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Galvez-Carvajal L, Sánchez-Muñoz A, Álvarez M, Alba Linero E, del Rey M, Garrido A, Santoja Á, Moya A, Montes J, Chica-Parrado M, Sáez M, Aparicio J, González-Billalabeitia E, Terrasa Pons J, Méndez M, Luengo M, García del Muro J, Pascual J, Alba E. 789P A differential gene expression signature identifies a population of stage I testicular non-seminomatous germ cell tumours (NSGCT) at high risk of relapse. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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2
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Santonja A, Sánchez-Muñoz A, Lluch A, Chica-Parrado MR, Albanell J, Chacón JI, Antolín S, Jerez JM, de la Haba J, de Luque V, Fernández-De Sousa CE, Vicioso L, Plata Y, Ramírez-Tortosa CL, Álvarez M, Llácer C, Zarcos-Pedrinaci I, Carrasco E, Caballero R, Martín M, Alba E. Triple negative breast cancer subtypes and pathologic complete response rate to neoadjuvant chemotherapy. Oncotarget 2018; 9:26406-26416. [PMID: 29899867 PMCID: PMC5995183 DOI: 10.18632/oncotarget.25413] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [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: 03/07/2018] [Accepted: 04/28/2018] [Indexed: 12/31/2022] Open
Abstract
Triple negative breast cancer (TNBC) is a heterogeneous disease with distinct molecular subtypes that differentially respond to chemotherapy and targeted agents. The purpose of this study is to explore the clinical relevance of Lehmann TNBC subtypes by identifying any differences in response to neoadjuvant chemotherapy among them. We determined Lehmann subtypes by gene expression profiling in paraffined pre-treatment tumor biopsies from 125 TNBC patients treated with neoadjuvant anthracyclines and/or taxanes +/- carboplatin. We explored the clinicopathological characteristics of Lehmann subtypes and their association with the pathologic complete response (pCR) to different treatments. The global pCR rate was 37%, and it was unevenly distributed within Lehmann’s subtypes. Basal-like 1 (BL1) tumors exhibited the highest pCR to carboplatin containing regimens (80% vs 23%, p=0.027) and were the most proliferative (Ki-67>50% of 88.2% vs. 63.7%, p=0.02). Luminal-androgen receptor (LAR) patients achieved the lowest pCR to all treatments (14.3% vs 42.7%, p=0.045 when excluding mesenchymal stem-like (MSL) samples) and were the group with the lowest proliferation (Ki-67≤50% of 71% vs 27%, p=0.002). In our cohort, only tumors with LAR phenotype presented non-basal-like intrinsic subtypes (HER2-enriched and luminal A). TNBC patients present tumors with a high genetic diversity ranging from highly proliferative tumors, likely responsive to platinum-based therapies, to a subset of chemoresistant tumors with low proliferation and luminal characteristics.
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Affiliation(s)
- Angela Santonja
- Instituto de Investigación Biomédica de Málaga (IBIMA), Hospitales Universitarios Regional y Virgen de la Victoria, Málaga, Spain.,Laboratorio de Biología Molecular del Cáncer, Centro de Investigaciones Médico-Sanitarias (CIMES), Universidad de Málaga, Málaga, Spain
| | - Alfonso Sánchez-Muñoz
- Unidad de Gestión Clínica Intercentro de Oncología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospitales Universitarios Regional y Virgen de la Victoria, Málaga, Spain.,Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain
| | - Ana Lluch
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain.,Spanish Breast Cancer Research Group (GEICAM), Madrid, Spain.,Department of Oncology and Hematology, Hospital Clínico Universitario, Valencia, Spain.,INCLIVA Biomedical Research Institute, Universidad de Valencia, Valencia, Spain
| | - Maria Rosario Chica-Parrado
- Instituto de Investigación Biomédica de Málaga (IBIMA), Hospitales Universitarios Regional y Virgen de la Victoria, Málaga, Spain.,Laboratorio de Biología Molecular del Cáncer, Centro de Investigaciones Médico-Sanitarias (CIMES), Universidad de Málaga, Málaga, Spain
| | - Joan Albanell
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain.,Spanish Breast Cancer Research Group (GEICAM), Madrid, Spain.,Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Medical Oncology Service, Hospital del Mar, Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
| | - José Ignacio Chacón
- Spanish Breast Cancer Research Group (GEICAM), Madrid, Spain.,Medical Oncology Service, Hospital Virgen de la Salud, Toledo, Spain
| | - Silvia Antolín
- Spanish Breast Cancer Research Group (GEICAM), Madrid, Spain.,Medical Oncology Service, Complejo Hospitalario Universitario de A Coruña, La Coruña, Spain
| | - José Manuel Jerez
- Department of Languages and Computer Science, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Juan de la Haba
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain.,Spanish Breast Cancer Research Group (GEICAM), Madrid, Spain.,Medical Oncology Service, Complejo Hospitalario Reina Sofía, Córdoba, Spain.,The Maimonides Institute for Biomedical Research (IMIBIC), Córdoba, Spain
| | - Vanessa de Luque
- Instituto de Investigación Biomédica de Málaga (IBIMA), Hospitales Universitarios Regional y Virgen de la Victoria, Málaga, Spain.,Laboratorio de Biología Molecular del Cáncer, Centro de Investigaciones Médico-Sanitarias (CIMES), Universidad de Málaga, Málaga, Spain
| | - Cristina Elisabeth Fernández-De Sousa
- Instituto de Investigación Biomédica de Málaga (IBIMA), Hospitales Universitarios Regional y Virgen de la Victoria, Málaga, Spain.,Laboratorio de Biología Molecular del Cáncer, Centro de Investigaciones Médico-Sanitarias (CIMES), Universidad de Málaga, Málaga, Spain
| | - Luis Vicioso
- Instituto de Investigación Biomédica de Málaga (IBIMA), Hospitales Universitarios Regional y Virgen de la Victoria, Málaga, Spain.,Department of Pathology, Hospitales Universitarios Regional y Virgen de la Victoria, Málaga, Spain.,Department of Pathology, Faculty of Medicine, Universidad de Málaga, Málaga, Spain
| | - Yéssica Plata
- Department of Oncology, Complejo Hospitalario de Jaén, Jaén, Spain
| | | | - Martina Álvarez
- Instituto de Investigación Biomédica de Málaga (IBIMA), Hospitales Universitarios Regional y Virgen de la Victoria, Málaga, Spain.,Laboratorio de Biología Molecular del Cáncer, Centro de Investigaciones Médico-Sanitarias (CIMES), Universidad de Málaga, Málaga, Spain.,Department of Pathology, Faculty of Medicine, Universidad de Málaga, Málaga, Spain
| | - Casilda Llácer
- Unidad de Gestión Clínica Intercentro de Oncología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospitales Universitarios Regional y Virgen de la Victoria, Málaga, Spain
| | - Irene Zarcos-Pedrinaci
- Medical Oncology Service, Hospital Costa del Sol, Marbella, Málaga, Spain.,Health Services Research on Chronic Diseases Network - REDISSEC, Marbella, Málaga, Spain
| | - Eva Carrasco
- Spanish Breast Cancer Research Group (GEICAM), Madrid, Spain
| | | | - Miguel Martín
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain.,Spanish Breast Cancer Research Group (GEICAM), Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - Emilio Alba
- Laboratorio de Biología Molecular del Cáncer, Centro de Investigaciones Médico-Sanitarias (CIMES), Universidad de Málaga, Málaga, Spain.,Unidad de Gestión Clínica Intercentro de Oncología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospitales Universitarios Regional y Virgen de la Victoria, Málaga, Spain.,Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain.,Spanish Breast Cancer Research Group (GEICAM), Madrid, Spain
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Aparicio J, Sánchez-Muñoz A, Gumà J, Domenech M, Meana J, García-Sánchez J, Bastús R, Gironés R, González-Billalabeitia E, Sagastibelza N, Ochenduszko S, Sánchez A, Terrasa J, Germà-Lluch J, García del Muro X. A Risk-Adapted Approach to Patients with Stage I Seminoma according to the Status of Rete Testis: The Fourth Spanish Germ Cell Cancer Group Study. Oncology 2018; 95:8-12. [DOI: 10.1159/000487438] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 01/30/2018] [Indexed: 12/11/2022]
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Gallegos Sancho MI, Márquez-Vázquez R, Sánchez-Muñoz A. Experience with eribulin in triple-negative metastatic breast cancer: case studies. Future Oncol 2018; 14:13-20. [DOI: 10.2217/fon-2017-0356] [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: 12/31/2022] Open
Abstract
Triple-negative breast cancers are defined as tumors negative for estrogen receptors, progesterone receptors and human EGFR2. These tumors exhibit diverse biological behavior and have a poor prognosis; chemotherapy is the mainstay of treatment. The first case involves a young woman with cerebral and cerebellar metastases who achieved a persistent objective response to fourth-line eribulin. In the second case, a woman who became metastatic during adjuvant therapy with anthracyclines and taxanes, and was refractory to capecitabine + bevacizumab, achieved a partial response and local symptom improvement with eribulin + bevacizumab. Last, a poly-treated patient demonstrated reasonable response and longer progression-free interval on third-line eribulin relative to previous lines of chemotherapy which is unusual in this clinical setting.
