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Luna J, Zafra J, Areses Manrique MC, Rodríguez A, Sotoca A, Fírvida JL, Chicas-Sett R, Mielgo X, Reyes JCT, Couñago F. New challenges in the combination of radiotherapy and immunotherapy in non-small cell lung cancer. World J Clin Oncol 2021; 12:983-999. [PMID: 34909394 PMCID: PMC8641011 DOI: 10.5306/wjco.v12.i11.983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/06/2021] [Accepted: 10/12/2021] [Indexed: 02/06/2023] Open
Abstract
Immunotherapy has represented one of the main medical revolutions of recent decades, and is currently a consolidated treatment for different types of tumors at different stages and scenarios, and is present in a multitude of clinical trials. One of the diseases in which it is most developed is non-small cell lung cancer. The combination of radiotherapy and immunotherapy in cancer in general and lung cancer in particular currently represents one of the main focuses of basic and clinical research in oncology, due to the synergy of this interaction, which can improve tumor response, resulting in improved survival and disease control. In this review we present the biochemical and molecular basis of the interaction between radiotherapy and immunotherapy. We also present the current clinical status of this interaction in each of the stages and cases of non-small cell lung cancer, with the main results obtained in the different studies both in terms of tumor response and survival as well as toxicity. Finally, we mention the main studies underway and the challenges of this interaction in the coming years, including how these treatments should be combined to achieve the greatest efficacy with the fewest possible side effects (dose, type of radiotherapy and drugs, sequence of treatments).
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Affiliation(s)
- Javier Luna
- Department of Radiation Oncology, Oncohealth Institute, Fundación Jiménez Díaz, Madrid 28040, Spain
| | - Juan Zafra
- Department of Radiation Oncology, Dr. Negrín University Hospital of Gran Canaria, Las Palmas 35010, Spain
| | | | - Aurora Rodríguez
- Department of Radiation Oncology, Ruber International Hospital, Madrid 28034, Spain
| | - Amalia Sotoca
- Department of Radiation Oncology, Ruber International Hospital, Madrid 28034, Spain
| | - Jose Luis Fírvida
- Department of Medical Oncology, Ourense University Hospital, Ourense 32005, Spain
| | - Rodolfo Chicas-Sett
- Department of Radiation Oncology, Dr. Negrín University Hospital of Gran Canaria, Las Palmas 35010, Spain
| | - Xabier Mielgo
- Department of Medical Oncology, Hospital Universitario Fundación Alcorcón, Alcorcón 28922, Spain
| | | | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario QuirónSalud Madrid, Hospital La Luz, Universidad Europea de Madrid, Madrid 28223, Spain
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Arias Ron D, Labandeira CM, Areses Manrique MC, Sampedro Domarco P, Abdulkader I, García-Mata J, Rolfo C, González-Rivas D, Fírvida JL. Dramatic Response of Leptomeningeal Carcinomatosis to Nivolumab in PD-L1 Highly Expressive Non-small Cell Lung Cancer: A Case Report. Front Oncol 2019; 9:819. [PMID: 31552167 PMCID: PMC6743439 DOI: 10.3389/fonc.2019.00819] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/09/2019] [Indexed: 12/26/2022] Open
Abstract
In a patient who had been diagnosed of located squamous cell lung carcinoma, pneumonectomy, and adjuvant chemotherapy were performed. Brain recurrence and subsequent lung metastatic disease were uncontrolled by neurosurgery, holocranial radiotherapy, and first-line chemotherapy. In August 2015, appearance of leptomeningeal carcinomatosis triggered severe clinical deterioration and threatened the patient's life. Anti-PD1 immune checkpoint inhibitor Nivolumab was initiated in an attempt to stop tumor growth, achieving a spectacular brain and pulmonary complete response and clinical improvement, without serious adverse effects. High expression PD-L1 level (100%) was found in the pathological tissue sample. Nivolumab was maintained for more than 2 years and stopped in December 2017 after 28 months of treatment, with no disease evidence. More than 3 years after its onset, the patient maintains an outstanding PS with complete tumor response and no evidence of disease in last surveillance CT scan and brain MRI.
