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Ruíz-Patiño A, Rojas L, Zuluaga J, Arrieta O, Corrales L, Martín C, Franco S, Raez L, Rolfo C, Sánchez N, Cardona AF. Genomic ancestry and cancer among Latin Americans. Clin Transl Oncol 2024:10.1007/s12094-024-03415-6. [PMID: 38581481 DOI: 10.1007/s12094-024-03415-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 02/20/2024] [Indexed: 04/08/2024]
Abstract
Latin American populations, characterized by intricate admixture patterns resulting from the intermingling of ancestries from European, Native American (NA) Asian, and African ancestries which result in a vast and complex genetic landscape, harboring unique combinations of novel variants. This genetic diversity not only poses challenges in traditional population genetics methods but also opens avenues for a deeper understanding of its implications in health. In cancer, the interplay between genetic ancestry, lifestyle factors, and healthcare disparities adds a layer of complexity to the varying incidence and mortality rates observed across different Latin American subpopulations. This complex interdependence has been unveiled through numerous studies, whether conducted on Latin American patients residing on the continent or abroad, revealing discernible differences in germline composition that influence divergent disease phenotypes such as higher incidence of Luminal B and Her2 breast tumors, EGFR and KRAS mutated lung adenocarcinomas in addition to an enrichment in BRCA1/2 pathogenic variants and a higher than expected prevalence of variants in colorectal cancer associated genes such as APC and MLH1. In prostate cancer novel risk variants have also been solely identified in Latin American populations. Due to the complexity of genetic divergence, inputs from each individual ancestry seem to carry independent contributions that interplay in the development of these complex disease phenotypes. By understanding these unique population characteristics, genomic ancestries hold a promising avenue for tailoring prognostic assessments and optimizing responses to oncological interventions.
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Affiliation(s)
- Alejandro Ruíz-Patiño
- Clinical Genetics, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia
- GIGA/TERA Research Group, CTIC/Universidad El Bosque, Bogotá, Colombia
| | - Leonardo Rojas
- GIGA/TERA Research Group, CTIC/Universidad El Bosque, Bogotá, Colombia
- Thoracic Oncology Unit, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
| | - Jairo Zuluaga
- GIGA/TERA Research Group, CTIC/Universidad El Bosque, Bogotá, Colombia
- Thoracic Oncology Unit, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
| | - Oscar Arrieta
- Instituto Nacional de Cancerología -INCaN, Mexico City, Mexico
| | - Luis Corrales
- Thoracic Oncology Unit, Centro de Investigación y Manejo del Cáncer (CIMCA), San José, Costa Rica
| | - Claudio Martín
- Thoracic Oncology Unit, Instituto Alexander Fleming, Buenos Aires, Argentina
| | - Sandra Franco
- GIGA/TERA Research Group, CTIC/Universidad El Bosque, Bogotá, Colombia
- Breast Cancer Unit, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
| | - Luis Raez
- Oncology Department, Memorial Cancer Institute (MCI), Memorial Healthcare System, Miami, FL, USA
| | - Christian Rolfo
- Center for Thoracic Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Natalia Sánchez
- GIGA/TERA Research Group, CTIC/Universidad El Bosque, Bogotá, Colombia
- Institute of Research, Science and Education, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
| | - Andrés Felipe Cardona
- GIGA/TERA Research Group, CTIC/Universidad El Bosque, Bogotá, Colombia.
- Thoracic Oncology Unit, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia.
- Institute of Research, Science and Education, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia.
- Direction of Research and Education, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Cra. 14 #169-49, Bogotá, Colombia.
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Ruiz G, Enrico D, Mahmoud YD, Ruiz A, Cantarella MF, Leguina L, Barberis M, Beña A, Brest E, Starapoli S, Mendoza Bertelli A, Tsou F, Pupareli C, Coppola MP, Scocimarro A, Sena S, Levit P, Perfetti A, Aman E, Girotti MR, Arrieta O, Martín C, Salanova R. Association of PD-L1 expression with driver gene mutations and clinicopathological characteristics in non-small cell lung cancer: A real-world study of 10 441 patients. Thorac Cancer 2024; 15:895-905. [PMID: 38456253 PMCID: PMC11016406 DOI: 10.1111/1759-7714.15244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Programmed death ligand-1 (PD-L1) expression is a well-known predictive biomarker of response to immune checkpoint blockade in non-small cell lung cancer (NSCLC). However, there is limited evidence of the relationship between PD-L1 expression, clinicopathological features, and their association with major driver mutations in NSCLC patients in Latin America. METHODS This retrospective study included patients from Argentina with advanced NSCLC, and centralized evaluation of PD-L1 expression concurrently with genomic alterations in the driver genes EGFR, ALK, ROS1, BRAF, and/or KRAS G12C in FFPE tissue samples. RESULTS A total of 10 441 patients with advanced NSCLC were analyzed. Adenocarcinoma was the most frequent histological subtype (71.1%). PD-L1 expression was categorized as PD-L1 negative (45.1%), PD-L1 positive low-expression 1%-49% (32.3%), and PD-L1 positive high-expression ≥50% (22.6%). Notably, current smokers and males were more likely to have tumors with PD-L1 tumor proportion score (TPS) ≥50% and ≥ 80% expression, respectively (p < 0.001 and p = 0.013). Tumors with non-adenocarcinoma histology had a significantly higher median PD-L1 expression (p < 0.001). Additionally, PD-L1 in distant nodes was more likely ≥50% (OR 1.60 [95% CI: 1.14-2.25, p < 0.01]). In the multivariate analysis, EGFR-positive tumors were more commonly associated with PD-L1 low expression (OR 0.62 [95% CI: 0.51-0.75], p < 0.01), while ALK-positive tumors had a significant risk of being PD-L1 positive (OR 1.81 [95% CI: 1.30-2.52], p < 0.01). CONCLUSIONS PD-L1 expression was associated with well-defined clinicopathological and genomic features. These findings provide a comprehensive view of the expression of PD-L1 in patients with advanced NSCLC in a large Latin American cohort.
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Affiliation(s)
- Gonzalo Ruiz
- Pathology & Molecular Biology LaboratoriesBiomakersBuenos AiresArgentina
| | - Diego Enrico
- Thoracic Oncology Unit, Department of Medical OncologyAlexander Fleming Cancer InstituteBuenos AiresArgentina
- Clinical Research Unit, Department of Medical OncologyAlexander Fleming Cancer InstituteBuenos AiresArgentina
| | - Yamil D. Mahmoud
- Universidad Argentina de la Empresa (UADE), Instituto de Tecnología (INTEC)Buenos AiresArgentina
- Laboratorio de Glicomedicina, Instituto de Biología y Medicina Experimental (IBYME)Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET)Buenos AiresArgentina
| | - Alan Ruiz
- Pathology & Molecular Biology LaboratoriesBiomakersBuenos AiresArgentina
| | | | - Laura Leguina
- Pathology & Molecular Biology LaboratoriesBiomakersBuenos AiresArgentina
| | - Mariana Barberis
- Pathology & Molecular Biology LaboratoriesBiomakersBuenos AiresArgentina
| | - Asunción Beña
- Pathology & Molecular Biology LaboratoriesBiomakersBuenos AiresArgentina
| | - Esteban Brest
- Pathology & Molecular Biology LaboratoriesBiomakersBuenos AiresArgentina
| | - Solange Starapoli
- Pathology & Molecular Biology LaboratoriesBiomakersBuenos AiresArgentina
| | | | - Florencia Tsou
- Thoracic Oncology Unit, Department of Medical OncologyAlexander Fleming Cancer InstituteBuenos AiresArgentina
- Clinical Research Unit, Department of Medical OncologyAlexander Fleming Cancer InstituteBuenos AiresArgentina
| | - Carmen Pupareli
- Thoracic Oncology Unit, Department of Medical OncologyAlexander Fleming Cancer InstituteBuenos AiresArgentina
- Clinical Research Unit, Department of Medical OncologyAlexander Fleming Cancer InstituteBuenos AiresArgentina
| | - María Pía Coppola
- Medical Oncology UnitHospital Zonal Especializado en Agudos y Crónicos Dr. Antonio CetrangoloBuenos AiresArgentina
| | - Alejandra Scocimarro
- Medical Oncology UnitHospital Zonal Especializado en Agudos y Crónicos Dr. Antonio CetrangoloBuenos AiresArgentina
| | - Susana Sena
- Medical Oncology DepartmentHospital AlemánBuenos AiresArgentina
| | - Patricio Levit
- Medical Oncology UnitUnión Personal‐Accord SaludBuenos AiresArgentina
| | - Aldo Perfetti
- Medical Oncology UnitUnión Personal‐Accord SaludBuenos AiresArgentina
- Medical Oncology DepartmentCentro de Educación Médica e Investigaciones Clínicas (CEMIC)Buenos AiresArgentina
| | - Enrique Aman
- Medical Oncology Unit, Swiss Medical GroupBuenos AiresArgentina
| | - María Romina Girotti
- Pathology & Molecular Biology LaboratoriesBiomakersBuenos AiresArgentina
- Universidad Argentina de la Empresa (UADE), Instituto de Tecnología (INTEC)Buenos AiresArgentina
| | - Oscar Arrieta
- Head of Thoracic Oncology UnitUnidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología (INCan)Mexico CityMexico
| | - Claudio Martín
- Thoracic Oncology Unit, Department of Medical OncologyAlexander Fleming Cancer InstituteBuenos AiresArgentina
- Clinical Research Unit, Department of Medical OncologyAlexander Fleming Cancer InstituteBuenos AiresArgentina
| | - Rubén Salanova
- Pathology & Molecular Biology LaboratoriesBiomakersBuenos AiresArgentina
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3
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Caballé-Perez E, Hernández-Pedro N, Ramos-Ramírez M, Barrios-Bernal P, Romero-Núñez E, Lucio-Lozada J, Ávila-Ríos S, Reyes-Terán G, Cardona AF, Arrieta O. Impact of KRAS G12D subtype and concurrent pathogenic mutations on advanced non-small cell lung cancer outcomes. Clin Transl Oncol 2024; 26:836-850. [PMID: 37490263 PMCID: PMC10981588 DOI: 10.1007/s12094-023-03279-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/09/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE Mutations in the Kirsten rat sarcoma viral (KRAS) oncogene constitute a significant driver of lung adenocarcinoma, present in 10-40% of patients, which exhibit heterogeneous clinical outcomes, mainly driven by concurrent genetic alterations. However, characterization of KRAS mutational subtypes and their impact on clinical outcomes in Latin America is limited. METHODS A cohort study was conducted at the National Cancer Institute (INCan) of Mexico. Individuals with advance-staged of adenocarcinoma and KRAS mutations, detected by next-generation sequencing, having undergone at least one line of therapy were included for analysis. Clinical and pathological characteristics were retrieved from institutional database from June 2014 to March 2023. RESULTS KRAS was identified in fifty-four (15.6%) of 346 patients, among which 50 cases were included for analysis. KRASG12D (n = 16, 32%) and KRASG12C (n = 16, 32%) represented the most prevalent subtypes. KRASG12D mutations were associated with female (p = 0.018), never smokers (p = 0.108), and concurrences with EGFR (25.0% vs. 17.6%, p = 0.124) and CDKN2A (18.8% vs. 14.7%, p = 0.157). KRASG12D patients showed a better ORR (66.6% vs. 30.0%; OR 4.66, 95% CI 1.23-17.60, p = 0.023) and on multivariate analysis was significantly associated with better PFS (HR 0.36, 95% CI 0.16-0.80; p = 0.012) and OS (HR 0.24, 95% CI 0.08-0.70; p = 0.009). CONCLUSIONS To our knowledge, this study represents the first effort to comprehensively characterize the molecular heterogeneity of KRAS-mutant NSCLC in Latin American patients. Our data reinforce the current view that KRAS-mutated NSCLC is not a single oncogene-driven disease and emphasizes the prognostic impact of diverse molecular profiles in this genomically defined subset of NSCLC. Further validation is warranted in larger multicenter Latin American cohorts to confirm our findings.
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Affiliation(s)
- Enrique Caballé-Perez
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
- Personalized Medicine Laboratory, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Norma Hernández-Pedro
- Personalized Medicine Laboratory, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Maritza Ramos-Ramírez
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Pedro Barrios-Bernal
- Personalized Medicine Laboratory, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Eunice Romero-Núñez
- Personalized Medicine Laboratory, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - José Lucio-Lozada
- Personalized Medicine Laboratory, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | | | - Andrés F Cardona
- Thoracic Oncology Unit and Direction of Research, Science and Education, Luis Carlos Sarmiento Angulo, Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
- Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico.
- Personalized Medicine Laboratory, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico.
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Allende S, Turcott JG, Verástegui E, Rodríguez-Mayoral O, Flores-Estrada D, Pérez Camargo DA, Ramos-Ramírez M, Martínez-Hernández JN, Oñate-Ocaña LF, Pina PS, Cardona AF, Arrieta O. Early Incorporation to Palliative Care (EPC) in Patients With Advanced Non-Small Cell Lung Cancer: The PACO Randomized Clinical Trial. Oncologist 2024:oyae050. [PMID: 38558247 DOI: 10.1093/oncolo/oyae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/16/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Patients with non-small cell lung cancer (NSCLC) experience a considerable disease burden, evident in symptomatic and psychological spheres. Advanced cancer represents a complex scenario for patients and the healthcare team. Early palliative care (EPC) has been proven as a clinically meaningful strategy in this context by several randomized trials but not in a resource-limited setting. This study aimed to evaluate the effect of EPC compared with standard oncological care (SOC) in patients with metastatic NSCLC in Mexico. MATERIALS AND METHODS A prospective, randomized clinical trial was conducted at Instituto Nacional de Cancerologia in Mexico. All patients had histologically confirmed metastatic NSCLC without previous treatment. Patients were randomly assigned (1:1) to receive SOC or SOC + EPC. The EPC group was introduced to the palliative care team at baseline after randomization, which was integrated by psychologists, bachelor's in nutrition, specialized nurses, and physicians. Patients randomized to this arm had programmed visits to meet with the team at baseline and through the 2nd, 4th-, and 6th cycles thereafter. The primary endpoint was overall survival (OS); secondary outcomes included quality of life (QoL), anxiety and depression, and symptom intensity. They were assessed using the instruments EORTC QLQ-C30 questionnaire, Edmonton Symptom Assessment Scale (ESAS), and the Hospital Anxiety and Depression Scale (HADS) (clinicaltrials.gov [NCT01631565]). Questionnaires were completed at baseline, at 2nd, 4th, and 6th cycles of treatment. RESULTS Between March 2012 and June 2015, 201 patients were assessed for eligibility and 146 were enrolled and allocated to receive EPC (73) or SOC (73). Median OS for patients in the EPC vs SOC arm was 18.1 months (95% CI, 7.9-28.4) and 10.5 months (95% CI, 4.7-16.2) (P = .029). Having a poor performance status (HR 1.7 [1.2-2.5]; P = .004) and allocation to the control group (HR 1.5 [1.03-2.3]; P = .034) were independently associated with a worse OS. Those patients with a global QoL > 70 at baseline had a better OS if they were In the EPC arm (38.7 months (95% CI, 9.9-67.6) vs SOC 21.4 months (95% CI, 12.4-30.3)). Mean QoL had a numerical improvement in patients allocated to EPC after 6 cycles of follow-up, nonetheless this difference was not statistically significant (55.1 ± 23.7 vs 56.9 ± 25.3; P = .753). There were no significant differences in anxiety and depression at all study points. CONCLUSIONS EPC is associated with a significant improvement in OS, although, we observed that the greatest benefit of providing EPC was observed in those with a global QoL > 70 at baseline. This study did not identify significant changes in terms of QoL or symptom burden between the study groups after follow-up. Evidence robustly suggests that EPC should be considered part of the multidisciplinary treatment of metastatic NSCLC patients since diagnosis. According to our study, EPC can be implemented in low- or middle-income countries (LMIC).
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Affiliation(s)
- Silvia Allende
- Department of Palliative Care, Instituto Nacional de Cancerología, Mexico City, México
| | - Jenny G Turcott
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, Mexico City, México
| | - Emma Verástegui
- Department of Palliative Care, Instituto Nacional de Cancerología, Mexico City, México
| | | | | | | | | | | | - Luis F Oñate-Ocaña
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, Mexico City, México
| | | | - Andrés F Cardona
- Research and Education Direction, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
- Foundation for Clinical and Applied Cancer Research, FICMAC and Molecular Oncology and Biology Systems Group, Universidad El Bosque, Bogotá, Colombia
| | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, Mexico City, México
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de Miguel-Perez D, Ak M, Mamindla P, Russo A, Zenkin S, Ak N, Peddagangireddy V, Lara-Mejia L, Gunasekaran M, Cardona AF, Naing A, Hirsch FR, Arrieta O, Colen RR, Rolfo C. Validation of a multiomic model of plasma extracellular vesicle PD-L1 and radiomics for prediction of response to immunotherapy in NSCLC. J Exp Clin Cancer Res 2024; 43:81. [PMID: 38486328 PMCID: PMC10941547 DOI: 10.1186/s13046-024-02997-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/27/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Immune-checkpoint inhibitors (ICIs) have showed unprecedent efficacy in the treatment of patients with advanced non-small cell lung cancer (NSCLC). However, not all patients manifest clinical benefit due to the lack of reliable predictive biomarkers. We showed preliminary data on the predictive role of the combination of radiomics and plasma extracellular vesicle (EV) PD-L1 to predict durable response to ICIs. MAIN BODY Here, we validated this model in a prospective cohort of patients receiving ICIs plus chemotherapy and compared it with patients undergoing chemotherapy alone. This multiparametric model showed high sensitivity and specificity at identifying non-responders to ICIs and outperformed tissue PD-L1, being directly correlated with tumor change. SHORT CONCLUSION These findings indicate that the combination of radiomics and EV PD-L1 dynamics is a minimally invasive and promising biomarker for the stratification of patients to receive ICIs.
