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Powles T, Tomczak P, Park SH, Venugopal B, Ferguson T, Symeonides SN, Hajek J, Gurney H, Chang YH, Lee JL, Sarwar N, Thiery-Vuillemin A, Gross-Goupil M, Mahave M, Haas NB, Sawrycki P, Burgents JE, Xu L, Imai K, Quinn DI, Choueiri TK, Choueiri T, Park SH, Venugopal B, Ferguson TR, Hajek J, Lin TP, Symeonides SN, Lee JL, Sawrycki P, Haas NB, Gurney HP, Mahave M, Sarwar N, Thiery-Vuillemin A, Gross-Goupil M, Chevreau C, Burke JM, Doshi G, Melichar B, Topart D, Oudard S, Kopyltsov E, Hammers HJ, Quinn DI, Alva A, Menezes JDJ, Silva AGE, Winquist EW, Hamzaj A, Procopio G, Karaszewska B, Nowakowska-Zajdel EM, Alekseev BY, Gafanov RA, Izmailov A, Semenov A, Afanasyev SG, Lipatov ON, Powles TB, Srinivas S, McDermott D, Kochuparambil ST, Davis ID, Peltola K, Sabbatini R, Chung J, Shkolnik MI, Matveev VB, Gajate Borau P, McCune S, Hutson TE, Dri A, Sales SC, Yeung C, Alcala Castro CM, Bostrom P, Laguerre B, Buttigliero C, de Giorgi U, Fomin EA, Zakharia Y, Hwang C, Singer EA, Yorio JT, Waterhouse D, Kowalyszyn RD, Alfie MS, Yanez Ruiz E, Buchler T, Kankaanranta K, Ferretti G, Kimura G, Nishimura K, Masumori N, Tamada S, Kato H, Kitamura H, Danielewicz I, Wojcik-Tomaszewska J, Sala Gonzalez N, Chiu KY, Atkins MB, Heath E, Rojas-Uribe GA, Gonzalez Fernandez ME, Feyerabend S, Pignata S, Numakura K, Cybulska Stopa B, Zukov R, Climent Duran MA, Maroto Rey PJ, Montesa Pino A, Chang CH, Vengalil S, Waddell TS, Cobb PW, Hauke R, Anderson DM, Sarantopoulos J, Gourdin T, Zhang T, Jayram G, Fein LE, Harris C, Beato PMM, Flores F, Estay A, Rubiano JA, Bedke J, Hauser S, Neisius A, Busch J, Anai S, Tsunemori H, Sawka D, Sikora-Kupis B, Arranz JA, Delgado I, Chen CH, Gunderson E, Tykodi S, Koletsky A, Chen K, Agrawal M, Kaen DL, Sade JP, Tatangelo MD, Parnis F, Barbosa FM, Faucher G, Iqbal N, Marceau D, Paradis JB, Hanna N, Acevedo A, Ibanez C, Villanueva L, Galaz PP, Durango IC, Manneh R, Kral Z, Holeckova P, Hakkarainen H, Ronkainen H, Abadie-Lacourtoisie S, Tartas S, Goebell PJ, Grimm MO, Hoefner T, Wirth M, Panic A, Schultze-Seemann W, Yokomizo A, Mizuno R, Uemura H, Eto M, Tsujihata M, Matsukawa Y, Murakami Y, Kim M, Hamberg P, Marczewska-Skrodzka M, Szczylik C, Humphreys AC, Jiang P, Kumar B, Lu G, Desai A, Karam JA, Keogh G, Fleming M, Zarba JJ, Leiva VE, Mendez GA, Harris SJ, Brown SJ, Antonio Junior JN, Costamilan RDC, Rocha RO, Muniz D, Brust L, Lalani AK, Graham J, Levesque M, Orlandi F, Kotasek R, Deville JL, Borchiellini D, Merseburger A, Rink M, Roos F, McDermott R, Oyama M, Yamamoto Y, Tomita Y, Miura Y, Ioritani N, Westgeest H, Kubiatowski T, Bal W, Girones Sarrio R, Rowe J, Prow DM, Senecal F, Hashemi-Sadraei N, Cole SW, Kendall SD, Richards DA, Schnadig ID, Gupta M. Pembrolizumab versus placebo as post-nephrectomy adjuvant therapy for clear cell renal cell carcinoma (KEYNOTE-564): 30-month follow-up analysis of a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol 2022; 23:1133-1144. [PMID: 36055304 DOI: 10.1016/s1470-2045(22)00487-9] [Citation(s) in RCA: 110] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/08/2022] [Accepted: 07/19/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND The first interim analysis of the KEYNOTE-564 study showed improved disease-free survival with adjuvant pembrolizumab compared with placebo after surgery in patients with clear cell renal cell carcinoma at an increased risk of recurrence. The analysis reported here, with an additional 6 months of follow-up, was designed to assess longer-term efficacy and safety of pembrolizumab versus placebo, as well as additional secondary and exploratory endpoints. METHODS In the multicentre, randomised, double-blind, placebo-controlled, phase 3 KEYNOTE-564 trial, adults aged 18 years or older with clear cell renal cell carcinoma with an increased risk of recurrence were enrolled at 213 hospitals and cancer centres in North America, South America, Europe, Asia, and Australia. Eligible participants had an Eastern Cooperative Oncology Group performance status of 0 or 1, had undergone nephrectomy 12 weeks or less before randomisation, and had not received previous systemic therapy for advanced renal cell carcinoma. Participants were randomly assigned (1:1) via central permuted block randomisation (block size of four) to receive pembrolizumab 200 mg or placebo intravenously every 3 weeks for up to 17 cycles. Randomisation was stratified by metastatic disease status (M0 vs M1), and the M0 group was further stratified by ECOG performance status and geographical region. All participants and investigators involved in study treatment administration were masked to the treatment group assignment. The primary endpoint was disease-free survival by investigator assessment in the intention-to-treat population (all participants randomly assigned to a treatment). Safety was assessed in the safety population, comprising all participants who received at least one dose of pembrolizumab or placebo. As the primary endpoint was met at the first interim analysis, updated data are reported without p values. This study is ongoing, but no longer recruiting, and is registered with ClinicalTrials.gov, NCT03142334. FINDINGS Between June 30, 2017, and Sept 20, 2019, 994 participants were assigned to receive pembrolizumab (n=496) or placebo (n=498). Median follow-up, defined as the time from randomisation to data cutoff (June 14, 2021), was 30·1 months (IQR 25·7-36·7). Disease-free survival was better with pembrolizumab compared with placebo (HR 0·63 [95% CI 0·50-0·80]). Median disease-free survival was not reached in either group. The most common all-cause grade 3-4 adverse events were hypertension (in 14 [3%] of 496 participants) and increased alanine aminotransferase (in 11 [2%]) in the pembrolizumab group, and hypertension (in 13 [3%] of 498 participants) in the placebo group. Serious adverse events attributed to study treatment occurred in 59 (12%) participants in the pembrolizumab group and one (<1%) participant in the placebo group. No deaths were attributed to pembrolizumab. INTERPRETATION Updated results from KEYNOTE-564 support the use of adjuvant pembrolizumab monotherapy as a standard of care for participants with renal cell carcinoma with an increased risk of recurrence after nephrectomy. FUNDING Merck Sharp & Dohme LLC, a subsidiary of Merck & Co, Inc, Rahway, NJ, USA.
