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Arias-Martinez A, Martínez de Castro E, Gallego J, Arrazubi V, Custodio A, Fernández Montes A, Diez M, Hernandez R, Limón ML, Cano JM, Vidal-Tocino R, Macias I, Visa L, Martin Richard M, Sauri T, Hierro C, Gil M, Cerda P, Martínez Moreno E, Martínez Lago N, Mérida-García AJ, Gómez González L, García Navalón FJ, Ruiz Martín M, Marín G, López-López F, Ruperez Blanco AB, Fernández AF, Jimenez-Fonseca P, Carmona-Bayonas A, Alvarez-Manceñido F. Is there a preferred platinum and fluoropyrimidine regimen for advanced HER2-negative esophagogastric adenocarcinoma? Insights from 1293 patients in AGAMENON-SEOM registry. Clin Transl Oncol 2024:10.1007/s12094-024-03388-6. [PMID: 38361134 DOI: 10.1007/s12094-024-03388-6] [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: 12/22/2023] [Accepted: 01/06/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND The optimal chemotherapy backbone for HER2-negative advanced esophagogastric cancer, either in combination with targeted therapies or as a comparator in clinical trials, is uncertain. The subtle yet crucial differences in platinum-based regimens' safety and synergy with combination treatments need consideration. METHODS We analyzed cases from the AGAMENON-SEOM Spanish registry of HER2-negative advanced esophagogastric adenocarcinoma treated with platinum and fluoropyrimidine from 2008 to 2021. This study focused exclusively on patients receiving one of the four regimens: FOLFOX (5-FU and oxaliplatin), CAPOX (capecitabine and oxaliplatin), CP (capecitabine and cisplatin) and FP (5-FU and cisplatin). The aim was to determine the most effective and tolerable platinum and fluoropyrimidine-based chemotherapy regimen and to identify any prognostic factors. RESULTS Among 1293 patients, 36% received either FOLFOX (n = 468) or CAPOX (n = 466), 20% CP (n = 252), and 8% FP (n = 107). FOLFOX significantly increased PFS (progression free survival) compared to CP, with a hazard ratio of 0.73 (95% CI 0.58-0.92, p = 0.009). The duration of treatment was similar across all groups. Survival outcomes among regimens were similar, but analysis revealed worse ECOG-PS (Eastern Cooperative Oncology Group-Performance Status), > 2 metastatic sites, bone metastases, hypoalbuminemia, higher NLR (neutrophil-to-lymphocyte ratio), and CP regimen as predictors of poor PFS. Fatigue was common in all treatments, with the highest incidence in FOLFOX (77%), followed by FP (72%), CAPOX (68%), and CP (60%). Other notable toxicities included neuropathy (FOLFOX 69%, CAPOX 62%), neutropenia (FOLFOX 52%, FP 55%), hand-foot syndrome in CP (46%), and thromboembolic events (FP 12%, CP 11%). CONCLUSIONS FOLFOX shown better PFS than CP. Adverse effects varied: neuropathy was more common with oxaliplatin, while thromboembolism was more frequent with cisplatin.
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Affiliation(s)
- Aranzazu Arias-Martinez
- Doctoral Program in Pharmacy, Universidad de Granada, Barrio Verxeles n°13 2°, CP 27850, Granada, Viveiro, Spain.
| | - Eva Martínez de Castro
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Javier Gallego
- Medical Oncology Department, Hospital General Universitario de Elche, Elche, Spain
| | - Virginia Arrazubi
- Medical Oncology Department, Hospital Universitario de Navarra, IdiSNA, Pamplona, Spain
| | - Ana Custodio
- Medical Oncology Department, Hospital Universitario La Paz, CIBERONC, CB16/12/00398, Madrid, Spain
| | - Ana Fernández Montes
- Medical Oncology Department, Complejo Hospitalario Universitario de Orense, Orense, Spain
| | - Marc Diez
- Medical Oncology Department, Hospital Universitario Vall d'Hebron, VHIO, Barcelona, Spain
| | - Raquel Hernandez
- Medical Oncology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - María Luisa Limón
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Juana María Cano
- Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Rosario Vidal-Tocino
- Medical Oncology Department, Complejo Asistencial Universitario de Salamanca - IBSAL, Salamanca, Spain
| | - Ismael Macias
- Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain
| | - Laura Visa
- Medical Oncology Department, Hospital Universitario El Mar, Barcelona, Spain
| | - Marta Martin Richard
- Medical Oncology Department, Instituto Catalán de Oncología (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Tamara Sauri
- Medical Oncology Department, Hospital Clinic, Barcelona, Spain
| | - Cinta Hierro
- Medical Oncology Department, Instituto Catalán de Oncología (ICO)-Badalona, Barcelona; Badalona-Applied Research Group in Oncology (B-ARGO), Badalona, Spain
| | - Mireia Gil
- Medical Oncology Department, Hospital General Universitario de Valencia-Ciberonc CB16/12/0035, Valencia, Spain
| | - Paula Cerda
- Medical Oncology Department, Hospital Universitario Santa Creu y Sant Pau, Barcelona, Spain
| | - Elia Martínez Moreno
- Medical Oncology Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Nieves Martínez Lago
- Medical Oncology Department, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | | | - Lucía Gómez González
- Medical Oncology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Maribel Ruiz Martín
- Medical Oncology Department, Complejo Asistencial Universitario de Palencia, Palencia, Spain
| | - Gema Marín
- Medical Oncology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Flora López-López
- Medical Oncology Department, Hospital Universitario del Sureste, Madrid, Spain
| | | | | | - Paula Jimenez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | - Alberto Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, University of Murcia, IMIB, Murcia, Spain
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Guillot Morales M, Visa L, Brozos Vázquez E, Feliu Batlle J, Khosravi Shahi P, Laquente Sáez B, de San Vicente Hernández BL, Macarulla T, Gironés Sarrió R. Update on the management of older patients with pancreatic adenocarcinoma: a perspective from medical oncology. Clin Transl Oncol 2024:10.1007/s12094-024-03386-8. [PMID: 38329611 DOI: 10.1007/s12094-024-03386-8] [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: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 02/09/2024]
Abstract
In the context of pancreatic cancer, surgical intervention is typically recommended for localized tumours, whereas chemotherapy is the preferred approach in the advanced and/or metastatic setting. However, pancreatic cancer is closely linked to ageing, with an average diagnosis at 72 years. Paradoxically, despite its increased occurrence among older individuals, this population is often underrepresented in clinical studies, complicating the decision-making process. Age alone should not determine the therapeutic strategy but, given the high comorbidity and mortality of this disease, a comprehensive geriatric assessment (CGA) is necessary to define the best treatment, prevent toxicity, and optimize older patient care. In this review, a group of experts from the Oncogeriatrics Section of the Spanish Society of Medical Oncology (Sociedad Española de Oncología Médica, SEOM), the Spanish Cooperative Group for the Treatment of Digestive Tumours (Grupo Español de Tratamiento de los Tumores Digestivos, TTD), and the Multidisciplinary Spanish Group of Digestive Cancer (Grupo Español Multidisciplinar en Cáncer Digestivo, GEMCAD) have assessed the available scientific evidence and propose a series of recommendations on the management and treatment of the older population with pancreatic cancer.
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Affiliation(s)
- Mónica Guillot Morales
- Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Department of Medical Oncology, Son Espases University Hospital, Carretera de Valldemossa, 79, Islas Baleares, 07120, Palma de Mallorca, Spain.
| | - Laura Visa
- Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Mar-Parc de Salut Mar Hospital, Barcelona, Spain
| | - Elena Brozos Vázquez
- Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, A Coruña University Clinical Hospital, A Coruña, Spain
| | - Jaime Feliu Batlle
- Multidisciplinary Spanish Group of Digestive Cancer (GEMCAD), La Paz University Hospital, IDIPAZ, CIBERONC, Cathedra UAM-AMGEN, Madrid, Spain
| | - Parham Khosravi Shahi
- Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Gregorio Marañón University Hospital, Madrid, Spain
| | - Berta Laquente Sáez
- Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, ICO L´Hospitalet-IDIBELL, Barcelona, Spain
| | | | - Teresa Macarulla
- Spanish Cooperative Group for the Treatment of Digestive Tumours (TTD), Hebron University Hospital, Vall d, Barcelona, Spain
| | - Regina Gironés Sarrió
- Spanish Society of Medical Oncology (SEOM), Polytechnic la Fe University Hospital, Valencia, Spain
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Pérez-Wert P, Custodio A, Jimenez-Fonseca P, Carmona-Bayonas A, Lecumberri A, Cacho Lavin D, Losantos García I, Fernández Montes A, Cano JM, Limón ML, Hernández San Gil R, Diez M, Vidal Tocino R, Macías Declara I, Visa L, Pimentel Cáceres P, Gil Raga M, Martínez Moreno E, Sauri T, Martín Richard M, Granja M, Cerdà P, Gómez González L, Mérida-García A, Ruiz Martín M, Gallego J. Efficacy and safety of chemotherapy in young patients with advanced gastroesophageal adenocarcinoma: data from the Spanish AGAMENON-SEOM registry. Gastric Cancer 2024; 27:131-145. [PMID: 37964032 DOI: 10.1007/s10120-023-01443-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/19/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Gastroesophageal adenocarcinoma in young adults (GCYA) counts for 10-15% of diagnoses. Previous studies have mainly focused on surgical outcomes in patients with resectable tumors; however, systemic therapy for advanced GCYA remains under-evaluated. This study aims to assess the efficacy-related outcomes and safety of first-line chemotherapy (CT) in younger versus older patients with advanced gastroesophageal adenocarcinoma. METHODS Patients with advanced gastroesophageal adenocarcinoma from the AGAMENON-SEOM registry treated with first-line polychemotherapy between January 2008 and October 2022 were included. We compared clinicopathological features, therapies received, efficacy-related outcomes, and toxicity between individuals aged < and ≥ 45 years. RESULTS Out of 3386 patients, 263 (7.8%) were < 45 years. Young patients exhibited a higher proportion of females affected, lower ECOG-PS ≥ 2, fewer comorbidities, and more aggressive disease-related features, such as higher proportion of diffuse subtype, signet-ring cells, plastic linitis, grade 3, peritoneal metastases and metastatic disease at diagnosis. They received more triple-agent combinations and underwent more surgeries in metastatic setting. No significant differences were observed between groups in overall response rate (53.1% vs. 52.3% in < and ≥ 45 years, respectively, p = 0.579), progression-free survival (6.1 vs. 6.83 months, p = 0.158) and overall survival (11.07 vs. 10.81 months, p = 0.82), even after adjusting for potential confounding factors. Grade 3-4 adverse events were comparable in both groups, although toxicity leading to treatment discontinuation was more frequent in older patients. CONCLUSIONS In the AGAMENON-SEOM registry, younger patients with GCYA exhibited more aggressive clinicopathological features, and despite receiving more aggressive treatments, similar efficacy outcomes and toxicity profiles were achieved compared to their older counterparts. In the AGAMENON-SEOM registry, GEAC in < 45 years showed more aggressive clinicopathological features and, although treated with more intense first-line CT regimens, similar efficacy outcomes and toxicity were achieved compared to older patients.
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Affiliation(s)
- Pablo Pérez-Wert
- Medical Oncology Department, Hospital Universitario La Paz, CIBERONC CB16/12/00398, Paseo de La Castellana, 261, 28046, Madrid, Spain.
| | - Ana Custodio
- Medical Oncology Department, Hospital Universitario La Paz, CIBERONC CB16/12/00398, Paseo de La Castellana, 261, 28046, Madrid, Spain
| | - Paula Jimenez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | - Alberto Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, University of Murcia, IMIB, Murcia, Spain
| | - Arturo Lecumberri
- Medical Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Diego Cacho Lavin
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | | | | | - Juana María Cano
- Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - María Luisa Limón
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - Marc Diez
- Medical Oncology Department, Hospital Universitario Val d´Hebron, Vall Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Rosario Vidal Tocino
- Medical Oncology Department, Complejo Asistencial Universitario de Salamanca-IBSAL, Salamanca, Spain
| | | | - Laura Visa
- Medical Oncology Department, Hospital Universitario El Mar, Barcelona, Spain
| | - Paola Pimentel Cáceres
- Medical Oncology Department, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - Mireia Gil Raga
- Medical Oncology Department, Hospital General Universitario de Valencia, Valencia, Spain
| | - Elia Martínez Moreno
- Medical Oncology Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Tamara Sauri
- Medical Oncology Department, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | | | - Mónica Granja
- Medical Oncology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Paula Cerdà
- Medical Oncology Department, Hospital Universitario Santa Creu I Sant Pau, Barcelona, Spain
| | - Lucía Gómez González
- Medical Oncology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Maribel Ruiz Martín
- Medical Oncology Department, Hospital Universitario Río Carrión, Palencia, Spain
| | - Javier Gallego
- Medical Oncology Department, Hospital General Universitario of Elche, Elche, Spain
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Bosch-Compte R, Visa L, Rios A, Duran X, Fernández-Real M, Gomariz-Vilaldach G, Masclans JR. Prognostic factors in oncological patients with solid tumours requiring intensive care unit admission. Oncol Lett 2023; 26:525. [PMID: 37927417 PMCID: PMC10623089 DOI: 10.3892/ol.2023.14112] [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: 06/22/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
The aim of the present study was to identify factors predicting in-hospital mortality in patients with cancer admitted to a medical Intensive Care Unit (ICU), and to evaluate their functional status and survival during follow-up at the oncology service in the initial 12 months after hospital discharge. A retrospective observational study was performed on 129 consecutive oncological patients with solid tumours admitted to the medical ICU of the Hospital del Mar (Barcelona, Spain) between January 2016 and June 2018. Demographics, and clinical data in-ICU and in-hospital mortality were recorded. Post-hospital discharge follow-up was also carried out. ICU and hospital mortality rates were 24% (n=31) and 40.3% (n=52), respectively. Sequential Organ Failure Assessment (SOFA) score (HR, 1.20; 95% CI, 1.01-1.42; P=0.037), neutropenia on admission (HR, 8.53; 95% CI, 2.15-33.82; P=0.002), metastatic disease (HR, 3.92; 95% CI, 1.82-8.45; P<0.001), need for invasive mechanical ventilation (HR, 5.78; 95% CI, 1.61-20.73; P=0.007), surgery during hospital admission (HR, 0.23; 95% CI, 0.09-0.61; P=0.003) and ICU stay (>48 h) (HR, 0.11; 95% CI, 0.04-0.29; P<0.001) were the independent risk factors for ICU mortality. Overall, 59.5% of the survivors had good functional status at hospital discharge and 28.7% of patients with cancer admitted to the ICU were alive 1 year after hospital discharge, most of them (85.7%) with good functional status (Eastern Cooperative Oncology Group 0-1). In conclusion, hospital mortality may be associated with SOFA score at ICU admission, the need for invasive mechanical ventilation, neutropenia and metastatic disease. Only 40% of patients with oncological disease admitted to the ICU died during their hospital stay, and >50% of the survivors presented good functional status at hospital discharge. Notably, 1 year after hospital discharge, 28.7% of patients were alive, most of them with a good functional status.
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Affiliation(s)
- Raquel Bosch-Compte
- Department of Critical Care Medicine, Hospital del Mar, 08003 Barcelona, Spain
| | - Laura Visa
- Department of Medical Oncology, Hospital del Mar, 08003 Barcelona, Spain
- Network Biomedical Research Center in Cancer, Ministry of Science and Innovation, Government of Spain, 28029 Madrid, Spain
| | - Alejandro Rios
- Department of Medical Oncology, Hospital del Mar, 08003 Barcelona, Spain
| | - Xavier Duran
- Hospital del Mar Medical Research Institute Foundation, 08003 Barcelona, Spain
| | - Maria Fernández-Real
- Department of Critical Care Medicine, Hospital del Mar, 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute Foundation, 08003 Barcelona, Spain
| | - Gemma Gomariz-Vilaldach
- Department of Critical Care Medicine, Hospital del Mar, 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute Foundation, 08003 Barcelona, Spain
| | - Joan Ramon Masclans
- Department of Critical Care Medicine, Hospital del Mar, 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute Foundation, 08003 Barcelona, Spain
- Department of Medicine and Life Sciences, Pompeu Fabra University, 08002 Barcelona, Spain
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Jimenez-Fonseca P, Foy V, Raby S, Carmona-Bayonas A, Macía-Rivas L, Arrazubi V, Cacho Lavin D, Hernandez San Gil R, Custodio A, Cano JM, Fernández Montes A, Mirallas O, Macias Declara I, Vidal Tocino R, Visa L, Limón ML, Pimentel P, Martínez Lago N, Sauri T, Martín Richard M, Mangas M, Gil Raga M, Calvo A, Reguera P, Granja M, Martín Carnicero A, Hernández Pérez C, Cerdá P, Gomez Gonzalez L, Garcia Navalon F, Pacheco Barcia V, Gutierrez Abad D, Ruiz Martín M, Weaver J, Mansoor W, Gallego J. The AGAMENON-SEOM model for prediction of survival in patients with advanced HER2-positive oesophagogastric adenocarcinoma receiving first-line trastuzumab-based therapy. Ther Adv Med Oncol 2023; 15:17588359231157641. [PMID: 36895850 PMCID: PMC9989382 DOI: 10.1177/17588359231157641] [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: 08/17/2022] [Accepted: 01/30/2023] [Indexed: 03/06/2023] Open
Abstract
Background Trastuzumab and chemotherapy is the standard first-line treatment in human epidermal growth factor receptor 2 (HER2)-positive advanced gastro-oesophageal cancer. The objective was to develop a predictive model for overall survival (OS) and progression-free survival (PFS) in patients treated with trastuzumab. Methods Patients with HER2-positive advanced gastro-oesophageal adenocarcinoma (AGA) from the Spanish Society of Medical Oncology (SEOM)-AGAMENON registry and treated first line with trastuzumab and chemotherapy between 2008 and 2021 were included. The model was externally validated in an independent series (The Christie NHS Foundation Trust, Manchester, UK). Results In all, 737 patients were recruited (AGAMENON-SEOM, n = 654; Manchester, n = 83). Median PFS and OS in the training cohort were 7.76 [95% confidence interval (CI), 7.13-8.25] and 14.0 months (95% CI, 13.0-14.9), respectively. Six covariates were significantly associated with OS: neutrophil-to-lymphocyte ratio, Eastern Cooperative Oncology Group performance status, Lauren subtype, HER2 expression, histological grade and tumour burden. The AGAMENON-HER2 model demonstrated adequate calibration and fair discriminatory ability with a c-index for corrected PFS/OS of 0.606 (95% CI, 0.578-0.636) and 0.623 (95% CI, 0.594-0.655), respectively. In the validation cohort, the model is well calibrated, with a c-index of 0.650 and 0.683 for PFS and OS, respectively. Conclusion The AGAMENON-HER2 prognostic tool stratifies HER2-positive AGA patients receiving trastuzumab and chemotherapy according to their estimated survival endpoints.
