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Bernardez B, Mangues Bafalluy I, Martínez Callejo V, Fernández Ávila JJ, Marcos Rodríguez JA, Parada Aradilla MA, Martínez Bautista MJ. Risk stratification model for the pharmaceutical care of oncology patients with solid or hematologic neoplasms. Farm Hosp 2024:S1130-6343(23)00943-1. [PMID: 38461113 DOI: 10.1016/j.farma.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 03/11/2024] Open
Abstract
OBJECTIVE We aimed to develop of a risk stratification model for the pharmaceutical care (PC) of patients with solid or hematologic neoplasms who required antineoplastic agents or supportive treatments. METHOD The risk stratification model was collaboratively developed by oncology pharmacists from the Spanish Society of Hospital Pharmacy (SEFH). It underwent refinement through three workshops and a pilot study. Variables were defined, grouped into four dimensions, and assigned relative weights. The pilot study collected and analyzed data from participating centers to determine priority levels and evaluate variable contributions. The study followed the Kaiser Permanente pyramid model, categorizing patients into three priority levels: Priority 1 (intensive PC, 90th percentile), Priority 2 (60th-90th percentiles), and Priority 3 (60th percentile). Cut-off points were determined based on this stratification. Participating centers recorded variables in an Excel sheet, calculating mean weight scores for each priority level and the total risk score. RESULTS The participants agreed to complete a questionnaire that comprised 22 variables grouped into 4 dimensions: demographic (maximum score =11); social and health variables and cognitive and functional status (maximum = 19); clinical and health services utilization (maximum = 25); and treatment-related (maximum = 41). From the results of applying the model to the 199 patients enrolled, the cutoff points for categorization were 28 or more points for priority 1, 16 to 27 points for priority 2 and less than 16 for priority 3; more than 80% of the total score was based on the dimensions of 'clinical and health services utilization' and 'treatment-related'. Interventions based on the pharmaceutical care model were recommended for patients with solid or hematological neoplasms, according to their prioritization level. CONCLUSION This stratification model enables the identification of cancer patients requiring a higher level of pharmaceutical care and facilitates the adjustment of care capacity. Validation of the model in a representative population is necessary to establish its effectiveness.
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Affiliation(s)
- Beatriz Bernardez
- Departamento de Medicina, Universidad de Santiago de Compostela, Santiago de Compostela, España; Unidad de Farmacia Oncológica, Servicio de Farmacia, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España; Grupo de Farmacología, Instituto de Investigación Santiago de Compostela (IDIS), Santiago de Compostela, España.
| | - Irene Mangues Bafalluy
- Servicio de Farmacia, Hospital Universitario Arnau de Vilanova de Lleida, Lleida, España; Grupo de Farmacoepidemiología y Farmacodinamia, Institut de Recerca Biomèdica, IRBLleida, Lleida, España
| | - Virginia Martínez Callejo
- Unidad de Farmacia Oncológica, Servicio de Farmacia, Hospital Universitario Marqués de Valdecilla, Santander, España
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Bernardez B, Mangues-Bafalluy I, Callejo VM, Ávila JJF, Rodríguez JAM, Aradilla MAP, Bautista MJM. Risk stratification model for the pharmaceutical care of oncology patients with solid or hematologic neoplasms. Farm Hosp 2023:S1130-6343(23)00106-X. [PMID: 37884399 DOI: 10.1016/j.farma.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVE We aimed to develop of a risk stratification model for the pharmaceutical care of patients with solid or hematologic neoplasms who required antineoplastic agents or supportive treatments. METHOD The risk stratification model was collaboratively developed by oncology pharmacists from the Spanish Society of Hospital Pharmacy (SEFH). It underwent refinement through 3 workshops and a pilot study. Variables were defined, grouped into 4 dimensions, and assigned relative weights. The pilot study collected and analyzed data from participating centers to determine priority levels and evaluate variable contributions. The study followed the Kaiser Permanente pyramid model, categorizing patients into 3 priority levels: Priority 1 (intensive PC, 90th percentile), Priority 2 (60th-90th percentiles), and Priority 3 (60th percentile). Cut-off points were determined based on this stratification. Participating centers recorded variables in an Excel sheet, calculating mean weight scores for each priority level and the total risk score. RESULTS The participants agreed to complete a questionnaire that comprised 22 variables grouped into 4 dimensions: demographic (maximum score=11); social and health variables and cognitive and functional status (maximum=19); clinical and health services utilization (maximum=25); and treatment-related (maximum=41). From the results of applying the model to the 199 patients enrolled, the cut-off points for categorization were 28 or more points for priority 1, 16-27 points for priority 2, and less than 16 for priority 3; more than 80% of the total score was based on the dimensions of "clinical and health services utilization" and "treatment-related." Interventions based on the pharmaceutical care model were recommended for patients with solid or hematological neoplasms, according to their prioritization level. CONCLUSION This stratification model enables the identification of cancer patients requiring a higher level of pharmaceutical care and facilitates the adjustment of care capacity. Validation of the model in a representative population is necessary to establish its effectiveness.
