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Bessa X, Vidal J, Balboa JC, Márquez C, Duenwald S, He Y, Raymond V, Faull I, Burón A, Álvarez-Urturi C, Castells X, Bellosillo B, Montagut C. High accuracy of a blood ctDNA-based multimodal test to detect colorectal cancer. Ann Oncol 2023; 34:1187-1193. [PMID: 37805131 DOI: 10.1016/j.annonc.2023.09.3113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/22/2023] [Accepted: 09/22/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Detection of circulating tumor DNA (ctDNA) is a minimally invasive and convenient blood-based screening strategy that may increase effectiveness of colorectal cancer (CRC) screening. PATIENTS AND METHODS A novel multimodal ctDNA-based blood assay that integrates genomics, epigenomics and fragmentomics, as well as proteomics in a refined version, was tested in blood samples from two cohorts: (i) consecutive fecal immunochemical test (FIT)-positive individuals from the CRC Barcelona stool-based screening program; (ii) patients diagnosed with CRC. Primary endpoint was the performance of the test to detect CRC at different tumor-node-metastasis (TNM) stages. Secondary endpoint was the ability of the test to detect advanced precancerous lesions (advanced adenoma or advanced serrated lesion). RESULTS A total of 623 blood samples were analyzed in the primary analysis. Sensitivity and specificity of the assay to detect CRC was 93% and 90%, respectively. The sensitivity of CRC detection according to TNM stages was 84% for stage I, 94% for stage II and 96% for stage III (70/73) (P< 0.024). Sensitivity to detect advanced precancerous lesions was 23% with a refined version of the test (including protein and updating bioinformatic thresholding). CONCLUSION A blood-based multimodal ctDNA assay detected CRC with high accuracy. This minimally invasive, accessible and convenient assay may help to increase the effectiveness of CRC screening.
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Affiliation(s)
- X Bessa
- Gastroenterology Department, Hospital del Mar Research Institute, Barcelona.
| | - J Vidal
- Medical Oncology Department, Hospital del Mar Research Institute, CIBERONC, Barcelona, Spain
| | - J C Balboa
- Gastroenterology Department, Hospital del Mar Research Institute, Barcelona
| | - C Márquez
- Gastroenterology Department, Hospital del Mar Research Institute, Barcelona
| | | | - Y He
- Guardant Health Inc., Redwood City, USA
| | - V Raymond
- Guardant Health Inc., Redwood City, USA
| | - I Faull
- Guardant Health Inc., Redwood City, USA
| | - A Burón
- Epidemiology and Evaluation Department, Hospital del Mar Medical Research Institute, Barcelona, Spain; RICAPPS (Research Network on Chronicity, Primary Care and Prevention and Health Promotion), Madrid, Spain
| | - C Álvarez-Urturi
- Gastroenterology Department, Hospital del Mar Research Institute, Barcelona
| | - X Castells
- Epidemiology and Evaluation Department, Hospital del Mar Medical Research Institute, Barcelona, Spain; RICAPPS (Research Network on Chronicity, Primary Care and Prevention and Health Promotion), Madrid, Spain
| | - B Bellosillo
- Pathology Department, Hospital del Mar Medical Research Institute, CIBERONC, Barcelona, Spain
| | - C Montagut
- Medical Oncology Department, Hospital del Mar Research Institute, CIBERONC, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain.
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Montagut C, Gambardella V, Cabeza-Segura M, Fleitas T, Cervantes A. In the literature: December 2021. ESMO Open 2021; 7:100352. [PMID: 34920292 PMCID: PMC8685987 DOI: 10.1016/j.esmoop.2021.100352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- C Montagut
- Department of Medical Oncology, Hospital del Mar - IMIM, Barcelona, Spain; CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - V Gambardella
- CIBERONC, Instituto de Salud Carlos III, Madrid, Spain; Department of Medical Oncology, Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - M Cabeza-Segura
- Department of Medical Oncology, Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - T Fleitas
- CIBERONC, Instituto de Salud Carlos III, Madrid, Spain; Department of Medical Oncology, Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - A Cervantes
- CIBERONC, Instituto de Salud Carlos III, Madrid, Spain; Department of Medical Oncology, Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain.
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Montagut C, Vidal J. ctDNA to detect minimal residual disease in pancreatic cancer: moving into clinical trials. Ann Oncol 2019; 30:1410-1413. [PMID: 31418008 DOI: 10.1093/annonc/mdz236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Montagut
- Medical Oncology Department, Hospital del Mar-IMIM, CIBERONC, Instituto de Salud Carlos III, Barcelona; HM Hospitales - Hospital HM Delfos, Barcelona.
| | - J Vidal
- Medical Oncology Department, Hospital del Mar-IMIM, CIBERONC, Instituto de Salud Carlos III, Barcelona; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
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Montagut C, Tsui DW, Diaz LA. Detection of somatic RAS mutations in circulating tumor DNA from metastatic colorectal cancer patients: are we ready for clinical use? Ann Oncol 2019; 29:1083-1084. [PMID: 29554200 DOI: 10.1093/annonc/mdy091] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- C Montagut
- Department of Medical Oncology and Cancer Research Program, Hospital del Mar-IMIM, Barcelona, Spain; Departments of Medicine, New York, USA.
| | - D W Tsui
- Pathology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - L A Diaz
- Departments of Medicine, New York, USA
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Vidal J, Bellosillo B, Santos Vivas C, García-Alfonso P, Carrato A, Cano MT, García-Carbonero R, Élez E, Losa F, Massutí B, Valladares-Ayerbes M, Viéitez JM, Manzano JL, Azuara D, Gallego J, Pairet S, Capellá G, Salazar R, Tabernero J, Aranda E, Montagut C. Ultra-selection of metastatic colorectal cancer patients using next-generation sequencing to improve clinical efficacy of anti-EGFR therapy. Ann Oncol 2019; 30:439-446. [PMID: 30689692 DOI: 10.1093/annonc/mdz005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Extended RAS analysis is mandatory in metastatic colorectal cancer (mCRC) patients. The optimal threshold of RAS mutated subclones to identify patients most likely to benefit from antiepidermal growth factor receptor (EGFR) therapy is controversial. Our aim was to assess the clinical impact of detecting mutations in RAS, BRAF, PIK3CA and EGFRS492R in basal tissue tumour samples by using a highly sensitive next-generation sequencing (NGS) technology in mCRC patients treated with chemotherapy plus anti-EGFR or anti-vascular endothelial growth factor. PATIENTS AND METHODS Five hundred and eighty-one tumour samples from untreated mCRC patients from 7 clinical studies were collected. Mutational analysis was carried out by standard-of-care (therascreen pyro) with a sensitivity detection of 5% mutant allele fraction (MAF), and compared with NGS technology using 454GS Junior platform (Roche Applied Science, Germany) with a sensitivity of 1%. Molecular results were correlated with clinical outcomes. RESULTS After quality assessment, 380 samples were evaluable for molecular analysis. Standard-of-care mutational analysis detected RAS, BRAFV600E or PIK3CA mutations in 56.05% of samples compared with 69.21% by NGS (P = 0.00018). NGS identified coexistence of multiple low-frequency mutant alleles in 96 of the 263 mutated cases (36.5%; range 2-7). Response rate (RR), progression-free survival (PFS) and overall survival (OS) were increasingly improved in patients with RAS wild-type, RAS/BRAF wild-type or quadruple (KRAS/NRAS/BRAF/PIK3CA) wild-type tumours treated with anti-EGFR, assessed by standard-of-care. No additional benefit in RR, PFS or OS was observed by increasing the detection threshold to 1% by NGS. An inverse correlation between the MAF of the most prevalent mutation detected by NGS and anti-EGFR response was observed (P = 0.039). EGFRS492Rmutation was not detected in untreated samples. CONCLUSIONS No improvement in the selection of patients for anti-EGFR therapy was obtained by adjusting the mutation detection threshold in tissue samples from 5% to 1% MAF. Response to anti-EGFR was significantly better in patients with quadruple wild-type tumours.
