1
|
Yubero A, Estévez P, Barquín A, Sánchez L, Santaballa A, Pajares B, Reche P, Salvador C, Manso L, Márquez R, González-Martín A. Rucaparib for PARP inhibitor-pretreated ovarian cancer: A GEICO retrospective subgroup analysis from the Spanish Rucaparib Access Program. Gynecol Oncol Rep 2023; 48:101211. [PMID: 37396679 PMCID: PMC10314222 DOI: 10.1016/j.gore.2023.101211] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 07/04/2023] Open
Abstract
The poly(ADP-ribose) polymerase inhibitor (PARPi) rucaparib is approved as maintenance therapy for patients with platinum-sensitive recurrent high-grade ovarian cancer (HGOC). The efficacy and safety of rucaparib after PARPi therapy are largely unknown; therefore, we analyzed outcomes in the subgroup of PARPi-pretreated patients from Spanish hospitals participating in the Rucaparib Access Program. This post hoc subgroup analysis explored baseline characteristics, treatment exposure, safety, effectiveness, and subsequent therapy among women receiving rucaparib 600 mg twice daily after at least one prior PARPi for HGOC. Of 14 women eligible for the analysis, 11 (79%) had tumors harboring BRCA1/2 mutations. Patients had received a median of 5 (range 3-8) treatment lines before rucaparib. Twelve patients (86%) had previously received olaparib and two (14%) niraparib; 12 patients received rucaparib as treatment for platinum-resistant HGOC, one as treatment for platinum-sensitive HGOC, and one as maintenance therapy. Progression-free survival was 0.2-9.1 months. One of seven patients assessable for response by RECIST achieved stable disease. Adverse events occurred in 11 patients (79%; grade 3 in 29%), leading to treatment interruption in eight patients (57%), dose reduction in six (43%), but treatment discontinuation in only one (7%). No new safety signals were observed. This is one of the first reported series of real-world data on rucaparib after prior PARPi for HGOC. In this heavily pretreated population, rucaparib demonstrated meaningful activity in some patients and tolerability consistent with previous prospective trials. Future investigation should focus on identifying patients who may benefit from rucaparib after prior PARPi exposure.
Collapse
Affiliation(s)
- Alfonso Yubero
- Medical Oncology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Aránzazu Barquín
- Medical Oncology, Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - Luisa Sánchez
- Medical Oncology, Clínica Universidad de Navarra, Madrid, Spain
| | - Ana Santaballa
- Medical Oncology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Bella Pajares
- Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Piedad Reche
- Medical Oncology, Hospital Universitario Torrecárdenas, Almería, Spain
| | - Carmen Salvador
- Medical Oncology, Hospital Lluís Alcanyís de Xàtiva, Xàtiva, Spain
| | - Luis Manso
- Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Raúl Márquez
- Medical Oncology, MD Anderson Cancer Center, Madrid, Spain
| | - Antonio González-Martín
- Medical Oncology, Clínica Universidad de Navarra, Madrid, Spain
- Centre for Applied Medical Research, Pamplona, Spain
| |
Collapse
|
2
|
Cerezo MV, Soria-Reyes LM, Pajares B, Gómez-Millán J, Blanca MJ. Development and psychometric properties of the Stressors in Breast Cancer Scale. Front Psychol 2023; 14:1102169. [PMID: 37057161 PMCID: PMC10086352 DOI: 10.3389/fpsyg.2023.1102169] [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] [Received: 11/18/2022] [Accepted: 02/23/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundA diagnosis of breast cancer generates psychological stress, due not only to treatment and its side effects but also to the impact on different areas of the patient’s daily life. Although there are instruments for measuring psychological stress in the cancer context, there is currently no tool for assessing stressors specific to breast cancer.AimsThe aim of this study was to develop the Stressors in Breast Cancer Scale (SBCS).MethodA panel of experts evaluated the clarity and relevance of scale items, providing validity evidence based on test content. Psychometric properties of the scale were then analyzed.ResultsValidity evidence based on the internal structure of the SBCS was obtained through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), following a cross-validation strategy. The CFA supported a second-order factor model with five dimensions: physical appearance and sex strains, health and daily difficulties, interpersonal relationship strains, healthcare strains, and worries and concerns about the future. This structure was invariant across two groups distinguished by time from cancer diagnosis (less than 3 and 3 years or more from diagnosis). Reliability, based on McDonald’s omega and Cronbach’s alpha coefficients, ranged from 0.83 to 0.89 for factor scores, and reached 0.95 for total scores. Validity evidence was also provided by correlations with depression, anxiety, perceived stress, and perceived health and quality of life.DiscussionThe results support the use of the SBCS for measuring stress as a stimulus in the breast cancer context. Implications for clinical practice and research are discussed.
Collapse
Affiliation(s)
- M. Victoria Cerezo
- Department of Psychobiology and Methodology of Behavioural Sciences, University of Malaga, Málaga, Spain
- *Correspondence: M. Victoria Cerezo,
| | - Lorena M. Soria-Reyes
- Department of Psychobiology and Methodology of Behavioural Sciences, University of Malaga, Málaga, Spain
| | - Bella Pajares
- Instituto de Investigaciones Biomédicas de Málaga, University of Malaga, Málaga, Spain
| | - Jaime Gómez-Millán
- Instituto de Investigaciones Biomédicas de Málaga, University of Malaga, Málaga, Spain
| | - María J. Blanca
- Department of Psychobiology and Methodology of Behavioural Sciences, University of Malaga, Málaga, Spain
| |
Collapse
|
3
|
Roldán-Jiménez C, Martín-Martín J, Pajares B, Ribelles N, Alba E, Cuesta-Vargas AI. Factors associated with upper limb function in breast cancer survivors. PM R 2023; 15:151-156. [PMID: 34713595 DOI: 10.1002/pmrj.12731] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 09/24/2021] [Accepted: 10/25/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Breast cancer survivors may have side effects from treatment, such as impaired upper limb function after surgery, which may be affected by a range of factors. OBJECTIVE To analyze the association between upper limb function and strength, fear avoidance, and central sensitization symptoms among breast cancer survivors, and to explore how these variables are associated with upper limb function. DESIGN Validation cohort. SETTING Institutional practice at a public hospital. PATIENTS One hundred seventy-four breast cancer survivors who had been undergone surgery for a primary tumor. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Upper limb function was measured by the Upper Limb Functional Index (ULFI-Sp). Independent outcomes were: handgrip strength, which was measured using a Jamar dynamometer on the dominant side; fear avoidance, measured using the Fear-Avoidance Components Scale (FACS-Sp); and central sensitization symptoms, which were measured using the Central Sensitisation Inventory (CSI-Sp). A linear regression model explaining the ULFI-Sp results was constructed with the variables. RESULTS The regression model was significant (F = 46.826; p < .0001), and explained 45% of the variance of the ULFI values. All variables showed strong associations with upper limb function. CONCLUSIONS Greater upper limb function is associated with higher grip strength, lower fear-avoidance behavior and fewer central sensitization symptoms among breast cancer survivors. These variables explained 45% of the upper limb function in the regression model, and concur with earlier research showing that factors such as central sensitization symptoms and kinesiophobia negatively affect upper limb function in such patients. Clinicians should therefore take into account strength, fear avoidance, and central sensitization symptoms when considering interventions aimed at improving upper limb function among breast cancer survivors.
Collapse
Affiliation(s)
- Cristina Roldán-Jiménez
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Andalucía Tech., Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Grupo de Clinimetría (F-14), Málaga, Spain
| | - Jaime Martín-Martín
- Instituto de Investigación Biomédica de Málaga (IBIMA), Grupo de Clinimetría (F-14), Málaga, Spain.,Department of Human Anatomy, Legal Medicine and History of Science; Area of Legal Medicine, University of Málaga, Faculty of Medicine, Málaga, Spain
| | - Bella Pajares
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Nuria Ribelles
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Emilio Alba
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Antonio I Cuesta-Vargas
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Andalucía Tech., Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Grupo de Clinimetría (F-14), Málaga, Spain.,School of Clinical Science, Faculty of Health Science, Queensland University Technology, Brisbane, Queensland, Australia
| |
Collapse
|
4
|
Yubero A, Barquín A, Estévez P, Pajares B, Sánchez L, Reche P, Alarcón J, Calzas J, Gaba L, Fuentes J, Santaballa A, Salvador C, Manso L, Herrero A, Taus Á, Márquez R, Madani J, Merino M, Marquina G, Casado V, Constenla M, Gutiérrez M, Dosil A, González-Martín A. Rucaparib in recurrent ovarian cancer: real-world experience from the rucaparib early access programme in Spain – A GEICO study. BMC Cancer 2022; 22:1150. [DOI: 10.1186/s12885-022-10191-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background:
Rucaparib is a poly(ADP-ribose) polymerase inhibitor approved in Europe as maintenance therapy for recurrent platinum-sensitive (Pt-S) ovarian cancer (OC). The Rucaparib Access Programme (RAP) was designed to provide early access to rucaparib for the above-mentioned indication, as well as for patients with BRCA-mutated Pt-S or platinum-resistant (Pt-R) OC and no therapeutic alternatives.
Methods:
In this observational, retrospective study we analysed the efficacy and safety of rucaparib within the RAP in Spain. Hospitals associated with the Spanish Ovarian Cancer Research Group (GEICO) recruited patients with high-grade epithelial ovarian, fallopian tube, or primary peritoneal cancer treated with rucaparib 600 mg twice daily as maintenance or treatment (Pt-S/Pt-R) in the RAP. Baseline characteristics, efficacy, and safety data were collected.
Results:
Between July 2020 and February 2021, 51 patients treated in 22 hospitals in the RAP were included in the study. Eighteen patients with a median of 3 (range, 1–6) prior treatment lines received rucaparib as maintenance; median progression-free survival (PFS) for this group was 9.1 months (95% confidence interval [CI], 4.2–11.6 months). Among 33 patients (median 5 [range, 1–9] prior treatment lines) who received rucaparib as treatment, 7 and 26 patients had Pt-S and Pt-R disease, respectively. Median PFS was 10.6 months (95% CI, 2.5 months-not reached) in the Pt-S group and 2.2 months (95% CI, 1.1–3.2 months) in the Pt-R group. Grade ≥ 3 treatment-emergent adverse events were reported in 39% of all patients, the most common being anaemia (12% and 15% in the maintenance and treatment groups, respectively). At data cut-off, 5 patients remained on treatment.
Conclusion
Efficacy results in these heavily pre-treated patients were similar to those from previous trials. The safety profile of rucaparib in real life was predictable and manageable.
Collapse
|
5
|
Pérez‐Cruzado D, Roldan‐Jimenez C, Iglesias‐Campos M, Pajares B, Alba E, Cuesta‐Vargas A. Validation of pain catastrophizing scale on breast cancer survivor. Pain Pract 2022; 22:711-717. [PMID: 36136052 PMCID: PMC9828215 DOI: 10.1111/papr.13163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 06/23/2022] [Accepted: 09/19/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Pain catastrophizing scale (PCS) is the most used scale to measure pain catastrophizing. In breast cancer survivors (BCS), pain catastrophizing is related to upper-limbs dysfunction and disability. This study aimed to assess the internal consistency, internal structure, and convergent validity of the Spanish version of the PCS in Spanish BCS. MATERIAL AND METHODS Breast cancer survivors were recruited from the service of Medical Oncology of the University Clinical Hospital Virgen de la Victoria, in Málaga (Spain). The psychometric properties were evaluated with analysis factor structure by maximum likelihood extraction (MLE), internal consistency, and construct validity by confirmatory factor analysis (CFA). RESULTS Factor structure was three-dimensional, and one item was removed due to cross-loading. The new 12-item PCS showed a high internal consistency for the total score (α = 0.91) and a good homogeneity, and CFA revealed a satisfactory fit. PCS showed an acceptable correlation with FACS (r = 0.53, p < 0.01). CONCLUSION Pain catastrophizing scale is a valid and reliable instrument to evaluate pain catastrophizing in Spanish BCS. This tool may help clinicians in the management of pain by assessing pain and by measuring the effect of interventions.
