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Ros J, Vivancos A, Tabernero J, Élez E. Circulating tumor DNA, and clinical features to guide rechallenge with BRAF inhibitors in BRAF-V600E mutated metastatic colorectal cancer. Ann Oncol 2024; 35:240-241. [PMID: 37866812 DOI: 10.1016/j.annonc.2023.10.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023] Open
Affiliation(s)
- J Ros
- Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.
| | - A Vivancos
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - J Tabernero
- Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - E Élez
- Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
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Baraibar I, Ros J, Saoudi N, Salvà F, García A, Castells M, Tabernero J, Élez E. Sex and gender perspectives in colorectal cancer. ESMO Open 2023; 8:101204. [PMID: 37018873 PMCID: PMC10163160 DOI: 10.1016/j.esmoop.2023.101204] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 04/05/2023] Open
Abstract
Historically women were frequently excluded from clinical trials and drug usage to protect unborn babies from potential harm. As a consequence, the impact of sex and gender on both tumour biology and clinical outcomes has been largely underestimated. Although interrelated and often used interchangeably, sex and gender are not equivalent concepts. Sex is a biological attribute that defines species according to their chromosomal makeup and reproductive organ, while gender refers to a chosen sexual identity. Sex dimorphisms are rarely taken into account, in either preclinical or clinical research, with inadequate analysis of differences in outcomes according to sex or gender still widespread, reflecting a gap in our knowledge for a large proportion of the target population. Underestimation of sex-based differences in study design and analyses has invariably led to 'one-drug' treatment regimens for both males and females. For patients with colorectal cancer (CRC), sex also has an impact on the disease incidence, clinicopathological features, therapeutic outcomes, and tolerability to anticancer treatments. Although the global incidence of CRC is higher in male subjects, the proportion of patients presenting right-sided tumours and BRAF mutations is higher among females. Concerning sex-related differences in treatment efficacy and toxicity, drug dosage does not take into account sex-specific differences in pharmacokinetics. Toxicity associated with fluoropyrimidines, targeted therapies, and immunotherapies has been reported to be more extensive for females with CRC than for males, although evidence about differences in efficacy is more controversial. This article aims to provide an overview of the research achieved so far into sex and gender differences in cancer and summarize the growing body of literature illustrating the sex and gender perspective in CRC and their impact in relation to tumour biology and treatment efficacy and toxicity. We propose endorsing research on how biological sex and gender influence CRC as an added value for precision oncology.
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Toledano-Fonseca M, Gómez-España MA, Élez E, Grávalos C, García-Alfonso P, Rodríguez R, Losa F, Alés Díaz I, Graña B, Valladares-Ayerbes M, García-Ortiz MV, Polo E, Salgado M, Rivera F, Safont MJ, Salud A, Ruiz-Casado A, Tabernero JM, Riesco MC, Rodríguez-Ariza A, Aranda E. A signature of circulating microRNAs predicts the response to treatment with FOLFIRI plus aflibercept in metastatic colorectal cancer patients. Biomed Pharmacother 2023; 159:114272. [PMID: 36706629 DOI: 10.1016/j.biopha.2023.114272] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/10/2023] [Accepted: 01/17/2023] [Indexed: 01/27/2023] Open
Abstract
The benefit of adding the antiangiogenic drug aflibercept to FOLFIRI regime in metastatic colorectal cancer (CRC) patients resistant to or progressive on an oxaliplatin-based therapy has been previously demonstrated. However, the absence of validated biomarkers to predict greater outcomes is a major challenge encountered when using antiangiogenic therapies. In this study we investigated profiles of circulating microRNAs (miRNAs) to build predictive models of response to treatment and survival. Plasma was obtained from 98 metastatic CRC patients enrolled in a clinical phase II trial before receiving FOLFIRI plus aflibercept treatment, and the circulating levels of 754 individual miRNAs were quantified using real-time PCR. A distinct signature of circulating miRNAs differentiated responder from non-responder patients. Remarkably, most of these miRNAs were found to target genes that are involved in angiogenic processes. Accordingly, some of these miRNAs had predictive value and entered in predictive models of response to therapy, progression of disease, and survival of patients treated with FOLFIRI plus aflibercept. Among these miRNAs, circulating levels of hsa-miR-33b-5p efficiently discriminated between responder and non-responder patients and predicted the risk of disease progression. Moreover, the combination of circulating VEGF-A and miR-33b-5p levels improved clinical stratification of metastatic CRC patients who were to receive FOLFIRI plus aflibercept treatment. In conclusion, our study supports circulating miRNAs as valuable biomarkers for predicting better outcomes in metastatic CRC patients treated with FOLFIRI plus aflibercept.
