1
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Sotelo M, Alonso-Gordoa T, Gajate P, Gallardo E, Morales-Barrera R, Pérez-Gracia JL, Puente J, Sánchez P, Castellano D, Durán I. Atezolizumab in locally advanced or metastatic urothelial cancer: a pooled analysis from the Spanish patients of the IMvigor 210 cohort 2 and 211 studies. Clin Transl Oncol 2020; 23:882-891. [PMID: 32897497 PMCID: PMC7979625 DOI: 10.1007/s12094-020-02482-9] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/18/2020] [Indexed: 12/28/2022]
Abstract
Background The studies IMvigor 210 cohort 2 and IMvigor211 evaluated the efficacy of atezolizumab in patients with locally advanced or metastatic urothelial cancer (mUC) upon progression to platinum-based chemotherapy worldwide. Yet, the real impact of this drug in specific geographical regions is unknown.
Materials and methods We combined individual-level data from the 131 patients recruited in Spain from IMvigor210 cohort 2 and IMvigor211 in a pooled analysis. Efficacy and safety outcomes were assessed in the overall study population and according to PD-L1 expression on tumour-infiltrating immune cells. Results Full data were available for 127 patients; 74 (58%) received atezolizumab and 53 (42%) chemotherapy. Atezolizumab patients had a numerically superior median overall survival although not reaching statistical significance (9.2 months vs 7.7 months). No statistically significant differences between arms were observed in overall response rates (20.3% vs 37.0%) or progression-free survival (2.1 months vs 5.3 months). Nonetheless, median duration of response was superior for the immunotherapy arm (non-reached vs 6.4 months; p = 0.005). Additionally, among the responders, the 12-month survival rates seemed to favour atezolizumab (66.7% vs 19.9%). When efficacy was analyzed based on PD-L1 expression status, no significant differences were found. Treatment-related adverse events of any grade occurred more frequently in the chemotherapy arm [46/57 (81%) vs 44/74 (59%)]. Conclusion Patients who achieved an objective response on atezolizumab presented a longer median duration of response and numerically superior 12 month survival rates when compared with chemotherapy responders along with a more favorable safety profile. PD-L1 expression did not discriminate patients who might benefit from atezolizumab.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- B7-H1 Antigen/metabolism
- Carcinoma, Transitional Cell/drug therapy
- Carcinoma, Transitional Cell/metabolism
- Carcinoma, Transitional Cell/mortality
- Carcinoma, Transitional Cell/secondary
- Cohort Studies
- Female
- Humans
- Lymphocytes, Tumor-Infiltrating/metabolism
- Male
- Middle Aged
- Progression-Free Survival
- Spain
- Survival Rate
- Treatment Outcome
- Ureteral Neoplasms/drug therapy
- Ureteral Neoplasms/metabolism
- Ureteral Neoplasms/mortality
- Ureteral Neoplasms/pathology
- Urethral Neoplasms/drug therapy
- Urethral Neoplasms/metabolism
- Urethral Neoplasms/mortality
- Urethral Neoplasms/pathology
- Urinary Bladder Neoplasms/drug therapy
- Urinary Bladder Neoplasms/metabolism
- Urinary Bladder Neoplasms/mortality
- Urinary Bladder Neoplasms/pathology
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Affiliation(s)
- M Sotelo
- Marqués de Valdecilla University Hospital, Edificio Sur. Despacho 277, Avda Valdecilla s/n, 39005, Santander, Spain
| | | | - P Gajate
- Ramon y Cajal University Hospital, Madrid, Spain
| | - E Gallardo
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | | | | | - J Puente
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - P Sánchez
- Medical Department, Roche Farma S.A., Madrid, Spain
| | - D Castellano
- Doce de Octubre University Hospital, Madrid, Spain
| | - I Durán
- Marqués de Valdecilla University Hospital, Edificio Sur. Despacho 277, Avda Valdecilla s/n, 39005, Santander, Spain.
- Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.
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2
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Gallardo E, Méndez-Vidal MJ, Pérez-Gracia JL, Sepúlveda-Sánchez JM, Campayo M, Chirivella-González I, García-Del-Muro X, González-Del-Alba A, Grande E, Suárez C. Correction to: SEOM clinical guideline for treatment of kidney cancer (2017). Clin Transl Oncol 2019; 21:692-693. [PMID: 30798511 DOI: 10.1007/s12094-019-02058-2] [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: 11/28/2022]
Abstract
The conflict of interest declaration was published incorrectly in the original version.
