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García-Donas J, de Velasco G, Madurga R, Chamorro J, Rosero D, Etxaniz O, Pérez-Gracia JL, Pinto Á, Cacho D, Barba M, Borrega P, Lázaro M, Rodriguez L, Villalobos L, García L, Cuellar A, Solís-Hernández MP, González A, Pernaut C, Rodríguez-Moreno JF. Case-control study assessing the impact of COVID19 in advanced kidney cancer patients treated with antiangiogenics or immunotherapy: the COVID-REN study. Clin Transl Oncol 2024; 26:732-738. [PMID: 37556096 DOI: 10.1007/s12094-023-03295-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Cancer is a risk factor for developing severe COVID19. Additionally, SARS-CoV2 has a special tropism for renal cells and complications like thrombosis or cytokine storm could be enhanced by standard treatments in kidney cancer (i.e., antiangiogenics or immunotherapy). Thus, understanding the impact of COVID19 in patients with this tumor is key for their correct management. METHODS We designed a retrospective case-control study comparing the outcome of three groups of advanced kidney cancer patients on systemic treatment: cohort A (developed COVID19 while on antiangiogenics), cohort B (developed COVID19 while on immunotherapy) and cohort C (non-infected). Matching factors were age, gender, and treatment. RESULTS 95 patients were recruited in 16 centers in Spain from September 2020 to May 2021. Finally, 85 were deemed as eligible (23 cohort A, 21 cohort B, 41 cohort C). Patients with COVID required more dose interruptions (25 vs. six) and hospitalizations (10 vs. none) than those without COVID (both p = 0.001). No difference between cohorts A and B was observed regarding hospitalization or length of stay. No ICU admission was registered and one patient in cohort B died due to COVID19. Regarding cancer evolution, three patients in cohort A presented progressive disease after COVID19 compared to two in cohort B. One case in cohort B, initially deemed as stable disease, achieved a partial response after COVID19. CONCLUSIONS Kidney cancer patients who developed COVID19 while on systemic therapy required more treatment interruptions and hospitalizations than those non-infected. However, no significant impact on cancer outcome was observed. Also, no difference was seen between cases on antiangiogenics or immunotherapy.
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Affiliation(s)
| | | | - Rodrigo Madurga
- Faculty of Experimental Sciences, Universidad Francisco de Vitoria, Madrid, Spain
| | | | - Diana Rosero
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Diego Cacho
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - María Barba
- HM Hospitales-Centro Integral Oncológico Clara Campal, Madrid, Spain
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Carril-Ajuria L, Colomba E, Romero-Ferreiro C, Cerbone L, Ratta R, Barthelemy P, Vindry C, Fléchon A, Cherifi F, Boughalem E, Linassier C, Fornarini G, Rebuzzi SE, Gross-Goupil M, Saldana C, Martin-Soberón M, de Velasco G, Manneh R, Pernaut C, Sanchez de Torre A, Flippot R, Escudier B, Albiges L. Frontline immune checkpoint inhibitor-based combination therapy in metastatic renal cell carcinoma patients with poor performance status. Eur J Cancer 2023; 180:21-29. [PMID: 36527973 DOI: 10.1016/j.ejca.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Immune checkpoint inhibitor-based combination therapy (ICI-based combination) is a new standard of care for metastatic clear cell renal cell carcinoma (mRCC) in the frontline setting. Patients with poor performance status (PS) (≥2) were excluded from pivotal trials. Hence, the activity and safety of ICI-based combination therapy in this group of patients is still unknown. METHODS We performed a multicentre retrospective study of PS ≥2 mRCC patients who received frontline ICI-based combination, either nivolumab-ipilimumab (NI) or pembrolizumab-axitinib (AP). Patients' characteristics, clinical outcomes, and toxicity were collected. We analysed overall response rate (ORR), median progression-free survival (mPFS), median overall survival (mOS) and grade ≥3 adverse events (G ≥ 3AEs). The association between the predictive biomarker IPI (immune prognostic index) and ORR/PFS/OS was also evaluated. RESULTS We identified 70 mRCC patients with PS ≥2 treated with ICI-based combination across 14 institutions between October 2017 and December 2021, including 45 and 25 patients were treated with NI and AP, respectively. Median age at diagnosis was 63 years, 51 (73%) were male, only 17 (24%) had prior nephrectomy, 50 (71%) had synchronous metastatic disease at diagnosis, and 16 (23%) had brain metastases. Sixty-one (87%) and 9 (13%) patients had ECOG (Eastern Cooperative Oncology Group) PS 2 and 3, respectively, and 25 (36%) and 45 (64%) patients were intermediate and poor International Metastatic RCC Database Consortium (IMDC) risk, respectively. Among all, 91% were clear cell RCC, 7 patients had sarcomatoid features. At the time of the analysis (median follow-up 11.1 months), 41% patients were dead. Median PFS and mOS in the entire cohort were 5.4 months and 16.0 months, respectively; ORR was 31%. No significant differences in ORR, PFS, OS, or G ≥3AEs were seen between NI and AP. The intermediate and poor IPI groups were significantly associated with reduced ORR and shorter PFS. CONCLUSION We report the first cohort of PS ≥2 mRCC patients treated with frontline ICI-based combination therapy. The survival outcomes in our cohort were inferior to that reported in pivotal trials. No significant differences in ORR, PFS, OS or toxicity were seen between NI and AP. Prospective real-world studies are needed to confirm these results.
