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Loibl S, Azim HA, Bachelot T, Berveiller P, Bosch A, Cardonick E, Denkert C, Halaska MJ, Hoeltzenbein M, Johansson ALV, Maggen C, Markert UR, Peccatori F, Poortmans P, Saloustros E, Saura C, Schmid P, Stamatakis E, van den Heuvel-Eibrink M, van Gerwen M, Vandecaveye V, Pentheroudakis G, Curigliano G, Amant F. ESMO Expert Consensus Statements on the management of breast cancer during pregnancy (PrBC). Ann Oncol 2023; 34:849-866. [PMID: 37572987 DOI: 10.1016/j.annonc.2023.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/14/2023] Open
Abstract
The management of breast cancer during pregnancy (PrBC) is a relatively rare indication and an area where no or little evidence is available since randomized controlled trials cannot be conducted. In general, advances related to breast cancer (BC) treatment outside pregnancy cannot always be translated to PrBC, because both the interests of the mother and of the unborn should be considered. Evidence remains limited and/or conflicting in some specific areas where the optimal approach remains controversial. In 2022, the European Society for Medical Oncology (ESMO) held a virtual consensus-building process on this topic to gain insights from a multidisciplinary group of experts and develop statements on controversial topics that cannot be adequately addressed in the current evidence-based ESMO Clinical Practice Guideline. The aim of this consensus-building process was to discuss controversial issues relating to the management of patients with PrBC. The virtual meeting included a multidisciplinary panel of 24 leading experts from 13 countries and was chaired by S. Loibl and F. Amant. All experts were allocated to one of four different working groups. Each working group covered a specific subject area with two chairs appointed: Planning, preparation and execution of the consensus process was conducted according to the ESMO standard operating procedures.
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Affiliation(s)
- S Loibl
- GBG c/o GBG Forschungs GmbH, Neu-Isenburg; Centre for Haematology and Oncology Bethanien, Frankfurt am Main, Frankfurt; Goethe University Frankfurt, Frankfurt am Main, Frankfurt, Germany.
| | - H A Azim
- Breast Cancer Center, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - T Bachelot
- Department of medical oncology, Centre Léon Bérard, Lyon, France
| | - P Berveiller
- Department of Gynecology and Obstetrics, Poissy-Saint Germain Hospital, Poissy; UMR 1198 - BREED, INRAE, Paris Saclay University, RHuMA, Montigny-Le-Bretonneux, France
| | - A Bosch
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund; Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - E Cardonick
- Cooper Medical School at Rowan University, Camden, USA
| | - C Denkert
- Philipps-University Marburg and Marburg University Hospital (UKGM), Marburg, Germany
| | - M J Halaska
- Department of Obstetrics and Gynaecology, Third Faculty of Medicine, Charles University in Prague and Universital Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - M Hoeltzenbein
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Pharmacology and Toxicology, Embryotox Center of Clinical Teratology and Drug Safety in Pregnancy, Berlin, Germany
| | - A L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Cancer Registry of Norway, Oslo, Norway
| | - C Maggen
- Department of Obstetrics and Prenatal Medicine, University Hospital Brussels, Brussels, Belgium
| | - U R Markert
- Placenta Lab, Department of Obstetrics, Jena University Hospital, Jena, Germany
| | - F Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - P Poortmans
- Iridium Netwerk, Antwerp; University of Antwerp, Antwerp, Belgium
| | - E Saloustros
- Department of Oncology, University General Hospital of Larissa, Larissa, Greece
| | - C Saura
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - P Schmid
- Cancer Institute, Queen Mary University London, London, UK
| | - E Stamatakis
- Department of Anesthesiology, 'Alexandra' General Hospital, Athens, Greece
| | | | - M van Gerwen
- Gynecologic Oncology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam; Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, University of Amsterdam; Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - V Vandecaveye
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - G Pentheroudakis
- European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - G Curigliano
- Division of Early Drug Development, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - F Amant
- Gynecologic Oncology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam; Division Gynaecologic Oncology, UZ Leuven, Belgium
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Trama A, Stark D, Bozovic-Spasojevic I, Gaspar N, Peccatori F, Toss A, Bernasconi A, Quarello P, Scheinemann K, Jezdic S, Blondeel A, Mountzios G, Bielack S, Saloustros E, Ferrari A. Cancer burden in adolescents and young adults in Europe. ESMO Open 2023; 8:100744. [PMID: 36753992 PMCID: PMC10024081 DOI: 10.1016/j.esmoop.2022.100744] [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: 08/25/2022] [Revised: 11/10/2022] [Accepted: 11/10/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cancer epidemiology is unique in adolescents and young adults (AYAs; aged 15-39 years). The European Society for Medical Oncology/European Society for Paediatric Oncology (ESMO/SIOPE) AYA Working Group aims to describe the burden of cancers in AYAs in Europe and across European Union (EU) countries. PATIENTS AND METHODS We used data available on the Global Cancer Observatory. We retrieved crude and age-standardised (World Standard Population) incidence and mortality rates. We reported about AYA cancer burden in Europe and between 28 EU member states. We described incidence and mortality for all cancers and for the 13 cancers most relevant to the AYA population. RESULTS Incidence and mortality varied widely between countries with the highest mortality observed in Eastern EU countries. Cancers of the female breast, thyroid and male testis were the most common cancers across countries followed by melanoma of skin and cancers of the cervix. Variations in cancer incidence rates across different populations may reflect different distribution of risk factors, variations in the implementation or uptake of screening as well as overdiagnosis. AYA cancer mortality disparities may be due to variation in early-stage diagnoses, different public education and awareness of cancer symptoms, different degrees of access or availability of treatment. CONCLUSIONS Our results highlight the future health care needs and requirements for AYA-specialised services to ensure a homogeneous treatment across different countries as well as the urgency for preventive initiatives that can mitigate the increasing burden.
