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Moisuc DC, Constantinescu D, Marinca MV, Gafton B, Pavel-Tanasa M, Cianga P. Cyclophilin A: An Independent Prognostic Factor for Survival in Patients with Metastatic Colorectal Cancer Treated with Bevacizumab and Chemotherapy. Cancers (Basel) 2024; 16:385. [PMID: 38254874 PMCID: PMC10814009 DOI: 10.3390/cancers16020385] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/11/2024] [Accepted: 01/14/2024] [Indexed: 01/24/2024] Open
Abstract
Colorectal cancer (CRC) ranks as second most common cause of cancer-related deaths. The CRC management considerably improved in recent years, especially due to biological therapies such as bevacizumab. The lack of predictive or prognostic biomarkers remains one of the major disadvantages of using bevacizumab in the CRC management. We performed a prospective study to analyze the prognostic and predictive roles of three potential serum biomarkers (Cyclophilin A (CypA), copeptin and Tie2) investigated by ELISA in 56 patients with metastatic CRC undergoing bevacizumab and chemotherapy between May 2019 and September 2021 at baseline and after one and six months of therapy. We showed that low levels of CypA at baseline and after one month of treatment were associated with better overall survival (OS) (42 versus 24 months, p = 0.029 at baseline; 42 versus 25 months, p = 0.039 after one month). For copeptin and Tie2, Kaplan-Meier curves showed no correlation between these biomarkers and OS or progression-free survival. When adjusting for baseline and post-treatment factors, a multivariate Cox analysis showed that low values of CypA at baseline and after one month of treatment were independent prognostic factors for OS and correlated with a better prognosis in metastatic CRC patients.
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Affiliation(s)
- Diana Cornelia Moisuc
- Immunology Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.C.M.); (D.C.)
| | - Daniela Constantinescu
- Immunology Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.C.M.); (D.C.)
- Immunology Department, “St. Spiridon” Hospital, 700111 Iasi, Romania
| | - Mihai Vasile Marinca
- Oncology Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.V.M.); (B.G.)
- Oncology Department, Regional Institute of Oncology, 700483 Iasi, Romania
| | - Bogdan Gafton
- Oncology Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.V.M.); (B.G.)
- Oncology Department, Regional Institute of Oncology, 700483 Iasi, Romania
| | - Mariana Pavel-Tanasa
- Immunology Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.C.M.); (D.C.)
- Immunology Department, “St. Spiridon” Hospital, 700111 Iasi, Romania
| | - Petru Cianga
- Immunology Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.C.M.); (D.C.)
- Immunology Department, “St. Spiridon” Hospital, 700111 Iasi, Romania
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Lozneanu L, Caruntu ID, Amalinei C, Moscalu M, Gafton B, Marinca MV, Rusu A, Balan R, Giusca SE. Periostin in ovarian carcinoma: from heterogeneity to prognostic value. Folia Histochem Cytobiol 2023; 61:1-16. [PMID: 36880681 DOI: 10.5603/fhc.a2023.0004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/16/2023] [Accepted: 01/24/2023] [Indexed: 03/08/2023] Open
Abstract
INTRODUCTION Periostin (POSTN), an extracellular matrix protein, is involved in tumor-associated extracellular matrix (ECM) remodeling. However, its potential value as a prognostic and/or predictive factor has not yet been confirmed. The present study aims to assess POSTN expression separately in tumor cells and stroma of different ovarian carcinoma (OC) histological types, and its relationship with clinicopathological features. MATERIAL AND METHODS 102 cases of different histological OC subtypes were immunohistochemically investigated, for POSTN expression assessment in both epithelial tumor cells and tumor stroma. Statistical analysis was performed to correlate POSTN profile with clinicopathological characteristics, therapeutic response, and survival. RESULTS POSTN expression in epithelial tumor cells was significantly correlated with POSTN expression in tumor stroma. The expression of POSTN in tumor cells was associated with histological type, tumor type (type I and II), tumor recurrence, progression-free survival (PFS), and overall survival (OS), whereas stromal POSTN expression was significantly correlated with age, histological type, tumor type, grade, and stage, residual disease, tumor recurrence, response to chemotherapy, and OS. Survival analysis revealed significant differences of PFS and OS in patients with high POSTN expression in tumor cells and negative stromal POSTN expression compared to patients with low POSTN expression in tumor cells and positive stromal POSTN expression (PFS: hazard ratio (HR) = 2.11, 95% confidence interval (CI): 1.33-3.37, P = 0.002; OS: HR = 1.78, 95% CI: 1.09-2.89, P = 0.019). CONCLUSIONS The comparative assessment of POSTN immunoexpression in two tumor compartments: in tumor cells and stroma, by use of different scoring systems revealed that higher stromal POSTN levels are evidently correlated with unfavorable clinical features and poorer prognosis, while POSTN expression in tumor cells seems to be associated with a better patient outcome.
