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Provencio M, Cobo M, Rodriguez-Abreu D, Carcereny E, Cantero A, Calvo V, López Castro R, Bernabé R, Bosch-Barrera J, Massutí B, García Campelo R, Sánchez-Hernández A, Laura Ortega A, Guirado M, Del Barco E, Camps C, Casal-Rubio J, Dómine M, Angeles Sala M, Padilla A, Luís González Larriba J, de Asís Aparisi F. Describing differences among populations of thoracic tumors patients under and over 80 years: Data analysis from the SLCG thoracic tumor registry. Lung Cancer 2024; 190:107513. [PMID: 38432027 DOI: 10.1016/j.lungcan.2024.107513] [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: 09/26/2023] [Revised: 12/29/2023] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES Cancer is a disease of old age; however, most studies usually included minority of patients fit elderly. The purpose is to investigate the clinical characteristics and genetic information of patients with thoracic tumors who are 80 years old or older compared to those under 80 years old. STUDY DESIGN AND METHODS The Thoracic Tumor Registry (TTR) is a Spanish observational, prospective cohort study that included patients diagnosed with thoracic tumors. Data were collected from medical records related to sociodemographic, epidemiological, clinical, molecular/genetic, and treatment outcome variables. RESULTS The total number of patients, recruited from August 2016 to April 2023, was 26.193 (93,1 % were younger than 80 years and 6,9 % were 80 years or older). In the group of older patients: the male ratio increased (72,9 % vs. 80 %); the number of elderly people who had never smoked or were ex-smokers increased (9,9 % vs. 21,1 % and 44,8 % vs. 61,3 %, respectively) and the number of current smokers decreased (43,3 % vs. 17,5 %); had higher ECOG performance status at diagnosis (for ECOG ≥ 2, 15 % vs. 32,9 %), and there were more patients with previous cancer (17,3 % vs. 28 %). The proportion of men is higher than that of women (73 % vs. 27 % in <80 years and 80 % vs. 20 % in ≥80 years). For all biomarkers, the proportion of patients who had a molecular determination was lower in older patients. There were no differences in terms of alterations in the biomarkers tested; except for EGFR, for which the positivity rate was higher in patients aged 80 years and older (25 % vs. 15,3 %). CONCLUSION The proportion of older patients with targeted mutations is higher. So, at least at diagnosis, it should be proceeded in a standard way. Then, when it comes to treatment, comorbidities and patient's baseline situation should be considered. CLINICAL TRIAL REGISTRATION NCT02941458.
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Affiliation(s)
| | - Manuel Cobo
- Medical Oncology Intercenter Unit. Regional and Virgen de la Victoria University Hospitals. IBIMA, Málaga, Spain
| | | | - Enric Carcereny
- Institut Català D'oncologia Badalona- Hospital Germans Trias I Pujol, B-Argo Group, Badalona, Spain
| | - Alexandra Cantero
- Medical Oncology Intercenter Unit. Regional and Virgen de la Victoria University Hospitals. IBIMA, Málaga, Spain
| | - Virginia Calvo
- Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | - Reyes Bernabé
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Joaquim Bosch-Barrera
- Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta and Precision Oncology Group (OncoGIR-Pro), Institut d'Investigacions Biomèdiques de Girona (IDIBGI), Girona, Spain
| | - Bartomeu Massutí
- Hospital General Universitario Dr. Balmis de Alicante, Alicante, Spain
| | | | | | | | - Maria Guirado
- Hospital General Universitario de Elche, Elche, Spain
| | - Edel Del Barco
- Complejo Asistencial Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Carlos Camps
- Hospital General Universitario de Valencia, Valencia, Spain
| | | | - Manuel Dómine
- Hospital Universitario Fundación Jiménez Díaz. IIS-FJD, Madrid
| | | | - Airam Padilla
- Hospital Universitario Nuestra Señora De La Candelaria, Santa Cruz de Tenerife, Spain
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Bernabé R, Liu SV, Sánchez-Gastaldo A, Alonso García M. Long-Term Survival and Stable Disease in a Patient with Extensive-Stage Small-Cell Lung Cancer after Treatment with Carboplatin, Etoposide and Atezolizumab. Oncol Ther 2024; 12:175-182. [PMID: 38280181 PMCID: PMC10881916 DOI: 10.1007/s40487-023-00257-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 12/07/2023] [Indexed: 01/29/2024] Open
Abstract
Survival beyond 2 years is rare in patients with extensive-stage small-cell lung cancer (ES-SCLC) treated with chemotherapy alone. We describe a patient with ES-SCLC who was treated with carboplatin, etoposide and the programmed death-ligand 1 inhibitor atezolizumab in the IMpower133 study (ClinicalTrials.gov registration: NCT02763579) and who achieved exceptionally long-term survival. Treatment-naïve patients with ES-SCLC (n = 403) were included in the IMpower133 study, and the identified patient had been randomised to the investigational treatment arm, where patients received induction therapy with carboplatin and etoposide plus atezolizumab for four 21-day cycles, followed by ongoing maintenance therapy with atezolizumab. The patient had achieved a partial response after induction therapy, and then received seven cycles of atezolizumab maintenance therapy until immune-related toxicities necessitated discontinuation. The patient was alive with an ongoing response and excellent performance status more than 6 years after starting treatment and 5 years after discontinuing atezolizumab maintenance. In conclusion, this patient with ES-SCLC from the IMpower133 study is a rare example of ongoing survival more than 6 years beyond diagnosis and the start of treatment with first-line atezolizumab. This demonstrates the potential durability of response with immunotherapy.
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Affiliation(s)
- Reyes Bernabé
- Department of Medical Oncology, Hospital Universitario Virgen del Rocío, Av. Manuel Siurot S/N, 41013, Seville, Spain.
| | - Stephen V Liu
- Division of Medical Oncology, Georgetown University, Washington, DC, USA
| | - Amparo Sánchez-Gastaldo
- Department of Medical Oncology, Hospital Universitario Virgen del Rocío, Av. Manuel Siurot S/N, 41013, Seville, Spain
| | - Miriam Alonso García
- Department of Medical Oncology, Hospital Universitario Virgen del Rocío, Av. Manuel Siurot S/N, 41013, Seville, Spain
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Provencio M, Carcereny E, López Castro R, Calvo V, Rodríguez Abreu D, Cobo M, Ortega AL, Bernabé R, Guirado M, Massutí B, del Barco-Morillo E, Bosch-Barrera J, Camps C, Carroll R, Rault C, Chaib C, Penrod J, Vo L, Ralphs E, Daumont MJ. Real-world treatment patterns and survival outcomes for patients with stage III non-small cell lung cancer in Spain: a nationwide cohort study. Transl Lung Cancer Res 2023; 12:2113-2128. [PMID: 38025806 PMCID: PMC10654433 DOI: 10.21037/tlcr-23-176] [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: 03/11/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023]
Abstract
Background The burden of non-small cell lung cancer (NSCLC) remains high in Spain, with lung cancer accounting for 20% of cancer-related deaths annually. Programs such as the Spanish Thoracic Tumour Registry (TTR) and the global I-O Optimise initiative have been developed to observe patients in clinical practice with the aim of improving outcomes. This analysis examined treatment patterns and survival in patients with stage III NSCLC from the TTR. These patients represent a heterogenous group with complex treatment pathways. Methods The TTR is an ongoing, observational, prospective, and retrospective cohort multicentre study (NCT02941458) that follows patients with thoracic cancer in Spain. Adults aged ≥18 years with stage IIIA/IIIB NSCLC enrolled in the TTR between 01 Jan 2010 and 31 Oct 2019 were included in this analysis. Initial treatment received was described by cancer stage and histology (squamous and non-squamous NSCLC). Kaplan-Meier estimates of progression-free survival (PFS) and overall survival (OS) were calculated over a 5-year period. Results A total of 1,838 patients were included in the cohort, including 1,082 with stage IIIA (58.9%) and 756 with stage IIIB (41.1%). Median follow-up was 18.3 months. The median age of patients was 66 years, and most had non-squamous NSCLC (54.0%), were male (81.2%), and were active or former smokers (93.4%). Overall, 26.3% of patients received surgical resection (37.0% for stage IIIA and 11.1% for stage IIIB). The most frequent initial treatment received was concurrent chemoradiotherapy for stage IIIA (30.2%) and stage IIIB (37.0%) patients. Median OS was lower in patients with stage IIIB than stage IIIA (28 vs. 37 months) disease and was lower for patients with squamous than non-squamous histology (19 vs. 26 months). Median PFS and OS varied when patients were stratified by initial treatment. Conclusions This TTR analysis describes the clinical reality surrounding the initial management and survival outcomes for stage III NSCLC in Spain and presents survival outcomes comparable with other real-world evidence. It provides insights into the diverse approaches used before the availability of immunotherapies and targeted treatments in the non-metastatic NSCLC setting.
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Affiliation(s)
- Mariano Provencio
- Department of Medical Oncology, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - Enric Carcereny
- Medical Oncology Department, Catalan Institute of Oncology (ICO)-Badalona Badalona-Applied Research Group in Oncology (B-ARGO), Barcelona, Spain
| | - Rafael López Castro
- Oncology Department, Valladolid University Clinical Hospital, Valladolid, Spain
| | - Virginia Calvo
- Department of Medical Oncology, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - Delvys Rodríguez Abreu
- Thoracic, Skin Tumors & Clinical Trials Unit, Hospital Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Manuel Cobo
- Department of Medical Oncology, Málaga General University Hospital and Virgen de la Victoria, IBIMA, Málaga, Spain
| | | | - Reyes Bernabé
- Thoracic Oncology Cancer Unit, Virgen del Rocío University Hospital, Seville, Spain
| | - Maria Guirado
- Department of Medical Oncology, Elche University General Hospital, Elche, Spain
| | - Bartomeu Massutí
- Department of Medical Oncology, Alicante University General Hospital, Alicante, Spain
| | | | | | - Carlos Camps
- Molecular Oncology Laboratory, Valencia University General Hospital, Valencia, Spain
| | - Robert Carroll
- Bristol Myers Squibb, Centre for Observational Research and Data Sciences, Uxbridge, UK
| | | | | | | | - Lien Vo
- Bristol Myers Squibb, Princeton, NJ, USA
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4
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Provencio M, Nadal E, González-Larriba JL, Martínez-Martí A, Bernabé R, Bosch-Barrera J, Casal-Rubio J, Calvo V, Insa A, Ponce S, Reguart N, de Castro J, Mosquera J, Cobo M, Aguilar A, López Vivanco G, Camps C, López-Castro R, Morán T, Barneto I, Rodríguez-Abreu D, Serna-Blasco R, Benítez R, Aguado de la Rosa C, Palmero R, Hernando-Trancho F, Martín-López J, Cruz-Bermúdez A, Massuti B, Romero A. Perioperative Nivolumab and Chemotherapy in Stage III Non-Small-Cell Lung Cancer. N Engl J Med 2023; 389:504-513. [PMID: 37379158 DOI: 10.1056/nejmoa2215530] [Citation(s) in RCA: 61] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
BACKGROUND Approximately 20% of patients with non-small-cell lung cancer (NSCLC) receive a diagnosis of stage III disease. There is no current consensus regarding the most appropriate treatment for these patients. METHODS In this open-label, phase 2 trial, we randomly assigned patients with resectable stage IIIA or IIIB NSCLC to receive neoadjuvant nivolumab plus platinum-based chemotherapy (experimental group) or chemotherapy alone (control group), followed by surgery. Patients in the experimental group who had R0 resections received adjuvant treatment with nivolumab for 6 months. The primary end point was a pathological complete response (0% viable tumor in resected lung and lymph nodes). Secondary end points included progression-free survival and overall survival at 24 months and safety. RESULTS A total of 86 patients underwent randomization; 57 were assigned to the experimental group and 29 were assigned to the control group. A pathological complete response occurred in 37% of the patients in the experimental group and in 7% in the control group (relative risk, 5.34; 95% confidence interval [CI], 1.34 to 21.23; P = 0.02). Surgery was performed in 93% of the patients in the experimental group and in 69% in the control group (relative risk, 1.35; 95% CI, 1.05 to 1.74). Kaplan-Meier estimates of progression-free survival at 24 months were 67.2% in the experimental group and 40.9% in the control group (hazard ratio for disease progression, disease recurrence, or death, 0.47; 95% CI, 0.25 to 0.88). Kaplan-Meier estimates of overall survival at 24 months were 85.0% in the experimental group and 63.6% in the control group (hazard ratio for death, 0.43; 95% CI, 0.19 to 0.98). Grade 3 or 4 adverse events occurred in 11 patients in the experimental group (19%; some patients had events of both grades) and 3 patients in the control group (10%). CONCLUSIONS In patients with resectable stage IIIA or IIIB NSCLC, perioperative treatment with nivolumab plus chemotherapy resulted in a higher percentage of patients with a pathological complete response and longer survival than chemotherapy alone. (Funded by Bristol Myers Squibb and others; NADIM II ClinicalTrials.gov number, NCT03838159; EudraCT number, 2018-004515-45.).
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Affiliation(s)
- Mariano Provencio
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Ernest Nadal
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - José L González-Larriba
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Alex Martínez-Martí
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Reyes Bernabé
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Joaquim Bosch-Barrera
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Joaquín Casal-Rubio
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Virginia Calvo
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Amelia Insa
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Santiago Ponce
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Noemí Reguart
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Javier de Castro
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Joaquín Mosquera
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Manuel Cobo
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Andrés Aguilar
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Guillermo López Vivanco
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Carlos Camps
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Rafael López-Castro
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Teresa Morán
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Isidoro Barneto
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Delvys Rodríguez-Abreu
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Roberto Serna-Blasco
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Raquel Benítez
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Carlos Aguado de la Rosa
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Ramón Palmero
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Florentino Hernando-Trancho
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Javier Martín-López
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Alberto Cruz-Bermúdez
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Bartomeu Massuti
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
| | - Atocha Romero
- From Hospital Universitario Puerta de Hierro-Majadahonda (M.P., V.C., R.S.-B., J.M.-L., A.C.-B., A.R.), Hospital Universitario Clínico San Carlos (J.L.G.-L., C.A.R., F.H.-T.), Hospital Universitario 12 de Octubre (S.P.), Hospital Universitario La Paz (J.C.), and the Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (R. Benítez), Madrid, Institut Català d'Oncologia, L'Hospitalet de Llobregat (E.N., R.P.), Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebrón (A.M.-M.), the Medical Oncology Department Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, Institut de Investigacions Biomèdiques (N.R.), and Instituto Oncológico Dr. Rosell, Dexeus University Hospital (A.A.), Barcelona, Hospital Universitario Virgen del Rocio, Seville (R. Bernabé), Institut Català d'Oncologia, Hospital Universitari Dr. Josep Trueta, Girona (J.B.-B.), Complejo Hospitalario Universitario de Vigo, Pontevedra (J.C.-R.), Fundación Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Valencia (A.I.), and Hospital General Universitario de Valencia, Universidad de Valencia and Centro de Investigación Biomédica en Red Cáncer (C.C.), Valencia, Complejo Hospitalario Universitario A Coruña, A Coruña (J.M.), the Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga (M.C.), Hospital Universitario Cruces, Barakaldo (G.L.V.), Hospital Clínico Universitario de Valladolid, Valladolid (R.L.-C.), the Medical Oncology Department, Catalan Institute of Oncology, Badalona-Germans Trias i Pujol Hospital, Badalona Applied Research Group in Oncology, Fundació Institut de Investigado de Ciences de la Salut Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona (T.M.), Hospital Universitario Reina Sofia, Córdoba (I.B.), Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), and Hospital Universitario Dr. Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante (B.M.) - all in Spain
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5
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Timilsina M, Fey D, Buosi S, Janik A, Costabello L, Carcereny E, Abreu DR, Cobo M, Castro RL, Bernabé R, Minervini P, Torrente M, Provencio M, Nováček V. Synergy between imputed genetic pathway and clinical information for predicting recurrence in early stage non-small cell lung cancer. J Biomed Inform 2023; 144:104424. [PMID: 37352900 DOI: 10.1016/j.jbi.2023.104424] [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: 12/15/2022] [Revised: 06/06/2023] [Accepted: 06/11/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE Lung cancer exhibits unpredictable recurrence in low-stage tumors and variable responses to different therapeutic interventions. Predicting relapse in early-stage lung cancer can facilitate precision medicine and improve patient survivability. While existing machine learning models rely on clinical data, incorporating genomic information could enhance their efficiency. This study aims to impute and integrate specific types of genomic data with clinical data to improve the accuracy of machine learning models for predicting relapse in early-stage, non-small cell lung cancer patients. METHODS The study utilized a publicly available TCGA lung cancer cohort and imputed genetic pathway scores into the Spanish Lung Cancer Group (SLCG) data, specifically in 1348 early-stage patients. Initially, tumor recurrence was predicted without imputed pathway scores. Subsequently, the SLCG data were augmented with pathway scores imputed from TCGA. The integrative approach aimed to enhance relapse risk prediction performance. RESULTS The integrative approach achieved improved relapse risk prediction with the following evaluation metrics: an area under the precision-recall curve (PR-AUC) score of 0.75, an area under the ROC (ROC-AUC) score of 0.80, an F1 score of 0.61, and a Precision of 0.80. The prediction explanation model SHAP (SHapley Additive exPlanations) was employed to explain the machine learning model's predictions. CONCLUSION We conclude that our explainable predictive model is a promising tool for oncologists that addresses an unmet clinical need of post-treatment patient stratification based on the relapse risk while also improving the predictive power by incorporating proxy genomic data not available for specific patients.
