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Saura C, Ortiz C, Matito J, Arenas EJ, Suñol A, Martín Á, Córdoba O, Martínez-Sabadell A, García-Ruiz I, Miranda I, Morales-Comas C, Carrasco E, Viaplana C, Peg V, Nuciforo P, Bayó-Puxan N, Gonzalez-Medina A, Miquel JM, Gómez-Rey M, Villacampa G, Arévalo S, Espinosa-Bravo M, Balmaña J, Dienstmann R, Arribas J, Tabernero J, Vivancos A, Sansó M. Early-Stage Breast Cancer Detection in Breast Milk. Cancer Discov 2023; 13:2180-2191. [PMID: 37704212 PMCID: PMC10551665 DOI: 10.1158/2159-8290.cd-22-1340] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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] [Received: 02/11/2023] [Revised: 06/27/2023] [Accepted: 07/07/2023] [Indexed: 09/15/2023]
Abstract
Breast cancer occurring during pregnancy (PrBC) and postpartum (PPBC) is usually diagnosed at more advanced stages compared with other breast cancer, worsening its prognosis. PPBC is particularly aggressive, with increased metastatic risk and mortality. Thus, effective screening methods to detect early PrBC and PPBC are needed. We report for the first time that cell-free tumor DNA (ctDNA) is present in breast milk (BM) collected from patients with breast cancer. Analysis of ctDNA from BM detects tumor variants in 87% of the cases by droplet digital PCR, while variants remain undetected in 92% of matched plasma samples. Retrospective next-generation sequencing analysis in BM ctDNA recapitulates tumor variants, with an overall clinical sensitivity of 71.4% and specificity of 100%. In two cases, ctDNA was detectable in BM collected 18 and 6 months prior to standard diagnosis. Our results open up the potential use of BM as a new source for liquid biopsy for PPBC detection. SIGNIFICANCE For the first time, we show that BM obtained from patients with breast cancer carries ctDNA, surpassing plasma-based liquid biopsy for detection and molecular profiling of early-stage breast cancer, even prior to diagnosis by image. See related commentary by Cunningham and Turner, p. 2125. This article is featured in Selected Articles from This Issue, p. 2109.
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Affiliation(s)
- Cristina Saura
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus. Barcelona, Spain
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Carolina Ortiz
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus. Barcelona, Spain
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Judit Matito
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus. Barcelona, Spain
| | - Enrique J. Arenas
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus. Barcelona, Spain
- Centro de Investigación Biomédica en Red en Cáncer (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | - Anna Suñol
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus. Barcelona, Spain
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ágatha Martín
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus. Barcelona, Spain
| | - Octavi Córdoba
- Servicio Obstetricia y Ginecología, Hospital Universitari Son Espases (HUSE), Palma, Spain
- Institut de Investigació de les Illes Balears (IdISBa), Palma, Spain
- Universitat de les Illes Balears (UIB), Palma, Spain
| | - Alex Martínez-Sabadell
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus. Barcelona, Spain
| | - Itziar García-Ruiz
- Obstetrics Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ignacio Miranda
- Radiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Clara Morales-Comas
- Gynecology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Estela Carrasco
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus. Barcelona, Spain
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Cristina Viaplana
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus. Barcelona, Spain
| | - Vicente Peg
- Centro de Investigación Biomédica en Red en Cáncer (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
- Pathology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Paolo Nuciforo
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus. Barcelona, Spain
| | - Neus Bayó-Puxan
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus. Barcelona, Spain
| | - Alberto Gonzalez-Medina
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus. Barcelona, Spain
| | - Josep M. Miquel
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus. Barcelona, Spain
| | - Marina Gómez-Rey
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus. Barcelona, Spain
| | - Guillermo Villacampa
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus. Barcelona, Spain
| | - Silvia Arévalo
- Obstetrics Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Martín Espinosa-Bravo
- Gynecology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Judith Balmaña
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus. Barcelona, Spain
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Rodrigo Dienstmann
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus. Barcelona, Spain
| | - Joaquin Arribas
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus. Barcelona, Spain
- Centro de Investigación Biomédica en Red en Cáncer (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
- Hospital del Mar Research Institute (HMRI), Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Josep Tabernero
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus. Barcelona, Spain
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- University of Vic-Central University of Catalonia (UVic-UCC), Barcelona, VIC, Spain
- IOB Institute of Oncology, Quiron Group, Barcelona, Spain
| | - Ana Vivancos
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus. Barcelona, Spain
| | - Miriam Sansó
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus. Barcelona, Spain
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2
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Serra-Camprubí Q, Verdaguer H, Oliveros W, Lupión-Garcia N, Llop-Guevara A, Molina C, Vila-Casadesús M, Turpin A, Neuzillet C, Frigola J, Querol J, Yáñez-Bartolomé M, Castet F, Fabregat-Franco C, Escudero-Iriarte C, Escorihuela M, Arenas EJ, Bernadó-Morales C, Haro N, Giles FJ, Pozo ÓJ, Miquel JM, Nuciforo PG, Vivancos A, Melé M, Serra V, Arribas J, Tabernero J, Peiró S, Macarulla T, Tian TV. Human Metastatic Cholangiocarcinoma Patient-Derived Xenografts and Tumoroids for Preclinical Drug Evaluation. Clin Cancer Res 2023; 29:432-445. [PMID: 36374558 PMCID: PMC9873249 DOI: 10.1158/1078-0432.ccr-22-2551] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/14/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Cholangiocarcinoma (CCA) is usually diagnosed at advanced stages, with limited therapeutic options. Preclinical models focused on unresectable metastatic CCA are necessary to develop rational treatments. Pathogenic mutations in IDH1/2, ARID1A/B, BAP1, and BRCA1/2 have been identified in 30%-50% of patients with CCA. Several types of tumor cells harboring these mutations exhibit homologous recombination deficiency (HRD) phenotype with enhanced sensitivity to PARP inhibitors (PARPi). However, PARPi treatment has not yet been tested for effectiveness in patient-derived models of advanced CCA. EXPERIMENTAL DESIGN We have established a collection of patient-derived xenografts from patients with unresectable metastatic CCA (CCA_PDX). The CCA_PDXs were characterized at both histopathologic and genomic levels. We optimized a protocol to generate CCA tumoroids from CCA_PDXs. We tested the effects of PARPis in both CCA tumoroids and CCA_PDXs. Finally, we used the RAD51 assay to evaluate the HRD status of CCA tissues. RESULTS This collection of CCA_PDXs recapitulates the histopathologic and molecular features of their original tumors. PARPi treatments inhibited the growth of CCA tumoroids and CCA_PDXs with pathogenic mutations of BRCA2, but not those with mutations of IDH1, ARID1A, or BAP1. In line with these findings, only CCA_PDX and CCA patient biopsy samples with mutations of BRCA2 showed RAD51 scores compatible with HRD. CONCLUSIONS Our results suggest that patients with advanced CCA with pathogenic mutations of BRCA2, but not those with mutations of IDH1, ARID1A, or BAP1, are likely to benefit from PARPi therapy. This collection of CCA_PDXs provides new opportunities for evaluating drug response and prioritizing clinical trials.