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Affiliation(s)
| | - Emeline Colomba
- Medical Oncology Department, Institute Gustave Roussy, Villejuif, France
| | - Carmen Romero-Ferreiro
- Instituto de Investigacion Sanitaria, Hospital 12 de Octubre (imas12), Madrid, Spain; Faculty of Health Sciences, Universidad Francisco de Vitoria, 28223 Madrid, Spain
| | - Luigi Cerbone
- Medical Oncology Department, Institute Gustave Roussy, Villejuif, France
| | | | - Philippe Barthelemy
- Medical Oncology, Hôpitaux Universitaires de Strasbourg/ICANS, Strasbourg, France
| | | | - Aude Fléchon
- Medical Oncology, Centre Léon Bérard, 69008 Lyon, France
| | | | - Elouen Boughalem
- Medical Oncology, Institut de Cancerologie de l'Ouest, 49055 Angers, France
| | - Claude Linassier
- Medical Oncology, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Giuseppe Fornarini
- Medical Oncology, U.O. Oncologia Medica 1 RCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Sara E Rebuzzi
- Medical Oncology, U.O. Oncologia Medica 1 RCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Marine Gross-Goupil
- Medical Oncology, Centre Hospitalier Universitaire Saint-André, Bordeaux, France
| | - Carolina Saldana
- Medical Oncology, Hôpital Henri Mondor, APHP, Univ Paris Est Creteil, Créteil, France
| | | | | | - Ray Manneh
- Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia
| | - Cristina Pernaut
- Medical Oncology, University Hopital Severo Ochoa, Leganés, Madrid, Spain
| | | | - Ronan Flippot
- Medical Oncology Department, Institute Gustave Roussy, Villejuif, France
| | - Bernard Escudier
- Medical Oncology Department, Institute Gustave Roussy, Villejuif, France
| | - Laurence Albiges
- Medical Oncology Department, Institute Gustave Roussy, Villejuif, France.
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Carril L, Colomba E, Romero-Ferreiro C, Cerbone L, Ratta R, Barthélémy P, Vindry C, Cherifi F, Boughalem E, Linassier C, Fornarini G, Gross-Goupil M, Saldana C, Martin Soberón MC, de Velasco G, Pernaut C, Alves Costa Silva C, Flippot R, Escudier B, Albiges L. Efficacy of first-line combination therapy in metastatic renal cell carcinoma (mRCC) patients (pts) with poor performance status (PS). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.320] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
320 Background: Immune checkpoint combination therapy (ICI-combo) is the new standard of care for mRCC in first-line setting. However, pts with poor PS (≥2) were excluded from pivotal trials. Hence, the activity and safety of ICI-combo in this group of pts is still unknown. Methods: We performed a multicentre retrospective study of PS≥2 mRCC pts who received ICI-combo, either nivolumab-ipilimumab (NI) or pembrolizumab-axitinib (PA) as first-line treatment between 2017-2021. Patient’s characteristics, clinical outcomes and toxicity were retrospectively reviewed. We analysed overall response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS) and grade ≥3 treatment-related adverse events (G≥3 AEs) in pts treated with NI or PA. The association between LIPI (Lung Immune Prognostic Index) and ORR, PFS and OS was also evaluated. Results: We identified 56 mRCC pts with PS≥2 treated with ICI-combo across 13 institutions. Thirty-six and 20 pts were treated with NI and PA respectively. Median age at diagnosis was 64 (31-83) years, 38 (68%) were male, 16 (29%) had prior nephrectomy and 40 (71%) had synchronous metastatic disease at diagnosis. Respectively, 19 (34%) and 37 (66%) pts were intermediate and poor risk according to IMDC. Fifty pts (89%) were clear cell RCC, and only 4 pts had sarcomatoid features reported. At the time of analysis (median follow-up 11.1 months(mo)) 45% pts were dead. The ORR for the entire cohort was 27%; ORR was numerically higher with PA (42%) than with NI (20%) but did not reach statistical significancy (p=0.157). Median PFS (mPFS) and mOS in the entire cohort were 4.4 mo and 15.9 mo respectively. No significant differences in PFS, OS or the rate of G≥3AEs were seen between the NI and PA groups. Efficacy and toxicity outcomes are described in the table below. No significant differences in OS or PFS according to the IMDC risk score were observed (p=0.818). However, LIPI was significantly associated with OS (poor LIPI: HR=8.18; p=0.004) and PFS (Intermediate LIPI: HR=2.4; p=0.048 and poor LIPI: HR=8.59; p<0.001). LIPI was predictive of response in patients treated with NI (p=0.024). Conclusions: We report the first cohort of PS≥2 mRCC pts treated with ICI-combo in first-line setting. No significant differences in ORR, PFS or OS were seen between NI and PA. LIPI was significantly associated with both OS and PFS, and was predictive of ORR in the NI group. Prospective real-world studies are needed to confirm these results.[Table: see text]
