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Aragón-Sánchez S, Sánchez-Bayona R, López-Marín L, Ciruelos-Gil E, Parrilla-Rubio L, Zaragoza-Ballester P, Galindo-Izquierdo A, García-Chapinal B, Álvaro-Valiente L, Oliver-Pérez MR. De-escalating axillary management after neoadjuvant chemotherapy in breast cancer: The ratio of positive sentinel lymph nodes matters. Surg Oncol 2024; 54:102062. [PMID: 38531288 DOI: 10.1016/j.suronc.2024.102062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 03/07/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND De-escalation of axillary surgery in breast cancer (BC) patients diminishes sequelae without compromising cancer outcomes. Surgical management of the axilla is challenging after neoadjuvant treatment. We aimed to identify the factors associated with residual axillary disease amenable to lymphadenectomy in patients with positive sentinel lymph node biopsy (SLNB). METHODS We conducted a retrospective observational study in Hospital 12 de Octubre (Spain). We included BC patients with positive SLNB who underwent axillary dissection after neoadjuvant chemotherapy. Univariate and multivariate logistic regression models were performed to identify independent predictors of residual axillary disease. We estimated the ratio of positive nodes in SLNB and assessed the diagnostic validity of this ratio in relation to residual axillary disease. RESULTS We included 103 patients in the study. Residual axillary disease was identified in 54 patients (52.4%). Clinically node positive status at diagnosis (OR = 18.3, 95%CI: 4.0-83.6) and a ratio of positive nodes in SLNB ≥0.5 (OR = 6.5, 95%CI 41.7-23.7) were associated with residual axillary disease. The sensitivity and negative predictive value of a ratio of positive nodes in SLNB ≥0.5 were 87% (95%CI 75.1%-94.6%) and 75% (95%CI 55.1%-89.3%), respectively. CONCLUSIONS In our study, for patients with positive SLNB after neoadjuvant chemotherapy, stage N+ at diagnosis and a ratio of positive nodes in SLNB ≥0.5 were independent risk factors of positive residual axillary disease. This ratio is a feasible measure with a good diagnostic validity for residual axillary disease and could be used as a guiding factor in the surgical management of these patients.
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Affiliation(s)
- S Aragón-Sánchez
- Department of Obstetrics and Gynaecology. University Hospital 12 de Octubre. Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre [imas12]. Universidad Complutense de Madrid, Madrid, Spain
| | - R Sánchez-Bayona
- Instituto de Investigación Sanitaria Hospital 12 de Octubre [imas12]. Universidad Complutense de Madrid, Madrid, Spain; Department of Medical Oncology. University Hospital 12 de Octubre. Madrid, Spain.
| | - L López-Marín
- Department of Obstetrics and Gynaecology. University Hospital 12 de Octubre. Madrid, Spain
| | - E Ciruelos-Gil
- Instituto de Investigación Sanitaria Hospital 12 de Octubre [imas12]. Universidad Complutense de Madrid, Madrid, Spain; Department of Medical Oncology. University Hospital 12 de Octubre. Madrid, Spain
| | - L Parrilla-Rubio
- Instituto de Investigación Sanitaria Hospital 12 de Octubre [imas12]. Universidad Complutense de Madrid, Madrid, Spain; Department of Pathology. University Hospital 12 de Octubre. Madrid, Spain
| | | | - A Galindo-Izquierdo
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Hospital 12 de Octubre, Complutense University, Madrid, Spain; Research Institute Hospital 12 de Octubre (imas12), Madrid, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS network), RD21/0012/0024, Madrid, Spain
| | - B García-Chapinal
- Department of Obstetrics and Gynaecology. University Hospital 12 de Octubre. Madrid, Spain
| | - L Álvaro-Valiente
- Department of Obstetrics and Gynaecology. University Hospital 12 de Octubre. Madrid, Spain
| | - M R Oliver-Pérez
- Department of Obstetrics and Gynaecology. University Hospital 12 de Octubre. Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre [imas12]. Universidad Complutense de Madrid, Madrid, Spain
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2
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Lambertini M, Blondeaux E, Agostinetto E, Hamy AS, Kim HJ, Di Meglio A, Bernstein Molho R, Hilbers F, Pogoda K, Carrasco E, Punie K, Bajpai J, Ignatiadis M, Moore HCF, Phillips KA, Toss A, Rousset-Jablonski C, Peccatori FA, Renaud T, Ferrari A, Paluch-Shimon S, Fruscio R, Cui W, Wong SM, Vernieri C, Ruddy KJ, Dieci MV, Matikas A, Rozenblit M, Villarreal-Garza C, De Marchis L, Del Mastro L, Puglisi F, Del Pilar Estevez-Diz M, Rodriguez-Wallberg KA, Mrinakova B, Meister S, Livraghi L, Clatot F, Yerushalmi R, De Angelis C, Sánchez-Bayona R, Meattini I, Cichowska-Cwalińska N, Berlière M, Salama M, De Giorgi U, Sonnenblick A, Chiodi C, Lee YJ, Maria C, Azim HA, Boni L, Partridge AH. Pregnancy After Breast Cancer in Young BRCA Carriers: An International Hospital-Based Cohort Study. JAMA 2024; 331:49-59. [PMID: 38059899 PMCID: PMC10704340 DOI: 10.1001/jama.2023.25463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023]
Abstract
Importance Young women with breast cancer who have germline pathogenic variants in BRCA1 or BRCA2 face unique challenges regarding fertility. Previous studies demonstrating the feasibility and safety of pregnancy in breast cancer survivors included limited data regarding BRCA carriers. Objective To investigate cumulative incidence of pregnancy and disease-free survival in young women who are BRCA carriers. Design, Setting, and Participants International, multicenter, hospital-based, retrospective cohort study conducted at 78 participating centers worldwide. The study included female participants diagnosed with invasive breast cancer at age 40 years or younger between January 2000 and December 2020 carrying germline pathogenic variants in BRCA1 and/or BRCA2. Last delivery was October 7, 2022; last follow-up was February 20, 2023. Exposure Pregnancy after breast cancer. Main Outcomes and Measures Primary end points were cumulative incidence of pregnancy after breast cancer and disease-free survival. Secondary end points were breast cancer-specific survival, overall survival, pregnancy, and fetal and obstetric outcomes. Results Of 4732 BRCA carriers included, 659 had at least 1 pregnancy after breast cancer and 4073 did not. Median age at diagnosis in the overall cohort was 35 years (IQR, 31-38 years). Cumulative incidence of pregnancy at 10 years was 22% (95% CI, 21%-24%), with a median time from breast cancer diagnosis to conception of 3.5 years (IQR, 2.2-5.3 years). Among the 659 patients who had a pregnancy, 45 (6.9%) and 63 (9.7%) had an induced abortion or a miscarriage, respectively. Of the 517 patients (79.7%) with a completed pregnancy, 406 (91.0%) delivered at term (≥37 weeks) and 54 (10.4%) had twins. Among the 470 infants born with known information on pregnancy complications, 4 (0.9%) had documented congenital anomalies. Median follow-up was 7.8 years (IQR, 4.5-12.6 years). No significant difference in disease-free survival was observed between patients with or without a pregnancy after breast cancer (adjusted hazard ratio, 0.99; 95% CI, 0.81-1.20). Patients who had a pregnancy had significantly better breast cancer-specific survival and overall survival. Conclusions and Relevance In this global study, 1 in 5 young BRCA carriers conceived within 10 years after breast cancer diagnosis. Pregnancy following breast cancer in BRCA carriers was not associated with decreased disease-free survival. Trial Registration ClinicalTrials.gov Identifier: NCT03673306.
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Affiliation(s)
- Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U. O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Eva Blondeaux
- U. O. Epidemiologia Clinica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Elisa Agostinetto
- Breast Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - Anne-Sophie Hamy
- Department of Medical Oncology, Universite Paris Cité, Institut Curie, Paris, France
| | - Hee Jeong Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Antonio Di Meglio
- Cancer Survivorship Program–Molecular Predicitors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Rinat Bernstein Molho
- Susanne Levy Gertner Oncogenetics Unit, Danek Gertner Institute of Human Genetics, Chaim Sheba Medical Center Affiliated to Tel Aviv University, Tel Hashomer, Israel
| | - Florentine Hilbers
- Department of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Katarzyna Pogoda
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Estela Carrasco
- Hereditary Cancer Genetics Unit, Medical Oncology Department, Vall d´Hebron University Hospital, Vall d´Hebron Institute of Oncology, Barcelona, Spain
| | - Kevin Punie
- Department of General Medical Oncology and Multidisciplinary Breast Center, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Michail Ignatiadis
- Breast Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - Halle C. F. Moore
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Kelly-Anne Phillips
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Angela Toss
- Department of Oncology and Haematology, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Fedro A. Peccatori
- Gynecologic Oncology Department, European Institute of Oncology (IRCCS), Milan, Italy
| | | | - Alberta Ferrari
- Hereditary Breast and Ovarian Cancer Unit and General Surgery 3–Senology, Surgical Department, Fondazione IRCCS Policlinico San Matteo, and University of Pavia, Pavia, Italy
| | - Shani Paluch-Shimon
- Breast Oncology Unit, Sharett Institute of Oncology, Hadassah University Hospital, and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Robert Fruscio
- UO Gynecology, Department of Medicine and Surgery, University of Milan–Bicocca, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Wanda Cui
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stephanie M. Wong
- Stroll Cancer Prevention Centre, Jewish General Hospital, and McGill University Medical School, Montreal, Quebec, Canada
| | - Claudio Vernieri
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- IFOM ETS, AIRC Institute of Molecular Oncology, Milan, Italy
| | - Kathryn J. Ruddy
- Department of Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Maria Vittoria Dieci
- Dipartimento di Scienze Chirurgiche, Oncologiche, e Gastroenterologiche, Università di Padova, Padova, Italy
- Oncologia 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Alexios Matikas
- Department of Oncology/Pathology, Karolinska Institute, and Breast Center, Karolinska University Hospital, Stockholm, Sweden
| | - Mariya Rozenblit
- Department of Medical Oncology, Smilow Cancer Hospital at Yale New Haven, New Haven, Connecticut
| | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion–TecSalud, Tecnologico de Monterrey, Monterrey, Mexico
| | - Laura De Marchis
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Rome, Italy
- Division of Oncology, Department of Hematology, Oncology, and Dermatology, Umberto 1 University Hospital, Rome, Italy
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U. O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Fabio Puglisi
- Department of Medical Oncology, Centro di Riferimento Oncologico di Avano (CRO) IRCCS, Aviano, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Maria Del Pilar Estevez-Diz
- Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Kenny A. Rodriguez-Wallberg
- Department of Oncology-Pathology, Laboratory of Translational Fertility Preservation, Karolinska Institute, Stockholm, Sweden
- Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Bela Mrinakova
- First Department of Oncology, Comenius University and St Elisabeth Cancer Institute, Bratislava, Slovakia
| | - Sarah Meister
- Department of Obstetrics and Gynecology, Ludwig Maximilian University (LMU) Hospital, LMU Munich, Germany
| | - Luca Livraghi
- Department of Medical Oncology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
- Department of Medical Oncology, Hospital of Prato, Azienda USL Toscana Centro, Italy
| | - Florian Clatot
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Rinat Yerushalmi
- Department of Medical Oncology, Davidoff Center, Rabin Medical Center, Petah Tikva, Tel Aviv University, Tel Aviv, Israel
| | - Carmine De Angelis
- Department of Medical Oncology, University of Naples Federico II, Napoli, Italy
| | | | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences M. Serio, University of Florence, and Radiation Oncology Unit, Oncology Department, Florence University Hospital, Florence, Italy
| | - Natalia Cichowska-Cwalińska
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
- Early Phase Clinical Trials Centre, Medical University of Gdańsk, Gdańsk, Poland
| | - Martine Berlière
- Department of Medical Oncology and Breast Surgery, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Mahmoud Salama
- Oncofertility Consortium and Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Amir Sonnenblick
- Oncology Division, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Camila Chiodi
- Cancer Survivorship Program–Molecular Predicitors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Young-Jin Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Camille Maria
- Department of Medical Oncology, Universite Paris Cité, Institut Curie, Paris, France
| | - Hatem A. Azim
- Breast Cancer Center, Hospital Zambrano Hellion–TecSalud, Tecnologico de Monterrey, Monterrey, Mexico
- Cairo Oncology Center, Cairo, Egypt
| | - Luca Boni
- U. O. Epidemiologia Clinica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Ann H. Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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3
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Terán S, Alva M, Tolosa P, Rey-Cárdenas M, Madariaga A, Lema L, Ruano Y, Manso L, Ciruelos E, Sánchez-Bayona R. Analysis of the association of HER-2 low carcinomas and PAM50 assay in hormone receptor positive early-stage breast cancer. Breast 2023; 71:42-46. [PMID: 37481795 PMCID: PMC10392598 DOI: 10.1016/j.breast.2023.07.009] [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: 03/26/2023] [Revised: 05/28/2023] [Accepted: 07/19/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND HER2-low has emerged as a new predictive biomarker in metastatic breast cancer. However, its prognostic value in early-stage carcinomas needs to be revisited. We aimed to evaluate the association of HER2-low carcinomas with PAM50 risk groups combined with clinicopathological variables in early breast cancer. METHODS We conducted a retrospective analysis of 332 patients with early-stage breast cancer that underwent PAM50 signature analysis between 2015 and 2021at Hospital Universitario 12 de Octubre (Madrid, Spain). Clinical and pathological variables were collected from medical records. After adjusting for potential confounders, we estimated Odds Ratio (OR) and 95% confidence interval for high-risk PAM50 subgroup, comparing HER2-low versus HER2-zero carcinomas by multivariable logistic regression. P values below 0.05 were deemed statistically significant. RESULTS 192 (57%) patients were classified as HER2-low carcinomas. Median follow-up was 34 months. Adjusted OR for high-risk PAM50 when comparing HER2-low versus HER2-zero carcinomas was 1.31 (95% CI: 0.75-2.30, p = 0.33). The multivariable model detected significant associations for Ki-67% (≥20% vs. <20%: OR = 4.03, 95% CI: 2.15-7.56, p < 0.001), T staging category (T2/T3 vs. T1: OR = 3.44, 95% CI: 1.96-6.04, p < 0.001), progesterone receptor (PR ≥ 20% vs. <20%: OR = 0.44, 95% CI: 0.23-0.83, p = 0.01), nodal staging category (N+ vs. N0: OR = 3.8, 95% CI: 1.89-7.62, p < 0.001) and histological grade (grade 2 vs. 1: OR = 2.41, 95% CI: 1.01-5.73, p = 0.04; grade 3 vs 1: OR = 5.40, 95%CI: 1.98-14.60, p = 0.001). CONCLUSIONS In this early-stage breast cancer cohort, HER2-low was not associated with a high-risk PAM50 compared to HER2-zero carcinomas. Ki-67 ≥ 20%, T2/T3, histological grade 2/3, N+ and PR<20% were significantly associated to a high-risk PAM50.
