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Cunha MT, Gouveia MC, Neto FL, Testa L, Hoff PM, de Azambuja E, Bonadio RC. Long-term outcomes of neoadjuvant immunotherapy plus chemotherapy in patients with early-stage triple-negative breast cancer: an extracted individual patient data and trial-level meta-analysis. Br J Cancer 2024; 130:242-250. [PMID: 38012381 PMCID: PMC10803354 DOI: 10.1038/s41416-023-02501-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/30/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Neoadjuvant immunotherapy (nIO) has emerged as a treatment option for stage II-III triple-negative breast cancer (TNBC). While randomised clinical trials (RCTs) demonstrated pathological complete response rate benefit to nIO added to chemotherapy, additional data on long-term outcomes is warranted. We performed this analysis to evaluate long-term efficacy outcomes of nIO in TNBC. METHODS We searched databases for RCTs evaluating nIO in early-stage TNBC. A meta-analysis of extracted individual patient data (EIPD) was performed to evaluate EFS and OS, with data from reported Kaplan-Meier plots. Additionally, we conducted a trial-level meta-analysis using fixed and random effects models. RESULTS The literature search resulted in four included RCTs with available EFS or OS (KEYNOTE-522, IMpassion031, I-SPY2 and GeparNuevo). EIPD showed that the addition of nIO to chemotherapy provides statistically significant benefits in EFS (HR 0.62, 0.50-0.76; p < 0.001) and OS (HR 0.62, 0.46-0.82, p < 0.001). Number needed to treat to avoid one EFS or OS event in 4 years was 9 and 14, respectively. Trial-level meta-analysis yielded similar results (EFS: HR 0.64, 0.51-0.79; OS: 0.57, 0.37-0.89). CONCLUSIONS Results show that nIO combined with chemotherapy can provide significant EFS and OS benefits, supporting its use as standard treatment for early-stage TNBC.
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Affiliation(s)
- Mateus Trinconi Cunha
- Instituto do Câncer do Estado de São Paulo, University of São Paulo, São Paulo, Brazil.
| | | | - Felippe Lazar Neto
- Instituto do Câncer do Estado de São Paulo, University of São Paulo, São Paulo, Brazil
| | - Laura Testa
- Instituto do Câncer do Estado de São Paulo, University of São Paulo, São Paulo, Brazil
- Instituto D'Or de Pesquisa e Ensino (IDOR), São Paulo, Brazil
| | - Paulo Marcelo Hoff
- Instituto do Câncer do Estado de São Paulo, University of São Paulo, São Paulo, Brazil
- Instituto D'Or de Pesquisa e Ensino (IDOR), São Paulo, Brazil
| | - Evandro de Azambuja
- Université Libre de Bruxelles (U.L.B), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Brussels, Belgium
| | - Renata Colombo Bonadio
- Instituto do Câncer do Estado de São Paulo, University of São Paulo, São Paulo, Brazil
- Instituto D'Or de Pesquisa e Ensino (IDOR), São Paulo, Brazil
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Nogueira-Rodrigues A, Rosa DD, Suzuki DA, Paulino E, Landeiro LCG, Scaranti M, Madi MR, Hoff PM. Breast and gynecologic cancers as a Brazilian health priority. Rev Assoc Med Bras (1992) 2023; 69:e2023S120. [PMID: 37556639 PMCID: PMC10411703 DOI: 10.1590/1806-9282.2023s120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/17/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE Cancer imposes a profound burden on low- and middle-income countries where 65% of the global cancer deaths occurred in 2020. The objective of the present review was to describe female cancer epidemiology in Brazil, barriers to prevention, screening, and treatment, and to propose strategies to a better control. METHODS For the process of literature search and scientific acquisition, we have utilized the terms "female cancer" AND "breast cancer," AND "cervical cancer" AND "endometrial cancer" AND "ovarian cancer" AND "Brazil" in PubMed. References of the articles included in this review were manually searched in order to identify relevant studies on the topic. The official Brazilian epidemiology data were extensively analyzed at the governmental site www.inca.gov.br. RESULTS Considering cases of breast and gynecologic cancers together, 105,770 new cases are expected to be diagnosed yearly, positioning female cancer as the highest cancer incidence in Brazil. Female breast cancer is the most common and the leading cause of death from cancer in the female population in all regions of Brazil, except in the North, where cervical cancer ranks first. Cervical cancer, a preventable disease, corresponds to the third-most common neoplasia in women, with higher incidences in the North and Northeast regions of Brazil. An upward trend has been observed in endometrial cancer incidence, a tendency that follows the increase of its two most common risk factors: population aging and obesity. Ovarian cancer currently occupies the eighth position among female cancers in Brazil, but it is the most lethal gynecologic cancer. The main strategies to reduce female cancer mortality rates are the reduction of inequalities in healthcare services and the early diagnosis of cases. The lack of a specific national cancer program results in a reactive and unplanned approach to healthcare provision, ultimately leading to suboptimal resource utilization and higher expenditure. CONCLUSION Analyzed together, breast and gynecologic cancers correspond to the leading cause of cancer in Brazil. A heterogeneous group, female cancer includes diseases with a high primary and secondary prevention potential. The organization of a female cancer program in Brazil prioritizing primary and secondary prevention strategies, such as adequate mammography screening and human papillomavirus vaccination coverage, could significantly improve female cancer control in the country.
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Affiliation(s)
| | | | | | - Eduardo Paulino
- Sociedade Brasileira de Oncologia Clínica – São Paulo (SP), Brazil
| | | | - Mariana Scaranti
- Sociedade Brasileira de Oncologia Clínica – São Paulo (SP), Brazil
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Peixoto D, Callia JPB, Bittencourt MS, Generoso G, Anastácio VM, Alves-Jr JL, Silva TLD, Belizário JC, Araújo BLM, Ho W, Diz MDPE, Hoff PM, Abdala E, Ibrahim KY. Clinical presentation and in-hospital prognosis of lung cancer patients presenting with suspected and confirmed COVID-19. Braz J Med Biol Res 2022; 55:e12140. [PMID: 36102415 PMCID: PMC9467285 DOI: 10.1590/1414-431x2022e12140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/13/2022] [Indexed: 01/08/2023] Open
Abstract
We sought to compare the clinical presentation and prognosis of patients with lung cancer and confirmed COVID-19 infection to those with negative RT-PCR SARS-CoV-2 results. We included patients with confirmed lung cancer and suspected COVID-19 who presented to the emergency department. The primary outcome was in-hospital mortality and secondary outcomes included admission to intensive care unit (ICU) or mechanical ventilation. We analyzed the characteristics according to RT-PCR results and primary outcome. We constructed a logistic regression for each RT-PCR result group to find potential predictors of the primary outcome. Among 110 individuals with confirmed lung cancer (65±9 years, 51% male), 38 patients had positive RT-PCR and 72 patients had negative RT-PCR. There was no difference between groups for any clinical characteristic or comorbidities though individuals with confirmed COVID-19 had higher functionality in the ECOG scale. Leucocytes and lymphocytes were lower in individuals with positive tests. The primary outcome occurred in 58 (53%) individuals, 37 (34%) were admitted to the ICU, and 29 (26%) required mechanical ventilation. Although mortality was similar between the two groups, individuals with confirmed COVID-19 were significantly more likely to be admitted to the ICU or receive mechanical ventilation. Only lower lymphocytes and higher CRP were significantly associated with higher mortality. The clinical presentation of COVID-19 in lung cancer is not sufficient to identify higher or lower probability groups among symptomatic individuals, the overall mortality is high irrespective of RT-PCR results, and lymphopenia on admission was associated with the diagnosis and prognosis for COVID-19.
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Affiliation(s)
- D Peixoto
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - J P B Callia
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M S Bittencourt
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - G Generoso
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - V M Anastácio
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - J L Alves-Jr
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - T L da Silva
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - J C Belizário
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - B L M Araújo
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - W Ho
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M D P E Diz
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - P M Hoff
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - E Abdala
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - K Y Ibrahim
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Braghiroli MI, Vicentini MFB, Fonseca LGD, Souza KT, Bonadio RC, Braghiroli OFM, Mathias MCM, Talans A, Zambrano Mendoza ME, Martins JG, Sabagga J, Moniz CVMV, Hoff PM. Irinotecan combined with Panitumumab or cetuximab as third-line treatment for metastatic colorectal cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e15551] [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
e15551 Background: Literature suggests that the addition of cetuximab can overcome the resistance to irinotecan treatment for metastatic colorectal cancer (mCRC). It is unknown if the combination of panitumumab with irinotecan could also revert treatment resistance and offer a better response rate after progression on irinotecan monotherapy. In this study, we aim to compare the impact of panitumumab plus irinotecan (P+I) or cetuximab plus irinotecan (C+I) on overall survival as a third line mCRC treatment. Methods: This is a single institution, retrospective cohort analysis, evaluating the overall survival of mCRC patients exposed to an anti-EGFR antibody plus irinotecan, upon progression on irinotecan monotherapy. Overall survival function was estimated using the Kaplan-Meier method and compared using the log-rank test. Results: We identified 460 patients with mCRC that fulfilled inclusion criteria, treated between July 2008 and April 2018. One hundred eighty-three (183) patients received (I+C), and 277 received (I+P). Upon diagnosis, the median age was 55.9 years (range, 19 - 83 years), with a male to female ratio of 1.3:1. All patients received the combination of irinotecan and anti-EGFR targeting antibodies for at least one cycle (D1 and D15). Partial response occurred in 22.6% of patients [23.5% for (I+C) and 22.0% for (I+P)], and 25,2% had stable disease [27.8% for (I+C) and 23.6% for (I+P)]. Interestingly, response rate in patients with right-sided tumors was 3.3% in the (I+C) regimen and 14.3% in the (I+P) regimen. The disease control rate was 50.3% in the (I+C) combination and 45.7% in the (I+P) combination (p = 0.358). The median overall survival (mOS) for all patients was 9.63 months, 8.97 to the group C+I and 10.74 to P+I (p = 0.73). Regarding primary tumor location, the mOS was 6.34 mo for right-sided tumors and 10.74 mo for left-sided tumors (p = 0.022). The 3-year survival rate was 5.6% for the (C+I) treated patients and 3.2% for (P+I). Conclusions: (P+I) and (C+I) combinations showed similar response rate and mOS as a third-line treatment for mCRC, suggesting that both anti-EGFR agents can be used in this setting. A perceived tendency for a superior response with the (I+P) regimen in right-sided tumors might warrant further investigation in prospective studies.
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Affiliation(s)
| | | | | | | | | | | | | | - Aley Talans
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | | | | | - Jorge Sabagga
- Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | | | - Paulo Marcelo Hoff
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
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Hidalgo Filho CMT, Lazar Neto F, Da Rocha JW, Bonadio RC, Hoff PM. Impact of readmission for patients with cancer in a public health system. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18633] [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
e18633 Background: Patients with cancer have high mortality during hospitalization and poor prognosis after discharge. However, most evidence comes from developed countries where early diagnosis is common and a higher number of treatment options are available. In addition, socioeconomic disparity is also known to impact on cancer prognosis. We aimed to investigate the impact of hospitalizations, early readmissions, and Human Development Index (HDI) among cancer patients in a public tertiary hospital in Brazil. Methods: A retrospective study was conducted including patients admitted at a Brazilian tertiary cancer center from February 1st to November 30th of 2021. Data was collected from patients' electronic health records. COVID-19 diagnosed patients were excluded. We evaluated 7-day and 30-day readmission rate, and post-discharge survival. We retrieved patients' home address region HDI from the latest Brazilian Census and investigated if it would affect hospitalization and post-discharge outcomes. Overall survival (OS) after discharge was compared between groups with log-rank test and categorical variables proportions with chi-square test. Results: A total of 3711 patients were included during the period. The median age was 64 years (IQR 53-72); nearly half were female (51%). The most common cancer diagnosis was breast cancer (538, 15%) followed by prostate (308, 8.4%), colon (298, 8.1%) and lung (269, 7.3%). The median hospitalization length was 6 days (IQR 4-11). The overall in-hospital mortality rate was 20% (n = 734). Patients initially admitted to the Intensive Care Unit (ICU) had a higher mortality compared to wards (44% vs 17%, p < 0.001). Of those discharged, 9.9% and 28% of the patients were readmitted within 7 and 30 days, respectively. The median overall survival (mOS) of the discharged patients was 182 days (95% CI 160-201 days). Early readmission within 7 and 30 days were associated with poorer overall survival after discharge (Table, p < 0.001). We have not found any association between the HDI and in-hospital mortality, rate of readmissions or overall survival after discharge. Conclusions: Early readmission is an important prognostic factor and should be taken into consideration when discussing post-discharge treatment objectives. HDI does not seem to affect neither hospitalization nor survival outcomes in a publicly funded cancer center.[Table: see text]
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Affiliation(s)
| | | | | | | | - Paulo Marcelo Hoff
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
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Lazar Neto F, Hidalgo Filho CMT, Da Rocha JW, Bonadio RC, Hoff PM. Hospitalization and post-discharge survival outcomes of adolescents and young adults with cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18687] [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
e18687 Background: Cancer incidence has increased among adolescents and young adults (AYA) over the last two decades. Younger patients often present with late diagnosis, aggressive disease, and are more likely to receive chemotherapy during cancer treatment. We investigated admission outcomes and post-discharge survival of AYA who were hospitalized after urgent admission. Methods: Retrospective cohort of patients with solid tumor diagnosis and age between 18 and 39 years, hospitalized after urgent admission to a tertiary, publicly-funded, cancer hospital in São Paulo, Brazil, from February 1st to December 31th 2021. We excluded patients with positive COVID-19 RT-PCR. We collected data on gender, cancer diagnosis, length of hospital stay, in-hospital mortality, chemotherapy infusion either before and during hospitalization; and last-follow up date and status. AYA admissions were compared to older adults (≥ 40 years [non-AYA]) admissions with chi-squared test. Overall survival (OS) after discharge between groups was analyzed with the log-rank test. Results: Of 4011 admissions, 312 were AYA. The median age was 34 (IQR 29-38) and most patients were female (63%). Compared to older adults (N = 3699), a higher proportion of AYA patients had breast cancer (25% vs 15%), central nervous system cancer (8.4% vs 2.6%), cervical cancer (12% vs 2.7%) and germinative cancer (4.5% vs 0.3%). The median length of hospital stay was 6 days (IQR 4-10). AYA were more likely to be under chemotherapy treatment during (11% versus 4%, p = 0.001) and within 30 days before hospitalization (32% vs 20%, p = 0.001). The overall in-hospital mortality rate was lower among AYA compared to older adults during the same period (12% vs 20%, p = 0.01). However, of those who died, a higher proportion were prescribed chemotherapy infusion before (38% vs 19%, p = 0.004) and during (15% vs 3.3%, p = 0.003) hospitalization; and a higher number of patients deceased on intensive-care unit beds, although the difference was not statistically significant (46% versus 36%, p = 0.2). Despite similar rates of 30-days readmissions (29% versus 26%, p = 0.3), AYA had better prognosis after discharge (mOS 295 days versus 181 days, p = 0.002). Conclusions: AYA patients had better hospitalization outcomes and were more likely to receive aggressive care near the end of life. Despite similar rates of early (≤ 30 days) readmissions, AYA had higher median overall survival after discharge compared to older adults. These finding should be taken into consideration when discussing hospitalization goals during admission of AYA with cancer.
