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Boormans JL, Sylvester R, Anson-Cartwright L, Glicksman RM, Hamilton RJ, Hahn E, Daugaard G, Lauritsen J, Wagner T, Avuzzi B, Nicolai N, Del Muro XG, Aparicio J, Stalder O, Rothermundt C, Fischer S, Laguna MP. Prognostic Factor Risk Groups for Clinical Stage I Seminoma: An Individual Patient Data Analysis by the European Association of Urology Testicular Cancer Guidelines Panel and Guidelines Office. Eur Urol Oncol 2024; 7:537-543. [PMID: 37951820 DOI: 10.1016/j.euo.2023.10.014] [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: 09/07/2023] [Revised: 09/28/2023] [Accepted: 10/18/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND The relapse rate in patients with clinical stage I (CSI) seminomatous germ cell tumor of the testis (SGCTT) who were undergoing surveillance after radical orchidectomy is 4-30%, depending on tumor size and rete testis invasion (RTI). However, the level of evidence supporting the use of both risk factors in clinical decision-making is low. OBJECTIVE We aimed to identify the most important prognostic factors for relapse in CSI SGCTT patients. DESIGN, SETTING, AND PARTICIPANTS Individual patient data for 1016 CSI SGCTT patients diagnosed between 1994 and 2019 with normal postorchidectomy serum tumor marker levels and undergoing surveillance were collected from nine institutions. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multivariable Cox proportional hazard regression models were fit to identify the most important prognostic factors. The primary endpoint was the time to first relapse by imaging and/or markers. Relapse probabilities were estimated by the Kaplan-Meier method. RESULTS AND LIMITATIONS After a median follow-up of 7.7 yr, 149 (14.7%) patients had relapsed. Categorical tumor size (≤2, >2-5, and >5 cm), presence of RTI, and lymphovascular invasion were used to form three risk groups: low (56.4%), intermediate (41.3%), and high (2.3%) risks with 5-yr cumulative relapse probabilities of 8%, 20%, and 44%, respectively. The model outperformed the currently used model with tumor size ≤4 versus >4 cm and presence of RTI (Harrell's C index 0.65 vs 0.61). The low- and intermediate-risk groups were validated successfully in an independent cohort of 285 patients. CONCLUSIONS The risk of relapse after radical orchidectomy in CSI SGCTT patients under surveillance is low. We propose a new risk stratification model that outperformed the current model and identified a small subgroup with a high risk of relapse. PATIENT SUMMARY The risk of relapse after radical orchidectomy in patients with clinical stage I seminomatous germ cell tumor of the testis is low. We propose a new risk stratification model that outperformed the current model and identified a small subgroup with a high risk of relapse.
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Affiliation(s)
- Joost L Boormans
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Richard Sylvester
- European Association of Urology Guidelines Office, Brussels, Belgium
| | - Lynn Anson-Cartwright
- Department of Surgery (Urology), Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Robert J Hamilton
- Department of Surgery (Urology), Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ezra Hahn
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Gedske Daugaard
- Department of Oncology 5073, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jakob Lauritsen
- Department of Oncology 5073, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Wagner
- Department of Oncology 5073, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Barbara Avuzzi
- Radiation Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nicola Nicolai
- Urology Unit, Fondazione IRCCS Instituto Nazionale dei Tumori, Milan, Italy
| | - Xavier García Del Muro
- Department of Medical Oncology, Hospital Universitario y Politécnico La Fe, Valencia, Spain(1)
| | - Jorge Aparicio
- Department of Medical Oncology, Hospital Universitario y Politécnico La Fe, Valencia, Spain(1)
| | - Odile Stalder
- Clinical Trials Unit Bern, University of Bern, Bern, Switzerland
| | - Christian Rothermundt
- Department of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Stefanie Fischer
- Department of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - M Pilar Laguna
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey
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Valladares-Ayerbes M, Safont MJ, González Flores E, García-Alfonso P, Aranda E, Muñoz AML, Falcó Ferrer E, Cirera Nogueras L, Rodríguez-Salas N, Aparicio J, Llanos Muñoz M, Pimentel Cáceres PP, Castillo Trujillo OA, Vidal Tocino R, Salgado Fernández M, Salud-Salvia A, Massuti Sureda B, Garcia-Carbonero R, Vicente Conesa MÁ, Lloansí Vila A. Sequential RAS mutations evaluation in cell-free DNA of patients with tissue RAS wild-type metastatic colorectal cancer: the PERSEIDA (Cohort 2) study. Clin Transl Oncol 2024:10.1007/s12094-024-03487-4. [PMID: 38642257 DOI: 10.1007/s12094-024-03487-4] [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: 03/01/2024] [Accepted: 03/25/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE RAS (KRAS/NRAS) mutational status on a tumor biopsy is mandatory to guide the best treatment in metastatic colorectal cancer (mCRC). Determining the RAS mutational status by tumor-tissue biopsy is essential in guiding the optimal treatment decision for mCRC. RAS mutations are negative predictive factors for the use of EGFR monoclonal antibodies. Cell-free DNA (cfDNA) analysis enables minimally invasive monitoring of tumor evolution. METHODS/PATIENTS PERSEIDA was an observational, prospective study assessing cfDNA RAS, BRAF and EGFR mutations (using Idylla™) in first-line mCRC, RAS wild-type (baseline tumor-tissue biopsy) patients (cohort 2). Plasma samples were collected before first-line treatment, after 20 ± 2 weeks, and at disease progression. RESULTS 117 patients were included (103 received panitumumab + chemotherapy as first-line treatment). At baseline, 7 (6.8%) patients had RAS mutations, 4 (3.9%) BRAF mutations and no EGFR mutations were detected (cfDNA, panitumumab + chemotherapy subpopulation [panitumumab + Ch]). The baseline RAS mutational status concordance between tissue and liquid biopsies was 94.0% (93.2%, panitumumab + Ch). At 20 weeks, only one patient in the study (included in the panitumumab + Ch) had an emerging cfDNA RAS mutation. No emerging BRAF or EGFR mutations were reported. At disease progression, 6 patients had emergent mutations not present at baseline (RAS conversion rate: 13.3% [6/45]; 15.0% [6/40], panitumumab + Ch). CONCLUSIONS The concordance rate between liquid and solid biopsies at baseline was very high, as previously reported, while our results suggest a considerable emergence of RAS mutations during disease progression. Thus, the dynamics of the genomic landscape in ctDNA may provide relevant information for the management of mCRC patients.
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Affiliation(s)
| | - Maria José Safont
- Consorcio Hospital General Universitario de Valencia, Universidad de Valencia, Valencia; CIBERONC, Valencia, Spain
| | | | - Pilar García-Alfonso
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, Madrid, Spain
| | | | | | | | | | | | - Jorge Aparicio
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
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Rodríguez-Lescure Á, Gallego J, Garcia-Alfonso P, Massuti B, Márquez R, Calvo L, Sánchez-Rovira P, Antón A, Chacón JI, Ciruelos E, Ponce JJ, Santaballa A, Valladares-Ayerbes M, Dueñas MR, Alonso V, Aparicio J, Encinas S, Robles L, Escudero MJ, Caballero R, Bezares S, de la Haba-Rodriguez J. Hypertension as predictive factor for bevacizumab-containing first-line therapy in metastatic breast and colorectal cancer in BRECOL (GEICAM/2011-04) study. Clin Transl Oncol 2024:10.1007/s12094-024-03411-w. [PMID: 38578537 DOI: 10.1007/s12094-024-03411-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/16/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Retrospective data suggest an association between bevacizumab efficacy and the incidence of arterial hypertension (AHT). Additionally, epigenetic mechanisms have been related to AHT. METHODS This prospective observational study conducted by GEICAM Spanish Breast Cancer Research Group included metastatic breast (MBC) or colorectal (mCRC) cancer patients treated with bevacizumab-containing chemotherapy as first-line treatment. Blood pressure (BP) levels were measured (conventional and 24-h Holter monitoring) at baseline and up to cycle 3. Primary endpoint assessed BP levels increase as predictive factor for progression-free survival (PFS). Germline DNA methylation profile was explored in pre-treatment blood samples; principal component analysis was used to define an epigenetic predictive score for increased BP levels. RESULTS From Oct-2012 to Jul-2016, 143 (78 MBC and 65 mCRC) patients were included. The incidence of AHT according to guidelines was neither predictive of PFS nor of best overall tumor response (BOR). No statistically significant association was observed with systolic BP nor diastolic BP increment for PFS or BOR. Grade 3 and 4 adverse events were observed in 37 and 5% of patients, respectively. We identified 27 sites which baseline methylation status was significantly associated to BP levels increase secondary to bevacizumab-containing chemotherapy. CONCLUSIONS Neither the frequency of AHT nor the increase of BP levels were predictive of efficacy in MBC and mCRC patients treated with bevacizumab-containing chemotherapy. CLINICAL TRIAL REGISTRY ClinicalTrials.gov Identifier: NCT01733628.
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Affiliation(s)
- Álvaro Rodríguez-Lescure
- Medical Oncology Department, Hospital General Universitario de Elche, Carrer Almazara, 11, 03203, Elche, Alicante, Spain.
- GEICAM Spanish Breast Cancer Group, Madrid, Spain.
| | - Javier Gallego
- Medical Oncology Department, Hospital General Universitario de Elche, Carrer Almazara, 11, 03203, Elche, Alicante, Spain
| | - Pilar Garcia-Alfonso
- Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina de la Universidad Complutense de Madrid, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Bartomeu Massuti
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - Raúl Márquez
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- MD Anderson Cancer Center Madrid, Madrid, Spain
| | - Lourdes Calvo
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Pedro Sánchez-Rovira
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- Hospital Universitario de Jaén, Jaén, Spain
| | - Antonio Antón
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- Instituto de Investigación Sanitaria de Aragón (IISA), Hospital Universitario Miguel Servet, Universidad de Zaragoza, Saragossa, Spain
| | - José Ignacio Chacón
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- Hospital Universitario de Toledo, Toledo, Spain
| | - Eva Ciruelos
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Jose Juan Ponce
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - Ana Santaballa
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Manuel Valladares-Ayerbes
- Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - Vicente Alonso
- Instituto de Investigación Sanitaria de Aragón (IISA), Hospital Universitario Miguel Servet, Universidad de Zaragoza, Saragossa, Spain
| | - Jorge Aparicio
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Luis Robles
- Hospital Universitario, 12 de Octubre, Madrid, Spain
| | | | | | | | - Juan de la Haba-Rodriguez
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- Instituto Maimónides de Investigación Biomédica (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain
- Oncology Biomedical Research National Network (CIBERONC-ISCIII), Madrid, Spain
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Contreras-Toledo D, Jiménez-Fonseca P, López CL, Montes AF, López Muñoz AM, Vázquez Rivera F, Alonso V, Alcaide J, Salvà F, Covela Rúa M, Guillot M, Martín Carnicero A, Jimeno Mate R, Cameselle García S, Asensio Martínez E, González Astorga B, Fernandez-Diaz AB, González Villaroel P, Virgili Manrique AC, Melián Sosa M, Alonso B, Cousillas Castiñeiras A, Castañón López C, Aparicio J, Carmona-Bayonas A. Dynamic nature of BRAF or KRAS p.G12C mutations in second-line therapy for advanced colorectal cancer patients: do early and late effects exist? Br J Cancer 2024; 130:777-787. [PMID: 38191609 PMCID: PMC10912758 DOI: 10.1038/s41416-023-02563-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 12/08/2023] [Accepted: 12/19/2023] [Indexed: 01/10/2024] Open
Abstract
INTRODUCTION The mitogen-activated protein kinase (MAPK) signalling network aberrations in metastatic colorectal cancer (mCRC) generate intrinsic dynamic effects and temporal variations that are crucial but often overlooked in clinical trial populations. Here, we investigate the time-varying impact of MAPK pathway mutation genotype on each treatment line's contribution to the overall clinical course. METHODS The PROMETEO study focused on mCRC patients undergoing second-line treatment at 20 hospitals. We evaluated genotypes and employed flexible models to analyse the dynamic effect of each mutation. RESULTS We examined data derived from 1160 patients. The effects of KRAS G12C or G12V, and BRAF V600E are clearly time-varying, with unexpected consequences such as the deleterious effect of BRAF V600E vs other genotypes dissipating over time when subjects receive antiangiogenics, or KRAS G12V and G12C showing increasing aggressiveness over time. Thus, contrary to expectations, the 12-month survival rate from the second line for those who survived >6 months was 49.9% (95% CI, 32.7-67.3) for KRAS G12C and 59% (95% CI, 38.5-80.6) for BRAF V600E. CONCLUSIONS The dynamic perspective is essential for understanding the behaviour of tumours with specific genotypes, especially from the second line onward. This may be relevant in patient monitoring and treatment decision-making, particularly in cases with distinct mutations.
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Affiliation(s)
- Débora Contreras-Toledo
- Department of Medical Oncology, Hospital Universitario Central de Asturias, ISPA, Universidad de Oviedo, Oviedo, Spain.
| | - Paula Jiménez-Fonseca
- Department of Medical Oncology, Hospital Universitario Central de Asturias, ISPA, Universidad de Oviedo, Oviedo, Spain
| | - Carlos López López
- Department of Medical Oncology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria (UNICAN), Santander, Spain
| | - Ana Fernández Montes
- Department of Medical Oncology, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | | | - Francisca Vázquez Rivera
- Department of Medical Oncology, Hospital Universitario de Santiago, Santiago de Compostela, Spain
| | - Vicente Alonso
- Department of Medical Oncology, Hospital Universitario Miguel Servet, IISA, Zaragoza, Spain
| | - Julia Alcaide
- Department of Medical Oncology, Hospital Costa del Sol, Marbella, Medical Oncology Intercenter Unit, Hospital Universitario Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | - Francesc Salvà
- Department of Medical Oncology, Hospital Universitario Vall D'Hebrón, Vall D´Hebrón Institute of Oncology (VHIO), Barcelona, Spain
| | - Marta Covela Rúa
- Department of Medical Oncology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Mónica Guillot
- Department of Medical Oncology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Raquel Jimeno Mate
- Department of Medical Oncology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | | | | | | | | | | | | | - Marcos Melián Sosa
- Department of Medical Oncology, Instituto Valenciano de Oncología (IVO), Valencia, Spain
| | - Beatriz Alonso
- Department of Medical Oncology, Hospital Universitario de Canarias, Tenerife, Spain
| | | | | | - Jorge Aparicio
- Department of Medical Oncology, Hospital Universitario y Politécnico La Fe de Valencia, Valencia, Spain
| | - Alberto Carmona-Bayonas
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, Universidad de Murcia, IMIB, Murcia, Spain.