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Affiliation(s)
- Santiago Terán
- Medical Oncology department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Manuel Alva
- Medical Oncology department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Pablo Tolosa
- Medical Oncology department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Ainhoa Madariaga
- Medical Oncology department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Laura Lema
- Medical Oncology department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Yolanda Ruano
- Pathology department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Luis Manso
- Medical Oncology department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Eva Ciruelos
- Medical Oncology department, Hospital Universitario 12 de Octubre, Madrid, Spain
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4
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Lim KHJ, Westphalen CB, Berghoff AS, Cardone C, Connolly EA, Güven DC, Kfoury M, Kocakavuk E, Mandó P, Mariamidze E, Matikas A, Moutafi M, Oing C, Pihlak R, Punie K, Sánchez-Bayona R, Sobczuk P, Starzer AM, Tečić Vuger A, Zhu H, Cruz-Ordinario MVB, Altuna SC, Canário R, Vuylsteke P, Banerjee S, de Azambuja E, Cervantes A, Lambertini M, Mateo J, Amaral T. Young oncologists' perspective on the role and future of the clinician-scientist in oncology. ESMO Open 2023; 8:101625. [PMID: 37659290 PMCID: PMC10480053 DOI: 10.1016/j.esmoop.2023.101625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 09/04/2023] Open
Affiliation(s)
- K H J Lim
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester; Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK.
| | - C B Westphalen
- Department of Internal Medicine III, University Hospital LMU Munich, Comprehensive Cancer Centre Munich and German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - A S Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - C Cardone
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - E A Connolly
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, Australia
| | - D C Güven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - M Kfoury
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - E Kocakavuk
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - P Mandó
- Clinical Oncology Department, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - E Mariamidze
- Todua Clinic Department of Oncology and Haematology, Tbilisi, Georgia
| | - A Matikas
- Breast Center, Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| | - M Moutafi
- Department of Oncology, Attikon University Hospital, Athens, Greece
| | - C Oing
- Translational and Clinical Research Institute, Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK; Mildred Scheel Cancer Career Centre HaTriCS4, University Cancer Centre Hamburg, University Medical Centre Eppendorf, Hamburg, Germany
| | - R Pihlak
- Medical Oncology Department, St Bartholomew's Hospital, London, UK
| | - K Punie
- Department of Medical Oncology, GZA Hospitals Sint-Augustinus, Wilrijk, Belgium
| | - R Sánchez-Bayona
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Sobczuk
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - A M Starzer
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - A Tečić Vuger
- Breast Cancer Unit, Medical Oncology Department, University Hospital for Tumors, Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia
| | - H Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - M V B Cruz-Ordinario
- Section of Medical Oncology, Cancer Institute, St. Luke's Medical Center, Quezon City, Metro Manila, the Philippines
| | - S C Altuna
- Department of Medical Oncology, Oncomédica, Caracas, Venezuela
| | - R Canário
- Cancer Metastasis, i3S-Institute for Research & Innovation in Health, Porto; Research Centre, Portuguese Oncology Institute of Porto, Porto; ICBAS, School of Medicine and Biomedical Sciences, Porto, Portugal
| | - P Vuylsteke
- Department of Internal Medicine, University of Botswana, Gaborone, Botswana
| | - S Banerjee
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London; The Institute of Cancer Research, London, UK
| | - E de Azambuja
- Institut Jules Bordet and L'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - A Cervantes
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Salud Carlos III, Madrid; Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria (INCLIVA), Universidad Valencia, Valencia, Spain
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa; Department of Medical Oncology, U.O. Clinical di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - J Mateo
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital Campus, Barcelona, Spain
| | - T Amaral
- Centre for Dermatooncology, Eberhard Karls University of Tübingen, Tübingen; Cluster of Excellence IFIT (EXC2180), Tübingen, Germany
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5
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Jimeno R, Mouron S, Salgado R, Loi S, Pérez-Mies B, Sánchez-Bayona R, Manso L, Martínez M, Garrido-García A, Serrano-Pardo R, Colomer R, Quintela-Fandino M. Tumor P70S6K hyperactivation is inversely associated with tumor-infiltrating lymphocytes in triple-negative breast cancer. Clin Transl Oncol 2023; 25:1124-1131. [PMID: 36508123 PMCID: PMC10025236 DOI: 10.1007/s12094-022-03006-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/07/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Triple-negative breast cancer (TNBC) is characterized by large heterogeneity and relative lack of available targeted therapies. To find therapeutic strategies for distinct patients with TNBC, several approaches have been used for TNBC clustering, including recently immune and phosphoproteomic patterns. Based on 70-kDa ribosomal protein S6 kinase (P70S6K)-TNBC clustering, the current study explores the immune profiling in TNBC tumors. METHODS Stromal tumor-infiltrating lymphocytes (sTILs) were evaluated in human TNBC tumor samples. Furthermore, immunohistochemistry staining for CD8, CD4, Foxp3, and CD20 was performed in tissue microarrays (TMA) sections. RESULTS Histological analysis showed decreased sTILs, CD20+ cells, and CD8+/CD4+ ratio in high phosphorylated P70S6K (p-P70S6K) tumors. Moreover, p-P70S6K score was directly correlated with CD4+ and Foxp3+ T cells, while it was inversely correlated with CD8+/CD4+ and CD8+/Foxp3+ ratios. CONCLUSION sTIL infiltration and lymphocyte profiling vary in the context of hyperactivation of P70S6K in TNBC tumors.
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Affiliation(s)
- Rebeca Jimeno
- Breast Cancer Clinical Research Unit, Clinical Research Program, CNIO, Madrid, Spain
| | - Silvana Mouron
- Breast Cancer Clinical Research Unit, Clinical Research Program, CNIO, Madrid, Spain
| | - Roberto Salgado
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Pathology, GZA-ZNA, Antwerp, Belgium
| | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Cancer Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Belén Pérez-Mies
- Department of Pathology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRyCIS), Madrid, Spain
- Faculty of Medicine, Universidad de Alcalá, Alcalá de Henares, Spain
- CIBERONC, Madrid, Spain
| | | | - Luis Manso
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Mario Martínez
- Department of Pathology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ana Garrido-García
- Department of Medical Oncology, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Ramón Colomer
- Department of Medical Oncology, Hospital Universitario La Princesa, Madrid, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Miguel Quintela-Fandino
- Breast Cancer Clinical Research Unit, Clinical Research Program, CNIO, Madrid, Spain.
- Medical Oncology, Hospital Universitario de Fuenlabrada, Madrid, Spain.
- Endowed Chair of Personalised Precision Medicine, Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
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Tolosa P, Pascual T, Hernando C, Servitja S, Fernández A, Brasó-Maristany F, Benitez J, Lema L, Ruano Y, Parrilla L, Roncero AM, Sánchez-Bayona R, Alva M, Villacampa G, Moreno-Villa MR, Canes J, Salvador F, Prat A, Ciruelos E. Abstract P5-02-44: Efficacy analysis of CDK4/6 inhibitors in combination with endocrine therapy treatment in HR+/HER2- breast cancer according to PAM50 intrinsic subtype: primary results of SOLTI-1801_CDK-PREDICT study. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p5-02-44] [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: 03/06/2023]
Abstract
Abstract
Background: First-line treatment with cyclin-dependent kinase 4 and 6 inhibitors (CDK4/6i) plus endocrine therapy (ET) has demonstrated efficacy in improving progression-free survival (PFS), overall response rate (ORR) and, more recently, ribociclib was also improve overall survival (OS) in hormone receptor-positive/HER2-negative (HR+/HER2-) advanced breast cancer (aBC). Unfortunately, most patients eventually progress and develop secondary or primary endocrine resistance. To date, no clinical or molecular markers have shown clinical utility in this setting. However, data from retrospective analysis suggest that intrinsic subtypes (IS) are prognostic and predict benefit from CDK4/6i+ET (Finn SABCS 2017, Prat. JCO 2021). Here, we have evaluated the impact of IS in PFS and ORR.
Methods: This study prospectively evaluated patients with HR+/HER2- aBC treated in the first-line setting with CDK4/6i + ET from February 2015 to January 2022 across 5 hospitals in Spain. Tumor biopsies had been performed within 90 days prior the patient started the CDK4/6i + ET. RNA from FFPE tumors was analyzed at the nCounter® (Nanostring Technologies) using a 72 custom gene panel including the PAM50 genes. The primary objective is to correlate the baseline PAM50 IS with PFS. The Kaplan-Meier method and multivariable cox model PFS analyses were performed adjusting for previous endocrine sensitivity, visceral disease, and metastatic onset disease. Secondary objectives were to estimate the ORR based on RECIST1.1 and its association with IS and the development of a prognostic algorithm that includes clinical and genomic data.
Results: From May 2020 to May 2022, 113 patients with PAM50 results who met all eligibility criteria, including sample quality, were included. IS distribution was 42.5% Luminal A, 46.9% luminal B, 7.1% HER2-enriched, 0.9% basal-like and 2.6% Normal-like (89.4% luminal vs 10.6% non-luminal). Baseline patient characteristics are shown in table 1. The median follow-up for PFS was 18.5 m (interquartile range 10.0 – 31.7m). Median PFS for Luminal vs no-luminal subtypes was 26.8 m (95% CI: 18.9 - 43.8 m) and 10.0 m (95% CI: 5.8 - 26.0 m) (adjusted hazard ratio [aHR]= 2.44 95% IC: 1.17 - 5.07). Median PFS by all IS was not reached (NR) for Luminal A (95% CI: 23.0 – NR); 19.5 m luminal B (95% CI: 15.7 - 27.3 m, aHR vs Luminal A= 1.98 95% IC: 1.09 - 3.62), 10.0 m HER2-E (95% CI: 4.4 - NR, aHR vs Luminal A= 2.75 95% IC: 1.05 - 7.18), 12.4 m Normal-like (95% CI: 5.8 - NR, aHR vs Luminal A= 19.35 95% IC: 2.32 - 160.89) and not estimable for basal-like (aHR vs Luminal A= 5.44 95% IC: 1.44 - 20.60). ORR was not significantly higher in Luminal B (55.1%) and HER2-E (57.1%) subtype versus luminal A (46.3%) (p=0.677). OS follow-up is still immature.
Conclusions: We confirmed the independent prognostic value of the PAM50 IS in first-line HR+/HER2- breast cancer treated with CDK4/6i+ET. Further gene expression analysis and development of a prognostic composite score is ongoing and will be presented at the conference.
This project has received a research grant from “Instituto de Salud Carlos III (ISCIII), Ministerio de Economía y Competitividad” (Spain) awarded within the National Research Program with reference PI 18/01408, co-funded with European Union ERDF funds.
Baseline patient characteristics
Citation Format: Pablo Tolosa, Tomás Pascual, Cristina Hernando, Sonia Servitja, Adela Fernández, Fara Brasó-Maristany, Javier Benitez, Laura Lema, Yolanda Ruano, Lucia Parrilla, Ana María Roncero, Rodrigo Sánchez-Bayona, Manuel Alva, Guillermo Villacampa, María Rocío Moreno-Villa, Jordi Canes, Fernando Salvador, Aleix Prat, Eva Ciruelos. Efficacy analysis of CDK4/6 inhibitors in combination with endocrine therapy treatment in HR+/HER2- breast cancer according to PAM50 intrinsic subtype: primary results of SOLTI-1801_CDK-PREDICT study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-02-44.
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Affiliation(s)
- Pablo Tolosa
- 1SOLTI Cancer Research Group, Barcelona, Spain/Medical Oncology Department, Hospital 12 de Octubre, Madrid., Madrid, Madrid, Spain
| | - Tomás Pascual
- 2Medical Oncology Department, Hospital Clínic of Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain, Catalonia, Spain
| | | | | | - Adela Fernández
- 5Medical Oncology Department, Hospital Ramon y Cajal, Madrid, Spain; Alcalá de Henares University, Faculty of Medicine, Madrid, Spain, Spain
| | - Fara Brasó-Maristany
- 6Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS)
| | - Javier Benitez
- 7Oncology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Laura Lema
- 8Medical Oncology Department, Hospital 12 de Octubre, Madrid, Spain
| | - Yolanda Ruano
- 9Molecular Pathology Unit, Hospital Universitario 12 de Octubre Research Institute, Madrid, Spain
| | - Lucia Parrilla
- 10Pathology department, Hospital Universitario 12 de Octubre, Madrid Spain
| | - Ana María Roncero
- 11Medical Oncology Department, Hospital 12 de Octubre, Madrid, Spain
| | - Rodrigo Sánchez-Bayona
- 12Medical Oncology Department, Hospital 12 de Octubre, Madrid. SOLTI Cancer Research Group, Barcelona, Spain
| | - Manuel Alva
- 13Medical Oncology Department, Hospital 12 de Octubre, Madrid, Spain
| | - Guillermo Villacampa
- 14SOLTI Cancer Research Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain/The Institute of Cancer Research. Oncology Data Science, London, United Kingdom
| | | | - Jordi Canes
- 16SOLTI Cancer Research Group, Barcelona, Spain
| | | | | | - Eva Ciruelos
- 19SOLTI Breast Cancer Research Group, Barcelona, Spain/Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain, Madrid, Spain
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Mouron S, Bueno MJ, Muñoz M, Torres R, Rodríguez S, Apala JV, Silva J, Sánchez-Bayona R, Manso L, Guerra J, Rodriguez-Lajusticia L, Malon D, Malumbres M, Quintela-Fandino M. p27Kip1 V109G as a biomarker for CDK4/6 inhibitors indication in hormone receptor-positive breast cancer. JNCI Cancer Spectr 2023; 7:7048676. [PMID: 36806942 PMCID: PMC10035773 DOI: 10.1093/jncics/pkad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023] Open
Abstract
CDK4/6 inhibitors benefit a minority of patients who receive them in the breast cancer adjuvant setting. p27Kip1 is a protein that inhibits CDK/Cyclin complexes. We hypothesized that single-nucleotide polymorphisms that impaired p27Kip1 function could render patients refractory to endocrine therapy but responsive to CDK4/6 inhibitors, narrowing the patient subpopulation that requires CDK4/6 inhibitors. We found that the p27Kip1 V109G single-nucleotide polymorphism is homozygous in approximately 15% of hormone-positive breast cancer patients. Polymorphic patients experience rapid failure in response to endocrine monotherapy compared with wild-type or heterozygous patients in the first-line metastatic setting (progression-free survival: 92 vs 485 days, P < .001); when CDK4/6 inhibitors are added, the differences disappear (progression-free survival: 658 vs 761 days, P = .92). As opposed to wild-type p27Kip1, p27Kip1 V109G is unable to suppress the kinase activity of CDK4 in the presence of endocrine inhibitors; however, palbociclib blocks CDK4 kinase activity regardless of the p27Kip1 status. p27Kip1 genotyping could constitute a tool for treatment selection.
