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Alonso N, Menao S, Lastra R, Arruebo M, Bueso MP, Pérez E, Murillo ML, Álvarez M, Alonso A, Rebollar S, Cruellas M, Arribas D, Ramos M, Isla D, Galano-Frutos JJ, García-Cebollada H, Sancho J, Andrés R. Association between missense variants of uncertain significance in the CHEK2 gene and hereditary breast cancer: a cosegregation and bioinformatics analysis. Front Genet 2024; 14:1274108. [PMID: 38476463 PMCID: PMC10927753 DOI: 10.3389/fgene.2023.1274108] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/06/2023] [Indexed: 03/14/2024] Open
Abstract
Inherited mutations in the CHEK2 gene have been associated with an increased lifetime risk of developing breast cancer (BC). We aim to identify in the study population the prevalence of mutations in the CHEK2 gene in diagnosed BC patients, evaluate the phenotypic characteristics of the tumor and family history, and predict the deleteriousness of the variants of uncertain significance (VUS). A genetic study was performed, from May 2016 to April 2020, in 396 patients diagnosed with BC at the University Hospital Lozano Blesa of Zaragoza, Spain. Patients with a genetic variant in the CHEK2 gene were selected for the study. We performed a descriptive analysis of the clinical variables, a bibliographic review of the variants, and a cosegregation study when possible. Moreover, an in-depth bioinformatics analysis of CHEK2 VUS was carried out. We identified nine genetic variants in the CHEK2 gene in 10 patients (two pathogenic variants and seven VUS). This supposes a prevalence of 0.75% and 1.77%, respectively. In all cases, there was a family history of BC in first- and/or second-degree relatives. We carried out a cosegregation study in two families, being positive in one of them. The bioinformatics analyses predicted the pathogenicity of six of the VUS. In conclusion, CHEK2 mutations have been associated with an increased risk for BC. This risk is well-established for foundation variants. However, the risk assessment for other variants is unclear. The incorporation of bioinformatics analysis provided supporting evidence of the pathogenicity of VUS.
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Affiliation(s)
- Natalia Alonso
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
- Medical Oncology Department, Hospital San Pedro, Logroño, Spain
| | - Sebastián Menao
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
- Biochemistry Department, University Hospital Lozano Blesa, Zaragoza, Spain
| | - Rodrigo Lastra
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
- Medical Oncology Department, University Hospital Lozano Blesa, Zaragoza, Spain
| | - María Arruebo
- Biochemistry Department, University Hospital Lozano Blesa, Zaragoza, Spain
| | - María P. Bueso
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
- Medical Oncology Department, University Hospital Lozano Blesa, Zaragoza, Spain
| | - Esther Pérez
- Breast Unit, University Hospital Lozano Blesa, Zaragoza, Spain
| | - M. Laura Murillo
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
- Medical Oncology Department, University Hospital Lozano Blesa, Zaragoza, Spain
| | - María Álvarez
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
- Medical Oncology Department, University Hospital Lozano Blesa, Zaragoza, Spain
| | - Alba Alonso
- Biochemistry Department, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Soraya Rebollar
- Biochemistry Department, University Hospital Lozano Blesa, Zaragoza, Spain
| | - Mara Cruellas
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
- Medical Oncology Department, University Hospital of Valld’Hebron, and Valld’Hebron Institute of Oncology, Barcelona, Spain
| | - Dolores Arribas
- General Surgery Department, University Hospital Lozano Blesa, Zaragoza, Spain
| | - Mónica Ramos
- Biochemistry Department, University Hospital Lozano Blesa, Zaragoza, Spain
| | - Dolores Isla
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
- Medical Oncology Department, University Hospital Lozano Blesa, Zaragoza, Spain
| | - Juan José Galano-Frutos
- Department of Biochemistry, Molecular and Cell Biology, Faculty of Science, University of Zaragoza, Zaragoza, Spain
- Biocomputation and Complex Systems Physics Institute (BIFI), Joint Units BIFI-IQFR (CSIC) and GBs-CSIC, University of Zaragoza, Zaragoza, Spain
| | - Helena García-Cebollada
- Department of Biochemistry, Molecular and Cell Biology, Faculty of Science, University of Zaragoza, Zaragoza, Spain
- Biocomputation and Complex Systems Physics Institute (BIFI), Joint Units BIFI-IQFR (CSIC) and GBs-CSIC, University of Zaragoza, Zaragoza, Spain
| | - Javier Sancho
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
- Department of Biochemistry, Molecular and Cell Biology, Faculty of Science, University of Zaragoza, Zaragoza, Spain
- Biocomputation and Complex Systems Physics Institute (BIFI), Joint Units BIFI-IQFR (CSIC) and GBs-CSIC, University of Zaragoza, Zaragoza, Spain
| | - Raquel Andrés
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
- Medical Oncology Department, University Hospital Lozano Blesa, Zaragoza, Spain
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Iranzo P, Callejo A, Arbej J, Menao S, Isla D, Andrés R. [Risk factors for cancer-related cognitive impairment in breast and colorectal cancer patients who undergo chemotherapy]. An Sist Sanit Navar 2023; 46:e1040. [PMID: 37594060 PMCID: PMC10498134 DOI: 10.23938/assn.1040] [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: 11/05/2022] [Revised: 03/28/2023] [Accepted: 06/08/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Our study aims to evaluate the impact of different factors on cancer-related cognitive impairment in patients who undergo chemotherapy. METHODOLOGY Prospective longitudinal single-centre study that included patients with breast and colon carcinoma who underwent chemotherapy as part of their treatment. Clinical and genetic characteristics of the patients (single nucleotide polymorphisms, SNPs) were collected. Patients' neurocognitive status was assessed using eleven validated tests at three time points: before chemotherapy (M0 - baseline), between one and four weeks after completing chemotherapy (M1), and between 24-30 weeks after completing chemotherapy (M2). RESULTS Sixty-two patients were included in this study; 82% were female, median age was 56 years (range 30-74), and 64.5% had been diagnosed with breast cancer. Overall, better cognitive results at M0 were associated with age < 55 years, higher educational level, absence of comorbidities, and the CC variant rs471692 (TOP2A). Significant decline was found between M0 to M1 in the Rey Auditory Verbal Learning Test and the Letter and Number test, with evidence of recovery in M2 compared to M0 regarding the following test: Visual Memory, Functioning Assessment Short Test (FAST), Digit Symbol Substitution and Cube. In the multivariate analysis, being =55 years of age, adjuvant chemotherapy, presence of comorbidities, tobacco and alcohol use, and GT variant rs1800795 were associated with cognitive decline between M0 and M1. CONCLUSION Being =55 years of age, female, presence of comorbidities and basic education level are related to a higher risk of cognitive impairment after chemotherapy.
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Affiliation(s)
| | | | - Julio Arbej
- Servicio de Psiquiatría. Hospital Clínico Universitario Lozano Blesa. Zaragoza. España..
| | - Sebastian Menao
- Servicio de Bioquímica. Hospital Clínico Universitario Lozano Blesa. Zaragoza. España..
| | - Dolores Isla
- Servicio de Bioquímica. Hospital Clínico Universitario Lozano Blesa. Zaragoza. España..
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Martín M, Carrasco E, Rodríguez-Lescure Á, Andrés R, Servitja S, Antón A, Ruiz-Borrego M, Bermejo B, Guerrero Á, Ramos M, Santaballa A, Muñoz M, Cruz J, Lopez-Tarruella S, Chacón JI, Álvarez I, Martínez P, Miralles JJ, Polonio Ó, Jara C, Aguiar-Bujanda D. Long-term outcomes of high-risk HR-positive and HER2-negative early breast cancer patients from GEICAM adjuvant studies and El Álamo IV registry. Breast Cancer Res Treat 2023:10.1007/s10549-023-07002-1. [PMID: 37338729 PMCID: PMC10361852 DOI: 10.1007/s10549-023-07002-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/29/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE The monarchE trial showed that the addition of abemaciclib improves efficacy in patients with high-risk early breast cancer (EBC). We analyzed the long-term outcomes of a population similar to the monarchE trial to put into context the potential benefit of abemaciclib. METHODS HR-positive/HER2-negative EBC patients eligible for the monarchE study were selected from 3 adjuvant clinical trials and a breast cancer registry. Patients with ≥ 4 positive axillary lymph nodes (N +) or 1-3 N + with tumor size ≥ 5 cm and/or histologic grade 3 and/or Ki67 ≥ 20%, who had undergone surgery with curative intent and had received anthracyclines ± taxanes and endocrine therapy in the neoadjuvant and /or adjuvant setting were included. We performed analysis of Invasive Disease-Free Survival (iDFS), Distant Disease-Free Survival (dDFS) and Overall Survival (OS) at 5 and 10 years, as well as yearly (up to 10) of Invasive Relapse Rate (IRR), Distant Relapse Rate (DRR) and Death Rate (DR). RESULTS A total of 1,617 patients were analyzed from the GEICAM-9906 (312), GEICAM-2003-10 (210), and GEICAM-2006-10 (160) trials plus 935 from El Álamo IV. With a median follow-up of 10.1 years, the 5 and 10 years iDFS rates were 75.2% and 57.0%, respectively. The dDFS and OS rates at 5 years were 77.4% and 88.8% and the respective figures at 10 years were 59.7% and 70.9%. CONCLUSIONS This data points out the need for new therapies for those patients. A longer follow-up of the monarchE study to see the real final benefit with abemaciclib is warranted. TRIAL REGISTRATION ClinTrials.gov: GEICAM/9906: NCT00129922; GEICAM/ 2003-10: NCT00129935 and GEICAM/ 2006-10: NCT00543127.
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Affiliation(s)
- Miguel Martín
- Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, Madrid, Spain.
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain.
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain.
| | - Eva Carrasco
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain
| | - Álvaro Rodríguez-Lescure
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain
- Hospital General Universitario de Elche, Elche, Spain
| | - Raquel Andrés
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Sonia Servitja
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain
- Hospital del Mar, Barcelona, Spain
| | - Antonio Antón
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain
- Hospital Universitario Miguel Servet, Universidad de Zaragoza, Instituto Investigación Sanitaria Aragón (IISA), Zaragoza, Spain
| | - Manuel Ruiz-Borrego
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Begoña Bermejo
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain
- Hospital Clínico Universitario de Valencia, Biomedical Research Institute INCLIVA. Universidad de Valencia, Valencia, Spain
| | - Ángel Guerrero
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain
- Instituto Valenciano de Oncología, Valencia, Spain
| | - Manuel Ramos
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain
- Centro Oncológico de Galicia, A Coruña, Spain
| | - Ana Santaballa
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain
- Hospital Universitario La Fe, Valencia, Spain
| | - Montserrat Muñoz
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain
- Department of Medical Oncology and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - Josefina Cruz
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain
- Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Sara Lopez-Tarruella
- Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, Madrid, Spain
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain
| | - Jose I Chacón
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain
- Hospital Universitario de Toledo, Toledo, Spain
| | - Isabel Álvarez
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain
- Hospital de Donostia, San Sebastian, Spain
| | - Purificación Martínez
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain
- Hospital Universitario Basurto, Bilbao, Spain
| | | | | | - Carlos Jara
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain
- Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | - David Aguiar-Bujanda
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain
- Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
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Martínez-Jáñez N, Ezquerra MB, Henao F, Manso L, Antón A, Zamora P, Murillo SM, Tolosa P, Andrés R, Calvo L, Galve E, Lopez R, de la Peña FA, López-Tarruella S, Boronat L, Martos T, Chacón JI, Álvarez I, de la Haba-Rodríguez J, Antón FM. Abstract P4-01-28: PALBOSPAIN: OBSERVATIONAL ANALYSIS OF FIRST-LINE THERAPY WITH PALBOCICLIB IN PATIENTS WITH HR+/HER2- METASTATIC BREAST CANCER (MBC) IN REAL-LIFE CONDITIONS. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p4-01-28] [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: 03/06/2023]
Abstract
Abstract
INTRODUCTION AND OBJECTIVES Palbociclib associated with hormone therapy (HT) has shown significant benefit in progression-free survival (PFS) and response rate versus HT alone in patients with HR+, HER2- MBC. The PALBOSPAIN study evaluates the efficacy and safety of palbociclib treatment under real-life conditions. The main objective of the study was to assess PFS, and secondary objectives were overall survival (OS), response rate, time to next line of treatment, percentage of dose reduction and safety.
MATERIAL AND METHODS This is an observational, ambispective, multicenter, nation-wide study. Patients diagnosed with HR+/HER2- MBC who had started first-line treatment with palbociclib between November 2017 and November 2019 were included. Patients treated within a clinical trial were excluded, as were those who had received any previous systemic treatment for advanced disease.
RESULTS 762 patients from 35 centers were included. 79% (n=600) were postmenopausal, 54.9% (n=418) had visceral disease, and 30.6% (n=233) had de-novo metastatic disease. Palbocliclib was combined with an aromatase inhibitor in 69.6% of patients and fulvestrant in 30.2% Four groups were established to assess efficacy (table 1): overall population; patients with de-novo metastatic disease (cohort A); patients relapsing >12 months after the end of adjuvant hormonal therapy (cohort B); and patients relapsing within 12 months after the end of adjuvant hormonal therapy (cohort C). Median PFS was 24 months (CI 95%; 25-27) overall and 28 (IC 95%; 23-39), 29 (IC 95%;25-35) and 14 months (IC 95%;11-17) for cohorts a, B and C, respectively. Median overall survival was 42 months (40-NA). The most common side effects were neutropenia (71.3%, grade 3-4 in 52.5%, no episodes of febrile neutropenia), fatigue (38.6%), leucopenia (29.8%), anemia (28.9%), articular pain (19%), and thrombocytopenia (2,2%). 49% (n=385) of patients required dose reduction of palbociclib (one level in 27.6% and two levels in 21.4%).
CONCLUSION In the first two years after its approval in Spain, palbociclib in first line of HR+/HER2- MBC in real-life conditions yielded PFS and safety results comparable to those of PALOMA 2 and PALOMA 3 clinical trials. OS results were poorer, although the population included in this retrospective study is heterogeneous and median survival values have not been reached in some subgroups.
Table 1. Efficay results of palbociclib in real world
Citation Format: Noelia Martínez-Jáñez, Meritxell Bellet Ezquerra, Fernando Henao, Luis Manso, Antonio Antón, Pilar Zamora, Serafin Morales Murillo, Pablo Tolosa, Raquel Andrés, Lourdes Calvo, Elena Galve, Rafael Lopez, Francisco Ayala de la Peña, Sara López-Tarruella, Laia Boronat, Tamara Martos, J. Ignacio Chacón, Isabel Álvarez, Juan de la Haba-Rodríguez, Fernando Moreno Antón. PALBOSPAIN: OBSERVATIONAL ANALYSIS OF FIRST-LINE THERAPY WITH PALBOCICLIB IN PATIENTS WITH HR+/HER2- METASTATIC BREAST CANCER (MBC) IN REAL-LIFE CONDITIONS [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-01-28.