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Affiliation(s)
- J Vidal
- Medical Oncology Department, Hospital del Mar-IMIM, CIBERONC Instituto de Salud Carlos III, Barcelona
| | - B Bellosillo
- Pathology Department, Hospital del Mar, Barcelona
| | - C Santos Vivas
- Translational Research Laboratory, Medical Oncology Department, Catalan Institute of Oncology (ICO), ICO-Bellvitge Biomedical Research Institute (IDIBELL)-CIBERONC Instituto de Salud Carlos III, L'Hospitalet de Llobregat, Barcelona
| | | | - A Carrato
- Medical Oncology Department, Hospital Ramón y Cajal, IRYCIS, CIBERONC Instituto de Salud Carlos III, Alcala University, Madrid
| | - M T Cano
- Medical Oncology Department, IMIBIC, Reina Sofía Hospital, University of Cordoba, CIBERONC Instituto de Salud Carlos III
| | - R García-Carbonero
- Oncology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre, (imas12), UCM, CNIO, CIBERONC Instituto de Salud Carlos III, Madrid
| | - E Élez
- Medical Oncology Department, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), CIBERONC Instituto de Salud Carlos III, Universitat Autònoma de Barcelona, Barcelona
| | - F Losa
- Medical Oncology Department, Hospital Sant Joan Despí - Moisés Broggi, Barcelona
| | - B Massutí
- Medical Oncology Department, Hospital General Universitario, Alicante
| | - M Valladares-Ayerbes
- Medical Oncology Department, Complejo Hospitalario Universitario de A Coruña, A Coruña
| | - J M Viéitez
- Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo
| | - J L Manzano
- Medical Oncology Department, ICO, Badalona, Barcelona
| | - D Azuara
- Translational Research Laboratory, Medical Oncology Department, Catalan Institute of Oncology (ICO), ICO-Bellvitge Biomedical Research Institute (IDIBELL)-CIBERONC Instituto de Salud Carlos III, L'Hospitalet de Llobregat, Barcelona
| | - J Gallego
- Medical Oncology Department, Hospital General Universitario de Elche, Alicante
| | - S Pairet
- Pathology Department, Hospital del Mar, Barcelona
| | - G Capellá
- Faculty of Medicine, Department of Clinical Sciences, Translational Research Laboratory, ICO-IDIBELL, L'Hospitalet de Llobregat, University of Barcelona, CIBERONC Instituto de Salud Carlos III, Barcelona, Spain
| | - R Salazar
- Translational Research Laboratory, Medical Oncology Department, Catalan Institute of Oncology (ICO), ICO-Bellvitge Biomedical Research Institute (IDIBELL)-CIBERONC Instituto de Salud Carlos III, L'Hospitalet de Llobregat, Barcelona
| | - J Tabernero
- Medical Oncology Department, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), CIBERONC Instituto de Salud Carlos III, Universitat Autònoma de Barcelona, Barcelona
| | - E Aranda
- Medical Oncology Department, IMIBIC, Reina Sofía Hospital, University of Cordoba, CIBERONC Instituto de Salud Carlos III
| | - C Montagut
- Medical Oncology Department, Hospital del Mar-IMIM, CIBERONC Instituto de Salud Carlos III, Barcelona.
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Tarazona Llavero N, Fontana E, Gambardella V, Gimeno-Valiente F, Castillo J, Calon A, Martínez-Ciarpaglini C, Peiró-Chova L, Huerta M, Zuñiga S, Rentero-Garrido P, Montón-Bueno J, Roda D, Roselló S, Bellosillo B, Vivancos A, Nyamundana G, Montagut C, Sadanandam A, Cervantes A. A multi-omic analysis for prospective patient stratification in localised colorectal cancer (CRC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Montagut C, Alonso V, Escudero P, Fernández-Martos C, Salud Salvia A, Méndez M, Gallego Plazas J, Rodriguez J, Martín-Richard M, Fernández-Plana J, Aparicio J, Feliu Batlle J, García de Albéniz X, Rojo F, Fernández V, Claes B, Maertens G, Sablon E, Jacobs B, Maurel J. Clinical impact of circulating tumor RAS and BRAF mutation dynamics in metastatic colorectal cancer patients treated with first-line chemotherapy plus anti-EGFR therapy: Combined analysis of two prospective clinical trials. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fisher G, Guerra W, Day C, Montagut C. Optimizing the use of EGFR antibodies across the continuum of care in mCRC: Effect of online education on clinician knowledge, competence and confidence. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Van Cutsem E, Cuyle P, Huijberts S, Schellens J, Elez E, Yaeger R, Fakih M, Montagut C, Peeters M, Desai J, Yoshino T, Ciardiello F, Wasan H, Maharry K, Christy-Bittel J, Gollerkeri A, Kopetz S, Grothey A, Tabernero J. BEACON CRC study safety lead-in: Assessment of the BRAF inhibitor encorafenib + MEK inhibitor binimetinib + anti–epidermal growth factor receptor antibody cetuximab for BRAFV600E metastatic colorectal cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy149.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Vidal J, Dalmeses A, Vivas CS, Garcia-Carbonero R, García-Alfonso P, Carrato A, Elez E, Ortiz M, Losa F, Massutí B, Valladares-Ayerbes M, Manzano J, de Prado JV, Gallego J, Grávalos C, Varela M, Azuara D, Tabernero J, Salazar R, Aranda E, Bellosillo B, Montagut C. Ultra-selection of metastatic colorectal cancer patients using next generation sequencing platform to improve clinical efficacy of anti-EGFR therapy. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy149.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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12
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Abad A, Martínez-Balibrea E, Viéitez J, Alonso-Orduña V, García Alfonso P, Manzano J, Massutí B, Benavides M, Carrato A, Zanui M, Gallego J, Grávalos C, Conde V, Provencio M, Valladares-Ayerbes M, Salazar R, Sastre J, Montagut C, Rivera F, Aranda E. Genotype-based selection of treatment of patients with advanced colorectal cancer (SETICC): a pharmacogenetic-based randomized phase II trial. Ann Oncol 2018; 29:439-444. [DOI: 10.1093/annonc/mdx737] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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13
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Grasselli J, Elez E, Caratù G, Matito J, Santos C, Macarulla T, Vidal J, Garcia M, Viéitez JM, Paéz D, Falcó E, Lopez Lopez C, Aranda E, Jones F, Sikri V, Nuciforo P, Fasani R, Tabernero J, Montagut C, Azuara D, Dienstmann R, Salazar R, Vivancos A. Concordance of blood- and tumor-based detection of RAS mutations to guide anti-EGFR therapy in metastatic colorectal cancer. Ann Oncol 2018; 28:1294-1301. [PMID: 28368441 PMCID: PMC5834108 DOI: 10.1093/annonc/mdx112] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Circulating tumor DNA (ctDNA) is a potential source for tumor genome analysis. We explored the concordance between the mutational status of RAS in tumor tissue and ctDNA in metastatic colorectal cancer (mCRC) patients to establish eligibility for anti-epidermal growth factor receptor (EGFR) therapy. Patients and methods A prospective-retrospective cohort study was carried out. Tumor tissue from 146 mCRC patients was tested for RAS status with standard of care (SoC) PCR techniques, and Digital PCR (BEAMing) was used both in plasma and tumor tissue. Results ctDNA BEAMing RAS testing showed 89.7% agreement with SoC (Kappa index 0.80; 95% CI 0.71 − 0.90) and BEAMing in tissue showed 90.9% agreement with SoC (Kappa index 0.83; 95% CI 0.74 − 0.92). Fifteen cases (10.3%) showed discordant tissue-plasma results. ctDNA analysis identified nine cases of low frequency RAS mutations that were not detected in tissue, possibly due to technical sensitivity or heterogeneity. In six cases, RAS mutations were not detected in plasma, potentially explained by low tumor burden or ctDNA shedding. Prediction of treatment benefit in patients receiving anti-EGFR plus irinotecan in second- or third-line was equivalent if tested with SoC PCR and ctDNA. Forty-eight percent of the patients showed mutant allele fractions in plasma below 1%. Conclusions Plasma RAS determination showed high overall agreement and captured a mCRC population responsive to anti-EGFR therapy with the same predictive level as SoC tissue testing. The feasibility and practicality of ctDNA analysis may translate into an alternative tool for anti-EGFR treatment selection.
