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Matos LL, Kowalski LP, Chaves ALF, de Oliveira TB, Marta GN, Curado MP, de Castro Junior G, Farias TP, Bardales GS, Cabrera MA, Capuzzo RDC, de Carvalho GB, Cernea CR, Dedivitis RA, Dias FL, Estefan AM, Falco AH, Ferraris GA, Gonzalez-Motta A, Gouveia AG, Jacinto AA, Kulcsar MAV, Leite AK, Lira RB, Mak MP, De Marchi P, de Mello ES, de Matos FCM, Montero PH, de Moraes ED, de Moraes FY, Morais DCR, Poenitz FM, Poitevin A, Riveros HO, Sanabria Á, Ticona-Castro M, Vartanian JG, Viani G, Vines EF, William Junior WN, Conway D, Virani S, Brennan P. Latin American Consensus on the Treatment of Head and Neck Cancer. JCO Glob Oncol 2024; 10:e2300343. [PMID: 38603656 DOI: 10.1200/go.23.00343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/02/2023] [Revised: 12/19/2023] [Accepted: 02/07/2024] [Indexed: 04/13/2024] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is well known as a serious health problem worldwide, especially in low-income countries or those with limited resources, such as most countries in Latin America. International guidelines cannot always be applied to a population from a large region with specific conditions. This study established a Latin American guideline for care of patients with head and neck cancer and presented evidence of HNSCC management considering availability and oncologic benefit. A panel composed of 41 head and neck cancer experts systematically worked according to a modified Delphi process on (1) document compilation of evidence-based answers to different questions contextualized by resource availability and oncologic benefit regarding Latin America (region of limited resources and/or without access to all necessary health care system infrastructure), (2) revision of the answers and the classification of levels of evidence and degrees of recommendations of all recommendations, (3) validation of the consensus through two rounds of online surveys, and (4) manuscript composition. The consensus consists of 12 sections: Head and neck cancer staging, Histopathologic evaluation of head and neck cancer, Head and neck surgery-oral cavity, Clinical oncology-oral cavity, Head and neck surgery-oropharynx, Clinical oncology-oropharynx, Head and neck surgery-larynx, Head and neck surgery-larynx/hypopharynx, Clinical oncology-larynx/hypopharynx, Clinical oncology-recurrent and metastatic head and neck cancer, Head and neck surgery-reconstruction and rehabilitation, and Radiation therapy. The present consensus established 48 recommendations on HNSCC patient care considering the availability of resources and focusing on oncologic benefit. These recommendations could also be used to formulate strategies in other regions like Latin America countries.
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Affiliation(s)
- Leandro Luongo Matos
- Head and Neck Surgery, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
- Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil
| | | | | | | | | | | | - Gilberto de Castro Junior
- Clinical Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Andrés Munyo Estefan
- Profesor Adjunto Catedra de Otorrinolaringologia del Hospital de Clínicas, Montevidéu, Uruguay
| | | | | | | | - Andre Guimarães Gouveia
- Juravinski Cancer Centre, Department of Oncology, Division of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| | | | - Marco Aurelio Vamondes Kulcsar
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
| | - Ana Kober Leite
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
| | - Renan Bezerra Lira
- AC Camargo Cancer Center and Hospital Albert Einstein, São Paulo, Brazil
| | - Milena Perez Mak
- 3Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | | | | | | | - Pablo H Montero
- Department of Surgical Oncology and Head and Neck Surgery, Division of Surgery, P. Universidad Católica de Chile, Santiago, Chile
| | | | | | | | | | | | | | - Álvaro Sanabria
- 4Department of Surgery, Universidad de Antioquia, Hospital Alma Mater, Medellin, Colombia
| | - Miguel Ticona-Castro
- 5ESMO Member, Peruvian Society of Medical Oncology (S.P.O.M.) Member, La Molina, Peru
| | - José Guilherme Vartanian
- 6Head and Neck Surgery and Otorhinolaryngology Department, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Gustavo Viani
- 7Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Eugenio F Vines
- Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | | | | | - Shama Virani
- International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France
| | - Paul Brennan
- International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France
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Silva LC, Leite AA, Borgato GB, Wagner VP, Martins MD, Loureiro FJA, Lopes MA, Santos-Silva AR, Sperandio M, de Castro Junior G, Kowalski LP, Squarize CH, Castilho RM, Vargas PA. Oral squamous cell carcinoma cancer stem cells have different drug sensitive to pharmacological NFκB and histone deacetylation inhibition. Am J Cancer Res 2023; 13:6038-6050. [PMID: 38187064 PMCID: PMC10767341] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/06/2023] [Indexed: 01/09/2024] Open
Abstract
Despite many progresses in the development of new systemic therapies for oral squamous cell carcinoma (OSCC), the five-year survival rate of OSCC is low. The traditional chemotherapies approach (cisplatin - CDDP) shows some limitations like drug toxicity, limited efficacy, and drug resistance. Promising studies suggested OSCC cancer stem cells (CSC) presented resistance to CDDP. We have previously studied many targets, and we extensively showed the efficacy of the NFκB signaling and the role of histones acetylation, on different malignant tumors, including adenoid cystic carcinoma and mucoepidermoid carcinoma, but until then the effects of the NFkB inhibitor and histone deacetylase (HDAC) inhibitor on the biology of OSCC were not evaluated. Here we assessed the pharmacological inhibitor of NFκB emetine and HDAC inhibitor SAHA on the behavior of CSC derived from OSCC. Our data suggested that CDDP administration resulted in reduced viability of bulk OSCC cells and increased CSC. A single and isolated shot of emetine and SAHA were able to disrupt CSC by inhibiting the NFκB pathway and increasing the histone acetylation levels, respectively. Further, the combined administration of emetine and SAHA presented the same CSC disruption as seen in emetine alone.