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Affiliation(s)
- Noelia Martínez-Jáñez
- 1Medical Oncology Hospital Universitario Ramón y Cajal. Madrid. Spain. GEICAM Spanish Breast Cancer Group., TRES CANTOS, Madrid, Spain
| | - Meritxell Bellet Ezquerra
- 2Vall d’Hebron Institute of Oncology (VHIO) and Vall d’Hebron University Hospital, and SOLTI Group, Barcelona, Spain
| | - Fernando Henao
- 3Medical Oncology Hospital Virgen de la Macarena. Sevilla. Spain
| | - Luis Manso
- 4Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Antonio Antón
- 5Hospital Universitario Miguel Servet. GEICAM Spanish Breast Cancer Group., Spain
| | - Pilar Zamora
- 6Hospital Universitario de La Paz, Madrid, Spain
| | | | - Pablo Tolosa
- 8SOLTI Cancer Research Group, Barcelona, Spain/Medical Oncology Department, Hospital 12 de Octubre, Madrid., Madrid, Spain
| | - Raquel Andrés
- 9Hospital Clínico Universitario Lozano Blesa. GEICAM Spanish Breast Cancer Group., Spain
| | - Lourdes Calvo
- 10Oncology Department-Universitary Hospital A Coruña, A Coruña, Galicia, Spain
| | | | - Rafael Lopez
- 12Medical Oncology Hospital Clínico Universitario de Santiago CHUS. La Coruña Spain
| | | | - Sara López-Tarruella
- 14Hospital Universitario Gregorio Marañón. CIBERONC-ISCIII. GEICAM Spanish Breast Cancer Group., Spain
| | - Laia Boronat
- 15Medical Oncology Hospital de la Santa Creu i Sant Pau. Barcelona. Spain
| | - Tamara Martos
- 16Medical Oncology. Hospital del Mar. Barcelona. Spain
| | - J. Ignacio Chacón
- 17Hospital Universitario de Toledo. GEICAM Spanish Breast Cancer Group., Spain
| | - Isabel Álvarez
- 18Hospital Universitario Donostia-BioDonostia. GEICAM Spanish Breast Cancer Group., Spain
| | - Juan de la Haba-Rodríguez
- 19Instituto Maimonides de Investigacion Biomedica, Hospital Reina Sofia, Universidad de Córdoba. GEICAM Spanish Breast Cancer Group., Spain
| | - Fernando Moreno Antón
- 20Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), CIBERONC, Madrid, Spain
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Novoa SA, Rodríguez CA, Cruz J, López-Tarruella S, Tibau A, Adrover E, Miguel A, Margelí M, Martínez P, Hernández M, Antón A, Rodríguez-Lescure Á, Falo C, Álvarez I, Malón D, Andrés R, Alonso-Romero JL, Gómez C, Illaramendi JJ, Campo R, Miralles JJ, Bezares S, Rojo F, Guerrero-Zotano A. Abstract P4-07-45: Treatment strategies for advanced triple negative breast cancer patients as per routine clinical practice: analysis from the observational study GEICAM/2014-03 (RegistEM). Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p4-07-45] [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: 03/06/2023]
Abstract
Abstract
Background: Triple negative breast cancer (TNBC) is well known for its more aggressive course and poorer prognosis compared to other BC subtypes. RegistEM study provides real world data to understand the distribution of BC subtypes in the advanced setting, being its primary objective. Biological samples collection is part of its procedures. This is a non-interventional cohort study and 1,907 patients (pts) have been enrolled up to now (females and males) with advanced BC (ABC), diagnosed from Jan-2016 to Dec-2019, either after recurrence or as first BC diagnosis, in 38 Spanish sites. These pts will be followed for at least 5 years.
Methods: In the current analysis (cut-off date 08/April/2022, database ongoing), we describe characteristics, treatment patterns and outcomes, including comparison between recurrent and de novo disease, of 157 pts with advanced TNBC included in the RegistEM study. Those pts represent the 10% of pts available in the database at the cut-off date and with ABC diagnosis up to December 2018 (n=1559). The BC clinical subtypes were histologically confirmed on the most recent tumor lesion (metastatic [M] or primary BC) before starting with the 1st-line therapy.
Results: At first ABC diagnosis, 73% pts had recurrent early BC (EBC), 26% de novo MBC and 1% unresectable locally ABC (ULABC). Median age was 57 years (range 30-88), all pts were women, 98% Caucasian and 65% postmenopausal. Family history of BC and/or ovarian cancer was reported in 37% pts, and a hereditary-risk genetic test was performed in 59 of 147 pts. Germline BRCA1/2 and TP53 were the most frequently mutated genes, 21% (6/28) and 47% (8/17) pts, respectively. Visceral involvement was present in 69% pts (similar between recurrent EBC and de novo ABC, although brain metastases were only present in the recurrent EBC group), and ≤ 2 metastatic locations in 59%. In 61% (70/115) pts with recurrent EBC, the subtype was assessed in metastatic lesions, and 39 pts of them also had TN subtype in primary BC. In terms of the most frequent therapies by line: 1) 1st-line: chemotherapy (CT) (60%) and CT/biological therapy (BT) (39%). Of the 87 pts with CT alone, monotherapy was the preferred option in 57% pts (capecitabine 25%, taxanes 16%, and eribulin or vinorelbine, 5% each). Bevacizumab was the most frequent BT (79%) combined with CT (single agent in 56% pts, mostly taxanes and capecitabine). Progressive disease (PD) was reported in 85% pts (similar in pts with both recurrent and de novo MBC or ULABC); 2) 2nd-line: CT (79%) (monotherapy capecitabine, eribulin, taxanes) and CT/BT (17%) (CT-containing bevacizumab 82%). Progression was reported in 92% pts; 3) 3rd-line: CT (90%) (eribulin 33%, platinum-based 25%) and CT/BT (9%) (CT-containing bevacizumab 67%). Progression was reported in 88% pts. At database cut-off date, death was reported in 133 (85%) pts, mainly because of PD. Overall survival (OS) was similar between both groups, recurrent and de novo MBC.
Conclusion: In this population of Spanish TNBC pts with ABC, three quarters had recurrent disease. De novo ABC pts had a higher proportion of non-visceral metastases, with absence of brain involvement at the first diagnosis. Single-agent CT and CT plus bevacizumab were the most frequent therapies, and OS was similar between recurrent and de novo MBC pts, although numerically higher in the later group.
Citation Format: Silvia Antolin Novoa, César A Rodríguez, Josefina Cruz, Sara López-Tarruella, Ariadna Tibau, Encarna Adrover, Ana Miguel, Mireia Margelí, Purificación Martínez, María Hernández, Antonio Antón, Álvaro Rodríguez-Lescure, Catalina Falo, Isabel Álvarez, Diego Malón, Raquel Andrés, José L Alonso-Romero, César Gómez, J. José Illaramendi, Ruth Campo, Juan José Miralles, Susana Bezares, Federico Rojo, Angel Guerrero-Zotano. Treatment strategies for advanced triple negative breast cancer patients as per routine clinical practice: analysis from the observational study GEICAM/2014-03 (RegistEM) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-45.
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Affiliation(s)
- Silvia Antolin Novoa
- 1Complejo Hospitalario Universitario A Coruña (CHUAC). GEICAM Spanish Breast Cancer Group., Spain
| | - César A Rodríguez
- 2Hospital Universitario de Salamanca-IBSAL. GEICAM Spanish Breast Cancer Group., Spain
| | - Josefina Cruz
- 3Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Sara López-Tarruella
- 4Hospital Universitario Gregorio Marañón. CIBERONC-ISCIII. GEICAM Spanish Breast Cancer Group., Spain
| | - Ariadna Tibau
- 5Hospital de la Santa Creu i Sant Pau. GEICAM Spanish Breast Cancer Group, Spain
| | - Encarna Adrover
- 6Complejo Hospitalario Universitario de Albacete. GEICAM Spanish Breast Cancer Group., Spain
| | - Ana Miguel
- 7ALTHAIA Xarxa asistencial de Manresa. GEICAM Spanish Breast Cancer Group., Spain
| | - Mireia Margelí
- 8SOLTI Cancer Research Group. Medical Oncology Department, ICO Badalona, B-ARGO Group. GEICAM Spasnish Breast Cancer Group., Catalonia, Spain
| | | | - María Hernández
- 10Complejo Hospitalario Universitario de Gran Canaria Dr. Negrín. GEICAM Spanish Breast Cancer Group., Spain
| | - Antonio Antón
- 11Hospital Universitario Miguel Servet. GEICAM Spanish Breast Cancer Group., Spain
| | | | - Catalina Falo
- 13ICO Hospitalet. GEICAM Spanish Breast Cancer Group., Spain
| | - Isabel Álvarez
- 14Hospital Universitario Donostia-BioDonostia. GEICAM Spanish Breast Cancer Group., Spain
| | - Diego Malón
- 15Hospital Universitario Fuenlabrada. GEICAM Spanish Breast Cancer Group
| | - Raquel Andrés
- 16Hospital Clínico Universitario Lozano Blesa. GEICAM Spanish Breast Cancer Group., Spain
| | - José L Alonso-Romero
- 17Hospital Clínico Universitario Virgen de la Arrixaca. GEICAM Spanish Breast Cancer Group
| | - César Gómez
- 18Hospital Universitario Infanta Sofía. GEICAM Spanish Breast Cancer Group
| | - J. José Illaramendi
- 19Hospital Universitario de Navarra-Nafarroako Unibertsitate Ospitalea. GEICAM Spanish Breast Cancer Group
| | - Ruth Campo
- 20GEICAM Spanish Breast Cancer Group., Spain
| | | | | | | | - Angel Guerrero-Zotano
- 24Fundación Instituto Valenciano de Oncología (FIVO). GEICAM Spanish Breast Cancer Group., Spain
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López-Tarruella S, Guerrero-Zotano A, Cruz J, Novoa SA, Martínez P, Hernández M, Rodríguez CA, Chacón JI, Tibau A, Falo C, Rodríguez-Lescure Á, Margelí M, Servitja S, Andrés R, Galán-Gramaje M, Adrover E, Miguel A, Villanueva R, Varela S, Campo R, Escudero MJ, Bezares S, Rojo F, Álvarez I. Abstract P4-07-38: Real-world data of Advanced Breast Cancer (ABC) patients with HER2-positivity before the second-line therapy: data from the observational study GEICAM/2014-03 (RegistEM). Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p4-07-38] [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: 03/06/2023]
Abstract
Abstract
Background: Over the last years, the treatment of HER2-positive (HER2+) breast cancer (BC) patients (pts) has been changing because of the development of new anti-HER2 agents. In the current analysis, we describe the features, treatment patterns, progression-free survivall (PFS) and overall survival (OS) outcomes of BC pts with HER2 + (immunohistochemistry [IHC] 3+ or IHC 2+ and in situ hybridization [ISH]+), following ASCO/CAP 2018 guidelines in the most recent tumor lesion before the 2nd-line.
Methods: The RegistEM study is an ongoing BC registry study that is providing prospective data from around 1900 pts diagnosed with advanced BC (ABC) between 01/Jan/2016 and 31/Dec/2019, in 38 Spanish institutions from GEICAM network. In this analysis, 296 HER2+ BC pts have been included, representing the 18% of pts available in the database at the cut-off date (08/Apr/2022), with ABC diagnosis before 2019 (n=1559).
Results: At first ABC diagnosis, 58% (n=173) pts had recurrent disease (>36 months [mo] from initial BC diagnosis in 62%), 41% (n=120) de novo metastatic BC and 1% (n=3) unresectable locally ABC (ULABC); the median age was 58 years, 68% were postmenopausal and there was only 1 male pt. From total 296 pts, 66% had hormone receptor expression [HR+]; the BC subtype was assessed in tumor tissue from the breast (58%) or a metastatic lesion (34%), and in 8% pts, HER2 positivity was observed after the 1st-line. Family history of BC and/or ovarian cancer was reported in 28% pts, and a hereditary-risk genetic test was performed in 26% pts (n=74/282). Germline BRCA1/2 and TP53 genetic testing were reported in 14 and 26 pts respectively, being mutated in 3/14 (21%) and 5/26 (19%) pts. Bone (50%), lymph nodes (49%), liver (35%), lung (31%), soft tissue (8%) and central nervous system (CNS), mostly in brain (8%), were the main metastatic sites. One hundred pts were diagnosed with CNS metastases: 24 at baseline, 48 during the 1st-line and 28 in subsequent lines. Additional data according to HR status and type of ABC are detailed in the table below, showing a worse prognosis in absence of HR expression. In HR- pts, bone metastases were less frequent and lymph nodes metastases more frequent compared to HR+ pts. Visceral disease was present in 69% (66% in HR+ and 74% in HR-; non-statistically significant) pts and ≈80% had ≤3 (54%, ≤2) locations involved. The most common therapies by line were: 1) 1st-line: Chemotherapy (CT) + biological therapy (BT) (38%), CT + BT+ endocrine therapy (ET) (35%), and ET + BT [11%]; 2) 2nd-line: BT (55%), CT + BT (20%) and ET + BT (15%); 3) 3rd-line: CT + BT (49%) and BT (31%). The median (95% confidence interval [CI]) progression-free survival (PFS) on 1st, 2nd and 3rd line was 18 (15-22), 8 (7-9) and 6 (5-8) mo, respectively. The median (95% CI) overall survival (OS) from ABC diagnosis was 43 (40-49) mo. These survival outcomes were higher in HR+ pts, however, the differences were only statistically significant in OS (p=0.006; log-rank). At database cut-off date, death was reported in 47% pts.
Conclusions: In spite of the anti-HER2 therapies administered in the advanced setting, the HR expression is a relevant prognostic factor, with a clinically and statistically significant impact in OS, improving the outcomes of HR+ pts.
Citation Format: Sara López-Tarruella, Angel Guerrero-Zotano, Josefina Cruz, Silvia Antolin Novoa, Purificación Martínez, María Hernández, César A Rodríguez, J. Ignacio Chacón, Ariadna Tibau, Catalina Falo, Álvaro Rodríguez-Lescure, Mireia Margelí, Sonia Servitja, Raquel Andrés, María Galán-Gramaje, Encarna Adrover, Ana Miguel, Rafael Villanueva, Silvia Varela, Ruth Campo, Mª José Escudero, Susana Bezares, Federico Rojo, Isabel Álvarez. Real-world data of Advanced Breast Cancer (ABC) patients with HER2-positivity before the second-line therapy: data from the observational study GEICAM/2014-03 (RegistEM) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-38.