Collapse
Affiliation(s)
- David Pérez‐Cruzado
- Departamento de Fisioterapia, Facultad de Ciencias de la SaludUniversidad de Málaga, Andalucía Tech.MálagaColombia,Instituto de Investigación Biomédica de Málaga (IBIMA) Grupo de Clinimetría (F‐14)MálagaColombia
| | - Cristina Roldan‐Jimenez
- Departamento de Fisioterapia, Facultad de Ciencias de la SaludUniversidad de Málaga, Andalucía Tech.MálagaColombia,Instituto de Investigación Biomédica de Málaga (IBIMA) Grupo de Clinimetría (F‐14)MálagaColombia
| | - Marcos Iglesias‐Campos
- UGCI Oncología Médica Hospitales Universitarios Regional y Virgen de la VictoriaMálagaColombia,Instituto de Investigación Biomédica de Málaga (IBIMA)MálagaSpain
| | - Bella Pajares
- UGCI Oncología Médica Hospitales Universitarios Regional y Virgen de la VictoriaMálagaColombia,Instituto de Investigación Biomédica de Málaga (IBIMA)MálagaSpain
| | - Emilio Alba
- UGCI Oncología Médica Hospitales Universitarios Regional y Virgen de la VictoriaMálagaColombia,Instituto de Investigación Biomédica de Málaga (IBIMA)MálagaSpain
| | - Antonio Cuesta‐Vargas
- Departamento de Fisioterapia, Facultad de Ciencias de la SaludUniversidad de Málaga, Andalucía Tech.MálagaColombia,Instituto de Investigación Biomédica de Málaga (IBIMA) Grupo de Clinimetría (F‐14)MálagaColombia,School of Clinical Science, Faculty of Health ScienceQueensland University TechnologyBrisbaneQueenslandAustralia
| |
Collapse
|
6
|
Escriche-Escuder A, Trinidad-Fernández M, Pajares B, Iglesias-Campos M, Alba E, García-Almeida JM, Roldán-Jiménez C, Cuesta-Vargas AI. Responsiveness of the new index muscular echotexture in women with metastatic breast cancer: an exercise intervention study. Sci Rep 2022; 12:15148. [PMID: 36071122 PMCID: PMC9452568 DOI: 10.1038/s41598-022-19532-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 08/30/2022] [Indexed: 12/05/2022] Open
Abstract
Ultrasound imaging texture analyses may provide information on tissue homogeneity changes in metastatic breast cancer (MBC) through second-order analyzes based on the gray-level co-occurrence matrix. This study aimed to analyze the responsiveness and correlations of biomarkers of muscular and fat echotexture after an exercise intervention in women with MBC. A 12-week exercise intervention was conducted in 2019, including aerobic and strength training. Echotexture variables were obtained at baseline and after intervention from the quadriceps (Q) and biceps brachii and brachialis. Mean differences were calculated using the T-Student parametric test for dependent samples of the differences in the means (P = 0.05; 95% CI). Data obtained from 13 MBC women showed significant differences in some echotexture variables after the intervention. QLQ-BR23 questionnaire correlated with several echotexture variables from muscle and subcutaneous fat. PFS-R scale correlated positively with the Q Subcutaneous Fat Non-Contraction Homogeneity (R = 0.43, P < 0.05). Q Muscle Non-Contraction Energy and Q Muscle Non-Contraction Textural Correlation explained 90% of the variance of QLQ-BR23. Some muscle and subcutaneous fat echotexture biomarkers showed good responsiveness after the exercise intervention. Additionally, some muscle and subcutaneous fat variables correlated with QLQ-BR23 and cancer-related fatigue measured by PFS-R scale in MBC patients. Trial registration: NCT03879096
Collapse
Affiliation(s)
- Adrian Escriche-Escuder
- Department of Physiotherapy, University of Malaga, C/ Arquitecto Peñalosa, 3, 29071, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Manuel Trinidad-Fernández
- Department of Physiotherapy, University of Malaga, C/ Arquitecto Peñalosa, 3, 29071, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Bella Pajares
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,UGCI Oncología Médica Hospitales Universitarios Regional y Virgen de la Victoria, Málaga, Spain
| | - Marcos Iglesias-Campos
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,UGCI Oncología Médica Hospitales Universitarios Regional y Virgen de la Victoria, Málaga, Spain
| | - Emilio Alba
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,UGCI Oncología Médica Hospitales Universitarios Regional y Virgen de la Victoria, Málaga, Spain
| | - José Manuel García-Almeida
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,UGCI Endocrinología y Nutrición, Hospital Regional Universitario y Virgen de la Victoria, Málaga, Spain
| | - Cristina Roldán-Jiménez
- Department of Physiotherapy, University of Malaga, C/ Arquitecto Peñalosa, 3, 29071, Málaga, Spain. .,Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.
| | - Antonio I Cuesta-Vargas
- Department of Physiotherapy, University of Malaga, C/ Arquitecto Peñalosa, 3, 29071, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| |
Collapse
|
7
|
Pajares B, Roldán-Jiménez C, Alba E, Cuesta-Vargas AI. Implementation of a Standard Care Program of Therapeutic Exercise in Metastatic Breast Cancer Patients. Int J Environ Res Public Health 2022; 19:11203. [PMID: 36141470 PMCID: PMC9517612 DOI: 10.3390/ijerph191811203] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND There is little information on the feasibility and benefit of therapeutic exercise (TE) in women with metastatic breast cancer (MBC). The aim of this article is to describe the implementation of a TE intervention in MBC patients, and to determine the recruitment, compliance and improvement in outcomes after its completion. METHODS The "Therapeutic Exercise program in MBC" (TEP-MBC) consists of 1 h of individualized TE supervised by a physiotherapist in a group format, consisting of four groups of seven to eight participants. TEP-MBC was delivered twice a week, lasting 12 weeks (22 sessions), with patients considered to have completed the program when attending at least 17 sessions (>75% attendance). After referral, patients underwent a clinical interview and a physical and functional assessment. This information was complemented with patient-reported outcomes. Data about referral, compliance and assessment were collected. RESULTS Only 11 of the 30 patients completed the program. Drop-out was mainly related to personal issues and symptoms arising from the disease or treatment. All patients who completed the program improved cancer-related fatigue and increased their functional parameters. CONCLUSIONS The TEP-MBC was safe and feasible in patients with MBC, although with low compliance. The high variability in baseline measures reflects the heterogeneous level of function.
Collapse
Affiliation(s)
- Bella Pajares
- UGCI Oncología Médica Hospitales Universitarios Regional y Virgen de la Victoria, 29010 Málaga, Spain
| | - Cristina Roldán-Jiménez
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Andalucia Tech, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29590 Málaga, Spain
| | - Emilio Alba
- UGCI Oncología Médica Hospitales Universitarios Regional y Virgen de la Victoria, 29010 Málaga, Spain
| | - Antonio I. Cuesta-Vargas
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Andalucia Tech, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29590 Málaga, Spain
- School of Clinical Science, Faculty of Health Science, Queensland University Technology, 2 George St., Brisbane City, QLD 4000, Australia
| |
Collapse
|
8
|
Santonja Á, Moya-García AA, Ribelles N, Jiménez-Rodríguez B, Pajares B, Fernández-De Sousa CE, Pérez-Ruiz E, Del Monte-Millán M, Ruiz-Borrego M, de la Haba J, Sánchez-Rovira P, Romero A, González-Neira A, Lluch A, Alba E. Role of germline variants in the metastasis of breast carcinomas. Oncotarget 2022; 13:843-862. [PMID: 35782051 PMCID: PMC9245581 DOI: 10.18632/oncotarget.28250] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022] Open
Abstract
Most cancer-related deaths in breast cancer patients are associated with metastasis, a multistep, intricate process that requires the cooperation of tumour cells, tumour microenvironment and metastasis target tissues. It is accepted that metastasis does not depend on the tumour characteristics but the host’s genetic makeup. However, there has been limited success in determining the germline genetic variants that influence metastasis development, mainly because of the limitations of traditional genome-wide association studies to detect the relevant genetic polymorphisms underlying complex phenotypes. In this work, we leveraged the extreme discordant phenotypes approach and the epistasis networks to analyse the genotypes of 97 breast cancer patients. We found that the host’s genetic makeup facilitates metastases by the dysregulation of gene expression that can promote the dispersion of metastatic seeds and help establish the metastatic niche—providing a congenial soil for the metastatic seeds.
Collapse
Affiliation(s)
- Ángela Santonja
- Instituto de Investigación Biomédica de Málaga (IBIMA), Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Spain.,Laboratorio de Biología Molecular del Cáncer, Centro de Investigaciones Médico-Sanitarias (CIMES), Universidad de Málaga, Málaga, Spain.,These authors contributed equally to this work
| | - Aurelio A Moya-García
- Laboratorio de Biología Molecular del Cáncer, Centro de Investigaciones Médico-Sanitarias (CIMES), Universidad de Málaga, Málaga, Spain.,Departmento de Biología Molecular y Bioquímica, Universidad de Málaga, Málaga, Spain.,These authors contributed equally to this work
| | - Nuria Ribelles
- Unidad de Gestión Clínica Intercentro de Oncología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain.,Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain
| | - Begoña Jiménez-Rodríguez
- Unidad de Gestión Clínica Intercentro de Oncología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain
| | - Bella Pajares
- Unidad de Gestión Clínica Intercentro de Oncología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain
| | - Cristina E Fernández-De Sousa
- Instituto de Investigación Biomédica de Málaga (IBIMA), Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Spain.,Laboratorio de Biología Molecular del Cáncer, Centro de Investigaciones Médico-Sanitarias (CIMES), Universidad de Málaga, Málaga, Spain
| | | | - María Del Monte-Millán
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | | | - Juan de la Haba
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain.,Biomedical Research Institute, Complejo Hospitalario Reina Sofía, Córdoba, Spain
| | | | - Atocha Romero
- Molecular Oncology Laboratory, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Anna González-Neira
- Human Genotyping-CEGEN Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Ana Lluch
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain.,Department of Oncology and Hematology, Hospital Clínico Universitario, Valencia, Spain.,INCLIVA Biomedical Research Institute, Universidad de Valencia, Valencia, Spain
| | - Emilio Alba
- Laboratorio de Biología Molecular del Cáncer, Centro de Investigaciones Médico-Sanitarias (CIMES), Universidad de Málaga, Málaga, Spain.,Unidad de Gestión Clínica Intercentro de Oncología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain.,Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain
| |
Collapse
|
9
|
Cuesta-Vargas A, Buchan J, Alba E, Iglesias Campos M, Roldán-Jiménez C, Pajares B. Development of a functional assessment task in metastatic breast cancer patients: the 30-second lie-to-sit test. Disabil Rehabil 2022; 45:1877-1884. [PMID: 35611501 DOI: 10.1080/09638288.2022.2076937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To develop a physical function test based on lie-to-sit transition and to study its feasibility in patients suffering from metastatic breast cancer (MBC). MATERIALS AND METHODS This cross-sectional study recruited 90 women diagnosed with MBC. Patients were asked to transfer from lying to sitting position as fast as possible during 30 s, performing the 30-second lie-to-sit test (30-LTS). Heart rate (HR), rate of perceived exertion (RPE) and number of repetitions were measured. An assessment included the 30-second sit-to-stand test (30-STS), handgrip strength, Upper Limb Functional Index (ULFI) and Lower Limb Functional Index (LLFI). Pearson correlation was calculated between 30-LTS and independent outcomes. A linear regression model explaining the 30-LTS results was further constructed with variables that had a significant correlation. RESULTS About 72 patients were measured, of which 65 were able to perform 30-LTS. Subjects performed 8.13 repetitions on average, with a mean RPE of 4.78 (0-10), reaching 63.08% of maximal HR. 30-LTS was significantly correlated with 30-STS (r = 0.567), handgrip (p = 0.26) and LLFI (r = 0.348). The regression model was significant (F = 4.742; p = 0.00), and these variables explained 32% of the variance of the 30-LTS. CONCLUSION The 30-LTS showed to be a feasible functional and submaximal test in a sample of MBC. IMPLICATIONS FOR REHABILITATIONThe 30-second lie-to-sit (30-LTS) developed does not require the patient to acquire a standing position and therefore it is an alternative to other more biomechanically demanding tests such as a 30 second sit-to-stand test or Timed up-and-go.30-LTS involves both a functional and energy system assessment tool that can be implemented by allied health professionals in oncology rehabilitation to individualize exercise prescription, as well as for functional screening purposes.The present study adds value to current research focused on individualizing exercise prescription in the oncology field and provides reference values of function in metastatic breast cancer patients.
Collapse
Affiliation(s)
- Antonio Cuesta-Vargas
- Physical Therapy Department, Faculty of Health Sciences, Málaga University, Andalucia Tech, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,School of Clinical Science, Faculty of Health Science, Queensland University Technology, Brisbane, Australia
| | - Jena Buchan
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Emilio Alba
- University Hospital Virgen de la Victoria, Málaga, Spain
| | - Marcos Iglesias Campos
- Unidad de Gestión Clínica Intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria. IBIMA, Málaga, Spain
| | - Cristina Roldán-Jiménez
- Physical Therapy Department, Faculty of Health Sciences, Málaga University, Andalucia Tech, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Bella Pajares
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| |
Collapse
|
10
|
Roldán-Jiménez C, Pajares B, Ruiz-Medina S, Trinidad-Fernández M, González-Sánchez M, Ribelles N, García-Almeida JM, Ríos-López MJ, Alba E, Cuesta-Vargas AI. Design and implementation of a standard care programme of therapeutic exercise and education for breast cancer survivors. Support Care Cancer 2022; 30:1243-1251. [PMID: 34463835 PMCID: PMC8405716 DOI: 10.1007/s00520-021-06470-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 07/24/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Breast cancer survivors (BCS) face several symptoms and are at higher risk of weight gain following diagnosis. Current literature shows that both exercise and diet play a key role in recovery of BCS. However, there is a gap between current guidelines and the real-world context. The aim of this article is to describe the process behind a free, not-for-profit community-based therapeutic exercise and education programme (TEEP) for BCS in the clinical setting. METHODS The "Onco-Health Club" (OHC) consists of therapeutic exercise (TE) intervention aimed at ameliorating cancer-related fatigue (CRF) and improving QoL and physical function. TE is supplemented with nutritional education, providing information about the Mediterranean diet. To this end, patients are recruited from an oncologist and are referred to a physiotherapist and a nutritionist for baseline assessment. TEEP consists of a 3-month intervention, delivered twice a week in a group format with 1 h of TE and 30 min of nutritional education. BCS then have a final assessment and are advised to continue with a healthy lifestyle. Data about referral, compliance and assessment were collected. RESULTS From May 2017 to February of 2020, a total of 158 patients were recruited from 8 cohorts and 142 initially started the OHC. From 119 that joined the program, 96 patients were considered to have finished it with good adherence (assistance > 80%). BCS significantly improved their QoL, as well as upper and lower limb's function, and increased their level of physical activity. CRF tended to decrease (p = 0.005). CONCLUSIONS This study obtained data on recruitment, compliance, and possible limitations of these kinds of programmes in a real-world context. Further research is needed in order to optimize patient engagement and compliance, as well as to determine the transferability of these programmes in the clinical setting. TRIAL REGISTRATION NCT03879096, Registered 18th March 2019. Retrospectively registered.
