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de Paiva BBM, Pereira PD, de Andrade CMV, Gomes VMR, Souza-Silva MVR, Martins KPMP, Sales TLS, de Carvalho RLR, Pires MC, Ramos LEF, Silva RT, de Freitas Martins Vieira A, Nunes AGS, de Oliveira Jorge A, de Oliveira Maurílio A, Scotton ALBA, da Silva CTCA, Cimini CCR, Ponce D, Pereira EC, Manenti ERF, Rodrigues FD, Anschau F, Botoni FA, Bartolazzi F, Grizende GMS, Noal HC, Duani H, Gomes IM, Costa JHSM, di Sabatino Santos Guimarães J, Tupinambás JT, Rugolo JM, Batista JDL, de Alvarenga JC, Chatkin JM, Ruschel KB, Zandoná LB, Pinheiro LS, Menezes LSM, de Oliveira LMC, Kopittke L, Assis LA, Marques LM, Raposo MC, Floriani MA, Bicalho MAC, Nogueira MCA, de Oliveira NR, Ziegelmann PK, Paraiso PG, de Lima Martelli PJ, Senger R, Menezes RM, Francisco SC, Araújo SF, Kurtz T, Fereguetti TO, de Oliveira TC, Ribeiro YCNMB, Ramires YC, Lima MCPB, Carneiro M, Bezerra AFB, Schwarzbold AV, de Moura Costa AS, Farace BL, Silveira DV, de Almeida Cenci EP, Lucas FB, Aranha FG, Bastos GAN, Vietta GG, Nascimento GF, Vianna HR, Guimarães HC, de Morais JDP, Moreira LB, de Oliveira LS, de Deus Sousa L, de Souza Viana L, de Souza Cabral MA, Ferreira MAP, de Godoy MF, de Figueiredo MP, Guimarães-Junior MH, de Paula de Sordi MA, da Cunha Severino Sampaio N, Assaf PL, Lutkmeier R, Valacio RA, Finger RG, de Freitas R, Guimarães SMM, Oliveira TF, Diniz THO, Gonçalves MA, Marcolino MS. Potential and limitations of machine meta-learning (ensemble) methods for predicting COVID-19 mortality in a large inhospital Brazilian dataset. Sci Rep 2023; 13:3463. [PMID: 36859446 PMCID: PMC9975879 DOI: 10.1038/s41598-023-28579-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/20/2023] [Indexed: 03/03/2023] Open
Abstract
The majority of early prediction scores and methods to predict COVID-19 mortality are bound by methodological flaws and technological limitations (e.g., the use of a single prediction model). Our aim is to provide a thorough comparative study that tackles those methodological issues, considering multiple techniques to build mortality prediction models, including modern machine learning (neural) algorithms and traditional statistical techniques, as well as meta-learning (ensemble) approaches. This study used a dataset from a multicenter cohort of 10,897 adult Brazilian COVID-19 patients, admitted from March/2020 to November/2021, including patients [median age 60 (interquartile range 48-71), 46% women]. We also proposed new original population-based meta-features that have not been devised in the literature. Stacking has shown to achieve the best results reported in the literature for the death prediction task, improving over previous state-of-the-art by more than 46% in Recall for predicting death, with AUROC 0.826 and MacroF1 of 65.4%. The newly proposed meta-features were highly discriminative of death, but fell short in producing large improvements in final prediction performance, demonstrating that we are possibly on the limits of the prediction capabilities that can be achieved with the current set of ML techniques and (meta-)features. Finally, we investigated how the trained models perform on different hospitals, showing that there are indeed large differences in classifier performance between different hospitals, further making the case that errors are produced by factors that cannot be modeled with the current predictors.
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Affiliation(s)
- Bruno Barbosa Miranda de Paiva
- grid.8430.f0000 0001 2181 4888Computer Science Department, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
| | - Polianna Delfino Pereira
- grid.8430.f0000 0001 2181 4888Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil ,Institute for Health Technology Assessment (IATS/ CNPq), R. Ramiro Barcelos, 2359, building 21, room 507, Porto Alegre, Brazil
| | - Claudio Moisés Valiense de Andrade
- grid.8430.f0000 0001 2181 4888Computer Science Department, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
| | - Virginia Mara Reis Gomes
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, room 246, Belo Horizonte, Brazil
| | - Maira Viana Rego Souza-Silva
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, room 246, Belo Horizonte, Brazil
| | - Karina Paula Medeiros Prado Martins
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, room 246, Belo Horizonte, Brazil
| | - Thaís Lorenna Souza Sales
- grid.428481.30000 0001 1516 3599Universidade Federal de São João del-Rei, R. Sebastião Gonçalves Coelho, 400, Divinópolis, Brazil
| | | | - Magda Carvalho Pires
- grid.8430.f0000 0001 2181 4888Department of Statistics, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, ICEx, room 4071, Belo Horizonte, Brazil
| | - Lucas Emanuel Ferreira Ramos
- grid.8430.f0000 0001 2181 4888Department of Statistics, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, ICEx, room 4071, Belo Horizonte, Brazil
| | - Rafael Tavares Silva
- grid.8430.f0000 0001 2181 4888Department of Statistics, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, ICEx, room 4071, Belo Horizonte, Brazil
| | | | | | | | | | | | | | | | - Daniela Ponce
- grid.410543.70000 0001 2188 478XFaculdade de Medicina de Botucatu-Universidade Estadual Paulista “Júlio de Mesquita Filho”, Av. Prof. Mário Rubens Guimarães Montenegro, s/n-UNESP-Campus de Botucatu, Botucatu, Brazil
| | | | | | - Fernanda d’Athayde Rodrigues
- grid.414449.80000 0001 0125 3761Hospital de Clínicas de Porto Alegre, R. Ramiro Barcelos, 2350, Porto Alegre, Brazil
| | - Fernando Anschau
- grid.414914.dHospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | | | - Frederico Bartolazzi
- Hospital Santo Antônio, Pç. Dr. Márcio Carvalho Lopes Filho, 501, Curvelo, Brazil
| | - Genna Maira Santos Grizende
- grid.477816.b0000 0004 4692 337XHospital Santa Casa de Misericórdia de Belo Horizonte, Av. Francisco Sales, 1111, Belo Horizonte, Brazil
| | - Helena Carolina Noal
- grid.411239.c0000 0001 2284 6531Universidade Federal de Santa Maria/Hospital Universitário/EBSERH, Av. Roraima, 1000, building 22, Santa Maria, Brazil
| | - Helena Duani
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, room 246, Belo Horizonte, Brazil
| | - Isabela Moraes Gomes
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, room 246, Belo Horizonte, Brazil
| | | | | | | | - Juliana Machado Rugolo
- grid.410543.70000 0001 2188 478XFaculdade de Medicina de Botucatu-Universidade Estadual Paulista “Júlio de Mesquita Filho”, Av. Prof. Mário Rubens Guimarães Montenegro, s/n-UNESP-Campus de Botucatu, Botucatu, Brazil