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Affiliation(s)
- Sara López-Tarruella
- 1Hospital Universitario Gregorio Marañón. CIBERONC-ISCIII. GEICAM Spanish Breast Cancer Group., Spain
| | - Angel Guerrero-Zotano
- 2Fundación Instituto Valenciano de Oncología (FIVO). GEICAM Spanish Breast Cancer Group., Spain
| | - Josefina Cruz
- 3Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Silvia Antolin Novoa
- 4Complejo Hospitalario Universitario A Coruña (CHUAC). GEICAM Spanish Breast Cancer Group., Spain
| | | | - María Hernández
- 6Complejo Hospitalario Universitario de Gran Canaria Dr. Negrín. GEICAM Spanish Breast Cancer Group., Spain
| | - César A Rodríguez
- 7Hospital Universitario de Salamanca-IBSAL. GEICAM Spanish Breast Cancer Group., Spain
| | - J. Ignacio Chacón
- 8Hospital Universitario de Toledo. GEICAM Spanish Breast Cancer Group., Spain
| | - Ariadna Tibau
- 9Hospital de la Santa Creu i Sant Pau. GEICAM Spanish Breast Cancer Group, Spain
| | - Catalina Falo
- 10ICO Hospitalet. GEICAM Spanish Breast Cancer Group., Spain
| | | | - Mireia Margelí
- 12SOLTI Cancer Research Group. Medical Oncology Department, ICO Badalona, B-ARGO Group. GEICAM Spasnish Breast Cancer Group., Catalonia, Spain
| | | | - Raquel Andrés
- 14Hospital Clínico Universitario Lozano Blesa. GEICAM Spanish Breast Cancer Group., Spain
| | | | - Encarna Adrover
- 16Complejo Hospitalario Universitario de Albacete. GEICAM Spanish Breast Cancer Group., Spain
| | - Ana Miguel
- 17ALTHAIA Xarxa asistencial de Manresa. GEICAM Spanish Breast Cancer Group., Spain
| | - Rafael Villanueva
- 18Institut Català d’Oncologia. GEICAM Spanish Breast Cancer Group., Spain
| | - Silvia Varela
- 19Hospital Universitario Lucus Augusti. GEICAM Spanish Breast Cancer Group., Spain
| | - Ruth Campo
- 20GEICAM Spanish Breast Cancer Group., Spain
| | | | | | | | - Isabel Álvarez
- 24Hospital Universitario Donostia-BioDonostia. GEICAM Spanish Breast Cancer Group., Spain
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de la Cruz-Merino L, Gion M, Cruz J, Alonso-Romero JL, Quiroga V, Moreno F, Andrés R, Santisteban M, Ramos M, Holgado E, Cortés J, López-Miranda E, Cortés A, Henao F, Palazón-Carrión N, Rodriguez LM, Ceballos I, Soto A, Puertes A, Casas M, Benito S, Chiesa M, Bezares S, Caballero R, Jiménez-Cortegana C, Sánchez-Margalet V, Rojo F. Pembrolizumab in combination with gemcitabine for patients with HER2-negative advanced breast cancer: GEICAM/2015-04 (PANGEA-Breast) study. BMC Cancer 2022; 22:1258. [PMID: 36463104 PMCID: PMC9719636 DOI: 10.1186/s12885-022-10363-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/24/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND We evaluated a new chemoimmunotherapy combination based on the anti-PD1 monoclonal antibody pembrolizumab and the pyrimidine antimetabolite gemcitabine in HER2- advanced breast cancer (ABC) patients previously treated in the advanced setting, in order to explore a potential synergism that could eventually obtain long term benefit in these patients. METHODS HER2-negative ABC patients received 21-day cycles of pembrolizumab 200 mg (day 1) and gemcitabine (days 1 and 8). A run-in-phase (6 + 6 design) was planned with two dose levels (DL) of gemcitabine (1,250 mg/m2 [DL0]; 1,000 mg/m2 [DL1]) to determine the recommended phase II dose (RP2D). The primary objective was objective response rate (ORR). Tumor infiltrating lymphocytes (TILs) density and PD-L1 expression in tumors and myeloid-derived suppressor cells (MDSCs) levels in peripheral blood were analyzed. RESULTS Fourteen patients were treated with DL0, resulting in RP2D. Thirty-six patients were evaluated during the first stage of Simon's design. Recruitment was stopped as statistical assumptions were not met. The median age was 52; 21 (58%) patients had triple-negative disease, 28 (78%) visceral involvement, and 27 (75%) ≥ 2 metastatic locations. Progression disease was observed in 29 patients. ORR was 15% (95% CI, 5-32). Eight patients were treated ≥ 6 months before progression. Fourteen patients reported grade ≥ 3 treatment-related adverse events. Due to the small sample size, we did not find any clear association between immune tumor biomarkers and treatment efficacy that could identify a subgroup with higher probability of response or better survival. However, patients that experienced a clinical benefit showed decreased MDSCs levels in peripheral blood along the treatment. CONCLUSION Pembrolizumab 200 mg and gemcitabine 1,250 mg/m2 were considered as RP2D. The objective of ORR was not met; however, 22% patients were on treatment for ≥ 6 months. ABC patients that could benefit of chemoimmunotherapy strategies must be carefully selected by robust and validated biomarkers. In our heavily pretreated population, TILs, PD-L1 expression and MDSCs levels could not identify a subgroup of patients for whom the combination of gemcitabine and pembrolizumab would induce long term benefit. TRIAL REGISTRATION ClinicalTrials.gov and EudraCT (NCT03025880 and 2016-001,779-54, respectively). Registration dates: 20/01/2017 and 18/11/2016, respectively.
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Affiliation(s)
- L. de la Cruz-Merino
- grid.411375.50000 0004 1768 164XDepartment of Medical Oncology, Medicine Department, Virgen Macarena University Hospital, University of Seville, Dr. Fedriani St, No. 3, Seville, 41009 Spain ,grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain
| | - M. Gion
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.411347.40000 0000 9248 5770Department of Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J. Cruz
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.411220.40000 0000 9826 9219Department of Medical Oncology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - JL. Alonso-Romero
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.411372.20000 0001 0534 3000Department of Medical Oncology, Hospital Clínico Universitario Virgen de La Arrixaca-IMIB, Murcia, Spain
| | - V. Quiroga
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.418701.b0000 0001 2097 8389Department of Medical Oncology, Badalona Applied Research Group in Oncology (B-ARGO Group), Catalan Institute of Oncology, Badalona, Spain
| | - F. Moreno
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.411068.a0000 0001 0671 5785Department of Medical Oncology, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - R. Andrés
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.411050.10000 0004 1767 4212Department of Medical Oncology, Hospital Clínico Universitario Lozano Blesa, Saragossa, Spain
| | - M. Santisteban
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.411730.00000 0001 2191 685XDepartment of Medical Oncology, Clínica Universidad de Navarra, Navarra, Spain ,grid.508840.10000 0004 7662 6114IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - M. Ramos
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.418394.3Department of Medical Oncology, Centro Oncológico de Galicia, A Coruña, Spain
| | - E. Holgado
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.414808.10000 0004 1772 3571Department of Medical Oncology, Hospital La Luz, Quironsalud, Madrid, Spain
| | - J. Cortés
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,International Breast Cancer Center (IBCC), Quiron Group, Barcelona and Madrid, Spain ,grid.411083.f0000 0001 0675 8654Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain ,grid.119375.80000000121738416Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - E. López-Miranda
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.411347.40000 0000 9248 5770Department of Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - A. Cortés
- grid.411347.40000 0000 9248 5770Department of Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - F. Henao
- grid.411375.50000 0004 1768 164XDepartment of Medical Oncology, Medicine Department, Virgen Macarena University Hospital, University of Seville, Dr. Fedriani St, No. 3, Seville, 41009 Spain ,grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain
| | - N. Palazón-Carrión
- grid.411375.50000 0004 1768 164XDepartment of Medical Oncology, Medicine Department, Virgen Macarena University Hospital, University of Seville, Dr. Fedriani St, No. 3, Seville, 41009 Spain ,grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain
| | - L. M. Rodriguez
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.411220.40000 0000 9826 9219Department of Medical Oncology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - I. Ceballos
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.411220.40000 0000 9826 9219Department of Medical Oncology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - A. Soto
- grid.411372.20000 0001 0534 3000Department of Medical Oncology, Hospital Clínico Universitario Virgen de La Arrixaca-IMIB, Murcia, Spain
| | - A. Puertes
- grid.411372.20000 0001 0534 3000Department of Medical Oncology, Hospital Clínico Universitario Virgen de La Arrixaca-IMIB, Murcia, Spain
| | - M. Casas
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain
| | - S. Benito
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain
| | - M. Chiesa
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain
| | - S. Bezares
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain
| | - R. Caballero
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain
| | - C. Jiménez-Cortegana
- grid.411375.50000 0004 1768 164XMedical Biochemistry and Molecular Biology and Immunology Department, Virgen Macarena University Hospital, University of Seville, Seville, Spain
| | - V. Sánchez-Margalet
- grid.411375.50000 0004 1768 164XMedical Biochemistry and Molecular Biology and Immunology Department, Virgen Macarena University Hospital, University of Seville, Seville, Spain
| | - F. Rojo
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.419651.e0000 0000 9538 1950Pathology Department, IIS-Fundación Jiménez Díaz, Madrid, Spain ,CIBERONC-ISCIII, Madrid, Spain
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Pena-Couso L, Ercibengoa M, Mercadillo F, Gómez-Sánchez D, Inglada-Pérez L, Santos M, Lanillos J, Gutiérrez-Abad D, Hernández A, Carbonell P, Letón R, Robledo M, Rodríguez-Antona C, Perea J, Urioste M, Alonso MÁ, Andrés R, Arévalo S, del Mar Arias M, Balmaña J, Beristain E, Blanco I, Boronat M, Brunet J, Cózar MV, del Campo M, Díaz A, Gabau E, Barcina MJ, González M, Guitart M, Hernán I, Hernández HS, Hernando S, Lacambra C, Lasa A, Lastra E, Llort G, del Rosario Marín M, Marrupe D, Martínez F, Martínez V, Martorell L, Orera M, Pedrinaci S, Pérez P, Pineda M, Plasencia AM, Cajal TRY, Robles L, Rodà D, Rodríguez N, Rosell J, Sáez R, Salvat M, Sánchez A, Santana A, Soto JL, Toll A, Tuneu A, Vázquez C. Considerations on diagnosis and surveillance measures of PTEN hamartoma tumor syndrome: clinical and genetic study in a series of Spanish patients. Orphanet J Rare Dis 2022; 17:85. [PMID: 35227301 PMCID: PMC8886852 DOI: 10.1186/s13023-021-02079-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background The limited knowledge about the PTEN hamartoma tumor syndrome (PHTS) makes its diagnosis a challenging task. We aimed to define the clinical and genetic characteristics of this syndrome in the Spanish population and to identify new genes potentially associated with the disease. Results We reviewed the clinical data collected through a specific questionnaire in a series of 145 Spanish patients with a phenotypic features compatible with PHTS and performed molecular characterization through several approaches including next generation sequencing and whole exome sequencing (WES). Macrocephaly, mucocutaneous lesions, gastrointestinal polyposis and obesity are prevalent phenotypic features in PHTS and help predict the presence of a PTEN germline variant in our population. We also find that PHTS patients are at risk to develop cancer in childhood or adolescence. Furthermore, we observe a high frequency of variants in exon 1 of PTEN, which are associated with renal cancer and overexpression of KLLN and PTEN. Moreover, WES revealed variants in genes like NEDD4 that merit further research. Conclusions This study expands previously reported findings in other PHTS population studies and makes new contributions regarding clinical and molecular aspects of PHTS, which are useful for translation to the clinic and for new research lines. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-02079-7.
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Álvarez I, Guerrero-Zotano Á, Cruz J, Martínez P, Hernández M, Rodríguez CA, Rodríguez-Lescure Á, Antolín S, Adrover E, Andrés R, Falo C, Chacón JI, Miguel A, Servitja S, Gramaje MG, Vila MM, Raposo CG, Echarri MJ, Villanueva R, Martorell ATI, Ferreiro SV, Campo R, Miralles JJ, Bezares S, Rojo F, López-Tarruella S. Abstract P1-15-04: Features of HER2+ metastasic patients (pts) from a prospective registry of advanced breast cancer (ABC), GEICAM/2014-03 (RegistEM). Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p1-15-04] [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: The RegistEM study is a non-interventional study that is providing prospective data from around 1900 ABC pts (females and males) diagnosed with advanced disease between 01/Jan/2016 and 31/Dec/2019, either after recurrence or at 1st diagnosis, in 38 Spanish sites representative of the national territory and whose investigators are GEICAM members. Methods: In the current analysis (cut-off date 10/May/2021, ongoing database), we describe the features of 279 pts included in the RegistEM study, with HER2+ (immunohistochemistry [IHQ] 3+, IHQ 2+ and in situ hybridization [ISH]+) tumors at any time of their ABC (5% after the 1st-line therapy). This subgroup has been evaluated because of the interest from a clinical perspective. Multivariate Cox analysis aiming to identify factors associated with overall survival (OS) were built. Results: 279 pts were identified, representing the 15% pts available in the database at the cut-off date. At first ABC diagnosis, 48% pts had recurrent BC (>12 months [mo] from initial BC diagnosis in 93%), 51% de novo metastatic BC and 1% unresectable locally advanced BC (ULABC). The median age was 59 years, 98% were white , 71% postmenopausal and only 1 male was part of this subset. Considering the BC subtype assessed in the most recent tumor lesion before the 1st-line therapy, 264 pts wereHER2 positive (67% with hormone receptor [HR]+). Family history of BC and/or ovarian cancer was reported in 31% pts, and an hereditary-risk genetic test was performed in 25% (66/267 pts). BRCA1/2 and TP53 mutations were reported in 4/20 and 4/19 pts, respectively, and p53 overexpression in 20/46 pts. Lymph nodes (56%), bone (49%), liver (34%), lung (33%), soft tissue (10%) and brain (8%) were the main metastatic sites. Additional data according to HR status and type of ABC are detailed in the table below. In HR- pts, bone metastases were less frequent and lymph nodes metastases more frequent compared to HR+ pts. Visceral disease was present in 68% pts and ≈75% had ≤3 (47% ≤2) locations involved. The most common therapies by line were: 1) 1st-line: CT + dual anti-HER2 blockade (3%), chemotherapy (CT) (almost in all pts taxane-based)+dual anti-HER2 blockade + endocrine therapy (ET) (mainly aromatase inhibitors) (35%), and ET + anti-HER2 blockade or ET + cyclin-dependent kinases 4/6 inhibitors (11%); 2) 2nd-line: anti-HER2 blockade (56%) [mostly an antibody-drug conjugate (90%)], CT + anti-HER2 blockade (18%) and ET + anti-HER2 blockade (14%); 3) 3rd-line: CT + anti-HER2 blockade (55%) and anti-HER2 blockade (22%). The median time-to-progressions to 1st-, 2nd- and 3rd-line were 14, 5, and 4 mo, respectively. A 4th-line therapy was reported in 52% of pts who received a 3rd-line. At database cut-off date, death was reported in 34% of pts. The median OS of this subset of pts was 41 mo (36-49). In a multivariate Cox regression analysis, the following variables were significantly related with worse survival (from ABC diagnosis): Brain (HR=2.62; 95% CI, 1.02-6.73) and Visceral no Brain involvement (HR=2.15; 95% CI, 1.02-4.53) compare to only soft tissue lesions; early stage at first diagnosis (HR=1.77; 95% CI, 1.15-2.73); HR- (HR=1.70; 95% CI, 1.11-2.60) and age (HR=1.04; 95% CI, 1.02-1.07). Conclusions: In this cohort of HER2+ pts with advanced disease, half of them had de novo ABC which was associated with better OS. The median PFS in 1st- and 3rd-line were slightly better in HR+ pts, and in 2nd-line was similar between HR+ and HR- cohorts.
HR+181 (67%)HR- 91 (33%)Recurrent EBC134 (48%)ULABC or de novo M1 145 (52%)Time to recurrence >12 mo in EBC pts., n8435125NALocation of metastaticsites, nBoneBrainLiverLungLymph nodesSoft tissue104 10 62 57 90 1829 9 3232 64 1059 15 36 47 51 2278 6 59 46 1056Líne123123123123n180935690492613385521446333Deaths, n211112111161715141584Therapies by line, nET/BT261922101910212100ET12441011022323CT/BT/ET935031038305830CT/BT4017307581552182366924CT3572353711211BT6431373651145143385The most frequent therapies, nCT + dual anti-HER2 blockade + ET8623331551CT + single-agent HER2 blockade + ET522CT + dual anti-HER2 blockade3493644391016252CT + single-agent HER2 blockade4825641588211521CT5573354711411ET*22105212162644ET + HER2 blockade1213411662782Anti-HER2 blockade6431073651145143382Median duration of treatment, mo125585310441064TTP (mo), median (range)15(1-47)5(1-32)5(0-18)11(2-38)5(1-27)4(2-12)12 (1-47)5(1-26)4(0-17)17(2-45)7(1-32)4(1-18)Median PFS, mo14561154------HR: hormone receptor; EBC: early breast cancer; ULABC: unresectable locally advanced breast cancer; M1: metastatic; mo: month; ET: endrocrine therapy; BT: biological therapy; CT: chemotherapy; TTP: time-to-progression; PFS: progression-free survival. *ET includes aromatase inhibitors or selective estrogen receptor degraders, as single-agents or combined with cyclin-dependent kinases 4/6 inhibitors.
Citation Format: Isabel Álvarez, Ángel Guerrero-Zotano, Josefina Cruz, Purificación Martínez, María Hernández, César A Rodríguez, Álvaro Rodríguez-Lescure, Silvia Antolín, Encarna Adrover, Raquel Andrés, Catalina Falo, Jose Ignacio Chacón, Ana Miguel, Sonia Servitja, Maria Galán Gramaje, Mireia Margelí Vila, César Gómez Raposo, María Jose Echarri, Rafael Villanueva, Ariadna TIbau Martorell, Silvia Varela Ferreiro, Ruth Campo, Juan Jose Miralles, Susana Bezares, Federico Rojo, Sara López-Tarruella. Features of HER2+ metastasic patients (pts) from a prospective registry of advanced breast cancer (ABC), GEICAM/2014-03 (RegistEM) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-15-04.
