1
|
Vidal-Millan S, Zatarain-Barrón ZL, Daza-Galicia K, Shveid Gerson D, Pichardo-Rojas P, Salazar-Pigeon A, Wegman-Ostrosky T. Case report: Benign and malignant tumors in adult patients with neurofibromatosis type 1: a comprehensive case series from a large oncologic reference center. Front Oncol 2024; 13:1291286. [PMID: 38260834 PMCID: PMC10800395 DOI: 10.3389/fonc.2023.1291286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/08/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose Neurofibromatosis type 1 (NF1) is a complex, multisystem disorder that is characterized, among other features, by a higher risk of developing benign and malignant tumors. Despite NF1 being one of the most common autosomal dominant genetic disorders, data from adult individuals in several world regions remain elusive, including Hispanics. Methods The present is a retrospective cohort study conducted among adult patients with a confirmed diagnosis of NF1 who attended a single cancer-reference center, the Instituto Nacional de Cancerología in Mexico City from 2001 to 2021. Data were extracted from electronic health records and collected in an anonymous database by an NF1-expert physician in order to obtain demographic characteristics and detailed information regarding the development of tumors among this patient subgroup. All patients with malignant tumors or with benign tumors, which severely affected their quality of life, were included in this study. Results Patient records were reviewed from 2001 to 2021. A total of N = 29 patients met the criteria, with a higher proportion of female compared with male subjects [N = 22 (75.9%) vs. N = 7 (24.1%)]. Patients had a mean age at diagnosis of tumors of 32.2 years (SD = 11.2 years). In terms of malignant neoplasms, the most frequent malignant tumor presented by patients in this cohort was malignant peripheral nerve sheath tumors (N = 7, 24.1%), this was followed by breast cancer (n = 4, 13.8% among all patients, 18.2% among female patients). Other tumors also identified in this cohort included melanoma, gastrointestinal stromal tumors, and rectal cancer. Conclusion In Mexico, patients diagnosed with NF1 develop diverse tumors as adults. As described in other studies, the most frequent malignant tumor in this patient population is the malignant peripheral nerve sheath tumor. Further studies are required to increase the scarce information available for adult Hispanics with NF1.
Collapse
Affiliation(s)
- Silvia Vidal-Millan
- Hereditary Cancer Clinic, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | | | - Kena Daza-Galicia
- Subdirection of Basic Research, Instituto Nacional de Cancerología, Mexico City, Mexico
- Faculty of Higher Studies Iztacala, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Pavel Salvador Pichardo-Rojas
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, United States
| | - Alejandro Salazar-Pigeon
- Plan of Combined Studies in Medicine (PECEM-MD/PhD), Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Talia Wegman-Ostrosky
- Subdirection of Basic Research, Instituto Nacional de Cancerología, Mexico City, Mexico
| |
Collapse
|
2
|
Chamorro DF, Cardona AF, Rodríguez J, Ruiz-Patiño A, Arrieta O, Moreno-Pérez DA, Rojas L, Zatarain-Barrón ZL, Ardila DV, Viola L, Recondo G, Blaquier JB, Martín C, Raez L, Samtani S, Ordóñez-Reyes C, Garcia-Robledo JE, Corrales L, Sotelo C, Ricaurte L, Cuello M, Mejía S, Jaller E, Vargas C, Carranza H, Otero J, Archila P, Bermudez M, Gamez T, Russo A, Malapelle U, de Miguel Perez D, de Lima VCC, Freitas H, Saldahna E, Rolfo C, Rosell R. Genomic Landscape of Primary Resistance to Osimertinib Among Hispanic Patients with EGFR-Mutant Non-Small Cell Lung Cancer (NSCLC): Results of an Observational Longitudinal Cohort Study. Target Oncol 2023; 18:425-440. [PMID: 37017806 DOI: 10.1007/s11523-023-00955-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) mutations (EGFRm) represent one of the most common genomic alterations identified among patients with non-small cell lung cancer (NSCLC). Several targeted agents for patients with EGFRm have been proven safe and effective, including the third-generation tyrosine kinase inhibitor (TKI) osimertinib. Nonetheless, some patients will present with or develop EGFR-TKI resistance mechanisms. OBJECTIVE We characterized the genomic landscape of primary resistance to osimertinib among Hispanic patients with EGFR-mutant NSCLC. METHODS An observational longitudinal cohort study was conducted with two groups of patients, those with intrinsic resistance (cohort A) and those with long-term survival (cohort B). All patients were treated and followed between January 2018 and May 2022. All patients were assessed for Programmed Cell Death Ligand 1 (PD-L1) expression and Bcl-2-like protein 11 (BIM)/AXL mRNA expression before starting TKI. After 8 weeks of treatment, a liquid biopsy was performed to determine the presence of circulating free DNA (cfDNA), and next-generation sequencing (NGS) was used to identify mutations at the time of progression. In both cohorts, overall response rate (ORR), progression-free survival (PFS), and overall survival (OS) were evaluated. RESULTS We found a homogeneous distribution of EGFR-sensitizing mutations in both cohorts. For cohort A, exon 21 mutations were more common than exon 19 deletions (ex19dels) for cohort B (P = 0.0001). The reported ORR for osimertinib was 6.3% and 100% for cohorts A and B, respectively (P = 0.0001). PFS was significantly higher in cohort B (27.4 months vs. 3.1 months; P = 0.0001) and ex19del patients versus L858R (24.5 months, 95% confidence interval [CI] 18.2-NR), vs. 7.6 months, 95% CI 4.8-21.1; P = 0.001). OS was considerably lower for cohort A (20.1 months vs. 36.0 months; P = 0.0001) and was better for patients with ex19del, no brain metastasis, and low tumor mutation burden. At the time of progression, more mutations were found in cohort A, identifying off-target alterations more frequently, including TP53, RAS, and RB1. CONCLUSION EGFR-independent alterations are common among patients with primary resistance to osimertinib and significantly impact PFS and OS. Our results suggest that among Hispanic patients, other variables associated with intrinsic resistance include the number of commutations, high levels AXL mRNA, and low levels of BIM mRNA, T790M de novo, EGFR p.L858R presence, and a high tumoral mutational burden.
Collapse
Affiliation(s)
- Diego F Chamorro
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Andrés F Cardona
- Direction of Research, Science, and Education, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Calle 168 # 14, 110221, Bogotá, Colombia.
- Thoracic Oncology Unit, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia.
| | - July Rodríguez
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Alejandro Ruiz-Patiño
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Oscar Arrieta
- Thoracic Oncology Unit and Personalized Oncology Laboratory, National Cancer Institute (INCan), México City, Mexico
| | - Darwin A Moreno-Pérez
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Leonardo Rojas
- Thoracic Oncology Unit and Personalized Oncology Laboratory, National Cancer Institute (INCan), México City, Mexico
| | - Zyanya Lucia Zatarain-Barrón
- Thoracic Oncology Unit and Personalized Oncology Laboratory, National Cancer Institute (INCan), México City, Mexico
| | - Dora V Ardila
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Lucia Viola
- Thoracic Oncology Unit, Fundación Neumológica Colombiana-FNC, Bogotá, Colombia
| | - Gonzalo Recondo
- Thoracic Oncology Unit, Centro de Educación Médica e Investigaciones Clinicas (CEMIC), Buenos Aires, Argentina
| | - Juan B Blaquier
- Thoracic Oncology Unit, Centro de Educación Médica e Investigaciones Clinicas (CEMIC), Buenos Aires, Argentina
| | - Claudio Martín
- Thoracic Oncology Unit, Alexander Fleming Institute, Buenos Aires, Argentina
| | - Luis Raez
- Thoracic Oncology Program, Memorial Cancer Institute, Florida Atlantic University (FAU), Miami, FL, USA
| | - Suraj Samtani
- Medical Oncology Department, Bradford Hill Institute, Santiago, Chile
| | - Camila Ordóñez-Reyes
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | | | - Luis Corrales
- Thoracic Oncology Unit, Centro de Investigación y Manejo del Cáncer-CIMCA, San José, Costa Rica
| | - Carolina Sotelo
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | | | - Mauricio Cuello
- Medical Oncology Department, Hospital de Clínicas, Universidad de la Republica-UdeLAR, Montevideo, Uruguay
| | - Sergio Mejía
- Toracic Oncology Unit, Oncology Department, Cancer Institute, Clínica de las Américas, Medellín, Colombia
| | - Elvira Jaller
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Carlos Vargas
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Hernán Carranza
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Jorge Otero
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Pilar Archila
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Maritza Bermudez
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Tatiana Gamez
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Alessandro Russo
- Medical Oncology Department, Azienda Ospedaliera Papardo, Messina, Sicilia, Italy
| | - Umberto Malapelle
- Predictive Molecular Pathology Laboratory, Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Diego de Miguel Perez
- Thoracic Oncology Center, Tisch Cáncer Center, Mount Sinai Hospital System & Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | | | - Helano Freitas
- Thoracic Oncology Unit, A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | - Erick Saldahna
- Thoracic Oncology Unit, A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | - Christian Rolfo
- Thoracic Oncology Center, Tisch Cáncer Center, Mount Sinai Hospital System & Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Rafael Rosell
- Cancer Biology and Precision Medicine Program, Germans Trias i Pujol Research Institute (IGTP)/Dr. Rosell Oncology Institute (IOR) Quirón-Dexeus University Institute, Barcelona, Spain
| |
Collapse
|
3
|
Arrieta O, Hernández-Pedro N, Maldonado F, Ramos-Ramírez M, Yamamoto-Ramos M, López-Macías D, Lozano F, Zatarain-Barrón ZL, Turcott JG, Barrios-Bernal P, Orozco-Morales M, Flores-Estrada D, Cardona AF, Rolfo C, Cacho-Díaz B. Nitroglycerin Plus Whole Intracranial Radiation Therapy for Brain Metastases in Patients With Non-Small Cell Lung Cancer: A Randomized, Open-Label, Phase 2 Clinical Trial. Int J Radiat Oncol Biol Phys 2023; 115:592-607. [PMID: 35157994 DOI: 10.1016/j.ijrobp.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE Hypoxia has been associated with chemoradioresistance secondary to vascular endothelial growth factor receptor induced by hypoxia-induced factor (HIF). Nitroglycerin (NTG) can reduce HIF-1 in tissues, and this may have antiangiogenic, proapoptotic, and antiefflux effects. Particularly, epidermal growth factor-mutated (EGFRm) tumor cell lines have been shown to overexpress both vascular endothelial growth factor and HIF. In this phase 2 study, we evaluated the effect of transdermal NTG plus whole brain radiation therapy (WBRT) in patients with non-small cell lung cancer (NSCLC) with brain metastases (BM). METHODS This was an open-label, phase 2 clinical trial with 96 patients with NSCLC and BM. Patients were randomized 1:1 to receive NTG plus WBRT (30 Gy in 10 fractions) or WBRT alone. The primary endpoint was intracranial objective response rate (iORR) evaluated 3 months posttreatment. NTG was administered using a transdermal 36-mg patch from Monday through Friday throughout WBRT administration (10 days). The protocol was retrospectively registered at ClinicalTrials.gov (NCT04338867). RESULTS Fifty patients were allocated to the control group, and 46 were allocated to the experimental group (NTG); among these, 26 (52%) had EGFRm in the control group and 21 (45.7%) had EGFRm in the NTG arm. In terms of the iORR, patients in the NTG group had a significantly higher response compared with controls (56.5% [n = 26/46 evaluable patients] vs 32.7% [n = 16/49 evaluable patients]; relative risk, 1.73; 95% confidence interval [CI], 1.08-2.78; P = .024). Additionally, patients who received NTG + WBRT had an independently prolonged intracranial progression-free survival (ICPFS) compared with those who received WBRT alone (27.7 vs 9.6; hazard ratio [HR], 0.5; 95% CI, 0.2-0.9; P = .020); this positively affected overall progression-free survival among patients who received systemic therapy (n = 88; HR, 0.5; 95% CI, 0.2-0.9; P = .043). The benefit of ICPFS (HR, 0.4; 95% CI, 0.2-0.9; P = .030) was significant in the EGFRm patient subgroup. No differences were observed in overall survival. A significantly higher rate of vomiting presented in the NTG arm of the study (P = .016). CONCLUSIONS The concurrent administration of NTG and radiation therapy improves iORR and ICPFS among patients with NSCLC with BM. The benefit in ICPFS is significant in the EGFRm patient subgroup.
Collapse
Affiliation(s)
- Oscar Arrieta
- Thoracic Oncology Unit and Laboratory of Personalized Medicine.
| | - Norma Hernández-Pedro
- Thoracic Oncology Unit and Laboratory of Personalized Medicine; Personalized Medicine Laboratory
| | - Federico Maldonado
- Department of Radio-Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | | | | | - Francisco Lozano
- Department of Radio-Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - Jenny G Turcott
- Thoracic Oncology Unit and Laboratory of Personalized Medicine
| | | | | | | | - Andrés F Cardona
- Clinical and Translational Oncology Group, Fundación Santa Fe de Bogotá, Bogotá, Colombia; Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia
| | - Christian Rolfo
- Marlene and Stewart Greenbaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland
| | | |
Collapse
|
4
|
Raez LE, Arrieta O, Chamorro DF, Soberanis-Piña PD, Corrales L, Martín C, Cuello M, Samtani S, Recondo G, Mas L, Zatarain-Barrón ZL, Ruíz-Patiño A, García-Robledo JE, Ordoñez-Reyes C, Jaller E, Dickson F, Rojas L, Rolfo C, Rosell R, Cardona AF. Durvalumab After Chemoradiation for Unresectable Stage III Non-Small Cell Lung Cancer: Inferior Outcomes and Lack of Health Equity in Hispanic Patients Treated With PACIFIC Protocol (LA1-CLICaP). Front Oncol 2022; 12:904800. [PMID: 35903685 PMCID: PMC9321635 DOI: 10.3389/fonc.2022.904800] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesTo compare the rate disparity between outcomes (overall survival (OS), progression-free survival (PFS), and safety) of concurrent chemoradiation (cCRT) followed by durvalumab in two patient cohorts with locally advanced (LA) stage III non-small cell lung cancer (NSCLC), one non-Hispanic White (NHW), and the other Latin-American.MethodsA multicenter retrospective study was performed, including 80 Hispanic and 45 NHW LA stage III NSCLC patients treated with cCRT followed by durvalumab. Both cohorts were analyzed in terms of main outcomes (OS, PFS, and safety) and compared between them and with the PACIFIC trial population outcomes. The efficacy-effectiveness gap was assessed using an efficacy-effectiveness (EE) factor that was calculated by dividing each cohort median overall survival by the corresponding reference OS from the PACIFIC trial. In both cohorts, results of PD-L1 testing were recorded, and the main outcomes were compared according to PD-1 expression levels (≥50%, 1–49%, and <1%).ResultsFor the entire population (N=125), the overall response rate (ORR) was 57.6% (N=72), and 18.4% (N=25) achieved stable disease. OS was 26.3 months (95%CI 23.9-28.6), and PFS was 20.5 months (95%CI 18.0-23.0). PFS assessed by ethnicity showed a median for the Hispanic population of 19.4 months (95%CI 16.4-22.5) and 21.2 months (95%CI 17.2-23.3; p=0.76) for the NHW group. OS by race showed a significant difference in favor of the NHW group, with a median OS of 27.7 months (95%CI 24.6-30.9) vs. 20.0 months (95%CI 16.4-23.5) for Hispanics. (P=0.032). Unadjusted 12-month and 24-month OS was 86.6% (95%CI 79.9–88.0) and 46.6% (95%CI 40.2–48.3) for NHW compared to 82.5% (95%CI 77.1–84.2) and 17.5% (95%CI 15.6-24.5) in Hispanics. NHW had an EE factor of 0.78 and Hispanics had 0.58, showing a reduction in survival versus NHW and PACIFIC of 20% and 42%, respectively. HR for the OS among NHWs and Hispanics was 1.53 (95%CI 1.12-1.71; P=0.052) and 2.31 (95%CI 1.76-2.49; P=0.004). Fifty-six patients (44.8%) had some degree of pneumonitis due to cCRT plus durvalumab. There was no difference in the proportion of pneumonitis according to race (P=0.95), and the severity of pneumonitis was not significantly different between Hispanics and NHWs (P=0.41).ConclusionsAmong patients with LA stage III NSCLC, NHW had better survival outcomes when compared to Hispanics, with an OS that seems to favor the NHW population and with an EE factor that shows a shorter survival in Hispanics compared with NHW and with the PACIFIC trial group.