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Affiliation(s)
- Queralt Serra-Camprubí
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Helena Verdaguer
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain.,Gastrointestinal and Endocrine Tumor Unit, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Winona Oliveros
- Life Sciences Department, Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | - Núria Lupión-Garcia
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Alba Llop-Guevara
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Cristina Molina
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Maria Vila-Casadesús
- Cancer Genomics Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Anthony Turpin
- Université de Lille, CNRS INSERM UMR9020-U1277, CANTHER Cancer Heterogeneity Plasticity and Resistance to Therapies, Lille, France.,Medical Oncology Department, CHRU Lille, Lille, France
| | - Cindy Neuzillet
- Gastrointestinal Oncology, Medical Oncology Department, Curie Institute, Versailles St-Quentin-Paris Saclay University, Saint-Cloud, France
| | - Joan Frigola
- Clinical Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Jessica Querol
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Mariana Yáñez-Bartolomé
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Florian Castet
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain.,Gastrointestinal and Endocrine Tumor Unit, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Carles Fabregat-Franco
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain.,Gastrointestinal and Endocrine Tumor Unit, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Carmen Escudero-Iriarte
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Marta Escorihuela
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Enrique J. Arenas
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Cristina Bernadó-Morales
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Noemí Haro
- Neurosciences Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | - Óscar J. Pozo
- Neurosciences Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Josep M. Miquel
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Paolo G. Nuciforo
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Ana Vivancos
- Cancer Genomics Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Marta Melé
- Life Sciences Department, Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | - Violeta Serra
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Joaquín Arribas
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer, Monforte de Lemos, Madrid, Spain.,Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Josep Tabernero
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain.,Gastrointestinal and Endocrine Tumor Unit, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Sandra Peiró
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain.,Corresponding Authors: Tian V. Tian, Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain. Phone: (34)932543450, ext. 8656; E-mail: ; Teresa Macarulla, ; and Sandra Peiró,
| | - Teresa Macarulla
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain.,Gastrointestinal and Endocrine Tumor Unit, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Corresponding Authors: Tian V. Tian, Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain. Phone: (34)932543450, ext. 8656; E-mail: ; Teresa Macarulla, ; and Sandra Peiró,
| | - Tian V. Tian
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain.,Corresponding Authors: Tian V. Tian, Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain. Phone: (34)932543450, ext. 8656; E-mail: ; Teresa Macarulla, ; and Sandra Peiró,
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3
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Verdaguer H, Saurí T, Acosta DA, Guardiola M, Sierra A, Hernando J, Nuciforo P, Miquel JM, Molero C, Peiró S, Serra-Camprubí Q, Villacampa G, Aguilar S, Vivancos A, Tabernero J, Dienstmann R, Macarulla T. ESMO Scale for Clinical Actionability of Molecular Targets driving targeted treatment in patients with cholangiocarcinoma. Clin Cancer Res 2022; 28:1662-1671. [PMID: 35042699 DOI: 10.1158/1078-0432.ccr-21-2384] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/15/2021] [Accepted: 12/30/2021] [Indexed: 11/16/2022]
Abstract
Purpose: Treatment options for advanced cholangiocarcinoma are limited and prognosis is poor. Cholangiocarcinomas are highly heterogeneous at the molecular level, with divergent patterns between intrahepatic and extrahepatic forms, intrahepatic being particularly rich in actionable alterations. We compared survival in patients with advanced cholangiocarcinoma harboring alterations matched to targeted drugs, with patients harboring non-actionable alterations. Experimental design: Patients with cholangiocarcinoma treated between 2011 and 2020 at one institution, with available molecular analyses, were retrospectively reviewed. Genomic alteration actionability was classified according to the ESMO Scale for Clinical Actionability of Molecular Targets (ESCAT) and correlated with efficacy endpoints. Results: Of 327 patients included, 78.9% had intrahepatic cholangiocarcinoma, 97.9% had received chemotherapy for metastatic disease. Actionable molecular alterations per ESCAT were identified in 184 patients (56.3%), including IDH1 mutations and FGFR2 fusions (23.1% and 8.0% of intrahepatic cholangiocarcinoma patients, respectively). Median overall survival in 50 patients with ESCAT I-IV alterations who received matched therapy (48 with intrahepatic cholangiocarcinoma) was 22.6 months (95%CI:20.1-32.8), compared to 14.3 months (95%CI:11.9-18.1) in 130 patients without actionable ESCAT alterations (HR=0.58, 95%CI:0.40-0.85; P=0.005). Among patients receiving matched targeted therapy, median progression-free survival was longer for patients with alterations classified as ESCAT I-II compared to ESCAT III-IV (5.0 versus 1.9 months; HR=0.36, 95%CI:0.15-0.87; P=0.02). Conclusions: ESCAT represents a tool to guide clinicians in fine-tuning use of molecular profiling data to choose matched targeted therapies. Our data demonstrate that targeted treatment administered per alteration actionability according to ESCAT is associated with improved survival in cholangiocarcinoma, particularly in ESCAT I-II intrahepatic cholangiocarcinoma.
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Affiliation(s)
- Helena Verdaguer
- Gastrointestinal Cancer Unit, Vall d�'Hebron University Hospital & Vall d'Hebron Institute of Oncology (VHIO)
| | - Tamara Saurí
- Medical Oncology Department, Hospital Clinic of Barcelona
| | - Daniel Alejandro Acosta
- Gastrointestinal Cancer Unit, Vall d�'Hebron University Hospital & Vall d'Hebron Institute of Oncology (VHIO)
| | - Magdalena Guardiola
- Oncology Data Science (ODysSey) Group, Vall d'Hebron Institute of Oncology (VHIO)
| | - Alexandre Sierra
- Gastrointestinal Cancer Unit, Vall d'Hebron Institute of Oncology (VHIO)
| | - Jorge Hernando
- Medical Oncology Department, Vall d'Hebron University Hospital
| | - Paolo Nuciforo
- Molecular Oncology, Vall d'Hebron Institute of Oncology (VHIO)
| | - Josep M Miquel
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Cristina Molero
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology (VHIO)
| | | | | | | | - Susana Aguilar
- Molecular Prescreening Program, Vall d'Hebron Institute of Oncology
| | - Ana Vivancos
- Cancer Genomic Group, Vall d'Hebron Institute of Oncology (VHIO)
| | - Josep Tabernero
- Medical Oncology Department, Vall d'Hebron University Hospital. Vall d'Hebron Institute of Oncology
| | - Rodrigo Dienstmann
- Medical Oncology - Oncology Data Science, Vall d'Hebron Institute of Oncology
| | - Teresa Macarulla
- Gastrointestinal Cancer Unit, Vall d'Hebron University Hospital & Vall d'Hebron Institute of Oncology (VHIO)
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Elez E, Cebria A, Bosch-Barrera J, Almudena C, Montosa FG, Paez D, Quintanar Verduguez MT, Vaswani AR, Rogado Revuelta J, Sánchez Cánovas M, Sanz-Garcia E, Miquel JM, González Flores E, Rodríguez-Lescure Á, Vera R. Identifying burnout in young oncologists: The sooner the better. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.11010] [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
11010 Background: Professional burnout is an important issue for the healthcare systems with potentially relevant consequences in the quality of patient care. Young oncologists are a special risk population, due to high workload, academic pressure and other specific factors related to cancer care. Work life and lifestyle factors are related with burnout levels and may define specific interventions to reduce and prevent burnout. Methods: A survey based on the validated Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI-HSS MP) was conducted. Additional questions to explore work life and lifestyle factors were included. We studied potential burnout amongst young Spanish oncologists (residents and oncologist in the first 5 years of professional performance). Statistical analyses, including linear regression, were carried out to test the relations between overall burnout score and work and lifestyle factors. Results: We obtained 243 responses to the survey. The sample was representative in terms of age, sex, geographic region, professional profile (residents and young oncologists) and a homogeneous distribution per year of residence (final participation rate was of 26.6%). Regarding 5 Burnout profiles, 32.1% of the participants were classified as Ineffective, 25.1% as Burnout, 21% as Engaged, 17.3% as Overextended and 4.5% as Disengaged. Percentage of Burnout profile is higher in medical oncology residents (28.24%) than in young oncologists (19.79%). The highest percentage of burnout profile was observed in the second-year residents (35,71%) and gradually decreases, in parallel to an increase in the engaged profile. The multivariable linear regression analysis showed a significant correlation between not having a good work life balance and adequate vacation time and the burnout score. Conclusions: Burnout affects a significant number of young oncologists with significantly different profiles and differences across regions. Adapted interventions to the most frequent profiles and at different stages of the training and professional career may be necessary particularly at the early beginning. Actions towards achieving a better work and personal life balance and stress management could be effective. These results are the basis for the prospective part of our study that aims to design an intervention and to assess its efficacy in this population.
