequalities Research Group - Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain; Dr. Josep Trueta Hospitaland Girona Biomedical Research Institute (IDIBGi), Girona, Spain
| | - A Blancafort
- University of Girona and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; Assistència Sanitària Institute, Girona, Spain; Catalan Institute of Oncology, Girona, Spain; Dr. Josep Trueta Hospital, Girona, Spain; Dr. Josep Trueta Hospital and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; Health Inequalities Research Group - Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain; Dr. Josep Trueta Hospitaland Girona Biomedical Research Institute (IDIBGi), Girona, Spain
| | - G Casoliva
- University of Girona and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; Assistència Sanitària Institute, Girona, Spain; Catalan Institute of Oncology, Girona, Spain; Dr. Josep Trueta Hospital, Girona, Spain; Dr. Josep Trueta Hospital and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; Health Inequalities Research Group - Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain; Dr. Josep Trueta Hospitaland Girona Biomedical Research Institute (IDIBGi), Girona, Spain
| | - G Oliveras
- University of Girona and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; Assistència Sanitària Institute, Girona, Spain; Catalan Institute of Oncology, Girona, Spain; Dr. Josep Trueta Hospital, Girona, Spain; Dr. Josep Trueta Hospital and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; Health Inequalities Research Group - Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain; Dr. Josep Trueta Hospitaland Girona Biomedical Research Institute (IDIBGi), Girona, Spain
| | - M Casas
- University of Girona and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; Assistència Sanitària Institute, Girona, Spain; Catalan Institute of Oncology, Girona, Spain; Dr. Josep Trueta Hospital, Girona, Spain; Dr. Josep Trueta Hospital and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; Health Inequalities Research Group - Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain; Dr. Josep Trueta Hospitaland Girona Biomedical Research Institute (IDIBGi), Girona, Spain
| | - M Buxo
- University of Girona and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; Assistència Sanitària Institute, Girona, Spain; Catalan Institute of Oncology, Girona, Spain; Dr. Josep Trueta Hospital, Girona, Spain; Dr. Josep Trueta Hospital and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; Health Inequalities Research Group - Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain; Dr. Josep Trueta Hospitaland Girona Biomedical Research Institute (IDIBGi), Girona, Spain
| | - E Saiz
- University of Girona and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; Assistència Sanitària Institute, Girona, Spain; Catalan Institute of Oncology, Girona, Spain; Dr. Josep Trueta Hospital, Girona, Spain; Dr. Josep Trueta Hospital and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; Health Inequalities Research Group - Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain; Dr. Josep Trueta Hospitaland Girona Biomedical Research Institute (IDIBGi), Girona, Spain
| | - G Viñas
- University of Girona and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; Assistència Sanitària Institute, Girona, Spain; Catalan Institute of Oncology, Girona, Spain; Dr. Josep Trueta Hospital, Girona, Spain; Dr. Josep Trueta Hospital and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; Health Inequalities Research Group - Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain; Dr. Josep Trueta Hospitaland Girona Biomedical Research Institute (IDIBGi), Girona, Spain
| | - J Dorca
- University of Girona and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; Assistència Sanitària Institute, Girona, Spain; Catalan Institute of Oncology, Girona, Spain; Dr. Josep Trueta Hospital, Girona, Spain; Dr. Josep Trueta Hospital and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; Health Inequalities Research Group - Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain; Dr. Josep Trueta Hospitaland Girona Biomedical Research Institute (IDIBGi), Girona, Spain
| | - R Porta
- University of Girona and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; Assistència Sanitària Institute, Girona, Spain; Catalan Institute of Oncology, Girona, Spain; Dr. Josep Trueta Hospital, Girona, Spain; Dr. Josep Trueta Hospital and Girona Biomedical Research Institute (IDIBGi), Girona, Spain; Health Inequalities Research Group - Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain; Dr. Josep Trueta Hospitaland Girona Biomedical Research Institute (IDIBGi), Girona, Spain
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Cufi S, Corominas-Faja B, Vazquez-Martin A, Oliveras-Ferraros C, Dorca J, Bosch-Barrera J, Martin-Castillo B, Menendez JA. Metformin-induced preferential killing of breast cancer initiating CD44+CD24-/low cells is sufficient to overcome primary resistance to trastuzumab in HER2+ human breast cancer xenografts. Oncotarget 2012; 3:395-8. [PMID: 22565037 PMCID: PMC3380574 DOI: 10.18632/oncotarget.488] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [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] [Indexed: 11/25/2022] Open
Abstract
Trastuzumab-refractory breast cancer stem cells (CSCs) could also explain the high rate of primary resistance to single-agent trastuzumab in HER2 gene-amplified breast cancer patients. The identification of agents with strong selective toxicity for trastuzumab-resistant breast CSCs may have tremendous relevance for how HER2+ breast cancer patients should be treated. Using the human breast cancer cell line JIMT-1, which was established from the pleural metastasis of a patient who was clinically resistant to trastuzumab ab initio, we examined whether preferential killing of the putative CD44+CD24-/low breast CSC population might be sufficient to overcome primary resistance to trastuzumab in vivo. Because recent studies have shown that the anti-diabetic biguanide metformin can exert antitumor effects by targeted killing of CSC-like cells, we explored whether metformin's ability to preferentially kill breast cancer initiating CD44+CD24-/low cells may have the potential to sensitize JIMT-1 xenograft mouse models to trastuzumab. Upon isolation for breast cancer initiating CD44+CD24-/low cells by employing magnetic activated cell sorting, we observed the kinetics of metformin-induced killing drastically varied among CSC and non-CSC subpopulations. Metformin's cell killing effect increased dramatically by more than 10-fold in CD44+CD24-/low breast CSC cells compared to non-CD44+CD24-/low immunophenotypes. While seven-weeks treatment length with trastuzumab likewise failed to reduce tumor growth of JIMT-1 xenografts, systemic treatment with metformin as single agent resulted in a significant two-fold reduction in tumor volume. When trastuzumab was combined with concurrent metformin, tumor volume decreased sharply by more than four-fold. Given that metformin-induced preferential killing of breast cancer initiating CD44+CD24-/low subpopulations is sufficient to overcome in vivo primary resistance to trastuzumab, the incorporation of metformin into trastuzumab-based regimens may provide a valuable strategy for treatment of HER2+ breast cancer patients.