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Affiliation(s)
- A Trama
- Research Department, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
| | - D Stark
- Leeds Institute of Medical Research, School of Medicine University of Leeds, Leeds, UK
| | - I Bozovic-Spasojevic
- Medical Oncology Department, Institute for Oncology and Radiology of Serbia, Belgrade, Republic of Serbia
| | - N Gaspar
- Department of Oncology for Child and Adolescent, Gustave Roussy Cancer Campus, Villejuif, France
| | - F Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - A Toss
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - A Bernasconi
- Research Department, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - P Quarello
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza, Torino, Italy; University of Torino, Torino, Italy
| | - K Scheinemann
- Division of Oncology-Hematology, Department of Pediatrics, Kantonsspital Aarau, Aarau, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Department of Pediatrics, McMaster Children's Hospital and McMaster University, Hamilton, Canada
| | - S Jezdic
- Scientific and Medical Division, European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - A Blondeel
- Department of Scientific Programme Coordination, European Society for Paediatric Oncology (SIOP Europe), Brussels, Belgium
| | - G Mountzios
- 2nd Department of Medical Oncology and Clinical Trial Unit, Henry Dunant Hospital, Athens, Greece
| | - S Bielack
- Zentrum für Kinder, Jugend und Frauenmedizin Pädiatrie 5, Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - E Saloustros
- Department of Oncology, University Hospital of Larissa, Larissa, Greece
| | - A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Spathas N, Goussia A, Koliou G, Gogas H, Zagouri F, Bobos M, Pectasides D, Galani E, Koutras A, Zarkavelis G, Saloustros E, Bafaloukos D, Karanikiotis C, Aravantinos G, Psyrri A, Razis E, Koumarianou A, Res E, Linardou H, Fountzilas G. 27P Association between CD8+ tumor infiltrating lymphocytes and the clinical outcome of patients with operable breast cancer treated with adjuvant dose-dense chemotherapy: A 10-year follow up report of a Hellenic Cooperative Oncology Group observational study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.042] [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: 11/01/2022] Open
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Pappas G, Saloustros E, Boutis A, Tsoukalas N, Nikolaou M, Christopoulou A, Agelaki S, Boukovinas I, Ardavanis A, Saridaki Z. Vaccine third dose and cancer patients: necessity or luxury? ESMO Open 2021; 6:100306. [PMID: 34773904 PMCID: PMC8579882 DOI: 10.1016/j.esmoop.2021.100306] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 11/23/2022] Open
Abstract
The current state of the SARS-CoV-2 pandemic is an equilibrium between expanding vaccine coverage on the one hand, and emergence of variants of concern which compromise vaccine effectiveness and enhance viral transmission on the other. Inequity in vaccine distribution, primarily an ethical issue, challenges this equilibrium, as industrialized countries prepare to administer a third booster dose to their population. Solid tumor cancer patients typically respond well to initial full vaccination and someone could argue that they should not be prioritized for an adjuvant third dose, since protection from severe disease has largely been achieved with the two-dose regimen. Nevertheless, their immune status is dynamic and not all of them exhibit an adequate immune response. A booster third dose is necessary for the inadequate responders, while it will result in better protection of all patients from mild disease as well, which if presented could have ominous consequences due to their overall frailty, and their need to adhere to strict therapeutic schemes. International scientific and public health communities should develop approaches that allow for wide immediate vaccination coverage of the developing world, in parallel with administration of adjuvant doses to solid tumor cancer patients (and other at-risk categories) of the developed nations, in order to avoid prolonging the pandemic, which will be prospectively against cancer patients' best interest.
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Affiliation(s)
- G Pappas
- Institute of Continuing Medical Education of Ioannina, Ioannina, Greece
| | - E Saloustros
- Hellenic Society of Medical Oncology (HeSMO), Athens, Greece
| | - A Boutis
- Hellenic Society of Medical Oncology (HeSMO), Athens, Greece
| | - N Tsoukalas
- Hellenic Society of Medical Oncology (HeSMO), Athens, Greece
| | - M Nikolaou
- Hellenic Society of Medical Oncology (HeSMO), Athens, Greece
| | - A Christopoulou
- Hellenic Society of Medical Oncology (HeSMO), Athens, Greece
| | - S Agelaki
- Hellenic Society of Medical Oncology (HeSMO), Athens, Greece
| | - I Boukovinas
- Hellenic Society of Medical Oncology (HeSMO), Athens, Greece
| | - A Ardavanis
- Hellenic Society of Medical Oncology (HeSMO), Athens, Greece
| | - Z Saridaki
- Hellenic Society of Medical Oncology (HeSMO), Athens, Greece.
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Ferrari A, Stark D, Peccatori FA, Fern L, Laurence V, Gaspar N, Bozovic-Spasojevic I, Smith O, De Munter J, Derwich K, Hjorth L, van der Graaf WTA, Soanes L, Jezdic S, Blondeel A, Bielack S, Douillard JY, Mountzios G, Saloustros E. Adolescents and young adults (AYA) with cancer: a position paper from the AYA Working Group of the European Society for Medical Oncology (ESMO) and the European Society for Paediatric Oncology (SIOPE). ESMO Open 2021; 6:100096. [PMID: 33926710 PMCID: PMC8103533 DOI: 10.1016/j.esmoop.2021.100096] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [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: 01/20/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 12/17/2022] Open
Abstract
It is well recognised that adolescents and young adults (AYA) with cancer have inequitable access to oncology services that provide expert cancer care and consider their unique needs. Subsequently, survival gains in this patient population have improved only modestly compared with older adults and children with cancer. In 2015, the European Society for Medical Oncology (ESMO) and the European Society for Paediatric Oncology (SIOPE) established the joint Cancer in AYA Working Group in order to increase awareness among adult and paediatric oncology communities, enhance knowledge on specific issues in AYA and ultimately improve the standard of care for AYA with cancer across Europe. This manuscript reflects the position of this working group regarding current AYA cancer care, the challenges to be addressed and possible solutions. Key challenges include the lack of specific biological understanding of AYA cancers, the lack of access to specialised centres with age-appropriate multidisciplinary care and the lack of available clinical trials with novel therapeutics. Key recommendations include diversifying interprofessional cooperation in AYA care and specific measures to improve trial accrual, including centralising care where that is the best means to achieve trial accrual. This defines a common vision that can lead to improved outcomes for AYA with cancer in Europe.
