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Lopez-Tarruella S, Del Monte-Millán M, Roche-Molina M, Jerez Y, Echavarria Diaz-Guardamino I, Herrero López B, Gamez Casado S, Marquez-Rodas I, Alvarez E, Cebollero M, Massarrah T, Ocaña I, Arias A, García-Sáenz JÁ, Moreno Anton F, Olier Garate C, Moreno Muñoz D, Marrupe D, Lara Álvarez MÁ, Enrech S, Bueno Muiño C, Martín M. Correlation between breast cancer subtypes determined by immunohistochemistry and n-COUNTER PAM50 assay: a real-world study. Breast Cancer Res Treat 2024; 203:163-172. [PMID: 37773555 PMCID: PMC10771357 DOI: 10.1007/s10549-023-07094-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 08/13/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE Molecular subtyping based on gene expression profiling (i.e., PAM50 assay) aids in determining the prognosis and treatment of breast cancer (BC), particularly in hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative tumors, where luminal A and B subtypes have different prognoses and treatments. Several surrogate classifications have been proposed for distinguishing between the luminal A and B subtypes. This study determines the accuracy of local immunohistochemistry (IHC) techniques for classifying HR-positive/HER2-negative (HR+/HER2-) tumors according to intrinsic subtypes using the nCOUNTER PAM50 assay as reference and the HR status definition according the ASCO/CAP recommendations. METHODS Molecular subtypes resulting from nCOUNTER PAM50 performed in our laboratory between 2014 and 2020 were correlated with three different proxy surrogates proposed in the literature based on ER, PR, HER2, and Ki67 expression with different cut-off values. Concordance was measured using the level of agreement and kappa statistics. RESULTS From 1049 samples with the nCOUNTER test, 679 and 350 were luminal A and B subtypes, respectively. Only a poor-to-fair correlation was observed between the three proxy surrogates and real genomic subtypes as determined by nCOUNTER PAM50. Moreover, 5-11% and 18-36% of the nCOUNTER PAM50 luminal B and A tumors were classified as luminal A and B, respectively, by these surrogates. CONCLUSION The concordance between luminal subtypes determined by three different IHC-based classifiers and the nCOUNTER PAM50 assay was suboptimal. Thus, a significant proportion of luminal A and B tumors as determined by the surrogate classifiers could be undertreated or over-treated.
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Affiliation(s)
- Sara Lopez-Tarruella
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), CIBERONC, Geicam, Universidad Complutense, 28007, Madrid, Spain
| | - María Del Monte-Millán
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CiberOnc, Madrid, Spain
| | - Marta Roche-Molina
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Yolanda Jerez
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CiberOnc, Madrid, Spain
| | - Isabel Echavarria Diaz-Guardamino
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CiberOnc, Madrid, Spain
| | - Blanca Herrero López
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Salvador Gamez Casado
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Iván Marquez-Rodas
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CiberOnc, Madrid, Spain
| | - Enrique Alvarez
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - María Cebollero
- Pathology Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Tatiana Massarrah
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CiberOnc, Madrid, Spain
| | - Inmaculada Ocaña
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Ainhoa Arias
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - José Ángel García-Sáenz
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - Fernando Moreno Anton
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - Clara Olier Garate
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Alcorcon, Spain
| | - Diana Moreno Muñoz
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Alcorcon, Spain
| | - David Marrupe
- Department of Oncologia, Hospital Universitario de Móstoles, Mostoles, Spain
| | - Miguel Ángel Lara Álvarez
- Medical Oncology Department, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid, Spain
| | - Santos Enrech
- Medical Oncology Department, Hospital Universitario de Getafe, Madrid, Spain
| | - Coralia Bueno Muiño
- Medical Oncology Department, Hospital Infanta Cristina (Parla), Fundación de Investigación Biomédica del H.U. Puerta de Hierro, Majadahonda, 28009, Madrid, Spain
| | - Miguel Martín
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), CIBERONC, Geicam, Universidad Complutense, 28007, Madrid, Spain.
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Bueno-Muiño C, Echavarría I, López-Tarruella S, Roche-Molina M, del Monte-Millán M, Massarrah T, Jerez Y, Ayala de la Peña F, García-Sáenz JÁ, Moreno F, Rodríguez-Lescure Á, Malón-Giménez D, Ballesteros García AI, Marín-Aguilera M, Galván P, Brasó-Maristany F, Waks AG, Tolaney SM, Mittendorf EA, Vivancos A, Villagrasa P, Parker JS, Perou CM, Paré L, Villacampa G, Prat A, Martín M. Assessment of a Genomic Assay in Patients With ERBB2-Positive Breast Cancer Following Neoadjuvant Trastuzumab-Based Chemotherapy With or Without Pertuzumab. JAMA Oncol 2023; 9:841-846. [PMID: 37103916 PMCID: PMC10141274 DOI: 10.1001/jamaoncol.2023.0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/22/2022] [Indexed: 04/28/2023]
Abstract
Importance Biomarkers to guide the use of pertuzumab in the treatment of early-stage ERBB2 (formerly HER2)-positive breast cancer beyond simple ERBB2 status are needed. Objective To determine if use of the HER2DX genomic assay (Reveal Genomics) in pretreatment baseline tissue samples of patients with ERBB2-positive breast cancer is associated with response to neoadjuvant trastuzumab-based chemotherapy with or without pertuzumab. Design, Setting, and Participants This is a retrospective diagnostic/prognostic analysis of a multicenter academic observational study in Spain performed during 2018 to 2022 (GOM-HGUGM-2018-05). In addition, a combined analysis with 2 previously reported trials of neoadjuvant cohorts with results from the assay (DAPHNe and I-SPY2) was performed. All patients had stage I to III ERBB2-positive breast cancer, signed informed consent, and had available formalin-fixed paraffin-embedded tumor specimens obtained prior to starting therapy. Exposures Patients received intravenous trastuzumab, 8 mg/kg, loading dose, followed by 6 mg/kg every 3 weeks in combination with intravenous docetaxel, 75 mg/m2, every 3 weeks and intravenous carboplatin area under the curve of 6 every 3 weeks for 6 cycles, or this regimen plus intravenous pertuzumab, 840 mg, loading dose, followed by an intravenous 420-mg dose every 3 weeks for 6 cycles. Main Outcome and Measures Association of baseline assay-reported pathologic complete response (pCR) score with pCR in the breast and axilla, as well as association of baseline assay-reported pCR score with response to pertuzumab. Results The assay was evaluated in 155 patients with ERBB2-positive breast cancer (mean [range] age, 50.3 [26-78] years). Clinical T1 to T2 and node-positive disease was present in 113 (72.9%) and 99 (63.9%) patients, respectively, and 105 (67.7%) tumors were hormone receptor positive. The overall pCR rate was 57.4% (95% CI, 49.2%-65.2%). The proportion of patients in the assay-reported pCR-low, pCR-medium, and pCR-high groups was 53 (34.2%), 54 (34.8%), and 48 (31.0%), respectively. In the multivariable analysis, the assay-reported pCR score (as a continuous variable from 0-100) showed a statistically significant association with pCR (odds ratio [OR] per 10-unit increase, 1.43; 95% CI, 1.22-1.70; P < .001). The pCR rates in the assay-reported pCR-high and pCR-low groups were 75.0% and 28.3%, respectively (OR, 7.85; 95% CI, 2.67-24.91; P < .001). In the combined analysis (n = 282), an increase in pCR rate due to pertuzumab was found in the assay-reported pCR-high tumors (OR, 5.36; 95% CI, 1.89-15.20; P < .001) but not in the assay-reported pCR-low tumors (OR, 0.86; 95% CI, 0.30-2.46; P = .77). A statistically significant interaction between the assay-reported pCR score and the effect of pertuzumab in pCR was observed. Conclusions and Relevance This diagnostic/prognostic study demonstrated that the genomic assay predicted pCR following neoadjuvant trastuzumab-based chemotherapy with or without pertuzumab. This assay could guide therapeutic decisions regarding the use of neoadjuvant pertuzumab.
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Affiliation(s)
- Coralia Bueno-Muiño
- Medical Oncology Department, Hospital Infanta Cristina (Parla), Fundación de Investigación Biomédica del H.U. Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Isabel Echavarría
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - Sara López-Tarruella
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Geicam, Universidad Complutense, Madrid, Spain
| | - Marta Roche-Molina
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - María del Monte-Millán
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - Tatiana Massarrah
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - Yolanda Jerez
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | | | - José Ángel García-Sáenz
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, CIBERONC, Madrid, Spain
| | - Fernando Moreno
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, CIBERONC, Madrid, Spain
| | | | | | | | | | - Patricia Galván
- Translational Genomics and Targeted Therapies in Solid Tumors, Department of Medical Oncology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Fara Brasó-Maristany
- Translational Genomics and Targeted Therapies in Solid Tumors, Department of Medical Oncology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Adrienne G. Waks
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Sara M. Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Elizabeth A. Mittendorf
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Ana Vivancos
- Cancer Genomics Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | | | - Joel. S. Parker
- Department of Genetics, Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill
| | - Charles M. Perou
- Department of Genetics, Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill
| | | | | | - Aleix Prat
- Reveal Genomics, Barcelona, Spain
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
- Department of Medical Oncology, Hospital Clinic of Barcelona, Spain
- Institute of Oncology-Quirón, Barcelona, Spain
| | - Miguel Martín
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Geicam, Universidad Complutense, Madrid, Spain
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Echavarria Diaz-Guardamino I, Lopez-Tarruella Cobo S, Del Monte-Millan M, Alvarez E, Jerez Y, Moreno Anton F, García Saenz J, Massarrah T, Ocaña I, Cebollero M, Ballesteros Garcia A, Bohn Sarmiento U, Gomez H, Fuentes H, Herrero Lopez B, Gamez Casado S, Bueno O, Jiménez-Santos M, Roche-Molina M, Martin Jimenez M. 141MO Pathological response and early survival data according to TNBCtype4 classifier in operable triple-negative breast cancer (TNBC) treated with neoadjuvant carboplatin and docetaxel. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.176] [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: 11/26/2022] Open
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Martín M, Del Monte-Millán M, Jerez Y, Echavarria Diaz-Guardamino I, Herrero Lopez B, Gamez Casado S, Roche-Molina M, Marquez-Rodas I, Cebollero M, Alvarez E, Massarrah T, Ocaña I, Arias A, García Saenz J, Moreno Anton F, Olier Garate C, Moreno Muñoz D, Marrupe Gonzalez D, Merina T, Lopez-Tarruella Cobo S. 85P Correlation between nCOUNTER PAM-50 assay and three IHC-based surrogate intrinsic breast cancer subtype classifiers: A real-world study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.100] [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: 11/28/2022] Open
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García-Sáenz JÁ, Martínez-Jáñez N, Cubedo R, Jerez Y, Lahuerta A, González-Santiago S, Ferrer N, Ramos M, Alonso-Romero JL, Antón A, Carrasco E, Chen J, Neuwirth R, Galinsky K, Vincent S, Leonard EJ, Slamon D. Sapanisertib plus Fulvestrant in Postmenopausal Women with Estrogen Receptor-Positive/HER2-Negative Advanced Breast Cancer after Progression on Aromatase Inhibitor. Clin Cancer Res 2022; 28:1107-1116. [PMID: 34980598 PMCID: PMC9365359 DOI: 10.1158/1078-0432.ccr-21-2652] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/04/2021] [Accepted: 12/27/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE This phase II study investigated daily or weekly sapanisertib (a selective dual inhibitor of mTOR complexes 1 and 2) in combination with fulvestrant. PATIENTS AND METHODS Postmenopausal women with estrogen receptor-positive (ER+)/HER2-negative (HER2-) advanced or metastatic breast cancer following progression during/after aromatase inhibitor treatment were randomized to receive fulvestrant 500 mg (28-day treatment cycles), fulvestrant plus sapanisertib 4 mg daily, or fulvestrant plus sapanisertib 30 mg weekly, until progressive disease, unacceptable toxicity, consent withdrawal, or study completion. RESULTS Among 141 enrolled patients, baseline characteristics were balanced among treatment arms, including prior cyclin-dependent kinase-4/6 (CDK4/6) inhibitor treatment in 33% to 35% of patients. Median progression-free survival (PFS; primary endpoint) was 3.5 months in the single-agent fulvestrant arm, compared with 7.2 months for fulvestrant plus sapanisertib daily [HR, 0.77; 95% confidence interval (CI), 0.47-1.26] and 5.6 months for fulvestrant plus sapanisertib weekly (HR, 0.88; 95% CI, 0.53-1.45). The greatest PFS benefits were seen in patients who had previously received CDK4/6 inhibitors. The most common adverse events were nausea, vomiting, and hyperglycemia, all occurring more frequently in the combination therapy arms. Treatment discontinuation due to adverse events occurred more frequently in the two combination therapy arms than with single-agent fulvestrant (32% and 36% vs. 4%, respectively). CONCLUSIONS Fulvestrant plus sapanisertib daily/weekly resulted in numerically longer PFS in patients with ER+/HER2- advanced or metastatic breast cancer, compared with single-agent fulvestrant. The combination was associated with increased toxicity. Further development of sapanisertib using these dosing schedules in this setting is not supported by these data.