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Affiliation(s)
| | | | - Alfonso Sánchez-Muñoz
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Málaga, Spain & Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
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5
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Godoy-Ortiz A, Plata Y, Alcaide J, Galeote A, Pajares B, Saez E, Alba E, Sánchez-Muñoz A. Bevacizumab for recurrent, persistent or advanced cervical cancer: reproducibility of GOG 240 study results in "real world" patients. Clin Transl Oncol 2017; 20:922-927. [PMID: 29222647 DOI: 10.1007/s12094-017-1808-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 08/08/2017] [Accepted: 11/14/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE Bevacizumab is the only therapeutic target approved for patients with persistent, recurrent or advanced cervical cancer from a phase III study that combined with chemotherapy; it proves a significant increase in overall survival. To retrospectively assess the efficacy and safety of bevacizumab as the first-line treatment in patients from usual clinical practice with recurrent/persistent or advanced cervical cancer. PATIENTS AND METHODS Treatment consisted of cisplatin 50 mg/m2 or carboplatin AUC 5 plus paclitaxel 175 mg/m2 for 6-8 cycles and bevacizumab 15 mg/kg every 3 weeks up to progression or unacceptable toxicity. The endpoints were progression-free survival (PFS), overall survival (OS), response rates (RR) and toxicity. RESULTS Twenty-seven patients were included from January 2014 to June 2017, with a median follow-up 10, 1 months. Eleven percent had recurrent/persistent disease and 89% had metastatic disease at diagnosis. The prior exposition to platinum was 70%. The median PFS and OS were 9, 6 and 21, 5 months, respectively. There was an increase of fistula formation (22%). All of them had pelvic and peritoneal disease at the beginning of treatment and previous treatment with chemoradiotherapy; non-incidence differences were found according to the type of platinum agent used. There were two treatment-related deaths, one from intestinal perforation and another from severe sepsis. CONCLUSION Finally, although our study does have certain limitations, we believe that it can provide useful information and encouraging evidence that the routine use of bevacizumab as part of first-line treatment of patients with advanced cervical cancer may be associated with outcomes comparable with those obtained in GOG240 study.
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Affiliation(s)
- A Godoy-Ortiz
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain.
| | - Y Plata
- Department of Oncology, Complejo Hospitalario de Jaén, Jaén, Spain
| | - J Alcaide
- Medical Oncology Service, Hospital Costa del Sol, Málaga, Marbella, Spain
| | - A Galeote
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain
| | - B Pajares
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - E Saez
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain
| | - E Alba
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain.,Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain
| | - A Sánchez-Muñoz
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
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Aparicio J, Maroto P, García del Muro X, Sánchez-Muñoz A, Gumà J, Margelí M, Sáenz A, Sagastibelza N, Castellano D, Arranz J, Hervás D, Bastús R, Fernández-Aramburo A, Sastre J, Terrasa J, López-Brea M, Dorca J, Almenar D, Carles J, Hernández A, Germà J. Prognostic factors for relapse in stage I seminoma: a new nomogram derived from three consecutive, risk-adapted studies from the Spanish Germ Cell Cancer Group (SGCCG). Ann Oncol 2014; 25:2173-2178. [DOI: 10.1093/annonc/mdu437] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Sánchez-Muñoz A, Plata-Fernández Y, Jaén A, Lomas M, Fernández M, Llácer C, Fernández M, Ribelles N, Alba E, Sánchez-Rovira P. Proliferation determined by ki67 marker and pCR in locally advanced breast cancer patients treated with neo-adjuvant chemotherapy. Breast J 2013; 19:685-6. [PMID: 24118566 DOI: 10.1111/tbj.12194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Alfonso Sánchez-Muñoz
- Medical Oncology Service, Hospital Universitario Virgen de la Victoria, Málaga, Spain
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Sánchez-Muñoz A, Plata-Fernández Y, Fernández M, Jaén-Morago A, Fernández-Navarro M, de la Torre-Cabrera C, Ramirez-Tortosa C, Pascual J, Alba E, Sánchez-Rovira P. Tumor histological subtyping determined by hormone receptors and HER2 status defines different pathological complete response and outcome to dose-dense neoadjuvant chemotherapy in breast cancer patients. Clin Transl Oncol 2013; 16:548-54. [PMID: 24085576 DOI: 10.1007/s12094-013-1116-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 09/18/2013] [Indexed: 02/08/2023]
Abstract
PURPOSE To assess the impact in pathological complete response (pCR) and outcome of two dose-dense neoadjuvant chemotherapy (DDNC) regimens among different histological subtypes determined by hormonal receptor (HR) and HER2 status in breast cancer patients. METHODS A total of 127 breast cancer patients were treated with DDNC in two prospective studies. A: adriamycin 40 mg/m(2) on day (d) 1 plus paclitaxel 150 mg/m(2) and gemcitabine 2,000 mg/m(2) on d2 for six cycles (n = 54). B: epirubicin 90 mg/m(2), cyclophosphamide 600 mg/m(2) on d1 for three cycles, followed by paclitaxel 150 mg/m(2) and gemcitabine 2,500 mg/m(2) on d1 ± trastuzumab according to HER2 status (n = 73). Histological subtypes of breast cancer were 49 % HR+/HER2-, 17.5 % HR+/HER2+, 13.5 % HR-/HER2+ and 20 % HR-/HER2-. RESULTS pCR (absence of invasive cells in breast and lymph node) was achieved in 35 patients (28 %). The pCR rate was significantly different between histological subtypes: HR+/HER2- (9 %), HR+/HER2+ (23 %), HR-/HER2+ (50 %), HR-/HER2- (56 %) (p < 0.001). The median follow-up was 81 months (r: 15-150 months). HR-/HER2- tumor subtype had a significantly worse DFS compared to HR+/HER2- (p = 0.02), RH+/HER2+ (p = 0.04) and HR-/HER2+ tumor subtypes (p = 0.02). HR-/HER2- tumor subtype had a significantly shorter OS compared to HR+/HER2- (p = 0.007), RH+/HER2+ (p = 0.05), and HR-/HER2+ (p = 0.03) tumor subtypes. However, no significant difference was observed in DFS and OS among HR-/HER2- tumors that achieved a pCR. CONCLUSIONS HR-/HER2- and HR-/HER2+ subtypes had a high pCR rate to DDNC. HR-/HER2- tumors had a worse outcome compared to other tumor subtypes but no significant difference was observed among HR-/HER2- tumors that achieved a pCR.
