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Ramchandani A, Mihic-Góngora L, Hernández R, Zafra-Poves M, Muñoz MM, Ferreira E, Cruz-Castellanos P, Fernández-Montes A, Pacheco-Barcia V, Jiménez-Fonseca P, Calderon C. Psychological factors and prognostic communication preferences in advanced cancer: multicentre study. BMJ Support Palliat Care 2024; 13:e1342-e1350. [PMID: 37491146 DOI: 10.1136/spcare-2023-004221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/09/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVES Communication regarding prognosis to patients with advanced cancer is fundamental for informed medical decision making. Our objective was to analyse (1) the proportion of subjects with advanced cancer who prefer to know their prognosis, (2) the characteristics associated with patients' preference for prognostic information, (3) the psychological factors that impact the preference to know prognosis and 4) the concordance between preference for prognostic information perceived among physicians and patients. METHODS A prospective, cross-sectional design was adopted. Data were collected from 748 participants with advanced cancer at 15 tertiary hospitals in Spain. Participants completed the following questionnaires: Mental Adjustment to Cancer; Trust in the Physician; Uncertainty in Illness Scale Patient's Prognostic Preferences. RESULTS Fifty-two per cent of advanced cancer sufferers preferred to know the prognosis of their disease. Compared with participants who preferred not to know, those who did reported more uncertainty, greater satisfaction with their physician and higher scores on positive attitude (all p=0.001). Thirty-seven per cent of the physicians believed that patients want to know their prognosis, indicating that they underestimate the number of such patients. No significant differences were found regarding preference to know prognosis as a function of sociodemographic and clinical variables. CONCLUSIONS A substantial proportion of individuals with advanced cancer prefer to know the prognosis of their disease. It appears that knowing their prognosis was mainly motivated by a need to maintain a positive attitude, lessen uncertainty and by satisfaction with the physician. It is important to explore patients' preferences for information to offer more personalised communication.
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Affiliation(s)
- Avinash Ramchandani
- Department of Medical Oncology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Luka Mihic-Góngora
- Department of Medical Oncology, Hospital Universitario Central de Asturias, Instituto de Investigación del Principado de Asturias, ISPA, Oviedo, Spain
| | - Raquel Hernández
- Department of Medical Oncology, Hospital Universitario de Canarias, La Laguna, Canarias, Spain
| | - Marta Zafra-Poves
- Department of Medical Oncology, Hospital General Universitario José M Morales Meseguer, Murcia, Spain
| | - María M Muñoz
- Department of Medical Oncology, Hospital General Virgen de la Luz, Cuenca, Spain
| | - Estrella Ferreira
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | | | - Ana Fernández-Montes
- Department of Medical Oncology, Complejo Hospitalario de Orense, Ourense, Galicia, Spain
| | - Vilma Pacheco-Barcia
- Department of Medical Oncology, Hospital Central de la Defensa Gomez Ulla, Madrid, Spain
| | | | - Caterina Calderon
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
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2
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Escobar Y, Ramchandani A, Salgado M, Castillo-Trujillo A, Martínez de Castro E, Diaz de Corcuera I, Vera R, Lacalle A, Torres I, Pérez Segura P, Hierro C, Soto de Prado D, Cotes A, Marín Zafra G, Marsé Fabregat R, Virizuela J, Villa JC, Borrega P, Jimenez-Fonseca P. What do patients and oncologists think about the evaluation and management of cancer-related anorexia-cachexia? The Quasar_SEOM study. Clin Transl Oncol 2023; 25:3479-3491. [PMID: 37289352 DOI: 10.1007/s12094-023-03212-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/29/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Cancer patients often suffer from malnutrition and early detection and raising awareness of nutritional issues is crucial in this population. METHODS The Spanish Oncology Society (SEOM) conducted the Quasar_SEOM study to investigate the current impact of the Anorexia-Cachexia Syndrome (ACS). The study employed questionnaires and the Delphi method to gather input from both cancer patients and oncologists on key issues related to early detection and treatment of ACS. A total of 134 patients and 34 medical oncologists were surveyed about their experiences with ACS. The Delphi methodology was used to evaluate oncologists' perspectives of ACS management, ultimately leading to a consensus on the most critical issues. RESULTS Despite widespread acknowledgement of malnutrition in cancer as a significant issue by 94% of oncologists, the study revealed deficiencies in knowledge and protocol implementation. A mere 65% of physicians reported being trained to identify and treat these patients, with 53% failing to address ACS in a timely manner, 30% not monitoring weight, and 59% not adhering to any clinical guidelines. The lack of experience was identified as the primary hindrance to the use of orexigens in 18% of cases. Furthermore, patients reported concerns and a perception of inadequate attention to malnutrition-related issues from their physicians. CONCLUSION The results of this study point to a gap in the care of this syndrome and a need to improve education and follow-up of cancer patients with anorexia-cachexia.
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Affiliation(s)
- Yolanda Escobar
- Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Avinash Ramchandani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain
| | | | - Alfredo Castillo-Trujillo
- Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Avenida de Roma s/n, Oviedo, Spain
| | - Eva Martínez de Castro
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIBAL, Santander, Spain
| | | | - Ruth Vera
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - Irene Torres
- Medical Oncology Department, Hospital Clínico Universitario Lozano Bleza, Zaragoza, Spain
| | - Pedro Pérez Segura
- Medical Oncology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Cinta Hierro
- Medical Oncology Department, Instituto Catalán de Oncología (ICO), Badalona, Spain
| | - Diego Soto de Prado
- Medical Oncology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Almudena Cotes
- Medical Oncology Department, Hospital Universitario de Elda, Elda, Spain
| | - Gema Marín Zafra
- Medical Oncology Department, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | | | - Juan Virizuela
- Medical Oncology Department, Hospital Universitario Virgen de La Macarena, Sevilla, Spain
| | - Jose Carlos Villa
- Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Pablo Borrega
- Medical Oncology Department, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Paula Jimenez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Avenida de Roma s/n, Oviedo, Spain.
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3
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Martinez Lago N, Carmona-Bayonas A, Pieras Lopez A, Ramchandani A, Longo F, Martin Carnicero A, Granja Ortega M, Calvo A, Hernandez R, Castro Unanua N, Assaf J, Azkarate A, Hernandez-Perez C, Camara J, Saurí T, Custodio A, Cano J, Fernandez Montes A, Martinez de Castro E, Gallego J. 1394P Frequentist and Bayesian analysis of second line treatment effectiveness in AGAMENON-SEOM gastric cancer registry. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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4
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Jiménez-Labaig P, Pacheco-Barcia V, Cebrià A, Gálvez F, Obispo B, Páez D, Quílez A, Quintanar T, Ramchandani A, Remon J, Rogado J, Sánchez DA, Sánchez-Cánovas M, Sanz-García E, Sesma A, Tarazona N, Cotés A, González E, Bosch-Barrera J, Fernández A, Felip E, Vera R, Rodríguez-Lescure Á, Élez E. Identifying and preventing burnout in young oncologists, an overwhelming challenge in the COVID-19 era: a study of the Spanish Society of Medical Oncology (SEOM). ESMO Open 2021; 6:100215. [PMID: 34325108 PMCID: PMC8332651 DOI: 10.1016/j.esmoop.2021.100215] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/07/2021] [Accepted: 06/25/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Young oncologists are at particular risk of professional burnout, and this could have a significant impact on their health and care of their patients. The coronavirus disease 2019 (COVID-19) pandemic has forced rapid changes in professionals' jobs and training, with the consequent physical and psychological effects. We aimed to characterize burnout levels and determinants in young oncologists, and the effects of the pandemic on their training and health. METHODS Two online surveys were conducted among oncology residents and young oncology specialists in Spain. The first addressed professional burnout and its determinants before the COVID-19 pandemic, while the second analyzed the impact of the pandemic on health care organization, training, and physical and psychological health in the same population. RESULTS In total, 243 respondents completed the first survey, and 263 the second; 25.1% reported significant levels of professional burnout. Burnout was more common among medical oncology residents (28.2%), mainly in their second year of training. It was significantly associated with a poor work-life balance, inadequate vacation time, and the burnout score. Nearly three-quarters of respondents (72%) were reassigned to COVID-19 care and 84.3% of residents missed part of their training rotations. Overall, 17.2% of this population reported that they had contracted COVID-19, 37.3% had scores indicating anxiety, and 30.4% moderate to severe depression. Almost a quarter of young oncologists (23.3%) had doubts about their medical vocation. CONCLUSIONS Burnout affects a considerable number of young oncologists. The COVID-19 pandemic has had a profound impact on causes of burnout, making it even more necessary to periodically monitor it to define appropriate detection and prevention strategies.
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Affiliation(s)
- P Jiménez-Labaig
- Department of Medical Oncology, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - V Pacheco-Barcia
- Department of Medical Oncology, Gómez Ulla Military Hospital, Madrid, Spain
| | - A Cebrià
- Department of Mental Health, Parc Taulí University Hospital, Sabadell, Catalunya, Spain
| | - F Gálvez
- Department of Medical Oncology, Jaén University Hospital, Jaén, Andalucía, Spain
| | - B Obispo
- Department of Medical Oncology, Infanta Leonor University Hospital, Madrid, Spain
| | - D Páez
- Department of Medical Oncology, Santa Creu i Sant Pau University Hospital, Barcelona, Catalunya, Spain
| | - A Quílez
- Department of Medical Oncology, Can Misses Hospital, Área de salud de Ibiza y Formentera (ASEF), Ibiza, Illes Balears, Spain
| | - T Quintanar
- Department of Medical Oncology, Elche University General Hospital, Elche, Comunitat Valenciana, Spain
| | - A Ramchandani
- Department of Medical Oncology, University Hospital Complex, Insular-Materno Infantil de Gran Canaria, Las Palmas de Gran Canaria, Islas Canarias, Spain
| | - J Remon
- Department of Medical Oncology, HM Delfos Hospital, Barcelona, Catalunya, Spain
| | - J Rogado
- Department of Medical Oncology, Infanta Leonor University Hospital, Madrid, Spain
| | - D A Sánchez
- Department of Medical Oncology, Virgen de La Arrixaca University Hospital, Murcia, Región de Murcia, Spain
| | - M Sánchez-Cánovas
- Department of Hematology and Medical Oncology, Morales Meseguer University General Hospital, Murcia, Región de Murcia, Spain
| | - E Sanz-García
- Department of Medical Oncology, HM Sanchinarro Hospital-Centro Integral Oncológico Clara Campal (CIOOC), Madrid, Spain
| | - A Sesma
- Department of Medical Oncology, Lozano Blesa University Clinical Hospital, Zaragoza, Aragón, Spain
| | - N Tarazona
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, Comunitat Valenciana, Spain; Instituto de Salud Carlos III, CIBERONC, Madrid, Spain
| | - A Cotés
- Department of Medical Oncology, Elda General Hospital, Elda, Comunitat Valenciana, Spain
| | - E González
- Department of Medical Oncology, Virgen de las Nieves University Hospital, Granada, Andalucía, Spain
| | - J Bosch-Barrera
- Department of Medical Oncology, Dr. Josep Trueta University Hospital, Institut Català d'Oncologia (ICO), Girona, Catalunya, Spain
| | - A Fernández
- Department of Medical Oncology, University Hospital Complex of Ourense (CHUO), Ourense, Galicia, Spain
| | - E Felip
- Department of Medical Oncology, Vall d'Hebron University Hospital & Institute of Oncology (VHIO), Vall d'Hebron Hospital Campus, Barcelona, Catalunya, Spain
| | - R Vera
- Department of Medical Oncology, University Hospital Complex of Navarra, Pamplona, Navarra, Spain
| | - Á Rodríguez-Lescure
- Department of Medical Oncology, Elche University General Hospital, Elche, Comunitat Valenciana, Spain
| | - E Élez
- Department of Medical Oncology, Vall d'Hebron University Hospital & Institute of Oncology (VHIO), Vall d'Hebron Hospital Campus, Barcelona, Catalunya, Spain.