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Affiliation(s)
- Silvana Mouron
- Breast Cancer Clinical Research Unit, Centro Nacional de Investigaciones Oncológicas-CNIO, Madrid, Spain
| | - Maria J Bueno
- Breast Cancer Clinical Research Unit, Centro Nacional de Investigaciones Oncológicas-CNIO, Madrid, Spain
| | - Manuel Muñoz
- Breast Cancer Clinical Research Unit, Centro Nacional de Investigaciones Oncológicas-CNIO, Madrid, Spain
| | - Raul Torres
- Molecular Cytogenetics Unit, Centro Nacional de Investigaciones Oncológicas-CNIO, Madrid, Spain
| | - Sandra Rodríguez
- Molecular Cytogenetics Unit, Centro Nacional de Investigaciones Oncológicas-CNIO, Madrid, Spain
| | - Juan V Apala
- Breast Cancer Clinical Research Unit, Centro Nacional de Investigaciones Oncológicas-CNIO, Madrid, Spain
| | - Jorge Silva
- Breast Cancer Clinical Research Unit, Centro Nacional de Investigaciones Oncológicas-CNIO, Madrid, Spain
| | | | - Luis Manso
- Medical Oncology Department, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Juan Guerra
- Medical Oncology Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | | | - Diego Malon
- Medical Oncology Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Marcos Malumbres
- Cell Division & Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- Cancer Cell Cycle group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Miguel Quintela-Fandino
- Breast Cancer Clinical Research Unit, Centro Nacional de Investigaciones Oncológicas-CNIO, Madrid, Spain
- Medical Oncology Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
- Endowed Chair of Personalized Precision Medicine, Universidad Autonoma de Madrid (UAM) - Fundacion Instituto Roche, Madrid, Spain
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Sánchez-Bayona R, Alva M, López de sa A, Gilarranz YJ, Sánchez de torre A, Tolosa P, de luna A, López-Tarruella S, Lema L, Moreno F, Echavarria I, Madariaga A, Benítez J, Herrero B, Rey M, Ortega J, Gámez S, Modrego A, Lozano RM, Figuero-Pérez L, Jiménez R, Sevilla MG, González I, Beranek MB, de toro M, Massarrah T, del Monte-Millán M, Pinardo M, Manso L, Bueno-Muiño C, García-Sáenz JÁ, Martín M, Ciruelos E. Abstract P3-01-04: A real-world evidence study of everolimus plus endocrine therapy beyond CDK4/6 inhibitors for HR+/HER2- advanced breast cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p3-01-04] [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: 03/06/2023]
Abstract
Abstract
Introduction Since the approval a decade ago of everolimus in combination with endocrine therapy (ET), the treatment landscape of metastatic breast cancer (mBC) has changed dramatically. Endocrine monotherapy after progression to CDK4/6 inhibitors has shown a limited progression-free survival (PFS) below 3 months. Evidence of the efficacy of everolimus plus ET after CDK4/6 inhibitors is scarce. Methods We performed a retrospective observational study of patients with mBC treated with everolimus between September 2011 and April 2022 in 4 Spanish hospitals. Clinical and demographic data were collected from medical records. Our main objective was to estimate the median progression-free survival (mPFS) for everolimus + ET in patients previously treated with a CDK4/6 inhibitor. We also collected the adverse events (AE) related to everolimus. Quantitative variables were summarized with medians (range), and qualitative variables with proportions. We used the Kaplan-Meier method for survival estimates. Results We identified a total of 297 mBC patients treated with everolimus plus ET. The median follow-up time was 20 months (interquartile range: 1 – 97 months). In this cohort, the median age at diagnosis was 49 years (26 – 84 years). At the moment of starting everolimus, the median number of previous lines of treatment was 2 (0 – 12), 22% of patients were ‘de novo’ metastatic, 67% presented visceral involvement, 40% had received previous chemotherapy for advanced disease, and 51% (n=152) had received a previous CDK4/6 inhibitor. The ET combined with everolimus was exemestane (77%), fulvestrant (18%), and tamoxifen (5%). 45% of patients were alive at data cut-off. In patients previously treated with a CDK4/6 inhibitor, the estimated median PFS (mPFS) was 5.9 months (95%CI: 5.0 – 7.8 months). In patients without visceral involvement (n=52), mPFS was 7.2 months (95%CI: 5.5 – 11.0 months), and 5.6 months (95%CI: 3.9 – 7.8 months) in the presence of visceral metastasis (n=100). In patients without previous chemotherapy in the metastatic setting (n=109), mPFS was 7.2 months (95%CI: 5.9 – 8.4 months), and 4.6 months (95%CI: 3.1 – 5.7 months) for patients who had received previous chemotherapy (n=43). For patients without a previous CDK4/6 inhibitor (n=145), the median PFS was 8.3 months (95%CI: 6.4 – 10.3 months). Everolimus starting doses were 10 mg (83%), 5 mg (15%), and 7.5 mg (2%). Dexamethasone mouthwash was used by 44% of patients. The most frequent AE were mucositis (51%; 3% grade 3), anemia (41%; 3% grade 3), hyperglycemia (34%; 2% grade 3), rash (28%; 2% grade 3), neumonitis (21%; 2% grade 3), and diarrhea (17%; 1% grade 3). There were no grade 4-5 adverse events. Dose reduction was made in 35% of patients, and in 16% of patients the treatment was discontinued due to toxicity. Conclusions In our cohort, the use of everolimus plus ET in mBC patients previously treated with a CDK4/6 inhibitor showed a clinically significant benefit in terms of PFS, especially in patients without visceral metastasis, and no previous chemotherapy for advanced disease. In this real-world study, the toxicity profile of everolimus was manageable.
Citation Format: Rodrigo Sánchez-Bayona, Manuel Alva, Alfonso López de sa, Yolanda Jerez Gilarranz, Ana Sánchez de torre, Pablo Tolosa, Alicia de luna, Sara López-Tarruella, Laura Lema, Fernando Moreno, Isabel Echavarria, Ainhoa Madariaga, Javier Benítez, Blanca Herrero, Macarena Rey, Justo Ortega, Salvador Gámez, Andrea Modrego, Rocío Martín Lozano, Luis Figuero-Pérez, Roberto Jiménez, Marta González Sevilla, Irene González, Marianela Bringas Beranek, María de toro, Tatiana Massarrah, María del Monte-Millán, Marina Pinardo, Luis Manso, Coralia Bueno-Muiño, José Ángel García-Sáenz, Miguel Martín, Eva Ciruelos. A real-world evidence study of everolimus plus endocrine therapy beyond CDK4/6 inhibitors for HR+/HER2- advanced breast cancer. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-01-04.
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Affiliation(s)
- Rodrigo Sánchez-Bayona
- 1Medical Oncology Department, Hospital 12 de Octubre, Madrid. SOLTI Cancer Research Group, Barcelona, Spain
| | - Manuel Alva
- 2Medical Oncology Department, Hospital 12 de Octubre, Madrid, Spain
| | | | | | | | - Pablo Tolosa
- 6SOLTI Cancer Research Group, Barcelona, Spain/Medical Oncology Department, Hospital 12 de Octubre, Madrid, Madrid, Spain
| | | | - Sara López-Tarruella
- 8Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain
| | - Laura Lema
- 9Medical Oncology Department, Hospital 12 de Octubre, Madrid, Spain
| | | | - Isabel Echavarria
- 11Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio M2arañón, CiberOnc, Madrid, Spain
| | | | | | - Blanca Herrero
- 14Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | | | - Salvador Gámez
- 17Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | - Rocío Martín Lozano
- 19Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid
| | - Luis Figuero-Pérez
- 20Medical Oncology Department, Complejo Asistencial Universitario de Salamanca, Castilla y Leon, Spain
| | - Roberto Jiménez
- 21Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Irene González
- 23Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - María de toro
- 25Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Tatiana Massarrah
- 26Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain
| | - María del Monte-Millán
- 27Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain
| | - Marina Pinardo
- 28Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Luis Manso
- 29Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Coralia Bueno-Muiño
- 30Medical Oncology Department, Hospital Infanta Cristina (Parla), Fundación de Investigación Biomédica del H.U. Puerta de Hierro, Majadahonda, 28009 Madrid, spail, Spain
| | | | - Miguel Martín
- 32Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Eva Ciruelos
- 33SOLTI Breast Cancer Research Group, Barcelona, Spain/Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
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Quintela-Fandino M, Mouron S, Bueno MJ, Muñoz M, Torres R, Rodriguez S, Sánchez-Bayona R, Manso L, Silva J, Malumbres M. Abstract P5-02-28: p27Kip1 V109G single-nucleotide polymorphism (SNP): pinpointing the hormone-receptor positive breast cancer subpopulation that requires CDK4/6 inhibitors in addition to endocrine therapy. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p5-02-28] [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: 03/06/2023]
Abstract
Abstract
Background: CDK4/6 inhibitors benefit a limited percentage of hormone receptor-positive breast cancer (HRPBC) patients in the adjuvant setting: according to the MonarchE study, from all patients treated with the endocrine plus CDK4/6 inhibitor combination, 84% were adequately treated with endocrine therapy alone, ~5% experienced benefit from the combination, and 11% were not rescued from relapse by abemaciclib. Given the side effects and the cost, biomarkers to guide treatment decisions in this setting are appealing. We found that the p27Kip1 V109G SNP was enriched in HRPBC patients experiencing relapse despite endocrine treatment. p27Kip1 binds to cyclins and CDKs, restraining cells from cycling by inhibiting the formation of CDK/cyclin complexes and their kinase activity, resulting in less phosphorylation of Rb. A functionally impaired p27Kip1 could render tumor cells insensitive to endocrine therapy, while being rescued by CDK4/6 inhibitors. Thus, this SNP could narrow down the patient population that requires adjuvant CDK4/6 inhibitors. Methods: Isogenic HRPBC cell lines, wild-type or polymorphic homozygous for the p27Kip1 V109G SNP were generated with CRISPR-Cas9. Cell cycle and cell viability were assessed with BRDU incorporation and colony assays. Immunoprecipitation coupled with western blot (WB) was used to measure the formation of CDK/Cyclin complexes; Rb phosphorylation was assessed by WB. An in vitro kinase assay was set up to measure the CDK4 activity of p27Kip1/CDK/Cyclin complexes. Patients (n=115) with metastatic, HRPBC receiving endocrine monotherapy or in combination with CDK4/6 inhibitors were genotyped for the p27Kip1 V109G SNP, and PFS by genotype and therapy compared with the Kaplan-Meier method. All statistical tests were two-sided. Results: three isogenic polymorphic clones were generated from the wild-type T47-D hormone-positive cell line. The three clones were resistant to hormonal deprivation compared to wild-type cells. The relative plating efficiency (RPE) in the colony assays of the polymorphic clones exposed to hormonal deprivation compared to that of deprived T47-D cells was 550% (clone C1), 165% (clone E1) and 100% (Clone F5); P< 0.005. The three clones were also resistant to fulvestrant (Fulv) (300%, 170% and 180%, respectively); P< 0.005. Cell cycle (positive BRDU cells) decreased ~3 fold in wild type cells (18% to 6.5%) when exposed to hormonal deprivation or Fulv, but remained unaltered in the polymorphic clones. However, when palbociclib was added to hormonal deprivation or Fulv, the effects in RPE increased and were similar in polymorphic clones and parental cells (>5% RPE compared to vehicle, both in polymorphic and wild-type cells). The p27Kip1 V109G SNP was found in homozygosity in ~15% of metastatic HRPBC patients. When patients received endocrine monotherapy in the first-line setting, polymorphic patients experience rapid failure (N=51) compared to wild-type/heterozygous patients (4.3 vs. 21.1 months; P < 0.0001). However, when patients received hormonal plus CDK4/6 inhibitors, the differences disappeared (18.3 vs. 24.3 months; P=0.85). Mechanistically, we observed that the formation of CDK2/CyclinA, CDK2/CyclinE and CDK4/Cyclin D1 complexes was >200% higher in polymorphic than in wild-type cells (P< 0.05). Regarding CDK4 kinase activity of p27Kip1/CDK/Cyclin complexes, as opposed to wild-type p27Kip1, p27Kip1 V109G was unable to suppress the kinase activity of CDK4 in presence of Fulv or hormonal deprivation. However, palbociclib was able to fully suppress CDK4 kinase activity regardless of the p27Kip1 genotype. Conclusion: Germline p27Kip1 genotyping can constitute a tool for treatment selection: whereas wild-type patients are adequately treated with endocrine monotherapy, polymorphic patients are inherently resistant, but are rescued with CDK4/6 inhibitors. Thus, hormonal+CDK4/6 inhibitor combos could be reserved for the polymorphic patients.
Citation Format: Miguel Quintela-Fandino, Silvana Mouron, Maria J. Bueno, Manuel Muñoz, Raul Torres, Sandra Rodriguez, Rodrigo Sánchez-Bayona, Luis Manso, Jorge Silva, Marcos Malumbres. p27Kip1 V109G single-nucleotide polymorphism (SNP): pinpointing the hormone-receptor positive breast cancer subpopulation that requires CDK4/6 inhibitors in addition to endocrine therapy. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-02-28.
