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Karathanasis P, Bletsa G, Tsakogiannis D, Zografos C, Zagouri F, Zografos G, Michalopoulos N. Cell-free DNA concentration in patients with different molecular subtypes of breast cancer. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01574-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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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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Rugo HS, O'Shaughnessy J, Boyle F, Toi M, Broom R, Blancas I, Gumus M, Yamashita T, Im YH, Rastogi P, Zagouri F, Song C, Campone M, San Antonio B, Shahir A, Hulstijn M, Brown J, Zimmermann A, Wei R, Johnston S, Reinisch M, Tolaney SM. Adjuvant Abemaciclib Combined with Endocrine Therapy for High Risk Early Breast Cancer: Safety and Patient-Reported Outcomes From the monarchE Study. Ann Oncol 2022; 33:616-627. [PMID: 35337972 DOI: 10.1016/j.annonc.2022.03.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [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: 01/18/2022] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In monarchE, abemaciclib plus endocrine therapy (ET) as adjuvant treatment of hormone receptor-positive, human epidermal growth factor 2-negative, high risk, early breast cancer demonstrated a clinically meaningful improvement in invasive disease-free survival versus ET alone. Detailed safety analyses conducted at a median follow-up of 27 months and key patient-reported outcomes (PRO) are presented. PATIENTS AND METHODS The safety population included all patients who received at least one dose of study treatment (n=5591). Safety analyses included incidence, management, and outcomes of common and clinically relevant adverse events (AEs). Patient-reported health-related quality-of-life, ET symptoms, fatigue, and side effect burden were assessed. RESULTS The addition of abemaciclib to ET resulted in higher incidence of Grade≥3 AEs (49.7% vs 16.3% with ET alone), predominantly laboratory cytopenias (e.g., neutropenia [19.6%]) without clinical complications. Abemaciclib-treated patients experienced more serious adverse events (SAEs; 13.3% vs 7.8%). Discontinuation of abemaciclib and/or ET due to AEs occurred in 18.5% of patients, mainly due to Grade1/2 AEs (66.8%). AEs were managed with comedications (e.g., antidiarrheals), abemaciclib dose holds (61.7%), and/or dose reductions (43.4%). Diarrhea was generally low grade (Grade1/2: 77%); Grade2/3 events were highest in the first month (20.5%), most short-lived (≤7 days) and did not recur. Venous thromboembolic events (VTE) were higher with abemaciclib+ET (2.5%) vs ET (0.6%); in the abemaciclib arm, increased VTE risk was observed with tamoxifen vs AIs (4.3% vs 1.8%). PROs were similar between arms, including being 'bothered by side effects of treatment', except for diarrhea. At ≥3 months, most patients reporting diarrhea reported "a little bit" or "somewhat". CONCLUSION In patients with high risk EBC, adjuvant abemaciclib+ET has an acceptable safety profile and tolerability is supported by PRO findings. Most AEs were reversible and manageable with comedications and/or dose modifications, consistent with the known abemaciclib toxicity profile.
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Affiliation(s)
- H S Rugo
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, USA.
| | - J O'Shaughnessy
- Baylor University Medical Center, Texas Oncology, US Oncology, Dallas TX, USA
| | - F Boyle
- Patricia Ritchie Centre for Cancer Care and Research, Mater Hospital, Sydney; University of Sydney, Sydney, Australia
| | - M Toi
- Kyoto University Hospital, Kyoto, Japan
| | - R Broom
- Auckland City Hospital, Auckland, New Zealand
| | - I Blancas
- Hospital Universitario Clínico San Cecilio, Granada, Spain; Medicine Department. University of Granada, Spain
| | - M Gumus
- Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | | | - Y-H Im
- Division of Hematology/Medical Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - P Rastogi
- University of Pittsburgh/UPMC, NSABP Foundation, Pittsburgh, USA
| | - F Zagouri
- National and Kapodistrian University of Athens, Department of Clinical Therapeutics, School of Medicine, Athens, Greece
| | - C Song
- Fujian Medical University Union Hospital, Fujian, China
| | - M Campone
- Institut de Cancérologie de l'Ouest, Centre René Gauducheau, Nantes / Saint-Herblain, France
| | | | - A Shahir
- Eli Lilly and Company, Indianapolis, USA
| | - M Hulstijn
- Eli Lilly and Company, Indianapolis, USA
| | - J Brown
- Eli Lilly and Company, Indianapolis, USA
| | | | - Ran Wei
- Eli Lilly and Company, Indianapolis, USA
| | - S Johnston
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - M Reinisch
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
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Liontos M, Andrikopoulou A, Koutsoukos K, Markellos C, Skafida E, Fiste O, Kaparelou M, Thomakos N, Haidopoulos D, Rodolakis A, Dimopoulos MA, Zagouri F. Neutrophil-to-lymphocyte ratio and chemotherapy response score as prognostic markers in ovarian cancer patients treated with neoadjuvant chemotherapy. J Ovarian Res 2021; 14:148. [PMID: 34724958 PMCID: PMC8561989 DOI: 10.1186/s13048-021-00902-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/13/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is the recommended approach in patients with advanced epithelial ovarian cancer (EOC). However, most patients eventually relapse despite the initial high response rate to chemotherapy. Neutrophil-to-lymphocyte ratio is a well-known biomarker that reflects severe inflammation, critical illness, and mortality in various diseases. Chemotherapy response score (CRS) and neutrophil-to-lymphocyte ratio (NLR) have been identified as potential biomarkers of platinum resistance and disease prognosis. We retrospectively evaluated 132 patients with stage IIIc or IV ovarian/fallopian tube/primary peritoneal cancer who had received NACT followed by IDS from 01/01/2003 to 31/12/2018. CRS was assessed on omental specimens collected from IDS according to ICCR guidelines. RESULTS Median age was 64.57 years (SD: 9.72; range 39.2-87.1). Most ovarian tumors were serous epithelial (90.9%; 120/132). An elevated NLR (defined as > 3) was observed in 72% (95/132) of patients in contrast with 28% (37/132) of patients characterized by low NLR status. Median PFS (mPFS) and median overall survival (mOS) were 13.05 months (95% CI: 11.42-14.67)) and 34.69 months (95% CI: 23.26-46.12) respectively. In univariate analysis, CRS3 score was significantly associated with prolonged mPFS (CRS1/2: 12.79 months vs CRS3: 17.7 months; P = 0.008). CRS score was not associated with mOS (P = 0.876). High NLR was not significantly associated with mPFS (P = 0.128), however it was significantly associated with poor mOS (P = 0.012). In multivariate analysis, only performance of surgery maintained its statistical significance with both PFS (P = 0.001) and OS (P = 0.008). CONCLUSION NLR could serve as a useful predictor of OS but not PFS in ovarian cancer patients receiving NACT. In accordance with our previous study, CRS score at omentum was found to be associated with PFS but not OS in ovarian cancer patients treated with NACT and IDS.
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Affiliation(s)
- M Liontos
- Department of Clinical Therapeutics, Alexandra General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - A Andrikopoulou
- Department of Clinical Therapeutics, Alexandra General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - K Koutsoukos
- Department of Clinical Therapeutics, Alexandra General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - C Markellos
- Department of Clinical Therapeutics, Alexandra General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - E Skafida
- Department of Clinical Therapeutics, Alexandra General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - O Fiste
- Department of Clinical Therapeutics, Alexandra General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - M Kaparelou
- Department of Clinical Therapeutics, Alexandra General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - N Thomakos
- Department of Obstetrics and Gynecology, Alexandra General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - D Haidopoulos
- Department of Obstetrics and Gynecology, Alexandra General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - A Rodolakis
- Department of Obstetrics and Gynecology, Alexandra General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - M A Dimopoulos
- Department of Clinical Therapeutics, Alexandra General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - F Zagouri
- Department of Clinical Therapeutics, Alexandra General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Andrikopoulou A, Korakiti AM, Apostolidou K, Dimopoulos MA, Zagouri F. Immune checkpoint inhibitor administration during pregnancy: a case series. ESMO Open 2021; 6:100262. [PMID: 34487972 PMCID: PMC8426195 DOI: 10.1016/j.esmoop.2021.100262] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/07/2021] [Accepted: 08/12/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Immune checkpoint inhibitors have been widely implemented in current clinical practice. Although cancer occurs in ∼1 out of 1000 pregnancies, treatment remains challenging. Until now, limited data exist regarding immunotherapy administration during pregnancy. This systemic review aims to synthesize all available data from immunotherapy administration in pregnant women and evaluate the efficacy and safety of immunotherapy during pregnancy. PATIENTS AND METHODS Eligible studies were identified by a search of the PubMed Medline database and Food and Drug Administration Adverse Events Reporting System Public Dashboard for the period 1 January 2000 to 1 April 2021; the algorithm consisted of a predefined combination of the words 'immunotherapy', 'cancer' and 'pregnancy'. PRISMA guidelines were applied in this study. RESULTS Overall, seven articles (seven pregnancies, nine neonates) were retrieved. The mean duration of immunotherapy administration was 9.8 weeks [standard deviation (SD): 11.27; median: 7.0; range: 1-32]. In all cases specified, melanoma was the malignancy reported. The mean gestational age at delivery was 30.4 weeks (SD: 5.03; median: 32.0; range: 24-38), whereas the mean weight of neonates at delivery was 1267 g (SD: 412.0; median: 1400; range: 590-1701). Only one neonate was born term at 38 weeks of pregnancy (11.1%; 1/9). Complications during pregnancy were observed in 71.4% of cases: intrauterine growth restriction (three cases), HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count) (one case), placental insufficiency (one case) and low fetal heart rate (one case). The mean progression-free survival and overall survival were 16.0 and 25.2 months, respectively. CONCLUSION The administration of immune checkpoint inhibitors during pregnancy is associated with increased incidence of pregnancy complications, prematurity and low birth weight. The administration of these regimens is not recommended during gestation. Whenever applied, close monitoring of the mother and the fetus is required.