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Affiliation(s)
- Isabel Álvarez
- Unidad de Gestión del Cáncer de Guipúzcoa (Osakidetza-OSI Donostialdea_Onkologikoa)-BioDonostia. GEICAM Spanish Breast Cancer Group, San Sebastián, Spain
| | - Ángel Guerrero-Zotano
- Fundación Instituto Valenciano de Oncología (FIVO). GEICAM Spanish Breast Cancer Group, Valencia, Spain
| | - Josefina Cruz
- Hospital Universitario de Canarias. GEICAM Spanish Breast Cancer Group, Santa Cruz de Tenerife, Spain
| | | | - María Hernández
- Complejo Hospitalario Universitario de Gran Canaria Doctor Negrín. GEICAM Spanish Breast Cancer Group, Las Palmas de Gran Canaria, Spain
| | - César A Rodríguez
- Hospital Universitario de Salamanca-IBSAL. GEICAM Spanish Breast Cancer Group, Salamanca, Spain
| | | | - Silvia Antolín
- Hospital Clínico Universitario Lozano Blesa. GEICAM Spanish Breast Cancer Group, Zaragoza, Spain
| | - Encarna Adrover
- Hospital General Universitario de Albacete. GEICAM Spanish Breast Cancer Group, Albacete, Spain
| | - Raquel Andrés
- Hospital Clínico Universitario Lozano Blesa. GEICAM Spanish Breast Cancer Group, Zaragoza, Spain
| | - Catalina Falo
- ICO Hospitalet. GEICAM Spanish Breast Cancer Group, Barcelona, Spain
| | - Jose Ignacio Chacón
- Hospital Virgen de la Salud. GEICAM Spanish Breast Cancer group, Toledo, Spain
| | - Ana Miguel
- ALTHAIA Xarxa asistencial de Manresa. GEICAM Spanish Breast Cancer Group, Barcelona, Spain
| | - Sonia Servitja
- Hospital del Mar. GEICAM Spanish Breast Cancer Group, Barcelona, Spain
| | - Maria Galán Gramaje
- Hospital Son Llátzer. GEICAM Spanish Breast Cancer Group, Palma de Mallorca, Spain
| | - Mireia Margelí Vila
- ICO-Badalona.B-ARGO (Badalona Appllied Reasearch Group in Oncology). GEICAM Spanish Breast Cancer Group, Barcelona, Spain
| | - César Gómez Raposo
- Hospital Universitario Infanta Sofía. GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | - María Jose Echarri
- Hospital Severo Ochoa. GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | - Rafael Villanueva
- Hospital de Sant Joan Despi Moisés Broggi. GEICAM Spanish Breast Cancer Group, Barcelona, Spain
| | | | | | - Ruth Campo
- GEICAM Spanish Breast Cancer Group, San Sebastián, Spain
| | | | | | - Federico Rojo
- Hospital Universitario Fundación Jiménez Díaz. Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense. GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | - Sara López-Tarruella
- Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense. CIBERONC-ISCIII- .GEICAM Spanish Breast Cancer Group, Madrid, Spain
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10
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Manso L, Salvador F, Villagrasa P, Chic N, Bermejo B, Cejalvo JM, Izarzugaza Y, Cantos B, Blanch S, Margeli M, Alonso JL, Martínez A, Villanueva R, Guerra JA, Andrés R, Zamora P, Nogales E, Juan M, Gonzalez-Farre B, Wilkinson GA, Heineman TC, Nuovo G, Loghmani H, Coffey M, Gonzalez A, Martínez D, Paré L, Pascual T, Gonzalez X, Prat A, Gavilá J. Abstract CT191: A window-of-opportunity study with atezolizumab and the oncolytic virus pelareorep in early breast cancer (AWARE-1). Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-ct191] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: A previous phase 2 study in metastatic breast cancer demonstrated a statistically significant improvement in overall survival (OS) in patients treated with pelareorep (pela), an intravenously delivered immuno-oncolytic reovirus, given in combination with paclitaxel (PTX) versus PTX alone [1]. We hypothesized that the OS benefit from pela + PTX may be attributed to an adaptive T cell response triggered by pela. To examine if pela can mediate the priming of an anti-tumor immune response, and the impact of checkpoint blockade therapy on this response, we and SOLTI research group are conducting the AWARE-1 study (NCT04102618) in patients with early breast cancer. The initial translational research results from this study are presented here. Methods: AWARE-1 is a window-of-opportunity study to evaluate the safety and effect of pela ± atezolizumab on the tumor microenvironment (TME) in 38 women with early breast cancer. Patients are treated with pela on days 1, 2, 8, and 9, and atezolizumab is administered on day 3. Tumor biopsies are collected at diagnosis, day 3, and day ~21. Five patient cohorts are being examined: Cohort 1: HR+/HER2-neg (10 patients) receiving pelareorep + letrozole (without atezolizumab); Cohort 2: HR+/HER2-neg (10 patients) receiving pelareorep + letrozole + atezolizumab; Cohort 3: TNBC (6 patients) receiving pelareorep + atezolizumab; Cohort 4: HR+/HER2+ (6 patients) receiving pelareorep + trastuzumab + atezolizumab; Cohort 5: HR-neg/HER+ (6 patients) receiving pelareorep + trastuzumab + atezolizumab. The primary endpoint is CelTIL score [2], a metric for quantifying changes in tumor cellularity and the number of tumor infiltrating lymphocytes (TILs), where an increase in CelTIL score has been associated with a favorable response to treatment. Tumor tissue is being examined for pela replication, changes to the TME by immunohistochemistry (IHC), PD-L1 expression by the Ventana SP142 assay used as the atezolizumab companion diagnostic, and T cell clonality by T cell receptor sequencing (TCR-seq). Peripheral blood is also being examined by TCR-seq. Results: Changes in the TME by IHC demonstrate that treatment with pela in the presence of atezolizumab increases the CD8/Treg ratio, a predictor of greater therapeutic efficacy, similar to preclinical breast cancer mouse models [3, 4]. Detailed TCR-seq, Ventana PD-L1 assay results, and IHC analysis will be presented, focusing on differences between patients receiving pela in the absence or presence of atezolizumab (Cohorts 1 and 2, respectively), and between CelTIL scores of responders and non-responders. Overall, these data demonstrate that pela can promote an inflamed tumor phenotype that allows for synergy with checkpoint blockade therapy in breast cancer.
References: [1] Bernstein, V., et al. Breast Cancer Res Treat, 2018. 167(2): p. 485-493. [2] Nuciforo, P., et al. Ann Oncol, 2018. 29(1): p. 170-177. [3] Mostafa, A.A., et al. Cancers (Basel), 2018. 10(6). [4] Lee, J., et al. Cancer Research, 2020. 80(16 Supplement): p. 2206-2206.
Citation Format: Luis Manso, Fernando Salvador, Patricia Villagrasa, Nuria Chic, Begoña Bermejo, Juan M. Cejalvo, Yann Izarzugaza, Blanca Cantos, Salvador Blanch, Mireia Margeli, Jose L. Alonso, Alejandro Martínez, Rafael Villanueva, Juan A. Guerra, Raquel Andrés, Pilar Zamora, Esteban Nogales, Manel Juan, Blanca Gonzalez-Farre, Grey A. Wilkinson, Thomas C. Heineman, Gerard Nuovo, Houra Loghmani, Matt Coffey, Azucena Gonzalez, Débora Martínez, Laia Paré, Tomás Pascual, Xavier Gonzalez, Aleix Prat, Joaquín Gavilá. A window-of-opportunity study with atezolizumab and the oncolytic virus pelareorep in early breast cancer (AWARE-1) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr CT191.
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Affiliation(s)
- Luis Manso
- 1Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Nuria Chic
- 3Medical Oncology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Begoña Bermejo
- 4Hospital Clínico Universitario de Valencia, INCLIVA (Instituto de investigación sanitaria) and CIBERONC, Valencia, Spain
| | - Juan M. Cejalvo
- 4Hospital Clínico Universitario de Valencia, INCLIVA (Instituto de investigación sanitaria) and CIBERONC, Valencia, Spain
| | - Yann Izarzugaza
- 5Oncolytics Biotech Inc.Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Blanca Cantos
- 6Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | - Mireia Margeli
- 8Medical Oncology Department, ICO Badalona, Institut Català d'Oncologia, Barcelona, Spain
| | - Jose L. Alonso
- 9Oncolytics Biotech Inc.Hospital Clínico Universitario Virgen de la Arrixaca-IMIB, Murcia, Spain
| | - Alejandro Martínez
- 10Medical Oncology Department, Hospital Universitari Quirón Dexeus, Barcelona, Spain
| | | | | | - Raquel Andrés
- 13Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Pilar Zamora
- 14Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | | | - Manel Juan
- 3Medical Oncology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | | | | | - Gerard Nuovo
- 19Ohio State University Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH
| | | | - Matt Coffey
- 17Oncolytics Biotech Inc., Calgary, Alberta, Canada
| | - Azucena Gonzalez
- 3Medical Oncology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Débora Martínez
- 20Medical Oncology Department, Hospital Clinic de Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Laia Paré
- 3Medical Oncology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Tomás Pascual
- 2SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - Xavier Gonzalez
- 21Hospital Universitari General de Catalunya, Sant Cugat del Vallés, Spain
| | - Aleix Prat
- 22SOLTI Breast Cancer Research Group; Medical Oncology Department, Hospital Clinic de Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS); Medicine Department, University of Barcelona, Barcelona, Spain
| | - Joaquín Gavilá
- 7Instituto Valenciano de Oncología (IVO), Valencia, Spain
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Alonso Marin N, Ocáriz M, Gascon Ruiz M, Sesma Goñi A, Zurera Berjaga M, Zapata-Garcia M, Ruiz Moreno I, Moratiel Pellitero A, Marti Pi M, Goas Gomez A, Cruellas M, Alvarez M, Andrés R, Isla D, Lastra R. Hereditary breast cancer associated with the CHEK2 gene: Study through NGS in a Spanish cohort. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e22502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e22502 Background: Inherited mutations in the CHEK2 gene have been associated with an increased lifetimerisk of develop breast cancer (BC). The main objective of the study is to identify in our population the prevalence of mutations in the CHEK2 gene in diagnosed BC patients, as well as to evaluate the phenotypic characteristics of the tumour and family history. Methods: A genetic study was performed in 396 patients diagnosed of BC at the University Hospital Lozano Blesa of Zaragoza (Spain). We selected 9 patients with genetic variants in the CHEK2 gene and performed a descriptive analysis of the clinical variables, a bibliographic review of the genetic variants and a co-segregation study. Results: We identified 2 pathogenic variants ( CHEK2 c.349 A>G and c.507delT) and 6 variants of uncertain significance (VUS). The genotypic characteristics of the VUS are summarized in the table. In all cases there was a family history of BC in first and /or second degree relatives. The variant cosegregated with the disease in one of the families. Conclusions: The pathogenic missense variant c.349A>G was found in two families. This is a rare missense variant. Studies have shown that this variant had a significant impact on the protein based on in silico prediction and has been associated with BC. In our study, this variant was found in a patient with renal carcinoma and was identified in a proband with a strong family history of pancreatic and ovarian cancer (OC). However, there aren’t exist data about the risk of developing other cancer, different of BC, with this specific mutation. The other pathogenic variant detected was CHEK2 c.507delT in a family with history of BC and OC. This variant is a frameshift mutation, predicted to cause loss of normal protein function. CHEK2 507delT was reported in one of 12 BC families in one series and is possible its relation with OC. With regard to the VUS the cosegregation analysis in selected families may help understand if a variant could have played a role in developing cancer. In conclusion, CHEK2 mutations have been associated with increased risk for BC. However, the frequency of carriers may vary depending on the population, and different mutations may be associated with different cancer risks. More studies are needed to establish a complete range of risks associated with CHEK2 mutations. [Table: see text]
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Affiliation(s)
| | - Maitane Ocáriz
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Marta Gascon Ruiz
- Department of Medical Oncology, Hospital Clinico Lozano Blesa, Zaragoza, Spain
| | - Andrea Sesma Goñi
- Department of Medical Oncology, Hospital Clinico Lozano Blesa, Zaragoza, Spain
| | | | - Maria Zapata-Garcia
- Department of Medical Oncology, Hospital Clinico Lozano Blesa, Zaragoza, Spain
| | - Ines Ruiz Moreno
- Department of Medical Oncology, Hospital Clinico Lozano Blesa, Zaragoza, Spain
| | | | - Maria Marti Pi
- Department of Medical Oncology, Hospital Clinico Lozano Blesa, Zaragoza, Spain
| | - Ana Goas Gomez
- Department of Medical Oncology, Hospital Clinico Lozano Blesa, Zaragoza, Spain
| | - Mara Cruellas
- Medical Oncology Department, University Hospital Vall d´Hebron and Vall d´Hebron Institute of Oncology, Barcelona, Spain
| | - Maria Alvarez
- Medical Oncology, Hospital Clinico Lozano Blesa, Zaragoza, Spain
| | - Raquel Andrés
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Zaragoza, Spain
| | | | - Rodrigo Lastra
- Department of Medical Oncology, Hospital Clinico Lozano Blesa, Zaragoza, Spain
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12
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Guerrero-Zotano A, Jara C, López-Tarruella S, Rodríguez CA, Adrover E, Falo C, Martínez P, Antolín S, Margeli M, Cruz J, Rodríguez-Lescure A, Iranzo V, Gómez-Raposo C, Illarramendi JJ, Malón D, Alonso JL, Antón A, Andrés R, Herranz J, Bezares S, Caballero R, Álvarez I, Rojo F. Abstract PS5-22: Mutational profile from circulating tumor DNA in triple negative breast cancer: Results from the prospective registry of unresectable locally advanced or metastatic breast cancer GEICAM/2014-03 (RegistEM). Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps5-22] [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: The RegistEM is a non-interventional cohort study enrolling 1,867 patients (pts) (males or females) with advanced breast cancer diagnosed from January 2016 to December 2019, either after recurrence or as first diagnosis, in 38 Spanish sites. Triple negative BC (TNBC) is clinically defined based on lack of expression of both estrogen and progesterone receptors, and HER2 overexpression, and constitutes approximately 16% of BC cases. It is a particularly proliferative and aggressive BC subtype characterized by higher rates of relapse, greater metastatic potential, and shorter overall survival compared with other BC subtypes. Recent studies have shown hormone receptor status can change from the primary (P) to the recurrence tumor (M) in a proportion of cases, inducing a switch to TNBC in the recurrence, while other remains TNBC both in the P and M setting. This feature might impact survival and treatment options. Methods: We selected TNBC pts from the RegistEM study with ctDNA plasma samples available from the relapse. TNBC pts were classified into 2 groups according to clinical subtype (CS): 1) CS-converted (CS-C), with a discordant phenotype (TN subtype in M but not in P); and 2) CS-non-converted (CS-NC), with TN phenotype in P and M. To compare the mutation profiles of the 2 groups, next-generation sequencing (NGS) was performed using the AVENIO Expanded ctDNA Analysis Kit (Roche Sequencing Solutions, Inc; 77 genes; SNPs, indels, fusions and CNVs). Genomics alterations at individual level and grouped by pathway were explored for pathogenic and probably pathogenics variants. Genomics findings were correlated with clinicopathological data and outcomes, in terms of progression-free survival (PFS) and response to first line chemotherapy treatment. Kaplan-Meier estimator and Cox regression model were used to analyze PFS, and Fisher’s test to analyze contingency tables. Bonferroni correction was used for multiple testing. Results: NGS data was available from 32 (17%) TNBC pts; 22 (69%) pts CS-NC and 10 (31%) CS-C. The time from diagnosis to relapse was 29.2 months (m) for CS-NC and 60.2m for CS-C (HR=4.81, 95% confidence interval (CI) (1.59-14.59), p=0.0055; adjusted for confounders: menopausal status, grade, stage). In the metastatic setting, CS-NC had similar PFS than CS-C (8.3m CS-C vs 5.3m CS-NC; HR=1.63, 95% CI (0.71-3.72), p=0.2442). A median of 3 genomic alterations were found, similar in both groups. The most frequent somatic alterations were TP53 (50%), MAP2K1 (25%) and APC (25%). CS-C were enriched for MAP2K1 (60% vs. 9% in CS-NC; p=0.0243). No single genomic alteration was associated with outcome. Forty-percent of tumors harbored at least 1 mutation in PI3K-AKT-mTOR pathway (PIK3CA, PIK3R1, AKT1, AKT2, PTEN or MTOR genes), with similar incidence between CS-NC and CS-C. Pts with an altered PI3K-AKT-mTOR pathway had poor PFS (3.9m mutant vs 6.7m wild-type (WT); HR=3.02, 95% CI (1.4-6.56), p=0.0033) and a trend to worse response (complete or parcial response and stable disease: 23% mutant vs 77% WT, p=0.1581). CS-C tumors presented an altered MAPK-ERK pathway (mutations in KRAS, NRAS, BRAF, MAP2K1 or RAF1 genes) more frequently in comparison to CS-NC (60% vs 23%, p=0.0557), with no differences in response or PFS. Finally tumors with a high mutation allele frequency (≥mean) showed poor PFS (HR=3.64, 95% CI (1.52-8.75), p=0.0038). Conclusion: Analysis of ctDNA reveals diverse mutational spectrum in metastatic TNBC, suggesting that the presence of PI3K-AKT-mTOR pathway alterations associates with worse outcome and poor response to standard therapies. The clinical subtype conversions from luminal primary tumor are enriched in MAPK-ERK pathway alterations.
