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Saoudi González N, Ros J, Baraibar I, Salvà F, Rodríguez-Castells M, Alcaraz A, García A, Tabernero J, Élez E. Cetuximab as a Key Partner in Personalized Targeted Therapy for Metastatic Colorectal Cancer. Cancers (Basel) 2024; 16:412. [PMID: 38254903 PMCID: PMC10814823 DOI: 10.3390/cancers16020412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Cetuximab, a chimeric IgG1 monoclonal antibody targeting the epidermal growth factor receptor (EGFR), has revolutionized personalized treatment of metastatic colorectal cancer (mCRC) patients. This review highlights the mechanism of action, characteristics, and optimal indications for cetuximab in mCRC. Cetuximab has emerged as a pivotal partner for novel therapies in specific molecular subgroups, including BRAF V600E, KRAS G12C, and HER2-altered mCRC. Combining cetuximab with immunotherapy and other targeted agents further expands the therapeutic landscape, offering renewed hope for mCRC patients who face the development of resistance to conventional therapies. Ongoing clinical trials have continued to uncover innovative cetuximab-based treatment strategies, promising a brighter future for mCRC patients. This review provides a comprehensive overview of cetuximab's role and its evolving importance in personalized targeted therapy of mCRC patients, offering valuable insights into the evolving landscape of colorectal cancer treatment.
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Affiliation(s)
- Nadia Saoudi González
- Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain; (N.S.G.); (F.S.)
- Vall d’Hebron Hospital Campus, 08035 Barcelona, Spain
| | - Javier Ros
- Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain; (N.S.G.); (F.S.)
- Vall d’Hebron Hospital Campus, 08035 Barcelona, Spain
| | - Iosune Baraibar
- Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain; (N.S.G.); (F.S.)
- Vall d’Hebron Hospital Campus, 08035 Barcelona, Spain
| | - Francesc Salvà
- Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain; (N.S.G.); (F.S.)
- Vall d’Hebron Hospital Campus, 08035 Barcelona, Spain
| | - Marta Rodríguez-Castells
- Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain; (N.S.G.); (F.S.)
- Vall d’Hebron Hospital Campus, 08035 Barcelona, Spain
| | - Adriana Alcaraz
- Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain; (N.S.G.); (F.S.)
- Vall d’Hebron Hospital Campus, 08035 Barcelona, Spain
| | - Ariadna García
- Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain; (N.S.G.); (F.S.)
| | - Josep Tabernero
- Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain; (N.S.G.); (F.S.)
- Vall d’Hebron Hospital Campus, 08035 Barcelona, Spain
| | - Elena Élez
- Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain; (N.S.G.); (F.S.)
- Vall d’Hebron Hospital Campus, 08035 Barcelona, Spain
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Rodriguez Castells M, Baraibar I, Ros J, Saoudi N, Salvà F, García A, Alcaraz A, Tabernero J, Élez E. The impact of clinical and translational research on the quality of life during the metastatic colorectal cancer patient journey. Front Oncol 2023; 13:1272561. [PMID: 37909013 PMCID: PMC10614292 DOI: 10.3389/fonc.2023.1272561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/30/2023] [Indexed: 11/02/2023] Open
Abstract
The journey of metastatic colorectal cancer patients is complex and challenging, requiring coordination and collaboration between multiple healthcare providers. Understanding patients' needs, fears, feelings, concerns, and behaviors is essential for providing individualized patient-centered care. In recent years, mCRC patients have experienced improvements in clinical outcomes, from 16 months of overall survival to 32 months, thanks to research. However, there is still room for improvement, and integrating clinical and translational research into routine practice can help patients benefit from treatments and techniques that would not be an option. In the Journey of mCRC patients, living well with cancer and quality of life becomes a priority given the outcomes of the disease. Patient reported outcomes (PRO) and Patient Reported Outcome Measures (PROMs) are becoming therefore new estimands in Oncology. Patient advocates represent important figures in this process by prioritizing issues and research questions; evaluating research designs and the performance of the research; the analysis and interpretation of data; and how results are disseminated. Multidisciplinary Tumor Boards and shared decision-making is essential for designing treatment strategies for individual patients. Quality of Life is often prioritized only when it comes to refractory advanced disease and end-of-life care, but it has to be integrated from the beginning, as the emotional impact of diagnosis leads to a vulnerable situation where patients' needs and preferences can be easily overseen. First-line treatment will be chosen among more treatment options than subsequent lines, with longer progression-free survival and a bigger impact on the outcomes. Practicing patient-centered care and optimizing first-line treatment for colorectal cancer patients requires a comprehensive understanding of patient experience and treatment outcomes, which can guide clinical practice and inform regulatory decisions for the benefit of patients.
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Affiliation(s)
- Marta Rodriguez Castells
- Medical Oncology Department, Vall d’Hebron University Hospital, Barcelona, Spain
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Iosune Baraibar
- Medical Oncology Department, Vall d’Hebron University Hospital, Barcelona, Spain
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Javier Ros
- Medical Oncology Department, Vall d’Hebron University Hospital, Barcelona, Spain
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Nadia Saoudi
- Medical Oncology Department, Vall d’Hebron University Hospital, Barcelona, Spain
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Francesc Salvà
- Medical Oncology Department, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Ariadna García
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Adriana Alcaraz
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Josep Tabernero
- Medical Oncology Department, Vall d’Hebron University Hospital, Barcelona, Spain
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Elena Élez
- Medical Oncology Department, Vall d’Hebron University Hospital, Barcelona, Spain
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
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Ros J, Salva F, Dopazo C, López D, Saoudi N, Baraibar I, Charco R, Tabernero J, Elez E. Correction To: Liver transplantation in metastatic colorectal cancer: are we ready for it? Br J Cancer 2023; 129:733. [PMID: 37488449 PMCID: PMC10421846 DOI: 10.1038/s41416-023-02370-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Affiliation(s)
- Javier Ros
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), 08035, Barcelona, Spain.
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, 80131, Naples, Italy.
| | - Francesc Salva
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), 08035, Barcelona, Spain
| | - Cristina Dopazo
- Department of HPB Surgery and Transplants, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Daniel López
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), 08035, Barcelona, Spain
| | - Nadia Saoudi
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), 08035, Barcelona, Spain
| | - Iosune Baraibar
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), 08035, Barcelona, Spain
| | - Ramon Charco
- Department of HPB Surgery and Transplants, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Josep Tabernero
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), 08035, Barcelona, Spain
| | - Elena Elez
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), 08035, Barcelona, Spain
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Ros J, Baraibar I, Saoudi N, Rodriguez M, Salvà F, Tabernero J, Élez E. Immunotherapy for Colorectal Cancer with High Microsatellite Instability: The Ongoing Search for Biomarkers. Cancers (Basel) 2023; 15:4245. [PMID: 37686520 PMCID: PMC10486610 DOI: 10.3390/cancers15174245] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Microsatellite instability (MSI) is a biological condition associated with inflamed tumors, high tumor mutational burden (TMB), and responses to immune checkpoint inhibitors. In colorectal cancer (CRC), MSI tumors are found in 5% of patients in the metastatic setting and 15% in early-stage disease. Following the impressive clinical activity of immune checkpoint inhibitors in the metastatic setting, associated with deep and long-lasting responses, the development of immune checkpoint inhibitors has expanded to early-stage disease. Several phase II trials have demonstrated a high rate of pathological complete responses, with some patients even spared from surgery. However, in both settings, not all patients respond and some responses are short, emphasizing the importance of the ongoing search for accurate biomarkers. While various biomarkers of response have been evaluated in the context of MSI CRC, including B2M and JAK1/2 mutations, TMB, WNT pathway mutations, and Lynch syndrome, with mixed results, liver metastases have been associated with a lack of activity in such strategies. To improve patient selection and treatment outcomes, further research is required to identify additional biomarkers and refine existing ones. This will allow for the development of personalized treatment approaches and the integration of novel therapeutic strategies for MSI CRC patients with liver metastases.
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Affiliation(s)
- Javier Ros
- Medical Oncology Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (J.R.); (I.B.); (N.S.); (M.R.); (F.S.); (J.T.)
- Vall d’Hebron Institute of Oncology, 08035 Barcelona, Spain
| | - Iosune Baraibar
- Medical Oncology Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (J.R.); (I.B.); (N.S.); (M.R.); (F.S.); (J.T.)
- Vall d’Hebron Institute of Oncology, 08035 Barcelona, Spain
| | - Nadia Saoudi
- Medical Oncology Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (J.R.); (I.B.); (N.S.); (M.R.); (F.S.); (J.T.)
- Vall d’Hebron Institute of Oncology, 08035 Barcelona, Spain
| | - Marta Rodriguez
- Medical Oncology Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (J.R.); (I.B.); (N.S.); (M.R.); (F.S.); (J.T.)
- Vall d’Hebron Institute of Oncology, 08035 Barcelona, Spain
| | - Francesc Salvà
- Medical Oncology Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (J.R.); (I.B.); (N.S.); (M.R.); (F.S.); (J.T.)
- Vall d’Hebron Institute of Oncology, 08035 Barcelona, Spain
| | - Josep Tabernero
- Medical Oncology Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (J.R.); (I.B.); (N.S.); (M.R.); (F.S.); (J.T.)
- Vall d’Hebron Institute of Oncology, 08035 Barcelona, Spain
| | - Elena Élez
- Medical Oncology Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (J.R.); (I.B.); (N.S.); (M.R.); (F.S.); (J.T.)
- Vall d’Hebron Institute of Oncology, 08035 Barcelona, Spain
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Saoudi González N, Salvà F, Ros J, Baraibar I, Rodríguez-Castells M, García A, Alcaráz A, Vega S, Bueno S, Tabernero J, Elez E. Unravelling the Complexity of Colorectal Cancer: Heterogeneity, Clonal Evolution, and Clinical Implications. Cancers (Basel) 2023; 15:4020. [PMID: 37627048 PMCID: PMC10452468 DOI: 10.3390/cancers15164020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023] Open
Abstract
Colorectal cancer (CRC) is a global health concern and a leading cause of death worldwide. The disease's course and response to treatment are significantly influenced by its heterogeneity, both within a single lesion and between primary and metastatic sites. Biomarkers, such as mutations in KRAS, NRAS, and BRAF, provide valuable guidance for treatment decisions in patients with metastatic CRC. While high concordance exists between mutational status in primary and metastatic lesions, some heterogeneity may be present. Circulating tumor DNA (ctDNA) analysis has proven invaluable in identifying genetic heterogeneity and predicting prognosis in RAS-mutated metastatic CRC patients. Tumor heterogeneity can arise from genetic and non-genetic factors, affecting tumor development and response to therapy. To comprehend and address clonal evolution and intratumoral heterogeneity, comprehensive genomic studies employing techniques such as next-generation sequencing and computational analysis are essential. Liquid biopsy, notably through analysis of ctDNA, enables real-time clonal evolution and treatment response monitoring. However, challenges remain in standardizing procedures and accurately characterizing tumor subpopulations. Various models elucidate the origin of CRC heterogeneity, highlighting the intricate molecular pathways involved. This review focuses on intrapatient cancer heterogeneity and genetic clonal evolution in metastatic CRC, with an emphasis on clinical applications.
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Affiliation(s)
- Nadia Saoudi González
- Vall d’Hebron Institute of Oncology, 08035 Barcelona, Spain; (N.S.G.)
- Oncology Department, Vall d’Hebron Hospital, 08035 Barcelona, Spain
| | - Francesc Salvà
- Vall d’Hebron Institute of Oncology, 08035 Barcelona, Spain; (N.S.G.)
- Oncology Department, Vall d’Hebron Hospital, 08035 Barcelona, Spain
| | - Javier Ros
- Vall d’Hebron Institute of Oncology, 08035 Barcelona, Spain; (N.S.G.)
- Oncology Department, Vall d’Hebron Hospital, 08035 Barcelona, Spain
| | - Iosune Baraibar
- Vall d’Hebron Institute of Oncology, 08035 Barcelona, Spain; (N.S.G.)
- Oncology Department, Vall d’Hebron Hospital, 08035 Barcelona, Spain
| | - Marta Rodríguez-Castells
- Vall d’Hebron Institute of Oncology, 08035 Barcelona, Spain; (N.S.G.)
- Oncology Department, Vall d’Hebron Hospital, 08035 Barcelona, Spain
| | - Ariadna García
- Vall d’Hebron Institute of Oncology, 08035 Barcelona, Spain; (N.S.G.)
| | - Adriana Alcaráz
- Vall d’Hebron Institute of Oncology, 08035 Barcelona, Spain; (N.S.G.)
- Oncology Department, Vall d’Hebron Hospital, 08035 Barcelona, Spain
| | - Sharela Vega
- Oncology Department, Vall d’Hebron Hospital, 08035 Barcelona, Spain
| | - Sergio Bueno
- Oncology Department, Vall d’Hebron Hospital, 08035 Barcelona, Spain
| | - Josep Tabernero
- Vall d’Hebron Institute of Oncology, 08035 Barcelona, Spain; (N.S.G.)
- Oncology Department, Vall d’Hebron Hospital, 08035 Barcelona, Spain
| | - Elena Elez
- Vall d’Hebron Institute of Oncology, 08035 Barcelona, Spain; (N.S.G.)
- Oncology Department, Vall d’Hebron Hospital, 08035 Barcelona, Spain
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Ros J, Rodríguez-Castells M, Saoudi N, Baraibar I, Salva F, Tabernero J, Élez E. Treatment of BRAF-V600E mutant metastatic colorectal cancer: new insights and biomarkers. Expert Rev Anticancer Ther 2023; 23:797-806. [PMID: 37482749 DOI: 10.1080/14737140.2023.2236794] [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: 05/11/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION The presence of a BRAF-V600E mutation in metastatic colorectal cancer (mCRC) is observed in approximately 12% of cases and is associated with poor prognosis and aggressive disease. Unlike melanoma, the development of successful BRAF blockade in colorectal cancer has been complex. The phase III BEACON trial made significant progress in the development of BRAF inhibitors by establishing encorafenib-cetuximab as the new standard of care for patients with mCRC who have progressed to one or two previous lines of treatment. Nonetheless, not all patients respond to encorafenib-based combinations, and some responses are short-lived. Identifying new strategies to boost antitumor activity and improve survival is paramount. AREAS COVERED The development of targeted therapy for BRAF-V600E mCRC starting with BRAF inhibitors as monotherapy through novel combinations with anti-VEGF or anti-PD1 agents to enhance antitumor activity is reviewed, with a particular focus on the development of predictive and prognostic biomarkers. EXPERT OPINION There is a crucial need to better understand tumor biology and develop accurate and reliable biomarkers to enhance the antitumor activity of encorafenib-based combinations. The RNF43 mutation is an accurate and reliable predictive biomarker of response, and combinations that target crosstalk between the MAPK pathway, the immune system, and WNT pathways seem promising.
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Affiliation(s)
- Javier Ros
- Vall d'Hebron University Hospital, Barcelona, Spain
- Medical Oncology Department, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Marta Rodríguez-Castells
- Vall d'Hebron University Hospital, Barcelona, Spain
- Medical Oncology Department, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Nadia Saoudi
- Vall d'Hebron University Hospital, Barcelona, Spain
- Medical Oncology Department, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Iosune Baraibar
- Vall d'Hebron University Hospital, Barcelona, Spain
- Medical Oncology Department, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Francesc Salva
- Vall d'Hebron University Hospital, Barcelona, Spain
- Medical Oncology Department, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Josep Tabernero
- Vall d'Hebron University Hospital, Barcelona, Spain
- Medical Oncology Department, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Elena Élez
- Vall d'Hebron University Hospital, Barcelona, Spain
- Medical Oncology Department, Vall d'Hebron Institute of Oncology, Barcelona, Spain
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Baraibar I, García A, Salvà F, Ros J, Saoudi N, Comas R, Castillo G, Sanchis M, García-Álvarez A, Hernando J, Capdevila J, Castells MR, Martí M, Landolfi S, Espín E, Navalpotro B, Guevara J, Dopazo C, Nuciforo P, Vivancos A, Tabernero J, Élez E. Impact of the COVID-19 pandemic in the early-onset colorectal cancer. Transl Oncol 2023; 32:101668. [PMID: 37031602 PMCID: PMC10073589 DOI: 10.1016/j.tranon.2023.101668] [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] [Received: 02/08/2023] [Revised: 03/20/2023] [Accepted: 04/04/2023] [Indexed: 04/08/2023] Open
Abstract
The COVID19 pandemic has affected the spectrum of cancer care worldwide. Early onset colorectal cancer (EOCRC) is defined as diagnosis below the age of 50. Patients with EOCRC faced multiple challenges during the COVID19 pandemic and in some institutions it jeopardized cancer diagnosis and care delivery. Our study aims to identify the clinicopathological features and outcomes of patients with EOCRC in our Centre during the first wave of the pandemic in comparison with the same period in 2019 and 2021. Patients with EOCRC visited for the first time at Vall d'Hebron University Hospital in Spain from the 1st March to 31st August of 2019, 2020 and 2021 were included in the analysis. 177 patients with EOCRC were visited for the first time between 2019 and 2021, of which 90 patients met the inclusion criteria (2019: 30 patients, 2020: 29 patients, 2021: 31 patients). Neither differences in frequency nor in stage at diagnosis or at first visit during the given periods were observed. Of note, indication of systemic therapy in the adjuvant or metastatic setting was not altered. Days to treatment initiation and enrollment in clinical trials in this subpopulation was not affected due to the COVID-19 outbreak.
