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Martín-Villares C, Álvarez-Tato C, Díez-González L, Rodríguez A, Fernández-Cascón S, Manzanares-López-Rendo C, Álvarez-Álvarez I. Epidemiología de la Parálisis Facial durante la Pandemia COVID-19 en el Complejo Asistencial Universitario de León. ORL 2023. [DOI: 10.14201/orl.29028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Introducción y objetivo: Están surgiendo en la literatura diferentes series clínicas sobre la prevalencia de la parálisis facial (PF) en la pandemia. Algunos investigadores sugieren un vínculo entre la parálisis facial y el SARS-CoV-2, aunque otros autores no encuentran diferencias significativas en la incidencia de parálisis facial coincidiendo con PCR-SARS-CoV-2 positiva. Tras dos años de la pandemia de COVID-19, sigue sin estar claro atribuir al virus SARS-CoV-2 un aumento de la incidencia de casos de PF.Método: Presentamos los resultados de las investigaciones sobre la incidencia de PF durante la pandemia de COVID-19 en una población de más de 350.000 personas en una única institución del norte de España. Nuestra investigación se centra en algunos aspectos epidemiológicos de la distribución temporal de los casos de PF durante las ondas pandémicas. Revisamos los casos de PF durante 2018-21 y calculamos la incidencia bruta anual. También recolectamos 7 pacientes a los que se les realizó la prueba de SARS-CoV-2 por PCR en hisopo nasal. Finalmente, exploró la posibilidad de grupos de PF alrededor de los "picos" de la pandemia de COVID-19 según los datos del Ministerio de Salud de España sobre la incidencia acumulada de 14 días de casos positivos de COVID-19 por cada 100,000 habitantes.Resultados: Recogimos 209 pacientes que desarrollaron PA entre el 1 de marzo de 2020 y el 30 de mayo de 2021. Los clasificamos según las 4 ondas pandémicas de incidencia acumulada de 14 días de SARS-CoV-2 por 100.000 habitantes en España. Un número similar de casos de PF fueron diagnosticados a lo largo de toda la pandemia, sin identificarse “clusters” de PF durante las “olas” o los “picos”. En base a esta distribución uniforme de casos durante los 14 meses de pandemia, concluimos que no hemos encontrado un aumento de la incidencia de casos de BP en relación al aumento de la incidencia acumulada de contagio por virus SARS-CoV-2 en nuestra población. La incidencia bruta anual de PF fue: 34 por 100.000 personas-año en 2018, 30 por 100.000 personas-año en 2019, 31 por 100.000 personas-año en 2020 y 29 por 100.000 personas-año en 2021. A 7 pacientes se les realizó la prueba de SARS-CoV-2 por PCR en hisopo nasal coincidiendo con el episodio de PF, pero solo 2 resultaron positivos. Discusión y Conclusiones: Tras detectar una distribución uniforme de casos durante los 14 meses de pandemia, concluimos que no hemos encontrado un aumento de la incidencia de casos de BP en relación al aumento de la incidencia acumulada de contagio por virus SARS-CoV-2 en nuestra población.