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Affiliation(s)
- J Grasselli
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Barcelona.,Department of Medical Oncology, Catalan Institute of Oncology, Universitat de Barcelona, L'Hospitalet, Barcelona
| | - E Elez
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Barcelona.,Department of Medical Oncology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona
| | - G Caratù
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology, Barcelona
| | - J Matito
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology, Barcelona
| | - C Santos
- Department of Medical Oncology, Catalan Institute of Oncology, Universitat de Barcelona, L'Hospitalet, Barcelona
| | - T Macarulla
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Barcelona.,Department of Medical Oncology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona
| | - J Vidal
- Department of Medical Oncology, Del Mar University Hospital, Barcelona
| | - M Garcia
- Department of Medical Oncology, Catalan Institute of Oncology, Universitat de Barcelona, L'Hospitalet, Barcelona
| | - J M Viéitez
- Department of Medical Oncology, Asturias University Hospital, Oviedo
| | - D Paéz
- Department of Medical Oncology, Santa Creu i Sant Pau University Hospital, Barcelona
| | - E Falcó
- Department of Medical Oncology, Son Llatzer University Hospital, Palma de Mallorca
| | - C Lopez Lopez
- Department of Medical Oncology, Marques de Valdecilla University Hospital, Santander
| | - E Aranda
- Department of Medical Oncology, Reina Sofía University Hospital, Córdoba, Spain
| | - F Jones
- Sysmex Inostics, Mundelein, USA
| | - V Sikri
- Sysmex Inostics, Mundelein, USA
| | - P Nuciforo
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology, Barcelona
| | - R Fasani
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology, Barcelona
| | - J Tabernero
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Barcelona.,Department of Medical Oncology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona
| | - C Montagut
- Department of Medical Oncology, Del Mar University Hospital, Barcelona
| | - D Azuara
- Traslational Research Laboratory, Catalan Institute of Oncology, L'Hospitalet, Barcelona
| | - R Dienstmann
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Barcelona.,Oncology Data Science Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - R Salazar
- Department of Medical Oncology, Catalan Institute of Oncology, Universitat de Barcelona, L'Hospitalet, Barcelona
| | - A Vivancos
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology, Barcelona
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Vidal J, Muinelo L, Dalmases A, Jones F, Edelstein D, Iglesias M, Orrillo M, Abalo A, Rodríguez C, Brozos E, Vidal Y, Candamio S, Vázquez F, Ruiz J, Guix M, Visa L, Sikri V, Albanell J, Bellosillo B, López R, Montagut C. Plasma ctDNA RAS mutation analysis for the diagnosis and treatment monitoring of metastatic colorectal cancer patients. Ann Oncol 2018; 28:1325-1332. [PMID: 28419195 PMCID: PMC5834035 DOI: 10.1093/annonc/mdx125] [Citation(s) in RCA: 247] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background RAS assessment is mandatory for therapy decision in metastatic colorectal cancer (mCRC) patients. This determination is based on tumor tissue, however, genotyping of circulating tumor (ct)DNA offers clear advantages as a minimally invasive method that represents tumor heterogeneity. Our study aims to evaluate the use of ctDNA as an alternative for determining baseline RAS status and subsequent monitoring of RAS mutations during therapy as a component of routine clinical practice. Patients and methods RAS mutational status in plasma was evaluated in mCRC patients by OncoBEAM™ RAS CRC assay. Concordance of results in plasma and tissue was retrospectively evaluated. RAS mutations were also prospectively monitored in longitudinal plasma samples from selected patients. Results Analysis of RAS in tissue and plasma samples from 115 mCRC patients showed a 93% overall agreement. Plasma/tissue RAS discrepancies were mainly explained by spatial and temporal tumor heterogeneity. Analysis of clinico-pathological features showed that the site of metastasis (i.e. peritoneal, lung), the histology of the tumor (i.e. mucinous) and administration of treatment previous to blood collection negatively impacted the detection of RAS in ctDNA. In patients with baseline mutant RAS tumors treated with chemotherapy/antiangiogenic, longitudinal analysis of RAS ctDNA mirrored response to treatment, being an early predictor of response. In patients RAS wt, longitudinal monitoring of RAS ctDNA revealed that OncoBEAM was useful to detect emergence of RAS mutations during anti-EGFR treatment. Conclusion The high overall agreement in RAS mutational assessment between plasma and tissue supports blood-based testing with OncoBEAM™ as a viable alternative for genotyping RAS of mCRC patients in routine clinical practice. Our study describes practical clinico-pathological specifications to optimize RAS ctDNA determination. Moreover, OncoBEAM™ is useful to monitor RAS in patients undergoing systemic therapy to detect resistance and evaluate the efficacy of particular treatments.