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Affiliation(s)
| | | | | | | | - Paulo Marcelo Hoff
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
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7
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Moniz CMV, Riechelmann RP, Oliveira SCR, Bariani GM, Rivelli TG, Ortega C, Pereira AAL, Meireles SI, Franco R, Chen A, Bonadio RC, Nahas C, Sabbaga J, Coudry RA, Braghiroli MI, Hoff PM. A Prospective Cohort Study of Biomarkers in Squamous Cell Carcinoma of the Anal Canal (SCCAC) and their Influence on Treatment Outcomes. J Cancer 2021; 12:7018-7025. [PMID: 34729104 PMCID: PMC8558650 DOI: 10.7150/jca.57678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 10/05/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Although Chemoradiation (CRT) is the curative treatment for SCCAC, many patients present primary resistance. Since it is a rare tumor, response predictors remain unknown. Methods: We performed a prospective cohort study to evaluate biomarkers associated with CRT response, progression-free survival (PFS), and overall survival (OS). The primary endpoint was response at 6 months (m). Tumor DNA and HPV were analyzed by next-generation sequencing, while KI-67 and PD-L1 by immunohistochemistry in tumor tissue. Results: Seventy-eight patients were recruited between October/2011 and December/2015, and 75 were response evaluable. The median age was 57 years, 65% (n=49) were stage III and 12% (n=9) were HIV positive (HIV+). At 6m, 62.7% (n=47) presented CR. On multivariate analyses, stage II patients were 4.7 more likely to achieve response than stage III (OR, 4.70; 95%CI, 1.36-16.30; p=0.015). HIV+ was associated with a worse response (OR, 5.72; 95%CI, 2.5-13.0; p<0.001). 5-year PFS and OS rates were 63.3% and 76.4%, respectively, with a median follow up of 66m. On multivariate analyses, older age (HR 1.06, p=0.022, 95%IC 1.01-1.11) and absence of CR at 6m (HR 3.36, p=0.007, 95%IC 1.39-8.09) were associated with inferior OS. The 5-year OS rate was 62.5% in HIV+ group compared to 78% among HIV- pts, although this difference was not statistically significant (p=0.4). PIK3CA, MET and TP53 mutations, HPV, Ki-67 expression, and PD-L1 expression, were not associated with PFS and OS. Conclusions: Clinical stage III and HIV+ were associated with worse response to CRT at 6m. The absence of CR was the main factor associated with poor 5-year OS.
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Affiliation(s)
- Camila Motta Venchiarutti Moniz
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.,Instituto D'Or de Pesquisa e Ensino - IDOR, Sao Paulo, SP, BR
| | | | | | - Giovanni Mendonça Bariani
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Thomas Giollo Rivelli
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Cintia Ortega
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | | | - Rejane Franco
- Universidade Federal do Paraná - Hospital de Clínicas, Curitiba, PR, Brasil
| | - Andre Chen
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Renata Colombo Bonadio
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Caio Nahas
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Jorge Sabbaga
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Maria Ignez Braghiroli
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.,Instituto D'Or de Pesquisa e Ensino - IDOR, Sao Paulo, SP, BR
| | - Paulo Marcelo Hoff
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.,Instituto D'Or de Pesquisa e Ensino - IDOR, Sao Paulo, SP, BR
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Peixoto RD, Coutinho AK, Weschenfelder RF, Prolla G, Rocha D, Andrade AC, Rego JF, Fernandes GDS, Crosara M, Hoff PM, Dienstmann R, Costa E Silva M, Riechelmann RP. Fluorouracil Bolus Use in Infusional Regimens Among Oncologists-A Survey by Brazilian Group of Gastrointestinal Tumors. JCO Glob Oncol 2021; 7:1270-1275. [PMID: 34383598 PMCID: PMC8389882 DOI: 10.1200/go.21.00167] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The utility of administering fluorouracil (5-FU) in bolus in regimens of infusional 5-FU has been questioned. We aimed to quantify the use of 5-FU bolus in infusional regimens for gastrointestinal malignancies among Brazilian oncologists. METHODS This was a cross-sectional electronic survey composed of eight multiple-choice questions sent to Brazilian oncologists during 14 days in February 2021. The survey instrument collected demographic data of participants and assessed practices in terms of 5-FU bolus use. We evaluated the association of demographic variables and 5-FU prescribing patterns with Fisher’s exact test (odds ratio [OR]). RESULTS The survey was completed by 332 medical oncologists. Overall, 37% were experienced oncologists and 32% were gastrointestinal specialists. In the first-line metastatic and in the adjuvant settings, 40% and 67% of oncologists always prescribe 5-FU bolus in infusional regimens, respectively. Experienced oncologists more frequently omit 5-FU bolus when compared with early-career oncologists, both in the metastatic (41% v 26%; OR, 1.98; P = .005) and adjuvant settings (28% v 14%; OR, 2.32; P = .003). In addition, more GI specialists remove 5-FU bolus when compared with generalists, but only in the metastatic setting (44% v 25%; OR, 2.33; P = .001). GI specialists are more likely to consider that treatment efficacy is not affected by 5-FU bolus withdrawal than are generalists (89% v 75%; OR, 2.65; P = .003). Most respondents (67%) keep leucovorin at the same doses when omitting 5-FU bolus, and only 16% always recommend dihydropyrimidine dehydrogenase testing. CONCLUSION Our survey indicates that experience in oncology practice and percentage of time dedicated to treat GI cancers influence the prescription of 5-FU bolus in Brazil, with more frequent omission of it among experienced gastrointestinal specialists, particularly in the metastatic setting.
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Affiliation(s)
| | - Anelisa K Coutinho
- Clínica AMO: GEM Assistencia Medica Especializada Sociedade Simples Ltda, Salvador, Brazil
| | | | - Gabriel Prolla
- PUCRS: Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Juliana Florinda Rego
- Onofre Lopes University Hospital: Hospital Universitario Onofre Lopes, Natal, Brazil
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Dornellas A, Moraes PM, Victor CR, Bonadio RC, Braghiroli MI, Chen ATC, Ortega C, Nahas C, Hoff PM, Moniz CMV. Definitive chemoradiotherapy for squamous cell carcinoma of the anal canal (SCCAC) with cisplatin and capecitabine: A prospective cohort—preliminary results. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e15506] [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
e15506 Background: SCCAC is a rare disease. The standard care treatment with curative intent is chemoradiation with mitomycin (MMC) or cisplatin (CDDP) plus infusional 5-FU. Capecitabine may replace 5-FU in MMC doublet. However, MMC and infusional pumps are unavailable in many underdeveloped countries, and there is a lack of prospective data regarding the feasibility and safety of capecitabine combined with CDDP in definitive chemoradiotherapy. Methods: A Prospective cohort study aimed to evaluate the safety and efficacy of treatment with chemoradiation with CDDP60mg/m2 D1 and D29 plus capecitabine 825mg/m2/day BID in a population without MMC and infusional pump access. Eligible pts had T2-4/N0-3/M0 disease and were candidates to full curative CRT. Toxicity evaluation was the primary endpoint, secondary endpoint was response by RECIST v.1.1 at 8 weeks(w) and 6 months(m). The study data were prospectively collected using REDCap. Results: 23 pts were enrolled from Aug/2019 to Oct/2020 with a median follow-up of 7m. Median age 59 years; 76% (n=16) were stage III, 48% (n=11) were ECOG1, and 15% (n=3) were HIV+. All pts received concomitant radiotherapy, MVAT, with a median dose 54Gy in the primary tumor and 45Gy in elective nodes. At 8w, 18 patients were evaluable for response, 56% (n=10) had complete response (CR),39% (n=7) had partial response (PR) and 5% (n=1) progressive disease (PD). At 6 months 11 patients were evaluable for response, 64%(n=7) had CR, 18% (n=2) PR and 18% (n=2) PD. Any grade 3/4 toxicity was present in six pts, four of them radiodermatitis. The most frequent grade toxicities were nausea and radiodermatitis in all pts, anemia 81% (n=17), diarrhea 62% (n=13). Two older pts had definitive suspension of treatment due to toxicity. Three pts had hospitalization because of a skin infection. Six pts had disease recurrence, and two died by the cutoff date. One death related to diarrhea and vomiting toxicity in an older 84-year pt. OS and PFS are not reached. Conclusions: Definitive chemoradiotherapy with cisplatin and capecitabine is feasible; however, the older population is more vulnerable to treatment complications. Further prospective studies with a higher number of patients and longer follow up are required to evaluate SLP and OS.
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Affiliation(s)
- Abraão Dornellas
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | - Cinthia Ortega
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Caio Nahas
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Marcelo Hoff
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
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10
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Araujo HA, Moniz CMV, Braghiroli OFM, Mak MP, Uratani LF, Dahmer Tiecher R, Moraes PM, Barbosa I, Camargo VPD, Braghiroli MIFM, Castro G, Hoff PM, Diz MDP. Proton pump inhibitors and antibiotics impact on toxicities and clinical outcomes in cancer patients treated with immunotherapy. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.2652] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2652 Background: Gut microbiome dysbiosis impairs systemic immune responses and recent evidence suggests its critical role in patients (pts) treated with immune checkpoint inhibitors (ICI). Proton pump inhibitors (PPI) and antibiotics (ATB) may alter the microbiome and their impact on clinical outcomes and toxicities requires further investigation. Methods: This retrospective cohort included consecutive metastatic cancer pts treated with ICI with palliative intent. We reviewed pts' records, concomitant medication and toxicities graded by CTCAE 4.0. Pts with PPI or ATB exposure were analyzed according to previous use (pPPI and pATB, ≤60 days to ICI) and concomitant use (cPPI and cATB). We estimated median overall survival (mOS) and progression free survival (PFS) by Kaplan–Meier and used a Cox proportional-hazards model to adjust for differences in baseline characteristics. Toxicities and ATB/PPI interaction was calculated using Pearson Chi-square method. Results: We enrolled 216 pts with a median age of 59 years, mostly ECOG-PS 0 (34%) or 1 (58%). ICI employed were mostly anti-PD-1 (60.2%), anti-CTLA-4 (16.2%) and anti-PD-L1 (12.5%). Most frequent primary tumor sites were lung n = 39 (18.1%), gastrointestinal n = 34 (15.7%) and melanoma n = 33 (15.2%). Half of the pts (108) received ATB and 114 (52.8%) PPI. Compared to control, pPPI group n = 57 (26.4%) had shorter mOS (11.6m vs 19.7m, p < 0.001) and PFS (2.8m vs 8.5m, p < 0.001), but no statistically significant difference in toxicities grade ≥3 and/or leading to ICI discontinuation (36% vs 29.1%; p = 0.29). cPPI n = 100 (46.3%) depicted a negative impact on mOS (12.1m vs 17.0m; p = 0.01), PFS (4.3m vs 7.1m; p = 0.04) and augmented toxicities (42% vs 19%; p < 0.001). pATB n = 34 (15.7%) had shorter OS (6.9m vs 19.3m, p < 0.001) and PFS (3.2 vs 7.2m, p = 0.005) and higher incidence of toxicities (45.9% vs 28.1%; p = 0.04 ). cATB use n = 92 (42.6%) did not impact OS (12.1m vs 15.6m; p = 0.32) or PFS (5.5m vs 5.9m; p = 0.82), but had a higher incidence of toxicities: 37% vs. 24.2% (p = 0.05). Multivariate analyses confirmed that pATB therapy and pPPI respectively remained as independent prognostic variables associated with OS (HR 2.39; 95% CI, 1.60-3.59; P <.001 and HR 1.73; 95% CI 1.23-2.44; P = 0.002) and PFS (HR 1.72; 95% CI, 1.14-2.61; P = 0.01 and HR 2.36; 95% CI 1.67 - 3.34; P < 0.001) adjusted by performance status, age and line of treatment. Conclusions: These data suggest that concomitant use of PPI and ATB is associated with increased toxicities in ICI treated pts. pPPI and pATB can negatively impact OS and PFS and merit clinician’s attention.
