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Ruiz G, Enrico D, Mahmoud YD, Ruiz A, Cantarella MF, Leguina L, Barberis M, Beña A, Brest E, Starapoli S, Mendoza Bertelli A, Tsou F, Pupareli C, Coppola MP, Scocimarro A, Sena S, Levit P, Perfetti A, Aman E, Girotti MR, Arrieta O, Martín C, Salanova R. Association of PD-L1 expression with driver gene mutations and clinicopathological characteristics in non-small cell lung cancer: A real-world study of 10 441 patients. Thorac Cancer 2024; 15:895-905. [PMID: 38456253 PMCID: PMC11016406 DOI: 10.1111/1759-7714.15244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Programmed death ligand-1 (PD-L1) expression is a well-known predictive biomarker of response to immune checkpoint blockade in non-small cell lung cancer (NSCLC). However, there is limited evidence of the relationship between PD-L1 expression, clinicopathological features, and their association with major driver mutations in NSCLC patients in Latin America. METHODS This retrospective study included patients from Argentina with advanced NSCLC, and centralized evaluation of PD-L1 expression concurrently with genomic alterations in the driver genes EGFR, ALK, ROS1, BRAF, and/or KRAS G12C in FFPE tissue samples. RESULTS A total of 10 441 patients with advanced NSCLC were analyzed. Adenocarcinoma was the most frequent histological subtype (71.1%). PD-L1 expression was categorized as PD-L1 negative (45.1%), PD-L1 positive low-expression 1%-49% (32.3%), and PD-L1 positive high-expression ≥50% (22.6%). Notably, current smokers and males were more likely to have tumors with PD-L1 tumor proportion score (TPS) ≥50% and ≥ 80% expression, respectively (p < 0.001 and p = 0.013). Tumors with non-adenocarcinoma histology had a significantly higher median PD-L1 expression (p < 0.001). Additionally, PD-L1 in distant nodes was more likely ≥50% (OR 1.60 [95% CI: 1.14-2.25, p < 0.01]). In the multivariate analysis, EGFR-positive tumors were more commonly associated with PD-L1 low expression (OR 0.62 [95% CI: 0.51-0.75], p < 0.01), while ALK-positive tumors had a significant risk of being PD-L1 positive (OR 1.81 [95% CI: 1.30-2.52], p < 0.01). CONCLUSIONS PD-L1 expression was associated with well-defined clinicopathological and genomic features. These findings provide a comprehensive view of the expression of PD-L1 in patients with advanced NSCLC in a large Latin American cohort.
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Affiliation(s)
- Gonzalo Ruiz
- Pathology & Molecular Biology LaboratoriesBiomakersBuenos AiresArgentina
| | - Diego Enrico
- Thoracic Oncology Unit, Department of Medical OncologyAlexander Fleming Cancer InstituteBuenos AiresArgentina
- Clinical Research Unit, Department of Medical OncologyAlexander Fleming Cancer InstituteBuenos AiresArgentina
| | - Yamil D. Mahmoud
- Universidad Argentina de la Empresa (UADE), Instituto de Tecnología (INTEC)Buenos AiresArgentina
- Laboratorio de Glicomedicina, Instituto de Biología y Medicina Experimental (IBYME)Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET)Buenos AiresArgentina
| | - Alan Ruiz
- Pathology & Molecular Biology LaboratoriesBiomakersBuenos AiresArgentina
| | | | - Laura Leguina
- Pathology & Molecular Biology LaboratoriesBiomakersBuenos AiresArgentina
| | - Mariana Barberis
- Pathology & Molecular Biology LaboratoriesBiomakersBuenos AiresArgentina
| | - Asunción Beña
- Pathology & Molecular Biology LaboratoriesBiomakersBuenos AiresArgentina
| | - Esteban Brest
- Pathology & Molecular Biology LaboratoriesBiomakersBuenos AiresArgentina
| | - Solange Starapoli
- Pathology & Molecular Biology LaboratoriesBiomakersBuenos AiresArgentina
| | | | - Florencia Tsou
- Thoracic Oncology Unit, Department of Medical OncologyAlexander Fleming Cancer InstituteBuenos AiresArgentina