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Affiliation(s)
- Luan César Silva
- Department of Oral Diagnosis, Piracicaba Dental School, University of CampinasPiracicaba, SP, Brazil
- Laboratory of Epithelial Biology, Department of Periodontics and Oral Medicine, University of Michigan School of DentistryAnn Arbor, MI, USA
| | - Amanda Almeida Leite
- Department of Oral Diagnosis, Piracicaba Dental School, University of CampinasPiracicaba, SP, Brazil
| | | | - Vivian Petersen Wagner
- Academic Unit of Oral and Maxillofacial Medicine and Pathology, Department of Clinical Dentistry, University of SheffieldSheffield, SY, UK
| | - Manoela Domingues Martins
- Department of Oral Diagnosis, Piracicaba Dental School, University of CampinasPiracicaba, SP, Brazil
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do SulPorto Alegre, Brazil
| | | | - Márcio Ajudarte Lopes
- Department of Oral Diagnosis, Piracicaba Dental School, University of CampinasPiracicaba, SP, Brazil
| | - Alan Roger Santos-Silva
- Department of Oral Diagnosis, Piracicaba Dental School, University of CampinasPiracicaba, SP, Brazil
| | - Marcelo Sperandio
- Department of Oral Pathology & Medicine, Sao Leopoldo Mandic Dental Institute and Research CenterCampinas, SP, Brazil
| | - Gilberto de Castro Junior
- Serviço de Oncologia Clínica, Instituto do Câncer do Estado de São Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São PauloSão Paulo, SP, Brazil
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery, University of Sao Paulo Medical School and Head and Neck Surgery and Otorhinolaryngology Department, AC Camargo Cancer CenterSão Paulo, SP, Brazil
| | - Cristiane H Squarize
- Laboratory of Epithelial Biology, Department of Periodontics and Oral Medicine, University of Michigan School of DentistryAnn Arbor, MI, USA
| | - Rogerio Moraes Castilho
- Laboratory of Epithelial Biology, Department of Periodontics and Oral Medicine, University of Michigan School of DentistryAnn Arbor, MI, USA
| | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Piracicaba Dental School, University of CampinasPiracicaba, SP, Brazil
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Menezes FDS, Verzinhasse Peres S, de Castro Junior G, Antunes JLF, Latorre MDRDDO, Toporcov TN. Survival inequalities in head and neck cancers: A hospital-based cohort study. Head Neck 2023; 45:2377-2393. [PMID: 37401537 DOI: 10.1002/hed.27433] [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: 09/30/2022] [Revised: 03/23/2023] [Accepted: 06/10/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND We investigated whether the socioeconomic status (SES) influenced survival rates in oropharynx cancers (OPC), oral cavity cancers (OCC), and larynx cancers (LC) in Brazilian patients. METHODS This hospital-based cohort study assessed the age-standardized 5-year relative survival (RS) using the Pohar Perme estimator. RESULTS Overall, we identified 37 191 cases, and 5-year RS were 24.4%, 34.1%, and 44.9% in OPC, OCC, and LC, respectively. In multiple Cox regression, the highest risk of death occurred in the most vulnerable social strata for all subsites-that is, illiterates or patients relying on publicly funded healthcare services. Disparities increased over time by 34.9% in OPC due to the rising of survival rates in the highest SES, whereas they reduced by 10.2% and 29.6% in OCC and LC. CONCLUSIONS The potential inequities were more significant for OPC than for OCC and LC. It is urgent to tackle social disparities to improve prognoses in highly unequal countries.