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Bellido-Castillo E, López-Sala A, Aparicio J, Cuadras D, Palacio-Navarro A. Verbal episodic memory in children undergoing temporal lobe epilepsy surgery: a one-year follow-up study. Rev Neurol 2024; 78:61-71. [PMID: 38289244 DOI: 10.33588/rn.7803.2022308] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Verbal episodic memory (VEM) is often unimpaired in children with focal epilepsy undergoing left temporal lobe resections, unlike what we might expect in the adult brain. The latter findings suggest that epileptiform activity in early life disrupts memory system lateralization, leading to the development of bilateral memory representation. The present study aims to analyze whether the laterality of epilepsy is a major predictor for post-operative VEM prognosis in pediatric temporal lobe epilepsy (TLE) surgery. This research also pretends to provide evidence about the relationship of VEM performance with other relevant demographical and clinical factors such as sex, age at onset of seizures, age at surgery and duration of epilepsy, as well as to study the impact of presurgical VEM performance on postsurgical outcomes. PATIENTS AND METHODS Pre-operative and one-year follow-up post-operative word-list recall scores from 25 children who underwent TLE surgery (left-sided, n = 11; right-sided, n = 14) were extracted from the Hospital Sant Joan de Deu database and were retrospectively analyzed. RESULTS No significant presurgical intergroup differences were found when comparing VEM scores by laterality of epilepsy (p > 0.5). Looking at the left TLE group, a high negative correlation was found between the onset age and the pre-operative long-term free recall score (rho = -0.72, p = 0.01). No significant pre- to post-operative intragroup changes were found regarding VEM performance, regardless of epilepsy laterality (left TLE group, p > 0.56; right TLE group, p > 0.12). CONCLUSIONS The laterality of epilepsy does not show to be a significant factor in and of itself regarding presurgical VEM outcome and its prognosis one year after surgery, thus supporting the bilateral memory representation hypothesis. Furthermore, a younger age at onset of seizures seems to be related with a better pre-operative VEM performance, likely due to a more efficient reorganization of memory system induced by a greater brain plasticity at lower ages; however, this relationship has been only reported for the left-sided epilepsies in our sample.
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Affiliation(s)
| | - A López-Sala
- Hospital Sant Joan de Déu, Esplugues de Llobregat, España
| | - J Aparicio
- Hospital Sant Joan de Déu, Esplugues de Llobregat, España
| | - D Cuadras
- Hospital Sant Joan de Déu, Esplugues de Llobregat, España
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Fernández Montes A, Alonso V, Aranda E, Élez E, García Alfonso P, Grávalos C, Maurel J, Vera R, Vidal R, Aparicio J. SEOM-GEMCAD-TTD clinical guidelines for the systemic treatment of metastatic colorectal cancer (2022). Clin Transl Oncol 2023; 25:2718-2731. [PMID: 37133732 PMCID: PMC10425293 DOI: 10.1007/s12094-023-03199-1] [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: 04/10/2023] [Accepted: 04/10/2023] [Indexed: 05/04/2023]
Abstract
Colorectal cancer (CRC) is the second leading cause of cancer deaths in Spain. Metastatic disease is present in 15-30% of patients at diagnosis and up to 20-50% of those with initially localized disease eventually develop metastases. Recent scientific knowledge acknowledges that this is a clinically and biologically heterogeneous disease. As treatment options increase, prognosis for individuals with metastatic disease has steadily improved over recent decades. Disease management should be discussed among experienced, multidisciplinary teams to select the most appropriate systemic treatment (chemotherapy and targeted agents) and to integrate surgical or ablative procedures, when indicated. Clinical presentation, tumor sidedness, molecular profile, disease extension, comorbidities, and patient preferences are key factors when designing a customized treatment plan. These guidelines seek to provide succinct recommendations for managing metastatic CRC.
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Affiliation(s)
- Ana Fernández Montes
- Medical Oncology Department, Complexo Hospitalario Universitario, Ourense (CHUO), C/ Ramón Puga, 56, 32005 Ourense, Spain
| | - Vicente Alonso
- Medical Oncology Department, Hospital Universitario Miguel Servet, Saragossa, Spain
| | - Enrique Aranda
- Medical Oncology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Elena Élez
- Medical Oncology Department, Hospital Universitario Vall D’Hebron, Barcelona, Spain
| | - Pilar García Alfonso
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Grávalos
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Joan Maurel
- Medical Oncology Department, Hospital Clínic, Barcelona, Spain
| | - Ruth Vera
- Medical Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Rosario Vidal
- Medical Oncology Department, Complejo Asistencial Universitario, Salamanca, Spain
| | - Jorge Aparicio
- Medical Oncology Department, Hospital Universitari I Politècnic la Fe, Valencia, Spain
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Muñoz AJ, Souto JC, Lecumberri R, Obispo B, Sanchez A, Aparicio J, Aguayo C, Gutierrez D, Palomo AG, Fanjul V, Del Rio-Bermudez C, Viñuela-Benéitez MC, Hernández-Presa MÁ. Development of a predictive model of venous thromboembolism recurrence in anticoagulated cancer patients using machine learning. Thromb Res 2023; 228:181-188. [PMID: 37348318 DOI: 10.1016/j.thromres.2023.06.015] [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: 10/27/2022] [Revised: 05/29/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Patients with cancer and venous thromboembolism (VTE) show a high risk of VTE recurrence during anticoagulant treatment. This study aimed to develop a predictive model to assess the risk of VTE recurrence within 6 months at the moment of primary VTE diagnosis in these patients. MATERIALS AND METHODS Using the EHRead® technology, based on Natural Language Processing (NLP) and machine learning (ML), the unstructured data in electronic health records from 9 Spanish hospitals between 2014 and 2018 were extracted. Both clinically- and ML-driven feature selection were performed to identify predictors for VTE recurrence. Logistic regression (LR), decision tree (DT), and random forest (RF) algorithms were used to train different prediction models, which were subsequently validated in a hold-out data set. RESULTS A total of 16,407 anticoagulated cancer patients with diagnosis of VTE were identified (54.4 % male and median age 70). Deep vein thrombosis, pulmonary embolism and metastases were observed in 67.2 %, 26.6 %, and 47.7 % of the patients, respectively. During the study follow-up, 11.4 % of the patients developed a recurrent VTE, being more frequent in patients with lung cancer. Feature selection and model training based on ML identified primary pulmonary embolism, deep vein thrombosis, metastasis, adenocarcinoma, hemoglobin and serum creatinine levels, platelet and leukocyte count, family history of VTE, and patients' age as predictors of VTE recurrence within 6 months of VTE diagnosis. The LR model had an AUC-ROC (95 % CI) of 0.66 (0.61, 0.70), the DT of 0.69 (0.65, 0.72) and the RF of 0.68 (0.63, 0.72). CONCLUSIONS This is the first ML-based predictive model designed to predict 6-months VTE recurrence in patients with cancer. These results hold great potential to assist clinicians to identify the high-risk patients and improve their clinical management.
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Affiliation(s)
- Andres J Muñoz
- Gregorio Marañón Health Research Institute, Complutense University, Madrid, Spain.
| | - Juan Carlos Souto
- Hematology Department, Santa Creu I Sant Pau Hospital, Barcelona, Spain
| | - Ramón Lecumberri
- Hematology Service, Clínica Universidad de Navarra, Pamplona, Spain; CIBERCV, Carlos III Health Institute, Madrid, Spain
| | - Berta Obispo
- Oncology Department, Infanta Leonor Hospital, Madrid, Spain
| | - Antonio Sanchez
- Oncology Department, Puerta de Hierro Hospital, Madrid, Spain
| | - Jorge Aparicio
- Oncology Department, Polytechnic and University Hospital of La Fé, Valencia, Spain
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Condominas E, Migliorelli C, Bachiller A, Aparicio J, San Antonio-Arce MV, Mananas MA. Evaluation of connectivity measures to identify Seizure Onset and Propagation Zones in Refractory Epilepsy: A Case study with two different Post- Surgical Outcomes . Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-4. [PMID: 38083084 DOI: 10.1109/embc40787.2023.10340078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
High Frequency Oscillations (HFO) have been found very useful in refractory epilepsy. They have been used to identify the epileptogenic zone and as a promising clinical biomarker for presurgical evaluation in childhood epilepsy. There is controversy about whether there is a spread of HFOs and their propagation. Some researchers reinforce the idea of dealing with epilepsy as a network disorder, so the fact of propagation can promote this research. The hypothesis of this study is that connectivity methods can be useful to detect the seizure onset and propagation zones. Methodology has been applied to two cases where the clinical outcomes after surgery were free of seizures and not free. Promising results were obtained to understand both situations. A future study with more cases is necessary to obtain strong conclusions.Clinical Relevance- This exploratory study shows the relationship between connectivity measures and the propagation of HFOs and this can be useful to know the epileptogenic function of these waves that, nowadays, are unknown. Connectivity features in conjunction with other multivariate estimators can be a tool to help in identifying the regions of interest in refractory epilepsy.
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Boormans J, Sylvester RJ, Anson-Cartwright L, Glicksman R, Hamilton RJ, Daugaard G, Lauritsen J, Wagner T, Avuzzi B, Nicolai N, Aparicio J, Garcia del Muro X, Laguna P. European Association of Urology (EAU) Testicular Cancer Guidelines Panel: A new prognostic factor risk group classification for patients with clinical stage 1 seminoma in active surveillance. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.410] [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: 03/18/2023] Open
Abstract
410 Background: Between 4%- 30% of patients with clinical stage 1 (CS I) seminoma testis (ST) in active surveillance (AS) relapse depending on pathological risk factors tumor size (TS) and rete testis invasion (RTI). The level of evidence supporting these pathological risk factors in clinical decision-making is low due to heterogeneous study design and reporting and the difficulty to analyze patient subgroups according to combination of these factors. The objectives of the present study were to identify the most important pathological prognostic factors predicting relapse in CS I seminoma patients with normal post-orchidectomy serum tumor marker (STM) levels in AS and to construct risk-groups for guiding treatment decision-making and follow-up. Methods: Individual patient data from 1016 CS I-ST patients diagnosed between February 1994 and January 2019 in AS were collected from 9 institutions. Central pathology review was not routinely performed in all institutions; therefore, pagetoid and stromal RTI were not differentiated explicitly in most cases. Assessing patient age, pre-orchidectomy STM b-human chorionic gonadotropin and lactate dehydrogenase, pathological TS, RTI, lympho-vascular invasion (LVI), multi-focality, and GCNIS, multivariable Cox proportional hazards regression models were fit to identify the most important prognostic factors for the time to first relapse by imaging and/or markers (primary endpoint). Probabilities of relapse were estimated using Kaplan-Meier curves. Results: After median follow-up of 7.7 years, 149 (14.7%) patients relapsed, 104 identified by imaging alone, 44 by imaging with elevated STMs and 1 by elevated STMs alone. Excluding 18 patients with unknown LVI from the multivariable analyses, TS (≤ 2 cm, between 2 and 5 cm, > 5 cm), presence of RTI and presence of LVI were used to form three risk groups: very low, low and high-risk (Table). Five-years probability of relapse varied from 8% in the very low risk-group to 44% in the high risk-group. The new model outperformed the current model with TS < 4cm vs ≥ 4 and RTI (Harrell's C index 0.65 vs 0.61) and identifies a subgroup of patients with a higher risk of relapse. Conclusions: The new risk-group stratification for CS I -ST patients in AS outperforms the histopathological model based on TS and RTI. It will serve to better inform patients on the risk of relapse during follow-up after orchidectomy but requires an independent validation. [Table: see text]
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Affiliation(s)
| | | | | | | | | | - Gedske Daugaard
- University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | | | - Thomas Wagner
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Barbara Avuzzi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nicola Nicolai
- Urology Unit - Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Jorge Aparicio
- Hospital Universitario y Politecnico La Fe, Valencia, Spain
| | | | - Pilar Laguna
- Istanbul Medipol University, Dept urology, Istanbul, Turkey
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10
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Okuno K, Kandimalla R, Mendiola M, Balaguer F, Bujanda L, Fernandez-Martos C, Aparicio J, Feliu J, Tokunaga M, Kinugasa Y, Maurel J, Goel A. A microRNA signature for risk-stratification and response prediction to FOLFOX-based adjuvant therapy in stage II and III colorectal cancer. Mol Cancer 2023; 22:13. [PMID: 36670412 PMCID: PMC9854096 DOI: 10.1186/s12943-022-01699-2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 12/08/2022] [Indexed: 01/22/2023] Open
Affiliation(s)
- Keisuke Okuno
- grid.410425.60000 0004 0421 8357Department of Molecular Diagnostics and Experimental Therapeutics, Beckman Research Institute of City of Hope, Biomedical Research Center, 1218 S. Fifth Avenue, Suite 2226, Monrovia, CA 91016 USA ,grid.265073.50000 0001 1014 9130Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Raju Kandimalla
- grid.411588.10000 0001 2167 9807Center for Gastrointestinal Research; Center for Translational Genomics and Oncology, Baylor Scott & White Research Institute, Charles A Sammons Cancer Center, Baylor University Medical Center, Dallas, TX USA
| | - Marta Mendiola
- grid.5515.40000000119578126Department of Medical Oncology, La Paz University Hospital (IdiPAZ), CIBERONC, cátedra UAM-AMGEN, Madrid, Spain
| | - Francesc Balaguer
- grid.5841.80000 0004 1937 0247Department of Gastroenterology, Hospital Clinic de Barcelona, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Luis Bujanda
- grid.11480.3c0000000121671098Department of Gastroenterology, Instituto Biodonostia, CIBERehd, Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
| | | | - Jorge Aparicio
- grid.84393.350000 0001 0360 9602Department of Medical Oncology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Jaime Feliu
- grid.5515.40000000119578126Department of Medical Oncology, La Paz University Hospital (IdiPAZ), CIBERONC, cátedra UAM-AMGEN, Madrid, Spain
| | - Masanori Tokunaga
- grid.265073.50000 0001 1014 9130Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yusuke Kinugasa
- grid.265073.50000 0001 1014 9130Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Joan Maurel
- grid.10403.360000000091771775Translational Genomics and Targeted Therapies Group. Medical Oncology, Hospital Clinic of Barcelona, CIBERehd, IDIBAPS, Villarroel 170, 08036 Barcelona, Spain
| | - Ajay Goel
- grid.410425.60000 0004 0421 8357Department of Molecular Diagnostics and Experimental Therapeutics, Beckman Research Institute of City of Hope, Biomedical Research Center, 1218 S. Fifth Avenue, Suite 2226, Monrovia, CA 91016 USA ,grid.411588.10000 0001 2167 9807Center for Gastrointestinal Research; Center for Translational Genomics and Oncology, Baylor Scott & White Research Institute, Charles A Sammons Cancer Center, Baylor University Medical Center, Dallas, TX USA ,grid.410425.60000 0004 0421 8357City of Hope Comprehensive Cancer Center, Duarte, CA USA
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Valladares-Ayerbes M, Garcia-Alfonso P, Muñoz Luengo J, Pimentel Caceres PP, Castillo Trujillo OA, Vidal-Tocino R, Llanos M, Llorente Ayala B, Limon Miron ML, Salud A, Cirera Nogueras L, Garcia-Carbonero R, Safont MJ, Falco Ferrer E, Aparicio J, Vicente Conesa MA, Guillén-Ponce C, Garcia-Teijido P, Medina Magan MB, Busquier I, Salgado M, Lloansí Vila A. Evolution of RAS Mutations in Cell-Free DNA of Patients with Tissue RAS Wild-Type Metastatic Colorectal Cancer Receiving First-Line Treatment: The PERSEIDA Study. Cancers (Basel) 2022; 14:6075. [PMID: 36551560 PMCID: PMC9776941 DOI: 10.3390/cancers14246075] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
The serial analysis of cell-free DNA (cfDNA) enables minimally invasive monitoring of tumor evolution, providing continuous genetic information. PERSEIDA was an observational, prospective study assessing the cfDNA RAS (KRAS/NRAS) mutational status evolution in first-line, metastatic CRC, RAS wild-type (according to baseline tumor tissue biopsy) patients. Plasma samples were collected before first-line treatment, after 20 ± 2 weeks, and at disease progression. One hundred and nineteen patients were included (102 received panitumumab and chemotherapy as first-line treatment-panitumumab subpopulation). Fifteen (12.6%) patients presented baseline cfDNA RAS mutations (n = 14 [13.7%], panitumumab subpopulation) (mutant allele fraction ≥0.02 for all results). No patients presented emergent mutations (cfDNA RAS mutations not present at baseline) at 20 weeks. At disease progression, 11 patients (n = 9; panitumumab subpopulation) presented emergent mutations (RAS conversion rate: 19.0% [11/58]; 17.7% [9/51], panitumumab subpopulation). In contrast, three (5.2%) patients presenting baseline cfDNA RAS mutations were RAS wild-type at disease progression. No significant associations were observed between overall response rate or progression-free survival and cfDNA RAS mutational status in the total panitumumab subpopulation. Although, in patients with left-sided tumors, a significantly longer progression-free survival was observed in cfDNA RAS wild-type patients compared to those presenting cfDNA RAS mutations at any time. Continuous evaluation of RAS mutations may provide valuable insights on tumor molecular dynamics that can help clinical practice.