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Affiliation(s)
- A Andrikopoulou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - A M Korakiti
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - K Apostolidou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - M A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - F Zagouri
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
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Rugo H, O’Shaughnessy J, Song C, Broom R, Gumus M, Yamashita T, San Antonio B, Shahir A, Zimmermann A, Zagouri F, Reinisch M. Safety outcomes from monarchE: Phase 3 study of abemaciclib combined with endocrine therapy for the adjuvant treatment of HR+, HER-2-, node-positive, high risk, early breast cancer. Breast 2021. [DOI: 10.1016/s0960-9776(21)00101-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Paschou SA, Stefanaki K, Psaltopoulou T, Liontos M, Koutsoukos K, Zagouri F, Lambrinoudaki I, Dimopoulos MA. How we treat endocrine complications of immune checkpoint inhibitors. ESMO Open 2021; 6:100011. [PMID: 33399077 PMCID: PMC7807832 DOI: 10.1016/j.esmoop.2020.100011] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/06/2020] [Accepted: 11/10/2020] [Indexed: 12/18/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) are antibodies that target certain immune checkpoints (ICs), such as cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), programmed death 1 (PD-1) or its ligand (PD-L1), and have emerged as a powerful new tool for oncologists. As these immune checkpoints are crucial for immunological self-tolerance, such therapies can trigger autoimmune adverse effects. Endocrine complications are among the most common, including hypophysitis, thyroid dysfunction, diabetes mellitus and primary adrenal insufficiency, while autoimmune polyendocrine syndrome type 2 (APS-2) may also present. The aim of this article is to critically appraise the literature and present (i) the biological role and function of the main ICs, (ii) the use of ICIs in the treatment of various cancer types, (iii) the endocrine complications of cancer immunotherapy with ICIs and (iv) practical recommendations for screening and management of patients with such endocrinopathies in everyday clinical practice.
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Affiliation(s)
- S A Paschou
- Division of Endocrinology, Diabetes and Metabolism, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - K Stefanaki
- Division of Endocrinology, Diabetes and Metabolism, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - T Psaltopoulou
- Division of Hematology and Oncology, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - M Liontos
- Division of Hematology and Oncology, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - K Koutsoukos
- Division of Hematology and Oncology, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - F Zagouri
- Division of Hematology and Oncology, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - I Lambrinoudaki
- Second Department of Obstetrics and Gynecology, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - M-A Dimopoulos
- Division of Hematology and Oncology, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
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Papageorgiou C, Zagouri F, Dimopoulos M, Manios E, Kafouris P, Tousoulis D, Anagnostopoulos C, Toutouzas K. Vascular inflammation and cardiovascular burden in metastatic breast cancer female patients receiving hormonal treatment and CDK 4/6 inhibitors or everolimus. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3270] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Chemotherapy regimens for breast cancer treatment can promote vascular dysfunction and lead to high cardiovascular risk.
Purpose
The aim of this study was to investigate the cardiovascular burden and vascular inflammation in metastatic breast cancer patients receiving either CDK 4/6 inhibitors and hormonal treatment or standard everolimus and hormonal treatment.
Methods
22 consecutive female patients with metastatic breast cancer that expressed estrogen and /or progesteron receptor and were HER2-negative were enrolled. Patients with active infection, chronic autoimmune disease and history of chemotherapy for the metastatic disease and/or adjuvant chemotherapy during the past 3 years were excluded. All subjects received hormonal treatment and of those, 10 received everolimus and 12 received therapy with CDK 4/6 inhibitors. The two groups were matched for age, history of hypertension, diabetes, dyslipidemia, smoking and all were free of major cardiovascular events for the past 6 months. Regional wall thickness (RWT) and left ventricle mass (LVM) measurements by transthoracic echocardiographic study were obtained followed by 24 hour ambulatory blood pressure monitoring, and 18F-fluorodeoxyglucose positron-emission tomography/computed tomography imaging. Radiotracer uptake in the aortic wall (ascending, arch, descending, abdominal), was quantified as tissue-to-background ratio (TBR).Each patient was assessed for the aforementioned parameters before the initiation and after 6 months of treatment.
Results
At follow up, patients assigned to CDK4/6 treatment demonstrated increased measurements of 24 hour systolic blood pressure (SBP) (p=0.004), daytime SBP(p=0.004) and night time SBP (p=0.012) (Group effect). The 24 hour mean arterial pressure measurements were also higher in CDK 4/6 population, in comparison to everolimus that displayed firm values. (Group effect- p=0.035, Interaction effect-p=0.023).Additionally, 24 hour diastolic blood pressure recordings in CDK 4/6 therapy were higher opposed to everolimus that remained consistent (Interaction effect- p=0.010). In CDK 4/6 group, TBR aorta measurements also increased significantly, whereas TBR values in everolimus remained stable. (Interaction effect-p=0.049). Both therapeutic regimens displayed statistically significant damaging effect with regards to the following variables: Night-time SBP (p=0.032), RWT (p<0.001), and LVM (p<0.001).
Conclusion
Chemotherapy with novel CDK 4/6 inhibitors and hormonal treatment can lead to increased vascular inflammation, and higher blood pressure values compared to the combination of everolimus and hormonal treatment in female patients with HR-positive HER2-negative metastatic breast cancer. Moreover, both treatment strategies promote remodelling of the left ventricle by means of increased RWT and mass. Further research and longitudinal studies in this field are required to validate the above findings.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Papageorgiou
- Alexandra University Hospital, Department of Clinical Therapeutics, Athens, Greece
| | - F Zagouri
- Alexandra University Hospital, Department of Clinical Therapeutics, Athens, Greece
| | - M Dimopoulos
- Alexandra University Hospital, Department of Clinical Therapeutics, Athens, Greece
| | - E Manios
- Alexandra University Hospital, Department of Clinical Therapeutics, Athens, Greece
| | - P Kafouris
- Academy of Athens Biomedical Research Foundation, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, Athens, Greece
| | | | - K Toutouzas
- Hippokration General Hospital, Athens, Greece
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Zagouri F. 318P The real-world Hellenic disease management patterns with everolimus (EVE) for women with hormone-receptor-positive (HR+), human epidermal growth factor receptor-2 negative (HER2-) advanced breast cancer (aBC): ‘The MIRROR’ study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.420] [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: 11/25/2022] Open
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Tsironis G, Liontos M, Kyriazoglou A, Koutsoukos K, Tsiara A, Kaparelou M, Zakopoulou R, Cohen A, Skafida E, Fontara S, Zagouri F, Bamias A, Dimopoulos MA. Axitinib as a third or further line of treatment in renal cancer: a single institution experience. BMC Urol 2020; 20:60. [PMID: 32487200 PMCID: PMC7265645 DOI: 10.1186/s12894-020-00618-1] [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: 01/12/2020] [Accepted: 04/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kidney cancer is a lethal neoplasm that affects several thousands of people every year. Renal cell carcinoma (RCC) is the most common histologic type. Recent developments in the therapeutic approach include antiangiogenic targeted approaches and Immunotherapy. Thus, the therapeutic algorithm of RCC patients and the survival outcomes have changed dramatically. METHODS Herein we present a retrospective study of the patients treated in our Department with an antiangiogenic agent -Axitinib, a tyrosine kinase inhibitor- as a third or further line treatment. Statistical analysis was performed with SPSS, including the available clinicopathological data of the patients included. RESULTS Axitinib was found to be active in patients who received this treatment beyond second line. The toxicity profile of this regimen did not reveal any unknown adverse events. CONCLUSIONS Our real world data reflect that axitinib is a safe and effective option, even beyond the second line.
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Affiliation(s)
- G Tsironis
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - M Liontos
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - A Kyriazoglou
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece.
| | - K Koutsoukos
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - A Tsiara
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - M Kaparelou
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - R Zakopoulou
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - A Cohen
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - E Skafida
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - S Fontara
- 1st Department of Radiology, Aretaieio University hospital, Athens, Greece
| | - F Zagouri
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - A Bamias
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - M A Dimopoulos
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
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Koumarianou A, Makrantonakis P, Zagouri F, Papadimitriou C, Christopoulou A, Samantas E, Christodoulou C, Psyrri A, Bafaloukos D, Aravantinos G, Papakotoulas P, Baka S, Andreadis C, Alexopoulos A, Bompolaki I, Kampoli Κ, Liori S, Karvounis K, Ardavanis A. ABREAST: a prospective, real-world study on the effect of nab-paclitaxel treatment on clinical outcomes and quality of life of patients with metastatic breast cancer. Breast Cancer Res Treat 2020; 182:85-96. [PMID: 32418045 DOI: 10.1007/s10549-020-05677-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/09/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The efficacy of nab-paclitaxel in patients with metastatic breast cancer (MBC) has been demonstrated in randomized clinical trials. However, real-world evidence on effectiveness remains limited. PATIENTS AND METHODS The primary objective of this multicenter prospective study was to assess the overall response rate (ORR) of patients with MBC treated with nab-paclitaxel. Secondary objectives included progression-free survival (PFS), overall survival (OS) and quality of life, assessed with the Functional Assessment of Cancer Therapy-Breast (FACT-B) instrument. RESULTS Eligible patients (N = 150; 36% with de novo MBC presentation) with a median age of 64.5 years were enrolled (86% were ER+, 33.3% (50/150) were ≥ 70 years of age and 53% were treated in the third or later line of treatment). A median of 6 cycles were administered but 26% of patients required dose reduction due to toxicity. The ORR was 26.7% [95% confidence interval (CI) 19.6-33.7], the median PFS was 6.2 months (95% CI 5.2-7.3), and the median OS 21.1 months (95% CI 17.2-not estimable). There was no statistical significant difference in the median PFS of patients < and ≥ 70 years of age. The patients' baseline FACT-B total score remained unchanged. The serious and non-serious adverse event incidence rates were 13% and 48%, respectively. CONCLUSIONS This prospective study provides further evidence on quality of life, efficacy, and safety of nab-paclitaxel in patients with MBC and sheds more light in special subpopulations such as the elderly and those treated beyond the second line.
