1
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Rubio-Viqueira B, Tarruella MM, Lázaro M, Estévez SV, Córdoba-Ortega JF, Maiques IM, González JG, Cordellat AB, Valdivia-Bautista J, Arenas CG, Sánchez Torres JM. PD-L1 testing and clinical management of newly diagnosed metastatic non-small cell lung cancer in Spain: MOREL study. Lung Cancer Manag 2021; 10:LMT53. [PMID: 34899993 PMCID: PMC8656292 DOI: 10.2217/lmt-2021-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/04/2021] [Indexed: 11/21/2022] Open
Abstract
Aim To describe the clinical management and PD-L1 testing of patients with newly diagnosed stage IV non-small cell lung cancer (NSCLC) without driver mutations in Spain. Methods Multicenter, retrospective study. Results Among 297 evaluated patients, 89.2% received systemic treatment for stage IV disease, of whom 53.6% received platinum doublet therapy, 26.8% immunotherapy as monotherapy and 14.7% immunotherapy + chemotherapy, with 9.4% receiving treatment as part of a clinical trial. Treatment was initiated 1 month after histological diagnosis, with PD-L1 test results available in most cases (92.6%). PD-L1 testing was performed in 287 patients, 95.1% by in-house tests, mostly with the 22C3 pharmDx assay. The factor most strongly associated with treatment selection was, as expected, the expression of PD-L1. Conclusion PD-L1 testing is implemented in clinical practice and seems to guide treatment decisions in patients with NSCLC in Spain.
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Affiliation(s)
- Belen Rubio-Viqueira
- Department of Medical Oncology, Quirónsalud Madrid Hospital, Pozuelo de Alarcón, Madrid, Spain
| | | | - Martín Lázaro
- Department of Medical Oncology, Álvaro Cunqueiro University Hospital, Vigo, Pontevedra, 36213, Spain
| | | | | | | | - Jorge García González
- Department of Medical Oncology, University Clinical Hospital of Santiago de Compostela, A Coruña, 15706, Spain
| | - Ana Blasco Cordellat
- Department of Medical Oncology, Hospital General Universitario de Valencia, CIBERONC, Valencia, 46014, Spain
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2
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Provencio M, Terrasa J, Garrido P, Campelo RG, Aparisi F, Diz P, Aguiar D, García-Giron C, Hidalgo J, Aguado C, González JG, Esteban E, Gómez-Aldavarí L, Moran T, Juan O, Chara LE, Marti JL, Castro RL, Ortega AL, Moreno EM, Coves J, Sánchez Peña AM, Bosch-Barrera J, Gastaldo AS, Núñez NF, Del Barco E, Cobo M, Isla D, Majem M, Navarro F, Calvo V. Osimertinib in advanced EGFR-T790M mutation-positive non-small cell lung cancer patients treated within the Special Use Medication Program in Spain: OSIREX-Spanish Lung Cancer Group. BMC Cancer 2021; 21:230. [PMID: 33676426 PMCID: PMC7937205 DOI: 10.1186/s12885-021-07922-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 02/17/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AURA study reported 61% objective response rate and progression-free survival of 9.6 months with osimertinib in patients with EGFR/T790M+ non-small cell lung cancer. Due to lack of real-world data, we proposed this study to describe the experience with osimertinib in Spain. METHODS Post-authorization, non-interventional Special Use Medication Program, multicenter, retrospective study in advanced EGFR/T790M+ non-small cell lung cancer. One hundred-fifty five patients were enrolled (August 2016-December 2018) from 30 sites. PRIMARY OBJECTIVE progression-free survival. Secondary objectives: toxicity profile, objective response rate, and use of health service resources. RESULTS 70% women, median age 66. 63.9% were non-smokers and 99% had adenocarcinoma. Most patients had received at least one prior treatment (97%), 91.7% had received previous EGFR-tyrosine kinase inhibitors and 2.8% osimertinib as first-line treatment. At data cutoff, median follow-up was 11.8 months. One hundred-fifty five patients were evaluable for response, 1.3% complete response, 40.6% partial response, 31% stable disease and 11.6% disease progression. Objective response rate was 42%. Median progression-free survival was 9.4 months. Of the 155 patients who received treatment, 76 (49%) did not reported any adverse event, 51% presented some adverse event, most of which were grade 1 or 2. The resource cost study indicates early use is warranted. CONCLUSION This study to assess the real-world clinical impact of osimertinib showed high drug activity in pretreated advanced EGFR/T790M+ non-small cell lung cancer, with manageable adverse events. TRIAL REGISTRATION Clinical trial registration number: NCT03790397 .