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Affiliation(s)
| | | | | | | | | | | | - Marta Llanos
- Hospital Universitario de Canarias, 38320 San Cristóbal de La Laguna, Spain
| | | | | | - Antonieta Salud
- Hospital Universitario Arnau de Vilanova, 25198 Lleida, Spain
| | | | | | | | | | - Jorge Aparicio
- Hospital Universitari i Politècnic La Fe, 46026 València, Spain
| | | | | | | | | | - Isabel Busquier
- Consorcio Hospitalario Provincial de Castellón, 12002 Castellón de la Plana, Spain
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12
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Aparicio J, Virgili Manrique AC, Capdevila J, Muñoz Boza F, Galván P, Richart P, Oliveres H, Páez D, Hernando J, Serrano S, Vera R, Hernandez-Yagüe X, Gallego RÁ, Riesco-Martinez MC, García de Albeniz X, Maurel J. Randomized phase II trial of FOLFIRI-panitumumab compared with FOLFIRI alone in patients with RAS wild-type circulating tumor DNA metastatic colorectal cancer beyond progression to first-line FOLFOX-panitumumab: the BEYOND study (GEMCAD 17-01). Clin Transl Oncol 2022; 24:2155-2165. [PMID: 35761123 PMCID: PMC9522782 DOI: 10.1007/s12094-022-02868-x] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/27/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Panitumumab plus FOLFOX (P-FOLFOX) is standard first-line treatment for RAS wild-type (WT) metastatic colorectal cancer. The value of panitumumab rechallenge is currently unknown. We assessed addition of panitumumab to FOLFIRI (P-FOLFIRI) beyond progression to P-FOLFOX in patients with no RAS mutations in liquid biopsy (LB). METHODS In this randomized phase II trial, patients were assigned (3:2 ratio) to second-line P-FOLFIRI (arm A) or FOLFIRI alone (arm B). LB for circulating tumor DNA analysis was collected at study entry and at disease progression. Primary endpoint was 6-month progression-free survival. Two-stage Simon design required 85 patients to be included (EudraCT 2017-004519-38). RESULTS Between February 2019 and November 2020, 49 patients were screened (16 RAS mutations in LB detected) and 31 included (18 assigned to arm A and 13 to arm B). The study was prematurely closed due to inadequate recruitment. Serious adverse events were more frequent in arm A (44% vs. 23%). Overall response rate was 33% (arm A) vs. 7.7% (arm B). Six-month progression-free survival rate was 66.7% (arm A) and 38.5% (arm B). Median progression-free survival was 11.0 months (arm A) and 4.0 months (arm B) (hazard ratio, 0.58). At disease progression, RAS or BRAF mutations in LB were found in 4/11 patients (36%) in arm A and 2/10 (20%) in arm B. CONCLUSIONS The BEYOND study suggests a meaningful benefit of P-FOLFIRI beyond progression to P-FOLFOX in metastatic colorectal cancer patients with WT RAS status selected by LB. This strategy deserves further investigation.
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Affiliation(s)
- Jorge Aparicio
- Medical Oncology Department, Hospital Universitari i Politècnic La Fe, Avda. Abril Martorell 106, 46026, Valencia, Spain.
| | | | - Jaume Capdevila
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall Hebron Institute of Oncology (VHIO), Barcelona, Spain
- IOB-Teknon, Barcelona, Spain
| | - Félix Muñoz Boza
- Medical Oncology Department, Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Patricia Galván
- Translational Genomics and Targeted Therapies in Solid Tumors, Medical Oncology Department, Hospital Clínic de Barcelona, C/ Villaroel, 170, 08036, Barcelona, Spain
| | - Paula Richart
- Medical Oncology Department, Hospital Universitari i Politècnic La Fe, Avda. Abril Martorell 106, 46026, Valencia, Spain
| | - Helena Oliveres
- Translational Genomics and Targeted Therapies in Solid Tumors, Medical Oncology Department, Hospital Clínic de Barcelona, C/ Villaroel, 170, 08036, Barcelona, Spain
| | - David Páez
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jorge Hernando
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Sara Serrano
- Medical Oncology Department, Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Ruth Vera
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - Rafael Álvarez Gallego
- Medical Oncology Department, Hospital Madrid Norte San Chinarro-Centro Integral Oncologico Clara Campal, Madrid, Spain
| | | | | | - Joan Maurel
- Translational Genomics and Targeted Therapies in Solid Tumors, Medical Oncology Department, Hospital Clínic de Barcelona, C/ Villaroel, 170, 08036, Barcelona, Spain.
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13
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Valladares M, Safont Aguileria M, González-Flores E, García Alfonso P, López Muñoz A, Aranda Aguilar E, Falco Ferrer E, Rodriguez-Salas N, Cirera L, Llanos-Munoz M, Aparicio J, Pimentel P, Castillo Trujillo A, Salgado Fernandez M, Salud Salvia M, Vidal Tocino R, Massuti Sureda B, Garcia-Carbonero R, Vicente Conesa M, Lloansi Vila A. 382P Sequential RAS mutation status evaluation in circulating free DNA (cfDNA) in RAS wild type (wt) metastatic colorectal cancer (mCRC) patients (pt) starting first-line (1L) treatment with panitumumab (P) and chemotherapy (CT). PERSEIDA (Idylla Cohort) study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.520] [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: 11/01/2022] Open
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14
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Muñoz Martín AJ, Palacios ML, Souto JC, Obispo B, Aparicio J, Garcia-Palomo A, Sanchez A, Aguayo C, Gutierrez Abad D, Viñuela-Benéitez MC, Benavent D, Taberna M, Arumi D, Hernández-Presa MÁ. Predicting major bleeding events in anticoagulated cancer patients with venous thromboembolism using real-world data and machine learning. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18744] [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
e18744 Background: Evidence regarding the clinical predictors of bleeding risk in patients with cancer and venous thromboembolism (VTE) is lacking. Our aim was to develop a predictive model to assess the risk of major bleeding (MB) in anticoagulant-treated patients with active cancer during the first 6 months following VTE diagnosis. Methods: Observational, retrospective, and multicenter study based on the secondary analysis of unstructured clinical data in electronic health records (EHRs). Using the EHRead technology, based on Natural Language Processing (NLP) and machine learning (ML), data were collected from EHRs from 9 Spanish hospitals between 2014 and 2018. The study population comprised all adult cancer patients with a diagnosis of VTE under anticoagulant treatment and no history of MB. This population was downsampled to prevent bias and class imbalance. A total of 94 patient characteristics were explored, and Random Forest (RF) feature selection was performed to identify the most relevant predictors. Multiple algorithms were used to train different prediction models, which were subsequently validated in a hold-out dataset. The model with the best performance metrics (i.e., ROC-AUC) was selected as the final model. Results: Among a source population of 2,893,208 patients, 21,227 anticoagulant-treated patients with VTE and active cancer were identified from EHRs. Of these, 53.9% men, with a median age (Q1, Q3) of 70 (59,80) years. The median duration of follow up across all patients was 0.7 (0.11, 2.03) years. During the study period, estimated in-hospital prevalence of cancer-related VTE was 5.8 %. The most common type of VTE at baseline was deep vein thrombosis (68.2 % of patients), followed by pulmonary embolism (28.4%). The most frequent primary cancers were colorectal (10.1%) and lung cancer (8.5 %). Of all trained and validated models, the RF approach yielded the best performance, with a ROC-AUC = 0.7. The following predictors of MB were identified: hemoglobin levels, presence of metastasis, patient’s age, platelet count, leukocyte count, and serum creatinine levels. Conclusions: This is the first multicenter study to use NLP to extract the unstructured information from EHRs to develop a predictive model for MB in anticoagulated cancer patients with VTE. These results may improve the prevention and management of bleeding in these patients.
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Affiliation(s)
- Andrés J. Muñoz Martín
- Instituto Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | | | | | - Berta Obispo
- Department of Medical Oncology. Infanta Leonor University Hospital, Madrid, Spain
| | - Jorge Aparicio
- Hospital Universitario y Politecnico de La Fe, Valencia, Spain
| | | | - Antonio Sanchez
- Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
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15
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Muñoz Martín AJ, Huerga Domínguez S, Souto JC, Rogado Revuelta J, Sanchez A, Garcia-Palomo A, Aparicio J, Aguayo C, Gutierrez Abad D, Ortega L, Viñuela-Benéitez MC, Fanjul V, Casadevall D, Arumi D, Hernández-Presa MÁ. Predicting recurrence of venous thromboembolism in anticoagulated cancer patients using real-world data and machine learning. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18742] [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
e18742 Background: The clinical predictors of venous thromboembolism (VTE) recurrence in patients with cancer are not well known. Our objective was to develop a predictive model for risk of VTE recurrence in anticoagulant-treated cancer patients within the first 6 months following VTE diagnosis. Methods: Using the EHRead technology, based on Natural Language Processing (NLP) and machine learning (ML), the unstructured clinical data in EHRs from 9 Spanish hospitals between 2014 and 2018 was extracted and analyzed. The study population, comprising all adult anticoagulated cancer patients with VTE, was downsampled to prevent bias and class imbalance. A total of 94 patient characteristics were explored, and Random Forest (RF) feature selection was performed to identify the most relevant predictors for VTE recurrence. Multiple algorithms were used to train different prediction models, which were subsequently validated in a hold-out dataset. The model with the best performance metrics (i.e., ROC-AUC) was selected as the final model. Results: From a source population of 2,893,208 patients, 21,227 anticoagulant-treated patients with VTE and active cancer (53.9% male, median age of 70 years) were identified. Across the study period, yearly incidence of VTE remained relatively stable, ranging from 2.7 to 3.9%. The most common type of VTE was deep vein thrombosis (68.2% of patients), followed by pulmonary embolism (28.4%). Regarding primary cancer locations, the most frequent were colorectal (10.1%) and lung cancer (8.5%). Of all trained and validated models, the RF approach yielded the best performance, with a ROC-AUC = 0.72. The following predictors of VTE recurrence were identified: pulmonary embolism, deep vein thrombosis, metastasis, adenocarcinoma, hemoglobin values, serum creatinine values, platelet count, leukocyte count, family history of VTE, and patients’ age. Conclusions: Using NLP and ML, we were able to use the real-world data in EHRs to build a predictive model of VTE recurrence in cancer patients based on individual clinical features. These results may improve the clinical management of VTE recurrence in this population.
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Affiliation(s)
- Andrés J. Muñoz Martín
- Instituto Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | | | | | | | - Antonio Sanchez
- Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | - Jorge Aparicio
- Hospital Universitario y Politecnico de La Fe, Valencia, Spain
| | | | | | - Laura Ortega
- Instituto Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
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Martín AM, Lecumberri R, Souto J, Aparicio J, Obispo B, Sanchez A, Aguayo C, Gutiérrez D, Viñuela-Benéitez M, Menke S, Casero H, Arumí D, Hernández-Presa MÁ. PO-57: Venous thromboembolism recurrence during anticoagulant treatment in gastrointestinal cancer patients. Thromb Res 2022. [DOI: 10.1016/s0049-3848(22)00247-x] [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: 11/30/2022]
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17
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Bastida G, Marín-Jiménez I, Forés A, García-Planella E, Argüelles-Arias F, Tagarro I, Fernandez-Nistal A, Montoto C, Aparicio J, Aguas M, Santos-Fernández J, Boscá-Watts MM, Ferreiro-Iglesias R, Merino O, Aldeguer X, Cortés X, Sicilia B, Mesonero F, Barreiro-de Acosta M. Treatment patterns and intensification within 5 year of follow-up of the first-line anti-TNFα used for the treatment of IBD: Results from the VERNE study. Dig Liver Dis 2022; 54:76-83. [PMID: 34244110 DOI: 10.1016/j.dld.2021.06.005] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/24/2021] [Accepted: 06/06/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Anti-TNFα represent one of the main treatment approaches for the management of inflammatory bowel diseases (IBD). Therefore,the evaluation of their treatment patterns over time provides valuable insights about the clinical value of therapies and associated costs. AIMS To assess the treatment patterns with the first anti-TNFα in IBD. METHODS Retrospective, observational study. RESULTS 310 IBD patients were analyzed along a 5-year follow-up period. 56.2% of Crohn's disease (CD) patients started with adalimumab (ADA), while 43.8% started with infliximab (IFX). 12.9% of ulcerative colitis (UC) patients initiated with ADA, while 87.1% initiated with IFX. Treatment intensification was required in 28.9% of CD and 37.1% of UC patients. Median time to treatment intensification was shorter in UC than in CD (5.3 vs. 14.3 months; p = 0.028). Treatment discontinuation due to reasons other than remission were observed in 40.7% of CD and 40.5% of UC patients, although, in UC patients there was a trend to lower discontinuation rates with IFX (36.6%) than with ADA (66.7%). Loss of response accounted for approximately one-third of discontinuations, in both CD and UC. CONCLUSIONS Around one-third of IBD biologic-naive patients treated with an anti-TNFα required treatment intensification (earlier in UC) and around 40% discontinued the anti-TNFα due to inappropriate disease control.
