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Santos FA, Reis RM, Barroti LC, Pereira AAL, Matsushita MM, de Carvalho AC, Datorre JG, Berardinelli GN, Araujo RLC. Overall Survival, BRAF, RAS, and MSI Status in Patients Who Underwent Cetuximab After Refractory Chemotherapy for Metastatic Colorectal Cancer. J Gastrointest Cancer 2024; 55:344-354. [PMID: 37608030 DOI: 10.1007/s12029-023-00964-x] [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] [Accepted: 08/12/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE Evaluate overall survival (OS), RAS, BRAF, and MSI frequencies in patients with metastatic colorectal cancer (mCRC), refractory to chemotherapy, and finally treated with cetuximab. METHODS A retrospective cohort study to evaluate 211 mCRC patients with wild-type KRAS treated with cetuximab. BRAF V600E, KRAS, NRAS gene mutations, and MSI status were identified using PCR techniques in a population of pre-treated patients who were refractory to fluoropyrimidines, oxaliplatin, and irinotecan. In addition, we evaluated the mutation frequency of the BRAF and NRAS genes and the MSI status of this population. Uni- and multivariate analyses were performed for independent prognostic factors of OS. RESULTS The median OS was 10.4 months, 6.6 months for patients with right and 11.5 months for left colon cancers (p = 0.02). The frequencies of mutations were BRAF at 3.9% (median OS of 4.9 months), NRAS at 3.38% (median OS of 6.9 months), and MSI-High status at 3.3% (median OS of 4.6 months). The OS, NRAS, and MSI frequencies were similar to those found in other studies that evaluated cetuximab in poly-treated patients and were associated with lower survival rates in univariate analyses. The frequency of BRAF mutations was lower than that found in previous studies. The only variable that remained significant for OS in the multivariate model was tumour laterality, with patients with right colon cancer presenting a worse prognosis (HR = 2.81). CONCLUSION Although BRAF, NRAS mutations, and MSI-High status were associated with shorter OS in univariate analyses, only tumour laterality remained an independent prognostic factor in the multivariate analysis.
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Affiliation(s)
| | - Rui Manuel Reis
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
- Life and Health Sciences Research Institute (ICVS), School Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimaraes, Portugal
| | - Lucas C Barroti
- Department of Dermatology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Allan A L Pereira
- Clinical Oncology Department, Hospital Sirio Libanes de Brasilia-DF, Sao Paulo, Brazil
| | | | | | | | | | - Raphael L C Araujo
- Department of Surgery, Digestive Surgery Service, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
- Instituto de Ensino e Pesquisa, Barretos Cancer Hospital, Sao Paulo, Brazil.
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Miranda TA, Girardi DM, Pereira AAL. Combining cabozantinib, nivolumab and ipilimumab in advanced hepatocellular carcinoma: does benefit outweigh toxicity? Chin Clin Oncol 2024; 0:cco-23-106. [PMID: 38247721 DOI: 10.21037/cco-23-106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Affiliation(s)
- Thiago A Miranda
- Department of Medical Oncology, Hospital Sírio-Libanês, Brasília, Brazil
| | - Daniel M Girardi
- Department of Medical Oncology, Hospital Sírio-Libanês, Brasília, Brazil
| | - Allan A L Pereira
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
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3
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de Sousa CFPM, Pereira AAL, Gouveia AG, Hanna SA, Moraes FY, Arruda GV, Marta GN. Does Endocrine Therapy for DCIS Patients Treated with Breast-Conserving Surgery Followed by Postoperative Radiation Therapy is Needed? A Brazilian Retrospective Cohort Study. Int J Radiat Oncol Biol Phys 2023; 117:e173. [PMID: 37784785 DOI: 10.1016/j.ijrobp.2023.06.1016] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) International previous clinical trials have demonstrated increased local control. Adjuvant endocrine therapy (ET) is a component of hormone receptor-positive breast ductal carcinoma in situ (DCIS) treatment. Previous trials have shown local control benefits. However, there are still questions regarding the reproducibility of those results in real-life scenarios and for different populations, especially in patients who received breast-conserving surgery followed by postoperative radiation therapy. Therefore, we retrospectively evaluated the impact of adjuvant ET for CDIS from a large State database in Brazil. MATERIALS/METHODS We retrospectively evaluated the Fundação Oncocentro de São Paulo (FOSP) database, which collects information on hospitals and oncology departments in the State of São Paulo, Brazil. The endpoints were local