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Affiliation(s)
- Mariano Provencio
- Medical Oncology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain. .,Health Research Institute, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain. .,Universidad Autónoma de Madrid, Madrid, Spain.
| | - Josefa Terrasa
- Medical Oncology Department, Hospital Universitari Son Espases, Islas Balears, Palma de Mallorca, Spain
| | - Pilar Garrido
- Medical Oncology Department, IRYCIS Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Rosario García Campelo
- Medical Oncology Department, Hospital Universitario A Coruña, A Coruña, Spain.,Instituto de Investigación Biomédica A Coruña INIBIC, A Coruña, Spain
| | - Francisco Aparisi
- Medical Oncology Department Valencia, Hospital General Universitario de Valencia, Madrid, Spain
| | - Pilar Diz
- Medical Oncology Department León, Complejo Asistencial Universitario de León, Madrid, Spain
| | - David Aguiar
- Medical Oncology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de GC, Spain
| | - Carlos García-Giron
- Medical Oncology Department, Hospital Universitario De Burgos, Burgos, Spain
| | - Julia Hidalgo
- Medical Oncology Department, Hospital Lluís Alcanyis, Xátiva, Valencia, Spain
| | - Carlos Aguado
- Medical Oncology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Jorge García González
- Medical Oncology Department Santiago de Compostela, Hospital Clínico Universitario de Santiago, Madrid, Spain
| | - Emilio Esteban
- Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Lorenzo Gómez-Aldavarí
- Medical Oncology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Teresa Moran
- Institut Català d'Oncologia Badalona, Medical Oncology Department, Badalona, Barcelona, Spain.,Hospital Universitari Germans Trias i Pujol, Barcelona, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Badalona Applied Research Group in Oncology, Barcelona, Spain.,Fundació Germans Trias i Pujol, Barcelona, Spain
| | - Oscar Juan
- Medical Oncology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Luís Enrique Chara
- Medical Oncology Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Juan L Marti
- Medical Oncology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Rafael López Castro
- Medical Oncology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ana Laura Ortega
- Medical Oncology Department, Complejo Hospitalario de Jaen, Jaen, Spain
| | | | - Juan Coves
- Medical Oncology Department, Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - Ana M Sánchez Peña
- Medical Oncology Department, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Joaquim Bosch-Barrera
- Department of Oncology, Catalan Institute of Oncology. Dr. Josep Trueta University Hospital, Girona, Spain
| | | | | | - Edel Del Barco
- Medical Oncology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Manuel Cobo
- Hospitales Universitarios Regional y Virgen de la Victoria, IBIMA, Unidad de Gestión Clínica Intercentros de Oncología Médica, Málaga, Spain
| | - Dolores Isla
- Medical Oncology Department, Hospital Universitario Lozano Blesa, Zaragoza, Aragón, Spain
| | - Margarita Majem
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Fátima Navarro
- Medical Oncology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Virginia Calvo
- Medical Oncology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain. .,Health Research Institute, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
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3
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Pereira-Veiga T, González-Conde M, León-Mateos L, Piñeiro-Cid R, Abuín C, Muinelo-Romay L, Martínez-Fernández M, Brea Iglesias J, García González J, Anido U, Aguín-Losada S, Cebey V, Costa C, López-López R. Longitudinal CTCs gene expression analysis on metastatic castration-resistant prostate cancer patients treated with docetaxel reveals new potential prognosis markers. Clin Exp Metastasis 2021; 38:239-251. [PMID: 33635497 PMCID: PMC7987626 DOI: 10.1007/s10585-021-10075-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/27/2021] [Indexed: 12/16/2022]
Abstract
CTCs have extensively been used for the monitoring and characterization of metastatic prostate cancer, but their application in the clinic is still very scarce. Besides, the resistance mechanisms linked to prostate cancer treatment remain unclear. Liquid biopsies represent the most promising alternative due to the complexity of biopsying bone metastasis and the duration of the disease. We performed a prospective longitudinal study in CTCs from 20 castration-resistant prostate cancer patients treated with docetaxel. For that, we used CellSearch® technology and a custom gene expression panel with qRT-PCR using a CTCs negative enrichment approach. We found that CTCs showed a hybrid phenotype during the disease, where epithelial features were associated with the presence of ≥ 5 CTCs/7.5 mL of blood, while high relative expression of the gene MYCL was observed preferentially in the set of samples with < 5 CTCs/7.5 mL of blood. At baseline, patients whose CTCs had stem or hybrid features showed a later progression. After 1 cycle of docetaxel, high relative expression of ZEB1 indicated worse outcome, while KRT19 and KLK3 high expression could predisposed the patients to a worse prognosis at clinical progression. In the present work we describe biomarkers with clinical relevance for the prediction of early response or resistance in castration-resistant prostate cancer patients. Besides, we question the utility of targeted isolated CTCs and the use of a limited number of markers to define the CTCs population.