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Affiliation(s)
- G Bastida
- Department of Gastroenterology, Hospital La Fe, Valencia, Spain.
| | - I Marín-Jiménez
- Department of Gastroenterology, Hospital Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - A Forés
- Hospital General Universitario de Castellón, Castellón, Spain
| | | | | | - I Tagarro
- Takeda Farmacéutica España S.A., Madrid, Spain
| | | | - C Montoto
- Takeda Farmacéutica España S.A., Madrid, Spain
| | - J Aparicio
- Takeda Farmacéutica España S.A., Madrid, Spain
| | - M Aguas
- Department of Gastroenterology, Hospital La Fe, Valencia, Spain
| | - J Santos-Fernández
- Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain
| | - M M Boscá-Watts
- IBD Unit, Gastroenterology Department of the University Clinic Hospital of Valencia, Valencia, Spain
| | - R Ferreiro-Iglesias
- Department of Gastroenterology, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - O Merino
- Department of Gastroenterology, Hospital Universitario Cruces, Bilbao, Spain
| | - X Aldeguer
- Department of Gastroenterology, Hospital Dr Josep Trueta, Girona, Spain
| | - X Cortés
- IBD Unit, Gastroenterology Section, Internal Medicine Hospital of Sagunto, Sagunto, Spain; University of Cardenal Herrera-CEU, Castellón, Spain
| | - B Sicilia
- Hospital Universitario de Burgos, Burgos, Spain
| | - F Mesonero
- Gastroenterology Department, Hospital Ramón y Cajal, Madrid, Spain
| | - M Barreiro-de Acosta
- Department of Gastroenterology, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
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Aparicio J, Manrique AV, Capdevila J, Boza FM, Galván P, Richart P, Oliveres H, Paez D, Hernando J, Serrano SG, Vera R, Hernandez X, Gallego RA, Riesco-Martinez M, García de Albeniz X, Maurel J. 416P Randomized phase II trial of second-line FOLFIRI-panitumumab vs FOLFIRI alone in Ras wild type (wt) metastatic colorectal cancer (mCRC) patients beyond progression to first-line FOLFOX-panitumumab: BEYOND study (GEMCAD 17-01). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.937] [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: 11/25/2022] Open
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Longo F, Jorge M, Yaya R, Montes AF, Lago NM, Brozos E, Aparicio J, Quintero G, Ceballos E, Buxó E, Lopez AM, Pellón ML, Molina R, Diaz-Paniagua L, Cerdà P, Leiva PL, Carnicero AM, Cousillas A, Paris L, García-Paredes B, Romero C, Ortega M, Molero A, la Torre SD, Jen MH, Díaz-Cerezo S. Real-life use of ramucirumab in gastric cancer in Spain: the RAMIS study. Future Oncol 2021; 17:1777-1791. [PMID: 33590772 DOI: 10.2217/fon-2020-1216] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Aims: To obtain real-world data on ramucirumab use and effectiveness for the treatment of advanced gastric cancer (AGC) or gastroesophageal junction adenocarcinoma (GEJ). Methods: Observational, retrospective study carried out in 20 Spanish hospitals, in patients who started ramucirumab treatment between December 2015 and December 2018. Descriptive analysis was conducted for patient characteristics, treatment patterns and effectiveness outcomes. Results: Three hundred seventeen patients were included (93.7% treated with ramucirumab-paclitaxel and 6.3% with ramucirumab); age 62.5 (11.3) years; 66.9% male. Median progression-free survival and overall survival were 3.9 months (95% CI: 3.4-4.3) and 7.4 (95% CI: 6.4-8.9) in combination regimen and 2.0 (1.1-2.8) and 4.3 (95% CI: 1.9-7.3) in monotherapy, respectively. Conclusion: The study findings were consistent with available real-world studies and randomized clinical trials.
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Affiliation(s)
- Federico Longo
- Hospital Universitario Ramón y Cajal, IRYCIS, CIBERONC, Madrid, 28034, Spain
| | - Mónica Jorge
- Hospital Álvaro Cunqueiro, Vigo (Pontevedra), 36213, Spain
| | - Ricardo Yaya
- Instituto Valenciano de Oncología (IVO), Valencia, 46009, Spain
| | | | | | - Elena Brozos
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela (La Coruña), 15706, Spain
| | - Jorge Aparicio
- Hospital Universitario y Politécnico La Fe, Valencia, 46026, Spain
| | | | | | - Elvira Buxó
- Hospital Quirón Salud, Barcelona, 08023, Spain
| | | | - Maria Luz Pellón
- Complexo Universitario Hospitalario de El Ferrol (La Coruña), 15405, Spain
| | - Raquel Molina
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares (Madrid), 28805, Spain
| | | | - Paula Cerdà
- Centro Médico Teknon, Barcelona, 08022, Spain
| | | | | | - Antía Cousillas
- Complexo Universitario Hospitalario de Pontevedra, 36071, Spain
| | - Lorena Paris
- Centro Oncológico de Galicia, La Coruña, 15009, Spain
| | | | | | - María Ortega
- Department of Medical, Lilly, Madrid, 28108, Spain
| | | | | | - Min-Hua Jen
- European Statistics Group, Lilly, Surrey, GU206PH, UK
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Aparicio J. Recent treatment advances in clinical stage i nonseminomatous germ cell tumors. Actas Urol Esp 2021; 45:326-327. [PMID: 33622525 DOI: 10.1016/j.acuro.2020.08.014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/22/2020] [Indexed: 11/29/2022]
Affiliation(s)
- J Aparicio
- Servicio de Oncología Médica, Hospital Universitario y Politécnico La Fe, Valencia, España.
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21
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Seidel C, Daugaard G, Nestler T, Tryakin A, Fedyanin M, Fankhauser CD, Hermanns T, Aparicio J, Heinzelbecker J, Paffenholz P, Heidenreich A, De Giorgi U, Cathomas R, Lorch A, Fingerhut A, Gayer F, Bremmer F, Giannatempo P, Necchi A, Raggi D, Aurilio G, Casadei C, Hentrich M, Tran B, Dieckmann KP, Brito M, Ruf C, Mazzocca A, Vincenzi B, Stahl O, Bokemeyer C, Oing C. The prognostic significance of lactate dehydrogenase levels in seminoma patients with advanced disease: an analysis by the Global Germ Cell Tumor Collaborative Group (G3). World J Urol 2021; 39:3407-3414. [PMID: 33683412 PMCID: PMC8510898 DOI: 10.1007/s00345-021-03635-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/05/2021] [Indexed: 01/01/2023] Open
Abstract
Purpose The prognostic significance of lactate dehydrogenase (LDH) in patients with metastatic seminoma is not defined. We investigated the prognostic impact of LDH levels prior to first-line systemic treatment and other clinical characteristics in this subset of patients. Methods Files from two registry studies and one single-institution database were analyzed retrospectively. Uni- and multivariate analyses were conducted to identify patient characteristics associated with recurrence free survival (RFS), overall survival (OS), and complete response rate (CRR). Results The dataset included 351 metastatic seminoma patients with a median follow-up of 5.36 years. Five-year RFS, OS and CRR were 82%, 89% and 52%, respectively. Explorative analysis revealed a cut-off LDH level of < 2.5 upper limit of normal (ULN) (n = 228) vs. ≥ 2.5 ULN (n = 123) to be associated with a significant difference concerning OS associated with 5-years OS rates of 93% vs. 83% (p = 0.001) which was confirmed in multivariate analysis (HR 2.87; p = 0.004). Furthermore, the cut-off LDH < 2.5 ULN vs. ≥ 2.5 ULN correlated with RFS and CRR associated with a 5-years RFS rate and CRR of 76% vs. 86% (p = 0.012) and 32% vs. 59% (p ≤ 0.001), respectively. Conclusions LDH levels correlate with treatment response and survival in metastatic seminoma patients and should be considered for their prognostic stratification.
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Affiliation(s)
- Christoph Seidel
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Tim Nestler
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| | - Alexey Tryakin
- Department of Clinical Pharmacology and Chemotherapy, N. N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | - Mikhail Fedyanin
- Department of Clinical Pharmacology and Chemotherapy, N. N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | | | | | - Jorge Aparicio
- Medical Oncology Department, Hospital La Fe - On behalf of the Spanish Germ Cell Cancer Group, Valencia, Spain
| | | | - Pia Paffenholz
- Department of Urology, University Hospital Cologne, Cologne, Germany.,Department of Urology, Medical University Vienna, Vienna, Austria
| | - Axel Heidenreich
- Department of Urology, Uro-Onology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura Dei Tumori (IRST) IRCCS - On behalf of the Italian Germ Cell Cancer Group (IGG), Meldola, Italy
| | - Richard Cathomas
- Department of Oncology/Hematology, Kantonsspital Graubünden, Chur, Switzerland
| | - Anja Lorch
- Department of Oncology and Hematology, University Hospital Zürich, Zurich, Switzerland.,Department of Urology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Anna Fingerhut
- Department of Urology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Fabian Gayer
- Department of Urology, University Clinic Göttingen, Göttingen, Germany
| | - Felix Bremmer
- Department of Pathology, University Clinic Göttingen, Göttingen, Germany
| | | | - Andrea Necchi
- Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniele Raggi
- Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Gaetano Aurilio
- Medical Division of Urogenital and Head and Neck Cancer, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Chiara Casadei
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura Dei Tumori (IRST) IRCCS - On behalf of the Italian Germ Cell Cancer Group (IGG), Meldola, Italy
| | - Marcus Hentrich
- Department of Hematology and Oncology, Red Cross Hospital, University of Munich, Munich, Germany
| | - Ben Tran
- Peter MacCallum Cancer Centre, Melbourne, Australia.,Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | | | - Margarido Brito
- Instituto Português de Oncologia de Lisboa, Lisboa, Portugal
| | - Christian Ruf
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| | | | | | - Olof Stahl
- SWENOTECA, Trondheim, Norway.,Department of Oncology, Skane University Hospital, Lund, Sweden
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Christoph Oing
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Mildred Scheel Career Center HaTriCS4, University Medical Center Eppendorf, Hamburg, Germany
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Aparicio J, Esposito F, Serrano S, Falco E, Escudero P, Ruiz-Casado A, Manzano H, Fernandez-Montes A. Metastatic Colorectal Cancer. First Line Therapy for Unresectable Disease. J Clin Med 2020; 9:E3889. [PMID: 33265959 PMCID: PMC7761096 DOI: 10.3390/jcm9123889] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 01/09/2023] Open
Abstract
Colorectal cancer (CRC) is a commonly diagnosed malignancy. The prognosis of patients with unresectable, metastatic colorectal cancer (mCRC) is dismal and medical treatment is mainly palliative in nature. Although chemotherapy remains the backbone of treatment, the landscape is changing with the understanding of its heterogeneity and molecular biology. First-line therapy relies on a combination of chemotherapy and targeted therapies, according to clinical patient characteristics and tumor molecular profile. Here we review current evidence from randomized clinical trials for using chemotherapy doublets or triplets, and for the addition of bevacizumab or anti-epidermal growth factor receptor (EGFR) agents. Novel therapies developed for small, selected populations are also discussed.
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Affiliation(s)
- Jorge Aparicio
- Department of Medical Oncology, Hospital Universitario y Politecnico La Fe, E-46007 Valencia, Spain
| | - Francis Esposito
- Department of Medical Oncology, Hospital Clinic, E-08041 Barcelona, Spain;
| | - Sara Serrano
- Department of Medical Oncology, Hospital Universitario Sant Joan de Reus, E-43204 Reus, Spain;
| | - Esther Falco
- Department of Medical Oncology, Hospital Son Llatzer, E-07004 Palma de Mallorca, Spain;
| | - Pilar Escudero
- Department of Medical Oncology, Hospital Clínico Universitario Lozano Blesa, E-50002 Zaragoza, Spain;
| | - Ana Ruiz-Casado
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro, E-28220 Madrid, Spain;
| | - Hermini Manzano
- Department of Medical Oncology, Hospital Quirón Salud Palmaplanas, E-07004 Palma de Mallorca, Spain;
| | - Ana Fernandez-Montes
- Department of Medical Oncology, Complejo Hospitalario de Orense, E-32001 Orense, Spain;
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Pedraja J, Maestre J, Rabanal J, Morales C, Aparicio J, del Moral I. Role of 3D printing in the protection of surgical and critical care professionals in the COVID-19 pandemic. Revista Española de Anestesiología y Reanimación (English Edition) 2020. [PMCID: PMC7546187 DOI: 10.1016/j.redare.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gomez OH, Soto VH, Machado I, Mendez M, Cuatrecasas M, Horndler C, Vermeulen L, Hoorn ST, Mendiola M, Martín-Richard M, Ruiz-Casado A, Galvez E, Aparicio J, García IS, Leno R, Fernández-Martos C, Alonso-Orduna V, Montes AF, Maurel J, Feliu J. 474P Prognostic and predictive role of Consensus Molecular Subtypes (CMS) determined by immunohistochemistry in metastatic colorectal cancer (mCRC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.585] [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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Galvez-Carvajal L, Sánchez-Muñoz A, Álvarez M, Alba Linero E, del Rey M, Garrido A, Santoja Á, Moya A, Montes J, Chica-Parrado M, Sáez M, Aparicio J, González-Billalabeitia E, Terrasa Pons J, Méndez M, Luengo M, García del Muro J, Pascual J, Alba E. 789P A differential gene expression signature identifies a population of stage I testicular non-seminomatous germ cell tumours (NSGCT) at high risk of relapse. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.861] [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] Open
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26
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Seguí E, Alonso-Orduna V, Sesma A, Martin-Richard M, Salud A, Fernández-Montes A, Fernández-Martos C, Ruiz-Casado A, Gallego J, Aparicio J, Gálvez E, Manzano H, Alcaide-Garcia J, Gallego R, Falco E, Esposito F, Oliveres H, Torres F, Feliu J, Maurel J. 471P Identification and validation of a new prognostic score in metastatic colorectal cancer (mCRC): GEMCAD score. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.582] [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: 11/25/2022] Open
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27
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Vera R, Gómez ML, Ayuso JR, Figueras J, García-Alfonso P, Martínez V, Lacasta A, Ruiz-Casado A, Safont MJ, Aparicio J, Campos JM, Cámara JC, Martín-Richard M, Montagut C, Pericay C, Vieitez JM, Falcó E, Jorge M, Marín M, Salgado M, Viúdez A. Correlation of RECIST, Computed Tomography Morphological Response, and Pathological Regression in Hepatic Metastasis Secondary to Colorectal Cancer: The AVAMET Study. Cancers (Basel) 2020; 12:cancers12082259. [PMID: 32806731 PMCID: PMC7465835 DOI: 10.3390/cancers12082259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/02/2020] [Accepted: 08/08/2020] [Indexed: 01/03/2023] Open
Abstract
Background: The prospective phase IV AVAMET study was undertaken to correlate response evaluation criteria in solid tumors (RECIST)-defined response rates with computed tomography-based morphological criteria (CTMC) and pathological response after liver resection of colorectal cancer metastases. Methods: Eligible patients were aged ≥18 years, with Eastern Cooperative Oncology Group (ECOG) performance status 0/1 and histologically-confirmed colon or rectal adenocarcinoma with measurable liver metastases. Preoperative treatment was bevacizumab (7.5 mg on day 1) + XELOX (oxaliplatin 130 mg/m2, capecitabine 1000 mg/m2 bid on days 1–14 q3w). After three cycles, response was evaluated by a multidisciplinary team. Patients who were progression-free and metastasectomy candidates received one cycle of XELOX before undergoing surgery 3–5 weeks later, followed by four cycles of bevacizumab + XELOX. Results: A total of 83 patients entered the study; 68 were eligible for RECIST, 67 for CTMC, and 51 for pathological response evaluation. Of these patients, 49% had a complete or partial RECIST response, 91% had an optimal or incomplete CTMC response, and 81% had a complete or major pathological response. CTMC response predicted 37 of 41 pathological responses versus 23 of 41 responses predicted using RECIST (p = 0.008). Kappa coefficients indicated a lack of correlation between the results of RECIST and morphological responses and between morphological and pathological response rates. Conclusion: CTMC may represent a better marker of pathological response to bevacizumab + XELOX than RECIST in patients with potentially-resectable CRC liver metastases.
