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Carrato A, Pazo-Cid R, Macarulla T, Gallego J, Jiménez-Fonseca P, Rivera F, Cano MT, Rodriguez-Garrote M, Pericay C, Alés I, Layos L, Graña B, Iranzo V, Gallego I, Garcia-Carbonero R, de Mena IR, Guillén-Ponce C, Aranda E. Nab-Paclitaxel plus Gemcitabine and FOLFOX in Metastatic Pancreatic Cancer. NEJM Evid 2024; 3:EVIDoa2300144. [PMID: 38320486 DOI: 10.1056/evidoa2300144] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Nab-Paclitaxel plus Gemcitabine and FOLFOXThis randomized, open-label, phase II trial compared nab-paclitaxel/gemcitabine followed by modified FOLFOX versus nab-paclitaxel/gemcitabine alone for the first-line treatment of metastatic pancreatic ductal adenocarcinoma. Patients receiving nab-paclitaxel plus gemcitabine followed by modified FOLFOX-6 (oxaliplatin, leucovorin, and 5-fluorouracil) had a 12-month and 24-month overall survival of 55.3% and 22.4%, respectively, compared with 35.4% and 7.6% in the control group; there was a higher incidence of grade 3 or higher neutropenia and thrombocytopenia. No significant differences in febrile neutropenia, epistaxis or hemorrhage of grade 3 or higher in either group were reported. Two toxic deaths (2.6%) occurred in the experimental group.
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Affiliation(s)
- Alfredo Carrato
- Department of Medical Oncology, Alcalá University, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Ramon y Cajal University Hospital, Madrid
- Pancreatic Cancer Europe, Brussels
| | - Roberto Pazo-Cid
- Department of Medical Oncology, Aragon Institute of Biomedical Research, Miguel Servet University Hospital, Zaragoza, Spain
| | - Teresa Macarulla
- Vall d'Hebrón Institute of Oncology, Vall d'Hebrón University Hospital, Barcelona
| | - Javier Gallego
- Department of Medical Oncology, Elche University Hospital, Alicante, Spain
| | - Paula Jiménez-Fonseca
- Department of Medical Oncology, Asturias Central University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Fernando Rivera
- Department of Medical Oncology, Marques de Valdecilla University Hospital, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
| | - Maria Teresa Cano
- Department of Medical Oncology, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Cordoba University, Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Reina Sofia University Hospital, Cordoba, Spain
| | - Mercedes Rodriguez-Garrote
- Department of Medical Oncology, University, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Ramon y Cajal University Hospital, Madrid
| | - Carles Pericay
- Department of Medical Oncology, Sabadell University Hospital, Parc Tauli, Sabadell, Spain
| | - Inmaculada Alés
- Unidad de Gestión Clínica Intercentros (UGCI) Medical Oncology, University Regional and Virgen Victoria Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| | - Laura Layos
- Medical Oncology Department, Catalan Institute of Oncology (ICO), Badalona Applied Research Group in Oncology (B-ARGO), Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Begoña Graña
- Department of Medical Oncology, A Coruña University Hospital, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | - Vega Iranzo
- Department of Medical Oncology, University General Hospital Valencia, Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Valencia University, Valencia, Spain
| | - Inmaculada Gallego
- Department of Medical Oncology, Virgen del Rocio University Hospital, Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain
| | - Rocio Garcia-Carbonero
- Department of Medical Oncology, Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Universidad Complutense Madrid (UCM), Madrid
| | | | | | - Enrique Aranda
- Department of Medical Oncology, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Cordoba University, Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Reina Sofia University Hospital, Cordoba, Spain
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Vidal J, Fernández-Rodríguez MC, Casadevall D, García-Alfonso P, Páez D, Guix M, Alonso V, Cano MT, Santos C, Durán G, Elez E, Manzano JL, Garcia-Carbonero R, Ferreiro R, Losa F, Pineda E, Sastre J, Rivera F, Bellosillo B, Tabernero J, Aranda E, Salazar R, Montagut C. Liquid Biopsy Detects Early Molecular Response and Predicts Benefit to First-Line Chemotherapy plus Cetuximab in Metastatic Colorectal Cancer: PLATFORM-B Study. Clin Cancer Res 2023; 29:379-388. [PMID: 36074154 DOI: 10.1158/1078-0432.ccr-22-1696] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/22/2022] [Accepted: 09/02/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE Chemotherapy plus anti-EGFR is standard first-line therapy in RAS wild-type (wt) metastatic colorectal cancer (mCRC), but biomarkers of early response are clinically needed. We aimed to define the utility of ctDNA to assess early response in patients with mCRC receiving first-line anti-EGFR therapy. EXPERIMENTAL DESIGN Prospective multicentric study of tissue patients with RAS wt mCRC treated with first-line chemotherapy plus cetuximab undergoing sequential liquid biopsies. Baseline and early (C3) ctDNA were analyzed by NGS. Trunk mutations were assessed as surrogate marker of total tumor burden. RAS/BRAF/MEK/EGFR-ECD were considered mutations of resistance. ctDNA results were correlated with clinical outcome. RESULTS One hundred patients were included. ctDNA was detected in 72% of patients at baseline and 34% at C3. Decrease in ctDNA trunk mutations correlated with progression-free survival (PFS; HR, 0.23; P = 0.001). RAS/BRAF were the only resistant mutations detected at C3. An increase in the relative fraction of RAS/BRAF at C3 was followed by an expansion of the RAS clone until PD, and was associated with shorter PFS (HR, 10.5; P < 0.001). The best predictor of response was the combined analysis of trunk and resistant mutations at C3. Accordingly, patients with "early molecular response" (decrease in trunk and decrease in resistant mutations) had better response (77.5% vs. 25%, P = 0.008) and longer PFS (HR, 0.18; P < 0.001) compared with patients with "early molecular progression" (increase in trunk and/or increase in resistant mutations). CONCLUSIONS ctDNA detects early molecular response and predicts benefit to chemotherapy plus cetuximab. A comprehensive NGS-based approach is recommended to integrate information on total disease burden and resistant mutations. See related commentary by Eluri et al., p. 302.