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Affiliation(s)
| | | | | | | | | | | | | | - Ingrid Barbosa
- Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | | | | | - Gilberto Castro
- Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | - Paulo Marcelo Hoff
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
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11
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McCleary NJ, Harmsen WS, VanCutsem E, Sobrero AF, Goldberg RM, Tabernero J, Seymour M, Saltz LB, Giantonio BJ, Dirk A, Rothenberg ML, Koopman M, Schmoll HJ, Pitot HC, Hoff PM, Falcone A, De Gramont A, Shi Q. Survival outcomes among older adults (OA) receiving second-line therapy for metastatic CRC (mCRC): 5,289 patients (pts) from the ARCAD Clinical Trials Program. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.7009] [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
7009 Background: Survival outcomes of 2nd line mCRC therapy for OA are poorly understood. We evaluated the rates and survival outcomes of 2nd line therapy among OA age 70+ compared to younger adults (YA) age < 70 following progression on 1st line clinical trials. Methods: Associations between clinical characteristics of pts with available treatment data after progression on 10 of 23 1st line ARCAD trials, time to initial progression (TTiP) and 2nd line therapy were evaluated. Time to progression (TTP) and overall survival (OS) were compared between OA and YA enrolled on 2nd line trials by Cox regression, adjusting for age, sex, ECOG PS, number of metastatic sites, presence of metastasis in lung/liver/peritoneum. Results: Sixteen percent of 1st line ARCAD trial participants were age 70+ (n = 870). Data for 2nd line therapy was available for 60.6% pts (3206/5289). Each additional decade of life was associated with 11% lower odds of receiving 2nd line therapy in multivariate analysis (p = 0.0117). OA participating in 2nd line trials (7.9% age 75+ of 7921) experience similar TTP and OS to YA (mTTP: 5.1 vs. 5.2mos; mOS 11.6 vs 12.4mos, respectively). Conclusions: We did not observe a statistical difference in survival outcomes by age following 2nd line mCRC therapy. Further study is needed to examine unmeasured comorbidity and use of geriatric assessment to select OA likely to benefit from 2nd line therapy. [Table: see text]
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Affiliation(s)
| | | | | | | | | | - Josep Tabernero
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Matt Seymour
- NIHR Clinical Research Network, Leeds UK St James's Hospital, and University of Leeds, Leeds, United Kingdom
| | - Leonard B. Saltz
- Department of Colorectal Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Arnold Dirk
- Instituto CUF de Oncologia, Lisbon, Portugal
| | | | | | | | | | - Paulo Marcelo Hoff
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
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12
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Moniz CMV, Riechelmann RP, Braghiroli MI, Ribeiro SC, Rivelli TG, Bariani GM, Chen ATC, Nahas C, Bonadio RC, Ortega C, Franco R, Meireles S, Pereira AAL, Sabbaga J, Coudry RA, Hoff PM. Prospective study of biomarkers in squamous cell carcinoma of the anal canal (SCCAC) and their influence on treatment outcomes: Five-year long-term results. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4053] [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
4053 Background: Chemoradiation (CRT) is a curative treatment for SCCAC. However, some patients (pts) present primary CRT resistance. As a rare tumor, there is a lack of prospective studies of prognostic factors in this setting. Methods: This prospective cohort study was aimed to evaluate predictive biomarkers (Ki-67, PD-L1, Human papillomavirus (HPV), HIV status, and tumor DNA mutations) in SCCAC. We published the 6 months (m) response rate (RR) of this cohort showing that HIV- were 5.7 times more likely to achieve response 6m post CRT (OR 5.72, CI 95% 2.5-13.0, P < 0.001). Now we report the long-term follow-up results of 5-year progression-free survival (PFS) and overall survival (OS). Eligible pts had T2-4/N0-3/M0 disease and were candidates to standard CRT. DNA mutations were analyzed by next-generation sequencing (NGS). HPV positivity was tested by PapilloCheck Test. KI-67 and PD-L1 were evaluated by immunohistochemistry. Results: 78 pts were recruited from Jan/2011 to Dec/2015. 75 were evaluable for PFS and OS. The median age was 57 years; 49 (65%) were stage III, and 9 (12%) were HIV+. HPV was evaluated in 67 and found in 47 (70.1%); HPV16 was the most common. PD-L1 was tested in 61; 10 (16.4%) had positive expression > 1%. Ki-67 was performed in 65, with a median of 50% (range 1-90%). The median follow up is 66m. 5-year PFS and OS rates were 63.3% (95% CI 51.2-73.2%) and 76.4% (95% CI 64.8-84.6%), respectively. In a multivariate analysis, age (HR 1.06, P = 0.022, IC 95% 1.01-1.11) and absence of complete response at 6m (HR 3.36, P = 0.007, IC 95% 1.39-8.09) was associated with inferior OS. The OS rate was 62.5% in HIV+ group (95% CI 22.9-86%) in comparison with 78% (95% CI 65.7-86.3%) among HIV- pts, although this difference was not statistically significant (P = 0.400). A tendency to inferior OS was observed among pts with p53 codon 72 polymorphism (HR 2.83, P = 0.181, 95% CI 0.61-13.02). Other tumor mutations, HPV, Ki-67 expression, and PD-L1 expression, were not associated with PFS and OS. Conclusions: HIV- pts were 5.7 times more likely to achieve response 6m post CRT. The absence of complete response at 6m was the main factor associated with poor 5-year OS. New strategies of follow up and complementary treatment should be studied in late responders and HIV+ pts to ensure the success of curative treatment. Clinical trial information: 36211 .
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Affiliation(s)
| | | | | | | | | | - Giovanni M. Bariani
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | | | - Caio Nahas
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | | | - Cinthia Ortega
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Rejane Franco
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | | | | | - Jorge Sabbaga
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | | | - Paulo Marcelo Hoff
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
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13
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McCleary NJ, Harmsen WS, VanCutsem E, Sobrero AF, Goldberg RM, Tabernero J, Seymour M, Saltz LB, Giantonio BJ, Dirk A, Rothenberg ML, Koopman M, Schmoll HJHJ, Pitot HC, Hoff PM, Falcone A, De Gramont A, Shi Q, Lichtman SM. Receipt and survival outcomes by age following second-line therapy for metastatic CRC (mCRC): Analysis of 5,289 patients from the ARCAD Clinical Trials Program. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6 Background: Rates and survival outcomes for second-line therapy for mCRC for OA vs. YA are poorly understood. Methods: Pts with available subsequent treatment data after progression from 10 1st line trials were included. Associations between key clinical/disease characteristics, time to initial progression (TTiP) and rate of receipt of second-line therapy were evaluated. Time to progression (TTP) and overall survival (OS) were compared between OA and YA who were enrolled on second-line trials by Cox regression, adjusting for age, sex, ECOG PS, number of metastatic sites, presence of metastasis in lung/liver/peritoneum. Results: OA comprised 16.4% of first-line trials. OA and ECOG PS >0 were less likely to receive second-line therapy than YA. Odds of receiving second-line therapy decreased by 11% for each additional decade of life in multivariate analysis (p=0.0117). OA enrolled in second-line trials experience similar mTTP and mOS as YA (5.1 vs. 5.2mos; 11.6 vs 12.4mos, respectively). Conclusions: OA are less likely to receive 2nd line therapy for mCRC. We did not observe a statistical difference in survival outcomes for OA vs. YA following second-line therapy. Further study is needed to examine unmeasured factors, including comorbidity and functional status given observed inferior outcomes among adults with ECOG PS >0, and consideration given to inclusion of geriatric assessment to select OA likely to benefit from 2nd line therapy for mCRC. [Table: see text]
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Affiliation(s)
| | | | | | | | | | - Josep Tabernero
- Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Matt Seymour
- NIHR Clinical Research Network, Leeds UK St James's Hospital, and University of Leeds, Leeds, United Kingdom
| | | | | | - Arnold Dirk
- Instituto CUF de Oncologia, Lisbon, Portugal
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14
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De Castria TB, Amorim LC, Ramos MFKP, Pereira MA, de Mello ES, Faraj S, Sabbaga J, Hoff PM. Impact of adjuvant treatment according to gastric cancer molecular subtypes. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e15513] [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
e15513 Background: The four subtypes of gastric adenocarcinoma (GC) identified by the Cancer Genome Atlas project (TCGA) have different molecular signatures and prognosis. Several centers have tried to classify GC using immunohistochemistry (IHC) and in situ hybridization (ISH), examining the tumors according to Epstein–Barr virus (EBV) status, microsatellite instability (MSI), aberrant E-cadherin expression and TP53 status. Here we aim to verify the impact of adjuvant/perioperative chemotherapy (ACT/PCT) or adjuvant chemoradiation (CRT) according to the molecular subtypes profile. Methods: We retrospectively reviewed all GC patients who underwent gastrectomy and D2-lymphadenectomy at our institution from a prospective collected medical database. Deficient DNA mismatch repair (dMMR), E-cadherin and p53 were evaluated by IHC for determining the MSI, genomically stable (GS) and chromosomal instability (CIN, with and without p53 aberrant) subtypes, respectively. EBV positivity was detected by ISH. Results: Among the 178 stage II/III patients included, 67 had surgery alone, 47 received ACT/PCT and 64 CRT. 16 had aberrant E-cadherin (GS, 9%), 33 dMMR (MSI, 18.5%), 74 aberrant p53 expression (CIN p53-aberrant, 41.6%), 104 normal p53 expression (CIN p53-normal, 58.4%) and 18 EBV-positivity (EBV, 10.1%). Two or more altered status were present in GC of 16 patients. When analyzed independently, Kaplan-Meier survival analysis showed that EBV, dMMR, CIN p53-normal and GS subtypes did not obtain any benefit of ACT/PCT or CRT in disease free survival (DFS) (p = 0.71; p = 0.33; p = 0.41; p = 0.21, respectively). Meantime, those treatments impact positively in DFS for EBV-negative, proficient MMR and non-GS (p = 0.01; p = 0.007; p = 0.01). CIN subtype with p53 aberrant obtained most benefit for ACT/PCT or CRT (p < 0.001). Conclusions: In accordance with other studies we achieved no benefit for adjuvant chemotherapy in patients with EBV, dMMR and GS GC subtypes. Patients with p53 aberrant expression had greater benefit for ACT/PCT or CRT. This simple method of classification can potentially help to tailor adjuvant treatment.
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Affiliation(s)
| | | | | | | | | | - Sheila Faraj
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Jorge Sabbaga
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
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15
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Crosara Alves Texeira M, Moura K, Cabral P, Silva SM, Pereira AAL, Costa F, Sabagga J, Hoff PM, Fernandes GDS. Colorectal cancer (CRC) among very elderly ( > 80 yo) patients (pts): A Brazilian single institution cohort. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.507] [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
507 Background: Approximately 60% of all cancers and 70% of the mortality occurs in pts aged 65 years and over. Despite that, there is a significant lack of evidence regarding the safety and efficacy of treatments for this part of the population. Our goal is to profile very elderly (VE) pts with gastrintestinal malignancies to highlight research opportunities and improve cancer care among this growing population. Methods: We retrospectively analyzed very elderly pts that attended at Sírio Libanês Hospital in Brazil in a 3 year period and had colorrectal cancer (CRC) diagnosed. We collected information from electronic medical charts on age, gender, ECOG-PS, staging, and surgery. We also gathered information about the type of treatment and survival from diagnosis. Results: Of 88 consecutive VE GI cancer pts, 40 (45,4%) were found to have CRC being 29 colon and 11 rectum. 14 patients were considered to have right sided tumors and 26 left sided. Among CRC pts, the median age was 82, 5 yo and 21 (52.5%) were men. ECOG-PS at diagnosis was 0/1 in 29pts, 19 (47.5%) presented as stage IV disease and 27 pts had surgery of the primary site. As treatment 23(57.5%) received chemotherapy, being 4 adjuvant and 19 palliative. Single agent fluoropyrimidine was the first line therapy in 47%, chemotherapy doublet in 42%, 26% pts received anti-VEGF. Six patients with rectal cancer received chemoRT. The median survival among the stage IV CRC pts was 27.5ms. Conclusions: This cohort is one of the few reported data on VE population cancer, the incidence of cancer in this age group is high and deserve to be more characterized in both trials and retrospective data. Interestingly, those patients seem to benefit from treatments likewise historic data from average age patients. Treatment details, tumor location, pathology, and survival curves will be presented.
