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Bullock A, Grossman J, Fakih M, Lenz H, Gordon M, Margolin K, Wilky B, Mahadevan D, Trent J, Bockorny B, Moser J, Balmanoukian A, Schlechter B, Ortuzar Feliu W, Rosenthal K, Bullock B, Stebbing J, Godwin J, O'Day S, Tsimberidou A, El-Khoueiry A. LBA O-9 Botensilimab, a novel innate/adaptive immune activator, plus balstilimab (anti-PD-1) for metastatic heavily pretreated microsatellite stable colorectal cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.453] [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: 11/01/2022] Open
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2
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Xia Y, Jin R, Peng L, Shou J, Wang J, Jin Y, Liang F, Zhao J, Wu M, Li Q, Zhang B, Wu X, Lan F, Xia L, Yan J, Shao Y, Stebbing J, Shen H, Li W. 1215P EGFR-mutated squamous cell lung cancer and its association with outcomes. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1820] [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: 11/25/2022] Open
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3
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Page K, Martinson LJ, Hastings RK, Fernandez-Garcia D, Gleason KLT, Gray MC, Rushton AJ, Goddard K, Guttery DS, Stebbing J, Coombes RC, Shaw JA. Prevalence of ctDNA in early screen-detected breast cancers using highly sensitive and specific dual molecular barcoded personalised mutation assays. Ann Oncol 2021; 32:1057-1060. [PMID: 33932505 DOI: 10.1016/j.annonc.2021.04.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/25/2021] [Indexed: 12/27/2022] Open
Affiliation(s)
- K Page
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - L J Martinson
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - R K Hastings
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - D Fernandez-Garcia
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - K L T Gleason
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - M C Gray
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - A J Rushton
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - K Goddard
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - D S Guttery
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - J Stebbing
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - R C Coombes
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - J A Shaw
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK.
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Balachandran K, Williams J, Bell D, Brown A, Mahmoud S, Hurhangee P, Ramakrishnan R, Cleator S, Coombes R, Hatcher O, Rehman F, Stebbing J, Kenny L. 176P Breast cancer treatment during the first wave of the COVID-19 pandemic at a UK centre. Ann Oncol 2021. [PMCID: PMC8106259 DOI: 10.1016/j.annonc.2021.03.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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5
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Stebbing J, Zhang H, Xu Y, Lit LC, Green AR, Grothey A, Lombardo Y, Periyasamy M, Blighe K, Zhang W, Shaw JA, Ellis IO, Lenz HJ, Giamas G. Correction to: KSR1 regulates BRCA1 degradation and inhibits breast cancer growth. Oncogene 2021; 40:3473. [PMID: 33888869 DOI: 10.1038/s41388-021-01759-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- J Stebbing
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Imperial College Centre for Translational and Experimental Medicine, Hammersmith Hospital Campus, London, UK
| | - H Zhang
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Imperial College Centre for Translational and Experimental Medicine, Hammersmith Hospital Campus, London, UK
| | - Y Xu
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Imperial College Centre for Translational and Experimental Medicine, Hammersmith Hospital Campus, London, UK
| | - L C Lit
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Imperial College Centre for Translational and Experimental Medicine, Hammersmith Hospital Campus, London, UK.,Faculty of Medicine, Department of Physiology, University of Malaya, Kuala, Lumpur, Malaysia
| | - A R Green
- Department of Cellular Pathology, Queen's Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - A Grothey
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Imperial College Centre for Translational and Experimental Medicine, Hammersmith Hospital Campus, London, UK
| | - Y Lombardo
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Imperial College Centre for Translational and Experimental Medicine, Hammersmith Hospital Campus, London, UK
| | - M Periyasamy
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Imperial College Centre for Translational and Experimental Medicine, Hammersmith Hospital Campus, London, UK
| | - K Blighe
- Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, UK
| | - W Zhang
- Division of Medical Oncology, University of Southern California, Norris Comprehensive Cancer Centre, Keck School of Medicine, Los Angeles, CA, USA
| | - J A Shaw
- Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, UK
| | - I O Ellis
- Faculty of Medicine, Department of Physiology, University of Malaya, Kuala, Lumpur, Malaysia
| | - H J Lenz
- Division of Medical Oncology, University of Southern California, Norris Comprehensive Cancer Centre, Keck School of Medicine, Los Angeles, CA, USA
| | - G Giamas
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Imperial College Centre for Translational and Experimental Medicine, Hammersmith Hospital Campus, London, UK.
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Pallett SJC, Denny SJ, Patel A, Charani E, Mughal N, Stebbing J, Davies GW, Moore LSP. Point-of-care SARS-CoV-2 serological assays for enhanced case finding in a UK inpatient population. Sci Rep 2021; 11:5860. [PMID: 33712679 PMCID: PMC7955061 DOI: 10.1038/s41598-021-85247-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 05/05/2020] [Accepted: 02/23/2021] [Indexed: 12/13/2022] Open
Abstract
Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) has become a global pandemic. Case identification is currently made by real-time polymerase chain reaction (PCR) during the acute phase and largely restricted to healthcare laboratories. Serological assays are emerging but independent validation is urgently required to assess their utility. We evaluated five different point-of-care (POC) SARS-CoV-2 antibody test kits against PCR, finding concordance across the assays (n = 15). We subsequently tested 200 patients using the OrientGene COVID-19 IgG/IgM Rapid Test Cassette and find a sensitivity of 74% in the early infection period (day 5–9 post symptom onset), with 100% sensitivity not seen until day 13, demonstrating inferiority to PCR testing in the infectious period. Negative rate was 96%, but in validating the serological tests uncovered potential false-negatives from PCR testing late-presenting cases. A positive predictive value (PPV) of 37% in the general population precludes any use for general screening. Where a case definition is applied however, the PPV is substantially improved (95.4%), supporting use of serology testing in carefully targeted, high-risk populations. Larger studies in specific patient cohorts, including those with mild infection are urgently required to inform on the applicability of POC serological assays to help control the spread of SARS-CoV-2 and improve case finding of patients that may experience late complications.
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Affiliation(s)
- S J C Pallett
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK.,Clinical Infection Department, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - S J Denny
- Clinical Infection Department, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK.,North West London Pathology, Fulham Palace Road, London, W6 8RF, UK
| | - A Patel
- Clinical Infection Department, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - E Charani
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - N Mughal
- Clinical Infection Department, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK.,North West London Pathology, Fulham Palace Road, London, W6 8RF, UK.,NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - J Stebbing
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - G W Davies
- Clinical Infection Department, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - L S P Moore
- Clinical Infection Department, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK. .,North West London Pathology, Fulham Palace Road, London, W6 8RF, UK. .,NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK.
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7
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Kumleben N, Bhopal R, Czypionka T, Gruer L, Kock R, Stebbing J, Stigler FL. Test, test, test for COVID-19 antibodies: the importance of sensitivity, specificity and predictive powers. Public Health 2020; 185:88-90. [PMID: 32590234 PMCID: PMC7287442 DOI: 10.1016/j.puhe.2020.06.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 10/29/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody tests of varying specificity and sensitivity are now available. For informing individuals whether they have had coronavirus disease 2019 (COVID-19), they need to be very accurate. For measuring population prevalence of past infection, the numbers of false positives and negatives need to be roughly equal. With a series of worked examples for a notional population of 100,000 people, we show that even test systems with a high specificity can yield a large number of false positive results, especially where the population prevalence is low. For example, at a true population prevalence of 5%, using a test with 99% sensitivity and specificity, 16% of positive results will be false and thus 950 people will be incorrectly informed they have had the infection. Further confirmatory testing may be needed. Giving false reassurance on which personal or societal decisions might be based could be harmful for individuals, undermine public confidence and foster further outbreaks.
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Affiliation(s)
- N Kumleben
- Greenmantle LLC, New York City, NY 10010, USA.
| | - R Bhopal
- Usher Institute, University of Edinburgh, Edinburgh, EH8 9AG, UK.
| | - T Czypionka
- Institute for Advanced Studies, 1080 Vienna, Austria; London School of Economics and Political Science, London, UK.
| | - L Gruer
- Usher Institute, University of Edinburgh, Edinburgh, EH8 9AG, UK; Institute of Health and Wellbeing, University of Glasgow, G12 8RZ, UK.
| | - R Kock
- Department of Pathobiology and Population Science, Royal Veterinary College, Hawkshead Lane, Hatfield, AL9 7TA, UK.
| | - J Stebbing
- Imperial College, Hammersmith Hospital, London, W12 0HS, UK.
| | - F L Stigler
- Österreichische Gesundheitskasse, 8010 Graz, Austria.
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8
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Maclean W, Singh R, Mackenzie P, White D, Benton S, Stebbing J, Rockall T, Jourdan I. The two-week rule colorectal cancer pathway: an update on recent practice, the unsustainable burden on diagnostics and the role of faecal immunochemical testing. Ann R Coll Surg Engl 2020; 102:308-311. [PMID: 32081023 PMCID: PMC7099154 DOI: 10.1308/rcsann.2020.0019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Survival for colorectal cancer is improved by earlier detection. Rapid assessment and diagnostic demand have created a surge in two-week rule referrals and have subsequently placed a greater burden on endoscopy services. Between 2009 and 2014, a mean of 709 patients annually were referred to Royal Surrey County Hospital with a detection rate of 53 cancers per year giving a positive predictive value for these patients of 7.5%. We aimed to assess what impact the 2015 changes in National Institute for Health and Care Excellence referral criteria had on local cancer detection rate and endoscopy services. METHODS A prospectively maintained database of patients referred under the two-week rule pathway for April 2017-2018 was sub-analysed and the data cross-referenced with all diagnostic reports. FINDINGS There were 1,414 referrals, which is double the number of previous years; 80.6% underwent endoscopy as primary investigation and 62 cancers were identified, 51 being of colorectal and anal origin (positive predictive value 3.6%). A total of 88 patients were diagnosed, with other significant colorectal disease defined as high-risk adenomas, colitis and benign ulcers. Overall, a total of 10.6% of our two-week rule patients had a significant finding.Since the 2015 referral criteria, despite a dramatic rise in two-week rule referrals, there has been no increase in cancer detection. It has placed significant pressure on diagnostic services. This highlights the need for a less invasive, cheaper yet sensitive test to rule out cancer such as faecal immunochemical testing that can enable clinicians to triage and reduce referral to endoscopy in symptomatic patients.
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Affiliation(s)
- W Maclean
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - R Singh
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - P Mackenzie
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - D White
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - S Benton
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - J Stebbing
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - T Rockall
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - I Jourdan
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
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9
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Stebbing J, Baranau Y, Baryash V, Manikhas A, Moiseyenko V, Dzagnidze G, Zhavrid E, Boliukh D, Stroyakovskiy D, Pikiel J, Eniu A, Komov D, Lee S, Kim M, Kim S, Park S, Bae J, Esteva F. 3-year follow-up of a phase III trial comparing the efficacy and safety of neoadjuvant and adjuvant trastuzumab and its biosimilar CT-P6 in HER2 positive early breast cancer (EBC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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10
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Esteva FJ, Baranau YV, Baryash V, Manikhas A, Moiseyenko V, Dzagnidze G, Zhavrid E, Boliukh D, Stroyakovskiy D, Pikiel J, Eniu AE, Li RK, Rusyn AV, Tiangco B, Lee SJ, Lee SY, Yu SY, Stebbing J. Efficacy and safety of CT-P6 versus reference trastuzumab in HER2-positive early breast cancer: updated results of a randomised phase 3 trial. Cancer Chemother Pharmacol 2019; 84:839-847. [PMID: 31428820 PMCID: PMC6768896 DOI: 10.1007/s00280-019-03920-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 07/12/2019] [Accepted: 07/30/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Neoadjuvant CT-P6, a trastuzumab biosimilar, demonstrated equivalent efficacy to reference trastuzumab in a phase 3 trial of HER2-positive early-stage breast cancer (EBC) (NCT02162667). We report post hoc analyses evaluating pathological complete response (pCR) and breast pCR alongside additional efficacy and safety measures. METHODS Following neoadjuvant treatment and surgery, patients received adjuvant CT-P6 or trastuzumab (6 mg/kg) every 3 weeks for ≤ 1 year. RESULTS In total, 271 and 278 patients received CT-P6 and trastuzumab, respectively. pCR and breast pCR rates were comparable between treatment groups regardless of age, region, or clinical stage. Overall, 47.6% (CT-P6) and 52.2% (trastuzumab) of patients experienced study drug-related treatment-emergent adverse events (TEAEs), including 17 patients reporting heart failure (CT-P6: 10; trastuzumab: 7). Two CT-P6 and three trastuzumab patients discontinued adjuvant treatment due to TEAEs. CONCLUSION Adjuvant CT-P6 demonstrated comparable efficacy and safety to trastuzumab at 1 year in patients with HER2-positive EBC, supporting CT-P6 and trastuzumab comparability.