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Affiliation(s)
- José Á. García-Sáenz
- Medical Oncology, Hospital Clínico Universitario San Carlos, Madrid, Spain.,Centro de Investigación Biomédica en Red CIBERONC-ISCIII, Madrid, Spain.,GEICAM Spanish Breast Cancer Group, Madrid, Spain.,Corresponding Author: José Á. García-Sáenz, Medical Oncology, Hospital Clínico Universitario San Carlos, Calle del Prof Martín Lagos, Madrid 28040, Spain. Phone: 349-1330-3000, ext. 7768; E-mail:
| | - Noelia Martínez-Jáñez
- GEICAM Spanish Breast Cancer Group, Madrid, Spain.,Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ricardo Cubedo
- GEICAM Spanish Breast Cancer Group, Madrid, Spain.,Medical Oncology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Yolanda Jerez
- Centro de Investigación Biomédica en Red CIBERONC-ISCIII, Madrid, Spain.,GEICAM Spanish Breast Cancer Group, Madrid, Spain.,Medical Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Fundación de Investigación Biomédica, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Ainhara Lahuerta
- GEICAM Spanish Breast Cancer Group, Madrid, Spain.,Medical Oncology, Onkologikoa, Gipuzkoa, Spain
| | - Santiago González-Santiago
- GEICAM Spanish Breast Cancer Group, Madrid, Spain.,Medical Oncology, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain
| | - Nieves Ferrer
- GEICAM Spanish Breast Cancer Group, Madrid, Spain.,Medical Oncology, Hospital Universitari Son Espases, Palma, Spain
| | - Manuel Ramos
- GEICAM Spanish Breast Cancer Group, Madrid, Spain.,Medical Oncology, Centro Oncológico de Galicia, A Coruña, Spain
| | - Jose L. Alonso-Romero
- GEICAM Spanish Breast Cancer Group, Madrid, Spain.,Medical Oncology, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | - Antonio Antón
- GEICAM Spanish Breast Cancer Group, Madrid, Spain.,Medical Oncology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Eva Carrasco
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | - Jingjing Chen
- Takeda Development Center Americas, Inc. (TDCA), Lexington, Massachusetts
| | - Rachel Neuwirth
- Takeda Development Center Americas, Inc. (TDCA), Lexington, Massachusetts
| | - Kevin Galinsky
- Takeda Development Center Americas, Inc. (TDCA), Lexington, Massachusetts
| | - Sylvie Vincent
- Takeda Development Center Americas, Inc. (TDCA), Lexington, Massachusetts
| | - E. Jane Leonard
- Takeda Development Center Americas, Inc. (TDCA), Lexington, Massachusetts
| | - Dennis Slamon
- Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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Lopez-Tarruella S, Echavarria I, Jerez Y, Herrero B, Gamez S, Martin M. How we treat HR-positive, HER2-negative early breast cancer. Future Oncol 2022; 18:1003-1022. [PMID: 35094535 DOI: 10.2217/fon-2021-0668] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The present goal of therapy for early hormone receptor-positive (HR+)/human EGF receptor 2-negative (HER2-) BC is to optimize disease-free survival (DFS) and overall survival (OS) rates with the currently available therapies while avoiding any relevant long-term sequalae. Local therapies have evolved toward less aggressive techniques (i.e. breast-preserving surgery, sentinel lymph node biopsy and intraoperative radiotherapy), which significantly reduce the long-term sequalae observed with more radical treatments. Endocrine therapy (ET) is still the cornerstone of adjuvant treatment because it significantly reduces BC relapse and mortality. Adjuvant chemotherapy is today recommended only for a particular subset of patients with a high risk of recurrence with ET alone, identified through genomic assays, age and/or disease stage. Bisphosphonates reduce the risk of bone metastasis and produce a slight although statistically significant improvement in survival in postmenopausal women. The CDK 4/6 inhibitor abemaciclib has been recently approved by the US FDA for patients at high risk of relapse.
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Affiliation(s)
- Sara Lopez-Tarruella
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, CiberOnc, GEICAM, Madrid, 28007, Spain
| | - Isabel Echavarria
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, 28007, Spain
| | - Yolanda Jerez
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, CiberOnc, GEICAM, Madrid, 28007, Spain
| | - Blanca Herrero
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, 28007, Spain
| | - Salvador Gamez
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, 28007, Spain
| | - Miguel Martin
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, CiberOnc, GEICAM, Madrid, 28007, Spain
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López-Tarruella S, del Monte-Millán M, Alvarez E, Jerez Y, Saenz JÁG, Echavarria I, Moreno F, Márquez-Rodas I, Bueno-Muiño C, Herrero B, Cebollero M, Ramos-Medina R, Lobato N, González del Val R, Palomero MI, Lizarraga S, Bohn U, Ballesteros AI, Rincón P, Massarrah T, Ocaña I, Villarejo L, Perou CM, Martin M. Abstract PS4-12: Potential value of FOXA1 expression as genomic predictor of response to docetaxel and carboplatin neoadjuvant (NA) chemotherapy in patients with triple negative breast cancer (TNBC). Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps4-12] [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: TNBC is a particularly aggressive subtype with high recurrence rates and poor long-term survival. Anthracycline-free regimens based on docetaxel plus carboplatin (TCb) achieve around 50-55% pathologic complete responses (pCR) which correlates with better survival outcomes. Identification of genomic predictors of response is key to individualize therapies for this heterogeneous breast cancer (BC) subgroup. FOXA1 is a pioneer factor for androgen (AR) and estrogen receptors (ER). Its under-expression has been linked to cancer stemness in TNBC and better prognosis in ER-positive BC. The differential expression of AR, FOXA1 and BRCA1 is associated with sensitivity to chemotherapy in TNBC patients. Data support the plasticity role of FOXA1 driving basal to luminal BC cells by inducing luminal genes but also by repressing the basal phenotype and thus, tumor aggressiveness, although its role as a biomarker in TNBC is still controversial. We have analyzed RNAseq data of FOXA1 and AR in a series of TNBC tumors homogenously treated with neoadjuvant TCb to study their correlation with survival and response. Methodology: 300 TNBC patients have been included in a multicenter, prospective, non-randomized trial aimed to identify predictors of response to TCb in the neoadjuvant setting (NCT01560663). 278/300 patients were evaluable. PAM50 subtypes (NanoString nCounter) and RNAseq (HiSeq2500) were analyzed for those patients with both available samples and evaluable pathological response (n=208). Correlations were studied by the Kendall method. Linear or logistic regressions were adjusted for univariant analysis depending on numerical or categorical response variables, respectively. Results: FOXA1 and AR were differentially expressed between basal and non-basal tumor subtypes (PAM50), being overexpressed in non-basal (p<0.001 for both FOXA1 and AR). FOXA1 and AR were significantly overexpressed in non-basal subtypes from the Vanderbilt TNBC-type classification (36/208) as well. Both genes expression showed a significant correlation with several luminal marker genes. AR was significantly associated with ANXA9 (p=0,008), GATA3 (p=0,00002) and XBP1 (p<0.001), while FOXA1 expression was positively associated with ANXA9 (p=0,03), ESR1 (p<0.001),GATA3 (p<0.001) and XBP1 (p<0.001). In terms of response, significant differences in FOXA1 expression levels were found between responders and non-responders by Residual Disease Burden (RCB) classification taking response as binary variable of PCR vs RCB-I/II/III (p=0.003) as well as pCR/RCB-I vs RCB-II/III (p=0.008) with responders showing a lower FOXA1 expression level. The same analysis for AR expression did not show statistically significant differences. Within the PAM50 basal subgroup, neither AR nor FOXA1 individual gene expression (172/208) showed association with response. For survival, with a median follow-up of 36 months, neither FOXA1 nor AR showed significant impact on EFS or OS per univariate Cox regression analysis (EFS: HRFOXA1 1.076; p=0.307; HRAR 1.156, p=0.084 and OS: HRFOXA11.120, p=0.140; HRAR 1.152, p=0.121). Conclusions: Within our cohort, FOXA1 expression is a better predictor of response to NA chemotherapy than AR. FOXA1 is overexpressed in TNBC tumors who do not achieve pCR with neoadjuvant TCb chemotherapy, correlating with non-basal tumor subtypes. This suggests that measuring FOXA1 expression levels in patients with TNBC could be useful to predict response to TCb regimen enabling physicians to select more effective alternative NA schemes in this population.
Citation Format: Sara López-Tarruella, María del Monte-Millán, Enrique Alvarez, Yolanda Jerez, José Ángel García Saenz, Isabel Echavarria, Fernando Moreno, Ivan Márquez-Rodas, Coralia Bueno-Muiño, Blanca Herrero, Maria Cebollero, Rocío Ramos-Medina, Nerea Lobato, Ricardo González del Val, Maria Isabel Palomero, Santiago Lizarraga, Uriel Bohn, Ana Isabel Ballesteros, Patricia Rincón, Tatiana Massarrah, Inmaculada Ocaña, Lucía Villarejo, Charles M Perou, Miguel Martin. Potential value of FOXA1 expression as genomic predictor of response to docetaxel and carboplatin neoadjuvant (NA) chemotherapy in patients with triple negative breast cancer (TNBC) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS4-12.
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Affiliation(s)
- Sara López-Tarruella
- 1Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain
| | - María del Monte-Millán
- 1Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain
| | - Enrique Alvarez
- 2Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Yolanda Jerez
- 1Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain
| | | | - Isabel Echavarria
- 2Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Fernando Moreno
- 3Department of Medical Oncology, Hospital Clínico San Carlos, CIBERONC, Madrid, Spain
| | - Ivan Márquez-Rodas
- 1Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain
| | - Coralia Bueno-Muiño
- 4Medical Oncology Department, Hospital Infanta Cristina, Parla, Madrid, Spain
| | - Blanca Herrero
- 2Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Maria Cebollero
- 5Pathology Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain 5Gynecology Service, Hospital General Universitario Gregorio Marañón, IiSGM, Universidad Complutense, Madrid, Spain
| | - Rocío Ramos-Medina
- 1Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain
| | - Nerea Lobato
- 2Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ricardo González del Val
- 2Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Maria Isabel Palomero
- 2Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Santiago Lizarraga
- 6Gynecology Service, Hospital General Universitario Gregorio Marañón, IiSGM, Universidad Complutense, Madrid, Spain
| | - Uriel Bohn
- 7Department of Medical Oncology, Hospital Universitario Dr Negrin, Las Palmas de Gran Canaria, Spain
| | | | - Patricia Rincón
- 6Gynecology Service, Hospital General Universitario Gregorio Marañón, IiSGM, Universidad Complutense, Madrid, Spain
| | - Tatiana Massarrah
- 1Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain
| | - Inmaculada Ocaña
- 2Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Lucía Villarejo
- 2Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Charles M Perou
- 9Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC
| | - Miguel Martin
- 1Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain
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Jerez Y, Herrero B, Arregui M, Morón B, Martín M, Echavarría I. Neratinib for the treatment of early-stage, hormone receptor-positive, HER2-overexpressed breast cancer. Future Oncol 2020; 16:1165-1177. [PMID: 32458702 DOI: 10.2217/fon-2020-0046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
HER2-positive breast cancer accounts for 18-20% of all breast cancers. Despite significant advances and the currently available adjuvant treatments for management of the disease, approximately 25% of HER2-positive early-stage breast cancer patients show relapse and die. Neratinib is an irreversible tyrosine kinase inhibitor. Multiple studies have reported its significant antitumor activity in metastatic HER2-positive breast cancer. It is administered orally and has also been tested in the adjuvant setting. In this article, we present a comprehensive review of the pharmacokinetics and pharmacodynamics of neratinib as well as its clinical efficacy, with an emphasis on early HER2-positive breast cancer and suggestions for future directions for neratinib research.