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Affiliation(s)
- A Koumarianou
- Hematology Oncology Unit, Fourth Department of Internal Medicine, ATTIKON University General Hospital, National and Kapodistrian University of Athens, Medical School, Rimini 1, 124 62, Haidari, Athens, Greece.
| | - P Makrantonakis
- Second Chemotherapeutic Clinic, THEAGENIO Anti-Cancer Hospital of Thessaloniki, Thessaloniki, Greece
| | - F Zagouri
- Therapeutic Clinic, ALEXANDRA General Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - C Papadimitriou
- Oncology Unit, 2nd Dept. of Surgery, ARETAIEIO University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - A Christopoulou
- Oncology Department, AGIOS ANDREAS General Hospital of Patras, Patras, Greece
| | - E Samantas
- Third Oncology Clinic, AGIOI ANARGIROI Athens General Hospital, Athens, Greece
| | - C Christodoulou
- Second Oncology Clinic, METROPOLITAN Athens Private Hospital, Piraeus, Greece
| | - A Psyrri
- Division Medical Oncology, ATTIKON University General Hospital of Athens, Haidari, Greece
| | - D Bafaloukos
- First Oncology Clinic, METROPOLITAN Athens Private Hospital, Piraeus, Greece
| | - G Aravantinos
- Second Oncology Clinic, AGIOI ANARGIROI Athens General Hospital, Athens, Greece
| | - P Papakotoulas
- First Chemotherapeutic Oncology Department, THEAGENION Anti-Cancer Hospital of Thessaloniki, Thessaloniki, Greece
| | - S Baka
- Oncology Department, European INTERBALKAN Private Hospital of Thessaloniki, Thessaloniki, Greece
| | - C Andreadis
- Third Department of Clinical Oncology and Chemotherapy, THEAGENION Anti-Cancer Hospital of Thessaloniki, Thessaloniki, Greece
| | - A Alexopoulos
- Oncology Department, HYGEIA Athens Private Hospital, Maroussi, Athens, Greece
| | - I Bompolaki
- Oncology Department, AGIOS GEORGIOS General Hospital of Chania, Chania, Crete, Greece
| | - Κ Kampoli
- Hematology Oncology Unit, Fourth Department of Internal Medicine, ATTIKON University General Hospital, National and Kapodistrian University of Athens, Medical School, Rimini 1, 124 62, Haidari, Athens, Greece
| | - S Liori
- First Department of Medical Oncology, AGIOS SAVVAS Athens General Hospital, Athens, Greece
| | - K Karvounis
- Medical Department Hematology/Oncology, Genesis Pharma S.A, Halandri, Athens, Greece
| | - A Ardavanis
- First Department of Medical Oncology, AGIOS SAVVAS Athens General Hospital, Athens, Greece
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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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13
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Maniou I, Kontos M, Kontzoglou K, Pagkalos I, Zografos CG, Zagouri F, Zografos GC. The learning curve of breast lesion excision system: Balancing patient's safety and surgical training. Breast J 2019; 26:803-805. [PMID: 31845446 DOI: 10.1111/tbj.13632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/25/2019] [Accepted: 09/06/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Ioanna Maniou
- Breast Unit, 1st Department of Propaedeutic Surgery, Hippokration Hospital, University of Athens, Athens, Greece.,Department of Gynecology and Obstetrics, Lausanne, Switzerland
| | - Michalis Kontos
- 1st Department of Surgery, "Laikon" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - K Kontzoglou
- 2nd Department of Propedeutic Surgery, "Laikon" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - I Pagkalos
- Gynecologist-Obstetrician, Geneve, Switzerland
| | - C G Zografos
- Breast Unit, 1st Department of Propaedeutic Surgery, Hippokration Hospital, University of Athens, Athens, Greece
| | - F Zagouri
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - G C Zografos
- Breast Unit, 1st Department of Propaedeutic Surgery, Hippokration Hospital, University of Athens, Athens, Greece
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14
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Kyriazoglou A, Konteles V, Liontos M, Sofianidis G, Zagouri F, Koutsoukos K, Tsironis G, Tsiara A, Kaparelou M, Zakopoulou R, Cohen A, Dimitriadis E, Mahaira L, Michali D, Arnogiannaki N, Stefanaki K, Dimopoulos M, Kattamis A. Expression analysis of NHEJ and HR genes in Ewing sarcomas: Indications of DSB repair dysfunction. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz283.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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15
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Fountzilas E, Koliou GA, Rapti V, Nikolakopoulos A, Christopoulou A, Moirogiorgou E, Binas I, Aravantinos G, Kostadima L, Nikolaidi A, Karteri S, Zagouri F, Saridaki Z, Molfeta A, Oikonomopoulou P, Res E, Tryfonopoulos D, Koumakis G, Fountzilas G, Razis E. Clinical outcome and toxicity data in patients with advanced breast cancer treated with cyclin-dependent kinase 4/6 (CDK4/6) inhibitors combined with endocrine therapy in a real-world clinical setting. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz242.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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16
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Amant F, Berveiller P, Boere IA, Cardonick E, Fruscio R, Fumagalli M, Halaska MJ, Hasenburg A, Johansson ALV, Lambertini M, Lok CAR, Maggen C, Morice P, Peccatori F, Poortmans P, Van Calsteren K, Vandenbroucke T, van Gerwen M, van den Heuvel-Eibrink M, Zagouri F, Zapardiel I. Gynecologic cancers in pregnancy: guidelines based on a third international consensus meeting. Ann Oncol 2019; 30:1601-1612. [PMID: 31435648 DOI: 10.1093/annonc/mdz228] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We aimed to provide comprehensive protocols and promote effective management of pregnant women with gynecological cancers. New insights and more experience have been gained since the previous guidelines were published in 2014. Members of the International Network on Cancer, Infertility and Pregnancy (INCIP), in collaboration with other international experts, reviewed existing literature on their respective areas of expertise. Summaries were subsequently merged into a manuscript that served as a basis for discussion during the consensus meeting. Treatment of gynecological cancers during pregnancy is attainable if management is achieved by collaboration of a multidisciplinary team of health care providers. This allows further optimization of maternal treatment, while considering fetal development and providing psychological support and long-term follow-up of the infants. Nonionizing imaging procedures are preferred diagnostic procedures, but limited ionizing imaging methods can be allowed if indispensable for treatment plans. In contrast to other cancers, standard surgery for gynecological cancers often needs to be adapted according to cancer type and gestational age. Most standard regimens of chemotherapy can be administered after 14 weeks gestational age but are not recommended beyond 35 weeks. C-section is recommended for most cervical and vulvar cancers, whereas vaginal delivery is allowed in most ovarian cancers. Breast-feeding should be avoided with ongoing chemotherapeutic, endocrine or targeted treatment. More studies that focus on the long-term toxic effects of gynecologic cancer treatments are needed to provide a full understanding of their fetal impact. In particular, data on targeted therapies that are becoming standard of care in certain gynecological malignancies is still limited. Furthermore, more studies aimed at the definition of the exact prognosis of patients after antenatal cancer treatment are warranted. Participation in existing registries (www.cancerinpregnancy.org) and the creation of national tumor boards with multidisciplinary teams of care providers (supplementary Box S1, available at Annals of Oncology online) is encouraged.
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Affiliation(s)
- F Amant
- Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek and Amsterdam University Medical Centers, the Netherlands; Department of Oncology, KU Leuven, Leuven, Belgium.
| | - P Berveiller
- Department of Obstetrics and Gynecology, Centre Hospitalier de Poissy-Saint-Germain-en-Laye, Poissy, France
| | - I A Boere
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - E Cardonick
- Department of Obstetrics and Gynecology, Cooper University Health Care, Camden, USA
| | - R Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan Bicocca, San Gerardo Hospital, Monza, Italy
| | - M Fumagalli
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - M J Halaska
- Department of Obstetrics and Gynaecology, 3rd Medical Faculty, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - A Hasenburg
- Department of Obstetrics and Gynecology, Mainz University Medical Center, Mainz, Germany
| | - A L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - M Lambertini
- Department of Medical Oncology, IRCCS Policlinico San Martino Hospital, Genova, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - C A R Lok
- Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek and Amsterdam University Medical Centers, the Netherlands
| | - C Maggen
- Department of Oncology, KU Leuven, Leuven, Belgium
| | - P Morice
- Department of Gynecologic Surgery, Institute de Cancérologie Gustave Roussy, Villejuif, France
| | - F Peccatori
- Department of Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - P Poortmans
- Department of Radiation Oncology, Institut Curie and Paris Sciences & Lettres - PSL University, Paris, France
| | - K Van Calsteren
- Department of Development and Regeneration, University Hospitals Leuven, Leuven, Belgium
| | | | - M van Gerwen
- Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek and Amsterdam University Medical Centers, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - F Zagouri
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, University of Athens, Athens, Greece
| | - I Zapardiel
- Department of Gynecologic Oncology, La Paz University Hospital, Madrid, Spain
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Foukas P, Koliou GA, Papoudou-Bai A, Charchanti A, Vrettou E, Poulios C, Chatzopoulos K, Kotoula V, Fountzilas E, Zakopoulou R, Visvikis A, Pentheroudakis G, Pectasides D, Aravantinos G, Oikonomopoulos G, Papanikolaou A, Haidopoulos D, Zagouri F, Fountzilas G, Goussia A. Prognostic significance of elements of the adaptive immunity in the microenvironment of epithelial ovarian cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz250.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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18
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Fountzilas E, Koliou GA, Zagouri F, Pentheroudakis G, Christodoulou C, Koutras A, Pectasides D, Bafaloukos D, Samantas E, Aravantinos G, Papakostas P, Psyrri A, Kosmidis P, Koumarianou A, Razis E, Linardou H, Christopoulou A, Karanikiotis C, Gogas H, Fountzilas G. The clinical impact of adjuvant dose-dense sequential chemotherapy (dds-CT) in patients with high-risk operable breast cancer (BC): Pooled analysis of 6 clinical trials. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.021] [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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19
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Anastasiou M, Antonopoulos AS, Oikonomou E, Zagouri F, Siasos G, Vogiatzi G, Tsalamandris S, Mistakidi CV, Psaltopoulou T, Bamias A, Dimopoulos M, Tousoulis D. P1573Chemotherapy-induced vasotoxicity in patients undergoing therapy for breast cancer. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0333] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiotoxicity is a well-known adverse effect of anthracycline and HER-2 monoclonal antibodies, however the vascular effects of these agents remain less-well studied.
Purpose
To explore the effects of breast chemotherapy on vascular function.
Methods
A total of 57 female patients undergoing breast diagnosed with breast cancer and scheduled for anthracycline-based and HER-2 chemotherapy were included in this study. At baseline, at 3, 6 and 12 months, patients underwent assessment of cardiac function by transthoracic echocardiography, endothelial function assessment by brachial flow mediated dilation (FMD) and assessment of arterial stiffness by carotid-radial pulse wave velocity (PWV) and augmentation index (Aix).
Results
There was a significant decrease in left ventricular ejection fraction (LVEF) overtime compared to baseline (A). This was paralleled by a significant decrease in brachial FMD at 6 months (B) and a significant increase in PWV compared to baseline (C). There was no significant change in Aix compared to baseline levels (D). Chemotherapy-induced cardiotoxicity (expressed by the change in LVEF) was not associated with either the change in FMD or PWV at 6 months.