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Affiliation(s)
- Beatriz Bernardez
- Departamento de Medicina, Universidad de Santiago de Compostela, Santiago, Spain; Unidad de Farmacia Oncológica, Servicio de Farmacia, Hospital Clínico, Universitario de Santiago de Compostela, Santiago, Spain; Grupo de Farmacología, Instituto de Investigación Santiago de Compostela (IDIS), Santiago, Spain.
| | - Irene Mangues-Bafalluy
- Servicio de Farmacia, Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Grupo de Farmacoepidemiología y Farmacodinamia, Institut de Recerca Biomèdica, IRBLleida, Lleida, Spain
| | - Virginia Martínez Callejo
- Unidad de Farmacia Oncológica, Servicio de Farmacia, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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Abou Jokh Casas E, Martinez NP, Anido Herranz U, Cabezas Agricola JM, Varela Ferreiro S, Carral Maseda A, Fernandez Calvo O, Mato Mato JA, Nogareda Seoane Z, Rodriguez Martinez de LLano S, Quindós Varela M, Baron F, Rodriguez Fonseca O, Cousillas Castiñeira A, Muñiz Garcia G, De Matias Leralta JM, Fernández Catalina P, Cameselle Teijeiro JM, Bernardez B, Pubul Nuñez V. Real-world efficacy and safety of peptide receptor radionuclide therapy (PRRT) in gastroenteropancreatic neuroendocrine tumors (GEP-NETs). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.364] [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
364 Background: PRRT with 177Lu-Dotatate (Lutathera) is a radiolabeled somatostatin analog indicated treatment of somatostatin receptor (STTR) positive GEP-NETs. The study aims to establish the efficacy and safety of PRRT in GEP-NETs in a real-world setting. Methods: We conducted an observational, retrospective, multicentric study of 40 patients with GEP-NET treated with PRRT belonging to GGNET (Galician Research Group on Neuroendocrine Tumors) network at Nuclear Medicine Department of Santiago de Compostela University Hospital (Spain). Patients characteristics, overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and toxicity data were retrospectively collected and analyzed. Results: Data from 40 patients (pts) treated between 2016 and 2020 were recorded in this study. Median age was 63.5 years (range 41-85) and 55% were male. The baseline ECOG PS 0/1/2 was 15 (37.5%)/16 (40%)/9 (22.5%). Tumor location was intestinal 26 pts (65%), pancreas in 11 pts (27.5%) and unknown origin in 3 pts (7.5%). 25 pts (62.5%) were none functioning. Tumor grade G1/G2/G3 were 17 pts (42.5%)/ 20 pts (50%)/ 3 pts (7.5%), and Ki 67 < 2/3-20/ > 20%/unknown was 11 pts (27.5%)/ 21 pts (52.5%)/ 3 pts (7.5%)/ 5 pts (12.5%), respectively. The most frequent site of metastasis was liver in 32 pts (80%), lymph nodes in 19 pts (47.5%), peritoneum 11 pts (27.5%) and bone 10 pts (25%). Surgery: 22 pts (55%) primary tumor surgery and 8 pts (20%) metastasectomy. Previous systemic treatments included somatostatin analogs (SSA) in 40 pts (100%), everolimus in 26 pts (65%) and sunitnib in 11 pts (27.5%), others 7 pts (17.5%). 34 pts (85%) completed 4 cycles of treatment (6 pts (15%) non-complete due to premature death). 35 pts were evaluable for early response (after 2 cycles of treatment). Early ORR and DCR were 2.8% and 74.2%, respectively. 26 pts were evaluable after finishing treatment (6 pts premature death and 8 pending evaluation). ORR and DCR were 19.2% and 92.3%. With a median follow up of 21 months, 14 pts (35%) had died. Median OS was not reached (NR) and median PFS was 27.2 m (95% CI 16.0-38.4m). Tumor grade G1-2 (p < 0.001), Ki 67 <20% (p = 0.002), primary tumor surgery (p = 0.039) and metastasectomy (p = 0.030) were associated with prolonged PFS. Mild adverse events were most frequent after the 1º doses in 27.5% patients, and medium-term toxicity was present in 25.6%, mainly hematological, G1-G2 25.6%, and G3 5%. Conclusions: 177Lu-Dotatate is a safe and effective treatment for those patients diagnosed with metastatic GEP-NET and positive somatostatin receptors, with an excellent clinical and radiological response. Furthermore, we have identified some predictive factors to OS that should be taken into consideration.