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Affiliation(s)
- Mohan Timilsina
- Data Science Institute, Insight Centre for Data Analytics, University of Galway, Ireland.
| | - Dirk Fey
- Systems Biology Ireland, University College Dublin, Ireland.
| | - Samuele Buosi
- Data Science Institute, Insight Centre for Data Analytics, University of Galway, Ireland.
| | | | | | - Enric Carcereny
- Catalan Institute of Oncology, Hospital Universitari Germans Trias i Pujol, B-ARGO, IGTP, Badalona, Spain.
| | | | - Manuel Cobo
- Medical Oncology Intercenter Unit. Regional and Virgen de la Victoria University Hospitals. IBIMA. Málaga., Spain.
| | | | - Reyes Bernabé
- Hospital Universitario Virgen del Rocio, Sevilla, Spain.
| | | | - Maria Torrente
- Medical Oncology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
| | - Mariano Provencio
- Medical Oncology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
| | - Vít Nováček
- Data Science Institute, Insight Centre for Data Analytics, University of Galway, Ireland; Faculty of Informatics, Masaryk University Brno, Czech Republic; Masaryk Memorial Cancer Institute, Brno, Czech Republic.
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6
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Isla D, Sánchez A, Casal J, Cobo M, Majem M, Reguart N, Zugazagoitia J, Bernabé R. PD-1/PD-L1 Inhibitors as Monotherapy in the First-Line Treatment of Advanced Non-Small Cell Lung Cancer Patients with High PD-L1 Expression: An Expert Position Statement. J Clin Med 2023; 12:5063. [PMID: 37568465 PMCID: PMC10420126 DOI: 10.3390/jcm12155063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 07/28/2023] [Accepted: 07/30/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION There are currently three first-line immunotherapy options used as monotherapy in advanced non-small cell lung cancer (NSCLC) patients with high programmed death ligand 1 (PD-L1) expression (≥50%). This manuscript aims to evaluate the available data on atezolizumab (AT), cemiplimab (CEMI), and pembrolizumab (PEMBRO) and to study the results obtained during pivotal trials, especially regarding patient subgroups. METHODS Nominal group and Delphi techniques were used. Eight Spanish experts in lung cancer (the scientific committee of the project) analyzed the use of immunotherapy monotherapy as first-line treatment in patients with NSCLC and high PD-L1 expression. The expert scientific committee formulated several statements based on a scientific review and their own clinical experience. Subsequently, 17 additional Spanish lung cancer experts were selected to appraise the committee's statements through two Delphi rounds. They completed a Delphi round via an online platform and voted according to a scale from 1 (strongly disagree) to 10 (strongly agree). The statements were approved if ≥70% of experts voted 7 or more. RESULTS A total of 20 statements were proposed covering the following areas: (1) general characteristics of pivotal clinical trials; (2) overall main outcomes of pivotal clinical trials; and (3) subgroup analysis. All statements reached consensus in the first round. CONCLUSIONS AT, CEMI, and PEMBRO as monotherapy can be considered the standard of care in patients with advanced NSCLC and high PD-L1 expression (≥50%). Moreover, some differences noted among the drugs analyzed in this document might facilitate treatment decision-making, especially in clinically relevant patient subgroups, when using PD-1/PD-L1 inhibitors. The high level of agreement reached among experts supports the proposed statements.
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Affiliation(s)
- Dolores Isla
- Medical Oncology Department, University Hospital Lozano Blesa, 50009 Zaragoza, Spain
| | - Alfredo Sánchez
- Medical Oncology Department, Consorci Hospitalari Provincial de Castelló, 12002 Castelló, Spain
| | - Joaquín Casal
- Medical Oncology Department, Hospital Álvaro Cunqueiro, Área Sanitaria de Vigo, 36213 Vigo, Spain
| | - Manuel Cobo
- UGC Intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, 29010 Málaga, Spain
- IBIMA, 29010 Málaga, Spain
| | - Margarita Majem
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | - Noemi Reguart
- Medical Oncology Department, Hospital Clínic, IDIBAPS, 08036 Barcelona, Spain;
| | - Jon Zugazagoitia
- Medical Oncology Department, 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Reyes Bernabé
- Medical Oncology Department, Hospital Virgen del Rocio, Universidad de Sevilla, 41013 Sevilla, Spain
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7
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Arriola E, Bernabé R, Campelo RG, Biscuola M, Enguita AB, López-Ríos F, Martínez R, Mezquita L, Palanca S, Pareja MJ, Zugazagoitia J, Arrabal N, García JF, Carcedo D, de Álava E. Cost-Effectiveness of Next-Generation Sequencing Versus Single-Gene Testing for the Molecular Diagnosis of Patients With Metastatic Non-Small-Cell Lung Cancer From the Perspective of Spanish Reference Centers. JCO Precis Oncol 2023; 7:e2200546. [PMID: 36862967 DOI: 10.1200/po.22.00546] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
PURPOSE The aim of this study was to assess the cost-effectiveness of using next-generation sequencing (NGS) versus single-gene testing (SgT) for the detection of genetic molecular subtypes and oncogenic markers in patients with advanced non-small-cell lung cancer (NSCLC) in the setting of Spanish reference centers. METHODS A joint model combining decision tree with partitioned survival models was developed. A two-round consensus panel was performed to describe clinical practice of Spanish reference centers, providing data on testing rate, prevalence of alterations, turnaround times, and treatment pathways. Treatment efficacy data and utility values were obtained from the literature. Only direct costs (euros, 2022), obtained from Spanish databases, were included. A lifetime horizon was considered, so a 3% discount rate for future costs and outcomes was considered. Both deterministic and probabilistic sensitivity analyses were performed to assess uncertainty. RESULTS A target population of 9,734 patients with advanced NSCLC was estimated. If NGS was used instead of SgT, 1,873 more alterations would be detected and 82 more patients could potentially be enrolled in clinical trials. In the long term, using NGS would provide 1,188 additional quality-adjusted life-years (QALYs) in the target population compared with SgT. On the other hand, the incremental cost of NGS versus SgT in the target population was €21,048,580 euros for a lifetime horizon (€1,333,288 for diagnosis phase only). The obtained incremental cost-utility ratios were €25,895 per QALY gained, below the standard cost-effectiveness thresholds. CONCLUSION Using NGS in Spanish reference centers for the molecular diagnosis of patients with metastatic NSCLC would be a cost-effective strategy over SgT.
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Affiliation(s)
| | - Reyes Bernabé
- Institute of Biomedicine of Sevilla (IBiS), Virgen del Rocio University Hospital/CSIC/University of Sevilla/CIBERONC, Seville, Spain
| | - Rosario García Campelo
- Hospital Universitario de A Coruña, A Coruña Institute of Biomedicine of A Coruña (INIBIC), A Coruña, Spain
| | - Michele Biscuola
- Institute of Biomedicine of Sevilla (IBiS), Virgen del Rocio University Hospital/CSIC/University of Sevilla/CIBERONC, Seville, Spain
| | | | | | | | | | - Sarai Palanca
- Hospital Universitario y Politécnico de La Fe, Valencia, Spain.,University of Valencia, Spain
| | - María Jesús Pareja
- Institute of Biomedicine of Sevilla (IBiS), Virgen del Rocio University Hospital/CSIC/University of Sevilla/CIBERONC, Seville, Spain
| | - Jon Zugazagoitia
- Hospital Universitario 12 de octubre, Madrid, Spain.,Hospital Universitario 12 de Octubre (i+12), Madrid, Spain.,Hospital Universitario 12 de Octubre (i+12) / Spanish National Cancer Research Center (CNIO), Madrid, Spain.,CIBERONC, Madrid, Spain
| | | | | | | | - Enrique de Álava
- Institute of Biomedicine of Sevilla (IBiS), Virgen del Rocio University Hospital/CSIC/University of Sevilla/CIBERONC, Seville, Spain.,University of Seville, Seville, Spain
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8
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Romero A, Serna R, Nadal E, Larriba JG, Martínez-Martí A, Bernabé R, Bosch-Barrera J, Fernandez AG, Calvo V, Insa A, Ponce S, Reguart N, De Castro J, Massutí B, Palmero R, Aguado de la Rosa C, Mosquera J, Cobo M, Aguilar A, Vivanco GL, Camps C, Trancho FH, Castro RL, Moran T, Barneto I, Rodríguez-Abreu D, Cruz A, Provencio M. MA06.03 Pre-treatment ctDNA Levels Significantly Predicts of OS and PFS in NADIM II Trial. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.106] [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: 11/30/2022]
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9
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Casarrubios M, Provencio M, Nadal E, Insa A, Del Rosario García-Campelo M, Lázaro-Quintela M, Dómine M, Majem M, Rodriguez-Abreu D, Martinez-Marti A, De Castro Carpeño J, Cobo M, López Vivanco G, Del Barco E, Bernabé R, Viñolas N, Barneto Aranda I, Massuti B, Sierra-Rodero B, Martinez-Toledo C, Fernández-Miranda I, Serna-Blanco R, Romero A, Calvo V, Cruz-Bermúdez A. Tumor microenvironment gene expression profiles associated to complete pathological response and disease progression in resectable NSCLC patients treated with neoadjuvant chemoimmunotherapy. J Immunother Cancer 2022; 10:jitc-2022-005320. [PMID: 36171009 PMCID: PMC9528578 DOI: 10.1136/jitc-2022-005320] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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] [Accepted: 09/13/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Neoadjuvant chemoimmunotherapy for non-small cell lung cancer (NSCLC) has improved pathological responses and survival rates compared with chemotherapy alone, leading to Food and Drug Administration (FDA) approval of nivolumab plus chemotherapy for resectable stage IB-IIIA NSCLC (AJCC 7th edition) without ALK or EGFR alterations. Unfortunately, a considerable percentage of tumors do not completely respond to therapy, which has been associated with early disease progression. So far, it is impossible to predict these events due to lack of knowledge. In this study, we characterized the gene expression profile of tumor samples to identify new biomarkers and mechanisms behind tumor responses to neoadjuvant chemoimmunotherapy and disease recurrence after surgery. METHODS Tumor bulk RNA sequencing was performed in 16 pretreatment and 36 post-treatment tissue samples from 41 patients with resectable stage IIIA NSCLC treated with neoadjuvant chemoimmunotherapy from NADIM trial. A panel targeting 395 genes related to immunological processes was used. Tumors were classified as complete pathological response (CPR) and non-CPR, based on the total absence of viable tumor cells in tumor bed and lymph nodes tested at surgery. Differential-expressed genes between groups and pathway enrichment analysis were assessed using DESeq2 and gene set enrichment analysis. CIBERSORTx was used to estimate the proportions of immune cell subtypes. RESULTS CPR tumors had a stronger pre-established immune infiltrate at baseline than non-CPR, characterized by higher levels of IFNG, GZMB, NKG7, and M1 macrophages, all with a significant area under the receiver operating characteristic curve (ROC) >0.9 for CPR prediction. A greater effect of neoadjuvant therapy was also seen in CPR tumors with a reduction of tumor markers and IFNγ signaling after treatment. Additionally, the higher expression of several genes, including AKT1, BST2, OAS3, or CD8B; or higher dendritic cells and neutrophils proportions in post-treatment non-CPR samples, were associated with relapse after surgery. Also, high pretreatment PD-L1 and tumor mutational burden levels influenced the post-treatment immune landscape with the downregulation of proliferation markers and type I interferon signaling molecules in surgery samples. CONCLUSIONS Our results reinforce the differences between CPR and non-CPR responses, describing possible response and relapse immune mechanisms, opening the possibility of therapy personalization of immunotherapy-based regimens in the neoadjuvant setting of NSCLC.
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Affiliation(s)
- Marta Casarrubios
- Medical Oncology, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda-Madrid, Spain
| | - Mariano Provencio
- Medical Oncology, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda-Madrid, Spain
| | - Ernest Nadal
- Medical Oncology, Catalan Institute of Oncology, Oncobell Program, IDIBELL, L'Hospitalet de Llobregat, L'Hospitalet, Barcelona, Spain
| | - Amelia Insa
- Medical Oncology, Fundación INCLIVA, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | | | - Manuel Dómine
- Medical Oncology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Margarita Majem
- Medical Oncology, Hospital de la Santa Creu i Sant Pau Servei de Oncologia Medica, Barcelona, Spain
| | - Delvys Rodriguez-Abreu
- Medical Oncology, Hospital Universitario Insular de Gran Canaria, Las Palmas, Canarias, Spain
| | - Alex Martinez-Marti
- Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Barcelona, Spain, Barcelona, Barcelona, Spain
| | | | - Manuel Cobo
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| | | | - Edel Del Barco
- Medical Oncology, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Reyes Bernabé
- Medical Oncology, Hospital U. Virgen Rocio, Seville, Spain
| | | | | | | | - Belén Sierra-Rodero
- Medical Oncology, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda-Madrid, Spain
| | - Cristina Martinez-Toledo
- Medical Oncology, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda-Madrid, Spain
| | - Ismael Fernández-Miranda
- Medical Oncology, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda-Madrid, Spain
| | - Roberto Serna-Blanco
- Medical Oncology, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda-Madrid, Spain
| | - Atocha Romero
- Medical Oncology, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda-Madrid, Spain
| | - Virginia Calvo
- Medical Oncology, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda-Madrid, Spain
| | - Alberto Cruz-Bermúdez
- Medical Oncology, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda-Madrid, Spain
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Provencio M, Serna R, Nadal E, Glez Larriba J, Martínez-Martí A, Bernabé R, Bosch-Barrera J, Garcia Benito C, Calvo V, Insa A, Ponce S, Reguart N, De Castro J, Massutí B, Palmero R, Aguado de la Rosa C, Mosquera J, Cobo M, Aguilar A, López Vivanco G, Camps C, Hernando Trancho F, López Castro R, Moran T, Barneto I, Rodríguez-Abreu D, Romero A. PL03.12 Progression Free Survival and Overall Survival in NADIM II Study. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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11
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Provencio M, Cobo M, Rodriguez-Abreu D, Calvo V, Carcereny E, Cantero A, Bernabé R, Benitez G, Castro RL, Massutí B, del Barco E, García Campelo R, Guirado M, Camps C, Ortega AL, González Larriba JL, Sánchez A, Casal J, Sala MA, Juan-Vidal O, Bosch-Barrera J, Oramas J, Dómine M, Trigo JM, Blanco R, Calzas J, Morilla I, Padilla A, Pimentao J, Sousa PA, Torrente M. Determination of essential biomarkers in lung cancer: a real-world data study in Spain with demographic, clinical, epidemiological and pathological characteristics. BMC Cancer 2022; 22:732. [PMID: 35790916 PMCID: PMC9254518 DOI: 10.1186/s12885-022-09830-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background The survival of patients with lung cancer has substantially increased in the last decade by about 15%. This increase is, basically, due to targeted therapies available for advanced stages and the emergence of immunotherapy itself. This work aims to study the situation of biomarker testing in Spain. Patients and methods The Thoracic Tumours Registry (TTR) is an observational, prospective, registry-based study that included patients diagnosed with lung cancer and other thoracic tumours, from September 2016 to 2020. This TTR study was sponsored by the Spanish Lung Cancer Group (GECP) Foundation, an independent, scientific, multidisciplinary oncology society that coordinates more than 550 experts and 182 hospitals across the Spanish territory. Results Nine thousand two hundred thirty-nine patients diagnosed with stage IV non-small cell lung cancer (NSCLC) between 2106 and 2020 were analysed. 7,467 (80.8%) were non-squamous and 1,772 (19.2%) were squamous. Tumour marker testing was performed in 85.0% of patients with non-squamous tumours vs 56.3% in those with squamous tumours (p-value < 0.001). The global testing of EGFR, ALK, and ROS1 was 78.9, 64.7, 35.6% respectively, in non-squamous histology. PDL1 was determined globally in the same period (46.9%), although if we focus on the last 3 years it exceeds 85%. There has been a significant increase in the last few years of all determinations and there are even close to 10% of molecular determinations that do not yet have targeted drug approval but will have it in the near future. 4,115 cases had a positive result (44.5%) for either EGFR, ALK, KRAS, BRAF, ROS1, or high PDL1. Conclusions Despite the lack of a national project and standard protocol in Spain that regulates the determination of biomarkers, the situation is similar to other European countries. Given the growing number of different determinations and their high positivity, national strategies are urgently needed to implement next-generation sequencing (NGS) in an integrated and cost-effective way in lung cancer.
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12
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Dafni U, Soo RA, Peters S, Tsourti Z, Zygoura P, Vervita K, Han JY, De Castro J, Coate L, Früh M, Hashemi SMS, Nadal E, Carcereny E, Sala MA, Bernabé R, Provencio M, Cuffe S, Roschitzki-Voser H, Ruepp B, Rosell R, Stahel RA. Impact of smoking status on the relative efficacy of the EGFR TKI/angiogenesis inhibitor combination therapy in advanced NSCLC-a systematic review and meta-analysis. ESMO Open 2022; 7:100507. [PMID: 35696746 PMCID: PMC9271510 DOI: 10.1016/j.esmoop.2022.100507] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 03/22/2022] [Revised: 04/27/2022] [Accepted: 05/04/2022] [Indexed: 11/12/2022] Open
Abstract
Background The ETOP 10-16 BOOSTER trial failed to demonstrate a progression-free survival (PFS) benefit for adding bevacizumab to osimertinib in second line. An exploratory subgroup analysis, however, suggested a PFS benefit of the combination in patients with a smoking history and prompted us to do this study. Methods A systematic review and meta-analysis to evaluate the differential effect of smoking status on the benefit of adding an angiogenesis inhibitor to epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor therapy was carried out. All relevant randomized controlled trials appearing in main oncology congresses or in PubMed as of 1 November 2021 were used according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. Primarily PFS according to smoking status, and secondarily overall survival (OS) were of interest. Pooled and interaction hazard ratios (HRs) were estimated by fixed or random effects models, depending on the detected degree of heterogeneity. Bias was assessed using the revised Cochrane tool for randomized controlled trials (RoB 2). Results Information by smoking was available for 1291 patients for PFS (seven studies) and 678 patients for OS (four studies). The risk of bias was low for all studies. Combination treatment significantly prolonged PFS for smokers [n = 502, HR = 0.55, 95% confidence interval (CI): 0.44-0.69] but not for nonsmokers (n = 789, HR = 0.92, 95% CI: 0.66-1.27; treatment-by-smoking interaction P = 0.02). Similarly, a significant OS benefit was found for smokers (n = 271, HR = 0.66, 95% CI: 0.47-0.93) but not for nonsmokers (n = 407, HR = 1.07, 95% CI: 0.82-1.42; treatment-by-smoking interaction P = 0.03). Conclusion In advanced EGFR-non-small-cell lung cancer patients, the addition of an angiogenesis inhibitor to EGFR-tyrosine kinase inhibitor therapy provides a statistically significant PFS and OS benefit in smokers, but not in non-smokers. The biological basis for this observation should be pursued and could determine whether this might be due to a specific co-mutational pattern produced by tobacco exposure. Target population consists of EGFR-non-small-cell lung cancer patients. The relative effect of adding an angiogenesis inhibitor to EGFR tyrosine kinase inhibitor by smoking status was explored. In patients with smoking history, the addition of an angiogenesis inhibitor provides significant PFS and OS benefit. This is not the case in patients with a negative smoking history. The biological basis for this observation should be pursued.