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5
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Alvarez-Manceñido F, Jimenez-Fonseca P, Carmona-Bayonas A, Arrazubi V, Hernandez R, Cano JM, Custodio A, Pericay Pijaume C, Aguado G, Martínez Lago N, Sánchez Cánovas M, Cacho Lavin D, Visa L, Martinez-Torron A, Arias-Martinez A, López F, Limón ML, Vidal Tocino R, Fernández Montes A, Alsina M, Pimentel P, Reguera P, Martín Carnicero A, Ramchandani A, Granja M, Azkarate A, Martín Richard M, Serra O, Hernández Pérez C, Hurtado A, Gil-Negrete A, Sauri T, Morales Del Burgo P, Gallego J. Is advanced esophageal adenocarcinoma a distinct entity from intestinal subtype gastric cancer? Data from the AGAMENON-SEOM Registry. Gastric Cancer 2021; 24:926-936. [PMID: 33651195 DOI: 10.1007/s10120-021-01169-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Advanced esophageal adenocarcinoma (EAC) is generally treated similarly to advanced gastroesophageal junction (GEJ-AC) and gastric (GAC) adenocarcinomas, although GAC clinical trials rarely include EAC. This work sought to compare clinical characteristics and treatment outcomes of advanced EAC with those of GEJ-AC and GAC and examine prognostic factors. PATIENTS AND METHODS Participants comprised patients with advanced EAC, intestinal GEJ-AC, and GAC treated with platin and fluoropyrimidine (plus trastuzumab when HER2 status was positive). Overall and progression-free survival were estimated using the Kaplan-Meier method. Cox proportional hazards regression gauged the prognostic value of the AGAMENON model. RESULTS Between 2008 and 2019, 971 participants from the AGAMENON-SEOM registry were recruited at 35 centers. The sample included 67.3% GAC, 13.3% GEJ-AC, and 19.4% EAC. Pulmonary metastases were most common in EAC and peritoneal metastases in GAC. Median PFS and OS were 7.7 (95% CI 7.3-8.0) and 13.9 months (12.9-14.7). There was no difference in PFS or OS between HER2- and HER2+ tumors from the three locations (p > 0.05). Five covariates were found to be prognostic for the entire sample: ECOG-PS, histological grade, number of metastatic sites, NLR, and HER2+ tumors treated with trastuzumab. In EAC, the same variables were prognostic except for grade. The favorable prognosis for HER2+ cancers treated with trastuzumab was homogenous for all three subgroups (p = 0.351) and, after adjusting for the remaining covariates, no evidence supported primary tumor localization as a prognostic factor (p = 0.331). CONCLUSION Our study supports the hypothesis that EAC exhibits clinicopathological characteristics, prognostic factors, and treatment outcomes comparable to intestinal GEJ-AC and GAC.
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Affiliation(s)
- Felipe Alvarez-Manceñido
- Pharmacy Department, Hospital Universitario Central de Asturias, Avenida Roma s/n, 33011, Oviedo, Spain.
| | - Paula Jimenez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | - Alberto Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, University of Murcia, IMIB, Murcia, Spain
| | - Virginia Arrazubi
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Raquel Hernandez
- Medical Oncology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - Juana M Cano
- Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Ana Custodio
- Medical Oncology Department, Hospital Universitario La Paz, CIBERONC CB16/12/00398, Madrid, Spain
| | | | - Gema Aguado
- Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Nieves Martínez Lago
- Medical Oncology Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Manuel Sánchez Cánovas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Diego Cacho Lavin
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Laura Visa
- Medical Oncology Department, Hospital Universitario El Mar, Barcelona, Spain
| | - Alba Martinez-Torron
- Pharmacy Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Aranzazu Arias-Martinez
- Pharmacy Department, Hospital Universitario Central de Asturias, Avenida Roma s/n, 33011, Oviedo, Spain
| | - Flora López
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - M Luisa Limón
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Rosario Vidal Tocino
- Medical Oncology Department, Complejo Asistencial Universitario de Salamanca-IBSAL, Salamanca, Spain
| | | | - Maria Alsina
- Medical Oncology Department, Hospital Universitario Vall d'Hebron, Vall Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Paola Pimentel
- Medical Oncology Department, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - Pablo Reguera
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Avinash Ramchandani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Mónica Granja
- Medical Oncology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Aitor Azkarate
- Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain
| | - Marta Martín Richard
- Medical Oncology Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - Olbia Serra
- Medical Oncology Department, Catalan Institute of Oncology, L'Hospitalet, Spain
| | - Carolina Hernández Pérez
- Medical Oncology Department, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain
| | - Alicia Hurtado
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Aitziber Gil-Negrete
- Medical Oncology Department, Hospital Universitario Donostia, San Sebastián, Spain
| | - Tamara Sauri
- Medical Oncology Department, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | | | - Javier Gallego
- Medical Oncology Department, Hospital General Universitario de Elche, Elche, Spain
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6
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Jimenez-Fonseca P, Carmona-Bayonas A, Martinez-Torron A, Alsina M, Custodio A, Serra O, Cacho Lavin D, Limón ML, Sauri T, López F, Visa L, Granja M, Martínez Lago N, Arrazubi V, Vidal Tocino R, Hernandez R, Aguado G, Cano JM, Martín Carnicero A, Mangas M, Pimentel P, Fernández Montes A, Macias Declara I, Longo F, Ramchandani A, Martín Richard M, Hurtado A, Azkarate A, Hernández Pérez C, Serrano R, Gallego J. External validity of clinical trials with diverse trastuzumab-based chemotherapy regimens in advanced gastroesophageal adenocarcinoma: data from the AGAMENON-SEOM registry. Ther Adv Med Oncol 2021; 13:17588359211019672. [PMID: 34211587 PMCID: PMC8216357 DOI: 10.1177/17588359211019672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/29/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Trastuzumab combined with cisplatin and fluoropyrimidines, either capecitabine or 5-fluorouracile (XP/FP), is the standard first-line treatment for advanced, HER2-positive, gastric cancer patients based on the ToGA trial. Despite the lack of phase III trials, many clinicians administer trastuzumab with alternative regimens. One meta-analysis suggests that substituting cisplatin for oxaliplatin might lead to greater efficacy and less toxicity. METHODS 594 patients with HER2-positive gastroesophageal adenocarcinoma were recruited from the AGAMENON-SEOM registry. The objective was to evaluate the external validity of clinical trials with chemotherapy and trastuzumab. RESULTS The regimens used in at least 5% of the patients were XP (27%), oxaliplatin and capecitabine (CAPOX) (26%), oxaliplatin and 5-fluorouracil (FOLFOX) (14%), FP (14%), triplet with anthracycline/docetaxel (7%), and carboplatin-FU (5%). Median exposure to trastuzumab was longer with FOLFOX (11.4 months, 95% CI, 9.1-21.0) versus ToGA regimens (7.5, 6.4-8.5), p < 0.001. Patients with HER2-IHC 3+ cancers had higher response rates than those with IHC 2+/FISH+, odds-ratio 1.97 (95% CI, 1.25-3.09). The results achieved with CAPOX-trastuzumab were comparable to those attained with ToGA regimens. FOLFOX-trastuzumab was superior to ToGA schemes in terms of overall survival (OS), with a greater magnitude of effect in IHC 2+/FISH+ tumors (HR 0.47, 0.24-0.92) compared with IHC 3+ (HR 0.69, 0.49-0.96), and in diffuse (HR 0.37, 0.20-0.69) versus intestinal-type tumors (HR 0.76, 0.54-1.06). CONCLUSION We have updated the external validity of clinical trials with trastuzumab in first-line treatment of gastric cancer. Our data confirm the comparable outcomes of ToGA regimens and CAPOX-trastuzumab in clinical practice and point toward a possible benefit of FOLFOX-trastuzumab, contingent on the subtypes typically less sensitive to trastuzumab, to be confirmed in clinical trials.
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Affiliation(s)
- Paula Jimenez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | - Alberto Carmona-Bayonas
- Medical Oncology Department, Hospital Universitario Morales Meseguer, Calle Marqués de los Vélez, s/n, Murcia, 30007, Spain
| | - Alba Martinez-Torron
- Pharmacy Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Maria Alsina
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona Vall Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Ana Custodio
- Medical Oncology Department, Hospital Universitario La Paz, CIBERONC CB16/12/00398, Madrid, Spain
| | - Olbia Serra
- Medical Oncology Department, Catalan Institute of Oncology, L’Hospitalet, Spain
| | - Diego Cacho Lavin
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - María Luisa Limón
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Tamara Sauri
- Medical Oncology Department, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Flora López
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Laura Visa
- Medical Oncology Department, Hospital Universitario El Mar, Barcelona, Spain
| | - Mónica Granja
- Medical Oncology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Nieves Martínez Lago
- Medical Oncology Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Virginia Arrazubi
- Medical Oncology Department, Complejo Hospitalario de Navarra, IdiSNA (Navarra Institute for Health Research), Pamplona, Spain
| | - Rosario Vidal Tocino
- Medical Oncology Department, Complejo Asistencial Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Raquel Hernandez
- Medical Oncology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - Gema Aguado
- Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Juana María Cano
- Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | - Monserrat Mangas
- Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain
| | - Paola Pimentel
- Medical Oncology Department, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | | | | | - Federico Longo
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Avinash Ramchandani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Marta Martín Richard
- Medical Oncology Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - Alicia Hurtado
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Aitor Azkarate
- Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain
| | - Carolina Hernández Pérez
- Medical Oncology Department, Hospital Universitario Nuestra Señora de the Candelaria, Tenerife, Spain
| | - Raquel Serrano
- Medical Oncology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Javier Gallego
- Medical Oncology Department, Hospital General Universitario of Elche, Elche, Spain
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7
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Cotes Sanchís A, Gallego J, Hernandez R, Arrazubi V, Custodio A, Cano JM, Aguado G, Macias I, Lopez C, López F, Visa L, Garrido M, Martínez Lago N, Fernández Montes A, Limón ML, Azkárate A, Pimentel P, Reguera P, Ramchandani A, Cacho JD, Martín Carnicero A, Granja M, Martín Richard M, Hernández Pérez C, Hurtado A, Serra O, Buxo E, Vidal Tocino R, Jimenez-Fonseca P, Carmona-Bayonas A. Second-line treatment in advanced gastric cancer: Data from the Spanish AGAMENON registry. PLoS One 2020; 15:e0235848. [PMID: 32735623 PMCID: PMC7394396 DOI: 10.1371/journal.pone.0235848] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/24/2020] [Indexed: 01/21/2023] Open
Abstract
Background Second-line treatments boost overall survival in advanced gastric cancer (AGC). However, there is a paucity of information as to patterns of use and the results achieved in actual clinical practice. Materials and methods The study population comprised patients with AGC in the AGAMENON registry who had received second-line. The objective was to describe the pattern of second-line therapies administered, progression-free survival following second-line (PFS-2), and post-progression survival since first-line (PPS). Results 2311 cases with 2066 progression events since first-line (89.3%) were recorded; 245 (10.6%) patients died during first-line treatment and 1326/2066 (64.1%) received a second-line. Median PFS-2 and PPS were 3.1 (95% CI, 2.9–3.3) and 5.8 months (5.5–6.3), respectively. The most widely used strategies were monoCT (56.9%), polyCT (15.0%), ramucirumab+CT (12.6%), platinum-reintroduction (8.3%), trastuzumab+CT (6.1%), and ramucirumab (1.1%). PFS-2/PPS medians gradually increased in monoCT, 2.6/5.1 months; polyCT 3.4/6.3 months; ramucirumab+CT, 4.1/6.5 months; platinum-reintroduction, 4.2/6.7 months, and for the HER2+ subgroup in particular, trastuzumab+CT, 5.2/11.7 months. Correlation between PFS since first-line and OS was moderate in the series as a whole (Kendall’s τ = 0.613), lower in those subjects who received second-line (Kendall’s τ = 0.539), especially with ramucirumab+CT (Kendall’s τ = 0.413). Conclusion This analysis reveals the diversity in second-line treatment for AGC, highlighting the effectiveness of paclitaxel-ramucirumab and, for a selected subgroup of patients, platinum reintroduction; both strategies endorsed by recent clinical guidelines.
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Affiliation(s)
| | - Javier Gallego
- Medical Oncology Department, Hospital General Universitario de Elche, Elche, Spain
- * E-mail:
| | - Raquel Hernandez
- Medical Oncology Department, Hospital Universitario de Canarias, Tenerife
| | - Virginia Arrazubi
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Ana Custodio
- Medical Oncology Department, Hospital Universitario La Paz, CIBERONC CB16/12/00398, Madrid, Spain
| | - Juana María Cano
- Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Gema Aguado
- Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Ismael Macias
- Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain
| | - Carlos Lopez
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Flora López
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Laura Visa
- Medical Oncology Department, Hospital Universitario El Mar, Barcelona, Spain
| | - Marcelo Garrido
- Medical Oncology Department, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Nieves Martínez Lago
- Medical Oncology Department, Complejo Hospitalario Universitario de A Coruña, Coruña, Spain
| | | | - María Luisa Limón
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Aitor Azkárate
- Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain
| | - Paola Pimentel
- Medical Oncology Department, Hospital Santa Lucía, Cartagena, Spain
| | - Pablo Reguera
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Avinash Ramchandani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Juan Diego Cacho
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | | | - Mónica Granja
- Medical Oncology Department, Hospital Universitario Clínico San Carlos Madrid, Spain
| | - Marta Martín Richard
- Medical Oncology Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - Carolina Hernández Pérez
- Medical Oncology Department, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain
| | - Alicia Hurtado
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Olbia Serra
- Medical Oncology Department, Catalan Institute of Oncology, L’Hospitalet, Spain
| | - Elvira Buxo
- Medical Oncology Department, Hospital Universitario Vall d’Hebron, Barcelona, Spain
| | - Rosario Vidal Tocino
- Medical Oncology Department, Complejo Asistencial Universitario de Salamanca, IBSAL, Salamanca, Spain
| | - Paula Jimenez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | - Alberto Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, University of Murcia, IMIB, Murcia, Spain
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García-García T, Carmona-Bayonas A, Jimenez-Fonseca P, Jara C, Beato C, Castelo B, Mangas M, de Castro EM, Ramchandani A, Gomez D, Calderón C. Biopsychosocial and clinical characteristics in patients with resected breast and colon cancer at the beginning and end of adjuvant treatment. BMC Cancer 2019; 19:1143. [PMID: 31771533 PMCID: PMC6880341 DOI: 10.1186/s12885-019-6358-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 11/12/2019] [Indexed: 01/05/2023] Open
Abstract
Background The aim of this study was to analyze biopsychosocial factors affecting how patients cope with cancer and adjuvant treatment and to appraise psychological distress, coping, perceived social support, quality of life and SDM before and after adjuvant treatment in breast cancer patients compared to colon cancer patients. Methods NEOcoping is a national, multicenter, cross-sectional, prospective study. The sample comprised 266 patients with colon cancer and 231 with breast cancer. The instruments used were the Brief Symptom Inventory (BSI), Mini-Mental Adjustment to Cancer (Mini-MAC), Multidimensional Scale of Perceived Social Support (MSPSS), Shared Decision-Making Questionnaire-Patient (SDM-Q-9) and Physician’s (SDM-Q-Doc), and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ). Results Breast cancer patients reacted worse to the diagnosis of cancer with more symptoms of anxiety, depression, and somatization, and were less satisfied with their involvement than those with colon cancer (p = 0.003). Participants with colon cancer were older and had more physical symptoms and functional limitations at the beginning of adjuvant treatment, while there were scarcely any differences between the two groups at the end of adjuvancy, at which time both groups suffered greater psychological and physical effects and scored lower on coping strategies, except for anxious preoccupation. Conclusions Breast cancer patients need more information and involvement of the oncologist in shared decision-making, as well as and more medical and psychological support when beginning adjuvant treatment. Both breast and colon cancer patients may require additional psychological care at the end of adjuvancy.