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Affiliation(s)
| | | | | | | | - Raul Torres
- 5CNIO - Spanish National Cancer Research Center
| | | | - Rodrigo Sánchez-Bayona
- 7Medical Oncology Department, Hospital 12 de Octubre, Madrid. SOLTI Cancer Research Group, Barcelona, Spain
| | - Luis Manso
- 8Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jorge Silva
- 9CNIO - Spanish National Cancer Research Center
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Chang-Azancot L, Abizanda P, Gijón M, Kenig N, Campello M, Juez J, Talaya A, Gómez-Bajo G, Montón J, Sánchez-Bayona R. Age and Breast Reconstruction. Aesthetic Plast Surg 2023; 47:63-72. [PMID: 35927500 DOI: 10.1007/s00266-022-03024-0] [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: 05/04/2022] [Accepted: 07/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Breast reconstruction is frequently offered to cancer patients who undergo mastectomy. Older women tend to have lower rates of reconstruction mostly due to an age-based discretion. We aimed to assess the safety of this surgery in this population. METHODS We conducted a single-center retrospective analysis of patients who underwent breast reconstruction following mastectomy between 2015 and 2020 at "Complejo Hospitalario Universitario de Albacete." Patients were classified according to age when the reconstruction process began (group A: < 65 years-group B: > 65 years). Differences in demographics and clinical data were analyzed using Student's t test and Chi-square test. Multivariable logistic regression models were used to estimate odds ratio (OR) and confidence intervals (CIs) for surgical complications according to age group. Propensity-score matching was used as a sensitivity analysis to test consistency among results. RESULTS We included 304 women (266: group A-38: group B). Complete reconstruction was achieved in 48.1% of patients in group A vs 10.5% in group B (P < 0.001). After adjusting for potential confounders, age was not associated with an increased risk of surgical complications, neither overall (OR 0.88, 95%CI 0.40-1.95), early (OR 1.35, 95%CI 0.58-3.13) nor late (OR 1.05, 95%CI 0.40-2.81). Radiotherapy and smoking history were significant predictors for complications in every setting. CONCLUSIONS In our cohort, age at breast reconstruction is not associated with a higher risk of surgical complications, in contrast to radiotherapy and smoking history. Therefore, age should not be a limiting factor when considering breast reconstruction. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Luis Chang-Azancot
- Plastic Surgery Department, Complejo Hospitalario Universitario de Albacete, 02006, Albacete, Spain.
| | - Pedro Abizanda
- Geriatrics Department, Complejo Hospitalario Universitario of Albacete, Albacete, Spain.,CIBERFES, Instituto de Salud Carlos III, Madrid, Spain
| | - María Gijón
- Plastic Surgery Department, Complejo Hospitalario Universitario de Albacete, 02006, Albacete, Spain
| | - Nitzan Kenig
- Plastic Surgery Department, Complejo Hospitalario Universitario de Albacete, 02006, Albacete, Spain
| | - Manuel Campello
- Plastic Surgery Department, Complejo Hospitalario Universitario de Albacete, 02006, Albacete, Spain
| | - Jessica Juez
- Plastic Surgery Department, Complejo Hospitalario Universitario de Albacete, 02006, Albacete, Spain
| | - Antonio Talaya
- Plastic Surgery Department, Complejo Hospitalario Universitario de Albacete, 02006, Albacete, Spain
| | - Gregorio Gómez-Bajo
- Plastic Surgery Department, Complejo Hospitalario Universitario de Albacete, 02006, Albacete, Spain
| | - Javier Montón
- Plastic Surgery Department, Complejo Hospitalario Universitario de Albacete, 02006, Albacete, Spain.,Anatomy and Embryology Unit, Faculty of Medicine, University of Castilla-La Mancha (UCLM), Albacete, Spain
| | - Rodrigo Sánchez-Bayona
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, 28041, Madrid, Spain
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11
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Aguilera-Buenosvinos I, Martínez-González MÁ, Zazpe I, Romanos-Nanclares A, Sánchez-Bayona R, Toledo E. Associations between overall, healthful, and unhealthful low-fat dietary patterns and breast cancer risk in a Mediterranean cohort: The SUN project. Nutrition 2023; 109:111967. [PMID: 36738657 DOI: 10.1016/j.nut.2022.111967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/25/2022] [Accepted: 12/31/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Dietary patterns may have a greater influence on human health than individual foods or nutrients, and they are also of substantial interest in the field of breast cancer prevention. Beyond the adequate balance of macronutrients, evidence indicates that the quality of macronutrient sources may play an important role in health outcomes. We sought to examine the relationship between healthful and unhealthful low-fat dietary patterns in relation to breast cancer. METHODS We used observational data from a Mediterranean cohort study (the Seguimiento Universidad de Navarra project). We prospectively followed 10 930 middle-aged women initially free of breast cancer during a median follow-up of 12.1 y. We calculated an overall, an unhealthful, and a healthful low-fat diet score, based on a previously validated 136-item food frequency questionnaire and grouped participants into tertiles. Incident breast cancer-overall and stratified by menopausal status-was the primary outcome. It was self-reported by participants and confirmed based on medical reports or consultation of the National Death Index. We used multivariable Cox regression models adjusted for potential confounders. RESULTS During 123 297 person-years of follow-up, 150 cases of incident breast cancer were confirmed. No significant associations were observed for overall or premenopausal breast cancer. For postmenopausal women, we observed a significant association for moderate adherence to the unhealthful low-fat dietary score and postmenopausal breast cancer (comparing tertile 2 to tertile 1; hazard ratio = 2.18; 95% confidence interval, 1.15-4.13). CONCLUSIONS In conclusion, no clear associations were observed, although more research is needed to address the association between an unhealthful dietary pattern and postmenopausal breast cancer risk.
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Affiliation(s)
- Inmaculada Aguilera-Buenosvinos
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Navarra Institute for Health Research, IdiSNA, Pamplona, Spain
| | - Miguel Ángel Martínez-González
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Navarra Institute for Health Research, IdiSNA, Pamplona, Spain; Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain; Department of Nutrition, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA USA
| | - Itziar Zazpe
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Department of Nutrition and Food Sciences and Physiology, University of Navarra, Irunlarrea, Spain
| | - Andrea Romanos-Nanclares
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Estefanía Toledo
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Navarra Institute for Health Research, IdiSNA, Pamplona, Spain; Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain.
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12
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Olivera-Salguero R, Seguí E, Cejalvo JM, Oliveira M, Tolosa P, Vidal M, Malumbres M, Gavilá J, Saura C, Pernas S, López R, Margelí M, Balmaña J, Muñoz M, Blancas I, Boni V, Ciruelos E, Galve E, Perelló A, Sánchez-Bayona R, de la Cruz S, de la Hoya M, Galván P, Sanfeliu E, Gonzalez-Farre B, Sirenko V, Blanch-Torras A, Canes J, Masanas H, Olmos R, Forns M, Prat A, Casas A, Pascual T. HOPE (SOLTI-1903) breast cancer study: real-world, patient-centric, clinical practice study to assess the impact of genomic data on next treatment decision-choice in patients with locally advanced or metastatic breast cancer. Front Oncol 2023; 13:1151496. [PMID: 37188177 PMCID: PMC10175800 DOI: 10.3389/fonc.2023.1151496] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
Background Metastatic breast cancer (mBC) causes nearly all BC-related deaths. Next-generation sequencing (NGS) technologies allow for the application of personalized medicine using targeted therapies that could improve patients' outcomes. However, NGS is not routinely used in the clinical practice and its cost induces access-inequity among patients. We hypothesized that promoting active patient participation in the management of their disease offering access to NGS testing and to the subsequent medical interpretation and recommendations provided by a multidisciplinary molecular advisory board (MAB) could contribute to progressively overcome this challenge. We designed HOPE (SOLTI-1903) breast cancer trial, a study where patients voluntarily lead their inclusion through a digital tool (DT). The main objectives of HOPE study are to empower mBC patients, gather real-world data on the use of molecular information in the management of mBC and to generate evidence to assess the clinical utility for healthcare systems. Trial design After self-registration through the DT, the study team validates eligibility criteria and assists patients with mBC in the subsequent steps. Patients get access to the information sheet and sign the informed consent form through an advanced digital signature. Afterwards, they provide the most recent (preferably) metastatic archival tumor sample for DNA-sequencing and a blood sample obtained at the time of disease progression for ctDNA analysis. Paired results are reviewed by the MAB, considering patient's medical history. The MAB provides a further interpretation of molecular results and potential treatment recommendations, including ongoing clinical trials and further (germline) genetic testing. Participants self-document their treatment and disease evolution for the next 2 years. Patients are encouraged to involve their physicians in the study. HOPE also includes a patient empowerment program with educational workshops and videos about mBC and precision medicine in oncology. The primary endpoint of the study was to describe the feasibility of a patient-centric precision oncology program in mBC patients when a comprehensive genomic profile is available to decide on a subsequent line of treatment. Clinical trial registration www.soltihope.com, identifier NCT04497285.
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Affiliation(s)
| | - Elia Seguí
- SOLTI Cancer Research Group, Barcelona, Spain
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Juan Miguel Cejalvo
- SOLTI Cancer Research Group, Barcelona, Spain
- Hospital Clínico Universitario de Valencia, INCLIVA (Instituto de Investigación Sanitaria), Universidad Valencia, Valencia, Spain
| | - Mafalda Oliveira
- SOLTI Cancer Research Group, Barcelona, Spain
- Medical Oncology Department, Vall d’Hebron University Hospital, Barcelona, Spain
- Breast Cancer Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Pablo Tolosa
- SOLTI Cancer Research Group, Barcelona, Spain
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Maria Vidal
- SOLTI Cancer Research Group, Barcelona, Spain
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Breast Cancer Unit, Institute of Oncology Barcelona (IOB) – Quirónsalud, Barcelona, Spain
| | - Marcos Malumbres
- Cancer Cell Cycle Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Cell Division and Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Joaquín Gavilá
- SOLTI Cancer Research Group, Barcelona, Spain
- Instituto Valenciano de Oncología (IVO), Valencia, Spain
| | - Cristina Saura
- SOLTI Cancer Research Group, Barcelona, Spain
- Medical Oncology Department, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Sonia Pernas
- SOLTI Cancer Research Group, Barcelona, Spain
- Medical Oncology Department, Catalan Institute of Oncology (ICO)/Institut d’Investigació Biomédica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Rafael López
- SOLTI Cancer Research Group, Barcelona, Spain
- Medical Oncology Department and Translational Medical Oncology Group, Clinical University Hospital and Health Research Institute of Santiago de Compostela (IDIS)-CIBERONC, Santiago de Compostela, Spain
| | - Mireia Margelí
- SOLTI Cancer Research Group, Barcelona, Spain
- Catalan Institute of Oncology (ICO), Hospital Germans Trias i Pujol/Badalona Applied Research Group in Oncology (B-ARGO Group), Oncology Department, Badalona, Spain
| | - Judith Balmaña
- SOLTI Cancer Research Group, Barcelona, Spain
- Medical Oncology Department, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Montserrat Muñoz
- SOLTI Cancer Research Group, Barcelona, Spain
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Isabel Blancas
- SOLTI Cancer Research Group, Barcelona, Spain
- Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria de Granada (ibs. Granada) and Medicine Department, Granada University, Granada, Spain
| | - Valentina Boni
- SOLTI Cancer Research Group, Barcelona, Spain
- Next Madrid, Universitary Hospital Quiron Salud Madrid, Madrid, Spain
| | - Eva Ciruelos
- SOLTI Cancer Research Group, Barcelona, Spain
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Centro Integral Oncológico Clara Campal HM (CIOCC), Madrid, Spain
| | - Elena Galve
- SOLTI Cancer Research Group, Barcelona, Spain
- Hospital Universitario Basurto (OSI Bilbao-Basurto), Bilbao, Spain
| | - Antonia Perelló
- SOLTI Cancer Research Group, Barcelona, Spain
- Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Rodrigo Sánchez-Bayona
- SOLTI Cancer Research Group, Barcelona, Spain
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Susana de la Cruz
- SOLTI Cancer Research Group, Barcelona, Spain
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Miguel de la Hoya
- Molecular Oncology Laboratory, CIBERONC, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Patricia Galván
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Esther Sanfeliu
- SOLTI Cancer Research Group, Barcelona, Spain
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Pathology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Blanca Gonzalez-Farre
- SOLTI Cancer Research Group, Barcelona, Spain
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Pathology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Valeria Sirenko
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | - Jordi Canes
- SOLTI Cancer Research Group, Barcelona, Spain
| | | | - Rosa Olmos
- Asociación Española de Cáncer de Mama Metastásico, Oviedo, Spain
| | - Margarita Forns
- Asociación Española de Cáncer de Mama Metastásico, Oviedo, Spain
| | - Aleix Prat
- SOLTI Cancer Research Group, Barcelona, Spain
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Ana Casas
- SOLTI Cancer Research Group, Barcelona, Spain
- Fundación Actitud Frente al Cáncer, Sevilla, Spain
- *Correspondence: Tomás Pascual, ; Ana Casas,
| | - Tomás Pascual
- SOLTI Cancer Research Group, Barcelona, Spain
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain
- *Correspondence: Tomás Pascual, ; Ana Casas,
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13
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Mair MJ, Cardone C, Connolly L, Kfoury M, Lambertini M, Lim J, Mariamidze E, Matikas A, Pihlak R, Punie K, Oing C, Sánchez-Bayona R, Sobczuk P, Zhu H, Berghoff AS, Amaral T. Career and Professional Development for Young Oncologists. Oncol Res Treat 2023; 46:67-71. [PMID: 36473447 DOI: 10.1159/000528541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
Young oncologists around the globe face many challenges when it comes to their career and professional development. Aspects such as time management, work-life balance, career progression, and educational opportunities are only some of them. Professional societies have identified these challenges in this professional group and designed programs to tackle them specifically. The importance of this strategy cannot be overstated, as young oncologists, defined by most societies as oncologists under 40 years of age, compose almost 50% of the oncology workforce. On the other hand, recent surveys have shown that many young oncologists are considering alternative career paths due to burnout issues aggravated by the COVID-19 pandemic, on top of all other challenges. The virtual setting that has been forcedly introduced into our professional life has shortened distances between professionals and might have contributed to more accessible access to information and opportunities that some young oncologists could not profit from due to their traveling constraints. On the other hand, this virtual setting has shown us the asymmetries in opportunities for these professionals. Knowledgeable of all this, we summarize in this article some of the career and professional development offers available to all young oncologists, which we consider could help them deal with current and future challenges.