- Clinical Research Unit, Department of Medical OncologyAlexander Fleming Cancer InstituteBuenos AiresArgentina
| | - Carmen Pupareli
- Thoracic Oncology Unit, Department of Medical OncologyAlexander Fleming Cancer InstituteBuenos AiresArgentina
- Clinical Research Unit, Department of Medical OncologyAlexander Fleming Cancer InstituteBuenos AiresArgentina
| | - María Pía Coppola
- Medical Oncology UnitHospital Zonal Especializado en Agudos y Crónicos Dr. Antonio CetrangoloBuenos AiresArgentina
| | - Alejandra Scocimarro
- Medical Oncology UnitHospital Zonal Especializado en Agudos y Crónicos Dr. Antonio CetrangoloBuenos AiresArgentina
| | - Susana Sena
- Medical Oncology DepartmentHospital AlemánBuenos AiresArgentina
| | - Patricio Levit
- Medical Oncology UnitUnión Personal‐Accord SaludBuenos AiresArgentina
| | - Aldo Perfetti
- Medical Oncology UnitUnión Personal‐Accord SaludBuenos AiresArgentina
- Medical Oncology DepartmentCentro de Educación Médica e Investigaciones Clínicas (CEMIC)Buenos AiresArgentina
| | - Enrique Aman
- Medical Oncology Unit, Swiss Medical GroupBuenos AiresArgentina
| | - María Romina Girotti
- Pathology & Molecular Biology LaboratoriesBiomakersBuenos AiresArgentina
- Universidad Argentina de la Empresa (UADE), Instituto de Tecnología (INTEC)Buenos AiresArgentina
| | - Oscar Arrieta
- Head of Thoracic Oncology UnitUnidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología (INCan)Mexico CityMexico
| | - Claudio Martín
- Thoracic Oncology Unit, Department of Medical OncologyAlexander Fleming Cancer InstituteBuenos AiresArgentina
- Clinical Research Unit, Department of Medical OncologyAlexander Fleming Cancer InstituteBuenos AiresArgentina
| | - Rubén Salanova
- Pathology & Molecular Biology LaboratoriesBiomakersBuenos AiresArgentina
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Enrico D, Tsou F, Catani G, Pupareli C, Girotti MR, Ulloa Alvarez DE, Waisberg F, Rodríguez A, Reyes R, Chacón M, Reguart N, Martín C. Overcoming Resistance to Osimertinib by T790M Loss and C797S Acquisition Using Gefitinib in a Patient With EGFR-Mutant NSCLC: A Case Report. JTO Clin Res Rep 2022; 4:100456. [PMID: 36798785 PMCID: PMC9926104 DOI: 10.1016/j.jtocrr.2022.100456] [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: 09/25/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 12/29/2022] Open
Abstract
Limited strategies are available at disease progression on osimertinib for patients with EGFR-mutant NSCLC. The emergence of the on-target EGFR C797S mutation has been described as one of the most common mechanisms of resistance. In addition, loss of the EGFR T790M mutation has been mainly investigated as a resistance phenomenon to second-line osimertinib exposure. Remarkably, by studying the molecular profile at progression, it has been reported that the presence of the EGFR-sensitizing mutation, concurrently with the T790M, and C797S resulted in resistance to the current available EGFR tyrosine kinase inhibitors. Here, we report the first clinical evidence of gefitinib efficacy at EGFR exon 19 deletion/C797S mutation/T790M loss-mediated resistance to first-line osimertinib. Our findings highlight that dynamic genetic monitoring is a crucial approach in the evolution of EGFR-mutant NSCLC to understand the acquired molecular mechanisms for driving the best treatment strategy.
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Affiliation(s)
- Diego Enrico
- Thoracic Oncology Unit, Department of Medical Oncology, Alexander Fleming Cancer institute, Buenos Aires, Argentina
- Clinical Research Unit, Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
- Corresponding author. Address for correspondence: Diego Enrico, MD, Thoracic Oncology Unit, Department of Medical Oncology, Alexander Fleming Cancer Institute, 1180 Crámer, Buenos Aires (1426), Argentina.