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Affiliation(s)
- J Vidal
- Cancer Research Program, FIMIM Hospital del Mar, Barcelona, Spain.,Medical Oncology Department, Hospital del Mar, Barcelona
| | - L Muinelo
- Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - A Dalmases
- Pathology Department, Hospital del Mar, Barcelona
| | - F Jones
- Sysmex Inostics Inc., Mundelein, USA
| | | | - M Iglesias
- Cancer Research Program, FIMIM Hospital del Mar, Barcelona, Spain.,Pathology Department, Hospital del Mar, Barcelona
| | - M Orrillo
- Medical Oncology Department, Hospital del Mar, Barcelona
| | - A Abalo
- Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - C Rodríguez
- Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - E Brozos
- Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - Y Vidal
- Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - S Candamio
- Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - F Vázquez
- Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - J Ruiz
- Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - M Guix
- Medical Oncology Department, Hospital del Mar, Barcelona
| | - L Visa
- Medical Oncology Department, Hospital del Mar, Barcelona
| | - V Sikri
- Sysmex Inostics Inc., Mundelein, USA
| | - J Albanell
- Cancer Research Program, FIMIM Hospital del Mar, Barcelona, Spain.,Medical Oncology Department, Hospital del Mar, Barcelona.,Universitat Pompeu Fabra, Barcelona, Spain
| | - B Bellosillo
- Medical Oncology Department, Hospital del Mar, Barcelona.,Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - R López
- Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - C Montagut
- Cancer Research Program, FIMIM Hospital del Mar, Barcelona, Spain.,Medical Oncology Department, Hospital del Mar, Barcelona
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Patel UB, Brown G, Machado I, Santos-Cores J, Pericay C, Ballesteros E, Salud A, Isabel-Gil M, Montagut C, Maurel J, Ramón-Ayuso J, Martin N, Estevan R, Fernandez-Martos C. MRI assessment and outcomes in patients receiving neoadjuvant chemotherapy only for primary rectal cancer: long-term results from the GEMCAD 0801 trial. Ann Oncol 2017; 28:344-353. [PMID: 28426108 DOI: 10.1093/annonc/mdw616] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background Primary chemotherapy has been tested as a possible approach for patients with high risk features but predicted clear mesorectal margins on preoperative MRI assessment. This study investigates the prognostic relevance of baseline and post-treatment MRI and pathology staging in rectal cancer patients undergoing primary chemotherapy. Patients and methods Forty-six patients with T3 tumour > =2 mm from the mesorectal fascia were prospectively treated with Neoadjuvant Capecitabine, Oxaliplatin and Bevacizumab prior to surgery between 2009 and 2011. The baseline and post-treatment MRI: T, Nodal and Extra-mural venous invasion (EMVI) status were recorded as well as post-treatment MRI Tumour regression grade (TRG) and modified-RECIST assessment of tumour length. The post-treatment pathology (yp) assessments of T3 substage, N, EMVI and TRG status were also recorded. Three-year disease-free survival (DFS) and cumulative incidence of recurrence were estimated by using the Kaplan-Meier product-limit method, and Cox proportional hazards models were used to determine associations between staging and response on MRI and pathology with survival outcomes. Results About 46 patients underwent neoadjuvant chemotherapy alone for high risk margin safe primary rectal cancer. The median follow-up was 41 months, 5 patients died and 11 patients experienced relapse (2 local, 8 distant and 1 both). In total 23/46 patients were identified with MRI features of EMVI at baseline. mrEMVI positive status carried independent prognostic significance for DFS (P = 0.0097) with a hazard ratio of 31.33 (95% CI: 2.3-425.4). The histopathologic factor that was of independent prognostic importance was a final ypT downstage of ypT3a or less, hazard ratio: 14.0 (95% CI: 1.5-132.5). Conclusions mrEMVI is an independent prognostic factor at baseline for poor outcomes in rectal cancer treated with neoadjuvant chemotherapy while ≤ypT3a is associated with an improvement in DFS. Future preoperative therapy evaluation in rectal cancer patients will need to stratify treatment according to baseline EMVI status as a crucial risk factor for recurrence in patients with predicted CRM clear rectal cancer.
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Affiliation(s)
- U B Patel
- Radiology Department, London North-West Healthcare NHS Trust, London
| | - G Brown
- Radiology Department, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - I Machado
- Department of Pathology, Valencia Institute of Oncology, Valencia, Spain
| | - J Santos-Cores
- Department of Radiology, Fundacion InstitutoValenciano de Oncologia, Valencia, Spain
| | - C Pericay
- Department of Medical Oncology, Corporació Sanitària Parc Taulí, Parc Taulí, 1, Sabadell, Barcelona, Spain
| | - E Ballesteros
- Department of Radiology, Corporación Sanitaria Parc Taulí, Sabadell, Barcelona, Spain
| | - A Salud
- Department of Medical Oncology, Corporació Sanitària Parc Taulí, Parc Taulí, 1, Sabadell, Barcelona, Spain
| | - M Isabel-Gil
- Department of Radiology, Hospital Universitari Arnau de Vilanova, Lleida
| | - C Montagut
- Department of Medical Oncology Department, Hospital del Mar, Barcelona
| | - J Maurel
- Department of Medical Oncology, Corporació Sanitària Parc Taulí, Parc Taulí, 1, Sabadell, Barcelona, Spain
| | - J Ramón-Ayuso
- Department of Radiology, Hospital Clinic de Barcelona, Barcelona
| | - N Martin
- Department of Pivotal, Madrid, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - R Estevan
- Department of Surgery, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - C Fernandez-Martos
- Department of Medical Oncology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
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Gambardella V, Sampera A, Castillo J, Sánchez-Martín F, Gimeno-Valiente F, Tarazona N, Roda D, Rovira A, Rosello M, Albanell J, Montagut C, Cervantes A. SRC-S6 axis as a potential mechanism of resistance to anti HER2 treatment in gastric cancer (GC) cell lines. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx511.008] [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: 11/14/2022] Open
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Tabernero J, Ciardiello F, Montagut C, Ding C, Kopetz S, Tuxen Poulsen T, Bardelli A, Wyrwicz L, Cubillo A, Santos C, Fumi G, Zagonel V, Bennouna J, Siena S, Falcone A, Benavent M, Argiles G, Kragh M, Horak I, Dvorkin M. Efficacy and safety of Sym004 in refractory metastatic colorectal cancer with acquired resistance to anti-EGFR therapy: Results of a randomized phase II study (RP2S). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vera R, Gómez M, Ayuso J, Figueras J, Garcia-Alfonso P, Martinez V, Lacasta A, Ruiz A, Safont M, Aparicio J, Campos J, Cámara J, Martin M, Montagut C, Pericay C, Viéitez J, Falcó E, Jorge M, Marín Vera M, Salgado Fernandez M. Correlation between RECIST-criteria, morphologic response by CT and pathologic regression in hepatic metastasis secondary to colorectal cancer: The AVAMET study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.115] [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: 11/14/2022] Open
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Huijberts S, Schellens J, Elez E, Cuyle PJ, Van Cutsem E, Yaeger R, Fakih M, Montagut C, Peeters M, Desai J, Yoshino T, Ciardiello F, Wasan H, Grothey A, Maharry K, Gollerkeri A, Kopetz S. BEACON CRC: safety lead-in (SLI) for the combination of binimetinib (BINI), encorafenib (ENCO), and cetuximab (CTX) in patients (pts) with BRAF-V600E metastatic colorectal cancer (mCRC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Garcia Foncillas J, Tabernero J, Aranda Aguilar E, Benavides M, Camps C, López R, Montagut C, Anton Torres A, Lopez Vivanco G, Diaz Rubio E, Rojo F, Vivancos A. First prospective multicenter real-world RAS mutation comparison between OncoBEAM-based liquid biopsy and tissue analysis. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx363.045] [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: 11/14/2022] Open