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Affiliation(s)
- Paula Jimenez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | - Victoria Foy
- Department of Medical Oncology, Christie Hospital, Manchester, UK
| | - Sophie Raby
- Department of Medical Oncology, Christie Hospital, Manchester, UK
| | - Alberto Carmona-Bayonas
- Medical Oncology Department, Hospital Universitario Morales Meseguer, Calle Marqués de los Vélez, s/n, Murcia 30007, Spain
| | - Lola Macía-Rivas
- Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Virginia Arrazubi
- Medical Oncology Department, Complejo Hospitalario de Navarra, IdiSNA (Navarra Institute for Health Research), Pamplona, Spain
| | - Diego Cacho Lavin
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | | | - Ana Custodio
- Medical Oncology Department, Hospital Universitario La Paz, CIBERONC CB16/12/00398, Madrid, Spain
| | - Juana María Cano
- Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | - Oriol Mirallas
- Medical Oncology Department, Hospital Universitario Vall d'Hebron, Vall Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Rosario Vidal Tocino
- Medical Oncology Department, Complejo Asistencial Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Laura Visa
- Medical Oncology Department, Hospital Universitario El Mar, Barcelona, Spain
| | - María Luisa Limón
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Paola Pimentel
- Medical Oncology Department, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - Nieves Martínez Lago
- Medical Oncology Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Tamara Sauri
- Medical Oncology Department, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | | | - Monserrat Mangas
- Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain
| | - Mireia Gil Raga
- Medical Oncology Department, Hospital General Universitario de Valencia, Valencia, Spain
| | - Aitana Calvo
- Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Pablo Reguera
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Mónica Granja
- Medical Oncology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Carolina Hernández Pérez
- Medical Oncology Department, Hospital Universitario Nuestra Señora de the Candelaria, Santa Cruz de Tenerife, Spain
| | - Paula Cerdá
- Medical Oncology Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - Lucía Gomez Gonzalez
- Medical Oncology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | | | | | - David Gutierrez Abad
- Medical Oncology Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Maribel Ruiz Martín
- Medical Oncology Department, Hospital Universitario Rio Carrión de Zamora, Zamora, Spain
| | - Jamie Weaver
- Department of Medical Oncology, Christie Hospital/University of Manchester, Manchester, UK
| | - Wasat Mansoor
- Department of Medical Oncology, Christie Hospital/University of Manchester, Manchester, UK
| | - Javier Gallego
- Medical Oncology Department, Hospital General Universitario of Elche, Elche, Spain
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6
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Valcarcel S, Gallego J, Jimenez-Fonseca P, Diez M, de Castro EM, Hernandez R, Arrazubi V, Custodio A, Cano JM, Montes AF, Macias I, Visa L, Calvo A, Tocino RV, Lago NM, Limón ML, Granja M, Gil M, Pimentel P, Macia-Rivas L, Pérez CH, Mangas M, Carnicero AM, Cerdà P, Gonzalez LG, Navalon FG, Rambla MDM, Richard MM, Carmona-Bayonas A. Does HER2 status influence in the benefit of ramucirumab and paclitaxel as second line treatment of advanced gastro-esophageal adenocarcinoma? Data from the AGAMENON-SEOM registry. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04294-6. [PMID: 36042046 DOI: 10.1007/s00432-022-04294-6] [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: 06/16/2022] [Accepted: 08/14/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE This study aimed to compare ramucirumab-paclitaxel versus chemotherapy in second-line (2L) advanced gastroesophageal cancer (aGEC) based on HER2 status and analyze prognostic factors. METHODS The study includes patients from the AGAMENON-SEOM registry with aGEC and known HER2 status who received 2L between 2016 and 2021. The Kaplan-Meier method was used to calculate progression-free survival (PFS) and overall survival (OS) and multivariable Cox regression analysis was done to adjust for confounding variables. RESULTS Of the 552 patients who met the selection criteria, 149 (26.9%) had HER2-positive aGEC, 89 were treated with chemotherapy, and 60 with ramucirumab-paclitaxel, and 403 had an HER2-negative aGEC, 259 were treated with chemotherapy, and 144 with ramucirumab-paclitaxel. In the whole sample, 2L PFS was 3.0 months (95% CI 2.8-3.2), 2L OS, 5.7 months (5.2-6.3), and ramucirumab-paclitaxel versus chemotherapy was associated with increased PFS (HR 0.64, 95% CI 0.53-0.78, p < 0.0001) and OS (HR 0.68, 0.55-0.83, p = 0.0002). Median PFS of ramucirumab- paclitaxel versus chemotherapy was 3.5 vs 2.8 months (HR 0.67, 0.54-0.83, p = 0.0004) in HER2-negative, and 4.7 vs 2.7 months (HR 0.57, 0.40-0.82, p = 0.0031) in HER2-positive aGEC, respectively. Median OS for ramucirumab-paclitaxel versus chemotherapy was 6.6 vs 5 months (HR 0.67, 0.53-0.85, p = 0.0007) in HER2-negative, and 7.4 vs 5.6 months (HR 0.70, 0.53-1.04, p = 0.083) in HER2-positive aGEC, respectively. ECOG-PS, tumor burden, Lauren subtype, and neutrophil-lymphocyte ratio were prognostic factors. CONCLUSIONS In patients with an aGEC from the AGAMENON-SEOM registry, 2L treatment with ramucirumab-paclitaxel was superior to chemotherapy in PFS, OS and response rate, independent of HER2 status.
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Affiliation(s)
- Sena Valcarcel
- Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Avenida Roma Sn., CP 33011, Oviedo, Spain.
| | - Javier Gallego
- Medical Oncology Department, Hospital General Universitario de Elche, Elche, Spain
| | - Paula Jimenez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | - Marc Diez
- Medical Oncology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Eva Martínez de Castro
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Raquel Hernandez
- Medical Oncology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - Virginia Arrazubi
- Medical Oncology Department, Hospital Universitario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Ana Custodio
- Medical Oncology Department, Hospital Universitario La Paz, CIBERONC CB16/12/00398, Madrid, Spain
| | - Juana María Cano
- Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Ana Fernández Montes
- Medical Oncology Department, Complejo Hospitalario Universitario de Ourense, Orense, Spain
| | - Ismael Macias
- Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain
| | - Laura Visa
- Medical Oncology Department, Hospital Universitario El Mar, Barcelona, Spain
| | - Aitana Calvo
- Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Rosario Vidal Tocino
- Medical Oncology Department, Complejo Asistencial Universitario de Salamanca - IBSAL, Salamanca, Spain
| | - Nieves Martínez Lago
- Medical Oncology Department, Complejo Hospitalario Universitario de A Coruña, Coruña, Spain
| | - María Luisa Limón
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Mónica Granja
- Medical Oncology Department, Hospital Universitario Clínico San Carlos Madrid, Madrid, Spain
| | - Mireia Gil
- Medical Oncology Department, Hospital General Universitario de Valencia, Ciberonc CB16/12/0035, Valencia, Spain
| | - Paola Pimentel
- Medical Oncology Department, Hospital Santa Lucía, Cartagena, Spain
| | - Lola Macia-Rivas
- Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Carolina Hernández Pérez
- Medical Oncology Department, Hospital Universitario Nuestra Señora de La Candelaria, Tenerife, Spain
| | - Montserrat Mangas
- Medical Oncology Department, Hospital Galdakao-Usansolo, Galdakao-Usansolo, Spain
| | | | - Paula Cerdà
- Medical Oncology Department, Hospital Santa Creu I Sant Pau, Barcelona, Spain
| | - Lucía Gomez Gonzalez
- Medical Oncology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | | | | | - Marta Martin Richard
- Medical Oncology Department, Catalan Institute of Oncology (ICO), L'Hospitalet, Spain
| | - Alberto Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, University of Murcia, IMIB, CP13/00126, PI17/0050 (ISCIII& FEDER), Murcia, Spain
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7
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Plazas JG, Arias-Martinez A, Lecumberri A, Martínez de Castro E, Custodio A, Cano JM, Hernandez R, Montes AF, Macias I, Pieras-Lopez A, Diez M, Visa L, Tocino RV, Lago NM, Limón ML, Gil M, Pimentel P, Mangas M, Granja M, Carnicero AM, Pérez CH, Gonzalez LG, Jimenez-Fonseca P, Carmona-Bayonas A. Sex and gender disparities in patients with advanced gastroesophageal adenocarcinoma: data from the AGAMENON-SEOM registry. ESMO Open 2022; 7:100514. [PMID: 35714478 PMCID: PMC9271495 DOI: 10.1016/j.esmoop.2022.100514] [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: 03/26/2022] [Revised: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background Recommendations for research articles include the use of the term sex when reporting biological factors and gender for identities or psychosocial or cultural factors. There is an increasing awareness of incorporating the effect of sex and gender on cancer outcomes. Thus, these types of analyses for advanced gastroesophageal adenocarcinoma are relevant. Patients and methods Patients with advanced gastroesophageal adenocarcinoma from the Spanish AGAMENON-SEOM registry treated with first-line combination chemotherapy were selected. Epidemiology, characteristics of the disease, treatment selection, and results were examined according to sex. Results This analysis included 3274 advanced gastroesophageal adenocarcinoma patients treated with combination chemotherapy between 2008 and 2021: 2313 (70.7%) men and 961 (29.3%) women. Tumors in females were more frequently HER2-negative (67.8% versus 60.8%; P < 0.0001), grade 3 (45.4% versus 36.8%; P < 0.001), diffuse (43.3% versus 26.5%; P < 0.0001), and signet ring cell histology (40.5 versus 23.9%; P < 0.0001). Peritoneal spread was more common in women (58.6% versus 38.9%; P < 0.0001), while liver burden was lower (58.9% versus 71.1%; P < 0.0001). There were no significant differences in treatment recommendation. Treatment doses, density, and duration were comparable between sexes. Women experienced more diarrhea (46% versus 37%; P < 0.0001), neutropenia (51% versus 43%; P < 0.0001), and anemia (62% versus 57%; P < 0.0001). After a median 59.6-month follow-up [95% confidence interval (CI) 54.5-70.8], there were no statistically significant differences between the sexes in progression-free survival [6.21 months (95% CI 5.8-6.5 months) versus 6.08 months (95% CI 5.8-6.3 months); log-rank test, χ2 = 0.1, 1 df, P = 0.8] or in overall survival [10.6 months (95% CI 9.8-11.1 months) versus 10.9 months (95% CI 10.4-11.4 months); log-rank test: χ2 = 0.6, 1 df, P = 0.5]. Conclusion This sex analysis of patients with advanced gastroesophageal adenocarcinoma from the AGAMENON-SEOM registry receiving first-line polychemotherapy found no differences in survival. Although women had worse prognostic histopathology, metastatic disease pattern, and greater toxicity, treatment allocation and compliance were equivalent. Sex and gender are determinants of health inequalities and may affect treatments, tolerability, and therapeutic outcomes. According to sex, subtle biological and clinical differences exist in advanced gastroesophageal adenocarcinoma. Women with advanced gastroesophageal adenocarcinoma experience greater toxicity with therapeutic results comparable with men. Stratification and analysis by sex in studies of gastroesophageal adenocarcinoma should be considered.
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Affiliation(s)
- J Gallego Plazas
- Medical Oncology Department, Hospital General Universitario de Elche, Elche, Spain.
| | - A Arias-Martinez
- Pharmacy Department, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
| | - A Lecumberri
- Medical Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - E Martínez de Castro
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - A Custodio
- Medical Oncology Department, Hospital Universitario La Paz, CIBERONC CB16/12/00398, Madrid, Spain
| | - J M Cano
- Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - R Hernandez
- Medical Oncology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - A F Montes
- Medical Oncology Department, Complejo Hospitalario de Ourense, Ourense, Spain
| | - I Macias
- Medical Oncology Department, Hospital Universitario Parc Taulí, Sabadell, Spain
| | - A Pieras-Lopez
- Pharmacy Department, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - M Diez
- Medical Oncology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - L Visa
- Medical Oncology Department, Hospital Universitario El Mar, Barcelona, Spain
| | - R V Tocino
- Medical Oncology Department, Complejo Asistencial Universitario de Salamanca - ISBAL, Salamanca, Spain
| | - N Martínez Lago
- Medical Oncology Department, Complejo Hospitalario Universitario de A Coruña, Coruña, Spain
| | - M L Limón
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - M Gil
- Medical Oncology Department, Hospital General Universitario de Valencia - Ciberonc CB16/12/0035, Valencia, Spain
| | - P Pimentel
- Medical Oncology Department, Hospital Santa Lucía, Cartagena, Spain
| | - M Mangas
- Medical Oncology Department, Hospital Galdakao-Usansolo, Galdakao-Usansolo, Spain
| | - M Granja
- Medical Oncology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - A M Carnicero
- Medical Oncology Department, Hospital San Pedro, Logroño, Spain
| | - C Hernández Pérez
- Medical Oncology Department, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain
| | - L G Gonzalez
- Medical Oncology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - P Jimenez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | - A Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, University of Murcia, IMIB, Murcia, Spain
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8
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Jiménez-Fonseca P, Carmona-Bayonas A, Gallego Plazas J, Custodio A, Visa L, Martínez de Castro E, Gómez González L, Moreno Gutierrez M, Polanco Sanchez C, Xiao H. P-30 First-line (1L) treatment patterns in advanced gastric, gastroesophageal junction, and esophageal adenocarcinoma (GC/GEJC/EAC): Data from the Spanish AGAMENON-SEOM registry. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.121] [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: 11/16/2022] Open
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9
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Pueyo-Périz E, Téllez-Marquès C, Radosevic A, Morató O, Visa L, Ilzarbe L, Berjano E, de Vicente E, Poves I, Ielpo B, Grande L, Burdío F, Sánchez-Velázquez P. Radiofrequency-assisted transection of the pancreas vs stapler in distal pancreatectomy: a propensity score matched cohort analysis. Sci Rep 2022; 12:7486. [PMID: 35523857 PMCID: PMC9076639 DOI: 10.1038/s41598-022-11583-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 04/25/2022] [Indexed: 12/20/2022] Open
Abstract
To demonstrate the efficacy of radiofrequency for pancreatic stump closure in reducing the incidence of postoperative pancreatic fistula (POPF) in distal pancreatectomy (DP) compared with mechanical transection methods. Despite all the different techniques of pancreatic stump closure proposed for DP, best practice for avoiding POPF remains an unresolved issue, with an incidence of up to 30% regardless of center volume or surgical expertise. DP was performed in a cohort of patients by applying radiofrequency to stump closure (RF Group) and compared with mechanical closure (Control Group). A propensity score (PS) matched cohort study was carried out to minimize bias from nonrandomized treatment assignment. Cohorts were matched by PS accounting for factors significantly associated with either undergoing RF transection or mechanical closure through logistic regression analysis. The primary end-point was the incidence of clinically relevant POPF (CR-POPF). Of 89 patients included in the whole cohort, 13 case patients from the RF-Group were 1:1 matched to 13 control patients. In both the first independent analysis of unmatched data and subsequent adjustment to the overall propensity score-matched cohort, a higher rate of CR-POPF in the Control Group compared with the RF-Group was detected (25.4% vs 5.3%, p = 0.049 and 53.8% vs 0%; p = 0.016 respectively). The RF Group showed better outcomes in terms of readmission rate (46.2% vs 0%, p = 0.031). No significant differences were observed in terms of mortality, major complications (30.8% vs 0%, p = 0.063) or length of hospital stay (5.7 vs 5.2 days, p = 0.89). Findings suggest that the RF-assisted technique is more efficacious in reducing CR-POPF than mechanical pancreatic stump closure.
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Affiliation(s)
- E Pueyo-Périz
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Passeig Maritim 25-29, Barcelona, Spain.
| | - C Téllez-Marquès
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Passeig Maritim 25-29, Barcelona, Spain
| | - A Radosevic
- Department of Radiology, Hospital del Mar, Passeig Maritim 25-29, Barcelona, Spain
| | - O Morató
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Passeig Maritim 25-29, Barcelona, Spain
| | - L Visa
- Department of Oncology, Hospital del Mar-IMIM-CIBERONC, Passeig Maritim 25-29, Barcelona, Spain
| | - L Ilzarbe
- Department of Gastroenterology, Hospital del Mar, Passeig Maritim 25-29, Barcelona, Spain
| | - E Berjano
- BioMIT, Department of Electronic Engineering, Universitat Politècnica de València, Valencia, Spain
| | - E de Vicente
- Department of Surgery, Hospital Sanchinarro, Madrid, Spain
| | - I Poves
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Passeig Maritim 25-29, Barcelona, Spain
| | - B Ielpo
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Passeig Maritim 25-29, Barcelona, Spain
| | - L Grande
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Passeig Maritim 25-29, Barcelona, Spain
| | - F Burdío
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Passeig Maritim 25-29, Barcelona, Spain
| | - P Sánchez-Velázquez
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Passeig Maritim 25-29, Barcelona, Spain.
