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Martin-Broto J, Martinez-Garcia J, Moura DS, Redondo A, Gutierrez A, Lopez-Pousa A, Martinez-Trufero J, Sevilla I, Diaz-Beveridge R, Solis-Hernandez MP, Carnero A, Perez M, Marcilla D, Garcia-Foncillas J, Romero P, Fernandez-Jara J, Lopez-Lopez D, Arribas I, Hindi N. Phase II trial of CDK4/6 inhibitor palbociclib in advanced sarcoma based on mRNA expression of CDK4/ CDKN2A. Signal Transduct Target Ther 2023; 8:405. [PMID: 37875500 PMCID: PMC10598203 DOI: 10.1038/s41392-023-01661-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/06/2023] [Accepted: 09/16/2023] [Indexed: 10/26/2023] Open
Abstract
Cyclin-dependent kinases 4 and 6 (CDK4/6) inhibitors demonstrated activity in terms of progression-free survival (PFS) in advanced dedifferentiated liposarcoma (DD-LPS), a sarcoma with CDK4 amplification. CDK4 overexpression is by far more common than amplification in sarcomas and it might be a rational target for CDK inhibitors. Preclinical investigators of this study found that CDK4 overexpression, while not of CDKN2A, was the most consistent predictive factor for palbociclib efficacy in sarcomas. Advanced adult-type soft-tissue sarcoma, excluding DD-LPS, or bone sarcoma patients, progressing after at least one systemic line, whose tumors overexpressed CDK4, but not CDKN2A at baseline biopsy, were accrued in this single-arm phase II trial (EudraCT number: 2016-004039-19). With the main endpoint of a 6-month PFS rate, 40% was considered promising in this population. Palbociclib was administered orally at 125 mg/day for 21 days in 28-day cycles. A total of 214 patients with 236 CDK4/CDKN2A determinations were assessed for prescreening, archival material (141), and screening, baseline biopsy (95). There were 28 (29%) with favorable mRNA profiles from 95 screened patients at baseline. From 23 enrolled patients, 21 evaluable, the 6-month PFS rate was 29% (95% CI 9-48), and there were 6 patients out of 21 with a PFS longer than 6 months. The median PFS and overall survival were 4.2 (95% CI 3.6-4.8) and 12 (95% CI 8.7-15.4) months, respectively. Translational research showed a significant correlation between CDK4 mRNA and protein expression. Palbociclib was active in a variety of sarcoma subtypes, selected by CDK4/CDKN2A, and deserves further investigation in the sarcoma context.
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Affiliation(s)
- Javier Martin-Broto
- Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid (IIS-FJD, UAM), 28040, Madrid, Spain.
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital, 28040, Madrid, Spain.
- General de Villalba University Hospital, 28400, Madrid, Spain.
| | | | - David S Moura
- Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid (IIS-FJD, UAM), 28040, Madrid, Spain
| | - Andres Redondo
- Department of Medical Oncology, Hospital Universitario La Paz-IdiPAZ, P. Castellana, 261, 28046, Madrid, Spain
| | - Antonio Gutierrez
- Hematology Department, University Hospital Son Espases, 07120, Mallorca, Spain
| | | | | | - Isabel Sevilla
- Investigación Clínica y Traslacional en Cáncer/ Instituto de Investigaciones Biomédicas de Malaga (IBIMA)/ Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Malaga, Spain
| | - Roberto Diaz-Beveridge
- Medical Oncology Department, Hospital Universitari i Politècnic La Fe, 46026, Valencia, Spain
| | | | - Amancio Carnero
- Instituto de Biomedicina de Sevilla (IBiS; HUVR, CSIC, US), 41013, Sevilla, Spain
| | - Marco Perez
- Instituto de Biomedicina de Sevilla (IBiS; HUVR, CSIC, US), 41013, Sevilla, Spain
- Pathology Department, Virgen del Rocio University Hospital, 41013, Sevilla, Spain
| | - David Marcilla
- Pathology Department, Virgen del Rocio University Hospital, 41013, Sevilla, Spain
| | - Jesus Garcia-Foncillas
- Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid (IIS-FJD, UAM), 28040, Madrid, Spain
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital, 28040, Madrid, Spain