Citation Format: Angel Guerrero-Zotano, Carlos Jara, Sara López-Tarruella, César A Rodríguez, Encarna Adrover, Catalina Falo, Purificación Martínez, Silvia Antolín, Mireia Margeli, Josefina Cruz, Alvaro Rodríguez-Lescure, Vega Iranzo, César Gómez-Raposo, Jose Juan Illarramendi, Diego Malón, Jose Luis Alonso, Antonio Antón, Raquel Andrés, Jesús Herranz, Susana Bezares, Rosalía Caballero, Isabel Álvarez, Federico Rojo. Mutational profile from circulating tumor DNA in triple negative breast cancer: Results from the prospective registry of unresectable locally advanced or metastatic breast cancer GEICAM/2014-03 (RegistEM) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS5-22.
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Affiliation(s)
- Angel Guerrero-Zotano
- 1Fundación Instituto Valenciano de Oncología (FIVO). Spanish Breast Cancer Group, Valencia, Spain
| | - Carlos Jara
- 2Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos. Spanish Breast Cancer Group, Madrid, Spain
| | - Sara López-Tarruella
- 3Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense. CIBERONC-ISCIII. Spanish Breast Cancer Group, Madrid, Spain
| | - César A Rodríguez
- 4Hospital Clínico Universitario de Salamanca-IBSAL. Spanish Breast Cancer Group, Salamanca, Spain
| | - Encarna Adrover
- 5Complejo Hospitalario Universitario de Albacete. Spanish Breast Cancer Group, Albacete, Spain
| | - Catalina Falo
- 6Institut Català d’Oncologia (ICO)-Hospitalet-Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona. Spanish Breast Cancer Group, Barcelona, Spain
| | | | - Silvia Antolín
- 8Complejo Hospitalario Universitario A Coruña (CHUAC). Spanish Breast Cancer Group, Valencia, Spain
| | - Mireia Margeli
- 9ICO-Badalona. Hospital Germans Trias i Pujol, Badalona. Spanish Breast Cancer Group, Badalona, Barcelona, Spain
| | - Josefina Cruz
- 10Hospital Universitario de Canarias. Spanish Breast Cancer Group, Santa Cruz de Tenerife, Spain
| | | | - Vega Iranzo
- 12Consorcio Hospital General Universitario de Valencia. Spanish Breast Cancer Group, Valencia, Spain
| | - César Gómez-Raposo
- 13Infanta Sofía University Hospital. Spanish Breast Cancer Group, Madrid, Spain
| | - Jose Juan Illarramendi
- 14Complejo Hospitalario de Navarra, Servicio Navarro de Salud-Osasunbidea. Spanish Breast Cancer Group, Pamplona, Spain
| | - Diego Malón
- 15Hospital Universitario de Fuenlabrada. Spanish Breast Cancer Group, Madrid, Spain
| | - Jose Luis Alonso
- 16Hospital Clínico Universitario Virgen de la Arrixaca, (IMIB-Arrixaca), Universidad de Murcia. Spanish Breast Cancer Group, Murcia, Spain
| | - Antonio Antón
- 17Hospital Universitario Miguel Servet, Instituto de Investigación Sanitaria de Aragón (IIS Aragón). Spanish Breast Cancer Group, Zaragoza, Spain
| | - Raquel Andrés
- 18Hospital Universitario Lozano Blesa. Spanish Breast Cancer Group, Zaragoza, Spain
| | | | | | | | - Isabel Álvarez
- 20Hospital Universitario Donostia-BioDonostia. Spanish Breast Cancer Group, San Sebastián, Spain
| | - Federico Rojo
- 21Hospital Universitario Fundación Jiménez Díaz. CIBERONC-ISCIII. Spanish Breast Cancer Group, Madrid, Spain
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Manso L, Villagrasa P, Chic N, Bermejo B, Cejalvo JM, Izarzugaza Y, Cantos B, Blanch S, Margeli M, Alonso JL, Martínez A, Villanueva R, Guerra JA, Andrés R, Zamora P, Nogales E, Juan M, González B, Laeufle R, Nuovo G, Wilkinson G, Coffey M, González A, Martínez D, Paré L, Salvador F, Gonzalez X, Prat A, Gavilá J. Abstract PS12-08: A window-of-opportunity study with atezolizumab and the oncolytic virus pelareorep in early breast cancer (REO-027, AWARE-1). Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps12-08] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: A previous phase 2 study in metastatic breast cancer compared treatment with intravenously delivered oncolytic reovirus, pelareorep (pela), in combination with paclitaxel (PTX) versus PTX alone. This study demonstrated a statistically significant improvement in overall survival (OS), without differences in objective response or progression-free survival. We hypothesized that the OS benefit from pela + PTX may be attributed to an adaptive immune response triggered by pela. To test this hypothesis, and examine if pela can mediate the priming of an anti-tumor immune response, we designed a study called AWARE-1 (A window-of-opportunity study of pela in Early Breast Cancer), which is currently enrolling and for which initial translational research results are presented.
Methods: AWARE-1 is evaluating the safety and effect of pela ± atezolizumab on the tumor microenvironment (TME) in 38 women with early breast cancer. Patients are treated with pela on days 1, 2, 8, and 9, while atezolizumab is administered on day 3. Tumor biopsies are collected at diagnosis, day 3, and day ~21. Five cohorts will be examined: Cohort 1: Hormone Receptor-positive/HER2-negative (HR+/HER2-neg) (10 patients), pelareorep + letrozole. Cohort 2: HR+/HER2-neg (10 patients), pelareorep + letrozole + atezolizumab. Cohort 3: Triple Negative Breast Cancer (TNBC) (6 patients), pelareorep + atezolizumab. Cohort 4: Hormone Receptor-positive/HER2-positive (HR+/HER2+) (6 patients), pelareorep + trastuzumab + atezolizumab. Cohort 5: Hormone Receptor-negative/HER2-positive (HR-/HER2+) (6 patients), pelareorep + trastuzumab + atezolizumab. The primary endpoint of the study is CelTIL score, a metric for quantifying the changes in tumor cellularity and infiltration of TILs, where an increase in CelTIL is associated with a favorable response to treatment. Tumor tissue was examined for pela replication, and changes to the TME were assessed by imaging mass cytometry (IMC), immunohistochemistry, and T cell receptor sequencing (TCR-seq). Peripheral blood was also examined by TCR-seq.
Results: Detailed translational research results will be presented from patients in cohort 1, who received just pelareorep and letrozole. CelTIL score increased in 5/10 patients at day 3 biopsies and 6/10 patients at day 21 biopsies. Preliminary results show high levels of viral replication (>50% of tumor cells) while immunohistochemistry and IMC analysis revealed changes to the TME, with increases in CD8+ T cells and upregulation of PD-L1 at both day 3 and day 21 biopsies. Overall, preliminary data from cohort 1 of AWARE-1 demonstrate pela-mediated priming of an adaptive immune response. (NCT04102618)
Citation Format: Luis Manso, Patricia Villagrasa, Nuria Chic, Begoña Bermejo, Juan Miguel Cejalvo, Yann Izarzugaza, Blanca Cantos, Salvador Blanch, Mireia Margeli, Jose Luis Alonso, Alejandro Martínez, Rafael Villanueva, Juan Antonio Guerra, Raquel Andrés, Pilar Zamora, Esteban Nogales, Manel Juan, Blanca González, Rita Laeufle, Gerard Nuovo, Grey Wilkinson, Matt Coffey, Azucena González, Débora Martínez, Laia Paré, Fernando Salvador, Xavier Gonzalez, Aleix Prat, Joaquín Gavilá. A window-of-opportunity study with atezolizumab and the oncolytic virus pelareorep in early breast cancer (REO-027, AWARE-1) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS12-08.
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Affiliation(s)
- Luis Manso
- 1Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Nuria Chic
- 3Hospital Clinic de Barcelona, Barcelona, Spain
| | - Begoña Bermejo
- 4Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Yann Izarzugaza
- 5Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Blanca Cantos
- 6Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | - Mireia Margeli
- 8Institut Català d’Oncologia, ICO Badalona, Barcelona, Spain
| | - Jose Luis Alonso
- 9Hospital Clínico Universitario Virgen de la Arrixaca-IMIB, Murcia, Spain
| | | | | | | | - Raquel Andrés
- 13Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | | | - Manel Juan
- 3Hospital Clinic de Barcelona, Barcelona, Spain
| | | | | | - Gerard Nuovo
- 17Ohio State University Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Colombus, OH
| | | | | | | | - Débora Martínez
- 18Hospital Clinic de Barcelona/August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Laia Paré
- 2SOLTI Breast Cancer Research Group, Barcelona, Spain
| | | | - Xavier Gonzalez
- 19Hospital Universitari General de Catalunya, San Cugat del Vallés, Barcelona, Spain
| | - Aleix Prat
- 20Hospital Clinic de Barcelona/SOLTI Breast Cancer Research Group/August Pi i Sunyer Biomedical Research Institute (IDIBAPS)/Medicine Department, University of Barcelona, Barcelona, Spain
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De la Cruz L, Gion M, Cruz J, Alonso JL, Quiroga V, Moreno F, Santisteban M, Andrés R, Holgado E, Palazón N, Rodríguez LM, Soto A, Cortés J, Cortés A, Ramos M, Casas M, Chiesa M, Bezares S, Caballero R, Rojo F. Abstract PS4-38: Association of tumor infiltrating lymphocytes (TILs) density and PD-L1 expression with pembrolizumab (P) plus gemcitabine (Gem) efficacy in patients with HER2-negative advanced breast cancer (ABC) from the GEICAM/2015-04 (PANGEA-Breast) study. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps4-38] [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 Immune cells (ICs) infiltration and immune checkpoints have been shown to be important for BC patients’ (pts) prognosis and response to immunotherapy. We aimed to analyze the relation between TILs prevalence and PD-L1 expression with efficacy to an immunostimulatory combination with P and Gem in ABC HER2-negative pts previously treated with ≤4 chemotherapy and/or ≥2 hormone therapy lines from the PANGEA-Breast trial (NCT03025880). Methods Pre-treatment (ttm) metastatic BC samples were assessed for TILs density [% of occupied stromal area upon H&E staining] and for PD-L1 immunohistochemistry expression using monoclonal anti-PD-L1 antibody clone 22C3 (Merck) by calculating ICs score (% of positive infiltrated ICs) and combined positive score [CPS; PD-L1 stained cells (tumor cells, lymphocytes, macrophages) divided by total viable tumor cells, multiplied by 100]. Cut-offs ≥5%, ≥10%, ≥30% were explored for TILs. PD-L1 scores were considered positive if ≥1%. Cut-offs (≥5%, ≥20%, ≥50%) were additionally assessed for PD-L1 as CPS. Logistic regression models were used to evaluate association between TILs density and PD-L1 expression with ttm efficacy in terms of Objective Response Rate [ORR; Complete + Partial Response (CR + PR)], Clinical Benefit Rate [CBR; CR + PR + Stable Disease ≥24 weeks] and Progression Free Survival (PFS), according to RECIST v1.1. Results Thirty-six pts were included, 58% had triple negative BC and 98% ECOG score ≤1. Median number of prior ttm lines was 4. ORR and CBR were 15.2% and 17%, respectively; median PFS was 3.1 months. TILs and PD-L1 were evaluated in 30 and 29 pts, respectively. No association was found between TILs density and ttm efficacy in terms of ORR, CBR and PFS. Analysis of PD-L1 ICs score did not reveal any significant association with ORR, CBR or PFS. However, pts with negative PD-L1 expression by CPS (<1%) had a significantly prolonged PFS [p-value=0.031; HR 0.39 (95%CI 0.16; 0.95)], not maintained at CPS <20% cut-off [p-value=0.062; HR 0.42 (95%CI 0.17; 1.08)]. Conclusions Our findings support that: 1) P plus Gem ttm in heavily pre-treated HER2-negative ABC pts obtains a modest ORR of 15.2%; 2) TILs density and PD-L1 expression in ICs does not predict its benefit; 3) PD-L1 in tumor cells scored as CPS impacts in worse outcome (PFS) but not in ORR, suggesting an eventual prognostic role in this population; 4) no long-term responders were observed with P plus Gem in this trial.
Citation Format: Luis De la Cruz, María Gion, Josefina Cruz, Jose Luis Alonso, Vanesa Quiroga, Fernando Moreno, Marta Santisteban, Raquel Andrés, Esther Holgado, Natalia Palazón, Luz Milva Rodríguez, Asunción Soto, Javier Cortés, Alfonso Cortés, Manuel Ramos, Maribel Casas, Massimo Chiesa, Susana Bezares, Rosalía Caballero, Federico Rojo. Association of tumor infiltrating lymphocytes (TILs) density and PD-L1 expression with pembrolizumab (P) plus gemcitabine (Gem) efficacy in patients with HER2-negative advanced breast cancer (ABC) from the GEICAM/2015-04 (PANGEA-Breast) study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS4-38.