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Affiliation(s)
- Ludmila Lozneanu
- Department of Morpho-Functional Sciences - Histology, Pathology, University of Medicine and Pharmacy.,Department of Pathology
| | - Irina-Draga Caruntu
- Department of Morpho-Functional Sciences - Histology, Pathology, University of Medicine and Pharmacy. .,Department of Pathology -.
| | - Cornelia Amalinei
- Department of Morpho-Functional Sciences - Histology, Pathology, University of Medicine and Pharmacy
| | - Mihaela Moscalu
- Department of Preventive Medicine and Interdisciplinarity - Medical Informatics and Biostatistics, "Grigore T. Popa" University of Medicine and Pharmacy Iasi, Romania
| | - Bogdan Gafton
- Department of Medicine III - Oncology, "Grigore T. Popa" University of Medicine and Pharmacy Iasi, Romania.,Department of Oncology - Regional Institute of Oncology, Iasi, Romania
| | - Mihai Vasile Marinca
- Department of Medicine III - Oncology, "Grigore T. Popa" University of Medicine and Pharmacy Iasi, Romania.,Department of Oncology - Regional Institute of Oncology, Iasi, Romania
| | - Andreea Rusu
- Department of Morpho-Functional Sciences - Histology, Pathology, University of Medicine and Pharmacy
| | - Raluca Balan
- Department of Morpho-Functional Sciences - Histology, Pathology, University of Medicine and Pharmacy
| | - Simona-Eliza Giusca
- Department of Morpho-Functional Sciences - Histology, Pathology, University of Medicine and Pharmacy.,Department of Pathology
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Bordeianu G, Filip N, Cernomaz A, Veliceasa B, Hurjui LL, Pinzariu AC, Pertea M, Clim A, Marinca MV, Serban IL. The Usefulness of Nanotechnology in Improving the Prognosis of Lung Cancer. Biomedicines 2023; 11:biomedicines11030705. [PMID: 36979684 PMCID: PMC10045176 DOI: 10.3390/biomedicines11030705] [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] [Received: 01/20/2023] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/02/2023] Open
Abstract
Lung cancer remains a major public health problem both in terms of incidence and specific mortality despite recent developments in terms of prevention, such as smoking reduction policies and clinical management advances. Better lung cancer prognosis could be achieved by early and accurate diagnosis and improved therapeutic interventions. Nanotechnology is a dynamic and fast-developing field; various medical applications have been developed and deployed, and more exist as proofs of concepts or experimental models. We aim to summarize current knowledge relevant to the use of nanotechnology in lung cancer management. Starting from the chemical structure-based classification of nanoparticles, we identify and review various practical implementations roughly organized as diagnostic or therapeutic in scope, ranging from innovative contrast agents to targeted drug carriers. Available data are presented starting with standards of practice and moving to highly experimental methods and proofs of concept; particularities, advantages, limits and future directions are explored, focusing on the potential impact on lung cancer clinical prognosis.
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Affiliation(s)
- Gabriela Bordeianu
- Department of Morpho-Functional Sciences (II), Discipline of Biochemistry, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Nina Filip
- Department of Morpho-Functional Sciences (II), Discipline of Biochemistry, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (N.F.); (A.C.)
| | - Andrei Cernomaz
- III-rd Medical Department, Discipline of Pneumology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (N.F.); (A.C.)
| | - Bogdan Veliceasa
- Department of Orthopedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Loredana Liliana Hurjui
- Department of Morpho-Functional Sciences (II), Discipline of Physiology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Alin Constantin Pinzariu
- Department of Morpho-Functional Sciences (II), Discipline of Physiology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Mihaela Pertea
- Department of Plastic Surgery and Reconstructive Microsurgery, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Andreea Clim
- Department of Morpho-Functional Sciences (II), Discipline of Physiology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Mihai Vasile Marinca
- III-rd Medical Department, Discipline of Oncology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ionela Lacramioara Serban
- Department of Morpho-Functional Sciences (II), Discipline of Physiology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
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Gherasim-Morogai N, Afrasanie VA, Gafton B, Marinca MV, Alexa-Stratulat T. Can Extended Chemotherapy Improve Glioblastoma Outcomes? A Retrospective Analysis of Survival in Real-World Patients. J Pers Med 2022; 12:jpm12101670. [PMID: 36294809 PMCID: PMC9604763 DOI: 10.3390/jpm12101670] [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] [Received: 08/27/2022] [Revised: 09/24/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
Standard treatment for glioblastoma multiforme (GBM) is surgery followed by radiotherapy plus concurrent chemotherapy with daily temozolomide (TMZ), and six subsequent TMZ 5/28-day cycles. Research has focused on identifying more effective alternatives to the current protocol, including extension of the number of adjuvant TMZ cycles. We performed a retrospective analysis of all GBM patients treated in our hospital (160 patients, 2011−2020). Median follow-up was 16.0 months. Analysis of prognostic factors was performed with a particular focus on the benefit of extending TMZ chemotherapy. Improved survival correlated with younger age, female gender, good performance status, absence of cognitive dysfunctions, no steroid use, and total tumor resection. Median progression-free survival (PFS) was 12 months and median overall survival (OS) was 20.0 months for the entire cohort. Median OS by adjuvant TMZ was 10.0 months if no adjuvant chemotherapy given (group 0), 15.0 months for patients that did not complete six TMZ cycles (group A), 24.0 months for those that did (group B), and 29.0 months for patients having received more than six cycles (group C) (p < 0.0001). At the three-year mark, 15.9% patients were alive in group A, 24.4% in group B and 38.1% in group C. Carefully selected GBM patients may derive benefit from extending the standard adjuvant chemotherapy beyond six TMZ cycles, but more data is required.