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10
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Kroese TE, van Hillegersberg R, Schoppmann S, Deseyne PR, Nafteux P, Obermannova R, Nordsmark M, Pfeiffer P, Hawkings MA, Smyth E, Markar S, Hanna GB, Cheong E, Chaudry A, Elme A, Adenis A, Piessen G, Gani C, Bruns CJ, Moehler M, Liakakos T, Reynolds J, Morganti A, Rosati R, Castoro C, D'Ugo D, Roviello F, Bencivenga M, de Manzoni G, Jeene P, van Sandick JW, Muijs C, Slingerland M, Nieuwenhuijzen G, Wijnhoven B, Beerepoot LV, Kolodziejczyk P, Polkowski WP, Alsina M, Pera M, Kanonnikoff TF, Nilsson M, Guckenberger M, Monig S, Wagner D, Wyrwicz L, Berbee M, Gockel I, Lordick F, Griffiths EA, Verheij M, van Rossum PS, van Laarhoven HW, Rosman C, Rütten H, Gootjes EC, Vonken FE, van Dieren JM, Vollebergh MA, van der Sangen M, Creemers GJ, Zander T, Schlößer H, Cascinu S, Mazza E, Nicoletti R, Damascelli A, Slim N, Passoni P, Cossu A, Puccetti F, Barbieri L, Fanti L, Azzolini F, Ventoruzzo F, Szczepanik A, Visa L, Reig A, Roques T, Harrison M, Ciseł B, Pikuła A, Skórzewska M, Vanommeslaeghe H, Van Daele E, Pattyn P, Geboes K, Callebout E, Ribeiro S, van Duijvendijk P, Tromp C, Sosef M, Warmerdam F, Heisterkamp J, Heisterkamp J, Vera A, Jordá E, López-Mozos F, Fernandez-Moreno MC, Barrios-Carvajal M, Huerta M, de Steur W, Lips I, Diez M, Castro S, O'Neill R, Holyoake D, Hacker U, Denecke T, Kuhnt T, Hoffmeister A, Kluge R, Bostel T, Grimminger P, Jedlička V, Křístek J, Pospíšil P, Mourregot A, Maurin C, Starling N, Chong I. Definitions and treatment of oligometastatic oesophagogastric cancer according to multidisciplinary tumour boards in Europe. Eur J Cancer 2022; 164:18-29. [DOI: 10.1016/j.ejca.2021.11.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/28/2021] [Indexed: 12/17/2022]
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11
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Corbera A, Rios-Hoyo A, Visa L, Casadevall D, Ilzarbe L, Barranco L, Radosevic A, Servitja S. Incidence of complications associated to bile duct stents, in patients with advanced cancer: a single-center experience. Support Care Cancer 2022; 30:4373-4378. [DOI: 10.1007/s00520-021-06737-1] [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] [Received: 07/01/2021] [Accepted: 12/03/2021] [Indexed: 12/09/2022]
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Zaragoza-Huesca D, Garrido-Rodríguez P, Jiménez-Fonseca P, Martínez de Castro E, Sánchez-Cánovas M, Visa L, Custodio A, Fernández-Montes A, Peñas-Martínez J, Morales del Burgo P, Gallego J, Luengo-Gil G, Vicente V, Martínez-Martínez I, Carmona-Bayonas A. Identification of Thrombosis-Related Genes in Patients with Advanced Gastric Cancer: Data from AGAMENON-SEOM Registry. Biomedicines 2022; 10:biomedicines10010148. [PMID: 35052827 PMCID: PMC8773420 DOI: 10.3390/biomedicines10010148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 02/01/2023] Open
Abstract
Advanced gastric cancer is one of the most thrombogenic neoplasms. However, genetic mechanisms underlying this complication remain obscure, and the molecular and histological heterogeneity of this neoplasm hinder the identification of thrombotic biomarkers. Therefore, our main objective was to identify genes related to thrombosis regardless of Lauren subtypes. Furthermore, in a secondary exploratory study, we seek to discover thrombosis-associated genes that were specific to each TCGA molecular subtype. We designed a nested case-control study using the cohort of the AGAMENON national advanced gastric cancer registry. Ninety-seven patients were selected—48 with and 49 without venous thromboembolism (using propensity score matching to adjust for confounding factors)—and a differential gene expression array stratified by Lauren histopathological subtypes was carried out in primary tumor samples. For the secondary objective, the aforementioned differential expression analysis was conducted for each TCGA group. Fifteen genes were determined to be associated with thrombosis with the same expression trend in both the intestinal and diffuse subtypes. In thrombotic subjects, CRELD1, KCNH8, CRYGN, MAGEB16, SAA1, ARL11, CCDC169, TRMT61A, RIPPLY3 and PLA2G6 were underexpressed (adjusted-p < 0.05), while PRKD3, MIR5683, SDCBP, EPS8 and CDC45 were overexpressed (adjusted-p < 0.05), and correlated, by logistic regression, with lower or higher thrombotic risk, respectively, in the overall cohort. In each TCGA molecular subtype, we identified a series of genes differentially expressed in thrombosis that appear to be subtype-specific. We have identified several genes associated with venous thromboembolism in advanced gastric cancer that are common to Lauren intestinal and diffuse subtypes. Should these genetic factors be validated in the future, they could be complemented with existing clinical models to bolster the ability to predict thrombotic risk in individuals with advanced gastric adenocarcinoma.
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Affiliation(s)
- David Zaragoza-Huesca
- Centro Regional de Hemodonación, Department of Haematology and Medical Oncology, Hospital General Universitario Morales Meseguer, University of Murcia, IMIB-Arrixaca, 30003 Murcia, Spain; (D.Z.-H.); (P.G.-R.); (M.S.-C.); (J.P.-M.); (G.L.-G.); (V.V.); (A.C.-B.)
| | - Pedro Garrido-Rodríguez
- Centro Regional de Hemodonación, Department of Haematology and Medical Oncology, Hospital General Universitario Morales Meseguer, University of Murcia, IMIB-Arrixaca, 30003 Murcia, Spain; (D.Z.-H.); (P.G.-R.); (M.S.-C.); (J.P.-M.); (G.L.-G.); (V.V.); (A.C.-B.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras, U-765-CIBERER, Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Paula Jiménez-Fonseca
- Department of Medical Oncology, Instituto de Investigación Sanitaria del Principado de Asturias—ISPA, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain;
| | - Eva Martínez de Castro
- Department of Medical Oncology, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain;
| | - Manuel Sánchez-Cánovas
- Centro Regional de Hemodonación, Department of Haematology and Medical Oncology, Hospital General Universitario Morales Meseguer, University of Murcia, IMIB-Arrixaca, 30003 Murcia, Spain; (D.Z.-H.); (P.G.-R.); (M.S.-C.); (J.P.-M.); (G.L.-G.); (V.V.); (A.C.-B.)
| | - Laura Visa
- Department of Medical Oncology, Hospital del Mar, 08003 Barcelona, Spain;
| | - Ana Custodio
- Department of Medical Oncology, Hospital Universitario La Paz, CIBERONC CB16/12/00398, 28046 Madrid, Spain;
| | - Ana Fernández-Montes
- Department of Medical Oncology, Complejo Hospitalario Universitario de Ourense, 32005 Ourense, Spain;
| | - Julia Peñas-Martínez
- Centro Regional de Hemodonación, Department of Haematology and Medical Oncology, Hospital General Universitario Morales Meseguer, University of Murcia, IMIB-Arrixaca, 30003 Murcia, Spain; (D.Z.-H.); (P.G.-R.); (M.S.-C.); (J.P.-M.); (G.L.-G.); (V.V.); (A.C.-B.)
| | | | - Javier Gallego
- Department of Medical Oncology, Hospital General Universitario de Elche, 03203 Elche, Spain;
| | - Ginés Luengo-Gil
- Centro Regional de Hemodonación, Department of Haematology and Medical Oncology, Hospital General Universitario Morales Meseguer, University of Murcia, IMIB-Arrixaca, 30003 Murcia, Spain; (D.Z.-H.); (P.G.-R.); (M.S.-C.); (J.P.-M.); (G.L.-G.); (V.V.); (A.C.-B.)
| | - Vicente Vicente
- Centro Regional de Hemodonación, Department of Haematology and Medical Oncology, Hospital General Universitario Morales Meseguer, University of Murcia, IMIB-Arrixaca, 30003 Murcia, Spain; (D.Z.-H.); (P.G.-R.); (M.S.-C.); (J.P.-M.); (G.L.-G.); (V.V.); (A.C.-B.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras, U-765-CIBERER, Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Irene Martínez-Martínez
- Centro Regional de Hemodonación, Department of Haematology and Medical Oncology, Hospital General Universitario Morales Meseguer, University of Murcia, IMIB-Arrixaca, 30003 Murcia, Spain; (D.Z.-H.); (P.G.-R.); (M.S.-C.); (J.P.-M.); (G.L.-G.); (V.V.); (A.C.-B.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras, U-765-CIBERER, Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-968-341-990
| | - Alberto Carmona-Bayonas
- Centro Regional de Hemodonación, Department of Haematology and Medical Oncology, Hospital General Universitario Morales Meseguer, University of Murcia, IMIB-Arrixaca, 30003 Murcia, Spain; (D.Z.-H.); (P.G.-R.); (M.S.-C.); (J.P.-M.); (G.L.-G.); (V.V.); (A.C.-B.)
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13
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Martínez-Bosch N, Cristóbal H, Iglesias M, Gironella M, Barranco L, Visa L, Calafato D, Jiménez-Parrado S, Earl J, Carrato A, Manero-Rupérez N, Moreno M, Morales A, Guerra C, Navarro P, García de Frutos P. Soluble AXL is a novel blood marker for early detection of pancreatic ductal adenocarcinoma and differential diagnosis from chronic pancreatitis. EBioMedicine 2022; 75:103797. [PMID: 34973624 PMCID: PMC8724936 DOI: 10.1016/j.ebiom.2021.103797] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 10/11/2021] [Revised: 12/10/2021] [Accepted: 12/16/2021] [Indexed: 02/07/2023] Open
Abstract
Background Early diagnosis is crucial for patients with pancreatic ductal adenocarcinoma (PDAC). The AXL receptor tyrosine kinase is proteolytically processed releasing a soluble form (sAXL) into the blood stream. Here we explore the use of sAXL as a biomarker for PDAC. Methods AXL was analysed by immunohistochemistry in human pancreatic tissue samples. RNA expression analysis was performed using TCGA/GTEx databases. The plasma concentrations of sAXL, its ligand GAS6, and CA19-9 were studied in two independent cohorts, the HMar cohort (n = 59) and the HClinic cohort (n = 142), including healthy controls, chronic pancreatitis (CP) or PDAC patients, and in a familial PDAC cohort (n = 68). AXL expression and sAXL release were studied in PDAC cell lines and murine models. Findings AXL is increased in PDAC and precursor lesions as compared to CP or controls. sAXL determined in plasma from two independent cohorts was significantly increased in the PDAC group as compared to healthy controls or CP patients. Patients with high levels of AXL have a lower overall survival. ROC analysis of the plasma levels of sAXL, GAS6, or CA19-9 in our cohorts revealed that sAXL outperformed CA19-9 for discriminating between CP and PDAC. Using both sAXL and CA19-9 increased the diagnostic value. These results were validated in murine models, showing increased sAXL specifically in animals developing PDAC but not those with precursor lesions or acinar tumours. Interpretation sAXL appears as a biomarker for early detection of PDAC and PDAC–CP discrimination that could accelerate treatment and improve its dismal prognosis. Funding This work was supported by grants PI20/00625 (PN), RTI2018-095672-B-I00 (AM and PGF), PI20/01696 (MG) and PI18/01034 (AC) from MICINN-FEDER and grant 2017/SGR/225 (PN) from Generalitat de Catalunya.
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Affiliation(s)
- Neus Martínez-Bosch
- Cancer Research Program, Hospital del Mar Medical Research Institute (IMIM), Unidad Asociada IIBB-CSIC, Barcelona, Spain
| | - Helena Cristóbal
- Department of Cell Death and Proliferation, Institute of Biomedical Research of Barcelona (IIBB)-CSIC and Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Mar Iglesias
- Department of Pathology, Autonomous University of Barcelona, Hospital del Mar, Centro de Investigación Biomédica en Red de Oncología (CIBERONC), Barcelona, Spain
| | - Meritxell Gironella
- Gastrointestinal & Pancreatic Oncology Group, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD); Hospital Clínic of Barcelona and IDIBAPS; Barcelona, Spain
| | - Luis Barranco
- Cancer Research Program, Hospital del Mar Medical Research Institute (IMIM), Unidad Asociada IIBB-CSIC, Barcelona, Spain; Department of Gastroenterology, Hospital del Mar, Barcelona, Spain
| | - Laura Visa
- Department of Medical Oncology, Hospital del Mar, Barcelona, Spain
| | - Domenico Calafato
- Department of Cell Death and Proliferation, Institute of Biomedical Research of Barcelona (IIBB)-CSIC and Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Silvia Jiménez-Parrado
- Molecular Oncology Program, Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain
| | - Julie Earl
- Molecular Epidemiology and Predictive Tumour Markers Group, Medical Oncology Research Laboratory, Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain. CIBERONC
| | - Alfredo Carrato
- Molecular Epidemiology and Predictive Tumour Markers Group, Medical Oncology Research Laboratory, Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain. CIBERONC
| | - Noemí Manero-Rupérez
- Cancer Research Program, Hospital del Mar Medical Research Institute (IMIM), Unidad Asociada IIBB-CSIC, Barcelona, Spain
| | - Mireia Moreno
- Cancer Research Program, Hospital del Mar Medical Research Institute (IMIM), Unidad Asociada IIBB-CSIC, Barcelona, Spain
| | - Albert Morales
- Department of Cell Death and Proliferation, IIBB-CSIC, Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clínic, CIBEREHD and IDIBAPS, Barcelona, Spain
| | - Carmen Guerra
- Molecular Oncology Program, Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain
| | - Pilar Navarro
- Cancer Research Program, Hospital del Mar Medical Research Institute (IMIM), Unidad Asociada IIBB-CSIC, Barcelona, Spain; Department of Cell Death and Proliferation, Institute of Biomedical Research of Barcelona (IIBB)-CSIC and Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain.
| | - Pablo García de Frutos
- Department of Cell Death and Proliferation, IIBB-CSIC, Unidad Asociada IMIM/IIBB-CSIC; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and IDIBAPS, Barcelona, Spain.
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14
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Alvarez-Manceñido F, Jimenez-Fonseca P, Carmona-Bayonas A, Arrazubi V, Hernandez R, Cano JM, Custodio A, Pericay Pijaume C, Aguado G, Martínez Lago N, Sánchez Cánovas M, Cacho Lavin D, Visa L, Martinez-Torron A, Arias-Martinez A, López F, Limón ML, Vidal Tocino R, Fernández Montes A, Alsina M, Pimentel P, Reguera P, Martín Carnicero A, Ramchandani A, Granja M, Azkarate A, Martín Richard M, Serra O, Hernández Pérez C, Hurtado A, Gil-Negrete A, Sauri T, Morales Del Burgo P, Gallego J. Is advanced esophageal adenocarcinoma a distinct entity from intestinal subtype gastric cancer? Data from the AGAMENON-SEOM Registry. Gastric Cancer 2021; 24:926-936. [PMID: 33651195 DOI: 10.1007/s10120-021-01169-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Advanced esophageal adenocarcinoma (EAC) is generally treated similarly to advanced gastroesophageal junction (GEJ-AC) and gastric (GAC) adenocarcinomas, although GAC clinical trials rarely include EAC. This work sought to compare clinical characteristics and treatment outcomes of advanced EAC with those of GEJ-AC and GAC and examine prognostic factors. PATIENTS AND METHODS Participants comprised patients with advanced EAC, intestinal GEJ-AC, and GAC treated with platin and fluoropyrimidine (plus trastuzumab when HER2 status was positive). Overall and progression-free survival were estimated using the Kaplan-Meier method. Cox proportional hazards regression gauged the prognostic value of the AGAMENON model. RESULTS Between 2008 and 2019, 971 participants from the AGAMENON-SEOM registry were recruited at 35 centers. The sample included 67.3% GAC, 13.3% GEJ-AC, and 19.4% EAC. Pulmonary metastases were most common in EAC and peritoneal metastases in GAC. Median PFS and OS were 7.7 (95% CI 7.3-8.0) and 13.9 months (12.9-14.7). There was no difference in PFS or OS between HER2- and HER2+ tumors from the three locations (p > 0.05). Five covariates were found to be prognostic for the entire sample: ECOG-PS, histological grade, number of metastatic sites, NLR, and HER2+ tumors treated with trastuzumab. In EAC, the same variables were prognostic except for grade. The favorable prognosis for HER2+ cancers treated with trastuzumab was homogenous for all three subgroups (p = 0.351) and, after adjusting for the remaining covariates, no evidence supported primary tumor localization as a prognostic factor (p = 0.331). CONCLUSION Our study supports the hypothesis that EAC exhibits clinicopathological characteristics, prognostic factors, and treatment outcomes comparable to intestinal GEJ-AC and GAC.
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Affiliation(s)
- Felipe Alvarez-Manceñido
- Pharmacy Department, Hospital Universitario Central de Asturias, Avenida Roma s/n, 33011, Oviedo, Spain.
| | - Paula Jimenez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | - Alberto Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, University of Murcia, IMIB, Murcia, Spain
| | - Virginia Arrazubi
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Raquel Hernandez
- Medical Oncology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - Juana M Cano
- Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Ana Custodio
- Medical Oncology Department, Hospital Universitario La Paz, CIBERONC CB16/12/00398, Madrid, Spain
| | | | - Gema Aguado
- Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Nieves Martínez Lago
- Medical Oncology Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Manuel Sánchez Cánovas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Diego Cacho Lavin
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Laura Visa
- Medical Oncology Department, Hospital Universitario El Mar, Barcelona, Spain
| | - Alba Martinez-Torron
- Pharmacy Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Aranzazu Arias-Martinez
- Pharmacy Department, Hospital Universitario Central de Asturias, Avenida Roma s/n, 33011, Oviedo, Spain
| | - Flora López
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - M Luisa Limón
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Rosario Vidal Tocino
- Medical Oncology Department, Complejo Asistencial Universitario de Salamanca-IBSAL, Salamanca, Spain
| | | | - Maria Alsina
- Medical Oncology Department, Hospital Universitario Vall d'Hebron, Vall Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Paola Pimentel
- Medical Oncology Department, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - Pablo Reguera
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Avinash Ramchandani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Mónica Granja
- Medical Oncology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Aitor Azkarate
- Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain
| | - Marta Martín Richard
- Medical Oncology Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - Olbia Serra
- Medical Oncology Department, Catalan Institute of Oncology, L'Hospitalet, Spain
| | - Carolina Hernández Pérez
- Medical Oncology Department, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain
| | - Alicia Hurtado
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Aitziber Gil-Negrete
- Medical Oncology Department, Hospital Universitario Donostia, San Sebastián, Spain
| | - Tamara Sauri
- Medical Oncology Department, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | | | - Javier Gallego
- Medical Oncology Department, Hospital General Universitario de Elche, Elche, Spain
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15
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Jimenez-Fonseca P, Carmona-Bayonas A, Martinez-Torron A, Alsina M, Custodio A, Serra O, Cacho Lavin D, Limón ML, Sauri T, López F, Visa L, Granja M, Martínez Lago N, Arrazubi V, Vidal Tocino R, Hernandez R, Aguado G, Cano JM, Martín Carnicero A, Mangas M, Pimentel P, Fernández Montes A, Macias Declara I, Longo F, Ramchandani A, Martín Richard M, Hurtado A, Azkarate A, Hernández Pérez C, Serrano R, Gallego J. External validity of clinical trials with diverse trastuzumab-based chemotherapy regimens in advanced gastroesophageal adenocarcinoma: data from the AGAMENON-SEOM registry. Ther Adv Med Oncol 2021; 13:17588359211019672. [PMID: 34211587 PMCID: PMC8216357 DOI: 10.1177/17588359211019672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/13/2021] [Accepted: 04/29/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Trastuzumab combined with cisplatin and fluoropyrimidines, either capecitabine or 5-fluorouracile (XP/FP), is the standard first-line treatment for advanced, HER2-positive, gastric cancer patients based on the ToGA trial. Despite the lack of phase III trials, many clinicians administer trastuzumab with alternative regimens. One meta-analysis suggests that substituting cisplatin for oxaliplatin might lead to greater efficacy and less toxicity. METHODS 594 patients with HER2-positive gastroesophageal adenocarcinoma were recruited from the AGAMENON-SEOM registry. The objective was to evaluate the external validity of clinical trials with chemotherapy and trastuzumab. RESULTS The regimens used in at least 5% of the patients were XP (27%), oxaliplatin and capecitabine (CAPOX) (26%), oxaliplatin and 5-fluorouracil (FOLFOX) (14%), FP (14%), triplet with anthracycline/docetaxel (7%), and carboplatin-FU (5%). Median exposure to trastuzumab was longer with FOLFOX (11.4 months, 95% CI, 9.1-21.0) versus ToGA regimens (7.5, 6.4-8.5), p < 0.001. Patients with HER2-IHC 3+ cancers had higher response rates than those with IHC 2+/FISH+, odds-ratio 1.97 (95% CI, 1.25-3.09). The results achieved with CAPOX-trastuzumab were comparable to those attained with ToGA regimens. FOLFOX-trastuzumab was superior to ToGA schemes in terms of overall survival (OS), with a greater magnitude of effect in IHC 2+/FISH+ tumors (HR 0.47, 0.24-0.92) compared with IHC 3+ (HR 0.69, 0.49-0.96), and in diffuse (HR 0.37, 0.20-0.69) versus intestinal-type tumors (HR 0.76, 0.54-1.06). CONCLUSION We have updated the external validity of clinical trials with trastuzumab in first-line treatment of gastric cancer. Our data confirm the comparable outcomes of ToGA regimens and CAPOX-trastuzumab in clinical practice and point toward a possible benefit of FOLFOX-trastuzumab, contingent on the subtypes typically less sensitive to trastuzumab, to be confirmed in clinical trials.