| | - Pablo Romero
- Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid (IIS-FJD, UAM), 28040, Madrid, Spain
| | - Javier Fernandez-Jara
- Radiology Department, Fundación Jimenez Diaz University Hospital, 28040, Madrid, Spain
| | - Daniel Lopez-Lopez
- Instituto de Biomedicina de Sevilla (IBiS; HUVR, CSIC, US), 41013, Sevilla, Spain
- Computational Medicine Platform, Fundación progreso y salud (FPS), Hospital Virgen del Rocío, 41013, Seville, Spain
- Bioinformatics in Rare Diseases (BiER). Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), FPS, Hospital Virgen del Rocio, Sevilla, Spain
| | - Ivan Arribas
- Universitat de València - ERI-CES, 46010, Valencia, Spain
| | - Nadia Hindi
- Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid (IIS-FJD, UAM), 28040, Madrid, Spain
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital, 28040, Madrid, Spain
- General de Villalba University Hospital, 28400, Madrid, Spain
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Martin-Broto J, Hindi N, Cruz J, Martinez-Trufero J, Valverde C, De Sande LM, Sala A, Bellido L, De Juan A, Rubió-Casadevall J, Diaz-Beveridge R, Cubedo R, Tendero O, Salinas D, Gracia I, Ramos R, Baguè S, Gutierrez A, Duran-Moreno J, Lopez-Pousa A. Relevance of Reference Centers in Sarcoma Care and Quality Item Evaluation: Results from the Prospective Registry of the Spanish Group for Research in Sarcoma (GEIS). Oncologist 2018; 24:e338-e346. [PMID: 30409793 DOI: 10.1634/theoncologist.2018-0121] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 08/28/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Reference centers (RCs) are a key point for improving the survival of patients with soft-tissue sarcomas (STS). The aim of this study was to evaluate selected items in the management of patients with STS, comparing results between RC and local hospitals (LHs). MATERIALS AND METHODS Diagnostic and therapeutic data from patients diagnosed between January 2004 and December 2011 were collected. Correlation with outcome was performed. RESULTS A total of 622 sarcomas were analyzed, with a median follow-up of 40 months. Imaging of primary tumor preoperatively (yes vs. no) correlated with a higher probability of free surgical margins (77.4% versus 53.7%; p = .006). The provenance of the biopsy (RC vs. LH) significantly affected relapse-free survival (RFS; 3-year RFS 66% vs. 46%, respectively; p = .019). Likewise, 3-year RFS was significantly worse in cases with infiltrated (55.6%) or unknown (43.4%) microscopic surgical margins compared with free margins (63.6%; p < .001). Patients managed by RCs had a better 3-year overall survival compared with those managed by LHs (82% vs. 70.4%, respectively; p = .003). Perioperative chemotherapy in high-risk STS, more frequently administered in RCs than in LHs, resulted in significantly better 3-year RFS (66% vs. 44%; p = .011). In addition, patients with stage IV disease treated in RCs survived significantly longer compared with those in LHs (30.4 months vs. 18.5 months; p = .036). CONCLUSION Our series indicate that selected quality-of-care items were accomplished better by RCs over LHs, all with significant prognostic value in patients with STS. Early referral to an RC should be mandatory if the aim is to improve the survival of patients with STS. IMPLICATIONS FOR PRACTICE This prospective study in patients diagnosed with soft-tissue sarcoma shows the prognostic impact of reference centers in the management of these patients. The magnitude of this impact encompasses all steps of the process, from the initial management (performing diagnostic biopsy) to the advanced disease setting. This is the first prospective evidence showing improvement in outcomes of patients with metastatic disease when they are managed in centers with expertise. This study provides extra data supporting referral of patients with sarcoma to reference centers.