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Affiliation(s)
| | | | - Bogdan Gafton
- Medical Oncology Department, Regional Institute of Oncology, 700483 Iasi, Romania
- Oncology Department, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Mihai Vasile Marinca
- Medical Oncology Department, Regional Institute of Oncology, 700483 Iasi, Romania
- Oncology Department, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence:
| | - Teodora Alexa-Stratulat
- Medical Oncology Department, Regional Institute of Oncology, 700483 Iasi, Romania
- Oncology Department, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
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Prutianu I, Alexa-Stratulat T, Cristea EO, Nicolau A, Moisuc DC, Covrig AA, Ivanov K, Croitoru AE, Miron MI, Dinu MI, Ivanov AV, Marinca MV, Radu I, Gafton B. Oxaliplatin-induced neuropathy and colo-rectal cancer patient’s quality of life: Practical lessons from a prospective cross-sectional, real-world study. World J Clin Cases 2022; 10:3101-3112. [PMID: 35647128 PMCID: PMC9082707 DOI: 10.12998/wjcc.v10.i10.3101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/27/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colon cancer is one the most common forms of cancer in both sexes. Due to important progress in the field of early detection and effective treatment, colon and rectal cancer survivors currently account for 10% of cancer survivors worldwide. However, the effects of anti-cancer treatments, especially oxaliplatin-based chemotherapy, on the quality of life (QoL) have been less evaluated. Although the incidence of severe chemotherapy-induced neuropathy (CIPN) in clinical studies is below 20%, data from real-world studies is scarce, and CIPN is probably under-reported due to patient selection and the patients’ fear that reporting side-effects might lead to treatment cessation.
AIM To determine the impact of CIPN on QoL in colorectal cancer patients with a recent history of oxaliplatin-based chemotherapy.
METHODS We performed a prospective cross-sectional study in two major Romanian oncology tertiary hospitals—the Regional Institute of Oncology Iași (Iasi, Romania) and the Fundeni Clinical Oncology Institute (Bucharest, Romania). All consecutive patients with colon or rectal cancer, undergoing Oxaliplatin-based chemotherapy that consented to enroll in the study, were assessed by means of two questionnaires—the EORTC QQ-CR29 (quality of life in colon and rectal cancer patients) and the QLQ-CIPN20 (assessment of neuropathy). Several demographical, social, clinical and treatment data were also collected. Statistical analysis was performed by means of SPSS v20. The student t test was used to assess the relationship between the QLQ-CIPN20 and QLQ-CR29 results. Kaplan Meyer-curves were used to report 3-year progression-free survival (PFS) in patients that discontinued chemotherapy vs those that completed the recommended course.
RESULTS Of the 267 patients that fulfilled the inclusion criteria in the pre-specified time frame, 101 (37.8%) agreed to participate in the clinical study. At the time of the enrolment in the study, over 50% of the patients had recently interrupted their oxaliplatin-based chemotherapy, most often due to neuropathy. Almost 85% of the responders reported having tingling or numbness in their fingers or hands, symptoms that were associated with pain in over 20% of the cases. When comparing the scores in the two questionnaires, a statistically significant relationship (P < 0.001) was found between the presence of neuropathic symptoms and a decreased quality of life. This correlation was consistent when the patients were stratified by sex, disease stage, comorbidities and the presence of stoma or treatment type, suggesting that neuropathy in itself may be a reason for a decreased quality of life. At the 3 year final assessment, median recurrence-free survival in stage III patients was 26.88 mo. When stratified by completion of chemotherapy, median recurrence free-survival of stage III patients that completed chemotherapy was 28.27 mo vs 24.33 mo in patients that discontinued chemotherapy due to toxicity, a difference that did not reach statistical significance.
CONCLUSION CIPN significantly impacts QoL in colorectal cancer patients. CIPN is also the most frequent reason for treatment discontinuation. Physicians should actively assess for CIPN in order to prevent chronic neuropathy.