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Affiliation(s)
- F J Esteva
- Perlmutter Cancer Center, NYU Langone Health, 160 E 34th Street, New York, 10016, USA.,New York University Langone Medical Center, 550 1st Avenue, New York, 10016, USA
| | - Y V Baranau
- Department of Oncology, Belarusian State Medical University, 220013, Minsk, Belarus
| | - V Baryash
- Department of Oncology, Belarusian State Medical University, 220013, Minsk, Belarus
| | - A Manikhas
- City Clinical Oncology Dispensary, Saint Petersburg, 198255, Russian Federation
| | - V Moiseyenko
- GBUZ Saint Petersburg Clinical Research Center of Specialised Types of Care (Oncology), Saint Petersburg, 197758, Russian Federation
| | - G Dzagnidze
- S. Khechinashvili University Clinic, Ltd, 0177, Tbilisi, Georgia
| | - E Zhavrid
- N.N. Alexandrov National Cancer Centre of Belarus, 223040, Minsk Region, Belarus
| | - D Boliukh
- Vinnytsya Regional Clinical Oncology Dispensary, Vinnytsia, 21029, Ukraine
| | - D Stroyakovskiy
- Moscow City Oncology Hospital, Moscow, 143423, Russian Federation
| | - J Pikiel
- Wojewodzkie Centrum Onkologii, 80-219, Gdańsk, Poland
| | - A E Eniu
- Cancer Institute "Ion Chiricuta", 400015, Cluj-Napoca, Romania
| | - R K Li
- St. Luke's Medical Center, 1102, Quezon City, Philippines
| | - A V Rusyn
- Transcarpathian Regional Clinical Oncology Dispensary, Transcarpathian, 88000, Ukraine
| | - B Tiangco
- The Medical City, Ortigas Avenue, Pasig City, Philippines
| | - S J Lee
- CELLTRION, Inc., Incheon, 22014, Republic of Korea
| | - S Young Lee
- CELLTRION, Inc., Incheon, 22014, Republic of Korea
| | - S Y Yu
- CELLTRION, Inc., Incheon, 22014, Republic of Korea
| | - J Stebbing
- Division of Cancer, Imperial Centre for Translational and Experimental Medicine, Du Cane Road, London, W12 0HS, UK. .,Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK.
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11
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Murphy R, Adams L, Brown A, Cleator C, Gurjal D, Stebbing J, Kenny L, Rehman F. Impact of Routine Use of CDK4/6 Inhibitor Therapy on Breast Cancer Outpatient Clinic Workload and Patient Experience. Clin Oncol (R Coll Radiol) 2019. [DOI: 10.1016/j.clon.2019.03.029] [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: 11/24/2022]
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12
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Cereser B, Tabassum N, Carter P, Del Bel Belluz L, Stebbing J. Abstract P4-04-06: Study of the mutational landscape of normal and pregnant breast to predict pregnancy-associated breast cancer risk. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-04-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Amongst the various risk factors for breast cancer (BC), the molecular basis which may explain the correlation between age at first full-term and breast cancer risks is still understudied. Epidemiology studies indicate that an early first full-term pregnancy (before 25 years of age) confers a significant level of protection towards the development of post-menopausal BC compared to the risk in nulliparous or late-parous women. On the other hand, any pregnancy relates to a higher risk in developing cancer during or within one year of pregnancy (pregnancy-associated breast cancer, PABC). Thus, the relation between age of pregnancy and breast cancer risk may be too difficult to explain using only epidemiology data.
Aims of the study: With our research study, we aim to study a cohort of 60 normal breast samples of nulliparous and age-matched early- and late-parous women collected from Komen Tissue Bank, University of Indiana, and to create for the first time a mathematical model of cell clone expansion in the normal breast growth. This will allow us to determine how the rates of both cancer drivers, passenger mutations and genetic variations are affected by pregnancy. We then aim to translate this in cancer tissues, and to determine how the rate of the same mutations in both pregnancy and non pregnancy-associated cancers (post-menopausal). At the same time, we intend to create a mouse model which will be used to further validate our model, where driver mutations will be induced in the mammary epithelium of pregnant mice of different ages. This will allow us to test our model of growth of a mutated clone in a pregnancy environment, and to determine what are the molecular changes in the pregnant mammary gland which can trigger a different BC risk in the early-parous cohort.
Results: To examine the mutational landscape in the normal parous and nulliparous women, we extracted DNA from laser-capture microdissected epithelium and the stroma, the latter of which will be used to eliminate germ line mutations. We are currently analysing the results from Whole Genome Sequencing at 30x 100pe on a MGISEQ2000 platform on a first set of samples (two nulliparous samples and two age-matched parous samples from both early and late pregnancy). Our procedure for processing and analysis of this data follows the Broad Institute's “GATK Best Practice Guidelines” for use of next generation sequencing (NGS) data. Based on the collected data, we plan to continue with targeted sequencing or whole genome sequencing on the remaining samples.
Conclusions: Our study will provide novel information on which areas of the genome are mostly mutated or altered in the normal breast, and will indicate how mutated cells, including mutations in driver genes for breast cancer, and genetic alterations change in the contest of pregnancy. With the mathematical model of clone growth/extinction, we intend to explain how different ages of pregnancy can significantly alter the clone composition in the normal breast and result in a different probability of developing breast cancer.
Citation Format: Cereser B, Tabassum N, Carter P, Del Bel Belluz L, Stebbing J. Study of the mutational landscape of normal and pregnant breast to predict pregnancy-associated breast cancer risk [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-04-06.
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Affiliation(s)
- B Cereser
- Imperial College London, London, United Kingdom
| | - N Tabassum
- Imperial College London, London, United Kingdom
| | - P Carter
- Imperial College London, London, United Kingdom
| | | | - J Stebbing
- Imperial College London, London, United Kingdom
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13
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Esteva FJ, Lee S, Yu S, Kim M, Kim N, Stebbing J. Abstract P6-17-03: 24 months results from a double-blind, randomized phase III trial comparing the efficacy and safety of neoadjuvant then adjuvant trastuzumab and its biosimilar candidate CT-P6 in HER2 positive early breast cancer (EBC). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-17-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background CT-P6 is a proposed biosimilar to reference trastuzumab (RTZ). A double-blind, randomized, phase III trial showed similar efficacy and safety for CT-P6 and RTZ in HER2 positive EBC (NCT02162667). The primary endpoint, pathological complete response rate was within the predefined margin to demonstrate similarity (Lancet Oncol 2017). Safety and efficacy at 1 year (ESMO 2017), and cardiac toxicity at a median of 19 months (SABCS 2017) were similar between the two treatment groups. Here we report updated disease-free survival (DFS), overall survival (OS) and cardiac toxicity data with a median follow-up of 2 years.
Methods A total of 549 patients with HER2 positive EBC were randomized to receive CT-P6 (n=271) or RTZ (n=278) in combination with docetaxel (Cycles 1-4) and 5-fluorouracil, epirubicin and cyclophosphamide (Cycles 5-8). CT-P6 or RTZ was administered at 8 mg/kg (Cycle 1 only) followed by 6 mg/kg every 3 weeks. After surgery, patients received CT-P6 or RTZ monotherapy then entered the follow-up period up to 3 year of last patient enrollment. Time to event analyses were performed using Cox regression and Kaplan-Meier methods.
Results A total of 528 patients (259/271 in CT-P6 and 269/278 in RTZ) entered the follow-up period after completing therapy. The median follow-up duration was over 27 months. The number of DFS events (32 [12.4%] in CT-P6 and 26 [10.0%] in RTZ) and OS events (14 [5.2%] in CT-P6 and 12 [4.3%] in RTZ) were comparable in the ITT set. Additionally, DFS and OS were similar between CT-P6 group and RTZ group in both the per-protocol set (PPS) and the ITT set. In the ITT set, the proportion of 2-year DFS (95% CI) was 86% (80% – 90%) in CT-P6 and 90% (85% – 93%) in RTZ. The proportion of 2-year OS was 97% (93% – 98%) in CT-P6 and 98% (96% – 99%) in RTZ. Median DFS and OS have not been reached. After 1-year treatment, no new cases of heart failure were reported during the follow-up period. Left ventricular ejection fraction (LVEF) was similar in both groups (mean LVEF, more than 60%).
Table 1.Summary of Long Term Efficacy Endpoints PPSITT set CT-P6 (n=248)Reference Trastuzumab (n=256)CT-P6 (n=258)Reference Trastuzumab (n=261)Proportion of DFS1 year (95% CI)0.95 (0.91 – 0.97)0.96 (0.93 – 0.98)0.95 (0.91 – 0.97)0.96 (0.93 – 0.98)2 years (95% CI)0.86 (0.80 – 0.90)0.90 (0.85 – 0.93)0.86 (0.80 – 0.90)0.90 (0.85 – 0.93)p-value0.33240.3085 CT-P6 (n=248)Reference Trastuzumab (n=256)CT-P6 (n=271)Reference Trastuzumab (n=278)Proportion of OS1 year (95% CI)1.00 (1.00 – 1.00)1.00 (0.97 – 1.00)0.99 (0.97 – 1.00)0.99 (0.97 – 1.00)2 year (95% CI)0.97 (0.94 – 0.99)0.98 (0.96 – 0.99)0.97 (0.93 – 0.98)0.98 (0.96 – 0.99)3 year (95% CI)0.94 (0.88 – 0.97)0.93 (0.86 – 0.96)0.92 (0.86 – 0.96)0.93 (0.87 – 0.96)p-value0.93290.5057
Conclusions The efficacy and cardiac toxicity profile between CT-P6 and RTZ in EBC patients were consistent with published data. Time to event analyses as secondary efficacy endpoints supported the similarity for the two study drugs. CT-P6 was consistently well tolerated with a similar cardiotoxicity profile to that of RTZ through long duration of follow-up.
Citation Format: Esteva FJ, Lee S, Yu S, Kim M, Kim N, Stebbing J. 24 months results from a double-blind, randomized phase III trial comparing the efficacy and safety of neoadjuvant then adjuvant trastuzumab and its biosimilar candidate CT-P6 in HER2 positive early breast cancer (EBC) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-17-03.
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Affiliation(s)
- FJ Esteva
- New York University Langone Health, New York; Celltrion, Inc., Incheon, Korea; NIHR Research Professor, Imperial College, London, United Kingdom
| | - S Lee
- New York University Langone Health, New York; Celltrion, Inc., Incheon, Korea; NIHR Research Professor, Imperial College, London, United Kingdom
| | - S Yu
- New York University Langone Health, New York; Celltrion, Inc., Incheon, Korea; NIHR Research Professor, Imperial College, London, United Kingdom
| | - M Kim
- New York University Langone Health, New York; Celltrion, Inc., Incheon, Korea; NIHR Research Professor, Imperial College, London, United Kingdom
| | - N Kim
- New York University Langone Health, New York; Celltrion, Inc., Incheon, Korea; NIHR Research Professor, Imperial College, London, United Kingdom
| | - J Stebbing
- New York University Langone Health, New York; Celltrion, Inc., Incheon, Korea; NIHR Research Professor, Imperial College, London, United Kingdom
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Blighe K, DeDionisio L, Christie KA, Chawes B, Shareef S, Kakouli-Duarte T, Chao-Shern C, Harding V, Kelly RS, Castellano L, Stebbing J, Lasky-Su JA, Nesbit MA, Moore CBT. Gene editing in the context of an increasingly complex genome. BMC Genomics 2018; 19:595. [PMID: 30086710 PMCID: PMC6081867 DOI: 10.1186/s12864-018-4963-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 07/26/2018] [Indexed: 12/15/2022] Open
Abstract
The reporting of the first draft of the human genome in 2000 brought with it much hope for the future in what was felt as a paradigm shift toward improved health outcomes. Indeed, we have now mapped the majority of variation across human populations with landmark projects such as 1000 Genomes; in cancer, we have catalogued mutations across the primary carcinomas; whilst, for other diseases, we have identified the genetic variants with strongest association. Despite this, we are still awaiting the genetic revolution in healthcare to materialise and translate itself into the health benefits for which we had hoped. A major problem we face relates to our underestimation of the complexity of the genome, and that of biological mechanisms, generally. Fixation on DNA sequence alone and a 'rigid' mode of thinking about the genome has meant that the folding and structure of the DNA molecule -and how these relate to regulation- have been underappreciated. Projects like ENCODE have additionally taught us that regulation at the level of RNA is just as important as that at the spatiotemporal level of chromatin.In this review, we chart the course of the major advances in the biomedical sciences in the era pre- and post the release of the first draft sequence of the human genome, taking a focus on technology and how its development has influenced these. We additionally focus on gene editing via CRISPR/Cas9 as a key technique, in particular its use in the context of complex biological mechanisms. Our aim is to shift the mode of thinking about the genome to that which encompasses a greater appreciation of the folding of the DNA molecule, DNA- RNA/protein interactions, and how these regulate expression and elaborate disease mechanisms.Through the composition of our work, we recognise that technological improvement is conducive to a greater understanding of biological processes and life within the cell. We believe we now have the technology at our disposal that permits a better understanding of disease mechanisms, achievable through integrative data analyses. Finally, only with greater understanding of disease mechanisms can techniques such as gene editing be faithfully conducted.