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Affiliation(s)
- A Sánchez-Muñoz
- Medical Oncology Service, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010, Málaga, Spain,
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9
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Sánchez-Muñoz A, Plata-Fernández YM, Fernández M, Jaén-Morago A, Fernández-Navarro M, de la Torre-Cabrera C, Ramirez-Tortosa C, Lomas-Garrido M, Llácer C, Navarro-Perez V, Alba-Conejo E, Sánchez-Rovira P. The role of immunohistochemistry in breast cancer patients treated with neoadjuvant chemotherapy: an old tool with an enduring prognostic value. Clin Breast Cancer 2013; 13:146-52. [PMID: 23318089 DOI: 10.1016/j.clbc.2012.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 10/07/2012] [Accepted: 11/08/2012] [Indexed: 01/28/2023]
Abstract
BACKGROUND To assess the molecular subtypes determined by hormonal receptors (HR) and human epidermal growth factor receptor 2 (HER2) status and the role of proliferation measured by the Ki-67 marker as predictive and prognostic factors in breast cancer patients treated with neoadjuvant chemotherapy. METHODS A total of 127 breast cancer patients were treated with neoadjuvant chemotherapy every 2 weeks as part of 2 studies. Study A consisted of the administration of Adriamycin (40 mg/m(2)) on day 1 plus paclitaxel (150 mg/m(2)) and gemcitabine 2000 mg/m(2)) on day 2 for 6 cycles (n = 54). Study B consisted of the administration of epirubicin (90 mg/m(2)), cyclophosphamide (600 mg/m(2)) on day 1 for 3 cycles, followed by the administration of paclitaxel (150 mg/m(2)) and gemcitabine 2500 (mg/m(2)) on day 1 with or without trastuzumab according to HER2 status (n = 73). In study A, patients did not receive trastuzumab regardless of HER2 status. The molecular subtypes of the patients with breast cancer were classified as 49% HR(+)/HER2(-), 17.5% HR(+)/HER2(+), 13.5% HR(-)/HER2(+), and 20% HR(-)/HER2(-). RESULTS Pathologic complete response (pCR), defined as the absence of invasive cells in the breast and the lymph nodes, was achieved in 35 (28%) patients. The pCR rate was significantly different between the molecular subtypes of breast cancer, with 9% in HR(+)/HER2(-), 23% in HR(+)/HER2(+), 50% in HR(-)/HER2(+), and 56% in HR(-)/HER2(-) tumors (P < .001). The pCR rate was significantly higher in tumors that had high Ki-67 (≥20%) expression and were HR(-). HER2(+) was associated with a higher trend of pCR but did not reach statistical significance. The median follow-up was 81 months (r = 15-150 months). Patients who achieved a pCR had a significantly lower recurrence (P = .01) and higher overall survival (P = .02) compared with those who did not achieve pCR. A multivariate analysis revealed that pCR (hazard ratio 0.24 [95% CI, 0.07-0.7]; P = .019), the molecular subtype (hazard ratio 0.3 [95% CI, 0.1-0.8]; P = .02), and the Ki-67 index (hazard ratio 3.2 [95% CI, 1.4-7.1]; P = .004) were significant independent predictors of disease-free survival. Similar results were obtained for overall survival, in which the pCR rate (hazard ratio 0.119 [95% CI, 0.028-0.5]; P = .004), the molecular subtype (hazard ratio 0.17 [95% CI, 0.03-0.86]; P = .02), and the Ki-67 index (hazard ratio 3.6 [95% CI, 1.3-9.7]; P = .01) also displayed a significant influence on survival. CONCLUSIONS Molecular subtypes and Ki-67 index were independent prognostic factors for disease-free survival and overall survival in breast cancer patients treated with neoadjuvant chemotherapy. A high rate of Ki-67 and HR(-) expression were predictors of pCR.
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Affiliation(s)
- Alfonso Sánchez-Muñoz
- Medical Oncology Service, Hospital Universitario Virgen de la Victoria de Málaga, Málaga, Spain.
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Sánchez-Muñoz A, Román-Jobacho A, Pérez-Villa L, Sánchez-Rovira P, Miramón J, Pérez D, Sáez MI, de Luque V, Medina L, Ramírez-Tortosa CL, Vicioso L, Medina JA, Ribelles N, Alba E. Male Breast Cancer: Immunohistochemical Subtypes and Clinical Outcome Characterization. Oncology 2012; 83:228-33. [DOI: 10.1159/000341537] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 06/27/2012] [Indexed: 12/30/2022]
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11
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Aparicio J, Maroto P, del Muro XG, Gumà J, Sánchez-Muñoz A, Margelí M, Doménech M, Bastús R, Fernández A, López-Brea M, Terrassa J, Meana A, del Prado PM, Sastre J, Satrústegui JJ, Gironés R, Robert L, Germà JR. Risk-Adapted Treatment in Clinical Stage I Testicular Seminoma: The Third Spanish Germ Cell Cancer Group Study. J Clin Oncol 2011; 29:4677-4681. [DOI: 10.1200/jco.2011.36.0503] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Purpose To confirm the efficacy of a risk-adapted treatment approach for patients with clinical stage I seminoma. The aim was to reduce both the risk of relapse and the proportion of patients receiving adjuvant chemotherapy while maintaining a high cure rate. Patients and Methods From 2004 to 2008, 227 patients were included after orchiectomy in a multicenter study. Eighty-four patients (37%) presented no local risk factors, 44 patients (19%) had tumors larger than 4 cm, 25 patients (11%) had rete testis involvement, and 74 patients (33%) had both criteria. Only the latter group received two courses of adjuvant carboplatin, whereas the rest were managed by surveillance. Results After a median follow-up time of 34 months, 16 relapses (7%) have been documented (15 [9.8%] among patients on surveillance and one [1.4%] among those treated with carboplatin). All relapses occurred in retroperitoneal lymph nodes, except for one case in pelvic nodes. Median node size was 25 mm, and median time to recurrence was 14 months. All patients were rendered disease-free with chemotherapy. The actuarial 3-year disease-free survival rate was 88.1% (95% CI, 82.3% to 93.9%) for patients on surveillance and 98.0% (95% CI, 94.0% to 100%) for those treated with adjuvant chemotherapy. Overall 3-year survival was 100%. Conclusion With the limitations of the short follow-up duration, we confirm that a risk-adapted approach is effective for stage I seminoma. Adjuvant carboplatin seems adequate treatment for patients with 2 risk criteria, as is active surveillance for those with 0 to one risk factors. More reliable predictive factors are needed to improve the applicability of this model.