Collapse
Affiliation(s)
- Cristina Roldán-Jiménez
- Departamento de Fisioterapia, Facultad de Ciencias de La Salud, Universidad de Málaga, Andalucia Tech, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Bella Pajares
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | | | - Manuel Trinidad-Fernández
- Departamento de Fisioterapia, Facultad de Ciencias de La Salud, Universidad de Málaga, Andalucia Tech, Málaga, Spain
| | - Manuel González-Sánchez
- Departamento de Fisioterapia, Facultad de Ciencias de La Salud, Universidad de Málaga, Andalucia Tech, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Nuria Ribelles
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | | | | | - Emilio Alba
- Hospital Universitario Virgen de La Victoria, Málaga, Spain
| | - Antonio Ignacio Cuesta-Vargas
- Departamento de Fisioterapia, Facultad de Ciencias de La Salud, Universidad de Málaga, Andalucia Tech, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- School of Clinical Science, Faculty of Health Science, Queensland University Technology, Brisbane, Australia
| |
Collapse
|
11
|
Gutiérrez-Sánchez D, Roldán-Jiménez C, Pajares B, Alba E, Cuesta-Vargas AI. Validity and reliability of the Spanish fear-avoidance components scale in breast cancer survivors. Eur J Cancer Care (Engl) 2021; 30:e13506. [PMID: 34423870 DOI: 10.1111/ecc.13506] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The aim of this study was to carry out a psychometric analysis of the Fear-Avoidance Components Scale (FACS-Sp) in Spanish breast cancer survivors (BCS). METHODS A validation study was carried out in 154 BCS. Participants were recruited from the service of Medical Oncology of the University Clinical Hospital Virgen de la Victoria, in Málaga (Spain). A psychometric analysis of internal consistency, internal structure and convergent validity of the FACS-Sp was performed. Cronbach's alpha was calculated for internal consistency. Exploratory Factor Analysis was used to determine the internal structure of the FACS-Sp. Convergent validity with the Tampa Scale of Kinesiophobia (TSK) and the Pain Catastrophizing Scale (PCS) was determined using the Pearson correlation coefficient. RESULTS The internal consistency was high (McDonald's ω = 0.91). The Exploratory Factor Analysis yielded one factor explaining the 40.80% of total variance. Convergent validity with the TSK and the PCS was demonstrated. CONCLUSIONS The FACS-Sp has demonstrated to be a valid and reliable measure for assessing pain-related fear avoidance in BCS based on internal consistency, structural validity and convergent validity. Further studies that analyse other measurement properties in different Spanish cancer populations are needed.
Collapse
Affiliation(s)
| | - Cristina Roldán-Jiménez
- Department of Physiotherapy, University of Málaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Bella Pajares
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Emilio Alba
- Unidad de gestión clínica (UGI) Oncología Médica, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Antonio I Cuesta-Vargas
- Department of Physiotherapy, University of Málaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,School of Clinical Science, Faculty of Health Science, Queensland University of Technology, Brisbane, Queensland, Australia
| |
Collapse
|
12
|
Iglesias Campos M, Pajares B, Roldán Jiménez C, Jimenez B, Alba E, Cuesta Vargas A. Feasibility and patient perception of a web-based exercise program during COVID pandemic in breast and ovarian cancer patients. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e13623] [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
e13623 Background: Current literature shows us that therapeutic exercise has multiple benefits in oncology patients, such as improvement in quality of life or a reduction in cancer-related fatigue. Furthermore, given the risk of obesity, both exercise and diet play a key role in recovery from cancer. As a consequence of the COVID-19 pandemic, oncology patients present more difficulties to attend programs as they are considered a risk population, so new online exercise programs should be developed to ensure that patients take advantage of them in the post-COVID era. The main objective was to study patient´s perspectives and the feasibility of a web-based tailored and supervised therapeutic exercise program during COVID pandemic. Methods: A prospective study was performance on patients recruited from the Medical Oncology Unit of the Hospital Virgen de la Victoria, Malaga. Participants were between 18 and 65 years old and diagnosed of early resected breast cancer after finishing chemotherapy (CT) or metastatic ovarian (MOC) or breast cancer (MBC) with or without active treatment. Patients had had a good performance status (PS) with no prior cardiovascular history, and they were excluded if they were not used to online technologies. The duration of the program was 3 months, twice a week, delivered by a physiotherapist and a nutritionist. At the end of the program, women were asked 9 questions about their perspectives on the program. All of them signed informed consent. Results: 17 breast cancer survivor (BCS), 10 MBC and 3 MOC patients were initially recruited. From 30 patients recruited, 5 BCS did not started the program because of clinical contraindication and 5 patients left due to personal issues. 15 out of the remaining 20 completed the survey. All of patients reported that the program had contributed to improve their mood during the pandemic due to issues such functional ability, feeling better or less asthenia, and serving as improvement and encouragement in their lives. 86,7% reported having met their objectives and 100% reported going to continue doing some type of exercise or physical activity on a regular basis after the program is finished. Regarding advantages of online format compared to the face-to-face one, they reported avoiding displacement and lower risk of contagion. Lately, if they could participate again, 50% reported they would prefer online, while the remining 50% would prefer traditional modality. Conclusions: At the light of these results, the tele-exercise program contributed to improve the mood and fatigue of patients during the pandemic. The web-based program seems to be feasible and allow patients to meet their objectives after program completion and encourage them to keep doing some type of physical activity.
Collapse
Affiliation(s)
- Marcos Iglesias Campos
- Unidad de Gestión Clínica Intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, IBIMA, Málaga, Málaga, Spain
| | - Bella Pajares
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | | | | | - Emilio Alba
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | | |
Collapse
|
13
|
Pajares B, Iglesias Campos M, Díaz T, Peralta RJ, Alba E, Marquez A. Genetic and clinical characterization of multigene hereditary breast and ovarian cancer (HBOC) panels in Málaga (Spain). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e22530] [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
e22530 Background: Next Generation Sequencing (NGS) technologies have transformed hereditary breast and ovarian cancer (HBOC) testing process. Several multigene panels (MP) include from 10 to 100 candidate cancer susceptibility genes, but there is a debate about what genes should and should not be tested because of lack of actionability. Few studies have been reported about MP in Europe or Spanish cancer families and no studies in Andalusian population (southern Spain). Methods: We investigated a panel of 17 known genes of high/moderate-risk for HBOC in 938 clinically suspicious HBOC Andalusian families (SEOM 2015 criteria), tested from 2017 to 2019. Multigene panel including BRCA,1 BRCA2, CHEK2, PALB2, BRIP1, ATM, MLH1, MSH2, MSH6, PMS2, CDH1, NF1, PTEN, p53, STK11, RAD51C and RAD51D was performed. Results: We identified 130 patients who carried a high- or moderate-risk pathogenic variants: 61 in BRCA2 (47%), 30 in BRCA 1 (23%), 10 in CHEK2 (8%), 7 in ATM (5%), 7 in PALB2 (5%), 4 in RAD51 (3%), 4 in BRIP1 (3%), 4 in MSH6 (3%), 2 in MLH1 (1,5%) and 1 in MSH2. We detected 220 patients carry variants of uncertain significance (VUS), with a total of 248 VUS (some patients carried more than one VUS): 46 (19%) in ATM, 38 (15%) in BRCA 2, 28 (11%) in MSH6, 19 (8%) in PMS2, 17 (7%) in BRIP1, 16 (6%) in NF1, 14 (6%) in MSH2 and 12 (5%) in CDH1 and PALB2. The most frequent criteria in the entire cohort was “High-grade epithelial non-mucinous ovarian cancer”, reported in 243 cases (26%)”, whereas “Breast cancer (BC) diagnostic under 35” was the most frequent criteria between positives (48 cases (40%)). One case carried two pathogenic variants: BRCA2 and MUTYH. Conclusions: This is the first study reporting the mutational profile of MP gene testing in Andalusia. 70% of mutations were due to BRCA1 and 2 followed by far by CHEK2, ATM and PALB2. We also identified a large amount of VUS in BRCA2, ATM and MSH6. MP improve the diagnostic in andalusian HBOC patients.
Collapse
Affiliation(s)
- Bella Pajares
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Marcos Iglesias Campos
- Unidad de Gestión Clínica Intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, IBIMA, Málaga, Málaga, Spain
| | | | - Rafael Jesus Peralta
- Unidad de Gestión Clínica Intercentros de Oncología Médica. Hospitales Universitarios Regional y Virgen de la Victoria, IBIMA Málaga, Malaga, Spain
| | - Emilio Alba
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Antonia Marquez
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| |
Collapse
|
14
|
Iglesias Campos M, Pajares B, Roldán Jiménez C, Bermejo-Perez MJ, Alba E, Cuesta Vargas A. Functional status of patients suffering from ovarian cancer: A cross-sectional study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e17556] [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
e17556 Background: Physical activity displays multiple benefits in oncology patients, with the strongest evidence related to breast cancer. But there is little information about patient with ovarian cancer, even less in those who are metastatic. The main objective of this study was to assess and describe the performance´s in patients suffering from ovarian cancer in terms of function and cancer-related fatigue (CRF). Methods: Patients willing to join therapeutic exercise program (TEP) were at the Medical Oncology Unit of the Hospital Virgen de la Victoria, Malaga. A physiotherapist carried out an interview and a baseline assessment. The following outcomes were recorded: number of repetitions (n) performed in 30 seconds sit-to-stand test (30-STS), handgrip strength (Kg), cancer related fatigue (CRF) measured by Piper Fatigue Scale (0-10), upper and lower limb function measured by Upper Limb Functional Index (ULFI) and Lower Upper Limb Functional Index (LLFI), respectively (%). Results: Patients recruited had a diagnosed of an advanced ovarian cancer receiving or not active treatment. All participants had a good performance status (PS) and signed informed consent. 8 women were included, with a mean age of 52.66 (9.53) years and a mean BMI of 27.22 (4.56) kg/m2. Women performed 22 (4.24) repetitions of 30-STS test. Handgrip strength was 22 (2.7) Kg and CRF 5.43 (2.91) points. Patients reported 64.81% (34.65) and 66.83% (37.91) in ULFI and LLFI questionnaires, respectively. Conclusions: At the light of these preliminary results, ovarian cancer patients present a good level of function measured by 30-STS and a good grip strength. However, they report a moderate level of CRF and affected upper and lower limbs function. In additions, patients measured had function enough to participate in a therapeutic exercise program. Given the heterogeneity of the sample and its low number of participants, future studies with a wider sample should be carried out.
Collapse
Affiliation(s)
- Marcos Iglesias Campos
- Unidad de Gestión Clínica Intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, IBIMA, Málaga, Málaga, Spain
| | - Bella Pajares
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | | | - Maria-Jose Bermejo-Perez
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Emilio Alba
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | | |
Collapse
|
15
|
Escriche-Escuder A, Trinidad-Fernández M, Pajares B, Iglesias-Campos M, Alba E, Cuesta-Vargas AI, Roldán-Jiménez C. Ultrasound use in metastatic breast cancer to measure body composition changes following an exercise intervention. Sci Rep 2021; 11:8858. [PMID: 33893370 PMCID: PMC8065020 DOI: 10.1038/s41598-021-88375-5] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/12/2021] [Indexed: 01/04/2023] Open
Abstract
Changes in body composition and muscle dysfunction are common in metastatic breast cancer (MBC). Ultrasound imaging (US) offers reliable information about muscle and fat tissue architecture (thickness) and quality (echo-intensity). This study aimed to analyze the responsiveness of thickness and echo-intensity and its possible relationship with functional and patient reported-outcomes (PRO) in MBC patients after an exercise intervention. A prospective study was conducted in 2019. A 12-week exercise program was performed, including aerobic exercise and strength training. Measurements were made at baseline and after intervention. Thickness and echo-intensity were obtained from the quadriceps and biceps brachii and brachialis (BB). Mean differences were calculated using the T-Student parametric test for dependent samples of the differences in the means before and after the intervention (p = 0.05; 95% CI). Data from 13 MBC patients showed that some US muscle variables had significant differences after intervention. Best correlations were found between the quality of life questionnaire (QLQ-BR23) PRO and variables from BB muscle thickness in contraction (r = 0.61, p < 0.01), and Non-contraction (r = 0.55, p < 0.01). BB Muscle Non-contraction Thickness also explained 70% of QLQ-BR23 variance. In conclusion, muscle architecture biomarkers showed great responsiveness and are correlated with PRO after an exercise intervention in MBC patients.
Collapse
Affiliation(s)
- Adrian Escriche-Escuder
- Department of Physiotherapy, University of Malaga, C/Arquitecto Peñalosa, 3, 29071, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Manuel Trinidad-Fernández
- Department of Physiotherapy, University of Malaga, C/Arquitecto Peñalosa, 3, 29071, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Bella Pajares
- UGCI Oncológica Médica, Hospital Regional Universitario y Virgen de la Victoria, Málaga, Spain
| | - Marcos Iglesias-Campos
- UGCI Oncológica Médica, Hospital Regional Universitario y Virgen de la Victoria, Málaga, Spain
| | - Emilio Alba
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- UGCI Oncológica Médica, Hospital Regional Universitario y Virgen de la Victoria, Málaga, Spain
| | - Antonio I Cuesta-Vargas
- Department of Physiotherapy, University of Malaga, C/Arquitecto Peñalosa, 3, 29071, Málaga, Spain.