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Affiliation(s)
- Maximilian J Mair
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Claudia Cardone
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori- IRCCS-Fondazione G. Pascale, Naples, Italy
| | - Liz Connolly
- Department of Medical Oncology, Chris O Brien Lifehouse, Sydney, New South Wales, Australia
| | - Maria Kfoury
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy.,Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Jonathan Lim
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Elene Mariamidze
- Todua Clinic Department of Oncology and Haematology, Tbilisi, Georgia
| | - Alexios Matikas
- Breast Center, Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| | - Rille Pihlak
- Medical Oncology Department, St Bartholomew's Hospital, London, UK
| | - Kevin Punie
- Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute and University Hospitals Leuven, Leuven, Belgium
| | - Christoph Oing
- Translational and Clinical Research Institute, Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | | | - Pawel Sobczuk
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Skłodowska-Curie National Research instutute of Oncology, Warsaw, Poland
| | - Hongcheng Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Anna S Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Teresa Amaral
- Skin Cancer Clinical Trials Center, Eberhard Karls University, Tuebingen, Germany
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14
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Mouron S, Bueno MJ, Lluch A, Manso L, Calvo I, Cortes J, Garcia-Saenz JA, Gil-Gil M, Martinez-Janez N, Apala JV, Caleiras E, Ximénez-Embún P, Muñoz J, Gonzalez-Cortijo L, Murillo R, Sánchez-Bayona R, Cejalvo JM, Gómez-López G, Fustero-Torre C, Sabroso-Lasa S, Malats N, Martinez M, Moreno A, Megias D, Malumbres M, Colomer R, Quintela-Fandino M. Phosphoproteomic analysis of neoadjuvant breast cancer suggests that increased sensitivity to paclitaxel is driven by CDK4 and filamin A. Nat Commun 2022; 13:7529. [PMID: 36477027 PMCID: PMC9729295 DOI: 10.1038/s41467-022-35065-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022] Open
Abstract
Precision oncology research is challenging outside the contexts of oncogenic addiction and/or targeted therapies. We previously showed that phosphoproteomics is a powerful approach to reveal patient subsets of interest characterized by the activity of a few kinases where the underlying genomics is complex. Here, we conduct a phosphoproteomic screening of samples from HER2-negative female breast cancer receiving neoadjuvant paclitaxel (N = 130), aiming to find candidate biomarkers of paclitaxel sensitivity. Filtering 11 candidate biomarkers through 2 independent patient sets (N = 218) allowed the identification of a subgroup of patients characterized by high levels of CDK4 and filamin-A who had a 90% chance of achieving a pCR in response to paclitaxel. Mechanistically, CDK4 regulates filamin-A transcription, which in turn forms a complex with tubulin and CLIP-170, which elicits increased binding of paclitaxel to microtubules, microtubule acetylation and stabilization, and mitotic catastrophe. Thus, phosphoproteomics allows the identification of explainable factors for predicting response to paclitaxel.
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Affiliation(s)
- S Mouron
- Breast Cancer Clinical Research Unit Centro Nacional de Investigaciones Oncológicas - CNIO, Madrid, Spain
| | - M J Bueno
- Breast Cancer Clinical Research Unit Centro Nacional de Investigaciones Oncológicas - CNIO, Madrid, Spain
| | - A Lluch
- Medical Oncology Department, Hospital Clínico Universitario, Valencia, Spain
| | - L Manso
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - I Calvo
- Medical Oncology Department MD, Anderson Cancer Center Madrid, Madrid, Spain
| | - J Cortes
- International Breast Cancer Center Quiron Group, Barcelona, Spain
- Vall d'Hebron Institute of Oncology, Vall d'Hebron Hospital, Barcelona, Spain
| | - J A Garcia-Saenz
- Medical Oncology Department, Hospital Clinico San Carlos, Madrid, Spain
| | - M Gil-Gil
- Medical Oncoogy Department Institut, Catala d'Oncologia-IDIBELL L'Hospitalet de, Llobregat, Spain
| | - N Martinez-Janez
- Medical Oncology Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - J V Apala
- Breast Cancer Clinical Research Unit Centro Nacional de Investigaciones Oncológicas - CNIO, Madrid, Spain
| | - E Caleiras
- Histopathology Unit Centro Nacional de Investigaciones Oncológicas - CNIO, Madrid, Spain
| | - Pilar Ximénez-Embún
- Proteomics Unit Centro Nacional de Investigaciones Oncológicas - CNIO, Madrid, Spain
| | - J Muñoz
- Proteomics Unit Centro Nacional de Investigaciones Oncológicas - CNIO, Madrid, Spain
| | - L Gonzalez-Cortijo
- Medical Oncology Department, Hospital Universitario Quironsalud, Madrid, Spain
| | - R Murillo
- Pathology Department, Hospital Universitario Quironsalud, Madrid, Spain
| | - R Sánchez-Bayona
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J M Cejalvo
- Medical Oncology Department, Hospital Clínico Universitario, Valencia, Spain
| | - G Gómez-López
- Bioinformatics Unit Centro Nacional de Investigaciones Oncológicas - CNIO, Madrid, Spain
| | - C Fustero-Torre
- Bioinformatics Unit Centro Nacional de Investigaciones Oncológicas - CNIO, Madrid, Spain
| | - S Sabroso-Lasa
- Genetic & Molecular Epidemiology Group Centro Nacional de Investigaciones Oncológicas - CNIO, Madrid, Spain
| | - N Malats
- Genetic & Molecular Epidemiology Group Centro Nacional de Investigaciones Oncológicas - CNIO, Madrid, Spain
| | - M Martinez
- Pathology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Moreno
- Pathology Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - D Megias
- Confocal Microscopy Unit Centro Nacional de Investigaciones Oncológicas - CNIO, Madrid, Spain
| | - M Malumbres
- Cell Division and Cancer Group Centro Nacional de Investigaciones Oncológicas - CNIO, Madrid, Spain
| | - R Colomer
- Medical Oncology Department, Hospital Universitario La Princesa, Madrid, Spain
- Endowed Chair of Personalized Precision Medicine Universidad Autonoma de Madrid (UAM) - Fundacion Instituto Roche, Madrid, Spain
| | - M Quintela-Fandino
- Breast Cancer Clinical Research Unit Centro Nacional de Investigaciones Oncológicas - CNIO, Madrid, Spain.
- Endowed Chair of Personalized Precision Medicine Universidad Autonoma de Madrid (UAM) - Fundacion Instituto Roche, Madrid, Spain.
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15
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Blancas I, Fakhouri W, Molero A, Díaz-Cerezo S, Haro J, Faris L, Sánchez-Bayona R. Abemaciclib for treating patients with HR+, HER2- advanced/metastatic breast cancer in Spain: a real-world study. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01509-x] [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: 11/19/2022]
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16
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Hato L, Inogés S, Pérez B, Mejías L, Sánchez-Bayona R, Santisteban M, López A. Abstract P2-14-11: Immune response monitoring in breast cancer patients treated with neoadjuvant chemotherapy combined with dendritic cell vaccines. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p2-14-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
INTRODUCTION. Breast cancer (BC) is one of the most frequent cancers in women worldwide. Lack of therapeutic efficacy in some BC subtypes makes it necessary to develop new strategies. It is known that immune system plays a key role in the tumour control. Moreover, BC is immunogenic and the intensity of the immune response influences the clinical efficacy, and is correlated with a good prognosis. For that, manipulating the immune system to make it more effective could be an option. We design a clinical trial (NCT01431196) to evaluate the clinical efficacy of the combination of standard treatment with monocyte-derived dendritic cells vaccines preloaded with autologous tumour lysate (DCV) in stage I-III BC patients without HER2 overexpression. An in-depth immunological study was carried out. OBJECTIVES. To evaluate the immune response induced by the combination of neoadjuvant chemotherapy ± DCV ± radiation ± endocrine therapy in BC patients. METHODS. Serum and peripheral blood mononuclear cells (PBMCs) were collected from 20 luminal and triple negative BC patients before and after treatment. In serum, the presence of anti-tumour antibodies was studied by flow cytometry. PBMCs phenotype was evaluated by flow cytometry. In addition, functional studies were performed by incubating PBMCs with dendritic cells preloaded with autologous tumour lysate to evaluate specific immune response; specifically, T cell proliferation assay by [3H] thymidine incorporation and IFN-γ-producing cell assays by ELISPOT were done. Finally, the TCR clonality was assessed by flow cytometry. RESULTS. We identified IgG and IgM antibodies specific for breast cancer cell lines in the serum of 20 % and 40% of patients. Myeloid-derived suppressor cells decreased and NK cells increased with the treatment. Moreover, activation markers, such as HLADR, significantly increased in CD4+ and CD8+ lymphocytes after treatment, whereas PD1 and TIM3 decreased. In addition, an increase in the proliferation of specific T cells and in the number of IFN-γ producing cells after stimulation with tumor lysate pulsed DC was detected after treatment. Finally, very good clinical responders (pT4/5 with Miller&Payne classification and pN0) had higher TCR diversity index (DI) in CD4+ and CD8+ T cells in pretreatment samples: in CD8+ T cells, diversity index decreased in both groups after treatment, with higher difference in the VGCR group. CONCLUSION. Our study provides strong support that combined treatment induce humoral and cellular immune responses. We observed an activation of the immune system and a decrease in some immune checkpoints and MDSC. Finally, patients with a higher TCR-DI initially have a better clinical response and treatment induced oligoclonal activation of T cells.
Citation Format: Laura Hato, Susana Inogés, Belén Pérez, Luis Mejías, Rodrigo Sánchez-Bayona, Marta Santisteban, Ascensión López. Immune response monitoring in breast cancer patients treated with neoadjuvant chemotherapy combined with dendritic cell vaccines [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-14-11.
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Affiliation(s)
- Laura Hato
- Clinica Universidad de Navarra, Pamplona, Spain
| | | | - Belén Pérez
- Clinica Universidad de Navarra, Pamplona, Spain
| | - Luis Mejías
- Clinica Universidad de Navarra, Pamplona, Spain
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17
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Vidal M, Muñoz M, Margeli M, González X, Amillano K, Sánchez-Bayona R, Salvador F, Pascual T, Prat A, Bellet M. Abstract OT2-11-07: Solti-1905. Elacestrant in preoperative setting, a window of opportunity study (ELIPSE trial). Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-ot2-11-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background.Patients with hormone receptor-positive/HER2-negative (HR+/HER2-) breast cancer (BC) are mainly treated with therapies that target estrogen receptor (ER) signaling to impair tumor cell proliferation. Several drugs targeting the ER pathway are currently used in the clinical practice including aromatase inhibitors (AI) that limit the production of estradiol, selective ER modulators (SERMs) that compete with estradiol for binding ER, and selective ER degraders (SERDs) that induce ER degradation. Despite the availability of these drugs, finding new ET remains a clinical unmet need since some patients do not initially respond to these treatments or become resistant to available endocrine agents. Elacestrant is an orally bioavailable drug that acts as SERD in breast tissue promoting degradation of ER and inhibiting breast cancer cell proliferation. Several clinical studies have confirmed the tolerable safety profile of elacestrant in BC (Bardia A et al. ASCO, 2021) and a phase III trial investigating elacestrant versus standard ET in metastatic BC patients is ongoing for patients treated with at least 1 prior ET and a CDK4/6 inhibitor for advanced BC (EMERALD; NCT03778931). In this study, we aim to investigate the biological effect of elacestrant on cell proliferation in patients with ER+/HER2- resectable BC. Study design. ELIPSE is prospective, multicenter, single-arm, window-of-opportunity study designed to evaluate the biological effect of elacestrant in treatment naïve patients with ER+/HER2- resectable BC. The study population consists of postmenopausal women with clinically negative axillary lymph node (cN0) and whose primary tumors are≥ 1.5 cm by ultrasound with Ki67 ≥10% locally assessed. Patients will receive 400 mg of elacestrant in monotherapy orally, once a day, continuously. After 4 weeks of treatment, surgery will be performed in accordance with local practice. Two biopsies of the same lesion will be obtained as mandatory: a baseline sample and a surgical sample (tumor core-biopsy is permitted if surgery is not performed after 4 weeks of treatment). Plasma samples for biomarkers will be collected at baseline, surgery and end of study visit. The primary objective is to evaluate the Complete Cell Cycle Arrest rate (defined as Ki67 ≤ 2.7%) by central assessment after 4 weeks of elacestrant therapy. Secondary endpoints include:. 1) safety,. 2) correlation of biological activity determined by changes in: Ki67 as a continuous variable, intrinsic PAM50 subtypes, proliferative signatures, tumor cellularity and tumor-infiltrating lymphocytes (CelTIL, Nuciforo P et al., Ann Oncol, 2018) in tumor samples taken before and at the end of treatment, and. 3) analysis of ctDNA dynamics after treatment. As of July 2021, 7 patients have been enrolled in 4 sites in Spain. NCT04797728. Acknowledgement. This study is financially supported by Radius Pharmaceuticals, Inc.
Citation Format: María Vidal, Montserrat Muñoz, Mireia Margeli, Xavier González, Kepa Amillano, Rodrigo Sánchez-Bayona, Fernando Salvador, Tomás Pascual, Aleix Prat, Meritxell Bellet. Solti-1905. Elacestrant in preoperative setting, a window of opportunity study (ELIPSE trial) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT2-11-07.
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Affiliation(s)
- María Vidal
- SOLTI Breast Cancer Research Group/Hospital Clinic de Barcelona/August Pi i Sunyer Biomedical Research Institute (IDIBAPS)/University of Barcelona, Barcelona, Spain
| | - Montserrat Muñoz
- SOLTI Breast Cancer Research Group/Hospital Clinic de Barcelona/August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | | | | | | | | | | | - Aleix Prat
- SOLTI Breast Cancer Research Group/Hospital Clinic de Barcelona/August Pi i Sunyer Biomedical Research Institute (IDIBAPS)/University of Barcelona, Barcelona, Spain
| | - Meritxell Bellet
- Vall d’Hebron University Hospital/Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
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Villacampa G, Tolosa P, Salvador F, Sánchez-Bayona R, Villanueva L, Dienstmann R, Ciruelos E, Pascual T. Addition of immune checkpoint inhibitors to chemotherapy versus chemotherapy alone in first-line metastatic triple-negative breast cancer: a systematic review and meta-analysis. Cancer Treat Rev 2022; 104:102352. [DOI: 10.1016/j.ctrv.2022.102352] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 12/31/2022]
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Santisteban M, Solans BP, Hato L, Urrizola A, Mejías LD, Salgado E, Sánchez-Bayona R, Toledo E, Rodríguez-Spiteri N, Olartecoechea B, Idoate MA, López-Díaz de Cerio A, Inogés S. Final results regarding the addition of dendritic cell vaccines to neoadjuvant chemotherapy in early HER2-negative breast cancer patients: clinical and translational analysis. Ther Adv Med Oncol 2021; 13:17588359211064653. [PMID: 34987618 PMCID: PMC8721381 DOI: 10.1177/17588359211064653] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/16/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Primary breast cancer (BC) has shown a higher immune infiltration than the metastatic disease, justifying the optimal scenario for immunotherapy. Recently, neoadjuvant chemotherapy (NAC) combined with immune checkpoint inhibitors has demonstrated a gain in pathological complete responses (tpCR) in patients with BC. The aim of our study is to evaluate the safety, feasibility, and efficacy of the addition of dendritic cell vaccines (DCV) to NAC in HER2-negative BC patients. METHODS Thirty-nine patients with early BC received DCV together with NAC conforming the vaccinated group (VG) and compared with 44 patients as the control group (CG). All patients received anthracyclines and taxanes-based NAC (ddECx4→Dx4) followed by surgery ± radiotherapy ± hormonotherapy. RESULTS The tpCR rate was 28.9% in the VG and 9.09% in the CG (p = 0.03). Pathological CR in the triple negative (TN) BC were 50.0% versus 30.7% (p = 0.25), 16.6% versus 0% in luminal B (p = 0.15), and none among luminal A patients in VG versus CG, respectively. Impact of DCV was significantly higher in the programmed cell death ligand 1 (PD-L1) negative population (p < 0.001). PD-L1 expression was increased in patients with residual disease in the VG as compared with the CG (p < 0.01). No grade ⩾3 vaccine-related adverse events occurred. With a median follow-up of 8 years, no changes were seen in event-free survival or overall survival. Phenotypic changes post DCV in peripheral blood were observed in myeloid-derived suppressor cells (MDSC), NK, and T cells. Increase in blood cell proliferation and interferon (IFN)-γ production was detected in 69% and 74% in the VG, respectively. Humoral response was also found. Clonality changes in TCR-β repertoire were detected in 67% of the patients with a drop in diversity index after treatment. CONCLUSION The combination of DCV plus NAC is safe and increases tpCR, with a significant benefit among PD-L1-negative tumors. DCV modify tumor milieu and perform cellular and humoral responses in peripheral blood with no impact in outcome. TRIAL REGISTRATION ClinicalTrials.gov number: NCT01431196. EudraCT 2009-017402-36.