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Affiliation(s)
- Jorge Aparicio
- Jorge Aparicio, Hospital Universitario y Politécnico La Fe, Valencia; Pablo Maroto and Lidia Robert, Hospital de Sant Pau, Barcelona; Xavier García del Muro and José R. Germà, Idibell-Institut Catalá d'Oncologia Duran i Reynals, L'Hospitalet; Josep Gumà, Hospital Universitari Sant Joan, Reus; Alfonso Sánchez-Muñoz, Hospital Clínico Universitario Virgen de la Victoria, Málaga; Mireia Margelí, Hospital Universitari Germans Trias i Pujol, Badalona; Montserrat Doménech, Hospital Althaia, Manresa; Romá Bastús
| | - Pablo Maroto
- Jorge Aparicio, Hospital Universitario y Politécnico La Fe, Valencia; Pablo Maroto and Lidia Robert, Hospital de Sant Pau, Barcelona; Xavier García del Muro and José R. Germà, Idibell-Institut Catalá d'Oncologia Duran i Reynals, L'Hospitalet; Josep Gumà, Hospital Universitari Sant Joan, Reus; Alfonso Sánchez-Muñoz, Hospital Clínico Universitario Virgen de la Victoria, Málaga; Mireia Margelí, Hospital Universitari Germans Trias i Pujol, Badalona; Montserrat Doménech, Hospital Althaia, Manresa; Romá Bastús
| | - Xavier García del Muro
- Jorge Aparicio, Hospital Universitario y Politécnico La Fe, Valencia; Pablo Maroto and Lidia Robert, Hospital de Sant Pau, Barcelona; Xavier García del Muro and José R. Germà, Idibell-Institut Catalá d'Oncologia Duran i Reynals, L'Hospitalet; Josep Gumà, Hospital Universitari Sant Joan, Reus; Alfonso Sánchez-Muñoz, Hospital Clínico Universitario Virgen de la Victoria, Málaga; Mireia Margelí, Hospital Universitari Germans Trias i Pujol, Badalona; Montserrat Doménech, Hospital Althaia, Manresa; Romá Bastús
| | - Josep Gumà
- Jorge Aparicio, Hospital Universitario y Politécnico La Fe, Valencia; Pablo Maroto and Lidia Robert, Hospital de Sant Pau, Barcelona; Xavier García del Muro and José R. Germà, Idibell-Institut Catalá d'Oncologia Duran i Reynals, L'Hospitalet; Josep Gumà, Hospital Universitari Sant Joan, Reus; Alfonso Sánchez-Muñoz, Hospital Clínico Universitario Virgen de la Victoria, Málaga; Mireia Margelí, Hospital Universitari Germans Trias i Pujol, Badalona; Montserrat Doménech, Hospital Althaia, Manresa; Romá Bastús
| | - Alfonso Sánchez-Muñoz
- Jorge Aparicio, Hospital Universitario y Politécnico La Fe, Valencia; Pablo Maroto and Lidia Robert, Hospital de Sant Pau, Barcelona; Xavier García del Muro and José R. Germà, Idibell-Institut Catalá d'Oncologia Duran i Reynals, L'Hospitalet; Josep Gumà, Hospital Universitari Sant Joan, Reus; Alfonso Sánchez-Muñoz, Hospital Clínico Universitario Virgen de la Victoria, Málaga; Mireia Margelí, Hospital Universitari Germans Trias i Pujol, Badalona; Montserrat Doménech, Hospital Althaia, Manresa; Romá Bastús
| | - Mireia Margelí
- Jorge Aparicio, Hospital Universitario y Politécnico La Fe, Valencia; Pablo Maroto and Lidia Robert, Hospital de Sant Pau, Barcelona; Xavier García del Muro and José R. Germà, Idibell-Institut Catalá d'Oncologia Duran i Reynals, L'Hospitalet; Josep Gumà, Hospital Universitari Sant Joan, Reus; Alfonso Sánchez-Muñoz, Hospital Clínico Universitario Virgen de la Victoria, Málaga; Mireia Margelí, Hospital Universitari Germans Trias i Pujol, Badalona; Montserrat Doménech, Hospital Althaia, Manresa; Romá Bastús
| | - Montserrat Doménech
- Jorge Aparicio, Hospital Universitario y Politécnico La Fe, Valencia; Pablo Maroto and Lidia Robert, Hospital de Sant Pau, Barcelona; Xavier García del Muro and José R. Germà, Idibell-Institut Catalá d'Oncologia Duran i Reynals, L'Hospitalet; Josep Gumà, Hospital Universitari Sant Joan, Reus; Alfonso Sánchez-Muñoz, Hospital Clínico Universitario Virgen de la Victoria, Málaga; Mireia Margelí, Hospital Universitari Germans Trias i Pujol, Badalona; Montserrat Doménech, Hospital Althaia, Manresa; Romá Bastús
| | - Romá Bastús
- Jorge Aparicio, Hospital Universitario y Politécnico La Fe, Valencia; Pablo Maroto and Lidia Robert, Hospital de Sant Pau, Barcelona; Xavier García del Muro and José R. Germà, Idibell-Institut Catalá d'Oncologia Duran i Reynals, L'Hospitalet; Josep Gumà, Hospital Universitari Sant Joan, Reus; Alfonso Sánchez-Muñoz, Hospital Clínico Universitario Virgen de la Victoria, Málaga; Mireia Margelí, Hospital Universitari Germans Trias i Pujol, Badalona; Montserrat Doménech, Hospital Althaia, Manresa; Romá Bastús
| | - Antonio Fernández
- Jorge Aparicio, Hospital Universitario y Politécnico La Fe, Valencia; Pablo Maroto and Lidia Robert, Hospital de Sant Pau, Barcelona; Xavier García del Muro and José R. Germà, Idibell-Institut Catalá d'Oncologia Duran i Reynals, L'Hospitalet; Josep Gumà, Hospital Universitari Sant Joan, Reus; Alfonso Sánchez-Muñoz, Hospital Clínico Universitario Virgen de la Victoria, Málaga; Mireia Margelí, Hospital Universitari Germans Trias i Pujol, Badalona; Montserrat Doménech, Hospital Althaia, Manresa; Romá Bastús
| | - Marta López-Brea
- Jorge Aparicio, Hospital Universitario y Politécnico La Fe, Valencia; Pablo Maroto and Lidia Robert, Hospital de Sant Pau, Barcelona; Xavier García del Muro and José R. Germà, Idibell-Institut Catalá d'Oncologia Duran i Reynals, L'Hospitalet; Josep Gumà, Hospital Universitari Sant Joan, Reus; Alfonso Sánchez-Muñoz, Hospital Clínico Universitario Virgen de la Victoria, Málaga; Mireia Margelí, Hospital Universitari Germans Trias i Pujol, Badalona; Montserrat Doménech, Hospital Althaia, Manresa; Romá Bastús
| | - Josefa Terrassa
- Jorge Aparicio, Hospital Universitario y Politécnico La Fe, Valencia; Pablo Maroto and Lidia Robert, Hospital de Sant Pau, Barcelona; Xavier García del Muro and José R. Germà, Idibell-Institut Catalá d'Oncologia Duran i Reynals, L'Hospitalet; Josep Gumà, Hospital Universitari Sant Joan, Reus; Alfonso Sánchez-Muñoz, Hospital Clínico Universitario Virgen de la Victoria, Málaga; Mireia Margelí, Hospital Universitari Germans Trias i Pujol, Badalona; Montserrat Doménech, Hospital Althaia, Manresa; Romá Bastús
| | - Andrés Meana
- Jorge Aparicio, Hospital Universitario y Politécnico La Fe, Valencia; Pablo Maroto and Lidia Robert, Hospital de Sant Pau, Barcelona; Xavier García del Muro and José R. Germà, Idibell-Institut Catalá d'Oncologia Duran i Reynals, L'Hospitalet; Josep Gumà, Hospital Universitari Sant Joan, Reus; Alfonso Sánchez-Muñoz, Hospital Clínico Universitario Virgen de la Victoria, Málaga; Mireia Margelí, Hospital Universitari Germans Trias i Pujol, Badalona; Montserrat Doménech, Hospital Althaia, Manresa; Romá Bastús
| | - Purificación Martínez del Prado
- Jorge Aparicio, Hospital Universitario y Politécnico La Fe, Valencia; Pablo Maroto and Lidia Robert, Hospital de Sant Pau, Barcelona; Xavier García del Muro and José R. Germà, Idibell-Institut Catalá d'Oncologia Duran i Reynals, L'Hospitalet; Josep Gumà, Hospital Universitari Sant Joan, Reus; Alfonso Sánchez-Muñoz, Hospital Clínico Universitario Virgen de la Victoria, Málaga; Mireia Margelí, Hospital Universitari Germans Trias i Pujol, Badalona; Montserrat Doménech, Hospital Althaia, Manresa; Romá Bastús
| | - Javier Sastre
- Jorge Aparicio, Hospital Universitario y Politécnico La Fe, Valencia; Pablo Maroto and Lidia Robert, Hospital de Sant Pau, Barcelona; Xavier García del Muro and José R. Germà, Idibell-Institut Catalá d'Oncologia Duran i Reynals, L'Hospitalet; Josep Gumà, Hospital Universitari Sant Joan, Reus; Alfonso Sánchez-Muñoz, Hospital Clínico Universitario Virgen de la Victoria, Málaga; Mireia Margelí, Hospital Universitari Germans Trias i Pujol, Badalona; Montserrat Doménech, Hospital Althaia, Manresa; Romá Bastús
| | - Juan J. Satrústegui
