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Hernández JJC, Arrula VA, Álvarez YE, Castaño AG, de Castro JJG, Docampo LI, Sorrosal JL, Segura PP, Domínguez AR, Campos-Lucas FJ, Rodríguez IS, Bessa M, Gratal P, Caballero-Martínez F, Martín DM, Antón-Rodríguez C, López R. Indicators to evaluate quality of care in head and neck cancer in Spain. Clin Transl Oncol 2024; 26:1089-1097. [PMID: 37848694 PMCID: PMC11026290 DOI: 10.1007/s12094-023-03298-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/25/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE This study aimed to develop a set of criteria and indicators to evaluate the quality of care of patients with head and neck cancer (HNC). METHODS A systematic literature review was conducted to identify valuable criteria/indicators for the assessment of the quality of care in HNC. With the aid of a technical group, a scientific committee of oncologists specialised in HNC used selected criteria to propose indicators that were evaluated with a two-round Delphi method. Indicators on which consensus was achieved were then prioritised by the scientific committee to develop a final set of indicators. RESULTS We proposed a list of 50 indicators used in the literature or developed by us to be evaluated with a Delphi method. There was consensus on the appropriateness of 47 indicators in the first round; the remaining 3 achieved consensus in the second round. The 50 indicators were scored to prioritise them, leading to a final selection of 29 indicators related to structure (3), process (22), or outcome (4) and covering diagnosis, treatment, follow-up, and health outcomes in patients with HNC. Easy-to-use index cards were developed for each indicator, with their criterion, definition, formula for use in real-world clinical practice, rationale, and acceptable level of attainment. CONCLUSIONS We have developed a set of 29 evidence-based and expert-supported indicators for evaluating the quality of care in HNC, covering diagnosis, treatment, follow-up, and health outcomes.
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Affiliation(s)
- Juan Jesús Cruz Hernández
- Departamento de Medicina, Universidad de Salamanca, Consejero Emérito de la Fundación ECO, Campus Universitario Miguel de Unamuno s/n, 37007, Salamanca, Spain.
- Fundación ECO, Madrid, Spain.
| | | | - Yolanda Escobar Álvarez
- Fundación ECO, Madrid, Spain
- Servicio de Oncología Médica, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Almudena García Castaño
- Servicio de Oncología Médica, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | - Julio Lambea Sorrosal
- Servicio de Oncología Médica, Hospital Clínico Universitario Lozano Blesa, Saragossa, Spain
| | - Pedro Pérez Segura
- Fundación ECO, Madrid, Spain
- Servicio de Oncología Médica, Hospital Clínico San Carlos, Madrid, Spain
| | - Antonio Rueda Domínguez
- Fundación ECO, Madrid, Spain
- Servicio de Oncología Médica, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | | | | | | | | | | | | | - Rafael López
- Fundación ECO, Madrid, Spain
- Servicio de Oncología Médica, Hospital Clínico Universitario e Instituto de Investigación Sanitaria (IDIS) de Santiago de Compostela, CIBERONC, Santiago de Compostela, Spain
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Rubió-Casadevall J, Cirauqui Cirauqui B, Martinez Trufero J, Plana Serrahima M, García Castaño A, Carral Maseda A, Iglesias Docampo L, Pérez Segura P, Ceballos Lenza I, Gutiérrez Calderón V, Fuster Salvà J, Pena Álvarez C, Hernandez I, del Barco Morillo E, Chaves Conde M, Martínez Galán J, Durán Sánchez M, Quiroga V, Ortega E, Mesia R. TTCC-2019-02: real-world evidence of first-line cetuximab plus paclitaxel in recurrent or metastatic squamous cell carcinoma of the head and neck. Front Oncol 2023; 13:1226939. [PMID: 37601652 PMCID: PMC10432957 DOI: 10.3389/fonc.2023.1226939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/27/2023] [Indexed: 08/22/2023] Open
Abstract