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Affiliation(s)
- U Dafni
- National and Kapodistrian University of Athens, Athens, Greece; Frontier Science Foundation Hellas, Athens, Greece
| | - R A Soo
- National University Cancer Institute, Department of Haematology-Oncology, Singapore
| | - S Peters
- Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Z Tsourti
- Frontier Science Foundation Hellas, Athens, Greece
| | - P Zygoura
- Frontier Science Foundation Hellas, Athens, Greece
| | - K Vervita
- Frontier Science Foundation Hellas, Athens, Greece
| | - J-Y Han
- National Cancer Center, Center for Lung Cancer, Goyang, Republic of Korea
| | - J De Castro
- Hospital Universitario La Paz, Medical Oncology Department, Madrid, Spain; Spanish Lung Cancer Group (SLCG), Barcelona, Spain
| | - L Coate
- Mid-Western Cancer Centre and University Hospital Limerick, Limerick, Ireland; Cancer Trials Ireland, Innovation House, Dublin, Ireland
| | - M Früh
- Cantonal Hospital St. Gallen, Oncology and Hematology, St. Gallen, Switzerland; Inselspital Bern, Department of Oncology, Bern, Switzerland; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - S M S Hashemi
- Amsterdam UMC, VU University Medical Center, Department of Pulmonary Diseases, Amsterdam, the Netherlands
| | - E Nadal
- Spanish Lung Cancer Group (SLCG), Barcelona, Spain; ICO L'Hospitalet, Medical Oncology Department, Barcelona, Spain
| | - E Carcereny
- Spanish Lung Cancer Group (SLCG), Barcelona, Spain; Institut Català d'Oncologia Badalona-Hospital Germans Trias i Pujol, B-ARGO Group, Medical Oncology Department, Badalona, Spain
| | - M A Sala
- Spanish Lung Cancer Group (SLCG), Barcelona, Spain; Hospital Universitario Basurto, Medical Oncology Department, Bilbao, Spain
| | - R Bernabé
- Spanish Lung Cancer Group (SLCG), Barcelona, Spain; Hospital Virgen del Rocio, Medical Oncology Department, Seville, Spain
| | - M Provencio
- Spanish Lung Cancer Group (SLCG), Barcelona, Spain; Hospital Puerta de Hierro, Majadahonda Medical Oncology Service, Madrid, Spain
| | - S Cuffe
- Cancer Trials Ireland, Innovation House, Dublin, Ireland; St. James's Hospital, Department of Medical Oncology, Dublin, Ireland
| | | | - B Ruepp
- ETOP IBCSG Partners Foundation, Coordinating Office, Bern, Switzerland
| | - R Rosell
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain; Catalan Institute of Oncology (ICO), Honorary Consultant, Barcelona, Spain
| | - R A Stahel
- ETOP IBCSG Partners Foundation, Coordinating Office, Bern, Switzerland.
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13
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Ferrer L, Nadal E, Guidel F, Insa A, Menu P, Casal J, Domine M, Massuti B, Majem M, Martinez-Marti A, Campelo RG, de Castro Carpeño J, Cobo M, Lopez Vivanco G, del Barco E, Bernabé R, Vinolas N, Barneto I, Colin T, Provencio-Pulla M. Multimodal prediction of response to neoadjuvant nivolumab and chemotherapy for surgically resectable stage IIIA non–small cell lung cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.8542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8542 Background: The NADIM trial (NCT03081689), led by the Spanish Lung Cancer Group, assessed the antitumor activity and safety of neoadjuvant chemoimmunotherapy for resectable stage IIIA NSCLC. Patients received neoadjuvant nivolumab and paclitaxel-carboplatin for three cycles before surgical resection, followed by one year of adjuvant nivolumab. At 24 months, progression-free survival (PFS) was 77%, suggesting that neoadjuvant chemoimmunotherapy represents a promising option in this setting. Pathological complete response (pCR) could potentially be used as an important surrogate endpoint for survival. We present here a re-analysis of the NADIM cohort aiming to develop a machine learning algorithm to predict the pCR status based on multimodal baseline data. Methods: We combined baseline clinical data (e.g., age, smoking status), biological data (e.g., tumor histology, mutations), radiology reports and radiomics analysis of the baseline CT scan in a multimodal analysis. While 46 patients were enrolled in the NADIM trial, only 28 had a complete set of data available for this retrospective study. For each patient, tumors were segmented on the baseline CT-scan in 3D by a Deep Learning algorithm. Radiomics features were extracted following the IBSI standards and combined with the other data modalities. A filter-based variable selection method was applied before training several machine learning algorithms. The optimization criterion was the Area Under the ROC Curve (AUC). Due to the small size of the cohort, a leave-one-out cross-validation approach was used to properly estimate the model performance. For a sub-cohort of 20 patients for which data have been collected longitudinally during the neoadjuvant treatment, an additional Delta-radiomics model was used to predict the pCR status. Results: An XGBoost algorithm with a linear base learner displayed an AUC of 0.69, a precision of 75%, a sensitivity of 83% and a specificity of 50%. Features with highest weight in the algorithm were a mix of radiological, radiomics, biological and clinical features (including the neutrophils to lymphocytes ratio, mutations and histology) highlighting the importance of a truly multimodal analysis. Indeed, withdrawing a specific data modality (e.g., radiomics or biological features), led to a decrease of ̃15% of the AUC. Inclusion of the Delta-radiomics analysis on the data collected longitudinally prior to surgery led to an improved AUC of 0.76 in that patient sub-cohort. Conclusions: This study is, to our knowledge, the first to offer a multimodal analysis of the response to neoadjuvant treatment for surgically resectable stage IIIA NSCLC and is a proof of concept that a machine learning algorithm can be used to predict the pCR in this context. These preliminary results are being confirmed in the ongoing NADIM II trial. Clinical trial information: NCT03838159.
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Affiliation(s)
| | - Ernest Nadal
- Institut Català d’Oncologia, L’Hospitalet, Barcelona, Spain
| | | | - Amelia Insa
- Hospital Clinico Universitario de Valencia, Valencia, Spain
| | | | | | - Manuel Domine
- Instituto de Investigación Sanitaria, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - Alex Martinez-Marti
- Medical Oncology Department, Vall d´Hebron University Hospital/Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Javier de Castro Carpeño
- Translational Oncology Unit at Medical Oncology Division, Hospital Universitario La Paz, Madrid, Spain
| | - Manuel Cobo
- UGC Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | | | | | - Reyes Bernabé
- Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | | | | | - Mariano Provencio-Pulla
- Instituto Investigacion Sanitaria Puerta de Hierro-Segovia de Arana, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
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14
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Provencio-Pulla M, Nadal E, Larriba JLG, Martinez-Marti A, Bernabé R, Bosch-Barrera J, Casal J, Calvo V, Insa A, Aix SP, Reguart N, Carpeño JDC, Mosquera J, Benitez R, Aguado De La Rosa C, Palmero R, Hernando-Trancho F, Romero A, Cruz Bermudez A, Massuti B. Nivolumab + chemotherapy versus chemotherapy as neoadjuvant treatment for resectable stage IIIA NSCLC: Primary endpoint results of pathological complete response (pCR) from phase II NADIM II trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.8501] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8501 Background: Non-small cell lung cancer (NSCLC) is incurable in most patients with locally advanced stage IIIA disease. Previous results indicate that the use of neoadjuvant chemoimmunotherapy could increase the percentage of cured patients being a promising therapeutic option that has to be tested in randomized clinical trials. Methods: NADIM II (NCT03838159) is an open-label, randomized, two-arm, phase II, multi-center clinical trial. Patients with resectable clinical stage IIIA (per AJCC 7th ed) NSCLC, ECOG PS 0-1, and no known EGFR/ALK alterations were randomized to receive Nivolumab (NIVO) 360mg + Paclitaxel 200mg/m2 + Carboplatin AUC5 for 3 cycles every 21 days (+/- 3 days) as neoadjuvant treatment followed by surgery, or Paclitaxel 200mg/m2 + Carboplatin AUC5 for 3 cycles every 21 days (+/- 3 days) followed by surgery. Patients with R0 resection confirmed by pathological evaluation initiated adjuvant administration of NIVO within the 3rd to 8th week (+7 days) from surgery and for 6 months. The primary endpoint was pathological complete response (pCR) by blinded independent pathological review (BIPR) in the intent-to-treat population (ITT). pCR was defined as 0% viable tumor cells in resected lung and lymph nodes; patients who did not undergo surgery were classified as non-responders. Major pathological response (MPR; ≤ 10% viable tumor) per BIPR, overall response rate (ORR), toxicity profile, and potential predictive biomarkers are secondary endpoints. Results: Between February 8, 2019, and November 11, 2021, 90 patients were enrolled, of whom 87 patients were valid. Neoadjuvant NIVO + chemo significantly increased the pCR rate compared to chemo in the ITT (36.2% vs 6.8%; Relative Risk (RR) 5.25 [99% CI 1.32-20.87]; P = 0.0071). NIVO + chemo also improved MPR rates vs chemo in the ITT (52 % vs 14 %), as well as ORR (74 % vs 48%). Definitive surgery occurred for 91% of pts treated with NIVO + chemo and 69% with chemo; surgery was cancelled rarely due to AEs (1 pts/experimental arm) and due to disease progression in 1 and 4 pts in the experimental and control arm respectively. Grade 3-4-related AEs were reported in 24 % vs 10% in the NIVO + chemo vs chemo arms, respectively. In the ITT experimental arm, patients with pCR had higher PD-L1 TPS (median 70%, IQR 5-90%) compared to non-responders (median 0%, IQR 0-37.5%, P = 0.0035). AUC to predict pCR was 0.734 (95% CI 0.59-0.88; P = 0.005). The pCR rate rises across increasing categories of PD-L1 TPS ( < 1% 14.3%; 1-49% 41.7%; ≥50% 61.1%; P = 0.008). Conclusions: This study confirms the superiority of the chemo-immuno combination in patients with resectable stage IIIA NSCLC in terms of pCR, as well as the feasibility of surgery, with a moderate increase in grade 3-4 toxicity. Thus, this treatment should become the standard of care in these patients. Clinical trial information: NCT03838159.
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Affiliation(s)
- Mariano Provencio-Pulla
- Instituto Investigacion Sanitaria Puerta de Hierro-Segovia de Arana, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Ernest Nadal
- Institut Català d’Oncologia, L’Hospitalet, Barcelona, Spain
| | | | - Alex Martinez-Marti
- Medical Oncology Department, Vall d´Hebron University Hospital/Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Reyes Bernabé
- Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | | | - Virginia Calvo
- Instituto Investigacion Sanitaria Puerta de Hierro-Segovia de Arana, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Amelia Insa
- Hospital Clinico Universitario de Valencia, Valencia, Spain
| | | | - Noemi Reguart
- Medical Oncology, Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Joaquín Mosquera
- Medical Oncology Dept, University Hospital A Coruña (CHUAC-SERGAS), A Coruña, Spain
| | - Raquel Benitez
- Bioinformatic Unit, spaninsh National Cancer Research Centre, Madrid, Spain
| | | | - Ramon Palmero
- Department of Medical Oncology, Catalan Institute of Oncology, Barcelona, Spain
| | | | - Atocha Romero
- Liquid Biopsy Laboratory, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Alberto Cruz Bermudez
- Instituto Investigacion Sanitaria Puerta de Hierro-Segovia de Arana, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
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Remon J, Bernabé R, Diz P, Felip E, González-Larriba JL, Lázaro M, Mielgo-Rubio X, Sánchez A, Sullivan I, Massutti B. SEOM-GECP-GETTHI Clinical Guidelines for the treatment of patients with thymic epithelial tumours (2021). Clin Transl Oncol 2022; 24:635-645. [PMID: 35122634 PMCID: PMC8817662 DOI: 10.1007/s12094-022-02788-w] [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] [Accepted: 01/20/2022] [Indexed: 11/27/2022]
Abstract
Thymic epithelial tumours (TET) represent a heterogeneous group of rare malignancies that include thymomas and thymic carcinoma. Treatment of TET is based on the resectability of the tumour. If this is considered achievable upfront, surgical resection is the cornerstone of treatment. Platinum-based chemotherapy is the standard regimen for advanced TET. Due to the rarity of this disease, treatment decisions should be discussed in specific multidisciplinary tumour boards, and there are few prospective clinical studies with new strategies. However, several pathways involved in TET have been explored as potential targets for new therapies in previously treated patients, such as multi-tyrosine kinase inhibitors with antiangiogenic properties and immune checkpoint inhibitors (ICI). One third of patient with thymoma present an autoimmune disorders, increasing the risk of immune-related adverse events and autoimmune flares under ICIs. In these guidelines, we summarize the current evidence for the therapeutic approach in patients with TET and define levels of evidence for these decisions.
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Affiliation(s)
- J Remon
- Department of Medical Oncology, Centro Integral Oncológico Clara Campal (HM-CIOCC), Hospital HM Nou Delfos, HM Hospitales, Avinguda de Vallcarca, 151, 08023, Barcelona, Spain.
| | - R Bernabé
- Department of Medical Oncology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - P Diz
- Department of Medical Oncology, Hospital Universitario de León, León, Spain
| | - E Felip
- Department of Medical Oncology, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - J L González-Larriba
- Department of Medical Oncology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - M Lázaro
- Department of Medical Oncology, Hospital Alvaro Cunqueiro, Vigo, Spain
| | - X Mielgo-Rubio
- Department of Medical Oncology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - A Sánchez
- Department of Medical Oncology, Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - I Sullivan
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - B Massutti
- Department of Medical Oncology, Hospital General Universitario de Alicante, Alicante, Spain
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16
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Arriola E, González-Cao M, Domine M, De Castro J, Cobo M, Bernabé R, Navarro A, Sullivan I, Trigo JM, Mosquera J, Crama L, Isla D. Addition of Immune Checkpoint Inhibitors to Chemotherapy vs Chemotherapy Alone as First-Line Treatment in Extensive-Stage Small-Cell Lung Carcinoma: A Systematic Review and Meta-Analysis. Oncol Ther 2022; 10:167-184. [PMID: 35032007 PMCID: PMC9098752 DOI: 10.1007/s40487-021-00182-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/23/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction The addition of immune checkpoint inhibitors (ICIs) to conventional chemotherapy (CT) as first-line treatment improves survival in extensive-stage small-cell lung cancer (ES-SCLC). The aim of this meta-analysis was to determine the relative efficacy of first-line ICIs compared with CT in patients with ES-SCLC. Methods Two independent reviewers extracted relevant data according to PRISMA guidelines and assessed the risk of bias using the Cochrane Collaboration's risk-of-bias tool. Meta-analysis was conducted using random-effects models to calculate an average effect size for overall survival (OS), progression-free survival (PFS), and safety outcomes in the overall populations and clinically relevant subgroups. Results A literature search of PubMed and Embase was performed. Six randomized controlled clinical trials (IMpower133, CHECKMATE-451, CASPIAN, KEYNOTE-604, and phase II and III ipilimumab plus CT trials) with a total of 3757 patients were included. Compared with CT alone, ICIs plus CT showed a favourable effect on OS (hazard ratio [HR] 0.85; 95% confidence intervals [CI] 0.79–0.96) and PFS (HR 0.78; 95% CI 0.72–0.83) but a non-significant increase in the risk of experiencing any adverse event (relative risk, 1.05; 95% CI 0.99–1.11). The estimated HR for OS favoured ICI combinations in all planned subgroups according to age (< 65 years/≥ 65 years), sex (men/women), and ECOG performance status (0/1). Analysis by specific ICI revealed significant improvements in OS only for atezolizumab + CT (HR 1.36; 95% CI 1.09–1.69) and durvalumab + CT (HR 1.35; 95% CI 1.12–1.62) compared with CT alone. Conclusion Combining anti-programmed cell death ligand 1 antibodies with platinum/etoposide is a superior therapeutic approach compared to CT alone for the first-line treatment of patients with ES-SCLC. Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s40487-021-00182-0.