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Affiliation(s)
| | | | | | | | | | | | - Jorge Sabagga
- Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
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16
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da Fonseca LG, Marta GN, Braghiroli MIFM, Chagas AL, Carrilho FJ, Hoff PM, Sabbaga J. Safety and efficacy of cytotoxic chemotherapy in hepatocellular carcinoma after first-line treatment with sorafenib. BMC Cancer 2018; 18:1250. [PMID: 30545331 PMCID: PMC6293528 DOI: 10.1186/s12885-018-5173-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/03/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Before the targeted therapies era, cytotoxic chemotherapy (CCT) was an option for advanced hepatocellular carcinoma (HCC), even with the lack of supporting evidence. Since the last decade, sorafenib has been established as the first-line therapy. Although new agents are being incorporated, CCT is still considered in regions where new drugs are not available or for patients who progressed through the approved therapies and remain in good clinical condition. We aimed to describe our experience regarding the use of CCT as second-line treatment after sorafenib. METHODS A database of 273 patients was evaluated. Patients that received CCT after sorafenib progression were selected for the analysis. Descriptive statistics was used for categorical and continue variables. Median survival was estimated with Kaplan-Meier curves. Variables were found to be significant if the two-sided p value was ≤ 0.05 on multivariate testing using the Cox regression model. RESULTS Forty-five patients received CCT; 33 (73.3%) had Child-Pugh classification A, and 34 (75.6%) had stage C according to the Barcelona Clinic Liver Cancer (BCLC) staging system. The most used regimen was doxorubicin in 25 patients (55.6%). Median overall survival (OS) was 8.05 months (95% confidence interval [CI] 2.73 - 9.88 months). The 6-month and 1-year survival probability was 52.4% and 27.36%, respectively. Eastern Cooperative Oncology Group performance status (ECOG PS) 0-1 and disease control with sorafenib was independently associated with better OS in patients treated with CCT. Any-grade toxicities were observed in 82.2% and grade 3-4 in 44.4% of the patients. CONCLUSION In accordance with previous studies, CCT had a notable rate of adverse events. The poor prognosis of this cohort suggests that CCT may not alter the natural history of HCC after sorafenib progression.
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Affiliation(s)
- Leonardo Gomes da Fonseca
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, Av Dr Arnaldo, 251, São Paulo, ZIP code: 01246-000, Brazil.
| | - Guilherme Nader Marta
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, Av Dr Arnaldo, 251, São Paulo, ZIP code: 01246-000, Brazil
| | - Maria Ignez Freitas Melro Braghiroli
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, Av Dr Arnaldo, 251, São Paulo, ZIP code: 01246-000, Brazil
| | - Aline Lopes Chagas
- São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo - Hospital das Clínicas Complex, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Flair Jose Carrilho
- São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo - Hospital das Clínicas Complex, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Paulo Marcelo Hoff
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, Av Dr Arnaldo, 251, São Paulo, ZIP code: 01246-000, Brazil
| | - Jorge Sabbaga
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, Av Dr Arnaldo, 251, São Paulo, ZIP code: 01246-000, Brazil
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Gulhati P, Yin J, Pederson L, Schmoll HJ, Hoff PM, Douillard JY, Hecht JR, Tournigand C, Tebbut N, Chibaudel B, De Gramont A, Shi Q, Overman MJ. Change in CEA as an early predictor of progression to first-line systemic therapy in metastatic colorectal cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.3525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Pat Gulhati
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | - J. Randolph Hecht
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | | | - Niall Tebbut
- University of Sydney Medical School, Sydney, Australia
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18
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Nader Marta G, Fonseca LGD, Braghiroli MIFM, Hoff PM, Sabbaga J. Does cytotoxic chemotherapy (CT) have a role in palliative treatment of hepatocellular carcinoma (HCC)? J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.10114] [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)
| | | | | | | | - Jorge Sabbaga
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
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Avila MS, Ayub-Ferreira SM, de Barros Wanderley MR, das Dores Cruz F, Gonçalves Brandão SM, Rigaud VOC, Higuchi-Dos-Santos MH, Hajjar LA, Kalil Filho R, Hoff PM, Sahade M, Ferrari MSM, de Paula Costa RL, Mano MS, Bittencourt Viana Cruz CB, Abduch MC, Lofrano Alves MS, Guimaraes GV, Issa VS, Bittencourt MS, Bocchi EA. Carvedilol for Prevention of Chemotherapy-Related Cardiotoxicity: The CECCY Trial. J Am Coll Cardiol 2018. [PMID: 29540327 DOI: 10.1016/j.jacc.2018.02.049] [Citation(s) in RCA: 300] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Anthracycline (ANT) chemotherapy is associated with cardiotoxicity. Prevention with β-blockers remains controversial. OBJECTIVES This prospective, randomized, double-blind, placebo-controlled study sought to evaluate the role of carvedilol in preventing ANT cardiotoxicity. METHODS The authors randomized 200 patients with HER2-negative breast cancer tumor status and normal left ventricular ejection fraction (LVEF) referred for ANT (240 mg/m2) to receive carvedilol or placebo until chemotherapy completion. The primary endpoint was prevention of a ≥10% reduction in LVEF at 6 months. Secondary outcomes were effects of carvedilol on troponin I, B-type natriuretic peptide, and diastolic dysfunction. RESULTS Primary endpoint occurred in 14 patients (14.5%) in the carvedilol group and 13 patients (13.5%) in the placebo group (p = 1.0). No differences in changes of LVEF or B-type natriuretic peptide were noted between groups. A significant difference existed between groups in troponin I levels over time, with lower levels in the carvedilol group (p = 0.003). Additionally, a lower incidence of diastolic dysfunction was noted in the carvedilol group (p = 0.039). A nonsignificant trend toward a less-pronounced increase in LV end-diastolic diameter during the follow-up was noted in the carvedilol group (44.1 ± 3.64 mm to 45.2 ± 3.2 mm vs. 44.9 ± 3.6 mm to 46.4 ± 4.0 mm; p = 0.057). CONCLUSIONS In this largest clinical trial of β-blockers for prevention of cardiotoxicity under contemporary ANT dosage, the authors noted a 13.5% to 14.5% incidence of cardiotoxicity. In this scenario, carvedilol had no impact on the incidence of early onset of LVEF reduction. However, the use of carvedilol resulted in a significant reduction in troponin levels and diastolic dysfunction. (Carvedilol Effect in Preventing Chemotherapy-Induced Cardiotoxicity [CECCY]; NCT01724450).
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Affiliation(s)
- Mônica Samuel Avila
- Heart Failure Department, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Silvia Moreira Ayub-Ferreira
- Heart Failure Department, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Mauro Rogerio de Barros Wanderley
- Heart Failure Department, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fatima das Dores Cruz
- Heart Failure Department, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Sara Michelly Gonçalves Brandão
- Heart Failure Department, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vagner Oliveira Carvalho Rigaud
- Heart Failure Department, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Ludhmila Abrahão Hajjar
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo-Universidade de São Paulo, São Paulo, Brazil
| | - Roberto Kalil Filho
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo-Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Marcelo Hoff
- Instituto do Câncer do Estado de São Paulo-Universidade de São Paulo, São Paulo, Brazil
| | - Marina Sahade
- Instituto do Câncer do Estado de São Paulo-Universidade de São Paulo, São Paulo, Brazil
| | - Marcela S M Ferrari
- Instituto do Câncer do Estado de São Paulo-Universidade de São Paulo, São Paulo, Brazil
| | | | - Max Senna Mano
- Instituto do Câncer do Estado de São Paulo-Universidade de São Paulo, São Paulo, Brazil
| | - Cecilia Beatriz Bittencourt Viana Cruz
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo-Universidade de São Paulo, São Paulo, Brazil
| | - Maria Cristina Abduch
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marco Stephan Lofrano Alves
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Guilherme Veiga Guimaraes
- Heart Failure Department, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Victor Sarli Issa
- Heart Failure Department, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marcio Sommer Bittencourt
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo-Universidade de São Paulo, São Paulo, Brazil; Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Edimar Alcides Bocchi
- Heart Failure Department, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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Riechelmann RP, Leite LAS, Glasberg J, Bariani GM, Rivelli TG, Nebuloni DR, Puty F, Kappeler C, Pereira KMC, Queiroz MA, Hoff PM. Regorafenib in antiangiogenic-naive, chemotherapy-refractory advanced colorectal cancer: A phase IIb trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.782] [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
782 Background: The oral multikinase inhibitor regorafenib improves overall survival in advanced colorectal cancer (CRC). The aim of this study was to investigate the safety and efficacy of regorafenib in antiangiogenic-naïve patients with chemotherapy-refractory CRC. Methods: In this single-center, single-arm, phase 2b study, patients received regorafenib 160 mg/day for 3 weeks on/1 week off. Tumor response assessed by RECIST 1.1 and tumor metabolic response by [18F] fluorodeoxyglucose positron emission tomography (PET/CT) according to the European Organization for Research and Treatment of Cancer (EORTC) criteria were evaluated at week 8 (W8). PFS rate was defined as the percentage of evaluable patients alive without progression at W8. Safety was assessed until the cut-off date (May 2, 2017). Results: Overall, 59 patients (59.3% male; median age 58.0 yrs) received regorafenib (median dose 148.8 mg/day). The W8 PFS rate was 46.6% (95% CI 33.3% - 60.1%) and median PFS and OS were 3.6 and 7.5 months, respectively. Overall disease control rate (DCR) was 50.8% by RECIST and 62.7% by EORTC criteria (Table). Most common regorafenib-related grade ≥3 AEs were hypertension (35.6%), hand-foot skin reaction (HFSR) (25.4%) and hypophosphatemia (22.0%). One patient discontinued treatment due to drug-related HFSR. Conclusions: The W8 PFS rate and overall DCR support the anti-tumor activity of regorafenib in antiangiogenic-naïve, chemotherapy-refractory advanced CRC. Compared with the previous phase 3 CORRECT and CONCUR trials, the median PFS suggests a better outcome in this population. These data provide the basis for further investigation of regorafenib’s role in earlier treatment lines in metastatic CRC and on the use of PET/CT in tumor response assessment. Clinical trial information: NCT02465502. [Table: see text]
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de M Rêgo JF, de Medeiros RSS, Braghiroli MI, Galvão B, Neto JEB, Munhoz RR, Guerra J, Nonogaki S, Kimura L, Pfiffer TE, de Castro G, Hoff PM, Filho DR, Costa FP, Riechelmann RP. Expression of ERCC1, Bcl-2, Lin28a, and Ki-67 as biomarkers of response to first-line platinum-based chemotherapy in patients with high-grade extrapulmonary neuroendocrine carcinomas or small cell lung cancer. Ecancermedicalscience 2017; 11:767. [PMID: 28955403 PMCID: PMC5606295 DOI: 10.3332/ecancer.2017.767] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Indexed: 12/15/2022] Open
Abstract
Background Small cell lung cancer (SCLC) and high-grade extrapulmonary neuroendocrine carcinomas (EPNEC) share similar histopathological features and treatment, but outcomes may differ. We evaluated in our study the expression of biomarkers associated with response rate (RR) to chemotherapy and overall survival (OS) for these entities. Materials and Methods This is a multicentre retrospective analysis of advanced EPNEC and SCLC patients treated with platinum-based chemotherapy. Paraffin-embedded tumour samples were reviewed by a single pathologist and tested for immunohistochemistry (IHC) expression of Ki-67, ERCC1, Bcl-2, and Lin28a. All images were evaluated by the same radiologist and RR was determined by RECIST 1.1. Results From July, 2006 to July, 2014, 142 patients were identified, being 82 (57.7%) SCLC and 60 (42.3%) EPNEC. Clinical characteristics and median Ki-67 (SCLC: 60%; EPNEC: 50%; p = 0.86) were similar between the groups. RR was higher for SCLC patients (86.8% versus 44.6%; p<0.001), but median OS was similar (10.3 months in SCLC and 11.1 months in EPNEC; HR 0.69, p = 0.07). Bcl-2 expression was higher in SCLC patients (46.3% versus 28.3%, p = 0.03) and was associated with worse prognosis in EPNEC (median OS 8.0 months versus 14.7 months; HR 0.47, p = 0.02). Conclusion EPNEC patients presented inferior RR to platinum-based chemotherapy than SCLC but tended to live longer. Neither ERCC1, Lin28, or Ki-67 were prognostic or predictive for RR in EPNEC or SCLC. High Bcl-2 expression was associated with poor prognosis in EPNEC patients.