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Affiliation(s)
- Elena Elez
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Annabel Cebria
- CIBERSAM, Mental Health Department, Parc Tauli University Hospital, Sabadell, Spain
| | | | - Cotes Almudena
- Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain
| | | | - David Paez
- Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | - Manuel Sánchez Cánovas
- Department of Hematology and Medical Oncology, Hospital G. Universitario Morales Meseguer, IMIB-Arrixaca, Murcia, Spain
| | | | | | | | | | - Ruth Vera
- Complejo Hospitalario de Navarra, Pamplona, Spain
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Verdaguer H, Guardiola-Fernandez M, Mancuso FM, Acosta D, Buxó E, Hernando J, Diez M, Laquente B, Baraibar I, Ros J, Garcia A, Matito J, Martin A, Sierra A, Villacampa G, Molero C, Miquel JM, Vivancos A, Dienstmann R, Macarulla T. DNA damage repair (DDR) gene mutations (mut) are predictors of response to platinum-based chemotherapy in advanced pancreatic cancer (PC) patients (pts). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16805] [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
e16805 Background: Somatic DDR mut have been reported in close to 10% of PC samples. In this study we investigate their predictive value for response to platinum-based chemotherapy. Methods: Case-control study with pts deriving response to oxaliplatin-based treatment (partial or complete response at any line) [n = 30] versus no response (progression in first restaging at 1st line) [n = 18]. An in-house NGS panel test of 420 genes was performed on tumor samples. DDR mut were classified in 2 subgroups: (a) functional BRCA1, BRCA2 or PALB2; and (b) any functional DDR gene mut, including those in (a). Results: 48 pts were included, median ages was 54.5 years (30-74), 29 male, 26 were diagnosed with stage IV, 36 pts (75%) received FOLFIRINOX and 37 received platinum-based chemotherapy as 1st. line treatment. Prevalence of DDR mut are described in the table. Among responders, 3 tumors had BRCA2 mt, 3 BRCA1, 2 ATM, and 1 each with BRCA2 + MSH2, PALB2, PMS2, MUYTH, RECQL4 + MDC1. Among non-responders 1 tumor each had ATM, FANCD2 and BLM. Median progression-free survival (PFS) with oxaliplatin-based chemotherapy in pts with BRCA1, BRCA2 or PALB2 mut tumors was 21.7 months (95% CI 12.3-NA); among those with any DDR mt was 12.3 months (95% CI 9.13-NA); while in pts whose tumors had no DDR mut was 6.4 months (95% CI 3.07-13)(Log-rank P-value = 0.02 comparison subgroup [a] vs. others; P-value = 0.1 subgroup [b] vs. others). Conclusions: The subgroup of pts with PC whit tumors harboring DDR gene mut, particularly functional BRCA1, BRCA2 or PALB2, have higher response rate and longer PFS with oxaplatin-based chemotherapy. [Table: see text]
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Affiliation(s)
| | | | - Francesco M Mancuso
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Daniel Acosta
- Vall d’Hebron University Hospital Barcelona Spain y Vall d’hebron insitute of Oncology (VHIO), Barcelona, Spain
| | - Elvira Buxó
- Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Marc Diez
- Vall d´Hebron University Hospital, Barcelona, Spain
| | | | - Iosune Baraibar
- Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Javier Ros
- Medical Oncology Department, Vall d´Hebron University Hospital/Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Judit Matito
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Agatha Martin
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Guillermo Villacampa
- Oncology Data Science Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | - Ana Vivancos
- Cancer Genomics Lab and Molecular Pathology Lab, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Rodrigo Dienstmann
- Oncology Data Science Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
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Cedrés S, Ponce-Aix S, Iranzo P, Callejo A, Pardo N, Navarro A, Martinez-Marti A, Gómez-Abecia S, Zucchiatti AC, Sansano I, Enguita AB, Miquel JM, Viaplana C, Dienstmann R, Paz-Ares L, Felip E. Analysis of mismatch repair (MMR) proteins expression in a series of malignant pleural mesothelioma (MPM) patients. Clin Transl Oncol 2020; 22:1390-1398. [PMID: 31916017 DOI: 10.1007/s12094-019-02275-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/16/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Promising results have been reported with immune checkpoint inhibitors (ICI) in a small proportion of MPM patients. MMR deficiency (dMMR) has been well described in several malignancies and was approved as a biomarker for anti-PD-1 inhibitors. Next generation sequencing (NGS) data demonstrated that 2% of MPM harbor microsatellite instability. The aim of this study is to characterize MMR by immunohistochemistry (IHC) in a series of MPM including a subset of patients treated with immunotherapy. METHODS Tumors of 159 MPM p diagnosed between 2002 and 2017 were reviewed. Formalin-fixed, paraffin-embedded tissue was stained for MLH1, MSH2, MSH6 and PMS2 and tumors were classified as dMMR (MMR protein expression negative) and MMR intact (all MMR proteins positively expressed). We retrospectively collected clinical outcomes under standard chemotherapy and experimental immunotherapy in the entire cohort. RESULTS MMR protein expression was analyzed in 158 samples with enough tissue and was positive in all of the cases. Twenty two patients received ICI with anti-CTLA4 or anti-PD-1 blockade in clinical trials, 58% had a response or stable disease for more than 6 m, with median progression-free survival (PFS) of 5.7 m (2.1-26.1 m). The median overall survival (mOS) in all population was 15 months (m) (13.5-18.8 m). In a multivariable model factors associated to improved mOS were PS 0, neutrophil-lymphocyte ratio (NLR) < 5 and epithelioid histology (p < 0.001). CONCLUSIONS In our series we were unable to identify any MPM patient with dMMR by IHC. Further studies are needed to elucidate potential predictive biomarkers of ICI benefit in MPM.
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Affiliation(s)
- S Cedrés
- Medical Oncology Department, Vall d´Hebron University Hospital and Institute of Oncology, Barcelona, Spain.
- Servicio de Oncología, Hospital Vall D´Hebron, Paseo Vall d´Hebron 119-129, 08035, Barcelona, Spain.