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Affiliation(s)
| | | | | | - Luigi Cerbone
- Departement de Medicine Oncologique, Gustave Roussy, Villejuif, France
| | - Raffaele Ratta
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | | | | | - Claude Linassier
- Department of Medical Oncology, CHU Bretonneau Centre, Tours University, France, Tours, France
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marine Gross-Goupil
- Centre Hospitalier Universitaire de Bordeaux-Hôpital Saint-André, Bordeaux, France
| | | | | | | | - Cristina Pernaut
- Hospital Universitario 12 de Octubre, Medical Oncology Department, Madrid, Spain
| | | | | | | | - Laurence Albiges
- Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
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Rodriguez CA, Garcia-Gomez J, Ribelles N, Gavila J, Pernas S, Rodriguez-Lescure A, Urrutikoetxea A, Pernaut C, Lopez A, Garcia-Mata J. Abstract P2-13-04: Impact of the adjuvant treatment with trastuzumab in HER2 positive breast cancer in the real-world setting. Analysis of two cohorts (1997-2005/2006-2015) in 1970 patients. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-13-04] [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
INTRODUCTION: Although large randomized trials assessing the benefit of adjuvant trastuzumab in HER2-positive (HER2+) breast cancer have clearly demonstrated a significant improvement in long-term survival, it is necessary to know the impact of the use of trastuzumab adjuvant in the real life population, which includes patients frequently excluded from clinical trials, such as those with very small tumors without node involvement, or advanced age. The objective of this study is to describe the outcomes of women who received adjuvant trastuzumab for HER2+ cáncer since it was approved in 2006, compared with a previous cohort of HER2+ patients not treated with trastuzumab in 7 Spanish centers.
METHODS: Women with newly diagnosed stage I-III, HER2+ breast cancer, between 1997 and 2015 were included in the study. Two cohorts were considered: The No-Trastuzumab cohort (No-T), between 1997 and 2005, and the Trastuzumab cohort (T) with trastuzumab-treated women between 2006 and 2015. Kaplan-Meier estimates were used to evaluate DFS and OS. Additionally, cohorts were analyzed by pathologic tumour size, lymph node involvement and hormonal receptor status to stratify outcome measures.
RESULTS: A total of 2134 patients were identified. In 164 cases, data were insufficient or the follow-up incomplete. Therefore, the final analysis included 1970 patients, of whom 539 belong to the "No-T" cohort and 1431 to the "T" cohort. The median follow-up was 81 months. Median age: 53 years [22-98]. A total of 699 patients had T1 tumors [43% in the "No-T" cohort vs 33% in the "T" cohort]. 55% of the cases were N0 [58% and 54% in the "No-T" and "T" cohorts respectively]. The status of the hormonal receptors was well balanced between groups [36% ER negative in both]. Regarding the type of adjuvant treatment administered, in the "T" cohort more patients received adjuvant chemotherapy [65% vs 97%] and also in the “T” group combinations of taxanes and anthracyclines were more frequent [14% vs 72%]. The proportion of adjuvant endocrine therapy was similar in both groups [37% vs 34%].
In the “T” cohort, median Disease Free Survival (DFS) was not-reached, compared with 149 months in the “No-T” group. 5-year DFS was 83% vs 65% respectively [p<0.001]. 5-year DFS was also superior and statistically significant in all the subgroups analyzed, including patients with T1 tumors (87% vs 57%), N0 (87% vs 78%), patients T1N0 (88% vs 74%) and HR positive (86% vs 71%) or negative (78% vs 50%). Similarly, Overall Survival (OS) was increased in patients treated with Trastuzumab (median: 224 months vs not-reached, 5-year OS: 92% vs 75% [p <0.001].) 5-year OS was also statistically superior in the T1 subgroup (92% vs 72%), and N0 (95% vs 88%). [p<0.001 in all subanalysis].