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Affiliation(s)
- Paula Jimenez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | - Alberto Carmona-Bayonas
- Medical Oncology Department, Hospital Universitario Morales Meseguer, Calle Marqués de los Vélez, s/n, Murcia, 30007, Spain
| | - Alba Martinez-Torron
- Pharmacy Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Maria Alsina
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona Vall Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Ana Custodio
- Medical Oncology Department, Hospital Universitario La Paz, CIBERONC CB16/12/00398, Madrid, Spain
| | - Olbia Serra
- Medical Oncology Department, Catalan Institute of Oncology, L’Hospitalet, Spain
| | - Diego Cacho Lavin
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - María Luisa Limón
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Tamara Sauri
- Medical Oncology Department, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Flora López
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Laura Visa
- Medical Oncology Department, Hospital Universitario El Mar, Barcelona, Spain
| | - Mónica Granja
- Medical Oncology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Nieves Martínez Lago
- Medical Oncology Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Virginia Arrazubi
- Medical Oncology Department, Complejo Hospitalario de Navarra, IdiSNA (Navarra Institute for Health Research), Pamplona, Spain
| | - Rosario Vidal Tocino
- Medical Oncology Department, Complejo Asistencial Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Raquel Hernandez
- Medical Oncology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - Gema Aguado
- Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Juana María Cano
- Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | - Monserrat Mangas
- Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain
| | - Paola Pimentel
- Medical Oncology Department, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | | | | | - Federico Longo
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Avinash Ramchandani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Marta Martín Richard
- Medical Oncology Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - Alicia Hurtado
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Aitor Azkarate
- Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain
| | - Carolina Hernández Pérez
- Medical Oncology Department, Hospital Universitario Nuestra Señora de the Candelaria, Tenerife, Spain
| | - Raquel Serrano
- Medical Oncology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Javier Gallego
- Medical Oncology Department, Hospital General Universitario of Elche, Elche, Spain
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16
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Argudo N, Rodó-Pin A, Martínez-Llorens J, Marco E, Visa L, Messaggi-Sartor M, Balañá-Corberó A, Ramón JM, Rodríguez-Chiaradía DA, Grande L, Pera M. Feasibility, tolerability, and effects of exercise-based prehabilitation after neoadjuvant therapy in esophagogastric cancer patients undergoing surgery: an interventional pilot study. Dis Esophagus 2021; 34:5906903. [PMID: 32940327 DOI: 10.1093/dote/doaa086] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/08/2020] [Accepted: 07/23/2020] [Indexed: 12/11/2022]
Abstract
Patients requiring surgery for locally advanced esophagogastric cancer often require neoadjuvant therapy (NAT), which may have a detrimental impact on cardiorespiratory reserve. The aims of this study were to investigate the feasibility and tolerability of a 5-week preoperative high-intensity interval training program after NAT, and to assess the potential effects of the training protocol on exercise capacity, muscle function, and health-related quality of life (HRQL). We prospectively studied consecutive patients with resectable locally advanced esophageal and gastric cancer in whom NAT was planned (chemo- or chemoradiotherapy). Feasibility was assessed with the TELOS (Technological, Economics, Legal, Operational, and Scheduling) components, and data on exercise tolerability (attendance and occurrence of adverse or unexpected events). Exercise capacity was assessed with peak oxygen uptake (VO2peak) in a cardiopulmonary exercise test at baseline, post-NAT, and following completion of a high-intensity interval exercise training (25 sessions). Changes in muscle strength and HRQL were also assessed. Of 33 recruited subjects (mean age 65 years), 17 received chemoradiotherapy and 16 chemotherapy. All the TELOS components were addressed before starting the intervention; from a total of 17 questions considered as relevant for a successful implementation, seven required specific actions to prevent potential concerns. Patients attended a mean of 19.4 (6.4) exercise sessions. The predefined level of attendance (≥15 sessions of scheduled sessions) was achieved in 27 out of 33 (81.8%) patients. Workload progression was adequate in 24 patients (72.7%). No major adverse events occurred. VO2peak decreased significantly between baseline and post-NAT (19.3 vs. 15.5 mL/Kg/min, P < 0.05). Exercise led to a significant improvement of VO2peak (15.5 vs. 19.6 mL/kg/min, P < 0.05). Exercise training was associated with clinically relevant improvements in some domains of HRQL, with the social and role function increasing by 10.5 and 11.6 points, respectively, and appetite loss and fatigue declining by 16 and 10.5, respectively. We conclude that a structured exercise training intervention is feasible and safe following NAT in patients with esophagogastric cancer, and it has positive effects to restore exercise capacity to baseline levels within 5 weeks with some improvements in HRQL.
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Affiliation(s)
- Núria Argudo
- Section of Gastrointestinal Surgery. Hospital del Mar. Hospital del Mar Medical Research Institute (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Rodó-Pin
- Department of Pulmonary Medicine. Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra (UPF), CIBERES, (ISCIII), Barcelona, Barcelona, Spain
| | - Juana Martínez-Llorens
- Department of Pulmonary Medicine. Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra (UPF), CIBERES, (ISCIII), Barcelona, Barcelona, Spain
| | - Ester Marco
- Department of Physical Medicine and Rehabilitation. Parc de Salut Mar (Hospital del Mar-Hospital de l'Esperança). Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM). Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Visa
- Department of Medical Oncology. Hospital del Mar, Barcelona, Spain
| | - Monique Messaggi-Sartor
- Department of Physical Medicine and Rehabilitation. Parc de Salut Mar (Hospital del Mar-Hospital de l'Esperança). Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM). Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Balañá-Corberó
- Department of Pulmonary Medicine. Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra (UPF), CIBERES, (ISCIII), Barcelona, Barcelona, Spain
| | - José M Ramón
- Section of Gastrointestinal Surgery. Hospital del Mar. Hospital del Mar Medical Research Institute (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Diego A Rodríguez-Chiaradía
- Department of Pulmonary Medicine. Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra (UPF), CIBERES, (ISCIII), Barcelona, Barcelona, Spain
| | - Luis Grande
- Section of Gastrointestinal Surgery. Hospital del Mar. Hospital del Mar Medical Research Institute (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Pera
- Section of Gastrointestinal Surgery. Hospital del Mar. Hospital del Mar Medical Research Institute (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain
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17
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Casasola-Sánchez LE, Burdio-Pinilla F, Pereira-Rodríguez JA, Radosevic A, Visa L, Sánchez-Velázquez P. Abdominal Wall Metastasis of Pancreatic Cancer: The Tip of the Iceberg-Case Report. Pancreas 2021; 50:e31-e32. [PMID: 33835982 DOI: 10.1097/mpa.0000000000001761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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18
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Cotes Sanchís A, Gallego J, Hernandez R, Arrazubi V, Custodio A, Cano JM, Aguado G, Macias I, Lopez C, López F, Visa L, Garrido M, Martínez Lago N, Fernández Montes A, Limón ML, Azkárate A, Pimentel P, Reguera P, Ramchandani A, Cacho JD, Martín Carnicero A, Granja M, Martín Richard M, Hernández Pérez C, Hurtado A, Serra O, Buxo E, Vidal Tocino R, Jimenez-Fonseca P, Carmona-Bayonas A. Second-line treatment in advanced gastric cancer: Data from the Spanish AGAMENON registry. PLoS One 2020; 15:e0235848. [PMID: 32735623 PMCID: PMC7394396 DOI: 10.1371/journal.pone.0235848] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/24/2020] [Indexed: 01/21/2023] Open
Abstract
Background Second-line treatments boost overall survival in advanced gastric cancer (AGC). However, there is a paucity of information as to patterns of use and the results achieved in actual clinical practice. Materials and methods The study population comprised patients with AGC in the AGAMENON registry who had received second-line. The objective was to describe the pattern of second-line therapies administered, progression-free survival following second-line (PFS-2), and post-progression survival since first-line (PPS). Results 2311 cases with 2066 progression events since first-line (89.3%) were recorded; 245 (10.6%) patients died during first-line treatment and 1326/2066 (64.1%) received a second-line. Median PFS-2 and PPS were 3.1 (95% CI, 2.9–3.3) and 5.8 months (5.5–6.3), respectively. The most widely used strategies were monoCT (56.9%), polyCT (15.0%), ramucirumab+CT (12.6%), platinum-reintroduction (8.3%), trastuzumab+CT (6.1%), and ramucirumab (1.1%). PFS-2/PPS medians gradually increased in monoCT, 2.6/5.1 months; polyCT 3.4/6.3 months; ramucirumab+CT, 4.1/6.5 months; platinum-reintroduction, 4.2/6.7 months, and for the HER2+ subgroup in particular, trastuzumab+CT, 5.2/11.7 months. Correlation between PFS since first-line and OS was moderate in the series as a whole (Kendall’s τ = 0.613), lower in those subjects who received second-line (Kendall’s τ = 0.539), especially with ramucirumab+CT (Kendall’s τ = 0.413). Conclusion This analysis reveals the diversity in second-line treatment for AGC, highlighting the effectiveness of paclitaxel-ramucirumab and, for a selected subgroup of patients, platinum reintroduction; both strategies endorsed by recent clinical guidelines.
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Affiliation(s)
| | - Javier Gallego
- Medical Oncology Department, Hospital General Universitario de Elche, Elche, Spain
- * E-mail:
| | - Raquel Hernandez
- Medical Oncology Department, Hospital Universitario de Canarias, Tenerife
| | - Virginia Arrazubi
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Ana Custodio
- Medical Oncology Department, Hospital Universitario La Paz, CIBERONC CB16/12/00398, Madrid, Spain
| | - Juana María Cano
- Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Gema Aguado
- Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Ismael Macias
- Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain
| | - Carlos Lopez
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Flora López
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Laura Visa
- Medical Oncology Department, Hospital Universitario El Mar, Barcelona, Spain
| | - Marcelo Garrido
- Medical Oncology Department, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Nieves Martínez Lago
- Medical Oncology Department, Complejo Hospitalario Universitario de A Coruña, Coruña, Spain
| | | | - María Luisa Limón
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Aitor Azkárate
- Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain
| | - Paola Pimentel
- Medical Oncology Department, Hospital Santa Lucía, Cartagena, Spain
| | - Pablo Reguera
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Avinash Ramchandani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Juan Diego Cacho
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | | | - Mónica Granja
- Medical Oncology Department, Hospital Universitario Clínico San Carlos Madrid, Spain
| | - Marta Martín Richard
- Medical Oncology Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - Carolina Hernández Pérez
- Medical Oncology Department, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain
| | - Alicia Hurtado
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Olbia Serra
- Medical Oncology Department, Catalan Institute of Oncology, L’Hospitalet, Spain
| | - Elvira Buxo
- Medical Oncology Department, Hospital Universitario Vall d’Hebron, Barcelona, Spain
| | - Rosario Vidal Tocino
- Medical Oncology Department, Complejo Asistencial Universitario de Salamanca, IBSAL, Salamanca, Spain
| | - Paula Jimenez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | - Alberto Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, University of Murcia, IMIB, Murcia, Spain
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Manero-Rupérez N, Martínez-Bosch N, Barranco LE, Visa L, Navarro P. The Galectin Family as Molecular Targets: Hopes for Defeating Pancreatic Cancer. Cells 2020; 9:E689. [PMID: 32168866 PMCID: PMC7140611 DOI: 10.3390/cells9030689] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/21/2020] [Accepted: 02/27/2020] [Indexed: 12/14/2022] Open
Abstract
Galectins are a family of proteins that bind β-galactose residues through a highly conserved carbohydrate recognition domain. They regulate several important biological functions, including cell proliferation, adhesion, migration, and invasion, and play critical roles during embryonic development and cell differentiation. In adults, different galectin members are expressed depending on the tissue type and can be altered during pathological processes. Numerous reports have shown the involvement of galectins in diseases, mostly inflammation and cancer. Here, we review the state-of-the-art of the role that different galectin family members play in pancreatic cancer. This tumor is predicted to become the second leading cause of cancer-related deaths in the next decade as there is still no effective treatment nor accurate diagnosis for it. We also discuss the possible translation of recent results about galectin expression and functions in pancreatic cancer into clinical interventions (i.e., diagnosis, prediction of prognosis and/or therapy) for this fatal disease.
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Affiliation(s)
- Noemí Manero-Rupérez
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Cancer Research Program, Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Neus Martínez-Bosch
- Cancer Research Program, Hospital del Mar Medical Research Institute (IMIM), Unidad Asociada IIBB-CSIC, 08003 Barcelona, Spain;
| | - Luis E Barranco
- Department of Gastroenterolgy, Hospital del Mar-IMIM, 08003 Barcelona, Spain;
| | - Laura Visa
- Department of Medical Oncology, Hospital del Mar-IMIM-CIBERONC, 08003 Barcelona, Spain;
| | - Pilar Navarro
- Cancer Research Program, Hospital del Mar Medical Research Institute (IMIM), Unidad Asociada IIBB-CSIC, 08003 Barcelona, Spain
- Institute of Biomedical Research of Barcelona (IIBB-CSIC), 08036 Barcelona, Spain
- Institut d’Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain;
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Suárez-Piñera M, Visa L, Ilzarbe L, Zugazaga A, Poves I, Mestre-Fusco A, Iglesias M. PET/CT imaging with somatostatin analogues for the assessment of neuroendocrine tumours, initial experience. Rev Esp Med Nucl Imagen Mol 2019. [DOI: 10.1016/j.remnie.2019.02.009] [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: 10/27/2022]
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21
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Sampera A, Sánchez-Martín FJ, Arpí O, Visa L, Iglesias M, Menéndez S, Gaye É, Dalmases A, Clavé S, Gelabert-Baldrich M, Poulsen TT, Kragh M, Bellosillo B, Albanell J, Rovira A, Montagut C. HER-Family Ligands Promote Acquired Resistance to Trastuzumab in Gastric Cancer. Mol Cancer Ther 2019; 18:2135-2145. [DOI: 10.1158/1535-7163.mct-19-0455] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/28/2019] [Accepted: 08/27/2019] [Indexed: 11/16/2022]
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22
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Carmona-Bayonas A, Jimenez-Fonseca P, Garrido M, Custodio A, Hernandez R, Lacalle A, Cano JM, Aguado G, Martínez de Castro E, Alvarez Manceñido F, Macias I, Visa L, Martín Richard M, Mangas M, Sánchez Cánovas M, Longo F, Iglesias Rey L, Martínez Lago N, Martín Carnicero A, Sánchez A, Azkárate A, Limón ML, Hernández Pérez C, Ramchandani A, Pimentel P, Cerdá P, Serrano R, Gil-Negrete A, Marín M, Hurtado A, Sánchez Bayona R, Gallego J. Multistate Models: Accurate and Dynamic Methods to Improve Predictions of Thrombotic Risk in Patients with Cancer. Thromb Haemost 2019; 119:1849-1859. [PMID: 31461750 DOI: 10.1055/s-0039-1694012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Research into cancer-associated thrombosis (CAT) entails managing dynamic data that pose an analytical challenge. Thus, methods that assume proportional hazards to investigate prognosis entail a risk of misinterpreting or overlooking key traits or time-varying effects. We examined the AGAMENON registry, which collects data from 2,129 patients with advanced gastric cancer. An accelerated failure time (AFT) multistate model and flexible competing risks regression were used to scrutinize the time-varying effect of CAT, as well as to estimate how covariates dynamically predict cumulative incidence. The AFT model revealed that thrombosis shortened progression-free survival and overall survival with adjusted time ratios of 0.72 and 0.56, respectively. Nevertheless, its prognostic effect was nonproportional and disappeared over time if the subject managed to survive long enough. CAT that occurred later had a more pronounced prognostic effect. In the flexible competing risks model, multiple covariates were seen to have significant time-varying effects on the cumulative incidence of CAT (Khorana score, secondary thromboprophylaxis, high tumor burden, and cisplatin-containing regimen), whereas other predictors exerted a constant effect (signet ring cells and primary thromboprophylaxis). The model that assumes proportional hazards was incapable of capturing the effect of these covariates and predicted the cumulative incidence in a biased way. This study evinces that flexible and multistate models are a useful and innovative method to describe the dynamic effect of variables associated with CAT and should be more widely used.