Collapse
Affiliation(s)
- Luis E. Raez
- Thoracic Oncology Program, Memorial Cancer Institute, Florida Atlantic University (FAU), Miami, FL, United States
| | - Oscar Arrieta
- Thoracic Oncology Unit and Personalized Oncology Laboratory, National Cancer Institute (INCan), Mexico City, Mexico
| | - Diego F. Chamorro
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | | | - Luis Corrales
- Thoracic Oncology Unit, Centro de Investigación y Manejo del Cáncer – CIMCA, San José, Costa Rica
| | - Claudio Martín
- Thoracic Oncology Unit, Alexander Fleming Institute, Buenos Aires, Argentina
| | - Mauricio Cuello
- Medical Oncology Department, Hospital de Clínicas, Universidad de la Republica – UdeLAR, Montevideo, Uruguay
| | - Suraj Samtani
- Medical Oncology Department, Clinica Las Condes, Santiago, Chile
| | - Gonzalo Recondo
- Thoracic Oncology Unit, Centro de Educación Médica e Investigaciones Clinicas (CEMIC), Buenos Aires, Argentina
| | - Luis Mas
- Medical Oncology Department, Instituto Nacional de Enfermedades Neoplásicas – INEN, Lima, Peru
| | - Zyanya Lucia Zatarain-Barrón
- Thoracic Oncology Unit and Personalized Oncology Laboratory, National Cancer Institute (INCan), Mexico City, Mexico
| | - Alejandro Ruíz-Patiño
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | | | - Camila Ordoñez-Reyes
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Elvira Jaller
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Franco Dickson
- Thoracic Oncology Program, Memorial Cancer Institute, Florida Atlantic University (FAU), Miami, FL, United States
| | - Leonardo Rojas
- Clinical Oncology Department, Clínica Colsanitas, Bogotá, Colombia
| | - Christian Rolfo
- Thoracic Oncology Center, Tisch Cáncer Center, Mount Sinai Hospital System & Icahn School of Medicine, Mount Sinai, New York, NY, United States
| | - Rafael Rosell
- Cancer Biology and Precision Medicine Program, Germans Trias i Pujol Research Institute (IGTP)/Dr. Rosell Oncology Institute (IOR) Quirón-Dexeus University Institute, Barcelona, Spain
| | - Andrés F. Cardona
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
- Direction of Research, Science and Education, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
- *Correspondence: Andrés F. Cardona,
| |
Collapse
|
5
|
Rojas L, Mayorga D, Ruiz-Patiño A, Rodríguez J, Cardona AF, Archila P, Avila J, Bravo M, Ricaurte L, Sotelo C, Arrieta O, Zatarain-Barrón ZL, Carranza H, Otero J, Vargas C, Barrón F, Corrales L, Martín C, Recondo G, Pino LE, Bermudez MA, Gamez T, Ordoñez-Reyes C, García-Robledo JE, de Lima VC, Freitas H, Santoyo N, Malapelle U, Russo A, Rolfo C, Rosell R. Human papillomavirus infection and lung adenocarcinoma: special benefit is observed in patients treated with immune checkpoint inhibitors. ESMO Open 2022; 7:100500. [PMID: 35753086 PMCID: PMC9434139 DOI: 10.1016/j.esmoop.2022.100500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/27/2022] [Accepted: 04/19/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Human papilloma virus (HPV) has been associated with the development and modulation of response in a series of neoplasms. In the case of lung adenocarcinoma, its role in etiology and pathogenesis is still controversial. Considering that this infection brings foreign epitopes, it could be of prognostic significance in patients with lung adenocarcinoma treated with immunotherapy. METHODS In a retrospective cohort study we evaluated the presence of HPV genomic material in lung adenocarcinoma primary lesions with the INNO-LiPA platform. Viral replication was also evaluated by detecting the presence of oncoprotein E6/E7 messenger RNA (mRNA) by quantitative RT-PCR. To confirm possible hypotheses regarding viral oncogenesis, vascular endothelial growth factor (VEGF) and hypoxia-inducible factor 1 (HIF1) were evaluated with stromal fibrosis and immunoscore. RESULTS A total of 133 patients were included in the analysis, of whom 34 tested positive for HPV, reaching an estimated prevalence of 25.6% [95% confidence interval (CI) 18.2% to 32.9%]. E6/7 mRNA was identified in 28 out of the 34 previously positive cases (82.3%). In immune checkpoint inhibitor (ICI)-treated patients, the median overall survival reached 22.3 months [95% CI 19.4 months- not reached (NR)] for HPV-negative and was not reached in HPV-positive (HPV+) ones (95% CI 27.7-NR; P = 0.008). With regard to progression-free survival, HPV- patients reached a median of 9.2 months (95% CI 7.9-11.2 months) compared to 14.3 months (95% CI 13.8-16.4 months) when HPV was positive (P = 0.001). The overall response rate for HPV+ patients yielded 82.4% compared to 47.1% in negative ones. No differences regarding programmed death-ligand 1, VEGF, HIF1, stromal fibrosis, or immunoscore were identified. CONCLUSIONS In patients with HPV+ lung adenocarcinoma, a significant benefit in overall response and survival outcomes is observed.
Collapse
Affiliation(s)
- L Rojas
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia; Oncology Department, Clinica Colsanitas, Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (FOX-G), Universidad el Bosque, Bogotá, Colombia; Clinical and Traslational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia
| | - D Mayorga
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (FOX-G), Universidad el Bosque, Bogotá, Colombia
| | - A Ruiz-Patiño
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (FOX-G), Universidad el Bosque, Bogotá, Colombia
| | - J Rodríguez
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (FOX-G), Universidad el Bosque, Bogotá, Colombia
| | - A F Cardona
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia; Oncology Department, Clinica Colsanitas, Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (FOX-G), Universidad el Bosque, Bogotá, Colombia; Clinical and Traslational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia.
| | - P Archila
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (FOX-G), Universidad el Bosque, Bogotá, Colombia
| | - J Avila
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (FOX-G), Universidad el Bosque, Bogotá, Colombia
| | - M Bravo
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (FOX-G), Universidad el Bosque, Bogotá, Colombia
| | - L Ricaurte
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (FOX-G), Universidad el Bosque, Bogotá, Colombia; Pathology Department, Mayo Clinic, Rochester, USA
| | - C Sotelo
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (FOX-G), Universidad el Bosque, Bogotá, Colombia
| | - O Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), México City, México
| | - Z L Zatarain-Barrón
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), México City, México
| | - H Carranza
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia; Oncology Department, Clinica Colsanitas, Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (FOX-G), Universidad el Bosque, Bogotá, Colombia; Clinical and Traslational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia
| | - J Otero
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia; Oncology Department, Clinica Colsanitas, Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (FOX-G), Universidad el Bosque, Bogotá, Colombia; Clinical and Traslational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia
| | - C Vargas
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia; Oncology Department, Clinica Colsanitas, Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (FOX-G), Universidad el Bosque, Bogotá, Colombia; Clinical and Traslational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia
| | - F Barrón
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), México City, México
| | - L Corrales
- Medical Oncology Department, Centro de Investigación y Manejo del Cáncer - CIMCA, San José, Costa Rica
| | - C Martín
- Thoracic Oncology Unit, Alexander Fleming Institute, Buenos Aires, Argentina
| | - G Recondo
- Thoracic Oncology Unit, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - L E Pino
- Clinical Oncology Department, Institute of Oncology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - M A Bermudez
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (FOX-G), Universidad el Bosque, Bogotá, Colombia
| | - T Gamez
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (FOX-G), Universidad el Bosque, Bogotá, Colombia
| | - C Ordoñez-Reyes
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (FOX-G), Universidad el Bosque, Bogotá, Colombia
| | | | - V C de Lima
- Medical Oncology Department, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Oncologia D'Or, São Paulo, Brazil
| | - H Freitas
- Medical Oncology Department, Thoracic Oncology Section, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - N Santoyo
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (FOX-G), Universidad el Bosque, Bogotá, Colombia
| | - U Malapelle
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - A Russo
- Medical Oncology Unit, A.O. Papardo, Messina, Italy
| | - C Rolfo
- Center for Thoracic Oncology, Tisch Cancer Center, Mount Sinai Hospital System & Icahn School of Medicine, Mount Sinai, New York, USA
| | - R Rosell
- Coyote Research Group, Pangaea Oncology, Laboratory of Molecular Biology, Quiron-Dexeus University Institute, Barcelona, Spain; Institut d'Investigació en Ciències Germans Trias i Pujol, Badalona, Spain; Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Badalona, Spain
| | | |
Collapse
|
6
|
Cardona AF, Mejía SA, Viola L, Chamorro DF, Rojas L, Ruíz-Patiño A, Serna A, Martínez S, Muñoz Á, Rodríguez J, García-Robledo JE, Pino LE, Zatarain-Barrón ZL, Arrieta O. Lung Cancer in Colombia. J Thorac Oncol 2022; 17:953-960. [PMID: 35717323 DOI: 10.1016/j.jtho.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Andres Felipe Cardona
- Direction of Research, Science and Education, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia; Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia.
| | - Sergio A Mejía
- Cancer Institute, Clinica las Americas - AUNA, Medellin, Colombia
| | - Lucia Viola
- Thoracic Oncology Unit, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - Diego F Chamorro
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Leonardo Rojas
- Clinical Oncology Department, Clínica Colsanitas, Bogotá, Colombia
| | - Alejandro Ruíz-Patiño
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Adriana Serna
- Thoracic Surgery Department, Marly Clinic "Jorge Cavelier Gaviria," Chía, Cundinamarca, Colombia
| | - Stella Martínez
- Thoracic Surgery Department, Clínica Colsanitas, Bogotá, Cundinamarca, Colombia
| | - Álvaro Muñoz
- Radiation Oncology Department, Carlos Ardila Lülle Cancer Institute-ICCAL, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - July Rodríguez
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | | | - Luis Eduardo Pino
- Clinical Oncology Department, Carlos Ardila Lülle Cancer Institute-ICCAL, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Zyanya Lucia Zatarain-Barrón
- Thoracic Oncology Unit and Personalized Oncology Laboratory, National Cancer Institute (INCan), México City, México
| | - Oscar Arrieta
- Thoracic Oncology Unit and Personalized Oncology Laboratory, National Cancer Institute (INCan), México City, México
| |
Collapse
|
7
|
Cardona AF, Ruiz-Patiño A, Recondo G, Martín C, Raez L, Samtani S, Minata JN, Blaquier JB, Enrico D, Burotto M, Ordóñez-Reyes C, Chamorro DF, Garcia-Robledo JE, Corrales L, Zatarain-Barrón ZL, Más L, Sotelo C, Ricaurte L, Santoyo N, Cuello M, Mejía S, Jaller E, Vargas C, Carranza H, Otero J, Rodríguez J, Archila P, Bermudez M, Gamez T, de Lima VC, Freitas H, Russo A, Polo C, Malapelle U, Perez DDM, Rolfo C, Viola L, Rosell R, Arrieta O. Mechanisms of Resistance to first-line Osimertinib in Hispanic patients with EGFR mutant non-small cell lung cancer (FRESTON-CLICaP). Clin Lung Cancer 2022; 23:522-531. [DOI: 10.1016/j.cllc.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/24/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022]
|
8
|
Cerezo-Cortés MI, Rodríguez-Castillo JG, Mata-Espinosa DA, Bini EI, Barrios-Payan J, Zatarain-Barrón ZL, Anzola JM, Cornejo-Granados F, Ochoa-Leyva A, Del Portillo P, Murcia MI, Hernández-Pando R. Close Related Drug-Resistance Beijing Isolates of Mycobacterium tuberculosis Reveal a Different Transcriptomic Signature in a Murine Disease Progression Model. Int J Mol Sci 2022; 23:ijms23095157. [PMID: 35563545 PMCID: PMC9100210 DOI: 10.3390/ijms23095157] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 12/10/2022] Open
Abstract
Mycobacterium tuberculosis (MTB) lineage 2/Beijing is associated with high virulence and drug resistance worldwide. In Colombia, the Beijing genotype has circulated since 1997, predominantly on the pacific coast, with the Beijing-Like SIT-190 being more prevalent. This genotype conforms to a drug-resistant cluster and shows a fatal outcome in patients. To better understand virulence determinants, we performed a transcriptomic analysis with a Beijing-Like SIT-190 isolate (BL-323), and Beijing-Classic SIT-1 isolate (BC-391) in progressive tuberculosis (TB) murine model. Bacterial RNA was extracted from mice lungs on days 3, 14, 28, and 60. On average, 0.6% of the total reads mapped against MTB genomes and of those, 90% against coding genes. The strains were independently associated as determined by hierarchical cluster and multidimensional scaling analysis. Gene ontology showed that in strain BL-323 enriched functions were related to host immune response and hypoxia, while proteolysis and protein folding were enriched in the BC-391 strain. Altogether, our results suggested a differential bacterial transcriptional program when evaluating these two closely related strains. The data presented here could potentially impact the control of this emerging, highly virulent, and drug-resistant genotype.
Collapse
Affiliation(s)
- María Irene Cerezo-Cortés
- Laboratorio de Micobacterias, Departamento de Microbiología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá 111321, Colombia; (M.I.C.-C.); (J.G.R.-C.)
| | - Juan Germán Rodríguez-Castillo
- Laboratorio de Micobacterias, Departamento de Microbiología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá 111321, Colombia; (M.I.C.-C.); (J.G.R.-C.)
| | - Dulce Adriana Mata-Espinosa
- Sección de Patología Experimental, Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México 14080, Mexico; (D.A.M.-E.); (E.I.B.); (J.B.-P.); (Z.L.Z.-B.)
| | - Estela Isabel Bini
- Sección de Patología Experimental, Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México 14080, Mexico; (D.A.M.-E.); (E.I.B.); (J.B.-P.); (Z.L.Z.-B.)
| | - Jorge Barrios-Payan
- Sección de Patología Experimental, Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México 14080, Mexico; (D.A.M.-E.); (E.I.B.); (J.B.-P.); (Z.L.Z.-B.)
| | - Zyanya Lucia Zatarain-Barrón
- Sección de Patología Experimental, Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México 14080, Mexico; (D.A.M.-E.); (E.I.B.); (J.B.-P.); (Z.L.Z.-B.)
| | - Juan Manuel Anzola
- Grupo de Biotecnología Molecular, Grupo de Bioinformática y Biología Computacional, Corporación CorpoGen, Bogotá 110311, Colombia; (J.M.A.); (P.D.P.)
- Universidad Central, Facultad de Ingeniería y Ciencias Básicas Bogotá, Bogotá 100270, Colombia
| | - Fernanda Cornejo-Granados
- Departamento de Microbiología Molecular, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca 62210, Mexico; (F.C.-G.); (A.O.-L.)
| | - Adrian Ochoa-Leyva
- Departamento de Microbiología Molecular, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca 62210, Mexico; (F.C.-G.); (A.O.-L.)
| | - Patricia Del Portillo
- Grupo de Biotecnología Molecular, Grupo de Bioinformática y Biología Computacional, Corporación CorpoGen, Bogotá 110311, Colombia; (J.M.A.); (P.D.P.)
| | - Martha Isabel Murcia
- Laboratorio de Micobacterias, Departamento de Microbiología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá 111321, Colombia; (M.I.C.-C.); (J.G.R.-C.)
- Correspondence: (M.I.M.); (R.H.-P.)
| | - Rogelio Hernández-Pando
- Sección de Patología Experimental, Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México 14080, Mexico; (D.A.M.-E.); (E.I.B.); (J.B.-P.); (Z.L.Z.-B.)
- Correspondence: (M.I.M.); (R.H.-P.)
| |
Collapse
|
9
|
Arrieta O, Zatarain-Barrón ZL, Cardona AF, Corrales L, Martin C, Cuello M. Uniting Latin America Through Research: How Regional Research Can Strengthen Local Policies, Networking, and Outcomes for Patients With Lung Cancer. Am Soc Clin Oncol Educ Book 2022; 42:1-7. [PMID: 35503985 DOI: 10.1200/edbk_349951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lung cancer represents a considerable global health threat, leading the list in terms of cancer-related deaths worldwide. An important proportion of lung cancer cases occur within Latin America, and current projections show that over the next decade, the number of deaths due to lung cancer will double in the region, underscoring the need to implement evidence-based interventions to improve outcomes. Several challenges have limited the progress in lung cancer research in Latin America for many years, though recently the surge of multidisciplinary, transnational, and transcultural research groups have overcome many of these limitations. The increase in region-specific knowledge has improved cancer care in the area, providing clinicians with a specific demographic and molecular profile for Hispanic patients with lung cancer; as a result, the implementation of precision oncology has benefited from a profound knowledge of the patient profile. Nonetheless, there are still challenges to improve research in Latin America, including stabilizing funding sources to continue independent research, supporting mentoring programs and an early immersion in clinical research for early career fellows, and overcoming barriers for publishing.
Collapse
Affiliation(s)
- Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - Andrés F Cardona
- Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
| | - Luis Corrales
- Clinical Oncology Department, Centro de Investigaciones y Manejo del Cancer, San Jose, Costa Rica
| | - Claudio Martin
- Thoracic Oncology Unit, Instituto Fleming, Buenos Aires, Argentina
| | - Mauricio Cuello
- Medical Oncology Department, Hospital de Clinica, Universidad de la Republica, Montevideo, Uruguay
| |
Collapse
|
10
|
Arrieta O, Zatarain-Barrón ZL, Turcott JG, Barrón F, Yendamuri S, Cardona AF, Rosell R. Association of BMI With Benefit of Metformin Plus Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors in Patients With Advanced Lung Adenocarcinoma: A Secondary Analysis of a Phase 2 Randomized Clinical Trial. JAMA Oncol 2022; 8:477-479. [PMID: 35024769 PMCID: PMC8759028 DOI: 10.1001/jamaoncol.2021.7015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, México City, México
| | | | - Jenny G. Turcott
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, México City, México
| | - Feliciano Barrón
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, México City, México
| | - Sai Yendamuri
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Andrés F. Cardona
- Luis Carolos Sarmiento Angulo Cancer Treatment and Research Center, Bogotá, Columbia,Foundation for Clinical and Applied Cancer Research, Bogotá, Columbia,Molecular Oncology and Biology Systems Research Group, Universidad El Bosque, Bogotá, Columbia
| | - Rafael Rosell
- Catalan Institute of Oncology, Germans Trias i Pujol Research Institute and Hospital Campus Can Ruti, Barcelona, Spain
| |
Collapse
|
11
|
Burgos R, Cardona AF, Santoyo N, Ruiz-Patiño A, Cure-Casilimas J, Rojas L, Ricaurte L, Muñoz Á, Garcia-Robledo JE, Ordoñez C, Sotelo C, Rodríguez J, Zatarain-Barrón ZL, Pineda D, Arrieta O. Case Report: Differential Genomics and Evolution of a Meningeal Melanoma Treated With Ipilimumab and Nivolumab. Front Oncol 2022; 11:691017. [PMID: 35070950 PMCID: PMC8766339 DOI: 10.3389/fonc.2021.691017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022] Open
Abstract
Primary melanocytic tumors of the CNS are extremely rare conditions, encompassing different disease processes including meningeal melanoma and meningeal melanocytosis. Its incidence range between 3-5%, with approximately 0.005 cases per 100,000 people. Tumor biological behavior is commonly aggressive, with poor prognosis and very low survivability, and a high recurrence rate, even after disease remission with multimodal treatments. Specific genetic alterations involving gene transcription, alternative splicing, RNA translation, and cell proliferation are usually seen, affecting genes like BRAF, TERT, GNAQ, SF3B1, and EIF1AX. Here we present an interesting case of a 59-year-old male presenting with neurologic symptoms and a further confirmed diagnosis of primary meningeal melanoma. Multiple therapy lines were used, including radiosurgery, immunotherapy, and chemotherapy. The patient developed two relapses and an evolving genetic makeup that confirmed the disease’s clonal origin. We also provide a review of the literature on the genetic basis of primary melanocytic tumors of the CNS.
