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Ardavanis-Loukeris G, Kokkali S, Perdikari K, Karatrasoglou E, Talagani S, Tzovaras A, Ardavanis A. A Real-world Study of Everolimus Plus Aromatase Inhibitor in Hormone Receptor-positive, HER2-negative Advanced Breast Cancer. Anticancer Res 2024; 44:1559-1565. [PMID: 38537957 DOI: 10.21873/anticanres.16953] [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: 12/26/2023] [Revised: 01/22/2024] [Accepted: 02/25/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND/AIM Everolimus in combination with exemestane was shown to offer benefit versus exemestane monotherapy in hormone receptor (HR)-positive, HER2-negative advanced breast cancer patients who progressed after aromatase inhibitor (AI) therapy. PATIENTS AND METHODS The medical records of metastatic breast cancer patients, treated with everolimus, were retrospectively reviewed to generate real life safety and efficacy data. RESULTS Sixty-eight percent of the patients had received chemotherapy (for early or metastatic disease) and 26% had received chemotherapy for metastatic disease. Among the 25 included patients, the most common adverse events were fatigue, neutropenia, epistaxis, stomatitis, and pneumonitis. Toxicity led to treatment discontinuation in 3 patients (12%). The median progression-free survival (PFS) was 7 months (95%CI=3.5-10.5). With a median follow-up of 73.3 months, the median overall survival was not reached. Twenty-five percent of the patients had received prior therapy with CDK4/6 inhibitors. Median PFS was significantly shorter in this subgroup (p=0.025). There was also a trend towards a longer PFS in patients with grade 3 breast cancer (p=0.085) and in patients receiving everolimus as first-line treatment (p=0.081). Some long responses were noted, with four patients exhibiting a PFS >5 years. CONCLUSION These real-life data show that everolimus in combination with AI in patients with HER2-negative, HR-positive advanced breast cancer is an effective treatment with an acceptable toxicity profile.
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Affiliation(s)
| | - Stefania Kokkali
- 1 Medical Oncology Clinic, Saint-Savvas Anticancer Hospital, Athens, Greece;
- Oncology Unit, 2 Department of Medicine, National and Kapodistrian University of Athens, Medical School, Hippocratio General Hospital of Athens, Athens, Greece
| | | | | | - Sofia Talagani
- 1 Medical Oncology Clinic, Saint-Savvas Anticancer Hospital, Athens, Greece
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Galiti D, Linardou H, Agelaki S, Karampeazis A, Tsoukalas N, Psyrri A, Karamouzis M, Syrigos KN, Ardavanis A, Athanasiadis I, Arvanitou E, Sgourou S, Mala A, Vallilas C, Boukovinas I. Exploring the Use of a Digital Platform for Cancer Patients to Report Their Demographics, Disease and Therapy Characteristics, Age, and Educational Disparities: An Early-Stage Feasibility Study. Curr Oncol 2023; 30:7608-7619. [PMID: 37623032 PMCID: PMC10453047 DOI: 10.3390/curroncol30080551] [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: 04/01/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION The increasing burden of cancer, the development of novel therapies, and the COVID-19 pandemic have made cancer care more complex. Digital innovation was then pushed toward developing platforms to facilitate access to cancer care. Age, education, and other disparities were, however, shown to limit the use of the digital health innovation. The aim of this early-stage feasibility study was to assess whether Greek cancer patients would register at CureCancer and self-report their demographics, disease and therapy characteristics, and socioeconomic issues. The study was organized by the Hellenic Society of Medical Oncology. METHODS Patients from nine cancer centers were invited to register on the CureCancer platform and complete an anonymous questionnaire on demographics, disease and therapy characteristics, and socioeconomic issues. Patients were also encouraged to upload, in a secure area for them, their medical files and share them with their physicians. They were then asked to comment on their experience of registration and how easy it was to upload their medical files. RESULTS Of the 159 patients enrolled, 144 (90.56%) registered, and 114 of those (79.16%) completed the questionnaire, suggesting that the study is feasible. Users' median age was 54.5 years, and 86.8% of them were university and high school graduates. Most patients (79.8%) reported their specific type of cancer diagnosis, and all reported their therapy characteristics. Breast and lung cancers were the most common. A total of 87 patients (76.3%) reported being on active cancer therapy, 46 (40.4%) had metastatic disease, and 51 (44.7%) received supportive care medications. Eighty-one (71.05%) patients received prior cancer therapies, and twenty-seven recalled prior supportive care medications. All patients reported visiting non-oncology Health Care Professionals during the study. Nineteen of 72 (26.39%) patients who worked prior to cancer diagnosis changed work status; 49 (42.98) patients had children under 24 years; and 16 (14%) patients lived alone. Nine (7.9%) patients were members of patient associations. Registration was "much/very much" easy for 98 (86.0%) patients, while 67 (58.8%) had difficulties uploading their files. Patients commented on the well-organized data access, improved communication, feeling safe, medication adherence, interventions from a distance, and saving time and money. Over 80% of patients "preferred the digital way". DISCUSSION A total of 114 patients succeeded in registering on the digital platform and reporting their demographics, disease and therapy characteristics, and socioeconomic issues. Age and educational disparities were disclosed and highlighted the need for educational programs to help older people and people of lower education use digital innovation. Health care policy measures would support patients' financial burden associated with work changes, living alone, and children under 24 years old at school or college. Policy actions would motivate patients to increase their participation in patient associations. According to the evidence DEFINED framework, the number of patients, and the focus on enrollment, engagement, and user experience, the study fulfills actionability level criterion 1.
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Affiliation(s)
- Dimitra Galiti
- Clinic of Oral Diagnosis and Radiology, School of Dentistry, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | | | - Sofia Agelaki
- Hellenic Society of Medical Oncology, 11475 Athens, Greece
| | | | | | - Amanda Psyrri
- Hellenic Society of Medical Oncology, 11475 Athens, Greece
| | | | | | | | | | | | | | - Anastasia Mala
- Hellenic Society of Medical Oncology, 11475 Athens, Greece
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Kokkali S, Kyriazoglou A, Mangou E, Economopoulou P, Panousieris M, Psyrri A, Ardavanis A, Vassos N, Boukovinas I. Real-World Data on Cabozantinib in Advanced Osteosarcoma and Ewing Sarcoma Patients: A Study from the Hellenic Group of Sarcoma and Rare Cancers. J Clin Med 2023; 12:jcm12031119. [PMID: 36769769 PMCID: PMC9918141 DOI: 10.3390/jcm12031119] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/04/2023] [Accepted: 01/18/2023] [Indexed: 02/05/2023] Open
Abstract
Advanced osteosarcomas (OSs) and Ewing sarcomas (ESs) tend to have poor prognosis with limited therapeutic options beyond first-line therapy. Aberrant angiogenesis and MET signaling play an important role in preclinical models. The anti-angiogenic drug cabozantinib was tested in a phase 2 trial of advanced OS and ES and was associated with clinical benefits. We retrospectively analyzed the off-label use of cabozantinib in adult patients with advanced OS and ES/primitive neuroectodermal tumors (PNETs) in three centers of the Hellenic Group of Sarcoma and Rare Cancers (HGSRC). Between April 2019 and January 2022, 16 patients started taking 60 mg of cabozantinib for advanced bone sarcoma or PNET. Median age at cabozantinib initiation was 31 years (17-83). All patients had received peri-operative chemotherapy for primary sarcoma and between 0 and 4 lines of treatment (median; 2.5) for advanced disease. The most common adverse effects included fatigue, anorexia, hypertransaminasemia, weight loss, and diarrhea. One toxic death was noted (cerebral hemorrhage). Dose reduction to 40 mg was required in 31.3% of the patients. No objective response was noted, and 9/16 patients exhibited stable disease outcomes. Progression-free survival varied from 1 to 8 (median; 5) months. Our study demonstrates that cabozantinib has antitumor activity in this population. In the real-life setting, we observed similar adverse events as in the CABONE study and in other neoplasms.
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Affiliation(s)
- Stefania Kokkali
- Department of Medical Oncology, Saint-Savvas Anticancer Hospital, 11522 Athens, Greece
- Medical Oncology Unit, Department of Internal Medicine, Hippocratio General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Correspondence: ; Tel.: +30-2132089511
| | - Anastasios Kyriazoglou
- Medical Oncology Unit, Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Elpida Mangou
- Department of Medical Oncology, Saint-Savvas Anticancer Hospital, 11522 Athens, Greece
| | - Panagiota Economopoulou
- Medical Oncology Unit, Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Michail Panousieris
- Department of Medical Oncology, Saint-Savvas Anticancer Hospital, 11522 Athens, Greece
| | - Amanda Psyrri
- Medical Oncology Unit, Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Alexandros Ardavanis
- Department of Medical Oncology, Saint-Savvas Anticancer Hospital, 11522 Athens, Greece
| | - Nikolaos Vassos
- Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Ioannis Boukovinas
- Department of Medical Oncology, Bioclinic Hospital, 54622 Thessaloniki, Greece
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Fortis SP, Sofopoulos M, Goulielmaki M, Arnogiannaki N, Ardavanis A, Perez SA, Gritzapis AD, Baxevanis CN. Association between Intratumoral CD8+ T Cells with FoxP3+ and CD163+ Cells: A Potential Immune Intrinsic Negative Feedback Mechanism for Acquired Immune Resistance. Cancers (Basel) 2022; 14:cancers14246208. [PMID: 36551693 PMCID: PMC9777444 DOI: 10.3390/cancers14246208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Acquired immune resistance (AIR) describes a situation in which cancer patients who initially responded clinically to immunotherapies, after a certain period of time, progress with their disease. Considering that AIR represents a feedback response of the tumor against the immune attack generated during the course of immunotherapies, it is conceivable that AIR may also occur before treatment initiation as a mechanism to escape endogenous adaptive antitumor immunity (EAAI). In the present study, we assessed the EAAI in paraffin-embedded breast primary tumor tissue samples and drew correlations with the clinical outcomes. In particular, we analyzed densities of CD8+ cells as elements mediating antitumor cytotoxicity, and of CD163+ and FoxP3+ cells as suppressor elements. We found a direct correlation between the densities of CD8+ cells and of CD163+ and/or FoxP3+ cells in the vast majority of patients' tumors. Importantly, the vast majority of patients whose tumors were overpopulated by CD8+ cells developed AIR, which was characterized by high intratumoral CD163+ and/or FoxP3+ cell densities and reduced overall survival (OS). We also showed that AIR depends on the levels of CD8+ cell-ratios in the tumor center to the invasive margin. Our data suggest that tumors develop AIR only when under a robust endogenous immune pressure.
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Affiliation(s)
- Sotirios P. Fortis
- Cancer Immunology and Immunotherapy Center, Cancer Research Center, Saint Savas Cancer Hospital, 11522 Athens, Greece
| | | | - Maria Goulielmaki
- Cancer Immunology and Immunotherapy Center, Cancer Research Center, Saint Savas Cancer Hospital, 11522 Athens, Greece
| | - Niki Arnogiannaki
- Pathology Department, Saint Savas Cancer Hospital, 11522 Athens, Greece
| | - Alexandros Ardavanis
- First Medical Oncology Clinic, Saint Savas Cancer Hospital, 11522 Athens, Greece
| | - Sonia A. Perez
- Cancer Immunology and Immunotherapy Center, Cancer Research Center, Saint Savas Cancer Hospital, 11522 Athens, Greece
| | - Angelos D. Gritzapis
- Cancer Immunology and Immunotherapy Center, Cancer Research Center, Saint Savas Cancer Hospital, 11522 Athens, Greece
| | - Constantin N. Baxevanis
- Cancer Immunology and Immunotherapy Center, Cancer Research Center, Saint Savas Cancer Hospital, 11522 Athens, Greece
- Correspondence: ; Tel.: +30-21064-09380
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Mountzios G, Planchard D, Metro G, Tsiouda D, Prelaj A, Lampaki S, Shalata W, Riudavets M, Christopoulos P, Girard N, Albarrán-Artahona V, Garcia Campelo R, Samitas K, Banna GL, Boukovinas I, Agbarya A, Koumarianou A, Perdikouri EI, Kosmidis P, Linardou H, Mauri D, Mavroudis D, Athanasiadis I, Kalofonos H, Xenidis N, Korantzis I, Ardavanis A, Rallis G, Bottiglieri A, Efthymiadis K, Oikonomopoulos G, Kokkalis A, Saloustros E, Tsoukalas N, Bartzi D, Economopoulou P, Psyrri A, Reck M, Lo Russo G. Molecular Epidemiology and Treatment Patterns of Patients With EGFR Exon 20-Mutant NSCLC in the Precision Oncology Era: The European EXOTIC Registry. JTO Clin Res Rep 2022; 4:100433. [PMID: 36793384 PMCID: PMC9923191 DOI: 10.1016/j.jtocrr.2022.100433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/01/2022] [Accepted: 11/05/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Real-world evidence regarding molecular epidemiology and management patterns of patients with EGFR exon-20 mutated, advanced NSCLC outside the context of clinical trials is lacking. Methods We created a European registry for patients with advanced EGFR exon 20-mutant NSCLC diagnosed from January 2019 to December 2021. Patients enrolled in clinical trials were excluded. Clinicopathologic and molecular epidemiology data were collected, and treatment patterns were recorded. Clinical end points according to treatment assignment were assessed using Kaplan-Meier curves and Cox regression models. Results Data on 175 patients from 33 centers across nine countries were included in the final analysis. Median age was 64.0 (range: 29.7-87.8) years. Main features included female sex (56.3%), never or past smokers (76.0%), adenocarcinoma (95.4%), and tropism for bone (47.4%) and brain (32.0%) metastases. Mean programmed death-ligand 1 tumor proportional score was 15.8% (range: 0%-95%) and mean tumor mutational burden was 7.06 (range: 0-18.8) mutations per megabase. Exon 20 was detected in the tissue (90.7%), plasma (8.7%), or both (0.6%), using mostly targeted next-generation sequencing (64.0%) or polymerase chain reaction (26.0%). Mutations were mainly insertions (59.3%), followed by duplications (28.1%), deletions-insertions (7.7%), and the T790M (4.5%). Insertions and duplications were located mainly in the near loop (codons 767-771, 83.1%) and the far loop (codons 771-775, 13%) and only in 3.9% within the C helix (codons 761-766). Main co-alterations included mutations in TP53 (61.8%) and MET amplifications (9.4%). Treatment on mutation identification included chemotherapy (CT) (33.8%), CT-immunotherapy (IO) (18.2%), osimertinib (22.1%), poziotinib (9.1%), mobocertinib (6.5%), mono-IO (3.9%), and amivantamab (1.3%). Disease control rates were 66.2% with CT plus or minus IO, 55.8% with osimertinib, 64.8% with poziotinib, and 76.9% with mobocertinib. Corresponding median overall survival was 19.7, 15.9, 9.2, and 22.4 months, respectively. In multivariate analysis, type of treatment (new targeted agents versus CT ± IO) affected progression-free survival (p = 0.051) and overall survival (p = 0.03). Conclusions EXOTIC represents the largest academic real-world evidence data set on EGFR exon 20-mutant NSCLC in Europe. Indirectly compared, treatment with new exon 20-targeting agents is likely to confer survival benefit than CT plus or minus IO.
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Affiliation(s)
- Giannis Mountzios
- Fourth Oncology Department and Clinical Trials Unit, Henry Dunant Hospital Center, Athens, Greece,Corresponding author. Address for correspondence: Giannis Mountzios, MD, PhD, Fourth Oncology Department and Clinical Trials Unit, Henry Dunant Hospital Center, Mesogeion 107 Avenue, PC 11526, Athens, Greece.