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Affiliation(s)
- Fabrício Dos Santos Menezes
- Department of Health Education, Federal University of Sergipe, Lagarto, Brazil
- Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil
| | | | - Gilberto de Castro Junior
- Instituto do Câncer do Estado de São Paulo (ICESP) and School of Medicine, University of São Paulo, São Paulo, Brazil
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Magnabosco FF, Brescia MDG, Nascimento Júnior CP, Massoni Neto LM, Arap SS, de Castro Junior G, Ledesma FL, Ferreira Alves VA, Kowalski LP, Martin RM, de Menezes Montenegro FL. Time to Recurrence as a Prognostic Factor in Parathyroid Carcinoma. J Endocr Soc 2023; 7:bvad067. [PMID: 37334212 PMCID: PMC10274572 DOI: 10.1210/jendso/bvad067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Indexed: 06/20/2023] Open
Abstract
Background Parathyroid carcinoma (PC) is a rare and challenging disease without clearly understood prognostic factors. Adequate management can improve outcomes. Characteristics of patients treated for PC over time and factors affecting prognosis were analyzed. Methods Retrospective cohort study including surgically treated patients for PC between 2000 and 2021. If malignancy was suspected, free-margin resection was performed. Demographic, clinical, laboratory, surgical, pathological, and follow-up characteristics were assessed. Results Seventeen patients were included. Mean tumor size was 32.5 mm, with 64.7% staged as pT1/pT2. None had lymph node involvement at admission, and 2 had distant metastases. Parathyroidectomy with ipsilateral thyroidectomy was performed in 82.2%. Mean postoperative calcium levels were different between patients who developed recurrence vs those who did not (P = .03). Six patients (40%) had no recurrence during follow-up, 2 (13.3%) only regional, 3 (20%) only distant, and 4 (26.6%) both regional and distant. At 5 and 10 years, 79% and 56% of patients were alive, respectively. Median disease-free survival was 70 months. Neither Tumor, Nodule, Metastasis system nor largest tumor dimension (P = .29 and P = .74, respectively) were predictive of death. En bloc resection was not superior to other surgical modalities (P = .97). Time between initial treatment and development of recurrence negatively impacted overall survival rate at 36 months (P = .01). Conclusion Patients with PC can survive for decades and have indolent disease course. Free margins seem to be the most important factor in initial surgery. Recurrence was common (60%), but patients with disease recurrence within 36 months of initial surgery had a lower survival rate.
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Affiliation(s)
- Felipe Ferraz Magnabosco
- Correspondence: Felipe Ferraz Magnabosco, Av. Dr. Enéas Carvalho de Aguiar, 255—Cerqueira César, São Paulo, SP, 05403-000, Brazil.
| | - Marilia D’Elboux Guimarães Brescia
- Division of Head and Neck Surgery, LIM-28, Laboratorio de Cirurgia de Cabeca e Pescoco, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, 05403-000, Brazil
| | - Climério Pereira Nascimento Júnior
- Division of Head and Neck Surgery, LIM-28, Laboratorio de Cirurgia de Cabeca e Pescoco, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, 05403-000, Brazil
| | - Ledo Mazzei Massoni Neto
- Division of Head and Neck Surgery, LIM-28, Laboratorio de Cirurgia de Cabeca e Pescoco, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, 05403-000, Brazil
| | - Sergio Samir Arap
- Division of Head and Neck Surgery, LIM-28, Laboratorio de Cirurgia de Cabeca e Pescoco, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, 05403-000, Brazil
| | - Gilberto de Castro Junior
- Department of Clinical Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, SP, 05403-000, Brazil
| | - Felipe Lourenço Ledesma
- Department of Pathology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, SP, 05403-000, Brazil
| | - Venancio Avancini Ferreira Alves
- Department of Pathology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, SP, 05403-000, Brazil
| | - Luiz Paulo Kowalski
- Division of Head and Neck Surgery, LIM-28, Laboratorio de Cirurgia de Cabeca e Pescoco, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, 05403-000, Brazil
| | - Regina Matsunaga Martin
- Division of Endocrinology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, SP, 05403-000, Brazil
| | - Fabio Luiz de Menezes Montenegro
- Division of Head and Neck Surgery, LIM-28, Laboratorio de Cirurgia de Cabeca e Pescoco, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, 05403-000, Brazil
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Silva SB, Wanderley CWS, Gomes Marin JF, de Macedo MP, do Nascimento ECT, Antonacio FF, Figueiredo CS, Trinconi Cunha M, Cunha FQ, de Castro Junior G. Tumor glycolytic profiling through 18F-FDG PET/CT predicts immune checkpoint inhibitor efficacy in advanced NSCLC. Ther Adv Med Oncol 2022; 14:17588359221138386. [PMID: 36506107 PMCID: PMC9730014 DOI: 10.1177/17588359221138386] [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: 06/29/2022] [Accepted: 10/24/2022] [Indexed: 12/12/2022] Open
Abstract