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Affiliation(s)
| | | | - Paula Jimenez-Fonseca
- Department of Medical Oncology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Carlos Jara
- Department of Medical Oncology, Hospital Universitario Fundación Alcorcón- Universidad Rey Juan Carlos, Madrid, Spain
| | - Carmen Beato
- Department of Medical Oncology, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | - Beatriz Castelo
- Department of Medical Oncology, Hospital Universitario La Paz, Madrid, Spain
| | - Montserrat Mangas
- Department of Medical Oncology, Hospital Galdakao-Usansolo, Galdakao-Usansolo, Spain
| | - Eva Martínez de Castro
- Department of Medical Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Avinash Ramchandani
- Department of Medical Oncology, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain
| | - David Gomez
- Department of Medical Oncology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Caterina Calderón
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.
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9
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Carmona-Bayonas A, Jimenez-Fonseca P, Garrido M, Custodio A, Hernandez R, Lacalle A, Cano JM, Aguado G, Martínez de Castro E, Alvarez Manceñido F, Macias I, Visa L, Martín Richard M, Mangas M, Sánchez Cánovas M, Longo F, Iglesias Rey L, Martínez Lago N, Martín Carnicero A, Sánchez A, Azkárate A, Limón ML, Hernández Pérez C, Ramchandani A, Pimentel P, Cerdá P, Serrano R, Gil-Negrete A, Marín M, Hurtado A, Sánchez Bayona R, Gallego J. Multistate Models: Accurate and Dynamic Methods to Improve Predictions of Thrombotic Risk in Patients with Cancer. Thromb Haemost 2019; 119:1849-1859. [PMID: 31461750 DOI: 10.1055/s-0039-1694012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Research into cancer-associated thrombosis (CAT) entails managing dynamic data that pose an analytical challenge. Thus, methods that assume proportional hazards to investigate prognosis entail a risk of misinterpreting or overlooking key traits or time-varying effects. We examined the AGAMENON registry, which collects data from 2,129 patients with advanced gastric cancer. An accelerated failure time (AFT) multistate model and flexible competing risks regression were used to scrutinize the time-varying effect of CAT, as well as to estimate how covariates dynamically predict cumulative incidence. The AFT model revealed that thrombosis shortened progression-free survival and overall survival with adjusted time ratios of 0.72 and 0.56, respectively. Nevertheless, its prognostic effect was nonproportional and disappeared over time if the subject managed to survive long enough. CAT that occurred later had a more pronounced prognostic effect. In the flexible competing risks model, multiple covariates were seen to have significant time-varying effects on the cumulative incidence of CAT (Khorana score, secondary thromboprophylaxis, high tumor burden, and cisplatin-containing regimen), whereas other predictors exerted a constant effect (signet ring cells and primary thromboprophylaxis). The model that assumes proportional hazards was incapable of capturing the effect of these covariates and predicted the cumulative incidence in a biased way. This study evinces that flexible and multistate models are a useful and innovative method to describe the dynamic effect of variables associated with CAT and should be more widely used.
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Affiliation(s)
- Alberto Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital General Universitario Morales Meseguer, University of Murcia, IMIB, Murcia, Spain
| | - Paula Jimenez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Marcelo Garrido
- Medical Oncology Department, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Ana Custodio
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Raquel Hernandez
- Medical Oncology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - Alejandra Lacalle
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Juana María Cano
- Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Gema Aguado
- Medical Oncology Department, Hospital Universitario Gregorio Marañon, Madrid, Spain
| | - Eva Martínez de Castro
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Ismael Macias
- Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain
| | - Laura Visa
- Medical Oncology Department, Hospital Universitario El Mar, Barcelona, Spain
| | - Marta Martín Richard
- Medical Oncology Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - Monserrat Mangas
- Medical Oncology Department, Hospital Galdakao-Usansolo, Galdakao-Usansolo, Spain
| | - Manuel Sánchez Cánovas
- Hematology and Medical Oncology Department, Hospital General Universitario Morales Meseguer, University of Murcia, IMIB, Murcia, Spain
| | - Federico Longo
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Nieves Martínez Lago
- Medical Oncology Department, Complejo Hospitalario Universitario de A Coruña, La Coruña, Spain
| | | | - Ana Sánchez
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Aitor Azkárate
- Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain
| | - María Luisa Limón
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Carolina Hernández Pérez
- Medical Oncology Department, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain
| | - Avinash Ramchandani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Paola Pimentel
- Medical Oncology Department, Hospital Santa Lucia, Cartagena, Spain
| | - Paula Cerdá
- Medical Oncology Department, Centro Médico Teknon, Barcelona, Spain
| | - Raquel Serrano
- Medical Oncology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Aitziber Gil-Negrete
- Medical Oncology Department, Hospital Universitario Donostia, San Sebastián, Spain
| | - Miguel Marín
- Medical Oncology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Alicia Hurtado
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - Javier Gallego
- Medical Oncology Department, Hospital General Universitario de Elche, Elche, Spain
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10
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Calderón C, Jiménez-Fonseca P, Hernández R, Mar Muñoz MD, Mut M, Mangas-Izquierdo M, Vicente MÁ, Ramchandani A, Carmona-Bayonas A. Quality of life, coping, and psychological and physical symptoms after surgery for non-metastatic digestive tract cancer. Surg Oncol 2019; 31:26-32. [PMID: 31493647 DOI: 10.1016/j.suronc.2019.08.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 07/17/2019] [Accepted: 08/22/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the impact of curative surgery for non-metastatic digestive tract cancers on quality of life (QoL), psychological status, and coping strategies. METHODS A prospective, transversal, multicenter study was conducted in 404 patients: 361 with colorectal, 44 with gastroesophageal, and 35 with pancreaticobiliary cancer six months after surgery. Participants completed questionnaires evaluating QoL, including functioning (EORTC-QLC-C30), coping strategies (Mini-MAC), and psychological distress (BSI-18). RESULTS The effects of surgery had a strong impact on functional domains, global QoL, and symptoms, especially in pancreaticobiliary and gastroesophageal cancer. Patients with pancreaticobiliary and gastroesophageal cancer had lower functional scale scores than those with colorectal cancer. Fatigue, appetite loss, diarrhea, depression, and psychological distress were the most common symptoms after surgery. Subjects with pancreaticobiliary cancer reported more fatigue, pain, insomnia, depression, somatization and psychological distress, whereas individuals with gastroesophageal cancer exhibited more fatigue, nausea/vomiting, diarrhea, depression, psychological distress, and helplessness than those with colorectal cancer. Only participants with colorectal cancer displayed improved QoL six months post-surgery, albeit their psychological state had worsened. CONCLUSION Surgeons should discuss expectations regarding symptoms and QoL with patients prior to surgery to minimize physical and psychological impact.
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Affiliation(s)
- Caterina Calderón
- Department of Clinical Psychology and Psychobiology. Faculty of Psychology. University of Barcelona, Spain.
| | - Paula Jiménez-Fonseca
- Department of Medical Oncology, Hospital Universitario Central of Asturias, Oviedo, Spain
| | - Raquel Hernández
- Department of Medical Oncology, Hospital Universitario de Canarias, Tenerife, Spain
| | | | - Margarida Mut
- Department of Medical Oncology, Hospital Universitario Son Espases, Mallorca, Spain
| | | | - M Ángeles Vicente
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Avinash Ramchandani
- Department of Medical Oncology, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain
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11
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Viúdez A, Carmona-Bayonas A, Gallego J, Lacalle A, Hernández R, Cano JM, Macías I, Custodio A, Martínez de Castro E, Sánchez A, Iglesia L, Reguera P, Visa L, Azkarate A, Sánchez-Cánovas M, Mangas M, Limón ML, Martínez-Torrón A, Asensio E, Ramchandani A, Martín-Carnicero A, Hurtado A, Cerdà P, Garrido M, Sánchez-Bayonas R, Serrano R, Jiménez-Fonseca P. Optimal duration of first-line chemotherapy for advanced gastric cancer: data from the AGAMENON registry. Clin Transl Oncol 2019; 22:734-750. [PMID: 31385226 DOI: 10.1007/s12094-019-02183-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 05/23/2019] [Accepted: 07/08/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The optimal duration of first-line chemotherapy for patients with advanced gastric cancer is unknown. Diverse clinical trials have proposed different strategies including limited treatment, maintenance of some drugs, or treatment until progression. METHOD The sample comprises patients from the AGAMENON multicenter registry without progression after second evaluation of response. The objective was to explore the optimal duration of first-line chemotherapy. A frailty multi-state model was conducted. RESULTS 415 patients were divided into three strata: discontinuation of platinum and maintenance with fluoropyrimidine until progression (30%, n = 123), complete treatment withdrawal prior to progression (52%, n = 216), and full treatment until progression (18%, n = 76). The hazard of tumor progression decreased by 19% per month with the full treatment regimen. However, we found no evidence that fluoropyrimidine maintenance (hazard ratio [HR] 1.07, confidence interval [CI] 95%, 0.69-1.65) worsened progression-free survival (PFS) with respect to treatment until progression. Predictive factors for PFS were ECOG performance status, ≥ 3 metastatic sites, prior tumor response, and bone metastases. Toxicity grade 3/4 was more common in those who continued the full treatment until progression vs fluoropyrimidine maintenance (16% vs 6%). CONCLUSION The longer duration of the full initial regimen exerted a protective effect on the patients of this registry. Platinum discontinuation followed by fluoropyrimidine maintenance yields comparable efficacy to treatment up to PD, with a lower rate of serious adverse events.
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Affiliation(s)
- A Viúdez
- Medical Oncology Department, Complejo Hospitalario de Navarra (CHN), OncobionaTras Unit, Navarrabiomed, Navarrabiomed Biomedical Center, IdiSNA, Irunlarrea 3, 31008, Pamplona, Navarra, Spain.