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Martín-Villares C, Díez-González L, Martín-Sigüenza G, Rodríguez A, Ramírez JE, Álvarez-Álvarez I. Pólipos nasales, cirugía de revisión e inflamación eosinofílica. ORL 2023. [DOI: 10.14201/orl.29027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Introducción y objetivo: El tratamiento de la poliposis nasal son los corticoides, y si fallan, la cirugía. Sin embargo, muchos pacientes necesitan cirugías sucesivas, por lo que necesitan mejores tratamientos La investigación básica sobre respuesta inmune inflamatoria tipo 2 en mucosa rinosinusal nos ofrece la posibilidad de bloquear la reacción inflamatoria inmunomediada en la mucosa de pacientes con poliposis nasal. Disponemos de anticuerpos monoclonales capaces de bloquear inmunoglobulinas Il-4 e Il-13, Il-5 y eosinófilos e IgE en la mucosa nasal. Dada la asociación entre pólipos nasales e inflamación tipo 2 en el 85% de los pacientes, el conocimiento sobre eosinófilos y terapias biológicas podría cambiar el manejo de las recurrencias de pólipos y podría evitar procedimientos sucesivos o cirugías radicales.Método: Revisamos una cohorte retrospectiva de pacientes sometidos a CENS en nuestro Departamento entre el 1 de enero de 2016 y el 30 de diciembre de 2020, con más de un año de seguimiento. Todos los procedimientos quirúrgicos se realizaron con la técnica descrita por Stammberger: se respetó la mucosa sana y se abrieron todas las cavidades sinusales patológicas. Las muestras de tejido quirúrgico se tiñeron con hematoxilina-eoxilina y se realizó la identificación de eosinófilos. Se investigó la tasa de cirugía de revisión quirúrgica. Finalmente, se comunica los datos de nuestra experiencia preliminar en productos biológicos para pacientes con pólipos nasales. Resultados: La tasa global de cirugía de revisión fue del 18%. Se realizó recuento de eosinófilos en 157 pacientes con pólipos nasales. De ellos, el 71% (n=111) presentó un recuento elevado de eosinófilos en las piezas quirúrgicas. Los pacientes con pólipos nasales y un recuento elevado de eosinófilos tuvieron una Tasa de Revisión Quirúrgica del 34,2% (38/111). Si los eosinófilos no estaban elevados en el tejido polipoideo, la Tasa de Revisión Quirúrgica fue del 16,6% (8/48), con diferencias significativas en la prueba de Chi-cuadrado (p=0,0125). La comparación de pacientes con alto recuento de eosinófilos en la mucosa reveló un OR de 3,2117 (IC95% 1,2440-8,2918). Se administra terapia biológica en 5 pacientes con asma grave mal controlada con corticoides y beta agonistas. A pesar del corto seguimiento, hasta la fecha no hemos reintervenido paciente tras biológicos.Discusión y Conclusiones: Muchos pacientes con pólipos nasales necesitan cirugías sucesivas, por lo que necesitan un mejor tratamiento. Es importante considerar los factores específicos del paciente que afectan las tasas de cirugía de revisión, como el recuento elevado de eosinófilos, para encontrar mejores tratamientos. Las terapias biológicas pueden cambiar el manejo de las recurrencias de pólipos y podrían evitar procedimientos sucesivos o cirugías radicales en estos pacientes de alto riesgo.
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Álvarez-Álvarez I, Martín-Villares C, Rodríguez-García A, Fernández-Cascón S, Ballesteros-Pomar M, Pérez-Herrero C, Díez-González L. Intento autolitico con herida cervical en paciente COVID. ORL 2023. [DOI: 10.14201/orl.29065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Introducción y objetivo: La pandemia Covid ha provocado, además del ingente número de infectados con secuelas y fallecidos, una crisis económica de severas repercusiones que, sumada a las limitaciones en términos de interacción social en los periodos de confinamiento, puede desencadenar o acentuar patologías psiquiátricas en algunas personas. La máxima expresión de alguno de estos trastornos es el suicidio, como en el caso que presentamos.
Método: Varón de 55 años con antecedente depresivo en 2008 que fue resuelto con medicación y apoyo psicológico. Como consecuencia del cierre de su negocio por la pandemia, sumado a problemas familiares, sufre una recaída en su ánimo depresivo, lo que le lleva (septiembre 2020) a intentar quitarse la vida provocándose graves lesiones craneales por golpes y varias heridas en las muñecas y el cuello con un cuchillo de grandes dimensiones. Se desconocían sus antecedentes y que estaba infectado por Covid, dato que fue comprobado en la PCR de cribado cuando ya estaba en el quirófano.
Al ingreso comprobamos la presencia de un cuchillo de grandes dimensiones (18 X3 cm de hoja) profundamente clavado en el lado izquierdo del cuello, desde en nivel del tiroides al cóndilo occipital, así como otras heridas incisas en ambas muñecas y lado derecho del cuello, y un extenso scalp por heridas inciso contusas craneales, que no provocaron fracturas.