| | - David Planchard
- Thoracic Group, Department of Medical Oncology, Institut Gustave-Roussy, Villejuif, France
| | - Giulio Metro
- Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Dora Tsiouda
- Department of Thoracic Oncology, Theageneion Hospital, Thessaloniki, Greece
| | - Arsela Prelaj
- Thoracic Oncology Unit, Medical Oncology Department 1, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy,Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Sofia Lampaki
- Department of Pneumonology, “Papanikolaou” Hospital, Thessaloniki, Greece
| | - Walid Shalata
- The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center and Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Mariona Riudavets
- Thoracic Group, Department of Medical Oncology, Institut Gustave-Roussy, Villejuif, France
| | - Petros Christopoulos
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital and German Center for Lung Research (DZL), Heidelberg, Germany
| | - Nicolas Girard
- Thorax Institute, Institut Curie, Paris, France and UVSQ, Paris-Saclay University, Versailles, France
| | | | - Rosario Garcia Campelo
- Medical Oncology Department, Thoracic Tumors Unit, University Hospital A Coruña and Biomedical Research Institute (INIBIC, A Coruña), Coruña, Spain
| | | | | | - Ioannis Boukovinas
- Department of Medical Oncology, Bioclinic Hospital, Thessaloniki, Greece
| | - Abed Agbarya
- Institute of Oncology, Bnai Zion Medical Center, Haifa, Israel
| | - Anna Koumarianou
- Department of Medical Oncology, Attikon University Hospital, Athens, Greece
| | | | - Paris Kosmidis
- Second Department of Medical Oncology, Hygeia Hospital, Athens, Greece
| | - Helena Linardou
- Fourth Oncology Department, Metropolitan Hospital, Athens, Greece
| | - David Mauri
- Department of Medical Oncology, University Hospital of Ioannina, Ioannina, Greece
| | - Dimitrios Mavroudis
- Department of Medical Oncology, University Hospital of Herakleion, Herakleion, Greece
| | | | | | - Nikolaos Xenidis
- Department of Medical Oncology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | | | - Grigorios Rallis
- Department of Medical Oncology, “Theageneion Hospital,” Thessaloniki, Greece
| | - Achille Bottiglieri
- Thoracic Oncology Unit, Medical Oncology Department 1, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy,Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | | | - Alexandros Kokkalis
- Department of Medical Oncology, University Hospital of Larisa, Larisa, Greece
| | | | - Nikolaos Tsoukalas
- Department of Medical Oncology, 401 General Military Hospital, Athens, Greece
| | - Dimitra Bartzi
- Department of Medical Oncology, 251 General Airforce Hospital, Athens, Greece
| | - Panagiota Economopoulou
- Department of Medical Oncology, 2nd Department of Internal Medicine, Attikon University Hospital, Athens, Greece
| | - Amanda Psyrri
- Department of Medical Oncology, 2nd Department of Internal Medicine, Attikon University Hospital, Athens, Greece
| | - Martin Reck
- Lung Clinic, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany
| | - Giuseppe Lo Russo
- Thoracic Oncology Unit, Medical Oncology Department 1, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy,Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
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Tsoukalas N, Christopoulou A, Timotheadou E, Athanasiadis I, Koumarianou A, Peroukidis S, Samelis G, Psyrri A, Kapodistrias N, Nikolakopoulos A, Andreadis C, Ardavanis A, Kalofonos C, Samantas E, Papandreou C, Mavroudis D, Bokas A, Barbounis V, Kentepozidis N, Athanasiadis A, Papakotoulas P, Boukovinas I. EP10.01-018 Thromboprophylaxis for Lung Cancer Patients: Results From ACT4CAT Trial. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.895] [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: 11/26/2022]
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Tsoukalas N, Christopoulou A, Koumarianou A, Timotheadou E, Athanasiadis I, Samelis G, Peroukidis S, Psyrri A, Kapodistrias N, Nikolakopoulos A, Demiri SG, Andreadis C, Bokas A, Ardavanis A, Samantas E, Mavroudis D, Barbounis V, Athanasiadis A, Papakotoulas P, Boukovinas I. Prevention of venous thromboembolism in ambulatory patients with active cancer: Results from ACT4CAT study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18677] [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
e18677 Background: Venous ThromboEmbolism (VTE), might be a challenge with a lot of negative consequences for patients with active cancer. VTE affects ongoing anticancer treatment, worsening morbidity and mortality, increases economic burden and escalates psychological distress. Incidence of VTE in patients with cancer reported 20%. Current guidelines recommend pharmacologic prophylaxis in ambulatory cancer patients with Khorana score ≥2. Methods: ACT4CAT is a prospective observational phase IV study conducted by HeSMO Greece, aiming to record the clinical practice of VTE prophylaxis in active cancer patients. Ambulatory patients who received thromboprophylaxis enrolled after signing informed consent. Study was approved by bioethics committee. Results: 691 patients from 19 oncology departments received thromboprophylaxis in 1st line 57.6%, 2nd line 14.8%, adjuvant 9.0% and neoadjuvant 7.5%. Age ≥65 found 55%, BMI≥30 17.5% and males 63%. Tumor types: gastrointestinal 45.4%, lung 25.8%, urological 11.6%, gynecological 6.0%, breast 4.2% and others 7.0%. High-Risk for Thrombosis Agents (HRTAs) received 87.2%, specifically: platinum agents (56.3%), antimetabolites (54.2%) and immunotherapy (12.1%). 54,5% of the anticancer agents had potential drug-drug interaction (DDI) with anticoagulation treatment. Thromboprophylaxis duration lasted 5.3±3.5 months. Main agents were: tinzaparin 89.6%, fondaparinux 6.0%, bemiparin 2.2%, enoxaparin 1.6%, apixaban 0.3% and rivaroxaban 0.3%. Intermediate thromboprophylaxis dose received 68% of patients, lower in adjuvant setting (45.2%), with a preference in metastatic cases (OR: 1.5 95% CI: 1.02-2.3, p = 0.026). 14 thrombotic events reported (efficacy: 98.0%, 95%CI: 96.6-98.8%) and 12 grade 1 bleeding (1.7%, 95%CI: 1.0-3.0%). Conclusions: Prevention of VTE in ambulatory patients with active cancer found effective and safe. Apart from the Khorana score, specific patient characteristics, metastasis, HRTAs and DDIs seemed that affect clinical decision for thromboprophylaxis mainly with LMWHs and often on intermediate dose regardless the clinical setting. Oncologists appeared informed that CAT is not negligible risk. Clinical trial information: NCT03909399. [Table: see text]
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Affiliation(s)
| | | | - Anna Koumarianou
- On behalf of the Hellenic Society of Medical Oncology, Athens, Greece
| | - Eleni Timotheadou
- On behalf of the Hellenic Society of Medical Oncology (HeSMO, http://www.hesmo.gr/en), Athens, Greece, Athens, Greece
| | | | - Georgios Samelis
- On behalf of the Hellenic Society of Medical Oncology, Athens, Greece
| | | | - Amanda Psyrri
- On behalf of the Hellenic Society of Medical Oncology, Athens, Greece
| | | | - Achilleas Nikolakopoulos
- On behalf of the Hellenic Society of Medical Oncology (HeSMO, http://www.hesmo.gr/en), Athens, Greece, Athens, Greece
| | - Stamatina G Demiri
- On behalf of the Hellenic Society of Medical Oncology (HeSMO, http://www.hesmo.gr/en), Athens, Greece, Athens, Greece
| | | | - Alexandros Bokas
- On behalf of the Hellenic Society of Medical Oncology, Athens, Greece
| | | | | | | | - Vasileios Barbounis
- On behalf of the Hellenic Society of Medical Oncology (HeSMO, http://www.hesmo.gr/en), Athens, Greece, Athens, Greece
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Tsoukalas N, Christopoulou A, Timotheadou E, Athanasiadis I, Koumarianou A, Peroukidis S, Samelis G, Psyrri A, Kapodistrias N, Nikolakopoulos A, Andreadis C, Ardavanis A, Samantas E, Papandreou C, Mavroudis D, Bokas A, Barbounis V, Kentepozidis N, Athanasiadis A, Papakotoulas P, Boukovinas I. PO-45: Cancer-associated thrombosis (CAT) in gynecological cancers: data from ACT4CAT study. Thromb Res 2022. [DOI: 10.1016/s0049-3848(22)00235-3] [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: 10/18/2022]
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Kokkali S, Boukovinas I, Samantas E, Papakotoulas P, Athanasiadis I, Andreadis C, Makrantonakis P, Samelis G, Timotheadou E, Vassilopoulos G, Papadimitriou C, Tzanninis D, Ardavanis A, Kotsantis I, Karvounis-Marolachakis K, Theodoropoulou T, Psyrri A. A Multicenter, Prospective, Observational Study to Assess the Clinical Activity and Impact on Symptom Burden and Patients' Quality of Life in Patients with Advanced Soft Tissue Sarcomas Treated with Trabectedin in a Real-World Setting in Greece. Cancers (Basel) 2022; 14:1879. [PMID: 35454787 PMCID: PMC9031293 DOI: 10.3390/cancers14081879] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 11/16/2022] Open
Abstract
This non-interventional, multicenter, prospective study aimed to evaluate the real-world activity of trabectedin, and its impact on symptom burden and quality of life in patients with advanced soft tissue sarcoma (aSTS) treated in routine clinical settings in Greece. Patients with histologically confirmed aSTS newly initiated on trabectedin were enrolled. The primary endpoint was progression-free survival (PFS) rate at 6 months. Secondary endpoints included PFS rate at 3 months, median PFS, objective response rate (ORR), disease control rate (DCR), overall survival (OS), and an assessment of the impact of treatment on health-related quality of life (HRQoL), cancer-related symptom burden and symptom interference with function, as well as all-cause treatment discontinuation rate. A total of 64 eligible patients from 13 Greek centers were evaluated. Patients received a median of three trabectedin cycles per patient (interquartile range [IQR]: 2.0-6.0). Median PFS was 6.6 months with 67.9% and 51.2% of patients free from progression at 3 and 6 months, respectively. ORR was 7.8% and DCR 21.9%. Median OS was 13.1 months. No significant changes from enrolment were noted in HRQoL scores. In total, 30 patients (46.9%) had at least one trabectedin-related adverse drug reaction (ADR) and 9 (14.1%) at least one serious ADR. The treatment discontinuation rate due to toxicity was 9.4%. These results suggest that trabectedin is an active treatment with clinically meaningful benefits in patients with aSTS with no new safety signals.
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Affiliation(s)
- Stefania Kokkali
- First Department of Medical Oncology, Agios Savvas Athens General Hospital, 11522 Athens, Greece;
| | - Ioannis Boukovinas
- Medical Oncology, Bioclinic of Thessaloniki, 54622 Thessaloniki, Greece;
| | - Epaminondas Samantas
- Third Oncology Clinic, Agioi Anargiroi Athens General Hospital, 14564 Athens, Greece;
| | - Pavlos Papakotoulas
- First Chemotherapeutic Oncology Department, Theagenion Anti-Cancer Hospital of Thessaloniki, 54639 Thessaloniki, Greece;
| | - Ilias Athanasiadis
- Oncology Department, Hygeia Athens Private Hospital, 15123 Maroussi, Greece;
| | - Charalampos Andreadis
- Third Department of Clinical Oncology and Chemotherapy, Theagenion Anti-Cancer Hospital of Thessaloniki, 54639 Thessaloniki, Greece;
| | - Parisis Makrantonakis
- Second Department of Clinical Oncology and Chemotherapy, Theagenion Anti-Cancer Hospital of Thessaloniki, 54639 Thessaloniki, Greece;
| | - Georgios Samelis
- Oncology Department, Hippocration General Hospital of Athens, 11527 Athens, Greece;
| | - Eleni Timotheadou
- Department of Medical Oncology, Papageorgiou Hospital, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54629 Thessaloniki, Greece;
| | | | - Christos Papadimitriou
- Oncology Unit, Aretaieion University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | | | - Alexandros Ardavanis
- First Department of Medical Oncology, Agios Savvas Athens General Hospital, 11522 Athens, Greece;
| | - Ioannis Kotsantis
- Division Medical Oncology, Attikon University General Hospital of Athens, 12462 Haidari, Greece; (I.K.); (A.P.)
| | | | | | - Amanda Psyrri
- Division Medical Oncology, Attikon University General Hospital of Athens, 12462 Haidari, Greece; (I.K.); (A.P.)
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10
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Kokkali S, Saloustros E, Stefanou D, Makrantonakis P, Kentepozidis N, Boukovinas I, Xenidis N, Katsaounis P, Ardavanis A, Ziras N, Christopoulou A, Rigas G, Kalbakis K, Vardakis N, Emmanouilides C, Athanasiadis I, Anagnostopoulos A, Hatzidaki D, Prinarakis E, Simopoulou F, Kotsakis A, Georgoulias V. Front-Line Bevacizumab plus Chemotherapy with or without Maintenance Therapy for Metastatic Breast Cancer: An Observational Study by the Hellenic Oncology Research Group. Curr Oncol 2022; 29:1237-1251. [PMID: 35200604 PMCID: PMC8871254 DOI: 10.3390/curroncol29020105] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
Front-line bevacizumab (BEV) in combination with taxanes offers benefit in progression-free survival (PFS) in metastatic breast cancer (mBC). The medical records of mBC patients, treated with front-line BEV-based chemotherapy, were retrospectively reviewed in order to generate real life safety and efficacy data. Patients with human epidermal growth factor receptor 2 (HER2)-negative mBC treated with front-line BEV in combination with chemotherapy were eligible. Maintenance therapy with BEV and/or hormonal agents was at the physicians’ discretion. Among the 387 included patients, the most common adverse events were anemia (61.9%, mainly grade 1), grade 3/4 neutropenia (16.5%), grade 1/2 fatigue (22.3%), and grade 1/2 neuropathy (19.6%). Dose reductions were required in 164 cycles (7.1%) and toxicity led to treatment discontinuation in 21 patients (5.4%). The median PFS and the median overall survival (OS) were 13.3 (95% CI: 11.7–14.8) and 32.3 months (95% CI: 27.7–36.9), respectively. Maintenance therapy, with hormonal agents (ET) and/or BEV, was associated with longer OS versus no maintenance therapy (47.2 versus 23.6 months; p < 0.001) in patients with hormone receptor (HR)-positive disease and BEV maintenance offered longer OS versus no maintenance in patients with HR-negative disease (52.8 versus 23.3; p = 0.023). These real-life data show that front-line BEV-based chemotherapy in HER2-negative mBC patients is an effective treatment with an acceptable toxicity profile. The potential benefit of maintenance treatment, especially ET, is important and warrants further research.
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Affiliation(s)
- Stefania Kokkali
- 1st Department of Medical Oncology, Saint Savas Anticancer Hospital, 11522 Athens, Greece; (S.K.); (D.S.); (A.A.)
| | | | - Dimitra Stefanou
- 1st Department of Medical Oncology, Saint Savas Anticancer Hospital, 11522 Athens, Greece; (S.K.); (D.S.); (A.A.)
| | - Paris Makrantonakis
- 2nd Department of Medical Oncology, Theageneio Anticancer Hospital, 54639 Thessaloniki, Greece;
| | - Nikolaos Kentepozidis
- Department of Medical Oncology, 251 Airforce General Hospital, 11525 Athens, Greece;
| | | | - Nikolaos Xenidis
- Department of Medical Oncology, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece;
| | - Panagiotis Katsaounis
- 1st Department of Medical Oncology, Metropolitan General Hospital, 11522 Athens, Greece;
| | - Alexandros Ardavanis
- 1st Department of Medical Oncology, Saint Savas Anticancer Hospital, 11522 Athens, Greece; (S.K.); (D.S.); (A.A.)
| | - Nikolaos Ziras
- 2nd Department of Medical Oncology, Metaxas’ Anticancer Hospital, 18537 Piraeus, Greece;
| | | | - George Rigas
- Medical Oncology Unit, General Hospital of Volos, 38222 Volos, Greece;
| | - Kostas Kalbakis
- Department of Medical Oncology, University Hospital of Heraklion, 71500 Crete, Greece; (K.K.); (N.V.)
| | - Nikolaos Vardakis
- Department of Medical Oncology, University Hospital of Heraklion, 71500 Crete, Greece; (K.K.); (N.V.)
| | | | - Ilias Athanasiadis
- 2nd Department of Medical Oncology, MITERA Hospital, 11522 Athens, Greece;
| | | | - Dora Hatzidaki
- Department of Medical Oncology, Hellenic Oncology Research Group, 11471 Athens, Greece; (D.H.); (E.P.)
| | - Efthimios Prinarakis
- Department of Medical Oncology, Hellenic Oncology Research Group, 11471 Athens, Greece; (D.H.); (E.P.)
| | - Foteini Simopoulou
- Department of Radiation Oncology, Iaso Thessaly Hospital, 41005 Larissa, Greece;
| | - Athanasios Kotsakis
- Department of Oncology, University Hospital of Larissa, 41221 Larissa, Greece;
- Correspondence: (A.K.); (V.G.); Tel./Fax: +30-2413502009 (A.K.); +30-2106448450 (V.G.)
| | - Vassilis Georgoulias
- Department of Medical Oncology, Hellenic Oncology Research Group, 11471 Athens, Greece; (D.H.); (E.P.)
- Correspondence: (A.K.); (V.G.); Tel./Fax: +30-2413502009 (A.K.); +30-2106448450 (V.G.)
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11
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Christopoulou A, Ardavanis A, Papandreou C, Koumakis G, Papatsimpas G, Papakotoulas P, Tsoukalas N, Andreadis C, Samelis G, Papakostas P, Aravantinos G, Ziras N, Souggleri M, Kalofonos C, Samantas E, Makrantonakis P, Pentheroudakis G, Athanasiadis A, Stergiou H, Bokas A, Grivas A, Tripodaki ES, Varthalitis I, Timotheadou E, Boukovinas I. Prophylaxis of cancer‑associated venous thromboembolism with low‑molecular‑weight heparin‑tinzaparin: Real world evidence. Oncol Lett 2022; 23:115. [PMID: 35251346 PMCID: PMC8850961 DOI: 10.3892/ol.2022.13235] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/15/2021] [Indexed: 11/05/2022] Open
Abstract
Thromboprophylaxis, as a preventive measure for cancer-associated thrombosis (CAT), may be beneficial for patients with active cancer and high-risk for thrombosis. The present post hoc analysis include a total of 407 patients enrolled in the Greek Management of Thrombosis study, who received thromboprophylaxis with tinzaparin. The objectives of the present analysis were: i) To obtain sufficient evidence for the administration of prophylaxis in patients with active cancer, irrespective of Khorana risk assessment model score; ii) to identify the selection criteria for both dose and duration of tinzaparin; and iii) to evaluate the efficacy and safety of tinzaparin administered for CAT prophylaxis. The main tumor types for the patients included in the present study were as follows: Lung (25.1%), pancreatic (14.3%), breast (9.1%), stomach (8.4%), colorectal (7.9%) and ovarian (7.6%). Furthermore, metastatic disease was observed in 69.5% of the patients. High thrombotic burden agents (HTBAs) were administered to 66.3% of the patients, and 17.4% received erythropoietin. A total of 43.7% of the patients exhibited a Khorana score <2. The results of the present study demonstrated that both the presence of metastatic disease and the use of HTBAs seemed to influence oncologists' decisions for the use of thromboprophylaxis in patients with active cancer, regardless of Khorana score. Tinzaparin, in dose expressed in the standard notation for heparins, i.e., anti-Xa factor international units (Anti-Xa IU), was administered at an intermediate dose (InterD; 8,000-12,000 Anti-Xa IU; once daily) to 52.4% of patients, while the remaining patients received a prophylactic dose (ProD; ≤4,500 Anti-Xa IU; once daily). The average duration of thromoprophylaxis was 5 months. Furthermore, a total of 14 (3.4%) thrombotic events and 6 (1.5%) minor bleeding events were recorded. A total of four thrombotic events were observed following an InterD treatment of tinzaparin, while 10 thrombotic events were observed following ProD treatment. The present study also demonstrated that an InterD of tinzaparin was administered more frequently to patients with a body mass index >30 kg/m2, a history of smoking and a history of metastatic disease, along with administration of erythropoietin. InterD tinzaparin treatment was found to be potentially more efficacious and without safety concerns. The present study is a registered clinical trial (ClinicalTrials.gov code, NCT03292107; registration date, September 25, 2017).
