1
|
Nadal E, Bosch-Barrera J, Cedrés S, Coves J, García-Campelo R, Guirado M, López-Castro R, Ortega AL, Vicente D, de Castro-Carpeño J. SEOM clinical guidelines for the treatment of malignant pleural mesothelioma (2020). Clin Transl Oncol 2021; 23:980-987. [PMID: 33538989 PMCID: PMC8057959 DOI: 10.1007/s12094-020-02532-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 11/25/2022]
Abstract
Mesothelioma is a rare and aggressive tumour with dismal prognosis arising in the pleura and associated with asbestos exposure. Its incidence is on the rise worldwide. In selected patients with early-stage MPM, a maximal surgical cytoreduction in combination with additional antitumour treatment may be considered in selected patients assessed by a multidisciplinary tumor board. In patients with unresectable or advanced MPM, chemotherapy with platinum plus pemetrexed is the standard of care. Currently, no standard salvage therapy has been approved yet, but second-line chemotherapy with vinorelbine or gemcitabine is commonly used. Novel therapeutic approaches based on dual immunotherapy or chemotherapy plus immunotherapy demonstrated promising survival benefit and will probably be incorporated in the future.
Collapse
Affiliation(s)
- E. Nadal
- Department of Medical Oncology, Catalan Institute of Oncology, Hospital Duran i Reynals, Avda Gran Via 199-203, l’Hospitalet de Llobregat, Barcelona, Spain
| | - J. Bosch-Barrera
- Department of Medical Oncology, Catalan Institute of Oncology, Hospital Josep Trueta, Girona, Spain
| | - S. Cedrés
- Department of Medical Oncology, Vall d’Hebron Institute of Oncology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - J. Coves
- Department of Medical Oncology, Hospital Son Llatzer, Palma de Mallorca, Spain
| | - R. García-Campelo
- Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain
| | - M. Guirado
- Department of Medical Oncology, Hospital General Universitario de Elche, Elche, Spain
| | - R. López-Castro
- Department of Medical Oncology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - A. L. Ortega
- Department of Medical Oncology, Complejo Hospitalario de Jaén, Jaén, Spain
| | - D. Vicente
- Department of Clinical Oncology, Hospital Universitario Virgen de Macarena, Sevilla, Spain
| | | |
Collapse
|
2
|
Cedrés S, Ponce-Aix S, Iranzo P, Callejo A, Pardo N, Navarro A, Martinez-Marti A, Gómez-Abecia S, Zucchiatti AC, Sansano I, Enguita AB, Miquel JM, Viaplana C, Dienstmann R, Paz-Ares L, Felip E. Analysis of mismatch repair (MMR) proteins expression in a series of malignant pleural mesothelioma (MPM) patients. Clin Transl Oncol 2020; 22:1390-1398. [PMID: 31916017 DOI: 10.1007/s12094-019-02275-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 10/16/2019] [Accepted: 12/16/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Promising results have been reported with immune checkpoint inhibitors (ICI) in a small proportion of MPM patients. MMR deficiency (dMMR) has been well described in several malignancies and was approved as a biomarker for anti-PD-1 inhibitors. Next generation sequencing (NGS) data demonstrated that 2% of MPM harbor microsatellite instability. The aim of this study is to characterize MMR by immunohistochemistry (IHC) in a series of MPM including a subset of patients treated with immunotherapy. METHODS Tumors of 159 MPM p diagnosed between 2002 and 2017 were reviewed. Formalin-fixed, paraffin-embedded tissue was stained for MLH1, MSH2, MSH6 and PMS2 and tumors were classified as dMMR (MMR protein expression negative) and MMR intact (all MMR proteins positively expressed). We retrospectively collected clinical outcomes under standard chemotherapy and experimental immunotherapy in the entire cohort. RESULTS MMR protein expression was analyzed in 158 samples with enough tissue and was positive in all of the cases. Twenty two patients received ICI with anti-CTLA4 or anti-PD-1 blockade in clinical trials, 58% had a response or stable disease for more than 6 m, with median progression-free survival (PFS) of 5.7 m (2.1-26.1 m). The median overall survival (mOS) in all population was 15 months (m) (13.5-18.8 m). In a multivariable model factors associated to improved mOS were PS 0, neutrophil-lymphocyte ratio (NLR) < 5 and epithelioid histology (p < 0.001). CONCLUSIONS In our series we were unable to identify any MPM patient with dMMR by IHC. Further studies are needed to elucidate potential predictive biomarkers of ICI benefit in MPM.