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Vidal J, Viéitez J, Paez D, Santos C, Falcó E, López López C, Valladares-Ayerbes M, Robles L, Garcia-Alfonso P, Duran Ogaya G, Azuara D, Dalmeses A, Bellosillo Paricio B, CAPELLA G, Salazar R, Aranda Aguilar E, Montagut C. Circulating tumor (ct) DNA captures intrapatient heterogeneity in metastatic colorectal (mCRC) patients (pts) progressing to FOLFIRI+panitumumab. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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González-Cao M, Arance A, Piulats JM, Marquez-Rodas I, Manzano JL, Berrocal A, Crespo G, Rodriguez D, Perez-Ruiz E, Berciano M, Soria A, Castano AG, Espinosa E, Montagut C, Alonso L, Puertolas T, Aguado C, Royo MA, Blanco R, Rodríguez JF, Muñoz E, Mut P, Barron F, Martin-Algarra S. Pembrolizumab for advanced melanoma: experience from the Spanish Expanded Access Program. Clin Transl Oncol 2017; 19:761-768. [DOI: 10.1007/s12094-016-1602-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 12/16/2016] [Indexed: 11/28/2022]
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Azuara D, Garcia-Carbonero R, Alfonso PG, Santos-Vivas C, Navarro V, Varela M, Carrato A, Elez E, Cano M, Losa F, Montagut C, Sureda BM, Manzano J, Vieitez J, Valladares-Ayerbes M, Sanjuan X, Capellá G, Tabernero J, Aranda E, Salazar R. Extended genotyping of RAS/BRAF for improved selection of metastatic CRC patients to anti-EGFR therapy: Comparison of three platforms. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw363.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vercauteren E, Bellon E, Vermeiren K, De Freitas F, De Haes E, Van Gestel S, Murray S, Grauslund M, Melchior L, D'Haene N, Le Mercier M, Bellosillo B, Montagut C, Van Brussel M, Sablon E, Maertens G. Ultra-rapid, sensitive, and fully automated extended RAS testing for metastatic colorectal cancer – evaluation of an NRAS/BRAF/EGFR492 module. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw380.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Barrull JV, Romay LM, Dalmases A, Abalo A, Vela M, Rodríguez MA, Muset M, Ruiz J, Iglesias M, Blanco C, López E, Rodríguez C, Jones F, Edelstein D, Lukas A, Albanell J, Bellosillo B, Candamio S, Montagut C, López R. Accuracy of plasma RAS mutation testing for therapy selection and monitoring of colorectal cancer patients. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.81] [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: 11/14/2022] Open
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Sampera A, Gelabert-Baldrich M, Sánchez-Martín F, Dalmases A, Arpi O, Iglesias M, Martínez A, Rovira A, Albanell J, Montagut C. Identification of molecular mechanisms of acquired resistance to trastuzumab in gastric cancer. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61442-9] [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: 11/24/2022]
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Grasselli J, Elez E, Caratù G, Matito J, Santos C, Macarulla T, Vidal J, Garcia M, Viéitez J, Paéz D, Falcó E, Lopez CL, Aranda E, Jones F, Sikri V, Nuciforo P, Dienstmann R, Montagut C, Tabernero J, Azuara D, Salazar R, Vivancos A. O-024 Circulating tumor DNA extended RAS mutational analysis as a surrogate of mutational status of tumor samples in metastatic colorectal cancer and its impact on patient selection for anti-EGFR therapy. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw198.24] [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: 11/12/2022] Open
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Garcia RV, Gomez M, Ayuso J, Figueras J, Alfonso PG, Martinez V, Lacasta A, Ruiz A, Safont M, Aparicio J, Campos J, Camara J, Martin-Richard M, Montagut C, Pericay C, Vieitez J, Falco E, Jorge M, Marin M, Salgado M. 2051 Relation between RAS mutations and radiologic (RECIST and morphologic) and pathologic response, in hepatic metastasis secondary to colorectal cancer: The AVAMET study. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30974-1] [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]
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Fernandez-Martos C, Garcia-Albeniz X, Pericay C, Maurel J, Aparicio J, Montagut C, Safont M, Salud A, Vera R, Massuti B, Escudero P, Alonso V, Bosch C, Martin M, Minsky B. Chemoradiation, surgery and adjuvant chemotherapy versus induction chemotherapy followed by chemoradiation and surgery: long-term results of the Spanish GCR-3 phase II randomized trial. Ann Oncol 2015; 26:1722-8. [DOI: 10.1093/annonc/mdv223] [Citation(s) in RCA: 205] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 05/02/2015] [Indexed: 12/17/2022] Open
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García Alfonso P, Ortiz M, Durán G, Falcó E, Muñoz A, García-Paredes B, Salgado M, López-Ladrón A, Vieitez de Prado J, Valladares M, Salud A, Guillén-Ponce C, Lopez R, Robles L, Juárez A, Serrano S, Montagut C, Zanui M, Gil Raga M, La Casta A, Benavides M, Aranda E. P-272 Phase II study of Regorafenib as single agent for the treatment of patients with metastatic colorectal cancer with any RAS or BRAF mutation and previously treated with FOLFOXIRI plus bevacizumab. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv233.269] [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: 11/12/2022] Open
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Azuara D, Santos C, Lopez-Doriga A, Grasselli J, Nadal M, Sanjuan X, Marin F, Morell M, Montal R, Moreno V, Montagut C, Bellosillo B, Argiles G, Elez E, Tabernero J, Capellá G, Salazar R. O-012 Nanofluidic digital PCR and extended genotyping of RAS, BRAF and PI3KCA for improved selection of metastatic colorectal cancer patients to anti-EGFR therapies. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv235.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Affiliation(s)
- C Montagut
- Department of Medical Oncology Cancer Research Program, FIMIM, Hospital del Mar, Barcelona, Spain
| | - G Siravegna
- Department of Oncology, University of Torino, Candiolo Candiolo Cancer Institute - FPO, IRCCS, Candiolo FIRC Institute of Molecular Oncology (IFOM), Milan, Italy
| | - A Bardelli
- Department of Oncology, University of Torino, Candiolo Candiolo Cancer Institute - FPO, IRCCS, Candiolo
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Pera M, Gallego R, Montagut C, Martín-Richard M, Iglesias M, Conill C, Reig A, Balagué C, Pétriz L, Momblan D, Bellmunt J, Maurel J. Phase II trial of preoperative chemoradiotherapy with oxaliplatin, cisplatin, and 5-FU in locally advanced esophageal and gastric cancer. Ann Oncol 2012; 23:664-670. [PMID: 21652581 DOI: 10.1093/annonc/mdr291] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Based on a phase I study showing the feasibility of combining of oxaliplatin, cisplatin, and 5-fluorouracil (5-FU) (OCF) with radiation therapy (RT) in esophageal cancer, the efficacy of this regimen in esophageal, gastroesophageal (GE), and gastric (G) cancer was assessed in this phase II multicenter study. PATIENTS AND METHODS Patients with resectable tumors were eligible. Treatment included two cycles of oxaliplatin 85 mg/m(2), cisplatin 55 mg/m(2), and continuously infused 5-FU 3 g/m(2) in 96 h and concurrent RT (45 Gy), followed by surgery after 6-8 weeks. Primary end point was complete pathologic response (pCR). RESULTS Forty-one patients were enrolled. Tumor location was esophagus 39% (squamous 10/adenocarcinoma 6), GE junction 32%, and stomach 29%. G3-G4 adverse events included asthenia (27%) and neutropenia (14%). One toxic death occurred. Thirty-one patients (75.6%) underwent surgery (R0 in 94%). Pathologic response was achieved in 58% of patients, with pCR in 50% and 16% of esophageal and GE/G cancer, respectively. pCR was achieved in 67% of squamous cell carcinoma. Survival: median follow-up, 50.4 months; median progression-free survival and overall survival were 23.2 and 28.4 months, respectively. CONCLUSION Preoperative OCF plus RT showed an acceptable toxicity and promising activity especially in squamous cell esophageal cancer.