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Affiliation(s)
- M Toledano-Fonseca
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), E14004 Córdoba, Spain; Cancer Network Biomedical Research Center (CIBERONC), Instituto de Salud Carlos III, E28029 Madrid, Spain.
| | - M A Gómez-España
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), E14004 Córdoba, Spain; Department of Medical Oncology, Reina Sofía University Hospital, E14004 Córdoba, Spain.
| | - E Élez
- Department of Medical Oncology, Vall d'Hebron Hospital Campus and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain.
| | - C Grávalos
- Department of Medical Oncology, H. Universitario 12 de Octubre, Instituto de Investigación i+12, Avenida de Córdoba, S/N, 28041 Madrid, Spain.
| | - P García-Alfonso
- Department of Medical Oncology, H. Gregorio Marañón, Calle del Doctor Esquerdo, 46, 28007 Madrid, Spain.
| | - R Rodríguez
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), E14004 Córdoba, Spain; Department of Medical Oncology, Reina Sofía University Hospital, E14004 Córdoba, Spain.
| | - F Losa
- Department of Medical Oncology, ICO-CSI. H. Sant Joan Despí - Moisés Broggi, Carrer d'Oriol Martorell, 12, 08970 Sant Joan Despí, Barcelona, Spain.
| | - I Alés Díaz
- Department of Medical Oncology, Unidad de Gestión Clínica Intercentros de Oncología Médica. Hospitales Universitarios Regional y Virgen de la Victoria. IBIMA, Campus de Teatinos, S/N, 29010 Málaga, Spain.
| | - B Graña
- Department of Medical Oncology, C. H. Universitario, Lugar, Xubias de Arriba, 84, 15006 A Coruña, Spain.
| | - M Valladares-Ayerbes
- Department of Medical Oncology, H. Virgen del Rocío, IBIS, Av. Manuel Siurot s/n, 41013 Sevilla, Spain.
| | - M V García-Ortiz
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), E14004 Córdoba, Spain; Cancer Network Biomedical Research Center (CIBERONC), Instituto de Salud Carlos III, E28029 Madrid, Spain.
| | - E Polo
- Department of Medical Oncology, H. Miguel Servet, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain.
| | - M Salgado
- Department of Medical Oncology, C. H. Universitario de Ourense, Calle Ramón Puga Noguerol, 54, 32005 Orense, Spain.
| | - F Rivera
- Department of Medical Oncology, H. Universitario Marqués de Valdecilla, IDIVAL, Avenida de Valdecilla, 25, 39008 Santander, Spain.
| | - M J Safont
- Department of Medical Oncology, H. General Universitario, CIBERONC, Universidad de Valencia, Avenida de les Tres Creus, 2, 46014 Valencia, Spain.
| | - A Salud
- Department of Medical Oncology, H. Universitario Arnau de Vilanova, Avenida Alcalde Rovira Roure, 80, 25198 Lérida, Spain.
| | - A Ruiz-Casado
- Department of Medical Oncology, H. Puerta de Hierro Majadahonda, Calle Joaquín Rodrigo, 1, 28222 Majadahonda, Spain.
| | - J M Tabernero
- Department of Medical Oncology, Vall d'Hebron Hospital Campus and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain.
| | - M C Riesco
- Department of Medical Oncology, H. Universitario 12 de Octubre, Instituto de Investigación i+12, Avenida de Córdoba, S/N, 28041 Madrid, Spain.
| | - A Rodríguez-Ariza
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), E14004 Córdoba, Spain; Cancer Network Biomedical Research Center (CIBERONC), Instituto de Salud Carlos III, E28029 Madrid, Spain; Department of Medical Oncology, Reina Sofía University Hospital, E14004 Córdoba, Spain.
| | - E Aranda
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), E14004 Córdoba, Spain; Cancer Network Biomedical Research Center (CIBERONC), Instituto de Salud Carlos III, E28029 Madrid, Spain; Department of Medical Oncology, Reina Sofía University Hospital, E14004 Córdoba, Spain; Department of Medicine, Faculty of Medicine, University of Córdoba, E14004 Córdoba, Spain.