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Affiliation(s)
- E Gallardo
- Medical Oncology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí, 1, 08208, Sabadell, Spain
| | - M J Méndez-Vidal
- Medical Oncology Department, Maimonides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, Córdoba, Spain
| | - J L Pérez-Gracia
- Medical Oncology Department, Clinica Universidad de Navarra, Pamplona, Spain
| | | | - M Campayo
- Medical Oncology Department, Hospital Universitari Mutua Terrassa, Terrassa, Spain
| | - I Chirivella-González
- Medical Oncology Department, Hospital Clínico, Universidad de Valencia, Valencia, Spain
| | - X García-Del-Muro
- Medical Oncology Department, Institut Catala d'Oncologia, Idibell, Universitat de Barcelona, Barcelona, L'Hospitalet de Llobregat, Spain
| | - A González-Del-Alba
- Oncology Department, Hospital Universitario Son Espases, Palma De Mallorca, Spain
| | - E Grande
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - C Suárez
- Medical Oncology Department, Vall d'Hebron University Hospital and Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain.
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3
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Sánchez-Paulete AR, Teijeira A, Cueto FJ, Garasa S, Pérez-Gracia JL, Sánchez-Arráez A, Sancho D, Melero I. Antigen cross-presentation and T-cell cross-priming in cancer immunology and immunotherapy. Ann Oncol 2018; 28:xii44-xii55. [PMID: 28945841 DOI: 10.1093/annonc/mdx237] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Dendritic cells (DCs) are the main professional antigen-presenting cells for induction of T-cell adaptive responses. Cancer cells express tumor antigens, including neoantigens generated by nonsynonymous mutations, but are poor for antigen presentation and for providing costimulatory signals for T-cell priming. Mounting evidence suggests that antigen transfer to DCs and their surrogate presentation on major histocompatibility complex class I and II molecules together with costimulatory signals is paramount for induction of viral and cancer immunity. Of the great diversity of DCs, BATF3/IRF8-dependent conventional DCs type 1 (cDC1) excel at cross-presentation of tumor cell-associated antigens. Location of cDC1s in the tumor correlates with improved infiltration by CD8+ T cells and tumor-specific T-cell immunity. Indeed, cDC1s are crucial for antitumor efficacy using checkpoint inhibitors and anti-CD137 agonist monoclonal antibodies in mouse models. Enhancement and exploitation of T-cell cross-priming by cDC1s offer opportunities for improved cancer immunotherapy, including in vivo targeting of tumor antigens to internalizing receptors on cDC1s and strategies to increase their numbers, activation and priming capacity within tumors and tumor-draining lymph nodes.
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Affiliation(s)
- A R Sánchez-Paulete
- Division of Immunology and Immunotherapy, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona
| | - A Teijeira
- Division of Immunology and Immunotherapy, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona
| | - F J Cueto
- Immunobiology Laboratory, Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid.,Department of Biochemistry, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid
| | - S Garasa
- Division of Immunology and Immunotherapy, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona
| | - J L Pérez-Gracia
- University Clinic, University of Navarra, Pamplona, Spain.,CIBERONC, Madrid, Spain
| | - A Sánchez-Arráez
- Division of Immunology and Immunotherapy, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona
| | - D Sancho
- Immunobiology Laboratory, Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid
| | - I Melero
- Division of Immunology and Immunotherapy, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona.,University Clinic, University of Navarra, Pamplona, Spain.,CIBERONC, Madrid, Spain
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4
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Gallardo E, Méndez-Vidal MJ, Pérez-Gracia JL, Sepúlveda-Sánchez JM, Campayo M, Chirivella-González I, García-del-Muro X, González-del-Alba A, Grande E, Suárez C. SEOM clinical guideline for treatment of kidney cancer (2017). Clin Transl Oncol 2018; 20:47-56. [PMID: 29134564 PMCID: PMC5785618 DOI: 10.1007/s12094-017-1765-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 10/06/2017] [Indexed: 01/05/2023]
Abstract
The goal of this article is to provide recommendations about the management of kidney cancer. Based on pathologic and molecular features, several kidney cancer variants were described. Nephron-sparing techniques are the gold standard of localized disease. After a randomized trial, sunitinib could be considered in adjuvant treatment in high-risk patients. Patients with advanced disease constitute a heterogeneous population. Prognostic classification should be considered. Both sunitinib and pazopanib are the standard options for first-line systemic therapy in advanced renal cell carcinoma. Based on the results of two randomized trials, both nivolumab and cabozantinib should be considered the standard for second and further lines of therapy. Response evaluation for present therapies is a challenge.
