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Rassy E, Boussios S, Chebly A, Farra C, Kattan J, Pavlidis N. Comparative genomic characterization of melanoma of known and unknown primary. Clin Transl Oncol 2021; 23:2302-2308. [PMID: 33934271 DOI: 10.1007/s12094-021-02629-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/22/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND This study aims to genomically characterize melanoma of unknown primary (MUP) in comparison to melanomas of cutaneous primary (MCP). METHODS Eligible cases were collected from the MSK-IMPACT™ Clinical Sequencing Cohort published in the cBioPortal database. Genomic analysis was performed using a hybridization-capture-based next-generation sequencing assay designed to detect mutations, small insertions and deletions, copy number alterations, and genomic rearrangements. RESULTS Among 462 patients of whom 18.4% had MUP, brain metastasis was more common among patients with MUP (23% vs 7.1%). The differences in genomic profiling between MCP and MUP did not reach statistical significance. The 187 MCP and 44 MUP patients treated with immune checkpoint inhibitors had a median overall survival of 49 and 44 months, respectively (p = 0.705). CONCLUSIONS The differences in somatic mutation patterns and survival outcomes were not statistically significant. These findings may allude to similar carcinogenic processes but should be considered exploratory and interpreted with caution.
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Affiliation(s)
- E Rassy
- Gustave Roussy, Département de médecine oncologique, 94805, Villejuif, France. .,Department of Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
| | - S Boussios
- Faculty of Life Sciences and Medicine, School of Cancer and Pharmaceutical Sciences, King's College London, London, SE1 9RT, UK.,Medway NHS Foundation Trust, Windmill Road, Gillingham, Kent, ME7 5NY, UK.,AELIA Organization, 9th Km Thessaloniki, Thermi, 57001, Thessaloniki, Greece
| | - A Chebly
- Medical Genetics Unit, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - C Farra
- Medical Genetics Unit, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Genetics, Hotel Dieu de France Medical Center, Beirut, Lebanon
| | - J Kattan
- Department of Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - N Pavlidis
- University of Ioannina, 45110, Ioannina, Greece
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Pavlidis N, Kofinas A, Papanikolaou MG, Miras HN, Drouza C, Kalampounias AG, Kabanos TA, Konstandi M, Leondaritis G. Synthesis, characterization and pharmacological evaluation of quinoline derivatives and their complexes with copper(ΙΙ) in in vitro cell models of Alzheimer's disease. J Inorg Biochem 2021; 217:111393. [PMID: 33610031 DOI: 10.1016/j.jinorgbio.2021.111393] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/30/2021] [Accepted: 02/05/2021] [Indexed: 12/17/2022]
Abstract
Alzheimer's disease (AD) is a neurodegenerative disorder of the central nervous system. The main pathophysiological mechanisms involve cholinergic neurotransmission, beta-amyloid (Αβ) and Tau proteins, several metal ions and oxidative stress, among others. Current drugs offer only relief of symptoms and not a cure of AD. Accumulating evidence suggests that multifunctional compounds, targeting multiple pathophysiological mechanisms, may have a great potential for the treatment of AD. In this study, we report on the synthesis and physicochemical characterization of four quinoline-based metal chelators and their respective copper(II) complexes. Most compounds were non-toxic at concentrations ≤5 μM. In neuroprotection studies employing undifferentiated and differentiated SH-SY5Y cells, the metal chelator N2,N6-di(quinolin-8-yl)pyridine-2,6-dicarboxamide (H2dqpyca) appeared to exert significant neuroprotection against both, Aβ peptide- and H2O2-induced toxicities. The copper(II) complex [CuII(H2bqch)Cl2].3H2O (H2bqch = N,N'-Bis(8-quinolyl)cyclohexane-1,2-diamine) also protected against H2O2-induced toxicity, with a half-maximal effective concentration of 80 nM. Molecular docking simulations, using the crystal structure of the acetylcholinesterase (AChE)-rivastigmine complex as a template, indicated a strong interaction of the metal chelator H2dqpyca, followed by H2bqch, with both the peripheral anionic site and the catalytic active site of AChE. In conclusion, the sufficient neuroprotection provided by the metal chelator H2dqpyca and the copper(II) complex [CuII(H2bqch)Cl2].3H2O along with the evidence for interaction between H2dqpyca and AChE, indicate that these compounds have the potential and should be further investigated in the framework of preclinical studies employing animal models of AD as candidate multifunctional lead compounds for the treatment of the disease.
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Affiliation(s)
- Nikolaos Pavlidis
- Department of Pharmacology, Faculty of Medicine, University of Ioannina, Ioannina 45110, Greece; Section of Inorganic and Analytical Chemistry, Department of Chemistry, University of Ioannina, Ioannina 45110, Greece.
| | - Aristeidis Kofinas
- Department of Pharmacology, Faculty of Medicine, University of Ioannina, Ioannina 45110, Greece.
| | - Michael G Papanikolaou
- Section of Inorganic and Analytical Chemistry, Department of Chemistry, University of Ioannina, Ioannina 45110, Greece.
| | - Haralampos N Miras
- West CHEM, School of Chemistry, University of Glasgow, Glasgow G12 8QQ, UK.
| | - Chryssoula Drouza
- Department of Agricultural Sciences, Biotechnology and Food Science, Cyprus University of Technology, Limassol 3036, Cyprus.
| | - Angelos G Kalampounias
- Physical Chemistry Laboratory, Department of Chemistry, University of Ioannina, Ioannina 45110, Greece; Institute of Materials Science and Computing, University Research Center of Ioannina (URCI), Ioannina 45110, Greece.
| | - Themistoklis A Kabanos
- Section of Inorganic and Analytical Chemistry, Department of Chemistry, University of Ioannina, Ioannina 45110, Greece.
| | - Maria Konstandi
- Department of Pharmacology, Faculty of Medicine, University of Ioannina, Ioannina 45110, Greece.
| | - George Leondaritis
- Department of Pharmacology, Faculty of Medicine, University of Ioannina, Ioannina 45110, Greece.
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Kattan J, Rassy E, Bakouny Z, Assi T, Pavlidis N. A network meta-analysis of the frontline immune-checkpoint inhibitor-based regimens in advanced non-small cell lung cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy486.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Janinis J, Giannakakis T, Athanasiades A, Fountzilas G, Bafaloukos D, Kosmidis P, Nikolaides K, Pavlidis N, Skarlos D. A Randomized Open-Label Parallel-Group Study Comparing Ondansetron with Ondansetron plus Dexamethasone in Patients with Metastatic Breast Cancer Receiving High-Dose Epirubicin. A Hellenic Cooperative Oncology Group Study. Tumori 2018; 86:37-41. [PMID: 10778764 DOI: 10.1177/030089160008600107] [Citation(s) in RCA: 9] [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: 11/15/2022]
Abstract
AIMS AND BACKGROUND The purpose of this multicenter randomized, open-label, parallel-group study was to assess whether the addition of low-dose dexamethasone to ondansetron results in improved control of chemotherapy-induced emesis in patients undergoing first-line chemotherapy with high-dose epirubicin. METHODS & STUDY DESIGN Patients were randomized to receive either 24 mg of ondansetron or 24 mg of ondansetron plus 8 mg of dexamethasone administered as an intravenous infusion 30 minutes prior to administration of chemotherapy. Both groups of patients received 8 mg of ondansetron given orally from day 2 to 5 two times daily. Fifty-three patients received ondansetron and 50 received ondansetron plus dexamethasone. The patients recorded nausea and the number of vomits and retches daily on diary cards. RESULTS Significantly more patients in the ondansetron plus dexamethasone group experienced neither vomiting nor retching during the first day of the first course of chemotherapy compared to those receiving ondansetron alone (79.6% vs 53.8%, P = 0.0062). Furthermore, there was a trend in favor of ondansetron plus dexamethasone in the control of nausea. There was no statistically significant difference between ondansetron plus dexamethasone versus ondansetron alone in protecting patients from emesis between days 2 and 5 of the first course of chemotherapy (66.7% vs 62.7%, P = 0.68). This was probably due to the small sample size. Ondansetron was well tolerated, with 15 patients (15%) reporting adverse events such as headache or constipation. CONCLUSIONS It appears that ondansetron given intravenously in combination with dexamethasone is more effective than ondansetron alone in the control of acute emesis in patients undergoing their first course of chemotherapy with high-dose epirubicin. No difference between the regimens was found with regard to nausea and delayed emesis control.
