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Cueva JF, Palacio I, Churruca C, Herrero A, Pardo B, Constenla M, Santaballa A, Manso L, Estévez P, Maximiano C, Legerén M, Marquina G, de Juan A, Quindós M, Sánchez L, Barquin A, Fernández I, Martín C, Juárez A, Martín T, García Y, Yubero A, Gallego A, Martínez Bueno A, Guerra E, González-Martín A. Real-world safety and effectiveness of maintenance niraparib for platinum-sensitive recurrent ovarian cancer: A GEICO retrospective observational study within the Spanish expanded-access programme. Eur J Cancer 2023; 182:3-14. [PMID: 36706655 DOI: 10.1016/j.ejca.2022.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022]
Abstract
AIM To describe patient characteristics, effectiveness and safety in a real-world population treated with niraparib in the Spanish expanded-access programme. PATIENTS AND METHODS This retrospective observational study included women with platinum-sensitive recurrent high-grade serous ovarian cancer who received maintenance niraparib within the Spanish niraparib expanded-access programme. Eligible patients had received ≥2 previous lines of platinum-containing therapy, remained platinum-sensitive after the penultimate line of platinum and had responded to the most recent platinum-containing therapy. Niraparib dosing was at the treating physician's discretion (300 mg/day fixed starting dose or individualised starting dose [ISD] according to baseline body weight and platelet count). Safety, impact of dose adjustments, patient characteristics and effectiveness were analysed using data extracted from medical records. RESULTS Among 316 eligible patients, 80% had BRCA wild-type tumours and 66% received an ISD. Median niraparib duration was 7.8 months. The most common adverse events typically occurred within 3 months of starting niraparib. Median progression-free survival was 8.6 (95% confidence interval [CI] 7.6-10.0) months. One- and 2-year overall survival rates were 86% (95% CI 81-89%) and 65% (95% CI 59-70%), respectively. Dose interruptions, dose reductions, haematological toxicities and asthenia/fatigue were less common with ISD than fixed starting dose niraparib, but progression-free survival was similar irrespective of dosing strategy. Subsequent therapy included platinum in 71% of patients who received further treatment. CONCLUSION Outcomes in this large real-world dataset of niraparib-treated patients are consistent with phase III trials, providing reassuring evidence of the tolerability and activity of niraparib maintenance therapy for platinum-sensitive recurrent ovarian cancer. CLINICALTRIALS GOV REGISTRATION NCT04546373.
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Affiliation(s)
- Juan F Cueva
- Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
| | - Isabel Palacio
- Hospital Universitario Central de Asturias, Oviedo, Spain.
| | | | - Ana Herrero
- Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - Beatriz Pardo
- Institut Català d'Oncologia (ICO) Duran i Reynals, Barcelona, Spain.
| | - Manuel Constenla
- Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain.
| | - Ana Santaballa
- Hospital Universitario i Politècnic la Fe, Valencia, Spain.
| | - Luis Manso
- Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - Purificación Estévez
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain.
| | | | - Marta Legerén
- Hospital Universitario Clínico San Cecilio, Granada, Spain.
| | - Gloria Marquina
- Hospital Clínico San Carlos, Department of Medicine, School of Medicine, Complutense University (UCM), Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - Ana de Juan
- Hospital Universitario Marqués de Valdecilla, Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.
| | - María Quindós
- Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | | | | | | | | | | | - Teresa Martín
- Hospital Universitario de Salamanca, Salamanca, Spain.
| | - Yolanda García
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Spain.
| | - Alfonso Yubero
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
| | | | | | - Eva Guerra
- Hospital Universitario Ramón y Cajal, Madrid, Spain.
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Yubero A, Barquín A, Estévez P, Pajares B, Sánchez L, Reche P, Alarcón J, Calzas J, Gaba L, Fuentes J, Santaballa A, Salvador C, Manso L, Herrero A, Taus Á, Márquez R, Madani J, Merino M, Marquina G, Casado V, Constenla M, Gutiérrez M, Dosil A, González-Martín A. Rucaparib in recurrent ovarian cancer: real-world experience from the rucaparib early access programme in Spain – A GEICO study. BMC Cancer 2022; 22:1150. [DOI: 10.1186/s12885-022-10191-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background:
Rucaparib is a poly(ADP-ribose) polymerase inhibitor approved in Europe as maintenance therapy for recurrent platinum-sensitive (Pt-S) ovarian cancer (OC). The Rucaparib Access Programme (RAP) was designed to provide early access to rucaparib for the above-mentioned indication, as well as for patients with BRCA-mutated Pt-S or platinum-resistant (Pt-R) OC and no therapeutic alternatives.
Methods:
In this observational, retrospective study we analysed the efficacy and safety of rucaparib within the RAP in Spain. Hospitals associated with the Spanish Ovarian Cancer Research Group (GEICO) recruited patients with high-grade epithelial ovarian, fallopian tube, or primary peritoneal cancer treated with rucaparib 600 mg twice daily as maintenance or treatment (Pt-S/Pt-R) in the RAP. Baseline characteristics, efficacy, and safety data were collected.
Results:
Between July 2020 and February 2021, 51 patients treated in 22 hospitals in the RAP were included in the study. Eighteen patients with a median of 3 (range, 1–6) prior treatment lines received rucaparib as maintenance; median progression-free survival (PFS) for this group was 9.1 months (95% confidence interval [CI], 4.2–11.6 months). Among 33 patients (median 5 [range, 1–9] prior treatment lines) who received rucaparib as treatment, 7 and 26 patients had Pt-S and Pt-R disease, respectively. Median PFS was 10.6 months (95% CI, 2.5 months-not reached) in the Pt-S group and 2.2 months (95% CI, 1.1–3.2 months) in the Pt-R group. Grade ≥ 3 treatment-emergent adverse events were reported in 39% of all patients, the most common being anaemia (12% and 15% in the maintenance and treatment groups, respectively). At data cut-off, 5 patients remained on treatment.
Conclusion
Efficacy results in these heavily pre-treated patients were similar to those from previous trials. The safety profile of rucaparib in real life was predictable and manageable.
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Lopez R, Antón A, Aranda E, Carrato A, Constenla M, Cruz-Hernández JJ, Díaz-Rubio E, Feyjóo M, García-Foncillas J, Gascón P, Guillem V, Lugo I, Camps C. Evaluation of Spanish hospitals participating in the Quality Oncology Practice Initiative program. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.29_suppl.222] [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: 11/20/2022] Open
Abstract
222 Background: Measuring and tracking quality of care is highly relevant in today’s healthcare. The Quality Oncology Practice Initiative (QOPI) program is a referral for evaluating oncology practices worldwide. The ECO Foundation (Excellence and Quality in Oncology), a collaboration of oncology experts from the major Spanish hospitals involved in cancer treatment, reached an agreement with ASCO (American Society of Clinical Oncology) to include Spanish hospitals in its QOPI program. Methods: We analyzed the results of the QOPI core module measures from 19 Spanish hospitals submitting their data in nine rounds (from Fall 2015 to Fall 2019). Results: Of the 19 hospitals, 15 participated more than once; none participated in all 9 rounds (2 hospitals participated in 8 rounds). The highest scores were for pathology report confirming malignancy, documenting plan of care for moderate/severe pain and chemotherapy dose, and chemotherapy administered to patients with metastatic solid tumor with performance status undocumented. Measures regarding a summary of chemotherapy treatment, tobacco use cessation counseling, and assessment of patient emotional well-being were among the lowest scored measures. Six of the 15 practices who participated repeatedly achieved a better score in their last round compared to their first. Overall, scores of Spanish hospitals improved from 67.79% in Fall 2015 to 68.91% in Fall 2019. Conclusions: This is the first study to evaluate QOPI scores in Spain; it showed that repeated participation enhances quality of care, although there is room for improvement. The ECO Foundation will continue supporting and engaging with practices to increase their participation in order to improve oncology care and implement strategies that address the areas for improvement.
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Affiliation(s)
- Rafael Lopez
- Fundación ECO, Medical Oncology Service, Hospital Clínico Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | - Antonio Antón
- Fundación ECO, Medical Oncology Service, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Enrique Aranda
- Fundación ECO, Medical Oncology Service, Hospital Reina Sofía, Córdoba, Spain
| | - Alfredo Carrato
- Fundación ECO, Medical Oncology Service, Hospital Ramón y Cajal, Madrid, Spain
| | - Manuel Constenla
- Fundación ECO, Medical Oncology Service, Complejo Hospitalario Universitario Pontevedra, Pontevedra, Spain
| | - Juan J. Cruz-Hernández
- Fundación ECO, Medical Oncology Service, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | - Eduardo Díaz-Rubio
- Fundación ECO, Vicepresidencia de la Real Academia Nacional de Medicina, IdISCC, CIBERONC, Madrid, Spain
| | - Margarita Feyjóo
- Fundación ECO, Medical Oncology Service, Hospital Universitario La Moraleja, Sanitas, Madrid, Spain
| | | | - Pere Gascón
- Fundación ECO, Laboratory of Molecular & Translational Oncology-CELLEX, Barcelona, Spain
| | - Vicente Guillem
- Fundación ECO, Medical Oncology Service, Instituto Valenciano de Oncología, Valencia, Spain
| | | | - Carlos Camps
- Fundación ECO, Medical Oncology Service, Hospital General de Valencia, CIBERONC, Departament de Medicina, Universitat de Valencia, Valencia, Spain
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Suh HJ, Flórez Á, Sacristán V, Rodríguez Martinez Á, Fernández F, Vilanova-Trillo L, Constenla M, Pereiro M. Cutaneous adverse events in patients receiving anticancer therapy in a tertiary hospital setting: the old and the new. Int J Dermatol 2020; 60:208-216. [PMID: 33502780 DOI: 10.1111/ijd.15081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/11/2020] [Accepted: 07/01/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Targeted therapies and immunotherapies are increasingly prescribed, but classic chemotherapy agents are still highly used in cancer treatment. Both therapies, the old and the new, are associated with cutaneous adverse events (CAEs) that can cause treatment interruptions or reduce the quality of life of patients. METHODS An observational, cross-sectional, single-center study that included consecutive cancer patients presenting CAEs. The main objective was to describe CAEs derived from antineoplastic drugs. Secondary objectives were to determine the number and severity of CAEs and if there were differences regarding CAEs between conventional chemotherapeutics and targeted therapies. RESULTS A total of 114 patients were included with a total number of 177 CAEs. Of the 114 patients, 64 presented a single CAE, 37 patients had two CAEs, and 13 patients presented three CAEs. The most frequent CAEs were pruritus, xerosis, palmar-plantar erythrodysesthesia (PPE), and alopecia. The majority of CAEs were mild (63.2%), followed by moderate (29.9%) and severe (6.7%) CAEs. Of the 114 patients, 103 (90.3%) received topical agents and 11 (9.7%) required systemic treatment for the management of CAEs. Prophylactic treatment for CAE was delivered to only 4/114 (3.5%) patients. No significant differences were found in the number or severity of CAEs between conventional chemotherapy and targeted therapy. CONCLUSIONS Close collaboration between oncologists and dermatologists is essential to start preventive measures on time, enhance patient education, and avoid unnecessary dose reductions or treatment interruptions. The multidisciplinary approach can offer better management of skin toxicities.
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Affiliation(s)
- Hae-Jin Suh
- Dermatology Department, Pontevedra University Hospital, Pontevedra, Spain
| | - Ángeles Flórez
- Dermatology Department, Pontevedra University Hospital, Pontevedra, Spain
| | - Víctor Sacristán
- Medical Oncology Department, A Coruña University Hospital, A Coruña, Spain
| | | | | | | | - Manuel Constenla
- Medical Oncology Department, Pontevedra University Hospital, Pontevedra, Spain
| | - Manuel Pereiro
- Surgical Medical Specialties Department, Dermatology Section, Santiago de Compostela University, Santiago de Compostela, Spain
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Barnadas A, Muñoz M, Margelí M, Chacón JI, Cassinello J, Antolin S, Adrover E, Ramos M, Carrasco E, Jimeno MA, Ojeda B, González X, González S, Constenla M, Florián J, Miguel A, Llombart A, Lluch A, Ruiz-Borrego M, Colomer R, Del Barco S. BOMET-QoL-10 questionnaire for breast cancer patients with bone metastasis: the prospective MABOMET GEICAM study. J Patient Rep Outcomes 2019; 3:72. [PMID: 31865481 PMCID: PMC6925605 DOI: 10.1186/s41687-019-0161-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 11/15/2019] [Indexed: 11/18/2022] Open
Abstract
Background Bone metastasis (BM) is the most common site of disease in metastatic breast cancer (MBC) patients. BM impacts health-related quality of life (HRQoL). We tested prospectively the psychometric properties of the Bone Metastasis Quality of Life (BOMET-QoL-10) measure on MBC patients with BM. Methods Patients completed the BOMET-QoL-10 questionnaire, the Visual Analogue Scale (VAS) for pain, and a self-perceived health status item at baseline and at follow-up visits. We performed psychometric tests and calculated the effect size of specific BM treatment on patients´ HRQoL. Results Almost 70% of the 172 patients reported symptoms, 23.3% experienced irruptive pain, and over half were receiving chemotherapy. BOMET-QoL-10 proved to be a quick assessment tool performing well in readability and completion time (about 10 min) with 0–1.2% of missing/invalid data. Although BOMET-QoL-10 scores remained fairly stable during study visits, differences were observed for patient subgroups (e.g., with or without skeletal-related events or adverse effects). Scores were significantly correlated with physician-reported patient status, patient-reported pain, symptoms, and perceived health status. BOMET-QoL-10 scores also varied prospectively according to changes in pain intensity. Conclusions BOMET-QoL-10 performed well as a brief, easy-to-administer, useful, and sensitive HRQoL measure for potential use for clinical practice with MBC patients. Trial registration NCT03847220. Retrospectively registered on clinicaltrials.gov (February the 20th 2019).
