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García-Donas J, de Velasco G, Madurga R, Chamorro J, Rosero D, Etxaniz O, Pérez-Gracia JL, Pinto Á, Cacho D, Barba M, Borrega P, Lázaro M, Rodriguez L, Villalobos L, García L, Cuellar A, Solís-Hernández MP, González A, Pernaut C, Rodríguez-Moreno JF. Case-control study assessing the impact of COVID19 in advanced kidney cancer patients treated with antiangiogenics or immunotherapy: the COVID-REN study. Clin Transl Oncol 2024; 26:732-738. [PMID: 37556096 DOI: 10.1007/s12094-023-03295-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/06/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Cancer is a risk factor for developing severe COVID19. Additionally, SARS-CoV2 has a special tropism for renal cells and complications like thrombosis or cytokine storm could be enhanced by standard treatments in kidney cancer (i.e., antiangiogenics or immunotherapy). Thus, understanding the impact of COVID19 in patients with this tumor is key for their correct management. METHODS We designed a retrospective case-control study comparing the outcome of three groups of advanced kidney cancer patients on systemic treatment: cohort A (developed COVID19 while on antiangiogenics), cohort B (developed COVID19 while on immunotherapy) and cohort C (non-infected). Matching factors were age, gender, and treatment. RESULTS 95 patients were recruited in 16 centers in Spain from September 2020 to May 2021. Finally, 85 were deemed as eligible (23 cohort A, 21 cohort B, 41 cohort C). Patients with COVID required more dose interruptions (25 vs. six) and hospitalizations (10 vs. none) than those without COVID (both p = 0.001). No difference between cohorts A and B was observed regarding hospitalization or length of stay. No ICU admission was registered and one patient in cohort B died due to COVID19. Regarding cancer evolution, three patients in cohort A presented progressive disease after COVID19 compared to two in cohort B. One case in cohort B, initially deemed as stable disease, achieved a partial response after COVID19. CONCLUSIONS Kidney cancer patients who developed COVID19 while on systemic therapy required more treatment interruptions and hospitalizations than those non-infected. However, no significant impact on cancer outcome was observed. Also, no difference was seen between cases on antiangiogenics or immunotherapy.
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Affiliation(s)
| | | | - Rodrigo Madurga
- Faculty of Experimental Sciences, Universidad Francisco de Vitoria, Madrid, Spain
| | | | - Diana Rosero
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Diego Cacho
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - María Barba
- HM Hospitales-Centro Integral Oncológico Clara Campal, Madrid, Spain
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2
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Lázaro M, Lupiáñez P, Sola-Leyva A, Pozo-Gualda T, Oltolina F, Jimenez-Carretero M, Jimenez-Lopez C, Carrasco-Jiménez MP, Iglesias GR. The importance of cell uptake in photothermal treatments mediated by biomimetic magnetic nanoparticles. Colloids Surf B Biointerfaces 2024; 234:113722. [PMID: 38160473 DOI: 10.1016/j.colsurfb.2023.113722] [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: 09/20/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
Biomimetic magnetic nanoparticles (BMNPs) mediated by MamC have proven to be photothermal agents able to allow an optimized cytotoxicity against tumoral cells when used simultaneously as drug nanotransporters and as hyperthermia agents. However, it remains unclear whether BMNPs need to be internalized by the cells and/or if there is a threshold for internal Fe concentration for the photothermal therapy to be effective. In this study, three different situations for photothermal treatments have been simulated to disentangle the effect of BMNPs cell uptake on cell viability after photothermal treatments. Human hepatoblastoma (HepG2) cell line was treated with suspensions of BMNPs, and protocols were developed to have only intracellular BMNPs, only extracellular BMNPs or both, followed by photothermal exposure of the treated cell cultures. Our data demonstrate that: (1) Although the heating efficiency of the photothermal agent is not altered by its location (intra/extracellular), the intracellular location of BMNPs is crucial to ensure the cytotoxic effect of photothermal treatments, especially at low Fe concentration. In fact, the concentration of BMNPs needed to reach the same cytotoxic effect following upon laser irradiation of 0.2 W/cm2 is three times larger if BMNPs are located extracellularly compared to that needed if BMNPs are located intracellularly; (2) For a given location of the BMNPs, cell death increases with BMNPs (or Fe) concentration. When BMNPs are located intracellularly, there is a threshold for Fe concentration (∼ 0.5 mM at laser power intensities of 0.1 W/cm2) needed to affect cell viability following upon cell exposure to photothermia. (3) Bulk temperature rise is not the only factor accounting for cell death. Actually, temperature increases inside the cells cause more damage to cell structures and trigger cell death more efficiently than an increase in the temperature outside the cell.
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Affiliation(s)
- M Lázaro
- NanoMag Laboratory. Department of Applied Physics, Edificio I+D Josefina Castro, University of Granada, Instituto de Investigación Biosanitaria, Av. de Madrid, 28, Granada 18012, Spain
| | - P Lupiáñez
- NanoMag Laboratory. Department of Applied Physics, Edificio I+D Josefina Castro, University of Granada, Instituto de Investigación Biosanitaria, Av. de Madrid, 28, Granada 18012, Spain
| | - A Sola-Leyva
- Department of Biochemistry and Molecular Biology I, Faculty of Sciences, 18071 Granada, Spain
| | - T Pozo-Gualda
- Department of Microbiology, Faculty of Sciences, 18071 Granada, Spain
| | - F Oltolina
- Department of Microbiology, Faculty of Sciences, 18071 Granada, Spain
| | | | - C Jimenez-Lopez
- Department of Microbiology, Faculty of Sciences, 18071 Granada, Spain.
| | - M P Carrasco-Jiménez
- Department of Biochemistry and Molecular Biology I, Faculty of Sciences, 18071 Granada, Spain.
| | - G R Iglesias
- NanoMag Laboratory. Department of Applied Physics, Edificio I+D Josefina Castro, University of Granada, Instituto de Investigación Biosanitaria, Av. de Madrid, 28, Granada 18012, Spain
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3
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Martin-Sanchez F, Lázaro M, López-Otín C, Andreu AL, Cigudosa JC, Garcia-Barbero M. Correction: Personalized Precision Medicine for Health Care Professionals: Development of a Competency Framework. JMIR Med Educ 2023; 9:e46366. [PMID: 36802457 PMCID: PMC10013127 DOI: 10.2196/46366] [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] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
[This corrects the article DOI: 10.2196/43656.].
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Affiliation(s)
- Fernando Martin-Sanchez
- Department of Biomedical Informatics and Digital HealthNational Institute of Health Carlos IIIMadridSpain
| | - Martín Lázaro
- Department of Medical Oncology, University Hospital Complex of VigoVigoSpain
| | | | - Antoni L Andreu
- European Infrastructure for Translational MedicineAmsterdamNetherlands
| | - Juan Cruz Cigudosa
- Department of University, Innovation and Digital Transformation, the Government of NavarraNavarraSpain
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4
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Martin-Sanchez F, Lázaro M, López-Otín C, Andreu AL, Cigudosa JC, Garcia-Barbero M. Personalized Precision Medicine for Health Care Professionals: Development of a Competency Framework. JMIR Med Educ 2023; 9:e43656. [PMID: 36749626 PMCID: PMC9943053 DOI: 10.2196/43656] [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] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/21/2022] [Accepted: 01/11/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Personalized precision medicine represents a paradigm shift and a new reality for the health care system in Spain, with training being fundamental for its full implementation and application in clinical practice. In this sense, health care professionals face educational challenges related to the acquisition of competencies to perform their professional practice optimally and efficiently in this new environment. The definition of competencies for health care professionals provides a clear guide on the level of knowledge, skills, and attitudes required to adequately carry out their professional practice. In this context, this acquisition of competencies by health care professionals can be defined as a dynamic and longitudinal process by which they use knowledge, skills, attitudes, and good judgment associated with their profession to develop it effectively in all situations corresponding to their field of practice. OBJECTIVE This report aims to define a proposal of essential knowledge domains and common competencies for all health care professionals, which are necessary to optimally develop their professional practice within the field of personalized precision medicine as a fundamental part of the medicine of the future. METHODS Based on a benchmark analysis and the input and expertise provided by a multidisciplinary group of experts through interviews and workshops, a new competency framework that would guarantee the optimal performance of health care professionals was defined. As a basis for the development of this report, the most relevant national and international competency frameworks and training programs were analyzed to identify aspects that are having an impact on the application of personalized precision medicine and will be considered when developing professional competencies in the future. RESULTS This report defines a framework made up of 58 competencies structured into 5 essential domains: determinants of health, biomedical informatics, practical applications, participatory health, and bioethics, along with a cross-cutting domain that impacts the overall performance of the competencies linked to each of the above domains. Likewise, 6 professional profiles to which this proposal of a competency framework is addressed were identified according to the area where they carry out their professional activity: health care, laboratory, digital health, community health, research, and management and planning. In addition, a classification is proposed by progressive levels of training that would be advisable to acquire for each competency according to the professional profile. CONCLUSIONS This competency framework characterizes the knowledge, skills, and attitudes required by health care professionals for the practice of personalized precision medicine. Additionally, a classification by progressive levels of training is proposed for the 6 professional profiles identified according to their professional roles.
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Affiliation(s)
- Fernando Martin-Sanchez
- Department of Biomedical Informatics and Digital Health, National Institute of Health Carlos III, Madrid, Spain
| | - Martín Lázaro
- Department of Medical Oncology, University Hospital Complex of Vigo, Vigo, Spain
| | | | - Antoni L Andreu
- European Infrastructure for Translational Medicine, Amsterdam, Netherlands
| | - Juan Cruz Cigudosa
- Department of University, Innovation and Digital Transformation, the Government of Navarra, Navarra, Spain
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5
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Remon J, Bernabé R, Diz P, Felip E, González-Larriba JL, Lázaro M, Mielgo-Rubio X, Sánchez A, Sullivan I, Massutti B. SEOM-GECP-GETTHI Clinical Guidelines for the treatment of patients with thymic epithelial tumours (2021). Clin Transl Oncol 2022; 24:635-645. [PMID: 35122634 PMCID: PMC8817662 DOI: 10.1007/s12094-022-02788-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 11/27/2022]
Abstract
Thymic epithelial tumours (TET) represent a heterogeneous group of rare malignancies that include thymomas and thymic carcinoma. Treatment of TET is based on the resectability of the tumour. If this is considered achievable upfront, surgical resection is the cornerstone of treatment. Platinum-based chemotherapy is the standard regimen for advanced TET. Due to the rarity of this disease, treatment decisions should be discussed in specific multidisciplinary tumour boards, and there are few prospective clinical studies with new strategies. However, several pathways involved in TET have been explored as potential targets for new therapies in previously treated patients, such as multi-tyrosine kinase inhibitors with antiangiogenic properties and immune checkpoint inhibitors (ICI). One third of patient with thymoma present an autoimmune disorders, increasing the risk of immune-related adverse events and autoimmune flares under ICIs. In these guidelines, we summarize the current evidence for the therapeutic approach in patients with TET and define levels of evidence for these decisions.
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Affiliation(s)
- J Remon
- Department of Medical Oncology, Centro Integral Oncológico Clara Campal (HM-CIOCC), Hospital HM Nou Delfos, HM Hospitales, Avinguda de Vallcarca, 151, 08023, Barcelona, Spain.
| | - R Bernabé
- Department of Medical Oncology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - P Diz
- Department of Medical Oncology, Hospital Universitario de León, León, Spain
| | - E Felip
- Department of Medical Oncology, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - J L González-Larriba
- Department of Medical Oncology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - M Lázaro
- Department of Medical Oncology, Hospital Alvaro Cunqueiro, Vigo, Spain
| | - X Mielgo-Rubio
- Department of Medical Oncology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - A Sánchez
- Department of Medical Oncology, Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - I Sullivan
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - B Massutti
- Department of Medical Oncology, Hospital General Universitario de Alicante, Alicante, Spain
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6
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Rubio-Viqueira B, Tarruella MM, Lázaro M, Estévez SV, Córdoba-Ortega JF, Maiques IM, González JG, Cordellat AB, Valdivia-Bautista J, Arenas CG, Sánchez Torres JM. PD-L1 testing and clinical management of newly diagnosed metastatic non-small cell lung cancer in Spain: MOREL study. Lung Cancer Manag 2021; 10:LMT53. [PMID: 34899993 PMCID: PMC8656292 DOI: 10.2217/lmt-2021-0008] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/04/2021] [Indexed: 11/21/2022] Open
Abstract
Aim To describe the clinical management and PD-L1 testing of patients with newly diagnosed stage IV non-small cell lung cancer (NSCLC) without driver mutations in Spain. Methods Multicenter, retrospective study. Results Among 297 evaluated patients, 89.2% received systemic treatment for stage IV disease, of whom 53.6% received platinum doublet therapy, 26.8% immunotherapy as monotherapy and 14.7% immunotherapy + chemotherapy, with 9.4% receiving treatment as part of a clinical trial. Treatment was initiated 1 month after histological diagnosis, with PD-L1 test results available in most cases (92.6%). PD-L1 testing was performed in 287 patients, 95.1% by in-house tests, mostly with the 22C3 pharmDx assay. The factor most strongly associated with treatment selection was, as expected, the expression of PD-L1. Conclusion PD-L1 testing is implemented in clinical practice and seems to guide treatment decisions in patients with NSCLC in Spain.