Conclusions
Breast chemotherapy-induced cardiotoxicity is paralleled by vasotoxicity, which is manifested as endothelial dysfunction and increased arterial stiffness. Systemic vasotoxicity is not directly related to cardiotoxicity, suggesting that monitoring of both cardiac and vascular function could be useful in identifying early signs of cardiovascular toxicity.
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Affiliation(s)
- M Anastasiou
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - A S Antonopoulos
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - E Oikonomou
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - F Zagouri
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - G Siasos
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - G Vogiatzi
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - S Tsalamandris
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - C V Mistakidi
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - T Psaltopoulou
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - A Bamias
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - M Dimopoulos
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
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20
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Zografos E, Anagnostopoulos A, Papadopoulou A, Legaki E, Zagouri F, Marinos E, Tsangaris G, Gazouli M. Identification of serum proteome signatures of male breast cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz095.063] [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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21
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Papanikolaou IG, Dimitrakakis C, Zagouri F, Marinopoulos S, Giannos A, Zografos E, Zografos CG, Kritikou D, Rodolakis A, Zografos GC, Loutradis D. Paving the way for changing perceptions in breast surgery: a systematic literature review focused on oncological and aesthetic outcomes of oncoplastic surgery for breast cancer. Breast Cancer 2019; 26:416-427. [PMID: 30955172 DOI: 10.1007/s12282-019-00968-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 03/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The emphasis on aesthetic outcomes and quality of life after breast cancer surgery has motivated breast surgeons to develop oncoplastic breast conserving surgery (OPS). Training programs are still rare in most countries, and there is little standardization, which challenges the scientific evaluation of these techniques. This systematic review aims to assess oncological and cosmetic outcomes of OPS. METHODS After a strict selection process with precise inclusion and exclusion criteria, oncologic and aesthetic outcomes of oncoplastic surgery were searched, using the MEDLINE database up to September 30th, 2017. Available published literature was classified in levels of evidence. After a thorough screening process, only studies with the best level of evidence were included on selection. Systematic reviews and meta-analyses were not included for methodological reasons. RESULTS Titles and abstracts of 2.854 citations were identified and after screening 15 prospective studies including 1.391 patients were reviewed and scored in detail. Local relapse was found in 2.8% of cases with a wide range of follow-up (from 6 to 74 months). Close margins were retrieved in 11% of cases and positive margins in 9.4% of cases. Mastectomy was implemented in 6.9% of breast cancer patients to whom OPS was performed. Good cosmetic outcomes were detected in 90.2% of patients undergoing OPS, leaving open issues for who should perform cosmetic evaluation and which method should be used. CONCLUSION Tumor margins, mastectomy rates, and cosmetic outcomes of OPS have to be further improved by standardizing various aspects of OPS. Research efforts should focus on level I evidence assessing both oncological and aesthetic outcomes of OPS and survival rates.
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Affiliation(s)
- I G Papanikolaou
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece.
| | - C Dimitrakakis
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece
| | - F Zagouri
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - S Marinopoulos
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece
| | - A Giannos
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece
| | - E Zografos
- 1st Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - C G Zografos
- 1st Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - D Kritikou
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A Rodolakis
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece
| | - G C Zografos
- 1st Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - D Loutradis
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece
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22
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Kourea HP, Koletsa T, Kotoula V, Koliou GA, Batistatou A, Pentheroudakis G, Arapantoni-Dadioti P, Zagouri F, Bobos M, Sotiropoulou M, Papoudou-Bai A, Chrisafi S, Efstratiou I, Aravantinos G, Nicolaou I, Gogas H, Visvikis A, Christodoulou C, Petraki C, Koutras A, Psyrri A, Pectasides D, Fountzilas G. Abstract P4-08-13: Prognostic significance of CD8+ tumor-infiltrating lymphocytes (TILs) in patients with early breast cancer (EBC) treated with dose-dense sequential adjuvant chemotherapy (dds-CT). An observational study (ACTRN12616001043426). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-08-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background - aim: Information on the prognostic role of cytotoxic CD8+ T cells in the era of modern adjuvant CT is limited. The primary objective of the present report is to assess the prognostic impact of CD8+ cells in patients with intermediate or high-risk EBC (T1-3N1-2M0) treated with dds-CT. Secondary endpoints are safety, disease-free survival (DFS) and overall survival (OS).
Patients and Methods: Patients (N=1,000) were treated with 4 cycles of Epirubicin, 75mg/m2, and Cyclophophamide, 600mg/m2 every 2 weeks followed by 4 cycles of Docetaxel (D), 100mg/m2 every 3 weeks with G-CSF support in all cycles. Trastuzumab was initiated concurrently with D and continued for a total of 1 year. Hormonal and radiation therapy were given post CT, as indicated. Formalin-fixed paraffin-embedded tumors were available for 642 patients (64.2%) and were centrally assessed for immunohistochemical subtypes (IHC4; N=526), stromal TILs density by morphology (N=636), as well as stromal and intratumoral cytotoxic CD8+ T cell numbers (N=554). TILs and CD8+ were assessed as continuous variables for associations and as 10% increments for outcome.
Results: In total, 901/1,000 pts (90.1%) completed 8 cycles of CT. Severe (gradeIII-IV) toxicitiesincludedneutropenia (5.6%), leucopenia (3.6%), lymphopenia (2.1%), hand-footsyndrome (2.1%), and hepatotoxicity (1.8%). Febrileneutropenia occurred in 1.6% of the patients. The 5-year DFS and OS rates were 89.5% and 93.1%, respectively. Luminal A tumors were classified in 26.2%, Luminal B in 35.2%, luminal HER2 in 9.5%; HER2-enriched in 7.2%; and, triple-negative (TNBC) in 21.9% of informative patients. Among subtypes, stromal TILs density was higher in HER2-enriched and TNBC (p<0.001); intratumoral CD8+ values were higher in TNBC (p<0.001); and, stromal CD8+ were higher in HER2-enriched (p=0.034). In all patients, TILs density and intratumoral CD8+ cell numbers were not associated with DFS and OS, while increased stromal CD8+ were marginally associated with prolonged DFS (HR=0.98, 95%CI 0.96-1.00, p=0.066).Adjusted for histological grade, menopausal, ER/PgR and nodal status, higher stromal CD8+ were associated with prolonged DFS (HR=0.98, 95% CI 0.96-1.00, p=0.043). In TNBC, higher stromal TILs density conferred prolonged DFS (HR=0.97, 95%CI 0.94-0.99, p=0.029), which retained its prognostic significance in multivariate analysis (HR=0.97, 95% CI 0.94-1.00, p=0.049).
Conclusions: In this study, dds-CT was well tolerated and active in patients with EBC. We confirm the presence of morphologically assessed higher TILs density, and of higher cytotoxic CD8+ T cell numbers in hormone receptor negative EBC, as well as the favorable prognostic impact of higher stromal TILs density in TNBC. In comparison to stromal TILs density, higher stromal CD8+ may confer favorable prognosis irrespectively of EBC subtype. Stromal CD8+ seems to be a marker worth further standardizing for reporting on immune cell infiltrates in EBC.
Citation Format: Kourea HP, Koletsa T, Kotoula V, Koliou G-A, Batistatou A, Pentheroudakis G, Arapantoni-Dadioti P, Zagouri F, Bobos M, Sotiropoulou M, Papoudou-Bai A, Chrisafi S, Efstratiou I, Aravantinos G, Nicolaou I, Gogas H, Visvikis A, Christodoulou C, Petraki C, Koutras A, Psyrri A, Pectasides D, Fountzilas G. Prognostic significance of CD8+ tumor-infiltrating lymphocytes (TILs) in patients with early breast cancer (EBC) treated with dose-dense sequential adjuvant chemotherapy (dds-CT). An observational study (ACTRN12616001043426) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-08-13.
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Affiliation(s)
- HP Kourea
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
| | - T Koletsa
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
| | - V Kotoula
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
| | - G-A Koliou
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
| | - A Batistatou
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
| | | | | | - F Zagouri
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
| | - M Bobos
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
| | - M Sotiropoulou
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
| | - A Papoudou-Bai
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
| | - S Chrisafi
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
| | - I Efstratiou
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
| | - G Aravantinos
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
| | - I Nicolaou
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
| | - H Gogas
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
| | - A Visvikis
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
| | | | - C Petraki
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
| | - A Koutras
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
| | - A Psyrri
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
| | - D Pectasides
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
| | - G Fountzilas
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece
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Fountzila E, Kotoula V, Koliou GA, Giannoulatou E, Gogas H, Papadimitriou C, Tikas I, Papadopoulou K, Zagouri F, Christodoulou C, Koutras A, Razis E, Papakostas P, Samantas E, Aravantinos G, Psyrri A, Pectasides D, Futreal A, Tsimberidou AM, Fountzilas G. Actionable mutations and overall survival in 3,211 patients with cancer: The Hellenic cooperative oncology group precision medicine initiative. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy303.046] [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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24
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Liontos M, Sotiropoulou M, Kaparelou M, Tzannis K, Tsironis G, Kyriazoglou A, Tsiara A, Zakopoulou R, Koutsoukos K, Zagouri F, Vlachos D, Thomakos N, Haidopoulos D, Rodolakis A, Dimopoulos M, Bamias A. Evaluation of chemotherapy response score and lymphocytic infiltration as prognostic markers in ovarian cancer patients treated with neoadjuvant chemotherapy. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy285.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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25
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Anastasiou M, Oikonomou E, Zagouri F, Siasos G, Antonopoulos AS, Tsalamandris S, Papakostas P, Psaltopoulou T, Bamias A, Dimopoulos MA, Tousoulis D. P1577Cancer therapeutic related vaso- and cardio-toxicity in patients receiving chemotherapy for breast cancer. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1577] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Anastasiou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - E Oikonomou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - F Zagouri
- Alexandra University Hospital, Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece
| | - G Siasos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - A S Antonopoulos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - S Tsalamandris
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - P Papakostas
- Hippokration General Hospital, Department of Internal Medicine, Athens, Greece
| | - T Psaltopoulou
- National & Kapodistrian University of Athens, Department of Hygiene, Epidemiology and Medical Statistics, Athens, Greece
| | - A Bamias
- Alexandra University Hospital, Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece
| | - M A Dimopoulos
- Alexandra University Hospital, Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece
| | - D Tousoulis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
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Bamias A, Gibbs E, Khoon Lee C, Davies L, Dimopoulos M, Zagouri F, Veillard AS, Kosse J, Santaballa A, Mirza MR, Tabaro G, Vergote I, Bloemendal H, Lykka M, Floquet A, Gebski V, Pujade-Lauraine E. Bevacizumab with or after chemotherapy for platinum-resistant recurrent ovarian cancer: exploratory analyses of the AURELIA trial. Ann Oncol 2018; 28:1842-1848. [PMID: 28481967 DOI: 10.1093/annonc/mdx228] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background In the open-label randomized phase III AURELIA trial, adding bevacizumab to chemotherapy for platinum-resistant ovarian cancer (PROC) significantly improved progression-free survival and response rate versus chemotherapy alone, but not overall survival (OS). We explored the effect of bevacizumab use after disease progression (PD) in patients randomized to chemotherapy alone. Patients and methods In AURELIA, 361 women with PROC were randomized to chemotherapy alone or with bevacizumab. Patients initially randomized to chemotherapy were offered bevacizumab after PD. Post hoc analyses assessed efficacy and safety in three subgroups: chemotherapy alone, chemotherapy followed by bevacizumab after PD, and chemotherapy plus bevacizumab at randomization. Results Of the 182 patients randomized to chemotherapy alone, 72 (40%) received bevacizumab after PD and 110 (60%) never received bevacizumab. There were no significant differences in patient and disease characteristics between these subgroups at baseline or the time of PD. Compared with patients never receiving bevacizumab, the risk of death was significantly reduced in patients receiving bevacizumab either upfront with chemotherapy [hazard ratio (HR) = 0.68, 95% confidence interval (CI) 0.52-0.90] or after PD (HR = 0.60, 95% CI 0.43-0.86). The tolerability of bevacizumab was similar with administration upfront or after PD. Conclusions Post-PD bevacizumab use may have confounded OS results in AURELIA. In these exploratory analyses of non-randomized subgroups, bevacizumab use, either with chemotherapy or after PD on chemotherapy alone, improved OS compared with no bevacizumab. Combining bevacizumab with chemotherapy at first appearance of platinum resistance maximises the likelihood of patients receiving this active treatment for PROC. ClinicalTrials.gov: NCT00976911.