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Affiliation(s)
- J Janinis
- Agii Anargiri Cancer Hospital, Kifissia, Athens, Greece.
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Pavlidis N, Nicolaides C, Bairaktari E, Kalef-Ezra J, Athanassiadis A, Seferiadis C, Fountzilas G. Soluble Interleukin-2 Receptors in Patients with Advanced Colorectal Carcinoma. Int J Biol Markers 2018; 11:6-11. [PMID: 8740635 DOI: 10.1177/172460089601100102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/15/2022]
Abstract
The levels of soluble interleukin-2 receptors (sIL-2R) were measured in the serum of 52 patients with advanced colorectal carcinoma and compared to CEA and CA 19-9 levels. Twenty-five normal, age and sex-matched individuals served as controls. Seventy-five per cent of the patients had increased mean serum levels of sIL-2R (1539 ± 155 U/ml), while normal controls had mean levels of 555 ± 31 U/ml (p < 0.001). The relationship with hepatic or lymph nodal metastases showed no statistically significant difference (p=0.34 and p=0.47, respectively). Serum sIL-2R levels showed a linear correlation with CEA (p < 0.05). Patients with lower pretreatment sIL-2R levels (less than 1.200 U/ml) had a longer survival than patients with higher initial levels (more than 1.200 U/ml) (p=0.0049). In conclusion, the present work shows that the serum levels of sIL-2R: a) are elevated in patients with advanced colorectal cancer, b) have no relationship with the type of metastases, c) correlate with serum CEA and d) have a prognostic value for survival.
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Affiliation(s)
- N Pavlidis
- Department of Medicine, University of loannina, Greece
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Dittrich C, Kosty M, Jezdic S, Pyle D, Berardi R, Bergh J, El Saghir N, Lotz JP, Österlund P, Pavlidis N, Purkalne G. ESMO/ASCO recommendations for a Global Curriculum (GC) in medical oncology-edition 2016. Ann Oncol 2016; 27:1378-81. [PMID: 27457308 PMCID: PMC4959930 DOI: 10.1093/annonc/mdw239] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Dittrich
- Centre for Oncology and Haematology, Kaiser Franz Josef-Spital, Vienna Applied Cancer Research-Institution for Translational Research, Vienna, Austria
| | - M Kosty
- Scripps Clinic, La Jolla, USA
| | - S Jezdic
- European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - D Pyle
- American Society of Clinical Oncology (ASCO), Alexandria, USA
| | - R Berardi
- Clinica di Oncologia Medica, A.O.U Ospedali Riuniti Università Politecnica delle Marche, Ancona, Italy
| | - J Bergh
- Department of Oncology-Pathology, Radiumhemmet, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - N El Saghir
- Department of Internal Medicine, NK Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - J-P Lotz
- Department of Medical Oncology, APHP, Tenon Hospital, IUC-UPMC, Sorbonne University, Paris, France
| | - P Österlund
- Department of Oncology, HUCH Helsinki University Central Hospital, Helsinki, Finland
| | - N Pavlidis
- Department of Medical Oncology, University of Ioannina, Ioannina, Greece
| | - G Purkalne
- Clinic of Oncology, Pauls Stradins Clinical University Hospital, Riga, Latvia
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Pentheroudakis G, Cardoso F, Arnold D, Sessa C, Peters S, Horwich A, Pavlidis N, Stahel R, Cervantes A. The ESMO guideline strategy: an identity statement and reflections on improvement. Ann Oncol 2015; 26 Suppl 5:v1-7. [PMID: 26314771 DOI: 10.1093/annonc/mdv299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Guidelines should provide recommendations on the optimal management of a patient in specific clinical circumstances based on the scientific evidence. ESMO, as Europe's leading society in medical oncology produces a range of guideline products in order to assist the cancer specialist towards implementation of quality cancer care, as well as in order to provide information to patients establishing standards for up-to-date optimal management. The ESMO 'guideline products' include the Clinical Practice Guidelines, the complementing Consensus Conferences on focused clinical scenarios, as well as memory tools such as print and e-Pocket Guidelines and Patient Guides. In this manuscript, methodology, design and characteristics of the ESMO guideline products are explained and discussed by their strengths and weaknesses, opportunities and threats in order to stimulate reflections on room for improvement and future strategy.
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Fizazi K, Greco FA, Pavlidis N, Daugaard G, Oien K, Pentheroudakis G. Cancers of unknown primary site: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 26 Suppl 5:v133-8. [PMID: 26314775 DOI: 10.1093/annonc/mdv305] [Citation(s) in RCA: 194] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Affiliation(s)
- K Fizazi
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Sud, Villejuif, France
| | - F A Greco
- Tennessee Oncology, Centennial Medical Center, Nashville, USA
| | - N Pavlidis
- Department of Medical Oncology, University of Ioannina, Ioannina, Greece
| | - G Daugaard
- Department of Oncology 5073, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - K Oien
- University of Glasgow, Institute of Cancer Sciences, Glasgow, UK
| | - G Pentheroudakis
- Department of Medical Oncology, University of Ioannina, Ioannina, Greece
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Kotteas EA, Pavlidis N. Neuroendocrine Merkel cell nodal carcinoma of unknown primary site: management and outcomes of a rare entity. Crit Rev Oncol Hematol 2014; 94:116-21. [PMID: 25573607 DOI: 10.1016/j.critrevonc.2014.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 11/24/2014] [Accepted: 12/10/2014] [Indexed: 11/17/2022] Open
Abstract
Merkel cell nodal carcinoma of unknown primary (MCCUP) is a rare neuroendocrine tumour with distinct clinical and biological behaviour. We conducted a review of retrospective data extracted from 90 patients focusing on the management and outcome of this disease. We also compared life expectancy of these patients with the outcome of patients with known Merkel primaries and with neuroendocrine cancers of unidentifiable primary. There is a limited body of data for this type of malignancy, however, patients with Merkel cell nodal carcinoma of unknown primary site, seem to have better survival when treated aggressively than patients with cutaneous Merkel tumours of the same stage and equal survival with patients with low-grade neuroendocrine tumour of unknown origin. The lack of prospective trials, and the inadequate data, hamper the management of these tumours. Establishment of treatment guidelines is urgently needed.
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Affiliation(s)
- E A Kotteas
- Department of Medical Oncology, School of Medicine, University of Ioannina, 45 500 Niarchos Avenue, Greece
| | - N Pavlidis
- Department of Medical Oncology, School of Medicine, University of Ioannina, 45 500 Niarchos Avenue, Greece.