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Affiliation(s)
- Javier Martin-Broto
- Biomedicine Institute of Seville (IBIS), Lab 215, CSIC, University of Seville, Seville, Spain
- Medical Oncology Department, Virgen del Rocio University Hospital, Seville, Spain
| | - Nadia Hindi
- Biomedicine Institute of Seville (IBIS), Lab 215, CSIC, University of Seville, Seville, Spain
- Medical Oncology Department, Virgen del Rocio University Hospital, Seville, Spain
| | - Josefina Cruz
- Medical Oncology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | | | - Claudia Valverde
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Angeles Sala
- Medical Oncology Department, Hospital de Basurto, Bilbao, Spain
| | - Lorena Bellido
- Medical Oncology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Ana De Juan
- Medical Oncology Department, Hospitalario Universitario Marqués de Valdecilla, Santander, Spain
| | - Jordi Rubió-Casadevall
- Medical Oncology Department, Hospital Josep Trueta, Instituto Catalán de Oncología, Girona, Spain
| | | | - Ricardo Cubedo
- Medical Oncology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Oscar Tendero
- Department of Orthopedic Surgery, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Diego Salinas
- Department of Orthopedic Surgery, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Isidro Gracia
- Department of Orthopedic Surgery, Hospital Universitari Sant Pau, Barcelona, Spain
| | - Rafael Ramos
- Department of Pathology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Silvia Baguè
- Department of Pathology, Hospital Universitari Sant Pau, Barcelona, Spain
| | - Antonio Gutierrez
- Department of Hematology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - José Duran-Moreno
- Department of Medical Oncology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Antonio Lopez-Pousa
- Department of Medical Oncology, Hospital Universitari Sant Pau, Barcelona, Spain
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Martin-Broto J, Redondo A, Valverde C, Vaz M, Mora J, Garcia del Muro X, Gutierrez A, Tous C, Carnero A, Marcilla D, Carranza A, Sancho P, Martinez-Trufero J, Diaz-Beveridge R, Cruz J, Encinas V, Taron M, Moura D, Luna P, Hindi N, Lopez-Pousa A. Gemcitabine plus sirolimus for relapsed and progressing osteosarcoma patients after standard chemotherapy: a multicenter, single-arm phase II trial of Spanish Group for Research on Sarcoma (GEIS). Ann Oncol 2017; 28:2994-2999. [DOI: 10.1093/annonc/mdx536] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Diaz-Beveridge R, Bruixola G, Lorente D, Caballero J, Rodrigo E, Segura Á, Akhoundova D, Giménez A, Aparicio J. An internally validated new clinical and inflammation-based prognostic score for patients with advanced hepatocellular carcinoma treated with sorafenib. Clin Transl Oncol 2017; 20:322-329. [PMID: 28801777 DOI: 10.1007/s12094-017-1720-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 07/24/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Sorafenib is a standard treatment for patients (pts) with advanced hepatocellular carcinoma (aHCC), although the clinical benefit is heterogeneous between different pts groups. Among novel prognostic factors, a low baseline neutrophil-to-lymphocyte ratio (bNLR) and early-onset diarrhoea have been linked with a better prognosis. PURPOSE To identify prognostic factors in pts with aHCC treated with 1st-line sorafenib and to develop a new prognostic score to guide management. MATERIALS AND METHODS Retrospective review of 145 pts bNLR, overall toxicity, early toxicity rates and overall survival (OS) were assessed. Univariate and multivariate analysis of prognostic factors for OS was performed. The prognostic score was calculated from the coefficients found in the Cox analysis. ROC curves and pseudoR2 index were used for internal validation. Discrimination ability and calibration were tested by Harrel's c-index (HCI) and Akaike criteria (AIC). RESULTS The optimal bNLR cut-off for the prediction of OS was 4 (AUC 0.62). Independent prognostic factors in multivariate analysis for OS were performance status (PS) (p < .0001), Child-Pugh (C-P) score (p = 0.005), early-onset diarrhoea (p = 0.006) and BNLR (0.011). The prognostic score based on these four variables was found efficient (HCI = 0.659; AIC = 1.180). Four risk groups for OS could be identified: a very low-risk (median OS = 48.6 months), a low-risk (median OS = 11.6 months), an intermediate-risk (median OS = 8.3 months) and a high-risk group (median OS = 4.4 months). CONCLUSIONS PS and C-P score were the main prognostic factors for OS, followed by early-onset diarrhoea and bNLR. We identified four risk groups for OS depending on these parameters. This prognostic model could be useful for patient stratification, but an external validation is needed.
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Affiliation(s)
- R Diaz-Beveridge
- Medical Oncology Department, University Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain.
| | - G Bruixola
- Medical Oncology Department, University Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - D Lorente
- Medical Oncology Department, University Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - J Caballero
- Medical Oncology Department, University Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - E Rodrigo
- Medical Oncology Department, University Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - Á Segura
- Medical Oncology Department, University Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - D Akhoundova
- Medical Oncology Department, University Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - A Giménez
- Medical Oncology Department, University Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - J Aparicio
- Medical Oncology Department, University Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
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