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Affiliation(s)
- Belen Rubio-Viqueira
- Department of Medical Oncology, Quirónsalud Madrid Hospital, Pozuelo de Alarcón, Madrid, Spain
| | | | - Martín Lázaro
- Department of Medical Oncology, Álvaro Cunqueiro University Hospital, Vigo, Pontevedra, 36213, Spain
| | | | | | | | - Jorge García González
- Department of Medical Oncology, University Clinical Hospital of Santiago de Compostela, A Coruña, 15706, Spain
| | - Ana Blasco Cordellat
- Department of Medical Oncology, Hospital General Universitario de Valencia, CIBERONC, Valencia, 46014, Spain
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7
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Casarrubios M, Cruz-Bermúdez A, Nadal E, Insa A, García Campelo MDR, Lázaro M, Dómine M, Majem M, Rodríguez-Abreu D, Martínez-Martí A, de Castro-Carpeño J, Cobo M, López-Vivanco G, Del Barco E, Bernabé Caro R, Viñolas N, Barneto Aranda I, Viteri S, Massuti B, Barquín M, Laza-Briviesca R, Sierra-Rodero B, Parra ER, Sanchez-Espiridion B, Rocha P, Kadara H, Wistuba II, Romero A, Calvo V, Provencio M. Pretreatment Tissue TCR Repertoire Evenness Is Associated with Complete Pathologic Response in Patients with NSCLC Receiving Neoadjuvant Chemoimmunotherapy. Clin Cancer Res 2021; 27:5878-5890. [PMID: 34376534 PMCID: PMC9401519 DOI: 10.1158/1078-0432.ccr-21-1200] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/01/2021] [Accepted: 08/03/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Characterization of the T-cell receptor (TCR) repertoire may be a promising source for predictive biomarkers of pathologic response to immunotherapy in locally advanced non-small cell lung cancer (NSCLC). EXPERIMENTAL DESIGN In this study, next-generation TCR sequencing was performed in peripheral blood and tissue samples of 40 patients with NSCLC, before and after neoadjuvant chemoimmunotherapy (NADIM clinical trial, NCT03081689), considering their complete pathologic response (CPR) or non-CPR. Beyond TCR metrics, tissue clones were ranked by their frequency and spatiotemporal evolution of top 1% clones was determined. RESULTS We have found a positive association between an uneven TCR repertoire in tissue samples at diagnosis and CPR at surgery. Moreover, TCR most frequently ranked clones (top 1%) present in diagnostic biopsies occupied greater frequency in the total clonal space of CPR patients, achieving an AUC ROC to identify CPR patients of 0.967 (95% confidence interval, 0.897-1.000; P = 0.001), and improving the results of PD-L1 tumor proportion score (TPS; AUC = 0.767; P = 0.026) or tumor mutational burden (TMB; AUC = 0.550; P = 0.687). Furthermore, tumors with high pretreatment top 1% clonal space showed similar immune cell populations but a higher immune reactive gene expression profile. Finally, the selective expansion of pretreatment tissue top 1% clones in peripheral blood of CPR patients suggests also a peripheral immunosurveillance, which could explain the high survival rate of these patients. CONCLUSIONS We have identified two parameters derived from TCR repertoire analysis that could outperform PD-L1 TPS and TMB as predictive biomarkers of CPR after neoadjuvant chemoimmunotherapy, and unraveled possible mechanisms of CPR involving enhanced tumor immunogenicity and peripheral immunosurveillance.
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Affiliation(s)
- Marta Casarrubios
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Alberto Cruz-Bermúdez
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain.,Corresponding Authors: Alberto Cruz-Bermúdez, Servicio de Oncología Médica, Instituto de Investigación, Sanitaria Puerta de Hierro, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid 28222, Spain. E-mail: ; and Mariano Provencio,
| | - Ernest Nadal
- Institut Català d'Oncologia, L'Hospitalet de Llobregat, L'Hospitalet De Llobregat, Barcelona, Spain
| | - Amelia Insa
- Fundación INCLIVA, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | | | - Manuel Dómine
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - Alex Martínez-Martí
- Hospital Universitario e Instituto de Oncología Vall d'Hebron (VHIO), Barcelona, Spain
| | | | - Manuel Cobo
- Hospital Universitario Regional de Málaga, Málaga, Spain
| | | | | | | | | | | | - Santiago Viteri
- Instituto Oncológico Dr. Rosell. Hospital Universitario Quiron Dexeus, Grupo QuironSalud, Barcelona, Spain
| | | | - Miguel Barquín
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Raquel Laza-Briviesca
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Belén Sierra-Rodero
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Edwin R. Parra
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Beatriz Sanchez-Espiridion
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pedro Rocha
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Humam Kadara
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ignacio I. Wistuba
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Atocha Romero
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Virginia Calvo
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Mariano Provencio
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain.,Corresponding Authors: Alberto Cruz-Bermúdez, Servicio de Oncología Médica, Instituto de Investigación, Sanitaria Puerta de Hierro, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid 28222, Spain. E-mail: ; and Mariano Provencio,
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Donas JG, de Velasco G, Alonso Gordoa T, Chamorro J, Rosero D, Etxaniz O, Perez-Gracia JL, Pinto A, Duran I, Cacho D, Barba M, Yagüe M, Borrega P, Lázaro M, Rodriguez L, Villalobos Leon MLL, Garcia Sanchez L, Cuellar MA, Rodriguez-Moreno JF. Retrospective study for the characterization of COVID-19 in renal cancer (COVID-REN) patients treated with antiangiogenics or immunotherapy and outcome comparison with non-infected cases. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.4577] [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
4577 Background: Cancer is recognized as a major risk factor for severe COVID19. However little is known about the impact of oncologic treatments in the evolution of the disease. On the other hand, the influence of SARS-CoV2 in cancer response remains to be established. We aim to determine both aspects in renal cancer patients receiving different therapeutic options. Methods: We designed a retrospective case-control study to compare the outcome of patients with advanced renal cancer who developed COVID19 under antiangiogenic treatment (cohort A [ChA]) vs immunotherapy (alone or in combination: cohort B [ChB]) vs matched controls (cohort C [ChC]). Controls were renal cancer patients who were not infected during the period of study. One control per case was selected regarding age, gender, kidney cancer histology and type of treatment. Results: From May 20 to Feb 21, 80 patients were recruited. We present the first 55 patients included (15 ChA, 16 ChB and 20 ChC, 4 patients were screening failure) from 13 centers in Spain. Median age was 62 (range 25 to 88) overall and 62 (range 44 to 88) in Ch A, 64,5 (range 42 to 83) in ChB and 61 (range 41 to 77) in ChC. 38 patients were male and 13 were female. Overall 45 cases were clear cell carcinoma (13 ChA, 14 ChB and 18 ChC), 4 papillary (1 ChA, 2 ChB and 1 ChC), 1 chromophobe (ChA) and 1 unclassified (ChC). Median number of prior lines of treatment was 2 (range 1 to 6) overall, (1 [range 1 to 4] in ChA, 2 [range 1 to 4] in ChB and 2 [range 1 to 6] in ChC). 25 patients required treatment interruptions (8 in ChA [32%], 14 in ChB [56%] and 3 [12%] in ChC). 9 patients were hospitalized (4 in Ch A, 5 in ChB and none in ChC) for a median of 10 days (range 4 to 16) overall (7 [range 4 to 14] in ChA and 12 [range 5 to 16] in ChB). No patient required ICU admission. Best tumor response was complete or partial (CR+PR) in 25 patients (5 [20%] in ChA, 9 [36%] in ChB and 11 [44%] in ChC). Clinical benefit (CR+PR+stable disease) was observed in 38 patients (11 [28,9%] in ChA, 10 [26,3%] in ChB and 17 [44,7%] in ChC). One patient in ChB died (due to COVID19). Updated results will be presented. Conclusions: Patients with renal cancer who developed COVID19 held treatment more frequently and presented lower clinical benefit rates than non infected cases. Patients receiving immunotherapy required more frequent dose interruptions and longer hospitalizations than cases on antiangiogenics. These results point to an impact of SARS-CoV2 in renal cancer outcome. Therapies administered to treat renal cancer, could play a role in the evolution of COVID19.
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Affiliation(s)
| | | | | | | | - Diana Rosero
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Olatz Etxaniz
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Alvaro Pinto
- Department of Medical Oncology, La Paz University Hospital, Madrid, Spain
| | - Ignacio Duran
- Hospital Universitario Marqués de Valdecilla, IDIVAL, Cantabria, Spain
| | - Diego Cacho
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - María Barba
- HM Sanchinarro Centro Integral Oncologico Clara Campal (CIOCC), Madrid, Spain
| | - Monica Yagüe
- HM Hospitales-Centro Integral Oncológico Clara Campal, Madrid, Spain
| | | | | | | | | | | | - M. Andres Cuellar
- Medical Oncology. Institut Català d'Oncologia (ICO) L'Hospitalet del Llobregat, Barcelona, Spain
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9
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Nascimento M, Lourenço B, Coelho I, Aguiar J, Lázaro M, Silva M, Pereira C, Neves-Caldas I, Gomes F, Garcia S, Nascimento S, Pereira G, Nogueira V, Costa P, Nobre A. No man is an island: spatial clustering and access to primary care as possible targets for the development of new community mental health approaches. BMC Health Serv Res 2020; 20:344. [PMID: 32321489 PMCID: PMC7178966 DOI: 10.1186/s12913-020-05190-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 04/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND to understand if patients seen at Centro Hospitalar Psiquiátrico de Lisboa (CHPL) live in geographical clusters or randomly throughout the city, as well as determine their access to the psychiatric hospital and primary care facilities (PCF). METHODS spatial autocorrelation statistics were performed (queen criterion of contiguity), regarding all patients observed at CHPL in 2017 (at the census subsection level), and considering not only their overall number but also main diagnosis, and admission to the psychiatric ward - voluntary or compulsory. Distance to the hospital and to the closest PCF was measured (for each patient and the variables cited above), and the mean values were compared. Finally, the total number of patients around each PCF was counted, considering specified radius sizes of 656 and 1000 m. RESULTS All 5161 patients (509 psychiatric admissions) were geolocated, and statistical significance regarding patient clustering was found for the total number (p-0.0001) and specific group of disorders, namely Schizophrenia and related disorders (p-0.007) and depressive disorders (p-0.0002). Patients who were admitted in a psychiatric ward live farther away from the hospital (p-0.002), with the compulsory admissions (versus voluntary ones) living even farther (p-0.004). Furthermore, defining a radius of 1000 m for each PCF allowed the identification of two PCF with more than 1000 patients, and two others with more than 800. CONCLUSIONS as patients seem to live in geographical clusters (and considering PCFs with the highest number of them), possible locations for the development of programs regarding mental health treatment and prevention can now be identified.