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Affiliation(s)
- Juliana Florinda de M Rêgo
- Instituto do Cancer do Estado de São Paulo - Adress: Dr Arnaldo Av, 251 - Sao Paulo/SP, 01246-000, Brazil.,Universidade Federal do Rio Grande do Norte - Adress: Nilo Peçanha Av, 620 - Natal/RN, 59012-300, Brazil.,Liga NorteRiograndense Contra o Cancer - Adress: Miguel Castro Av, 1355 - Natal/RN, 59075-740, Brazil
| | | | - Maria Ignez Braghiroli
- Instituto do Cancer do Estado de São Paulo - Adress: Dr Arnaldo Av, 251 - Sao Paulo/SP, 01246-000, Brazil.,Hospital Sirio Libanês - Adress: Dona Adma Jafet St, 115 - Sao Paulo/SP, 01308-050, Brazil
| | - Breno Galvão
- Instituto do Cancer do Estado de São Paulo - Adress: Dr Arnaldo Av, 251 - Sao Paulo/SP, 01246-000, Brazil.,Hospital Sirio Libanês - Adress: Dona Adma Jafet St, 115 - Sao Paulo/SP, 01308-050, Brazil
| | - João Evangelista Bezerra Neto
- Instituto do Cancer do Estado de São Paulo - Adress: Dr Arnaldo Av, 251 - Sao Paulo/SP, 01246-000, Brazil.,Hospital Sirio Libanês - Adress: Dona Adma Jafet St, 115 - Sao Paulo/SP, 01308-050, Brazil
| | - Rodrigo Ramella Munhoz
- Instituto do Cancer do Estado de São Paulo - Adress: Dr Arnaldo Av, 251 - Sao Paulo/SP, 01246-000, Brazil.,Hospital Sirio Libanês - Adress: Dona Adma Jafet St, 115 - Sao Paulo/SP, 01308-050, Brazil
| | - Juliana Guerra
- Instituto Adolfo Lutz - Adress: Dr Arnaldo Av, 355 - Sao Paulo/SP, 01246-000, Brazil
| | - Suely Nonogaki
- Instituto Adolfo Lutz - Adress: Dr Arnaldo Av, 355 - Sao Paulo/SP, 01246-000, Brazil
| | - Lidia Kimura
- Instituto Adolfo Lutz - Adress: Dr Arnaldo Av, 355 - Sao Paulo/SP, 01246-000, Brazil
| | - Tulio Eduardo Pfiffer
- Instituto do Cancer do Estado de São Paulo - Adress: Dr Arnaldo Av, 251 - Sao Paulo/SP, 01246-000, Brazil.,Hospital Sirio Libanês - Adress: Dona Adma Jafet St, 115 - Sao Paulo/SP, 01308-050, Brazil
| | - Gilberto de Castro
- Instituto do Cancer do Estado de São Paulo - Adress: Dr Arnaldo Av, 251 - Sao Paulo/SP, 01246-000, Brazil.,Hospital Sirio Libanês - Adress: Dona Adma Jafet St, 115 - Sao Paulo/SP, 01308-050, Brazil
| | - Paulo Marcelo Hoff
- Instituto do Cancer do Estado de São Paulo - Adress: Dr Arnaldo Av, 251 - Sao Paulo/SP, 01246-000, Brazil.,Hospital Sirio Libanês - Adress: Dona Adma Jafet St, 115 - Sao Paulo/SP, 01308-050, Brazil
| | - Duilio Rocha Filho
- Instituto do Cancer do Ceara - Adress: Papi Júnior St - Fortaleza/CE, 60351-010, Brazil
| | - Frederico Perego Costa
- Hospital Sirio Libanês - Adress: Dona Adma Jafet St, 115 - Sao Paulo/SP, 01308-050, Brazil
| | - Rachel P Riechelmann
- Instituto do Cancer do Estado de São Paulo - Adress: Dr Arnaldo Av, 251 - Sao Paulo/SP, 01246-000, Brazil.,Hospital Sirio Libanês - Adress: Dona Adma Jafet St, 115 - Sao Paulo/SP, 01308-050, Brazil
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Moniz CMV, Riechelmann RP, Ribeiro SC, Rivelli TG, Bariani GM, Chen A, Franco R, Nahas C, Pereira AAL, Ortega C, Sabbaga J, Meireles S, Coudry RA, Hoff PM. Prospective study of biomarkers in squamous cell carcinoma of the anal canal (SCCAC) and their influence on treatment outcomes: Final results. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.3577] [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
3577 Background: While chemoradiation (CRT) is a curative treatment for SCCAC, many patients (pts) present primary resistance. As a rare tumor, the predictors of response in this setting remain unknown. Methods: Prospective cohort study aimed to evaluate predictive biomarkers (Ki-67, PD-L1, Human papillomavirus (HPV), HIV status and mutations in tumoral DNA) associated with complete response (CR) following standard CRT for localized SCCAC. Eligible pts had T2-4/N0-3/M0 disease and were candidates to standard CRT. CR at 6 months (m) measured by RECIST 1.1 was the primary endpoint. DNA mutations were analyzed by next-generation (NGS) TruSight Tumor26 panel. HPV positivity was tested by PapilloCheck Test. KI-67 and PD-L1 were evaluated by immunohistochemistry. Results: 78 pts were recruited from Jan/2011 to Dec/2015. 75 were evaluable for response. Median age 57 years; 49 (65%) were stage III, and 9 (12%) were HIV+. At 6m 47 (62.7%) had CR, 18 (24%) partial response (PR) and 10 (13.3%) disease progression. HPV was evaluated in 67 and found in 47 (70.1%), the majority HPV16. PD-L1 was tested in 61, 10 (16.4%) had > 1% positive expression. Ki-67 was performed in 65, a median was 50% (1-90%) per patient. Clinical stage, HIV status, median KI-67, HPV and PD-L1 positivity, and treatment interruption were tested as predictive factors of CR in 6m by logistic regression. On multivariable analyses, ECII patients were 4.7 more likely to achieve CR than ECIII (OR 4.70 CI95%1.36-16.30; p = 0.015). HIV was borderline significant (OR 2.53 CI95% 0.9-7.1; p = 0.079). Analyzing the patients with PR and CR HIV+ was significantly associated with poor response. Patients HIV- were 5.7 more likely to achieve CR or PR (OR 5.72 CI95%2.5-13.0; p < 0.001). 25 patients had tumor samples proper for NGS, 17 had at least one pathogenic mutation. The most common mutated genes were PIK3CA and MET in 6. There was no differences in CR rates according to MET (50% vs 47.3%, p = 1) or PIK3CA (33.3% vs 47.3%, p = 0.6) mutation status. TP53 codon 72 polymorphism was present in 72% (n = 18) and was not associated with CR (44% VS 57%, p = 0.6). Conclusions: Our study suggests that HIV+ pts are less responsive to CRT.
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Affiliation(s)
| | | | | | | | | | - André Chen
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Rejane Franco
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Caio Nahas
- Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | | | - Cintia Ortega
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Jorge Sabbaga
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
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Santos VM, Azevedo RGMV, Lopez RVM, Hoff PM, Sabbaga J, Glasberg J. Does chemotherapy work in reversal of malignant obstruction due to gastric cancer? J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e21676] [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
e21676 Background: Malignant obstruction (MO) is a common complication in patients with gastric cancer. Although palliative chemotherapy has already shown beneficial for overall survival in advanced cases, its value for MO reversal is still unknown. Methods: Inthis retrospective study we analyzed all consecutive patients with metastatic gastric cancer admitted with MO at the Instituto do Câncer do Estado de São Paulo (ICESP) from 2008 to 2016. The primary and secondary endpoints were overall survival and obstruction reversal rate respectively. Clinical measures other than chemotherapy and alimentary pause included the use of octreotide 0.1 mg, 3 times a day, steroids, antiemetics and anticholinergic drugs. Survival curves were calculated by Kaplan-Meier and log-rank test was used to compare them. The Cox regression model was used to evaluate risk factors for overall survival and the hazard ratio (HR) was calculated with its respective 95% confidence intervals. The analysis was performed in SPSS v.18 for Windows statistical software, and the significance level was 5%. Results: One hundred and eighteen(118)patients were included. Median overall survival was 11.2 months and survival time after the MO was 3.6 months for the whole group. Median time of use of octreotide was 3 days. Reversal of obstruction was seen in 16 of 36 patients (38.4%) in which chemotherapy was used and only in 22 of the 92 patients (24%) treated with exclusive clinical measures. In spite of these figures a significant better overall survival (p 0.002) was achieved in the group of patients that reached obstruction reversal without chemotherapy (13.6 months vs. 11.6 months for the clinical treatment group). Conclusions: This study suggests that chemotherapy even when reversing MO, has no impact in patients overall survival. These finding is particularly relevant for cost contingency in settings with limited resources. .
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Affiliation(s)
| | | | | | | | - Jorge Sabbaga
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Joao Glasberg
- ABC Foundation School of Medicine, Santo André, Brazil
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Ramos REDO, Perez Mak M, Alves MFS, Piotto GHM, Takahashi TK, Gomes da Fonseca L, Silvino MCM, Hoff PM, de Castro G. Malignancy-Related Hypercalcemia in Advanced Solid Tumors: Survival Outcomes. J Glob Oncol 2017; 3:728-733. [PMID: 29244985 PMCID: PMC5735968 DOI: 10.1200/jgo.2016.006890] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Malignancy-related hypercalcemia (MRH) is associated with a dismal prognosis. The widespread use of bisphosphonates (BPs), availability of more effective drugs in cancer treatment, and improvement in supportive care might have attenuated its impact. Patients and Methods To assess overall survival (OS) of patients with MRH in a contemporary setting, we conducted a retrospective analysis of 306 patients with solid cancer hospitalized for symptomatic hypercalcemia. A multivariable Cox proportional hazards regression model was performed to evaluate possible prognostic factors associated with MRH. Results All patients had serum ionized calcium > 5.5 mg/dL or total Ca > 10.5 mg/dL. Median age was 57 years, and the majority had squamous cell carcinoma (62%) and Eastern Cooperative Oncology Group performance status > 1 (96%). Head and neck was the most frequent primary site (28%). Forty-five percent had no previous chemotherapy (CT), and subsequent CT was administered to 32%. Eighty-three percent received BP with no survival gain. Median OS was 40 (95% CI, 33 to 47) days. Patients with a performance status > 2, altered mental status, C-reactive protein > 30 mg/L, albumin < 2.5 g/dL, or body mass index < 18 kg/m2 had significantly poorer survival in a univariable analysis, and longer OS was related to treatment-naive patients, subsequent CT, and breast primary site. In the multivariable analysis, subsequent CT led to a median OS improvement of 144 versus 25 days (hazard ratio, 0.24; 95% CI, 0.14 to 0.40; P < .001). Conclusion In a contemporary setting, MRH remains a marker of poor prognosis. Patients treated with CT had better survival, which suggests that appropriate treatment of selected patients might alter the course of this syndrome.
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Affiliation(s)
| | - Milena Perez Mak
- All authors: Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | - Paulo Marcelo Hoff
- All authors: Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | - Gilberto de Castro
- All authors: Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
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Ribeiro U, Ramos MFKP, Pereira MA, Dias AR, Yagi OK, Faraj S, de Mello ES, Charruf AZ, Pereira GLS, Zilberstein B, Hoff PM, Cecconello I. Predictors of pathological response and tumor regression following neoadjuvant therapy in advanced gastric cancer patients. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.206] [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
206 Background: Neoadjuvant chemotherapy (NACT) has became the standard approach for patients with advanced gastric cancer. Clinicopathological characteristics can be utilized to evaluate the effect of NACT, and may be a useful tool to identify responsive patients. Methods: We retrospectively reviewed all patients with GC treated with NACT and R0 resection between 2009 and 2015 from a prospective collected database. Histopathological response to the treatment was graded from 0% to 100% and the clinicopathological characteristics assessed to identify predictors of tumor response. A threshold of 50% histopathological response was used for the analysis. Results: NACT was performed in 45 patients. Cisplatin-irinotecan therapy was used in 64.4% of patients and 11 (24.4%) tumors were located in the proximal stomach. Ten (22.2%) patients demonstrated a tumor regression of at least 50% and one patient had complete response. The mean number of lymph node retrieved was 38.1 and 66.7% patients had lymph node metastasis (LNM). Factors associated with > 50% of response by univariate analyses included lower neutrophil-lymphocyte ratio (NLR) ( p = 0.035), diffuse/mixed Lauren type ( p = 0.007), lower depth of tumor invasion ( p = 0.043) and non cisplatin-irinotecan therapy (p = 0.01). A slight tendency of poorly differentiated tumors respond better to NACT than differentiated type was observed ( p = 0.05). There was no significant difference regarding the presence of mucin, calcification and/or necrosis and the tumor response. Multivariate analysis identified NLR and diffuse/mixed tumors as independent predictors of pathologic response. Median follow-up for all patients was 26.5 months and recurrence-free survival (RFS) rate was 74.3% and 60% for patients with > 50% and < 50% of response, respectively ( p= 0.08). RFS was significantly different in patients without LNM compared to patients who have LNM (100% vs. 55.2%, p = 0.01), and in patients with fibroinflammatory/inflammatory stroma infiltration compared to patients with only fibrotic stroma (80% vs. 53.3%, p = 0.015). Conclusions: Diffuse/mixed histopathological type and lower NLR are independently predictors of tumor response after NACT.