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Affiliation(s)
- A Barnadas
- Medical Oncology Department, Hospital de la Santa Creu I Sant Pau, C/Sant Antoni Maria Claret, 167, 08041, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain.
| | - M Muñoz
- Medical Oncology Department, Hospital Clinic i Provincial, C/ Villarroel n° 170, 08036, Barcelona, Spain
| | - M Margelí
- Medical Oncology Department, Ctra, Hospital Germans Trias i Pujol, Canyet s/n, 08916 Badalona, Barcelona, Spain
| | - J I Chacón
- Medical Oncology Department, Hospital Virgen de la Salud, Avda. Barber, n° 30, 45005, Toledo, Spain
| | - J Cassinello
- Medical Oncology Department, Hospital General de Guadalajara, C/ Donantes de Sangre, s/n, 19002, Guadalajara, Spain
| | - S Antolin
- Medical Oncology Department, Complejo Hospitalario U. A Coruña, C/ Xubias de Abaixo s/n, 15006, A Coruña, Spain
| | - E Adrover
- Medical Oncology Department, Complejo Hospitalario Universitario de Albacete, C/ Hermanos Falcó n° 37, 02006, Albacete, Spain
| | - M Ramos
- Medical Oncology Department, Centro Oncológico de Galicia, C/ Doctor Camilo Veiras s/n, 15009, A Coruña, Spain
| | - E Carrasco
- GEICAM (Spanish Breast Cancer Group), Avda. de los Pirineos n° 7, 28703 San Sebastián de los Reyes, Madrid, Spain
| | - M A Jimeno
- GEICAM (Spanish Breast Cancer Group), Avda. de los Pirineos n° 7, 28703 San Sebastián de los Reyes, Madrid, Spain
| | - B Ojeda
- Medical Oncology Department, Hospital de la Santa Creu I Sant Pau, C/Sant Antoni Maria Claret, 167, 08041, Barcelona, Spain
| | - X González
- Medical Oncology Department, Hospital General de Catalunya, Carrer de Pedro Pons 1, 08195, Sant Cugat del Valles, Barcelona, Spain
| | - S González
- Medical Oncology Department, Hospital Mutua de Terrassa, Barcelona, Plaza del Dr. Robert n°5, 08221, Terrassa, Barcelona, Spain
| | - M Constenla
- Medical Oncology Department, Complejo Hospitalario De Pontevedra, Calle Mourente s/n, 36071, Pontevedra, Galicia, Spain
| | - J Florián
- Medical Oncology Department, Hospital Comarcal de Barbastro, Ctra. Nacional 240, s/n, 22300, Barbastro, Huesca, Spain
| | - A Miguel
- Medical Oncology Department, Hospital Althaia Manresa, C/ Dr. Joan Soler, s/n, 08243, Manresa, Barcelona, Spain
| | - A Llombart
- Medical Oncology Department, Hospital Arnau de Vilanova, Avda. Alcalde Rovira Roure, 80, 25198, Lleida, Spain
| | - A Lluch
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain.,Hospital Clínico Universitario de Valencia, Biomedical Research Institute INCLIVA, Valencia, Spain
| | - M Ruiz-Borrego
- Medical Oncology Department, Hospital Virgen del Rocío, Avda. Manuel Siurot, s/n, 41013, Sevilla, Spain
| | - R Colomer
- Medical Oncology Department, Hospital Universitario La Princesa, C/ Diego de León n° 62, 28006, Madrid, Spain
| | - S Del Barco
- Medical Oncology Department, Hospital U. Josep Trueta, Avda. De França s/n, 17007, Gerona, Spain
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Lopez R, Anton A, Aranda E, Carrato A, Constenla M, Cruz JJ, Diaz-Rubio E, Feyjoo M, Garcia-Foncillas J, Gascon P, Guillem V, Lugo I, Camps C. Implementation of the quality training program in Spain. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.27_suppl.11] [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: 11/20/2022] Open
Abstract
11 Background: The ECO Foundation is a collaboration of experts representing the major Spanish hospitals in the pursuit of excellence in cancer treatment. Since 2015, ECO has been collaborating with ASCO (American Society of Clinical Oncology) in quality initiatives in cancer care, like the QOPI (Quality Oncology Practice Initiative) program and the QOPI Certification Program (QCP). The Quality Training Program (QTP) is a 6-month course with 3 in-person learning sessions that prepares oncology teams to design, implement and lead successful quality improvement activities in their practices. In 2018, ECO reached a new agreement with ASCO to implement this program in Spain. Methods: The QTP was developed in Spain by ECO in collaboration with ASCO, following the same methodology and contents of ASCO’s program. The first session was carried out in October 2018, with 12 Spanish teams participating with diverse quality improvement projects. The program counted with ASCO and ECO faculty, constituted by experts in the quality and oncology field. Results: Each QTP Spanish team counted with 2-3 representatives from their hospitals and developed an improvement project, following the methodology of the course, including a problem statement, process map, cause and effect diagram, diagnostic data, aim statement, measures, baseline data, priority/pay-off matrix of possible changes/interventions, change data, next steps/plan for sustainability, among others. The projects were mainly focused on the waiting time reduction in the Emergency Area and from the patient’s visit to the oncologist until treatment administration, burnout reduction on oncology professionals, improvement of the identification and management of complications for cancer patients receiving immunotherapy, improvement of the uniformity in the medical records registry, among others. QTP participants presented their projects’ results on the third and last session of the program in April 2019 with positive outcomes. Conclusions: The QTP’s quality improvement approach allows Spanish teams and the ECO Foundation to enhance the goal of a quality-oriented health care system. ECO will continue pursuing excellence and quality with further initiatives like the QOPI program, the QCP and the QTP.
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Affiliation(s)
- Rafael Lopez
- Fundación ECO, Servicio de Oncología Médica, Hospital Clínico Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | - Antonio Anton
- Fundación ECO, Servicio de Oncología Médica, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Enrique Aranda
- Fundación ECO, Servicio de Oncología Médica, Hospital Reina Sofía de Córdoba, IMIBIC, CIBERONC, Universidad de Córdoba, Córdoba, Spain
| | - Alfredo Carrato
- Fundación ECO, Servicio de Oncología Médica, Hospital Ramón y Cajal, IRYCIS, CIBERONC, Universidad de Alcalá, Madrid, Spain
| | - Manuel Constenla
- Fundación ECO, Servicio de Oncología Médica, Complejo Hospitalario Universitario Pontevedra, Pontevedra, Spain
| | - Juan Jesús Cruz
- Fundación ECO, Servicio de Oncología Médica, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | - Eduardo Diaz-Rubio
- Fundación ECO, Real Academia Nacional de Medicina, IdISCC, CIBERONC, Madrid, Spain
| | - Margarita Feyjoo
- Fundación ECO, Servicio de Oncología Médica, Hospital Universitario La Moraleja, Sanitas, Madrid, Spain
| | | | - Pedro Gascon
- Fundación ECO, Servicio de Oncología Médica, Hospital Universitario Clinic, Barcelona, Spain
| | - Vicente Guillem
- Fundación ECO, Servicio de Oncología Médica, Instituto Valenciano de Oncología, Valencia, Spain
| | | | - Carlos Camps
- Fundación ECO, Servicio de Oncología Médica, Hospital General de Valencia, Universidad de Valencia, CIBERONC, Valencia, Spain
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Camps Herrero C, Antón Torres A, Cruz-Hernández JJ, Carrato A, Constenla M, Díaz-Rubio E, Feyjoo Saus M, Garcia-Foncillas J, Gascón P, Guillem V. Working towards a consensus on the oncological approach of breakthrough pain: a Delphi survey of Spanish experts. J Pain Res 2019; 12:2349-2358. [PMID: 31534359 PMCID: PMC6681159 DOI: 10.2147/jpr.s203903] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 07/02/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose There is a lack of standards for the diagnosis, assessment and management of breakthrough cancer pain (BTcP). La Fundación ECO (the Foundation for Excellence and Quality in Oncology) commissioned a study to establish a consensus and lay the foundations for the appropriate management of BTcP in oncology patients. Patients and methods A modified Delphi survey comprising two rounds was used to gather and analyze data, which was conducted over the Internet. Each statement that reached a consensus with the respondents was defined as a median consensus score (MED) of ≥7, and agreement among panelists as an interquartile range (IQR) of ≤3. Results In total, 69 medical oncologists responded, with a broad consensus that BTcP implied exacerbations of high-intensity pain, as opposed to moderate pain. Furthermore, they concurred that appropriate diagnostic equipment is needed, and that rapid-onset fentanyl formulations should be the preferred treatment for BTcP management. The panelists agreed that a lack of appropriate information and training to attend to patients, as well as limited patient visitation rights, were barriers to effective BTcP management. Regarding gaps in detected knowledge, the panelists were unsure of the measures necessary to assess the burden of the disease on the patient’s quality of life and associated medication costs. Alongside this, there was a lack of awareness of the technical specifics of the different formulations of rapid-onset fentanyl. Conclusion These results represent the current status of BTcP management. They may inform recommendations and provide a framework for future research.
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Affiliation(s)
- Carlos Camps Herrero
- Jefe de Servicio de Oncología Médica, Consorcio Hospital General Universitario, Valencia, Spain
| | - Antonio Antón Torres
- Jefe del Servicio de Oncología Médica, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Alfredo Carrato
- Jefe del Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Manuel Constenla
- Jefe de Servicio de Oncología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Eduardo Díaz-Rubio
- Jefe del Servicio de Oncología Médica, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Jesus Garcia-Foncillas
- Jefe de Servicio de Oncología Médica, Hospital Universitario "Fundación Jiménez Díaz", Madrid, Spain
| | - Pere Gascón
- Jefe del Servicio de Oncología Médica, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Vicente Guillem
- Jefe del Servicio de Oncología Médica, Instituto Valenciano de Oncología, Valencia, Spain
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Cousillas Castiñeiras A, Gallardo Martin E, Fernández Montes A, Covela Rúa M, Carmona Campos M, Salgado Fernandez M, Pellón Augusto M, Vidal Insua Y, Gonzalez Villarroel P, Martínez-Lago N, De la Cámara Gómez J, Candamio Folgar S, Brozos Vázquez E, Fernandez MJ, Vázquez Rivera F, Méndez Méndez J, Quintero Aldana G, Constenla M. Is there any affordable and reliable score in local gastric cancer? Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.218] [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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Afonso Afonso FJ, Fernández Núñez N, Vilchez Simo R, Firvida JL, De Dios Alvarez N, Campos Balea B, Ruiz Bañobre J, Areses Manrique MC, Agraso Busto S, Carmona Campos M, De Paz Árias LM, Cameselle Garcia S, Pereiro Corbacho D, Vázquez Estévez S, García Mata J, Casal Rubio J, Constenla M. Third and successive–lines of chemotherapy in NSCLC patients without therapeutic targets: Experience of the Grupo Gallego de Cáncer de Pulmón. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e20579] [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: 11/20/2022] Open
Abstract
e20579 Background: The current treatment of advanced non-small cell lung cancer (NSCLC) is conditioned by the presence of molecular and immunohistochemical biomarkers. In the absence of these, the therapeutic option is the use of chemotherapy with or without antiangiogenic agents. The efficacy of non-target systemic treatments is not proven, beyond a second-line and the experiences in their use are limited to retrospective analyzes. We present the experience of the Grupo Gallego de Cáncer de Pulmón in patients with advanced NSCLC treated exclusively with three or more lines of chemotherapy. Methods: Retrospective analysis of patients with advanced NSCLC, treated with three or more lines of chemotherapy in standard regimen, with or without antiangiogenic agents, in Galicia´s hospitals, Spain. Results: We included 168 patients (134 male and 34 female) treated with three or more chemotherapy lines, with a median age at the time of receiving the first-line, of 60.84 years (41-83). Of these, 51 (30,35%) received a fourth-line and 18 (10,74%) a fifth-line of treatment. None received antitarget therapy or immunotherapy. The median overall survival (OS) was 18.1 months. The median OS after the third line was 6.1 months, with 73% of patients alive at three months and 44% six months after the start of that therapeutic line. We did not appreciate differences in OS between those who received three lines and those who received the largest number of subsequent treatments. Our multivariate analysis (age, gender, histology, performance status at initiation of each teatment-line, response to previous treatments) identified that the individuals who benefited the most were those under the age of 60 years, PS-ECOG 0-1 at diagnosis and those with a more durable response to the first-line. Conclusions: The third-line of chemotherapy can benefit those patients with advanced NSCLC, under 60 years of age at the time of diagnosis, with good performance status and with long-lasting responses to the first line of treatment. We did not see benefit in adding fourth or fifth-line of chemotherapy. All data will be presented in the 2019 ASCO annual meeting.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Manuel Constenla
- Servicio de Oncología Médica, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
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10
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Lopez R, Anton A, Aranda E, Carrato A, Constenla M, Cruz JJ, Díaz-Rubio E, Feyjoo M, García Foncillas J, Gascon P, Guillem V, Lugo I, Camps C. Implementation of the Quality Training Program in Spain. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18296] [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: 11/20/2022] Open
Abstract
e18296 Background: The ECO Foundation is a collaboration of experts representing the major Spanish hospitals in the pursuit of excellence in cancer treatment. Since 2015, ECO has been collaborating with ASCO (American Society of Clinical Oncology) in quality initiatives in cancer care, like the QOPI (Quality Oncology Practice Initiative) program and the QOPI Certification Program (QCP). The Quality Training Program (QTP) is a 6-month program with 3 in-person learning sessions that prepares oncology teams to design implement and lead successful quality improvement activities in their practices. In 2018, ECO reached a new agreement with ASCO to implement this program in Spain. Methods: The QTP was developed in Spain by the ECO Foundation in collaboration with ASCO, following the same methodology and contents of ASCO’s program. The first session was carried out on October 2018, with 12 Spanish teams participating with diverse quality improvement projects. The program counted with ASCO and ECO faculty, constituted by experts in the quality and oncology field. Results: The QTP Spanish teams counted with 2-3 representatives from their hospitals. Each team develop an improvement project, following the methodology of the course, including a problem statement, process map, cause and effect diagram, diagnostic data, aim statement, measures, baseline data, priority/pay-off matrix of possible changes/interventions, change data, next steps/plan for sustainability, among others. The projects were mainly focused on the waiting time reduction in the Emergency Area, the waiting time reduction for cancer patients from the visit to the oncologist until treatment administration, burnout reduction on oncology professionals, improvement of the identification and management of complications for cancer patients receiving immunotherapy, improvement of the uniformity in the medical records registry, among others. QTP participants will present the results of their projects on the third and last session of the program, on April 2019. Conclusions: The quality improvement approach followed in the QTP allows Spanish teams and the ECO Foundation to enhance the goal of a quality-oriented health care system. ECO will continue pursuing excellence and quality with further initiatives like the QOPI program, the QCP and the QTP.