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Affiliation(s)
- A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | - D Stark
- Leeds Institute of Medical Research, School of Medicine University of Leeds, Leeds, UK.
| | - F A Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - L Fern
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - V Laurence
- Medical Oncology Department and SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, Paris, France
| | - N Gaspar
- Department of Oncology for Child and Adolescent, Gustave Roussy Cancer Campus, Villejuif, France
| | - I Bozovic-Spasojevic
- Medical Oncology Department, Institute for Oncology and Radiology of Serbia, Belgrade, Republic of Serbia
| | - O Smith
- National Children's Cancer Service, Children's Health Ireland at Crumlin and Systems Biology Ireland, University College Dublin, Dublin, Ireland
| | - J De Munter
- University Hospital Ghent Cancer Center, UZ Gent, Ghent, Belgium
| | - K Derwich
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - L Hjorth
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Pediatrics, Lund, Sweden
| | - W T A van der Graaf
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - L Soanes
- Teenage Cancer Trust, London, UK
| | - S Jezdic
- Scientific and Medical Division, European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - A Blondeel
- Department of Scientific Programme Coordination, European Society for Paediatric Oncology (SIOPE), Brussels, Belgium
| | - S Bielack
- Zentrum für Kinder, Jugend und Frauenmedizin Pädiatrie 5, KlinikumStuttgart - Olgahospital, Stuttgart, Germany
| | - J-Y Douillard
- Scientific and Medical Division, European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - G Mountzios
- 2nd Department of Medical Oncology and Clinical Trial Unit, Henry Dunant Hospital, Athens, Greece
| | - E Saloustros
- Department of Oncology, University Hospital of Larissa, Larissa, Greece
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Carneiro A, Amaral T, Brandao M, Scheffler M, Bol K, Ferrara R, Jalving M, Lo Russo G, Marquez-Rodas I, Matikas A, Mezquita L, Morgan G, Onesti C, Pilotto S, Saloustros E, Trapani D. LBA66_PR Disparities in access to oncology clinical trials in Europe in the period 2009-2019. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ragias D, Zonca C, Lantou A, Peccatori T, Peccatori F, Saloustros E. 1610P Undergraduate education in medical oncology lags behind in Greek universities. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Aravantinou Fatorou E, Koliou GA, Zagouri F, Kostadima L, Gogas H, Pectasides D, Binas I, Koutras A, Aravantinos G, Psyrri A, Lazaridis G, Bafaloukos D, Saloustros E, Karanikiotis C, Bombolaki I, Razis E, Koumarianou A, Papakostas P, Kosmidis P, Fountzilas G. 84P Actual 5-year survival of dose-dense sequential adjuvant chemotherapy in early breast cancer (BC) patients treated in the post-trastuzumab era: A pooled analysis of 3 clinical trials. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.024] [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: 11/17/2022] Open
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Mavroudis D, Saloustros E, Malamos N, Kakolyris S, Boukovinas I, Papakotoulas P, Kentepozidis N, Ziras N, Georgoulias V. Corrigendum to Six versus 12 months of adjuvant trastuzumab in combination with dose-dense chemotherapy for women with HER2-positive breast cancer: a multicenter randomized study by the Hellenic Oncology Research Group (HORG): Annals of Oncology, Volume 26, Issue 7, July 2015, Pages 1333-1340. Ann Oncol 2020; 31:444-445. [PMID: 32067691 DOI: 10.1016/j.annonc.2020.01.004] [Citation(s) in RCA: 3] [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: 11/26/2022] Open
Affiliation(s)
- D Mavroudis
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Greece.
| | - E Saloustros
- Oncology Unit, General Hospital of Heraklion 'Venizelio', Greece
| | - N Malamos
- Department of Medical Oncology, Elena Venizelou Hospital, Athens, Greece
| | - S Kakolyris
- Department of Medical Oncology, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - I Boukovinas
- Department of Medical Oncology, Bioklinic of Thessaloniki, Thessaloniki, Greece
| | - P Papakotoulas
- Department of Medical Oncology, Theageneio Hospital, Thessaloniki, Greece
| | - N Kentepozidis
- Department of Medical Oncology, 251 Airforce General Hospital, Athens, Greece
| | - N Ziras
- Department of Medical Oncology, Metaxa Hospital, Athens, Greece
| | - V Georgoulias
- Department of Medical Oncology, University of Crete, School of Medicine, Heraklion, Greece
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Kastrisiou M, Zarkavelis G, Kougioumtzi A, Tzallas C, Saloustros E, Kotsakis A, Papadopoulou E, Nasioulas G, Batistatou A, Magklara A, Pentheroudakis G. Customisation of therapeutic strategy in metastatic colorectal cancer by use of liquid biopsies: Updated results of an observational study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz413.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rounis K, Koukaki T, Christodoulou C, Papadimitriou C, Tryfonopoulos D, Mavroudis D, Aggelaki S, Fostira F, Saloustros E. Adjuvant radiotherapy induces secondary tumor events in breast cancer patients with Li-Fraumeni syndrome. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz096.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dalvi R, Li CK, Yonemori K, Ariffin H, Lyu C, Farid M, Gonzales-Santos J, Zhou Q, Bielack S, Brugieres L, Blondeel A, Essiaf S, Peccatori F, Jezdic S, Stark D, Douillard JY, Saloustros E, Mountzios G. Adolescents and young adults with cancer care in Asia: The joint ESMO/SIOPE/SIOP ASIA survey. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy442.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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13
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Boukovinas I, Lypas G, Liontos M, Andreadis C, Papandreou C, Papakotoulas P, Aravantinos G, Bournakis E, Karageorgopoulou S, Maragkouli E, Ziras N, Kakolyris S, Athanasiadis I, Linardou E, Koumarianou A, Kalofonos C, Pentheroudakis G, Korantzis I, Christodoulou C, Kosmidis P, Daliani D, Ardavanis A, Koumakis G, Bankousli I, Makrantonakis P, Kesisis G, Nikolaou M, Diamantidou E, Tsoukalas N, Xanthakis I, Fassas A, Barbounis V, Anagnostopoulos A, Polyzos A, Athanasiadis A, Syrios I, Peroukidis S, Mpompolaki I, Baka S, Androulakis N, Georgoulias V, Emmanouilidis C, Mavroudis D, Sgouros I, Stathopoulos C, Katopodi O, Varthalitis I, Sarikaki P, Saloustros E, Saridaki Z. Access to Genetic Testing Impacts Oncologists´ Decisions on Ovarian Cancer Personalized Treatment: Lessons Learned From a National Program in Greece. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.55800] [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