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Affiliation(s)
- Joana Vidal
- Medical Oncology Department, Hospital del Mar, Institut Mar Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, CIBERONC, Barcelona, Spain
| | | | - David Casadevall
- Medical Oncology Department, Hospital del Mar, Institut Mar Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, CIBERONC, Barcelona, Spain
| | | | - David Páez
- Medical Oncology Department, H. Santa Creu i Sant Pau, Barcelona, Spain
| | - Marta Guix
- Medical Oncology Department, Hospital del Mar, Institut Mar Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, CIBERONC, Barcelona, Spain
| | - Vicente Alonso
- Medical Oncology Department, H. Miguel Servet, Zaragoza, Spain
| | - Maria Teresa Cano
- Medical Oncology Department, IMIBIC, Reina Sofía Hospital, University of Cordoba, CIBERONC, Cordoba, Spain
| | - Cristina Santos
- Medical Oncology Department, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL)-CIBERONC, Barcelona, Spain
| | - Gema Durán
- Unidad de Gestión Clínica Intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | - Elena Elez
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, CIBERONC, Barcelona, Spain
| | - José Luís Manzano
- Medical Oncology Department, ICO, H. Germans Trias i Pujol, Barcelona, Spain
| | - Rocío Garcia-Carbonero
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), UCM, Madrid, Spain
| | - Reyes Ferreiro
- Medical Oncology Department, Hospital Ramón y Cajal, Madrid, Spain
| | - Ferran Losa
- Medical Oncology Department, Hospital Sant Joan Despí - Moisès Broggi, ICO-Hospitalet, Barcelona. Spain
| | - Estela Pineda
- Medical Oncology Department Hospital Clínic, Barcelona, Spain
| | - Javier Sastre
- Medical Oncology Department, Hospital Universitario Clínico San Carlos, CIBERONC, Madrid, Spain
| | - Fernando Rivera
- Medical Oncology Department Hospital Marqués de Valdecilla, IDIVAL, Santander, Spain
| | | | - Josep Tabernero
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, CIBERONC, Barcelona, Spain
| | - Enrique Aranda
- Medical Oncology Department, IMIBIC, Reina Sofía Hospital, University of Cordoba, CIBERONC, Cordoba, Spain
| | - Ramon Salazar
- Medical Oncology Department, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL)-CIBERONC, Barcelona, Spain
| | - Clara Montagut
- Medical Oncology Department, Hospital del Mar, Institut Mar Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, CIBERONC, Barcelona, Spain
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Carrato A, Pazo-Cid R, Macarulla T, Gallego J, Jiménez-Fonseca P, Rivera F, Cano MT, Rodríguez Garrote M, Pericay C, Diaz I, Layos L, Graña B, Iranzo V, Gallego-Jimenez I, Garcia-Carbonero R, Alvarez Alejandro M, Ruiz de Mena I, GUILLEN PONCE CARMEN, Aranda E. Sequential nab-paclitaxel/gemcitabine followed by modified FOLFOX for first-line metastatic pancreatic cancer: The SEQUENCE trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4022] [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
4022 Background: Sequential treatment with nab-paclitaxel, gemcitabine followed by oxaliplatin, leucovorin and 5-fluorouracil ( nab-P/Gem-mFOLFOX) have shown a good safety profile and clinical activity in metastatic pancreatic ductal adenocarcinoma (mPDAC) in a previously published phase I SEQUENCE trial. Methods: We have compared nab-P/Gem-mFOLFOX to the standard nab-P/Gem in first-line treatment, in an open-label multi-institutional prospective randomised phase II trial in patients with untreated mPDAC from 14 Spanish hospitals. Patients were allocated 1:1 to nab-paclitaxel (125 mg/m2) plus gemcitabine (1000 mg/m2) on days 1, 8 and 15, followed by modified FOLFOX-6 (oxaliplatin [85 mg/m2], L-leucovorin [200 mg/m2] or racemic leucovorin [400 mg/m2], 5-fluorouracil bolus [400 mg/m2], and 5-fluorouracil 48-hour continuous infusion [2400 mg/m2]) on day 29 of a 6-week cycle or nab-paclitaxel (125 mg/m2) plus gemcitabine (1000 mg/m2) on days 1, 8 and 15 of a 4-week cycle. The primary endpoint was the 12-month overall survival rate (OS) in randomised patients. EudraCT number 2014-005350-19; ClinicalTrial.gov identifier NCT02504333. Results: Between July 27, 2017, and April 16, 2019, 182 patients were screened and 157 randomised: 78 to nab-P/Gem-mFOLFOX and 79 to nab-P/Gem. Patients receiving nab-P/Gem-mFOLFOX showed a significantly higher 12-month, and 24-month OS (95% CI): 55.3% (44.2-66.5%) versus 35.4% (24.9-46.0%) (p = 0.016), and 22.4% (13.0-31.8%) versus 7.6% (1.8-13.4%) (p = 0.012), respectively. The median OS (95% CI) reached 13.2 (10.1-16.2) months with nab-P/Gem-mFOLFOX and 9.7 (7.5-12.0) months with nab-P/Gem (HR = 0.676, 95% CI 0.483-0.947, p = 0.023). 