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Matres A, Carballo N, Bernabé Y, Martínez A, Silverio A, Depares I, Cidoncha I, Beltran M, Braña I, Élez E, Díez M, Muñoz E, Saura C, Oaknin A, Macarulla T, Carles J, Felip E, Tabernero J, Garralda E, Pérez-Pujol S. Transition to the new EU CTIS Portal for Regulatory Clinical Trial Submissions: VHIO’s Start-Up Unit Analysis. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)00928-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Fernández Montes A, Élez E, Vivancos A, Martínez N, González P, Covela M, de la Cámara J, Cousillas A, Méndez JC, Graña B, Aranda E. Monitoring of RAS mutant clones in plasma of patients with RAS mutant metastatic colorectal cancer. Clin Transl Oncol 2022; 24:1209-1214. [PMID: 34997474 PMCID: PMC9107427 DOI: 10.1007/s12094-021-02767-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/23/2021] [Indexed: 11/24/2022]
Abstract
Purpose Some patients with histologically confirmed primary mCRC and mutated RAS reported undetectable RAS mutant clones in plasma after receiving anti-VEGF treatment. The aim was to prospectively assess it with its potential therapeutic implications. Methods RAS mutant genes in solid biopsy (before first-line treatment: FOLFOX/CAPOX + bevacizumab) were compared in liquid biopsy (before second-line treatment: panitumumab + FOLFIRI), using Idylla™ system. Discordant results between solid/liquid biopsies were assessed by the next-generation sequencing (NGS) test (solid/liquid biopsies). Results Twenty-three patients were assessed (seven had RAS mutant discrepancies between solid/liquid biopsies). The NGS test confirmed that 3/23 (13%) patients had undetectable RAS mutant clones in liquid biopsy and 3/23 (13%) presented discrepancies in solid biopsy (Idylla™ system vs. NGS test). Conclusion Thirteen percentage of patients had undetectable RAS mutant clones in liquid biopsy after first-line treatment. However, some discrepancies between solid and liquid biopsies have been observed. These results suggest a need to improve accuracy of RAS analyses, especially in solid biopsies.
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Affiliation(s)
- A Fernández Montes
- Medical Oncology Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain.
| | - E Élez
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Vivancos
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - N Martínez
- Medical Oncology Department, Hospital Universitario A Coruña, A Coruña, Spain
| | - P González
- Medical Oncology Department, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
| | - M Covela
- Medical Oncology Department, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - J de la Cámara
- Medical Oncology Department, Hospital Universitario Arquitecto Marcide, Ferrol, Spain
| | - A Cousillas
- Medical Oncology Department, Hospital Provincial de Pontevedra, Pontevedra, Spain
| | - J C Méndez
- Medical Oncology Department, Centro Oncológico de Galicia, A Coruña, Spain
| | - B Graña
- Medical Oncology Department, Hospital Universitario A Coruña, A Coruña, Spain
| | - E Aranda
- Medical Oncology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
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Jiménez-Labaig P, Pacheco-Barcia V, Cebrià A, Gálvez F, Obispo B, Páez D, Quílez A, Quintanar T, Ramchandani A, Remon J, Rogado J, Sánchez DA, Sánchez-Cánovas M, Sanz-García E, Sesma A, Tarazona N, Cotés A, González E, Bosch-Barrera J, Fernández A, Felip E, Vera R, Rodríguez-Lescure Á, Élez E. Identifying and preventing burnout in young oncologists, an overwhelming challenge in the COVID-19 era: a study of the Spanish Society of Medical Oncology (SEOM). ESMO Open 2021; 6:100215. [PMID: 34325108 PMCID: PMC8332651 DOI: 10.1016/j.esmoop.2021.100215] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/07/2021] [Accepted: 06/25/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Young oncologists are at particular risk of professional burnout, and this could have a significant impact on their health and care of their patients. The coronavirus disease 2019 (COVID-19) pandemic has forced rapid changes in professionals' jobs and training, with the consequent physical and psychological effects. We aimed to characterize burnout levels and determinants in young oncologists, and the effects of the pandemic on their training and health. METHODS Two online surveys were conducted among oncology residents and young oncology specialists in Spain. The first addressed professional burnout and its determinants before the COVID-19 pandemic, while the second analyzed the impact of the pandemic on health care organization, training, and physical and psychological health in the same population. RESULTS In total, 243 respondents completed the first survey, and 263 the second; 25.1% reported significant levels of professional burnout. Burnout was more common among medical oncology residents (28.2%), mainly in their second year of training. It was significantly associated with a poor work-life balance, inadequate vacation time, and the burnout score. Nearly three-quarters of respondents (72%) were reassigned to COVID-19 care and 84.3% of residents missed part of their training rotations. Overall, 17.2% of this population reported that they had contracted COVID-19, 37.3% had scores indicating anxiety, and 30.4% moderate to severe depression. Almost a quarter of young oncologists (23.3%) had doubts about their medical vocation. CONCLUSIONS Burnout affects a considerable number of young oncologists. The COVID-19 pandemic has had a profound impact on causes of burnout, making it even more necessary to periodically monitor it to define appropriate detection and prevention strategies.