control (LC), disease-specific survival (DSS), and overall survival (OS). Moreover, we investigated the influence of medical practice (public health care system, insurance, private) and educational level (illiterate and incomplete middle school were grouped as low; complete middle school, high school, and undergraduate were grouped as medium/high). RESULTS Data from 2,192 patients who underwent breast-conserving surgery and postoperative radiotherapy and were treated between 2000 and 2020 were analyzed. The median follow-up time was 48.99 months (IQR 29.93 - 88.67). In the cohort, 53.33% (n = 1169) of patients received adjuvant ET, and 46.67% did not (n = 1023). Overall, patients not receiving adjuvant ET tend to be older (p = 0.021) and have a lower educational level (p < 0.001). Median OS and DSS were not reached. The 10-year OS and DSS for patients receiving adjuvant ET versus those not receiving it was 89.36% vs. 91.47% and 97.54% vs. 98.48%, respectively. The HR for OS for adjuvant ET vs. no ET was 0.96 (95% CI 0.63 - 1.4; p = 0.83). The HR for DSS for adjuvant ET vs. no ET was 0.79 (95% CI 0.29 - 2.12; p = 0.63). The only variable associated with survival was educational level. The 10-year OS was significantly higher for patients with medium/high educational levels (93.25% vs. 87.31%). The HR for death for medium/high versus low educational level was 0.51 (95% CI 0.32 - 0.83; p = 0.007). Recurrence rates were low in the cohort. Only 1.5% of patients had local recurrence, and 0.2% had a regional recurrence. There was no significant difference between recurrence rates for adjuvant ET (p = 0.19 and p = 0.78, respectively). CONCLUSION The benefits of adjuvant ET in DCIS patients found in international clinical trials could not be demonstrated in a Brazilian cohort. Educational level significantly impacted survival and ET usage, reflecting the influence of socioeconomic factors. Identifying these more vulnerable populations can allow for more precise interventions.
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Affiliation(s)
- C F P M de Sousa
- Department of Radiation Oncology, Hospital Sírio Libanês, Sao Paulo, Brazil
| | | | - A G Gouveia
- Radiation Oncology Department, Américas Centro de Oncologia Integrado, Rio de Janeiro, Brazil
| | - S A Hanna
- Hospital Sírio-Libanês, São Paulo, Sao Paulo, Brazil
| | - F Y Moraes
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - G V Arruda
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP, Ribeirão Preto, Brazil
| | - G N Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil
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Starling MTM, Pereira AAL, de Sousa CFPM, Restini F, Hanna SA, Gouveia AG, Moraes FY, Arruda GV, Marta GN. Brazilian Pediatric Patients with Gliomas: Treatment Characteristics and Survival Outcomes. Int J Radiat Oncol Biol Phys 2023; 117:e531-e532. [PMID: 37785649 DOI: 10.1016/j.ijrobp.2023.06.1814] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Despite being the second most frequent tumors in children, pediatric central nervous system (CNS) tumors are rare, and there are limited epidemiological data. The current study aimed to determine the survival rates of patients diagnosed with pediatric gliomas in Brazil, accounting for the influence of age, treatment modalities, and tumor site using population-based national database. MATERIALS/METHODS Patients diagnosed with pediatric gliomas of CNS from 1999-2020 were identified from The Fundação Oncocentro de São Paulo database. The Kaplan-Meier and the log-rank test were used for survival analysis. RESULTS A total of 1296 patients were included. The most common histologic tumor type were glioblastomas (38.27%; n = 496), pilocytic astrocytoma (32.87%; n = 426) and astrocytoma grade II (20.76%; n = 269) A total of 379 (29.24%) had brainstem tumor. The 1-year, 3-year 5-year OS for pilocytic astrocytoma were 93.72%, 89.98%, and 88.97%; for grade II 80,36%, 71,89%, 68,60%; for grade III 53,72%; 31,87%, 28,33%; and for glioblastoma 52,90%, 28,76%, 25,20%, respectively. Brainstem tumors had the worse OS compared to no brainstem tumors (p = 0.001). For high-grade glioma (grade III and IV) excluding brainstem tumors (n = 570), young patients had greater median OS (0 to 3 years: 22 months; 4 to 18 years: 13 months - p = 0.005). Regarding the treatment modalities, combined treatments were associated with higher median survival compared to less intensive therapy (surgery: 11 months; surgery and chemotherapy: 16 months; surgery, radiotherapy, and chemotherapy: 20 months; p = 0.005) CONCLUSION: In our cohort, low-grade gliomas had favorable prognoses and outcomes. Patients diagnosed with glioblastomas and brainstem gliomas had the worst OS. For high-grade gliomas, undergoing treatment de-intensification in the Brazilian pediatric population is associated with worse survival.