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Affiliation(s)
- Diego de Miguel-Perez
- Center for Thoracic Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, Mount Sinai, 1470 Madison Ave, New York, NY, 10029, USA
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Murat Ak
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Alessandro Russo
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
- Medical Oncology Unit, A.O. Papardo & Department of Human Pathology, University of Messina, Messina, Italy
| | | | - Nursima Ak
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Vishal Peddagangireddy
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Luis Lara-Mejia
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Muthukumar Gunasekaran
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
- Departments of Surgery and Pediatrics, Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA
| | - Andres F Cardona
- Molecular Oncology and Biology Systems Research Group (Fox G), Universidad El Bosque, Bogota, Colombia
| | - Aung Naing
- Departments of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fred R Hirsch
- Center for Thoracic Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, Mount Sinai, 1470 Madison Ave, New York, NY, 10029, USA
| | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Rivka R Colen
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Christian Rolfo
- Center for Thoracic Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, Mount Sinai, 1470 Madison Ave, New York, NY, 10029, USA.
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Arrieta O, Cárdenas-Fernández D, Rodriguez-Mayoral O, Gutierrez-Torres S, Castañares D, Flores-Estrada D, Reyes E, López D, Barragán P, Soberanis Pina P, Cardona AF, Turcott JG. Mirtazapine as Appetite Stimulant in Patients With Non-Small Cell Lung Cancer and Anorexia: A Randomized Clinical Trial. JAMA Oncol 2024; 10:305-314. [PMID: 38206631 PMCID: PMC10784994 DOI: 10.1001/jamaoncol.2023.5232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/17/2023] [Indexed: 01/12/2024]
Abstract
Importance Currently there is no standard therapy to improve cancer-related anorexia, hampering survival. Mirtazapine has been suggested as a feasible option in this context. Objectives To assess the effect of mirtazapine on appetite and energy consumption in patients with advanced non-small cell lung cancer (NSCLC). Design, Setting, and Participants This randomized, double-blind, placebo-controlled clinical trial including adults was performed in a tertiary cancer care center from August 2018 to May 2022 with a follow-up of 8 weeks. Overall, 134 patients were screened; 114 were assessed for eligibility and 28 were excluded. Interventions Patients were randomized in a 1:1 ratio to receive mirtazapine, 15 mg, or placebo for 2 weeks followed by a dose escalation to 30 mg until week 8 or placebo. Both groups received nutritional assessment and dietary advice. Main outcomes and measures Appetite was assessed by the Anorexia Cachexia Scale and energy intake. Dietary parameters were evaluated at baseline, 4 weeks, and 8 weeks, with a 24-hour dietary recall, and energy quantification based on the Mexican system of nutritional equivalents. Results A total of 86 patients met the inclusion criteria and were randomized to the placebo (n = 43) or the mirtazapine group (n = 43). The mean (SD) age was 63.5 (11.2) years, 41 were women (57.7%) and had adenocarcinoma, Eastern Cooperative Oncology Group performance status scale score of 1, stage IV NSCLC, and were receiving first-line treatment. Baseline characteristics were similar between groups. There was no difference in appetite scores in patients who received mirtazapine or placebo after 4 and 8 weeks. After 4 weeks, mirtazapine significantly increased energy intake (379.3 kcal; 95% CI, 1382.6-576.1; P < .001) including proteins (22.5 g; 95% CI, 11.5-33.4; P = .001), carbohydrates (43.4 g; 95% CI, 13.1-73.8; P = .006), and fats (13.2 g; 95% CI, 6.0-20.4; P = .006). Fats intake was significantly higher in patients in the mirtazapine group (14.5 g vs 0.7 g; P = .02) after 8 weeks. The mirtazapine group significantly decreased the proportion of patients with sarcopenia (82.8% vs 57.1%, P = .03) at 8 weeks. Patients on mirtazapine tolerated the treatment well, but reported a higher perception of nightmares at 2 weeks based on a 10 cm VAS score (0 [25th-75th percentile, 0-1] vs 0 [25th-75th percentile, 0-0] in the control group; P = .009) but this finding was nonsignificant after 4 and 8 weeks. Conclusion and Relevance In this randomized clinical trial of patients with advanced NSCLC, there was no difference in appetite scores in all patients who received mirtazapine or placebo, but the mirtazapine group had a significant increase in energy intake through the 4- and 8-week follow-up, mainly in fat intake, which is a better and crucial source of energy. The addition of mirtazapine in the treatment of patients with advanced NSCLC and anorexia may help these patients achieve their energy requirements and improve health-related quality of life, specifically emotional and cognitive functioning. Trial Registration ClinicalTrials.gov Identifier: NCT04748523.
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Affiliation(s)
- Oscar Arrieta
- Thoracic Oncology Unit, National Cancer Institute of Mexico, Tlalpan, Mexico City, Mexico
| | - Daniela Cárdenas-Fernández
- Nutrition department of Thoracic Oncology Unit, National Cancer Institute of Mexico, Tlalpan, Mexico City, Mexico
| | - Oscar Rodriguez-Mayoral
- Palliative Care department, National Cancer Institute of Mexico, Tlalpan, Mexico City, Mexico
| | | | - Diana Castañares
- Thoracic Oncology Unit, National Cancer Institute of Mexico, Tlalpan, Mexico City, Mexico
| | - Diana Flores-Estrada
- Thoracic Oncology Unit, National Cancer Institute of Mexico, Tlalpan, Mexico City, Mexico
| | - Edgar Reyes
- Thoracic Oncology Unit, National Cancer Institute of Mexico, Tlalpan, Mexico City, Mexico
| | - Dennis López
- Thoracic Oncology Unit, National Cancer Institute of Mexico, Tlalpan, Mexico City, Mexico
| | - Pablo Barragán
- Thoracic Oncology Unit, National Cancer Institute of Mexico, Tlalpan, Mexico City, Mexico
| | - Pamela Soberanis Pina
- Thoracic Oncology Unit, National Cancer Institute of Mexico, Tlalpan, Mexico City, Mexico
| | | | - Jenny G. Turcott
- Nutrition department of Thoracic Oncology Unit, National Cancer Institute of Mexico, Tlalpan, Mexico City, Mexico
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7
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Lara-Mejía L, Cardona AF, Mas L, Martin C, Samtani S, Corrales L, Cruz-Rico G, Remon J, Galvez-Nino M, Ruiz R, Rios-Garcia E, Tejada F, Lozano-Vazquez N, Rosell R, Arrieta O. Impact of Concurrent Genomic Alterations on Clinical Outcomes in Patients With ALK-Rearranged NSCLC. J Thorac Oncol 2024; 19:119-129. [PMID: 37572870 DOI: 10.1016/j.jtho.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION ALK tyrosine kinase inhibitors have exhibited promising activity against advanced ALK-rearranged NSCLC. However, co-occurring genetic alterations, such as CDKN2A/B or TP53, may negatively affect the efficacy of targeted therapies. METHODS From December 2017 to December 2022, this study cohort analyzed next-generation sequencing data of 116 patients with metastatic ALK-rearranged NSCLC from five Latin American cancer centers. Clinicopathologic and molecular features were associated with clinical outcomes and risk of brain metastasis (BrM) in patients with and without concurrent somatic alterations. RESULTS All patients (N = 116) received a second-generation ALK tyrosine kinase inhibitor, and alectinib was selected in 87.2% of cases. Coalterations occurred in 62% of the cases; the most frequent were TP53 mutations (27%) and CDKN2A/B loss (18%). The loss of CDKN2A/B was associated with an increased risk of BrM, with a cumulative incidence of 33.3% versus 7.4% in the non-coaltered subgroup. Compared with patients without coalterations, patients with concurrent CDKN2A/B loss (n = 21) had a shorter median progression-free survival (10.2 versus 34.2 mo, p < 0.001) and overall survival (26.2 versus 80.7 mo, p < 0.001). In the multivariate analysis, co-occurring CDKN2A/B loss was associated with poorer progression-free survival and OS despite the presence of other somatic coalterations, TP53 mutations, BrM, and Eastern Cooperative Oncology Group Performance Status. CONCLUSIONS This study confirmed the worse prognostic value, which depicted co-occurring alterations in patients with ALK rearrangement. CDKN2A/B loss was substantially associated with worse outcomes and a higher risk of brain metastases. The evidence presented in our study may help select patients with ALK-positive tumors suitable for treatment escalation and closer brain follow-up.
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Affiliation(s)
- Luis Lara-Mejía
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), ad0h0, Mexico City, Mexico
| | - Andres F Cardona
- Direction of Research, Science, and Education, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
| | - Luis Mas
- Medical Oncology Unit, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru; Clinical Trials Unit, AUNA Ideas, Lima, Peru
| | - Claudio Martin
- Thoracic Oncology Unit, Alexander Fleming Institute, Buenos Aires, Argentina
| | - Suraj Samtani
- Medical Oncology Department, Clínica Las Condes Santiago, Las Condes, Chile
| | - Luis Corrales
- Thoracic Oncology Unit, Centro de Investigación y Manejo del Cancer (CIMCA), San Jose, Costa Rica
| | - Graciela Cruz-Rico
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), ad0h0, Mexico City, Mexico
| | - Jordi Remon
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Marco Galvez-Nino
- Clinical Trials Unit, AUNA Ideas, Lima, Peru; Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Peru
| | - Rossana Ruiz
- Medical Oncology Unit, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru; Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Peru
| | - Eduardo Rios-Garcia
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), ad0h0, Mexico City, Mexico
| | - Fernanda Tejada
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), ad0h0, Mexico City, Mexico
| | - Natalia Lozano-Vazquez
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), ad0h0, Mexico City, Mexico
| | - Rafael Rosell
- Oncology Institute Dr. Rosell, IOR, Dexeus University Hospital, Barcelona, Spain; Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), ad0h0, Mexico City, Mexico.
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8
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de Miguel-Perez D, Pickering EM, Malapelle U, Grier W, Pepe F, Pisapia P, Russo G, Pinto JA, Russo A, Troncone G, Culligan MJ, Scilla KA, Mehra R, Mohindra P, Arrieta O, Cardona AF, Del Re M, Sachdeva A, Hirsch FR, Wolf A, Friedberg JS, Rolfo C. Genomic profiling of tissue and blood predicts survival outcomes in patients with resected pleural mesothelioma. Eur J Cancer 2024; 196:113457. [PMID: 38008032 DOI: 10.1016/j.ejca.2023.113457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/10/2023] [Accepted: 11/16/2023] [Indexed: 11/28/2023]
Abstract
PURPOSE Pleural mesothelioma (PM) is an aggressive tumor still considered incurable, in part due to the lack of predictive biomarkers. Little is known about the clinical implications of molecular alterations in resectable PM tissues and blood. Here, we characterized genetic alterations to identify prognostic and predictive biomarkers in patients with resected PM. EXPERIMENTAL DESIGN Targeted next-generation sequencing was performed in retrospective pleural tumor tissue and paired plasma samples from stage IB-IIIB resected PM. Association between prognosis and presence of specific mutations was validated in silico. RESULTS Thirty PM tissues and paired blood samples from 12 patients were analyzed. High tissue tumor mutational burden (TMB) (>10 mutations/Mb), tissue median minor allele frequency (MAF) (>9 mutations/Mb), and blood TMB (>6 mutations/Mb), tissue KMT2C, PBRM1, PKHD1,EPHB1 and blood LIFR mutations correlated with longer disease-free survival and/or overall survival. High concordance (>80%) between tissue and blood was found for some mutations. CONCLUSIONS Tissue TMB and MAF, blood TMB, and specific mutations correlated with outcomes in patients with resected PM and should be further studied to validate their role as prognostic biomarkers and potentially predictive factors for combinations with immune-checkpoint inhibitors. This suggest that molecular profiling could identify longer survivors in patients with resected PM.
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Affiliation(s)
- Diego de Miguel-Perez
- Center for Thoracic Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Edward M Pickering
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Umberto Malapelle
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - William Grier
- Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - Francesco Pepe
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Pasquale Pisapia
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Gianluca Russo
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Joseph A Pinto
- Centro de Investigación Básica y Traslacional, Auna Ideas, Lima, Peru
| | - Alessandro Russo
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Giancarlo Troncone
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Melissa J Culligan
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, PA, USA
| | - Katherine A Scilla
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ranee Mehra
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Pranshu Mohindra
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Andres F Cardona
- Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC) / Foundation for Clinical and Applied Cancer Research (FICMAC) / Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Marzia Del Re
- Center for Thoracic Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashutosh Sachdeva
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Fred R Hirsch
- Center for Thoracic Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrea Wolf
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joseph S Friedberg
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, PA, USA
| | - Christian Rolfo
- Center for Thoracic Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA.
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9
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Sotelo-Rodríguez C, Vallejo-Ardila D, Ruiz-Patiño A, Chamorro DF, Rodríguez J, Moreno-Pérez DA, Carranza H, Otero J, Vargas C, Archila P, Rojas L, Zuluaga J, Rubio C, Ordóñez-Reyes C, Garcia-Robledo JE, Mejía S, Jaller E, Arrieta O, Cardona AF. Molecular Tumor Board Improves Outcomes for Hispanic Patients With Advanced Solid Tumors. JCO Glob Oncol 2024; 10:e2300011. [PMID: 38237094 PMCID: PMC10805441 DOI: 10.1200/go.23.00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/10/2023] [Accepted: 10/18/2023] [Indexed: 01/23/2024] Open
Abstract
PURPOSE Multidisciplinary molecular tumor boards (MTBs) decode complex genomic data into clinical recommendations. Although MTBs are well-established in the oncology practice in developed countries, this strategy needs to be better explored in developing countries. Herein, we describe the possible benefits and limitations of the first MTB established in Colombia. METHODS Demographic, clinical, and genomic information was collected between August 2020 and November 2021. By mid-2020, an MTB strategy was created to discuss clinical cases with one or more genomic alterations identified by next-generation sequencing using an open-access virtual platform. We characterized the patient population as benefiting from the recommended treatment option. We assessed the benefits and access to available targeted therapies that have the potential to change clinical management by making recommendations to treating oncologists on the basis of genomic profiling. However, we did not assess the treatment oncologists' compliance with MTB recommendations because they were not intended to replace clinical judgment/standard of care. RESULTS A total of 146 patients were included in the discussions of the MTB. The median age was 59 years, and 59.6% were women. Genomic results prompting a change in therapeutic decisions were obtained in 53.1% of patients (95% CI, 44.9 to 61.3). The most prevalent malignancy was non-small-cell lung cancer (51%). Other malignancies represented 60%, 50%, and 30% of patients with soft-tissue sarcomas, brain tumors, and breast cancer, respectively. CONCLUSION Using an open-access virtual platform, MTBs were feasible in low- and middle-income countries on the basis of the capability to provide the benefits and access to available targeted therapies that are not standard of care. Furthermore, MTB recommendations were made available to the treating oncologist in different locations across Colombia, providing the option to modify clinical management in most of these patients.
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Affiliation(s)
- Carolina Sotelo-Rodríguez
- Foundation for Clinical and Applied Cancer Research—FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Dora Vallejo-Ardila
- Foundation for Clinical and Applied Cancer Research—FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Alejandro Ruiz-Patiño
- Foundation for Clinical and Applied Cancer Research—FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Diego F. Chamorro
- Foundation for Clinical and Applied Cancer Research—FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - July Rodríguez
- Foundation for Clinical and Applied Cancer Research—FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Darwin A. Moreno-Pérez
- Foundation for Clinical and Applied Cancer Research—FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Hernán Carranza
- Foundation for Clinical and Applied Cancer Research—FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Jorge Otero
- Foundation for Clinical and Applied Cancer Research—FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Carlos Vargas
- Foundation for Clinical and Applied Cancer Research—FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Pilar Archila
- Foundation for Clinical and Applied Cancer Research—FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Leonardo Rojas
- Thoracic Oncology Unit, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
| | - Jairo Zuluaga
- Thoracic Oncology Unit, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
| | - Cladelis Rubio
- Foundation for Clinical and Applied Cancer Research—FICMAC, Bogotá, Colombia
| | - Camila Ordóñez-Reyes
- Foundation for Clinical and Applied Cancer Research—FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | | | - Sergio Mejía
- Thoracic Oncology Unit, Clínica Las Américas, Medellín, Colombia
| | - Elvira Jaller
- Foundation for Clinical and Applied Cancer Research—FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Oscar Arrieta
- Thoracic Oncology Unit, National Cancer Institute (INCan), México City, México
| | - Andrés F. Cardona
- Thoracic Oncology Unit, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
- Direction of Research, Science and Education, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
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10
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Mohar A, Paredes A, Brau-Figueroa H, Sánchez A, Palafox A, Rivera-Gómez R, Pech K, Carranza-Matus M, Arrieta O, Inchaustegui A, Moreno E, Piñeros M. Implementation of a population-based cancer registry network in Mexico 2017-2020. Salud Publica Mex 2023; 66:104-112. [PMID: 38065103 DOI: 10.21149/15258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/21/2023] [Indexed: 12/18/2023] Open
Abstract
The growing cancer burden particularly among less developed countries requires local data to plan and evaluate cancer control measures. This article describes the development of a population-based cancer registry network (PBCRN) in Mexico that took place between 2017 and 2020 and present related data. The PBCRN, led by the National Cancer Institute (Incan), included nine registries representing 11.3% of the Mexican population. Definitions, coding, and operative processes were based on international standards. All cities were visited to set up local structure; personnel were hired by Incan and trained in basic cancer registration in Merida. A specific software was developed. Regular virtual meetings took place for data verification and quality control. Data collection included institutions of the public and private health system. Personnel included 34 registrars, nine local leaders, and 12 staff members at the Incan. A total of 13 517 cases were recorded between 2017-2020, 64% percent of them were among females. Breast cancer was the more frequent malignancy (23.3%), followed by digestive organs with (18.4%) and female genital cancers (13.5%). Childhood (0-14 years) and adolescents cancer represented 4.4% of the total new cancer cases. The network was suspended in 2020. The present effort lacked sustainability and data were only partial. However, the experience provides valuable insights to be considered for the renewed cancer registration efforts that are currently ongoing in Mexico.