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Pentheroudakis G, Fotopoulos G, Gousia A, Bobos M, Chrysafi S, Fountzilas G, Pavlidis N. Activation Status and Prognostic Significance of the Wnt/B Catenin and Hedgehog/Smoothened Signalling Pathways in Patients with Cancer of Unknown Primary (Cup): a Translational Research Study of the Hellenic Cooperative Oncology Group (Hecog). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu345.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pentheroudakis G, Kotteas EA, Kotoula V, Papadopoulou K, Charalambous E, Cervantes A, Ciuleanu T, Fountzilas G, Pavlidis N. Mutational profiling of the RAS, PI3K, MET and b-catenin pathways in cancer of unknown primary: a retrospective study of the Hellenic Cooperative Oncology Group. Clin Exp Metastasis 2014; 31:761-9. [PMID: 24997156 DOI: 10.1007/s10585-014-9666-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 06/24/2014] [Indexed: 12/25/2022]
Abstract
Cancer of unknown primary origin (CUP) had a poor prognosis, determined by clinico-histological characteristics, partly due to the lack of insights on its biology. We screened tumour DNA from 87 patients with CUP for CTNNB1 (coding exons 2,3,4,5), MET (coding exon 18), PIK3CA (coding exons 9,20), KRAS (coding exons 1,2), BRAF (coding exon 15) gene mutations by using dd-sequencing and evaluated their impact on prognosis. Mutated gene incidences in the 87 CUP cases were: KRAS 11 (12.6 %), BRAF 5 (5.7 %), PIK3CA 8 (9 %), MET 6 (6.7 %) and CTNNB1 18 (20.7 %). Several mutations in the KRAS gene were not the commonly encountered mutations in other solid tumours. Activating mutations were observed in 10.2 % in KRAS, 4.5 % in BRAF, 6.6 % in PIK3CA, 4.5 % in MET, and 19.5 % in CTNNB1. Activating mutations in PIK3CA coding exon 9 were inversely correlated with MET coding exon 18 activating mutations (p = 0.036). MET activating mutations were prognostic for poor Progression-Free Survival (median PFS 5 vs 9 months, p = 0.009) and Overall Survival (median OS 7 vs 20 months, p = 0.005). The complex profile of either CTNNB1 or MET mutations also had an adverse prognostic significance (median OS 11 vs 21 months, p = 0.015). No other gene mutation exhibited prognostic significance. In multivariate analysis, poor performance status, male gender, visceral disease and adenocarcinoma histology, but not gene mutations, were independently associated with poor patient outcome. CTNNB1 gene mutations are frequent, and along with MET mutations have an adverse prognostic effect in patients with CUP.
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Affiliation(s)
- G Pentheroudakis
- Department of Medical Oncology, School of Medicine, University of Ioannina, Ioannina, Greece,
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Negru S, Papadopoulou E, Apessos A, Stanculeanu DL, Ciuleanu E, Volovat C, Croitoru A, Kakolyris S, Aravantinos G, Ziras N, Athanasiadis E, Touroutoglou N, Pavlidis N, Kalofonos HP, Nasioulas G. KRAS, NRAS and BRAF mutations in Greek and Romanian patients with colorectal cancer: a cohort study. BMJ Open 2014; 4:e004652. [PMID: 24859998 PMCID: PMC4039802 DOI: 10.1136/bmjopen-2013-004652] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Treatment decision-making in colorectal cancer is often guided by tumour tissue molecular analysis. The aim of this study was the development and validation of a high-resolution melting (HRM) method for the detection of KRAS, NRAS and BRAF mutations in Greek and Romanian patients with colorectal cancer and determination of the frequency of these mutations in the respective populations. SETTING Diagnostic molecular laboratory located in Athens, Greece. PARTICIPANTS 2425 patients with colorectal cancer participated in the study. PRIMARY AND SECONDARY OUTCOME MEASURES 2071 patients with colorectal cancer (1699 of Greek and 372 of Romanian origin) were analysed for KRAS exon 2 mutations. In addition, 354 tumours from consecutive patients (196 Greek and 161 Romanian) were subjected to full KRAS (exons 2, 3 and 4), NRAS (exons 2, 3 and 4) and BRAF (exon 15) analysis. KRAS, NRAS and BRAF mutation detection was performed by a newly designed HRM analysis protocol, followed by Sanger sequencing. RESULTS KRAS exon 2 mutations (codons 12/13) were detected in 702 of the 1699 Greek patients with colorectal carcinoma analysed (41.3%) and in 39.2% (146/372) of the Romanian patients. Among the 354 patients who were subjected to full KRAS, NRAS and BRAF analysis, 40.96% had KRAS exon 2 mutations (codons 12/13). Among the KRAS exon 2 wild-type patients 15.31% harboured additional RAS mutations and 12.44% BRAF mutations. The newly designed HRM method used showed a higher sensitivity compared with the sequencing method. CONCLUSIONS The HRM method developed was shown to be a reliable method for KRAS, NRAS and BRAF mutation detection. Furthermore, no difference in the mutation frequency of KRAS, NRAS and BRAF was observed between Greek and Romanian patients with colorectal cancer.
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Affiliation(s)
- Serban Negru
- University of Medicine and Pharmacy of Timisoara, Timisoara, Romania
| | | | - Angela Apessos
- Department of Molecular Biology, GENEKOR, Athens, Greece
| | | | | | | | - Adina Croitoru
- Department of Medical Oncology, Fundeni Clinical Institute Bucharest, Bucharest, Romania
| | - Stylianos Kakolyris
- Department of Medical Oncology, University General Hospital of Alexandroupolis, Thrace, Greece
| | - Gerasimos Aravantinos
- Second Department of Medical Oncology, “Agii Anargiri” Cancer Hospital, Athens, Greece
| | - Nikolaos Ziras
- First Department of Medical Oncology, ‘METAXA’ Anticancer Hospital of Athens, Athens, Greece
| | | | | | - Nikolaos Pavlidis
- Department of Medical Oncology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Haralabos P Kalofonos
- Clinical Oncology Laboratory, Division of Oncology, Department of Medicine, University of Patras, Patras Medical School, Rio, Greece
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Popescu R, Schäfer R, Califano R, Eckert R, Coleman R, Douillard JY, Cervantes A, Casali P, Sessa C, Van Cutsem E, de Vries E, Pavlidis N, Fumasoli K, Wörmann B, Samonigg H, Cascinu S, Cruz Hernández J, Howard A, Ciardiello F, Stahel R, Piccart M. The current and future role of the medical oncologist in the professional care for cancer patients: a position paper by the European Society for Medical Oncology (ESMO). Ann Oncol 2014; 25:9-15. [DOI: 10.1093/annonc/mdt522] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Boussios S, Han S, Fruscio R, Halaska M, Ottevanger P, Peccatori F, Koubková L, Pavlidis N, Amant F. Lung cancer in pregnancy: Report of nine cases from an international collaborative study. Lung Cancer 2013; 82:499-505. [DOI: 10.1016/j.lungcan.2013.09.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 08/28/2013] [Accepted: 09/04/2013] [Indexed: 11/16/2022]
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Stoyianni A, Pentheroudakis G, Benjamin H, Cervantes A, Ashkenazi K, Lazaridis G, Pavlidis N, Spector Y. Insights into the epithelial mesenchymal transition phenotype in cancer of unknown primary from a global microRNA profiling study. Clin Transl Oncol 2013; 16:725-31. [PMID: 24282096 DOI: 10.1007/s12094-013-1139-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 11/14/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE We sought to study the microRNA regulation of epithelial mesenchymal transition (EMT), the acquisition of migratory, mesenchymal-like properties of epithelial cells, in cancer of unknown primary (CUP). PATIENTS AND METHODS We studied the global expression profile of 982 microRNAs by means of microarray technology in 68 CUP cases immunohistochemically characterised as EMT-positive (n = 5 by % of cells or n = 10 by a semiquantitative H-score) or EMT-negative. RESULTS EMT-suppressive miRNAs such as miR-203 and members of the miR-200 family (miR-200a,b,c and miR-141) presented a 2.45 to 3.64-fold lower expression level in the EMT-positive cases without, however, reaching statistical significance. MiR-205, a squamous tissue-specific marker, was very variable in the data set. Excluding CUP cases with squamous cell histology, miR-205, miR-203 and the miR-200 family exhibited a trend of downregulation in EMT-positive cases. A similar pattern of miRNA expression was detected when the comparison took place between EMT-positive vs EMT-negative cases according to the H-score. Moreover, miR-203, miR-205 and miR-200c were numerically downregulated in those tumours with high expression of the EMT marker N-cadherin. CONCLUSIONS The EMT-suppressive miR-203 and miR-200 family were consistently but non-significantly downregulated in CUP with the EMT phenotype. A larger study is warranted to further explore the role of microRNAs in CUP.