Tras una TC urgente es trasladado al quirófano, y se practicó una traqueotomía reglada y se extrajo el cuchillo, que atravesaba la faringe y el suelo de la boca y se alojaba en el cóndilo occipital izquierdo, y se revisaron y suturaron todas las heridas y espacios cervicales seccionados
12 días después es dado de alta en UCI y trasladado a la planta de Psiquiatría por empeoramiento. Tras 2 meses de ingreso fue dado de alta.
Discusión: Se presenta este caso de grave episodio psiquiátrico con intento autolítico que precisó cirugía cervical urgente, para ilustrar alguno de los efectos colaterales de la pandemia Covid que, de forma tangencial, precisó nuestra atención como cirujanos de cabeza y cuello.
Conclusiones: La pandemia Covid, está provocando también un afloramiento y agravamiento de trastornos psiquiátricos, que está llevando a algunos pacientes a la decisión de suicidarse.
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Martín-Villares C, Álvarez-Tato C, Díez-González L, Rodríguez A, Fernandez-Cascón S, Manzanares-López-Rendo C, Álvarez-Álvarez I. Parálisis de Bell tras vacuna de la Influenza en un niño de 8 años. ORL 2023. [DOI: 10.14201/orl.29052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Introducción y objetivo: Durante la campaña de vacunación contra la influenza pandémica A (H1N1) en 2009, el riesgo relativo de parálisis de Bell (PA) después de la vacunación aumentó significativamente. Ahora, durante la pandemia de SARS-CoV-2, los datos de los ensayos de la vacuna SARS-CoV-2 Pfizer-BioNTech y Moderna sugieren un desequilibrio en la incidencia de BP después de la vacunación (siete casos) en comparación con el grupo placebo (un caso). Las agencias nacionales de farmacovigilancia señalaron que no se puede excluir una relación causal entre las vacunas y la PA y, en consecuencia, recomendaron una farmacovigilancia estricta para la PA después de la vacunación en grandes poblaciones.Método: Caso clínico y revisión de base de datos europea EudraVigilance sobre parálisis facial y parálisis de Bell en niños y niñas de 3 a 11 años.Resultados: CASO CLINICO: En diciembre de 2021, tuvimos la oportunidad de tratar a un niño de 8 años que desarrolló una parálisis facial derecha después de la vacuna contra la influenza. El 30 de noviembre de 2021, nuestro paciente recibió su primera dosis de la vacuna Vaxigrip Tetra. El 28 de diciembre de 2021, nuestro paciente recibió su segunda dosis de la vacuna VaxigripTetra. El 29 de diciembre de 2021 (24 horas) desarrolló dolor facial derecho con parálisis facial grado III de House-Brackmann. La prueba de PCR SARS-CoV-2 fue negativa en hisopado nasal, y la IgG SARS-CoV-2 también fue negativa. Se prescribió deflazacort (1,5 ml/Kg/día)y soporte ocular. La parálisis facial comenzó a mejorar cuatro días después y se logró la recuperación total.REVISION DE LA BASE DE DATOS EUDRAVIGILACE: Revisamos el informe de la base de datos europea de parálisis facial o parálisis de Bell para pacientes de 3 a 11 años, buscando pacientes similares entre 2021 y 2022. Recolectamos 53 pacientes con parálisis facial después de medicamentos o vacunas entre 2021-2022. De ellos, 41 pacientes con parálisis facial se desarrollaron después de las vacunas: 17 vacuna COVID-19, 8 influenza (5 vacuna pandémica H1Vi) y 5 vacuna Virus del Papiloma.Discusión y Conclusiones: Los datos de Eudravigilance sugieren que las vacunas desempeñan un papel en la etiopatogenia de la parálisis de Bell. De 53 niños que desarrollaron una parálisis facial después de un medicamento o una vacuna en los últimos diez años, el 77 % se desarrolló después de la vacunación. En esta campaña de vacunación contra la pandemia COVID-19, el otorrinolaringólogo debe estar alerta sobre estas patologías nerviosas en la población pediátrica.