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Affiliation(s)
- Estephany Abou Jokh Casas
- Nuclear Medicine Deparment-Hospital Clinico Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | | | | | - Jose Manuel Cabezas Agricola
- Endocrinology Department-Hospital Clinico Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | | | | | - Ovidio Fernandez Calvo
- Medical Oncology Department-Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | | | | | | | - Maria Quindós Varela
- Medical Oncology Dept. University Hospital A Coruña (CHUAC-SERGAS), A Coruña, Spain
| | - Francisco Baron
- Medical Oncology Department-University Hospital A Coruña, A Coruña, Spain
| | | | | | - Gloria Muñiz Garcia
- Nuclear Medicine Department-Complexo Hospitalario Universitario Ourense, Ourense, Spain
| | | | | | | | - Beatriz Bernardez
- Pharmacy Department, Hospital Clínico de Santiago (SERGAS), Clinical Pharmacology Group, Health Research Institute of Santiago de Com, Santiago De Compostela, Spain
| | - Virginia Pubul Nuñez
- Nuclear Medicine Department-Hospital Clinico Universitario de Santiago de Compostela, Santiago De Compostela, Spain
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Abou Jokh Casas E, Martinez Lago N, Cabezas Agricola JM, Anido Herranz U, Baron F, Fernandez Calvo O, Quindós Varela M, Varela Ferreiro S, Carral Maseda A, De Matias Leralta JM, Nogareda Seoane Z, Cousillas Castiñeira A, Rodriguez Martinez de LLano S, Mato Mato JA, Fernández Catalina P, Rodriguez Fonseca O, Muñiz Garcia G, Bernardez B, Cameselle Teijeiro JM, Pubul Nuñez V. The role of systemic inflammatory factors in gastroenteropancreatic neuroendocrine tumors (GEP-NETs) treated with peptide receptor radionuclide therapy (PRRT). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.371] [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
371 Background: Inflammation plays a key role in the pathophysiology of many diseases, including cancer. Systemic inflammatory factors have been validated as indicators of ongoing systemic inflammation that could be predictive markers of poor prognosis for oncological outcomes. However, it is unknown the prognostic impact of systemic inflammation markers in patients with GEP-NETs treated with PRRT. Methods: We conducted an observational, retrospective, multicentric study of 40 patients with GEP-NET treated with PRRT belonging to GGNET (Galician Research Group on Neuroendocrine Tumors) network at Nuclear Medicine Department of Santiago de Compostela University Hospital (Spain). The systemic inflammatory markers were calculated as follows: NLR = neutrophil count/lymphocyte count, PLR = platelet count/lymphocyte count, MLR= monocyte count/lymphocyte count, ALB= albumin levels and dNLR = neutrophil count/ (leucocytes count – neutrophils count). For the calculation of the different ratios, baseline analysis and after the second dose were used. The cut-off values were determined as the median of each values, correlating them with progression-free survival (PFS). Results: Data from 40 patients (pts) treated between 2016 and 2020 were recorded. Median age was 63.5 years (range 41-85) and 55% were male. Baseline ECOG PS 0/1/2 was 15 (37.5%)/16 (40%)/9 (22.5%). Tumor location was intestinal 26 pts (65%), pancreas 11 pts (27.5%) and unknown origin 3 pts (7.5%). 15 pts (37.5%) were functioning. Tumor grade G1/G2/G3 were 17 pts (42.5%)/ 20 pts (50%)/ 3 pts (7.5%), and Ki 67 <2/3-20/>20%/unknown were 11 pts (27.5%)/ 21 pts (52.5%)/ 3 pts (7.5%)/ 5 pts (12.5%), respectively. The most frequent site of metastasis was liver 32 pts (80%), lymph nodes 19 pts (47.5%), peritoneum 11 pts (27.5%) and bone 10 pts (25%). Surgery: 22 pts (55%) primary tumor surgery and 8 pts (20%) metastasectomy. Previous systemic treatments included somatostatin analogs (SSA) 40 pts (100%), everolimus 26 pts (65%) and sunitnib 11 pts (27.5%), others 7 pts (17.5%). The baseline cutoff-values for NLR was 2.61, for PLR 110.14, for MLR 