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Affiliation(s)
- Yolanda Jerez
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Departamento de Medicina, Universidad Complutense, CiberOnc, Madrid, Spain
| | - Blanca Herrero
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Departamento de Medicina, Universidad Complutense, CiberOnc, Madrid, Spain
| | - Marta Arregui
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Madrid, 28007, Spain
| | - Blanca Morón
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Madrid, 28007, Spain
| | - Miguel Martín
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Departamento de Medicina, Universidad Complutense, CiberOnc, Madrid, Spain
| | - Isabel Echavarría
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Departamento de Medicina, Universidad Complutense, CiberOnc, Madrid, Spain
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9
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Moreno F, Gayarre J, López-Tarruella S, del Monte-Millán M, Picornell AC, Álvarez E, García-Saenz JÁ, Jerez Y, Márquez-Rodas I, Echavarría I, Palomero M, Bueno C, Aragón Bodí AM, Muñoz MS, González del Val R, Bueno O, Cebollero-Presmanes M, Ocaña I, Arias A, Romero P, Massarrah T, Ramos-Medina R, Martín M. Concordance of Genomic Variants in Matched Primary Breast Cancer, Metastatic Tumor, and Circulating Tumor DNA: The MIRROR Study. JCO Precis Oncol 2019; 3:1-16. [DOI: 10.1200/po.18.00263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Genetic heterogeneity between primary tumors and their metastatic lesions has been documented in several breast cancer studies. However, the selection of therapy for patients with metastatic breast cancer and the search for biomarkers for targeted therapy are often based on findings from the primary tumor, mainly because of the difficulty of distant metastasis core biopsies. New methods for monitoring genomic changes in metastatic breast cancer are needed (ie, circulating tumor DNA [ctDNA] genomic analysis). The objectives of this study were to assess the concordance of genomic variants between primary and metastatic tumor tissues and the sensitivity of plasma ctDNA analysis to identify variants detected in tumor biopsies. PATIENTS AND METHODS Next-generation sequencing technology was used to assess the genomic mutation profile of a panel of 54 cancer genes in matched samples of primary tumor, metastatic tumor, and plasma from 40 patients with metastatic breast cancer. RESULTS Using Ion Torrent technology (ThermoFisher Scientific, Waltham, MA), we identified 110 variants that were common to the primary and metastatic tumors. ctDNA analysis had a sensitivity of 0.972 in detecting variants present in both primary and metastatic tissues. In addition, we identified 13 variants in metastatic tissue and ctDNA not present in primary tumor. CONCLUSION We identified genomic variants present in metastatic biopsies and plasma ctDNA that were not present in the primary tumor. Deep sequencing of plasma ctDNA detected most DNA variants previously identified in matched primary and metastatic tissues. ctDNA might aid in therapy selection and in the search for biomarkers for drug development in metastatic breast cancer.
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Affiliation(s)
- Fernando Moreno
- Centro de Investigación Biomédica en Red Cáncer, Madrid, Spain
| | - Javier Gayarre
- Centro de Investigación Biomédica en Red Cáncer, Madrid, Spain
| | - Sara López-Tarruella
- Centro de Investigación Biomédica en Red Cáncer, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Universidad Complutense, Madrid, Spain
| | | | | | - Enrique Álvarez
- Centro de Investigación Biomédica en Red Cáncer, Madrid, Spain
| | | | - Yolanda Jerez
- Centro de Investigación Biomédica en Red Cáncer, Madrid, Spain
| | | | | | | | | | | | | | | | - Oscar Bueno
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | | | - Ainhoa Arias
- Centro de Investigación Biomédica en Red Cáncer, Madrid, Spain
| | - Paula Romero
- Centro de Investigación Biomédica en Red Cáncer, Madrid, Spain
| | | | | | - Miguel Martín
- Centro de Investigación Biomédica en Red Cáncer, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Universidad Complutense, Madrid, Spain
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10
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Picornell AC, Echavarria I, Alvarez E, López-Tarruella S, Jerez Y, Hoadley K, Parker JS, Del Monte-Millán M, Ramos-Medina R, Gayarre J, Ocaña I, Cebollero M, Massarrah T, Moreno F, García Saenz JA, Gómez Moreno H, Ballesteros A, Ruiz Borrego M, Perou CM, Martin M. Breast cancer PAM50 signature: correlation and concordance between RNA-Seq and digital multiplexed gene expression technologies in a triple negative breast cancer series. BMC Genomics 2019; 20:452. [PMID: 31159741 PMCID: PMC6547580 DOI: 10.1186/s12864-019-5849-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 05/27/2019] [Indexed: 01/18/2023] Open
Abstract
Background Full RNA-Seq is a fundamental research tool for whole transcriptome analysis. However, it is too costly and time consuming to be used in routine clinical practice. We evaluated the transcript quantification agreement between RNA-Seq and a digital multiplexed gene expression platform, and the subtype call after running the PAM50 assay in a series of breast cancer patients classified as triple negative by IHC/FISH. The goal of this study is to analyze the concordance between both expression platforms overall, and for calling PAM50 triple negative breast cancer intrinsic subtypes in particular. Results The analyses were performed in paraffin-embedded tissues from 96 patients recruited in a multicenter, prospective, non-randomized neoadjuvant triple negative breast cancer trial (NCT01560663). Pre-treatment core biopsies were obtained following clinical practice guidelines and conserved as FFPE for further RNA extraction. PAM50 was performed on both digital multiplexed gene expression and RNA-Seq platforms. Subtype assignment was based on the nearest centroid classification following this procedure for both platforms and it was concordant on 96% of the cases (N = 96). In four cases, digital multiplexed gene expression analysis and RNA-Seq were discordant. The Spearman correlation to each of the centroids and the risk of recurrence were above 0.89 in both platforms while the agreement on Proliferation Score reached up to 0.97. In addition, 82% of the individual PAM50 genes showed a correlation coefficient > 0.80. Conclusions In our analysis, the subtype calling in most of the samples was concordant in both platforms and the potential discordances had reduced clinical implications in terms of prognosis. If speed and cost are the main driving forces then the preferred technique is the digital multiplexed platform, while if whole genome patterns and subtype are the driving forces, then RNA-Seq is the preferred method. Electronic supplementary material The online version of this article (10.1186/s12864-019-5849-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A C Picornell
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo 46, 28007, Madrid, Spain.
| | - I Echavarria
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - E Alvarez
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo 46, 28007, Madrid, Spain
| | - S López-Tarruella
- Medical Oncology Service, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM). CiberOnc, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Y Jerez
- Medical Oncology Service, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM). CiberOnc, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - K Hoadley
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J S Parker
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Del Monte-Millán
- Medical Oncology Service, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM). CiberOnc, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - R Ramos-Medina
- Medical Oncology Service, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM). CiberOnc, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J Gayarre
- Medical Oncology Service, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM). CiberOnc, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - I Ocaña
- Medical Oncology Service, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM). CiberOnc, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M Cebollero
- Anatomical Pathology Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - T Massarrah
- Medical Oncology Service, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM). CiberOnc, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - F Moreno
- Medical Oncology Service, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - J A García Saenz
- Medical Oncology Service, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - H Gómez Moreno
- Medicina Oncológic, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru
| | - A Ballesteros
- Medical Oncology Service, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - C M Perou
- Department of Genetics, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - M Martin
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, CiberOnc, GEICAM, Madrid, Spain
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Martín M, Ramos-Medina R, Garcia Sáenz J, del Monte-Millán M, Cebollero M, Moreno F, Echavarria I, Jerez Y, Massarrah T, Lopez-Tarruella Cobo S. Activity of chemotherapy drugs in patient-derived xenografts (PDXs) from chemotherapy naïve local-regional triple negative breast cancer (LR-TNBC) patients. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz095.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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García-González X, López-Tarruella S, García MI, González-Haba E, Blanco C, Salvador-Martin S, Jerez Y, Thomas F, Jarama M, Sáez MS, Martín M, López-Fernández LA. Severe toxicity to capecitabine due to a new variant at a donor splicing site in the dihydropyrimidine dehydrogenase (DPYD) gene. Cancer Manag Res 2018; 10:4517-4522. [PMID: 30349384 PMCID: PMC6190816 DOI: 10.2147/cmar.s174470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Severe, life-threatening adverse reactions to capecitabine sometimes occur in the treatment of solid tumors. Screening for dihydropyrimidine dehydrogenase (DPYD) deficiency is encouraged before start of treatment, but the genetic variants that are commonly analyzed often fail to explain toxicities seen in clinical practice. Here we describe the case of a 79-year-old Caucasian female with breast cancer who presented with life-threatening, rapidly increasing toxicity after 1 week of treatment with capecitabine and for whom routine genetic DPYD test resulted negative. DPYD exon sequencing found variant c.2242+1G>T at the donor splicing site of exon 19. This variant is responsible for skipping of exon 19 and subsequent generation of a non-functional DPYD enzyme. This variant has not been described previously but was found in three other members of the patient's family. With this case, we show that exon sequencing of DPYD in patients who experience marked toxicity to fluoropyrimidines and test negative for commonly evaluated variants can prove extremely useful for identifying new genetic variants and better explain adverse reactions causality.