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Affiliation(s)
- E. Gallardo
- Medical Oncology Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí, 1, 08208 Sabadell, Spain
| | - M. J. Méndez-Vidal
- Medical Oncology Department, Maimonides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, Córdoba, Spain
| | - J. L. Pérez-Gracia
- Medical Oncology Department, Clinica Universidad de Navarra, Pamplona, Spain
| | | | - M. Campayo
- Medical Oncology Department, Hospital Universitari Mutua Terrassa, Terrassa, Spain
| | | | - X. García-del-Muro
- Medical Oncology Department, Institut Catala d’Oncologia, Idibell, Universitat de Barcelona, Barcelona, L’Hospitalet de Llobregat Spain
| | - A. González-del-Alba
- Oncology Department, Hospital Universitario Son Espases, Palma De Mallorca, Spain
| | - E. Grande
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - C. Suárez
- Medical Oncology Department, Vall d’Hebron University Hospital and Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain
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5
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Sánchez-Paulete AR, Teijeira A, Cueto FJ, Garasa S, Pérez-Gracia JL, Sánchez-Arráez A, Sancho D, Melero I. Antigen cross-presentation and T-cell cross-priming in cancer immunology and immunotherapy. Ann Oncol 2017; 28:xii74. [PMID: 29253116 DOI: 10.1093/annonc/mdx727] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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6
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Maroto P, Esteban E, Parra EF, Mendez-Vidal MJ, Domenech M, Pérez-Valderrama B, Calderero V, Pérez-Gracia JL, Grande E, Algaba F. HIF pathway and c-Myc as biomarkers for response to sunitinib in metastatic clear-cell renal cell carcinoma. Onco Targets Ther 2017; 10:4635-4643. [PMID: 29033582 PMCID: PMC5614781 DOI: 10.2147/ott.s137677] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Clear-cell renal cell carcinoma (ccRCC) is a heterogeneous disease with a different clinical behavior and response to targeted therapies. Differences in hypoxia-inducible factor (HIF) expression have been used to classify von Hippel-Lindau gene (VHL)-deficient ccRCC tumors. c-Myc may be driving proliferation in HIF-2α-expressing tumors in a growth factor-independent manner. OBJECTIVE To explore the HIF-1α, HIF-2α and c-Myc baseline expression as potential predictors of sunitinib outcome as well as the effectiveness and safety with sunitinib in patients with metastatic ccRCC in routine clinical practice. METHODS This was an observational and prospective study involving 10 Spanish hospitals. Formalin-fixed, paraffin-embedded primary tumor samples from metastatic ccRCC patients who received sunitinib as first-line treatment were analyzed. Association between biomarker expression and sunitinib treatment outcomes was evaluated. Kaplan-Meier method was applied to measure progression-free survival (PFS) and overall survival. RESULTS Eighty-one patients were included: median PFS was 10.8 months (95% CI: 7.4-13.5 months), median overall survival was 21.8 months (95% CI: 14.7-29.8 months) and objective response rate was 40.7%, with 7.4% of patients achieving a complete response. Molecular marker staining was performed in the 69 available tumor samples. Significant association with lower PFS was identified for double c-Myc/HIF-2α-positive staining tumors (median 4.3 vs 11.5 months, hazard ratio =2.64, 95% CI: 1.03-6.80, P=0.036). A trend toward a lower PFS was found in positive c-Myc tumors (median 5.9 vs 10.9 months, P=0.263). HIF-1α and HIF-2α expression levels were not associated with clinical outcome. CONCLUSION These preliminary results suggest that predictive subgroups might be defined based on biomarkers such as c-Myc/HIF-2α. Further validation with more patients will be needed in order to confirm it. Outcomes with sunitinib in metastatic ccRCC in daily clinical practice resemble those obtained in clinical trials.