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Affiliation(s)
- Athina Christopoulou
- Oncology/Chemotherapy Department, ‘Saint Andrew’ General Hospital, 26335 Patras, Greece
| | - Alexandros Ardavanis
- 1st Department of Oncology, ‘Agios Savvas’ Anticancer Hospital, 11522 Athens, Greece
| | - Christos Papandreou
- Oncology Department, ‘Papageorgiou’ General Hospital, 56429 Thessaloniki, Greece
| | - Georgios Koumakis
- 1st Department of Oncology, ‘Agios Savvas’ Anticancer Hospital, 11522 Athens, Greece
| | | | - Pavlos Papakotoulas
- 1st Chemotherapy/Oncology Department, ‘Theagenio’ Anticancer Hospital, 54639 Thessaloniki, Greece
| | - Nikolaos Tsoukalas
- Oncology Department, 401 General Military Hospital, 11525 Athens, Greece
| | - Charalambos Andreadis
- 1st Chemotherapy/Oncology Department, ‘Theagenio’ Anticancer Hospital, 54639 Thessaloniki, Greece
| | - Georgios Samelis
- Oncology Department, ‘Ippokrateio’ General Hospital, 11527 Athens, Greece
| | - Pavlos Papakostas
- 2nd Oncology Department, Metropolitan General Hospital, 15562 Athens, Greece
| | - Gerasimos Aravantinos
- 2nd Oncology Department, ‘Agioi Anargyroi’ Anticancer Hospital, 14564 Athens, Greece
| | - Nikolaos Ziras
- Oncology Department, ‘Metaxa’ Anticancer Hospital, 18537 Piraeus, Greece
| | - Maria Souggleri
- Oncology/Chemotherapy Department, ‘Saint Andrew’ General Hospital, 26335 Patras, Greece
| | | | - Epameinondas Samantas
- 2nd Oncology Department, ‘Agioi Anargyroi’ Anticancer Hospital, 14564 Athens, Greece
| | | | | | | | - Helen Stergiou
- Oncology Department, Bioclinic Hospital, 54622 Thessaloniki, Greece
| | - Alexandros Bokas
- 1st Chemotherapy/Oncology Department, ‘Theagenio’ Anticancer Hospital, 54639 Thessaloniki, Greece
| | - Anastasios Grivas
- 1st Department of Oncology, ‘Agios Savvas’ Anticancer Hospital, 11522 Athens, Greece
| | - Elli-Sofia Tripodaki
- 1st Department of Oncology, ‘Agios Savvas’ Anticancer Hospital, 11522 Athens, Greece
| | | | - Eleni Timotheadou
- Oncology Department, ‘Papageorgiou’ General Hospital, 56429 Thessaloniki, Greece
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12
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Pappas G, Saloustros E, Boutis A, Tsoukalas N, Nikolaou M, Christopoulou A, Agelaki S, Boukovinas I, Ardavanis A, Saridaki Z. Vaccine third dose and cancer patients: necessity or luxury? ESMO Open 2021; 6:100306. [PMID: 34773904 PMCID: PMC8579882 DOI: 10.1016/j.esmoop.2021.100306] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 09/30/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 11/23/2022] Open
Abstract
The current state of the SARS-CoV-2 pandemic is an equilibrium between expanding vaccine coverage on the one hand, and emergence of variants of concern which compromise vaccine effectiveness and enhance viral transmission on the other. Inequity in vaccine distribution, primarily an ethical issue, challenges this equilibrium, as industrialized countries prepare to administer a third booster dose to their population. Solid tumor cancer patients typically respond well to initial full vaccination and someone could argue that they should not be prioritized for an adjuvant third dose, since protection from severe disease has largely been achieved with the two-dose regimen. Nevertheless, their immune status is dynamic and not all of them exhibit an adequate immune response. A booster third dose is necessary for the inadequate responders, while it will result in better protection of all patients from mild disease as well, which if presented could have ominous consequences due to their overall frailty, and their need to adhere to strict therapeutic schemes. International scientific and public health communities should develop approaches that allow for wide immediate vaccination coverage of the developing world, in parallel with administration of adjuvant doses to solid tumor cancer patients (and other at-risk categories) of the developed nations, in order to avoid prolonging the pandemic, which will be prospectively against cancer patients' best interest.
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Affiliation(s)
- G Pappas
- Institute of Continuing Medical Education of Ioannina, Ioannina, Greece
| | - E Saloustros
- Hellenic Society of Medical Oncology (HeSMO), Athens, Greece
| | - A Boutis
- Hellenic Society of Medical Oncology (HeSMO), Athens, Greece
| | - N Tsoukalas
- Hellenic Society of Medical Oncology (HeSMO), Athens, Greece
| | - M Nikolaou
- Hellenic Society of Medical Oncology (HeSMO), Athens, Greece
| | - A Christopoulou
- Hellenic Society of Medical Oncology (HeSMO), Athens, Greece
| | - S Agelaki
- Hellenic Society of Medical Oncology (HeSMO), Athens, Greece
| | - I Boukovinas
- Hellenic Society of Medical Oncology (HeSMO), Athens, Greece
| | - A Ardavanis
- Hellenic Society of Medical Oncology (HeSMO), Athens, Greece
| | - Z Saridaki
- Hellenic Society of Medical Oncology (HeSMO), Athens, Greece.
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13
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Tsoukalas N, Christopoulou A, Anastopoulou G, Papandreou C, Timotheadou E, Athanasiadis I, Koumarianou A, Peroukidis S, Samelis G, Psyrri A, Kapodistrias N, Nikolakopoulos A, Andreadis C, Ardavanis A, Samantas E, Bokas A, Barbounis V, Kentepozidis N, Mavroudis D, Athanasiadis A, Papakotoulas P, Boukovinas I. P-214 Should patients with active gastrointestinal tumors receive thromboprophylaxis to avoid the negative clinical consequences of CAT? Sub-analysis of ACT4CAT study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.268] [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] Open
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14
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Tsoukalas N, Christopoulou A, Papandreou CN, Koumarianou A, Athanasiadis I, Peroukidis S, Samelis G, Psyrri A, Kapodistrias N, Nikolakopoulos A, Andreadis C, Ardavanis A, Samantas E, Bokas A, Vassilios B, Kentepozidis NK, Mavroudis D, Athanasiadis A, Papakotoulas P, Boukovinas I. Thromboprophylaxis in active cancer patients: Is it a controversial clinical issue or not? Preliminary results of ACT4CAT study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e18803] [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
e18803 Background: Cancer Associated Thrombosis (CAT) is an increasing challenge for oncology patients since oncologists sometimes are reluctant to mitigate the risk with thromboprophylaxis. Active cancer patients while receiving chemotherapy have a 7fold risk of thrombosis compared with no cancer patients. Anticoagulation holds a prominent place in prevention of CAT usually with Low Molecular Weight Heparins (LMWHs). Methods: ACT4CAT is prospective observational study conducted by HeSMO across Greece, aiming to record the clinical practice of CAT prophylaxis in patients with solid tumors. Ambulatory, high thrombotic risk, active cancer patients who received thromboprophylaxis enrolled after signing informed consent. Results: Preliminary results collected from 18 oncology departments. From 431 enrolled patients 322 (65.4%) had completed the study. Tumor types included: lung 28.8%, gastrointestinal 39.8%, gynecological 7.0%, breast 4.4%, urological 7.0% and others 20%. Majority of patients (88.2%) received High-Risk for Thrombosis Chemotherapy Agents (HRTCAs) such as platinum agents (55.9%), antimetabolites (44.7%) and immunotherapy (12.6%). In 1st line were 62.1%, 2nd line 18.4%, adjuvant 8.9% and neoadjuvant 2.4%. The following table depicts: age, gender, metastatic disease, Khorana score ≥2 and HRTCAs. All patients received thromboprophylaxis for 5.3±3.6 months with: tinzaparin 90.8%, fondaparinux 5.5%, bemiparin 1.5%, enoxaparin 1.2%, apixaban 0.5% and rivaroxaban 0.5%. Intermediate doses received 70.9% of patients regardless clinical setting (1st, 2nd, adjuvant & neoadjuvant: 70.2%, 79.2%, 51.3% and 70.0% respectively, p = 0.0254), although intermediate doses were used more in metastatic stages (OR:2.4 95%CI: 1.4-4.2, p = 0.0028). Nine thrombotic events reported (2.1%, 95%CI: 1.1-3.9%), irrespective of clinical setting but with a trend towards prophylactic doses. Eleven grade 1 bleedings reported (2.6%, 95%CI: 1.4-4.5%), despite clinical setting or dose used. Conclusions: Thromboprophylaxis in ambulatory active cancer patients with high thrombotic risk is safe and effective. Oncologists are alerted about CAT negative influences in cancer patients’ prognosis. Apart from Khorana score, factors such as metastases, use of HRTCAs and drug-drug interactions influence the clinical decision of thromboprophylaxis in active cancer patients mainly with LMWHs and quite often with intermediate doses regardless clinical setting. Clinical trial information: NCT03909399. [Table: see text]
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Affiliation(s)
| | | | | | - Anna Koumarianou
- On behalf of the Hellenic Society of Medical Oncology, Athens, AZ, Greece
| | | | | | - Georgios Samelis
- On behalf of the Hellenic Society of Medical Oncology, Athens, Greece
| | - Amanda Psyrri
- On behalf of the Hellenic Society of Medical Oncology, Athens, Greece
| | | | | | | | | | | | - Alexandros Bokas
- On behalf of the Hellenic Society of Medical Oncology, Athens, Greece
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Baxevanis CN, Fortis SP, Ardavanis A, Perez SA. Exploring Essential Issues for Improving Therapeutic Cancer Vaccine Trial Design. Cancers (Basel) 2020; 12:cancers12102908. [PMID: 33050520 PMCID: PMC7600460 DOI: 10.3390/cancers12102908] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 12/24/2022] Open
Abstract
Therapeutic cancer vaccines have been at the forefront of cancer immunotherapy for more than 20 years, with promising results in phase I and-in some cases-phase II clinical trials, but with failures in large phase III studies. After dozens of clinical studies, only Dendreon's dendritic cell vaccine Sipuleucel-T has succeeded in receiving US FDA approval for the treatment of metastatic castrate-resistant prostate cancer. Although scientists working on cancer immunotherapy feel that this is an essential breakthrough for the field, they still expect that new vaccine regimens will yield better clinical benefits compared to the four months prolonged median overall survival (OS) Sipuleucel-T demonstrated in the IMPACT phase III clinical trial. Clinical development of cancer vaccines has been unsuccessful due to failures either in randomized phase II or-even worse-phase III trials. Thus, rigorous re-evaluation of these trials is urgently required in order to redefine aspects and optimize the benefits offered by therapeutic cancer vaccines. The scope of this review is to provide to the reader our thoughts on the key challenges in maximizing the therapeutic potentials of cancer vaccines, with a special focus on issues that touch upon clinical trial design.
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Affiliation(s)
- Constantin N. Baxevanis
- Cancer Immunology and Immunotherapy Center, Saint Savas Cancer Hospital, 171 Alexandras Avenue, 11522 Athens, Greece; (S.P.F.); (S.A.P.)
- Correspondence: ; Tel.: +30-210-640-9624
| | - Sotirios P. Fortis
- Cancer Immunology and Immunotherapy Center, Saint Savas Cancer Hospital, 171 Alexandras Avenue, 11522 Athens, Greece; (S.P.F.); (S.A.P.)
| | - Alexandros Ardavanis
- 1st Medical Oncology Clinic, Saint Savas Cancer Hospital, 171 Alexandras Avenue, 11522 Athens, Greece;
| | - Sonia A. Perez
- Cancer Immunology and Immunotherapy Center, Saint Savas Cancer Hospital, 171 Alexandras Avenue, 11522 Athens, Greece; (S.P.F.); (S.A.P.)
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16
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Tsoukalas N, Papakotoulas P, Christopoulou A, Ardavanis A, Koumakis G, Papandreou C, Papatsimpas G, Papakostas P, Samelis G, Andreadis C, Aravantinos G, Ziras N, Kalofonos C, Samantas E, Souggleri M, Makrantonakis P, Pentheroudakis G, Athanasiadis A, Stergiou H, Tripodaki ES, Bokas A, Grivas A, Timotheadou E, Bournakis E, Varthalitis I, Boukovinas I. Real-World Data on Thromboprophylaxis in Active Cancer Patients: Where Are We? Are We Getting There? Cancers (Basel) 2020; 12:cancers12071907. [PMID: 32679747 PMCID: PMC7409213 DOI: 10.3390/cancers12071907] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/29/2020] [Accepted: 07/03/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Cancer patients are at high risk for cancer-associated thrombosis (CAT). CAT is the second leading cause of death in these patients but it can be preventable with thromboprophylaxis. Patients and Methods: An observational, prospective, multicenter study aiming to record CAT management in clinical practice was conducted by the Hellenic Society of Medical Oncology (HeSMO). Results: A total of 426 active cancer patients (mean age 65.3 years, mean BMI: 26.1 kg/m2) who received thromboprophylaxis, were included from 18 oncology units. Tumor types were lung 25.1%, pancreas 13.9%, breast 8.7%, stomach 8.5%, ovarian 7.8%, and others 36%, while 69% had metastases. A total of 71% had a Khorana score ≤2 and 61% received High Thrombotic Risk Chemotherapy Agents (HTRCAs, e.g., platinum). For thromboprophylaxis patients received mainly Low Molecular Weight Heparins (LMWHs), on higher than prophylactic doses in 50% of cases. Overall, 16 (3.8%) thrombotic events and 6 (1.4%) bleeding events were recorded. Notably, patients on higher doses of LMWHs compared to patients who received standard prophylactic doses had 70% lower odds to develop thrombotic events (OR: 0.3, 95% CI: 0.10–1.0, p = 0.04). Conclusion: CAT is an important issue in oncology. Along with the Khorana score, factors as metastases and use of HTRCAs should also be taken into consideration. Thromboprophylaxis for active cancer patients with LMWHs, even on higher doses is safe and efficient.
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Affiliation(s)
- Nikolaos Tsoukalas
- 401 General Military Hospital, 11525 Athens, Greece
- Correspondence: ; Tel.: +30-6977366056
| | - Pavlos Papakotoulas
- “Theagenio” Anticancer Hospital, 54639 Thessaloniki, Greece; (P.P.); (C.A.); (A.B.)
| | | | - Alexandros Ardavanis
- “Agios Savvas” Anticancer Hospital, 11522 Athens, Greece; (A.A.); (G.K.); (E.-S.T.); (A.G.)
| | - Georgios Koumakis
- “Agios Savvas” Anticancer Hospital, 11522 Athens, Greece; (A.A.); (G.K.); (E.-S.T.); (A.G.)
| | | | | | | | | | | | | | | | | | | | - Maria Souggleri
- ‘‘Saint Andrew’’ General Hospital, 26335 Patras, Greece; (A.C.); (M.S.)
| | | | | | | | - Helen Stergiou
- “Bioclinic” Hospital, 54622 Thessaloniki, Greece; (H.S.); (I.B.)
| | - Elli-Sofia Tripodaki
- “Agios Savvas” Anticancer Hospital, 11522 Athens, Greece; (A.A.); (G.K.); (E.-S.T.); (A.G.)
| | - Alexandros Bokas
- “Theagenio” Anticancer Hospital, 54639 Thessaloniki, Greece; (P.P.); (C.A.); (A.B.)
| | - Anastasios Grivas
- “Agios Savvas” Anticancer Hospital, 11522 Athens, Greece; (A.A.); (G.K.); (E.-S.T.); (A.G.)
| | - Eleni Timotheadou
- “Papageorgiou” General Hospital, 56429 Thessaloniki, Greece; (C.P.); (E.T.)
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Souglakos J, Boukovinas I, Kakolyris S, Xynogalos S, Ziras N, Athanasiadis A, Androulakis N, Christopoulou A, Vaslamatzis M, Ardavanis A, Emmanouilides C, Bompolaki I, Kourousis C, Makrantonakis P, Christofyllakis C, Athanasiadis E, Kentepozidis N, Karampeazis A, Katopodi U, Anagnosopoulos A, Papadopoulos G, Prinarakis E, Kalisperi A, Mavroudis D, Georgoulias V. Three- versus six-month adjuvant FOLFOX or CAPOX for high-risk stage II and stage III colon cancer patients: the efficacy results of Hellenic Oncology Research Group (HORG) participation to the International Duration Evaluation of Adjuvant Chemotherapy (IDEA) project. Ann Oncol 2020; 30:1304-1310. [PMID: 31228203 DOI: 10.1093/annonc/mdz193] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The International Duration Evaluation of Adjuvant Chemotherapy (IDEA) aimed to investigate whether a 3 months (3M) of oxaliplatin/fluoropyrimidine-based adjuvant chemotherapy (CT) is non-inferior to the 6-month (6M) administration in 3-year disease-free survival (3yDFS) in high-risk (HR) stage II or stage III colon cancer (CC). METHODS Hellenic Oncology Research Group (HORG)-IDEA randomized patients between 3M and 6M of CT with FOLFOX4 or CAPOX. RESULTS In total 1115 patients, 413 with HR stage II and 702 with stage III CC, were randomized. The median follow-up was 67.0 (38.3-126.0) months. Overall, 394 DFS events (202 in 3M arm and 192 in 6M arm) where recorded. The 3yDFS rate was 77.2% [95% confidence interval (CI) 72.1% to 82.3%] for 3M and 77.9% (72.6% to 82.5%) for 6M of treatment [hazard ratio (HR) 1.05 (95% CI 0.61-1.55); P = 0.647]. Eighty DFS events (3M N = 41; 6M N = 39) were observed in HR stage II patients for a 3yDFS rate of 82.7% and 83.4%, respectively (HR 1.05; 95% CI 0.68-1.63, P = 0.829). For stage III patients, 314 DFS events (3M N = 161 and 6M N = 153) were observed, for a 3yDFS rate of 72.9% for 3M versus 74.1% for 6M (HR 1.06; 95% CI 0.81-1.42, P = 0.622). For HR stage II patients receiving FOLFOX4, 3yDFS rate was 76.7% for 3M and 79.3% for 6M (HR 1.21; 95% CI 0.54-2.70). For HR stage II patients receiving CAPOX the 3yDFS rate was 85.4% for 3M and 83.8% for 6M (HR 0.99; 95% CI 0.59-1.67). For stage III patients receiving FOLFOX4, the 3yDFS rate was 71.5% for 3M and 77.3% for 6M (HR 1.18; 95% CI 0.74-1.86). For stage III patients receiving CAPOX, the 3yDFS rate was 74.5% for 3M and 74.7% for 6M (HR 0.99; 95% CI 0.70-1.44). CONCLUSIONS The results of the HORG-IDEA study are in line with those of the global IDEA project, indicating that the 3yDFS is dependent on the administered adjuvant regimen and the choice and duration of regimen should be personalized. CLINICALTRIALS.GOV REGISTRATION NUMBER NCT01308086.