| | - S Ponce-Aix
- CIBERONC, Madrid, Spain
- Medical Oncology Department, University Hospital Doce de Octubre, Madrid, Spain
| | - P Iranzo
- Medical Oncology Department, Vall d´Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - A Callejo
- Medical Oncology Department, Vall d´Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - N Pardo
- Medical Oncology Department, Vall d´Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - A Navarro
- Medical Oncology Department, Vall d´Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - A Martinez-Marti
- Medical Oncology Department, Vall d´Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | | | - A C Zucchiatti
- Pathology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - I Sansano
- Pathological Anatomy Department, University Hospital Doce de Octubre, Madrid, Spain
| | - A B Enguita
- Pathological Anatomy Department, University Hospital Doce de Octubre, Madrid, Spain
| | - J M Miquel
- Vall d´Hebron Institute of Oncology, Barcelona, Spain
| | - C Viaplana
- Oncology Data Science (ODysSey) Group, Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - R Dienstmann
- Medical Oncology Department, Vall d´Hebron University Hospital and Institute of Oncology, Barcelona, Spain
- Oncology Data Science (ODysSey) Group, Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - L Paz-Ares
- CIBERONC, Madrid, Spain
- H12O-CNIO Lung Cancer Clinical Research Unit, Biomedical Research Foundation I+12, Madrid, Spain
- H12O-CNIO Lung Cancer Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- Medical School, Complutense University, Madrid, Spain
| | - E Felip
- Medical Oncology Department, Vall d´Hebron University Hospital and Institute of Oncology, Barcelona, Spain
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7
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Cedrés S, Felip E, Cruz C, Martinez de Castro A, Pardo N, Navarro A, Martinez-Marti A, Remon J, Zeron-Medina J, Balmaña J, Llop-Guevara A, Miquel JM, Sansano I, Nuciforo P, Mancuso F, Serra V, Vivancos A. Activity of HSP90 Inhibiton in a Metastatic Lung Cancer Patient With a Germline BRCA1 Mutation. J Natl Cancer Inst 2019. [PMID: 29529211 PMCID: PMC6093313 DOI: 10.1093/jnci/djy012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Heat shock proteins (HSPs) are molecular chaperones that maintain proteins in their correct conformation to ensure stability and protect carcinoma cells from apoptosis. HSP90 inhibitors (HSP90i) block multiple targets simultaneously, and despite responses in a selected population, no HSP90i have yet been approved. We present a patient with a lung tumor with an exceptional response to cisplatin/gemcitabine in combination with HSP90i, which nowadays continues with HSP90i maintenance after three years. Whole-exome sequencing of the lung tumor unveiled a BRCA1/2 deficiency mutational signature, and mutation analysis confirmed a germline BRCA1 mutation. The striking efficacy of HSP90i plus chemotherapy vs chemotherapy alone was reproduced in a patient-derived xenograft (PDX) model from a breast cancer patient with a BRCA1 mutation (mean tumor volume [SD], No. of tumors: vehicle 8.38 [7.07] mm3, n = 3; HSP90i 4.18 [1.93] mm3, n = 5; cisplatin plus gemcitabine 3.31 [1.95] mm3, n = 5; cisplatin plus gemcitabine plus HSP90i 0.065 [0.076] mm3, n = 6). This case and the PDX demonstrate the efficacy for therapeutic inhibition of HSP90 in a BRCA-mutated patient, opening a new potential avenue for better identifying patients who might benefit most from HSP90i.
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Affiliation(s)
- Susana Cedrés
- Thoracic Tumors Group, Vall d'hebron Institute of Oncology, Barcelona, Spain.,Oncology Department, Vall d'hebron University Hsopital
| | - Enriqueta Felip
- Thoracic Tumors Group, Vall d'hebron Institute of Oncology, Barcelona, Spain.,Oncology Department, Vall d'hebron University Hsopital.,Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Cristina Cruz
- Experimental Therapeutic Group, Barcelona, Spain.,Oncology Department, Vall d'hebron University Hsopital
| | - Ana Martinez de Castro
- Thoracic Tumors Group, Vall d'hebron Institute of Oncology, Barcelona, Spain.,Oncology Department, Vall d'hebron University Hsopital
| | - Nuria Pardo
- Thoracic Tumors Group, Vall d'hebron Institute of Oncology, Barcelona, Spain.,Oncology Department, Vall d'hebron University Hsopital.,Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Alejandro Navarro
- Thoracic Tumors Group, Vall d'hebron Institute of Oncology, Barcelona, Spain.,Oncology Department, Vall d'hebron University Hsopital.,Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Alex Martinez-Marti
- Thoracic Tumors Group, Vall d'hebron Institute of Oncology, Barcelona, Spain.,Oncology Department, Vall d'hebron University Hsopital.,Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Jordin Remon
- Thoracic Tumors Group, Vall d'hebron Institute of Oncology, Barcelona, Spain.,Oncology Department, Vall d'hebron University Hsopital
| | | | - Judith Balmaña
- Thoracic Tumors Group, Vall d'hebron Institute of Oncology, Barcelona, Spain.,Oncology Department, Vall d'hebron University Hsopital.,Universidad Autonoma de Barcelona, Barcelona, Spain
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8
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Cedres S, Ponce Aix S, Callejo A, Pardo N, Navarro A, Martinez Marti A, Sansano I, Enguita AB, Rodriguez G, Monton V, Miquel JM, Viaplana C, Dienstmann R, Felip E. Analysis of mismatch repair (MMR) proteins expression in a series of malignant pleural mesothelioma (MPM) patients. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e20062] [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
e20062 Background: The increasing incidence and poor outcome associated with MPM demand identification of effective treatment options. Promising results have been reported with immunotherapy (IO) in a small proportion of MPM patients (p). MMR deficiency (dMMR) has been well described in several malignancies and was recently approved as a tumor biomarker for IO with anti-PD-1 checkpoint inhibitor. Next generation sequencing (NGS) data demonstrated that 2% of MPM harbor microsatellite instability. The aim of this study is to characterize MMR by immunohistochemistry (IHC) in a series of MPM p. Methods: Tumors of 159 MPM p from Vall d´Hebron University Hospital and October 12th University Hospital diagnosed between 2002 and 2017 were reviewed. Formalin-fixed, paraffin-embedded tissue was stained for MLH1, MSH2, MSH6 and PMS2 and tumors were classified as dMMR when any MMR protein expression was negative and MMR intact when all MMR proteins were positively expressed. Associations between clinical variables and outcome were assessed with Cox regression models and survival data were calculated by the Kaplan-Meier method. Results: P characteristics: median age: 69 years (29-88 years), males: 71%, performance status (PS) 1:69%, asbestos exposure: 52%, stage III at diagnosis: 42%, epithelial subtype: 65%, systemic treatment 81% (57% chemotherapy with cisplatin plus pemetrexed in first line), 50% received second line and 28% third line. MMR protein expression was analyzed in 158 samples with enough tissue and was positive in all of the cases. The median overall survival (mOS) in all population was 15 months (m) (13.5-18.8m). In a multivariate model factors associated to improved mOS were PS 0 vs PS2 (13 v 2 m, HR 12.8, p < 0.01), neutrophil-lymphocyte ratio (NLR) < 5 (18 v 9 m in NLR ≥5,HR 1.5, p < 0.05) and epitheliod vs sarcomatoid histology (18 vs 4 m HR 4.7, p < 0.01). Thirteen p received IO with anti-CTLA4 or anti-PD-1 blockade in clinical trials, 58% had a response or stable disease for more than 6 m, with median progression-free survival (PFS) of 5.7 m (2.1-26.1m). Conclusions: In our series we were unable to identify any MPM patient with dMMR by IHC. Further studies are needed to elucidate novel predictive biomarkers benefit from IO in MPM.