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Affiliation(s)
- A Stoyianni
- Department of Medical Oncology, Medical School, University of Ioannina, Niarxou Avenue, 45500, Ioannina, Greece
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Boussios S, Pavlidis N. Renal cell carcinoma in pregnancy: a rare coexistence. Clin Transl Oncol 2013; 16:122-7. [DOI: 10.1007/s12094-013-1105-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 08/13/2013] [Indexed: 11/29/2022]
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Peccatori FA, Azim HA, Orecchia R, Hoekstra HJ, Pavlidis N, Kesic V, Pentheroudakis G. Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24 Suppl 6:vi160-70. [PMID: 23813932 DOI: 10.1093/annonc/mdt199] [Citation(s) in RCA: 461] [Impact Index Per Article: 41.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- F A Peccatori
- Fertility and Procreation Unit, Division of Gynaecologic Oncology, European Institute of Oncology, Milan, Italy
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Abstract
Cancer of unknown primary sites (CUP) is a compilation of various malignant entities--the majority of which behave aggressively and carry poor prognosis. CUP is classified into two different clinicopathological groups: the unfavourable (poor-prognosis) and the favourable (good-prognosis) group. Patients with favourable subsets are treated relevant to the hidden primary tumour chemotherapy regimens and/or radiotherapy. These patients exhibit better responses and prolonged survival. On the other hand, patients of unfavourable subsets are treated with various chemotherapy combinations of platinum- or taxane-containing regimens. Unfortunately, responses and overall survival in this group of CUP patient are not very promising. Several independent prognostic factors have been associated with survival of CUP patients. Since CUP is not an unknown disease, emerging therapeutic innovations are warranted.
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Affiliation(s)
- N Pavlidis
- Department of Medical Oncology, School of Medicine, University of Ioannina, Ioannina, Greece.
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Pavlidis N, Stahel R, Pentheroudakis G, Cervantes A. ESMO Consensus Conferences: another source of ESMO Clinical Practice Guidelines. Ann Oncol 2012; 23 Suppl 7:vii7-10. [PMID: 22997457 DOI: 10.1093/annonc/mds222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Nikitas N, Karadimou A, Tsitoura E, Soupos N, Tsiatas M, Karavasilis V, Pectasides D, Pavlidis N, Chrisofos M, Adamakis I, Murray S, Fountzilas G, Dimopoulos MA, Bamias A. Association of ERCC1 SNPs with outcome in platinum-treated patients with advanced urothelial cancer: a Hellenic Cooperative Oncology Group study. Pharmacogenomics 2012; 13:1595-607. [DOI: 10.2217/pgs.12.162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Aim: The association between two polymorphisms of ERCC1 and treatment outcomes after platinum-based chemotherapy in patients with advanced urothelial cancer (UC) was examined. Materials & methods: Genotyping of 19007C>T and 8092C>A polymorphisms was determined by PCR amplification and RFLP in 113 advanced UC patients, treated with platinum-based chemotherapy. Results: Seventy eight patients (69%) were carriers of the 19007T polymorphic allele: 51 (45%) heterozygotes and 27 (24%) homozygotes. Fifty three (47%) patients were carriers of the 8092A polymorphic allele: the frequencies of C/A and A/A genotypes were 37% and 10%, respectively. The T/T genotype was independently associated with prolonged median cancer-specific survival (not-reached vs 14.8 months; p = 0.026). There was no interaction between T/T or any other genotype with the type of platinum derivative (cisplatin/carboplatin). Conclusion: 19007C>T, especially in its homozygotic state, but not 8092C>A polymorphism, could be a useful prognostic marker in advanced UC treated with platinum-based chemotherapy. Original submitted 17 July 2012; Revision submitted 21 September 2012
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Affiliation(s)
- Nikitas Nikitas
- Department of Clinical Therapeutics, University of Athens Medical School, Oncology Unit, Alexandra Hospital, 80 Vas. Sofias Avenue, 115 28 Athens, Greece
| | - Alexandra Karadimou
- Department of Clinical Therapeutics, University of Athens Medical School, Oncology Unit, Alexandra Hospital, 80 Vas. Sofias Avenue, 115 28 Athens, Greece
| | - Eliza Tsitoura
- Molecular Virology Laboratory, Hellenic Pasteur Institute, Athens, Greece
| | - Nikolaos Soupos
- Department of Clinical Therapeutics, University of Athens Medical School, Oncology Unit, Alexandra Hospital, 80 Vas. Sofias Avenue, 115 28 Athens, Greece
| | - Marinos Tsiatas
- Department of Clinical Therapeutics, University of Athens Medical School, Oncology Unit, Alexandra Hospital, 80 Vas. Sofias Avenue, 115 28 Athens, Greece
| | - Vasilios Karavasilis
- Department of Medical Oncology, Aristotle University of Thessaloniki Medical School, Papageorgiou Hospital, Thessaloniki, Greece
| | | | - Nikolaos Pavlidis
- Department of Medical Oncology, University of Ioannina Medical School, Ioannina, Greece
| | | | - Ioannis Adamakis
- Department of Urology, University of Athens Medical School, Laikon Hospital, Athens, Greece
| | - Samuel Murray
- BioMarker Solutions, Department of Oncology, London, UK
| | - Georgios Fountzilas
- Department of Medical Oncology, Aristotle University of Thessaloniki Medical School
| | - Meleios-Athanasios Dimopoulos
- Department of Clinical Therapeutics, University of Athens Medical School, Oncology Unit, Alexandra Hospital, 80 Vas. Sofias Avenue, 115 28 Athens, Greece
| | - Aristotle Bamias
- Department of Clinical Therapeutics, University of Athens Medical School, Oncology Unit, Alexandra Hospital, 80 Vas. Sofias Avenue, 115 28 Athens, Greece
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Pliarchopoulou K, Kalogeras KT, Kronenwett R, Wirtz RM, Eleftheraki AG, Batistatou A, Bobos M, Soupos N, Polychronidou G, Gogas H, Samantas E, Christodoulou C, Makatsoris T, Pavlidis N, Pectasides D, Fountzilas G. Prognostic significance of RACGAP1 mRNA expression in high-risk early breast cancer: a study in primary tumors of breast cancer patients participating in a randomized Hellenic Cooperative Oncology Group trial. Cancer Chemother Pharmacol 2012; 71:245-55. [PMID: 23096218 DOI: 10.1007/s00280-012-2002-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 10/10/2012] [Indexed: 12/25/2022]
Abstract
PURPOSE RACGAP1 is a Rac GTPase-activating protein involved in cell growth regulation, cell transformation and metastasis. The aim of the present study was to explore the prognostic and/or predictive significance of RACGAP1 mRNA expression on disease-free survival (DFS) and overall survival (OS) in high-risk early breast cancer patients and compare it to that of Ki67 protein expression and to the Nottingham prognostic index (NPI). METHODS A total of 595 high-risk breast cancer patients were treated in a two-arm trial evaluating postoperative dose-dense sequential chemotherapy with epirubicin followed by CMF with or without paclitaxel. RNA was extracted from 314 formalin-fixed paraffin-embedded primary tumor tissue samples followed by one-step quantitative RT-PCR for assessing RACGAP1 mRNA expression. RESULTS High RACGAP1 mRNA expression (above the median) was associated with poor DFS (log-rank, p = 0.002) and OS (p < 0.001). High histological grade, as well as high Ki67 protein expression, was more frequent in the high-expression group of RACGAP1. Results of the Cox multivariate regression analysis revealed that high RACGAP1 mRNA expression independently predicted poor overall survival (Wald's p = 0.008). High Ki67 protein expression was also an adverse prognostic factor for death (p = 0.016), while high NPI score values were not. CONCLUSIONS High RACGAP1 mRNA expression, as assessed by qRT-PCR, was found to be of adverse prognostic significance in high-risk early breast cancer patients treated with dose-dense sequential chemotherapy. The utility of RACGAP1 mRNA expression in patient selection for treatment with aggressive chemotherapy regimens should be further explored and validated in larger cohorts.