| | - A Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, University of Murcia, IMIB, Murcia, Spain
| | - J Gallego
- Medical Oncology Department, Hospital Universitario de Elche, Elche, Spain
| | - A Lacalle
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - R Hernández
- Medical Oncology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - J M Cano
- Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - I Macías
- Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain
| | - A Custodio
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - E Martínez de Castro
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - A Sánchez
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - L Iglesia
- Medical Oncology Department, Complejo Hospitalario de Orense, Orense, Spain
| | - P Reguera
- Medical Oncology Department, Hospital Universitario Ramón Y Cajal, Madrid, Spain
| | - L Visa
- Medical Oncology Department, Hospital Universitario El Mar, Barcelona, Spain
| | - A Azkarate
- Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain
| | - M Sánchez-Cánovas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - M Mangas
- Medical Oncology Department, Hospital Galdakao-Usansolo, Galdakao-Usansolo, Spain
| | - M L Limón
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - A Martínez-Torrón
- Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - E Asensio
- Medical Oncology Department, Hospital Universitario de Elche, Elche, Spain
| | - A Ramchandani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - A Martín-Carnicero
- Medical Oncology Department, Complejo Hospitalario San Millán, Logroño, Spain
| | - A Hurtado
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - P Cerdà
- Medical Oncology Department, Centro Médico Tecknon, Barcelona, Spain
| | - M Garrido
- Medical Oncology Department, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - R Sánchez-Bayonas
- Medical Oncology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - R Serrano
- Medical Oncology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - P Jiménez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
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Carmona-Bayonas A, Jiménez-Fonseca P, Echavarria I, Sánchez Cánovas M, Aguado G, Gallego J, Custodio A, Hernández R, Viudez A, Cano JM, Martínez de Castro E, Macías I, Martín Carnicero A, Garrido M, Mangas M, Álvarez Manceñido F, Visa L, Azkarate A, Ramchandani A, Fernández Montes A, Longo F, Sánchez A, Pimentel P, Limón ML, Arias D, Cacho Lavin D, Sánchez Bayona R, Cerdá P, García Alfonso P. Surgery for metastases for esophageal-gastric cancer in the real world: Data from the AGAMENON national registry. Eur J Surg Oncol 2018; 44:1191-1198. [DOI: 10.1016/j.ejso.2018.03.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 03/16/2018] [Accepted: 03/22/2018] [Indexed: 12/19/2022] Open
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13
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Calderon C, Jiménez-Fonseca P, Ferrando PJ, Jara C, Lorenzo-Seva U, Beato C, García-García T, Castelo B, Ramchandani A, Muñoz MM, Martínez de Castro E, Ghanem I, Mangas M, Carmona-Bayonas A. Psychometric properties of the Shared Decision-Making Questionnaire (SDM-Q-9) in oncology practice. Int J Clin Health Psychol 2018; 18:143-151. [PMID: 30487919 PMCID: PMC6225052 DOI: 10.1016/j.ijchp.2017.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 12/19/2017] [Indexed: 12/30/2022] Open
Abstract
Background/Objective: This study sought to assess the psychometric properties of the 9-item Shared Decision-Making Questionnaire (SDM-Q-9) in patients with resected, non-metastatic cancer and eligible for adjuvant chemotherapy. Method: A total of 568 patients were recruited from a multi-institutional, prospective, transversal study. Patients answered the SDM-Q-9 after visiting their medical oncologist who, in turn, completed the SDM-Q-Physician version. Reliability, factorial structures [exploratory factor analysis (EFA), confirmatory factor analysis (CFA)], and convergent validity of the SDM-Q-9 scores were explored. Results: SDM-Q-9 showed a clear factorial structure, compatible with a strong and replicable general factor and a secondary group factor, in patients with resected, non-metastatic cancer. Total sum scores derived from the general factor showed good reliability in terms of omega coefficient: .90. The association between patient and physician perception of SDM was weak and failed to reach statistical significance. Males and patients over 60 years of age displayed the greatest satisfaction with SDM. Conclusions: SDM-Q-9 can aid in evaluating SDM from the cancer patients' perspective. SDM-Q-9 is helpful in studies examining patient perspectives of SDM and as an indicator of the degree of quality and satisfaction with health care and patient-physician relationship.
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Affiliation(s)
- Caterina Calderon
- Department of Clinical Psychology and Psychobiology. Faculty of Psychology. University of Barcelona, Spain
| | - Paula Jiménez-Fonseca
- Department of Medical Oncology. Hospital Universitario Central of Asturias, Oviedo, Spain
| | | | - Carlos Jara
- Department of Medical Oncology. Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Madrid, Spain
| | | | - Carmen Beato
- Department of Medical Oncology. Hospital Grupo Quirón, Sevilla, Spain
| | - Teresa García-García
- Department of Medical Oncology. Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Beatriz Castelo
- Department of Medical Oncology. Hospital Universitario La Paz, Madrid, Spain
| | - Avinash Ramchandani
- Department of Medical Oncology. Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain
| | - María Mar Muñoz
- Department of Medical Oncology. Hospital Virgen de La Luz, Cuenca, Spain
| | - Eva Martínez de Castro
- Department of Medical Oncology. Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Ismael Ghanem
- Department of Medical Oncology. Hospital Universitario La Paz, Madrid, Spain
| | - Montse Mangas
- Department of Medical Oncology. Hospital Galdakao -Usansolo, Galdakao-Usansolo, Spain
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Carmona-Bayonas A, Jiménez-Fonseca P, Custodio A, Sánchez Cánovas M, Hernández R, Pericay C, Echavarria I, Lacalle A, Visa L, Rodríguez Palomo A, Mangas M, Cano JM, Buxo E, Álvarez-Manceñido F, García T, Lorenzo JE, Ferrer-Cardona M, Viudez A, Azkarate A, Ramchandani A, Arias D, Longo F, López C, Sánchez Bayona R, Limón ML, Díaz-Serrano A, Fernández Montes A, Sala P, Cerdá P, Rivera F, Gallego J. Anthracycline-based triplets do not improve the efficacy of platinum-fluoropyrimidine doublets in first-line treatment of advanced gastric cancer: real-world data from the AGAMEMON National Cancer Registry. Gastric Cancer 2018; 21:96-105. [PMID: 28393278 DOI: 10.1007/s10120-017-0718-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 04/03/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although anthracycline-based triplets are one of the most widely used schedules to treat advanced gastric cancer (AGC), the benefit of including epirubicin in these therapeutic combinations remains unknown. This study aims to evaluate both the efficacy and tolerance of triplets with epirubicin vs. doublets with platinum-fluoropyrimidine in a national AGC registry. METHODS Patients with AGC treated with polychemotherapy without trastuzumab at 28 hospitals in Spain between 2008 and 2016 were included. The effect of anthracycline-based triplets against doublets was evaluated by propensity score matching (PSM) and Cox proportional hazards (PH) regression. RESULT A total of 1002 patients were included (doublets, n = 653; anthracycline-based triplets, n = 349). The multivariable Cox PH regression failed to detect significantly increased OS in favor of triplets with anthracyclines: HR 0.90 (95% CI, 0.78-1.05), p = 0.20035. After PSM, the sample contained 325 pairs with similar baseline characteristics. This method was also unable to reveal an increase in OS: 10.5 (95% CI, 9.7-12.3) vs. 9.9 (95% CI, 9.2-11.4) months, HR 0.91 (CI 95%, 0.76-1.083), and (log-rank test, p = 0.226). Response rates (42.1 vs. 33.1%, p = 0.12) and PFS (HR 0.95, CI 95%, 0.80-1.13, log-rank test, p = 0.873) were not significantly higher with epirubicin-based regimens. The triplets were associated with greater grade 3-4 hematological toxicity, and increased hospitalization due to toxicity by 68%. The addition of epirubicin is viable, but 23.7% discontinued treatment because of adverse effects or patient decision. CONCLUSION Anthracyclines added to platinum-fluoropyrimidine doublets did not improve the response rate or survival outcomes in patients with AGC but entailed greater toxicity.
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Affiliation(s)
- A Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, IMIB, Avenida Marqués de los Vélez, 30008, Murcia, Spain.
| | - P Jiménez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - A Custodio
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - M Sánchez Cánovas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, IMIB, Avenida Marqués de los Vélez, 30008, Murcia, Spain
| | - R Hernández
- Medical Oncology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - C Pericay
- Medical Oncology Department, Corporació Sanitària Parc Taulí , Sabadell, Spain
| | - I Echavarria
- Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - A Lacalle
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - L Visa
- Medical Oncology Department, Hospital Universitario Del Mar, Barcelona, Spain
| | - A Rodríguez Palomo
- Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - M Mangas
- Medical Oncology Department, Hospital Galdakao-Usansolo, Galdakao-Usansolo, Spain
| | - J M Cano
- Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain
| | - E Buxo
- Medical Oncology Department, Hospital Universitario Clinic, Barcelona, Spain
| | - F Álvarez-Manceñido
- Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - T García
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, IMIB, Avenida Marqués de los Vélez, 30008, Murcia, Spain
| | - J E Lorenzo
- Medical Oncology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - M Ferrer-Cardona
- Medical Oncology Department, Corporació Sanitària Parc Taulí , Sabadell, Spain
| | - A Viudez
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - A Azkarate
- Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain
| | - A Ramchandani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - D Arias
- Medical Oncology Department, Complejo Hospitalario de Orense, Orense, Spain
| | - F Longo
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - C López
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - R Sánchez Bayona
- Medical Oncology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - M L Limón
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - A Díaz-Serrano
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - A Fernández Montes
- Medical Oncology Department, Complejo Hospitalario de Orense, Orense, Spain
| | - P Sala
- Medical Oncology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - P Cerdá
- Medical Oncology Department, Clínica Tecknon de Barcelona, Barcelona, Spain
| | - F Rivera
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - J Gallego
- Medical Oncology Department, Hospital General Universitario de Elche, Elche, Spain
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Visa L, Jiménez-Fonseca P, Martínez EA, Hernández R, Custodio A, Garrido M, Viudez A, Buxo E, Echavarria I, Cano JM, Macias I, Mangas M, de Castro EM, García T, Manceñido FÁ, Montes AF, Azkarate A, Longo F, Serrano AD, López C, Hurtado A, Cerdá P, Serrano R, Gil-Negrete A, Carnicero AM, Pimentel P, Ramchandani A, Carmona-Bayonas A. Efficacy and safety of chemotherapy in older versus non-older patients with advanced gastric cancer: A real-world data, non-inferiority analysis. J Geriatr Oncol 2017; 9:254-264. [PMID: 29242093 DOI: 10.1016/j.jgo.2017.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/05/2017] [Accepted: 11/22/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Advanced gastric cancer (AGC) is a common neoplasm in older adults. Nevertheless, there are few specific management data in the literature. The aim of this study was to assess non-inferiority of survival and efficacy-related outcomes of chemotherapy used in older vs non-older patients with AGC. MATERIALS AND METHODS We recruited 1485 patients from the AGAMENON registry of AGC treated with polychemotherapy between 2008-2017. A statistical analysis was conducted to prove non-inferiority for overall survival (OS) associated with the use of chemotherapy schedules in individuals ≥70 vs.<70years. The fixed-margin method was used (hazard ratio [HR]<1.176) that corresponds to conserving at least 85% efficacy. RESULTS 33% (n=489) of the cases analyzed were ≥70 years. Two-agent chemotherapies and combinations with oxaliplatin (48% vs. 29%) were used more often in the older patients, as were modified schedules and/or lower doses. Toxicity grade 3-4 was comparable in both groups, although when looking at any grade, there were more episodes of enteritis, renal toxicity, and fatigue in older patients. In addition, toxicity was a frequent cause for discontinuing treatment in older patients. The response rate was similar in both groups. After adjusting for confounding factors, the non-inferiority of OS associated with schedules administered to the older vs. younger subjects was confirmed: HR 1.02 (90% CI, 0.91-1.14), P (non inferiority)=0.018, as well as progression-free survival: HR 0.97 (90% CI, 0.87-1.08), P(non-inferiority)=0.001. CONCLUSION In this AGC registry, the use of chemotherapy with schedules adapted to patients ≥70 years provided efficacy that was not inferior to that seen in younger cases, with comparable adverse effects.
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Affiliation(s)
- Laura Visa
- Medical Oncology Department, Hospital del Mar, Barcelona, Spain.
| | - Paula Jiménez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Raquel Hernández
- Medical Oncology Department, Hospital Universitario de Canarias, Tenerife
| | - Ana Custodio
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, CIBERONC CB16/12/00398, Spain
| | - Manuel Garrido
- Medical Oncology Department, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Antonio Viudez
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Elvira Buxo
- Medical Oncology Department, Hospital Universitari Clinic, Barcelona, Spain
| | - Ignacio Echavarria
- Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Juana María Cano
- Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain
| | - Ismael Macias
- Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain
| | - Montserrat Mangas
- Medical Oncology Department, Hospital Galdakao-Usansolo, Galdakao-Usansolo, Spain
| | - Eva Martínez de Castro
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Teresa García
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Felipe Álvarez Manceñido
- Medical Oncology Department, Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Aitor Azkarate
- Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain
| | - Federico Longo
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Carlos López
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Alicia Hurtado
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Paula Cerdá
- Medical Oncology Department, Centro Médico Teknon, Barcelona, Spain
| | - Raquel Serrano
- Medical Oncology Department, Hospital Universitario Virgen de las Nieves, Córdoba, Spain
| | - Aitziber Gil-Negrete
- Medical Oncology Department, Hospital Universitario Donostia, San Sebastián, Spain
| | - Alfonso Martín Carnicero
- Medical Oncology Department, Complejo Hospitalario San Millán-San Pedro de La Rioja, Logroño, Spain
| | - Paola Pimentel
- Medical Oncology Department, Hospital Santa Lucía, Cartagena, Spain
| | - Avinash Ramchandani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain
| | - Alberto Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
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16
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Jimenez-Fonseca P, Lorenzo-Seva U, Ferrando PJ, Carmona-Bayonas A, Beato C, García T, Muñoz MDM, Ramchandani A, Ghanem I, Rodríguez-Capote A, Jara C, Calderon C. The mediating role of spirituality (meaning, peace, faith) between psychological distress and mental adjustment in cancer patients. Support Care Cancer 2017; 26:1411-1418. [PMID: 29143135 DOI: 10.1007/s00520-017-3969-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 11/09/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objectives of this study were (a) to determine the psychometric properties of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) scale and (b) to provide that FACIT scores behave one-dimensional to establish the mediating role of spiritual well-being in psychological distress and mental adjustment in a sample of patients with non-metastatic, resected cancer. METHOD A total of 504 consecutive patients completed the FACIT-Sp, Brief Symptom Inventory, and Mini-Mental Adjustment to Cancer scales. The dimensionality and structure of the scale were assessed by semi-confirmatory factor analysis; the reliability of the derived scale scores was evaluated using the omega coefficient, and regression analysis appraised the FACIT-Sp's mediating role between psychological distress and mental adjustment. RESULTS A clear and theoretically interpretable solution in two factors that agreed generally with solutions reported in other languages was obtained for the FACIT item scores and omega reliabilities of the derived Meaning/Peace (0.85) and Faith (0.86) scales were acceptable. The oblique solution in two factors was compatible with an essentially unidimensional solution of general well-being and associated strongly with psychological distress and mental adjustment. Spiritual well-being acted as a partial mediator between psychological distress and mental adjustment strategies, such as fighting spirit, hope, and cognitive avoidance. CONCLUSIONS The Spanish version of the FACIT-Sp scale is a reliable and valid clinical evaluation tool, and further highlights the potential clinical implications of spirituality for improving quality of life and adjustment to cancer.