Background A significant proportion of patients with non-small-cell lung cancer (NSCLC) do not respond to immune checkpoint inhibitors (ICIs). Since metabolic reprogramming with increased glycolysis is a hallmark of cancer and is involved in immune evasion, we used 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) to evaluate the baseline glycolytic parameters of patients with advanced NSCLC submitted to ICIs, and assessed their predictive value. Methods 18F-FDG PET/CT results in the 3 months before ICIs treatment were included. Maximum standardized uptake values, whole metabolic tumor volume (wMTV), and whole-body total lesion glycolysis (wTLG) were evaluated. Cutoff values for high or low glycolytic categories were determined using receiver-operating characteristic curves. Progression-free survival (PFS) and overall survival (OS) were evaluated. Patients with a complete response and a matching group with resistance to ICIs underwent immunohistochemistry analysis. An unsupervised k-means clustering model integrating programmed cell death ligand 1 (PD-L1) expression, glycolytic parameters, and ICIs therapy was performed. Results In all, 98 patients were included. Lower baseline 18F-FDG PET/CT parameters were associated with responses to ICIs. Patients with low wMTV or wTLG had improved PFS and OS. High wTLG, strong tumor expression of glucose transporter-1, and lack of responses were significantly associated. Patients with low glycolytic parameters benefited from ICIs, regardless of chemotherapy. Conversely, those with high parameters benefited from the addition of chemotherapy. Patients with higher wTLG and lower PD-L1 were associated with progression and worse survival to ICIs monotherapy. Conclusions Glycolytic metabolic profiles established through baseline 18F-FDG PET/CT are useful biomarkers for evaluating ICI therapy in advanced NSCLC.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Fernando Q. Cunha
- Center for Research in Inflammatory Diseases (CRID) and Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
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Cunha MT, Carvalho VJ, Loureiro RM, Brantis-de-Carvalho CE, Cintra MB, de Castro Junior G. Letter to the editor: radiomics analysis for predicting pembrolizumab response in patients with advanced rare cancers. J Immunother Cancer 2021; 9:jitc-2021-003044. [PMID: 34315822 PMCID: PMC8317071 DOI: 10.1136/jitc-2021-003044] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 12/01/2022] Open
Abstract
A commentary on the original research article: ‘Radiomics analysis for predicting pembrolizumab response in patients with advanced rare cancers’. Of note, the predictor selection process, the cross-validation method, along with the lack of final testing of the developed model with a separated data set may mask overfitting, overestimating performance metrics.
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Affiliation(s)
- Mateus Trinconi Cunha
- Medical Oncology, Instituto do Cancer do Estado de Sao Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Vinicius Jardim Carvalho
- Computer Science, Instituto de Matematica e Estatistica, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | - Murilo Bicudo Cintra
- Radiology, Diagnosticos da America, Barueri, Brazil.,Radiology, Instituto do Cancer do Estado de Sao Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Gilberto de Castro Junior
- Medical Oncology, Instituto do Cancer do Estado de Sao Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
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Dziadziuszko R, Mok T, Peters S, Han JY, Alatorre-Alexander J, Leighl N, Sriuranpong V, Pérol M, de Castro Junior G, Nadal E, de Marinis F, Frontera OA, Tan DSW, Lee DH, Kim HR, Yan M, Riehl T, Schleifman E, Paul SM, Mocci S, Patel R, Assaf ZJ, Shames DS, Mathisen MS, Gadgeel SM. Blood First Assay Screening Trial (BFAST) in Treatment-Naive Advanced or Metastatic NSCLC: Initial Results of the Phase 2 ALK-Positive Cohort. J Thorac Oncol 2021; 16:2040-2050. [PMID: 34311110 DOI: 10.1016/j.jtho.2021.07.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/02/2021] [Accepted: 07/04/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The Blood First Assay Screening Trial is an ongoing open-label, multicohort study, prospectively evaluating the relationship between blood-based next-generation sequencing (NGS) detection of actionable genetic alterations and activity of targeted therapies or immunotherapy in treatment-naive advanced or metastatic NSCLC. We present data from the ALK-positive cohort. METHODS Patients aged more than or equal to 18 years with stage IIIB or IV NSCLC and ALK rearrangements detected by blood-based NGS using hybrid capture technology (FoundationACT) received alectinib 600 mg twice daily. Asymptomatic or treated central nervous system (CNS) metastases were permitted. Primary end point was investigator-assessed objective response rate (ORR; Response Evaluation Criteria in Solid Tumors version 1.1). Secondary end points were independent review facility-assessed ORR, duration of response, progression-free survival (PFS), overall survival, and safety. Exploratory end points were investigator-assessed ORR in patients with baseline CNS metastases and relationship between circulating biomarkers and response. RESULTS In total, 2219 patients were screened and blood-based NGS yielded results in 98.6% of the cases. Of these, 119 patients (5.4%) had ALK-positive disease; 87 were enrolled and received alectinib. Median follow-up was 12.6 months (range: 2.6-18.7). Confirmed ORR was 87.4% (95% confidence interval [CI]: 78.5-93.5) by investigator and 92.0% (95% CI: 84.1-96.7) by independent review facility. Investigator-confirmed 12-month duration of response was 75.9% (95% CI: 63.6-88.2). In 35 patients (40%) with baseline CNS disease, investigator-assessed ORR was 91.4% (95% CI: 76.9-98.2). Median PFS was not reached; 12-month investigator-assessed PFS was 78.4% (95% CI: 69.1-87.7). Safety data were consistent with the known tolerability profile of alectinib. CONCLUSIONS These results reveal the clinical application of blood-based NGS as a method to inform clinical decision-making in ALK-positive NSCLC.