| | - Joanna d’Arc Lyra Batista
- grid.440565.60000 0004 0491 0431Universidade Federal da Fronteira Sul, Av. Fernando Machado, 108E, Chapecó, Brazil
| | | | - José Miguel Chatkin
- grid.411379.90000 0001 2198 7041Hospital São Lucas PUCRS, Av. Ipiranga, 6690, Porto Alegre, Brazil
| | - Karen Brasil Ruschel
- grid.414871.f0000 0004 0491 7596Hospital Mãe de Deus, R. José de Alencar, 286, Porto Alegre, Brazil
| | | | | | - Luanna Silva Monteiro Menezes
- Hospital Metropolitano Odilon Behrens, R. Formiga, 50, Belo Horizonte, Brazil ,Hospital Luxemburgo, R. Gentios, 1350, Belo Horizonte, Brazil
| | | | - Luciane Kopittke
- grid.414914.dHospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | - Luisa Argolo Assis
- grid.412520.00000 0001 2155 6671Pontifícia Universidade Católica de Minas Gerais, Av. Dom José Gaspar, 500, Belo Horizonte, Brazil
| | - Luiza Margoto Marques
- grid.419130.e0000 0004 0413 0953Faculdade de Ciências Médicas de Minas Gerais, Al. Ezequiel Dias, 275, Belo Horizonte, Brazil
| | - Magda Cesar Raposo
- grid.428481.30000 0001 1516 3599Universidade Federal de São João del-Rei, R. Sebastião Gonçalves Coelho, 400, Divinópolis, Brazil
| | - Maiara Anschau Floriani
- grid.414856.a0000 0004 0398 2134Hospital Moinhos de Vento, R. Ramiro Barcelos, 910, Porto Alegre, Brazil ,Moinhos Research Institute, 910 Ramiro Barcelos Street, 5 floor, Porto Alegre, Brazil
| | - Maria Aparecida Camargos Bicalho
- grid.452464.50000 0000 9270 1314Fundação Hospitalar do Estado de Minas Gerais–FHEMIG, Cidade Administrativa de Minas Gerais, Edifício Gerais, 13rd floor, Rod. Papa João Paulo II, 3777, Belo Horizonte, Brazil
| | | | - Neimy Ramos de Oliveira
- grid.452464.50000 0000 9270 1314Hospital Eduardo de Menezes, R. Dr. Cristiano Rezende, 2213, Belo Horizonte, Brazil
| | | | | | | | - Roberta Senger
- grid.411239.c0000 0001 2284 6531Universidade Federal de Santa Maria/Hospital Universitário/EBSERH, Av. Roraima, 1000, building 22, Santa Maria, Brazil
| | | | | | | | - Tatiana Kurtz
- Hospital Santa Cruz, R. Fernando Abott, 174, Santa Cruz do Sul, Brazil
| | - Tatiani Oliveira Fereguetti
- grid.452464.50000 0000 9270 1314Hospital Eduardo de Menezes, R. Dr. Cristiano Rezende, 2213, Belo Horizonte, Brazil
| | | | | | | | | | - Marcelo Carneiro
- Hospital Santa Cruz, R. Fernando Abott, 174, Santa Cruz do Sul, Brazil
| | | | - Alexandre Vargas Schwarzbold
- grid.411239.c0000 0001 2284 6531Universidade Federal de Santa Maria/Hospital Universitário/EBSERH, Av. Roraima, 1000, building 22, Santa Maria, Brazil
| | | | - Barbara Lopes Farace
- grid.490178.3Hospital Risoleta Tolentino Neves, R. das Gabirobas, 01, Belo Horizonte, Brazil
| | | | | | | | | | - Gisele Alsina Nader Bastos
- grid.414856.a0000 0004 0398 2134Hospital Moinhos de Vento, R. Ramiro Barcelos, 910, Porto Alegre, Brazil
| | | | | | | | | | | | - Leila Beltrami Moreira
- grid.414449.80000 0001 0125 3761Hospital de Clínicas de Porto Alegre, R. Ramiro Barcelos, 2350, Porto Alegre, Brazil
| | | | | | | | - Máderson Alvares de Souza Cabral
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, room 246, Belo Horizonte, Brazil
| | - Maria Angélica Pires Ferreira
- grid.414449.80000 0001 0125 3761Hospital de Clínicas de Porto Alegre, R. Ramiro Barcelos, 2350, Porto Alegre, Brazil
| | - Mariana Frizzo de Godoy
- grid.411379.90000 0001 2198 7041Hospital São Lucas PUCRS, Av. Ipiranga, 6690, Porto Alegre, Brazil
| | | | | | - Mônica Aparecida de Paula de Sordi
- grid.410543.70000 0001 2188 478XFaculdade de Medicina de Botucatu-Universidade Estadual Paulista “Júlio de Mesquita Filho”, Av. Prof. Mário Rubens Guimarães Montenegro, s/n-UNESP-Campus de Botucatu, Botucatu, Brazil
| | | | - Pedro Ledic Assaf
- Hospital Metropolitano Doutor Célio de Castro, R. Dona Luiza, 311, Belo Horizonte, Brazil
| | - Raquel Lutkmeier
- grid.414914.dHospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | | | | | - Rufino de Freitas
- Hospital São João de Deus, R. do Cobre, 800, São João de Deus, Brazil
| | | | | | | | - Marcos André Gonçalves
- grid.8430.f0000 0001 2181 4888Computer Science Department, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
| | - Milena Soriano Marcolino
- Institute for Health Technology Assessment (IATS/ CNPq), R. Ramiro Barcelos, 2359, building 21, room 507, Porto Alegre, Brazil. .,Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, room 246, Belo Horizonte, Brazil. .,Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110 room 107. Santa Efigênia, Belo Horizonte, MG, CEP 30130-100, Brazil.
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2
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Rodrigues-Junior DM, Tan SS, Lim SK, Leong HS, Melendez ME, Ramos CRN, Viana LDS, Tan DSW, Carvalho AL, Iyer NG, Vettore AL. Circulating extracellular vesicle-associated TGFβ3 modulates response to cytotoxic therapy in head and neck squamous cell carcinoma. Carcinogenesis 2020; 40:1452-1461. [PMID: 31436806 DOI: 10.1093/carcin/bgz148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/14/2019] [Accepted: 08/20/2019] [Indexed: 01/28/2023] Open
Abstract
Management of locally advanced head and neck squamous cell carcinoma (HNSCC) requires a multi-prong approach comprising surgery, radiation and/or chemotherapy, yet outcomes are limited. This is largely due to a paucity of biomarkers that can predict response to specific treatment modalities. Here, we evaluated TGFβ3 protein levels in extracellular vesicles (EVs) released by HNSCC cells as a predictor for response to chemoradiation therapy (CRT). To this end, specific EV-fractions were isolated from cell lines or HNSCC patient plasma, and TGFβ3 protein was quantified. In patients treated with CRT, TGFβ3 levels were found to be significantly higher in plasma EV-fractions or non-responders compared with responders. High levels of TGFβ3 levels in Annexin V-EVs were associated with the worst progression-free survival. In vitro experiments demonstrated that TGFβ3 silencing sensitized HNSCC cells to cytotoxic therapies, and this phenotype could be rescued by treatment with exogenous. In addition, specific EV-fractions shed by cisplatin-resistant cells were sufficient to transfer the resistant phenotype to sensitive cells through activation of TGFβ-signaling pathway. Therefore, our data show that TGFβ3 transmitted through EV plays a significant role in response to cytotoxic therapy, which can be exploited as a potential biomarker for CRT response in HNSCC patients treated with curative intent.