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Affiliation(s)
- Marta Santisteban
- Department of Medical Oncology, Clínica Universidad de Navarra, Avda. Pío XII 36, 31008 Pamplona, Spain
- Breast Cancer Unit, Clínica Universidad de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Belén Pérez Solans
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Pharmacometrics and Systems Pharmacology, Universidad de Navarra, Pamplona, Spain
| | - Laura Hato
- Department of Immunology and Immunotherapy, Clínica Universidad de Navarra, Pamplona, Spain
| | - Amaia Urrizola
- Medical Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Luis Daniel Mejías
- Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Esteban Salgado
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Medical Oncology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - Estefanía Toledo
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona, Spain
| | | | | | | | - Ascensión López-Díaz de Cerio
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Department of Immunology and Immunotherapy, Clínica Universidad de Navarra, Pamplona, Spain
- Cell Therapy Unit, Clínica Universidad de Navarra, Pamplona, Spain
- Clínica Universidad de Navarra, Universidad de Navarra, Complejo Hospitalario de Navarra and IdisNA, Pamplona, Spain
| | - Susana Inogés
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Department of Immunology and Immunotherapy, Clínica Universidad de Navarra, Pamplona, Spain
- Cell Therapy Unit, Clínica Universidad de Navarra, Pamplona, Spain
- Clínica Universidad de Navarra, Universidad de Navarra, Complejo Hospitalario de Navarra and IdisNA, Pamplona, Spain
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Fernandez-Lazaro CI, Romanos-Nanclares A, Sánchez-Bayona R, Gea A, Sayon-Orea C, Martinez-Gonzalez MA, Toledo E. Dietary calcium, vitamin D, and breast cancer risk in women: findings from the SUN cohort. Eur J Nutr 2021; 60:3783-3797. [PMID: 33818633 DOI: 10.1007/s00394-021-02549-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 03/22/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Epidemiological evidence concerning the relationship between calcium and vitamin D intake and breast cancer (BC) is inconclusive. Moreover, the association according to menopausal status remains unclear. We aimed to assess whether total intakes from dietary and supplemental sources of calcium and vitamin D were associated with the incidence of BC in a Mediterranean cohort. METHODS We prospectively evaluated the association between intakes of calcium and vitamin D and BC risk among 10,812 women in the Seguimiento Universidad de Navarra (SUN) Project, a Spanish cohort of university graduates. RESULTS During a mean follow-up of 10.7 years, 101 incident BC cases were confirmed. Evidence of a non-linear association between total calcium intake and BC risk was found (Pnon-linearity = 0.011) with risk reductions associated with higher intake up to approximately 1400 mg/day. Moderate intake [Tertile 2 (T2)] of total calcium was associated with lower overall BC risk [HR for T2 vs. Tertile 1 (T1): 0.55; 95% CI 0.33-0.91] and also among postmenopausal women (HRT2 vs. T1 = 0.38; 95% CI 0.16-0.92). Intake of vitamin D was not associated with BC risk. CONCLUSIONS Our findings suggest an L-shaped association between total calcium intake and BC incidence. Moderate calcium intake may be associated with lower BC risk among overall and postmenopausal women, but not among premenopausal women. No evidence for any association between vitamin D intake and BC was found. Adherence to current guidelines recommendations for calcium intake may help to reduce BC risk.
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Affiliation(s)
- Cesar I Fernandez-Lazaro
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, C/Irunlarrea, 31008, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, 31008, Pamplona, Spain
| | - Andrea Romanos-Nanclares
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, C/Irunlarrea, 31008, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, 31008, Pamplona, Spain
| | - Rodrigo Sánchez-Bayona
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, C/Irunlarrea, 31008, Pamplona, Spain.,Department of Clinical Oncology, Clínica Universidad de Navarra, 31008, Pamplona, Spain
| | - Alfredo Gea
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, C/Irunlarrea, 31008, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, 31008, Pamplona, Spain.,Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), 28029, Madrid, Spain
| | - Carmen Sayon-Orea
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, C/Irunlarrea, 31008, Pamplona, Spain.,Public Health Institute, 31003, Pamplona, Spain
| | - Miguel A Martinez-Gonzalez
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, C/Irunlarrea, 31008, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, 31008, Pamplona, Spain.,Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), 28029, Madrid, Spain.,Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Estefanía Toledo
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, C/Irunlarrea, 31008, Pamplona, Spain. .,IdiSNA, Navarra Institute for Health Research, 31008, Pamplona, Spain. .,Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), 28029, Madrid, Spain.
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Aguilera-Buenosvinos I, Fernandez-Lazaro CI, Romanos-Nanclares A, Gea A, Sánchez-Bayona R, Martín-Moreno JM, Martínez-González MÁ, Toledo E. Dairy Consumption and Incidence of Breast Cancer in the 'Seguimiento Universidad de Navarra' (SUN) Project. Nutrients 2021; 13:nu13020687. [PMID: 33669972 PMCID: PMC7924827 DOI: 10.3390/nu13020687] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 01/21/2023] Open
Abstract
Dairy products might influence breast cancer (BC) risk. However, evidence is inconsistent. We sought to examine the association between dairy product consumption-and their subtypes-and incident BC in a Mediterranean cohort. The SUN ("Seguimiento Universidad de Navarra") Project is a Spanish dynamic ongoing cohort of university graduates. Dairy product consumption was estimated through a previously validated 136-item food frequency questionnaire (FFQ). Incident BC was reported in biennial follow-up questionnaires and confirmed with revision of medical records and consultation of the National Death Index. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated with Cox regression models. Among 123,297 women-years of follow-up (10,930 women, median follow-up 12.1 years), we confirmed 119 incident BC cases. We found a nonlinear association between total dairy product consumption and BC incidence (pnonlinear = 0.048) and a significant inverse association for women with moderate total dairy product consumption (HRQ2vs.Q1 = 0.49 (95% CI 0.28-0.84); HRQ3vs.Q1 = 0.49 (95% CI 0.29-0.84) ptrend = 0.623) and with moderate low-fat dairy product consumption (HRQ2vs.Q1 = 0.58 (95% CI 0.35-0.97); HRQ3vs.Q1 = 0.55 (95% CI 0.32-0.92), ptrend = 0.136). In stratified analyses, we found a significant inverse association between intermediate low-fat dairy product consumption and premenopausal BC and between medium total dairy product consumption and postmenopausal BC. Thus, dairy products, especially low-fat dairy products, may be considered within overall prudent dietary patterns.
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Affiliation(s)
- Inmaculada Aguilera-Buenosvinos
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, 31008 Pamplona, Spain; (I.A.-B.); (C.I.F.-L.); (A.R.-N.); (A.G.); (M.Á.M.-G.)
| | - Cesar Ignacio Fernandez-Lazaro
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, 31008 Pamplona, Spain; (I.A.-B.); (C.I.F.-L.); (A.R.-N.); (A.G.); (M.Á.M.-G.)
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - Andrea Romanos-Nanclares
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, 31008 Pamplona, Spain; (I.A.-B.); (C.I.F.-L.); (A.R.-N.); (A.G.); (M.Á.M.-G.)
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - Alfredo Gea
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, 31008 Pamplona, Spain; (I.A.-B.); (C.I.F.-L.); (A.R.-N.); (A.G.); (M.Á.M.-G.)
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), 28029 Madrid, Spain
| | - Rodrigo Sánchez-Bayona
- Department of Clinical Oncology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
| | - Jose M. Martín-Moreno
- Department of Preventive Medicine and Public Health, Medical School & INCLIVA, University of Valencia, 46010 Valencia, Spain;
| | - Miguel Ángel Martínez-González
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, 31008 Pamplona, Spain; (I.A.-B.); (C.I.F.-L.); (A.R.-N.); (A.G.); (M.Á.M.-G.)
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), 28029 Madrid, Spain
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Estefanía Toledo
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, 31008 Pamplona, Spain; (I.A.-B.); (C.I.F.-L.); (A.R.-N.); (A.G.); (M.Á.M.-G.)
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-948425600 (ext. 806224)
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Macías M, García-Cortés Á, Torres M, Ancizu-Marckert J, Ignacio Pascual J, Díez-Caballero F, Enrique Robles J, Rosell D, Miñana B, Mateos B, Ajona D, Sánchez-Bayona R, Bedialauneta O, Chocarro S, Navarro A, Andueza MP, Gúrpide A, Luis Perez-Gracia J, Alegre E, González Á. Characterization of the perioperative changes of exosomal immune-related cytokines induced by prostatectomy in early-stage prostate cancer patients. Cytokine 2021; 141:155471. [PMID: 33607398 DOI: 10.1016/j.cyto.2021.155471] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/25/2021] [Accepted: 02/03/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Myeloid-derived suppressor cells (MDSCs) are relevant in prostate cancer microenvironment collaborating in tumor development. The main tumor marker used in this disease, prostate-specific antigen (PSA), does not provide information related to this tumor microenvironment. Cancer cells secrete exosomes carrying bioactive molecules contributing to MDSCs recruitment and induction. The aim of this study was to characterize the perioperative changes of exosomal cytokines relevant in MDSCs recruitment induced by prostatectomy in prostate cancer patients. METHODS Blood was drawn from 26 early-stage prostate cancer patients before and after radical prostatectomy and from 16 healthy volunteers. Serum exosomes were separated by precipitation. Cytokines related with MDSC cell recruitment and activation CCL2, CXCL2, CXCL5, CXCL8, CXCL12, MIF, S100A9 and TGF-ß were measured in serum and serum-derived exosomes using immunometric assays. RESULTS All cytokines were detected both in serum and exosomes, except for CXCL12, which was detected only in serum. Exosomes were enriched specially in MIF, TGF-ß and CXCL2. Presurgical MIF levels in exosomes correlated negatively with serum PSA. Also, presurgical TGF-ß decreased both in serum and exosomes as Gleason score rises. Patientś presurgical exosomes had increased CCL2, CXCL5 and TGF-ß levels than exosomes from healthy controls. These differences were not observed when cytokines were analyzed in serum, except for TGF-ß. Cytokine levels of CCL2, CXCL5 decreased in patients' postsurgical exosomes, while TGF-ß further increased. On the contrary, S100A9 levels were lower in patientś presurgical exosomes but increased after radical prostatectomy. CONCLUSIONS Blood exosomal content in cytokines constitute an attractive source to evaluate MDSCs immunomodulators providing additional information related to tumor microenvironment in prostate cancer.
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Affiliation(s)
- Mónica Macías
- Service of Biochemistry, Clínica Universidad de Navarra, Av. de Pío XII 36, 31008 Pamplona, Spain
| | - Ángel García-Cortés
- Urology Department, Clínica Universidad de Navarra, Av. de Pío XII 36, 31008 Pamplona, Spain
| | - Marcos Torres
- Urology Department, Clínica Universidad de Navarra, Av. de Pío XII 36, 31008 Pamplona, Spain
| | - Javier Ancizu-Marckert
- Urology Department, Clínica Universidad de Navarra, Av. de Pío XII 36, 31008 Pamplona, Spain
| | - Juan Ignacio Pascual
- Urology Department, Clínica Universidad de Navarra, Av. de Pío XII 36, 31008 Pamplona, Spain
| | - Fernando Díez-Caballero
- Urology Department, Clínica Universidad de Navarra, Av. de Pío XII 36, 31008 Pamplona, Spain
| | - José Enrique Robles
- Urology Department, Clínica Universidad de Navarra, Av. de Pío XII 36, 31008 Pamplona, Spain
| | - David Rosell
- Urology Department, Clínica Universidad de Navarra, Av. de Pío XII 36, 31008 Pamplona, Spain
| | - Bernardino Miñana
- Urology Department, Clínica Universidad de Navarra, Calle Marquesado de Sta. Marta, 1, 28027 Madrid, Spain
| | - Beatriz Mateos
- Service of Biochemistry, Clínica Universidad de Navarra, Av. de Pío XII 36, 31008 Pamplona, Spain
| | - Daniel Ajona
- University of Navarra, Centro de Investigación Médica Aplicada (CIMA), Program in Solid Tumors, Av. de Pío XII 36, 31008 Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Calle de Irunlarrea, 3, 31008 Pamplona, Spain; Centro de Investigación Médica en Red de Cáncer (CIBERONC), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0 28029, Madrid, Spain; University of Navarra, School of Sciences, Department of Biochemistry and Genetics, Pamplona, Spain
| | - Rodrigo Sánchez-Bayona
- Oncology Department, Clínica Universidad de Navarra, Av. de Pío XII 36, 31008 Pamplona, Spain
| | | | - Susana Chocarro
- Urology Department, Clínica Universidad de Navarra, Av. de Pío XII 36, 31008 Pamplona, Spain
| | - Ana Navarro
- Urology Department, Clínica Universidad de Navarra, Av. de Pío XII 36, 31008 Pamplona, Spain
| | - María P Andueza
- Oncology Department, Clínica Universidad de Navarra, Av. de Pío XII 36, 31008 Pamplona, Spain
| | - Alfonso Gúrpide
- Oncology Department, Clínica Universidad de Navarra, Av. de Pío XII 36, 31008 Pamplona, Spain
| | - Jose Luis Perez-Gracia
- IdiSNA, Navarra Institute for Health Research, Calle de Irunlarrea, 3, 31008 Pamplona, Spain; Oncology Department, Clínica Universidad de Navarra, Av. de Pío XII 36, 31008 Pamplona, Spain
| | - Estibaliz Alegre
- Service of Biochemistry, Clínica Universidad de Navarra, Av. de Pío XII 36, 31008 Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Calle de Irunlarrea, 3, 31008 Pamplona, Spain
| | - Álvaro González
- Service of Biochemistry, Clínica Universidad de Navarra, Av. de Pío XII 36, 31008 Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Calle de Irunlarrea, 3, 31008 Pamplona, Spain.