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Affiliation(s)
- Ulysses Ribeiro
- Instituto do Cancer do Estado de Sao Paulo, ICESP-HCFMUSP, Sao Paulo, Brazil
| | | | | | - André Roncon Dias
- Insituto do Cancer do Estado de Sao Paulo, ICESP-HCFMUSP, Sao Paulo, Brazil
| | - Osmar Kenji Yagi
- Instituto do Cancer do Estado de Sao Paulo, ICESP-HCFMUSP, Sao Paulo, Brazil
| | - Sheila Faraj
- Instituto do Cancer do Estado de Sao Paulo, ICESP-HCFMUSP, Sao Paulo, Brazil
| | | | - Amir Zeide Charruf
- Instituo do Cancer do Estado de Sao Paulo, ICESP-HCFMUSP, Sao Paulo, Brazil
| | | | - Bruno Zilberstein
- Instituto do Cancer do Estado de Sao Paulo, ICESP-HCFMUSP, Sao Paulo, Brazil
| | - Paulo Marcelo Hoff
- Instituto do Cancer do Estado de Sao Paulo, Universidade de São Paulo, Sao Paulo, Brazil
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Abstract
489 Background: Cytotoxic chemotherapy with FOLFIRINOX (5-Fluoracil + Irinotecan + Oxaliplatin) is considered the standard treatment for fit patients (pts) with pancreatic adenocarcinoma. Disease progression after FOLFIRINOX invariably occurs, and there is no definition on the optimal strategy for the second-line treatment of these pts. Gemcitabine is effective for advanced pancreatic cancer as first-line treatment, but its role after FOLFIRINROX progression is unknown. The present study aims to assess the efficacy of gemcitabine for treatment of advanced pancreatic cancer after progression to FOLFIRINOX. Methods: Single-institution, retrospective analysis of all pts consecutively diagnosed with advanced pancreatic cancer between January/2010, and October/2015, who received Gemcitabine as second line chemotherapy after progression to first line chemotherapy with FOLFIRINOX. Tumor responses were assessed through RECIST 1.1. PFS and OS were calculated using Kaplan Meier method. Results: 28 pts were included in our analysis. Median age was 55 years (38-75), and 19 pts (67%) were male. The median ECOG was 1 (0-2). Pts received a median of 9 cycles of FOLFIRINOX as first line treatment (1-27), with an objective (ORR) response rate of 39%. The median number of second-line Gemcitabine cycles was 3 (1-8), with an ORR of 3%, and a 17% rate of disease control (stable disease + partial response). Five patients (18%) discontinued second line Gemcitabine due to toxicities and the remaining 23 (82%) due to disease progression. Median overall survival was 5.6 months (0,36-11,5) and median progression-free survival was 2 months (0.2-7.7). Grade ≥ 3 toxicities with Gemcitabine were experienced by 18% of the patients. No treatment-related deaths were reported. Conclusions: Gemcitabine after progression to FOLFIRINOX presented a modest activity on the present study, with prospective trials being necessary to further assess this issue. Due to the palliative goal of the treatment, with the objective of improving patient´s quality of life, the significant risk of treatment-related adverse events and the low efficacy of Gemcitabine should be considered before prescribing Gemcitabine routinely as a second-line treatment for pancreatic cancer.
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Affiliation(s)
- Bruno Melo Fernandes
- Instituto do Cancer do Estado de Sao Paulo, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Jorge Sabbaga
- Instituto do Cancer do Estado de Sao Paulo, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paulo Marcelo Hoff
- Instituto do Cancer do Estado de Sao Paulo, Universidade de São Paulo, Sao Paulo, Brazil
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Moniz CMV, Riechelmann RP, Ribeiro SC, Bariani GM, Rivelli TG, Ortega C, Pereira AAL, Meireles SI, Chen A, Nahas C, Sabagga J, Coudry RA, Hoff PM. The expression profile of biomarkers in squamous cell carcinoma of the anal canal and their influence on treatment outcomes: Preliminary results. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e15059] [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)
| | | | | | | | | | - Cintia Ortega
- Instituto do Câncer do Estado de São Paulo, Sao Paulo, Brazil
| | | | | | - André Chen
- Instituto do Câncer do Estado de São Paulo, Sao Paulo, Brazil
| | - Caio Nahas
- Instituto do Cancer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Jorge Sabagga
- Instituto do Cancer do Estado de Sao Paulo, Sao Paulo, Brazil
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Silva AA, Linck RDM, Lima JMDS, Matutino ARB, Silva SB, Vicentini MF, Felizola M, Gagliato DDM, Hoff PM, Mano MS. Metaplastic breast cancer: A single-institution experience. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e12575] [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)
| | | | | | | | | | | | | | | | | | - Max S. Mano
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
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de Castroneves LA, Negrão MV, de Freitas RMC, Papadia C, Lima JV, Fukushima JT, Simão EF, Kulcsar MAV, Tavares MR, Jorge AADL, de Castro G, Hoff PM, Hoff AO. Sorafenib for the Treatment of Progressive Metastatic Medullary Thyroid Cancer: Efficacy and Safety Analysis. Thyroid 2016; 26:414-9. [PMID: 26701095 DOI: 10.1089/thy.2015.0334] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Treatment of advanced medullary thyroid carcinoma (MTC) was recently improved with the approval of vandetanib and cabozantinib. However, there is still a need to explore sequential therapy with more than one tyrosine kinase inhibitor (TKI) and to explore alternative therapies when vandetanib and cabozantinib are not available. This study reports the authors' experience with sorafenib as a treatment for advanced MTC. METHODS This is a retrospective longitudinal study of 13 patients with progressive metastatic MTC treated with sorafenib 400 mg twice daily between December 2011 and January 2015. The primary endpoints were to evaluate response and progression-free survival (PFS) in patients treated with sorafenib outside a clinical trial. The secondary endpoint was an assessment of the toxicity profile. One patient was excluded because of a serious allergic skin rash one week after starting sorafenib. RESULTS The analysis included 12 patients with metastatic MTC (median age 48 years), 10 with sporadic and 2 with hereditary disease. The median duration of treatment was 11 months, and the median follow-up was 15.5 months. At data cutoff, 2/12 (16%) patients were still on treatment for 16 and 34 months. According to Response Evaluation Criteria in Solid Tumors analysis, 10 (83.3%) patients showed stable disease, and two (16.6%) had progression of disease; no partial response was observed. The median PFS was nine months. However, three patients with extensive and rapidly progressive disease died within three months of sorafenib treatment. The median PFS excluding these three patients was 12 months. Adverse events (AE) occurred in nine (75%) patients. The main AEs were skin toxicity, weight loss, and fatigue. Five (41.6%) patients needed dose reduction, and one patient discontinued treatment because of toxicity. CONCLUSIONS Treatment with sorafenib in progressive metastatic MTC is well tolerated and resulted in disease control and durable clinical benefit in 75% of patients. Sorafenib treatment could be considered when vandetanib and cabozantinib are not available or after failing these drugs.
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Affiliation(s)
- Luciana Audi de Castroneves
- 1 Endocrinology Department; Instituto do Câncer do Estado de São Paulo , Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo Vailati Negrão
- 2 Medical Oncology Department; Instituto do Câncer do Estado de São Paulo , Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ricardo Miguel Costa de Freitas
- 3 Radiology Department; Instituto do Câncer do Estado de São Paulo , Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Carla Papadia
- 1 Endocrinology Department; Instituto do Câncer do Estado de São Paulo , Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - José Viana Lima
- 4 Endocrinology Department, Irmandade da Santa Casa da Misericórdia de São Paulo , São Paulo, Brazil
| | - Julia T Fukushima
- 5 Intensive Care Unit; Instituto do Câncer do Estado de São Paulo , Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Marco Aurélio Vamondes Kulcsar
- 7 Head and Neck Surgery Department; Instituto do Câncer do Estado de São Paulo , Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marcos Roberto Tavares
- 8 Head and Neck Surgery Department; Hospital das Clínicas , Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alexander Augusto de Lima Jorge
- 9 Genetics Endocrinology LIM 25; Hospital das Clínicas , Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Gilberto de Castro
- 2 Medical Oncology Department; Instituto do Câncer do Estado de São Paulo , Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Marcelo Hoff
- 2 Medical Oncology Department; Instituto do Câncer do Estado de São Paulo , Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ana Oliveira Hoff
- 1 Endocrinology Department; Instituto do Câncer do Estado de São Paulo , Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Pereira GLS, Fonseca LGD, Ramos MFKP, Ribeiro U, Pereira G, Pereira MA, de Mello ES, Sabbaga J, Hoff PM. Prospective results of perioperative chemotherapy (PCT) with cisplatin and irinotecan for locally advanced gastric cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.147] [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
147 Background: An overall survival (OS) benefit with PCT over surgery alone for locally advanced gastric cancer was seen in phase III trials. The best PCT regimen is uncertain and options based in infusional 5-FU or capecitabine have cost limitation in the context of Brazilian public health system. The combination of cisplatin and irinotecan is active in the metastatic setting, with no need of ambulatory infusion devices. The aim of this study is to evaluate safety and preliminary efficacy of this scheme as PCT. Methods: This prospective single arm study included patients (pt) with locally advanced gastric cancer, T3/T4 and/or evident lymph node involvement, to receive PCT cisplatin (30 mg/m2) and irinotecan (60 mg/m2) D1 and D8, each 21 days, in total of 6 cycles (Cy). Results: Between June/2011 and January/2014, 25 pt were included, with the following characteristics: 64 years (34-78) as median age; 10 (40%) pt with intestinal subtype and 10 with diffuse; 24% of cases were proximal gastric tumors; 20% had dysphagia and 24% bleeding signs before treatment. The median number of Cy before surgery was 3; 19 (76%) pt had surgery and 8 (32%) re-started Cy after surgery. Toxicity grade 3 or 4 was seen in 13 (52%) pt and 3 had unexpected arterial ischemic events. Radiologic progression occurred in 8 (32%) pt. Of the 21 tissue samples available, the expression of MLH-1, HER-2 (+++), p53, p16, Ki67 and EGFR was detected in 100% (21/21), 9.5% (2/21), 90.5% (19/21), 81% (17/21), 100% (11/21 < 50% and 10/21 > 50%) and 100% (10/21 +1/2 and 11/21 +3/4) of the cases, respectively. No correlation was seen between them and pathologic response. With a median follow up of 382 days, 13 (52%) pt were alive and the median OS was 15.2 (IC95% 4.9-24.5) months. In a univariate analysis, dysphagia, less than 3 Cy, progressive disease and neutrophil-to-Lymphocyte ratio (NLR) > 2, were significantly related to shorter OS. In multivariate analysis, only NLR > 2 (p = 0.019) and dysphagia were negatively impacting on OS (p = 0.02). Conclusions: Although PCT with cisplatin and irinotecan for evident locally advanced gastric cancer showed acceptable resection rate and local control, the overall prognosis was limited in this setting.
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Affiliation(s)
| | | | | | | | - Gabriel Pereira
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | | | | | - Jorge Sabbaga
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
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Freire MP, de Oliveira Garcia D, Garcia CP, Campagnari Bueno MF, Camargo CH, Kono Magri ASG, Francisco GR, Reghini R, Vieira MF, Ibrahim KY, Rossi F, Hajjar L, Levin AS, Hoff PM, Pierrotti LC, Abdala E. Bloodstream infection caused by extensively drug-resistant Acinetobacter baumannii in cancer patients: high mortality associated with delayed treatment rather than with the degree of neutropenia. Clin Microbiol Infect 2015; 22:352-358. [PMID: 26711434 DOI: 10.1016/j.cmi.2015.12.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 12/08/2015] [Accepted: 12/09/2015] [Indexed: 11/30/2022]
Abstract
This study aimed to describe severe infections with extensively drug-resistant Acinetobacter baumannii-calcoaceticus complex (XDR-ABC), as well as to investigate risk factors for mortality, in cancer patients. It was a retrospective study including all patients diagnosed with XDR-ABC bacteraemia during hospitalization in the intensive care unit of a cancer hospital between July 2009 and July 2013. Surveillance cultures were collected weekly during the study period, and clonality was analysed using pulsed field gel electrophoresis (PFGE). We analysed underlying diseases, oncology therapy, neutrophil counts, infection site and management of infection, in terms of their correlation with 30-day mortality. During the study period, 92 patients with XDR-ABC bacteraemia were identified, of whom 35 (38.0%) were patients with haematological malignancy. We identified XDR-ABC strains with four different profile patterns, 91.3% of patients harbouring the predominant PFGE type. Of the 92 patients with XDR-ABC bacteraemia, 66 (71.7%) had central line-associated bloodstream infections; infection occurred during neutropenia in 22 (23.9%); and 58 (63.0%) died before receiving the appropriate therapy. All patients were treated with polymyxin, which was used in combination therapy in 30 of them (32.4%). The 30-day mortality rate was 83.7%. Multivariate analysis revealed that septic shock at diagnosis of XDR-ABC infection was a risk factor for 30-day mortality; protective factors were receiving appropriate therapy and invasive device removal within the first 48 h. Among cancer patients, ineffective management of such infection increases the risk of death, more so than do features such as neutropenia and infection at the tumour site.
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Affiliation(s)
- M P Freire
- Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | | | - C P Garcia
- Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - C H Camargo
- Bacteriology Centre, Adolfo Lutz Institute, São Paulo, Brazil
| | - A S G Kono Magri
- Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - G R Francisco
- Bacteriology Centre, Adolfo Lutz Institute, São Paulo, Brazil
| | - R Reghini
- Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - M F Vieira
- Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - K Y Ibrahim
- Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - F Rossi
- Microbiology Section, Central Laboratory, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - L Hajjar
- Intensive Care Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - A S Levin
- Department of Infectious Diseases, University of São Paulo School of Medicine, São Paulo, Brazil
| | - P M Hoff
- Department of Oncology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - L C Pierrotti
- Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Department of Infectious Diseases, University of São Paulo School of Medicine, São Paulo, Brazil
| | - E Abdala
- Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Department of Infectious Diseases, University of São Paulo School of Medicine, São Paulo, Brazil
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Pereira AAL, Rego JFDM, Munhoz RR, Hoff PM, Sasse AD, Riechelmann RP. The impact of complete chemotherapy stop on the overall survival of patients with advanced colorectal cancer in first-line setting: A meta-analysis of randomized trials. Acta Oncol 2015; 54:1737-46. [PMID: 25984931 DOI: 10.3109/0284186x.2015.1044022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 12/27/2022]
Abstract
BACKGROUND The impact of the duration of chemotherapy on the overall survival of patients with metastatic colorectal cancer (mCRC) is controversial and studies have failed to define a clear standard. METHODS We searched medical literature databases and oncology conferences proceedings for randomized controlled trials (RCT) that compared the overall survival of mCRC patients who received continuous first-line chemotherapy until disease progression versus those who were offered complete treatment stop after a fixed number of cycles. Studies including targeted agents were also included. A meta-analysis of reported hazard ratios (HRs) for survival was performed. RESULTS We retrieved 240 trials, of which six were eligible and five were included in the pooled analysis of overall survival (N = 3061). The overall survival between continuously delivered chemotherapy and complete stop was not statistically different (HR = 0.93, 95% CI 0.85-1.02; p = 0.12; I² = 5%). The results are similar when we analyzed separately the trials performing randomization before versus after induction therapy. The median chemotherapy free interval in the complete stop group was 3.9 months (3.6-4.3 months). Chemotherapy administered until progression was associated with more adverse effects and impaired quality of life. CONCLUSION Compared with first-line continuous chemotherapy administered until disease progression, complete treatment stop did not have a detrimental impact on the overall survival of patients with mCRC. Identification of predictive biomarkers could help clinicians to select the patients who would benefit from continuous cancer-directed therapies.
