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Gutierrez-Sainz L, Martinez-Fdez S, Pedregosa-Barbas J, Peña J, Alameda M, Viñal D, Villamayor J, Martinez-Recio S, Perez-Wert P, Pertejo-Fernandez A, Gallego A, Martinez-Marin V, Zamora P, Espinosa E, Mendiola M, Feliu J, Redondo A. Efficacy of second and third lines of treatment in advanced soft tissue sarcomas: a real-world study. Clin Transl Oncol 2023; 25:3519-3526. [PMID: 37329429 DOI: 10.1007/s12094-023-03221-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/19/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Soft tissue sarcomas (STSs) are an uncommon and heterogeneous group of tumours. Several drugs and combinations have been used in clinical practice as second-line (2L) and third-line (3L) treatment. The growth modulation index (GMI) has previously been used as an exploratory efficacy endpoint of drug activity and represents an intra-patient comparison. METHODS We performed a real-world retrospective study including all patients with advanced STS who had received at least 2 different lines of treatment for advanced disease between 2010 and 2020 at a single institution. The objective was to study the efficacy of both 2L and 3L treatments, analysing the time to progression (TTP) and the GMI (defined as the ratio of TTP between 2 consecutive lines of therapy). RESULTS Eighty-one patients were included. The median TTP after 2L and 3L treatment was 3.16 and 3.06 months, and the median GMI was 0.81 and 0.74, respectively. The regimens most frequently used in both treatments were trabectedin, gemcitabine-dacarbazine, gemcitabine-docetaxel, pazopanib and ifosfamide. The median TTP by each of these regimens was 2.80, 2.23, 2.83, 4.10, and 5.00 months, and the median GMI was 0.78, 0.73, 0.67, 1.08, and 0.94, respectively. In terms of histotype, we highlight the activity (GMI > 1.33) of gemcitabine-dacarbazine in undifferentiated pleomorphic sarcoma (UPS) and in leiomyosarcoma, pazopanib in UPS, and ifosfamide in synovial sarcoma. CONCLUSIONS In our cohort, regimens commonly used after first-line STS treatment showed only slight differences in efficacy, although we found significant activity of specific regimens by histotype.
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Affiliation(s)
- Laura Gutierrez-Sainz
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain.
| | - Sara Martinez-Fdez
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Jorge Pedregosa-Barbas
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Jesus Peña
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Maria Alameda
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
| | - David Viñal
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Julia Villamayor
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Sergio Martinez-Recio
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Pablo Perez-Wert
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Ana Pertejo-Fernandez
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Alejandro Gallego
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
- Department of Medical Oncology, Clínica Universidad de Navarra, Madrid, Spain
| | - Virginia Martinez-Marin
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
- Translational Oncology Group, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Pilar Zamora
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
- Translational Oncology Group, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain
- Cátedra UAM-AMGEN, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Enrique Espinosa
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
- Translational Oncology Group, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain
- Cátedra UAM-AMGEN, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Center for Biomedical Research in the Cancer Network (Centro de Investigación Biomédica en Red de Cáncer, CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Mendiola
- Center for Biomedical Research in the Cancer Network (Centro de Investigación Biomédica en Red de Cáncer, CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
- Molecular Pathology and Therapeutic Targets Group, IdiPAZ, Madrid, Spain
| | - Jaime Feliu
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
- Translational Oncology Group, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain
- Cátedra UAM-AMGEN, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Center for Biomedical Research in the Cancer Network (Centro de Investigación Biomédica en Red de Cáncer, CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | - Andres Redondo
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain.
- Translational Oncology Group, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain.
- Cátedra UAM-AMGEN, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
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Viñal D, Rueda-Lara A, Martinez-Perez D, Zwisler P, Garcia-Leal A, Ruiz-Gutierrez I, Jiménez-Bou D, Peña-Lopez J, Alameda-Guijarro M, Martin-Montalvo G, Perez-Wert P, Martínez-Recio S, Palacios ME, Ghanem I, Custodio AB, Gutiérrez-Sainz L, Feliu J, Rodriguez Salas N. Prognostic value of tumor budding in patients with stage II and III colon cancer: A single-institution experience. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.247] [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: 01/25/2023] Open
Abstract
247 Background: Tumor budding has recently been recognized as one important prognostic factor for recurrence in patients with localized colon cancer. Nevertheless, not all guidelines consider tumor budding in the decision-making process for selecting patients for adjuvant chemotherapy. We aim to assess the prognostic value of tumor budding in a cohort of patients with stage II and III colon cancer. Methods: We included patients with pathologically confirmed diagnosis of stage II and III colon cancer at Hospital Universitario La Paz and tumor budding assessment available, from October 2016 to August 2021. Tumor budding was reported following the recommendations from the 2016 International Tumour Budding Consensus Conference. Results: A total of 390 patients were included. Patients were predominantly men (55%) and had a median age of 75 (35-95). Fifty percent of the patients were stage II and 50% were localized in the right colon. Tumor budding was reported as low, intermediate, and high in 186 (48%), 110 (28%), and 94 (24%) patients, respectively. After a median follow up of 18 months, 63 recurrences and 73 deaths were observed. Time to recurrence was significantly worse for patients with high tumor budding. At 24 months, 91%, 79%, and 67% of patients with low, intermediate and high budding were recurrence-free. Median TTR was not reached in any of the three cohort (P <0.001). Comparing high vs low or intermediate budding, the hazard ratio (HR) for recurrence was 0.13 [confidence interval (CI)95%: 0.05 to 0.32; P < 0.001]. We performed a univariate analysis with the most relevant clinic-pathological features. T4, N2, R1, bowel obstruction or perforation, positive resection margins (R1), lymphovascular or perineural invasion, and mismatch repair protein status were found to be statistically associated with TTR and entered the multivariate analysis. T4, N2, R1 and high tumor budding (HR: 0.48 [CI95%: 0.28 to 0.84], P = 0.011) were independent prognostic factors for recurrence at the multivariate analysis. Conclusions: High tumor budding is an adverse independent prognostic factor for recurrence in patients with stage II and III colon cancer and should be acknowledge when considering adjuvant chemotherapy.
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Affiliation(s)
- David Viñal
- Department of Medical Oncology, Hospital Universitario La Paz, Madrid, Spain
| | - Antonio Rueda-Lara
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | | | - Patricia Zwisler
- Department of Medical Oncology, Hospital Universitario La Paz, Madrid, Spain
| | - Andrea Garcia-Leal
- Department of Medical Oncology, Hospital Universitario La Paz, Madrid, Spain
| | | | - Diego Jiménez-Bou
- Department of Medical Oncology, Hospital Universitario La Paz, Madrid, Spain
| | - Jesus Peña-Lopez
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | | | | | - Pablo Perez-Wert
- Medical Oncology Department, La Paz University Hospital, Madrid, Spain
| | | | | | - Ismael Ghanem
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Ana B. Custodio
- Department of Medical Oncology, La Paz University Hospital, Madrid, Spain
| | | | - Jaime Feliu
- Department of Medical Oncology, Hospital Universitario La Paz, Madrid, Spain
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