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Affiliation(s)
- Silvia Cufi
- Translational Research Laboratory, Catalan Institute of Oncology (ICO), Girona, Spain
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Simonetti A, Viasus D, Garcia-Vidal C, Adamuz J, Roset A, Manresa F, Dorca J, Gudiol F, Carratalà J. Timing of antibiotic administration and outcomes of hospitalized patients with community-acquired and healthcare-associated pneumonia. Clin Microbiol Infect 2011; 18:1149-55. [PMID: 22115052 DOI: 10.1111/j.1469-0691.2011.03709.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The effects of antibiotic timing on outcomes of patients with community-acquired pneumonia (CAP) are controversial. Moreover, no information is available regarding this issue in healthcare-associated pneumonia (HCAP). We aimed to determine the impact of antibiotic timing on 30-day mortality of patients with CAP and HCAP. Non-immunocompromised adults admitted to hospital through the emergency department (ED) with community-onset pneumonia were prospectively observed from 2001 to 2009. Patients who received prior antibiotics were excluded. Of 1593 patients with pneumonia who were analyzed, 1274 had CAP and 319 HCAP. The mean time from patient arrival at the ED until antibiotic administration was 5.8 h (standard deviation (SD) 3.5) in CAP and 6.1 h (SD 3.8) in HCAP (p 0.30). Mortality was higher in patients with HCAP (5.5% vs. 13.5%; p <0.001). After adjusting for confounding factors in a logistic regression analysis, the antibiotic administration ≤4 h was not associated with decreased 30-day mortality in patients with CAP (odds ratio (OR) 1.12, 95% confidence interval (CI) 0.57-2.21) and in patients with HCAP (OR 0.59, 95% CI 0.19-1.83). Similarly, antibiotic administration ≤8 h was not associated with decreased 30-day mortality in CAP (OR 1.58, 95% CI 0.64-3.88) and HCAP patients (OR 0.59, 95% CI 0.19-1.83). In conclusion, antibiotic administration within 4 or 8 h of arrival at the ED did not improve 30-day survival in hospitalized adults for CAP or HCAP.
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Affiliation(s)
- A Simonetti
- Service of Infectious Diseases, Hospital Universitari de Bellvitge, Feixa Llarga s/n, L'Hospitalet de Llobregat, Barcelona, Spain
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Garcia-Vidal C, Viasus D, Roset A, Adamuz J, Verdaguer R, Dorca J, Gudiol F, Carratalà J. Low incidence of multidrug-resistant organisms in patients with healthcare-associated pneumonia requiring hospitalization. Clin Microbiol Infect 2011; 17:1659-65. [DOI: 10.1111/j.1469-0691.2011.03484.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gasa M, Salord N, Fortuna AM, Mayos M, Vilarrasa N, Dorca J, Montserrat JM, Bonsignore MR, Monasterio C. Obstructive sleep apnoea and metabolic impairment in severe obesity. Eur Respir J 2011; 38:1089-97. [PMID: 21622590 DOI: 10.1183/09031936.00198810] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Obstructive sleep apnoea (OSA) seems to worsen metabolism. This effect has not been evaluated in morbid obesity (MO). We hypothesised that the metabolic profile is more impaired in MO patients with OSA than in those without, and investigated whether any specific metabolic dysfunction is related to OSA in MO. A prospective multicentre cross-sectional study was conducted in consecutive subjects before bariatric surgery. OSA was defined as apnoea/hypopnoea index (AHI) ≥15 by overnight polysomnography. Anthropometrical, blood pressure (BP) and fasting blood measurements were obtained the morning after. Metabolic syndrome (MetS) was defined according to National Cholesterol Education Program Adult Treatment Panel III modified criteria. 159 patients were studied: 72% were female and 72% had OSA. MetS prevalence was 70% in OSA versus 36% in non-OSA (p<0.001). As AHI severity increased, metabolic parameters progressively worsened, even in those without type 2 diabetes (DM2). AHI was independently associated with systolic and diastolic BP, triglycerides and the percentage of glycosylated haemoglobin (HbA1c) in the total sample, and with systolic BP, high-density lipoprotein cholesterol and HbA1c in those samples without DM2. OSA increased the adjusted odds ratio of having MetS by 2.8 (95% CI 1.3-6.2; p=0.009). In MO, OSA is associated with major metabolic impairment caused by higher BP and poorer lipid and glucose control, independent of central obesity or DM2.
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Affiliation(s)
- M Gasa
- Sleep Unit, Dept of Respiratory Medicine, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain.