39.7% patients in the nab-P/Gem-mFOLFOX group and 54.4% in nab-P/Gem group received subsequent anticancer treatments. Safety was comparable except for grade ≥3 neutropenia (46.1% versus 24.1%, p = 0.004) and grade ≥3 thrombocytopenia (23.7% versus 7.6%, p = 0.007) that were higher in the nab-P/Gem-mFOLFOX regimen. Two (2.6%) patients died due to adverse events in the nab-P/Gem-mFOLFOX arm. Conclusions: Nab-P/Gem-mFOLFOX showed significantly higher clinical activity than the standard nab-P/Gem treatment, with a manageable safety profile. This regimen represents a feasible and efficient new option for first-line treatment of mPDAC. Clinical trial information: NCT02504333.
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Affiliation(s)
- Alfredo Carrato
- IRYCIS, CIBERONC, Alcalá University, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Roberto Pazo-Cid
- Aragon Institute of Biomedical Research (IISA),Miguel Servet University Hospital, Zaragoza, Spain
| | - Teresa Macarulla
- Department of Medical Oncology, Vall d’Hebron Unveristy Hospital and Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | - Fernando Rivera
- University Hospital Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Maria Teresa Cano
- IMIBIC, University of Córdoba, CIBERONC, Reina Sofía University Hospital, Córdoba, Spain
| | | | - Carles Pericay
- Sabadell University Hospital. Parc Tauli. Sabadell., Sabadell, Spain
| | | | - Laura Layos
- ICO. Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Begoña Graña
- A Coruña University Hospital. Instituto Investigación Biomédica INIBIC, A Coruña, Spain
| | - Vega Iranzo
- Valencia University Hospital, CIBERONC, Valencia University, Valencia, Spain
| | | | | | | | | | | | - Enrique Aranda
- IMIBIC, Córdoba University, CIBERONC. Reina Sofía University Hospital, Córdoba, Spain
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Sastre J, García-Alfonso P, Viéitez JM, Cano MT, Rivera F, Reina-Zoilo JJ, Salud-Salvia A, Quintero G, Robles-Díaz L, Safont MJ, La Casta A, Gil S, Polo E, Asensio-Martínez E, García-Paredes B, López RL, Guillot M, Valladares-Ayerbes M, Aranda E, Díaz-Rubio E. Influence of BRAF and PIK3CA mutations on the efficacy of FOLFIRI plus bevacizumab or cetuximab as first-line therapy in patients with RAS wild-type metastatic colorectal carcinoma and <3 baseline circulating tumour cells: the randomised phase II VISNÚ-2 study. ESMO Open 2021; 6:100062. [PMID: 33711671 PMCID: PMC7970062 DOI: 10.1016/j.esmoop.2021.100062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/23/2020] [Accepted: 01/15/2021] [Indexed: 01/09/2023] Open
Abstract
Background We explored the influence of BRAF and PIK3CA mutational status on the efficacy of bevacizumab or cetuximab plus 5-fluorouracil/leucovorin and irinotecan (FOLFIRI) as first-line therapy in patients with RAS wild-type metastatic colorectal cancer (mCRC). Patients and methods VISNÚ-2 was a multicentre, randomised, phase II study. Patients with RAS wild-type mCRC and <3 circulating tumour cells/7.5 ml blood were stratified by BRAF/PIK3CA status (wild-type versus mutated) and number of affected organs (1 versus >1), and allocated to bevacizumab (5 mg/kg every 2 weeks) or cetuximab (400 mg/m2 then 250 mg/m2 weekly) plus FOLFIRI [irinotecan 180 mg/m2, leucovorin 400 mg/m2, 5-fluorouracil 400 mg/m2 (bolus) then 2400 mg/m2 (46-h continuous infusion) every 2 weeks]. The primary endpoint was progression-free survival (PFS). All analyses were exploratory. Results Two hundred and forty patients with BRAF/PIK3CA wild-type (n = 196) or BRAF- and/or PIK3CA-mutated tumours (n = 44) were enrolled. Median PFS was 12.7 and 8.8 months in patients with BRAF/PIK3CA wild-type and BRAF/PIK3CA-mutated tumours, respectively [hazard ratio (HR) = 1.22; 95% confidence interval (CI) 0.80-1.85; P = 0.3602]. In the BRAF- and/or PIK3CA-mutated cohort, median PFS was 2.8, 8.8 and 15.0 months in patients with BRAF/PI3KCA-mutated (n = 8), BRAF-mutated/PI3KCA wild-type (n = 16) and BRAF wild-type/PI3KCA-mutated (n = 20) tumours, respectively (P = 0.0002). PFS