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Affiliation(s)
- Ruth Vera
- Medical Oncology Department, Complejo Hospitalario de Navarra, Instituto de investigaciones Sanitarias de Navarra (IdISNA), 31008 Pamplona, Spain
| | - María Luisa Gómez
- Pathology Department, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain
| | - Juan Ramón Ayuso
- Radiology Department, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Joan Figueras
- General and digestive surgery Department, Hospital Universitario Josep Trueta, 17007 Girona, Spain
| | - Pilar García-Alfonso
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Virginia Martínez
- Medical Oncology Department, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Adelaida Lacasta
- Medical Oncology Department, Hospital Universitario Donostia, 20014 San Sebastian, Spain
| | - Ana Ruiz-Casado
- Medical Oncology Department, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain
| | - María José Safont
- Medical Oncology Department, Hospital General Universitario de Valencia, 46014 Valencia, Spain
| | - Jorge Aparicio
- Medical Oncology Department, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Juan Manuel Campos
- Medical Oncology Department, Hospital Arnau de Vilanova, 46015 Valencia, Spain
| | - Juan Carlos Cámara
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain
| | - Marta Martín-Richard
- Medical Oncology Department, Hospital la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | - Clara Montagut
- Medical Oncology Department, Hospital de Mar, 08003 Barcelona, Spain
| | - Carles Pericay
- Medical Oncology Department, C.S. Parc Taulí, 08208 Sabadell, Spain
| | - Jose María Vieitez
- Medical Oncology Department, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Esther Falcó
- Medical Oncology Department, Hospital Universitario Son Llàtzer, 07198 Palma de Mallorca, Spain
| | - Mónica Jorge
- Medical Oncology Department, Hospital Xeral Cíes, 36204 Vigo, Spain
| | - Miguel Marín
- Medical Oncology Department, Hospital Clínico Universitario de la Arrixaca, 30120 Murcia, Spain
| | - Mercedes Salgado
- Medical Oncology Department, Complejo Hospitalario de Ourense, 32005 Ourense, Spain
| | - Antonio Viúdez
- Medical Oncology Department, Complejo Hospitalario de Navarra, Instituto de investigaciones Sanitarias de Navarra (IdISNA), 31008 Pamplona, Spain
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Pedraja J, Maestre JM, Rabanal JM, Morales C, Aparicio J, Del Moral I. Role of 3D printing for the protection of surgical and critical care professionals in the COVID-19 pandemic. ACTA ACUST UNITED AC 2020; 67:417-424. [PMID: 32891414 PMCID: PMC7418764 DOI: 10.1016/j.redar.2020.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 11/21/2022]
Abstract
Antecedentes y objetivo Durante la pandemia de COVID-19 se produce una reducción del material para la protección de los profesionales. La impresión 3D ofrece la posibilidad de compensar la escasez de algunos de los suministros. El objetivo es describir el papel de la impresión 3D en un servicio de salud durante la pandemia de COVID-19, con énfasis en proceso para desarrollar un producto final listo para ser implementado en el entorno clínico. Materiales y métodos Se formó un grupo de trabajo entre la administración sanitaria, clínicos y otras instituciones público-privadas de Cantabria coordinado en el Hospital virtual Valdecilla. El proceso incluyó la recepción de las propuestas de impresión, el conocimiento de los recursos de impresión en la región, la selección de los dispositivos, la creación de un equipo para cada proyecto, diseño de prototipos, evaluación y rediseño, fabricación montaje y distribución. Resultados Se producen 1) dispositivos que ayudan a prevenir el contagio de los profesionales: pantallas de protección facial (2.400 unidades), accesorios personalizados para fotóforos (20 unidades) y horquillas salvaorejas para mascarillas (1.200 unidades); 2) productos relacionados con la ventilación de pacientes infectados: conectores de sistemas de ventilación no invasiva entre tubuladura y mascarilla; y 3) hisopos oro y nasofaríngeos (7.500 unidades) para la identificación de portadoras del coronavirus con el objetivo de diseñar protocolos de actuación en las área clínicas. Conclusiones La impresión 3D es un recurso válido para la producción de material de protección de los profesionales cuyo suministro está reducido durante una pandemia.
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Affiliation(s)
- J Pedraja
- Hospital virtual Valdecilla, Santander, España
| | - J M Maestre
- Hospital virtual Valdecilla, Santander, España; Servicio de Anestesiología y Reanimación, Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - J M Rabanal
- Hospital virtual Valdecilla, Santander, España; Servicio de Anestesiología y Reanimación, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - C Morales
- Hospital virtual Valdecilla, Santander, España; Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - J Aparicio
- Prevención de Riesgos, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - I Del Moral
- Hospital virtual Valdecilla, Santander, España
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Aparicio J, García Del Muro X, Maroto P, Terrasa J, Castellano D, Bastús R, Gumà J, Sagastibeltza N, Durán I, Ochenduszko S, Meana JA, García-Sánchez J, Arranz JA, Gironés R, Germà JR. Patterns of relapse and treatment outcome after active surveillance or adjuvant carboplatin for stage I seminoma: a retrospective study of the Spanish Germ Cell Cancer Group. Clin Transl Oncol 2020; 23:58-64. [PMID: 32462393 DOI: 10.1007/s12094-020-02393-9] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/10/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Active surveillance (AS) and adjuvant chemotherapy (AC) with carboplatin are valid alternatives for managing stage I seminoma, and most relapses can be cured with cisplatin-based chemotherapy. However, some reports suggest that AC may modify the classical pattern of recurrences. METHODS We analyzed all relapses observed in a series of 879 patients with stage I seminoma included in 4 consecutive studies of the Spanish Germ Cell Cancer Group. After a median follow-up of 67 months, recurrences were detected in 56/467 (12%) low-risk cases on AS and 13/412 (3%) high-risk cases after AC (p < 0.001). The objective was to describe clinical features, treatment and outcome. Univariate comparisons were performed between both groups. RESULTS No significant differences were found between relapses on AS and those after AC in terms of time to relapse (13 vs 17 months), size (26 vs 27 mm), location (retroperitoneum in 88% vs 85%), and method of detection (computed tomography in 77% vs 69%). Treatment consisted of chemotherapy (etoposide + cisplatin ± bleomycin) in 89% and 92%, respectively. Late relapses (after > 3 years) were seen in 11% vs 7.7% (p = NS) and second or successive recurrences in 1.8 vs 23% (p < 0.05). With a median follow-up of 130 moths, two patients died of seminoma-unrelated causes (AS group) and the rest are alive and disease-free. CONCLUSION In the setting of a risk-adapted treatment of stage I seminoma, the administration of two courses of AC in patients with tumor size > 4 cm and/or rete testis invasion is associated with a higher incidence of second recurrences but does not significantly modify the pattern of relapses or their outcome.
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Affiliation(s)
- J Aparicio
- Servicio de Oncología Médica, Hospital Universitario y Politécnico La Fe, Avda. Abril Martorell 106, 46026, Valencia, Spain.
| | - X García Del Muro
- Institut Catalá d'Oncologia Hospitalet, IDIBELL, University of Barcelona, Barcelona, Spain
| | - P Maroto
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J Terrasa
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - D Castellano
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - R Bastús
- Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - J Gumà
- Hospital Universitari Sant Joan, URV, IISPV, Reus, Spain
| | | | - I Durán
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - S Ochenduszko
- Hospital Universitario Doctor Peset, Valencia, Spain
| | - J A Meana
- Hospital General Universitario, Alicante, Spain
| | | | - J A Arranz
- Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - R Gironés
- Servicio de Oncología Médica, Hospital Universitario y Politécnico La Fe, Avda. Abril Martorell 106, 46026, Valencia, Spain
| | - J R Germà
- Institut Catalá d'Oncologia Hospitalet, IDIBELL, University of Barcelona, Barcelona, Spain
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Andermatten JA, Candela-Cantó S, Jou C, Aparicio J, Muchart J, Martinez OC, Rumià J, Hinojosa J. Gliomatosis cerebri and Rasmussen's encephalitis: Two different entities causing refractory epilepsy. Comparison through two clinical cases. Neurochirurgie 2020; 66:266-269. [PMID: 32439411 DOI: 10.1016/j.neuchi.2020.01.003] [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: 09/01/2019] [Revised: 01/10/2020] [Accepted: 01/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND IMPORTANCE Rasmussen's Encephalitis (RE) is a chronic and progressive childhood disease caused by an inflammatory disorder that affects a cerebral hemisphere. On the other hand, Gliomatosis Cerebri (GC) is a rare primary neoplastic glial process with a diffuse and infiltrative growth. CLINICAL PRESENTATION We present two clinical cases with a history of continuous focal epilepsy refractory to antiepileptic drugs. They share similar clinical and radiologic features, but a different histopathological diagnosis. A brain biopsy was needed to distinguish GC from a RE. CONCLUSION The debut of a drug-resistant epilepsy with focal seizures and an ipsilateral progressive hemiparesis suggests the diagnosis of RE. However, there are other entities such as GC, which, despite its rarity, should be considered in the differential diagnosis. So, in some cases, histological diagnosis is needed.
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Affiliation(s)
- J A Andermatten
- Neurosurgery Department, Sant Joan de Déu Barcelona Children's Hospital, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain.
| | - S Candela-Cantó
- Neurosurgery Department, Sant Joan de Déu Barcelona Children's Hospital, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain; Pediatric Epilepsy Surgery Unit, Sant Joan de Déu Barcelona Children's Hospital, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - C Jou
- Pediatric Epilepsy Surgery Unit, Sant Joan de Déu Barcelona Children's Hospital, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain; Pathology Department, Sant Joan de Déu Barcelona Children's Hospital, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - J Aparicio
- Pediatric Epilepsy Surgery Unit, Sant Joan de Déu Barcelona Children's Hospital, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - J Muchart
- Diagnostic Imaging Department, Sant Joan de Déu Barcelona Children's Hospital, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - O C Martinez
- Oncology Department, Sant Joan de Déu Barcelona Children's Hospital, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - J Rumià
- Neurosurgery Department, Sant Joan de Déu Barcelona Children's Hospital, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain; Pediatric Epilepsy Surgery Unit, Sant Joan de Déu Barcelona Children's Hospital, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - J Hinojosa
- Neurosurgery Department, Sant Joan de Déu Barcelona Children's Hospital, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain; Pediatric Epilepsy Surgery Unit, Sant Joan de Déu Barcelona Children's Hospital, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
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Seidel C, Daugaard G, Nestler T, Tryakin A, Fedyanin M, Fankhauser C, Hermanns T, Aparicio J, Heinzelbecker J, Paffenholz P, Heidenreich A, De Giorgi U, Cathomas R, Lorch A, Fingerhut A, Gayer F, Bremmer F, Giannatempo P, Necchi A, Aurilio G, Casadei C, Tran B, Dieckmann KP, Brito M, Ruf C, Oing C, Bokemeyer C. Human chorionic gonadotropin-positive seminoma patients: A registry compiled by the global germ cell tumor collaborative group (G3). Eur J Cancer 2020; 132:127-135. [PMID: 32361383 DOI: 10.1016/j.ejca.2020.03.022] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND The prognostic role of human chorionic gonadotropin (hCG) and lactate dehydrogenase (LDH) serum levels in seminoma patients remains uncertain. This observational study evaluates the prognostic impact of tumour marker levels, and other clinicopathological findings, in hCG-positive seminoma patients. METHODS Seminoma patients with serum hCG levels above normal at first diagnosis were eligible for recruitment. Statistical analysis, including multivariate regression, was performed to identify risk factors. Primary end-points were overall survival (OS) and recurrence-free survival (RFS). RESULTS We recruited 1031 hCG-positive patients (stage I: n = 586; stage II + III: n = 427) diagnosed between 1981 and 2018. In metastatic disease, LDH levels ≥3 above upper normal limit (UNL) pre- (n = 109) or post-orchiectomy (n = 73) and patients aged ≥40 years (n = 187) were associated with poor prognosis: 5-year OS rates of 84% (LDH ≥3 UNL pre-orchiectomy) versus 92% (<3 UNL pre-orchiectomy) (hazard ratio [HR]: 3.155, [95% confidence interval {CI}: 1.28-7.75], P = 0.012), 82% (≥3 UNL post-orchiectomy) versus 92% (<3 UNL post-orchiectomy) (HR: 6.877, [95% CI: 1.61-29.34]; P = 0.009) and 86% (≥40 years) versus 91% (<40 years) (HR: 6.870, [95% CI: 1.45-13.37], P = 0.009), respectively. A subset of patients with hCG levels ≥2000 IU/l pre-orchiectomy (n = 17) exhibited a poor prognosis, with 5-year OS rates of 73% (≥2000 IU/l) versus 94% (<2000 IU/l) (HR: 3.936, [95% CI: 1.02-12.61], P = 0.047). CONCLUSIONS Age and LDH levels are significantly associated with poor prognosis in hCG-positive seminoma patients. A small number of patients, with levels of hCG ≥2000 IU/l, may represent a separate prognostic subgroup associated with impaired survival rates.