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Padrones S, Garcia-Vidal C, Fernández-Serrano S, Fernández A, Masuet C, Carratalà J, Coromines M, Ardanuy C, Gudiol F, Manresa F, Dorca J. Impact of antibiotic therapy on systemic cytokine expression in pneumococcal pneumonia. Eur J Clin Microbiol Infect Dis 2010; 29:1243-51. [PMID: 20567869 DOI: 10.1007/s10096-010-0993-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 06/01/2010] [Indexed: 11/28/2022]
Abstract
The aim of this study was to compare the evolution of systemic cytokine levels over time in patients with pneumococal pneumonia treated either with β-lactam monotherapy or with combination therapy (β-lactam plus fluoroquinolone). Prospective observational study of hospitalized non-immunocompromised adults with PP. Concentrations of IL-6, IL-8, IL-10, and TNF-α were determined on days 0, 1, 2, 3, 5, and 7. Patients on β-lactam monotherapy were compared with those receiving combination therapy. Fifty-two patients were enrolled in the study. Concentrations of IL-6, IL-8, and IL-10 decreased rapidly in the first days after admission, in accordance with the mean time to defervescence. High levels of IL-6 were found in patients with the worst outcomes, measured by the need for intensive care unit admission and mortality. No major differences in demographic or clinical characteristics or severity of disease were found between patients treated with β-lactam monotherapy and those treated with combination therapy. IL-6 levels fell more rapidly in patients with combination therapy in the first 48 h (p = 0.016). Our data suggest that systemic expression of IL-6 production in patients with PP correlates with prognosis. Initial combination antibiotic therapy produces a faster decrease in this cytokine in the first 48 h.
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Affiliation(s)
- S Padrones
- Respiratory Medicine, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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Garcia-Vidal C, Ardanuy C, Tubau F, Viasus D, Dorca J, Linares J, Gudiol F, Carratala J. Pneumococcal pneumonia presenting with septic shock: host- and pathogen-related factors and outcomes. Thorax 2009; 65:77-81. [DOI: 10.1136/thx.2009.123612] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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36
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Martin-Castillo B, Dorca J, Vazquez-Martin A, Oliveras-Ferraros C, Lopez-Bonet E, Garcia M, Del Barco S, Menendez JA. Incorporating the antidiabetic drug metformin in HER2-positive breast cancer treated with neo-adjuvant chemotherapy and trastuzumab: an ongoing clinical-translational research experience at the Catalan Institute of Oncology. Ann Oncol 2009; 21:187-9. [PMID: 19884247 DOI: 10.1093/annonc/mdp494] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Garcia-Vidal C, Carratalà J, Fernández-Sabé N, Dorca J, Verdaguer R, Manresa F, Gudiol F. Aetiology of, and risk factors for, recurrent community-acquired pneumonia. Clin Microbiol Infect 2009; 15:1033-8. [PMID: 19673961 DOI: 10.1111/j.1469-0691.2009.02918.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Recurrent community-acquired pneumonia (CAP) requiring hospitalization is a matter of particular concern. However, current information on its prevalence, aetiology and risk factors is lacking. To address these issues, we performed an observational analysis of a prospective cohort of hospitalized adults with CAP. Recurrence was defined as two or more episodes of CAP 1 month apart within 3 years. Patients with severe immunosuppression or local predisposing factors were excluded. Of the 1556 patients, 146 (9.4%) had recurrent CAP. The most frequent causative organism was Streptococcus pneumoniae, both in patients with recurrent CAP and in those without recurrence. Haemophilus influenzae, other Gram-negative bacilli and aspiration pneumonia were more frequent among patients with recurrent CAP, whereas Legionella pneumophila was rarely identified in this group. Independent factors associated with recurrent CAP were greater age, lack of pneumococcal vaccination, chronic obstructive pulmonary disease (COPD) and corticosteroid therapy. In a sub-analysis of 389 episodes of pneumococcal pneumonia, the only independent risk factor for recurrence was lack of pneumococcal vaccination. Recurrence of CAP is not a rare clinical problem and it occurs mainly in the elderly, patients with COPD, and those receiving corticosteroids. Our study provides support for recommending pneumococcal vaccination for adults at risk of pneumonia, including those with a first episode of CAP.
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Affiliation(s)
- C Garcia-Vidal
- Infectious Disease, Institut d'Investigació Biomèdica de Bellvitge-Hospital Universitari de Bellvitge (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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Santin M, Dorca J, Alcaide F, Gonzalez L, Casas S, Lopez M, Guerra MR. Long-term relapses after 12-month treatment for Mycobacterium kansasii lung disease. Eur Respir J 2009; 33:148-52. [DOI: 10.1183/09031936.00024008] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Garcia-Vidal C, Fernández-Sabé N, Carratalà J, Díaz V, Verdaguer R, Dorca J, Manresa F, Gudiol F. Early mortality in patients with community-acquired pneumonia: causes and risk factors. Eur Respir J 2008; 32:733-9. [PMID: 18508820 DOI: 10.1183/09031936.00128107] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The first 48 h of evolution of patients with community-acquired pneumonia (CAP) are critical. The aim of the present study was to determine the frequency, causes and factors associated with early mortality in CAP. Nonimmunocompromised adults hospitalised with CAP were prospectively observed from 1995 to 2005. Early deaths, defined as death due to any cause < or = 48 h after admission, were compared with all patients who survived > 48 h. Furthermore, early deaths were compared with late deaths (patients who died > 48 h) and with survivors. Of 2,457 patients, 57 (2.3%) died < or = 48 h after admission. Overall mortality was 7.7%. The main causes of early mortality were respiratory failure and septic shock/multiorgan failure. Independent factors associated with early deaths were increased age, altered mental status at presentation, multilobar pneumonia, shock at admission, pneumococcal bacteraemia and discordant empiric antibiotic therapy. Currently, early mortality is relatively low and is caused by pneumonia-related factors. It occurs mainly among the elderly and in patients presenting with altered mental status, multilobar pneumonia and septic shock. Pneumococcal bacteraemia and discordant antibiotic therapy, mainly due to lack of coverage against Pseudomonas aeruginosa are also significant risk factors.