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Affiliation(s)
- Thais Pereira-Veiga
- Roche-Chus Joint Unit, Translational Medical Oncology Group, Oncomet, Health Research Institute of Santiago de Compostela (IDIS), Travesía da Choupana s/n, 15706, Santiago de Compostela, Spain.,Department of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Miriam González-Conde
- Roche-Chus Joint Unit, Translational Medical Oncology Group, Oncomet, Health Research Institute of Santiago de Compostela (IDIS), Travesía da Choupana s/n, 15706, Santiago de Compostela, Spain
| | - Luis León-Mateos
- Medical Oncology Department, University Clinical Hospital of Santiago de Compostela, 15706, Santiago de Compostela, Spain.,Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago de Compostela (IDIS), 15706, Santiago de Compostela, Spain
| | - Roberto Piñeiro-Cid
- Roche-Chus Joint Unit, Translational Medical Oncology Group, Oncomet, Health Research Institute of Santiago de Compostela (IDIS), Travesía da Choupana s/n, 15706, Santiago de Compostela, Spain.,Centro de Investigación Biomédica en Red Cáncer, CIBERONC, 28029, Madrid, Spain
| | - Carmen Abuín
- Roche-Chus Joint Unit, Translational Medical Oncology Group, Oncomet, Health Research Institute of Santiago de Compostela (IDIS), Travesía da Choupana s/n, 15706, Santiago de Compostela, Spain
| | - Laura Muinelo-Romay
- Centro de Investigación Biomédica en Red Cáncer, CIBERONC, 28029, Madrid, Spain.,Liquid Biopsy Analysis Unit, Translational Medical Oncology Group, Health Research Institute of Santiago de Santiago de Compostela (IDIS), Travesía da Choupana s/n, 15706, Santiago de Compostela, Spain
| | - Mónica Martínez-Fernández
- Genomes and Disease Lab. CIMUS, Universidade de Santiago de Compostela (USC), Avda. Barcelona 31, 15706, Santiago de Compostela, Spain
| | - Jenifer Brea Iglesias
- Genomes and Disease Lab. CIMUS, Universidade de Santiago de Compostela (USC), Avda. Barcelona 31, 15706, Santiago de Compostela, Spain
| | - Jorge García González
- Medical Oncology Department, University Clinical Hospital of Santiago de Compostela, 15706, Santiago de Compostela, Spain.,Centro de Investigación Biomédica en Red Cáncer, CIBERONC, 28029, Madrid, Spain.,Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago de Compostela (IDIS), 15706, Santiago de Compostela, Spain
| | - Urbano Anido
- Medical Oncology Department, University Clinical Hospital of Santiago de Compostela, 15706, Santiago de Compostela, Spain.,Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago de Compostela (IDIS), 15706, Santiago de Compostela, Spain
| | - Santiago Aguín-Losada
- Medical Oncology Department, University Clinical Hospital of Santiago de Compostela, 15706, Santiago de Compostela, Spain.,Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago de Compostela (IDIS), 15706, Santiago de Compostela, Spain
| | - Víctor Cebey
- Medical Oncology Department, University Clinical Hospital of Santiago de Compostela, 15706, Santiago de Compostela, Spain.,Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago de Compostela (IDIS), 15706, Santiago de Compostela, Spain
| | - Clotilde Costa
- Roche-Chus Joint Unit, Translational Medical Oncology Group, Oncomet, Health Research Institute of Santiago de Compostela (IDIS), Travesía da Choupana s/n, 15706, Santiago de Compostela, Spain. .,Centro de Investigación Biomédica en Red Cáncer, CIBERONC, 28029, Madrid, Spain.