- Jorge Aparicio, Hospital Universitario y Politécnico La Fe, Valencia; Pablo Maroto and Lidia Robert, Hospital de Sant Pau, Barcelona; Xavier García del Muro and José R. Germà, Idibell-Institut Catalá d'Oncologia Duran i Reynals, L'Hospitalet; Josep Gumà, Hospital Universitari Sant Joan, Reus; Alfonso Sánchez-Muñoz, Hospital Clínico Universitario Virgen de la Victoria, Málaga; Mireia Margelí, Hospital Universitari Germans Trias i Pujol, Badalona; Montserrat Doménech, Hospital Althaia, Manresa; Romá Bastús
| | - Regina Gironés
- Jorge Aparicio, Hospital Universitario y Politécnico La Fe, Valencia; Pablo Maroto and Lidia Robert, Hospital de Sant Pau, Barcelona; Xavier García del Muro and José R. Germà, Idibell-Institut Catalá d'Oncologia Duran i Reynals, L'Hospitalet; Josep Gumà, Hospital Universitari Sant Joan, Reus; Alfonso Sánchez-Muñoz, Hospital Clínico Universitario Virgen de la Victoria, Málaga; Mireia Margelí, Hospital Universitari Germans Trias i Pujol, Badalona; Montserrat Doménech, Hospital Althaia, Manresa; Romá Bastús
| | - Lidia Robert
- Jorge Aparicio, Hospital Universitario y Politécnico La Fe, Valencia; Pablo Maroto and Lidia Robert, Hospital de Sant Pau, Barcelona; Xavier García del Muro and José R. Germà, Idibell-Institut Catalá d'Oncologia Duran i Reynals, L'Hospitalet; Josep Gumà, Hospital Universitari Sant Joan, Reus; Alfonso Sánchez-Muñoz, Hospital Clínico Universitario Virgen de la Victoria, Málaga; Mireia Margelí, Hospital Universitari Germans Trias i Pujol, Badalona; Montserrat Doménech, Hospital Althaia, Manresa; Romá Bastús
| | - José R. Germà
- Jorge Aparicio, Hospital Universitario y Politécnico La Fe, Valencia; Pablo Maroto and Lidia Robert, Hospital de Sant Pau, Barcelona; Xavier García del Muro and José R. Germà, Idibell-Institut Catalá d'Oncologia Duran i Reynals, L'Hospitalet; Josep Gumà, Hospital Universitari Sant Joan, Reus; Alfonso Sánchez-Muñoz, Hospital Clínico Universitario Virgen de la Victoria, Málaga; Mireia Margelí, Hospital Universitari Germans Trias i Pujol, Badalona; Montserrat Doménech, Hospital Althaia, Manresa; Romá Bastús
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Sánchez-Muñoz A, Pérez-Ruiz E, Sáez MI, Trigo JM, Galindo MM, Manzaneque L, Jiménez B, Muros B, Alba E. Limited impact of palliative chemotherapy on survival in advanced solid tumours in patients with poor performance status. Clin Transl Oncol 2011; 13:426-9. [PMID: 21680304 DOI: 10.1007/s12094-011-0677-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Oncologists should carefully weigh up the risks and benefits of palliative chemotherapy in patients with advanced solid tumours (AST) and poor general status from the standpoint both of medical and ethical issues and of healthcare resources required. This study is intended to assess the impact on overall survival of palliative chemotherapy in patients with AST and admitted to hospital as a result of their poor ECOG status. MATERIALS AND METHODS We performed a retrospective analysis of 92 hospitalised patients with AST, ECOG 3-4, who were treated with palliative chemotherapy. Uni- and multivariate statistical analyses were conducted to determine the impact of clinical and disease variables (number of previous chemotherapy lines, presence of comorbidities, presentation of anorexia-cachexia syndrome, delirium, dyspnoea, ascitis, brain metastases, T-cell count, albumin, haemoglobin and LDH) on survival in this patient population. RESULTS Mean age was 54 years (range 15-80). No chemotherapy had been given for advanced disease in 74%, 13% had received one line, 6% 2 lines and 7% ≥3 lines. Median survival, i.e., after initiation of chemotherapy to death, in these patients was 33 days (range 1-1390). The median of chemotherapy cycles was 1. In the multivariate analysis, no previous chemotherapy, and absence of anorexia-cachexia syndrome and of comorbidities was associated with significantly improved survival in patients. Forty-nine percent of patients died within 30 days of therapy, 28% died between days 30 and 90, and only 23% of patients lived longer than 90 days. Grade 3-4 toxicities mainly entailed blood disorders, namely anaemia 8%, neutropenia 13% and thrombocytopenia 8%. Six patients (5%) developed sepsis after therapy; of these, 3 died from this toxicity, 1 patient suffered cardiac toxicity, one patient leukoencephalopathy and 1 patient acute pulmonary thromboembolism. CONCLUSION Palliative chemotherapy given to patients with AST and ECOG 3-4 with short life expectancy provided no benefit for survival. As a result, we may be over-treating these patients and contributing to poor-quality care.
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Affiliation(s)
- Alfonso Sánchez-Muñoz
- Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
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Sánchez-Muñoz A, Pérez-Ruiz E, Jurado JM, Ribelles N, Márquez A, Miramón J, Maíz M, Pajares B, Gallego E, Scholtz V, Jiménez B, Soler C, Molina M, García-Ríos I, Alba E. Outcome of Small Invasive Breast Cancer with No Axillary Lymph Node Involvement. Breast J 2010; 17:32-8. [DOI: 10.1111/j.1524-4741.2010.01026.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Sánchez-Muñoz A, Pérez-Ruiz E, Jurado JM, Ribelles N, Márquez A, Miramón J, Maíz M, Pajares B, Gallego E, Jiménez B, Alba E. Prognosis of Microinvasive Breast Carcinoma with Negative Axillary Nodes in Accordance with TNM Classification Criteria. Breast J 2010; 16:669-71. [PMID: 21070451 DOI: 10.1111/j.1524-4741.2010.00981.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Sánchez-Muñoz A, Mendiola C, Rodriguez CA, Pérez-Ruiz E, Jurado JM, Alonso-Carrión L, Ghanem I, Deelasco G, Quero Blanco C, Alba E. Bevacizumab plus low-dose metronomic oral cyclophosphamide in heavily pretreated recurrent ovarian cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e15507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Sánchez-Muñoz A, Gallego E, de Luque V, Pérez-Rivas LG, Vicioso L, Ribelles N, Lozano J, Alba E. Lack of evidence for KRAS oncogenic mutations in triple-negative breast cancer. BMC Cancer 2010; 10:136. [PMID: 20385028 PMCID: PMC2868051 DOI: 10.1186/1471-2407-10-136] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 04/13/2010] [Indexed: 12/17/2022] Open
Abstract
Background Mutational analysis of the KRAS gene has recently been established as a complementary in vitro diagnostic tool for the identification of patients with colorectal cancer who will not benefit from anti-epidermal growth factor receptor (EGFR) therapies. Assessment of the mutation status of KRAS might also be of potential relevance in other EGFR-overexpressing tumors, such as those occurring in breast cancer. Although KRAS is mutated in only a minor fraction of breast tumors (5%), about 60% of the basal-like subtype express EGFR and, therefore could be targeted by EGFR inhibitors. We aimed to study the mutation frequency of KRAS in that subtype of breast tumors to provide a molecular basis for the evaluation of anti-EGFR therapies. Methods Total, genomic DNA was obtained from a group of 35 formalin-fixed paraffin-embedded, triple-negative breast tumor samples. Among these, 77.1% (27/35) were defined as basal-like by immunostaining specific for the established surrogate markers cytokeratin (CK) 5/6 and/or EGFR. KRAS mutational status was determined in the purified DNA samples by Real Time (RT)-PCR using primers specific for the detection of wild-type KRAS or the following seven oncogenic somatic mutations: Gly12Ala, Gly12Asp, Gly12Arg, Gly12Cys, Gly12Ser, Gly12Val and Gly13Asp. Results We found no evidence of KRAS oncogenic mutations in all analyzed tumors. Conclusions This study indicates that KRAS mutations are very infrequent in triple-negative breast tumors and that EGFR inhibitors may be of potential benefit in the treatment of basal-like breast tumors, which overexpress EGFR in about 60% of all cases.