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Affiliation(s)
- Luis De la Cruz
- 1Hospital Universitario Virgen de la Macarena. GEICAM Spanish Breast Cancer Group, Seville, Spain
| | - María Gion
- 2Hospital Universitario Ramón y Cajal; Fundación Jiménez Díaz; GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | - Josefina Cruz
- 3Hospital Universitario de Canarias. GEICAM Spanish Breast Cancer Group., Santa Cruz de Tenerife, Spain
| | - Jose Luis Alonso
- 4Hospital Universitario Virgen de la Arrixaca-IMIB. GEICAM Spanish Breast Cancer Group, Murcia, Spain
| | - Vanesa Quiroga
- 5Badalona Applied Research Group in Oncology (B-ARGO Group), Catalan Institute of Oncology. GEICAM Spanish Breast Cancer Group, Badalona, Barcelona, Spain
| | - Fernando Moreno
- 6Hospital Clínico Universitario San Carlos. GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | - Marta Santisteban
- 7Clínica Universidad de Navarra. GEICAM Spanish Breast Cancer Group, Navarra, Spain
| | - Raquel Andrés
- 8Hospital Clínico Universitario Lozano Blesa. GEICAM Spanish Breast Cancer Group, Zaragoza, Spain
| | - Esther Holgado
- 9IOB Institute of Oncology, Hospital Ruber Juan Bravo. GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | - Natalia Palazón
- 1Hospital Universitario Virgen de la Macarena. GEICAM Spanish Breast Cancer Group, Seville, Spain
| | - Luz Milva Rodríguez
- 10Hospital Universitario de Canarias. GEICAM Spanish Breast Cancer Group, Santa Cruz de Tenerife, Spain
| | - Asunción Soto
- 11IMIB-Hospital Universitario Virgen de la Arrixaca. GEICAM Spanish Breast Cancer Group, Murcia, Spain
| | - Javier Cortés
- 12IOB Institute of Oncology, Quiron Group, Madrid & Barcelona/ES - Vall d´Hebron Institute of Oncology (VHIO).. GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | | | - Manuel Ramos
- 14Centro Oncológico de Galicia. GEICAM Spanish Breast Cancer Group, A Coruña, Spain
| | | | | | | | | | - Federico Rojo
- 16Fundación Jimenez Díaz. GEICAM Spanish Breast Cancer Group, Madrid, Spain
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15
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Jara C, Álvarez I, Rodríguez CA, Martínez P, Andrés R, Rodríguez-Lescure Á, Malón D, Alonso JL, Adrover E, Echarri MJ, Margeli M, Tibau A, Ramírez J, Antolín S, Campo R, Miralles JJ, Bezares S, Rojo F, López-Tarruella S, Guerrero-Zotano A. Abstract PS7-35: Geicam/2014-03 (registem): A prospective registry of advanced breast cancer: A subset of triple negative breast cancer patients with her2 low expression. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps7-35] [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: The RegistEM study will provide prospective data from advanced breast cancer (ABC) patients (pts). Understanding the real distribution of BC subtypes is its primary objective. A new nomenclature has been proposed for those cases with HER2 1+ or 2+ by immunohistochemistry and negative in situ hybridization, HER2-low BC. In clinical practice, these tumors are reported as HER2 negative. Methods: This is a non-interventional study that will enroll approximately 1,867 pts with ABC diagnosed from January 2016 to December 2019, either after recurrence or as 1st diagnosis, in 38 Spanish sites. Biological samples (primary and/or metastatic tumor lesions, and blood) collection is part of its procedures. In this analysis (cut-off date 01/April/2020, database ongoing), we describe the characteristics of pts with Triple Negative (TN) subtype and HER2-low expression (as mentioned above). Biomarkers, including HER2, were determined in either primary tumor (PT), M1 or in both, PT and M1. Results: This subset of pts make up 37.4% (n=49) of TN pts considered for this analysis (n=131). Their distribution within the three groups (PT, M1 and PT/M1), was 46.9% (n=23), 42.9% (n=21) and 10.2% (n=5), respectively. These pts were diagnosed with early BC (EBC) and at recurrence, 91.7% presented distant metastases. Median time from EBC diagnosis until recurrent disease in terms of ABC was 29.8 months (mo), with the majority of pts recurring at >12 mo (95.9%), similar to the whole TN subset. Most pts were Caucasian (98%), and at diagnosis of ABC, the median age was 60 years (range 31-84) and 65.3% were postmenopausal. A change of BC subtype was documented in 15/49 (30.6%) pts, with the higher rate in M1 group (52.4%); as opposed to the TN subset, a change to HER2+ disease was reported in 6/15 (40.0%) pts and just after the TN subtype in all cases. Family history of BC and/or ovarian cancer was reported in 42.9% pts and any genetic test to assess the hereditary risk was performed in 30.6% pts. Similarly to TN subset, lung (36.7%), lymph nodes and bone (34.7% each) and liver (24.5%) were the most frequent metastatic locations; central nervous system metastases were developed by 14.3% pts. Visceral involvement was present in 66.7% pts, being this rate lower in M1 compared to PT and PT/M1 groups. The most frequent 1st-line therapies were chemotherapy (CT) (44.9%) and CT/biological therapy (BT) (36.7%). Type of CT mainly included capecitabine (36.4%), taxanes (27.3%), eribulin (13.6%) and platinum-based combinations (13.6%). Most pts received CT as monotherapy (86.4%). Bevacizumab (BVZ) was the most frequent BT associated to CT (77.8%), mainly with capecitabine and/or paclitaxel (72.2%). Progressive disease to 1st-line therapy in the whole group was reported in 73.5% pts (higher than in TN subset), with a median time to progression (TTP) of 5.7 mo (range 1.7-15.0); PT was the group with a higher PD rate. A 2nd-line therapy was reported in 63.3% pts. Similarly to 1st-line setting, the most frequent 2nd-line therapies were CT (74.2%) and CT/BT (12.9%) (with BVZ in 75.0% pts). CT in monotherapy was reported in 69.6% pts (capecitabine 31.3%, eribulin 25.0%). Median duration of this line therapy was 3.0 mo (range 0.6-15.8), PD has been reported in 96.8% pts (similar between groups), and 3rd-line therapy in 25/49 (51.0%) pts.
Conclusions: In TN/HER2-low ABC pts, lung, lymph nodes and bone were the most frequent metastatic locations. As opposed to TN subset, HER2+ disease is part of the subtype changes reported. Although the main 1st- and 2nd-line therapies were CT and CT/BT, similarly to TN subset, the rate of pts with PD to 1st- and 2nd-line therapies is higher, and also those pts treated in the 3rd-line setting.
Citation Format: Carlos Jara, Isabel Álvarez, César A Rodríguez, Purificación Martínez, Raquel Andrés, Álvaro Rodríguez-Lescure, Diego Malón, Jose Luis Alonso, Encarna Adrover, María José Echarri, Mireia Margeli, Ariadna Tibau, Judith Ramírez, Silvia Antolín, Ruth Campo, Juan José Miralles, Susana Bezares, Federico Rojo, Sara López-Tarruella, Angel Guerrero-Zotano. Geicam/2014-03 (registem): A prospective registry of advanced breast cancer: A subset of triple negative breast cancer patients with her2 low expression [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-35.
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Affiliation(s)
- Carlos Jara
- 1Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos. Spanish Breast Cancer Group, Madrid, Spain
| | - Isabel Álvarez
- 2Hospital Universitario Donostia-BioDonostia. Spanish Breast Cancer Group, San Sebastián, Spain
| | - César A Rodríguez
- 3Hospital Universitario de Salamanca IBSAL. Spanish Breast Cancer Group, Salamanca, Spain
| | | | - Raquel Andrés
- 5Hospital Clínico Universitario Lozano Blesa. Spanish Breast Cancer Group, Zaragoza, Spain
| | | | - Diego Malón
- 7Hospital Universitario de Fuenlabrada. Spanish Breast Cancer Group, Madrid, Spain
| | - Jose Luis Alonso
- 8Hospital Clínico-Universitario Virgen de la Arrixaca-IMIB. Spanish Breast Cancer Group, Murcia, Spain
| | - Encarna Adrover
- 9Hospital General Universitario de Albacete. Spanish Breast Cancer Group, Albacete, Spain
| | | | - Mireia Margeli
- 11ICO-Badalona. Hospital Germans Trias i Pujol. Spanish Breast Cancer Group, Badalona, Barcelona, Spain
| | - Ariadna Tibau
- 12Hospital de la Santa Creu y Sant Pau,. Spanish Breast Cancer Group, Barcelona, Spain
| | - Judith Ramírez
- 13Hospital de Sagunto. Spanish Breast Cancer Group, Valencia, Spain
| | - Silvia Antolín
- 14Complejo Hospitalario Universitario A Coruña (CHUAC). Spanish Breast Cancer Group, A Coruña, Spain
| | - Ruth Campo
- 15Spanish Breast Cancer Group, Madrid, Spain
| | | | | | - Federico Rojo
- 16Hospital Universitario Fundación Jiménez Díaz. Spanish Breast Cancer Group, Madrid, Spain
| | - Sara López-Tarruella
- 17Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM). Universidad Complutense. CIBERONC-ISCIII. Spanish Breast Cancer Group, Madrid, Spain
| | - Angel Guerrero-Zotano
- 18Fundación Instituto Valenciano de Oncología (FIVO). Spanish Breast Cancer Group, Valencia, Spain
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González-Santiago S, Ramón y Cajal T, Aguirre E, Alés-Martínez JE, Andrés R, Balmaña J, Graña B, Herrero A, Llort G, González-del-Alba A. SEOM clinical guidelines in hereditary breast and ovarian cancer (2019). Clin Transl Oncol 2019; 22:193-200. [DOI: 10.1007/s12094-019-02262-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/05/2019] [Indexed: 12/17/2022]
Abstract
AbstractMutations in BRCA1 and BRCA2 high penetrance genes account for most hereditary breast and ovarian cancer, although other new high-moderate penetrance genes included in multigene panels have increased the genetic diagnosis of hereditary breast and ovarian cancer families by 50%. Multigene cancer panels provide new challenges related to increased frequency of variants of uncertain significance, new gene-specific cancer risk assessments, and clinical recommendations for carriers of mutations of new genes. Although clinical criteria for genetic testing continue to be largely based on personal and family history with around a 10% detection rate, broader criteria are being applied with a lower threshold for detecting mutations when there are therapeutic implications for patients with breast or ovarian cancer. In this regard, new models of genetic counselling and testing are being implemented following the registration of PARP inhibitors for individuals who display BRCA mutations. Massive sequencing techniques in tumor tissue is also driving a paradigm shift in genetic testing and potential identification of germline mutations. In this paper, we review the current clinical criteria for genetic testing, as well as surveillance recommendations in healthy carriers, risk reduction surgical options, and new treatment strategies in breast cancer gene-mutated carriers.
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Lopez-Tarruella S, Escudero MJ, Pollan M, Martín M, Jara C, Bermejo B, Guerrero-Zotano A, García-Saenz J, Santaballa A, Alba E, Andrés R, Martínez P, Calvo L, Fernández A, Batista N, Llombart-Cussac A, Antón A, Lahuerta A, de la Haba J, López-Vega JM, Carrasco E. Survival impact of primary tumor resection in de novo metastatic breast cancer patients (GEICAM/El Alamo Registry). Sci Rep 2019; 9:20081. [PMID: 31882586 PMCID: PMC6934456 DOI: 10.1038/s41598-019-55765-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 05/17/2019] [Accepted: 12/02/2019] [Indexed: 01/14/2023] Open
Abstract
The debate about surgical resection of primary tumor (PT) in de novo metastatic breast cancer (MBC) patients persists. We explored this approach's outcomes in patients included in a retrospective registry, named El Álamo, of breast cancer patients diagnosed in Spain (1990-2001). In this analysis we only included de novo MBC patients, 1415 of whom met the study's criteria. Descriptive, Kaplan-Meier and Cox regression analyses were carried out. Median age was 63.1 years, 49.2% of patients had single-organ metastasis (skin/soft tissue [16.3%], bone [33.8%], or viscera [48.3%]). PT surgery (S) was performed in 44.5% of the cases. S-group patients were younger, had smaller tumors, higher prevalence of bone and oligometastatic disease, and lower prevalence of visceral involvement. With a median follow-up of 23.3 months, overall survival (OS) was 39.6 versus 22.4 months (HR = 0.59, p < 0.0001) in the S- and non-S groups, respectively. The S-group OS benefit remained statistically and clinically significant regardless of metastatic location, histological type, histological grade, hormone receptor status and tumor size. PT surgery (versus no surgery) was associated with an OS benefit suggesting that loco-regional PT control may be considered in selected MBC patients. Data from randomized controlled trials are of utmost importance to confirm these results.
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Affiliation(s)
- Sara Lopez-Tarruella
- Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain.
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain.
| | - M J Escudero
- GEICAM, Spanish Breast Cancer Research Group, Madrid, Spain
| | - Marina Pollan
- Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Miguel Martín
- Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain
| | - Carlos Jara
- Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Madrid, Spain
| | - Begoña Bermejo
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain
- Hospital Clínico Universitario, Valencia. Biomedical Research Institute INCLIVA, Universidad de Valencia, Valencia, Spain
| | | | - José García-Saenz
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain
- Servicio de Oncología Médica, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | - Emilio Alba
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain
- Complejo Hospitalario Virgen de la Victoria, Málaga, Spain
| | - Raquel Andrés
- Hospital Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Lourdes Calvo
- Complejo Hospitalario Juan Canalejo, A Coruña, Spain
| | | | | | | | - Antonio Antón
- Hospital General Universitario Miguel Servet, Zaragoza, Spain
| | | | - Juan de la Haba
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain
- Complejo Hospitalario Reina Sofía, Córdoba, Spain
| | | | - E Carrasco
- GEICAM, Spanish Breast Cancer Research Group, Madrid, Spain
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18
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Virizuela JA, Garcia AM, de las Peñas R, Santaballa A, Andrés R, Beato C, de la Cruz S, Gavilá J, González-Santiago S, Fernández TL. Replied to “Some remarks to SEOM clinical guidelines on cardiovascular toxicity (2018)”. Clin Transl Oncol 2019; 21:1788-1789. [DOI: 10.1007/s12094-019-02173-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 06/28/2019] [Indexed: 11/30/2022]
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Andrés R, Menao S, Arruebo M, Quílez E, Cardiel MJ. Double heterozygous mutation in the BRCA1 and ATM genes involved in development of primary metachronous tumours: a case report. Breast Cancer Res Treat 2019; 177:767-770. [PMID: 31292799 DOI: 10.1007/s10549-019-05343-4] [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: 06/25/2019] [Accepted: 06/29/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Between 5 and 10% of cases of breast cancer (BC) are attributable to a genetic susceptibility. The BRCA1 and BRCA2 genes described in the late 1990s are associated with an increased risk of breast and ovarian cancer, and the clinical management of carriers of pathogenic variants in these genes is defined in several clinical guidelines (Paluch-Shimon et al. in Ann Oncol 27(suppl 5):v103-v110, 2016; Llort et al. in Clin Transl Oncol 17(12):956-961, 2015). However, the pathogenic variants in BRCA1 and BRCA2 represent only a third of the causes of hereditary BC (Easton et al. in N Engl J Med 372:2243-2257, 2015). The incorporation of NGS (Next Generation Sequencing) techniques in the genetic diagnosis of this pathology, in addition to minimising the cost and time of analysis, allows the simultaneous study of other genes of high and moderate penetrance (Easton et al. in N Engl J Med 372:2243-2257, 2015; Op. Cit.; Tung et al. in Cancer 121(1):25-33, 2015). To date, there are not many cases or series of patients that describe the co-occurrence of two pathogenic variants in these genes of BC. Cases of double heterozygosis have been described with the presence of pathogenic variants in BRCA1, BRCA2, PALB2, CHEK2, BLM or NBN (Nomizu et al. in Breast Cancer 22(5):557-61, 2015; Heidemann et al. in Breast Cancer Res Treat 134(3):1229-1239, 2012; Zuradelli et al. in Breast Cancer Res Treat 124(1):251-258, 2010; Sokolenko et al. in Breast Cancer Res Treat 145(2):553-562, 2014). METHODS We report the case of a patient diagnosed with multiple tumours who presented two pathogenic variants in heterozygosis. RESULTS Two pathogenic variants, c.5123C > A (p.Ala1708Glu) in the BRCA1 gene and c.2413C > T (p.Arg805X) in the ATM gene were detected in heterozygosis. Said variants were confirmed by Sanger-type sequencing using specific primers. CONCLUSIONS The implementation of gene panels using NGS in the study of hereditary cancer involves the detection of heterozygous double mutations in genes of high and moderate penetrance for cancer, although with a low frequency.