| | - Rafael López-López
- Roche-Chus Joint Unit, Translational Medical Oncology Group, Oncomet, Health Research Institute of Santiago de Compostela (IDIS), Travesía da Choupana s/n, 15706, Santiago de Compostela, Spain.,Medical Oncology Department, University Clinical Hospital of Santiago de Compostela, 15706, Santiago de Compostela, Spain.,Centro de Investigación Biomédica en Red Cáncer, CIBERONC, 28029, Madrid, Spain.,Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago de Compostela (IDIS), 15706, Santiago de Compostela, Spain
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4
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Arias Ron D, Areses Manrique MC, Mosquera Martínez J, García González J, Afonso Afonso FJ, Lázaro Quintela M, Fernández Núñez N, Azpitarte Raposeiras C, Amenedo Gancedo M, Santomé Couto L, García Campelo MR, Muñoz Iglesias J, Ruiz Bañobre J, Vilchez Simo R, Casal Rubio J, Campos Balea B, Carou Frieiro I, Alonso-Jaudenes Curbera G, Anido Herranz U, García Mata J, Fírvida Pérez JL. Efficacy and safety of Nivolumab in older patients with pretreated lung cancer: A subgroup analysis of the Galician lung cancer group. J Geriatr Oncol 2020; 12:410-415. [PMID: 33357975 DOI: 10.1016/j.jgo.2020.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/14/2020] [Accepted: 11/30/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Nivolumab is an anti PD1 immunotherapy drug approved for advanced Non-Small Cell Lung Cancer (NSCLC) patients who previously received at least one prior line of treatment. Older patients are often not represented in clinical trials and drugs with acceptable safety profiles are necessary. We aim to report the efficacy and safety profile of Nivolumab in the real-world older subgroup of the Galician lung cancer group study. PATIENTS AND METHODS We retrospectively reviewed 188 advanced NSCLC patients treated with at least one prior therapy. We collected data from patients who were ≥70 years old treated with Nivolumab in second or subsequent lines. Patient characteristics, treatment efficacy (overall survival, progression-free survival, and response rate), and safety profile were reported. RESULTS Thirty-eight patients aged ≥70 years were included in the subgroup analysis. The median age was 74.5 years, a high percentage of patients were males (95%), most had a Performance Status of 1 (79%) and only 13% were non-smokers. The predominant histology was adenocarcinoma (53%), and 18% of patients received 2 or more lines. The median Progression-Free Survival was 7.53 months (CI 4.3-17.3, p = 0.15) and the median Overall Survival was 14.85 months (CI 10.5-20.7, p = 0.44). The objective response rate was 42%. No new adverse events were reported in comparison to a global population. CONCLUSIONS The efficacy and safety profile of Nivolumab in advanced NSCLC patients treated with at least one prior therapy and age ≥70 years old can be overlapped to a global population. Further prospective trials are needed to define and confirm these results.
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Affiliation(s)
- David Arias Ron
- Medical Oncology Department, University Hospital Complex of Ourense, Ourense, Spain.