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Affiliation(s)
- K Blighe
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA, USA.
- Department of Cancer Studies and Molecular Medicine, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, LE2 7LX, UK.
- Bill Lyons Informatics Centre, UCL Cancer Institute, University College London, WC1E 6DD, London, UK.
| | - L DeDionisio
- Avellino Laboratories, Menlo Park, CA, 94025, USA
| | - K A Christie
- Biomedical Sciences Research Institute, University of Ulster, Coleraine, Northern Ireland, BT52 1SA, UK
| | - B Chawes
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - S Shareef
- University of Raparin, Ranya, Kurdistan Region, Iraq
| | - T Kakouli-Duarte
- Institute of Technology Carlow, Department of Science and Health, Kilkenny Road, Carlow, Ireland
| | - C Chao-Shern
- Biomedical Sciences Research Institute, University of Ulster, Coleraine, Northern Ireland, BT52 1SA, UK
- Avellino Laboratories, Menlo Park, CA, 94025, USA
| | - V Harding
- Imperial College London, Division of Cancer, Department of Surgery and Cancer, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - R S Kelly
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA, USA
| | - L Castellano
- Imperial College London, Division of Cancer, Department of Surgery and Cancer, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
- JMS Building, School of Life Sciences, University of Sussex, Falmer, Brighton, BN1 9QG, UK
| | - J Stebbing
- Imperial College London, Division of Cancer, Department of Surgery and Cancer, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - J A Lasky-Su
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA, USA
| | - M A Nesbit
- Biomedical Sciences Research Institute, University of Ulster, Coleraine, Northern Ireland, BT52 1SA, UK
| | - C B T Moore
- Biomedical Sciences Research Institute, University of Ulster, Coleraine, Northern Ireland, BT52 1SA, UK.
- Avellino Laboratories, Menlo Park, CA, 94025, USA.
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15
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Izumchenko E, Paz K, Ciznadija D, Sloma I, Katz A, Vasquez-Dunddel D, Ben-Zvi I, Stebbing J, McGuire W, Harris W, Maki R, Gaya A, Bedi A, Zacharoulis S, Ravi R, Wexler LH, Hoque MO, Rodriguez-Galindo C, Pass H, Peled N, Davies A, Morris R, Hidalgo M, Sidransky D. Patient-derived xenografts effectively capture responses to oncology therapy in a heterogeneous cohort of patients with solid tumors. Ann Oncol 2018; 28:2595-2605. [PMID: 28945830 DOI: 10.1093/annonc/mdx416] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background While patient-derived xenografts (PDXs) offer a powerful modality for translational cancer research, a precise evaluation of how accurately patient responses correlate with matching PDXs in a large, heterogeneous population is needed for assessing the utility of this platform for preclinical drug-testing and personalized patient cancer treatment. Patients and methods Tumors obtained from surgical or biopsy procedures from 237 cancer patients with a variety of solid tumors were implanted into immunodeficient mice and whole-exome sequencing was carried out. For 92 patients, responses to anticancer therapies were compared with that of their corresponding PDX models. Results We compared whole-exome sequencing of 237 PDX models with equivalent information in The Cancer Genome Atlas database, demonstrating that tumorgrafts faithfully conserve genetic patterns of the primary tumors. We next screened PDXs established for 92 patients with various solid cancers against the same 129 treatments that were administered clinically and correlated patient outcomes with the responses in corresponding models. Our analysis demonstrates that PDXs accurately replicate patients' clinical outcomes, even as patients undergo several additional cycles of therapy over time, indicating the capacity of these models to correctly guide an oncologist to treatments that are most likely to be of clinical benefit. Conclusions Integration of PDX models as a preclinical platform for assessment of drug efficacy may allow a higher success-rate in critical end points of clinical benefit.
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Affiliation(s)
- E Izumchenko
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, R&D, Baltimore
| | - K Paz
- Champions Oncology, R&D, Baltimore, USA
| | | | - I Sloma
- Champions Oncology, R&D, Baltimore, USA
| | - A Katz
- Champions Oncology, R&D, Baltimore, USA
| | | | - I Ben-Zvi
- Champions Oncology, R&D, Baltimore, USA
| | - J Stebbing
- Department of Surgery & Cancer, Imperial College, London, UK
| | - W McGuire
- Department of Internal Medicine, Division of Hematology/Oncology, Virginia Commonwealth University, Massey Cancer Center, Virginia Commonwealth University, Richmond
| | - W Harris
- Department of Medicine, Division of Oncology, University of Washington, Seattle
| | - R Maki
- Department of Pediatric Hematology Oncology, Mount Sinai School of Medicine, New York, USA
| | - A Gaya
- Guy's and St Thomas' Cancer Center, London
| | - A Bedi
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, R&D, Baltimore
| | - S Zacharoulis
- Department of Pediatric Oncology, The Royal Marsden Hospital, Harley Street Clinic, Sutton, UK
| | - R Ravi
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, R&D, Baltimore
| | - L H Wexler
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York
| | - M O Hoque
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, R&D, Baltimore
| | | | - H Pass
- Department of Cardiothoracic Surgery, New York University Langone Medical Center, New York, USA
| | - N Peled
- Research and Detection Unit for Thoracic malignancies, Sheba Medical Center, Tel Aviv, Israel
| | - A Davies
- Champions Oncology, R&D, Baltimore, USA
| | - R Morris
- Champions Oncology, R&D, Baltimore, USA
| | - M Hidalgo
- Division of Hematology-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - D Sidransky
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, R&D, Baltimore.
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16
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Begum S, Yiu A, Stebbing J, Castellano L. Novel tumour suppressive protein encoded by circular RNA, circ-SHPRH, in glioblastomas. Oncogene 2018; 37:4055-4057. [DOI: 10.1038/s41388-018-0230-3] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 01/27/2018] [Indexed: 01/03/2023]
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17
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Esteva FJ, Chung HC, Royce ME, Lee SY, Lee SJ, Stebbing J. Abstract P5-20-14: Cardiotoxicity in 1 year of treatment with reference trastuzumab and its biosimilar candidate CT-P6 in HER2 positive early stage breast cancer (EBC) patients. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-20-14] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background CT-P6 is a proposed biosimilar to reference trastuzumab. This trial (NCT02162667) evaluated the similarity of CT-P6 and reference trastuzumab for both efficacy and safety in HER2 positive EBC patients. The primary endpoint, pathological complete response (pCR) rate was entirely within the pre-defined equivalence margin (Stebbing et al., Lancet Oncology 2017). Efficacy and safety were similar between the two treatment groups. We aimed to investigate the cardiotoxicity in the 1 year treatment and follow-up period.
Methods A total of 549 patients with HER2 positive EBC were randomized to receive CT-P6 (n=271) or reference trastuzumab (n=278) in combination with docetaxel (Cycles 1-4) and 5-fluorouracil, epirubicin and cyclophosphamide (FEC, Cycles 5-8) in the neoadjuvant setting. CT-P6 or reference trastuzumab was administered at 8 mg/kg (Cycle 1 only) followed by 6 mg/kg every 3 weeks. After surgery, patients received monotherapy of CT-P6 or reference trastuzumab up to 10 cycles in the adjuvant setting. Left ventricular ejection fraction (LVEF) was evaluated by ECHO or MUGA at baseline, every 3 or 4 cycles during treatment and every 6 months thereafter. If LVEF decreased by ≥10 points from baseline and <50%, a reassessment was performed within 3 weeks and the patient was withdrawn from the study treatment if the cardiac toxicity was confirmed.
Results Median follow-up period was 19 months. In total, 96% of patients completed 8 cycles of taxane and anthracycline combination therapy during the neoadjuvant period and 90% of patients in each group received 1-year treatment of CT-P6 or reference trastuzumab.
The relative dose intensity of study drug was similar, indicating good tolerability of CT-P6 and reference trastuzumab (97.5% and 97.3% during the neoadjuvant period; 98.5% and 98.8% during the adjuvant period). Docetaxel and FEC combination therapies were administered approximately 96% of dose intensity in the two groups.
All patients had normal LVEF (≥55%) at baseline. Mean LVEF value was maintained more than 60% during 1-year treatment and follow-up period. Heart failure cases with LVEF decrease (≥10 points from baseline and <50%) were reported to be similar between two groups. Three patients in each group were withdrawn due to LVEF decrease. Adverse events of cardiac disorders were reported to be similar between two groups. All cases were mild or moderate except two cases.
Table 1. Summary of heart failure with LVEF decrease and cardiotoxicity CT-P6 (N=271)Reference Trastuzumab (N=278)LVEF decrease ≥ 10 points and below 50%9 (3.3%)7 (2.5%)- Asymptomatic9 (3.3%)6 (2.1%)- Symptomatic01 (0.4%)- Confirmed2 (0.7%)4 (1.4%)- Withdrawn3 (1.1%)3 (1.1%)Cardiac disorder by AEs31 (11.4%)38 (13.7%)- Grade 1 to 230 (11.0%)37 (13.3%)- Grade 3 to 51 (0.4%)11 (0.4%)21 Grade 3 of Adams-Strokes syndrome occurring 5 months after the completion of 1-year treatment; 2 Grade 5 of acute myocardial infarction occurring 10 days after Cycle 1 of the neoadjuvant therapy
Conclusions Combination therapy of CT-P6 with taxane/anthracycline and monotherapy of CT-P6 over 1 year period were well tolerated and cardiotoxicity was similar to reference trastuzumab.
Citation Format: Esteva FJ, Chung HC, Royce ME, Lee SY, Lee SJ, Stebbing J. Cardiotoxicity in 1 year of treatment with reference trastuzumab and its biosimilar candidate CT-P6 in HER2 positive early stage breast cancer (EBC) patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-20-14.