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Cristina Roldán-Jiménez
- Department of Physiotherapy, University of Malaga, C/Arquitecto Peñalosa, 3, 29071, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| |
Collapse
|
16
|
Roldán-Jiménez C, Pajares B, Iglesias Campos M, Trinidad-Fernández M, Gutiérrez-Sánchez D, Ribelles N, Alba E, Cuesta-Vargas AI. Structural validity and reliability of the Spanish Central Sensitization Inventory in breast cancer survivors. Pain Pract 2021; 21:740-746. [PMID: 33768652 DOI: 10.1111/papr.13009] [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] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/07/2021] [Accepted: 03/17/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION One of the most widely used instruments to identify symptoms that may be related to central sensitization is the Central Sensitization Inventory (CSI). Although this instrument has been translated and validated in Spanish patients with chronic musculoskeletal pain, no psychometric analysis has been carried out in breast cancer survivors. The aim of this study was to perform a psychometric analysis of the Spanish version of the Central Sensitization Inventory (CSI-Sp) in Spanish breast cancer survivors. MATERIALS AND METHODS A validation study was carried out in 183 breast cancer survivors. A psychometric analysis of internal consistency, factor structure, and test-retest reliability of the CSI-Sp was performed. Internal consistency was determined using Cronbach's alpha. Test-retest reliability was evaluated using the Intraclass Correlation Coefficient (ICC) Type 2.1. Exploratory factor analysis was used to determine the internal structure of the questionnaire. RESULTS The internal consistency was high (α = 0.91). The test-retest reliability was satisfactory with excellent values (ICC 2.1 = 0.95). The exploratory factor analysis yielded a one factor structure explaining the 33.88% of total variance. CONCLUSIONS The CSI-Sp has demonstrated to be a psychometrically strong measure for assessing central sensitization symptoms in breast cancer survivors based on internal consistency, test-retest reliability, and structural validity. Further studies that analyze other measurement properties in different Spanish clinical populations are needed.
Collapse
Affiliation(s)
- Cristina Roldán-Jiménez
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Andalucia Tech, Universidad de Málaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Bella Pajares
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Marcos Iglesias Campos
- Unidad de Gestión Clínica Intercentros de Oncología Médica, IBIMA, Hospitales Universitarios Regional y Virgen de la Victoria, Málaga, Spain
| | - Manuel Trinidad-Fernández
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Andalucia Tech, Universidad de Málaga, Málaga, Spain
| | - Daniel Gutiérrez-Sánchez
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,Departamento de Enfermería y Podología, Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, Spain
| | - Nuria Ribelles
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Emilio Alba
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Antonio Ignacio Cuesta-Vargas
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Andalucia Tech, Universidad de Málaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,School of Clinical Science, Faculty of Health Science, Queensland University Technology, Brisbane City, Qld, Australia
| |
Collapse
|
17
|
Ribelles N, Jerez JM, Rodriguez-Brazzarola P, Jimenez B, Diaz-Redondo T, Mesa H, Marquez A, Sanchez-Muñoz A, Pajares B, Carabantes F, Bermejo MJ, Villar E, Dominguez-Recio ME, Saez E, Galvez L, Godoy A, Franco L, Ruiz-Medina S, Lopez I, Alba E. Machine learning and natural language processing (NLP) approach to predict early progression to first-line treatment in real-world hormone receptor-positive (HR+)/HER2-negative advanced breast cancer patients. Eur J Cancer 2020; 144:224-231. [PMID: 33373867 DOI: 10.1016/j.ejca.2020.11.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND CDK4/6 inhibitors plus endocrine therapies are the current standard of care in the first-line treatment of HR+/HER2-negative metastatic breast cancer, but there are no well-established clinical or molecular predictive factors for patient response. In the era of personalised oncology, new approaches for developing predictive models of response are needed. MATERIALS AND METHODS Data derived from the electronic health records (EHRs) of real-world patients with HR+/HER2-negative advanced breast cancer were used to develop predictive models for early and late progression to first-line treatment. Two machine learning approaches were used: a classic approach using a data set of manually extracted features from reviewed (EHR) patients, and a second approach using natural language processing (NLP) of free-text clinical notes recorded during medical visits. RESULTS Of the 610 patients included, there were 473 (77.5%) progressions to first-line treatment, of which 126 (20.6%) occurred within the first 6 months. There were 152 patients (24.9%) who showed no disease progression before 28 months from the onset of first-line treatment. The best predictive model for early progression using the manually extracted dataset achieved an area under the curve (AUC) of 0.734 (95% CI 0.687-0.782). Using the NLP free-text processing approach, the best model obtained an AUC of 0.758 (95% CI 0.714-0.800). The best model to predict long responders using manually extracted data obtained an AUC of 0.669 (95% CI 0.608-0.730). With NLP free-text processing, the best model attained an AUC of 0.752 (95% CI 0.705-0.799). CONCLUSIONS Using machine learning methods, we developed predictive models for early and late progression to first-line treatment of HR+/HER2-negative metastatic breast cancer, also finding that NLP-based machine learning models are slightly better than predictive models based on manually obtained data.
Collapse
Affiliation(s)
- Nuria Ribelles
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain.
| | - Jose M Jerez
- University of Málaga, Department of Languages and Computer Science, E.T.S.I. Computing, Málaga, Spain
| | | | - Begoña Jimenez
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| | - Tamara Diaz-Redondo
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| | - Hector Mesa
- University of Málaga, Department of Languages and Computer Science, E.T.S.I. Computing, Málaga, Spain
| | - Antonia Marquez
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| | - Alfonso Sanchez-Muñoz
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| | - Bella Pajares
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| | - Francisco Carabantes
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| | - Maria J Bermejo
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| | - Ester Villar
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| | - Maria E Dominguez-Recio
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| | - Enrique Saez
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| | - Laura Galvez
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| | - Ana Godoy
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| | - Leo Franco
- University of Málaga, Department of Languages and Computer Science, E.T.S.I. Computing, Málaga, Spain
| | - Sofia Ruiz-Medina
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| | - Irene Lopez
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| | - Emilio Alba
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| |
Collapse
|
18
|
Ruíz S, Pajares B, Bermejo-Perez MJ, Roldán Jiménez C, Cuesta Vargas A, Alba Conejo E. Effect of tailored and supervised therapeutic exercise in metastatic breast cancer patients: A prospective study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e13075] [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
e13075 Background: The safety, feasibility and benefit of physical activity is robust in adjuvant breast cancer, but as far as we know, there is little information on the feasibility and benefit of exercise in women with advanced breast cancer. The objective of our study is to analyze the feasibility and impact on fatigue, quality of life and functionality of an individualized, prospective and supervised exercise program in a group of patients with metastatic breast cancer. Methods: A prospective study on 30 metastatic breast cancer patients who were recruited as volunteers between February 2018 and April 2019 by Medical Oncologists from the Medical Oncology Unit at University Clinical Hospital Virgen de la Victoria (Malaga, Spain). Participants included in this study were patients aged between 34 and 71 years old and all had metastatic breast cancer, not amenable to curative treatment. The intervention was a twelve-week Therapeutic Exercise and Education Programme delivered by a physiotherapist. The intervention was preceded by a physical assessment of the musculoskeletal system. The outcomes were cancer-related fatigue, quality of life and functional outcomes (patient- reported and other measured by investigators). Results: Of the 30 patients initially recruited, only 11 of them completed the program with an attendance greater or equal to 17 sessions (75% of assistance). Most of patients who dropped (19), did it because of personal matters, not related to disease progression. Regarding patients who completed the completion of physical activity program (n = 11), the majority were treated on first line of treatment with hormonal receptors positive tumors and bone metastasis. After the intervention, no major changes were observed in cancer-related fatigue, quality of life and several patients-reported outcomes, although an improvement in functionality was observed, in investigator-measured parameters (30-STS and adapted burpees). Conclusions: Our study shows that a supervised and individualized tailored physical activity program in metastatic breast cancer patients is safe and feasible, although more studies are needed to analyse its impact on improving functional parameters, fatigue and quality of life.
Collapse
Affiliation(s)
- Sofía Ruíz
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Bella Pajares
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Maria-Jose Bermejo-Perez
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | | | | | | |
Collapse
|
19
|
Ruíz S, Pajares B, Iglesias Campos M, Roldán Jiménez C, Cuesta Vargas A, Alba Conejo E. Analysis of the fatigue benefit, functionality, and body composition of a program of therapeutic exercise and healthy lifestyle habits in patients breast cancer operated. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e12533] [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
e12533 Background: Numerous studies support the benefit of physical exercise in breast cancer, with a lower rate of fatigue, lower risk of recurrence and greater survival. In addition, it prevents cardiovascular diseases, diabetes and obesity. The objective of this work is to analyze the effect of a program of physical exercise and habits of healthy life on fatigue, functionality and body composition in breast cancer patients of the Medical Oncology Unit of the Hospital Virgen de la Victoria, Malaga. Methods: Prospective study on 97 patients with breast cancer after completing locoregional treatment and systemic chemotherapy. Treatment with hormone therapy and trastuzumab was allowed. All patients were without disease, without cardiovascular history that contraindicated the program and have signed the relevant informed consent. The duration of the program was 3 months and the parameter measurement was performed before and after. The main objective was analyze cancer-related fatigue and secondary functional parameters, anthropometric and adherence to Mediterranean diet. Fatigue, parameters functional and adherence to Mediterranean diet were evaluated by tests specific and anthropometric by different measurements including use of Tanita TBF-300A. Results: 97 patients were recruited, with a median age of 52 years (32 and 69), 60% had received neo/adjuvant chemotherapy, 84% hormonal therapy and 12% trastuzumab. Most patients underwent conservative surgery. (76%). After 3 months of intervention, women improved significantly cancer-related fatigue (p = 0.000), levels of diet adherence Mediterranean (p = 0.000), as well as functional parameters. One was observed statistically significant improvement in limb functionality/mobility upper, lower limb and general functionality (p = 0.005, p = 0.013 and 0.000, respectively). No differences were observed in terms of mass index body, fat mass or lean mass. Conclusions: This study shows the benefit in functionality and fatigue of an exercise program therapeutic and healthy lifestyle habits in breast cancer operated patients. Despite a significant increase in adherence to the Mediterranean diet, it is not they observed differences in anthropometric parameters.
Collapse
Affiliation(s)
- Sofía Ruíz
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Bella Pajares
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Marcos Iglesias Campos
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | | | | | | |
Collapse
|
20
|
Jerez JM, Ribelles N, Rodriguez-Brazzarola P, Diaz Redondo T, Jimenez Rodriguez B, Sanchez-Muñoz A, Marquez A, Carabantes F, Pajares B, Villar E, Bermejo-Perez MJ, Saez Lara E, Dominguez-Recio ME, Godoy A, Mesa H, Galvez Carvajal L, Franco L, Ruíz S, López I, Alba E. Prediction of early progression (EP) to CDKIs first line treatment in ER+/HER2- metastatic breast cancer (MBC) using machine learning. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e13040] [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
e13040 Background: The treatment of luminal MBC has undergone a substantial change with the use of cyclin dependent kinase 4/6 inhibitors (CDKIs). Nevertheless, there is not a clearly defined subgroup of patients who do not initially respond to CDKIs and show EP. Methods: MBC ER+/HER2- patients who have received at least one line of treatment were eligible. The event of interest was disease progression within 6 months of first line treatment according to the type of therapy administered. The first line treatments were categorized in chemotherapy (CT), hormonal therapy (HT), CT plus maintenance HT and HT plus CDKIs. Free text data from clinical visits registered in our Electronic Health Record were obtained until the date of first treatment in order to generate a feature vector composed of the word frequencies for each visit of every patient. Six different machine learning algorithms were evaluated to predict the event of interest and to obtain the risk of EP for every type of therapy. Area under the ROC curve (AUC), True Positive Rate (TPR) and True Negative Rate (TNR) were assessed using 10-fold cross validation. Results: 610 RE+/HER2- MBC treated between November 1991 and August 2019 were included. Median follow up for metastatic disease was 28 months. 17426 clinical visits were analyzed (per patient: range 1-173; median 30). 119 patients received CT as first line treatment, 311 HT, 117 CT plus maintenance HT and 63 HT plus CDKIs. There were 379 patients with disease progression, from which 126 were within 6 months from first line treatment (54 events with CT, 57 with HT, 4 with CT plus maintenance HT and 11 with HT plus CDKIs). The model that yields the best results was the GLMBoost algorithm: AUC 0.72 (95%CI 0.67-0.77), TPR 70.85% (95%CI 70.63%-71.06%), TNR 66.27% (95% 66.08%-66.46%). Conclusions: Our model based on unstructured data from real-world patients predicts EP and establishes the risk for each of the different types of treatment for MBC ER+/HER2-. Obviously an additional validation is needed, but a tool with these characteristics could help to select the best available treatment when that decision has to be made, avoiding those therapies that are probably not to be effective.
