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Cambra MJ, Moreno F, Sanz X, Anglada L, Mollà M, Reyes V, Arenas M, Pedro A, Ballester R, García V, Casals J, Cusidó M, Jimenez C, Escribà JM, Macià M, Solé JM, Arcusa A, Seguí MA, Gonzalez S, Farrús B, Biete A. Role of boost radiotherapy for local control of pure ductal carcinoma in situ after breast-conserving surgery: a multicenter, retrospective study of 622 patients. Clin Transl Oncol 2019; 22:670-680. [PMID: 31264148 DOI: 10.1007/s12094-019-02168-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/17/2018] [Accepted: 06/19/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the effect of boost radiotherapy on ipsilateral breast tumor recurrence (IBTR) for ductal carcinoma in situ (DCIS) after breast-conserving surgery and whole breast radiotherapy (WBRT) with or without boost. METHODS AND MATERIALS Retrospective, multicentre study of 622 patients (624 tumors) diagnosed with pure DCIS from 1993-2011. RESULTS Most tumors (377/624; 60.4%) received a boost. At a median follow-up of 8.8 years, IBTR occurred in 64 cases (10.3%). A higher percentage of patients with risk factors for IBTR received a boost (p < 0.05). Boost was not associated with lower rates of IBTR than WBRT alone (HR 0.75, 95% CI 0.42-1.35). On the univariate analyses, IBTR was significantly associated with tumor size (11-20 mm, HR 2.32, 95% CI 1.27-4.24; and > 20 mm, HR 2.10, 95% CI 1.14-3.88), re-excision (HR 1.76, 95% CI 1.04-2.96), and tamoxifen (HR 2.03, 95% CI 1.12-3.70). Boost dose > 16 Gy had a protective effect (HR 0.39, 95% CI 0.187-0.824). Multivariate analyses confirmed the independent associations between IBTR and 11-20 mm (p = 0.02) and > 20 mm (p = 0.009) tumours, and re-excision (p = 0.006). On the margin-stratified multivariate analysis, tamoxifen was a poor prognostic factor in the close/positive margin subgroup (HR 4.28 95% CI 1.23-14.88), while the highest boost dose ( > 16 Gy) had a significant positive effect (HR 0.34, 95% CI 0.13-0.86) in the negative margin subgroup. CONCLUSIONS Radiotherapy boost did not improve the risk of IBTR. Boost radiotherapy was more common in patients with high-risk disease. Tumor size and re-excision were significant independent prognostic factors.
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Affiliation(s)
- M J Cambra
- Department of Radiation Oncology, Hospital Universitari General de Catalunya-Grupo Quirónsalud (IOV-HGC-Quironsalud), Carrer Pedro i Pons 1, 08195, Sant Cugat del Vallés, Barcelona, Spain.
| | - F Moreno
- Department of Radiation Oncology, Institut Català d'Oncologia L'Hospitalet, L'Hospitalet de Llobregat, Avda de la Granvia, 199, 08908, Barcelona, Spain
| | - X Sanz
- Department of Radiation Oncology, Parc de Salut MAR, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - L Anglada
- Department of Radiation Oncology, ICO Girona, Avda de França, s/n, 17007, Girona, Spain
| | - M Mollà
- Department of Radiation Oncology, Hospital Vall d'Hebrón, Pg Vall d'Hebron 119, 129, 08035, Barcelona, Spain.,Department of Radiation Oncology, Hospital Clìnic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - V Reyes
- Department of Radiation Oncology, Hospital Vall d'Hebrón, Pg Vall d'Hebron 119, 129, 08035, Barcelona, Spain
| | - M Arenas
- Department of Radiation Oncology, Hospital Universitari Sant Joan Reus, Avda del Dr. Josep Laporte, 2, 43204, Reus, Tarragona, Spain
| | - A Pedro
- Department of Radiation Oncology, Hospital Plató, c/Plató, 21, 08006, Barcelona, Spain
| | - R Ballester
- Department of Radiation Oncology, Institut Català D'Oncologia-Badalona, Carretera del Canyet, s/n, 08916, Badalona, Barcelona, Spain
| | - V García
- Department of Radiation Oncology, Hospital Arnau de Vilanova, Avda Alcalde Rovira Roure, 80, 25198, Lleida, Spain
| | - J Casals
- Department of Radiation Oncology, Hospital Quirón, Plaça Alfonso Comín, 5, 08023, Barcelona, Spain
| | - M Cusidó
- Department of Gynecology and Obstetrics, Hospital Universitari Dexeus-Grupo Quirónsalud, c/Sabino Arana, 5-19, 08028, Barcelona, Spain
| | - C Jimenez
- Biostatistics and Bioinformatic Expert, Olesa de Montserrat, c/Urgell 55 A, 08640, Barcelona, Spain
| | - J M Escribà
- Catalan Cancer Registry, Cancer Planning Directorate, L'Hospitalet de Llobregat, Avda de La Granvia, s/n, 08908, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - M Macià
- Department of Radiation Oncology, Institut Català d'Oncologia L'Hospitalet, L'Hospitalet de Llobregat, Avda de la Granvia, 199, 08908, Barcelona, Spain
| | - J M Solé
- Department of Radiation Oncology, Consorci Sanitari de Terrassa, Ctra. Torrebonica s/n, 08227, Terrassa, Barcelona, Spain
| | - A Arcusa
- Department of Medical Oncology, Ctra. Torrebonica s/n, Consorci Sanitari de Terrassa, 08227, Terrassa, Barcelona, Spain
| | - M A Seguí
- Department of Medical Oncology, Corporació Sanitaria Parc Taulí, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - S Gonzalez
- Department of Medical Oncology, Hospital Universitari Mútua de Terrassa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain
| | - B Farrús
- Department of Radiation Oncology, Hospital Clìnic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - A Biete
- Department of Radiation Oncology, Hospital Clìnic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
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Martín M, Barrios CH, Torrecillas L, Ruiz-Borrego M, Bines J, Segalla J, Ruiz A, García-Sáenz JA, Torres R, de la Haba J, García E, Gómez HL, Llombart A, Rodríguez de la Borbolla M, Baena JM, Barnadas A, Calvo L, Pérez-Michel L, Ramos M, Castellanos J, Rodríguez-Lescure A, Cárdenas J, Vinholes J, Martínez de Dueñas E, Godes MJ, Seguí MA, Antón A, López-Álvarez P, Moncayo J, Amorim G, Villar E, Reyes S, Sampaio C, Cardemil B, Escudero MJ, Bezares S, Carrasco E, Lluch A. Abstract GS2-04: Efficacy results from CIBOMA/2004-01_GEICAM/2003-11 study: A randomized phase III trial assessing adjuvant capecitabine after standard chemotherapy for patients with early triple negative breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-gs2-04] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Triple negative breast cancers (TNBC) have a greater risk of relapse than non-TNBC. New therapeutic approaches are needed for these patients (pts). CIBOMA/2004-01_GEICAM/2003-11 is a multinational, randomized phase III trial exploring adjuvant capecitabine (X) after completion of standard treatment in early TNBC pts.
Materials and Methods: Patients with operable, node-positive (or node-negative with tumor size ≥ 1 cm), centrally confirmed hormone receptor-negative, HER2-negative early BC, who had received 6–8 cycles (cy) of standard anthracycline and/or taxane-containing chemotherapy or 4 cy of doxorubicin-cyclophosphamide (for node-negative disease) in the (neo)adjuvant setting, were eligible. Patients were randomized to either 8 cy of X (1,000 mg/m2 bid, days 1–14, every 3 weeks) or observation. Stratification factors included center, prior taxane-based therapy, number of involved axillary lymph nodes and phenotype (basal vs non-basal, according to cytokeratins 5/6 and/or EGFR positivity). The primary objective was to compare the disease-free survival (DFS) between both treatment arms, and secondary objectives included the comparison in terms of 5-year DFS, overall survival (OS) and safety. Assuming a 30% risk reduction in DFS rate at 5 years (from 64.7% to 73.7%, hazard ratio 0.70) with 80% power and a two-tailed log-rank test at 0.05, 834 evaluable pts were needed. 876 pts had to be finally enrolled considering a drop-out rate of 5%.
Results: Recruitment of 876 pts from 8 countries was completed in September 2011. Median age was 49 years; 68.5% of pts were postmenopausal, 55.5% were lymph node negative, 71.7% had a basal phenotype, 67.5% received chemotherapy based on anthracyclines and taxanes. Median follow-up was 7.3 years (range 0.0 to 11.1). DFS was not significantly prolonged with X vs observation (hazard ratio (HR) 0.82; 95% confidence interval (CI), 0.63 to 1.06; P=0.1353). Five-year DFS was 79.6% (95% CI, 75.8% to 83.4%) with X and 76.8% (95% CI, 72.7% to 80.9%) with observation. OS was not statistically different between treatment arms (HR 0.92; 95% CI, 0.66 to 1.28; P=0.6228). In subgroup analysis for DFS, we found no statistically significant interaction between X treatment and different subgroups, with the exception of basal vs non-basal phenotypes (basal HR 0.97, 95% CI 0.72 to 1.32, P=0.8620; non-basal HR 0.51, 95% CI, 0.31 to 0.86, P=0.0101; interaction P=0.0357). Similar results were found for OS (basal HR 1.20, 95% CI 0.81 to 1.77, P=0.3684; non-basal HR 0.48, 95% CI, 0.26 to 0.91, P=0.0205; interaction P=0.0155). 75.2% of pts completed 8 cy of X, with a median relative dose intensity of 86.3%. Grade (G) 3 or higher adverse events (AEs) were observed in 40.4% of pts in X arm. In 9.6% of pts the AEs were related with X. Hand-foot syndrome was the most common AE in X arm (G3 on 18.8% of pts).