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Affiliation(s)
- M Nascimento
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal.
| | - B Lourenço
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
| | - I Coelho
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
| | - J Aguiar
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
| | - M Lázaro
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
| | - M Silva
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
| | - C Pereira
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
| | - I Neves-Caldas
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
| | - F Gomes
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
| | - S Garcia
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
| | - S Nascimento
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
| | - G Pereira
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
| | - V Nogueira
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
| | - P Costa
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
| | - A Nobre
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
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Isla D, Massuti B, Lázaro M, de Alda LR, Gordo R, Ortega-Joaquín N, Oyagüez I. Cost analysis of the management of brain metastases in patients with advanced ALK+ NSCLC: alectinib versus crizotinib. Lung Cancer Manag 2020; 9:LMT28. [PMID: 32256712 PMCID: PMC7110588 DOI: 10.2217/lmt-2019-0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim To estimate management cost of NSCLC ALK+ patients with and without brain metastasis (BM), and to compare annual costs in patients treated with alectinib or crizotinib. Methods Management cost/year (€ 2018) in patients with and without BM was estimated with disaggregated resource consumption provided by local oncologists, including medical visits, hospitalizations, diagnostic/laboratory tests, imaging techniques and surgical procedures. The comparison of costs/year with alectinib and crizotinib, considered the cumulative 12-month incidence of BM in ALEX trial (9.4 and 41.4%, respectively). Results Management cost was €6173.42/patient-year without BM and €21,637.50/patient-year with BM. With alectinib, average cost/patient was lower than crizotinib (€4948.51/patient-year). Conclusion Prevention of BM with alectinib may result in reductions of cost/year in the management of advanced ALK+ NSCLC.
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Affiliation(s)
- Dolores Isla
- Medical Oncology Department, Lozano Blesa University Clinical Hospital, Zaragoza, Spain
| | - Bartomeu Massuti
- Medical Oncology Department, University General Hospital of Alicante, Alicante, Spain
| | - Martín Lázaro
- Medical Oncology Department, University Hospital Complex of Vigo, Vigo, Pontevedra, Spain
| | | | - Rocio Gordo
- Medical Department, Roche Pharma, Madrid, Spain
| | - Nuria Ortega-Joaquín
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, Spain
| | - Itziar Oyagüez
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, Spain
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Vázquez Estévez S, Anido U, Lázaro M, Fernández O, Fernández Núñez N, de Dios Álvarez N, Varela V, Campos Balea B, Agraso S, Areses MC, Iglesias L, Blanco M, Maciá S, Anton Aparicio LM. A new scenario in metastatic renal cell carcinoma: a SOG-GU consensus. Clin Transl Oncol 2020; 22:1565-1579. [PMID: 32062835 DOI: 10.1007/s12094-020-02300-2] [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: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND This article describes and compares approved targeted therapies and the newer immunotherapy agents. MATERIALS AND METHODS This article especially performs an in-depth review of currently available data for tivozanib, explaining its mechanism of action, its safety profile and its role as an efficacy drug in the management of renal cancer. RESULTS Despite the fact that the treatment of advanced RCC has been dramatically modified in recent years, durable remissions are scarce and it remains a lethal disease. For first- and second-line therapy, there is now growing evidence to guide the selection of the appropriate treatment. CONCLUSIONS Several TKIs are standard of care at different settings. Among those approved TKIs, tivozanib has similar efficacy than others with a better safety profile. The use of prognostic factors is critical to the selection of optimal therapy.
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Affiliation(s)
- S Vázquez Estévez
- Medical Oncology Department, Hospital Universitario Lucus Augusti (Lugo), Dr. Ulises Romero, s/n, 27003, Lugo, Spain.
| | - U Anido
- Medical Oncology Department, Complejo Hospitalario Universitario Santiago de Compostela, Trav. da Choupana, s/n, 15702, Santiago de Compostela, Spain
| | - M Lázaro
- Medical Oncology Department, Hospital Álvaro Cunqueiro, Camiño dos Cañotais 44, 36312, Vigo, Spain
| | - O Fernández
- Medical Oncology Department, Complexo Hospitalario Universitario de Ourense, Ramón Puga Noguerol, 54, 32005, Ourense, Spain
| | - N Fernández Núñez
- Medical Oncology Department, Hospital Universitario Lucus Augusti (Lugo), Dr. Ulises Romero, s/n, 27003, Lugo, Spain
| | - N de Dios Álvarez
- Medical Oncology Department, Hospital Álvaro Cunqueiro, Camiño dos Cañotais 44, 36312, Vigo, Spain
| | - V Varela
- Medical Oncology Department, Complejo Hospitalario Universitario Santiago de Compostela, Trav. da Choupana, s/n, 15702, Santiago de Compostela, Spain
| | - B Campos Balea
- Medical Oncology Department, Hospital Universitario Lucus Augusti (Lugo), Dr. Ulises Romero, s/n, 27003, Lugo, Spain
| | - S Agraso
- Medical Oncology Department, Hospital Álvaro Cunqueiro, Camiño dos Cañotais 44, 36312, Vigo, Spain
| | - M C Areses
- Medical Oncology Department, Complexo Hospitalario Universitario de Ourense, Ramón Puga Noguerol, 54, 32005, Ourense, Spain
| | - L Iglesias
- Medical Oncology Department, Complexo Hospitalario Universitario de Ourense, Ramón Puga Noguerol, 54, 32005, Ourense, Spain
| | - M Blanco
- Medical Oncology Department, Complejo Hospitalario Universitario Santiago de Compostela, Trav. da Choupana, s/n, 15702, Santiago de Compostela, Spain
| | - S Maciá
- Oncology Medical Department, Pivotal, Calle Gobelas, no 19, 28023, Madrid, Spain
| | - L M Anton Aparicio
- Medical Oncology Department, Complejo Hospitalario Universitario A Coruña, As Xubias, 84, 15006, A Coruña, Spain
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Lázaro M, Valderrama BP, Suárez C, de-Velasco G, Beato C, Chirivella I, González-del-Alba A, Laínez N, Méndez-Vidal MJ, Arranz JA. SEOM clinical guideline for treatment of kidney cancer (2019). Clin Transl Oncol 2020; 22:256-269. [DOI: 10.1007/s12094-019-02285-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 12/26/2019] [Indexed: 12/18/2022]
Abstract
AbstractIn this article, we review de state of the art on the management of renal cell carcinoma (RCC) and provide recommendations on diagnosis and treatment. Recent advances in molecular biology have allowed the subclassification of renal tumours into different histologic variants and may help to identify future prognostic and predictive factors. For patients with localized disease, surgery is the treatment of choice with nephron-sparing surgery recommended when feasible. No adjuvant therapy has demonstrated a clear benefit in overall survival. Considering the whole population of patients with advanced disease, the combination of axitinib with either pembrolizumab or avelumab increase response rate and progression-free survival, compared to sunitinib, but a longer overall survival has only been demonstrated so far with the pembrolizumab combo. For patients with IMDC intermediate and poor prognosis, nephrectomy should not be considered mandatory. In this subpopulation, the combination of ipilimumab and nivolumab has also demonstrated a superior response rate and overall survival vs. sunitinib. In patients progressing to one or two antiangiogenic tyrosine-kinase inhibitors, both nivolumab and cabozantinib in monotherapy have shown benefit in overall survival compared to everolimus. Although no clear sequence can be recommended, medical oncologists and patients should be aware of the recent advances and new strategies that improve survival and quality of life in patients with metastatic RCC.
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13
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Lázaro M, Vázquez L, Laffond E, Moreno E, Macias EM, Dávila I. Resolution of Type IV Hypersensitivity After Bone Marrow Transplantation. J Investig Allergol Clin Immunol 2019; 28:190. [PMID: 29939137 DOI: 10.18176/jiaci.0226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M Lázaro
- Allergy Service, University Hospital of Salamanca, Salamanca, Spain
| | - L Vázquez
- Hematology Service, University Hospital, Salamanca, Spain.,Biomedical Research Institute, Salamanca, Spain
| | - E Laffond
- Biomedical Research Institute, Salamanca, Spain
| | - E Moreno
- Allergy Service, University Hospital of Salamanca, Salamanca, Spain.,Biomedical Research Institute, Salamanca, Spain.,Department of Biomedical and Diagnostic Sciences, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - E M Macias
- Allergy Service, University Hospital of Salamanca, Salamanca, Spain.,Biomedical Research Institute, Salamanca, Spain
| | - I Dávila
- Allergy Service, University Hospital of Salamanca, Salamanca, Spain.,Biomedical Research Institute, Salamanca, Spain.,Department of Biomedical and Diagnostic Sciences, Faculty of Medicine, University of Salamanca, Salamanca, Spain
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14
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Martos Gisbert N, Aguilar M, Laporta R, Lázaro M, Aguado S, Sandoval R, Ussetti Gil M. Comparison of Extracorporeal Photopheresis and Thymoglobulin for the Treatment of Chronic Lung Allograft Dysfunction. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Carvalhão Gil L, Lázaro M, Ponte A. Do Not be Afraid: Novel Approaches to the Treatment of Anxiety Disorders. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.1872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IntroductionAnxiety disorders (AD) are associated with significant morbidity and often are chronic and resistant to the treatment. A fascinating aspect of AD is the interplay of genetic and experiential factors. It is stablished that abnormal genes predispose to pathological anxiety states; however evidence clearly indicates that traumatic life events and stress are also etiologically relevant. The behavioral theories of anxiety postulates that anxiety is a conditioned response to a specific environmental stimulus. There may be two ways to neutralize fear conditioning either by facilitating a process called extinction or by blocking a process called reconsolidation.ObjectivesReview novel approaches to the treatment of AD.AimsTo update on treatment for AD.MethodsA literature search was performed on PubMed database.ResultsCognitive behavioral therapies use exposure techniques, in which the patient has to confront the fear-inducing stimuli in a safe environment in order to facilitate the fear extinction. The therapy is often context-specific, so one way of strengthen extinction learning is by boosting NMDA receptor activation, either with direct acting agonists (D-cycloserine) or with indirect glycine enhancing agents (selective glycine reuptake inhibitors). Memory reconsolidation is based on the notion that memories are dynamic rather than stable. Reactivation of a memory can return it to a labile state from which it must be reconsolidated. Blocking reconsolidation is a therapeutic opportunity of update and alter the memory, weakening traumatic memories. Beta-blockers and opioids may disrupt this process.ConclusionsPsychotherapy and psychopharmacology may have a synergistic role in AD treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Carvalhão Gil L, Lázaro M, Ponte A, Teixeira J, Prata Ribeiro H, Mota T. Treatment of alcoholism – New targets? Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.1713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionAlcohol use disorders (AUD) is a preventable cause of significant morbidity and mortality worldwide. AUD is a heterogeneous disorder stemming from a complex interaction of neurobiological, genetic, and environmental factors. To achieve treatment effectiveness this heterogenity should be considered, as well as safety.ObjectivesReview mechanisms underlying alcohol addiction in order to work out new, more effective treatment strategies.AimTo update on treatment for alcoholism.MethodsA literature search was performed on PubMed database.ResultsAlcohol dependence is a chronic, relapsing condition in which there is evidence of significant change in the motivation and control systems in the brain. Increasingly drug therapy is focused not just on the treatment of the acute withdrawal syndrome, but on modifying these other dysregulated brain systems. Of the numerous neurotransmitter systems that have been identified for the development of new medicines, the most promising compounds appear to be those that modulate the function of opioids, glutamate with or without gamma-aminobutyric acid, and serotonin. Other putative therapeutic medications including direct modulators of dopamine function and enzyme inhibitors also shall be discussed. At present, only four medications are approved for the treatment of alcohol dependence in Europe, that is naltrexone, acamprosate, disulfiram and the most recent nalmefene. Among other promising strategies the following drugs are mentioned: baclofen, topiramate, ondansetron, aripiprazole, rimonabant and varenicline.ConclusionsPharmacological development remains a high priority in the alcoholism field. Drugs have different safety profiles that need to be balanced with the treatment objective, individual patient preferences and comorbid conditions.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Nascimento M, Lázaro M, Reis J, Pereira G, Bacelar F, Nobre A. Affective disorders, psychosis and lipid levels: Is there a connection? Linking psychopathology, clinical exams and neurobiology. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.1439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionPublished research regarding the relationship between lipid levels in affective disorders has been contradictory. Additionally, most studies correlating psychosis to lipid serum concentrations only concern schizophrenic patients.ObjectiveTo access the relationship between serum lipid levels with the diagnosis and pathophysiology of affective disorders.MethodsDiagnostic data (ICD–10: F31–32), including mood and psychotic features, were prospectively collected for all patients admitted at the affective disorder ward at Centro Hospitalar Psiquiátrico de Lisboa (Portugal), during the third trimester of 2016. Serum concentrations of triglycerides and total/HDL/LDL cholesterol were evaluated using standard laboratory tests. Statistical analysis was performed for possible correlations between serum lipid levels and:– different stages of bipolar disorder (BD);– elevated versus depressive mood (unipolar and bipolar);– depressive mood (BD versus non-BD);– psychotic features.ResultsSixty-three patients admitted were enrolled in this study: 47 presented with BD (32 manic, 10 depressives and 5 mixed episodes) and 16 presented depressive disorders. Statistical analysis (R software) revealed that depressed bipolar patients had significantly higher triglyceride (P = 0.026), total and LDL cholesterol (P = 0.525) levels than other states; mixed episodes presented higher HDL levels (P = 0.542). Although not significant, manic patients’ HDL levels were consistently elevated compared to depressive ones, whom presented with lower values overall. Finally, when adjusted for age, psychotic patients showed lower levels of total (P = 0.031) and LDL cholesterol (P = 0.052) compared to non-psychotic patients.ConclusionsThere is a potential link between serum lipid levels and diagnosis/psychopathology of affective disorders. Further research is needed to characterize its pathophysiologic relevance.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Nascimento M, Lázaro M, Reis J, Pereira G, Bacelar F, Nobre A. Insomnia and aggressiveness in affective disorders: Self-assessment versus clinical examination. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.1380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionAlthough, disturbances of sleep, as well as aggressiveness, have been described in patients with mood disorders, these patients may not be aware of them.Objectives/aimsTo access the personal perception of sleep, disturbances and aggressiveness in patients with mood disorders, admitted to an acute psychiatric ward.MethodsDiagnostic data (ICD-10: F31–33), including mood evaluation, were prospectively collected for all patients admitted at the affective disorder ward at Centro Hospitalar Psiquiátrico de Lisboa (Portugal), during the third trimester of 2016. Then, 2 auto-questionnaires – Athens insomnia scale (AIS) and Buss and Perry aggression scale (both validated to the Portuguese population) – were applied to these patients. Statistical analysis was performed for possible correlations between patients’ mood and the questionnaires’ scores, using R software.ResultsThirty-eight patients admitted were enrolled in this study: 28 with bipolar disorder (19 manic, 4 depressive and 5 mixed episodes), and 10 with depressive disorder. Depressed patients presented statistically higher values in the AIS (average = 20), compared to manic (14) and mixed ones (17.2) (P = 0.031). However, there were no statistical differences found between depressed patients (bipolar versus non-bipolar). Even though manic patients presented an increased average score in the Buss and Perry questionnaire (both total–65; but also sub-scores), these values were not significantly different than depressed (60) or mixed patients’ scores (57.4).ConclusionsEven though some symptoms (like sleep or aggressiveness) seem to be relevant to the clinics, patients with affective disorders do not seem to be aware these disturbances, and therefore are not able to acknowledge their relevance.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Lázaro M, Carvalhão Gil L, Ponte A, Mota T. Do not forget alcohol damage – Cognitive impairments related to alcohol. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.1740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
IntroductionChronic excessive alcohol consumption may lead to structural and functional damage of the brain. Alcohol-related cognitive impairments are well-established and confirmed by neuropsychological and neuroimaging studies. However, the influence of each neuropathological mechanisms is still under discussion. This topic is increasingly becoming focus of attention in psychiatry.ObjectivesReview the neuropathology, clinical features, neuropsychology and management of alcohol-related cognitive impairments.AimsEvaluate clinical impact, management and prognosis of alcohol-related cognitive impairments.MethodsA literature search was performed on PubMed and Medscape database.ResultsAccording to our literature research, there is a debate concerning the relative contributions of the direct toxic effect of alcohol and the impact of thiamine deficiency on the alcohol-related cognitive impairments. Research about this issue is challenging, considering the multiple patterns of alcohol abuse, the personal and lifestyle factors, and the vulnerability of specific brain regions. The cognitive decline is linked to neuroanatomical alterations and primarily affects executive functions, episodic memory, and visuospatial capacities. These deficits may range from mild to severe but usually remain undiagnosed, unless they are specifically investigated. Maintenance of lasting abstinence is associated with cognitive recovery, but some impairments may persist and interfere with the prognosis.ConclusionRecognizing and screening for alcohol-related cognitive impairments is crucial to offer significant benefits to patients by optimising management strategies.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Lázaro M, Gallardo E, Doménech M, Pinto Á, González-del-Alba A, Del Alba AG, Puente J, Fernández O, Font A, Lainez N, Vázquez S. SEOM Clinical Guideline for treatment of muscle-invasive and metastatic urothelial bladder cancer (2016). Clin Transl Oncol 2016; 18:1197-1205. [PMID: 27900539 PMCID: PMC5138255 DOI: 10.1007/s12094-016-1584-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 11/15/2016] [Indexed: 12/21/2022]
Abstract
The goal of this article is to provide recommendations for the diagnosis and treatment of muscle-invasive and metastatic bladder cancer. The diagnosis of muscle-invasive bladder cancer is made by pathologic evaluation after transurethral resection. Recently, a molecular classification has been proposed. Staging of muscle-invasive bladder cancer must be done by computed tomography scans of the chest, abdomen and pelvis and classified on the basis of UICC system. Radical cystectomy and lymph node dissection are the treatment of choice. In muscle-invasive bladder cancer, neoadjuvant chemotherapy should be recommended in patients with good performance status and no renal function impairment. Although there is insufficient evidence for use of adjuvant chemotherapy, its use must be considered when neoadjuvant therapy had not been administered in high-risk patients. Multimodality bladder-preserving treatment in localized disease is an alternative in selected and compliant patients for whom cystectomy is not considered for clinical or personal reasons. In metastatic disease, the first-line treatment for patients must be based on cisplatin-containing combination. Vinflunine is the only drug approved for use in second line in Europe. Recently, immunotherapy treatment has demonstrated activity in this setting.
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Affiliation(s)
- M Lázaro
- Medical Oncology Department, Hospital Álvaro Cunqueiro-Complexo Hospitalario Universitario de Vigo, Estrada Clara Campoamor, 34136312, Vigo, Spain.
| | - E Gallardo
- Medical Oncology Department, Parc Taulí Sabadell Hospital Universitari, Sabadell, Spain
| | - M Doménech
- Medical Oncology Department, Althaia, Xarxa Assisencial i Universitària de Manresa, Manresa, Spain
| | - Á Pinto
- Medical Oncology Department, Hospital Universitario La Paz-Idipaz, Madrid, Spain
| | | | - A González Del Alba
- Medical Oncology Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - J Puente
- Medical Oncology Department, Hospital Universitario San Carlos, Madrid, Spain
| | - O Fernández
- Complexo Hospitalario Universitario de Ourense, Badalona, Spain
| | - A Font
- Medical Oncology Department, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - N Lainez
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - S Vázquez
- Medical Oncology Department, Hospital Universitario Lucus Augusti, Lugo, Spain
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Vázquez S, Casal J, Afonso Afonso FJ, Fírvida JL, Santomé L, Barón F, Lázaro M, Pena C, Amenedo M, Abdulkader I, González-Arenas C, Fachal L, Vega A. EGFR testing and clinical management of advanced NSCLC: a Galician Lung Cancer Group study (GGCP 048-10). Cancer Manag Res 2016; 8:11-20. [PMID: 26893581 PMCID: PMC4745839 DOI: 10.2147/cmar.s85173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose This study aimed to assess the incidence of mutations in the epidermal growth factor receptor (EGFR) gene in non-small-cell lung cancer (NSCLC) patients in the Galician region of Spain and the clinical management and outcome of patients carrying EGFR mutations. Patients and methods All newly diagnosed advanced or metastatic NSCLC patients were screened for EGFR mutations in matched tumor samples (tissue or cytology specimens) and serum samples. Results Of 198 patients screened for EGFR mutations in tumor samples, 184 had evaluable data and, of these, 25 (13.6%) had EGFR mutations (84% sensitizing mutations). EGFR mutation was found in serum in 14 (8.1%) patients (of 174 evaluable). Compared to matched tumor tissue, serum EGFR mutation testing specificity and sensitivity were 99% and 52%, respectively. All but two patients received gefitinib. Median progression-free survival and overall survival were 10 (95% confidence interval: 4.8–15.3) months and 17.8 (95% confidence interval: 13.9–21.6) months, respectively, in patients carrying sensitizing mutations. Conclusion The incidence of EGFR mutations in Galicia is consistent with previous data in Spain. Our results also support the feasibility of EGFR testing to guide treatment decision making using tumor tissue or cytology samples, or serum samples if tumor specimens are unavailable. These findings also confirm that first-line gefitinib is an active treatment option in Caucasians with EGFR mutation-positive NSCLC.
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Affiliation(s)
- Sergio Vázquez
- Medical Oncology Department, Lucus Augusti University Hospital, Lugo, Spain
| | - Joaquín Casal
- Medical Oncology Department, University Hospital Complex of Vigo, Pontevedra, Spain
| | | | - José Luis Fírvida
- Medical Oncology Department, University Hospital Complex of Ourense, Ourense, Spain
| | - Lucía Santomé
- Medical Oncology Department Povisa Hospital, Vigo, Spain
| | - Francisco Barón
- Medical Oncology Department, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Martín Lázaro
- Medical Oncology Department, Hospital Complex of Pontevedra, Pontevedra, Spain
| | - Carolina Pena
- Medical Oncology Department, Hospital Complex of Pontevedra, Pontevedra, Spain
| | - Margarita Amenedo
- Medical Oncology Department, Oncology Center of Galicia, A Coruña, Spain
| | - Ihab Abdulkader
- Anatomical Pathology Department, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Laura Fachal
- Galician Public Foundation of Genomic Medicine-SERGAS, Santiago de Compostela Clinic Hospital, Santiago de Compostela, Spain
| | - Ana Vega
- Galician Public Foundation of Genomic Medicine-SERGAS, Santiago de Compostela Clinic Hospital, Santiago de Compostela, Spain
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Pedrosa M, Prieto-García A, Sala-Cunill A, Baeza ML, Cabañas R, Campos A, Cimbollek S, Gómez-Traseira C, González Quevedo T, Guilarte M, Jurado-Palomo J, Lobera T, López-Serrano MC, Marcos C, Piñero-Saavedra M, Prior N, Sáenz de San Pedro B, Ferrer M, Barceló JM, Daschner A, Echechipía M, Garcés M, Iriarte P, Jáuregui I, Lázaro M, Quiñones M, Veleiro B, Villareal O. Management of angioedema without urticaria in the emergency department. Ann Med 2014; 46:607-18. [PMID: 25580506 DOI: 10.3109/07853890.2014.949300] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Angioedema refers to a localized, transient swelling of the deep skin layers or the upper respiratory or gastrointestinal mucosa. It develops as a result of mainly two different vasoactive peptides, histamine or bradykinin. Pathophysiology, as well as treatment, is different in each case; nevertheless, the resulting signs and symptoms may be similar and difficult to distinguish. Angioedema may occur at any location. When the affected area involves the upper respiratory tract, both forms of angioedema can lead to an imminent upper airway obstruction and a life-threatening emergency. Emergency physicians must have a basic understanding of the pathophysiology underlying this process. Angioedema evaluation in the emergency department (ED) should aim to distinguish between histamine- and bradykinin-induced angioedema, in order to provide appropriate treatment to patients. However, diagnostic methods are not available at the ED setting, neither to confirm one mechanism or the other, nor to identify a cause. For this reason, the management of angioedema should rely on clinical data depending on the particular features of the episode and the patient in each case. The history-taking should be addressed to identify a possible etiology or triggering agent, recording complete information for an ulterior diagnostic study in the outpatient clinic. It is mandatory quickly to recognize and treat a potential life-threatening upper airway obstruction or anaphylaxis. This review focuses on the underlying mechanisms and management of histamine- and bradykinin-induced angioedema at the emergency department and provides an update on the currently available treatments.
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Affiliation(s)
- Maria Pedrosa
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.