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Affiliation(s)
- M Pera
- Section of Gastrointestinal Surgery, Hospital Universitario del Mar and Institut de Recerca Hospital del Mar (IMIM), Universitat Autónoma de Barcelona, Barcelona.
| | - R Gallego
- Department of Medical Oncology and Radiation Therapy, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona Medical School, Barcelona
| | - C Montagut
- Service of Medical Oncology, Hospital Universitario del Mar and Institut de Recerca Hospital del Mar (IMIM), Barcelona
| | | | | | - C Conill
- Department of Medical Oncology and Radiation Therapy, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona Medical School, Barcelona
| | - A Reig
- Services of Radiotherapy, Hospital Universitario del Mar and Institut de Recerca Hospital del Mar (IMIM), Barcelona
| | | | - L Pétriz
- Services of Radiation Therapy, Hospital de Sant Pau, Barcelona
| | - D Momblan
- Service of Gastrointestinal Surgery, Hospital Clinic, Barcelona, Spain
| | - J Bellmunt
- Service of Medical Oncology, Hospital Universitario del Mar and Institut de Recerca Hospital del Mar (IMIM), Barcelona
| | - J Maurel
- Department of Medical Oncology and Radiation Therapy, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona Medical School, Barcelona
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Geva R, Jensen BV, Fountzilas G, Yoshino T, Paez D, Montagut C, Sougklakos I, Cappuzzo F, Cervantes-Ruiperez A, Papamichael D, Frattini M, Vincenzi B, Macarulla T, Loupakis F, Spindler KG, Qvortrup C, Ciardiello F, Tejpar S. An international consortium study in chemorefractory metastatic colorectal cancer (mCRC) patients (pts) to assess the impact of FCGR polymorphisms on cetuximab efficacy. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3528] [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: 11/20/2022] Open
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Szyldergemajn SA, Gonçalves A, Metges JP, Gunzer K, Montagut C, Salazar R, Alsina M, Evans TRJ, Swinson D, Petty RD, Singer H, Kahatt CM. IMAGE, a randomized phase Ib/II study of elisidepsin in pretreated advanced gastroesophageal cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Montagut C, Arriola E, Galvan AB, Rojo FG, Salido M, Gallen M, Garcia M, Martinez A, Pons F, Servitja S, Iglesias M, Menendez S, Serrano S, Sole F, Rovira A, Albanell J, Bellmunt J. ALK chromosomal alterations in neuroendocrine tumors. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.10585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Montagut C, Galvan AB, Gallen M, Salido M, Sole F, Rojo FG, Arriola E, Rovira A, Bellmunt J, Albanell J. ALK chromosomal alterations in colon cancer patients. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.10537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Iglesias M, Rojo FG, Martinez-Fernandez A, Arumí M, Bellosillo B, Rovira A, Bellmunt J, Albanell J, Montagut C. Mitogen-activated protein kinase phosphatase-1 (MKP-1) as a biomarker of resistance to cetuximab in colorectal cancer patients. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Pera M, Gallego R, Martin-Richard M, Montagut C, Iglesias M, Conill C, Balaguer C, Petriz L, Momblan D, Maurel J. Phase II study with preoperative oxaliplatin (O), cisplatin (P), 5-fluorouracil (F) (OPF) and radiation (XRT) in patients with esophageal (ES), gastroesophageal (GE), and gastric (G) cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15612] [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
e15612 Background: A phase I study showed the feasibility of the triplet combination (OPF) with XRT in ES and GE cancer (Maurel et al, IJRBOP, 2005). We conducted a phase II study to evaluate the efficacy of the regimen. Methods: Enrolled pts had resectable, high-risk (HR) based on endoscopic ultrasonography (EUS) (uT3, uN1 or uT4 if deemed resectable) ES, GE and G cancer. The primary objective was to determine the pathologic complete response (pCR). If 2 or more pCR were reported in the first 18 pts treated, enrollment continues with 23 additional pts. Eligibility criteria: squamous cell or adenocarcinoma of the ES, GE or G cancer and ECOG Performance status (PS) 0–1. Staging was done with EUS and computed spiral tomography. Laparoscopic staging was mandatory for pts with ES, GE and G adenocarcinoma. Pts received 2 cycles of O 85 mg/m2, P 55 mg/m2, F (3 g/m2 in 96h CI) q4w, with concomitant 45 Gy XRT in 25 fractions; surgery was planned 5–8 weeks after XRT. All pathological specimens were reviewed by a unique pathologist and regression analysis was recorded using Cologne (C) and M.D.Anderson (MDA) classification for ES and European Journal of Surgical Oncology (EJSO) for GE and G. Results: Between 5/04 to 12/07, 41 pts were enrolled in 5 Spanish Institutions. Median age 62 yrs (39–75 yrs); Male/female 83%/17%; PS 0/1 27%/73%; ES/GE/G 39%/32%/29%; EUS stageT3N0 (20%), T2–3N1 (65%) and T4 (10%). G3/4 adverse events included asthenia (27%), infection (7%), diarrhea (7%) and stomatitis (5%). There were 2 toxic deaths. Of the 31 pts who underwent surgery, there were R0=94%/R1=3%/R2= 3%. 7/41 pts (17%) achieved pCR. Using C and MDA classification, 9/14 (61%) and 12/14 (85%) ES achieved grade IV/III and P0/P1 regression, respectively. With EJSO classification 3/17 (18%) GE and G tumors achieved pCR. Median time to progression or death (PFS) was 16.2 (CI:12.2-NR) months (mo). Median overall survival (OS) was 28.9 mo. (CI: 22.5-NR). Conclusions: Although in the whole group pCR, PFS and OS does not appear superior to results achieved in other trials with preoperative P/F/XRT in HR pts, the OPF regimen seems specially active in ES cancer. No significant financial relationships to disclose.
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Affiliation(s)
- M. Pera
- Hospital Universitario del Mar, Barcelona, Spain; Hospital Clinic, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain
| | - R. Gallego
- Hospital Universitario del Mar, Barcelona, Spain; Hospital Clinic, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain
| | - M. Martin-Richard
- Hospital Universitario del Mar, Barcelona, Spain; Hospital Clinic, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain
| | - C. Montagut
- Hospital Universitario del Mar, Barcelona, Spain; Hospital Clinic, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain
| | - M. Iglesias
- Hospital Universitario del Mar, Barcelona, Spain; Hospital Clinic, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain
| | - C. Conill
- Hospital Universitario del Mar, Barcelona, Spain; Hospital Clinic, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain
| | - C. Balaguer
- Hospital Universitario del Mar, Barcelona, Spain; Hospital Clinic, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain
| | - L. Petriz
- Hospital Universitario del Mar, Barcelona, Spain; Hospital Clinic, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain
| | - D. Momblan
- Hospital Universitario del Mar, Barcelona, Spain; Hospital Clinic, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain
| | - J. Maurel
- Hospital Universitario del Mar, Barcelona, Spain; Hospital Clinic, Barcelona, Spain; Hospital de Sant Pau, Barcelona, Spain
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Montagut C, Albanell J, Bellmunt J. Prostate cancer. Multidisciplinary approach: a key to success. Crit Rev Oncol Hematol 2008; 68 Suppl 1:S32-6. [PMID: 18723370 DOI: 10.1016/j.critrevonc.2008.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Accepted: 07/08/2008] [Indexed: 10/21/2022] Open
Abstract
Diagnosis and treatment of prostate cancer has improved in the last few years, in part due to a multidisciplinary approach between urologists, oncologists, radiotherapists, radiologists, pathologists, basic and translational researchers for a successful management. The TAX 327 study is the paradigm of a smooth communication between expert physicians that led to the approval of docetaxel in metastatic hormone-resistant prostate cancer (HRPC). Survival benefit with docetaxel in HRPC was confirmed in an updated survival analysis reported this year. A nomogram to predict survival in metastatic HRPC treated with chemotherapy was established based on the TAX 327 study. Unfortunately in early prostate cancer, some of the phase III clinical trials with chemotherapy had to be closed due to lack of sufficient accrual, due to, at least in part, an unsuccessful collaboration between urologists, medical oncologists and radiotherapists. In earlier phases of prostate cancer, a successful multidisciplinary approach has led to important advances in genomics, biomarkers and imaging techniques that have created big excitement for future improvements in the management of prostate cancer. An example is the validation of novel molecular diagnosis tests such as PCA3 or TMPRSS2 - ETS in urinary samples. Importantly, we should not forget that the key for a successful future development in the management of prostate cancer will require the expertise of all disciplines to provide optimal care.