Background: State health insurance authorities in Greece do not reimburse genetic testing for cancer predisposition. The Hellenic Society of Medical Oncology has launched and carries out a national program covering genetic testing for BRCA1/2 mutations detection, with the financial support of pharmaceutical industry. Aim: This analysis evaluates how, during this program, access to genetic testing transformed the oncologists' therapeutic approach toward their ovarian cancer patients and how the results impacted treatment decisions concerning PARP inhibitors. Adoption of testing by healthy relatives and timing of testing in the disease continuum were also evaluated. Methods: Adult patients with high-grade epithelial ovarian carcinoma, irrespectively of family history or age at diagnosis were eligible for this program. Genetic counseling was recommended before testing, and both were offered at no financial cost. First degree family members of pathogenic mutation carriers were also offered free counseling and testing. Results: From March 2015 through January 2018, 708 patients were enrolled and tested. One hundred and forty seven (20.7%) mutation carriers were identified, 102 (14.4%) in BRCA1 and 45 (6.3%) in BRCA2 gene. Testing was more often pursued at initial diagnosis (61%) than at recurrence (39%), as recorded for 409 patients with available relevant information. During the 1st year of the program, average monthly tests performed were 25.1, while during the 3rd year this number increased to 34.3 tests per month. Among patients who tested positive for deleterious BRCA1/2 mutations, relapse was reported in 58 patients, 94.8% of which (n= 55) received treatment with the PARP inhibitor olaparib as per its indication. Family members of 21 patients (14.3%), out of the 147 who tested positive, received genetic counseling and testing for the mutation identified in the context of the program. Conclusion: Free access to genetic testing for BRCA1/2 for ovarian cancer patients and genetic consultation facilitates testing uptake, affects common clinical practice & has major impact on patients and their families. Still, diffusion of genetic information and broader testing of family members require further efforts by the oncological community.
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Affiliation(s)
- I. Boukovinas
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - G. Lypas
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - M. Liontos
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - C. Andreadis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - C. Papandreou
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - P. Papakotoulas
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - G. Aravantinos
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - E. Bournakis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - S. Karageorgopoulou
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - E. Maragkouli
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - N. Ziras
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - S. Kakolyris
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - I. Athanasiadis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - E. Linardou
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - A. Koumarianou
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - C. Kalofonos
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - G. Pentheroudakis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - I. Korantzis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - C. Christodoulou
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - P. Kosmidis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - D. Daliani
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - A. Ardavanis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - G. Koumakis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - I. Bankousli
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - P. Makrantonakis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - G. Kesisis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - M. Nikolaou
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - E. Diamantidou
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - N. Tsoukalas
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - I. Xanthakis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - A. Fassas
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - V. Barbounis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - A. Anagnostopoulos
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - A. Polyzos
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - A. Athanasiadis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - I. Syrios
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - S. Peroukidis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - I. Mpompolaki
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - S. Baka
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - N. Androulakis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - V. Georgoulias
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - C. Emmanouilidis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - D. Mavroudis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - I. Sgouros
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - C. Stathopoulos
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - O. Katopodi
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - I. Varthalitis
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - P. Sarikaki
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - E. Saloustros
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
| | - Z. Saridaki
- Hellenic Society of Medical Oncology, Athens, Greece: 2Hellenic Society of Medical Oncology, Thessaloniki, Greece: 3Hellenic Society of Medical Oncology, Larisa, Greece
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Ntellas P, Spathas N, Zylis D, Agelaki S, Zintzaras E, Saloustros E. Taxane & cyclophosphamide vs anthracycline & taxane combination therapy as adjuvant treatment of breast cancer: A meta-analysis of randomized-controlled trials by the Hellenic Academy of Oncology (E.AK.O.). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy270.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sifaki-Pistolla D, Saloustros E, Pitsoulis G, Vamvakas L, Mavroudis D, Georgoulias V, Lionis C. Colon and rectal cancer incidence are rising among young Europeans: Results from the cancer registry of Crete. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chatzea VE, Sifaki-Pistolla D, Koinis F, Saloustros E, Vamvakas L, Pitsoulis G, Tzanakis N, Mavroudis D, Georgoulias V, Lionis C. Cancer incidence and mortality trends in Crete, Greece during the last two decades (1992-2013): Results from the cancer registry of Crete. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx385.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Liu S, Shapiro JM, Saloustros E, Stratakis CA. Bone Abnormalities in Mice with Protein Kinase A (PKA) Defects Reveal a Role of Cyclic AMP Signaling in Bone Stromal Cell-Dependent Tumor Development. Horm Metab Res 2016; 48:714-725. [PMID: 27728928 DOI: 10.1055/s-0042-117111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Protein kinase A (PKA) is an important enzyme for all eukaryotic cells. PKA phosphorylates other proteins, thus, it is essential for the regulation of many diverse cellular functions, including cytoplasmic trafficking and signaling, organelle structure and mitochondrial oxidation, nuclear gene expression, the cell cycle, and cellular division. The PKA holoenzyme is composed of 2 regulatory and 2 catalytic subunits. Four regulatory (R1α, R1β, R2α, and R2β) and 4 catalytic subunits (Cα, Cβ, Cγ, and Prkx) have been identified, giving rise to mainly PKA-I (when the 2 regulatory subunits are either R1α or R1β), or PKA-II (when the 2 regulatory subunits are either R2α or R2β). Mutations in the PKA subunits can lead to altered total PKA activity or abnormal PKA-I to PKA-II ratio, leading to various abnormalities in both humans and mice. These effects can be tissue-specific. We studied the effect of PKA subunit defects on PKA activity and bone morphology of mice that were single or double heterozygous for null alleles of the various PKA subunit genes. Bone lesions including fibrous dysplasia, myxomas, osteo-sarcomas, -chondromas and -chondrosarcomas were found in these mice. Observational and molecular studies showed that these lesions were derived from bone stromal cells (BSCs). We conclude that haploinsufficiency for different PKA subunit genes affected bone lesion formation, new bone generation, organization, and mineralization in variable ways. This work identified a PKA subunit- and activity-dependent pathway of bone lesion formation from BSCs with important implications for understanding how cyclic AMP affects the skeleton and its tumorigenesis.