was similar with bevacizumab plus FOLFIRI versus cetuximab plus FOLFIRI in BRAF/PIK3CA wild-type (HR = 0.99; 95% CI 0.67-1.45; P = 0.9486) and BRAF/PIK3CA-mutated tumours (HR = 1.11; 95% CI 0.53-2.35; P = 0.7820). The most common grade 3/4 treatment-related adverse events were neutropenia, diarrhoea and asthenia in both treatment groups. Conclusions BRAF/PIK3CA status influences outcomes in patients with RAS wild-type mCRC but does not appear to assist with the selection of first-line targeted therapy. This study examined if BRAF/PIK3CA mutational status can guide therapy in RAS wild-type mCRC. BRAF mutations were associated with poorer survival outcomes, and were potentiated by PI3KCA mutations. Bevacizumab-FOLFIRI versus cetuximab-FOLFIRI had similar outcomes in BRAF /PIK3CA wild-type and BRAF /PIK3CA-mutated tumours. BRAF and PI3KCA mutations have a role as prognostic but not predictive factors.
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Affiliation(s)
- J Sastre
- Medical Oncology, Hospital Clínico San Carlos, Instituto de Investigación Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain.
| | - P García-Alfonso
- Medical Oncology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - J M Viéitez
- Medical Oncology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - M T Cano
- Medical Oncology, IMIBIC, Reina Sofía Hospital, University of Córdoba, CIBERONC, Instituto de Salud Carlos III, Cordoba, Spain
| | - F Rivera
- Medical Oncology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - J J Reina-Zoilo
- Medical Oncology, Complejo Hospitalario Virgen de la Macarena, Seville, Spain
| | - A Salud-Salvia
- Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain
| | - G Quintero
- Medical Oncology, Hospital Lucus Augusti, Lugo, Spain
| | - L Robles-Díaz
- Medical Oncology, Hospital 12 de Octubre, Madrid, Spain
| | - M J Safont
- Medical Oncology, Hospital General Universitario de Valencia, Valencia, Spain
| | - A La Casta
- Medical Oncology, Hospital de Donostia, Guipúzcoa, Spain
| | - S Gil
- Medical Oncology, Hospital Universitario Regional y Virgen de la Victoria, Malaga, Spain
| | - E Polo
- Medical Oncology, Hospital Miguel Servet, Zaragoza, Spain
| | - E Asensio-Martínez
- Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain
| | - B García-Paredes
- Medical Oncology, Hospital Clínico San Carlos, Instituto de Investigación Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - R L López
- Medical Oncology, University Clinical Hospital and Health Research Institute (IDIS), CIBERONC, Santiago de Compostela University School of Medicine, Santiago de Compostela, Spain
| | - M Guillot
- Medical Oncology, Hospital Son Espases, Palma de Mallorca, Spain
| | - M Valladares-Ayerbes
- Medical Oncology, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica (INIBIC), A Coruña, Spain
| | - E Aranda
- Medical Oncology, IMIBIC, Reina Sofía Hospital, University of Córdoba, CIBERONC, Instituto de Salud Carlos III, Cordoba, Spain
| | - E Díaz-Rubio
- Medical Oncology, Hospital Clínico San Carlos, Instituto de Investigación Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
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Saavedra EI, Gomez MA, Cano MT, Perdomo E, Toledano M, Aranda E. Impact of KRAS mutations in clinical features and survival in pancreatic cancer patients: A single institution experience. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e15779] [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
e15779 Background: Pancreatic cancer (PC) is currently one of the most lethal tumors. In recent years, although improvements have been developed in the detection and treatment of this disease, the 5-year survival is less than 10%. KRAS plays a key role in ras/mitogen-activated protein kinase signaling. Somatic mutation in KRAS mutations have been shown to be early events in the carcinogenesis of PC. KRAS mutations as a prognostic factor for PC remains inconclusive. Methods: We performed a retrospective study of our patients (pts) to demonstrate the impact of KRAS mutations in clinical features and survival in real-life clinical practice. This was an observational study of all patients with histological confirmed PC referred to Medical Oncology between April 2017 to December 2018 and followed until February 2019. KRAS mutations were analyzed by sequencing codons 12, 13, and 61 in