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Affiliation(s)
- Dorival Mendes Rodrigues-Junior
- Department of Biological Sciences, Universidade Federal de São Paulo, Diadema, Brazil.,Cancer Therapeutics Research Laboratory, National Cancer Centre of Singapore, Singapore
| | - Soon Sim Tan
- Institute of Medical Biology, A*-STAR, Singapore
| | | | - Hui Sun Leong
- Cancer Therapeutics Research Laboratory, National Cancer Centre of Singapore, Singapore
| | | | | | | | - Daniel S W Tan
- Cancer Therapeutics Research Laboratory, National Cancer Centre of Singapore, Singapore.,Division of Medical Oncology, National Cancer Centre of Singapore, Singapore
| | | | - N Gopalakrishna Iyer
- Cancer Therapeutics Research Laboratory, National Cancer Centre of Singapore, Singapore.,Division of Surgical Oncology, National Cancer Centre of Singapore, Singapore
| | - Andre Luiz Vettore
- Department of Biological Sciences, Universidade Federal de São Paulo, Diadema, Brazil
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3
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De Marchi P, Melendez ME, Laus AC, Kuhlmann PA, de Carvalho AC, Arantes LMRB, Evangelista AF, Andrade ES, de Castro G, Reis RM, Carvalho AL, de Souza Viana L. The role of single-nucleotide polymorphism (SNPs) in toxicity of induction chemotherapy based on cisplatin and paclitaxel in patients with advanced head and neck cancer. Oral Oncol 2019; 98:48-52. [PMID: 31539757 DOI: 10.1016/j.oraloncology.2019.09.013] [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: 08/08/2019] [Accepted: 09/13/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Induction chemotherapy in locally-advanced head and neck squamous cell carcinoma (LAHNSCC) patients is potentially associated to serious adverse events. Biomarkers associated with toxicity could tailor its indication. This study evaluated the association between single-nucleotide polymorphisms (SNPs) in metabolic genes and toxicity to induction chemotherapy. METHODS 59 LAHNSCC phase II clinical trial patients (NCT00959387) were assessed regarding 47 metabolic genes (366 SNPs). Toxicities were graded (CTCAE 3.0) and statistical analysis was performed. RESULTS The SNPs rs8187710 (ABCC2) and rs1801131 (MTHFR) were associated to increased risk of gastrointestinal toxicity, whereas the SNPs rs3788007 (ABCG1) and rs4148943 (CHST3) were associated to decreased risk. Two other SNPs, rs2301159 (SLC10A2) and rs2470890 (CYP1A2), were associated with increased risk of hematological toxicity. Nevertheless, these SNPs did not remain significant after adjusting for multiple comparisons. CONCLUSIONS This study could not demonstrate relationship between SNPs and toxicity to induction chemotherapy in LAHNSCC patients. The small number of patients may have affected the results.
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Affiliation(s)
- Pedro De Marchi
- Department of Medical Oncology, Barretos Cancer Hospital, Barretos, SP, Brazil.
| | - Matias E Melendez
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, SP, Brazil
| | - Ana C Laus
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, SP, Brazil
| | - Pamela A Kuhlmann
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, SP, Brazil
| | | | | | | | - Edilene S Andrade
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, SP, Brazil
| | | | - Rui M Reis
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, SP, Brazil
| | - André Lopes Carvalho
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, SP, Brazil; Department of Head and Neck Surgery, Barretos Cancer Hospital, Barretos, SP, Brazil
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4
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Haddad R, Guigay J, Keilholz U, Clement PM, Fayette J, de Souza Viana L, Rolland F, Cupissol D, Geoffrois L, Kornek G, Licitra L, Melichar B, Ribaldo Nicolau U, Rauch D, Zanetta-Devauges S, Cohen EEW, Machiels JP, Tahara M, Vermorken J, Geng Y, Zografos E, Gauler T. Afatinib as second-line treatment in patients with recurrent/metastatic squamous cell carcinoma of the head and neck: Subgroup analyses of treatment adherence, safety and mode of afatinib administration in the LUX-Head and Neck 1 trial. Oral Oncol 2019; 97:82-91. [PMID: 31450171 DOI: 10.1016/j.oraloncology.2019.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/26/2019] [Accepted: 08/03/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Patients with head and neck squamous cell carcinoma (HNSCC) can experience severe symptom burden and/or difficulty swallowing, leading to problems with treatment adherence/administration. In LUX-Head and Neck 1 (LH&N1; NCT01345682), second-line afatinib improved progression-free survival (PFS) versus methotrexate in patients with recurrent/metastatic HNSCC. We report adherence and safety across pre-specified and additional subgroups potentially linked to afatinib PFS benefit in LH&N1 (p16 status, smoking history), and afatinib adherence, safety and efficacy by administration (oral versus feeding tube; post-hoc analysis). METHODS Patients were randomized (2:1) to afatinib (40 mg/day) or intravenous methotrexate (40 mg/m2/week). RESULTS Among 320 afatinib-treated and 160 methotrexate-treated patients, 83-92% and 76-92% (of patients with data available) across all subgroups took ≥80% of treatment. Across p16 status and smoking history subgroups, the most common treatment-related adverse events (AEs) were diarrhea (70-91%), rash/acne (72-84%), stomatitis (34-73%) with afatinib; and included stomatitis (39-100%), fatigue (22-50%), nausea (19-36%) with methotrexate. Dose reduction decreased AE incidence/severity. Baseline characteristics were generally similar between oral/feeding tube (n = 276/n = 46) groups. 89%/89% (of patients with data available) took ≥80% of assigned afatinib. Median PFS was 2.6 versus 2.7 months (hazard ratio: 0.997; 95% confidence interval: 0.72-1.38). The most common afatinib-related AEs were: rash/acne (74% versus 74%), diarrhea (73% versus 65%), stomatitis (40% versus 30%). CONCLUSION Subgroup analyses of LH&N1 demonstrate that afatinib has predictable and manageable safety across patient subgroups, with high treatment adherence, and is effective via oral and feeding tube administration.
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Affiliation(s)
- Robert Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School and Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Joel Guigay
- Centre Antoine Lacassagne, FHU OncoAge, Université Côte d'Azur, Nice, France
| | - Ulrich Keilholz
- Medical Department, Charité Comprehensive Cancer Center, Berlin, Germany
| | - Paul M Clement
- Department of Oncology, KU Leuven, Leuven Cancer Institute, Leuven, Belgium
| | | | - Luciano de Souza Viana
- Department of Medical Oncology, Hospital de Câncer de Barretos, Barretos, São Paulo, Brazil
| | - Frédéric Rolland
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Didier Cupissol
- Institut du Cancer de Montpellier Val d'Aurelle, Montpellier, France
| | - Lionnel Geoffrois
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | - Gabriela Kornek
- Klinische Abteilung für Onkologie, Universitätsklinik für Innere Medizin, Vienna, Austria
| | - Lisa Licitra
- Department of Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, and University of Milan, Milan, Italy
| | - Bohuslav Melichar
- Department of Oncology, Palacky University Medical School, Olomouc, Czech Republic
| | | | - Daniel Rauch
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | | | - Ezra E W Cohen
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Jean-Pascal Machiels
- Institut Roi Albert II, Service d'Oncologie Médicale, Cliniques Universitaires Saint-Luc and Institut de Recherche Clinique et Expérimentale (Pole MIRO), Université Catholique de Louvain, Brussels, Belgium
| | - Makoto Tahara
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Jan Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium
| | - Yuan Geng
- Boehringer Ingelheim (China) Investment Co., Ltd., Shanghai, China
| | | | - Thomas Gauler
- Department of Medicine, West German Cancer Center, University Hospital Essen of the University Duisburg-Essen, Essen, Germany
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5
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Burtness B, Haddad R, Dinis J, Trigo J, Yokota T, de Souza Viana L, Romanov I, Vermorken J, Bourhis J, Tahara M, Martins Segalla JG, Psyrri A, Vasilevskaya I, Nangia CS, Chaves-Conde M, Kiyota N, Homma A, Holeckova P, Del Campo JM, Asarawala N, Nicolau UR, Rauch D, Even C, Wang B, Gibson N, Ehrnrooth E, Harrington K, Cohen EEW. Afatinib vs Placebo as Adjuvant Therapy After Chemoradiotherapy in Squamous Cell Carcinoma of the Head and Neck: A Randomized Clinical Trial. JAMA Oncol 2019; 5:1170-1180. [PMID: 31194247 DOI: 10.1001/jamaoncol.2019.1146] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Locoregionally advanced head and neck squamous cell cancer (HNSCC) is treated curatively; however, risk of recurrence remains high among some patients. The ERBB family blocker afatinib has shown efficacy in recurrent or metastatic HNSCC. Objective To assess whether afatinib therapy after definitive chemoradiotherapy (CRT) improves disease-free survival (DFS) in patients with HNSCC. Design, Setting, and Participants This multicenter, phase 3, double-blind randomized clinical trial (LUX-Head & Neck 2) studied 617 patients from November 2, 2011, to July 4, 2016. Patients who had complete response after CRT, comprising radiotherapy with cisplatin or carboplatin, with or without resection of residual disease, for locoregionally advanced high- or intermediate-risk HNSCC of the oral cavity, hypopharynx, larynx, or oropharynx were included in the study. Data analysis was of the intention-to-treat population. Interventions Patients were randomized (2:1) to treatment with afatinib (40 mg/d) or placebo, stratified by nodal status (N0-2a or N2b-3) and Eastern Cooperative Oncology Group performance status (0 or 1). Treatment continued for 18 months or until disease recurrence, unacceptable adverse events, or patient withdrawal. Main Outcomes and Measures The primary end point was DFS, defined as time from the date of randomization to the date of tumor recurrence or secondary primary tumor or death from any cause. Secondary end points were DFS at 2 years, overall survival (defined as time from the date of randomization to death), and health-related quality of life. Results A total of 617 patients were studied (mean [SD] age, 58 [8.4] years; 528 male [85.6%]). Recruitment was stopped after a preplanned interim futility analysis on July 4, 2016, on recommendation from an independent data monitoring committee. Treatment was discontinued. Median DFS was 43.4 months (95% CI, 37.4 months to not estimable) in the afatinib group and not estimable (95% CI, 40.1 months to not estimable) in the placebo group (hazard ratio, 1.13; 95% CI, 0.81-1.57; stratified log-rank test P = .48). The most common grade 3 and 4 drug-related adverse effects were acneiform rash (61 [14.8%] of 411 patients in the afatinib group vs 1 [0.5%] of 206 patients in the placebo group), stomatitis (55 [13.4%] in the afatinib group vs 1 [0.5%] in the placebo group), and diarrhea (32 [7.8%] in the afatinib group vs 1 [0.5%] in the placebo group). Conclusions and Relevance This study's findings indicate that treatment with afatinib after CRT did not improve DFS and was associated with more adverse events than placebo in patients with primary, unresected, clinically high- to intermediate-risk HNSCC. The use of adjuvant afatinib after CRT is not recommended. Trial Registration ClinicalTrials.gov identifier: NCT01345669.