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Affiliation(s)
| | | | - C F P M de Sousa
- Department of Radiation Oncology, Hospital Sírio Libanês, Sao Paulo, Brazil
| | - F Restini
- Hospital Sirio Libanes, Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - S A Hanna
- Hospital Sírio-Libanês, São Paulo, Sao Paulo, Brazil
| | - A G Gouveia
- Radiation Oncology Department, Américas Centro de Oncologia Integrado, Rio de Janeiro, Brazil
| | - F Y Moraes
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - G V Arruda
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP, Ribeirão Preto, Brazil
| | - G N Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil
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Girardi DM, Pacífico JPM, Guedes de Amorim FPL, dos Santos Fernandes G, Teixeira MC, Pereira AAL. Immunotherapy and Targeted Therapy for Hepatocellular Carcinoma: A Literature Review and Treatment Perspectives. Pharmaceuticals (Basel) 2020; 14:28. [PMID: 33396181 PMCID: PMC7824026 DOI: 10.3390/ph14010028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 02/06/2023] Open
Abstract
Advanced hepatocellular carcinoma is a prevalent and potentially aggressive disease. For more than a decade, treatment with sorafenib has been the only approved therapeutic approach. Moreover, no agent has been proven to prolong survival following the progression of disease after sorafenib treatment. However, in recent years, this scenario has changed substantially with several trials being conducted to examine the effects of immunotherapy and novel targeting agents. Several immune checkpoint inhibitors have shown promising results in early-stage clinical trials. Moreover, phase III trials with large cohorts have demonstrated remarkable improvement in survival with the use of new targeted therapies in second-line treatment. Treatment regimens involving the combination of two immune checkpoint inhibitors as well as immune checkpoint inhibitors and anti-angiogenic targeted therapies have shown potential to act synergistically in clinical trials. Recently, the combination of atezolizumab and bevacizumab evaluated in a phase III clinical trial has demonstrated survival superiority in the first-line treatment; it is the new considered standard of care. In this manuscript, we aimed to review the latest advances in the systemic treatment of advanced hepatocellular carcinoma focusing on immunotherapy and targeted therapies.
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Affiliation(s)
- Daniel M. Girardi
- Hospital Sírio-Libanes, SGAS 613/614 Conjunto E Lote 95-Asa Sul, Brasília 70200-730, Brazil; (G.d.S.F.); (A.A.L.P.)
- Hospital de Base do Distrito Federal, SMHS-Área Especial, Q. 101-Asa Sul, Brasília 70330-150, Brazil;
| | - Jana Priscila M. Pacífico
- Escola Superior de Ciências em Saúde, SMHN Conjunto A Bloco 01 Edifício Fepecs-Asa Norte, Brasília 70710-907, Brazil; (J.P.M.P.); (F.P.L.G.d.A.)
| | - Fernanda P. L. Guedes de Amorim
- Escola Superior de Ciências em Saúde, SMHN Conjunto A Bloco 01 Edifício Fepecs-Asa Norte, Brasília 70710-907, Brazil; (J.P.M.P.); (F.P.L.G.d.A.)
| | - Gustavo dos Santos Fernandes
- Hospital Sírio-Libanes, SGAS 613/614 Conjunto E Lote 95-Asa Sul, Brasília 70200-730, Brazil; (G.d.S.F.); (A.A.L.P.)
| | - Marcela C. Teixeira
- Hospital de Base do Distrito Federal, SMHS-Área Especial, Q. 101-Asa Sul, Brasília 70330-150, Brazil;
- Hospital DF Star, SGAS I SGAS 914-Asa Sul, Brasília 70390-140, Brazil
| | - Allan A. L. Pereira
- Hospital Sírio-Libanes, SGAS 613/614 Conjunto E Lote 95-Asa Sul, Brasília 70200-730, Brazil; (G.d.S.F.); (A.A.L.P.)
