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Mansinho A, Cruz A, Marconi L, Pinto C, Augusto I. Avelumab as First-Line Maintenance Treatment in Locally Advanced or Metastatic Urothelial Carcinoma. Adv Ther 2023; 40:4134-4150. [PMID: 37608243 DOI: 10.1007/s12325-023-02624-9] [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: 06/02/2023] [Accepted: 07/20/2023] [Indexed: 08/24/2023]
Abstract
This work provides a summary of guideline recommendations and an expert position on the use of maintenance avelumab therapy based on a review of current international clinical practice guidelines for locally advanced or metastatic urothelial carcinoma (UC). A PubMed literature search was conducted in March 2022 (updated in July 2023) to identify guidelines for locally advanced or metastatic UC. An expert panel (four oncologists and one urologist) reviewed the guidelines and clinical evidence, and discussed practical questions regarding the use of avelumab maintenance therapy in this clinical setting. The National Comprehensive Cancer Network, European Association of Urology and European Society for Medical Oncology guidelines recommend first-line cisplatin-containing chemotherapy for cisplatin-eligible patients, carboplatin-gemcitabine for cisplatin-ineligible patients who are fit for carboplatin, or immunotherapy with programmed death ligand-1 (PD-L1) inhibitors (e.g. atezolizumab) in platinum-ineligible patients. Maintenance avelumab is recommended in patients with response/stable disease following chemotherapy (regardless of PD-L1 status). In patients who relapse after/during chemotherapy, options include immunotherapy, erdafitinib [in those with fibroblast growth factor receptor (FGFR) mutations], enfortumab vedotin or further chemotherapy. The expert panel provided the following practical guidance: (1) consider maintenance avelumab in all eligible patients; (2) continue avelumab until disease progression/unacceptable toxicity; (3) ideally, administer six cycles of platinum-based chemotherapy prior to maintenance avelumab; (4) perform radiological evaluation after four chemotherapy cycles and prior to maintenance avelumab; (5) carboplatin-gemcitabine followed by maintenance avelumab is preferred in cisplatin-ineligible patients (regardless of PD-L1 expression), but consider first-line immunotherapy in PD-L1-positive patients and platinum-ineligible patients (regardless of PD-L1 status); and (6) for patients who relapse on avelumab, second-line options include enfortumab vedotin, FGFR inhibitors (in those with FGFR mutations) or clinical trial inclusion. In conclusion, avelumab maintenance therapy is recommended following platinum-based chemotherapy in all eligible patients with locally advanced or metastatic UC, continued until disease progression or unacceptable toxicity.
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Affiliation(s)
- André Mansinho
- Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal.
- Faculdade de Medicina, Instituto de Medicina Molecular-João Lobo Antunes, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal.
| | - Andreia Cruz
- Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida 865, 4200-072, Porto, Portugal
| | - Lorenzo Marconi
- Centro Hospitalar Universitario de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal
| | - Cidália Pinto
- Centro Hospitalar Universitário do Algarve- Hospital de Faro, Rua Leão Penedo, 8000-386, Faro, Portugal
| | - Isabel Augusto
- Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4200-100, Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-100, Porto, Portugal
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Valente A, Teixeira Tavares N, Caeiro C, Barbosa M, Augusto I. The Role of Cyclin-Dependent Kinase 4/6 Inhibitors Treatment in Oligometastatic Breast Cancer: A Case Report on a Possible Curative Intent Strategy. Cureus 2023; 15:e34893. [PMID: 36925985 PMCID: PMC10013604 DOI: 10.7759/cureus.34893] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2023] [Indexed: 02/14/2023] Open
Abstract
A small but important subset of patients with metastatic breast cancer has an oligometastatic disease. Some of these patients are highly responsive to systemic therapy and have the potential to achieve complete remission with treatment. However, it remains to be clarified the best locoregional and systemic treatment strategy for such patients and what features can determine whose patients are the best candidates. We also don't know what will be the role of cyclin-dependent kinase 4/6 inhibitors in those cases. We report the case of a 41-year-old woman with HR-positive/HER2-negative oligometastatic breast cancer who, after an excellent response to systemic treatment with palbociclib, anastrozole, and goserelin, underwent breast surgery and liver metastasectomy. After completing three years of systemic treatment, the CDK inhibitor was discontinued, maintaining the hormone therapy. The patient remained under regular follow-up with no evidence of disease after eight months.