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Affiliation(s)
- Alejandro Mohar
- Unidad de Epidemiología e Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología. Mexico City, Mexico. Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México. Mexico City, Mexico..
| | - Andrea Paredes
- Coordinación del Registro Nacional de Cáncer, Instituto Nacional de Cancerología. Mexico City, Mexico..
| | | | - Alejandro Sánchez
- Dirección de Prospectiva Sectorial, Secretaría de Salud. Guadalajara, Jalisco, Mexico..
| | | | - Rebeca Rivera-Gómez
- US-Mexico-Border Health Commission, Tijuana Population-Based Cancer Registry BajaREG. Tijuana, Baja California, Mexico..
| | - Kristal Pech
- Unidad de Epidemiología e Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología. Mexico City, Mexico..
| | - Mario Carranza-Matus
- Departamento de Registros en Salud, Secretaría de Salud. Guadalajara, Jalisco, México..
| | - Oscar Arrieta
- Dirección General, Instituto Nacional de Cancerología. Mexico City, Mexico..
| | | | - Elena Moreno
- Registro de Cáncer de La Paz. La Paz, Baja California Sur, Mexico..
| | - Marion Piñeros
- Cancer Surveillance Branch, International Agency for Research on Cancer. Lyon, France.
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11
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Avilés-Salas A, Cabrera-Miranda L, Hernández-Pedro N, Vargas-Lías DS, Samtani S, Muñoz-Montaño W, Motola-Kuba D, Corrales-Rodríguez L, Martín C, Cardona AF, Palomares-Palomares CB, Arrieta O. PD-L1 expression complements CALGB prognostic scoring system in malignant pleural mesothelioma. Front Oncol 2023; 13:1269029. [PMID: 38111532 PMCID: PMC10725960 DOI: 10.3389/fonc.2023.1269029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/30/2023] [Indexed: 12/20/2023] Open
Abstract
Background Programmed death ligand-1 (PD-L1) expression is a predictive biomarker in patients with lung cancer, but its role in malignant pleural mesothelioma (MPM) remains unclear. Evidence suggests that higher PD-L1 expression is correlated with worse survival. CALGB is the main scoring system used to predict the benefit of chemotherapy treatment. This study aimed to determine the prognostic value of PD-L1 expression and its addition to CALGB scoring system in patients with MPM. Methods In this retrospective analysis, we evaluated samples with confirmed locally advanced or metastatic MPM. PD-L1 Tumor Proportional Score (TPS) was determined by immunohistochemistry at diagnosis. Results 73 patients were included in this study. A cutoff value of 15 was set for a high or low PD-L1 TPS. In total, 71.2% (n=52) and 28.8% (n=21) of individuals harbored low or high PD-L1 expression, respectively. PD-L1High was associated with worse median progression-free Survival (mPFS) [4.9 vs. 10.8 months; HR 2.724, 95% CI (1.44-5.14); p = 0.002] and Overall Survival (OS) [6.0 vs. 20.9 months; HR 6.87, 95% CI (3.4-8.7); p<0.001] compared to patients with PD-L1Low. Multivariate analysis confirmed that PD-L1 expression was an independent factor for PFS and OS in patients with MPM and CALGB score of 5-6. Conclusion PD-L1 addition to CALGB scale improves its prognostic estimation of MPM survival and should be considered in future research.
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Affiliation(s)
| | - Luis Cabrera-Miranda
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Norma Hernández-Pedro
- Personalized Medicine Laboratory, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - Suraj Samtani
- Medical Oncology Department, Clínica Las Condes Santiago, Santiago, Chile
| | - Wendy Muñoz-Montaño
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Daniel Motola-Kuba
- Departments of Biomedical Research and Gastroenterology and Liver Unit and Hemodialysis Unit, Medica Sur Clinic and Foundation, Mexico City, Mexico
| | | | - Claudio Martín
- Department of Medicine, Western University, London, ON, Canada
| | - Andrés F. Cardona
- Thoracic Oncology Unit and Direction of Research, Science and Education, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
- Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | | | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
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12
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Heredia D, Bolaño-Guerra L, Valencia-Velarde A, Santoyo EV, Lara-Mejía L, Cárdenas-Fernández D, Orozco M, Cruz-Rico G, Arrieta O. Liquid biopsy in clinical outcomes and detection of T790M mutation in metastatic non-small cell lung cancer after progression to EGFR-TKI. Cancer Biomark 2023:CBM230124. [PMID: 38108344 DOI: 10.3233/cbm-230124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
BACKGROUND Liquid biopsy (LB) is used to detect epidermal growth factor receptor (EGFR) mutations in non-small cell lung cancer (NSCLC) and has been demonstrated to have prognostic and predictive value. OBJECTIVE To associate the rates of EGFR and T790M mutations detected by LB during disease progression after first- or second-generation EGFR-TKIs with clinical characteristics and survival outcomes. METHODS From January 2018 to December 2021, 295 patients with advanced EGFR mutant (EGFRm) NSCLC treated with first- or second-generation EGFR-TKIs were retrospectively analyzed. LB was collected at the time of progression. The frequency of EGFRT790M mutations, overall survival (OS), and the clinical characteristics associated with LB positivity were determined. RESULTS The prevalence of EGFRT790M mutation detected using LB was 44%. In patients with negative vs. positive LB, the median OS was 45.0 months vs. 25.0 months (p= 0.0001), respectively. Patients with a T790M mutation receiving osimertinib had a median OS of 44 months (95% CI [33.05-54.99]). Clinical characteristics associated with positive LB at progression extra-thoracic involvement, > 3 metastatic sites, and bone metastases. CONCLUSIONS Our findings showed that LB positivity was associated with worse survival outcomes and specific clinical characteristics. This study also confirmed the feasibility and detection rate of T790M mutation in a Latin American population.
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Affiliation(s)
- David Heredia
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | - Angel Valencia-Velarde
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Edgar Varela Santoyo
- Medical Oncology Department, Centro Oncológico Estatal, ISSSEMyN, Toluca, Mexico
| | - Luis Lara-Mejía
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Daniela Cárdenas-Fernández
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Mario Orozco
- Neuroimmunology Laboratory, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Graciela Cruz-Rico
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Oscar Arrieta
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología, Mexico City, Mexico
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13
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Cardona AF, Ávila V, Arrieta O. Treatment for Advanced Non-Small Lung Cancer (NSCLC) with Mutated EGFR in Low- and Middle-Income Countries (LMICs). J Immunother Precis Oncol 2023; 6:185-186. [PMID: 38143954 PMCID: PMC10734397 DOI: 10.36401/jipo-23-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 12/26/2023]
Affiliation(s)
- Andrés F. Cardona
- Thoracic Oncology Unit, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
- GIGA Research Group, Universidad El Bosque, Bogotá, Colombia
- Direction of Research, Science and Education, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
| | - Vaneza Ávila
- Thoracic Oncology Unit, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
| | - Oscar Arrieta
- Thoracic Oncology Unit, National Cancer Institute (INCan), México City, México
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14
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Hernández-Pedro N, Arroyo-Hernández M, Barrios-Bernal P, Romero-Nuñez E, Sosa-Hernandez VA, Ávila-Ríos S, Maravillas-Montero JL, Pérez-Padilla R, de Miguel-Perez D, Rolfo C, Arrieta O. Impact of Tyrosine Kinase Inhibitors on the Immune Response to SARS-CoV-2 Vaccination in Patients with Non-Small Cell Lung Cancer. Vaccines (Basel) 2023; 11:1612. [PMID: 37897014 PMCID: PMC10611320 DOI: 10.3390/vaccines11101612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Immune dysregulation and cancer treatment may affect SARS-CoV-2 vaccination protection. Antibody production by B-cells play a vital role in the control and clearance of the SARS-CoV-2 virus. This study prospectively explores B-cell seroconversion following SARS-CoV-2 immunization in healthy individuals and non-small cell lung cancer (NSCLC) patients undergoing oncological treatment. 92 NSCLC patients and 27 healthy individuals' blood samples were collected after receiving any COVID-19 vaccine. Serum and mononuclear cells were isolated, and a serum surrogate virus neutralization test kit evaluated SARS-CoV-2 antibodies. B-cell subpopulations on mononuclear cells were characterized by flow cytometry. Patients were compared based on vaccination specifications and target mutation oncological treatment. A higher percentage of healthy individuals developed more SARS-CoV-2 neutralizing antibodies than NSCLC patients (63% vs. 54.3%; p = 0.03). NSCLC patients receiving chemotherapy (CTX) or tyrosine kinase inhibitors (TKIs) developed antibodies in 45.2% and 53.7%, of cases, respectively, showing an impaired antibody generation. CTX patients exhibited trends towards lower median antibody production than TKIs (1.0, IQR 83 vs. 38.23, IQR 89.22; p = 0.069). Patients receiving immunotherapy did not generate antibodies. A sub-analysis revealed that those with ALK mutations exhibited non-significant trends towards higher antibody titers (63.02, IQR 76.58 vs. 21.78, IQR 93.5; p = 0.1742) and B-cells quantification (10.80, IQR 7.52 vs. 7.22, IQR 3.32; p = 0.1382) against the SARS-CoV-2 spike protein than EGFR patients; nonetheless, these differences were not statistically significant. This study shows that antibodies against SARS-CoV-2 may be impaired in patients with NSCLC secondary to EGFR-targeted TKIs compared to ALK-directed treatment.
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Affiliation(s)
- Norma Hernández-Pedro
- Laboratorio de Medicina Personalizada, Instituto Nacional de Cancerología, S.S.A., San Fernando 22 Sección XVI, Tlalpan, Mexico City 14080, Mexico; (N.H.-P.); (P.B.-B.); (E.R.-N.)
| | - Marisol Arroyo-Hernández
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, S.S.A., San Fernando 22 Sección XVI, Tlalpan, Mexico City 14080, Mexico;
| | - Pedro Barrios-Bernal
- Laboratorio de Medicina Personalizada, Instituto Nacional de Cancerología, S.S.A., San Fernando 22 Sección XVI, Tlalpan, Mexico City 14080, Mexico; (N.H.-P.); (P.B.-B.); (E.R.-N.)
| | - Eunice Romero-Nuñez
- Laboratorio de Medicina Personalizada, Instituto Nacional de Cancerología, S.S.A., San Fernando 22 Sección XVI, Tlalpan, Mexico City 14080, Mexico; (N.H.-P.); (P.B.-B.); (E.R.-N.)
| | - Victor A. Sosa-Hernandez
- Red de Apoyo a la Investigación, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (V.A.S.-H.); (J.L.M.-M.)
| | - Santiago Ávila-Ríos
- Centro de Investigación en Enfermedades Infecciosas (CIENI), Instituto Nacional de Enfermedades Respiratorias, Calzada de Tlalpan 4502, Belisario Domínguez Sección XVI, Tlalpan, Mexico City 14080, Mexico;
| | - José Luis Maravillas-Montero
- Red de Apoyo a la Investigación, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (V.A.S.-H.); (J.L.M.-M.)
| | - Rogelio Pérez-Padilla
- Department of Research on Tobacco and COPD, Instituto Nacional de Enfermedades Respiratorias, Calzada de Tlalpan 4502, Belisario Domínguez Sección XVI, Tlalpan, Mexico City 14080, Mexico;
| | - Diego de Miguel-Perez
- Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY 11776, USA; (D.d.M.-P.); (C.R.)
| | - Christian Rolfo
- Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY 11776, USA; (D.d.M.-P.); (C.R.)
| | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, S.S.A., San Fernando 22 Sección XVI, Tlalpan, Mexico City 14080, Mexico;
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15
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Arrieta O, Bolaño-Guerra LM, Caballé-Pérez E, Lara-Mejía L, Turcott JG, Gutiérrez S, Lozano-Ruiz F, Cabrera-Miranda L, Arroyave-Ramírez AM, Maldonado-Magos F, Corrales L, Martín C, Gómez-García AP, Cacho-Díaz B, Cardona AF. Perilesional edema diameter associated with brain metastases as a predictive factor of response to radiotherapy in non-small cell lung cancer. Front Oncol 2023; 13:1251620. [PMID: 37916162 PMCID: PMC10616784 DOI: 10.3389/fonc.2023.1251620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/18/2023] [Indexed: 11/03/2023] Open
Abstract
Background Different prognostic scales exist in patients with brain metastasis, particularly in lung cancer. The Graded Prognostic Assessment for lung cancer using molecular markers (Lung-molGPA index) for brain metastases is a powerful prognostic tool that effectively identifies patients at different risks. However, these scales do not include perilesional edema diameter (PED) associated with brain metastasis. Current evidence suggests that PED might compromise the delivery and efficacy of radiotherapy to treat BM. This study explored the association between radiotherapy efficacy, PED extent, and gross tumor diameter (GTD). Aim The aim of this study was to evaluate the intracranial response (iORR), intracranial progression-free survival (iPFS), and overall survival (OS) according to the extent of PED and GT. Methods Out of 114 patients with BM at baseline or throughout the disease, 65 were eligible for the response assessment. The GTD and PED sum were measured at BM diagnosis and after radiotherapy treatment. According to a receiver operating characteristic (ROC) curve analysis, cutoff values were set at 27 mm and 17 mm for PED and GT, respectively. Results Minor PED was independently associated with a better iORR [78.8% vs. 50%, OR 3.71 (95% CI 1.26-10.99); p = 0.018] to brain radiotherapy. Median iPFS was significantly shorter in patients with major PED [6.9 vs. 11.8 months, HR 2.9 (95% CI 1.7-4.4); p < 0.001] independently of other prognostic variables like the Lung-molGPA and GTD. A major PED also negatively impacted the median OS [18.4 vs. 7.9 months, HR 2.1 (95% CI 1.4-3.3); p = 0.001]. Conclusion Higher PED was associated with an increased risk of intracranial progression and a lesser probability of responding to brain radiotherapy in patients with metastatic lung cancer. We encourage prospective studies to confirm our findings.
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Affiliation(s)
- Oscar Arrieta
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), México City, Mexico
| | - Laura Margarita Bolaño-Guerra
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), México City, Mexico
| | - Enrique Caballé-Pérez
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), México City, Mexico
| | - Luis Lara-Mejía
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), México City, Mexico
| | - Jenny G. Turcott
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), México City, Mexico
| | - Salvador Gutiérrez
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), México City, Mexico
| | | | - Luis Cabrera-Miranda
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), México City, Mexico
| | | | | | - Luis Corrales
- Oncology Department, Hospital San Juan de Dios, San José, Costa Rica
| | - Claudio Martín
- Thoracic Oncology Unit, Alexander Fleming Institute, Buenos Aires, Argentina
| | - Ana Pamela Gómez-García
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), México City, Mexico
| | - Bernardo Cacho-Díaz
- Neuro-oncology Unit, Instituto Nacional de Cancerología (INCan), México City, Mexico
| | - Andrés F. Cardona
- Direction of Research and Education, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center - Cancer Treatment and Research Cente (CTIC), Bogotá, Colombia
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16
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Calderon-Hernandez J, Jarquin-Yañez L, Reyes-Arreguin L, Diaz-Padilla LA, Gonzalez-Compean JL, Gonzalez-Montalvo P, Rivera-Gomez R, Villanueva-Toledo JR, Pech K, Arrieta O, Leal YA. Childhood acute lymphoblastic leukemia survival and spatial analysis of socio-environmental risks in Mexico. Front Oncol 2023; 13:1236942. [PMID: 37901312 PMCID: PMC10603203 DOI: 10.3389/fonc.2023.1236942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/22/2023] [Indexed: 10/31/2023] Open
Abstract
Background Acute lymphoblastic leukemia (ALL) etiology remains largely unknown; incidence patterns by age, sex, and geographical distribution suggest a potential environmental role. Aim To identify ALL clusters from four contrasting urban areas of Mexico and to characterize the sources of environmental carcinogens. Methods Hospital-based ALL cases (n = 443) diagnosed in children <19 years old from the Metropolitan Zones of Merida and San Luis Potosi, the State of Mexico, and Tijuana were analyzed (2015-2020). ALL cases were coded according to the International Classification of Diseases for Oncology. ALL clusters were identified by Kernel Density, and excess risk was estimated. Data of particulate matter ≤2.5 µm (PM2.5) concentrations measured by community-monitoring stations were analyzed. Geocoded datasets of benzene, polycyclic aromatic hydrocarbons, and PM2.5 sources were analyzed to characterize patterns of exposure in ALL clusters. Results The survival rate for ALL ranged from 61.5% to 78.6%. Seven ALL clusters with excess risk (RR 1.4-2.3, p < 0.05) were identified. The carcinogen sources included artisanal brick kilns, gas stations, cement works, carpentry, paint, and chemical manufacturing establishments. PM2.5 levels ranged from 15 µg/m3 to 37 µg/m3 among study areas. Conclusion ALL clusters were identified at the community level; the excess risk could be explained by small-scale carcinogen sources. The levels of PM2.5 in outdoor air ranged from 3 to 6 times above the World Health Organization (WHO) air quality guidelines. Healthcare providers must raise awareness of the increased risk of ALL in children living near sources of environmental carcinogens; cancer control and prevention strategies must be steered from a multi-sectoral and multi-action perspective to protect children's health.