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Affiliation(s)
- S Liu
- Section on Endocrinology and Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - J M Shapiro
- Section on Endocrinology and Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - E Saloustros
- Section on Endocrinology and Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - C A Stratakis
- Section on Endocrinology and Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland, USA
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Saloustros E, Boukovinas I, Kalbakis K, Katsaounis P, Ardavanis A, Vamvakas L, Papazisis K, Prinarakis E, Skaltsi T, Georgoulias V, Mavroudis D. Bevacizumab plus dose-dense neoadjuvant FEC followed by docetaxel chemotherapy in patients with HER2-negative breast cancer: a multicentre, phase 2 study by the Hellenic Oncology Research Group. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw364.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lypas G, Tryfonopoulos D, Saloustros E, Zacharopoulou P, Florentin L, Apessos A, Kabletsas E, Prinarakis E, Barbounis V, Fountzilas G, Mavroudis D, Georgoulias V. Clinicopathological characteristics and BRCA1/2 mutation rate in male breast cancer: a retrospective case series by the Hellenic Society of Medical Oncology. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw364.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mavroudis D, Matikas A, Malamos N, Papakotoulas P, Kakolyris S, Boukovinas I, Athanasiadis A, Kentepozidis N, Ziras N, Katsaounis P, Saloustros E, Georgoulias V. Dose-dense FEC followed by docetaxel versus docetaxel plus cyclophosphamide as adjuvant chemotherapy in women with HER2-negative, axillary lymph node-positive early breast cancer: a multicenter randomized study by the Hellenic Oncology Research Group (HORG). Ann Oncol 2016; 27:1873-8. [DOI: 10.1093/annonc/mdw274] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/01/2016] [Indexed: 11/14/2022] Open
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Nikolaou M, Saloustros E, Polyzos A, Christophyllakis C, Kentepozidis N, Vamvakas L, Kalbakis K, Agelaki S, Georgoulias V, Mavroudis D. Final results of weekly paclitaxel and carboplatin plus bevacizumab as first-line treatment of triple-negative breast cancer. A multicenter phase I-II trial by the Hellenic Oncology Research Group. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw365.21] [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: 11/14/2022] Open
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Mavroudis D, Saloustros E, Boukovinas I, Papakotoulas P, Kakolyris S, Ziras N, Christophylakis C, Kentepozidis N, Timotheadou E, Rigas G, Varthalitis II, Kalbakis K, Agelaki S, Georgoulias V. Abstract P1-12-02: Sequential versus concurrent administration of epirubicin and docetaxel as adjuvant chemotherapy in women with high-risk axillary lymph node negative early breast cancer. An interim analysis of a multicenter randomized study from the Hellenic oncology research group. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-12-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: To compare the sequential versus the concurrent administration of epirubicin and docetaxel as adjuvant therapy in high risk axillary node negative women with early breast cancer.
Patients and treatment: Women 18-75 years old with invasive breast adenocarcinoma surgically resected with no infiltrated axillary lymph nodes and absence of metastatic disease were randomized to receive 4 cycles of epirubicin 90mg/m2 followed by 4 cycles of docetaxel 75mg/m2 (sequential regimen) or 6 cycles of epirubicin 75mg/m2 followed by docetaxel 75mg/m2 (concurrent regimen). All chemotherapy cycles were administered every 21 days with prophylactic G-CSF support for days 3-10 only for the concurrent regimen. Stratification was based on menopausal status, tumor size and hormone receptor expression. By protocol amendment in 2008 women with HER2 positive tumors were excluded. The primary endpoint of the study was to compare the disease-free survival (DFS) at 5 years and 329 patients were scheduled to enroll on each arm.
Results: Between 2001-2013, 658 women were randomized and received the sequential (n=329) or the concurrent (n=329) regimen. The median age was 53 and 52 years, premenopausal status 43.8% versus 44.1%, tumor size <2cm in 44.1% versus 44.4%, histological grade 3 tumor in 52% versus 53.5% and hormone receptor negative disease in 33.1% versus 37.4% of patients in the sequential and concurrent regimens, respectively. After a median follow up of 70.5 and 70 months, there were 29 (8.8%) versus 42 (12.8%) disease relapses (p=0.102) and 11 (3.3%) versus 19 (5.8%) deaths (p=0.135), in the sequential and concurrent arms, respectively. The median DFS has not yet been reached in either arm (p=0.053) and the 5-year DFS rates were 92.6% versus 88.2% for sequential and concurrent arms, respectively. Dose reduction was required in 1.2% versus 3% (p=0.001) of the treatment cycles in the sequential and concurrent arms, respectively. Toxicity included grade 2-4 neutropenia in 54% versus 41% (p=0.001), febrile neutropenia 2.7% versus 6.1% (p=0.06), anemia 12% versus 17% (p=0.07), nausea/vomiting 18.5% versus 12.4% (p=0.03) of patients in the sequential and concurrent arms, respectively. There were no toxic deaths.
Conclusion: In this interim analysis both the efficacy and the toxicity profile seem to favor the sequential over the concurrent regimen.
Citation Format: Mavroudis D, Saloustros E, Boukovinas I, Papakotoulas P, Kakolyris S, Ziras N, Christophylakis C, Kentepozidis N, Timotheadou E, Rigas G, Varthalitis I-I, Kalbakis K, Agelaki S, Georgoulias V. Sequential versus concurrent administration of epirubicin and docetaxel as adjuvant chemotherapy in women with high-risk axillary lymph node negative early breast cancer. An interim analysis of a multicenter randomized study from the Hellenic oncology research group. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-12-02.