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Affiliation(s)
- Ana Valente
- Medical Oncology, Centro Hospitalar e Universitário de São João, Porto, PRT
| | | | - Cláudia Caeiro
- Medical Oncology, Centro Hospitalar e Universitário de São João, Porto, PRT
| | - Miguel Barbosa
- Medical Oncology, Centro Hospitalar e Universitário de São João, Porto, PRT
| | - Isabel Augusto
- Medical Oncology, Centro Hospitalar e Universitário de São João, Porto, PRT
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Valente A, Costa M, Pinto R, Cirnes L, Augusto I, Schmitt F. PAM50 genomic test in the management of early breast cancer – the importance of clinical-pathological data. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01559-3] [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: 11/19/2022]
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Costa M, Valente A, Freitas M, Almeida C, Teixeira C, Gonçalves M, Tavares N, Almeida D, Caeiro C, Augusto I, Sousa I, Barbosa M. Clinical benefit and tolerability of CDK4/6 inhibitors in the treatment of breast cancer advanced in the geriatric population – real life data from a Hospital Center. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01519-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Costa M, Valente A, Freitas M, Almeida C, Tavares N, Almeida D, Caeiro C, Augusto I, Sousa I, Barbosa M. Advanced breast cancer treatment after CDK4/6– inhibitors - the experience of a Hospital Center. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01538-6] [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: 11/19/2022]
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Veloso Gonçalves M, Teixeira C, Lopes De Almeida C, Baptista Freitas M, Valente A, Costa M, Marques Ribeiro M, Augusto I, Barbosa M, Meireles S. Prognostic evaluation in hormonosensitive metastatic prostate cancer taking into account the stratification criteria of the LATITUDE and CHARTED studies - the experience of one center. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02533-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Valente A, J. Costa M, Nogueira Costa I, Reis J, Baptista Freitas M, Lopes Almeida C, Teixeira C, Veloso Gonçalves M, Ribeiro M, Meireles S, Barbosa M, Augusto I. Sunitinib treatment modification in metastatic renal cell carcinoma – the impact of 2/1 dosing schedule and dose reduction in survival outcomes. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02552-6] [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: 11/11/2022] Open
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Costa I, Reis J, Meireles S, Ribeiro MJ, Augusto I, Barbosa M. Metastatic Castration-Resistant Prostate Cancer with BRCA2 Mutation: The Challenge Incorporating PARP Inhibitors and Platinum in Treatment Sequencing. Eur J Case Rep Intern Med 2022; 9:003331. [PMID: 35774732 PMCID: PMC9239024 DOI: 10.12890/2022_003331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/19/2022] [Indexed: 11/09/2022] Open
Abstract
Prostate cancer is the second most frequent malignancy in men worldwide. Despite the improvement in survival achieved by increasingly early diagnosis and advances in treatment, it is still associated with high mortality. Because of its molecular heterogeneity, there is a need to identify genetic alterations in order to apply targeted therapies. Increasing evidence suggests that the PARP inhibitor olaparib could have a significant synthetic lethal effect in prostate cancer with homologous recombination defects, such as BRCA1/2 mutations. It is not yet known if, under these circumstances, platinum-based chemotherapy induces higher response rates in prostate cancer. We present the case of a patient with BRCA2-mutated metastatic castration-resistant prostate cancer whose treatment sequence included carboplatin and olaparib.
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Affiliation(s)
- Inês Costa
- Medical Oncology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Joana Reis
- Medical Oncology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Sara Meireles
- Medical Oncology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Maria João Ribeiro
- Medical Oncology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Isabel Augusto
- Medical Oncology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Miguel Barbosa
- Medical Oncology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
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Valente A, J. Costa M, Nogueira Costa I, Reis J, Baptista Freitas M, Lopes De Almeida C, Ribeiro M, Meireles S, Augusto I. Cabazitaxel as 3rd-4th line of treatment in castration-resistant metastatic prostate cancer - assessment of the impact of prior treatments on survival outcomes. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)03145-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Costa I, Reis J, Valente C, Costa M, Fernandes C, Ribeiro M, Meireles S, Augusto I. Prognostic value of tPSA’s early response in elderly patients with metastatic castration-resistant prostate cancer in treatment with Enzalutamide. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)36206-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Simões J, Tavares N, Borges C, Pinto R, Silva M, Paiva M, Sousa C, Sousa I, Almeida D, Augusto I, Caeiro C, Meireles S. High-sensitivity troponin as a cardiotoxicity biomarker in breast cancer treatment. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz265.081] [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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Simões J, Augusto I, Meireles S, Vendeira L, Silva C. Metastatic castration-resistant prostate cancer and the challenge of a patient with chronic kidney disease in hemodialysis. Autops Case Rep 2018; 8:e2018011. [PMID: 29780751 PMCID: PMC5953181 DOI: 10.4322/acr.2018.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 02/09/2018] [Indexed: 11/23/2022] Open
Abstract
At a time when the population shows increasing longevity, entities such as cancer and chronic
kidney disease (CKD) are more frequently connected. In the United States, approximately
6% of the patients on hemodialysis have cancer. The challenge to manage oncologic patients
with CKD in a hemodialytic program represents a great shortage of available information on
the choice of the best drug, timing, dosage adjustments, dialysis method, and treatment safety.
We present the case of a patient with prostate cancer and terminal CKD in hemodialysis, and
the treatment sequence after the development of resistance to hormonal blockade therapy,
which included docetaxel, enzalutamide, and radium-223.