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Affiliation(s)
- Raquel Andrés
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
| | - Sebastian Menao
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - María Arruebo
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Elisa Quílez
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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Llombart A, Andrés R, Anton Torres A, Martinez N, Rodriguez C, Sánchez-Rovira P, Rojas B, Ruiz Borrego M, Bermejo B, Martinez de Dueñas E. Impact of the 21-gene assay on treatment decisions in high-risk patients with ER-positive HER2-negative early breast cancer: Results of the KARMA Dx study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz095.027] [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: 11/15/2022] Open
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21
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Gavilá J, Oliveira M, Pascual T, Perez-Garcia J, Gonzàlez X, Canes J, Paré L, Calvo I, Ciruelos E, Muñoz M, Virizuela JA, Ruiz I, Andrés R, Perelló A, Martínez J, Morales S, Marín-Aguilera M, Martínez D, Quero JC, Llombart-Cussac A, Prat A. Safety, activity, and molecular heterogeneity following neoadjuvant non-pegylated liposomal doxorubicin, paclitaxel, trastuzumab, and pertuzumab in HER2-positive breast cancer (Opti-HER HEART): an open-label, single-group, multicenter, phase 2 trial. BMC Med 2019; 17:8. [PMID: 30621698 PMCID: PMC6325829 DOI: 10.1186/s12916-018-1233-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 12/10/2018] [Indexed: 01/06/2023] Open
Affiliation(s)
- Joaquín Gavilá
- Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - Mafalda Oliveira
- Vall d' Hebron University Hospital/Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Tomás Pascual
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Hospital Clínic, Barcelona, Spain.,SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - Jose Perez-Garcia
- Vall d' Hebron University Hospital/Vall d'Hebron Institute of Oncology, Barcelona, Spain.,Instituto Oncológico Baselga, Hospital Quirón, Barcelona, Spain
| | - Xavier Gonzàlez
- SOLTI Breast Cancer Research Group, Barcelona, Spain.,Institut Oncològic Rosell, Hospital General Catalunya, Barcelona, Spain
| | - Jordi Canes
- SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - Laia Paré
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Isabel Calvo
- Centro Integral Oncológico Clara Campal, Madrid, Spain
| | | | - Montserrat Muñoz
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Hospital Clínic, Barcelona, Spain
| | | | - Isabel Ruiz
- Hospital Universitario Sant Joan De Reus, Reus, Spain
| | - Raquel Andrés
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | | | | | | | - Débora Martínez
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | | | - Aleix Prat
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain. .,Hospital Clínic, Barcelona, Spain. .,SOLTI Breast Cancer Research Group, Barcelona, Spain.
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Ayala de la Peña F, Andrés R, Garcia-Sáenz JA, Manso L, Margelí M, Dalmau E, Pernas S, Prat A, Servitja S, Ciruelos E. SEOM clinical guidelines in early stage breast cancer (2018). Clin Transl Oncol 2019; 21:18-30. [PMID: 30443868 PMCID: PMC6339657 DOI: 10.1007/s12094-018-1973-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 02/06/2023]
Abstract
Breast cancer is the most common cancer in women in our country and it is usually diagnosed in the early and potentially curable stages. Nevertheless, around 20-30% of patients will relapse despite appropriate locoregional and systemic therapies. A better knowledge of this disease is improving our ability to select the most appropriate therapy for each patient with a recent diagnosis of an early stage breast cancer, minimizing unnecessary toxicities and improving long-term efficacy.
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Affiliation(s)
- F. Ayala de la Peña
- Department of Hematology and Medical Oncology, Hospital G. Universitario Morales Meseguer, Avda. Marqués de los Vélez, s/n, 30001 Murcia, Spain
| | - R. Andrés
- Division of Medical Oncology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - J. A. Garcia-Sáenz
- Department of Medical Oncology, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - L. Manso
- Department of Medical Oncology, University Hospital, 12 de Octubre, Madrid, Spain
| | - M. Margelí
- Department of Medical Oncology, Breast Cancer Unit, B-ARGO Group, Institut Català d’Oncologia, Badalona, Spain
| | - E. Dalmau
- Department of Oncology, Parc Taulí Sabadell, Hospital Universitari, Barcelona, Spain
| | - S. Pernas
- Department of Medical Oncology, Breast Cancer Unit, Institut Català d’Oncologia, Barcelona, Spain
| | - A. Prat
- Department of Medical Oncology, Hospital Clínic, Barcelona, Spain
| | - S. Servitja
- Department of Medical Oncology, Hospital del Mar, Barcelona, Spain
| | - E. Ciruelos
- Department of Medical Oncology, Breast Cancer Unit, University Hospital, 12 de Octubre, Madrid, Spain
- HM Hospitales, Madrid, Spain
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Andrés R, Mayordomo JI, Zaballos P, Rodino J, Isla D, Escudero P, Elosegui L, Filipovich E, Saenz A, Polo E, Tres A. Prognostic Value of Serum S-100B in Malignant Melanoma. Tumori 2018; 90:607-10. [PMID: 15762365 DOI: 10.1177/030089160409000613] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and Background Although there is no established tumor marker of proven value for patients with melanoma, high serum levels of S-100B protein have been found in patients with melanoma and distant metastases. This study was performed to assess the prognostic value of this marker. Methods and Study Design Serum S-100B protein was measured by means of the LIA-mat System 300 (Sangtec S-100B LIA, AB Sangtec Medical, Bromma, Sweden) in 85 patients with melanoma. Results Mean serum S-100B protein was 0.075 μg/L (range, 0.001-0.470) in 66 patients with non-metastatic melanoma (stage I-III) versus 0.441 μg/L (range, 0.001-16.840) in 19 patients with metastatic melanoma (stage IV) (P <0.001, Mann Whitney U test). The median follow-up time was 329 days. Serum levels above 0.150 μg/L were found in 10 of patients with non-metastatic melanoma (15.2%) and in 17 of 19 patients with metastatic disease (89.4%). Median survival was 256 days for the 27 patients with serum S-100B levels above 0.150 μg/L versus 561 days for the 58 patients with normal values (P <0.3973). Conclusion Serum S-100B is a useful tumor marker in melanoma.
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Affiliation(s)
- Raquel Andrés
- Division of Medical Oncology, University Hospital, Zaragoza, Spain.
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24
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Puértolas I, Frutos Pérez-Surio A, Alcácera MA, Andrés R, Salvador MDT. Effectiveness of biosimilar filgrastim vs. original granulocyte colony-stimulating factors in febrile neutropenia prevention in breast cancer patients. Eur J Clin Pharmacol 2017; 74:315-321. [PMID: 29152672 DOI: 10.1007/s00228-017-2365-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 06/26/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study is to describe the effectiveness of biosimilar filgrastim and original granulocyte colony-stimulating factors (G-CSFs), lenograstim and pegfilgrastim, in febrile neutropenia (FN) prevention in breast cancer patients receiving docetaxel/doxorubicin/cyclophosphamide (TAC) as adjuvant/neoadjuvant treatment and to analyze their treatment patterns. METHODS A pharmacoepidemiology cohort study was developed in a university hospital (with 23 healthcare centers) with retrospective data collection (2012-2014). Effectiveness of G-CSFs was assessed by the FN incidence. Other parameters analyzed were as follows: moderate and severe neutropenia incidence, neutropenia-related hospitalizations, dosage, and duration. Data was analyzed using each cycle as a unit of analysis. RESULTS We identified 98 patients representing 518 chemotherapy cycles, 215 with original G-CSFs (35 lenograstim and 180 pegfilgrastim) and 303 with biosimilar filgrastim. The FN incidence was similar in both groups (3.7% original vs. 3.3% biosimilar; p = 0.79). No statistically significant differences were found in moderate and severe neutropenia incidence (4.7 vs. 6.3%; p = 0.43) or neutropenia-related hospitalizations (3.3 vs. 3.6%; p = 0.19). When the three drugs were evaluated separately, a higher FN incidence was observed with lenograstim than with pegfilgratim or biosimilar (p = 0.024). The dosage and duration of biosimilar were lower than lenograstim (4.9 vs. 5.7 μg/kg/day; 5 vs. 7 days; p < 0.001). CONCLUSION An abbreviated 5-day course of biosimilar filgrastim provided optimal primary prophylaxis against FN post-chemotherapy TAC in patients with breast cancer. The clinical relevance of the highest FN incidence in the lenograstim cohort needs further attention.
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Affiliation(s)
- Isabel Puértolas
- Pharmacy Department, Lozano Blesa University Clinical Hospital, Zaragoza, Spain. .,Investigational Drug Service, Aragon Institute for Health Research, Zaragoza, Spain.
| | - Alberto Frutos Pérez-Surio
- Pharmacy Department, Lozano Blesa University Clinical Hospital, Zaragoza, Spain.,Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
| | | | - Raquel Andrés
- Medical Oncology Department, Lozano Blesa University Clinical Hospital, Zaragoza, Spain.,Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
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Márquez-Rodas I, Pollán M, Escudero MJ, Ruiz A, Martín M, Santaballa A, Martínez del Prado P, Batista N, Andrés R, Antón A, Llombart A, Fernandez Aramburu A, Adrover E, González S, Seguí MA, Calvo L, Lizón J, Rodríguez Lescure Á, Ramón y Cajal T, Llort G, Jara C, Carrasco E, López-Tarruella S. Frequency of breast cancer with hereditary risk features in Spain: Analysis from GEICAM "El Álamo III" retrospective study. PLoS One 2017; 12:e0184181. [PMID: 28985233 PMCID: PMC5630120 DOI: 10.1371/journal.pone.0184181] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 08/16/2017] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To determine the frequency of breast cancer (BC) patients with hereditary risk features in a wide retrospective cohort of patients in Spain. METHODS a retrospective analysis was conducted from 10,638 BC patients diagnosed between 1998 and 2001 in the GEICAM registry "El Álamo III", dividing them into four groups according to modified ESMO and SEOM hereditary cancer risk criteria: Sporadic breast cancer group (R0); Individual risk group (IR); Familial risk group (FR); Individual and familial risk group (IFR) with both individual and familial risk criteria. RESULTS 7,641 patients were evaluable. Of them, 2,252 patients (29.5%) had at least one hereditary risk criteria, being subclassified in: FR 1.105 (14.5%), IR 970 (12.7%), IFR 177 (2.3%). There was a higher frequency of newly diagnosed metastatic patients in the IR group (5.1% vs 3.2%, p = 0.02). In contrast, in RO were lower proportion of big tumors (> T2) (43.8% vs 47.4%, p = 0.023), nodal involvement (43.4% vs 48.1%, p = 0.004) and lower histological grades (20.9% G3 for the R0 vs 29.8%) when compared to patients with any risk criteria. CONCLUSIONS Almost three out of ten BC patients have at least one hereditary risk cancer feature that would warrant further genetic counseling. Patients with hereditary cancer risk seems to be diagnosed with worse prognosis factors.
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Affiliation(s)
- Iván Márquez-Rodas
- Servicio de Oncología Médica, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Spanish Breast Cancer Research Group (GEICAM), San Sebastian de los Reyes, Spain
- * E-mail:
| | - Marina Pollán
- Spanish Breast Cancer Research Group (GEICAM), San Sebastian de los Reyes, Spain
- Instituto de Salud Carlos III, Madrid, Spain
| | - María José Escudero
- Spanish Breast Cancer Research Group (GEICAM), San Sebastian de los Reyes, Spain
| | - Amparo Ruiz
- Spanish Breast Cancer Research Group (GEICAM), San Sebastian de los Reyes, Spain
- Servicio de Oncología Médica, Instituto Valenciano de Oncología, Valencia, Spain
| | - Miguel Martín
- Servicio de Oncología Médica, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Spanish Breast Cancer Research Group (GEICAM), San Sebastian de los Reyes, Spain
| | - Ana Santaballa
- Spanish Breast Cancer Research Group (GEICAM), San Sebastian de los Reyes, Spain
- Servicio de Oncología Médica, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Purificación Martínez del Prado
- Spanish Breast Cancer Research Group (GEICAM), San Sebastian de los Reyes, Spain
- Servicio de Oncología Médica, Hospital de Basurto-Osakidetza, Bilbao, Spain
| | - Norberto Batista
- Spanish Breast Cancer Research Group (GEICAM), San Sebastian de los Reyes, Spain
- Servicio de Oncología Médica, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Raquel Andrés
- Spanish Breast Cancer Research Group (GEICAM), San Sebastian de los Reyes, Spain
- Servicio de Oncología Médica, Hospital Lozano Blesa, Zaragoza, Spain
| | - Antonio Antón
- Spanish Breast Cancer Research Group (GEICAM), San Sebastian de los Reyes, Spain
- Servicio de Oncología Médica, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Antonio Llombart
- Spanish Breast Cancer Research Group (GEICAM), San Sebastian de los Reyes, Spain
- Servicio de Oncología Médica, Hospital Arnau de Vilanova, Valencia, Spain
| | - Antonio Fernandez Aramburu
- Spanish Breast Cancer Research Group (GEICAM), San Sebastian de los Reyes, Spain
- Sección de Oncología Médica, Complejo Universitario de Albacete, Albacete, Spain
| | - Encarnación Adrover
- Spanish Breast Cancer Research Group (GEICAM), San Sebastian de los Reyes, Spain
- Sección de Oncología Médica, Complejo Universitario de Albacete, Albacete, Spain
| | - Sonia González
- Spanish Breast Cancer Research Group (GEICAM), San Sebastian de los Reyes, Spain
- Servicio de Oncología Médica, Servicio de Oncología Médica, Hospital Mútua de Terrassa, Barcelona, Spain
| | - Miguel Angel Seguí
- Spanish Breast Cancer Research Group (GEICAM), San Sebastian de los Reyes, Spain
- Servicio de Oncología Médica, Hospital de Sabadell-Consorcio Sanitario Parc Taulì de Sabadell, Barcelona, Spain
| | - Lourdes Calvo
- Spanish Breast Cancer Research Group (GEICAM), San Sebastian de los Reyes, Spain
- Servicio de Oncología Médica, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - José Lizón
- Spanish Breast Cancer Research Group (GEICAM), San Sebastian de los Reyes, Spain
- Servicio de Oncología Médica, Hospital Universitario Sant Joan, Alicante, Spain
| | - Álvaro Rodríguez Lescure
- Spanish Breast Cancer Research Group (GEICAM), San Sebastian de los Reyes, Spain
- Servicio de Oncología Médica, Hospital General Universitario de Elche, Elche, Spain
| | - Teresa Ramón y Cajal
- Spanish Breast Cancer Research Group (GEICAM), San Sebastian de los Reyes, Spain
- Servicio de Oncología Médica, Hospital de Sant Pau, Barcelona, Spain
| | - Gemma Llort
- Spanish Breast Cancer Research Group (GEICAM), San Sebastian de los Reyes, Spain
- Unitat de Consell Genetic, Institut Oncologic del Valles, Terrasa, Spain
| | - Carlos Jara
- Spanish Breast Cancer Research Group (GEICAM), San Sebastian de los Reyes, Spain
- Unidad de Oncología, Hospital Universitario Fundación Alcorcón, Alcorcon, Madrid, Spain
| | - Eva Carrasco
- Spanish Breast Cancer Research Group (GEICAM), San Sebastian de los Reyes, Spain
| | - Sara López-Tarruella
- Servicio de Oncología Médica, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Spanish Breast Cancer Research Group (GEICAM), San Sebastian de los Reyes, Spain
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González-Martín A, Alba E, Ciruelos E, Cortés J, Llombart A, Lluch A, Andrés R, Álvarez I, Aramendía JM, de la Peña FA, Barnadas A, Batista N, Calvo L, Galve E, García-Palomo A, García-Sáenz JÁ, de la Haba J, López R, López-Vivanco G, Martínez-Jáñez N, de Dueñas EM, Plazaola A, Rodríguez-Lescure Á, Ruiz M, Sánchez-Rovira P, Santaballa A, Seguí MÁ, Tusquets I, Zamora P, Martín M. Nab-Paclitaxel in Metastatic Breast Cancer: Defining the Best Patient Profile. Curr Cancer Drug Targets 2017; 16:415-28. [PMID: 26278712 DOI: 10.2174/1568009615666150817121731] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 05/10/2015] [Accepted: 08/12/2015] [Indexed: 11/22/2022]
Abstract
Around 40% of patients with breast cancer will present with a recurrence of the disease. Chemotherapy is recommended for patients with recurrent hormone-independent or hormone-refractory breast cancer and almost all patients with metastatic breast cancer (MBC) receive chemotherapy during their medical history. Nanoparticle albuminbound (nab)-paclitaxel is a solvent-free, 130-nanometer particle formulation of paclitaxel. Nab-paclitaxel can be administered to all patients for whom the treatment choice is a taxane. In this review, 6 patient profiles for which nabpaclitaxel may be particularly useful are described and analyzed: (i) as first-line treatment of MBC, (ii) as second-line treatment of MBC after oral chemotherapy, (iii) after a standard taxane, (iv) as third-line treatment after a standard taxane and oral chemotherapy, (v) for patients with HER2-positive MBC and (vi) for patients with intolerance to standard taxanes. Nab-paclitaxel is a rational treatment choice for patients with MBC in different settings, as well as for those with prior exposure to a standard taxane.