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Affiliation(s)
- Iosune Baraibar
- Department of Medical Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain.
| | - Ariadna García
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
| | - Francesc Salvà
- Department of Medical Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
| | - Javier Ros
- Department of Medical Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
| | - Nadia Saoudi
- Department of Medical Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
| | - Raquel Comas
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
| | - Gloria Castillo
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
| | - Mireia Sanchis
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
| | - Alejandro García-Álvarez
- Department of Medical Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
| | - Jorge Hernando
- Department of Medical Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
| | - Jaume Capdevila
- Department of Medical Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
| | - Marta R Castells
- Department of Medical Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
| | - Marc Martí
- Department of General Surgery, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain
| | - Stefania Landolfi
- Department of Pathological Anatomy, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain
| | - Eloy Espín
- Department of General Surgery, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain
| | - Begoña Navalpotro
- Department of Radiation Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain
| | - Jorge Guevara
- Department of Gastroenterology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain
| | - Cristina Dopazo
- Department of General Surgery, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain
| | - Paolo Nuciforo
- Department of Medical Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain
| | - Ana Vivancos
- Department of Medical Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain
| | - Josep Tabernero
- Department of Medical Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
| | - Elena Élez
- Department of Medical Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
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Ros J, Matito J, Villacampa G, Comas R, Garcia A, Martini G, Baraibar I, Saoudi N, Salvà F, Martin Á, Antista M, Toledo R, Martinelli E, Pietrantonio F, Boccaccino A, Cremolini C, Dientsmann R, Tabernero J, Vivancos A, Elez E. Plasmatic BRAF-V600E allele fraction as a prognostic factor in metastatic colorectal cancer treated with BRAF combinatorial treatments. Ann Oncol 2023; 34:543-552. [PMID: 36921693 DOI: 10.1016/j.annonc.2023.02.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/24/2023] [Accepted: 02/24/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Combination of a BRAF inhibitor (BRAFi) and an anti-epidermal growth factor receptor (EGFR), with or without a MEK inhibitor (MEKi), improves survival in BRAF-V600E-mutant metastatic colorectal cancer (mCRC) over standard chemotherapy. However, responses are heterogeneous and there are no available biomarkers to assess patient prognosis or guide doublet- or triplet-based regimens. In order to better characterize the clinical heterogeneity observed, we assessed the prognostic and predictive role of the plasmatic BRAF allele fraction (AF) for these combinations. PATIENTS AND METHODS A prospective discovery cohort including 47 BRAF-V600E-mutant patients treated with BRAFi-anti-EGFR ± MEKi in clinical trials and real-world practice was evaluated. Results were validated in an independent multicenter cohort (n= 29). Plasmatic BRAF-V600E AF cut-off at baseline was defined in the discovery cohort with droplet digital PCR (ddPCR). All patients had tissue-confirmed BRAF-V600E mutations. RESULTS Patients with high AF have major frequency of liver metastases and more metastatic sites. In the discovery cohort, median progression-free survival (PFS) and overall survival (OS) were 4.4 and 10.1 months, respectively. Patients with high BRAF AF (≥2%, n = 23) showed worse PFS [hazard ratio (HR) 2.97, 95% confidence interval (CI) 1.55-5.69; P = 0.001] and worse OS (HR 3.28, 95% CI 1.58-6.81; P = 0.001) than low-BRAF AF patients (<2%, n = 24). In the multivariable analysis, BRAF AF levels maintained independent significance. In the validation cohort, high BRAF AF was associated with worse PFS (HR 3.83, 95% CI 1.60-9.17; P = 0.002) and a trend toward worse OS was observed (HR 1.86, 95% CI 0.80-4.34; P = 0.15). An exploratory analysis of predictive value showed that high-BRAF AF patients (n = 35) benefited more from triplet therapy than low-BRAF AF patients (n = 41; PFS and OS interaction tests, P < 0.01). CONCLUSIONS Plasmatic BRAF AF determined by ddPCR is a reliable surrogate of tumor burden and aggressiveness in BRAF-V600E-mutant mCRC treated with a BRAFi plus an anti-EGFR with or without a MEKi and identifies patients who may benefit from treatment intensification. Our results warrant further validation of plasmatic BRAF AF to refine clinical stratification and guide treatment strategies.
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Affiliation(s)
- J Ros
- Medical Oncology Department, Vall d'Hebron Hospital Campus, Barcelona, Spain; Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - J Matito
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - G Villacampa
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; The Institute of Cancer Research, London, UK
| | - R Comas
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - A Garcia
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - G Martini
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - I Baraibar
- Medical Oncology Department, Vall d'Hebron Hospital Campus, Barcelona, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - N Saoudi
- Medical Oncology Department, Vall d'Hebron Hospital Campus, Barcelona, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - F Salvà
- Medical Oncology Department, Vall d'Hebron Hospital Campus, Barcelona, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Á Martin
- Medical Oncology Department, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - M Antista
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - R Toledo
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - E Martinelli
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - F Pietrantonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - A Boccaccino
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - C Cremolini
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - R Dientsmann
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - J Tabernero
- Medical Oncology Department, Vall d'Hebron Hospital Campus, Barcelona, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - A Vivancos
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - E Elez
- Medical Oncology Department, Vall d'Hebron Hospital Campus, Barcelona, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.
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9
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Ros J, Salva F, Dopazo C, López D, Saoudi N, Baraibar I, Charco R, Tabernero J, Elez E. Liver transplantation in metastatic colorectal cancer: are we ready for it? Br J Cancer 2023; 128:1797-1806. [PMID: 36879000 PMCID: PMC10147684 DOI: 10.1038/s41416-023-02213-1] [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: 09/01/2022] [Revised: 02/10/2023] [Accepted: 02/17/2023] [Indexed: 03/08/2023] Open
Abstract
Colorectal cancer (CRC) is a prevalent disease worldwide, with more than 50% of patients developing metastases to the liver. Five-year overall survival remains modest among patients with metastatic CRC (mCRC) treated with conventional therapies however, liver transplantation in a highly selected population can improve clinical outcomes with an impressive 5-year overall survival of 83%. Despite liver transplantation appearing to be a promising therapeutical option for well-selected patients with mCRC with the liver-limited disease, these data come from small monocentric trials which included a heterogeneous population. Currently, several clinical trials are evaluating liver transplantation in this scenario, aiming for a more accurate patient selection by integrating liquid biopsy, tissue profiling, and nuclear medicine to the already known clinical biomarkers that eventually may lead to a survival improvement. In this paper, the clinical outcomes and inclusion criteria from the most relevant clinical trials and clinical series involving liver transplantation in patients with liver-limited disease colorectal cancer are reviewed as well as the trials currently recruiting.
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Affiliation(s)
- Javier Ros
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), 08035, Barcelona, Spain.
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, 80131, Naples, Italy.
| | - Francesc Salva
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), 08035, Barcelona, Spain
| | - Cristina Dopazo
- Department of HPB Surgery and Transplants, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Daniel López
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), 08035, Barcelona, Spain
| | - Nadia Saoudi
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), 08035, Barcelona, Spain
| | - Iosune Baraibar
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), 08035, Barcelona, Spain
| | - Ramon Charco
- Department of HPB Surgery and Transplants, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Josep Tabernero
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), 08035, Barcelona, Spain
| | - Elena Elez
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), 08035, Barcelona, Spain
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10
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Martini G, Belli V, Napolitano S, Ciaramella V, Ciardiello D, Belli A, Izzo F, Avallone A, Selvaggi F, Menegon Tasselli F, Santaniello W, Franco R, Puig I, Ramirez L, Chicote I, Mancuso F, Caratu G, Serres X, Fasani R, Jimenez J, Ros J, Baraibar I, Mulet N, Della Corte CM, Troiani T, Vivancos A, Dienstmann R, Elez E, Palmer HG, Tabernero J, Martinelli E, Ciardiello F, Argilés G. Establishment of patient-derived tumor organoids to functionally inform treatment decisions in metastatic colorectal cancer. ESMO Open 2023; 8:101198. [PMID: 37119788 DOI: 10.1016/j.esmoop.2023.101198] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND Metastatic colorectal cancer (mCRC) patients tend to have modest benefits from molecularly driven therapeutics. Patient-derived tumor organoids (PDTOs) represent an unmatched model to elucidate tumor resistance to therapy, due to their high capacity to resemble tumor characteristics. MATERIALS AND METHODS We used viable tumor tissue from two cohorts of patients with mCRC, naïve or refractory to treatment, respectively, for generating PDTOs. The derived models were subjected to a 6-day drug screening assay (DSA) with a comprehensive pipeline of chemotherapy and targeted drugs against almost all the actionable mCRC molecular drivers. For the second cohort DSA data were matched with those from PDTO genotyping. RESULTS A total of 40 PDTOs included in the two cohorts were derived from mCRC primary tumors or metastases. The first cohort included 31 PDTOs derived from patients treated in front line. For this cohort, DSA results were matched with patient responses. Moreover, RAS/BRAF mutational status was matched with DSA cetuximab response. Ten out of 12 (83.3%) RAS wild-type PDTOs responded to cetuximab, while all the mutant PDTOs, 8 out of 8 (100%), were resistant. For the second cohort (chemorefractory patients), we used part of tumor tissue for genotyping. Four out of nine DSA/genotyping data resulted applicable in the clinic. Two RAS-mutant mCRC patients have been treated with FOLFOX-bevacizumab and mitomycin-capecitabine in third line, respectively, based on DSA results, obtaining disease control. One patient was treated with nivolumab-second mitochondrial-derived activator of caspases mimetic (phase I trial) due to high tumor mutational burden at genotyping, experiencing stable disease. In one case, the presence of BRCA2 mutation correlated with DSA sensitivity to olaparib; however, the patient could not receive the therapy. CONCLUSIONS Using CRC as a model, we have designed and validated a clinically applicable methodology to potentially inform clinical decisions with functional data. Undoubtedly, further larger analyses are needed to improve methodology success rates and propose suitable treatment strategies for mCRC patients.
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Affiliation(s)
- G Martini
- Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, Naples
| | - V Belli
- Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, Naples
| | - S Napolitano
- Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, Naples
| | - V Ciaramella
- Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, Naples
| | - D Ciardiello
- Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, Naples
| | - A Belli
- Hepatobiliary Surgical Oncology Unit, Istituto Nazionale Tumori-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G. Pascale, Napoli
| | - F Izzo
- Hepatobiliary Surgical Oncology Unit, Istituto Nazionale Tumori-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G. Pascale, Napoli
| | - A Avallone
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G. Pascale, Napoli
| | - F Selvaggi
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania Luigi Vanvitelli, Naples
| | - F Menegon Tasselli
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania Luigi Vanvitelli, Naples
| | - W Santaniello
- Hepatobiliary Surgical Oncology Unit, AORN Cardarelli, Naples
| | - R Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - I Puig
- Translational Program, Stem Cells and Cancer Laboratory, Vall D'Hebron Institute of Oncology (VHIO), Barcelona
| | - L Ramirez
- Translational Program, Stem Cells and Cancer Laboratory, Vall D'Hebron Institute of Oncology (VHIO), Barcelona
| | - I Chicote
- Translational Program, Stem Cells and Cancer Laboratory, Vall D'Hebron Institute of Oncology (VHIO), Barcelona
| | - F Mancuso
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona
| | - G Caratu
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona
| | - X Serres
- Department of Interventional Radiology, Hospital Universitari Vall d'Hebron, Barcelona
| | - R Fasani
- Molecular Oncology Lab, Vall d'Hebron Institute of Oncology, Barcelona
| | - J Jimenez
- Molecular Oncology Lab, Vall d'Hebron Institute of Oncology, Barcelona
| | - J Ros
- Vall d'Hebron Hospital Campus and Institute of Oncology (VHIO), Barcelona
| | - I Baraibar
- Vall d'Hebron Hospital Campus and Institute of Oncology (VHIO), Barcelona
| | - N Mulet
- B-ARGO Badalona Applied Research Group in Oncology, Catalan Institute of Oncology, Badalona
| | - C M Della Corte
- Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, Naples
| | - T Troiani
- Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, Naples
| | - A Vivancos
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona
| | - R Dienstmann
- Oncology Data Science, Vall d'Hebron Institute of Oncology, Barcelona
| | - E Elez
- Vall d'Hebron Hospital Campus and Institute of Oncology (VHIO), Barcelona
| | - H G Palmer
- Translational Program, Stem Cells and Cancer Laboratory, Vall D'Hebron Institute of Oncology (VHIO), Barcelona
| | - J Tabernero
- Vall d'Hebron Hospital Campus and Institute of Oncology (VHIO), Barcelona
| | - E Martinelli
- Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, Naples
| | - F Ciardiello
- Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, Naples
| | - G Argilés
- Vall d'Hebron Hospital Campus and Institute of Oncology (VHIO), Barcelona; Universitat Autònoma de Barcelona, Barcelona, Spain; Memorial Sloan Kettering Cancer Center, New York, USA.
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11
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Baraibar I, Ros J, Saoudi N, Salvà F, García A, Castells M, Tabernero J, Élez E. Sex and gender perspectives in colorectal cancer. ESMO Open 2023; 8:101204. [PMID: 37018873 PMCID: PMC10163160 DOI: 10.1016/j.esmoop.2023.101204] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 04/05/2023] Open
Abstract
Historically women were frequently excluded from clinical trials and drug usage to protect unborn babies from potential harm. As a consequence, the impact of sex and gender on both tumour biology and clinical outcomes has been largely underestimated. Although interrelated and often used interchangeably, sex and gender are not equivalent concepts. Sex is a biological attribute that defines species according to their chromosomal makeup and reproductive organ, while gender refers to a chosen sexual identity. Sex dimorphisms are rarely taken into account, in either preclinical or clinical research, with inadequate analysis of differences in outcomes according to sex or gender still widespread, reflecting a gap in our knowledge for a large proportion of the target population. Underestimation of sex-based differences in study design and analyses has invariably led to 'one-drug' treatment regimens for both males and females. For patients with colorectal cancer (CRC), sex also has an impact on the disease incidence, clinicopathological features, therapeutic outcomes, and tolerability to anticancer treatments. Although the global incidence of CRC is higher in male subjects, the proportion of patients presenting right-sided tumours and BRAF mutations is higher among females. Concerning sex-related differences in treatment efficacy and toxicity, drug dosage does not take into account sex-specific differences in pharmacokinetics. Toxicity associated with fluoropyrimidines, targeted therapies, and immunotherapies has been reported to be more extensive for females with CRC than for males, although evidence about differences in efficacy is more controversial. This article aims to provide an overview of the research achieved so far into sex and gender differences in cancer and summarize the growing body of literature illustrating the sex and gender perspective in CRC and their impact in relation to tumour biology and treatment efficacy and toxicity. We propose endorsing research on how biological sex and gender influence CRC as an added value for precision oncology.
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12
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Ros J, Balconi F, Baraibar I, Saoudi Gonzalez N, Salva F, Tabernero J, Elez E. Advances in immune checkpoint inhibitor combination strategies for microsatellite stable colorectal cancer. Front Oncol 2023; 13:1112276. [PMID: 36816981 PMCID: PMC9932591 DOI: 10.3389/fonc.2023.1112276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/18/2023] [Indexed: 02/05/2023] Open
Abstract
Immune checkpoint inhibitors have reshaped the prognostic of several tumor types, including metastatic colorectal tumors with microsatellite instability (MSI). However, 90-95% of metastatic colorectal tumors are microsatellite stable (MSS) in which immunotherapy has failed to demonstrate meaningful clinical results. MSS colorectal tumors are considered immune-cold tumors. Several factors have been proposed to account for this lack of response to immune checkpoint blockade including low levels of tumor infiltrating lymphocytes, low tumor mutational burden, a high rate of WNT/β-catenin pathway mutations, and liver metastases which have been associated with immunosuppression. However, studies with novel combinations based on immune checkpoint inhibitors are showing promising activity in MSS colorectal cancer. Here, we review the underlying biological facts that preclude immunotherapy activity, and detail the different immune checkpoint inhibitor combinations evaluated, along with novel immune-based therapies, to overcome innate mechanisms of resistance in MSS colorectal cancer.