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Affiliation(s)
- Rafael Lopez
- Fundación ECO, Servicio de Oncología Médica, Hospital Clínico Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | - Antonio Anton
- Fundación ECO, Servicio de Oncología Médica, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Enrique Aranda
- Fundación ECO, Servicio de Oncología Médica, Hospital Reina Sofía de Córdoba, IMIBIC, CIBERONC, Universidad de Córdoba, Córdoba, Spain
| | - Alfredo Carrato
- Fundación ECO, Servicio de Oncología Médica, Hospital Ramón y Cajal, Madrid, Spain
| | - Manuel Constenla
- Fundación ECO, Servicio de Oncología Médica, Complejo Hospitalario Universitario Pontevedra, Pontevedra, Spain
| | - Juan Jesús Cruz
- Fundación ECO, Servicio de Oncología Médica, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | - Eduardo Díaz-Rubio
- Fundación ECO, Vicepresidente de la Real Academia de Medicina; IdISCC; CIBERONC, Madrid, Spain
| | - Margarita Feyjoo
- Fundación ECO, Servicio de Oncología Médica, Hospital Universitario La Moraleja, Sanitas, Madrid, Spain
| | | | - Pedro Gascon
- Fundación ECO, Servicio de Oncología Médica, Hospital Universitario Clinic, Barcelona, Spain
| | - Vicente Guillem
- Fundación ECO, Servicio de Oncología Médica, Instituto Valenciano de Oncología, Valencia, Spain
| | | | - Carlos Camps
- ECO Foundation, Medical Oncology Department, General University Hospital of Valencia, Valencia, Spain, Department of Medicine, Universitat de Valencia (CIBERONC), Madrid, Spain
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Raposeiras CA, De Dios Alvarez N, Garcia J, Areses Manrique MC, Fernández Núñez N, Afonso Afonso FJ, Amenedo M, Veiga NQ, Cebey V, Lazaro Quintela M, Firvida JL, Campos Balea B, Ruiz Bañobre J, Varela Pose V, Agraso Busto S, Constenla M. Efficacy and safety of Crizotinib in patients with ALK positive non small cell lung cancer (NSCLC): Real-world findings. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e20636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20636 Background: First or second line crizotinib has shown greater efficacy in clinical trials than chemotherapy in patients with NSCLC ALK positive and it was the first approved ALK inhibitor. However, there are limited data describing the use of crizotinib and its outcomes in real-world settings. Methods: This is a retrospective, observational study of patients crizotinib treated ALK positive metastatic NSCLC, who received treatment between 1 January 2013 and 30 november 2018. The primary objective was progression free survival (PFS); secondary objetives were overall survival (OS), response rates and toxicity. Results: Fifty-eight patients with NSCLC ALK+ were recollected, 33 women and 25 men. The median age was 61 years (25-88); 46.6% were never smokers, 31% were former smokers. The majority (96.6%) had confirmed adenocarcinoma histology and 25.9% had brain metastases at inicial treatment. Crizotinib was used as first line 55.2% and second line in 37.9%. Progression disease was the most frequent reason of discontinuation of crizotinib (74%) and in 5 patients was discontinued because of toxicity. The most frequent toxicities were edemas (37.9%), increased transaminases (27.5), diarrhea (24%) and nauseas (20%). Grade 3-4 toxicities were present in 4 cases with increase transaminases, 1 case of neumonitis and 2 patients with diarrhea. The response rate was 63.8%. The median PFS was 12.66 months (95% CI :7.95- 17.38) and median OS was 23.36 months (95%CI: 16.29-30.44).In patients with brain metastases (15) the response rate was 46.6% and median OS decrease to 15.36 months (95%CI: 0.1-30.8). Conclusions: Our findings indicate that the results of crizotinib in the real world are consistent or sightly improved with prior clinical trial in PFS and OS, despite our sample includes patients for first line and second/later line crizotinib and ¼ of patients had brain metastasic at crizotinib initiation.
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Affiliation(s)
| | | | - Jorge Garcia
- Complejo Hospitalario Universitario de Santiago, Santiago De Compostela, Spain
| | | | | | | | | | | | - Victor Cebey
- Complejo Hospitalario Santiago de Compostela, Santiago De Compostela, Spain
| | | | | | | | | | - Vanesa Varela Pose
- Medical Oncology Department. Complejo Hospitalario Universitario de Santiago, Santiago De Compostela, Spain
| | | | - Manuel Constenla
- Servicio de Oncología Médica, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
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12
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Lopez R, Anton A, Aranda E, Carrato A, Constenla M, Cruz JJ, Díaz-Rubio E, Feyjoo M, García Foncillas J, Gascon P, Guillem V, Lugo I, Camps C. The Quality Oncology Practice Initiative Program: Experience in Spain. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18267] [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: 11/20/2022] Open
Abstract
e18267 Background: Patient care quality is a discipline with enormous relevance in today’s healthcare. Quality Oncology Practice Initiative (QOPI) is a referral worldwide in quality for oncology practices. The ECO Foundation is a collaboration of experts representing the major Spanish hospitals in the pursuit of excellence in cancer treatment. ECO reached an agreement with QOPI to involve Spanish hospitals in the QOPI program. Methods: 7 rounds of data collection have taken place (Fall 2015 to Round 2 2018). Practices had to register online and submit data into the QOPI platform, and the ECO Foundation offered them the necessary support. 18 Spanish hospitals have participated in the 7 rounds, and 12 of them have repeated participation. Core, Lung Cancer and Breast Cancer modules were completed. Results: During the 7 rounds, 2341 charts were submitted by the Spanish practices. The percentage of participating practices that presented results higher than 70% was successively 64%, 50%, 75%, 100% in the three following rounds and 88% in the last round. For the 12 hospitals that repeated participation, 8 reported improvements at different degrees of their global scores. These hospitals specifically show an improvement in the QOPI measures related to the signed patient consent for chemotherapy and the documentation of the patient consent in the practitioner note, the chemotherapy intent documentation, the appropriate completion of the chemotherapy planning, the documentation of the number of chemotherapy cycles and the development and documentation of the pain assessment. On the other hand, regarding QOPI Certification, three Spanish hospitals have received this accreditation in September 2017 and one in June 2018. Conclusions: These preliminary results are a good starting point for the continued implementation of the QOPI program in Spain, thus providing a well-structured approach to analyze cancer care. The ECO Foundation will continue pursuing excellence and quality with further activities like the QOPI Certification program and Quality Training Program, with these performed for the first time in Spain in 2017 and 2018 respectively.
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Affiliation(s)
- Rafael Lopez
- Fundación ECO, Servicio de Oncología Médica, Hospital Clínico Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | - Antonio Anton
- Fundación ECO, Servicio de Oncología Médica, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Enrique Aranda
- Fundación ECO, Servicio de Oncología Médica, Hospital Reina Sofía de Córdoba, IMIBIC, CIBERONC, Universidad de Córdoba, Córdoba, Spain
| | - Alfredo Carrato
- Fundación ECO, Servicio de Oncología Médica, Hospital Ramón y Cajal, Madrid, Spain
| | - Manuel Constenla
- Fundación ECO, Servicio de Oncología Médica, Complejo Hospitalario Universitario Pontevedra, Pontevedra, Spain
| | - Juan Jesús Cruz
- Fundación ECO, Servicio de Oncología Médica, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | - Eduardo Díaz-Rubio
- Fundación ECO, Vicepresidente de la Real Academia de Medicina; IdISCC; CIBERONC, Madrid, Spain
| | - Margarita Feyjoo
- Fundación ECO, Servicio de Oncología Médica, Hospital Universitario La Moraleja, Sanitas, Madrid, Spain
| | | | - Pedro Gascon
- Fundación ECO, Servicio de Oncología Médica, Hospital Universitario Clinic, Barcelona, Spain
| | - Vicente Guillem
- Fundación ECO, Servicio de Oncología Médica, Instituto Valenciano de Oncología, Valencia, Spain
| | | | - Carlos Camps
- ECO Foundation, Medical Oncology Department, General University Hospital of Valencia, Valencia, Spain, Department of Medicine, Universitat de Valencia (CIBERONC), Madrid, Spain
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13
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Gomez A, Gómez Solana P, Ruiz E, Anton A, Aranda E, Camps C, Constenla M, Cruz JJ, Díaz-Rubio E, Feyjoo M, García Foncillas J, Gascon P, Guillem V, Lopez R, Lugo I, Carrato A. Strategies for reducing grade 2 and 3 adverse events due to immunotherapy in a Spanish university hospital. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18295] [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: 11/20/2022] Open
Abstract
e18295 Background: To develop an improvement project, the Lung Cancer Unit of Ramón y Cajal Hospital (Madrid) analyzed 45 patients treated with immunotherapy in 2017 and detected that 55% presented moderate-to-severe Adverse Events (AEs). Consequently, a specialized team from Ramon y Cajal Hospital and the ECO Foundation proposed to identify improvement areas that reduce grade 2 (G2) and 3 (G3) AEs. ECO is a collaboration of experts representing the major Spanish hospitals in the pursuit of excellence in cancer treatment. Methods: The team used as an instrument the American Society of Clinical Oncology (ASCO) Quality Training Program (QTP). A data collection process was conducted before attending the first out of three sessions of the QTP with the revision of medical records from lung cancer patients. The goal for the final QTP session in June 2018 was to reduce G2 and G3 AEs by 25%, by standardizing patient education sessions using ASCO guidelines for the management of immune-related AEs. Results: The data collected showed that G2 and G3 AEs had an impact on quality of care, specifically a treatment delay in 31% of patients, unscheduled visits in 19%, serious complications in 11% and patient dissatisfaction with the reporting system. The team created a cause and effect diagram, in which the most relevant causes were inadequate patient knowledge and a lack of communication with patients between visits. A run chart of the percentage of G2 and G3 AEs during 2017 displayed that G2 AEs were higher during January and August; and G3 AEs in February and December. The team, including patient advocates, prioritized the implementation of these short-term measures for patients: improvement of education, education follow-up, satisfaction questionnaire development and AE knowledge test. By June 2018, the resulting value of the “(mean + range)/standard deviation” formula for AEs perceived knowledge in patients increased from 5.4 to 11.1 points, the same value for patients’ AEs knowledge increased from 7.3 to 13.8 points, the percentage of G2 AEs reduced in 5% and the percentage of G3 AEs maintained in 0%. Conclusions: This improvement approach indicates the need to continue further quality projects in healthcare. Broader participation of Spanish hospitals in improvement initiatives will enhance the goal of a quality-oriented health care system.
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Affiliation(s)
- Ana Gomez
- Servicio de Oncología Médica, Hospital Ramón y Cajal, Madrid, Spain
| | | | - Elena Ruiz
- Unidad de Ensayos Clínicos, Hospital Ramón y Cajal, Madrid, Spain
| | - Antonio Anton
- Fundación ECO, Servicio de Oncología Médica, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Enrique Aranda
- Fundación ECO, Servicio de Oncología Médica, Hospital Reina Sofía de Córdoba, IMIBIC, CIBERONC, Universidad de Córdoba, Córdoba, Spain
| | - Carlos Camps
- ECO Foundation, Medical Oncology Department, General University Hospital of Valencia, Valencia, Spain, Department of Medicine, Universitat de Valencia (CIBERONC), Madrid, Spain
| | - Manuel Constenla
- Fundación ECO, Servicio de Oncología Médica, Complejo Hospitalario Universitario Pontevedra, Pontevedra, Spain
| | - Juan Jesús Cruz
- Fundación ECO, Servicio de Oncología Médica, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | - Eduardo Díaz-Rubio
- Fundación ECO, Vicepresidente de la Real Academia de Medicina; IdISCC; CIBERONC, Madrid, Spain
| | - Margarita Feyjoo
- Fundación ECO, Servicio de Oncología Médica, Hospital Universitario La Moraleja, Sanitas, Madrid, Spain
| | | | - Pedro Gascon
- Fundación ECO, Servicio de Oncología Médica, Hospital Universitario Clinic, Barcelona, Spain
| | - Vicente Guillem
- Fundación ECO, Servicio de Oncología Médica, Instituto Valenciano de Oncología, Valencia, Spain
| | - Rafael Lopez
- Fundación ECO, Servicio de Oncología Médica, Hospital Clínico Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | | | - Alfredo Carrato
- Fundación ECO, Servicio de Oncología Médica, Hospital Ramón y Cajal, Madrid, Spain
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López R, Antón A, Aranda E, Carrato A, Constenla M, Cruz JJ, Díaz-Rubio E, Feyjóo M, García-Foncillas J, Gascón P, Guillem V, Lugo I, Rogado Á, Camps C. QIM19-135: The Quality Oncology Practice Initiative Program: Experience in Spain. J Natl Compr Canc Netw 2019. [DOI: 10.6004/jnccn.2018.7175] [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: 11/17/2022]
Abstract
Background: Patient quality care is a discipline that has acquired enormous relevance in today’s healthcare. The Quality Oncology Practice Initiative (QOPI) is a referral worldwide in terms of quality for oncology practices. The ECO Foundation is a foundation of experts representing the major Spanish hospitals involved in the treatment of cancer patients. ECO reached an agreement with ASCO to involve Spanish hospitals in the QOPI program. Methods: 6 rounds of data collection have taken place (Fall 2015 to Round 1 2018). Practices had to register online and submit data into the QOPI platform, and the ECO Foundation offered all centers the necessary support. 17 Spanish hospitals have participated in the 6 rounds, and 7 of them have repeated participation. Core and lung cancer modules were completed. Results: During the 6 rounds, 1,877 charts were submitted by the Spanish practices. In most of the rounds, the highest scores were: pathology report confirming malignancy; number of chemotherapy cycles documented; patient consent for chemotherapy; and 5 measures of the lung cancer module. The lowest scores were: chemotherapy treatment summary provided to patient within 3 months of chemotherapy end; chemotherapy treatment summary provided or communicated to practitioner(s) within 3 months of chemotherapy end; smoking/tobacco use cessation counselling recommended to smokers/tobacco users in past year; and tobacco cessation counselling administered or patient referred in past year. The percentage of participating practices that presented results higher than 70% was successively 64%, 50%, 75%, and 100% in the last 3 rounds. For the 7 hospitals that repeated participation, 3 reported an improvement of their global scores. Regarding QOPI Certification, 3 Spanish hospitals received this accreditation in September 2017 and one in June 2018. Conclusions: These preliminary results are a good starting point for the continued implementation of the QOPI program in Spain, thus providing a well-structured approach to analyze cancer care. The ECO Foundation will continue pursuing excellence and quality with further activities like the QOPI Certification program and Quality Training Program, these being performed for the first time in Spain in 2017 and 2018, respectively.