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Affiliation(s)
- Xandra García-González
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,
| | - Sara López-Tarruella
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - María Isabel García
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,
| | - Eva González-Haba
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,
| | - Carolina Blanco
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,
| | - Sara Salvador-Martin
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,
| | - Yolanda Jerez
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Fabienne Thomas
- Department of Pharmacology, Institut Claudius-Regaud, CRCT, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - María Jarama
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,
| | - María Sanjurjo Sáez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,
| | - Miguel Martín
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Luis Andrés López-Fernández
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,
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Martín M, de la Torre-Montero JC, López-Tarruella S, Pinilla K, Casado A, Fernandez S, Jerez Y, Puente J, Palomero I, González Del Val R, Del Monte-Millan M, Massarrah T, Vila C, García-Paredes B, García-Sáenz JA, Lluch A. Persistent major alopecia following adjuvant docetaxel for breast cancer: incidence, characteristics, and prevention with scalp cooling. Breast Cancer Res Treat 2018; 171:627-634. [PMID: 29923063 PMCID: PMC6133184 DOI: 10.1007/s10549-018-4855-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 06/13/2018] [Indexed: 11/29/2022]
Abstract
Background Persistent alopecia (PA) after docetaxel has been recently described. The aim of our study is to establish the incidence and characteristics of PA following adjuvant docetaxel for breast cancer (BC) and to test the ability of scalp cooling in prevention. Patients and methods BC patients receiving adjuvant chemotherapy followed or not by endocrine therapy (and a control group receiving only endocrine therapy) were interviewed in a single institution at 1.5 to 5 years following primary diagnosis searching for PA. A confirmatory prevalence study was later performed in other two institutions. Finally, a prevention study using prophylactic scalp cooling (PSC) with ELASTO-GEL hypothermia caps in patients receiving adjuvant docetaxel was performed. Results In the initial prevalence study (492 patients), minor forms of PA (grade 1) were recorded with all chemotherapy regimens and aromatase inhibitors. Patients receiving docetaxel regimens at cumulative dose (CD) ≥ 400 mmg/m2 presented a significantly higher prevalence of grades 1 PA (33–52%) and 2 PA (5–12%). Prevalence of grade 2 PA with docetaxel CD ≥ 400 mmg/m2 was confirmed in two other institutions. Overall, grade 2 PA was seen in 10.06% (95% CI 7.36–13.61) of 358 patients with docetaxel regimens reaching CD ≥ 400 mmg/m2, but not in patients with lower docetaxel CD, other chemotherapy regimens, or endocrine therapy alone. In prevention trial, no grade 2 PA occurred among 116 patients receiving adjuvant docetaxel (≥ 400 mmg/m2) and PSC followed-up after a 96 months median time. PSC was well tolerated. No scalp relapses were seen among 30 patients (22% of all inclusions) having disease relapse. Conclusion Adjuvant treatment with docetaxel (CD ≥ 400 mmg/m2) is associated with a significant rate of grade 2 PA, leading to wearing a wig, in around 10% of patients. This toxicity was completely prevented with scalp cooling. Clinical Trial Reference: NCT00515762. Electronic supplementary material The online version of this article (10.1007/s10549-018-4855-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Martín
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain. .,Hospital General Universitario Gregorio Marañón, Medical Oncology Service, Calle Maiquez, no. 9, 28007, Madrid, Spain.
| | - J C de la Torre-Montero
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain.,Universidad Pontificia Comillas, Madrid, Spain
| | - S López-Tarruella
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - K Pinilla
- Medical Oncology Department, Hospital Clínico Universitario, CIBERONC, Valencia, Spain
| | - A Casado
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - S Fernandez
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain.,Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - Y Jerez
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - J Puente
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - I Palomero
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - R González Del Val
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - M Del Monte-Millan
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - T Massarrah
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - C Vila
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - B García-Paredes
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - J A García-Sáenz
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - A Lluch
- Medical Oncology Department, Hospital Clínico Universitario, CIBERONC, Valencia, Spain
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Echavarria I, López-Tarruella S, Picornell A, García-Saenz JÁ, Jerez Y, Hoadley K, Gómez HL, Moreno F, Monte-Millan MD, Márquez-Rodas I, Alvarez E, Ramos-Medina R, Gayarre J, Massarrah T, Ocaña I, Cebollero M, Fuentes H, Barnadas A, Ballesteros AI, Bohn U, Perou CM, Martin M. Pathological Response in a Triple-Negative Breast Cancer Cohort Treated with Neoadjuvant Carboplatin and Docetaxel According to Lehmann's Refined Classification. Clin Cancer Res 2018; 24:1845-1852. [PMID: 29378733 DOI: 10.1158/1078-0432.ccr-17-1912] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/09/2017] [Accepted: 01/25/2018] [Indexed: 02/06/2023]
Abstract
Purpose: Triple-negative breast cancer (TNBC) requires the iden- tification of reliable predictors of response to neoadjuvant chemotherapy (NACT). For this purpose, we aimed to evaluate the performance of the TNBCtype-4 classifier in a cohort of patients with TNBC treated with neoadjuvant carboplatin and docetaxel (TCb).Methods: Patients with TNBC were accrued in a nonrandomized trial of neoadjuvant carboplatin AUC 6 and docetaxel 75 mg/m2 for six cycles. Response was evaluated in terms of pathologic complete response (pCR, ypT0/is ypN0) and residual cancer burden by Symmans and colleagues. Lehmann's subtyping was performed using the TNBCtype online tool from RNAseq data, and germline sequencing of a panel of seven DNA damage repair genes was conducted.Results: Ninety-four out of the 121 patients enrolled in the trial had RNAseq available. The overall pCR rate was 44.7%. Lehmann subtype distribution was 34.0% BL1, 20.2% BL2, 23.4% M, 14.9% LAR, and 7.4% were classified as ER+. Response to NACT with TCb was significantly associated with Lehmann subtype (P = 0.027), even in multivariate analysis including tumor size and nodal involvement, with BL1 patients achieving the highest pCR rate (65.6%), followed by BL2 (47.4%), M (36.4%), and LAR (21.4%). BL1 was associated with a significant younger age at diagnosis and higher ki67 values. Among our 10 germline mutation carriers, 30% were BL1, 40% were BL2, and 30% were M.Conclusions: TNBCtype-4 is associated with significantly different pCR rates for the different subtypes, with BL1 and LAR displaying the best and worse responses to NACT, respectively. Clin Cancer Res; 24(8); 1845-52. ©2018 AACR.
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Affiliation(s)
- Isabel Echavarria
- Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), CiberOnc, Madrid, Spain.
| | - Sara López-Tarruella
- Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), CiberOnc, Madrid, Spain
| | - Antoni Picornell
- Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), CiberOnc, Madrid, Spain
| | | | - Yolanda Jerez
- Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), CiberOnc, Madrid, Spain
| | - Katherine Hoadley
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Henry L Gómez
- Medical Oncology, Instituto Nacional de Enfermedades Neoplasicas - INEN, Lima, Peru
| | | | | | - Iván Márquez-Rodas
- Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), CiberOnc, Madrid, Spain
| | - Enrique Alvarez
- Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), CiberOnc, Madrid, Spain
| | - Rocío Ramos-Medina
- Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), CiberOnc, Madrid, Spain
| | - Javier Gayarre
- Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), CiberOnc, Madrid, Spain
| | - Tatiana Massarrah
- Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), CiberOnc, Madrid, Spain
| | - Inmaculada Ocaña
- Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), CiberOnc, Madrid, Spain
| | - María Cebollero
- Department of Pathology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Hugo Fuentes
- Medical Oncology, Instituto Nacional de Enfermedades Neoplasicas - INEN, Lima, Peru
| | - Agusti Barnadas
- Medical Oncology Department, Hospital de Sant Pau, Barcelona, Spain
| | | | - Uriel Bohn
- Medical Oncology, Hospital de Gran Canaria Dr. Negrin, Las Palmas, Spain
| | - Charles M Perou
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Miguel Martin
- Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Universidad Complutense, CiberOnc, GEICAM, Madrid, Spain.
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15
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Lobo M, López-Tarruella S, Luque S, Lizarraga S, Flores-Sánchez C, Bueno O, Solera J, Jerez Y, Del Val RG, Palomero MI, Cebollero M, Echavarría I, Torres G, Martín M, Márquez-Rodas I. Evaluation of Breast Cancer Patients with Genetic Risk in a University Hospital: Before and After the Implementation of a Heredofamilial Cancer Unit. J Genet Couns 2017; 27:854-862. [PMID: 29247312 DOI: 10.1007/s10897-017-0187-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 03/25/2017] [Accepted: 11/27/2017] [Indexed: 12/01/2022]
Abstract
The identification of patients at risk for breast cancer by genetic testing has proven to reduce breast cancer mortality. In 2010, due to a lack of systematization in hereditary cancer assistance in our center, we implemented a multidisciplinary Heredofamilial Cancer Unit (HFCU). We analyze if the HFCU improved the rates of referrals and preventive management of breast cancer patients with genetic risk. We retrospectively compared family history records, referrals of high-risk patients to genetic counseling, and detection and management of patients with BRCA1/2 mutations in two cohorts of breast cancer patients diagnosed before (first period: 2007-2010) and after the creation of the HFCU (second period: 2010-2013). In the first period, 893 patients were included, and 902 were included in the second. Due to the inability to establish their genetic risk, 142 patients (15.9%) vs. 70 (7.8%) were excluded from analysis (p < 0.001). Among the evaluable patients, 194 (25.8%) vs. 223 (26.8%) fulfilled one or more risk criteria (p = 0.65). Family history documentation in patient's medical records (92.4 vs. 97.8%, p < 0.001) and referral rate (26.3 vs. 52%, p < 0.0001) significantly increased in the second period. Eight BRCA1/2 mutations were detected among patients referred in the first period and 17 among those referred to the HFCU. The rate of preventive surgeries in patients with BRCA mutations significantly increased in the second period (25 vs. 76.5%, p = 0.03). In conclusion, there was a clear improvement in family history records, referrals, and preventive surgeries in breast cancer patients with genetic risk after the implementation of the HFCU.
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Affiliation(s)
- Miriam Lobo
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Sara López-Tarruella
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Soledad Luque
- Servicio de Ginecología, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Santiago Lizarraga
- Servicio de Ginecología, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Carmen Flores-Sánchez
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Oscar Bueno
- Servicio de Radiodiagnóstico, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Jesús Solera
- Instituto de Genética Molecular, Hospital La Paz, Universidad Autónoma, Madrid, Spain
| | - Yolanda Jerez
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Ricardo González Del Val
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - María Isabel Palomero
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - María Cebollero
- Servicio de Anatomía Patológica, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Isabel Echavarría
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Gabriela Torres
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Miguel Martín
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Iván Márquez-Rodas
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain.
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Echavarria I, Jerez Y, Martin M, López-Tarruella S. Incorporating CDK4/6 Inhibitors in the Treatment of Advanced Luminal Breast Cancer. Breast Care (Basel) 2017; 12:296-302. [PMID: 29234248 PMCID: PMC5704690 DOI: 10.1159/000481656] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
After optimizing endocrine monotherapy modalities in the setting of advanced luminal breast cancer (BC), dual endocrine/targeted therapy combinations have been tested with positive results, and are transforming this BC subtype treatment landscape. Cell cycle deregulation is a hallmark of cancer that has become a key druggable target in hormone receptor (HR)-positive BC due to its role in endocrine resistance mechanisms. Cyclin dependent kinase (CDK)4/6 inhibitors have experienced a fast development in combination with endocrine therapy and have already been commercialized in some countries. In this review, we will summarize the development of these CDK4/6 inhibitors in luminal BC, from the preclinical data to the pivotal phase III trials that led to their approval, focusing on the efficacy and safety data for each of the treatment settings. Moreover, we will consider the challenges CDK4/6 inhibitors face in their positioning in the algorithm of treatment for advanced luminal BC and the considerations physicians should take into account when selecting these therapies for their patients. However, we are still in need of reliable predictive biomarkers in order to identify patients who will derive the greatest benefit from these drug combinations that are not exempt from toxicity.