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Affiliation(s)
- J Souglakos
- Hellenic Oncology Research Group, Athens, Greece.
| | - I Boukovinas
- Hellenic Oncology Research Group, Athens, Greece
| | - S Kakolyris
- Hellenic Oncology Research Group, Athens, Greece
| | - S Xynogalos
- Hellenic Oncology Research Group, Athens, Greece
| | - N Ziras
- Hellenic Oncology Research Group, Athens, Greece
| | | | | | | | | | - A Ardavanis
- Hellenic Oncology Research Group, Athens, Greece
| | | | - I Bompolaki
- Hellenic Oncology Research Group, Athens, Greece
| | - C Kourousis
- Hellenic Oncology Research Group, Athens, Greece
| | | | | | | | | | | | - U Katopodi
- Hellenic Oncology Research Group, Athens, Greece
| | | | | | - E Prinarakis
- Hellenic Oncology Research Group, Athens, Greece
| | - A Kalisperi
- Hellenic Oncology Research Group, Athens, Greece
| | - D Mavroudis
- Hellenic Oncology Research Group, Athens, Greece
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18
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Mosa E, Manouvelou S, Tolia M, Tsoukalas N, Ardavanis A, Stasinopoulou M, Kyrgias G, Tavernaraki A. Acute Leriche Syndrome in Pancreatic Adenocarcinoma: A Case Report. Curr Med Imaging 2020; 16:622-624. [DOI: 10.2174/1573405615666190206161013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 01/04/2019] [Accepted: 01/10/2019] [Indexed: 11/22/2022]
Abstract
Introduction:
Coexistance of pancreatic carcinoma and Leriche syndrome is an extremely
rare pathological condition. Leriche syndrome is defined as occlusion of the distal aorta at
the bifurcation into the common iliac arteries.
Case Report:
We report the case of a 57-year old male patient with a locally advanced pancreatic
tumor that during chemotherapy presented Leriche syndrome. Four months after the diagnosis and
although the initial staging by MRI had only revealed a few atheromatic lesions of the abdominal
aorta, the patient complained about claudication of the legs and hypoesthesia. Angiography with
multi-detector computed tomography (MDCTA) was performed using aortography protocol and
three-dimensional reconstruction of the images followed, deCmonstrating the relationship between
pancreatic carcinoma and Leriche syndrome.
:
Review of the literature revealed that acute abdominal thrombosis is rare in cancer
patients. To our knowledge, complete occlusion of the aorta in a patient with pancreatic cancer has
not been reported yet.
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Affiliation(s)
- Eftychia Mosa
- Department of Radiology, St. Savvas Anticancer Hospital of Athens, Athens, Greece
| | - Stamo Manouvelou
- Department of Radiology, St. Savvas Anticancer Hospital of Athens, Athens, Greece
| | - Maria Tolia
- Department of Radiotherapy, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larisa, Greece
| | | | - Alexandros Ardavanis
- Second Department of Medical Oncology, St. Savvas Anticancer Hospital of Athens, Athens, Greece
| | | | - George Kyrgias
- Department of Radiotherapy, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larisa, Greece
| | - Aggeliki Tavernaraki
- Department of Radiology, St. Savvas Anticancer Hospital of Athens, Athens, Greece
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19
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Tsoukalas N, Christopoulou A, Papandreou CN, Kapodistrias N, Koumarianou A, Peroukidis S, Kalofonos H, Samelis G, Andreadis C, Ardavanis A, Samantas E, Bokas A, Ligdas A, Athanasiadis I, Barbounis V, Kentepozidis NK, Mavroudis D, Athanasiadis A, Papakotoulas P, Boukovinas I. ACT for prevention and prophylaxis of cancer-associated thrombosis (CAT). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e14135] [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
e14135 Background: CAT is the 2nd leading cause of death in oncology patients and there is need for thrombosis management across the natural history of cancer because of its dynamic nature. Anticoagulant therapy is the cornerstone of prevention and treatment, since thrombosis interferes with cancer treatment, increases health care resource utilization, imposes emotional and economic burden. Methods: A prospective observational study conducted by HeSMO across Greece, aiming to record the clinical practice of CAT prophylaxis in patients with solid tumors. Ambulatory, high risk for thrombosis, active cancer patients who received thromboprophylaxis are enrolled after signing informed consent. Results: Preliminary results are collected from 17 oncology departments. From the 272 enrolled patients, 176 (64.7%) have completed second visit (3-4 cycles of anticancer treatment). Primary cancers included: lung 31.3%, pancreas 26.1%, colorectal 13.6%, gynecological cancers 10.2%, stomach 7.8%, bladder 6.3%, and others.75.6% of the patients had metastatic disease. 1/3 of the patients were smokers or ex-smokers, and 33% underwent surgery. Most of patients (65.9%) were at 1st line treatment and 17.6% at 2nd line. The vast majority (90.3%) were treated with High-Risk for Thrombosis Chemotherapy Agents (HRTCAs) such as cisplatin etc. Regarding Khorana score, 65.1% had ≥2. In particular, 86.7% of patients with Khorana score ≤1 received HRTCAs while 95.4% of patients with score = 2.All patients received thromboprophylaxis, specifically: 93.0% tinzaparin, 5.2% fondaparinux and 1.8% other (enoxaparin, bemiparin) with average duration 5.3±3.1 months. 67.1% of the patients received higher than standard prophylactic doses. 3 patients (1.7%) experienced thrombotic events (2 DVT and 1 PE). These 3 patients had metastases and were treated with HRTCAs. Five grade 1 bleeding events were reported (2.8%). Conclusions: Thromboprophylaxis of CAT is both safe and effective. Oncologists are alerted about CAT negative influences in cancer patients’ prognosis. Apart from Khorana score, factors such as metastases, use of HRTCAs along with drug-drug interactions, increase the LMWHs usage often in higher than prophylactic doses in CAT management. Clinical trial information: NCT03909399.
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Affiliation(s)
- Nikolaos Tsoukalas
- On behalf of the Hellenic Society of Medical Oncology (HeSMO, http://www.hesmo.gr/en), Athens, Greece
| | - Athina Christopoulou
- On behalf of the Hellenic Society of Medical Oncology (HeSMO, http://www.hesmo.gr/en), Athens, Greece
| | - Christos N Papandreou
- On behalf of the Hellenic Society of Medical Oncology (HeSMO, http://www.hesmo.gr/en), Athens, Greece
| | - Nikolaos Kapodistrias
- On behalf of the Hellenic Society of Medical Oncology (HeSMO, http://www.hesmo.gr/en), Athens, Greece, Athens, Greece
| | - Anna Koumarianou
- On behalf of the Hellenic Society of Medical Oncology (HeSMO, http://www.hesmo.gr/en), Athens, Greece, Athens, AZ, Greece
| | - Stavros Peroukidis
- On behalf of the Hellenic Society of Medical Oncology (HeSMO, http://www.hesmo.gr/en), Athens, Greece, Athens, Greece
| | - Haralabos Kalofonos
- On behalf of the Hellenic Society of Medical Oncology (HeSMO, http://www.hesmo.gr/en), Athens, Greece, Athens, Greece
| | - Georgios Samelis
- On behalf of the Hellenic Society of Medical Oncology (HeSMO, http://www.hesmo.gr/en), Athens, Greece, Athens, Greece
| | - Charalampos Andreadis
- On behalf of the Hellenic Society of Medical Oncology (HeSMO, http://www.hesmo.gr/en), Athens, Greece
| | - Alexandros Ardavanis
- On behalf of the Hellenic Society of Medical Oncology (HeSMO, http://www.hesmo.gr/en), Athens, Greece, Athens, Greece
| | - Epaminontas Samantas
- On behalf of the Hellenic Society of Medical Oncology (HeSMO, http://www.hesmo.gr/en), Athens, Greece, Athens, Greece
| | - Alexandros Bokas
- On behalf of the Hellenic Society of Medical Oncology (HeSMO, http://www.hesmo.gr/en), Athens, Greece
| | - Athanasios Ligdas
- On behalf of the Hellenic Society of Medical Oncology (HeSMO, http://www.hesmo.gr/en), Athens, Greece, Athens, Greece
| | - Ilias Athanasiadis
- On behalf of the Hellenic Society of Medical Oncology (HeSMO, http://www.hesmo.gr/en), Athens, Greece, Athens, AZ, Greece
| | - Vasileios Barbounis
- On behalf of the Hellenic Society of Medical Oncology (HeSMO, http://www.hesmo.gr/en), Athens, Greece, Athens, Greece
| | - Nikolaos K. Kentepozidis
- On behalf of the Hellenic Society of Medical Oncology (HeSMO, http://www.hesmo.gr/en), Athens, Greece, Athens, Greece
| | - Dimitrios Mavroudis
- On behalf of the Hellenic Society of Medical Oncology (HeSMO, http://www.hesmo.gr/en), Athens, Greece, Athens, Greece
| | - Athanasios Athanasiadis
- On behalf of the Hellenic Society of Medical Oncology (HeSMO, http://www.hesmo.gr/en), Athens, Greece, Athens, Greece
| | - Pavlos Papakotoulas
- On behalf of the Hellenic Society of Medical Oncology (HeSMO, http://www.hesmo.gr/en), Athens, Greece, Athens, Greece
| | - Ioannis Boukovinas
- On behalf of the Hellenic Society of Medical Oncology (HeSMO, http://www.hesmo.gr/en), Athens, Greece
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20
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Koumarianou A, Makrantonakis P, Zagouri F, Papadimitriou C, Christopoulou A, Samantas E, Christodoulou C, Psyrri A, Bafaloukos D, Aravantinos G, Papakotoulas P, Baka S, Andreadis C, Alexopoulos A, Bompolaki I, Kampoli Κ, Liori S, Karvounis K, Ardavanis A. ABREAST: a prospective, real-world study on the effect of nab-paclitaxel treatment on clinical outcomes and quality of life of patients with metastatic breast cancer. Breast Cancer Res Treat 2020; 182:85-96. [PMID: 32418045 DOI: 10.1007/s10549-020-05677-4] [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: 03/26/2020] [Accepted: 05/09/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The efficacy of nab-paclitaxel in patients with metastatic breast cancer (MBC) has been demonstrated in randomized clinical trials. However, real-world evidence on effectiveness remains limited. PATIENTS AND METHODS The primary objective of this multicenter prospective study was to assess the overall response rate (ORR) of patients with MBC treated with nab-paclitaxel. Secondary objectives included progression-free survival (PFS), overall survival (OS) and quality of life, assessed with the Functional Assessment of Cancer Therapy-Breast (FACT-B) instrument. RESULTS Eligible patients (N = 150; 36% with de novo MBC presentation) with a median age of 64.5 years were enrolled (86% were ER+, 33.3% (50/150) were ≥ 70 years of age and 53% were treated in the third or later line of treatment). A median of 6 cycles were administered but 26% of patients required dose reduction due to toxicity. The ORR was 26.7% [95% confidence interval (CI) 19.6-33.7], the median PFS was 6.2 months (95% CI 5.2-7.3), and the median OS 21.1 months (95% CI 17.2-not estimable). There was no statistical significant difference in the median PFS of patients < and ≥ 70 years of age. The patients' baseline FACT-B total score remained unchanged. The serious and non-serious adverse event incidence rates were 13% and 48%, respectively. CONCLUSIONS This prospective study provides further evidence on quality of life, efficacy, and safety of nab-paclitaxel in patients with MBC and sheds more light in special subpopulations such as the elderly and those treated beyond the second line.
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Affiliation(s)
- A Koumarianou
- Hematology Oncology Unit, Fourth Department of Internal Medicine, ATTIKON University General Hospital, National and Kapodistrian University of Athens, Medical School, Rimini 1, 124 62, Haidari, Athens, Greece.
| | - P Makrantonakis
- Second Chemotherapeutic Clinic, THEAGENIO Anti-Cancer Hospital of Thessaloniki, Thessaloniki, Greece
| | - F Zagouri
- Therapeutic Clinic, ALEXANDRA General Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - C Papadimitriou
- Oncology Unit, 2nd Dept. of Surgery, ARETAIEIO University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - A Christopoulou
- Oncology Department, AGIOS ANDREAS General Hospital of Patras, Patras, Greece
| | - E Samantas
- Third Oncology Clinic, AGIOI ANARGIROI Athens General Hospital, Athens, Greece
| | - C Christodoulou
- Second Oncology Clinic, METROPOLITAN Athens Private Hospital, Piraeus, Greece
| | - A Psyrri
- Division Medical Oncology, ATTIKON University General Hospital of Athens, Haidari, Greece
| | - D Bafaloukos
- First Oncology Clinic, METROPOLITAN Athens Private Hospital, Piraeus, Greece
| | - G Aravantinos
- Second Oncology Clinic, AGIOI ANARGIROI Athens General Hospital, Athens, Greece
| | - P Papakotoulas
- First Chemotherapeutic Oncology Department, THEAGENION Anti-Cancer Hospital of Thessaloniki, Thessaloniki, Greece
| | - S Baka
- Oncology Department, European INTERBALKAN Private Hospital of Thessaloniki, Thessaloniki, Greece
| | - C Andreadis
- Third Department of Clinical Oncology and Chemotherapy, THEAGENION Anti-Cancer Hospital of Thessaloniki, Thessaloniki, Greece
| | - A Alexopoulos
- Oncology Department, HYGEIA Athens Private Hospital, Maroussi, Athens, Greece
| | - I Bompolaki
- Oncology Department, AGIOS GEORGIOS General Hospital of Chania, Chania, Crete, Greece
| | - Κ Kampoli
- Hematology Oncology Unit, Fourth Department of Internal Medicine, ATTIKON University General Hospital, National and Kapodistrian University of Athens, Medical School, Rimini 1, 124 62, Haidari, Athens, Greece
| | - S Liori
- First Department of Medical Oncology, AGIOS SAVVAS Athens General Hospital, Athens, Greece
| | - K Karvounis
- Medical Department Hematology/Oncology, Genesis Pharma S.A, Halandri, Athens, Greece
| | - A Ardavanis
- First Department of Medical Oncology, AGIOS SAVVAS Athens General Hospital, Athens, Greece
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21
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Brown TA, Mittendorf EA, Hale DF, Myers JW, Peace KM, Jackson DO, Greene JM, Vreeland TJ, Clifton GT, Ardavanis A, Litton JK, Shumway NM, Symanowski J, Murray JL, Ponniah S, Anastasopoulou EA, Pistamaltzian NF, Baxevanis CN, Perez SA, Papamichail M, Peoples GE. Prospective, randomized, single-blinded, multi-center phase II trial of two HER2 peptide vaccines, GP2 and AE37, in breast cancer patients to prevent recurrence. Breast Cancer Res Treat 2020; 181:391-401. [PMID: 32323103 PMCID: PMC7188712 DOI: 10.1007/s10549-020-05638-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 04/08/2020] [Indexed: 12/03/2022]
Abstract
Purpose AE37 and GP2 are HER2 derived peptide vaccines. AE37 primarily elicits a CD4+ response while GP2 elicits a CD8+ response against the HER2 antigen. These peptides were tested in a large randomized trial to assess their ability to prevent recurrence in HER2 expressing breast cancer patients. The primary analyses found no difference in 5-year overall disease-free survival (DFS) but possible benefit in subgroups. Here, we present the final landmark analysis. Methods In this 4-arm, prospective, randomized, single-blinded, multi-center phase II trial, disease-free node positive and high-risk node negative breast cancer patients enrolled after standard of care therapy. Six monthly inoculations of vaccine (VG) vs. control (CG) were given as the primary vaccine series with 4 boosters at 6-month intervals. Demographic, safety, immunologic, and DFS data were evaluated. Results 456 patients were enrolled; 154 patients in the VG and 147 in CG for AE37, 89 patients in the VG and 91 in CG for GP2. The AE37 arm had no difference in DFS as compared to CG, but pre-specified exploratory subgroup analyses showed a trend towards benefit in advanced stage (p = 0.132, HR 0.573 CI 0.275–1.193), HER2 under-expression (p = 0.181, HR 0.756 CI 0.499–1.145), and triple-negative breast cancer (p = 0.266, HR 0.443 CI 0.114–1.717). In patients with both HER2 under-expression and advanced stage, there was significant benefit in the VG (p = 0.039, HR 0.375 CI 0.142–0.988) as compared to CG. The GP2 arm had no significant difference in DFS as compared to CG, but on subgroup analysis, HER2 positive patients had no recurrences with a trend toward improved DFS (p = 0.052) in VG as compared to CG. Conclusions This phase II trial reveals that AE37 and GP2 are safe and possibly associated with improved clinical outcomes of DFS in certain subgroups of breast cancer patients. With these findings, further evaluations are warranted of AE37 and GP2 vaccines given in combination and/or separately for specific subsets of breast cancer patients based on their disease biology.
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Affiliation(s)
- Tommy A Brown
- Department of Surgery, Brooke Army Medical Center, Ft. Sam Houston, San Antonio, TX, USA
| | - Elizabeth A Mittendorf
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Division of Breast Surgery, Department of Surgery, Breast Oncology Program, Brigham and Women's Hospital, Dana-Farber/Brigham and Women's Hospital, Boston, MA, USA
| | - Diane F Hale
- Department of Surgery, Brooke Army Medical Center, Ft. Sam Houston, San Antonio, TX, USA
| | - John W Myers
- Department of Surgery, Brooke Army Medical Center, Ft. Sam Houston, San Antonio, TX, USA
| | - Kaitlin M Peace
- Department of Surgery, Brooke Army Medical Center, Ft. Sam Houston, San Antonio, TX, USA
| | - Doreen O Jackson
- Department of Surgery, Brooke Army Medical Center, Ft. Sam Houston, San Antonio, TX, USA
| | - Julia M Greene
- Department of Surgery, Brooke Army Medical Center, Ft. Sam Houston, San Antonio, TX, USA
| | - Timothy J Vreeland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G Travis Clifton
- Department of Surgery, Brooke Army Medical Center, Ft. Sam Houston, San Antonio, TX, USA
| | - Alexandros Ardavanis
- Cancer Immunology and Immunotherapy Center, St. Savas Cancer Hospital, Athens, Greece
| | - Jennifer K Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - J Symanowski
- Department of Cancer Biostatistics, Levine Cancer Institute, Charlotte, NC, USA
| | - James L Murray
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sathibalan Ponniah
- Cancer Vaccine Development Laboratory, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - E A Anastasopoulou
- Cancer Immunology and Immunotherapy Center, St. Savas Cancer Hospital, Athens, Greece
| | - N F Pistamaltzian
- Cancer Immunology and Immunotherapy Center, St. Savas Cancer Hospital, Athens, Greece
| | | | - Sonia A Perez
- Cancer Immunology and Immunotherapy Center, St. Savas Cancer Hospital, Athens, Greece
| | - Michael Papamichail
- Cancer Immunology and Immunotherapy Center, St. Savas Cancer Hospital, Athens, Greece
| | - George E Peoples
- Department of Surgery, Uniformed Services Health University, Bethesda, MD, USA. .,Cancer Vaccine Development Program, 1305 East Houston Street, San Antonio, TX, 78205, USA.