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Affiliation(s)
- C Garcia-Vidal
- Infectious Disease Service, Hospital University of Bellvitge, Feixa Llarga s/n 08907 L'Hospitalet, Barcelona, Spain.
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Colomer R, Tusquets I, Calvo L, Dorca J, Adrover E, Sanchez-Rovira P, Rifa J, De La Haba J, Virizuela JA, Beltran M. Liposomal doxorubicin (M) plus gemcitabine (G) as first line treatment in metastatic breast carcinoma: A phase I-II study. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.10651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10651 Background: We designed a phase I-II trial to determine the combination dose of liposomal doxorubicin (Myocet) plus gemcitabine (Gemzar), and to evaluate the safety and feasibility of the regimen Methods: Patients with histologically confirmed breast cancer, untreated distant metastasis, age >18 years old, left ventricular ejection fraction (LVEF) >50% and adequate bone marrow, renal and hepatic function were included in the study. Patients received up to six cycles of treatment. No G-CSF support was used prophylactically. LVEF was repeated at 3, and 6 months, and every 6 months thereafter. Results: Phase I: After 6 patients, the recommended dose was M (55 mg/m2) D1 and G (900 mg/m2) D1 and 8, administered every 21 days. Phase II: 53 patients have been enrolled; 52 are included in the safety analysis and 42 in the efficacy analysis. The median age of the population was 61 years of age (32–79). ECOG PS was 0 in 55%, 1 in 41%, 2 in 4%. Postmenopausal status in 87%. Main histology was ductal carcinoma (85%). Prior adjuvant anthracyclines had been administered in 19 cases (median dose of doxorubicin: 300 mg/m2, or epirubicin: 425 mg/m2). Metastasic lesions were in liver (25), lung (17), bone (16), and lymph nodes (25). Patients received a median number of 5 cycles (range 1–6). Median relative dose intensity was 83% for M and 75% for G. Grade III-IV hematologic toxicity per administered cycles was: leukopenia (21.9%), neutropenia (31.2%), febrile neutropenia (4 %), and thrombocytopenia (7.4%). Grade III-IV non-hematologic toxicities were stomatitis (4.8%), nausea (1.7%), vomiting (2.2%), asthenia (2.6%) and diarrhea (0.8%). Thirteen of 52 pts (25%) had alopecia grade III-IV. No signs or symptoms of cardiac impairment have been seen. An objective response rate of 62% was obtained (95% CI: 45.6- 76.4%). Two patients had complete response (4.8%), 24 partial response (57.1%), 10 stable disease and 6 progressive disease. The response rate was similar in patients with or without previous adjuvant anthracyclines (68.5% and 61%, respectively). Conclusions: The combination of liposomal doxorubicin plus gemcitabine has high efficacy and low toxicity in advanced breast cancer patients, and may be a valuable option in patients that have received adjuvant anthracyclines. [Table: see text]
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Affiliation(s)
- R. Colomer
- Institut Catala d’Oncologia, Girona, Spain; Hospital del Mar, Barcelona, Spain; Hospital Juan Canalejo, La Coruña, Spain; Hospital General Alicante, Alicante, Spain; Hospital de Jaen, Jaen, Spain; Hospital Son Dureta, Palma de Mallorca, Spain; Hospital Reina Sofía, Cordoba, Spain; Hospital Virgen Macarena, Sevilla, Spain
| | - I. Tusquets
- Institut Catala d’Oncologia, Girona, Spain; Hospital del Mar, Barcelona, Spain; Hospital Juan Canalejo, La Coruña, Spain; Hospital General Alicante, Alicante, Spain; Hospital de Jaen, Jaen, Spain; Hospital Son Dureta, Palma de Mallorca, Spain; Hospital Reina Sofía, Cordoba, Spain; Hospital Virgen Macarena, Sevilla, Spain
| | - L. Calvo
- Institut Catala d’Oncologia, Girona, Spain; Hospital del Mar, Barcelona, Spain; Hospital Juan Canalejo, La Coruña, Spain; Hospital General Alicante, Alicante, Spain; Hospital de Jaen, Jaen, Spain; Hospital Son Dureta, Palma de Mallorca, Spain; Hospital Reina Sofía, Cordoba, Spain; Hospital Virgen Macarena, Sevilla, Spain
| | - J. Dorca
- Institut Catala d’Oncologia, Girona, Spain; Hospital del Mar, Barcelona, Spain; Hospital Juan Canalejo, La Coruña, Spain; Hospital General Alicante, Alicante, Spain; Hospital de Jaen, Jaen, Spain; Hospital Son Dureta, Palma de Mallorca, Spain; Hospital Reina Sofía, Cordoba, Spain; Hospital Virgen Macarena, Sevilla, Spain
| | - E. Adrover
- Institut Catala d’Oncologia, Girona, Spain; Hospital del Mar, Barcelona, Spain; Hospital Juan Canalejo, La Coruña, Spain; Hospital General Alicante, Alicante, Spain; Hospital de Jaen, Jaen, Spain; Hospital Son Dureta, Palma de Mallorca, Spain; Hospital Reina Sofía, Cordoba, Spain; Hospital Virgen Macarena, Sevilla, Spain
| | - P. Sanchez-Rovira
- Institut Catala d’Oncologia, Girona, Spain; Hospital del Mar, Barcelona, Spain; Hospital Juan Canalejo, La Coruña, Spain; Hospital General Alicante, Alicante, Spain; Hospital de Jaen, Jaen, Spain; Hospital Son Dureta, Palma de Mallorca, Spain; Hospital Reina Sofía, Cordoba, Spain; Hospital Virgen Macarena, Sevilla, Spain
| | - J. Rifa
- Institut Catala d’Oncologia, Girona, Spain; Hospital del Mar, Barcelona, Spain; Hospital Juan Canalejo, La Coruña, Spain; Hospital General Alicante, Alicante, Spain; Hospital de Jaen, Jaen, Spain; Hospital Son Dureta, Palma de Mallorca, Spain; Hospital Reina Sofía, Cordoba, Spain; Hospital Virgen Macarena, Sevilla, Spain
