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Freyer G, Martinez-Jañez N, Kukielka-Budny B, Ulanska M, Bourgeois H, Muñoz M, Morales S, Calero JB, Cortesi L, Pintér T, Palácová M, Cherciu N, Petru E, Ettl J, de Almeida C, Villanova G, Raymond R, Minh CTT, Rodrigues A, Cazzaniga ME. Single-agent metronomic versus weekly oral vinorelbine as first-line chemotherapy in patients with HR-positive/HER2-negative advanced breast cancer: The randomized Tempo Breast study. Breast 2024; 74:103681. [PMID: 38377732 PMCID: PMC10891320 DOI: 10.1016/j.breast.2024.103681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/23/2024] [Accepted: 02/08/2024] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Single-agent oral vinorelbine is a standard of care for hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer (ABC) that has progressed on endocrine therapy. Metronomic administration may offer a better balance of efficacy and safety than standard regimens, but data from previous trials are scarce. METHODS In this open-label, multicenter, phase II trial, patients were randomized to oral vinorelbine administered on a metronomic (50 mg three times weekly) or weekly (60 mg/m2 in cycle 1, increasing to 80 mg/m2 if well tolerated) schedule. Treatment was continued until disease progression or intolerance. The primary endpoint was disease control rate (DCR, the proportion of patients with a best overall confirmed response of CR, PR, or stable disease lasting 6 months or more). RESULTS One-hundred sixty-three patients were randomized and treated. The DCR was 63.4% (95% confidence interval [CI]: 52.0-73.8) with metronomic vinorelbine and 72.8% (95% CI: 61.8-82.1) with weekly vinorelbine. Weekly vinorelbine was also associated with longer progression-free survival (5.6 vs 4.0 months) and overall survival (26.7 vs 22.3 months) than metronomic vinorelbine, but was associated with more adverse events. CONCLUSIONS In this randomized phase II trial, single-agent metronomic oral vinorelbine was effective and well tolerated as first-line chemotherapy for patients with HR-positive/HER2-negative ABC. Formal comparisons are not done in this phase II study and one can simply observe that confidence intervals of all endpoints overlap. When deciding for a chemotherapy after failure of endocrine therapy and CDK 4/6 inhibitors, oral vinorelbine might be an option to be given with either schedule. CLINICAL TRIAL REGISTRATION NUMBER EudraCT 2014-003860-19.
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Affiliation(s)
- Gilles Freyer
- Medical Oncology Department, Institut de Cancérologie des HCL, 165 chemin du Grand Revoyet, 69495 Pierre-Bénite & Université de Lyon, Lyon, France.
| | - Noelia Martinez-Jañez
- Oncology Department, Hospital Universitario Ramón y Cajal, Carretera De Colmenar Viejo km. 9,1, 28034 Madrid, Spain.
| | - Bożena Kukielka-Budny
- Oncology Department, Centrum Onkologii Ziemi Lubelskiej, Ul. Jaczewskiego 7, 20-090 Lublin, Poland.
| | - Malgorzata Ulanska
- Oncology Department, Centrum Terapii Wspolczesnej, Ul. Kopcinskiego 21, 90-242 Łódź, Poland.
| | - Hugues Bourgeois
- Oncology Department, Centre Jean-Bernard, 9 rue Beauverger, 72015 Le Mans, France.
| | - Montserrat Muñoz
- Oncology Department, Hospital Clinic i Provincial de Barcelona, 170 Esc.2, pl. 5(a), 08036 Barcelona, Spain.
| | - Serafin Morales
- Oncology Department, Hospital Universitario Arnau De Vilanova, Avenida Alcalde Rovira Roure, 80, 25198 Lleida, Spain.
| | - Juan Bayo Calero
- Oncology Department, Hospital Juan Ramón Jiménez, C/ Ronda Norte, s/n, 21005 Huelva, Spain.
| | - Laura Cortesi
- Hematology and Oncology Department, AOU Policlinico di Modena, Via del Pozzo, 71, 41125 Modena, Italy.
| | - Tamás Pintér
- Oncology Department, Petz Aladár County Hospital, Vasvári Pál u. 2-4, 9024 Győr, Hungary.
| | - Markéta Palácová
- Oncology Department, Masakikuv Oncologicky Ustav, Zluty Kopek 7, 656 53 Brno, Czech Republic.
| | - Nelli Cherciu
- Oncology Department, SC Oncolab SRL, Str. Bujorului, Nr. 7, 200385 Craiova, Romania.
| | - Edgar Petru
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz, 15, 8036 Graz, Austria.
| | - Johannes Ettl
- Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany.
| | - Cécilia de Almeida
- Pierre Fabre Medicament, Medical & Patient/Consumer Department, 33 Av. Emile Zola, 92100 Boulogne Billancourt, France.
| | - Gustavo Villanova
- Pierre Fabre Medicament, Medical & Patient/Consumer Department, 33 Av. Emile Zola, 92100 Boulogne Billancourt, France.
| | - Romain Raymond
- Pierre Fabre Medicament, Medical & Patient/Consumer Department, 33 Av. Emile Zola, 92100 Boulogne Billancourt, France.
| | - Christine Ta Thanh Minh
- Pierre Fabre Medicament, Medical & Patient/Consumer Department, 33 Av. Emile Zola, 92100 Boulogne Billancourt, France.
| | - Ana Rodrigues
- Oncology Department, Instituto Portugues de Oncologia do Porto Francisco Gentil, EPE, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal.
| | - Marina E Cazzaniga
- Phase 1 Clinical Research Unit, ASST Monza, via Pergolesi 33, 20052 Monza, Italy; Medical Oncology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milan, Italy.