Collapse
Affiliation(s)
- Jose Manuel Jerez
- Grupo de Inteligencia Computacional en Biomedicina, ETSI Ingeniería Informática, Universidad de Málaga, Málaga, Spain
| | - Nuria Ribelles
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Pablo Rodriguez-Brazzarola
- Grupo de Inteligencia Computacional en Biomedicina, ETSI Ingeniería Informática, Universidad de Málaga, Málaga, Spain
| | - Tamara Diaz Redondo
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Begoña Jimenez Rodriguez
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Alfonso Sanchez-Muñoz
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Antonia Marquez
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Francisco Carabantes
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Bella Pajares
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Ester Villar
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Maria-Jose Bermejo-Perez
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Enrique Saez Lara
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, NJ, Spain
| | - Maria Emilia Dominguez-Recio
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Ana Godoy
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Hector Mesa
- Grupo de Inteligencia Computacional en Biomedicina, ETSI Ingeniería Informática, Universidad de Málaga, Málaga, Spain
| | - Laura Galvez Carvajal
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Leo Franco
- Grupo de Inteligencia Computacional en Biomedicina, ETSI Ingeniería Informática, Universidad de Málaga, Málaga, Spain
| | - Sofía Ruíz
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Irene López
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Emilio Alba
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Malaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| |
Collapse
|
21
|
Cuesta-Vargas AI, Pajares B, Trinidad-Fernandez M, Alba E, Roldan-Jiménez C. Inertial Sensors Embedded in Smartphones as a Tool for Fatigue Assessment Based on Acceleration in Survivors of Breast Cancer. Phys Ther 2020; 100:447-456. [PMID: 32031221 DOI: 10.1093/ptj/pzz173] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/05/2019] [Accepted: 09/23/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cancer-related fatigue is a symptom commonly reported in survivors of breast cancer and is the most variable symptom. Besides questionnaires like PIPER to assess cancer-related fatigue, there is a need to objectively measure fatigue. OBJECTIVE The aim of this study was to assess the physiological dimension of fatigue based on acceleration during a 30-second maximal sit-to-stand test. DESIGN This was a cross-sectional study. METHODS Linear acceleration from a smartphone placed on the sternum was recorded in 70 survivors of breast cancer. Fourth-degree polynomial adjustment from the acceleration signal to the vertical and anterior-posterior axis was calculated. The fatigue temporal cut-off point was detected as a change in the curve slope of the first maximum point of acceleration. RESULTS Women were aged 51.8 (8.9) years with a body mass index of 25.4 (5.1) Kg/m2. They performed 23.6 (6.57) number of repetitions. The mean fatigue cut-off point from the total sample was 10.2 (3.1) seconds. LIMITATIONS Further research should employ time-prolonged tests to study acceleration behavior beyond 30 seconds as well as include a physiological criterion that justifies the nonlinear saturation of the acceleration-based criterion. CONCLUSIONS This study assessed fatigue through a low-cost and easy-to-use methodology during a functional and widely used test such as 30-second maximal sit-to-stand. This would allow clinicians to assess fatigue in a short-effort exercise to individualize exercise prescription dose, measure changes during intervention, and track fatigue objectively throughout survivorship.
Collapse
Affiliation(s)
- Antonio Ignacio Cuesta-Vargas
- Physical Therapy Department, Health Sciences Faculty, University of Málaga, Av/Arquitecto Penalosa s/n (Treatinos Campus Expansion), Málaga 29071 Spain; The Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; and School of Clinical Science, Faculty of Health Science, Queensland University Technology, Brisbane, Queensland, Australia
| | - Bella Pajares
- The Institute of Biomedical Research in Malaga (IBIMA)
| | | | - Emilio Alba
- University of Málaga, Andalucia Tech, and The Institute of Biomedical Research in Malaga (IBIMA), Oncology
| | - Cristina Roldan-Jiménez
- Physical Therapy Department, Health Sciences Faculty, University of Málaga, Andalucía Tech, Málaga, Spain, and The Institute of Biomedical Research in Malaga (IBIMA)
| |
Collapse
|
22
|
Cuesta-Vargas AI, Buchan J, Pajares B, Alba E, Trinidad-Fernández M, Ruiz-Medina S, García-Almeida JM, Ríos-López MJ, Roldán-Jiménez C. Energy System Assessment in Survivors of Breast Cancer. Phys Ther 2020; 100:438-446. [PMID: 32043129 DOI: 10.1093/ptj/pzz177] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 09/23/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Survivors of breast cancer commonly report functional limitations, including cancer-related fatigue (CRF) and decreased aerobic capacity. One key gap is addressing the 3 energy systems (aerobic, anaerobic lactic, and alactic), requiring assessment to establish a baseline exercise intensity and duration. OBJECTIVE This study examined the feasibility of energy system-based assessment, also providing descriptive values for assessment performance in this population. DESIGN This was a cross-sectional study. METHODS Seventy-two posttreatment survivors of breast cancer were recruited. Following a baseline musculoskeletal assessment, women attempted 3 energy system assessments: submaximal aerobic (multistage treadmill), anaerobic alactic (30-second sit-to-stand [30-STS]), and anaerobic lactic (adapted burpees). Heart rate (HR) and rating of perceived exertion (RPE) were recorded. Secondary outcomes included body composition, CRF, and upper- and lower-limb functionality. RESULTS Seventy of 72 participants performed the 30-STS and 30 completed the adapted burpees task. HR and RPE specific to each task were correlated, reflecting increased intensity. Women reported low-moderate levels of CRF scores (3% [2.1]) and moderate-high functionality levels (upper-limb: 65.8% [23.3]; lower-limb: 63.7% [34.7]). LIMITATIONS All survivors of breast cancer had relatively low levels of CRF and moderate functioning. Additionally, on average, participants were classified as "overweight" based on BMI. CONCLUSION This study is the first to our knowledge to demonstrate feasibility of energy system assessment in survivors of breast cancer. Using a combination of HR and RPE, as well as baseline assessment of each energy system, clinicians may improve ability to prescribe personalized exercise and give patients greater ability to self-monitor intensity and progress.
Collapse
Affiliation(s)
- Antonio Ignacio Cuesta-Vargas
- Physical Therapy Department, Faculty of Health Sciences, Málaga University, Andalucia Tech, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Av/Arquitecto Penalosa s/n, 29009 Málaga, Spain.,School of Clinical Science, Faculty of Health Science, Queensland University Technology, Brisbane, Queensland, Australia
| | - Jena Buchan
- School of Allied Health Sciences, Griffith University, Brisbane, Queensland, Australia
| | - Bella Pajares
- University Hospital Virgen de la Victoria, Málaga, Spain
| | - Emilio Alba
- University Hospital Virgen de la Victoria, Málaga, Spain
| | - Manuel Trinidad-Fernández
- Physical Therapy Department, Faculty of Health Sciences, Málaga University and Instituto de Investigación Biomédica de Málaga (IBIMA)
| | | | | | | | - Cristina Roldán-Jiménez
- Physical Therapy Department, Faculty of Health Sciences, Málaga University and Instituto de Investigación Biomédica de Málaga (IBIMA)
| |
Collapse
|
23
|
Zapata I, Alvarez M, Hidalgo R, Pajares B, Garcia-Anaya MJ, Toledo MD, Trigo JM, Lupiañez-Perez Y, Medina JA, Jaime Gomez-Millan J. Causes of death in patients with locally advanced head and neck cancer treated with radiotherapy and systemic therapy. BMC Cancer 2019; 19:1241. [PMID: 31864338 PMCID: PMC6925882 DOI: 10.1186/s12885-019-6427-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 12/03/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To investigate the incidence of non-cancer mortalities and prognostic factors associated with competitive causes of death in a homogeneous cohort of patients with locally advanced head and neck cancer treated with radiotherapy and systemic treatment. METHODS This study included 284 patients with locally advanced head and neck cancer treated with radiotherapy and systemic treatment between 2005 and 2017. The cumulative incidence of death associated with tumour, second tumours, treatment, side effects and comorbidity was calculated. A Fine and Gray regression model was used to investigate factors associated with cancer and competitive mortality. RESULTS The cumulative incidence of tumoral death at 5 and 10 years were 35 and 47% respectively, whereas the cumulative incidence of competitive mortality were 10 and 12% respectively. In the multivariate analysis, age and comorbidity were independent factors for non-cancer mortality. Patients with a high risk of non-cancer mortality presented a cumulative incidence of 17.3% at 5 years and 18.4% at 10 years. CONCLUSIONS This study demonstrated a high incidence of competing mortality in older patients with comorbidities. Non-cancer deaths should be considered when selecting patients for combination therapies and in the study design ofclinical trials.
Collapse
Affiliation(s)
- I Zapata
- Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n., 29010, Malaga, Spain
| | - M Alvarez
- Laboratorio de biología molecular del cancer, centro de investigaciones medico-sanitarias (CIMES), Universidad de Málaga, Malaga, Spain.,Instituto de investigación biomédica de Malaga, Campus Teatinos s/n., 29010, Malaga, Spain.,Pathology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n., 29010, Malaga, Spain
| | - R Hidalgo
- Servicio central de Informatica, Universidad de Malaga, Malaga, Spain
| | - B Pajares
- Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010, Malaga, Spain
| | - M J Garcia-Anaya
- Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n., 29010, Malaga, Spain
| | - M D Toledo
- Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n., 29010, Malaga, Spain
| | - J M Trigo
- Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010, Malaga, Spain
| | - Y Lupiañez-Perez
- Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n., 29010, Malaga, Spain
| | - J A Medina
- Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n., 29010, Malaga, Spain
| | - J Jaime Gomez-Millan
- Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n., 29010, Malaga, Spain. .,Instituto de investigación biomédica de Malaga, Campus Teatinos s/n., 29010, Malaga, Spain.
| |
Collapse
|
24
|
Conejo I, Pajares B, Alba E, Cuesta-Vargas AI. Effect of neuromuscular taping on musculoskeletal disorders secondary to the use of aromatase inhibitors in breast cancer survivors: a pragmatic randomised clinical trial. Altern Ther Health Med 2018; 18:180. [PMID: 29890985 PMCID: PMC5996544 DOI: 10.1186/s12906-018-2236-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 05/21/2018] [Indexed: 12/27/2022]
Abstract
Background Aromatase inhibitors reduce breast cancer recurrence rates in postmenopausal women by about 30% compared with tamoxifen while treatments differ. Unfortunately, nearly half of women taking AIs report AI-associated arthralgia (AIA), leading to therapy abandon in on third of patients, which could lead to cancer recurrence. The purpose of the current study was to evaluate the effectiveness of Neuromuscular Taping (NMT) in the treatment of AIA in women who have been treated of BC. Methods This study included 40 BC survivors receiving endocrine therapy (either AIs or TMX) from Hospital Universitario Virgen de la Victoria (Málaga, Spain) suffered from AIA. Patients were randomized to one of the two groups that made this pilot study: A. Placebo intervention B. Real NMT. Clinical data were collected from medical history, grip strength, algometry measured, questionnaires and VAS scale. There have been three interventions prior to the completion of the study, 5 weeks later. The primary objective of this pilot study was to achieve an improvement of pain by 20% decrease of VAS. Results Significant differences in measures of VAS (p = 0.009), global health status/QoL (p = 0.005), fatigue (p = 0.01) and pain (p = 0.04) were observed post intervention with NMT. Conclusions An intervention by NMT to MSCM under treatment with AIs improves their subjective sensation of pain. In addition, this taping had an impact on variables related to the quality of life. This pilot study may be the basis for others to support the use of NMT for the treatment of AIAs, thereby improving their well-being and reducing the dropout rate. Trial registration ClinicalTrials.gov Identifier: NCT02406794. Registered on 2 April 2015 Retrospectively registered.
Collapse
|
25
|
Pajares B, Porta J, Porta JM, Sousa CFD, Moreno I, Porta D, Durán G, Vega T, Ortiz I, Muriel C, Alba E, Márquez A. Hereditary breast and ovarian cancer in Andalusian families: a genetic population study. BMC Cancer 2018; 18:647. [PMID: 29884136 PMCID: PMC5994127 DOI: 10.1186/s12885-018-4537-9] [Citation(s) in RCA: 4] [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: 06/30/2017] [Accepted: 05/21/2018] [Indexed: 11/24/2022] Open
Abstract
Background The BRCA1/2 mutation profile varies in Spain according to the geographical area studied. The mutational profile of BRCA1/2 in families at risk for hereditary breast and ovarian cancer has not so far been reported in Andalusia (southern Spain). Methods We analysed BRCA1/2 germline mutations in 562 high-risk cases with breast and/or ovarian cancer from Andalusian families from 2010 to 2015. Results Among the 562 cases, 120 (21.4%) carried a germline pathogenic mutation in BRCA1/2; 50 in BRCA1 (41.7%) and 70 in BRCA2 (58.3%). We detected 67 distinct mutations (29 in BRCA1 and 38 in BRCA2), of which 3 in BRCA1 (c.845C > A, c.1222_1223delAC, c.2527delA) and 5 in BRCA2 (c.293 T > G, c.5558_5559delGT, c.6034delT, c.6650_6654delAAGAT, c.6652delG) had not been previously described. The most frequent mutations in BRCA1 were c.5078_5080delCTG (10%) and c.5123C > A (10%), and in BRCA2 they were c.9018C > A (14%) and c.5720_5723delCTCT (8%). We identified 5 variants of unknown significance (VUS), all in BRCA2 (c.5836 T > C, c.6323G > T, c.9501 + 3A > T, c.8022_8030delGATAATGGA, c.10186A > C). We detected 76 polymorphisms (31 in BRCA1, 45 in BRCA2) not associated with breast cancer risk. Conclusions This is the first study reporting the mutational profile of BRCA1/2 in Andalusia. We identified 21.4% of patients harbouring BRCA1/2 mutations, 58.3% of them in BRCA2. We also characterized the clinical data, mutational profile, VUS and haplotype profile. Electronic supplementary material The online version of this article (10.1186/s12885-018-4537-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Bella Pajares
- Clinical Oncology Unit Hospitales Universitarios Regional y Virgen de la Victoria. Instituto de Investigación Biomédica de Málaga (IBIMA), Campus Teatinos s/n. 29010, Malaga, Spain.