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Affiliation(s)
- Javier Ros
- Medical Oncology, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain,Oncologia Medica, Dipartimento di Medicina di Precisione, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Francesca Balconi
- Medical Oncology, University Hospital and University of Cagliari, Cagliari, Italy
| | - Iosune Baraibar
- Medical Oncology, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Francesc Salva
- Medical Oncology, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Josep Tabernero
- Medical Oncology, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Elena Elez
- Medical Oncology, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain,*Correspondence: Elena Elez,
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13
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Salva F, Paes R, Costa e Silva M, Cruz H, Saoudi Gonzalez N, Baraibar I, Ros Montañá J, Comas R, Ruiz-Pace F, Garcia A, Dalpino R, Jácome AA, Tabernero J, Elez E, Dienstmann R. Identification and external validation of clinical-molecular features to predict benefit from oxaliplatin reintroduction/rechallenge in patients with refractory metastatic colorectal cancer (mCRC). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.153] [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: 01/25/2023] Open
Abstract
153 Background: Oxaliplatin is a backbone cytotoxic treatment for mCRC patients, particularly in the front-line setting. In the refractory disease, current treatment options are scarce and with limited efficacy. Several retrospective studies have explored the efficacy of oxaliplatin reintroduction/rechallenge (OxRe) in this scenario. However, more evidence is still needed to determine which patients do benefit from this treatment strategy. Methods: The discovery cohort includes all patients treated with oxaliplatin in a third- or fourth-line setting at VHIO between 2015 and 2021 (N = 102). Results were externally validated in a real-world cohort of patients treated at community oncology practices from Oncoclínicas Group in Brazil (N = 157). We analyzed the impact of clinical-molecular features in uni- and multivariable prognostic models in terms of median progression free survival (mPFS) (discovery cohort) and median time to treatment discontinuation (mTTD) (validation cohort). For both cohorts separately, data was extracted from EHRs in structured formats (demographics, tumor characteristics, pharmacy records) and combined with elements from unstructured sources (physician notes on progression and survival status) using technology-based abstraction techniques. Results: In the discovery cohort, 102 out of 735 mCRC patients (13,9%) were eligible. Median oxaliplatin-free interval (from Oxl stop to OxRe) was 17 months (CI95% 13.0-23.2). In OxRe setting, mPFS was 4.0 months (CI95% 3.29-5.03). In PFS multivariate analysis, determinants of favorable outcome were left tumor location (p = 0.01), oxaliplatin-free interval (p = 0.03), administration of Bev in refractory setting (p = 0.001), and not receiving Bev in first-line treatment (p = 0.008). Overall, 27% of all patients had a mPFS > 6 months with OxRe. In the validation cohort, out of 4,317 patients with mCRC, 157 (4%) were treated with OxRe. Median oxaliplatin-free interval was 15 months. Median time to treatment discontinuation (mTTD) of the OxRe was 3.4 months (CI95% 2.8-4.2). In multivariable model, the only independent prognostic factor was addition of Bev to OxRe (p = 0.036). Interestingly, 31% of all patients had mTTD > 6 months, largely enriched (65%) in patients with first Bev exposure at the time of OxRe. Conclusions: This study suggests that in refractory mCRC patients re-exposed to oxaliplatin-based chemotherapy, the addition of Bev is associated with improved outcomes. One-third of the patients are long-term responders (PFS/TTD > 6 months), reinforcing the value of this strategy in selected populations and the relevance of anti-angiogenic agents in refractory mCRC.
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Affiliation(s)
- Francesc Salva
- Vall d’Hebron Institute of Oncology (VHIO), Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | | | | | | | | | - Iosune Baraibar
- Vall d’Hebron Institute of Oncology (VHIO), Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | - Javier Ros Montañá
- Vall d’Hebron Institute of Oncology (VHIO), Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | - Raquel Comas
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Fiorella Ruiz-Pace
- Oncology Data Science (ODysSey) Group, Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Ariadna Garcia
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | - Josep Tabernero
- Vall D'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Elena Elez
- Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology (VHIO), UVic-UCC, Barcelona, Spain
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14
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Élez E, Mulet-Margalef N, Sanso M, Ruiz-Pace F, Mancuso FM, Comas R, Ros J, Argilés G, Martini G, Sanz-Garcia E, Baraibar I, Salvà F, Noguerido A, Cuadra-Urteaga JL, Fasani R, Garcia A, Jimenez J, Aguilar S, Landolfi S, Hernández-Losa J, Braña I, Nuciforo P, Dienstmann R, Tabernero J, Salazar R, Vivancos A. A Comprehensive Biomarker Analysis of Microsatellite Unstable/Mismatch Repair Deficient Colorectal Cancer Cohort Treated with Immunotherapy. Int J Mol Sci 2022; 24:ijms24010118. [PMID: 36613564 PMCID: PMC9820517 DOI: 10.3390/ijms24010118] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
The search for immunotherapy biomarkers in Microsatellite Instability High/Deficient Mismatch Repair system (MSI-H/dMMR) metastatic colorectal cancer (mCRC) is an unmet need. Sixteen patients with mCRC and MSI-H/dMMR (determined by either immunohistochemistry or polymerase chain reaction) treated with PD-1/PD-L1 inhibitors at our institution were included. According to whether the progression-free survival with PD-1/PD-L1 inhibitors was longer than 6 months or shorter, patients were clustered into the IT-responder group (n: 9 patients) or IT-resistant group (n: 7 patients), respectively. In order to evaluate determinants of benefit with PD-1/PD-L1 inhibitors, we performed multimodal analysis including genomics (through NGS panel tumour-only with 431 genes) and the immune microenvironment (using CD3, CD8, FOXP3 and PD-L1 antibodies). The following mutations were more frequent in IT-resistant compared with IT-responder groups: B2M (4/7 versus 2/9), CTNNB1 (2/7 versus 0/9), and biallelic PTEN (3/7 versus 1/9). Biallelic ARID1A mutations were found exclusively in the IT-responder group (4/9 patients). Tumour mutational burden did not correlate with immunotherapy benefit, neither the rate of indels in homopolymeric regions. Of note, biallelic ARID1A mutated tumours had the highest immune infiltration and PD-L1 scores, contrary to tumours with CTNNB1 mutation. Immune microenvironment analysis showed higher densities of different T cell subpopulations and PD-L1 expression in IT-responders. Misdiagnosis of MSI-H/dMMR inferred by discordances between immunohistochemistry and polymerase chain reaction was only found in the IT-resistant population (3/7 patients). Biallelic ARID1A mutations and Wnt signalling activation through CTNNB1 mutation were associated with high and low T cell immune infiltrates, respectively, and deserve special attention as determinants of response to PD-1/PD-L1 inhibitors. The non-MSI-H phenotype in dMMR is associated with poor benefit to immunotherapy. Our results suggest that mechanisms of resistance to immunotherapy are multi-factorial.
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Affiliation(s)
- Elena Élez
- Colorectal Cancer Program, Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Núria Mulet-Margalef
- Colorectal Cancer Program, Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
- Colorectal Cancer Unit, Medical Oncology Department, Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Miriam Sanso
- Cancer Genomics Group, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
- Genomics for Precision Oncology Laboratory, Fundació Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain
| | - Fiorella Ruiz-Pace
- Oncology Data Science Group, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Francesco M. Mancuso
- Cancer Genomics Group, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
- Research and Development Department, Universal Diagnostics S.L., 41013 Sevilla, Spain
| | - Raquel Comas
- Oncology Data Science Group, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Javier Ros
- Colorectal Cancer Program, Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
- Departament of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, 81100 Naples, Italy
| | - Guillem Argilés
- Colorectal Cancer Program, Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Giulia Martini
- Colorectal Cancer Program, Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
- Departament of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, 81100 Naples, Italy
| | - Enrique Sanz-Garcia
- Colorectal Cancer Program, Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Iosune Baraibar
- Colorectal Cancer Program, Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Francesc Salvà
- Colorectal Cancer Program, Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Alba Noguerido
- Colorectal Cancer Program, Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Jose Luis Cuadra-Urteaga
- Colorectal Cancer Program, Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
- Medical Oncology, IOB—Hospital Quirón, 08023 Barcelona, Spain
| | - Roberta Fasani
- Molecular Oncology Group, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Ariadna Garcia
- Colorectal Cancer Program, Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Jose Jimenez
- Molecular Oncology Group, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Susana Aguilar
- Molecular Prescreening Program, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Stefania Landolfi
- Department of Pathology, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
| | | | - Irene Braña
- Medical Oncology Department, Research Unit for Molecular Therapy of Cancer, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Paolo Nuciforo
- Molecular Oncology Group, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Rodrigo Dienstmann
- Oncology Data Science Group, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Josep Tabernero
- Colorectal Cancer Program, Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Ramon Salazar
- Colorectal Cancer Unit, Medical Oncology Department, Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Medical Oncology Department, Catalan Institute of Oncology, Oncobell Program (IDIBELL), CIBERONC, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Ana Vivancos
- Cancer Genomics Group, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
- Correspondence: ; Tel.: +34-932-543-450
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15
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Saoudi Gonzalez N, López D, Gómez D, Ros J, Baraibar I, Salva F, Tabernero J, Élez E. Pharmacokinetics and pharmacodynamics of approved monoclonal antibody therapy for colorectal cancer. Expert Opin Drug Metab Toxicol 2022; 18:755-767. [PMID: 36582117 DOI: 10.1080/17425255.2022.2160316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The introduction of monoclonal antibodies to the chemotherapy backbone treatment has challenged the paradigm of metastatic colorectal cancer (mCRC) treatment. Their mechanism of action and pharmacokinetics are complex but important to understand in order to improve patient selection and treatment outcomes for mCRC population. AREAS COVERED This review examines the scientific data, pharmacodynamics, and pharmacokinetics of approved monoclonal antibodies used to treat mCRC patients, including agents targeting signaling via VEGFR (bevacizumab and ramucirumab), EGFR (cetuximab and panitumumab), HER2/3 target therapy, and immunotherapy agents such as pembrolizumab or nivolumab. Efficacy and mechanism of action of bispecific antibodies are also covered. EXPERT OPINION mCRC is a heterogeneous disease and the optimal selection and sequence of treatments is challenging. Monoclonal antibodies have complex pharmacokinetics and pharmacodynamics, with important interactions between them. The arrival of bioequivalent molecules to the market increases the need for the characterization of pharmacokinetics and pharmacodynamics of classic monoclonal antibodies to reach bioequivalent novel molecules.
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Affiliation(s)
- Nadia Saoudi Gonzalez
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Medical Oncology Department, Vall d'Hebron Institute of Oncology, Vhio Barcelona, Spain
| | - Daniel López
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Diego Gómez
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Javier Ros
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Medical Oncology Department, Vall d'Hebron Institute of Oncology, Vhio Barcelona, Spain
| | - Iosune Baraibar
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Medical Oncology Department, Vall d'Hebron Institute of Oncology, Vhio Barcelona, Spain
| | - Francesc Salva
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Medical Oncology Department, Vall d'Hebron Institute of Oncology, Vhio Barcelona, Spain
| | - Josep Tabernero
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Medical Oncology Department, Vall d'Hebron Institute of Oncology, Vhio Barcelona, Spain
| | - Elena Élez
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Medical Oncology Department, Vall d'Hebron Institute of Oncology, Vhio Barcelona, Spain
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Ros J, Saoudi N, Baraibar I, Salva F, Tabernero J, Elez E. Encorafenib plus cetuximab for the treatment of BRAF-V600E-mutated metastatic colorectal cancer. Therap Adv Gastroenterol 2022; 15:17562848221110644. [PMID: 35812780 PMCID: PMC9260564 DOI: 10.1177/17562848221110644] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/14/2022] [Indexed: 02/04/2023] Open
Abstract
B-type RAF (BRAF)-V600E mutations in metastatic colorectal cancer (mCRC) have been described in up to 12% of the patients. This mutation confers a bad prognostic and poor response with standard chemotherapy. Unlike the scenario for BRAF mutant melanoma, successful BRAF blockade in mCRC has emerged as a complex path, primarily due to the complex underlying biology of mCRC. The BEACON trial has reshaped the therapeutic landscape of BRAF mCRC demonstrating the benefit of the BRAF inhibitor encorafenib in combination with the anti-epidermal growth factor receptor cetuximab. This paper aims to review the main features of BRAF mCRC as well as to review the development of targeted therapy and biomarkers in this specific population. Finally, a deep insight into the underlying biology and molecular classification of BRAF-V600E mCRC has also been performed. The words 'BRAF-V600E mutation', 'colorectal cancer', 'BRAF inhibitors', 'consensus molecular subtypes', 'encorafenib', and 'cetuximab' were used to identify the clinical trials from phase I to phase III related to the development of BRAF inhibitors in this population. A deep search among international meetings (American Society of Clinical Oncology and European Society of Medical Oncology) has been performed to incorporate the last trials presented. BRAF-V600E mCRC is a challenging disease, mostly because of its molecular biology. The BEACON trial has been the most important therapeutic change in the last decade. Nevertheless, new information regarding biomarkers or novel combinations including BRAF inhibitors plus immune checkpoint inhibitors are also promising.
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Affiliation(s)
- Javier Ros
- Department of Medical Oncology, Vall d’Hebron
Institute of Oncology, Barcelona, Spain
- Medical Oncology, Department of Precision
Medicine, Università degli Studi della Campania Luigi Vanvitelli, Naples,
Italy
| | - Nadia Saoudi
- Department of Medical Oncology, Vall d’Hebron
Institute of Oncology, Barcelona, Spain
| | - Iosune Baraibar
- Department of Medical Oncology, Vall d’Hebron
Institute of Oncology, Barcelona, Spain
| | - Francesc Salva
- Department of Medical Oncology, Vall d’Hebron
Institute of Oncology, Barcelona, Spain
| | - Josep Tabernero
- Department of Medical Oncology, Vall d’Hebron
Institute of Oncology, Barcelona, Spain
| | - Elena Elez
- Department of Medical Oncology, Vall d’Hebron
Institute of Oncology, Centro Cellex, Carrer de Natzaret, 115-117, 08035
Barcelona, Spain
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Cabrero-de las Heras S, Losa F, Hernández-Yagüe X, Soler G, Bugés C, Baraibar I, Plaja A, Teixidor E, Martínez-Balibrea E. Abstract 3489: Luminex-based analysis of serum CXC chemokines showing their usefulness as prognostic and/or predictive biomarkers in metastatic colorectal cancer patients. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-3489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: CXC chemokines are a family of small, secreted, chemotactic molecules acting through the binding to their corresponding CXC receptors (CXCRs) and stimulating the migration of cells, most notably those of the immune system. They have been associated with both pro-tumor and anti-tumor activity. Previously, we reported increased expression and secretion levels of CXCL1, 2 and 8 in oxaliplatin (OXA)-resistant colorectal cancer (CRC) cell lines. The aim of this study is to evaluate the usefulness of measuring the serum levels of a CXC chemokine panel in CRC patients as prognostic and/or predictive biomarkers of first-line treatment.
Material and Methods: In this multicenter study sera from advanced CRC patients to be treated with OXA-based schedules were collected at three different time points between November 2016 and June 2021: before treatment (PRET), at first response evaluation (EVAR) and at the time of progression/end of study (PROG). Levels of CXCL1, 2, 5, 6, 8, 9, 10, 11, 12, 13, 16 chemokines were analyzed using a custom Bio-plex Pro Human assay (Bio-Rad, USA) in a Luminex® 200 equipment. Comparisons of chemokines’ levels between Responders (R) and Non-Responders (NR) at different time-points were carried out using the Mann Whitney U and Wilcoxon tests. Log Rank and Cox regression were used to study differences in progression-free (PFS) and overall survival (OS); Chi-square or Fisher’s tests were used to study associations between categorical variables. All differences were considered statistically significant when p values ≤ 0.05.
Results: A total of 107 patients were enrolled in this study: 72% male; median age 66 years old; metastasis: 78% liver, 41% lung; mutations: 44% KRAS, 4% BRAF; treatments: FOLFOX/XELOX = 30%/4% plus Bevacizumab/anti-EGFR = 36%/24%; 64% responders (complete response + partial response); 13% stable disease; 11% progressors. All chemokines could be detected in the samples. Levels below median (LBM) of CXCL1, 8, 11 and 13 correlated with better OS (HR=0.55 p=0.02; HR=0.47 p=0.005; HR=0.6 p=0.05; HR=0.54 p=0.02, respectively). LBM of CXCL16 correlated with better OS and PFS (HR=0.6 p=0.04; HR=0.6 p=0.005) and of CXCL5 with better PFS (HR 0.6 p 0.011); mean CXCL9 levels were lower in responders’ PRET samples (p=0.03) and LBM correlated with better OS (HR=0.5 p=0.019). In responders, all chemokines except CXCL10, 13 and 16 presented decreased levels at EVAR vs. PRET. Moreover, CXCL1, 2, 5, 8, 11 and 16 levels increased at PROG vs. EVAR. In non-responders, non-conclusive results were found.
