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Font A, Ruiz de Porras V, Valderrama BP, Ramirez JL, Nonell L, Virizuela JA, Anido U, González-del-Alba A, Lainez N, Llorente MDM, Jiménez N, Mellado B, García-Donas J, Bellmunt J. Epithelial-to-Mesenchymal Transition Mediates Resistance to Maintenance Therapy with Vinflunine in Advanced Urothelial Cell Carcinoma. Cancers (Basel) 2021; 13:cancers13246235. [PMID: 34944855 PMCID: PMC8699401 DOI: 10.3390/cancers13246235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/03/2021] [Accepted: 12/10/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Platinum-based chemotherapy is the first-line treatment for advanced urothelial cell carcinoma (aUCC). After first-line treatment, we previously showed that maintenance therapy with vinflunine improves progression-free survival. However, some patients are resistant to vinflunine and the specific mechanisms of resistance in aUCC are unclear. We analyzed the genomic landscape and the biological processes potentially related to vinflunine activity and found that epithelial-to-mesenchymal transition (EMT) plays a pivotal role as a resistance mechanism. In experiments with cell lines, curcumin reversed EMT and sensitized cells to vinflunine. We suggest that EMT mediates resistance to vinflunine and that the reversion of this process could enhance the effect of vinflunine in aUCC patients. Abstract In the phase II MAJA trial, maintenance therapy with vinflunine resulted in longer progression-free survival compared to best supportive care in advanced urothelial cell carcinoma (aUCC) patients who did not progress after first-line platinum-based chemotherapy. However, despite an initial benefit observed in some patients, unequivocal resistance appears which underlying mechanisms are presently unknown. We have performed gene expression and functional enrichment analyses to shed light on the discovery of these underlying resistance mechanisms. Differential gene expression profile of eight patients with poor outcome and nine with good outcome to vinflunine administered in the MAJA trial were analyzed. RNA was isolated from tumor tissue and gene expression was assessed by microarray. Differential expression was determined with linear models for microarray data. Gene Set Enrichment Analysis (GSEA) was used for the functional classification of the genes. In vitro functional studies were performed using UCC cell lines. Hierarchical clustering showed a differential gene expression pattern between patients with good and poor outcome to vinflunine treatment. GSEA identified epithelial-to-mesenchymal transition (EMT) as the top negatively enriched hallmark in patients with good outcome. In vitro analyses showed that the polyphenol curcumin downregulated EMT markers and sensitized UCC cells to vinflunine. We conclude that EMT mediates resistance to vinflunine and suggest that the reversion of this process could enhance the effect of vinflunine in aUCC patients.
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Affiliation(s)
- Albert Font
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Germans Trias i Pujol, Ctra. Can Ruti-Camí de les Escoles s/n, 08916 Badalona, Spain;
- Catalan Institute of Oncology, Badalona Applied Research Group in Oncology (B·ARGO), Ctra. Can Ruti-Camí de les Escoles s/n, 08916 Badalona, Spain;
| | - Vicenç Ruiz de Porras
- Catalan Institute of Oncology, Badalona Applied Research Group in Oncology (B·ARGO), Ctra. Can Ruti-Camí de les Escoles s/n, 08916 Badalona, Spain;
- Germans Trias i Pujol Research Institute (IGTP), Ctra. Can Ruti-Camí de les Escoles s/n, 08916 Badalona, Spain
| | - Begoña P. Valderrama
- Department of Medical Oncology, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain;
| | - Jose Luis Ramirez
- Department of Haematology, Catalan Institute of Oncology, University Hospital Germans Trias i Pujol, Ctra. Can Ruti-Camí de les Escoles s/n, 08916 Badalona, Spain;
| | - Lara Nonell
- MARGenomics, Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain;
| | - José Antonio Virizuela
- Department of Medical Oncology, Hospital Universitario Virgen de Macarena, 41009 Seville, Spain;
| | - Urbano Anido
- Department of Medical Oncology, Complejo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain;
| | - Aránzazu González-del-Alba
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro-Majadahonda, 28222 Madrid, Spain;
| | - Nuria Lainez
- Department of Medical Oncology, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain;
| | - Maria del Mar Llorente
- Department of Medical Oncology, Hospital General Universitario de Elda, 03600 Alicante, Spain;
| | - Natalia Jiménez
- Translational Genomics and Targeted Therapeutics in Solid Tumors Laboratory, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain;
| | - Begoña Mellado
- Department of Medical Oncology, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain;
| | - Jesus García-Donas
- Division of Medical Oncology, HM Hospitales-Centro Integral Oncológico Hospital de Madrid Clara Campal, 28050 Madrid, Spain
- Correspondence: (J.G.D.); (J.B.)
| | - Joaquim Bellmunt
- Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Correspondence: (J.G.D.); (J.B.)