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22
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Nicolatou‐Galitis O, Papadopoulou E, Vardas E, Kouri M, Galiti D, Galitis E, Alexiou K, Tsiklakis K, Ardavanis A, Razis E, Athanasiadis I, Droufakou S, Psyrri A, Karamouzis MV, Linardou H, Daliani D, Tzanninis D, Sachanas S, Laschos K, Kyrtsonis M, Antoniou F, Laskarakis A, Giassas S, Nikolaidi A, Rigakos G, Ntokou A, Migliorati CA, Ripamonti CI. Alveolar bone histological necrosis observed prior to extractions in patients, who received bone‐targeting agents. Oral Dis 2020; 26:955-966. [DOI: 10.1111/odi.13294] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 12/26/2019] [Accepted: 01/28/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Ourania Nicolatou‐Galitis
- Clinic of Hospital Dentistry Densstal School National & Kapodistrian University of Athens Athens Greece
| | - Erofili Papadopoulou
- Clinic of Hospital Dentistry Densstal School National & Kapodistrian University of Athens Athens Greece
| | - Emmanouil Vardas
- Clinic of Hospital Dentistry Densstal School National & Kapodistrian University of Athens Athens Greece
| | - Maria Kouri
- Clinic of Hospital Dentistry Densstal School National & Kapodistrian University of Athens Athens Greece
| | - Dimitra Galiti
- Clinic of Oral Diagnosis & Radiology Dental School National & Kapodistrian University of Athens Athens Greece
| | - Evangelos Galitis
- Clinic of Oral and Maxillofacial Surgery Dental School National & Kapodistrian University of Athens Athens Greece
| | - Konstantina‐Eleni Alexiou
- Clinic of Oral Diagnosis & Radiology Dental School National & Kapodistrian University of Athens Athens Greece
| | - Kostas Tsiklakis
- Clinic of Oral Diagnosis & Radiology Dental School National & Kapodistrian University of Athens Athens Greece
| | | | - Evangelia Razis
- Third Medical Oncology Department Hygeia Hospital Athens Greece
| | | | | | - Amanda Psyrri
- Attikon Hospital National and Kapodistrian University of Athens Athens Greece
| | - Michalis V. Karamouzis
- Department of Biological Chemistry and First Department of Internal Medicine Laikon Hospital, Medical School National and Kapodistrian University of Athens Athens Greece
| | | | - Danai Daliani
- First Medical Oncology Department Euroclinic of Athens Athens Greece
| | | | - Sotirios Sachanas
- Department of Hematology Athens Medical Center Psychikon Branch Athens Greece
| | - Konstantinos Laschos
- 2nd Oncology Department General and Oncologic Hospital “Agii Anargyri” Athens Greece
| | | | - Fotini Antoniou
- Department of Oncology Unit Elena Venizelou Maternity Hospital Athens Greece
| | | | - Styllianos Giassas
- 2nd Oncology Clinic IASO Maternity Hospital and 3rd Oncology Clinic Metropolitan General Hospital Athens Greece
| | | | - George Rigakos
- Third Medical Oncology Department Hygeia Hospital Athens Greece
| | - Anna Ntokou
- Oncology Department Saint Savvas Hospital Athens Greece
| | - Cesar A. Migliorati
- Department of Diagnostic Sciences and Oral Medicine University of Florida Health Science Center College of Dentistry Gainesville FL USA
| | - Carla I. Ripamonti
- Supportive Care Unit Department of Medical Oncology and Haematology Fondazione IRRCS Istituto Nazionale dei Tumori Milano Italy
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23
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Koumarianou A, Makrantonakis P, Zagouri F, Papadimitriou C, Christopoulou A, Samantas E, Christodoulou C, Psyrri A, Bafaloukos D, Aravantinos G, Papakotoulas P, Baka S, Andreadis C, Alexopoulos A, Bombolaki I, Kampoli K, Liori S, Karvounis K, Ardavanis A. Abstract P2-15-07: Real-world multicenter, prospective study of the effects of nab-paclitaxel on clinical outcomes and quality of life of patients with metastatic breast cancer in Greece. The ‘ABReast’ study. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p2-15-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Nanoparticle albumin-bound (nab)-paclitaxel (nab-P) is approved for the treatment of patients with metastatic breast cancer (MBC) who have failed first-line treatment for metastatic disease and for whom standard, anthracycline containing therapy is not indicated. Real-world evidence on the effectiveness of nab-P is sparse. From this perspective, this non-interventional study was designed to assess the impact of nab-P on the clinical outcomes and the quality of life of patients with MBC in the routine care of Greece. Materials and methods: This multicenter prospective study enrolled consented females with MBC initiated (≤7 days prior to enrollment) on nab-P according to physicians decision. Clinicopathologic parameters and patient-reported outcomes [Functional Assessment of Cancer Therapy-Breast (FACT-B)] were collected at approximately 9-week intervals during the first 12 months of study participation and approximately every 18 weeks thereafter, until the end of the study observation period (maximum 30 months). Results: Between April 2016 and October 2017, 150 eligible patients (99.3% Caucasian) were enrolled in the study in 16 oncology centers. The patients’ median age was 64.5 years (range: 30.7-84.0) and ECOG performance status was 0 in 66.4% and 1 in 26.2%. 45.3% of patients had ≥1 comorbidity (21.3% cardiovascular diseases). The median time elapsed since MBC diagnosis was 22.4 months, while 36.0% of patients were de novo metastatic. The distribution of hormone receptor (HR)/human epidermal growth factor receptor 2 (HER2) status was 74.6% HR+/HER2-, 11.9% HR-/HER2-, 11.2% HR+/HER2+, and 2.2% HR-/HER2+. Most commonly occurring metastatic sites were the bones (55.3%), lung (50.0%), and liver (40.0%). Prior taxane-based therapy was annotated in 40.0% of patients. Of the patients, 11.3% received nab-P as first, 36.0% as second, 23.3% as third, and 29.3% as fourth or further treatment line. A median of 6 cycles (range: 1-33) was administered; 42.7% of the patients completed >6 and 22.0% >8 cycles. Dose reductions were required for 26.0% of the patients, mainly due to toxicity. The objective response rate was 26.7% and the clinical benefit rate was 44.0%. After a median follow-up of 19.3 months, 92 patients had progressed and 57 had died (14 without progression). The median progression-free survival (PFS) was 6.2 months [95% confidence interval (CI): 5.2-7.3]. The 6- and 12-month PFS rates were 50.6% and 30.5%, respectively. The median overall survival was 21.1 months (95% CI: 17.2-not estimable). Liver [hazard ratio (HR): 1.81; 95% CI: 1.24-2.66] and lung (HR: 1.53; 95% CI: 1.04-2.25) metastases were associated with a higher risk of progression or death. No statistically significant change in the patients’ baseline FACT-B total score (median: 93.0) was observed. The serious and non-serious adverse event (AE) incidence rates were 12.7% and 48.0%, respectively with a total of 37 grade ≥3 AEs (not including disease progression) reported. Conclusion: This study generated real-world evidence on the effectiveness of nab-paclitaxel; no new safety signals emerged.
Citation Format: Anna Koumarianou, Paris Makrantonakis, Flora Zagouri, Christos Papadimitriou, Athina Christopoulou, Epaminontas Samantas, Christos Christodoulou, Amanda Psyrri, Dimitris Bafaloukos, Gerasimos Aravantinos, Pavlos Papakotoulas, Sofia Baka, Charalampos Andreadis, Athanasios Alexopoulos, Iliada Bombolaki, Katerina Kampoli, Sofia Liori, Kiki Karvounis, Alexandros Ardavanis. Real-world multicenter, prospective study of the effects of nab-paclitaxel on clinical outcomes and quality of life of patients with metastatic breast cancer in Greece. The ‘ABReast’ study [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-15-07.
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Affiliation(s)
- Anna Koumarianou
- 1Hematology Oncology Unit, Fourth Department of Internal Medicine, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Flora Zagouri
- 3Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | | | - Amanda Psyrri
- 8Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | - Sofia Baka
- 9European Interbalkan Medical Center, Thessaloniki, Greece
| | | | | | | | - Katerina Kampoli
- 12National and Kapodistrian University of Athens, Athens, Greece
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Papakotoulas P, Tsoukalas N, Christopoulou A, Ardavanis A, Koumakis G, Papandreou C, Papatsimpas G, Papakostas P, Samelis G, Andreadis C, Aravantinos G, Ziras N, Kalofonos C, Samantas E, Souggleri M, Makrantonakis P, Pentheroudakis G, Athanasiadis A, Stergiou H, Tripodaki S, Bokas A, Grivas A, Timotheadou E, Bournakis E, Varthalitis I, Boukovinas I. Management of Cancer-associated Thrombosis (CAT): Symptomatic or Incidental. Anticancer Res 2020; 40:305-313. [PMID: 31892581 DOI: 10.21873/anticanres.13954] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 11/20/2019] [Accepted: 11/25/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cancer-associated thrombosis (CAT), the second leading cause of death in patients with cancer can be treated with low molecular weight heparin (LMWH) according to guidelines. PATIENTS AND METHODS A multicenter prospective observational study was carried out to record anti-thrombotic treatment practice, assess thrombosis recurrence and bleeding, and identify potential risk factors. Adult patients from 18 Oncology Departments throughout Greece were followed-up for 12 months. RESULTS A total of 120 patients with CAT receiving anticoagulant treatment were enrolled (35% incidental); 85% were treated for more than 6 months, 95.8% were treated with tinzaparin and smaller percentages with other agents. Thrombosis recurred in three patients and there was minor bleeding in four patients. Bleeding was associated with high body mass index (>35 kg/m2), trauma history, renal insufficiency and bevacizumab use. CONCLUSION Incidental thrombosis contributes significantly to CAT burden. Long-term use of LMWH seems to be effective and safe. Several risk factors associated with bleeding should be considered during anti-coagulation therapy planning.
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Sofopoulos M, Fortis SP, Vaxevanis CK, Sotiriadou NN, Arnogiannaki N, Ardavanis A, Vlachodimitropoulos D, Perez SA, Baxevanis CN. The prognostic significance of peritumoral tertiary lymphoid structures in breast cancer. Cancer Immunol Immunother 2019; 68:1733-1745. [PMID: 31598757 DOI: 10.1007/s00262-019-02407-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [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: 05/29/2019] [Accepted: 09/29/2019] [Indexed: 12/31/2022]
Abstract
Tumors and their surrounding area represent spatially organized "ecosystems", where tumor cells and the immune contextures of the different compartments are in a dynamic interplay, with potential clinical impact. Here, we aimed to investigate the prognostic significance of peritumoral tertiary lymphoid structures (TLS) either alone or jointly with the intratumoral densities and spatial distribution of CD8 + and CD163 + cells in breast cancer (BCa) patients. TLS were identified peritumorally, within the area distancing up to 5 mm from the infiltrative tumor border, counted and further characterized as adjacent or distal, in formalin-fixed, paraffin-embedded tumor tissue samples from a cohort of 167 patients, with histologically confirmed invasive ductal BCa. TLS and tumor-infiltrating immune cells were determined by H&E and immunohistochemistry. Clinical follow-up was available for 112 of these patients. Patients with peritumoral TLS exhibited worse disease-free survival (DFS) and overall survival (OS) as compared to patients lacking TLS. Moreover, the density of peritumoral TLS was found to be crucial for prognosis, since patients with abundant TLS exhibited the worst DFS and OS. By combining the density of adjacent TLS (aTLS) with our recently published intratumoral signatures based on the differential distribution of CD8 + and CD163 + in the tumor center and invasive margin, we created two improved immune signatures with superior prognostic strength and higher patient population coverage. Our observations strengthen the notion for the fundamental role of the dynamic interplay between the immune cells within the tumor microenvironment (center/invasive margin) and the tumor surrounding area (peritumoral TLS) on the clinical outcome of BCa patients.
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Affiliation(s)
| | - Sotirios P Fortis
- Cancer Immunology and Immunotherapy Center, Saint Savas Cancer Hospital, 171 Alexandras Avenue, 11522, Athens, Greece
| | - Christoforos K Vaxevanis
- Cancer Immunology and Immunotherapy Center, Saint Savas Cancer Hospital, 171 Alexandras Avenue, 11522, Athens, Greece
| | | | | | | | | | - Sonia A Perez
- Cancer Immunology and Immunotherapy Center, Saint Savas Cancer Hospital, 171 Alexandras Avenue, 11522, Athens, Greece
| | - Constantin N Baxevanis
- Cancer Immunology and Immunotherapy Center, Saint Savas Cancer Hospital, 171 Alexandras Avenue, 11522, Athens, Greece.
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26
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Koufopoulos N, Nasi D, Goudeli C, Antoniadou F, Kokkali S, Pigadioti E, Provatas I, Maggo E, Ardavanis A, Terzakis E, Arkoumani E, J Agnantis N, Apostolikas N, Khaldi L. Primary squamous cell carcinoma of the ovary. Review of the literature. J BUON 2019; 24:1776-1784. [PMID: 31786837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Primary squamous cell carcinoma (SCC) of the ovary is rare. Most cases arise from a cystic teratoma or less frequently from Brenner tumor or endometriosis. We reviewed 36 cases of primary ovarian SCC reported in the literature including a case diagnosed and treated in our institution. METHODS Data was collected by using the key-words "primary squamous cell carcinoma" and "ovary" on Google Scholar and PubMed in April 2018. All reviewed cases were analyzed according to diagnosis, surgical approach, adjuvant therapy and outcome. RESULTS To date 23 articles presenting 36 cases of primary ovarian SCC are reported. Nine patients had stage I, 8 stage II, 11 stage III and 5 stage IV disease, whereas 3 patients had in situ carcinoma. All patients underwent surgery (mainly hysterectomy with bilateral salpingo-oophorectomy). Adjuvant therapy was reported in 24 patients, 15 of which received chemotherapy, 6 radiotherapy and 3 a combination of both. Chemotherapy regimens were similar to the ones used in ovarian carcinoma (more often platinum plus paclitaxel). Follow-up period was in general short and survival varied between 9 days and 14 years, depending on the stage at diagnosis. CONCLUSIONS Primary ovarian SCC is a rare entity with poor prognosis, compared to serous carcinoma. Treatment is usually extrapolated from classical ovarian carcinoma algorithms, including surgical management combined with adjuvant chemotherapy with or without radiotherapy. Further investigations are needed to define optimal treatment, such as chemotherapy regimens and the role of radiotherapy and lymph node dissection.
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Affiliation(s)
- Nektarios Koufopoulos
- Department of Pathology, Anticancer Oncologic Hospital "Saint Savvas", Athens, Greece
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Kokkali S, Ntokou A, Drizou M, Perdikari K, Makaronis P, Katsarou E, Koufopoulos N, Tzovaras A, Ardavanis A. Nivolumab in patients with rare head and neck carcinomas: A single center's experience. Oral Oncol 2019; 101:104359. [PMID: 31300270 DOI: 10.1016/j.oraloncology.2019.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 07/02/2019] [Accepted: 07/04/2019] [Indexed: 12/19/2022]
Abstract
Immunotherapy (IO) with anti-PD1 inhibitors is available for the treatment of recurrent/metastatic squamous cell carcinomas of the head and neck (SCCHD) since 2016. Both nivolumab and pembrolizumab were tested in phase 3 randomized trials in adults progressing on or after platinum-based therapy and were found to confer an overall survival benefit compared to investigator's choice. However, very limited data exist concerning IO use in rare subtypes of head and neck carcinoma, like salivary gland carcinoma. We retrospectively collected clinical data of all patients diagnosed with rare subtypes of head and neck carcinoma, who were treated with immune checkpoint inhibitors in our department during the last 5 years. We analyzed safety and efficacy of these therapies. We identified six patients who received nivolumab for recurrent or metastatic head and neck carcinomas, between 31 and 57 years old. All patients had received at least one line of platinum-chemotherapy, as well as radiation therapy. Treatment was administered every 2 weeks, at a dose of 3 mg per kilogram of body weight. Number of nivolumab cycles varied between 2 and 18. Progression-free survival varied from 1 to 12 months and overall survival from 4 to 24 months. Tolerance was very good, except for one case of diabetes and hypothyroidism requiring medication. There is currently insufficient evidence regarding the optimal treatment of the rare non-squamous cell carcinoma of the head and neck. Our case series supports a role for immunotherapy in these patients. However, larger collaborative studies are needed to evaluate this treatment.
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Affiliation(s)
- Stefania Kokkali
- First Medical Oncology Department, Saint-Savvas Anticancer Hospital, L.Alexandras 171, 11521 Athens, Greece.
| | - Anna Ntokou
- First Medical Oncology Department, Saint-Savvas Anticancer Hospital, L.Alexandras 171, 11521 Athens, Greece
| | - Maria Drizou
- First Medical Oncology Department, Saint-Savvas Anticancer Hospital, L.Alexandras 171, 11521 Athens, Greece
| | - Konstantina Perdikari
- First Medical Oncology Department, Saint-Savvas Anticancer Hospital, L.Alexandras 171, 11521 Athens, Greece
| | - Panagiotis Makaronis
- First Medical Oncology Department, Saint-Savvas Anticancer Hospital, L.Alexandras 171, 11521 Athens, Greece
| | - Elena Katsarou
- First Medical Oncology Department, Saint-Savvas Anticancer Hospital, L.Alexandras 171, 11521 Athens, Greece
| | - Nektarios Koufopoulos
- Pathology Department, Saint-Savvas Anticancer Hospital, L.Alexandras 171, 11521 Athens, Greece
| | - Alexandros Tzovaras
- First Medical Oncology Department, Saint-Savvas Anticancer Hospital, L.Alexandras 171, 11521 Athens, Greece
| | - Alexandros Ardavanis
- First Medical Oncology Department, Saint-Savvas Anticancer Hospital, L.Alexandras 171, 11521 Athens, Greece
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Malik Z, Heidenreich A, Bracarda S, Ardavanis A, Parente P, Scholz HJ, Ozatilgan A, Ecstein-Fraisse E, Hitier S, Di Lorenzo G. Real-world experience with cabazitaxel in patients with metastatic castration-resistant prostate cancer: a final, pooled analysis of the compassionate use programme and early access programme. Oncotarget 2019; 10:4161-4168. [PMID: 31289614 PMCID: PMC6609246 DOI: 10.18632/oncotarget.27031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/29/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cabazitaxel is a second-generation taxane approved for use in patients with metastatic castration-resistant prostate cancer (mCRPC) previously treated with docetaxel. Early access programmes were established to allow eligible patients with mCRPC access to cabazitaxel before regulatory approval. MATERIALS AND METHODS The primary objective was to allow access to cabazitaxel before commercial availability for patients with mCRPC whose disease had progressed during or after chemotherapy with docetaxel; the secondary objective was overall safety. Patients received cabazitaxel 25 mg/m2 on Day 1 of a 21-day cycle, with daily oral 10 mg prednisone/prednisolone. G-CSF was administered per ASCO guidelines. RESULTS In total, 1432 patients received cabazitaxel across 41 countries between 2010 and 2014 (median 6.0 treatment cycles [range 1-49]). The most frequently occurring treatment-emergent adverse events (TEAEs) possibly related to treatment were diarrhoea (33.3%), fatigue (25.4%) and anaemia (23.7%); the most frequently occurring possibly related Grade 3/4 TEAEs were neutropenia (18.7%) and febrile neutropenia (6.9%). G-CSF was administered in ≥ 1 cycle in 64% of patients (10.1% therapeutic use; 57.8% prophylactic use; 9.7% both uses). CONCLUSION The safety profile of cabazitaxel in this pooled analysis of two cabazitaxel early access programmes was manageable and consistent with previous Phase III trials (TROPIC, PROSELICA).