| | - Florencia Tsou
- Thoracic Oncology Unit, Department of Medical Oncology, Alexander Fleming Cancer institute, Buenos Aires, Argentina
- Clinical Research Unit, Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Greta Catani
- Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Carmen Pupareli
- Thoracic Oncology Unit, Department of Medical Oncology, Alexander Fleming Cancer institute, Buenos Aires, Argentina
| | | | | | - Federico Waisberg
- Clinical Research Unit, Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
- Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Andrés Rodríguez
- Clinical Research Unit, Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
- Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Roxana Reyes
- Thoracic Oncology Unit, Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | - Matías Chacón
- Clinical Research Unit, Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
- Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Noemí Reguart
- Thoracic Oncology Unit, Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
- Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Claudio Martín
- Thoracic Oncology Unit, Department of Medical Oncology, Alexander Fleming Cancer institute, Buenos Aires, Argentina
- Clinical Research Unit, Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
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Narváez D, Waisberg F, Soule T, Angel M, Bruno L, Girotti MR, Pupareli C, Chacón M, Petracci FE. Precision medicine in the real-world setting. Clinical activity of talazoparib in a woman with hormone receptor-positive HER2-negative metastatic breast cancer with pathogenic mutation in somatic BRCA2. Ecancermedicalscience 2022; 16:1448. [DOI: 10.3332/ecancer.2022.1448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Indexed: 11/06/2022] Open
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Angel MO, Pupareli C, Soule T, Tsou F, Leiva M, Losco F, Esteso F, O Connor JM, Luca R, Petracci F, Girotti R, Mahmoud YD, Martín C, Chacón M. Implementation of a molecular tumour board in LATAM: the impact on treatment decisions for patients evaluated at Instituto Alexander Fleming, Argentina. Ecancermedicalscience 2021; 15:1312. [PMID: 35047063 PMCID: PMC8723751 DOI: 10.3332/ecancer.2021.1312] [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: 07/03/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The role of the molecular tumour board (MTB) is to recommend personalised therapy for patients with cancer beyond standard-of-care treatment. A comprehensive molecular analysis of the tumour in a molecular pathology laboratory is important for all targeted therapies approaches. Here we report the 1-year experience of the Instituto Alexander Fleming Molecular Tumour Board. PATIENTS AND METHODS The MTB of the Instituto Alexander Fleming was launched in December 2019 in a monthly meeting. In each interactive monthly session, five cases were presented and discussed by the members. These cases were referred by the treating oncologists. The MTB recommendations were sent to each physician individually, and to the rest of the meeting participants. This was discussed with the patients/families by the treating oncologist. The final decision to choose therapy was left to the treating physicians. Of the 32 patients presented at MTB, 28 (87.5%) had potentially actionable alterations and only 4 (12.5%) had no actionable mutation. Six (19%) patients received a local regulatory agency approved drug recommendation, nine (28%) patients received an off-label approval treatment recommendation and three (9%) patients did not receive the treatment due to access and reimbursement of the drug. CONCLUSION In most of the cases evaluated, the MTB was able to provide treatment recommendations based on targetable genetic alterations. Molecular-guided extended personalised patient care is effective for a small but clinically significant proportion of patients in challenging clinical situations. We believe that the implementation of a MTB is feasible in the Latin America (LATAM) region.
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Affiliation(s)
- Martín Osvaldo Angel
- Genitourinary Oncology Unit, Instituto Alexander Fleming, Cramer 1180, Ciudad Autonoma de Buenos Aires, C1426ANZ, Argentina
- https://orcid.org/0000-0002-1463-8887
| | - Carmen Pupareli
- Thoracic Oncology Unit, Instituto Alexander Fleming, Cramer 1180, Ciudad Autonoma de Buenos Aires, C1426ANZ, Argentina
| | - Tomas Soule
- Sarcoma and Melanoma Oncology Unit, Instituto Alexander Fleming, Cramer 1180, Ciudad Autonoma de Buenos Aires, C1426ANZ, Argentina
| | - Florencia Tsou
- Thoracic Oncology Unit, Instituto Alexander Fleming, Cramer 1180, Ciudad Autonoma de Buenos Aires, C1426ANZ, Argentina