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Affiliation(s)
- Rafal Dziadziuszko
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Tony Mok
- State Key Laboratory of Translational Oncology, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Solange Peters
- Oncology Department, University Hospital (CHUV), University of Lausanne, Switzerland
| | - Ji-Youn Han
- Center for Lung Cancer, National Cancer Center, Goyang, South Korea
| | | | - Natasha Leighl
- Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Virote Sriuranpong
- Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Maurice Pérol
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | | | - Ernest Nadal
- Catalan Institute of Oncology, L'Hospitalet, Barcelona, Spain
| | - Filippo de Marinis
- European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | | | - Daniel S W Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Dae Ho Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hye Ryun Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Centre, Yonsei University College of Medicine, Seoul, South Korea
| | - Mark Yan
- F. Hoffmann-La Roche, Mississauga, Canada
| | - Todd Riehl
- Genentech, Inc., South San Francisco, California
| | | | - Sarah M Paul
- Genentech, Inc., South San Francisco, California
| | | | - Rajesh Patel
- Genentech, Inc., South San Francisco, California
| | | | | | | | - Shirish M Gadgeel
- Department of Internal Medicine, Henry Ford Cancer Institute, Henry Ford Health System, Detroit, Michigan.
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Harada G, Amano MT, Antonacio FF, Behar MH, Nabuco-de-Araujo PHX, Buchpiguel CA, Junior GDC. Dramatic Response to Pembrolizumab Monotherapy in a Patient With ARID1A-Mutant Lung Adenocarcinoma: Case Report. Clin Lung Cancer 2021; 22:e708-e711. [PMID: 33658161 DOI: 10.1016/j.cllc.2021.01.011] [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: 06/25/2020] [Revised: 01/17/2021] [Accepted: 01/21/2021] [Indexed: 11/18/2022]
Abstract
Immunotherapy based on immune checkpoint inhibitors (ICIs) either alone or in combination with platinum-based chemotherapy has dramatically changed the therapeutic scenario in non-small cell lung cancer. However, only a subset of patients derives clinical benefits. Although programmed death-ligand 1 (PD-L1) and tumor mutational burden (TMB) are known to be prognostic and demonstrated utility in selecting patients for immunotherapy response, they are imperfect biomarkers. Recent evidence demonstrates that AT-rich interaction domain 1A (ARID1A) deficiency is associated with high antitumor immunity, mismatch repair and TMB, and thus may potentially contribute as a predictive biomarker for ICIs. We herein describe a 60-year-old woman, former smoker, who was diagnosed with lung adenocarcinoma metastatic to the left adrenal gland, with a PD-L1 expression of 60%. Next-generation sequencing test revealed an ARID1A mutation (F2141fs*59, variant allele frequency = 22.5%), TMB of 92 mut/Mb and stable microsatellite status. Given the high PD-L1 expression, elevated TMB, and ARID1A mutation, the patient started on first-line treatment with pembrolizumab monotherapy, and, 5 months after initiating treatment, presented an expressive reduction of lung lesion and a complete response of the adrenal gland. This case illustrates a dramatic response to ICI monotherapy in a lung cancer patient with ARID1A mutation. Predictive biomarkers for immune checkpoint blockade are of the utmost importance to select the patients who truly benefit from immunotherapy. The combination of biomarkers may be the most effective strategy to improve outcomes with ICIs, and ARID1A status should definitely be taken into account when present.
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Affiliation(s)
| | | | | | | | | | - Carlos Alberto Buchpiguel
- Hospital do Coração - HCOR, São Paulo, Brazil; Department of Radiology and Oncology - Sao Paulo University School of Medicine, São Paulo, Brazil
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Haradaa G, Antonacio FF, Gongora AB, Behar MH, Capareli FC, Bastos DA, Munhoz RR, Costa FP, Jardim DL, Arrais-Rodrigues C, Novis Y, Katz A, de Castro Junior G. SARS-CoV-2 testing for asymptomatic adult cancer patients before initiating systemic treatments: a systematic review. Ecancermedicalscience 2020; 14:1100. [PMID: 33082850 PMCID: PMC7532035 DOI: 10.3332/ecancer.2020.1100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction Cancer patients may have a higher risk of severe events and unfavourable outcomes in the setting of COVID-19. This review addresses the question of whether to test asymptomatic cancer patients before initiating systemic cancer treatments. Methods This systematic review was conducted based on the PRISMA framework. Pubmed, Embase, Web of Science and Cochrane Central Register of Controlled Trials were systematically searched, as well as guidelines from international institutions involved in cancer care and COVID-19 research. Studies published in English, from 1 December 2019 to 27 May 2020 were considered eligible. We included studies which mentioned testing strategies for SARS-CoV-2 of asymptomatic cancer patients before starting immunosuppressive treatments. Results We identified 1,163 studies and 4 guidelines through the literature search. A total of 18 articles were considered eligible and were included in the final analysis. Two articles were cohort studies, and the remaining were expert consensuses and published guidelines. The most common recommendation among the studies in this systematic review was to test asymptomatic patients for SARS-CoV-2 prior to treatment. Conclusion There is a lack of studies which directly address COVID-19 testing of asymptomatic patients before treatment. Our systematic review showed that most of the published data favours routine test for SARS-CoV-2 before initiating systemic treatment but failed to identify a good level of evidence to support these recommendations. Based upon this review, we proposed local recommendations at our centre. Each institution should consider the pros and cons of testing asymptomatic patients, evaluating accessibility to testing resources and local epidemiology.