Collapse
Affiliation(s)
- Remberto Burgos
- Neurosurgery Department, Clínica del Country/Clínica Colsanitas, Bogotá, Colombia
| | - Andrés F Cardona
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia.,Direction of Research and Education, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
| | - Nicolas Santoyo
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
| | - Alejandro Ruiz-Patiño
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | | | - Leonardo Rojas
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia.,Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia.,Clinical Oncology Department, Clínica Colsanitas, Bogotá, Colombia
| | - Luisa Ricaurte
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia.,Direction of Research and Education, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
| | - Álvaro Muñoz
- Radiotherapy Department, Carlos Ardila Lulle Institute of Cancer (ICCAL), Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | | | - Camila Ordoñez
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Carolina Sotelo
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - July Rodríguez
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Zyanya Lucia Zatarain-Barrón
- Thoracic Oncology Unit and Personalized Oncology Laboratory, National Cancer Institute (INCan), México City, Mexico
| | - Diego Pineda
- Thoracic Oncology Unit and Personalized Oncology Laboratory, National Cancer Institute (INCan), México City, Mexico
| | - Oscar Arrieta
- Radiology Department, Clinica del County/Resonancia Magnética de Colombia, Bogotá, Colombia
| |
Collapse
|
12
|
Cardona AF, Jaramillo-Velásquez D, Ruiz-Patiño A, Polo C, Jiménez E, Hakim F, Gómez D, Ramón JF, Cifuentes H, Mejía JA, Salguero F, Ordoñez C, Muñoz Á, Bermúdez S, Useche N, Pineda D, Ricaurte L, Zatarain-Barrón ZL, Rodríguez J, Avila J, Rojas L, Jaller E, Sotelo C, Garcia-Robledo JE, Santoyo N, Rolfo C, Rosell R, Arrieta O. Efficacy of osimertinib plus bevacizumab in glioblastoma patients with simultaneous EGFR amplification and EGFRvIII mutation. J Neurooncol 2021; 154:353-364. [PMID: 34498213 DOI: 10.1007/s11060-021-03834-3] [Citation(s) in RCA: 2] [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] [Received: 07/08/2021] [Accepted: 08/19/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Amplification of EGFR and its active mutant EGFRvIII are common in glioblastoma (GB). While EGFR and EGFRvIII play critical roles in pathogenesis, targeted therapy with EGFR-tyrosine kinase inhibitors or antibodies has shown limited efficacy. To improve the likelihood of effectiveness, we targeted adult patients with recurrent GB enriched for simultaneous EGFR amplification and EGFRvIII mutation, with osimertinib/bevacizumab at doses described for non-small cell lung cancer. METHODS We retrospectively explored whether previously described EGFRvIII mutation in association with EGFR gene amplification could predict response to osimertinib/bevacizumab combination in a subset of 15 patients treated at recurrence. The resistance pattern in a subgroup of subjects is described using a commercial next-generation sequencing panel in liquid biopsy. RESULTS There were ten males (66.7%), and the median patient's age was 56 years (range 38-70 years). After their initial diagnosis, 12 patients underwent partial (26.7%) or total resection (53.3%). Subsequently, all cases received IMRT and concurrent and adjuvant temozolomide (TMZ; the median number of cycles 9, range 6-12). The median follow-up after recurrence was 17.1 months (95% CI 12.3-22.6). All patients received osimertinib/bevacizumab as a second-line intervention with a median progression-free survival (PFS) of 5.1 months (95% CI 2.8-7.3) and overall survival of 9.0 months (95% CI 3.9-14.0). The PFS6 was 46.7%, and the overall response rate was 13.3%. After exposure to the osimertinib/bevacizumab combination, the main secondary alterations were MET amplification, STAT3, IGF1R, PTEN, and PDGFR. CONCLUSIONS While the osimertinib/bevacizumab combination was marginally effective in most GB patients with simultaneous EGFR amplification plus EGFRvIII mutation, a subgroup experienced a long-lasting meaningful benefit. The findings of this brief cohort justify the continuation of the research in a clinical trial. The pattern of resistance after exposure to osimertinib/bevacizumab includes known mechanisms in the regulation of EGFR, findings that contribute to the understanding and targeting in a stepwise rational this pathway.
Collapse
Affiliation(s)
- Andrés F Cardona
- Clinical and Translational Oncology Group, Brain Tumor Unit, Clínica del Country, Calle 116 No. 9 - 72, c. 318, Bogotá, Colombia. .,Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia. .,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia. .,Thoracic Oncology Unit, Clínica del Country, Bogotá, Colombia.
| | | | - Alejandro Ruiz-Patiño
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Carolina Polo
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Enrique Jiménez
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Fernando Hakim
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Diego Gómez
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | | | | | | | - Fernando Salguero
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Camila Ordoñez
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Álvaro Muñoz
- Radio-Oncology Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Sonia Bermúdez
- Neuroradiology Section, Radiology Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Nicolas Useche
- Neuroradiology Section, Radiology Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Diego Pineda
- Neuroradiology Section, Radiology Department, Clínica del Country, Bogotá, Colombia
| | | | | | - July Rodríguez
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Jenny Avila
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Leonardo Rojas
- Clinical and Translational Oncology Group, Brain Tumor Unit, Clínica del Country, Calle 116 No. 9 - 72, c. 318, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia.,Clinical Oncology Department, Clínica Colsanitas, Bogotá, Colombia
| | - Elvira Jaller
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Carolina Sotelo
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | | | - Nicolas Santoyo
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Christian Rolfo
- Center for Thoracic Oncology, Tisch Cáncer Center, Mount Sinai Hospital System & Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Rafael Rosell
- Cancer Biology and Precision Medicine Program, Catalan Institute of Oncology, Barcelona, Spain
| | - Oscar Arrieta
- Laboratory of Personalized Medicine, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| |
Collapse
|
13
|
Turcott JG, Zatarain-Barrón ZL, Cárdenas Fernández D, Castañares Bolaños DT, Arrieta O. Appetite stimulants for patients with cancer: current evidence for clinical practice. Nutr Rev 2021; 80:857-873. [PMID: 34389868 DOI: 10.1093/nutrit/nuab045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The incidence of neoplastic diseases has increased worldwide, with an estimated global burden of 19.3 million incident cases and 10 million deaths in 2020-a considerable increase compared with 9.6 million deaths in 2018. One of the most prevalent problems faced by patients with cancer and their physicians is malnutrition. It is estimated that patients with cancer have important nutritional alterations in 25% to 70% of cases, which directly affects many spheres of patient care and well-being, including quality of life, treatment toxicity, and survival outcomes. Despite the overwhelming need to address this pressing issue, current evidence in terms of pharmacologic interventions for cancer-related anorexia remains inconclusive, and there is no current standard of care for patients with cancer-related anorexia. Nonetheless, international guidelines recommend promoting anabolism through nutritional, physical, and pharmacologic therapies. In this review, the available information is summarized regarding pharmacologic therapies to treat cancer-related anorexia and findings are highlighted from a clinical stance.
Collapse
Affiliation(s)
- Jenny G Turcott
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | | | | | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, Mexico City, Mexico
| |
Collapse
|
14
|
Arrieta O, Maldonado F, Turcott JG, Zatarain-Barrón ZL, Barrón F, Blake-Cerda M, Cabrera-Miranda LA, Cardona AF, de la Garza JG, Rosell R. Prophylactic Cranial Irradiation Reduces Brain Metastases and Improves Overall Survival in High-Risk Metastatic Non-Small Cell Lung Cancer Patients: A Randomized phase 2 Study (PRoT-BM trial). Int J Radiat Oncol Biol Phys 2021; 110:1442-1450. [PMID: 33640422 DOI: 10.1016/j.ijrobp.2021.02.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/27/2021] [Accepted: 02/19/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To date, studies regarding the use of prophylactic cranial irradiation (PCI) versus standard of care (SoC) for patients with non-small cell lung cancer (NSCLC) have not shown a significant effect in terms of overall survival (OS). Additionally, the effect of PCI among high-risk patients has been scarcely studied. The objective of this randomized phase 2 study was to evaluate the role of PCI in a population of patients at high risk for development of brain metastases (BM). METHODS AND MATERIALS Eligible patients had histologically confirmed NSCLC without baseline BM, harboring epidermal growth factor receptor mutations, anaplastic lymphoma kinase rearrangements, or elevated carcinoembryonic antigen levels at the time of diagnosis. Participants received systemic therapy according to molecular status, those without progressive disease were then assigned to receive SoC or SoC + PCI (25 Gy in 10 fractions). The primary outcome was cumulative incidence of brain metastases (CBM). The secondary endpoints included progression-free survival and OS. Quality of life and neurocognitive function are discussed in a separate article (Clinicaltrials.gov: NCT01603849). RESULTS From May 2012 to December 2017, 84 patients were enrolled in the study, with 41 patients allocated to receive PCI and 43 received SoC. Patients allocated to receive PCI had a CBM at 24 months of 7% versus 38% in those allocated to the SoC arm. PCI was associated with a hazard ratio of 0.12 (95% confidence interval, 0.035-0.42) for developing BM. A benefit in OS was also observed (64.5 vs 19.8 months; hazard ratio: 0.41 (95% confidence interval, 0.22-0.78; P =∙007). CONCLUSIONS Among a selected population at high risk for developing BM, PCI significantly decreased CBM in addition to increasing progression-free survival and OS. To our knowledge, this is the first study to evaluate PCI in epidermal growth factor receptor mutations, anaplastic lymphoma kinase rearrangements, or elevated carcinoembryonic antigen levels in patients with NSCLC, showing a significant improvement in CBM. This relevant information should be of particular importance in the context of patients without access to third-generation targeted agents. Further studies are warranted to ascertain this effect.
Collapse
Affiliation(s)
- Oscar Arrieta
- Thoracic Oncology Unit, National Cancer Institute, México City, México.
| | - Federico Maldonado
- Departamento de Radio-Oncología, National Cancer Institute, México City, México
| | - Jenny G Turcott
- Thoracic Oncology Unit, National Cancer Institute, México City, México
| | | | - Feliciano Barrón
- Thoracic Oncology Unit, National Cancer Institute, México City, México
| | - Mónika Blake-Cerda
- Departamento de Radio-Oncología, National Cancer Institute, México City, México
| | | | - Andrés F Cardona
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia; Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia
| | | | - Rafael Rosell
- Catalan Institute of Oncology, Germans Trias i Pujol Research Institute and Hospital Campus Can Ruti Barcelona, Spain
| |
Collapse
|
15
|
Maldonado F, Gonzalez-Ling A, Oñate-Ocaña LF, Cabrera-Miranda LA, Zatarain-Barrón ZL, Turcott JG, Flores-Estrada D, Lozano-Ruiz F, Cacho-Díaz B, Arrieta O. Prophylactic Cranial Irradiation in Patients With High-Risk Metastatic Non-Small Cell Lung Cancer: Quality of Life and Neurocognitive Analysis of a Randomized Phase II Study. Int J Radiat Oncol Biol Phys 2021; 111:81-92. [PMID: 33915217 DOI: 10.1016/j.ijrobp.2021.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/31/2021] [Accepted: 04/14/2021] [Indexed: 01/05/2023]
Abstract
PURPOSE To this date, studies regarding the use of prophylactic cranial irradiation (PCI) versus standard of care (SoC) for patients with non-small cell lung cancer have shown limited benefit in survival outcomes, in addition to the potential effects on quality of life (QoL) and neurocognitive function (NCF). This randomized, phase II study evaluated the role of PCI in QoL and NCF, in a population comprised of subjects at a high risk for development of brain metastases (BM). METHODS AND MATERIALS Eligible patients had histologically confirmed non-small cell lung cancer without baseline BM, harboring epidermal growth factor receptor mutations, anaplastic lymphoma kinase rearrangements, or elevated carcinoembryonic antigen (CEA) at diagnosis. Participants were assigned to receive SoC or SoC plus PCI (25 Gy in 10 fractions). Primary endpoint was BM at 24 months (BM-24), for which the study was powered. Secondary endpoints included QoL assessed using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) and the Lung Cancer module (LC13) and NCF assessed using the Mini Mental State Examination (MMSE). Patients were followed every 3 months for a year for QoL and NCF. RESULTS From May 2012 to December 2017, 84 patients were enrolled in the study, 41 were allocated to PCI while 43 received SoC. Efficacy outcomes are discussed in a separate article. The global health-QoL scores were similar at 3, 6, 9, and 12 months after randomization between both study arms, with no significant differences when comparing by groups. At 1-year postrandomization, median global health QoL scores were 83 (p25-p75: 75-83) and 83 (p25-p75: 75-83) in the control and experimental arms, respectively. There were no significant changes in terms of the mean differences between subjects in either study arm when analyzing the change between baseline and 12-month scores (16.4 ± 19.9 vs 12.9 ± 14.7; P = .385). Seventeen patients were alive at database lockdown in February 2020, without significant differences in median MMSE (30 [p25-75: 29-30] vs 30 [p25-75: 28-30]) or QLQ-C30 scores (75.0 [p25-75: 50-87.2] vs 67.0 [p25-75: 50.0-100.0]). CONCLUSIONS Among a selected high-risk population for developing BM, PCI did not significantly decrease QoL or neurocognitive function as assessed using the MMSE. Future studies are warranted to assess this observation, using more varied and sensitive tools available to date.
Collapse
|
16
|
Zatarain-Barrón ZL, Cardona AF, Díaz-García D, Trejo Rosales R, Rojas L, Cruz-Rico G, Nagy R, Cabrera L, Vargas C, Saam J, Barrón F, Arrieta O. Cell-Free Circulating Tumor DNA Improves Standard Genotyping of Non-Small-Cell Lung Cancer and Increases Detection of Targetable Alterations in a Selected Hispanic Cohort. Oncology 2021; 99:539-546. [PMID: 33902046 DOI: 10.1159/000514648] [Citation(s) in RCA: 2] [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] [Received: 10/13/2020] [Accepted: 01/21/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Several studies have shown that the non-small-cell lung cancer (NSCLC) genomic background among Hispanics differs from other populations. The finding of low-frequency genomic alterations in cell-free DNA (cfDNA) can increase diagnostic accuracy and could improve treatment in NSCLC. METHODS Data from 54 Hispanic patients with advanced NSCLC with high clinical suspicion for ALK, EGFR, and ROS1 mutations were collected (including young age, female sex, and non-smokers). cfDNA was extracted from plasma and analyzed using a commercial next-generation sequencing test (Guardant360) which detects genomic alterations in 74 genes. RESULTS The median age was 56 years (range 31-83). Most patients were female (661.1%) and never smokers (72.3%). Among the patients included, 96% (52/54) had cfDNA detectable alterations with a mean number of 3.37 cfDNA alterations per test (range 1-10). cfDNA was able to detect some genomic alterations previously undetected by tissue biopsy. Among patients with insufficient or unavailable tissue to perform testing, mutations in EGFR and ALK which led to a change in therapy were determined using cfDNA in 28.8 and 3.8% of cases, respectively. Among patients with cfDNA alterations, 46.1% (n = 24) were switched to a targeted therapy with a median progression-free survival of 11.1 months (95% CI 7.6-14.6) and an overall survival of 40.3 months (95% CI 27.1-53.6). Concurrent genetic mutations with TP53 and KRAS negatively impacted the prognosis. CONCLUSIONS In a selected population of NSCLC Hispanic patients, comprehensive cfDNA analysis allowed a treatment change in 46.1% of the cases. Guardant360 allows the identification of genomic alterations to improve treatment selection and increase prognosis.
Collapse
Affiliation(s)
| | - Andrés F Cardona
- Clinical and Traslational Oncology Group, Clínica del Country, Bogotá, Colombia
| | - Diego Díaz-García
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - Leonardo Rojas
- Oncology Department, Clínica Colsanitas, Bogotá, Colombia
| | - Graciela Cruz-Rico
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - Luis Cabrera
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Carlos Vargas
- Clinical and Traslational Oncology Group, Clínica del Country, Bogotá, Colombia
| | | | - Feliciano Barrón
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| |
Collapse
|
17
|
Rodríguez J, Avila J, Rolfo C, Ruíz-Patiño A, Russo A, Ricaurte L, Ordóñez-Reyes C, Arrieta O, Zatarain-Barrón ZL, Recondo G, Cardona AF. When Tissue is an Issue the Liquid Biopsy is Nonissue: A Review. Oncol Ther 2021; 9:89-110. [PMID: 33689160 PMCID: PMC8140006 DOI: 10.1007/s40487-021-00144-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/11/2021] [Indexed: 02/07/2023] Open
Abstract
Precision medicine has impacted the field of medical oncology by introducing personalized therapies, improving all measurable outcomes. This field, in turn, has expanded to obtaining and analyzing a vast and ever-increasing amount of genomic information. One technique currently applied is the liquid biopsy, which consists of detecting and isolating DNA and exosomes in cancer patients. Newly developed techniques have made it possible to use the liquid biopsy in a wide range of settings. However, challenges regarding the validation of its clinical utility exist because of a lack of standardization across different techniques and tumor types, confounder genomic information, lack of appropriate clinical trial designs, and a non-measured, and therefore not estimated, economic impact on population health. Nowadays, liquid biopsy is not routinely used, but ongoing research is increasing its popularity, and a new era in oncology is developing. Therefore, it is essential to have an in-depth understanding of the liquid biopsy technique. In this review, we summarize the leading techniques and liquid biopsy applications in cancer.
Collapse
Affiliation(s)
- July Rodríguez
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogota, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G/ONCOLGroup), Universidad El Bosque, Bogota, Colombia
| | - Jenny Avila
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogota, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G/ONCOLGroup), Universidad El Bosque, Bogota, Colombia
| | - Christian Rolfo
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alejandro Ruíz-Patiño
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogota, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G/ONCOLGroup), Universidad El Bosque, Bogota, Colombia
| | - Alessandro Russo
- Medical Oncology Unit A.O. Papardo and Department of Human Pathology, University of Messina, Messina, Italy
| | - Luisa Ricaurte
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogota, Colombia
- Pathology Department, Mayo Clinic, Rochester, MN, USA
| | | | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - Gonzalo Recondo
- Thoracic Oncology Section, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Andrés F Cardona
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogota, Colombia.
- Molecular Oncology and Biology Systems Research Group (Fox-G/ONCOLGroup), Universidad El Bosque, Bogota, Colombia.