CONCLUSIONS: Adjuvant treatment with Trastuzumab under conditions of real clinical practice in HER2+ early breast cancer, shows a highly significant benefit in terms of DFS and OS, regardless of the stage of the disease or other clinical variables. A very important benefit was reached in patients with small tumors, node-negative disease, or both conditions (T1N0). The benefit was also obtained regardless of the expression of hormonal receptors.
Citation Format: Rodriguez CA, Garcia-Gomez J, Ribelles N, Gavila J, Pernas S, Rodriguez-Lescure A, Urrutikoetxea A, Pernaut C, Lopez A, Garcia-Mata J. Impact of the adjuvant treatment with trastuzumab in HER2 positive breast cancer in the real-world setting. Analysis of two cohorts (1997-2005/2006-2015) in 1970 patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-13-04.
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Affiliation(s)
- CA Rodriguez
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain; Complejo Hospitalario de Orense, Orense, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Instituto Catalan de Oncologia, L'Hospitalet, Barcelona, Spain; Hospital General Universitario de Elche, Elche, Alicante, Spain; Onkologikoa, San Sebastian, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Complejo Asistencial Universitario de Leon, Leon, Spain
| | - J Garcia-Gomez
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain; Complejo Hospitalario de Orense, Orense, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Instituto Catalan de Oncologia, L'Hospitalet, Barcelona, Spain; Hospital General Universitario de Elche, Elche, Alicante, Spain; Onkologikoa, San Sebastian, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Complejo Asistencial Universitario de Leon, Leon, Spain
| | - N Ribelles
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain; Complejo Hospitalario de Orense, Orense, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Instituto Catalan de Oncologia, L'Hospitalet, Barcelona, Spain; Hospital General Universitario de Elche, Elche, Alicante, Spain; Onkologikoa, San Sebastian, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Complejo Asistencial Universitario de Leon, Leon, Spain
| | - J Gavila
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain; Complejo Hospitalario de Orense, Orense, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Instituto Catalan de Oncologia, L'Hospitalet, Barcelona, Spain; Hospital General Universitario de Elche, Elche, Alicante, Spain; Onkologikoa, San Sebastian, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Complejo Asistencial Universitario de Leon, Leon, Spain
| | - S Pernas
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain; Complejo Hospitalario de Orense, Orense, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Instituto Catalan de Oncologia, L'Hospitalet, Barcelona, Spain; Hospital General Universitario de Elche, Elche, Alicante, Spain; Onkologikoa, San Sebastian, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Complejo Asistencial Universitario de Leon, Leon, Spain
| | - A Rodriguez-Lescure
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain; Complejo Hospitalario de Orense, Orense, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Instituto Catalan de Oncologia, L'Hospitalet, Barcelona, Spain; Hospital General Universitario de Elche, Elche, Alicante, Spain; Onkologikoa, San Sebastian, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Complejo Asistencial Universitario de Leon, Leon, Spain
| | - A Urrutikoetxea
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain; Complejo Hospitalario de Orense, Orense, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Instituto Catalan de Oncologia, L'Hospitalet, Barcelona, Spain; Hospital General Universitario de Elche, Elche, Alicante, Spain; Onkologikoa, San Sebastian, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Complejo Asistencial Universitario de Leon, Leon, Spain
| | - C Pernaut
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain; Complejo Hospitalario de Orense, Orense, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Instituto Catalan de Oncologia, L'Hospitalet, Barcelona, Spain; Hospital General Universitario de Elche, Elche, Alicante, Spain; Onkologikoa, San Sebastian, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Complejo Asistencial Universitario de Leon, Leon, Spain
| | - A Lopez
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain; Complejo Hospitalario de Orense, Orense, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Instituto Catalan de Oncologia, L'Hospitalet, Barcelona, Spain; Hospital General Universitario de Elche, Elche, Alicante, Spain; Onkologikoa, San Sebastian, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Complejo Asistencial Universitario de Leon, Leon, Spain
| | - J Garcia-Mata
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain; Complejo Hospitalario de Orense, Orense, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Instituto Catalan de Oncologia, L'Hospitalet, Barcelona, Spain; Hospital General Universitario de Elche, Elche, Alicante, Spain; Onkologikoa, San Sebastian, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Complejo Asistencial Universitario de Leon, Leon, Spain
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Abstract
Neoadjuvant treatment allows us to improve surgical results and test new drugs. In recent years, there have been significant advances in the field of neoadjuvant treatment, including hormonal neoadjuvant therapy in luminal tumors, double blockade in HER2-positive tumors, and the use of platinum salts in triple-negative tumors.