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Affiliation(s)
- Jaqueline Calderon-Hernandez
- Facultad de Medicina/CIAAS, Universidad Autónoma de San Luis Potosi, San Luis Potosi, Mexico
- Global Public Health Program, Boston College, Boston, MA, United States
| | - Lizet Jarquin-Yañez
- Consejo Nacional de Humanidades, Ciencias y Tecnologías (CONAHCYT), Ciudad de México, Mexico
| | - Luis Reyes-Arreguin
- Facultad de Medicina/CIAAS, Universidad Autónoma de San Luis Potosi, San Luis Potosi, Mexico
| | - Luis A Diaz-Padilla
- Servicio de Oncología Pediátrica de la Unidad Médica de Alta Especialidad (UMAE), Centro Médico Nacional "Ignacio García Téllez", Instituto Mexicano de Seguro Social (IMSS), Mérida, Yucatán, Mexico
| | - Jose Luis Gonzalez-Compean
- Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional Unidad Tamaulipas, Victoria, Tamaulipas, Mexico
| | - Pablo Gonzalez-Montalvo
- Servicio de Oncología Pediátrica, Hospital O'Horán, Servicios de Salud de Yucatán/Facultad de Medicina, Universidad Autónoma de Yucatán, Yucatán, Mexico
| | - Rebeca Rivera-Gomez
- Facultad de Ciencias de la Salud, Universidad Autónoma de Baja California, Tijuana, Baja California, Mexico
- Comisión de Salud Fronteriza Mexico-Estados, Registro Poblacional de Cáncer de Tijuana BajaREG, Tijuana, Baja California, Mexico
| | - Jairo R Villanueva-Toledo
- Consejo Nacional de Humanidades, Ciencias y Tecnologías (CONAHCYT) - Fundación IMSS, A.C., Ciudad de México, Mexico
| | - Kristal Pech
- Departamento de Epidemiología del Instituto Nacional de Cancerología, Ciudad de México, Mexico
| | - Oscar Arrieta
- Coordinación del Registro Nacional de Cáncer del Instituto Nacional de Cancerología, Ciudad de México, Mexico
| | - Yelda A Leal
- Coordinación del Registro Nacional de Cáncer del Instituto Nacional de Cancerología, Ciudad de México, Mexico
- Registro Poblacional de Cáncer Mérida, Unidad Médica de Alta Especialidad (UMAE), Centro Médico Nacional "Ignacio García Téllez", Instituto Mexicano de Seguro Social (IMSS), Mérida, Yucatán, Mexico
- Centro Institucional de Capacitación y Registro de Cáncer, Coordinación de Investigación en Salud, Instituto Mexicano de Seguro Social (IMSS), Ciudad de México, Mexico
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17
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São José C, Garcia-Pelaez J, Ferreira M, Arrieta O, André A, Martins N, Solís S, Martínez-Benítez B, Ordóñez-Sánchez ML, Rodríguez-Torres M, Sommer AK, Te Paske IBAW, Caldas C, Tischkowitz M, Tusié MT, Hoogerbrugge N, Demidov G, de Voer RM, Laurie S, Oliveira C. Combined loss of CDH1 and downstream regulatory sequences drive early-onset diffuse gastric cancer and increase penetrance of hereditary diffuse gastric cancer. Gastric Cancer 2023; 26:653-666. [PMID: 37249750 PMCID: PMC10361908 DOI: 10.1007/s10120-023-01395-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/30/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Germline CDH1 pathogenic or likely pathogenic variants cause hereditary diffuse gastric cancer (HDGC). Once a genetic cause is identified, stomachs' and breasts' surveillance and/or prophylactic surgery is offered to asymptomatic CDH1 carriers, which is life-saving. Herein, we characterized an inherited mechanism responsible for extremely early-onset gastric cancer and atypical HDGC high penetrance. METHODS Whole-exome sequencing (WES) re-analysis was performed in an unsolved HDGC family. Accessible chromatin and CDH1 promoter interactors were evaluated in normal stomach by ATAC-seq and 4C-seq, and functional analysis was performed using CRISPR-Cas9, RNA-seq and pathway analysis. RESULTS We identified a germline heterozygous 23 Kb CDH1-TANGO6 deletion in a family with eight diffuse gastric cancers, six before age 30. Atypical HDGC high penetrance and young cancer-onset argued towards a role for the deleted region downstream of CDH1, which we proved to present accessible chromatin, and CDH1 promoter interactors in normal stomach. CRISPR-Cas9 edited cells mimicking the CDH1-TANGO6 deletion display the strongest CDH1 mRNA downregulation, more impacted adhesion-associated, type-I interferon immune-associated and oncogenic signalling pathways, compared to wild-type or CDH1-deleted cells. This finding solved an 18-year family odyssey and engaged carrier family members in a cancer prevention pathway of care. CONCLUSION In this work, we demonstrated that regulatory elements lying down-stream of CDH1 are part of a chromatin network that control CDH1 expression and influence cell transcriptome and associated signalling pathways, likely explaining high disease penetrance and very young cancer-onset. This study highlights the importance of incorporating scientific-technological updates and clinical guidelines in routine diagnosis, given their impact in timely genetic diagnosis and disease prevention.
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Affiliation(s)
- Celina São José
- i3S-Instituto de Investigação e Inovação em Saúde, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal
- IPATIMUP-Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal
- Doctoral Programme in Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - José Garcia-Pelaez
- i3S-Instituto de Investigação e Inovação em Saúde, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal
- IPATIMUP-Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal
- Doctoral Programme in Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marta Ferreira
- i3S-Instituto de Investigação e Inovação em Saúde, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal
- IPATIMUP-Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal
- Department Computer Science Faculty of Science, University of Porto, Porto, Portugal
| | - Oscar Arrieta
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Ana André
- i3S-Instituto de Investigação e Inovação em Saúde, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal
- IPATIMUP-Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal
| | - Nelson Martins
- i3S-Instituto de Investigação e Inovação em Saúde, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal
- IPATIMUP-Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal
- Master Programme in Molecular Medicine and Oncology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Samantha Solís
- INCMNSZ/Instituto de Investigaciones Biomédicas, Unidad de Biología Molecular y Medicina Genómica Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, UNAM Mexico City, Mexico
| | - Braulio Martínez-Benítez
- Pathology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, INCMNSZ Mexico City, Mexico
| | - María Luisa Ordóñez-Sánchez
- INCMNSZ/Instituto de Investigaciones Biomédicas, Unidad de Biología Molecular y Medicina Genómica Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, UNAM Mexico City, Mexico
| | - Maribel Rodríguez-Torres
- INCMNSZ/Instituto de Investigaciones Biomédicas, Unidad de Biología Molecular y Medicina Genómica Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, UNAM Mexico City, Mexico
| | - Anna K Sommer
- Institute of Human Genetics, Medical Faculty, University of Bonn, Bonn, Germany
| | - Iris B A W Te Paske
- Department of Human Genetics, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Carlos Caldas
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
- Cambridge Experimental Cancer Medicine Centre (ECMC), CRUK Cambridge Centre, NIHR Cambridge Biomedical Research Centre, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Marc Tischkowitz
- Department of Medical Genetics, National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Maria Teresa Tusié
- INCMNSZ/Instituto de Investigaciones Biomédicas, Unidad de Biología Molecular y Medicina Genómica Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, UNAM Mexico City, Mexico
| | - Nicoline Hoogerbrugge
- Department of Human Genetics, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - German Demidov
- Institute of Medical Genetics and Applied Genomics, Tübingen, Germany
| | - Richarda M de Voer
- Department of Human Genetics, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Steve Laurie
- The Barcelona Institute of Science and Technology, CNAG-CRG, Centre for Genomic Regulation (CRG), Barcelona, Spain
| | - Carla Oliveira
- i3S-Instituto de Investigação e Inovação em Saúde, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal.
- IPATIMUP-Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal.
- FMUP-Faculty of Medicine of the University of Porto, Porto, Portugal.
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18
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Cabrera-Galeana P, Reynoso-Noverón N, González-Nuñez C, Arrieta O, Torres J, Allende S, Vilar-Compte D, Díaz C, Cano C, Álvarez M, Mohar A. Mortality Prognosis Factors in Patients with Active Cancer Under Treatment, and Severe COVID-19. Arch Med Res 2023; 54:102868. [PMID: 37586114 DOI: 10.1016/j.arcmed.2023.102868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 07/07/2023] [Accepted: 08/02/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND COVID-19 is associated with systemic inflammation. This inflammatory response is further deregulated by oncological treatments increasing mortality in this population. However, there is conflicting information regarding the clinical factors that increase mortality in patients with severe COVID-19. OBJECTIVE The aim of this study was to identify prognostic factors associated with mortality during severe COVID-19 in patients with active cancer. In addition, the correlation between oncologic codes and mortality related to severe COVID-19 was evaluated. PATIENTS AND METHODS We analyzed a cohort of Mexican patients with active cancer and severe COVID-19 between March 2020 and February 2021. We collected information on patient demographic characteristics, COVID-19 symptoms, clinical and laboratory data, and treatments. Patients were classified according to oncologic code. We defined the oncological code based on clinical stage, treatment intention, performance status before COVID-19, and median overall survival with palliative treatment. A log-rank test was performed to determine survival. A multivariate logistic regression model was used to adjust for potential confounders. RESULTS One hundred fifty-two patients with severe COVID-19 were analyzed. The red oncologic code was associated with an increased risk of mortality OR 22.8 (CI 95% 5.0-105.1, p <0.001), low oxygen saturation OR 5.4 (CI 95% 1.7-17.4, p = 0.005), chronic corticosteriod use OR 4.3 (CI 95% 1.0-18.1, p = 0.050) and high D-dimer level OR 3.2 (CI 95% 1.2-8.2, p = 0.019). CONCLUSIONS The survival of patients with active cancer and severe COVID-19 was possible to identify, at the time of admission, specific oncological characteristics. Based on this code, decreased oxygen saturation, increased D-dimer levels, and chronic corticosteroid use were the main predictive factors related to mortality.
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Affiliation(s)
| | | | | | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Juan Torres
- Faculty of Medicine, Universidad Nacional Autónoma de Mexico, Mexico City, Mexico
| | - Silvia Allende
- Palliative Care Department, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Diana Vilar-Compte
- Department Infectious Disease, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Consuelo Díaz
- Medical Oncology Division, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Claudia Cano
- Medical Oncology Division, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Miguel Álvarez
- Medical Oncology Division, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Alejandro Mohar
- Cancer Epidemiology and Biomedical Research Unit, Instituto Nacional de Cancerología, Mexico City, Mexico; Biomedical Research Institute, Universidad Nacional Autónoma de Mexico, Mexico City, Mexico.
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19
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Sakai Y, Kawaguchi N, Arrieta O, Sato T. Data-driven cascade control system: Response estimation and controller design. ISA Trans 2023; 140:157-169. [PMID: 37330388 DOI: 10.1016/j.isatra.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/04/2023] [Accepted: 06/05/2023] [Indexed: 06/19/2023]
Abstract
In this study, we propose a data-driven design method for a cascade control system with inner and outer control loops. First, the input-output response of a controlled plant, which varies with the controller parameters of a fixed-structure inner-outer control law, is estimated directly from open-loop input-output data. Next, based on the estimated response, the controller parameters are optimized to minimize the difference between a reference model with a controlled closed-loop system. In the proposed method, the response of a fictitious reference input, which varies with the controller parameters, is estimated, and then the closed-loop response is estimated. Therefore, a closed-loop input-output data is not required, and the controller parameters are determined directly from an open-loop input-output data. Furthermore, the time constant of a reference model is also optimized so as to reduce the control error. The proposed method is compared with both conventional single-loop and cascade data-driven methods by means of numerical examples.
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Affiliation(s)
- Y Sakai
- Department of Mechanical Engineering, Graduate School of Engineering, University of Hyogo, 2167, Shosha, Himeji, Hyogo 671-2280, Japan.
| | - N Kawaguchi
- Department of Mechanical Engineering, Graduate School of Engineering, University of Hyogo, 2167, Shosha, Himeji, Hyogo 671-2280, Japan.
| | - O Arrieta
- Instituto de Investigaciones en Ingeniería, Facultad de Ingeniería, Universidad de Costa Rica, 11501-2060 San José, Costa Rica; Departament de Telecomunicació i d'Enginyeria de Sistemes, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain.
| | - T Sato
- Department of Mechanical Engineering, Graduate School of Engineering, University of Hyogo, 2167, Shosha, Himeji, Hyogo 671-2280, Japan.
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20
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Cárdenas-Fernández D, Soberanis Pina P, Turcott JG, Chávez-Tapia N, Conde-Flores E, Cardona AF, Arrieta O. Management of diarrhea induced by EGFR-TKIs in advanced lung adenocarcinoma. Ther Adv Med Oncol 2023; 15:17588359231192396. [PMID: 37655206 PMCID: PMC10467292 DOI: 10.1177/17588359231192396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/19/2023] [Indexed: 09/02/2023] Open
Abstract
The identification of Epidermal Growth Factor Receptor (EGFR) mutations in lung adenocarcinoma has facilitated the development of personalized medicine based on oncogenic drivers. EGFR-Tyrosine Kinase Inhibitors (TKIs) are part of the targeted therapy; they impede the phosphorylation of the intracellular tyrosine kinase component of EGFR and consequently block signal transduction pathways. These drugs inhibit the proliferation and survival of tumor cells, leading to long-term progression-free survival and overall survival. Diarrhea is one of the most frequent adverse events associated with EGFR-TKIs, affecting at least 18% of patients and reaching up to 95% in some cases. Diarrhea should be managed carefully given its association with important complications, treatment interruptions, and dose reductions. Moreover, nutritional status and quality of life (QoL) can deteriorate due to severe diarrhea. Changes in diet, such as increment of fiber, supplementation with glutamine, and use of probiotics, may contribute to a decrease in the incidence of diarrhea. Improving the control of diarrhea can provide a significant benefit to the QoL of patients.
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Affiliation(s)
| | | | - Jenny G. Turcott
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | - Emilio Conde-Flores
- Comprehensive Cancer Center, Medica Sur Clinic Foundation, Mexico City, Mexico
| | - Andrés F. Cardona
- Foundation for Clinical and Applied Cancer Research-FICMAC , Bogotá, Colombia
| | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, Av. San Fernando #22, Sección XVI, Tlalpan, Mexico City 14080, Mexico
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21
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Cardona AF, Chamorro Ortiz DF, Ruíz-Patiño A, Gomez D, Muñoz Á, Ardila DV, Garcia-Robledo JE, Ordóñez-Reyes C, Sussmann L, Mosquera A, Forero Y, Rojas L, Hakim F, Jimenez E, Ramón JF, Cifuentes H, Pineda D, Mejía JA, Rodríguez J, Archila P, Sotelo C, Moreno-Pérez DA, Arrieta O. DICER1-associated central nervous system sarcoma: A comprehensive clinical and genomic characterization of case series of young adult patients. Neurooncol Pract 2023; 10:381-390. [PMID: 37457227 PMCID: PMC10346402 DOI: 10.1093/nop/npad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Background DICER1 alterations are associated with intracranial tumors in the pediatric population, including pineoblastoma, pituitary blastoma, and the recently described "primary DICER1-associated CNS sarcoma" (DCS). DCS is an extremely aggressive tumor with a distinct methylation signature and a high frequency of co-occurring mutations. However, little is known about its treatment approach and the genomic changes occurring after exposure to chemoradiotherapy. Methods We collected clinical, histological, and molecular data from eight young adults with DCS. Genomic analysis was performed by Next-generation Sequencing (NGS). Subsequently, an additional germline variants analysis was completed. In addition, an NGS analysis on post-progression tumor tissue or liquid biopsy was performed when available. Multiple clinicopathological characteristics, treatment variables, and survival outcomes were assessed. Results Median age was 20 years. Most lesions were supratentorial. Histology was classified as fusiform cell sarcomas (50%), undifferentiated (unclassified) sarcoma (37.5%), and chondrosarcoma (12.5%). Germline pathogenic DICER1 variants were present in two patients, 75% of cases had more than one somatic alteration in DICER1, and the most frequent commutation was TP53. Seven patients were treated with surgery, Ifosfamide, Cisplatin, and Etoposide (ICE) chemotherapy and radiotherapy. The objective response was 75%, and the median time to progression (TTP) was 14.5 months. At progression, the most common mutations were in KRAS and NF1. Overall survival was 30.8 months. Conclusions DCS is an aggressive tumor with limited therapeutic options that requires a comprehensive diagnostic approach, including molecular characterization. Most cases had mutations in TP53, NF1, and PTEN, and most alterations at progression were related to MAPK, RAS and PI3K signaling pathways.