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Affiliation(s)
- Edurne Arriola
- Medical Oncology Department, Hospital Universitari del Mar-CIBERONC, Passeig Marítim 25-29, 08003 Barcelona, Spain
| | | | - Manuel Domine
- Medical Oncology Department, Fundación Jiménez Díaz, Madrid, Spain
| | - Javier De Castro
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Manuel Cobo
- Inter-Center Medical Oncology Clinical Management Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| | - Reyes Bernabé
- Medical Oncology Department, Hospital Virgen del Rocío, Sevilla, Spain
| | - Alejandro Navarro
- Medical Oncology Department, Vall d’Hebron University Hospital & Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Ivana Sullivan
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - José Manuel Trigo
- Medical Oncology Department, Hospital Virgen de la Victoria, Málaga, Spain
| | - Joaquín Mosquera
- Medical Oncology Department, Hospital Universitario A Coruña, A Coruña, Spain
| | | | - Dolores Isla
- Medical Oncology Department, Hospital Universitario Lozano Blesa, Zaragoza, Spain
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Soo RA, Han JY, Dafni U, Cho BC, Yeo CM, Nadal E, Carcereny E, de Castro J, Sala MA, Bernabé R, Coate L, Provencio Pulla M, Garcia Campelo R, Cuffe S, Hashemi SMS, Früh M, Massuti B, Garcia-Sanchez J, Dómine M, Majem M, Sanchez-Torres JM, Britschgi C, Pless M, Dimopoulou G, Roschitzki-Voser H, Ruepp B, Rosell R, Stahel RA, Peters S. A randomised phase II study of osimertinib and bevacizumab versus osimertinib alone as second-line targeted treatment in advanced NSCLC with confirmed EGFR and acquired T790M mutations: the European Thoracic Oncology Platform (ETOP 10-16) BOOSTER trial. Ann Oncol 2021; 33:181-192. [PMID: 34839016 DOI: 10.1016/j.annonc.2021.11.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [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: 08/23/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND While osimertinib, a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) is the standard treatment in patients with advanced non-small-cell lung cancer (NSCLC) with sensitising EGFR and acquired T790M mutations, progression inevitably occurs. The angiogenic pathway is implicated in EGFR TKI resistance. PATIENTS AND METHODS BOOSTER is an open-label randomised phase II trial investigating the efficacy and safety of combined osimertinib 80 mg daily and bevacizumab 15 mg/kg every 3 weeks, versus osimertinib alone, in patients with EGFR-mutant advanced NSCLC and acquired T790M mutations after failure on previous EGFR TKI therapy. Primary endpoint was investigator-assessed progression-free survival (PFS). Secondary endpoints were overall survival (OS), objective response rate (ORR) and adverse events (AEs). RESULTS Between May 2017 and February 2019, 155 patients were randomised (combination: 78; osimertinib: 77). At data cut-off of 22 February 2021, median follow-up was 33.8 months [interquartile range (IQR): 26.5-37.6 months] and 129 (83.2%) PFS events were reported in the intention-to-treat population. There was no difference in median PFS between the combination [15.4 months; 95% confidence interval (CI) 9.2-18.0 months] and osimertinib arm (12.3 months; 95% CI 6.2-17.2 months; stratified log-rank P = 0.83), [hazard ratio (HR) = 0.96; 95% CI 0.68-1.37]. Median OS was 24.0 months (95% CI 17.8-32.1 months) in the combination arm and 24.3 months (95% CI 16.9-37.0 months) in the osimertinib arm (stratified log-rank P = 0.91), (HR = 1.03; 95% CI 0.67-1.56). Exploratory analysis revealed a significant interaction of smoking history with treatment for PFS (adjusted P = 0.0052) with a HR of 0.52 (95% CI 0.30-0.90) for smokers, and 1.47 (95% CI 0.92-2.33) for never smokers. ORR was 55% in both arms and the median time to treatment failure was significantly shorter in the combination than in the osimertinib arm, 8.2 months versus 10.8 months, respectively (P = 0.0074). Safety of osimertinib and bevacizumab was consistent with previous reports with grade ≥3 treatment-related AEs (TRAEs) reported in 47% and 18% of patients on combination and osimertinib alone, respectively. CONCLUSIONS No difference in PFS was observed between osimertinib plus bevacizumab and osimertinib alone. Grade ≥3 TRAEs were more common in patients on combination.
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Affiliation(s)
- R A Soo
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - J-Y Han
- National Cancer Center, Center for Lung Cancer, Goyang, Republic of Korea
| | - U Dafni
- National and Kapodistrian University of Athens, Athens, Greece; Frontier Science Foundation Hellas, Athens, Greece
| | - B C Cho
- Yonsei Cancer Center, Yonsei University College of Medicine, Division of Medical Oncology, Seoul, Republic of Korea
| | - C M Yeo
- Medical Oncology Department, Tan Tock Seng Hospital, Singapore, Singapore
| | - E Nadal
- Medical Oncology Department, ICO L'Hospitalet, Barcelona, Spain
| | - E Carcereny
- Medical Oncology Department, Institut Català d'Oncologia Badalona Hospital Germans Trias i Pujol, B-ARGO Group, Badalona, Spain
| | - J de Castro
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - M A Sala
- Medical Oncology Department, Hospital Universitario Basurto, Bilbao, Spain
| | - R Bernabé
- Medical Oncology Department, Hospital Virgen del Rocio, Sevilla, Spain
| | - L Coate
- Mid-Western Cancer Centre and University Hospital Limerick, Limerick, Ireland
| | - M Provencio Pulla
- Hospital Puerta de Hierro, Majadahonda Medical Oncology Service, Madrid, Spain
| | - R Garcia Campelo
- Medical Oncology Department, Hospital Teresa Herrera, La Coruña, Spain
| | - S Cuffe
- Department of Medical Oncology, St. James's Hospital, Dublin, Ireland
| | - S M S Hashemi
- Department of Pulmonary Diseases, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - M Früh
- Cantonal Hospital St. Gallen, Oncology and Hematology, St. Gallen, Switzerland; Department of Oncology, Inselspital Bern, Bern, Switzerland
| | - B Massuti
- Medical Oncology Department, Hospital General Universitario Alicante, Alicante, Spain
| | - J Garcia-Sanchez
- Medical Oncology Service, Hospital Arnau Vilanova, Valencia, Spain
| | - M Dómine
- Department of Oncology, Hospital Universitario Fundacion Jimenez Díaz (IIS-FJD), Madrid, Spain
| | - M Majem
- Medical Oncology Department, Hospital De La Santa Creu I Sant Pau, Barcelona, Spain
| | - J-M Sanchez-Torres
- Medical Oncology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - C Britschgi
- Department of Medical Oncology and Hematology, University Hospital Zurich, Comprehensive Cancer Center Zurich, Zurich, Switzerland
| | - M Pless
- Cantonal Hospital Winterthur, Oncology and Haematology, Winterthur, Switzerland
| | - G Dimopoulou
- Frontier Science Foundation Hellas, Athens, Greece
| | - H Roschitzki-Voser
- European Thoracic Oncology Platform (ETOP), Coordinating Office, Bern, Switzerland
| | - B Ruepp
- European Thoracic Oncology Platform (ETOP), Coordinating Office, Bern, Switzerland
| | - R Rosell
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Barcelona, Spain; Catalan Institute of Oncology (ICO), Honorary Consultant, Barcelona, Spain
| | - R A Stahel
- European Thoracic Oncology Platform (ETOP), Coordinating Office, Bern, Switzerland.
| | - S Peters
- Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland
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18
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Provencio M, Nadal E, Insa A, Campelo MG, Pereiro D, Domine M, Majem M, Abreu DR, Martinez-Marti A, De Castro J, Cobo M, Vivanco GL, Del Barco E, Bernabé R, Viñolas N, Barneto I, Viteri S, Pereira E, Royuela A, Casarrubios M, Salas C, Parra E, Wistuba I, Calvo V, Laza - Briviesca R, Romero A, Massuti B, Cruz A. OA20.01 Long Term Survival in Operable Stage Iiia Nsclc Patients Treated With Neoadjuvant Nivolumab Plus Chemotherapy - Nadim Study. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Romero A, Nadal E, Serna R, Insa A, Campelo MG, Benito C, Domine M, Majem M, Abreu DR, Martinez-Marti A, De Castro J, Cobo M, Vivanco GL, Del Barco E, Bernabé R, Viñolas N, Barneto I, Viteri S, Pereira E, Royuela A, Casarrubios M, Calvo V, Laza - Briviesca R, Massuti B, Cruz A, Sánchez-Herrero E, Provencio M. OA20.02 Pre-Treatment Levels of ctDNA for Long-Term Survival Prediction in Stage IIIA NSCLC Treated With Neoadjuvant Chemo-Immunotherapy. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Calvo V, Carcereny E, Abreu DR, Lopez-Castro R, Guirado M, Camps C, Cobo M, Ortega A, Bernabé R, Massuti B, Mosquera J, Del Barco E, Gonzalez - Larriba J, Bosch - Barrera J, Ojeda CG, Domine M, Juan O, Martínez-Cutillas M, Benítez G, Collazo-Lorduy A, Cucurull M, Provencio M. OA14.01 Family History of Cancer and Lung Cancer: Information from the Thoracic Tumors Registry (TTR Study). J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Gutiérrez L, Royuela A, Carcereny E, López-Castro R, Rodríguez-Abreu D, Massuti B, González-Larriba JL, García-Campelo R, Bosch-Barrera J, Guirado M, Camps C, Dómine M, Bernabé R, Casal J, Oramas J, Ortega AL, Sala MA, Padilla A, Aguiar D, Juan-Vidal O, Blanco R, del Barco E, Martínez-Banaclocha N, Benítez G, de Vega B, Hernández A, Saigi M, Franco F, Provencio M. Prognostic model of long-term advanced stage (IIIB-IV) EGFR mutated non-small cell lung cancer (NSCLC) survivors using real-life data. BMC Cancer 2021; 21:977. [PMID: 34465283 PMCID: PMC8406921 DOI: 10.1186/s12885-021-08713-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/16/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND There is a lack of useful diagnostic tools to identify EGFR mutated NSCLC patients with long-term survival. This study develops a prognostic model using real world data to assist clinicians to predict survival beyond 24 months. METHODS EGFR mutated stage IIIB and IV NSCLC patients diagnosed between January 2009 and December 2017 included in the Spanish Lung Cancer Group (SLCG) thoracic tumor registry. Long-term survival was defined as being alive 24 months after diagnosis. A multivariable prognostic model was carried out using binary logistic regression and internal validation through bootstrapping. A nomogram was developed to facilitate the interpretation and applicability of the model. RESULTS 505 of the 961 EGFR mutated patients identified in the registry were included, with a median survival of 27.73 months. Factors associated with overall survival longer than 24 months were: being a woman (OR 1.78); absence of the exon 20 insertion mutation (OR 2.77); functional status (ECOG 0-1) (OR 4.92); absence of central nervous system metastases (OR 2.22), absence of liver metastases (OR 1.90) or adrenal involvement (OR 2.35) and low number of metastatic sites (OR 1.22). The model had a good internal validation with a calibration slope equal to 0.781 and discrimination (optimism corrected C-index 0.680). CONCLUSIONS Survival greater than 24 months can be predicted from six pre-treatment clinicopathological variables. The model has a good discrimination ability. We hypothesized that this model could help the selection of the best treatment sequence in EGFR mutation NSCLC patients.
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Affiliation(s)
- Lourdes Gutiérrez
- Medical Oncology Department, Hospital Universitario Puerta de Hierro, Calle Joaquín Rodrigo n1, 28222, Majadahonda, Madrid, Spain
| | - Ana Royuela
- Biostatistics Unit, Puerta de Hierro Biomedical Research Institute (IDIPHISA), CIBERESP, Madrid, Spain
| | - Enric Carcereny
- Catalan Institute of Oncology, Hospital Universitari Germans Trias i Pujol, B-ARGO, IGTP, 08916 Badalona, Barcelona Spain
| | | | | | - Bartomeu Massuti
- Hospital General Universitario de Alicante, 03010 Alicante, Spain
| | | | | | - Joaquim Bosch-Barrera
- Catalan Institute of Oncology, Hospital Universitari Dr. Josep Trueta 17007, Girona, Spain
| | - María Guirado
- Hospital General Universitario de Elche, 03203 Elche, Alicante Spain
| | - Carlos Camps
- Hospital General Universitario de Valencia, Universitat De València, CIBERONC, 46014 Valencia, Spain
| | - Manuel Dómine
- Hospital Universitario Fundación Jiménez Diaz, IIS-FJD, 28040 Madrid, Spain
| | - Reyes Bernabé
- Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain
| | - Joaquín Casal
- Complexo Hospitalario Universitario A Coruña, 15006 A Coruña, Spain
| | - Juana Oramas
- Hospital Universitario de Canarias, 38320 San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | | | - Mª. Angeles Sala
- Hospital Universitario Basurto - OSI Bilbao Basurto, 48013 Bilbao, Spain
| | - Airam Padilla
- Hospital Universitario Nuestra Señora de la Candelaria, 38010 Santa Cruz de Tenerife, Spain
| | - David Aguiar
- Hospital Universitario de Gran Canaria Dr. Negrín, 35010 Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Oscar Juan-Vidal
- Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Remei Blanco
- Oncology Service, Consorci Sanitari de Terrassa, 08191 Rubí, Barcelona, Spain
| | - Edel del Barco
- Hospital Clínico Universitario de Salamanca, 37007 Salamanca, Spain
| | | | - Gretel Benítez
- Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - Blanca de Vega
- Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Ainhoa Hernández
- Catalan Institute of Oncology, Hospital Universitari Germans Trias i Pujol, B-ARGO, IGTP, 08916 Badalona, Barcelona Spain
| | - Maria Saigi
- Catalan Institute of Oncology, Hospital Universitari Germans Trias i Pujol, B-ARGO, IGTP, 08916 Badalona, Barcelona Spain
| | - Fernando Franco
- Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Madrid, Spain
| | - Mariano Provencio
- Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Madrid, Spain
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22
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Calvo V, Domine M, Sullivan I, Gonzalez-Larriba JL, Ortega AL, Bernabé R, Sala MA, Campos B, De Castro J, Martín-Martorell P, Bosch-Barrera J, Mielgo X, Vilà L, Casal J, Ros S, Martinez Aguillo M, Padilla A, Sandiego S, Aires Machado J, Provencio-Pulla M. A phase III clinical trial of adjuvant chemotherapy versus chemoimmunotherapy for stage IB-IIIA completely resected non-small cell lung cancer (NSCLC) patients nadim-adjuvant: New adjuvant trial of chemotherapy versus chemoimmunotherapy. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.tps8581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
TPS8581 Background: The results of current studies are considered acceptable evidence to support the hypothesis of efficacy of the proposed combination of immunotherapy with chemotherapy (CT-IO) in patients with NSCLC stages Ib-IIIA candidates for adjuvant treatment. Methods: This is an open-label, randomised, two-arm, phase III, multi-centre clinical trial. Primary objective and endpoint: The primary objective is disease free survival (DFS) defined time from randomization to the earliest event defined as disease recurrence, any new lung cancer (even in the opposite lung), or death from any cause at any known point in time Sample size: 210 patients NSCLC stages Ib-IIIA (Experimental Arm (Adjuvant Chemotherapy-Inmunotherapy + maintenance adjuvant Inmunotherapy): 105 patients, Control Arm (Adjuvant Chemotherapy): 105 patients Treatment Patients randomised to the experimental arm will receive Nivolumab 360mg + Paclitaxel 200mg/m2 + Carboplatin AUC5 for 4 cycles every 21 days (+/- 3 days) as adjuvant treatment followed by maintenance adjuvant treatment for 6 cycles with Nivolumab 480 mg Q4W (+/- 3 days). Patients randomized to the control arm will receive Paclitaxel 200mg/m2 + Carboplatin AUC5 for 4 cycles every 21 days (+/- 3 days) followed by 2 observation visits. Total trial duration: 6.5 years, 3.5 years of recruitment, 1 year of adjuvant treatment or observation and 2 years of follow up. The start date was January 2021. The estimated primary completion date is June 2027. Clinical trial information: NCT04564157.
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Affiliation(s)
- Virginia Calvo
- Instituto Investigacion Sanitaria Puerta de Hierro-Segovia de Arana, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Manuel Domine
- Instituto de Investigación Sanitaria, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Ivana Sullivan
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Reyes Bernabé
- Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | | | - Javier De Castro
- Translational Oncology Unit at Medical Oncology Division, Hospital Universitario La Paz, IdipAZ, Madrid, Spain
| | | | | | - Xabier Mielgo
- Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | - Laia Vilà
- Parc Taulí University Hospital, Parc Taulí Institute of Research and Innovation I3PT, Barcelona Autonomous University, Spain, Sabadell, Spain
| | | | - Silver Ros
- Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | - Airam Padilla
- Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Jonathan Aires Machado
- Department of Clinical Oncology, University Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Mariano Provencio-Pulla
- Instituto Investigacion Sanitaria Puerta de Hierro-Segovia de Arana, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
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23
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Camerini A, Morabito A, Montanino A, Bernabé R, Grossi F, Ramlau R, Ciuleanu TE, Ceresoli GL, Pasello G, de Marinis F, Bosch-Barrera J, Laundreau P, Gautier S, Ta Thanh Minh C, Kowalski D. Metronomic oral vinorelbine in previously untreated advanced non-small-cell lung cancer patients unfit for platinum-based chemotherapy: results of the randomized phase II Tempo Lung trial. ESMO Open 2021; 6:100051. [PMID: 33611164 PMCID: PMC7903063 DOI: 10.1016/j.esmoop.2021.100051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/08/2020] [Revised: 12/12/2020] [Accepted: 12/16/2020] [Indexed: 12/27/2022] Open
Abstract
Background To assess the efficacy and safety of a metronomic schedule of oral vinorelbine (mVNR) in advanced non-small-cell lung cancer (NSCLC) in patients unfit for platinum-based combination chemotherapy. Patients and methods This was a multicenter, prospective, randomized, open-label phase II study in treatment-naive patients with TNM stage IIIB/IV NSCLC. Patients received mVNR at a fixed dose of 50 mg × 3 or standard schedule 60-80 mg/m2 weekly until disease progression or unacceptable toxicity. The primary endpoint was progression-free survival (PFS) without grade 4 toxicity (G4PFS; NCI-CTC v4). Main secondary objectives were safety, disease control rate (DCR) without grade 4 toxicity (G4DCR), DCR, PFS, overall survival (OS) and quality of life (QoL). Results A total of 167 patients were included, 83 and 84 patients in the mVNR and standard arms, respectively. The median G4PFS was 4.0 months [95% confidence interval (CI): 2.6-4.3] and 2.2 months (95% CI: 1.5-2.9), hazard ration (HR) = 0.63 (95% CI: 0.45-0.88), P = 0.0068 in favor of metronomic arm; G4DCR was 45.8% and 26.8% in the mVNR and standard arms, respectively. Grade 3-4 treatment-related adverse events were less frequent in the mVNR arm (25.3% versus 54.4%) mainly owing to a reduction in all grades (15.7% versus 51.9%) and grade 3-4 neutropenia (10.8% versus 42%). PFS was 4.3 (95% CI: 3.3-5.1) and 3.9 months (95% CI: 2.8-5.2) in mVNR and standard arms, respectively. No difference in median OS was observed. QoL was comparable between arms. Conclusions Metronomic oral vinorelbine significantly prolonged median G4PFS in advanced NSCLC patients unfit for platinum combinations as first-line treatment. It was associated with a clear reduction in toxicity and may be considered as an important option in this challenging population. First-line oral vinorelbine prolonged PFS without grade 4 toxicity in platinum-unfit patients with advanced NSCLC. Metronomic oral vinorelbine is associated with a clear reduction of grade 3-4 toxicities (mainly hematological ones). Metronomic oral vinorelbine allows home treatment and easy tailoring of the treatment according to patient tolerance.