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Affiliation(s)
- Cristina Pernaut
- Breast Cancer Unit, Medical Oncology Department, University Hospital 12 de Octubre, Madrid, Spain
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6
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Cala MP, Agulló‐Ortuño MT, Prieto‐García E, González‐Riano C, Parrilla‐Rubio L, Barbas C, Díaz‐García CV, García A, Pernaut C, Adeva J, Riesco MC, Rupérez FJ, Lopez‐Martin JA. Multiplatform plasma fingerprinting in cancer cachexia: a pilot observational and translational study. J Cachexia Sarcopenia Muscle 2018; 9:348-357. [PMID: 29464940 PMCID: PMC5879957 DOI: 10.1002/jcsm.12270] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 10/04/2017] [Accepted: 10/24/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Cachexia is a metabolic syndrome that affects up to 50-80% of cancer patients. The pathophysiology is characterized by a variable combination of reduced food intake and abnormal metabolism, including systemic inflammation and negative protein and energy balance. Despite its high clinical significance, defined diagnostic criteria and established therapeutic strategies are lacking. The 'omics' technologies provide a global view of biological systems. We hypothesize that blood-based metabolomics might identify findings in cachectic patients that could provide clues to gain knowledge on its pathophysiology, and eventually postulate new therapeutic strategies. METHODS This is a cross-sectional observational study in two cohorts of cancer patients, with and without cachexia. Patients were consecutively recruited from routine clinical practice of a General Oncology Department at '12 de Octubre' University Hospital. Selected clinical and biochemical features were collected. Blood metabolite fingerprinting was performed using three analytical platforms, gas chromatography coupled to mass spectrometry (GC-MS), capillary electrophoresis coupled to mass spectrometry (CE-MS), and liquid chromatography coupled to mass spectrometry (LC-MS). Besides, we performed pathway-based metabolite analyses to obtain more information on biological functions. RESULTS A total of 15 subjects were included in this study, 8 cachectic and 7 non-cachectic patients. Metabolomic analyses were able to correctly classify their samples in 80% (GC-MS), 97% (CE-MS), 96% [LC-MS (positive mode)], and 89% [LC-MS (negative mode)] of the cases. The most prominent metabolic alteration in plasma of cachectic patients was the decrease of amino acids and derivatives [especially arginine, tryptophan, indolelactic acid, and threonine, with 0.4-fold change (FC) compared with non-cachectic patients], along with the reduction of glycerophospholipids [mainly lysophosphatidylcholines(O-16:0) and lysophosphatidylcholines(20:3) sn-1, FC = 0.1] and sphingolipids [SM(d30:0), FC = 0.5]. The metabolite with the highest increase was cortisol (FC = 1.6). Such alterations suggest a role of the following metabolic pathways in the pathophysiology of cancer cachexia: arginine and proline metabolism; alanine, aspartate, and glutamate metabolism; phenylalanine metabolism; lysine degradation; aminoacyl-tRNA biosynthesis; fatty acid elongation in mitochondria; tricarboxylic acids cycle; among others. CONCLUSIONS These findings suggest that plasma amino acids and lipids profiling has great potential to find the mechanisms involved in the pathogenesis of cachexia. Metabolic profiling of plasma from cancer patients show differences between cachexia and non-cachexia in amino acids and lipids that might be related to mechanisms involved in its pathophysiology. A better understanding of these mechanisms might identify novel therapeutic approaches to palliate this unmet medical condition.