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Affiliation(s)
- Alberto Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital General Universitario Morales Meseguer, University of Murcia, IMIB, Murcia, Spain
| | - Paula Jimenez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Marcelo Garrido
- Medical Oncology Department, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Ana Custodio
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Raquel Hernandez
- Medical Oncology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - Alejandra Lacalle
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Juana María Cano
- Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Gema Aguado
- Medical Oncology Department, Hospital Universitario Gregorio Marañon, Madrid, Spain
| | - Eva Martínez de Castro
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Ismael Macias
- Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain
| | - Laura Visa
- Medical Oncology Department, Hospital Universitario El Mar, Barcelona, Spain
| | - Marta Martín Richard
- Medical Oncology Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - Monserrat Mangas
- Medical Oncology Department, Hospital Galdakao-Usansolo, Galdakao-Usansolo, Spain
| | - Manuel Sánchez Cánovas
- Hematology and Medical Oncology Department, Hospital General Universitario Morales Meseguer, University of Murcia, IMIB, Murcia, Spain
| | - Federico Longo
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Nieves Martínez Lago
- Medical Oncology Department, Complejo Hospitalario Universitario de A Coruña, La Coruña, Spain
| | | | - Ana Sánchez
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Aitor Azkárate
- Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain
| | - María Luisa Limón
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Carolina Hernández Pérez
- Medical Oncology Department, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain
| | - Avinash Ramchandani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Paola Pimentel
- Medical Oncology Department, Hospital Santa Lucia, Cartagena, Spain
| | - Paula Cerdá
- Medical Oncology Department, Centro Médico Teknon, Barcelona, Spain
| | - Raquel Serrano
- Medical Oncology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Aitziber Gil-Negrete
- Medical Oncology Department, Hospital Universitario Donostia, San Sebastián, Spain
| | - Miguel Marín
- Medical Oncology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Alicia Hurtado
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - Javier Gallego
- Medical Oncology Department, Hospital General Universitario de Elche, Elche, Spain
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Viúdez A, Carmona-Bayonas A, Gallego J, Lacalle A, Hernández R, Cano JM, Macías I, Custodio A, Martínez de Castro E, Sánchez A, Iglesia L, Reguera P, Visa L, Azkarate A, Sánchez-Cánovas M, Mangas M, Limón ML, Martínez-Torrón A, Asensio E, Ramchandani A, Martín-Carnicero A, Hurtado A, Cerdà P, Garrido M, Sánchez-Bayonas R, Serrano R, Jiménez-Fonseca P. Optimal duration of first-line chemotherapy for advanced gastric cancer: data from the AGAMENON registry. Clin Transl Oncol 2019; 22:734-750. [PMID: 31385226 DOI: 10.1007/s12094-019-02183-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/08/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The optimal duration of first-line chemotherapy for patients with advanced gastric cancer is unknown. Diverse clinical trials have proposed different strategies including limited treatment, maintenance of some drugs, or treatment until progression. METHOD The sample comprises patients from the AGAMENON multicenter registry without progression after second evaluation of response. The objective was to explore the optimal duration of first-line chemotherapy. A frailty multi-state model was conducted. RESULTS 415 patients were divided into three strata: discontinuation of platinum and maintenance with fluoropyrimidine until progression (30%, n = 123), complete treatment withdrawal prior to progression (52%, n = 216), and full treatment until progression (18%, n = 76). The hazard of tumor progression decreased by 19% per month with the full treatment regimen. However, we found no evidence that fluoropyrimidine maintenance (hazard ratio [HR] 1.07, confidence interval [CI] 95%, 0.69-1.65) worsened progression-free survival (PFS) with respect to treatment until progression. Predictive factors for PFS were ECOG performance status, ≥ 3 metastatic sites, prior tumor response, and bone metastases. Toxicity grade 3/4 was more common in those who continued the full treatment until progression vs fluoropyrimidine maintenance (16% vs 6%). CONCLUSION The longer duration of the full initial regimen exerted a protective effect on the patients of this registry. Platinum discontinuation followed by fluoropyrimidine maintenance yields comparable efficacy to treatment up to PD, with a lower rate of serious adverse events.
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Affiliation(s)
- A Viúdez
- Medical Oncology Department, Complejo Hospitalario de Navarra (CHN), OncobionaTras Unit, Navarrabiomed, Navarrabiomed Biomedical Center, IdiSNA, Irunlarrea 3, 31008, Pamplona, Navarra, Spain.
| | - A Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, University of Murcia, IMIB, Murcia, Spain
| | - J Gallego
- Medical Oncology Department, Hospital Universitario de Elche, Elche, Spain
| | - A Lacalle
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - R Hernández
- Medical Oncology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - J M Cano
- Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - I Macías
- Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, 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
| | - A Sánchez
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - L Iglesia
- Medical Oncology Department, Complejo Hospitalario de Orense, Orense, Spain
| | - P Reguera
- Medical Oncology Department, Hospital Universitario Ramón Y Cajal, Madrid, Spain
| | - L Visa
- Medical Oncology Department, Hospital Universitario El Mar, Barcelona, Spain
| | - A Azkarate
- Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain
| | - M Sánchez-Cánovas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - M Mangas
- Medical Oncology Department, Hospital Galdakao-Usansolo, Galdakao-Usansolo, Spain
| | - M L Limón
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - A Martínez-Torrón
- Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - E Asensio
- Medical Oncology Department, Hospital Universitario de Elche, Elche, Spain
| | - A Ramchandani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - A Martín-Carnicero
- Medical Oncology Department, Complejo Hospitalario San Millán, Logroño, Spain
| | - A Hurtado
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - P Cerdà
- Medical Oncology Department, Centro Médico Tecknon, Barcelona, Spain
| | - M Garrido
- Medical Oncology Department, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - R Sánchez-Bayonas
- Medical Oncology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - R Serrano
- Medical Oncology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - P Jiménez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
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25
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Gaye E, Bellosillo Paricio B, Visa L, Iglesias Coma M, Sanchez Martin F, Sampera Borràs A, Montagut Viladot C. Plasma ctDNA mutation anaysis for identification of initial and acquired resistance to HER2-targeted therapy in advanced gastric cancer patients. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy316.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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26
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Martinez-Bosch N, Barranco LE, Orozco CA, Moreno M, Visa L, Iglesias M, Oldfield L, Neoptolemos JP, Greenhalf W, Earl J, Carrato A, Costello E, Navarro P. Increased plasma levels of galectin-1 in pancreatic cancer: potential use as biomarker. Oncotarget 2018; 9:32984-32996. [PMID: 30250644 PMCID: PMC6152472 DOI: 10.18632/oncotarget.26034] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 08/01/2018] [Accepted: 08/16/2018] [Indexed: 01/08/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDA) is the most frequent type of pancreatic cancer and one of the deadliest diseases overall. New biomarkers are urgently needed to allow early diagnosis, one of the only factors that currently improves prognosis. Here we analyzed whether the detection of circulating galectin-1 (Gal-1), a soluble carbohydrate-binding protein overexpressed in PDA tissue samples, can be used as a biomarker for PDA. Gal-1 levels were determined by ELISA in plasma from healthy controls and patients diagnosed with PDA, using three independent cohorts. Patients with chronic pancreatitis (CP) were also included in the study to analyze the potential of Gal-1 to discriminate between cancer and inflammatory process. Plasma Gal-1 levels were significantly increased in patients with PDA as compared to controls in all three cohorts. Gal-1 sensitivity and specificity values were similar to that of the CA19-9 biomarker (the only FDA-approved blood test biomarker for PDA), and the combination of Gal-1 and CA19-9 significantly improved their individual discriminatory powers. Moreover, high levels of Gal-1 were associated with lower survival in patients with non-resected tumors. Collectively, our data indicate a strong potential of using circulating Gal-1 levels as a biomarker for detection and prognostics of patients with PDA.
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Affiliation(s)
- Neus Martinez-Bosch
- Cancer Research Program, IMIM, Hospital del Mar Medical Research Institute, Unidad Asociade CSIC, Barcelona, Spain
| | - Luis E Barranco
- Cancer Research Program, IMIM, Hospital del Mar Medical Research Institute, Unidad Asociade CSIC, Barcelona, Spain
- Department of Gastroenterology, Universidad Autonoma de Barcelona, Hospital del Mar, Barcelona, Spain
| | - Carlos A Orozco
- Cancer Research Program, IMIM, Hospital del Mar Medical Research Institute, Unidad Asociade CSIC, Barcelona, Spain
| | - Mireia Moreno
- Cancer Research Program, IMIM, Hospital del Mar Medical Research Institute, Unidad Asociade CSIC, Barcelona, Spain
| | - Laura Visa
- Department of Medical Oncology, Hospital del Mar, Barcelona, Spain
| | - Mar Iglesias
- Department of Pathology, Universidad Autonoma de Barcelona, Hospital del Mar, CIBERONC, Barcelona, Spain
| | - Lucy Oldfield
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - John P Neoptolemos
- Department of General Surgery, University of Heidelberg, Heidelberg, Germany
| | - William Greenhalf
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Julie Earl
- Department of Medical Oncology, Ramon y Cajal University Hospital, CIBERONC, IRYCIS, Alcala University, Madrid, Spain
| | - Alfredo Carrato
- Department of Medical Oncology, Ramon y Cajal University Hospital, CIBERONC, IRYCIS, Alcala University, Madrid, Spain
| | - Eithne Costello
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Pilar Navarro
- Cancer Research Program, IMIM, Hospital del Mar Medical Research Institute, Unidad Asociade CSIC, Barcelona, Spain
- Institute of Biomedical Research of Barcelona (IIBB-CSIC), Barcelona, Spain
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27
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Carmona-Bayonas A, Jiménez-Fonseca P, Echavarria I, Sánchez Cánovas M, Aguado G, Gallego J, Custodio A, Hernández R, Viudez A, Cano JM, Martínez de Castro E, Macías I, Martín Carnicero A, Garrido M, Mangas M, Álvarez Manceñido F, Visa L, Azkarate A, Ramchandani A, Fernández Montes A, Longo F, Sánchez A, Pimentel P, Limón ML, Arias D, Cacho Lavin D, Sánchez Bayona R, Cerdá P, García Alfonso P. Surgery for metastases for esophageal-gastric cancer in the real world: Data from the AGAMENON national registry. Eur J Surg Oncol 2018; 44:1191-1198. [DOI: 10.1016/j.ejso.2018.03.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 03/16/2018] [Accepted: 03/22/2018] [Indexed: 12/19/2022] Open
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28
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Velasco AG, Macarulla T, Sánchez CB, Martín M, García C, Pericay C, Merino S, Visa L, Martín T, Pedraza M, Carnero B, Guardeño R, Pellín L, Vilanova D, Laquente B. Quality of life of patients with metastatic pancreatic adenocarcinoma initiating first‐line chemotherapy in routine practice. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.159] [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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Vidal J, Muinelo L, Dalmases A, Jones F, Edelstein D, Iglesias M, Orrillo M, Abalo A, Rodríguez C, Brozos E, Vidal Y, Candamio S, Vázquez F, Ruiz J, Guix M, Visa L, Sikri V, Albanell J, Bellosillo B, López R, Montagut C. Plasma ctDNA RAS mutation analysis for the diagnosis and treatment monitoring of metastatic colorectal cancer patients. Ann Oncol 2018; 28:1325-1332. [PMID: 28419195 PMCID: PMC5834035 DOI: 10.1093/annonc/mdx125] [Citation(s) in RCA: 247] [Impact Index Per Article: 41.2] [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] [Indexed: 02/06/2023] Open
Abstract
Background RAS assessment is mandatory for therapy decision in metastatic colorectal cancer (mCRC) patients. This determination is based on tumor tissue, however, genotyping of circulating tumor (ct)DNA offers clear advantages as a minimally invasive method that represents tumor heterogeneity. Our study aims to evaluate the use of ctDNA as an alternative for determining baseline RAS status and subsequent monitoring of RAS mutations during therapy as a component of routine clinical practice. Patients and methods RAS mutational status in plasma was evaluated in mCRC patients by OncoBEAM™ RAS CRC assay. Concordance of results in plasma and tissue was retrospectively evaluated. RAS mutations were also prospectively monitored in longitudinal plasma samples from selected patients. Results Analysis of RAS in tissue and plasma samples from 115 mCRC patients showed a 93% overall agreement. Plasma/tissue RAS discrepancies were mainly explained by spatial and temporal tumor heterogeneity. Analysis of clinico-pathological features showed that the site of metastasis (i.e. peritoneal, lung), the histology of the tumor (i.e. mucinous) and administration of treatment previous to blood collection negatively impacted the detection of RAS in ctDNA. In patients with baseline mutant RAS tumors treated with chemotherapy/antiangiogenic, longitudinal analysis of RAS ctDNA mirrored response to treatment, being an early predictor of response. In patients RAS wt, longitudinal monitoring of RAS ctDNA revealed that OncoBEAM was useful to detect emergence of RAS mutations during anti-EGFR treatment. Conclusion The high overall agreement in RAS mutational assessment between plasma and tissue supports blood-based testing with OncoBEAM™ as a viable alternative for genotyping RAS of mCRC patients in routine clinical practice. Our study describes practical clinico-pathological specifications to optimize RAS ctDNA determination. Moreover, OncoBEAM™ is useful to monitor RAS in patients undergoing systemic therapy to detect resistance and evaluate the efficacy of particular treatments.
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Affiliation(s)
- J Vidal
- Cancer Research Program, FIMIM Hospital del Mar, Barcelona, Spain.,Medical Oncology Department, Hospital del Mar, Barcelona
| | - L Muinelo
- Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - A Dalmases
- Pathology Department, Hospital del Mar, Barcelona
| | - F Jones
- Sysmex Inostics Inc., Mundelein, USA
| | | | - M Iglesias
- Cancer Research Program, FIMIM Hospital del Mar, Barcelona, Spain.,Pathology Department, Hospital del Mar, Barcelona
| | - M Orrillo
- Medical Oncology Department, Hospital del Mar, Barcelona
| | - A Abalo
- Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - C Rodríguez
- Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - E Brozos
- Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - Y Vidal
- Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - S Candamio
- Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - F Vázquez
- Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - J Ruiz
- Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - M Guix
- Medical Oncology Department, Hospital del Mar, Barcelona
| | - L Visa
- Medical Oncology Department, Hospital del Mar, Barcelona
| | - V Sikri
- Sysmex Inostics Inc., Mundelein, USA
| | - J Albanell
- Cancer Research Program, FIMIM Hospital del Mar, Barcelona, Spain.,Medical Oncology Department, Hospital del Mar, Barcelona.,Universitat Pompeu Fabra, Barcelona, Spain
| | - B Bellosillo
- Medical Oncology Department, Hospital del Mar, Barcelona.,Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - R López
- Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - C Montagut
- Cancer Research Program, FIMIM Hospital del Mar, Barcelona, Spain.,Medical Oncology Department, Hospital del Mar, Barcelona
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Carmona-Bayonas A, Jiménez-Fonseca P, Custodio A, Sánchez Cánovas M, Hernández R, Pericay C, Echavarria I, Lacalle A, Visa L, Rodríguez Palomo A, Mangas M, Cano JM, Buxo E, Álvarez-Manceñido F, García T, Lorenzo JE, Ferrer-Cardona M, Viudez A, Azkarate A, Ramchandani A, Arias D, Longo F, López C, Sánchez Bayona R, Limón ML, Díaz-Serrano A, Fernández Montes A, Sala P, Cerdá P, Rivera F, Gallego J. Anthracycline-based triplets do not improve the efficacy of platinum-fluoropyrimidine doublets in first-line treatment of advanced gastric cancer: real-world data from the AGAMEMON National Cancer Registry. Gastric Cancer 2018; 21:96-105. [PMID: 28393278 DOI: 10.1007/s10120-017-0718-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 04/03/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although anthracycline-based triplets are one of the most widely used schedules to treat advanced gastric cancer (AGC), the benefit of including epirubicin in these therapeutic combinations remains unknown. This study aims to evaluate both the efficacy and tolerance of triplets with epirubicin vs. doublets with platinum-fluoropyrimidine in a national AGC registry. METHODS Patients with AGC treated with polychemotherapy without trastuzumab at 28 hospitals in Spain between 2008 and 2016 were included. The effect of anthracycline-based triplets against doublets was evaluated by propensity score matching (PSM) and Cox proportional hazards (PH) regression. RESULT A total of 1002 patients were included (doublets, n = 653; anthracycline-based triplets, n = 349). The multivariable Cox PH regression failed to detect significantly increased OS in favor of triplets with anthracyclines: HR 0.90 (95% CI, 0.78-1.05), p = 0.20035. After PSM, the sample contained 325 pairs with similar baseline characteristics. This method was also unable to reveal an increase in OS: 10.5 (95% CI, 9.7-12.3) vs. 9.9 (95% CI, 9.2-11.4) months, HR 0.91 (CI 95%, 0.76-1.083), and (log-rank test, p = 0.226). Response rates (42.1 vs. 33.1%, p = 0.12) and PFS (HR 0.95, CI 95%, 0.80-1.13, log-rank test, p = 0.873) were not significantly higher with epirubicin-based regimens. The triplets were associated with greater grade 3-4 hematological toxicity, and increased hospitalization due to toxicity by 68%. The addition of epirubicin is viable, but 23.7% discontinued treatment because of adverse effects or patient decision. CONCLUSION Anthracyclines added to platinum-fluoropyrimidine doublets did not improve the response rate or survival outcomes in patients with AGC but entailed greater toxicity.
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Affiliation(s)
- A Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, IMIB, Avenida Marqués de los Vélez, 30008, Murcia, Spain.
| | - P Jiménez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - A Custodio
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - M Sánchez Cánovas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, IMIB, Avenida Marqués de los Vélez, 30008, Murcia, Spain
| | - R Hernández
- Medical Oncology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - C Pericay
- Medical Oncology Department, Corporació Sanitària Parc Taulí , Sabadell, Spain
| | - I Echavarria
- Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - A Lacalle
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - L Visa
- Medical Oncology Department, Hospital Universitario Del Mar, Barcelona, Spain
| | - A Rodríguez Palomo
- Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - M Mangas
- Medical Oncology Department, Hospital Galdakao-Usansolo, Galdakao-Usansolo, Spain
| | - J M Cano
- Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain
| | - E Buxo
- Medical Oncology Department, Hospital Universitario Clinic, Barcelona, Spain
| | - F Álvarez-Manceñido
- Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - T García
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, IMIB, Avenida Marqués de los Vélez, 30008, Murcia, Spain
| | - J E Lorenzo
- Medical Oncology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - M Ferrer-Cardona
- Medical Oncology Department, Corporació Sanitària Parc Taulí , Sabadell, Spain
| | - A Viudez
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - A Azkarate
- Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain
| | - A Ramchandani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - D Arias
- Medical Oncology Department, Complejo Hospitalario de Orense, Orense, Spain
| | - F Longo
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - C López
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - R Sánchez Bayona
- Medical Oncology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - M L Limón
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - A Díaz-Serrano
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - A Fernández Montes
- Medical Oncology Department, Complejo Hospitalario de Orense, Orense, Spain
| | - P Sala
- Medical Oncology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - P Cerdá
- Medical Oncology Department, Clínica Tecknon de Barcelona, Barcelona, Spain
| | - F Rivera
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - J Gallego
- Medical Oncology Department, Hospital General Universitario de Elche, Elche, Spain
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Gironés R, Morilla I, Guillen-Ponce C, Torregrosa MD, Paredero I, Bustamante E, Del Barco S, Soler G, Losada B, Visa L, Llabrés E, Fox B, Firvida JL, Blanco R, Antonio M, Aparisi F, Pi-Figueras M, Gonzalez-Flores E, Molina-Garrido MJ, Saldaña J. Geriatric oncology in Spain: survey results and analysis of the current situation. Clin Transl Oncol 2017; 20:1087-1092. [PMID: 29327240 PMCID: PMC6061214 DOI: 10.1007/s12094-017-1813-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 11/16/2017] [Indexed: 11/30/2022]
Abstract
Introduction Geriatric oncology (GO) is a discipline that focuses on the management of elderly patients with cancer. The Spanish Society of Medical Oncology (SEOM) created a Working group dedicated to geriatric oncology in February 2016. Objectives The main goal of this study was to describe the current situation in Spain regarding the management of elderly cancer patients through an online survey of medical oncologists. Methods A descriptive survey was sent to several hospitals by means of the SEOM website. A personal e-mail was also sent to SEOM members. Results Between March 2016 and April 2017, 154 answers were collected. Only 74 centers (48%) had a geriatrics department and a mere 21 (14%) medical oncology departments had a person dedicated to GO. The vast majority (n = 135; 88%) had the perception that the number of elderly patients with cancer seen in clinical practice had increased. Eighteen (12%) oncologists had specific protocols and geriatric scales were used at 55 (31%) centers. Almost all (92%) claimed to apply special management practices using specific tools. There was agreement that GO afforded certain potential advantages. Finally, 99% of the oncologists surveyed believed it and that training in GO had to be improved. Conclusions From the nationwide survey promoted by the Spanish Geriatric Oncology Working Group on behalf of SEOM, we conclude that there is currently no defined care structure for elderly cancer patients. There is an increasing perception of the need for training in GO. This survey reflects a reality in which specific needs are perceived.