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Affiliation(s)
- A Bamias
- HECOG and Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - E Gibbs
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - C Khoon Lee
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - L Davies
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - M Dimopoulos
- HECOG and Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - F Zagouri
- HECOG and Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - A-S Veillard
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - J Kosse
- AGO and Department of Gynaecology, Sana Klinikum Offenbach, Offenbach, Germany
| | - A Santaballa
- GEICO and Medical Oncology Department, University Hospital and Polytechnic, Valencia, Spain
| | - M R Mirza
- NSGO and Department of Oncology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - G Tabaro
- MITO and USCC/Dir. Scientifica, Centro di Riferimento Oncologico, CRO-IRCCS, Aviano, Italy
| | - I Vergote
- BGOG and Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, University Hospital Leuven, Leuven, Belgium
| | - H Bloemendal
- DGOG and Department of Internal Medicine/Oncology, Meander Medical Center, Amersfoort, The Netherlands
| | - M Lykka
- HECOG and Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - A Floquet
- GINECO and Medical Oncology and Genetics Department, Institut Bergonié, Bordeaux
| | - V Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - E Pujade-Lauraine
- GINECO and Paris Descartes University, AP-HP Central Paris University Hospitals, Paris, France
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Tsiatas M, Kalogeras KT, Manousou K, Wirtz RM, Gogas H, Veltrup E, Zagouri F, Lazaridis G, Koutras A, Christodoulou C, Pentheroudakis G, Petraki C, Bafaloukos D, Pectasides D, Kosmidis P, Samantas E, Karanikiotis C, Papakostas P, Dimopoulos MA, Fountzilas G. Abstract P1-07-03: Evaluation of the prognostic value of CD3, CD8 and FOXP3 mRNA expression in early breast cancer patients treated with anthracycline-based adjuvant chemotherapy. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-07-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Tumor-infiltrating lymphocytes (TILs) have been shown to be of prognostic value in several cancer types. In early breast cancer, TILs have a prognostic utility, as well, especially in HER2-positive and triple-negative breast cancer (TNBC). TILs presence is broadly associated with improved survival, however there is controversy regarding TILs subpopulations. In general, T cell infiltration is higher in non-luminal and more aggressive tumors, like the basal-like subtype. Among TILs subpopulations, CD8-positive T cell infiltration is associated with better outcome, whereas high numbers of FOXP3-positive T regulatory cells are associated with worse outcome in ER-positive tumors and better outcome in HER2-positive and TNBC tumors.
Patients and Methods: Early breast cancer patients, treated with anthracycline-based chemotherapy within two randomized trials (HE10/97 and HE10/00) were included in the study. We evaluated, by qRT-PCR, 826 macrodissected formalin-fixed paraffin-embedded tumor tissue samples for mRNA expression of CD3, CD8 and FOXP3for potential prognostic significance in terms of disease-free survival (DFS) and overall survival (OS). TILs were evaluated in whole sections as percent of total cells.
Results: Median age was 52.7 years, while 54.2% of the patients were postmenopausal and 79.0% ER/PgR-positive. After a median follow-up of 133.0 months, 255 patients (30.9%) had died and 314 (38.0%) had disease progression. All three mRNA markers were positively correlated with TILs (Spearman's r=0.52 for CD3, 0.41 for CD8 and 0.47 for FOXP3, all p-values <0.001), while Ki67 protein expression was greater in tumors with high mRNA expression (median cut-off) of the markers (Mann-Whitney, all p-values <0.001). Additionally, tumors of higher histological grade and negative ER/PgR status were more frequent in patients with high CD3, CD8 or FOXP3 mRNA expression, as compared to patients with low expression, (chi-square, p-values <0.010). In the univariate analysis, high CD3 and CD8 mRNA expression was found to be of favorable prognostic value for DFS (HR=0.74, 95% CI 0.59-0.92, Wald's p=0.007 and HR=0.76, 95% CI 0.61-0.95, p=0.016, respectively). In multivariate analyses, the association of high CD8 mRNA expression with increased DFS was retained (HR=0.77, 95% CI 0.60-0.99, p=0.048), whereas that of high CD3 mRNA expression was of marginal statistical significance (HR=0.77, 95% CI 0.59-1.01, p=0.059). Moreover, a significant interaction was observed between HER2 status and CD3 mRNA expression with respect to DFS (interaction p=0.032). In the HER2-positive subgroup, the hazard ratio associated with high CD3 mRNA expression was of greater magnitude (HR=0.48, 95% CI 0.30-0.76, p=0.002) compared to the hazard ratio presented above, for the entire cohort. No significant findings were observed for FOXP3 in terms of DFS, while none of the studied markers were of prognostic value for OS.
Conclusions: High CD3 and CD8 mRNA expression in early breast cancer patients is of prognostic value for decreased risk for relapse and, in the future, could potentially be of importance in deciding the most appropriate therapeutic strategy in light of the recent immune-related treatment developments.
Citation Format: Tsiatas M, Kalogeras KT, Manousou K, Wirtz RM, Gogas H, Veltrup E, Zagouri F, Lazaridis G, Koutras A, Christodoulou C, Pentheroudakis G, Petraki C, Bafaloukos D, Pectasides D, Kosmidis P, Samantas E, Karanikiotis C, Papakostas P, Dimopoulos M-A, Fountzilas G. Evaluation of the prognostic value of CD3, CD8 and FOXP3 mRNA expression in early breast cancer patients treated with anthracycline-based adjuvant chemotherapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-07-03.
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Affiliation(s)
- M Tsiatas
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; STRATYFIER Molecular Pathology GmbH, Cologne, Germany
| | - KT Kalogeras
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; STRATYFIER Molecular Pathology GmbH, Cologne, Germany
| | - K Manousou
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; STRATYFIER Molecular Pathology GmbH, Cologne, Germany
| | - RM Wirtz
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; STRATYFIER Molecular Pathology GmbH, Cologne, Germany
| | - H Gogas
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; STRATYFIER Molecular Pathology GmbH, Cologne, Germany
| | - E Veltrup
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; STRATYFIER Molecular Pathology GmbH, Cologne, Germany
| | - F Zagouri
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; STRATYFIER Molecular Pathology GmbH, Cologne, Germany
| | - G Lazaridis
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; STRATYFIER Molecular Pathology GmbH, Cologne, Germany
| | - A Koutras
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; STRATYFIER Molecular Pathology GmbH, Cologne, Germany
| | - C Christodoulou
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; STRATYFIER Molecular Pathology GmbH, Cologne, Germany
| | - G Pentheroudakis
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; STRATYFIER Molecular Pathology GmbH, Cologne, Germany
| | - C Petraki
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; STRATYFIER Molecular Pathology GmbH, Cologne, Germany
| | - D Bafaloukos
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; STRATYFIER Molecular Pathology GmbH, Cologne, Germany
| | - D Pectasides
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; STRATYFIER Molecular Pathology GmbH, Cologne, Germany
| | - P Kosmidis
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; STRATYFIER Molecular Pathology GmbH, Cologne, Germany
| | - E Samantas
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; STRATYFIER Molecular Pathology GmbH, Cologne, Germany
| | - C Karanikiotis
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; STRATYFIER Molecular Pathology GmbH, Cologne, Germany
| | - P Papakostas
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; STRATYFIER Molecular Pathology GmbH, Cologne, Germany
| | - M-A Dimopoulos
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; STRATYFIER Molecular Pathology GmbH, Cologne, Germany
| | - G Fountzilas
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; STRATYFIER Molecular Pathology GmbH, Cologne, Germany
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Kotoula V, Giannoulatou E, Papadopoulou K, Tikas I, Manousou K, Bobos M, Lakis S, Lazaridis G, Efstratiou I, Zagouri F, Pentheroudakis G, Gogas H, Christodoulou C, Koutras A, Psyrri A, Papandreou C, Papakostas P, Bafaloukos D, Pectasides D, Fountzilas G. Intrinsic tumor features underlying clinical subtype discordance in early breast cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.033] [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: 11/15/2022] Open
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Kotoula V, Giannoulatou E, Kouvatseas G, Tikas I, Lazaridis G, Charalambous E, Efstratiou I, Bobos M, Tsolaki E, Zagouri F, Christodoulou C, Pentheroudakis G, Koutras A, Papakostas P, Kosmidis PA, Pectasides D, Fountzilas G. Abstract P6-09-07: Mutation characteristics and tumor infiltrating lymphocytes in early and metastatic HER2-positive breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-09-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background-aim: HER2-positive breast cancer (BC) features high rates of tumor infiltrating lymphocytes (TILs) and mutations (mut) in various genes, more frequently in TP53. We investigated associations between TILs and mutations in HER2-positive BC and their impact on patient outcome in early and metastatic BC (EBC and MBC, respectively), which remain largely unexplored.