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Rovai M, Caja G, Salama A, Jubert A, Lázaro B, Lázaro M, Leitner G. Identifying the major bacteria causing intramammary infections in individual milk samples of sheep and goats using traditional bacteria culturing and real-time polymerase chain reaction. J Dairy Sci 2014; 97:5393-400. [DOI: 10.3168/jds.2014-7988] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 05/08/2014] [Indexed: 11/19/2022]
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Juan O, Sánchez-Hernández A, Vázquez S, Casal J, Firvida JL, Aparisi F, Muñoz J, García-Sánchez J, Gironés R, Lázaro M, Giner V. Full-dose cisplatin and oral vinorelbine concomitant with radiotherapy in unresectable stage III non-small cell lung cancer: a multi-center phase II study. Anticancer Res 2014; 34:1959-1966. [PMID: 24692732] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM To evaluate the efficacy and toxicities of combination of cisplatin and oral vinorelbine given at full doses concomitantly with radiotherapy for non-small cell lung cancer (NSCLC). PATIENTS AND METHODS Untreated patients with locally advanced inoperable stage IIIA/IIIB NSCLC were eligible for study inclusion. Treatment consisted of four cycles of oral vinorelbine at 60 mg/m(2) on days 1 and 8, and cisplatin at 80 mg/m(2) on day 1 every three weeks plus radiotherapy 66 Gy starting on day 1 of cycle 2 in fractions of 2 Gy/day over 6.5 weeks. RESULTS Forty-eight patients were enrolled. Their characteristics included: median age 61 years; female gender 10%; stage IIIA 46% and IIIB 54%; squamous carcinoma 63%, performance status PS0 42%; PS1 58%. Selected grade 3/4 toxicities were as follows: neutropenia 33%, concomitant febrile neutropenia 14.6%, anemia 12.5%, thrombocytopenia 16.6%, and esophagitis 12.5%. Two treatment-related deaths were reported, both during cycle 1. Radiotherapy was administered to 87.5% of patients; 7.1% of them received less than 60 Gy and 23.8% had delays due to adverse events. The objective response rate was 77.3%, with two complete responses and 32 partial responses. With a median follow-up of 19 months, the median progression-free survival was 12 months, and the 1-year overall survival rate was 72.3%. Median overall survival was 27.8 months, although the 95% confidence interval has not yet been achieved. CONCLUSION Full doses of cisplatin and oral vinorelbine can be administered with concomitant radiotherapy, with good efficacy and an acceptable safety profile for patients with stage IIIA/IIIB NSCLC.
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Affiliation(s)
- Oscar Juan
- Department of Medical Oncology, La Fe University Hospital, Bulevar Sur s/n. 46026, Valencia, Spain.
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Marco J, Barba R, Lázaro M, Matía P, Plaza S, Canora J, Zapatero A. Bronchopulmonary complications associated to enteral nutrition devices in patients admitted to Internal Medicine Departments. Rev Clin Esp 2013. [DOI: 10.1016/j.rceng.2013.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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26
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Afonso FJ, Anido U, Fernández-Calvo O, Vázquez-Estévez S, León L, Lázaro M, Ramos M, Antón-Aparicio L. Erratum to: Comprehensive overview of the efficacy and safety of sorafenib in advanced or metastatic renal cell carcinoma after a first tyrosine kinase inhibitor. Clin Transl Oncol 2013. [DOI: 10.1007/s12094-013-1032-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Marco J, Barba R, Lázaro M, Matía P, Plaza S, Canora J, Zapatero A. Bronchopulmonary complications associated to enteral nutrition devices in patients admitted to internal medicine departments. Rev Clin Esp 2013; 213:223-8. [PMID: 23566479 DOI: 10.1016/j.rce.2013.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 01/26/2013] [Accepted: 01/28/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Enteral nutrition using feeding devices such as nasogastric (NG) tube or percutaneous endoscopic gastrostomy (PEG) is an effective feeding method subject that may give rise to complications. We have studied the relationship between enteral nutrition feeding devices in patients admitted to the Internal Medicine Departments and the development of pulmonary complications (bronchial aspiration and aspiration pneumonia). PATIENTS AND METHODS All of the patients discharge between 2005 and 2009 from the Internal Medicine (IM) Departments of the public hospitals of the National Health System in Spain were analyzed. The data of patients with bronchial aspiration or aspiration pneumonia who also were carriers of NG tubes or PEG, were obtained from the Minimum Basic Data Set (MBDS). RESULTS From a total of 2,767,259 discharges, 26,066 (0.92%) patients with nasogastric tube (NG tube) or percutaneous gastrostomy (PEG) were identified. A total of 21.5% of patients with NG tube and 25.9% of patients with PEG had coding for a bronchopulmonary aspiration on their discharge report versus 1.2% of patients without an enteral feeding tube. In the multivariate analysis, the likelihood of suffering bronchoaspiration was 9 times greater in patients with SNG (OR: 9.1; 95% CI: 8.7-9.4) and 15 greater in subjects with PEG (OR: 15.2; 95% CI: 14.5-15.9) than in subjects without SNG or PEG. Mean stay (9.2 and 12.7 more days), diagnostic complexity and costs were much higher in patients with SNG or PEG compared to patients in hospital who did not require these devices. CONCLUSIONS An association was found between SNG and PEG for enteral feeding and pulmonary complications. Mean stay, diagnostic complexity and cost per admission of these patients was higher in patients who did not require enteral nutrition.
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Affiliation(s)
- J Marco
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Madrid, Spain.
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Afonso FJ, Anido U, Fernández-Calvo O, Vázquez-Estévez S, León L, Lázaro M, Ramos M, Antón-Aparicio L. Comprehensive overview of the efficacy and safety of sorafenib in advanced or metastatic renal cell carcinoma after a first tyrosine kinase inhibitor. Clin Transl Oncol 2013; 15:425-33. [PMID: 23401018 DOI: 10.1007/s12094-012-0985-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 11/29/2012] [Indexed: 12/18/2022]
Abstract
We performed a literature search that shed light on the signaling pathways involved in the sorafenib activity as first- or subsequent-line treatment, taking into account its toxicity profile. Sorafenib appears to have better tolerability when compared with other agents in the same indication. Cross-resistance between tyrosine kinase inhibitors (TKIs) may be limited, even after failure with a previous VEGFR inhibitor, but the optimal sequence with TKIs remains to be determined. Randomized trials of second-line treatment options have showed either modest or no differences in terms of progression-free and overall survival (OS). Direct comparison between sorafenib and axitinib demonstrated differences in terms of PFS in favor of axitinib, but not in terms of OS as second-line treatment. In contrast, a phase III study showed a benefit in OS, favoring sorafenib when compared with temsirolimus. In conclusion, after using other VEGF inhibitor such as sunitinib, sorafenib is active and safe for the treatment of patients with advanced or metastatic RCC.
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Affiliation(s)
- F J Afonso
- Complexo Hospitalario Arquitecto Marcide, Ferrol, Spain
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Lambea J, Hinojo C, Lainez N, Lázaro M, León L, Rodríguez A, Soto de Prado D, Esteban E. Quality of life and supportive care for patients with metastatic renal cell carcinoma. Cancer Metastasis Rev 2012; 31 Suppl 1:S33-9. [PMID: 22684341 DOI: 10.1007/s10555-012-9357-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In recent years, a key issue in the management of patients with metastatic renal cell carcinoma (mRCC) has been the assessment of health-related quality of life (HRQoL), particularly following the introduction of targeted therapies that have brought significant improvements in progression-free survival and quality of life in these patients. HRQoL is becoming one of the main factors influencing choice of therapy, and HRQoL experienced during first-line treatment may affect the choice of the second-line therapy. Consequently, several trials have been conducted to evaluate the impact of approved targeted therapies for mRCC on HRQoL, and this measure is being introduced with increasing frequency in the trial design. With respect to agents used after progression on cytokines, sunitinib and temsirolimus have yielded better HRQoL scores, and sorafenib and pazopanib have shown stable HRQoL scores compared with placebo. Regarding targeted agents approved for patients who progress on a first-line tyrosine kinase inhibitor, everolimus has shown to delay and reduce the degree of Karnofsky performance status deterioration compared with placebo. Moreover, evidence obtained from these trials shows that tumor response and delay in disease progression affect HRQoL. In this article, we review the different HRQoL scales used to evaluate patients with mRCC along with the results obtained in clinical trials. Given that HRQoL is determined not only by treatment-related effects but also by mRCC symptoms and its clinical complications, the characteristics and appropriate treatment of the most commonly experienced symptoms, including anorexia, fatigue, pain, anemia, and venous thromboembolism, are also reviewed.
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Affiliation(s)
- Julio Lambea
- Hospital Clínico Universitario de Zaragoza, Zaragoza, Spain
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Santillán S, Cantalapiedra D, Pérez-Carbonero L, Romera A, Fernández-Pedrosa V, Collado C, Rodríguez de Pablos R, Zúñiga-Trejos S, Triviño J, Rosa-Rosa J, Gil M, Miñambres R, Felipe V, Fernández P, Buades C, Lázaro M. 211. Cardiogene profile v2 en aneurisma de aorta torácica familiar. estudio genético y prevención. Cirugía Cardiovascular 2012. [DOI: 10.1016/s1134-0096(12)70429-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Vázquez S, León L, Fernández O, Lázaro M, Grande E, Aparicio L. Sunitinib: the first to arrive at first-line metastatic renal cell carcinoma. Adv Ther 2012; 29:202-17. [PMID: 22328304 DOI: 10.1007/s12325-011-0099-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Indexed: 10/14/2022]
Abstract
Tyrosine kinase inhibitors (TKIs) are beneficial for the treatment of renal cell carcinoma (RCC), gastrointestinal stromal tumors (GIST), pancreatic neuroendocrine tumors (pNETs), and other tumors. The antitumor activity of sunitinib has been based on time-related parameters such as progression-free survival (PFS) and overall survival (OS). Advances in knowledge of the molecular mechanisms and oncogenic processes associated with RCC have enabled the availability of rational targets for pharmacotherapy. Although each small molecule is modeled to block the activity of selected kinase signaling enzymes, it is increasingly evident that many have nontargeted effects (on other kinases) that may cause unexpected complications. The recommended dose for sunitinib in patients with advanced RCC is a 50 mg oral daily dose, with or without food, on a 4/2 week schedule (4 weeks "on" vs. 2 weeks "off") until progression. An alternative continuous 37.5 mg/day dosing schedule has also been evaluated and appears to be well tolerated, allowing the maintenance of the dose density of sunitinib with a similar outcome. The continuous administration schedule provides a constant exposure to the drug, and may prevent potential tumor regrowth and angiogenesis recovery. Most side effects are reversible and should not result in sunitinib discontinuation. In this article, the body of evidence behind the use of sunitinib in metastatic RCC (mRCC) compared to other targeted agents that have recently come into the field is summarized, and the need for correct management of an adverse event profile in order to better optimize available treatment options is underlined.
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Bustos A, Álvarez R, Aramburo PM, Carabantes F, Díaz N, Florián J, Lázaro M, de Segovia JMM, Gasquet JA, Alegre A. Evaluation of clinical use and effectiveness of darbepoetin alfa in cancer patients with chemotherapy-induced anemia. Curr Med Res Opin 2012; 28:57-67. [PMID: 22070513 DOI: 10.1185/03007995.2011.639352] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To investigate the patterns of use of darbepoetin alfa in Spanish centers, and to evaluate its effectiveness in the treatment of chemotherapy-induced anemia under clinical practice conditions. METHODS This was an observational, retrospective, multicenter study in adult patients with non-myeloid malignancies who initiated chemotherapy and darbepoetin alfa. Data was collected for up to 16 weeks or until treatment discontinuation. RESULTS A total of 685 patients (72.7% with solid tumors and 27.3% with hematologic malignancies) were included in the study. Median age was 64.7 years (range 18.5-88.9 years), 50.7% were women, 82.4% had ECOG status 0-1 and 80.5% had stage III/IV cancer. At darbepoetin initiation, mean hemoglobin (Hb) was 100 g/L (SD 10), with 11.0% and 23.1% of patients below 90 g/L in solid and hematologic malignancies, respectively. A decrease in transfusion requirements was observed between weeks 5-16 with respect to weeks 0-16 (13.3% [95% CI: 10.7 to 15.9] versus 19.0% [95% CI: 16.0 to 22.0]). Hb levels were significantly increased during the treatment (mean change of 10.4 g/L for solid tumors [p < 0.001], and 16.6 g/L for hematologic malignancies [p < 0.001]). The percentage of patients with baseline Hb level <110 g/L who achieved an Hb level ≥110 g/L during the study was 66.5% (95% CI: 62.5% to 70.5%). Six serious adverse reactions were considered related to darbepoetin alfa (thromboembolic events, 1.0%). CONCLUSIONS With the limitation of a retrospective design, our results suggest that darbepoetin alfa is a well tolerated treatment that increases hemoglobin levels and reduces the need for transfusion in cancer patients receiving chemotherapy in clinical practice.