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Affiliation(s)
- Barbara Burtness
- Department of Medicine and Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Robert Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - José Dinis
- Instituto Português de Oncologia, Porto, Portugal
| | - José Trigo
- Department of Medical Oncology, Hospital Virgen de la Victoria, IBIMA, Malaga, Spain
| | - Tomoya Yokota
- Division of Gastrointestinal Oncology, Shizuoka Cancer Centre, Shizuoka, Japan
| | | | - Ilya Romanov
- Russian Oncological Research Centre, Moscow, Russia
| | - Jan Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium
| | - Jean Bourhis
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Makoto Tahara
- Department of Head and Neck Medical Oncology, National Cancer Centre Hospital East, Kashiwa, Japan
| | | | - Amanda Psyrri
- Department of Internal Medicine, National Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | | | | | | | - Naomi Kiyota
- Department of Medical Oncology and Hematology, Kobe University Hospital Cancer Center, Kobe, Japan
| | - Akihiro Homma
- Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Petra Holeckova
- Department of Oncology and Radiotherapy, Hospital Na Bulovce and 1st Medical Faculty of Charles University, Prague, Czech Republic
| | | | - Nirav Asarawala
- Shree Krishna Hospital and Medical Research Centre, Gujarat, India
| | | | - Daniel Rauch
- Inselspital, University Hospital Bern, Bern, Switzerland
| | - Caroline Even
- Department of Head and Neck Cancer, Gustave Roussy, Villejuif, France
| | - Bushi Wang
- Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut
| | - Neil Gibson
- Boehringer Ingelheim Pharma GmbH & Co KG, Biberach, Germany
| | | | - Kevin Harrington
- Division of Radiotherapy and Imaging, The Royal Marsden Hospital/The Institute of Cancer Research, National Institute for Health Research Biomedical Research Centre, London, United Kingdom
| | - Ezra E W Cohen
- Department of Translational Science, Moores Cancer Centre, University of California at San Diego, La Jolla
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6
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Rodrigues-Junior DM, Tan SS, de Souza Viana L, Carvalho AL, Lim SK, Iyer NG, Vettore AL. A preliminary investigation of circulating extracellular vesicles and biomarker discovery associated with treatment response in head and neck squamous cell carcinoma. BMC Cancer 2019; 19:373. [PMID: 31014274 PMCID: PMC6480898 DOI: 10.1186/s12885-019-5565-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 03/31/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is a paucity of plasma-based biomarkers that prospectively segregate the outcome of patients with head and neck squamous-cell carcinoma (HNSCC) treated with chemoradiation therapy (CRT). Plasma extracellular vesicles (EVs) might be an alternative source for discovery of new specific markers present in patients with HNSCC, which could help to re-direct patients to appropriate curative therapies without delay. METHODS In order to identify new markers in plasma compartments, Cholerae toxin B chain (CTB) and Annexin V (AV) were used to isolate EVs from pooled plasma samples from patients with locally advanced HNSCC who responded (CR, n = 6) or presented incomplete response (NR, n = 6) to CRT. The crude plasma and EVs cargo were screened by antibody array. RESULTS Of the 370 polypeptides detected, 119 proteins were specific to NR patients while 38 were exclusive of the CR subjects. The Gene Set Enrichment Analysis (GSEA) and Search Tool for the Retrieval of Interacting Genes (STRING) database analysis indicated that the content of circulating plasma EVs might have a relevant function for the tumor intercellular communication in the HNSCC patients. CONCLUSION This study provides a list of potential markers present in plasma compartments that might contribute to the development of tools for prediction and assessment of CRT response and potentially guide therapeutic decisions in this context.
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Affiliation(s)
- Dorival Mendes Rodrigues-Junior
- Department of Biological Science, Laboratório de Biologia Molecular do Câncer, UNIFESP, Universidade Federal de São Paulo, Rua Pedro de Toledo, 669 - 11° andar, São Paulo, SP, 04039-032, Brazil.,Cancer Therapeutics Research Laboratory, National Cancer Centre of Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Soon Sim Tan
- Institute of Medical Biology, A*-STAR, Singapore, Singapore
| | | | - Andre Lopes Carvalho
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, SP, Brazil
| | - Sai Kiang Lim
- Institute of Medical Biology, A*-STAR, Singapore, Singapore
| | - N Gopalakrishna Iyer
- Cancer Therapeutics Research Laboratory, National Cancer Centre of Singapore, 11 Hospital Drive, Singapore, 169610, Singapore. .,Division of Surgical Oncology, National Cancer Centre of Singapore, Singapore, Singapore.
| | - Andre Luiz Vettore
- Department of Biological Science, Laboratório de Biologia Molecular do Câncer, UNIFESP, Universidade Federal de São Paulo, Rua Pedro de Toledo, 669 - 11° andar, São Paulo, SP, 04039-032, Brazil.
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7
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Rodrigues-Junior DM, Tan SS, Lim SK, de Souza Viana L, Carvalho AL, Vettore AL, Iyer NG. High expression of MLANA in the plasma of patients with head and neck squamous cell carcinoma as a predictor of tumor progression. Head Neck 2019; 41:1199-1205. [PMID: 30803092 DOI: 10.1002/hed.25510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 10/08/2017] [Revised: 05/04/2018] [Accepted: 08/15/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND There is a paucity of plasma-based biomarkers that predict outcome in patients with head and neck squamous cell carcinoma (HNSCC) treated with chemoradiation therapy (CRT). Here, we evaluate the prognostic potential of plasma Melanoma-Antigen Recognized by T-cells 1 (MLANA) in this setting. METHODS MLANA expression in HNSCC lines were evaluated by reverse transcription polymerase chain reaction, whereas plasma levels were quantified using ELISA in 48 patients with locally advanced HNSCC undergoing a phase 2 trial with CRT. RESULTS MLANA is expressed at variable levels in a panel of HNSCC lines. In plasma, levels were elevated in patients with tumor relapse compared to those without (P < .004); 73.9% of the patients expressing high plasma MLANA levels progressed with recurrent disease (P = .020). Multivariate analysis showed that plasma MLANA levels and tumor resectability were independent prognostic factors for progression free survival. CONCLUSION Plasma MLANA expression appears to be an effective noninvasive biomarker for outcomes in patients treated with CRT, and could potentially guide therapeutic decisions in this context.