| | - J. De La Haba
- Institut Catala d’Oncologia, Girona, Spain; Hospital del Mar, Barcelona, Spain; Hospital Juan Canalejo, La Coruña, Spain; Hospital General Alicante, Alicante, Spain; Hospital de Jaen, Jaen, Spain; Hospital Son Dureta, Palma de Mallorca, Spain; Hospital Reina Sofía, Cordoba, Spain; Hospital Virgen Macarena, Sevilla, Spain
| | - J. A. Virizuela
- Institut Catala d’Oncologia, Girona, Spain; Hospital del Mar, Barcelona, Spain; Hospital Juan Canalejo, La Coruña, Spain; Hospital General Alicante, Alicante, Spain; Hospital de Jaen, Jaen, Spain; Hospital Son Dureta, Palma de Mallorca, Spain; Hospital Reina Sofía, Cordoba, Spain; Hospital Virgen Macarena, Sevilla, Spain
| | - M. Beltran
- Institut Catala d’Oncologia, Girona, Spain; Hospital del Mar, Barcelona, Spain; Hospital Juan Canalejo, La Coruña, Spain; Hospital General Alicante, Alicante, Spain; Hospital de Jaen, Jaen, Spain; Hospital Son Dureta, Palma de Mallorca, Spain; Hospital Reina Sofía, Cordoba, Spain; Hospital Virgen Macarena, Sevilla, Spain
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Mykietiuk A, Carratalà J, Domínguez A, Manzur A, Fernández-Sabé N, Dorca J, Tubau F, Manresa F, Gudiol F. Effect of prior pneumococcal vaccination on clinical outcome of hospitalized adults with community-acquired pneumococcal pneumonia. Eur J Clin Microbiol Infect Dis 2006; 25:457-62. [PMID: 16773389 DOI: 10.1007/s10096-006-0161-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to evaluate the effect of prior pneumococcal vaccination on the clinical outcome of 554 consecutive hospitalized adults with community-acquired pneumococcal pneumonia from 1995 to 2004, 61 of whom had been vaccinated in the 5 years before admission. Outcome variables that were compared in vaccinated and unvaccinated adults included the occurrence of bacteremia, the time to resolution of pneumonia symptoms, the length of hospital stay, and mortality. Prior pneumococcal vaccination was associated with a lower risk of bacteremia (odds ratio 0.46, 95% CI 0.22-0.98). Compared with unvaccinated patients, vaccine recipients had better clinical outcomes, which included a faster resolution of pneumonia symptoms. The median length of hospital stay was shorter in vaccinated patients (8.0 vs. 9.0 days; p=0.032). Overall case-fatality rates did not differ significantly between groups (1.6% vs. 6.2%; p=0.233). In conclusion, prior pneumococcal vaccination appears to be associated with a lower risk of bacteremia, a faster time to resolution of symptoms, and a shorter hospital stay in adults with pneumococcal pneumonia. The findings presented here provide additional support to the current vaccine recommendations and should encourage healthcare providers to increase pneumococcal vaccine coverage among targeted adult populations.
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Affiliation(s)
- A Mykietiuk
- Infectious Disease Service, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, University of Barcelona, Feixa Llarga s/n, L'Hospitalet, 08907, Barcelona, Spain
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Aparicio J, Germà JR, García del Muro X, Maroto P, Arranz JA, Sáenz A, Barnadas A, Dorca J, Gumà J, Olmos D, Bastús R, Carles J, Almenar D, Sánchez M, Paz-Ares L, Satrústegui JJ, Mellado B, Balil A, López-Brea M, Sánchez A. Risk-Adapted Management for Patients With Clinical Stage I Seminoma: The Second Spanish Germ Cell Cancer Cooperative Group Study. J Clin Oncol 2005; 23:8717-23. [PMID: 16260698 DOI: 10.1200/jco.2005.01.9810] [Citation(s) in RCA: 168] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To assess the efficacy of a risk-adapted treatment policy for patients with stage I seminoma by using universally accepted risk criteria. Patients and Methods Between 1999 and 2003, 314 patients with clinical stage I seminoma after orchiectomy were prospectively included. One hundred patients (31.8%) presented no risk factors and were managed with surveillance. In contrast, 131 patients (41.7%) had tumors larger than 4 cm, 33 patients (10.5%) had rete testis involvement, and 50 patients (15.9%) had both risk factors. All the latter received two courses of adjuvant carboplatin. Results Chemotherapy was well tolerated, as only 17 patients (7.9%) presented grade 3 to 4 toxicity. Relapses were observed in six patients (6.0%) on surveillance and in seven patients (3.3%) treated with carboplatin (0.8% of tumors larger than 4 cm, 9.1% of those involving the rete testis, and 6.0% of patients with both risk criteria). All were located at the retroperitoneum, except for one at the spermatic cord. Median tumor size was 25 mm (range, 11 to 70 mm), and median time to relapse was 9 months (range, 4 to 28 months). All patients were rendered disease-free with chemotherapy (etoposide plus cisplatin). Median follow-up was 34 months (range, 12 to 72 months). The actuarial 5-year disease-free survival rate was 93.4% for patients on surveillance and 96.2% for patients treated with adjuvant chemotherapy. Overall 5-year survival was 100%. Conclusion Adjuvant carboplatin is effective in reducing the relapse rate in patients with stage I seminoma and risk factors. A risk-adapted strategy is safe and feasible and should be considered an alternative to systematic approaches, such as irradiation, chemotherapy, or surveillance.