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Virizuela JA, Camblor-Álvarez M, Luengo-Pérez LM, Grande E, Álvarez-Hernández J, Sendrós-Madroño MJ, Jiménez-Fonseca P, Cervera-Peris M, Ocón-Bretón MJ. Nutritional support and parenteral nutrition in cancer patients: an expert consensus report. Clin Transl Oncol 2017; 20:619-629. [PMID: 29043569 DOI: 10.1007/s12094-017-1757-4] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/30/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Malnutrition is a frequent medical problem of cancer patients that negatively impacts their quality of life. METHODS A multidisciplinary group of experts in Medical Oncology, Pharmacy, and Nutrition convened to discuss the management of the nutritional support in cancer patients. RESULTS Of the 18 questions addressed, 9 focused on nutritional support, 5 were related to parenteral nutrition (PN) and 4 about home PN (HPN). The panel of experts recommends using nutritional screening routinely, at diagnosis and throughout the disease course, for detecting the risk of malnutrition and, if it is positive, to perform a complete nutritional assessment, to diagnose malnutrition. Currently, there are different screening tools and methods that allow us to detect nutritional risk. Based on the evidence and experience, the panel stated that PN is indicated mainly when it is not possible to use the digestive tract and/or oral feeding and/or enteral nutrition is not sufficient or possible. The nutritional needs of the cancer patients, except in those cases where individualized measures are required, should be considered similar to healthy individuals (25-30 kcal/kg/day). The panel considers that the nutritional monitoring of the cancer patient should be multidisciplinary and adapted to the characteristics of each center. Additionally, the objective of the HPN is to improve or maintain the nutritional status of a patient at home. CONCLUSIONS This document seeks to lay down a set of recommendations and to identify key issues that may be useful for the nutritional management of cancer patients.
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Affiliation(s)
- J A Virizuela
- Department of Medical Oncology, Virgen Macarena University Hospital, Calle Dr. Fedriani, 3, 41009, Sevilla, Spain.
| | - M Camblor-Álvarez
- Endocrinology and Nutritional Department, Gregorio Marañón University General Hospital, Madrid, Spain
| | - L M Luengo-Pérez
- Dietetic and Clinical Nutrition Unit, Endocrinology and Nutritional Department, Infanta Cristina University Hospital, Badajoz, Spain
| | - E Grande
- Department of Medical Oncology, Ramón y Cajal Hospital, Madrid, Spain
| | - J Álvarez-Hernández
- Endocrinology and Nutritional Department, Prince of Asturias University Hospital, Alcalá de Henares, Madrid, Spain
| | | | - P Jiménez-Fonseca
- Department of Medical Oncology, Asturias Central University Hospital, Oviedo, Spain
| | - M Cervera-Peris
- Pharmacy Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | - M J Ocón-Bretón
- Endocrinology and Nutritional Department, Lozano Blesa Clinic University Hospital, Zaragoza, Spain
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Carmona-Bayonas A, Sánchez-Cánovas M, Plasencia JM, Custodio A, Martínez de Castro E, Virizuela JA, Ayala de la Peña F, Jiménez-Fonseca P. Key points to optimizing management and research on cancer-associated thrombosis. Clin Transl Oncol 2017; 20:119-126. [PMID: 28593335 DOI: 10.1007/s12094-017-1692-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 05/25/2017] [Indexed: 12/12/2022]
Abstract
Despite the fact that thromboembolism is relatively common in oncology patients and that the interrelationship between thrombotic risk and specific mechanisms of tumorigenesis has long been known, many cardinal elements of prevention and treatment remain unresolved. Among the existing knowledge gaps, the need to validate the Ay scale and compare it to the Khorana index, develop, and standardize the use of predictive biomarkers for thrombotic risk, conduct clinical trials in thromboprophylaxis adapted to thrombotic risk, evaluate the efficacy and safety of direct anticoagulants, select patients who can benefit from anticoagulants for antitumor treatment, validate the EPIPHANY study decision tree to choose patients with low-risk pulmonary embolism, and accumulate more practical experience in special situations (rethrombosis, prolonged therapy beyond 6 months, etc.) are especially remarkable. These gray areas surrounding cancer-related thromboembolism explain why it continues to be a relatively common cause of serious events, at times interfering significantly with the development of new tumor-fighting strategies.
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Affiliation(s)
- A Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Calle Marqués de los Vélez s/n, 30008, Murcia, Spain.
| | - M Sánchez-Cánovas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Calle Marqués de los Vélez s/n, 30008, Murcia, Spain
| | - J M Plasencia
- Radiology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - A Custodio
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - E Martínez de Castro
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - J A Virizuela
- Medical Oncology Department, Hospital Universitario Virgen de Macarena, Seville, Spain
| | - F Ayala de la Peña
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Calle Marqués de los Vélez s/n, 30008, Murcia, Spain
| | - P Jiménez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
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Rivera F, Andres R, Felip E, Garcia-Campelo R, Lianes P, Llombart A, Piera JM, Puente J, Rodriguez CA, Vera R, Virizuela JA, Martin M, Garrido P. Medical oncology future plan of the Spanish Society of Medical Oncology: challenges and future needs of the Spanish oncologists. Clin Transl Oncol 2017; 19:508-518. [PMID: 28005259 PMCID: PMC5346109 DOI: 10.1007/s12094-016-1595-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 04/07/2016] [Accepted: 09/23/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The SEOM Future Plan is aimed at identifying the main challenges, trends and needs of the medical oncology speciality over the next years, including potential oncologist workforce shortages, and proposing recommendations to overcome them. METHODS The estimations of the required medical oncologists workforce are based on an updated Medical Oncologist Register in Spain, Medical Oncology Departments activity data, dedication times and projected cancer incidence. Challenges, needs and future recommendations were drawn from an opinion survey and an advisory board. RESULTS A shortage of 211 FTE medical oncologist specialists has been established. To maintain an optimal ratio of 158 new cases/FTE, medical oncology workforce should reach 1881 FTE by 2035. CONCLUSIONS Main recommendations to face the growing demand and complexity of oncology services include a yearly growth of 2.5% of medical oncologist's workforce until 2035, and development and application of more accurate quality indicators for cancer care and health outcomes measure.