- Clinical and Traslational Oncology Group, Clinica del Country, Bogota, Colombia.
| |
Collapse
|
18
|
Arrieta O, Barrón F, Ramírez-Tirado LA, Zatarain-Barrón ZL, Cardona AF, Díaz-García D, Yamamoto Ramos M, Mota-Vega B, Carmona A, Peralta Álvarez MP, Bautista Y, Aldaco F, Gerson R, Rolfo C, Rosell R. Efficacy and Safety of Pembrolizumab Plus Docetaxel vs Docetaxel Alone in Patients With Previously Treated Advanced Non-Small Cell Lung Cancer: The PROLUNG Phase 2 Randomized Clinical Trial. JAMA Oncol 2021; 6:856-864. [PMID: 32271354 DOI: 10.1001/jamaoncol.2020.0409] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Importance Because of socioeconomic factors, many patients with advanced non-small cell lung cancer (NSCLC) do not receive immunotherapy in the first-line setting. It is unknown if the combination of immunotherapy with chemotherapy can provide clinical benefits in immunotherapy-naive patients with disease progression after treatment with platinum-based chemotherapy. Objective To evaluate the safety and efficacy of the combination of pembrolizumab plus docetaxel in patients with previously treated advanced NSCLC following platinum-based chemotherapy regardless of EGFR variants or programmed cell death ligand 1 status. Design, Setting, and Participants The Pembrolizumab Plus Docetaxel for Advanced Non-Small Cell Lung Cancer (PROLUNG) trial randomized 78 patients with histologically confirmed advanced NSCLC in a 1:1 ratio to receive either pembrolizumab plus docetaxel or docetaxel alone from December 2016 through May 2019. Interventions The experimental arm received docetaxel on day 1 (75 mg/m2) plus pembrolizumab on day 8 (200 mg) every 3 weeks for up to 6 cycles followed by pembrolizumab maintenance until progression or unacceptable toxic effects. The control arm received docetaxel monotherapy. Main Outcomes and Measures The primary end point was overall response rate (ORR). Secondary end points included progression-free survival (PFS), overall survival, and safety. Results Among 78 recruited patients, 32 (41%) were men, 34 (44%) were never smokers, and 25 (32%) had an EGFR/ALK alteration. Forty patients were allocated to receive pembrolizumab plus docetaxel, and 38 were allocated to receive docetaxel. A statistically significant difference in ORR, assessed by an independent reviewer, was found in patients receiving pembrolizumab plus docetaxel vs patients receiving docetaxel (42.5% vs 15.8%; odds ratio, 3.94; 95% CI, 1.34-11.54; P = .01). Patients without EGFR variations had a considerable difference in ORR of 35.7% vs 12.0% (P = .06), whereas patients with EGFR variations had an ORR of 58.3% vs 23.1% (P = .14). Overall, PFS was longer in patients who received pembrolizumab plus docetaxel (9.5 months; 95% CI, 4.2-not reached) than in patients who received docetaxel (3.9 months; 95% CI, 3.2-5.7) (hazard ratio, 0.24; 95% CI, 0.13-0.46; P < .001). For patients without variations, PFS was 9.5 months (95% CI, 3.9-not reached) vs 4.1 months (95% CI, 3.5-5.3) (P < .001), whereas in patients with EGFR variations, PFS was 6.8 months (95% CI, 6.2-not reached) vs 3.5 months (95% CI, 2.3-6.2) (P = .04). In terms of safety, 23% (9 of 40) vs 5% (2 of 38) of patients experienced grade 1 to 2 pneumonitis in the pembrolizumab plus docetaxel and docetaxel arms, respectively (P = .03), while 28% (11 of 40) vs 3% (1 of 38) experienced any-grade hypothyroidism (P = .002). No new safety signals were identified. Conclusions and Relevance In this phase 2 study, the combination of pembrolizumab plus docetaxel was well tolerated and substantially improved ORR and PFS in patients with advanced NSCLC who had previous progression after platinum-based chemotherapy, including NSCLC with EGFR variations. Trial Registration ClinicalTrials.gov Identifier: NCT02574598.
Collapse
Affiliation(s)
- Oscar Arrieta
- Thoracic Oncology Unit, Laboratory of Experimental Oncology, National Cancer Institute (INCan), Mexico City, Mexico
| | - Feliciano Barrón
- Thoracic Oncology Unit, Laboratory of Experimental Oncology, National Cancer Institute (INCan), Mexico City, Mexico
| | | | - Zyanya Lucia Zatarain-Barrón
- Thoracic Oncology Unit, Laboratory of Experimental Oncology, National Cancer Institute (INCan), Mexico City, Mexico
| | - Andrés F Cardona
- Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia.,Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (G-FOX), Universidad el Bosque, Bogotá, Colombia
| | - Diego Díaz-García
- Thoracic Oncology Unit, Laboratory of Experimental Oncology, National Cancer Institute (INCan), Mexico City, Mexico
| | - Masao Yamamoto Ramos
- Thoracic Oncology Unit, Laboratory of Experimental Oncology, National Cancer Institute (INCan), Mexico City, Mexico
| | - Beatriz Mota-Vega
- Thoracic Oncology Unit, Laboratory of Experimental Oncology, National Cancer Institute (INCan), Mexico City, Mexico
| | - Amir Carmona
- Thoracic Oncology Unit, Laboratory of Experimental Oncology, National Cancer Institute (INCan), Mexico City, Mexico
| | - Marco Polo Peralta Álvarez
- Thoracic Oncology Unit, Laboratory of Experimental Oncology, National Cancer Institute (INCan), Mexico City, Mexico
| | - Yolanda Bautista
- Hospital de Oncología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Fernando Aldaco
- Servicio de Oncología Médica, Centro Médico Nacional 20 de Noviembre, Mexico City, Mexico
| | - Raquel Gerson
- Departamento de Oncología, Centro Médico ABC, Mexico City, Mexico
| | - Christian Rolfo
- Thoracic Medical Oncology and Early Clinical Trials, Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore
| | - Rafael Rosell
- Molecular and Cellular Oncology Laboratory, Germans Trias i Pujol Research Institute and Hospital (IGTP), Barcelona, Spain
| |
Collapse
|
19
|
Cardona AF, Ruiz-Patiño A, Arrieta O, Ricaurte L, Zatarain-Barrón ZL, Rodriguez J, Avila J, Rojas L, Recondo G, Barron F, Archila P, Sotelo C, Bravo M, Zamudio N, Corrales L, Martín C, Rolfo C, Viola L, Carranza H, Vargas C, Otero J, Bermudez M, Gamez T, Pino LE, Rosell R. Genotyping Squamous Cell Lung Carcinoma in Colombia (Geno1.1-CLICaP). Front Oncol 2021; 10:588932. [PMID: 33384957 PMCID: PMC7771515 DOI: 10.3389/fonc.2020.588932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/10/2020] [Indexed: 11/29/2022] Open
Abstract
Background Lung cancer is a public health problem, and squamous cell carcinoma (SCC) is the second most prevalent subtype of this neoplasm. Compared to other subtypes, including adenocarcinoma, SCC is less well understood in terms of molecular pathogenesis, limiting therapeutic options among targeted agents approved for other disease subgroups. In this study, we sought to characterize the SCC genomic profile using a validated Next Generation Sequencing (NGS) platform. Methods The comprehensive NGS assay (TruSight Tumor 170) was used in order to target the full coding regions of 170 cancer-related genes on SCC samples. PD-L1 expression in tumor cells (TCs) was assessed using clone 22C3 (Dako). Clinical outcomes were correlated with molecular profile, including progression free survival (PFS), overall response rate (ORR), and overall survival (OS). Results A total of 26 samples were included, median age was 67 years (r, 33–83) and 53.8% were men. Tobacco consumption was identified in all subjects (mean 34-year package). For first-line treatment 80.8% of patients received cisplatin or carboplatin plus gemcitabine. In terms of molecular profile, we identified a high prevalence of inactivating mutations in TP53 (61.5%), PIK3CA (34.6%), MLL2 (34.6%), KEAP1 (38.4%), and NOTCH1 (26.9%). PD-L1 expression ranged from negative, 1, 2–49, and ≥50% in 23.1, 38.5, 26.9, and 11.5%, respectively. Interestingly, the genetic alterations did not have an effect in PFS, OS or ORR in this study. However, PDL1 expression was higher among those who had mutations in TP53 (p = 0.037) and greater expression of PDL1 was related to PIK3CA alterations (p = 0.05). Conclusions The genomic profile of SCC encompasses important genes including TP53, PIK3CA and KEAP1. TP53 mutations could be associated with PDL1 expression, generating hypothesis regarding specific treatment options.
Collapse
Affiliation(s)
- Andrés F Cardona
- Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia.,Department of Medical Oncology, Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia
| | - Alejandro Ruiz-Patiño
- Department of Medical Oncology, Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), México City, México
| | - Luisa Ricaurte
- Department of Medical Oncology, Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia
| | | | - July Rodriguez
- Department of Medical Oncology, Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Jenny Avila
- Department of Medical Oncology, Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Leonardo Rojas
- Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia.,Oncology Department, Clínica Colsanitas, Bogotá, Colombia
| | - Gonzalo Recondo
- Thoracic Oncology Section, Centro de Educación Médica e Investigaciones Clínicas - CEMIC, Buenos Aires, Argentina
| | - Feliciano Barron
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), México City, México
| | - Pilar Archila
- Department of Medical Oncology, Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia
| | - Carolina Sotelo
- Department of Medical Oncology, Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Melissa Bravo
- Department of Medical Oncology, Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia
| | - Nataly Zamudio
- Department of Medical Oncology, Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia
| | - Luis Corrales
- Oncology Department, Hospital San Juan de Dios, San José Costa Rica, Costa Rica
| | - Claudio Martín
- Medical Oncology Group, Fleming Institute, Buenos Aires, Argentina
| | - Christian Rolfo
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Lucia Viola
- Thoracic Oncology Unit, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - Hernán Carranza
- Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia.,Department of Medical Oncology, Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Carlos Vargas
- Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia.,Department of Medical Oncology, Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Jorge Otero
- Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia.,Department of Medical Oncology, Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Maritza Bermudez
- Department of Medical Oncology, Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Tatiana Gamez
- Department of Medical Oncology, Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Luis Eduardo Pino
- Department of Medical Oncology, Fundación Santa Fé de Bogotá, Bogotá, Colombia
| | - Rafael Rosell
- Department of Medical Oncology, Catalan Institute of Oncology, Barcelona, Spain
| |
Collapse
|
20
|
Arrieta O, Cardona AF, Lara-Mejía L, Heredia D, Barrón F, Zatarain-Barrón ZL, Lozano F, de Lima VC, Maldonado F, Corona-Cruz F, Ramos M, Cabrera L, Martin C, Corrales L, Cuello M, Arroyo-Hernández M, Aman E, Bacon L, Baez R, Benitez S, Botero A, Burotto M, Caglevic C, Ferraris G, Freitas H, Kaen DL, Lamot S, Lyons G, Mas L, Mata A, Mathias C, Muñoz A, Patane AK, Oblitas G, Pino L, Raez LE, Remon J, Rojas L, Rolfo C, Ruiz-Patiño A, Samtani S, Viola L, Viteri S, Rosell R. Recommendations for detection, prioritization, and treatment of thoracic oncology patients during the COVID-19 pandemic: the THOCOoP cooperative group. Crit Rev Oncol Hematol 2020; 153:103033. [PMID: 32650215 PMCID: PMC7305738 DOI: 10.1016/j.critrevonc.2020.103033] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/13/2020] [Indexed: 12/16/2022] Open
Abstract
The world currently faces a pandemic due to SARS-CoV-2. Relevant information has emerged regarding the higher risk of poor outcomes in lung cancer patients. As such, lung cancer patients must be prioritized in terms of prevention, detection and treatment. On May 7th, 45 experts in thoracic cancers from 11 different countries were invited to participate. A core panel of experts regarding thoracic oncology care amidst the pandemic gathered virtually, and a total of 60 initial recommendations were drafted based on available evidence, 2 questions were deleted due to conflicting evidence. By May 16th, 44 experts had agreed to participate, and voted on each of the 58 recommendation using a Delphi panel on a live voting event. Consensus was reached regarding the recommendations (>66 % strongly agree/agree) for 56 questions. Strong consensus (>80 % strongly agree/agree) was reached for 44 questions. Patients with lung cancer represent a particularly vulnerable population during this time. Special care must be taken to maintain treatment while avoiding exposure.
Collapse
Affiliation(s)
- Oscar Arrieta
- Instituto Nacional de Cancerología, Mexico City, Mexico.
| | - Andrés F Cardona
- Thoracic Oncology Clinic, Clínica del Country, Bogotá, Colombia; Foundation for Clinical and Applied Cancer Research, Bogotá, Colombia
| | | | - David Heredia
- Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | | | | | | | | | | | - Maritza Ramos
- Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Luis Cabrera
- Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Claudio Martin
- Thoracic Oncology Unit, Alexander Fleming Institute, Buenos Aires, Argentina; Hospital Maria Ferrer, Buenos Aires, Argentina
| | - Luis Corrales
- Oncology Department, Hospital San Juan de Dios, San José Costa Rica, Costa Rica; Oncología Médica, Centro de Investigación y Manejo del Cáncer (CIMCA), San José, Costa Rica
| | - Mauricio Cuello
- Department of Oncology, Hospital de Clínicas, Universidad de la República - UDELAR, Montevideo, Uruguay
| | | | - Enrique Aman
- Clinical Oncology Unit, Swiss Medical Group, Buenos Aires, Argentina
| | - Ludwing Bacon
- Centro de Oncología, Hospital Vivián Pellas, Nicaragua
| | - Renata Baez
- National Institute for Respiratory Diseases, Mexico City, Mexico
| | - Sergio Benitez
- Coordinador de la sección Oncología, asociación Argentina de Medicina Respiratoria, Argentina
| | | | - Mauricio Burotto
- Clínica Universidad de los Andes, Centro de Estudios Clínicos Bradford Hill, Chile
| | - Christian Caglevic
- Departamento de Investigación del Cáncer- Fundación Arturo López Pérez, Santiago, Chile
| | - Gustavo Ferraris
- Centro Médico Dean Funes, Radioterapia Oncológica, Córdoba, Argentina
| | - Helano Freitas
- Departamento de Oncologia Clínica - A C Camargo Cancer Center, São Paulo, Brazil
| | | | - Sebastián Lamot
- CONCIENCIA, Instituto Oncohematológico de la Patagonia, Chile
| | - Gustavo Lyons
- Department of Thoracic Surgery, Hospital Británico, Buenos Aires, Argentina
| | - Luis Mas
- Medical Oncology Department, National Institute for Neoplastic Diseases - INEN, Lima, Peru
| | - Andrea Mata
- Hospital La Católica Goicoechea, San José, Costa Rica
| | | | | | - Ana Karina Patane
- Hospital de Rehabilitacion Respiratoria María Ferrer, Buenos Aires, Argentina
| | | | - Luis Pino
- Medical Oncology Group, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Luis E Raez
- Thoracic Oncology Program Memorial Cancer Institute, Memorial Healthcare System, Pembroke Pines, FL, United States
| | - Jordi Remon
- Medical Oncology Department, Centro Integral Oncología Clara Campal Bacelona, HM-Delfos, Barcelona, Spain
| | - Leonardo Rojas
- Medical Oncology Department, Clínica Colsanitas, Bogotá, Colombia
| | - Christian Rolfo
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | | | - Suraj Samtani
- Medical Oncology Department, Clínica Bradford Hill, Santiago, Chile
| | - Lucia Viola
- Fundación neumológica colombiana, Bogotá, Colombia
| | - Santiago Viteri
- Instituto Oncológico Dr. Rosell. Centro Médico Teknon. Grupo QuironSalud. Barcelona, España
| | - Rafael Rosell
- Cancer Biology and Precision Medicine Program, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| |
Collapse
|
21
|
Arrieta O, Lara-Mejía L, Zatarain-Barrón ZL. Carboplatin plus etoposide or topotecan for small-cell lung cancer. Lancet Oncol 2020; 21:1132-1134. [DOI: 10.1016/s1470-2045(20)30427-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/14/2020] [Indexed: 11/27/2022]
|
22
|
Ruiz-Patiño A, Cardona AF, Arrieta O, Rolfo C, Gómez HL, Raez LE, Lopes G, Zatarain-Barrón ZL, Ricaurte L, Zamudio-Molano N, Rangel V, Oviedo J, Solano MP, Rojas L, Corrales L, Martín C, Mas L, Cuello M, Barrón F, Otero J, Carranza H, Vargas C, Rosell R. Scientific publications in cancer: in Latin America, strong scientific networks increase productivity (the TENJIN study). J Clin Epidemiol 2020; 126:1-8. [PMID: 32540384 DOI: 10.1016/j.jclinepi.2020.05.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 04/22/2020] [Accepted: 05/11/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The objectives of this study are to evaluate the relationship between authorship networking, socioeconomic factors, and scientific productivity across Latin America. METHODS In a bibliometric analysis of cancer-related Latin-American publications, the relationship between authorship network indicators, sociodemographic factors, and number of peer-reviewed indexed publications per country was explored. A systematic review of the literature for cancer publications between 2000 and 2018 using the Scopus database limited to Latin-American authors was used for the construction of coauthorship and publication networks and their respective metrics. Sociodemographic variables including percentage of invested gross domestic product in research, population, and cancer incidence were also estimated. Multiple linear regression models were constructed to determine the relationship between productivity and the aforementioned variables. RESULTS A total of 8,528 articles across nine countries were included. Brazil was the most productive nation with 41.8% of identified references followed by Mexico (16.6%) and Argentina (12.9%). Latin America experienced a 9% growth in number of publications across the studied time frame. After analyzing networking and sociodemographic variables, number of authors in a collaboration network and percentage of invested gross domestic product were associated with high productivity yielding a multiple regression model with an R2 value of 0.983. CONCLUSIONS This study indicates that extensive authorship networking and a high investment in research strongly predict cancer-related productivity.