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Affiliation(s)
- Zafar Malik
- 1The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK
- Correspondence to: Zafar Malik, email:
| | - Axel Heidenreich
- 1The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK
- 2Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Sergio Bracarda
- 3Azienda USL Toscana Sud-Est, Istituto Toscana Tumori (ITT), Ospedale San Donato, Arezzo, Italy
| | | | | | | | | | | | | | - Giuseppe Di Lorenzo
- 10Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
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Nikolaou M, Ziras N, Athanasiadis I, Ardavanis A, Vaslamatzis M, Kentepozidis NK, Makrantonakis P, Christopoulou A, Michalaki V, Polyzos A, Emmanouilides CE, Vardakis N, Kotsakis A, Georgoulias V. Real life efficacy and safety data of bevacizumab-based front line treatment in advance or metastatic ovarian cancer patients: Focus on patients with malignant ascites—A phase IV study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.5562] [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
5562 Background: The standard of care for Epithelial Ovarian cancer (EOC) is the combination of a taxane plus a platinum compound (TC) whereas the addition of bevacizumab (bev) to this regimen (TC-bev) has been shown to improve the PFS. Patients (pts) with ascites have more aggressive disease and less overall survival. The aim of the study was to evaluate the safety of the TC/bev regimen in the real life clinical practice. Methods: A multi-center observational study, approved by the ethics committees of the participating centers, including 314 pts with stage III/IV EOC, was conducted (11.2011-06.2014) in Greece. Two independent cohorts, with similar clinico-pathologic characteristics, were treated with front-line TC (n = 109) or TC/bev (n = 205) according to the physician’s choice. 83 (40.5%) and 40 (36.7%) in the TC/bev and TC groups presented with ascites. Results: Disease control was achieved in 90.7% and in 78.9% of patients treated with TC/bev and TC, respectively (p = 0.003). Pts with ascites treated with TC/bev experienced a better overall response rate (ORR) (68.7% Vs 55%) and less progression disease (PD) compared to patients receiving TC (13.2% Vs 30.8%). The median PFS in all pts was 21.5mo and 12.4mo (p < 0.001) and median PFS in ascites pts was 18.1mo and 10.3mo in the TC/bev and TC cohort , respectively (p < 0.001). The median OS was not reached in the TC/bev group and it was 36.9mo in the TC group, ( p = 0.059) while in the ascites pts also has not reached and it is 22.5m, respectively ( p = 0.023). The 3 year survival rate in all pts was 59.4% and 50.4% and in ascites pts was 55.3% and 30% in the TC/bev and TC respectively. Neutropenia was the most common grade 3/4 adverse event in 16.6% and 9.1% in TC/bev- and TC- treated patients ( p = 0.072) with no other adverse events > 5%. Conclusions: These real life data demonstrate that the combination of TC/bev represents an active and well tolerated regimen offering survival benefit in patients with stage III/IV EOC and especially in patients with ascites. Additional larger prospective studies are required to confirm these observations. Clinical trial information: NCT01982500.
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Affiliation(s)
| | - Nikolaos Ziras
- Hellenic Oncology Research Group (HORG), Athens, AZ, Greece
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Sougklakos I, Boukovinas I, Xynogalos S, Kakolyris S, Ziras N, Vaslamatzis M, Athanasiadis A, Ardavanis A, Androulakis NEM, Christopoulou A, Makrantonakis P, Bompolaki I, Christofyllakis C, Kentepozidis NK, Emmanouilides CE, Kouroussis C, Prinarakis E, Kalisperi A, Mavroudis D, Georgoulias V. Three versus six months adjuvant FOLFOX or CAPOX for high risk stage II and stage III colon cancer patients: The efficacy results of Hellenic Oncology Research Group (HORG) participation to the International Duration Evaluation of Adjuvant chemotherapy (IDEA) project. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3500] [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
3500 Background: The IDEA aimed to investigate whether a 3-month (3M) of oxaliplatin/fluoropyrimidines-based adjuvant chemotherapy (CT) is non-inferior to the 6-month (6M) in 3-year disease free survival (DFS) in stage high risk stage II and in stage III colon cancer (CC). Methods: HORG-IDEA randomized patients between 3M and 6M of CT with FOLFOX4 or CAPOX with primary end point the 3 years DFS (3yDFS). Results: In total 1121 patients, 413 with high risk stage and 708 with stage IIICC, were randomized between May 2009 and October 2015. The median follow-up was 67 (38-126) months. There were 79 DFS events (43 in 3M and 38 in 6M arm) in high risk stage II patients leading to 3yDFS rate of 82.7 and 83.4% for 3M and 6M, respectively (HR: 1.05; 95%CI: 0.68-1.63, p = 0.829). Similarly, 214 DFS events (161 in 3M and 153 in 6M arm) has been recorded in stage III patients, leading to a 3yDFS rate of 72.9% in the 3M vs. 74.1% in the 6M (HR = 1.06; 95%CI: 0.81–1.42, p = 0.622). For high risk stage II patients receiving FOLFOX4, 3yDFS rate was 76.7% in the 3M vs.79.3% in the 6M (HR = 1.21; 95%CI: 0.54–2.70 p = 0.641). For high risk stage II patients receiving CAPOX 3-year DFS rate was 85.4% in the 3M vs. 83.8% in the 6M (HR = 0.99; 95%CI: 0.59–1.67 p = 0.968). For stage III CC patients receiving mFOLFOX6, 3-year DFS rate was 71.5% in the 3M vs.77.3% in the 6M (HR = 1.18; 95%CI: 0.74–1.86 p = 0.479). For stage III CC patients receiving CAPOX 3-year DFS rate was 74.5% in the 3M vs. 74.7% in the 6M (HR = 0.99; 95%CI: 0.70–1.44 p = 0.991). Conclusions: The results of the HORG-IDEA study are in line with those of the global IDEA project, indicating that 3yDFS is depended on the administered adjuvant regimen, and the choice of regimen and duration should be personalized. Clinical trial information: NCT01308086.
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Affiliation(s)
| | | | | | | | | | | | | | - Alexandros Ardavanis
- Cancer Immunology and Immunotherapy Center, Saint Savas Cancer Hospital, Athens, Greece
| | | | | | | | | | | | | | | | | | | | | | - Dimitrios Mavroudis
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Greece
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Koufopoulos N, Kokkali S, Manatakis D, Balalis D, Nasi D, Ardavanis A, Korkolis D, Khaldi L. Primary peripheral neuroectodermal tumor (PNET) of the adrenal gland: a rare entity. J BUON 2019; 24:770-778. [PMID: 31128035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE Ewing Sarcoma/Primitive Neuroectodermal Tumor (ES/PNET) is a malignant small round cell tumor belonging to the Ewing Sarcoma Family of Tumors. It occurs more commonly in children and young adults. Its localization in the adrenal gland is extremely rare. We reviewed 35 cases of ES/PNET of the adrenal gland reported in the literature and presented our case. METHODS Data were collected by searching for ES/PNET and adrenal gland key words on Google Scholar and PubMed in March 2018, including a case diagnosed in our department. We analyzed all reviewed cases for diagnosis, surgical and systemic therapy and outcome. RESULTS To date 24 articles presenting cases of ES/PNET of the adrenal gland are reported in the literature. We included in our review 35 cases previously described and one new case. Histologically all cases consisted of sheets of small round cells. Immunohistochemistry was also performed in all cases. Most cases stained positive for CD99 and negative for lymphocytic markers. Markers of epithelial differentiation displayed variable results. In all cases tested, characteristic translocations were displayed supporting the diagnosis. All patients but four were treated surgically and the majority received adjuvant therapy. Only very few cases received neoadjuvant chemotherapy. CONCLUSIONS Primary ES/PNET of the adrenal gland is a rare tumor, showing specific morphological, immunohistochemical and cytogenetic characteristics. Treatment consists of surgery, chemotherapy and radiotherapy. Further investigations paired with long term follow-up are necessary to define prognosis for this rare entity.
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MESH Headings
- 12E7 Antigen/genetics
- Adolescent
- Adrenal Gland Neoplasms/epidemiology
- Adrenal Gland Neoplasms/genetics
- Adrenal Gland Neoplasms/pathology
- Adrenal Gland Neoplasms/therapy
- Adrenal Glands/pathology
- Adult
- Child
- Child, Preschool
- Female
- Gene Expression Regulation, Neoplastic/genetics
- Humans
- Male
- Middle Aged
- Neuroectodermal Tumors, Primitive, Peripheral/epidemiology
- Neuroectodermal Tumors, Primitive, Peripheral/genetics
- Neuroectodermal Tumors, Primitive, Peripheral/pathology
- Neuroectodermal Tumors, Primitive, Peripheral/therapy
- Prognosis
- Sarcoma, Ewing/epidemiology
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/pathology
- Sarcoma, Ewing/therapy
- Young Adult
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Kontos CK, Avgeris M, Vassilacopoulou D, Ardavanis A, Scorilas A. Molecular Effects of Treatment of Human Colorectal Cancer Cells with Natural and Classical Chemotherapeutic Drugs: Alterations in the Expression of Apoptosis-related BCL2 Family Members, Including BCL2L12. Curr Pharm Biotechnol 2019; 19:1064-1075. [DOI: 10.2174/1389201019666181112101410] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 08/19/2018] [Accepted: 10/02/2018] [Indexed: 11/22/2022]
Affiliation(s)
- Christos K. Kontos
- Department of Biochemistry and Molecular Biology, National and Kapodistrian University of Athens, Athens, Greece
| | - Margaritis Avgeris
- Department of Biochemistry and Molecular Biology, National and Kapodistrian University of Athens, Athens, Greece
| | - Dido Vassilacopoulou
- Department of Biochemistry and Molecular Biology, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Ardavanis
- First Department of Medical Oncology, "Saint Savvas" Anticancer Hospital, Athens, Greece
| | - Andreas Scorilas
- Department of Biochemistry and Molecular Biology, National and Kapodistrian University of Athens, Athens, Greece
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Avgeris M, Tsilimantou A, Levis PK, Tokas T, Sideris DC, Stravodimos K, Ardavanis A, Scorilas A. Loss of GAS5 tumour suppressor lncRNA: an independent molecular cancer biomarker for short-term relapse and progression in bladder cancer patients. Br J Cancer 2018; 119:1477-1486. [PMID: 30374124 PMCID: PMC6288135 DOI: 10.1038/s41416-018-0320-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 01/03/2023] Open
Abstract
Background Bladder cancer (BlCa) heterogeneity and the lack of personalised prognosis lead to patients’ highly variable treatment outcomes. Here, we have analysed the utility of the GAS5 tumour-suppressor lncRNA in improving BlCa prognosis. Methods GAS5 was quantified in a screening cohort of 176 patients. Hedegaard et al. (2016) (n = 476) and TCGA provisional (n = 413) were used as validation cohorts. Survival analysis was performed using recurrence and progression for NMIBC, or death for MIBC. Internal validation was performed by bootstrap analysis, and decision curve analysis was used to evaluate the clinical benefit on disease prognosis. Results GAS5 levels were significantly downregulated in BlCa and associated with invasive high-grade tumours, and high EORTC-risk NMIBC patients. GAS5 loss was strongly and independently correlated with higher risk for NMIBC early relapse (HR = 2.680, p = 0.011) and progression (HR = 6.362, p = 0.035). Hedegaard et al. and TCGA validation cohorts’ analysis clearly confirmed the association of GAS5 loss with NMIBC worse prognosis. Finally, multivariate models incorporating GAS5 with disease established markers resulted in higher clinical benefit for NMIBC prognosis. Conclusions GAS5 loss is associated with adverse outcome of NMIBC and results in improved positive prediction of NMIBC patients at higher risk for short-term relapse and progression, supporting personalised prognosis and treatment decisions.
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Affiliation(s)
- Margaritis Avgeris
- Department of Biochemistry and Molecular Biology, Faculty of Biology, National and Kapodostrian University of Athens, Athens, Greece
| | - Anastasia Tsilimantou
- Department of Biochemistry and Molecular Biology, Faculty of Biology, National and Kapodostrian University of Athens, Athens, Greece
| | - Panagiotis K Levis
- First Department of Urology, "Laiko" General Hospital, Medical School, National and Kapodostrian University of Athens, Athens, Greece
| | - Theodoros Tokas
- First Department of Urology, "Laiko" General Hospital, Medical School, National and Kapodostrian University of Athens, Athens, Greece
| | - Diamantis C Sideris
- Department of Biochemistry and Molecular Biology, Faculty of Biology, National and Kapodostrian University of Athens, Athens, Greece
| | - Konstantinos Stravodimos
- First Department of Urology, "Laiko" General Hospital, Medical School, National and Kapodostrian University of Athens, Athens, Greece
| | - Alexandros Ardavanis
- First Medical Oncology Clinic, "Saint Savvas" Anticancer Hospital, Athens, Greece
| | - Andreas Scorilas
- Department of Biochemistry and Molecular Biology, Faculty of Biology, National and Kapodostrian University of Athens, Athens, Greece.
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34
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Tsoukalas N, Papakotoulas P, Christopoulou A, Ardavanis A, Koumakis G, Papandreou C, Papatsimpas G, Papakostas P, Andreadis C, Aravantinos G, Ziras N, Kalofonos H, Samantas E, Sougleri M, Makrantonakis P, Pentheroudakis G, Athanasiadis A, Bournakis E, Varthalitis I, Boukovinas I. Prevention and prophylaxis of thrombosis in cancer patients. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy300.036] [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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35
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Boukovinas I, Lypas G, Liontos M, Andreadis C, Papandreou C, Papakotoulas P, Aravantinos G, Bournakis E, Karageorgopoulou S, Maragkouli E, Ziras N, Kakolyris S, Athanasiadis I, Linardou E, Koumarianou A, Kalofonos C, Pentheroudakis G, Korantzis I, Christodoulou C, Kosmidis P, Daliani D, Ardavanis A, Koumakis G, Bankousli I, Makrantonakis P, Kesisis G, Nikolaou M, Diamantidou E, Tsoukalas N, Xanthakis I, Fassas A, Barbounis V, Anagnostopoulos A, Polyzos A, Athanasiadis A, Syrios I, Peroukidis S, Mpompolaki I, Baka S, Androulakis N, Georgoulias V, Emmanouilidis C, Mavroudis D, Sgouros I, Stathopoulos C, Katopodi O, Varthalitis I, Sarikaki P, Saloustros E, Saridaki Z. Access to Genetic Testing Impacts Oncologists´ Decisions on Ovarian Cancer Personalized Treatment: Lessons Learned From a National Program in Greece. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.55800] [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
Background: State health insurance authorities in Greece do not reimburse genetic testing for cancer predisposition. The Hellenic Society of Medical Oncology has launched and carries out a national program covering genetic testing for BRCA1/2 mutations detection, with the financial support of pharmaceutical industry. Aim: This analysis evaluates how, during this program, access to genetic testing transformed the oncologists' therapeutic approach toward their ovarian cancer patients and how the results impacted treatment decisions concerning PARP inhibitors. Adoption of testing by healthy relatives and timing of testing in the disease continuum were also evaluated. Methods: Adult patients with high-grade epithelial ovarian carcinoma, irrespectively of family history or age at diagnosis were eligible for this program. Genetic counseling was recommended before testing, and both were offered at no financial cost. First degree family members of pathogenic mutation carriers were also offered free counseling and testing. Results: From March 2015 through January 2018, 708 patients were enrolled and tested. One hundred and forty seven (20.7%) mutation carriers were identified, 102 (14.4%) in BRCA1 and 45 (6.3%) in BRCA2 gene. Testing was more often pursued at initial diagnosis (61%) than at recurrence (39%), as recorded for 409 patients with available relevant information. During the 1st year of the program, average monthly tests performed were 25.1, while during the 3rd year this number increased to 34.3 tests per month. Among patients who tested positive for deleterious BRCA1/2 mutations, relapse was reported in 58 patients, 94.8% of which (n= 55) received treatment with the PARP inhibitor olaparib as per its indication. Family members of 21 patients (14.3%), out of the 147 who tested positive, received genetic counseling and testing for the mutation identified in the context of the program. Conclusion: Free access to genetic testing for BRCA1/2 for ovarian cancer patients and genetic consultation facilitates testing uptake, affects common clinical practice & has major impact on patients and their families. Still, diffusion of genetic information and broader testing of family members require further efforts by the oncological community.