Conclusion: our results show that serum levels of specific CXC chemokines may be used as prognostic/predictive markers in metastatic CRC. Further analysis will be performed, and an update of this study will be presented in the AACR meeting.
Citation Format: Sara Cabrero-de las Heras, Ferran Losa, Xavier Hernández-Yagüe, Gemma Soler, Cristina Bugés, Iosune Baraibar, Andrea Plaja, Eduard Teixidor, Eva Martínez-Balibrea. Luminex-based analysis of serum CXC chemokines showing their usefulness as prognostic and/or predictive biomarkers in metastatic colorectal cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3489.
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Affiliation(s)
| | - Ferran Losa
- 2Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
| | | | - Gemma Soler
- 2Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
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Ros Montañá J, Navarro V, Comas R, Garcia A, Saoudi Gonzalez N, Baraibar I, Salva F, Vivancos A, Tabernero J, Elez E. Molecular characterization and subsequent treatments after encorafenib-cetuximab +/- binimetinib in BRAF V600E-mutated colorectal cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.3562] [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
3562 Background: The BRAF-V600E mutation confers poor prognosis in patients with mCRC. E-C+/-B improve clinical outcomes compared with standard of care. Data about subsequent treatment lines and the impact of NGS in the treatment choice after the BRAF targeted treatment are still limited. We have analyzed the global overall survival (OS) and the impact of NGS to guide subsequent treatments (approved targeted therapies (TT) or clinical trials (CT)) after E-C+/-B. Methods: Patients who had received E-C+/-B were included. Clinical data was collected prospectively. Tissue NGS was performed prospectively and retrospectively using an in-house NGS panel (VHIO-300). Subsequent treatments’ clinical outcomes were described. Percentage of patients who received TT or CT based on NGS results is reported. Clinical outcomes were calculated using survival Kaplan-Meier curves. Results: From 2017 to 2021, 59 patients with refractory mCRC received E-C+/-B at our institution. 50 patients have already progressed to the BRAF inhibitor combination and 9 patients remain on BRAF inhibitor treatment. Tumor tissue for NGS testing before BRAF inhibitor treatment was available in 70% of patients (41/59). BRAF-V600E mutation was confirmed in tissue using ddPCR in all patients. The most frequent alterations were: BRAF-V600E 93%, TP53 64%, RNF43 30%, APC 20%, PIK3CA 14%, NOTCH1/2 9%, RANBP2 8%, PTEN 8%, MET amplification 5%. MSI incidence was 10%, 2 out of 6 (33%) received subsequent immunotherapy. After the BRAF inhibitor combination, 23 patients (38%) did not receive subsequent treatment (clinical deterioration or death). The 27 remaining patients (62%) received 41 subsequent treatments (37% of them were TT or CT). Median subsequent lines after the BRAF inhibitor combination were 1 (0-3). NGS led to targeted therapy in 20% of the patients: BRAF inhibitors combos (20%), microtubule inhibitors (13%), antiPD1 (13%), NOTCH inhibitors (6%), and MET inhibitor (6%). ORR among patients who received matched TT or CT was 6% and DCR (CR+PR+SD) was 47%. The median OS after the BRAF inhibitor was 3.8 months; 10.1 months vs 3.0 months (HR 0.43 (95%CI 0.2-0.95), p = 0.04) for those patients who received TT or CT vs patients who did not receive TT or CT. When MSI patients were excluded mOS was 5.2 vs 3.0 months (HR 0.61 (95%CI 0.27-1.37), p = 0.23) respectively. There were no differences in terms of OS regarding the number of previous lines (0-1 vs 2-3, HR 0.75 (95%CI 0.4-1.42), p = 0.37) or with the BRAF inhibitor regimen used (E-C vs E-C-B) (HR 0.84, (95%CI 0.44-1.6), p = 0.61) Conclusions: This study suggests that patients with BRAF-V600E mutant mCRC could have benefit when treated with TT and/or in CT after a BRAF inhibitor-based therapy, including immunotherapy. Genomic analysis might help to guide subsequent treatments. Because of molecular heterogeneity, these patients should be discussed in Molecular Tumor Boards.
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Affiliation(s)
- Javier Ros Montañá
- Vall d’Hebron Institute of Oncology (VHIO), Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | | | - Raquel Comas
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | - Iosune Baraibar
- Vall d’Hebron Institute of Oncology (VHIO), Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | | | - Ana Vivancos
- Cancer Genomics Group, Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Elena Elez
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Saoudi Gonzalez N, Ros Montañá J, Martini G, Comas R, Garcia A, Baraibar I, Salva F, Laia C, Castillo G, Navarro Garces V, Perez-Lopez R, Palmer HG, Vivancos A, Tabernero J, Elez E. Impact of circulating tumor DNA (ctDNA) mutant allele fraction in response to anti-angiogenic therapy in RAS-mutant metastatic colorectal cancer (mCRC): Clinical data in the first-line setting and correlation in patient-derived xenograft (PDX) models. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.3560] [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
3560 Background: Currently, there are no well-established biomarkers available to select mCRC patients (pts) who will benefit most from antiangiogenic therapy. RAS mutant (mt) allele fraction in plasma (plMAF) is an independent prognostic factor in mCRC. Preliminary data from our group suggests the possible predictive role of plMAF in RAS mt pts treated with 1st line chemotherapy (ct) +/- bevacizumab (bev). Methods: Data prospectively/retrospectively collected from RASmt mCRC pts who received 1st line ct+/-bev treatment in our center, selecting the subset of pts with plMAF sample evaluable with digital PCR (BEAMing) at baseline. Pts were stratified as high (≥ 5.8%) or low ( < 5.8%) plMAF, based on a previously established prognostic cutoff (Elez et al, Mol Onc 2019). We investigated the associations between clinic-pathological variables, overall survival (OS), and progression-free survival (PFS) stratified by plMAF RAS levels using Cox regression models. OS and PFS were calculated by Kaplan-Meier method. Murine PDX were developed from mCRC pts including models from patients with KRASG12/G13 mutations to explore recapitulation of the clinical findings. Results: From October ‘17 to December ‘21, 102 basal plasma samples were analyzed by BEAMing. 47 pts (46%) were classified as high, 39 pts (38%) as low, and 16 (16%) as no-mt detected by BEAMing (non-shedding). OS was significant longer in low plMAF pts than in high plMAF pts (median OS 15.9 vs 37.1 months (mo); HR 0.43; p = 0.001). In high plMAF pts, a trend towards a better PFS was observed in those pts treated with ct+bev compared to ct alone (median 9.4 vs 6.1 mo; HR 0.6; p = 0.18). No differences were observed in low plMAF pts treated with ct +/- bev (median 14.5 vs 14.9 mo; HR 1.2; p = 0.58). Results were not modified when adjusted by the presence of liver metastases. The multivariate PFS model showed no association between RAS plMAF and clinicopathological variables, except for treatment benefit with ct+bev and better outcomes in pts with resectable liver metastases. Interestingly, human ctDNA in one murine PDX model from non-shedding pt was not detectable, whereas human ctDNA was present in another PDX model with a plMAF of 36.2%. Conclusions: This study suggests that plMAF could be a promising predictive biomarker of response to bev in 1st line RASmt mCRC, but more pts need to be analyzed to confirm this effect. Our results confirm the prognostic role of RASmt plMAF in mCRC. plMAF could partially depend on tumor cell shedding degree and characteristics on the tumor vasculature architecture, this is being investigated in ongoing imaging studies and PDX models. These models will also help to understand the biology behind tumor response to bev and its connection with ctDNA shedding.
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Affiliation(s)
| | | | | | - Raquel Comas
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Ariadna Garcia
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Iosune Baraibar
- Vall d’Hebron Institute of Oncology (VHIO), Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | | | - Cabellos Laia
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Gloria Castillo
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Raquel Perez-Lopez
- Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Hector G. Palmer
- Stem Cells and Cancer Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Ana Vivancos
- Cancer Genomics Group, Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Elena Elez
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Ros J, Saoudi N, Salvà F, Baraibar I, Alonso G, Tabernero J, Elez E. Ongoing and evolving clinical trials enhancing future colorectal cancer treatment strategies. Expert Opin Investig Drugs 2022; 31:235-247. [PMID: 35133234 DOI: 10.1080/13543784.2022.2040016] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Molecular profiling has led to significantly longer survival in metastatic colorectal cancer (CRC) patients. Clinical guidelines recommend testing for KRAS/NRAS, BRAF and MSI status and over the last few years several promising new biomarkers have also been identified. Circulating tumor DNA has reshaped the prognosis of localized CRC. These genomic findings can guide treatment management to improve clinical outcomes. AREAS COVERED Preclinical and clinical data over the last decade were reviewed for known and novel biomarkers with clinical implications in refractory and metastatic CRC. In the localized stage, al clinical trials involving new approaches such as liquid biopsy or neoadjuvant immunotherapy are also discussed. Molecular alterations and targeted agents are described, and data from completed and ongoing studies with targeted therapy and immunotherapies are presented. EXPERT OPINION The implementation of liquid biopsies in the localized CRC setting has reshaped management of this disease. The expanded use of biomarkers to guide the treatment of patients with CRC has revealed a level of complexity arising from interactions between different biomarkers. Prevalence of most established targetable biomarkers is low, however the number of identified biomarkers in CRC is increasing. Thus, metastatic CRC may ultimately be considered an umbrella diagnosis encompassing numerous rare disease subtypes.
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Affiliation(s)
- Javier Ros
- Medical Oncology, Vall d'Hebron University Hospital and Vall D'Hebron Institute of Oncology (VHIO), Barcelona, Spain.,Department of Precision Medicine, Medical Oncology, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Campania, Italy
| | - Nadia Saoudi
- Medical Oncology, Vall d'Hebron University Hospital and Vall D'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Francesc Salvà
- Medical Oncology, Vall d'Hebron University Hospital and Vall D'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Iosune Baraibar
- Medical Oncology, Vall d'Hebron University Hospital and Vall D'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Guzman Alonso
- Medical Oncology, Vall d'Hebron University Hospital and Vall D'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Josep Tabernero
- Medical Oncology, Vall d'Hebron University Hospital and Vall D'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Elena Elez
- Medical Oncology, Vall d'Hebron University Hospital and Vall D'Hebron Institute of Oncology (VHIO), Barcelona, Spain
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Baraibar I, Mirallas O, Saoudi N, Ros J, Salvà F, Tabernero J, Élez E. Combined Treatment with Immunotherapy-Based Strategies for MSS Metastatic Colorectal Cancer. Cancers (Basel) 2021; 13:6311. [PMID: 34944931 PMCID: PMC8699573 DOI: 10.3390/cancers13246311] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 11/08/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 12/24/2022] Open
Abstract
In recent years, deepening knowledge of the complex interactions between the immune system and cancer cells has led to the advent of effective immunotherapies that have revolutionized the therapeutic paradigm of several cancer types. However, colorectal cancer (CRC) is one of the tumor types in which immunotherapy has proven less effective. While there is solid clinical evidence for the therapeutic role of immune checkpoint inhibitors in mismatch repair-deficient (dMMR) and in highly microsatellite instable (MSI-H) metastatic CRC (mCRC), blockade of CTLA-4 or PD-L1/PD-1 as monotherapy has not conferred any major clinical benefit to patients with MMR-proficient (pMMR) or microsatellite stable (MSS) mCRC, reflecting 95% of the CRC population. There thus remains a high unmet medical need for the development of novel immunotherapy approaches for the vast majority of patients with pMMR or MSS/MSI-low (MSI-L) mCRC. Defining the molecular mechanisms for immunogenicity in mCRC and mediating immune resistance in MSS mCRC is needed to develop predictive biomarkers and effective therapeutic combination strategies. Here we review available clinical data from combinatorial therapeutic approaches using immunotherapy-based strategies for MSS mCRC.
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Affiliation(s)
- Iosune Baraibar
- Department of Medical Oncology, Vall d’Hebron University Hospital, Passeig de la Vall d’Hebron, 119, 08035 Barcelona, Spain; (O.M.); (N.S.); (J.R.); (F.S.); (J.T.); (E.É.)
- Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Oriol Mirallas
- Department of Medical Oncology, Vall d’Hebron University Hospital, Passeig de la Vall d’Hebron, 119, 08035 Barcelona, Spain; (O.M.); (N.S.); (J.R.); (F.S.); (J.T.); (E.É.)
| | - Nadia Saoudi
- Department of Medical Oncology, Vall d’Hebron University Hospital, Passeig de la Vall d’Hebron, 119, 08035 Barcelona, Spain; (O.M.); (N.S.); (J.R.); (F.S.); (J.T.); (E.É.)
- Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Javier Ros
- Department of Medical Oncology, Vall d’Hebron University Hospital, Passeig de la Vall d’Hebron, 119, 08035 Barcelona, Spain; (O.M.); (N.S.); (J.R.); (F.S.); (J.T.); (E.É.)
- Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Francesc Salvà
- Department of Medical Oncology, Vall d’Hebron University Hospital, Passeig de la Vall d’Hebron, 119, 08035 Barcelona, Spain; (O.M.); (N.S.); (J.R.); (F.S.); (J.T.); (E.É.)
- Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Josep Tabernero
- Department of Medical Oncology, Vall d’Hebron University Hospital, Passeig de la Vall d’Hebron, 119, 08035 Barcelona, Spain; (O.M.); (N.S.); (J.R.); (F.S.); (J.T.); (E.É.)
- Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Elena Élez
- Department of Medical Oncology, Vall d’Hebron University Hospital, Passeig de la Vall d’Hebron, 119, 08035 Barcelona, Spain; (O.M.); (N.S.); (J.R.); (F.S.); (J.T.); (E.É.)
- Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
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22
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Ros J, Baraibar I, Martini G, Salvà F, Saoudi N, Cuadra-Urteaga JL, Dienstmann R, Tabernero J, Élez E. The Evolving Role of Consensus Molecular Subtypes: a Step Beyond Inpatient Selection for Treatment of Colorectal Cancer. Curr Treat Options Oncol 2021; 22:113. [PMID: 34741675 DOI: 10.1007/s11864-021-00913-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 12/24/2022]
Abstract
OPINION STATEMENT The heterogenous nature of colorectal cancer (CRC) renders it a major clinical challenge. Increasing genomic understanding of CRC has improved our knowledge of this heterogeneity and the main cancer drivers, with significant improvements in clinical outcomes. Comprehensive molecular characterization has allowed clinicians a more precise range of treatment options based on biomarker selection. Furthermore, this deep molecular understanding likely extends therapeutic options to a larger number of patients. The biological associations of consensus molecular subtypes (CMS) with clinical outcomes in localized CRC have been validated in retrospective clinical trials. The prognostic role of CMS has also been confirmed in the metastatic setting, with CMS2 having the best prognosis, whereas CMS1 tumors are associated with a higher risk of progression and death after chemotherapy. Similarly, according to mesenchymal features and immunosuppressive molecules, CMS1 responds to immunotherapy, whereas CMS4 has a poorer prognosis, suggesting that a CMS1 signature could identify patients who may benefit from immune checkpoint inhibitors regardless of microsatellite instability (MSI) status. The main goal of these comprehensive analyses is to switch from "one marker-one drug" to "multi-marker drug combinations" allowing oncologists to give "the right drug to the right patient." Despite the revealing data from transcriptomic analyses, the high rate of intra-tumoral heterogeneity across the different CMS subgroups limits its incorporation as a predictive biomarker. In clinical practice, when feasible, comprehensive genomic tests should be performed to identify potentially targetable alterations, particularly in RAS/BRAF wild-type, MSI, and right-sided tumors. Furthermore, CMS has not only been associated with clinical outcomes and specific tumor and patient phenotypes but also with specific microbiome patterns. Future steps will include the integration of clinical features, genomics, transcriptomics, and microbiota to select the most accurate biomarkers to identify optimal treatments, improving individual clinical outcomes. In summary, CMS is context specific, identifies a level of heterogeneity beyond standard genomic biomarkers, and offers a means of maximizing personalized therapy.