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Affiliation(s)
- Andrés F Cardona
- Direction of Research, Science and Education, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
| | - Diego Fernando Chamorro Ortiz
- Foundation for Clinical and Applied Cancer Research, FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Alejandro Ruíz-Patiño
- Foundation for Clinical and Applied Cancer Research, FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Diego Gomez
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Álvaro Muñoz
- Radiotherapy Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Dora V Ardila
- Foundation for Clinical and Applied Cancer Research, FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | | | - Camila Ordóñez-Reyes
- Foundation for Clinical and Applied Cancer Research, FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Liliana Sussmann
- Foundation for Clinical and Applied Cancer Research, FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Andrés Mosquera
- Foundation for Clinical and Applied Cancer Research, FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Yency Forero
- Foundation for Clinical and Applied Cancer Research, FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Leonardo Rojas
- Direction of Research, Science and Education, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
| | - Fernando Hakim
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Enrique Jimenez
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | | | | | - Diego Pineda
- Neuro-Radiology Section, Radiology Department, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center, CTIC, Bogotá, Colombia
| | | | - July Rodríguez
- Foundation for Clinical and Applied Cancer Research, FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Pilar Archila
- Foundation for Clinical and Applied Cancer Research, FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Carolina Sotelo
- Foundation for Clinical and Applied Cancer Research, FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Darwin A Moreno-Pérez
- Foundation for Clinical and Applied Cancer Research, FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Oscar Arrieta
- Personalized Oncology Laboratory, National Cancer Institute (INCan), México City, México
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Barrios-Bernal P, Hernández-Pedro N, Lara-Mejía L, Arrieta O. Obesity paradox and lung cancer, metformin-based therapeutic opportunity? Oncotarget 2023; 14:670-671. [PMID: 37395790 PMCID: PMC10317038 DOI: 10.18632/oncotarget.28432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Indexed: 07/04/2023] Open
Affiliation(s)
| | | | | | - Oscar Arrieta
- Correspondence to:Oscar Arrieta, Thoracic Oncology Functional Unit (UFOT), Laboratorio de Medicina Personalizada, Instituto Nacional de Cancerología, S.S.A., Mexico City 14080, Mexico email
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23
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Alvarado-Miranda A, Lara-Medina FU, Muñoz-Montaño WR, Zinser-Sierra JW, Galeana PAC, Garza CV, Sanchez Benitez D, Limón Rodríguez JA, Arce Salinas CH, Guijosa A, Arrieta O. Capecitabine Plus Aromatase Inhibitor as First Line Therapy for Hormone Receptor Positive, HER2 Negative Metastatic Breast Cancer. Curr Oncol 2023; 30:6097-6110. [PMID: 37504314 PMCID: PMC10377785 DOI: 10.3390/curroncol30070454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/29/2023] Open
Abstract
(1) Background: recent evidence suggests that long low-dose capecitabine regimens have a synergistic effect with endocrine therapy as aromatase inhibitors (AIs), and might increase overall survival for hormone-receptor-positive, HER2-negative, metastatic breast cancer compared to both treatments. We performed a retrospective study to confirm the efficacy and expand the safety data for capecitabine plus AI (a combination henceforth named XELIA) for this indication. (2) We conducted a single-center retrospective cohort study of 163 hormone receptor-positive metastatic breast cancer patients who received either the XELIA regimen, capecitabine, or an aromatase inhibitor (AI) as single agents in first-line treatment. The primary endpoint was progression-free survival, and the secondary endpoints were overall survival, best objective response, and toxicity incidence. (3) Results: the median progression-free survival for patients receiving XELIA, AI, and capecitabine was 29.37 months (20.91 to 37.84; 95% CI), 20.04 months (7.29 to 32.80; 95% CI) and 10.48 (8.69 to 12.28; 95% CI), respectively. The overall response rate was higher in the XELIA group (29.5%) than in the AI (14.3%) and capecitabine (9.1%) groups. However, the differences in overall survival were not statistically significant. Apart from hand-foot syndrome, there were no statistically significant differences in adverse events between the groups. (4) Conclusions: this retrospective study suggests that progression-free survival and overall response rates improved with the XELIA regimen compared to use of aromatase inhibitors and capecitabine alone. Combined use demonstrated an adequate safety profile and might represent an advantageous treatment in places where CDK 4/6 is not available. Larger studies and randomized clinical trials are required to confirm the effects shown in our study.
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Affiliation(s)
| | | | | | - Juan W Zinser-Sierra
- Gastrointestinal Oncology Unit, Instituto Nacional de Cancerología, Mexico City 14080, Mexico
| | | | - Cynthia Villarreal Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnológico de Monterrey, San Pedro Garza García 66278, Mexico
| | | | | | | | - Alberto Guijosa
- School of Medicine, Universidad Panamericana, Mexico City 03920, Mexico
| | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
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24
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Hernandez-Martinez JM, Rosell R, Arrieta O. Somatic and germline ATM variants in non-small-cell lung cancer: Therapeutic implications. Crit Rev Oncol Hematol 2023:104058. [PMID: 37343657 DOI: 10.1016/j.critrevonc.2023.104058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/16/2023] [Indexed: 06/23/2023] Open
Abstract
ATM is an apical kinase of the DNA damage response involved in the repair of DNA double-strand breaks. Germline ATM variants (gATM) have been associated with an increased risk of developing lung adenocarcinoma (LUAD), and approximately 9% of LUAD tumors harbor somatic ATM mutations (sATM). Biallelic carriers of pathogenic gATM exhibit a plethora of immunological abnormalities, but few studies have evaluated the contribution of immune dysfunction to lung cancer susceptibility. Indeed, little is known about the clinicopathological characteristics of lung cancer patients with sATM or gATM alterations. The introduction of targeted therapies and immunotherapies, and the increasing number of clinical trials evaluating treatment combinations, warrants a careful reexamination of the benefits and harms that different therapeutic approaches have had in lung cancer patients with sATM or gATM. This review will discuss the role of ATM in the pathogenesis of lung cancer, highlighting potential therapeutic approaches to manage ATM-deficient lung cancers.
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Affiliation(s)
- Juan-Manuel Hernandez-Martinez
- Thoracic Oncology Unit and Experimental Oncology Laboratory, Instituto Nacional de Cancerología de México (INCan); CONACYT-Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Rafael Rosell
- Institut d'Investigació en Ciències Germans Trias i Pujol, Badalona, Spain; (4)Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Oscar Arrieta
- Thoracic Oncology Unit and Experimental Oncology Laboratory, Instituto Nacional de Cancerología de México (INCan).
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25
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Chamorro DF, Cardona AF, Rodríguez J, Ruiz-Patiño A, Arrieta O, Moreno-Pérez DA, Rojas L, Zatarain-Barrón ZL, Ardila DV, Viola L, Recondo G, Blaquier JB, Martín C, Raez L, Samtani S, Ordóñez-Reyes C, Garcia-Robledo JE, Corrales L, Sotelo C, Ricaurte L, Cuello M, Mejía S, Jaller E, Vargas C, Carranza H, Otero J, Archila P, Bermudez M, Gamez T, Russo A, Malapelle U, de Miguel Perez D, de Lima VCC, Freitas H, Saldahna E, Rolfo C, Rosell R. Genomic Landscape of Primary Resistance to Osimertinib Among Hispanic Patients with EGFR-Mutant Non-Small Cell Lung Cancer (NSCLC): Results of an Observational Longitudinal Cohort Study. Target Oncol 2023; 18:425-440. [PMID: 37017806 DOI: 10.1007/s11523-023-00955-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) mutations (EGFRm) represent one of the most common genomic alterations identified among patients with non-small cell lung cancer (NSCLC). Several targeted agents for patients with EGFRm have been proven safe and effective, including the third-generation tyrosine kinase inhibitor (TKI) osimertinib. Nonetheless, some patients will present with or develop EGFR-TKI resistance mechanisms. OBJECTIVE We characterized the genomic landscape of primary resistance to osimertinib among Hispanic patients with EGFR-mutant NSCLC. METHODS An observational longitudinal cohort study was conducted with two groups of patients, those with intrinsic resistance (cohort A) and those with long-term survival (cohort B). All patients were treated and followed between January 2018 and May 2022. All patients were assessed for Programmed Cell Death Ligand 1 (PD-L1) expression and Bcl-2-like protein 11 (BIM)/AXL mRNA expression before starting TKI. After 8 weeks of treatment, a liquid biopsy was performed to determine the presence of circulating free DNA (cfDNA), and next-generation sequencing (NGS) was used to identify mutations at the time of progression. In both cohorts, overall response rate (ORR), progression-free survival (PFS), and overall survival (OS) were evaluated. RESULTS We found a homogeneous distribution of EGFR-sensitizing mutations in both cohorts. For cohort A, exon 21 mutations were more common than exon 19 deletions (ex19dels) for cohort B (P = 0.0001). The reported ORR for osimertinib was 6.3% and 100% for cohorts A and B, respectively (P = 0.0001). PFS was significantly higher in cohort B (27.4 months vs. 3.1 months; P = 0.0001) and ex19del patients versus L858R (24.5 months, 95% confidence interval [CI] 18.2-NR), vs. 7.6 months, 95% CI 4.8-21.1; P = 0.001). OS was considerably lower for cohort A (20.1 months vs. 36.0 months; P = 0.0001) and was better for patients with ex19del, no brain metastasis, and low tumor mutation burden. At the time of progression, more mutations were found in cohort A, identifying off-target alterations more frequently, including TP53, RAS, and RB1. CONCLUSION EGFR-independent alterations are common among patients with primary resistance to osimertinib and significantly impact PFS and OS. Our results suggest that among Hispanic patients, other variables associated with intrinsic resistance include the number of commutations, high levels AXL mRNA, and low levels of BIM mRNA, T790M de novo, EGFR p.L858R presence, and a high tumoral mutational burden.
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Affiliation(s)
- Diego F Chamorro
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Andrés F Cardona
- Direction of Research, Science, and Education, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Calle 168 # 14, 110221, Bogotá, Colombia.
- Thoracic Oncology Unit, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia.
| | - July Rodríguez
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Alejandro Ruiz-Patiño
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Oscar Arrieta
- Thoracic Oncology Unit and Personalized Oncology Laboratory, National Cancer Institute (INCan), México City, Mexico
| | - Darwin A Moreno-Pérez
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Leonardo Rojas
- Thoracic Oncology Unit and Personalized Oncology Laboratory, National Cancer Institute (INCan), México City, Mexico
| | - Zyanya Lucia Zatarain-Barrón
- Thoracic Oncology Unit and Personalized Oncology Laboratory, National Cancer Institute (INCan), México City, Mexico
| | - Dora V Ardila
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Lucia Viola
- Thoracic Oncology Unit, Fundación Neumológica Colombiana-FNC, Bogotá, Colombia
| | - Gonzalo Recondo
- Thoracic Oncology Unit, Centro de Educación Médica e Investigaciones Clinicas (CEMIC), Buenos Aires, Argentina
| | - Juan B Blaquier
- Thoracic Oncology Unit, Centro de Educación Médica e Investigaciones Clinicas (CEMIC), Buenos Aires, Argentina
| | - Claudio Martín
- Thoracic Oncology Unit, Alexander Fleming Institute, Buenos Aires, Argentina
| | - Luis Raez
- Thoracic Oncology Program, Memorial Cancer Institute, Florida Atlantic University (FAU), Miami, FL, USA
| | - Suraj Samtani
- Medical Oncology Department, Bradford Hill Institute, Santiago, Chile
| | - Camila Ordóñez-Reyes
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | | | - Luis Corrales
- Thoracic Oncology Unit, Centro de Investigación y Manejo del Cáncer-CIMCA, San José, Costa Rica
| | - Carolina Sotelo
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | | | - Mauricio Cuello
- Medical Oncology Department, Hospital de Clínicas, Universidad de la Republica-UdeLAR, Montevideo, Uruguay
| | - Sergio Mejía
- Toracic Oncology Unit, Oncology Department, Cancer Institute, Clínica de las Américas, Medellín, Colombia
| | - Elvira Jaller
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Carlos Vargas
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Hernán Carranza
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Jorge Otero
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Pilar Archila
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Maritza Bermudez
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Tatiana Gamez
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Alessandro Russo
- Medical Oncology Department, Azienda Ospedaliera Papardo, Messina, Sicilia, Italy
| | - Umberto Malapelle
- Predictive Molecular Pathology Laboratory, Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Diego de Miguel Perez
- Thoracic Oncology Center, Tisch Cáncer Center, Mount Sinai Hospital System & Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | | | - Helano Freitas
- Thoracic Oncology Unit, A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | - Erick Saldahna
- Thoracic Oncology Unit, A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | - Christian Rolfo
- Thoracic Oncology Center, Tisch Cáncer Center, Mount Sinai Hospital System & Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Rafael Rosell
- Cancer Biology and Precision Medicine Program, Germans Trias i Pujol Research Institute (IGTP)/Dr. Rosell Oncology Institute (IOR) Quirón-Dexeus University Institute, Barcelona, Spain
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Turcott J, Cárdenas-Fernandez D, Rodríguez-Mayoral O, Zatarain-Barrón L, Gutierrez-Torres S, Castañares D, Reyes E, Lopez D, Barragan P, Heredia D, Lara-Mejía L, Cardona A, Flores D, Arrieta O. Effect Of Mirtazapine On Energy Intake In Patients With Anorexia Associated With Non-Small Cell Lung Cancer. Clin Nutr ESPEN 2023. [DOI: 10.1016/j.clnesp.2022.09.048] [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: 03/28/2023]
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Cárdenas-Fernández D, Turcott J, Miyagui-Adame S, Gutierrez-Torres S, Arrieta O. Sarcopenia As A Predictive Factor Of Carboplatin Toxicity In Patients With Advanced Non-Small Cell Lung Cancer. Clin Nutr ESPEN 2023. [DOI: 10.1016/j.clnesp.2022.09.054] [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: 03/28/2023]
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Mimenza-Alvarado AJ, Arrieta O, Celis MA, Domínguez-Cherit J, Islas-Andrade S, Lifshitz A, Mansilla A, Martínez I, Moreno M, Reyes-Sánchez AA, Rocha-Arrieta LL, Ruiz-Argüelles GJ, Sotelo J, Verástegui E, Vilar-Compte D, Toussaint S. [Clinical research and the pharmaceutical industry]. GAC MED MEX 2023; 159. [PMID: 36857554 DOI: 10.24875/gmm.22000279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 03/03/2023] Open
Affiliation(s)
- Alberto J Mimenza-Alvarado
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Oscar Arrieta
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Miguel A Celis
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Judith Domínguez-Cherit
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Sergio Islas-Andrade
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Alberto Lifshitz
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Armando Mansilla
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Iris Martínez
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Mucio Moreno
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Alejandro A Reyes-Sánchez
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Luisa L Rocha-Arrieta
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Guillermo J Ruiz-Argüelles
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Julio Sotelo
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Emma Verástegui
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Diana Vilar-Compte
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Sonia Toussaint
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
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Arrieta O, Hernández-Pedro N, Maldonado F, Ramos-Ramírez M, Yamamoto-Ramos M, López-Macías D, Lozano F, Zatarain-Barrón ZL, Turcott JG, Barrios-Bernal P, Orozco-Morales M, Flores-Estrada D, Cardona AF, Rolfo C, Cacho-Díaz B. Nitroglycerin Plus Whole Intracranial Radiation Therapy for Brain Metastases in Patients With Non-Small Cell Lung Cancer: A Randomized, Open-Label, Phase 2 Clinical Trial. Int J Radiat Oncol Biol Phys 2023; 115:592-607. [PMID: 35157994 DOI: 10.1016/j.ijrobp.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE Hypoxia has been associated with chemoradioresistance secondary to vascular endothelial growth factor receptor induced by hypoxia-induced factor (HIF). Nitroglycerin (NTG) can reduce HIF-1 in tissues, and this may have antiangiogenic, proapoptotic, and antiefflux effects. Particularly, epidermal growth factor-mutated (EGFRm) tumor cell lines have been shown to overexpress both vascular endothelial growth factor and HIF. In this phase 2 study, we evaluated the effect of transdermal NTG plus whole brain radiation therapy (WBRT) in patients with non-small cell lung cancer (NSCLC) with brain metastases (BM). METHODS This was an open-label, phase 2 clinical trial with 96 patients with NSCLC and BM. Patients were randomized 1:1 to receive NTG plus WBRT (30 Gy in 10 fractions) or WBRT alone. The primary endpoint was intracranial objective response rate (iORR) evaluated 3 months posttreatment. NTG was administered using a transdermal 36-mg patch from Monday through Friday throughout WBRT administration (10 days). The protocol was retrospectively registered at ClinicalTrials.gov (NCT04338867). RESULTS Fifty patients were allocated to the control group, and 46 were allocated to the experimental group (NTG); among these, 26 (52%) had EGFRm in the control group and 21 (45.7%) had EGFRm in the NTG arm. In terms of the iORR, patients in the NTG group had a significantly higher response compared with controls (56.5% [n = 26/46 evaluable patients] vs 32.7% [n = 16/49 evaluable patients]; relative risk, 1.73; 95% confidence interval [CI], 1.08-2.78; P = .024). Additionally, patients who received NTG + WBRT had an independently prolonged intracranial progression-free survival (ICPFS) compared with those who received WBRT alone (27.7 vs 9.6; hazard ratio [HR], 0.5; 95% CI, 0.2-0.9; P = .020); this positively affected overall progression-free survival among patients who received systemic therapy (n = 88; HR, 0.5; 95% CI, 0.2-0.9; P = .043). The benefit of ICPFS (HR, 0.4; 95% CI, 0.2-0.9; P = .030) was significant in the EGFRm patient subgroup. No differences were observed in overall survival. A significantly higher rate of vomiting presented in the NTG arm of the study (P = .016). CONCLUSIONS The concurrent administration of NTG and radiation therapy improves iORR and ICPFS among patients with NSCLC with BM. The benefit in ICPFS is significant in the EGFRm patient subgroup.