| | | | | | - Jorge García González
- Medical Oncology Department, Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS), Santiago de Compostela 15706, Spain
| | | | | | | | | | | | | | | | - Jose Muñoz Iglesias
- Medical Oncology Department, University Hospital Complex of Ourense, Ourense, Spain
| | - Juan Ruiz Bañobre
- Medical Oncology Department, Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS), Santiago de Compostela 15706, Spain
| | - Rocío Vilchez Simo
- Medical Oncology Department, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | | | - Begoña Campos Balea
- Medical Oncology Department, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Iria Carou Frieiro
- Medical Oncology Department, Complejo Hospitalario de Pontevedra, Pontevedra, Spain
| | | | - Urbano Anido Herranz
- Medical Oncology Department, Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS), Santiago de Compostela 15706, Spain
| | - Jesús García Mata
- Medical Oncology Department, University Hospital Complex of Ourense, Ourense, Spain
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5
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Romero A, Jantus-Lewintre E, García-Peláez B, Royuela A, Insa A, Cruz P, Collazo A, Pérez Altozano J, Vidal OJ, Diz P, Cobo M, Hernández B, Vázquez Estevez S, Benítez G, Guirado M, Majem M, Bernabé R, Ortega AL, Blasco A, Bosch-Barrera J, Jurado JM, García González J, Viteri S, Garcia Giron C, Massutí B, Lopez Martín A, Rodriguez-Festa A, Calabuig-Fariñas S, Molina-Vila MÁ, Provencio M. Comprehensive cross-platform comparison of methods for non-invasive EGFR mutation testing: results of the RING observational trial. Mol Oncol 2020; 15:43-56. [PMID: 33107189 PMCID: PMC7782072 DOI: 10.1002/1878-0261.12832] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/01/2020] [Accepted: 10/22/2020] [Indexed: 12/19/2022] Open
Abstract
Several platforms for noninvasive EGFR testing are currently used in the clinical setting with sensitivities ranging from 30% to 100%. Prospective studies evaluating agreement and sources for discordant results remain lacking. Herein, seven methodologies including two next‐generation sequencing (NGS)‐based methods, three high‐sensitivity PCR‐based platforms, and two FDA‐approved methods were compared using 72 plasma samples, from EGFR‐mutant non‐small‐cell lung cancer (NSCLC) patients progressing on a first‐line tyrosine kinase inhibitor (TKI). NGS platforms as well as high‐sensitivity PCR‐based methodologies showed excellent agreement for EGFR‐sensitizing mutations (K = 0.80–0.89) and substantial agreement for T790M testing (K = 0.77 and 0.68, respectively). Mutant allele frequencies (MAFs) obtained by different quantitative methods showed an excellent reproducibility (intraclass correlation coefficients 0.86–0.98). Among other technical factors, discordant calls mostly occurred at mutant allele frequencies (MAFs) ≤ 0.5%. Agreement significantly improved when discarding samples with MAF ≤ 0.5%. EGFR mutations were detected at significantly lower MAFs in patients with brain metastases, suggesting that these patients risk for a false‐positive result. Our results support the use of liquid biopsies for noninvasive EGFR testing and highlight the need to systematically report MAFs.
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Affiliation(s)
- Atocha Romero
- Liquid Biopsy Laboratory, Biomedical Sciences Research Institute Puerta de Hierro-Majadahonda, Madrid, Spain.,Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Eloisa Jantus-Lewintre
- CIBERONC, Madrid, Spain.,Mixed Unit TRIAL, Príncipe Felipe Research Center & General University Hospital of Valencia Research Foundation, Spain.,Biotechnology Department, Universitat Politècnica de València, Spain
| | - Beatriz García-Peláez
- Laboratory of Oncology/Pangaea Oncology, Quirón-Dexeus University Hospital, Barcelona, Spain
| | - Ana Royuela
- Biostatistics Unit, CIBERESP, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Amelia Insa
- Hospital Clínico Universitario de Valencia, Spain
| | | | - Ana Collazo