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Affiliation(s)
- Susana Cedres
- Vall d´Hebron University Hospital /Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Ana Callejo
- Vall d´Hebron University Hospital /Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Nuria Pardo
- Vall d’Hebron University Hospital /Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Alejandro Navarro
- Vall d'Hebron University Hospital/Vall d´Hebron Institute Oncolgy (VHIO), Barcelona, Spain
| | - Alex Martinez Marti
- Vall d´Hebron University Hospital /Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | | | - Victor Monton
- Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Cristina Viaplana
- Oncology Data Science (ODysSey) Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Rodrigo Dienstmann
- Oncology Data Science Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Enriqueta Felip
- Vall d’Hebron University Hospital, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
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9
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Martinez-Marti A, Felip E, Matito J, Mereu E, Navarro A, Cedrés S, Pardo N, Martinez de Castro A, Remon J, Miquel JM, Guillaumet-Adkins A, Nadal E, Rodriguez-Esteban G, Arqués O, Fasani R, Nuciforo P, Heyn H, Villanueva A, Palmer HG, Vivancos A. Dual MET and ERBB inhibition overcomes intratumor plasticity in osimertinib-resistant-advanced non-small-cell lung cancer (NSCLC). Ann Oncol 2018; 28:2451-2457. [PMID: 28961841 PMCID: PMC5834054 DOI: 10.1093/annonc/mdx396] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Third-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) such as osimertinib are the last line of targeted treatment of metastatic non-small-cell lung cancer (NSCLC) EGFR-mutant harboring T790M. Different mechanisms of acquired resistance to third-generation EGFR-TKIs have been proposed. It is therefore crucial to identify new and effective strategies to overcome successive acquired mechanisms of resistance. Methods For Amplicon-seq analysis, samples from the index patient (primary and metastasis lesions at different timepoints) as well as the patient-derived orthotopic xenograft tumors corresponding to the different treatment arms were used. All samples were formalin-fixed paraffin-embedded, selected and evaluated by a pathologist. For droplet digital PCR, 20 patients diagnosed with NSCLC at baseline or progression to different lines of TKI therapies were selected. Formalin-fixed paraffin-embedded blocks corresponding to either primary tumor or metastasis specimens were used for analysis. For single-cell analysis, orthotopically grown metastases were dissected from the brain of an athymic nu/nu mouse and cryopreserved at -80°C. Results In a brain metastasis lesion from a NSCLC patient presenting an EGFR T790M mutation, we detected MET gene amplification after prolonged treatment with osimertinib. Importantly, the combination of capmatinib (c-MET inhibitor) and afatinib (ErbB-1/2/4 inhibitor) completely suppressed tumor growth in mice orthotopically injected with cells derived from this brain metastasis. In those mice treated with capmatinib or afatinib as monotherapy, we observed the emergence of KRAS G12C clones. Single-cell gene expression analyses also revealed intratumor heterogeneity, indicating the presence of a KRAS-driven subclone. We also detected low-frequent KRAS G12C alleles in patients treated with various EGFR-TKIs. Conclusion Acquired resistance to subsequent EGFR-TKI treatment lines in EGFR-mutant lung cancer patients may induce genetic plasticity. We assess the biological insights of tumor heterogeneity in an osimertinib-resistant tumor with acquired MET-amplification and propose new treatment strategies in this situation.
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Affiliation(s)
- A Martinez-Marti
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona;; Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona;; Autonomous University of Barcelona (UAB), Barcelona
| | - E Felip
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona;; Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona;; Autonomous University of Barcelona (UAB), Barcelona;.
| | - J Matito
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona
| | - E Mereu
- Single Cell Genomics Group, Centro Nacional de Análisis Genómico (CNAG) - Center for Genomic Regulation (CRG), Barcelona Institute of Science and Technology (BIST), Barcelona;; Pompeu Fabra University (UPF), Barcelona
| | - A Navarro
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona;; Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona
| | - S Cedrés
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona;; Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona
| | - N Pardo
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona;; Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona;; Autonomous University of Barcelona (UAB), Barcelona
| | - A Martinez de Castro
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona;; Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona
| | - J Remon
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona;; Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona
| | - J M Miquel
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona
| | - A Guillaumet-Adkins
- Single Cell Genomics Group, Centro Nacional de Análisis Genómico (CNAG) - Center for Genomic Regulation (CRG), Barcelona Institute of Science and Technology (BIST), Barcelona;; Pompeu Fabra University (UPF), Barcelona
| | - E Nadal
- Chemoresistance and Predictive Factors Group, Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology (ICO) Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Barcelona;; Department of Medical Oncology, ICO, IDIBELL, L'Hospitalet, Barcelona
| | - G Rodriguez-Esteban
- Single Cell Genomics Group, Centro Nacional de Análisis Genómico (CNAG) - Center for Genomic Regulation (CRG), Barcelona Institute of Science and Technology (BIST), Barcelona;; Pompeu Fabra University (UPF), Barcelona
| | | | - R Fasani
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona
| | - P Nuciforo
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona
| | - H Heyn
- Single Cell Genomics Group, Centro Nacional de Análisis Genómico (CNAG) - Center for Genomic Regulation (CRG), Barcelona Institute of Science and Technology (BIST), Barcelona;; Pompeu Fabra University (UPF), Barcelona
| | - A Villanueva
- Chemoresistance and Predictive Factors Group, Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology (ICO) Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Barcelona;; Xenopat S.L., Business Bioincubator, Bellvitge Health Science Campus, Barcelona, Spain
| | | | - A Vivancos
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona;.
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10
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Oliveira M, Baird RD, van Rossum AGJ, Beelen K, Garcia-Corbacho J, Mandjes IAM, Vallier AL, van Werkhoven E, Garrigós L, Kumar S, van Tinteren H, Muñoz S, Linossi C, Rosing H, Miquel JM, Schrier M, de Vries Schultink A, Saura C, Gallagher WM, Bernards R, Tabernero J, Cortés J, Caldas C, Linn SC. Abstract OT2-01-11: Phase II of POSEIDON: A phase Ib / randomized phase II trial of tamoxifen plus taselisib or placebo in hormone receptor positive, HER2 negative, metastatic breast cancer patients with prior exposure to endocrine treatment. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-ot2-01-11] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The combination of PI3K-AKT-mTOR pathway inhibitors with endocrine therapy can improve clinical outcomes of hormone receptor positive (HR+) metastatic breast cancer (MBC) patients. Taselisib is a potent and selective PI3K inhibitor, with greater selectivity against mutant (MUT) PI3Kα isoforms than wild-type (WT) via a unique mechanism. Phase Ib data of POSEIDON with Taselisib + tamoxifen (TAM) demonstrated encouraging activity in patients with heavily pre-treated MBC, with an acceptable toxicity profile (Baird et al, ASCO 2016). The recommended phase II dose (RP2D) was Taselisib 4mg plus TAM 20mg, both administered on a daily continuous schedule. ctDNA monitoring may have value in drug development by (1) assessing predictive biomarkers to therapy, (2) providing an early indication of treatment response, and (3) shedding light on potential mechanisms of acquired drug resistance. In some patients included in phase Ib of POSEIDON, tumor response was preceded by a corresponding early change in plasma PIK3CA ctDNA levels. Methods: The phase II portion of the POSEIDON trial is a two-arm, randomized, double blind study of Taselisib plus TAM versus placebo (PLA) plus TAM in pre- and postmenopausal women with HR+/HER2- MBC. In the first part of the Phase II, 180 patients will be randomized (1:1) to receive continuous TAM with either Taselisib at the RP2D or PLA until disease progression, unacceptable toxicity or patient / physician decision. Crossover is allowed upon progressive disease in those patients receiving PLA plus TAM, after collection of tumor and blood samples for exploratory biomarker analysis. Stratification is based on menopausal status, histology [lobular breast cancer (LBC) vs. ductal/others], PIK3CA mutation (WT vs. exon 9 vs. exon 20), prior everolimus, timing of recurrence/progression after prior endocrine therapy, number of prior chemotherapy (CT) lines, and treatment center. After recruiting the initial 180 patients, trial will focus in LBC, until a total number of 110 patients with LBC are enrolled. Other key eligibility criteria include presence of measurable or evaluable disease (RECIST 1.1), prior progression to endocrine treatment, maximum of 5 prior CT lines in the metastatic setting, absence of diabetes under medical treatment, and absence of chronic inflammatory bowel disease. Primary endpoint is investigator-assessed PFS. Key secondary endpoints are PFS in LBC, objective response rate, clinical benefit rate, safety, and exploratory biomarker analysis (including ctDNA). The study has a 90% power at a two-sided log-rank test significance level of 0.2 to detect an HR of 0.64, which corresponds to an increase in median PFS from 4.5 months in the PLA plus TAM arm to 7 months in the Taselisib plus TAM arm. Enrollment to POSEIDON Phase II started in June 2016 (Clinicaltrials.gov NCT02285179).