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Affiliation(s)
- Isabel Echavarria
- Department of Medical Oncology, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Universidad Complutense de Madrid, CiberOnc, Madrid, Spain
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Perez Ramirez S, del Monte-Millán M, López-Tarruella S, Márquez-Rodas I, Jerez Y, Lobo Samper F, Izarzugaza Peron Y, Martínez Jañez N, García-Saenz J, Moreno Antón F, Zamora Auñón P, Arroyo Yustos M, Lara Álvarez M, Ciruelos Gil E, Manso Sánchez L, Echarri González M, Guerra Martínez J, Jara Sánchez C, Valentín Maganto V, Martin Jimenez M. Distribution of genomically defined recurrence risk in luminal A and B breast tumors defined by inmunohistochemistry: A retrospective study in Spanish population. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Blanco Codesido M, Calvo Ferrandiz A, Lopez-Tarruella Cobo S, Alvarez R, Jerez Y, Marquez Rodas I, Perez Ramirez S, Muñoz A, Calles A, Sabin Domínguez P, López C, Picornell A, Puente B, Rubio C, Herencia M, Massarrah T, Jimenez MM. Validation of the Royal Marsden Hospital (RMH) prognostic score on an enriched early treatment line cohort for phase I trial patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx367.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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Echavarria Diaz-Guardamino I, Picornell A, López-Tarruella S, Jerez Y, Hoadley K, Alvarez E, del Monte-Millán M, Gayarre J, Ramos-Medina R, Massarrah T, Ocaña I, Cebollero M, Moreno Antón F, García-Saenz J, Gomez Moreno H, Fuentes H, Ballesteros Garcia A, Bohn Sarmiento U, Perou C, Martin Jimenez M. Pathological response in a triple-negative breast cancer cohort treated with neoadjuvant carboplatin and docetaxel according to Lehmann’s refined classification (TNBCtype-4). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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González-Rivera M, Lobo M, López-Tarruella S, Jerez Y, del Monte-Millán M, Massarrah T, Ramos-Medina R, Ocaña I, Picornell A, Santillán Garzón S, Pérez-Carbornero L, García-Saenz JA, Gómez H, Moreno F, Márquez-Rodas I, Fuentes H, Martin M. Erratum to: Frequency of germline DNA genetic findings in an unselected prospective cohort of triple-negative breast cancer patients participating in a platinum-based neoadjuvant chemotherapy trial. Breast Cancer Res Treat 2017; 165:471. [DOI: 10.1007/s10549-017-4396-0] [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: 11/28/2022]
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Picornell A, Echavarria Diaz-Guardamino I, Alvarez Castillo E, Lopez-Tarruella Cobo S, Jerez Y, Hoadley K, Parker J, del Monte-Millán M, Ramos Medina R, Gayarre J, Ocaña I, Cebollero M, Massarrah T, Moreno Antón F, García-Saenz J, Gomez Moreno H, Ballesteros Garcia A, Ruiz Borrego M, Perou C, Martin Jimenez M. Breast cancer PAM50 subtypes: Correlation between RNA-Seq and multiplexed gene expression platforms. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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22
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Rodas IM, Ruiz MR, Cobo SLT, Gracia JP, Sarvise MP, Alvarez R, de Miguel E, Jerez Y, Ferrandiz AC, Codesido MB, Gayarre J, Medina RR, Calles A, Aznar M, Planelles L, Quintero M, Algarra SM, Jimenez MM, Melero I. Safety and immunobiological activity of intratumoral (IT) double-stranded RNA (dsRNA) BO-112 in solid malignancies: First in human clinical trial. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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López-Tarruella S, Jerez Y, Márquez-Rodas I, Echavarria I, Martin M. Ribociclib for the treatment of advanced hormone receptor-positive, HER2-negative breast cancer. Future Oncol 2017; 13:2137-2149. [PMID: 28758424 DOI: 10.2217/fon-2017-0183] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
CDK4/6 inhibitors are a promising new class of drugs for hormone-receptor-positive breast cancer and have been shown to overcome and delay hormone resistance in advanced breast cancer. Ribociclib, a selective oral inhibitor of CDK4/6, was approved by the US FDA for first-line treatment of hormone-receptor-positive/HER2-negative metastatic breast cancer. This review summarizes the clinical evidence available for ribociclib, from preclinical data to the pivotal studies, with a special focus on toxicity and its management. In addition, this article reviews potential new combinations under study, as well as ongoing clinical trials both in the metastatic and early setting. Finally, this review compares ribociclib activity and toxicity with those of the drugs of the same class (palbociclib and abemaciclib).
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Affiliation(s)
- Sara López-Tarruella
- Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), CiberOnc, Madrid, Spain
| | - Yolanda Jerez
- Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), CiberOnc, Madrid, Spain
| | - Iván Márquez-Rodas
- Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), CiberOnc, Madrid, Spain
| | - Isabel Echavarria
- Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), CiberOnc, Madrid, Spain
| | - Miguel Martin
- Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Universidad Complutense, CiberOnc, GEICAM, Madrid, Spain
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Abstract
INTRODUCTION Despite the advances in the treatment of HER2-positive breast cancer, resistance to actual chemotherapeutic regimens eventually occurs. Neratinib, an orally available pan-inhibitor of the ERBB family, represents an interesting new option for early-stage HER2-positive breast cancer. Areas covered: In this article, the development of neratinib, with a special focus on its potential value in the treatment of early-stage HER2-positive breast cancer, has been reviewed. For this purpose, a literature search was conducted, including preclinical studies, early-phase trials in advanced cancer with neratinib in monotherapy and in combination, and phase II and large phase III trials in the early setting. Management of neratinib-induced toxicity, future perspectives for the drug, and ongoing trials are also discussed in this review. Expert commentary: Neratinib is emerging as a promising oral drug for the treatment of HER2-positive breast cancer. Although FDA and EMA approval is derived from the extended adjuvant treatment, this setting may not be the ideal scenario to obtain the beneficial effects of neratinib. Confirmatory data in the neoadjuvant setting and subgroup analysis from the ExTENET trial might bring some light into the best setting for neratinib therapy. Data from confirmatory trials in the metastatic setting are also required.
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Affiliation(s)
- Isabel Echavarria
- a Medical Oncology Department , Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) , Madrid , Spain
| | - Sara López-Tarruella
- b Medical Oncology Department , Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CiberOnc , Madrid , Spain
| | - Iván Márquez-Rodas
- b Medical Oncology Department , Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CiberOnc , Madrid , Spain
| | - Yolanda Jerez
- b Medical Oncology Department , Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CiberOnc , Madrid , Spain
| | - Miguel Martin
- c Instituto de Investigación Sanitaria Gregorio Maranon (IiSGM), Universidad Complutense, CiberOnc, GEICAM , Madrid , Spain
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Jerez Y, Lopez-Tarruella S, Marquez-Rodas I, Perez S, Ocaña A, Echavarria I, Lobo M, Gallego I, Torres G, Ortega L, Garcia G, Palomero I, Gonzalez Del Val R, Massarrah T, Esteban M, Del Monte-Millan M, Martin M. Abstract P4-20-01: Implications of financial modeling in breast cancer clinical research from 1990 to 2010. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-20-01] [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
SUMMARY: Over the past two decades significant progress has been made in breast cancer treatment resulting in a substantial improvement in patients' outcome. But we have to think about who promotes all this research and the consequences of the type of fundingThis project aims to evaluate the implication of finance in clinical research and the variance according to the type of funding.
OBJETIVES: To evaluate the financial evolvement of breast cancer clinical trials in the past two decades, regarding the phase of development design of the studies, the collaboration between Academy (Acad) and Industry (Ind), the sample size, the study results and the statistical analyses conducted.
METHODS: A systematic review was performed using MEDLINE to identify breast cancer randomized clinical trials published between January1990 and December2010. Studies that involved chemotherapy, endocrine and/or targeted therapies, wherethe primary endpoint was considered adequate to support a drug approval in oncology according to the FDA and EMA (U.S. Food and Drug Administration and European Medicines Agency, respectively), were included.
RESULTS:Data were evaluated 2,211 and 472 met selection criteria comprised in the methodology During the first decade the Acad was the main breast cancer research promoter being replaced by the Inv. throughout the second decade (p <0.0001). Thirty nine percent of the studies evaluated were phase III (39% Acad, 61% Ind), 15% were phase II (30% Acad, 70% Ind) and the remaining 47% were not classified by authors (65% Acad 35% Ind). As for the primary endpoint, 25% of the phase III trials evaluated progression free survival, 15% overall response rate, 1% time to progression and only 5% examined overall survival. Sixty five percent of the trials were national (60% Acad 40% Ind) and 35% international (25% Acad 75% Ind). Single-center studies accounted for 11% of the trial (65% Acad 35% Ind). Most of the national trials were developed by the US. Fifty four percent of the studies were conducted by research groups (67% supported by Ind. and 33% Acad.). The Ind sponsored 26% of the studies in the first decade and 50% during the second. The median number of patients enrolled by research groups was 892 in contrast with 409 included by other organizations. The primary endpoint was achieved in 19% of the Acad trials and 21% of the Ind trials. Only 53% of the studies declared intention to treat based analysis in their statistical workout.
RESULTS ACADEMY(%)INDUSTRY (%)PPROMOTION OF THE STUDY1990-2000121(26)68(14)0,0001 2001-2010105(22)178(38)0,0001STUDY DESIGNUNICENTRIC TRIALS34(7)18(4)0,007 MULTICENTRIC TRIALS191(40)228(48) NATIONAL TRIALS183(39)122(26)0,0001 INTERNATIONAL TRIALS42(9)124(26) COOPERATIVE GROUP95(20)160(34) NOT COOPERATIVE GROUP130(28)86(18) STATISTICAL ANALYSISINTENT OF TREAT86(18)163(35) NOT DECLARATED140(30)83(18)
CONCLUSIONS:There is a significant tendency towards the promotion of research by the pharmaceutical industries during the last two decades, leading a change in the clinical trials design and the endpoints.
Citation Format: Jerez Y, Lopez-Tarruella S, Marquez-Rodas I, Perez S, Ocaña A, Echavarria I, Lobo M, Gallego I, Torres G, Ortega L, Garcia G, Palomero I, Gonzalez Del Val R, Massarrah T, Esteban M, Del Monte-Millan M, Martin M. Implications of financial modeling in breast cancer clinical research from 1990 to 2010 [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-20-01.
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Affiliation(s)
- Y Jerez
- Hospital Gregorio Marañon, Madrid, Spain; Yale University, Albacete University Hospital, New Haven, Albacete
| | - S Lopez-Tarruella
- Hospital Gregorio Marañon, Madrid, Spain; Yale University, Albacete University Hospital, New Haven, Albacete
| | - I Marquez-Rodas
- Hospital Gregorio Marañon, Madrid, Spain; Yale University, Albacete University Hospital, New Haven, Albacete
| | - S Perez
- Hospital Gregorio Marañon, Madrid, Spain; Yale University, Albacete University Hospital, New Haven, Albacete
| | - A Ocaña
- Hospital Gregorio Marañon, Madrid, Spain; Yale University, Albacete University Hospital, New Haven, Albacete
| | - I Echavarria
- Hospital Gregorio Marañon, Madrid, Spain; Yale University, Albacete University Hospital, New Haven, Albacete
| | - M Lobo
- Hospital Gregorio Marañon, Madrid, Spain; Yale University, Albacete University Hospital, New Haven, Albacete
| | - I Gallego
- Hospital Gregorio Marañon, Madrid, Spain; Yale University, Albacete University Hospital, New Haven, Albacete
| | - G Torres
- Hospital Gregorio Marañon, Madrid, Spain; Yale University, Albacete University Hospital, New Haven, Albacete
| | - L Ortega
- Hospital Gregorio Marañon, Madrid, Spain; Yale University, Albacete University Hospital, New Haven, Albacete
| | - G Garcia
- Hospital Gregorio Marañon, Madrid, Spain; Yale University, Albacete University Hospital, New Haven, Albacete
| | - I Palomero
- Hospital Gregorio Marañon, Madrid, Spain; Yale University, Albacete University Hospital, New Haven, Albacete
| | - R Gonzalez Del Val
- Hospital Gregorio Marañon, Madrid, Spain; Yale University, Albacete University Hospital, New Haven, Albacete
| | - T Massarrah
- Hospital Gregorio Marañon, Madrid, Spain; Yale University, Albacete University Hospital, New Haven, Albacete
| | - M Esteban
- Hospital Gregorio Marañon, Madrid, Spain; Yale University, Albacete University Hospital, New Haven, Albacete
| | - M Del Monte-Millan
- Hospital Gregorio Marañon, Madrid, Spain; Yale University, Albacete University Hospital, New Haven, Albacete
| | - M Martin
- Hospital Gregorio Marañon, Madrid, Spain; Yale University, Albacete University Hospital, New Haven, Albacete
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Echavarria I, Granja M, Bueno C, Lopez-Tarruella S, Peinado P, Sotelo M, Jerez Y, Moreno F, Torres G, Lobo M, Marquez-Rodas I, Del Monte-Millan M, Martín M, García-Saenz JA. Multicenter analysis of neoadjuvant docetaxel, carboplatin, and trastuzumab in HER2-positive breast cancer. Breast Cancer Res Treat 2016; 162:181-189. [PMID: 28040858 DOI: 10.1007/s10549-016-4098-z] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 12/28/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE In an era where neoadjuvant dual blockade is emerging as the standard of care for early and locally advanced HER2-positive breast cancer, we aimed to identify predictors of response to single-blockade chemotherapy. METHODS This retrospective analysis reviewed all the incident stage I-III HER2-positive breast cancer patients who received neoadjuvant docetaxel, carboplatin, and trastuzumab (TCH) in three institutions. pCR was defined as the absence of invasive tumor in breast and axillary nodes (ypT0/isypN0). RESULTS From 2008 to 2015, 84 patients receiving neoadjuvant TCH were identified within our institutions. The mean age at diagnosis was 51.8 years. 59.5% of the patients were hormone receptor (HR) positive, lymph node involvement occurred in 67.9%, and clinical distribution was 2.4, 65.5, and 32.1% for stage I, II, and III, respectively. pCR rate was 47.6%; there was a significantly lower response in HR-positive patients compared to HR-negative ones (34 vs 67.6%, p = 0.005). pCR rate was associated with tumor size, whereas differences did not reach significance either for stage or for nodal status. Multivariate analysis found that only HR status was associated with response (p = 0.003). At a median follow-up of 31.7 months, disease-free survival, distant disease-free survival, and overall survival were 78.6, 85.7, and 94%, respectively. Breast-conserving surgery was performed in 44% of the patients. Overall, TCH was well tolerated, with low rates of grade 3-4 adverse events, and neither late toxicities nor cardiac dysfunctions were reported. CONCLUSIONS Neoadjuvant TCH, an anthracycline-free single-blockade regimen, achieved a pCR of 47.6%. Further molecular analyses are required in order to identify stronger predictive markers of pCR and thus for an accurate selection of patients who do not benefit from dual blockade.