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Affiliation(s)
- Oscar Arrieta
- Thoracic Oncology Unit and Laboratory of Personalized Medicine.
| | - Norma Hernández-Pedro
- Thoracic Oncology Unit and Laboratory of Personalized Medicine; Personalized Medicine Laboratory
| | - Federico Maldonado
- Department of Radio-Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | | | | | - Francisco Lozano
- Department of Radio-Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - Jenny G Turcott
- Thoracic Oncology Unit and Laboratory of Personalized Medicine
| | | | | | | | - Andrés F Cardona
- Clinical and Translational Oncology Group, Fundación Santa Fe de Bogotá, Bogotá, Colombia; Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia
| | - Christian Rolfo
- Marlene and Stewart Greenbaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland
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de Miguel-Perez D, Russo A, Gunasekaran M, Buemi F, Hester L, Fan X, Carter-Cooper BA, Lapidus RG, Peleg A, Arroyo-Hernández M, Cardona AF, Naing A, Hirsch FR, Mack PC, Kaushal S, Serrano MJ, Adamo V, Arrieta O, Rolfo C. Baseline extracellular vesicle TGF-β is a predictive biomarker for response to immune checkpoint inhibitors and survival in non-small cell lung cancer. Cancer 2023; 129:521-530. [PMID: 36484171 DOI: 10.1002/cncr.34576] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 07/25/2022] [Revised: 10/09/2022] [Accepted: 10/24/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Immune-checkpoint inhibitors (ICIs) are an effective therapeutic strategy, improving the survival of patients with lung cancer compared with conventional treatments. However, novel predictive biomarkers are needed to stratify which patients derive clinical benefit because the currently used and highly heterogenic histological PD-L1 has shown low accuracy. Liquid biopsy is the analysis of biomarkers in body fluids and represents a minimally invasive tool that can be used to monitor tumor evolution and treatment effects, potentially reducing biases associated with tumor heterogeneity associated with tissue biopsies. In this context, cytokines, such as transforming growth factor-β (TGF-β), can be found free in circulation in the blood and packaged into extracellular vesicles (EVs), which have a specific delivery tropism and can affect in tumor/immune system interaction. TGF-β is an immunosuppressive cytokine that plays a crucial role in tumor immune escape, treatment resistance, and metastasis. Thus, we aimed to evaluate the predictive value of circulating and EV TGF-β in patients with non-small-cell lung cancer receiving ICIs. METHODS Plasma samples were collected in 33 patients with advanced non-small-cell lung cancer before and during treatment with ICIs. EV were isolated from plasma by serial ultracentrifugation methods and circulating and EV TGF-β expression levels were evaluated by enzyme-linked immunosorbent assay. RESULTS Baseline high expression of TGF-β in EVs was associated with nonresponse to ICIs as well as shorter progression-free survival and overall survival, outperforming circulating TGF-β levels and tissue PD-L1 as a predictive biomarker. CONCLUSION If validated, EV TGF-β could be used to improve patient stratification, increasing the effectiveness of treatment with ICIs and potentially informing combinatory treatments with TGF-β blockade. PLAIN LANGUAGE SUMMARY Treatment with immune-checkpoint inhibitors (ICIs) has improved the survival of some patients with lung cancer. However, the majority of patients do not benefit from this treatment, making it essential to develop more reliable biomarkers to identify patients most likely to benefit. In this pilot study, the expression of transforming growth factor-β (TGF-β) in blood circulation and in extracellular vesicles was analyzed. The levels of extracellular vesicle TGF-β before treatment were able to determine which patients would benefit from treatment with ICIs and have a longer survival with higher accuracy than circulating TGF-β and tissue PD-L1, which is the currently used biomarker in clinical practice.
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Affiliation(s)
- Diego de Miguel-Perez
- Center for Thoracic Oncology, Tisch Cancer Institute, Mount Sinai Medical System & Icahn School of Medicine, Mount Sinai, New York, New York, USA.,Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Alessandro Russo
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Medical Oncology Unit, A.O. Papardo & Department of Human Pathology, University of Messina, Messina, Italy
| | - Muthukumar Gunasekaran
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Departments of Surgery and Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Francesco Buemi
- Medical Oncology Unit, A.O. Papardo & Department of Human Pathology, University of Messina, Messina, Italy
| | - Lisa Hester
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Xiaoxuan Fan
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Brandon A Carter-Cooper
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Rena G Lapidus
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ariel Peleg
- Center for Thoracic Oncology, Tisch Cancer Institute, Mount Sinai Medical System & Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | | | - Andres F Cardona
- Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC)/Foundation for Clinical and Applied Cancer Research (FICMAC)/Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogota, Colombia
| | - Aung Naing
- Departments of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Fred R Hirsch
- Center for Thoracic Oncology, Tisch Cancer Institute, Mount Sinai Medical System & Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Philip C Mack
- Center for Thoracic Oncology, Tisch Cancer Institute, Mount Sinai Medical System & Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Sunjay Kaushal
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Departments of Surgery and Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Maria Jose Serrano
- GENYO Centre for Genomics and Oncological Research, Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain
| | - Vincenzo Adamo
- Medical Oncology Unit, A.O. Papardo & Department of Human Pathology, University of Messina, Messina, Italy
| | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Christian Rolfo
- Center for Thoracic Oncology, Tisch Cancer Institute, Mount Sinai Medical System & Icahn School of Medicine, Mount Sinai, New York, New York, USA.,Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Islas-Andrade S, Rocha-Arrieta LL, Arrieta O, Celis MA, Domínguez-Cherit J, Lifshitz A, Mansilla-Olivares A, Martínez I, Mimenza-Alvarado AJ, Moreno M, Reyes-Sánchez A, Ruiz-Argüelles GJ, Soda-Merhy A, Sotelo J, Toussaint S, Vilar-Compte D, Verástegui E. Cannabinoides y su uso terapéutico. GAC MED MEX 2023. [DOI: 10.24875/gmm.22000184] [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: 02/11/2023] Open
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Belgers V, Röttgering JG, Douw L, Klein M, Ket JC, van de Ven PM, Würdinger T, van Linde ME, Niers JM, Weber M, Olde Rikkert MG, Lopez-Sendon J, Arrieta O, Svendsen KB, Chagas MH, de Almeida CM, Kouwenhoven MC, de Witt Hamer PC. Cannabinoids to Improve Health-Related Quality of Life in Patients with Neurological or Oncological Disease: A Meta-Analysis. Cannabis Cannabinoid Res 2023; 8:41-55. [PMID: 35861789 PMCID: PMC9940814 DOI: 10.1089/can.2021.0187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Cannabinoids have been suggested to alleviate frequently experienced symptoms of reduced mental well-being such as anxiety and depression. Mental well-being is an important subdomain of health-related quality of life (HRQoL). Reducing symptoms and maintaining HRQoL are particularly important in malignant primary brain tumor patients, as treatment options are often noncurative and prognosis remains poor. These patients frequently report unprescribed cannabinoid use, presumably for symptom relieve. As studies on brain tumor patients specifically are lacking, we performed a meta-analysis of the current evidence on cannabinoid efficacy on HRQoL and mental well-being in oncological and neurological patients. Methods: We performed a systematic PubMed, PsychINFO, Embase, and Web of Science search according to PRISMA guidelines on August 2 and 3, 2021. We included randomized controlled trials (RCTs) that assessed the effects of tetrahydrocannabinol (THC) or cannabidiol (CBD) on general HRQoL and mental well-being. Pooled effect sizes were calculated using Hedges g. Risk of bias of included studies was assessed using Cochrane's Risk of Bias tool. Results: We included 17 studies: 4 in oncology and 13 in central nervous system (CNS) disease. Meta-analysis showed no effect of cannabinoids on general HRQoL (g=-0.02 confidence interval [95% CI -0.11 to 0.06]; p=0.57) or mental well-being (g=-0.02 [95% CI -0.16 to 0.13]; p=0.81). Conclusions: RCTs in patients with cancer or CNS disease showed no effect of cannabinoids on HRQoL or mental well-being. However, studies were clinically heterogeneous and since many glioma patients currently frequently use cannabinoids, future studies are necessary to evaluate its value in this specific population.
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Affiliation(s)
- Vera Belgers
- Department of Neurology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Brain Tumor Center Amsterdam, Amsterdam, The Netherlands
- Address correspondence to: Vera Belgers, MSc, MD, Department of Neurology, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081HV, The Netherlands,
| | - Jantine G. Röttgering
- Cancer Center Amsterdam, Brain Tumor Center Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology and Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Linda Douw
- Cancer Center Amsterdam, Brain Tumor Center Amsterdam, Amsterdam, The Netherlands
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Martin Klein
- Cancer Center Amsterdam, Brain Tumor Center Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology and Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Johannes C.F. Ket
- Department of Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Peter M. van de Ven
- Department of Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Thomas Würdinger
- Cancer Center Amsterdam, Brain Tumor Center Amsterdam, Amsterdam, The Netherlands
- Department of Neurosurgery, and Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Myra E. van Linde
- Cancer Center Amsterdam, Brain Tumor Center Amsterdam, Amsterdam, The Netherlands
- Department of Medical Oncology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Johanna M. Niers
- Department of Neurology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Brain Tumor Center Amsterdam, Amsterdam, The Netherlands
| | - Markus Weber
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Marcel G. Olde Rikkert
- Departments of Geriatric Medicine/Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jose Lopez-Sendon
- Department of Neurology, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Oscar Arrieta
- Thoracic Oncology Unit and Experimental Oncology Laboratory, Instituto Nacional de Cancerología de México (INCan), Tlalpan, México
| | | | - Marcos H.N. Chagas
- Department of Gerontology, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Carlos M.O. de Almeida
- Bairral Institute of Psychiatry, Itapira, Brazil (M.H.N.C.)
- School of Health Sciences, State University of Amazonas, Manaus, Amazon, Brazil
| | - Mathilde C.M. Kouwenhoven
- Department of Neurology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Brain Tumor Center Amsterdam, Amsterdam, The Netherlands
| | - Philip C. de Witt Hamer
- Cancer Center Amsterdam, Brain Tumor Center Amsterdam, Amsterdam, The Netherlands
- Department of Neurosurgery, and Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Cifuentes C, Lombana M, Vargas H, Laguado P, Ruiz-Patiño A, Rojas L, Navarro U, Vargas C, Ricaurte L, Arrieta O, Zatarain-Barron L, Zapata L, González G, Ortiz C, Bernal L, Restrepo JG, Viola L, Grosso F, Zapata R, Mantilla W, Carranza H, Bustillo I, Llinas N, Duarte R, Rodríguez J, Archila P, Ávila J, Bermúdez M, Gámez T, Sotelo C, Otero J, Forero E, Lema M, Limpias C, Ordóñez-Reyes C, Mejía S, Rolfo C, Rosell R, Cardona AF. Application of Comprehensive Genomic Profiling-Based Next-Generation Sequencing Assay to Improve Cancer Care in a Developing Country. Cancer Control 2023; 30:10732748231175256. [PMID: 37148308 PMCID: PMC10164853 DOI: 10.1177/10732748231175256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Abstract
PURPOSE Identifying actionable oncogenic mutations have changed the therapeutic landscape in different types of tumors. This study investigated the utility of comprehensive genomic profiling (CGP), a hybrid capture-based next-generation sequencing (NGS) assay, in clinical practice in a developing country. METHODS In this retrospective cohort study, CGP was performed on clinical samples from patients with different solid tumors recruited between December 2016 and November 2020, using hybrid capture-based genomic profiling, at the individual treating physicians' request in the clinical care for therapy decisions. Kaplan-Meier survival curves were estimated to characterize the time-to-event variables. RESULTS Patients median age was 61 years (range: 14-87 years), and 64.7% were female. The most common histological diagnosis was lung primary tumors, with 90 patients corresponding to 52.9% of the samples (95% CI 45.4-60.4%). Actionable mutations with FDA-approved medications for specific alterations correspondent to tumoral histology were identified in 58 cases (46.4%), whereas other alterations were detected in 47 different samples (37.6%). The median overall survival was 15.5 months (95% CI 11.7 months-NR). Patients who were subjected to genomic evaluation at diagnosis reached a median overall survival of 18.3 months (95% CI 14.9 months-NR) compared to 14.1 months (95% CI 11.1 months-NR) in patients who obtained genomic evaluation after tumor progression and during standard treatment (P = .7). CONCLUSION CGP of different types of tumors identifies clinically relevant genomic alterations that have benefited from targeted therapy and improve cancer care in a developing country to guide personalized treatment to beneficial outcomes of cancer patients.
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Affiliation(s)
- Claudia Cifuentes
- Clinical Oncology Department, Hospital Universitario Mayor de Mederi, Bogotá, Colombia
| | - Milton Lombana
- Hematology and Oncology Department, Clínica de Occidente, Cali, Colombia
| | - Henry Vargas
- Oncology Department, Clínica Colsanitas, Bogotá, Colombia
| | - Paola Laguado
- Clinical Research Institute, Clínica del Country, Bogotá Colombia
| | - Alejandro Ruiz-Patiño
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Leonardo Rojas
- Oncology Department, Clínica Colsanitas, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
- Clinical Oncology Department, Clínica del Country, Bogotá, Colombia
| | - Uriel Navarro
- Clinical Oncology Department, Clínica General del Norte, Barranquilla, Colombia
| | - Carlos Vargas
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
- Clinical Oncology Department, Clínica del Country, Bogotá, Colombia
| | | | - Oscar Arrieta
- Thoracic Oncology Unit, National Cancer Institute (INCan), México City, México
| | | | - Leandro Zapata
- Oncology Department, San Vicente Fundación, Medellín, Colombia
| | - Guido González
- Centro Integral del Cáncer, Clínica de Occidente, Cali, Colombia
| | - Carlos Ortiz
- Clinical Oncology Department, Clínica del Country, Bogotá, Colombia
| | - Laura Bernal
- Oncology Department, Clínica Colsanitas, Bogotá, Colombia
- Clinical Oncology Department, Clínica Marly, Bogotá, Colombia
| | - Juan G Restrepo
- Oncology Department, Fundación Valle de Lili, Cali, Colombia
| | - Lucia Viola
- Thoracic Oncology Unit, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - Fabio Grosso
- Oncology Department, Medical Plus, Bogotá, Colombia
| | - Ricardo Zapata
- Oncology Department, Clínica Cardio-VID, Medellín, Colombia
| | - William Mantilla
- Hematology and Oncology Department, Fundación Cardio Infantil, Bogotá, Colombia
| | - Hernán Carranza
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
- Clinical Oncology Department, Clínica del Country, Bogotá, Colombia
| | - Iván Bustillo
- Oncology Department, Clínica Porto Azul, Barranquilla, Colombia
| | - Néstor Llinas
- Oncology Department, Clínica Vida, Medellín, Colombia
| | - Ricardo Duarte
- Oncology Department, Clínica Colsanitas, Bogotá, Colombia
| | - July Rodríguez
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Pilar Archila
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Jenny Ávila
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Maritza Bermúdez
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Tatiana Gámez
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Carolina Sotelo
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Jorge Otero
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Elkin Forero
- Clinical Oncology Department, Hospital Universitario Mayor de Mederi, Bogotá, Colombia
| | - Mauricio Lema
- Hematology and Oncology Department, Clínica Astorga, Medellín, Colombia
| | | | - Camila Ordóñez-Reyes
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Sergio Mejía
- Clinical Oncology Department, San Vicente Fundación, Medellín, Colombia
| | - Christian Rolfo
- Thoracic Oncology Center, Icahn School of Medicine at Mount Sinai Tisch Cáncer Center, Mount Sinai Hospital System, New York, NY, US
| | - Rafael Rosell
- Cancer Biology and Precision Medicine Program, Catalan Institute of Oncology, Barcelona, Spain
| | - Andrés F Cardona
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
- Direction of Research, Science and Education, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
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Verástegui E, Páez R, Arrieta O. Towards objectivity in ethical assessment: legibility as part of informed consent form comprehension. GAC MED MEX 2023; 159:426-431. [PMID: 38096850 DOI: 10.24875/gmm.m23000823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/06/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The experience on informed consent form (ICF) readability at the Research Ethics Committee of the National Institute of Cancerology of Mexico (INCan) is described. OBJECTIVE To evaluate the readability of a randomly-selected sample of ICFs submitted for review between March 1, 2022 and March 31, 2023. The number of pages, the time the reader takes to read the text and the level of education necessary to understand it were determined. RESULTS More than half the ICFs from internal investigations were shown to be somewhat or very difficult to read; the level of education required to understand them was up to 9.9 years, and the reading time was short. The ICF texts from international multicenter investigations were aimed at an average education level of 5.5 years and had normal readability. Most ICFs from external trials require a reading time of more than 60 minutes per ICF. CONCLUSION It is necessary to have tools that provide objectivity to the evaluation of ICFs under investigation by ethics committees, which should be indicators of their comprehension, such as readability of the documents.