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Affiliation(s)
- Thomas Powles
- Royal Free Hospital NHS Foundation Trust, University College London, London, UK; Barts Cancer Institute, Experimental Cancer Medicine Centre, Queen Mary University of London, St Bartholomew's Hospital, London, UK.
| | - Piotr Tomczak
- Poznań University of Medical Sciences, Poznań, Poland
| | - Se Hoon Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Balaji Venugopal
- Beatson West of Scotland Cancer Centre, Glasgow, UK; Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | - Stefan N Symeonides
- Cancer Research UK Edinburgh Centre, Edinburgh, UK; Edinburgh Cancer Centre, Edinburgh, UK; Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | | | - Howard Gurney
- Department of Clinical Medicine, Macquarie University, Sydney, NSW, Australia
| | | | - Jae Lyun Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | | | | | | | | | - Piotr Sawrycki
- Wojewódzki Szpital Zespolony im L Rydygiera w Toruniu, Torun, Poland
| | | | - Lei Xu
- Merck & Co, Inc, Rahway, NJ, USA
| | | | - David I Quinn
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
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Gomez H, Neciosup S, Tosello C, Mano M, Bines J, Ismael G, Santi PX, Pinczowsky H, Neron Y, Fanelli M, Fein L, Sampaio C, Lerzo G, Capo A, Zarba JJ, Blajman C, Varela MS, Martínez-Mesa J, Werutsky G, Barrios CH. Abstract P4-12-26: A phase II randomized study of lapatinib in combination with capecitabine, vinorelbine or gemcitabine as first or second line-therapy in patients with HER2 positive metastatic breast cancer progressing after taxane (LACOG 0801). Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p4-12-26] [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:
Lapatinib-Capecitabine (LC) is approved for the treatment of advanced or metastatic breast cancer (MBC) whose tumors overexpress HER2 and who have received prior therapy including an anthracycline, a taxane (T), and trastuzumab (H). LACOG 0801 evaluated different L-based chemotherapies as first and second-line treatments in MBC.
Methods:
This is a randomized, open label, multicenter, phase II trial of L 1250 mg BID given continuously in combination with C 2000 mg/m2 d1-14 (LC), or Vinorelbine (V) 25mg/m2 d1 and 8 (LV) or Gemcitabine (G) 1000 mg/m2 d1 and 8 (LG), in 21 days cycles. Primary endpoint was ORR (RECIST). Secondary endpoints included progression free survival (PFS), overall survival, tolerability and safety. Patients with HER2 positive MBC who had failed a T-based treatment and who had ≤1 chemotherapy regimen in the metastatic setting were included. Prior therapy with H was not mandatory. Patients were stratified by the presence of liver metastasis, previous use of H, and T administered in the neo/adjuvant or the metastatic setting. With an expected ORR of 23% in the control arm (LC), we hypothesized an absolute increase of 12% in the experimental arms using Simon's design.
Results:
A total of 142 pts from Argentina, Brazil and Peru were included from 2009-2012. Patient baseline characteristics were well balanced between the three arms. Median age was 51y, 58% postmenopausal, 65% ECOG 1, 49% had visceral disease (32% liver metastasis), 57% hormone receptor negative and only 47% had received prior H. Median number of administered cycles was 6 (LC = 5; LV = 7; LG = 6). ORR was 47.1% (95%CI 38.5; 67.1), 55.6% (95%CI 29.6; 60.0) and 41.3% (95%CI 43.2; 73.0) in LC, LV and LG, respectively. Median PFS was 9.1m (95%CI 6.1; 14.7), 7.0m (95%CI 5.0; 9.9) and 6.8m (95%CI 5.8; 9.9) in LC, LV and LG arms respectively. Survival data will be updated. The proportion of patients with at least one adverse event (AE) was 96% in all arms. Most common all grade AE were diarrhea (76%), hand-foot syndrome (HFS) (45%) and vomiting (39%) in LC; diarrhea (71%), neutropenia (68%) and nausea (43%) in LV; diarrhea (64%), neutropenia (60%), anemia and increased ALT both 44% in LG. The most frequent grade 3 and 4 AEs were HFS (18%), diarrhea (6%) and increased ALT/AST (4%) in LC; neutropenia (36%), diarrhea (9%) and febrile neutropenia (6%) in LV; and neutropenia (47%), ALT/AST elevation (13%) and rash (4%) in LG. Discontinuation due to toxicity occurred in 16%, 7% and 20% of patients in arms LC, LV and LG respectively.