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Affiliation(s)
| | | | | | | | | | - Teresa García
- Hospital Universitario Morales Meseguer, Murcia, Spain
| | | | | | | | | | - Carlos Jara
- Hospital Universitario Fundación Alcorcón-Universidad Rey Juan Carlos, Madrid, Spain
| | - Caterina Calderon
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Passeig de la Vall d'Hebron, 171, 08035, Barcelona, Spain.
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17
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Carmona-Bayonas A, Jiménez-Fonseca P, Lorenzo MLS, Ramchandani A, Martínez EA, Custodio A, Garrido M, Echavarría I, Cano JM, Barreto JEL, García TG, Manceñido FÁ, Lacalle A, Cardona MF, Mangas M, Visa L, Buxó E, Azkarate A, Díaz-Serrano A, Montes AF, Rivera F. On the Effect of Triplet or Doublet Chemotherapy in Advanced Gastric Cancer: Results From a National Cancer Registry. J Natl Compr Canc Netw 2017; 14:1379-1388. [PMID: 27799509 DOI: 10.6004/jnccn.2016.0148] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 07/21/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is currently no consensus regarding first-line chemotherapy for patients with advanced gastric cancer (AGC) who are ineligible to receive trastuzumab. The objective of this study was to evaluate the efficacy and tolerance of triplets versus doublets by analyzing a national gastric cancer registry. PATIENTS AND METHOD Patients with AGC treated with polychemotherapy without associating trastuzumab were included from 2008 through 2016. The effect of triplets versus doublets was compared using 3 methods: Cox proportional hazards regression, propensity score matching (PSM), and coarsened exact matching (CEM). RESULTS A total of 970 patients were recruited (doublets: n=569; triplets: n=401). In the multivariate Cox model, the use of triplets was associated with better overall survival (OS), with a hazard ratio (HR) of 0.84 (95% CI, 0.72-0.98; P=.035). After PSM, the sample contained 340 pairs. A significant increase in OS, 11.14 months (95% CI, 9.60-12.68) versus 9.60 months (95% CI, 8.44-10.75), was seen in favor of triplets (HR, 0.77; 95% CI, 0.65-0.92; stratified log-rank test, P=.004). The effect appeared to be comparable for anthracycline-based (HR, 0.78; 95% CI, 0.64-0.94) or docetaxel-based triplets (HR, 0.78; 95% CI, 0.60-1.009). The trend was similar after applying the CEM algorithm, with an HR of 0.78 (95% CI, 0.63-0.97; P=.03). Triplet therapy was viable and relative dose intensities exceeded 85%, except for cisplatin in DCX (docetaxel, cisplatin, capecitabine). Triplets had more severe toxicity overall, especially hematologic, hepatic, and mucosal adverse events. CONCLUSIONS With the limitations of a retrospective study that examines a heterogeneous set of chemotherapy regimens, we found that triplets are feasible in daily practice and are associated with a discreet benefit in efficacy at the expense of a moderate increase in toxicity.
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Affiliation(s)
- Alberto Carmona-Bayonas
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Paula Jiménez-Fonseca
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Maria Luisa Sánchez Lorenzo
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Avinash Ramchandani
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Elena Asensio Martínez
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Ana Custodio
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Marcelo Garrido
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Isabel Echavarría
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Juana María Cano
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Jose Enrique Lorenzo Barreto
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Teresa García García
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Felipe Álvarez Manceñido
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Alejandra Lacalle
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Marta Ferrer Cardona
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Monserrat Mangas
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Laura Visa
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Elvira Buxó
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Aitor Azkarate
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Asunción Díaz-Serrano
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Ana Fernández Montes
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
| | - Fernando Rivera
- From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain
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Jiménez Fonseca P, Carmona-Bayonas A, Hernández R, Custodio A, Cano JM, Lacalle A, Echavarria I, Macias I, Mangas M, Visa L, Buxo E, Álvarez Manceñido F, Viudez A, Pericay C, Azkarate A, Ramchandani A, López C, Martinez de Castro E, Fernández Montes A, Longo F, Sánchez Bayona R, Limón ML, Diaz-Serrano A, Martin Carnicero A, Arias D, Cerdà P, Rivera F, Vieitez JM, Sánchez Cánovas M, Garrido M, Gallego J. Lauren subtypes of advanced gastric cancer influence survival and response to chemotherapy: real-world data from the AGAMENON National Cancer Registry. Br J Cancer 2017; 117:775-782. [PMID: 28765618 PMCID: PMC5589993 DOI: 10.1038/bjc.2017.245] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [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: 04/25/2017] [Revised: 06/19/2017] [Accepted: 07/04/2017] [Indexed: 12/17/2022] Open
Abstract
Background: The choice of chemotherapy in HER2-negative gastric cancer is based on centre’s preferences and adverse effects profile. No schedule is currently accepted as standard, nor are there any factors to predict response, other than HER2 status. We seek to evaluate whether Lauren type influences the efficacy of various chemotherapies and on patient overall survival (OS). Methods: We have conducted a multicenter study in 31 hospitals. The eligibility criteria include diagnosis of stomach or gastroesophageal junction adenocarcinoma, HER2 negativity, and chemotherapy containing 2–3 drugs. Cox proportional hazards regression adjusted for confounding factors, with tests of ‘treatment-by-histology’ interaction, was used to estimate treatment effect. Results: Our registry contains 1303 tumours analysable for OS end points and 730 evaluable for overall response rate (ORR). A decrease in ORR was detected in the presence of a diffuse component: odds ratio 0.719 (95% confidence interval (CI), 0.525–0.987), P=0.039. Anthracycline- or docetaxel-containing schedules increased ORR only in the intestinal type. The diffuse type displayed increased mortality with hazard ratio (HR) of 1.201 (95% CI, 1.054–1.368), P=0.0056. Patients receiving chemotherapy with docetaxel exhibited increased OS limited to the intestinal type: HR 0.65 (95% CI, 0.49–0.87), P=0.024, with no increment in OS for the subset having a diffuse component. With respect to progression-free survival (PFS), a significant interaction was seen in the effect of docetaxel-containing schedules, with better PFS limited to the intestinal type subgroup, in the comparison against any other schedule: HR 0.65 (95% CI, 0.50–0.85), P=0.015, and against anthracycline-based regimens: HR 0.64 (95% CI, 0.46–0.88), P=0.046. Conclusions: As a conclusion, in this registry, Lauren classification tumour subtypes predicted survival and responded differently to chemotherapy. Future clinical trials should stratify effect estimations based on histology.
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Affiliation(s)
- Paula Jiménez Fonseca
- Department of Medical Oncology, Central de Asturias University Hospital, Oviedo 33011, Spain
| | - Alberto Carmona-Bayonas
- Department of Hematology and Medical Oncology, Morales Meseguer University Hospital, Murcia 30008, Spain
| | - Raquel Hernández
- Department of Medical Oncology, Canarias University Hospital, Tenerife 38320, Spain
| | - Ana Custodio
- Department of Medical Oncology, La Paz University Hospital, Madrid 28046, Spain
| | - Juana Maria Cano
- Department of Medical Oncology, Ciudad Real General Hospital, Ciudad Real 13005, Spain
| | - Alejandra Lacalle
- Department of Medical Oncology, Complejo Hospitalario de Navarra, Pamplona 31008, Spain
| | - Isabel Echavarria
- Department of Medical Oncology, Gregorio Marañón University Hospital, Madrid 28007, Spain
| | - Ismael Macias
- Department of Medical Oncology, Parc Tauli University Hospital, Sabadell 08208, Spain
| | - Monserrat Mangas
- Department of Medical Oncology, Hospital Galdakao-Usansolo, Galdakao-Usansolo 48960, Spain
| | - Laura Visa
- Department of Medical Oncology, El Mar University Hospital, Barcelona 08003, Spain
| | - Elvira Buxo
- Department of Medical Oncology, Hospital Clinic, Barcelona 08036, Spain
| | | | - Antonio Viudez
- Department of Medical Oncology, Complejo Hospitalario de Navarra, Pamplona 31008, Spain
| | - Carles Pericay
- Department of Medical Oncology, Parc Tauli University Hospital, Sabadell 08208, Spain
| | - Aitor Azkarate
- Department of Medical Oncology, Son Espases University Hospital, Mallorca 07120, Spain
| | - Avinash Ramchandani
- Department of Medical Oncology, Insular de Gran Canaria University Hospital, Las Palmas de Gran Canaria 35016, Spain
| | - Carlos López
- Department of Medical Oncology, Marqués de Valdecilla University Hospital, Santander 39008, Spain
| | - Eva Martinez de Castro
- Department of Medical Oncology, Marqués de Valdecilla University Hospital, Santander 39008, Spain
| | - Ana Fernández Montes
- Department of Medical Oncology, Complejo Hospitalario de Orense, Orense 32005, Spain
| | - Federico Longo
- Department of Medical Oncology, Ramón y Cajal University Hospital, Madrid 28034, Spain
| | | | - Maria Luisa Limón
- Department of Medical Oncology, Virgen del Rocío University Hospital, Sevilla 41013, Spain
| | - Asun Diaz-Serrano
- Department of Medical Oncology, 12 de Octubre University Hospital, Madrid 28041, Spain
| | | | - David Arias
- Department of Medical Oncology, Complejo Hospitalario de Orense, Orense 32005, Spain
| | - Paula Cerdà
- Department of Medical Oncology, Tecknon Cancer Institute, Barcelona 08022, Spain
| | - Fernando Rivera
- Department of Medical Oncology, Marqués de Valdecilla University Hospital, Santander 39008, Spain
| | - Jose Maria Vieitez
- Department of Medical Oncology, Central de Asturias University Hospital, Oviedo 33011, Spain
| | - Manuel Sánchez Cánovas
- Department of Hematology and Medical Oncology, Morales Meseguer University Hospital, Murcia 30008, Spain
| | - M Garrido
- Department of Medical Oncology, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - J Gallego
- Department of Medical Oncology, Elche University Hospital, Elche 03203, Spain
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Jiménez-Fonseca P, Carmona-Bayonas A, Font C, Plasencia-Martínez J, Calvo-Temprano D, Otero R, Beato C, Biosca M, Sánchez M, Benegas M, Varona D, Faez L, Antonio M, de la Haba I, Madridano O, Solis MP, Ramchandani A, Castañón E, Marchena PJ, Martín M, de la Peña FA, Vicente V. The prognostic impact of additional intrathoracic findings in patients with cancer-related pulmonary embolism. Clin Transl Oncol 2017; 20:230-242. [DOI: 10.1007/s12094-017-1713-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 07/03/2017] [Indexed: 02/13/2023]
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Custodio A, Carmona-Bayonas A, Jiménez-Fonseca P, Sánchez ML, Viudez A, Hernández R, Cano JM, Echavarria I, Pericay C, Mangas M, Visa L, Buxo E, García T, Rodríguez Palomo A, Álvarez Manceñido F, Lacalle A, Macias I, Azkarate A, Ramchandani A, Fernández Montes A, López C, Longo F, Sánchez Bayona R, Limón ML, Díaz-Serrano A, Hurtado A, Madero R, Gómez C, Gallego J. Nomogram-based prediction of survival in patients with advanced oesophagogastric adenocarcinoma receiving first-line chemotherapy: a multicenter prospective study in the era of trastuzumab. Br J Cancer 2017; 116:1526-1535. [PMID: 28463962 PMCID: PMC5518851 DOI: 10.1038/bjc.2017.122] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [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: 01/04/2017] [Revised: 03/14/2017] [Accepted: 04/10/2017] [Indexed: 12/20/2022] Open
Abstract
Background: To develop and validate a nomogram and web-based calculator to predict overall survival (OS) in Caucasian-advanced oesophagogastric adenocarcinoma (AOA) patients undergoing first-line combination chemotherapy. Methods: Nine hundred twenty-four AOA patients treated at 28 Spanish teaching hospitals from January 2008 to September 2014 were used as derivation cohort. The result of an adjusted-Cox proportional hazards regression was represented as a nomogram and web-based calculator. The model was validated in 502 prospectively recruited patients treated between October 2014 and December 2016. Harrell's c-index was used to evaluate discrimination. Results: The nomogram includes seven predictors associated with OS: HER2-positive tumours treated with trastuzumab, Eastern Cooperative Oncology Group performance status, number of metastatic sites, bone metastases, ascites, histological grade, and neutrophil-to-lymphocyte ratio. Median OS was 5.8 (95% confidence interval (CI), 4.5–6.6), 9.4 (95% CI, 8.5–10.6), and 14 months (95% CI, 11.8–16) for high-, intermediate-, and low-risk groups, respectively (P<0.001), in the derivation set and 4.6 (95% CI, 3.3–8.1), 12.7 (95% CI, 11.3–14.3), and 18.3 months (95% CI, 14.6–24.2) for high-, intermediate-, and low-risk groups, respectively (P<0.001), in the validation set. The nomogram is well-calibrated and reveals acceptable discriminatory capacity, with optimism-corrected c-indices of 0.618 (95% CI, 0.591–0.631) and 0.673 (95% CI, 0.636–0.709) in derivation and validation groups, respectively. The AGAMENON nomogram outperformed the Royal Marsden Hospital (c-index=0.583; P=0.00046) and Japan Clinical Oncology Group prognostic indices (c-index=0.611; P=0.03351). Conclusions: We developed and validated a straightforward model to predict survival in Caucasian AOA patients initiating first-line polychemotherapy. This model can contribute to inform clinical decision-making and optimise clinical trial design.