diagnostic tumor tissues from formalin fixed paraffin embedded tissue using PCR and liquid biopsy test (BEAMing technology). Categorical variables were statistically analyzed with Fisher’s exact test and continuous variables with T-student for differences between both groups. Survival was analyzed by Kaplan–Meier estimation and log-rank testing while Cox regression was used to estimed hazard ratios. Results: Our study cohort was 64 pts. 43% of pts died, the most die at home (25%). Median follow-up was 552 days (18 months). Metastatic pts had an expected overall survival (OS) of 376 days, locally advanced 525 days and localized stage 592 days but not statistically significant difference (p = 0.11). Wild-type pts had an expected OS of 559 days and KRAS mutated 389 days with statistically significant difference. (p = 0.032). Conclusions: KRAS mutations are associated with a poorer survival in patients with pancreatic cancer in all stages. These results suggest that KRAS mutations may be an important biomarker in determining response and prognosis in patients with high risk and in developing specific treatments for these patients in clinical applications.[Table: see text]
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Affiliation(s)
| | | | - Maria Teresa Cano
- IMIBIC, Reina Sofía Hospital, University of Córdoba, CIBERONC, Instituto de Salud Carlos III/ Spain, Córdoba, Spain
| | | | - Marta Toledano
- Instituto Maimonides Investigación Biomédica de Córdoba, Córdoba, Spain
| | - Enrique Aranda
- IMIBIC, Reina Sofía Hospital, University of Córdoba, CIBERONC, Instituto de Salud Carlos III/ Spain, Córdoba, Spain
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Vidal J, Bellosillo B, Santos Vivas C, García-Alfonso P, Carrato A, Cano MT, García-Carbonero R, Élez E, Losa F, Massutí B, Valladares-Ayerbes M, Viéitez JM, Manzano JL, Azuara D, Gallego J, Pairet S, Capellá G, Salazar R, Tabernero J, Aranda E, Montagut C. Ultra-selection of metastatic colorectal cancer patients using next-generation sequencing to improve clinical efficacy of anti-EGFR therapy. Ann Oncol 2019; 30:439-446. [PMID: 30689692 DOI: 10.1093/annonc/mdz005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Extended RAS analysis is mandatory in metastatic colorectal cancer (mCRC) patients. The optimal threshold of RAS mutated subclones to identify patients most likely to benefit from antiepidermal growth factor receptor (EGFR) therapy is controversial. Our aim was to assess the clinical impact of detecting mutations in RAS, BRAF, PIK3CA and EGFRS492R in basal tissue tumour samples by using a highly sensitive next-generation sequencing (NGS) technology in mCRC patients treated with chemotherapy plus anti-EGFR or anti-vascular endothelial growth factor. PATIENTS AND METHODS Five hundred and eighty-one tumour samples from untreated mCRC patients from 7 clinical studies were collected. Mutational analysis was carried out by standard-of-care (therascreen pyro) with a sensitivity detection of 5% mutant allele fraction (MAF), and compared with NGS technology using 454GS Junior platform (Roche Applied Science, Germany) with a sensitivity of 1%. Molecular results were correlated with clinical outcomes. RESULTS After quality assessment, 380 samples were evaluable for molecular analysis. Standard-of-care mutational analysis detected RAS, BRAFV600E or PIK3CA mutations in 56.05% of samples compared with 69.21% by NGS (P = 0.00018). NGS identified coexistence of multiple low-frequency mutant alleles in 96 of the 263 mutated cases (36.5%; range 2-7). Response rate (RR), progression-free survival (PFS) and overall survival (OS) were increasingly improved in patients with RAS wild-type, RAS/BRAF wild-type or quadruple (KRAS/NRAS/BRAF/PIK3CA) wild-type tumours treated with anti-EGFR, assessed by standard-of-care. No additional benefit in RR, PFS or OS was observed by increasing the detection threshold to 1% by NGS. An inverse correlation between the MAF of the most prevalent mutation detected by NGS and anti-EGFR response was observed (P = 0.039). EGFRS492Rmutation was not detected in untreated samples. CONCLUSIONS No improvement in the selection of patients for anti-EGFR therapy was obtained by adjusting the mutation detection threshold in tissue samples from 5% to 1% MAF. Response to anti-EGFR was significantly better in patients with quadruple wild-type tumours.