Conclusion:
LV and LG seems to be active combinations in patients with HER2 positive MBC after T failure. The high ORR observed in this study might be explained, among other factors, by the inclusion of patients with less prior treatment exposure. No new safety signals where reported with these two novel Lapatinib/chemotherapy combinations. The different side effect profile may help in selecting the most appropriate regimen for a particular patient.
Sponsor: Latin American Cooperative Oncology Group (LACOG) with support from GlaxoSmithKline.
ClinicalTrials.gov number NCT01050322.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-12-26.
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Affiliation(s)
- H Gomez
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil; Instituto Nacional de Câncer do Brasil, Rio de Janeiro, Brazil; Fundação Doutor Amaral Carvalho, Jaú, Brazil; Faculdade de Medicina do ABC, Santo André, Brazil; Centro de Pesquisas Oncológicas de Santa Catarina, Florianópolis, Brazil; Hospital A.C. Camargo, São Paulo, Brazil; Centro Oncológico de Rosário, Rosario, Argentina; Clinica Amo, Salvador, Brazil; Investigaciones Clinicas Ciudad de Buenos Aires, Buenos Aires, Argentina; Fundación Centro Oncológico de Integración Regional, Mendoza, Argentina; Centro San Roque, Tucuman, Argentina; ISIS Clínica Especializada, Santa Fé, Argentina; CER Instituto Médico, Buenos Aires, Argentina; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; PUCRS School of Medicine, Hospital São Lucas, Porto Alegre, Brazil
| | - S Neciosup
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil; Instituto Nacional de Câncer do Brasil, Rio de Janeiro, Brazil; Fundação Doutor Amaral Carvalho, Jaú, Brazil; Faculdade de Medicina do ABC, Santo André, Brazil; Centro de Pesquisas Oncológicas de Santa Catarina, Florianópolis, Brazil; Hospital A.C. Camargo, São Paulo, Brazil; Centro Oncológico de Rosário, Rosario, Argentina; Clinica Amo, Salvador, Brazil; Investigaciones Clinicas Ciudad de Buenos Aires, Buenos Aires, Argentina; Fundación Centro Oncológico de Integración Regional, Mendoza, Argentina; Centro San Roque, Tucuman, Argentina; ISIS Clínica Especializada, Santa Fé, Argentina; CER Instituto Médico, Buenos Aires, Argentina; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; PUCRS School of Medicine, Hospital São Lucas, Porto Alegre, Brazil
| | - C Tosello
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil; Instituto Nacional de Câncer do Brasil, Rio de Janeiro, Brazil; Fundação Doutor Amaral Carvalho, Jaú, Brazil; Faculdade de Medicina do ABC, Santo André, Brazil; Centro de Pesquisas Oncológicas de Santa Catarina, Florianópolis, Brazil; Hospital A.C. Camargo, São Paulo, Brazil; Centro Oncológico de Rosário, Rosario, Argentina; Clinica Amo, Salvador, Brazil; Investigaciones Clinicas Ciudad de Buenos Aires, Buenos Aires, Argentina; Fundación Centro Oncológico de Integración Regional, Mendoza, Argentina; Centro San Roque, Tucuman, Argentina; ISIS Clínica Especializada, Santa Fé, Argentina; CER Instituto Médico, Buenos Aires, Argentina; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; PUCRS School of Medicine, Hospital São Lucas, Porto Alegre, Brazil
| | - M Mano