Conclusions: In our study, the addition of adjuvant X after standard (neo) adjuvant anthracycline and/or taxane-containing chemotherapy was not associated with a statistically significant improvement of DFS or OS compared to observation in pts with early TNBC. However, in a subgroup analysis a significant DFS and OS improvement was observed with X in pts with non-basal phenotype.
Sponsor: CIBOMA.
Citation Format: Martín M, Barrios CH, Torrecillas L, Ruiz-Borrego M, Bines J, Segalla J, Ruiz A, García-Sáenz JA, Torres R, de la Haba J, García E, Gómez HL, Llombart A, Rodríguez de la Borbolla M, Baena JM, Barnadas A, Calvo L, Pérez-Michel L, Ramos M, Castellanos J, Rodríguez-Lescure A, Cárdenas J, Vinholes J, Martínez de Dueñas E, Godes MJ, Seguí MA, Antón A, López-Álvarez P, Moncayo J, Amorim G, Villar E, Reyes S, Sampaio C, Cardemil B, Escudero MJ, Bezares S, Carrasco E, Lluch A. Efficacy results from CIBOMA/2004-01_GEICAM/2003-11 study: A randomized phase III trial assessing adjuvant capecitabine after standard chemotherapy for patients with early triple negative breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS2-04.
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Affiliation(s)
- M Martín
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - CH Barrios
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - L Torrecillas
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - M Ruiz-Borrego
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - J Bines
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - J Segalla
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - A Ruiz
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - JA García-Sáenz
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - R Torres
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - J de la Haba
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - E García
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - HL Gómez
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - A Llombart
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - M Rodríguez de la Borbolla
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - JM Baena
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - A Barnadas
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - L Calvo
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - L Pérez-Michel
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - M Ramos
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - J Castellanos
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - A Rodríguez-Lescure
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - J Cárdenas
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - J Vinholes
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - E Martínez de Dueñas
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - MJ Godes
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - MA Seguí
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - A Antón
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - P López-Álvarez
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - J Moncayo
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - G Amorim
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - E Villar
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - S Reyes
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - C Sampaio
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - B Cardemil
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - MJ Escudero
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - S Bezares
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - E Carrasco
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
| | - A Lluch
- Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain; Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre/RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre/RS, Brazil; Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico DF, Mexico; Hospital Universitario Virgen del Rocío, Seville, Spain; Instituto Nacional de Câncer (INCA) José Alencar Gomes da Silva, Rio de Janeiro, Brazil; Hospital Amaral Carvalho, Chácara Braz Miraglia, Jaú - SP, Brazil; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clínico San Carlos, Madrid, Spain; Instituto Nacional del Cáncer, Santiago, Chile; Hospital Universitario Reina Sofía, Córdoba, Spain; Hospital General Universitario Morales Messeguer, Murcia, Spain; In
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García J, De La Haba J, Servitja S, Santaballa A, De Paz L, Plata Y, Garau I, Florián J, Chacón JI, García P, Zamora P, Orcajo L, Rodríguez-Villanueva J, San José B, Martínez E, Seguí MA. Abstract P6-09-33: CASCADE study: Rapid survival decline per treatment line in metastatic breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-09-33] [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: 11/16/2022]
Abstract
Abstract
BACKGROUND: Appraisal of the impact that current therapeutic strategies of advanced breast cancer (ABC) have on the survival expectancy, is vital to understand the prognosis of this disease. This entails assessing simultaneously the tumour phenotype and the therapeutic approach used per line of treatment. CASCADE is an epidemiological, retrospective, multicenter study aimed to retrieve demographic and clinical information from a representative cohort of ABC patients treated within the Spanish National Healthcare System.
MATERIAL AND METHODS: 13 Spanish public hospitals serving nearly 5M inhabitants (~10% of the national population) identified 422 ABC patients between 01/2007 and 12/2008 who received active treatment for their disease and were followed until death, lost to follow-up, or until December 2013. Overall Survival (OS) was analysed per tumour immunotype and treatment line from the diagnosis until a minimum of 10 patients were still evaluable. OS resulting from the different therapeutic approaches per line was also revised. Data collected included demographical, pathological, diagnostic, and therapeutic information for the entire follow-up. Descriptive statistics were applied (Methods previously described in SABCS 2015 Poster P3-07-39).
RESULTS: Remarkably, by the 2nd line of treatment, on average, one third of the OS is already gone. Tumour type imposes clear differences in this decline rate. As expected, triple-negative patients have the shortest survival expectancy at diagnosis, but their OS attrition rate is the slowest compared to the other subgroups (Table 1).
Table 1. OS per tumour type and line of treatment in ABC.PopulationOS from ABC Diagnosis (months)OS from 1L (months)OS from 2L (months)OS from 3L (months)OS from 4L (months)OS from 5L (months)Whole (N=422)33.532.622.616.613.513.3HER2-/HR+ (N=187)38.637.122.415.612.610.2Triple-negative (N=67)19.016.515.814.110.29.5HER2+/HR+ (N=72)34.433.729.421.620.318.9HER2+/HR- (N=53)36.335.423.113.19.314.1
OS time derived from the five mayor therapeutic approaches used at any given line, could only be registered for chemotherapy, hormone therapy and chemo + anti-HER2 therapy. Regardless of their treatment history, patients treated exclusively with hormone therapy portray a less aggressive behaviour than those treated with chemotherapy only, resembling the natural history of HER2-/HR+ and triple-negative phenotypes (Table 2).
Table 2. OS per pharmacological approach and line of treatment in ABC.Pharmacological treatmentOS from 1L (months)OS from 2L (months)OS from 3L (months)OS from 4L (months)OS from 5L (months)OS from 6L (months)OS from 7L (months)Chemotherapy (N=155)25.012.513.310.88.310.87.2Hormone therapy (N=92)44.030.922.311.214.0--Chemo + Anti-HER2 thp. (N=57)36.927.218.814.125.8--Chemo + Other Targeted thp. (N=44)19.721.014.121.1---Chemo + Hormone thp. (N=38)44.325.0-----Other Targeted thp.: anti-angiogenic antibody, mTOR inhibitor, anti-EGFR antibody, etc.
CONCLUSION: Chances to benefit from effective treatments may be jeopardized if their start is postponed to late lines. Only the most widely used therapies and, ultimately chemotherapy, hold until very late in the treatment of the advanced disease.
Citation Format: García J, De La Haba J, Servitja S, Santaballa A, De Paz L, Plata Y, Garau I, Florián J, Chacón JI, García P, Zamora P, Orcajo L, Rodríguez-Villanueva J, San José B, Martínez E, Seguí MA. CASCADE study: Rapid survival decline per treatment line in metastatic breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-09-33.