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Affiliation(s)
- Christoph Seidel
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Tim Nestler
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| | - Alexey Tryakin
- Department of Clinical Pharmacology and Chemotherapy, N. N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | - Mikhail Fedyanin
- Department of Clinical Pharmacology and Chemotherapy, N. N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | | | - Thomas Hermanns
- Department of Urology, University Hospital Zürich, Zurich, Switzerland
| | - Jorge Aparicio
- Medical Oncology Department, Hospital La Fe, On behalf of the Spanish Germ Cell Cancer Group, Valencia, Spain
| | | | - Pia Paffenholz
- Department of Urology, University Hospital Cologne, Cologne, Germany; Department of Urology, Medical University Vienna, Austria
| | - Axel Heidenreich
- Department of Urology, University Hospital Cologne, Cologne, Germany; Department of Urology, Medical University Vienna, Austria
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, On behalf of the Italian Germ Cell Cancer Group (IGG), Meldola, Italy
| | - Richard Cathomas
- Department of Oncology/Hematology, Kantonsspital Graubünden, Chur, Switzerland
| | - Anja Lorch
- Department of Oncology and Hematology, University Hospital Zürich, Zurich, Switzerland; Department of Urology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Anna Fingerhut
- Department of Urology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Fabian Gayer
- Department of Pathology, University Clinic Göttingen, Göttingen, Germany
| | - Felix Bremmer
- Department of Pathology, University Clinic Göttingen, Göttingen, Germany
| | | | - Andrea Necchi
- Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Gaetano Aurilio
- Medical Division of Urogenital and Head & Neck Cancer, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Chiara Casadei
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, On behalf of the Italian Germ Cell Cancer Group (IGG), Meldola, Italy
| | - Ben Tran
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Margarida Brito
- Instituto Português de Oncologia de Lisboa, Lisboa, Portugal
| | - Christian Ruf
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| | - Christoph Oing
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Seidel CA, Daugaard G, Nestler T, Tryakin A, Fankhauser CD, Hermanns T, Aparicio J, Heinzelbecker J, Paffenholz P, Heidenreich A, De Giorgi U, Cathomas R, Lorch A, Bremmer F, Giannatempo P, Necchi A, Aurilio G, Casadei C, Oing C, Bokemeyer C. Prognostic impact of LDH and HCG levels in marker-positive seminomas. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
392 Background: The prognostic impact of LDH and HCG serum levels in marker positive metastatic seminoma patients is uncertain. This analysis evaluated the association between LDH and HCG levels with oncological outcomes in this patient population. Methods: Seminoma patients with elevated HCG levels were retrospectively analyzed. After stratification according to tumor marker levels pre- and post-orchiectomy, outcomes of subgroups were compared using log-rank test and cox-regression analysis. Study endpoints were cancer specific- (CSS) and recurrence-free survival (RFS). Results: In total, 429 HCG-positive metastatic seminoma patients (stage II n=291; stage III n=138) diagnosed between 1981 and 2018 were included. LDH + HCG levels ranged from 124 U/l to 8833 U/l (median: 619; IQR: 955) + 2 IU/l to 283,782 IU/l (median: 20; IQR: 63) pre- and from 107 U/l to 8650 U/l (median: 324; IQR: 481) + 0 IU/l to 36700 IU/l post-orchiectomy (median: 30; IQR: 121), respectively. Five-year CSS and RFS rates were 90% and 79%, respectively. Patients with LDH levels pre-orchiectomy <1.5 UNL (n=142) had a 5-year CSS (RFS) rate of 97% (88%), compared to 86% (81%) for ≥1.5 to 3 UNL (n=40), 83% (77%) for >3 to 5 UNL (n=44) and 83% (72%) for >5 UNL (n=44) (CSS p <0.001; RFS p=0.142). Concerning LDH levels post-orchiectomy this stratification was not significant but patients with LDH levels ≥3 UNL (n=77) displayed an impaired prognosis associated with a 5-year CSS (RFS) rate of 85% (79%) compared to 94% (82%) for levels <3 UNL (n=186) (CSS p=0.025; RFS p=0.447). Patients with HCG levels ≥2000 IU/l (n=17) pre- but not post-orchiectomy had a 5-year CSS (RFS) rate of 73% (60%) compared to 94% (79%) for patients with HCG levels <2000 IU/l (n=855) (CSS p=0.09; RFS p=0.04). In cox-regression analysis LDH ≥1.5 UNL (p=0.037; HR 3.32, CI95%1.08-10.26) and HCG levels ≥2000 IU/l (p=0.044; HR 3.69, 95%CI1.04-13.13) pre-orchiectomy were confirmed as prognostic factors for CSS. Conclusions: LDH levels inversely correlate with survival outcomes, suggesting ≥1.5 UNL pre- and ≥3 UNL post-orchiectomy as potential cut-off values for further risk assessment. Patients with extensive HCG elevations may represent an unfavorable subgroup concerning RFS and CSS, but only few patients were affected.
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Affiliation(s)
| | - Gedske Daugaard
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tim Nestler
- Department of Urology and Uro-Oncology, University Hospital of Cologne, Cologne, Germany
| | - Alexey Tryakin
- N.N.Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | | | - Thomas Hermanns
- University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | | | | | - Pia Paffenholz
- Department of Urology and Uro-Oncology, University Hospital of Cologne, Cologne, Germany
| | | | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Richard Cathomas
- Department of Oncology, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Anja Lorch
- Universitätsspital Zürich, Klinik für Medizinische Onkologie und Hämatologie, Zürich, Switzerland
| | | | | | - Andrea Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gaetano Aurilio
- Medical Oncology Division of Urogenital and Head and Neck Tumors, European Institute of Oncology, Milan, Italy
| | - Chiara Casadei
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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García-Peñas JJ, Smeyers-Durá P, Roldán-Aparicio S, Aparicio J. [The role of eslicarbazepine acetate in the treatment of focal-onset epilepsy in pediatric age: practical issues]. Rev Neurol 2020; 71:S1-S17. [PMID: 33103232 DOI: 10.33588/rn.71s01.2020562] [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: 11/24/2022]
Abstract
Eslicarbazepine acetate (ESL) is a third-generation antiepileptic drug (AED) of the carboxamide family and structurally related to carbamazepine and oxcarbazepine, although it has pharmacological differences that may have relevant implications of clinical utility. Since 2009 in Europe, ESL has been indicated for use in adults as adjuvant therapy in patients with partial-onset seizures (currently called focal-onset), with or without secondary generalization (with or without evolution to bilateral tonic-clonic, in current terminology). In 2017, the indication for adjunctive therapy of patients with partial-onset seizures with or without secondary generalization was extended to its use as monotherapy in adults and as adjuvant therapy in adolescents and children older than 6 years. A group of experts carried out this review aimed at the aspects of most interest in the clinical practice of the use of ESL in the pediatric population, including differential aspects from other AEDs. Aspects such as efficacy, dosage, clinical response depending on age, tolerability and its management, neurocognitive and behavioral profile, need for monitoring of any analytical parameter, role of plasma level monitoring, possible added value of the once-daily administration, clinical situations in which the addition of ESL would be recommended, use with other sodium channel blockers, how to switch from carbamazepine/oxcarbazepine, potential interactions with other AEDs, potential interactions with drugs other than AEDs, and some practical issues that require additional research.
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Affiliation(s)
- J J García-Peñas
- Hospital Infantil Universitario Niño Jesús, 28009 Madrid, España
| | | | | | - J Aparicio
- Hospital Sant Joan de Deu, Esplugues de Llobregat, España
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Fischer S, Tandstad T, Cohn-Cedermark G, Thibault C, Vincenzi B, Klingbiel D, Albany C, Necchi A, Terbuch A, Lorch A, Aparicio J, Heidenreich A, Hentrich M, Wheater M, Langberg CW, Ståhl O, Fankhauser CD, Hamid AA, Koutsoukos K, Shamash J, White J, Bokemeyer C, Beyer J, Gillessen S. Outcome of Men With Relapses After Adjuvant Bleomycin, Etoposide, and Cisplatin for Clinical Stage I Nonseminoma. J Clin Oncol 2019; 38:1322-1331. [PMID: 31877087 DOI: 10.1200/jco.19.01876] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Clinical stage I (CSI) nonseminoma (NS) is a disease limited to the testis without metastases. One treatment strategy after orchiectomy is adjuvant chemotherapy. Little is known about the outcome of patients who experience relapse after such treatment. PATIENTS AND METHODS Data from 51 patients with CSI NS who experienced a relapse after adjuvant bleomycin, etoposide, and cisplatin (BEP) from 18 centers/11 countries were collected and retrospectively analyzed. Primary outcomes were overall and progression-free survivals calculated from day 1 of treatment at first relapse. Secondary outcomes were time to, stage at, and treatment of relapse and rate of subsequent relapses. RESULTS Median time to relapse was 13 months, with the earliest relapse 2 months after start of adjuvant treatment and the latest after 25 years. With a median follow-up of 96 months, the 5-year PFS was 67% (95% CI, 54% to 82%) and the 5-year OS was 81% (95% CI, 70% to 94%). Overall, 19 (37%) of 51 relapses occurred later than 2 years. Late relapses were associated with a significantly higher risk of death from NS (hazard ratio, 1.10 per year; P = .01). Treatment upon relapse was diverse: the majority of patients received a combination of chemotherapy and surgery. Twenty-nine percent of patients experienced a subsequent relapse. At last follow-up, 41 patients (80%) were alive and disease-free, eight (16%) had died of progressive disease, and one patient (2%) each had died from therapy-related or other causes. CONCLUSION Outcomes of patients with relapse after adjuvant BEP seem better compared with patients who experience relapse after treatment of metastatic disease but worse compared with those who have de-novo metastatic disease. We found a substantial rate of late and subsequent relapses. There seem to be three patterns of relapse with different outcomes: pure teratoma, early viable NS relapse (< 2 years), and late viable NS relapse (> 2 years).
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Affiliation(s)
- Stefanie Fischer
- Cantonal Hospital St Gallen, Department of Medical Oncology and Hematology, St. Gallen, Switzerland.,Manchester Cancer Research Centre, Division of Cancer Sciences, University of Manchester, and The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Torgrim Tandstad
- The Cancer Clinic, St Olavs University Hospital, Trondheim, Norway.,SWENOTECA, Trondheim, Norway
| | - Gabriella Cohn-Cedermark
- SWENOTECA, Trondheim, Norway.,Department of Oncology-Pathology, Karolinska Institute, Stockholm, and Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Constance Thibault
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, Paris, France
| | | | | | - Costantine Albany
- Indiana University School of Medicine, Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Angelika Terbuch
- Abteilung für Onkologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Austria
| | - Anja Lorch
- Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
| | - Jorge Aparicio
- Hospital Universitari I Politècnic La Fe, Valencia, Spain, Spanish Germ Cell Cancer Group
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Marcus Hentrich
- Department of Hematology and Oncology, Red Cross Hospital, University of Munich, Munich, Germany
| | - Matthew Wheater
- Medical Oncology, University Hospital Southampton, Southampton, United Kingdom
| | - Carl W Langberg
- SWENOTECA, Trondheim, Norway.,The Cancer Centre, Oslo University Hospital, Oslo, Norway
| | - Olof Ståhl
- SWENOTECA, Trondheim, Norway.,Department of Oncology, Skane University Hospital, Lund, Sweden
| | | | - Anis A Hamid
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Jeff White
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | - Jörg Beyer
- University Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Silke Gillessen
- Cantonal Hospital St Gallen, Department of Medical Oncology and Hematology, St. Gallen, Switzerland.,Manchester Cancer Research Centre, Division of Cancer Sciences, University of Manchester, and The Christie NHS Foundation Trust, Manchester, United Kingdom.,University of Bern, Bern, Switzerland.,Oncology Institute of Southern Switzerland, Bellinzona and Universita della Svizzera Italiana, Lugano, Switzerland
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Honecker F, Aparicio J, Berney D, Beyer J, Bokemeyer C, Cathomas R, Clarke N, Cohn-Cedermark G, Daugaard G, Dieckmann KP, Fizazi K, Fosså S, Germa-Lluch JR, Giannatempo P, Gietema JA, Gillessen S, Haugnes HS, Heidenreich A, Hemminki K, Huddart R, Jewett MAS, Joly F, Lauritsen J, Lorch A, Necchi A, Nicolai N, Oing C, Oldenburg J, Ondruš D, Papachristofilou A, Powles T, Sohaib A, Ståhl O, Tandstad T, Toner G, Horwich A. ESMO Consensus Conference on testicular germ cell cancer: diagnosis, treatment and follow-up. Ann Oncol 2019; 29:1658-1686. [PMID: 30113631 DOI: 10.1093/annonc/mdy217] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The European Society for Medical Oncology (ESMO) consensus conference on testicular cancer was held on 3-5 November 2016 in Paris, France. The conference included a multidisciplinary panel of 36 leading experts in the diagnosis and treatment of testicular cancer (34 panel members attended the conference; an additional two panel members [CB and K-PD] participated in all preparatory work and subsequent manuscript development). The aim of the conference was to develop detailed recommendations on topics relating to testicular cancer that are not covered in detail in the current ESMO Clinical Practice Guidelines (CPGs) and where the available level of evidence is insufficient. The main topics identified for discussion related to: (1) diagnostic work-up and patient assessment; (2) stage I disease; (3) stage II-III disease; (4) post-chemotherapy surgery, salvage chemotherapy, salvage and desperation surgery and special topics; and (5) survivorship and follow-up schemes. The experts addressed questions relating to one of the five topics within five working groups. Relevant scientific literature was reviewed in advance. Recommendations were developed by the working groups and then presented to the entire panel. A consensus vote was obtained following whole-panel discussions, and the consensus recommendations were then further developed in post-meeting discussions in written form. This manuscript presents the results of the expert panel discussions, including the consensus recommendations and a summary of evidence supporting each recommendation. All participants approved the final manuscript.