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Affiliation(s)
- FJ Esteva
- New York University Langone Medical Center; Yonsei Cancer Center, Yonsei University College of Medicine; Clinical Trialist and Breast Cancer Oncologist; Celltrion, Inc.; Imperial College/Imperial Healthcare NHS Trust
| | - HC Chung
- New York University Langone Medical Center; Yonsei Cancer Center, Yonsei University College of Medicine; Clinical Trialist and Breast Cancer Oncologist; Celltrion, Inc.; Imperial College/Imperial Healthcare NHS Trust
| | - ME Royce
- New York University Langone Medical Center; Yonsei Cancer Center, Yonsei University College of Medicine; Clinical Trialist and Breast Cancer Oncologist; Celltrion, Inc.; Imperial College/Imperial Healthcare NHS Trust
| | - SY Lee
- New York University Langone Medical Center; Yonsei Cancer Center, Yonsei University College of Medicine; Clinical Trialist and Breast Cancer Oncologist; Celltrion, Inc.; Imperial College/Imperial Healthcare NHS Trust
| | - SJ Lee
- New York University Langone Medical Center; Yonsei Cancer Center, Yonsei University College of Medicine; Clinical Trialist and Breast Cancer Oncologist; Celltrion, Inc.; Imperial College/Imperial Healthcare NHS Trust
| | - J Stebbing
- New York University Langone Medical Center; Yonsei Cancer Center, Yonsei University College of Medicine; Clinical Trialist and Breast Cancer Oncologist; Celltrion, Inc.; Imperial College/Imperial Healthcare NHS Trust
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18
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Affiliation(s)
- G Miller
- Departments of Surgery and Cell Biology, New York University School of Medicine, New York, NY, USA
| | - J Stebbing
- Department of Surgery and Cancer, Imperial College, London, UK
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Chandrasinghe P, Cereser B, Moorghen M, Al Bakir I, Tabassum N, Hart A, Stebbing J, Warusavitarne J. Role of SMAD proteins in colitis-associated cancer: from known to the unknown. Oncogene 2017; 37:1-7. [DOI: 10.1038/onc.2017.300] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/14/2017] [Accepted: 07/19/2017] [Indexed: 02/07/2023]
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20
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Esteva F, Baranau Y, Baryash V, Manikhas A, Moiseyenko V, Dzagnidze G, Zhavrid E, Boliukh D, Stroyakovskiy D, Pikiel J, Eniu A, Komov D, Zautashvili Z, Morar-Bolba G, Li R, Lifirenko I, Rusyn A, Lee S, Yu S, Stebbing J. Double-blind, randomized phase III study to compare the efficacy and safety of trastuzumab and its biosimilar candidate CT-P6 in HER2 positive early breast cancer (EBC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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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21
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Harrod A, Fulton J, Nguyen VTM, Periyasamy M, Ramos-Garcia L, Lai CF, Metodieva G, de Giorgio A, Williams RL, Santos DB, Gomez PJ, Lin ML, Metodiev MV, Stebbing J, Castellano L, Magnani L, Coombes RC, Buluwela L, Ali S. Genomic modelling of the ESR1 Y537S mutation for evaluating function and new therapeutic approaches for metastatic breast cancer. Oncogene 2017; 36:2286-2296. [PMID: 27748765 PMCID: PMC5245767 DOI: 10.1038/onc.2016.382] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 07/23/2016] [Accepted: 08/29/2016] [Indexed: 02/07/2023]
Abstract
Drugs that inhibit estrogen receptor-α (ER) activity have been highly successful in treating and reducing breast cancer progression in ER-positive disease. However, resistance to these therapies presents a major clinical problem. Recent genetic studies have shown that mutations in the ER gene are found in >20% of tumours that progress on endocrine therapies. Remarkably, the great majority of these mutations localize to just a few amino acids within or near the critical helix 12 region of the ER hormone binding domain, where they are likely to be single allele mutations. Understanding how these mutations impact on ER function is a prerequisite for identifying methods to treat breast cancer patients featuring such mutations. Towards this end, we used CRISPR-Cas9 genome editing to make a single allele knock-in of the most commonly mutated amino acid residue, tyrosine 537, in the estrogen-responsive MCF7 breast cancer cell line. Genomic analyses using RNA-seq and ER ChIP-seq demonstrated that the Y537S mutation promotes constitutive ER activity globally, resulting in estrogen-independent growth. MCF7-Y537S cells were resistant to the anti-estrogen tamoxifen and fulvestrant. Further, we show that the basal transcription factor TFIIH is constitutively recruited by ER-Y537S, resulting in ligand-independent phosphorylation of Serine 118 (Ser118) by the TFIIH kinase, cyclin-dependent kinase (CDK)7. The CDK7 inhibitor, THZ1 prevented Ser118 phosphorylation and inhibited growth of MCF7-Y537S cells. These studies confirm the functional importance of ER mutations in endocrine resistance, demonstrate the utility of knock-in mutational models for investigating alternative therapeutic approaches and highlight CDK7 inhibition as a potential therapy for endocrine-resistant breast cancer mediated by ER mutations.
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Affiliation(s)
- A Harrod
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - J Fulton
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - V T M Nguyen
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - M Periyasamy
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - L Ramos-Garcia
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - C-F Lai
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - G Metodieva
- School of Biological Sciences, University of Essex, Wivenhoe Park, Colchester, UK
| | - A de Giorgio
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - R L Williams
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - D B Santos
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - P J Gomez
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - M-L Lin
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - M V Metodiev
- School of Biological Sciences, University of Essex, Wivenhoe Park, Colchester, UK
| | - J Stebbing
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - L Castellano
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - L Magnani
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - R C Coombes
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - L Buluwela
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - S Ali
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
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22
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Wendler F, Favicchio R, Simon T, Alifrangis C, Stebbing J, Giamas G. Extracellular vesicles swarm the cancer microenvironment: from tumor-stroma communication to drug intervention. Oncogene 2017; 36:877-884. [PMID: 27546617 DOI: 10.1038/onc.2016.253] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/07/2016] [Accepted: 06/07/2016] [Indexed: 02/06/2023]
Abstract
Intercellular communication sets the pace for transformed cells to survive and to thrive. Extracellular vesicles (EVs), such as exosomes, microvesicles and large oncosomes, are involved in this process shuttling reciprocal signals and other molecules between transformed and stromal cells, including fibroblasts, endothelial and immune cells. As a result, these cells are adapted or recruited to a constantly evolving cancer microenvironment. Moreover, EVs take part in the response to anticancer therapeutics not least by promoting drug resistance throughout the targeted tumor. Finally, circulating EVs can also transport important molecules to remote destinations in order to prime metastatic niches in an otherwise healthy tissue. Although the understanding of EV biology remains a major challenge in the field, their characteristics create new opportunities for advances in cancer diagnostics and therapeutics.
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Affiliation(s)
- F Wendler
- School of Life Sciences, Department of Biochemistry and Biomedicine, University of Sussex, Brighton, UK
| | - R Favicchio
- Imperial College London, Department of Surgery and Cancer, Division of Cancer, London, UK
| | - T Simon
- School of Life Sciences, Department of Biochemistry and Biomedicine, University of Sussex, Brighton, UK
| | - C Alifrangis
- Imperial College London, Department of Medical Oncology, NHS Trust, Hammersmith Hospital, London, UK
| | - J Stebbing
- Imperial College London, Department of Surgery and Cancer, Division of Cancer, London, UK
| | - G Giamas
- School of Life Sciences, Department of Biochemistry and Biomedicine, University of Sussex, Brighton, UK
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23
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Giamas G, Grothey T, Grothey A, Stebbing J. Abstract P4-03-02: Stromal kinome screening identifies a novel regulatory kinase implicated in fibroblast-mediated progression of invasion in triple negative breast cancer tumours. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-03-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was not presented at the symposium.
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Affiliation(s)
- G Giamas
- University of Sussex, United Kingdom; Imperial College, United Kingdom
| | - T Grothey
- University of Sussex, United Kingdom; Imperial College, United Kingdom
| | - A Grothey
- University of Sussex, United Kingdom; Imperial College, United Kingdom
| | - J Stebbing
- University of Sussex, United Kingdom; Imperial College, United Kingdom
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24
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Nachiappan S, Askari A, Mamidanna R, Munasinghe A, Currie A, Stebbing J, Faiz O. Initiation of adjuvant chemotherapy within 8 weeks of elective colorectal resection improves overall survival regardless of reoperation. Colorectal Dis 2016; 18:1041-1049. [PMID: 27807941 DOI: 10.1111/codi.13308] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 01/08/2016] [Indexed: 02/08/2023]
Abstract
AIM Reoperation after elective colorectal resection may delay the start of adjuvant chemotherapy (AC). The study investigated the dual impact of a reoperation and AC delay on overall survival (OS). METHOD The Hospital Episode Statistics database was analysed between 1997 and 2012. Patients were divided into colon and rectal cancer cohorts and data were analysed based on whether there was delay in receiving AC beyond 8 weeks and whether a patient suffered reoperation within 30 days. Multivariate regression analysis was undertaken to investigate the relationship between delay in giving AC and reoperation and their combined effect on OS. RESULTS Logistic regression showed reoperation, amongst other things, to be an independent predictor of AC delay, in both colon and rectal cancer (colon, odds ratio 2.31, P < 0.001; rectal, odds ratio 2.19, P < 0.001). There was no significant difference in OS between patients who had no AC delay but suffered a reoperation and patients who had no AC delay and no reoperation. Patients who had AC delay but no reoperation, however, had significantly worse OS compared to those who had no AC delay and no reoperation [colon, hazard ratio (HR) 1.16, P < 0.001; rectal, HR 1.17, P < 0.001]. Individuals who had both AC delay and a reoperation also had worse OS compared with patients who had neither (colon, HR 1.33, P = 0.037; rectal, HR 1.38, P < 0.001). CONCLUSION Delayed receipt of AC beyond 8 weeks after surgery is associated with significantly reduced OS regardless of reoperation status in both colon and rectal cancer patients.
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Affiliation(s)
- S Nachiappan
- Surgical Epidemiology, Trials and Outcomes Centre (SETOC), St Mark's Hospital and Academic Institute, Watford Road, Harrow, Middlesex. .,Department of Surgery and Cancer, Imperial College London, London, UK.
| | - A Askari
- Surgical Epidemiology, Trials and Outcomes Centre (SETOC), St Mark's Hospital and Academic Institute, Watford Road, Harrow, Middlesex.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - R Mamidanna
- Surgical Epidemiology, Trials and Outcomes Centre (SETOC), St Mark's Hospital and Academic Institute, Watford Road, Harrow, Middlesex.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - A Munasinghe
- Surgical Epidemiology, Trials and Outcomes Centre (SETOC), St Mark's Hospital and Academic Institute, Watford Road, Harrow, Middlesex.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - A Currie
- Surgical Epidemiology, Trials and Outcomes Centre (SETOC), St Mark's Hospital and Academic Institute, Watford Road, Harrow, Middlesex.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - J Stebbing
- Department of Surgery and Cancer, Imperial College London, London, UK.,Hammersmith Hospital, London, UK
| | - O Faiz
- Surgical Epidemiology, Trials and Outcomes Centre (SETOC), St Mark's Hospital and Academic Institute, Watford Road, Harrow, Middlesex.,Department of Surgery and Cancer, Imperial College London, London, UK
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Davies A, Hidalgo M, Stebbing J, Ciznadija D, Katz A, Sidransky D. Mouse clinical trials of pancreatic cancer: Integration of PDX models with genomics to improve patient outcomes to chemotherapeutics. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw392.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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26
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Coombes RC, Kilburn LS, Tubiana-Mathieu N, Olmos T, Van Bochove A, Perez-Lopez FR, Palmieri C, Stebbing J, Bliss JM. Epirubicin dose and sequential hormonal therapy-Mature results of the HMFEC randomised phase III trial in premenopausal patients with node positive early breast cancer. Eur J Cancer 2016; 60:146-53. [PMID: 27125966 DOI: 10.1016/j.ejca.2016.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 02/18/2016] [Accepted: 03/01/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND The hormonal manipulation 5-Fluoro-uracil Epirubicin Cyclophosphamide (HMFEC) trial was developed at a time of uncertainty around the dose intensity of chemotherapy given to premenopausal patients with node positive breast cancer and to the benefits of tailored endocrine therapy in such patients. PATIENTS AND METHODS HMFEC was a multi-centre, phase III, open label, randomised controlled trial with a 2 × 2 factorial design. Eligible patients were premenopausal with node positive early breast cancer; significant cardiac disease or uncontrolled hypertension was exclusion criterion. Patients were allocated to receive either eight cycles of FE50C or FE75C (given 3 weekly) with or without hormone manipulation (HM; tamoxifen or luteinising hormone releasing hormone (LHRH) agonists according to residual hormone levels at the end of chemotherapy) irrespective of ER status. The primary end-point was disease free survival (DFS). Principal analyses were by intention to treat (ITT); however, to reflect contemporary practice, subgroup analyses according to ER status were also conducted. The mature follow-up now available from this modest sized trial enables presentation of definitive results. RESULTS Between 1992 and 2000 a total of 785 patients were randomised into the HMFEC trial (203 FE50C-HM, 191 FE50C+HM, 198 FE75C-HM, 193 FE75C+HM). At a median follow-up of 7.4 years, 245 DFS events have been reported (92 ER-, 153 ER+/unknown). The effects on DFS were not statistically significantly different according to epirubicin dose (hazard ratio [HR] = 0.82, 95% confidence interval [CI] 0.63-1.06; p = 0.13 FE75C versus FE50C); however, FE75C appeared to induce more alopecia and neutropenia. No statistically significant evidence was observed to support an improvement in DFS in patients allocated HM either overall (HR = 0.88, 95% CI 0.68-1.13; p = 0.32) or in patients with ER+/unknown disease (HR = 0.85, 95% CI 0.62-1.17; p = 0.32) although effect sizes are consistent with worthwhile clinical effects. Overall, there was no evidence of a difference in survival between any of the four treatment groups of the trial. CONCLUSION Higher doses of epirubicin cause more adverse events in the absence of clear improvement in overall survival. Endocrine therapy with either tamoxifen or goserelin provided no significant added benefit to cytotoxic chemotherapy in this group of patients. TRIAL REGISTRATION NUMBER ISRCTN98335268.