Methods:In 352 primary paraffin tumors from patients with HER2-positive disease, we examined amino acid changing mutations (<0.1% minor allele frequency) in 58 genes for type and possible clonality (>20% variant frequency). Study groups were: (A) 218 EBC, including 117 patients treated with adjuvant chemotherapy only (CT) and 101 patients treated with CT and trastuzumab (CTT); (B) 134 MBC, including 95 patients who relapsed upon adjuvant CT without trastuzumab (R-MBC) and 39 patients who were first diagnosed with metastatic disease (de novo MBC). TILs were assessed as percentage of stromal tumor area. Clinical endpoints were disease-free survival in 5 years (5yr DFS) for EBC, and time-to-progression (TTP) from 1st line CTT treatment start for MBC.
Results: 243/352 tumors (69%) carried at least one mut; 27/352 (8%) of tumors >10 up to 150 mut (hypermut); 192/352 (54%) at least one possibly clonal mut. Mean mut number and TP53 mut in particular were highest in R-MBC and lowest in EBC; mean TILs density followed the opposite pattern (all p<0.001). TILs density was lower in all settings in hypermut tumors and in tumors with multiple clonal mut (p values 0.043 – 0.050). Upon multivariate analysis in EBC, higher risk for relapse in 5yrs was noticed for CT patients compared to CTT (odds ratio [OR] 2.39, 95%CI [CI] 1.13-5.04, p=0.023) and for >3 compared to 0-3 positive nodes (OR 3.83, CI 1.76-8.34, p=0.001); lower risk for relapse was observed for higher TILs irrespectively of treatment (OR 0.93, CI 0.90-0.97, p=0.001), for TP53 mut (OR 0.39, CI 0.18-0.87, p=0.022) and for clonal TP53 mut in CTT-treated patients (OR 0.10, CI 0.02-0.58) but not in CT-treated patients (interaction p=0.084). The presence of any clonal mut (hazard ratio [HR] 2.77, CI 1.42-5.38) and of clonal TP53 mut (HR 2.24, CI 1.20-4.17) conferred worse TTP in de novo but not in R-MBC; these interactions remained significant upon multivariate analysis (interaction p=0.007 and p=0.061, respectively). Higher TILs in the absence of clonal mut conferred longer TTP (HR 0.75, CI 0.56-0.99) but no such effect was observed for tumors with clonal mut (multivariate interaction p=0.052). Classic independent predictors of unfavorable TTP in MBC were younger age (p=0.002), absence of hormone receptors (p=0.001) and poor performance status (p=0.044). PIK3CA mut did not remain significant in any of the examined settings.
Conclusions: The expected pattern of higher TILs associated with mutation number and clonality was not observed in HER2-positive BC; the favorable effect of TILs only in the absence of clonal mut in MBC may imply exhausted immune response. Clonal TP53 mut may serve as a predictor for trastuzumab benefit in EBC but as an adverse prognosticator in trastuzumab-treated de novo MBC, which, if further validated, is of potential clinical relevance.Background-aim: HER2-positive breast cancer (BC) features high rates of tumor infiltrating lymphocytes (TILs) and mutations (mut) in various genes, more frequently in TP53. We investigated associations between TILs and mutations in HER2-positive BC and their impact on patient outcome in early and metastatic BC (EBC and MBC, respectively), which remain largely unexplored.
Methods:In 352 primary paraffin tumors from patients with HER2-positive disease, we examined amino acid changing mutations (<0.1% minor allele frequency) in 58 genes for type and possible clonality (>20% variant frequency). Study groups were: (A) 218 EBC, including 117 patients treated with adjuvant chemotherapy only (CT) and 101 patients treated with CT and trastuzumab (CTT); (B) 134 MBC, including 95 patients who relapsed upon adjuvant CT without trastuzumab (R-MBC) and 39 patients who were first diagnosed with metastatic disease (de novo MBC). TILs were assessed as percentage of stromal tumor area. Clinical endpoints were disease-free survival in 5 years (5yr DFS) for EBC, and time-to-progression (TTP) from 1st line CTT treatment start for MBC.
Results: 243/352 tumors (69%) carried at least one mut; 27/352 (8%) of tumors >10 up to 150 mut (hypermut); 192/352 (54%) at least one possibly clonal mut. Mean mut number and TP53 mut in particular were highest in R-MBC and lowest in EBC; mean TILs density followed the opposite pattern (all p<0.001). TILs density was lower in all settings in hypermut tumors and in tumors with multiple clonal mut (p values 0.043 – 0.050). Upon multivariate analysis in EBC, higher risk for relapse in 5yrs was noticed for CT patients compared to CTT (odds ratio [OR] 2.39, 95%CI [CI] 1.13-5.04, p=0.023) and for >3 compared to 0-3 positive nodes (OR 3.83, CI 1.76-8.34, p=0.001); lower risk for relapse was observed for higher TILs irrespectively of treatment (OR 0.93, CI 0.90-0.97, p=0.001), for TP53 mut (OR 0.39, CI 0.18-0.87, p=0.022) and for clonal TP53 mut in CTT-treated patients (OR 0.10, CI 0.02-0.58) but not in CT-treated patients (interaction p=0.084). The presence of any clonal mut (hazard ratio [HR] 2.77, CI 1.42-5.38) and of clonal TP53 mut (HR 2.24, CI 1.20-4.17) conferred worse TTP in de novo but not in R-MBC; these interactions remained significant upon multivariate analysis (interaction p=0.007 and p=0.061, respectively). Higher TILs in the absence of clonal mut conferred longer TTP (HR 0.75, CI 0.56-0.99) but no such effect was observed for tumors with clonal mut (multivariate interaction p=0.052). Classic independent predictors of unfavorable TTP in MBC were younger age (p=0.002), absence of hormone receptors (p=0.001) and poor performance status (p=0.044). PIK3CA mut did not remain significant in any of the examined settings.
Conclusions: The expected pattern of higher TILs associated with mutation number and clonality was not observed in HER2-positive BC; the favorable effect of TILs only in the absence of clonal mut in MBC may imply exhausted immune response. Clonal TP53 mut may serve as a predictor for trastuzumab benefit in EBC but as an adverse prognosticator in trastuzumab-treated de novo MBC, which, if further validated, is of potential clinical relevance.
Citation Format: Kotoula V, Giannoulatou E, Kouvatseas G, Tikas I, Lazaridis G, Charalambous E, Efstratiou I, Bobos M, Tsolaki E, Zagouri F, Christodoulou C, Pentheroudakis G, Koutras A, Papakostas P, Kosmidis PA, Pectasides D, Fountzilas G. Mutation characteristics and tumor infiltrating lymphocytes in early and metastatic HER2-positive breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-09-07.
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Affiliation(s)
- V Kotoula
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia; Health Data Specialists Ltd, Athens, Greece
| | - E Giannoulatou
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia; Health Data Specialists Ltd, Athens, Greece
| | - G Kouvatseas
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia; Health Data Specialists Ltd, Athens, Greece
| | - I Tikas
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia; Health Data Specialists Ltd, Athens, Greece
| | - G Lazaridis
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia; Health Data Specialists Ltd, Athens, Greece
| | - E Charalambous
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia; Health Data Specialists Ltd, Athens, Greece
| | - I Efstratiou
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia; Health Data Specialists Ltd, Athens, Greece
| | - M Bobos
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia; Health Data Specialists Ltd, Athens, Greece
| | - E Tsolaki
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia; Health Data Specialists Ltd, Athens, Greece
| | - F Zagouri
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia; Health Data Specialists Ltd, Athens, Greece
| | - C Christodoulou
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia; Health Data Specialists Ltd, Athens, Greece
| | - G Pentheroudakis
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia; Health Data Specialists Ltd, Athens, Greece
| | - A Koutras
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia; Health Data Specialists Ltd, Athens, Greece
| | - P Papakostas
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia; Health Data Specialists Ltd, Athens, Greece
| | - PA Kosmidis
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia; Health Data Specialists Ltd, Athens, Greece
| | - D Pectasides
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia; Health Data Specialists Ltd, Athens, Greece
| | - G Fountzilas
- Hellenic Cooperative Oncology Group (HeCOG), Athens, Greece; Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia; Health Data Specialists Ltd, Athens, Greece
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Koutsoukos K, Zagouri F, Tzannis K, Karavasilis V, Samantas E, Aravantinos G, Koutras A, Gkerzelis I, Chamylos E, Kostouros E, Lykka M, Tsironis G, Dimitriadis I, Liontos M, Fountzilas G, Dimopoulos M, Bamias A. Efficacy and safety of the combination of bevacizumab (BEV) and temsirolimus (TEM) in patients with metastatic renal cancer (mRCC) after first-line anti-VEGF treatment: A Hellenic Cooperative Oncology group (HeCOG) phase II trial. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw373.51] [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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Liontos M, Gavalas N, Tzanis K, Trachana SP, Kostouros E, Zagouri F, Koutsoukos K, Lykka M, Tsironis G, Dimitriadis I, Terpos E, Dimopoulos M, Bamias A. Prognostic and predictive significance of VEGF and TNF&agr; levels in ascites of patients with epithelial ovarian cancer. Correlation with lymphocytes subpopulations. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw374.16] [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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32
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Fountzila E, Kotoula V, Zagouri F, Giannoulatou E, Kouvatseas G, Pentheroudakis G, Koletsa T, Bobos M, Papadopoulou K, Samantas E, Demiri E, Miliaras S, Christodoulou C, Chrisafi S, Razis E, Fostira F, Pectasides D, Zografos G, Fountzilas G. Patient-private disease evolution and heterogeneity in bilateral breast cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw364.38] [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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Trillsch F, Mahner S, Hilpert F, Davies L, García-Martínez E, Kristensen G, Savarese A, Vuylsteke P, Los M, Zagouri F, Gladieff L, Sehouli J, Khoon Lee C, Gebski V, Pujade-Lauraine E. Prognostic and predictive effects of primary versus secondary platinum resistance for bevacizumab treatment for platinum-resistant ovarian cancer in the AURELIA trial. Ann Oncol 2016; 27:1733-9. [PMID: 27287207 DOI: 10.1093/annonc/mdw236] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 05/31/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Progression-free survival (PFS), objective response rate (ORR), and patient-reported outcomes (PROs) were significantly improved by adding bevacizumab to chemotherapy for platinum-resistant ovarian cancer (PROC) in the phase III AURELIA trial. We explored treatment outcomes according to primary platinum resistance (PPR) versus secondary platinum resistance (SPR). PATIENTS AND METHODS Patients were categorized as PPR (disease progression <6 months after completing first-line platinum therapy) or SPR (progression ≥6 months after first platinum but <6 months after second). The exploratory Cox and logistic regression analyses correlated PFS, ORR, overall survival (OS), and PROs with the time to development of platinum resistance. RESULTS Baseline characteristics were similar in patients with PPR (n = 262; 73%) and SPR (n = 99; 27%), although ascites were more common in the PPR subgroup. In bevacizumab-treated patients (n = 179), SPR was associated with improved PFS (median 10.2 versus 5.6 months in PPR patients; P < 0.001) and OS (median 22.2 versus 13.7 months, respectively; P < 0.001) but not PROs (22% versus 22% with improved abdominal/gastrointestinal symptoms at week 8/9). In multivariate analyses, SPR remained an independent prognostic factor for better PFS [adjusted hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.25-0.67; P < 0.001] and OS (HR 0.49, 95% CI 0.30-0.80; P = 0.005) in bevacizumab-treated patients, but was not statistically significant for either end point in the chemotherapy-alone subgroup. The magnitude of PFS benefit from bevacizumab appeared greater in SPR than PPR patients (HR 0.30 versus 0.55, respectively; interaction P = 0.07) with a similar direction of effect for OS (interaction P = 0.18). CONCLUSIONS In bevacizumab-treated patients, PFS and OS were more favorable in SPR than PPR patients with equally improved PROs. The PFS and OS benefit from combining bevacizumab with chemotherapy was more pronounced in SPR than PPR PROC. PPR versus SPR should be a stratification factor in future trials evaluating anti-angiogenic therapy for PROC.