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Affiliation(s)
- Jorge Aparicio
- Department of Medical Oncology, Hospital Universitario La Fe, Avda Campanar 21, E-46009 Valencia, Spain.
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Alfageme I, Aspa J, Bello S, Blanquer J, Blanquer R, Borderías L, Bravo C, de Celis R, de Gracia X, Dorca J, Gallardo J, Gallego M, Menéndez R, Molinos L, Paredes C, Rajas O, Rello J, Rodríguez de Castro F, Roig J, Sánchez-Gascón F, Torres A, Zalacaín R. [Guidelines for the diagnosis and management of community-acquired pneumonia. Spanish Society of Pulmonology and Thoracic Surgery (SEPAR)]. Arch Bronconeumol 2005. [PMID: 15919009 PMCID: PMC7131668 DOI: 10.1157/13074594] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
We report the case of a patient who presented with cancer-associated retinopathy and small cell carcinoma of the lung, which was treated surgically because the initial diagnostic biopsy finding was squamous cell carcinoma. The patient then underwent chemotherapy and radiation therapy. We discuss the characteristics and pathogenesis of this paraneoplastic syndrome as well as its association with the lung tumor's aberrant production of a protein that competes with retinal recoverin at the photoreceptors of the retinal cone.
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Affiliation(s)
- C Bidegain
- Servicio de Cirugía Torácica, Clínica Girona, Girona, Spain.
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Bidegain C, Rigalt J, Ribot E, Dorca J, Vayreda J. Carcinoma broncogénico microcítico y retinopatía asociada a cáncer. Arch Bronconeumol 2005. [DOI: 10.1157/13070807] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Aparicio J, Germa JR, Garcia Del Muro X, Maroto P, Arranz JA, Saenz A, Barnadas A, Dorca J, Alba E. Risk-adapted management of stage I seminoma: The second Spanish Germ Cell Cancer Group (GG) study. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4518] [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: 11/20/2022] Open
Affiliation(s)
- J. Aparicio
- Hospital Universitario La Fe, Valencia, Spain; Institut Catala de Oncologia, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain; Hospital Gregorio Marañon, Madrid, Spain; Hospital Clínico, Zaragoza, Spain; Hospital Germans Trias i Pujol, Badalona, Spain; Hospital Josep Trueta, Girona, Spain; Hospital Clínico, Malaga, Spain
| | - J. R. Germa
- Hospital Universitario La Fe, Valencia, Spain; Institut Catala de Oncologia, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain; Hospital Gregorio Marañon, Madrid, Spain; Hospital Clínico, Zaragoza, Spain; Hospital Germans Trias i Pujol, Badalona, Spain; Hospital Josep Trueta, Girona, Spain; Hospital Clínico, Malaga, Spain
| | - X. Garcia Del Muro
- Hospital Universitario La Fe, Valencia, Spain; Institut Catala de Oncologia, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain; Hospital Gregorio Marañon, Madrid, Spain; Hospital Clínico, Zaragoza, Spain; Hospital Germans Trias i Pujol, Badalona, Spain; Hospital Josep Trueta, Girona, Spain; Hospital Clínico, Malaga, Spain
| | - P. Maroto
- Hospital Universitario La Fe, Valencia, Spain; Institut Catala de Oncologia, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain; Hospital Gregorio Marañon, Madrid, Spain; Hospital Clínico, Zaragoza, Spain; Hospital Germans Trias i Pujol, Badalona, Spain; Hospital Josep Trueta, Girona, Spain; Hospital Clínico, Malaga, Spain
| | - J. A. Arranz
- Hospital Universitario La Fe, Valencia, Spain; Institut Catala de Oncologia, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain; Hospital Gregorio Marañon, Madrid, Spain; Hospital Clínico, Zaragoza, Spain; Hospital Germans Trias i Pujol, Badalona, Spain; Hospital Josep Trueta, Girona, Spain; Hospital Clínico, Malaga, Spain
| | - A. Saenz
- Hospital Universitario La Fe, Valencia, Spain; Institut Catala de Oncologia, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain; Hospital Gregorio Marañon, Madrid, Spain; Hospital Clínico, Zaragoza, Spain; Hospital Germans Trias i Pujol, Badalona, Spain; Hospital Josep Trueta, Girona, Spain; Hospital Clínico, Malaga, Spain
| | - A. Barnadas
- Hospital Universitario La Fe, Valencia, Spain; Institut Catala de Oncologia, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain; Hospital Gregorio Marañon, Madrid, Spain; Hospital Clínico, Zaragoza, Spain; Hospital Germans Trias i Pujol, Badalona, Spain; Hospital Josep Trueta, Girona, Spain; Hospital Clínico, Malaga, Spain
| | - J. Dorca
- Hospital Universitario La Fe, Valencia, Spain; Institut Catala de Oncologia, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain; Hospital Gregorio Marañon, Madrid, Spain; Hospital Clínico, Zaragoza, Spain; Hospital Germans Trias i Pujol, Badalona, Spain; Hospital Josep Trueta, Girona, Spain; Hospital Clínico, Malaga, Spain
| | - E. Alba
- Hospital Universitario La Fe, Valencia, Spain; Institut Catala de Oncologia, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain; Hospital Gregorio Marañon, Madrid, Spain; Hospital Clínico, Zaragoza, Spain; Hospital Germans Trias i Pujol, Badalona, Spain; Hospital Josep Trueta, Girona, Spain; Hospital Clínico, Malaga, Spain