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Affiliation(s)
- R C Coombes
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - L S Kilburn
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - N Tubiana-Mathieu
- Department of Medical Oncology and Radiotherapy, Limoges University Hospital, Limoges, Spain
| | - T Olmos
- Medical Oncology Department, Instituto Valenciano de Oncologia (IVO), Valencia, Spain
| | - A Van Bochove
- Department of Internal Medicine, Zaans Medical Centre, Zaandam, Netherlands
| | - F R Perez-Lopez
- Faculty of Medicine, University of Zaragoza and Lozano-Blesa University Hospital, Zaragoza, Spain
| | - C Palmieri
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - J Stebbing
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - J M Bliss
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
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Rampias T, Favicchio R, Stebbing J, Giamas G. Targeting tumor-stroma crosstalk: the example of the NT157 inhibitor. Oncogene 2016; 35:2562-4. [PMID: 26477311 DOI: 10.1038/onc.2015.392] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/08/2015] [Indexed: 01/05/2023]
Abstract
Recent clinical research has provided evidence that cancer progression and therapy resistance is driven not only by tumor's genetic profile but also by complex paracrine interactions within the tumor microenvironment (TME). The role of TME in modulating tumor drug sensitivity is increasingly recognized and targeting TME has been the focus of novel therapeutic approaches. Two recent reports show that a new anti-cancer drug, the inhibitor NT157 has the potential to inhibit IGF-1R and STAT3 signaling pathways in cancer cells and stroma cells of TME leading to a decrease in cancer cell survival.
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Affiliation(s)
- T Rampias
- School of Life Sciences, Department of Biochemistry and Biomedicine, University of Sussex, Brighton, UK
| | - R Favicchio
- Department of Surgery and Cancer, Imperial College, Hammersmith Hospital Campus, London, UK
| | - J Stebbing
- Department of Surgery and Cancer, Imperial College, Hammersmith Hospital Campus, London, UK
| | - G Giamas
- School of Life Sciences, Department of Biochemistry and Biomedicine, University of Sussex, Brighton, UK
- Department of Surgery and Cancer, Imperial College, Hammersmith Hospital Campus, London, UK
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28
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Pinato DJ, Chowdhury S, Stebbing J. TAMing resistance to multi-targeted kinase inhibitors through Axl and Met inhibition. Oncogene 2016; 35:2684-6. [PMID: 26434595 DOI: 10.1038/onc.2015.374] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 08/28/2015] [Indexed: 02/08/2023]
Abstract
TAM (Tyro3-Axl-Mer) receptor tyrosine kinases and Met are implicated in several hallmarks of cancer progression including sustained angiogenesis, enhanced motility, tissue invasion and acquisition of metastatic potential through the upregulation of epithelial-to-mesenchymal transition. Increasing evidence has confirmed Axl and Met as emerging central drivers of adaptive resistance to targeted therapies across a wide variety of cancers. In this issue of Oncogene, Zhou et al. describe the mechanisms linking Axl and Met activation to acquired resistance to sunitinib in renal cell carcinoma (RCC), providing a pre-clinical rationale for the development of Axl and Met inhibitors including cabozantinib in anti-angiogenic resistant RCC.
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Affiliation(s)
- D J Pinato
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - S Chowdhury
- Department of Medical Oncology, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - J Stebbing
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
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Bidard FC, Peeters D, Fehm T, Nole F, Gisbert-Criado R, Mavroudis D, Grisanti S, Generali D, Garcia-Saenz JA, Stebbing J, Caldas C, Gazzaniga P, Manso L, Zamarchi R, Fernandez de Lascoiti A, de Mattos-Arruda L, Ignatiadis M, van Laere SJ, Meier-Stiegen F, Sandri MT, Vidal-Martinez J, Politaki E, Consoli F, Bottini A, Diaz-Rubio E, Krell J, Dawson SJ, Raimondi C, Rutten A, Janni W, Munzone E, Carañana V, Agelaki S, Almici C, Dirix L, Solomayer E, Zorzino L, Reis-Filho JS, Squifflet P, Pantel K, Beije N, Sleijfers S, Pierga JY, Michiels S. Abstract P2-08-08: Circulating tumor cells count-based nomograms to predict survival of metastatic breast cancer patients: Results from the European pooled analysis. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-08-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The European Pooled Analysis of CTC (EPAC) in metastatic breast cancer, based on 1,944 individual data from patients with various tumor types and clinical settings (Bidard et al, Lancet Oncol 2014), has established CTC count (CellSearch) at baseline and during therapy as a level of evidence 1 independent prognostic biomarker and demonstrated its superiority over serum blood markers. As part of the study pre-planned objectives, we sought to establish nomograms allowing accurate individual survival predictions.
Methods: Using individual data from 17 centers, we built simplified multivariate prognostic models taking into account the independent prognostic clinico-pathological (CP) characteristics including CTC count, dichotomized using the 5CTC/7.5ml threshold, at baseline and at 3-5 weeks after the start of a new treatment regimen, and derived nomograms for progression-free survival (PFS) and overall survival (OS) prediction at baseline and after 3-5 weeks of treatment. We report here the internal validation of these nomograms. Discrimination of the models was assessed using the c-index estimated by a jackknife procedure and the calibration was visually assessed through 10-fold crossvalidated calibration plots at 1,2,3 years for OS and 1,2 years for PFS.
Results: Multivariate models at baseline for PFS and OS were fitted on 1501 and 568 individual patient data with CTC count at baseline and CTC count at baseline and after 3-5 weeks, respectively. Models include tumor subtype, the number of previous chemotherapy lines (0/1/≥2), PS, age (<=50/>50-65/>65 years), metastasis-free intervals (0/>0-3/>3 years), metastatic sites (liver and CNS) and CTC count at baseline and eventually at 3-5 weeks of treatment. The C-index increased from 0.722 to 0.755 (increase in C-index:0.033, 95% CI [0.019;0.045]) when adding baseline CTC to the CP only model for OS (n=1501). For those patients with CTC values at 3-5 weeks (n=568), there was an additional increase in the C-index when adding CTC at 3-5 weeks to a model with already CP and baseline CTC from 0.731 to 0.743 (increase in C-index 0.013, 95% CI [-0.004;0.025]). The model with CP and baseline CTC counts showed a good calibration for OS at 1,2,3 years and the model with CP, baseline CTC and CTC count at 3-5 weeks a moderately good calibration. Similar results were obtained for PFS.
Conclusion: From the largest database with individual CTC data, we were able to build PFS and OS survival nomograms, with satisfactory discrimination and calibration. Our planned next step is to validate the nomogram in an additional cohort.
Citation Format: Bidard F-C, Peeters D, Fehm T, Nole F, Gisbert-Criado R, Mavroudis D, Grisanti S, Generali D, Garcia-Saenz JA, Stebbing J, Caldas C, Gazzaniga P, Manso L, Zamarchi R, Fernandez de Lascoiti A, de Mattos-Arruda L, Ignatiadis M, van Laere SJ, Meier-Stiegen F, Sandri M-T, Vidal-Martinez J, Politaki E, Consoli F, Bottini A, Diaz-Rubio E, Krell J, Dawson S-J, Raimondi C, Rutten A, Janni W, Munzone E, Carañana V, Agelaki S, Almici C, Dirix L, Solomayer E, Zorzino L, Reis-Filho JS, Squifflet P, Pantel K, Beije N, Sleijfers S, Pierga J-Y, Michiels S. Circulating tumor cells count-based nomograms to predict survival of metastatic breast cancer patients: Results from the European pooled analysis. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-08-08.
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Affiliation(s)
- F-C Bidard
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - D Peeters
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - T Fehm
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - F Nole
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - R Gisbert-Criado
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - D Mavroudis
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - S Grisanti
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - D Generali
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - JA Garcia-Saenz
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - J Stebbing
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - C Caldas
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - P Gazzaniga
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - L Manso
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - R Zamarchi
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - A Fernandez de Lascoiti
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - L de Mattos-Arruda
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - M Ignatiadis
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - SJ van Laere
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - F Meier-Stiegen
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - M-T Sandri
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - J Vidal-Martinez
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - E Politaki
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - F Consoli
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - A Bottini
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - E Diaz-Rubio
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - J Krell
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - S-J Dawson
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - C Raimondi
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - A Rutten
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - W Janni
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - E Munzone
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - V Carañana
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - S Agelaki
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - C Almici
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - L Dirix
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - E Solomayer
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - L Zorzino
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - JS Reis-Filho
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - P Squifflet
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - K Pantel
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - N Beije
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - S Sleijfers
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - J-Y Pierga
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - S Michiels
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
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Schofield GM, Urch CE, Stebbing J, Giamas G. Reply: When does a human being die? QJM 2016; 109:146. [PMID: 26408572 DOI: 10.1093/qjmed/hcv164] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- G M Schofield
- From the Department of Surgery and Cancer, Imperial College London, London, UK
| | - C E Urch
- From the Department of Surgery and Cancer, Imperial College London, London, UK
| | - J Stebbing
- From the Department of Surgery and Cancer, Imperial College London, London, UK
| | - G Giamas
- From the Department of Surgery and Cancer, Imperial College London, London, UK
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Oskrochi Y, Razi K, Stebbing J, Crane J. Angiosarcoma and Dialysis-related Arteriovenous Fistulae: A Comprehensive Review. Eur J Vasc Endovasc Surg 2016; 51:127-33. [PMID: 26482509 DOI: 10.1016/j.ejvs.2015.08.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/19/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE/BACKGROUND To conduct a comprehensive review of cases, presentation, diagnosis, and management of angiosarcoma in arteriovenous fistulae (AVF) created for haemodialysis. METHODS Two authors independently conducted systematic searches and extraction of articles from the Embase, AMED, Health Management Information Consortium, and MEDLINE databases in keeping with the inclusion/exclusion criteria and Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. RESULTS Twenty-two unique patient cases were identified; 20 of the cases were men and mean ± SD age of presentation was 54.9 ± 13.6 years. Nineteen cases were post-transplant and 18 were on antirejection agents. The most common presenting symptom was pain, with or without a mass. The initial diagnosis was most often thrombosis/infection of the AVF and the diagnostic interval to a correct diagnosis of angiosarcoma was between 2 and 40 weeks. Mean ± SD time to presentation of symptoms from fistula formation was 118.9 ± 57.5 months, while from transplant it was 96.9 ± 70.0 months. Amputation was the most common treatment modality and mean ± SD survival was 8.8 ± 3.7 months. CONCLUSION Angiosarcoma should be suspected in previously quiescent AVF that presents with pain. The presence of a rapidly enlarging mass or bleeding/bruising should be taken as alarm indicators and warrant urgent investigation in accordance with local cancer guidelines. Any surgical procedure should involve histological samples as a matter of course.
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Affiliation(s)
- Y Oskrochi
- West London Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, DuCane Road, London W12 0HS, UK
| | - K Razi
- Department of General Surgery, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear NE29 8NH, UK
| | - J Stebbing
- Department of Cancer Medicine and Oncology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - J Crane
- West London Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, DuCane Road, London W12 0HS, UK.
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Nachiappan S, Askari A, Mamidanna R, Munasinghe A, Currie A, Stebbing J, Faiz O. The impact of adjuvant chemotherapy timing on overall survival following colorectal cancer resection. Eur J Surg Oncol 2015; 41:1636-44. [PMID: 26456792 DOI: 10.1016/j.ejso.2015.09.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/24/2015] [Accepted: 09/03/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Several studies including two meta-analyses have showed that delay between surgery and adjuvant chemotherapy adversely impacts colorectal cancer survival. This study investigated this impact at a population level over a fifteen year period in England. METHODS The Hospital Episode Statistics database was analysed between 1997 and 2012. Colonic cancer and rectal cancer patients were collated and multivariate Cox regression analyses were undertaken to ascertain the relationship between chemotherapy delay and overall survival. RESULTS A total of 181 984 patients underwent resection without any reoperation (106 477 (58.5%) having colonic cancer and 75 507 (41.5%) having rectal cancer). In total, 30 836 (16.9%) received adjuvant chemotherapy. 9019 (49.3%), 4573 (25.0%), 2587 (14.1%), 1323 (7.2%) and 804 (4.4%) of 18 306 colonic cancer patients received within 8 weeks, 8-10 weeks, 10-12 weeks, 12-14 weeks and 14-16 weeks, respectively. Sequentially worse overall survival was observed: <8 weeks: Ref; 8-10 wks: Hazard Ratio (HR) 1.09; 10-12 wks: HR 1.13; 12-14 wks HR 1.32 and 14-16 wks: HR 1.32, p < 0.001. 5625 (44.9%), 3087 (24.6%), 1940 (15.5%), 1162 (9.3%) and 716 (5.7%) of 12 530 rectal cancer patients received within 8 weeks, 8-10 weeks, 10-12 weeks, 12-14 weeks and 14-16 weeks, respectively. Sequentially worse overall survival was observed: <8 weeks: Ref; 8-10 wks: HR 1.09; 10-12 wks: HR 1.22; 12-14 wks HR 1.23 and 14-16 wks: HR 1.31, p < 0.001. CONCLUSION Adjuvant chemotherapy delay adversely impacts colonic and rectal cancer survival. Efforts to prevent complications such as reoperation and to improve access to chemotherapy services, will improve survival in this patient cohort.