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Díez-González L, Poncela-Blanco M, Mayo-Yáñez M. Rhinosinusal myiasis by Oestrus ovis third stage larva. Med Clin (Barc) 2020; 155:566-567. [PMID: 31767128 DOI: 10.1016/j.medcli.2019.09.010] [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: 07/25/2019] [Revised: 08/21/2019] [Accepted: 09/05/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Laura Díez-González
- Otorhinolaryngology - Head and Neck Surgery Department, Complejo Hospitalario de Palencia, 34005 Palencia, Castilla y León, Spain
| | - María Poncela-Blanco
- Otorhinolaryngology - Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006 A Coruña, Galicia, Spain
| | - Miguel Mayo-Yáñez
- Otorhinolaryngology - Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006 A Coruña, Galicia, Spain; Clinical Research in Medicine, International Center for Doctorate and Advanced Studies (CIEDUS), Universidade de Santiago de Compostela (USC), 15782 Santiago de Compostela, Galicia, Spain.
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Tibau A, Díez-González L, Navarro B, Galán-Moya EM, Templeton AJ, Seruga B, Pandiella A, Amir E, Ocana A. Impact of Availability of Companion Diagnostics on the Clinical Development of Anticancer Drugs. Mol Diagn Ther 2018; 21:337-343. [PMID: 28247182 DOI: 10.1007/s40291-017-0267-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Companion diagnostics permit the selection of patients likely to respond to targeted anticancer drugs; however, it is unclear if the drug development process differs between drugs developed with or without companion diagnostics. Identification of differences in study design could help future clinical development. PATIENTS AND METHODS Anticancer drugs approved for use in solid tumors between 28 September 2000 and 4 January 2014 were identified using a search of the US FDA website. Phase III trials supporting registration were extracted from the drug label. Each published study was reviewed to obtain information about the phase I and II trials used for the development of the respective drug. RESULTS We identified 35 drugs and 59 phase III randomized trials supporting regulatory approval. Fifty-three phase I trials and 47 phase II trials were cited in the studies and were used to support the design of these phase III trials. The approval of drugs using a companion diagnostic has increased over time (p for trend 0.01). Expansion cohorts were more frequently observed with drugs developed with a companion diagnostic (62 vs. 20%; p = 0.005). No differences between drugs developed with or without a companion diagnostic were observed for the design of phase I and II studies. CONCLUSIONS The approval of drugs developed with a companion diagnostic has increased over time. The availability of a companion diagnostic was associated with more frequent use of phase I expansion cohorts comprising patients selected by the companion diagnostic.
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Affiliation(s)
| | - Laura Díez-González
- Translational Research Unit, CIBERONC, Albacete University Hospital, Albacete, Spain
| | - Beatriz Navarro
- Clinical Research Support Unit, Albacete University Hospital, Albacete and Fundación Hospital Nacional de Paraplejicos, Toledo, Spain
| | - Eva M Galán-Moya
- Translational Research Unit, CIBERONC, Albacete University Hospital, Albacete, Spain
| | - Arnoud J Templeton
- Department of Medical Oncology and Hematology, St. Claraspital, Basel, Switzerland
| | - Bostjan Seruga
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Eitan Amir
- Divisions of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Alberto Ocana
- Translational Research Unit, CIBERONC, Albacete University Hospital, Albacete, Spain. .,Medical Oncology Department and Translational Research Unit, Albacete University Hospital, Edificio de Investigación, Calle Francisco Javier de Moya, 02006, Albacete, Spain. .,Regional Biomedical Research Center (CRIB), Castilla La Mancha University, Albacete, Spain.