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Affiliation(s)
- Alfonso Sánchez-Muñoz
- Servicio de Oncología Médica, Hospital Universitario Virgen de Victoria, Campus de Teatinos s/n, 29010 Málaga, Spain
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Alonso L, Gallego E, González FJ, Sánchez-Muñoz A, Torres E, Pajares BI, Leeflang S, Baha C. Gonadotropin and steroid receptors as prognostic factors in advanced ovarian cancer: a retrospective study. Clin Transl Oncol 2010; 11:748-52. [PMID: 19917538 DOI: 10.1007/s12094-009-0437-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Ovarian cancer is a chemosensitive tumour, but two thirds of women have a recurrence during the follow- up, even after an optimal surgical debulking followed by chemotherapy with a platinum and a taxane compound. Cytotoxic drugs are used in a second- or third-line setting but tumour progression is the rule. Also patients with the same histology achieve different outcomes in terms of survival. We decided to study gonadotropin and steroid receptors and to consider if these histological markers could select patients with different prognosis. MATERIALS AND METHODS In our study we have measured by immunohistochemistry oestrogen, progestin and gonadotropin- releasing hormone receptors (Gn-RHRs) in paraffinembedded ovarian cancer tissue in a sample of 62 consecutive patients with advanced ovarian cancer treated with surgery and adjuvant chemotherapy. Descriptive methods, a survival analysis (Kaplan-Meier) and a Cox regression analysis were done. RESULTS Oestrogen receptors (ERs) were positive in 65% of patients and the same positivity was obtained for progestin receptors (PRs), with 74% showing some positivity for Gn-RHR receptors. Maximal cytoreduction and ERs, but not gonadotropin receptors, were independently associated with overall survival, with better survival for oestrogennegative tumours. No association was established for progression- free survival. CONCLUSIONS We can conclude that ER status in our series is an independent prognostic factor for ovarian cancer with better survival for oestrogen-negative receptor tumours. PRs could also have a prognostic role in association with ERs.
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Affiliation(s)
- Lorenzo Alonso
- Medical Oncology Service, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
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Pérez-Regadera J, Sánchez-Muñoz A, De-la-Cruz J, Ballestín C, Lora D, García-Martín R, Alonso-Carrión L, Mendiola C, Lanzós E. Cisplatin-Based Radiochemotherapy Improves the Negative Prognosis of c-erbB-2 Overexpressing Advanced Cervical Cancer. Int J Gynecol Cancer 2010; 20:164-72. [DOI: 10.1111/igc.0b013e3181ad3e11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Sánchez-Muñoz A, Mendiola C, Pérez-Ruiz E, Rodríguez-Sánchez CA, Jurado JM, Alonso-Carrión L, Ghanem I, de Velasco G, Quero-Blanco C, Alba E. Bevacizumab plus Low-Dose Metronomic Oral Cyclophosphamide in Heavily Pretreated Patients with Recurrent Ovarian Cancer. Oncology 2010; 79:98-104. [DOI: 10.1159/000320602] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 07/21/2010] [Indexed: 11/19/2022]
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Sánchez-Muñoz A, Ribelles N, Márquez A, Pérez-Ruiz E, Alba E. Aromatase Inhibitors As Adjuvant Therapy for Breast Cancer: Overall Survival Versus Disease-Free Survival As a Primary End Point in Clinical Practice. J Clin Oncol 2009; 27:e255-6; author reply e257-8. [DOI: 10.1200/jco.2009.25.3914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Alfonso Sánchez-Muñoz
- Medical Oncology Department, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - Nuria Ribelles
- Medical Oncology Department, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - Antonia Márquez
- Medical Oncology Department, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - Elisabeth Pérez-Ruiz
- Medical Oncology Department, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - Emilio Alba
- Medical Oncology Department, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
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Sánchez-Muñoz A, Pérez-Ruiz E, Jiménez B, Ribelles N, Márquez A, García-Ríos I, Alba Conejo E. Targeted therapy of metastatic breast cancer. Clin Transl Oncol 2009; 11:643-50. [DOI: 10.1007/s12094-009-0419-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sánchez-Muñoz A, Jurado JM, Pérez-Ruiz E, Alba E. Second complete remission induced by cyclophosphamide plus bevacizumab in two patients with heavily pre-treated ovarian cancer. Clin Transl Oncol 2009; 11:329-31. [DOI: 10.1007/s12094-009-0363-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Metastatic breast cancer (MBC) occurs in 20-30% of women with breast cancer and is an incurable disease. Treatment is palliative and directed to prolong survival, decrease symptoms and improve patients' quality of life. For patients with hormone receptor-negative disease or for hormone receptor-positive disease that has become resistant to endocrine therapy, or is progressing rapidly and life threatening, cytotoxic chemotherapy is indicated. However, the optimal duration of chemotherapy treatment for MBC is still a matter of debate. Studies using maintenance chemotherapy regimens standard in the 1990s showed a consistent benefit with a more prolonged time to progression, although an improvement in survival was only demonstrated in one study. Two recent trials with newer cytotoxic agents showed controversial results; whereas one study concluded that the policy of prolonging treatment in chemotherapy-sensitive patients, after aggressive, modern combination chemotherapy, cannot be recommended for women with MBC, the other study showed that maintenance therapy with pegylated liposomal doxorubicin significantly prolonged time to progression in MBC patients after first-line chemotherapy without significant clinical toxicity. Initial data regarding metronomic chemotherapy indicate that continuously low-dose cyclophosphamide and methotrexate is minimally toxic and effective in heavily pretreated breast cancer patients. In daily practice, maintenance chemotherapy is a reasonable strategy that prolongs time to progression in patients with MBC who did not show progression after first-line chemotherapy. However, this benefit should be considered together with toxicities of treatment and the patient's preference.