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Affiliation(s)
- S Nachiappan
- Surgical Epidemiology, Trials and Outcomes Centre (SETOC), St Mark's Hospital & Academic Institute, Watford Road, Harrow, Middlesex, HA1 3UJ, United Kingdom; Department of Surgery & Cancer, Imperial College London, London SW7 2AZ, United Kingdom.
| | - A Askari
- Surgical Epidemiology, Trials and Outcomes Centre (SETOC), St Mark's Hospital & Academic Institute, Watford Road, Harrow, Middlesex, HA1 3UJ, United Kingdom; Department of Surgery & Cancer, Imperial College London, London SW7 2AZ, United Kingdom
| | - R Mamidanna
- Surgical Epidemiology, Trials and Outcomes Centre (SETOC), St Mark's Hospital & Academic Institute, Watford Road, Harrow, Middlesex, HA1 3UJ, United Kingdom; Department of Surgery & Cancer, Imperial College London, London SW7 2AZ, United Kingdom
| | - A Munasinghe
- Surgical Epidemiology, Trials and Outcomes Centre (SETOC), St Mark's Hospital & Academic Institute, Watford Road, Harrow, Middlesex, HA1 3UJ, United Kingdom; Department of Surgery & Cancer, Imperial College London, London SW7 2AZ, United Kingdom
| | - A Currie
- Surgical Epidemiology, Trials and Outcomes Centre (SETOC), St Mark's Hospital & Academic Institute, Watford Road, Harrow, Middlesex, HA1 3UJ, United Kingdom; Department of Surgery & Cancer, Imperial College London, London SW7 2AZ, United Kingdom
| | - J Stebbing
- Hammersmith Hospital, 150 Du-Cane Road, London W12 0HS, United Kingdom; Department of Surgery & Cancer, Imperial College London, London SW7 2AZ, United Kingdom
| | - O Faiz
- Surgical Epidemiology, Trials and Outcomes Centre (SETOC), St Mark's Hospital & Academic Institute, Watford Road, Harrow, Middlesex, HA1 3UJ, United Kingdom; Department of Surgery & Cancer, Imperial College London, London SW7 2AZ, United Kingdom
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Mapelli P, Aboagye EO, Stebbing J, Sharma R. Epigenetic changes in gastroenteropancreatic neuroendocrine tumours. Oncogene 2015; 34:4439-47. [PMID: 25435371 DOI: 10.1038/onc.2014.379] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 09/25/2014] [Accepted: 10/10/2014] [Indexed: 02/07/2023]
Abstract
An understanding of epigenetic drivers of tumorigenesis has developed rapidly during the last years. The identification of these changes including DNA methylation and histone modifications in gastroenteropancreatic neuroendocrine tumours (GEP-NETs) is a step forward in trying to define underlying biologic processes in this heterogeneous disease. The reversible nature of these changes represents a potential therapeutic target. We present an overview of the current knowledge of epigenetic alterations related to GEP-NETs, focusing on the influence and impact these changes have on pathogenesis and prognosis. The potential role of demethylating agents in the management of this patient population is discussed.
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Affiliation(s)
- P Mapelli
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - E O Aboagye
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - J Stebbing
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - R Sharma
- Department of Experimental Medicine, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK
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Abstract
For most of human history there has been no particular importance of establishing the exact time of a person's death, only whether the person is alive or dead. With modern medical advances, however, more precise answers are looked for. For a definition of death to succeed is important that it is a universal definition and that under it, all human beings are correctly identified as alive or dead. This article initially examines the most commonly proposed positions on when a human being dies those of cardiopulmonary death, whole brain death, brainstem death and higher brain death and for each describes scenarios that provide counter-intuitive results. Intuition is used as a benchmark as this is what our patients most commonly use. The second part of the article seeks to establish a more robust definition of death. We argue that death is an event that takes place at a set point in time, when the collection of bodily processes that maintains homoeostasis finally cease. Based upon defining 'human being' as being in possession of human DNA and Olsen's Animalism, the model is applicable to a full lifespan and maintains personal identity throughout the course of life. That this conclusion will interfere with clinical practice concerning organ transplantation is considered, but countered with the argument that there has been a conflation of the normative question of timing of organ retrieval for transplantation with the metaphysical question of what is death.
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Affiliation(s)
- G M Schofield
- From the Department of Surgery and Cancer, Imperial College London, London, UK
| | - C E Urch
- From the Department of Surgery and Cancer, Imperial College London, London, UK
| | - J Stebbing
- From the Department of Surgery and Cancer, Imperial College London, London, UK
| | - G Giamas
- From the Department of Surgery and Cancer, Imperial College London, London, UK
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36
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Benhaim L, Zhang W, Wakatsuki T, Yang D, Gerger A, Bohanes P, Paez D, Loupakis F, LaBonte MJ, Ning Y, El-Khoueiry R, Ladner R, Wilson P, Zhang H, Giamas G, Stebbing J, Lenz HJ. Genetic variants of kinase suppressors of Ras (KSR1) to predict survival in patients with ERα-positive advanced breast cancer. Pharmacogenomics J 2015; 15:235-40. [PMID: 25287073 DOI: 10.1038/tpj.2014.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 07/29/2014] [Accepted: 08/13/2014] [Indexed: 01/01/2023]
Abstract
In patients with breast cancer (BC), deregulation of estrogen receptor (ERα) activity may account for most resistance to endocrine therapies. Our previous study used a whole-human kinome siRNA screen to identify functional actors in ERα modulation and showed the implication of proteins kinase suppressors of ras (KSR1). From those findings we evaluated the clinical impact of KSR1 variants in patients with ERα+ BC treated with TAM. DNA was obtained from 222 patients with advanced ERα+ BC treated with TAM who had undergone surgery from 1981 to 2003. We selected three potentially functional relevant KSR1 polymorphisms; two within the 3'UTR (rs224190, rs1075952) and one in the coding exon 7 (rs2293180). The primary end points were overall survival (OS) and disease-free survival (DFS). After a 6.4-year median follow-up, patients carrying the rs2241906 TT genotype showed shorter DFS (2.1 vs 7.1 years, P=0.005) and OS (2.6 vs 8.4 years P=0.002) than those with the TC or TT genotypes. Those associations remained significant in the multivariable analysis adjusting age, lymph node status, LMTK3 and IGFR variants and HER2 status. The polymorphisms rs2241906 and rs1075952 were in linkage disequilibrium. No association was shown between rs2293180 and survival. Among the actors of ERα signaling, KSR1 rs2241906 variants may predict survival in patients with advanced ERα+ BC treated with adjuvant TAM.
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Affiliation(s)
- L Benhaim
- 1] University of Southern California Norris Comprehensive Cancer Center, Division of Medical Oncology, Los Angeles, CA, USA [2] UMRS-775 "Bases moléculaires de la réponse aux xénobiotiques", University Paris Descartes, Paris, France
| | - W Zhang
- University of Southern California Norris Comprehensive Cancer Center, Division of Medical Oncology, Los Angeles, CA, USA
| | - T Wakatsuki
- University of Southern California Norris Comprehensive Cancer Center, Division of Medical Oncology, Los Angeles, CA, USA
| | - D Yang
- University of Southern California Norris Comprehensive Cancer Center, Division of Medical Oncology, Los Angeles, CA, USA
| | - A Gerger
- University of Southern California Norris Comprehensive Cancer Center, Division of Medical Oncology, Los Angeles, CA, USA
| | - P Bohanes
- University of Southern California Norris Comprehensive Cancer Center, Division of Medical Oncology, Los Angeles, CA, USA
| | - D Paez
- University of Southern California Norris Comprehensive Cancer Center, Division of Medical Oncology, Los Angeles, CA, USA
| | - F Loupakis
- University of Southern California Norris Comprehensive Cancer Center, Division of Medical Oncology, Los Angeles, CA, USA
| | - M J LaBonte
- University of Southern California Norris Comprehensive Cancer Center, Division of Medical Oncology, Los Angeles, CA, USA
| | - Y Ning
- University of Southern California Norris Comprehensive Cancer Center, Division of Medical Oncology, Los Angeles, CA, USA
| | - R El-Khoueiry
- University of Southern California Norris Comprehensive Cancer Center, Division of Medical Oncology, Los Angeles, CA, USA
| | - R Ladner
- University of Southern California Norris Comprehensive Cancer Center, Division of Medical Oncology, Los Angeles, CA, USA
| | - P Wilson
- University of Southern California Norris Comprehensive Cancer Center, Division of Medical Oncology, Los Angeles, CA, USA
| | - H Zhang
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - G Giamas
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - J Stebbing
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - H J Lenz
- University of Southern California Norris Comprehensive Cancer Center, Division of Medical Oncology, Los Angeles, CA, USA
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Roca-Alonso L, Castellano L, Mills A, Dabrowska AF, Sikkel MB, Pellegrino L, Jacob J, Frampton AE, Krell J, Coombes RC, Harding SE, Lyon AR, Stebbing J. Myocardial MiR-30 downregulation triggered by doxorubicin drives alterations in β-adrenergic signaling and enhances apoptosis. Cell Death Dis 2015; 6:e1754. [PMID: 25950484 PMCID: PMC4669718 DOI: 10.1038/cddis.2015.89] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 12/14/2014] [Accepted: 01/12/2015] [Indexed: 12/22/2022]
Abstract
The use of anthracyclines such as doxorubicin (DOX) has improved outcome in cancer patients, yet associated risks of cardiomyopathy have limited their clinical application. DOX-associated cardiotoxicity is frequently irreversible and typically progresses to heart failure (HF) but our understanding of molecular mechanisms underlying this and essential for development of cardioprotective strategies remains largely obscure. As microRNAs (miRNAs) have been shown to play potent regulatory roles in both cardiovascular disease and cancer, we investigated miRNA changes in DOX-induced HF and the alteration of cellular processes downstream. Myocardial miRNA profiling was performed after DOX-induced injury, either via acute application to isolated cardiomyocytes or via chronic exposure in vivo, and compared with miRNA profiles from remodeled hearts following myocardial infarction. The miR-30 family was downregulated in all three models. We describe here that miR-30 act regulating the β-adrenergic pathway, where preferential β1- and β2-adrenoceptor (β1AR and β2AR) direct inhibition is combined with Giα-2 targeting for fine-tuning. Importantly, we show that miR-30 also target the pro-apoptotic gene BNIP3L/NIX. In aggregate, we demonstrate that high miR-30 levels are protective against DOX toxicity and correlate this in turn with lower reactive oxygen species generation. In addition, we identify GATA-6 as a mediator of DOX-associated reductions in miR-30 expression. In conclusion, we describe that DOX causes acute and sustained miR-30 downregulation in cardiomyocytes via GATA-6. miR-30 overexpression protects cardiac cells from DOX-induced apoptosis, and its maintenance represents a potential cardioprotective and anti-tumorigenic strategy for anthracyclines.