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Ocaña A, Díez-González L, Esparís-Ogando A, Montero JC, Amir E, Pandiella A. Neuregulin expression in solid tumors: prognostic value and predictive role to anti-HER3 therapies. Oncotarget 2018; 7:45042-45051. [PMID: 27074567 PMCID: PMC5216704 DOI: 10.18632/oncotarget.8648] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 02/20/2016] [Accepted: 03/28/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Neuregulins (NRG) are a family of epidermal growth factor ligands which act through binding to HER3 and HER4 receptors. NRGs are widely expressed in solid tumors. Their prognostic significance or their role as predictors of benefit from anti-HER3 therapy is not known. RESULTS Of 29 included studies, 7 studies reported the association between NRG and outcome. NRG was most commonly expressed in breast, prostate, colon and bladder cancers. NRG expression was not associated with either OS or PFS (HR: 3.47, 95% CI 0.78-15.47, p = 0.10 and HR: 1.64, 95% CI 0.94-2.86, p = 0.08, respectively). In 4 placebo controlled trials of anti-HER3 therapy, the addition of anti-HER3 antibodies to control therapy in unselected patients was not associated with improved PFS (HR: 0.88, 95% CI 0.75-1.04. p = 0.14). However, in patients with high NRG expression, there was significantly delayed progression (HR: 0.35, 95% CI 0.23-0.52, p < 0.001). Anti-HER3 antibodies were associated with increased risk of diarrhea, nausea and rash. METHODS A search of electronically available databases identified studies exploring clinical outcomes based on NRG expression, as well as placebo-controlled trials of HER3-directed therapy reporting results based on NRG expression status. Data were combined in a meta-analysis using generic inverse variance and random effects modeling for studies reporting the hazard ratio (HR) for overall (OS) or progression-free survival (PFS). Mantel-Haenszel random-effect modeling was used for odds ratio (OR) for 3-year and 5-year OS and PFS. CONCLUSIONS NRG expression is not associated with either OS or PFS, but is a predictor of benefit from anti-HER3 antibodies.
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Affiliation(s)
- Alberto Ocaña
- Translational Research Unit, Albacete University Hospital, Albacete, Spain
| | | | - Azucena Esparís-Ogando
- Cancer Research Center (CIC-IBMCC), CSIC-University of Salamanca, Salamanca, Spain.,IBSAL, Salamanca, Spain
| | - Juan Carlos Montero
- Cancer Research Center (CIC-IBMCC), CSIC-University of Salamanca, Salamanca, Spain
| | - Eitan Amir
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Atanasio Pandiella
- Cancer Research Center (CIC-IBMCC), CSIC-University of Salamanca, Salamanca, Spain
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Adam R, Díez-González L, Ocaña A, Šeruga B, Amir E, Templeton AJ. Prognostic role of telomere length in malignancies: A meta-analysis and meta-regression. Exp Mol Pathol 2017; 102:455-474. [PMID: 28506770 DOI: 10.1016/j.yexmp.2017.05.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 04/18/2017] [Accepted: 05/11/2017] [Indexed: 01/22/2023]
Abstract
Telomere length (TL) has been associated with several health conditions including cancer. To quantify the effect of TL on outcomes in malignancies and explore the role of type of TL measurement we conducted a librarian-led systematic search of electronic databases identified publications exploring the prognostic role of TL on cancer outcomes. Overall survival (OS) was the primary outcome measure while other time-to-event endpoints were secondary outcomes. Data from studies reporting a hazard ratio (HR) with 95% confidence interval (CI) and/or p-value were pooled in a meta-analysis. HRs were weighted by generic inverse variance and computed by random effects modeling. All statistical tests were two-sided. Sixty-one studies comprising a total of 14,720 patients were included of which 41 (67%) reported OS outcomes. Overall, the pooled HR for OS was 0.88 (95%CI=0.69-1.11, p=0.28). Long (versus short) telomeres were associated with improved outcomes in chronic lymphatic leukemia (CLL) and urothelial cancer (HR=0.45, 95%CI=0.29-0.71 and HR=0.68, 95%CI=0.46-1.00, respectively), conversely worse OS was seen with hepatocellular carcinoma (HR=1.90, 95%CI=1.51-2.38). Pooled HRs (95% CI) for progression-free survival, relapse/disease-free survival, cancer-specific survival, and treatment-free survival were 0.56 (0.41-0.76), 0.76 (0.53-1.10), 0.72 (0.48-1.10), and 0.48 (0.39-0.60), respectively. There was substantial heterogeneity of tissues and methods used for TL measurement and no clear association between TL and outcome was identified in subgroups. In conclusion, there is inconsistent effect of TL on cancer outcomes possibly due to variable methods of measurement. Standardization of measurement and reporting of TL is warranted before the prognostic value of TL can be accurately assessed.