| | - Javier Porta
- Genologica, Paseo de la Farola 16, 29016, Malaga, Spain
| | | | - Cristina Fernández-de Sousa
- Clinical Oncology Unit Hospitales Universitarios Regional y Virgen de la Victoria. Instituto de Investigación Biomédica de Málaga (IBIMA), Campus Teatinos s/n. 29010, Malaga, Spain
| | - Ignacio Moreno
- Clinical Oncology Unit Hospitales Universitarios Regional y Virgen de la Victoria. Instituto de Investigación Biomédica de Málaga (IBIMA), Campus Teatinos s/n. 29010, Malaga, Spain
| | - Daniel Porta
- Genologica, Paseo de la Farola 16, 29016, Malaga, Spain
| | - Gema Durán
- Clinical Oncology Unit Hospitales Universitarios Regional y Virgen de la Victoria. Instituto de Investigación Biomédica de Málaga (IBIMA), Campus Teatinos s/n. 29010, Malaga, Spain
| | - Tamara Vega
- Genologica, Paseo de la Farola 16, 29016, Malaga, Spain
| | | | - Carolina Muriel
- Clinical Oncology Unit Hospitales Universitarios Regional y Virgen de la Victoria. Instituto de Investigación Biomédica de Málaga (IBIMA), Campus Teatinos s/n. 29010, Malaga, Spain
| | - Emilio Alba
- Clinical Oncology Unit Hospitales Universitarios Regional y Virgen de la Victoria. Instituto de Investigación Biomédica de Málaga (IBIMA), Campus Teatinos s/n. 29010, Malaga, Spain
| | - Antonia Márquez
- Clinical Oncology Unit Hospitales Universitarios Regional y Virgen de la Victoria. Instituto de Investigación Biomédica de Málaga (IBIMA), Campus Teatinos s/n. 29010, Malaga, Spain
| |
Collapse
|
26
|
Godoy-Ortiz A, Plata Y, Alcaide J, Galeote A, Pajares B, Saez E, Alba E, Sánchez-Muñoz A. Bevacizumab for recurrent, persistent or advanced cervical cancer: reproducibility of GOG 240 study results in "real world" patients. Clin Transl Oncol 2017; 20:922-927. [PMID: 29222647 DOI: 10.1007/s12094-017-1808-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/14/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE Bevacizumab is the only therapeutic target approved for patients with persistent, recurrent or advanced cervical cancer from a phase III study that combined with chemotherapy; it proves a significant increase in overall survival. To retrospectively assess the efficacy and safety of bevacizumab as the first-line treatment in patients from usual clinical practice with recurrent/persistent or advanced cervical cancer. PATIENTS AND METHODS Treatment consisted of cisplatin 50 mg/m2 or carboplatin AUC 5 plus paclitaxel 175 mg/m2 for 6-8 cycles and bevacizumab 15 mg/kg every 3 weeks up to progression or unacceptable toxicity. The endpoints were progression-free survival (PFS), overall survival (OS), response rates (RR) and toxicity. RESULTS Twenty-seven patients were included from January 2014 to June 2017, with a median follow-up 10, 1 months. Eleven percent had recurrent/persistent disease and 89% had metastatic disease at diagnosis. The prior exposition to platinum was 70%. The median PFS and OS were 9, 6 and 21, 5 months, respectively. There was an increase of fistula formation (22%). All of them had pelvic and peritoneal disease at the beginning of treatment and previous treatment with chemoradiotherapy; non-incidence differences were found according to the type of platinum agent used. There were two treatment-related deaths, one from intestinal perforation and another from severe sepsis. CONCLUSION Finally, although our study does have certain limitations, we believe that it can provide useful information and encouraging evidence that the routine use of bevacizumab as part of first-line treatment of patients with advanced cervical cancer may be associated with outcomes comparable with those obtained in GOG240 study.
Collapse
Affiliation(s)
- A Godoy-Ortiz
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain.
| | - Y Plata
- Department of Oncology, Complejo Hospitalario de Jaén, Jaén, Spain
| | - J Alcaide
- Medical Oncology Service, Hospital Costa del Sol, Málaga, Marbella, Spain
| | - A Galeote
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain
| | - B Pajares
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - E Saez
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain
| | - E Alba
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain.,Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain
| | - A Sánchez-Muñoz
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| |
Collapse
|
27
|
Gomez-Millan J, Pajares B, Perez-Villa L, Carnero A, Alvarez M, De Luque V, Rivas F, Trigo JM, Toledo MD, Alba E, Medina JA. Subcellular localisation of pMEK has a different prognosis in locally advanced head and neck cancer treated with concomitant radiochemotherapy. BMC Cancer 2016; 16:829. [PMID: 27793200 PMCID: PMC5084350 DOI: 10.1186/s12885-016-2869-x] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 10/21/2016] [Indexed: 12/30/2022] Open
Abstract
Background MEK1 (MAP2K1) and MEK2 (MAP2K2) are closely related dual-specificity protein kinases which function by phosphorylating both serine/threonine and tyrosine residues of their substrates ERK1 and ERK2, controlling fundamental cellular processes that include cell growth and proliferation. To investigate the prognostic significance of pMEK expression in the nucleus and cytoplasm among patients with locally advanced head and neck cancer treated with concurrent radiochemotherapy. Methods Immunohistochemistry was performed on the retrieved archival tissue of 96 patients to detect pMEK, p53 and Ki-67. Results Sixty-six percent of patients were positive for pMEK expression in the nucleus and 41 % in cytoplasm. On univariate analysis, high nuclear pMEK was predictive of worse 5y-DFS and 5y-OS, with a trend to significance (26 % vs. 41 %, p = 0.09; 36 % vs. 47 %, p = 0.07). High cytoplasmic pMEK was predictive of better 5-y OS and 5-y DFS outcomes (61 % vs. 27 %, p = 0.01; 46 % vs. 22 %, p = 0.02). On multivariate analysis, low cytoplasmic pMEK and high nuclear pMEK predicted worse DFS and OS (p = 0.01; p = 0.04 and p = 0.02; p = 0.02 respectively). Conclusions Subcellular localisation of pMEK has different prognosis in locally advanced head and neck cancer treated with radiochemotherapy.
Collapse
Affiliation(s)
- J Gomez-Millan
- Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010, Malaga, Spain.
| | - B Pajares
- Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010, Malaga, Spain.
| | - L Perez-Villa
- Pathology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010, Malaga, Spain
| | - A Carnero
- Instituto de Biomedicina de Sevilla (IBIS), Consejo superior de investigaciones científicas, Campus Universitario Virgen del Rocío, Avda, Manuel Siurot s/n, 41013, Sevilla, Spain
| | - M Alvarez
- Pathology Department, Facultad de Medicina, UMA, Campus Teatinos s/n, 29010, Malaga, Spain
| | - V De Luque
- Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010, Malaga, Spain
| | - F Rivas
- Agencia Sanitaria Costa del Sol, Unidad de Investigación, Autovia A-7, Km 187, 29063, Marbella, Málaga, Spain.,Red Nacional de Investigación de Servicios de Salud en Enfermedades crónicas (REDISSEC), Madrid, Spain
| | - J M Trigo
- Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010, Malaga, Spain
| | - M D Toledo
- Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010, Malaga, Spain
| | - E Alba
- Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010, Malaga, Spain
| | - J A Medina
- Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010, Malaga, Spain
| |
Collapse
|
28
|
Santonja A, Pajares B, Jiménez-Rodríguez B, Sousa CFD, Ribelles N, Lluch-Hernandez A, Catoira I, Perez-Ruiz E, Martin M, Del Monte-Millan M, Gonzalez-Neira A, Pita G, Pujana M, Ruiz M, Bonifaci N, De la Haba J, Sanchez-Rovira P, Alba E, Romero A. Germline genetic background contribution to metastatic dissemination in breast cancer extreme phenotype patients. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw393.04] [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
|
29
|
Muriel Lopez C, Perez-Ruiz E, Gonzalez I, Ales I, Pascual J, Duran G, Rivas-Ruiz F, Benavides M, Marquez A, Pajares B, Plata Y, Diaz T, Zarcos I, Alcaide J, Gimenez F, Lopez P, Gil S, Muros B, Rueda A, Alba E. 2304 Polychemotherapy on patients with pancreatic carcinoma: Experience of four hospitals in Spain. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31220-5] [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: 10/22/2022]
|
30
|
Pérez-Rivas LG, Jerez JM, Carmona R, de Luque V, Vicioso L, Claros MG, Viguera E, Pajares B, Sánchez A, Ribelles N, Alba E, Lozano J. A microRNA signature associated with early recurrence in breast cancer. PLoS One 2014; 9:e91884. [PMID: 24632820 PMCID: PMC3954835 DOI: 10.1371/journal.pone.0091884] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 02/14/2014] [Indexed: 12/20/2022] Open
Abstract
Recurrent breast cancer occurring after the initial treatment is associated with poor outcome. A bimodal relapse pattern after surgery for primary tumor has been described with peaks of early and late recurrence occurring at about 2 and 5 years, respectively. Although several clinical and pathological features have been used to discriminate between low- and high-risk patients, the identification of molecular biomarkers with prognostic value remains an unmet need in the current management of breast cancer. Using microarray-based technology, we have performed a microRNA expression analysis in 71 primary breast tumors from patients that either remained disease-free at 5 years post-surgery (group A) or developed early (group B) or late (group C) recurrence. Unsupervised hierarchical clustering of microRNA expression data segregated tumors in two groups, mainly corresponding to patients with early recurrence and those with no recurrence. Microarray data analysis and RT-qPCR validation led to the identification of a set of 5 microRNAs (the 5-miRNA signature) differentially expressed between these two groups: miR-149, miR-10a, miR-20b, miR-30a-3p and miR-342-5p. All five microRNAs were down-regulated in tumors from patients with early recurrence. We show here that the 5-miRNA signature defines a high-risk group of patients with shorter relapse-free survival and has predictive value to discriminate non-relapsing versus early-relapsing patients (AUC = 0.993, p-value<0.05). Network analysis based on miRNA-target interactions curated by public databases suggests that down-regulation of the 5-miRNA signature in the subset of early-relapsing tumors would result in an overall increased proliferative and angiogenic capacity. In summary, we have identified a set of recurrence-related microRNAs with potential prognostic value to identify patients who will likely develop metastasis early after primary breast surgery.
Collapse
Affiliation(s)
- Luis G Pérez-Rivas
- Laboratorio de Oncología Molecular, Servicio de Oncología Médica, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - José M Jerez
- Departamento de Lenguajes y Ciencias de la Computación, Universidad de Málaga, Málaga, Spain
| | - Rosario Carmona
- Plataforma Andaluza de Bioinformática, Universidad de Málaga, Málaga, Spain
| | - Vanessa de Luque
- Laboratorio de Oncología Molecular, Servicio de Oncología Médica, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Luis Vicioso
- Servicio de Anatomía Patológica, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - M Gonzalo Claros
- Plataforma Andaluza de Bioinformática, Universidad de Málaga, Málaga, Spain; Departmento de Biología Molecular y Bioquímica, Universidad de Málaga, Málaga, Spain
| | - Enrique Viguera
- Departmento of Biología Celular, Genética y Fisiología Animal, Universidad de Málaga, Málaga, Spain
| | - Bella Pajares
- Laboratorio de Oncología Molecular, Servicio de Oncología Médica, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Alfonso Sánchez
- Laboratorio de Oncología Molecular, Servicio de Oncología Médica, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Nuria Ribelles
- Laboratorio de Oncología Molecular, Servicio de Oncología Médica, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Emilio Alba
- Laboratorio de Oncología Molecular, Servicio de Oncología Médica, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - José Lozano
- Laboratorio de Oncología Molecular, Servicio de Oncología Médica, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain; Departmento de Biología Molecular y Bioquímica, Universidad de Málaga, Málaga, Spain
| |
Collapse
|
31
|
Pajares B, Perez-Villa L, Trigo JM, Toledo MD, Álvarez M, Jimenez B, Medina JA, de Luque V, Jerez JM, Alba E. Concurrent radiotherapy plus epidermal growth factor receptor inhibitors in patients with human papillomavirus-related head and neck cancer. Clin Transl Oncol 2013; 16:418-24. [DOI: 10.1007/s12094-013-1099-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 07/29/2013] [Indexed: 10/26/2022]
|
32
|
Pajares B, Pollán M, Martín M, Mackey JR, Lluch A, Gavila J, Vogel C, Ruiz-Borrego M, Calvo L, Pienkowski T, Rodríguez-Lescure Á, Seguí MA, Tredan O, Antón A, Ramos M, Cámara MDC, Rodríguez-Martín C, Carrasco E, Alba E. Obesity and survival in operable breast cancer patients treated with adjuvant anthracyclines and taxanes according to pathological subtypes: a pooled analysis. Breast Cancer Res 2013; 15:R105. [PMID: 24192331 PMCID: PMC3978725 DOI: 10.1186/bcr3572] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 10/16/2013] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Obesity is an unfavorable prognostic factor in breast cancer (BC) patients regardless of menopausal status and treatment received. However, the association between obesity and survival outcome by pathological subtype requires further clarification. METHODS We performed a retrospective analysis including 5,683 operable BC patients enrolled in four randomized clinical trials (GEICAM/9906, GEICAM/9805, GEICAM/2003-02, and BCIRG 001) evaluating anthracyclines and taxanes as adjuvant treatments. Our primary aim was to assess the prognostic effect of body mass index (BMI) on disease recurrence, breast cancer mortality (BCM), and overall mortality (OM). A secondary aim was to detect differences of such prognostic effects by subtype. RESULTS Multivariate survival analyses adjusting for age, tumor size, nodal status, menopausal status, surgery type, histological grade, hormone receptor status, human epidermal growth factor receptor 2 (HER2) status, chemotherapy regimen, and under-treatment showed that obese patients (BMI 30.0 to 34.9) had similar prognoses to that of patients with a BMI < 25 (reference group) in terms of recurrence (Hazard Ratio [HR] = 1.08, 95% Confidence Interval [CI] = 0.90 to 1.30), BCM (HR = 1.02, 0.81 to 1.29), and OM (HR = 0.97, 0.78 to 1.19). Patients with severe obesity (BMI ≥ 35) had a significantly increased risk of recurrence (HR = 1.26, 1.00 to 1.59, P = 0.048), BCM (HR = 1.32, 1.00 to 1.74, P = 0.050), and OM (HR = 1.35, 1.06 to 1.71, P = 0.016) compared to our reference group. The prognostic effect of severe obesity did not vary by subtype. CONCLUSIONS Severely obese patients treated with anthracyclines and taxanes present a worse prognosis regarding recurrence, BCM, and OM than patients with BMI < 25. The magnitude of the harmful effect of BMI on survival-related outcomes was similar across subtypes.