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Affiliation(s)
- Dorival Mendes Rodrigues-Junior
- Biological Science Department, Campus Diadema, Universidade Federal de São Paulo, Diadema, São Paulo, Brazil.,Cancer Therapeutics Research Laboratory, National Cancer Centre, Singapore
| | | | | | - Luciano de Souza Viana
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Andre Lopes Carvalho
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Andre Luiz Vettore
- Biological Science Department, Campus Diadema, Universidade Federal de São Paulo, Diadema, São Paulo, Brazil
| | - N Gopalakrishna Iyer
- Cancer Therapeutics Research Laboratory, National Cancer Centre, Singapore.,Division of Surgical Oncology, National Cancer Centre, Singapore
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8
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Laus AC, de Paula FE, de Lima MA, Carlos CD, Gomes INF, de Marchi P, Valente JKN, Pioltini ABM, Miziara JE, da Silva CM, Viana LDS, Scapulatempo-Neto C, Reis RM. EGF+61 A>G polymorphism is not associated with lung cancer risk in the Brazilian population. Mol Biol Rep 2019; 46:2417-2425. [PMID: 30783937 DOI: 10.1007/s11033-019-04702-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/27/2018] [Accepted: 02/12/2019] [Indexed: 01/22/2023]
Abstract
Epidermal growth factor (EGF) and its receptor (EGFR) play an important role in lung carcinogenesis. A functional single nucleotide polymorphism (SNP) in EGF promoter region (EGF+61 A>G-rs4444903) has been associated with cancer susceptibility. Yet, in lung cancer, the EGF+61 A>G role is unclear. The aim of this study was to evaluate the risk of lung cancer associated with EGF+61 A>G SNP in the Brazilian population. For that, 669 lung cancer patients and 1104 controls were analyzed. EGF+61 A>G genotype was assessed by PCR-RFLP and TaqMan genotyping assay. Both patients and controls were in Hardy-Weinberg equilibrium. As expected, uni- and multivariate analyses showed that tobacco consumption and age were significant risk factors for lung cancer. The genotype frequencies in lung cancer patients were 27.3% of AA, 47.4% of AG and 25.3% of GG, and for controls were 25.3% of AA, 51.6% of AG and 23.1% of GG. The allele frequencies were 51.1% of A and 48.9% of G for both cases and controls. No significant differences for the three genotypes (AA, AG and GG-codominant model) were observed between cases and controls. We then grouped AG and GG (recessive model) genotypes, as well as AA and AG (dominant model), and again, no significant differences were also found. This is the largest study to explore EGF+61 A>G polymorphism association with lung cancer risk and suggests that this SNP is not a risk factor for lung cancer in the Brazilian population.
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Affiliation(s)
- Ana Carolina Laus
- Molecular Oncology Research Center, Barretos Cancer Hospital, Antenor Duarte Villela St, 1331, Barretos, SP, 14784-400, Brazil
| | - Flavia Escremim de Paula
- Molecular Oncology Research Center, Barretos Cancer Hospital, Antenor Duarte Villela St, 1331, Barretos, SP, 14784-400, Brazil
| | - Marcos Alves de Lima
- Epidemiology and Biostatistics Department, Barretos Cancer Hospital, Barretos, Brazil
| | - Carolina Dias Carlos
- Molecular Oncology Research Center, Barretos Cancer Hospital, Antenor Duarte Villela St, 1331, Barretos, SP, 14784-400, Brazil
| | - Izabela Natalia Faria Gomes
- Molecular Oncology Research Center, Barretos Cancer Hospital, Antenor Duarte Villela St, 1331, Barretos, SP, 14784-400, Brazil
| | - Pedro de Marchi
- Medical Oncology Department, Barretos Cancer Hospital, Barretos, Brazil
| | | | | | | | | | | | | | - Rui Manuel Reis
- Molecular Oncology Research Center, Barretos Cancer Hospital, Antenor Duarte Villela St, 1331, Barretos, SP, 14784-400, Brazil. .,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal. .,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
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9
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Portas J, Corrêa D, Queija D, Arantes LMRB, Viana LDS, Carvalho AL. Effect of Induction Chemotherapy on Swallowing in Head and Neck Cancer Patients. Asian Pac J Cancer Prev 2019; 20:91-96. [PMID: 30678386 PMCID: PMC6485558 DOI: 10.31557/apjcp.2019.20.1.91] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To evaluate the effect of induction chemotherapy on swallowing and swallowing-related quality of life of patients with oropharyngeal, laryngeal and hypopharyngeal cancer. Study design: Prospective study of 33 patients with locally advanced tumors who were eligible for treatment with neoadjuvant chemotherapy followed by radiotherapy and concurrent chemotherapy. A multidimensional assessment of swallowing was performed using the following tools: (1) Clinical analysis, numerical scale for general pain and painful swallowing, American Speech and Hearing Association (ASHA) Functional Communication Measures (FCM) swallowing assessment scales, (2) assessment of Swallowing-Related Quality of Life (The MD Anderson Dysphagia Inventory - MDADI), and (3) swallowing videofluoroscopy. Results: There was a reduction in general pain scale (p=0.021), and quality of life (emotional, functional and physical) improved from average limitation (score of 61-80) to minimal limitation (81-100) after induction chemotherapy. According to the swallowing videofluoroscopy results, 26 (78.7%) of the patients had some degree of dysphagia pre-treatment, which decreased to 21 (63.6%) after induction. Conclusion: Our results suggest that induction chemotherapy improves numerous aspects of swallowing and has a positive impact on the quality of life of pre-chemoradiotherapy patients.
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Affiliation(s)
- Juliana Portas
- SLP Head and Neck Department, Barretos Cancer Hospital, Barretos-SP, Brazil.
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10
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Jacinto AA, Batalha Filho ES, Viana LDS, De Marchi P, Capuzzo RDC, Gama RR, Boldrini Junior D, Santos CR, Pinto GDJ, Dias JM, Canton HP, Carvalho R, Radicchi LA, Bentzen S, Zubizarreta E, Carvalho AL. Feasibility of concomitant cisplatin with hypofractionated radiotherapy for locally advanced head and neck squamous cell carcinoma. BMC Cancer 2018; 18:1026. [PMID: 30352576 PMCID: PMC6199702 DOI: 10.1186/s12885-018-4893-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 10/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background The evolution of radiotherapy over recent decades has reintroduced the hypofractionation for many tumor sites with similar outcomes to those of conventional fractionated radiotherapy. The use of hypofractionation in locally advanced head and neck cancer (LAHNC) has been already used, however, its use has been restricted to only a few countries. The aim of this trial was to evaluate the safety and feasibility of moderate hypofractionated radiotherapy (HYP-RT) with concomitant cisplatin (CDDP). Methods This single-arm trial was designed to evaluate the safety and feasibility of HYP-RT with concomitant CDDP in LAHNC. Stage III and IV patients withnonmetastatic disease were enrolled. Patients were submitted to intensity modulatedradiation therapy, which comprised 55 Gy/20 fractions to the gross tumor and44–48 Gy/20 fractions to the areas of subclinical disease. Concomitant CDDPconsisted of 4 weekly cycles of 35 mg/m2. The primary endpoints were the treatment completion rate and acute toxicity. Results Twenty patients were enrolled from January 2015 to September 2016, and 12 (60%) were classified as unresectable. All patients completed the total dose of radiotherapy, and 19 patients (95%) received at least 3 of 4 cycles of chemotherapy. The median overall treatment time was 29 days (27–34). Grade 4 toxicity was reported twice (1 fatigue and 1 lymphopenia). The rates of grade 3 dermatitis and mucositis were 30% and 40%, respectively, with spontaneous resolution. Nasogastric tubes were offered to 15 patients (75%) during treatment; 4 patients (20%) needed feeding tubes after 2 months, and only 1 patient needed a feeding tube after 12 months. Conclusion HYP-RT with concomitant CDDP was considered feasible for LAHNC, and the rate of acute toxicity was comparable to that of standard concomitant chemoradiation. A feeding tube was necessary for most patients during treatment. Further investigation of this strategy is warranted. Trial registration ClinicalTrials, NCT03194061. Registered 21 Jun 2017 – Retrospectively registered.