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Affiliation(s)
- Mónica Patricia Cala
- Centre for Metabolomic and Bioanalysis (CEMBIO), Facultad de FarmaciaUniversidad San Pablo CEUUrbanización Montepríncipe, M‐501 km 028660Boadilla del Monte, MadridSpain
- Grupo de Investigación en Química Analítica y Bioanalítica (GABIO), Department of Chemistry, Faculty of SciencesUniversidad de los AndesCra. 1 No. 18a‐10111710BogotáColombia
| | - María Teresa Agulló‐Ortuño
- Clinical & Translational Cancer Research GroupInstituto de Investigación Sanitaria Hospital 12 de Octubre (i+12)Av Córdoba s/n28041MadridSpain
| | - Elena Prieto‐García
- Clinical & Translational Cancer Research GroupInstituto de Investigación Sanitaria Hospital 12 de Octubre (i+12)Av Córdoba s/n28041MadridSpain
| | - Carolina González‐Riano
- Centre for Metabolomic and Bioanalysis (CEMBIO), Facultad de FarmaciaUniversidad San Pablo CEUUrbanización Montepríncipe, M‐501 km 028660Boadilla del Monte, MadridSpain
| | - Lucía Parrilla‐Rubio
- Medical Oncology DepartmentHospital Universitario 12 de OctubreAv de Córdoba s/n28041MadridSpain
| | - Coral Barbas
- Centre for Metabolomic and Bioanalysis (CEMBIO), Facultad de FarmaciaUniversidad San Pablo CEUUrbanización Montepríncipe, M‐501 km 028660Boadilla del Monte, MadridSpain
| | - Carmen Vanesa Díaz‐García
- Clinical & Translational Cancer Research GroupInstituto de Investigación Sanitaria Hospital 12 de Octubre (i+12)Av Córdoba s/n28041MadridSpain
| | - Antonia García
- Centre for Metabolomic and Bioanalysis (CEMBIO), Facultad de FarmaciaUniversidad San Pablo CEUUrbanización Montepríncipe, M‐501 km 028660Boadilla del Monte, MadridSpain
| | - Cristina Pernaut
- Medical Oncology DepartmentHospital Universitario 12 de OctubreAv de Córdoba s/n28041MadridSpain
| | - Jorge Adeva
- Medical Oncology DepartmentHospital Universitario 12 de OctubreAv de Córdoba s/n28041MadridSpain
| | - María Carmen Riesco
- Medical Oncology DepartmentHospital Universitario 12 de OctubreAv de Córdoba s/n28041MadridSpain
| | - Francisco Javier Rupérez
- Centre for Metabolomic and Bioanalysis (CEMBIO), Facultad de FarmaciaUniversidad San Pablo CEUUrbanización Montepríncipe, M‐501 km 028660Boadilla del Monte, MadridSpain
| | - Jose Antonio Lopez‐Martin
- Clinical & Translational Cancer Research GroupInstituto de Investigación Sanitaria Hospital 12 de Octubre (i+12)Av Córdoba s/n28041MadridSpain
- Medical Oncology DepartmentHospital Universitario 12 de OctubreAv de Córdoba s/n28041MadridSpain
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Lopez-Martin J, Cala M, Prieto-García E, Gonzalez Riano C, Díaz-García C, García A, Pardo Marqués V, Ruperez Pascualena F, García-Ruiz I, Pernaut C, Otero I, Parrilla Rubio L, Riesco M, Adeva Alfonso J, Barbas C, Agulló-Ortuño M. Metabolomics in cancer cachexia. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx390.055] [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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8
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Pascual T, Apellániz-Ruiz M, Pernaut C, Cueto-Felgueroso C, Villalba P, Álvarez C, Manso L, Inglada-Pérez L, Robledo M, Rodríguez-Antona C, Ciruelos E. Polymorphisms associated with everolimus pharmacokinetics, toxicity and survival in metastatic breast cancer. PLoS One 2017; 12:e0180192. [PMID: 28727815 PMCID: PMC5519037 DOI: 10.1371/journal.pone.0180192] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 06/12/2017] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Metastatic breast cancer (MBC) progressing after endocrine therapy frequently activates PI3K/AKT/mTOR pathway. The BOLERO-2 trial showed that everolimus-exemestane achieves increased progression free survival (PFS) compared with exemestane. However, there is great inter-patient variability in toxicity and response to exemestane-everolimus treatment. The objective of this study was to perform an exploratory study analyzing the implication of single nucleotide polymorphisms (SNPs) on outcomes from this treatment through a pharmacogenetic analysis. PATIENTS AND METHODS Blood was collected from 90 postmenopausal women with hormone receptor-positive, HER2-negative MBC treated with exemestane-everolimus following progression after prior treatment with a non-steroidal aromatase inhibitor. Everolimus pharmacokinetics was measured in 37 patients. Twelve SNPs in genes involved in everolimus pharmacokinetics and pharmacodynamics were genotyped and associations assessed with drug plasma levels, clinically relevant toxicities (non-infectious pneumonitis, mucositis, hyperglycemia and hematological toxicities), dose reductions or treatment suspensions due to toxicity, progression free survival (PFS) and overall survival. RESULTS We found that CYP3A4 rs35599367 variant (CYP3A4*22 allele) carriers had higher everolimus blood concentration compared to wild type patients (P = 0.019). ABCB1 rs1045642 was associated with risk of mucositis (P = 0.031), while PIK3R1 rs10515074 and RAPTOR rs9906827 were associated with hyperglycemia and non-infectious pneumonitis (P = 0.016 and 0.024, respectively). Furthermore, RAPTOR rs9906827 was associated with PFS (P = 0.006). CONCLUSIONS CYP3A4*22 allele influenced plasma concentration of everolimus and several SNPs in PI3K/AKT/mTOR pathway genes were associated with treatment toxicities and prognosis. These results require replication, but suggest that germline variation could influence everolimus outcomes in MBC.