Collapse
|
33
|
Ribelles N, Santonja A, Pajares B, Llácer C, Alba E. The seed and soil hypothesis revisited: current state of knowledge of inherited genes on prognosis in breast cancer. Cancer Treat Rev 2013; 40:293-9. [PMID: 24112814 DOI: 10.1016/j.ctrv.2013.09.010] [Citation(s) in RCA: 33] [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: 06/11/2013] [Revised: 09/03/2013] [Accepted: 09/06/2013] [Indexed: 10/26/2022]
Abstract
The crucial event in the course of malignancies such as breast cancer is its metastatic spread from the primary tumor of origin to distant organs. The natural history of a tumor is determined by the expression of its genes, and in this sense, knowledge has advanced dramatically in recent decades. However, much less is known about the role that the patient plays in the behavior of a tumor. In this article, we review the evidence regarding the genetic background of the host in metastatic tumor dissemination, providing information from epidemiological studies as well as from animal models and human studies. Undoubtedly, the elucidation of possible interpersonal variability in susceptibility to developing metastases would significantly contribute to improve management of cancer patients.
Collapse
Affiliation(s)
- Nuria Ribelles
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain.
| | | | | | | | | |
Collapse
|
34
|
Pollán M, Pajares B, Martin M, Mackey JR, Lluch A, Gavila J, Vogel CL, Ruiz Borrego M, Calvo L, Pienkowski T, Rodriguez-Lescure A, Seguí MA, Tredan O, Anton A, Ramos Vazquez M, Camara MC, Rodriguez-Martin C, Carrasco EM, Alba E. The effect of obesity on prognosis in operable breast cancer patients treated with adjuvant anthracyclines and taxanes according to pathologic subtypes. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.1031] [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
1031 Background: According to observational studies, obesity is an unfavourable prognostic factor in breast cancer (BC), regardless of menopausal status and treatment received. Information collected in clinical trials should confirm this effect and serves to test its homogeneity by pathologic subtype. Methods: We retrospectively analysed 5,683 operable BC patients enrolled in four randomized clinical trials (GEICAM/9906, 9805, 2003–02, and BCIRG 001) evaluating adjuvant anthracyclines and taxanes. Our primary aim was to assess the prognostic effect of body mass index (BMI) on disease recurrence, breast cancer mortality (BCM), and overall mortality (OM). A secondary aim was to detect differences by BC subtypes (ER/PR-positive/HER2-negative, HER2-positive, triple-negative). Cox models were fitted for each end-point, adjusted by potential confounders. Results: Analyses adjusting for age, tumor size, nodal status, menopausal status, surgery, grade, hormone receptor and HER2 status, chemotherapy regimen, and undertreatment showed that obese patients (BMI 30.0–34.9) had similar prognoses to that of patients with a BMI<25 (reference group) in terms of recurrence (HR 1.08 [95% CI 0.9–1.3]; p=0.41), BCM (HR 1.02 [0.81–1.29]; p=0.85), and OM (HR 0.97 [0.78–1.19]; p=0.747). Patients with severe obesity (BMI≥35) had a significantly increased risk of recurrence (HR 1.26 [1.00–1.59]; p=0.05), BCM (HR 1.32 [1.00–1.74]; p=0.05), and OM (HR 1.35 [1.06–1.71]; p=0.02) compared to our reference group (Table). The prognostic effect of severe obesity did not vary by subtype. Conclusions: Severely obese patients treated with anthracyclines and taxanes present a worse prognosis regarding recurrence, BCM, and OM than patients with a BMI<25. The magnitude of the harmful effect of BMI was similar across subtypes. [Table: see text]
Collapse
Affiliation(s)
- Marina Pollán
- National Center of Epidemiology, Instituto Salud Carlos III, Madrid, Spain
| | - Bella Pajares
- Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Miguel Martin
- Medical Oncology, Instituto de Investigación Sanitaria Gregorio Marañon, Universidad Complutense, Madrid, Spain
| | | | - Ana Lluch
- Hospital Clínico de Valencia - INCLIVA Health Research Institute, University of Valencia., Valencia, Spain
| | | | - Charles L. Vogel
- University of Miami School of Medicine, Comprehensive Cancer Research Group, Inc., Miami, FL
| | | | - Lourdes Calvo
- Complexo Hospitalario Universitario de A Coruña, A Coruna, Spain
| | | | | | - Miquel Angel Seguí
- Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Oncològic del Vallès, Sabadell, Spain
| | | | - Antonio Anton
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | | | | | - Emilio Alba
- Hospital Clínico Universitario Virgen de la Victoria, Malaga, Spain
| | | |
Collapse
|
35
|
Pajares B, Trigo JM, Toledo MD, Álvarez M, González-Hermoso C, Rueda A, Medina JA, de Luque V, Jerez JM, Alba E. Differential outcome of concurrent radiotherapy plus epidermal growth factor receptor inhibitors versus radiotherapy plus cisplatin in patients with human papillomavirus-related head and neck cancer. BMC Cancer 2013; 13:26. [PMID: 23331666 PMCID: PMC3637564 DOI: 10.1186/1471-2407-13-26] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 01/10/2013] [Indexed: 11/24/2022] Open
Abstract
Background Human papillomavirus (HPV)-related head and neck cancer has been associated with an improved prognosis in patients treated with radiotherapy (RT) +/− chemotherapy (CT); however, RT combined with epidermal growth factor receptor (EGFR) inhibitors has not been fully studied in this group of patients. Methods Immunohistochemical expression of p16 and PCR of HPV16 DNA were retrospectively analyzed in tumor blocks from 108 stage III/IV head and neck cancer patients treated with RT+CT (56) or RT+EGFR inhibitors (52). Disease-free survival (DFS) and overall survival (OS) were analyzed by the Kaplan-Meier method. Results DNA of HPV16 was found in 12 of 108 tumors (11%) and p16 positivity in 18 tumors (17%), with similar rates in both arms of treatment. After a median follow-up time of 35 months (range 6–135), p16-positive patients treated with RT+EGFR inhibitors showed improved survival compared with those treated with RT+CT (2-year OS 88% vs. 60%, HR 0.18; 95% CI 0.04 to 0.88; p = 0.01; and 2-year DFS 75% vs. 47%, HR 0.17; 95% CI 0.03 to 0.8; p = 0.01). However, no differences were observed in p16-negative patients (2-year OS 56% vs. 53%, HR 0.97; 95% CI 0.55 to 1.7; p = 0.9; and 2-year DFS 43% vs. 45%, HR 0.99; 95% CI 0.57 to 1.7; p = 0.9). Conclusions This is the first study to show that p16-positive patients may benefit more from RT+EGFR inhibitors than conventional RT+CT. These results are hypothesis-generating and should be confirmed in prospective trials.
Collapse
Affiliation(s)
- Bella Pajares
- Department of Medical Oncology, University Hospital Virgen de la Victoria, Málaga, Spain.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Ribelles N, Perez-Villa L, Jerez JM, Pajares B, Vicioso L, Jimenez B, de Luque V, Franco L, Gallego E, Marquez A, Alvarez M, Sanchez-Muñoz A, Perez-Rivas L, Alba E. Pattern of recurrence of early breast cancer is different according to intrinsic subtype and proliferation index. Breast Cancer Res 2013; 15:R98. [PMID: 24148581 PMCID: PMC3978680 DOI: 10.1186/bcr3559] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [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: 04/30/2013] [Accepted: 10/07/2013] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Recurrence risk in breast cancer varies throughout the follow-up time. We examined if these changes are related to the level of expression of the proliferation pathway and intrinsic subtypes. METHODS Expression of estrogen and progesterone receptor, Ki-67, human epidermal growth factor receptor 2 (HER2), epidermal growth factor receptor (EGFR) and cytokeratin 5/6 (CK 5/6) was performed on tissue-microarrays constructed from a large and uniformly managed series of early breast cancer patients (N = 1,249). Subtype definitions by four biomarkers were as follows: luminal A (ER + and/or PR+, HER2−, Ki-67 <14), luminal B (ER + and/or PR+, HER2−, Ki-67 ≥14), HER2-enriched (any ER, any PR, HER2+, any Ki-67), triple-negative (ER−, PR−, HER2−, any Ki-67). Subtype definitions by six biomarkers were as follows: luminal A (ER + and/or PR+, HER2−, Ki-67 <14, any CK 5/6, any EGFR), luminal B (ER + and/or PR+, HER2−, Ki-67 ≥14, any CK 5/6, any EGFR), HER2-enriched (ER−, PR−, HER2+, any Ki-67, any CK 5/6, any EGFR), Luminal-HER2 (ER + and/or PR+, HER2+, any Ki-67, any CK 5/6, any EGFR), Basal-like (ER−, PR−, HER2−, any Ki-67, CK5/6+ and/or EGFR+), triple-negative nonbasal (ER−, PR−, HER2−, any Ki-67, CK 5/6−, EGFR−). Each four- or six-marker defined intrinsic subtype was divided in two groups, with Ki-67 <14% or with Ki-67 ≥14%. Recurrence hazard rate function was determined for each intrinsic subtype as a whole and according to Ki-67 value. RESULTS Luminal A displayed a slow risk increase, reaching its maximum after three years and then remained steady. Luminal B presented most of its relapses during the first five years. HER2-enriched tumors show a peak of recurrence nearly twenty months post-surgery, with a greater risk in Ki-67 ≥14%. However a second peak occurred at 72 months but the risk magnitude was greater in Ki-67 <14%. Triple negative tumors with low proliferation rate display a smooth risk curve, but with Ki-67 ≥14% show sharp peak at nearly 18 months. CONCLUSIONS Each intrinsic subtype has a particular pattern of relapses over time which change depending on the level of activation of the proliferation pathway assessed by Ki-67. These findings could have clinical implications both on adjuvant treatment trial design and on the recommendations concerning the surveillance of patients.
Collapse
Affiliation(s)
- Nuria Ribelles
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Lidia Perez-Villa
- Department of Pathology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Jose Manuel Jerez
- Department of Languages and Computer Science, University of Malaga, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Bella Pajares
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Luis Vicioso
- Department of Pathology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Begoña Jimenez
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Vanessa de Luque
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Leonardo Franco
- Department of Languages and Computer Science, University of Malaga, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Elena Gallego
- Department of Pathology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Antonia Marquez
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Martina Alvarez
- Department of Pathology, University of Malaga, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Alfonso Sanchez-Muñoz
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Luis Perez-Rivas
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Emilio Alba
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| |
Collapse
|
37
|
Alba E, Albanell J, Chacon Lopez-Muniz JI, Calvo L, De la Haba- Rodriguez J, Sanchez Rovira P, Plazaola A, Barnadas A, Seguí-Palmer MA, Arcusa Lanza A, Ramos Vazquez M, Rojo F, Burgues O, Pajares B, Bermejo B, Sanchez-Muñoz A, Casas MI, Caballero R, Carrasco EM, Lluch A. Role of proliferation in response to neoadjuvant chemotherapy in GEICAM/2006-03 and GEICAM/2006-14 breast cancer patients. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.10616] [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
10616 Background: Ki67 proliferation biomarker determined by immunohistochemistry (IHC) has been studied as a prognostic and predictive factor in Operable Breast Cancer (OBC). Ki67 modifications after neoadjuvant endocrine therapy have been correlated with long term outcome. However, there is no robust data about its predictive role in Neoadjuvant Chemotherapy (NC). In this study, we investigated Ki67 value as predictor of NC efficacy. Methods: 193 patients (pts) from 2 GEICAM phase II randomized trials (2006-03 and 2006-14) were included: 78 (40%) received epirubicine plus cyclophosphamide followed by docetaxel (EC-D), 41 (21%) EC-D plus carboplatin, and out of the 74 HER2+ pts, 37 (19%) received EC-D plus tratuzumab and 37 (19%) EC-D plus lapatinib. Median age was 49 years. From series, 87% were invasive ductal carcinoma, 58% premenopausal, 50% grade III, 23% luminal , 39% basal and 38% HER2+. Ki67 was centrally assessed by IHC (MIB1 clone) and median score was 40% (range 1-100%). Pathological Complete Response (pCR), defined as absence of invasive cells in breast and lymph nodes, was achieved in 56 pts (29%). Univariate and multivariate logistic regression models were used to study the association of each clinical-pathological variable with pCR. ROC curves were used to determine the most accurate ki67 cut-off for predicting NC response. Results: Ki67≥50% was defined as the most accurate threshold to select patients obtaining benefit from NC. In the univariate analysis, histological grade (p=0.01), treatment (P=0.006), ER (p<0.0001), PR (p<0.0001), HER2 (p=0.01), and Ki67≥50% (p=0.0003) were statistically associated with pCR. A multivariate logistic regression showed that only Ki67≥ 50% (p=0.0003; OR=5.4 CI95% 2.1-13.4), ER (p=0.0001; OR=0.2 CI95% 0.1-0.4), and HER2 status (p<0.0001; OR=8.8 CI95% 3.3-23.6) were predictive for pCR (AUC=0.7812). Conclusions: These results suggest that a high proliferation in breast cancer measured by Ki67 marker is an independent predictive factor for pCR in an unclassified HER2 population of OBC patients treated with NC.