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Affiliation(s)
- P Maroto
- Department of Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona
| | - E Esteban
- Department of Oncology, Nuevo HUCA, Oviedo
| | | | | | - M Domenech
- Department of Oncology, Hospital de Althaia Xarxa Asistencial Manresa, Barcelona
| | | | - V Calderero
- Department of Oncology, H. Fundación Miguel Servet, Zaragoza
| | - J L Pérez-Gracia
- Department of Oncology, Clinica Universitaria de Pamplona, Pamplona
| | - E Grande
- Department of Oncology, H. Ramón y Cajal, Madrid
| | - F Algaba
- Pathology Unit, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
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7
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Pérez-Gracia JL, Rodríguez Ruiz ME, Fusco JP, Gúrpide A. [Treatment of prostate cancer according to life expectancy, comorbidity and clinical practice guidelines]. An Sist Sanit Navar 2015; 38:463-464. [PMID: 26786375 DOI: 10.23938/assn.0288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- J L Pérez-Gracia
- Departamento de Oncología, Clínica Universidad de Navarra, Pamplona, 31008, Spain.
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8
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Durán I, Garzón C, Sánchez A, García-Carbonero I, Pérez-Gracia JL, Seguí-Palmer MÁ, Wei R, Restovic G, Gasquet JA, Gutiérrez L. Cost analysis of skeletal-related events in Spanish patients with bone metastases from solid tumours. Clin Transl Oncol 2013; 16:322-9. [PMID: 23943561 PMCID: PMC3924023 DOI: 10.1007/s12094-013-1077-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 07/02/2013] [Indexed: 10/29/2022]
Abstract
PURPOSE To estimate the cost per skeletal-related event (SRE) in patients with bone metastases secondary to solid tumours in the Spanish healthcare setting. METHODS Patients diagnosed with bone metastases secondary to breast, prostate or lung cancer were included in this multicentre, observational study. SREs are defined as pathologic fracture (vertebral and non-vertebral fracture), radiation to bone, spinal cord compression or surgery to bone. Health resource utilisation associated with these events (inpatient stays, outpatient, emergency room and home health visits, nursing home stays and procedures) were collected retrospectively for all SREs that occurred in the 97 days prior to enrolment and prospectively during follow-up. Unit costs were obtained from the 2010 eSalud healthcare costs database. RESULTS A total of 93 Spanish patients with solid tumours were included (31 had breast cancer, 21 prostate cancer and 41 lung cancer), contributing a total of 143 SREs to this cost analysis. Inpatient stays (between 9.0 and 29.9 days of mean length of stay per inpatient stay by SRE type) and outpatient visits (between 1.7 and 6.4 mean visits per SRE type) were the most frequently reported types of health resources utilised. The mean cost per SRE was between <euro>2,377.79 (radiation to bone) and <euro>7,902.62 (spinal cord compression). CONCLUSION SREs are associated with a significant consumption of healthcare resources that generate a substantial economic burden for the Spanish healthcare system.
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Affiliation(s)
- I Durán
- Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain,
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9
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Castellano D, del Muro XG, Pérez-Gracia JL, González-Larriba JL, Abrio MV, Ruiz MA, Pardo A, Guzmán C, Cerezo SD, Grande E. Patient-reported outcomes in a phase III, randomized study of sunitinib versus interferon-{alpha} as first-line systemic therapy for patients with metastatic renal cell carcinoma in a European population. Ann Oncol 2009; 20:1803-12. [PMID: 19549706 PMCID: PMC2768734 DOI: 10.1093/annonc/mdp067] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: The purpose of this study is to evaluate the impact on the health-related quality of life (HRQoL) of sunitinib versus interferon-alpha (IFN-α) treatment in patients with metastatic renal cell carcinoma (mRCC). Patients and methods: In all, 304 mRCC patients (European cohort) were randomized 1 : 1 to receive sunitinib (50 mg/day for 4 weeks, followed by 2 weeks off) or IFN-α (9 million units s.c. injection three times/week). The following questionnaires were completed (days 1 and 28 per cycle): Functional Assessment of Cancer Therapy-General (FACT-G), the FACT-Kidney Symptom Index and the EuroQol Group's EQ-5D self-report questionnaire (EQ-5D). Results correspond to an ongoing trial with progression-free survival time as primary end point, and patients were still being followed up. Data were analyzed using repeated measures mixed effects models (MEMs) that allow the inclusion of initial differences and uncompleted repeated measures, with the assumption of data missing at random. Six-cycle results were included. Results: Results consistently showed that patients in sunitinib group experienced statistically significantly milder kidney-related symptoms, better cancer-specific HRQoL and general health status (in social utility scores) during the study period as measured by these patient-reported outcome end points. No statistical differences between groups were found on the FACT-G physical well-being subscale or the EQ-5D VAS values. Conclusions: Results from MEM showed the sunitinib's benefit on HRQoL compared with IFN-α.