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Affiliation(s)
| | | | - Coralia Bueno
- Hospital Universitario Infanta Cristina, Parla, Madrid, Spain
| | | | | | - Miguel Sotelo
- Hospital Universitario Infanta Cristina, Parla, Madrid, Spain
| | - Yolanda Jerez
- Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain
| | | | - Gabriela Torres
- Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Miriam Lobo
- Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Ivan Marquez-Rodas
- Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain
| | | | - Miguel Martín
- Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain
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Márquez-Rodas I, Lobo M, Flores-Sanchez C, Sanz M, Luque S, Lizarraga S, González-Asanza C, Pajares JA, Peligros MI, Bueno O, Mata C, Lopez C, López-Tarruella S, Jerez Y, Muñoz-Martin A, Blanco M, Die-Trill M, Justel JP, Solera J, Martin M. Five Years of Multidisciplinary Care in Hereditary Cancer: Our Experience in a Spanish University Hospital. Oncology 2016; 92:68-74. [PMID: 27855387 DOI: 10.1159/000452280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 10/06/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyse the evolution of a multidisciplinary heredofamilial cancer unit (HFCU) in a university hospital. METHODS This was a retrospective analysis of the activity of our HFCU in its first 5 years of existence. RESULTS Between July 2010 and July 2015, 1,518 patients from 1,318 families attended our HFCU. Genetic testing was offered to 862 patients. Of those, 833 (96.6%) accepted testing, with available results for 636 (76.4%). Pathogenic mutations in BRCA1 and BRCA2 were found in 175 patients. Lynch syndrome and adenomatous polyposis were the most frequent syndromes diagnosed (151/175, 86.3%) among 17 different syndromes studied. Of the 404 patients without a previous genetic diagnosis in the family, 62 (15.3%) were found to have mutations in disease-causing genes. Prophylactic surgery and follow-up (33.7%) or follow-up only (66.3%) was proposed for mutation carriers according to international guidelines and patients' preferences. CONCLUSION We have a high mutation detection rate, genetic test acceptance, and compliance with risk reduction strategies. However, there is room for improvement, especially in genetic testing timing, considering that an increase in the indications for genetic testing is expected.
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Affiliation(s)
- I Márquez-Rodas
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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Lobo M, Lopez-Tarruella S, Luque S, Lizarraga S, Rincon P, Hernandez A, Mendizabal E, Bueno O, Cebollero M, Perez Ramirez S, Jerez Y, Palomero Plaza M, Gonzalez del Val R, Garcia G, Echavarria Diaz-Guardamino I, Calin A, Blanco J, Flores Sanchez C, Martin M, Marquez-Rodas I. Evaluation of breast cancer patients with genetic risk: Before and after a multidisciplinary heredofamiliar cancer unit implementation. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw385.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Diaz-Guardamino IE, Lopez-Tarruella S, García-Sáenz J, Moreno HG, Moreno F, Jerez Y, Fuentes H, Marquez-Rodas I, Cebollero M, Del Monte-Millan M, Picornell A, Massarrah T, Barnadas A, Prat A, García AB, Bosch RC, Pelaez B, González-Rivera M, Perou C, Martin M. Intrinsic subtype and response to neoadjuvant chemotherapy with carboplatin and docetaxel (TCb) in triple-negative breast cancer (TNBC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw364.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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30
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Lobo de Mena M, Lopez-Tarruella S, Luque Molina S, Lizarraga S, Rincon P, Hernandez A, Mendizabal E, Bueno O, Cebollero M, Perez Ramirez S, Jerez Y, Palomero I, Gonzalez del Val R, Gallego I, Echavarria Diaz Guardamino I, Calin A, Blanco J, Flores Sanchez C, Martin M, Marquez Rodas I. The implementation of a multidisciplinary heredofamilial cancer unit to increase the referral and preventive surgeries of breast cancer patients with genetic risk in a university hospital. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e13031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Patricia Rincon
- Instituto de Investigación Santiaria Gregorio Marañon, Madrid, Spain
| | - Angel Hernandez
- Instituto de Investigacion Sanitaria Gregorio Marañon, Madrid, Spain
| | - Elsa Mendizabal
- Instituto de Investigacion Sanitaria Gregorio Marañon, Madrid, Spain
| | - Oscar Bueno
- Radiologia Hospital Gregorio Marañon, Madrid, Spain
| | - Maria Cebollero
- Instituto de Investigacion Sanitaria Gregorio Marañon, Madrid, Spain
| | | | - Yolanda Jerez
- Hospital Universitario Gregorio Marañon, Madrid, Spain
| | - Isabel Palomero
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Iria Gallego
- Instituto de Investigacion Sanitaria Gregorio Marañon, Madrid, Spain
| | | | - Ana Calin
- Instituto de Investigacion Sanitaria Gregorio Marañon, Madrid, Spain
| | - Jose Blanco
- Instituto de Investigacion Sanitaria Gregorio Marañon, Madrid, Spain
| | | | - Miguel Martin
- Hospital General Universitario Gregorio Marañon, Madrid, Spain
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Seguí-Palmer MA, Martinez Janez N, Blanco E, Batista JN, Munoz M, Rodriguez CA, Fernandez I, Jerez Y, Garau I, Amillano K, Garcia C, Perello A, Santaballa A, Borrega P, Salvador J, Garcia A, Ruiz M, Pellin L, Andres R. Time to definitive deterioration in patients with metastatic breast cancer subjected to second-line monochemotherapy. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e12504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Montserrat Munoz
- H. Clínic de Barcelona y Genómica Traslacional y Terapias Dirigidas en Tumores Sólidos, Barcelona, Spain
| | | | | | - Yolanda Jerez
- Hospital Universitario Gregorio Marañon, Madrid, Spain
| | | | - Kepa Amillano
- Hospital Universitari de Sant Joan de Reus, Tarragona, Spain
| | - Carlos Garcia
- Complejo Asistencial de Burgos, Hospital General Yagüe, Burgos, Spain
| | | | - Ana Santaballa
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | | | - Andres Garcia
- Complejo Asistencial de León, Hospital de León, Leon, Spain
| | - Manuel Ruiz
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Raquel Andres
- Department of Medical Oncology, Hospital Clínico Lozano Blesa, Zaragoza, Spain
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Jerez Y, Lopez-Tarruella S, Marquez Rodas I, Ocana A, Perez Ramirez S, Echavarria Diaz Guardamino I, Lobo de Mena M, Torres G, Gallego I, Ortega L, Garcia G, Gonzalez del Val R, Palomero I, Massarrah T, Esteban M, del Monte M, Martin M. Implication of MODEL of financing clinical research in breast cancer during the past two decades. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e14046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Yolanda Jerez
- Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain
| | | | | | - Alberto Ocana
- Medical Oncology Department, Salamanca University Hospital, Salamanca, Spain
| | | | | | | | - Gabriela Torres
- Instituto de investigacion sanitaria gregorio marañon, Madrid, Spain
| | - Iria Gallego
- Instituto de Investigacion Sanitaria Gregorio Marañon, Madrid, Spain
| | - Laura Ortega
- Instituto De Investigacion Sanitaria Gregorio Marañon, Madrid, Spain
| | - Gonzalo Garcia
- Instituto De Investigacion Sanitaria Gregorio Marañon, Madrid, Spain
| | | | - Isabel Palomero
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Tatiana Massarrah
- Instituto de investigacion sanitaria gregorio marañon, Madrid, Spain
| | - Magdalena Esteban
- Instituto De Investigacion Sanitaria Gregorio Marañon, Madrid, Spain
| | - Maria del Monte
- Instituto De Investigacion Sanitaria Gregorio Marañon, Madrid, Spain
| | - Miguel Martin
- Hospital General Universitario Gregorio Marañon, Madrid, Spain
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González-Rivera M, Lobo M, López-Tarruella S, Jerez Y, del Monte-Millán M, Massarrah T, Ramos-Medina R, Ocaña I, Picornell A, Garzón SS, Pérez-Carbornero L, García-Saenz JA, Gómez H, Moreno F, Márquez-Rodas I, Fuentes H, Martin M. Frequency of germline DNA genetic findings in an unselected prospective cohort of triple-negative breast cancer patients participating in a platinum-based neoadjuvant chemotherapy trial. Breast Cancer Res Treat 2016; 156:507-515. [DOI: 10.1007/s10549-016-3792-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 04/06/2016] [Indexed: 01/30/2023]
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Ocaña A, Ruiz Borrego M, Gil-Martín M, Antolín S, Guerrero Á, Vidal Boixader L, Martín M, Trigo Pérez JM, Rojo F, Jerez Y, Atienza M, Pernas S, Hernando A, Carrasco E, Benito S, Caballero R, Pandiella A. Abstract OT3-01-02: A phase I-II trial of dasatinib in combination with trastuzumab (T) and paclitaxel in the first line treatment of HER2 positive metastatic breast cancer (MBC) patients: GEICAM/2010-04. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-ot3-01-02] [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: Resistance to targeted-therapies is a current problem in our clinical practice. In HER2 overexpressing tumors, resistance to trastuzumab-based therapies is widely observed. Expression of SRC has been pre-clinically linked to trastuzumab resistance and the addition of the multi-tyrosine kinase inhibitor dasatinib to trastuzumab increases its antitumor activity (Seoane S, et al. J Natl Cancer Inst. 2010). On previous studies, Dasatinib showed a good toxicity profile, with low grade 3-4 toxicity rates (E. Mayer, et al. J Clin Oncol 2009). We have designed a phase I-II trial combining dasatinib with standard trastuzumab/paclitaxel. (ClinicalTrials.gov Identifier: NCT01306942). In this abstract we report the description of the phase II part of the trial which is ongoing.
Trial Design: Eligible patients must be HER2+ (evaluated by central laboratory and assessed by immunohistochemistry and fluorescent in-situ hybridization) MBC and candidates for trastuzumab + chemotherapy as first line treatment. Taxanes and trastuzumab administered in the adjuvant setting are permitted if given >12 months before the inclusion. Patients with CNS involvement are eligible if treated and clinically stable without medication. Treatment consists of trastuzumab 2 mg/kg weekly (following a loading dose of 4 mg/kg in cycle 1), weekly paclitaxel (80 mg/m2, 3 weeks on-one week off) and dasatinib 100 mg once daily (based on the recommended phase II dose from the phase I part, Gil-Martin M, et al. European Breast Cancer Conference 2014, P-041) in a 28-days cycle. Patients are treated until radiologic or symptomatic progression or unacceptable toxicity.