Collapse
Affiliation(s)
- Alejandro Ruiz-Patiño
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (FOX-G), Universidad el Bosque, Bogotá, Colombia
| | - Andrés Felipe Cardona
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (FOX-G), Universidad el Bosque, Bogotá, Colombia; Clinical and Traslational Oncology Group, Clínica del Country, Bogotá, Colombia.
| | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología - INCaN, México City, Mexico
| | - Christian Rolfo
- Thoracic Medical Oncology and Early Clinical Trials Unit, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center (UMGCCC), Baltimore, MD, USA
| | - Henry L Gómez
- Medical Oncology Department, Instituto Nacional de Enfermedades Neoplásicas - INEN, Lima, Peru
| | - Luis E Raez
- Thoracic Oncology Program, Memorial Cancer Institute (MCI), Florida International University (FIU), Miami, FL, USA
| | - Gilberto Lopes
- Global Oncology Department, University of Miami, Sylvester Comprehensive Cancer Center and Miller School of Medicine, Miami, FL, USA
| | | | - Luisa Ricaurte
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia; Pathology Department, Mayo Clinic, Rochester, MN, USA
| | | | - Valentina Rangel
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
| | - Juan Oviedo
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
| | - Maria Paula Solano
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
| | - Leonardo Rojas
- Molecular Oncology and Biology Systems Research Group (FOX-G), Universidad el Bosque, Bogotá, Colombia; Clinical and Traslational Oncology Group, Clínica del Country, Bogotá, Colombia; Oncology Department, Clínica Colsanitas, Bogotá, Colombia
| | - Luis Corrales
- Clinical Oncology Department, Centro de Investigaciones y Manejo del Cáncer, San José, Costa Rica
| | - Claudio Martín
- Thoracic Oncology Unit, Instituto Fleming, Buenos Aires, Argentina
| | - Luis Mas
- Medical Oncology Department, Instituto Nacional de Enfermedades Neoplásicas - INEN, Lima, Peru
| | - Mauricio Cuello
- Medical Oncology Department, Hospital de Clínica, Universidad de la Republica - UdeLAR, Montevideo, Uruguay
| | - Feliciano Barrón
- Thoracic Oncology Unit, Instituto Nacional de Cancerología - INCaN, México City, Mexico
| | - Jorge Otero
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (FOX-G), Universidad el Bosque, Bogotá, Colombia
| | - Hernán Carranza
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (FOX-G), Universidad el Bosque, Bogotá, Colombia; Clinical and Traslational Oncology Group, Clínica del Country, Bogotá, Colombia
| | - Carlos Vargas
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (FOX-G), Universidad el Bosque, Bogotá, Colombia; Clinical and Traslational Oncology Group, Clínica del Country, Bogotá, Colombia
| | - Rafael Rosell
- Cancer Biology and Precision Medicine Program Catalan Institute of Oncology; Germans Trias i Pujol Health Sciences Institute and Hospital Badalona, Barcelona, Spain
| |
Collapse
|
23
|
Turcott JG, Martinez-Samano JE, Cardona AF, Bassarmal SS, Ramírez-Tirado LA, Zatarain-Barrón ZL, Barrón F, Corrales L, Martín C, Barragán-Castillo PA, Ruiz-Patiño A, Flores-Estrada D, Arrieta O. The Role of a Cachexia Grading System in Patients with Non-Small Cell Lung Cancer Treated with Immunotherapy: Implications for Survival. Nutr Cancer 2020; 73:794-801. [PMID: 32482104 DOI: 10.1080/01635581.2020.1769691] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The association between cancer-induced weight-loss (CIWL) and poor clinical outcomes in patients treated with immunotherapy is scarcely understood. We evaluated the use of a cachexia-grading system in IO-treated non-small cell lung cancer (NSCLC) patients in order to predict clinical outcomes. MATERIALS 300 patients with NSCLC, who received immunotherapy during any line of therapy, were included. All patients were graded according to a previously validated cachexia scale, which takes into consideration body mass index (BMI) and weight loss, stratifying patients into five risk categories (0 [pre-cachexia] - 4 [refractory cachexia]). Primary endpoint was overall survival (OS). RESULTS Ninety-one (30.3%) patients were classified in the low risk category, 176 (58.6%) were classified in the intermediate risk category and 33 (11%) were in the high risk category. Patients classified as low-risk had a significantly longer OS compared with those with intermediate or high risk (22.4 mo, [95%CI: 16.6-NR] vs. 17.1 [95%CI: 13.5-22.4] vs. 8.0 [3.9-18.4]; p < 0.001). In the multivariate analysis, after adjusting for age, hemoglobin and ORR, hazard of death increased as per the cachexia risk scale (Hazard ratio: 1.62 [1.22-2.16]; p = 0.001). CONCLUSION Cachexia is independently associated with worse OS in NSCLC patients who receive immunotherapy, highlighting the role for nutritional assessment.
Collapse
Affiliation(s)
- Jenny G Turcott
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | - Andrés F Cardona
- Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia.,Oncology Unit, Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia.,Clinical Research and Biology Systems Department, Universidad el Bosque, Bogotá, Colombia
| | | | | | | | - Feliciano Barrón
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Luis Corrales
- Oncology Unit, Hospital San Juan de Dios, San José de Costa Rica, Costa Rica
| | - Claudio Martín
- Medical Oncology Department, Thoracic Oncology Section, Instituto Fleming, Buenos Aires, Argentina
| | | | - Alejandro Ruiz-Patiño
- Oncology Unit, Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia
| | | | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, Mexico City, Mexico
| |
Collapse
|
24
|
Zatarain-Barrón ZL, Ramos-Espinosa O, Marquina-Castillo B, Barrios-Payán J, Cornejo-Granados F, Maya-Lucas O, López-Leal G, Molina-Romero C, Anthony RM, Ochoa-Leyva A, De La Rosa-Velázquez IA, Rebollar-Vega RG, Warren RM, Mata-Espinosa DA, Hernández-Pando R, van Soolingen D. Evidence for the Effect of Vaccination on Host-Pathogen Interactions in a Murine Model of Pulmonary Tuberculosis by Mycobacterium tuberculosis. Front Immunol 2020; 11:930. [PMID: 32508826 PMCID: PMC7248268 DOI: 10.3389/fimmu.2020.00930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 04/21/2020] [Indexed: 12/18/2022] Open
Abstract
The global control of Tuberculosis remains elusive, and Bacillus Calmette-Guérin (BCG) -the most widely used vaccine in history-has proven insufficient for reversing this epidemic. Several authors have suggested that the mass presence of vaccinated hosts might have affected the Mycobacterium tuberculosis (MTB) population structure, and this could in turn be reflected in a prevalence of strains with higher ability to circumvent BCG-induced immunity, such as the recent Beijing genotype. The effect of vaccination on vaccine-escape variants has been well-documented in several bacterial pathogens; however the effect of the interaction between MTB strains and vaccinated hosts has never been previously described. In this study we show for the first time the interaction between MTB Beijing-genotype strains and BCG-vaccinated hosts. Using a well-controlled murine model of progressive pulmonary tuberculosis, we vaccinated BALB/c mice with two different sub-strains of BCG (BCG-Phipps and BCG-Vietnam). Following vaccination, the mice were infected with either one of three selected MTB strains. Strains were selected based on lineage, and included two Beijing-family clinical isolates (strains 46 and 48) and a well-characterized laboratory strain (H37Rv). Two months after infection, mice were euthanized and the bacteria extracted from their lungs. We characterized the genomic composite of the bacteria before and after exposure to vaccinated hosts, and also characterized the local response to the bacteria by sequencing the lung transcriptome in animals during the infection. Results from this study show that the interaction within the lungs of the vaccinated hosts results in the selection of higher-virulence bacteria, specifically for the Beijing genotype strains 46 and 48. After exposure to the BCG-induced immune response, strains 46 and 48 acquire genomic mutations associated with several virulence factors. As a result, the bacteria collected from these vaccinated hosts have an increased ability for immune evasion, as shown in both the host transcriptome and the histopathology studies, and replicates far more efficiently compared to bacteria collected from unvaccinated hosts or to the original-stock strain. Further research is warranted to ascertain the pathways associated with the genomic alterations. However, our results highlight novel host-pathogen interactions induced by exposure of MTB to BCG vaccinated hosts.
Collapse
Affiliation(s)
- Zyanya Lucia Zatarain-Barrón
- Experimental Pathology Laboratory, Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Octavio Ramos-Espinosa
- Experimental Pathology Laboratory, Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Brenda Marquina-Castillo
- Experimental Pathology Laboratory, Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Jorge Barrios-Payán
- Experimental Pathology Laboratory, Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Fernanda Cornejo-Granados
- Departamento de Microbiología Molecular, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, Mexico
| | - Otoniel Maya-Lucas
- Department of Genetics and Molecular Biology, Centro de Investigaciones y de Estudios Avanzados (CINVESTAV), Mexico City, Mexico
| | - Gamaliel López-Leal
- Departamento de Microbiología Molecular, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, Mexico
| | - Camilo Molina-Romero
- Experimental Pathology Laboratory, Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Richard M Anthony
- Tuberculosis Reference Laboratory, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Adrián Ochoa-Leyva
- Departamento de Microbiología Molecular, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, Mexico
| | - Inti Alberto De La Rosa-Velázquez
- Genomics Laboratory, Red de Apoyo a la Investigación (RAI), Universidad Nacional Autónoma de México - Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Rosa Gloria Rebollar-Vega
- Genomics Laboratory, Red de Apoyo a la Investigación (RAI), Universidad Nacional Autónoma de México - Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Robin M Warren
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, MRC Centre for Molecular and Cellular Biology, Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Dulce Adriana Mata-Espinosa
- Experimental Pathology Laboratory, Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Rogelio Hernández-Pando
- Experimental Pathology Laboratory, Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Dick van Soolingen
- Tuberculosis Reference Laboratory, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| |
Collapse
|
25
|
Arrieta O, Ramirez-Tirado LA, Zatarain-Barrón ZL. Metformin Plus Tyrosine Kinase Inhibitors in Epidermal Growth Factor Receptor-Mutated Non-Small Cell Lung Cancer-Reply. JAMA Oncol 2020; 6:782-783. [PMID: 32163099 DOI: 10.1001/jamaoncol.2020.0062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), México City, México
| | | | | |
Collapse
|
26
|
Cardona AF, Ruiz-Patiño A, Ricaurte L, Zatarain-Barrón ZL, Barrón F, Arrieta O. Chronic and Severe Non-Lichenoid Oral Ulcers Induced by Nivolumab - Diagnostic and Therapeutic Challenge: A Case Report. Case Rep Oncol 2020; 13:314-320. [PMID: 32308598 PMCID: PMC7154263 DOI: 10.1159/000505968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/14/2020] [Indexed: 12/17/2022] Open
Abstract
Due to the widespread use of immune checkpoint inhibitors and the growing research efforts in this area, immune-mediated toxicity is well recognized. Nonetheless, few severe cases of oral or upper gastrointestinal tract mucosal involvement have been documented. Early recognition and prompt treatment are key to the adequate management of these patients. We present a male 93-year-old patient with an advanced head and neck tumor treated with nivolumab who developed severe oral ulcers. After discontinuation of nivolumab, he received initial steroid treatment without any significant improvement. Histopathologic analysis of the lesions revealed a pattern similar to graft versus host disease. Extrapolating the results of colchicine mouth washing in patients with active oral ulcers and Behçet's disease, this strategy was implemented with concomitant metronomic cyclophosphamide, achieving complete ulcer resolution. Metagenomic oral bacterial sequencing during instauration of the lesions and highest extension revealed a significant decrease in microbiomic diversity and expansion of Haemophilus parainfluenzae similar to patients with active Behçet's disease. In conclusion, oral ulcers associated with immune checkpoint inhibitors correspond to a difficult-to-treat entity that could physiopathologically be related to both graft versus host disease and Behçet's disease.
Collapse
Affiliation(s)
- Andrés F Cardona
- Clinical and Translational Oncology Group, Clinica del Country, Bogotá, Colombia.,Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Alejandro Ruiz-Patiño
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Luisa Ricaurte
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | | | - Feliciano Barrón
- Thoracic Oncology Unit, National Cancer Institute (INCan), Mexico City, Mexico
| | - Oscar Arrieta
- Thoracic Oncology Unit, National Cancer Institute (INCan), Mexico City, Mexico
| |
Collapse
|
27
|
Arrieta O, Ramírez-Tirado LA, Caballé-Perez E, Mejia-Perez A, Zatarain-Barrón ZL, Cardona AF, Lozano-Ruíz F, Segura-González M, Cruz-Rico G, Maldonado F, Rosell R. Response rate of patients with baseline brain metastases from recently diagnosed non-small cell lung cancer receiving radiotherapy according to EGFR, ALK and KRAS mutation status. Thorac Cancer 2020; 11:1026-1037. [PMID: 32072746 PMCID: PMC7113051 DOI: 10.1111/1759-7714.13359] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/29/2020] [Indexed: 01/15/2023] Open
Abstract
Background Previous studies have identified that patients with EGFR mutations tend to have better responses to targeted therapy, as well as chemotherapy; however, the effect of genetic alterations in terms of radiotherapy (RT)‐related outcomes has not been fully assessed. We studied the impact of common non‐small cell lung cancer (NSCLC) genetic alterations (EGFR, ALK and KRAS) in relation to objective response rate (ORR) to RT in patients with brain metastases. Methods From 2009–2015, 153 patients with an available genotyping status were treated with whole‐brain irradiation (WBI) before receiving systemic therapy. Primary outcome was ORR; secondary outcomes included intracranial progression‐free survival (IPFS) and overall survival (OS). Results Overall, ORR was 47.1%. ORR to RT varied significantly according to molecular status: EGFR (64.5%) ALK (54.5%) KRAS (20%) and WT (35.4%) (P = 0.001). EGFR mutation was the only independently associated factor for response to WBI (RR 3.52 [95% CI 1.6–7.7]; P = 0.002). Median IPFS was 10.8 months [95% CI 8.2–13.5] overall; however, IPFS also varied significantly according to molecular status: EGFR (18.2 months), ALK (18.4 months), KRAS (6.0 months) and WT (8.7 months) (P < 0.0001). OS for EGFR, ALK, KRAS and WT patients was 36.6, 32.2, 15.5 and 22.4 months, respectively (P = 0.014). Intracranial‐ORR (HR 0.4 [95% CI 0.2–0.6], P < 0.001) and mutation status (HR 0.7 [95% CI 0.6–0.9], P < 0.042) were independently associated with a higher OS. Conclusions RT response varies as per tumor molecular status. The presence of EGFR mutations favors the organ‐specific response to RT, and is associated with longer OS in patients with NSCLC and BM. Key points This study addressed for the first time the difference in radiotherapy‐related outcomes in patients with different genotypes of non‐small cell lung cancer (NSCLC) before they received systemic therapy. Results show that response to radiotherapy varies as per tumor molecular status, particularly EGFR‐mutated tumors, have a favorable response to radiotherapy, contrary to KRAS‐mutated tumors.
Collapse
Affiliation(s)
- Oscar Arrieta
- Thoracic Oncology Unit, National Cancer Institute (INCan), México City, Mexico.,Experimental Oncology Laboratory, National Cancer Institute (INCan), Mexico City, Mexico
| | - Laura-Alejandra Ramírez-Tirado
- Thoracic Oncology Unit, National Cancer Institute (INCan), México City, Mexico.,Experimental Oncology Laboratory, National Cancer Institute (INCan), Mexico City, Mexico
| | | | - Alberto Mejia-Perez
- Department of Imagenology, National Cancer Institute (INCan), Mexico City, Mexico
| | | | - Andrés F Cardona
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia
| | | | | | - Graciela Cruz-Rico
- Experimental Oncology Laboratory, National Cancer Institute (INCan), Mexico City, Mexico
| | - Federico Maldonado
- Thoracic Oncology Unit, National Cancer Institute (INCan), México City, Mexico
| | - Rafael Rosell
- Personalized Medicine Program, Catalan Institute of Oncology-ICO, Barcelona, Spain
| |
Collapse
|
28
|
Corrales L, Rosell R, Cardona AF, Martín C, Zatarain-Barrón ZL, Arrieta O. Lung cancer in never smokers: The role of different risk factors other than tobacco smoking. Crit Rev Oncol Hematol 2020; 148:102895. [PMID: 32062313 DOI: 10.1016/j.critrevonc.2020.102895] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/21/2020] [Accepted: 01/29/2020] [Indexed: 12/16/2022] Open
Abstract
Lung cancer (LC), the leading cause of cancer-related deaths worldwide, is a complex and highly heterogeneous disease. Additional to its biological complexity, LC patients are often confronted with a high degree of stigma, mostly from the association of the disease with tobacco. Nonetheless, a proportion of LC patients are never-smokers, a population which we are beginning to comprehensively explore. Several risk factors have been linked to LC in never-smokers. Studies have consistently shown that radon exposure and domestic fuel smoke increase LC risk. Additionally, infections such as Mycobacterium tuberculosis, and Human Papilloma Virus are also risk factors. Other less conclusive associations include inflammatory diseases such as asthma and sarcoidosis. Moreover, we are now aware that molecular characteristics of LC vary widely according to smoking history, with important therapeutic implications. This review comprehensively assesses the current knowledge in terms of risk factors and disease characteristics in the never-smoker lung cancer population.
Collapse
Affiliation(s)
- Luis Corrales
- Centro de Investigación y Manejo del Cáncer (CIMCA), San José, Costa Rica; Hospital San Juan de Dios, San José, Costa Rica
| | - Rafael Rosell
- Catalan Institute of Oncology, Germans Trias i Pujol Research Institute and Hospital Campus Can Ruti Barcelona, Spain
| | - Andrés F Cardona
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia; Clinical and Traslational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia
| | - Claudio Martín
- Medical Oncology Department, Thoracic Oncology Section, Instituto Fleming, Buenos Aires, Argentina
| | | | | |
Collapse
|
29
|
Cardona AF, Arrieta O, Ruiz-Patiño A, Sotelo C, Zamudio-Molano N, Zatarain-Barrón ZL, Ricaurte L, Raez L, Álvarez MPP, Barrón F, Rojas L, Rolfo C, Karachaliou N, Molina-Vila MA, Rosell R. Precision medicine and its implementation in patients with NTRK fusion genes: perspective from developing countries. Ther Adv Respir Dis 2020; 14:1753466620938553. [PMID: 32643553 PMCID: PMC7350048 DOI: 10.1177/1753466620938553] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022] Open
Abstract
Precision oncology is the field that places emphasis on the diagnosis and treatment of tumors that harbor specific genomic alterations susceptible to inhibition or modulation. Although most alterations are only present in a minority of patients, a substantial effect on survival can be observed in this subgroup. Mass genome sequencing has led to the identification of a specific driver in the translocations of the tropomyosin receptor kinase family (NTRK) in a subset of rare tumors both in children and in adults, and to the development and investigation of Larotrectinib. This medication was granted approval by the US Food and Drug Administration for NTRK-positive tumors, regardless of histology or age group, as such, larotrectinib was the first in its kind to be approved under the premise that molecular pattern is more important than histology in terms of therapeutic approach. It yielded significant results in disease control with good tolerability across a wide range of diseases including rare pediatric tumors, salivary gland tumors, gliomas, soft-tissue sarcomas, and thyroid carcinomas. In addition, and by taking different approaches in clinical trial design and conducting allocation based on biomarkers, the effects of target therapies can be isolated and quantified. Moreover, and considering developing nations and resource-limited settings, precision oncology could offer a tool to reduce cancer-related disability and hospital costs. In addition, developing nations also present patients with rare tumors that lack a chance of treatment, outside of clinical trials. This, in turn, offers the possibility for international collaboration, and contributes to employment, education, and health service provisions. The reviews of this paper are available via the supplemental material section.