Objectives The aim of this study was to confirm the efficacy of the ERBITAX scheme (paclitaxel 80 mg/m2 weekly and cetuximab 400 mg/m2 loading dose, and then 250 mg/m2 weekly) as first-line treatment for patients with recurrent/metastatic squamous cell carcinoma of the head and neck (SCCHN) who are medically unfit for cisplatin-based (PT) chemotherapy. Materials and methods This retrospective, non-interventional study involved 16 centers in Spain. Inclusion criteria were to have started receiving ERBITAX regimen from January 2012 to December 2018; histologically confirmed SCCHN including oral cavity, oropharynx, hypopharynx, and larynx; age ≥18 years; and platinum (PT) chemotherapy ineligibility due to performance status, comorbidities, high accumulated dose of PT, or PT refractoriness. Results A total of 531 patients from 16 hospitals in Spain were enrolled. The median age was 66 years, 82.7% were male, and 83.5% were current/former smokers. Patients were ineligible to receive PT due to ECOG 2 (50.3%), comorbidities (32%), PT cumulative dose ≥ 225 mg/m2 (10.5%), or PT refractoriness (7.2%). Response rate was 37.7%. Median duration of response was 5.6 months (95% CI: 4.4-6.6). With a median follow-up of 8.7 months (95% CI: 7.7-10.2), median PFS and OS were 4.5 months (95% CI: 3.9-5.0) and 8.9 months (95% CI: 7.8-10.3), respectively. Patients treated with immunotherapy after ERBITAX had better OS with a median of 29.8 months compared to 13.8 months for those who received other treatments. The most common grade ≥ 3 toxicities were acne-like rash in 36 patients (6.8%) and oral mucositis in 8 patients (1.5%). Five (0.9%) patients experienced grade ≥ 3 febrile neutropenia. Conclusion This study confirms the real-world efficacy and tolerability of ERBITAX as first-line treatment in recurrent/metastatic SCCHN when PT is not feasible. Immunotherapy after treatment with ERBITAX showed remarkable promising survival, despite potential selection bias.
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Affiliation(s)
- Jordi Rubió-Casadevall
- Medical Oncology Department, Institut Català d’Oncologia Girona, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Beatriz Cirauqui Cirauqui
- Medical Oncology Department, Institut Català d’Oncologia Badalona, B-ARGO Group, IGTP, Badalona, Spain
| | | | - Maria Plana Serrahima
- Medical Oncology Department, Institut Català d’Oncologia (ICO-Hospitalet), IDIBELL, Hospitalet de Llobregat, Llobregat, Spain
| | | | | | | | - Pedro Pérez Segura
- Medical Oncology Department, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Isaac Ceballos Lenza
- Medical Oncology Department, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Spain
| | | | - José Fuster Salvà
- Medical Oncology Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Irene Hernandez
- Medical Oncology Department, Hospital Universitario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Edel del Barco Morillo
- Medical Oncology Department, Hospital Universitario de Salamanca, IBSAL, Salamanca, Spain
| | - Manuel Chaves Conde
- Medical Oncology Department, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - Joaquina Martínez Galán
- Medical Oncology Department, Hospital Universitario Virgen Nieves, Instituto de Investigación Biosanitaria ibs, Granada, Spain
| | | | - Vanesa Quiroga
- Medical Oncology Department, Institut Català d’Oncologia Badalona, B-ARGO Group, IGTP, Badalona, Spain
| | - Eugenia Ortega
- Medical Oncology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Ricard Mesia
- Medical Oncology Department, Institut Català d’Oncologia Badalona, B-ARGO Group, IGTP, Badalona, Spain
- Spanish Group of Head and Neck Cancer Treatment (TTCC), Madrid, Spain
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3
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Hitt R, Mesía R, Lozano A, Iglesias Docampo L, Grau JJ, Taberna M, Rubió-Casadevall J, Martínez-Trufero J, Morillo EDB, García Girón C, Vázquez Estévez S, Cirauqui B, Cruz-Hernández JJ. Randomized phase 3 noninferiority trial of radiotherapy and cisplatin vs radiotherapy and cetuximab after docetaxel-cisplatin-fluorouracil induction chemotherapy in patients with locally advanced unresectable head and neck cancer. Oral Oncol 2022; 134:106087. [PMID: 36126605 DOI: 10.1016/j.oraloncology.2022.106087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 07/27/2022] [Accepted: 08/12/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Concurrent chemoradiotherapy is the standard treatment for patients with unresectable, locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN); induction chemotherapy (ICT) may provide survival benefits in some patients. This study aimed to demonstrate the noninferiority of concomitant cetuximab plus radiotherapy (cet+RT) vs cisplatin plus radiotherapy (cis+RT) in patients with unresectable LA-SCCHN who were responsive to ICT. MATERIALS AND METHODS This randomized, open-label, phase 3 trial studied patients with unresectable LA-SCCHN who received 3 cycles of ICT (docetaxel, cisplatin, and 5-fluorouracil; TPF) followed by cis+RT (standard arm) or cet+RT (experimental arm). The primary endpoint was