- Hospital de Base do Distrito Federal, SMHS-Área Especial, Q. 101-Asa Sul, Brasília 70330-150, Brazil;
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6
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Willauer AN, Liu Y, Pereira AAL, Lam M, Morris JS, Raghav KPS, Morris VK, Menter D, Broaddus R, Meric-Bernstam F, Hayes-Jordan A, Huh W, Overman MJ, Kopetz S, Loree JM. Clinical and molecular characterization of early-onset colorectal cancer. Cancer 2019; 125:2002-2010. [PMID: 30854646 DOI: 10.1002/cncr.31994] [Citation(s) in RCA: 181] [Impact Index Per Article: 36.2] [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: 07/26/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) incidence is increasing in adults younger than 50 years. This study evaluated clinical and molecular features to identify those features unique to early-onset CRC that differentiate these patients from patients 50 years old or older. METHODS Baseline characteristics were evaluated according to the CRC onset age with 3 independent cohorts. A fourth cohort was used to describe the impact of age on the consensus molecular subtype (CMS) prevalence. RESULTS This retrospective review of more than 36,000 patients with CRC showed that early-onset patients were more likely to have microsatellite instability (P = .038), synchronous metastatic disease (P = .009), primary tumors in the distal colon or rectum (P < .0001), and fewer BRAF V600 mutations (P < .001) in comparison with patients 50 years old or older. Patients aged 18 to 29 years had fewer adenomatous polyposis coli (APC) mutations (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.35-0.90; P = .015) and an increased prevalence of signet ring histology (OR, 4.89; 95% CI, 3.23-7.39; P < .0001) in comparison with other patients younger than 50 years. In patients younger than 40 years, CMS1 was the most common subtype, whereas CMS3 and CMS4 were uncommon (P = .003). CMS2 was relatively stable across age groups. Early-onset patients with inflammatory bowel disease were more likely to have mucinous or signet ring histology (OR, 5.54; 95% CI, 2.24-13.74; P = .0004) and less likely to have APC mutations (OR, 0.24; 95% CI, 0.07-0.75; P = .019) in comparison with early-onset patients without predisposing conditions. CONCLUSIONS Early-onset CRC is not only distinct from traditional CRC: special consideration should be given to and further investigations should be performed for both very young patients with CRC (18-29 years) and those with predisposing conditions. The etiology of the high rate of CMS1 in patients younger than 40 years deserves further exploration.
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Affiliation(s)
- Alexandra N Willauer
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yusha Liu
- Department of Statistics, Rice University, Houston, Texas
| | - Allan A L Pereira
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael Lam
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey S Morris
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kanwal P S Raghav
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Van K Morris
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Menter
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Russell Broaddus
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andrea Hayes-Jordan
- Department of Pediatric Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Winston Huh
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael J Overman
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Scott Kopetz
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jonathan M Loree
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Khan M, Loree JM, Advani SM, Ning J, Li W, Pereira AAL, Lam M, Raghav K, Morris VK, Broaddus R, Maru D, Overman MJ, Kopetz S. Prognostic Implications of Mucinous Differentiation in Metastatic Colorectal Carcinoma Can Be Explained by Distinct Molecular and Clinicopathologic Characteristics. Clin Colorectal Cancer 2018; 17:e699-e709. [PMID: 30205948 DOI: 10.1016/j.clcc.2018.07.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 05/23/2018] [Revised: 07/09/2018] [Accepted: 07/11/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The mucinous histologic subtype accounts for 5% to 20% of colorectal cancer (CRC) cases but remains poorly characterized. The present study characterized the baseline characteristics, mutational profile, and clinical outcomes of patients diagnosed with mucinous CRC. MATERIALS AND METHODS We identified 1877 patients with metastatic CRC with available histologic findings and molecular profiling and summarized the baseline clinical and pathologic characteristics and overall survival (OS) stratified by the histologic type. The data from separate cohorts with consensus molecular subtype (CMS) and CpG island methylator information were also