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Tolosa P, Sanchez-Torre A, de Cabo HB, Sánchez-Bayona R, Herrera M, Yarza R, Lema L, Manso L, Ciruelos E. Abstract PO-020: Impact of CDK 4/6i withdrawal or dose adjustment on COVID-19 incidence in HR+/HER2- mBC patients during the pandemic. Clin Cancer Res 2020. [DOI: 10.1158/1557-3265.covid-19-po-020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: On January 30th, 2020, the World Health Organization (WHO) declared public health emergencies of international concern (PHEIC) because of the outbreak of SARS-CoV2 and coronavirus disease 2019 (COVID-19). It has rapidly expanded all around the world, highlighting Madrid as one of the cities with a highest incidence. Oncologists have had to adapt treatments in order to reduce the pandemic impact. CDK4/6 inhibitors (CDK4/6i) in combination with hormone therapy are the standard of care in hormone receptor-positive (HR+), HER2-negative (HER2-) metastatic breast cancer (mBC) patients (P). Asymptomatic neutrophil count decrease is the most frequent toxicity of these agents and may negatively impact on incidence and severity of COVID-19 disease.
Methods: Hospitalized P increased exponentially from 10 to 16 March 2020 in our hospital. 78 P diagnosed with ER+/HER2- mBC were on CDK4/6i treatment at that time. At the physicians’ discretion CDK4/6i withdrawal or dose adjustment was performed (considering age, comorbidities, and presence of previous neutropenia). The presence of risk factors such as advanced age or previous neutropenia were key issues when deciding to withdraw or adjust CDK4/6i. We conducted a retrospective analysis to evaluate this decision. All P were selected, and data were collected on May 15th, 2020. The main end point was to evaluate the impact of CDK4/6i withdrawal or dose adjustment (non-exposed) on the incidence of COVID-19 defined as high clinical suspicion (including anosmia) or positive PCR; we estimate the odds ratio (OR) through logistic regression. As secondary objectives P characteristics were evaluated to identify and control potential confounding factors, we also calculate adjusted OR by multivariate analysis.
Results: A total of 78 P were evaluated, 44 P treated with palbociclib, 21 with ribociclib, and 13 with abemaciclib in combination with hormonal therapies. Incidence of COVID-19 was 7.7% (6/78 P), 12.8% (5/39) in exposed P, and 2.7% (1/39) in non-exposed P. The OR for exposed patients was 5.8 IC 95% (0.62 to 50.25) p 0,077. Age over 65 years and bone-only disease were associated with a lower COVID 19 relative risk, while diabetes mellitus was associated with a higher incidence. None of the 25 patients over age 70 were infected. In multivariate analysis the adjusted OR for exposed P was 7.68 (p 0.24). Incidence of COVID-19 was numerically higher in patients treated with ribociclib (14.29%) compared to palbociclib (4.55%) or abemaciclib (7.69%). No risk of progression disease was observed in P who had CDK 4/6i withdrawn or dose reduction (p 0.98).
Conclusions: Despite the lack of statistical significance, CDK4/6i withdrawn or dose reduction may reduce the incidence of COVID-19. Greater collection of data during COVID-19 pandemic is needed and will provide us with strong evidence to make decisions in case of new outbreaks.
Citation Format: Pablo Tolosa, Ana Sanchez-Torre, Helena Bote de Cabo, Rodrigo Sánchez-Bayona, Mercedes Herrera, Ramón Yarza, Laura Lema, Luis Manso, Eva Ciruelos. Impact of CDK 4/6i withdrawal or dose adjustment on COVID-19 incidence in HR+/HER2- mBC patients during the pandemic [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-020.
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Affiliation(s)
- Pablo Tolosa
- University Hospital 12 de Octubre, Madrid, Spain
| | | | | | | | | | - Ramón Yarza
- University Hospital 12 de Octubre, Madrid, Spain
| | - Laura Lema
- University Hospital 12 de Octubre, Madrid, Spain
| | - Luis Manso
- University Hospital 12 de Octubre, Madrid, Spain
| | - Eva Ciruelos
- University Hospital 12 de Octubre, Madrid, Spain
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Leone A, Martínez-González MÁ, Martin-Gorgojo A, Sánchez-Bayona R, De Amicis R, Bertoli S, Battezzati A, Bes-Rastrollo M. Mediterranean diet, Dietary Approaches to Stop Hypertension, and Pro-vegetarian dietary pattern in relation to the risk of basal cell carcinoma: a nested case-control study within the Seguimiento Universidad de Navarra (SUN) cohort. Am J Clin Nutr 2020; 112:364-372. [PMID: 32492135 DOI: 10.1093/ajcn/nqaa127] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 05/07/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The association of dietary pattern with the risk of basal cell carcinoma (BCC) is little understood and has scarcely been investigated. OBJECTIVES We assessed the association of several complete dietary patterns [Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and Pro-vegetarian dietary pattern] with the risk of BCC, conducting a nested case-control study (4 controls for each case). METHODS Cases and controls were selected from the SUN (Seguimiento Universidad de Navarra) cohort using risk set sampling. Cases were identified among subjects free of skin cancer at baseline but who later reported a physician-made BCC diagnosis during the follow-up period. In the cohort we identified 101 incident cases of BCC. RESULTS In multivariable-adjusted conditional logistic regression analyses, better adherence to the Mediterranean diet (highest compared with lowest quintile) was associated with a 72% relative reduction in the odds of BCC (OR: 0.28; 95% CI: 0.10, 0.77; Ptrend = 0.014); the DASH diet was associated with a 68% RR reduction (OR: 0.32; 95% CI: 0.14, 0.76; Ptrend = 0.013) for the comparison between extreme quintiles. No association was found between a Pro-vegetarian dietary pattern and BCC. Higher fruit consumption (highest compared with lowest quintile, OR: 0.27; 95% CI: 0.11, 0.64; Ptrend < 0.001) and low-fat dairy products (OR: 0.39; 95% CI: 0.16, 0.92; Ptrend = 0.014) were associated with a lower BCC risk. CONCLUSIONS Our results suggest that Mediterranean and DASH dietary patterns may be associated with a lower risk of BCC, but confirmatory studies are required.
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Affiliation(s)
- Alessandro Leone
- International Center for the Assessment of Nutritional Status, Department of Food, Environmental and Nutritional Sciences, University of Milan, Milan, Italy
| | - Miguel Á Martínez-González
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain.,Physiopathology of Obesity and Nutrition Networking Biomedical Research Centre (CIBERobn), Spanish National Institute of Health Carlos III, Madrid, Spain.,Navarra's Health Research Institute, Pamplona, Spain.,Department of Nutrition, TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Alejandro Martin-Gorgojo
- Dermatology & Venereology Department, "Madrid Salud" Regional Healthcare Agency, Madrid City Council, Madrid, Spain
| | - Rodrigo Sánchez-Bayona
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain.,Department of Medical Oncology, University of Navarra Clinic, Pamplona, Spain
| | - Ramona De Amicis
- International Center for the Assessment of Nutritional Status, Department of Food, Environmental and Nutritional Sciences, University of Milan, Milan, Italy
| | - Simona Bertoli
- International Center for the Assessment of Nutritional Status, Department of Food, Environmental and Nutritional Sciences, University of Milan, Milan, Italy.,Department of Endocrine and Metabolic Diseases, Obesity Unit and Laboratory of Nutrition and Obesity Research, IRCCS (Scientific Institute for Research, Hospitalization, and Healthcare) Italian Auxologic Institute (IAI), Milan, Italy
| | - Alberto Battezzati
- International Center for the Assessment of Nutritional Status, Department of Food, Environmental and Nutritional Sciences, University of Milan, Milan, Italy
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain.,Physiopathology of Obesity and Nutrition Networking Biomedical Research Centre (CIBERobn), Spanish National Institute of Health Carlos III, Madrid, Spain.,Navarra's Health Research Institute, Pamplona, Spain
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Romanos-Nanclares A, Toledo E, Sánchez-Bayona R, Sánchez-Quesada C, Martínez-González MÁ, Gea A. Healthful and unhealthful provegetarian food patterns and the incidence of breast cancer: Results from a Mediterranean cohort. Nutrition 2020; 79-80:110884. [PMID: 32736167 DOI: 10.1016/j.nut.2020.110884] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/06/2020] [Accepted: 05/14/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Provegetarian diets, also known as predominantly plant-based (but not vegetarian or vegan) or plant-forward diets, have been associated with health benefits. However, a distinction is needed between high- and low-quality provegetarian dietary patterns (PVGs). We sought to examine potential associations between PVG indices and breast cancer (BC) incidence. METHODS We assessed 10 812 women in the Seguimiento Universidad de Navarra cohort. We calculated an overall PVG pattern from a validated semi-quantitative food-frequency questionnaire as proposed by Martínez-Gonzalez et al, assigning positive scores (based on quintiles) to plant foods and reversing the quintile scores for animal foods. Participants were categorized according to tertiles of the overall score. We also calculated a healthful PVG (hPVG) and unhealthful PVG (uPVG) as proposed by Satija et al. RESULTS: After a median of 11.5 years of follow-up, 101 incident BC cases, confirmed by medical records, were observed. A significant inverse association with BC (comparing tertile 2 vs. tertile 1, HR= 0.55; 95% confidence interval, 0.32-0.95) was identified for a modest overall PVG, but not for hPVG and uPVG separately. Nevertheless, the highest tertile was not associated with BC. CONCLUSIONS In this large prospective cohort study, a moderate adherence to a PVG might decrease the risk of BC. Further studies should replicate and expand these results to other racial, ethnic, and socioeconomic groups.
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Affiliation(s)
- Andrea Romanos-Nanclares
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Estefanía Toledo
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain.
| | - Rodrigo Sánchez-Bayona
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Department of Oncology, University of Navarra, Clínica Universidad de Navarra, Pamplona, Spain
| | - Cristina Sánchez-Quesada
- Department of Health Sciences, Faculty of Experimental Sciences, University of Jaen, Jaen, Spain
| | - Miguel Ángel Martínez-González
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Alfredo Gea
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain
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Sánchez-Bayona R, Gea A, Gardeazabal I, Romanos-Nanclares A, Martínez-González MÁ, Bes-Rastrollo M, Santisteban M, Toledo E. Binge Drinking and Risk of Breast Cancer: Results from the SUN ('Seguimiento Universidad de Navarra') Project. Nutrients 2020; 12:nu12030731. [PMID: 32164388 PMCID: PMC7146187 DOI: 10.3390/nu12030731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/08/2020] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 01/26/2023] Open
Abstract
Alcohol intake is associated with the risk of breast cancer. Different patterns of alcohol-drinking may have different effects on breast cancer even when keeping constant the total amount of alcohol consumed. We aimed to assess the association between binge drinking and breast cancer risk. The SUN Project is a Spanish dynamic prospective cohort of university graduates initiated in 1999. In the 556-item lifestyle baseline questionnaire a validated food-frequency questionnaire was embedded. Participants completed biennial follow-up questionnaires. Cox regression models were used to estimate the hazard ratio (HR) for breast cancer associated with the exposure to binge drinking. A stratified analysis was performed according to menopausal status. We included 9577 women (mean age = 34 years, SD = 10 years), with a median follow-up of 11.8 years. Among 104,932 women-years of follow-up, we confirmed 88 incident cases of breast cancer. Women in the binge drinking group showed a higher risk of breast cancer (HR = 1.76; 95% CI: 1.03–2.99) compared to women in the non-binge drinking category. In the stratified analysis, a 2-fold higher risk for premenopausal breast cancer was associated with binge drinking habit (HR = 2.06; 95% CI: 1.11–3.82). This study adds new evidence on the association of binge drinking with breast cancer risk.
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Affiliation(s)
- Rodrigo Sánchez-Bayona
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain; (R.S.-B.); (I.G.); (A.R.-N.); (M.Á.M.-G.); (M.B.-R.); (E.T.)
- Department of Clinical Oncology, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
| | - Alfredo Gea
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain; (R.S.-B.); (I.G.); (A.R.-N.); (M.Á.M.-G.); (M.B.-R.); (E.T.)
- Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), 28029 Madrid, Spain
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- Correspondence: ; Tel.: +34-948-425-600 (ext. 806637)
| | - Itziar Gardeazabal
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain; (R.S.-B.); (I.G.); (A.R.-N.); (M.Á.M.-G.); (M.B.-R.); (E.T.)
- Department of Clinical Oncology, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
| | - Andrea Romanos-Nanclares
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain; (R.S.-B.); (I.G.); (A.R.-N.); (M.Á.M.-G.); (M.B.-R.); (E.T.)
| | - Miguel Ángel Martínez-González
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain; (R.S.-B.); (I.G.); (A.R.-N.); (M.Á.M.-G.); (M.B.-R.); (E.T.)
- Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), 28029 Madrid, Spain
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain; (R.S.-B.); (I.G.); (A.R.-N.); (M.Á.M.-G.); (M.B.-R.); (E.T.)
- Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), 28029 Madrid, Spain
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - Marta Santisteban
- Department of Clinical Oncology, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - Estefanía Toledo
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain; (R.S.-B.); (I.G.); (A.R.-N.); (M.Á.M.-G.); (M.B.-R.); (E.T.)
- Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), 28029 Madrid, Spain
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
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Sánchez-Bayona R, Gardeazabal I, Fernandez-Lazaro CI, Martinez-Gonzalez MA, Romanos-Nanclares A, Alvarez-Alvarez I, Gea A, Santisteban M, Toledo E. Abstract P5-08-04: Physical activity, sedentary behaviour, and risk of breast cancer: Results from the SUN (‘Seguimiento Universidad de Navarra’) project. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p5-08-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Breast cancer is the leading type of cancer in women worldwide. Some factors, like leisure-time physical activity (LTPA), have been inversely associated with the risk of breast cancer. Nevertheless, evidence on the influence of sedentary lifestyles, LTPA, and their combined exposure on breast cancer risk is still limited. We aimed to assess sedentary behavior and recreational PA in relation to subsequent risk of breast cancer in a Mediterranean cohort.
METHODS: The SUN Project is a Spanish dynamic prospective cohort of university graduates initiated in 1999. The baseline assessment included a validated questionnaire on LTPA and sedentary habits. Participants completed biennial follow-up questionnaires, which inquired about medical diagnosis of breast cancer. Self-reported information was confirmed with medical reports; self-reported cases pending confirmation were added to confirmed cases and together they were labeled as "probable cases". For our analyses, we included 10,812 women, with a median follow-up of 11.8 years. Multivariable Cox regression models were used to estimate the hazard ratio (HR) for breast cancer according to 3 categories of weekly METs-hours of LTPA (low: 0-6, medium: 6.1-16.5, high >16.5), h/d of TV watching (<1h, 1-2 h, >2 h) and an 8-item PA Score (low:<2, medium-low:2-3, medium-high:4-5, high:6-8). We first fitted models for overall breast cancer incidence and then separate analyses according to menopausal status at diagnosis.