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Affiliation(s)
- I. Boukovinas
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - G. Lypas
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - M. Liontos
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - C. Andreadis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - C. Papandreou
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - P. Papakotoulas
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - G. Aravantinos
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - E. Bournakis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - S. Karageorgopoulou
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - E. Maragkouli
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - N. Ziras
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - S. Kakolyris
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - I. Athanasiadis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - E. Linardou
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - A. Koumarianou
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - C. Kalofonos
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - G. Pentheroudakis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - I. Korantzis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - C. Christodoulou
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - P. Kosmidis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - D. Daliani
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - A. Ardavanis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - G. Koumakis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - I. Bankousli
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - P. Makrantonakis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - G. Kesisis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - M. Nikolaou
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - E. Diamantidou
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - N. Tsoukalas
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - I. Xanthakis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - A. Fassas
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - V. Barbounis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - A. Anagnostopoulos
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - A. Polyzos
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - A. Athanasiadis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - I. Syrios
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - S. Peroukidis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - I. Mpompolaki
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - S. Baka
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - N. Androulakis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - V. Georgoulias
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - C. Emmanouilidis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - D. Mavroudis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - I. Sgouros
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - C. Stathopoulos
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - O. Katopodi
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - I. Varthalitis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - P. Sarikaki
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - E. Saloustros
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - Z. Saridaki
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
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Nikolaou M, Ziras N, Athanasiadis I, Ardavanis A, Vaslamatzis M, Kentepozidis N, Makrantonakis P, Christopoulou A, Michalaki V, Polizos A, Emmanouilidis C, Georgoulias V. The role of bevacizumab plus front-line chemotherapy in patients with malignant ascites of ovarian cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy285.184] [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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37
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Papadopoulos EI, Papachristopoulou G, Ardavanis A, Scorilas A. A comprehensive clinicopathological evaluation of the differential expression of microRNA-331 in breast tumors and its diagnostic significance. Clin Biochem 2018; 60:24-32. [PMID: 30063890 DOI: 10.1016/j.clinbiochem.2018.07.008] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/12/2018] [Accepted: 07/19/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE MicroRNA-331 (miR-331) has shown regulatory activity against several genes whose expression has been claimed to be deregulated in breast tumors, including that of epidermal growth factor receptor 2 (HER2). Herein, the clinical value of miR-331 expression was investigated by analyzing its levels in breast benign and malignant tumors. METHODS The expression levels of miR-331 were quantified via real-time PCR in 130 malignant and 66 benign breast tissue specimens collected after surgical resection of primary tumors. The generated data were analyzed by applying several statistical tests in order to examine the relationship of miR-331 expression with various established clinicopathological features and survival data of patients. RESULTS Our data showed that miR-331 was overexpressed in malignant breast tumors compared to their benign counterparts both overall (P = 0.026) and individually when the subgroups of fibroadenoma and invasive ductal carcinoma were analyzed with each other (P = 0.001). ROC curve analysis confirmed the diagnostic value of these variations, providing an AUC value equal to 0.597 (P = 0.026) and 0.663 (P = 0.001), respectively. Furthermore, miR-331 levels were elevated (P = 0.026) in ductal cancerous specimens compared to the lobular ones but failed to correlate with other clinicopathological features or survival data of the breast cancer patients. CONCLUSIONS Our results provide evidence that miR-331 levels might provide valuable information regarding the differential diagnosis of benign and malignant breast tumors but present no prognostic value for breast cancer.
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MESH Headings
- Adenofibroma/diagnosis
- Adenofibroma/genetics
- Adenofibroma/pathology
- Biomarkers, Tumor/metabolism
- Breast Neoplasms/diagnosis
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Lobular/diagnosis
- Carcinoma, Lobular/genetics
- Carcinoma, Lobular/pathology
- Diagnosis, Differential
- Female
- Humans
- MicroRNAs/genetics
- Prognosis
- Real-Time Polymerase Chain Reaction
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Affiliation(s)
- Emmanuel I Papadopoulos
- Department of Biochemistry and Molecular Biology, Faculty of Biology, National and Kapodistrian University of Athens, Panepistimiopolis, Athens, Greece
| | - Georgia Papachristopoulou
- Department of Biochemistry and Molecular Biology, Faculty of Biology, National and Kapodistrian University of Athens, Panepistimiopolis, Athens, Greece; First Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Pathology, "Saint Savvas" Cancer Hospital of Athens, Greece
| | - Alexandros Ardavanis
- First Department of Medical Oncology, "Saint Savvas" Cancer Hospital of Athens, 171 Alexandras Ave., 11522 Athens, Greece
| | - Andreas Scorilas
- Department of Biochemistry and Molecular Biology, Faculty of Biology, National and Kapodistrian University of Athens, Panepistimiopolis, Athens, Greece.
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Kokkali S, Drizou M, Tripodaki E, Stefanou D, Magou E, Zylis D, Kapiris M, Nasi D, Georganta C, Ardavanis A. Updated results of biweekly gemcitabine/nab-paclitaxel as first-line treatment for advanced pancreatic cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.141] [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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39
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Tsoukalas N, Papakotoulas P, Christopoulou A, Ardavanis A, Koumakis G, Papandreou C, Papatsibas G, Papakostas P, Andreadis C, Aravantinos G, Ziras N, Kalofonos CP, Samantas E, Maria S, Makrantonakis P, Pentheroudakis GE, Athanasiadis A, Bournakis E, Varthalitis II, Boukovinas I. Is cancer associated thrombosis (CAT) a neglected issue? Greek management of thrombosis (GMaT) in cancer patients. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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40
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Kokkali S, Tripodaki ES, Drizou M, Stefanou D, Magou E, Zylis D, Kapiris M, Nasi D, Georganta C, Ardavanis A. Biweekly Gemcitabine/Nab-Paclitaxel as First-line Treatment for Advanced Pancreatic Cancer. In Vivo 2018; 32:653-657. [PMID: 29695574 PMCID: PMC6000799 DOI: 10.21873/invivo.11289] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 01/07/2018] [Revised: 02/13/2018] [Accepted: 02/20/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND/AIM During recent years, a survival advantage was reported for first-line treatment of advanced pancreatic cancer with two new regimens, FOLFIRINOX and gemcitabine/nab-paclitaxel, over gemcitabine monotherapy. Gemcitabine/nab-paclitaxel administration on days 1, 8 and 15 of a 4-week cycle is associated with some practical disadvantages. We adopted a biweekly regimen with the same dose density. PATIENTS AND METHODS Patients with Eastern Cooperative Oncology Group performance status 0-2 diagnosed with advanced histologically or cytologically confirmed pancreatic cancer and no prior treatment were included in the study. Study combination included 1.5 g/m2 gemcitabine and 175 mg/m2 nab-paclitaxel given every 2 weeks. Survival analysis was performed using the Kaplan-Meier method. RESULTS Forty-six patients were treated with this regimen. Adverse events were similar to those of the original regimen. Median progression-free and overall survival were 5 and 10 months, respectively. CONCLUSION Biweekly gemcitabine/nab-paclitaxel seems to have a similar safety and efficacy profile as the original regimen.
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Affiliation(s)
- Stefania Kokkali
- First Medical Oncology Clinic, Saint Savvas Anticancer Hospital, Athens, Greece
| | | | - Maria Drizou
- First Medical Oncology Clinic, Saint Savvas Anticancer Hospital, Athens, Greece
| | - Dimitra Stefanou
- First Medical Oncology Clinic, Saint Savvas Anticancer Hospital, Athens, Greece
| | - Elpida Magou
- First Medical Oncology Clinic, Saint Savvas Anticancer Hospital, Athens, Greece
| | - Dimosthenis Zylis
- First Medical Oncology Clinic, Saint Savvas Anticancer Hospital, Athens, Greece
| | - Matthaios Kapiris
- First Medical Oncology Clinic, Saint Savvas Anticancer Hospital, Athens, Greece
| | - Despoina Nasi
- First Medical Oncology Clinic, Saint Savvas Anticancer Hospital, Athens, Greece
| | - Chara Georganta
- First Medical Oncology Clinic, Saint Savvas Anticancer Hospital, Athens, Greece
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Mittendorf EA, Ardavanis A, Litton JK, Shumway NM, Hale DF, Murray JL, Perez SA, Ponniah S, Baxevanis CN, Papamichail M, Peoples GE. Primary analysis of a prospective, randomized, single-blinded phase II trial evaluating the HER2 peptide GP2 vaccine in breast cancer patients to prevent recurrence. Oncotarget 2018; 7:66192-66201. [PMID: 27589688 PMCID: PMC5323226 DOI: 10.18632/oncotarget.11751] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [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: 02/07/2016] [Accepted: 07/09/2016] [Indexed: 11/25/2022] Open
Abstract
GP2 is a HER2-derived, HLA-A2+ restricted peptide. Phase I studies showed GP2 administered with GM-CSF to be safe and immunogenic. Here we report the primary analysis of a prospective, randomized, multicenter phase II adjuvant trial conducted to determine the vaccine's efficacy. The trial enrolled HLA-A2+, clinically disease-free, node-positive and high-risk node-negative breast cancer patients with tumors expressing HER2 (immunohistochemistry[IHC] 1+-3+). Patients were randomized to GP2+GM-CSF versus GM-CSF alone. Disease-free survival (DFS) was analyzed in intention-to-treat (ITT) and per-treatment cohorts; pre-specified subgroup analyses were performed for patients with IHC 3+ or FISH+ disease. The trial enrolled 180 patients; 89 received GP2+GM-CSF and 91 received GM-CSF alone. The groups were well-matched for clinicopathologic characteristics. Toxicities have been minimal. The Kaplan-Meier estimated 5-year DFS rate in the ITT analyses was 88% (95% CI:78-94%) in vaccinated vs. 81% (95% CI:69-89%) (P = 0.43) in control patients after a 34 month median follow-up. In the per-treatment analysis, the estimated 5-year DFS rates were 94% (95% CI:83-98%) and 85% (73-92%) (P = 0.17). In IHC 3+/FISH+ patients, the estimated 5-year DFS rate was 94% (82-98%) in vaccinated patients (n = 51) vs. 89% (71-96%) in control patients (n = 50), (P = 0.86) in the ITT analyses and 100% vs. 89% (71-96%) in vaccinated vs. control patients in the per-treatment analyses (P = 0.08). While the overall ITT analysis did not demonstrate benefit to vaccination, this trial confirmed that the GP2 vaccine is safe and suggests that vaccination may have clinical activity, particularly in patients with HER2 overexpression who received the full vaccine series (ie per-treatment group).
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Affiliation(s)
- Elizabeth A Mittendorf
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alexandros Ardavanis
- Cancer Immunology and Immunotherapy Center, St. Savas Cancer Hospital, Athens, Greece
| | - Jennifer K Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nathan M Shumway
- Department of Hematology/Oncology, Brooke Army Medical Center, Ft. Sam Houston, TX, USA
| | - Diane F Hale
- Department of Surgery, Brooke Army Medical Center, Ft. Sam Houston, TX, USA
| | - James L Murray
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sonia A Perez
- Cancer Immunology and Immunotherapy Center, St. Savas Cancer Hospital, Athens, Greece
| | - Sathibalan Ponniah
- Cancer Vaccine Development Laboratory, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Michael Papamichail
- Cancer Immunology and Immunotherapy Center, St. Savas Cancer Hospital, Athens, Greece
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Souglakos J, Boukovinas I, Xynogalos S, Kakolyris S, Ziras N, Vaslamatzis M, Ardavanis A, Athanasiadis A, Androulakis NEM, Kentepozidis NK, Christopoulou A, Makrantonakis P, Varthalitis II, Christofyllakis C, Emmanouilides CE, Mavroudis D, Prinarakis E, Kalisperi A, Hatzidaki D, Georgoulias V. Three versus six months adjuvant oxaliplatin plus fluoropyrimidine chemotherapy for patients with stage III colon cancer: The Hellenic Oncology Research Group (HORG) participation to the International Duration Evaluation of Adjuvant (IDEA) chemotherapy project. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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
730 Background: The IDEA international collaboration aimed to combine data from 6 randomized trials to investigate whether a 3-month (3m) of oxaliplatin/fluoropyrimidines-based adjuvant chemotherapy (CT) is non-inferior to the 6-month(6m) for 3-year disease free survival (DFS)in stage III colon cancer (CC). Methods: HORG-IDEA randomized patients between 3Mand 6M of CT with mFOLFOX6 or CAPOX. DFS was estimated using the Kaplan–Meier method and described using 3 years DFS rate. Results: In total708 patients were randomized between May 2009 and October2015, 354in each arm. Among them the basic characteristics was: median age 63.9 years; mFOLFOX6: 41.8% and CAPOX 58.2%, N1: 74.9%, N2: 25.2%; T1-3: 86.4%, T4: 13.6%. DFS median follow-up was 54.2 months. There were 214 DFS events (109in 3M and 105 in 6M arm) leading to a 3-year DFS rate of 73.2% in the 3M vs. 74.9% in the 6M (HR = 1.03; 95%CI 0.80–1.43, p = 0.622).For patients receiving mFOLFOX6, 3-year DFS rate was 71.8% in the 3M vs.77.7% in the 6M (HR = 1.18; 95%CI 0.74–1.88 p = 0.478). For patients receiving CAPOX 3-year DFS rate was 74.7% in the 3M vs. 74.8% in the 6M (HR = 0.99; 95%CI 0.69–1.45 p = 0.994).94.2% and 78.0% of pts completed 3 and 6 months of CT, respectively. Overall, 96.9% and 89.5% of patients completed 3 months (arm A) and 6 months (arm B) of CT, respectively. Median oxaliplatin doses intensity were 97.3% in 3M and 73.2% in 6M (505.0 and 738.3 mg/m2).Overall maximum neuropathy during treatment grade 2/3-4 was 23.9/5.9%in 3M and38.7/13.7%in 6M; p < 0.0001. In addition, worst grade 2/3-4 diarrhea was 11.1/4/0 in 3M and in 12.3/7.36M; p = 0.03. Conclusions: Since the HORG-IDEA study was designed in order to contribute patients in the IDEA project, the result on the study should be interpreted together with those of the whole IDEA project. Nevertheless, the results of the HORG-IDEA study are in line with those of the whole IDEA project, indicating that the results are depended on the administered adjuvant regimen, and the choice of regimen and duration should be depended on tumor characteristics and patient preference. Clinical trial information: NCT01308086.
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Mathioudaki K, Prezas P, Alexopoulou D, Diamandis E, Xynopoulos D, Ardavanis A, Arnogiannaki N, Scorilas A, Talieri M. Clinical significance of kallikrein-related peptidase 7 (KLK7) in colorectal cancer. Thromb Haemost 2017. [DOI: 10.1160/th08-07-0471] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryHuman tissue kallikrein-related peptidases are a family of 15 secreted serine proteases, located at chromosome 19q13.4. Most of them have been reported to be potential biomarkers for several carcinomas and other diseases. Human tissue kallikrein-related peptidase 7 (KLK7) has been purified from human stratum corneum and resembles a chymotryptic endopeptidase originally called stratum corneum chymotryptic enzyme (SCCE). In this study, we examined for the first time, the prognostic value of KLK7 mRNA expression, using a semi-quantitative RT-PCR method, in 105 colorectal cancer tissues for 54 of which, paired normal colonic mucosa were available. Furthermore, we analysed the expression of KLK7 in 10 adenomas, in 18 biopsies of inflamed colon mucosa, as well as in 22 human cancer cell lines of various origin, four of them being of colon. A defined number of colon cancer samples were also examined by immunohisto-chemistry. KLK7 expression was higher in cancerous than in normal tissues. Less differentiated tumors of more advanced stage showed higher KLK7 expression. Follow-up analysis revealed that KLK7 was significantly associated with shorter overall survival (OS) and disease-free survival (DFS). In addition, selected colon cancer samples highly expressing KLK7 gene, showed intense immunohistochemical staining for KLK7, enhancing RTPCR results. Present data suggest that KLK7 gene is up-regulated in colon cancer and its expression predicts poor prognosis for colon cancer patients.