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Affiliation(s)
- Rafael López
- aFundación ECO, Madrid, Spain
- bHospital Clínico Universitario de Santiago de Compostela, Santiago, Spain
| | - Antonio Antón
- aFundación ECO, Madrid, Spain
- cHospital Universitario Miguel Servet, Zaragoza, Spain
| | - Enrique Aranda
- aFundación ECO, Madrid, Spain
- dHospital Reina Sofía de Córdoba, Córdoba, Spain
| | - Alfredo Carrato
- aFundación ECO, Madrid, Spain
- eHospital Ramón y Cajal, IRYCIS, CIBERONC, Universidad de Alcalá, Madrid, Spain
| | - Manuel Constenla
- aFundación ECO, Madrid, Spain
- fComplejo Hospitalario Universitario Pontevedra, Pontevedra, Spain
| | - Juan Jesús Cruz
- aFundación ECO, Madrid, Spain
- gHospital Clínico Universitario de Salamanca, Salamanca, Spain
| | - Eduardo Díaz-Rubio
- aFundación ECO, Madrid, Spain
- hReal Academia de Medicina, IdISCC, CIBERONC, Madrid, Spain
| | - Margarita Feyjóo
- aFundación ECO, Madrid, Spain
- iHospital Universitario La Moraleja, Sanitas, Madrid, Spain
| | | | - Pere Gascón
- aFundación ECO, Madrid, Spain
- kHospital Universitario Clinic, Barcelona, Spain
| | - Vicente Guillem
- aFundación ECO, Madrid, Spain
- lInstituto Valenciano de Oncología, Valencia, Spain
| | | | | | - Carlos Camps
- aFundación ECO, Madrid, Spain
- mHospital General de Valencia, Universitat de Valencia (CIBERONC), Valencia, Spain
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15
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Gomez A, Gómez Solana P, Ruiz E, Anton A, Aranda E, Camps C, Constenla M, Cruz JJ, Díaz Rubio E, Feyjoo M, García Foncillas J, Gascon P, Guillem V, Lopez R, Lugo I, Carrato A. Strategies for reducing grade 2 and 3 adverse events due to immunotherapy in a Spanish university hospital. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.30_suppl.288] [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: 11/20/2022] Open
Abstract
288 Background: To develop an improvement project, the Lung Cancer Unit of Ramón y Cajal Hospital (Madrid) analyzed 45 patients treated with immunotherapy in 2017 and detected that 55% presented moderate-to-severe Adverse Events (AEs). Consequently, a specialized team from Ramon y Cajal Hospital and ECO Foundation proposed to identify improvement areas that reduce grade 2 (G2) and 3 (G3) AEs. ECO is a collaboration of experts representing the major Spanish hospitals in the pursuit of excellence in cancer treatment. Methods: The team used as an instrument the American Society of Clinical Oncology (ASCO) Quality Training Program (QTP). A data collection process was conducted before attending the first out of three sessions of the QTP with the revision of medical records from lung cancer patients. The goal for the final QTP session in late-June 2018 was to reduce G2 and G3 AEs by 25%, by standardizing patient education sessions using ASCO guidelines for the management of immune-related AEs. Results: The data collected showed that G2 and G3 AEs had an impact on quality of care, specifically a treatment delay in 31% of patients, unscheduled visits in 19%, serious complications in 11% and patient dissatisfaction with the reporting system. The team created a cause and effect diagram, in which the most relevant causes were inadequate patient knowledge and a lack of communication with patients between visits, in addition to a Pareto chart, in which the more frequent AEs were asthenia, respiratory infection, cough, among others. A run chart of percentage of G2 and G3 AEs during 2017 displayed that G2 AEs were higher during January and August; and G3 AEs in February and December. The team, including patient advocates, prioritized the implementation of these short-term measures for patients: improvement of education, education follow-up, satisfaction questionnaire development and AE knowledge test. By mid-June 2018, new data will be collected to determine the effectivity of these measures. Conclusions: This improvement approach indicates the need to continue further quality projects in healthcare. Broader participation of Spanish hospitals in improvement initiatives will enhance the goal of a quality-oriented health care system.
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Affiliation(s)
- Ana Gomez
- Servicio de Oncología Médica, Hospital Ramón y Cajal, Madrid, Spain
| | | | - Elena Ruiz
- Unidad de Ensayos Clínicos, Hospital Ramón y Cajal, Madrid, Spain
| | - Antonio Anton
- Servicio de Oncología Médica, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Enrique Aranda
- Servicio de Oncología Médica, Hospital Reina Sofía de Córdoba, Córdoba, Spain
| | - Carlos Camps
- Servicio de Oncología Médica, Hospital General de Valencia, Valencia, Spain
| | - Manuel Constenla
- Servicio de Oncología Médica, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Juan Jesús Cruz
- Servicio de Oncología Médica, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | - Eduardo Díaz Rubio
- Vicepresidente de la Real Academia de Medicina, IdISCC, CIBERONC, Madrid, Spain
| | - Margarita Feyjoo
- Servicio de Oncología Médica, Hospital Universitario La Moraleja, Sanitas, Madrid, Spain
| | | | - Pedro Gascon
- Servicio de Oncología Médica, Hospital Universitario Clinic, Barcelona, Spain
| | - Vicente Guillem
- Servicio de Oncología Médica, Instituto Valenciano de Oncología, Valencia, Spain
| | - Rafael Lopez
- Servicio de Oncología Médica, Hospital Clínico Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | | | - Alfredo Carrato
- Servicio de Oncología Médica, Hospital Ramón y Cajal, Madrid, Spain
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Lopez R, Anton A, Aranda E, Carrato A, Constenla M, Cruz JJ, Díaz Rubio E, Feyjoo M, García Foncillas J, Gascon P, Guillem V, Lugo I, Camps C. The Quality Oncology Practice Initiative program: Experience in Spain. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.30_suppl.310] [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: 11/20/2022] Open
Abstract
310 Background: Patient care quality is a discipline with enormous relevance in today’s healthcare. Quality Oncology Practice Initiative (QOPI) is a referral worldwide in quality for oncology practices. ECO Foundation is a collaboration of experts representing the major Spanish hospitals involved in the treatment of cancer patients. ECO reached an agreement with QOPI to involve Spanish hospitals in the QOPI program. Methods: Six rounds of data collection have taken place (Fall 2015 to Round 1 2018). Practices had to register online and submit data into the QOPI platform, and ECO Foundation offered all centers the necessary support. 17 Spanish hospitals have participated in the six rounds, and 7 of them have repeated participation. Core and Lung Cancer modules were completed. Results: During the six rounds, 1877 charts were submitted by the Spanish practices. In most of the rounds, the highest scores were: Pathology report confirming malignancy, Number of chemotherapy cycles documented, Patient consent for chemotherapy and 5 measures of the Lung Cancer module. The lowest scores were: Chemotherapy treatment summary provided to patient within 3 months of chemotherapy end, Chemotherapy treatment summary provided or communicated to practitioner(s) within 3 months of chemotherapy end, Smoking/tobacco use cessation counselling recommended to smokers/tobacco users in past year and Tobacco cessation counselling administered or patient referred in past year. The percentage of participating practices that presented results higher than 70% was successively 64%, 50%, 75% and 100% in the last three rounds. For the 7 hospitals that repeated participation, 3 reported an improvement of their global scores. Regarding QOPI Certification, three Spanish hospitals received this accreditation in September 2017 and one in June 2018. Conclusions: These preliminary results are a good starting point for the continued implementation of the QOPI program in Spain, thus providing a well-structured approach to analyze cancer care. ECO Foundation will continue pursuing excellence and quality with further activities like the QOPI Certification program and Quality Training Program, these being performed for the first time in Spain in 2017 and 2018 respectively.
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Affiliation(s)
- Rafael Lopez
- Servicio de Oncología Médica, Hospital Clínico Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | - Antonio Anton
- Servicio de Oncología Médica, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Enrique Aranda
- Servicio de Oncología Médica, Hospital Reina Sofía de Córdoba, Córdoba, Spain
| | - Alfredo Carrato
- Servicio de Oncología Médica, Hospital Ramón y Cajal, Madrid, Spain
| | - Manuel Constenla
- Servicio de Oncología Médica, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Juan Jesús Cruz
- Servicio de Oncología Médica, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | - Eduardo Díaz Rubio
- Vicepresidente de la Real Academia de Medicina, IdISCC, CIBERONC, Madrid, Spain
| | - Margarita Feyjoo
- Servicio de Oncología Médica, Hospital Universitario La Moraleja, Sanitas, Madrid, Spain
| | | | - Pedro Gascon
- Servicio de Oncología Médica, Hospital Universitario Clinic, Barcelona, Spain
| | - Vicente Guillem
- Servicio de Oncología Médica, Instituto Valenciano de Oncología, Valencia, Spain
| | | | - Carlos Camps
- Servicio de Oncología Médica, Hospital General de Valencia, Valencia, Spain
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Constenla M, Padrós F, Villanueva-González A, Del Pozo R, Palenzuela O. Horizontal transmission of Endolimax piscium, causative agent of systemic amoebiasis in Senegalese sole Solea senegalensis. Dis Aquat Organ 2018; 130:235-240. [PMID: 30259875 DOI: 10.3354/dao03272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Systemic amoebiasis of Senegalese sole Solea senegalensis is caused by Endolimax piscium Constenla, Padrós & Palenzuela, 2014 a cryptic parasitic member of the Archamoebae whose epidemiology is yet unknown. To test whether the parasite can be transmitted horizontally, an experimental trial by cohabitation between non-infected and infected fish was designed. Transmission of the parasite from naturally infected to healthy fish was confirmed in the experiment, with the water as the most likely route of infection. Under the conditions of the study, the infection process was remarkably slow, as parasites could be detected by in situ hybridization within the intestinal mucosa of recipient fish only after 17 wk of cohabitation, and none of the new hosts displayed clinical signs of disease. Long prepatent period and the need for additional triggering factors for the development of the clinical condition are suggested. The intestinal mucosa is proposed as the tissue where the amoeba can survive as endocommensal, but also as an invasion route from which the parasite would disperse to other organs.
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Affiliation(s)
- M Constenla
- Departament de Biologia Animal, de Biologia Vegetal i d'Ecologia and Servei de Diagnòstic Patològic en Peixos, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
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18
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Guillem V, Bofill S, Feyjoo M, Anton A, Aranda E, Camps C, Carrato A, Constenla M, Cruz-Hernández JJ, Diaz Rubio E, Garcia-Foncillas J, Gascon P, Lopez R, Soler B, Escobar Y. Clinical practice evaluation of opioids induced constipation management in oncologic patients: The EIO-50 project. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e22175] [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)
| | | | | | - Antonio Anton
- Hospital Universitario Miguel Servet, Servicio de Oncología, Zaragoza, Spain
| | - Enrique Aranda
- Reina Sofía Hospital, University of Cordoba, Maimonides Institute of Biomedical Research, Spanish Cancer Network, Instituto de Salud Carlos III, Cordoba, Spain
| | - Carlos Camps
- Fundación ECO - Fundación para la Excelencia y la Calidad de la Oncología, Madrid, Spain
| | | | | | | | | | - Jesus Garcia-Foncillas
- Oncology Department and Translational Oncology Division, University Hospital Fundacion Jimenez Diaz, Madrid, Spain
| | | | - Rafael Lopez
- Hospital Clinico Santiago, Santiago De Compostela, Spain
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19
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Guillem Porta V, Anton A, Aranda E, Carrato A, Constenla M, Cruz-Hernández JJ, Diaz Rubio E, Garcia-Foncillas J, Gascon P, Lopez R, Caballero F, Monge D, Garcia de Leonardo C, Campos FJ, Camps C. The future of precision medicine, strengths and weaknesses: An expert position paper. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18879] [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)
| | - Antonio Anton
- Hospital Universitario Miguel Servet, Servicio de Oncología, Zaragoza, Spain
| | - Enrique Aranda
- Reina Sofía Hospital, University of Cordoba, Maimonides Institute of Biomedical Research, Spanish Cancer Network, Instituto de Salud Carlos III, Cordoba, Spain
| | | | | | - Juan J. Cruz-Hernández
- Complejo Asistencial Universitario de Salamanca, Oncology Department, Head of Department, Salamanca, Spain
| | - Eduardo Diaz Rubio
- Hospital Clinico Universitario San Carlos, IdISSC, CIBERONC, Madrid, Spain
| | | | | | | | | | - Diana Monge
- Francisco de Vitoria University, Madrid, Spain
| | | | | | - Carlos Camps
- Laboratorio de Oncología Molecular, FIHGUV; CIBERONC; Servicio de Oncología Médica, HGUV; Departament de Medicina, Universitat de València, Valencia, Spain
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20
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Cousillas A, Gallardo Martin E, Vazquez Tunas LM, Carou I, Quiroga N, Azpitarte C, Jato CL, Garcia Arroyo FR, Constenla M. Dynamic perspective of neutrophil-lymphocyte ratio in metastatic gastric cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16095] [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)
| | | | | | - Iria Carou
- Complejo Hospitalario de Pontevedra, Pontevedra, Spain
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21
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Cousillas A, Gallardo E, Carou I, Rodriguez Á, Sacristán V, Vázquez L, López-Jato C, Garcia Arroyo FR, Azpitarte C, López-Clemente P, Constenla M. Role of nutritional and inflammatory status in the prognosis of advanced gastric cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.35] [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: 11/20/2022] Open
Abstract
35 Background: This study explores the prognosis impact of nutritional and immune status in metastatic gastric cancer (GC). Recently research has been focused on a proinflammatory status and the relevance of inmune system of the patient in GC. Neutrophil-lymphocyte ratio (NLR) and prognostic nutritional index (PNI) has showed prognostic value in local disease. Our study was assesed in metastatic disease. Methods: One hundred and twenty patients with metastatic gastric adenocarcinoma were retrospectively evaluated between 2011 and 2015. 67.2% were metastatic at diagnosis and 32.8% had a recurrence of disease. Clinical, laboratory and histopathological characteristics were selected as risk factors. The optimal cut-off levels were defined as NLR = 3, PNI (10 x albumin concentration +0.005 x total lymphocyte count) = 43.8, albumin = 3.5 g/dL, body mass index (BMI) = 25. Patients with high NLR and hypoalbuminemia were defined as 2, patients who presented only one abnormally were defined as 1 and those with neither abnormality were defined as 0. Lab data levels were related with survival by Kaplan-Meier and compared by long-rank test. Results: Among 120 patients, mean age was 69 years old, 35% female and 72.5% had no comorbidity. NLR > 3 (6.7 vs 12.5months, p = 0.001), low PNI (7.7 vs 13.1months, p = 0.01) and low albumin (6.2 vs 11.2 months, p = 0.002) were correlated with OS. Significantly, patients with an BMI < 25 had a worse prognosis compared with patients with BMI ≥ 25 (7.4 vs 12.4months, p = 0.02). Obesity in metastatic GC was related with good prognosis in our review. In the group of patients with hypoalbuminemia and h-NLR (27.6%) OS was much worse than patients with normal albumin and low-NLR, 33.6% (4.4months vs. 12.8 months, p < 0.001) Conclusions: High NLR ( > 3) and low PNI ( < 43.8), albumin ( < 3.5g/dL) were correlated with worse outcomes. Moreover, the association in a score of NLR plus albumin showed eight months OS diference. As a recent data in other cancer sites, obesity was related with good prognosis in mGC in our review.