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Affiliation(s)
- Iulian Prutianu
- Medical Oncology, SC MNT Healthcare Europe SRL, Iasi 700021, Romania
| | - Teodora Alexa-Stratulat
- Medical Oncology-Radiotherapy, University of Medicine and Pharmacy Grigore T Popa Iasi, Iasi 700483, Romania
| | | | - Andrei Nicolau
- Oral and Maxillo-facial Surgery, University of Medicine and Pharmacy Grigore T Popa Iasi, Iasi 700021, Romania
| | | | | | - Karina Ivanov
- Medical Oncology, Regional Oncology Institute Iasi, Iasi 700483, Romania
| | - Adina Emilia Croitoru
- Department of Medical Oncology, Fundeni Clinical Institute, Bucuresti 022328, Romania
| | - Monica Ionela Miron
- Department of Medical Oncology, Fundeni Clinical Institute, Bucuresti 022328, Romania
| | - Mihaela Ioana Dinu
- Department of Medical Oncology, Fundeni Clinical Institute, Bucuresti 022328, Romania
| | - Anca Viorica Ivanov
- Paediatrics, University of Medicine and Pharmacy “Grigore T Popa”, Iasi 700021, Romania
| | - Mihai Vasile Marinca
- Medical Oncology-Radiotherapy, University of Medicine and Pharmacy Grigore T Popa Iasi, Iasi 700483, Romania
| | - Iulian Radu
- Department of Surgery, Department of Surgical Oncology, University of Medicine and Pharmacy “Grigore T Popa”, Regional Institute of Oncology, Iasi 700021, Romania
| | - Bogdan Gafton
- Medical Oncology-Radiotherapy, University of Medicine and Pharmacy Grigore T Popa Iasi, Iasi 700483, Romania
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Marinca MV, Moisuc DC, Gafton B, Stratulat AT, Cianga P. Antiangiogenic drug-induced proteinuria as a predictive factor in metastatic colorectal cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e15538] [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
e15538 Background: Treatment with bevacizumab, a humanized monoclonal antibody that inhibits vascular endothelial growth factor (VEGF) is known to cause adverse effects such as proteinuria, hypertension, fistulas, and thromboembolic events which, in addition to chemotherapy-induced toxicity, affect the quality of life. However, while bevacizumab-induced hypertension has been linked to increased overall survival, data on proteinuria are controversial. Methods: We performed a retrospective analysis to observe the influence of adverse effects (AEs) on the results of treatment with bevacizumab and chemotherapy in patients with metastatic colorectal cancer (mCRC). Results: Out of the 3497 mCRC patients admitted to our center between 2014 and 2019, 150 met the criteria for inclusion in our analysis. Of these, 50.7% experienced proteinuria and had reached a longer overall survival (OS, 40 versus 25 months, p = 0.015) and progression free survival (PFS, 15 versus 12 months, p = 0.039). Patients with anemia during treatment, regardless of grade, had a 20-month shorter survival. The following groups were identified as having a lower risk of death: patients with proteinuria (HR 0.630; 95% CI 0.424-0.935; p = 0.022), disease control (HR 0.436; 95% CI 0.291-0.653; p< 0.001) and non-metastatic stage at diagnosis (HR 0.477; 95% CI 0.300-0.757; p = 0.002). Anemia was a negative prognostic factor (HR 2.153; 95% CI 1.343-3.454; p = 0.001). Conclusions: Proteinuria seems to be a useful predictive factor in mCRC patients undergoing bevacizumab-based systemic therapy. Since it is already routinely assessed in this clinical setting, proteinuria could be easily integrated in the decision-making process and thus allow physicians to further individualize systemic treatments. Retrospective analyses, as our study, are setting the basis for prospective studies, required for the validation of these results.
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Affiliation(s)
| | | | - Bogdan Gafton
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | | | - Petru Cianga
- “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
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Stemmer SM, Manojlovic NS, Marinca MV, Petrov P, Cherciu N, Ganea D, Ciuleanu TE, Pusca IA, Beg MS, Purcell WT, Croitoru AE, Ilieva RN, Natošević S, Nita AL, Kalev DN, Harpaz Z, Farbstein M, Silverman MH, Bristol D, Itzhak I, Fishman P. Namodenoson in Advanced Hepatocellular Carcinoma and Child-Pugh B Cirrhosis: Randomized Placebo-Controlled Clinical Trial. Cancers (Basel) 2021; 13:E187. [PMID: 33430312 PMCID: PMC7825785 DOI: 10.3390/cancers13020187] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 12/20/2022] Open
Abstract
Namodenoson, an A3 adenosine-receptor agonist, showed promising results in advanced hepatocellular carcinoma (HCC) and moderate hepatic dysfunction (Child-Pugh B; CPB) in a phase I/II clinical study. This phase II study investigated namodenoson as second-line therapy in such patients. Patients were randomized 2:1 to twice a day (BID) namodenoson (25 mg; n = 50) or placebo (n = 28). The primary endpoint (overall survival [OS]) was not met. Median OS was 4.1/4.3 months for namodenoson/placebo (hazard ratio [HR], 0.82; 95% confidence interval [CI] 0.49-1.38; p = 0.46). Pre-planned subgroup analysis of CPB7 patients (34 namodenoson-treated, 22 placebo-treated) showed a nonsignificant improvement in OS/progression-free survival (PFS). OS: 6.9 versus 4.3 months; HR, 0.81; 95% CI: 0.45-1.43, p = 0.46. PFS: 3.5 versus 1.9 months; HR, 0.89; 95% CI: 0.51-1.55, p = 0.67 (log-rank test). The difference in 12-month OS was significant (44% versus 18%, p = 0.028). Response rates were determined in patients for whom ≥ 1 assessment post-baseline was available (34 namodenoson-treated, 21 placebo-treated). Partial response was achieved by 3/34 (8.8%) and 0/21 (0%) patients, respectively. Namodenoson was well-tolerated, with a safety profile comparable to that of the placebo group. No treatment-related deaths were reported; no patients withdrew due to toxicity. In conclusion, namodenoson demonstrated a favorable safety profile and a preliminary efficacy signal in HCC CPB.