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Affiliation(s)
- D Castellano
- Oncology Department, University Hospital, Madrid, Spain
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10
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Santisteban M, Pérez-Gracia JL, Ceballos J, Vivas I, García-Foncillas J. Oxaliplatin plus gemcitabine as a salvage schedule for hormone-refractory prostate adenocarcinoma. Clin Transl Oncol 2008; 10:372-4. [PMID: 18558585 DOI: 10.1007/s12094-008-0214-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We report a case of hormone-refractory prostate cancer (HRPC) treated with oxaliplatin plus gemcitabine in a third-line schedule after liver progression, with an excellent clinical, biochemical and radiological response and with an acceptable tolerance. Prior chemotherapy regimens included docetaxel plus estramustine and oral etoposide. To our knowledge, this is the first report that shows this approach in an HRPC patient.
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Affiliation(s)
- M Santisteban
- Medical Oncology Department, Clínica Universitaria de Navarra, Pamplona, Spain.
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11
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Ceballos J, Lopez-Picazo J, Reyna C, Moreno Jimenez M, Pérez-Gracia JL, Ponz Sarvise M, Olier C, Gil Bazo I, Gurpide A, Garcia-Foncillas J. CEA response as a prognostic marker in non-small-cell lung carcinoma (NSCLC) patients treated with gefitinib or erlotinib. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.19071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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12
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Gil-Bazo I, Ponz-Sarvisé M, Chen JS, Rodríguez J, Ngwega PA, Reyna C, Pérez-Gracia JL, García- Foncillas J, Calvo A, Panizo-Santos A. Inhibitor of differentiation-1 (Id1) characterization in poor prognosis (PP) hormone-refractory (HR) metastatic prostate cancer (CaP) primary tumors and matched metastases (MTS) using a new monoclonal antibody (MoAb). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.22025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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13
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Abstract
Renal cell carcinoma presents several unique features, which distinguish it from other tumours. The increase in survival that has been described in patients with renal cell carcinoma following nephrectomy breaks a classical rule of oncology, which states that surgery of the primary tumour has no role in the treatment of patients with advanced disease. Together with melanoma, it is the only tumour in which immunomodulatory treatments with drugs such as interleukin-2 produces a clinical benefit to patients. In randomized trials treatment of metastatic renal cell carcinoma with high dose interleukin-2 has confirmed its ability to induce long-term complete responses, which in practice can be considered equivalent to cure. Lastly, renal cell carcinoma is being used as a clinical model to demonstrate the role of several targeted treatments, with over 30 novel agents under development. It has been the first tumour type in which treatment with angiogenesis inhibitors has shown a clinical benefit. This article reviews the most relevant aspects of renal cell carcinoma, including epidemiology, prognostic factors, clinical presentation, molecular bases and the current status of development of the most relevant novel treatments for this disease.
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Affiliation(s)
- J L Pérez-Gracia
- Departamento de Onología Médica, Clínica Universitaria de Navarra, Universidad de Navarra, Pamplona, Spain.
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14
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Pérez-Gracia JL, López-Picazo JM, Martín-Algarra S, Viteri S, García-Foncillas J, Gúrpide A. [Small-cell lung cancer]. Rev Med Univ Navarra 2007; 51:7-13. [PMID: 17886708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Small cell lung cancer is one of the most aggressive solid tumors because of its rapid growth and early tendency to spread to distant organs. Nonetheless, it is also one of the most sensitive tumors to chemotherapy and radiotherapy, which can give patients with limited disease a chance to become long-term survivors. These characteristics have made this tumor a clinical model to explore various treatment strategies, including concomitant chemotherapy and radiotherapy, alternant chemotherapy, high-dose chemotherapy with hematologic support, or use of whole-brain prophylactic radiotherapy. In addition, in recent years, small cell lung cancer has been used as a platform to develop some new targeted therapy agents or immunotherapeutic approaches.