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Affiliation(s)
- David Arias Ron
- Medical Oncology Department, University Hospital Complex of Ourense, Ourense, Spain
| | - Carmen M Labandeira
- Neurology Department, University Hospital Complex of Vigo, Hospital Alvaro Cunqueiro, Pontevedra, Spain
| | | | | | - Ihab Abdulkader
- Anatomopathology Department, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jesús García-Mata
- Medical Oncology Department, University Hospital Complex of Ourense, Ourense, Spain
| | - Christian Rolfo
- Thoracic Medical Oncology, Early Clinical Trials, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, United States
| | - Diego González-Rivas
- Thoracic Surgery Department, Hospital San Rafael, Coruña, Spain.,Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Shanghai, China
| | - Jose Luis Fírvida
- Medical Oncology Department, University Hospital Complex of Ourense, Ourense, Spain
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Juan Ó, Vazquez S, Rubio JC, Fírvida JL, Aparisi F, Muñóz J, Sánchez JG, Gironés R, Quintela ML, Giner V, Hernández AS. P2.02-012 Long-Term Survival of Phase II of Full-Dose Oral Vinorelbine Combined with Cisplatin & Radiotherapy in Locally Advanced NSCLC. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1159] [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: 11/30/2022]
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Gómez S, Areses C, Fernandez N, Garcia J, Costa M, Fírvida JL, Campos B, Hernandez E, Taboada B, Castro E, Veiras M, Afonso J, Azpitarte C, Amenedo M, Rubio JC. P2.02-029 Concomitant ChemoRadiotherapy for Locally Advanced Non-Small Cell Lung Cancer: A Phase II Study from the Galician Lung Cancer Group. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1176] [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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Campelo RG, Areses MC, Baron F, Afonso-Afonso F, Costa M, Fernandez N, Amenedo M, Alonso-Jaudenes Curvera G, Vázquez M, Simo RV, Martinez JM, Garcia J, Gómez S, Campos B, Mata JG, Herranz UA, Fírvida JL. P3.02c-098 An Observational Study of the Efficacy and Safety of Nivolumab in Patients with Advanced NSCLC. A Galician Lung Cancer Group. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1894] [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: 11/29/2022]
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Rubio JC, Vázquez S, Vázquez F, Amenedo M, Fírvida JL, Mel JR, Huidobro G, Alvarez E, Lázaro M, Alonso G, Fernández I. A phase II randomized trial of gemcitabine-docetaxel versus gemcitabine-cisplatin in patients with advanced non-small cell lung carcinoma. Cancer Chemother Pharmacol 2009; 64:379-84. [PMID: 19139896 DOI: 10.1007/s00280-008-0884-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Revised: 11/18/2008] [Accepted: 11/21/2008] [Indexed: 11/27/2022]
Abstract
PURPOSE To test efficacy and tolerability of non-platinum regimens for advanced non-small-cell lung cancer (NSCLC). METHODS Chemonaive patients with measurable stage IIIB/IV NSCLC treated with gemcitabine and cisplatin (GC), or gemcitabine and docetaxel (GD), maximumsix cycles in a phase IIB trial. RESULTS A total of 108 patients were randomized. Response rates (GC vs. GD, respectively): complete 3.6/2.0%, Partial 30.9/38.0%. Median Overall Survival (OS): 8.9 months in both groups (P = 0.53); and median time to progression (TTP): 6.2/5.5 months respectively (P = 0.61). Toxicities included (GC vs. GD, respectively): grade 3-4 neutropenia 49.1/41.2%; grade 3 thrombocytopenia 30.9/3.9%; grade 3 anemia 14.5/3.9%. Non-haematological toxicity was similar, except for nausea and vomiting, (16.3/2%); renal toxicity (3.7/0%) and hepatic toxicity (5.6/12.7%). CONCLUSIONS With a higher overall response rate and lower toxicity, GD is a good first treatment option for advanced NSCLC.
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Affiliation(s)
- Joaquín Casal Rubio
- Department of Medical Oncology, Hospital do Meixoeiro, C/Meixoeiro, s/n, 36200, Vigo (Pontevedra), Spain.