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Affiliation(s)
- R Gironés
- Medical Oncology Unit. Hospital Lluís Alcanyís, Crta Xàtiva A Silla Km 2, Xàtiva, 46800, Valencia, Spain.
| | - I Morilla
- Institut Català D'Oncologia-L'Hospitalet, Barcelona, Spain
| | | | | | - I Paredero
- Hospital Universitario Dr Peset, Valencia, Spain
| | - E Bustamante
- Althaia, Xarxa Assistencial I Universitaria Manresa, Barcelona, Spain
| | - S Del Barco
- Hospital Universitari Dr. Josep Trueta. ICO Girona, Girona, Spain
| | - G Soler
- Institut Català D'Oncologia-L'Hospitalet, Barcelona, Spain
| | - B Losada
- Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - L Visa
- Hospital Del Mar, Barcelona, Spain
| | - E Llabrés
- Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain
| | - B Fox
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J L Firvida
- Complejo Hospitalario Universitario de Ourense (CHUO), Ourense, Spain
| | - R Blanco
- Consorci Sanitari de Terrassa, Barcelona, Spain
| | - M Antonio
- Institut Català D'Oncologia-L'Hospitalet, Barcelona, Spain
| | - F Aparisi
- Hospital General de Valencia, Valencia, Spain
| | | | | | | | - J Saldaña
- Institut Català D'Oncologia-L'Hospitalet, Barcelona, Spain
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Visa L, Jiménez-Fonseca P, Martínez EA, Hernández R, Custodio A, Garrido M, Viudez A, Buxo E, Echavarria I, Cano JM, Macias I, Mangas M, de Castro EM, García T, Manceñido FÁ, Montes AF, Azkarate A, Longo F, Serrano AD, López C, Hurtado A, Cerdá P, Serrano R, Gil-Negrete A, Carnicero AM, Pimentel P, Ramchandani A, Carmona-Bayonas A. Efficacy and safety of chemotherapy in older versus non-older patients with advanced gastric cancer: A real-world data, non-inferiority analysis. J Geriatr Oncol 2017; 9:254-264. [PMID: 29242093 DOI: 10.1016/j.jgo.2017.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 08/02/2017] [Revised: 10/05/2017] [Accepted: 11/22/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Advanced gastric cancer (AGC) is a common neoplasm in older adults. Nevertheless, there are few specific management data in the literature. The aim of this study was to assess non-inferiority of survival and efficacy-related outcomes of chemotherapy used in older vs non-older patients with AGC. MATERIALS AND METHODS We recruited 1485 patients from the AGAMENON registry of AGC treated with polychemotherapy between 2008-2017. A statistical analysis was conducted to prove non-inferiority for overall survival (OS) associated with the use of chemotherapy schedules in individuals ≥70 vs.<70years. The fixed-margin method was used (hazard ratio [HR]<1.176) that corresponds to conserving at least 85% efficacy. RESULTS 33% (n=489) of the cases analyzed were ≥70 years. Two-agent chemotherapies and combinations with oxaliplatin (48% vs. 29%) were used more often in the older patients, as were modified schedules and/or lower doses. Toxicity grade 3-4 was comparable in both groups, although when looking at any grade, there were more episodes of enteritis, renal toxicity, and fatigue in older patients. In addition, toxicity was a frequent cause for discontinuing treatment in older patients. The response rate was similar in both groups. After adjusting for confounding factors, the non-inferiority of OS associated with schedules administered to the older vs. younger subjects was confirmed: HR 1.02 (90% CI, 0.91-1.14), P (non inferiority)=0.018, as well as progression-free survival: HR 0.97 (90% CI, 0.87-1.08), P(non-inferiority)=0.001. CONCLUSION In this AGC registry, the use of chemotherapy with schedules adapted to patients ≥70 years provided efficacy that was not inferior to that seen in younger cases, with comparable adverse effects.
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Affiliation(s)
- Laura Visa
- Medical Oncology Department, Hospital del Mar, Barcelona, Spain.
| | - Paula Jiménez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Raquel Hernández
- Medical Oncology Department, Hospital Universitario de Canarias, Tenerife
| | - Ana Custodio
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, CIBERONC CB16/12/00398, Spain
| | - Manuel Garrido
- Medical Oncology Department, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Antonio Viudez
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Elvira Buxo
- Medical Oncology Department, Hospital Universitari Clinic, Barcelona, Spain
| | - Ignacio Echavarria
- Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Juana María Cano
- Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain
| | - Ismael Macias
- Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain
| | - Montserrat Mangas
- Medical Oncology Department, Hospital Galdakao-Usansolo, Galdakao-Usansolo, Spain
| | - Eva Martínez de Castro
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Teresa García
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Felipe Álvarez Manceñido
- Medical Oncology Department, Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Aitor Azkarate
- Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain
| | - Federico Longo
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Carlos López
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Alicia Hurtado
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Paula Cerdá
- Medical Oncology Department, Centro Médico Teknon, Barcelona, Spain
| | - Raquel Serrano
- Medical Oncology Department, Hospital Universitario Virgen de las Nieves, Córdoba, Spain
| | - Aitziber Gil-Negrete
- Medical Oncology Department, Hospital Universitario Donostia, San Sebastián, Spain
| | - Alfonso Martín Carnicero
- Medical Oncology Department, Complejo Hospitalario San Millán-San Pedro de La Rioja, Logroño, Spain
| | - Paola Pimentel
- Medical Oncology Department, Hospital Santa Lucía, Cartagena, Spain
| | - Avinash Ramchandani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain
| | - Alberto Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
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Carmona-Bayonas A, Jiménez-Fonseca P, Lorenzo MLS, Ramchandani A, Martínez EA, Custodio A, Garrido M, Echavarría I, Cano JM, Barreto JEL, García TG, Manceñido FÁ, Lacalle A, Cardona MF, Mangas M, Visa L, Buxó E, Azkarate A, Díaz-Serrano A, Montes AF, Rivera F. On the Effect of Triplet or Doublet Chemotherapy in Advanced Gastric Cancer: Results From a National Cancer Registry. J Natl Compr Canc Netw 2017; 14:1379-1388. [PMID: 27799509 DOI: 10.6004/jnccn.2016.0148] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 07/21/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is currently no consensus regarding first-line chemotherapy for patients with advanced gastric cancer (AGC) who are ineligible to receive trastuzumab. The objective of this study was to evaluate the efficacy and tolerance of triplets versus doublets by analyzing a national gastric cancer registry. PATIENTS AND METHOD Patients with AGC treated with polychemotherapy without associating trastuzumab were included from 2008 through 2016. The effect of triplets versus doublets was compared using 3 methods: Cox proportional hazards regression, propensity score matching (PSM), and coarsened exact matching (CEM). RESULTS A total of 970 patients were recruited (doublets: n=569; triplets: n=401). In the multivariate Cox model, the use of triplets was associated with better overall survival (OS), with a hazard ratio (HR) of 0.84 (95% CI, 0.72-0.98; P=.035). After PSM, the sample contained 340 pairs. A significant increase in OS, 11.14 months (95% CI, 9.60-12.68) versus 9.60 months (95% CI, 8.44-10.75), was seen in favor of triplets (HR, 0.77; 95% CI, 0.65-0.92; stratified log-rank test, P=.004). The effect appeared to be comparable for anthracycline-based (HR, 0.78; 95% CI, 0.64-0.94) or docetaxel-based triplets (HR, 0.78; 95% CI, 0.60-1.009). The trend was similar after applying the CEM algorithm, with an HR of 0.78 (95% CI, 0.63-0.97; P=.03). Triplet therapy was viable and relative dose intensities exceeded 85%, except for cisplatin in DCX (docetaxel, cisplatin, capecitabine). Triplets had more severe toxicity overall, especially hematologic, hepatic, and mucosal adverse events. CONCLUSIONS With the limitations of a retrospective study that examines a heterogeneous set of chemotherapy regimens, we found that triplets are feasible in daily practice and are associated with a discreet benefit in efficacy at the expense of a moderate increase in toxicity.
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Affiliation(s)
- Alberto Carmona-Bayonas
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Paula Jiménez-Fonseca
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Maria Luisa Sánchez Lorenzo
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Avinash Ramchandani
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Elena Asensio Martínez
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Ana Custodio
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Marcelo Garrido
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Isabel Echavarría
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Juana María Cano
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Jose Enrique Lorenzo Barreto
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Teresa García García
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Felipe Álvarez Manceñido
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Alejandra Lacalle
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Marta Ferrer Cardona
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Monserrat Mangas
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Laura Visa
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Elvira Buxó
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Aitor Azkarate
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Asunción Díaz-Serrano
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Ana Fernández Montes
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Fernando Rivera
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
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Jiménez-Fonseca P, Hernandez R, Custodio A, Ramchandani Vaswani A, Sánchez Cánovas M, Sánchez Bayona R, López López C, Echavarria Diaz-Guardamino I, Visa L, Buxo Orra E, Arias D, Viudez A, Martin Carnicero A, Cerdà P, Ferrer M, Lorenzo Barreto J, Limón M, MACIAS I, Felices P. Prognostic effect of surgery of metastases in patients with advanced gastric cancer: Real-world data from the AGAMENON registry. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.077] [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: 11/15/2022] Open
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Macias I, Carmona-Bayonas A, Ferrer M, Hernandez R, Custodio A, Lacalle A, Lorenzo Barreto J, Echavarria Diaz-Guardamino I, Visa L, Buxo Orra E, Mangas Izquierdo M, Azkarate A, Diaz A, Viudez A, Sanchez Canovas M, Ramchandani Vaswani A, Longo F, Martinez de Castro E, Gallego Plazas J, Jimenez Fonseca P. Anthracycline-based triplets do not improve the efficacy of platinum-fluoropyrimidine doublets in advanced gastric cancer: AGAMENON study data. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.043] [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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Carmona-Bayonas A, Jiménez-Fonseca P, Hernández R, Custodio A, Cano J, Lacalle A, Echavarria Diaz-Guardamino I, MACIAS I, Mangas Izquierdo M, Visa L, Buxo Orra E, Azkarate A, Ramchandani Vaswani A, Martínez de Castro E, Fernández Montes A, Longo F, Sánchez Bayona R, Limón M, Martín Carnicero A, Gallego Plazas J. Treatment of advanced gastric cancer based on Lauren’s histological: Real-world data from the AGAMEMON National Cancer Registry. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.061] [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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Jiménez Fonseca P, Carmona-Bayonas A, Hernández R, Custodio A, Cano JM, Lacalle A, Echavarria I, Macias I, Mangas M, Visa L, Buxo E, Álvarez Manceñido F, Viudez A, Pericay C, Azkarate A, Ramchandani A, López C, Martinez de Castro E, Fernández Montes A, Longo F, Sánchez Bayona R, Limón ML, Diaz-Serrano A, Martin Carnicero A, Arias D, Cerdà P, Rivera F, Vieitez JM, Sánchez Cánovas M, Garrido M, Gallego J. Lauren subtypes of advanced gastric cancer influence survival and response to chemotherapy: real-world data from the AGAMENON National Cancer Registry. Br J Cancer 2017; 117:775-782. [PMID: 28765618 PMCID: PMC5589993 DOI: 10.1038/bjc.2017.245] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/19/2017] [Accepted: 07/04/2017] [Indexed: 12/17/2022] Open
Abstract
Background: The choice of chemotherapy in HER2-negative gastric cancer is based on centre’s preferences and adverse effects profile. No schedule is currently accepted as standard, nor are there any factors to predict response, other than HER2 status. We seek to evaluate whether Lauren type influences the efficacy of various chemotherapies and on patient overall survival (OS). Methods: We have conducted a multicenter study in 31 hospitals. The eligibility criteria include diagnosis of stomach or gastroesophageal junction adenocarcinoma, HER2 negativity, and chemotherapy containing 2–3 drugs. Cox proportional hazards regression adjusted for confounding factors, with tests of ‘treatment-by-histology’ interaction, was used to estimate treatment effect. Results: Our registry contains 1303 tumours analysable for OS end points and 730 evaluable for overall response rate (ORR). A decrease in ORR was detected in the presence of a diffuse component: odds ratio 0.719 (95% confidence interval (CI), 0.525–0.987), P=0.039. Anthracycline- or docetaxel-containing schedules increased ORR only in the intestinal type. The diffuse type displayed increased mortality with hazard ratio (HR) of 1.201 (95% CI, 1.054–1.368), P=0.0056. Patients receiving chemotherapy with docetaxel exhibited increased OS limited to the intestinal type: HR 0.65 (95% CI, 0.49–0.87), P=0.024, with no increment in OS for the subset having a diffuse component. With respect to progression-free survival (PFS), a significant interaction was seen in the effect of docetaxel-containing schedules, with better PFS limited to the intestinal type subgroup, in the comparison against any other schedule: HR 0.65 (95% CI, 0.50–0.85), P=0.015, and against anthracycline-based regimens: HR 0.64 (95% CI, 0.46–0.88), P=0.046. Conclusions: As a conclusion, in this registry, Lauren classification tumour subtypes predicted survival and responded differently to chemotherapy. Future clinical trials should stratify effect estimations based on histology.
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Affiliation(s)
- Paula Jiménez Fonseca
- Department of Medical Oncology, Central de Asturias University Hospital, Oviedo 33011, Spain
| | - Alberto Carmona-Bayonas
- Department of Hematology and Medical Oncology, Morales Meseguer University Hospital, Murcia 30008, Spain
| | - Raquel Hernández
- Department of Medical Oncology, Canarias University Hospital, Tenerife 38320, Spain
| | - Ana Custodio
- Department of Medical Oncology, La Paz University Hospital, Madrid 28046, Spain
| | - Juana Maria Cano
- Department of Medical Oncology, Ciudad Real General Hospital, Ciudad Real 13005, Spain
| | - Alejandra Lacalle
- Department of Medical Oncology, Complejo Hospitalario de Navarra, Pamplona 31008, Spain
| | - Isabel Echavarria
- Department of Medical Oncology, Gregorio Marañón University Hospital, Madrid 28007, Spain
| | - Ismael Macias
- Department of Medical Oncology, Parc Tauli University Hospital, Sabadell 08208, Spain
| | - Monserrat Mangas
- Department of Medical Oncology, Hospital Galdakao-Usansolo, Galdakao-Usansolo 48960, Spain
| | - Laura Visa
- Department of Medical Oncology, El Mar University Hospital, Barcelona 08003, Spain
| | - Elvira Buxo
- Department of Medical Oncology, Hospital Clinic, Barcelona 08036, Spain
| | | | - Antonio Viudez
- Department of Medical Oncology, Complejo Hospitalario de Navarra, Pamplona 31008, Spain
| | - Carles Pericay
- Department of Medical Oncology, Parc Tauli University Hospital, Sabadell 08208, Spain
| | - Aitor Azkarate
- Department of Medical Oncology, Son Espases University Hospital, Mallorca 07120, Spain
| | - Avinash Ramchandani
- Department of Medical Oncology, Insular de Gran Canaria University Hospital, Las Palmas de Gran Canaria 35016, Spain
| | - Carlos López
- Department of Medical Oncology, Marqués de Valdecilla University Hospital, Santander 39008, Spain
| | - Eva Martinez de Castro
- Department of Medical Oncology, Marqués de Valdecilla University Hospital, Santander 39008, Spain
| | - Ana Fernández Montes
- Department of Medical Oncology, Complejo Hospitalario de Orense, Orense 32005, Spain
| | - Federico Longo
- Department of Medical Oncology, Ramón y Cajal University Hospital, Madrid 28034, Spain
| | | | - Maria Luisa Limón
- Department of Medical Oncology, Virgen del Rocío University Hospital, Sevilla 41013, Spain
| | - Asun Diaz-Serrano
- Department of Medical Oncology, 12 de Octubre University Hospital, Madrid 28041, Spain
| | | | - David Arias
- Department of Medical Oncology, Complejo Hospitalario de Orense, Orense 32005, Spain
| | - Paula Cerdà
- Department of Medical Oncology, Tecknon Cancer Institute, Barcelona 08022, Spain
| | - Fernando Rivera
- Department of Medical Oncology, Marqués de Valdecilla University Hospital, Santander 39008, Spain
| | - Jose Maria Vieitez
- Department of Medical Oncology, Central de Asturias University Hospital, Oviedo 33011, Spain
| | - Manuel Sánchez Cánovas
- Department of Hematology and Medical Oncology, Morales Meseguer University Hospital, Murcia 30008, Spain
| | - M Garrido
- Department of Medical Oncology, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - J Gallego
- Department of Medical Oncology, Elche University Hospital, Elche 03203, Spain
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Custodio A, Carmona-Bayonas A, Jiménez-Fonseca P, Sánchez ML, Viudez A, Hernández R, Cano JM, Echavarria I, Pericay C, Mangas M, Visa L, Buxo E, García T, Rodríguez Palomo A, Álvarez Manceñido F, Lacalle A, Macias I, Azkarate A, Ramchandani A, Fernández Montes A, López C, Longo F, Sánchez Bayona R, Limón ML, Díaz-Serrano A, Hurtado A, Madero R, Gómez C, Gallego J. Nomogram-based prediction of survival in patients with advanced oesophagogastric adenocarcinoma receiving first-line chemotherapy: a multicenter prospective study in the era of trastuzumab. Br J Cancer 2017; 116:1526-1535. [PMID: 28463962 PMCID: PMC5518851 DOI: 10.1038/bjc.2017.122] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/14/2017] [Accepted: 04/10/2017] [Indexed: 12/20/2022] Open
Abstract
Background: To develop and validate a nomogram and web-based calculator to predict overall survival (OS) in Caucasian-advanced oesophagogastric adenocarcinoma (AOA) patients undergoing first-line combination chemotherapy. Methods: Nine hundred twenty-four AOA patients treated at 28 Spanish teaching hospitals from January 2008 to September 2014 were used as derivation cohort. The result of an adjusted-Cox proportional hazards regression was represented as a nomogram and web-based calculator. The model was validated in 502 prospectively recruited patients treated between October 2014 and December 2016. Harrell's c-index was used to evaluate discrimination. Results: The nomogram includes seven predictors associated with OS: HER2-positive tumours treated with trastuzumab, Eastern Cooperative Oncology Group performance status, number of metastatic sites, bone metastases, ascites, histological grade, and neutrophil-to-lymphocyte ratio. Median OS was 5.8 (95% confidence interval (CI), 4.5–6.6), 9.4 (95% CI, 8.5–10.6), and 14 months (95% CI, 11.8–16) for high-, intermediate-, and low-risk groups, respectively (P<0.001), in the derivation set and 4.6 (95% CI, 3.3–8.1), 12.7 (95% CI, 11.3–14.3), and 18.3 months (95% CI, 14.6–24.2) for high-, intermediate-, and low-risk groups, respectively (P<0.001), in the validation set. The nomogram is well-calibrated and reveals acceptable discriminatory capacity, with optimism-corrected c-indices of 0.618 (95% CI, 0.591–0.631) and 0.673 (95% CI, 0.636–0.709) in derivation and validation groups, respectively. The AGAMENON nomogram outperformed the Royal Marsden Hospital (c-index=0.583; P=0.00046) and Japan Clinical Oncology Group prognostic indices (c-index=0.611; P=0.03351). Conclusions: We developed and validated a straightforward model to predict survival in Caucasian AOA patients initiating first-line polychemotherapy. This model can contribute to inform clinical decision-making and optimise clinical trial design.