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Affiliation(s)
- J L Pérez-Gracia
- Departamento de Oncología, Cínica Universítaria, Facultad de Medicina, Universidad de Navarra, Pamplona.
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15
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Alfaro C, Murillo O, Tirapu I, Azpilicueta A, Huarte E, Arina A, Arribillaga L, Pérez-Gracia JL, Bendandi M, Prieto J, Lasarte JJ, Melero I. [The immunotherapy potential of agonistic anti-CD137 (4-1BB) monoclonal antibodies for malignancies and chronic viral diseases]. An Sist Sanit Navar 2006; 29:77-96. [PMID: 16670731 DOI: 10.4321/s1137-66272006000100007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pharmacological intervention on the immune system to achieve more intense lymphocyte responses has potential application in tumour immunology and in the treatment of chronic viral diseases. Immunostimulating monoclonal antibodies are defined as a new family of drugs that augment cellular immune responses. They interact as artificial ligands with functional proteins of the immune system, either activating or inhibiting their functions. There are humanized monoclonal antibodies directed to the inhibitory receptor CD152 (CTLA-4) that are being tested in clinical trials with evidence of antitumoural activity. As a drawback, anti-CTLA-4 monoclonal antibodies induce severe autoimmunity reactions in a fraction of the patients. Anti-CD137 monoclonal antibodies have the ability to induce potent immune responses mainly mediated by cytotoxic lymphocytes with the result of frequent complete tumour eradications in mice. Comparative studies in experimental models indicate that the antitumour activity of anti-CD137 monoclonal antibodies is superior to that of anti-CD152. CD137 (4-1BB) is a leukocyte differentiation antigen selectively expressed on the surface of activated T and NK lymphocytes, as well as on dendritic cells. Monoclonal antibodies acting as artificial stimulatory ligands of this receptor (anti-CD137 agonist antibodies) enhance cellular antitumoural and antiviral immunity in a variety of mouse models. Paradoxically, anti-CD137 monoclonal antibodies are therapeutic or preventive in the course of model autoimmune diseases in mice. In light of these experimental results, a number of research groups have humanized antibodies against human CD137 and early clinical trials are about to start.
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MESH Headings
- Animals
- Antibodies, Monoclonal/therapeutic use
- Antigens, CD/immunology
- Antigens, Differentiation/immunology
- Antineoplastic Agents/therapeutic use
- Autoimmunity
- Bone Marrow Transplantation/immunology
- CTLA-4 Antigen
- Cancer Vaccines/immunology
- Cancer Vaccines/therapeutic use
- Chronic Disease
- Clinical Trials as Topic
- Clinical Trials, Phase II as Topic
- Clinical Trials, Phase III as Topic
- Cytokines/immunology
- Humans
- Immunotherapy
- Mice
- Mice, Transgenic
- Neoplasms/immunology
- Neoplasms/therapy
- Neoplasms, Experimental/drug therapy
- Neoplasms, Experimental/immunology
- Receptors, Nerve Growth Factor/immunology
- Receptors, Tumor Necrosis Factor/immunology
- Transplantation, Homologous
- Tumor Cells, Cultured
- Tumor Necrosis Factor Receptor Superfamily, Member 9
- Viral Vaccines/immunology
- Viral Vaccines/therapeutic use
- Virus Diseases/immunology
- Virus Diseases/therapy
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Affiliation(s)
- C Alfaro
- Area de Terapia Génica y Hepatología, Centro de Investigación Médica Aplicada, Pamplona
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16