noninferiority of the experimental arm vs the standard arm in terms of overall survival (OS), based on a hazard ratio (HR) of < 1.3. Secondary endpoints included progression-free survival, overall response, safety, and quality of life (QOL). RESULTS Between July 15, 2008, and July 5, 2013, 519 patients were recruited and started ICT; 407 patients received post-ICT treatment (cis+RT, n = 205; cet+RT, n = 202). At a median follow-up of 43.9 (cis+RT) and 41.1 (cet+RT) months, median OS was 63.6 and 42.9 months with cis+RT and cet+RT, respectively (HR [90% CI] = 1.106 [0.888-1.378], P =.4492). There were no differences in progression-free survival, overall response rates, or adverse event rates between groups. There was greater late neurotoxicity with cis+RT than cet+RT (P =.0058). Several QOL dimensions improved with cet+RT vs cis+RT (physical functioning, P =.0287; appetite loss, P =.0248; social contact, P =.0153). CONCLUSION Noninferiority of cet+RT over cis+RT was not demonstrated.
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Affiliation(s)
- Ricardo Hitt
- Medical Oncology Service, University Hospital Severo Ochoa, Leganés, Madrid, Spain.
| | - Ricard Mesía
- Medical Oncology Department, Institut Català d́Oncologia (ICO), Hospitalet, Barcelona, Spain
| | - Alicia Lozano
- Radiotherapy Oncology Department, Institut Català d́Oncologia (ICO), Hospitalet, Barcelona, Spain
| | | | - Juan J Grau
- Medical Oncology Department, Hospital Clinic, Barcelona, Spain
| | - Miren Taberna
- Medical Oncology Department, Institut Català d́Oncologia (ICO), ONCOBELL, IDIBELL, Hospitalet, Barcelona, Spain
| | - Jordi Rubió-Casadevall
- Medical Oncology Department, University Hospital Josep Trueta, Institut Català d'Oncologia (ICO), Girona, Spain
| | | | - Edel Del Barco Morillo
- Medical Oncology Service, University Hospital of Salamanca- IBSAL (Biomedical Research Institute of Salamanca), Salamanca, Spain
| | | | | | - Beatriz Cirauqui
- Medical Oncology Department, Institut Català d'Oncologia (ICO), Badalona Applied Research Group in Oncology (B-ARGO), Badalona, Spain
| | - Juan Jesús Cruz-Hernández
- Medical Oncology Service, University Hospital of Salamanca- IBSAL (Biomedical Research Institute of Salamanca), Salamanca, Spain
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Ribrag V, Wainberg ZA, Iglesias Docampo L, Ramkumar T, Barys L, Chen S, Raccuglia M, Wilbaux M, Beltz K, Luyt A, Fan YY, Suenaga N, Luo F, Dai X, Lai C, Chen J. Pharmacokinetic and pharmacodynamic activity evaluation of MAK683, a selective oral embryonic ectoderm development (EED) inhibitor, in adults with advanced malignancies in a first-in-human study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.3083] [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
3083 Background: Polycomb Repressive Complex 2 (PRC2) regulates transcription via trimethylation of histone H3 at lysine 27 (H3K27me3). Its dysregulation and over-expression are associated with tumorigenesis in several conditions. MAK683 is a potent oral inhibitor of PRC2 activation, allosterically targeting the EED–H3K27me3 binding site. Methods: NCT02900651 is an ongoing first-in-human dose-escalation study of MAK683 in adults with advanced malignancies. MAK683 was administered fasted once (QD) or twice daily (BID) on a continuous schedule in 28-day treatment cycles. The pharmacokinetic (PK) profile of MAK683 was assessed in sequential blood samples on Days 1, 8 and/or 15 of Cycles 1–6. MAK683 pharmacodynamic activity in Cycle 1, measured by change in H3K27me3, was evaluated in peripheral blood monocytes on Days 1, 8, and 15 by flow cytometry and in tumor biopsies at baseline and Day 15 by H-score. Results: As of Aug 30, 2021, 125 patients had received MAK683 at doses of 10–800 mg QD or 60–450 mg BID. MAK683 was well absorbed with a median Tmax of ̃1-4 hours across cohorts. PK exposure (Cmax, AUC) increased generally with dose over the entire dose range with no major deviation from dose proportionality, taking into account the sample size and PK variability. Apparent terminal half-life (geometric mean) was 2.5–6.6 hours across cohorts and constant over time. MAK683 accumulation of ̃0.9-2.2-fold (QD) or ̃1.3-2.0-fold (BID) was seen with repeat dosing. Peripheral monocytes showed substantial on-treatment reductions from baseline in the H3K27me3/H3 ratio across doses. Maximum percentage reduction was proportional to cumulative MAK683 AUC, with a trend towards greater reductions at higher baseline H3K27me3. H3K27me3 H-score reductions from baseline > 40 were observed in 7/10 patients with diffuse large B-cell lymphoma (n = 4) or epithelioid sarcoma (n = 6) and paired baseline–Day 15 biopsies. RNA-seq characterization of biopsy samples is ongoing. Conclusions: MAK683 has a PK profile supportive of QD or BID dosing in patients with advanced malignancies. Analysis of H3K27me3 in blood monocytes and tumor biopsy confirm the in vivo pharmacodynamic activity of MAK683. Clinical trial information: NCT02900651.