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Affiliation(s)
- Roman Adam
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Laura Díez-González
- Traslational Research laboratory, Albacete University Hospital, and Regional Biomedical Research Center, Castilla La Mancha University, Albacete, Spain
| | - Alberto Ocaña
- Traslational Research laboratory, Albacete University Hospital, and Regional Biomedical Research Center, Castilla La Mancha University, Albacete, Spain
| | - Boštjan Šeruga
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Eitan Amir
- Divisions of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Canada
| | - Arnoud J Templeton
- Faculty of Medicine, University of Basel, Basel, Switzerland; Department of Medical Oncology and Hematology, St. Claraspital, Basel, Switzerland.
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Ocana A, Ethier JL, Díez-González L, Corrales-Sánchez V, Srikanthan A, Gascón-Escribano MJ, Templeton AJ, Vera-Badillo F, Seruga B, Niraula S, Pandiella A, Amir E. Influence of companion diagnostics on efficacy and safety of targeted anti-cancer drugs: systematic review and meta-analyses. Oncotarget 2016; 6:39538-49. [PMID: 26446908 PMCID: PMC4741844 DOI: 10.18632/oncotarget.5946] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 08/01/2015] [Accepted: 09/06/2015] [Indexed: 12/31/2022] Open
Abstract
Background Companion diagnostics aim to identify patients that will respond to targeted therapies, therefore increasing the clinical efficacy of such drugs. Less is known about their influence on safety and tolerability of targeted anti-cancer agents. Methods and findings Randomized trials evaluating targeted agents for solid tumors approved by the US Food and Drug Administration since year 2000 were assessed. Odds ratios (OR) and and 95% confidence intervals (CI) were computed for treatment-related death, treatment-discontinuation related to toxicity and occurrence of any grade 3/4 adverse events (AEs). The 12 most commonly reported individual AEs were also explored. ORs were pooled in a meta-analysis. Analysis comprised 41 trials evaluating 28 targeted agents. Seventeen trials (41%) utilized companion diagnostics. Compared to control groups, targeted drugs in experimental arms were associated with increased odds of treatment discontinuation, grade 3/4 AEs, and toxic death irrespective of whether they utilized companion diagnostics or not. Compared to drugs without available companion diagnostics, agents with companion diagnostics had a lower magnitude of increased odds of treatment discontinuation (OR = 1.12 versus 1.65, p < 0.001) and grade 3/4 AEs (OR = 1.09 versus 2.10, p < 0.001), but no difference in risk of toxic death (OR = 1.40 versus 1.27, p = 0.69). Differences between agents with and without companion diagnostics were greatest for diarrhea (OR = 1.29 vs. 2.43, p < 0.001), vomiting (OR = 0.86 vs. 1.44, p = 0.005), cutaneous toxicity (OR = 1.82 vs. 3.88, p < 0.001) and neuropathy (OR = 0.64 vs. 1.60, p < 0.001). Conclusions Targeted drugs with companion diagnostics are associated with improved safety, and tolerability. Differences were most marked for gastrointestinal, cutaneous and neurological toxicity.
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Affiliation(s)
- Alberto Ocana
- Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, Switzerland
| | - Josee-Lyne Ethier
- Department of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Laura Díez-González
- Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, Switzerland
| | | | | | | | - Arnoud J Templeton
- Department of Medical Oncology and Hematology, CancerCare Manitoba and University of Manitoba, Winnipeg, Canada
| | | | - Bostjan Seruga
- Centro de Investigación del Cáncer CIC-CSIC, Universidad de Salamanca, Salamanca, Spain
| | | | | | - Eitan Amir
- Department of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia
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Ocaña A, Pérez-Peña J, Díez-González L, Sánchez-Corrales V, Templeton A, Seruga B, Amir E, Pandiella A. Transcriptomic analyses identify association between mitotic kinases, PDZ-binding kinase and BUB1, and clinical outcome in breast cancer. Breast Cancer Res Treat 2016; 156:1-8. [PMID: 26897635 DOI: 10.1007/s10549-016-3720-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/14/2016] [Indexed: 12/26/2022]
Abstract
Protein kinases are important components in oncogenic transformation of breast cancer. Evaluation of upregulated genes that codify for protein kinases could be used as biomarkers to predict clinical outcome. Gene expression and functional analyses using public datasets were performed to identify differential gene expression and functions in basal-like tumors compared with normal breast tissue. Overall survival (OS) associated with upregulated genes was explored using the KM Plotter online tool. The prognostic influence of these genes in luminal tumors and systemically untreated patients was also assessed. Of the 426 transcripts identified in basal-like tumors, 11 genes that coded for components of protein kinases were upregulated with more than a fourfold change. Regulation of cell cycle was an enriched function containing 10 of these 11 identified genes. Among them, expression of four genes, BUB1β, CDC28, NIMA, and PDZ binding kinase, were all associated with improved OS when using at least one probe in the basal-like subtype. Two genes, BUB1β and PDZ binding kinase, showed consistent association with improved OS irrespective of the gene probe used for the analysis. No association was observed for these genes with relapse-free survival. In contrast, both BUB1β and PDZ binding kinase showed worse OS in luminal tumors and in a cohort of systemically untreated patients. BUB1β and PDZ binding kinase are associated with improved OS in basal-like tumors and worse OS in luminal and untreated patients. The association with a better outcome in basal-like tumors could be due to a more favorable response to chemotherapy.