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Affiliation(s)
- F Rivera
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
- Sociedad Española de Oncología Médica (SEOM), C/ Velázquez, 7-3º planta, 28001, Madrid, Spain.
- 2013-2015 SEOM Executive Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain.
| | - R Andres
- Medical Oncology Department, Hospital Clínico Lozano Blesa, Zaragoza, Spain
- SEOM Future Plan Advisory Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - E Felip
- Institut d'Oncologia, Vall d'Hebron University Hospital, Barcelona, Spain
- SEOM Future Plan Advisory Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - R Garcia-Campelo
- Medical Oncology Department, Complejo Hospitalario Universitario A Coruña, Coruña, Spain
- 2015-2017 SEOM Executive Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - P Lianes
- Medical Oncology Department, Hospital de Mataró, Mataró, Barcelona, Spain
- 2013-2015 SEOM Executive Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - A Llombart
- Medical Oncology Department, Hospital Universitàri Arnau de Vilanova, Lleida, Spain
- 2013-2015 SEOM Executive Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - J M Piera
- Medical Oncology Department, University Hospital Donostia, Donostia/San Sebastián, Spain
- SEOM Future Plan Advisory Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - J Puente
- Medical Oncology Department, Hospital Clínico Universitario San Carlos, Madrid, Spain
- SEOM Future Plan Advisory Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - C A Rodriguez
- Medical Oncology Department, Hospital Clínico Universitario, Salamanca, Spain
- 2015-2017 SEOM Executive Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - R Vera
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
- 2015-2017 SEOM Executive Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - J A Virizuela
- Medical Oncology Department, Complejo Hospitalario Regional Virgen Macarena, Sevilla, Spain
- 2015-2017 SEOM Executive Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - M Martin
- Department of Medical Oncology, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- 2015-2017 SEOM Executive Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - P Garrido
- Department of Medical Oncology, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain
- 2013-2015 SEOM Executive Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
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Adamo B, Vidal M, Gomez Pardo P, Zaragoza K, Ciruelos E, Virizuela JA, Blanch Tormo S, Pérez-Fidalgo JA, Murillo L, Lopez-Gonzalez A, Amillano Parraga K, Martinez Jañez N, Gonzàlez Farré X, Prat A. Abstract OT1-01-04: VENTANA (SOLTI-1501): Oral metronomic vinorelbine combined with endocrine therapy in luminal/HER2-negative early breast cancer: A window of opportunity trial. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-ot1-01-04] [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
The CDK4/6 inhibitor palbociclib, in combination with endocrine therapy (ET), has been approved for patients (pts) with HR+/HER2- metastatic breast cancer (BC), suggesting that inhibition of the cell cycle in combination with ET is a strategy to keep exploring. In this context, vinorelbine (VNB) inhibits chromosome segregation during mitosis and blocks cells at G2/M. Interestingly, several metronomic schedules of VNB are being used in the clinical setting, a strategy that might not only affect cell-cycle but also aims to target tumor angiogenesis.
VENTANA is a “window-of-opportunity” trial designed to explore whether, similarly to CDK4/6 and mTOR inhibitors, oral metronomic VNB in combination with endocrine therapy induces a superior anti-proliferative effect than ET alone, as suggested by preclinical and clinical studies. We believe that a biological synergy of the combined treatment could open the door to include this treatment strategy in pts with BC as an alternative to CDK4/6 inhibitors.
METHODS
VENTANA is a phase 0 multicenter, three-arm, randomized clinical trial of oral metronomic VNB and letrozole (LET) versus either treatment alone in postmenopausal women with newly diagnosed, untreated HR+ and HER2-, stage I-III operable BC. Other eligibility criteria include primary tumor size ≥1 cm (cT1-3) and N0-1, ECOG PS 0-1 and evaluable diagnostic tumor sample. Pts are randomized (1:1:1) to receive LET 2.5mg daily, oral VNB 50mg 3 days a week, or LET 2.5mg daily and oral VNB 50mg 3 times a week. After 3 weeks of treatment, pts will undergo surgery, and both pre-treatment and post-treatment surgical samples will be analyzed for gene expression. Primary objective is to test if oral metronomic VNB and LET induce a superior anti-proliferative effect than either drug alone in pts with early BC defined as Luminal by PAM50. This will be evaluated by the expression of 11 proliferative genes contained in the PAM50 subtype predictor (BIRC5, CCNB1, CDC20, CDCA1, CEP55, KNTC2, MKI67, PTTG1, RRM2, TYMS and UBE2C) as surrogate signature biomarker of its anticancer activity.
VENTANA is a proof-of-concept study to describe the change in the expression of a proliferation-related gene signature in all 3 treatment arms. Changes in the proliferation signature will be determined by following formula: Mean suppression of proliferation signature score = 100 − [geometric mean (post treatment proliferation score / pre-treatment proliferation score · 100)]. By evaluating other BC-related gene signatures (560 genes), the antiangiogenic and immunogenic potential of the treatment arms will also be compared and genes regulated in a treatment-specific manner identified. All analyses will be performed within the different PAM50-defined subtypes (Luminal, Luminal A or Luminal B).
As the primary endpoint is continuous and there are no previous data to make assumptions about the degree of suppression of these genes, the sample size has not been determined by statistical calculations. A sample size of 20 pts per arm is considered appropriate to support our hypothesis. The targeted accrual of 60 pts will be enrolled in 10 sites across Spain (EudraCT Number 2015-004714-24).