- Hospital Universitario Sanchinarro, Madrid, Spain
| | | | | | - Pilar Diz
- Complejo Asistencial Universitario de León, Spain
| | - Manuel Cobo
- Hospital Regional Universitario, Málaga, Spain
| | | | | | - Gretel Benítez
- Complejo Hospitalario Universitario Insular de Gran Canaria, Las Palmas, Spain
| | - Maria Guirado
- Hospital General Universitario de Elche, Alicante, Spain
| | | | | | | | | | | | - Jose M Jurado
- Hospital Universitario Clínico San Cecilio, Granada, Spain
| | | | - Santiago Viteri
- Instituto Oncológico Dr. Rosell, Hospital Universitario Dexeus, Grupo Quiron Salud, Barcelona, Spain
| | | | | | | | - Alejandro Rodriguez-Festa
- Liquid Biopsy Laboratory, Biomedical Sciences Research Institute Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Silvia Calabuig-Fariñas
- CIBERONC, Madrid, Spain.,Mixed Unit TRIAL, Príncipe Felipe Research Center & General University Hospital of Valencia Research Foundation, Spain.,Department of Pathology, Universitat de València, Spain
| | | | - Mariano Provencio
- Liquid Biopsy Laboratory, Biomedical Sciences Research Institute Puerta de Hierro-Majadahonda, Madrid, Spain.,Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
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6
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Areses Manrique MC, Mosquera Martínez J, García González J, Afonso Afonso FJ, Lázaro Quintela M, Fernández Núñez N, Azpitarte Raposeiras C, Amenedo Gancedo M, Santomé Couto L, García Campelo MR, Muñoz Iglesias J, Cortegoso Mosquera A, Vilchez Simo R, Casal Rubio J, Campos Balea B, Carou Frieiro I, Alonso-Jaudenes Curbera G, Anido Herranz U, García Mata J, Fírvida Pérez JL. Real world data of nivolumab for previously treated non-small cell lung cancer patients: a Galician lung cancer group clinical experience. Transl Lung Cancer Res 2018; 7:404-415. [PMID: 30050778 DOI: 10.21037/tlcr.2018.04.03] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Recently, immunotherapy has changed the standard of treatment in non-small cell lung cancer (NSCLC). Outside clinical trials, data of real life is lacking. This is an observational study that represents the real world experience with nivolumab in pretreated NSCLC. Methods Eligibility criteria included, histologically confirmed NSCLC, stage IIIB and IV, evaluable disease and at least one prior therapy. Patients received nivolumab until progressive disease (PD) or unacceptable toxicity. The main aim of the study was to report the efficacy and safety profile of Nivolumab in pretreated patients with advanced NSCLC of our everyday clinical practice. The secondary aim was to perform subgroup analysis by clinical features. Results From August of 2015 to January of 2017, 188 patients were enrolled. The patients demographics were: median age 58 years, 144 male; 17 never smoker and 171 former/current smoker; 112 adenocarcinoma, 66 squamous-cell carcinoma and 10 not otherwise specified (NOS); 61 stage IIIB and 127 stage IV; 15 performance status (PS) 0, 154 PS 1 and 19 PS 2; 5 epidermal growth factor receptor (EGFR) and 1 anaplastic lymphoma kinase (ALK); 42 with central nervous system (CNS) metastases; and 71 received 2 or more prior therapy lines. Of the 188 patients enrolled, 25 (13.3%) were not evaluated, 3 (1.6%) had complete response (CR), 45 (23.9%) partial response (PR), 48 (25.5%) disease stabilization (DS) and 67 (35.6%) PD. The median of progression-free survival (PFS) was 4.83 months (95% CI, 3.6-5.9) and overall survival (OS) was 12.85 months (95% CI, 9.07-16.62). The subgroup analysis revealed statistical significance in OS for patients with CNS metastases 14.8 months (95% CI, 11.5-17.3) vs. 5.09 months (95% CI, 0.3-9.8) and also PS 0 [not reached (NR)] vs. PS 1 11.7 months vs. PS 2 3.4 months (95% CI, 2.3-4.4). The safety profile was in accordance with the literature data. Conclusions This study represents the real word experience with nivolumab and the results are consistent with previously reported in clinical trials. PS 2 and the presence of CNS metastases are associated with poor prognosis.