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Affiliation(s)
- J García
- Complejo Hospitalario, Orense, Spain; Hospital Reina Sofía, Córdoba, Spain; Hospital del Mar, Barcelona, Spain; Hospital La Fe, Valencia, Spain; Hospital Arquitecto Marcide, Ferrol, A Coruña, Spain; Hospital Médico Quirúrgico, Jaén, Spain; Hospital Son Llàtzer, Son Ferriol, Palma de Mallorca, Spain; Hospital de Barbastro, Barbastro, Huesca, Spain; Hospital Virgen de la Salud, Toledo, Spain; Hospital San Agustín, Avilés, Asturias, Spain; Hospital La Paz, Madrid, Spain; EISAI Pharmaceuticals, Madrid, Spain; OXON Epidemiology, Madrid, Spain; Hospital Provincial, Castellón de la Plana, Castellón, Spain; Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - J De La Haba
- Complejo Hospitalario, Orense, Spain; Hospital Reina Sofía, Córdoba, Spain; Hospital del Mar, Barcelona, Spain; Hospital La Fe, Valencia, Spain; Hospital Arquitecto Marcide, Ferrol, A Coruña, Spain; Hospital Médico Quirúrgico, Jaén, Spain; Hospital Son Llàtzer, Son Ferriol, Palma de Mallorca, Spain; Hospital de Barbastro, Barbastro, Huesca, Spain; Hospital Virgen de la Salud, Toledo, Spain; Hospital San Agustín, Avilés, Asturias, Spain; Hospital La Paz, Madrid, Spain; EISAI Pharmaceuticals, Madrid, Spain; OXON Epidemiology, Madrid, Spain; Hospital Provincial, Castellón de la Plana, Castellón, Spain; Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - S Servitja
- Complejo Hospitalario, Orense, Spain; Hospital Reina Sofía, Córdoba, Spain; Hospital del Mar, Barcelona, Spain; Hospital La Fe, Valencia, Spain; Hospital Arquitecto Marcide, Ferrol, A Coruña, Spain; Hospital Médico Quirúrgico, Jaén, Spain; Hospital Son Llàtzer, Son Ferriol, Palma de Mallorca, Spain; Hospital de Barbastro, Barbastro, Huesca, Spain; Hospital Virgen de la Salud, Toledo, Spain; Hospital San Agustín, Avilés, Asturias, Spain; Hospital La Paz, Madrid, Spain; EISAI Pharmaceuticals, Madrid, Spain; OXON Epidemiology, Madrid, Spain; Hospital Provincial, Castellón de la Plana, Castellón, Spain; Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - A Santaballa
- Complejo Hospitalario, Orense, Spain; Hospital Reina Sofía, Córdoba, Spain; Hospital del Mar, Barcelona, Spain; Hospital La Fe, Valencia, Spain; Hospital Arquitecto Marcide, Ferrol, A Coruña, Spain; Hospital Médico Quirúrgico, Jaén, Spain; Hospital Son Llàtzer, Son Ferriol, Palma de Mallorca, Spain; Hospital de Barbastro, Barbastro, Huesca, Spain; Hospital Virgen de la Salud, Toledo, Spain; Hospital San Agustín, Avilés, Asturias, Spain; Hospital La Paz, Madrid, Spain; EISAI Pharmaceuticals, Madrid, Spain; OXON Epidemiology, Madrid, Spain; Hospital Provincial, Castellón de la Plana, Castellón, Spain; Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - L De Paz
- Complejo Hospitalario, Orense, Spain; Hospital Reina Sofía, Córdoba, Spain; Hospital del Mar, Barcelona, Spain; Hospital La Fe, Valencia, Spain; Hospital Arquitecto Marcide, Ferrol, A Coruña, Spain; Hospital Médico Quirúrgico, Jaén, Spain; Hospital Son Llàtzer, Son Ferriol, Palma de Mallorca, Spain; Hospital de Barbastro, Barbastro, Huesca, Spain; Hospital Virgen de la Salud, Toledo, Spain; Hospital San Agustín, Avilés, Asturias, Spain; Hospital La Paz, Madrid, Spain; EISAI Pharmaceuticals, Madrid, Spain; OXON Epidemiology, Madrid, Spain; Hospital Provincial, Castellón de la Plana, Castellón, Spain; Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - Y Plata
- Complejo Hospitalario, Orense, Spain; Hospital Reina Sofía, Córdoba, Spain; Hospital del Mar, Barcelona, Spain; Hospital La Fe, Valencia, Spain; Hospital Arquitecto Marcide, Ferrol, A Coruña, Spain; Hospital Médico Quirúrgico, Jaén, Spain; Hospital Son Llàtzer, Son Ferriol, Palma de Mallorca, Spain; Hospital de Barbastro, Barbastro, Huesca, Spain; Hospital Virgen de la Salud, Toledo, Spain; Hospital San Agustín, Avilés, Asturias, Spain; Hospital La Paz, Madrid, Spain; EISAI Pharmaceuticals, Madrid, Spain; OXON Epidemiology, Madrid, Spain; Hospital Provincial, Castellón de la Plana, Castellón, Spain; Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - I Garau
- Complejo Hospitalario, Orense, Spain; Hospital Reina Sofía, Córdoba, Spain; Hospital del Mar, Barcelona, Spain; Hospital La Fe, Valencia, Spain; Hospital Arquitecto Marcide, Ferrol, A Coruña, Spain; Hospital Médico Quirúrgico, Jaén, Spain; Hospital Son Llàtzer, Son Ferriol, Palma de Mallorca, Spain; Hospital de Barbastro, Barbastro, Huesca, Spain; Hospital Virgen de la Salud, Toledo, Spain; Hospital San Agustín, Avilés, Asturias, Spain; Hospital La Paz, Madrid, Spain; EISAI Pharmaceuticals, Madrid, Spain; OXON Epidemiology, Madrid, Spain; Hospital Provincial, Castellón de la Plana, Castellón, Spain; Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - J Florián
- Complejo Hospitalario, Orense, Spain; Hospital Reina Sofía, Córdoba, Spain; Hospital del Mar, Barcelona, Spain; Hospital La Fe, Valencia, Spain; Hospital Arquitecto Marcide, Ferrol, A Coruña, Spain; Hospital Médico Quirúrgico, Jaén, Spain; Hospital Son Llàtzer, Son Ferriol, Palma de Mallorca, Spain; Hospital de Barbastro, Barbastro, Huesca, Spain; Hospital Virgen de la Salud, Toledo, Spain; Hospital San Agustín, Avilés, Asturias, Spain; Hospital La Paz, Madrid, Spain; EISAI Pharmaceuticals, Madrid, Spain; OXON Epidemiology, Madrid, Spain; Hospital Provincial, Castellón de la Plana, Castellón, Spain; Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - JI Chacón
- Complejo Hospitalario, Orense, Spain; Hospital Reina Sofía, Córdoba, Spain; Hospital del Mar, Barcelona, Spain; Hospital La Fe, Valencia, Spain; Hospital Arquitecto Marcide, Ferrol, A Coruña, Spain; Hospital Médico Quirúrgico, Jaén, Spain; Hospital Son Llàtzer, Son Ferriol, Palma de Mallorca, Spain; Hospital de Barbastro, Barbastro, Huesca, Spain; Hospital Virgen de la Salud, Toledo, Spain; Hospital San Agustín, Avilés, Asturias, Spain; Hospital La Paz, Madrid, Spain; EISAI Pharmaceuticals, Madrid, Spain; OXON Epidemiology, Madrid, Spain; Hospital Provincial, Castellón de la Plana, Castellón, Spain; Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - P García
- Complejo Hospitalario, Orense, Spain; Hospital Reina Sofía, Córdoba, Spain; Hospital del Mar, Barcelona, Spain; Hospital La Fe, Valencia, Spain; Hospital Arquitecto Marcide, Ferrol, A Coruña, Spain; Hospital Médico Quirúrgico, Jaén, Spain; Hospital Son Llàtzer, Son Ferriol, Palma de Mallorca, Spain; Hospital de Barbastro, Barbastro, Huesca, Spain; Hospital Virgen de la Salud, Toledo, Spain; Hospital San Agustín, Avilés, Asturias, Spain; Hospital La Paz, Madrid, Spain; EISAI Pharmaceuticals, Madrid, Spain; OXON Epidemiology, Madrid, Spain; Hospital Provincial, Castellón de la Plana, Castellón, Spain; Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - P Zamora
- Complejo Hospitalario, Orense, Spain; Hospital Reina Sofía, Córdoba, Spain; Hospital del Mar, Barcelona, Spain; Hospital La Fe, Valencia, Spain; Hospital Arquitecto Marcide, Ferrol, A Coruña, Spain; Hospital Médico Quirúrgico, Jaén, Spain; Hospital Son Llàtzer, Son Ferriol, Palma de Mallorca, Spain; Hospital de Barbastro, Barbastro, Huesca, Spain; Hospital Virgen de la Salud, Toledo, Spain; Hospital San Agustín, Avilés, Asturias, Spain; Hospital La Paz, Madrid, Spain; EISAI Pharmaceuticals, Madrid, Spain; OXON Epidemiology, Madrid, Spain; Hospital Provincial, Castellón de la Plana, Castellón, Spain; Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - L Orcajo
- Complejo Hospitalario, Orense, Spain; Hospital Reina Sofía, Córdoba, Spain; Hospital del Mar, Barcelona, Spain; Hospital La Fe, Valencia, Spain; Hospital Arquitecto Marcide, Ferrol, A Coruña, Spain; Hospital Médico Quirúrgico, Jaén, Spain; Hospital Son Llàtzer, Son Ferriol, Palma de Mallorca, Spain; Hospital de Barbastro, Barbastro, Huesca, Spain; Hospital Virgen de la Salud, Toledo, Spain; Hospital San Agustín, Avilés, Asturias, Spain; Hospital La Paz, Madrid, Spain; EISAI Pharmaceuticals, Madrid, Spain; OXON Epidemiology, Madrid, Spain; Hospital Provincial, Castellón de la Plana, Castellón, Spain; Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - J Rodríguez-Villanueva
- Complejo Hospitalario, Orense, Spain; Hospital Reina Sofía, Córdoba, Spain; Hospital del Mar, Barcelona, Spain; Hospital La Fe, Valencia, Spain; Hospital Arquitecto Marcide, Ferrol, A Coruña, Spain; Hospital Médico Quirúrgico, Jaén, Spain; Hospital Son Llàtzer, Son Ferriol, Palma de Mallorca, Spain; Hospital de Barbastro, Barbastro, Huesca, Spain; Hospital Virgen de la Salud, Toledo, Spain; Hospital San Agustín, Avilés, Asturias, Spain; Hospital La Paz, Madrid, Spain; EISAI Pharmaceuticals, Madrid, Spain; OXON Epidemiology, Madrid, Spain; Hospital Provincial, Castellón de la Plana, Castellón, Spain; Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - B San José