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Affiliation(s)
- D Mavroudis
- From the Breast Cancer Investigators of the Hellenic Oncology Research Group (HORG), Athens, Greece
| | - E Saloustros
- From the Breast Cancer Investigators of the Hellenic Oncology Research Group (HORG), Athens, Greece
| | - I Boukovinas
- From the Breast Cancer Investigators of the Hellenic Oncology Research Group (HORG), Athens, Greece
| | - P Papakotoulas
- From the Breast Cancer Investigators of the Hellenic Oncology Research Group (HORG), Athens, Greece
| | - S Kakolyris
- From the Breast Cancer Investigators of the Hellenic Oncology Research Group (HORG), Athens, Greece
| | - N Ziras
- From the Breast Cancer Investigators of the Hellenic Oncology Research Group (HORG), Athens, Greece
| | - C Christophylakis
- From the Breast Cancer Investigators of the Hellenic Oncology Research Group (HORG), Athens, Greece
| | - N Kentepozidis
- From the Breast Cancer Investigators of the Hellenic Oncology Research Group (HORG), Athens, Greece
| | - E Timotheadou
- From the Breast Cancer Investigators of the Hellenic Oncology Research Group (HORG), Athens, Greece
| | - G Rigas
- From the Breast Cancer Investigators of the Hellenic Oncology Research Group (HORG), Athens, Greece
| | - I-I Varthalitis
- From the Breast Cancer Investigators of the Hellenic Oncology Research Group (HORG), Athens, Greece
| | - K Kalbakis
- From the Breast Cancer Investigators of the Hellenic Oncology Research Group (HORG), Athens, Greece
| | - S Agelaki
- From the Breast Cancer Investigators of the Hellenic Oncology Research Group (HORG), Athens, Greece
| | - V Georgoulias
- From the Breast Cancer Investigators of the Hellenic Oncology Research Group (HORG), Athens, Greece
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Mavroudis D, Saloustros E, Malamos N, Kakolyris S, Boukovinas I, Papakotoulas P, Kentepozidis N, Ziras N, Georgoulias V. Six versus 12 months of adjuvant trastuzumab in combination with dose-dense chemotherapy for women with HER2-positive breast cancer: a multicenter randomized study by the Hellenic Oncology Research Group (HORG). Ann Oncol 2015; 26:1333-40. [PMID: 25935793 DOI: 10.1093/annonc/mdv213] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 04/23/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Adjuvant trastuzumab in combination with chemotherapy improves survival of women with HER2-positive early breast cancer. In this study, we compared 12 versus 6 months of adjuvant trastuzumab. PATIENTS AND METHODS Axillary node-positive or high-risk node-negative women with HER2-positive early breast cancer were randomized to receive 12 or 6 months of adjuvant trastuzumab concurrently with dose-dense, granulocyte colony-stimulating factor (G-CSF)-supported docetaxel (75 mg/m(2) every 14 days for four cycles). All patients received upfront dose-dense, G-CSF-supported FEC (5-fluorouracil 700 mg/m(2), epirubicin 75 mg/m(2), cyclophosphamide 700 mg/m(2) every 14 days for four cycles). Randomization was carried out before commence of chemotherapy. The primary end point was the 3-year disease-free survival (DFS). RESULTS A total of 481 patients were randomized to receive 12 months (n = 241) or 6 months (n = 240) of adjuvant trastuzumab. Chemotherapy was completed in 99% and 98% of patients, while trastuzumab therapy in 100% and 96% of patients in the 12- and 6-month groups, respectively. After 47 and 51 months of median follow-up, there were 17 (7.1%) and 28 (11.7%) disease relapses in the 12- and 6-month groups (P = 0.08). The 3-year DFS was 95.7% versus 93.3% in favor of the 12-month treatment group (hazard ratio = 1.57; 95% confidence interval 0.86-2.10; P = 0.137). There was no difference in terms of overall survival and cardiac toxicity between the two groups. CONCLUSIONS Our study failed to show noninferiority for the 6-month arm. The results further support the current standard of care that is administration of adjuvant trastuzumab for 12 months.