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Affiliation(s)
- L Roca-Alonso
- Division of Oncology, Department of Surgery and Cancer, 1st Floor, Imperial Centre for Translational and Experimental Medicine (ICTEM), Imperial College, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| | - L Castellano
- Division of Oncology, Department of Surgery and Cancer, 1st Floor, Imperial Centre for Translational and Experimental Medicine (ICTEM), Imperial College, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| | - A Mills
- National Heart and Lung Institute, Imperial College, 4th Floor, ICTEM, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| | - A F Dabrowska
- Division of Oncology, Department of Surgery and Cancer, 1st Floor, Imperial Centre for Translational and Experimental Medicine (ICTEM), Imperial College, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| | - M B Sikkel
- National Heart and Lung Institute, Imperial College, 4th Floor, ICTEM, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| | - L Pellegrino
- Division of Oncology, Department of Surgery and Cancer, 1st Floor, Imperial Centre for Translational and Experimental Medicine (ICTEM), Imperial College, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| | - J Jacob
- Division of Oncology, Department of Surgery and Cancer, 1st Floor, Imperial Centre for Translational and Experimental Medicine (ICTEM), Imperial College, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| | - A E Frampton
- Division of Oncology, Department of Surgery and Cancer, 1st Floor, Imperial Centre for Translational and Experimental Medicine (ICTEM), Imperial College, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
- Hepato-Pancreato-Biliary Surgical Unit, Department of Surgery and Cancer, Imperial College, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| | - J Krell
- Division of Oncology, Department of Surgery and Cancer, 1st Floor, Imperial Centre for Translational and Experimental Medicine (ICTEM), Imperial College, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| | - R C Coombes
- Division of Oncology, Department of Surgery and Cancer, 1st Floor, Imperial Centre for Translational and Experimental Medicine (ICTEM), Imperial College, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| | - S E Harding
- National Heart and Lung Institute, Imperial College, 4th Floor, ICTEM, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| | - A R Lyon
- National Heart and Lung Institute, Imperial College, 4th Floor, ICTEM, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Imperial college, London SW3 6NP, UK
| | - J Stebbing
- Division of Oncology, Department of Surgery and Cancer, 1st Floor, Imperial Centre for Translational and Experimental Medicine (ICTEM), Imperial College, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
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38
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Stebbing J, Zhang H, Xu Y, Lit LC, Green AR, Grothey A, Lombardo Y, Periyasamy M, Blighe K, Zhang W, Shaw JA, Ellis IO, Lenz HJ, Giamas G. KSR1 regulates BRCA1 degradation and inhibits breast cancer growth. Oncogene 2015; 34:2103-14. [PMID: 24909178 DOI: 10.1038/onc.2014.129] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 04/02/2014] [Accepted: 04/12/2014] [Indexed: 12/16/2022]
Abstract
Kinase suppressor of Ras-1 (KSR1) facilitates signal transduction in Ras-dependent cancers, including pancreatic and lung carcinomas but its role in breast cancer has not been well studied. Here, we demonstrate for the first time it functions as a tumor suppressor in breast cancer in contrast to data in other tumors. Breast cancer patients (n>1000) with high KSR1 showed better disease-free and overall survival, results also supported by Oncomine analyses, microarray data (n=2878) and genomic data from paired tumor and cell-free DNA samples revealing loss of heterozygosity. KSR1 expression is associated with high breast cancer 1, early onset (BRCA1), high BRCA1-associated ring domain 1 (BARD1) and checkpoint kinase 1 (Chk1) levels. Phospho-profiling of major components of the canonical Ras-RAF-mitogen-activated protein kinases pathway showed no significant changes after KSR1 overexpression or silencing. Moreover, KSR1 stably transfected cells formed fewer and smaller size colonies compared to the parental ones, while in vivo mouse model also demonstrated that the growth of xenograft tumors overexpressing KSR1 was inhibited. The tumor suppressive action of KSR1 is BRCA1 dependent shown by 3D-matrigel and soft agar assays. KSR1 stabilizes BRCA1 protein levels by reducing BRCA1 ubiquitination through increasing BARD1 abundance. These data link these proteins in a continuum with clinical relevance and position KSR1 in the major oncoprotein pathways in breast tumorigenesis.
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Affiliation(s)
- J Stebbing
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Imperial College Centre for Translational and Experimental Medicine, Hammersmith Hospital Campus, London, UK
| | - H Zhang
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Imperial College Centre for Translational and Experimental Medicine, Hammersmith Hospital Campus, London, UK
| | - Y Xu
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Imperial College Centre for Translational and Experimental Medicine, Hammersmith Hospital Campus, London, UK
| | - L C Lit
- 1] Division of Cancer, Department of Surgery and Cancer, Imperial College London, Imperial College Centre for Translational and Experimental Medicine, Hammersmith Hospital Campus, London, UK [2] Faculty of Medicine, Department of Physiology, University of Malaya, Kuala, Lumpur, Malaysia
| | - A R Green
- Department of Cellular Pathology, Queen's Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - A Grothey
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Imperial College Centre for Translational and Experimental Medicine, Hammersmith Hospital Campus, London, UK
| | - Y Lombardo
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Imperial College Centre for Translational and Experimental Medicine, Hammersmith Hospital Campus, London, UK
| | - M Periyasamy
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Imperial College Centre for Translational and Experimental Medicine, Hammersmith Hospital Campus, London, UK
| | - K Blighe
- Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, UK
| | - W Zhang
- Division of Medical Oncology, University of Southern California, Norris Comprehensive Cancer Centre, Keck School of Medicine, Los Angeles, CA, USA
| | - J A Shaw
- Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, UK
| | - I O Ellis
- Faculty of Medicine, Department of Physiology, University of Malaya, Kuala, Lumpur, Malaysia
| | - H J Lenz
- Division of Medical Oncology, University of Southern California, Norris Comprehensive Cancer Centre, Keck School of Medicine, Los Angeles, CA, USA
| | - G Giamas
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Imperial College Centre for Translational and Experimental Medicine, Hammersmith Hospital Campus, London, UK
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Mudan S, Giakoustidis A, Morrison D, Iosifidou S, Raobaikady R, Neofytou K, Stebbing J. 1000 Port-A-Cath ® placements by subclavian vein approach: single surgeon experience. World J Surg 2015; 39:328-34. [PMID: 25245435 DOI: 10.1007/s00268-014-2802-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Totally implantable venous access ports are widely used for the administration of chemotherapy in patients with cancer. Although there are several approaches to implantation, here we describe Port-A-Cath(®) (PAC) placement by percutaneous puncture of the subclavian vein with ultrasonographic guidance. PATIENTS AND METHODS Data on our vascular access service were collected prospectively from June 2004. This service included port-a-caths and Hickman lines. Once 1000 consecutive port-a-caths(®) had been reached the study was closed and data analysed for the port-a-caths(®) alone. The left subclavian vein was the preferred site for venous access, with the right subclavian and jugular veins being the alternative choices if the initial approach failed. Patients were followed up in the short-term, and all the procedures were carried out by a single surgeon at each one of two institutions. RESULTS Venous access by PAC was established in 100 % of the 1,000 cases. Of the 952 patients where the left subclavian vein was chosen for the first attempt of puncture, the success rate of PAC placement was 95 % (n = 904). Pneumothorax occurred in 12 patients (1.2 %), and a wound haematoma occurred in 4 (0.4 %) out of the total 1,000 patients. No infections were recorded during the immediate post-operative period but only in the long-term post-operative use with 8 patients requiring removal of the PAC due to infection following administration of chemotherapy. CONCLUSION This is a very large series of PAC placement with an ultrasound-guided approach for left subclavian vein and X-ray confirmation, performed by a single surgeon, demonstrating both the safety and effectiveness of the procedure.
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Affiliation(s)
- S Mudan
- Department of Academic Surgery, The Royal Marsden NHS Trust, Fulham Road, London, SW3 6JJ, UK
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Pinato DJ, Karamanakos G, Arizumi T, Adjogatse D, Kim YW, Stebbing J, Kudo M, Jang JW, Sharma R. Dynamic changes of the inflammation-based index predict mortality following chemoembolisation for hepatocellular carcinoma: a prospective study. Aliment Pharmacol Ther 2014; 40:1270-81. [PMID: 25327965 DOI: 10.1111/apt.12992] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 08/27/2014] [Accepted: 09/28/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Transarterial chemoembolisation (TACE) is a standard treatment for unresectable, intermediate stage hepatocellular carcinoma (HCC). Survival after TACE, however, can be highly variable, with no suitable biomarker predicting therapeutic outcome. The inflammation-based index (IBI) has previously been shown to independently predict overall survival (OS) in all stages of HCC. AIM To explore the prognostic ability of IBI as a predictor of survival after TACE. METHODS Baseline staging, biochemical and clinicopathological features including IBI were studied in a derivation set of 64 patients undergoing TACE for intermediate stage HCC. Dynamic changes in IBI before and after TACE were studied as predictors of survival using both a univariate and multivariate Cox regression model and further validated in two independent patient cohorts from Korea (n = 76) and Japan (n = 577). RESULTS Pre-treatment IBI predicted for OS in the derivation set (P = 0.001). Other univariate predictors of OS included radiological response to TACE (P < 0.001), pre-TACE CLIP score (P < 0.01), tumour diameter >5 cm (P = 0.05) and AFP ≥400 (P < 0.001). Normalisation of IBI post-TACE was associated with radiological response by mRECIST criteria and improved OS (P < 0.001). Normalisation of IBI remained a significant multivariate predictor of OS in both the derivation and validation sets (P < 0.001). CONCLUSIONS Normalisation of IBI after TACE is shown to be an independent predictor of survival and may be integrated into the retreatment criteria for repeat TACE in intermediate stage HCC. IBI and its dynamic changes after treatment are validated as a biomarker allowing the stratification of patients with a significant survival advantage following initial TACE.
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Affiliation(s)
- D J Pinato
- Division of Experimental Medicine, Imperial College London, Hammersmith Hospital, London, UK
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Sagoo MS, Harbour JW, Stebbing J, Bowcock AM. Combined PKC and MEK inhibition for treating metastatic uveal melanoma. Oncogene 2014; 33:4722-3. [PMID: 24413085 PMCID: PMC4356624 DOI: 10.1038/onc.2013.555] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 11/15/2013] [Indexed: 12/11/2022]
Abstract
Uveal melanoma (UM) is the most common primary intraocular malignancy and the second most common form of melanoma. UM has a strong tendency for metastatic disease, and no effective treatments have yet been identified. Activating oncogenic mutations are commonly found in GNAQ and GNA11 in UM, and inhibiting key downstream effectors of the GNAQ/11 signaling pathway represents a rational therapeutic approach for treating metastatic UM. Chen et al., doi:10.1038/onc.2013.418, now confirm activation of the MAPK and PKC pathways as a result of GNAQ and GNA11 activating mutations in melanocytes, and they demonstrate that MAPK activation occurs downstream of PKC activation. PKC inhibitors disrupt MAPK signaling and block proliferation of GNAQ/11 mutant UM cell lines and slow the in vivo growth of xenografted UM tumors without inducing their shrinkage. However, a combination of PKC and MEK inhibition led to sustained MAPK pathway inhibition and tumor regression in vivo. Hence, the authors concluded that MEK and PKC inhibition is synergistic, with superior efficacy to treatment of GNAQ/GNA11 mutant UMs with either drug alone.
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Affiliation(s)
- MS Sagoo
- Ocular Oncology Service, Moorfields Eye Hospital and St Bartholomew’s Hospital and UCL Institute of Ophthalmology, London, UK
| | - JW Harbour
- Ocular Oncology Service, Bascom Palmer Eye Institute & Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - J Stebbing
- Department of Oncology, Imperial College, Hammersmith Campus, London, UK
| | - AM Bowcock
- National Heart and Lung Institute (NHLI), Imperial College of Science and Technology, London, UK
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Stebbing J, Zacharoulis S, Gaya A, McGuire W, Harris W, Maki R, Hidalgo M, Davies A, Vasquez-Dunddel D, Ciznadija D, Katz A, Sidransky D, Paz K. Patient-Derived Xenografts Accurately Capture Clinical Responses to Treatment. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu358.4] [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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Miller H, Castellano L, Frampton A, Stronach E, Flora R, Stebbing J, Frilling A. Role of Microrna As Biomarkers in Small Bowel Neuroendocrine Tumours. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu345.27] [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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Annels NE, Simpson GR, Denyer M, McGrath SE, Falgari G, Killick E, Eeles R, Stebbing J, Pchejetski D, Cutress R, Murray N, Michael A, Pandha H. Spontaneous antibodies against Engrailed-2 (EN2) protein in patients with prostate cancer. Clin Exp Immunol 2014; 177:428-38. [PMID: 24654775 PMCID: PMC4226594 DOI: 10.1111/cei.12332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2014] [Indexed: 11/27/2022] Open
Abstract
We reported the expression of the homeodomain-containing transcription factor Engrailed-2 (EN2) in prostate cancer and showed that the presence of EN2 protein in the urine was highly predictive of prostate cancer. This study aimed to determine whether patients with prostate cancer have EN2 autoantibodies, what the prevalence of these antibodies is and whether they are associated with disease stage. The spontaneous immunoglobulin (Ig)G immune response against EN2 and for comparison the tumour antigen New York Esophageal Squamous Cell Carcinoma 1 (NY-ESO-1), were tested by enzyme-linked immunosorbent assay (ELISA) in three different cohorts of prostate cancer patients as well as a group of men genetically predisposed to prostate cancer. Thirty-two of 353 (9·1%) of the SUN cohort representing all stages of prostate cancer demonstrated EN2 IgG responses, 12 of 107 patients (11·2%) in the advanced prostate cancer patients showed responses, while only four of 121 patients (3·3%) with castrate-resistant prostate cancer showed EN2 autoantibodies. No significant responses were found in the predisposed group. Anti-EN2 IgG responses were significantly higher in patients with prostate cancer compared to healthy control males and similarly prevalent to anti-NY-ESO-1 responses. While EN2 autoantibodies are not a useful diagnostic or monitoring tool, EN2 immunogenicity provides the rationale to pursue studies using EN2 as an immunotherapeutic target.