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Affiliation(s)
- Tomas Pascual
- Medical Oncology Department, 12 de Octubre University Hospital, Madrid, Spain
| | - María Apellániz-Ruiz
- Hereditary Endocrine Cancer Group, Human Cancer Genetics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Cristina Pernaut
- Medical Oncology Department, 12 de Octubre University Hospital, Madrid, Spain
| | | | - Pablo Villalba
- Biochemistry Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Carlos Álvarez
- Biochemistry Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Luis Manso
- Biochemistry Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Lucia Inglada-Pérez
- Hereditary Endocrine Cancer Group, Human Cancer Genetics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Mercedes Robledo
- Hereditary Endocrine Cancer Group, Human Cancer Genetics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Cristina Rodríguez-Antona
- Hereditary Endocrine Cancer Group, Human Cancer Genetics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Eva Ciruelos
- Medical Oncology Department, 12 de Octubre University Hospital, Madrid, Spain
- * E-mail:
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Pascual-Martínez T, Apellániz-Ruiz M, Pernaut C, Cueto-Felgueroso C, Villalba P, Alvarez C, Manso L, Rodriguez-Antona C, Ciruelos EM. Abstract P3-07-40: Pharmacogenetic study of exemestane and everolimus in metastatic breast cancer patients progressing on prior non-steroidal aromatase inhibitors. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-07-40] [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: Activation of the mTOR pathway has been observed in patients (pts) with metastatic breast cancer (MBC) progressing on endocrine therapy. BOLERO-2 trial demonstrated a significant increase in progression free survival (PFS) obtained with everolimus (EVE) and exemestane (EXE) versus EXE alone in pts refractory to a prior non-steroidal aromatase inhibitors (NSAI). However, there is large interindividual variability in toxicity and efficacy profiles of EXE-EVE treatment. Single Nucleotide Polymorphisms (SNPs) have been proposed to explain some of these differences. The objective of this study was to perform a pharmacogenetic analysis to identify SNPs associated with EVE toxicity and activity.
Methods: This is a prospective unicentric clinical trial for postmenopausal pts with hormone receptor-positive, HER2 negative, MBC progressing on prior NSAI, treated with EXE-EVE.
Blood samples were obtained from all pts, and 12 SNPs in key genes involved in EXE pharmacokinetics (ABCB1, CYP2C8, CYP3A4, CYP3A5) and pharmacodynamics (AKT1, AKT2, FGFR4, PHLPP2, PIK3R1, RAPTOR) were genotyped. EVE pharmacokinetics data was available for a subset of 37 pts. The association between the SNPs and EVE pharmacokinetic parameters were analyzed using U-Mann-Whitney test. A selection of clinically relevant toxicities (non-infectious pneumonitis (NIP), mucositis, hyperglycemia and hematological) was analyzed using binary logistic regression. Cox regression was used to analyze the association of SNPs with time to treatment modifications (reduction or interruption) due to toxicity, PFS and OS.
Results: 90 patients with median age of 62 yrs were included. At data cut off, a total of 77 pts had discontinued treatment. Major reasons for discontinuation were: disease progression (80%), adverse events (17%) and death (2%). Number of prior chemotherapy lines: 0; 50%, 1;18%, 2;10%, ≥3; 22%. 76% of pts experienced at least one adverse event related to EVE.
CYP3A4 rs35599367 (CYP3A4*22 allele) heterozygous pts had higher EVE concentration in blood compared to wild type pts (P=0.019), in agreement with previous data.
Regarding EVE toxicities, ABCB1 SNP rs1045642 showed a higher risk of mucositis (HR=2.3, 95%CI=1.1-4.8, P=0.031; multivariable analysis), and PIK3R1 rs10515074 variant was inversely associated with hyperglycemia (HR=0.24, 95%CI=0.1-0.8, P=0.016; multivariable analysis). RAPTOR rs9906827 protected for NIP (HR=0.38, 95%CI=0.2-0.9, P=0.024; multivariable analysis). When analyzing the time to treatment modification due to any toxicity, we observed a trend for FGFR4 rs351855 and RAPTOR rs9906827 (HR=0.59, 95%CI=0.3-1.0, P=0.06 and HR=0.71, 95%CI=0.5-1.1, P=0.12; respectively, in multivariable analysis).