summarized. RESULTS The mucinous histologic type was found in 277 of the 1877 patients (14.8%) and was associated with an increased prevalence of microsatellite instability (P < .001) and a right-sided primary (P < .001). An increased frequency of CMS1 (microsatellite instability immune) and lower rates of CMS2 (canonical) were identified, with mucinous compared with nonmucinous adenocarcinoma (P < .0001). Mutations in SMAD4 (P < .001), GNAS (P < .001), ERBB2 (P = .02), BRAF (P < .001), and KRAS (P < .001) occurred at greater frequencies in the mucinous CRC cases, and TP53 (P < .001), APC (P < .001), and NRAS mutations (P = .03) were less common. Univariate (hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.17-1.63; P < .001) and multivariate analysis (HR, 1.36; 95% CI, 1.12-1.64; P = .002) demonstrated that the mucinous histologic type is associated with worse OS. The features associated with the mucinous histologic subtype were independent predictors for shorter OS, including BRAF (HR, 1.74; 95% CI, 1.35-2.25; P < .001) and KRAS (HR, 1.42; 95% CI, 1.22-1.65; P < .001) mutations, right-sided location (HR, 1.20; 95% CI, 1.04-1.39; P = .01), and synchronous metastases (HR, 2.92; 95% CI, 2.49-3.42; P < .001). CONCLUSION Compared with nonmucinous adenocarcinoma, the mucinous histologic type is associated with a worse prognosis, even when controlling for known prognostic features. This unique biologic behavior should be considered in the treatment and prognostic assessment of patients with CRC.
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Affiliation(s)
- Maliha Khan
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jonathan M Loree
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shailesh M Advani
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Jing Ning
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wen Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Allan A L Pereira
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Lam
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kanwal Raghav
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Van K Morris
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Russell Broaddus
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dipen Maru
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael J Overman
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Scott Kopetz
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Loree JM, Pereira AAL, Lam M, Willauer AN, Raghav K, Dasari A, Morris VK, Advani S, Menter DG, Eng C, Shaw K, Broaddus R, Routbort MJ, Liu Y, Morris JS, Luthra R, Meric-Bernstam F, Overman MJ, Maru D, Kopetz S. Classifying Colorectal Cancer by Tumor Location Rather than Sidedness Highlights a Continuum in Mutation Profiles and Consensus Molecular Subtypes. Clin Cancer Res 2017; 24:1062-1072. [PMID: 29180604 DOI: 10.1158/1078-0432.ccr-17-2484] [Citation(s) in RCA: 189] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/13/2017] [Accepted: 11/15/2017] [Indexed: 12/15/2022]
Abstract
Purpose: Colorectal cancers are classified as right/left-sided based on whether they occur before/after the splenic flexure, with established differences in molecular subtypes and outcomes. However, it is unclear if this division is optimal and whether precise tumor location provides further information.Experimental Design: In 1,876 patients with colorectal cancer, we compared mutation prevalence and overall survival (OS) according to side and location. Consensus molecular subtype (CMS) was compared in a separate cohort of 608 patients.Results: Mutation prevalence differed by side and location for TP53, KRAS, BRAFV600, PIK3CA, SMAD4, CTNNB1, GNAS, and PTEN Within left- and right-sided tumors, there remained substantial variations in mutation rates. For example, within right-sided tumors, RAS mutations decreased from 70% for cecal, to 43% for hepatic flexure location (P = 0.0001), while BRAFV600 mutations increased from 10% to 22% between the same locations (P < 0.0001). Within left-sided tumors, the sigmoid and rectal region had more TP53 mutations (P = 0.027), less PIK3CA (P = 0.0009), BRAF (P = 0.0033), or CTNNB1 mutations (P < 0.0001), and less MSI (P < 0.0001) than other left-sided locations. Despite this, a left/right division preceding the transverse colon maximized prognostic differences by side and transverse colon tumors had K-modes mutation clustering that appeared more left than right sided. CMS profiles showed a decline in CMS1 and CMS3 and rise in CMS2 prevalence moving distally.Conclusions: Current right/left classifications may not fully recapitulate regional variations in tumor biology. Specifically, the sigmoid-rectal region appears unique and the transverse colon is distinct from other right-sided locations. Clin Cancer Res; 24(5); 1062-72. ©2017 AACRSee related commentary by Dienstmann, p. 989.