- Complejo Hospitalario, Orense, Spain; Hospital Reina Sofía, Córdoba, Spain; Hospital del Mar, Barcelona, Spain; Hospital La Fe, Valencia, Spain; Hospital Arquitecto Marcide, Ferrol, A Coruña, Spain; Hospital Médico Quirúrgico, Jaén, Spain; Hospital Son Llàtzer, Son Ferriol, Palma de Mallorca, Spain; Hospital de Barbastro, Barbastro, Huesca, Spain; Hospital Virgen de la Salud, Toledo, Spain; Hospital San Agustín, Avilés, Asturias, Spain; Hospital La Paz, Madrid, Spain; EISAI Pharmaceuticals, Madrid, Spain; OXON Epidemiology, Madrid, Spain; Hospital Provincial, Castellón de la Plana, Castellón, Spain; Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - E Martínez
- Complejo Hospitalario, Orense, Spain; Hospital Reina Sofía, Córdoba, Spain; Hospital del Mar, Barcelona, Spain; Hospital La Fe, Valencia, Spain; Hospital Arquitecto Marcide, Ferrol, A Coruña, Spain; Hospital Médico Quirúrgico, Jaén, Spain; Hospital Son Llàtzer, Son Ferriol, Palma de Mallorca, Spain; Hospital de Barbastro, Barbastro, Huesca, Spain; Hospital Virgen de la Salud, Toledo, Spain; Hospital San Agustín, Avilés, Asturias, Spain; Hospital La Paz, Madrid, Spain; EISAI Pharmaceuticals, Madrid, Spain; OXON Epidemiology, Madrid, Spain; Hospital Provincial, Castellón de la Plana, Castellón, Spain; Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - MA Seguí
- Complejo Hospitalario, Orense, Spain; Hospital Reina Sofía, Córdoba, Spain; Hospital del Mar, Barcelona, Spain; Hospital La Fe, Valencia, Spain; Hospital Arquitecto Marcide, Ferrol, A Coruña, Spain; Hospital Médico Quirúrgico, Jaén, Spain; Hospital Son Llàtzer, Son Ferriol, Palma de Mallorca, Spain; Hospital de Barbastro, Barbastro, Huesca, Spain; Hospital Virgen de la Salud, Toledo, Spain; Hospital San Agustín, Avilés, Asturias, Spain; Hospital La Paz, Madrid, Spain; EISAI Pharmaceuticals, Madrid, Spain; OXON Epidemiology, Madrid, Spain; Hospital Provincial, Castellón de la Plana, Castellón, Spain; Hospital Parc Taulí, Sabadell, Barcelona, Spain
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4
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Mateo F, Arenas EJ, Aguilar H, Serra-Musach J, de Garibay GR, Boni J, Maicas M, Du S, Iorio F, Herranz-Ors C, Islam A, Prado X, Llorente A, Petit A, Vidal A, Català I, Soler T, Venturas G, Rojo-Sebastian A, Serra H, Cuadras D, Blanco I, Lozano J, Canals F, Sieuwerts AM, de Weerd V, Look MP, Puertas S, García N, Perkins AS, Bonifaci N, Skowron M, Gómez-Baldó L, Hernández V, Martínez-Aranda A, Martínez-Iniesta M, Serrat X, Cerón J, Brunet J, Barretina MP, Gil M, Falo C, Fernández A, Morilla I, Pernas S, Plà MJ, Andreu X, Seguí MA, Ballester R, Castellà E, Nellist M, Morales S, Valls J, Velasco A, Matias-Guiu X, Figueras A, Sánchez-Mut JV, Sánchez-Céspedes M, Cordero A, Gómez-Miragaya J, Palomero L, Gómez A, Gajewski TF, Cohen EEW, Jesiotr M, Bodnar L, Quintela-Fandino M, López-Bigas N, Valdés-Mas R, Puente XS, Viñals F, Casanovas O, Graupera M, Hernández-Losa J, Ramón Y Cajal S, García-Alonso L, Saez-Rodriguez J, Esteller M, Sierra A, Martín-Martín N, Matheu A, Carracedo A, González-Suárez E, Nanjundan M, Cortés J, Lázaro C, Odero MD, Martens JWM, Moreno-Bueno G, Barcellos-Hoff MH, Villanueva A, Gomis RR, Pujana MA. Stem cell-like transcriptional reprogramming mediates metastatic resistance to mTOR inhibition. Oncogene 2016; 36:2737-2749. [PMID: 27991928 PMCID: PMC5442428 DOI: 10.1038/onc.2016.427] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 03/10/2016] [Revised: 08/31/2016] [Accepted: 10/10/2016] [Indexed: 01/16/2023]
Abstract
Inhibitors of the mechanistic target of rapamycin (mTOR) are currently used to treat advanced metastatic breast cancer. However, whether an aggressive phenotype is sustained through adaptation or resistance to mTOR inhibition remains unknown. Here, complementary studies in human tumors, cancer models and cell lines reveal transcriptional reprogramming that supports metastasis in response to mTOR inhibition. This cancer feature is driven by EVI1 and SOX9. EVI1 functionally cooperates with and positively regulates SOX9, and promotes the transcriptional upregulation of key mTOR pathway components (REHB and RAPTOR) and of lung metastasis mediators (FSCN1 and SPARC). The expression of EVI1 and SOX9 is associated with stem cell-like and metastasis signatures, and their depletion impairs the metastatic potential of breast cancer cells. These results establish the mechanistic link between resistance to mTOR inhibition and cancer metastatic potential, thus enhancing our understanding of mTOR targeting failure.
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Affiliation(s)
- F Mateo
- Breast Cancer and Systems Biology Laboratory, Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Spain
| | - E J Arenas
- Oncology Program, Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - H Aguilar
- Breast Cancer and Systems Biology Laboratory, Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Spain
| | - J Serra-Musach
- Breast Cancer and Systems Biology Laboratory, Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Spain
| | - G Ruiz de Garibay
- Breast Cancer and Systems Biology Laboratory, Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Spain
| | - J Boni
- Breast Cancer and Systems Biology Laboratory, Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Spain
| | - M Maicas
- Centre for Applied Medical Research (CIMA) and Department of Biochemistry and Genetics, University of Navarra, Pamplona, Spain
| | - S Du
- Department of Radiation Oncology, New York University School of Medicine, New York, NY, USA
| | - F Iorio
- European Molecular Biology Laboratory-European Bioinformatics Institute (EMBL-EBI), Wellcome Trust Genome Campus, Cambridge, UK.,Cancer Genome Project, Wellcome Trust Sanger Institute, Hinxton, UK
| | - C Herranz-Ors
- Breast Cancer and Systems Biology Laboratory, Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Spain
| | - A Islam
- Department of Genetic Engineering and Biotechnology, University of Dhaka, Dhaka, Bangladesh
| | - X Prado
- Breast Cancer and Systems Biology Laboratory, Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Spain
| | - A Llorente
- Breast Cancer and Systems Biology Laboratory, Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Spain
| | - A Petit
- Department of Pathology, University Hospital of Bellvitge, IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - A Vidal
- Department of Pathology, University Hospital of Bellvitge, IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - I Català
- Department of Pathology, University Hospital of Bellvitge, IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - T Soler
- Department of Pathology, University Hospital of Bellvitge, IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - G Venturas
- Department of Pathology, University Hospital of Bellvitge, IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - A Rojo-Sebastian
- Department of Pathology, MD Anderson Cancer Center, Madrid, Spain
| | - H Serra
- Angiogenesis Research Group, ProCURE, ICO, IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - D Cuadras
- Statistics Unit, IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - I Blanco
- Hereditary Cancer Programme, ICO, IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - J Lozano
- Department of Molecular Biology and Biochemistry, Málaga University, and Molecular Oncology Laboratory, Mediterranean Institute for the Advance of Biotechnology and Health Research (IBIMA), University Hospital Virgen de la Victoria, Málaga, Spain
| | - F Canals
- ProteoRed-Instituto de Salud Carlos III, Proteomic Laboratory, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, Barcelona, Spain
| | - A M Sieuwerts
- Department of Medical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Cancer Genomics Centre, Rotterdam, The Netherlands
| | - V de Weerd
- Department of Medical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Cancer Genomics Centre, Rotterdam, The Netherlands
| | - M P Look
- Department of Medical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Cancer Genomics Centre, Rotterdam, The Netherlands
| | - S Puertas
- Chemoresistance and Predictive Factors Laboratory, ProCURE, ICO, IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - N García
- Breast Cancer and Systems Biology Laboratory, Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Spain
| | - A S Perkins
- University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, NY, USA
| | - N Bonifaci
- Breast Cancer and Systems Biology Laboratory, Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Spain
| | - M Skowron
- Breast Cancer and Systems Biology Laboratory, Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Spain
| | - L Gómez-Baldó
- Breast Cancer and Systems Biology Laboratory, Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Spain
| | - V Hernández
- Biological Clues of the Invasive and Metastatic Phenotype Laboratory, IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - A Martínez-Aranda
- Biological Clues of the Invasive and Metastatic Phenotype Laboratory, IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - M Martínez-Iniesta