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Affiliation(s)
- K Pliarchopoulou
- Oncology Section, Second Department of Internal Medicine, Hippokration Hospital, University of Athens School of Medicine, Athens, Greece
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22
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Golfinopoulos V, Pentheroudakis G, Goussia A, Siozopoulou V, Bobos M, Krikelis D, Cervantes A, Ciuleanu T, Marselos M, Fountzilas G, Malamou-Mitsi V, Pavlidis N. Intracellular signalling via the AKT axis and downstream effectors is active and prognostically significant in cancer of unknown primary (CUP): a study of 100 CUP cases. Ann Oncol 2012; 23:2725-2730. [DOI: 10.1093/annonc/mds097] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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23
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Pavlidis N. 203. Treatment of metastases with unknown primary – A medical oncologist view. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.06.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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24
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Fountzilas G, Gogas H, Pavlidis N, Eleftheraki A, Skarlos D, Koutras A, Timotheadou E, Papandreou C, Pectasides D, Dimopoulos M. Dose-Dense Sequential Adjuvant Chemotherapy With Epirubicin, Paclitaxel and CMF Versus Epirubicin, Cmf and Weekly Docetaxel or Paclitaxel Followed by Trastuzumab for One Year in Patients With Early Breast Cancer. Ann Oncol 2012. [DOI: 10.1093/annonc/mds392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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25
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Pentheroudakis G, Nicolaou I, Kotoula V, Fountzilas E, Markou K, Eleftheraki AG, Fragkoulidi A, Karasmanis I, Tsigka A, Angouridakis N, Vlachtsis K, Nikolaou A, Pavlidis N, Fountzilas G. Prognostic utility of angiogenesis and hypoxia effectors in patients with operable squamous cell cancer of the larynx. Oral Oncol 2012; 48:709-16. [PMID: 22366437 DOI: 10.1016/j.oraloncology.2012.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 01/29/2012] [Accepted: 02/01/2012] [Indexed: 10/28/2022]
Abstract
Angiogenesis is active in localised laryngeal squamous cell carcinoma. We assessed relative messenger RNA (mRNA) and immunohistochemical (IHC) expression of Vascular Endothelial Growth Factors (VEGF) A, B, C, their receptors VEGFR1, 2, 3, Neuropilins 1, 2 (NRP1, 2) and Hypoxia-Inducible Factor 1A (HIF1A) in paraffin-embedded localised laryngeal carcinomas. In 289 patients with T3-4 (77.8%), node-negative (84.1%) tumours of the larynx, high VEGFA and VEGFR1 mRNA correlated with advanced T stage, while low VEGFB and VEGFC mRNA with alcohol abuse and supraglottic primary, respectively (p<0.05). Age <55 was associated with high IHC expression of VEGFA, C and poor tumour differentiation with high IHC VEGFA. At a median follow-up of 74.5months, patients with VEGFR1-high tumours had significantly poorer disease-free survival (Hazard Ratio [HR] 1.93, p=0.008) and shorter overall survival (OS, HR 1.71, p=0.041). An association with dismal OS was seen for high VEGFR3 tumoural mRNA expression (HR 1.76, p=0.02). IHC expression of VEGF family proteins in the tumour was not prognostic and had poor concordance with mRNA expression (kappa<0.1, p=NS). In multivariate analysis, node-positive status, non-supraglottic localization, high VEGFR1 mRNA and high IHC VEGFA expression were significantly associated with relapse, while node-positive status, high VEGFR1 and VEGFC mRNA expression in the tumour with risk of death. In laryngeal cancer, upregulated mRNA expression of VEGFR1 and VEGFC is associated with poor patient outcome.
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Affiliation(s)
- G Pentheroudakis
- Department of Medical Oncology, Ioannina University Hospital, Ioannina, Greece.
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Azim HA, Santoro L, Russell-Edu W, Pentheroudakis G, Pavlidis N, Peccatori FA. P4-11-03: Prognosis of Pregnancy-Associated Breast Cancer: A Meta-Analysis Involving 39,415 Patients. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-11-03] [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
Pregnancy-associated breast cancer (PABC), defined as breast cancer diagnosed during pregnancy or one year after is a relatively rare disease and hence considerable controversy exists regarding its prognosis compared to non-pregnancy-related breast cancer.
Methods: Two of the authors independently performed a literature search on MEDLINE and Cochrane Library with no date or language restrictions. Eligible studies were control-matched, population-based and hospital-based studies that have addressed the outcome of patients diagnosed during pregnancy or one-year afterwards. The control group was defined as patients diagnosed with breast cancer not related to pregnancy. The primary and secondary end-points were overall and disease-free survival respectively. Pooling of data was done using the random effect model. To control for potential differences between the two groups in systemic treatment and clinico-pathological features (e.g. tumor size, nodal status, ER, etc …) that could affect prognosis, we performed a sensitivity analysis by pooling the hazard ratios (HRs) of the adjusted multivariate models within each study. We also analyzed differences according to time of diagnosis (during pregnancy or post-partum), type of study and year of reporting the study. Finally, we communicated with the authors of the eligible studies to collect unpublished statistics relevant to our analysis to further refine our findings.
Results: 29 studies were included in this meta-analysis (2903 cases and 36, 512 controls). Women diagnosed with PABC had a significantly higher risk of death compared to those diagnosed with non-pregnancy-related breast cancer (pooled hazard ratio (pHR): 1.47 [95% CI: 1.30−1.65]). A sensitivity analysis including 11 studies (1222 PABC cases, 19231 controls) adjusted for differences in tumor size, nodal status and systemic treatment showed the same result (pHR: 1.44 [95% CI: 1.17−1.77]). These findings were consistent in patients diagnosed either during pregnancy (pHR: 1.30 [95% CI: 1.01−1.67]) or in the post-partum period (pHR: 1.56 [95% CI: 1.08−2.26]) with no heterogeneity observed (p=0.43). Sensitivity analyses according to the type and year of study showed the same findings. Regarding the secondary end-point, only ten studies (531 cases, 1842 controls) provided sufficient information to estimate disease-free survival, and indeed PABC patients had a higher risk of relapse compared to breast cancer controls [pHR: 1.59 (95%CI: 1.23−2.07)]. Collection of unpublished data is currently ongoing and further analyses will be presented at the meeting.