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Affiliation(s)
- A Custodio
- Medical Oncology Department, Hospital Universitario La Paz, Paseo de la Castellana, 261, Madrid 28046, Spain
| | - A Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Av Marqués de los Vélez, s/n, Murcia 30008, Spain
| | - P Jiménez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, Av. Roma, s/n, Oviedo 33011, Spain
| | - M L Sánchez
- Medical Oncology Department, MD Anderson Cancer Center, Calle de Arturo Soria, 270, Madrid 28033, Spain
| | - A Viudez
- Medical Oncology Department, Complejo Hospitalario de Navarra, Calle de Irunlarrea, 3, Pamplona 31008, Spain
| | - R Hernández
- Medical Oncology Department, Hospital Universitario de Canarias, Carretera de Ofra, s/n, San Cristóbal de La Laguna, Santa Cruz de Tenerife 38320, Spain
| | - J M Cano
- Medical Oncology Department, Hospital General Universitario de Ciudad Real, Calle Obispo Rafael Torija, s/n, Ciudad Real 13005, Spain
| | - I Echavarria
- Medical Oncology Department, Hospital Universitario Gregorio Marañón, Calle del Dr Esquerdo, 46, Madrid 28007, Spain
| | - C Pericay
- Medical Oncology Department, Corporació Sanitària Parc Taulí, Parc Taulí, 1, Sabadell, Barcelona 08208, Spain
| | - M Mangas
- Medical Oncology Department, Hospital Galdakao-Usansolo, Barrio Labeaga, s/n, Usansolo, Bizkaia 48960, Spain
| | - L Visa
- Medical Oncology Department, Hospital Universitario del Mar, Passeig Marítim, 25-29, Barcelona 08003, Spain
| | - E Buxo
- Medical Oncology Department, Hospital Universitario Clínic i Provincial de Barcelona, Carrer de Villarroel, 170, Barcelona08036, Spain
| | - T García
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Av Marqués de los Vélez, s/n, Murcia 30008, Spain
| | - A Rodríguez Palomo
- Pharmacy Department, Hospital Universitario Central de Asturias, Av. Roma, s/n, Oviedo 33011, Spain
| | - F Álvarez Manceñido
- Medical Oncology Department, Hospital Universitario Central de Asturias, Av. Roma, s/n, Oviedo 33011, Spain
| | - A Lacalle
- Medical Oncology Department, Complejo Hospitalario de Navarra, Calle de Irunlarrea, 3, Pamplona 31008, Spain
| | - I Macias
- Medical Oncology Department, Corporació Sanitària Parc Taulí, Parc Taulí, 1, Sabadell, Barcelona 08208, Spain
| | - A Azkarate
- Medical Oncology Department, Hospital Universitario Son Espases, Carrer de Valldemossa, 79, Palma, Islas Baleares 07120, Spain
| | - A Ramchandani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Av Marítima Sur, s/n, Las Palmas de Gran Canaria 35001, Spain
| | - A Fernández Montes
- Medical Oncology Department, Complejo Hospitalario Universitario de Ourense, Calle Ramon Puga Noguerol, 54, Ourense 32005, Spain
| | - C López
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Av. Valdecilla, 25, Santander 39008, Spain
| | - F Longo
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Ctra. Colmenar Viejo, km. 9,100, Madrid 28034, Spain
| | - R Sánchez Bayona
- Medical Oncology Department, Clínica Universidad de Navarra, Av. de Pío XII, 36, Pamplona, Navarra 31008, Spain
| | - M L Limón
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Av. Manuel Siurot, s/n, Sevilla 41013, Spain
| | - A Díaz-Serrano
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Avenida de Córdoba s/n, Madrid 28041, Spain
| | - A Hurtado
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Calle Budapest, 1, Alcorcón, Madrid 28922, Spain
| | - R Madero
- Biostatistics Unit, Hospital Universitario La Paz, Paseo de la Castellana, 261, Madrid 28046, Spain
| | - C Gómez
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Avenida de Córdoba s/n, Madrid 28041, Spain
| | - J Gallego
- Medical Oncology Department, Hospital General Universitario de Elche, Camí de l'Almazara, 11, Elche, Alicante 03203, Spain
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Jiménez-Fonseca P, Carmona-Bayonas A, Sánchez Lorenzo ML, Plazas JG, Custodio A, Hernández R, Garrido M, García T, Echavarría I, Cano JM, Rodríguez Palomo A, Mangas M, Macías Declara I, Ramchandani A, Visa L, Viudez A, Buxó E, Díaz-Serrano A, López C, Azkarate A, Longo F, Castañón E, Sánchez Bayona R, Pimentel P, Limón ML, Cerdá P, Álvarez Llosa R, Serrano R, Lobera MPF, Alsina M, Hurtado Nuño A, Gómez-Martin C. Prognostic significance of performing universal HER2 testing in cases of advanced gastric cancer. Gastric Cancer 2017; 20:465-474. [PMID: 27599830 DOI: 10.1007/s10120-016-0639-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/26/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Trastuzumab significantly improves overall survival (OS) when added to cisplatin and fluoropyrimidine as a treatment for HER2-positive advanced gastric cancers (AGC). The aim of this study was to evaluate the impact of the gradual implementation of HER2 testing on patient prognosis in a national registry of AGC. METHODS This Spanish National Cancer Registry includes cases who were consecutively recruited at 28 centers from January 2008 to January 2016. The effect of missing HER2 status was assessed using stratified Cox proportional hazards (PH) regression. RESULTS The rate of HER2 testing increased steadily over time, from 58.3 % in 2008 to 92.9 % in 2016. HER2 was positive in 194 tumors (21.3 %). In the stratified Cox PH regression, each 1 % increase in patients who were not tested for HER2 at the institutions was associated with an approximately 0.3 % increase in the risk of death: hazard ratio, 1.0035 (CI 95 %, 1.001-1.005), P = 0.0019. Median OS was significantly lower at institutions with the highest proportions of patients who were not tested for HER2. CONCLUSION Patients treated at centers that took longer to implement HER2 testing exhibited worse clinical outcomes. The speed of implementation behaves as a quality-of-care indicator. Reviewed guidelines on HER2 testing should be used to achieve this goal in a timely manner.
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Affiliation(s)
- Paula Jiménez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, Avenida de Roma s/n, 33011, Oviedo, Spain.
| | - Alberto Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain
| | - Maria Luisa Sánchez Lorenzo
- Medical Oncology Department, Hospital Universitario Central de Asturias, Avenida de Roma s/n, 33011, Oviedo, Spain
| | - Javier Gallego Plazas
- Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain
| | - Ana Custodio
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Raquel Hernández
- Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz De Tenerife, Spain
| | - Marcelo Garrido
- Medical Oncology Department, Pontificia Universidad Católica de Chile, Santiago De Chile, Chile
| | - Teresa García
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain
| | - Isabel Echavarría
- Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Juana María Cano
- Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain
| | | | - Monserrat Mangas
- Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain
| | | | - Avinash Ramchandani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas De Gran Canaria, Spain
| | - Laura Visa
- Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain
| | - Antonio Viudez
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Elvira Buxó
- Medical Oncology Department, Hospital Clínic, Barcelona, Spain
| | | | - Carlos López
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Aitor Azkarate
- Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain
| | - Federico Longo
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Eduardo Castañón
- Medical Oncology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Paola Pimentel
- Medical Oncology Department, Hospital Santa Lucía, Cartagena, Spain
| | - Maria Luisa Limón
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Paula Cerdá
- Medical Oncology Department, Instituto Oncológico Teknon, Barcelona, Spain
| | | | - Raquel Serrano
- Medical Oncology Department, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | | | - María Alsina
- Medical Oncology Department, Hospital Universitario Vall d'Hebron and VHIO-Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Alicia Hurtado Nuño
- Medical Oncology Department, Hospital Universitario Fundación Alcorcon, Madrid, Spain
| | - Carlos Gómez-Martin
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain
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Font C, Carmona-Bayonas A, Beato C, Reig Ò, Sáez A, Jiménez-Fonseca P, Plasencia JM, Calvo-Temprano D, Sanchez M, Benegas M, Biosca M, Varona D, Vicente MA, Faez L, Solís MDP, de la Haba I, Antonio M, Madridano O, Castañon E, Martinez MJ, Marchena P, Ramchandani A, Dominguez A, Puerta A, Martinez de la Haza D, Pueyo J, Hernandez S, Fernandez-Plaza A, Martinez-Encarnacion L, Martin M, Marin G, Ayala F, Vicente V, Otero R. Clinical features and short-term outcomes of cancer patients with suspected and unsuspected pulmonary embolism: the EPIPHANY study. Eur Respir J 2016; 49:13993003.00282-2016. [DOI: 10.1183/13993003.00282-2016] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 10/13/2016] [Indexed: 12/29/2022]
Abstract
The study aimed to identify predictors of overall 30-day mortality in cancer patients with pulmonary embolism including suspected pulmonary embolism (SPE) and unsuspected pulmonary embolism (UPE) events. Secondary outcomes included 30- and 90-day major bleeding and venous thromboembolism (VTE) recurrence.The study cohort included 1033 consecutive patients with pulmonary embolism from the multicentre observational ambispective EPIPHANY study (March 2006–October 2014). A subgroup of 497 patients prospectively assessed for the study were subclassified into three work-up scenarios (SPE, truly asymptomatic UPE and UPE with symptoms) to assess outcomes.The overall 30-day mortality rate was 14%. The following variables were associated with the overall 30-day mortality on multivariate analysis: VTE history, upper gastrointestinal cancers, metastatic disease, cancer progression, performance status, arterial hypotension <100 mmHg, heart rate >110 beats·min−1, basal oxygen saturation <90% and SPE (versus overall UPE).The overall 30-day mortality was significantly lower in patients with truly asymptomatic UPE events (3%) compared with those with UPE-S (20%) and SPE (21%) (p<0.0001). Thirty- and 90-day VTE recurrence and major bleeding rates were similar in all the groups.In conclusion, variables associated with the severity of cancer and pulmonary embolism were associated with short-term mortality. Our findings may help to develop pulmonary embolism risk-assessment models in this setting.
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Plasencia-Martínez JM, Carmona-Bayonas A, Calvo-Temprano D, Jiménez-Fonseca P, Fenoy F, Benegas M, Sánchez M, Font C, Varona D, Martínez de la Haza D, Pueyo J, Biosca M, Antonio M, Beato C, Solís P, Fáez L, de Al Haba I, Hernández-Muñiz S, Madridano O, Martín M, Castañón E, Ramchandani A, Marchena P, Sánchez-Cánovas M, Vicente MÁ, Martínez MJ, Fernández-Plaza Á, Martínez-Encarnación L, Puerta A, Domínguez Á, Rodríguez D, Marín G, Otero R, Sánchez-Lasheras F, Vicente V. Prognostic value of computed tomography pulmonary angiography indices in patients with cancer-related pulmonary embolism: Data from a multicenter cohort study. Eur J Radiol 2016; 87:66-75. [PMID: 28065377 DOI: 10.1016/j.ejrad.2016.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 11/02/2016] [Accepted: 12/12/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyze the prognostic value of pulmonary artery obstruction versus right-ventricle (RV) dysfunction radiologic indices in cancer-related pulmonary embolism (PE). METHODS We enrolled 303 consecutive patients with paraneoplastic PE, evaluated by computed tomography pulmonary angiography (CTPA) between 2013 and 2014. The primary outcome measure was serious complications at 15days. Multivariate analyses were conducted by using binary logistic and robust regressions. Radiological features such as the Qanadli index (QI) and RV dysfunction signs were analyzed with Spearman's partial rank correlations. RESULTS RV diameter was the only radiological variable associated with an adverse outcome. Subjects with enlarged RV (diameter>45mm) had more 15-day complications (58% versus 40%, p=0.001). The QI correlated with the RV diameter (r=0.28, p<0.001), left ventricle diameter (r=-0.19, p<0.001), right ventricular-to-left ventricular diameter ratio (r=0.39, p<0.001), pulmonary artery diameter (r=0.22, p<0.001), and pulmonary artery/ascending aorta ratio (r=0.27, p<0.001). A QI≥50% was only associated with 15-day complications in subjects with enlarged RV, inverted intraventricular septum, or chronic cardiopulmonary diseases. The central or peripheral PE location did not affect the correlations among radiological variables and was not associated with clinical outcomes. CONCLUSIONS Right ventricular dysfunction signs in CTPA are more useful than QI in predicting cancer-related PE outcome.