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Maroto-Rey P, García Del Muro X, Paz-Ares L, Aparicio J, Sastre J, Dorca J, Terrassa J, Arranz JA, Barnadas J, Germa JR. Risk adapted surveillance for stage I non–seminomatous testicular tumors (NSGCT). Results of a prospective multicenter study. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4524] [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: 11/20/2022] Open
Affiliation(s)
- P. Maroto-Rey
- Htal Sant Pau, Barcelona, Spain; ICO, Barcelona, Spain; Htal 12 de Octubre, Madrid, Spain; Htal La Fe, Valencia, Spain; Htal Clinico San Carlos, Madrid, Spain; Htal Josep Trueta, Girona, Spain; Htal Son Dureta, Mallorca, Spain; Htal Gregorio Marañon, Madrid, Spain; Htal Germans Trias i Pujol, Badalona, Spain
| | - X. García Del Muro
- Htal Sant Pau, Barcelona, Spain; ICO, Barcelona, Spain; Htal 12 de Octubre, Madrid, Spain; Htal La Fe, Valencia, Spain; Htal Clinico San Carlos, Madrid, Spain; Htal Josep Trueta, Girona, Spain; Htal Son Dureta, Mallorca, Spain; Htal Gregorio Marañon, Madrid, Spain; Htal Germans Trias i Pujol, Badalona, Spain
| | - L. Paz-Ares
- Htal Sant Pau, Barcelona, Spain; ICO, Barcelona, Spain; Htal 12 de Octubre, Madrid, Spain; Htal La Fe, Valencia, Spain; Htal Clinico San Carlos, Madrid, Spain; Htal Josep Trueta, Girona, Spain; Htal Son Dureta, Mallorca, Spain; Htal Gregorio Marañon, Madrid, Spain; Htal Germans Trias i Pujol, Badalona, Spain
| | - J. Aparicio
- Htal Sant Pau, Barcelona, Spain; ICO, Barcelona, Spain; Htal 12 de Octubre, Madrid, Spain; Htal La Fe, Valencia, Spain; Htal Clinico San Carlos, Madrid, Spain; Htal Josep Trueta, Girona, Spain; Htal Son Dureta, Mallorca, Spain; Htal Gregorio Marañon, Madrid, Spain; Htal Germans Trias i Pujol, Badalona, Spain
| | - J. Sastre
- Htal Sant Pau, Barcelona, Spain; ICO, Barcelona, Spain; Htal 12 de Octubre, Madrid, Spain; Htal La Fe, Valencia, Spain; Htal Clinico San Carlos, Madrid, Spain; Htal Josep Trueta, Girona, Spain; Htal Son Dureta, Mallorca, Spain; Htal Gregorio Marañon, Madrid, Spain; Htal Germans Trias i Pujol, Badalona, Spain
| | - J. Dorca
- Htal Sant Pau, Barcelona, Spain; ICO, Barcelona, Spain; Htal 12 de Octubre, Madrid, Spain; Htal La Fe, Valencia, Spain; Htal Clinico San Carlos, Madrid, Spain; Htal Josep Trueta, Girona, Spain; Htal Son Dureta, Mallorca, Spain; Htal Gregorio Marañon, Madrid, Spain; Htal Germans Trias i Pujol, Badalona, Spain
| | - J. Terrassa
- Htal Sant Pau, Barcelona, Spain; ICO, Barcelona, Spain; Htal 12 de Octubre, Madrid, Spain; Htal La Fe, Valencia, Spain; Htal Clinico San Carlos, Madrid, Spain; Htal Josep Trueta, Girona, Spain; Htal Son Dureta, Mallorca, Spain; Htal Gregorio Marañon, Madrid, Spain; Htal Germans Trias i Pujol, Badalona, Spain
| | - J. A. Arranz
- Htal Sant Pau, Barcelona, Spain; ICO, Barcelona, Spain; Htal 12 de Octubre, Madrid, Spain; Htal La Fe, Valencia, Spain; Htal Clinico San Carlos, Madrid, Spain; Htal Josep Trueta, Girona, Spain; Htal Son Dureta, Mallorca, Spain; Htal Gregorio Marañon, Madrid, Spain; Htal Germans Trias i Pujol, Badalona, Spain
| | - J. Barnadas
- Htal Sant Pau, Barcelona, Spain; ICO, Barcelona, Spain; Htal 12 de Octubre, Madrid, Spain; Htal La Fe, Valencia, Spain; Htal Clinico San Carlos, Madrid, Spain; Htal Josep Trueta, Girona, Spain; Htal Son Dureta, Mallorca, Spain; Htal Gregorio Marañon, Madrid, Spain; Htal Germans Trias i Pujol, Badalona, Spain
| | - J. R. Germa
- Htal Sant Pau, Barcelona, Spain; ICO, Barcelona, Spain; Htal 12 de Octubre, Madrid, Spain; Htal La Fe, Valencia, Spain; Htal Clinico San Carlos, Madrid, Spain; Htal Josep Trueta, Girona, Spain; Htal Son Dureta, Mallorca, Spain; Htal Gregorio Marañon, Madrid, Spain; Htal Germans Trias i Pujol, Badalona, Spain
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Santin M, Alcaide F, Benitez MA, Salazar A, Ardanuy C, Podzamczer D, Rufi G, Dorca J, Martin R, Gudiol F. Incidence and molecular typing of Mycobacterium kansasii in a defined geographical area in Catalonia, Spain. Epidemiol Infect 2004; 132:425-32. [PMID: 15188712 PMCID: PMC2870122 DOI: 10.1017/s095026880300150x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A retrospective population-based study was conducted between January 1990 and December 1998 to investigate the incidence of Mycobacterium kansasji disease and the heterogeneity of the isolates in a well-defined geographical area in Catalonia, Spain. A total of 136 patients were identified. Overall incidence and incidence in AIDS patients was 1.5 (95% CI 1.2-1.8) and 1089.6 (95% CI 689-1330) cases/100,000 persons per year respectively, which is comparable to that reported from most of other geographical areas. Surprisingly, although 7 subtypes of M. kansasii have been consistently reported, in the present study 91 of the 93 isolates (97.8%) tested for genotype were subtype I, regardless of HIV status of the patients. In conclusion, the high rate of infection observed in the AIDS population contributes significantly to the burden of the M. kansasii disease in our area. M. kansasii disease in our geographical area was almost exclusively caused by subtype I regardless of HIV status.