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Affiliation(s)
- Salomon M. Stemmer
- Davidoff Cancer Center, Rabin Medical Center-Beilinson Hospital, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv 49100, Israel;
| | - Nebojsa S. Manojlovic
- Department of Gastroenterology and Hepatology, Military Medical Academy, 11000 Belgrade, Serbia;
| | - Mihai Vasile Marinca
- Department of Oncology, Iasi Regional Oncology Institute, Institutul Regional de Oncologie Iasi—Sectia Oncologie Medical, 700483 Iasi, Romania;
| | - Petar Petrov
- Department of Medical Oncology and Oncological Diseases in Pneumology, Complex Oncology Center–Plovdiv, EOOD, 4000 Plovdiv, Bulgaria;
| | - Nelly Cherciu
- Oncology Department, Clinica Onco-Life, 200255 Craiova, Romania;
| | - Doina Ganea
- Medical Oncology Department, Sf. Ioan Cel Nou County Clinical Emergency Hospital, 720224 Suceava, Romania;
| | - Tudor Eliade Ciuleanu
- Institute of Oncology, University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania;
| | | | - Muhammad Shaalan Beg
- Division of Hematology and Medical Oncology, the University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
| | - William T. Purcell
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO 80045, USA;
| | | | - Rumyana Nedyalkova Ilieva
- Department of Medical Oncology, Multiprofile Hospital for Active Treatment Central Onco Hospital OOD, 4000 Plovdiv, Bulgaria;
| | | | | | | | - Zivit Harpaz
- R&D, Can-Fite BioPharma, 10 Bareket St., P.O.Box 7537, Petah-Tikva 49170, Israel; (Z.H.); (M.F.); (M.H.S.); (D.B.); (I.I.)
| | - Motti Farbstein
- R&D, Can-Fite BioPharma, 10 Bareket St., P.O.Box 7537, Petah-Tikva 49170, Israel; (Z.H.); (M.F.); (M.H.S.); (D.B.); (I.I.)
| | - Michael H. Silverman
- R&D, Can-Fite BioPharma, 10 Bareket St., P.O.Box 7537, Petah-Tikva 49170, Israel; (Z.H.); (M.F.); (M.H.S.); (D.B.); (I.I.)
| | - David Bristol
- R&D, Can-Fite BioPharma, 10 Bareket St., P.O.Box 7537, Petah-Tikva 49170, Israel; (Z.H.); (M.F.); (M.H.S.); (D.B.); (I.I.)
| | - Inbal Itzhak
- R&D, Can-Fite BioPharma, 10 Bareket St., P.O.Box 7537, Petah-Tikva 49170, Israel; (Z.H.); (M.F.); (M.H.S.); (D.B.); (I.I.)
| | - Pnina Fishman
- R&D, Can-Fite BioPharma, 10 Bareket St., P.O.Box 7537, Petah-Tikva 49170, Israel; (Z.H.); (M.F.); (M.H.S.); (D.B.); (I.I.)
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Afrăsânie VA, Gafton B, Marinca MV, Alexa-Stratulat T, Miron L, Rusu C, Ivanov AV, Balan GG, Croitoru AE. The Coexistence of RAS and BRAF Mutations in Metastatic Colorectal Cancer: A Case Report and Systematic Literature Review. J Gastrointestin Liver Dis 2020; 29:251-256. [PMID: 32530992 DOI: 10.15403/jgld-1003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/13/2020] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND AIMS The coexistence of RAS and BRAF mutations is extremely rare, occurring in approximately 0.05% of patients with metastatic colorectal cancer (mCRC). Starting from a case presentation, this review aims to examine the prevalence, clinical, histopathological and molecular features of tumors with concomitant mutations. METHODS Case report and systematic review. We performed a systematic literature search in PubMed and EMBASE using the following MeSH terms: "coexistence" OR "concomitant" AND "RAS" AND "BRAF" AND "colorectal cancer" from the inception of the databases onwards. RESULTS We present the case of a 53-year-old man diagnosed with metastatic rectal adenocarcinoma with both a KRAS and a BRAF mutation. The review included eleven papers reporting on a total of 30 mCRC cases with concomitant RAS and BRAF mutations. The male/female ratio was 11/5. The average age was 58.5 years. The tumor was located in nine cases on the right colon and in two cases in the left colon. 43.3% of subjects had liver metastases, and 6.6% had lung metastases. Next-generation sequencing (NGS) was used in 36.6% of cases and polymerase chain reaction (PCR) in 16.6% of cases. KRAS mutations were present in 83.3% of patients and NRAS mutations in 16.6% of patients. Survival could be assessed in 10 patients and the median was 21.1 months (about 30% lower than the survival in the general mCRC population). CONCLUSION The results of this systematic review suggest the need to design a cohort study (either prospective or retrospective) to better characterize the patients with concomitant RAS and BRAF mutations and to establish the optimal treatment for this rare situation.
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Affiliation(s)
| | - Bogdan Gafton
- Gr. T. Popa University of Medicine and Pharmacy, Iași; Oncology Dept., Regional Institute of Oncology, Iași, Romania. .
| | - Mihai Vasile Marinca
- Gr. T. Popa University of Medicine and Pharmacy, Iași; Oncology Dept., Regional Institute of Oncology, Iași, Romania.
| | - Teodora Alexa-Stratulat
- Gr. T. Popa University of Medicine and Pharmacy, Iași; Oncology Dept., Regional Institute of Oncology, Iași, Romania.
| | - Lucian Miron
- Gr. T. Popa University of Medicine and Pharmacy, Iași; Oncology Dept., Regional Institute of Oncology, Iași, Romania.
| | - Cristina Rusu
- Gr. T. Popa University of Medicine and Pharmacy, Iași, Romania.
| | | | - Gheorghe G Balan
- Gr. T. Popa University of Medicine and Pharmacy, Iași; Gastroenterology Dept., Sf. Spiridon University Clinical Emergency Hospital, Iași, Romania.
| | - Adina-Emilia Croitoru
- Titu Maiorescu University of Medicine, Bucharest; Oncology Dept., Fundeni Clinical Institute, Bucharest, Romania.