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Affiliation(s)
- Emma Verástegui
- Palliative Care Department, Instituto Nacional de Cancerología
| | - Ricardo Páez
- Bioethics Master's Degree and Doctorate Program, Universidad Nacional Autónoma de México
| | - Oscar Arrieta
- General Directorate, Instituto Nacional de Cancerología. Mexico City, Mexico
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35
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Ruiz-Argüelles GJ, Rocha-Arrieta LL, Arrieta O, Celis MA, Domínguez-Cherit J, Islas-Andrade S, Lifshitz A, Mansilla-Olivares A, Martínez I, Mimenza AJ, Moreno M, Reyes-Sánchez AA, Soda-Merhy A, Sotelo J, Toussaint S, Vilar-Compte D, Verástegui E. Some reflections about physicians' updating. GAC MED MEX 2023; 159:278-279. [PMID: 37699210 DOI: 10.24875/gmm.m23000791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/30/2023] [Indexed: 09/14/2023] Open
Affiliation(s)
- Guillermo J Ruiz-Argüelles
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Luisa L Rocha-Arrieta
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Oscar Arrieta
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Miguel A Celis
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Judith Domínguez-Cherit
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Sergio Islas-Andrade
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Alberto Lifshitz
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Armando Mansilla-Olivares
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Iris Martínez
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Alberto José Mimenza
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Mucio Moreno
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Alejandro A Reyes-Sánchez
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Antonio Soda-Merhy
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Julio Sotelo
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Sonia Toussaint
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Diana Vilar-Compte
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Emma Verástegui
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
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Soberanis Pina P, Lara-Mejía L, Matias-Cruz V, Barrón F, Cardona AF, Raez LE, Rios-Garcia E, Arrieta O. Case report: Osimertinib administration during pregnancy in a woman with advanced EGFR-mutant non-small cell lung cancer. Front Oncol 2023; 13:1108124. [PMID: 37035182 PMCID: PMC10079944 DOI: 10.3389/fonc.2023.1108124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Lung cancer (LC) is one of the most common causes of death worldwide. The identification of oncogene-addicted driving mutations suitable for targeted therapy has improved clinical outcomes in advanced diseases. Clinical trials, on the other hand, rarely involve vulnerable groups such as pregnant women. We report a 37-year-old woman with advanced non-small cell lung cancer (NSCLC) harboring an exon 19 deletion of EGFR treated with afatinib. After the initial treatment, the patient achieved a complete response and had an unplanned pregnancy. Targeted therapy was withheld during the first trimester and resumed with osimertinib in the second trimester in which the patient developed oligohydramnios and intrauterine growth restriction (IUGR) of the baby. Osimertinib was delayed at two different times during the third trimester with complete resolution of the oligohydramnios. The baby was born at 37.3 weeks of gestation (WOG) with no signs of congenital disorders. After delivery, the mother restarted osimertinib and maintained a complete response. This case suggests that osimertinib could be an acceptable option for tumor control during pregnancy in EGFR-mutant NSCLC. This information do not replace current recommendations for avoiding pregnancy and promoting contraceptive usage in patients receiving any cancer therapy.
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Affiliation(s)
- Pamela Soberanis Pina
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Luis Lara-Mejía
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Venecia Matias-Cruz
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Feliciano Barrón
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Andrés F. Cardona
- Direction of Research and Education, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center - CTIC, Bogotá, Colombia
| | - Luis E. Raez
- Thoracic Oncology Program, Memorial Cancer Institute/Florida Atlantic University, Miami, FL, United States
| | - Eduardo Rios-Garcia
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Oscar Arrieta
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
- *Correspondence: Oscar Arrieta, ;
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37
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Avilés-Salas A, Vélez-Valle A, Bryon-Gallego A, Arrieta O. [Pulmonary lymphoepithelioma-like carcinoma with expression of Epstein-Barr virus and PD-L1]. Medicina (B Aires) 2023; 83:319-323. [PMID: 37094205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
Pulmonary lymphoepithelioma-like carcinoma is a rare type of non-small cell lung cancer, it accounts for approximately 0.7% of all cases. It is usually associated with Epstein-Barr virus infection and is more prevalent in Southeast Asia; however, it is extremely rare in Latin America. We present a 65-year-old man with a primary pulmonary lymphoepithelioma-like carcinoma, who presented with cough, dyspnoea and weight loss. Computer tomographic scan of the thorax showed a nodule localized in the right lung. A transthoracic biopsy of the lung lesion was made and the microscopic observation revealed large polygonal cells that proliferated in a nest pattern with infiltration by lymphocytes and plasma cells around the interstitium. The tumour cells were positive for citokeratin 5/6 and p63, and negative for Napsin A and thyroid transcription factor 1 (TTF-1). PD-L1 expression was positive (approximately 100%) in the immunohistochemical study, and the nuclei of the tumour cells were positive for EBV-encoded small RNA in-situ hybridization (EBER-ISH). The patient underwent six cycles of platinum-based combination (gencitabine/ carboplatin) chemotherapy plus durvalumab. He presented progression of the disease and finally he died 9 months after diagnosis.
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Affiliation(s)
- Alejandro Avilés-Salas
- Departamento de Patología, Instituto Nacional de Cancerología, México. E-mail:
- Facultad de Medicina, Universidad Nacional Autónoma de México, México
| | - Alina Vélez-Valle
- Departamento de Patología, Instituto Nacional de Cancerología, México
| | | | - Oscar Arrieta
- 2Departamento de Oncología Torácica, Instituto Nacional de Cancerología, México
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38
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Islas-Andrade S, Rocha-Arrieta LL, Arrieta O, Celis MA, Domínguez-Cherit J, Lifshitz A, Mansilla-Olivares A, Martínez I, Mimenza AJ, Moreno M, Reyes-Sánchez AA, Ruiz-Argüelles GJ, Soda-Merhy A, Sotelo J, Toussaint S, Vilar-Compte D, Verástegui E. Cannabinoids and their therapeutic use. GAC MED MEX 2023; 159:1-2. [PMID: 36930563 DOI: 10.24875/gmm.m22000731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Affiliation(s)
- Sergio Islas-Andrade
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Luisa L Rocha-Arrieta
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Oscar Arrieta
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Miguel A Celis
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Judith Domínguez-Cherit
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Alberto Lifshitz
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Armando Mansilla-Olivares
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Iris Martínez
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Alberto José Mimenza
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Mucio Moreno
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Alejandro A Reyes-Sánchez
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Guillermo J Ruiz-Argüelles
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Antonio Soda-Merhy
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Julio Sotelo
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Sonia Toussaint
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Diana Vilar-Compte
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Emma Verástegui
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
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39
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Mimenza-Alvarado AJ, Arrieta O, Celis MA, Domínguez-Cherit J, Islas-Andrade S, Lifshitz A, Mansilla A, Martínez I, Moreno M, Reyes-Sánchez AA, Rocha-Arrieta LL, Argüelles GJR, Sotelo J, Verástegui E, Vilar-Compte D, Toussaint S. Clinical research and the pharmaceutical industry. GAC MED MEX 2023; 159:89-90. [PMID: 37094241 DOI: 10.24875/gmm.m22000754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Affiliation(s)
- Alberto J Mimenza-Alvarado
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Oscar Arrieta
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Miguel A Celis
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Judith Domínguez-Cherit
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Sergio Islas-Andrade
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Alberto Lifshitz
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Armando Mansilla
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Iris Martínez
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Mucio Moreno
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Alejandro A Reyes-Sánchez
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Luisa L Rocha-Arrieta
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Guillermo J Ruiz Argüelles
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Julio Sotelo
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Emma Verástegui
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Diana Vilar-Compte
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Sonia Toussaint
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
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40
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Avilés-Salas A, Vélez-Valle A, Fernández-Vargas OE, Arrieta O. [Primary mediastinal myelolipoma]. Medicina (B Aires) 2023; 83:455-458. [PMID: 37379542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023] Open
Abstract
Myelolipoma is a benign non-functional tumor. Most of them are asymptomatic and discovered incidentally, either through imaging studies or at autopsy. While it most commonly occurs in the adrenal gland, it has also been reported at extra-adrenal sites. We present the case of a 65-year-old woman with a primary mediastinal myelolipoma. Computer tomographic scan of the thorax showed an ovoid tumor with well-defined borders of 6.5 × 4.2 cm, located in the posterior mediastinum. A transthoracic biopsy of the lesion was made, and the microscopic observation revealed hematopoietic cells and mature adipose tissue. Although computed tomography and magnetic resonance imaging are effective in diagnosing mediastinal myelolipoma, histopathological examination is essential for the definitive diagnosis.
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Affiliation(s)
- Alejandro Avilés-Salas
- Departamento de Patología, Instituto Nacional de Cancerología, México. E-mail:
- Facultad de Medicina, Universidad Nacional Autónoma de México, México
| | - Alina Vélez-Valle
- Departamento de Patología, Instituto Nacional de Cancerología, México
| | | | - Oscar Arrieta
- Departamento de Oncología Torácica, Instituto Nacional de Cancerología, México
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41
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Avilés-Salas A, Díaz-García DA, Lara-Mejía L, Cardona AF, Orozco-Morales M, Catalán R, Hernández-Pedro NY, Rios-Garcia E, Ramos-Ramírez M, Arrieta O. LKB1 Loss Assessed by Immunohistochemistry as a Prognostic Marker to First-Line Therapy in Advanced Non-Small-Cell Lung Cancer. Curr Oncol 2022; 30:333-343. [PMID: 36661676 PMCID: PMC9857995 DOI: 10.3390/curroncol30010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
(1) Background: Liver kinase B1 (LKB1) is a tumor suppressor gene involved in cell growth and metabolism. However, its alterations are not routinely assessed for guiding therapy in clinical practice. We assessed LKB1 expression by immunohistochemistry as a potential biomarker. (2) Methods: This bicentric retrospective cohort study analyzed data from patients with advanced NSCLC who initiated platinum-based chemotherapy or epidermal growth factor receptor- tyrosine kinase inhibitor (EGFR-TKI) between January 2016 and December 2020. Kaplan-Meier and Cox regression models were used for survival curves and multivariate analysis. (3) Results: 110 patients were evaluated, and the clinical stage IV predominated the lung adenocarcinoma histology. LKB1 loss was observed in 66.3% of cases. LKB1 loss was associated with non-smokers, the absence of wood smoke exposure and an EGFR wild-type status. The median progression-free survival (PFS) and overall survival (OS) in the population were 11.1 and 26.8 months, respectively, in the loss group, compared with cases exhibiting a positive expression. After an adjustment by age, smoking status, Eastern Cooperative Oncology Group Performance Score (ECOG-PS), EGFR status and type of administered therapy, LKB1 loss was significantly associated with worse PFS and OS. (4) Conclusion: Patients with an LKB1 loss had worse clinical outcomes. This study warrants prospective assessments to confirm the prognostic role of the LKB1 expression in advanced NSCLC.
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Affiliation(s)
- Alejandro Avilés-Salas
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
| | - Diego A. Díaz-García
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
- Personalized Medicine Laboratory, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
| | - Luis Lara-Mejía
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
| | - Andrés F. Cardona
- Direction of Research and Education, Luis Carlos Sarmeinto Angulo Cancer Treatment and Research Center—CTIC, Bogotá 110131, Colombia
| | - Mario Orozco-Morales
- Personalized Medicine Laboratory, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
- Neuroimmunology Laboratory, Instituto Nacional de Neurología y Neurocirugía, Mexico City 14269, Mexico
| | - Rodrigo Catalán
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
- Personalized Medicine Laboratory, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
| | - Norma Y. Hernández-Pedro
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
- Personalized Medicine Laboratory, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
| | - Eduardo Rios-Garcia
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
- Personalized Medicine Laboratory, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
| | - Maritza Ramos-Ramírez
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
- Personalized Medicine Laboratory, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
| | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
- Personalized Medicine Laboratory, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
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42
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Moreno M, Arrieta O, Celis MA, Domínguez J, Islas-Andrade S, Lifshitz A, Mansilla-Olivares A, Martínez I, Mimenza-Alvarado AJ, Reyes-Sánchez A, Ruiz-Argüelles GJ, Soda-Merhy A, Verástegui E, Rocha-Arrieta LL, Toussaint S, Vilar-Compte D, Sotelo J. Who judges medical practice? GAC MED MEX 2022; 158:332-334. [PMID: 36572021 DOI: 10.24875/gmm.m22000704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Lawsuits due to patient perception of inappropriate medical actions are a growing reality in medical practice, which entails widespread concern in the medical community. Lawsuits often entail additional circumstances beyond the primary concern of preventing or sanctioning acts of medical negligence. CETREMI proposes various recommendations aimed at legal and medical professionals to improve this circumstance and avoid harming the doctor-patient relationship.
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Affiliation(s)
- Mucio Moreno
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Oscar Arrieta
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Miguel A Celis
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Judith Domínguez
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Sergio Islas-Andrade
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Alberto Lifshitz
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Armando Mansilla-Olivares
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Iris Martínez
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Alberto J Mimenza-Alvarado
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Alejandro Reyes-Sánchez
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Guillermo J Ruiz-Argüelles
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Antonio Soda-Merhy
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Emma Verástegui
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Luisa L Rocha-Arrieta
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Sonia Toussaint
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Diana Vilar-Compte
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Julio Sotelo
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
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43
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Lifshitz A, Arrieta O, Celis MA, Domínguez-Cherit J, Islas-Andrade S, Mansilla-Olivares A, Martínez I, Mimenza-Alvarado AJ, Reyes-Sánchez AA, Rocha-Arrieta LL, Ruiz-Argüelles GJ, Soda-Merhy A, Sotelo-Morales J, Toussaint S, Vilar-Compte D, Verástegui E. Role of individual physicians in pharmacovigilance. GAC MED MEX 2022; 158:257-258. [PMID: 36572037 DOI: 10.24875/gmm.m22000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Alberto Lifshitz
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Oscar Arrieta
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Miguel A Celis
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Judith Domínguez-Cherit
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Sergio Islas-Andrade
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Armando Mansilla-Olivares
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Iris Martínez
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Alberto J Mimenza-Alvarado
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Alejandro A Reyes-Sánchez
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Luisa L Rocha-Arrieta
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Guillermo J Ruiz-Argüelles
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Antonio Soda-Merhy
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Julio Sotelo-Morales
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Sonia Toussaint
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Diana Vilar-Compte
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Emma Verástegui
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
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Ortiz Valdez E, Rangel-Escareño C, Matus Santos JA, Vázquez Romo R, Guijosa A, Villarreal-Garza C, Arrieta O, Rodríguez-Bautista R, Caro-Sánchez CH, Ortega Gómez A. Characterization of triple negative breast cancer gene expression profiles in Mexican patients. Mol Clin Oncol 2022; 18:5. [PMID: 36605097 PMCID: PMC9808158 DOI: 10.3892/mco.2022.2601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 10/05/2022] [Indexed: 12/23/2022] Open
Abstract
Triple negative breast cancer (TNBC) is an aggressive type of cancer that accounts for ~23% of breast tumors in Mexico. In an attempt to understand in an improved way the behavior of TNBC, throughout the years, gene expression in these tumors has been studied. Lehman et al identified 6 subtypes of gene expression in TNBC with distinct characteristics. In the present study, it was aimed to assess clinical, pathological and prognostic characteristics of TNBC in a Mexican-based cohort. A total of 55 patients diagnosed with TNBC at Mexico's National Institute of Cancer (INCan) were included. Tumor needle biopsy samples were obtained and subjected to microarray analysis. Patients were thus classified into one of the 6 TNBC molecular subtypes. The prognostic, clinical and pathological information of patients was obtained, and differences across molecular subtypes were sought. Out of the 55 included patients, the following subtypes were identified: 9 basal-like-1, 11 basal-like-2 (BSL2), 16 immunomodulatory (IM), 12 mesenchymal, 6 androgen receptor-like and 1 mesenchymal stem-like. Mean follow-up time was 47.1 months. The IM molecular subtype had the best overall survival (OS) (median OS was not reached). BSL2 had the worst OS (15 months). A complete pathologic response to neoadjuvant chemotherapy was obtained more often in the IM subtype (P=0.032). No significant associations were found between any of the clinical or pathological characteristics and the TNBC molecular subtypes. The results obtained from the present study should be considered when seeking to implement a clinical-molecular model for TNBC patient care, particularly in Hispanic-based populations, as they have been frequently underrepresented in clinical studies assessing TNBC molecular subtypes.