0.31, for ALB 4.2. and for dNLR 1.71. The cutoff-values after the 2nd dose for NLR was 2.3, for PLR 2.15, for MLR 0.3, for ALB 4.2 and for dNLR 1.48. With a median follow up of 21 months, 14 pts (35%) had died. Median PFS was 27.2 m (95% CI 16.0-38.4m) and OS was not reached (NR). Pts with baseline higher NLR (>2.61 vs. <2.61) had a significantly lower PFS: 15.8 m vs. NR (HR 0.181; 95% CI 0.051-0.638, p=0.03), which was also true for pts with elevated dNLR (>1.71 vs. <1.71): PFS 15.8 m vs. NR (HR 0.174; 0.049-0.614, p=0.03). Baseline PLR, ALB, MLR and NLR, PLR, ALB, dNLR and MLR values after the 2nd dose was not statistically significant for PFS. Conclusions: We have identified that baseline NLR and dNRL are significant predictive factors in patients with GEP-NETs treated with PRRT.
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Affiliation(s)
- Estephany Abou Jokh Casas
- Nuclear Medicine Deparment-Hospital Clinico Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | | | - Jose Manuel Cabezas Agricola
- Endocrinology Department-Hospital Clinico Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | | | - Francisco Baron
- Medical Oncology Department-University Hospital A Coruña, A Coruña, Spain
| | - Ovidio Fernandez Calvo
- Medical Oncology Department-Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Maria Quindós Varela
- Medical Oncology Dept. University Hospital A Coruña (CHUAC-SERGAS), A Coruña, Spain
| | | | | | | | | | | | | | | | | | | | - Gloria Muñiz Garcia
- Nuclear Medicine Department-Complexo Hospitalario Universitario Ourense, Ourense, Spain
| | - Beatriz Bernardez
- Pharmacy Department, Hospital Clínico de Santiago (SERGAS), Clinical Pharmacology Group, Health Research Institute of Santiago de Com, Santiago De Compostela, Spain
| | | | - Virginia Pubul Nuñez
- Nuclear Medicine Department-Hospital Clinico Universitario de Santiago de Compostela, Santiago De Compostela, Spain
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Bernardez B, Franco B, Mayo N, Cueva J, Lale M, Duran G, Touris M, Lopez E, Mosquera A, Blanco S, Sanchez B, Garcia A, Lopez R, Lamas M. Real world of infusion related reactions in an oncology outpatient clinic. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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)
- Beatriz Bernardez
- Pharmacy Department, Hospital Clínico de Santiago (SERGAS) .Clinical Pharmacology Group, Health Research Institute of Santiago de Com, Santiago De Compostela, Spain
| | - Borja Franco
- Pharmacy Department. Torrecardenas Hospital., Almeria, Spain
| | - Nieves Mayo
- Oncology Outpatient Clinic. Hospital Clinico de Santiago de Compostela, Santiago De Compostela, Spain
| | - Juan Cueva
- Oncology Department. Hospital Clínico Universitario de Santiago de Compostela., Santiago, Spain
| | - Mar Lale
- Quality and Attention patient subdirection. Hospital Clinico Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | - Goretti Duran
- Pharmacy Department, University Hospital of Santiago (SERGAS), Trav. Choupana s/n 15706 Santiago de Compostela, Spain; Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago De Compostela, Spain
| | - Manuel Touris
- Pharmacy Department. Complejo Hospitalario Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | - Elena Lopez
- Pharmacy Department. Complejo Hospitalario Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | - Alicia Mosquera
- Pharmacy Department. Complejo Hospitalario Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | - Sara Blanco
- Pharmacy Department, University Hospital of Santiago (SERGAS), Santiago De Compostela, Spain
| | - Bibiana Sanchez
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | - Alba Garcia
- Pharmacy Departmente. Hospital Clinico Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | - Rafael Lopez
- IDIS; CIBERONC,Hospital Clínico Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | - Maria Lamas