- Chemoresistance and Predictive Factors Laboratory, ProCURE, ICO, IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - X Serrat
- Cancer and Human Molecular Genetics, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - J Cerón
- Cancer and Human Molecular Genetics, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - J Brunet
- Hereditary Cancer Programme, ICO, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - M P Barretina
- Department of Medical Oncology, ICO, IDIBGI, Girona, Spain
| | - M Gil
- Department of Medical Oncology, ICO, IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - C Falo
- Department of Medical Oncology, ICO, IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - A Fernández
- Department of Medical Oncology, ICO, IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - I Morilla
- Department of Medical Oncology, ICO, IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - S Pernas
- Department of Medical Oncology, ICO, IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - M J Plà
- Department of Gynecology, University Hospital of Bellvitge, IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - X Andreu
- Department of Pathology, Parc Taulí Hospital Consortium, Sabadell, Barcelona, Spain
| | - M A Seguí
- Medical Oncology Service, Parc Taulí Hospital Consortium, Sabadell, Barcelona, Spain
| | - R Ballester
- Department of Radiation Oncology, University Hospital Germans Trias i Pujol, ICO, Germans Trias i Pujol Research Institute (IGTP), Badalona, Barcelona, Spain
| | - E Castellà
- Department of Pathology, University Hospital Germans Trias i Pujol, ICO, IGTP, Badalona, Barcelona, Spain
| | - M Nellist
- Department of Clinical Genetics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - S Morales
- Hospital Arnau de Vilanova, University of Lleida, Biomedical Research Institute of Lleida (IRB Lleida), Lleida, Spain
| | - J Valls
- Hospital Arnau de Vilanova, University of Lleida, Biomedical Research Institute of Lleida (IRB Lleida), Lleida, Spain
| | - A Velasco
- Hospital Arnau de Vilanova, University of Lleida, Biomedical Research Institute of Lleida (IRB Lleida), Lleida, Spain
| | - X Matias-Guiu
- Hospital Arnau de Vilanova, University of Lleida, Biomedical Research Institute of Lleida (IRB Lleida), Lleida, Spain
| | - A Figueras
- Angiogenesis Research Group, ProCURE, ICO, IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - J V Sánchez-Mut
- Cancer Epigenetics and Biology Program (PEBC), IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - M Sánchez-Céspedes
- Cancer Epigenetics and Biology Program (PEBC), IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - A Cordero
- Cancer Epigenetics and Biology Program (PEBC), IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - J Gómez-Miragaya
- Cancer Epigenetics and Biology Program (PEBC), IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - L Palomero
- Breast Cancer and Systems Biology Laboratory, Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Spain
| | - A Gómez
- Cancer Epigenetics and Biology Program (PEBC), IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - T F Gajewski
- Departments of Pathology and Medicine, University of Chicago, Chicago, IL, USA
| | - E E W Cohen
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - M Jesiotr
- Department of Pathology, Military Institute of Medicine, Warsaw, Poland
| | - L Bodnar
- Department of Oncology, Military Institute of Medicine, Warsaw, Poland
| | - M Quintela-Fandino
- Breast Cancer Clinical Research Unit, Spanish National Cancer Research Center (CNIO), Madrid, Spain
| | - N López-Bigas
- Department of Experimental and Health Sciences, Barcelona Biomedical Research Park, Pompeu Fabra University (UPF), Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - R Valdés-Mas
- Department of Biochemistry and Molecular Biology, University Institute of Oncology of Asturias, University of Oviedo, Oviedo, Spain
| | - X S Puente
- Department of Biochemistry and Molecular Biology, University Institute of Oncology of Asturias, University of Oviedo, Oviedo, Spain
| | - F Viñals
- Angiogenesis Research Group, ProCURE, ICO, IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - O Casanovas
- Angiogenesis Research Group, ProCURE, ICO, IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - M Graupera
- Angiogenesis Research Group, ProCURE, ICO, IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - J Hernández-Losa
- Department of Pathology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - S Ramón Y Cajal
- Department of Pathology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - L García-Alonso
- European Molecular Biology Laboratory-European Bioinformatics Institute (EMBL-EBI), Wellcome Trust Genome Campus, Cambridge, UK
| | - J Saez-Rodriguez
- European Molecular Biology Laboratory-European Bioinformatics Institute (EMBL-EBI), Wellcome Trust Genome Campus, Cambridge, UK
| | - M Esteller
- Cancer Epigenetics and Biology Program (PEBC), IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain.,Department of Physiological Sciences II, School of Medicine, University of Barcelona, Barcelona, Spain
| | - A Sierra
- Molecular and Translational Oncology Laboratory, Biomedical Research Center CELLEX-CRBC, Biomedical Research Institute 'August Pi i Sunyer' (IDIBAPS), and Systems Biology Department, Faculty of Science and Technology, University of Vic, Central University of Catalonia, Barcelona, Spain
| | - N Martín-Martín
- Center for Cooperative Research in Biosciences (CIC bioGUNE), Derio, Spain
| | - A Matheu
- Neuro-Oncology Section, Oncology Department, Biodonostia Research Institute, San Sebastian, Spain.,Ikerbasque, Basque Foundation for Science, Bilbao, Spain
| | - A Carracedo
- Center for Cooperative Research in Biosciences (CIC bioGUNE), Derio, Spain.,Ikerbasque, Basque Foundation for Science, Bilbao, Spain.,Department of Biochemistry and Molecular Biology, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - E González-Suárez
- Cancer Epigenetics and Biology Program (PEBC), IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - M Nanjundan
- Department of Cell Biology, Microbiology, and Molecular Biology, University of South Florida, Tampa, FL, USA
| | - J Cortés
- Department of Medical Oncology, VHIO, Vall d'Hebron University Hospital, Barcelona, Spain
| | - C Lázaro
- Hereditary Cancer Programme, ICO, IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - M D Odero
- Centre for Applied Medical Research (CIMA) and Department of Biochemistry and Genetics, University of Navarra, Pamplona, Spain
| | - J W M Martens
- Department of Medical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Cancer Genomics Centre, Rotterdam, The Netherlands
| | - G Moreno-Bueno
- Department of Biochemistry, Autonomous University of Madrid (UAM), Biomedical Research Institute 'Alberto Sols' (Spanish National Research Council (CSIC)-UAM), Translational Research Laboratory, Hospital La Paz Institute for Health Research (IdiPAZ), and MD Anderson International Foundation, Madrid, Spain
| | - M H Barcellos-Hoff
- Department of Radiation Oncology, New York University School of Medicine, New York, NY, USA
| | - A Villanueva
- Chemoresistance and Predictive Factors Laboratory, ProCURE, ICO, IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - R R Gomis
- Oncology Program, Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - M A Pujana
- Breast Cancer and Systems Biology Laboratory, Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Spain
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5
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Muñoz M, Santaballa A, Seguí MA, Beato C, de la Cruz S, Espinosa J, Fonseca PJ, Perez J, Quintanar T, Blasco A. SEOM Clinical Guideline of fertility preservation and reproduction in cancer patients (2016). Clin Transl Oncol 2016; 18:1229-1236. [PMID: 27896641 PMCID: PMC5138251 DOI: 10.1007/s12094-016-1587-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [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: 11/14/2016] [Accepted: 11/16/2016] [Indexed: 11/30/2022]
Abstract
Chemotherapy and radiotherapy often result in reduced fertility in cancer patients. With increasing survival rates, fertility is an important quality-of-life concern for many young cancer patients. Around 70–75% of young cancer survivors are interested in parenthood but the numbers of patients who access fertility preservation techniques prior to treatment are significantly lower. Moreover, despite existing guidelines, healthcare professionals do not address fertility preservation issues adequately. There is a critical need for improvements in clinical care to ensure patients are well informed about infertility risks and fertility preservation options and to support them in their reproductive decision-making prior to cancer treatment.
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Affiliation(s)
- M Muñoz
- Servicio de Oncología Médica, Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Hospital Clínic de Barcelona, Villarroel, 170-08036, Barcelona, Spain.