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Affiliation(s)
- Javier Ros
- Medical Oncology, Vall d'Hebron University Hospital and Vall D'Hebron Institute of Oncology (VHIO), Barcelona, Spain. .,Department of Precision Medicine, Medical Oncology, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Campania, Italy.
| | - Iosune Baraibar
- Medical Oncology, Vall d'Hebron University Hospital and Vall D'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Giulia Martini
- Department of Precision Medicine, Medical Oncology, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Campania, Italy
| | - Francesc Salvà
- Medical Oncology, Vall d'Hebron University Hospital and Vall D'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Nadia Saoudi
- Medical Oncology, Vall d'Hebron University Hospital and Vall D'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Rodrigo Dienstmann
- Oncology Data Science (ODysSey) Group, Vall D'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall D'Hebron, Vall D'Hebron Barcelona Hospital Campus (Spain), Barcelona, Spain
| | - Josep Tabernero
- Medical Oncology, Vall d'Hebron University Hospital and Vall D'Hebron Institute of Oncology (VHIO), Barcelona, Spain.,IOB, Barcelona, Spain.,UVic-UCC, Vic, Spain
| | - Elena Élez
- Medical Oncology, Vall d'Hebron University Hospital and Vall D'Hebron Institute of Oncology (VHIO), Barcelona, Spain
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Vilalta-Lacarra A, Rodriguez-Remirez M, Lopez-Erdozain I, Puyalto A, Baraibar I, Corral J, Gúrpide A, López-Picazo J, Pérez-Gracia J, Andueza M, Catalan V, Fruhbeck G, Pio R, Ajona D, Gil-Bazo I. P12.03 The Time of Anti-PD-1 Infusion Improves Survival Outcomes by Fasting Conditions Simulation in Non-Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Valdivia A, Salva F, Ros J, Baraibar I, Argiles Martinez G, Saoudi Gonzalez N, Garcia A, Mulet Margalef N, Cuadra Urteaga J, Capdevila J, Salud Salvia M, Paez D, Casado E, Comas R, Ruiz-Pace F, Villacampa Javierre G, Acosta Eyzaguirre D, Dienstmann R, Elez Fernandez M, Tabernero J. 426P Spotlight on refractory metastatic colorectal cancer (refMCRC): Role of prognostic characteristics in the continuum of care. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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25
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Élez E, Ros J, Martini G, Matito J, Villacampa G, Salva F, Baraibar I, Saoudi N, Garcia A, Comas R, Ciardiello D, Martinelli E, Nuciforo P, Pálmer H, Dienstmann R, Toledo R, Ciardiello F, Tabernero J, Vivancos A. LBA-3 Integrated analysis of cell-free DNA (cfDNA) BRAF mutant allele fraction (MAF) and whole exome sequencing in BRAFV600E metastatic colorectal cancer (mCRC) treated with BRAF-antiEGFR +/- MEK inhibitors. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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26
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Napoli S, Sanchis M, Baraibar I, Garcia A, Ann Wornham N, Sanchez N, Piris A, Garralda E, Elez Fernandez E, Tabernero J, Nuciforo P, Bayo N. P-112 Compliance analysis of biological samples and questionnaire collection in a colorectal cancer microbiome study: The VHIO experience. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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27
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Saoudi Gonzalez N, Salvà F, Ros J, Baraibar I, Marmolejo D, Valdivia A, Cuadra-Urteaga JL, Mulet N, Tabernero J, Élez E. Up-to-date role of aflibercept in the treatment of colorectal cancer. Expert Opin Biol Ther 2021; 21:1315-1324. [PMID: 34085884 DOI: 10.1080/14712598.2021.1935231] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: Colorectal cancer (CRC) is a major public health problem. Despite major progress understanding the biological basis of this tumor added to the incorporation of optimized diagnostic and therapeutic strategies, prognosis after progression on first-line standard treatment remains poor. Several antiangiogenic treatments have demonstrated improvement in overall survival (OS) in the second-line treatment being aflibercept, a fully humanized recombinant protein, one of them. The results of the VELOUR study showed that the addition of aflibercept to second-line FOLFIRI improved OS and progression-free survival.Areas covered: A literature review of published clinical studies was performed in order to discuss the clinical data on aflibercept in mCRC from early drug development to real-world data.Expert opinion: The combination of aflibercept with FOLFIRI provides a statistical improvement in OS and in all the efficacy endpoints analyzed in the VELOUR trial, showing efficacy independently on time to progression, molecular status, prior biological treatment, or age. Further studies are needed to find new biomarkers and molecular characterization in order to better select patients that could benefit from this treatment.
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Affiliation(s)
- Nadia Saoudi Gonzalez
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Francesc Salvà
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Medical Oncology Department, Vall d'Hebron Institute of Oncology, VHIO Barcelona, Spain
| | - Javier Ros
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Medical Oncology Department, Vall d'Hebron Institute of Oncology, VHIO Barcelona, Spain
| | - Iosune Baraibar
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Medical Oncology Department, Vall d'Hebron Institute of Oncology, VHIO Barcelona, Spain
| | - David Marmolejo
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Augusto Valdivia
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | | | - Nuria Mulet
- Medical Oncology Department, Vall d'Hebron Institute of Oncology, VHIO Barcelona, Spain.,Medical Oncology Department, Catalan Institute of Oncology, lDIBELL, Bellvitge Biomedical Research Institute, L'Hospitalet De Llobregat, Spain
| | - Josep Tabernero
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Medical Oncology Department, Vall d'Hebron Institute of Oncology, VHIO Barcelona, Spain
| | - Elena Élez
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Medical Oncology Department, Vall d'Hebron Institute of Oncology, VHIO Barcelona, Spain
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28
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Baraibar I, Salva F, Comas R, Ros J, Garcia A, Sanchis M, Cuadra JL, Saoudi N, Valdivia A, Mulet N, Virgili A, Hernando J, Capdevila J, Martí M, Landolfi S, Verdaguer H, Espin E, Nuciforo P, Tabernero J, Elez E. Young-onset colorectal cancer: A call for action. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.10563] [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
10563 Background: Young-onset colorectal cancer (YOCR) is defined as diagnosis below the age of 50. Over the past decades, the incidence of YOCRC has increased at an alarming rate, but causes and pathogenesis still remain unknown. Early detection of colorectal cancer (CRC) has demonstrated to improve survival. Despite these facts, adults < 50 years old are not yet included in screening programs and YOCRC is not well characterized. We aimed to characterize the clinical and molecular characteristics of YOCRC in patients (pts) diagnosed at our institution. Methods: Consecutive pts with a diagnosis of CRC below the age of 50 visited for the first time at Vall d’Hebron University Hospital in Spain between January 2017 and October 2020 were included in the analysis. Data of clinicopathologic features and treatment were collected retrospectively from medical records. Results: 205 pts met the inclusion criteria, 111 (54%) were females, 8 (4%) presented a personal history of cancer at diagnosis and 109 (53%) a family history of cancer. Age at diagnosis was: < 30: 10 (5%), {30 – 40): 52 (25%), {40-45): 51 (25%), {45-50): 92 (45%). Site of primary tumor was: right colon: 50 (24%), left colon: 107 (52%): rectum: 48 (24%). Stage at diagnosis was I: 3 (1%), II: 14 (7%), III: 60 (29%), IV: 128 (63%). 6 of 14 (43%) and 44 of 60 patients (73%) with stage II and III CRC presented disease progression after initial treatment, respectively. Molecular status was: KRAS mutation: 74 (36%), NRAS mutation: 7 (3%), BRAF mutation: 12 (6%), MSI-H: 12 (6%). 43 pts (21%) had documentation of genetic counseling. Median (range) number of lines of treatment for metastatic disease was 3 (1-7), 53 pts (30%) received at least 4 lines of treatment. Median (range) number of metastatic sites was: 2 (1-6). 114 patients (55.6%) had died at the cut-off timepoint. Conclusions: YOCR is usually diagnosed with a more advanced stage than standard-onset CRC, with a poorer course of the disease. Further studies in young adults with CRC should address this phenomenon to understand the underlying causes, and prioritize genetic counseling. Our results support the unmet need of initiating screening programs in adults younger than 50 years, the urgency for a global consensus and a call for action.
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Affiliation(s)
- Iosune Baraibar
- Vall d’Hebron Institute of Oncology (VHIO), Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | - Francesc Salva
- Vall d’Hebron Institute of Oncology (VHIO), Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | - Raquel Comas
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Javier Ros
- Vall d’Hebron Institute of Oncology (VHIO), Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | - Ariadna Garcia
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Mireia Sanchis
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Nadia Saoudi
- Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | - Augusto Valdivia
- Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | - Nuria Mulet
- Instituto Catalan de Oncologia de Hospitalet, Barcelona, Spain
| | | | - Jorge Hernando
- Vall d’Hebron Institute of Oncology (VHIO), Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | - Jaume Capdevila
- Vall d’Hebron Institute of Oncology (VHIO), Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | - Marc Martí
- Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Stefania Landolfi
- Pathology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Helena Verdaguer
- Vall d’Hebron Institute of Oncology (VHIO), Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | - Eloy Espin
- Department of General and Digestive Surgery, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | - Paolo Nuciforo
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Josep Tabernero
- Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology (VHIO), UVic-UCC, Barcelona, Spain
| | - Elena Elez
- Vall d’Hebron Institute of Oncology (VHIO), Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
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Oberoi HK, Serres-Créixams X, Alonso G, Matos I, Hernando-Calvo A, Muñoz-Couselo E, Diez M, Baraibar I, Vieito M, Saavedra Santa Gadea O, Galvao V, Mur-Bonet G, Cunill-Macià G, Oliveira M, Felip E, Macarulla T, Elez E, Tabernero J, Brana I, Garralda E. ItRECIST adapted efficacy assessment in solid tumors treated with intratumoral immunotherapy. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.2557] [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
2557 Background: The development of human intratumoral therapy (HIT-IT) has surged as a promising strategy to overcome resistance to checkpoint inhibitors (CPI), promoting a stronger tumor-specific immune response while reducing systemic exposure. A broad variety of agents (i.e: oncolytic viruses, toll-like receptors agonists) administered both in superficial- and deep-seated lesions are being currently tested in clinical trials (CT). Due to the local intervention on tumors, radiological assessment by standard RECIST is challenging and new methods of response that capture and integrate the local and systemic response to HIT-IT are needed. We aimed to evaluate the feasibility and clinical utility of itRECIST (Goldmacher et al., 2020) in patients (pts) treated with HIT-IT in early phase CT. Methods: Retrospective analysis of a cohort of pts with different solid tumor types enrolled in CT including HIT-IT in our institution between August’18 and January’21. Clinical characteristics were collected. Efficacy in target-injected (T-I) and target-non-injected (T-NI) lesions was assessed by objective response rate (ORR) and disease control rate (DCR), as per itRECIST. Overall disease ORR and DCR were assessed per RECIST 1.1/iRECIST. Treatment-related adverse events (TRAEs) were assessed with CTCAE v.5.0. ORR was calculated with Clopper-Pearson method. Survival analysis was made using Kaplan-Meier method. Results: A total of 37 pts were included. Median age was 66 years, 19 pts (51%) were male, all pts had ECOG 0-1. 24 pts (65%) were CPI-naïve. Median previous lines of therapy was 2 (range [r]: 0-11). All pts (100%) received minimum 1 dose of HIT-IT. 6 pts (16%) were treated with monotherapy and 31 pts (84%) in combination with CPI. Median HIT-IT and CPI doses administered were 4 (r: 1-9) and 2 (r: 1-13), respectively. Injected lesions: cutaneous (16.2%), subcutaneous (21.6%), lymph node (32.4%), liver (29.7%). Median size of T-I lesions was 40 mm (r: 19-260). At data cutoff, 32 pts were evaluable. Median follow-up was 14.4 weeks (r: 1.0-81.1). Per RECIST 1.1, overall ORR was 6% (95% CI, 5-7) and DCR was 38% (95% CI, 21-56). Per itRECIST, ORR was 19% (95% CI, 7-36) and DCR was 63% (95% CI, 44-79) in T-I lesions (n = 32), and 10% (95% CI, 22-27) and 48% (95% CI, 29-67) in T-NI lesions (n = 29). Mean decrease in responding T-I and T-NI lesions was -47% (r: -21 to -100) and -41% (r: -26 to -59), respectively. No non-target (NT) lesion was injected. Median progression-free survival was 7.4 weeks (95% CI, 6.6 – 8.2). Median overall survival was 10.0 months (95% CI, 2.3 – 17.7). Incidence of TRAE was 58% (grade 1-2 IT-related pyrexia 43%; grade 3-4, 5%). No treatment-related deaths were recorded. Conclusions: ItRECIST is feasible to implement and adds precision to the radiological assessment of local and distant anti-tumor activity of HIT-IT. No safety issues were detected in our cohort.
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Affiliation(s)
- Honey Kumar Oberoi
- Vall d’Hebron Institute of Oncology (VHIO), Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | | | - Guzman Alonso
- Vall d’Hebron Institute of Oncology (VHIO), Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | - Ignacio Matos
- Vall d’Hebron Institute of Oncology (VHIO), Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | - Alberto Hernando-Calvo
- Vall d’Hebron Institute of Oncology (VHIO), Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | - Eva Muñoz-Couselo
- Vall d’Hebron Institute of Oncology (VHIO), Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | - Marc Diez
- Vall d’Hebron Institute of Oncology (VHIO), Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | - Iosune Baraibar
- Vall d’Hebron Institute of Oncology (VHIO), Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | - Maria Vieito
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital (HUVH), Barcelona, Spain
| | | | - Vladimir Galvao
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | | | - Enriqueta Felip
- Vall d’Hebron Institute of Oncology (VHIO), Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | - Teresa Macarulla
- Vall d’Hebron Institute of Oncology (VHIO), Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | - Elena Elez
- Vall d’Hebron Institute of Oncology (VHIO), Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | - Josep Tabernero
- Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology (VHIO), UVic-UCC, Barcelona, Spain
| | - Irene Brana
- Vall d’Hebron University Hospital, Vall d’Hebrón Institute of Oncology, Barcelona, Spain
| | - Elena Garralda
- Vall d’Hebron Institute of Oncology (VHIO), Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
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30
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Ros J, Baraibar I, Sardo E, Mulet N, Salvà F, Argilés G, Martini G, Ciardiello D, Cuadra JL, Tabernero J, Élez E. BRAF, MEK and EGFR inhibition as treatment strategies in BRAF V600E metastatic colorectal cancer. Ther Adv Med Oncol 2021; 13:1758835921992974. [PMID: 33747149 PMCID: PMC7903827 DOI: 10.1177/1758835921992974] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 01/13/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION BRAF driver mutations are found in up to 15% of patients with colorectal cancer (CRC) and lead to constitutive activation of BRAF kinase and sustained RAS/RAF/MEK/ERK pathway signaling. BRAF mutations define a sub-population characterized by a poor prognosis and dismal median survival. Following successful outcomes with BRAF inhibition in BRAF mutant metastatic melanoma, this approach was evaluated in metastatic colorectal cancer (mCRC). The development and combination of targeted therapies against multiple signaling pathways has proved particularly successful, with improved survival and response rates. AREAS COVERED This review addresses the development of therapeutic strategies with inhibitors targeting MAPK/ERK and EGFR signaling in BRAF V600E mutated mCRC, focusing on encorafenib, binimetinib and cetuximab. A pharmacological and clinical review of these drugs and the therapeutic approaches behind their optimization are presented. EXPERT OPINION Exploiting knowledge of the mechanisms of resistance to BRAF inhibitors has been crucial to developing effective therapeutic strategies in BRAF-V600E mutant mCRC. The BEACON trial is a successful example of this approach, using encorafenib and cetuximab with or without binimetinib in patients with previously treated BRAF V600E mutant mCRC, showing an impressive improvement in clinical outcomes and tolerable toxicity compared with chemotherapy, establishing a new standard of care in this setting.