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Affiliation(s)
- Eric Ortiz Valdez
- Breast Tumors Department, Mexico's National Institute of Cancer, Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Claudia Rangel-Escareño
- Computational Genomics Department, Instituto Nacional de Medicina Genómica, Arenal Tepepan, Tlalpan, Mexico City 14610, Mexico
| | - Juan Antonio Matus Santos
- Breast Tumors Department, Mexico's National Institute of Cancer, Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Rafael Vázquez Romo
- Breast Tumors Department, Mexico's National Institute of Cancer, Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Alberto Guijosa
- School of Medicine, Universidad Panamericana, Benito Juárez, Mexico City 03920, Mexico
| | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnológico de Monterrey, Real San Agustín, San Pedro Garza García, Nuevo León 66278, Mexico
| | - Oscar Arrieta
- Thoracic Oncology Unit, Mexico's National Institute of Cancer, Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Rubén Rodríguez-Bautista
- Thoracic Oncology Unit, Mexico's National Institute of Cancer, Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Claudia H. Caro-Sánchez
- Pathology Department, Mexico's National Institute of Cancer, Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Alette Ortega Gómez
- Laboratory of Translational Medicine, Mexico's National Institute of Cancer, Sección XVI, Tlalpan, Mexico City 14080, Mexico,Correspondence to: Dr Alette Ortega Gómez, Laboratory of Translational Medicine, Mexico's National Institute of Cancer, 22 San Fernando Avenue, Sección XVI, Tlalpan, Mexico City 14080, Mexico
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45
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Heredia D, Mas L, Cardona AF, Oyervides V, Motta Guerrero R, Galvez-Nino M, Lara-Mejía L, Aliaga-Macha C, Carracedo C, Varela-Santoyo E, Ramos-Ramírez M, Davila-Dupont D, Martínez J, Cruz-Rico G, Remon J, Arrieta O. A high number of co-occurring genomic alterations detected by NGS is associated with worse clinical outcomes in advanced EGFR-mutant lung adenocarcinoma: Data from LATAM population. Lung Cancer 2022; 174:133-140. [PMID: 36379126 DOI: 10.1016/j.lungcan.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Co-occurring genomic alterations identified downstream main oncogenic drivers have become more evident since the introduction of next-generation sequencing (NGS) analyses at diagnosis and progression. Emerging evidence has stated that co-occurring genomic alterations at diagnosis might represent de novo and primary resistance mechanisms to tyrosine kinase inhibitors (TKIs) in advanced EGFR-mutant (EGFRm) non-small lung cancer (NSCLC). In this study, we assessed the prognostic role of co-occurring genomic alterations in advanced EGFRm NSCLC. METHODS A cohort of 111 patients with advanced NSCLC harboring EGFR-sensitive mutations detected by PCR was analyzed in 5 Latin American oncological centers from January 2019 to December 2020. All eligible patients received upfront therapy with EGFR-TKI. Co-occurring genomic alterations were determined at diagnosis in every patient by the NGS (FoundationOneCDx) comprehensive platform, which evaluates 324 known cancer-related genes. RESULTS EGFR exon19 deletion was the most frequent oncogenic driver mutation (60.4 %) detected by NGS. According to the NGS assay, 31 % and 68.3 % of patients had 1-2 and ≥ 3 co-occurring genomic alterations, respectively. The most frequent co-occurring genomic alterations were TP53 mutations (64.9 %) followed by CDKN2AB alterations (13.6 %), BRCA2 (13.6 %), and PTEN (12.7 %) mutations. Baseline central nervous system disease was present in 42.7 % of patients. First- or second-generation EGFR TKIs (gefitinib, afatinib, or erlotinib) were the most common treatment in 67.5 % of patients, while osimertinib was administered in 27.9 % of cases. The median PFS in all evaluated patients was 13.63 months (95 %CI: 11.79-15.52). Using ≥ 3 co-occurring alterations as the cut-off point, patients with ≥ 3 co-occurring genomic alterations showed a median PFS, of 12.7 months (95 %CI: 9.92-15.5) vs 21.3 months (95 %CI: 13.93-NR) in patients with 2 or less co-occurring genomic alterations [HR 3.06, (95 %CI: 1.55-5.48) p = 0.0001]. Also, patients with a TP53 mutation had a shorter PFS, 13.6 (95 %CI: 10.7-15.5) vs 19.2 months (95 %CI: 12.8-NR); in wild type TP53 [HR 2.01 (95 %CI: 1.18-3.74) p = 0.12]. In the multivariate analysis, the number (≥3) of concurrent genomic alterations and ECOG PS of 2 or more were related to a significant risk factor for progression [HR 2.79 (95 %CI: 1.49-5.23) p = 0.001 and HR 2.42 (95 %CI: 1.22-4.80) p = 0.011 respectively]. CONCLUSION EGFR-mutant NSCLC is not a single oncogene-driven disease in the majority of cases, harboring a higher number of co-occurring genomic alterations. This study finds the number of co-occurring genomic alterations and the presence of TP53 mutations as negative prognostic biomarkers, which confers potentially earlier resistance mechanisms to target therapy.
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Affiliation(s)
- David Heredia
- Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, México
| | - Luis Mas
- Medical Oncology Unit, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Perú
| | - Andres F Cardona
- Direction of Research, Science and Education, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogota, Colombia
| | - Víctor Oyervides
- Lung Tumours Unit, Centro Universitario Contra el Cáncer Hospital Universitario "Dr. José Eleuterio González" Monterrey, Nuevo León, México
| | | | - Marco Galvez-Nino
- Medical Oncology Unit, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Perú
| | - Luis Lara-Mejía
- Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, México
| | | | - Carlos Carracedo
- Clinical Oncology Department, Centro Oncológico Aliada, Lima, Perú
| | - Edgar Varela-Santoyo
- Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, México
| | - Maritza Ramos-Ramírez
- Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, México
| | - David Davila-Dupont
- Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, México
| | - Juan Martínez
- Lung Tumours Unit, Centro Universitario Contra el Cáncer Hospital Universitario "Dr. José Eleuterio González" Monterrey, Nuevo León, México
| | - Graciela Cruz-Rico
- Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, México
| | - Jordi Remon
- Department of Medical Oncology, Centro Integral Oncológico Clara Campal (HM-CIOCC), Hospital HM Delfos, HM Hospitales, Barcelona, Spain
| | - Oscar Arrieta
- Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, México.
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46
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Avilés‐Salas A, Flores‐Estrada D, Lara‐Mejía L, Catalán R, Cruz‐Rico G, Orozco‐Morales M, Heredia D, Bolaño‐Guerra L, Soberanis‐Piña PD, Varela‐Santoyo E, Cardona AF, Arrieta O. Modifying factors of PD-L1 expression on tumor cells in advanced non-small-cell lung cancer. Thorac Cancer 2022; 13:3362-3373. [PMID: 36317227 PMCID: PMC9715877 DOI: 10.1111/1759-7714.14695] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Programmed death ligand-1 (PD-L1) expression predicts immunotherapy utility in nononcogenic addictive lung adenocarcinoma (ADC). However, its reproducibility and reliability may be compromised outside clinical trials. This study aimed to evaluate factors associated with PD-L1 expression in lung ADC. METHODS This observational study assessed 547 tumor samples with advanced lung ADC from January 2016 to December 2020 in a single cancer institution. Tumor samples were stained by at least one approved PD-L1 clone, SP263 (Ventana) or 22C3 (Dako), and stratified in tumor proportion score (TPS) <1%, 1-49%, or ≥50%. RESULTS Of all the tumor samples, positive PD-L1 staining was higher in poorly differentiated tumors (67.3% vs. 32.7%, p < 0.001). Analytical factors associated with a PD-L1 high expression (TPS ≥ 50%) were the SP263 clone (19.6% vs. 8.2%, p < 0.001), time of archival tumor tissue <12 months (15.3% vs. 3.8%, p = 0.024), whenever the analysis was performed in the most recent years (2019-2020) (19.0% vs. 8.3%, p < 0.001), and whenever the analysis was performed by pathologists in the academic setting (Instituto Nacional de Cancerologia, INCan) (19.9% vs. 11.9%, p = 0.001). In the molecular analysis, EGFR wild-type tumors had an increased proportion of PD-L1 positive and PD-L1 high cases (60.2% vs. 47.9%, p = 0.006 and 17.4% vs.8.5%, p = 0.004). A moderate correlation (r = 0.69) in the PD-L1 TPS% was observed between the two different settings (INCan vs. external laboratories). CONCLUSION Clinicopathological factors were associated with an increased PD-L1 positivity rate. These differences were significant in the PD-L1 high group and associated with the academic setting, the SPS263 clone, time of archival tumor tissue <12 months, and a more recent period in the PD-L1 analysis.
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Affiliation(s)
- Alejandro Avilés‐Salas
- Thoracic Oncology Unit, Department of PathologyInstituto Nacional de CancerologíaMexico CityMexico
| | - Diana Flores‐Estrada
- Thoracic Oncology Unit, Department of Thoracic OncologyInstituto Nacional de CancerologíaMexico CityMexico
| | - Luis Lara‐Mejía
- Thoracic Oncology Unit, Department of Thoracic OncologyInstituto Nacional de CancerologíaMexico CityMexico
| | - Rodrigo Catalán
- Thoracic Oncology Unit, Department of Thoracic OncologyInstituto Nacional de CancerologíaMexico CityMexico
| | - Graciela Cruz‐Rico
- Thoracic Oncology Unit, Department of Thoracic OncologyInstituto Nacional de CancerologíaMexico CityMexico
| | - Mario Orozco‐Morales
- Laboratory of Personalized MedicineInstituto Nacional de CancerologíaMexico CityMexico
| | - David Heredia
- Thoracic Oncology Unit, Department of Thoracic OncologyInstituto Nacional de CancerologíaMexico CityMexico
| | - Laura Bolaño‐Guerra
- Thoracic Oncology Unit, Department of Thoracic OncologyInstituto Nacional de CancerologíaMexico CityMexico
| | | | - Edgar Varela‐Santoyo
- Thoracic Oncology Unit, Department of Thoracic OncologyInstituto Nacional de CancerologíaMexico CityMexico
| | - Andrés F. Cardona
- Clinical and Translational Oncology GroupFundación Santa Fe de BogotáBogotáColombia
| | - Oscar Arrieta
- Thoracic Oncology Unit, Department of Thoracic OncologyInstituto Nacional de CancerologíaMexico CityMexico
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47
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Leal YA, Torres J, Gamboa R, Mantilla-Morales A, Piña-Sanchez P, Arrieta O, Bonifaz L, Meneses A, Duque C, Piñeros M. Cancer Incidence in Merida, Mexico 2015-2018: First Report from the Population-based Cancer Registry. Arch Med Res 2022; 53:859-866. [PMID: 36462950 DOI: 10.1016/j.arcmed.2022.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Cancer registries are essential for monitoring cancer burden and patterns, and document changes in time for cancer control. Hereby, we present the first results of four years of the Merida population-based cancer registry in Mexico. METHODS The registry collects data on all new cancers diagnosed since 2015 using both active and passive methods including a total of 104 information sources. Definitions and coding follow international standards. Using CanReg5 software, age-standardized incidence rates (ASR/100,000 person years) were computed by direct method using the world standard population. RESULTS A total of 5684 new cancer cases were registered during 2015-2018, 2321 in males and 3363 in females corresponding to age-adjusted incidence rates (ASR per 100,000) of 128.5, and 153.1, respectively. Most frequent cancers among males were prostate cancer (ASR 29.8), lymphomas (ASR 10.9) and colorectal cancer (ASR 9.7) while among females it was breast cancer (ASR 49.3), cervical cancer (ASR 17.5) and corpus uteri (ASR 11.5). Childhood cancers (0-14 year) represented 2.9% of all cancers, with leukemias accounting for 52% of the new cases. Overall, 87.6% of new cases were microscopically verified. CONCLUSIONS The data reported provide information on the cancer profile in Merida. Prostate and breast cancer are the main incident cancers. Cervical cancers present high rates among women, while lymphomas and liver cancer data merit further exploration. Efforts to support the Merida cancer registry as well as other registries in Mexico need to be pursued in order to have locally recorded data to support cancer control measures.
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Affiliation(s)
- Yelda A Leal
- Centro Institucional de Capacitación y Registro de Cáncer, Unidad Médica de Alta Especialidad, Centro Médico Nacional, Ignacio García Téllez, Instituto Mexicano de Seguro Social, Mérida, Yucatán, México.
| | - Javier Torres
- Unidad de Investigación Médica en Enfermedades Infecciosas y Parasitarias, Centro Médico Nacional Siglo XXI, Instituto Mexicano de Seguro Social, Ciudad de México, México
| | - Ricardo Gamboa
- Departamento de Oncología, Unidad de Investigación Médica en Enfermedades Oncológicas, Centro Médico Nacional, Ignacio García Téllez, Instituto Mexicano de Seguro Social, Mérida, Yucatán, México
| | - Alejandra Mantilla-Morales
- Laboratorio de Patología de la Unidad de Investigación Médica en Enfermedades Oncológicas, Oncología Centro Médico Nacional Siglo XXI, Instituto Mexicano de Seguro Social, Ciudad de México, México
| | - Patricia Piña-Sanchez
- Unidad de Investigación Médica en Enfermedades Oncológicas, Hospital de Oncología, Centro Medico Nacional Siglo XXI, Ciudad de México, México
| | - Oscar Arrieta
- Coordinación del Registro Nacional de Cáncer del Instituto Nacional de Cancerología, Ciudad de México
| | - Laura Bonifaz
- Coordinación de Investigación en Salud, Centro Medico Nacional Siglo XXI, Instituto Mexicano de Seguro Social, Ciudad de México, México
| | - Abelardo Meneses
- Dirección General del Instituto Nacional de Cancerología, Ciudad de México, México
| | - Celida Duque
- Dirección de Prestaciones Médicas, Instituto Mexicano de Seguro Social, Ciudad de México, México
| | - Marion Piñeros
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, Francia
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Cacho-Diaz B, Arrieta O. NCMP-03. HEADACHE IN PATIENTS WITH NON-CNS CANCER. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.731] [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] Open
Abstract
Abstract
BACKGROUND
Almost everybody will experience at least one headache episode and almost 40% of the world-population will be diagnosed with some sort of cancer during their life; nevertheless, their association has scantly been measured. Aim: To identify if headache characteristics and/or accompanying signs were associated with brain metastases (BM) in patients with non-CNS cancer.
METHODS
Patients with systemic cancer and headache sent for evaluation between June 2012 and June 2018 were included. Hematologic or primary CNS tumors were excluded. Magnetic resonance imaging (MRI) was performed in most; the remaining were followed for at least a year. Logistic regression analyses were used to measure associations.
RESULTS
From 572 patients with cancer and headache, 216 (38%) were diagnosed with BM. Variables significantly (P < 0.05) associated with BM after multivariable analysis were male gender (OR 1.97), headache starting after cancer diagnosis (OR 21), oppressive type (OR 1.9), presence of vomiting (OR 5.78), not increased by changes in position (OR 2.2), and generalized location (OR 0.34). Having another symptom/sign other than headache was seen in 73% of patients with BM and was significantly associated with a higher risk of BM [OR 6.08 (9%%CI 2.1-17.3)], especially if patients presented with altered mental status (OR 15), visual complaint (OR 15), focal motor weakness (OR 11), seizures (OR 15), ataxia (OR 19), and/or vertigo (OR 3.8).
CONCLUSION
Headache in patients with cancer should be considered a warning sign, it′s characteristics and accompanying signs should be considered to assess individually the risk of being diagnosed with BM.
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Affiliation(s)
| | - Oscar Arrieta
- Instituto Nacional de Cancerología, Mexico , Distrito Federal , Mexico
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49
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Solomon BJ, Bauer TM, Ignatius Ou SH, Liu G, Hayashi H, Bearz A, Penkov K, Wu YL, Arrieta O, Jassem J, Calella AM, Peltz G, Polli A, Thurm H, Mok T. Post Hoc Analysis of Lorlatinib Intracranial Efficacy and Safety in Patients With ALK-Positive Advanced Non-Small-Cell Lung Cancer From the Phase III CROWN Study. J Clin Oncol 2022; 40:3593-3602. [PMID: 35605188 PMCID: PMC9622589 DOI: 10.1200/jco.21.02278] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/08/2022] [Accepted: 04/04/2022] [Indexed: 07/29/2023] Open
Abstract
PURPOSE Lorlatinib significantly improved progression-free survival (PFS) versus crizotinib and showed robust intracranial activity in patients with previously untreated advanced ALK-positive non-small-cell lung cancer (NSCLC) in the phase III CROWN trial. Here, we report post hoc efficacy outcomes in patients with and without brain metastases at baseline, and present data on the incidence and management of CNS adverse events (AEs) in CROWN. METHODS Eligible patients were randomly assigned 1:1 to first-line lorlatinib (100 mg once daily) or crizotinib (250 mg twice a day); no crossover between treatment arms was permitted. Tumor assessments, including CNS magnetic resonance imaging, were performed at screening and then at 8-week intervals. Regular assessments of patient-reported outcomes were conducted. RESULTS PFS by blinded independent central review was improved with lorlatinib versus crizotinib in patients with and without brain metastases at baseline (12-month PFS rates: 78% v 22% and 78% v 45%, respectively). Lorlatinib was associated with lower 12-month cumulative incidence of CNS progression versus crizotinib in patients with (7% v 72%) and without (1% v 18%) brain metastases at baseline. In total, 35% of patients had CNS AEs with lorlatinib, most of grade 1 severity. Occurrence of CNS AEs did not result in a clinically meaningful difference in patient-reported quality of life. At analysis, 56% of CNS AEs had resolved (33% without intervention; 17% with lorlatinib dose modification), and 38% were unresolved; most required no intervention. Lorlatinib dose modification did not notably influence PFS. CONCLUSION First-line lorlatinib improved PFS outcomes and reduced CNS progression versus crizotinib in patients with advanced ALK-positive non-small-cell lung cancer with or without brain metastases at baseline. Half of all CNS AEs resolved without intervention or with lorlatinib dose modification.
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Affiliation(s)
| | - Todd M. Bauer
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN
| | | | - Geoffrey Liu
- Princess Margaret Cancer Centre, Toronto, Canada
| | | | - Alessandra Bearz
- Centro di Riferimento Oncologico, Istituto Nazionale Tumori, IRCCS, Aviano, Italy
| | - Konstantin Penkov
- Private Medical Institution Euromedservice, St Petersburg, Russian Federation
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Oscar Arrieta
- Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | | | | | | | | | - Tony Mok
- State Key Laboratory of Translational Oncology, Chinese University of Hong Kong, Shatin, Hong Kong
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50
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Moreno M, Arrieta O, Celis MA, Domínguez J, Islas-Andrade S, Lifshitz A, Mansilla-Olivares A, Martínez I, Mimenza-Alvarado AJ, Reyes-Sánchez A, Ruiz-Argüelles GJ, Soda-Merhy A, Verástegui E, Rocha-Arrieta LL, Toussaint S, Vilar-Compte D, Sotelo J. ¿Quién juzga la actuación médica? GAC MED MEX 2022. [DOI: 10.24875/gmm.22000210] [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: 11/06/2022] Open
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