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Affiliation(s)
- J Vidal
- Medical Oncology Department, Hospital del Mar-IMIM, CIBERONC Instituto de Salud Carlos III, Barcelona
| | - B Bellosillo
- Pathology Department, Hospital del Mar, Barcelona
| | - C Santos Vivas
- Translational Research Laboratory, Medical Oncology Department, Catalan Institute of Oncology (ICO), ICO-Bellvitge Biomedical Research Institute (IDIBELL)-CIBERONC Instituto de Salud Carlos III, L'Hospitalet de Llobregat, Barcelona
| | | | - A Carrato
- Medical Oncology Department, Hospital Ramón y Cajal, IRYCIS, CIBERONC Instituto de Salud Carlos III, Alcala University, Madrid
| | - M T Cano
- Medical Oncology Department, IMIBIC, Reina Sofía Hospital, University of Cordoba, CIBERONC Instituto de Salud Carlos III
| | - R García-Carbonero
- Oncology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre, (imas12), UCM, CNIO, CIBERONC Instituto de Salud Carlos III, Madrid
| | - E Élez
- Medical Oncology Department, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), CIBERONC Instituto de Salud Carlos III, Universitat Autònoma de Barcelona, Barcelona
| | - F Losa
- Medical Oncology Department, Hospital Sant Joan Despí - Moisés Broggi, Barcelona
| | - B Massutí
- Medical Oncology Department, Hospital General Universitario, Alicante
| | - M Valladares-Ayerbes
- Medical Oncology Department, Complejo Hospitalario Universitario de A Coruña, A Coruña
| | - J M Viéitez
- Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo
| | - J L Manzano
- Medical Oncology Department, ICO, Badalona, Barcelona
| | - D Azuara
- Translational Research Laboratory, Medical Oncology Department, Catalan Institute of Oncology (ICO), ICO-Bellvitge Biomedical Research Institute (IDIBELL)-CIBERONC Instituto de Salud Carlos III, L'Hospitalet de Llobregat, Barcelona
| | - J Gallego
- Medical Oncology Department, Hospital General Universitario de Elche, Alicante
| | - S Pairet
- Pathology Department, Hospital del Mar, Barcelona
| | - G Capellá
- Faculty of Medicine, Department of Clinical Sciences, Translational Research Laboratory, ICO-IDIBELL, L'Hospitalet de Llobregat, University of Barcelona, CIBERONC Instituto de Salud Carlos III, Barcelona, Spain
| | - R Salazar
- Translational Research Laboratory, Medical Oncology Department, Catalan Institute of Oncology (ICO), ICO-Bellvitge Biomedical Research Institute (IDIBELL)-CIBERONC Instituto de Salud Carlos III, L'Hospitalet de Llobregat, Barcelona
| | - J Tabernero
- Medical Oncology Department, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), CIBERONC Instituto de Salud Carlos III, Universitat Autònoma de Barcelona, Barcelona
| | - E Aranda
- Medical Oncology Department, IMIBIC, Reina Sofía Hospital, University of Cordoba, CIBERONC Instituto de Salud Carlos III
| | - C Montagut
- Medical Oncology Department, Hospital del Mar-IMIM, CIBERONC Instituto de Salud Carlos III, Barcelona.
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7
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Morales-Estevez C, Manzanares-Martin B, de la Haba-Rodriguez J, Gonzalez-Fernandez R, López-González J, Moreno A, Porras I, Ortiz MJ, Gómez-España MA, Cano MT, Chia-Delgado B, Serrano R, Rubio MJ, Aranda E. Killer-cell Inmunoglobulin-like Receptor (KIR) genes as a predictor of response to the anti-HER therapy in solid tumors. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e13024] [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)
- Cristina Morales-Estevez
- Oncology Department, Maimonides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, Córdoba, Spain
| | - Barbara Manzanares-Martin
- Inmunology Department, Maimonides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, Córdoba, Spain
| | - Juan de la Haba-Rodriguez
- Medical Oncology Department University Reina Sofia Hospital. Biomedical Research Institute Maimonides, Cordoba, Spain
| | - Rafael Gonzalez-Fernandez
- Inmunology Department, Maimonides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, Cordoba, Spain
| | - Javier López-González
- Oncology Department, Maimonides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, Córdoba, Spain
| | | | | | - Maria Jose Ortiz
- Reina Sofia Hospital, University of Cordoba, Maimonides Institute of Biomedical Research (IMIBIC). Spanish Cancer Network (RTICC), Instituto de Salud Carlos III, Cordoba, Spain
| | - María Auxiliadora Gómez-España
- Oncology Department, Maimonides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, Córdoba, Spain
| | - Maria Teresa Cano
- Department of Clinical Oncology, Hospital Reina Sofia, Cordoba, Spain
| | - Beatriz Chia-Delgado
- Oncology Department, Maimonides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, Córdoba, Spain
| | | | | | - Enrique Aranda
- Reina Sofia Hospital, University of Cordoba, Maimonides Institute of Biomedical Research, Spanish Cancer Network, Instituto de Salud Carlos III, Córdoba, Spain
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8