Citation Format: Oliveira M, Baird RD, van Rossum AGJ, Beelen K, Garcia-Corbacho J, Mandjes IAM, Vallier AL, van Werkhoven E, Garrigós L, Kumar S, van Tinteren H, Muñoz S, Linossi C, Rosing H, Miquel JM, Schrier M, de Vries Schultink A, Saura C, Gallagher WM, Bernards R, Tabernero J, Cortés J, Caldas C, Linn SC. Phase II of POSEIDON: A phase Ib / randomized phase II trial of tamoxifen plus taselisib or placebo in hormone receptor positive, HER2 negative, metastatic breast cancer patients with prior exposure to endocrine treatment [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT2-01-11.
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Affiliation(s)
- M Oliveira
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Cambridge Cancer Centre, Cambridge, United Kingdom; Netherlands Cancer Institute, Amsterdam, Netherlands; Hospital Clinic, Barcelona, Spain; UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland; Hospital Ramón y Cajal, Madrid, Spain
| | - RD Baird
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Cambridge Cancer Centre, Cambridge, United Kingdom; Netherlands Cancer Institute, Amsterdam, Netherlands; Hospital Clinic, Barcelona, Spain; UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland; Hospital Ramón y Cajal, Madrid, Spain
| | - AGJ van Rossum
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Cambridge Cancer Centre, Cambridge, United Kingdom; Netherlands Cancer Institute, Amsterdam, Netherlands; Hospital Clinic, Barcelona, Spain; UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland; Hospital Ramón y Cajal, Madrid, Spain
| | - K Beelen
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Cambridge Cancer Centre, Cambridge, United Kingdom; Netherlands Cancer Institute, Amsterdam, Netherlands; Hospital Clinic, Barcelona, Spain; UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland; Hospital Ramón y Cajal, Madrid, Spain
| | - J Garcia-Corbacho
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Cambridge Cancer Centre, Cambridge, United Kingdom; Netherlands Cancer Institute, Amsterdam, Netherlands; Hospital Clinic, Barcelona, Spain; UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland; Hospital Ramón y Cajal, Madrid, Spain
| | - IAM Mandjes
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Cambridge Cancer Centre, Cambridge, United Kingdom; Netherlands Cancer Institute, Amsterdam, Netherlands; Hospital Clinic, Barcelona, Spain; UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland; Hospital Ramón y Cajal, Madrid, Spain
| | - AL Vallier
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Cambridge Cancer Centre, Cambridge, United Kingdom; Netherlands Cancer Institute, Amsterdam, Netherlands; Hospital Clinic, Barcelona, Spain; UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland; Hospital Ramón y Cajal, Madrid, Spain
| | - E van Werkhoven
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Cambridge Cancer Centre, Cambridge, United Kingdom; Netherlands Cancer Institute, Amsterdam, Netherlands; Hospital Clinic, Barcelona, Spain; UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland; Hospital Ramón y Cajal, Madrid, Spain
| | - L Garrigós
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Cambridge Cancer Centre, Cambridge, United Kingdom; Netherlands Cancer Institute, Amsterdam, Netherlands; Hospital Clinic, Barcelona, Spain; UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland; Hospital Ramón y Cajal, Madrid, Spain
| | - S Kumar
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Cambridge Cancer Centre, Cambridge, United Kingdom; Netherlands Cancer Institute, Amsterdam, Netherlands; Hospital Clinic, Barcelona, Spain; UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland; Hospital Ramón y Cajal, Madrid, Spain
| | - H van Tinteren
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Cambridge Cancer Centre, Cambridge, United Kingdom; Netherlands Cancer Institute, Amsterdam, Netherlands; Hospital Clinic, Barcelona, Spain; UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland; Hospital Ramón y Cajal, Madrid, Spain
| | - S Muñoz
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Cambridge Cancer Centre, Cambridge, United Kingdom; Netherlands Cancer Institute, Amsterdam, Netherlands; Hospital Clinic, Barcelona, Spain; UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland; Hospital Ramón y Cajal, Madrid, Spain
| | - C Linossi
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Cambridge Cancer Centre, Cambridge, United Kingdom; Netherlands Cancer Institute, Amsterdam, Netherlands; Hospital Clinic, Barcelona, Spain; UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland; Hospital Ramón y Cajal, Madrid, Spain
| | - H Rosing
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Cambridge Cancer Centre, Cambridge, United Kingdom; Netherlands Cancer Institute, Amsterdam, Netherlands; Hospital Clinic, Barcelona, Spain; UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland; Hospital Ramón y Cajal, Madrid, Spain
| | - JM Miquel
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Cambridge Cancer Centre, Cambridge, United Kingdom; Netherlands Cancer Institute, Amsterdam, Netherlands; Hospital Clinic, Barcelona, Spain; UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland; Hospital Ramón y Cajal, Madrid, Spain
| | - M Schrier
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Cambridge Cancer Centre, Cambridge, United Kingdom; Netherlands Cancer Institute, Amsterdam, Netherlands; Hospital Clinic, Barcelona, Spain; UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland; Hospital Ramón y Cajal, Madrid, Spain
| | - A de Vries Schultink
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Cambridge Cancer Centre, Cambridge, United Kingdom; Netherlands Cancer Institute, Amsterdam, Netherlands; Hospital Clinic, Barcelona, Spain; UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland; Hospital Ramón y Cajal, Madrid, Spain
| | - C Saura
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Cambridge Cancer Centre, Cambridge, United Kingdom; Netherlands Cancer Institute, Amsterdam, Netherlands; Hospital Clinic, Barcelona, Spain; UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland; Hospital Ramón y Cajal, Madrid, Spain
| | - WM Gallagher
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Cambridge Cancer Centre, Cambridge, United Kingdom; Netherlands Cancer Institute, Amsterdam, Netherlands; Hospital Clinic, Barcelona, Spain; UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland; Hospital Ramón y Cajal, Madrid, Spain
| | - R Bernards
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Cambridge Cancer Centre, Cambridge, United Kingdom; Netherlands Cancer Institute, Amsterdam, Netherlands; Hospital Clinic, Barcelona, Spain; UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland; Hospital Ramón y Cajal, Madrid, Spain
| | - J Tabernero
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Cambridge Cancer Centre, Cambridge, United Kingdom; Netherlands Cancer Institute, Amsterdam, Netherlands; Hospital Clinic, Barcelona, Spain; UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland; Hospital Ramón y Cajal, Madrid, Spain
| | - J Cortés
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Cambridge Cancer Centre, Cambridge, United Kingdom; Netherlands Cancer Institute, Amsterdam, Netherlands; Hospital Clinic, Barcelona, Spain; UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland; Hospital Ramón y Cajal, Madrid, Spain
| | - C Caldas
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Cambridge Cancer Centre, Cambridge, United Kingdom; Netherlands Cancer Institute, Amsterdam, Netherlands; Hospital Clinic, Barcelona, Spain; UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland; Hospital Ramón y Cajal, Madrid, Spain
| | - SC Linn
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Cambridge Cancer Centre, Cambridge, United Kingdom; Netherlands Cancer Institute, Amsterdam, Netherlands; Hospital Clinic, Barcelona, Spain; UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland; Hospital Ramón y Cajal, Madrid, Spain
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Martinez Marti A, Cabrera G, Ortiz C, Vilaro M, Miquel JM, Cedres Perez S, Navarro A, Pardo Aranda N, Martinez P, Piera A, Carbonell LL, De la Fuente I, Garcia S, Sansano I, Felip E. Results of patients with thoracic cancers older than 70 years included in clinical trials: A center experience. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e20582] [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)
- Alex Martinez Marti
- Medical Oncology Department Vall d´Hebron Institute of Oncology-Vall D'Hebron University Hospital, Barcelona, Spain
| | | | | | - Marta Vilaro
- Oncology Data Science (OdysSey) Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | | | - Alejandro Navarro