The primary objective for this phase II is efficacy, measured by Objective Response Rate (ORR according to RECIST 1.1). Secondary objectives are: Safety (evaluated using NCI-CTCAE v 4.03), Clinical Benefit Rate, Time to Progression, Progression Free Survival and Response Duration. Pharmacodynamic biomarkers include pAKT, pS6, pSRC, pErk1/2 in tumor tissue samples, mononuclear cells in blood samples and in skin tissue. An additional exploratory objective is to evaluate the correlation between the early presence of lymphocytosis and efficacy. The study will be considered positive if ORR increases 25% from a 50% ORR observed in previous studies with paclitaxel + trastuzumab. We need to include 28 evaluable patients to demonstrate this hypothesis (with an alpha error of 0.05 and a statistical power of 80%), assuming a 10% drop-out rate. Twenty one patients have already been included. Recruitment is expected to finish by the end of 2015.
Citation Format: Ocaña A, Ruiz Borrego M, Gil-Martín M, Antolín S, Guerrero Á, Vidal Boixader L, Martín M, Trigo Pérez JM, Rojo F, Jerez Y, Atienza M, Pernas S, Hernando A, Carrasco E, Benito S, Caballero R, Pandiella A. A phase I-II trial of dasatinib in combination with trastuzumab (T) and paclitaxel in the first line treatment of HER2 positive metastatic breast cancer (MBC) patients: GEICAM/2010-04. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT3-01-02.
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Affiliation(s)
- A Ocaña
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto Catalán de Oncología de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain; Fundación Jiménez Díaz, Madrid, Spain; Hospital General Universitario Gregorio Marañón, Madrid, Spain; GEICAM Spanish Breast Cancer Group, Madrid, Spain; Centro de Investigación del Cáncer, CSIC-Universidad de Salamanca, Salamanca, Spain
| | - M Ruiz Borrego
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto Catalán de Oncología de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain; Fundación Jiménez Díaz, Madrid, Spain; Hospital General Universitario Gregorio Marañón, Madrid, Spain; GEICAM Spanish Breast Cancer Group, Madrid, Spain; Centro de Investigación del Cáncer, CSIC-Universidad de Salamanca, Salamanca, Spain
| | - M Gil-Martín
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto Catalán de Oncología de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain; Fundación Jiménez Díaz, Madrid, Spain; Hospital General Universitario Gregorio Marañón, Madrid, Spain; GEICAM Spanish Breast Cancer Group, Madrid, Spain; Centro de Investigación del Cáncer, CSIC-Universidad de Salamanca, Salamanca, Spain
| | - S Antolín
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto Catalán de Oncología de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain; Fundación Jiménez Díaz, Madrid, Spain; Hospital General Universitario Gregorio Marañón, Madrid, Spain; GEICAM Spanish Breast Cancer Group, Madrid, Spain; Centro de Investigación del Cáncer, CSIC-Universidad de Salamanca, Salamanca, Spain
| | - Á Guerrero
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto Catalán de Oncología de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain; Fundación Jiménez Díaz, Madrid, Spain; Hospital General Universitario Gregorio Marañón, Madrid, Spain; GEICAM Spanish Breast Cancer Group, Madrid, Spain; Centro de Investigación del Cáncer, CSIC-Universidad de Salamanca, Salamanca, Spain
| | - L Vidal Boixader
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto Catalán de Oncología de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain; Fundación Jiménez Díaz, Madrid, Spain; Hospital General Universitario Gregorio Marañón, Madrid, Spain; GEICAM Spanish Breast Cancer Group, Madrid, Spain; Centro de Investigación del Cáncer, CSIC-Universidad de Salamanca, Salamanca, Spain
| | - M Martín
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto Catalán de Oncología de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain; Fundación Jiménez Díaz, Madrid, Spain; Hospital General Universitario Gregorio Marañón, Madrid, Spain; GEICAM Spanish Breast Cancer Group, Madrid, Spain; Centro de Investigación del Cáncer, CSIC-Universidad de Salamanca, Salamanca, Spain
| | - JM Trigo Pérez
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto Catalán de Oncología de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain; Fundación Jiménez Díaz, Madrid, Spain; Hospital General Universitario Gregorio Marañón, Madrid, Spain; GEICAM Spanish Breast Cancer Group, Madrid, Spain; Centro de Investigación del Cáncer, CSIC-Universidad de Salamanca, Salamanca, Spain
| | - F Rojo
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto Catalán de Oncología de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain; Fundación Jiménez Díaz, Madrid, Spain; Hospital General Universitario Gregorio Marañón, Madrid, Spain; GEICAM Spanish Breast Cancer Group, Madrid, Spain; Centro de Investigación del Cáncer, CSIC-Universidad de Salamanca, Salamanca, Spain
| | - Y Jerez
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto Catalán de Oncología de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain; Fundación Jiménez Díaz, Madrid, Spain; Hospital General Universitario Gregorio Marañón, Madrid, Spain; GEICAM Spanish Breast Cancer Group, Madrid, Spain; Centro de Investigación del Cáncer, CSIC-Universidad de Salamanca, Salamanca, Spain
| | - M Atienza
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto Catalán de Oncología de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain; Fundación Jiménez Díaz, Madrid, Spain; Hospital General Universitario Gregorio Marañón, Madrid, Spain; GEICAM Spanish Breast Cancer Group, Madrid, Spain; Centro de Investigación del Cáncer, CSIC-Universidad de Salamanca, Salamanca, Spain
| | - S Pernas
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto Catalán de Oncología de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain; Fundación Jiménez Díaz, Madrid, Spain; Hospital General Universitario Gregorio Marañón, Madrid, Spain; GEICAM Spanish Breast Cancer Group, Madrid, Spain; Centro de Investigación del Cáncer, CSIC-Universidad de Salamanca, Salamanca, Spain
| | - A Hernando
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto Catalán de Oncología de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain; Fundación Jiménez Díaz, Madrid, Spain; Hospital General Universitario Gregorio Marañón, Madrid, Spain; GEICAM Spanish Breast Cancer Group, Madrid, Spain; Centro de Investigación del Cáncer, CSIC-Universidad de Salamanca, Salamanca, Spain
| | - E Carrasco
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto Catalán de Oncología de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain; Fundación Jiménez Díaz, Madrid, Spain; Hospital General Universitario Gregorio Marañón, Madrid, Spain; GEICAM Spanish Breast Cancer Group, Madrid, Spain; Centro de Investigación del Cáncer, CSIC-Universidad de Salamanca, Salamanca, Spain
| | - S Benito
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto Catalán de Oncología de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain; Fundación Jiménez Díaz, Madrid, Spain; Hospital General Universitario Gregorio Marañón, Madrid, Spain; GEICAM Spanish Breast Cancer Group, Madrid, Spain; Centro de Investigación del Cáncer, CSIC-Universidad de Salamanca, Salamanca, Spain
| | - R Caballero
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto Catalán de Oncología de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain; Fundación Jiménez Díaz, Madrid, Spain; Hospital General Universitario Gregorio Marañón, Madrid, Spain; GEICAM Spanish Breast Cancer Group, Madrid, Spain; Centro de Investigación del Cáncer, CSIC-Universidad de Salamanca, Salamanca, Spain
| | - A Pandiella
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto Catalán de Oncología de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain; Fundación Jiménez Díaz, Madrid, Spain; Hospital General Universitario Gregorio Marañón, Madrid, Spain; GEICAM Spanish Breast Cancer Group, Madrid, Spain; Centro de Investigación del Cáncer, CSIC-Universidad de Salamanca, Salamanca, Spain
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Casla S, López-Tarruella S, Jerez Y, Marquez-Rodas I, Barakat R, Martín M. Abstract P1-10-10: An integrative intervention to change breast cancer patients' lifestyle: A medical challenge. A randomize controlled trial. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-10-10] [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. Physical exercise increases breast cancer (BC) patients' survival. However, only about two thirds of them follow the American Guidelines of Exercise to cancer survivors. The aim of this study was to examine the effect of an exercise intervention in breast cancer patients' lifestyle.
Methods. A randomized clinical trial evaluated an intervention (EXE) vs. a control (CON) group in early stage BC patients who recently finished the chemo and radio (neo) adjuvant. Intervention consists on exercise group classes combining aerobic and resistance activities designed specially for the necessities of these patients. Intensity was increasing gradually and intervention was controlled by a qualified in oncologic exercise specialist. CON group maintained their lifestyle without changes. Leisure-time exercise levels (LTEL), quality of life (QoL), grip strength index (GSI), physical capacity (VO2max) and fatigue, were assessed at baseline and after 3 months in both groups. Women who had been participated in the intervention group were followed up after six months to know if lifestyle levels were maintained.
ANCOVA and Pearson Test were used to analyze the continuous variables of baseline and final data and ANOVA test was used to analyze the follow-up data. A 95% of CI was calculated and p < 0.05 was determined as statistically significant.
Results 89 women, aged 49.06±8.75, completed the study, 44 in EXE group and 45 in CON group. Adherence rate was on average of 89%. Main results are presented in the Table.
Main ResultsMEASUREEXE GroupEXE GroupEXE GroupCON GroupCON Group BLFFUBLFQoL*+107.53±17.99112.88±17.74110.96±14.40104.94±17.65103.11±19.26LTEL*+18.73±20.5345.11±14.6134.56±19.5116.02±8.5215.04±4.75GSI*+2.07±1.082.60±0.832.48±0.582.03±0.722.12±0.69VO2max*+26.99±4.3532.58±4.9632.11±7.1027.73±4.8227.08±3.73Fatigue *+130.09±19.68135.94±18.20138.24±17.49124.83±24.66124.00±24.20BL=baseline; F= Final; FU= Follow-Up. *Significant differences between EXE and CON. + Significant differences between BL and FU.
There was a significant improvement in LTEL (p=0.0001) and in QoL (p=0.0001) comparing EXE vs. CON group. In addition, results showed a correlation between this two variables in EXE group (r=0.22; p=0.013). These significant improvements, as well as the mentioned correlation, were maintained in the 6-months follow-up assessment in EXE group.
Significant differences between groups were observed in GSI (p=0.004), and in VO2max levels (p=0.001). EXE group showed a significant improvement in fatigue levels compared with CON group (p=0.0001). All these significant improvements were maintained in the 6-months follow-up assessment in EXE group, as well as previous variables.
Conclusion. These results suggest that an exercise intervention increases LTEL correlated to a better QoL, improving patients' lifestyle that could be long lasting. These changes may ameliorate psychological and physical BC treatments side effects, such as fatigue, in patients with early breast cancer that has recently finished adjuvant treatments.
Citation Format: Casla S, López-Tarruella S, Jerez Y, Marquez-Rodas I, Barakat R, Martín M. An integrative intervention to change breast cancer patients' lifestyle: A medical challenge. A randomize controlled trial. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-10-10.