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Affiliation(s)
| | - Elena Gallardo
- Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Iria Carou
- Complejo Universitario de Pontevedra, Pontevedra, Spain
| | | | | | - Lidia Vázquez
- Complejo Universitario de Pontevedra, Pontevedra, Spain
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22
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Constenla M, Padrós F, Del Pozo R, Palenzuela O. Development of different diagnostic techniques for Endolimax piscium (archamoebae) and their applicability in Solea senegalensis clinical samples. J Fish Dis 2016; 39:1433-1443. [PMID: 27260115 DOI: 10.1111/jfd.12480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/19/2016] [Accepted: 02/23/2016] [Indexed: 06/05/2023]
Abstract
Systemic amoebiasis of sole is caused by Endolimax piscium, a cryptic parasitic archamoeba whose epidemiology and pathogeny are yet unknown. To establish reliable detection methods for this parasite, a battery of molecular diagnostic tools (ISH, PCR and qPCR) were developed and evaluated with a panel of clinical samples from symptomatic diseased fish and from apparently normal animals of different stocks. As there is neither enough background information on the epidemiology of the disease nor a validated reference method, comparison of tests used a composite reference method approach. The ISH technique was the most specific and sensitive in intestine samples and particularly useful as a reference confirmatory method, while the best method in muscle samples was qPCR. Application of the tests to asymptomatic fish demonstrated presence of parasites in a large proportion (>25%) of their intestines, suggesting that this is the point of entry of the amoebae and the initial stage in the development of the disease. The triggering factors that facilitate the breaching of the intestinal barrier by E. piscium, causing granulomatous lesions in other organs and systemic spreading, are not completely understood but our results point to the connective tissue as a preferential target for parasite development and migration.
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Affiliation(s)
- M Constenla
- Departament de Biologia Animal, de Biologia Vegetal i d'Ecologia and Servei de Diagnòstic Patològic en Peixos, XRAq (Generalitat de Catalunya), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - F Padrós
- Departament de Biologia Animal, de Biologia Vegetal i d'Ecologia and Servei de Diagnòstic Patològic en Peixos, XRAq (Generalitat de Catalunya), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - R Del Pozo
- Instituto de Acuicultura de Torre de la Sal (IATS-CSIC), Castellón, Spain
| | - O Palenzuela
- Instituto de Acuicultura de Torre de la Sal (IATS-CSIC), Castellón, Spain.
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23
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Borro JM, Regueiro F, Pértega S, Constenla M, Pita S. Comparative Study of Survival following Videothoracoscopic Lobectomy Procedures for Lung Cancer: Single- versus Multiple-port Approaches. Arch Bronconeumol 2016; 53:199-205. [PMID: 27614811 DOI: 10.1016/j.arbres.2016.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 06/21/2016] [Accepted: 06/26/2016] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Video-assisted thoracoscopic surgery has become the technique of choice in the early stages of lung cancer in many centers although there is no evidence that all of the surgical approaches achieve the same long-term survival. METHOD We carried out a retrospective review of 276 VATS lobectomies performed in our department, analyzing age, sex, comorbidities, current smoker, FEV1 and FCV, surgical approach, TNM and pathological stage, histologic type, neoadjuvant or coadjuvant chemotherapy, relapse and metastasis time, with the main aim of evaluating the survival rate and disease-free time, especially with regard to the two/three versus single port approach. RESULT The one/four year global survival rate was 88.1 and 67.6% respectively. Bivariate analysis found that the variables associated with survival are comorbidity, histological type, stage, surgical approach and need for chemotherapy. When we independently analyzed the surgical approach, we found a lower survival rate in the single-port group vs. the two/three-port group (VATS). Stratifying by tumoral stage (stage I) and by tumor size (T2) survival was significantly lower for patients with single-port group in comparison to VATS approach. In the multivariate analysis, single-port group is associated with a higher risk of death (HR=1.78). In analyzing disease-free survival, differences were found in both cases in favor of two/three port VATS: p=.093 for local relapses and p=.091 for the development of metastasis. CONCLUSIONS These results challenge the use of the single port technique in malignant lung pathologies, suggesting the need for clinical trials in order to identify the role this technique may have in lung cancer surgery.
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Affiliation(s)
- José M Borro
- Departamento de Cirugía Torácica, Hospital Universitario de A Coruña, A Coruña, España.
| | | | - Sonia Pértega
- Departamento de Epidemiología Clínica y Bioestadística, Hospital Universitario de A Coruña, A Coruña, España
| | - Manuel Constenla
- Departamento de Oncología Médica, Hospital de Pontevedra, Pontevedra, España
| | - Salvador Pita
- Departamento de Epidemiología Clínica y Bioestadística, Hospital Universitario de A Coruña, A Coruña, España
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Quintero Aldana GA, Candamio Folgar S, Méndez JCM, Reboredo M, Jorge Fernández M, Constenla M, Romero Reinoso C, Fernández MS. First-line panitumumab plus docetaxel and cisplatin in advanced gastric or gastroesophageal junction adenocarcinoma: Results of a phase II trial (SPIGA). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e15507] [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)
| | | | | | - Margarita Reboredo
- Complejo Hospitalario Universitario de A Coruña- Hospital Teresa Herrera, A Coruña, Spain
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25
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Arriola E, Paredes A, Gomez RG, Diz P, Constenla M, Girón CG, Amador M, Reck M, Vivanco GL. 147P: Level of concordance between EGFR mutation status obtained from tissue/cytology and blood (plasma) for advanced non-small-cell lung cancer in Spain: ASSESS study. J Thorac Oncol 2016. [DOI: 10.1016/s1556-0864(16)30257-x] [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: 11/26/2022]
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26
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Constenla M, Cevas F, Cabezón Gutierrez L, Jiménez BM, Alonso V, Vazquez-Estevez S, Villanueva N, Garcia Mata J, Ballesteros J, Triguboff E. Prevalence of cancer-related pain in different tumor entities: ATLAS Study in Spanish oncology units. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e12609] [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
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27
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Martín M, Martínez N, Ramos M, Calvo L, Lluch A, Zamora P, Muñoz M, Carrasco E, Caballero R, García-Sáenz JÁ, Guerra E, Caronia D, Casado A, Ruíz-Borrego M, Hernando B, Chacón JI, De la Torre-Montero JC, Jimeno MÁ, Heras L, Alonso R, De la Haba J, Pita G, Constenla M, González-Neira A. Standard versus continuous administration of capecitabine in metastatic breast cancer (GEICAM/2009-05): a randomized, noninferiority phase II trial with a pharmacogenetic analysis. Oncologist 2015; 20:111-2. [PMID: 25601966 DOI: 10.1634/theoncologist.2014-0379] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The approved capecitabine regimen as monotherapy in metastatic breast cancer (MBC) is 1,250 mg/m(2) twice daily for 2 weeks on and 1 week off (Cint). Dose modifications are often required because of severe hand-foot syndrome (HFS). We tested a continuous regimen with a lower daily dose but a similar cumulative dose in an attempt to reduce the severity of adverse events (AEs) while maintaining efficacy. METHODS We randomized 195 patients with HER-2/neu-negative MBC to capecitabine 800 mg/m(2) twice daily throughout the 21-day cycle (Ccont) or to Cint to assess noninferiority in the percentage of patients free of progression at 1 year. Secondary endpoints included efficacy and safety. Associations between polymorphisms in capecitabine metabolism-related genes and drug response were assessed. RESULTS The percentage of patients free of progression at 1 year was 27.3% with Cint versus 25.3% with Ccont (difference of -2.0%; 95% confidence interval: -15.5% to 11.5%, exceeding the 15% deemed noninferior). Differences regarding other efficacy variables were also not found. Grade 3-4 HFS was the most frequent AE (41.1% in Cint vs. 42.3% in Ccont). Grade 3-4 neutropenia, thrombocytopenia, diarrhea, and stomatitis were more frequent with Cint. A 5' untranslated region polymorphism in the carboxylesterase 2 gene was associated with HFS. One polymorphism in cytidine deaminase and two in thymidine phosphorylase were associated with survival. CONCLUSION Our study was unable to show noninferiority with the continuous capecitabine regimen (Ccont) compared with the approved intermittent regimen (Cint). Further investigation is required to improve HFS. Polymorphisms in several genes might contribute to interindividual differences in response to capecitabine.
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Affiliation(s)
- Miguel Martín
- Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain;
| | | | | | - Lourdes Calvo
- Complejo Hospitalario A Coruña (CHUAC), A Coruña, Spain
| | - Ana Lluch
- Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | | | - Eva Carrasco
- GEICAM (Spanish Breast Cancer Group), San Sebastián de los Reyes, Madrid, Spain
| | - Rosalía Caballero
- GEICAM (Spanish Breast Cancer Group), San Sebastián de los Reyes, Madrid, Spain
| | | | - Eva Guerra
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Daniela Caronia
- Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain
| | | | | | | | | | | | | | - Lucía Heras
- Hospital General De Hospitalet, Hospitalet de Llobregat, Barcelona, Spain
| | - Rosario Alonso
- Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain
| | - Juan De la Haba
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)-Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain
| | - Guillermo Pita
- Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain
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Esquerdo G, Doménech M, López P, Pedro C, Villadiego K, Constenla M, Sánchez-Rovira P, Gasquet JA, Rodríguez CA. Darbepoetin alfa administered once every three weeks for the treatment of anemia in elderly patients with non-myeloid tumors receiving chemotherapy. Tumori 2014. [PMID: 24852870 DOI: 10.1700/1491.16423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS AND BACKGROUND The present study aims to describe the hematological response to darbepoetin alfa (DA) under daily clinical practice conditions in anemic elderly patients with non-myeloid tumors receiving chemotherapy. METHODS AND STUDY DESIGN This was a prospective, observational, multicenter study in elderly (≥65 years) patients with non-myeloid cancer receiving DA (500 μg every 3 weeks) for chemotherapy-induced anemia (hemoglobin [Hb] level ≤11.0 g/dL). RESULTS A total of 102 anemic patients with solid tumors and 51 with hematological malignancies were included in 28 centers in Spain. Mean age (±SD) was 73.4 (±5.8) years, and mean baseline Hb level was 10.0 (±0.8) g/dL. DA was administered for a median of 8 weeks. Of the 115 subjects with a post-baseline Hb value, the percentage of patients who achieved a hematopoietic response (Hb increase ≥2 g/dL or reaching ≥12 g/dL without transfusions in the previous 28 days) was 69.7% (95% CI 56.1% to 83.3%). Functional Assessment of Cancer Therapy-Fatigue subscale scores increased during the study (median change 1.0 [Q1 -5.0, Q3 9.0], P = 0.04). One patient (0.7%) experienced a non-serious adverse reaction (cutaneous rash). CONCLUSION The study results suggest that DA is an effective and well-tolerated therapy for the treatment of chemotherapy-induced anemia in elderly patients.
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Constenla M, Padrós F, Palenzuela O. Endolimax piscium sp. nov. (Amoebozoa), causative agent of systemic granulomatous disease of cultured sole, Solea senegalensis Kaup. J Fish Dis 2014; 37:229-240. [PMID: 23496286 DOI: 10.1111/jfd.12097] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 01/21/2013] [Accepted: 01/29/2013] [Indexed: 06/01/2023]
Abstract
A new amoeba species pathogenic for Senegalese sole is described based on ultrastructural analysis and SSU rDNA phylogenetic inference. The parasite presents round to ovoid trophozoites (<5 μm) with a high degree of intracellular simplification. No mitochondria were observed, but mitosome-like organelles were present. No cysts could be detected. Phylogenetic analysis confirmed the Senegalese sole parasite as an amitochondriate Archamoeba related to Endolimax nana and Iodamoeba spp., and we tentatively describe it as a new species in the genus Endolimax, Endolimax piscium. However, the genetic distance with E. nana is quite large, with only 60% pairwise identity between both SSU rDNA genotypes. Although the overall topology of the Archamoebae cladograms containing E. piscium was consistent, the support for the branching of Endolimax spp. relative to its closest neighbours was variable, being higher with distance or parsimony-based inference methods than with ML or Bayesian trees. The use of stringent alignment sampling masks also caused instability and reduced support for some branches, including the monophyly of Endolimax spp. in the most conservative data sets. The characterization of other Archamoebae parasitizing fish could help to clarify the status of E. piscium and to interpret the large genetic distance observed between Endolimax species.
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Affiliation(s)
- M Constenla
- XRAq (Generalitat de Catalunya), Departament de Biologia Animal, de Biologia Vegetal i d'Ecologia, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
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30
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Esquerdo G, Doménech M, López P, Pedro C, Villadiego K, Constenla M, Sánchez-Rovira P, Gasquet JA, Rodríguez CA. Darbepoetin Alfa Administered Once Every Three Weeks for the Treatment of Anemia in Elderly Patients with Non-myeloid Tumors Receiving Chemotherapy. Tumori 2014; 100:225-31. [DOI: 10.1177/030089161410000218] [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
Aims and Background The present study aims to describe the hematological response to darbepoetin alfa (DA) under daily clinical practice conditions in anemic elderly patients with non-myeloid tumors receiving chemotherapy. Methods and Study Design This was a prospective, observational, multicenter study in elderly (≥65 years) patients with non-myeloid cancer receiving DA (500 g every 3 weeks) for chemotherapy-induced anemia (hemoglobin [Hb] level ≤11.0 g/dL). Results A total of 102 anemic patients with solid tumors and 51 with hematological malignancies were included in 28 centers in Spain. Mean age (±SD) was 73.4 (±5.8) years, and mean baseline Hb level was 10.0 (±0.8) g/dL. DA was administered for a median of 8 weeks. Of the 115 subjects with a post-baseline Hb value, the percentage of patients who achieved a hematopoietic response (Hb increase ≥2 g/dL or reaching ≥12 g/dL without transfusions in the previous 28 days) was 69.7% (95% CI 56.1% to 83.3%). Functional Assessment of Cancer Therapy-Fatigue subscale scores increased during the study (median change 1.0 [Q1 −5.0, Q3 9.0], P = 0.04). One patient (0.7%) experienced a non-serious adverse reaction (cutaneous rash). Conclusion The study results suggest that DA is an effective and well-tolerated therapy for the treatment of chemotherapy-induced anemia in elderly patients.