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Affiliation(s)
- A Camerini
- Medical Oncology Department, Versilia Hospital, Lido di Camaiore, Italy.
| | - A Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori, "Fondazione G. Pascale", IRCCS, Napoli, Italy
| | - A Montanino
- Thoracic Medical Oncology, Istituto Nazionale Tumori, "Fondazione G. Pascale", IRCCS, Napoli, Italy
| | - R Bernabé
- Medical Oncology Department, Hospital Virgen del Rocio, Institute for Biomedical Research, Seville, Spain
| | - F Grossi
- Division of Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - R Ramlau
- Oncology Department, Poznan University of Medical Sciences, Poland
| | - T-E Ciuleanu
- Oncology Institute "Pr Dr Ion Chiricuta", Cluj-Napoca, Romania
| | - G-L Ceresoli
- Oncology Department, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - G Pasello
- Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - F de Marinis
- Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan, Italy
| | - J Bosch-Barrera
- Lung Cancer Unit, Catalan Institute of Oncology, Hospital Universitari Dr Josep Trueta, Girona, Spain
| | - P Laundreau
- Medical Affairs Oncology, Pierre Fabre Médicament, Boulogne, France
| | - S Gautier
- IRPF, Pierre Fabre Médicament, Toulouse, France
| | - C Ta Thanh Minh
- Medical Affairs Oncology, Pierre Fabre Médicament, Boulogne, France
| | - D Kowalski
- Lung Cancer and Chest Tumours Department, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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24
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Romero A, Jantus-Lewintre E, García-Peláez B, Royuela A, Insa A, Cruz P, Collazo A, Pérez Altozano J, Vidal OJ, Diz P, Cobo M, Hernández B, Vázquez Estevez S, Benítez G, Guirado M, Majem M, Bernabé R, Ortega AL, Blasco A, Bosch-Barrera J, Jurado JM, García González J, Viteri S, Garcia Giron C, Massutí B, Lopez Martín A, Rodriguez-Festa A, Calabuig-Fariñas S, Molina-Vila MÁ, Provencio M. Comprehensive cross-platform comparison of methods for non-invasive EGFR mutation testing: results of the RING observational trial. Mol Oncol 2020; 15:43-56. [PMID: 33107189 PMCID: PMC7782072 DOI: 10.1002/1878-0261.12832] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 06/28/2020] [Revised: 10/01/2020] [Accepted: 10/22/2020] [Indexed: 12/19/2022] Open
Abstract
Several platforms for noninvasive EGFR testing are currently used in the clinical setting with sensitivities ranging from 30% to 100%. Prospective studies evaluating agreement and sources for discordant results remain lacking. Herein, seven methodologies including two next‐generation sequencing (NGS)‐based methods, three high‐sensitivity PCR‐based platforms, and two FDA‐approved methods were compared using 72 plasma samples, from EGFR‐mutant non‐small‐cell lung cancer (NSCLC) patients progressing on a first‐line tyrosine kinase inhibitor (TKI). NGS platforms as well as high‐sensitivity PCR‐based methodologies showed excellent agreement for EGFR‐sensitizing mutations (K = 0.80–0.89) and substantial agreement for T790M testing (K = 0.77 and 0.68, respectively). Mutant allele frequencies (MAFs) obtained by different quantitative methods showed an excellent reproducibility (intraclass correlation coefficients 0.86–0.98). Among other technical factors, discordant calls mostly occurred at mutant allele frequencies (MAFs) ≤ 0.5%. Agreement significantly improved when discarding samples with MAF ≤ 0.5%. EGFR mutations were detected at significantly lower MAFs in patients with brain metastases, suggesting that these patients risk for a false‐positive result. Our results support the use of liquid biopsies for noninvasive EGFR testing and highlight the need to systematically report MAFs.
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Affiliation(s)
- Atocha Romero
- Liquid Biopsy Laboratory, Biomedical Sciences Research Institute Puerta de Hierro-Majadahonda, Madrid, Spain.,Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Eloisa Jantus-Lewintre
- CIBERONC, Madrid, Spain.,Mixed Unit TRIAL, Príncipe Felipe Research Center & General University Hospital of Valencia Research Foundation, Spain.,Biotechnology Department, Universitat Politècnica de València, Spain
| | - Beatriz García-Peláez
- Laboratory of Oncology/Pangaea Oncology, Quirón-Dexeus University Hospital, Barcelona, Spain
| | - Ana Royuela
- Biostatistics Unit, CIBERESP, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Amelia Insa
- Hospital Clínico Universitario de Valencia, Spain
| | | | - Ana Collazo
- Hospital Universitario Sanchinarro, Madrid, Spain
| | | | | | - Pilar Diz
- Complejo Asistencial Universitario de León, Spain
| | - Manuel Cobo
- Hospital Regional Universitario, Málaga, Spain
| | | | | | - Gretel Benítez
- Complejo Hospitalario Universitario Insular de Gran Canaria, Las Palmas, Spain
| | - Maria Guirado
- Hospital General Universitario de Elche, Alicante, Spain
| | | | | | | | | | | | - Jose M Jurado
- Hospital Universitario Clínico San Cecilio, Granada, Spain
| | | | - Santiago Viteri
- Instituto Oncológico Dr. Rosell, Hospital Universitario Dexeus, Grupo Quiron Salud, Barcelona, Spain
| | | | | | | | - Alejandro Rodriguez-Festa
- Liquid Biopsy Laboratory, Biomedical Sciences Research Institute Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Silvia Calabuig-Fariñas
- CIBERONC, Madrid, Spain.,Mixed Unit TRIAL, Príncipe Felipe Research Center & General University Hospital of Valencia Research Foundation, Spain.,Department of Pathology, Universitat de València, Spain
| | | | - Mariano Provencio
- Liquid Biopsy Laboratory, Biomedical Sciences Research Institute Puerta de Hierro-Majadahonda, Madrid, Spain.,Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
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Carcereny Costa E, Guirado M, Camps Herrero C, Bosch Barrera J, García-Campelo MR, Ortega Granados A, Gonzalez-Larriba J, De Dios Alvare N, Domine Gomez M, Massuti Sureda B, Sala M, Bernabé R, Oramas Rodriguez J, del Barco Morillo E, Padilla A, Aguiar Bujanda D, Cerezo Gonzalez S, Lopez Castro R, Rodriguez Abreu D, Provencio M. Tobacco use in lung cancer (LC) patients (p) in Spain. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz266.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rodriguez Abreu D, Guirado M, Camps Herrero C, Bosch Barrera J, Bernabé R, Casal J, García-Campelo MR, Gonzalez-Larriba J, Massuti Sureda B, Ortega Granados A, Domine Gomez M, Sala M, Padilla A, Del Barco Morillo E, Oramas Rodriguez J, Blanco Guerrero R, Aguiar Bujanda D, López Castro R, Carcereny Costa E, Provencio M. Biomarker testing of lung cancer in Spain. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz266.005] [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: 11/13/2022] Open
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Kowalski D, Morabito A, Montanino A, Bernabé R, Grossi F, Ramlau R, Ciuleanu TE, Ceresoli G, Pasello G, de Marinis F, Bosch Barrera J, Landreau P, Gautier S, Ta Thanh Minh C, Camerini A. Final results of randomized phase II trial of metronomic vs weekly oral vinorelbine (OV) as first-line chemotherapy (CT) in advanced NSCLC patients unfit to platinum-based CT (P-CT): Tempo-Lung. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Laza-Briviesca R, Cruz-Bermudez A, Casarrubios M, Nadal E, Molla MAI, García-Campelo MR, Huidobro G, Gomez MD, Tarruella MM, Abreu DR, Martinez-Marti A, De Carpeno JC, Dols MC, Vivanco GL, del Barco Morillo E, Bernabé R, Viñolas N, Aranda ICB, Sureda BM, Provencio M. Immune cell biomarkers on neo-adjuvant chemo-immunotherapy treatment for resectable stage IIIA NSCLC patients. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz253.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ciruelos EM, Díaz MN, Isla MD, López R, Bernabé R, González E, Cirauqui B, Coves J, Morales S, Arcediano A, Barneto I, Cerezuela P, Illarramendi JJ, Morales C, Ponce S. Patient preference for oral chemotherapy in the treatment of metastatic breast and lung cancer. Eur J Cancer Care (Engl) 2019; 28:e13164. [PMID: 31571304 DOI: 10.1111/ecc.13164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 05/02/2017] [Revised: 10/31/2018] [Accepted: 04/17/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Although new therapies against metastatic cancer have been developed in recent decades, chemotherapy is still an important treatment option. Prolonged treatment and side-effects are often discouraging for patients, and in many cases, therapy is only palliative, not curative. This study explores patient preference for oral or intravenous (IV) chemotherapy in the treatment of metastatic breast or lung cancer. METHODS It is a descriptive, open label, multicentre, nation-wide study, in which a 16-item questionnaire consisting of single-choice questions scored on a 5-point Likert scale was administered to patients in a single visit, and another 11-item questionnaire was self-administered by the patient's oncologist. RESULTS A total of 131 breast and lung cancer specialists at 64 hospitals enrolled 412 patients (lung cancer = 161; breast cancer = 251). To be eligible, patients must have already received IV therapy and at least 2 cycles of oral chemotherapy. Most (77%) patients expressed preference for oral therapy. Most considered their daily life was less disrupted with tablets (70.4%), had no trouble swallowing them (86.9%), and were not concerned about forgetting to take them (56.8%). Half (56.3%) were worried about problems related to drug infusion with IV therapy, 61.7% were concerned about nurses failing to find a suitable vein, and 63.1% were dissatisfied with hospital waiting times. A uniform response was obtained from both samples of patients. CONCLUSION Convenience, ease of administration, fewer side effects and better quality of life tilt the balance towards oral drug administration.
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Affiliation(s)
| | | | | | - Rafael López
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Reyes Bernabé
- Hospital Universitario Nuestra Señora del Rocío, Seville, Spain
| | | | | | - Juan Coves
- Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
| | | | | | | | - Pablo Cerezuela
- Hospital General Universitario Santa Lucía, Cartagena, Spain
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Provencio M, Carcereny E, Rodríguez-Abreu D, López-Castro R, Guirado M, Camps C, Bosch-Barrera J, García-Campelo R, Ortega-Granados AL, González-Larriba JL, Casal-Rubio J, Domine M, Massutí B, Sala MÁ, Bernabé R, Oramas J, Del Barco E. Lung cancer in Spain: information from the Thoracic Tumors Registry (TTR study). Transl Lung Cancer Res 2019; 8:461-475. [PMID: 31555519 DOI: 10.21037/tlcr.2019.08.05] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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]
Abstract
Background Lung cancer remains a leading cause of cancer incidence and mortality worldwide. Although Spain contributes to global statistics related to cancer, it is difficult to discern aspects linked to clinical presentation of the disease or molecular testing. The Thoracic Tumor Registry (TTR) was created with the aim of filling this gap. Methods Observational cohort multicenter study performed in Spain, including patients with lung cancer or other types of thoracic tumors undergoing active treatment or palliative care only. Enrollment took place between August 2016 and December 2018. The evaluation included a review of demographic, epidemiological, clinical and molecular data. Results A total of 6,600 patients diagnosed with non-small cell lung cancer (NSCLC) were recruited at 56 Spanish hospitals. The mean age at diagnosis was 64 years. The majority of patients (80%) presented with advanced disease, being adenocarcinoma the most frequent histological type. Up to 86% of patients were current- or ex-smokers, with men starting to smoke earlier than women (average age 17.9 vs. 19.2 years). Sixty-seven percent of patients underwent some type of molecular testing. Mutations in EGFR and KRAS genes were found in 18% and 28% of patients, respectively. Conclusions Our findings suggest that the TTR study accurately describes the clinical reality of lung cancer in Spain, including useful information on smoking status as well as molecular profiling and tumor histology, and can therefore be used to drive improvements in health care. Social and political pressure to reduce tobacco consumption among the population should be reinforced, particularly among youth.
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Affiliation(s)
| | - Enric Carcereny
- Instituto Catalán de Oncología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Reyes Bernabé
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Juana Oramas
- Hospital Universitario de Canarias, Santa Cruz Tenerife, Spain
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González-Cao M, Moran T, Dalmau J, Garcia-Corbacho J, Bernabé R, Juan O, De Castro J, Blanco R, Meyerhans A, Blanco J, Karachaliou N, Brander C, Garcia-Prado J, Carrillo J, Provencio M, Molina Vila MA, Massuti B, Clotet B, Martinez-Picado J, Rosell R. Phase II study of durvalumab (MEDI4736) in cancer patients HIV-1-infected. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.2501] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2501 Background: Durvalumab (MEDI4736), a programmed cell death-ligand 1 (PD-L1) blocking antibody, is currently approved for treatment of several cancer types. As HIV-1-infected (HIV+) patients have been excluded from cancer clinical trials, there are no data on the safety of durvalumab in this population. Methods: DURVAST (NCT03094286) is a multicenter, open-label, phase 2 clinical trial evaluating the safety and feasibility of durvalumab treatment at the recommended dose of 1500 mg Q4W in HIV+ cancer patients with solid tumors. Secondary endpoints include analyses of antitumoral activity in terms of objective response rate and duration of response (DOR). An associated translational sub-study includes the assessment of antiviral activity and the interaction of chronic viral infection with anti-cancer response and drug tolerance. Results: Twenty HIV+ individuals with advanced solid tumors were enrolled (Table). All participants maintained their standard-of-care antiretroviral therapy. Basal plasma viremia was undetectable and CD4+ T-cell count was over 200/mm3. There were no durvalumab-related serious adverse events. Only 8 patients (40%) presented drug-related adverse events (all grade 1-2) including diarrhea (15%), rash (15%), nausea (15%) and asthenia (10%). Best response includes: partial response in 5 (25%) (4 NSCLC and 1 anal cancer), stable disease in 4 (20%) (3 NSCLC and 1 melanoma) and progression disease in 11 (55%) patients. At data cut-off, 8 patients (40%) remained on therapy for a median of 10.5 months (range: 6-19 m). Median DOR has not been reached (range 1m to 19 m+). Plasma viremia remained suppressed during the study suggesting no viral reactivation upon durvalumab treatment. Conclusions: DURVAST study demonstrates durvalumab safety in HIV+ cancer patients and suggests an excellent tolerance profile. Understanding how chronic viral infection could contribute to a better tolerance towards immune checkpoint inhibitors will open a new way for the development of safer anti-cancer immunotherapy strategies. Clinical trial information: NCT03094286. [Table: see text]
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Affiliation(s)
| | - Teresa Moran
- Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Barcelona, Spain
| | | | | | | | - Oscar Juan
- Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | - Javier De Castro
- Translational Oncology Unit at Medical Oncology Division, Hospital Universitario La Paz, IdipAZ, Madrid, Spain
| | | | - Andreas Meyerhans
- Infection Biology Laboratory, University Pompeu Fabra, Barcelona, Spain
| | - Julia Blanco
- AIDS Research Institute, IrsiCaixa, Badalona, Spain, Barcelona, Spain
| | - Niki Karachaliou
- Translational Cancer Research Unit, Instituto Oncológico Dr Rosell, Dexeus University Hospital, Barcelona, Spain
| | | | | | | | - Mariano Provencio
- Medical Oncology Service. Hospital Universitario Puerta de Hierro, Madrid, Spain, Madrid, Spain
| | | | | | | | | | - Rafael Rosell
- Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain and Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain and Institute of Oncology Rosell (IOR), University Hospital Sagrat Cor, Badalona, Barcelona, Spain
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Provencio M, Nadal E, Insa A, Garcia-Campelo R, Casal Rubio J, Domine M, Majem M, Rodriguez-Abreu D, Martinez Marti A, Cobo M, Lopez-Vivanco G, del Barco E, Bernabé R, Vinolas N, Barneto I, Viteri S, Martín-Martorell P, Jove M, Franco F, Massuti B. Neoadjuvant chemo-immunotherapy for the treatment of stage IIIA resectable non-small-cell lung cancer (NSCLC): A phase II multicenter exploratory study—Final data of patients who underwent surgical assessment. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.8509] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8509 Background: Patients with stage IIIA (N2 or T4N0) are potentially curable but median overall survival is only around 15 months and complete pathologic response with conventional chemotherapy (CT) is no more than 9%. Methods: A Phase II, single-arm, open-label multicenter study of resectable stage IIIA N2-NSCLC adult patients with CT plus IO as a neoadjuvant treatment: three cycles of Nivolumab (NV) 360mg IV Q3W + paclitaxel 200mg/m2 + carboplatin AUC 6 IV Q3W followed by adjuvant NV treatment for 1 year. After complete neoadjuvant therapy, tumor assessment is performed prior to surgery. Surgery is performed in the 3rd or 4th week after day 21 of the third cycle of neoadjuvant treatment. The study aims to recruit 46 pts. The primary endpoint is Progression-Free Survival (PFS) at 24 months. Efficacy is explored using objective pathologic response criteria. We present final data on all patients included in this study that underwent surgical assessment. Results: At the time of submission, 46 pts had been included and 41 had undergone surgery. CT-IO was well-tolerated and surgery was not delayed in any patient. None of the pts withdrew from the study preoperatively due to progression or toxicity. 41 surgeries had been performed and all tumors were deemed resectable, with R0 resection in all cases. 34 pts (83%) achieved major pathologic response (MPR) (CI 95% 71-95%), and 24 (71%) of them had a complete pathologic response (CPR) (CI 95% 54-87%). Downstaging was seen in 90% (CI 95% 81-100%) of cases. By RECIST, 29 pts (71%) (CI 95% 56-85%) had partial response and 3 (7%) (CI 95% 0-16%) complete response. Conclusions: This is the first multicentric study to CT-IO in the neoadjuvant setting in stage IIIA. Neoadjuvant CT-IO with nivolumab in resectable IIIA NSCLC yields a high complete pathologic response rate that has never been seen previously and unsuspected by RECIST criteria. Preliminary correlative analyses in blood samples are included in a separate abstract. EudraCT Number: 2016-003732-20. Clinical trial information: NCT 03081689.