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Affiliation(s)
- S Casla
- Technical University of Madrid, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - S López-Tarruella
- Technical University of Madrid, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Y Jerez
- Technical University of Madrid, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - I Marquez-Rodas
- Technical University of Madrid, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - R Barakat
- Technical University of Madrid, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M Martín
- Technical University of Madrid, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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Anguera G, Tibau A, Andrés-Pretel F, Andrés M, Seruga B, Templeton A, Jerez Y, Vera-Badillo F, Barnadas A, Martin M, Amir E, Ocańa A. 1215 Role of cooperative groups and funding source in clinical studies that support approved therapy for breast cancer. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30519-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gonzalez-Rivera M, Daoud L, Picornell A, Duran E, Ocana I, Andres S, Ramos-Medina R, Jerez Y, Lopez-Tarruella S, Rojo F, Martin M. 1910 Genomic Prognostic Profile (PAM50) and clinical-pathological characteristics in breast cancer: A prospective description of the associations found in clinical practicez. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30859-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Casla S, López-Tarruella S, Jerez Y, Marquez-Rodas I, Galvão DA, Newton RU, Cubedo R, Calvo I, Sampedro J, Barakat R, Martín M. Supervised physical exercise improves VO2max, quality of life, and health in early stage breast cancer patients: a randomized controlled trial. Breast Cancer Res Treat 2015; 153:371-82. [PMID: 26293147 DOI: 10.1007/s10549-015-3541-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 08/10/2015] [Indexed: 01/31/2023]
Abstract
Breast cancer patients suffer impairment in cardiorespiratory fitness after treatment for primary disease, affecting patients' health and survival. The aim of this study was to evaluate the ability of a pragmatic exercise intervention to improve cardiorespiratory fitness of breast cancer patients after primary treatment. Between February 2013 and December 2014, 94 women with early stage (I-III) breast cancer, 1-36 months post-chemotherapy, and radiotherapy were randomly assigned to an intervention program (EX) combining supervised aerobic and resistance exercise (n = 44) or usual care (CON) (n = 45) for 12 weeks. Primary study endpoint was VO2max. Secondary endpoints were muscle strength, shoulder range of motion, body composition, and quality of life (QoL). Assessments were undertaken at baseline, 12-week, and 6-month follow-ups. Eighty-nine patients aged 29-69 years were assessed at baseline and 12 weeks. The EX group showed significant improvements in VO2max, muscle strength, percent fat, and lean mass (p ≤ 0.001 in all cases) and QoL compared with usual care (CON). Apart from body composition, improvements were maintained for the EX at 6-month follow-up. There were no adverse events during the testing or exercise intervention program. A combined exercise intervention produced considerable improvement in cardiorespiratory fitness, physical function, and quality of life in breast cancer patients previously treated with chemotherapy and radiation therapy. Importantly, most of these benefits were maintained 6 months after ceasing the supervised exercise intervention.
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Affiliation(s)
- Soraya Casla
- Physical Activity and Sport Science Faculty, Technical University of Madrid, Calle Martín Fierro, 7, C.P.: 28040, Madrid, Spain,
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Casla S, López-Tarruella S, Jerez Y, Márquez-Rodas I, Cubedo R, Calvo I, Martinez A, Cano S, Barakat R, Martín M. Abstract P5-15-08: Exercise intervention to run away from breast cancer treatment side effects: An integrative approach. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p5-15-08] [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. Some studies have shown that exercise increases breast cancer (BC) patients’ quality of life (QoL) during and after treatments. The aim of this study was to investigate the effect of an specific exercise intervention in QoL and in the exercise levels of these patients.
Methods. A randomized controlled trial evaluated an intervention (IG) vs a control group (CG) in early stage BC patients who recently finished chemo & radio therapies. Intervention consists on controlled group classes combining aerobic and resistance activities. CG maintained their previous lifestyle. QoL, leisure-time exercise levels (LTEL), chest (CMS) and legs maximal strength (LMS), physical capacity (PC) and some psychological variables, were assessed at baseline and after 3 months in both groups. Women who participated in the IG were followed up (FU) after 6 months.
Statistical analysis (SA) were performed using unpaired t-test on continuous variables comparing CG vs IG, considering possible confounders. Pearson correlation analyses were employed to examine possible correlations. 6 months FU data were analyzed comparing baseline and after intervention results using non-parametric test (n=13). SA was performed with SPSS v18 software. 95% CI was calculated and statistical significance level of p < 0.05 was used.
Results. 59 women (median 48.97±8.35 years old) completed this study. No differences between groups were observed at baseline. Average attendance rate to the program was 89%. There was a significant rise in LTEL (t123=16.33; p=0.0001) and in QoL (t123=2.88; p=0.005) comparing IG vs CG. Results also showed a correlation between QoL and LTEL in patients of IG only (r=0.22; p=0.013). Significant differences between groups were observed in both physical and psychological variablesafter training program.
Table 1. Results summary comparing intervention and control group.VARIABLESIntervention Group (n= 27) Mean±SDControl Group (n=32) Mean±SDFollow-Up (n=13) Mean±SDQoL*+112.88±17.74±103.11±19.26110.96±14.40LTEL*+45.11±14.6114.87±4.7834.56±19.51Body Fat Mass34.63±6.736.47±7.4735.74±4.56Muscle mass41.3±3.1638.78±8.5141.48±2.01Strength Index*+2.6±0.832.12±0.692.32±0.58CMS*+45.89±11.0731.47±9.8753.76±12.42LMS*+93.07±27.369.00±24.94114.65±24.29PC*+32.58±4.9627.08±3.7332.11±7.10FACT-F *+135.94±18.20124.00±24.20138.24±17.49SF-36 Physical Dimension*+48.49±4.8345.61±5.8249.75±2.75SF-36 Psychological Dimension*+43.00±8.1137.03±12.5844.33±7.33Depression*+6.83±7.8312.55±10.775.88±5.19*Significant differences were found between control and intervention group. + Significant differences were maintained between baseline and follow-up assessments.
No differences taking into account confounders were observed.Variable changes were maintained in FU participants assessed after 6 months. Correlation between QoL and LTEL (r=0.52; p=0.008) and significant weight loss (χ22=6.08; p=0.048) were observed.
Conclusion. These results suggest that a specifically designed BC exercise program increases LTEL, which correlates to a better QoL. This may reduce psychological and physical side effects of systemic treatment in patients with early BC that have recently finished treatments, even producing lifestyle changes in BC patients that could be long lasting.
Citation Format: Soraya Casla, Sara López-Tarruella, Yolanda Jerez, Iván Márquez-Rodas, Ricardo Cubedo, Isabel Calvo, Ana Martinez, Sara Cano, Rubén Barakat, Miguel Martín. Exercise intervention to run away from breast cancer treatment side effects: An integrative approach [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-15-08.
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Affiliation(s)
- Soraya Casla
- 1Technical University of Madrid, Faculty of Physical Activity and Sport Science-INEF
| | - Sara López-Tarruella
- 2Servicio Oncología Médica. Instituto de Investigación Sanitaria Gregorio Marañón
| | - Yolanda Jerez
- 2Servicio Oncología Médica. Instituto de Investigación Sanitaria Gregorio Marañón
| | - Iván Márquez-Rodas
- 2Servicio Oncología Médica. Instituto de Investigación Sanitaria Gregorio Marañón
| | | | | | - Ana Martinez
- 1Technical University of Madrid, Faculty of Physical Activity and Sport Science-INEF
| | - Sara Cano
- 1Technical University of Madrid, Faculty of Physical Activity and Sport Science-INEF
| | - Rubén Barakat
- 1Technical University of Madrid, Faculty of Physical Activity and Sport Science-INEF
| | - Miguel Martín
- 2Servicio Oncología Médica. Instituto de Investigación Sanitaria Gregorio Marañón
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Martín M, Custodio S, de Las Casas MLM, García-Sáenz JÁ, de la Torre JC, Bellón-Cano JM, López-Tarruella S, Vidaurreta-Lazaro M, de la Orden V, Jerez Y, Márquez-Rodas I, Casado A, Sastre J, Díaz-Rubio E. Circulating tumor cells following first chemotherapy cycle: an early and strong predictor of outcome in patients with metastatic breast cancer. Oncologist 2013; 18:917-23. [PMID: 23873719 DOI: 10.1634/theoncologist.2012-0479] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We investigated the prognostic significance of circulating tumor cells (CTCs) determined immediately before the second cycle of chemotherapy in patients with metastatic breast cancer (MBC). The CTC counts were taken at baseline, before the first cycle of chemotherapy (CTC-0), and on day 21 before commencing the second cycle of chemotherapy (CTC-21) in consecutive MBC patients. The study's primary objectives were to analyze relationships between CTC-21 count and overall survival (OS). Based on the current literature, the CTC measurements were dichotomized as 0-4 versus ≥ 5 CTCs. Of 117 patients recruited, 99 were evaluable. Patients with 0-4 CTCs on day 21 had a significantly better OS than those with ≥ 5 CTCs (median OS: 38.5 months vs. 8.7 months). They also had a significantly better progression-free survival (PFS; median: 9.4 months vs. 3.0 months) and clinical benefit rate (77% vs. 44%). The OS of patients whose baseline CTCs were ≥ 5 but dropped to <5 on day 21 was apparently similar to those who had <5 CTCs at baseline. In a Cox regression analysis, CTC-21 was the only independent variable significantly predicting OS and PFS. Our data indicate that CTCs determined immediately before the second cycle of chemotherapy is an early and strong predictor of treatment outcome in MBC patients.
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Affiliation(s)
- Miguel Martín
- Medical Oncology Service, Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Universidad Complutense, Madrid, Spain.
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Márquez-Rodas I, López-Tarruella S, Jerez Y, Cavanagh M, Custodio S, López-Trabada D, Moya B, Pérez S, Rupérez AB, Martín M. Evaluation of a heredofamilial cancer unit in increasing family history collection and genetic counseling referrals among Spanish oncologists at a university hospital. J Genet Couns 2013; 23:108-13. [PMID: 23771728 DOI: 10.1007/s10897-013-9617-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 05/29/2013] [Indexed: 01/13/2023]
Abstract
A comprehensive family history is essential to identify patients at risk for hereditary cancer who could benefit from genetic counseling (GC). In a previous study, we observed a low occurrence of family history record (FHR) collection rate and GC referral among oncologists at our institution. The present work analyzes whether the implementation of a heredofamilial cancer unit (HFCU) would improve these parameters. We retrospectively compared the FHR rate in clinical records, National Cancer Institute (NCI) general criteria for hereditary cancer suspicion, GC referrals and FHR quality in two cohorts: cohort 1 (patients diagnosed before HFCU creation) and cohort 2 (after HFCU creation). Of 1,175 patients (590 cohort 1 and 585 cohort 2), FHRs were consigned in 27.3 % and 52.5 % of patients, respectively (p < 0.001). The GC referral of patients with any NCI criterion was 13.6 % xin cohort 1 vs. 40.5 % in cohort 2 (p < 0.001). FHR quality improved in terms of the total number of relatives (164 vs. 314, p = 0.1, N.S.) and number of healthy relatives consigned (80 vs. 191, p < 0.01). Nine mutations (6 BRCA, 1 MEN1, 2 Lynch), 4 unknown significance variants (all in BRCA) and 2 with no mutation were identified among patients referred from cohort 2. We conclude that the creation of a heredofamilial cancer unit has changed both FHR and GC referrals among oncologists at our institution, although continuous educational efforts are required.
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Affiliation(s)
- Iván Márquez-Rodas
- Servicio de Oncología Médica; Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Calle Maiquez 7, 28007, Madrid, Spain,
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Abstract
Neratinib is an orally available, small, irreversible, pan-HER kinase inhibitor. HER-2-positive breast cancer is a breast cancer subtype with an increasing body of knowledge regarding potential targeted drug combinations that are significantly improving outcomes through a biologically tailored therapy approach; neratinib emerges as a promising tool in this context. This article reviews the molecular and clinical development of neratinib, an example of a covalent drug, from preclinical models to Phase III clinical trials, focusing on breast cancer treatment. The potential combinations of neratinib with chemotherapy in the metastatic, adjuvant and even neoadjuvant settings are appraised. These results and future perspectives will be discussed.
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Affiliation(s)
- Sara López-Tarruella
- Medical Oncology Service, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Calle Dr Esquerdo 46, 28007, Madrid, Spain
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Khosravi-Shahi P, Jerez Y, Mondejar R, Tapia G, Lopez MP, Martin M. Outcome of phyllodes tumors of the breast: A series of consecutive cases. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e20506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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