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Affiliation(s)
| | | | | | | | - Louise Barys
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Shuqi Chen
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Marc Raccuglia
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Mélanie Wilbaux
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Karen Beltz
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Amy Luyt
- Novartis Institutes for BioMedical Research, Cambridge, MA
| | - Yu Yun Fan
- Novartis Institutes for BioMedical Research Co. Ltd, Shanghai, China
| | | | - Fangjun Luo
- Novartis Institutes for BioMedical Research Co. Ltd, Shanghai, China
| | - Xuan Dai
- Novartis Institutes for BioMedical Research Co. Ltd, Shanghai, China
| | - Clinton Lai
- Novartis Institutes for BioMedical Research Co. Ltd, Shanghai, China
| | - Jia Chen
- Novartis Institutes for BioMedical Research Co. Ltd, Shanghai, China
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Garon EB, Scagliotti GV, Gautschi O, Reck M, Thomas M, Iglesias Docampo L, Kalofonos H, Kim JH, Gans S, Brustugun OT, Orlov SV, Cuyun Carter G, Zimmermann AH, Oton AB, Alexandris E, Lee P, Wolff K, Stefaniak VJ, Socinski MA, Pérol M. Exploratory analysis of front-line therapies in REVEL: a randomised phase 3 study of ramucirumab plus docetaxel versus docetaxel for the treatment of stage IV non-small-cell lung cancer after disease progression on platinum-based therapy. ESMO Open 2020; 5:e000567. [PMID: 31958290 PMCID: PMC7003392 DOI: 10.1136/esmoopen-2019-000567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/11/2019] [Accepted: 11/19/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Non-small-cell lung cancer (NSCLC) is a heterogeneous disease. Front-line therapy may affect responses to subsequent treatment regimens, thus influencing second-line therapy decision making. In the randomised phase 3 REVEL study, second-line ramucirumab plus docetaxel (ram+doc) versus docetaxel (doc) improved survival of patients with metastatic NSCLC. We explore efficacy, safety and quality-of-life (QoL) in REVEL based on front-line therapy. METHODS Patients were grouped by specific front-line therapy received. Overall survival (OS), progression-free survival (PFS), objective response rate, safety and QoL were assessed descriptively. Kaplan-Meier estimation and Cox proportional hazards modelling were used; frequencies reported in percentages. RESULTS Baseline characteristics of 1253 patients were generally well balanced between treatment arms within each front-line therapy subgroup. For patients with non-squamous disease (n=912), induction therapies included platinum-based chemotherapy plus a taxane (n=227; 25%) or pemetrexed (n=449; 49%), with (n=172; 19%) or without bevacizumab. For patients with squamous disease (n=328), induction therapies included platinum-based chemotherapy plus gemcitabine (n=176; 54%) or a taxane (n=69; 21%). A highly selected subgroup (n=127; 14%) received pemetrexed continuation maintenance therapy. Ram+doc improved median OS and PFS versus doc across front-line therapy subgroups, as reflected by HRs ranging from 0.78 to 0.91 and 0.66 to 0.92, respectively, similar to results in the overall intention-to-treat cohort (HRs: 0.86 and 0.76, respectively). High-grade treatment-emergent adverse events of special interest (including neutropenia, febrile neutropenia, leucopenia and hypertension) were generally higher in ram+doc-treated patients relative to doc-treated patients regardless of front-line therapy. No clear differences in safety or QoL were seen across front-line therapy subgroups; outcomes were consistent with those reported in the overall intention-to-treat cohort. CONCLUSIONS Results of this exploratory analysis suggest that second-line ram+doc may be effective regardless of prior treatment with platinum-based chemotherapy plus a taxane, pemetrexed, gemcitabine or bevacizumab. Overall, ram+doc is clinically beneficial across a wide range of patients with metastatic NSCLC who have progressed after various front-line therapies. TRIAL REGISTRATION NUMBER NCT01168973.