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Pérez-Gracia JL, Colomer R, Esteban E, Barceló R, Benavides M, Puertas J, Arcediano A, Tornamira MV, Valentín V, Muñoz A, Cortés-Funes H, Hornedo J. High-dose mitoxantrone and cyclophosphamide without stem cell support in patients with high-risk and advanced breast carcinoma: a Phase II multicentric trial. Cancer 2002. [PMID: 11745183 DOI: 10.1002/1097-0142(20011115)92:10<2508::aid-cncr1601>3.0.co;2-#] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Currently employed high-dose regimens for patients with breast carcinoma consist mainly of single-cycle combinations of alkylating agents. In a previous Phase I trial, the authors developed a tandem high-dose combination of two cycles of mitoxantrone and cyclophosphamide for the treatment of patients with metastatic breast carcinoma (MBC) and high-risk breast carcinoma (HRBC). Treatment was delivered with granulocyte-colony stimulating factor (G-CSF) but without stem cell support to avoid potential tumor cell reinfusion. The objective was to validate the safety and obtain preliminary efficacy assessment of this combination in a Phase II trial. METHODS Fifty-three patients were included: 27 patients with MBC and 26 patients with HRBC. After standard induction treatment, patients received two cycles of mitoxantrone 25 mg/m2 and cyclophosphamide 4000 mg/m2 separated by a 4-week interval. Patients received G-CSF and ciprofloxacin until hematologic recovery. Follow-up was performed in an outpatient setting. RESULTS One hundred one of 106 projected cycles (95%) were delivered. The mean dose intensities achieved were mitoxantrone 5.8 mg/m2 per week and cyclophosphamide 933 mg/m2 per week. Infection developed in 46% of the cycles, and platelet transfusions were required in 42%. Nonhematologic toxicity was mainly Grade 3 emesis. There were no toxic deaths. In 17 evaluable patients with MBC, 13 patients (77%) had response improvements, including 7 complete responses (41%). CONCLUSIONS Treatment with two cycles of mitoxantrone 25 mg/m2 and cyclophosphamide 4000 mg/m2 with G-CSF but without stem cell support was well tolerated. The dose intensities achieved approach those obtained with conventional high-dose therapy. This combination warrants further investigation as an alternative to conventional high-dose regimens.
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Affiliation(s)
- J L Pérez-Gracia
- Medical Oncology Division, Hospital 12 de Octubre, Madrid, Spain
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17
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Pérez-Gracia JL, Colomer R, Esteban E, Barceló R, Benavides M, Puertas J, Arcediano A, Tornamira MV, Valentín V, Muñoz A, Cortés-Funes H, Hornedo J. High-dose mitoxantrone and cyclophosphamide without stem cell support in patients with high-risk and advanced breast carcinoma: a Phase II multicentric trial. Cancer 2001; 92:2508-16. [PMID: 11745183 DOI: 10.1002/1097-0142(20011115)92:10<2508::aid-cncr1601>3.0.co;2-#] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Currently employed high-dose regimens for patients with breast carcinoma consist mainly of single-cycle combinations of alkylating agents. In a previous Phase I trial, the authors developed a tandem high-dose combination of two cycles of mitoxantrone and cyclophosphamide for the treatment of patients with metastatic breast carcinoma (MBC) and high-risk breast carcinoma (HRBC). Treatment was delivered with granulocyte-colony stimulating factor (G-CSF) but without stem cell support to avoid potential tumor cell reinfusion. The objective was to validate the safety and obtain preliminary efficacy assessment of this combination in a Phase II trial. METHODS Fifty-three patients were included: 27 patients with MBC and 26 patients with HRBC. After standard induction treatment, patients received two cycles of mitoxantrone 25 mg/m2 and cyclophosphamide 4000 mg/m2 separated by a 4-week interval. Patients received G-CSF and ciprofloxacin until hematologic recovery. Follow-up was performed in an outpatient setting. RESULTS One hundred one of 106 projected cycles (95%) were delivered. The mean dose intensities achieved were mitoxantrone 5.8 mg/m2 per week and cyclophosphamide 933 mg/m2 per week. Infection developed in 46% of the cycles, and platelet transfusions were required in 42%. Nonhematologic toxicity was mainly Grade 3 emesis. There were no toxic deaths. In 17 evaluable patients with MBC, 13 patients (77%) had response improvements, including 7 complete responses (41%). CONCLUSIONS Treatment with two cycles of mitoxantrone 25 mg/m2 and cyclophosphamide 4000 mg/m2 with G-CSF but without stem cell support was well tolerated. The dose intensities achieved approach those obtained with conventional high-dose therapy. This combination warrants further investigation as an alternative to conventional high-dose regimens.