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López-González J, Morales-Estevez C, Alberti-Vargas F, de la Haba-Rodriguez J, Gonzalez-Fernandez R, Cano MT, Porras I, Ortiz MJ, Gómez-España MA, Manzanares-Martin B, Moreno A, Aranda E. Analysis of the HLA-I genotypes in patients with solid tumours who were treated with anti-HER therapy. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e14505] [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)
- Javier López-González
- Oncology Department, Maimonides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, Córdoba, Spain
| | - Cristina Morales-Estevez
- Oncology Department, Maimonides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, Córdoba, Spain
| | | | - Juan de la Haba-Rodriguez
- Medical Oncology Department University Reina Sofia Hospital. Biomedical Research Institute Maimonides, Cordoba, Spain
| | - Rafael Gonzalez-Fernandez
- Inmunology Department, Maimonides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, Cordoba, Spain
| | - Maria Teresa Cano
- Department of Clinical Oncology, Hospital Reina Sofia, Cordoba, Spain
| | | | - Maria Jose Ortiz
- Reina Sofia Hospital, University of Cordoba, Maimonides Institute of Biomedical Research (IMIBIC). Spanish Cancer Network (RTICC), Instituto de Salud Carlos III, Cordoba, Spain
| | - María Auxiliadora Gómez-España
- Oncology Department, Maimonides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, Córdoba, Spain
| | - Barbara Manzanares-Martin
- Inmunology Department, Maimonides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, Córdoba, Spain
| | | | - Enrique Aranda
- Reina Sofia Hospital, University of Cordoba, Maimonides Institute of Biomedical Research, Spanish Cancer Network, Instituto de Salud Carlos III, Córdoba, Spain
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9
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Morales-Estevez C, Moreno A, Porras I, Cano MT, Sanchez P, Fuentes H, Rodríguez-Alonso B, Rodriguez-Alonso RM, Ortiz-Morales MJ, Gómez-España MA, de la Haba-Rodriguez J, Aranda E, Alberti-Vargas F. The genomic profile (GP) of early breast cancer (EBC): Daily practice analysis. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e23143] [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)
- Cristina Morales-Estevez
- Oncology Department, Maimonides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, Córdoba, Spain
| | | | | | - Maria Teresa Cano
- Department of Clinical Oncology, Hospital Reina Sofia, Cordoba, Spain
| | - Pedro Sanchez
- Hospital Reina Sofia Oncologia Medica, Cordoba, Spain
| | - Helena Fuentes
- Pathological Anatomy Department, Maimonides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, Córdoba, Spain
| | - Beatriz Rodríguez-Alonso
- Oncology Department, Maimonides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, Córdoba, Spain
| | | | - Maria Jose Ortiz-Morales
- Oncology Department, Maimonides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, Córdoba, Spain
| | - María Auxiliadora Gómez-España
- Oncology Department, Maimonides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, Córdoba, Spain
| | - Juan de la Haba-Rodriguez
- Medical Oncology Department University Reina Sofia Hospital. Biomedical Research Institute Maimonides, Cordoba, Spain
| | - Enrique Aranda
- Reina Sofia Hospital, University of Cordoba, Maimonides Institute of Biomedical Research, Spanish Cancer Network, Instituto de Salud Carlos III, Córdoba, Spain
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10
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Morales-Estevez C, Manzanares-Martin B, Gonzalez-Fernandez R, Porras I, Gomez-España M, Cano MT, Ortiz MJ, Moreno A, Serrano R, de la Haba-Rodriguez J, Aranda E. Association of Killer cell immunoglobulin-like receptors (KIRs) polymorphisms and advanced cancer in a Caucasian population. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e12563] [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)
| | - Barbara Manzanares-Martin
- Inmunology Department, Maimonides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, Córdoba, Spain
| | - Rafael Gonzalez-Fernandez
- Oncology Department, Maimonides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, Cordoba, Spain
| | | | - M.Auxiliadora Gomez-España
- Reina Sofía Hospital, University of Córdoba, Maimonides Institute of Biomedical Research (IMIBIC). Spanish Cancer Network (RTICC), Instituto de Salud Carlos III, Cordoba, Spain
| | - Maria Teresa Cano
- Department of Clinical Oncology, Hospital Reina Sofia, Cordoba, Spain
| | - Maria Jose Ortiz
- Reina Sofía Hospital, University of Córdoba, Maimonides Institute of Biomedical Research (IMIBIC). Spanish Cancer Network (RTICC), Instituto de Salud Carlos III, Cordoba, Spain
| | | | | | - Juan de la Haba-Rodriguez
- Medical Oncology Department University Reina Sofia Hospital. Biomedical Research Institute Maimonides, Cordoba, Spain
| | - Enrique Aranda
- Reina Sofía Hospital, University of Córdoba, Maimonides Institute of Biomedical Research (IMIBIC). Spanish Cancer Network (RTICC), Instituto de Salud Carlos III, Córdoba, Spain