Regarding activity, RAPTOR rs9906827 was also associated with longer PFS (dominant model HR=0.48, 95%CI=0.3-0.8, P=0.006; multivariable analysis). No SNP was significantly associated with OS.
Conclusions: We found altered EVE pharmacokinetics for CYP3A4*22 carriers and protection for NIP and longer PFS for RAPTOR rs9906827. This study supports prospective trials for genetic testing prior to EXE-EVE therapy to stratify patients according to toxicity and efficacy risk profiles.
Citation Format: Pascual-Martínez T, Apellániz-Ruiz M, Pernaut C, Cueto-Felgueroso C, Villalba P, Alvarez C, Manso L, Rodriguez-Antona C, Ciruelos EM. Pharmacogenetic study of exemestane and everolimus in metastatic breast cancer patients progressing on prior non-steroidal aromatase inhibitors. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-07-40.
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Affiliation(s)
- T Pascual-Martínez
- Hospital 12 de Octubre, Madrid, Spain; Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - M Apellániz-Ruiz
- Hospital 12 de Octubre, Madrid, Spain; Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - C Pernaut
- Hospital 12 de Octubre, Madrid, Spain; Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - C Cueto-Felgueroso
- Hospital 12 de Octubre, Madrid, Spain; Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - P Villalba
- Hospital 12 de Octubre, Madrid, Spain; Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - C Alvarez
- Hospital 12 de Octubre, Madrid, Spain; Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - L Manso
- Hospital 12 de Octubre, Madrid, Spain; Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - C Rodriguez-Antona
- Hospital 12 de Octubre, Madrid, Spain; Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - EM Ciruelos
- Hospital 12 de Octubre, Madrid, Spain; Spanish National Cancer Research Centre (CNIO), Madrid, Spain
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Ponce Aix S, Blazquez M, Iglesias L, Núñez JA, Zugazagoitia J, Muñoz C, Parrilla L, Pernaut C, Otero I, Andres E, Cortes-Funes H. Pemetrexed (Pem) in combination with cisplatin (CP) or carboplatin (CB) for stage IV NSCLC: A single-institution experience. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e19160] [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)
- Santiago Ponce Aix
- Hospital Universitario 12 de Octubre, Medical Oncology Department, Madrid, Spain
| | | | - Lara Iglesias
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Jon Zugazagoitia
- Hospital Universitario 12 de Octubre, Medical Oncology Department, Madrid, Spain
| | - Cesar Muñoz
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Lucia Parrilla
- Medical Oncology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Cristina Pernaut
- Hospital Universitario 12 de Octubre, Medical Oncology Department, Madrid, Spain
| | - Irene Otero
- Hospital Universitario 12 de Octubre, Medical Oncology Department, Madrid, Spain
| | - Eva Andres
- Clinical Investigation Unit-Epidemiology and Health Public CIBER's, 12 de Octubre University Hospital, Madrid, Spain
| | - Hernan Cortes-Funes
- Medical Oncology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
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Rodriguez Garzotto A, Cortijo Casacajares S, Pernaut C, Ruiz Ares GJ, Otero Blas I, Heine O, Turner M, Rebollo Laserna F, Cortes Funes H, Lorenz A. Erythropoiesis-stimulating agents for the treatment of chemotherapy-induced anemia: comparisons from real-world clinical experience. J Blood Med 2014; 5:43-8. [PMID: 24855398 PMCID: PMC4011805 DOI: 10.2147/jbm.s57887] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background The purpose of this paper is to report real-world data on the relative effectiveness of a biosimilar erythropoiesis-stimulating agent (ESA; Binocrit®), and other available ESAs for the treatment of chemotherapy-induced anemia. Methods Data were collected retrospectively from single centers in Spain (n=284) and Germany (n=145). Hemoglobin outcomes, transfusion requirements, and serious drug-related adverse events were assessed for each ESA. Results Hemoglobin outcomes and transfusion requirements were generally similar in the different ESA treatment groups assessed. No serious drug-related adverse events were recorded in any of the treatment groups. Conclusion These data confirm the real-world effectiveness and safety of a biosimilar ESA (Binocrit®) for the treatment of cancer patients with chemotherapy-induced anemia.
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Affiliation(s)
| | | | - Cristina Pernaut
- Hospital Universitario 12 de Octubre, Ctra Andalucía, Madrid, Spain
| | | | - Irene Otero Blas
- 1Hospital Universitario 12 de Octubre, Ctra Andalucía, Madrid, Spain
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