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Affiliation(s)
| | | | - Pilar López
- Hospital General Virgen de las Nieves, Granada
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31
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Constenla M, Aparicio J, Gómez MA, Grávalos C, Gómez LJL, Manzano JL, Pineda MD, Sevilla I, De Prado JMV, Viudez A, López-Gómez M, Cámara JC, López-Vivanco G, Aranda F, Barbón A, Palomo-Jimenez PI, Feliu J. Patient Profile and Tolerability of Raltitrexed in Monotherapy and in Combination with Oxaliplatin as Advanced Colorrectal Teatment. Ralto Study. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt203.256] [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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Constenla M, Aparicio J, Gomez M, Gravalos Castro C, Lopez-Gomez M, Manzano JL, Pineda MD, Cano JM, Sevilla I, Vieitez de Prado JM, Viudez A, Lopez-Gomez L, Camara JC, Lopez-Vivanco G, Aranda F, Palomo-Jimenez PI, Barbon A, Feliu Batlle J. Tolerability of raltitrexed when it is used in monotherapy and in combination with oxaliplatin (TOMOX) as advanced colorectal cancer treatment in normal clinical practice. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e14648] [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: 11/20/2022] Open
Abstract
e14648 Background: Fluoropyrimidines (FP) based chemotherapy continue to be the cornerstone of advanced colorectal cancer (aCRC) treatment. However, FP cannot be appropriated for some patients (FP intolerance, DPD deficit, history of ischemic heart disease, etc). In these cases, Raltitrexed (R) in monotherapy or in combination with oxaliplatin (TOMOX) could be an effective alternative to FP. Methods: We assessed in an observational retrospective study the patient profile and the tolerability of R when it is used in monotherapy or in combination with oxaliplatin (TOMOX) as aCRC treatment in the normal clinical practice setting. Data from patients treated between 2010 and 2012 were collected from 15 Spanish hospitals. Reason for choosing R as aCRC treatment, patient and disease characteristics, previous treatment and toxicity were gathered. Results: The data from 144 patients treated with R (72) and TOMOX (72) were included in the analysis (64% male, median age 68 years, ECOG PS 0/1/2 in 18%/62%/19%). The main reasons to choose R were: similar efficacy and safety to other treatments (19%), convenience of the administration (18%), cardiovascular disease (17%), resistance to FP (14%), previous FP inacceptable toxicity (10%) and old age (11%). R was mainly used as third or successive treatment line (64%) while TOMOX was equally used in all treatment lines (37%, 28% and 35%). The mean number of cycles was 5 (1-15). The dose was reduced in 26% of the patients and the treatment administration was delayed in 53%. The creatinine clearance was only calculated in 20% of the cycles. The most common grade 3-4 toxicities were neutropenia (8%), anaemia (5%), nausea (2%), vomiting (1%), diarrhoea (7%) and hepatic toxicity (4%). There were 2 toxic deaths (1.4%). Conclusions: R and TOMOX represent a safe alternative for aCRC patients in which FP are not appropriated. Despite R good tolerance in normal clinical practice, it is a must to assess creatinine clearance before each cycle.
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Affiliation(s)
| | - Jorge Aparicio
- Department of Medical Oncology, La Fe University Hospital, Valencia, Spain
| | - M.Auxiliadora Gomez
- Medical Oncology Department. University Reina Sofia Hospital. Biomedical Research Institute Maimonidas, Cordoba, Spain
| | | | - Miriam Lopez-Gomez
- Oncology Department. Hospital Universitario Infanta Sofia, San Sebastian de los Reyes, Spain
| | | | | | | | - Isabel Sevilla
- Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | | | - Antonio Viudez
- Service of Medical Oncology, Hospital de Navarra, Pamplona, Spain
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Rodriguez Sanchez A, García Domínguez R, De Velasco G, Pinto A, Puente J, Rubio G, Vazquez-Estevez S, Juan M, Constenla M, Lopez Brea M, Sereno M, Puertas JL, Garrido M, Marrupe D, Villalobos ML, Cantos B, de Portugal T, Vilchez R, Gonzalez-Larriba JL, Arranz Arija JA. Pazopanib in metastatic renal carcinoma (mRC): Experience of 31 centers in Spain in first, second, third, or subsequent lines in daily clinical practice. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e15609] [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
e15609 Background: In clinical trials pazopanib (P) was superior to placebo, noninferior to sunitinib, and very well tolerated as 1st-line for mRC, but there is limited information in daily clinical practice. Methods: We retrospectively reviewed 159 patients (p) who received P in in 31 centers in Spain during the first 18 month after P approval, to evaluate the timing of use and its efficacy. Results: Mean age was 66 y, 64.8% were males, 81.1% clear-cell, 12% non-clear cell, and 6.9% unspecified. At diagnosis of mRC 73.6% had nephrectomy, 78.6% and 71.7% of p were of good-intermediate risk (MSKCC and Heng criteria respectively). Metastatic sites were lung (59.7%), lymph nodes (26.4%), bone (22.6%), skin/soft-tissues (17.6%), liver (11.9%), CNS (2.5%), and 31.4% others (adrenal, pancreas, etc.). Median follow-up since diagnosis of mRC was 16 months (m). P was given as 1st systemic treatment in 81 p, (50.9%), as 2nd line in 32 p (20.1%, most after sunitinib, 17 due to intolerance), or as ≥3r line (46 p, 29%). Median follow-up after P was 7 m in 1st line, and 10 m in 2nd or ≥ 3rd line. Toxicity was as expected. No toxic deaths were registered. At the time of analysis, 85 p have discontinued P (progression: 73 p, toxicity: 10 p, other causes: 2 p), and 35 p have died. The table shows time to treatment failure due to progression or toxicity (TTF), and overall survival (OS) since the 1st dose of P. There were statistically significant differences in 1st line TTF and OS between MSKCC subgroups. Conclusions: In p with mRC and good-intermediate prognosis, P appears to be as effective in daily clinical practice as it was in 1st line trials. P also showed efficacy in p with poor risk, in 2nd-line (particularly progression or intolerance to sunitinib), and after 2 or more TKIs. Updated analysis will be available in June 2013. [Table: see text]
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Affiliation(s)
| | | | | | | | - Javier Puente
- Hospital Clinico Universitario San Carlos, Madrid, Spain
| | | | | | - Marta Juan
- Hospital del Bierzo, Ponferrada - León, Spain
| | | | | | - Maria Sereno
- Oncology Department, Hospital Infanta Sofía, Madrid, Spain
| | | | | | | | | | - Blanca Cantos
- Hospital Universitario Puerta de Hierro, Madrid, Spain
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Lorenzo I, Constenla M, Palacios P, García-Arroyo FR, Fernández I, Campos B, Salgado L, Carrete N. Docetaxel as single-agent treatment in elderly patients with advanced breast cancer. Clin Drug Investig 2012; 25:249-56. [PMID: 17523775 DOI: 10.2165/00044011-200525040-00004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To assess the efficacy and safety profile of docetaxel, as a single agent, in the treatment of elderly patients with advanced breast cancer. METHODS Twenty-eight patients, with a median age of 72 (range 66-84) years, were included in the study and received docetaxel (50-100 mg/m(2)) every 3-4 weeks as first- or second-line treatment of advanced breast cancer. Granulocyte colony-stimulating factor (G-CSF) was administered as primary prophylaxis in 97% of cycles. RESULTS The overall response rate was 50% (95% CI 32, 69). The median time to disease progression was 10.7 months (95% CI 10.0, 11.5), and the median overall survival was 26.6 months (95% CI 16.6, 36.7). Neutropenia was the most frequent grade 3/4 toxicity (18% of patients and 5% of cycles). There was just one case of febrile neutropenia that resulted in toxic death. Severe neutropenia only occurred in patients who did not receive G-CSF support from the start of the study treatment. Vomiting was the most frequent grade 3/4 non-haematological toxicity (11% of patients and 2% of cycles). CONCLUSION Docetaxel as a single agent is active in elderly patients with advanced breast cancer. The use of prophylactic G-CSF allowed the administration of high doses of docetaxel with minimal myelosuppression.
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Affiliation(s)
- I Lorenzo
- Servicio de Oncología, Complexo Hospitalario de Pontevedra, Pontevedra, Spain
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Provencio M, Sánchez A, Domine M, Artal A, Garcia-Gomez R, Constenla M, Sanchez Torres JM, Castro J, Vinolas N, Huelves M, Perez J, Sanchez-Hernandez A. Prospective study into the necessity of hemogram on day 8 in oral vinorelbine and cisplatin regimen. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e18011] [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: 11/20/2022] Open
Abstract
e18011 Background: One of the standard treatments for metastatic non-small-cell lung cancer patients is the combination of cisplatin plus vinorelbine. This regimen is associated with a high rate of severe neutropenia, and a hemogram is therefore routinely performed on day 8 before the administration of vinorelbine. However, no prospective study has ever examined the rate of neutropenia detected in this hemogram or the rate of discontinuation of chemotherapy as a result. Since one of the objectives in the treatment of advanced lung cancer is to maintain quality of life, we performed this prospective study of cisplatin plus vinorelbine to address the question of whether this hemogram on day 8 could be avoided, thus eliminating unnecessary venipunctures without endangering patient safety. Methods: We included 58 chemotherapy-naïve advanced NSCLC patients from 10 centers. They received intravenous doses of cisplatin on day 1 plus oral vinorelbine on days 1 and 8, every 3 weeks, for a maximum of six cycles. Median age was 61 years; 87% were males; ECOG 1: 66%. Results: Of 189 cycles analyzed, vinorelbine was administered on day 8 in 661 (97.8%), and the dose was reduced or canceled in 15 (2.2%; IC 95%: 0.5 - 5.45) due to hematological toxicity. Conclusions: The hemogram on day 8 could potentially be avoided in patients ECOG 0-1 while still maintaining an acceptable safety margin.
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Affiliation(s)
| | - Antonio Sánchez
- Department of Medical Oncology, Puerta de Hierro University Hospital, Madrid, Spain
| | - Manuel Domine
- Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Angel Artal
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | | | | | | | | | - Javier Perez
- Instituto Catalan de Oncologia, Barcelona, Spain
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Constenla M, Carrassón M, Moyà CM, Fernàndez-Chacón A, Padrós F, Repullés-Albelda A, Montero FE. Parasitisation by Bathycreadium elongatum (Digenea, Opecoelidae) in pyloric caeca of Trachyrincus scabrus (Teleostei, Macrouridae). Dis Aquat Organ 2011; 96:239-247. [PMID: 22132502 DOI: 10.3354/dao02393] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A novel process of transmural passive displacement of a digenean parasite was studied in the digestive tract of the roughsnout grenadier Trachyrincus scabrus, which is found in the northwestern Mediterranean Sea. This mechanism seems to facilitate the elimination of a significant portion of intestinal parasites. The digenean parasite Bathycreadium elongatum was found in the intestine, mainly within pyloric caeca, in 74.4% of T. scabrus, with a mean abundance of 44 individuals per fish. Nodule-like lesions were also found in the mesentery of pyloric caeca of infected T. scabrus. Histological sections of the nodules revealed granulomatous inflammatory responses surrounding degraded digeneans. Partial nucleotide sequences of the 28S rRNA gene obtained from intracaecal B. elongatum and from the core of the nodules of the mesentery of pyloric caeca showed 100% mutual identity with an overlap of 971 bp. The greatest abundance of both intracaecal B. elongatum and nodules occurred in spring. During summer, and especially autumn, the abundance of intracaecal B. elongatum decreased. Prevalence and abundance of nodules increased in autumn. In winter intracaecal parasite abundance and prevalence began to increase, but decreased again in nodules. During spring and summer, parasites pass into the visceral cavity, hypothetically owing to the fragility of the wall of pyloric caeca in their apical zone, and become degraded through a granulomatous inflammatory response. This process seems to have a detrimental effect on the B. elongatum cycle since some of parasites are trapped and degrade in the connective tissue in which they are unable to complete their life cycle.
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Affiliation(s)
- M Constenla
- 'Departament de Biologia Animal, Biologia Vegetal i Ecologia, Universitat Autànoma de Barcelona, Cerdanyola, 08193 Barcelona, Spain.
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Provencio-Pulla M, Sanchez-Hernandez A, Domine M, Artal A, Garcia-Gomez R, Constenla M, Vinolas N, De Castro J, Sanchez JM, Perez FJ. Cisplatin (CDDP) plus oral vinorelbine (NVBO) as first-line treatment for advanced non-small cell lung cancer (NSCLC): Prospective analysis to improve the patient’s convenience on day 8 NVBO administration. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e18060] [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: 11/20/2022] Open
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Constenla M, Padrós F. Histopathological and ultrastructural studies on a novel pathological condition in Solea senegalensis. Dis Aquat Organ 2010; 90:191-196. [PMID: 20815327 DOI: 10.3354/dao02233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A new parasitic disease affecting cultured sole Solea senegalensis (Kaup, 1858) is characterised by the presence of external protuberances in the skin of the affected fish. These lesions correspond to nodules in the muscular tissue showing an abscess-like aspect. Similar lesions were found in the kidney, heart, liver and digestive tract. Histological sections of these nodules revealed the presence of a large core formed mainly of necrotic tissue surrounded with fibroblasts and macrophages. Round-shaped plasmodial organisms were found in the external layer of the nodules and usually inside macrophages or fibroblasts. These organisms were also observed in the intestinal mucosa inside phagocytic cells or parasitophorous vacuoles within the enterocytes. The morphological and ultrastructural characteristics of these organisms are similar to the morphology of some groups of parasites described as fish pathogens. The main features suggest that these organisms could be amoebae or parasites with an amoeboid or plasmodial form in their developmental cycle.
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Affiliation(s)
- M Constenla
- XRAq (Generalitat de Catalunya), Departament de Biologia Animal, de Biologia Vegetal i d'Ecologia, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona 08193, Spain.