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil; Instituto Nacional de Câncer do Brasil, Rio de Janeiro, Brazil; Fundação Doutor Amaral Carvalho, Jaú, Brazil; Faculdade de Medicina do ABC, Santo André, Brazil; Centro de Pesquisas Oncológicas de Santa Catarina, Florianópolis, Brazil; Hospital A.C. Camargo, São Paulo, Brazil; Centro Oncológico de Rosário, Rosario, Argentina; Clinica Amo, Salvador, Brazil; Investigaciones Clinicas Ciudad de Buenos Aires, Buenos Aires, Argentina; Fundación Centro Oncológico de Integración Regional, Mendoza, Argentina; Centro San Roque, Tucuman, Argentina; ISIS Clínica Especializada, Santa Fé, Argentina; CER Instituto Médico, Buenos Aires, Argentina; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; PUCRS School of Medicine, Hospital São Lucas, Porto Alegre, Brazil
| | - J Bines
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil; Instituto Nacional de Câncer do Brasil, Rio de Janeiro, Brazil; Fundação Doutor Amaral Carvalho, Jaú, Brazil; Faculdade de Medicina do ABC, Santo André, Brazil; Centro de Pesquisas Oncológicas de Santa Catarina, Florianópolis, Brazil; Hospital A.C. Camargo, São Paulo, Brazil; Centro Oncológico de Rosário, Rosario, Argentina; Clinica Amo, Salvador, Brazil; Investigaciones Clinicas Ciudad de Buenos Aires, Buenos Aires, Argentina; Fundación Centro Oncológico de Integración Regional, Mendoza, Argentina; Centro San Roque, Tucuman, Argentina; ISIS Clínica Especializada, Santa Fé, Argentina; CER Instituto Médico, Buenos Aires, Argentina; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; PUCRS School of Medicine, Hospital São Lucas, Porto Alegre, Brazil
| | - G Ismael
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil; Instituto Nacional de Câncer do Brasil, Rio de Janeiro, Brazil; Fundação Doutor Amaral Carvalho, Jaú, Brazil; Faculdade de Medicina do ABC, Santo André, Brazil; Centro de Pesquisas Oncológicas de Santa Catarina, Florianópolis, Brazil; Hospital A.C. Camargo, São Paulo, Brazil; Centro Oncológico de Rosário, Rosario, Argentina; Clinica Amo, Salvador, Brazil; Investigaciones Clinicas Ciudad de Buenos Aires, Buenos Aires, Argentina; Fundación Centro Oncológico de Integración Regional, Mendoza, Argentina; Centro San Roque, Tucuman, Argentina; ISIS Clínica Especializada, Santa Fé, Argentina; CER Instituto Médico, Buenos Aires, Argentina; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; PUCRS School of Medicine, Hospital São Lucas, Porto Alegre, Brazil
| | - PX Santi
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil; Instituto Nacional de Câncer do Brasil, Rio de Janeiro, Brazil; Fundação Doutor Amaral Carvalho, Jaú, Brazil; Faculdade de Medicina do ABC, Santo André, Brazil; Centro de Pesquisas Oncológicas de Santa Catarina, Florianópolis, Brazil; Hospital A.C. Camargo, São Paulo, Brazil; Centro Oncológico de Rosário, Rosario, Argentina; Clinica Amo, Salvador, Brazil; Investigaciones Clinicas Ciudad de Buenos Aires, Buenos Aires, Argentina; Fundación Centro Oncológico de Integración Regional, Mendoza, Argentina; Centro San Roque, Tucuman, Argentina; ISIS Clínica Especializada, Santa Fé, Argentina; CER Instituto Médico, Buenos Aires, Argentina; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; PUCRS School of Medicine, Hospital São Lucas, Porto Alegre, Brazil
| | - H Pinczowsky
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil; Instituto Nacional de Câncer do Brasil, Rio de Janeiro, Brazil; Fundação Doutor Amaral Carvalho, Jaú, Brazil; Faculdade de Medicina do ABC, Santo André, Brazil; Centro de Pesquisas Oncológicas de Santa Catarina, Florianópolis, Brazil; Hospital A.C. Camargo, São Paulo, Brazil; Centro Oncológico de Rosário, Rosario, Argentina; Clinica Amo, Salvador, Brazil; Investigaciones Clinicas Ciudad de Buenos Aires, Buenos Aires, Argentina; Fundación Centro Oncológico de Integración Regional, Mendoza, Argentina; Centro San Roque, Tucuman, Argentina; ISIS Clínica Especializada, Santa Fé, Argentina; CER Instituto Médico, Buenos Aires, Argentina; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; PUCRS School of Medicine, Hospital São Lucas, Porto Alegre, Brazil