Citation Format: Adamo B, Vidal M, Gomez Pardo P, Zaragoza K, Ciruelos E, Virizuela JA, Blanch Tormo S, Pérez-Fidalgo JA, Murillo L, Lopez-Gonzalez A, Amillano Parraga K, Martinez Jañez N, Gonzàlez Farré X, Prat A. VENTANA (SOLTI-1501): Oral metronomic vinorelbine combined with endocrine therapy in luminal/HER2-negative early breast cancer: A window of opportunity trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT1-01-04.
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Affiliation(s)
- B Adamo
- Hospital Clínic de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Clínica Quirón Sagrado Corazón, Sevilla, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico Universitario de Valencia, Valencia, Spain; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Hospital de León, León, Spain; Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Hospital Universitari General de Catalunya, Sant Cugat del Vallés, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - M Vidal
- Hospital Clínic de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Clínica Quirón Sagrado Corazón, Sevilla, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico Universitario de Valencia, Valencia, Spain; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Hospital de León, León, Spain; Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Hospital Universitari General de Catalunya, Sant Cugat del Vallés, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - P Gomez Pardo
- Hospital Clínic de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Clínica Quirón Sagrado Corazón, Sevilla, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico Universitario de Valencia, Valencia, Spain; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Hospital de León, León, Spain; Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Hospital Universitari General de Catalunya, Sant Cugat del Vallés, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - K Zaragoza
- Hospital Clínic de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Clínica Quirón Sagrado Corazón, Sevilla, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico Universitario de Valencia, Valencia, Spain; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Hospital de León, León, Spain; Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Hospital Universitari General de Catalunya, Sant Cugat del Vallés, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - E Ciruelos
- Hospital Clínic de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Clínica Quirón Sagrado Corazón, Sevilla, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico Universitario de Valencia, Valencia, Spain; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Hospital de León, León, Spain; Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Hospital Universitari General de Catalunya, Sant Cugat del Vallés, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - JA Virizuela
- Hospital Clínic de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Clínica Quirón Sagrado Corazón, Sevilla, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico Universitario de Valencia, Valencia, Spain; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Hospital de León, León, Spain; Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Hospital Universitari General de Catalunya, Sant Cugat del Vallés, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - S Blanch Tormo
- Hospital Clínic de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Clínica Quirón Sagrado Corazón, Sevilla, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico Universitario de Valencia, Valencia, Spain; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Hospital de León, León, Spain; Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Hospital Universitari General de Catalunya, Sant Cugat del Vallés, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - JA Pérez-Fidalgo
- Hospital Clínic de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Clínica Quirón Sagrado Corazón, Sevilla, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico Universitario de Valencia, Valencia, Spain; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Hospital de León, León, Spain; Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Hospital Universitari General de Catalunya, Sant Cugat del Vallés, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - L Murillo
- Hospital Clínic de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Clínica Quirón Sagrado Corazón, Sevilla, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico Universitario de Valencia, Valencia, Spain; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Hospital de León, León, Spain; Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Hospital Universitari General de Catalunya, Sant Cugat del Vallés, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - A Lopez-Gonzalez
- Hospital Clínic de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Clínica Quirón Sagrado Corazón, Sevilla, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico Universitario de Valencia, Valencia, Spain; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Hospital de León, León, Spain; Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Hospital Universitari General de Catalunya, Sant Cugat del Vallés, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - K Amillano Parraga
- Hospital Clínic de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Clínica Quirón Sagrado Corazón, Sevilla, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico Universitario de Valencia, Valencia, Spain; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Hospital de León, León, Spain; Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Hospital Universitari General de Catalunya, Sant Cugat del Vallés, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - N Martinez Jañez
- Hospital Clínic de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Clínica Quirón Sagrado Corazón, Sevilla, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico Universitario de Valencia, Valencia, Spain; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Hospital de León, León, Spain; Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Hospital Universitari General de Catalunya, Sant Cugat del Vallés, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - X Gonzàlez Farré
- Hospital Clínic de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Clínica Quirón Sagrado Corazón, Sevilla, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico Universitario de Valencia, Valencia, Spain; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Hospital de León, León, Spain; Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Hospital Universitari General de Catalunya, Sant Cugat del Vallés, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - A Prat
- Hospital Clínic de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Clínica Quirón Sagrado Corazón, Sevilla, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico Universitario de Valencia, Valencia, Spain; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Hospital de León, León, Spain; Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Hospital Universitari General de Catalunya, Sant Cugat del Vallés, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain
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Gavilá J, Perez-Garcia J, Calvo I, Ciruelos E, Muñoz M, Virizuela JA, Ruiz I, Andrés R, Morales S, Perelló A, Sánchez P, Garcia-Saenz JA, Quero Guillen JC, González-Santiago S, Garau Llinas I, González-Martín A, Cantos Sánchez de Ibargüen B, Zaragoza K, de la Peña L, Llombart-Cussac A, Oliveira M. Abstract P4-21-05: Neoadjuvant non-pegylated liposomal doxorubicin plus paclitaxel, trastuzumab and pertuzumab in patients with HER2+ breast cancer – Final results of the SOLTI OPTI-HER HEART study. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-21-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
INTRODUCTION
Targeting HER2 by dual blockade with trastuzumab (T) and pertuzumab (P) in a taxane-based regimen is an active neoadjuvant treatment (NAT) of HER2+ early breast cancer (EBC). Addition of an anthracycline could further enhance this response, but potential cardiac toxicity is a concern. The Opti-HER HEART trial (NCT01669239) aims to optimize neoadjuvant treatment while minimizing cardiac risk, by combining T+P with a taxane and non-pegylated liposomal doxorubicin (NPLD).