Collapse
Affiliation(s)
- Andrés F. Cardona
- Clinical and Translational Oncology Group, Clínica del Country, Calle 116 No. 9-72, c. 318, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (FOX-G), Universidad el Bosque, Bogotá, Colombia
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
| | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCaN), México city, México
| | - Alejandro Ruiz-Patiño
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (FOX-G), Universidad el Bosque, Bogotá, Colombia
| | - Carolina Sotelo
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (FOX-G), Universidad el Bosque, Bogotá, Colombia
| | | | | | - Luisa Ricaurte
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (FOX-G), Universidad el Bosque, Bogotá, Colombia
- Pathology Department, Mayo Clinic, Rochester, Minnesota, Estados Unidos
| | - Luis Raez
- Thoracic Oncology Program, Memorial Cancer Institute (MCI), Florida International University (FIU), Miami, Florida
| | | | - Feliciano Barrón
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCaN), México city, México
| | - Leonardo Rojas
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
- Oncology Department, Clínica Colsanitas, Bogotá, Colombia
| | - Christian Rolfo
- Thoracic Medical Oncology and Early Clinical Trials Unit, University of Maryland, Baltimore, MD, USA
| | | | - Miguel Angel Molina-Vila
- Pangaea Oncology, Laboratory of Molecular Biology, Quirón-Dexeus University Institute, Barcelona, Catalunya, Spain
| | - Rafael Rosell
- Germans Trias i Pujol Research Institute and Hospital (IGTP), Badalona, Catalunya, Spain
| |
Collapse
|
30
|
Arrieta O, Barrón F, Padilla MÁS, Avilés-Salas A, Ramírez-Tirado LA, Arguelles Jiménez MJ, Vergara E, Zatarain-Barrón ZL, Hernández-Pedro N, Cardona AF, Cruz-Rico G, Barrios-Bernal P, Yamamoto Ramos M, Rosell R. Effect of Metformin Plus Tyrosine Kinase Inhibitors Compared With Tyrosine Kinase Inhibitors Alone in Patients With Epidermal Growth Factor Receptor-Mutated Lung Adenocarcinoma: A Phase 2 Randomized Clinical Trial. JAMA Oncol 2019; 5:e192553. [PMID: 31486833 PMCID: PMC6735425 DOI: 10.1001/jamaoncol.2019.2553] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/08/2019] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Metformin hydrochloride is emerging as a repurposed anticancer drug. Preclinical and retrospective studies have shown that it improves outcomes across a wide variety of neoplasms, including lung cancer. Particularly, evidence is accumulating regarding the synergistic association between metformin and epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs). OBJECTIVE To assess the progression-free survival (PFS) in patients with advanced lung adenocarcinoma who received treatment with EGFR-TKIs plus metformin compared with those who received EGFR-TKIs alone. DESIGN, SETTING, AND PARTICIPANTS Open-label, randomized, phase 2 trial conducted at the Instituto Nacional de Cancerología (INCan), Mexico City, Mexico. Eligible patients were 18 years or older, had histologically confirmed stage IIIB-IV lung adenocarcinoma with an activating EGFR mutation. INTERVENTIONS Patients were randomly allocated to receive EGFR-TKIs (erlotinib hydrochloride, afatinib dimaleate, or gefitinib at standard dosage) plus metformin hydrochloride (500 mg twice a day) or EGFR-TKIs alone. Treatment was continued until occurrence of intolerable toxic effects or withdrawal of consent. MAIN OUTCOMES AND MEASURES The primary outcome was PFS in the intent-to-treat population. Secondary outcomes included objective response rate, disease control rate, overall survival (OS), and safety. RESULTS Between March 31, 2016, and December 31, 2017, a total of 139 patients (mean [SD] age, 59.4 [12.0] years; 65.5% female) were randomly assigned to receive EGFR-TKIs (n = 70) or EGFR-TKIs plus metformin (n = 69). The median PFS was significantly longer in the EGFR-TKIs plus metformin group (13.1; 95% CI, 9.8-16.3 months) compared with the EGFR-TKIs group (9.9; 95% CI, 7.5-12.2 months) (hazard ratio, 0.60; 95% CI, 0.40-0.94; P = .03). The median OS was also significantly longer for patients receiving the combination therapy (31.7; 95% CI, 20.5-42.8 vs 17.5; 95% CI, 11.4-23.7 months; P = .02). CONCLUSIONS AND RELEVANCE To our knowledge, this is the first study to prospectively show that the addition of metformin to standard EGFR-TKIs therapy in patients with advanced lung adenocarcinoma significantly improves PFS. These results justify the design of a phase 3, placebo-controlled study. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03071705.
Collapse
Affiliation(s)
- Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Feliciano Barrón
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | | | | | | | - Edgar Vergara
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - Norma Hernández-Pedro
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Andrés F. Cardona
- Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
- Clinical Research and Biology Systems Department, Universidad el Bosque, Bogotá, Colombia
| | - Graciela Cruz-Rico
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Pedro Barrios-Bernal
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Masao Yamamoto Ramos
- Department of Radiology and Imaging, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Rafael Rosell
- Catalan Institute of Oncology, Germans Trias i Pujol Research Institute and Hospital Campus Can Ruti, Barcelona, Spain
| |
Collapse
|
31
|
Sotelo-Rodríguez DC, Ruíz-Patiño A, Ricaurte L, Arrieta O, Zatarain-Barrón ZL, Cardona AF. Challenges and shifting paradigms in clinical trials in oncology: the case for immunological and targeted therapies. Ecancermedicalscience 2019; 13:936. [PMID: 31552109 PMCID: PMC6695130 DOI: 10.3332/ecancer.2019.936] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Indexed: 11/20/2022] Open
Abstract
The advent of immunotherapy has undoubtedly changed the current standard for cancer treatment. Immunotherapy offers the possibility of achieving excellent results—a new alternative for patients with advanced-stage or relapsed disease. Nowadays, the progress made in tumour biology has led to multiple advances in clinical and translational cancer research. Many oncogenic pathways responsible for tumour growth and metastases have been described and, consequently, multiple new cancer therapeutic agents have been developed and are under current investigation. Due to this rapid increase in knowledge and pharmaceutical development, traditional clinical trials designs have encountered major limitations. The pharmacological differences (in toxicity profiles and effectiveness patterns) between immunotherapy and chemotherapy have caused traditional clinical trials to evolve in order to meet this emerging need. This review focuses on the different options pertaining to clinical trial design that have arisen in the field of immuno-oncology, as well as the challenges of accurately interpreting traditional survival analyses within this novel area of cancer medicine.
Collapse
Affiliation(s)
| | | | - Luisa Ricaurte
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá 100110, Colombia
| | - Oscar Arrieta
- Thoracic Oncology Unit and Laboratory of Personalized Medicine, Instituto Nacional de Cancerología (INCan), México City 14080, Mexico
| | - Zyanya Lucia Zatarain-Barrón
- Thoracic Oncology Unit and Laboratory of Personalized Medicine, Instituto Nacional de Cancerología (INCan), México City 14080, Mexico
| | - Andrés F Cardona
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá 100110, Colombia.,Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá 100110, Colombia
| |
Collapse
|
32
|
Turcott JG, Juárez-Hernández E, Sánchez-Lara K, Flores-Estrada D, Zatarain-Barrón ZL, Arrieta O. Baseline Dysgeusia in Chemotherapy-Naïve Non-Small Cell Lung Cancer Patients: Association with Nutrition and Quality of Life. Nutr Cancer 2019; 72:194-201. [DOI: 10.1080/01635581.2019.1633362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
| | | | - Karla Sánchez-Lara
- Thoracic Oncology Unit, National Cancer Institute (INCan), Mexico City, Mexico
| | | | | | - Oscar Arrieta
- Thoracic Oncology Unit, National Cancer Institute (INCan), Mexico City, Mexico
| |
Collapse
|
33
|
Cardona AF, Ruiz-Patiño A, Zatarain-Barrón ZL, Hakim F, Jiménez E, Mejía JA, Ramón JF, Useche N, Bermúdez S, Pineda D, Cifuentes H, Rojas L, Ricaurte L, Pino LE, Balaña C, Arrieta O. Systemic management of malignant meningiomas: A comparative survival and molecular marker analysis between Octreotide in combination with Everolimus and Sunitinib. PLoS One 2019; 14:e0217340. [PMID: 31220093 PMCID: PMC6586269 DOI: 10.1371/journal.pone.0217340] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 05/10/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose To compare the effectiveness of octreotide/everolimus vs. sunitinib for the systemic treatment of recurrent aggressive meningiomas. Methods 31 patients with recurrent or refractory WHO II or WHO III meningiomas were examined in two reference centers in Colombia. Patients who had systemic treatment (sunitinib, everolimus/octreotide) and a complete follow-up were included. Overall survival (OS), progression-free survival (PFS) and toxicities were evaluated. Additionally, tissue samples were examined for PDGFRβ and VEGFR2, their expression was correlated with outcomes. Results Twenty-two patients (72%) were female with a median age of 55 years (SD±15.3). The most prevalent histology was anaplastic meningioma in 20 patients (65%) with 48% of patients suffering from three previous relapses before the start of systemic treatment. A total of 14 patients received combination therapy with octreotide/everolimus, 11 received sunitinib and the remaining 6 received other second-line agents. Median OS was 37.3 months (95%CI 28.5–42.1) and the PFS during the treatment with everolimus/octreotide (EO) and sunitinib (Su) was 12.1 months (95%CI 9.2–21.1) and 9.1 months (95%CI 6.8–16.8); p = 0.43), respectively. The OS of the group treated with the EO→Su→Bev sequence (1st/2nd/3rd line) was 6.5 months longer than the Su→EO→Bev sequence (36.0 vs. 29.5 months) (p = 0.0001). When analyzing molecular markers, the positive PDGFRβ and negative VEGFR2 expression were associated with longer survival both in OS and PFS. Conclusion Sunitinib and octreotide/everolimus have similar efficacy and safety in the systemic management of refractory meningioma. VEGFR2 and PDGFRβ expression are associated with better outcomes.
Collapse
Affiliation(s)
- Andrés F. Cardona
- Brain Tumor Section, Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia
- Foundation for Clinical and Applied Cancer Research–FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Group (G-FOX), Universidad El Bosque, Bogotá, Colombia
- * E-mail: ,
| | | | | | - Fernando Hakim
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Neuroscience Department, Universidad El Bosque, Bogotá, Colombia
| | - Enrique Jiménez
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Neuroscience Department, Universidad El Bosque, Bogotá, Colombia
| | - Juan Armando Mejía
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Neuroscience Department, Universidad El Bosque, Bogotá, Colombia
| | - Juan Fernando Ramón
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Neuroscience Department, Universidad El Bosque, Bogotá, Colombia
| | - Nicolás Useche
- Neuroscience Department, Universidad El Bosque, Bogotá, Colombia
- Neuroradiology Section, Radiology Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Sonia Bermúdez
- Neuroscience Department, Universidad El Bosque, Bogotá, Colombia
- Neuroradiology Section, Radiology Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Diego Pineda
- Brain Tumor Section, Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia
- Neuroradiology Section, Clínica del Country, Bogotá, Colombia
| | | | - Leonardo Rojas
- Brain Tumor Section, Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia
- Foundation for Clinical and Applied Cancer Research–FICMAC, Bogotá, Colombia
- Clinical Oncology Department, Clínica Colsanitas, Bogotá, Colombia
| | - Luisa Ricaurte
- Foundation for Clinical and Applied Cancer Research–FICMAC, Bogotá, Colombia
| | - Luis Eduardo Pino
- Clinical Oncology Group, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Carmen Balaña
- Neuro-Oncology Section, Oncology Department, Hospital Germans Trias I Pujol, Catalan Institute of Oncology–ICO, Barcelona, Spain
| | - Oscar Arrieta
- Laboratory of Experimental Oncology, Instituto Nacional de Cancerología (INCaN), México City, México
| |
Collapse
|
34
|
Cardona AF, Ricaurte L, Zatarain-Barrón ZL, Arrieta O. Squamous cell lung cancer: genomic evolution and personalized therapy. ACTA ACUST UNITED AC 2019; 61:329-338. [DOI: 10.21149/10115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 04/30/2019] [Indexed: 11/06/2022]
|
35
|
Cardona AF, Rojas L, Zatarain-Barrón ZL, Ruiz-Patiño A, Ricaurte L, Corrales L, Martín C, Freitas H, Cordeiro de Lima VC, Rodriguez J, Avila J, Bravo M, Archila P, Carranza H, Vargas C, Otero J, Barrón F, Karachaliou N, Rosell R, Arrieta O. Multigene Mutation Profiling and Clinical Characteristics of Small-Cell Lung Cancer in Never-Smokers vs. Heavy Smokers (Geno1.3-CLICaP). Front Oncol 2019; 9:254. [PMID: 31058075 PMCID: PMC6481272 DOI: 10.3389/fonc.2019.00254] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/20/2019] [Indexed: 12/14/2022] Open
Abstract
Objectives: Lung cancer is a heterogeneous disease. Presentation and prognosis are known to vary according to several factors, such as genetic and demographic characteristics. Small-cell lung cancer incidence is increasing in never-smokers. However, the disease phenotype in this population is different compared with patients who have a smoking history. Material and Methods: To further investigate the clinical and genetic characteristics of this patient subgroup, a cohort of small cell lung cancer patients was divided into smokers (n = 10) and never/ever-smokers (n = 10). A somatic mutation profile was obtained using a comprehensive NGS assay. Clinical outcomes were compared using the Kaplan-Meier method and Cox proportional models. Results: Median age was 63 years (46–81), 40% were men, and 90% had extended disease. Smoker patients had significantly more cerebral metastases (p = 0.04) and were older (p = 0.03) compared to their non-smoker counterparts. For never/ever smokers, the main genetic mutations were TP53 (80%), RB1 (40%), CYLD (30%), and EGFR (30%). Smoker patients had more RB1 (80%, p = 0.04), CDKN2A (30%, p = 0.05), and CEBPA (30%, p = 0.05) mutations. Response rates to first-line therapy with etoposide plus cisplatin/carboplatin were 50% in smokers and 90% in never/ever smokers (p = 0.141). Median overall survival was significantly longer in never smokers compared with smokers (29.1 months [23.5–34.6] vs. 17.3 months [4.8–29.7]; p = 0.0054). Never/ever smoking history (HR 0.543, 95% CI 0.41–0.80), limited-stage disease (HR 0.56, 95% CI 0.40–0.91) and response to first-line platinum-based chemotherapy (HR 0.63, 95% CI 0.60–0.92) were independently associated with good prognosis. Conclusion: Our data supports that never/ever smoker patients with small-cell lung cancer have better prognosis compared to their smoker counterparts. Further, patients with never/ever smoking history who present with small-cell lung cancer have a different mutation profile compared with smokers, including a high frequency of EGFR, MET, and SMAD4 mutations. Further studies are required to assess whether the differential mutation profile is a consequence of a diverse pathological mechanism for disease onset.
Collapse
Affiliation(s)
- Andrés F Cardona
- Clinical and Translational Oncology Group, Clinica del Country, Bogotá, Colombia.,Foundation for Clinical and Applied Cancer Research, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Leonardo Rojas
- Clinical and Translational Oncology Group, Clinica del Country, Bogotá, Colombia.,Foundation for Clinical and Applied Cancer Research, Bogotá, Colombia.,Clinical Oncology Department, Clínica Colsanitas, Bogotá, Colombia
| | | | | | - Luisa Ricaurte
- Foundation for Clinical and Applied Cancer Research, Bogotá, Colombia
| | - Luis Corrales
- Department of Oncology, Hospital San Juan de Dios, San José, Costa Rica
| | - Claudio Martín
- Medical Oncology Group, Fleming Institute, Buenos Aires, Argentina
| | - Helano Freitas
- Department of Oncology, A.C. Camargo Cancer Center, São Paulo, Brazil
| | | | - July Rodriguez
- Foundation for Clinical and Applied Cancer Research, Bogotá, Colombia
| | - Jenny Avila
- Foundation for Clinical and Applied Cancer Research, Bogotá, Colombia
| | - Melissa Bravo
- Foundation for Clinical and Applied Cancer Research, Bogotá, Colombia
| | - Pilar Archila
- Foundation for Clinical and Applied Cancer Research, Bogotá, Colombia
| | - Hernán Carranza
- Clinical and Translational Oncology Group, Clinica del Country, Bogotá, Colombia.,Foundation for Clinical and Applied Cancer Research, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Carlos Vargas
- Clinical and Translational Oncology Group, Clinica del Country, Bogotá, Colombia.,Foundation for Clinical and Applied Cancer Research, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Jorge Otero
- Clinical and Translational Oncology Group, Clinica del Country, Bogotá, Colombia.,Foundation for Clinical and Applied Cancer Research, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Feliciano Barrón
- Thoracic Oncology Unit, National Cancer Institute (INCan), Mexico City, Mexico
| | - Niki Karachaliou
- Instituto Oncológico Dr. Rosell (IOR), Quirón-Dexeus University Institute, Barcelona, Spain.,Instituto Oncológico Dr. Rosell (IOR), Sagrat Cor Hospital, Barcelona, Spain
| | - Rafael Rosell
- Cancer Biology and Precision Medicine Program, Catalan Institute of Oncology, Barcelona, Spain
| | - Oscar Arrieta
- Thoracic Oncology Unit, National Cancer Institute (INCan), Mexico City, Mexico
| |
Collapse
|
36
|
Arrieta O, Barrón F, Maldonado F, Cabrera L, Corona-Cruz JF, Blake M, Ramírez-Tirado LA, Zatarain-Barrón ZL, Cardona AF, García O, Arén O, De la Garza J. Radical consolidative treatment provides a clinical benefit and long-term survival in patients with synchronous oligometastatic non-small cell lung cancer: A phase II study. Lung Cancer 2019; 130:67-75. [PMID: 30885354 DOI: 10.1016/j.lungcan.2019.02.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 10/23/2018] [Revised: 01/30/2019] [Accepted: 02/06/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Evidence is rapidly accumulating for the use of radical consolidative treatment (RCT) for patients with oligometastatic non-small cell lung cancer (NSCLC). Nonetheless, published studies have several limitations, including a selection of patients whose favorable characteristics might dictate therapeutic success, as well as scarce prospective data regarding overall survival (OS). The objective of this study was to determine whether RCT increases OS in patients with oligometastatic NSCLC. MATERIALS AND METHODS In this prospective, single-arm phase II study, we sought to evaluate the efficacy of RCT in patients with oligometastatic NSCLC in terms of OS. Patients with pathologically confirmed stage IV NSCLC who presented ≤5 synchronous, any-site metastases (including central nervous system [CNS] metastases), as assessed by PET-CT, were included. All patients received four initial cycles of systemic treatment. Following, those with stable disease/partial response received RCT to the primary site and metastases. The response to RCT was evaluated with PET-CT. The primary end-point was OS. Secondary end-points included progression-free survival (PFS) and best response by PET-CT. The study is registered in clinicaltrials.gov (NCT02805530). RESULTS Thirty-seven patients were included in the analysis. The mean age was 55.8 years (range: 33-75 years). At diagnosis, 43.2% of patients presented with CNS metastases. Following RCT, 19 (51.4%) patients achieved a complete-response (CR) by PET-CT, while 18 (48.6%) had a non-complete response (NON-CR). The median OS was nonreached (NR) and was positively affected by CR on PET-CT (NR vs. 27.4 [95% CI: 16.4-38.3]; p = 0.011). The median PFS was 23.5 months (95% CI: 13.6-33.3) and was positively affected by CR on PET-CT (NR vs. 14.3 [95% CI: 11.7-16.9]; p < 0.001; HR: 0.19 [0.07-0.52]; p=0.001). CONCLUSION Patients with oligometastatic NSCLC who undergo RCT have a high response rate and favorable OS. Patients with a CR by PET-CT have significantly longer OS, rendering this an important potential prognostic marker.