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Affiliation(s)
- Alberto Ocaña
- Translational Research Unit, Albacete University Hospital, Calle Francisco Javier de Moya, 02006, Albacete, Spain.
| | - Javier Pérez-Peña
- Translational Research Unit, Albacete University Hospital, Calle Francisco Javier de Moya, 02006, Albacete, Spain
| | - Laura Díez-González
- Translational Research Unit, Albacete University Hospital, Calle Francisco Javier de Moya, 02006, Albacete, Spain
| | - Verónica Sánchez-Corrales
- Translational Research Unit, Albacete University Hospital, Calle Francisco Javier de Moya, 02006, Albacete, Spain
| | - Arnoud Templeton
- Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Bostjan Seruga
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Eitan Amir
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
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Ocaña A, Díez-González L, García-Olmo DC, Templeton AJ, Vera-Badillo F, José Escribano M, Serrano-Heras G, Corrales-Sánchez V, Seruga B, Andrés-Pretel F, Pandiella A, Amir E. Circulating DNA and Survival in Solid Tumors. Cancer Epidemiol Biomarkers Prev 2015; 25:399-406. [PMID: 26604269 DOI: 10.1158/1055-9965.epi-15-0893] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 11/04/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The ability to undertake molecular analysis to inform on prognosis and predictors of response to therapy is limited by accessibility of tissue. Measurement of total circulating free DNA (cfDNA) or circulating tumor DNA (ctDNA) in peripheral blood may allow easier access to tumor material and help to predict clinical outcomes. METHODS A systematic review of electronic databases identified publications exploring the association between cfDNA or ctDNA and overall survival (OS) in solid tumors. HRs for OS were extracted from multivariable analyses and included in a meta-analysis. Pooled HRs were computed and weighted using generic inverse variance and random-effect modeling. For studies not reporting multivariable analyses, univariable ORs were estimated from Kaplan-Meier curves for OS at 1 and 3 years. RESULTS Thirty-nine studies comprising 4,052 patients were included in the analysis. Detection of ctDNA was associated with a significantly worse OS in multivariable analyses [HR, 2.70; 95% confidence interval (CI), 2.02-3.61; P < 0.001). Similar results were observed in the univariable analyses at 3 and 1 year (OR, 4.83; 95% CI, 3.20-7.28; P < 0.001).There was also a statistically significant association between high total cfDNA and worse OS for studies reporting multivariable and univariate data at 3 years (HR, 1.91; 95% CI, 1.59-2.29; P < 0.001 and OR, 2.82; 95% CI, 1.93-4.13; P < 0.001, respectively). CONCLUSIONS High levels of total cfDNA and presence of ctDNA are associated with worse survival in solid tumors. IMPACT Circulating DNA is associated with worse outcome in solid tumors.
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Affiliation(s)
- Alberto Ocaña
- Translational Oncology Unit, Albacete University Hospital, Albacete, Spain.
| | | | | | - Arnoud J Templeton
- Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Francisco Vera-Badillo
- Divisions of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Canada
| | | | | | | | - Bostjan Seruga
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | | | - Eitan Amir
- Divisions of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Canada
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