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Cabañes N, Igea JM, de la Hoz B, Agustín P, Blanco C, Domínguez J, Lázaro M, Lleonart R, Méndez J, Nieto A, Rodríguez A, Rubia N, Tabar A, Beitia JM, Dieguez MC, Martínez-Cócera C, Quirce S. Latex allergy: Position Paper. J Investig Allergol Clin Immunol 2012; 22:313-330. [PMID: 23101306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Correct management of latex allergy is essential to ensure adequate care of patients who are allergic to latex, which is ubiquitous in the health care setting. In this Position Paper, the Latex Committee of the Spanish Society of Allergology and Clinical Immunology provides guidelines for the management of latex allergy.
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Affiliation(s)
- N Cabañes
- Allergy Department, Hospital Virgen del Valle, Toledo, Spain
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Lázaro M, Varela S, Vazquez S, Villanueva M, Firvida J, Amenedo M, Afonso F, Senin C, Grande C. 9099 POSTER Biweekly Docetaxel-Cisplatin in Chemonaive Patients With Advanced Epidermoid Carcinoma of the Lung – a Phase II Study of Galician Lung Cancer Group. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72411-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vázquez S, Villanueva M, Firvida J, Lázaro M, Campos B, Grande C, Fernandez A, Varela S, Casal J, Perez E. 9085 POSTER Gemcitabine Plus Oral Vinorelbine as Salvage Therapy Treatment for Patients With Advanced Non-small-cell Lung Cancer and Squamous Histology – a Gallclan Lung Cancer Group Study (GGCP042/09) Grupo Galego De Cancro De Pulmon (GGCP). Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72397-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lázaro M, Ramos A, Ussetti P, Asensio A, Laporta R, Muñez E, Sánchez-Romero I, Tejerina E, Burgos R, Moñivas V, Varela A. Aspergillus endocarditis in lung transplant recipients: case report and literature review. Transpl Infect Dis 2011; 13:186-91. [DOI: 10.1111/j.1399-3062.2010.00589.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Diéguez MC, Cerecedo I, Muriel A, Losada A, García E, Lázaro M, de la Hoz B. Adaptation and validation of the Spanish version of the Quality Of Life in Latex Allergy questionnaire (QOLLA). J Investig Allergol Clin Immunol 2011; 21:283-289. [PMID: 21721374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE The aim of the present study was to translate into Spanish and transculturally adapt the Quality of Life in Latex Allergy questionnaire (QOLLA) in order to provide a validated instrument for use in research and daily practice. METHODS Patients diagnosed with latex allergy were invited to participate in an observational prospective multicenter study to validate the Spanish version of the QOLLA following the recommendations of the World Health Organization. The study included 3 phases--feasibility, reliability, and cross-sectional validation-and was approved by the Ethics Committee of Hospital Ramón y Cajal. RESULTS Mean time to complete the questionnaire was 4.7 minutes. The maximum score was 28 (mean, 7.7; median, 4).The SF-12 score ranged from 25.8 to 51.6 in the physical domain and from 20.8 to 61.5 in the mental domain. Internal consistency was excellent (Cronbach alpha, 0.9348). The kappa index fluctuated between 0.40 and 0.93. A kappa of 0.84 was obtained for the global score in 5 categories. Sixty patients were included to evaluate construct validity. Mean age was 39 years and 49 patients were women (80%). The global score ranged between 0 and 30 (mean, 11.69; median, 11). Spearman correlation coefficients between the QOLLA and a visual analog scale and the SF-12 physical, mental, and severity scales according to the researcher were--0.47, 0.37, 0.29, and 0.54, respectively. CONCLUSION The QOLLA is a feasible, valid, and reliable instrument for the measurement of disease-specific quality of life in adult patients diagnosed with latex allergy. It could play an important role in determining suitable treatment for latex-allergy.
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Affiliation(s)
- M C Diéguez
- Sección de Alergia, Servicio de Medicina Interna, Hospital del Sureste, Arganda del Rey, Spain
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Casal J, Varela S, Anido U, Lázaro M, Fírvida JL, Vazquez-Estevez S, Villanueva M, Amenedo M, Caeiro M, Gomez A. Docetaxel (D) and cisplatin (C) induction chemotherapy followed by concurrent thoracic radiotherapy (TRT) and biweekly D and C for stage III non-small cell lung cancer (NSCLC): A Galician Lung Cancer Group study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.7090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Vazquez S, Firvida J, Lázaro M, Barón FJ, Alonso-Jaudenes Curbera G, Amenedo M, Santomé L, Afonso FJ, Cardona JV, Casal J. A Galician Lung Cancer Group phase II study: Erlotinib as maintenance therapy after concurrent chemoradiotherapy in patients (p) with stage III non-small cell lung cancer (NSCLC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.7091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Leon L, Vazquez S, Gracia J, Casal J, Lázaro M, Fírvida JL, Amenedo M, Santomé L, Cardona JV, Maciá S. A Galician Lung Cancer Group phase II study of bevacizumab (B), cisplatin, and vinorelbine in chemotherapy-naive patients (p) with non-squamous non-small cell lung cancer (NSCLC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e18052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Albillo J, Eaton K, Lázaro M, Peregrin E, Perez B, Ruberte A, Betancor D, Collazos R, Nieto M, Martín de Francisco L. P01-04 - A descriptive study of patients with bipolar affective disorder admitted in brief hospitalization unit, university hospital of la Princesa. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)70209-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Bustos A, Carabantes F, Álvarez R, Díaz N, Bueso P, Lázaro M, Gasquet J, Alegre A. 3074 Darbepoetin alfa for the treatment of chemotherapy-induced anemia in patients with solid tumors. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70673-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Allende I, Gardeazábal J, Lázaro M, Díaz-Pérez JL. [Problems with phototesting for the diagnosis of solar urticaria]. Actas Dermosifiliogr 2009; 100:524-525. [PMID: 19709566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
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Bellmunt J, Trigo J, Calvo E, Carles J, Perez-Gracia J, Rubió J, Virizuela J, López R, Lázaro M, Albanell J. Activity of a multitargeted, metronomic, and maximum-tolerated dose “chemo-switch” regimen in metastatic renal cell carcinoma (mRCC): A phase II study of sorafenib, gemcitabine (Gem), and metronomic capecitabine (Cap) in patients with advanced mRCC (SOGUG-02–06). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5040] [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
5040 Background: Maximal tolerated dose (MTD) chemotherapy followed by metronomic chemotherapy (low doses administered on a frequent schedule) acts on tumor vascular endothelial cells and enhances the antitumor effect of anti-angiogenic agents (Pietras et al. J Clin Oncol. 2007). This study investigated treatment of mRCC with Gem at MTD combined with metronomic Cap and the multikinase inhibitor sorafenib. Methods: Eligible patients had cytologically or histologically confirmed mRCC, Eastern Cooperative Oncology Group (ECOG) performance status ≤1 and no previous targeted therapy or chemotherapy, and were unsuitable for or intolerant to immunotherapy. Treatment consisted of six 3-week cycles of Gem 1000 mg/m2 i.v. (days 1 and 8), oral Cap 500 mg/m2 b.i.d. (days 1 to 14) and oral sorafenib 400 mg b.i.d. (every day), followed by sorafenib monotherapy (at the discretion of the investigator). Study endpoints included median progression-free survival (PFS, primary endpoint), disease control rate according to Response Evaluation Criteria in Solid Tumors, and safety. Results: Forty patients were enrolled and received at least one dose of treatment (median age 63 yrs, male n = 24, ECOG 0/1 n = 18/22, 1–2/>2 metastatic sites n = 31/9). Median duration of treatment was 6 months. Among 36 evaluable patients, 17 (47%) had a partial response and 17 (47%) achieved stable disease. Median PFS was 10.2 months (95% CI 7.6, 20.5). The most common adverse events (AEs) were fatigue/asthenia (78%) hand-foot syndrome (75%) and mucositis (69%). Most AEs were grade1/2, no grade 4 toxicities occurred. One patient had grade 5 dyspnea; 6 patients discontinued treatment for AEs. Conclusions: PFS and objective responses in this study were greater than those observed in previous studies with Gem and Cap or sorafenib monotherapy in patients with mRCC, while AEs remained moderate in the majority of patients. These findings confirm the synergistic activity of the “chemo-switch” concept seen in preclinical models. The combination of sorafenib with MTD Gem and metronomic Cap warrants further investigation in mRCC. [Table: see text]
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Affiliation(s)
- J. Bellmunt
- University Hospital del Mar, Barcelona, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; University Hospital Valle Hebron, Barcelona, Spain; Clinica Universitaria de Navarra, Pamplona, Spain; Hospital Universitari Josep Trueta, Girona, Spain; Hospital Virgen Macarena, Sevilla, Spain; Hospital Clinico Universitario, Santiago de Compostela, Spain; Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - J. Trigo
- University Hospital del Mar, Barcelona, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; University Hospital Valle Hebron, Barcelona, Spain; Clinica Universitaria de Navarra, Pamplona, Spain; Hospital Universitari Josep Trueta, Girona, Spain; Hospital Virgen Macarena, Sevilla, Spain; Hospital Clinico Universitario, Santiago de Compostela, Spain; Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - E. Calvo
- University Hospital del Mar, Barcelona, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; University Hospital Valle Hebron, Barcelona, Spain; Clinica Universitaria de Navarra, Pamplona, Spain; Hospital Universitari Josep Trueta, Girona, Spain; Hospital Virgen Macarena, Sevilla, Spain; Hospital Clinico Universitario, Santiago de Compostela, Spain; Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - J. Carles
- University Hospital del Mar, Barcelona, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; University Hospital Valle Hebron, Barcelona, Spain; Clinica Universitaria de Navarra, Pamplona, Spain; Hospital Universitari Josep Trueta, Girona, Spain; Hospital Virgen Macarena, Sevilla, Spain; Hospital Clinico Universitario, Santiago de Compostela, Spain; Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - J. Perez-Gracia
- University Hospital del Mar, Barcelona, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; University Hospital Valle Hebron, Barcelona, Spain; Clinica Universitaria de Navarra, Pamplona, Spain; Hospital Universitari Josep Trueta, Girona, Spain; Hospital Virgen Macarena, Sevilla, Spain; Hospital Clinico Universitario, Santiago de Compostela, Spain; Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - J. Rubió
- University Hospital del Mar, Barcelona, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; University Hospital Valle Hebron, Barcelona, Spain; Clinica Universitaria de Navarra, Pamplona, Spain; Hospital Universitari Josep Trueta, Girona, Spain; Hospital Virgen Macarena, Sevilla, Spain; Hospital Clinico Universitario, Santiago de Compostela, Spain; Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - J. Virizuela
- University Hospital del Mar, Barcelona, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; University Hospital Valle Hebron, Barcelona, Spain; Clinica Universitaria de Navarra, Pamplona, Spain; Hospital Universitari Josep Trueta, Girona, Spain; Hospital Virgen Macarena, Sevilla, Spain; Hospital Clinico Universitario, Santiago de Compostela, Spain; Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - R. López