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Affiliation(s)
| | | | - Rodrigo Ramela Munhoz
- a Department of Radiology and Oncology , Instituto do Cancer do Estado de Sao Paulo , Sao Paulo , Brazil
| | - Paulo Marcelo Hoff
- a Department of Radiology and Oncology , Instituto do Cancer do Estado de Sao Paulo , Sao Paulo , Brazil
| | | | - Rachel P Riechelmann
- a Department of Radiology and Oncology , Instituto do Cancer do Estado de Sao Paulo , Sao Paulo , Brazil
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Braghiroli MI, de Celis Ferrari ACR, Pfiffer TE, Alex AK, Nebuloni D, Carneiro AS, Caparelli F, Senna L, Lobo J, Hoff PM, Riechelmann RP. Phase II trial of metformin and paclitaxel for patients with gemcitabine-refractory advanced adenocarcinoma of the pancreas. Ecancermedicalscience 2015; 9:563. [PMID: 26316884 PMCID: PMC4544571 DOI: 10.3332/ecancer.2015.563] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In patients with adenocarcinoma of the pancreas, there are no standard second-line regimens. Many pre-clinical studies have shown that metformin alone or when combined with paclitaxel has antitumour effects on this tumour. We have tested here the combination of paclitaxel and metformin for patients with gemcitabine-refractory pancreatic cancer. METHODS An uncontrolled phase II trial was carried out based on a two-stage Simon's design, with metformin and paclitaxel for patients with locally advanced or metastatic pancreatic cancer whose disease had progressed during first line treatment with a gemcitabine-based regimen. The primary endpoint was the disease control rate at eight weeks as per response evaluation criteria in solid tumours (RECIST) 1.1. Patients received paclitaxel 80 mg/m(2) weekly for three weeks every 28 days and metformin 850 mg p.o. t.i.d. continuously until progression or intolerance state was reached. RESULTS Twenty patients were enrolled from July 2011 to January 2014: N = 6 (31.6%) achieved the primary endpoint, with all presenting stable disease. Median overall survival (OS) was 128 days (range 17-697) and the median progression free survival (PFS) was 44 days (range 14-210). Eight patients (40%) presented treatment-related G3-4 toxicities with the most common one being diarrhoea. CONCLUSIONS Despite the encouraging pre-clinical evidence of the antitumour activity of metformin in adenocarcinoma of the pancreas, the primary endpoint of the disease control rate was not met. Besides, the treatment combination was poorly tolerated and could not be studied further. This study highlights the importance of performing clinical trials to reassure preclinical or observational data.
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Affiliation(s)
- Maria Ignez Braghiroli
- Discipline of Radiology and Oncology, Instituto do Cancer do Estado de São Paulo, Universidade de São Paulo, Brazil, Av Dr Arnaldo 251, 12º andar São Paulo, SP, 01246-000 Brazil
| | - Anezka C R de Celis Ferrari
- Discipline of Radiology and Oncology, Instituto do Cancer do Estado de São Paulo, Universidade de São Paulo, Brazil, Av Dr Arnaldo 251, 12º andar São Paulo, SP, 01246-000 Brazil
| | - Tulio Eduardo Pfiffer
- Discipline of Radiology and Oncology, Instituto do Cancer do Estado de São Paulo, Universidade de São Paulo, Brazil, Av Dr Arnaldo 251, 12º andar São Paulo, SP, 01246-000 Brazil
| | - Alexandra Kichfy Alex
- Discipline of Radiology and Oncology, Instituto do Cancer do Estado de São Paulo, Universidade de São Paulo, Brazil, Av Dr Arnaldo 251, 12º andar São Paulo, SP, 01246-000 Brazil
| | - Daniela Nebuloni
- Discipline of Radiology and Oncology, Instituto do Cancer do Estado de São Paulo, Universidade de São Paulo, Brazil, Av Dr Arnaldo 251, 12º andar São Paulo, SP, 01246-000 Brazil
| | - Allyne S Carneiro
- Discipline of Radiology and Oncology, Instituto do Cancer do Estado de São Paulo, Universidade de São Paulo, Brazil, Av Dr Arnaldo 251, 12º andar São Paulo, SP, 01246-000 Brazil
| | - Fernanda Caparelli
- Discipline of Radiology and Oncology, Instituto do Cancer do Estado de São Paulo, Universidade de São Paulo, Brazil, Av Dr Arnaldo 251, 12º andar São Paulo, SP, 01246-000 Brazil
| | - Luiz Senna
- Discipline of Radiology and Oncology, Instituto do Cancer do Estado de São Paulo, Universidade de São Paulo, Brazil, Av Dr Arnaldo 251, 12º andar São Paulo, SP, 01246-000 Brazil
| | - Juliana Lobo
- Discipline of Radiology and Oncology, Instituto do Cancer do Estado de São Paulo, Universidade de São Paulo, Brazil, Av Dr Arnaldo 251, 12º andar São Paulo, SP, 01246-000 Brazil
| | - Paulo Marcelo Hoff
- Discipline of Radiology and Oncology, Instituto do Cancer do Estado de São Paulo, Universidade de São Paulo, Brazil, Av Dr Arnaldo 251, 12º andar São Paulo, SP, 01246-000 Brazil
| | - Rachel P Riechelmann
- Discipline of Radiology and Oncology, Instituto do Cancer do Estado de São Paulo, Universidade de São Paulo, Brazil, Av Dr Arnaldo 251, 12º andar São Paulo, SP, 01246-000 Brazil
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Tefferi A, Kantarjian H, Rajkumar SV, Baker LH, Abkowitz JL, Adamson JW, Advani RH, Allison J, Antman KH, Bast RC, Bennett JM, Benz EJ, Berliner N, Bertino J, Bhatia R, Bhatia S, Bhojwani D, Blanke CD, Bloomfield CD, Bosserman L, Broxmeyer HE, Byrd JC, Cabanillas F, Canellos GP, Chabner BA, Chanan-Khan A, Cheson B, Clarkson B, Cohn SL, Colon-Otero G, Cortes J, Coutre S, Cristofanilli M, Curran WJ, Daley GQ, DeAngelo DJ, Deeg HJ, Einhorn LH, Erba HP, Esteva FJ, Estey E, Fidler IJ, Foran J, Forman S, Freireich E, Fuchs C, George JN, Gertz MA, Giralt S, Golomb H, Greenberg P, Gutterman J, Handin RI, Hellman S, Hoff PM, Hoffman R, Hong WK, Horowitz M, Hortobagyi GN, Hudis C, Issa JP, Johnson BE, Kantoff PW, Kaushansky K, Khayat D, Khuri FR, Kipps TJ, Kripke M, Kyle RA, Larson RA, Lawrence TS, Levine R, Link MP, Lippman SM, Lonial S, Lyman GH, Markman M, Mendelsohn J, Meropol NJ, Messinger Y, Mulvey TM, O'Brien S, Perez-Soler R, Pollock R, Prchal J, Press O, Radich J, Rai K, Rosenberg SA, Rowe JM, Rugo H, Runowicz CD, Sandmaier BM, Saven A, Schafer AI, Schiffer C, Sekeres MA, Silver RT, Siu LL, Steensma DP, Stewart FM, Stock W, Stone R, Storb R, Strong LC, Tallman MS, Thompson M, Ueno NT, Van Etten RA, Vose JM, Wiernik PH, Winer EP, Younes A, Zelenetz AD, LeMaistre CA. In Support of a Patient-Driven Initiative and Petition to Lower the High Price of Cancer Drugs. Mayo Clin Proc 2015; 90:996-1000. [PMID: 26211600 PMCID: PMC5365030 DOI: 10.1016/j.mayocp.2015.06.001] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 06/04/2015] [Accepted: 06/04/2015] [Indexed: 10/23/2022]
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Munhoz RR, Pereira AAL, Sasse AD, Hoff PM, Traina TA, Hudis CA, Marques RJ. The role of LHRH agonists in ovarian function preservation in premenopausal women undergoing chemotherapy for early stage breast cancer: A systematic review and meta-analysis. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.1050] [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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de Andrade DC, Teixeira MJ, Galhardoni R, Ferreira KA, Malieno PB, Scisci N, Riechelmann RP, Teixeira WG, Saragiotto DF, Silva VA, Raicher I, de Castro I, Parravano D, Fukushima JT, Lefaucheur JP, Bouhassira D, Macarenco RSES, de Mello ES, Hoff PM. A phase III, randomized, double-blind, placebo-controlled trial to evaluate the efficacy and safety of pregabalin in the prevention and reduction of oxaliplatin-induced painful neuropathy (PreOx). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.3575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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)
| | | | - Ricardo Galhardoni
- Centro de Dor, Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Karine A.S.L. Ferreira
- Centro de Dor, Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Paula Braz Malieno
- Centro de Dor, Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Nathalia Scisci
- Centro de Dor, Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - William G.J. Teixeira
- Centro de Dor, Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Valquiria Aparecida Silva
- Centro de Dor, Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Irina Raicher
- Centro de Dor, Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Isac de Castro
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Daniella Parravano
- Centro de Dor, Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Julia Tizue Fukushima
- Instituto do Cancer do Estado de Sao Paulo- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Jean-Pascal Lefaucheur
- Faculté de Médecine, Université Paris Est Créteil, Service de Physiologie, Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique, Hôpitaux de Paris, Paris, France
| | - Didier Bouhassira
- INSERM E-332, AP-HP Hôpital Ambroise Pare ́, Boulogne and Universite ́ Versailles-Saint-Quentin, Paris, France
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Rego JFDM, Medeiros RSS, Braghiroli MIFM, Galvao B, Bezerra Neto JE, Munhoz RR, Guerra JM, Kimura L, Nonogaki S, Pfiffer TEF, Castro G, Hoff PM, Rocha Filho D, Costa F, Riechelmann RP. High-grade extrapulmonary neuroendocrine carcinomas and small cell lung cancer: Different entities, same treatment. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e15176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Breno Galvao
- Instituto do Cancer do Estado de Sao Paulo, Sao Paulo, Brazil
| | | | | | | | | | | | | | - Gilberto Castro
- Instituto do Cancer do Estado de Sao Paulo, Sao Paulo, SP, Brazil
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Fernandes GDS, Xavier F, Braghiroli MI, Machado K, Souza KT, Paterlini ACCR, Blumm Ferreira FS, Hoff PM. Efficacy and safety of rivaroxaban in Brazilian oncologic patients with thrombosis. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e20643] [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)
| | | | | | | | - Karla Teixeira Souza
- Instituto do Cancer do Estado de Sao Paulo - Faculdade de Medicina da Universida, Sao Paulo, Brazil
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Rocha LSDS, Negrao MV, Girardi DDM, Camargo VPD, Alban LBV, Hoff PM, Feher O. Perioperative chemotherapy with cisplatin (CP) and doxorubicin (DOX) with and without high-dose methotrexate (HDM) in adult osteosarcoma (AOT): Is methotrexate warranted? J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.10523] [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)
| | | | | | | | | | | | - Olavo Feher
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
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40
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Rego JFDM, Medeiros RSS, Braghiroli MIFM, Bezerra Neto JE, Munhoz RR, Guerra JM, Kimura L, Nonogaki S, Pfiffer TEF, Galvao B, Hoff PM, Rocha Filho D, Costa F, Riechelmann RP. Evaluation of predictive biomarkers of response and prognosis in patients with high-grade extrapulmonary neuroendocrine carcinomas treated with platin-based chemotherapy. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e15183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Breno Galvao
- Instituto do Cancer do Estado de Sao Paulo, Sao Paulo, Brazil
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41
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DA Fonseca LG, Barroso-Sousa R, Bento ADASA, Blanco BP, Valente GL, Pfiffer TEF, Hoff PM, Sabbaga J. Safety and efficacy of sorafenib in patients with Child-Pugh B advanced hepatocellular carcinoma. Mol Clin Oncol 2015; 3:793-796. [PMID: 26171182 DOI: 10.3892/mco.2015.536] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 03/27/2015] [Indexed: 01/17/2023] Open
Abstract
Sorafenib demonstrated a survival benefit in the treatment of advanced hepatocellular carcinoma (HCC) in phase III trials. However, almost all the patients included in those trials exhibited well-preserved liver function (Child-Pugh A). The aim of this study was to describe our experience with sorafenib in Child-Pugh B HCC patients. A database of patients with advanced HCC treated with sorafenib was retrospectively evaluated. The median overall survival of Child-Pugh B patients (n=20) was 2.53 months [95% confidence interval (CI): 0.33-5.92 months] and of Child-Pugh A patients (n=100) 9.71 months (95% CI: 6.22-13.04). Child-Pugh B patients had a significantly poorer survival compared to Child-Pugh A patients (P=0.002). The toxicities were similar between the two groups. Metastasis, vascular invasion and α-fetoprotein level >1,030 ng/ml were not associated with survival among Child-Pugh B patients (P=0.281, 0.189 and 0.996, respectively). Although the survival outcomes were worse in Child-Pugh B patients treated with sorafenib, the toxicity profile was manageable. Therefore, there remains the question of whether to treat this subgroup of patients and more data are required to define the role of sorafenib in the context of liver dysfunction.