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Carrato A, Gomez A, Escudero MP, Chaves M, Rivera F, Marcuello E, González Flores E, Grávalos C, Constenla M, Aranda E. Panitumumab plus irinotecan, both given every 3 weeks (Q3W), as second-line treatment for irinotecan-naïve metastatic colorectal cancer (mCRC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14025] [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: 11/20/2022] Open
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Schwenkglenks M, Pettengell R, Jackisch C, Paridaens R, Constenla M, Bosly A, Szucs TD, Leonard R. Risk factors for chemotherapy-induced neutropenia occurrence in breast cancer patients: data from the INC-EU Prospective Observational European Neutropenia Study. Support Care Cancer 2010; 19:483-90. [PMID: 20306092 DOI: 10.1007/s00520-010-0840-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 02/16/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chemotherapy-induced neutropenia (CIN) places patients at risk of life-threatening infections. While reduction of chemotherapy dose or delay of the subsequent treatment cycle and, consequently, reduction of relative dose intensity (RDI) may limit myelotoxicity, these actions can also impact adversely on treatment outcome and should be avoided in adjuvant settings. PATIENTS AND METHODS Based on data from 444 breast cancer patients in the INC-EU Prospective Observational European Neutropenia Study, we have evaluated patient-specific and treatment-specific factors that impact on the incidence of grade 4 CIN (absolute neutrophil count <0.5 × 10(9)/L), either during the first or in any cycle of (neo)adjuvant chemotherapy, across a range of regimens and doses. RESULTS Using multivariate logistic regression analysis, risk factors for grade 4 CIN were identified as older age, lower weight, higher planned dose intensity of doxorubicin, epirubicin, or docetaxel, higher number of planned cycles, vascular comorbidity, lower baseline white blood cell count, and higher baseline bilirubin. Use of colony-stimulating factor before a neutropenic event occurred, dose delays, and dose reductions were protective against grade 4 CIN. CONCLUSIONS By identifying risk factors for grade 4 CIN, CSF prophylaxis may be appropriately targeted to prevent low RDI in patients treated with curative intent.
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Roca JM, Alonso V, Pericay C, Escudero P, Salud A, Losa F, López LJ, Guasch I, Méndez M, Quintero-Aldana G, Grande C, Vicente P, Arrivi A, Martin C, Moreno I, García P, Antón I, Constenla M, Yubero A, Cirera L. Cetuximab Given Every 2 Weeks plus Irinotecan Is an Active and Safe Option for Previously Treated Patients with Metastatic Colorectal Cancer. Chemotherapy 2010; 56:142-6. [DOI: 10.1159/000313527] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Accepted: 01/01/2010] [Indexed: 11/19/2022]
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Pettengell R, Constenla M, Schwenkglenks M. P76 Incidence of febrile neutropenia, chemotherapy delivery and use of colony-stimulating factor in NHL patients of different age groups. Crit Rev Oncol Hematol 2009. [DOI: 10.1016/s1040-8428(09)70114-3] [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: 10/20/2022] Open
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Sanchez A, Provencio M, Artal A, Constenla M, Garcia-Gomez R, Viñolas N, Domine M, Perez FJ, Gayo J. Cisplatin (CDDP) plus oral vinorelbine (NVBO) as first-line treatment for advanced non-small cell lung cancer (NSCLC): Prospective analysis to improve the patient's convenience on day 8 NVBO administration. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e19096] [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
e19096 Background: Severe neutropenia observed during chemotherapy (CT) is a clinical finding leading to treatment modification and, sometimes, life-threatening events. The results of a previous study with 180 p treated with IV vinorelbine plus CDDP as first-line treatment for advanced NSCLC could lead to consider not performing a blood count prior to day 8 vinorelbine administration for patients aged 70 years (y) or less who presented a good haematological tolerability profile during previous cycles (cy) in order to improve treatment convenience. The aim of this study is to prospectively validate these results with the combination of NVBO plus CDDP. Methods: Between October 2007 and September 2008, 31 chemo-naïve p with histologically confirmed stage IIIB/IV NSCLC were included. Treatment consisted of CDDP 75 mg/m2 day 1 plus NVBO 80 mg/m2 days 1 and 8, with a prior test of myelosensitivity at 60 mg/m2 for the first cycle, every 21 days. Patient's characteristics were: Median age, 62 years (range 32–73); males, 93.5%; smokers, 38.7%; all PS 0–1; adenocarcinoma, 33.3% / squamous, 36.7%; stage IIIB, 14.8% / IV, 85.2%. Results: We analyzed 129 cy. NVBO administration on day 8 was cancelled in 3 cycles due to haematological events (2.3% [95% CI: 0.4%-6.6%]. The reported events were: 1 grade-2 neutropenia, 1 grade-4 neutropenia and 1 grade- 2 thrombocytopenia. Among 22 p evaluable for response, 10 p achieved partial response (overall response rate, 45.5% [95% CI: 24.4- 67.8]). Toxicity was mild with neutropenia WHO grade 3–4 observed in 2.1% cy (9.7% p), leukopenia grade 3 in 1.4% cy (6.5% p); 1 case of febrile neutropenia was reported. Grade-3 fatigue was observed in 6 cy (6 p), grade-3 nausea in 2 cy (2 p) and grade-3 vomiting in 2 cy (2 p). Conclusions: The findings of this study could lead to consider not performing a blood count prior to day 8 NVBO administration for patients aged 70 y or less who presented a good haematological tolerability profile during previous cycles in first-line treatment for advanced NSCLC. [Table: see text]
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Affiliation(s)
- A. Sanchez
- Hospital Provincial de Castellon, Castellon, Spain; Hospital Universitario Puerta de Hierro, Madrid, Spain; Hospital Universitario Miguel Servet, Zaragoza, Spain; Hospital Provincial de Pontevedra, Pontevedra, Spain; Hospital Universitario Gregorio Marañon, Madrid, Spain; Hospital Clinic i Provincial, Barcelona, Spain; Fundación Jimenez Diaz, Madrid, Spain; ICO, Hospital Duran I Reynals, L’Hospitalet de Llobregat, Spain; Pierre Fabre Iberica, S.A., Barcelona, Spain
| | - M. Provencio
- Hospital Provincial de Castellon, Castellon, Spain; Hospital Universitario Puerta de Hierro, Madrid, Spain; Hospital Universitario Miguel Servet, Zaragoza, Spain; Hospital Provincial de Pontevedra, Pontevedra, Spain; Hospital Universitario Gregorio Marañon, Madrid, Spain; Hospital Clinic i Provincial, Barcelona, Spain; Fundación Jimenez Diaz, Madrid, Spain; ICO, Hospital Duran I Reynals, L’Hospitalet de Llobregat, Spain; Pierre Fabre Iberica, S.A., Barcelona, Spain
| | - A. Artal
- Hospital Provincial de Castellon, Castellon, Spain; Hospital Universitario Puerta de Hierro, Madrid, Spain; Hospital Universitario Miguel Servet, Zaragoza, Spain; Hospital Provincial de Pontevedra, Pontevedra, Spain; Hospital Universitario Gregorio Marañon, Madrid, Spain; Hospital Clinic i Provincial, Barcelona, Spain; Fundación Jimenez Diaz, Madrid, Spain; ICO, Hospital Duran I Reynals, L’Hospitalet de Llobregat, Spain; Pierre Fabre Iberica, S.A., Barcelona, Spain
| | - M. Constenla
- Hospital Provincial de Castellon, Castellon, Spain; Hospital Universitario Puerta de Hierro, Madrid, Spain; Hospital Universitario Miguel Servet, Zaragoza, Spain; Hospital Provincial de Pontevedra, Pontevedra, Spain; Hospital Universitario Gregorio Marañon, Madrid, Spain; Hospital Clinic i Provincial, Barcelona, Spain; Fundación Jimenez Diaz, Madrid, Spain; ICO, Hospital Duran I Reynals, L’Hospitalet de Llobregat, Spain; Pierre Fabre Iberica, S.A., Barcelona, Spain
| | - R. Garcia-Gomez
- Hospital Provincial de Castellon, Castellon, Spain; Hospital Universitario Puerta de Hierro, Madrid, Spain; Hospital Universitario Miguel Servet, Zaragoza, Spain; Hospital Provincial de Pontevedra, Pontevedra, Spain; Hospital Universitario Gregorio Marañon, Madrid, Spain; Hospital Clinic i Provincial, Barcelona, Spain; Fundación Jimenez Diaz, Madrid, Spain; ICO, Hospital Duran I Reynals, L’Hospitalet de Llobregat, Spain; Pierre Fabre Iberica, S.A., Barcelona, Spain
| | - N. Viñolas
- Hospital Provincial de Castellon, Castellon, Spain; Hospital Universitario Puerta de Hierro, Madrid, Spain; Hospital Universitario Miguel Servet, Zaragoza, Spain; Hospital Provincial de Pontevedra, Pontevedra, Spain; Hospital Universitario Gregorio Marañon, Madrid, Spain; Hospital Clinic i Provincial, Barcelona, Spain; Fundación Jimenez Diaz, Madrid, Spain; ICO, Hospital Duran I Reynals, L’Hospitalet de Llobregat, Spain; Pierre Fabre Iberica, S.A., Barcelona, Spain
| | - M. Domine
- Hospital Provincial de Castellon, Castellon, Spain; Hospital Universitario Puerta de Hierro, Madrid, Spain; Hospital Universitario Miguel Servet, Zaragoza, Spain; Hospital Provincial de Pontevedra, Pontevedra, Spain; Hospital Universitario Gregorio Marañon, Madrid, Spain; Hospital Clinic i Provincial, Barcelona, Spain; Fundación Jimenez Diaz, Madrid, Spain; ICO, Hospital Duran I Reynals, L’Hospitalet de Llobregat, Spain; Pierre Fabre Iberica, S.A., Barcelona, Spain
| | - F. J. Perez
- Hospital Provincial de Castellon, Castellon, Spain; Hospital Universitario Puerta de Hierro, Madrid, Spain; Hospital Universitario Miguel Servet, Zaragoza, Spain; Hospital Provincial de Pontevedra, Pontevedra, Spain; Hospital Universitario Gregorio Marañon, Madrid, Spain; Hospital Clinic i Provincial, Barcelona, Spain; Fundación Jimenez Diaz, Madrid, Spain; ICO, Hospital Duran I Reynals, L’Hospitalet de Llobregat, Spain; Pierre Fabre Iberica, S.A., Barcelona, Spain
| | - J. Gayo
- Hospital Provincial de Castellon, Castellon, Spain; Hospital Universitario Puerta de Hierro, Madrid, Spain; Hospital Universitario Miguel Servet, Zaragoza, Spain; Hospital Provincial de Pontevedra, Pontevedra, Spain; Hospital Universitario Gregorio Marañon, Madrid, Spain; Hospital Clinic i Provincial, Barcelona, Spain; Fundación Jimenez Diaz, Madrid, Spain; ICO, Hospital Duran I Reynals, L’Hospitalet de Llobregat, Spain; Pierre Fabre Iberica, S.A., Barcelona, Spain
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Esquerdo G, Doménech M, Bermejo JC, López P, Pedro C, Villadiego K, Constenla M, Sánchez-Rovira P, Gasquet JA, Rodríguez CA. Final results of a prospective, observational study of the effectiveness of darbepoetin alfa administered every three weeks for the treatment of chemotherapy-induced anaemia in elderly patients. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20654] [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: 11/20/2022] Open
Abstract
e20654 Background: Cancer incidence is increasing in elderly but specific treatment data in this population is not often available. The objectives of this study were to evaluate the effectiveness and safety of darbepoetin alfa (DA) administered once every 3 weeks (Q3W) for the treatment of chemotherapy-induced anaemia (CIA) in elderly within routine clinical practice. Methods: Prospective, observational, single-arm, multicentre study performed in 28 centres across Spain. Eligible patients (pts):≥65 years, anaemic (haemoglobin [Hb] 11 g/dl), with non-myeloid malignancies, and scheduled to receive ≥9 weeks (wks) of chemotherapy. Pts were treated with a fixed dose of DA 500 μg Q3W and treatment stopped if Hb levels exceeded 13g/dl. Primary endpoint was hematopoietic response (Hb increase ≥2g/dl or Hb ≥12g/dl without transfusions in the previous 28 days). Secondary endpoints included percentage of pts achieving target Hb (>11g/dl from wk 5 till end of treatment without red blood cell transfusion within 28 days), changes in the Functional Assessment of Cancer Therapy-Fatigue (FACT-F) scale and the incidence of adverse reactions. Results: Data were prospectively collected from 153 pts: women (56.86%), mean (SD) age 73.43 (5.77) years, ECOG Performance Status 0–1 (65.36%) with solid tumors (66.67%) and lymphoproliferative malignancies (33.33%) and stage III/IV (63.40%). Most pts (90.20%) had baseline Hb levels between 9–11g/dL. DA was administered for a median of 9.0 wks (range: 1–22.57). The Kaplan-Meier percentage (KM; 95% CI) of pts who achieved hematopoietic response was 69.70% (56.06–83.34) and 72.22% (57.5–86.94) for pts who achieved target Hb (>11g/dL). FACT-F median score at baseline was 29.00 and 33.00 at the end of the study. Only one (0.7%) non-serious adverse reaction (cutaneous eruption) was reported. Conclusions: These results suggest that DA given at 500 μg Q3W to elderly pts with non-myeloid malignancies is an effective and well-tolerated treatment for CIA. [Table: see text]
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Affiliation(s)
- G. Esquerdo
- Clinica Benidorm, Barcelona, Spain; Althaia, Barcelona, Spain; H. Sagrat Cor, Barcelona, Spain; H. Virgen de las Nieves, Granada, Spain; H. del Mar, Barcelona, Spain; H. de Pontevedra, Pontevedra, Spain; H. Jaén, Jaén, Spain; Amgen, S.A., Barcelona, Spain; H. Universitario de Salamanca, Salamanca, Spain
| | - M. Doménech
- Clinica Benidorm, Barcelona, Spain; Althaia, Barcelona, Spain; H. Sagrat Cor, Barcelona, Spain; H. Virgen de las Nieves, Granada, Spain; H. del Mar, Barcelona, Spain; H. de Pontevedra, Pontevedra, Spain; H. Jaén, Jaén, Spain; Amgen, S.A., Barcelona, Spain; H. Universitario de Salamanca, Salamanca, Spain
| | - J. C. Bermejo
- Clinica Benidorm, Barcelona, Spain; Althaia, Barcelona, Spain; H. Sagrat Cor, Barcelona, Spain; H. Virgen de las Nieves, Granada, Spain; H. del Mar, Barcelona, Spain; H. de Pontevedra, Pontevedra, Spain; H. Jaén, Jaén, Spain; Amgen, S.A., Barcelona, Spain; H. Universitario de Salamanca, Salamanca, Spain
| | - P. López
- Clinica Benidorm, Barcelona, Spain; Althaia, Barcelona, Spain; H. Sagrat Cor, Barcelona, Spain; H. Virgen de las Nieves, Granada, Spain; H. del Mar, Barcelona, Spain; H. de Pontevedra, Pontevedra, Spain; H. Jaén, Jaén, Spain; Amgen, S.A., Barcelona, Spain; H. Universitario de Salamanca, Salamanca, Spain