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Affiliation(s)
- F Trillsch
- Department of Gynecology and Obstetrics, AGO and University of Munich, Munich Department of Gynecology and Gynecologic Oncology, AGO and University Medical Center Hamburg-Eppendorf, Hamburg
| | - S Mahner
- Department of Gynecology and Obstetrics, AGO and University of Munich, Munich
| | - F Hilpert
- AGO and Onkologisches Therapiezentrum am Krankenhaus Jerusalem, Hamburg, Germany
| | - L Davies
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - E García-Martínez
- Department of Hematology and Medical Oncology, GEICO and University Hospital JM Morales Meseguer, Murcia, Spain
| | - G Kristensen
- Department of Gynecologic Oncology and Institute for Cancer Genetics and Informatics and Institute for Clinical Medicine, NSGO and Oslo University Hospital, University of Oslo, Oslo, Norway
| | - A Savarese
- Department of Medical Oncology '1', MITO and Regina Elena National Cancer Institute, Rome, Italy
| | - P Vuylsteke
- Medical Oncology, BGOG and CHU UCL Namur, Site Sainte Elisabeth, Namur, Belgium
| | - M Los
- Department of Internal Medicine/Oncology, DGOG and St Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - F Zagouri
- Department of Clinical Therapeutics, HECOG and University of Athens, Medical School, Athens, Greece
| | - L Gladieff
- Institut Claudius-Regaud, Departement d'Oncologie Médicale, GINECO and Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - J Sehouli
- Department of Gynecology, AGO and Charité Medical University of Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - C Khoon Lee
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - V Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - E Pujade-Lauraine
- GINECO and Université Paris Descartes, AP-HP, Hôpitaux Universitaires Paris Centre, Site Hôtel Dieu, Oncologie, Paris, France
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Psaltopoulou T, Sergentanis T, Ntanasis-Stathopoulos I, Tzanninis IG, Zagouri F, Karadimitris A. SUN-LB040: Overweight, Obesity and Risk of Non-Hodgkin Lymphoma: A Meta-Analysis of Cohort Studies. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30761-5] [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: 11/15/2022]
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Georgiadou D, Sergentanis T, Sakellariou S, Filippakis G, Zagouri F, Vlachodimitropoulos D, Psaltopoulou T, Lazaris A, Patsouris E, Zografos G. VEGF and Id-1 in pancreatic adenocarcinoma: Prognostic significance and impact on angiogenesis. Eur J Surg Oncol 2014; 40:1331-7. [DOI: 10.1016/j.ejso.2014.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 11/29/2013] [Accepted: 01/04/2014] [Indexed: 12/15/2022] Open
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Kotoula V, Zagouri F, Timotheadou E, Alexopoulou Z, Wirtz R, Lyberopoulou A, Lakis S, Gogas H, Charalambous E, Pentheroudakis G, Pectasides D, Koutras A, Papakostas P, Christodoulou C, Kosmidis P, Kalogeras K, Fountzilas G. Investigating the Clinical Relevance of Genomic Characteristics in Luminal a and B Breast Cancer (Bc). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu327.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Zagouri F, Peroukidis S, Tzannis K, Kouloulias V, Bamias A. Current clinical practice guidelines on chemotherapy and radiotherapy for the treatment of non-metastatic muscle-invasive urothelial cancer: a systematic review and critical evaluation by the Hellenic Genito-Urinary Cancer Group (HGUCG). Crit Rev Oncol Hematol 2014; 93:36-49. [PMID: 25205597 DOI: 10.1016/j.critrevonc.2014.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 06/30/2014] [Accepted: 08/14/2014] [Indexed: 12/15/2022] Open
Abstract
Radical cystectomy is the treatment of choice in localized muscle-invasive urothelial cancer. Nevertheless, relapses are frequent and systemic chemotherapy has been employed in order to reduce this risk. In addition, bladder preservation strategies are appealing. During the last decade, there has been a difficulty in conducting and completing large-scale trials in urothelial cancer. This has resulted in relatively few changes in the existing guidelines. Recent studies have created renewed interest in certain fields, such as the role of chemo-radiotherapy and management of unfit patients. In addition, application of certain guidelines has been limited in everyday practice. We conducted a systematic review of the existing guidelines and recent randomized trials not included in these guidelines, and developed a treatment algorithm, regarding non-surgical therapies for non-metastatic, muscle-invasive urothelial cancer based predominantly on patients' fitness for the available therapeutic modalities.
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Affiliation(s)
- F Zagouri
- Department of Clinical Therapeutics, University of Athens, Athens, Greece
| | - S Peroukidis
- Medical Oncology Department, University of Patras, Rion, Greece
| | - K Tzannis
- Department of Clinical Therapeutics, University of Athens, Athens, Greece
| | - V Kouloulias
- Radiotherapy Department, Attikon University Hospital, Athens, Greece
| | - A Bamias
- Department of Clinical Therapeutics, University of Athens, Athens, Greece.
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Thomakos N, Sotiropoulou M, Zacharakis D, Koutroumpa I, Valla E, Trachana S, Haidopoulos D, Zagouri F, Vlachos G, Rodolakis A. A new suggested pattern-based clinical classification system for endocervical adenocarcinoma. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.170] [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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Koutras AK, Kotoula V, Papadimitriou C, Dionysopoulos D, Zagouri F, Kalofonos HP, Kourea HP, Skarlos DV, Samantas E, Papadopoulou K, Kosmidis P, Pectasides D, Fountzilas G. Vascular endothelial growth factor polymorphisms and clinical outcome in patients with metastatic breast cancer treated with weekly docetaxel. Pharmacogenomics J 2013; 14:248-55. [PMID: 24061601 DOI: 10.1038/tpj.2013.36] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 08/03/2013] [Accepted: 08/15/2013] [Indexed: 11/09/2022]
Abstract
The aim of the study was to evaluate the association of vascular endothelial growth factor (VEGF) genotypes with treatment efficacy in a phase II trial. This study evaluated weekly docetaxel, as first-line treatment for metastatic breast cancer. Existing data from in vitro and animal model experiments suggest that docetaxel at low doses has anti-angiogenic activity. DNA was extracted from blood samples of 86 patients participating in the trial. Genotyping was performed for selected single-nucleotide polymorphisms (SNPs; VEGF-2578, -1498, -1154, and +936). Moreover, due to the highly polymorphic nature of the studied areas, we were able to analyze additional registered SNPs. All candidate genotypes were evaluated for associations with overall survival (OS), progression-free survival (PFS) and response rate. The VEGF-1154 GG genotype was more frequent in patients not responding to treatment compared with responders (42.9% vs 0.0%, P=0.048). Moreover, the VEGF-2578 AA genotype was associated with longer PFS compared with CC (hazard ratio (HR)=0.40; 95% confidence interval (CI) 0.17-0.98; pairwise P=0.0457). Patients with the VEGF-1190 GG genotype demonstrated shorter PFS compared with those with the alternative genotypes (GA and AA) combined (HR=3.85; 95% CI: 1.20-12.50; P=0.0224). In addition, the VEGF-2551/-2534 homozygous del18bp and VEGF-2430/-2425 homozygous ins1bp genotypes were associated with worse PFS compared with no deletion and no insertion, respectively (HR=2.49; 95% CI: 1.02-6.07; pairwise P=0.0442 and HR=2.57; 95% CI: 1.05-6.27; pairwise P=0.0385, respectively). Furthermore, patients with the VEGF-1498 CC genotype exhibited longer median OS compared with those with the alternatives genotypes (CT and TT) combined (HR=0.27; 95% CI: 0.08-0.89; P=0.0311). In multivariate analysis, the VEGF-2578 AA genotype retained its significance (P=0.0220) for PFS. Our results support the association of specific VEGF genotypes with clinical outcome in patients with metastatic breast cancer treated with a potentially anti-angiogenic regimen, such as weekly docetaxel. However, current results should be validated prospectively in larger cohorts.