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Affiliation(s)
- Javier Ros
- Department of Medical Oncology, Vall d’Hebron University Hospital, Passeig de la Vall d’Hebron, 119, Barcelona, Catalunya 08035, Spain
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Iosune Baraibar
- Department of Medical Oncology, Vall d’Hebron University Hospital, Barcelona, Catalunya, Spain
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Emilia Sardo
- Department of Medical Oncology, Vall d’Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Nuria Mulet
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Department of Medical Oncology, Institut Catala d’ Oncologia, Barcelona, Spain
| | - Francesc Salvà
- Department of Medical Oncology, Vall d’Hebron University Hospital, Barcelona, Catalunya, Spain
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Guillem Argilés
- Department of Medical Oncology, Vall d’Hebron University Hospital, Barcelona, Catalunya, Spain
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Giulia Martini
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Medicine, Università degli Studi della Campania Luigi Vanvitelli, Naples, Caserta, Campania, Italy
| | - Davide Ciardiello
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Medicine, Università degli Studi della Campania Luigi Vanvitelli, Naples, Caserta, Campania, Italy
| | | | - Josep Tabernero
- Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron Barcelona Hospital Campus, UVic-UCC, Passeig Vall d’Hebron, Barcelona, Spain
| | - Elena Élez
- Department of Medical Oncology, Vall d’Hebron University Hospital, Barcelona, Catalunya, Spain
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
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31
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Kagawa Y, Elez E, García-Foncillas J, Bando H, Taniguchi H, Vivancos A, Akagi K, García A, Denda T, Ros J, Nishina T, Baraibar I, Komatsu Y, Ciardiello D, Oki E, Kudo T, Kato T, Yamanaka T, Tabernero J, Yoshino T. Combined Analysis of Concordance between Liquid and Tumor Tissue Biopsies for RAS Mutations in Colorectal Cancer with a Single Metastasis Site: The METABEAM Study. Clin Cancer Res 2021; 27:2515-2522. [PMID: 33602686 DOI: 10.1158/1078-0432.ccr-20-3677] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/04/2020] [Accepted: 02/12/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE OncoBEAM™ is a circulating tumor DNA (ctDNA) test that uses the BEAMing digital PCR technology. We clarified the association between the baseline tumor burden and discordance in the RAS status by metastatic sites in patients with a single metastatic site. EXPERIMENTAL DESIGN Data from previous Spanish and Japanese studies investigating the concordance of the RAS status between OncoBEAM™ and tissue biopsy in 221 patients with metastatic colorectal cancer (mCRC) were used. We collected data from patients with liver, peritoneal, or lung metastases and evaluated the concordance rates according to the metastatic site and the association between the concordance rate and tumor burden. RESULTS Patients had metastases in the liver (n = 151), peritoneum (n = 25), or lung (n = 45) with concordance rates of 91% (95% confidence interval, 85%-95%), 88% (68%-97%), and 64% (49%-78%), respectively. Factors associated with concordance included the baseline longest diameter and lesion number (P = 0.004), and sample collection interval (P = 0.036). Concordance rates ≥90% were observed in the following groups: liver metastases alone, regardless of the baseline longest diameter and lesion number; peritoneal metastases alone in patients with a baseline longest diameter ≥20 mm; and lung metastases alone in patients with a baseline longest diameter ≥20 mm and/or number of lesions ≥10. CONCLUSIONS Plasma ctDNA-based liquid biopsy in patients with mCRC may be useful depending on the metastatic site. The maximum diameter and lesion number should be carefully considered when determining patients' RAS status with only peritoneal or lung metastases.
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Affiliation(s)
- Yoshinori Kagawa
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Elena Elez
- Department of Medical Oncology, Vall d'Hebron University Hospital (HUVH), Vall d'Hebron Institute of Oncology (VHIO), IOB-Quiron, UVic-UCC, Barcelona, Spain
| | - Jesús García-Foncillas
- Department of Oncology, Fundacion Jimenez Diaz University Hospital, Autonomous University, Madrid, Spain
| | - Hideaki Bando
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Hiroya Taniguchi
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Ana Vivancos
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Kiwamu Akagi
- Division of Molecular Diagnosis and Cancer Prevention, Saitama Cancer Center, Ina, Saitama, Japan
| | - Ariadna García
- Department of Medical Oncology, Vall d'Hebron University Hospital (HUVH), Vall d'Hebron Institute of Oncology (VHIO), IOB-Quiron, UVic-UCC, Barcelona, Spain
| | - Tadamichi Denda
- Division of Gastroenterology, Chiba Cancer Center, Chuo, Chiba, Japan
| | - Javier Ros
- Department of Medical Oncology, Vall d'Hebron University Hospital (HUVH), Vall d'Hebron Institute of Oncology (VHIO), IOB-Quiron, UVic-UCC, Barcelona, Spain
| | - Tomohiro Nishina
- Department of Gastrointestinal Medical Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime, Japan
| | - Iosune Baraibar
- Department of Medical Oncology, Vall d'Hebron University Hospital (HUVH), Vall d'Hebron Institute of Oncology (VHIO), IOB-Quiron, UVic-UCC, Barcelona, Spain
| | - Yoshito Komatsu
- Department of Cancer Chemotherapy, Hokkaido University Hospital Cancer Center, Sapporo, Hokkaido, Japan
| | - Davide Ciardiello
- Department of Medical Oncology, Vall d'Hebron University Hospital (HUVH), Vall d'Hebron Institute of Oncology (VHIO), IOB-Quiron, UVic-UCC, Barcelona, Spain.,Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Eiji Oki
- Department of Surgery and Science, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Toshihiro Kudo
- Department of Frontier Science for Cancer and Chemotherapy, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Takeshi Kato
- Department of Surgery, National Hospital Organization Osaka National Hospital, Chuo, Osaka, Japan
| | - Takeharu Yamanaka
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan
| | - Josep Tabernero
- Department of Medical Oncology, Vall d'Hebron University Hospital (HUVH), Vall d'Hebron Institute of Oncology (VHIO), IOB-Quiron, UVic-UCC, Barcelona, Spain
| | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
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Martini G, Dienstmann R, Ros J, Baraibar I, Cuadra-Urteaga JL, Salva F, Ciardiello D, Mulet N, Argiles G, Tabernero J, Elez E. Molecular subtypes and the evolution of treatment management in metastatic colorectal cancer. Ther Adv Med Oncol 2020; 12:1758835920936089. [PMID: 32782486 PMCID: PMC7383645 DOI: 10.1177/1758835920936089] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 01/29/2020] [Accepted: 05/22/2020] [Indexed: 12/22/2022] Open
Abstract
Colorectal cancer (CRC) is a heterogeneous disease representing a therapeutic challenge, which is further complicated by the common occurrence of several molecular alterations that confer resistance to standard chemotherapy and targeted agents. Mechanisms of resistance have been identified at multiple levels in the epidermal growth factor receptor (EGFR) pathway, including mutations in KRAS, NRAS, and BRAF V600E, and in the HER2 and MET receptors. These alterations represent oncogenic drivers that may co-exist in the same tumor with other primary and acquired alterations via a clonal selection process. Other molecular alterations include DNA damage repair mechanisms and rare kinase fusions, potentially offering a rationale for new therapeutic strategies. In recent years, genomic analysis has been expanded by a more complex study of epigenomic, transcriptomic, and microenvironment features. The Consensus Molecular Subtype (CMS) classification describes four CRC subtypes with distinct biological characteristics that show prognostic and potential predictive value in the clinical setting. Here, we review the panorama of actionable targets in CRC, and the developments in more recent molecular tests, such as liquid biopsy analysis, which are increasingly offering clinicians a means of ensuring optimal tailored treatments for patients with metastatic CRC according to their evolving molecular profile and treatment history.
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Affiliation(s)
- Giulia Martini
- Università della Campania L. Vanvitelli, Naples
- Vall d’Hebron Institute of Oncology, P/ Vall D’Hebron 119-121, Barcelona, 08035, Spain
| | | | - Javier Ros
- Vall d’Hebron Hospital, Barcelona, Catalunya, Spain
| | | | | | | | - Davide Ciardiello
- Università della Campania L. Vanvitelli, Naples
- Vall d’Hebron Hospital, Barcelona, Catalunya, Spain
| | - Nuria Mulet
- Vall d’Hebron Hospital, Barcelona, Catalunya, Spain
| | | | | | - Elena Elez
- Vall D’Hebron Institute of Oncology P/Vall D’Hebron 119-121, Barcelona, 08035 Spain
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Baraibar I, Ros J, Mulet N, Salvà F, Argilés G, Martini G, Cuadra JL, Sardo E, Ciardiello D, Tabernero J, Élez E. Incorporating traditional and emerging biomarkers in the clinical management of metastatic colorectal cancer: an update. Expert Rev Mol Diagn 2020; 20:653-664. [PMID: 32552041 DOI: 10.1080/14737159.2020.1782194] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Molecular profiling has led to significantly longer survival in metastatic colorectal cancer (mCRC) patients. Clinical guidelines recommend testing for KRAS/NRAS, BRAF and MSI status, and new biomarkers such as HER2 amplification and NTRK fusions have emerged more recently in refractory CRC, supported by overwhelming clinical relevance. These biomarkers can guide treatment management to improve clinical outcomes in these patients. AREAS COVERED Preclinical and clinical data over the last decade were reviewed for known and novel biomarkers with clinical implications in refractory CRC. Molecular alterations are described for classic and novel biomarkers, and data for completed and ongoing studies with targeted and immunotherapies are presented. EXPERT OPINION Use of targeted therapies based on biomarker testing in CRC has enabled impressive improvements in clinical outcomes in refractory patients. BRAF, MSI, NRAS and KRAS should be tested upfront in all patients given their indisputable therapeutic implications. Other molecular alterations such as HER2 and NTRK are emerging. Testing for these alterations may further improve outcomes for refractory CRC patients. Nonetheless, many key aspects remain to be defined including the optimal timing and technique for testing, the most adequate panel, and whether all patients should be tested for all alterations.
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Affiliation(s)
- Iosune Baraibar
- Department of Medical Oncology, Vall d'Hebron University Hospital , Barcelona, Spain.,Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO) , Barcelona, Spain
| | - Javier Ros
- Department of Medical Oncology, Vall d'Hebron University Hospital , Barcelona, Spain.,Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO) , Barcelona, Spain
| | - Nuria Mulet
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO) , Barcelona, Spain.,Department of Medical Oncology, Institut Català D' oncologia-IDIBELL , Barcelona, Spain
| | - Francesc Salvà
- Department of Medical Oncology, Vall d'Hebron University Hospital , Barcelona, Spain.,Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO) , Barcelona, Spain
| | - Guillem Argilés
- Department of Medical Oncology, Vall d'Hebron University Hospital , Barcelona, Spain.,Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO) , Barcelona, Spain
| | - Giulia Martini
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO) , Barcelona, Spain.,Dipartimento di Medicina di Precisione, Università Degli Studi Della Campania Luigi Vanvitelli , Naples, Italy
| | | | - Emilia Sardo
- Department of Medical Oncology, Vall d'Hebron University Hospital , Barcelona, Spain
| | - Davide Ciardiello
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO) , Barcelona, Spain.,Dipartimento di Medicina di Precisione, Università Degli Studi Della Campania Luigi Vanvitelli , Naples, Italy
| | - Josep Tabernero
- Department of Medical Oncology, Vall d'Hebron University Hospital , Barcelona, Spain.,Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO) , Barcelona, Spain
| | - Elena Élez
- Department of Medical Oncology, Vall d'Hebron University Hospital , Barcelona, Spain.,Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO) , Barcelona, Spain
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Kagawa Y, Fernandez EE, Garcia-Foncillas J, Bando H, Taniguchi H, Vivancos A, Akagi K, Garcia A, Denda T, Ros J, Nishina T, Baraibar I, Komatsu Y, Ciardiello D, Oki E, Satoh T, Kato T, Yamanaka T, Tabernero J, Yoshino T. O-21 METABEAM study: Combined analysis of concordance studies between liquid and tissue biopsies for RAS mutations in colorectal cancer patients with single metastatic sites. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ros Montañá J, Martini G, Baraibar I, Villacampa G, Comas R, Ciardiello D, Garcia A, Hernandez Yague X, Queralt B, Salud Salvia A, Argiles G, Cuadra JL, Toledo RA, Chicote I, Mulet N, Vivancos A, Palmer HG, Dienstmann R, Tabernero J, Elez E. Patient and tumor characteristics as determinants of overall survival (OS) in BRAF V600 mutant (mt) metastatic colorectal cancer (mCRC) treated with doublet or triplet targeted therapy. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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
4112 Background: BRAF V600 mt mCRC is an aggressive disease with poor OS under standard chemotherapy. Treatment with doublet and triplet targeted combinations, such as BRAF inhibitor+ antiEGFR+/- MEK inhibitor, has been shown to improve outcomes. Prognostic factors in this targeted treated population remain to be studied. Methods: Prospective international cohort of patients who received doublet or triplet anti-BRAF combinations in clinical trials or as compassionate use. Univariate Cox models for OS were constructed and the strongest predictors in stepwise variable selection were used to develop a prognostic score. The final multivariate model with selected predictors was stratified by prior lines. Results: In total, 42 patients were enrolled. Median age 60.7 y (33-83), 61% female, 61% right-sided tumors, 26% received 2 or more prior chemotherapy lines. One patient (2.6%) achieved complete response and 36% had partial response with median follow-up of 14.3 months. Median progression-free survival was 5.5 months (CI95% 4.4-10.4) and median OS (mOS) was 10.7 months (CI95% 8.4-22.1). In univariate models, ECOG performance status (1 vs 0), CEA levels (high - > 3.5 ng/mL- vs low - < 3.5 ng/mL), CA 19.9 (high vs. low), LDH (high vs. low), number of metastatic sites and presence of liver metastasis were significant prognostic factors. On the other hand, MSI status and peritoneal or nodal metastasis did not associate with outcome. In multivariable model, strongest determinants of OS were ECOG and baseline CEA levels. If high-risk for both factors (ECOG 1 and CEA high, 46% of the patients), mOS was 5.6 months (CI95% 4.2-NA); if intermediate-risk (either ECOG 1 or CEA high, 33%), mOS was 13.5 months (CI95% 10.6-NA); if low-risk (ECOG 0 and CEA low, 21%), mOS not reached (CI95% 16.5-NA). Differences between intermediate- and high-risk prognostic groups compared to low-risk were significant (HR = 5.9, p = 0.03; and HR = 25.9, p < 0.001, respectively). Conclusions: Patients characteristics such as ECOG and surrogates of tumor burden like CEA levels remain important OS determinants in BRAF V600 mt mCRC treated with doublet or triplet targeted therapy. In fact, there are not prognostic scores regarding BRAF mt mCRC treated with targeted therapies. Our study suggests that these prognostic factors may be considered as stratification factors in future clinical trials.
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Affiliation(s)
| | - Giulia Martini
- Medical Oncology, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Iosune Baraibar
- Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Guillermo Villacampa
- Oncology Data Science Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Raquel Comas
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Davide Ciardiello
- Medical Oncology, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Ariadna Garcia
- Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Xavier Hernandez Yague
- Medical Oncology, Institut Catala d'Oncologia, Universitary Hospital Dr. Josep Trueta, Girona, Spain
| | - Bernardo Queralt
- Medical Oncology, Institut Catala d'Oncologia, Universitary Hospital Dr. Josep Trueta, Girona, Spain
| | | | - Guillem Argiles
- Vall d’Hebron University Hospital and Institute of Oncology (VHIO), CIBERONC, TTD Group, Barcelona, Spain
| | | | - Rodrigo A Toledo
- Vall d´Hebron Institute Oncology and Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Barcelona, Spain
| | | | - Nuria Mulet
- Instituto Catalan de Oncologia de Hospitalet, Barcelona, Spain
| | - Ana Vivancos
- Cancer Genomics Lab and Molecular Pathology Lab, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Hector G. Palmer
- Stem Cells and Cancer Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Rodrigo Dienstmann
- Oncology Data Science Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Josep Tabernero
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Elena Elez
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Martini G, Elez E, Mancuso FM, Gomez MA, Caratu G, Matito J, Argiles G, Mulet N, Baraibar I, Ros J, Garcia A, Comas R, Ligero M, Santos C, Nuciforo P, Dienstmann R, Tabernero J, Aranda E, Perez-Lopez R, Vivancos A. The predictive role of plasma mutant allele fraction to antiangiogenic drugs in patients with mCRC: An expanded analysis of surrogate biomarkers of response to first-line treatment with bevacizumab. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.3541] [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
3541 Background: So far, no biomarkers of response to anti-angiogenic drugs are available in colorectal cancer (CRC) treatment. Liquid biopsy tracks dynamic mutational changes in CRC patients (pts). RAS mutant allele fraction in plasma (plMAF) is an independent prognostic marker in metastatic CRC (mCRC). We explored the predictive value of plMAF in RAS mutant pts treated in 1st line with chemotherapy +/- bevacizumab (bev). Methods: A multicentric prospective/retrospective analysis was conducted. We collected data from 226 mCRC pts and selected the subset not eligible for metastasis resection with basal plMAF sample evaluable for RAS mutant MAF quantification with digital PCR (BEAMing). Pts were stratified as high (≥ 5.8%) or low ( < 5.8%) plMAF. We investigated associations between clinicopathological variables and progression-free survival (PFS) stratified by plMAF RAS levels using Cox regression models and survival data were calculated by Kaplan-Meier method. Computational analysis of baseline CT scan data extracted 93 radiomics features of all the lesions per patient including 1) 1st class from density histogram distribution and texture analysis by 2) 2nd order and 3) higher order feature classes. The radiomic features distribution between pts with high and low pIMAF was assessed with Student’s t-test analysis. Results: From October 17 to May 19, 63 basal plasma samples were analysed with BEAMing. 42 pts (67.7%) were classified as high and 21 pts (32,3%) as low plMAF. In high plMAF subgroup, a statistically significant longer PFS favouring FOLFOX+bev was observed, compared to FOLFOX alone (10.7 vs 6.9 mts; HR: 0.30; p = 0.002). In low RAS plMAF subgroup, no differences in terms of PFS were observed in either arm (8.9 vs 8.7 mts; HR: 0.7; p = 0.6). Multivariate PFS model showed no association between RAS plMAF and clinicopathological variables, except for high RAS plMAF and treatment benefit with FOLFOX+bev. The CT-radiomics signature, that may translate tumor vascularization, differentiated patients with high vs low pIMAF (p = 0.002). 58 patients (92%) had similar radiomic score; 5 patients with high plMAF (8%) presented very heterogeneous radiomic score distribution. Conclusions: Tumor-borne RAS plMAFs may constitute a potential predictive biomarker of efficacy for anti-angiogenic drugs in mCRC. Next steps will include the identification of -histological, transcriptomic and radiomic- surrogate biomarkers of response that reflect tumor irrigational status.