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Affiliation(s)
- D Mavroudis
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion
| | - E Saloustros
- Oncology Unit, General Hospital of Heraklion 'Venizelio'
| | - N Malamos
- Department of Medical Oncology, Elena Venizelou Hospital, Athens
| | - S Kakolyris
- Department of Medical Oncology, University General Hospital of Alexandroupolis, Alexandroupolis
| | - I Boukovinas
- Department of Medical Oncology, Bioklinic of Thessaloniki, Thessaloniki
| | - P Papakotoulas
- Department of Medical Oncology, Theageneio Hospital, Thessaloniki
| | - N Kentepozidis
- Department of Medical Oncology, 251 Airforce General Hospital, Athens
| | - N Ziras
- Department of Medical Oncology, Metaxa Hospital, Athens
| | - V Georgoulias
- Department of Medical Oncology, University of Crete, School of Medicine, Heraklion, Greece
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Vamvakas L, Karampeazis⁎ A, Nikolaou C, Ardavanis A, Saloustros E, Kalbakis K, Zafeiriou Z, Stoltidis D, Kalykaki A, Georgoulias V, Mavroudis D. Paclitaxel and bevacizumab as first-line treatment in elderly women with HER-2 negative locally advanced or metastatic breast cancer: Preliminary results a multicenter phase II trial from Hellenic Oncology Research Group. J Geriatr Oncol 2012. [DOI: 10.1016/j.jgo.2012.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Karampeazis⁎ A, Ardavanis A, Kentepozidis N, Nikolaou C, Bozionelou V, Papakotoulas P, Tryfonidis K, Saloustros E, Mavroudis D, Georgoulias V, Vamvakas L. Cyclophosphamide and liposomal-encapsulated doxorubicin (MYOCET®) in elderly women with HER-2 negative locally advanced or metastatic breast cancer: Preliminary results of a multicenter phase II trial from the Hellenic Oncology Research Group. J Geriatr Oncol 2012. [DOI: 10.1016/j.jgo.2012.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kontopodis E, Christophylakis C, Kentepozidis N, Boukovinas I, Giassas S, Saloustros E, Kalykaki A, Bozionelou V, Georgoulias V, Mavroudis D. Docetaxel (D), Gemcitabine (G) and Bevacizumab (BEV) as Salvage Chemotherapy (CT) for HER-2 Negative Metastatic Breast Cancer (MBC). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)32961-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Saloustros E, Kalbakis K, Vardakis N, Kalykaki A, Milaki G, Rovithi M, Agelaki S, Saridaki Z, Georgoulias V, Mavroudis D. Metronomic vinorelbine plus bevacizumab as salvage therapy for patients with metastatic breast cancer. J BUON 2011; 16:215-218. [PMID: 21766488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE Continuous administration of oral vinorelbine, given 3 times a week (metronomic), is feasible and exceptionally well tolerated at doses up to 50 mg with clinical activity against refractory tumors. In this phase II study oral metronomic vinorelbine and bevacizumab were evaluated as salvage therapy in women with pretreated metastatic breast cancer (MBC). METHODS Patients received oral vinorelbine (50 mg 3 times a week) and bevacizumab (10 mg/kg) biweekly in cycles of 28 days. The primary endpoint was objective response rate (ORR). A preplanned analysis was performed when the first 13 patients were evaluated for tumor response. RESULTS One patient (7.7%) achieved partial response (PR) and 6 (46.1%) stable disease (SD). The combination was very well tolerated but, as per protocol, the study was closed prematurely due to lack of efficacy. CONCLUSION The combination of oral metronomic vinorelbine and bevacizumab has good tolerance but minimal activity in terms of objective responses in pretreated patients with MBC.
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Affiliation(s)
- E Saloustros
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Crete, Greece
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Karachaliou N, Saloustros E, Vamvakas L, Mavroudis D, Georgoulias V. Proteinuria and favourable clinical response in a patient receiving paclitaxel + bevacizumab for metastatic breast cancer. Ann Oncol 2010; 21:1729-1730. [PMID: 20601370 DOI: 10.1093/annonc/mdq328] [Citation(s) in RCA: 3] [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: 11/13/2022] Open
Affiliation(s)
- N Karachaliou
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Crete, Greece
| | - E Saloustros
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Crete, Greece
| | - L Vamvakas
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Crete, Greece
| | - D Mavroudis
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Crete, Greece
| | - V Georgoulias
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Crete, Greece.
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Saloustros E, Zaganas I, Mavridis M, Vamvakas L, Plaitakis A, Georgoulias V, Mavroudis D. Anti-CV2 associated cerebellar degeneration after complete response to chemoradiation of head and neck carcinoma. J Neurooncol 2009; 97:291-4. [PMID: 19798470 DOI: 10.1007/s11060-009-0022-2] [Citation(s) in RCA: 7] [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] [Received: 05/06/2009] [Accepted: 09/21/2009] [Indexed: 12/11/2022]
Abstract
Paraneoplastic cerebellar degeneration is a rare neurological disorder that frequently precedes the detection of malignancy. Here, we report the case of a 60 year-old woman with locally advanced squamous cell carcinoma of the tongue who developed a subacute cerebellar syndrome associated with the presence of anti-CV2/CRMP5 antibodies in the cerebrospinal fluid, after achieving complete remission of the primary tumor and the involved cervical lymph nodes by chemoradiation. The patient's symptoms on presentation were dizziness and gait unsteadiness. On examination she showed dysarthria, nystagmus and limb and gait ataxia. The diagnosis of paraneoplastic cerebellar syndrome was made on the basis of the clinical findings and immunological testing that revealed the presence of anti-CV2/CRMP5 antibodies in the patient's cerebrospinal fluid. This syndrome, which is very rare in association with head and neck cancer, commonly precedes the detection of malignancy by a year or more and has been documented in only a few cases after completion of anticancer treatment.
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Affiliation(s)
- Emmanouel Saloustros
- Department of Medical Oncology, University Hospital of Heraklion, Voutes, 71110, Heraklion, Crete, Greece
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Gioulbasanis I, Karampeazis A, Vamvakas L, Kalbakis K, Saloustros E, Sfakiotaki G, Xyrafas A, Georgoulias V, Mavroudis D. 9040 Short term (2-month) survival prognostication in newly-diagnosed patients with Non-Small Cell Lung Cancer. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71753-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Abstract
Systemic chemotherapy provides improvement in both survival and quality of life for patients with advanced non-small-cell lung cancer (NSCLC). Elderly patients have more comorbidities and tend to tolerate more poorly aggressive chemotherapy and radiation therapy than younger individuals. Our purpose in this article is to summarize recent studies of single-agent chemotherapy and combination regimens with cytotoxic or targeted therapies in the management of elderly patients with advanced NSCLC. We have reviewed the available evidence in the literature to gauge the results of therapy for elderly patients with lung cancer. We found that single-agent chemotherapy remains the standard of care for nonselected elderly patients. Retrospective analyses suggest that the efficacy of platinum-based combination chemotherapy is similar in fit older and younger patients, with increased but acceptable toxicity for elderly patients. Therefore, the outcomes in the fit elderly mirror results observed in younger patients, although toxicity is generally greater.
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Affiliation(s)
- Lambros Vamvakas
- Department of Medical Oncology, University Hospital of Heraklion, Heraklion, Crete, Greece
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Abstract
BACKGROUND Paclitaxel and docetaxel are considered fundamental drugs in the treatment of breast cancer. OBJECTIVES To review the current role of taxanes in the treatment breast cancer, with emphasis on data from randomized trials comparing the two taxanes. METHODS We have reviewed the available evidence in the literature to gauge the results of therapy of early and advanced breast cancer with taxanes. RESULTS Clinically benefits were first shown in metastatic setting. More recently, benefits have also been seen in the therapy of early-stage disease. It seems reasonable to consider either drug as standard treatment for node-positive early stage or metastatic breast cancer. Future studies should explore the optimal way of combining taxanes with novel biological and cytotoxic drugs. CONCLUSION Based on existing evidence, clinicians should choose a taxane-based regimen for their patients, according to clinical activity, toxicity profile, pharmacokinetics, and a dosing schedule that best meets the therapeutic needs and convenience.