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Affiliation(s)
- F Honecker
- Tumor and Breast Center ZeTuP, St. Gallen, Switzerland; Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany.
| | - J Aparicio
- Department of Medical Oncology, Hospital Universitari i Politècnic la Fe, Valencia, Spain
| | - D Berney
- Department of Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - J Beyer
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - C Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany
| | - R Cathomas
- Department of Oncology and Hematology, Kantonsspital Graubünden, Chur, Switzerland
| | - N Clarke
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
| | - G Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - G Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - K-P Dieckmann
- Department of Urology, Asklepios Klinik Altona, Hamburg, Germany
| | - K Fizazi
- Department of Cancer Medicine, Gustave Roussy, University of Paris Sud, Villejuif, France
| | - S Fosså
- Department of Oncology, Oslo University Hospital Radiumhospitalet, Oslo, Norway
| | - J R Germa-Lluch
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), Barcelona University, Barcelona, Spain
| | - P Giannatempo
- Department of Medical Oncology, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - J A Gietema
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - S Gillessen
- Department of Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen; University of Bern, Bern, Switzerland
| | - H S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine, UIT - The Arctic University, Tromsø, Norway
| | - A Heidenreich
- Department of Urology, Uro-Oncology, Robot-assisted and Specialised Urologic Surgery, University of Cologne, Cologne, Germany
| | - K Hemminki
- Department of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - R Huddart
- Department of Radiotherapy and Imaging, The Institute of Cancer Research, Royal Marsden Hospital, Sutton, UK
| | - M A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
| | - F Joly
- Department of Urology-Gynaecology, Centre Francois Baclesse, Caen, France
| | - J Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A Lorch
- Department of Urology, Genitourinary Medical Oncology, Heinrich-Heine University Hospital Düsseldorf, Düsseldorf, Germany
| | - A Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - N Nicolai
- Department of Surgery, Urology and Testis Surgery Unit, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - C Oing
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany
| | - J Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway
| | - D Ondruš
- 1st Department of Oncology, St. Elisabeth Cancer Institute, Comenius University Faculty of Medicine, Bratislava, Slovak Republic
| | - A Papachristofilou
- Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - T Powles
- Department of Medical Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - A Sohaib
- Department of Radiology, Royal Marsden Hospital, Sutton, UK
| | - O Ståhl
- Department of Oncology, Skane University Hospital, Lund University, Lund, Sweden
| | - T Tandstad
- The Cancer Clinic, St. Olavs Hospital, Trondheim, Norway
| | - G Toner
- Department of Medical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia
| | - A Horwich
- The Institute of Cancer Research, Royal Marsden Hospital, Sutton, UK
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Maurel J, Alonso V, Escudero P, Fernández-Martos C, Salud A, Méndez M, Gallego J, Rodriguez JR, Martín-Richard M, Fernández-Plana J, Manzano H, Méndez JC, Zanui M, Falcó E, Gil-Raga M, Aparicio J, Feliu J, García-Albéniz X, Torres F, Rojo F, Bellosillo B, Mendiola M, Fernández V, Reig O, Claes B, Maertens G, Sablon E, Jacobs B, Montagut C. Clinical Impact of Circulating Tumor RAS and BRAF Mutation Dynamics in Patients With Metastatic Colorectal Cancer Treated With First-Line Chemotherapy Plus Anti-Epidermal Growth Factor Receptor Therapy. JCO Precis Oncol 2019; 3:1-16. [PMID: 35100697 DOI: 10.1200/po.18.00289] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE RAS and BRAF mutations can be detected as a mechanism of acquired resistance in circulating tumor (ct) DNA in patients with metastatic colorectal cancer treated with anti-epidermal growth factor receptor therapy. METHODS RAS and BRAF mutational status was assessed in ctDNA in a baseline plasma sample and a serum sample collected at the time of the last available determination (named secondary extraction) from patients with KRAS exon 2 wild-type metastatic colorectal cancer treated in two first-line prospective biomarker-designed clinical trials (PULSE, ClinicalTrials.gov identifier: NCT01288339; and POSIBA, ClincialTrials.gov identifier: NCT01276379). RESULTS Analysis of extended RAS and BRAF in tissue and plasma from 178 patients with KRAS exon 2 wild-type metastatic colorectal cancer showed a sensitivity of 64.1% and a specificity of 90%. The median overall survival (OS) of baseline patients with RAS and BRAF mutations in ctDNA was 22.3 months (95% CI, 15.6 to 29 months) and 8.9 months (95% CI, 6.3 to 11.4 months), respectively, which was significantly inferior to the median OS of 40.4 months (95% CI, 35.9 to 44.9 months) in two patients with wild-type disease (P < .001). Acquisition of RAS/BRAF mutations occurred in nine of 63 patients (14%) with progressive disease (PD; ie, blood draw within 1 month before PD or after PD) compared with six of 73 patients (8%) with no PD or blood extraction for ctDNA analysis before 1 month of PD (P = .47). Median OS in patients with RAS/BRAF acquisition was 23.9 months (95% CI, 19.7 to 27.9 months) compared with 40.6 months (95% CI, not reached to not reached) in patients who remained free of mutations (P = .016). CONCLUSION Our results confirm that baseline RAS and BRAF testing in ctDNA discriminates survival. The emergence of RAS/BRAF mutations has limited relevance for the time to progression to anti-epidermal growth factor receptor therapy.
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Affiliation(s)
- Joan Maurel
- Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jaime Feliu
- Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | | | | | | | - Oscar Reig
- Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | | | | | | | - Clara Montagut
- Hospital del Mar Medical Research Institute, Barcelona, Spain
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Vera R, Aparicio J, Carballo F, Esteva M, González-Flores E, Santianes J, Santolaya F, Fernández-Cebrián JM. Correction to: Recommendations for follow‑up of colorectal cancer survivors. Clin Transl Oncol 2019; 21:1440. [DOI: 10.1007/s12094-019-02088-w] [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: 10/27/2022]
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Garcia Torralba E, Castellano Gauna D, Sobrevilla N, Guma J, Luengo M, Aparicio J, Sanchez-Muñoz A, Mellado B, Saenz A, Valverde C, Fernández A, Margeli M, Duran I, Fernandez S, Sastre J, Ros S, Maroto P, Aguilar J, Garcia del Muro X, Gonzalez Billalabeitia E. Prognosis of anaemia in disseminated testicular germ cell tumours. On behalf of the Spanish Germ Cell Cancer Group (SGCCG). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz249.080] [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: 11/13/2022] Open
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Simarro J, Murria R, Pérez-Simó G, Llop M, Mancheño N, Ramos D, Juan ID, Barragán E, Laiz B, Cases E, Ansótegui E, Gómez-Codina J, Aparicio J, Salvador C, Juan Ó, Palanca S. Development, Implementation and Assessment of Molecular Diagnostics by Next Generation Sequencing in Personalized Treatment of Cancer: Experience of a Public Reference Healthcare Hospital. Cancers (Basel) 2019; 11:E1196. [PMID: 31426418 PMCID: PMC6721584 DOI: 10.3390/cancers11081196] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 07/30/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 02/07/2023] Open
Abstract
The establishment of precision medicine in cancer patients requires the study of several biomarkers. Single-gene testing approaches are limited by sample availability and turnaround time. Next generation sequencing (NGS) provides an alternative for detecting genetic alterations in several genes with low sample requirements. Here we show the implementation to routine diagnostics of a NGS assay under International Organization for Standardization (UNE-EN ISO 15189:2013) accreditation. For this purpose, 106 non-small cell lung cancer (NSCLC) and 102 metastatic colorectal cancer (mCRC) specimens were selected for NGS analysis with Oncomine Solid Tumor (ThermoFisher). In NSCLC the most prevalently mutated gene was TP53 (49%), followed by KRAS (31%) and EGFR (13%); in mCRC, TP53 (50%), KRAS (48%) and PIK3CA (16%) were the most frequently mutated genes. Moreover, NGS identified actionable genetic alterations in 58% of NSCLC patients, and 49% of mCRC patients did not harbor primary resistance mechanisms to anti-EGFR treatment. Validation with conventional approaches showed an overall agreement >90%. Turnaround time and cost analysis revealed that NGS implementation is feasible in the public healthcare context. Therefore, NGS is a multiplexed molecular diagnostic tool able to overcome the limitations of current molecular diagnosis in advanced cancer, allowing an improved and economically sustainable molecular profiling.
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Affiliation(s)
- Javier Simarro
- Molecular Biology Unit, Service of Clinical Analysis, University and Polytechnic La Fe Hospital, 46026 Valencia, Spain
- Clinical and Translational Cancer Research Group, Health Research Institute La Fe, 46026 Valencia, Spain
| | - Rosa Murria
- Molecular Biology Unit, Service of Clinical Analysis, University and Polytechnic La Fe Hospital, 46026 Valencia, Spain
- Clinical and Translational Cancer Research Group, Health Research Institute La Fe, 46026 Valencia, Spain
| | - Gema Pérez-Simó
- Molecular Biology Unit, Service of Clinical Analysis, University and Polytechnic La Fe Hospital, 46026 Valencia, Spain
- Clinical and Translational Cancer Research Group, Health Research Institute La Fe, 46026 Valencia, Spain
| | - Marta Llop
- Molecular Biology Unit, Service of Clinical Analysis, University and Polytechnic La Fe Hospital, 46026 Valencia, Spain
| | - Nuria Mancheño
- Department of Pathology, University and Polytechnic La Fe Hospital, 46026 Valencia, Spain
| | - David Ramos
- Department of Pathology, University and Polytechnic La Fe Hospital, 46026 Valencia, Spain
| | - Inmaculada de Juan
- Molecular Biology Unit, Service of Clinical Analysis, University and Polytechnic La Fe Hospital, 46026 Valencia, Spain
- Clinical and Translational Cancer Research Group, Health Research Institute La Fe, 46026 Valencia, Spain
| | - Eva Barragán
- Molecular Biology Unit, Service of Clinical Analysis, University and Polytechnic La Fe Hospital, 46026 Valencia, Spain
| | - Begoña Laiz
- Molecular Biology Unit, Service of Clinical Analysis, University and Polytechnic La Fe Hospital, 46026 Valencia, Spain
| | - Enrique Cases
- Department of Pulmonology, University and Polytechnic La Fe Hospital, 46026 Valencia, Spain
| | - Emilio Ansótegui
- Department of Pulmonology, University and Polytechnic La Fe Hospital, 46026 Valencia, Spain
| | - José Gómez-Codina
- Clinical and Translational Cancer Research Group, Health Research Institute La Fe, 46026 Valencia, Spain
- Department of Medical Oncology, University and Polytechnic La Fe Hospital, 46026 Valencia, Spain
| | - Jorge Aparicio
- Clinical and Translational Cancer Research Group, Health Research Institute La Fe, 46026 Valencia, Spain
- Department of Medical Oncology, University and Polytechnic La Fe Hospital, 46026 Valencia, Spain
| | - Carmen Salvador
- Clinical and Translational Cancer Research Group, Health Research Institute La Fe, 46026 Valencia, Spain
- Department of Medical Oncology, University and Polytechnic La Fe Hospital, 46026 Valencia, Spain
| | - Óscar Juan
- Department of Medical Oncology, University and Polytechnic La Fe Hospital, 46026 Valencia, Spain
| | - Sarai Palanca
- Molecular Biology Unit, Service of Clinical Analysis, University and Polytechnic La Fe Hospital, 46026 Valencia, Spain.
- Clinical and Translational Cancer Research Group, Health Research Institute La Fe, 46026 Valencia, Spain.
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Aparicio J, Virgili A, Capdevila J, Muñoz Boza F, Álvarez R, Bosch C, Cámara J, Fernandez-Martos C, Fernandez-Plana J, Gallego J, Gallego R, Hernández-Yagüe X, Macías Declara I, Rodríguez-Salas N, Vera R, Taberner M, Maurel J. Randomized phase II clinical trial to evaluate the efficacy of second-line FOLFIRI-panitumumab in patients with RAS wild-type metastatic colorectal cancer who have received FOLFOX-panitumumab in first-line (BEYOND). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.190] [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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Riechelmann RP, Srimuninnimit V, Bordonaro R, Kavan P, Di Bartolomeo M, Maiello E, Cicin I, García-Alfonso P, Chau I, Fedyanin MY, Martos CF, Ter-Ovanesov M, Peeters M, Ko YJ, Yalcin S, Karthaus M, Aparicio J, Heinemann V, Picard P, Bury D, Drea E, Sobrero A. Aflibercept Plus FOLFIRI for Second-line Treatment of Metastatic Colorectal Cancer: Observations from the Global Aflibercept Safety and Health-Related Quality-of-Life Program (ASQoP). Clin Colorectal Cancer 2019; 18:183-191.e3. [PMID: 31221542 DOI: 10.1016/j.clcc.2019.05.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 01/24/2019] [Revised: 05/03/2019] [Accepted: 05/08/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND The objectives of this study were to evaluate the safety profile of aflibercept and health-related quality of life (HRQL) in patients with metastatic colorectal cancer (mCRC) provided with aflibercept access before marketing authorization. PATIENTS AND METHODS Patients received aflibercept followed by FOLFIRI (fluorouracil, leucovorin, irinotecan) on day 1 of a 2-week cycle until disease progression, unacceptable toxicity, death, or patient/investigator decision to discontinue. Treatment-emergent adverse events (TEAEs) were evaluated, and HRQL was assessed at baseline, cycle 3, and every other cycle using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30, EORTC QLQ-CR29, and EuroQol 5-Dimensions 3-Levels questionnaires (NCT01571284). RESULTS Overall, 779 adult patients with mCRC, who received ≥ 1 prior oxaliplatin-based regimen and had disease progression during or following their last administration of oxaliplatin-based chemotherapy, were enrolled. At data cutoff, all patients had discontinued treatment, mainly owing to disease progression (51.7%). The most common TEAEs of any grade were diarrhea (61.6%), hypertension (48.4%), and nausea (43.3%). The most common grade 3/4 TEAEs were hypertension (24.1%), neutropenia (23.1%), and diarrhea (15.3%). Clinically meaningful changes in HRQL were reported for all measures. Most patients either had an improvement in their HRQL scores or remained stable during the treatment period based on patient-reported outcomes. CONCLUSION The data from this study support the tolerability of the combination of aflibercept and FOLFIRI in a setting that more closely approximates real life in patients with mCRC who failed to respond to oxaliplatin-based chemotherapy, and also suggest an improvement in HRQL.