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Affiliation(s)
- Jonathan M Loree
- Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Allan A L Pereira
- Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael Lam
- Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alexandra N Willauer
- Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kanwal Raghav
- Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Arvind Dasari
- Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Van K Morris
- Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shailesh Advani
- Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David G Menter
- Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Cathy Eng
- Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kenna Shaw
- Sheikh Khalifa Bin Zayed Al Nahyan Institute of Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Russell Broaddus
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark J Routbort
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yusha Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey S Morris
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rajyalakshmi Luthra
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Funda Meric-Bernstam
- Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael J Overman
- Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dipen Maru
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Scott Kopetz
- Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Munhoz RR, Pereira AAL, Sasse AD, Hoff PM, Traina TA, Hudis CA, Marques RJ. Gonadotropin-Releasing Hormone Agonists for Ovarian Function Preservation in Premenopausal Women Undergoing Chemotherapy for Early-Stage Breast Cancer: A Systematic Review and Meta-analysis. JAMA Oncol 2016; 2:65-73. [PMID: 26426573 DOI: 10.1001/jamaoncol.2015.3251] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
IMPORTANCE Chemotherapy may result in a detrimental effect on ovarian function and fertility in premenopausal women undergoing treatment for early-stage breast cancer (EBC). To minimize risk of harm to ovarian function and fertility for patients in this setting, careful considerations should be made. Gonadotropin-releasing hormone agonists (GnRHa) have been suggested as an alternative to prevent the loss of ovarian function due to exposure to cytotoxic agents, but GnRHa use for ovarian protection in EBC patients is not fully resolved. OBJECTIVE To determine the effectiveness of GnRHa administered concurrently with chemotherapy for ovarian function preservation. DATA SOURCES PubMed, SCOPUS, and Cochrane databases were searched for studies published between January 1975 and March 2015. The abstracts of the American Society of Clinical Oncology Annual Meeting between 1995 and 2014 and the San Antonio Breast Cancer Symposium between 2009 and 2014 were searched as well. STUDY SELECTION Prospective, randomized, clinical trials addressing the role of ovarian suppression with GnRHa in preventing early ovarian dysfunction in premenopausal women undergoing treatment for EBC were selected. DATA EXTRACTION AND SYNTHESIS Data extraction was performed independently by 2 authors. The methodology and the risk of bias were assessment based on the description of randomization method, withdrawals, and blinding process. MAIN OUTCOMES AND MEASURES Rate of resumption of regular menses after a minimal follow-up period of 6 months following chemotherapy was used as a surrogate to assess the incidence of ovarian dysfunction. Additional secondary outcomes included hormone levels and number of pregnancies. Risk ratio estimates were calculated based on the number of evaluable patients. Analyses were conducted using a random effect model. RESULTS Seven studies were included in this analysis, totaling 1047 randomized patients and 856 evaluable patients. The use of GnRHa was associated with a higher rate of recovery of regular menses after 6 months (odds ratio [OR], 2.41; 95% CI, 1.40-4.15; P = .002) and at least 12 months (OR, 1.85; 95% CI, 1.33-2.59; P < .001) following the last chemotherapy cycle. The use of GnRHa was also associated with a higher number of pregnancies (OR, 1.85; 95% CI, 1.02-3.36; P = .04), although this outcome was not uniformly reported and fertility or rate of pregnancy was not the primary outcome in any of the trials. CONCLUSIONS AND RELEVANCE Gonadotropin-releasing hormone agonists given with chemotherapy was associated with increased rates of recovery of regular menses in this meta-analysis. Evidence was insufficient to assess outcomes related to GnRHa and ovarian function and fertility and needs further investigation.
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Affiliation(s)
- Rodrigo R Munhoz
- Hospital Sírio Libanês, São Paulo, Brazil2Instituto do Cancer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Allan A L Pereira
- Hospital Sírio Libanês, São Paulo, Brazil2Instituto do Cancer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | | | - Paulo M Hoff
- Hospital Sírio Libanês, São Paulo, Brazil2Instituto do Cancer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Tiffany A Traina
- Breast Cancer Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Clifford A Hudis
- Breast Cancer Service, Memorial Sloan Kettering Cancer Center, New York, New York
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