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Affiliation(s)
- Edward B Garon
- Hematology-Oncology, David Geffen School of Medicine, Los Angeles, California, USA
| | | | - Oliver Gautschi
- Medical Oncology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Martin Reck
- LungenClinic, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Michael Thomas
- Thoracic Oncology, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg University Hospital, Heidelberg, Germany
| | | | | | - Joo-Hang Kim
- Hemato-Oncology, Bundang CHA Medical Center, Seongnam, South Korea
| | - Steven Gans
- Respiratory Diseases, Hospital Saint Jansdal, Harderwijk, The Netherlands
| | | | - Sergey V Orlov
- Medical, Saint Petersburg State University, Sankt-Peterburg, Russian Federation
| | | | | | - Ana B Oton
- Oncology, Eli Lilly and Co, Indianapolis, Indiana, USA
| | | | - Pablo Lee
- Oncology, Eli Lilly and Co, New York City, New York, USA
| | | | | | - Mark A Socinski
- Thoracic Oncology, AdventHealth Cancer Institute, Orlando, Florida, USA
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Olmos VP, Ramos Gallo MJ, Rebollo MA, Ortega DB, Docampo LI, Romera-Villegas A, Díaz EG, Martín AM. [Management of venous thromboembolism in oncological patients: Spanish clinical practice guidelines. Consensus SEACV-SEOM]. Med Clin (Barc) 2015; 144 Suppl 1:3-15. [PMID: 25771086 DOI: 10.1016/s0025-7753(15)30012-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Vanessa Pachón Olmos
- Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, España. Grupo de Trabajo Cáncer y Trombosis SEOM.
| | | | - Maite Antonio Rebollo
- Servicio de Oncología Médica, Institut Català d'Oncologia/Hospital Duran i Reynals, L'Hospitalet de Llobregat, Barcelona, España. Grupo de Trabajo Cáncer y Trombosis SEOM
| | | | - Lara Iglesias Docampo
- Servicio de Oncología Médica, Hospital Universitario 12 de Octubre, Madrid, España. Grupo de Trabajo Cáncer y Trombosis SEOM
| | - Antonio Romera-Villegas
- Servicio de Angiología y Cirugía Vascular, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Enrique Gallardo Díaz
- Servicio de Oncología Médica, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España. Grupo de Trabajo Cáncer y Trombosis SEOM
| | - Andrés Muñoz Martín
- Servicio de Oncología Médica, Hospital General Universitario Gregorio Marañón, Madrid, España. Grupo de Trabajo Cáncer y Trombosis SEOM
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Ramalingam SS, Jänne PA, Mok T, O'Byrne K, Boyer MJ, Von Pawel J, Pluzanski A, Shtivelband M, Docampo LI, Bennouna J, Zhang H, Liang JQ, Doherty JP, Taylor I, Mather CB, Goldberg Z, O'Connell J, Paz-Ares L. Dacomitinib versus erlotinib in patients with advanced-stage, previously treated non-small-cell lung cancer (ARCHER 1009): a randomised, double-blind, phase 3 trial. Lancet Oncol 2014; 15:1369-78. [DOI: 10.1016/s1470-2045(14)70452-8] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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