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9
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Afrăsânie VA, Adavidoaiei AM, Zamisnicu IH, Funingănă IG, Marinca MV, Gafton B, Clement DE, Păduraru MI, Demşa I, Miron L, Alexa-Stratulat T. A very rare presentation of lung cancer: Metastases to the distal phalanx of index-case report. Medicine (Baltimore) 2019; 98:e17892. [PMID: 31804306 PMCID: PMC6919407 DOI: 10.1097/md.0000000000017892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Acrometastases of the hand are an unusual sign of lung cancer onset and may often be mistaken for other benign disorders, thus delaying diagnosis and treatment. PATIENT CONCERNS A 58-year-old man presented at the Rheumatology Clinic with a lump in the distal phalanx of the right index finger associated with intense pain, swelling, rib pain, and hemoptysis. DIAGNOSES Given the clinical manifestations, an x-ray of the right hand was performed, and it revealed an osteolytic lesion in the distal phalanx of the right index finger. The subsequent CT of the thorax and abdomen showed a lung tumor, osteolytic lesions in the ribs, sternum, and the thoracic spine. INTERVENTIONS Amputation of the phalanx was decided on account of intense pain refractory to NSAIDs and opioids. Pathology assessment established the diagnosis of bone metastases secondary to lung adenocarcinoma. The patient underwent 6 cycles of first-line palliative chemotherapy with cisplatin and gemcitabine with partial response according to the RECIST 1.1. criteria. EGFR and ALK testing were not available at the time. A year later, the patient presented with progressive disease, which lead to 6 more cycles of chemotherapy with docetaxel. The disease progressed during chemotherapy and the patient was switched to erlotinib. OUTCOMES After 7 months of anti-EGFR treatment, the patient passed away due to disease progression, thus having an overall survival of 25 months. LESSONS On rare occasions, acrometastases of the hand may be the first manifestation of a lung cancer and, as such, they must be taken into consideration in the differential diagnosis of rheumatologic disorders. They are a poor prognosis marker, but some cases like this one can have a better survival than reported in the literature, most likely due to that particular cancer's biology.
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Affiliation(s)
- Vlad-Adrian Afrăsânie
- “Gr.T. Popa” University of Medicine and Pharmacy
- Medical Oncology Department, Regional Institute of Oncology
| | | | | | | | - Mihai Vasile Marinca
- “Gr.T. Popa” University of Medicine and Pharmacy
- Medical Oncology Department, Regional Institute of Oncology
| | - Bogdan Gafton
- “Gr.T. Popa” University of Medicine and Pharmacy
- Medical Oncology Department, Regional Institute of Oncology
| | | | - Marius-Ionut Păduraru
- “Gr.T. Popa” University of Medicine and Pharmacy
- Medical Oncology Department, Regional Institute of Oncology
| | - Irina Demşa
- Cardiology Department, Emergency Hospital “Sf. Spiridon,” Iaşi, Romania
| | - Lucian Miron
- “Gr.T. Popa” University of Medicine and Pharmacy
- Medical Oncology Department, Regional Institute of Oncology
| | - Teodora Alexa-Stratulat
- “Gr.T. Popa” University of Medicine and Pharmacy
- Medical Oncology Department, Regional Institute of Oncology
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10
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Stemmer SM, Manojlovic NS, Marinca MV, Petrov P, Cherciu N, Ganea D, Ciuleanu TE, Puscas IA, Beg MS, Purcell WT, Croitoru AE, Ilieva RN, Natošević S, Nita AL, Kalev DN, Harpaz Z, Farbstein M, Silverman MH, Fishman P, Llovet JM. A phase II, randomized, double-blind, placebo-controlled trial evaluating efficacy and safety of namodenoson (CF102), an A3 adenosine receptor agonist (A3AR), as a second-line treatment in patients with Child-Pugh B (CPB) advanced hepatocellular carcinoma (HCC). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.2503] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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
2503 Background: There is no established primary treatment for patients with advanced HCC and severe liver dysfunction (Child-Pugh B class; CPB), thus this representing a clear unmet need. Namodenoson, an A3AR agonist, showed promising preliminary results in this population in an open label phase 1/2 clinical study (NCT00790218), with median overall survival (OS) of 8.1 months. We present the results of a double blind, randomized phase 2, placebo-controlled study (NCT02128958), assessing the efficacy and safety of namodenoson as a second-line therapy of patients with advanced HCC and CPB class. Methods: Patients were randomized 2:1 to BID namodenoson (25 mg; n = 50) or placebo (n = 28) in 15 centers globally. Primary endpoint was OS and secondary endpoints were safety, progression-free survival (PFS), objective response (OR) and disease control rate (DCR). Assessment of OS and PFS was done by log rank test at a one final analysis when 75 deaths had occurred. Response was assessed by RECIST (local investigator) and mRECIST (central review). Results: The study did not meet the primary end point, with median OS 4.1 months (mo) for namodenoson vs. 4.3 mo for placebo (HR: 0.82). Pre-planned subgroup analysis of Child-Pugh 7 patients (n=56; namodenoson=34, placebo=21) showed median survival 6.8mo vs 4.3 mo [HR: 0.77 (95% CI 0.49-1.40)]. Similarly, for this subgroup of patients PFS was 3.5 mo vs 1.9 (HR=0.87). In terms of objective response, 3/34 patients assessed achieved OR (9%) with namodenoson vs 0% for placebo. Namodenoson was generally well-tolerated, with no treated patients being withdrawn for toxicity and no cases of treatment-related deaths. The most common adverse event (>10%) were anemia, abdominal pain, ascites, nausea, asthenia, fatigue, peripheral edema, and increased AST. Treatment-related grade 3 toxicities accounted for anemia, fatigue and hyponatremia. Conclusions: Namodenoson has demonstrated favorable clinical safety profile in patients with advanced HCC and severe liver dysfunction. Although the primary end-point was not met, the subgroup analysis showed a positive signal of efficacy for OS in patients with Child-Pugh 7. Both safety and efficacy results warrant testing this drug in a phase III trial. Clinical trial information: NCT02128958.