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Affiliation(s)
- Alexandre Arthur Jacinto
- Department of Radiation Oncology, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331, Barretos, SP, 14.784-400, Brazil.
| | | | - Luciano de Souza Viana
- Department of Medical Oncology, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331, Barretos, SP, 14.784-400, Brazil
| | - Pedro De Marchi
- Department of Medical Oncology, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331, Barretos, SP, 14.784-400, Brazil
| | - Renato de Castro Capuzzo
- Department of Head and Neck, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331, Barretos, SP, 14.784-400, Brazil
| | - Ricardo Ribeiro Gama
- Department of Head and Neck, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331, Barretos, SP, 14.784-400, Brazil
| | - Domingos Boldrini Junior
- Department of Head and Neck, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331, Barretos, SP, 14.784-400, Brazil
| | - Carlos Roberto Santos
- Department of Head and Neck, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331, Barretos, SP, 14.784-400, Brazil
| | - Gustavo Dix Junqueira Pinto
- Department of Medical Oncology, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331, Barretos, SP, 14.784-400, Brazil
| | - Josiane Mourão Dias
- Department of Medical Oncology, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331, Barretos, SP, 14.784-400, Brazil
| | - Heloisa Pelisser Canton
- Department of Radiation Oncology, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331, Barretos, SP, 14.784-400, Brazil
| | - Raiany Carvalho
- Department of Head and Neck, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331, Barretos, SP, 14.784-400, Brazil
| | - Lucas Augusto Radicchi
- Department of Radiation Oncology, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331, Barretos, SP, 14.784-400, Brazil
| | - Soren Bentzen
- University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, USA
| | - Eduardo Zubizarreta
- International Atomic of Energy Agency - Vienna International Centre, PO Box 100, A-1400, Vienna, Austria
| | - Andre Lopes Carvalho
- Department of Head and Neck, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331, Barretos, SP, 14.784-400, Brazil
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11
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Laus AC, Paula FED, Lima MAD, Carlos CD, Gomes INF, Marchi PRMD, Viana LDS, Reis RMV. Abstract A78: EGF+61 A>G polymorphism is not associated with lung cancer risk in Brazilian population. Clin Cancer Res 2018. [DOI: 10.1158/1557-3265.tcm17-a78] [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
Lung cancer is a malignancy with high incidence and mortality, being in Brazil the second most common cancer in men and the fourth in women. Epidermal growth factor (EGF) and its receptor (EGFR) play a central role in lung carcinogenesis, once EGF/EGFR interaction activates several intracellular pathways that control cellular growth, proliferation, differentiation, migration, and apoptosis. The association has been described between a single nucleotide polymorphism (SNP) in EGF promoter region (EGF+61 A>G – rs4444903) and cancer susceptibility to distinct tumors, including melanoma, gliomas, gastric cancer, hepatocellular carcinoma, and others. In lung cancer, the results are still scarce and unclear, with different reports showing discrepant results. Therefore, the aim of this study is to evaluate the risk of lung cancer development associated with the EGF+61 A>G SNP in a Brazilian population. For that, 437 lung cancer patients and 1104 controls were included in this study. Following DNA isolation from both tumor (FFPE) and controls (blood), the EGF+61 A>G genotype was assessed by polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP), and TaqMan Genotyping Assay, respectively. Statistical analysis included chi-square and Mann-Whitney tests, and logistic regression model to estimate Odds Ratios. As expected, uni- and multivariate analyses showed that tobacco consumption (p<0.001; OR=4.6; 95% CI 3.53-6.2 for smokers and p<0.001; OR 1.9; 95% CI 1.48-2.56 for ex-smokers) and age (p<0.001; OR=1.03; 95% CI 1.02-1.04 per year) were important risk factors for lung cancer. The genotype frequencies observed in lung cancer patients were 27.9% of AA, 45.1% of AG, and 20% of GG, and for controls were 25.3% of AA, 51.6% of AG, and 23.1% of GG. The allele frequencies were 51% of A and 49% of G in patients, and 50% of each allele in controls. Hardy-Weinberg equilibrium was estimated among patients and controls and no deviation was found in control group. However, patient's group revealed a p=0.039. No significant differences for the three genotypes (AA, AG, and GG) were observed between cases and controls (p=0.064; AG genotype: OR=0.79; 95% CI 0.605-1.033 and GG genotype: OR=1.05; 95% CI 0.78-1.43). We further grouped AG and GG genotypes and compared with the AA genotype, and also did not found significant differences (p=0.3; OR=0.87; 95% CI 0.681-1.120). Moreover, overall survival was calculated for patients considering AG/GG versus AA genotypes, and no significant differences were observed (p=0.21). In conclusion, the present study suggests that EGF+61 A>G polymorphism is not a risk factor for lung cancer in the Brazilian population.
Citation Format: Ana Carolina Laus, Flavia Escremim de Paula, Marcos Alves de Lima, Carolina Dias Carlos, Izabela Natalia Faria Gomes, Pedro Rafael Martins de Marchi, Luciano de Souza Viana, Rui Manuel Vieira Reis. EGF+61 A>G polymorphism is not associated with lung cancer risk in Brazilian population [abstract]. In: Proceedings of the AACR International Conference held in cooperation with the Latin American Cooperative Oncology Group (LACOG) on Translational Cancer Medicine; May 4-6, 2017; São Paulo, Brazil. Philadelphia (PA): AACR; Clin Cancer Res 2018;24(1_Suppl):Abstract nr A78.
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12
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Araujo LH, Baldotto C, Castro GD, Katz A, Ferreira CG, Mathias C, Mascarenhas E, Lopes GDL, Carvalho H, Tabacof J, Martínez-Mesa J, Viana LDS, Cruz MDS, Zukin M, Marchi PD, Terra RM, Ribeiro RA, Lima VCCD, Werutsky G, Barrios CH. Lung cancer in Brazil. J Bras Pneumol 2018; 44:55-64. [PMID: 29538545 PMCID: PMC6104542 DOI: 10.1590/s1806-37562017000000135] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [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: 04/27/2017] [Accepted: 07/10/2017] [Indexed: 11/22/2022] Open
Abstract
Lung cancer is one of the most incident types of cancer and a leading cause of cancer mortality in Brazil. We reviewed the current status of lung cancer by searching relevant data on prevention, diagnosis, and treatment in the country. This review highlights several issues that need to be addressed, including smoking control, patient lack of awareness, late diagnosis, and disparities in the access to cancer health care facilities in Brazil. We propose strategies to help overcome these limitations and challenge health care providers, as well as the society and governmental representatives, to work together and to take a step forward in fighting lung cancer.