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León L, Cueva-Banuelos JF, Huidobro G, Fírvida JL, Amenedo M, Lázaro M, Romero C, Estévez SV, Barón FJ, Grande C, García Mata J, González A, Castellanos J, Gómez A, Caeiro M, Rodríguez MR, Casal J. Gemcitabine, cisplatin and vinorelbine as induction chemotherapy followed by radical therapy in stage III non-small-cell lung cancer: a multicentre study of galician-lung-cancer-group. Lung Cancer 2003; 40:215-20. [PMID: 12711124 DOI: 10.1016/s0169-5002(03)00030-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE To determine the effectiveness of a gemcitabine-cisplatin-vinorelbine combination in patients with stage III non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS Patients (n=46) with stage III NSCLC and naive of therapy were recruited into the trial to receive gemcitabine (G, 1000 mg/m(2)) on days 1 and 8, cisplatin (C, 100 mg/m(2)) on day 1 and vinorelbine (V, 25 mg/m(2)) on days 1 and 8 every 21 days for three cycles. RESULTS Two patients achieved complete response (CR) and 23 partial response (PR), overall response 52%. Subsequent radical surgery included nine patients of whom four were non-resectable and five were resected and with 1 CR. Radiotherapy was administered to 31 patients, and two achieved CR. The median time to progression and overall survival were 37 and 50 weeks, respectively. Grade 3-4 neutropenia and thrombocytopenia occurred in 35% of cycles, with two toxic deaths. Severe non-haematological toxicity was uncommon. CONCLUSIONS This GCV combination is effective in patients with stage III NSCLC, and with an acceptable toxicity.
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Affiliation(s)
- Luis León
- Galician Lung Cancer Group, Pontevedra, Spain
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Fírvida JL, Irigoyen A, Vázquez-Estévez S, Díz P, Constenla M, Casal-Rubio J, Valladares-Ayerbes M, Castellanos J, Rodríguez R, Balcells M. Phase II study of irinotecan as first-line chemotherapy for patients with advanced colorectal carcinoma. Cancer 2001; 91:704-11. [PMID: 11241237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND The objective of this multicenter, open-labeled, Phase II study performed in Spain was to assess the efficacy and safety of irinotecan (CPT-11) as first-line chemotherapy for patients suffering from advanced colorectal carcinoma (CRC). METHODS Patients with histologically proven CRC and at least one bidimensionally measurable lesion, ages 18-70 years, with a performance status < or = 2, normal analytical values, and no prior chemotherapy or only adjuvant chemotherapy completed before study entry were selected. The treatment schedule was CPT-11 350 mg/m(2) intravenously administered once every 3 weeks. Both tumor response and toxicity were assessed using the World Health Organization and National Cancer Institute common toxicity criteria. Changes in performance status, weight, and symptoms also were measured. RESULTS Sixty-five patients (44 chemotherapy-naïve patients and 21 patients who completed prior adjuvant treatment) were enrolled. Of these, 24.7% of patients responded to the treatment, and 41.5% of patients had stable disease. Patients who had not received prior adjuvant chemotherapy had a lower rate of progression on therapy (27.3%) compared with those who had received prior adjuvant chemotherapy (42.9%). The median survival was 19.9 months (range, 0.3-29.3 months). No significant differences were found in the median survival between chemotherapy-naïve patients and patients who had received previous chemotherapy. Grade 3-4 diarrhea and neutropenia were the most frequent severe toxic events, which were observed in 23.1% and 30.8% of patients and in 5.9% and 10.9% of the cycles, respectively. CONCLUSIONS The current antitumor efficacy results show that 350 mg/m(2) of CPT-11 administered every 3 weeks is an active and feasible first-line chemotherapy regimen for patients with CRC. Finally, the overall safety data confirmed that CPT-11 is a well tolerated treatment.