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Affiliation(s)
- M Santin
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain
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Casals T, De-Gracia J, Gallego M, Dorca J, Rodríguez-Sanchón B, Ramos MD, Giménez J, Cisteró-Bahima A, Olveira C, Estivill X. Bronchiectasis in adult patients: an expression of heterozygosity for CFTR gene mutations? Clin Genet 2004; 65:490-5. [PMID: 15151509 DOI: 10.1111/j.0009-9163.2004.00265.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
While all patients with cystic fibrosis (CF) have mutations in both CFTR alleles, often only one CFTR change is detected in patients with other lung disorders. The aim of this study was to investigate whether heterozygosity for CFTR mutations could be a determinant risk factor in the development of bronchiectasis in adult patients. We have performed the CFTR gene analysis in a cohort of 55 bronchiectasis adult patients with unknown etiology. The 5T variant (TG)m and the M470V polymorphisms were also analyzed. A general population in which the same molecular analysis was previously performed was used as the control group. The mutational spectrum of patients was also compared with that found in our CF population. CFTR mutations/variants were found in 20 patients (36%), 14 with only one mutant gene (25%). All six patients colonized by Staphylococcus aureus presented with at least one CFTR change (p = 0.001). No statistical significance was observed between patients with and without mutations for other clinical features. The 5T variant was found in four patients. Additionally, 90% of patients with mutations had the more functional M470 allele (p < 0.001). These results suggest the involvement of the CFTR gene in bronchiectasis of unknown etiology in adult patients.
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Affiliation(s)
- T Casals
- Medical and Molecular Genetics Center, Institut Recerca Oncològica (IRO), Hospital Duran i Reynals, Gran Via s/n km 2.7, 09807 Barcelona, Spain.
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Aparicio J, García del Muro X, Maroto P, Paz-Ares L, Alba E, Sáenz A, Terrasa J, Barnadas A, Almenar D, Arranz JA, Sánchez M, Fernández A, Sastre J, Carles J, Dorca J, Gumà J, Yuste AL, Germà JR. Multicenter study evaluating a dual policy of postorchiectomy surveillance and selective adjuvant single-agent carboplatin for patients with clinical stage I seminoma. Ann Oncol 2003; 14:867-72. [PMID: 12796024 DOI: 10.1093/annonc/mdg241] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND After decades of irradiation as standard therapy for clinical stage I testicular seminoma, alternative treatment approaches have emerged including postorchiectomy surveillance and adjuvant chemotherapy. This study was performed to assess a dual policy of surveillance and selective single-agent carboplatin (for high-risk cases) in a multicenter setting. PATIENTS AND METHODS From 1994 to 1999, 203 patients with stage I seminoma were included. Sixty (29.6%) were considered poor-risk cases (i.e. with vascular invasion and/or pathological tumor stage pT2 or greater) and received two courses of adjuvant carboplatin, whereas 143 (70.4%) without risk criteria underwent close surveillance. RESULTS Median follow-up was 52 months (range 14-92). Relapses were observed in two (3.3%) patients treated with carboplatin and in 23 patients (16.1%) on surveillance, with a median time to recurrence of 11 months (range 3.9-39.6). All relapsing patients were rendered disease-free, mainly with cisplatin-based chemotherapy. Four patients died from tumor-unrelated causes. Actuarial 5-year overall survival was 96.7% and cause-specific survival was 100%. Five-year disease-free survival was 83.5% for patients on surveillance, and 96.6% for those receiving carboplatin. CONCLUSIONS This dual treatment policy is feasible in a multicenter setting and preserves 70% of patients from adjuvant chemotherapy. Single-agent carboplatin is effective in reducing the relapse rate in patients with high-risk stage I seminoma. A better definition of local risk features would probably improve patient selection, thus minimizing the incidence of recurrences on surveillance.
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Affiliation(s)
- J Aparicio
- Hospital Universitario La Fe, Valencia, Spain.
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