| | - A Santaballa
- Hospital Universitari I Politècnic la Fe, Valencia, Spain
| | - M A Seguí
- Corporació Sanitària Parc Taulì, Sabadell, Spain
| | - C Beato
- Hospital Universitario Virgen Macarena, Seville, Spain
| | - S de la Cruz
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | - J Espinosa
- Hospital General de Ciudad Real, Ciudad Real, Spain
| | - P J Fonseca
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J Perez
- Hospital General Universitario de Elche y Vega Baja, Elche, Spain
| | - T Quintanar
- Hospital General Universitario de Elche y Vega Baja, Elche, Spain
| | - A Blasco
- Hospital General Universitario de Valencia, Valencia, Spain
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6
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Pollán M, Pajares B, Martin M, Mackey JR, Lluch A, Gavila J, Vogel CL, Ruiz Borrego M, Calvo L, Pienkowski T, Rodriguez-Lescure A, Seguí MA, Tredan O, Anton A, Ramos Vazquez M, Camara MC, Rodriguez-Martin C, Carrasco EM, Alba E. The effect of obesity on prognosis in operable breast cancer patients treated with adjuvant anthracyclines and taxanes according to pathologic subtypes. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.1031] [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
1031 Background: According to observational studies, obesity is an unfavourable prognostic factor in breast cancer (BC), regardless of menopausal status and treatment received. Information collected in clinical trials should confirm this effect and serves to test its homogeneity by pathologic subtype. Methods: We retrospectively analysed 5,683 operable BC patients enrolled in four randomized clinical trials (GEICAM/9906, 9805, 2003–02, and BCIRG 001) evaluating adjuvant anthracyclines and taxanes. Our primary aim was to assess the prognostic effect of body mass index (BMI) on disease recurrence, breast cancer mortality (BCM), and overall mortality (OM). A secondary aim was to detect differences by BC subtypes (ER/PR-positive/HER2-negative, HER2-positive, triple-negative). Cox models were fitted for each end-point, adjusted by potential confounders. Results: Analyses adjusting for age, tumor size, nodal status, menopausal status, surgery, grade, hormone receptor and HER2 status, chemotherapy regimen, and undertreatment showed that obese patients (BMI 30.0–34.9) had similar prognoses to that of patients with a BMI<25 (reference group) in terms of recurrence (HR 1.08 [95% CI 0.9–1.3]; p=0.41), BCM (HR 1.02 [0.81–1.29]; p=0.85), and OM (HR 0.97 [0.78–1.19]; p=0.747). Patients with severe obesity (BMI≥35) had a significantly increased risk of recurrence (HR 1.26 [1.00–1.59]; p=0.05), BCM (HR 1.32 [1.00–1.74]; p=0.05), and OM (HR 1.35 [1.06–1.71]; p=0.02) compared to our reference group (Table). The prognostic effect of severe obesity did not vary by subtype. Conclusions: Severely obese patients treated with anthracyclines and taxanes present a worse prognosis regarding recurrence, BCM, and OM than patients with a BMI<25. The magnitude of the harmful effect of BMI was similar across subtypes. [Table: see text]
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Affiliation(s)
- Marina Pollán
- National Center of Epidemiology, Instituto Salud Carlos III, Madrid, Spain
| | - Bella Pajares
- Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Miguel Martin
- Medical Oncology, Instituto de Investigación Sanitaria Gregorio Marañon, Universidad Complutense, Madrid, Spain
| | | | - Ana Lluch
- Hospital Clínico de Valencia - INCLIVA Health Research Institute, University of Valencia., Valencia, Spain
| | | | - Charles L. Vogel
- University of Miami School of Medicine, Comprehensive Cancer Research Group, Inc., Miami, FL
| | | | - Lourdes Calvo
- Complexo Hospitalario Universitario de A Coruña, A Coruna, Spain
| | | | | | - Miquel Angel Seguí
- Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Oncològic del Vallès, Sabadell, Spain
| | | | - Antonio Anton
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | | | | | - Emilio Alba
- Hospital Clínico Universitario Virgen de la Victoria, Malaga, Spain
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7
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Sánchez-Rovira P, Seguí MA, Llombart A, Aranda E, Antón A, Sánchez A, Lomas M, Jaén A, Fernández M, Porras I, Dalmau E, Morales S, de la Haba-Rodríguez J. Bevacizumab plus preoperative chemotherapy in operable HER2 negative breast cancer: biomarkers and pathologic response. Clin Transl Oncol 2013; 15:810-7. [PMID: 23397155 PMCID: PMC3776259 DOI: 10.1007/s12094-013-1006-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 01/13/2013] [Indexed: 12/31/2022]
Abstract
Purpose The primary aim of this trial was to assess the rate of pathologic complete responses (pCR) of doxorubicin/cyclophosphamide (AC) followed by bevacizumab/docetaxel (BT), as neoadjuvant therapy for breast cancer (BC). Furthermore, the association between biomarkers and the pCR was explored. Methods Patients with HER-negative operable stage II–III BC ≥2 cm were enrolled. Four cycles of AC (A 60 mg/m2 and C 600 mg/m2, every 3 weeks) followed by 4 cycles of BT (B 15 mg/kg and T 75 mg/m2, every 3 weeks), were planned. A core-biopsy was performed for biological markers assessment. Results Seventy-two women were included. Forty-three (63 %) patients were hormone receptor-positive. Sixty-four (89 %) completed the planned treatment, and 66 evaluable patients underwent surgery (92 %): a pCR was achieved in 16 of them (24, 95 % CI 15–36 %). pCR was significantly higher in tumors hormone receptor-negative, and in those with Angiotensin II type 1 receptor (AGTR1) protein overexpression. The overall clinical response rate was 86 % (95 % CI 76–93 %), including 42 complete responses. No unexpected toxicities or treatment-related deaths were observed. Conclusion This regimen showed a remarkable clinical and pathological activity: the suggested relation between pCR and AGTR1 overexpression should be confirmed in larger trials.
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Affiliation(s)
- P Sánchez-Rovira
- Servicio de Oncología Médica, Complejo Hospitalario de Jaén, Avda. del Ejército Español, 10, 23007, Jaén, Spain,
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8
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Estévez LG, Martín M, Alba E, Colomer R, Lobo F, Lluch A, Adrover E, Albanell J, Barnadas A, García-Mata J, Llombart A, Muñoz M, Rodríguez C, Sánchez-Rovira P, Seguí MA, Tusquets I. Current controversies in the management of early breast cancer. Clin Transl Oncol 2007; 9:375-84. [PMID: 17594952 DOI: 10.1007/s12094-007-0070-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Medical professionals in general, and medical oncologists in particular, have highly stressful practices because they are under constant pressure to have the highest-quality, up-to-date evidence available in order to make the right decision for each individual patient. From a practical point of view, being updated on oncological and other medical specialties may seem an insurmountable task because the number of scientific publications has increased dramatically. The use of systematic reviews of randomised controlled trials or the application of results obtained from high-quality randomised controlled trials are some of the most common ways to address this need. Unfortunately, they do not cover all complex clinical situations that the majority of medical oncologists face in their outpatient consultations. In this review, we report the conclusions achieved in a multiexpert meeting where five important controversies in the treatment of breast cancer were analysed. Five highly experienced medical oncologists were required to defend an affirmative answer and another five were required to defend a negative answer for each of the clinical questions. After that, a one-day meeting was organised to debate each clinical question and to reach a consensus. We report here the content of this multi-expert meeting along with the conclusions drawn.
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Affiliation(s)
- L G Estévez
- Centro Integral Oncológico Clara Campal, C/Oña, Madrid, Spain
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9
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Sáez A, Andreu FJ, Seguí MA, Baré ML, Fernández S, Dinarés C, Rey M. HER-2 gene amplification by chromogenic in situ hybridisation (CISH) compared with fluorescence in situ hybridisation (FISH) in breast cancer—A study of two hundred cases. Breast 2006; 15:519-27. [PMID: 16290155 DOI: 10.1016/j.breast.2005.09.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [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: 07/07/2005] [Revised: 09/08/2005] [Accepted: 09/27/2005] [Indexed: 11/28/2022] Open
Abstract
The purpose of the study was to compare two methods used to analyse HER-2 gene amplification (fluorescence in situ hybridisation (FISH) and chromogenic in situ hybridisation (CISH)), and determine the accuracy of the antibodies CB11 and HercepTest for immunohistochemical detection of HER-2 overexpression from archival breast cancer tissue. Additionally, interobserver variability in the interpretation of CISH and immunohistochemical tests was measured. Two hundred cases of invasive breast carcinoma diagnosed between 2000 and 2003 were selected. Immunohistochemistry (IHC) was performed with HercepTest and CB11, and gene amplification was determined by FISH (PathVision, Vysis) and CISH (Zymed) using tissue macroarrays. An excellent concordance (94.8%) was found between CISH and FISH. Considering FISH as gold standard, sensitivity of CISH was 97.5% and specificity 94%. Overall interobserver agreement of CISH was 97.5% and of IHC 84%. Both antibodies showed a sensitivity of 95.2% and a specificity of 70.7% (CB11) and 81.2% (HercepTest). Our results show that CISH is a highly accurate, reproducible and practical technique to determine HER-2 gene amplification. CB11 and HercepTest are good screening methods with a high sensitivity. The performance of tissue macroarrays to test HER-2 status by IHC, FISH and CISH has demonstrated to be an available and effective method to study large series of tumours.
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Affiliation(s)
- A Sáez
- Department of Pathology, UDIAT Centre Diagnòstic-Corporació Parc Taulí, Parc Taulí s/n 08208 Sabadell, Barcelona, Spain.
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10
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Martín M, Lluch A, Seguí MA, Ruiz A, Ramos M, Adrover E, Rodríguez-Lescure A, Grosse R, Calvo L, Fernandez-Chacón C, Roset M, Antón A, Isla D, del Prado PM, Iglesias L, Zaluski J, Arcusa A, López-Vega JM, Muñoz M, Mel JR. Toxicity and health-related quality of life in breast cancer patients receiving adjuvant docetaxel, doxorubicin, cyclophosphamide (TAC) or 5-fluorouracil, doxorubicin and cyclophosphamide (FAC): impact of adding primary prophylactic granulocyte-colony stimulating factor to the TAC regimen. Ann Oncol 2006; 17:1205-12. [PMID: 16766587 DOI: 10.1093/annonc/mdl135] [Citation(s) in RCA: 157] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aim of the study was to analyse the toxicity and health related quality of life (HRQoL) of breast cancer patients treated with FAC (5-fluorouracil, doxorubicin, cyclophosphamide) and TAC (docetaxel, doxorubicin, cyclophosphamide) with and without primary prophylactic G-CSF (PPG). PATIENTS AND METHODS This was a phase III study to compare FAC and TAC as adjuvant treatment of high-risk node-negative breast cancer patients. After the entry of the first 237 patients, the protocol was amended to include PPG in the TAC arm due to the high incidence of febrile neutropenia. A total of 1047 evaluable patients from 49 centres in Spain, two in Poland and four in Germany were included in the trial. Side-effects and the scores of the EORTC QLQ-C30 and QLQ BR-23 questionnaires were compared in the three groups (FAC, TAC pre-amendment and TAC post-amendment). RESULTS The addition of PPG to TAC significantly reduced the incidence of neutropenic fever, grade 2-4 anaemia, asthenia, anorexia, nail disorders, stomatitis, myalgia and dysgeusia. Patient QoL decreased during chemotherapy, more with TAC than FAC, but returned to baseline values afterwards. The addition of PPG to TAC significantly reduced the percentage of patients with clinically relevant Global Health Status deterioration (10 or more points over baseline value) at the end of chemotherapy (64% versus 46%, P<0.03). CONCLUSIONS The addition of PPG significantly reduces the incidence of neutropenic fever associated with TAC chemotherapy as well as that of some TAC-induced haematological and extrahaematological side-effects. The HRQoL of patients treated with TAC is worse than that of those treated with FAC but improves with the addition of PPG, particularly in the final part of chemotherapy treatment.