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Affiliation(s)
- A Custodio
- Medical Oncology Department, Hospital Universitario La Paz, Paseo de la Castellana, 261, Madrid 28046, Spain
| | - A Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Av Marqués de los Vélez, s/n, Murcia 30008, Spain
| | - P Jiménez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, Av. Roma, s/n, Oviedo 33011, Spain
| | - M L Sánchez
- Medical Oncology Department, MD Anderson Cancer Center, Calle de Arturo Soria, 270, Madrid 28033, Spain
| | - A Viudez
- Medical Oncology Department, Complejo Hospitalario de Navarra, Calle de Irunlarrea, 3, Pamplona 31008, Spain
| | - R Hernández
- Medical Oncology Department, Hospital Universitario de Canarias, Carretera de Ofra, s/n, San Cristóbal de La Laguna, Santa Cruz de Tenerife 38320, Spain
| | - J M Cano
- Medical Oncology Department, Hospital General Universitario de Ciudad Real, Calle Obispo Rafael Torija, s/n, Ciudad Real 13005, Spain
| | - I Echavarria
- Medical Oncology Department, Hospital Universitario Gregorio Marañón, Calle del Dr Esquerdo, 46, Madrid 28007, Spain
| | - C Pericay
- Medical Oncology Department, Corporació Sanitària Parc Taulí, Parc Taulí, 1, Sabadell, Barcelona 08208, Spain
| | - M Mangas
- Medical Oncology Department, Hospital Galdakao-Usansolo, Barrio Labeaga, s/n, Usansolo, Bizkaia 48960, Spain
| | - L Visa
- Medical Oncology Department, Hospital Universitario del Mar, Passeig Marítim, 25-29, Barcelona 08003, Spain
| | - E Buxo
- Medical Oncology Department, Hospital Universitario Clínic i Provincial de Barcelona, Carrer de Villarroel, 170, Barcelona08036, Spain
| | - T García
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Av Marqués de los Vélez, s/n, Murcia 30008, Spain
| | - A Rodríguez Palomo
- Pharmacy Department, Hospital Universitario Central de Asturias, Av. Roma, s/n, Oviedo 33011, Spain
| | - F Álvarez Manceñido
- Medical Oncology Department, Hospital Universitario Central de Asturias, Av. Roma, s/n, Oviedo 33011, Spain
| | - A Lacalle
- Medical Oncology Department, Complejo Hospitalario de Navarra, Calle de Irunlarrea, 3, Pamplona 31008, Spain
| | - I Macias
- Medical Oncology Department, Corporació Sanitària Parc Taulí, Parc Taulí, 1, Sabadell, Barcelona 08208, Spain
| | - A Azkarate
- Medical Oncology Department, Hospital Universitario Son Espases, Carrer de Valldemossa, 79, Palma, Islas Baleares 07120, Spain
| | - A Ramchandani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Av Marítima Sur, s/n, Las Palmas de Gran Canaria 35001, Spain
| | - A Fernández Montes
- Medical Oncology Department, Complejo Hospitalario Universitario de Ourense, Calle Ramon Puga Noguerol, 54, Ourense 32005, Spain
| | - C López
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Av. Valdecilla, 25, Santander 39008, Spain
| | - F Longo
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Ctra. Colmenar Viejo, km. 9,100, Madrid 28034, Spain
| | - R Sánchez Bayona
- Medical Oncology Department, Clínica Universidad de Navarra, Av. de Pío XII, 36, Pamplona, Navarra 31008, Spain
| | - M L Limón
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Av. Manuel Siurot, s/n, Sevilla 41013, Spain
| | - A Díaz-Serrano
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Avenida de Córdoba s/n, Madrid 28041, Spain
| | - A Hurtado
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Calle Budapest, 1, Alcorcón, Madrid 28922, Spain
| | - R Madero
- Biostatistics Unit, Hospital Universitario La Paz, Paseo de la Castellana, 261, Madrid 28046, Spain
| | - C Gómez
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Avenida de Córdoba s/n, Madrid 28041, Spain
| | - J Gallego
- Medical Oncology Department, Hospital General Universitario de Elche, Camí de l'Almazara, 11, Elche, Alicante 03203, Spain
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Jiménez-Fonseca P, Carmona-Bayonas A, Sánchez Lorenzo ML, Plazas JG, Custodio A, Hernández R, Garrido M, García T, Echavarría I, Cano JM, Rodríguez Palomo A, Mangas M, Macías Declara I, Ramchandani A, Visa L, Viudez A, Buxó E, Díaz-Serrano A, López C, Azkarate A, Longo F, Castañón E, Sánchez Bayona R, Pimentel P, Limón ML, Cerdá P, Álvarez Llosa R, Serrano R, Lobera MPF, Alsina M, Hurtado Nuño A, Gómez-Martin C. Prognostic significance of performing universal HER2 testing in cases of advanced gastric cancer. Gastric Cancer 2017; 20:465-474. [PMID: 27599830 DOI: 10.1007/s10120-016-0639-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/26/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Trastuzumab significantly improves overall survival (OS) when added to cisplatin and fluoropyrimidine as a treatment for HER2-positive advanced gastric cancers (AGC). The aim of this study was to evaluate the impact of the gradual implementation of HER2 testing on patient prognosis in a national registry of AGC. METHODS This Spanish National Cancer Registry includes cases who were consecutively recruited at 28 centers from January 2008 to January 2016. The effect of missing HER2 status was assessed using stratified Cox proportional hazards (PH) regression. RESULTS The rate of HER2 testing increased steadily over time, from 58.3 % in 2008 to 92.9 % in 2016. HER2 was positive in 194 tumors (21.3 %). In the stratified Cox PH regression, each 1 % increase in patients who were not tested for HER2 at the institutions was associated with an approximately 0.3 % increase in the risk of death: hazard ratio, 1.0035 (CI 95 %, 1.001-1.005), P = 0.0019. Median OS was significantly lower at institutions with the highest proportions of patients who were not tested for HER2. CONCLUSION Patients treated at centers that took longer to implement HER2 testing exhibited worse clinical outcomes. The speed of implementation behaves as a quality-of-care indicator. Reviewed guidelines on HER2 testing should be used to achieve this goal in a timely manner.
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Affiliation(s)
- Paula Jiménez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, Avenida de Roma s/n, 33011, Oviedo, Spain.
| | - Alberto Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain
| | - Maria Luisa Sánchez Lorenzo
- Medical Oncology Department, Hospital Universitario Central de Asturias, Avenida de Roma s/n, 33011, Oviedo, Spain
| | - Javier Gallego Plazas
- Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain
| | - Ana Custodio
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Raquel Hernández
- Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz De Tenerife, Spain
| | - Marcelo Garrido
- Medical Oncology Department, Pontificia Universidad Católica de Chile, Santiago De Chile, Chile
| | - Teresa García
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain
| | - Isabel Echavarría
- Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Juana María Cano
- Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain
| | | | - Monserrat Mangas
- Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain
| | | | - Avinash Ramchandani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas De Gran Canaria, Spain
| | - Laura Visa
- Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain
| | - Antonio Viudez
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Elvira Buxó
- Medical Oncology Department, Hospital Clínic, Barcelona, Spain
| | | | - Carlos López
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Aitor Azkarate
- Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain
| | - Federico Longo
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Eduardo Castañón
- Medical Oncology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Paola Pimentel
- Medical Oncology Department, Hospital Santa Lucía, Cartagena, Spain
| | - Maria Luisa Limón
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Paula Cerdá
- Medical Oncology Department, Instituto Oncológico Teknon, Barcelona, Spain
| | | | - Raquel Serrano
- Medical Oncology Department, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | | | - María Alsina
- Medical Oncology Department, Hospital Universitario Vall d'Hebron and VHIO-Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Alicia Hurtado Nuño
- Medical Oncology Department, Hospital Universitario Fundación Alcorcon, Madrid, Spain
| | - Carlos Gómez-Martin
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain
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Diaz-Guardamino IE, Carmona-Bayonas A, Fonseca PJ, Martin AM, Lorenzo MS, Custodio A, Garrido M, Cano J, Barreto JL, Lacalle A, Cardona MF, Manga M, Visa L, Buxo E, Azkarate A, Diaz A, Ramchandani A, Mugica M, Sala P, Alfonso PG. First-line triplet or doublet chemotherapy for advanced gastric cancer: Analysis of 970 patients from a community practice registry. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw371.18] [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: 11/13/2022] Open
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41
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Sanchez-Martin FJ, Dalmases A, Bellosillo B, Argiles G, Gelabert M, Cañadas I, Vidal J, Siravegna G, Arena S, Koefoed K, Visa L, Arpí O, Horak ID, Iglesias M, Stroh C, Kragh M, Rovira A, Albanell J, Bardelli A, Tabernero J, Montagut C. Abstract 2149: The anti-EGFR antibody mixture Sym004 overcomes acquired resistance to cetuximab in colorectal cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-2149] [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
The anti-EGFR monoclonal antibodies (MoAbs) cetuximab and panitumumab are used to treat ‘RAS’ wild type metastatic colorectal cancer (MCRC), providing significant clinical benefit in patients. However, all patients ultimately develop disease progression, driven by acquisition of mutations in downstream effectors and in the extracellular domain (ECD) of EGFR, in approximately 25% of the cases. Sym004 is a novel 1:1 mixture of two non-overlapping anti-EGFR MoAbs that has recently shown promising clinical activity in a phase I trial in MCRC. Our aim was to determine the efficacy of Sym004 to circumvent cetuximab resistance driven by EGFR ECD mutations. Functional studies were performed to assess drug-receptor binding as well as ligand-dependent activation of individual EGFR mutants in the presence of cetuximab, panitumumab and Sym004. Cell viability and molecular effects of the drugs were assayed in cetuximab-resistant cell lines and in tumor xenograft models. Efficacy of Sym004 was evaluated in patients progressing to cetuximab that harbored an EGFR mutation in the post-cetuximab tumor sample. Sym004 effectively bound and abrogated ligand-induced phosphorylation of all individual EGFR mutants. Cells resistant to cetuximab harboring EGFR ECD mutations maintained sensitivity to Sym004, which was consistent with an effective suppression of EGFR downstream signaling, translating into profound and sustained tumor regression in the xenograft model. As a proof of principle, a patient with a tumor harboring an EGFR mutation (G465R) following cetuximab therapy benefited from Sym004 therapy. These data suggest that Sym004 is an active drug in MCRC resistant to cetuximab/panitumumab mediated by EGFR mutations. Overall, EGFR mutations are potential biomarkers of response to Sym004 to be evaluated in ongoing large clinical trials.
Citation Format: Francisco J. Sanchez-Martin, Alba Dalmases, Beatriz Bellosillo, Guillem Argiles, Mariona Gelabert, Israel Cañadas, Joana Vidal, Giulia Siravegna, Sabrina Arena, Klaus Koefoed, Laura Visa, Oriol Arpí, Ivan D. Horak, Mar Iglesias, Christopher Stroh, Michael Kragh, Ana Rovira, Joan Albanell, Alberto Bardelli, Josep Tabernero, Clara Montagut. The anti-EGFR antibody mixture Sym004 overcomes acquired resistance to cetuximab in colorectal cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2149.
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Affiliation(s)
| | - Alba Dalmases
- 2Pathology Department, Hospital del Mar, Barcelona, Spain
| | | | - Guillem Argiles
- 3Medical Oncology Department, Vall d′Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Mariona Gelabert
- 1Cancer Research Program, IMIM. Hospital del Mar, Barcelona, Spain
| | - Israel Cañadas
- 1Cancer Research Program, IMIM. Hospital del Mar, Barcelona, Spain
| | - Joana Vidal
- 4Medical Oncology Department, Hospital del Mar, Barcelona, Spain
| | - Giulia Siravegna
- 5Candiolo Cancer Institute – FPO, IRCCS, Candiolo, Torino, Italy
| | - Sabrina Arena
- 1Cancer Research Program, IMIM. Hospital del Mar, Barcelona, Spain
| | | | - Laura Visa
- 4Medical Oncology Department, Hospital del Mar, Barcelona, Spain
| | - Oriol Arpí
- 1Cancer Research Program, IMIM. Hospital del Mar, Barcelona, Spain
| | | | - Mar Iglesias
- 2Pathology Department, Hospital del Mar, Barcelona, Spain
| | | | | | - Ana Rovira
- 1Cancer Research Program, IMIM. Hospital del Mar, Barcelona, Spain
| | - Joan Albanell
- 4Medical Oncology Department, Hospital del Mar, Barcelona, Spain
| | - Alberto Bardelli
- 5Candiolo Cancer Institute – FPO, IRCCS, Candiolo, Torino, Italy
| | - Josep Tabernero
- 3Medical Oncology Department, Vall d′Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Clara Montagut
- 4Medical Oncology Department, Hospital del Mar, Barcelona, Spain
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Vidal J, Dalmases A, Vela MC, Muset MM, Piquer G, Visa L, Correa R, Martinez G, Sikri V, Tusquets I, Albanell J, Jones FS, Bellosillo B, Montagut C. Plasma RAS mutations for the selection and monitoring of colorectal cancer patients treated with anti-EGFR therapy. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e15123] [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)
- Joana Vidal
- Medical Oncology Department, Hospital del Mar, Barcelona, Spain
| | - Alba Dalmases
- Cancer Research Program, IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Medical Oncology Department, Hospital del Mar, Barcelona, Spain
| | | | | | - Gabriel Piquer
- IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain
| | | | - Roser Correa
- IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain
| | - Gemma Martinez
- Medical Oncology Department, Hospital del Mar, Barcelona, Spain
| | | | | | - Joan Albanell
- Department of Medical Oncology, University Hospital del Mar-IMIM, Barcelona, Spain
| | | | | | - Clara Montagut
- Medical Oncology Department, Hospital del Mar, Barcelona, Spain
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Sánchez-Martín FJ, Bellosillo B, Gelabert-Baldrich M, Dalmases A, Cañadas I, Vidal J, Martinez A, Argilés G, Siravegna G, Arena S, Koefoed K, Visa L, Arpí O, Horak ID, Iglesias M, Stroh C, Kragh M, Rovira A, Albanell J, Tabernero J, Bardelli A, Montagut C. The First-in-class Anti-EGFR Antibody Mixture Sym004 Overcomes Cetuximab Resistance Mediated by EGFR Extracellular Domain Mutations in Colorectal Cancer. Clin Cancer Res 2016; 22:3260-7. [PMID: 26888827 DOI: 10.1158/1078-0432.ccr-15-2400] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 02/08/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE Approved anti-EGFR antibodies cetuximab and panitumumab provide significant clinical benefit in patients with metastatic colorectal cancer (MCRC). However, patients ultimately develop disease progression, often driven by acquisition of mutations in the extracellular domain (ECD) of EGFR. Sym004 is a novel 1:1 mixture of two nonoverlapping anti-EGFR mAbs that recently showed promising clinical activity in a phase I trial in MCRC. Our aim was to determine the efficacy of Sym004 to circumvent cetuximab resistance driven by EGFR ECD mutations. EXPERIMENTAL DESIGN Functional studies were performed to assess drug-receptor binding as well as ligand-dependent activation of individual EGFR mutants in the presence of cetuximab, panitumumab, and Sym004. Cell viability and molecular effects of the drugs were assayed in cetuximab-resistant cell lines and in tumor xenograft models. Efficacy of Sym004 was evaluated in patients progressing to cetuximab that harbored EGFR mutation in the post-cetuximab tumor sample. RESULTS Contrary to cetuximab and panitumumab, Sym004 effectively bound and abrogated ligand-induced phosphorylation of all individual EGFR mutants. Cells resistant to cetuximab harboring mutations in EGFR maintained sensitivity to Sym004, which was consistent with an effective suppression of EGFR downstream signaling, translating into profound and sustained tumor regression in the xenograft model. As proof-of-principle, a patient with a tumor harboring an EGFR mutation (G465R) following cetuximab therapy benefited from Sym004 therapy. CONCLUSIONS Sym004 is an active drug in MCRC resistant to cetuximab/panitumumab mediated by EGFR mutations. EGFR mutations are potential biomarkers of response to Sym004 to be evaluated in ongoing large clinical trials. Clin Cancer Res; 22(13); 3260-7. ©2016 AACR.
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Affiliation(s)
| | - Beatriz Bellosillo
- Cancer Research Program, IMIM, Hospital del Mar, Barcelona, Spain. Department of Pathology, Hospital del Mar, Barcelona, Spain
| | | | - Alba Dalmases
- Cancer Research Program, IMIM, Hospital del Mar, Barcelona, Spain. Department of Pathology, Hospital del Mar, Barcelona, Spain
| | - Israel Cañadas
- Cancer Research Program, IMIM, Hospital del Mar, Barcelona, Spain
| | - Joana Vidal
- Department of Medical Oncology, Hospital del Mar, Barcelona, Spain
| | - Alejandro Martinez
- Cancer Research Program, IMIM, Hospital del Mar, Barcelona, Spain. Department of Medical Oncology, Hospital del Mar, Barcelona, Spain
| | - Guillem Argilés
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Giulia Siravegna
- Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy. Department of Oncology, University of Torino, Candiolo, Torino, Italy
| | - Sabrina Arena
- Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy. Department of Oncology, University of Torino, Candiolo, Torino, Italy
| | | | - Laura Visa
- Department of Medical Oncology, Hospital del Mar, Barcelona, Spain
| | - Oriol Arpí
- Cancer Research Program, IMIM, Hospital del Mar, Barcelona, Spain
| | | | - Mar Iglesias
- Department of Pathology, Hospital del Mar, Barcelona, Spain
| | | | | | - Ana Rovira
- Cancer Research Program, IMIM, Hospital del Mar, Barcelona, Spain
| | - Joan Albanell
- Cancer Research Program, IMIM, Hospital del Mar, Barcelona, Spain. Department of Medical Oncology, Hospital del Mar, Barcelona, Spain. Universitat Pompeu Fabra, Barcelona, Spain
| | - Josep Tabernero
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Alberto Bardelli
- Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy. Department of Oncology, University of Torino, Candiolo, Torino, Italy
| | - Clara Montagut
- Cancer Research Program, IMIM, Hospital del Mar, Barcelona, Spain. Department of Medical Oncology, Hospital del Mar, Barcelona, Spain.