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Affiliation(s)
- C Montagut
- Medical Oncology Service, Hospital del Mar - IMAS, University Pompeu Fabra (UPF), Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
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Abstract
The proteasome is an ubiquituous enzyme complex that plays a critical role in the degradation of many proteins involved in cell cycle regulation, apoptosis and angiogenesis. Since these pathways are fundamental for cell survival and proliferation, particularly in cancer cells, the inhibition of proteasome is an attractive potential anticancer therapy. Bortezomib (Velcade, formerly PS-341) is an extremely potent and selective proteasome inhibitor that shows strong activity in in vitro and in vivo laboratory studies against many solid and hematologic tumor types. Moreover, bortezomib, mainly by inhibition of the NF-kappaB pathway, has a chemosensitizing effect when administered together with other antitumoral drugs. Clinical phase I trials, showed good tolerance of bortezomib at doses that achieved a desired degree of proteasome inhibition. Phase II studies showed high response rates in refractory multiple myeloma patients, which led to the accelerated approval of bortezomib by the Food and Drug Administration (FDA) and the European Medicines Agency (EMEA) for this indication. A phase III trial comparing bortezomib to dexamethasone in refractory/relapsed multiple myeloma patients had to be halted due to a survival advantage in the bortezomib arm. Additional studies are focusing in the potential benefit of bortezomib in newly diagnosed multiple myeloma patients. In other solid and hematological malignancies, phase II studies with bortezomib alone or in combination are ongoing with encouraging results, particularly in lung cancer and lymphoma.
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Affiliation(s)
- C Montagut
- Medical Oncology Department & Experimental Cancer Therapeutics Unit, URTEC, Hospital del Mar, Barcelona, Spain
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Montagut C, Tusquets I, Ferrer B, Corominas JM, Bellosillo B, Campas C, Suarez M, Fabregat X, Campo E, Gascon P, Serrano S, Fernandez PL, Rovira A, Albanell J. Activation of nuclear factor-kappa B is linked to resistance to neoadjuvant chemotherapy in breast cancer patients. Endocr Relat Cancer 2006; 13:607-16. [PMID: 16728586 DOI: 10.1677/erc.1.01171] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The nuclear factor (NF)-kappaB system is a promising anticancer target due to its role in oncogenesis and chemoresistance in preclinical models. To provide evidence in a clinical setting on the role of NF-kappaB in breast cancer, we aimed to study the value of basal NF-kappaB/p65 in predicting resistance to neoadjuvant chemotherapy, and to characterise the pharmacodynamic changes in NF-kappaB/p65 expression following chemotherapy in patients with locally advanced breast cancer. Pre- and post-chemotherapy tumour specimens from 51 breast cancer patients treated with anthracycline- and/or taxane-containing neoadjuvant chemotherapy were assayed by immunohistochemistry for NF-kappaB/p65 subcellular expression. We studied NF-kappaB/p65, a well-characterised member of the NF-kappaB family that undergoes nuclear translocation when NF-kappaB is activated. Activation of NF-kappaB (i.e. nuclear NF-kappaB/p65 staining in pre-therapy specimens) was linked to chemoresistance. Patients with NF-kappaB/p65 nuclear staining in pre-treatment samples had a 20% clinical response rate, while patients with undetected nuclear staining had a 91% response rate to chemotherapy (P = 0.002). Notably, four patients achieved a complete histological response and none of them had pre-treatment NF-kappaB/p65 nuclear staining. Moreover, the number of patients with NF-kappaB/p65 activation increased after chemotherapy exposure. It is concluded that NF-kappaB/p65 activation assayed by immunohistochemistry is a predictive factor of resistance to neoadjuvant chemotherapy in breast cancer patients. Moreover, NF-kappaB activation was inducible following chemotherapy in a proportion of breast cancer patients. These novel clinical findings strengthen the rationale for the use of NF-kappaB inhibitors to prevent or overcome chemoresistance in breast cancer.
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Affiliation(s)
- C Montagut
- Medical Oncology Department, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Hospital Clinic, Barcelona 08035, Spain
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Domingo-Domènech J, Molina R, Castel T, Montagut C, Puig S, Conill C, Martí R, Vera M, Auge JM, Malvehy J, Grau JJ, Gascon P, Mellado B. Serum Protein S-100 Predicts Clinical Outcome in Patients with Melanoma Treated with Adjuvant Interferon – Comparison with Tyrosinase RT-PCR. Oncology 2005; 68:341-9. [PMID: 16020961 DOI: 10.1159/000086973] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2004] [Accepted: 10/03/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To study the clinical value of the determination of serum S-100 protein as a single tumor marker or in combination with tyrosinase RT-PCR in patients with melanoma receiving adjuvant interferon. PATIENTS AND METHODS Patients were tested for serum S-100 protein luminoimmunometric assay and for blood tyrosinase mRNA (RT-PCR), before starting interferon and every 2-3 months thereafter. RESULTS One hundred and six patients (stage IIA, 27; IIB, 19; III, 49; and IV, 11) were included in the study. Median follow-up was 51 months (range 2-76). In the univariate analysis, under treatment S-100 > or =0.15 microg/l and a positive RT-PCR correlated with a lower disease-free survival and overall survival (OS). In the multivariate analysis, clinical stage, under therapy positive RT-PCR and S-100 levels > or =0.15 mug/ml, were independent prognostic factors for OS. The hazard ratio for OS was 3.9 (95% CI, 1.67-9.15; p = 0.004) and 2.2 (95% CI, 1.05-4.6; p = 0.016) for S-100 > or =0.15 microg/l and positive RT-PCR, respectively. When both techniques where combined, a positive RT-PCR indicated a poorer clinical outcome only in patients with S-100 <0.15 microg/l. CONCLUSIONS S-100 > or =0.15 microg/l and a positive RT-PCR during adjuvant interferon therapy indicate a high risk of death in resected melanoma patients. S-100 determination has a higher positive predictive value than RT-PCR, while tyrosinase RT-PCR adds prognostic information in patients with S-100 <0.15 microg/l.
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Affiliation(s)
- J Domingo-Domènech
- Medical Oncology Department, Biochemistry Department, Hospital Clínic, IDIBAPS, Melanoma Group, Barcelona, Spain.