MATERIAL AND METHODS
Phase II open-label, single-arm study of six 21-day cycles of NPLD (50mg/m2 D1), paclitaxel (80mg/m2 D1,8,15), T (4mg/kg C1D1, followed by 2mg/kg weekly), and P (840mg C1D1, followed by 420mg C2-6D1) as NAT for patients (pts) with stage II-IIIB HER2+ BC. Primary objective was to evaluate cardiac safety of the combination, measured by the incidence of type A (symptomatic congestive heart failure ) or type B [asymptomatic reduction of Left Ventricular Ejection Fraction (LVEF) value: ≥10% absolute decrease and LVEF<50%, LVEF<40% or any absolute decrease ≥20%] events, during NAT. Eighty-three pts were required to reject with 80% confidence the null hypothesis that the combination increases the incidence of cardiac events above the historical control of 18% (3% type A; 15% type B).
RESULTS
Between June 2013 and January 2015, 83 pts with HER2+ EBC (stage II 78%, stage III 22%) and adequate cardiac function (LVEF≥55%) were enrolled. Mean age was 50 years, N+ 47%, hormone receptor (HR) positive 71% and median baseline LVEF 66%. Eighty-five percent of pts completed 6 cycles of NAT, whereas 15% discontinued NAT due to toxicity. Adverse events (AEs) leading to dose adjustments/temporary interruptions and discontinuation of at least 1 drug occurred in 70% and 21% of pts, respectively. Primary objective was met with an incidence of cardiac events during NAT of 4% (95%CI 1-10, 3pts, all type B). Cardiac events until study completion (1 year) were 8% (all type B). All (but 2 cases with no follow-up data) were reversible and only 1 pt presented an asymptomatic LVEF<40%. Neutropenia (45%) was the most frequent hematological toxicity (G3/4 34%; febrile neutropenia 6%), less frequent in the 71% of pts that received primary G-CSF prophylaxis (G3/4 25% vs. 67%). Common non-hematological toxicities were diarrhea (74%; G3 7%), asthenia (78%; G3 11%) and neurotoxicity (52%; G3/4 10%). Pathological complete response (pCR) in breast+axilla (ypT0/is ypN0) was 60% (87% in HR-) and 69% in breast (91% in HR-).
TOTALHR-HR+% ypT0/is (95% CI)69 (58-79)91 (72-99)61 (47-74)% ypT0/is ypN0 (95% CI)60 (46-71)87 (66-97)50 (36-64)
CONCLUSIONS
The neoadjuvant combination of T+P, paclitaxel and NPLD does not increase the risk for cardiac events in HER2+ BC pts. Since cardiac toxicities may present later, long-term cardiac monitoring is essential. Efficacy in terms of pCR was remarkable, being higher to historical values of combinations with dual anti-HER2 blockade and one of the highest reported among HR-HER2+ BC. This regimen administered with primary G-CSF prophylaxis and cardiac function monitoring may be an effective and secure option for early and locally advanced HER2+ pts with good cardiac function.
Citation Format: Gavilá J, Perez-Garcia J, Calvo I, Ciruelos E, Muñoz M, Virizuela JA, Ruiz I, Andrés R, Morales S, Perelló A, Sánchez P, Garcia-Saenz JA, Quero Guillen JC, González-Santiago S, Garau Llinas I, González-Martín A, Cantos Sánchez de Ibargüen B, Zaragoza K, de la Peña L, Llombart-Cussac A, Oliveira M. Neoadjuvant non-pegylated liposomal doxorubicin plus paclitaxel, trastuzumab and pertuzumab in patients with HER2+ breast cancer – Final results of the SOLTI OPTI-HER HEART study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-21-05.
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Affiliation(s)
- J Gavilá
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - J Perez-Garcia
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - I Calvo
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - E Ciruelos
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - M Muñoz
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - JA Virizuela
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - I Ruiz
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - R Andrés
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - S Morales
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - A Perelló
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - P Sánchez
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - JA Garcia-Saenz
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - JC Quero Guillen
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - S González-Santiago
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - I Garau Llinas
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - A González-Martín
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - B Cantos Sánchez de Ibargüen
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - K Zaragoza
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - L de la Peña
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - A Llombart-Cussac
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - M Oliveira
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
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7
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Jara C, Ayala F, Virizuela JA. The oncology day hospital in Spain: an updated analysis of Spanish Society of Medical Oncology (SEOM) looking forward. Clin Transl Oncol 2017; 19:269-272. [PMID: 28083756 PMCID: PMC5306221 DOI: 10.1007/s12094-016-1610-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 12/29/2016] [Indexed: 11/05/2022]
Affiliation(s)
- C Jara
- Medical Oncology, Fundación Alcorcón University Hospital, Alcorcón, Spain.