| | - Y Neron
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil; Instituto Nacional de Câncer do Brasil, Rio de Janeiro, Brazil; Fundação Doutor Amaral Carvalho, Jaú, Brazil; Faculdade de Medicina do ABC, Santo André, Brazil; Centro de Pesquisas Oncológicas de Santa Catarina, Florianópolis, Brazil; Hospital A.C. Camargo, São Paulo, Brazil; Centro Oncológico de Rosário, Rosario, Argentina; Clinica Amo, Salvador, Brazil; Investigaciones Clinicas Ciudad de Buenos Aires, Buenos Aires, Argentina; Fundación Centro Oncológico de Integración Regional, Mendoza, Argentina; Centro San Roque, Tucuman, Argentina; ISIS Clínica Especializada, Santa Fé, Argentina; CER Instituto Médico, Buenos Aires, Argentina; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; PUCRS School of Medicine, Hospital São Lucas, Porto Alegre, Brazil
| | - M Fanelli
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil; Instituto Nacional de Câncer do Brasil, Rio de Janeiro, Brazil; Fundação Doutor Amaral Carvalho, Jaú, Brazil; Faculdade de Medicina do ABC, Santo André, Brazil; Centro de Pesquisas Oncológicas de Santa Catarina, Florianópolis, Brazil; Hospital A.C. Camargo, São Paulo, Brazil; Centro Oncológico de Rosário, Rosario, Argentina; Clinica Amo, Salvador, Brazil; Investigaciones Clinicas Ciudad de Buenos Aires, Buenos Aires, Argentina; Fundación Centro Oncológico de Integración Regional, Mendoza, Argentina; Centro San Roque, Tucuman, Argentina; ISIS Clínica Especializada, Santa Fé, Argentina; CER Instituto Médico, Buenos Aires, Argentina; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; PUCRS School of Medicine, Hospital São Lucas, Porto Alegre, Brazil
| | - L Fein
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil; Instituto Nacional de Câncer do Brasil, Rio de Janeiro, Brazil; Fundação Doutor Amaral Carvalho, Jaú, Brazil; Faculdade de Medicina do ABC, Santo André, Brazil; Centro de Pesquisas Oncológicas de Santa Catarina, Florianópolis, Brazil; Hospital A.C. Camargo, São Paulo, Brazil; Centro Oncológico de Rosário, Rosario, Argentina; Clinica Amo, Salvador, Brazil; Investigaciones Clinicas Ciudad de Buenos Aires, Buenos Aires, Argentina; Fundación Centro Oncológico de Integración Regional, Mendoza, Argentina; Centro San Roque, Tucuman, Argentina; ISIS Clínica Especializada, Santa Fé, Argentina; CER Instituto Médico, Buenos Aires, Argentina; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; PUCRS School of Medicine, Hospital São Lucas, Porto Alegre, Brazil
| | - C Sampaio
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil; Instituto Nacional de Câncer do Brasil, Rio de Janeiro, Brazil; Fundação Doutor Amaral Carvalho, Jaú, Brazil; Faculdade de Medicina do ABC, Santo André, Brazil; Centro de Pesquisas Oncológicas de Santa Catarina, Florianópolis, Brazil; Hospital A.C. Camargo, São Paulo, Brazil; Centro Oncológico de Rosário, Rosario, Argentina; Clinica Amo, Salvador, Brazil; Investigaciones Clinicas Ciudad de Buenos Aires, Buenos Aires, Argentina; Fundación Centro Oncológico de Integración Regional, Mendoza, Argentina; Centro San Roque, Tucuman, Argentina; ISIS Clínica Especializada, Santa Fé, Argentina; CER Instituto Médico, Buenos Aires, Argentina; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; PUCRS School of Medicine, Hospital São Lucas, Porto Alegre, Brazil