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Affiliation(s)
- Emmanouel Saloustros
- University General Hospital of Heraklion, Department of Medical Oncology, Heraklion, Crete
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Karampeazis A, Vamvakas L, Saloustros E, Giannousi Z, Gioulbasanis I, Souglakos I, Agelaki S, Milaki G, Markos V, Mavroudis D. Results of the Comprehensive Geriatric Assessment (CGA) of elderly cancer patients in an academic mediacal oncology clinic. Crit Rev Oncol Hematol 2008. [DOI: 10.1016/s1040-8428(08)70070-2] [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: 11/24/2022] Open
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Gioulbasanis I, Giannousi Z, Saloustros E, Vamvakas L, Karambeazis A, Androulakis N, Kalbakis K, Kotsakis A, Kalykaki A, Vardakis N. Prognostic value of Mini Nutritional Assessment (MNA) score in elderly lung-cancer patients. Crit Rev Oncol Hematol 2008. [DOI: 10.1016/s1040-8428(08)70109-4] [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: 11/29/2022] Open
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Gioulbasanis I, Kalykaki A, Vamvakas L, Pallis A, Vardakis N, Saloustros E, Karampeazis A, Sfakiotaki G, Kalbakis K, Mavroudis D. Evaluation of mini nutritional assessment (MNA) in metastatic lung cancer patients: Correlation of laboratory values indicating malnutrition, inflammation, and cachexia with clinical data. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.19062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Vamvakas L, Karampeazis A, Agelaki S, Agelidou A, Kotsakis A, Kakolyris S, Polyzos A, Pallis A, Saloustros E, Georgoulias V. P.40 Oral vinorelbine and gemcitabine (oVG) versus docetaxel and gemcitabine (DG) as first-line treatment of patients with advanced non-small cell lung cancer (NSCLC): a subgroup analysis for elderly patients of a phase III randomized trial from the Hellenic Oncology Research Group (HORG). Crit Rev Oncol Hematol 2007. [DOI: 10.1016/s1040-8428(13)70213-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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38
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Falagas ME, Kavvadia PK, Mantadakis E, Kofteridis DP, Bliziotis IA, Saloustros E, Maraki S, Samonis G. Morganella morganii infections in a general tertiary hospital. Infection 2007; 34:315-21. [PMID: 17180585 DOI: 10.1007/s15010-006-6682-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [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: 03/31/2006] [Accepted: 08/22/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Morganella morganii is a commensal Gram-negative bacillus of the intestinal tract of humans and other mammals and reptiles. Few reports exist in the literature regarding infections caused by this organism. METHODS A retrospective study at the 650-bed University Hospital of Heraklion, Crete, Greece was performed during a 4-year period (2001-2004) to identify and analyze infections caused by M. morganii. RESULTS Twenty-four patients had M. morganii isolated from clinical specimens during the study period. Thirteen patients (54%) suffered from skin and soft tissue infections, five from pyelonephritis, three from female genital tract infections, one from pneumonia, one from gangrenous appendicitis, and one from tonsillitis. M. morganii was a constituent of polymicrobial infections in 14 patients (58%). The patients received various antibiotics, i.e., six patients received ciprofloxacin, four piperacillin/tazobactam, two amoxicillin/clavulanic acid, one ticarcillin/clavulanic acid, one ceftriaxone, one imipenem, and one cefuroxime monotherapy, whereas the remaining eight received antibiotic combinations. Two (both debilitated) of 24 patients (8%) died, despite antibiotic treatment. CONCLUSION Skin and soft tissue infection was the commonest type of infection due to M. morganii in our series. M. morganii is commonly a part of polymicrobial infections and can rarely cause fatalities in debilitated patients.
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Affiliation(s)
- M E Falagas
- Alfa Institute of Biomedical Sciences, 9 Neapoleos Street, 151 23, Marousi, Athens, Greece.
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Gikas A, Kritsotakis EI, Maraki S, Roumbelaki M, Babalis D, Scoulica E, Panoulis C, Saloustros E, Kontopodis E, Samonis G, Tselentis Y. A nosocomial, foodborne outbreak of Salmonella Enterica serovar Enteritidis in a university hospital in Greece: the importance of establishing HACCP systems in hospital catering. J Hosp Infect 2007; 66:194-6. [PMID: 17482719 DOI: 10.1016/j.jhin.2007.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Accepted: 03/01/2007] [Indexed: 11/19/2022]
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Kanoupakis E, Manios E, Mavrakis H, Tzerakis P, Kambouraki D, Klapsinos N, Saloustros E, Vardas P. P-073 Ventricular electrophysiological benefits derived from carvedilol administration in congestive heart failure. Europace 2003. [DOI: 10.1016/eupace/4.supplement_2.b84] [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: 10/14/2022] Open
Affiliation(s)
- E.M. Kanoupakis
- Cardiology Dept. Heraklion University Hospital Heraklion, Crete, Greece
| | - E.G. Manios
- Cardiology Dept. Heraklion University Hospital Heraklion, Crete, Greece
| | - H.E. Mavrakis
- Cardiology Dept. Heraklion University Hospital Heraklion, Crete, Greece
| | - P.G. Tzerakis
- Cardiology Dept. Heraklion University Hospital Heraklion, Crete, Greece
| | - D.C. Kambouraki
- Cardiology Dept. Heraklion University Hospital Heraklion, Crete, Greece
| | - N.C. Klapsinos
- Cardiology Dept. Heraklion University Hospital Heraklion, Crete, Greece
| | - E. Saloustros
- Cardiology Dept. Heraklion University Hospital Heraklion, Crete, Greece
| | - P.E. Vardas
- Cardiology Dept. Heraklion University Hospital Heraklion, Crete, Greece
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