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Affiliation(s)
- P Jiménez-Labaig
- Department of Medical Oncology, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - V Pacheco-Barcia
- Department of Medical Oncology, Gómez Ulla Military Hospital, Madrid, Spain
| | - A Cebrià
- Department of Mental Health, Parc Taulí University Hospital, Sabadell, Catalunya, Spain
| | - F Gálvez
- Department of Medical Oncology, Jaén University Hospital, Jaén, Andalucía, Spain
| | - B Obispo
- Department of Medical Oncology, Infanta Leonor University Hospital, Madrid, Spain
| | - D Páez
- Department of Medical Oncology, Santa Creu i Sant Pau University Hospital, Barcelona, Catalunya, Spain
| | - A Quílez
- Department of Medical Oncology, Can Misses Hospital, Área de salud de Ibiza y Formentera (ASEF), Ibiza, Illes Balears, Spain
| | - T Quintanar
- Department of Medical Oncology, Elche University General Hospital, Elche, Comunitat Valenciana, Spain
| | - A Ramchandani
- Department of Medical Oncology, University Hospital Complex, Insular-Materno Infantil de Gran Canaria, Las Palmas de Gran Canaria, Islas Canarias, Spain
| | - J Remon
- Department of Medical Oncology, HM Delfos Hospital, Barcelona, Catalunya, Spain
| | - J Rogado
- Department of Medical Oncology, Infanta Leonor University Hospital, Madrid, Spain
| | - D A Sánchez
- Department of Medical Oncology, Virgen de La Arrixaca University Hospital, Murcia, Región de Murcia, Spain
| | - M Sánchez-Cánovas
- Department of Hematology and Medical Oncology, Morales Meseguer University General Hospital, Murcia, Región de Murcia, Spain
| | - E Sanz-García
- Department of Medical Oncology, HM Sanchinarro Hospital-Centro Integral Oncológico Clara Campal (CIOOC), Madrid, Spain
| | - A Sesma
- Department of Medical Oncology, Lozano Blesa University Clinical Hospital, Zaragoza, Aragón, Spain
| | - N Tarazona
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, Comunitat Valenciana, Spain; Instituto de Salud Carlos III, CIBERONC, Madrid, Spain
| | - A Cotés
- Department of Medical Oncology, Elda General Hospital, Elda, Comunitat Valenciana, Spain
| | - E González
- Department of Medical Oncology, Virgen de las Nieves University Hospital, Granada, Andalucía, Spain
| | - J Bosch-Barrera
- Department of Medical Oncology, Dr. Josep Trueta University Hospital, Institut Català d'Oncologia (ICO), Girona, Catalunya, Spain
| | - A Fernández
- Department of Medical Oncology, University Hospital Complex of Ourense (CHUO), Ourense, Galicia, Spain
| | - E Felip
- Department of Medical Oncology, Vall d'Hebron University Hospital & Institute of Oncology (VHIO), Vall d'Hebron Hospital Campus, Barcelona, Catalunya, Spain
| | - R Vera
- Department of Medical Oncology, University Hospital Complex of Navarra, Pamplona, Navarra, Spain
| | - Á Rodríguez-Lescure
- Department of Medical Oncology, Elche University General Hospital, Elche, Comunitat Valenciana, Spain
| | - E Élez
- Department of Medical Oncology, Vall d'Hebron University Hospital & Institute of Oncology (VHIO), Vall d'Hebron Hospital Campus, Barcelona, Catalunya, Spain.