| | - F Ayala
- Medical Oncology, Morales Meseguer University General Hospital, Murcia, Spain
| | - J A Virizuela
- Medical Oncology, Virgen Macarena University Hospital, Seville, Spain
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8
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Carmona-Bayonas A, Jiménez-Fonseca P, Castañón E, Ramchandani-Vaswani A, Sánchez-Bayona R, Custodio A, Calvo-Temprano D, Virizuela JA. Chronic opioid therapy in long-term cancer survivors. Clin Transl Oncol 2016; 19:236-250. [PMID: 27443415 DOI: 10.1007/s12094-016-1529-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/27/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE Long-term cancer survivors develop special health issues and specific needs. Chronic pain, whether the consequence of their cancer or as a side effect of treatment, is one of their most prevalent concerns. METHODS We conducted a review of the English-language literature on long-term cancer survivorship and chronic opioid therapy, with the objective of determining the efficacy, safety and tolerability in this group of patients. Practical management recommendations are made on the basis of this review. RESULTS Pain syndromes encountered in the long-term cancer survivors are diverse. Opioid receptor pathways possess complex and pleiotropic functions and continuous over-activation may lead to de novo endocrinopathies, immunosuppression, neurocognitive impairment, or cell cycle disturbances with potential clinical connotations. However, there are insufficient data to support evidence-based decision making with respect to patient selection, doses, administration, monitoring and follow-up. Data about long-term treatment effectiveness and safety are limited and often aggravated by the overlapping of several diseases prevalent among long-term cancer survivors, as well as chronic opiate-induced toxicity. CONCLUSIONS Chronic opioid therapy is frequent in long-term cancer survivors, and may negatively affect the immune system, and produce health problems such as endocrinopathies, osteoporosis, neurological or cardiopulmonary effects, alterations of cell cycle kinetics, abuse and addiction. This review highlights the need for specialized teams to treat chronic pain in long-term cancer survivors from an integrative perspective.
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Affiliation(s)
- A Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria (IMIB), Avenue Marqués de los Vélez, s/n, 30008, Murcia, Spain.
| | - P Jiménez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, Avenida de Roma, s/n, 33011, Oviedo, Principado de Asturias, Spain
| | - E Castañón
- Medical Oncology Department, Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), Avenida Pío XII, 36, Pamplona, Spain
| | - A Ramchandani-Vaswani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Avenida Marítima del Sur, s/n, 35016, Las Palmas de Gran Canaria, Spain
| | - R Sánchez-Bayona
- Medical Oncology Department, Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), Avenida Pío XII, 36, Pamplona, Spain
| | - A Custodio
- Medical Oncology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, Madrid, Spain
| | - D Calvo-Temprano
- Radiology Department, Hospital Universitario Central de Asturias, Avenida de Roma, s/n, 33011, Oviedo, Principado de Asturias, Spain
| | - J A Virizuela
- Medical Oncology Department, Hospital Virgen de la Macarena, Avd. Doctor Fedriani, 3, 41071, Seville, Spain
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9
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Garcia del Muro X, Climent MA, Perez-Gracia JL, Mellado B, Virizuela JA, Castellano DE, Garcia Carbonero I, Gonzalez del Alba A, Alvarez Fernandez C, Mulet N, Duran I. Phase II study of pazopanib plus interferon alfa as first-line therapy of advanced renal cell carcinoma: A Spanish Oncology Genitourinary Group (SOGUG) study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.4571] [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)
| | | | | | - Begona Mellado
- Medical Oncology, Hospital Clínic Barcelona, Barcelona, Spain
| | - JA Virizuela
- Medical Oncology Department. Hospital Universitario Virgen Macarena, Seville, Spain
| | | | | | | | | | - Nuria Mulet
- Medical Oncology Department, Institut Català d'Oncologia, l'Hospitalet de Llobregat, Barcelona, Spain
| | - Ignacio Duran
- Hospital Universitario Virgen del Rocío, Seville, Spain
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10
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Matos I, Grau JJ, Grande E, Martinez Trufero J, Trigo JM, Lopez C, Manzano JL, Reig Ò, Alvarez C, Beltran M, Duran M, Aller J, Iglesias L, Arevalo S, Manzano A, Mesia R, Reina JJ, Sepúlveda JM, Virizuela JA, Capdevila J. Efficacy of multikinase inhibitors (MKIs) in successive treatment lines of refractory advanced thyroid cancer patients (pts). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e17553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ignacio Matos
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Enrique Grande
- Medical Oncology Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | | | | | - Carlos Lopez
- Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Jose Luis Manzano
- Institut Català d'Oncologia, Hospital Universitario German Trias i Pujol, Badalona, Spain
| | - Òscar Reig
- Translational Genomics and Targeted Therapeutics in Solid Tumors Lab (IDIBAPS), Medical Oncology. Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Miguel Beltran
- Institut Català d'Oncologia Hospital Universitari Josep Trueta, Girona, Spain
| | - Manuel Duran
- Rey Juan Carlos University Hospital, Madrid, Spain
| | - Javier Aller
- Puerta de Hierro University Hospital, Madrid, Spain
| | - Lara Iglesias
- Medical Oncology Dpt, 12 de Octubre Hospital, Madrid, Spain
| | | | | | - Ricard Mesia