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Affiliation(s)
| | - Alberto Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Av Marqués de los Vélez, s/n, 30008, Murcia, Spain
| | - David Calvo-Temprano
- Radiology Department, Hospital Universitario Central de Asturias, Avenida de Roma, s/n, 33011, Oviedo, Spain
| | - Paula Jiménez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, Avenida de Roma, s/n, 33011, Oviedo, Spain
| | - Francisco Fenoy
- Department of Physiology, Faculty of Medicine, Campus Universitario de Espinardo, University of Murcia, s/n, 30100 Espinardo, Murcia, Spain
| | - Mariana Benegas
- Radiology Department, Hospital Clínic de Barcelona (HCB), Villarroel, 170, 08036, Barcelona, Spain
| | - Marcelo Sánchez
- Radiology Department, Hospital Clínic de Barcelona (HCB), Villarroel, 170, 08036, Barcelona, Spain
| | - Carme Font
- Medical Oncology Department, Hospital Clínic de Barcelona, Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain
| | - Diego Varona
- Radiology Department, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - David Martínez de la Haza
- Radiology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda Granvia, 199-203, 08907, Hospitalet de Llobregat, Barcelona, Spain
| | - Jesús Pueyo
- Radiology Department, Clínica Universitaria de Navarra (CUN), Avda. Pío XII, 36. 31008, Pamplona, Spain
| | - Mercè Biosca
- Medical Oncology Department, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Maite Antonio
- Medical Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda Granvia, 199-203, 08907, Hospitalet de Llobregat, Barcelona, Spain
| | - Carmen Beato
- Medical Oncology Department, Hospital Nisa-Aljarafe, Avda. Plácido Fernández Viagas, s/n, 41950, Seville, Spain
| | - Pilar Solís
- Medical Oncology Department, Hospital Universitario Central de Asturias, Avenida de Roma, s/n, 33011, Oviedo, Spain
| | - Laura Fáez
- Medical Oncology Department, Hospital Universitario Central de Asturias, Avenida de Roma, s/n, 33011, Oviedo, Spain
| | - Irma de Al Haba
- Internal Medicine Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda Granvia, 199-203, 08907, Hospitalet de Llobregat, Barcelona, Spain
| | - Susana Hernández-Muñiz
- Radiology Department, Hospital Universitario Infanta Sofía, Paseo de Europa, 34, 28702, San Sebastián de los Reyes, Madrid, Spain
| | - Olga Madridano
- Internal Medicine Department, Hospital Universitario Infanta Sofía, Paseo de Europa, 34, 28702, San Sebastián de los Reyes, Madrid, Spain
| | - Mar Martín
- Internal Medicine Department, Hospital Universitario Infanta Sofía, Paseo de Europa, 34, 28702, San Sebastián de los Reyes, Madrid, Spain
| | - Eduardo Castañón
- Medical Oncology Department, Clínica Universitaria de Navarra (CUN), Avda. Pío XII, 36. 31008, Pamplona, Spain
| | - Avinash Ramchandani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Avenida Marítima del Sur, s/n. 35016 - Las Palmas de Gran Canaria, Spain
| | - Pablo Marchena
- Internal Medicine Department, Parc Sanitari Sant Joan de Déu, Carrer Antoni Pujadas, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain
| | - Manuel Sánchez-Cánovas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Av Marqués de los Vélez, s/n, 30008, Murcia, Spain
| | - María Ángeles Vicente
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Av Marqués de los Vélez, s/n, 30008, Murcia, Spain
| | - Mari José Martínez
- Medical Oncology Department, Hospital Santa Lucía, C/Mezquita, s/n, Paraje Los Arcos, 30202, Cartagena, Spain
| | - Ángela Fernández-Plaza
- Radiology Department, Hospital Santa Lucía, C/Mezquita, s/n, Paraje Los Arcos, 30202, Cartagena, Spain
| | | | - Alejandro Puerta
- Radiology Department, Hospital General Universitario Reina Sofía, Av. Intendente Jorge Palacios, 1, Murcia, Spain
| | - Ángel Domínguez
- Radiology Department, Hospital Universitario Virgen del Rocío, Av. Manuel Siurot, s/n, 41013, CIBER de Enfermedades Respiratorias, Seville, Spain
| | - Daniel Rodríguez
- Radiology Department, Hospital Clínico Universitario Virgen de la Arrixaca, Carretera de Cartagena, s/n, Murcia, Spain
| | - Gema Marín
- Medical Oncology Department, Hospital Clínico Universitario Virgen de la Arrixaca, Carretera de Cartagena, s/n, Murcia, Spain
| | - Remedios Otero
- Pneumology Department, Hospital Universitario Virgen del Rocío, Av. Manuel Siurot, s/n, 41013, CIBER de Enfermedades Respiratorias, Seville, Spain
| | - Fernando Sánchez-Lasheras
- Department of Construction and Manufacturing Engineering, Calle San Francisco, 1, 33003, University of Oviedo, Spain
| | - Vicente Vicente
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Av Marqués de los Vélez, s/n, 30008, Murcia, Spain
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Beato C, Faez L, Carmona-Bayonas A, Mediano M, Font C, Calvo-Temprano D, Fonseca PJ, Dominguez A, Hernandez MS, Biosca M, Haba I, Antonio M, Madriano O, Ramchandani A, Alvarez EC, Martinez M, Echaburu JV, Otero R. Outpatient management of cancer-associated pulmonary embolism (PE): analysis of lung carcinoma (LC) cohort from the Epiphany study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw390.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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25
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Diaz-Guardamino IE, Carmona-Bayonas A, Fonseca PJ, Martin AM, Lorenzo MS, Custodio A, Garrido M, Cano J, Barreto JL, Lacalle A, Cardona MF, Manga M, Visa L, Buxo E, Azkarate A, Diaz A, Ramchandani A, Mugica M, Sala P, Alfonso PG. First-line triplet or doublet chemotherapy for advanced gastric cancer: Analysis of 970 patients from a community practice registry. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw371.18] [Citation(s) in RCA: 1] [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: 11/13/2022] Open
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26
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Carmona-Bayonas A, Jiménez-Fonseca P, Virizuela J, Antonio M, Font C, Biosca M, Ramchandani A, Martinez-Garcia J, Hernando J, Espinosa J, de Castro EM, Ghanem I, Beato C, Blasco A, Garrido M, Mondéjar R, Arcusa MÁ, Aragón I, Manzano A, Sevillano E, Castañón E, Ayala F. Performance of the clinical index of stable febrile neutropenia (CISNE) in different types of infections and tumors. Clin Transl Oncol 2016; 19:386-395. [PMID: 27525978 DOI: 10.1007/s12094-016-1540-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 06/07/2016] [Accepted: 08/02/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The clinical index of stable febrile neutropenia (CISNE) can contribute to patient safety without increasing the complexity of decision-making. However, febrile neutropenia (FN) is a diverse syndrome. The aim of this analysis is to assess the performance of CISNE according to the type of tumor and infection and to characterize these patients. METHODS We prospectively recruited 1383 FN episodes in situations of apparent clinical stability. Bonferroni-adjusted z tests of proportions were used to assess the association between the infections suspected at the time of onset and the type of tumor with the risk of serious complications and mortality. The performance of CISNE was appraised in each category using the Breslow-Day test for homogeneity of odds ratios and Forest Plots. RESULTS 171 patients had a serious complication (12.3 %, 95 % confidence interval 10.7-14.2 %). The most common initial assumptive diagnoses were: fever without focus (34.5 %), upper respiratory infection (14.9 %), enteritis (12.7 %), stomatitis (11.8 %), and acute bronchitis (10.7 %). Lung and breast were the most common tumors, accounting for approximately 56 % of the series. The distribution of complications, mortality, and bacteremia varies for each of these categories. However, Breslow-Day tests indicate homogeneity of the odds ratio of the dichotomized CISNE score to predict complications in all infection and tumor subtypes. CONCLUSION Despite FN's clinical and microbiological heterogeneity, the CISNE score was seen to be consistent and robust in spite of these variations. Hence, it appears to be a safe tool in seemingly stable FN.
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Affiliation(s)
- A Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Calle Marqués de los Vélez s/n, 30008, Murcia, Spain.
| | | | - J Virizuela
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - M Antonio
- ICO Duran i Reynals, Barcelona, Spain
| | - C Font
- Hospital Universitario Clínic, Barcelona, Spain
| | - M Biosca
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - A Ramchandani
- Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain
| | | | - J Hernando
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - J Espinosa
- Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - E M de Castro
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - I Ghanem
- Hospital Universitario La Paz, Madrid, Spain
| | - C Beato
- Hospital Nisa Sevilla Aljarafe, Hospital Universitario Clínico San Carlos, Sevilla, Spain
| | - A Blasco
- Hospital General Universitario de Valencia, Valencia, Spain
| | - M Garrido
- Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - R Mondéjar
- Hospital Universitario de la Princesa, Madrid, Spain
| | - M Á Arcusa
- Consorci Sanitari de Terrassa, Barcelona, Spain
| | - I Aragón
- Hospital Juan Ramón Jiménez, Huelva, Spain
| | - A Manzano
- Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - E Sevillano
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - E Castañón
- Clínica Universidad de Navarra, Pamplona, Spain
| | - F Ayala
- Hospital Universitario Morales Messeguer, Murcia, Spain
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Carmona-Bayonas A, Font C, Jiménez-Fonseca P, Fenoy F, Otero R, Beato C, Plasencia J, Biosca M, Sánchez M, Benegas M, Calvo-Temprano D, Varona D, Faez L, Vicente M, de la Haba I, Antonio M, Madridano O, Ramchandani A, Castañón E, Marchena P, Martínez M, Martín M, Marín G, Ayala de la Peña F, Vicente V. On the necessity of new decision-making methods for cancer-associated, symptomatic, pulmonary embolism. Thromb Res 2016; 143:76-85. [DOI: 10.1016/j.thromres.2016.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 05/10/2016] [Indexed: 01/22/2023]
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Mangas M, Carmona Bayonas A, Sanchez Lorenzo ML, Ramchandani A, Garcia T, Custodio AB, Lorenzo Barreto JE, Echavarria Diaz Guardamino I, Diaz Serrano A, Cano JM, Azkarate A, Longo F, Mugica M, Sanchez R, Serrano R, Alvarez Manceñido FJ, Alsina M, Jiménez-Fonseca P, Garrido M, Gallego Plazas J. Prognostic factors for survival in patients with advanced gastric cancer treated with chemotherapy. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.142] [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
142 Background: A prognostic model in advanced gastric cancer that integrates the Her2 status,histopathological classifications and other patient’s or treatment-dependent parameters is lacking. The aim is to identify clinicopathological factors for overall survival in a cohort of patients with advanced gastric cancer. Methods: 526 consecutive patients with advanced adenocarcinoma of the distal esophagus, gastroesophageal junction or stomach were analyzed. All patients were treated with poly-chemotherapy ( ≥ 2 drugs) at 19 Spanish and one Chilean centers between 2012 and 2015. Characteristics of patients, tumors, therapies and pathological factors, were analyzed by a Cox proportional hazards model. Results: The median overall survival was 10.3 months [95% confidence interval (CI), 9.5-11.1], and the time to progression was 6.7 months (95% CI, 6.1-7.2). Independent prognostic factors associated with overall survival were: distal non-diffuse histopathological subtype (hazard ratio, (HR) 0.73), Her2 positive 3+ (HR 0.54), Her2 positive 2+ with FISH + (HR 0.68), surgery of metastases (HR 0.34), Eastern Cooperative Group performance status (ECOG PS) 2 (HR 2.5), ECOG PS 3 (HR 7.37), and only distant lymph node metastases (HR 0.63) (Table 1). Conclusions: We have identified clinicopathological prognostic factors that could be important to stratify advanced gastric cancer, with potential implications in research and treatment. [Table: see text]
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Affiliation(s)
| | | | | | | | - Teresa Garcia
- Hematology and Medical Oncology Department, University Hospital Morales Meseguer, Murcia, Spain
| | | | | | | | | | | | | | - Federico Longo
- Medical Oncology Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | | | | | | | | | - Maria Alsina
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Marcelo Garrido
- Departamento de Hemato-Oncología, Pontificia Universidad Católica de Chile, Santiago, Chile
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Rodriguez Rubi D, Calderon C, Beato C, Garcia T, Ramchandani A, Castelo B, Soriano C, de la Morena P, Sanchez MM, Fernandez Sanchez A, Mangas M, Martinez de Castro E, Carrion Galindo R, Donnay O, Cumplido Buron JD, San Gil RH, Carmona Bayonas A, Jiménez-Fonseca P, Ayala F, Jara-Sanchez C. Influence of clinical and psychological variables on coping strategies and quality of life of cancer patients: NEOCOPING study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.3_suppl.205] [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
205 Background: NEOCOPING study analyzes the influence of clinicopathological, personal and social variables on coping strategies and quality of life (QoL) in patients with resected tumors at the time of starting adjuvant chemotherapy. Methods: NEOCOPING is a prospective, multicenter, observational study that involves 19 centers and 34 researchers. Applied main questionnaires were: Mini-Mental Adjustment to Cancer (MAC), EORTC QLQ-C30, Brief Symptom Inventory (BSI-18), Shared Decision Making Questionnaire (SDM-Q) patient and doctor, and Multidimensional Scale of Perceived Social Support (MSPSS). Results: Table summarizes the characteristics of the first 71 patients enrolled. The most used coping strategies were fighting spirit (X=75.8, SD=25.9) and avoidance (X=64.6, SD=25); most patients were found to have good QoL (X=76.5, SD=16.6). Most did not have psychiatric symptoms, and were pleased with family and social support perceived. Patients were very satisfied with the information received (X=83, SD=19.9), and shared opinions with the doctor (X=90, SD=22.9). QoL was significantly negatively correlated with depression (r=-.688, r=.0001), anxiety (r=.-655, p=.0001), somatization (r=-.638, p=.0001) and hopelessness (r =-.287, p =.033). Depression and somatization predicted 54.8% of the QoL of this sample (F=23,636, p=.0001). Conclusions: Even though patients have a good QoL, adaptative coping strategies and no noticeable psychopathological symptoms at baseline, these symptoms may influence the well-being perception and modulate personal adaptations to the diagnosis and treatment of cancer at a curable stage. [Table: see text]