- University Hospital del Mar, Barcelona, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; University Hospital Valle Hebron, Barcelona, Spain; Clinica Universitaria de Navarra, Pamplona, Spain; Hospital Universitari Josep Trueta, Girona, Spain; Hospital Virgen Macarena, Sevilla, Spain; Hospital Clinico Universitario, Santiago de Compostela, Spain; Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - M. Lázaro
- University Hospital del Mar, Barcelona, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; University Hospital Valle Hebron, Barcelona, Spain; Clinica Universitaria de Navarra, Pamplona, Spain; Hospital Universitari Josep Trueta, Girona, Spain; Hospital Virgen Macarena, Sevilla, Spain; Hospital Clinico Universitario, Santiago de Compostela, Spain; Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - J. Albanell
- University Hospital del Mar, Barcelona, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; University Hospital Valle Hebron, Barcelona, Spain; Clinica Universitaria de Navarra, Pamplona, Spain; Hospital Universitari Josep Trueta, Girona, Spain; Hospital Virgen Macarena, Sevilla, Spain; Hospital Clinico Universitario, Santiago de Compostela, Spain; Complejo Hospitalario Universitario de Vigo, Vigo, Spain
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Bustos A, Cruz MA, Aramburo P, Carabantes F, Díaz N, Florián J, Lázaro M, Martín de Segovia JM, Gasquet JA, Alegre A. Evaluation of clinical use of darbepoetin alfa in patients with chemotherapy-induced anemia. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20585] [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
e20585 Background: Chemotherapy-induced anemia (CIA) is a frequent complication of patients (pts) with cancer and could be treated with erythropoiesis-stimulating agents such darbepoetin alfa (DA). The aim of this study was to investigate the patterns of use and effect of DA to treat CIA in clinical practice conditions. Methods: This was an observational, retrospective, multicenter study performed in 58 Spanish centres. Eligible pts were ≥18 yrs, diagnosed with non-myeloid malignancies and treated with chemotherapy (CT) and DA from October 2005 to October 2006. Data on demographic and clinical characteristics, CT and radiotherapy (RT), DA administration, red blood cell (RBC) transfusions, and haemoglobin (Hb) levels were collected from DA treatment initiation up to a maximum of 16 weeks or until treatment discontinuation. Results: A total of 685 pts were included in the study. Median age was 64.66 years (range 18.54–88.95), 50.7% were women, 74.11% had ECOG status 0–1 and 71.38% had stage III/IV cancer. Solid tumours represented 72.55% of the cases. The CT regimen included platinum derivates in 33.58% of the pts. At DA initiation, mean (SD) Hb was 10.00 g/dL (1.05) Administration of DA every three weeks occurred in 54.01% of the pts. Mean (SD) DA administration was 9.20 weeks (5.31). Hematopoietic response (defined as Hb ≥ 12 g/dL or Hb rise from baseline >2 g/dL in the absence of RBC transfusions during the previous 28 days) occurred in 63.24% (95% CI 59.49–66.83) of pts. A total of 88 pts (12.85%) required RBC transfusions from week 5 to end of treatment. Mean Hb (SD) at the end of treatment with DA was 11.36 g/dL (1.73). Adverse event (AE) potentially related to DA were reported in 20 pts (2.92%) and considered severe in 6 cases (0.88%). Conclusions: The findings of this study indicate that the use of DA for the treatment of CIA in real-life, daily oncology and haematology practice, is well-tolerated and effective for increasing haemoglobin to reduce the need of RBC transfusions. [Table: see text]
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Affiliation(s)
- A. Bustos
- Clinica Vistahermosa, Alicante, Spain; H. Virgen de la Salud, Toledo, Spain; H. Rúber Internacional, Madrid, Spain; H. Carlos Haya, Málaga, Spain; H. San Juan de Alicante, Alicante, Spain; H. de Barbastro, Barbastro, Spain; H. Xeral-Cies, Vigo, Spain; H. de Montecelo, Pontevedra, Spain; Amgen, S.A., Barcelona, Spain; H. de la Princesa, Madrid, Spain
| | - M. A. Cruz
- Clinica Vistahermosa, Alicante, Spain; H. Virgen de la Salud, Toledo, Spain; H. Rúber Internacional, Madrid, Spain; H. Carlos Haya, Málaga, Spain; H. San Juan de Alicante, Alicante, Spain; H. de Barbastro, Barbastro, Spain; H. Xeral-Cies, Vigo, Spain; H. de Montecelo, Pontevedra, Spain; Amgen, S.A., Barcelona, Spain; H. de la Princesa, Madrid, Spain
| | - P. Aramburo
- Clinica Vistahermosa, Alicante, Spain; H. Virgen de la Salud, Toledo, Spain; H. Rúber Internacional, Madrid, Spain; H. Carlos Haya, Málaga, Spain; H. San Juan de Alicante, Alicante, Spain; H. de Barbastro, Barbastro, Spain; H. Xeral-Cies, Vigo, Spain; H. de Montecelo, Pontevedra, Spain; Amgen, S.A., Barcelona, Spain; H. de la Princesa, Madrid, Spain
| | - F. Carabantes
- Clinica Vistahermosa, Alicante, Spain; H. Virgen de la Salud, Toledo, Spain; H. Rúber Internacional, Madrid, Spain; H. Carlos Haya, Málaga, Spain; H. San Juan de Alicante, Alicante, Spain; H. de Barbastro, Barbastro, Spain; H. Xeral-Cies, Vigo, Spain; H. de Montecelo, Pontevedra, Spain; Amgen, S.A., Barcelona, Spain; H. de la Princesa, Madrid, Spain
| | - N. Díaz
- Clinica Vistahermosa, Alicante, Spain; H. Virgen de la Salud, Toledo, Spain; H. Rúber Internacional, Madrid, Spain; H. Carlos Haya, Málaga, Spain; H. San Juan de Alicante, Alicante, Spain; H. de Barbastro, Barbastro, Spain; H. Xeral-Cies, Vigo, Spain; H. de Montecelo, Pontevedra, Spain; Amgen, S.A., Barcelona, Spain; H. de la Princesa, Madrid, Spain
| | - J. Florián
- Clinica Vistahermosa, Alicante, Spain; H. Virgen de la Salud, Toledo, Spain; H. Rúber Internacional, Madrid, Spain; H. Carlos Haya, Málaga, Spain; H. San Juan de Alicante, Alicante, Spain; H. de Barbastro, Barbastro, Spain; H. Xeral-Cies, Vigo, Spain; H. de Montecelo, Pontevedra, Spain; Amgen, S.A., Barcelona, Spain; H. de la Princesa, Madrid, Spain
| | - M. Lázaro
- Clinica Vistahermosa, Alicante, Spain; H. Virgen de la Salud, Toledo, Spain; H. Rúber Internacional, Madrid, Spain; H. Carlos Haya, Málaga, Spain; H. San Juan de Alicante, Alicante, Spain; H. de Barbastro, Barbastro, Spain; H. Xeral-Cies, Vigo, Spain; H. de Montecelo, Pontevedra, Spain; Amgen, S.A., Barcelona, Spain; H. de la Princesa, Madrid, Spain
| | - J. M. Martín de Segovia
- Clinica Vistahermosa, Alicante, Spain; H. Virgen de la Salud, Toledo, Spain; H. Rúber Internacional, Madrid, Spain; H. Carlos Haya, Málaga, Spain; H. San Juan de Alicante, Alicante, Spain; H. de Barbastro, Barbastro, Spain; H. Xeral-Cies, Vigo, Spain; H. de Montecelo, Pontevedra, Spain; Amgen, S.A., Barcelona, Spain; H. de la Princesa, Madrid, Spain
| | - J. A. Gasquet
- Clinica Vistahermosa, Alicante, Spain; H. Virgen de la Salud, Toledo, Spain; H. Rúber Internacional, Madrid, Spain; H. Carlos Haya, Málaga, Spain; H. San Juan de Alicante, Alicante, Spain; H. de Barbastro, Barbastro, Spain; H. Xeral-Cies, Vigo, Spain; H. de Montecelo, Pontevedra, Spain; Amgen, S.A., Barcelona, Spain; H. de la Princesa, Madrid, Spain
| | - A. Alegre
- Clinica Vistahermosa, Alicante, Spain; H. Virgen de la Salud, Toledo, Spain; H. Rúber Internacional, Madrid, Spain; H. Carlos Haya, Málaga, Spain; H. San Juan de Alicante, Alicante, Spain; H. de Barbastro, Barbastro, Spain; H. Xeral-Cies, Vigo, Spain; H. de Montecelo, Pontevedra, Spain; Amgen, S.A., Barcelona, Spain; H. de la Princesa, Madrid, Spain
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Leon L, Vázquez S, Gracia JM, Lázaro M, Fírvida JL, Casal J, Amenedo M, Santomé L, Gallego R, Anido U. Bevacizumab (B), cisplatin, and vinorelbine in chemotherapy-naive patients (p) with nonsquamous non-small cell lung cancer (NSCLC): A Galician Lung Cancer Group phase II study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e19089] [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
e19089 Background: Bevacizumab, an anti-VEGF monoclonal antibody, improves response rates and prolongs survival in p with non squamous NSCLC when combined with carboplatin-paclitaxel or cisplatin-gemcitabine. This single-arm, open-labeled phase II trial aims to evaluate the efficacy and safety profile of B in combination with another widely used chemotherapy doublet for NSCLC: cisplatin and vinorelbine. Methods: Chemotherapy-naïve p diagnosed with stage IIIB or IV non squamous NSCLC received cisplatin (80 mg/m2), vinorelbine (25 mg/m2 IV days 1 and 8) and B (15 mg/kg IV) on day 1 every 3 weeks for up to 6 cycles followed by B 15 mg/kg alone every 3 weeks until disease progression. Main eligibility criteria were: PS 0–1, no brain metastases, no history of hemoptysis, stable cardiac condition and no full dose anticoagulation. Primary endpoint was progression-free survival and secondary endpoints were RR, duration of response, OS, 1-year survival and safety profile of the combination. Results: 38 p have been enrolled in the study and data of 27 p have been included in this analysis. P characteristics were: male 66.7%; median age 57 years (range 41–74); ECOG PS 0/1 (%) 33.3/66.7; adenocarcinoma/other (%) 74.1/25.9; stage IIIB/IV (%) 25.9/74.1. Median number of cycles for B/cisplatin/vinorelbine was 4.0 (range 1–6) and median number of cycles for B maintenance was 2 (range 1–4). 17 p were evaluable for response according to RECIST criteria: PR 29.4% and SD 41.2%. With a median follow-up of 3.9 months (range 0.7–11.1), median PFS was 4.6 months (95% CI: 2.6–6.6) and median OS has not been reached yet. Hematological toxicities were: 1 p gr. 3 anemia; 2 p gr. 3 and 2 p gr. 4 leucopenia; 10 p gr. 3, 1 p gr. 4 neutropenia and 3 p febrile neutropenia. Most common grade 3/4 non hematological toxicities were: vomiting (1p gr. 4), high blood pressure, asthenia and hyperglycemia. 1 p experienced gr. 4 abdominal pain, 1 p. gr. 4 constipation, 1 p. gr. 4 nausea and 1 p gr. 4 respiratory infection. No grade 3/4 hemoptysis were reported. Conclusions: This interim analysis shows that B in combination with cisplatin and vinorelbine is safe and well tolerated and has a promising activity in chemo-naïve p with non squamous NSCLC. Survival data will be updated. [Table: see text]
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Affiliation(s)
- L. Leon
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain; Complejo Hospitalario Xeral-Calde, Lugo, Spain; Hospital de Cabueñes, Gijón, Spain; C.H. Universitario de Vigo - Hospital Xeral Cíes, Vigo, Spain; Complejo Hospitalario de Ourense, Ourense, Spain; C.H. Universitario de Vigo - Hospital do Meixoeiro, Vigo, Spain; Centro Oncológico de Galicia, A Coruña, Spain; Hospital Povisa, Vigo, Spain; Roche Farma, S.A., Madrid, Spain
| | - S. Vázquez
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain; Complejo Hospitalario Xeral-Calde, Lugo, Spain; Hospital de Cabueñes, Gijón, Spain; C.H. Universitario de Vigo - Hospital Xeral Cíes, Vigo, Spain; Complejo Hospitalario de Ourense, Ourense, Spain; C.H. Universitario de Vigo - Hospital do Meixoeiro, Vigo, Spain; Centro Oncológico de Galicia, A Coruña, Spain; Hospital Povisa, Vigo, Spain; Roche Farma, S.A., Madrid, Spain
| | - J. M. Gracia
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain; Complejo Hospitalario Xeral-Calde, Lugo, Spain; Hospital de Cabueñes, Gijón, Spain; C.H. Universitario de Vigo - Hospital Xeral Cíes, Vigo, Spain; Complejo Hospitalario de Ourense, Ourense, Spain; C.H. Universitario de Vigo - Hospital do Meixoeiro, Vigo, Spain; Centro Oncológico de Galicia, A Coruña, Spain; Hospital Povisa, Vigo, Spain; Roche Farma, S.A., Madrid, Spain
| | - M. Lázaro
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain; Complejo Hospitalario Xeral-Calde, Lugo, Spain; Hospital de Cabueñes, Gijón, Spain; C.H. Universitario de Vigo - Hospital Xeral Cíes, Vigo, Spain; Complejo Hospitalario de Ourense, Ourense, Spain; C.H. Universitario de Vigo - Hospital do Meixoeiro, Vigo, Spain; Centro Oncológico de Galicia, A Coruña, Spain; Hospital Povisa, Vigo, Spain; Roche Farma, S.A., Madrid, Spain