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Affiliation(s)
- A K Koutras
- Division of Oncology, Department of Medicine, University Hospital, University of Patras Medical School, Patras, Greece
| | - V Kotoula
- Department of Pathology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - C Papadimitriou
- Department of Clinical Therapeutics, 'Alexandra' Hospital, University of Athens School of Medicine, Athens, Greece
| | - D Dionysopoulos
- Department of Medical Oncology, 'Papageorgiou' Hospital, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - F Zagouri
- Department of Clinical Therapeutics, 'Alexandra' Hospital, University of Athens School of Medicine, Athens, Greece
| | - H P Kalofonos
- Division of Oncology, Department of Medicine, University Hospital, University of Patras Medical School, Patras, Greece
| | - H P Kourea
- Department of Pathology, University Hospital of Patras, Patras, Greece
| | - D V Skarlos
- Second Department of Medical Oncology, 'Metropolitan' Hospital, Piraeus, Greece
| | - E Samantas
- Third Department of Medical Oncology, 'Agii Anargiri' Cancer Hospital, Athens, Greece
| | - K Papadopoulou
- Department of Pathology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - P Kosmidis
- Second Department of Medical Oncology, Hygeia Hospital, Athens, Greece
| | - D Pectasides
- Oncology Section, Second Department of Internal Medicine, 'Hippokration' Hospital, Athens, Greece
| | - G Fountzilas
- Department of Medical Oncology, 'Papageorgiou' Hospital, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
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40
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Hilpert F, Fabbro M, Rubio MJ, Reuss A, Rosenberg P, Panici PB, Vuylsteke P, Witteveen P, Zagouri F, Pujade-Lauraine E. Symptoms and adverse effects with chemotherapy±bevacizumab for platinum-resistant recurrent ovarian cancer: Analysis of the phase III AURELIA trial. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.063] [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: 11/25/2022]
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41
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Zagouri F, Sergentanis TN, Chrysikos D, Zografos E, Rudas M, Steger G, Zografos G, Bartsch R. Fulvestrant and male breast cancer: a case series. Ann Oncol 2013; 24:265-6. [PMID: 23251011 DOI: 10.1093/annonc/mds597] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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42
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Panou M, Kavantzas N, Sergentanis T, Sakellariou S, Agrogiannis G, Chatzipantelis P, Anastasopoulou E, Soranoglou V, Zagouri F, Korkolopoulou P, Patsouris E, Bramis I, Zografos GC. Estimation of maspin's subcellular localization in invasive ductal breast cancer via light microscopy and computerized image analysis: a comparative study. J BUON 2013; 18:342-351. [PMID: 23818344] [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: 06/02/2023]
Abstract
PURPOSE Contradictory results have been reported concerning the role of maspin and its cellular distribution in breast cancer. The purpose of this study was to examine the subcellular localization (nuclear-cytoplasmic) of maspin in breast cancer and to compare the evaluation of maspin immunostaining via light microscopy (LM) to the estimation via computerized image analysis (CIA) system. We also examined correlations between maspin expression and several clinicopathological parameters. METHODS The sample consisted of 48 primary invasive ductal carcinomas (IDC) of the breast. Maspin immunostaining was quantified and graded via LM by two pathologists, separately in the nuclear and cytoplasmic compartments. Total maspin expression was also estimated via CIA system. Univariate non-parametric statistics and stepwise multivariate ordinal logistic regression were performed. RESULTS Both maspin components (nuclear and cytoplasmic) were closely associated with each other (p<0.001). Total maspin score was positively and closely associated with nuclear maspin (p<0.001) and cytoplasmic maspin (p<0.001). Total maspin , nuclear maspin and cytoplasmic maspin did not correlate significantly with either age, grade, T, N and M status, stage, micro vessel density (MVD) (CD34), ki-67, p53, estrogen receptor (ER) and HER-2 status, or with any of the 4 groups of the molecular classification. The only factor that showed a borderline inverse correlation with nuclear maspin (p=0.059) was progesterone receptors (PR) positivity. CONCLUSION The cytoplasmic and nuclear fractions of maspin seem to be closely interwoven. Evidently, both mutually intertwined counterparts were independently reflected upon the total maspin levels measured by CIA. Future studies should ideally encompass all three approaches (nuclear, cytoplasmic, total) adopted herein.
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Affiliation(s)
- M Panou
- 1st Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Azim HA, Michiels S, Zagouri F, Delaloge S, Filipits M, Namer M, Neven P, Symmans WF, Thompson A, André F, Loi S, Swanton C. Utility of prognostic genomic tests in breast cancer practice: The IMPAKT 2012 Working Group Consensus Statement. Ann Oncol 2013; 24:647-54. [PMID: 23337633 DOI: 10.1093/annonc/mds645] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND We critically evaluated the available evidence on genomic tests in breast cancer to define their prognostic ability and likelihood to determine treatment benefit. DESIGN Independent evaluation of six genomic tests [Oncotype Dx™, MammaPrint(®), Genomic Grade Index, PAM50 (ROR-S), Breast Cancer Index, and EndoPredict] was carried out by a panel of experts in three parameters: analytical validity, clinical validity, and clinical utility based on the principles of the EGAPP criteria. PANEL STATEMENTS: The majority of the working group members found the available evidence on the analytical and clinical validity of Oncotype Dx™ and MammaPrint(®) to be convincing. None of the genomic tests demonstrated robust evidence of clinical utility: it was not clear from the current evidence that modifying treatment decisions based on the results of a given genomic test could result in improving clinical outcome. CONCLUSIONS The IMPAKT 2012 Working Group proposed the following recommendations: (i) a need to develop models that integrate clinicopathologic factors along with genomic tests; (ii) demonstration of clinical utility should be made in the context of a prospective randomized trial; and (iii) the creation of registries for patients who are subjected to genomic testing in the daily practice.
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Affiliation(s)
- H A Azim
- Breast Cancer Translational Research Laboratory BCTL, J.C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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Papapanagiotou I, Kalles V, Al-Harethee W, Georgiou G, Matiatou M, Provatopoulou X, Zagouri F, Grigoropoulos P, Liakou P, Zografos G. 82 Pain in Stereotactic Breast Biopsy for Non-palpable Mammographic Lesions – Comparison of Two Biopsy Methods. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70150-8] [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: 10/28/2022]
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Bamias A, Sotiropoulou M, Zagouri F, Trachana P, Sakellariou K, Kostouros E, Kakoyianni K, Rodolakis A, Vlahos G, Haidopoulos D, Thomakos N, Antsaklis A, Dimopoulos MA. Prognostic evaluation of tumour type and other histopathological characteristics in advanced epithelial ovarian cancer, treated with surgery and paclitaxel/carboplatin chemotherapy: cell type is the most useful prognostic factor. Eur J Cancer 2011; 48:1476-83. [PMID: 22047635 DOI: 10.1016/j.ejca.2011.09.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 09/19/2011] [Accepted: 09/27/2011] [Indexed: 10/15/2022]
Abstract
AIM Ovarian carcinomas have been classified into types I and II according to the hypothesised mode of carcinogenesis and molecular characteristics. The prognostic significance of this classification has not been studied. PATIENTS AND METHODS Five hundred and sixty-eight patients with histologically confirmed, ovarian, fallopian tube or peritoneal carcinomas, international federation of gynecology and obstetrics (FIGO) stages IIC-IV, treated with paclitaxel/platinum following cytoreductive surgery, were included in this analysis. Type I included low-grade serous, mucinous, endometrioid and clear-cell and type II high-grade serous, unspecified adenocarcinomas and undifferentiated carcinomas. RESULTS Median overall survival (OS) was 49 months for type I versus 45 for type II (p=0.576). In contrast to type II, there was considerable prognostic heterogeneity among the subtypes included in type I. Cox regression analysis showed that cell-type classification: low-grade serous, mucinous, endometrioid, clear-cell, type II (high-grade serous, unspecified adenocarcinomas, undifferentiated carcinoma) was an independent predictor of survival (respective median OS 121 versus 15 versus 64 versus 29 versus 45 months, p=0.003). On the contrary, histopathological subtype or tumour type (I versus II) did not offer additional prognostic information. CONCLUSION The proposed model of ovarian tumourigenesis does not reflect tumour behaviour in advanced disease. Tumour-cell type is the most relevant histopathological prognostic factor in advanced ovarian cancer treated with platinum/paclitaxel.
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Affiliation(s)
- A Bamias
- Dept. of Clinical Therapeutics, Medical School, University of Athens, Athens, Greece.
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Bamias A, Karadimou A, Soupos N, Sotiropoulou M, Zagouri F, Haidopoulos D, Thomakos N, Rodolakis A, Antsaklis A, Dimopoulos M. Prognostic factors for early-stage epithelial ovarian cancer, treated with adjuvant carboplatin/paclitaxel chemotherapy: A single institution experience. Gynecol Oncol 2011; 123:37-42. [DOI: 10.1016/j.ygyno.2011.06.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 05/19/2011] [Accepted: 06/22/2011] [Indexed: 10/18/2022]
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Bamias A, Karadimou A, Lampaki S, Aravantinos G, Xanthakis I, Papandreou C, Lainakis G, Zagouri F, Soupos N, Kostouros E, Samantas E, Hatzimouratidis C, Konstantinidis C, Deliveliotis C, Pectasides DG, Fountzilas G, Dimopoulos MA. Prospective, randomized phase III study comparing two intensified regimens (methotrexate/vinblastine/doxorubicin hydrochloride/cisplatin [MVAC] versus gemcitabine/cisplatin) in patients with inoperable or recurrent urothelial cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4510] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [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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Zagouri F, Ziogas A, Gavalas N, Tsiatas M, Tsitsilonis O, Politi E, Liakou C, Karadimou A, Arapini K, Terpos E, Dimopoulos MA, Bamias A. The effect of VEGF on T cells from ovarian cancer patients and healthy individuals via VEGF receptor type 2. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e15552] [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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Kastritis E, Zagouri F, Dimopoulos MA, Papadimitriou CA. Carcinomatous meningitis from transitional cell carcinoma of the urinary bladder. J BUON 2011; 16:373-374. [PMID: 21766515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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50
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Zagouri F, Sergentanis T, Nonni A, Chrysikos D, Bletsa G, Flessas I, Lymperi M, Papadimitriou C, Dimopoulos AM, Zografos G. P115 Decreased Hsp90 expression in the continuum of breast lobular lesions. Breast 2011. [DOI: 10.1016/s0960-9776(11)70059-5] [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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