- Pharmacy Department, University Hospital of Santiago (SERGAS), Trav. Choupana s/n 15706 Santiago de Compostela, Spain; Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago De Compostela, Spain
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Diaz M, Llorente A, Touris M, Vidal Y, Mosquera A, Lopez E, Vazquez MF, Sanchez B, Duran G, Gonzalez-Anleo C, Garcia A, Lopez R, Lamas MJ, Bernardez B. Patients' perception about difficulty of treatment with trifluridine/tipiracil and pharmaceutical care: Effectiveness and safety. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e18249] [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
e18249 Background: Trifluridine/tipiracil (TAS) is a new alternative in metastatic colorectal cancer patients (pts) previously treated with fluoropyrimidines, oxaliplatin and irinotecan. Objective:to analyze patients` perception about difficulty of dosage regimen with TAS, the effectiveness and safety. Methods: Retrospective observational study, including pts treated with TAS during expanded access in Spain. Oncology pharmacists, as integral part of cancer team, provide direct patient care medication therapy review, pharmacotherapy management, disease management, medication safety, dispense the medication and other clinical support that may lead to improved quality and clinical outcomes for cancer patient at the beginning of treatment with TAS. About perception we applied a survey with a numeric rating scale (0-10 integers) with 3 questions: difficulty of dosage at the beginning, at the end of 3rd cycle, and the relevance of the information provided by the oncology pharmacist. Variables studied: sex, age, KRAS status, treatment line, ECOG performance status (PS), dose reduction, previous chemotherapy and adverse events (AE) classified according to CTCAE v4.0. Effectiveness variable: progression-free survival (PFS). Results: 12 pts (10 men; 7 mutated KRAS) were included; median age 60.5 years (range 52-81). TAS line: 3rd line (4), ≥ 4th (8). PS 1 in 10 patients; 2 pts PS 2. Dose reduction was necessary in 41.7% pts. Currently 5 pts are still alive and in the survey they scored the dosage regimen with ≤5 points at the beginning and the same after 3 cycles. The relevance of, information provided by the oncology pharmacist was evaluated with 10 points. Effectiveness: median PFS 3.1 months (0.5-8.3), 2 pts continue on treatment ( medianfollow-up 8.1 months). Overall survival is not evaluable. Grade 3/4 hemotologic toxicities were most common (anemia 8,3%, neutropenia 25%). Conclusions: The perceived dosage difficulty is low, contrary to expectations. It is important to emphasize the evaluation of the information provided by the oncological pharmacist. Our study supports an effectiviness similar than the efficacy. Hematological is the most important and common toxicity.
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Affiliation(s)
- Marca Diaz
- Gerencia de Atención Integrada de Albacete, Albacete, Spain
| | | | - Manuel Touris
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | - Yolanda Vidal
- Translational Oncology Laboratory, Medical Oncology Department, Santiago de Compostela, Spain
| | - Alicia Mosquera
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | - Elena Lopez
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | | | - Bibiana Sanchez
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | - Goretti Duran
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | - Cristina Gonzalez-Anleo
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | - Anais Garcia
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | - Rafael Lopez
- Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Maria J. Lamas
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | - Beatriz Bernardez
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago De Compostela, Spain