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Affiliation(s)
- Leonardo Gomes DA Fonseca
- Cancer Institute of the State of Sao Paulo, University of Sao Paulo, Sao Paulo, SP 01255-000, Brazil
| | - Romualdo Barroso-Sousa
- Cancer Institute of the State of Sao Paulo, University of Sao Paulo, Sao Paulo, SP 01255-000, Brazil
| | | | - Bruna Paccola Blanco
- Cancer Institute of the State of Sao Paulo, University of Sao Paulo, Sao Paulo, SP 01255-000, Brazil
| | - Gabriel Luis Valente
- Cancer Institute of the State of Sao Paulo, University of Sao Paulo, Sao Paulo, SP 01255-000, Brazil
| | | | - Paulo Marcelo Hoff
- Cancer Institute of the State of Sao Paulo, University of Sao Paulo, Sao Paulo, SP 01255-000, Brazil
| | - Jorge Sabbaga
- Cancer Institute of the State of Sao Paulo, University of Sao Paulo, Sao Paulo, SP 01255-000, Brazil
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42
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Petry V, Gagliato DM, Leal AIC, Arai RJ, Longo E, Andrade F, Ricci MD, Piato JR, Barroso-Sousa R, Hoff PM, Mano MS. Metronomic chemotherapy in the neoadjuvant setting: results of two parallel feasibility trials (TraQme and TAME) in patients with HER2+ and HER2- locally advanced breast cancer. ACTA ACUST UNITED AC 2015; 48:479-85. [PMID: 25760024 PMCID: PMC4445673 DOI: 10.1590/1414-431x20144354] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/05/2014] [Indexed: 11/23/2022]
Abstract
Neoadjuvant chemotherapy has practical and theoretical advantages over adjuvant
chemotherapy strategy in breast cancer (BC) management. Moreover, metronomic delivery
has a more favorable toxicity profile. The present study examined the feasibility of
neoadjuvant metronomic chemotherapy in two cohorts [HER2+ (TraQme) and HER2− (TAME)]
of locally advanced BC. Twenty patients were prospectively enrolled (TraQme, n=9;
TAME, n=11). Both cohorts received weekly paclitaxel at 100 mg/m2 during 8
weeks followed by weekly doxorubicin at 24 mg/m2 for 9 weeks in
combination with oral cyclophosphamide at 100 mg/day (fixed dose). The HER2+ cohort
received weekly trastuzumab. The study was interrupted because of safety issues.
Thirty-six percent of patients in the TAME cohort and all patients from the TraQme
cohort had stage III BC. Of note, 33% from the TraQme cohort and 66% from the TAME
cohort displayed hormone receptor positivity in tumor tissue. The pathological
complete response rates were 55% and 18% among patients enrolled in the TraQme and
TAME cohorts, respectively. Patients in the TraQme cohort had more advanced BC stages
at diagnosis, higher-grade pathological classification, and more tumors lacking
hormone receptor expression, compared to the TAME cohort. The toxicity profile was
also different. Two patients in the TraQme cohort developed pneumonitis, and in the
TAME cohort we observed more hematological toxicity and hand-foot syndrome. The
neoadjuvant metronomic chemotherapy regimen evaluated in this trial was highly
effective in achieving a tumor response, especially in the HER2+ cohort. Pneumonitis
was a serious, unexpected adverse event observed in this group. Further larger and
randomized trials are warranted to evaluate the association between metronomic
chemotherapy and trastuzumab treatment.
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Affiliation(s)
- V Petry
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - D M Gagliato
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - A I C Leal
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - R J Arai
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - E Longo
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - F Andrade
- Núcleo de Mastologia, Hospital Sírio Libanês, São Paulo, SP, Brasil
| | - M D Ricci
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - J R Piato
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - R Barroso-Sousa
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - P M Hoff
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M S Mano
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Protasio BM, Matutino ARB, Lage LV, De Santana IA, Ramos REDO, Caires-Lima R, Caires IQDS, Riechelmann RP, Saragiotto DF, Sabbaga J, Hoff PM. Safety and efficacy of adjuvant modified FLOX for patients (pts) with stage III colorectal cancer (CRC) treated in the community. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.3_suppl.760] [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
760 Background: Based on the NSABP-C07 trial, FLOX became one of the standard adjuvant regimens for pts with stage III CRC. However, its efficacy and safety have not been evaluated outside of clinical trials. Methods: Retrospective analysis of all consecutive stage III CRC pts who received adjuvant chemotherapy with modified FLOX (5-FU bolus 500 mg/m2 and bolus of LV 20 mg/m2 for 6 consecutive weeks and oxaliplatin 85 mg/m2 in 2 hours-infusion at weeks 1, 3 and 5, every 8 weeks). Logistic regression (LR) multivariable models were used to identify predictors of relapse at 2 years and factors associated with grade ≥3 toxicity. Two-sided p<0.05 were significant. Results: From Feb 2007 to Oct 2013, 267 pts were eligible: median age was 59 years, 53.2% were male and 83 (32.2%) were operated emergently. Most pts (68.2%) had stage IIIB CRC, with a median of 21 (range: 1-119) lymphnodes resected. Pathology characteristics: 32 (12%) were poorly differentiated, 132 (49.4%) had angiolymphatic invasion and 75 (28.1%) had perineural invasion. Median time to chemotherapy initiation was 63 days (range: 10-188). With a median follow-up of 24 months, 67 (25.1%) pts recurred. In LR, urgent surgery (odds ratio [OR]=1.9, 95% IC: 1.03-3.49; p=0.039), angiolymphatic invasion (OR=1.99, 1.09-3.64; p=0.024), and delay/dose reduction of chemotherapy (OR=2.62; 1.45-4.72; p=0.001) were predictors of recurrence at 2 years. Any grade ≥3 toxicity occurred in 98 (36.7%) pts, with diarrhea (16.1%), and neutropenia (15.3%) being the most frequent ones. A total of 9 (3.4%) pts died from any cause within 60 days of starting modified FLOX. Age ≥65 years (OR=2.6, 1.26-5.38; p=0.01) was associated with a higher risk of grade ≥3 toxicity in LR. Conclusions: The adjuvant modified FLOX was effective in stage III CRC pts treated in the community but offered significant risk of serious toxicity and death. This regimen should be probably restricted to fit pts who are ≤65 years. Also, similar to the stage II setting, we found that stage III CRC pts whose primary tumor were ressected emergently, those with angiolymphatic invasion or who received less dose-intense chemotherapy were at higher risk of recurrence.
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Affiliation(s)
| | | | - Liana Valente Lage
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Iuri Amorim De Santana
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | | | - Rafael Caires-Lima
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | - Jorge Sabbaga
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
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44
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Coart E, Saad ED, Shi Q, Sommeijer DW, Zalcberg JR, Maughan T, Goldberg RM, Schmoll HJ, Punt CJA, Van Cutsem E, Douillard JY, Hoff PM, Tebbutt NC, Fuchs CS, Falcone A, Tournigand C, De Gramont A, Sargent DJ, Burzykowski T, Buyse ME. Trial-level association between response-based endpoints (RBEs) and progression-free (PFS)/overall survival (OS) in first-line therapy for metastatic colorectal cancer (mCRC) in the ARCAD database. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.3_suppl.666] [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
666 Background: Early tumor shrinkage (ETS; ≥20% decrease from baseline) and early objective tumor response (EOTR; CR/PR by RECIST) are associated with improved PFS/OS to a similar extent than best overall response (BOR), confirmed response (ConfR) and non-progression rate (NPR; CR/PR/SD by RECIST) at the individual level in first-line mCRC (ASCO 2014, abstr 3538/3578). We assessed these RBEs at the trial level. Methods: Data were available on 12,185 pts enrolled in a total of 17 randomized trials of chemotherapy (CT) alone or with targeted agents (TAs). ETS, EOTR and NPR were assessed at 6/8/9 and 12 weeks (wks), whereas BOR and ConfR were ascertained within 26 wks from randomization. Association between treatment effects on RBEs and on PFS/OS was assessed by coefficients of determination (R2, adjusted for estimation errors) using a copula model). Results: None of the RBEs had consistently strong correlations with PFS or OS (Table). The number of trials was insufficient to obtain reliable estimates for antiangiogenics and anti-EGFR separately. Conclusions: Despite their individual-level associations with PFS and OS, RBEs do not appear to be surrogate endpoints in first-line mCRC, given their poor predictive ability. [Table: see text]
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Affiliation(s)
- Elisabeth Coart
- International Drug Development Institute, Louvain la Neuve, Belgium
| | | | - Qian Shi
- Mayo Clinic, Rochester, MN, Rochester, MN
| | | | | | - Tim Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, United Kingdom
| | | | - Hans-Joachim Schmoll
- University Clinic Halle (Saale), Department of Internal Medicine IV, Halle, Germany
| | | | | | | | - Paulo Marcelo Hoff
- Hospital Sírio-Libanês and Instituto do Cancer do Estado de São Paulo, Universidade de Sao Paulo, São Paulo, Brazil
| | | | | | - Alfredo Falcone
- U.O. Oncologia Medica II, Azienda Ospedaliero-Universitaria Pisana Istituto Toscano Tumori, Pisa, Italy
| | | | | | | | | | - Marc E. Buyse
- International Drug Development Institute, Leuven, Belgium
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45
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De Celis Ferrari ACR, Pfiffer TEF, Alex AK, Nebuloni DR, Carneiro AQ, Capareli FC, Leite LAS, Braghiroli MIFM, Lobo J, Hoff PM, Riechelmann RP. Phase II trial of metformin and paclitaxel for patients with gemcitabine-refractory advanced adenocarcinoma of the pancreas. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e15196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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)
| | | | | | | | | | | | | | | | - Juliana Lobo
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
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46
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Toloi DDA, Scaranti M, Fraile NMP, De Santana IA, Mencarini ACM, Munhoz RR, Camargo VPD, Castanheira VRC, Feher O, Chammas R, Hoff PM. Influence of histopathologic features and other risk factors on the outcomes of uveal melanoma patients submitted to ocular enucleation. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e20028] [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)
- Diego de Araujo Toloi
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Mariana Scaranti
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | | | - Iuri Amorim De Santana
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | | | - Rodrigo Ramella Munhoz
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | | | - Vera Regina Cardoso Castanheira
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - Departamento de Oftalomologia, São Paulo, Brazil
| | - Olavo Feher
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Roger Chammas
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
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47
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Saad ED, Coart E, Sommeijer DW, Shi Q, Zalcberg JR, Burzykowski T, Meyers JP, Hoff PM, Hecht JR, Hurwitz H, Tol J, Tebbutt NC, Fuchs CS, Diaz-Rubio E, Souglakos J, Falcone A, Kabbinavar FF, Sargent DJ, De Gramont A, Buyse ME. Early predictors of improved long-term outcomes in first-line antiangiogenics plus chemotherapy (anti-ANG/CT) in metastatic colorectal cancer (mCRC): Analysis of individual patient (pt) data from the ARCAD database. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.3578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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)
| | - Elisabeth Coart
- International Drug Development Institute, Louvain la Neuve, Belgium
| | - Dirkje Willemien Sommeijer
- NHMRC Clinical Trials Centre, Sydney; Academic Medical Centre, Amsterdam; Flevohospital, Almere, Amsterdam, Netherlands
| | | | | | | | | | | | - J. Randolph Hecht
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | | | - Jolien Tol
- Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | | | | | | | - John Souglakos
- University General Hospital of Heraklion, Department of Medical Oncology, Heraklion, Greece
| | - Alfredo Falcone
- U.O. Oncologia Medica 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | | | | | | | - Marc E. Buyse
- International Drug Development Institute (IDDI), Louvain la Neuve, Belgium
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Pereira AAL, Rego JFDM, Hoff PM, Sasse AD, Riechelmann RP. The effect of chemotherapy delivered until progression versus complete stop on the overall survival of patients with metastatic colorectal cancer: A meta-analysis of randomized trials. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.3542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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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49
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De Castria TB, Castro G, Hoff PM. Maintenance chemotherapy (MC) in advanced non-small cell lung cancer (NSCLC): A meta-analysis. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e19020] [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)
| | - Gilberto Castro
- Instituto do Cancer do Estado de Sao Paulo, São Paulo, Brazil
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50
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Bezerra R, Gumz BP, Etchebehere E, Santos AOLIVEIRA, Fernandes RRR, Hoff PM, Strecker R, Menezes M, Costa F. Whole-body diffusion-weighted MRI (DWMR) compared with [68Ga] DOTATOC-PET/CT (68Ga) and OctreoScan (OCT) for staging neuroendocrine tumors (NET). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e15167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | - Paulo Marcelo Hoff
- Hospital Sírio-Libanês and Instituto do Cancer do Estado de São Paulo, Universidade de Sao Paulo, São Paulo, Brazil
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