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44
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Sánchez-Martín FJ, Bellosillo B, Gelabert-Baldrich M, Dalmases A, Cañadas I, Vidal J, Martinez A, Argilés G, Siravegna G, Arena S, Koefoed K, Visa L, Arpí O, Horak ID, Iglesias M, Stroh C, Kragh M, Rovira A, Albanell J, Tabernero J, Bardelli A, Montagut C. The First-in-class Anti-EGFR Antibody Mixture Sym004 Overcomes Cetuximab Resistance Mediated by EGFR Extracellular Domain Mutations in Colorectal Cancer. Clin Cancer Res 2016. [PMID: 26888827 DOI: 10.1158/1078-0432.ccr-1 5-2400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Approved anti-EGFR antibodies cetuximab and panitumumab provide significant clinical benefit in patients with metastatic colorectal cancer (MCRC). However, patients ultimately develop disease progression, often driven by acquisition of mutations in the extracellular domain (ECD) of EGFR. Sym004 is a novel 1:1 mixture of two nonoverlapping anti-EGFR mAbs that recently showed promising clinical activity in a phase I trial in MCRC. Our aim was to determine the efficacy of Sym004 to circumvent cetuximab resistance driven by EGFR ECD mutations. EXPERIMENTAL DESIGN Functional studies were performed to assess drug-receptor binding as well as ligand-dependent activation of individual EGFR mutants in the presence of cetuximab, panitumumab, and Sym004. Cell viability and molecular effects of the drugs were assayed in cetuximab-resistant cell lines and in tumor xenograft models. Efficacy of Sym004 was evaluated in patients progressing to cetuximab that harbored EGFR mutation in the post-cetuximab tumor sample. RESULTS Contrary to cetuximab and panitumumab, Sym004 effectively bound and abrogated ligand-induced phosphorylation of all individual EGFR mutants. Cells resistant to cetuximab harboring mutations in EGFR maintained sensitivity to Sym004, which was consistent with an effective suppression of EGFR downstream signaling, translating into profound and sustained tumor regression in the xenograft model. As proof-of-principle, a patient with a tumor harboring an EGFR mutation (G465R) following cetuximab therapy benefited from Sym004 therapy. CONCLUSIONS Sym004 is an active drug in MCRC resistant to cetuximab/panitumumab mediated by EGFR mutations. EGFR mutations are potential biomarkers of response to Sym004 to be evaluated in ongoing large clinical trials. Clin Cancer Res; 22(13); 3260-7. ©2016 AACR.
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Affiliation(s)
| | - Beatriz Bellosillo
- Cancer Research Program, IMIM, Hospital del Mar, Barcelona, Spain. Department of Pathology, Hospital del Mar, Barcelona, Spain
| | | | - Alba Dalmases
- Cancer Research Program, IMIM, Hospital del Mar, Barcelona, Spain. Department of Pathology, Hospital del Mar, Barcelona, Spain
| | - Israel Cañadas
- Cancer Research Program, IMIM, Hospital del Mar, Barcelona, Spain
| | - Joana Vidal
- Department of Medical Oncology, Hospital del Mar, Barcelona, Spain
| | - Alejandro Martinez
- Cancer Research Program, IMIM, Hospital del Mar, Barcelona, Spain. Department of Medical Oncology, Hospital del Mar, Barcelona, Spain
| | - Guillem Argilés
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Giulia Siravegna
- Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy. Department of Oncology, University of Torino, Candiolo, Torino, Italy
| | - Sabrina Arena
- Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy. Department of Oncology, University of Torino, Candiolo, Torino, Italy
| | | | - Laura Visa
- Department of Medical Oncology, Hospital del Mar, Barcelona, Spain
| | - Oriol Arpí
- Cancer Research Program, IMIM, Hospital del Mar, Barcelona, Spain
| | | | - Mar Iglesias
- Department of Pathology, Hospital del Mar, Barcelona, Spain
| | | | | | - Ana Rovira
- Cancer Research Program, IMIM, Hospital del Mar, Barcelona, Spain
| | - Joan Albanell
- Cancer Research Program, IMIM, Hospital del Mar, Barcelona, Spain. Department of Medical Oncology, Hospital del Mar, Barcelona, Spain. Universitat Pompeu Fabra, Barcelona, Spain
| | - Josep Tabernero
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Alberto Bardelli
- Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy. Department of Oncology, University of Torino, Candiolo, Torino, Italy
| | - Clara Montagut
- Cancer Research Program, IMIM, Hospital del Mar, Barcelona, Spain. Department of Medical Oncology, Hospital del Mar, Barcelona, Spain.
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Gomez-Martin C, Pazo Cid RA, Salud A, Fonseca PJ, Leon A, Galan M, Visa L, Rivera F, Alsina M, Plaza C, Angulo B, Hernandez Prieto S, Dominguez C, Rodriguez Garcia M, Del Valle E, Fernandez S, Rojo F, Cuatrecasas M, Lopez-Rios F. Detection of actionable oncogene drivers alterations in HER2-amplified gastric cancer by next generation sequencing. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.3_suppl.67] [Citation(s) in RCA: 1] [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
67 Background: HER2 amplified cases are the only subset of gastric carcinoma (GC) patients with an approved targeted therapy (≈20%). In GC it is still unknown if there is a mutually exclusive pattern of mutations in major driver oncogenes. We performed a systematic search for targetable oncogenes in a cohort of HER2 amplified GC patients. Methods: 53 Formalin-fixed paraffin embedded samples from HER2 amplified GC patients (43 tumor and 10 normal samples) were selected for next generation sequencing (NGS). Before DNA extraction a macrodissection procedure was performed to guarantee at least 30% tumor in all cases. DNA samples were sequenced using the Ion Torrent Personal Genome Machine (PGM) sequencing platform (Life Technologies, Carlsbad, CA, USA). The Ion AmpliSeq Cancer Hotspot Panel v2 was used. This panel encompasses more than 2800 mutational hotspots of 50 oncogenes and tumor suppressor genes. Data were processed using the Ion Torrent platform-specific pipeline software Torrent suite v4.2. Moreover, sequencing data were analyzed with Ion Reporter software 4.2 to detect any copy number alteration of the genes included in the panel. Results: We successfully sequenced all samples. We identified 89 mutations in 12 genes (range from 1 ~ 9). The most frequent significant mutations included TP53 mutations (30), PI3KCA (3), SMAD4 (3), CDKN2A (4), CTNNB1 (3) and MET (3). Other mutations were found in KRAS, NOTCH, APC, and VHL genes. We also detected potential amplifications in the KRAS (4), EGFR (9), PI3KCA (11), AKT (6), FGFR (6), CDKN2A (4) and CDH1(8) genes. Among 43 tumor specimens, 86% of specimens harbored at least one genetic alteration, most of them linked to actionable mutations or amplifications Conclusions: Within HER2 amplified GCs, there are additional subsets with a potentially targetable oncogene. Future testing for these targets will benefit from including HER2 amplified GC patients Supported by the Spanish Ministry of Health, Fondo de Investigaciones Sanitarias grant PI11/01005 and European FEDER (PN I+D+I 2008‐20011).
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Affiliation(s)
- Carlos Gomez-Martin
- Medical Oncology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Roberto A. Pazo Cid
- Medical Oncology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | | | | | - Ana Leon
- Oncology Department and Translational Oncology Division, Fundacion Jimenez Diaz Hospital, Madrid, Spain
| | - MaCarmen Galan
- Institut Catalá d´Oncologia, Hospital Duran i Reynals, Barcelona, Spain
| | - Laura Visa
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | - Fernando Rivera
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Maria Alsina
- Hospital Universitario de Vall d'Hebron, Barcelona, Spain
| | - Carlos Plaza
- Centro Integral Oncológico Clara Campal, Madrid, Spain
| | | | - Susana Hernandez Prieto
- Laboratorio de Dianas Terapeuticas. Hospital Universitario Madrid Norte Sanchinarro, Madrid, Spain
| | - Carolina Dominguez
- Laboratorio de Dianas Terapeuticas. Hospital Universitario Madrid Norte Sanchinarro, Madrid, Spain
| | | | | | | | - Federico Rojo
- Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
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Vicente Conesa M, Faez Garcia L, Garrido M, Custodio A, López C, Visa L, Gallego Plazas J, Fernandez Arrojo S, Ramchandani A, Murias C, Iranzo V, Múgica M, Giraldo C, Hindi N, Erpel F, Pineda E, Buxo E, Jofré E, Jimenez Fonseca P, Carmona-Bayonas A. Prognostic Evaluation of a Multicenter Cohort of 484 Patients with Metastatic Gastroesophageal Adenocarcinoma. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.19] [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: 11/12/2022] Open
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Martin-Richard M, Gallego R, Pericay C, Garcia Foncillas J, Queralt B, Casado E, Barriuso J, Iranzo V, Juez I, Visa L, Saigi E, Barnadas A, Garcia-Albeniz X, Maurel J. Multicenter phase II study of oxaliplatin and sorafenib in advanced gastric adenocarcinoma after failure of cisplatin and fluoropyrimidine treatment. A GEMCAD study. Invest New Drugs 2014; 31:1573-9. [PMID: 24077981 DOI: 10.1007/s10637-013-0020-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 08/23/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cisplatin and fluoropyrimidine (CF) are standard first- line treatment in advanced gastric cancer, but no second-line treatment has yet been established. We present a phase II study in which we evaluated the efficacy and toxicity of the combination of Sorafenib (S), and Oxaliplatin as second-line therapy. METHODS Patients with progressive gastric adenocarcinoma after CF- first-line, ECOG 0-2, and measurable disease were included. The primary objective was PFS. Treatment doses were Oxaliplatin 130 mg/m²/3 weeks and Sorafenib 800 mg/bid/d. RESULTS We included 40 patients. CR was 2.5% and SD was 47.2%. Grade 3-4 toxic effects were neutropenia (9.8%), thrombocytopenia (7.3%), neurotoxicity (4.9%) and diarrhea (4.9%). Median PFS was 3 months (95%CI: 2.3-4.1) and median OS was 6.5 months (95% CI: 5.2-9.6). Time to progression (TTP) to first line therapy was a prognosis factor. Median OS was 9.7 months when time-to-progression during first-line chemotherapy was >6 months and 5.6 m when it was <6 months (p = 0.04). CONCLUSIONS Time-to-progression under a CF-based first-line therapy determines subgroups of GC patients with different prognosis. The combination of Oxaliplatin-Sorafenib in advanced GC patients previously treated with CF appears safe, but our results do not support the implementation of a phase III trial.
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Gomez-Martin C, Plaza JC, Pazo-Cid R, Salud A, Pons F, Fonseca P, Leon A, Alsina M, Visa L, Rivera F, Galan MC, Del Valle E, Vilardell F, Iglesias M, Fernandez S, Landolfi S, Cuatrecasas M, Mayorga M, Jose Paulés M, Sanz-Moncasi P, Montagut C, Garralda E, Rojo F, Hidalgo M, Lopez-Rios F. Level of HER2 gene amplification predicts response and overall survival in HER2-positive advanced gastric cancer treated with trastuzumab. J Clin Oncol 2013; 31:4445-52. [PMID: 24127447 DOI: 10.1200/jco.2013.48.9070] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [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: 12/12/2022] Open
Abstract
PURPOSE Previous studies have highlighted the importance of an appropriate human epidermal growth factor receptor 2 (HER2) evaluation for the proper identification of patients eligible for treatment with anti-HER2 targeted therapies. Today, the relationship remains unclear between the level of HER2 amplification and the outcome of HER2-positive gastric cancer treated with first-line chemotherapy with trastuzumab. The aim of this study was to determine whether the level of HER2 gene amplification determined by the HER2/CEP17 ratio and HER2 gene copy number could significantly predict some benefit in overall survival and response to therapy in advanced gastric cancer treated with trastuzumab-based chemotherapy. PATIENTS AND METHODS Ninety patients with metastatic gastric cancer treated with first-line trastuzumab-based chemotherapy were studied. The optimal cutoff values for HER2/CEP17 ratio and HER2 gene copy number (GCN) for discriminating positive results in terms of response and prolonged survival were determined using receiver operating characteristic curves analyses. RESULTS In this study, a median HER2/CEP17 ratio of 6.11 (95% CI, 2.27 to 21.90) and a median HER2 gene copy number of 11.90 (95% CI, 3.30 to 43.80) were found. A mean HER2/CEP17 ratio of 4.7 was identified as the optimal cutoff value discriminating sensitive and refractory patients (P = .005). Similarly, the optimal cutoff for predicting survival longer than 12 months was 4.45 (P = .005), and for survival longer than 16 months was 5.15 (P = .004). For HER2 GCN, the optimal cutoff values were 9.4, 10.0, and 9.5, respectively (P = .02). CONCLUSION The level of HER2 gene amplification significantly predicts sensitivity to therapy and overall survival in advanced gastric cancer treated with trastuzumab-based chemotherapy.
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Affiliation(s)
- Carlos Gomez-Martin
- Carlos Gomez-Martin, Elena Garralda, and Manuel Hidalgo, Spanish National Cancer Research Centre; Carlos Gomez-Martin, Jose Carlos Plaza, Fernando Lopez-Rios, and Manuel Hidalgo, Laboratorio Dianas Terapeuticas, Cenro Integral Oncologico Clara Campal, Hospital Universitario Sanchinarro; Federico Rojo and Ana Leon, Fundacion Jimenez Diaz, Madrid; Pilar Sanz-Moncasi, Hospital Royo-Villanova; Roberto Pazo-Cid and Elena del Valle, Hospital Universitario Miguel Servet, Zaragoza; Antonieta Salud and Felipe Vilardell, Hospital Universitario Arnau de Vilanova, Lérida; Francesc Pons, Mar Iglesias, and Clara Montagut, Hospital de Mar; Maria Alsina and Stefania Landolfi, Hospital Universitari Vall d'Hebrón; M. Carmen Galan and M. Jose Paulés, Instituto Catalan de Oncologia; Miriam Cuatrecasas and Laura Visa, Hospital Clinic Universitari, Barcelona; Paula Fonseca and Soledad Fernandez, Hospital Universitario Central de Asturias, Oviedo; Fernando Rivera and Marta Mayorga, Hospital Universitario Marques de Valdecilla, Santander, Spain
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Codony-Servat J, Marín-Aguilera M, Visa L, García-Albéniz X, Pineda E, Fernández PL, Filella X, Gascón P, Mellado B. Nuclear factor-kappa B and interleukin-6 related docetaxel resistance in castration-resistant prostate cancer. Prostate 2013; 73:512-21. [PMID: 23038213 DOI: 10.1002/pros.22591] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 08/30/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND Previous work showed that the NF-κB survival pathway is activated by docetaxel (D) and contributes to D resistance in prostate cancer. In this study we aimed to investigate the dynamics of the relationship between NF-κB and IL-6 in the shift from D-naive castration-resistant prostate cancer (CRPC) to D-resistance in patients and cell lines. METHODS CRPC tumor samples were tested for NF-κB/p65 and IL-6 by immunohistochemistry. CRPC patients treated with D were also tested for serum IL-6 (ELISA). Two D-resistant cell lines, PC-3R and DU-145R, derived from the CRPC cells PC-3 and DU-145, respectively, were tested for NF-κB activation (EMSA), NF-κB-related genes expression (RT-PCR), NF-κB inhibition (p65 siRNA) and IL-6 and IL-8 soluble levels (ELISA). RESULTS In CRPC patients treated with D (n = 72), pre-treatment IL-6 level correlated with nuclear NF-κB/p65 tumor staining and response to D, and was an independent prognostic factor for overall survival. However, IL-6 level changes under treatment did not correlate with clinical outcome. In PC-3 and DU-145 parental CRPC cells, as well as in D-resistant counterparts, D treatment induced NF-κB activation. In fact, NF-κB inhibition was sufficient to re-sensitize DU-145R cells to D. Despite enhanced NF-κB activity, IL-6 secretion in D-resistant cell lines was reduced and not induced by D treatment. The same occurred with IL-8 cytokine. CONCLUSIONS These preclinical and clinical results support a role of NF-κB and IL-6 in the resistance to D in CRPC, and support the investigation of targeted therapies to enhance the antitumor activity of D in this patient population.
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Affiliation(s)
- Jordi Codony-Servat
- Medical Oncology Department and Laboratory of Translational Oncology, Hospital Clínic-Fundació Clínic per a la recerca Biomèdica, Barcelona, Spain
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Ogbah Z, Visa L, Badenas C, Ríos J, Puig-Butille JA, Bonifaci N, Guino E, Augé JM, Kolm I, Carrera C, Pujana MÁ, Malvehy J, Puig S. Serum 25-hydroxyvitamin D3 levels and vitamin D receptor variants in melanoma patients from the Mediterranean area of Barcelona. BMC Med Genet 2013; 14:26. [PMID: 23413917 PMCID: PMC3648347 DOI: 10.1186/1471-2350-14-26] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 02/12/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND Serum 25-hydroxyvitamin D3 (Vitamin D) insufficiency and single-nucleotide polymorphisms (SNPs) on its receptor, Vitamin D receptor (VDR), have been reported to be involved in melanoma susceptibility in populations mostly from northern countries. OBJECTIVE To investigate 25-hydroxyvitamin D3 levels and VDR SNPs in melanoma patients from sunny area of Barcelona, two studies were carried out. The first study evaluated the levels of Vitamin D at time of melanoma diagnosis and the second one analyzed the association between VDR genetic variants and risk of having a high nevus number, the strongest phenotypic risk factor for melanoma. METHODS The levels of 25-hydroxyvitamin D3 in 81 melanoma patients at diagnosis were measured. In a second group of melanoma patients, including 150 with low and 113 with high nevus number, 11 VDR SNPs were analyzed for their association with nevus number. RESULTS In the first study, 68% of patients had insufficient levels of 25-hydroxyvitamin D3 (<25 ng/ml). Autumn-winter months and fair phototype were associated with 25-hydroxyvitamin D3 insufficiency; after multivariate analysis, season of sampling remained the only independent predictor of 25-hydroxyvitamin D3 levels. In the second study, VDR variant rs2189480 (P = 0.006) was associated with risk of high nevus number whereas rs2239179 (P = 0.044) and rs7975128 (P = 0.0005) were protective against high nevus number. After Bonferroni adjustment only rs7975128 remained significant. In stratified analysis, SNP rs7975128 was found protective against multiple melanomas (P = 0.021). CONCLUSION This study showed that even in Barcelona, a sunny Mediterranean area, 25-hydroxyvitamin D3 levels were sub-optimal in the majority of melanoma patients at diagnosis. The involvement of VDR in nevi and, in turn, in melanoma susceptibility has also been suggested. Larger studies are needed to confirm our findings.
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