RESULTS: Mean baseline age of our participants was 34.7 years (SD: 10.6 years). Among 115,802 women-years of follow-up, we identified 190 probable incident cases of breast cancer, out of which we confirmed 101. In multivariable-adjusted analyses, women in the highest category of LTPA showed a significantly lower risk of breast cancer (HR=0.55; 95% CI: 0.34-0.89) compared to women in the lowest category. Women watching >2 h/d of TV had a significantly higher risk of breast cancer (HR=1.71; 95% CI:1.05-2.78) compared to women who watched <1h/d of TV. Women in the highest category of the PA Score (6-8 points) showed a significant decrease in breast cancer risk compared to the lowest PA Score (<2 points) group (HR=0.34; 95% CI: 0.15-0.79). Results were consistent when we considered probable breast cancer cases.
CONCLUSION: In this Mediterranean cohort, women in the highest leisure-time PA categories showed a significant decrease in breast cancer risk. More than 2 h/day of TV watching was associated with a higher risk of breast cancer development. The harmful effect of TV watching persisted despite the practice of >6 MET-h/week of PA.
Hazard ratio (HR) and 95% confidence interval (95% CI) of breast cancer according to levels of LTPA.MET-h/week categoriesLow (0-6)Medium (6.1-16.5)High (>16.5)Cases/ Women-years31/2359032/3963238/52580Multivar. adjusted1 (ref)0.61 (0.37 - 1.00)0.55 (0.34 - 0.89)Hours/day of TV watching< 1 hour1-2 hours>2 hoursCases/ Women-years30/3546930/4484241/35491Multivar. adjusted1 (ref)0.92 (0.55 - 1.54)1.71 (1.05 - 2.78)Joint classificationMET>6MET>6MET<6MET<6TV<2hTV>2hTV<2hTV>2hCases/ Women-years42/6471728/2749518/1559413/7996Multivar. adjusted1 (ref)1.77 (1.09 - 2.88)1.73 (0.99 - 3.03)3.05(1.61 - 5.77)Physical Activity ScoreLow (<2)Medium-Low (2-3)Medium-High (4-5)High (6-8)Cases/ Women-years17/1276637/4542538/426249/14986Multivar. adjusted1 (ref)0.58 (0.32 - 1.03)0.59 (0.33 - 1.06)0.34 (0.15 - 0.79)
Citation Format: Rodrigo Sánchez-Bayona, Itziar Gardeazabal, Cesar Ignacio Fernandez-Lazaro, Miguel Angel Martinez-Gonzalez, Andrea Romanos-Nanclares, Ismael Alvarez-Alvarez, Alfredo Gea, Marta Santisteban, Estefanía Toledo. Physical activity, sedentary behaviour, and risk of breast cancer: Results from the SUN (‘Seguimiento Universidad de Navarra’) project [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-08-04.
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Eslava M, Sánchez-Bayona R, Garcia del Barrio M, Alegre E, Fernandez-Hidalgo O. Trastuzumab and thyroid dysfunction: An association to be aware of. J Cancer Res Ther 2020; 18:1183-1185. [DOI: 10.4103/jcrt.jcrt_66_19] [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: 11/04/2022]
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Alvarez-Mon MA, Llavero-Valero M, Sánchez-Bayona R, Pereira-Sanchez V, Vallejo-Valdivielso M, Monserrat J, Lahera G, Asunsolo Del Barco A, Alvarez-Mon M. Areas of Interest and Stigmatic Attitudes of the General Public in Five Relevant Medical Conditions: Thematic and Quantitative Analysis Using Twitter. J Med Internet Res 2019; 21:e14110. [PMID: 31140438 PMCID: PMC6658306 DOI: 10.2196/14110] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Twitter is an indicator of real-world performance, thus, is an appropriate arena to assess the social consideration and attitudes toward psychosis. OBJECTIVE The aim of this study was to perform a mixed-methods study of the content and key metrics of tweets referring to psychosis in comparison with tweets referring to control diseases (breast cancer, diabetes, Alzheimer, and human immunodeficiency virus). METHODS Each tweet's content was rated as nonmedical (NM: testimonies, health care products, solidarity or awareness and misuse) or medical (M: included a reference to the illness's diagnosis, treatment, prognosis, or prevention). NM tweets were classified as positive or pejorative. We assessed the appropriateness of the medical content. The number of retweets generated and the potential reach and impact of the hashtags analyzed was also investigated. RESULTS We analyzed a total of 15,443 tweets: 8055 classified as NM and 7287 as M. Psychosis-related tweets (PRT) had a significantly higher frequency of misuse 33.3% (212/636) vs 1.15% (853/7419; P<.001) and pejorative content 36.2% (231/636) vs 11.33% (840/7419; P<.001). The medical content of the PRT showed the highest scientific appropriateness 100% (391/391) vs 93.66% (6030/6439; P<.001) and had a higher frequency of content about disease prevention. The potential reach and impact of the tweets related to psychosis were low, but they had a high retweet-to-tweet ratio. CONCLUSIONS We show a reduced number and a different pattern of contents in tweets about psychosis compared with control diseases. PRT showed a predominance of nonmedical content with increased frequencies of misuse and pejorative tone. However, the medical content of PRT showed high scientific appropriateness aimed toward prevention.
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Affiliation(s)
| | - María Llavero-Valero
- Department of Endocrinology and Nutrition, Clinica Universidad de Navarra, Pamplona, Spain
| | | | | | | | - Jorge Monserrat
- Department of Medicine and Medical specialities, University of Alcala, Madrid, Spain
| | - Guillermo Lahera
- Department of Medicine and Medical specialities, University of Alcala, Madrid, Spain
- Instituto Ramon y Cajal de Investigaciones Sanitarias, Madrid, Spain
- Center for Biomedical Research in the Mental Health Network, Madrid, Spain
| | - Angel Asunsolo Del Barco
- Instituto Ramon y Cajal de Investigaciones Sanitarias, Madrid, Spain
- Department of Surgery, Medical and Social Sciences, University of Alcala, Madrid, Spain
- Department of Epidemiology & Biostatistics. Graduate School of Public Health and Health Policy, University of New York, New York, NY, United States
| | - Melchor Alvarez-Mon
- Instituto Ramon y Cajal de Investigaciones Sanitarias, Madrid, Spain
- Department of Medicine and Medical Specialities, University of Alcala, Madrid, Spain
- Service of Internal Medicine, Autoimmune Diseases and Rheumatology, Hospital Universitario Principe de Asturias, Alcala de Henares, Spain
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Gardeazabal I, Ruiz-Canela M, Sánchez-Bayona R, Romanos-Nanclares A, Aramendía-Beitia JM, Shivappa N, Hébert JR, Martínez-González MA, Toledo E. Dietary inflammatory index and incidence of breast cancer in the SUN project. Clin Nutr 2018; 38:2259-2268. [PMID: 30344023 DOI: 10.1016/j.clnu.2018.09.030] [Citation(s) in RCA: 11] [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: 05/29/2018] [Revised: 09/05/2018] [Accepted: 09/25/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND & AIMS Breast cancer (BC) is the most commonly diagnosed cancer, and diet is suspected to play a role in its development. Dietary factors may mediate this process through modulation of inflammation, though findings from previous studies have not been consistent. We aimed to longitudinally assess the association between the dietary inflammatory index (DII®), a frequently used method to assess the inflammatory potential of the diet, and incident BC. METHODS We included 10,713 middle-aged, Spanish female university graduates from the SUN cohort. DII® scores were derived from a validated 136-item food-frequency questionnaire, and it was based on scientific evidence on the relationship between diet and inflammatory biomarkers. Diagnosis of BC was reported by the participant or, if deceased, by the next of kin or identified from death certificates. Self-reports of BC were confirmed by revision of medical reports by an experienced oncologist. Cox proportional hazard models were used to estimate multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the association between quartiles of DII® and incident BC. RESULTS After 10.3 years of median follow-up, we identified 100 confirmed and 168 probable incident BC cases. The multivariable-adjusted HR for participants in the 4th quartile to the 1st quartile was 1.44 (95% CI 0.76-2.72; p-trend: 0.339) when confirmed cases were analyzed, and 1.20 (95% CI 0.72-1.99; p-trend: 0.757) for the probable cases. We neither observed statistically significant differences in regard to menopausal status. CONCLUSIONS The apparent increase in risk between DII® scores and BC in our cohort was not statistically significant, which could be partly explained by the small number of observed cases.
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Affiliation(s)
- I Gardeazabal
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Department of Oncology, University of Navarra Clinic, Pamplona, Spain
| | - M Ruiz-Canela
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Centro de Investigación Biomédica en Red Área de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
| | - R Sánchez-Bayona
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Department of Oncology, University of Navarra Clinic, Pamplona, Spain
| | - A Romanos-Nanclares
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
| | | | - N Shivappa
- Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; Connecting Health Innovations LLC, Columbia, SC 29201, USA
| | - J R Hébert
- Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; Connecting Health Innovations LLC, Columbia, SC 29201, USA
| | - M A Martínez-González
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Centro de Investigación Biomédica en Red Área de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
| | - E Toledo
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Centro de Investigación Biomédica en Red Área de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
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Carmona-Bayonas A, Jiménez-Fonseca P, Castañón E, Ramchandani-Vaswani A, Sánchez-Bayona R, Custodio A, Calvo-Temprano D, Virizuela JA. Chronic opioid therapy in long-term cancer survivors. Clin Transl Oncol 2016; 19:236-250. [PMID: 27443415 DOI: 10.1007/s12094-016-1529-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/27/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE Long-term cancer survivors develop special health issues and specific needs. Chronic pain, whether the consequence of their cancer or as a side effect of treatment, is one of their most prevalent concerns. METHODS We conducted a review of the English-language literature on long-term cancer survivorship and chronic opioid therapy, with the objective of determining the efficacy, safety and tolerability in this group of patients. Practical management recommendations are made on the basis of this review. RESULTS Pain syndromes encountered in the long-term cancer survivors are diverse. Opioid receptor pathways possess complex and pleiotropic functions and continuous over-activation may lead to de novo endocrinopathies, immunosuppression, neurocognitive impairment, or cell cycle disturbances with potential clinical connotations. However, there are insufficient data to support evidence-based decision making with respect to patient selection, doses, administration, monitoring and follow-up. Data about long-term treatment effectiveness and safety are limited and often aggravated by the overlapping of several diseases prevalent among long-term cancer survivors, as well as chronic opiate-induced toxicity. CONCLUSIONS Chronic opioid therapy is frequent in long-term cancer survivors, and may negatively affect the immune system, and produce health problems such as endocrinopathies, osteoporosis, neurological or cardiopulmonary effects, alterations of cell cycle kinetics, abuse and addiction. This review highlights the need for specialized teams to treat chronic pain in long-term cancer survivors from an integrative perspective.
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Affiliation(s)
- A Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria (IMIB), Avenue Marqués de los Vélez, s/n, 30008, Murcia, Spain.
| | - P Jiménez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, Avenida de Roma, s/n, 33011, Oviedo, Principado de Asturias, Spain
| | - E Castañón
- Medical Oncology Department, Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), Avenida Pío XII, 36, Pamplona, Spain
| | - A Ramchandani-Vaswani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Avenida Marítima del Sur, s/n, 35016, Las Palmas de Gran Canaria, Spain
| | - R Sánchez-Bayona
- Medical Oncology Department, Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), Avenida Pío XII, 36, Pamplona, Spain
| | - A Custodio
- Medical Oncology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, Madrid, Spain
| | - D Calvo-Temprano
- Radiology Department, Hospital Universitario Central de Asturias, Avenida de Roma, s/n, 33011, Oviedo, Principado de Asturias, Spain
| | - J A Virizuela
- Medical Oncology Department, Hospital Virgen de la Macarena, Avd. Doctor Fedriani, 3, 41071, Seville, Spain
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Di Scala M, Gil-Fariña I, Vanrell L, Sánchez-Bayona R, Alignani D, Olagüe C, Vales A, Berraondo P, Prieto J, González-Aseguinolaza G. Chronic exposure to IFNα drives medullar lymphopoiesis towards T-cell differentiation in mice. Haematologica 2015; 100:1014-22. [PMID: 25715405 DOI: 10.3324/haematol.2014.115410] [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: 08/08/2014] [Accepted: 02/12/2015] [Indexed: 12/23/2022] Open
Abstract
Interferon-α is a potent antiviral agent and a vigorous adjuvant in the induction of T-cell responses but its use is limited by hematologic toxicity. Interferon-α alters hematopoietic stem cell dormancy and impairs myelocytic and erythrocytic/megakaryocytic differentiation from hematopoietic progenitors. However, the effect of chronic interferon-α exposure on hematopoietic precursors has still not been well characterized. Here, we transduced the liver of mice with an adenoassociated vector encoding interferon-α to achieve sustained high serum levels of the cytokine. The bone marrow of these animals showed diminished long-term and short-term hematopoietic stem cells, reduction of multipotent progenitor cells, and marked decrease of B cells, but significant increase in the proportion of CD8(+) and CD4(+)CD8(+) T cells. Upon adoptive transfer to RAG(-/-) mice, bone marrow cells from interferon-α-treated animals generated CD4(+) and CD8(+) T cells while CD19(+), CD11b(+) and NK1.1(+) lineages failed to develop. These effects are associated with the transcriptional downregulation of transcription factors involved in B-cell differentiation and modulation of key factors for T-cell development. Thus, sustained interferon-α exposure causes hematopoietic stem cells exhaustion and drives common lymphoid progenitors towards T-cell generation.
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Affiliation(s)
- Marianna Di Scala
- Division of Hepatology and Gene Therapy, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
| | - Irene Gil-Fariña
- Division of Hepatology and Gene Therapy, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
| | - Lucia Vanrell
- Division of Hepatology and Gene Therapy, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
| | - Rodrigo Sánchez-Bayona
- Division of Hepatology and Gene Therapy, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
| | - Diego Alignani
- Department of Instrumental Techniques-Cytometry Unit, Center for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Cristina Olagüe
- Division of Hepatology and Gene Therapy, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
| | - Africa Vales
- Division of Hepatology and Gene Therapy, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
| | - Pedro Berraondo
- Division of Hepatology and Gene Therapy, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
| | - Jesús Prieto
- Division of Hepatology and Gene Therapy, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain University Clinic of Navarra, University of Navarra, Pamplona, Spain CIBERehd, University of Navarra, Pamplona, Spain
| | - Gloria González-Aseguinolaza
- Division of Hepatology and Gene Therapy, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
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