| | - G Lerzo
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil; Instituto Nacional de Câncer do Brasil, Rio de Janeiro, Brazil; Fundação Doutor Amaral Carvalho, Jaú, Brazil; Faculdade de Medicina do ABC, Santo André, Brazil; Centro de Pesquisas Oncológicas de Santa Catarina, Florianópolis, Brazil; Hospital A.C. Camargo, São Paulo, Brazil; Centro Oncológico de Rosário, Rosario, Argentina; Clinica Amo, Salvador, Brazil; Investigaciones Clinicas Ciudad de Buenos Aires, Buenos Aires, Argentina; Fundación Centro Oncológico de Integración Regional, Mendoza, Argentina; Centro San Roque, Tucuman, Argentina; ISIS Clínica Especializada, Santa Fé, Argentina; CER Instituto Médico, Buenos Aires, Argentina; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; PUCRS School of Medicine, Hospital São Lucas, Porto Alegre, Brazil
| | - A Capo
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil; Instituto Nacional de Câncer do Brasil, Rio de Janeiro, Brazil; Fundação Doutor Amaral Carvalho, Jaú, Brazil; Faculdade de Medicina do ABC, Santo André, Brazil; Centro de Pesquisas Oncológicas de Santa Catarina, Florianópolis, Brazil; Hospital A.C. Camargo, São Paulo, Brazil; Centro Oncológico de Rosário, Rosario, Argentina; Clinica Amo, Salvador, Brazil; Investigaciones Clinicas Ciudad de Buenos Aires, Buenos Aires, Argentina; Fundación Centro Oncológico de Integración Regional, Mendoza, Argentina; Centro San Roque, Tucuman, Argentina; ISIS Clínica Especializada, Santa Fé, Argentina; CER Instituto Médico, Buenos Aires, Argentina; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; PUCRS School of Medicine, Hospital São Lucas, Porto Alegre, Brazil
| | - JJ Zarba
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil; Instituto Nacional de Câncer do Brasil, Rio de Janeiro, Brazil; Fundação Doutor Amaral Carvalho, Jaú, Brazil; Faculdade de Medicina do ABC, Santo André, Brazil; Centro de Pesquisas Oncológicas de Santa Catarina, Florianópolis, Brazil; Hospital A.C. Camargo, São Paulo, Brazil; Centro Oncológico de Rosário, Rosario, Argentina; Clinica Amo, Salvador, Brazil; Investigaciones Clinicas Ciudad de Buenos Aires, Buenos Aires, Argentina; Fundación Centro Oncológico de Integración Regional, Mendoza, Argentina; Centro San Roque, Tucuman, Argentina; ISIS Clínica Especializada, Santa Fé, Argentina; CER Instituto Médico, Buenos Aires, Argentina; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; PUCRS School of Medicine, Hospital São Lucas, Porto Alegre, Brazil
| | - C Blajman
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil; Instituto Nacional de Câncer do Brasil, Rio de Janeiro, Brazil; Fundação Doutor Amaral Carvalho, Jaú, Brazil; Faculdade de Medicina do ABC, Santo André, Brazil; Centro de Pesquisas Oncológicas de Santa Catarina, Florianópolis, Brazil; Hospital A.C. Camargo, São Paulo, Brazil; Centro Oncológico de Rosário, Rosario, Argentina; Clinica Amo, Salvador, Brazil; Investigaciones Clinicas Ciudad de Buenos Aires, Buenos Aires, Argentina; Fundación Centro Oncológico de Integración Regional, Mendoza, Argentina; Centro San Roque, Tucuman, Argentina; ISIS Clínica Especializada, Santa Fé, Argentina; CER Instituto Médico, Buenos Aires, Argentina; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; PUCRS School of Medicine, Hospital São Lucas, Porto Alegre, Brazil