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Élez E, Ros J, Martini G, Matito J, Villacampa G, Salva F, Baraibar I, Saoudi N, Garcia A, Comas R, Ciardiello D, Martinelli E, Nuciforo P, Pálmer H, Dienstmann R, Toledo R, Ciardiello F, Tabernero J, Vivancos A. LBA-3 Integrated analysis of cell-free DNA (cfDNA) BRAF mutant allele fraction (MAF) and whole exome sequencing in BRAFV600E metastatic colorectal cancer (mCRC) treated with BRAF-antiEGFR +/- MEK inhibitors. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Vera R, Salgado M, Safont MJ, Gallego J, González E, Élez E, Aranda E. Controversies in the treatment of RAS wild-type metastatic colorectal cancer. Clin Transl Oncol 2020; 23:827-839. [PMID: 32789773 PMCID: PMC7979622 DOI: 10.1007/s12094-020-02475-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/03/2020] [Indexed: 01/05/2023]
Abstract
Objective To provide guidance for the management of RAS wild-type (wt) metastatic colorectal cancer (mCRC) in daily practice. Methods Nominal group and Delphi techniques were used. A steering committee of seven experts analyzed the current management of RAS wt mCRC, through which they identified controversies, critically analyzed the available evidence, and formulated several guiding statements for clinicians. Subsequently, a group of 30 experts (the expert panel) was selected to test agreement with the statements, through two Delphi rounds. The following response categories were established in both rounds: 1 = totally agree, 2 = basically agree, 3 = basically disagree, 4 = totally disagree. Agreement was defined if ≥ 75% of answers were in categories 1 and 2 (consensus with the agreement) or 3 and 4 (consensus with the disagreement). Results Overall, 71 statements were proposed, which incorporated the following areas: (1) overarching principles; (2) tumor location; (3) triplets; (4) maintenance; (5) second-line and beyond treatments; (6) Rechallenge and liquid biopsy. After the two Delphi rounds, only six statements maintained a lack of clear consensus. Conclusions This document aims to describe the expert’s attitude when dealing with several common clinical questions regarding patients with RAS wt mCRC. Electronic supplementary material The online version of this article (10.1007/s12094-020-02475-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R Vera
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - M Salgado
- Medical Oncology Department, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - M J Safont
- Medical Oncology Department, Hospital General Universitario de Valencia, Valencia, Spain
| | - J Gallego
- Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain
| | - E González
- Medical Oncology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - E Élez
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - E Aranda
- Medical Oncology Department, Maimonides Institute of Biomedical Research (IMIBIC), Hospital Reina Sofía, University of Córdoba, Av. Menendez Pidal, s/n, 14004, Córdoba, Spain.
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Santos C, Azuara D, Viéitez JM, Páez D, Falcó E, Élez E, López-López C, Valladares M, Robles-Díaz L, García-Alfonso P, Bugés C, Durán G, Salud A, Navarro V, Capellá G, Aranda E, Salazar R. Phase II study of high-sensitivity genotyping of KRAS, NRAS, BRAF and PIK3CA to ultra-select metastatic colorectal cancer patients for panitumumab plus FOLFIRI: the ULTRA trial. Ann Oncol 2019; 30:796-803. [PMID: 30840064 DOI: 10.1093/annonc/mdz082] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Several studies show the importance of accurately quantifying not only KRAS and other low-abundant mutations because benefits of anti-EGFR therapies may depend on certain sensitivity thresholds. We assessed whether ultra-selection of patients using a high-sensitive digital PCR (dPCR) to determine KRAS, NRAS, BRAF and PIK3CA status can improve clinical outcomes of panitumumab plus FOLFIRI. PATIENTS AND METHODS This was a single-arm phase II trial that analysed 38 KRAS, NRAS, BRAF and PIK3CA hotspots in tumour tissues of irinotecan-resistant metastatic colorectal cancer patients who received panitumumab plus FOLFIRI until disease progression or early withdrawal. Mutation profiles were identified by nanofluidic dPCR and correlated with clinical outcomes (ORR, overall response rate; PFS, progression-free survival; OS, overall survival) using cut-offs from 0% to 5%. A quantitative PCR (qPCR) analysis was also performed. RESULTS Seventy-two evaluable patients were enrolled. RAS (KRAS/NRAS) mutations were detected in 23 (32%) patients and RAS/BRAF mutations in 25 (35%) by dPCR, while they were detected in 7 (10%) and 11 (15%) patients, respectively, by qPCR. PIK3CA mutations were not considered in the analyses as they were only detected in 2 (3%) patients by dPCR and in 1 (1%) patient by qPCR. The use of different dPCR cut-offs for RAS (KRAS/NRAS) and RAS/BRAF analyses translated into differential clinical outcomes. The highest ORR, PFS and OS in wild-type patients with their lowest values in patients with mutations were achieved with a 5% cut-off. We observed similar outcomes in RAS/BRAF wild-type and mutant patients defined by qPCR. CONCLUSIONS High-sensitive dPCR accurately identified patients with KRAS, NRAS, BRAF and PIK3CA mutations. The optimal RAS/BRAF mutational cut-off for outcome prediction is 5%, which explains that the predictive performance of qPCR was not improved by dPCR. The biological and clinical implications of low-frequent mutated alleles warrant further investigations. CLINICALTRIALS.GOV NUMBER NCT01704703. EUDRACT NUMBER 2012-001955-38.