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Affiliation(s)
| | - Fernanda F Antonacio
- Oncology Centre, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil.,https://orcid.org/0000-0003-4012-3251
| | - Aline Bl Gongora
- Oncology Centre, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil.,https://orcid.org/0000-0003-4012-3251
| | - Marina H Behar
- Oncology Centre, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil.,https://orcid.org/0000-0003-4012-3251
| | - Fernanda C Capareli
- Oncology Centre, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil.,https://orcid.org/0000-0003-4012-3251
| | - Diogo A Bastos
- Oncology Centre, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil.,https://orcid.org/0000-0003-4012-3251
| | - Rodrigo R Munhoz
- Oncology Centre, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil.,https://orcid.org/0000-0003-4012-3251
| | - Frederico P Costa
- Oncology Centre, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil.,https://orcid.org/0000-0003-4012-3251
| | - Denis L Jardim
- Oncology Centre, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil.,https://orcid.org/0000-0003-4012-3251
| | - Celso Arrais-Rodrigues
- Oncology Centre, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil.,https://orcid.org/0000-0003-4012-3251
| | - Yana Novis
- Oncology Centre, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil.,https://orcid.org/0000-0003-4012-3251
| | - Artur Katz
- Oncology Centre, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil.,https://orcid.org/0000-0003-4012-3251
| | - Gilberto de Castro Junior
- Oncology Centre, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil.,https://orcid.org/0000-0003-4012-3251
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10
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Kowalski LP, Imamura R, Castro Junior GD, Marta GN, Chaves ALF, Matos LL, Bento RF. Effect of the COVID-19 Pandemic on the Activity of Physicians Working in the Areas of Head and Neck Surgery and Otorhinolaryngology. Int Arch Otorhinolaryngol 2020; 24:e258-e266. [PMID: 32754234 PMCID: PMC7394652 DOI: 10.1055/s-0040-1712169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 01/06/2023] Open
Abstract
Introduction
Coronavirus disease 2019 (COVID-19) is an acute infection caused by the new coronavirus (SARS-CoV-2) and it is highly transmissible, especially through respiratory droplets. To prepare the health system for the care of these patients also led to a restriction in the activity of several medical specialties. Physicians who work with patients affected by diseases of the head and neck region constitute one of the populations most vulnerable to COVID-19 and also most affected by the interruption of their professional activities.
Objective
The aim of the present study was to assess the impact of the COVID-19 pandemic on the practice of head and neck surgeons and otorhinolaryngologists in Brazil.
Methods
An anonymous online survey of voluntary participation was applied, containing 30 questions regarding demographic aspects, availability of personal protective equipment (PPE), and impact on the routine of head and neck surgeons and otorhinolaryngologists, as well as clinical oncologists and radiation oncologists who work with head and neck diseases.
Results
Seven hundred and twenty-nine answers were received in a period of 4 days, ∼ 40 days after the 1
st
confirmed case in Brazil. With professionals working in public and private services, there was a high level of concerns with the disease and its consequences, limited availability of PPE and a significant decrease in the volume of specialized medical care.
Conclusion
The study demonstrated a direct impact of the COVID-19 pandemic on the clinical practice of specialties related to the treatment of patients with diseases of the head and neck region already in the beginning of the illness management in Brazil.
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Affiliation(s)
- Luiz Paulo Kowalski
- Department of Head and Neck Surgery, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rui Imamura
- Department of Otorhinolaryngology, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Gilberto de Castro Junior
- Clinical Oncology Service, Instituto do Câncer do Estado de São Paulo (ICESP) and Discipline of Oncology, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, SP Brazil.,Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo (ICESP), Medical School, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Leandro Luongo Matos
- Department of Head and Neck Surgery, Instituto do Cancer do Estado de São Paulo (Icesp), Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ricardo Ferreira Bento
- Department of Otorhinolaryngology, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
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11
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Castro Junior GD, Harada G, Mello ESD. The importance of molecular characterization in lung cancer. ACTA ACUST UNITED AC 2019; 45:e20190139. [PMID: 31166375 PMCID: PMC6715024 DOI: 10.1590/1806-3713/e20190139] [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] [Indexed: 12/24/2022]
Affiliation(s)
- Gilberto de Castro Junior
- Serviço de Oncologia Clínica, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.,Centro de Oncologia, Hospital Sírio-Libanês, São Paulo (SP) Brasil
| | - Guilherme Harada
- Centro de Oncologia, Hospital Sírio-Libanês, São Paulo (SP) Brasil
| | - Evandro Sobroza de Mello
- Laboratório de Anatomia Patológica, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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12
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Abstract
It is encouraging to witness the recent price reduction and expanded access to next generation sequencing platforms, the increasing number of investments and publications on new targets and respective targeted drugs, as well as the worldwide excitement with anti-cancer personalised therapies. This editorial aims to highlight the limitations regarding the small proportion of solid cancers potentially eligible for the use of molecular-based targeted drugs until now. It also covers the expected clinical benefits in refractory patients treated by matched therapies, and detailed cost-effectiveness analysis of the use of DNA sequencing analysis oncology practice in an academic and large-scale community.