- https://orcid.org/0000-0002-0322-0434
| | - Mariano Leiva
- Head and Neck Oncology Unit, Instituto Alexander Fleming, Cramer 1180, Ciudad Autonoma de Buenos Aires, C1426ANZ, Argentina
| | - Federico Losco
- Genitourinary Oncology Unit, Instituto Alexander Fleming, Cramer 1180, Ciudad Autonoma de Buenos Aires, C1426ANZ, Argentina
- https://orcid.org/0000-0001-5084-3012
| | - Federico Esteso
- Gastrointestinal Oncology Unit, Instituto Alexander Fleming, Cramer 1180, Ciudad Autonoma de Buenos Aires, C1426ANZ, Argentina
- https://orcid.org/0000-0003-1977-9846
| | - Juan Manuel O Connor
- Gastrointestinal Oncology Unit, Instituto Alexander Fleming, Cramer 1180, Ciudad Autonoma de Buenos Aires, C1426ANZ, Argentina
- https://orcid.org/0000-0002-6975-5466
| | - Romina Luca
- Gastrointestinal Oncology Unit, Instituto Alexander Fleming, Cramer 1180, Ciudad Autonoma de Buenos Aires, C1426ANZ, Argentina
| | - Fernando Petracci
- Breast Cancer Unit, Instituto Alexander Fleming, Cramer 1180, Ciudad Autonoma de Buenos Aires, C1426ANZ, Argentina
- https://orcid.org/0000-0002-7701-3331
| | - Romina Girotti
- Laboratorio de Inmuno-Oncología Traslacional, Instituto de Biología y Medicina Experimental (IBYME), Vuelta de Obligado 2490, Ciudad Autonoma de Buenos Aires, C1428ADN, Argentina
| | - Yamil Damián Mahmoud
- Laboratorio de Inmuno-Oncología Traslacional, Instituto de Biología y Medicina Experimental (IBYME), Vuelta de Obligado 2490, Ciudad Autonoma de Buenos Aires, C1428ADN, Argentina
- https://orcid.org/0000-0001-7254-5892
| | - Claudio Martín
- Thoracic Oncology Unit, Instituto Alexander Fleming, Cramer 1180, Ciudad Autonoma de Buenos Aires, C1426ANZ, Argentina
- https://orcid.org/0000-0003-4135-7332
| | - Matías Chacón
- Clinical Oncology, Instituto Alexander Fleming, Cramer 1180, Ciudad Autonoma de Buenos Aires, C1426ANZ, Argentina
- https://orcid.org/0000-0001-6872-4185
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Tsou F, Angel M, Reinhold F, Gabay C, Bonet M, Bluthgen M, Minatta J, Bustos B, Novas C, Rizzo M, Kowalyszyn R, Cundom J, Richardet E, Ferreira G, Bradley DG, Roa G, Tatangelo M, Caglevic C, Pini A, Paskevicius M, Flores M, Pupareli C, Martin C. P21.13 Durvalumab in Locally-Advanced NSCLC in LATAM: Real World Data from Patients Included in the Early Access Program. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cardona A, Ruiz-Patiño A, Arrieta O, Martín C, Raez L, Barron LZ, Barrón F, Ricaurte L, Bravo-Garzón M, Mas L, Corrales-Rodriguez L, Rojas L, Lupinacci L, Perazzo F, Bas C, Carranza O, Pupareli C, Rizzo M, Mendoza RR, Rolfo C, Archila P, Rodríguez J, Sotelo C, Vargas C, Carranza H, Otero J, Pino L, Ortíz C, Laguado P, Rosell R. P2.25 Immunotherapy at Any Line of Treatment Improves Survival in Hispanic Patients with Advanced Metastatic Non-Small Cell Lung Cancer (NSCLC) Compared with Chemotherapy (Quijote-CLICaP). J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.09.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Juliá EP, Mandó P, Rizzo MM, Cueto GR, Tsou F, Luca R, Pupareli C, Bravo AI, Astorino W, Mordoh J, Martín C, Levy EM. Peripheral changes in immune cell populations and soluble mediators after anti-PD-1 therapy in non-small cell lung cancer and renal cell carcinoma patients. Cancer Immunol Immunother 2019; 68:1585-1596. [DOI: 10.1007/s00262-019-02391-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/03/2019] [Indexed: 12/22/2022]
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Chacón M, Eleta M, Espindola AR, Roca E, Méndez G, Rojo S, Pupareli C. Assessment of early response to imatinib 800 mg after 400 mg progression by 18F-fluorodeoxyglucose PET in patients with metastatic gastrointestinal stromal tumors. Future Oncol 2015; 11:953-64. [DOI: 10.2217/fon.14.292] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
ABSTRACT Introduction: Imatinib is the standard first-line therapy for advanced gastrointestinal stromal tumor. 18F-fluorodeoxyglucose PET computed tomography (FDG PET/CT) shows a faster response than computed tomography in nonpretreated patients. Patients & methods: After disease progression on imatinib 400 mg, 16 patients were exposed to 800 mg. Tumor response was evaluated by FDG PET/CT on days 7 and 37. Primary objective was to correlate early metabolic response (EMR) with progression-free survival (PFS). Results: EMR by FDG PET/CT scan was not predictive of PFS. Median PFS in these patients was 3 months. Overall survival was influenced by gastric primary site (p = 0.05). Conclusion: The assessment of EMR by FDG PET/CT in patients with advanced gastrointestinal stromal tumor exposed to imatinib 800 mg was not predictive of PFS or overall survival.