| | - J. L. Fírvida
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain; Complejo Hospitalario Xeral-Calde, Lugo, Spain; Hospital de Cabueñes, Gijón, Spain; C.H. Universitario de Vigo - Hospital Xeral Cíes, Vigo, Spain; Complejo Hospitalario de Ourense, Ourense, Spain; C.H. Universitario de Vigo - Hospital do Meixoeiro, Vigo, Spain; Centro Oncológico de Galicia, A Coruña, Spain; Hospital Povisa, Vigo, Spain; Roche Farma, S.A., Madrid, Spain
| | - J. Casal
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain; Complejo Hospitalario Xeral-Calde, Lugo, Spain; Hospital de Cabueñes, Gijón, Spain; C.H. Universitario de Vigo - Hospital Xeral Cíes, Vigo, Spain; Complejo Hospitalario de Ourense, Ourense, Spain; C.H. Universitario de Vigo - Hospital do Meixoeiro, Vigo, Spain; Centro Oncológico de Galicia, A Coruña, Spain; Hospital Povisa, Vigo, Spain; Roche Farma, S.A., Madrid, Spain
| | - M. Amenedo
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain; Complejo Hospitalario Xeral-Calde, Lugo, Spain; Hospital de Cabueñes, Gijón, Spain; C.H. Universitario de Vigo - Hospital Xeral Cíes, Vigo, Spain; Complejo Hospitalario de Ourense, Ourense, Spain; C.H. Universitario de Vigo - Hospital do Meixoeiro, Vigo, Spain; Centro Oncológico de Galicia, A Coruña, Spain; Hospital Povisa, Vigo, Spain; Roche Farma, S.A., Madrid, Spain
| | - L. Santomé
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain; Complejo Hospitalario Xeral-Calde, Lugo, Spain; Hospital de Cabueñes, Gijón, Spain; C.H. Universitario de Vigo - Hospital Xeral Cíes, Vigo, Spain; Complejo Hospitalario de Ourense, Ourense, Spain; C.H. Universitario de Vigo - Hospital do Meixoeiro, Vigo, Spain; Centro Oncológico de Galicia, A Coruña, Spain; Hospital Povisa, Vigo, Spain; Roche Farma, S.A., Madrid, Spain
| | - R. Gallego
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain; Complejo Hospitalario Xeral-Calde, Lugo, Spain; Hospital de Cabueñes, Gijón, Spain; C.H. Universitario de Vigo - Hospital Xeral Cíes, Vigo, Spain; Complejo Hospitalario de Ourense, Ourense, Spain; C.H. Universitario de Vigo - Hospital do Meixoeiro, Vigo, Spain; Centro Oncológico de Galicia, A Coruña, Spain; Hospital Povisa, Vigo, Spain; Roche Farma, S.A., Madrid, Spain
| | - U. Anido
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain; Complejo Hospitalario Xeral-Calde, Lugo, Spain; Hospital de Cabueñes, Gijón, Spain; C.H. Universitario de Vigo - Hospital Xeral Cíes, Vigo, Spain; Complejo Hospitalario de Ourense, Ourense, Spain; C.H. Universitario de Vigo - Hospital do Meixoeiro, Vigo, Spain; Centro Oncológico de Galicia, A Coruña, Spain; Hospital Povisa, Vigo, Spain; Roche Farma, S.A., Madrid, Spain
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Casal J, Vázquez S, León L, Lázaro M, Fírvida JL, Amenedo M, Alonso G, Santomé L, Afonso FJ. Erlotinib as maintenance therapy after concurrent chemoradiotherapy in patients (p) with stage III non-small cell lung cancer (NSCLC): A Galician Lung Cancer Group phase II study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.7537] [Citation(s) in RCA: 2] [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: 11/20/2022] Open
Abstract
7537 Background: Combination of platinum-based chemotherapy and radiotherapy is the standard treatment for p with unresectable stage III NSCLC, but considering the high rates of recurrence, it is necessary to improve these results. Erlotinib is an EGFR TKI that prolongs survival in p with recurrent and metastatic NSCLC. In this study, we aim to evaluate the role of erlotinib as maintenance therapy after a standard concurrent chemo-radiotherapy regimen in p with stage III NSCLC. Methods: P with unresectable stage IIIA/IIIB—without malignant effusions—NSCLC who had received a standard concurrent chemo-radiotherapy regimen and had no evidence of tumor progression were enrolled in this single arm, open-label phase II study and received erlotinib 150 mg/day po for 6 months. Main eligibility criteria were: PS 0–2, adequate bone marrow, hepatic and renal function and measurable disease by RECIST criteria. Primary endpoint was the percentage of p without evidence of disease progression after 6 months of erlotinib therapy and secondary endpoints were: PFS, OS, ORR and safety profile. Results: 49 p have been included in the study and data from 37 p are presented in this analysis. Baseline characteristics: median age 62 years (range 41–76); male 94.6%; caucasian 100%; smokers/never smokers (%) 97.3/2.7; ECOG PS 0/1/2 (%) 18.9/75.7/2.7; adenocarcinoma/squamous cell carcinoma/large cell carcinoma (%) 16.2/75.7/5.4; stage IIIA/IIIB (%) 16.2/83.8. Most common previous chemo-radiotherapy regimen is cisplatin/docetaxel/RT (83.8%). 27 p were evaluable for tumor response: CR 22.2%; PR 12.8%; SD 55.6%; PD 7.4%. Median TTP was 7.3 months (95% CI 5.8–16.9) and median OS was 18.7 months (95% CI 11.8-NA). Most common adverse events related to erlotinib were rash 30.6% (3 p gr. 3) and diarrhea 16.7%. Conclusions: Erlotinib as maintenance therapy is an active and well tolerated treatment after concurrent chemo- radiotherapy in p with stage III NSCLC. In spite of the majority of patients are caucasian, males, smokers with squamous cell carcinoma, maintenance with single agent erlotinib reached a promising median OS of 18.7 months. Updated data will be presented. No significant financial relationships to disclose.
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Affiliation(s)
- J. Casal
- Complejo Hospitalario Universitario de Vigo, Hospital do Meixoeiro, Vigo, Spain; Complejo Hospitalario Xeral-Calde, Lugo, Spain; Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain; C.H. Universitario de Vigo, Hospital Xeral Cíes, Vigo, Spain; Complejo Hospitalario de Ourense, Ourense, Spain; Centro Oncológico de Galicia, A Coruña, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Hospital Povisa, Vigo, Spain; Complejo Hospitalario Arquitecto Marcide, Ferrol
| | - S. Vázquez
- Complejo Hospitalario Universitario de Vigo, Hospital do Meixoeiro, Vigo, Spain; Complejo Hospitalario Xeral-Calde, Lugo, Spain; Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain; C.H. Universitario de Vigo, Hospital Xeral Cíes, Vigo, Spain; Complejo Hospitalario de Ourense, Ourense, Spain; Centro Oncológico de Galicia, A Coruña, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Hospital Povisa, Vigo, Spain; Complejo Hospitalario Arquitecto Marcide, Ferrol
| | - L. León
- Complejo Hospitalario Universitario de Vigo, Hospital do Meixoeiro, Vigo, Spain; Complejo Hospitalario Xeral-Calde, Lugo, Spain; Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain; C.H. Universitario de Vigo, Hospital Xeral Cíes, Vigo, Spain; Complejo Hospitalario de Ourense, Ourense, Spain; Centro Oncológico de Galicia, A Coruña, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Hospital Povisa, Vigo, Spain; Complejo Hospitalario Arquitecto Marcide, Ferrol
| | - M. Lázaro
- Complejo Hospitalario Universitario de Vigo, Hospital do Meixoeiro, Vigo, Spain; Complejo Hospitalario Xeral-Calde, Lugo, Spain; Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain; C.H. Universitario de Vigo, Hospital Xeral Cíes, Vigo, Spain; Complejo Hospitalario de Ourense, Ourense, Spain; Centro Oncológico de Galicia, A Coruña, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Hospital Povisa, Vigo, Spain; Complejo Hospitalario Arquitecto Marcide, Ferrol
| | - J. L. Fírvida
- Complejo Hospitalario Universitario de Vigo, Hospital do Meixoeiro, Vigo, Spain; Complejo Hospitalario Xeral-Calde, Lugo, Spain; Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain; C.H. Universitario de Vigo, Hospital Xeral Cíes, Vigo, Spain; Complejo Hospitalario de Ourense, Ourense, Spain; Centro Oncológico de Galicia, A Coruña, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Hospital Povisa, Vigo, Spain; Complejo Hospitalario Arquitecto Marcide, Ferrol
| | - M. Amenedo
- Complejo Hospitalario Universitario de Vigo, Hospital do Meixoeiro, Vigo, Spain; Complejo Hospitalario Xeral-Calde, Lugo, Spain; Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain; C.H. Universitario de Vigo, Hospital Xeral Cíes, Vigo, Spain; Complejo Hospitalario de Ourense, Ourense, Spain; Centro Oncológico de Galicia, A Coruña, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Hospital Povisa, Vigo, Spain; Complejo Hospitalario Arquitecto Marcide, Ferrol
| | - G. Alonso
- Complejo Hospitalario Universitario de Vigo, Hospital do Meixoeiro, Vigo, Spain; Complejo Hospitalario Xeral-Calde, Lugo, Spain; Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain; C.H. Universitario de Vigo, Hospital Xeral Cíes, Vigo, Spain; Complejo Hospitalario de Ourense, Ourense, Spain; Centro Oncológico de Galicia, A Coruña, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Hospital Povisa, Vigo, Spain; Complejo Hospitalario Arquitecto Marcide, Ferrol
| | - L. Santomé
- Complejo Hospitalario Universitario de Vigo, Hospital do Meixoeiro, Vigo, Spain; Complejo Hospitalario Xeral-Calde, Lugo, Spain; Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain; C.H. Universitario de Vigo, Hospital Xeral Cíes, Vigo, Spain; Complejo Hospitalario de Ourense, Ourense, Spain; Centro Oncológico de Galicia, A Coruña, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Hospital Povisa, Vigo, Spain; Complejo Hospitalario Arquitecto Marcide, Ferrol
| | - F. J. Afonso
- Complejo Hospitalario Universitario de Vigo, Hospital do Meixoeiro, Vigo, Spain; Complejo Hospitalario Xeral-Calde, Lugo, Spain; Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain; C.H. Universitario de Vigo, Hospital Xeral Cíes, Vigo, Spain; Complejo Hospitalario de Ourense, Ourense, Spain; Centro Oncológico de Galicia, A Coruña, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Hospital Povisa, Vigo, Spain; Complejo Hospitalario Arquitecto Marcide, Ferrol
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Rubio JC, Vázquez S, Vázquez F, Amenedo M, Fírvida JL, Mel JR, Huidobro G, Alvarez E, Lázaro M, Alonso G, Fernández I. A phase II randomized trial of gemcitabine-docetaxel versus gemcitabine-cisplatin in patients with advanced non-small cell lung carcinoma. Cancer Chemother Pharmacol 2009; 64:379-84. [PMID: 19139896 DOI: 10.1007/s00280-008-0884-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Revised: 11/18/2008] [Accepted: 11/21/2008] [Indexed: 11/27/2022]
Abstract
PURPOSE To test efficacy and tolerability of non-platinum regimens for advanced non-small-cell lung cancer (NSCLC). METHODS Chemonaive patients with measurable stage IIIB/IV NSCLC treated with gemcitabine and cisplatin (GC), or gemcitabine and docetaxel (GD), maximumsix cycles in a phase IIB trial. RESULTS A total of 108 patients were randomized. Response rates (GC vs. GD, respectively): complete 3.6/2.0%, Partial 30.9/38.0%. Median Overall Survival (OS): 8.9 months in both groups (P = 0.53); and median time to progression (TTP): 6.2/5.5 months respectively (P = 0.61). Toxicities included (GC vs. GD, respectively): grade 3-4 neutropenia 49.1/41.2%; grade 3 thrombocytopenia 30.9/3.9%; grade 3 anemia 14.5/3.9%. Non-haematological toxicity was similar, except for nausea and vomiting, (16.3/2%); renal toxicity (3.7/0%) and hepatic toxicity (5.6/12.7%). CONCLUSIONS With a higher overall response rate and lower toxicity, GD is a good first treatment option for advanced NSCLC.
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Affiliation(s)
- Joaquín Casal Rubio
- Department of Medical Oncology, Hospital do Meixoeiro, C/Meixoeiro, s/n, 36200, Vigo (Pontevedra), Spain.
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Allende I, Gardeazábal J, Lázaro M, Díaz-Pérez J. Problems With Phototesting for the Diagnosis of Solar Urticaria. Actas Dermo-Sifiliográficas (English Edition) 2009. [DOI: 10.1016/s1578-2190(09)70118-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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