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Affiliation(s)
| | | | - Jorge García González
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Urbano Anido Herranz
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
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7
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Areses MC, Campelo RG, García González J, Afonso FJ, Lazaro ME, Campos B, Azpitarte C, Amenedo M, Santomé L, Ron DA, Alonso-Jaudenes G, Baron F, Vilchez R, Casal J, Fernandez N, Carou I, Mosquera J, Anido U, Garcia Mata J, Firvida JL. The real-world experience with nivolumab in previously treated patients with advanced non small cell lung cancer (NSCLC): A Galician Lung Cancer Group clinical practice. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e20564] [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: 11/20/2022] Open
Abstract
e20564 Background: Nivolumab, was the first checkpoint inhibitor to show a survival benefit in previously treated patients with advanced NSCLC in two randomized trials (CheckMate 017 and 057). Experience in routine clinical practice may differ from that seen in a controlled clinical trial. This is an observational study that represents the real-world experience. Methods: Elegibility criteria included, histologically confirmed NSCLC stage IIIB vs IV, evaluable disease and at least one prior therapy. Patients received nivolumab 3 mg/kg IV (60 min) every 2 weeks until progressive disease or unacceptable toxicity. The aim of the study was to report the efficacy and safety profile of Nivolumab in pretreated patients with advanced NSCLC of our everyday clinical practice. The exploratory assessments include response rate (RR), progression-free survival (PFS), overall survival (OS) and treatment related adverse events (AEs). Results: From August 2015 to January 2017, with a median follow time of 18 months, 188 patients were enrolled from 9 different centers. Patients demographics were: median age 62 years, 44 female and 144 male; 17 never smoker and 171 former or current smoker; 105 adenocarcinoma, 7 large-cell carcinoma, 66 squamous, 3 adenosquamous and 7 NSCLC; 61 stage IIIB and 129 stage IV; 42 with central nervous system metastasis; and 70 received 2 or more prior therapy lines. Among 156 patients evaluated, 1,3% had CR, 28,2% PR, 29,7% SD and 40,8% PD. At the time of database lock, the median of PFS was 2.9 IC 95% (2,3-3.4) and OS was 12,8 IC 95% (9,2-16,4). The evaluation of PFS and OS by baseline characteristics doesn´t revealed statistical significance. Grade 1-2 treatment related adverse events (AEs) occurred in 58% of the patients: asthenia (22%), rash (14%), diarrhea (8%), anorexia (7%), endocrine (6%) and neumonitis (1,5%). Grade 3-4 AEs occurred in 5 patients; (3) diarrhea and (2) neumonitis and there were 3 treatment-related deaths. Conclusions: This study represents the real-word experience with nivolumab and the results are consistent with those previously reported in the CheckMate 017 and 057 trials.
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Affiliation(s)
- MC Areses
- Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | | | - Jorge García González
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | | | | | | | | | | | | | - David Arias Ron
- Complejo Hospitalario Universitario de Ourense, Orense, Spain
| | | | - Francisco Baron
- Complejo Hospitalario Universitario de Santiago, Santiago De Compostela, Spain
| | - Rocio Vilchez
- Complejo Hospitalario Universitario de Ferrol, A Coruña, Spain
| | - Joaquin Casal
- Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | - Iria Carou
- Complejo Hospitalario de Pontevedra, Pontevedra, Spain
| | - Joaquin Mosquera
- Medical Oncology Service, University Hospital A Coruña (XXIAC-SERGAS), A Coruña, Spain
| | - Urbano Anido
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiado De Complostela, Spain
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Uribe Echevarría L, Leimgruber C, García González J, Nevado A, Álvarez R, García LN, Quintar AA, Maldonado CA. Evidence of eosinophil extracellular trap cell death in COPD: does it represent the trigger that switches on the disease? Int J Chron Obstruct Pulmon Dis 2017; 12:885-896. [PMID: 28352169 PMCID: PMC5359000 DOI: 10.2147/copd.s115969] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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] [Indexed: 12/14/2022] Open
Abstract
In spite of the numerous studies on chronic obstructive pulmonary disease (COPD), the cellular and molecular basis of the disease’s development remain unclear. Neutrophils and eosinophils are known to be key players in COPD. Recently, neutrophil extracellular trap cell death (NETosis), a mechanism due to decondensation and extrusion of chromatin to form extracellular traps, has been demonstrated in COPD. However, there is limited knowledge about eosinophil extracellular trap cell death (EETosis) and its role in the pathogenesis of COPD. The aim of this study was to evaluate EETosis in stable COPD. Induced sputum obtained from healthy smokers and low exacerbation risk COPD A or B group patients or high exacerbation risk COPD C or D group patients were included. Samples were examined using electron microscopy and immunofluorescence. Healthy smokers (n=10) and COPD A (n=19) group exhibited neutrophilic or paucigranulocytic phenotypes, with NETosis being absent in these patients. In contrast, COPD B (n=29), with eosinophilic or mixed phenotypes, showed EETosis and incipient NETosis. COPD C (n=18) and COPD D groups (n=13) were differentiated from low exacerbation rate-COPD group by the abundant cellular debris, with COPD C group having an eosinophilic pattern and numerous cells undergoing EETosis. A hallmark of this group was the abundant released membranes that often appeared phagocytosed by neutrophils, which coincidentally exhibited early NETosis changes. The COPD D group included patients with a neutrophilic or mixed pattern, with abundant neutrophil extracellular trap-derived material. This study is the first to demonstrate EETosis at different stages of stable COPD. The results suggest a role for eosinophils in COPD pathophysiology, especially at the beginning and during the persistence of the disease, regardless of whether the patient quit smoking, with EETosis debris probably triggering uncontrolled NETosis. The main target of these findings should be young smokers with the potential to develop COPD.