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Bernardez B, Jose GMARIA, Duran G, Esteban H, Vidal Y, Candamio S, Anido U, Lopez R, Lamas MJ. Adherence to capecitabine in patients with colorectal or gastric cancer using microelectronic monitoring systems. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e14671] [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)
- Beatriz Bernardez
- Complexo Hospitalario Universiatrio de Santiago de Compostela, Santiago de Compostela, Spain
| | - Giraldez MARIA Jose
- Hospital Clinico Universitario de Santiago de Compostela, Santiago De Comppostela, Spain
| | - Goretti Duran
- Complexo Hospitalario Universiatrio de Santiago de Compostela, Santiago de Compostela, Spain
| | - Helena Esteban
- Hospital Clinico Universitario De Santiago De Compostela, Santiago De Compostela, Spain
| | - Yolanda Vidal
- Translational Oncology Laboratory, Medical Oncology Department, Santiago de Compostela, Spain
| | | | - Urbano Anido
- Complexo Hospitalario Universitario de Santiago de Compostela, Santiado de Complostela, Spain
| | - Rafael Lopez
- Hospital Clinico Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | - Maria J. Lamas
- Complexo Hospitalario Universiatrio de Santiago de Compostela, Santiago de Compostela, Spain
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Lamas MJ, Duran G, Balboa E, Bernardez B, Touris M, Vidal Y, Gallardo E, Lopez R, Carracedo A, Barros F. Use of a comprehensive panel of biomarkers to predict response to a fluorouracil-oxaliplatin regimen in patients with metastatic colorectal cancer. Pharmacogenomics 2011; 12:433-42. [PMID: 21449681 DOI: 10.2217/pgs.10.196] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
AIM Polymorphisms in the metabolism, detoxification or DNA repair pathways have been proposed as potential predictors of response to 5-fluorouracil and oxaliplatin. We have studied the predictive value of a set of germline genetic polymorphisms in metastatic colorectal cancer patients treated with mFolfox-6. MATERIALS & METHODS A total of 72 patients, comprising 50 men (69.4%) and 22 women (30.6%), were included after the signing of an informed consent form. Median age was 65.5 years (range: 32-80). All participants received mFolfox-6. DNA was extracted from peripheral blood samples and genotyped by direct sequencing, SnapShot(®) and multiplex PCR techniques. Eight polymorphisms within six genes were investigated: TS 5´-UTR (variable number tandem repeat + G/C), TS 3´-UTR (TS1494del6); MTHFR C677T and A1298C; GSTP1 I105V; ERCC1 C118T; XPD Lys751Gln and XRCC1 Arg399Gln. Association was evaluated by univariate analysis, and Cox regression and Kaplan-Meier assessed survival. The local ethics committee approved the pharmacogenetic study protocol and all subjects signed an informed consent before participating in the study. RESULTS The sample was in Hardy-Weinberg equilibrium. Only XPD Lys751Gln was found to be significantly associated with a favorable progression-free survival (PFS). Median PFS for XPD Lys751Gln patients (n = 33) was 16 months (95% CI: 9.2-22.7), 10 months (95% CI: 6.1-13.9) for Gln/Gln (n = 11) and 8 months (95% CI: 5.8-10.2) for Lys/Lys (n = 28), p = 0.019. The increased risk of progression was: 1.93 (95% CI: 1.13-13.30; p = 0.017) for Lys/Lys and 2.1 (95% CI: 1.01-4.22; p = 0.047) for Gln/Gln. Patients with one or two Val alleles of GSTP1 tended to a lower risk of progression compared with Ile/Ile homozygotes, p = 0.067. When XPD Lys751Gln and GSTP1 were analyzed jointly, patients who carried one or two favorable genotypes, XPD Lys751Gln and Val, had a longer median PFS: 11 months (95% CI: 7.4-14.6) compared with six (95% CI: 4.6-7.4) with unfavorable genotypes, p < 0.001. CONCLUSION In metastatic colorectal cancer patients treated with mFolfox-6, the combination of haplotype XPD Lys751Gln-GSTP1 105Val seems to predict the risk of progression.
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Affiliation(s)
- Maria J Lamas
- Oncology Pharmacy Unit, Complejo Hospitalario Universitario of Santiago (CHUS), Choupana S/N, Santiago de Compostela 15706, Spain.