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Senín LD, Pancorbo DM, Garcés MYR, Santos-Rubio MD, Calero JB. Relationship between Medication-Related Osteonecrosis of the Jaw and CDK4/6 Inhibitors in Breast Cancer. Curr Oncol 2024; 31:250-259. [PMID: 38248101 PMCID: PMC10814865 DOI: 10.3390/curroncol31010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/07/2023] [Accepted: 12/30/2023] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVE We aimed to evaluate the use of CDK4/6 inhibitors as a risk factor for medication-related osteonecrosis of the jaw (MRONJ) in a cohort of patients with metastatic breast cancer treated with denosumab. METHODS This was a multicentre, retrospective, observational study. All patients with breast cancer treated with denosumab (January 2011-December 2022) were included. The relationship between CDK4/6 inhibitors and MRONJ was analysed. RESULTS A total of 243 patients were included, ninety-five (44.2%) of whom used a CDK4/6 inhibitor. There were 21 patients with MRONJ. In patients treated with denosumab without CDK4/6 inhibitors, the incidence of MRONJ and mean time to the occurrence of MRONJ were 6.6% (8/120) and 16.8 months (SD 7.8), respectively; in patients treated with denosumab and CDK4/6 inhibitor, these values were 13.7% (13/95) and 15.4 months (SD 8.7), respectively. The difference in the incidence was not significant (p = 0.085). Among the 19 patients who used abemaciclib, the probability of MRONJ occurrence was significantly higher compared to patients not using CDK4/6 inhibitors (p = 0.0178). CONCLUSIONS These results suggest that the incidence of MRONJ in patients with metastatic breast cancer treated with denosumab is higher, and the onset of MRONJ occurs earlier in the presence of CDK4/6 inhibitors. The differences were statistically significant in the patients who used abemaciclib. Given that the use of this combination is very common in routine clinical practice, it would be advisable to carry out larger prospective studies to clarify the risk of this association.
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Affiliation(s)
| | - David Morales Pancorbo
- Department of Medical Oncology, Juan Ramón Jiménez University Hospital, 21005 Huelva, Spain; (D.M.P.)
| | | | | | - Juan Bayo Calero
- Department of Medical Oncology, Juan Ramón Jiménez University Hospital, 21005 Huelva, Spain; (D.M.P.)
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Domínguez Senín L, Rodriguez Garcés MY, Aviñó Tarazona V, Amor Urbano M, Santos-Rubio MD, Bayo Calero J. Analysis of neutropenia as a predictive factor of the efficacy of trifluridine-tipiracil treatment. Int J Clin Pharmacol Ther 2023; 61:346-353. [PMID: 37288835 DOI: 10.5414/cp204410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVES Trifluridine-tipiracil (TAS-102), an oral cytotoxic agent used in adult patients with refractory metastatic colorectal cancer (mCRC), has been associated with neutropenia (chemotherapy-induced neutropenia) (CIN)). MATERIALS AND METHODS We evaluated the efficacy and safety of TAS-102 in a group of 45 mCRC patients (median age 66 years) in Huelva province, Spain, in a retrospective, multicenter observational study. RESULTS We showed that the association between TAS-102 and CIN can be used as a predictor of efficacy. 20% (9/45) of patients with an Eastern Cooperative Oncology Group (ECOG) score of 2 had received at least one previous chemotherapy treatment. Overall, 75.5% (34/45) and 28.9% (13/45) had received anti-VEGF and anti-EGFR monoclonal antibodies, respectively. Additionally, 80% (36/45) of patients had received third-line treatment. The mean treatment period, duration of overall survival (OS), and duration of progression-free survival (PFS) were 3.4, 12, and 4 months, respectively. A partial response was seen in 2 patients (4.3%), and disease stabilization was observed in 10 patients (21.3%). Neutropenia was the most frequent grade 3 - 4 toxicity (46.7%; 21/45). Other findings were anemia (77.8%; 35/45), all grades of neutropenia (73.3%; 33/45), and gastrointestinal toxicity (53.3%; 24/45). The dose of TAS-102 needed to be reduced in 68.9% (31/45) of patients, whereas treatment needed to be interrupted in 80% (36/45) of patients. Grade 3 - 4 neutropenia was a positive prognostic factor for OS (p = 0.023). CONCLUSION A retrospective evaluation shows that grade 3 - 4 neutropenia is an independent predictor of treatment response and survival in patients undergoing routine treatment for mCRC, but this finding needs confirmation in a prospective study.