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Affiliation(s)
- Salomon M. Stemmer
- Davidoff Cancer Center, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel
| | | | | | - Petar Petrov
- Complex Oncology Center–Plovdiv, EOOD, Plovdiv, Bulgaria
| | | | - Doina Ganea
- Spitalul Judetean de Urgenta Sfantul Ioan cel Nou Suceava, Suceava, Romania
| | | | | | | | | | | | - Rumyana Nedyalkova Ilieva
- Multiprofile Hospital for Active Treatment Central Onco Hospital OOD Department of Medical Oncology, Plovdiv, Bulgaria
| | | | | | | | | | | | | | | | - Josep M Llovet
- Mount Sinai School of Medicine, New York University, New York, NY
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11
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Balan RA, Căruntu ID, Giuşcă SE, Lozneanu L, Păvăleanu I, Socolov RV, Miron L, Marinca MV, Amălinei C. Immunohistochemical significance of ER alpha, inhibin A, calretinin, and Ki67 expression in granulosa cell ovarian tumors. Rom J Morphol Embryol 2017; 58:753-760. [PMID: 29250651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Adult granulosa cell tumors (AGCTs) have a heterogeneous morphology and an unpredictable behavior, which can lead to a misinterpreted diagnosis. The aim of our study was to assess the immunoexpression of estrogen receptor (ER) alpha, Ki67, calretinin, and inhibin A in AGCTs, in order to evaluate their value in diagnosis and prognosis of this type of tumor. Immunohistochemical stainings for these markers were performed in 21 cases of AGCTs. The immunopositivity evaluation of calretinin and inhibin A was scored according to the percentage of staining intensity and the extent of positive cells, of ER alpha was scored based on the percentage of positive cells, and Ki67 score was recorded as the percentage of positively stained nuclei across the tumor, without taking in consideration the staining intensity. ER was positive in nine cases, Ki67 was expressed in 12 cases, calretinin showed positive immunoreactivity in 16 cases, and inhibin A was positive in 14 cases. Stromal cells presented also immunopositivity for inhibin A and calretinin in the negative cases. ER alpha and calretinin immunoexpression can help in identification of cell components of AGCT. Our results regarding Ki67 expression emphasize the potential utility of this marker in tumor behavior prediction. Inhibin A immunopositivity has an important value in AGCT diagnosis, in association to the other evaluated markers. Additional studies are needed to identify new specific and sensitive markers for AGCT or, at least, of a panel of markers which might contribute to a more accurate characterization of these tumors.
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Affiliation(s)
- Raluca Anca Balan
- Department of Morphofunctional Sciences - Histology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania;
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12
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Rusu-Cordunean F, Berlea ML, Cernomaz AT, Marinca MV, Peter S, Pavel I, Grigoriu BD. EGFR MUTATIONS IN NON-SMALL CELL LUNG CANCER: LOCAL EPIDEMIOLOGY AND CLINICAL IMPORTANCE. Rev Med Chir Soc Med Nat Iasi 2015; 119:1031-1036. [PMID: 26793845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Lung cancer's dismal prognosis led to new therapeutic approaches among which TKIs being among most promising; MATERIAL AND METHOD Retrospective study at the Regional Institute of Oncology Iasi of non small cell lung cancer patients which underwent molecular investigations between November 2013 - September 2014. EGFR mutation status (positive, negative, undetermined) was assessed with an Entrogen EGFR kit using DNA extracted from paraffin embedded samples (surgical or endobronchial biopsies) with the Macherey-Nagel "NucleoSpin FFPE DNAkit" and then amplified on a Applied Biosystem 7500 Real Time PCR System. RESULTS There were 63 adenocarcinoma samples (17 females, mean age 60,9 +/- 9 years): 49 primary lung tumors and 14 secondary lesions (brain, lymph nodes, pleural). There was insufficient bioptic material for three cases. TTF1 status was determined for 46 patients--six were negative. There were twelve mutations identified (7 female subjects, 5 male)--six L858R, five Del 19 and one G719X; ten were TTF1 positive for the remaining two TTF1 status was unknown. Female sex predominance was statistically significant (p = 0.02, chi squared). Mean age for mutation positive patients was 64 +/- 10 years; there were three never smokers, three active smokers and no data on smoking status was available for six subjects. CONCLUSION Although small dimension of the study group precludes statistical significance EGFR mutations seem to correlate with TTF1 status.