- Medical Oncology Department Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Nuria Pardo Aranda
- Medical Oncology Department Vall d'Hebron Institute of Oncology-Vall d´Hebron University Hospital, Barcelona, Spain
| | - Pablo Martinez
- Medical Oncology Department, Clinica Diagonal, Barcelona, Spain
| | - Adelaida Piera
- Medical Oncology Department Vall d'Hebron Institute of OncologyVall d´Hebron University Hospital, Barcelona, Spain
| | - LLuisa Carbonell
- Medical Oncology Department Vall d'Hebron Institute of OncologyVall d´Hebron University Hospital, Barcelona, Spain
| | - Iris De la Fuente
- Study Coordinator, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Silvia Garcia
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Irene Sansano
- Pathology Department, Vall d'Hebron University Hospital, Barcelona, Spain
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Pardo Aranda N, Ruiz F, Martinez Marti A, Navarro A, Cedres Perez S, de la Fuente I, Baste N, Vivancos A, Miquel JM, Dienstmann R, Felip E. Outcome of RAS mutated lung adenocarcinoma (ADC ) patients (pts) on standard chemotherapy (chemo) and immune checkpoint inhibitors (immuneCI). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e20597] [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)
- Nuria Pardo Aranda
- Medical Oncology Department Vall d'Hebron Institute of Oncology-Vall d´Hebron University Hospital, Barcelona, Spain
| | - Fiorella Ruiz
- Oncology Data Science (ODysSey) Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Alex Martinez Marti
- Medical Oncology Department Vall d´Hebron Institute of Oncology-Vall D'Hebron University Hospital, Barcelona, Spain
| | - Alejandro Navarro
- Medical Oncology Department Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Iris de la Fuente
- Medical Oncology Department Vall d'Hebron Institute of OncologyVall d´Hebron University Hospital, Barcelona, Spain
| | - Neus Baste
- Medical Oncology Department, Vall d’Hebron University Hospital, Barcelona, Spain, Barcelona, Spain
| | - Ana Vivancos
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Rodrigo Dienstmann
- Oncology Data Science (ODysSey) Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
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Lahoz A, Vilà MR, Fabre M, Miquel JM, Rivas M, Maines J, Castell JV, Gómez-Lechón MJ. An in vitro tool to assess cytochrome P450 drug biotransformation-dependent cytotoxicity in engineered HepG2 cells generated by using adenoviral vectors. Toxicol In Vitro 2013; 27:1410-5. [DOI: 10.1016/j.tiv.2012.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 07/31/2012] [Accepted: 08/02/2012] [Indexed: 10/28/2022]
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Kenzaoui BH, Vilà MR, Miquel JM, Cengelli F, Juillerat-Jeanneret L. Evaluation of uptake and transport of cationic and anionic ultrasmall iron oxide nanoparticles by human colon cells. Int J Nanomedicine 2012; 7:1275-86. [PMID: 22419874 PMCID: PMC3298390 DOI: 10.2147/ijn.s26865] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [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: 12/24/2022] Open
Abstract
Nanoparticles (NPs) are in clinical use or under development for therapeutic imaging and drug delivery. However, relatively little information exists concerning the uptake and transport of NPs across human colon cell layers, or their potential to invade three-dimensional models of human colon cells that better mimic the tissue structures of normal and tumoral colon. In order to gain such information, the interactions of biocompatible ultrasmall superparamagnetic iron oxide nanoparticles (USPIO NPs) (iron oxide core 9–10 nm) coated with either cationic polyvinylamine (aminoPVA) or anionic oleic acid with human HT-29 and Caco-2 colon cells was determined. The uptake of the cationic USPIO NPs was much higher than the uptake of the anionic USPIO NPs. The intracellular localization of aminoPVA USPIO NPs was confirmed in HT-29 cells by transmission electron microscopy that detected the iron oxide core. AminoPVA USPIO NPs invaded three-dimensional spheroids of both HT-29 and Caco-2 cells, whereas oleic acid-coated USPIO NPs could only invade Caco-2 spheroids. Neither cationic aminoPVA USPIO NPs nor anionic oleic acid-coated USPIO NPs were transported at detectable levels across the tight CacoReady™ intestinal barrier model or the more permeable mucus-secreting CacoGoblet™ model.
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Navarro M, Peris M, Binefa G, Nogueira JM, Miquel JM, Espinás JA, Borrás JM. [Colonoscopic findings from a pilot screening study for colorectal cancer in Catalonia]. Rev Esp Enferm Dig 2008; 100:343-8. [PMID: 18752363 DOI: 10.4321/s1130-01082008000600006] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE to evaluate lesions detected in two screening rounds performed in a pilot screening programme for colorectal cancer in Catalonia, Spain. MATERIAL AND METHODS a colorectal cancer screening programme was initiated in 2000. The target population included men and women aged 50-69 years. Screening consisted of biennial guaiac-based fecal occult blood testing (FOBT), and colonoscopy for participants with a positive FOBT. Any polyps found were removed, and biopsies were performed for any masses. RESULTS colonoscopies were performed in 442 of 495 people with positive FOBT. In 213 (48.2%), 36 invasive cancers, 121 high-risk adenomas, 29 low-risk adenomas, and 27 hyperplastic polyps were diagnosed. Lesion size was smaller than 10 mm in 25.8% of cases. Most detected lesions (37.2%) were located in the distal colon, followed by the proximal colon (5.7%) and both locations (5.2%). Advanced neoplasm was significantly associated with male gender and distal location. The prevalence of advanced proximal neoplasms among patients with no distal polyps was 5.1%. CONCLUSIONS the most common lesions detected by colonoscopy were high-risk adenomas located in the distal colon. FOBT is a suitable method for detecting small precancer lesions during population screening, and is thus a key factor in reducing the incidence of colorectal cancer.
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Affiliation(s)
- M Navarro
- Servicio de Prevencion y Control del Cancer, Institut Catala d'Oncologia, Barcelona
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Varas MJ, Miquel JM, Abad R, Espinós JC, Cañas MA, Fabra R, Bargalló D. [Interventionist endoscopic ultrasonography. A retrospective analysis of 60 procedures]. Rev Esp Enferm Dig 2007; 99:138-44. [PMID: 17516826 DOI: 10.4321/s1130-01082007000300004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION AND OBJECTIVE interventionist endoscopic ultrasonography is increasingly used because of its growing indications. We present here our retrospective and initial experience (60 procedures) with endoscopic ultrasonography (EUS) both for diagnosis (EUS-FNA) and therapy (EUS-guided tumorectomy and mucosectomy). PATIENTS AND METHOD in a group with 27 cases including 10 submucosal tumors (SMTs), 2 adenopathies, and 15 potential pancreatic tumors (8 pancreatic cancers), a sectorial EUS-FNA at 7.5 MHz was performed for diagnosis prior to therapy (mainly surgical). A pancreatic pseudocyst was drained. In 21 cases with 27 SMTs (10 patients with 13 carcinoids) a tumorectomy was carried out using the standard loop or assisted polypectomy technique with submucosal injection, and in a few cases (two) using elastic band ligation following a radial EUS at 7.5, 12, or 20 MHz. In 6 cases of superficial gastroesophageal cancer or gastric dysplasia an endoscopic mucosal resection (classic EMR) was performed after EUS or MPs at 7.5 and 20 MHz. Fifty-five patients with 60 lesions, 29 femaes and 26 males with a mean age of 60 years (30-88 years) were retrospectively analyzed. RESULTS diagnostic precision (P), sensitivity (S), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) for EUS-FNA was 85, 83, 100, 100, and 43%, respectively, when comparing results with specimen histology. P was higher for adenopathies (100%) and pancreatic tumors (87%) than for SMTs (80%). No complications arose, except for one episode of upper gastrointestinal bleeding (UGIB) (3.7%) that was endoscopically and satisfactorily treated in a gastric SMT. In the group with 21 patients (10 carcinoids with 13 tumors) 27 SMTs were endoscopically treated by tumorectomy with no perforation and only 2 UGIBs (7.4%), one of them self-limited, recorded. Endoscopic resection was complete in 92% of cases. No complications occurred with classic EMR, and all patients are still alive with no evidence of relapse, either local or metastatic. In this group the rate of complete resections was 100%. CONCLUSIONS EUS-FNA is a safe technique with high diagnostic accuracy. EUS-guided tumorectomy and mucosectomy are also safe and effective techniques in the endoscopic management of these tumors.