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Affiliation(s)
- A Sánchez-Muñoz
- Medical Oncology Service, Hospital Universitario Virgen de Victoria, Málaga, Spain
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Pérez-Regadera J, Sánchez-Muñoz A, De-la-Cruz J, Ballestín C, Lora D, García-Martín R, Mendiola C, Alonso L, Alba E, Lanzós E. Negative Prognostic Impact of the Coexpression of Epidermal Growth Factor Receptor and c-erbB-2 in Locally Advanced Cervical Cancer. Oncology 2009; 76:133-41. [DOI: 10.1159/000195539] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 09/05/2008] [Indexed: 11/19/2022]
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Sánchez-Muñoz A, Pérez-Ruiz E, Ribelles N, Márquez A, Alba E. Maintenance treatment in metastatic breast cancer. Expert Rev Anticancer Ther 2008. [DOI: 10.1586/14737140.8.11.1837] [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: 11/08/2022]
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Sánchez-Muñoz A, García-Tapiador AM, Martínez-Ortega E, Dueñas-García R, Jaén-Morago A, Ortega-Granados AL, Fernández-Navarro M, de la Torre-Cabrera C, Dueñas B, Rueda AI, Morales F, Ramírez-Torosa C, Martín-Salvago MD, Sánchez-Rovira P. Tumour molecular subtyping according to hormone receptors and HER2 status defines different pathological complete response to neoadjuvant chemotherapy in patients with locally advanced breast cancer. Clin Transl Oncol 2008; 10:646-53. [PMID: 18940745 DOI: 10.1007/s12094-008-0265-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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García-Velasco A, Mendiola C, Sánchez-Muñoz A, Ballestín C, Colomer R, Cortés-Funes H. Prognostic value of hormonal receptors, p53, ki67 and HER2/neu expression in epithelial ovarian carcinoma. Clin Transl Oncol 2008; 10:367-71. [PMID: 18558584 DOI: 10.1007/s12094-008-0213-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The role of molecular and biological factors in ovarian cancer is controversial. We investigated the levels of the estrogen (ER) and progesterone (PR) receptors, HER2/neu, p-53 and Ki 67 in patients with advanced ovarian cancer and correlated the results with the clinical course in order to define their predictive or prognostic significance. METHODS Paraffin-embedded tumor tissues from 72 patients with ovarian cancer treated from 1999 to 2003 were analyzed. Overexpression of C-erb-B2 was defined as herceptest ++/+++ and positive fluorescence in situ hybridization (FISH) or herceptest +++/+++. Positivity for ER and PR was determined by > or =10% of the cellular membranes immunostained. Statistical analysis was performed to evaluate the prognostic impact of the molecular markers. RESULTS 49 of the 72 patients were ER + (68%) and 36 PR + (50%). In 45 patients (62.5%) expression of p53 was > or =10%. Overexpression of C-erb-2 was found in 4 tumor samples (5%). A Ki67 labelled nuclear area >30% was found to be associated with a higher rate of complete response (chi(2); p=0.05). None of the biological markers were significantly associated with progression free survival (PFS). By multivariate analysis residual tumor after debulking surgery and ER status were associated with OS (p< or =0.05). CONCLUSIONS Ki67 nuclear expression >30% is predictive of complete response in advanced ovarian cancer. HER2/neu overexpression is scarce in our study. Positive ER is an independent prognostic factor for OS. Further research with larger studies and hormonal treatment is guaranteed.
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Affiliation(s)
- A García-Velasco
- Division of Medical Oncology, Institut Catalá d'Oncología, Hospital Universitario Dr. Josep Trueta, Girona, Spain.
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Sánchez-Muñoz A, García-Tapiador AM, Dueñas-García R, Jaén-Morago A, Ortega-Granados AL, Martínez-Ortega E, Fernández Morales M, Fernández-Navarro M, de la Torre Cabrera C, Dueñas B, Ureña C, Martínez J, Morales F, Ramírez-Tortosa C, Sánchez-Rovira P. Safety and efficacy of neo-adjuvant sequential dose-dense chemotherapy doublets combined with trastuzumab in patients with HER-2-positive early stage breast cancer. Breast J 2008; 14:506-7. [PMID: 18705667 DOI: 10.1111/j.1524-4741.2008.00634.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pérez-Regadera J, Sánchez-Muñoz A, De-la-Cruz J, Ballestín C, Lora D, García-Martín R, Alonso-Carrión L, Mendiola C, Lanzós E. Correlation between c-erb-B2 overexpression with disease-free survival and rate of pelvic relapse in patients with advanced cervical cancer treated with chemo-radiotherapy. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.16004] [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
16004 Aims: To determine the impact of the c-erb-B2 overexpression receptor on pelvic relapse and on disease-free survival (DFS) in patients with advanced cervical cancer receiving concurrent chemo-radiotherapy. Methods: One hundred thirty six patients with advanced cervical cancer (stage: 12 IB2-IIA, 34 IIB, 71 IIIB, 19 IVA); histology: 86 epidermoid and 14 adenocarcinoma) were analyzed to detect c-erbB-2 level using an immunohistochemical method (Herceptest Dako). Cases c-erbB-2 (+3) were considered positive. All patients received pelvic radiotherapy, brachitherapy and concurrent chemotherapy with two schedules: 48 patients with tegafur (800 mg/day via oral) and 88 with tegafur (same doses) plus five cycles of weekly cisplatin 40 mg/m2/week iv. Results: Of the 136 biopsies, 32 (23.5%) were c- erbB-2 positive. The disease free survival to 3 and 5 years of the patients were 61% and 58% for c-erb-B2 negative and 36% and 36% for c-erb- B2 positive (p=0.02), respectively.We divided our patients in four groups: c-erb-B2 positive treated with cisplatin; c-erb-B2 positive without cisplatin, c-erb-b2 negative treated with cisplatin and c-erb-b2 negative without cisplatin. The group of patients with c-erb-B2 overexpression that did not received platinum treatment had a higher rate of pelvis relapse (p<0.0001) and with a decreased DFS (p=0.0014). Conclusions: c-erbB-2 overexpression may imply a poor prognosis for patients with advanced cervix cancer, especially if they did not receive concurrent radiochemotherapy with cisplatin. No significant financial relationships to disclose.