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Affiliation(s)
| | - Carolina Leimgruber
- Electronic Microscopy Center, Instituto de Investigaciones en Ciencias de la Salud (INICSA-CONICET), Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | | | - Alberto Nevado
- Pneumonology Service, Sanatorio Allende (Nueva Córdoba), Córdoba, Argentina
| | - Ruth Álvarez
- Smoking Cessation Cente, Nuevo Hospital San Roque of Córdoba, Córdoba, Argentina
| | - Luciana N García
- Electronic Microscopy Center, Instituto de Investigaciones en Ciencias de la Salud (INICSA-CONICET), Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Amado A Quintar
- Electronic Microscopy Center, Instituto de Investigaciones en Ciencias de la Salud (INICSA-CONICET), Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Cristina A Maldonado
- Electronic Microscopy Center, Instituto de Investigaciones en Ciencias de la Salud (INICSA-CONICET), Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
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Areses Manrique C, Afonso Afonso FJ, Vazquez Rivera F, Lázaro Quintela M, Vazquez-Estevez S, Fernandez Calvo O, Vilchez Simo R, García González J, Perez Lopez E, Garcia Mata J, Anido Herranz U, Casal Rubio J, Firvida Perez JL. An observational study of the efficacy and safety of nivolumab in pretreated patients with advanced non small cell lung cancer (NSCLC): A Galician Lung Cancer Group Clinical Practice. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e20612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Jorge García González
- Complejo Hospitalario de Santiago de Compostela, Santiago De Compostela (La Coruna), Spain
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García González J, Pérez Fentes D, Aliste Santos C, Suárez Peñaranda JM, León Mateos L, López López R. Empleo de M-VAC en el tratamiento adyuvante del carcinoma sarcomatoide de vejiga. Actas Urol Esp 2009. [DOI: 10.4321/s0210-48062009000400019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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García González J, León Mateos L, López López R, Pérez Fentes D, Aliste Santos C, Suárez Peñaranda JM. Empleo de M-VAC en el tratamiento adyuvante del carcinoma sarcomatoide de vejiga. Actas Urol Esp 2009; 33:447-9. [DOI: 10.1016/s0210-4806(09)74175-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Welsh O, González JG, Diaz M, Madero D, González J. Therapeutic evaluation of ketoconazole in patients with coccidioidomycosis. Rev Infect Dis 1980; 2:651-5. [PMID: 6255546 DOI: 10.1093/clinids/2.4.651] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Eleven adult patients (seven men and four nonpregnant women) with coccidioidomycosis were treated orally with ketoconazole (R41,400). Two patients presented with disseminated coccidioidomycosis, six with pulmonary coccidioidomycosis, and three with the chronic cutaneous form of the disease. Diagnosis was established by culture of Coccidioides immitis and/or histopathologic identification of the fungus. All patients received 400 mg of ketoconazole per day for the first 10 days; afterwards four of them received 200 mg per day. Evaluation indicated that nine patients improved, one did not, and one could not be assessed. Treatment of coccidioidomycosis with ketoconazole appears to be reasonably effective and produces fewer adverse effects than does amphotericin B; however, further studies of the efficacy of this new drug are needed.
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