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Affiliation(s)
| | - Ernest Nadal
- Institut Català d’Oncologia, L’Hospitalet, Barcelona, Spain
| | - Amelia Insa
- Hospital Clinico Universitario de Valencia, Valencia, Spain
| | | | | | - Manuel Domine
- Oncology Department and Translational Oncology Division, University Hospital Fundacion Jimenez Diaz, Madrid, Spain
| | | | | | - Alex Martinez Marti
- Vall d´Hebron University Hospital /Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Manuel Cobo
- Hospital Regional Universitario de Malaga, Málaga, Spain
| | | | - Elvira del Barco
- Medical Oncology Department, Salamanca University Hospital, Salamanca, Spain
| | | | | | | | | | | | - Maria Jove
- Medical Oncology Department, Institut Català d’Oncologia, l’Hospitalet de Llobregat, Barcelona, Spain
| | - Fabio Franco
- Hospital Universitario Puerta de Hierro, Majadahonda-Madrid, Spain
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Laza Briviesca R, Cruz Bermudez A, Barquin M, Nadal E, Insa A, Garcia-Campelo R, De Dios Alvarez N, Domine M, Massuti B, Majem M, Rodriguez-Abreu D, Martinez Marti A, Cobo M, Lopez-Vivanco G, del Barco E, Bernabé R, Vinolas N, Barneto I, Viteri S, Provencio-Pulla M. Haematological biomarkers of pathological response on neo-adjuvant chemo-immunotherapy treatment for resectable stage IIIA non-small cell lung cancer (NSCLC) patients. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e20026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20026 Background: PD1/PDL1 treatments have become the main therapy in advanced stages of NSCLC due to its significant increase in overall survival (OS), but recently, combination with chemotherapy in locally advanced stages is showing promising results. Many studies have described the neutrophil-to-lymphocyte ratio (NLR) and platelets-to-lymphocyte ratio (PLR) as indicator of systemic inflammation, that could be use as biomarker of response to immunotherapy. In our study, we described the effect of neoadjuvant chemo-immunotherapy in Complete Blood Count (CBC) parameters and evaluated their relationship with pathological responses. Methods: Immune cell populations of 46 resectable stage IIIA NSCLC patients treated with neo-adjuvant chemo-immunotherapy from NADIM clinical trial were analysed. Samples were extracted before initiating the neo-adjuvant treatment with nivolumab plus carboplatin and at the third cycle before patients underwent surgery. We classified patients in 3 subgroups of pathological response assessed in the resection specimen: complete response (pCR), mayor response (< 10% viable tumour) and incomplete response (> 10% viable tumour). Wilcoxon and Mann-Whitney U statistic test were used to evaluated differences between pre and post treatment and between pathological responses groups respectively. Results: From 46 patients, 5 patients did not undergo surgery, so they were excluded from the analysis. Absolute numbers (x103cells/µl) of CBC were significantly reduced after neo-adjuvant treatment in patients, leucocytes (8.80 vs 6.64), Eosinophil (0.22 vs 0.15), Monocytes (0.72 vs 0.62), Neutrophils (5.53 vs 3.53), Haemoglobin (35.82 vs 29.68), Platelets (292.44 vs 227.22), NLR (2.73 vs 1.71) and PLR (143.34 vs 115.85) except Lymphocytes (2.22 vs 2.25) and Basophils (0.06 vs 0.05). Moreover, when the analysis was done by subgroups of pathological responses, PLR variation was significantly different between pCR and incomplete response (-21.33 vs -76.98) whereas NLR and the rest of the immune populations were no different between subgroups. Conclusions: In our study, NLR is not associated to chemo-immune neo-adjuvant treatment response. Nevertheless, in our cohort a higher decrease on PLR post neo-adjuvant treatment is associated to an incomplete pathological response.
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Affiliation(s)
- Raquel Laza Briviesca
- Instituto Investigacion Sanitaria Puerta De Hierro-Segovia De Arana, Hospital Universitario Puerta De Hierro-Majadahonda, Madrid, Sudan
| | - Alberto Cruz Bermudez
- Instituto Investigacion Sanitaria Puerta De Hierro-Segovia De Arana, Hospital Universitario Puerta De Hierro-Majadahonda, Madrid, Spain
| | - Miguel Barquin
- Hospital universitario Puerta de Hierro, Majadahonda, Spain
| | - Ernest Nadal
- Institut Català d’Oncologia, L’Hospitalet, Barcelona, Spain
| | - Amelia Insa
- Hospital Clinico Universitario de Valencia, Valencia, Spain
| | | | | | - Manuel Domine
- Oncology Department and Translational Oncology Division, University Hospital Fundacion Jimenez Diaz, Madrid, Spain
| | | | | | | | - Alex Martinez Marti
- Vall d´Hebron University Hospital /Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Manuel Cobo
- Hospital Regional Universitario de Malaga, Málaga, Spain
| | | | - Elvira del Barco
- Medical Oncology Department, Salamanca University Hospital, Salamanca, Spain
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Barquin M, Garcia-Garcia F, Romero A, Carcereny E, Rodriguez-Abreu D, Lopez Castro R, Guirado M, Camps C, Bosch-Barrera J, Massuti B, Ortega AL, Gonzalez-Larriba JL, Garcia-Campelo R, Domine M, Agraso Busto S, Sala MÁ, Oramas J, Bernabé R, Provencio-Pulla M. Sex is a strong prognostic factor for overall survival in advanced non small cell lung cancer patients and should be considered for survival rates estimations. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e20580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20580 Background: Biological differences between sexes have a major impact on disease and treatment outcome. In this paper, we evaluate the prognostic value of sex in advance NSCLC in the context of real world data. Methods: Clinical data from stage IV non-small cell lung cancer (NSCLC) patients from Hospital Puerta de Hierro (HPH) was retrieved from Electronical records using BigData Analytics (N = 387). In addition, data from Spanish Lung Cancer Group (GECP) Tumor Registry (N = 1382) and from a published study through cBioPortal (MSK) (N = 601) was analyzed. Survival curves were estimated using Kaplan-Meier analysis. Cox proportional hazards regression model was used to assess the prognostic factor of sex. Results: The median overall survival (OS) time was 12 months for men and 19 months for women (P < 0.001). Similarly, women with stage IV NSCLC harbouring an EGFR sensitizing mutation lived longer than men (median overall survival was 19 months for men and 32 months for women). Gender effect was still significant after adjustment by Cox regression for other potential confounding factors. The adjusted hazard ratios for sex were 0.65 (95% CI, 0.51-0.83), 0.84 (95% CI, 0.66-1.1) and 0.76 (95% CI, 0.65-0.88) for HPH, MSK and GECP data sets respectively. Similarly, in EGFR positive population adjusted hazard ratios for sex were 0.53 (95% CI, 0.25-1.1), 0.59 (95% CI, 0.35-0.98) and 0.60 (95% CI, 0.45-0.86) for HPH, MSK and GECP data sets respectively. Conclusions: Using real world data we confirm previous finding that among stage IV NSCLC patients, women live almost twice longer than men. This effect persisted after adjusting for several factors highlighting the fact that survival rates estimations which are usually performed grouping men and women together might not be accurate enough for prognosis assessments
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Affiliation(s)
- Miguel Barquin
- Hospital universitario Puerta de Hierro, Majadahonda, Spain
| | | | - Atocha Romero
- Hospital Universitario Puerta De Hierro-Majadahonda, Madrid, Spain
| | - Enric Carcereny
- Medical Oncology Department. Catalan Institute of Oncology, Hospital Germans Trias i Pujol, B.ARGO GROUP Badalona Applied Research Group in Oncology, Badalona, Spain
| | | | | | | | - Carlos Camps
- Servicio de Oncología Médica, Hospital General de Valencia, Valencia, Spain
| | | | | | | | | | | | - Manuel Domine
- Oncology Department and Translational Oncology Division, University Hospital Fundacion Jimenez Diaz, Madrid, Spain
| | | | | | - Juana Oramas
- Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
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Zugazagoitia J, Ramos I, Trigo JM, Palka M, Gómez-Rueda A, Jantus-Lewintre E, Camps C, Isla D, Iranzo P, Ponce-Aix S, García-Campelo R, Provencio M, Franco F, Bernabé R, Juan-Vidal O, Felip E, de Castro J, Sanchez-Torres JM, Faul I, Lanman RB, Garrido P, Paz-Ares L. Clinical utility of plasma-based digital next-generation sequencing in patients with advance-stage lung adenocarcinomas with insufficient tumor samples for tissue genotyping. Ann Oncol 2019; 30:290-296. [PMID: 30535340 DOI: 10.1093/annonc/mdy512] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [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] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Approximately 30% of tumor biopsies from patients with advanced-stage lung adenocarcinomas yield insufficient tissue for successful molecular subtyping. We have analyzed the clinical utility of next-generation sequencing (NGS) of cell-free circulating tumor DNA (ctDNA) in patients with inadequate tumor samples for tissue genotyping. PATIENTS AND METHODS We conducted the study in a multi-institutional prospective cohort of clinically unselected patients with advanced-stage lung adenocarcinomas with insufficient tissue for EGFR, ALK or ROS1 genotyping across 12 Spanish institutions (n = 93). ctDNA NGS was carried out by Guardant Health (Guardant360, Redwood City, CA), using a hybrid-capture-based 73-gene panel. Variants were deemed actionable if they were part of the OncoKB precision oncology knowledge database and classified in four levels of actionability based on their clinical or preclinical evidence for drug response. RESULTS Eighty-three out of 93 patients (89%) had detectable levels of ctDNA. Potentially actionable level 1-4 genomic alterations were detected in 53 cases (57%), of which 13 (14%) had level 1-2A alterations (Food and Drug Administration-approved and standard-care biomarkers according to lung cancer guidelines). Frequencies of each genomic alteration in ctDNA were consistent with those observed in unselected pulmonary adenocarcinomas. The majority of the patients (62%), particularly those with actionable alterations (87%), had more than one pathogenic variant in ctDNA. The median turnaround time to genomic results was 13 days. Twelve patients (13%) received genotype-matched therapies based on ctDNA results, deriving the expected clinical benefit. Patients with co-occurring pathogenic alterations had a significantly shorter median overall survival as compared with patients without co-occurring pathogenic alteration (multivariate hazard ratio = 5.35, P = 0.01). CONCLUSION Digital NGS of ctDNA in lung cancers with insufficient tumor samples for tissue sequencing detects actionable variants that frequently co-occur with other potentially clinically relevant genomic alterations, allowing timely initiation of genotype-matched therapies.
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Affiliation(s)
- J Zugazagoitia
- Medical Oncology Department, Hospital Universitario 12 de Octubre and i+12 Research Institute, Madrid, Spain; Lung Cancer Group, Clinical Research Program, Spanish National Cancer Research Center (CNIO), Madrid, Spain; CIBERONC, Madrid, Spain
| | - I Ramos
- Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - J M Trigo
- Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - M Palka
- Medical Oncology Department, IRYCIS Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - A Gómez-Rueda
- Medical Oncology Department, IRYCIS Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - E Jantus-Lewintre
- CIBERONC, Madrid, Spain; Molecular Oncology Laboratory, Fundación para la Investigación del Hospital General Universitario de Valencia, Valencia, Spain; Biotechnology Department, Universitat Politècnica de València, Valencia, Spain
| | - C Camps
- CIBERONC, Madrid, Spain; Medical Oncology Department, Hospital General Universitario de Valencia, Valencia, Spain; Medicine Department, Universidad de Valencia, Valencia, Spain
| | - D Isla
- Medical Oncology Department, Hospital Universitario Lozano Blesa, Zaragoza, Spain
| | - P Iranzo
- Medical Oncology Department, Hospital Universitario Lozano Blesa, Zaragoza, Spain
| | - S Ponce-Aix
- Medical Oncology Department, Hospital Universitario 12 de Octubre and i+12 Research Institute, Madrid, Spain; Lung Cancer Group, Clinical Research Program, Spanish National Cancer Research Center (CNIO), Madrid, Spain
| | - R García-Campelo
- Medical Oncology Department, Hospital Universitario Da Coruña, A Coruña, Spain
| | - M Provencio
- Medical Oncology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - F Franco
- Medical Oncology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - R Bernabé
- Medical Oncology Department, Hospital Universitario Vírgen del Rocío, Sevilla, Spain
| | - O Juan-Vidal
- Medical Oncology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - E Felip
- Medical Oncology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - J de Castro
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - J M Sanchez-Torres
- Medical Oncology Department, Hospital Universitario La Princesa, Madrid, Spain
| | - I Faul
- Medical Affairs, Guardant Health, Barcelona, Spain
| | - R B Lanman
- Medical Affairs, Guardant Health, Redwood City, USA
| | - P Garrido
- CIBERONC, Madrid, Spain; Medical Oncology Department, IRYCIS Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - L Paz-Ares
- Medical Oncology Department, Hospital Universitario 12 de Octubre and i+12 Research Institute, Madrid, Spain; Lung Cancer Group, Clinical Research Program, Spanish National Cancer Research Center (CNIO), Madrid, Spain; CIBERONC, Madrid, Spain; Complutense University, Madrid, Spain.
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Ramos García I, Sanchez Gastaldo A, Barneto I, Ayala P, Berciano M, Bernabé R, Robles M, Collado R, Alonso M, García T, Cobo Dols M, Trigo J. P2.04-24 Nivolumab in the "Real World": Are the Results of Clinical Trials Reproducible? J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Provencio-Pulla M, Nadal-Alforja E, Cobo M, Insa A, Costa Rivas M, Majem M, Rodriguez-Abreu D, Lopez-Vivanco G, Domine M, Del Barco Morillo E, Massuti B, Campelo RG, Martinez Marti A, Bernabé R, Franco F, Jove M, Arrabal R, Martin P, Casal J, Calvo V. Neoadjuvant chemo/immunotherapy for the treatment of stages IIIA resectable non-small cell lung cancer (NSCLC): A phase II multicenter exploratory study—NADIM study-SLCG. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.8521] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
| | | | - Manuel Cobo
- Hospital Regional Universitario de Malaga, Malaga, Spain
| | - Amelia Insa
- Hospital Clinico Universitario de Valencia, Valencia, Spain
| | | | | | | | | | - Manuel Domine
- Oncology Department and Translational Oncology Division, University Hospital Fundacion Jimenez Diaz, Madrid, Spain
| | | | | | | | | | - Reyes Bernabé
- Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Fernando Franco
- Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - Maria Jove
- Medical Oncology Department, Institut Català d’Oncologia, l’Hospitalet de Llobregat, Barcelona, Spain
| | - Ricardo Arrabal
- Thoracic Surgery Hospital Universitario Carlos Haya, Malaga, Spain
| | | | - Joaquin Casal
- Complejo Hospitalario Universitario de Vigo, Vigo, Spain
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Bernabé R, Hickson N, Wallace A, Blackhall FH. What do we need to make circulating tumour DNA (ctDNA) a routine diagnostic test in lung cancer? Eur J Cancer 2017; 81:66-73. [PMID: 28609695 DOI: 10.1016/j.ejca.2017.04.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [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: 01/16/2017] [Revised: 03/31/2017] [Accepted: 04/27/2017] [Indexed: 12/09/2022]
Abstract
The gold standard test for detection of epidermal growth factor receptor (EGFR) mutation is to genotype somatic DNA extracted from a tissue biopsy or cytology specimen. Yet, in at least 20% of patients this is not possible for various reasons including insufficient availability of neoplastic tissue, lack of fitness of the available tissue for a biopsy or that a biopsy is not technically feasible. Consequently, there has been intense investigation of circulating tumour DNA (ctDNA), released into the plasma fraction of blood from cancer cells during apoptosis/necrosis, as a minimally invasive 'liquid biopsy' and surrogate for cancer tissue. In 2014, the license for the EGFR tyrosine kinase inhibitor (EGFR-TKI), gefitinib, was updated to allow the use of plasma to determine EGFR mutation status in patients where tissue was not available. Then in 2016 the United States Food and Drug Administration (US FDA) approved the first companion diagnostic plasma EGFR test. Herein, we review the evidence for ctDNA as a diagnostic in patients with non-small cell lung cancer (NSCLC) and describe steps needed to incorporate such 'liquid biopsies' into everyday routine practice.
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Affiliation(s)
- Reyes Bernabé
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Medical Oncology Department, Hospital Virgen Del Rocio, Seville, Spain
| | - Nicholas Hickson
- Manchester Centre for Genomic Medicine, St. Mary's Hospital, Manchester, UK
| | - Andrew Wallace
- Manchester Centre for Genomic Medicine, St. Mary's Hospital, Manchester, UK
| | - Fiona Helen Blackhall
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Molecular and Clinical Cancer Sciences, University of Manchester, Manchester, UK.
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Abstract
The RAS-RAF-MEK-ERK pathway regulates processes involved in the proliferation and survival of cells. KRAS mutations, prevalent in approximately 30% of patients with non-small-cell lung cancer (NSCLC), result in constitutive activation of the pathway. Selumetinib (AZD6244, ARRY-142886) is a potent and selective inhibitor of MEK1/2 which has demonstrated significant efficacy in combination with docetaxel in patients with KRAS mutant pretreated advanced NSCLC. Several trials in combination with other chemotherapy and targeted therapy regimens in lung cancer are ongoing. We review the development of selumetinib in patients with NSCLC, summarize the pharmacodynamic, pharmacokinetic and tolerability characteristics, and the available clinical trial data to understand the role of selumetinib in the treatment of NSCLC.