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Affiliation(s)
- Vitor Fiorin Vasconcellos
- Clinical Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Leandro Machado Colli
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ahmad Awada
- Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Gilberto de Castro Junior
- Clinical Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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13
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de Castro Junior G, Segalla JG, de Azevedo SJ, Andrade CJ, Grabarz D, de Araújo Lima França B, Del Giglio A, Lazaretti NS, Álvares MN, Pedrini JL, Kussumoto C, de Matos Neto JN, Forones NM, Fernandes Júnior HJ, Borges G, Girotto G, da Silva IDCG, Maluf-Filho F, Skare NG. A randomised phase II study of chemoradiotherapy with or without nimotuzumab in locally advanced oesophageal cancer: NICE trial. Eur J Cancer 2018; 88:21-30. [DOI: 10.1016/j.ejca.2017.10.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 09/25/2017] [Accepted: 10/02/2017] [Indexed: 01/25/2023]
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14
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Gomes-Silva W, Prado Ribeiro AC, de Castro Junior G, Salvajoli JV, Rangel Palmier N, Lopes MA, Rocha MM, de Goes MF, Brandão TB, Santos-Silva AR. Head and neck radiotherapy does not increase gelatinase (metalloproteinase-2 and -9) expression or activity in teeth irradiated in vivo. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:175-182. [DOI: 10.1016/j.oooo.2017.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/14/2017] [Accepted: 04/17/2017] [Indexed: 11/27/2022]
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15
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Gomes-Silva W, Prado-Ribeiro AC, Brandão TB, Morais-Faria K, de Castro Junior G, Mak MP, Lopes MA, Rocha MM, Salo T, Tjäderhane L, de Goes MF, Santos-Silva AR. Postradiation Matrix Metalloproteinase-20 Expression and Its Impact on Dental Micromorphology and Radiation-Related Caries. Caries Res 2017; 51:216-224. [DOI: 10.1159/000457806] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 01/16/2017] [Indexed: 11/19/2022] Open
Abstract
Recent evidence suggests that head-and-neck radiotherapy (HNRT) increases active forms of matrix metalloproteinase-20 (MMP-20) in human tooth crowns, degrading the dentin-enamel junction (DEJ) and leading to enamel delamination, which is a pivotal step in the formation of radiation-related caries (RRC). Additional participation of enzymatic degradation of organic matrix components in caries progression was attributed to MMP-20 in dentin. Therefore, the current study tested the hypothesis that MMP-20 is overexpressed in the DEJ, dentin-pulp complex components, and carious dentin of post-HNRT patients, leading to detectable micromorphological changes to the enamel and dentin. Thirty-six teeth were studied, including 19 post-HNRT specimens and 17 nonirradiated controls. Optical light microscopy was used to investigate the micromorphological components of the DEJ, dentin-pulp complex components, and carious dentin. The samples were divided into 2 subgroups: nondemineralized ground sections (n = 20) and demineralized histological sections (n = 16). In addition, immunohistochemical analysis using the immunoperoxidase technique was conducted to semiquantitatively assess MMP-20 expression in the DEJ, dentin-pulp complex components, and carious dentin. No apparent damage to the DEJ microstructure or other dentin-pulp complex components was observed and no statistically significant differences were detected in MMP-20 expression (p > 0.05) between the irradiated and control groups. This study rejected the hypothesis that MMP-20 is overexpressed in the DEJ, dentin-pulp complex components, and carious dentin of post-HNRT patients, leading to detectable micromorphological changes. Hence, direct effects of radiation may not be regarded as an independent factor to explain aggressive clinical patterns of RRC.