Collapse
Affiliation(s)
- S Cedrés
- Medical Oncology Department, Vall d´Hebron University Hospital and Institute of Oncology, Barcelona, Spain.
- Servicio de Oncología, Hospital Vall D´Hebron, Paseo Vall d´Hebron 119-129, 08035, Barcelona, Spain.
| | - S Ponce-Aix
- CIBERONC, Madrid, Spain
- Medical Oncology Department, University Hospital Doce de Octubre, Madrid, Spain
| | - P Iranzo
- Medical Oncology Department, Vall d´Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - A Callejo
- Medical Oncology Department, Vall d´Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - N Pardo
- Medical Oncology Department, Vall d´Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - A Navarro
- Medical Oncology Department, Vall d´Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - A Martinez-Marti
- Medical Oncology Department, Vall d´Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | | | - A C Zucchiatti
- Pathology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - I Sansano
- Pathological Anatomy Department, University Hospital Doce de Octubre, Madrid, Spain
| | - A B Enguita
- Pathological Anatomy Department, University Hospital Doce de Octubre, Madrid, Spain
| | - J M Miquel
- Vall d´Hebron Institute of Oncology, Barcelona, Spain
| | - C Viaplana
- Oncology Data Science (ODysSey) Group, Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - R Dienstmann
- Medical Oncology Department, Vall d´Hebron University Hospital and Institute of Oncology, Barcelona, Spain
- Oncology Data Science (ODysSey) Group, Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - L Paz-Ares
- CIBERONC, Madrid, Spain
- H12O-CNIO Lung Cancer Clinical Research Unit, Biomedical Research Foundation I+12, Madrid, Spain
- H12O-CNIO Lung Cancer Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- Medical School, Complutense University, Madrid, Spain
| | - E Felip
- Medical Oncology Department, Vall d´Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| |
Collapse
|
3
|
Martinez-Marti A, Felip E, Matito J, Mereu E, Navarro A, Cedrés S, Pardo N, Martinez de Castro A, Remon J, Miquel JM, Guillaumet-Adkins A, Nadal E, Rodriguez-Esteban G, Arqués O, Fasani R, Nuciforo P, Heyn H, Villanueva A, Palmer HG, Vivancos A. Dual MET and ERBB inhibition overcomes intratumor plasticity in osimertinib-resistant-advanced non-small-cell lung cancer (NSCLC). Ann Oncol 2018; 28:2451-2457. [PMID: 28961841 PMCID: PMC5834054 DOI: 10.1093/annonc/mdx396] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Third-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) such as osimertinib are the last line of targeted treatment of metastatic non-small-cell lung cancer (NSCLC) EGFR-mutant harboring T790M. Different mechanisms of acquired resistance to third-generation EGFR-TKIs have been proposed. It is therefore crucial to identify new and effective strategies to overcome successive acquired mechanisms of resistance. Methods For Amplicon-seq analysis, samples from the index patient (primary and metastasis lesions at different timepoints) as well as the patient-derived orthotopic xenograft tumors corresponding to the different treatment arms were used. All samples were formalin-fixed paraffin-embedded, selected and evaluated by a pathologist. For droplet digital PCR, 20 patients diagnosed with NSCLC at baseline or progression to different lines of TKI therapies were selected. Formalin-fixed paraffin-embedded blocks corresponding to either primary tumor or metastasis specimens were used for analysis. For single-cell analysis, orthotopically grown metastases were dissected from the brain of an athymic nu/nu mouse and cryopreserved at -80°C. Results In a brain metastasis lesion from a NSCLC patient presenting an EGFR T790M mutation, we detected MET gene amplification after prolonged treatment with osimertinib. Importantly, the combination of capmatinib (c-MET inhibitor) and afatinib (ErbB-1/2/4 inhibitor) completely suppressed tumor growth in mice orthotopically injected with cells derived from this brain metastasis. In those mice treated with capmatinib or afatinib as monotherapy, we observed the emergence of KRAS G12C clones. Single-cell gene expression analyses also revealed intratumor heterogeneity, indicating the presence of a KRAS-driven subclone. We also detected low-frequent KRAS G12C alleles in patients treated with various EGFR-TKIs. Conclusion Acquired resistance to subsequent EGFR-TKI treatment lines in EGFR-mutant lung cancer patients may induce genetic plasticity. We assess the biological insights of tumor heterogeneity in an osimertinib-resistant tumor with acquired MET-amplification and propose new treatment strategies in this situation.