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Veiga R, Duran G, Lamas MJ, Cueva JF, Bernardez B, Curiel T, Lopez R. Practice pattern for patients receiving bevacizumab in metastatic breast cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e11533] [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: 11/20/2022] Open
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Lamas MJ, Duran G, Balboa E, Candamio S, Bernardez B, Carracedo A, Lopez R, Barros F. The value of genetic polymorphisms to predict toxicity in metastatic colorectal patients with irinotecan-based regimens. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14065] [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: 11/20/2022] Open
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Lamas MJ, Duran G, Balboa E, Bernardez B, Anido U, Gallardo E, Candamio S, Barros F, Carracedo A, Lopez R. Use of a comprehensive panel of biomarkers to predict response to a fluorouracil-oxaliplatin (mFOLFOX6) regimen in patients with metastatic colorectal cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e13504] [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: 11/20/2022] Open
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Rodriguez-Penin I, Lamas MJ, Iglesias-Santamaria A, Lema M, Bernardez B, Gonzalez-Pereira E, Busto F, Matilla B, Gonzalez P, Gonzalez-Costas S. Retrospective epidemiologic study to evaluate the pattern of use of biphosphonates in the treatment of bone metastasis in solid tumor cancer patients (REBIUS). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e19667] [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: 11/20/2022] Open
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Lamas MJ, Balboa E, Duran G, Rana P, Gomez A, Bernardez B, Lopez R, Carracedo A, Barros F. Analysis of pharmacogenetic biomarkers in rectal patients trated with chemoradiotherapy. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15051] [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
e15051 Background: 5FU-based chemoradiotherapy before total mesorectal excision (TME) is currently the gold standard treatment for stage II and III rectal cancer patients. Pathological complete response (pCR) is related with a longer survival. We have used known predictive pharmacogenetics biomarkers to identify in our series responders and non responders to preoperative RQ. Methods: 77 stage II/III rectal patients were genotyped using direct sequencing (TS VNTR) and SNAPshot (DPYD, EGFR) techniques. DNA was obtained from peripheral blood samples. We have studied Thymidylate synthetase (TS VNTR; high expression haplotypes: TSER 2R/3R, 3C/3G, 3G/3G and low expression: TSER 2R/2R, 2R/3C, 3C/3C; TS 1494del6: associated to a better efficay of 5Fu), dihydropyrimidine dehydrogenase (DPYD; DPYD*2 associated to worse toxicity), EGFR (CA repeats in intron 1: 16/16 associated to worse efficacy) polymorphisms. Median age of our study cohort was 65 years old (37–85). There were 24 female and 53 male patients. All of them were Caucasian. 21 patients (27.3%) had stage II and 56 (72.7%) stage III. They were staged by TC, colonoscopy and endorectal ultrasonography. The patients received 5fu 325 mg/m2/day continuous infusion along the hyperfractionated accelerated radiotherapy schedule (50,4 Gy). All were submitted to TME. Outcomes after surgery are measured by tumour regression grade (from TRG1= complete pathological response, to TRG5=no regression). Data were studied by univariate and multivariate analysis. Results: The sample was in Hardy-Weinberg equilibrium for all polymorphisms, irrespectively of the response status. 50 patients (64.9%) and 27 (35.1%) had low and high expression genotype for TS respectively. pCR (TRG1) was obtained in 24 patients (31,6%) and microscopic foci (TRG2) in 14 (18,2%), TRG 3–4 in 38 (49,3%), and 1 patient had no response (TRG5). We haven’t found a statistically significant relationship between TRG1 and TS status, or any other biomarker studied. There's no relationship also with initial clinical stage. Conclusions: Biomarkers EGFR (intron 1 CA repeats), TS (TS 1494del6, TS VNTR) and DPYD in blood samples, are not good enough to predict response to RQ in rectal cancer. No significant financial relationships to disclose.
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Affiliation(s)
- M. J. Lamas
- Hospital Clínico Universitario de Santiago, Santiago, Spain; Instituto Medicina Genomica Gallega, Santiago, Spain
| | - E. Balboa
- Hospital Clínico Universitario de Santiago, Santiago, Spain; Instituto Medicina Genomica Gallega, Santiago, Spain
| | - G. Duran
- Hospital Clínico Universitario de Santiago, Santiago, Spain; Instituto Medicina Genomica Gallega, Santiago, Spain
| | - P. Rana
- Hospital Clínico Universitario de Santiago, Santiago, Spain; Instituto Medicina Genomica Gallega, Santiago, Spain
| | - A. Gomez
- Hospital Clínico Universitario de Santiago, Santiago, Spain; Instituto Medicina Genomica Gallega, Santiago, Spain
| | - B. Bernardez
- Hospital Clínico Universitario de Santiago, Santiago, Spain; Instituto Medicina Genomica Gallega, Santiago, Spain
| | - R. Lopez
- Hospital Clínico Universitario de Santiago, Santiago, Spain; Instituto Medicina Genomica Gallega, Santiago, Spain
| | - A. Carracedo
- Hospital Clínico Universitario de Santiago, Santiago, Spain; Instituto Medicina Genomica Gallega, Santiago, Spain
| | - F. Barros
- Hospital Clínico Universitario de Santiago, Santiago, Spain; Instituto Medicina Genomica Gallega, Santiago, Spain
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