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Affiliation(s)
- Matías Chacón
- Grupo Argentino de Tumores Estromales Digestivos (GATE-D), Buenos Aires 1426, Argentina
| | - Martín Eleta
- Grupo Argentino de Tumores Estromales Digestivos (GATE-D), Buenos Aires 1426, Argentina
| | | | - Enrique Roca
- Grupo Argentino de Tumores Estromales Digestivos (GATE-D), Buenos Aires 1426, Argentina
| | - Guillermo Méndez
- Grupo Argentino de Tumores Estromales Digestivos (GATE-D), Buenos Aires 1426, Argentina
| | - Sandra Rojo
- Grupo Argentino de Tumores Estromales Digestivos (GATE-D), Buenos Aires 1426, Argentina
| | - Carmen Pupareli
- Grupo Argentino de Tumores Estromales Digestivos (GATE-D), Buenos Aires 1426, Argentina
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Bhargava P, Laheru D, Pupareli C, Van Kooten M, Martinez JL, Varela M, Cotreau MM, Credi M, Al‐Adhami M, Wood DL, Hidalgo M. Abstract C31: Phase 1 study of AV‐412, a novel irreversible EGFR inhibitor, administered daily in patients with advanced solid tumors. Clin Trials 2014. [DOI: 10.1158/1535-7163.targ-09-c31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Patané AK, Poleri C, Martín C, Pupareli C, Rosales A, Rivero H, Rojas O, Rosenberg M. [Surgically treated bronchopulmonary carcinoid tumours. Prognostic value of TNM staging 7a edition]. Medicina (B Aires) 2014; 74:437-442. [PMID: 25555002] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
We analyzed 43 women (61%) and 28 men (39%) surgically treated for carcinoid tumors from Jan/1975 to Dec/2011. Median age: 38 years (13-67). Typical carcinoid (TC) appeared in 63 (89%) patients, 8 (11%) suffered from atypical carcinoid (AC). Median follow-up: 4 years (1-24). TC stages were: IA = 33 (52%), IB = 10 (16%), IIA = 2 (3%), IIB = 2 (3%), IIIA = 12 (19%) and IIIB = 2 (3%); AC stages were: IA = 1 (12.5%), IIB = 1 (12.5%), IIIA = 2 (25%) and IIIB = 4 (50%). TNM classification did not show significant differences on 5-years survival period by stage (p = 0.689), even according to histological type (TC: p = 0.547; AC: p = 0.592). The disease-free survival rate was significantly lower (TC: 3 years vs. AC: 2 years, p = 0.000) and relapses were more frequent in AC (AC: 50% vs. TC: 2%, p = 0.000). The 7th TNM staging was not influential in estimating survival from carcinoid tumours in our population. The histological subtype was a better prognostic factor.
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Affiliation(s)
- Ana K Patané
- Hospital de Rehabilitación Respiratoria María Ferrer, Buenos Aires, Argentina. E-mail:
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Aceto GM, Solano AR, Neuman MI, Veschi S, Morgano A, Malatesta S, Chacon RD, Pupareli C, Lombardi M, Battista P, Marchetti A, Mariani-Costantini R, Podestà EJ. High-risk human papilloma virus infection, tumor pathophenotypes, and BRCA1/2 and TP53 status in juvenile breast cancer. Breast Cancer Res Treat 2009; 122:671-83. [PMID: 19851859 DOI: 10.1007/s10549-009-0596-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Accepted: 10/11/2009] [Indexed: 11/25/2022]
Abstract
Juvenile breast cancer is rare and poorly known. We studied a series of five breast cancer patients diagnosed within 25 years of age that included two adolescents, 12- and 15-years-old, and 3 young women, 21-, 21-, and 25-years-old, respectively. All cases were scanned for germline mutations along the entire BRCA1/2 coding sequences and TP53 exons 4-10, using protein truncation test, denaturing high performance liquid chromatography and direct sequencing. Paraffin-embedded primary tumors (available for 4/5 cases), and a distant metastasis (from the 15-years-old) were characterized for histological and molecular tumor subtype, human papilloma virus (HPV) types 16/18 E6 sequences and tumor-associated mutations in TP53 exons 5-8. A BRCA2 germline mutation (p.Ile2490Thr), previously reported in breast cancer and, as compound heterozygote, in Fanconi anemia, was identified in the 21-year-old patient diagnosed after pregnancy, negative for cancer family history. The tumor was not available for study. Only germline polymorphisms in BRCA1/2 and/or TP53 were detected in the other cases. The tumors of the 15- and 12-years-old were, respectively, classified as glycogen-rich carcinoma with triple negative subtype and as secretory carcinoma with basal subtype. The tumors of the 25-year-old and of the other 21-year-old were, respectively, diagnosed as infiltrating ductal carcinoma