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Affiliation(s)
- N E Annels
- Oncology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
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Roca-Alonso L, Castellano L, Mills A, Harding S, Lyon AR, Stebbing J. P65Myocardial miR-30 down-regulation caused by doxorubicin alters the beta-adrenergic system and mitochondrial death pathways. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu082.9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Pinato DJ, Shiner RJ, Seckl MJ, Stebbing J, Sharma R, Mauri FA. Prognostic performance of inflammation-based prognostic indices in primary operable non-small cell lung cancer. Br J Cancer 2014; 110:1930-5. [PMID: 24667648 PMCID: PMC3992503 DOI: 10.1038/bjc.2014.145] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/11/2014] [Accepted: 02/24/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND At least 30% of patients with primary resectable non-small cell lung cancer (NSCLC) will experience a relapse in their disease within 5 years following definitive treatment. Clinicopathological predictors have proved to be suboptimal in identifying high-risk patients. We aimed to establish whether inflammation-based scores offer an improved prognostic ability in terms of estimating overall (OS) and recurrence-free survival (RFS) in a cohort of operable, early-stage NSCLC patients. METHODS Clinicopathological, demographic and treatment data were collected prospectively for 220 patients operated for primary NSCLC at the Hammersmith Hospital from 2004 to 2011. Pretreatment modified Glasgow Prognostic Score (mGPS), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were tested together with established prognostic factors in uni- and multivariate Cox regression analyses of OS and RFS. RESULTS Half of the patients were male, with a median age of 65. A total of 57% were classified as stage I with adenocarcinoma being the most prevalent subtype (60%). Univariate analyses of survival revealed stage (P<0.001), grade (P=0.02), lymphovascular (LVI, P=0.001), visceral pleural invasion (VPI, P=0.003), mGPS (P=0.02) and NLR (P=0.04) as predictors of OS, with stage (P<0.001), VPI (P=0.02) and NLR (P=0.002) being confirmed as independent prognostic factors on multivariate analyses. Patients with more advanced stage (P<0.001) and LVI (P=0.008) had significantly shorter RFS. CONCLUSIONS An elevated NLR identifies operable NSCLC patients with a poor prognostic outlook and an OS difference of almost 2 years compared to those with a normal score at diagnosis. Our study validates the clinical utility of the NLR in early-stage NSCLC.
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Affiliation(s)
- D J Pinato
- Division of Experimental Medicine, Hammersmith Campus of Imperial College London, Du Cane Road, W120HS London, UK
| | - R J Shiner
- Department of Respiratory Medicine, National Heart and Lung Institute, Hammersmith Hospital, Du Cane Road, W120HS London, UK
| | - M J Seckl
- Division of Oncology, Hammersmith Campus of Imperial College London, Du Cane Road, W120HS London, UK
| | - J Stebbing
- Division of Oncology, Hammersmith Campus of Imperial College London, Du Cane Road, W120HS London, UK
| | - R Sharma
- Division of Experimental Medicine, Hammersmith Campus of Imperial College London, Du Cane Road, W120HS London, UK
| | - F A Mauri
- Department of Pathology, Hammersmith Campus of Imperial College London, Du Cane Road, W120HS London, UK
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Stebbing J, Lit LC, Zhang H, Darrington RS, Melaiu O, Rudraraju B, Giamas G. The regulatory roles of phosphatases in cancer. Oncogene 2014; 33:939-53. [PMID: 23503460 DOI: 10.1038/onc.2013.80] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 02/01/2013] [Indexed: 02/06/2023]
Abstract
The relevance of potentially reversible post-translational modifications required for controlling cellular processes in cancer is one of the most thriving arenas of cellular and molecular biology. Any alteration in the balanced equilibrium between kinases and phosphatases may result in development and progression of various diseases, including different types of cancer, though phosphatases are relatively under-studied. Loss of phosphatases such as PTEN (phosphatase and tensin homologue deleted on chromosome 10), a known tumour suppressor, across tumour types lends credence to the development of phosphatidylinositol 3-kinase inhibitors alongside the use of phosphatase expression as a biomarker, though phase 3 trial data are lacking. In this review, we give an updated report on phosphatase dysregulation linked to organ-specific malignancies.
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Affiliation(s)
- J Stebbing
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK
| | - L C Lit
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK
| | - H Zhang
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK
| | - R S Darrington
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK
| | - O Melaiu
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK
| | - B Rudraraju
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK
| | - G Giamas
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK
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Winder T, Giamas G, Wilson PM, Zhang W, Yang D, Bohanes P, Ning Y, Gerger A, Stebbing J, Lenz HJ. Insulin-like growth factor receptor polymorphism defines clinical outcome in estrogen receptor-positive breast cancer patients treated with tamoxifen. Pharmacogenomics J 2014; 14:28-34. [PMID: 23459444 DOI: 10.1038/tpj.2013.8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 01/10/2013] [Accepted: 02/04/2013] [Indexed: 02/07/2023]
Abstract
Compelling evidence points to a key role for insulin-like growth factor 1 (IGF1) signaling in breast cancer development and progression. In addition, IGF1 receptor (IGF1R) expression has been correlated and functionally linked with estrogen receptor (ER) signaling. Recent translational studies support a cross talk between IGF1R and ERα at different levels and data suggest enhanced IGF1R signaling as a causative mechanism of tamoxifen (TAM) resistance. We tested whether functional germline variations in the IGF pathway are associated with clinical outcome in ER-positive primary invasive breast cancer patients, who were treated with surgery and adjuvant TAM. Tissue samples of 222 patients with ER+ primary invasive breast cancer, who had undergone surgery at Charing Cross Hospital, London, UK between 1981 and 2003, were analyzed. Genomic DNA was extracted from formalin-fixed, paraffin-embedded tissue samples and six functional IGF1 pathway polymorphisms were analyzed using direct DNA sequencing and PCR-restriction fragment length polymorphism. In multivariable analysis, patients with primary invasive breast cancer carrying IGF1R_rs2016347 G allele had a significantly increased risk of early tumor progression (hazard ratio (HR) 2.01; adjusted P=0.004) and death (HR 1.84; adjusted P=0.023) compared with patients carrying G/T or T/T, independent of established clinicopathological determinants. This association remained significant after adjusting for multiple testing. In addition, we were able to demonstrate that IRS1_rs1801123 and IGFBP3_rs2854744 were significantly associated with lymph node involvement and tumor size, respectively. We provide the first evidence for IGF1R_rs2016347 as an independent prognostic marker for ER+ breast cancer patients treated with TAM and support a rational for combined treatment strategies.
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Affiliation(s)
- T Winder
- Division of Medical Oncology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
| | - G Giamas
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - P M Wilson
- 1] Department of Pathology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA [2] Department of Biochemistry and Molecular Biology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
| | - W Zhang
- Division of Medical Oncology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
| | - D Yang
- Department of Preventive Medicine and Molecular Biology University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
| | - P Bohanes
- Division of Medical Oncology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
| | - Y Ning
- Division of Medical Oncology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
| | - A Gerger
- Division of Medical Oncology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
| | - J Stebbing
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - H-J Lenz
- 1] Division of Medical Oncology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA [2] Department of Preventive Medicine and Molecular Biology University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
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Affiliation(s)
- A Januszewski
- Division of Surgery and Cancer, Imperial College London, ICTEM Building, London W12 0NN, UK
| | - N Tanna
- Division of Surgery and Cancer, Imperial College London, ICTEM Building, London W12 0NN, UK
| | - J Stebbing
- Division of Surgery and Cancer, Imperial College London, ICTEM Building, London W12 0NN, UK
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Bidard FC, Peeters D, Fehm T, Nole F, Gisbert-Criado R, Mavrudis D, Grisanti S, Generali D, Garcia-Saenz JA, Stebbing J, Caldas C, Gazzaniga P, Manso L, Zamarchi R, Antelo ML, de Mattos-Arruda L, Ignatiadis M, Lebofsky R, van Laere SJ, Meier-Stiegen F, Sandri MT, Vidal-Martinez J, Politaki E, Consoli F, Bottini A, Diaz-Rubio E, Krell J, Dawson SJ, Raimondi C, Rutten A, Janni W, Munzone E, Caranana V, Agelaki S, Almici C, Dirix L, Solomayer E, Zorzino L, Johannes H, Reis-Filho J, Pantel K, Pierga JY, Michiels S. Abstract PD6-5: Pooled analysis of circulating tumor cells in metastatic breast cancer: Findings from 1944 individual patients data. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-pd6-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Clinical validity of CTCs (CellSearch®) in metastatic breast cancer (MBC) patients has previously been assessed in studies with limited statistical power. We aimed to pool all European studies to obtain high-level evidence on the prognostic value of CTCs, to investigate their effects across different clinico-pathological characteristics and therapies and to further validate the MD Anderson/Institut Curie/Fox Chase CTC-based prognostic nomogram established in first-line treated MBC patients (Giordano et al, Clin Cancer Res 2013).
Material and methods: Methods were predefined in a written protocol. In December 2012, we searched for eligible studies that accrued patients in 2003-2012. We contacted all European laboratories using CellSearch®. We used likelihood ratio tests (LR) in Cox regression models stratified by study to assess the independent prognostic value of CTC when added to a clinicopathological (CP) model for progression-free (PFS) and overall survival (OS). Landmark analyses were used to assess the prognostic effect of early changes in CTC. The CTC-based nomogram (http://cancernomograms.com/CTCOnline.html) score was retrieved for every patient; we calculated C-indices, drew calibration plots and Kaplan-Meier curves according to quintiles of the nomogram score.
Results: We collected individual data of 1944 MBC patients, from 20 different studies (some unpublished), from 17 centers in 7 European countries. We observed 1507 PFS events and 929 deaths. Baseline CTC count was significantly associated with several patient characteristics, such as performance status (PS, p<10-4), synchronous metastasis (p<10- 2) tumor subtype (p<10-4), liver & bone metastases (p<10-4), CEA & CA15-3 levels (p<10-4). The CP model for OS included PS, MBC subtypes, number of previous lines of treatment, patient's age, metastasis-free interval, metastatic sites (p<0.01 for all). In a multivariate analysis containing the CP model parameters and CTC count at baseline, elevated CTC count (≥5) was a significant independent predictor of OS (n = 1444, HR = 2.7, 95%CI [2.2-3.2], LR p<10-4). Baseline serum markers added either no or marginal effect to the CP plus baseline CTC model for OS. In contrast, early changes in CTC status at week 3-5 significantly added prognostic information for OS to the model with CP factors and baseline CTC+ (n = 569, HR = 1.8 [2.2-3.2], LR p<0.001). In the population of interest (MBC treated by first line chemotherapy, n = 402 patients, 176 deaths), the CTC-based nomogram exhibited a good C-index for OS (0.69), was well calibrated and showed clear separation of the survival curves. Additional results, including subgroup analyses by tumor subtype and treatments will be presented at the meeting.
Conclusions: This pooled analysis is the largest study ever reported on CTC in MBC, with a previously unreached statistical power. It provides a clear level-of-evidence 1 on the independent prognostic value of CTCs before and during treatment in MBC. Also, the CTC-based prognostic nomogram is independently validated.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr PD6-5.
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Affiliation(s)
- F-C Bidard
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - D Peeters
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - T Fehm
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - F Nole
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - R Gisbert-Criado
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - D Mavrudis
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - S Grisanti
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - D Generali
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - JA Garcia-Saenz
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - J Stebbing
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - C Caldas
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - P Gazzaniga
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - L Manso
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - R Zamarchi
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - M-L Antelo
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - L de Mattos-Arruda
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - M Ignatiadis
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - R Lebofsky
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - SJ van Laere
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - F Meier-Stiegen
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - M-T Sandri
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - J Vidal-Martinez
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - E Politaki
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - F Consoli
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - A Bottini
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - E Diaz-Rubio
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - J Krell
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - S-J Dawson
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - C Raimondi
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - A Rutten
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - W Janni
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - E Munzone
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - V Caranana
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - S Agelaki
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - C Almici
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - L Dirix
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - E Solomayer
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - L Zorzino
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - H Johannes
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - J Reis-Filho
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - K Pantel
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - J-Y Pierga
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - S Michiels
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
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