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Affiliation(s)
- Joana Simões
- University of Porto, Centro Hospitalar de São João, Department of Oncology . Porto , Portugal
| | - Isabel Augusto
- University of Porto, Centro Hospitalar de São João, Department of Oncology . Porto , Portugal
| | - Sara Meireles
- University of Porto, Centro Hospitalar de São João, Department of Oncology . Porto , Portugal
| | - Lurdes Vendeira
- University of Porto, Centro Hospitalar de São João, Department of Urology . Porto , Portugal
| | - Carlos Silva
- University of Porto, Centro Hospitalar de São João, Department of Radiation Oncology . Porto , Portugal
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Ribeiro M, Povoa S, Tavares N, Marques C, Fernandes C, Almeida D, Augusto I. P-075 Neoadjuvant chemotherapy of esophageal cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw199.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fernandes AC, Capela A, Augusto I, Caeiro C, Damasceno M, Melo RB. PR50 HEPATIC METASTASECTOMY IN BREAST CANCER LIVER METASTASES: ONE CENTER EXPERIENCE. Breast 2013. [DOI: 10.1016/s0960-9776(13)70064-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Fernandes A, Meireles S, Augusto I, Aguas L, Damasceno M. Incidence of Thromboembolic Events in Patients Treated with Cisplatin-Based Chemotherapy. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)34190-9] [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: 11/28/2022] Open
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Costa BM, Caeiro C, Guimarães I, Martinho O, Jaraquemada T, Augusto I, Castro L, Osório L, Linhares P, Honavar M, Resende M, Braga F, Silva A, Pardal F, Amorim J, Nabiço R, Almeida R, Alegria C, Pires M, Pinheiro C, Carvalho E, Lopes JM, Costa P, Damasceno M, Reis RM. Prognostic value of MGMT promoter methylation in glioblastoma patients treated with temozolomide-based chemoradiation: a Portuguese multicentre study. Oncol Rep 2010; 23:1655-62. [PMID: 20428822 DOI: 10.3892/or_00000808] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Glioblastoma (GBM) is the most common and aggressive primary brain tumor. The identification of novel molecular prognostic markers of GBM has recently been an area of great interest in neuro-oncology. The methylation status of the MGMT gene promoter is currently a promising molecular prognostic marker, but some controversial data have precluded its clinical use. We analyzed MGMT methylation by methylation-specific PCR in 90 GBM patients from four Portuguese hospitals, uniformly treated with radiotherapy combined with concomitant and adjuvant temozolomide (Stupp protocol). The Kaplan-Meier method was used to construct survival curves, and the log-rank test and a Cox-regression model were used to analyze patient survival. The methylation status of MGMT was successfully determined in 89% (80/90) of the tumors. The frequency of tumoral MGMT promoter methylation was 47.5%. The median overall survivals (OSs) were 16 months (95% CI 12.2-19.8) and 13 months (95% CI 13.3-18.7) for patients whose tumors had a methylated or unmethylated MGMT, respectively. Univariate and multivariate analyses did not show any statistically significant association between MGMT methylation status and patient OS (P=0.583 by the log-rank test; P=0.617 by the Cox-regression test) or progression-free survival (P=0.775 by the log-rank test; P=0.691 by the Cox-regression test). None of the patient clinical features were significantly correlated with survival. This is the first study to report the frequency of MGMT methylation among Portuguese GBM patients. Our data did not show statistically significant associations between MGMT promoter methylation and the outcome of GBM patients treated with temozolomide. Additional robust prospective studies are warranted to clarify whether the MGMT status should be used in clinical decisions.
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Affiliation(s)
- Bruno M Costa
- Life and Health Sciences Research Institute (ICVS), Health Sciences School, University of Minho, Braga, Portugal
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Abstract
BACKGROUND The introduction of drugs, whose mechanisms of action are directed against specific molecules involved in cancer initiation and/or progression, has changed the daily workup of breast cancer patients. At present, HER2 expression and/or amplification should be evaluated in every primary invasive breast cancer either at the time of diagnosis or at the time of recurrence, mostly to guide selection of trastuzumab in the adjuvant and/or metastatic setting. The adequate selection of patients is an essential step for indication of anti-HER2 therapy. OBJECTIVE This review focuses on the state of the art for HER2 evaluation in breast cancer, as well as expectations regarding future molecular assays based on mechanisms of resistance to HER2-driven therapy. METHODS Data were obtained by searching the PubMed database, including the terms 'HER2', 'in situ hybridisation', 'immunohistochemistry', 'trastuzumab', 'breast cancer', 'therapy', 'resistance' and 'tyrosine-kinase inhibitors', with a preference for updated publications. CONCLUSION Pathologists have a central role in the selection of patients who will benefit from anti-HER-based therapies, with a responsibility to obtain the most reliable results for immunohistochemistry and in situ hybridisation techniques. Pre-analytical variables, such as type of fixative and time of fixation, are critical to guarantee consistent and quality assays, as well as to facilitate interpretation and decrease interobserver variability. Rigorous quality control and centralisation of techniques/interpretation of results are recommended to guarantee consistent assays.
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Affiliation(s)
- Fernanda Milanezi
- Institute of Molecular Pathology and Immunology of Porto University, Rua Roberto Frias, s/n, 4200-465, Porto, Portugal +351 225570700 ; +351 225570799 ;
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