| | - MS Varela
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil; Instituto Nacional de Câncer do Brasil, Rio de Janeiro, Brazil; Fundação Doutor Amaral Carvalho, Jaú, Brazil; Faculdade de Medicina do ABC, Santo André, Brazil; Centro de Pesquisas Oncológicas de Santa Catarina, Florianópolis, Brazil; Hospital A.C. Camargo, São Paulo, Brazil; Centro Oncológico de Rosário, Rosario, Argentina; Clinica Amo, Salvador, Brazil; Investigaciones Clinicas Ciudad de Buenos Aires, Buenos Aires, Argentina; Fundación Centro Oncológico de Integración Regional, Mendoza, Argentina; Centro San Roque, Tucuman, Argentina; ISIS Clínica Especializada, Santa Fé, Argentina; CER Instituto Médico, Buenos Aires, Argentina; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; PUCRS School of Medicine, Hospital São Lucas, Porto Alegre, Brazil
| | - J Martínez-Mesa
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil; Instituto Nacional de Câncer do Brasil, Rio de Janeiro, Brazil; Fundação Doutor Amaral Carvalho, Jaú, Brazil; Faculdade de Medicina do ABC, Santo André, Brazil; Centro de Pesquisas Oncológicas de Santa Catarina, Florianópolis, Brazil; Hospital A.C. Camargo, São Paulo, Brazil; Centro Oncológico de Rosário, Rosario, Argentina; Clinica Amo, Salvador, Brazil; Investigaciones Clinicas Ciudad de Buenos Aires, Buenos Aires, Argentina; Fundación Centro Oncológico de Integración Regional, Mendoza, Argentina; Centro San Roque, Tucuman, Argentina; ISIS Clínica Especializada, Santa Fé, Argentina; CER Instituto Médico, Buenos Aires, Argentina; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; PUCRS School of Medicine, Hospital São Lucas, Porto Alegre, Brazil
| | - G Werutsky
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil; Instituto Nacional de Câncer do Brasil, Rio de Janeiro, Brazil; Fundação Doutor Amaral Carvalho, Jaú, Brazil; Faculdade de Medicina do ABC, Santo André, Brazil; Centro de Pesquisas Oncológicas de Santa Catarina, Florianópolis, Brazil; Hospital A.C. Camargo, São Paulo, Brazil; Centro Oncológico de Rosário, Rosario, Argentina; Clinica Amo, Salvador, Brazil; Investigaciones Clinicas Ciudad de Buenos Aires, Buenos Aires, Argentina; Fundación Centro Oncológico de Integración Regional, Mendoza, Argentina; Centro San Roque, Tucuman, Argentina; ISIS Clínica Especializada, Santa Fé, Argentina; CER Instituto Médico, Buenos Aires, Argentina; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; PUCRS School of Medicine, Hospital São Lucas, Porto Alegre, Brazil
| | - CH Barrios
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil; Instituto Nacional de Câncer do Brasil, Rio de Janeiro, Brazil; Fundação Doutor Amaral Carvalho, Jaú, Brazil; Faculdade de Medicina do ABC, Santo André, Brazil; Centro de Pesquisas Oncológicas de Santa Catarina, Florianópolis, Brazil; Hospital A.C. Camargo, São Paulo, Brazil; Centro Oncológico de Rosário, Rosario, Argentina; Clinica Amo, Salvador, Brazil; Investigaciones Clinicas Ciudad de Buenos Aires, Buenos Aires, Argentina; Fundación Centro Oncológico de Integración Regional, Mendoza, Argentina; Centro San Roque, Tucuman, Argentina; ISIS Clínica Especializada, Santa Fé, Argentina; CER Instituto Médico, Buenos Aires, Argentina; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; PUCRS School of Medicine, Hospital São Lucas, Porto Alegre, Brazil
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