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Affiliation(s)
- J L Fírvida
- Complexo Hospitalario de Ourense, Ourense, Spain
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Parajó A, Fírvida JL, Otero E, García M, Montero M. [Isolated primary hyperaldosteronism caused by adrenocortical carcinoma]. ARCH ESP UROL 2000; 53:931-4. [PMID: 11213398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
OBJECTIVE To report a case of adrenocortical carcinoma and primary aldosteronism as the sole endocrine manifestation. METHODS/RESULTS A 39-year-old male with adrenocortical carcinoma and primary aldosteronism is presented. Following complete hormonal and radiological evaluation, right adrenalectomy and nephrectomy were performed (pT2pN0M0, stage II). Blood pressure, serum potassium and aldosterone levels returned to normal. The patient received adjuvant therapy with carboplatin and etoposide. After 15 months' disease-free interval, lung metastasis was diagnosed, without evidence of local recurrence until 5 months later, when hypertension and primary hyperaldosteronism reappeared. There were no other endocrine disorders. Treatment with spironolactone, 5-FU and adriamycin was instituted with no tumor response and the patient died 3 years later from complications of endobronchial metastasis. CONCLUSION Adrenocortical carcinoma with isolated primary hyperaldosteronism is uncommon and consequently there is no wide experience in regard to its diagnosis and treatment. Although randomized studies are not available, adjuvant therapy using other agents instead of mitotane (o,p-DDD), such as the combination of cisplatin and etoposide (VP-16), seems reasonable in the locally advanced stages. Mitotane may be useful when hypercortisolism is present, but its efficacy as an antitumor agent has been controversial.
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Affiliation(s)
- A Parajó
- Servicio de Cirugía, Hospital Santa María Nai, Orense, España
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Fírvida JL, Viñolas N, Muñoz M, Grau JJ, Daniels M, Estapé A, Estapé J. Age: a critical factor in cancer management. A prospective comparative study of 400 patients. Age Ageing 1999; 28:103-5. [PMID: 10350404 DOI: 10.1093/ageing/28.2.103] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND older people are often excluded from cancer treatments solely on the grounds of age. AIMS to compare cancer treatment in older and younger patients. PATIENTS AND METHODS between June 1992 and September 1994, 400 cancer patients were included in this prospective comparative study. The factors compared between younger and older subjects were performance status, associated chronic diseases, delay in diagnosis, stage of disease and initial treatment. RESULTS 54 patients (25.5%) under 70 years of age were asymptomatic at the time of diagnosis, in comparison with 25 (12.5%) of the 200 older patients (P < 0.001). Associated chronic pathologies were more frequent in the older patients (55% vs 18.5%, P < 0.001). There were no statistical differences between both groups in diagnostic delay. Localized disease was found in 127 (63%) of the younger patients and in 109 (54%) of the older patients, the difference not being significant. The percentage of patients who underwent oncological treatment was higher in the younger than the older group (87.5% vs 56%, P < 0.001). The main cause of therapeutic exclusion in both groups was poor performance status; however, in the older group other variables--such as the presence of chronic disease and patients' or relatives' wishes and doctors' opinions--influenced the decision not to give specific treatment. CONCLUSIONS this study confirms that the clinical characteristics and treatment of aged people with cancer are different from those of younger patients. Nevertheless, there is considerable doubt about whether an arbitrary age limit should continue to be accepted as a discriminatory factor in some diagnostic and therapeutic procedures in cancer patients.
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Affiliation(s)
- J L Fírvida
- Servicio de Coordinación Oncológica, Hospital Clinic, Barcelona, Spain
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Grau JJ, Cuchi A, Traserra J, Fírvida JL, Arias C, Blanch JL, Estapé J. Follow-up study in head and neck cancer: cure rate according to tumor location and stage. Oncology 1997; 54:38-42. [PMID: 8978591 DOI: 10.1159/000227659] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this clinical study was to analyze a long-term follow-up of all the patients with head and neck cancer in our institution. Between 1973 and 1993, 1,355 consecutive cases of head and neck cancerwere diagnosed, treated and followed up regularly. All were subjected to a multidisciplinary approach, and followed up until death or for 10 years with no event of disease. The local relapse rate was 20% and the node-regional relapse rate 15%. Distant metastases were observed in 6% of the patients mainly arising from the nasopharynx (23%) followed by the hypopharynx (11%). The main organ involved was the lung (50%). Median follow-up of the group was 10 years (range 4 months to 15 years). Cancer cure was observed after 5 years in glottic and supraglottic laryngeal carcinoma, oral and nasopharyngeal cancer and after 2.5 years in patients with cancer of the oropharynx and hypopharynx. The highest cure rate was 80% in the glottis, followed by 70% in the supraglottic area, 45% in the mouth, 30% in the nasopharynx, 25% in the oropharynx, and 20% in the hypopharynx. A second primary tumor was observed in 7% of the patients and a third primary in 0.6% of the patients. Only in 7 patients, the second or third primary was seen after 5 years of follow-up. Curability should be observed after 5 years from definitive therapy of glottic, supraglottic, oral and nasopharyngeal and earlier in oropharyngeal and hypopharyngeal cancer. Further follow-up should be discontinued. Second and third neoplasias are the main problems after 5 years of follow-up but their incidence is low.