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Liontos M, Koinis F, Chatsidis G, Kamposioras K, Papaxoinis G, Nikolaou M, Tsigaridas K, Voulgaris E, Pantavou E, Aravantinos G, Ardavanis A, Boukovinas I, Galani E, Angelaki S, Mountzios G, Saridaki Z, Varthalitis I, Tsoukalas N. New treatments in Oncology: Clinical practice regarding the management of Adverse Events (AEs). Results from a survey conducted by the Hellenic Group of Young Oncologists (HeGYO). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx385.018] [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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Gligorov J, Ataseven B, Verrill M, De Laurentiis M, Jung K, Azim H, Al-Sakaff N, Lauer S, Shing M, Pivot X, Koroveshi D, Bouzid K, Casalnuovo M, Cascallar D, Korbenfeld EP, Bastick P, Beith J, Colosimo M, Friedlander M, Ganju V, Green M, Patterson K, Redfern A, Richardson G, Ceric T, Gordana K, Beato CA, Ferrari M, Hegg R, Helena V, Ismael GF, Lessa AE, Mano M, Morelle A, Nogueira JA, Timcheva K, Tomova A, Tsakova M, Zlatareva-Petrova A, Asselah J, Assi H, Brezden-Masley C, Chia S, Freedman O, Harb M, Joy AA, Kulkarni S, Prady C, Gaete AAA, Matamala L, Torres R, Yanez E, Franco S, Urrego M, Gugić D, Vrbanec D, Melichar B, Prausová J, Vyzula R, Pilarte RG, León MI, Muñoz R, Ramos G, Azeem HA, Aziz AA, El Zawahry H, Osegueda FR, Alexandre J, Artignan X, Barletta H, Beguier E, Berdah JF, Marty CB, Bollet M, Bourgeois H, Bressac C, Burki F, Campone M, Coeffic D, Cojocarasu OZ, Dagada C, Dalenc F, Del Piano F, Desauw C, Desmoulins I, Dohollou N, Egreteau J, Ferrero JM, Foa C, Garidi R, Gasnault L, Gligorov J, Guardiola E, Hamizi S, Jarcau R, Jacquin JP, Jaubert D, Jolimoy G, Mineur HL, Largillier R, Leduc B, Martin P, Melis A, Monge J, Moullet I, Mousseau M, Nguyen S, Orfeuvre H, Petit T, Pivot X, Priou F, Bach IS, Simon H, Stefani L, Uwer L, Youssef A, Aktas B, von der Assen A, Augustin D, Balser C, Bauer LE, Bechtner C, Beyer G, Brucker C, Bückner U, Busch S, Christensen B, Deryal M, Farrokh A, Faust E, Friedrichs K, Graf H, Griesshammer M, Grischke EM, Hänle C, Heider A, Henschen S, Hesse T, Jackisch C, Kisro J, Köhler A, Kuemmel S, Lampe D, Lantzsch T, Latos K, Lex B, Liedtke C, Luedders D, Maintz C, Müller V, Overkamp F, Park-Simon TW, Paul M, Prechtl A, Ringsdorf U, Runnebaum I, Ruth S, Salat C, Scheffen I, Schilling J, Schmatloch S, Schmidt M, Schneeweiss A, Schrader I, Seipelt G, Simon E, Stefek A, Stickeler E, Thill M, Tio J, Tuczek A, Warm M, Weigel M, Wischnik A, Wojcinski S, Ziegler-Löhr K, Aravantinos G, Ardavanis A, Fountzilas G, Gogas H, Kakolyris S, Mavroudis D, Papadimitriou C, Papandreou C, Papazisis K, Castro H, Hernandez-Monroy CE, Ngan R, Yeo W, Bittner N, Boer K, Csejtei A, Horvath Z, Kocsis J, Mangel LC, Mezei K, Nagy Z, Szanto J, Atmakusuma D, Fadjari H, Kurnianda D, Prayogo N, Tanggo EH, Coate L, Hennessy B, Kelly C, Martin M, Nasim S, O'Connor M, Aieta M, Allegrini G, Amadori D, Bidoli P, Biti G, Bordonaro R, Bottini A, Carterni G, Cavanna L, Cazzaniga M, Cognetti F, Contu A, Cruciani G, Donadio M, Falcone A, Farci D, Forcignanò RC, Frassoldati A, Gaion F, Gamucci T, Giotta F, de Laurentiis M, Livi L, Lorusso V, Maiello E, Marchetti P, Mariani G, Mion M, Moscetti L, Musolino A, Pazzola A, Pedrazzoli P, Pigi A, de Placido S, Caremoli ER, Santoro A, Tienghi A, Ahn JS, Jung KH, Lee KS, Lee SH, Seo JH, Sohn JH, Cesas A, Juozaityte E, Cheah NLC, Chong FLT, Devi BC, Phua V, Teoh D, Ching LW, Yusof M, Corona J, Dominguez A, Mendoza RLG, Hernandez CA, Ramiro AJ, Santos JM, Espinosa PM, Villarreal Garza CM, Errihani H, Bakker S, van den Berkmortel F, Blaisse R, Huinink DTB, van den Bosch J, Braun J, Dercksen M, Droogendijk H, Erdkamp F, Haringhuizen A, de Jongh F, Kok T, Los M, Madretsma S, Terwogt JMM, van der Padt A, van Rossum-Schornagel QC, Smilde T, de Valk B, van der Velden A, van Warmerdam L, van de Wouw A, North R, Kersten C, Mjaaland I, Wist E, Aziz Z, Masood N, Rashid K, Shah M, Alcedo JC, Aleman D, Neciosup S, Reategui R, Valdiviezo N, Vera L, Fernando G, Roque F, Strebel HM, Krzemieniecki K, Litwiniuk M, Mruk A, Pienkowski T, Sawrycki P, Slomian G, Tomczak P, Afonso N, Cardoso F, Damasceno M, Nave M, Badulescu F, Ciule L, Curescu S, Eniu A, Filip D, Grecea D, Jinga DC, Lungulescu D, Oprean CM, Stanculeanu DL, Turdean M, Dvornichenko V, Emelyanov S, Lichinitser M, Manikhas A, Sakaeva D, Shirinkin V, Stroyakovskiy D, Abulkhair O, Zekri J, Filipovic S, Kovcin V, Nedovic J, Pesic J, Vasovic S, Ng R, Bystricky B, Leskova J, Mardiak J, Mišurová E, Wagnerova M, Takač I, Demetriou GS, Dreosti L, Govender P, Jordaan JP, Veersamy P, Romero JLA, Lopez NB, Arias CC, Chacon J, Aramburo AF, Morales LAF, Garcia M, Estevez LG, Garcia-Palomo Perez A, Garcia Saenz JA, Garcia Sanchis L, Cubells LG, Cortijo LG, Santiago SG, De Aranguiz BHF, Mañas JJI, Gallego PJ, Cussac AL, Ferrandiz CL, Garrido ML, Alvarez PL, Vega JML, Del Prado PM, Jañez NM, Murillo SM, Rosales AM, Jaso LM, Fernandez IP, Martorell AP, Carrion RP, Simon SP, Alcibar AP, Lorenzo JP, Garcia VQ, Asensio TRYC, Maicas MDT, Villanueva Silva MJ, Killander F, Svensson JH, Fehr M, Hauser N, Müller A, Pagani O, Passmann-Kegel H, Popescu R, Rabaglio M, Rauch D, Schlatter C, Zaman K, Chang TW, Huang CS, Wang HC, Yu JC, Bandidwattanawong C, Maneechavakajorn J, Seetalarom K, Dejthevaporn T(S, Somwangprasert A, Vongsaisuwon M, Akbulut H, Altundag K, Arican A, Bozcuk H, Eralp Y, Idris M, Isikdogan A, Senol CH, Sevinc A, Uygun K, Yucel E, Yucel I, Yumuk F, Shparyk Y, Voitko N, Jaloudi M, Adams J, Agrawal R, Ahmed S, Alhasso A, Allerton R, Anwar S, Archer C, Ashford R, Barraclough L, Bertelli G, Bishop J, Branson T, Butt M, Chakrabarti A, Chakraborti P, Churn M, Crowley C, Davis R, Dhadda A, Eldeeb H, Fraser J, Hall J, Hickish T, Hogg M, Howe T, Joffe J, Kelleher M, Kelly S, Kendall A, Kristeleit H, Lumsden G, Macmillan C, MacPherson I, Malik Z, Mithal N, Neal A, Panwar U, Proctor A, Proctor SJ, Raj S, Rehman S, Sandri I, Scatchard K, Sherwin E, Sims E, Singer J, Smith S, Tahir S, Taylor W, Tsalic M, Verrill M, Wardley A, Waters S, Wheatley D, Wright K, Yuille F, Alonso I, Artagaveytia N, Rodriguez R, Arbona E, Garcia Y, Lion L, Marcano D, Van Thuan T. Safety and tolerability of subcutaneous trastuzumab for the adjuvant treatment of human epidermal growth factor receptor 2-positive early breast cancer: SafeHer phase III study's primary analysis of 2573 patients. Eur J Cancer 2017. [DOI: 10.1016/j.ejca.2017.05.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fortis SP, Sofopoulos M, Sotiriadou NN, Haritos C, Vaxevanis CK, Anastasopoulou EA, Janssen N, Arnogiannaki N, Ardavanis A, Pawelec G, Perez SA, Baxevanis CN. Erratum to: Differential intratumoral distributions of CD8 and CD163 immune cells as prognostic biomarkers in breast cancer. J Immunother Cancer 2017; 5:48. [PMID: 28572978 PMCID: PMC5450300 DOI: 10.1186/s40425-017-0248-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 05/15/2017] [Indexed: 11/10/2022] Open
Abstract
[This corrects the article DOI: 10.1186/s40425-017-0240-7.].
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Affiliation(s)
- Sotirios P Fortis
- Cancer Immunology and Immunotherapy Center, Saint Savas Cancer Hospital, Athens, Greece
| | | | | | - Christoforos Haritos
- Cancer Immunology and Immunotherapy Center, Saint Savas Cancer Hospital, Athens, Greece
| | | | | | - Nicole Janssen
- Center for Medical Research, Eberhard-Karls Universität, Tübingen, Germany
| | | | | | - Graham Pawelec
- Center for Medical Research, Eberhard-Karls Universität, Tübingen, Germany
| | - Sonia A Perez
- Cancer Immunology and Immunotherapy Center, Saint Savas Cancer Hospital, Athens, Greece
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Peace KM, Mittendorf EA, Perez SA, Tzonis P, Pistamaltzian NF, Anastasopoulou EA, Vreeland TJ, Hale DF, Clifton GT, Litton JK, von Hofe E, Ardavanis A, Papamichail M, Peoples GE. Subgroup efficacy evaluation of the AE37 HER2 vaccine in breast cancer patients in the adjuvant setting. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.3088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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
3088 Background: AE37 is a Ii-Key hybrid of the HER2 peptide AE36 (HER2776-790), which stimulates peptide-specific T cells. We have completed the active phase of a prospective, randomized, multi-center, phase II trial of the AE37 vaccine in the adjuvant setting. The primary analysis, performed after a median follow up (f/u) of 25 months (mo), did not show a significant difference in disease free survival (DFS) between vaccinated and control patients (pts). However, demonstrating the efficacy of cancer vaccines may require more time than other therapies, especially in malignancies with relatively late recurrences like breast cancer. Here, we present updated efficacy data after extended f/u in subgroups of pts stratified by clinicopathologic characteristics. Methods: Clinically disease-free, node positive or high-risk node negative pts with any level of HER2 expression were randomized to receive AE37 + GM-CSF (VG) or GM-CSF alone (CG) following standard of care therapy. Pts received 6 monthly intradermal inoculations during the primary vaccine series (PVS) followed by 4 boosters administered every 6 mo. Kaplan Meier and log rank analyses were performed from the time of the first inoculation in pts who completed at least the PVS, according to stage, node status, tumor size, HER2 expression and ER/PR status. Results: There were no clinicopathologic differences between groups in the 298 enrolled pts (VG = 153, CG = 145). The vaccine is safe and well tolerated. After a median f/u of 55 mo, there was a trend toward improved DFS in the VG among stage IIB/III pts (VG, n = 73, DFS 82% vs CG, n = 61, 67%, HR = 0.48, p = 0.06) and those with low HER2 expression (HER2 LE, VG, n = 68, 89% vs CG, n = 66, 51%, HR = 0.47, p = 0.1). Improved DFS in the VG was documented in patients with both stage IIB/III disease and HER2 LE (VG, n = 39, 90% vs CG, n = 38, 32%, HR 0.3, p = 0.02) and triple negative (TNBC) pts (VG, n = 21, 89% vs CG, n = 21, 0%, HR 0.26, p = 0.05). Conclusions: The AE37 vaccine is safe and well tolerated and has statistically significant efficacy in stage IIB/III pts with HER2 LE and in TNBC pts. This justifies further evaluation in a phase III study enrolling stage IIb/III pts not eligible for trastuzumab treatment and the very high risk TNBC group. Clinical trial information: NCT00524277.
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Affiliation(s)
| | | | - Sonia A. Perez
- Cancer Immunology and Immunotherapy Center, Saint Savas Cancer Hospital, Athens, Greece
| | - Panagiotis Tzonis
- Cancer Immunology and Immunotherapy Center, Saint Savas Cancer Hospital, Athens, Greece
| | | | | | | | - Diane F Hale
- San Antonio Military Medical Center, San Antonio, TX
| | - Guy T Clifton
- San Antonio Military Medical Center, San Antonio, TX
| | | | | | - Alexandros Ardavanis
- Cancer Immunology and Immunotherapy Center, Saint Savas Cancer Hospital, Athens, Greece
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Fortis SP, Sofopoulos M, Sotiriadou NN, Haritos C, Vaxevanis CK, Anastasopoulou EA, Janssen N, Arnogiannaki N, Ardavanis A, Pawelec G, Perez SA, Baxevanis CN. Differential intratumoral distributions of CD8 and CD163 immune cells as prognostic biomarkers in breast cancer. J Immunother Cancer 2017; 5:39. [PMID: 28428887 PMCID: PMC5395775 DOI: 10.1186/s40425-017-0240-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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: 12/15/2016] [Accepted: 04/06/2017] [Indexed: 12/21/2022] Open
Abstract
Background Tumor immune cell infiltrates are essential in hindering cancer progression and may complement the TNM classification. CD8+ and CD163+ cells have prognostic impact in breast cancer but their spatial heterogeneity has not been extensively explored in this type of cancer. Here, their potential as prognostic biomarkers was evaluated, depending on their combined densities in the tumor center (TC) and the tumor invasive margin (IM). Methods CD8+ and CD163+ cells were quantified by immunohistochemistry of formalin-fixed, paraffin-embedded (FFPE) tumor tissue samples from a cohort totaling 162 patients with histologically-confirmed primary invasive non-metastatic ductal breast cancer diagnosed between 2000 and 2015. Clinical follow-up (median 6.9 years) was available for 97 of these patients. Results Differential densities of CD8+ and CD163+ cells in the combined TC and IM compartments (i.e., high(H)/low(L), respectively for CD8+ cells and the reverse L/H combination for CD163+ cells) were found to have significant prognostic value for survival, and allowed better patient stratification than TNM stage, tumor size, lymph node invasion and histological grade. The combined evaluation of CD8+ and CD163+ cell densities jointly in TC and IM further improves prediction of clinical outcomes based on disease-free and overall survival. Patients having the favorable immune signatures had favorable clinical outcomes despite poor clinicopathological parameters. Conclusions Given the important roles of CD8+ and CD163+ cells in regulating opposing immune circuits, adding an assessment of their differential densities to the prognostic biomarker armamentarium in breast cancer would be valuable. Larger validation studies are necessary to confirm these findings. Trial registrations Study code: IRB-ID 6079/448/10-6-13 Date of approval: 10/06/2013 Retrospective study (2000–2010) First patient prospectively enrolled 14/2/2014 Electronic supplementary material The online version of this article (doi:10.1186/s40425-017-0240-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sotirios P Fortis
- Cancer Immunology and Immunotherapy Center, Saint Savas Cancer Hospital, Athens, Greece
| | | | | | - Christoforos Haritos
- Cancer Immunology and Immunotherapy Center, Saint Savas Cancer Hospital, Athens, Greece
| | | | | | - Nicole Janssen
- Center for Medical Research, Eberhard-Karls Universität, Tübingen, Germany
| | | | | | - Graham Pawelec
- Center for Medical Research, Eberhard-Karls Universität, Tübingen, Germany
| | - Sonia A Perez
- Cancer Immunology and Immunotherapy Center, Saint Savas Cancer Hospital, Athens, Greece
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Souglakos J, Boukovinas I, Kakolyris S, Ziras N, Androulakis NEM, Ardavanis A, Kentepozidis NK, Vaslamatzis M, Athanasiadis A, Christopoulou A, Makrantonakis P, Polyzos A, Mavroudis D, Mala A, Kalisperi A, Xynogalos S, Varthalitis II, Kouroussis C, Prinarakis E, Georgoulias V. The Greek participitation to IDEA (International Duration Evaluation of Adjuvant Chemotherapy) study of 3 versus 6 months of adjuvant chemotherapy in stage III colon cancer: Patients’ characteristics and safety analysis. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.740] [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
740 Background: The International Duration Evaluation of Adjuvant (IDEA) collaboration was established to prospectively analyze data from six randomized trials to assess whether a 3-month course of oxaliplatin/fluoropyrimidines (FU)-based adjuvant chemotherapy (CT) is non-inferior to the 6-month current standard treatment in stage III colon cancer (CC). The primary endpoint of IDEA was 3-year disease-free survival. The accrual goal for the Greek IDEA study was 1.000 patients. Methods: Greek IDEA randomized patients with stage III colon cancer between 3 months (arm A) and 6 months (arm B) of adjuvant CT with modified (m) FOLFOX6 or XELOX (depending on physician/patient choice). Toxicity was graded during treatment and follow-up using NCI-CTCAE v3.0. Results: From May 2009 to October 2015, 708 patients were randomized in Greek centers either to arm A (n = 354, 50%) or to arm B (n = 354, 50.%). 297 (41.9%) patients received mFOLFOX6 and 411 (58.%) XELOX. The median age was 67 years (20-75) and 579 (81.8%) of them had PS 0. The patients’ population was balanced for the major risk factor between the two arms: N1/N2 disease (68.1/31.9% vs. 68.9/31.1 for ARM A and B, respectively), obstruction (4.5% vs. 2.5 for ARM A and B, respectively) and perforation (5.1% vs. 6.2 for ARM A and B, respectively). Overall, 96.9% and 89.5% of patients completed 3 months (arm A) and 6 months (arm B) of CT, respectively. Median oxaliplatin dose was 505 mg/m2 in arm A and 738 mg/m2 in arm B. Toxicity profiles were comparable between the two arm and the two fluoropyrimidines backbones with a total incidence of Grade 3/4 adverse events 18.9/4.4% and 19.7/5.1% for mFOLFOX6 and XELOX, respectively. Grade 2/3-4 peripheral neuropathy during the study was similar between arm A (33.9/4%) and B (38.7/3.7%). Conclusions: Both mFOLFOX6 and XELOX were safe. More patients completed the scheduled treatment in the 3-arm schedule.
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Stefanou D, Stamatopoulou S, Sakellaropoulou A, Akakios G, Gkiaouraki M, Gkeka D, Prevezanou M, Ardavanis A. Bevacizumab, pemetrexed and carboplatin in first-line treatment of non-small cell lung cancer patients: Focus on patients with brain metastases. Oncol Lett 2016; 12:4635-4642. [PMID: 28101218 DOI: 10.3892/ol.2016.5268] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 10/29/2015] [Accepted: 04/05/2016] [Indexed: 01/16/2023] Open
Abstract
Data concerning bevacizumab plus pemetrexed plus carboplatin as first-line treatment for patients with non-squamous non-small cell lung cancer (NSCLC) with or without brain metastases (BM) are lacking. The present study analyzed the efficacy and safety of this combination as induction therapy, followed by maintenance therapy with bevacizumab plus pemetrexed in non-squamous NSCLC patients with or without BM. Treatment-naïve patients with advanced non-squamous NSCLC and an Eastern Cooperative Oncology Group performance status score of 0-2 were eligible. Treatment consisted of carboplatin (area under the curve of 5), pemetrexed (500 mg/m2) and bevacizumab (15 mg/kg) every 3 weeks for 6 cycles. Responders and patients with stable disease received maintenance therapy with bevacizumab plus pemetrexed until disease progression, which was evaluated every 3 cycles, or unacceptable toxicity. Kaplan-Meier median progression-free survival (PFS) and overall survival (OS) times were the primary endpoints, and safety was the secondary endpoint. In total, 39 patients, aged 44-78 years (median, 60 years), were treated; 11 (28.2%) of whom presented with BM. The majority of patients (56.4%) completed 6 cycles of induction therapy, and 26 patients continued on to maintenance therapy. The median PFS time was 8.2 months [95% confidence interval (CI), 7.05-9.35] and the median OS time was 14.0 months (95% CI, 8.46-19.54). Median PFS and OS times did not differ significantly between patients with or without BM (log rank (Mantel-Cox): PFS, P=0.748 and OS, P=0.447). The majority of patients (76.9%) did not experience adverse events during treatment. Overall, bevacizumab plus pemetrexed plus carboplatin as induction therapy, followed by bevacizumab plus pemetrexed as maintenance therapy was effective and well tolerated in advanced NSCLC, whether brain metastases were present or not.
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Affiliation(s)
- Dimitra Stefanou
- First Department of Medical Oncology, St. Savas Anticancer Hospital, Athens 115 22, Greece
| | - Sofia Stamatopoulou
- First Department of Medical Oncology, St. Savas Anticancer Hospital, Athens 115 22, Greece
| | | | - Gavriil Akakios
- First Department of Medical Oncology, St. Savas Anticancer Hospital, Athens 115 22, Greece
| | - Marina Gkiaouraki
- First Department of Medical Oncology, St. Savas Anticancer Hospital, Athens 115 22, Greece
| | - Despina Gkeka
- First Department of Medical Oncology, St. Savas Anticancer Hospital, Athens 115 22, Greece
| | - Maria Prevezanou
- First Department of Medical Oncology, St. Savas Anticancer Hospital, Athens 115 22, Greece
| | - Alexandros Ardavanis
- First Department of Medical Oncology, St. Savas Anticancer Hospital, Athens 115 22, Greece
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