Collapse
Affiliation(s)
- Oscar Arrieta
- Thoracic Oncology Unit, National Cancer Institute (INCan), San Fernando #22, Sección XVI, Tlalpan, CP 14080, Mexico City, Mexico.
| | - Feliciano Barrón
- Thoracic Oncology Unit, National Cancer Institute (INCan), San Fernando #22, Sección XVI, Tlalpan, CP 14080, Mexico City, Mexico
| | - Federico Maldonado
- Thoracic Oncology Unit, National Cancer Institute (INCan), San Fernando #22, Sección XVI, Tlalpan, CP 14080, Mexico City, Mexico
| | - Luis Cabrera
- Thoracic Oncology Unit, National Cancer Institute (INCan), San Fernando #22, Sección XVI, Tlalpan, CP 14080, Mexico City, Mexico; Médica Sur Oncology Center, Mexico
| | - José Francisco Corona-Cruz
- Thoracic Oncology Unit, National Cancer Institute (INCan), San Fernando #22, Sección XVI, Tlalpan, CP 14080, Mexico City, Mexico
| | - Monika Blake
- Thoracic Oncology Unit, National Cancer Institute (INCan), San Fernando #22, Sección XVI, Tlalpan, CP 14080, Mexico City, Mexico
| | - Laura Alejandra Ramírez-Tirado
- Thoracic Oncology Unit, National Cancer Institute (INCan), San Fernando #22, Sección XVI, Tlalpan, CP 14080, Mexico City, Mexico
| | - Zyanya Lucia Zatarain-Barrón
- Thoracic Oncology Unit, National Cancer Institute (INCan), San Fernando #22, Sección XVI, Tlalpan, CP 14080, Mexico City, Mexico
| | - Andrés F Cardona
- Clinical and Traslational Oncology Group, Clínica del Country, Bogotá, Colombia; Foundation for Clinical and Applied Cancer Research- FICMAC, Bogotá, Colombia; Clinical Research and Biology Systems Department, Universidad El Bosque, Bogotá, Colombia
| | - Osvaldo García
- Thoracic Oncology Unit, National Cancer Institute (INCan), San Fernando #22, Sección XVI, Tlalpan, CP 14080, Mexico City, Mexico
| | - Osvaldo Arén
- Centro de Investigación Clínica Bradford Hill, Santiago, Chile
| | - Jaime De la Garza
- Thoracic Oncology Unit, National Cancer Institute (INCan), San Fernando #22, Sección XVI, Tlalpan, CP 14080, Mexico City, Mexico
| |
Collapse
|
37
|
Rojas L, Cardona AF, Trejo-Rosales R, Zatarain-Barrón ZL, Ramírez-Tirado LA, Ruiz-Patiño A, Campos Gómez S, Corrales L, Oblitas G, Bacon L, Martín C, de Lima VCC, Freitas HC, Mas L, Vargas C, Carranza H, Otero J, Pérez MA, González L, Chirinos L, Granados ST, Rodriguez J, Báez R, Remolina Bonilla YA, Núñez Cerrillo G, Archila P, Cuello M, Karachaliou N, Rosell R, Arrieta O. Characteristics and long-term outcomes of advanced pleural mesothelioma in Latin America (MeSO-CLICaP). Thorac Cancer 2019; 10:508-518. [PMID: 30706690 PMCID: PMC6397921 DOI: 10.1111/1759-7714.12967] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 12/27/2022] Open
Abstract
Background Malignant pleural mesothelioma (MPM) is an aggressive tumor, associated with poor prognosis. There is a lack of information about the clinical and pathological features related with survival in the Latin American population. Methods The MeSO‐CLICaP registry identified 302 patients with advanced MPM diagnosed and treated between January 2008 and March 2016. The Cox model was applied to determine the variables associated with survival. A random forest tree model was built to predict the response to first‐line chemotherapy among Latin American patients. Results The median age was 61.1 years (SD 10.6 years), 191 (63.2%) were men, 65.9% were ever smokers, and 38.7% had previous exposure to asbestos. A total of 237 (78.5%) had epithelioid tumors, and 188 (62.3%) and 114 (37.7%) cases had stage III or IV MPM, respectively. A total of 49 patients (16.2%) underwent pleurectomy, 57 (18.9%) received radiotherapy, and 279 patients received first‐line platinum‐based chemotherapy. The overall response rate to first‐line chemotherapy was 40.4%, progression‐free survival to first‐line treatment was 5.7 months (95% CI 4.9–6.5), and 63 (20.8%) patients had pemetrexed maintenance. The median overall survival was 16.8 months (95% CI 13.0–20.5), and multivariate analysis found that stage (P = 0.013), and pleurodesis (P = 0.048), were independent prognostic factors for first‐line overall survival. The model to predict response to first‐line chemotherapy obtained a 0.98 area under the curve, a sensitivity of 93%, and a specificity of 95% for detecting responders and non‐responders. Conclusion This study identifies factors associated with clinical benefit from chemotherapy among advanced MPM Latin American patients, emphasizing the impact of histology and the clinical benefit of chemotherapy on outcomes.
Collapse
Affiliation(s)
- Leonardo Rojas
- Clinical Oncology Department, Organización Sanitas Internacional, University Clinic Colombia, Bogota, Colombia.,Clinical and Traslational Oncology Group, Country Clinic, Bogota, Colombia.,Foundation for Clinical and Applied Cancer Research - FICMAC, Bogota, Colombia
| | - Andrés F Cardona
- Clinical and Traslational Oncology Group, Country Clinic, Bogota, Colombia.,Foundation for Clinical and Applied Cancer Research - FICMAC, Bogota, Colombia.,Clinical Research and Biology Systems Department, El Bosque University, Bogotá, Colombia
| | | | | | | | | | - Saúl Campos Gómez
- Medical Oncology Department, State Oncology Center ISSEMyM, Toluca, Mexico
| | - Luis Corrales
- Oncology Department, San Juan de Dios Hospital, San José Costa Rica, Costa Rica
| | | | - Ludwing Bacon
- Oncology Department, Roberto Calderón Hospital, Managua, Nicaragua
| | - Claudio Martín
- Thoracic Oncology Section, Alexander Fleming Institute, Buenos Aires, Argentina
| | | | - Helano C Freitas
- Medical Oncology Department, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Luis Mas
- Clinical Oncology Department, Naiional Institute for Neoplastic Diseases - INEN, Lima, Peru
| | - Carlos Vargas
- Clinical and Traslational Oncology Group, Country Clinic, Bogota, Colombia.,Foundation for Clinical and Applied Cancer Research - FICMAC, Bogota, Colombia.,Clinical Research and Biology Systems Department, El Bosque University, Bogotá, Colombia
| | - Hernán Carranza
- Clinical and Traslational Oncology Group, Country Clinic, Bogota, Colombia.,Foundation for Clinical and Applied Cancer Research - FICMAC, Bogota, Colombia.,Clinical Research and Biology Systems Department, El Bosque University, Bogotá, Colombia
| | - Jorge Otero
- Clinical and Traslational Oncology Group, Country Clinic, Bogota, Colombia.,Foundation for Clinical and Applied Cancer Research - FICMAC, Bogota, Colombia.,Clinical Research and Biology Systems Department, El Bosque University, Bogotá, Colombia
| | | | | | | | - Sara T Granados
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogota, Colombia
| | - July Rodriguez
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogota, Colombia.,Clinical Research and Biology Systems Department, El Bosque University, Bogotá, Colombia
| | - Renata Báez
- National Institute for Respiratory Diseases, Mexico City, Mexico
| | | | | | - Pilar Archila
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogota, Colombia.,Clinical Research and Biology Systems Department, El Bosque University, Bogotá, Colombia
| | - Mauricio Cuello
- Hospital de Clínicas, Republic University - UdeLAR, Montevideo, Uruguay
| | - Niki Karachaliou
- Dr. Rosell Oncology Institute (IOR), Catalan Institute of Oncology, Barcelona, Spain
| | - Rafael Rosell
- Dr. Rosell Oncology Institute (IOR), Catalan Institute of Oncology, Barcelona, Spain
| | - Oscar Arrieta
- Thoracic Oncology Unit, National Cancer Institute, Mexico City, Mexico
| | | |
Collapse
|
38
|
Hernandez-Martinez JM, Vergara E, Zatarain-Barrón ZL, Barrón-Barrón F, Arrieta O. VISTA/PD-1H: a potential target for non-small cell lung cancer immunotherapy. J Thorac Dis 2018; 10:6378-6382. [PMID: 30746169 DOI: 10.21037/jtd.2018.11.39] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Juan-Manuel Hernandez-Martinez
- Thoracic Oncology Unit and Experimental Oncology Laboratory, Instituto Nacional de Cancerología de México (INCan), Mexico City, Mexico.,CONACYT-Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Edgar Vergara
- Thoracic Oncology Unit and Experimental Oncology Laboratory, Instituto Nacional de Cancerología de México (INCan), Mexico City, Mexico
| | - Zyanya Lucia Zatarain-Barrón
- Thoracic Oncology Unit and Experimental Oncology Laboratory, Instituto Nacional de Cancerología de México (INCan), Mexico City, Mexico
| | - Feliciano Barrón-Barrón
- Thoracic Oncology Unit and Experimental Oncology Laboratory, Instituto Nacional de Cancerología de México (INCan), Mexico City, Mexico
| | - Oscar Arrieta
- Thoracic Oncology Unit and Experimental Oncology Laboratory, Instituto Nacional de Cancerología de México (INCan), Mexico City, Mexico
| |
Collapse
|
39
|
Hernandez-Martinez JM, Zatarain-Barrón ZL, Cardona AF, Arrieta O. The importance of PD-L1 diagnostic assay harmonization for the selection of lung cancer immunotherapy. J Thorac Dis 2018; 10:S4096-S4100. [PMID: 30631565 DOI: 10.21037/jtd.2018.10.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Juan-Manuel Hernandez-Martinez
- Thoracic Oncology Unit and Experimental Oncology Laboratory, Instituto Nacional de Cancerología de México (INCan), Mexico City, Mexico.,CONACYT-Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Zyanya Lucia Zatarain-Barrón
- Thoracic Oncology Unit and Experimental Oncology Laboratory, Instituto Nacional de Cancerología de México (INCan), Mexico City, Mexico
| | - Andrés F Cardona
- Clinical and Translational Oncology Group, Clinica del Country, Bogotá, Colombia.,Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Oscar Arrieta
- Thoracic Oncology Unit and Experimental Oncology Laboratory, Instituto Nacional de Cancerología de México (INCan), Mexico City, Mexico
| |
Collapse
|
40
|
Cardona AF, Rojas L, Zatarain-Barrón ZL, Freitas HC, Granados ST, Castillo O, Oblitas G, Corrales L, Castro CD, Ruiz-Patiño A, Martín C, Pérez MA, González L, Chirinos L, Vargas C, Carranza H, Otero J, Rodriguez J, Rodriguez J, Archila P, Lema M, Acosta Madiedo J, Karachaliu N, Wills B, Pino LE, de Lima V, Rosell R, Arrieta O. EGFR exon 20 insertion in lung adenocarcinomas among Hispanics (geno1.2-CLICaP). Lung Cancer 2018; 125:265-272. [DOI: 10.1016/j.lungcan.2018.10.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/21/2018] [Accepted: 10/05/2018] [Indexed: 01/14/2023]
|
41
|
Ruiz-Patiño A, Castro CD, Ricaurte LM, Cardona AF, Rojas L, Zatarain-Barrón ZL, Wills B, Reguart N, Carranza H, Vargas C, Otero J, Corrales L, Martín C, Archila P, Rodriguez J, Avila J, Bravo M, Pino LE, Rosell R, Arrieta O. EGFR Amplification and Sensitizing Mutations Correlate with Survival in Lung Adenocarcinoma Patients Treated with Erlotinib (MutP-CLICaP). Target Oncol 2018; 13:621-629. [DOI: 10.1007/s11523-018-0594-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
42
|
Turcott JG, Oñate-Ocaña LF, Soca-Chafre G, Ramírez-Tirado LA, Flores-Estrada D, Zatarain-Barrón ZL, Arrieta O. FAACT-Anorexia Cachexia Scale: Cutoff Value for Anorexia Diagnosis in Advanced Non-Small Cell Lung Cancer Patients. Nutr Cancer 2018; 71:409-417. [DOI: 10.1080/01635581.2018.1506488] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Jenny Georgina Turcott
- Thoracic Oncology Unit, National Cancer Institute of Mexico (INCan), Mexico City, Mexico
| | - Luis F. Oñate-Ocaña
- Clinical Research Division, Surgery Division, National Cancer Institute of Mexico (INCan), Mexico City, Mexico
| | - Giovanny Soca-Chafre
- Experimental Oncology Laboratory, National Cancer Institute of Mexico (INCan), Mexico City, Mexico
| | | | - Diana Flores-Estrada
- Thoracic Oncology Unit, National Cancer Institute of Mexico (INCan), Mexico City, Mexico
| | | | - Oscar Arrieta
- Thoracic Oncology Unit, National Cancer Institute of Mexico (INCan), Mexico City, Mexico
| |
Collapse
|
43
|
Cardona AF, Zatarain-Barrón ZL, Rubio C, Martínez S, Ruiz-Patiño A, Ricaurte L, Serna A, Barrios R, Garzón JC, Navarrete C, Balaguera A, Corrales L, Rojas L, Arrieta O. Probable hereditary familial overlap syndrome with multiple synchronous lung tumors. Lung Cancer 2018; 124:279-282. [PMID: 30268473 DOI: 10.1016/j.lungcan.2018.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 08/23/2018] [Accepted: 08/27/2018] [Indexed: 11/28/2022]
Abstract
Here we report a case of a young, never-smoker Hispanic woman with a hereditary familial overlap syndrome (Li-Fraumeni plus CDH1). The patient developed multiple synchronous primary lung adenocarcinomas related to Intra-Alveolar Tumor Spread (STAS) several years after the diagnosis of a locally advanced lower limb osteosarcoma. Comprehensive genomic profiling by next generation sequencing (NGS) was performed on 90 cancer-related genes over each lung lesion (including two nodules of acinar adenocarcinoma, one lepidic spread tumor and in the STAS area). Likewise, the broad genomic analysis was performed on archival tissue from the previous bone tumor. Lung tumors were found to harbor PIK3CA (invasive lesions) and a rare in-frame insertion of nucleotides in exon 19 of EGFR (lepidic tumor). STAS area showed KRAS and BRAF mutations in two different segments, and osteosarcoma tested positive for well known PIK3CA, KRAS and CDH1 alterations. This unique case raises practical questions as to the challenges of molecular testing and highlights the potential association of germline TP53 and CDH1 mutations with concurrent somatic alterations that elucidate the basis of tumor heterogeneity.
Collapse
Affiliation(s)
- Andrés F Cardona
- Clinical and Translational Oncology Group, Thoracic Oncology Unit, Institute of Oncology, Clínica del Country, Bogotá, Colombia; Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (Fox-G), Bogotá, Colombia.
| | - Zyanya Lucia Zatarain-Barrón
- Thoracic Oncology Unit and Laboratory of Personalized Medicine, Instituto Nacional de Cancerología (INCan), México City, Mexico
| | - Cladelis Rubio
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia
| | - Stella Martínez
- Thoracic Surgery Department, Clínica Colsanitas, Bogotá, Colombia
| | | | - Luisa Ricaurte
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia
| | - Adriana Serna
- Thoracic Surgery Department, Clínica Colsanitas, Bogotá, Colombia
| | - Rodolfo Barrios
- Thoracic Surgery Department, Clínica Colsanitas, Bogotá, Colombia
| | - Juan Carlos Garzón
- Thoracic Surgery Department, Clínica Colsanitas, Bogotá, Colombia; Thoracic Surgery Department, Fundación Cardio Infantil, Bogotá, Colombia
| | | | | | - Luis Corrales
- Oncology Department, Hospital San Juan de Dios, San José de Costa Rica, Costa Rica
| | - Leonardo Rojas
- Clinical Oncology Department, Clínica Colsanitas, Bogotá, Colombia
| | - Oscar Arrieta
- Thoracic Oncology Unit and Laboratory of Personalized Medicine, Instituto Nacional de Cancerología (INCan), México City, Mexico
| |
Collapse
|
44
|
Abstract
Fetal adenocarcinoma of the lung (FLAC) is a rare tumor. It accounts for ~0.1%-0.5% of all pulmonary neoplasms. Due to its rarity, much of the world literature regarding FLAC comes from case reports and case series. FLAC is an adenocarcinoma resembling developing fetal lung in its pseudoglandular stage (8-16 weeks of gestation). It is distinguishable from pulmonary blastoma (PB) because it lacks the mesenchymal component which is a hallmark finding in PB. Due to differences in histopathology and clinical course, FLAC has been further categorized into low-grade (L-FLAC) and high-grade (H-FLAC) forms. L-FLAC displays low nuclear atypia and prominent morule formation and has a pure pattern. H-FLAC typically presents with at least 50% fetal morphology, and is often associated with other conventional types of lung adenocarcinoma. FLAC expresses neuroendocrine markers and thyroid transcription factor 1 in most cases. L-FLAC has an aberrant nuclear/cytoplasmic expression of β-catenin and presents mutations in this gene. H-FLAC overexpresses p53. These tumors have a very low frequency of mutations in KRAS and EGFR; it is thought that they are different from a molecular point of view to conventional lung adenocarcinomas. Approximately 25%-40% of patients are asymptomatic at presentation; most of them are incidental findings on chest radiographs. H-FLAC is more common in elderly male patients, with a heavy smoking history. L-FLAC tends to occur in young females. Patients with L-FLAC are usually diagnosed with stage I-II disease, while patients with H-FLAC usually present with a more advanced-stage disease. Poor prognostic factors for FLAC are thoracic lymphadenopathy, metastases at diagnosis, and tumor recurrence; however, the 10-year survival for FLAC is estimated at 75%.