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Affiliation(s)
- M J Varas
- Unidad de Ecoendoscopia, Centro Médico Teknon, Barcelona, Spain.
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Miquel JM, Abad R, Souto J, Fabra R, Vila M, Bargalló D, Vázquez-Iglesia JL, Varas Lorenzo MJ. EUS-guided mucosectomy for gastrointestinal cancer. Rev Esp Enferm Dig 2006; 98:591-6. [PMID: 17048995 DOI: 10.4321/s1130-01082006000800004] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION the only way of improving prognosis and survival in gastrointestinal cancer is early diagnosis, with intramucosal localization as confirmed by endoscopic ultrasonography (EUS) or 20-MHz miniprobes (MPs) (T1) being most appropriate. Endoscopic mucosal resection (EMR) has proven effective in the treatment of this sort of lesions. PATIENTS AND METHOD in a group (18 cases) with 15 cases of superficial gastrointestinal cancer and 3 cases of severe gastric dysplasia, 9 cases (3 esophageal, 4 gastric, 2 rectal) underwent a classic EMR following EUS or a 7.5- and 20-MHz miniprobe exploration. RESULTS ultrasonographic studies showed a T1 in all but one esophageal case (Tis), and in both gastric dysplasias, with no changed layer structure being demonstrated in the latter (T0). No complications arose with classic EMR, and all 9 patients are alive and free from local or metastatic recurrence, except for one esophageal case, which recurred distally to the esophageal lesion (metachronous). CONCLUSIONS echoendoscopically-assisted EMR is a safe, effective technique in the endoscopic management of superficial gastrointestinal (esophageal, gastric, colorectal) cancer. Recurrence most likely depends upon cancer multiplicity.
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Affiliation(s)
- J M Miquel
- Echoendoscopy Unit, Centro Médico Delfos., A Coruña, Spain
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Abstract
INTRODUCTION Endoscopic ultrasonography (EUS) has already proven useful in the assessment of submucosal lesions, and the staging of gastrointestinal cancer, particularly gastric MALT-type lymphoma. The goal of this paper was EUS staging. PATIENTS AND METHOD 24 patients (10 females, 14 males) with a median age of 56 years and possibly gastric MALT lymphoma (25 cases) were studied using videoendoscopy, biopsies, and echoendoscopy with 7.5- and 20-MHz radial EUS, and also with 12- and 20-MHz miniprobes (MPs). Nineteen patients were definitely evaluated (7 females, 12 males) as having 20 MALT-type lymphomas, as five patients were post-hoc disregarded when an invasive, high-grade gastric lymphoma (3c) or plasmocytoma (2c) was subsequently demonstrated. Of these 19 patients, all had T1 lesions except for two with T2 lesions; one patient had a gastroduodenal T1 lymphoma. Echographic findings with MPs were compared to EUS (gold standard) and histology both before and after eradication. Then, patients were followed up every 1-3-6 months using videoendoscopy and MPs. RESULTS Echoendoscopy correctly identified T stages in 90% of cases. MPs identified T stages in 88% of cases, and N stages in 33% of cases, with results being slightly inferior to those obtained with conventional EUS (91 vs. 45%); they were consequently used for follow-up. After eradication, all but two patients are in complete remission and have been followed every 1-3-6 months using MPs without echographic abnormalities, except for a patient who relapsed.
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Affiliation(s)
- M J Varas
- Unit of Echoendoscopy, Centro Médico Teknon, CIMA, Centro Médico Delfos, Barcelona, Spain.
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Fernández Esparrach G, Castellote J, Xiol X, Guardiola J, Santín M, Rota R, Podzamczer D, Miquel JM. [Diagnosis and treatment of esophageal ulcers in patients seropositive for the human immunodeficiency virus (HIV-positive)]. Rev Esp Enferm Dig 1993; 84:81-4. [PMID: 8398377] [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] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Esophageal ulcers are often found in patients with human immunodeficiency virus infection. We have retrospectively reviewed the upper endoscopies performed in these patients during the last four years. 149 examinations were realized in 73 patients. Fourteen patients with esophageal ulcers were diagnosed. A severe immunological impairment was present in all patients (CD4 24.4 +/- 31.1 cells/ul). Symptoms were non-specific, with prevailing dysphagia and odynophagia. The etiological diagnosis was reached by histological studies and cultures in 5 cases (36%), three due to Herpes virus type I, one due to Cytomegalovirus and another one to Mycobacterium tuberculosis. Patients with multiple ulcers or small ones were successfully treated with antiviral drugs, even when the etiological studies were negative. Corticosteroids were useful in single and large ulcers in which diagnostic tests were negative.
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Sapp WJ, Philpott DE, Williams CS, Williams JW, Kato K, Miquel JM, Serova L. Comparative study of spermatogonial survival after x-ray exposure, high LET (HZE) irradiation or spaceflight. Adv Space Res 1992; 12:179-189. [PMID: 11537007 DOI: 10.1016/0273-1177(92)90106-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Spermatogonial cell loss has been observed in rats flown on Space Lab 3, Cosmos 1887, Cosmos 2044 and in mice following irradiation with X-ray or with high energy (HZE) particle beams. Spermatogonial loss is determined by cell counting in maturation stage 6 seminiferous [correction of seminferous] tubules. With the exception of Iron, laboratory irradiation experiments (with mice) revealed a similar pattern of spermatogonial loss proportional to the radiation dose at levels less than 0.1 Gy. Helium and Argon irradiation resulted in a 5% loss of spermatogonia after only 0.01 Gy exposure. However, significant spermatogonial loss (45%) occured at this radiation level with Iron particle beams. The loss of spermatogonia during each space flight was less than 10% when compared to control (non-flight) animals. This loss, although small, was significant. Although radiation may be a contributing factor in the loss of spermatogonia during space flight, exposure levels, as determined by dosimetry, were not significant to account for the total cell loss observed.
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Affiliation(s)
- W J Sapp
- Department of Biology, Tuskegee University, AL 36088
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Abstract
Twelve cases of superficial carcinoma of the esophagus, representing 4.9% of patients with carcinoma of the esophagus, were evaluated. All the patients were male smokers who drank alcohol excessively. The main clinical features were dysphagia, asthenia, anorexia, and weight loss. Most of the lesions were elevated and all endoscopic biopsies were positive for cancer. Half of the cases showed invasion of the submucosa; the remainder involved mucosa only. Ten patients are alive and free of metastatic disease.
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Benasco C, Casanovas T, Pou JM, Miquel JM. [Adenomas of the colon and rectum. Analysis of a series of 218 patients]. Rev Esp Enferm Apar Dig 1983; 63:149-62. [PMID: 6856932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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