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Affiliation(s)
- Rachel P Riechelmann
- Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil; Department of Clinical Oncology, AC Camargo Cancer Center, São Paulo, Brazil.
| | | | | | - Petr Kavan
- Gerald Bronfman Department of Oncology, McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal, Quebec, Canada
| | | | - Evaristo Maiello
- IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Irfan Cicin
- Division of Medical Oncology, Department of Internal Medicine, Balkan Oncology Hospital, Trakya University, Edirne, Turkey
| | - Pilar García-Alfonso
- Department of Medical Oncology, Hospital Universitario Gregorio Marañón de Madrid, Madrid, Spain
| | - Ian Chau
- Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Mikhail Y Fedyanin
- Department of Clinical Pharmacology and Chemotherapy, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia
| | | | - Mikhail Ter-Ovanesov
- Thoraco-abdominal Oncosurgical Department, Clinical Central Hospital of the Presidential Administration of the Russian Federation, Moscow, Russia
| | - Marc Peeters
- Department of Oncology, Antwerp University Hospital, Edegem, Belgium
| | - Yoo-Joung Ko
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Suayib Yalcin
- Department of Medical Oncology, Cancer Institute, Hacettepe University, Ankara, Turkey
| | - Meinolf Karthaus
- Klinikum Neuperlach, Städtisches Klinikum München, Munich, Germany
| | - Jorge Aparicio
- Hospital Universitario y Politécnico de La Fe, Valencia, Spain
| | - Volker Heinemann
- Department of Medical Oncology and Comprehensive Cancer Center, University Hospital Grosshadern, Ludwig Maximilian University of Munich, Munich, Germany
| | | | - Denise Bury
- Sanofi (contracted by Artech Information Systems LLC), Cambridge, MA
| | - Edward Drea
- Sanofi (contracted by Artech Information Systems LLC), Cambridge, MA
| | - Alberto Sobrero
- IRCCS Azienda Ospedaliera Universitaria San Martino, Genova, Italy
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Fischer SC, Tandstad T, Cohn-Cedermark GE, Thibault C, Vincenzi B, Klingbiel D, Albany C, Necchi A, Terbuch A, Lorch A, Aparicio J, Heidenreich A, Hentrich M, Wheater MJ, Langberg CW, Stahl O, Beyer J, Gillessen S. Outcome of men with relapses after adjuvant BEP for clinical stage I nonseminoma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
510 Background: Clin. stage I (CSI) non-seminoma (NS) is disease limited to the testis without metastases. One treatment strategy after orchiectomy is adjuvant (adjuv) chemotherapy with BEP after which relapses are rare. Little is known about the outcome of patients (pts) relapsing after such treatment. Methods: Data from 51 pts with CSI NS and relapse after adjuv BEP from 18 centers/11 countries was collected and retrospectively analyzed. Primary endpoints were OS and PFS calculated from start of treatment of relapse. Secondary outcomes were time to, stage at, and treatment of relapse as well as rate of subsequent relapses. Results: 23 pts received one cycle adjuv BEP and 28 pts two. Median time to relapse was 13 months, with the earliest relapse two months after start of adjuv BEP and the latest relapse recorded after 26 years. According to IGCCCG, 84% of pts classified as good prognosis at relapse. With a median follow up of 50 months 5y PFS was 64% (95% CI 52-80%) and 5y OS 79% (95% CI 68-92%). Treatment upon relapse was diverse, the majority of pts received combination- chemotherapy and surgery. 10 pts (20%) had pure mature teratoma at relapse treated with surgery alone. None of these pts experienced a second relapse. If teratoma relapses were excluded, 5y PFS dropped to 58% (44-77%) and 5y OS to 76% (63-92%). Relapses later than three years after adjuv therapy occured in 15/51 pts. (29%) and were associated with a statistically significant higher risk of death from germ-cell cancer (p=0.02). 15/51 pts (29%) experienced a subsequent relapse. Excluding pts with teratoma only, subsequent relapses occured in 15 of the remaining 41 pts (37%). At last follow-up, 41/51 (80%) pts were alive and disease-free, 8/51 (16%) had died from progressive disease and one pt each had died from therapy-related or other causes. Conclusions: Outcome of pts with relapse after adjuv BEP seems to be better compared to pts with relapse after metastatic disease, but worse compared to de novo metastatic pts. There is a substantial rate of late and subsequent relapses. Pts and care-takers need to be informed about this and therapy intensification at first relapse might be considered. However, considering the low rate of relapses, OS in general for CSI NS pts receiving adjuv BEP is excellent.
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Affiliation(s)
- Stefanie Christine Fischer
- Division of Cancer Sciences, University of Manchester, and The Christie Manchester, Manchester, United Kingdom
| | | | | | | | - Bruno Vincenzi
- Department of Medical Oncology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Dirk Klingbiel
- SAKK Coordinating Center, Bern, Switzerland, now at F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Costantine Albany
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Andrea Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Angelika Terbuch
- Abteilung für Onkologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Austria, Graz, Austria
| | - Anja Lorch
- Department of Urology, Heinrich-Heine-University, Duesseldorf, Germany, Duesseldorf, Germany
| | | | - Axel Heidenreich
- Department of Urology and Uro-Oncology, University Hospital of Cologne, Cologne, Germany
| | | | | | | | - Olof Stahl
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Joerg Beyer
- University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Silke Gillessen
- University of Manchester, and The Christie Manchester, UK, Manchester, United Kingdom
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Bayo J, Molina R, Pérez J, Pérez-Ruíz E, Aparicio J, Beato C, Berros JP, Bolaños M, Graña B, Santaballa A. SEOM clinical guidelines to primary prevention of cancer (2018). Clin Transl Oncol 2019; 21:106-113. [PMID: 30607789 PMCID: PMC6339664 DOI: 10.1007/s12094-018-02016-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 12/08/2018] [Accepted: 12/11/2018] [Indexed: 12/29/2022]
Abstract
Cancer is the leading social and healthcare problem of the twenty-first century. The aim of primary prevention is to decrease the incidence of cancer by avoiding the known causes and risk factors. Nevertheless, it has been estimated that cancer diagnoses could be halved through primary prevention measures. A comprehensive review of the scientific evidence regarding the main carcinogens and risk factors and primary prevention recommendations have been put forth based on this evidence. The GRADE scale has been used to classify the grade of evidence. We present the scientific evidence and recommendations for primary prevention of the major modifiable risk factors: smoking, alcohol, diet, obesity, physical activity, occupational and environmental factors, ultraviolet radiation, infections, and socioeconomic factors. Primary prevention is a simple, effective means to lower the incidence of cancer. Preventive measures must be circulated in the fight against cancer.
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Affiliation(s)
- J. Bayo
- Servicio de Oncología Médica, Hospital Juan Ramón Jiménez de Huelva, Ronda Exterior Norte, s/n, 21005 Huelva, Spain
| | - R. Molina
- Servicio de Oncología Médica, Hospital, Universitario Príncipe de Asturias, Madrid, Spain
| | - J. Pérez
- Servicio de Oncología Médica, Hospital Virgen de los Lirios, Alcoy, Spain
| | - E. Pérez-Ruíz
- Servicio de Oncología Médica, Complejo Hospital Costa del Sol, Marbella, Spain
| | - J. Aparicio
- Servicio de Oncología Médica, Hospital Universitari i Politècnic la Fe (Valencia), Valencia, Spain
| | - C. Beato
- Servicio de Oncología Médica, Complejo Hospitalario Regional Virgen Macarena, Seville, Spain
| | - J. P. Berros
- Servicio de Oncología Médica, Hospital, Universitario Central de Asturias, Asturias, Spain
| | - M. Bolaños
- Servicio de Oncología Médica, Hospital Juan Ramón Jiménez de Huelva, Ronda Exterior Norte, s/n, 21005 Huelva, Spain
| | - B. Graña
- Servicio de Oncología Médica, Complexo Hospitalario Universitario A Coruña (CHUAC), Coruna, Spain
| | - A. Santaballa
- Servicio de Oncología Médica, Hospital Universitari i Politècnic la Fe (Valencia), Valencia, Spain
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Gómez-España MA, Gallego J, González-Flores E, Maurel J, Páez D, Sastre J, Aparicio J, Benavides M, Feliu J, Vera R. SEOM clinical guidelines for diagnosis and treatment of metastatic colorectal cancer (2018). Clin Transl Oncol 2018; 21:46-54. [PMID: 30565083 PMCID: PMC6339676 DOI: 10.1007/s12094-018-02002-w] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 12/22/2022]
Abstract
Colorectal cancer (CRC) is the second cause of cancer death in Spain, the objective of this guide published by the Spanish Society of Medical Oncology is to develop a consensus for the diagnosis and management of metastatic disease. The optimal treatment strategy for patients with metastatic CRC should be discussed in a multidisciplinary expert team to select the most appropriate treatment, and integrate systemic treatment and other options such as surgery and ablative techniques depending on the characteristics of the tumour, the patient and the location of the disease and metastases.
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Affiliation(s)
- M A Gómez-España
- Servicio de Oncología Médica, H. Universitario Reina Sofía, IMIBIC, CIBERONC, Av. Menéndez Pidal, s/n, 14004, Córdoba, Spain.
| | - J Gallego
- Servicio de Oncología Médica, Hospital General Universitario, Elche, Spain
| | - E González-Flores
- Servicio de Oncología Médica, H. U. Virgen de las Nieves, Granada, Spain
| | - J Maurel
- Servicio de Oncología Médica, Hospital Clinic, Barcelona, Spain
| | - D Páez
- Servicio de Oncología Médica, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J Sastre
- Servicio de Oncología Médica, Hospital Clínico San Carlos, IdISSC, CIBERONC, Madrid, Spain
| | - J Aparicio
- Servicio de Oncología Médica, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M Benavides
- Servicio de Oncología Médica, H.U. Regional y Virgen de la Victoria, Málaga, Spain
| | - J Feliu
- Servicio de Oncología Médica, H. U. La Paz, UAM, CIBERONC, Madrid, Spain
| | - R Vera
- Servicio de Oncología Médica, Complejo Hospitalario de Navarra, IdiSNA, Pamplona, Spain
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Español Rego M, Alonso V, Aparicio J, Elez Fernandez E, Escudero P, Fernández-Martos C, Rodríguez N, Ruiz Casado A, Cid J, Cabezón R, Lozano M, Ginés A, Bianchi L, Garcia-Corbacho J, García de Albéniz X, Maurel J, Benitez Ribas D. AVEVAC: A phase I-II trial with avelumab plus autologous dendritic cell (ADC) vaccine in pre-treated mismatch repair-proficient (MSS) metastatic colorectal cancer (mCRC) patients (GEMCAD 16-02). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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46
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Montagut C, Alonso V, Escudero P, Fernández-Martos C, Salud Salvia A, Méndez M, Gallego Plazas J, Rodriguez J, Martín-Richard M, Fernández-Plana J, Aparicio J, Feliu Batlle J, García de Albéniz X, Rojo F, Fernández V, Claes B, Maertens G, Sablon E, Jacobs B, Maurel J. Clinical impact of circulating tumor RAS and BRAF mutation dynamics in metastatic colorectal cancer patients treated with first-line chemotherapy plus anti-EGFR therapy: Combined analysis of two prospective clinical trials. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.091] [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: 11/13/2022] Open
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Gil-López FJ, Montoya J, Falip M, Aparicio J, López-González FJ, Toledano R, Gil-Nagel A, Molins A, García I, Serrano P, Domenech G, Torres F, Donaire A, Carreño M. Retrospective study of perampanel efficacy and tolerability in myoclonic seizures. Acta Neurol Scand 2018; 138:122-129. [PMID: 29573400 DOI: 10.1111/ane.12931] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 02/27/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Perampanel is an antiepileptic drug (AED) approved for add-on treatment of focal seizures (with or without generalization) and primary generalized tonic-clonic (GTC) seizures. Our objective was to explore the effectiveness and tolerability of adjunctive perampanel in patients with drug-resistant myoclonic seizures, after failure of other AEDs. MATERIALS AND METHODS Retrospective, multicenter, observational study. Data were collected from individual patient clinical files and analysed using appropriate descriptive statistics and inferential analyses. RESULTS Data are reported for 31 patients with mean age 36.4 years, who had an average epilepsy duration of 18 years, previously taken an average of 5.03 AEDs, and were taking an average of 2.4 AEDs on perampanel initiation. Patients exhibited myoclonic, GTC, absence, tonic and focal seizures, and most had associated cognitive decline and/or ataxia. Median time on perampanel was 6 months, most common dose was 6 mg, and overall retention rate was 84%. The responder rate for myoclonic seizures was defined via reduction of days with myoclonic seizures per month. At 6 months, 15 (48.4%) of the 31 patients were classed as myoclonic seizure responders, 10 (32.3%) were myoclonic seizure free, and 39% saw improvements in functional ability. Of 17 patients with GTC seizures at baseline, 9 (53%) were responders at 6 months, and 8 (47.1%) were seizure free. The most frequent side effects were psychiatric disorders, instability, dizziness and irritability, and mostly resolved with dose reduction. Five patients discontinued perampanel due to side effects. CONCLUSIONS Perampanel caused clinically meaningful improvements in patients with drug-resistant myoclonic seizures. It was generally well tolerated, but psychiatric and neurological side effects sometimes required follow-up and dose reduction.
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Affiliation(s)
- F. J. Gil-López
- Epilepsy Unit; Department of Neurology; Hospital Clínic de Barcelona; Barcelona Spain
| | - J. Montoya
- Department of Neurology; Hospital Lluis Alcanyís; Xàtiva Spain
| | - M. Falip
- Epilepsy Unit; Department of Neurology; Hospital Universitari de Bellvitge; Hospitalet de Llobregat; Barcelona Spain
| | - J. Aparicio
- Epilepsy Unit; Department of Neurology; Hospital Sant Joan de Déu; Barcelona Spain
| | - F. J. López-González
- Epilepsy Unit; Department of Neurology; Complexo Hospitalario Universitario de Santiago de Compostela; A Coruña Spain
| | - R. Toledano
- Epilepsy Unit; Department of Neurology; Hospital Ruber Internacional; Madrid Spain
| | - A. Gil-Nagel
- Epilepsy Unit; Department of Neurology; Hospital Ruber Internacional; Madrid Spain
| | - A. Molins
- Department of Neurology; Hospital Josep Trueta de Girona; Girona Spain
| | - I. García
- Epilepsy Unit; Hospital Clínico Universitario San Carlos; Madrid Spain
| | - P. Serrano
- Department of Neurology; Hospital Carlos Haya; Málaga Spain
| | - G. Domenech
- Medical Statistics Core Facility; IDIBAPS-Hospital Clínic; Barcelona Spain
| | - F. Torres
- Medical Statistics Core Facility; IDIBAPS-Hospital Clínic; Barcelona Spain
| | - A. Donaire
- Epilepsy Unit; Department of Neurology; Hospital Clínic de Barcelona; Barcelona Spain
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - M. Carreño
- Epilepsy Unit; Department of Neurology; Hospital Clínic de Barcelona; Barcelona Spain
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS); Barcelona Spain
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48
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Aparicio J, Terrasa J. Controversies in the management of stage I seminoma: adjuvant carboplatin revisited. Clin Transl Oncol 2018; 21:246-247. [PMID: 29992462 DOI: 10.1007/s12094-018-1917-1] [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] [Received: 04/26/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Affiliation(s)
- J Aparicio
- Servicio de Oncología Médica, Hospital Universitario y Politécnico La Fe, Avda. Abril Martorell 106, 46026, Valencia, Spain.
| | - J Terrasa
- Servicio de Oncología Médica, Hospital Universitario Son Espases, Palma de Mallorca, Spain
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49
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Feliu J, Salud A, Pineda Losada E, Alonso V, Cubillo A, Soler G, Carmona A, Ruíz Casado A, Martinez-Amores B, Guillot Morales M, Llorca C, Castañon Lopez C, Soler Gonzalez G, Escudero P, Macias Declara I, Aparicio J. First-line treatment with panitumumab plus FOLFIRI in elderly patients with RAS/BRAF wild-type unresectable metastatic colorectal cancer and good performance status: OPALO trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps3618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jaime Feliu
- Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | - Antonio Cubillo
- HM Universitario Sanchinarro, Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain
| | - Gemma Soler
- Institut Català d'Oncologia, Barcelona, Spain
| | - Alberto Carmona
- Department of Hematology and Medical Oncology, Hospital G. Universitario Morales Meseguer, IMIB-Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | - Pilar Escudero
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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50
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Aparicio J, Sánchez-Muñoz A, Gumà J, Domenech M, Meana J, García-Sánchez J, Bastús R, Gironés R, González-Billalabeitia E, Sagastibelza N, Ochenduszko S, Sánchez A, Terrasa J, Germà-Lluch J, García del Muro X. A Risk-Adapted Approach to Patients with Stage I Seminoma according to the Status of Rete Testis: The Fourth Spanish Germ Cell Cancer Group Study. Oncology 2018; 95:8-12. [DOI: 10.1159/000487438] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 01/30/2018] [Indexed: 12/11/2022]
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