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Affiliation(s)
- C Santos
- Translational Research Laboratory, Institut Català d'Oncologia Oncobell Program-IDIBELL, L'Hospitalet de Llobregat; Department of Medical Oncology, Institut Català d'Oncologia Oncobell Program-IDIBELL, CIBERONC, L'Hospitalet de Llobregat
| | - D Azuara
- Translational Research Laboratory, Institut Català d'Oncologia Oncobell Program-IDIBELL, L'Hospitalet de Llobregat
| | - J M Viéitez
- Department of Medical Oncology, Hospital Universitario Central de Asturias, Oviedo
| | - D Páez
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona
| | - E Falcó
- Department of Medical Oncology, Hospital Son Llàtzer, Palma de Mallorca
| | - E Élez
- Department of Medical Oncology, Hospital Vall d'Hebrón, Barcelona
| | - C López-López
- Department of Medical Oncology, Hospital Universitario Marqués de Valdecilla, Santander
| | - M Valladares
- Department of Medical Oncology, Hospital Universitario de A Coruña, A Coruña
| | - L Robles-Díaz
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid
| | - P García-Alfonso
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Madrid
| | - C Bugés
- Department of Medical Oncology, Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Institut Català d'Oncologia-Hospital Germans Trias i Pujol
| | - G Durán
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga
| | - A Salud
- Department of Medical Oncology, Hospital Universitari Arnau de Vilanova, Lleida
| | - V Navarro
- Clinical Research Unit, Institut Català d'Oncologia, L'Hospitalet de Llobregat
| | - G Capellá
- Translational Research Laboratory, Institut Català d'Oncologia Oncobell Program-IDIBELL, L'Hospitalet de Llobregat
| | - E Aranda
- Department of Medical Oncology, IMIBIC, Hospital Universitario Reina Sofía, Universidad de Córdoba, CIBERONC, Córdoba, Spain
| | - R Salazar
- Translational Research Laboratory, Institut Català d'Oncologia Oncobell Program-IDIBELL, L'Hospitalet de Llobregat; Department of Medical Oncology, Institut Català d'Oncologia Oncobell Program-IDIBELL, CIBERONC, L'Hospitalet de Llobregat.
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10
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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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Vivancos A, Élez E, Salazar R. Circulating cell-free DNA as predictor of treatment failure after neoadjuvant chemoradiotherapy before surgery in patients with locally advanced rectal cancer: is it ready for primetime? Ann Oncol 2018; 29:532-534. [PMID: 29401228 DOI: 10.1093/annonc/mdy043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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)
- A Vivancos
- Cancer Genomics Lab, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - E Élez
- Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; CIBERONC, Barcelona, Spain; Universitat Autònoma de Barcelona (UAM), Barcelona, Spain
| | - R Salazar
- CIBERONC, Barcelona, Spain; Department of Medical Oncology, Catalan Institute of Oncology, Barcelona, Spain; Oncobell, IDIBELL, Barcelona, Spain; Universitat de Barcelona (UB), L'Hospitalet, Barcelona, Spain.