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Affiliation(s)
- Giulia Martini
- Medical Oncology, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Elena Elez
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Francesco M Mancuso
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Ginevra Caratu
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Judit Matito
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Guillem Argiles
- Vall d’Hebron University Hospital and Institute of Oncology (VHIO), CIBERONC, TTD Group, Barcelona, Spain
| | - Nuria Mulet
- Instituto Catalan de Oncologia de Hospitalet, Barcelona, Spain
| | - Iosune Baraibar
- Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Javier Ros
- Medical Oncology Department, Vall d´Hebron University Hospital/Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Ariadna Garcia
- Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Raquel Comas
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Marta Ligero
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Cristina Santos
- Translational Research Laboratory and Department of Medical Oncology, Institut Català d'Oncologia-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Paolo Nuciforo
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Rodrigo Dienstmann
- Oncology Data Science Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Josep Tabernero
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Enrique Aranda
- IMIBIC, Reina Sofía Hospital, University of Córdoba, CIBERONC, Instituto de Salud Carlos III/ Spain, Córdoba, Spain
| | - Raquel Perez-Lopez
- Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Ana Vivancos
- Cancer Genomics Lab and Molecular Pathology Lab, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
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Verdaguer H, Guardiola-Fernandez M, Mancuso FM, Acosta D, Buxó E, Hernando J, Diez M, Laquente B, Baraibar I, Ros J, Garcia A, Matito J, Martin A, Sierra A, Villacampa G, Molero C, Miquel JM, Vivancos A, Dienstmann R, Macarulla T. DNA damage repair (DDR) gene mutations (mut) are predictors of response to platinum-based chemotherapy in advanced pancreatic cancer (PC) patients (pts). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16805] [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
e16805 Background: Somatic DDR mut have been reported in close to 10% of PC samples. In this study we investigate their predictive value for response to platinum-based chemotherapy. Methods: Case-control study with pts deriving response to oxaliplatin-based treatment (partial or complete response at any line) [n = 30] versus no response (progression in first restaging at 1st line) [n = 18]. An in-house NGS panel test of 420 genes was performed on tumor samples. DDR mut were classified in 2 subgroups: (a) functional BRCA1, BRCA2 or PALB2; and (b) any functional DDR gene mut, including those in (a). Results: 48 pts were included, median ages was 54.5 years (30-74), 29 male, 26 were diagnosed with stage IV, 36 pts (75%) received FOLFIRINOX and 37 received platinum-based chemotherapy as 1st. line treatment. Prevalence of DDR mut are described in the table. Among responders, 3 tumors had BRCA2 mt, 3 BRCA1, 2 ATM, and 1 each with BRCA2 + MSH2, PALB2, PMS2, MUYTH, RECQL4 + MDC1. Among non-responders 1 tumor each had ATM, FANCD2 and BLM. Median progression-free survival (PFS) with oxaliplatin-based chemotherapy in pts with BRCA1, BRCA2 or PALB2 mut tumors was 21.7 months (95% CI 12.3-NA); among those with any DDR mt was 12.3 months (95% CI 9.13-NA); while in pts whose tumors had no DDR mut was 6.4 months (95% CI 3.07-13)(Log-rank P-value = 0.02 comparison subgroup [a] vs. others; P-value = 0.1 subgroup [b] vs. others). Conclusions: The subgroup of pts with PC whit tumors harboring DDR gene mut, particularly functional BRCA1, BRCA2 or PALB2, have higher response rate and longer PFS with oxaplatin-based chemotherapy. [Table: see text]
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Affiliation(s)
| | | | - Francesco M Mancuso
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Daniel Acosta
- Vall d’Hebron University Hospital Barcelona Spain y Vall d’hebron insitute of Oncology (VHIO), Barcelona, Spain
| | - Elvira Buxó
- Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Marc Diez
- Vall d´Hebron University Hospital, Barcelona, Spain
| | | | - Iosune Baraibar
- Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Javier Ros
- Medical Oncology Department, Vall d´Hebron University Hospital/Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Judit Matito
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Agatha Martin
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Guillermo Villacampa
- Oncology Data Science Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | - Ana Vivancos
- Cancer Genomics Lab and Molecular Pathology Lab, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Rodrigo Dienstmann
- Oncology Data Science Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
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Baraibar I, Mezquita L, Gil-Bazo I, Planchard D. Novel drugs targeting EGFR and HER2 exon 20 mutations in metastatic NSCLC. Crit Rev Oncol Hematol 2020; 148:102906. [PMID: 32109716 DOI: 10.1016/j.critrevonc.2020.102906] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [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: 12/06/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 02/03/2023] Open
Abstract
Approximately 4% of epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) present EGFR exon 20 in-frame insertions, accounting for 0.3 %-3.7 % of NSCLC. In addition, 2 %-4 % of patients with NSCLC harbor human epidermal growth factor receptor 2 gene (HER2) mutations, being the 90 % of them exon 20 insertions. These mutations confer intrinsic resistance to available EGFR tyrosine kinase inhibitors (TKIs) and anti-HER2 treatments, as they result in steric hindrance of the drug-binding pocket. Therefore, no targeted therapies have been approved for NSCLC patients with EGFR or HER2 exon 20- activating mutations to date and remain an unmet clinical need. Promising efforts to novel treatment development have been made. Early data provide encouraging activity of novel drugs targeting EGFR and HER2 mutations in metastatic NSCLC. In this review we will summarize all the data reported to date about these driver molecular alterations and potential targeted therapies.
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Affiliation(s)
- Iosune Baraibar
- Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain; Program of Solid Tumors, Center for Applied Medical Research, University of Navarra, Pamplona, Spain
| | | | - Ignacio Gil-Bazo
- Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain; Program of Solid Tumors, Center for Applied Medical Research, University of Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
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Baraibar I, Román M, López-Erdozain I, Oliver A, Vilalta A, Ajona D, Vicent S, De Andrea C, Pio R, Lasarte J, Calvo A, Gil-Bazo I. MA17.11 High Sensitivity to PD-1 Blockade Therapy After Ld1 Depletion in KRAS-Driven Lung Cancer Through CD8+/CD3+ Tumor Infiltration and PD-L1 Induction. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Duruisseaux M, Martínez-Cardús A, Calleja-Cervantes M, Moran S, Castro De Moura M, Davalos V, Piñeyro D, Girard N, Brevet M, Giroux-Leprieur E, Dumenil C, Pradotto M, Bironzo P, Capelletto E, Novello S, Cortot A, Copin M, Karachaliou N, Gonzalez-Cao M, Peralta S, Montuenga L, Gil-Bazo I, Baraibar I, Lozano M, Varela M, Ruffinelli J, Ramon P, Nadal E, Moran T, Perez L, Ramos I, Xiao Q, Fernandez A, Fraga M, Gut M, Gut I, Teixidó C, Vilariño N, Prat A, Reguart N, Benito A, Garrido P, Barragan I, Emile J, Rosell R, Brambilla E, Esteller M. Prédiction épigénétique du bénéfice clinique avec les anti-PD-1 dans le traitement des cancers du poumon non à petites cellules avancées : une étude internationale multicentrique rétrospective. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Román M, López I, Guruceaga E, Baraibar I, Ecay M, Collantes M, Nadal E, Vallejo A, Cadenas S, Miguel MED, Jang JH, Martin-Uriz PS, Castro-Labrador L, Vilas-Zornoza A, Lara-Astiaso D, Ponz-Sarvise M, Rolfo C, Santos ES, Raez LE, Taverna S, Behrens C, Weder W, Wistuba II, Vicent S, Gil-Bazo I. Inhibitor of Differentiation-1 Sustains Mutant KRAS-Driven Progression, Maintenance, and Metastasis of Lung Adenocarcinoma via Regulation of a FOSL1 Network. Cancer Res 2018; 79:625-638. [PMID: 30563891 DOI: 10.1158/0008-5472.can-18-1479] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 10/29/2018] [Accepted: 12/11/2018] [Indexed: 11/16/2022]
Abstract
Because of the refractory nature of mutant KRAS lung adenocarcinoma (LUAD) to current therapies, identification of new molecular targets is essential. Genes with a prognostic role in mutant KRAS LUAD have proven to be potential molecular targets for therapeutic development. Here we determine the clinical, functional, and mechanistic role of inhibitor of differentiation-1 (Id1) in mutant KRAS LUAD. Analysis of LUAD cohorts from TCGA and SPORE showed that high expression of Id1 was a marker of poor survival in patients harboring mutant, but not wild-type KRAS. Abrogation of Id1 induced G2-M arrest and apoptosis in mutant KRAS LUAD cells. In vivo, loss of Id1 strongly impaired tumor growth and maintenance as well as liver metastasis, resulting in improved survival. Mechanistically, Id1 was regulated by the KRAS oncogene through JNK, and loss of Id1 resulted in downregulation of elements of the mitotic machinery via inhibition of the transcription factor FOSL1 and of several kinases within the KRAS signaling network. Our study provides clinical, functional, and mechanistic evidence underscoring Id1 as a critical gene in mutant KRAS LUAD and warrants further studies of Id1 as a therapeutic target in patients with LUAD. SIGNIFICANCE: These findings highlight the prognostic significance of the transcriptional regulator Id1 in KRAS-mutant lung adenocarcinoma and provide mechanistic insight into how it controls tumor growth and metastasis.
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Affiliation(s)
- Marta Román
- Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain.,Program of Solid Tumors, Center for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Inés López
- Program of Solid Tumors, Center for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Elisabeth Guruceaga
- Proteomics, Genomics and Bioinformatics Core Facility, Center for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Iosune Baraibar
- Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain.,Program of Solid Tumors, Center for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Margarita Ecay
- Program of Solid Tumors, Center for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - María Collantes
- Program of Solid Tumors, Center for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Ernest Nadal
- Thoracic Oncology Unit, Department of Medical Oncology, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Adrián Vallejo
- Program of Solid Tumors, Center for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Silvia Cadenas
- Program of Solid Tumors, Center for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Marta Echavarri-de Miguel
- Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain.,Program of Solid Tumors, Center for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Jae Hwi Jang
- Klinik für Thoraxchirurgie, Universitätsspital Zürich, Zürich, Switzerland
| | - Patxi San Martin-Uriz
- Advanced Genomics Laboratory, Center for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Laura Castro-Labrador
- Advanced Genomics Laboratory, Center for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Amaia Vilas-Zornoza
- Advanced Genomics Laboratory, Center for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - David Lara-Astiaso
- Advanced Genomics Laboratory, Center for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Mariano Ponz-Sarvise
- Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain.,Program of Solid Tumors, Center for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Christian Rolfo
- Phase I-Early Clinical Trials Unit, Oncology Department, Antwerp University Hospital, Edegem, Belgium
| | - Edgardo S Santos
- Department of Oncology, Boca Ratón Regional Hospital, Boca Raton, Florida
| | - Luis E Raez
- Memorial Cancer Institute, Memorial Health Care System, Florida International University, Miami, Florida
| | - Simona Taverna
- Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council, Palermo, Italy
| | - Carmen Behrens
- Translational Molecular Pathology Department, MD Anderson Cancer Center, University of Texas, Houston, Texas
| | - Walter Weder
- Klinik für Thoraxchirurgie, Universitätsspital Zürich, Zürich, Switzerland
| | - Ignacio I Wistuba
- Translational Molecular Pathology Department, MD Anderson Cancer Center, University of Texas, Houston, Texas
| | - Silvestre Vicent
- Program of Solid Tumors, Center for Applied Medical Research, University of Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.,Department of Pathology, Anatomy and Physiology, University of Navarra, Pamplona, Spain
| | - Ignacio Gil-Bazo
- Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain. .,Program of Solid Tumors, Center for Applied Medical Research, University of Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
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Gil-Bazo I, Baraibar I, Roman Moreno M, Lopez I, Corral J, Lasarte J, Calvo A, Vicent S, Ajona D. MA06.03 PD-1 and Id-1 Combined Blockade Impacts Tumor Growth and Survival Through PD-L1 Expression and Tumor Infiltration by Immune-Related Cells. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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43
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Baraibar I, Roman M, Lopez I, Ajona D, Calvo A, Guruceaga E, Corral J, Lasarte JJ, Vicent S, Gil-Bazo I. Effect of anti-PD-1 and anti-Id-1 combo on tumor response and survival in lung cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.12085] [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)
- Iosune Baraibar
- Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Marta Roman
- Program of Solid Tumors, Center for Applied Medical Research, Pamplona, Spain
| | - Ines Lopez
- Program of Solid Tumors and Biomarkers, Center for Applied Medical Research, Pamplona, Spain
| | - Daniel Ajona
- Program of Solid Tumors . Center for Applied Medical Research, Pamplona, Spain
| | - Alfonso Calvo
- Center for Applied Medical Research, Pamplona, Spain
| | | | - Jesús Corral
- Department of Oncology. Clínica Universidad de Navarra, Pamplona, Spain
| | - Juan José Lasarte
- Program Immunology and Immunotherapy. Center for Applied Medical Research, Pamplona, Spain
| | - Silvestre Vicent
- Program of Solid Tumors, Centre for Applied Medical Research, Pamplona, Spain
| | - Ignacio Gil-Bazo
- Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain
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44
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Román M, Baraibar I, López I, Nadal E, Rolfo C, Vicent S, Gil-Bazo I. KRAS oncogene in non-small cell lung cancer: clinical perspectives on the treatment of an old target. Mol Cancer 2018; 17:33. [PMID: 29455666 PMCID: PMC5817724 DOI: 10.1186/s12943-018-0789-x] [Citation(s) in RCA: 195] [Impact Index Per Article: 32.5] [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: 10/15/2017] [Accepted: 02/01/2018] [Indexed: 12/14/2022] Open
Abstract
Lung neoplasms are the leading cause of death by cancer worldwide. Non-small cell lung cancer (NSCLC) constitutes more than 80% of all lung malignancies and the majority of patients present advanced disease at onset. However, in the last decade, multiple oncogenic driver alterations have been discovered and each of them represents a potential therapeutic target. Although KRAS mutations are the most frequently oncogene aberrations in lung adenocarcinoma patients, effective therapies targeting KRAS have yet to be developed. Moreover, the role of KRAS oncogene in NSCLC remains unclear and its predictive and prognostic impact remains controversial. The study of the underlying biology of KRAS in NSCLC patients could help to determine potential candidates to evaluate novel targeted agents and combinations that may allow a tailored treatment for these patients. The aim of this review is to update the current knowledge about KRAS-mutated lung adenocarcinoma, including a historical overview, the biology of the molecular pathways involved, the clinical relevance of KRAS mutations as a prognostic and predictive marker and the potential therapeutic approaches for a personalized treatment of KRAS-mutated NSCLC patients.
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Affiliation(s)
- Marta Román
- Department of Oncology, Clínica Universidad de Navarra, 31008, Pamplona, Spain.,Program of Solid Tumors and Biomarkers, Center for Applied Medical Research, Pamplona, Spain
| | - Iosune Baraibar
- Department of Oncology, Clínica Universidad de Navarra, 31008, Pamplona, Spain.,Program of Solid Tumors and Biomarkers, Center for Applied Medical Research, Pamplona, Spain
| | - Inés López
- Program of Solid Tumors and Biomarkers, Center for Applied Medical Research, Pamplona, Spain
| | - Ernest Nadal
- Thoracic Oncology Unit, Department of Medical Oncology, Catalan Institute of Oncology (ICO), L'Hospitalet del Llobregat, Barcelona, Spain
| | - Christian Rolfo
- Phase I-Early Clinical Phase I-Early Clinical Trials Unit, Oncology Department, Antwerp University Hospital, Edegem, Belgium
| | - Silvestre Vicent
- Program of Solid Tumors and Biomarkers, Center for Applied Medical Research, Pamplona, Spain.,Navarra Health Research Institute (IDISNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Ignacio Gil-Bazo
- Department of Oncology, Clínica Universidad de Navarra, 31008, Pamplona, Spain. .,Program of Solid Tumors and Biomarkers, Center for Applied Medical Research, Pamplona, Spain. .,Navarra Health Research Institute (IDISNA), Pamplona, Spain. .,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.