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13
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Negură L, Duşa CP, Balmuş MI, Azoicăi D, Negură AM, Marinca MV, Miron L. BRCA1 5382insC founder mutation has not a significative recurrent presence in Northeastern Romanian cancer patients. Rom J Morphol Embryol 2015; 56:379-385. [PMID: 26193202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Developed two decades ago, oncogenetic medical practice mainly concern breast, ovarian and colorectal cancers, and is targeting the hereditary risk factor, the only one that shows positive predictive value justifying the molecular diagnosis. Screening for BRCA1 and BRCA2 gene mutations is standard practice today for hereditary breast and ovarian cancer (HBOC) families in developed countries, offering the possibility of medical follow-up. The gold standard for molecular diagnosis is Sanger sequencing of all exons and exon-intron boundaries, which is expensive and time consuming. More than 3000 BRCA sequence variants are reported in international databases, but in some populations or ethnic groups a few founder mutations showed to have a recurrent presence. This may be very useful in establishing a combined technical approach for mutation detection, including rapid and cheap pre-screening methods for most common mutations. The BRCA1 5382insC mutation has an Ashkenazi founder effect and is also the second most recurrent mutation in Eastern European populations, having been already identified in several Romanian HBOC patients. Here we present a complete screening of consecutive series of breast and ovarian cancer patients for the presence of BRCA1 5382insC. The presence of the mutation was investigated by allele specific multiplex-PCR on genomic DNA extracted from peripheral blood. No mutation carrier was identified among breast or ovarian cancer patients. Our findings suggest that BRCA1 5382insC may not have a strong recurrent effect in Romanian population comparing to neighboring countries. This may be particularly useful in establishing further pre-screening strategies.
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Affiliation(s)
- Lucian Negură
- Department of Oncogenetics, "Grigore T. Popa" University of Medicine and Pharmacy, Iassy, Romania;
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14
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Gafton B, Porumb V, Ungurianu S, Marinca MV, Cocea C, Croitoru A, Balan G, Miron N, Eliade Ciuleanu T, Miron L. Hepatocellular carcinoma: insights in the biological treatment beyond sorafenib. J BUON 2014; 19:858-866. [PMID: 25536587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED Hepatocellular carcinoma has an increasing incidence and an impressive mortality. At present, the only authorized systemic treatment is the multi-kinase inhibitor sorafenib. A multitude of clinical trials are aimed at improving outcomes, both in firstY- and in second-line therapy. In this multitude of clinical trials, the purpose of our article was to familiarize physicians with the mechanisms of action of new biological therapies and to offer an algorithm for optimal trial selection for each patient, based on clinical and biological indicators. The available data were structured as follows: antiangiogenic therapy, c -MET inhibitors, combinations of chemotherapy with sorafenib, immune response modulators, cellular metabolism modulators, mTOR inhibitors, other multi-kinase inhibitors. CONCLUSION Treatment of advanced hepatocellular carcinoma remains a challenge for oncologists. Choosing the "right" trial may be the only chance of prolonging patient survival and improve his/her clinical status.
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Affiliation(s)
- Bogdan Gafton
- The University of Medicine and Pharmacy "Gr. T. Popa", Iasi, Romania
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15
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Marinca MV, Caruntu ID, Liliac L, Giusca SE, Marinca A, Miron L. Role of an extended pathology exam in risk classification of testicular germ cell tumors (GCTs). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e15032] [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
e15032 Background: The 1997 IGCCCG Consensus classification provides clinicians with enough information to efficiently choose between treatment options for most GCT patients. Nevertheless, therapy is ineffective in 5-10% of cases (even more in less developed countries), and about the same numbers experience severe side effects. This exploratory study aims to assess the impact of more rigorous and detailed pathology examination on improving the assignation of these patients to prognostic groups and, consequently, making optimal therapeutic decisions. Methods: Predefined features were reviewed on histology slides from 39 GCT patients followed-up for a median of 48.28 months. We designed a uniform pathology protocol, focused on identifying potential new prognostic factors. Categorical and continuous variables were quantified using light microscopy and computer-aided morphometry and, due to the small sample size, their statistical correlation was analyzed by exact tests and Spearman’s rho, respectively. Significant (2-sided p-value <0.05, under sample size reserve) coefficient values were entered in hierarchical cluster analysis (HCA). Results: Favorable IGCCCG group, presence of seminoma, glandular tissue pattern, presence and histoarchitecture of lymphocytic infiltrate associated better survival rates and lower risk of progression. Invasion of the epididymis and spermatic cord, presence of teratoma, choriocarcinoma and yolk-sac elements, papillary pattern and cell pleomorphism predicted poorer outcomes. HCA yielded 2 significantly distinct patient groups in terms of overall survival (p=0.018) and time to progression (p=0.080), but not disease-free survival (p=0.614). Conclusions: Quantification of tumor subtypes and other histology features of GCTs (e.g. necrosis, tissue patterns, inflammation) is feasible and, if standardized, may prove useful in optimal selection of risk groups, when performed by an experienced pathologist.
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Affiliation(s)
- Mihai Vasile Marinca
- Oncology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Irina Draga Caruntu
- Histopathology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Ludmila Liliac
- Histopathology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Simona Eliza Giusca
- Histopathology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Andreea Marinca
- Radiation Therapy Department, St. Spiridon Clinical Hospital, Iasi, Romania
| | - Lucian Miron
- Oncology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
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