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Affiliation(s)
- M Martín
- Hospital Universitario San Carlos, Madrid, Spain.
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11
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Climent MA, Seguí MA, Peiró G, Molina R, Lerma E, Ojeda B, López-López JJ, Alonso C. Prognostic value of HER-2/neu and p53 expression in node-positive breast cancer. HER-2/neu effect on adjuvant tamoxifen treatment. Breast 2001; 10:67-77. [PMID: 14965564 DOI: 10.1054/brst.2000.0225] [Citation(s) in RCA: 18] [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] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
HER-2/neu and p53 expression, conventional clinical and pathologic prognostic factors, were evaluated in a retrospective series of 283 node-positive breast cancer patients. Overexpression was determined by immunohistochemistry in formalin-fixed paraffin-embedded tissue blocks. Twenty one percent were HER-2/neu positive and 40% p53 positive. HER-2/neu expression was related to axillary lymph node metastasis (P=0.014), inflammatory infiltrates (P=0.004), and the absence of oestrogen (ER) (P=0.0026) and progesterone (P=0.01) receptors (PR). p53 expression was related to lymph node involvement (P=0.03), necrosis (P=0.036), absence of ER (P=0.028) and PR (P=0.065). p53 was not associated with outcome. HER-2/neu was an unfavourable prognostic factor for disease-free (DFS) (P=0.05) and overall survival (OS) (P=0.02) in univariate analysis. Multivariate analysis showed that the number of involved axillary nodes (P<0.00001), age (P=0.004), grade (P=0.04), and PR (P=0.04) were independent predictors for OS. ER-positive patients treated with adjuvant tamoxifen had shorter DFS and OS when they were HER-2/neu positive.
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Affiliation(s)
- M A Climent
- Instituto Valenciano de Oncología, Barcelona, Spain
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12
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Bonfill X, Montes J, Roqué M, Nogué M, Saigí E, Seguí MA, Blanco R, Arcusa A, Arjol A, Díaz C. [Prospective assessment of clinical outcomes in patients with lung cancer]. Med Clin (Barc) 2000; 114 Suppl 3:104-11. [PMID: 10994573] [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: 02/17/2023]
Abstract
BACKGROUND The aim of this study was to assess the outcome in patients with lung cancer. PATIENTS AND METHODS Prospective study in 93 patients with lung cancer in 3 community hospitals. In each evaluation (4-6 weeks) the following results were obtained: a) questionnaire on the quality of life or performance status (QoL/PS), based on different instruments (Karnofsky Performance Scale [KPS], ECOG, QLQ-C30, and the Nottingham Health Profile [NHP], and b) a clinical questionnaire. Active follow-up was for 18 months and survival tracking was to five years. A descriptive analysis of the outcome variables and a survival analysis (Kaplan-Meier) were done. The prognostic value of each instrument (Cox) and the correlation between the instruments (Spearman) were also evaluated. RESULTS The mean values recorded at the time of diagnosis between 60% and 70% of the maximum value possible. Mean survival was 12.4 months; accumulated survival was 30% to one year and 4% to 55 months. Only 17% of patients presented any disease-free period. Toxicity of treatment was almost always irrelevant. The correlation between the KPS, the QLQ-30 and the NHP was acceptable and their initial values were important prognostic factors. The QoL/PS scores for the survivors were similar to their initial values, but the global values were 11%. CONCLUSIONS The outcomes measures used in this study provide very useful information, although registration and analysis of the necessary data should be systematic. The KPS was comparable to the other QoL/PS indicators used, but it is shorter, more acceptable and easier to use. Better QoL/PS measurement instruments are needed to evaluate outcomes in the practice of clinical oncology.
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Affiliation(s)
- X Bonfill
- Centre d'Estudis, Programes i Serveis Sanitaris, Institut Universitari Fundació Parc Taulí Sabadell
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13
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Moyano AJ, Seguí MA, Abad T, Urruticoechea L, García López JL, Nogué M, Dominguez MS, Balcells M, Dorado JF. Ifosfamide and irinotecan in solid tumors: a phase I dose-finding trial. Semin Oncol 2000; 27:3-7. [PMID: 10697037] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The combination of ifosfamide and irinotecan was tested in a dose-finding study. The preliminary results of the combination in this phase I study did not show any major toxicity that could help to define the dose-limiting toxicity. The escalation continues even after nine levels; the study is therefore ongoing. The main toxicity is gastrointestinal, with mild nausea, vomiting, and diarrhea. There was some other irrelevant toxicity, which was easily manageable with the usual supportive therapy. When responses were evaluated, stable disease was found in some cases, suggesting some activity for the combination.
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Affiliation(s)
- A J Moyano
- Medical Oncology Service, Hospital Ramón y Cajal, Madrid, Spain
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14
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Vadell C, Seguí MA, Giménez-Arnau JM, Morales S, Cirera L, Bestit I, Batiste E, Blanco R, Jolis L, Boleda M, Antón I. Anticachectic efficacy of megestrol acetate at different doses and versus placebo in patients with neoplastic cachexia. Am J Clin Oncol 1998; 21:347-51. [PMID: 9708631 DOI: 10.1097/00000421-199808000-00006] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Anorexia and cachexia are present in the majority of patients with advanced-stage cancer. Several agents have been tested for their ability to reverse weight loss in these patients. Megestrol acetate has been demonstrated to improve appetite and weight, independent of tumor response, when used in the treatment of metastatic breast cancer. Several trials have studied the ability of megestrol acetate to stimulate weight gain in patients with non-hormone-sensitive tumors. One hundred fifty patients with a weight lost of more than 5% in the 3 previous months were randomized between double-blind megestrol acetate 160 mg daily (LMA), megestrol acetate 480 mg daily (HMA), or placebo (P). Weight, mid-arm circumference, triceps skinfold thickness (TST), performance status (Karnofsky index), and a quality-of-life status by seven linear analogic self-assessment scales were assessed before the start of treatment and at 4, 8, and 12 weeks thereafter. One hundred seven patients were assessable at 4 weeks, 79 at 8 weeks, and 64 at 12 weeks. Sixty-eight percent of patients treated with HMA increased their weights during their permanence on study, versus 37% and 38% of patients treated with P or LMA (p < 0.03). The mean weight gain after 12 weeks of treatment with HMA was 5.41 kg. A significant increase on TST was observed in the HMA group versus the LMA and P groups. There was no gain in performance status or quality of life in any group of treatment. The toxicity registered was mild. There were no thromboembolic events. This trial supports the efficacy of megestrol acetate at 480 mg/day in the treatment of cancer-related cachexia and anorexia, with mild toxicity. However, performance status and quality of life were not influenced by this treatment.
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Affiliation(s)
- C Vadell
- Hospital del Mar, Barcelona, Spain
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15
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Nogué M, Seguí MA, Saigí E, Batiste-Alentorn E, Arcusa A, Boleda M, Antón I. Protracted treatment with tegafur and low dose oral leucovorin in patients with advanced colorectal carcinoma. Cancer 1998; 83:254-8. [PMID: 9669807] [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: 02/08/2023]
Abstract
BACKGROUND Protracted oral administration of tegafur (TG) and leucovorin (LV) attempts to simulate the continuous infusion of 5-fluorouracil, with a higher intracellular folate pool. In a prior dose-finding study with a fixed TG dose of 0.75 g/m2/day for a period of 21 days and continuous oral LV, the recommended dose of LV was 45 mg/day in 28-day cycles. METHODS Thirty-nine patients with histologic confirmation of adenocarcinoma of the colon or rectum, either advanced or metastatic disease, and who were not candidates for radical treatment were included in a Phase II study using this schedule. RESULTS One hundred sixty-three cycles of chemotherapy were delivered (median, 4 cycles per patient). Toxicity was observed in the form of diarrhea, which was severe in 12 patients (30.7%). Grade 3 (according to the World Health Organization criteria) oral mucositis was recorded in 7 patients (18%). Asthenia was severe in 10% of the patients. Recuperation from toxicity was rapid and managed primarily on an outpatient basis. Two complete (5.1%) and 13 partial (33.3%) responses were observed, with a global response index of 38.5% (95% confidence interval, 23.2-53.6%). The median overall survival was 11.3 months. CONCLUSIONS The results of this study show that an all-oral regimen of tegafur and leucovorin can obtain biochemical modulation, with a significant response rate, in patients with advanced colorectal carcinoma. Randomized trials are needed to assess the possible advantage of this regimen over intravenous schedules.