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Affiliation(s)
- Luiz Henrique Araujo
- . Instituto Nacional de Câncer José Alencar Gomes da Silva - INCA - Rio de Janeiro (RJ) Brasil
- . Instituto COI de Educação e Pesquisa, Rio de Janeiro (RJ) Brasil
| | - Clarissa Baldotto
- . Instituto Nacional de Câncer José Alencar Gomes da Silva - INCA - Rio de Janeiro (RJ) Brasil
- . Instituto COI de Educação e Pesquisa, Rio de Janeiro (RJ) Brasil
| | - Gilberto de Castro
- . Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira - Icesp - São Paulo (SP) Brasil
- . Centro de Oncologia, Hospital Sírio-Libanês, São Paulo (SP) Brasil
| | - Artur Katz
- . Centro de Oncologia, Hospital Sírio-Libanês, São Paulo (SP) Brasil
| | - Carlos Gil Ferreira
- . Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro (RJ) Brasil
- . Fundação do Câncer, Rio de Janeiro (RJ) Brasil
| | | | | | | | - Heloisa Carvalho
- . Centro de Oncologia, Hospital Sírio-Libanês, São Paulo (SP) Brasil
- . Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | | | | | | | - Mauro Zukin
- . Instituto Nacional de Câncer José Alencar Gomes da Silva - INCA - Rio de Janeiro (RJ) Brasil
- . Instituto COI de Educação e Pesquisa, Rio de Janeiro (RJ) Brasil
| | | | - Ricardo Mingarini Terra
- . Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira - Icesp - São Paulo (SP) Brasil
| | | | | | - Gustavo Werutsky
- . Latin American Cooperative Oncology Group - LACOG - Porto Alegre (RS) Brasil
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Silva-Oliveira RJ, Melendez M, Martinho O, Zanon MF, Viana LDS, Carvalho AL, Reis RM. Abstract 4091: AKT can modulate the in vitro response of HNSCC cell to irreversible EGFR inhibitors. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-4091] [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: 11/16/2022]
Abstract
Abstract
Epidermal growth factor receptor (EGFR) is overexpressed in up to 90% of head and neck squamous cell carcinoma (HNSCC) tumors. Cetuximab is the first targeted (anti-EGFR) therapy approved for the treatment of patients with locally advanced HNSCC. However, its efficacy is limited due to primary and secondary resistance, and there is no predict biomarkers of response. New generation of EGFR inhibitors with pan HER targeting and irreversible action, such as afatinib and allitinib represents a significant therapeutic promise in HNSCC treatment. In this study, we intend to compare the potential cytotoxicity of two irreversible anti-EGFR inhibitors (afatinib and allitinib) with cetuximab and to identify potential predictive biomarkers of response in a panel of HNSCC cell lines. The mutational analysis in hotspot regions of EGFR, KRAS, NRAS, PIK3CA and PTEN in the eight HNSCC cell lines revealed an EGFR mutation (p.H773Y) and gene amplification in the HN13 cells, and KRAS mutation in the JHU-28 cell line. According to the growth inhibition score (GI), allitinib was the most cytotoxic drug, followed by afatinib and finally cetuximab. The HN13 cell line exhibited a less responsive behavior to all drugs assessed, and interestingly, also displayed the higher levels of AKT phosphorylation. Therefore, we further performed drug combinations and found that with anti-AKT agent (MK2206), afatinib and allitinib, but not cetuximab, sensitivity was restored. Additionally, AKT1gene editing in afatinib and allitinib-treated cell lines showed that AKT1 silencing-induced cell line decreased viability and increased cytotoxicity through caspases 3/7activation.Additionally, in silico analysis of TCGA database showed that AKT1 overexpression was present in 14.7% (41/279) of HNSCC cases, and was associated with perineural invasion in advanced stage. In conclusion, allitinib presented a greater cytotoxic profile when compared to afatinib and cetuximab, and the AKT pathway constitutes a predictive marker of allitinib response. Importantly, in allitinib and afatinib-resistant cases, the pharmacological combination with AKT inhibitors could restore response and increase treatment success.
Citation Format: Renato José Silva-Oliveira, Matias Melendez, Olga Martinho, Maicon Fernando Zanon, Luciano de Souza Viana, André Lopes Carvalho, Rui Manuel Reis. AKT can modulate the in vitro response of HNSCC cell to irreversible EGFR inhibitors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4091. doi:10.1158/1538-7445.AM2017-4091
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Affiliation(s)
| | | | - Olga Martinho
- 2Life and Health Sciences Research Institute, Braga, Portugal
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14
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Oliveira-Silva RJ, Carolina de Carvalho A, de Souza Viana L, Carvalho AL, Reis RM. Anti-EGFR Therapy: Strategies in Head and Neck Squamous Cell Carcinoma. Recent Pat Anticancer Drug Discov 2017; 11:170-83. [PMID: 26955963 DOI: 10.2174/1574892811666160309121238] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 03/06/2016] [Accepted: 03/06/2016] [Indexed: 11/22/2022]
Abstract
Epidermal growth factor receptor (EGFR) is a tyrosine kinase receptor that activates downstream signaling pathways, including the Ras-MEK-Erk and PI3K-AKT pathways, leading to cell proliferation, resistance to apoptosis, angiogenesis and the ability to metastasize. EGFR overexpression is a significant finding in cancer, particularly in head and neck cancer, where it is also associated with a poor prognosis. In recent years, several molecules have been designed to inhibit EGFR activation. Among the many available anti-EGFR drugs, only cetuximab was approved for the treatment of head and neck cancers. However, no predictive biomarkers of cetuximab response are currently known. In the present review, we provide an updated assessment of EGFR biology and its clinical impact in head and neck cancers. A special emphasis is placed on novel patents of EGFR-inhibitors that are anticipated to diversify the anti-EGFR therapies available to treat head and neck cancers. In particular, we outline a new class of irreversible multi-target inhibitors (e.g. afatinib, icotinib, CUDC-101), which may significantly contribute to new head and neck cancer therapies.
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Affiliation(s)
| | | | | | - André L Carvalho
- Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331, CEP 14784 400, Barretos, S. Paulo, Brazil.
| | - Rui M Reis
- Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331, CEP 14784 400, Barretos, S. Paulo, Brazil.
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Silva-Oliveira RJ, Silva VAO, Martinho O, Cruvinel-Carloni A, Melendez ME, Rosa MN, de Paula FE, de Souza Viana L, Carvalho AL, Reis RM. Cytotoxicity of allitinib, an irreversible anti-EGFR agent, in a large panel of human cancer-derived cell lines: KRAS mutation status as a predictive biomarker. Cell Oncol (Dordr) 2016; 39:253-63. [DOI: 10.1007/s13402-016-0270-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2016] [Indexed: 12/27/2022] Open
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Linhares MM, Affonso RJ, Viana LDS, Silva SRM, Denadai MVA, de Toledo SRC, Matos D. Genetic and Immunohistochemical Expression of Integrins ITGAV, ITGA6, and ITGA3 As Prognostic Factor for Colorectal Cancer: Models for Global and Disease-Free Survival. PLoS One 2015; 10:e0144333. [PMID: 26674523 PMCID: PMC4682960 DOI: 10.1371/journal.pone.0144333] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 08/26/2015] [Accepted: 10/16/2015] [Indexed: 12/22/2022] Open
Abstract
Objective To evaluate the relationship between the expression profiles of 84 extracellular matrix (ECM) genes and the prognosis of patients with colorectal cancer (CRC). Methods This retrospective study included 114 patients with stage I–IV CRC who underwent primary tumour resection. Quantitative real-time PCR and immunohistochemistry assays were conducted using primary tumour samples. Kaplan-Meier survival curves were also generated to identify differences in global survival (GS) and disease-free survival (DFS) for the hypo- or hyperexpression status of each marker. The log-rank test was used to verify whether the differences were significant. Stepwise Cox regression models were also used to identify the risk factors associated with GS and DFS in a multivariate mode, and then were used to score the risk of death associated with each marker, either independently or in association. Results In the univariate analyses, significant differences in GS in relation to the expression profiles of ITGAV (p = 0.001), ITGA3 (p = 0.002), ITGA6 (p = 0.001), SPARC (p = 0.036), MMP9 (p = 0.034), and MMP16 (p = 0.038) were observed. For DFS, significant differences were observed in associated with ITGAV (p = 0.004) and ITGA3 (p = 0.001). However, only the ITGAV and ITGA6 gene markers for GS (hazard ratio (HR) = 3.209, 95% confidence interval (CI) = 1.412–7.293, p = 0.005 and HR = 3.105, 95% CI = 1.367–7.055, p = 0.007, respectively), and ITGA3 for DFS (HR = 3.806, 95% CI = 1.573–9.209, p = 0.003), remained in the final Cox regression models. A scoring system was developed to evaluate the risk of patient death based on the number of markers for the components of the final GS model. Scores of 0, 1, or 2 were associated with the following mean survival rates [CI]: 47.162 [44.613–49.711], 39.717 [35.471–43.964], 30.197 [24.030–36.327], respectively. Conclusions Multivariate mathematical models demonstrated an association between hyperexpression of the ITGAV and ITGA6 integrins and GS, and also between the ITGA3 integrin and DFS, in patients with colorectal tumours. A risk scoring system based on detected hyperexpression of 0, 1, or 2 markers (e.g., ITGAV and/or ITGA6) was also found to accurately correlate with the GS curves generated for the present cohort.