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Domingo-Domenech J, Rovira A, Codony-Servat J, Filella X, Montagut C, Ross JS, Rolfe M, Gascon P, Albanell J, Mellado B. Nuclear Factor-κB(NF-κB)/Interleukin-6 (IL-6) pathway activation confers resistance to docetaxel (D) in hormone-independent prostate cancer (HIPC). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.9630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J. Domingo-Domenech
- Hosp Clinic, Barcelona, Spain; Albany Medcl Coll & Millennium Pharmaceuticals, Albany, NY; Millennium Pharmaceuticals Inc, Cambridge, MA
| | - A. Rovira
- Hosp Clinic, Barcelona, Spain; Albany Medcl Coll & Millennium Pharmaceuticals, Albany, NY; Millennium Pharmaceuticals Inc, Cambridge, MA
| | - J. Codony-Servat
- Hosp Clinic, Barcelona, Spain; Albany Medcl Coll & Millennium Pharmaceuticals, Albany, NY; Millennium Pharmaceuticals Inc, Cambridge, MA
| | - X. Filella
- Hosp Clinic, Barcelona, Spain; Albany Medcl Coll & Millennium Pharmaceuticals, Albany, NY; Millennium Pharmaceuticals Inc, Cambridge, MA
| | - C. Montagut
- Hosp Clinic, Barcelona, Spain; Albany Medcl Coll & Millennium Pharmaceuticals, Albany, NY; Millennium Pharmaceuticals Inc, Cambridge, MA
| | - J. S. Ross
- Hosp Clinic, Barcelona, Spain; Albany Medcl Coll & Millennium Pharmaceuticals, Albany, NY; Millennium Pharmaceuticals Inc, Cambridge, MA
| | - M. Rolfe
- Hosp Clinic, Barcelona, Spain; Albany Medcl Coll & Millennium Pharmaceuticals, Albany, NY; Millennium Pharmaceuticals Inc, Cambridge, MA
| | - P. Gascon
- Hosp Clinic, Barcelona, Spain; Albany Medcl Coll & Millennium Pharmaceuticals, Albany, NY; Millennium Pharmaceuticals Inc, Cambridge, MA
| | - J. Albanell
- Hosp Clinic, Barcelona, Spain; Albany Medcl Coll & Millennium Pharmaceuticals, Albany, NY; Millennium Pharmaceuticals Inc, Cambridge, MA
| | - B. Mellado
- Hosp Clinic, Barcelona, Spain; Albany Medcl Coll & Millennium Pharmaceuticals, Albany, NY; Millennium Pharmaceuticals Inc, Cambridge, MA
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Montagut C, Rovira A, Mellado B, Gascon P, Ross JS, Albanell J. Preclinical and clinical development of the proteasome inhibitor bortezomib in cancer treatment. Drugs Today (Barc) 2005; 41:299-315. [PMID: 16082428 DOI: 10.1358/dot.2005.41.5.893706] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The proteasome is a ubiquitous enzyme complex that plays a critical role in the degradation of many proteins involved in cell cycle regulation, apoptosis and angiogenesis. Since these pathways are fundamental for cell survival and proliferation, particularly in cancer cells, the inhibition of proteasome is an attractive potential anticancer therapy. The present review will focus on the proteasome inhibitor bortezomib (Velcade, formerly PS-341; Millennium Pharmaceuticals, Inc., Cambridge, MA, USA). Bortezomib is an extremely potent and selective proteasome inhibitor that shows strong activity in in vitro and in vivo laboratory studies against many solid and hematologic tumor types. Moreover, bortezomib, mainly by inhibition of the NF-kappaB pathway, has a chemosensitizing effect when administered together with other antitumoral drugs. Based on these results, bortezomib entered clinical phase I trials, alone or in combination with chemotherapy, that showed good tolerance at doses that achieved a desired degree of proteasome inhibition. Phase II studies showed high response rates in refractory multiple myeloma patients, which led to the accelerated approval of bortezomib by the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMEA) for this indication. A phase III trial comparing bortezomib with dexamethasone in refractory/ relapsed multiple myeloma patients had to be halted due to a survival advantage in the bortezomib arm. Additional studies are focusing on the potential benefit of bortezomib in newly diagnosed multiple myeloma patients. In other solid and hematological malignancies, phase II studies with bortezomib alone or in combination with other agents are ongoing. Encouraging results, particularly in lung cancer and lymphoma, have been observed. The critical molecules or genes responsible for tumor sensitivity to bortezomib continue to be evaluated using novel technologies.
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Affiliation(s)
- C Montagut
- Medical Oncology Department/CMHO, Hospital Clinic & Laboratory of Experimental Research, IDIBAPS, Barcelona, Spain
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Valle J, Montagut C, Pronk L, Jones E, Tosca M, Beech J, Taylor B, Zugmaier G, Gascon P, Albanell J. 287 A phase Ib study of pertuzumab (P), a recombinant humanized antibody to HER2, and capecitabine (C) in patients with advanced solid tumors. EJC Suppl 2004. [DOI: 10.1016/s1359-6349(04)80295-7] [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: 11/28/2022] Open
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Montagut C, Mellado B, Mármol M, Santos M, Domingo-Doménech J, García A, Ramón Y Cajal S, Puig-Tintoré LM, Gascon P, Ordi J. Immunohistochemical staining for p16INK4A selectively detects human papillomavirus-related premalignant and malignant vulvar lesions. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.5028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C. Montagut
- Hospital Clinic, Barcelona, Spain; Hospital Vall d'Hebron, Barcelona, Spain; Hosptal Vall d'Hebron, Barcelona, Spain
| | - B. Mellado
- Hospital Clinic, Barcelona, Spain; Hospital Vall d'Hebron, Barcelona, Spain; Hosptal Vall d'Hebron, Barcelona, Spain
| | - M. Mármol
- Hospital Clinic, Barcelona, Spain; Hospital Vall d'Hebron, Barcelona, Spain; Hosptal Vall d'Hebron, Barcelona, Spain
| | - M. Santos
- Hospital Clinic, Barcelona, Spain; Hospital Vall d'Hebron, Barcelona, Spain; Hosptal Vall d'Hebron, Barcelona, Spain
| | - J. Domingo-Doménech
- Hospital Clinic, Barcelona, Spain; Hospital Vall d'Hebron, Barcelona, Spain; Hosptal Vall d'Hebron, Barcelona, Spain
| | - A. García
- Hospital Clinic, Barcelona, Spain; Hospital Vall d'Hebron, Barcelona, Spain; Hosptal Vall d'Hebron, Barcelona, Spain
| | - S. Ramón Y Cajal
- Hospital Clinic, Barcelona, Spain; Hospital Vall d'Hebron, Barcelona, Spain; Hosptal Vall d'Hebron, Barcelona, Spain
| | - L. M. Puig-Tintoré
- Hospital Clinic, Barcelona, Spain; Hospital Vall d'Hebron, Barcelona, Spain; Hosptal Vall d'Hebron, Barcelona, Spain
| | - P. Gascon
- Hospital Clinic, Barcelona, Spain; Hospital Vall d'Hebron, Barcelona, Spain; Hosptal Vall d'Hebron, Barcelona, Spain
| | - J. Ordi
- Hospital Clinic, Barcelona, Spain; Hospital Vall d'Hebron, Barcelona, Spain; Hosptal Vall d'Hebron, Barcelona, Spain
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