Collapse
Affiliation(s)
- A Martinez-Marti
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona;; Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona;; Autonomous University of Barcelona (UAB), Barcelona
| | - E Felip
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona;; Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona;; Autonomous University of Barcelona (UAB), Barcelona;.
| | - J Matito
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona
| | - E Mereu
- Single Cell Genomics Group, Centro Nacional de Análisis Genómico (CNAG) - Center for Genomic Regulation (CRG), Barcelona Institute of Science and Technology (BIST), Barcelona;; Pompeu Fabra University (UPF), Barcelona
| | - A Navarro
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona;; Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona
| | - S Cedrés
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona;; Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona
| | - N Pardo
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona;; Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona;; Autonomous University of Barcelona (UAB), Barcelona
| | - A Martinez de Castro
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona;; Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona
| | - J Remon
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona;; Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona
| | - J M Miquel
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona
| | - A Guillaumet-Adkins
- Single Cell Genomics Group, Centro Nacional de Análisis Genómico (CNAG) - Center for Genomic Regulation (CRG), Barcelona Institute of Science and Technology (BIST), Barcelona;; Pompeu Fabra University (UPF), Barcelona
| | - E Nadal
- Chemoresistance and Predictive Factors Group, Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology (ICO) Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Barcelona;; Department of Medical Oncology, ICO, IDIBELL, L'Hospitalet, Barcelona
| | - G Rodriguez-Esteban
- Single Cell Genomics Group, Centro Nacional de Análisis Genómico (CNAG) - Center for Genomic Regulation (CRG), Barcelona Institute of Science and Technology (BIST), Barcelona;; Pompeu Fabra University (UPF), Barcelona
| | | | - R Fasani
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona
| | - P Nuciforo
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona
| | - H Heyn
- Single Cell Genomics Group, Centro Nacional de Análisis Genómico (CNAG) - Center for Genomic Regulation (CRG), Barcelona Institute of Science and Technology (BIST), Barcelona;; Pompeu Fabra University (UPF), Barcelona
| | - A Villanueva
- Chemoresistance and Predictive Factors Group, Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology (ICO) Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Barcelona;; Xenopat S.L., Business Bioincubator, Bellvitge Health Science Campus, Barcelona, Spain
| | | | - A Vivancos
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona;.
| |
Collapse
|
4
|
Remon J, Pardo N, Martinez-Martí A, Cedrés S, Navarro A, Martinez de Castro AM, Felip E. Corrigendum to "Immune-checkpoint inhibition in first-line treatment of advanced non-small cell lung cancer patients: Current status and future approaches" [Lung Cancer 106 (2017) 70-75]. Lung Cancer 2018; 117:80. [PMID: 29398170 DOI: 10.1016/j.lungcan.2017.11.007] [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: 11/16/2022]
Affiliation(s)
- J Remon
- Hospital Vall d'Hebron, Medical Oncology Department, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - N Pardo
- Hospital Vall d'Hebron, Medical Oncology Department, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - A Martinez-Martí
- Hospital Vall d'Hebron, Medical Oncology Department, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - S Cedrés
- Hospital Vall d'Hebron, Medical Oncology Department, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - A Navarro
- Hospital Vall d'Hebron, Medical Oncology Department, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - A M Martinez de Castro
- Hospital Vall d'Hebron, Medical Oncology Department, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - E Felip
- Hospital Vall d'Hebron, Medical Oncology Department, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| |
Collapse
|
5
|