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Affiliation(s)
- Reyes Bernabé
- The Christie NHS Foundation Trust, Manchester, UK
- Hospital Valme, Seville, Spain
| | - Ana Patrao
- The Christie NHS Foundation Trust, Manchester, UK
| | | | - Fiona Blackhall
- The Christie NHS Foundation Trust, Manchester, UK
- The University of Manchester, Manchester, UK
| | - Emma Dean
- The Christie NHS Foundation Trust, Manchester, UK
- The University of Manchester, Manchester, UK
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Moran T, Wei J, Cobo M, Qian X, Domine M, Zou Z, Bover I, Wang L, Provencio M, Yu L, Chaib I, You C, Massuti B, Song Y, Vergnenegre A, Lu H, Lopez-Vivanco G, Hu W, Robinet G, Yan J, Insa A, Xu X, Majem M, Chen X, de Las Peñas R, Karachaliou N, Sala MA, Wu Q, Isla D, Zhou Y, Baize N, Zhang F, Garde J, Germonpre P, Rauh S, ALHusaini H, Sanchez-Ronco M, Drozdowskyj A, Sanchez JJ, Camps C, Liu B, Rosell R, Colinet B, De Grève J, Germonpré P, Chen H, Chen X, Du J, Gao Y, Hu J, Hu W, Kong W, Li L, Li R, Li X, Liu B, Liu J, Lu H, Qian X, Ren W, Song Y, Wang L, Wei J, Wen L, Wu Q, Xiao X, Xu X, Yan J, Yang J, Yang M, Yang Y, Yin J, You C, Yu L, Yue X, Zhang F, Zhang J, Zhou Y, Zhu L, Zou Z, Baize N, Bombaron P, Chouaid C, Dansin E, Fournel P, Fraboulet G, Gervais R, Hominal S, Kahlout S, Lecaer H, Lena H, LeTreut J, Locher C, Molinier O, Monnet I, Oliviero G, Robinet G, Schoot R, Thomas P, Vergnènegre A, Berchem G, Rauh S, Al Husaini H, Aparisi F, Arriola E, Ballesteros I, Barneto I, Bernabé R, Blasco A, Bosch-Barrera J, Bover I, Calvo de Juan V, Camps C, Carcereny E, Catot S, Cobo M, De Las Peñas R, Dómine M, Felip E, García-Campelo MR, García-Girón C, García-Gómez R, Garcia-Sevila R, Garde J, Gasco A, Gil J, González-Larriba JL, Hernando-Polo S, Jantus E, Insa A, Isla D, Jiménez B, Lianes P, López-López R, López-Martín A, López-Vivanco G, Macias JA, Majem M, Marti-Ciriquian JL, Massuti B, Montoyo R, Morales-Espinosa D, Morán T, Moreno MA, Pallares C, Parera M, Pérez-Carrión R, Porta R, Provencio M, Reguart N, Rosell R, Rosillo F, Sala MA, Sanchez JM, Sullivan I, Terrasa J, Trigo JM, Valdivia J, Viñolas N, Viteri S, Botia-Castillo M, Mate JL, Perez-Cano M, Ramirez JL, Sanchez-Rodriguez B, Taron M, Tierno-Garcia M, Mijangos E, Ocaña J, Pereira E, Shao J, Sun X, O'Brate R. Two biomarker-directed randomized trials in European and Chinese patients with nonsmall-cell lung cancer: the BRCA1-RAP80 Expression Customization (BREC) studies. Ann Oncol 2014; 25:2147-2155. [PMID: 25164908 DOI: 10.1093/annonc/mdu389] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [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: 11/15/2022] Open
Abstract
BACKGROUND In a Spanish Lung Cancer Group (SLCG) phase II trial, the combination of BRCA1 and receptor-associated protein 80 (RAP80) expression was significantly associated with outcome in Caucasian patients with nonsmall-cell lung cancer (NSCLC). The SLCG therefore undertook an industry-independent collaborative randomized phase III trial comparing nonselected cisplatin-based chemotherapy with therapy customized according to BRCA1/RAP80 expression. An analogous randomized phase II trial was carried out in China under the auspices of the SLCG to evaluate the effect of BRCA1/RAP80 expression in Asian patients. PATIENTS AND METHODS Eligibility criteria included stage IIIB-IV NSCLC and sufficient tumor specimen for molecular analysis. Randomization to the control or experimental arm was 1 : 1 in the SLCG trial and 1 : 3 in the Chinese trial. In both trials, patients in the control arm received docetaxel/cisplatin; in the experimental arm, patients with low RAP80 expression received gemcitabine/cisplatin, those with intermediate/high RAP80 expression and low/intermediate BRCA1 expression received docetaxel/cisplatin, and those with intermediate/high RAP80 expression and high BRCA1 expression received docetaxel alone. The primary end point was progression-free survival (PFS). RESULTS Two hundred and seventy-nine patients in the SLCG trial and 124 in the Chinese trial were assessable for PFS. PFS in the control and experimental arms in the SLCG trial was 5.49 and 4.38 months, respectively [log rank P = 0.07; hazard ratio (HR) 1.28; P = 0.03]. In the Chinese trial, PFS was 4.74 and 3.78 months, respectively (log rank P = 0.82; HR 0.95; P = 0.82). CONCLUSION Accrual was prematurely closed on the SLCG trial due to the absence of clinical benefit in the experimental over the control arm. However, the BREC studies provide proof of concept that an international, nonindustry, biomarker-directed trial is feasible. Thanks to the groundwork laid by these studies, we expect that ongoing further research on alternative biomarkers to elucidate DNA repair mechanisms will help define novel therapeutic approaches. TRIAL REGISTRATION NCT00617656/GECP-BREC and ChiCTR-TRC-12001860/BREC-CHINA.
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Affiliation(s)
- T Moran
- Catalan Institute of Oncology, Medical Oncology Service, Hospital Germans Trias i Pujol, Badalona, Spain
| | - J Wei
- The Comprehensive Cancer Centre, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - M Cobo
- Medical Oncology Service, Hospital Carlos Haya, Malaga
| | - X Qian
- The Comprehensive Cancer Centre, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - M Domine
- Medical Oncology Service, Fundacion Jimenez Diaz, Madrid
| | - Z Zou
- The Comprehensive Cancer Centre, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - I Bover
- Medical Oncology Service, Hospital Son Llatzer, Palma de Mallorca
| | - L Wang
- The Comprehensive Cancer Centre, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - M Provencio
- Medical Oncology Service, Hospital Puerta de Hierro, Madrid, Spain
| | - L Yu
- The Comprehensive Cancer Centre, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - I Chaib
- Catalan Institute of Oncology, Medical Oncology Service, Hospital Germans Trias i Pujol, Badalona, Spain
| | - C You
- Department of Oncology, Suqian General Hospital, Suqian, China
| | - B Massuti
- Medical Oncology Service, Hospital General de Alicante, Alicante, Spain
| | - Y Song
- Department of Pneumology, Jinling Hospital, Nanjing, China
| | - A Vergnenegre
- Service de Pathologie Respiratoire et d'Allergologie, CHU Limoges, Limoges, France
| | - H Lu
- Department of Pneumology, Taizhou General Hospital, Taizhou, China
| | | | - W Hu
- The Comprehensive Cancer Centre, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - G Robinet
- Service Pneumologie, CHU Brest, Brest, France
| | - J Yan
- The Comprehensive Cancer Centre, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - A Insa
- Medical Oncology Service, Hospital Clinico de Valencia, Valencia, Spain
| | - X Xu
- Department of Pneumology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - M Majem
- Medical Oncology Service, Hospital Sant Pau, Barcelona, Spain
| | - X Chen
- Department of Oncology, Huaian General Hospital, Huaian, China
| | - R de Las Peñas
- Medical Oncology Service, Hospital Provincial de Castellon, Castellon, Spain
| | - N Karachaliou
- Translational Research Unit, Dr Rosell Oncology Institute, Quiron-Dexeus University Hospital, Barcelona
| | - M A Sala
- Medical Oncology Service, Hospital de Basurto, Bilbao, Spain
| | - Q Wu
- Department of Oncology, Yixin General Hospital, Yixin, China
| | - D Isla
- Medical Oncology Service, Hospital Lozano Blesa, Zaragoza, Spain
| | - Y Zhou
- Department of Oncology, Yixin General Hospital, Yixin, China
| | - N Baize
- Department de Pneumologie, CHU Angers, Angers, France
| | - F Zhang
- Department of Oncology, Maanshan General Hospital, Maanshan, China
| | - J Garde
- Medical Oncology Service, Hospital Arnau de Vilanova, Valencia, Spain
| | - P Germonpre
- Department of Pulmonary Medicine, Antwerp University Hospital, Edegem, Belgium
| | - S Rauh
- Department of Internal Medicine and Oncology, Centre Hospitalier Emile Mayrisch, Luxembourg, Luxembourg
| | - H ALHusaini
- Oncology Center, King Faisal Cancer Center, Riyadh, Saudi Arabia
| | - M Sanchez-Ronco
- Department of Health and Medicosocial Sciences, University of Alcala, Madrid
| | | | - J J Sanchez
- Department of Preventive Medicine, Autonomous University of Madrid, Madrid
| | - C Camps
- Medical Oncology Service, Hospital General de Valencia, Valencia
| | - B Liu
- The Comprehensive Cancer Centre, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - R Rosell
- Catalan Institute of Oncology, Cancer Biology and Precision Medicine Program, Hospital Germans Trias i Pujol, Badalona; MORe Foundation, Barcelona, Spain; Cancer Therapeutic Innovation Group, New York,USA.
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Grau-Rivera O, Sánchez-Valle R, Saiz A, Molinuevo JL, Bernabé R, Munteis E, Pujadas F, Salvador A, Saura J, Ugarte A, Titulaer M, Dalmau J, Graus F. Determination of neuronal antibodies in suspected and definite Creutzfeldt-Jakob disease. JAMA Neurol 2014; 71:74-8. [PMID: 24248099 DOI: 10.1001/jamaneurol.2013.4857] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Creutzfeldt-Jakob disease (CJD) and autoimmune encephalitis with antibodies against neuronal surface antigens (NSA-abs) may present with similar clinical features. Establishing the correct diagnosis has practical implications in the management of care for these patients. OBJECTIVE To determine the frequency of NSA-abs in the cerebrospinal fluid of patients with suspected CJD and in patients with pathologically confirmed (ie, definite) CJD. DESIGN, SETTING, AND PARTICIPANTS A mixed prospective (suspected) and retrospective (definite) CJD cohort study was conducted in a reference center for detection of NSA-abs. The population included 346 patients with suspected CJD and 49 patients with definite CJD. MAIN OUTCOMES AND MEASURES Analysis of NSA-abs in cerebrospinal fluid with brain immunohistochemistry optimized for cell-surface antigens was performed. Positive cases in the suspected CJD group were further studied for antigen specificity using cell-based assays. All definite CJD cases were comprehensively tested for NSA-abs, with cell-based assays used for leucine-rich glioma-inactivated 1 (LGI1), contactin-associated protein-like 2 (CASPR2), N-methyl-d-aspartate (NMDA), and glycine (GlY) receptors. RESULTS Neuronal surface antigens were detected in 6 of 346 patients (1.7%) with rapid neurologic deterioration suggestive of CJD. None of these 6 patients fulfilled the diagnostic criteria for probable or possible CJD. The target antigens included CASPR2, LGI1, NMDAR, aquaporin 4, Tr (DNER [δ/notch-like epidermal growth factor-related receptor]), and an unknown protein. Four of the patients developed rapidly progressive dementia, and the other 2 patients had cerebellar ataxia or seizures that were initially considered to be myoclonus without cognitive decline. The patient with Tr-abs had a positive 14-3-3 test result. Small cell lung carcinoma was diagnosed in the patient with antibodies against an unknown antigen. All patients improved or stabilized after appropriate treatment. None of the 49 patients with definite CJD had NSA-abs. CONCLUSIONS AND RELEVANCE A low, but clinically relevant, number of patients with suspected CJD had potentially treatable disorders associated with NSA-abs. In contrast, none of 49 patients with definite CJD had NSA-abs, including NMDAR-abs, GlyR-abs, LGI1-abs, or CASPR2-abs. These findings suggest that cerebrospinal fluid NSA-abs analysis should be included in the diagnostic workup of patients with rapidly progressive central nervous system syndromes, particularly when they do not fulfill the diagnostic criteria of probable or possible CJD.
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Affiliation(s)
| | - Raquel Sánchez-Valle
- Service of Neurology, Hospital Clínic, Barcelona, Spain2Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona, Spain
| | - Albert Saiz
- Service of Neurology, Hospital Clínic, Barcelona, Spain2Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona, Spain
| | - José Luis Molinuevo
- Service of Neurology, Hospital Clínic, Barcelona, Spain2Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona, Spain
| | - Reyes Bernabé
- Oncology Department, Hospital de Valme, Sevilla, Spain
| | - Elvira Munteis
- Neurology Department, Hospital del Mar Parc de Salut Mar, Barcelona, Spain
| | - Francesc Pujadas
- Neurology Department, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - Antoni Salvador
- Neurology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Júlia Saura
- Neurology Department, Hospital Sant Joan de Déu de Manresa, Manresa, Spain
| | - Antonio Ugarte
- Neurology Department, Hospital Sant Joan de Déu de Manresa, Manresa, Spain
| | - Maarten Titulaer
- Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona, Spain8Neurology Department, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Josep Dalmau
- Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona, Spain9Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain10Department of Neurology, University of Pennsylvania, Philadelphia
| | - Francesc Graus
- Service of Neurology, Hospital Clínic, Barcelona, Spain2Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona, Spain
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Vázquez-Román V, Utrilla JC, Fernández-Santos JM, Conde E, Bernabé R, Sampedro C, Martín-Lacave I. Postnatal fate of the ultimobranchial remnants in the rat thyroid gland. J Morphol 2013; 274:725-32. [PMID: 23355409 DOI: 10.1002/jmor.20126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 11/28/2012] [Accepted: 12/18/2012] [Indexed: 11/08/2022]
Abstract
The ultimobranchial follicles (UBFs) are considered embryonic remnants from the ultimobranchial body (UBB). They are follicular structures that vary in size and appearance depending on the age of the rat. The main objective of this article was to study the progressive changes in shape, size, and frequency of the UBFs in the postnatal rat, from birth to old-age. To accomplish that objective, a systematic morphometric and incidental study of the UBF has been carried out in 110 Wistar rats of different ages and both sexes, divided into three groups: 1) young rats (5-90-day-old); 2) adult rats (6-15-month-old), and 3) old rats (18-24-month-old). The glands were serially sectioned and immunostained for calcitonin at five equidistant levels. According to our results, UBFs were observed in all thyroid glands but a more exhaustive sampling was occasionally necessary in male rats. In young rats, immature UBFs predominantly appeared whereas in adult rats, mature UBFs with cystic appearance and variable luminal content prevailed. We frequently found spontaneous anomalous UBFs in old rats, which we have termed as "ultimobranchial cystadenomata." Additionally, in young rats, UBF areas significantly increased with age and they were larger when compared to that of normal thyroid follicles. Likewise, in adult rats, UBFs were significantly larger than normal thyroid follicles but only in female rats. In general, UBFs in females were also significantly larger than those found in male rats. Finally, all these differences related to UBFs together with a higher incidence in females of UB cystadenomata suggest a sexual dimorphism in regard to the destiny of these embryonic remnants during postnatal thyroid development.
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Affiliation(s)
- Victoria Vázquez-Román
- Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, Spain
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Gallego Jimenez I, Morales Pancorbo D, Fuentes Pradera J, Salvador J, Bayo JL, Bernabé R, Rodriguez de la Borbolla M, Fernandez Parra E, Lopez Ladron A. Prognostic analysis according to the expression of hormone receptors in HER2-positive breast cancer. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e11075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e11075 Background: Overexpression HER 2 + + + is a distinct group within the breast cancer with different treatments in both the adjuvant and advanced setting. However, from the clinical point of view, there are significant differences within this group HER2 + + + referred to response to trastuzumab, metastatic sites and survival intervals. Recently reported data guides to a worse prognosis in the subgroup expressing hormone receptors. We propose to study these differences in HER2 + + + between subgroups hormone receptor positive and negative. Methods: Retrospective observational study of all patients diagnosed with HER2 + + + at the Hospital Virgen de Valme between the years 2005-2011. We studied the disease-free interval (DFS) and global survival (OS). We also studied the frequency of brain metastases and cerebral disease-free interval (BDFS). We explore differences between the hormone receptor-negative groups (group A) and positive (group B). All patients have been treated with at least one line of trastuzumab. Results: N = 73 (40 group A and 33 group B). Median age was 58 and 55 respectively. 33 patients had metastases in the course of the disease. 7 patients initially diagnosed with metastatic stage. There is a difference of 5.0 months in group A favorable DFS (p = 0.28). The OS was 52 months in group A versus 48 months in group B (difference of 4 months p = 0.18). The BDFS was 57 months for group A and 15 months for group B (p = 0.1). The incidence of brain metastases was 27% versus 9%. Conclusions: Our data suggests a better prognosis in terms of DFS, OS and BDFS in hormone receptor-negative group. Likewise, the incidence of brain metastases was three times lower. We need well design clinical trials, monitoring and therapeutic strategies for this subgroup of patients.