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Affiliation(s)
- M Nogué
- Oncology Unit, Consorci Hospitalari Parc Taulí, Barcelona, Spain
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Peiró G, Lerma E, Climent MA, Seguí MA, Alonso MC, Prat J. Prognostic value of S-phase fraction in lymph-node-negative breast cancer by image and flow cytometric analysis. Mod Pathol 1997; 10:216-22. [PMID: 9071729] [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: 02/04/2023]
Abstract
Cellular DNA content and proliferation rates have been suggested as prognostic factors in breast carcinomas. A series of 271 lymph-node negative breast carcinoma patients without adjuvant therapy was reviewed (mean follow-up, 108 mo). Tumor cells from the same paraffin-embedded block tissue (Hedley's method) were analyzed by image analysis (IA) in Feulgen-stained smears and by flow cytometric analysis (FC). Clinicopathologic features, ploidy, S-phase fraction, and percentage of tumor cells with more than 5n DNA content (in diploid tumors, by IA) were related to outcome. The results of IA and FC were compared in 115 cases. Tumor size, histologic grade, desmoplasia and S-phase fraction were significant predictors of survival in multivariate analysis (Cox proportionate regression) (P < or = 0.03). Ploidy by the two methods showed agreement in 100 carcinomas (87%). Of the 15 discordant cases, FC detected 6 multiploid and 4 aneuploid-peridiploid. In contrast, IA detected more tetraploid carcinomas. Tumor size, histologic grade, desmoplasia, and S-phase fraction were independent predictors of long-term prognosis in our patients. Ploidy and percentage of tumor cells with more than 5n DNA content were not prognostic indicators. FC detected aneuploidy more frequently than did IA.
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Affiliation(s)
- G Peiró
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Spain
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Alonso MC, Tabernero JM, Ojeda B, Llanos M, Solà C, Climent MA, Seguí MA, López JJ. A phase III randomized trial of cyclophosphamide, mitoxantrone, and 5-fluorouracil (CNF) versus cyclophosphamide, adriamycin, and 5-fluorouracil (CAF) in patients with metastatic breast cancer. Breast Cancer Res Treat 1995; 34:15-24. [PMID: 7749156 DOI: 10.1007/bf00666487] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
One hundred patients with metastatic breast cancer were randomly selected to receive combined chemotherapy treatment with adriamycin (50 mg/m2) or mitoxantrone (12 mg/m2) associated with 5-fluorouracil (600 mg/m2) and cyclophosphamide (600 mg/m2) administered intravenously every 21 days with a maximum of ten cycles. All patients included in this study were under 75 years of age and had ECOG performance status of less than 4. They had not been treated previously with chemotherapy for metastatic disease. Patients treated with adjuvant chemotherapy, which could not have included anthracyclines, had to have relapsed at least 12 months after the completion of therapy. There were no statistically significant differences in pretreatment characteristics or metastatic disease location between the two groups. Ninety-four patients were assessable for response. No differences were observed in response rate or in survival between the groups. The response rate (complete response (CR) and partial response (PR)) was 68% (13% CR and 55% PR for CAF; 0% CR and 68% PR for CNF). Median survival for all patients was 19 months (18 months with CAF and 19 months with CNF). All patients were assessable for toxicity. There were no differences in gastrointestinal and cardiac toxicity. More grade I-II hematologic toxicity episodes (p < 0.001) and treatment delays (p = 0.05) due to leucopenia were observed with the CNF group, and more grade III alopecia (p < 0.001) was observed with the CAF group. Patients received further therapeutic manoeuvres after finishing the study with a sequential treatment consisting of hormonal therapy and chemotherapy with mitomycin (M) -vinblastine (Vbl) (M 10 mg/m2 day 1, Vbl 5 mg/m2 days 1, 15 and 29; maximum 5 cycles). This chemotherapy treatment was received by 32 patients, with a response rate of 34% and grade III-IV hematologic toxicity of 37%. Treatment with CNF can be considered a good alternative to CAF for first-line treatment of metastatic breast cancer. M-Vbl treatment is useful as second-line treatment in patients with prior adriamycin exposure.
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Affiliation(s)
- M C Alonso
- Medical Oncology Department, Universitat Autònoma de Barcelona, Hospital de Sant Pau, Spain
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Abstract
Tegafur is an effective oral fluoropyrimidine that shows the same activity as 5-fluorouracil for a similar spectrum of cancers. Their biochemical modulation with oral Leucovorin (LV) attempts to simulate treatment with a continuous infusion of 5-fluorouracil and LV with the added advantage of outpatient administration. Thirty-three patients with advanced adenocarcinoma were included in the study. The treatment consisted of tegafur, 0.75 g/m2/day, for 21 days, with oral LV at different dose levels, 15, 30, 45, 60 and 90 mg/day, in a 28-day cycle. A correlation between the LV dose and an increase in grade III/IV toxicity (especially diarrhea, oral mucositis and fatigue) was established in the nonlinear regression model, reaching a plateau at 60 mg of LV. For the tegafur dose used, the recommended dose of LV is in the range of 45-60 mg/day. This schedule could be considered to evaluate the possible therapeutic effect in phase II trials.
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Affiliation(s)
- M Nogué
- Medical Oncology Unit, Hospital de Sabadell, Spain
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Germá JR, Sagarra AF, Izquierdo MA, Seguí MA. Sequential trials of cisplatin, vinblastine, and bleomycin and etoposide and cisplatin in disseminated nonseminomatous germ cell tumors of the testis with a good prognosis at a single institution. Cancer 1993; 71:796-803. [PMID: 7679314 DOI: 10.1002/1097-0142(19930201)71:3<796::aid-cncr2820710323>3.0.co;2-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND With the introduction of cisplatin-based chemotherapy, approximately 80% of patients with disseminated nonseminomatous germ cell tumors (NSGCT) of the testis can be cured. These treatments have been associated with considerable toxic effects. Numerous trials have been performed with the challenge of minimizing toxic effects without jeopardizing prognosis in a subgroup of these patients with a good prognosis. METHODS A retrospective study comparing the efficacy and toxic effects of etoposide and cisplatin (EP) and cisplatin, vinblastine, and bleomycin (PVB) was done in two consecutive groups of patients who had comparable characteristics and disseminated NSGCT of the testis with a good prognosis. RESULTS Twenty of 22 (91%) patients receiving EP and 19 of 19 (100%) receiving PVB achieved a complete response with or without adjunctive surgery. At surgery, similar proportions of patients in both groups were found to have mature teratoma or fibrosis and necrosis. With a median follow-up of 111 months (PVB-treated group) and 43 months (EP-treated group), the actuarial overall survival was similar in both groups. One patient treated with PVB and five patients receiving EP had relapses. The recurrence-free survival was almost significantly higher with PVB than with EP (P = 0.054). Only patients in the PVB-treated group had pulmonary (5.5%) and cutaneous (16%) toxic effects. No differences regarding hematologic, neurologic, and renal toxic effects were found. CONCLUSIONS The omission of bleomycin in first-line therapy for disseminated NSGCT with a good prognosis should be adopted with caution because it seems to affect the therapeutic outcome, with more patients having relapses.
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Affiliation(s)
- J R Germá
- Oncology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma, Barcelona, Spain
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Germá JR, Izquierdo MA, Seguí MA, Climent MA, Ojeda B, Alonso C. Malignant ovarian germ cell tumors: the experience at the Hospital de la Santa Creu i Sant Pau. Gynecol Oncol 1992; 45:153-9. [PMID: 1375576 DOI: 10.1016/0090-8258(92)90278-q] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
From 1979 to 1990, 33 patients with pathologically confirmed malignant ovarian germ cell tumors (MOGCT) were referred after initial surgical procedure at the Department of Oncology, Hospital de la Santa Creu i Sant Pau. The median age was 22 years (range, 10 to 39). Stage distribution was as follows: stage I, 12 patients; stage II, 6 patients; stage III, 11 patients; stage IV, 3 patients; and unstaged, 1 patient. The histologic diagnoses were 10 dysgerminomas, 4 endodermal sinus tumors, 11 immature teratomas, and 8 mixed germ cell tumors. Twenty-eight out of the thirty-three patients received postoperative chemotherapy with POMB-ACE-PAV or other platinum-containing regimens. One patient with stage IV disease failed to respond to chemotherapy and she died. Sixteen out of the twenty-eight treated patients had second-look laparotomy, which showed mature teratoma in six and persistent malignant teratoma in one patient. This last patient had complete remission with second regimen. No patient has developed recurrence. With a median follow-up of 66 months (range, 10 to 133), 32 patients (97%) are alive without evidence of disease. These data confirm that platinum-containing regimens have dramatically improved the prognosis for patients with MOGCT. This paper discusses primary chemotherapy and the role of the second-look in these patients.
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Affiliation(s)
- J R Germá
- Department of Oncology, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma, Barcelona, Spain
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