Cedrés S, Ponce-Aix S, Pardo-Aranda N, Navarro-Mendivil A, Martinez-Marti A, Zugazagoitia J, Sansano I, Montoro MA, Enguita A, Felip E. Analysis of expression of PTEN/PI3K pathway and programmed cell death ligand 1 (PD-L1) in malignant pleural mesothelioma (MPM). Lung Cancer 2016; 96:1-6. [PMID: 27133741 DOI: 10.1016/j.lungcan.2016.03.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 12/19/2015] [Revised: 02/24/2016] [Accepted: 03/07/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) frequently express elevated AKT/mTOR activity. Previous reports in gliomas, colon, breast and prostate cancer suggest that PTEN/PI3K pathway may be important for the induction of PD-L1 expression. This study explored the expression of PTEN/PI3K pathway and PD-L1 in MPM and its relationship with the patient́s prognosis MATERIAL AND METHODS Twenty seven consecutive MPM patients were reviewed. Formalin-fixed, paraffin-embedded tissue biopsies were used for immunohistochemical analysis of PTEN/PI3K pathway and PD-L1 RESULTS: Expression of PTEN, mTOR, pAKT, p4EBP1, peif4E, pS6 and FOXO3a was found in 88.5%, 92.3%, 78.3%, 38.5%, 100%, 52.2% and 100% of tumors and PD-L1 in 23%. We found a significant correlation between pAKT, FOXO3a and PD-L1 expression and longer overall survival (p <0.05). We did not identify significant association between the level of PD-L1 expression and alterations in PI3K pathway CONCLUSIONS This study shows PTEN/PI3K pathway and PD-L1 in MPM are frequently activated. Our results suggests that there is not association between PD-L1 and the involvement of the PI3K pathway in MPM.
Collapse
Affiliation(s)
- S Cedrés
- Medical Oncology Service, Vall d́Hebron Institute Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Universidad Autonoma de Barcelona, Barcelona, Spain.
| | - S Ponce-Aix
- Medical Oncology Service, 12 de Octubre University Hospital, Madrid, Spain
| | - N Pardo-Aranda
- Medical Oncology Service, Vall d́Hebron Institute Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Universidad Autonoma de Barcelona, Barcelona, Spain
| | - A Navarro-Mendivil
- Medical Oncology Service, Vall d́Hebron Institute Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Universidad Autonoma de Barcelona, Barcelona, Spain
| | - A Martinez-Marti
- Medical Oncology Service, Vall d́Hebron Institute Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Universidad Autonoma de Barcelona, Barcelona, Spain
| | - J Zugazagoitia
- Medical Oncology Service, 12 de Octubre University Hospital, Madrid, Spain
| | - I Sansano
- Pathology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - M A Montoro
- Pathology Department, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - A Enguita
- Pathology Department, 12 de Octubre University Hospital, Madrid, Spain
| | - E Felip
- Medical Oncology Service, Vall d́Hebron Institute Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Universidad Autonoma de Barcelona, Barcelona, Spain
| |
Collapse
|
6
|
Cedrés S, Torrejon D, Martínez A, Martinez P, Navarro A, Zamora E, Mulet-Margalef N, Felip E. Neutrophil to lymphocyte ratio (NLR) as an indicator of poor prognosis in stage IV non-small cell lung cancer. Clin Transl Oncol 2012; 14:864-9. [PMID: 22855161 DOI: 10.1007/s12094-012-0872-5] [Citation(s) in RCA: 191] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 01/24/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND Neutrophil to lymphocyte ratio (NLR), an index of systemic inflammation, has been associated with worse survival for many types of cancer. The aim of this study is to investigate the clinical significance of the blood NLR as a prognostic factor in non-small cell lung cancer (NSCLC) patients. METHODS AND PATIENTS Stage IV NSCLC patients diagnosed in our institution between April 2004 and March 2009 were retrospectively reviewed. Potential prognostic factors such as histology, gender, performance status, response to chemotherapy and NLR were analyzed. NLR was assessed baseline and during chemotherapy treatment. Overall survival (OS) and progression free survival (PFS) were calculated by the Kaplan-Meier method. RESULTS A total of 171 patients were included in the study and 60 patients (35.1 %) presented a NLR ≥ 5. Median survival for the entire cohort was 9.3 months. We found that patients with undifferentiated carcinoma and patients with NLR ≥ 5 had a worse survival. Median PFS of patients with NLR <5 was 5.62 months and in patients with NLR ≥ 5 was 3.25 months (p = 0.098), and OS was 11.1 versus 5.6 months for patients with NLR<5 and NLR ≥ 5, respectively (p = 0.017). During the chemotherapy treatment, patients who normalized NLR after one cycle presented better outcomes (OS 8.7 vs. 4.3 months, p = 0.001, for patients who normalized NLR and for patients who remained persistently elevated). After multivariate analysis, histology and NLR remained independent predictors of survival (p < 0.05). CONCLUSION In our analysis, elevated NLR is a predictor of shorter survival in patients with advanced NSCLC and the variation of NLR during the first cycle of treatment predicts survival. NLR is an easily measured, reproducible test that could be considered to be incorporated in the routine practice in NSCLC patients.