Collapse
Affiliation(s)
| | - Oscar Arrieta
- Thoracic Oncology Unit, National Cancer Institute (INCan), México City, México
| | | | - Andrés F Cardona
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia,
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia,
| |
Collapse
|
45
|
Cardona AF, Arrieta O, Zapata MI, Rojas L, Wills B, Reguart N, Karachaliou N, Carranza H, Vargas C, Otero J, Archila P, Martín C, Corrales L, Cuello M, Ortiz C, Pino LE, Rosell R, Zatarain-Barrón ZL. Acquired Resistance to Erlotinib in EGFR Mutation-Positive Lung Adenocarcinoma among Hispanics (CLICaP). Target Oncol 2018; 12:513-523. [PMID: 28620690 DOI: 10.1007/s11523-017-0497-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Lung cancer harboring epidermal growth factor receptor (EGFR) mutations and treated with EGFR tyrosine kinase inhibitors (TKIs) all eventually develop acquired resistance to the treatment, with half of the patients developing EGFR T790M resistance mutations. OBJECTIVE The purpose of this study was to assess histological and clinical characteristics and survival outcomes in Hispanic EGFR mutated lung cancer patients after disease progression. PATIENTS AND METHODS EGFR mutation-positive lung cancer patients (n = 34) with acquired resistance to the EGFR-TKI erlotinib were identified from 2011 to 2015. Post-progression tumor specimens were collected for molecular analysis. Post-progression interventions, response to treatment, and survival were assessed and compared among all patients and those with and without T790M mutations. RESULTS Mean age was 59.4 ± 13.9 years, 65% were never-smokers, and 53% had a performance status 0-1. All patients received erlotinib as first-line treatment. Identified mutations included: 60% DelE19 (Del746-750) and 40% L858R. First-line erlotinib overall response rate (ORR) was 61.8% and progression free survival (PFS) was 16.8 months (95% CI: 13.7-19.9). Acquired resistance mutations identified were T790M mutation (47.1%); PI3K mutations (14.7%); EGFR amplification (14.7%); KRAS mutation (5.9%); MET amplification (8.8%); HER2 alterations (5.9%, deletions/insertions in e20); and SCLC transformation (2.9%). Of patients, 79.4% received treatment after progression. ORR for post-erlotinib treatment was 47.1% (CR 2/PR 14) and median PFS was 8.3 months (95% CI: 2.2-36.6). Median overall survival (OS) from treatment initiation was 32.9 months (95% CI: 30.4-35.3), and only the use of post-progression therapy affected OS in a multivariate analysis (p = 0.05). CONCLUSIONS Hispanic patients with acquired resistance to erlotinib continued to be sensitive to other treatments after progression. The proportion of T790M+ patients appears to be similar to that previously reported in Caucasians.
Collapse
Affiliation(s)
- Andrés F Cardona
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia. .,Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia. .,Internal Medicine Department, Universidad El Bosque- Fundación Santa Fe de Bogotá, Bogotá, Colombia.
| | - Oscar Arrieta
- Thoracic Oncology Unit and Laboratory of Personalized Medicine, Instituto Nacional de Cancerología (INCan), México City, México
| | - Martín Ignacio Zapata
- Internal Medicine Department, Universidad El Bosque- Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Leonardo Rojas
- Medical Oncology Department, Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Beatriz Wills
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia
| | - Noemí Reguart
- Medical Oncology, Hospital Clinic, Barcelona and Translational Genomics and Targeted Therapeutics in Solid Tumors, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Niki Karachaliou
- Translational Research Unit, IOR/Dexeus, University Hospital, Barcelona, Spain
| | - Hernán Carranza
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia.,Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia
| | - Carlos Vargas
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia.,Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia
| | - Jorge Otero
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia.,Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia
| | - Pilar Archila
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia
| | - Claudio Martín
- Medical Oncology Department, Thoracic Oncology Unit, Instituto Flemin, Buenos Aires, Argentina
| | - Luis Corrales
- Medical Oncology Department, Hospital San Juan de Dios, San José, Costa Rica
| | | | - Carlos Ortiz
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia
| | - Luis E Pino
- Clinical Oncology Group, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Rafael Rosell
- Medical Oncology Department, Catalan Institute of Oncology-ICO, Barcelona, Spain
| | - Zyanya Lucia Zatarain-Barrón
- Thoracic Oncology Unit and Laboratory of Personalized Medicine, Instituto Nacional de Cancerología (INCan), México City, México
| | | |
Collapse
|
46
|
Barrón F, Cardona AF, Corrales L, Ramirez-Tirado LA, Caballe-Perez E, Sanchez G, Flores-Estrada D, Zatarain-Barrón ZL, Arrieta O. Characteristics of progression to tyrosine kinase inhibitors predict overall survival in patients with advanced non-small cell lung cancer harboring an EGFR mutation. J Thorac Dis 2018; 10:2166-2178. [PMID: 29850120 DOI: 10.21037/jtd.2018.03.106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Non-small cell lung cancer (NSCLC) harboring EGFR-sensitizing mutations has a distinct biology and heterogeneous clinical behavior. We evaluated the characteristics to progression such as clinical patterns of progression (dramatic, gradual, and local) with the prognosis of NSCLC patients treated with tyrosine kinase inhibitors (TKIs). Methods We reviewed 123 advanced-NSCLC patients with an EGFR-sensitizing mutation treated with TKIs (gefitinib, erlotinib and afatinib). We assessed patients according to clinical factors and progression pattern to TKIs at three centers. Results For all patients, 58.5%, 31.7% and 9.8% harbored exon19 deletion, exon21 L858R mutation and other-sensitivity mutations, respectively. Median progression-free survival (PFS) was 8.8 months (95% CI: 7.9-9.7). Sixty percent of patients were asymptomatic. Dramatic-progression was the most frequent pattern (50.4%), followed by gradual-progression (32.5%), and local-progression (17.1%). Median overall survival (OS) was 23.1 months (95% CI: 17.4-28.9). In the univariate analysis, factors associated to a longer OS included pattern [gradual-progression (32.1), dramatic (19.5) and local (18.8 months), P=0.008], and the time to progression to TKI [>12 months (38.5), 6-12 months (19.1), <6 months (9.6), P<0.001]. Multivariate analysis showed that only time to progression to TKI was independently associated to OS and PFS. Conclusions Factors at TKI progression associated to a longer OS can define a subset of patients who may benefit from continued TKI therapy, as well as from local-ablative therapy in progression sites, especially in patients without T790M or who lack access to third-generation TKI.
Collapse
Affiliation(s)
- Feliciano Barrón
- Thoracic Oncology Unit, National Cancer Institute (INCan), Mexico City, Mexico
| | - Andrés F Cardona
- Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia.,Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia
| | - Luis Corrales
- Medical Oncology Department, Hospital San Juan de Dios, San José, Costa Rica
| | | | | | - Gisela Sanchez
- Thoracic Oncology Unit, National Cancer Institute (INCan), Mexico City, Mexico
| | | | | | - Oscar Arrieta
- Thoracic Oncology Unit, National Cancer Institute (INCan), Mexico City, Mexico
| | | |
Collapse
|
47
|
Barrón F, Zatarain-Barrón ZL, Cardona AF, Arrieta O. Extending the curve: survival of EGFR-mutated lung cancer patients in the 21 st century. J Thorac Dis 2018; 10:1265-1268. [PMID: 29708166 DOI: 10.21037/jtd.2018.03.28] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Feliciano Barrón
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), México City, México
| | | | - Andrés F Cardona
- Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia.,Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia
| | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), México City, México
| |
Collapse
|
48
|
Cardona AF, Zatarain-Barrón ZL, Rojas L, Arrieta O. The reality of complexity: concomitant genomic alterations in patients with EGFR mutations. J Thorac Dis 2018; 10:597-599. [PMID: 29608188 DOI: 10.21037/jtd.2017.12.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Andrés F Cardona
- Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia.,Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia.,Clinical Research and Biology Systems Department, Universidad el Bosque, Bogotá, Colombia
| | - Zyanya Lucia Zatarain-Barrón
- Thoracic Oncology Unit and Laboratory of Personalized Medicine, Instituto Nacional de Cancerología (INCan), México City, Mexico
| | - Leonardo Rojas
- Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia.,Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia.,Oncology Department, Sanitas Foundation, Clinica Colsanitas, Bogotá, Colombia
| | - Oscar Arrieta
- Thoracic Oncology Unit and Laboratory of Personalized Medicine, Instituto Nacional de Cancerología (INCan), México City, Mexico
| |
Collapse
|
49
|
Cardona AF, Rojas L, Wills B, Bernal L, Ruiz-Patiño A, Arrieta O, Hakim EJ, Hakim F, Mejía JA, Useche N, Bermúdez S, Carranza H, Vargas C, Otero J, Mayor LC, Ortíz LD, Franco S, Ortíz C, Gil-Gil M, Balaña C, Zatarain-Barrón ZL. Efficacy and safety of Levetiracetam vs. other antiepileptic drugs in Hispanic patients with glioblastoma. J Neurooncol 2017; 136:363-371. [PMID: 29177594 DOI: 10.1007/s11060-017-2660-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/29/2017] [Indexed: 01/05/2023]
Abstract
Epilepsy is a common symptom in patients with glioblastoma (GB). 213 patients with GB from RedLANO follow-up registry were included. All patients underwent surgery, if feasible, followed by chemoradiation based on temozolomide (Stupp platform). Information was recorded regarding demographics, seizure timing, anti-epileptic drugs (AEDs), dosage, time to next seizure, total seizures in 6 months, and main side effects of AEDs. The relationship between epilepsy treatment and overall survival (OS) was evaluated. Mean age was 53 years old and 56.8% were male. Seventy-eight patients (37%) were treated with levetiracetam (LEV), 27% were given another AED and 36% did not require any AED. Choice of AED was not associated with age (p = 0.67), performance status (p = 0.24) or anatomic tumor site (p = 0.34). Seizures and AED requirement were greater in those having primary GB (p = 0.04). After starting an AED, the mean time until next crisis was 9.9 days (SD ± 6.3), which was shorter in those receiving LEV (p = 0.03); mean number of seizures during the first 3 and 6 months were 2.9 and 4, respectively. Most patients treated with LEV (n = 46) required less than two medication adjustments compared to those treated with other AEDs (p = 0.02). Likewise, less patients exposed to LEV required a coadjuvant drug (p = 0.04). Additionally, patients receiving LEV had significantly less adverse effects compared to patients treated with another AED. OS was significantly higher in the group treated with LEV compared to other AEDs (25.5 vs. 17.9 months; p = 0.047). Patients treated with LEV had better seizure control and longer OS compared to other AEDs.
Collapse
Affiliation(s)
- Andrés F Cardona
- Brain Tumors Unit, Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia. .,Foundation for Clinical and Applied Cancer Research (FICMAC), Calle 116 No. 9 - 72, c. 318, Bogotá, Colombia. .,Latin American Neuro-Oncology Network (RedLANO), Bogotá, Colombia.
| | - Leonardo Rojas
- Clinical Oncology Department, Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Beatriz Wills
- Foundation for Clinical and Applied Cancer Research (FICMAC), Calle 116 No. 9 - 72, c. 318, Bogotá, Colombia
| | - Laura Bernal
- Internal Medicine Department, Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Oscar Arrieta
- Thoracic Oncology Unit and Laboratory of Personalized Medicine, Instituto Nacional de Cancerología (INCan), México City, Mexico
| | - Enrique Jiménez Hakim
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia.,Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia
| | - Fernando Hakim
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia.,Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia
| | - Juan Armando Mejía
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia.,Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia
| | - Nicolás Useche
- Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia.,Radiology Department, Neuro-radiology Section, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Sonia Bermúdez
- Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia.,Radiology Department, Neuro-radiology Section, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Hernán Carranza
- Brain Tumors Unit, Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia.,Foundation for Clinical and Applied Cancer Research (FICMAC), Calle 116 No. 9 - 72, c. 318, Bogotá, Colombia
| | - Carlos Vargas
- Brain Tumors Unit, Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia.,Foundation for Clinical and Applied Cancer Research (FICMAC), Calle 116 No. 9 - 72, c. 318, Bogotá, Colombia
| | - Jorge Otero
- Brain Tumors Unit, Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia.,Foundation for Clinical and Applied Cancer Research (FICMAC), Calle 116 No. 9 - 72, c. 318, Bogotá, Colombia
| | - Luis Carlos Mayor
- Neurology Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - León Darío Ortíz
- Latin American Neuro-Oncology Network (RedLANO), Bogotá, Colombia.,Neuro-Oncology Unit, Clinical Oncology Department, Clínica de Las Américas, Medellín, Colombia
| | - Sandra Franco
- Brain Tumors Unit, Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia
| | - Carlos Ortíz
- Brain Tumors Unit, Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia
| | - Miguel Gil-Gil
- Medical Oncology Service, Catalan Institute of Oncology, Hospital Duran I Reynals - IDIBELL, Hospitalet de Llobregat, Spain
| | - Carmen Balaña
- Medical Oncology Service, Catalan Institute of Oncology, Hospital Universitari Germans Trias i Pujol, IGTP, Badalona, Spain
| | - Zyanya Lucia Zatarain-Barrón
- Thoracic Oncology Unit and Laboratory of Personalized Medicine, Instituto Nacional de Cancerología (INCan), México City, Mexico
| |
Collapse
|
50
|
Wills B, Cardona AF, Rojas L, Ruiz-Patiño A, Arrieta O, Reguart N, Carranza H, Vargas C, Otero J, Corrales L, Martín C, Cuello M, Pino LE, Rolfo C, Rosell R, Zatarain-Barrón ZL. Survival Outcomes According to TIMP1 and EGFR Expression in Heavily Treated Patients with Advanced Non-small Cell Lung Cancer who Received Biweekly Irinotecan Plus Bevacizumab. Anticancer Res 2017; 37:6429-6436. [PMID: 29061829 DOI: 10.21873/anticanres.12097] [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] [Received: 06/14/2017] [Revised: 07/13/2017] [Accepted: 07/17/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Heavily treated patients with non-small cell lung cancer (NSCLC) have few treatment options, while irinotecan and bevacizumab have proven synergistic action in preclinical studies. PATIENTS AND METHODS A total of 49 patients with heavily treated NSCLC were enrolled from 2011-2014 and treated with irinotecan and bevacizumab. Treatment response along with mutational status of epidermal growth factor receptor (EGFR), and tissue inhibitor of metalloproteinases-1 (TIMP1) and EGFR expression were evaluated. Progression-free (PFS) and overall (OS) survival were monitored. RESULTS Median follow-up was 13.2 months. Twenty-three patients had received three or more prior therapy lines. Overall response rate was 32% [95% confidence interval (CI)=22%-39%] and 26% of patients achieved stable disease. Median PFS was 4.4 (95% CI=2.8-8.3) months and median OS 18.0 (95% CI=16.2-30.7) months. Nine patients harboring EGFR mutations had a long-lasting partial response. A shorter OS was found in patients with a higher TIMP1 expression (p=0.006). CONCLUSION Irinotecan combined with bevacizumab had favorable antitumor activity in heavily pretreated patients with NSCLC. These results suggest this is a reasonable strategy, particularly for patients with low TIMP1 expression.
Collapse
Affiliation(s)
- Beatriz Wills
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogota, Colombia.,Internal Medicine Department, Johns Hopkins University, Baltimore, MD, U.S.A
| | - Andrés F Cardona
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogota, Colombia .,Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogota, Colombia.,Research Department, University of Bosque, Bogota, Colombia
| | - Leonardo Rojas
- Oncology Department, Javeriana Oncology Center, San Ignacio Hospital, Bogota, Colombia.,Faculty of Medicine, Javeriana University, Bogotá, Colombia
| | | | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Noemí Reguart
- Medical Oncology Department, Hospital Clínic, Barcelona, Spain
| | - Hernán Carranza
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogota, Colombia.,Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogota, Colombia.,Research Department, University of Bosque, Bogota, Colombia
| | - Carlos Vargas
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogota, Colombia.,Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogota, Colombia.,Research Department, University of Bosque, Bogota, Colombia
| | - Jorge Otero
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogota, Colombia.,Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogota, Colombia.,Research Department, University of Bosque, Bogota, Colombia
| | - Luis Corrales
- Clinical Oncology Department, Hospital San Juan de Dios, San Jose, Costa Rica
| | - Claudio Martín
- Thoracic Oncology Unit, Alexander Fleming Institute, Buenos Aires, Argentina
| | - Mauricio Cuello
- Clinical Oncology Department, Clinics Hospital, University of the Republic (UdeLAR), Montevideo, Uruguay
| | | | - Christian Rolfo
- Early Clinical Trials Unit, Oncology Department, Antwerp University Hospital and Center for Oncological Research (CORE), Antwerp University, Edegem, Belgium
| | - Rafael Rosell
- Medical Oncology Department, Catalan Institute of Oncology, University Hospital "Germans Trias i Pujol", Barcelona, Spain
| | | | | |
Collapse
|