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16
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Lopes GL, Vattimo EFDQ, Castro Junior GD. Identifying activating mutations in the EGFR gene: prognostic and therapeutic implications in non-small cell lung cancer. J Bras Pneumol 2016; 41:365-75. [PMID: 26398757 PMCID: PMC4635957 DOI: 10.1590/s1806-37132015000004531] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Lung cancer is the leading cause of cancer-related deaths worldwide. Promising new therapies have recently emerged from the development of molecular targeted drugs; particularly promising are those blocking the signal transduction machinery of cancer cells. One of the most widely studied cell signaling pathways is that of EGFR, which leads to uncontrolled cell proliferation, increased cell angiogenesis, and greater cell invasiveness. Activating mutations in the EGFR gene (deletions in exon 19 and mutation L858R in exon 21), first described in 2004, have been detected in approximately 10% of all non-squamous non-small cell lung cancer (NSCLC) patients in Western countries and are the most important predictors of a response to EGFR tyrosine-kinase inhibitors (EGFR-TKIs). Studies of the EGFR-TKIs gefitinib, erlotinib, and afatinib, in comparison with platinum-based regimens, as first-line treatments in chemotherapy-naïve patients have shown that the EGFR-TKIs produce gains in progression-free survival and overall response rates, although only in patients whose tumors harbor activating mutations in the EGFR gene. Clinical trials have also shown EGFR-TKIs to be effective as second- and third-line therapies in advanced NSCLC. Here, we review the main aspects of EGFR pathway activation in NSCLC, underscore the importance of correctly identifying activating mutations in the EGFR gene, and discuss the main outcomes of EGFR-TKI treatment in NSCLC.
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17
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Trufelli DC, Matos LLD, Santana TA, Capelli FDA, Kanda JL, Del Giglio A, Castro Junior GD. Complete pathologic response as a prognostic factor for squamous cell carcinoma of the oropharynx post-chemoradiotherapy. Braz J Otorhinolaryngol 2015; 81:498-504. [PMID: 26277829 PMCID: PMC9449043 DOI: 10.1016/j.bjorl.2015.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 10/08/2014] [Indexed: 02/07/2023] Open
Abstract
Introduction Chemoradiotherapy for squamous cell carcinoma of the oropharynx (SCCO) provides good results for locoregional disease control, with high rates of complete clinical and pathologic responses, mainly in the neck. Objective To determine whether complete pathologic response after chemoradiotherapy is related to the prognosis of patients with SCCO. Methods Data were prospectively extracted from clinical records of N2 and N3 SCCO patients submitted to a planned neck dissection after chemoradiotherapy. Results A total of 19 patients were evaluated. Half of patients obtained complete pathologic response in the neck. Distant or locoregional recurrence occurred in approximately 42% of patients, and 26% died. Statistical analysis showed an association between complete pathologic response and lower disease recurrence rate (77.8% vs. 20.8%; p = 0.017) and greater overall survival (88.9% vs. 23.3%; p = 0.049). Conclusion The presence of a complete pathologic response after chemoradiotherapy positively influences the prognosis of patients with SCCO.
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Affiliation(s)
| | - Leandro Luongo de Matos
- Department of Public Health (Biostatistics), Faculdade de Medicina do ABC, Santo André, SP, Brazil.
| | | | | | - Jossi Ledo Kanda
- Discipline of Head and Neck Surgery, Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | - Auro Del Giglio
- Discipline of Oncology, Faculdade de Medicina do ABC, Santo André, SP, Brazil
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Abdala E, Costa SF, Strabelli TMV, Pierrotti LC, Caramori ML, Azevedo LSFD, Ibrahim KY, Dulley FL, Varkulja GF, Castro Junior GD, Almeida GMDD, Marques HHDS, Shikanai-Yasuda MA. Prophylaxis of fungal infections in transplant patients. Clinics (Sao Paulo) 2012; 67:681-4. [PMID: 22760912 PMCID: PMC3370325 DOI: 10.6061/clinics/2012(06)23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Edson Abdala
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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de Castro Junior G, Puglisi F, de Azambuja E, El Saghir NS, Awada A. Angiogenesis and cancer: A cross-talk between basic science and clinical trials (the "do ut des" paradigm). Crit Rev Oncol Hematol 2006; 59:40-50. [PMID: 16600618 DOI: 10.1016/j.critrevonc.2006.02.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Revised: 11/30/2005] [Accepted: 02/22/2006] [Indexed: 12/30/2022] Open
Abstract
Angiogenesis plays a crucial role in facilitating tumor growth and the metastatic process, and it is the result of a dynamic balance between pro-angiogenic factors, like vascular endothelial growth factor (VEGF) and platelet-derived growth factor, and antiangiogenic factors, like thrombospondin-1 and angiostatin. Many drugs that target human tumors, like bevacizumab and some VEGF-receptor tyrosine-kinase inhibitors (e.g., BAY 43-9006, SU11248 and PTK787/ZK222584) have been studied in clinical trials, with favorable toxicity reports and encouraging results in advanced colorectal cancer, renal cell cancer, breast cancer and non-squamous non-small cell lung cancer, either combined with chemotherapy, or in monotherapy. Another potential approach to inhibiting angiogenesis is through metronomic chemotherapy (low doses of chemotherapy for long periods of time). This review describes the mechanisms of the angiogenic process and evaluates the recent data about antiangiogenic therapies in clinical trials.
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