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Affiliation(s)
- J J Grau
- Department of Medical Oncology, Hospital Clinic, University of Barcelona, Spain
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Abstract
We have studied the effect on ototoxicity of maintaining serum calcium concentration by calcium gluconate infusion in cancer patients receiving high-dose cisplatin in a randomized study in two groups: 11 patients received calcium gluconate, 4 mg kg-1 i.v. infusion during cisplatin therapy; 11 other patients without any calcium supplementation served as controls. All of them received the first course of chemotherapy, based on cisplatin, 120 mg m2 with a hydration schedule. An audiogram was performed in each patient just before cisplatin and repeated after 1 day and 3 weeks. Mean total calcium concentration in control patients before and after chemotherapy was 2.2 +/- 0.14 (95% confidence interval 1.9-2.5) and 2.0 +/- 0.13 (95% CI 1.7-2.24) mmol 1(-1) respectively (P = 0.0004) and for ionized calcium 1.22 +/- 0.52 (95% CI 0.21-2.23) and 1.11 +/- 0.07 (95% CI 0.97-1.25) mmol 1(-1) respectively (P = 0.0005). Serum magnesium levels were maintained or increased by magnesium supplementation. Although there was no change in serum total or ionized calcium, or serum magnesium in the calcium infusion group, no differences in hearing loss between the groups were observed. High-dose cisplatin chemotherapy for cancer patients induces an acute decrease of serum total calcium and serum ionized calcium and audiometric changes. Maintenance of calcium serum levels by calcium gluconate infusion did not protect against ototoxicity in those patients.
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Affiliation(s)
- J J Grau
- University of Barcelona, Hospital Clinic, Medical Oncology Department, Barcelona, Spain
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Grau JJ, Cuchi A, Estapé J, Arias C, Mañé JM, Fírvida JL, Moreno F, Traserra J. Survival after chemotherapy with cisplatin and infusion of bleomycin prior to local-regional treatment in pyriform sinus cancer. Tumori 1996; 82:221-4. [PMID: 8693597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
AIMS AND BACKGROUND The purpose of this study was to retrospectively compare different approaches including neoadjuvant chemotherapy. METHODS Ninety-six consecutive patients with pyriform sinus squamous cell carcinoma with no distant metastases were entered. The first 48 patients were treated with surgery plus postoperative radiation therapy (50-60 Gy) over cervical lymphatics. The next 48 patients were treated by induction chemotherapy with two courses of cisplatin, 120 mg/m2 i.v. day one, plus bleomycin, 20 mg/m2/day for 5 consecutive days in 24-hr i.v. perfusion followed by definitive surgery and postoperative radiation therapy as in the first therapeutic group. RESULTS Definitive surgery was performed in 38 control vs 39 neoadjuvant patients. Complete response was observed in 9 (18.7%) and partial response in 32 (66.7%) of 48 chemotherapy-treated patients. Partial plus complete response was seen in 41 (85.4%) of the 48 patients. Comparison between controls versus chemotherapy-treated groups showed persistence of the disease in 10 vs 9 patients; local-regional relapses in 21 versus 14 patients; and distant metastases in 4 vs 2 patients. Median survival was 12 vs 40 months. Survival curves were statistically better in neoadjuvants than in controls (P < 0.025). CONCLUSIONS Multidisciplinary therapy slightly decreases the rate of local-regional relapses and distant metastases and should improve survival in this set of pyriform sinus cancer patients.
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Affiliation(s)
- J J Grau
- Department of Medical Oncology, Hospital Clinic, University of Barcelona, Spain
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