| | - C. Pedro
- Clinica Benidorm, Barcelona, Spain; Althaia, Barcelona, Spain; H. Sagrat Cor, Barcelona, Spain; H. Virgen de las Nieves, Granada, Spain; H. del Mar, Barcelona, Spain; H. de Pontevedra, Pontevedra, Spain; H. Jaén, Jaén, Spain; Amgen, S.A., Barcelona, Spain; H. Universitario de Salamanca, Salamanca, Spain
| | - K. Villadiego
- Clinica Benidorm, Barcelona, Spain; Althaia, Barcelona, Spain; H. Sagrat Cor, Barcelona, Spain; H. Virgen de las Nieves, Granada, Spain; H. del Mar, Barcelona, Spain; H. de Pontevedra, Pontevedra, Spain; H. Jaén, Jaén, Spain; Amgen, S.A., Barcelona, Spain; H. Universitario de Salamanca, Salamanca, Spain
| | - M. Constenla
- Clinica Benidorm, Barcelona, Spain; Althaia, Barcelona, Spain; H. Sagrat Cor, Barcelona, Spain; H. Virgen de las Nieves, Granada, Spain; H. del Mar, Barcelona, Spain; H. de Pontevedra, Pontevedra, Spain; H. Jaén, Jaén, Spain; Amgen, S.A., Barcelona, Spain; H. Universitario de Salamanca, Salamanca, Spain
| | - P. Sánchez-Rovira
- Clinica Benidorm, Barcelona, Spain; Althaia, Barcelona, Spain; H. Sagrat Cor, Barcelona, Spain; H. Virgen de las Nieves, Granada, Spain; H. del Mar, Barcelona, Spain; H. de Pontevedra, Pontevedra, Spain; H. Jaén, Jaén, Spain; Amgen, S.A., Barcelona, Spain; H. Universitario de Salamanca, Salamanca, Spain
| | - J. A. Gasquet
- Clinica Benidorm, Barcelona, Spain; Althaia, Barcelona, Spain; H. Sagrat Cor, Barcelona, Spain; H. Virgen de las Nieves, Granada, Spain; H. del Mar, Barcelona, Spain; H. de Pontevedra, Pontevedra, Spain; H. Jaén, Jaén, Spain; Amgen, S.A., Barcelona, Spain; H. Universitario de Salamanca, Salamanca, Spain
| | - C. A. Rodríguez
- Clinica Benidorm, Barcelona, Spain; Althaia, Barcelona, Spain; H. Sagrat Cor, Barcelona, Spain; H. Virgen de las Nieves, Granada, Spain; H. del Mar, Barcelona, Spain; H. de Pontevedra, Pontevedra, Spain; H. Jaén, Jaén, Spain; Amgen, S.A., Barcelona, Spain; H. Universitario de Salamanca, Salamanca, Spain
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Pettengell R, Bosly A, Szucs TD, Jackisch C, Leonard R, Paridaens R, Constenla M, Schwenkglenks M. Multivariate analysis of febrile neutropenia occurrence in patients with non-Hodgkin lymphoma: data from the INC-EU Prospective Observational European Neutropenia Study. Br J Haematol 2009; 144:677-85. [PMID: 19055662 PMCID: PMC2680267 DOI: 10.1111/j.1365-2141.2008.07514.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [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: 08/29/2008] [Accepted: 10/16/2008] [Indexed: 11/27/2022]
Abstract
Myelosuppression, particularly febrile neutropenia (FN), are serious dose-limiting toxicities that occur frequently during the first cycle of chemotherapy. Identifying patients most at risk of developing FN might help physicians to target prophylactic treatment with colony-stimulating factor (CSF), in order to decrease the incidence, or duration, of myelosuppression and facilitate delivery of chemotherapy as planned. We present a risk model for FN occurrence in the first cycle of chemotherapy, based on a subgroup of 240 patients with non-Hodgkin lymphoma (NHL) enroled in our European prospective observational study. Eligible patients had an International Prognostic Index of 0-3, and were scheduled to receive a new myelosuppressive chemotherapy regimen with at least four cycles. Clinically relevant factors significantly associated with cycle 1 FN were older age, increasing planned cyclophosphamide dose, a history of previous chemotherapy, a history of recent infection, and low baseline albumin (<35 g/l). Prophylactic CSF use and higher weight were associated with a significant protective effect. The model had high sensitivity (81%) and specificity (80%). Our model, together with treatment guidelines, may rationalise the clinical decision of whether to support patients with CSF primary prophylaxis based on their risk factor profile. Further validation is required.
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Affiliation(s)
- Ruth Pettengell
- Cellular and Molecular Medicine, St George's University of London, Cranmer Terrace, London, UK.
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Aranda E, Valladares M, Martinez-Villacampa M, Benavides M, Gomez A, Massutti B, Marcuello E, Constenla M, Cámara J, Carrato A, Dueñas R, Reboredo M, Navarro M, Díaz-Rubio E. Randomized study of weekly irinotecan plus high-dose 5-fluorouracil (FUIRI) versus biweekly irinotecan plus 5-fluorouracil/leucovorin (FOLFIRI) as first-line chemotherapy for patients with metastatic colorectal cancer: a Spanish Cooperative Group for the Treatment of Digestive Tumors Study. Ann Oncol 2009; 20:251-7. [DOI: 10.1093/annonc/mdn557] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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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47
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Rosell R, Robinet G, Szczesna A, Ramlau R, Constenla M, Mennecier BC, Pfeifer W, O'Byrne KJ, Welte T, Kolb R, Pirker R, Chemaissani A, Perol M, Ranson MR, Ellis PA, Pilz K, Reck M. Randomized phase II study of cetuximab plus cisplatin/vinorelbine compared with cisplatin/vinorelbine alone as first-line therapy in EGFR-expressing advanced non-small-cell lung cancer. Ann Oncol 2007; 19:362-9. [PMID: 17947225 DOI: 10.1093/annonc/mdm474] [Citation(s) in RCA: 225] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Lung Cancer Cetuximab Study is an open-label, randomized phase II pilot study of cisplatin and vinorelbine combined with the epidermal growth factor receptor (EGFR)-targeted monoclonal antibody cetuximab versus cisplatin and vinorelbine alone, in patients with advanced EGFR-expressing, non-small-cell lung cancer (NSCLC). End points of the study are activity, safety and pharmacokinetics. PATIENTS AND METHODS Following randomization, for a maximum of eight cycles, patients received three-weekly cycles of cisplatin (80 mg/m(2), day 1) and vinorelbine (25 mg/m(2) on days 1 and 8) alone or following cetuximab treatment (initial dose 400 mg/m(2), followed by 250 mg/m(2) weekly thereafter). RESULTS Eighty-six patients were randomly allocated to the study (43 per arm). Confirmed response rates were 28% in the cisplatin/vinorelbine arm (A) and 35% in the cetuximab plus cisplatin/vinorelbine arm (B). Median progression-free survival (PFS) was 4.6 months in arm A and 5.0 months in arm B, with PFS rates at 12 months of 0% and 15%, respectively. Median survival was 7.3 months in arm A and 8.3 months in arm B. The 24-month survival rates were 0% and 16%, respectively. The cetuximab combination was well tolerated. CONCLUSION In the first-line treatment of advanced NSCLC, the combination of cetuximab plus cisplatin/vinorelbine demonstrated an acceptable safety profile and the potential to improve activity over cisplatin/vinorelbine alone.
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Affiliation(s)
- R Rosell
- Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.
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48
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Ajani JA, Moiseyenko VM, Tjulandin S, Majlis A, Constenla M, Boni C, Rodrigues A, Fodor M, Chao Y, Voznyi E, Awad L, Van Cutsem E. Quality of life with docetaxel plus cisplatin and fluorouracil compared with cisplatin and fluorouracil from a phase III trial for advanced gastric or gastroesophageal adenocarcinoma: the V-325 Study Group. J Clin Oncol 2007; 25:3210-6. [PMID: 17664468 DOI: 10.1200/jco.2006.08.3956] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Therapy of patients with advanced gastric or gastroesophageal junction cancer should provide symptom relief and improve quality of life (QOL) because most patients are symptomatic at baseline. Using validated instruments, we prospectively assessed QOL (even after completion of protocol treatment) as one of the secondary end points of the V325 phase III trial. PATIENTS AND METHODS Four hundred forty-five patients randomly received either docetaxel 75 mg/m(2) and cisplatin 75 mg/m(2) each on day 1 plus fluorouracil 750 mg/m(2)/d continuous infusion on days 1 to 5 every 3 weeks (DCF) or cisplatin 100 mg/m(2) on day 1 plus fluorouracil 1,000 mg/m(2)/d continuous infusion on days 1 to 5 every 4 weeks (CF). The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) and, where available, the EuroQOL EQ-5D questionnaire were administered every 8 weeks from baseline until progression and then every 3 months. Time to definitive deterioration of QOL parameters was analyzed. RESULTS The proportions of patients having assessable EORTC QLQ-C30 and EQ-5D questionnaires at baseline were 86.0% and 78.7% with DCF, respectively, and 89.7% and 92.8% with CF, respectively. Time to 5% deterioration of global health status (primary end point) significantly favored DCF over CF (log-rank test, P = .01). QOL was preserved longer for patients on DCF than those on CF for all time to deterioration analyses, demonstrating the statistical superiority of DCF compared with CF. CONCLUSION V325 represents the largest trial with the longest prospectively controlled evaluations of QOL during protocol chemotherapy and follow-up in patients with advanced gastric or gastroesophageal junction cancer. In V325, advanced gastric or gastroesophageal junction cancer patients receiving DCF not only had statistically improved overall survival and time to tumor-progression, but they also had better preservation of QOL compared with patients receiving CF.
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Affiliation(s)
- Jaffer A Ajani
- Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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49
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Ajani JA, Moiseyenko VM, Tjulandin S, Majlis A, Constenla M, Boni C, Rodrigues A, Fodor M, Chao Y, Voznyi E, Marabotti C, Van Cutsem E. Clinical benefit with docetaxel plus fluorouracil and cisplatin compared with cisplatin and fluorouracil in a phase III trial of advanced gastric or gastroesophageal cancer adenocarcinoma: the V-325 Study Group. J Clin Oncol 2007; 25:3205-9. [PMID: 17664467 DOI: 10.1200/jco.2006.10.4968] [Citation(s) in RCA: 208] [Impact Index Per Article: 12.2] [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: 02/06/2023] Open
Abstract
PURPOSE For patients with advanced gastric or gastroesophageal cancer (AGGEC) providing clinical benefit with improved palliation is highly desirable. However, a prospective evaluation of clinical benefit in AGGEC patients has never before been reported in a phase III setting. PATIENTS AND METHODS In a multinational trial (V325), 445 patients were randomly assigned and treated with either docetaxel plus cisplatin and fluorouracil (DCF) or cisplatin and fluorouracil (CF). Clinical benefit was prospectively evaluated in this trial as a secondary end point. The primary measure for clinical benefit analysis was time to definitive worsening by one or more categories of Karnofsky performance status (KPS). Secondary clinical benefit end points included time to 5% definitive weight loss, time to definitive worsening of appetite by one grade, pain-free survival (defined as time to first appearance of pain), and time to first cancer pain-related opioid intake. Clinical benefit assessments were recorded at each clinic visit. RESULTS Clinical benefit assessments were performed in more than 75% of patients throughout V325. DCF significantly prolonged time to definitive worsening of KPS compared with CF (median, 6.1 v 4.8 months; hazard ratio, 1.38; 95% CI, 1.08 to 1.76; log-rank P = .009). Although time to definitive weight loss and time to definitive worsening of appetite favored DCF, the results were not statistically significant. Pain-free survival and time to first cancer pain-related opioid intake were comparable. CONCLUSION To our knowledge, V325 is the first phase III trial to report clinical benefit in AGGEC patients. Clinical benefit was assessed beyond protocol-specific chemotherapy. The addition of D to CF not only significantly improved clinical benefit but also improved quality of life, time to progression, and overall survival compared with CF.
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Affiliation(s)
- Jaffer A Ajani
- Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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50
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Romieu G, Clemens M, Mahlberg R, Fargeot P, Constenla M, Schütte M, Easton V, Skacel T, Bacon P, Brugger W. Pegfilgrastim supports delivery of FEC-100 chemotherapy in elderly patients with high risk breast cancer: a randomized phase 2 trial. Crit Rev Oncol Hematol 2007; 64:64-72. [PMID: 17317205 DOI: 10.1016/j.critrevonc.2006.12.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2006] [Revised: 12/19/2006] [Accepted: 12/19/2006] [Indexed: 10/23/2022] Open
Abstract
This randomized phase 2 study explored the feasibility of delivering four to six cycles of the dose-intensified regimen FEC-100 (5-fluorouracil, epirubicin, and cyclophosphamide) to elderly patients with stage II-III breast cancer, using pegfilgrastim for neutrophil support. Sixty patients aged 65-77 years received single 6mg doses of pegfilgrastim on day 2 of FEC-100, either as primary prophylaxis (all cycles: PP), or as secondary prophylaxis (all cycles following a neutropenic event: SP). Neutropenic events (a composite endpoint that included grade 3 neutropenia+fever, grade 4 neutropenia, infectious complication requiring systemic anti-infectives and chemotherapy dose delay/reduction) occurred in 24/30 (80%) of the PP and 21/29 (72%) of the SP group in the first cycle. Most patients received all chemotherapy cycles at full dose on schedule (26/30 [87%] PP; 20/29 [69%] SP). These data indicate that delivery of FEC-100 is feasible with pegfilgrastim support in elderly breast cancer patients.
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Affiliation(s)
- G Romieu
- CRLC Val d'Aurelle, Montpellier, France
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