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45
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Martin-Romano P, Baraibar I, Espinós J, Legaspi J, López-Picazo JM, Aramendía JM, Fernández OA, Santisteban M. Combination of pegylated liposomal doxorubicin plus gemcitabine in heavily pretreated metastatic breast cancer patients: Long-term results from a single institution experience. Breast J 2017; 24:473-479. [PMID: 29286192 DOI: 10.1111/tbj.12975] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/17/2017] [Accepted: 06/20/2017] [Indexed: 11/28/2022]
Abstract
The combination of Pegylated Liposomal Doxorubicin (PLD) plus Gemcitabine (GEM) has been previously investigated in the treatment of metastatic breast cancer (MBC). PLD is a doxorubicin formulation with prolonged circulation time and better tissue distribution. GEM is a nucleoside analog with nonoverlapping toxicity compared to PLD. The aim of our study was to assess efficacy, toxicity, and long-term outcome of this combination. Patients with heavily treated MBC were retrospectively analyzed. Chemotherapy consisted of PLD 25 mg/m2 and GEM 800 mg/m2 day 1, on a three-week schedule. Cardiac function was evaluated baseline and during treatment. Radiological response was graded according to RECIST criteria v1.1. Toxicity was scored according to CTCAE v4.0. Progression-free survival (PFS) and overall survival (OS) were evaluated. From 2001 to 2014, 122 pts were included. Median age was 55 (range: 28-84). Median previous treatment schedules in the metastatic scenario were 3 (range: 1-15). Most patients received prior anthracyclines (85%). Median number of metastatic sites was 2 (range: 1-7). Median number of cycles delivered was 5 (range: 1-36). Overall response rate was 31% (5% complete responses; 26% partial responses). Stable and progressive diseases were observed in 32% and 26% of patients. Grade ≥3 neutropenia was observed in 29 patients (24%). Grade ≥3 hand-foot syndrome was detected in 17 patients (14%), mostly since cycle 3 (88%). Median cumulative PLD dose was 125 mg/m2 . At a median follow-up of 101 months, median PFS and OS were 7 and 22 months, respectively. PLD-GEM combination achieves remarkable long-term outcomes with an acceptable toxicity profile in patients with MBC.
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Affiliation(s)
- Patricia Martin-Romano
- Department of Medical Oncology. Clínica, Universidad de Navarra, Pamplona, Navarra, Spain
| | - Iosune Baraibar
- Department of Medical Oncology. Clínica, Universidad de Navarra, Pamplona, Navarra, Spain
| | - Jaime Espinós
- Department of Medical Oncology. Clínica, Universidad de Navarra, Pamplona, Navarra, Spain
| | - Jairo Legaspi
- Department of Medical Oncology. Clínica, Universidad de Navarra, Pamplona, Navarra, Spain
| | - Jose M López-Picazo
- Department of Medical Oncology. Clínica, Universidad de Navarra, Pamplona, Navarra, Spain
| | - Jose Manuel Aramendía
- Department of Medical Oncology. Clínica, Universidad de Navarra, Pamplona, Navarra, Spain
| | - Oscar A Fernández
- Department of Medical Oncology. Clínica, Universidad de Navarra, Pamplona, Navarra, Spain
| | - Marta Santisteban
- Department of Medical Oncology. Clínica, Universidad de Navarra, Pamplona, Navarra, Spain
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46
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Castañón E, Soltermann A, López I, Román M, Ecay M, Collantes M, Redrado M, Baraibar I, López-Picazo JM, Rolfo C, Vidal-Vanaclocha F, Raez L, Weder W, Calvo A, Gil-Bazo I. The inhibitor of differentiation-1 (Id1) enables lung cancer liver colonization through activation of an EMT program in tumor cells and establishment of the pre-metastatic niche. Cancer Lett 2017; 402:43-51. [PMID: 28549790 DOI: 10.1016/j.canlet.2017.05.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/13/2017] [Accepted: 05/16/2017] [Indexed: 01/29/2023]
Abstract
Id1 promotes carcinogenesis and metastasis, and predicts prognosis of non-small cell lung cancer (NSCLC)-adenocarcionoma patients. We hypothesized that Id1 may play a critical role in lung cancer colonization of the liver by affecting both tumor cells and the microenvironment. Depleted levels of Id1 in LLC (Lewis lung carcinoma cells, LLC shId1) significantly reduced cell proliferation and migration in vitro. Genetic loss of Id1 in the host tissue (Id1-/- mice) impaired liver colonization and increased survival of Id1-/- animals. Histologically, the presence of Id1 in tumor cells of liver metastasis was responsible for liver colonization. Microarray analysis comparing liver tumor nodules from Id1+/+ mice and Id1-/- mice injected with LLC control cells revealed that Id1 loss reduces the levels of EMT-related proteins, such as vimentin. In tissue microarrays containing 532 NSCLC patients' samples, we found that Id1 significantly correlated with vimentin and other EMT-related proteins. Id1 loss decreased the levels of vimentin, integrinβ1, TGFβ1 and snail, both in vitro and in vivo. Therefore, Id1 enables both LLC and the host microenvironment for an effective liver colonization, and may represent a novel therapeutic target to avoid NSCLC liver metastasis.
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Affiliation(s)
- Eduardo Castañón
- Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain; Program of Solid Tumors and Biomarkers, Center for Applied Medical Research, Pamplona, Spain
| | - Alex Soltermann
- Institut für Klinische Pathologie, Universitätsspital Zürich, Zürich, Switzerland
| | - Inés López
- Program of Solid Tumors and Biomarkers, Center for Applied Medical Research, Pamplona, Spain
| | - Marta Román
- Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain; Program of Solid Tumors and Biomarkers, Center for Applied Medical Research, Pamplona, Spain
| | - Margarita Ecay
- Program of Solid Tumors and Biomarkers, Center for Applied Medical Research, Pamplona, Spain
| | - María Collantes
- Program of Solid Tumors and Biomarkers, Center for Applied Medical Research, Pamplona, Spain
| | - Miriam Redrado
- Program of Solid Tumors and Biomarkers, Center for Applied Medical Research, Pamplona, Spain
| | - Iosune Baraibar
- Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain; Program of Solid Tumors and Biomarkers, Center for Applied Medical Research, Pamplona, Spain
| | | | - Christian Rolfo
- Phase I-Early Clinical Trials Unit, Oncology Department, Antwerp University Hospital, Edegem, Belgium
| | - Fernando Vidal-Vanaclocha
- Valencia Institute of Pathology (IVP), Catholic University of Valencia School of Medicine and Odontology, Valencia, Spain
| | - Luis Raez
- Memorial Cancer Institute, Memorial Health Care System, Florida International University, Miami, FL, USA
| | - Walter Weder
- Klinik für Thoraxchirurgie, Universitätsspital Zürich, Zürich, Switzerland
| | - Alfonso Calvo
- Program of Solid Tumors and Biomarkers, Center for Applied Medical Research, Pamplona, Spain
| | - Ignacio Gil-Bazo
- Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain; Program of Solid Tumors and Biomarkers, Center for Applied Medical Research, Pamplona, Spain; Health Research Institute of Navarra (IDISNA), Pamplona, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Spain.
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47
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Baraibar I, Oroz R, Roman M, Martin P, Ponz-Sarvisé M, Rolfo CD, López-Picazo JM, Perez-Gracia JL, Gurpide A, Sala Elarre P, Gil-Bazo I. Lymphocytes and neutrophils count after two cycles and TTF1 expression as early outcome predictors during immunotherapy (IT) in stage IV non-small cell lung cancer (NSCLC) patients. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e20553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20553 Background: NSCLC therapeutic paradigm has changed with immune checkpoint blockers. Biomarkers predicting clinical benefit are still lacking. As previously shown in melanoma, changes in absolute lymphocytes and neutrophils count (ALC and ANC) during IT (PD-1/PD-L1 inhibitors) may be related to response in NSCLC (Nakamuta et al, Oncotarget 2016). TTF1 expression has been associated with PD-L1 expression (Vieira et al, Lung Cancer 2016). We aimed to investigate TTF1 expression and changes in ALC and ANC after 2 cycles and their potential association with clinical outcomes to IT. Methods: We retrospectively analyzed 26 consecutive patients with stage IV NSCLC treated with IT at Clínica Universidad de Navarra (Spain) during 2016. Radiological response was evaluated according to RECIST v1.1. The potential correlation between ALC and ANC changes during the first two cycles and response to treatment [disease control rate (DCR) vs progression] was evaluated using Student’s T-test. Fisher’s exact test was used to study the association between changes in ALC ( < 1,000 vs > 1,000) and ANC ( < 4,000 vs > 4,000) after 2 cycles and response to IT. TTF-1 expression was correlated with treatment response. Overall survival (OS) was assessed with Kaplan-Meier analysis and Log-rank test according to ALC and ANC. Results: An ALC increase after 2 cycles was significantly associated with DCR compared to progression (192 vs -155; p = 0.043). ALC > 1,000 after 2 cycles was more frequent among patients experiencing DCR compared to progression (87% vs 50%; p = 0.07). ALC > 1,000 after 2 cycles was more frequently observed among patients with TTF1+ tumors (93% vs 55%; p = 0.03). Patients with ANC < 4,000 showed a longer median OS (NR vs 19.25 months; p = 0.03). TTF1 expression in adenocarcinoma (n = 18) was associated with response to IT (83% vs 16%, p = 0.01). Conclusions: Despite this retrospective small series’ limitations, our results show that ALC and ANC changes during IT and TTF1 expression may act as early predictors of clinical benefit in stage IV NSCLC patients treated with PD1/PD-L1 blockers. Our results warrant further investigation in larger prospective series.
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Affiliation(s)
- Iosune Baraibar
- Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Marta Roman
- Program of Solid Tumors and Biomarkers, Center for Applied Medical Research, Pamplona, Spain
| | - Patricia Martin
- Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Christian Diego Rolfo
- Phase I-Early Clinical Trials Unit, Oncology Department, Antwerp University Hospital, Edegem, Belgium
| | | | | | - Alfonso Gurpide
- Department of Oncology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Pablo Sala Elarre
- Departament of Medical Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Ignacio Gil-Bazo
- Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain
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48
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Baraibar I, Quílez A, Salas D, Román M, Rolfo C, Pérez-Gracia JL, Gil-Bazo I. Pazopanib-induced asymptomatic radiological acute pancreatitis: A case report. Mol Clin Oncol 2017; 6:651-654. [PMID: 28529741 PMCID: PMC5431634 DOI: 10.3892/mco.2017.1210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 12/20/2016] [Indexed: 12/12/2022] Open
Abstract
The universal clinical use of multi-targeted tyrosine kinase inhibitors (TKIs) in patients diagnosed with advanced renal cell carcinoma (RCC) has significantly prolonged their estimated survival times and their quality of life. However, several adverse side-effects associated predominantly with the inhibition of the vascular endothelial growth factor receptor by these drugs may prove to be potentially life-threatening. One adverse event that is only rarely observed with the use of TKIs in this clinical setting is acute pancreatitis. In the present study, to the best of our knowledge, the first case of asymptomatic radiological acute pancreatitis associated with the use of pazopanib in monotherapy in a patient with RCC is presented. In addition, a comprehensive review of the literature on this topic is provided, and certain potential measures that may aid in early diagnosis and treatment are discussed.
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Affiliation(s)
- Iosune Baraibar
- Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Almudena Quílez
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Diego Salas
- Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Marta Román
- Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Christian Rolfo
- Phase I - Early Clinical Trials Unit, Antwerp University Hospital, Edegem, Belgium
| | | | - Ignacio Gil-Bazo
- Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain
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49
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Baraibar I, Martin-Romano P, Mejías L, Perez Solans B, Ceniceros L, Legazpi J, Gardeazabal I, Inoges S, Lopez-diaz A, Idoate M, Cordoba A, Santisteban M. Abstract P2-04-01: Increased stromal lymphocytes in breast cancer patients with autologous dendritic cell vaccination plus neoadjuvant chemotherapy. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-04-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Higher levels of TILs after neoadjuvant chemotherapy (NAC) in the residual tumor have been related to a better outcome in BC patients. According to International TILs working group (2014), we have quantified stromal TILs in a cohort of patients treated with NAC plus dendritic cell vaccines (cohort V) (NCT01431196 plus an expanded cohort) and in an historic cohort of patients treated with the same NAC without V (cohort C) in order to assess if the addition autologous dendritic cell vaccination pulsed with patient´s tumor lysates helps to increase TILs in the residual BC specimen. Our previous data with these cohorts of patients have shown an improved pCR and the stimulation of lymphocytes population in the peripheral blood from cohort V.
Methods: Classification of molecular subtypes was performed by IHC. We evaluated percentage of TILs by three different pathologists using stained HE core biopsy sections in paired samples taken at diagnosis (preNAC) and after surgery (postNAC) in a prospectively defined retrospective analysis.
Results: 79 patients were evaluated (cohort C 42; cohort V 37). Patients from V cohort were younger (p=0.01). Cohorts were well balanced for AJCC staging, molecular subtypes (cohort C: LA 26%, LB 45%, TN 29%; cohort V: LA 24%, LB 40%, TN 35%), stromal TILs preNAC [cohort C: median 9 (range, 1-24); cohort V: 6 (1-34); p=0.38] and stromal TILs postNAC [cohort C: 9 (2-52); cohort V 8 (4-50); p=0. 94]. Seventy-seven patients (97%) underwent surgery (cohort C 41; cohort V 36). Pathologic CR was higher in Cohort V (27% vs 7%; p=0.02). However a superior pCR rate was detected in TNBC subtype (cohort C 27%; cohort V 58%; p=0.15). Patients from Cohort V experienced an increment of stromal TILs after NAC plus autologous dendritic cell vaccination (preNAC: 6 (1-34); postNAC 8 (4-50); p=0.03), especially in TNBC [preNAC 14 (1-34); postNAC 30 (10-50); p=0.2]. A correlation analysis by Pearson´s R coefficient stated a strong association in V cohort between stromal TILs preNAC and postNAC (R=0.83) as well as a moderate correlation between stromal TILs postNAC and and molecular subtypes (R=0.6).
Table 1. Differences in Stromal TILs between studied cohorts PreNAC (median, range)PostNAC (median, range)P valueCohort C9 (1-66)9 (2-52)0.22Cohort V6 (1-34)8 (4-50)0.03*Cohort C LA LB TN5 (1-10) 9 (1-24) 12 (10-24)6 (3-12) 10 (2-40) 13 (5-52)0.69 0.17 1Cohort V LA LB TN5 (2-17) 6 (1-15) 14 (1-347 (4-12) 7 (4-27) 30 (10-50)0.18 0.08 0.2
Conclusion: Pathological complete responses were higher in BC patients treated with neoadjuvant chemotherapy plus active immunotherapy. The addition of autologous dendritic cell vaccines to NAC increases significantly stromal TILs in breast cancer patients.
Citation Format: Baraibar I, Martin-Romano P, Mejías L, Perez Solans B, Ceniceros L, Legazpi J, Gardeazabal I, Inoges S, Lopez-diaz A, Idoate M, Cordoba A, Santisteban M. Increased stromal lymphocytes in breast cancer patients with autologous dendritic cell vaccination plus neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-04-01.
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Affiliation(s)
- I Baraibar
- Clinica Universidad de Navarra; Hospital Virgen del Camino
| | | | - L Mejías
- Clinica Universidad de Navarra; Hospital Virgen del Camino
| | - B Perez Solans
- Clinica Universidad de Navarra; Hospital Virgen del Camino
| | - L Ceniceros
- Clinica Universidad de Navarra; Hospital Virgen del Camino
| | - J Legazpi
- Clinica Universidad de Navarra; Hospital Virgen del Camino
| | - I Gardeazabal
- Clinica Universidad de Navarra; Hospital Virgen del Camino
| | - S Inoges
- Clinica Universidad de Navarra; Hospital Virgen del Camino
| | - A Lopez-diaz
- Clinica Universidad de Navarra; Hospital Virgen del Camino
| | - M Idoate
- Clinica Universidad de Navarra; Hospital Virgen del Camino
| | - A Cordoba
- Clinica Universidad de Navarra; Hospital Virgen del Camino
| | - M Santisteban
- Clinica Universidad de Navarra; Hospital Virgen del Camino
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50
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Román M, Lopez I, Zubiri L, Sanchez R, Salas D, Gardeazabal I, Baraibar I, Santisteban M, Vicent S, Gil-Aldea I, Aguillo MM, Hernandez B, Lopez-Picazo J, Gurpide A, Guruceaga E, Perez-Gracia J, Collantes M, Ecay M, Gil-Bazo I. Id1 and Id3 genes confer poor prognosis in KRAS-mutant (KM) lung adenocarcinoma (LA) patients. Gene silencing reduces metastatic rate to the liver and increases survival. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw383.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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