Conclusion: To the best of our knowledge, this is the largest analysis addressing the prognosis of PABC. Our results confirm that PABC is independently associated with a worse prognosis whether diagnosis is made during pregnancy or in the post-partum period. This underscores the possible impact of pregnancy on breast cancer biology. In this regard, we are currently interrogating potential biological differences between PABC patients and matched breast cancer controls at the gene expression level to elucidate the biology of this relatively rare, yet very challenging disease.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-11-03.
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Affiliation(s)
- HA Azim
- 1Institut Jules Bordet, Brussels, Belgium; European Institute of Oncology, Milan, Italy; University of Ioannina, Ioannina, Greece
| | - L Santoro
- 1Institut Jules Bordet, Brussels, Belgium; European Institute of Oncology, Milan, Italy; University of Ioannina, Ioannina, Greece
| | - W Russell-Edu
- 1Institut Jules Bordet, Brussels, Belgium; European Institute of Oncology, Milan, Italy; University of Ioannina, Ioannina, Greece
| | - G Pentheroudakis
- 1Institut Jules Bordet, Brussels, Belgium; European Institute of Oncology, Milan, Italy; University of Ioannina, Ioannina, Greece
| | - N Pavlidis
- 1Institut Jules Bordet, Brussels, Belgium; European Institute of Oncology, Milan, Italy; University of Ioannina, Ioannina, Greece
| | - FA Peccatori
- 1Institut Jules Bordet, Brussels, Belgium; European Institute of Oncology, Milan, Italy; University of Ioannina, Ioannina, Greece
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Pavlidis N, Stahel R, Hansen H, Cervantes A. Fourteen years of evolution of ESMO Guidelines: from the minimum recommendations to the Consensus Conference-derived guidelines. Ann Oncol 2011; 22 Suppl 6:vi7-11. [PMID: 21908509 DOI: 10.1093/annonc/mdr370] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fizazi K, Greco FA, Pavlidis N, Pentheroudakis G. Cancers of unknown primary site: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2011; 22 Suppl 6:vi64-8. [PMID: 21908507 DOI: 10.1093/annonc/mdr389] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- K Fizazi
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris, Villejuif, France
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Psyrri A, Kalogeras KT, Kronenwett R, Wirtz RM, Batistatou A, Bournakis E, Timotheadou E, Gogas H, Aravantinos G, Christodoulou C, Makatsoris T, Linardou H, Pectasides D, Pavlidis N, Economopoulos T, Fountzilas G. Prognostic significance of UBE2C mRNA expression in high-risk early breast cancer. A Hellenic Cooperative Oncology Group (HeCOG) Study. Ann Oncol 2011; 23:1422-7. [PMID: 22056852 DOI: 10.1093/annonc/mdr527] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The ubiquitin-proteasome system (UPS) plays a pivotal role in tumorigenesis. Components of the UPS have recently been implicated in breast cancer progression. In the present study, we sought to explore the prognostic and/or predictive significance of UBE2C messenger RNA (mRNA) expression on disease-free survival (DFS) and overall survival (OS) in high-risk operable breast cancer patients. METHODS Five hundred and ninety-five high-risk breast cancer patients were treated in a two-arm trial evaluating postoperative, dose-dense sequential chemotherapy with epirubicin followed by CMF (cyclophosphamide, methotrexate and 5-fluorouracil) with or without paclitaxel (Taxol). RNA was extracted from 313 formalin-fixed primary tumor tissue samples followed by one-step quantitative RT-PCR for assessment of mRNA expression of UBE2C. RESULTS High UBE2C mRNA expression was associated with poor DFS (Wald's P = 0.003) and OS (Wald's P = 0.005). High tumor grade, as well as high Ki67 protein expression, was more frequent in the high-expression group of UBE2C. Results of the Cox multivariate regression analysis revealed that high UBE2C mRNA expression remained an independent adverse prognostic factor for relapse (P = 0.037) and death (P = 0.05). CONCLUSIONS High UBE2C mRNA expression was found to be of adverse prognostic significance in high-risk breast cancer patients. These findings need to be validated in larger cohorts.
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Affiliation(s)
- A Psyrri
- Second Department of Internal Medicine, Attikon University Hospital, Athens.
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Abstract
Cancer of unknown primary (CUP) is a common, well-recognized and heterogeneous clinical syndrome. Patients with CUP present with metastatic disease in the absence of an identifiable primary tumour despite a diagnostic work-up. Aetiologically, CUP might either harbor primaries that cannot be detected by the standardized diagnostic investigations or carry distinct genetic and epigenetic aberrations. In this article we try to clarify the clinical and pathological enigma of CUP by answering 20 important questions related to this entity.
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Affiliation(s)
- N Pavlidis
- Department of Medical Oncology, University of Ioannina, Ioannina, Greece
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Boussios S, Pentheroudakis G, Kamina S, Katsanos K, Pavlidis N. Docetaxel-induced enterocolitis: a serious and potentially fatal adverse event. J BUON 2011; 16:778-779. [PMID: 22331738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Van Cutsem E, Dicato M, Geva R, Arber N, Bang Y, Benson A, Cervantes A, Diaz-Rubio E, Ducreux M, Glynne-Jones R, Grothey A, Haller D, Haustermans K, Kerr D, Nordlinger B, Marshall J, Minsky BD, Kang YK, Labianca R, Lordick F, Ohtsu A, Pavlidis N, Roth A, Rougier P, Schmoll HJ, Sobrero A, Tabernero J, Van de Velde C, Zalcberg J. The diagnosis and management of gastric cancer: expert discussion and recommendations from the 12th ESMO/World Congress on Gastrointestinal Cancer, Barcelona, 2010. Ann Oncol 2011; 22 Suppl 5:v1-9. [PMID: 21633049 DOI: 10.1093/annonc/mdr284] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Well-recognized experts in the field of gastric cancer discussed during the 12th European Society Medical Oncology (ESMO)/World Congress Gastrointestinal Cancer (WCGIC) in Barcelona many important and controversial topics on the diagnosis and management of patients with gastric cancer. This article summarizes the recommendations and expert opinion on gastric cancer. It discusses and reflects on the regional differences in the incidence and care of gastric cancer, the definition of gastro-esophageal junction and its implication for treatment strategies and presents the latest recommendations in the staging and treatment of primary and metastatic gastric cancer. Recognition is given to the need for larger and well-designed clinical trials to answer many open questions.
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Affiliation(s)
- E Van Cutsem
- University Hospital Gasthuisberg, Leuven, Belgium.