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12
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Élez E, Kocáková I, Höhler T, Martens UM, Bokemeyer C, Van Cutsem E, Melichar B, Smakal M, Csőszi T, Topuzov E, Orlova R, Tjulandin S, Rivera F, Straub J, Bruns R, Quaratino S, Tabernero J. Abituzumab combined with cetuximab plus irinotecan versus cetuximab plus irinotecan alone for patients with KRAS wild-type metastatic colorectal cancer: the randomised phase I/II POSEIDON trial. Ann Oncol 2015; 26:132-140. [PMID: 25319061 DOI: 10.1093/annonc/mdu474] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [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: 12/17/2022] Open
Abstract
BACKGROUND Integrins are involved in tumour progression and metastasis, and differentially expressed on colorectal cancer (CRC) cells. Abituzumab (EMD 525797), a humanised monoclonal antibody targeting integrin αν heterodimers, has demonstrated preclinical activity. This trial was designed to assess the tolerability of different doses of abituzumab in combination with cetuximab and irinotecan (phase I) and explore the efficacy and tolerability of the combination versus that of cetuximab and irinotecan in patients with metastatic CRC (mCRC) (phase II part). METHODS Eligible patients had KRAS (exon 2) wild-type mCRC and had received prior oxaliplatin-containing therapy. The trial comprised an initial safety run-in using abituzumab doses up to 1000 mg combined with a standard of care (SoC: cetuximab plus irinotecan) and a phase II part in which patients were randomised 1 : 1 : 1 to receive abituzumab 500 mg (arm A) or 1000 mg (arm B) every 2 weeks combined with SoC, or SoC alone (arm C). The primary end point was investigator-assessed progression-free survival (PFS). Secondary end points included overall survival (OS), response rate (RR) and tolerability. Associations between tumour integrin expression and outcomes were also assessed. RESULTS Phase I showed that abituzumab doses up to 1000 mg were well tolerated in combination with SoC. Seventy-three (arm A), 71 (arm B) and 72 (arm C) patients were randomised to the phase II part. Baseline characteristics were balanced. PFS was similar in the three arms: arm A versus SoC, hazard ratio (HR) 1.13 [95% confidence interval (CI) 0.78-1.64]; arm B versus SoC, HR 1.11 (95% CI 0.77-1.61). RRs were also similar. A trend toward improved OS was observed: arm A versus SoC, HR 0.83 (95% CI 0.54-1.28); arm B versus SoC, HR 0.80 (95% CI 0.52-1.25). Grade ≥3 treatment-emergent adverse events were observed in 72%, 78% and 67% of patients. High tumour integrin αvβ6 expression was associated with longer OS in arms A [HR 0.55 (0.30-1.00)] and B [HR 0.41 (0.21-0.81)] than in arm C. CONCLUSION The primary PFS end point was not met, although predefined exploratory biomarker analyses identified subgroups of patients in whom abituzumab may have benefit. The tolerability of abituzumab combined with cetuximab and irinotecan was acceptable. Further study is warranted. CLINICALTRIALS.GOV IDENTIFIER: NCT01008475.
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Affiliation(s)
- E Élez
- Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - I Kocáková
- Department of Comprehensive Cancer Care, Masarykuv Onkologicky Ustav, Brno, Czech Republic
| | - T Höhler
- Medical Clinic I, Prosper-Hospital, Recklinghausen
| | - U M Martens
- Department of Hematology/Oncology, Cancer Center Heilbronn-Franken, Heilbronn
| | - C Bokemeyer
- Department of Oncology/Hematology, University Hospital Hamburg, Hamburg, Germany
| | - E Van Cutsem
- Department of Digestive Oncology, University Hospital Gasthuisberg Leuven and KULeuven, Leuven, Belgium
| | - B Melichar
- Department of Oncology, Palacký University Medical School and Teaching Hospital, Olomouc
| | - M Smakal
- Department of Oncology, Horovice, Czech Republic
| | - T Csőszi
- Department of Oncology, Jasz-Nagykun-Szolnok Megyei Hetenyi Geza Korhaz-Rendelointezet, Szolnok, Hungary
| | - E Topuzov
- GOU VPO St-Petersburg SMA, n/a Mechnikov Federal Agency of Healthcare, St Petersburg
| | - R Orlova
- City Clinical Oncology Dispensary, St Petersburg
| | - S Tjulandin
- S.I. Russian Cancer Research Center, Moscow, Russia
| | - F Rivera
- University Hospital Marques de Valdecilla, Santander, Spain
| | | | - R Bruns
- Merck KGaA, Darmstadt, Germany
| | | | - J Tabernero
- Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain.
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