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Isla D, Provencio M, Majem M, Felip E, Vinolas N, Campelo RG, de las Penas R, Carcereny E, Alberola V, Domine M, Blanco R, Dorta J, Bernabé R, Guillen C, Vadell C, Maestu I, Rodriguez D, Rubio-Viqueira B, Figueroa S, Garrido López P. Never-smoking women with lung cancer from the Spanish WORLD07 database. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.1531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1531 Background: Gender differences in lung cancer (LC) have been reported, but with many unresolved issues yet. Tobacco causes the majority of women lung cancer (WLC), although the rate of never-smoking WLC is higher than in men. Several factors may play etiologic roles, and an in-depth understanding is needed. Methods: WORLD07 is a Spanish prospective, multicenter, epidemiologic female-specific LC database sponsored by ICAPEM, a professional association committed with WLC research. In order to improve the knowledge on never-smoking WLC, information has been extracted from WORLD07 database. Results: From October/2007 to October/2011, 1371 newly diagnosed WLC were included in an e-database from 32 centers, 539 (39.3%) never-smoking. Patient (p) characteristics: median age 71.1 years(y); median age of menarche 13y.; motherhood 91.2% (median 2.3 children, median age at first child 26.4y); oral contraceptive use 11.9%; postmenopausal 88.9% (median age of menopause 49y); HRT 5.2%; second-hand smokers 40% (work-exposure 17.1%, home-exposure 88.8%); obesity 16.3%; familiar history of cancer 39.9% (LC 29.8%); previous history of cancer 13% (breast/lung/cervix: 41.4/5.7/2.9%); current LC histology(%): adenocarcinoma/SqCC/LCC/SCLC: 83.4/6.2/5.5/3.9; EGFR mut+ (268 p analyzed): 55.5% (exon 19/20/21(%): 61.1/7.4/36.9); TNM NSCLC I/II/III/IV(%): 14/3.3/19.8/60.3. Treatment: EGFR-TKI in p EGFR mut+, stage IV(1st-/2nd-line)(%): 51.7/15.4; stage IV NSCLC (1st-line/2nd-line): platinum-based CT 42.5%, EGFR-TKI 33.5%, combinations with bevacizumab 2.9% / EGFR-TKI 15.8%. Overall survival: median 27 months(m), 1/2-y(%) 74.8/55.2; stage IV NSCLC: median 20.5m, 1/2-y(%) 67/46; EGFR-mut+ p: median 27.3m, 1/2-y(%) 75/54.3. Conclusions: According to our e-database, WLC showed high rates of never-smokers (39.3%), and of relatives diagnosed with malignant tumours (39.9%, ≅1/3 LC). Adenocarcinoma was the most frequent histology (76.1%), and more than half of the cases analyzed harboured EGFR mutations. Although 40% were second-hand smokers, further investigations are warranted. Survival outcomes remain satisfactory, as expected from this selected subgroup of p. Additional epidemiologic and treatment data will be presented.
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Affiliation(s)
| | | | | | | | | | | | | | - Enric Carcereny
- Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Barcelona, Spain
| | | | - Manuel Domine
- Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | | | - Javier Dorta
- Hospital Univ. Ntra. Sra. de Candelaria, Santa Cruz de Tenerife, Spain
| | | | | | | | | | - Delvys Rodriguez
- Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Poveda A, López-Pousa A, Martín J, Del Muro JG, Bernabé R, Casado A, Balañá C, Sanmartín O, Menéndez MD, Escudero P, Cruz J, Belyakova E, Menéndez D, Buesa JM. Phase II Clinical Trial With Pegylated Liposomal Doxorubicin (CAELYX(R)/Doxil(R)) and Quality of Life Evaluation (EORTC QLQ-C30) in Adult Patients With Advanced Soft Tissue Sarcomas: A study of the Spanish Group for Research in Sarcomas (GEIS). Sarcoma 2011; 9:127-32. [PMID: 18521419 PMCID: PMC2395634 DOI: 10.1080/13577140500287024] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Revised: 07/05/2005] [Accepted: 07/22/2005] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Pegylated liposomal doxorubicin (PLD), a formulation with pharmacokinetic differences with respect to doxorubicin (DXR), might benefit patients with advanced soft tissue sarcoma (STS) pretreated with DXR. PATIENTS AND METHODS Patients with measurable and progressive STS received PLD at 35 mg/(2) every 3 weeks. Quality of life before and during treatment was assessed with EORTC QLQ-C30. RESULTS Twenty-eight patients, 22 DXR-pretreated, were given 140 cycles (median 3, range 1-18). Activity in 27 patients (5 GIST): one complete and one partial remission (both non-GIST and without prior DXR), 12 stabilizations and 13 progressions (response rate 7.4%, 95% CI: 0-17%). Grade 3 toxicity: palmar-plantar erythrodysesthesia (19% of patients), stomatitis (4%) or cutaneous (4%). Neutropenia grade>/=3 was detected in 16% of patients. Median relative dose intensity was 95%. Progression-free rate at 3 and 6 months was, respectively, 48 and 22%, median progression-free survival 5.8 months and median overall survival 8.7 months. QLQ-C30 at baseline and at weeks 6-11 in 23 and 13 patients, respectively, showed good reliability and validity. Quality of life did not seem to worsen during therapy. CONCLUSIONS PLD did not induce objective remissions in 22 STS patients pretreated with DXR, but progression-free rate figures support the use of this agent in patients who have not progressed under a DXR-containing regimen. The toxicity observed was comparable to that of other PLD schedules.
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Affiliation(s)
- A Poveda
- Instituto Valenciano de Oncología Valencia Spain
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Ruiz M, Salvador J, Bayo J, Lomas M, Moreno A, Valero M, Bernabé R, Vicente D, Jimenez J, López-Ladrón A. Multicenter study of weekly trastuzumab, paclitaxel, and carboplatin followed by a week of rest every 28 days in patients with HER2+ metastatic breast cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.1080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ruiz M, Salvador J, Bayo J, Lomas M, Moreno A, Valero M, Bernabé R, Vicente D, Jiménez J, Lopez-Ladrón A. Phase-II study of weekly schedule of trastuzumab, paclitaxel, and carboplatin followed by a week off every 28 days for HER2+ metastatic breast cancer. Cancer Chemother Pharmacol 2008; 62:1085-90. [DOI: 10.1007/s00280-008-0709-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Accepted: 02/11/2008] [Indexed: 11/30/2022]
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Ruiz M, Salvador J, Bayo J, Lomas M, Moreno A, Valero M, Bernabé R, Vicente D, Jiménez J, Lopez-Ladrón A. Multicenter study of weekly trastuzumab, paclitaxel and carboplatin followed by a week of rest every 28 days in patients with HER2+ metastatic breast cancer (MBC). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.1083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1083 Background: The addition of Carboplatin to Trastuzumab and Paclitaxel improves the efficacy in HER2+ metastatic breast cancer (MBC). We have conducted a multicenter Phase II study to investigate the efficacy and safety of this combination given weekly × 3 followed by 1 week of rest. Primary endpoint was objective response rate and secondary endpoints were time to progression, overall survival and to study the toxicity profile of the combination. Methods: Between August 2003 and April 2006, 40 patients with HER2+ MBC (IHC 3+ or FISH+) have been included in the study. Pats received Trastuzumab (loading dose of 4 mg/kg/wk and 2 mg/kg/d following wks), Paclitaxel (80 mg/m2) and Carboplatin (AUC 2) all given weekly × 3 followed by 1 week of rest. Treatment was given until disease progression or unacceptable toxicity. Results: 40 pats had baseline data available. Median age was 54 yrs (range 29–75). 38 (95%) pats received prior adjuvant or neoadjuvant treatment. 11 (27,5%) pats have received one prior CT line for metastatic disease. 87,5% pats had PS 0 or 1 at study entry. Disease sites were liver 16 (40%), bone 12 (30%), lymph nodes 13 (32,5%) and lung 8 (20%). 19 (47,5%) had = 2 lesions. 97,5% had measurable disease. 36 pats have been evaluated for response: 11 CR (31%, 95% CI: 15–46%), 11 PR (31%, 15- 36%), 9 SD (25%, 9–36%), 5 PD (14%, 2–26%) and 4 NE resulting in an ORR of 61% (95% CI: 45–77%) and tumor growth control rate (RR+SD) of 86% of patients (95% CI: 75–97%). Median TTP was 12.1 mo (95% CI: 8.8–19.9 mo) and median duration of response and OS have not been reached yet. For a time of observation of 35 mo, the OS is 80,6%. 37 patients have received 194 cycles with a median of 5 cycles. Grade 3–4 toxicities/pats were: 3(7.5%) anaemia, 2 (5%) leucopenia, 8(20%) neutropenia, 1 (2,5%) febrile neutropenia, 1 (2,5%) trombopenia, 2(5%) asthenia, 2(5%) diarrhea, 3(7.5%) nausea, 2(5%) vomiting, 3(7.5%) mucositis Conclusions: This interim analysis shows an interesting activity with this regimen. One week of rest may be of better convenience for the patient and hospital but also may improve the tolerability profile and efficacy of the combination. Further results would be available for presentation. No significant financial relationships to disclose.
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Affiliation(s)
- M. Ruiz
- Hospital Virgen del Rocio, Sevilla, Spain; Hospital de Valme, Sevilla, Spain; Hospital Juan Ramón Jiménez, Huelva, Spain; Hospital Infanta Cristina, Badajoz, Spain; Hospital SAS Jérez, Cádiz, Spain
| | - J. Salvador
- Hospital Virgen del Rocio, Sevilla, Spain; Hospital de Valme, Sevilla, Spain; Hospital Juan Ramón Jiménez, Huelva, Spain; Hospital Infanta Cristina, Badajoz, Spain; Hospital SAS Jérez, Cádiz, Spain
| | - J. Bayo
- Hospital Virgen del Rocio, Sevilla, Spain; Hospital de Valme, Sevilla, Spain; Hospital Juan Ramón Jiménez, Huelva, Spain; Hospital Infanta Cristina, Badajoz, Spain; Hospital SAS Jérez, Cádiz, Spain
| | - M. Lomas
- Hospital Virgen del Rocio, Sevilla, Spain; Hospital de Valme, Sevilla, Spain; Hospital Juan Ramón Jiménez, Huelva, Spain; Hospital Infanta Cristina, Badajoz, Spain; Hospital SAS Jérez, Cádiz, Spain
| | - A. Moreno
- Hospital Virgen del Rocio, Sevilla, Spain; Hospital de Valme, Sevilla, Spain; Hospital Juan Ramón Jiménez, Huelva, Spain; Hospital Infanta Cristina, Badajoz, Spain; Hospital SAS Jérez, Cádiz, Spain
| | - M. Valero
- Hospital Virgen del Rocio, Sevilla, Spain; Hospital de Valme, Sevilla, Spain; Hospital Juan Ramón Jiménez, Huelva, Spain; Hospital Infanta Cristina, Badajoz, Spain; Hospital SAS Jérez, Cádiz, Spain
| | - R. Bernabé
- Hospital Virgen del Rocio, Sevilla, Spain; Hospital de Valme, Sevilla, Spain; Hospital Juan Ramón Jiménez, Huelva, Spain; Hospital Infanta Cristina, Badajoz, Spain; Hospital SAS Jérez, Cádiz, Spain
| | - D. Vicente
- Hospital Virgen del Rocio, Sevilla, Spain; Hospital de Valme, Sevilla, Spain; Hospital Juan Ramón Jiménez, Huelva, Spain; Hospital Infanta Cristina, Badajoz, Spain; Hospital SAS Jérez, Cádiz, Spain
| | - J. Jiménez
- Hospital Virgen del Rocio, Sevilla, Spain; Hospital de Valme, Sevilla, Spain; Hospital Juan Ramón Jiménez, Huelva, Spain; Hospital Infanta Cristina, Badajoz, Spain; Hospital SAS Jérez, Cádiz, Spain
| | - A. Lopez-Ladrón
- Hospital Virgen del Rocio, Sevilla, Spain; Hospital de Valme, Sevilla, Spain; Hospital Juan Ramón Jiménez, Huelva, Spain; Hospital Infanta Cristina, Badajoz, Spain; Hospital SAS Jérez, Cádiz, Spain
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Bayo J, Salvador J, Lomas M, Ruiz M, Baena J, Vicente D, Bernabé R, Pineda M. Docetaxel followed by capecitabine as first-line chemotherapy in metastatic breast cancer patients: preliminary results. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.854] [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: 11/20/2022] Open
Affiliation(s)
- J. Bayo
- Hosp Juan Ramón Jiménez, Huelva, Spain; Hosp de Valme, Sevilla, Spain; Hosp Infanta Cristina, Badajoz, Spain; Hsopital Virgen del Rocío, Sevilla, Spain; Hosp Puerta del Mar, Cádiz, Spain
| | - J. Salvador
- Hosp Juan Ramón Jiménez, Huelva, Spain; Hosp de Valme, Sevilla, Spain; Hosp Infanta Cristina, Badajoz, Spain; Hsopital Virgen del Rocío, Sevilla, Spain; Hosp Puerta del Mar, Cádiz, Spain
| | - M. Lomas
- Hosp Juan Ramón Jiménez, Huelva, Spain; Hosp de Valme, Sevilla, Spain; Hosp Infanta Cristina, Badajoz, Spain; Hsopital Virgen del Rocío, Sevilla, Spain; Hosp Puerta del Mar, Cádiz, Spain
| | - M. Ruiz
- Hosp Juan Ramón Jiménez, Huelva, Spain; Hosp de Valme, Sevilla, Spain; Hosp Infanta Cristina, Badajoz, Spain; Hsopital Virgen del Rocío, Sevilla, Spain; Hosp Puerta del Mar, Cádiz, Spain
| | - J. Baena
- Hosp Juan Ramón Jiménez, Huelva, Spain; Hosp de Valme, Sevilla, Spain; Hosp Infanta Cristina, Badajoz, Spain; Hsopital Virgen del Rocío, Sevilla, Spain; Hosp Puerta del Mar, Cádiz, Spain
| | - D. Vicente
- Hosp Juan Ramón Jiménez, Huelva, Spain; Hosp de Valme, Sevilla, Spain; Hosp Infanta Cristina, Badajoz, Spain; Hsopital Virgen del Rocío, Sevilla, Spain; Hosp Puerta del Mar, Cádiz, Spain
| | - R. Bernabé
- Hosp Juan Ramón Jiménez, Huelva, Spain; Hosp de Valme, Sevilla, Spain; Hosp Infanta Cristina, Badajoz, Spain; Hsopital Virgen del Rocío, Sevilla, Spain; Hosp Puerta del Mar, Cádiz, Spain
| | - M. Pineda
- Hosp Juan Ramón Jiménez, Huelva, Spain; Hosp de Valme, Sevilla, Spain; Hosp Infanta Cristina, Badajoz, Spain; Hsopital Virgen del Rocío, Sevilla, Spain; Hosp Puerta del Mar, Cádiz, Spain
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Reina JJ, Sánchez-Rovira P, Bernabé R, Bolaños M, González E, Belón J, Gómez-Reina MJ, Gallurt P, Moreno-Nogueira JA. Biweekly administration of irinotecan (CPT-11), oxaliplatin (OX) and 5-fluorouracil (5-FU) as first-line treatment of advanced or metastatic colorectal cancer (MCRC). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3561] [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: 11/20/2022] Open
Affiliation(s)
- J. J. Reina
- Hospital Juan Ramón Jiménez, Huelva, Spain; Hospital Ciudad de Jaén, Jaén, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Hospital San Pedro de Alcántara, Cáceres, Spain; Hospital Virgen de las Nieves, Granada, Spain; Clínica del Doctor Belón, Granada, Spain; Hospital Puerta del Mar, Cádiz, Spain; Hospital de Puerto Real, Cádiz, Spain
| | - P. Sánchez-Rovira
- Hospital Juan Ramón Jiménez, Huelva, Spain; Hospital Ciudad de Jaén, Jaén, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Hospital San Pedro de Alcántara, Cáceres, Spain; Hospital Virgen de las Nieves, Granada, Spain; Clínica del Doctor Belón, Granada, Spain; Hospital Puerta del Mar, Cádiz, Spain; Hospital de Puerto Real, Cádiz, Spain
| | - R. Bernabé
- Hospital Juan Ramón Jiménez, Huelva, Spain; Hospital Ciudad de Jaén, Jaén, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Hospital San Pedro de Alcántara, Cáceres, Spain; Hospital Virgen de las Nieves, Granada, Spain; Clínica del Doctor Belón, Granada, Spain; Hospital Puerta del Mar, Cádiz, Spain; Hospital de Puerto Real, Cádiz, Spain
| | - M. Bolaños
- Hospital Juan Ramón Jiménez, Huelva, Spain; Hospital Ciudad de Jaén, Jaén, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Hospital San Pedro de Alcántara, Cáceres, Spain; Hospital Virgen de las Nieves, Granada, Spain; Clínica del Doctor Belón, Granada, Spain; Hospital Puerta del Mar, Cádiz, Spain; Hospital de Puerto Real, Cádiz, Spain
| | - E. González
- Hospital Juan Ramón Jiménez, Huelva, Spain; Hospital Ciudad de Jaén, Jaén, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Hospital San Pedro de Alcántara, Cáceres, Spain; Hospital Virgen de las Nieves, Granada, Spain; Clínica del Doctor Belón, Granada, Spain; Hospital Puerta del Mar, Cádiz, Spain; Hospital de Puerto Real, Cádiz, Spain
| | - J. Belón
- Hospital Juan Ramón Jiménez, Huelva, Spain; Hospital Ciudad de Jaén, Jaén, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Hospital San Pedro de Alcántara, Cáceres, Spain; Hospital Virgen de las Nieves, Granada, Spain; Clínica del Doctor Belón, Granada, Spain; Hospital Puerta del Mar, Cádiz, Spain; Hospital de Puerto Real, Cádiz, Spain
| | - M. J. Gómez-Reina
- Hospital Juan Ramón Jiménez, Huelva, Spain; Hospital Ciudad de Jaén, Jaén, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Hospital San Pedro de Alcántara, Cáceres, Spain; Hospital Virgen de las Nieves, Granada, Spain; Clínica del Doctor Belón, Granada, Spain; Hospital Puerta del Mar, Cádiz, Spain; Hospital de Puerto Real, Cádiz, Spain
| | - P. Gallurt
- Hospital Juan Ramón Jiménez, Huelva, Spain; Hospital Ciudad de Jaén, Jaén, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Hospital San Pedro de Alcántara, Cáceres, Spain; Hospital Virgen de las Nieves, Granada, Spain; Clínica del Doctor Belón, Granada, Spain; Hospital Puerta del Mar, Cádiz, Spain; Hospital de Puerto Real, Cádiz, Spain
| | - J. A. Moreno-Nogueira
- Hospital Juan Ramón Jiménez, Huelva, Spain; Hospital Ciudad de Jaén, Jaén, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Hospital San Pedro de Alcántara, Cáceres, Spain; Hospital Virgen de las Nieves, Granada, Spain; Clínica del Doctor Belón, Granada, Spain; Hospital Puerta del Mar, Cádiz, Spain; Hospital de Puerto Real, Cádiz, Spain
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