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Skarlos P, Christodoulou C, Kalogeras KT, Eleftheraki AG, Bobos M, Batistatou A, Valavanis C, Tzaida O, Timotheadou E, Kronenwett R, Wirtz RM, Kostopoulos I, Televantou D, Koutselini E, Papaspirou I, Papadimitriou CA, Pectasides D, Gogas H, Aravantinos G, Pavlidis N, Arapantoni P, Skarlos DV, Fountzilas G. Triple-negative phenotype is of adverse prognostic value in patients treated with dose-dense sequential adjuvant chemotherapy: a translational research analysis in the context of a Hellenic Cooperative Oncology Group (HeCOG) randomized phase III trial. Cancer Chemother Pharmacol 2011; 69:533-46. [DOI: 10.1007/s00280-011-1730-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 08/18/2011] [Indexed: 12/22/2022]
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Stovianni A, Goussia A, Pentheroudakis G, Siozopoulou V, Cervantes A, Bobos M, Fountzilas G, Malamou-Mitsi V, Pavlidis N. 1132 POSTER Epithelial-Mesenchymal Transition in Cancer of Unknown Primary. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)70775-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Pentheroudakis G, Petrakis D, Goussia A, Siozopoulou V, Bobos M, Fountzilas G, Cervantes A, Malamou-Mitsi V, Ciuleanu T, Pavlidis N. 1450 POSTER Immunohistochemical Profiling of Signalling Pathways in Cancer of Unknown Primary (CUP). Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)70943-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Petrakis D, Voulgaris E, Pentheroudakis G, Pavlidis N. 9437 POSTER Prognostic Factors in Patients With Cancer of Unknown Primary (CUP). Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72581-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Voulgaris E, Pentheroudakis G, Pavlidis N. Cancer and pregnancy: a comprehensive review. Surg Oncol 2011; 20:e175-85. [PMID: 21733678 DOI: 10.1016/j.suronc.2011.06.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 05/31/2011] [Accepted: 06/14/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pregnancy complicated by cancer is relatively rare but, as women in western societies tend to delay childbearing to the third and fourth decade of life, this phenomenon is going to be encountered more often in the future. MATERIAL AND METHODS Review of the literature and description of the different diagnostic and therapeutic approaches which are required to diagnose and treat pregnant mothers with cancer. RESULTS As in non-pregnant patients, every effort should be made to provide the maximal benefit and best prognosis to the pregnant patient. In most cases, in order to avoid any harm to the fetus, different diagnostic approach should be incorporated and treatment should be tailored to each pregnant woman. Cooperation of multidisciplinary teams, incorporating medical and radiation oncologists, surgeons, obstetricians, neonatologists and experienced nursing staff, is required to provide optimal care for the patient. The benefits from use of surgery, chemotherapy and/or radiotherapy as well as the mother's wishes and beliefs need to be factored into recommendations and treatment planning. CONCLUSIONS With the experience gained, the developments in clinical and radiation oncology and the cooperation of multidisciplinary teams, treatment of cancer during pregnancy with normal fetal outcome is feasible.
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Affiliation(s)
- E Voulgaris
- Department of Medical Oncology, University Hospital of Ioannina, Ioannina, Greece
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Voulgaris E, Pentheroudakis G, Pappa L, Bafa M, Goussia A, Dalezis P, Tsombanidou C, Geromichalos G, Papageorgiou A, Koutsilieris M, Malamou-Mitsi V, Pavlidis N. Positive urinary cytology in patients with lung cancer in the absence of obvious urine tract metastases. Lung Cancer 2011; 73:51-8. [DOI: 10.1016/j.lungcan.2010.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 10/10/2010] [Accepted: 10/24/2010] [Indexed: 11/28/2022]
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Skarlos P, Papadimitriou CA, Eleftheraki AG, Papaspirou I, Arapantoni P, Batistatou A, Pectasides DG, Rallis G, Gogas H, Markopoulos C, Pavlidis N, Koutselini H, Dionysopoulos D, Bafaloukos D, Aravantinos G, Razis E, Kalogeras KT, Skarlos DV, Fountzilas G. Prognostic value of immunophenotypic classification of breast cancer in high-risk patients treated with dose-dense sequential adjuvant chemotherapy. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e21110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kostadima L, Pentheroudakis G, Pavlidis N. Recurrent episodes of recall dermatitis of irradiated breast after LHRH agonist administration. J BUON 2011; 16:183-184. [PMID: 21674876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Kotoula V, Bobos M, Kalogeras KT, Timotheadou E, Skarlos DV, Pavlidis N, Koutras AK, Vlachodimitropoulos D, Pectasides D, Fountzilas G. Abstract P2-09-15: TOP2A and DARPP32 Are Associated with Response to Trastuzumab-Based Treatment of HER2-Positive Advanced Breast Cancer (ABC). Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p2-09-15] [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: HER2 status (gene amplification, protein overexpression) is the hallmark for the selection of patients who will benefit from trastuzumab-based treatment. Except for HER2, however, the status of additional genes located at chromosome 17q seems to have an impact on disease biology and patients’ outcome. In this retrospective study, we investigated the impact of TOP2A (chr 17q21-q22, telomerically to ERBB2) and PPP1R1B (DARPP32, chr 17q12, centromerically to ERBB2) status on the outcome of patients with ABC treated with trastuzumab-based regimens. Materials and Methods: In a cohort of 199 patients with ABC treated with 1st or 2nd line trastuzumab-containing regimens, tumor tissues were assessed for HER2 and TOP2A gene amplification (by FISH), HER2, TOP2A and DARPP32 mRNA expression (by RTQ-PCR), and Her2 and TopoIIa protein expression (by IHC). Tumors were HER2 positive (FISH amplified and/or 3+ by IHC) (n= 137) or negative (n=62). Disease outcome was assessed as time to progression (TTP), survival from trastuzumab administration (survivalT) and survival from 1st metastasis (survivalM). Results: In comparison to patients with HER2-negative tumors, those with HER2-positive tumors exhibited a longer TTP (Median [95% CI] = 13.7 [10.7-16.7] vs 9.2 [7.5-10.9], p=0.037) and survivalT (Median [95% CI] = 47.4 [37.9-56.9] vs 34.8 [24.3-45.4], p=0.008), as expected. HER2 positivity was strongly associated with relatively high HER2 mRNA and protein expression (P<0.001 for both) and with TOP2A amplification (P<0.001), but not with relatively high TOP2A mRNA and protein expression. DARPP32 mRNA strongly correlated with HER2 mRNA (P<0.001) and was associated with HER2 and TOP2A gene status (P<0.001), it was not however related to TOP2A mRNA, and TopoIIa and Her2 protein expression. The relative expression of DARPP32 to HER2 mRNA was occasionally very high, with ratios of DARPP32/HER2 >1 equally distributed among HER2-positive and negative tumors. In patients with HER2-positive tumors, TOP2A gene amplification was associated with longer survival, irrespectively of the chemotherapy regimen administered in addition to trastuzumab (survivalT: p=0.004, survivalM: p=0.003). Interestingly, in patients with HER2-negative tumors, DARPP32/HER2 ratios of >1 were associated with a favorable outcome (survivalT: p=0.008 and survivalM: p=0.043). No association with disease outcome was observed for high DARPP32 expression or for DARPP32/HER2 ratios in HER2-positive tumors.
Discussion: This study shows that genes located peripherally to HER2 on the same chromosome arm, such as TOP2A and DARPP32, may be concomitantly altered in the same breast tumor, but may have a different impact on the course of the disease. A favorable outcome may be predicted for HER2-positive tumors with amplified TOP2A and for HER2-negative tumors expressing higher DARPP32 mRNA in comparison to HER2.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-09-15.