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Padilla Garrido N, Aguado Correa F, Bayo Lozano E, Bayo Calero J, Ortega Moreno M. [Physicians' awareness and assessment of shared decision making in oncology practice.]. Rev Esp Salud Publica 2019; 93:e201910066. [PMID: 31594916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/07/2019] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE Implementation of Shared Decision Making (SDM) in oncology is limited. The objective of the study was to determine the extent of physicians' awareness of Shared Decision Making (SDM) in their treatment of cancer patients, the usefulness that they assign to SDM, the role they play, their assessment of SDM, and perceptions of the main barriers and facilitators to its use. METHODS A questionnaire was completed by medical oncologists, radiation oncologists and general surgeons working in Andalusia (Spain). Sociodemographic, clinical-care and aspects of SDM variables were collected. SDM was evaluated using the SDM-Q-Doc questionnaire. Non-parametric contrasts were used to determine the possible differences between medical specialties. RESULTS The questionnaire was sent to 351 physicians. The response rate was 37.04%, 63 women and 67 men, with an average age of 45.6 years and 18.04 years' experience. Of these, 33.08% were medical oncologists, 34.61% radiation oncologists and 29.23% general surgeons. A total of 82.3% stated they had received no training in SDM, whereas 33.8% said they knew a lot about SDM and applied it in practice; 80% considered it to be very useful. In addition, 60% of respondents said they were mainly the ones who made the decisions on treatment. An evaluation of SDM on the SDM-Q-Doc scale showed that all the specialities scored more than 80/100. The main barriers to applying SDM were the difficulty patients experienced in understanding what they needed to know, the lack of decision aids and time. CONCLUSIONS Some 82% of physicians have no training in SDM and 66% don´t use it in practice, with decisions on treatment taken mainly by the physicians themselves. Strategies to increase training in SDM and to implement it into clinical practice are important.
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Affiliation(s)
- Nuria Padilla Garrido
- Departamento de Métodos Cuantitativos para la Economía y la Empresa, Estadística e Investigación Operativa. Universidad de Huelva. Huelva. España
| | - Francisco Aguado Correa
- Departamento de Economía Financiera, Contabilidad y Dirección de Operaciones. Universidad de Huelva. Huelva. España
| | - Eloísa Bayo Lozano
- Servicio de Oncología Radioterápica. Hospital Juan Ramón Jiménez. Huelva. España
| | - Juan Bayo Calero
- Servicio de Oncología Médica. Hospital Juan Ramón Jiménez. Huelva. España
| | - Mónica Ortega Moreno
- Departamento de Métodos Cuantitativos para la Economía y la Empresa, Estadística e Investigación Operativa. Universidad de Huelva. Huelva. España
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Bolaños Naranjo M, Aviñó Tarazona V, Jiménez Ruiz FJ, Bayo Calero J. [Analysis of non-scheduled consultations in patients with digestive neoplasms]. Rev Esp Salud Publica 2019; 93:e201907049. [PMID: 31346155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 07/10/2019] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE Non-scheduled consultation is very frequent among patients with cancer, creating alterations and delays in programmed visits. We describe the incidence of non-scheduled consultations in patients with digestive cancer in our hospital. METHODS Descriptive, prospective, non-interventional study. In a six-month period (May-December 2017), non-scheduled visits were chronologically recorded in the medical oncology consultation of digestive tumours of Hospital Juan Ramón Jiménez de Huelva. We performed a descriptive analysis of the variables collected through the statistical program G-STAT v.2.0. RESULTS Patients with colon or rectal cancer generated most consultations (68.63%). followed by pancreatic (9.15%) and gastric (5.23%). Most patients had metastatic or advanced stage cancer (59.87%) and were under palliative or symptomatic treatment (58.82%). The most frequent reason for consultation was clinical symptoms (47.05%). followed by information demand (18.30 %). CONCLUSIONS Non-scheduled consultations in cancer patients are frequent; they cause interference in scheduled consultations and not always resolved satisfactorily. We propose several measures to reduce the number of non-scheduled consultation in oncology.
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Affiliation(s)
| | | | | | - Juan Bayo Calero
- Servicio de Oncología Médica. Hospital "Juan Ramón Jiménez". Huelva. España
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Bayo Calero J, Aviñó Tarazona V. A rapid response to pembrolizumab in a patient with metastatic melanoma. Immunotherapy 2017; 9:225-228. [PMID: 28231724 DOI: 10.2217/imt-2016-0136] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Prognosis for patients with metastatic melanoma stays poor. Recent advances in the field of immuno-oncology increased treatment options for these patients and gave chances for obtaining partial and even complete response, prolonging survival in a subset of patients. Here, we describe a case of a 55-year-old man with multiple melanoma metastases into lungs who showed an extraordinary response to pembrolizumab used as a first-line treatment. The therapy was well tolerated, with no adverse reactions reported.
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Affiliation(s)
- Juan Bayo Calero
- Oncology Department, Huelva Hospital Complex, Ronda Exterior Norte, w/n, 21005 Huelva, Spain
| | - Victoria Aviñó Tarazona
- Oncology Department, Huelva Hospital Complex, Ronda Exterior Norte, w/n, 21005 Huelva, Spain
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