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11
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Carrato A, Massuti Sureda B, Benavides M, Guillén Ponce C, Falco E, Garcia Alfonso P, Reboredo M, Cano MT, Gallego J, Vieitez de Prado JM, Layos L, Salud A, Alonso V, Dotor E, Yuste A, Gil S, Ferreiro Monteagudo R, Fernandez Rodriguez T, Grande E, Aranda E. Preliminary safety results of regorafenib (REG) as a single agent for first-line treatment of frail and/or unfit for polychemotherapy patients (pts) with metastatic colorectal cancer (mCRC): A phase II study of the Spanish Cooperative Group for Digestive Tumor Therapy (TTD). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e14524] [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)
- Alfredo Carrato
- Ramon y Cajal University Hospital, Medical Oncology Department, Madrid, Spain
| | | | | | | | | | | | | | - Maria Teresa Cano
- Department of Clinical Oncology, Hospital Reina Sofia, Cordoba, Spain
| | - Javier Gallego
- Servicio de Oncología Médica. Hospital General Universitario de Elche, Elche, Spain
| | | | - Laura Layos
- Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Antonia Salud
- University Hospital Arnau De Vilanova, Lerida, Spain
| | | | - Emma Dotor
- Institut Oncològic del Vallès, Corporació Sanitària Parc Taulí - Consorci Sanitari de Terrassa, Sabadell-Barcelona, Spain
| | - Ana Yuste
- Hospital General Universitario, Alicante, Spain
| | - Silvia Gil
- H. Universitario Regional y Virgen de la Victoria, Málaga, Spain
| | | | | | - Enrique Grande
- Hospital Universitario Ramon y Cajal, Medical Oncology Department, Madrid, Spain
| | - Enrique Aranda
- Reina Sofía Hospital, University of Córdoba, Maimonides Institute of Biomedical Research (IMIBIC). Spanish Cancer Network (RTICC), Instituto de Salud Carlos III, Córdoba, Spain
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12
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Pulido G, de la Haba-Rodriguez J, Gomez M, Jimenez J, Cano MT, Ortiz MJ, Aranda E. Association of extreme age with worse survival in advanced breast cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e11530] [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
e11530 Background: Age has been associated with survival in advance breast cancer. In the ALAMO Register prognostic index, older age was associated with mortality. Although recent reports suggest that age below 35 was also associated with worse prognosis. We analysed the impact of extreme ages in survival in an advance breast cancer cohort. Methods: Survival analysis of patients followed in the Advance Breast Cancer Cohort at the Reina Sofia Hospital between 1996-2006. Patients were classified in 4 groups of age: I (< 35), II (35-50), III (51-75) and IV (>75 years). Log-rank test was used to compare survivals between groups. Cases were censored after 5 years of follow-up. A uni and multivariate stepwise regression model was used to estimate factors associated with survival. Results: 212 cases of advance breast cancer were included. Patients’ main characteristics, distributed by age groups, are reported in the Table. Median (IQR) survival was shorter (p=0.01) in group I 12.4 (4.7-25.4) and group IV 10.8 (5.1-19.8) compared to groups II 23.5 (17-29.5) and group III 20.2 (15.2-23.7). Factors independently associated with survival were age groups 1-4 versus 2-3 (p=0.02), histologic grade II-II versus I-unknown (<0.01), disease free interval <24 months versus >24 months (p<0.01) and visceral versus non-visceral metastatic location (p<0.01). Conclusions: Extreme ages (<35 or >75 years) at the diagnosis of the advance breast cancer are associated with worse survival. This factor in addition with the histologic grades, the disease free interval and metastatic location were associated with survival. [Table: see text]
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Affiliation(s)
- Gema Pulido
- Medical Oncology Department University Reina Sofía Hospital, Cordoba, Spain
| | - Juan de la Haba-Rodriguez
- Medical Oncology Department University Reina Sofia Hospital. Biomedical Research Institute Maimonides, Cordoba, Spain
| | - M.Auxiliadora Gomez
- Medical Oncology Department. University Reina Sofia Hospital. Biomedical Research Institute Maimonidas, Cordoba, Spain
| | - Jeronimo Jimenez
- Department of Clinical Oncology, Hospital Reina Sofia, Cordoba, Spain
| | - Maria Teresa Cano
- Department of Clinical Oncology, Hospital Reina Sofia, Cordoba, Spain
| | - Maria Jose Ortiz
- Medical Oncology Department University Reina Sofía Hospital, Cordoba, Spain
| | - Enrique Aranda
- Medical Oncology Department University Reina Sofia Hospital. Biomedical Research Institute Maimonides, Cordoba, Spain
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13
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Affiliation(s)
- F J Burgos
- Department of Urology, Hospital Ramon y Cajal, Universidad Alcala, Madrid, Spain
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