Collapse
Affiliation(s)
- E. Alba
- Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | | | | | | | | | | | | | | | | | | | | | - Federico Rojo
- Cancer Research Unit, Fundacion Jimenez Diaz, Madrid, Spain
| | | | - Bella Pajares
- Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Begoña Bermejo
- Hospital Clinico Universitario Valencia, Valencia, Spain
| | | | | | - Rosalia Caballero
- Spanish Breast Cancer Research Group, GEICAM, San Sebastian De Los Reyes, Spain
| | | | | | | |
Collapse
|
38
|
Saez M, Trigo Perez JM, Perez-Rivas L, Perez-Villa L, Villatoro R, Montesa A, Cid J, Leon M, de Luque V, Fernandez C, Quero C, Pajares B, Alba E. Hypoxia-inducible factor (HIF) 1α and 2α as predictive markers of outcome to VEGFR tyrosine kinase inhibitors (TKI) in renal cell carcinoma (RCC). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.4630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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
4630 Background: Relevant biomarkers in RCC are needed to identify appropriate candidates for selected targeted therapies. Mutations in the von Hippel-Lindau (VHL) gene result in the accumulation of HIF and increased expression of proangiogenic factors, including VEGF. Methods: Metastatic clear RCC patients with available baseline tumor samples who received first-line oral VEGFR-TKI were included in this analysis. VHL mutation/hypermethylation status and HIF1α and HIF2α immunohistochemical staining were analyzed from paraffin-embedded tumors. Additionally, a panel of candidate VEGF and VEGFR2 genetic SNPs was determined from peripheral blood samples. HIF was scored as negative or positive based on staining intensity (0-10% and > 10%, respectively). Results were evaluated for associations with clinical outcome. Results: 80 patients were included: 71 evaluable for HIF expression, 63 for VHL status and 52 for SNPs. 73% received treatment with sunitinib and median follow-up was 21.5 months. Unlike VHL status, HIF1 and HIF2 positive expression showed a significant correlation with PFS and OS. HIF1α was also predictive for response rate (RR). On multivariate analysis adjusting for other prognostic factors, HIF1α and HIF2α remained the most significant independent predictive factors for survival (adjusted HR 0.09, 95% CI 0.03-0.28, p < 0.0001 and HR 0.13, 95% CI 0.04-0.37, p < 0.0001; respectively). We did not find any statistically significant differences based on the VEGF and VEGFR2 SNPs analyzed. Conclusions: HIF1α and HIF2α levels represent the most important independent predictive factors of outcome for VEGFR-TKI therapy in metastatic RCC. These findings may contribute to optimize treatment with targeted agents. [Table: see text]
Collapse
Affiliation(s)
- M.I. Saez
- Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | | | | | - L. Perez-Villa
- Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | | | - A. Montesa
- Hospital Universitario Carlos Haya, Malaga, Spain
| | - J.I. Cid
- Hospital Costa del Sol, Marbella, Spain
| | - M. Leon
- Hospital Universitario Carlos Haya, Malaga, Spain
| | - V. de Luque
- Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - C. Fernandez
- Hospital Universitario Virgen de la Victoria, Translational Oncology Research, Malaga, Spain
| | - C. Quero
- Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - B. Pajares
- Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - E. Alba
- Hospital Universitario Virgen de la Victoria, Malaga, Spain
| |
Collapse
|
39
|
Pajares B, Torres E, Trigo JM, Sáez MI, Ribelles N, Jiménez B, Alba E. Tyrosine kinase inhibitors and drug interactions: a review with practical recommendations. Clin Transl Oncol 2012; 14:94-101. [DOI: 10.1007/s12094-012-0767-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
40
|
Ribelles N, Perez-Villa L, Pajares B, Jerez JM, Vicioso L, Jimenez B, de LV, Franco L, Alvarez M, Perez-Rivas LG, Sanchez-Muñoz A, Gallego E, Marquez A, Hierro I, Alba E. P3-05-04: Changes in Recurrence Risk of Breast Cancer Intrisic Subtypes over Time. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p3-05-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Gene expression profiling and their immunohistochemistry-based surrogates have consistently revealed prognostically significant breast cancer (BC) subtypes: Luminal A (Lum A), Luminal B (Lum B), HER2, Basal-like (BL) and Triple negative phenotype-nonbasal (TNP-nb). In addition, there are clinical evidence that hazard of BC recurrence varies over time with two peaks of high risk at 18–24 and 60 months. This study compares the time-related patterns of recurrence within BC subtypes. Methods: Tissue microarrays were constructed from 937 early BC patients diagnosed and treated at our Hospital from 1982 to 2005 with available archival paraffin tissue blocks. BC subtypes were defined using an immunopanel of estrogen receptor, progesterone receptor, HER2, epidermal growth factor receptor, cytokeratin 5/6 and Ki67 by prespecified published methods. Univariate and multivariate analysis (Cox regression) were performed on progression-free survival. Smoothed curves for hazard rates (HR) were estimated by a Kernel-like smoothing procedure. The statistical analysis was done by using the R software environment.
Results: Cases were classified as follows: Lum A 46.8%, Lum B 25.2%, HER2 11.3%, BL 11.3%, TNP-nb 5.4%. None of the patients were treated with adjuvant trastuzumab. With a median follow up of 80 months age, tumor size, nodal status and intrinsic subtypes were independent prognostic factors. HER2 and BL show high and early peak in HR curves and decreasing sharply to 36 and 48 months respectively. HR in Lum A, Lum B and TNP-nb exhibit a smoother and nearly steady curve.
Conclusions: BC subtypes have distinct outcome but also displays different pattern of recurrence over time. These data might imply that pathways underlying early and late recurrences could be different. This additional information would suggest the convenience of considering different timings and duration of adjuvant treatments depending of BC subtypes, and also in the design of surveillance recommendations.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-05-04.
Collapse
Affiliation(s)
- N Ribelles
- 1Hospital Universitario Virgen de la Victoria, Malaga, Spain; Universidad de Malaga, Malaga, Spain
| | - L Perez-Villa
- 1Hospital Universitario Virgen de la Victoria, Malaga, Spain; Universidad de Malaga, Malaga, Spain
| | - B Pajares
- 1Hospital Universitario Virgen de la Victoria, Malaga, Spain; Universidad de Malaga, Malaga, Spain
| | - JM Jerez
- 1Hospital Universitario Virgen de la Victoria, Malaga, Spain; Universidad de Malaga, Malaga, Spain
| | - L Vicioso
- 1Hospital Universitario Virgen de la Victoria, Malaga, Spain; Universidad de Malaga, Malaga, Spain
| | - B Jimenez
- 1Hospital Universitario Virgen de la Victoria, Malaga, Spain; Universidad de Malaga, Malaga, Spain
| | - Luque V de
- 1Hospital Universitario Virgen de la Victoria, Malaga, Spain; Universidad de Malaga, Malaga, Spain
| | - L Franco
- 1Hospital Universitario Virgen de la Victoria, Malaga, Spain; Universidad de Malaga, Malaga, Spain
| | - M Alvarez
- 1Hospital Universitario Virgen de la Victoria, Malaga, Spain; Universidad de Malaga, Malaga, Spain
| | - LG Perez-Rivas
- 1Hospital Universitario Virgen de la Victoria, Malaga, Spain; Universidad de Malaga, Malaga, Spain
| | - A Sanchez-Muñoz
- 1Hospital Universitario Virgen de la Victoria, Malaga, Spain; Universidad de Malaga, Malaga, Spain
| | - E Gallego
- 1Hospital Universitario Virgen de la Victoria, Malaga, Spain; Universidad de Malaga, Malaga, Spain
| | - A Marquez
- 1Hospital Universitario Virgen de la Victoria, Malaga, Spain; Universidad de Malaga, Malaga, Spain
| | - I Hierro
- 1Hospital Universitario Virgen de la Victoria, Malaga, Spain; Universidad de Malaga, Malaga, Spain
| | - E Alba
- 1Hospital Universitario Virgen de la Victoria, Malaga, Spain; Universidad de Malaga, Malaga, Spain
| |
Collapse
|
41
|
Pajares B, Torres E, Jiménez B, Sevilla I, Rodríguez A, Rico JM, Trigo JM, Alba E. Multimodal treatment of desmoid tumours: the significance of local control. Clin Transl Oncol 2011; 13:189-93. [PMID: 21421464 DOI: 10.1007/s12094-011-0639-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Desmoid tumours are a rare group of tumours arising in the deep musculoaponeurotic structures and although they have no metastatic potential they can be locally aggressive with relapse rates of between 23-40%. Three sub-sites are reported: extra-abdominal, abdominal wall and intra-abdominal. The purpose of this study was to analyze patients with these tumours treated and followed at our institution and to determine factors influencing disease free survival. MATERIAL AND METHODS We conducted a retrospective study of 20 patients treated between 1997 and 2009. Data was compiled to include age, gender, surgical history, familial adenomatous polyposis (FAP), contraceptives, tumour site, first-line treatment, positive margins and adjuvant radiotherapy. A descriptive and survival statistical analysis was also performed. RESULTS Most patients were women, with a median age of 36 years, with abdominal wall involvement and treated with complete surgery without adjuvant radiotherapy. With a median follow-up of 35 months (range 0-188), local control at 5 years for any kind of treatment was 80%. Overall survival (OS) and 5-year progression-free survival (PFS) were 100% and 86%, respectively. CONCLUSION Desmoid tumours are group of rare tumours. Although complete surgical resection remains the cornerstone of treatment for resectable lesions, there is still substantial risk of recurrence. Our outcomes are comparable to those reported in the few series published to date.
Collapse
Affiliation(s)
- Bella Pajares
- Department of Clinical Oncology, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Jimenez B, Trigo Perez JM, Saez Medina MI, Quero Blanco C, Pajares B, Rueda A, Alba E. Efficacy and safety of weekly paclitaxel combined with cetuximab in the treatment of pretreated recurrent/metastatic head and neck cancer patients. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.5594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
43
|
Pajares B, Trigo Perez JM, Toledo MD, Alvarez M, Perez-Villa L, Gonzalez-Hermoso C, Rueda A, Medina JA, Jimenez B, Jerez JM, Perez L, Alba E. Human papillomavirus (HPV)–related head and neck squamous cell carcinoma (HNSCC) and outcome after treatment with epidermal growth factor receptor inhibitors (EGFR inhib) plus radiotherapy (RT) versus conventional chemotherapy (CT) plus RT. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.5528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
44
|
Ribelles N, Perez-Villa L, Pajares B, Jerez JM, Vicioso L, Jimenez B, de Luque V, Franco L, Alvarez M, Perez-Rivas LG, Sanchez-Muñoz A, Gallego E, Marquez A, Hierro I, Alba E. Recurrence risk of breast cancer intrinsic subtypes over time. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e21047] [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
|
45
|
Sánchez-Muñoz A, Pérez-Ruiz E, Jurado JM, Ribelles N, Márquez A, Miramón J, Maíz M, Pajares B, Gallego E, Scholtz V, Jiménez B, Soler C, Molina M, García-Ríos I, Alba E. Outcome of Small Invasive Breast Cancer with No Axillary Lymph Node Involvement. Breast J 2010; 17:32-8. [DOI: 10.1111/j.1524-4741.2010.01026.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
46
|
Sánchez-Muñoz A, Pérez-Ruiz E, Jurado JM, Ribelles N, Márquez A, Miramón J, Maíz M, Pajares B, Gallego E, Jiménez B, Alba E. Prognosis of Microinvasive Breast Carcinoma with Negative Axillary Nodes in Accordance with TNM Classification Criteria. Breast J 2010; 16:669-71. [PMID: 21070451 DOI: 10.1111/j.1524-4741.2010.00981.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
47
|
Jurado-García JM, Trigo Perez J, Sevilla I, Pajares B, Alonso-Carrión L, Pérez M, García-Puche JL, Alba E. Association of vascular endothelial growth factor (VEGF) with outcome in metastatic solid tumor treated with antiangiogenic therapy. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e21106] [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
|
48
|
Pajares B, Jurado J, Pérez E, Ortega J, Trigo J, Sevilla I, García-Puche J, Alba E. 1091 Associations between genetic KDR polymorphisms and survival in patients with metastatic cancer treated with antiangiogenic therapy. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70384-2] [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: 10/20/2022] Open
|
49
|
Jurado JM, Pajares B, Olmos D, Sevilla I, Alba E. 'Out of blue' Lhermitte's sign: three cases due to low cumulative doses of oxaliplatin. Ann Oncol 2008; 19:2093-4. [PMID: 18977850 DOI: 10.1093/annonc/mdn684] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|