with luminal A subtype and as lobular carcinoma with luminal B subtype. No somatic TP53 mutations were found, but tumor-associated HPV 16 E6 sequences were retrieved from the 12- and 25-year-old, while both HPV 16 and HPV 18 E6 sequences were found in the tumor of the 15-year-old and in its associated metastasis. Blood from the 15- and 25-year-old, diagnosed with high-stage disease, resulted positive for HPV 16 E6. All the HPV-positive cases were homozygous for arginine at TP53 codon 72, a genotype associated with HPV-related cancer risk, and the tumors showed p16(INK4A) immunostaining, a marker of HPV-associated cancers. Notably menarche at 11 years was reported for the two adolescents, while the 25-year-old was diagnosed after pregnancy and breast-feeding. Our data suggest that high-risk HPV infection is involved in a subset of histopathologically heterogeneous juvenile breast carcinomas associated with menarche or pregnancy and breast-feeding. Furthermore we implicate BRCA2 in a juvenile breast carcinoma diagnosed at 21 years of age, 4 years after an early full-term pregnancy, in absence of cancer family history.
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Affiliation(s)
- Gitana Maria Aceto
- Unit of Molecular Pathology and Genomics, Aging Research Center (CeSI) G. d'Annunzio University Foundation, Via Colle dell'Ara, 66100 Chieti, Italy
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12
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Sade JP, Chacon M, O′Connor JM, Pupareli C, Varela M, Chacon RD. Surgical and non-surgical treatment of pulmonary metastases of soft tissue sarcomas. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.9582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9582 Background: Several reports have shown a prolonged survival after surgery for lung metastases from soft tissue sarcomas (STS). This finding is in contrast with the results from chemotherapy. We performed a retrospective analysis to determine the impact of surgical and non surgical treatment in terms of time to progression (TTP) and disease specific survival (DSS). Methods: A review of 144 patients (pts) with STS treated at a single institution (december 1994-february 2005) was performed. Median age: 45 years old, female 53%. Extremity was the primary site in 54 pts and leiomyosarcoma was the most common histologic type (24%). In 42 pts pulmonary metastases were synchronous. The median disease free interval (DFI) was 11 months. Surgical treatment on the lung lesions was performed in 48 pts (group A), while 96 received medical treatment (group B). Results: Surgery was R0 in 90% of group A pts with only 4 lobectomies and 36 metastasectomies. Nine pts (19%) in this group received neo or adyuvant chemotherapy. The median TTP was 11 months (2–107) and 21 pts (44%) relapse in the lung (8 lung + other site). At the time of this analysis 13 pts (27%) are NED, with a DSS of 24 months for the surgical group. 28% remain alive at 5 years. In a univariate analysis only the number of lung metastases (1 vs 2 or more) was significant for DSS (p=0.05). Group B was treated primarily with chemotherapy being doxorubicin the most common drug used (89%). The RR was 23% with a median TTP of 3 months and a DSS of 12 months (1–98). Conclusions: The present results are similar with previous reports in terms of overall survival. Paliative chemotherapy showed modest activity and surgical treatment remains the only curative treatment modality for pts with lung metastases from STS. No significant financial relationships to disclose.
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Affiliation(s)
- J. P. Sade
- Instituto Alexander Fleming, Buenos Aires, Argentina
| | - M. Chacon
- Instituto Alexander Fleming, Buenos Aires, Argentina
| | | | - C. Pupareli
- Instituto Alexander Fleming, Buenos Aires, Argentina
| | - M. Varela
- Instituto Alexander Fleming, Buenos Aires, Argentina
| | - R. D. Chacon
- Instituto Alexander Fleming, Buenos Aires, Argentina
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Chacon M, Coronado C, O’connor JM, Nervo A, Pupareli C, Costanzo V, Nasroulah F, Varela M, Sade JP, Chacon R. Standard (SIDR) and intensive ifosfamide and doxorrubicin (IIDR) regimen in advanced soft tissue sarcoma (ASTS). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.9076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - A. Nervo
- Fleming, Buenos Aires, Argentina
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