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Affiliation(s)
- J. Pérez-Regadera
- Hospital Universitario 12 De Octubre, Madrid, Spain; Hospital Ciudad de Jaén, Jaén, Spain; Hospital Virgen de la Victoria, Málaga, Spain
| | - A. Sánchez-Muñoz
- Hospital Universitario 12 De Octubre, Madrid, Spain; Hospital Ciudad de Jaén, Jaén, Spain; Hospital Virgen de la Victoria, Málaga, Spain
| | - J. De-la-Cruz
- Hospital Universitario 12 De Octubre, Madrid, Spain; Hospital Ciudad de Jaén, Jaén, Spain; Hospital Virgen de la Victoria, Málaga, Spain
| | - C. Ballestín
- Hospital Universitario 12 De Octubre, Madrid, Spain; Hospital Ciudad de Jaén, Jaén, Spain; Hospital Virgen de la Victoria, Málaga, Spain
| | - D. Lora
- Hospital Universitario 12 De Octubre, Madrid, Spain; Hospital Ciudad de Jaén, Jaén, Spain; Hospital Virgen de la Victoria, Málaga, Spain
| | - R. García-Martín
- Hospital Universitario 12 De Octubre, Madrid, Spain; Hospital Ciudad de Jaén, Jaén, Spain; Hospital Virgen de la Victoria, Málaga, Spain
| | - L. Alonso-Carrión
- Hospital Universitario 12 De Octubre, Madrid, Spain; Hospital Ciudad de Jaén, Jaén, Spain; Hospital Virgen de la Victoria, Málaga, Spain
| | - C. Mendiola
- Hospital Universitario 12 De Octubre, Madrid, Spain; Hospital Ciudad de Jaén, Jaén, Spain; Hospital Virgen de la Victoria, Málaga, Spain
| | - E. Lanzós
- Hospital Universitario 12 De Octubre, Madrid, Spain; Hospital Ciudad de Jaén, Jaén, Spain; Hospital Virgen de la Victoria, Málaga, Spain
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López-Medrano F, del Val-Muñoz O, Sánchez-Muñoz A, San Juan R, Grávalos C. [Woman with a history of cancer and pain in the right thigh: an infection spread by contiguity]. Enferm Infecc Microbiol Clin 2006; 24:129-30. [PMID: 16545320 DOI: 10.1157/13085019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sánchez-Muñoz A, Aguado JM, López-Martín A, López-Medrano F, Lumbreras C, Rodríguez FJ, Colomer R, Cortés-Funes H. Usefulness of antibiotic-lock technique in management of oncology patients with uncomplicated bacteremia related to tunneled catheters. Eur J Clin Microbiol Infect Dis 2005; 24:291-3. [PMID: 15902539 DOI: 10.1007/s10096-005-1291-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A Sánchez-Muñoz
- Medical Oncology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
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de Lope ML, Batalha P, Sosa M, Rodríguez-Gómez FJ, Sánchez-Muñoz A, Pujol E, Aguado JM. Pleural empyema due to Salmonella enteritidis in a non-immunocompromised patient. Eur J Clin Microbiol Infect Dis 2004; 23:792-3. [PMID: 15605186 DOI: 10.1007/s10096-004-1204-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M León de Lope
- Service of Internal Medicine, Hospital Juan Ramón Jiménez, Ronda Norte, s/n, 21005, Huelva Spain
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Jimeno A, García-Velasco A, del Val O, González-Billalabeitia E, Hernando S, Hernández R, Sánchez-Muñoz A, López-Martín A, Durán I, Robles L, Cortés-Funes H, Paz-Ares L. Assessment of procalcitonin as a diagnostic and prognostic marker in patients with solid tumors and febrile neutropenia. Cancer 2004; 100:2462-9. [PMID: 15160353 DOI: 10.1002/cncr.20275] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cancer patients with fever and neutropenia currently are assessed on clinical grounds only. The current study prospectively evaluated the efficacy of baseline procalcitonin (PCT) in the detection of bacteremia and in the prediction of outcome in patients with solid tumors and febrile neutropenia. METHODS PCT levels were determined at baseline and every 48 hours in 104 patients undergoing chemotherapy who developed fever (axillary temperature > 38 degrees C on 2 occasions or > 38.3 degrees C in a single record) and neutropenia (absolute neutrophil count < 500 cells/microL). RESULTS The median baseline PCT values were significantly higher in patients who had microbiologically documented infections (1.24 ng/mL) compared with patients who had clinically documented infections (0.27 ng/mL) or fever of unknown origin (0.21 ng/mL; P < 0.01). Accordingly, a PCT cut-off value of 0.5 ng/mL was reached more frequently in patients who had microbiologically documented infections compared with patients who had clinically documented infections or fever of unknown origin (66.7% vs. 13.4%, respectively; P < 0.001). Furthermore, this threshold also was associated with an increased likelihood of treatment failure (70.0% vs. 14.9%; P < 0.001). All 4 septic patients and all 5 patients who ultimately died presented PCT values 5-fold to 10-fold greater than the median values. Clinical evaluation in combination with baseline PCT assessment appeared to improve clinical risk evaluation alone. CONCLUSIONS Baseline PCT levels were higher in patients who had febrile neutropenia with bacteremia compared with patients who had clinical infections or fever of unknown origin. PCT helped to identify patients who had microbiologic infections and patients who were at high risk of treatment failure, and PCT may constitute a complementary tool in the initial assessment of such patients.
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Affiliation(s)
- Antonio Jimeno
- Division of Medical Oncology, University Hospital 12 de Octubre, Madrid, Spain
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Jimeno A, García-Velasco A, Del Val O, González-Billalabeitia E, Hernando S, Hernández R, Sánchez-Muñoz A, López-Martín A, Cortés-Funes H, Paz-Ares L. Procalcitonin (PCT) as a diagnostic and prognostic marker in patients with solid tumors and febrile neutropenia. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.8037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A. Jimeno
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - O. Del Val
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - S. Hernando
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - R. Hernández
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | - L. Paz-Ares
- Hospital Universitario 12 de Octubre, Madrid, Spain
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García-Velasco A, Hernando S, Mendiola C, Castellano D, Sánchez-Muñoz A, Del Val O, Manso L, Quintela M, Cortés-Funes H. Paclitaxel, cisplatin, and cyclophosphamide (PCC) first-line chemotherapy for advanced ovarian carcinoma: Long-term results of a phase II study. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.5135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - L. Manso
- Hospital 12 de Octubre, Madrid, Spain
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Sánchez-Muñoz A, Gravalos Castro C, Colomer Bosch R, García Velasco A, García JP, Cortés-Funes H. [Generalized cutaneous-nodal metastatic spread as initial manifestation of the recurrence of a gastric adenocarcinoma]. Rev Clin Esp 2004; 203:597-8. [PMID: 14622511 DOI: 10.1157/13053731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- A Sánchez-Muñoz
- Servicio de Oncología Médica, Hospital Universitario 12 de Octubre, Madrid
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Hidalgo Natera A, Hervás Gómez R, Sánchez-Muñoz A, Eraso Sanz A, González Gutiérrez PJ, Iglesias Segarra C, Martínez Antonio E. Nódulos pulmonares múltiples asociados a derrame pleural izquierdo como forma de presentación de una tuberculosis pulmonar. Rev Clin Esp 2004; 204:659-60. [PMID: 15710077 DOI: 10.1016/s0014-2565(04)71574-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A Hidalgo Natera
- Servicios de Alergología, Hospital Universitario Doce de Octubre, Madrid
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Rodríguez Gómez FJ, Sánchez-Muñoz A, Borrero JJ, Merino Muñoz D, López Martín A, Pujol de la Llave E. [Hypervascular pelvic mass: an infrequent cause of digestive hemorrhage]. Rev Clin Esp 2003; 203:509-11. [PMID: 14563250 DOI: 10.1016/s0014-2565(03)71342-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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García-Donoso C, Sánchez-Muñoz A, López-Medrano F. Dermatomyositis and transitional cell carcinoma of the bladder: a rare paraneoplastic syndrome associated with tumor recurrence. Eur J Intern Med 2003; 14:397-398. [PMID: 14769504 DOI: 10.1016/s0953-6205(03)90012-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2003] [Accepted: 06/23/2003] [Indexed: 11/16/2022]
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Abstract
Intimal sarcoma of the aorta is a rare and aggressive mesenchymal neoplasm with a propensity to metastasize and to embolize distant arteries. The diagnosis is most commonly made by autopsy or after surgery for an aortic aneurysm. Surgery is the treatment of choice in patients who do not have metastatic disease. The prognosis is generally poor, with death resulting in most patients within a few months from diagnosis. We describe a rare case of intimal sarcoma of the aorta that showed simultaneous involvement of the thoracic and abdominal aorta and also widespread embolic metastases to the main large vessels of the brain, heart, liver, kidneys, and spleen.
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Affiliation(s)
- Alfonso Sánchez-Muñoz
- Division of Medical Oncology, Hospital Universitario Doce de Octubre, Avenida de Córdoba Km 5,4, E-28041, Madrid, Spain
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Sánchez-Muñoz A, López-Medrano F, Artiles Valle V, Jimeno Largo A, González-Billalabeitia E. Isquemia intestinal aguda extensa en el seno de carcinoma de colon con recidiva local. Rev Clin Esp 2003; 203:489-90. [PMID: 14563243 DOI: 10.1016/s0014-2565(03)71335-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- A Sánchez-Muñoz
- Servicio de Oncología Médica, Hospital Universitario 12 de Octubre, Madrid
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