- Medical Oncology Department, Institut Català d'Oncologia (ICO) L'Hospitalet, University of Barcelona, Barcelona, Spain
| | - Juan J Reina
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - JA Virizuela
- Medical Oncology Department. Hospital Universitario Virgen Macarena, Seville, Spain
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11
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Espinosa M, Falcon A, Gutierrez-Valencia A, Cervera A, Rosso-Fernandez CM, Martinez-Lozano E, Perez-Valderrama B, Martinez-Atienza J, Jimenez Gonzalez-Serna L, Sanchez-Simon I, Cruz M, Rodriguez A, Virizuela JA, Maiquez P, Hindi N, Gallego Jimenez I, Lopez-Cortes FL, Paz-Ares LG, Duran I. Pharmacokinetic food-effect study of abiraterone acetate (AA) in patients with metastatic castration resistant prostate cancer (mCRPC): The ABIFOOD trial (EudraCt number: 2012-003226-25). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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
227 Background: A.A has been approved for the treatment of mCRPC before and after docetaxel. The standard regime consists on daily A.A. 1.000 mg in a fasting state along with prednisone 10mg q.d. However, data from pharmacokinetic (PK) studies in patients (pts) and healthy volunteers has revealed a significant food-effect with up to 7-10 folder increase in area under plasma concentration-time curve (AUC) when A.A is given with food, specially with fat content, [Chi KN, J Clin Pharmacol 2015]. Methods: ABIFOOD is a phase I, randomized trial to evaluate the short and long-term effect of diet on the PKs of A.A. in pts with mCRPC who have progressed to docetaxel. Eligible pts include men ≥ 18 years old with mCRPC, ECOG performance status (PS) < 2 and an adequate organ function. Pts are randomly assigned to receive 4-weekly cycles of 250 mg A.A with standard meal (Arm A), 250 mg A.A with high-fat meal (Arm B) or 1000 mg A.A in fasting conditions (Arm C). PK analyses are conducted at week 1 (W1) and cycle 5. Results: Fifteen pts (5, 3 and 7 in arms A, B and C respectively) have been included and 6 are still on treatment. Median age is 72, 97% have ECOG-PS 1. Gleason Score is > 8 in 6 (40%) pts.Geometric mean abiraterone [AUC (ng.h/ml) (IQR)] at W1 did not significantly differ between treatment arms [arm A: 404.68 (368.4 - 488.2), arm B: 372 (334.6 - 440.5) arm C: 656.51 (387.8 – 1144.5) p 0.15]. PK data did not influence activity or toxicity. Progression free survival was 8.50, 6.33 and 4.86 months in Arms A, B and C respectively (p 0.53). One patient in arm A is still on treatment after 17 cycles. Conclusions: The administration of lower doses of A.A with food [regardless the fat content], might achieve comparable plasma levels to standard dosing with no detriment in efficacy or toxicity parameters. The study is actively recruiting and data on additional pts and long term PK parameters will be presented. Clinical trial information: EudraCt number: 2012-003226-25.
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Affiliation(s)
- M. Espinosa
- Medical Oncology Department. Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - A Falcon
- Medical Oncology Department. Hospital Universitario Virgen del Rocío, Seville, Sri Lanka
| | | | - A Cervera
- Pharmacology Department. Hospital Universitario Virgen del Rocío, Seville, Spain
| | - CM Rosso-Fernandez
- Clinical Research and Clinical Trials Unit. Hospital Universitario Virgen del Rocío, Seville, Spain
| | - E Martinez-Lozano
- Clinical Research and Clinical Trials Unit. Hospital Universitario Virgen del Rocío, Seville, Spain
| | - B Perez-Valderrama
- Medical Oncology Department. Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J Martinez-Atienza
- Clinical Research and Clinical Trials Unit. Hospital Universitario Virgen del Rocío, Seville, Spain
| | - L Jimenez Gonzalez-Serna
- Clinical Research and Clinical Trials Unit. Hospital Universitario Virgen del Rocío, Seville, Spain
| | - I Sanchez-Simon
- Oncology Department, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - M Cruz
- Medical Oncology Department. Hospital Universitario Virgen del Rocío, Seville, Spain
| | - A Rodriguez
- Medical Oncology Department. Hospital Universitario Virgen del Rocío, Seville, Spain
| | - JA Virizuela
- Medical Oncology Department. Hospital Universitario Virgen Macarena, Seville, Spain
| | - P Maiquez
- Pharmacology Department. Hospital Universitario Virgen del Rocío, Seville, Spain
| | - N Hindi
- Medical Oncology Department. Hospital Universitario Virgen del Rocío, Seville, Spain
| | - I Gallego Jimenez
- Medical Oncology Department. Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | | | - Ignacio Duran
- Hospital Universitario Virgen del Rocío, Seville, Spain
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12
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Gavilá J, Lopez-Tarruella S, Saura C, Muñoz M, Oliveira M, De la Cruz-Merino L, Morales S, Alvarez I, Virizuela JA, Martin M. SEOM clinical guidelines in metastatic breast cancer 2015. Clin Transl Oncol 2015; 17:946-55. [PMID: 26683474 PMCID: PMC4689775 DOI: 10.1007/s12094-015-1476-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 12/13/2022]
Abstract
Metastatic breast cancer is essentially an incurable disease. However, recent advances have resulted in a significant improvement of overall survival. The SEOM guidelines are intended to make evidence-based recommendations on how to manage patients with metastatic breast cancer to achieve the best patient outcomes based on a rational use of the currently available therapies. To assign a level of certainty and a grade of recommendation the United States Preventive Services Task Force guidelines methodology was selected as reference.
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Affiliation(s)
- J Gavilá
- Servicio de Oncología Médica, Fundación Instituto Valenciano de Oncología, Valencia, Spain.