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Affiliation(s)
| | | | | | - Teresa Garcia
- Hematology and Medical Oncology Department, University Hospital Morales Meseguer, Murcia, Spain
| | | | | | | | - Pilar de la Morena
- Hematology and Medical Oncology Department, University Hospital Morales Meseguer, Murcia, Spain
| | | | | | | | | | | | - Olga Donnay
- Hospital Universitario La Princesa, Madrid, Spain
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Echaburu JV, Blasco A, Martinez J, Font C, Antonio Rebollo M, Biosca M, Ramchandani A, Hernando-Cubero J, Martinez de Castro E, Espinosa J, Beato C, Aragon Manrique I, García Navalón FJ, Ghanem Canete I, Sevillano E, Manzano A, Garrido M, Castanon E, Jiménez-Fonseca P, Carmona Bayonas A. Development and validation of a Clinical Index of Severe Febrile Neutropenia: A prospective multicenter study. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9617] [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)
| | - Ana Blasco
- Hospital General Universitario de Valencia, Valencia, Spain
| | | | | | | | | | | | | | | | - Javier Espinosa
- Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | | | | | | | | | - Marcelo Garrido
- Departamento de Hemato-Oncología. Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Eduardo Castanon
- Medical Oncology, Clinica Universidad de Navarra, Navarra, Spain
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Carmona-Bayonas A, Jiménez-Fonseca P, Virizuela Echaburu J, Antonio M, Font C, Biosca M, Ramchandani A, Martínez J, Hernando Cubero J, Espinosa J, Martínez de Castro E, Ghanem I, Beato C, Blasco A, Garrido M, Bonilla Y, Mondéjar R, Arcusa Lanza MÁ, Aragón Manrique I, Manzano A, Sevillano E, Castañón E, Cardona M, Gallardo Martín E, Pérez Armillas Q, Sánchez Lasheras F, Ayala de la Peña F. Prediction of serious complications in patients with seemingly stable febrile neutropenia: validation of the Clinical Index of Stable Febrile Neutropenia in a prospective cohort of patients from the FINITE study. J Clin Oncol 2015; 33:465-71. [PMID: 25559804 DOI: 10.1200/jco.2014.57.2347] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To validate a prognostic score predicting major complications in patients with solid tumors and seemingly stable episodes of febrile neutropenia (FN). The definition of clinical stability implies the absence of organ dysfunction, abnormalities in vital signs, and major infections. PATIENTS AND METHODS We developed the Clinical Index of Stable Febrile Neutropenia (CISNE), with six explanatory variables associated with serious complications: Eastern Cooperative Oncology Group performance status ≥ 2 (2 points), chronic obstructive pulmonary disease (1 point), chronic cardiovascular disease (1 point), mucositis of grade ≥ 2 (National Cancer Institute Common Toxicity Criteria; 1 point), monocytes < 200 per μL (1 point), and stress-induced hyperglycemia (2 points). We integrated these factors into a score ranging from 0 to 8, which classifies patients into three prognostic classes: low (0 points), intermediate (1 to 2 points), and high risk (≥ 3 points). We present a multicenter validation of CISNE. RESULTS We prospectively recruited 1,133 patients with seemingly stable FN from 25 hospitals. Complication rates in the training and validation subsets, respectively, were 1.1% and 1.1% in low-, 6.1% and 6.2% in intermediate-, and 32.5% and 36% in high-risk patients; mortality rates within each class were 0% in low-, 1.6% and 0% in intermediate-, and 4.3% and 3.1% in high-risk patients. Areas under the receiver operating characteristic curves in the validation subset were 0.652 (95% CI, 0.598 to 0.703) for Talcott, 0.721 (95% CI, 0.669 to 0.768) for Multinational Association for Supportive Care in Cancer (MASCC), and 0.868 (95% CI, 0.827 to 0.903) for CISNE (P = .002 for comparison between CISNE and MASCC). CONCLUSION CISNE is a valid model for accurately classifying patients with cancer with seemingly stable FN episodes.
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Affiliation(s)
- Alberto Carmona-Bayonas
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile.
| | - Paula Jiménez-Fonseca
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Juan Virizuela Echaburu
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Maite Antonio
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Carme Font
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Mercè Biosca
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Avinash Ramchandani
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Jerónimo Martínez
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Jorge Hernando Cubero
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Javier Espinosa
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Eva Martínez de Castro
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Ismael Ghanem
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Carmen Beato
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Ana Blasco
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Marcelo Garrido
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Yaiza Bonilla
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Rebeca Mondéjar
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - María Ángeles Arcusa Lanza
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Isabel Aragón Manrique
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Aránzazu Manzano
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Elena Sevillano
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Eduardo Castañón
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Mercé Cardona
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Elena Gallardo Martín
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Quionia Pérez Armillas
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Fernando Sánchez Lasheras
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
| | - Francisco Ayala de la Peña
- Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile
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Ghanem I, Antonio Rebollo M, Garrido M, Martinez J, Font C, Ramchandani A, Biosca M, Beato C, Martinez de Castro E, Castanon E, Echaburu JV, Espinosa J, Sevillano E, Aragon Manrique I, Cardona M, Mondejar R, Baron F, Acevedo F, Jiménez-Fonseca P, Carmona Bayonas A. A nomogram for predicting serious complications in patients with solid tumors and apparently stable febrile neutropenia: Prospective data on 781 consecutive episodes from the FINITE study. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.31_suppl.165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
165 Background: An accurate estimate of the likelihood of serious complications in patients with otherwise apparently stable febrile neutropenia (FN) may assist in decision-making regarding individualized therapy. Our group has developed a prognostic score for predicting complications in patients with solid tumors and apparently stable episodes called CISNE (Clinical Index for Stable Febrile Neutropenia). The purpose of this study is to present a nomogram based on the previously mentioned index in a broader dataset of patients. Methods: FINITE is a prospective and multicenter study which aims to investigate prognostic factors and outcomes of FN episodes with clinical stability at first assessment, defined as events without acute organ dysfunction, vital signs abnormalities or major infections. We performed a nomogram based on the CISNE score which includes the following prognostic variables: ECOG PS≥2, chronic obstructive pulmonary disease, cardiovascular disease, mucositis NCI grade ≥2, monocytes <200/mm3 and stress-induced hyperglycemia. A calibration plot was used to analyze the accuracy of this multivariate nomogram. Results: From October 2012 to December 2013, 781 patients with apparently stable FN were recruited in 21 Spanish hospitals. The rate of infection-related complications and death was 15.6% (95% confidence interval [CI], 12.9-18.6%) and 1.7% (95% CI, 0.98%-3.01%). A nomogram was designed according to the CISNE score. The area under the ROC curve was 0.836 (95% CI, 0.808-0.861). The observed and predicted probabilities also matched closely. Conclusions: Our group has developed a user-friendly nomogram for predicting complications in patients with apparently stable FN. This nomogram may be particularly useful to prevent premature discharges of cancer patients starting inpatient management.
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Affiliation(s)
- Ismael Ghanem
- Medical Oncology Service, Hospital Universitario La Paz, Madrid, Spain
| | | | - Marcelo Garrido
- Departamento de Hemato-Oncología. Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | | | | | | | | | | | | | | | | | - Javier Espinosa
- Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | | | | | - Francisco Baron
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
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Fonseca P, Carmona-Bayonas A, Font C, Antonio Rebollo M, Ramchandani A, Hernando Cubero J, Espinosa J, De Castro E, Ghanem I, Martínez J, Beato C, Virizuela J, Blasco A, Bonilla Y, Manzano A, Castañon E, Sevillano E, Vicente Conesa M, De La Peña F. Prognostic Evaluation of Clinically Stable Febrile Neutropenia: Prospective Data from 921 Patients from the Finite Study. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu356.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Carmona-Bayonas A, Biosca M, Puig CF, Faez L, Solís Hernández M, Jimenez Fonseca P, Antonio Rebollo M, De La Haba I, Castanon Alvarez E, Beato C, Ramchandani A, Vicente Conesa M, Madridano O, Otero R. Outpatient Management of Cancer-Related Pulmonary Embolism: a Propensity Score-Matched Analysis of 803 Patients from the Epiphany Study. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu356.6] [Citation(s) in RCA: 1] [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: 11/13/2022] Open
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Vicente Conesa M, Faez Garcia L, Garrido M, Custodio A, López C, Visa L, Gallego Plazas J, Fernandez Arrojo S, Ramchandani A, Murias C, Iranzo V, Múgica M, Giraldo C, Hindi N, Erpel F, Pineda E, Buxo E, Jofré E, Jimenez Fonseca P, Carmona-Bayonas A. Prognostic Evaluation of a Multicenter Cohort of 484 Patients with Metastatic Gastroesophageal Adenocarcinoma. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.19] [Citation(s) in RCA: 1] [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: 11/12/2022] Open
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Espinosa J, Font C, Jiménez-Fonseca P, Biosca M, Ramchandani A, Antonio Rebollo M, Martinez de Castro E, Hernando J, Ghanem I, Martinez J, Beato C, Blasco A, Casao F, Bonilla Y, Mondejar R, Arcusa Lanza MA, Gallardo Martin E, Echaburu JV, Ayala F, Carmona Bayonas A. Prediction of major complications in patients with solid tumors and apparently stable febrile neutropenia: Validation of the CISNE risk score. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.9620] [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)
- Javier Espinosa
- Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | | | | | | | | | | | - Ismael Ghanem
- Medical Oncology Service, Hospital Universitario La Paz, Madrid, Spain
| | | | - Carmen Beato
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Ana Blasco
- Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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Ramchandani A, Mitra R. Poster 247: Long-Term Resolution of Symptoms From Lumbar Synovial Cyst Aspiration: A Case Report. Arch Phys Med Rehabil 2008. [DOI: 10.1016/j.apmr.2008.09.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Patel R, Krishnan R, Ramchandani A, Maru G. Polymeric black tea polyphenols inhibit mouse skin chemical carcinogenesis by decreasing cell proliferation. Cell Prolif 2008; 41:532-53. [PMID: 18400024 DOI: 10.1111/j.1365-2184.2008.00528.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the antitumour promoting effects and possible mechanisms of action of the most abundant polymeric black tea polyphenols (PBPs 1-5) or thearubigins, in vivo. MATERIALS AND METHODS Effect of PBP pre-treatments on 12-O-tetradecanoylphorbol-13-acetate (TPA) promoted skin papillomas was studied in 7,12-dimethylbenz(a)anthracene initiated mice over 40 weeks. Cell proliferation and apoptosis, in epidermis of the skin, were measured using appropriate immunohistochemical staining. Mitogen-activated protein kinase signalling studies were conducted with Western blot analysis at 10, 20, 30 and 40 weeks of promotion. RESULTS Pre-treatments with PBP fractions differentially altered latency, multiplicity and incidence of skin papillomas as compared to TPA treatments thereby exhibiting antipromoting effects. Most PBP fractions decreased TPA-induced cell proliferation by decreasing activation of signalling kinases (c-Jun N-terminal protein kinase, extracellular signal-regulated protein kinase, p38 protein kinase and Akt), transcription factors (activator protein-1 and nuclear factor kappa B) and inflammatory protein (cyclooxygenase 2). TPA-induced epidermal cell apoptosis was also decreased by pre-treatment with most PBP fractions. Higher levels of p53 and p21 in skin cells pre-treated with PBP fractions followed by TPA treatment as compared to only TPA-treated animals suggested possible activation of a cell cycle checkpoint. CONCLUSIONS PBP-2 was observed to be the most potent polymeric polyphenol fraction and PBP-4 and PBP-5 showed only marginal activity, whereas PBP-1 and PBP-3 displayed intermediate efficacies. In conclusion, the protective effects of PBP fractions could be attributed to inhibition of TPA-induced cellular proliferation.
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Affiliation(s)
- R Patel
- Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Kharghar, Navi Mumbai, India
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