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Affiliation(s)
- J L Pérez-Gracia
- Medical Oncology Division, Hospital 12 de Octubre, Madrid, Spain
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18
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García-Carbonero R, Mayordomo JI, Tornamira MV, López-Brea M, Rueda A, Guillem V, Arcediano A, Yubero A, Ribera F, Gómez C, Trés A, Pérez-Gracia JL, Lumbreras C, Hornedo J, Cortés-Funes H, Paz-Ares L. Granulocyte colony-stimulating factor in the treatment of high-risk febrile neutropenia: a multicenter randomized trial. J Natl Cancer Inst 2001; 93:31-8. [PMID: 11136839 DOI: 10.1093/jnci/93.1.31] [Citation(s) in RCA: 132] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Granulocyte colony-stimulating factors (G-CSFs) have been shown to help prevent febrile neutropenia in certain subgroups of cancer patients undergoing chemotherapy, but their role in treating febrile neutropenia is controversial. The purpose of our study was to evaluate-in a prospective multicenter randomized clinical trial-the efficacy of adding G-CSF to broad-spectrum antibiotic treatment of patients with solid tumors and high-risk febrile neutropenia. METHODS A total of 210 patients with solid tumors treated with conventional-dose chemotherapy who presented with fever and grade IV neutropenia were considered to be eligible for the trial. They met at least one of the following high-risk criteria: profound neutropenia (absolute neutrophil count <100/mm(3)), short latency from previous chemotherapy cycle (<10 days), sepsis or clinically documented infection at presentation, severe comorbidity, performance status of 3-4 (Eastern Cooperative Oncology Group scale), or prior inpatient status. Eligible patients were randomly assigned to receive the antibiotics ceftazidime and amikacin, with or without G-CSF (5 microg/kg per day). The primary study end point was the duration of hospitalization. All P values were two-sided. RESULTS Patients randomly assigned to receive G-CSF had a significantly shorter duration of grade IV neutropenia (median, 2 days versus 3 days; P = 0.0004), antibiotic therapy (median, 5 days versus 6 days; P = 0.013), and hospital stay (median, 5 days versus 7 days; P = 0.015) than patients in the control arm. The incidence of serious medical complications not present at the initial clinical evaluation was 10% in the G-CSF group and 17% in the control group (P = 0.12), including five deaths in each study arm. The median cost of hospital stay and the median overall cost per patient admission were reduced by 17% (P = 0.01) and by 11% (P = 0.07), respectively, in the G-CSF arm compared with the control arm. CONCLUSIONS Adding G-CSF to antibiotic therapy shortens the duration of neutropenia, reduces the duration of antibiotic therapy and hospitalization, and decreases hospital costs in patients with high-risk febrile neutropenia.
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Affiliation(s)
- R García-Carbonero
- Division of Medical Oncology, Hospital Universitario Doce de Octubre, Madrid, Spain
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19
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Pérez-Gracia JL, Colomer R, Ruiz-Casado A, Arcediano A, Tornamira MV, Gómez-Martin C, Valentin V, Mendiola C, Cortés-Funes H, Hornedo J. High-dose mitoxantrone and cyclophosphamide without stem cell support in high-risk and advanced solid tumors: a phase I trial. Bone Marrow Transplant 2001; 27:117-23. [PMID: 11281378 DOI: 10.1038/sj.bmt.1702751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This phase I study was designed to develop a high-dose combination of two cycles of mitoxantrone and cyclophosphamide in patients with solid tumors, as an alternative to single-cycle high-dose regimens that use only alkylating agents. Treatment was delivered with granulocyte colony-stimulating factor (G-CSF), but without stem cell support, in order to avoid potential tumor cell reinfusion. Thirty-one patients with advanced solid tumors received two cycles of high-dose mitoxantrone (20-30 mg/m2) plus high-dose cyclophosphamide (3000-4000 mg/m2). All patients received G-CSF until hematologic recovery. Dose-escalation was performed when less than 50% of cycles per level had dose-limiting toxicity (DLT). The maximum tolerated dose (MTD) achieved was mitoxantrone 25 mg/m2 and cyclophosphamide 4000 mg/m2. Main dose-limiting toxicities (DLTs) were hematological: grade IV neutropenia lasting more than 7 days and thrombopenia below 20 x 10(9)/l requiring more than one platelet transfusion. Non-hematological DLT consisted predominantly of grade III emesis and asthenia. Follow-up after each cycle was performed in an outpatient setting and there were no toxic deaths. In conclusion, the administration of two cycles of high-dose mitoxantrone and cyclophosphamide with G-CSF support is safe and feasible. MTD was mitoxantrone 25 mg/m2 and cyclophosphamide 4000 mg/m2. Evaluation of this regimen is being done in a phase II trial.
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Affiliation(s)
- J L Pérez-Gracia
- Division of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
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