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Affiliation(s)
- Marcelo Moura Linhares
- Postgraduate Program in Interdisciplinary Surgery Science, Federal University of São Paulo UNIFESP-Escola Paulista de Medicina, São Paulo, Brazil
- * E-mail:
| | - Renato José Affonso
- Postgraduate Program in Interdisciplinary Surgery Science, Federal University of São Paulo UNIFESP-Escola Paulista de Medicina, São Paulo, Brazil
- Hospital de Cancer de Barretos-Fundação Pio XII, Barretos, Brazil
| | - Luciano de Souza Viana
- Postgraduate Program in Interdisciplinary Surgery Science, Federal University of São Paulo UNIFESP-Escola Paulista de Medicina, São Paulo, Brazil
- Hospital de Cancer de Barretos-Fundação Pio XII, Barretos, Brazil
| | - Sandra Regina Morini Silva
- Postgraduate Program in Interdisciplinary Surgery Science, Federal University of São Paulo UNIFESP-Escola Paulista de Medicina, São Paulo, Brazil
- Hospital de Cancer de Barretos-Fundação Pio XII, Barretos, Brazil
| | - Marcos Vinicius Araujo Denadai
- Postgraduate Program in Interdisciplinary Surgery Science, Federal University of São Paulo UNIFESP-Escola Paulista de Medicina, São Paulo, Brazil
- Hospital de Cancer de Barretos-Fundação Pio XII, Barretos, Brazil
| | | | - Delcio Matos
- Postgraduate Program in Interdisciplinary Surgery Science, Federal University of São Paulo UNIFESP-Escola Paulista de Medicina, São Paulo, Brazil
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de Souza Viana L, de Aguiar Silva FC, Andrade Dos Anjos Jacome A, Calheiros Campelo Maia D, Duarte de Mattos M, Arthur Jacinto A, Elias Mamere A, Boldrini Junior D, de Castro Capuzzo R, Roberto Santos C, Lopes Carvalho A. Efficacy and safety of a cisplatin and paclitaxel induction regimen followed by chemoradiotherapy for patients with locally advanced head and neck squamous cell carcinoma. Head Neck 2015; 38 Suppl 1:E970-80. [PMID: 26031625 DOI: 10.1002/hed.24137] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 03/14/2015] [Accepted: 05/21/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The purpose of this phase II trial was to evaluate the tolerability, safety, and efficacy of a non-5-fluorouracil (5-FU)-based induction chemotherapy followed by chemoradiotherapy (CRT) for patients with locally advanced head and neck squamous cell carcinoma (HNSCC). METHODS Sixty patients with stage III to IV HNSCC were treated with induction paclitaxel and cisplatin (TP; paclitaxel 175 mg/m(2) and cisplatin 80 mg/m(2) , 3 cycles) followed by CRT (cisplatin 100 mg/m(2) ; D1, 22, and 43 of radiotherapy). RESULTS Fifty-six patients (93.3%) completed 3 cycles of induction TP (no treatment-related deaths), 52 (86.7%) completed definitive CRT per protocol (adverse event [AE] grade ≥2 in 53.3%). The overall response rate after induction TP was 82.5% for patients with resectable disease and 55.5% for unresectable disease (p = .023), and complete response (CR) rate after CRT was 70.0% for patients with resectable disease and 30.0% for unresectable disease (p = .005). CONCLUSION Induction TP followed by cisplatin based-CRT was well-tolerated, safe, and had high overall response rate in selected patients with locally advanced HNSCC. © 2015 Wiley Periodicals, Inc. Head Neck 38: E970-E980, 2016.
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Affiliation(s)
| | | | | | | | | | | | - Augusto Elias Mamere
- Department of Radiotherapy, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | | | | | - Carlos Roberto Santos
- Department of Head and Neck Surgery, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Andre Lopes Carvalho
- Department of Head and Neck Surgery, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
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Viana LDS, Affonso RJ, Silva SRM, Denadai MVA, Matos D, Salinas de Souza C, Waisberg J. Relationship between the Expression of the Extracellular Matrix Genes SPARC, SPP1, FN1, ITGA5 and ITGAV and Clinicopathological Parameters of Tumor Progression and Colorectal Cancer Dissemination. Oncology 2013; 84:81-91. [DOI: 10.1159/000343436] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 09/11/2012] [Indexed: 12/22/2022]
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Andrade e Silva UVD, Viana LDS, Oliveira e Castro PDTD, Almeida RDS, Silva RSPD. Sepse fatal após instilação intravesical de BCG: relato de caso. Rev Bras Ter Intensiva 2011. [DOI: 10.1590/s0103-507x2011000100016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Andrade E Silva UVD, Viana LDS, Oliveira E Castro PDTD, Almeida RDS, Silva RSPD. Fatal sepsis after intravesical instillation of BCG: case report. Rev Bras Ter Intensiva 2011; 23:104-107. [PMID: 25299561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 11/03/2010] [Indexed: 06/04/2023] Open
Abstract
Intravesical instillation of bacillus Calmette-Guérin (BCG) is the treatment of choice for carcinoma in situ and non-invasive high-grade superficial tumors of the urinary bladder. This treatment is well tolerated overall, but serious complications can occur. An elderly man with coronary disease and recurrent high-grade superficial carcinoma of the bladder underwent intravesical instillation of BCG and developed septic shock. He received wide range antibiotics, tuberculostatic and vasoactive drugs, corticosteroids, mechanical ventilation and renal replacement therapy without improvement. He died nine days after the intravesical instillation of BCG because of multiple organ failure.
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de Souza Viana L, Serufo JC, da Costa Rocha MO, Costa RN, Duarte RC. Performance of a modified MASCC index score for identifying low-risk febrile neutropenic cancer patients. Support Care Cancer 2007; 16:841-6. [PMID: 17960431 DOI: 10.1007/s00520-007-0347-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2007] [Accepted: 10/02/2007] [Indexed: 10/22/2022]
Abstract
GOALS OF WORK This is a prospective and observational study comparing the efficacy of risk-assessment models in patients with neutropenic fever in a reference treatment center. The meaning of the complex infection was evaluated. MATERIALS AND METHODS Patients were recruited throughout a 9-month period. Inclusion criteria were histologic diagnosis of malignancy, neutropenic febrile secondary to chemotherapy and/or radiotherapy (absolute neutrophil count of <500/microl and axillary temperature > or = 38 degrees C), and > or = 18 years of age. MAIN RESULTS Fifty-three febrile neutropenic patients were included. Twenty one of them were classified as low risk by the Multinational Association of Supportive Care in Cancer (MASCC) risk-index score. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the MASCC risk-index scores were, respectively 87.9, 85.0, 90.6, 80.9, and 86.8%. None of the low-risk patients died, but four patients classified as low risk by the MASCC model developed serious medical complications during febrile neutropenic episodes. When we subtracted patients with complex infections from the group of patients with the MASCC risk-index score of > or = 21, we got 15 patients that were classified as low risk by a proposed adjustment by complex infection (PACI) model. None of them developed serious medical complications. The sensitivity, specificity, PPV, NPV, and the accuracy of this new model were, respectively, 100, 75.0, 86.8, 100, and 90.6%. CONCLUSION The MASCC risk-index score had high sensitivity and specificity to predict the absence of complications, but the PACI model was better than MASCC for predicting the absence of complications in this febrile neutropenic patients.
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Affiliation(s)
- Luciano de Souza Viana
- Infectious Disease and Tropical Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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