Collapse
Affiliation(s)
- S Cedrés
- Medical Oncology Service, Vall d'Hebron University Hospital, Barcelona, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Cedrés S, Montero MA, Martinez P, Martinez A, Rodríguez-Freixinós V, Torrejon D, Gabaldon A, Salcedo M, Ramon Y Cajal S, Felip E. Exploratory analysis of activation of PTEN-PI3K pathway and downstream proteins in malignant pleural mesothelioma (MPM). Lung Cancer 2012; 77:192-8. [PMID: 22459204 DOI: 10.1016/j.lungcan.2012.02.022] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Revised: 02/10/2012] [Accepted: 02/29/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) is a highly aggressive neoplasm with elevated AKT/mTOR activity. We aimed to identify the expression and phosphorylation status of PTEN, PI3K and downstream signaling in MPM. PATIENTS AND METHODS Thirty consecutive MPM patients were identified. Clinical data analyzed: sex, age, histology, performance status (PS), white blood count, and neutrophil-lymphocyte ratio (NLR). Paraffin-embedded biopsies were used for immunohistochemical analysis. RESULTS Overexpression of PTEN, pMAPK, mTOR, pAKT, 4E-BP1, p4E-BP1, eIF-4E, peIF-4E, p-S6 and FOXO3a in MPM was found in 90%, 100%, 93.3%, 80%, 100%, 43.3%, 96.7%, 100%, 63.3% and 100% of tumors respectively. There was a significant correlation between low pS6 protein expression and longer progression free survival (PFS: 7.9 vs 5.6 months; p = 0.04) and overall survival (OS: 23.4 vs 5.6 months; p = 0.05). Patients with concomitant low expression of pS6 and p4E-BP1 and overexpression of FOXO3a had significantly better prognosis (34.6 vs 1.9 months; p = 0.004). In multivariate analysis, histology and NLR were independent prognostic factors (p = 0.02 and p = 0.04 respectively), but pS6 only showed a trend (p = 0.8). CONCLUSIONS This study shows PI3K pathway and downstream proteins in MPM are frequently activated and provides prognostic information. The role of PI3K pathway is worth of prospective validation in future studies on MPM.
Collapse
Affiliation(s)
- S Cedrés
- Medical Oncology Service/Vall d'Hebron University Hospital, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Abstract
Non-small-cell lung cancer (NSCLC) accounts for 80% of all lung cancer, which is the leading cause of cancer mortality. The majority of NSCLC patients present with advanced disease at diagnosis. Standard chemotherapy using platinum-containing doublets has reached a therapeutic plateau with a median survival of ~1 year. The development of more effective strategies in the first-line setting remains challenging. In selected chemotherapy-naïve, advanced, non-squamous patients, the combination of bevacizumab with chemotherapy was shown to produce better outcomes than chemotherapy alone. The potential benefit of maintenance/sequential treatment after initial platinum-based chemotherapy should be discussed in detail with each patient. Epidermal growth factor receptor (EGFR) mutation determination should be carried out in subgroups of patients characterized by a high prevalence of sensitizing mutations. When a mutation is present, first-line treatment with an EGFR tyrosine kinase inhibitor may be considered. Finally, a phase I study using an oral ALK inhibitor has produced promising results in NSCLC patients with ALK rearrangements, indicating that ALK represents a new therapeutic target in a molecularly defined subset of NSCLC. Ongoing studies in first-line therapy are focusing on targeted therapies and patient selection.
Collapse
Affiliation(s)
- E Felip
- Vall d'Hebron University Hospital, Barcelona, Spain.
| | | | | | | |
Collapse
|
9
|
Affiliation(s)
- E Felip
- Medical Oncology Service, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | | |
Collapse
|