| | - S Lopez-Tarruella
- Servicio de Oncología Médica, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - C Saura
- Servicio de Oncología Médica, Hospital Vall d' Hebron, Barcelona, Spain
| | - M Muñoz
- Servicio de Oncología Médica, Hospital Clinic I Provincial, Barcelona, Spain
| | - M Oliveira
- Servicio de Oncología Médica, Hospital Vall d' Hebron, Barcelona, Spain
| | - L De la Cruz-Merino
- Servicio de Oncología Médica, Complejo Hospitalario Regional Virgen Macarena, Seville, Spain
| | - S Morales
- Servicio de Oncología Médica, Hospital Universitari Arnau de Villanova de Lleida, Lleida, Spain
| | - I Alvarez
- Servicio de Oncología Médica, Hospital Donostia-Donostia Ospitalea, Donostia, Spain
| | - J A Virizuela
- Servicio de Oncología Médica, Complejo Hospitalario Regional Virgen Macarena, Seville, Spain
| | - M Martin
- Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
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13
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Lobo F, Virizuela JA, Dorta FJ, Florián J, Lomas M, Jiménez E, López P, Casado V, Léon A, Estévez LG, Dómine M. Gemcitabine/vinorelbine in metastatic breast cancer patients previously treated with anthracyclines: results of a phase II trial. Clin Breast Cancer 2003; 4:46-50. [PMID: 12744758 DOI: 10.3816/cbc.2003.n.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [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]
Abstract
This phase II study was designed to evaluate the response rate (RR) and toxicity of gemcitabine/vinorelbine in patients with metastatic breast cancer. All patients had previously received anthracyclines. Treatment consisted of gemcitabine 1200 mg/m2 and vinorelbine 30 mg/m2 on days 1 and 8, every 3 weeks. Twenty-five patients were enrolled. Median age was 59 years (range, 33-73 years). Ten patients had received only adjuvant therapy with anthracyclines. The remaining 15 patients had received chemotherapy for metastatic disease, including taxanes in 11 cases. Four patients could not be evaluated for response. By intent-to-treat analysis, the overall RR was 44% (95% CI, 24.4%-65%). Median duration of response and median time to treatment failure were 21 and 17 weeks, respectively. The main toxicity was hematologic, with grade 3/4 neutropenia occurring in 13 patients and 1 patient developing febrile neutropenia. Two deaths from pneumonia occurred. These results reveal an encouraging activity with a reasonable toxicity profile in a patient population with an unfavorable prognosis. Our group is conducting a randomized study to compare this combination with vinorelbine alone in patients with metastatic breast cancer after failure to respond to anthracyclines and taxanes
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Affiliation(s)
- F Lobo
- Fundación Jiménez Díaz, Madrid, Spain.
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14
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Iglesias L, Moreno JA, Torrija E, Murillo E, Codes M, Dugue A, Garcia E, Virizuela JA. UFT in combination as adjuvant therapy for breast cancer. Grupo Oncologico de Sevilla Seville, Spain. Oncology (Williston Park) 1997; 11:74-81. [PMID: 9348574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Between 1989 and 1993, 409 evaluable patients with breast cancer have been treated with tegafur and uracil (UFT) in an adjuvant setting in two different trials. Data from both trials were reviewed in December 1995 after a mean follow-up of 5.09 +/- 1.1 years (range, 2.9 to 7.1 years). The aim of the first trial was to demonstrate the activity of UFT 400 mg/day for 6 months plus prednimustine 60 mg/m2 for 7 consecutive days, every 28 days in 6 cycles given orally (arm B). This scheme was compared with 6 cycles of cyclophosphamide 600 mg/m2, plus methotrexate 40 mg/m2, plus fluorouracil 600 mg/m2, every 4 weeks (arm A). In this study, 187 premenopausal women were evaluable, 96 in arm A and 91 in arm B, all of whom had positive axillary nodes. Although there were more younger patients in arm A than in arm B, prognostic factors were similar in both groups. Disease-free survival and overall survival were similar in both arms. However, some concern is raised by the low disease-free survival rate. The toxicity was mild (mainly nausea and vomiting and alopecia) and slightly worse in arm A. We believe that oral administration could be a useful alternative to the parenteral route. In the second trial, 222 evaluable patients received 20 mg/day of tamoxifen (Nolvadex) for 1 year (arm A), or the same dose of tamoxifen plus UFT 400 mg/day for 6 months. All patients were postmenopausal, and the characteristics of the tumors were the same as those in patients in the first trial. In arm A there were 109 patients and in arm B, 113. The groups were well balanced. The overall survival and the disease-free survival rates were equal in both arms, but were longer in arm B in the subset of patients with five or more axillary-involved nodes. The toxicity was negligible in both arms. We conclude that UFT/tamoxifen might be useful in postmenopausal patients with five or more involved nodes who are unable to follow a more aggressive schedule because of their age or low performance status.
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Affiliation(s)
- L Iglesias
- Hospital Universitario, Virgen del Rocio, Seville, Spain
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15
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Lopez R, Peters GJ, Smitskamp-Wilms E, Virizuela JA, van Ark-Otte J, Pinedo HM, Giaccone G. In vitro sequence-dependent synergistic effect of suramin and camptothecin. Eur J Cancer 1994; 30A:1670-4. [PMID: 7833142 DOI: 10.1016/0959-8049(94)00321-u] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Suramin, a hexasulphonated naphthylurea with activity in prostatic cancer, possesses a wide variety of antitumour mechanisms of action, one of which is the inhibition of topoisomerase II. In this in vitro study, suramin was combined with the topoisomerase I inhibitor, camptothecin. Several suramin concentrations (0.2-3000 microM) were combined with camptothecin (0.4 pM-20 microM) in MCF-7 and PC3 human cancer cell line cultures. In addition, we studied the topoisomerase II and I gene expression by northern blot analysis, and the cell cycle distribution by flow cytometry, after exposure to suramin. While there was only an additive effect when suramin and camptothecin were added simultaneously, a remarkable synergism was obtained when camptothecin was added after a 3-day exposure to suramin. Topoisomerase II and I gene expression and the number of cells in S phase were significantly reduced after exposure to suramin. In conclusion, interaction of suramin with camptothecin is schedule-dependent and can be synergistic. These findings might help in identifying optimal combinations of suramin or other topoisomerase II inhibitors, with topoisomerase I inhibitors.
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Affiliation(s)
- R Lopez
- Hospital Txagorritxu, Vitoria, Spain
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