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Affiliation(s)
- V Kotoula
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
| | - M Bobos
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
| | - KT Kalogeras
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
| | - E Timotheadou
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
| | - DV Skarlos
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
| | - N Pavlidis
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
| | - AK Koutras
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
| | | | - D Pectasides
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
| | - G. Fountzilas
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
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Pavlidis N, Briasoulis E, Pentheroudakis G. Cancers of unknown primary site: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010; 21 Suppl 5:v228-31. [PMID: 20555087 DOI: 10.1093/annonc/mdq193] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- N Pavlidis
- Department of Medical Oncology, University of Ioannina, Greece
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Pentheroudakis G, Orecchia R, Hoekstra HJ, Pavlidis N. Cancer, fertility and pregnancy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010; 21 Suppl 5:v266-73. [PMID: 20555095 DOI: 10.1093/annonc/mdq198] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- G Pentheroudakis
- Department of Medical Oncology, Ioannina University Hospital, Greece
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Pavlidis N, Vermorken JB, Stahel R, Bernier J, Cervantes A, Pentheroudakis G, Audisio RA, Costa A. Undergraduate training in oncology: an ESO continuing challenge for medical students. Surg Oncol 2010; 21:15-21. [PMID: 20708925 DOI: 10.1016/j.suronc.2010.07.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 07/20/2010] [Accepted: 07/20/2010] [Indexed: 11/25/2022]
Abstract
During the last six years the European School of Oncology (ESO) opened an undergraduate programme for European medical students, aiming to further improve their oncology knowledge and clinical skills. In this endeavour a 5-day course is organized every summer at the University of Ioannina, Greece, where distinguished European oncologists introduce preselected medical students to cancer medicine. The programme includes teaching of several oncological topic regarding diagnosis and treatment of the most common tumours; interactive case presentations and discussions were also incorporated. An overall of 229 medical students, mostly from European medical schools, have been taking part to this intensive summer course, from 2004 to 2009. This article presents the detailed educational programme, the evaluation results and the outcome of the last six ESO courses; an assessment of the oncological curricula available across European faculties is also presented.
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Affiliation(s)
- N Pavlidis
- Department of Medical Oncology, Medical School, University of Ioannina, 451 10 Ioannina, Greece.
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Pavlidis N, Gatzemeier W, Popescu R, Stahel R, Pinedo H, Cavalli F, Costa A. The Masterclass of the European School of Oncology: The ‘key educational event’ of the school. Eur J Cancer 2010; 46:2159-65. [DOI: 10.1016/j.ejca.2010.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Accepted: 06/02/2010] [Indexed: 10/19/2022]
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Pentheroudakis G, Kostadima L, Dova L, Georgiou I, Tzavaras T, Vartholomatos G, Wirtz RM, Fountzilas G, Malamou-Mitsi V, Pavlidis N. A twisted kiss: in vitro and in vivo evidence of genetic variation and suppressed transcription of the metastasis-suppressor gene KiSS1 in early breast cancer. Neoplasma 2010; 57:47-54. [PMID: 19895172 DOI: 10.4149/neo_2010_01_047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
UNLABELLED KiSS-1 is ametastasis suppressor gene, its inactivation linked to advanced tumor stage and dismal prognosis. We studied its mutational status ,transcription and protein expression in human cancer cell lines and patients with early breast cancer.<br />Tumor tissue DNA and messenger RNA (mRNA) of KiSS1 exons III and IV from the human cancer cell lines Hela, Jurkat, A549, W138t, MCF-7 and from formalin-fixed resected breast adenocarcinomas from 50 women were analysed by means of PCR-SSCP, RT-PCR and sequencing. Tumor tissue was stained for KiSS1 protein expression by means of the streptavidin-biotin complex immunoperoxidase assay. Presence of KiSS1 mutation, mRNA levels and protein staining were examined for correlations with patient/tumor characteristics. <br />A transversion in exon IVa replacing cytosine with guanine was identified 242 base pairs from the translation start site (242C>G) in the cell lines MCF-7, A549 and in 5/50 tumors (10%), resulting in substitution of proline by arginine (P81R) and alteration of the protein tertiary structure. As the substitution was present in germ-line DNA in 3/5 breast cancer patients harbouring the polymorphism in their tumor, the incidence of tumour-specific somatic mutation was 4% among the 50 patiens with early breast cancer. Although the P81R substitution was associated with reduced KiSS1 protein immunoreactivity (56% in wild-type tumors versus 20% in KiSS1-variant tumours) and with axillary nodal involvement (55% in wild-type versus 80% in KiSS1-variant tumors), the correlations did not reach statistical significance. KiSS1 mRNA was detected in only 15/48 tumours (31%) and showed no correlation with mutation or protein expression. Twenty-six tumors stained for KiSS1 protein, in contrast to the universal strong staining seen in normal breast parenchyma and placental tissues. At amedian follow-up of 38 months, relapses occurred in 20% of women with non wild-type tumors versus 13% of women with wild-type KiSS1 tumors (p=0.7). Presence of KiSS1 mutation, mRNA levels and protein expression did not have prognostic significance for relapse-free survival.<br />In conclusion, altered nucleotide sequence and repression of transcription are two potential mechanisms of suppression of the anti-metastatic effects of KiSS1 in early breast cancer: Confirmation in larger cohorts and study of functional effects of the 242C>G exon IVa mutation are warranted. KEYWORDS KiSS1, metastasis-suppressor gene, breast cancer, mutation, transcription.
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Affiliation(s)
- G Pentheroudakis
- Department of Medical Oncology, Ioannina University Hospital, Greece
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Van Cutsem E, Dicato M, Arber N, Berlin J, Cervantes A, Ciardiello F, De Gramont A, Diaz-Rubio E, Ducreux M, Geva R, Glimelius B, Jones RG, Grothey A, Gruenberger T, Haller D, Haustermans K, Labianca R, Lenz H, Minsky B, Nordlinger B, Ohtsu A, Pavlidis N, Rougier P, Schmiegel W, Van de Velde C, Schmoll H, Sobrero A, Tabernero J. Molecular markers and biological targeted therapies in metastatic colorectal cancer: expert opinion and recommendations derived from the 11th ESMO/World Congress on Gastrointestinal Cancer, Barcelona, 2009. Ann Oncol 2010; 21 Suppl 6:vi1-10. [DOI: 10.1093/annonc/mdq273] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Kamposioras K, Pentheroudakis G, Pectasides D, Pavlidis N. Malignant melanoma of unknown primary site. To make the long story short. A systematic review of the literature. Crit Rev Oncol Hematol 2010; 78:112-26. [PMID: 20570171 DOI: 10.1016/j.critrevonc.2010.04.007] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 02/27/2010] [Accepted: 04/22/2010] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Although more than 90% of melanomas have a cutaneous origin, occasionally it is discovered as a secondary deposit without evident primary site. The aim of this study was to systematically review published literature and analyse data on incidence, presentation, therapeutic interventions, survival and prognostic factors. METHODS We searched MEDLINE, (search terms Melanom*, unknown origin, unknown primary, indolent, occult) and the abstracts from major congresses of the last 4 years and perused the references of the retrieved relevant articles. RESULTS 4348 patients with MUP were reported along with 132,643 patients with Melanoma of Known Primary (MKP). The incidence of MUP was 3.2%. The male to female ratio was 2:1 while the age peak was in the 4th and 5th decades. MUP patients harbouring nodal disease had a median overall survival ranging between 24 and 127 months, 5-year survival rate between 28.6% and 75.6% and 10-year survival rate between 18.8% and 62.9%. MUP patients with visceral disease had median survival times between 3 and 16 months, and 5-year survival rates between 5.9% and 18%. Presence of tumour regression in metastatic sites and low nodal burden were associated with favourable outcome. Potentially curative surgical treatment offered survival advantage in comparison to patients with residual metastatic foci. MUP patients who received adjuvant chemotherapy or radiotherapy paradoxically seemed to fare worse compared to patients observed. CONCLUSIONS This is the first review to bring together the information of 89 years and to analyze all the potential information accumulated. Although a well know entity no consensus is reached in order to describe MUP presentation, management or prognosis.
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Affiliation(s)
- K Kamposioras
- Panhellenic Association for Continual Medical Research (PACMeR), Greece.
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Pavlidis N, Hansen H, Stahel R. ESMO Clinical Practice Guidelines: development, implementation and dissemination. Ann Oncol 2010; 21 Suppl 5:v7-8. [DOI: 10.1093/annonc/mdq158] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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