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Affiliation(s)
- Antonio González-Martín
- Medical Oncology Department, MD Anderson Cancer Center, Madrid, C/ Arturo Soria, 270, 28033 - Madrid. Spain.
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Gavilá J, Perez-Garcia J, Calvo I, Ciruelos E, Muñoz M, Virizuela JA, Ruiz I, Andrés R, Morales S, Perelló A, Sánchez P, Garcia-Saenz JA, Quero Guillen JC, González-Santiago S, Garau Llinas I, González-Martín A, Cantos Sánchez de Ibargüen B, Zaragoza K, de la Peña L, Llombart-Cussac A, Oliveira M. Abstract P4-21-05: Neoadjuvant non-pegylated liposomal doxorubicin plus paclitaxel, trastuzumab and pertuzumab in patients with HER2+ breast cancer – Final results of the SOLTI OPTI-HER HEART study. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-21-05] [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
INTRODUCTION
Targeting HER2 by dual blockade with trastuzumab (T) and pertuzumab (P) in a taxane-based regimen is an active neoadjuvant treatment (NAT) of HER2+ early breast cancer (EBC). Addition of an anthracycline could further enhance this response, but potential cardiac toxicity is a concern. The Opti-HER HEART trial (NCT01669239) aims to optimize neoadjuvant treatment while minimizing cardiac risk, by combining T+P with a taxane and non-pegylated liposomal doxorubicin (NPLD).
MATERIAL AND METHODS
Phase II open-label, single-arm study of six 21-day cycles of NPLD (50mg/m2 D1), paclitaxel (80mg/m2 D1,8,15), T (4mg/kg C1D1, followed by 2mg/kg weekly), and P (840mg C1D1, followed by 420mg C2-6D1) as NAT for patients (pts) with stage II-IIIB HER2+ BC. Primary objective was to evaluate cardiac safety of the combination, measured by the incidence of type A (symptomatic congestive heart failure ) or type B [asymptomatic reduction of Left Ventricular Ejection Fraction (LVEF) value: ≥10% absolute decrease and LVEF<50%, LVEF<40% or any absolute decrease ≥20%] events, during NAT. Eighty-three pts were required to reject with 80% confidence the null hypothesis that the combination increases the incidence of cardiac events above the historical control of 18% (3% type A; 15% type B).
RESULTS
Between June 2013 and January 2015, 83 pts with HER2+ EBC (stage II 78%, stage III 22%) and adequate cardiac function (LVEF≥55%) were enrolled. Mean age was 50 years, N+ 47%, hormone receptor (HR) positive 71% and median baseline LVEF 66%. Eighty-five percent of pts completed 6 cycles of NAT, whereas 15% discontinued NAT due to toxicity. Adverse events (AEs) leading to dose adjustments/temporary interruptions and discontinuation of at least 1 drug occurred in 70% and 21% of pts, respectively. Primary objective was met with an incidence of cardiac events during NAT of 4% (95%CI 1-10, 3pts, all type B). Cardiac events until study completion (1 year) were 8% (all type B). All (but 2 cases with no follow-up data) were reversible and only 1 pt presented an asymptomatic LVEF<40%. Neutropenia (45%) was the most frequent hematological toxicity (G3/4 34%; febrile neutropenia 6%), less frequent in the 71% of pts that received primary G-CSF prophylaxis (G3/4 25% vs. 67%). Common non-hematological toxicities were diarrhea (74%; G3 7%), asthenia (78%; G3 11%) and neurotoxicity (52%; G3/4 10%). Pathological complete response (pCR) in breast+axilla (ypT0/is ypN0) was 60% (87% in HR-) and 69% in breast (91% in HR-).
TOTALHR-HR+% ypT0/is (95% CI)69 (58-79)91 (72-99)61 (47-74)% ypT0/is ypN0 (95% CI)60 (46-71)87 (66-97)50 (36-64)
CONCLUSIONS
The neoadjuvant combination of T+P, paclitaxel and NPLD does not increase the risk for cardiac events in HER2+ BC pts. Since cardiac toxicities may present later, long-term cardiac monitoring is essential. Efficacy in terms of pCR was remarkable, being higher to historical values of combinations with dual anti-HER2 blockade and one of the highest reported among HR-HER2+ BC. This regimen administered with primary G-CSF prophylaxis and cardiac function monitoring may be an effective and secure option for early and locally advanced HER2+ pts with good cardiac function.
Citation Format: Gavilá J, Perez-Garcia J, Calvo I, Ciruelos E, Muñoz M, Virizuela JA, Ruiz I, Andrés R, Morales S, Perelló A, Sánchez P, Garcia-Saenz JA, Quero Guillen JC, González-Santiago S, Garau Llinas I, González-Martín A, Cantos Sánchez de Ibargüen B, Zaragoza K, de la Peña L, Llombart-Cussac A, Oliveira M. Neoadjuvant non-pegylated liposomal doxorubicin plus paclitaxel, trastuzumab and pertuzumab in patients with HER2+ breast cancer – Final results of the SOLTI OPTI-HER HEART study [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 P4-21-05.
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Affiliation(s)
- J Gavilá
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - J Perez-Garcia
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - I Calvo
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - E Ciruelos
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - M Muñoz
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - JA Virizuela
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - I Ruiz
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - R Andrés
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - S Morales
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - A Perelló
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - P Sánchez
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - JA Garcia-Saenz
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - JC Quero Guillen
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - S González-Santiago
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - I Garau Llinas
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - A González-Martín
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - B Cantos Sánchez de Ibargüen
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - K Zaragoza
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - L de la Peña
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - A Llombart-Cussac
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - M Oliveira
- SOLTI Breast Cancer Research, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Centro Integral Oncológico Clara Campal, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona; Hospital Arnau de Vilanova de Valencia, Valencia, Spain; Hospital Virgen de la Macarena, Sevilla, Spain; Hospital Sant Joan de Reus, Reus, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain; Hospital Universitari Son Espases, Palma de Mallorca, Spain; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Hospital Universitario Clínico San Carlos, Madrid; Hospital Quirón Sagrado Corazón, Sevilla, Spain; Complejo Hospitalario San Pedro de Alcántara, Cáceres, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain
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Martín M, Ruiz Simón A, Ruiz Borrego M, Ribelles N, Rodríguez-Lescure Á, Muñoz-Mateu M, González S, Margelí Vila M, Barnadas A, Ramos M, Del Barco Berron S, Jara C, Calvo L, Martínez-Jáñez N, Mendiola Fernández C, Rodríguez CA, Martínez de Dueñas E, Andrés R, Plazaola A, de la Haba-Rodríguez J, López-Vega JM, Adrover E, Ballesteros AI, Santaballa A, Sánchez-Rovira P, Baena-Cañada JM, Casas M, del Carmen Cámara M, Carrasco EM, Lluch A. Epirubicin Plus Cyclophosphamide Followed by Docetaxel Versus Epirubicin Plus Docetaxel Followed by Capecitabine As Adjuvant Therapy for Node-Positive Early Breast Cancer: Results From the GEICAM/2003-10 Study. J Clin Oncol 2015; 33:3788-95. [PMID: 26416999 DOI: 10.1200/jco.2015.61.9510] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Capecitabine is an active drug in metastatic breast cancer (BC). GEICAM/2003-10 is an adjuvant trial to investigate the integration of capecitabine into a regimen of epirubicin and docetaxel for node-positive early BC. PATIENTS AND METHODS Patients with operable node-positive BC (T1-3/N1-3) were eligible. After surgery, 1,384 patients were randomly assigned to receive epirubicin plus cyclophosphamide (EC; 90 and 600 mg/m(2), respectively, × four cycles), followed by docetaxel (100 mg/m(2) × four cycles; EC-T) or epirubicin plus docetaxel (ET; 90 and 75 mg/m(2), respectively, × four cycles), followed by capecitabine (1,250 mg/m(2) twice a day on days 1 to 14, × four cycles; ET-X); all regimens were given every 3 weeks. The primary end point was invasive disease-free survival. Secondary end points included safety (with an alopecia-specific study) and overall survival (OS). RESULTS After a median follow-up of 6.6 years and 297 events, 86% of patients who received EC-T and 82% of those who received ET-X were invasive disease free at 5 years (hazard ratio, 1.30; 95% CI, 1.03 to 1.64; log-rank P = .03). The OS difference between arms was not statistically significant (hazard ratio, 1.13; 95% CI, 0.82 to 1.55; log-rank P = .46). The most frequent grade 3 to 4 adverse events in the EC-T versus ET-X arms were neutropenia (19% v 10%), with 7% febrile neutropenia across arms; fatigue (13% v 11%); diarrhea (3% v 11%); hand-foot syndrome (2% v 20%); mucositis (6% v 5%); vomiting (both, 5%); and myalgia (4.5% v 1%). Incomplete scalp hair recovery was more frequent in the EC-T than ET-X arm (30% v 14%), and patients who received EC-T wore wigs significantly longer than those who received ET-X (8.35 v 6.03 months). CONCLUSION Invasive disease-free survival, but not OS, was significantly superior for patients with node-positive early BC who received the adjuvant standard schedule EC-T than for those who received the experimental ET-X regimen. Toxicity profiles differed substantially across arms.
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Affiliation(s)
- Miguel Martín
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain.
| | - Amparo Ruiz Simón
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Manuel Ruiz Borrego
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Nuria Ribelles
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Álvaro Rodríguez-Lescure
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Montserrat Muñoz-Mateu
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Sonia González
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Mireia Margelí Vila
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Agustí Barnadas
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Manuel Ramos
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Sonia Del Barco Berron
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Carlos Jara
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Lourdes Calvo
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Noelia Martínez-Jáñez
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - César Mendiola Fernández
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - César A Rodríguez
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Eduardo Martínez de Dueñas
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Raquel Andrés
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Arrate Plazaola
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Juan de la Haba-Rodríguez
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Jose Manuel López-Vega
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Encarna Adrover
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Ana Isabel Ballesteros
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Ana Santaballa
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Pedro Sánchez-Rovira
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - José M Baena-Cañada
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Maribel Casas
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - María del Carmen Cámara
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Eva Maria Carrasco
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Ana Lluch
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
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Calvete O, Martinez P, Garcia-Pavia P, Benitez-Buelga C, Paumard-Hernández B, Fernandez V, Dominguez F, Salas C, Romero-Laorden N, Garcia-Donas J, Carrillo J, Perona R, Triviño JC, Andrés R, Cano JM, Rivera B, Alonso-Pulpon L, Setien F, Esteller M, Rodriguez-Perales S, Bougeard G, Frebourg T, Urioste M, Blasco MA, Benítez J. A mutation in the POT1 gene is responsible for cardiac angiosarcoma in TP53-negative Li-Fraumeni-like families. Nat Commun 2015; 6:8383. [PMID: 26403419 DOI: 10.1038/ncomms9383] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 08/14/2015] [Indexed: 12/30/2022] Open
Abstract
Cardiac angiosarcoma (CAS) is a rare malignant tumour whose genetic basis is unknown. Here we show, by whole-exome sequencing of a TP53-negative Li-Fraumeni-like (LFL) family including CAS cases, that a missense variant (p.R117C) in POT1 (protection of telomeres 1) gene is responsible for CAS. The same gene alteration is found in two other LFL families with CAS, supporting the causal effect of the identified mutation. We extend the analysis to TP53-negative LFL families with no CAS and find the same mutation in a breast AS family. The mutation is recently found once in 121,324 studied alleles in ExAC server but it is not described in any other database or found in 1,520 Spanish controls. In silico structural analysis suggests how the mutation disrupts POT1 structure. Functional and in vitro studies demonstrate that carriers of the mutation show reduced telomere-bound POT1 levels, abnormally long telomeres and increased telomere fragility.
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Affiliation(s)
- Oriol Calvete
- Human Genetics Group, Spanish National Cancer Research Center (CNIO), Melchor Fernandez Almagro 3, Madrid 28029, Spain.,Center for Biomedical Network Research on Rare Diseases (CIBERER), Madrid 28029, Spain
| | - Paula Martinez
- Telomeres and Telomerase Group, Spanish National Cancer Research Center (CNIO), Madrid 28029, Spain
| | - Pablo Garcia-Pavia
- Department of Cardiology. Hospital Universitario Puerta de Hierro, Mahadahonda, Madrid 28222, Spain.,Department of Cardiovascular Development and Repair, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid 28029, Spain
| | - Carlos Benitez-Buelga
- Human Genetics Group, Spanish National Cancer Research Center (CNIO), Melchor Fernandez Almagro 3, Madrid 28029, Spain
| | - Beatriz Paumard-Hernández
- Human Genetics Group, Spanish National Cancer Research Center (CNIO), Melchor Fernandez Almagro 3, Madrid 28029, Spain
| | - Victoria Fernandez
- Human Genetics Group, Spanish National Cancer Research Center (CNIO), Melchor Fernandez Almagro 3, Madrid 28029, Spain
| | - Fernando Dominguez
- Department of Cardiology. Hospital Universitario Puerta de Hierro, Mahadahonda, Madrid 28222, Spain
| | - Clara Salas
- Department of Pathology. Hospital Universitario Puerta de Hierro Majadahonda, Madrid 28222, Spain
| | - Nuria Romero-Laorden
- Oncology Department, Clara Campal Comprehensive Cancer Center, Sanchinarro, Madrid 28050, Spain
| | - Jesus Garcia-Donas
- Oncology Department, Clara Campal Comprehensive Cancer Center, Sanchinarro, Madrid 28050, Spain
| | - Jaime Carrillo
- Department of Experimental Models of Human Disease. Instituto Investigaciones Biomédicas (CSIC/UAM), Madrid 28029, Spain
| | - Rosario Perona
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Madrid 28029, Spain.,Department of Experimental Models of Human Disease. Instituto Investigaciones Biomédicas (CSIC/UAM), Madrid 28029, Spain
| | | | - Raquel Andrés
- Medical Oncology Service, Hospital Universitario Lozano Blesa, Zaragoza 50009, Spain
| | - Juana María Cano
- Medical Oncology Service, Hospital General de Ciudad Real, Ciudad Real 13005, Spain
| | - Bárbara Rivera
- Familial Cancer Clinical Unit, Spanish National Cancer Research Center (CNIO), Madrid 28029, Spain
| | - Luis Alonso-Pulpon
- Department of Cardiology. Hospital Universitario Puerta de Hierro, Mahadahonda, Madrid 28222, Spain
| | - Fernando Setien
- Cancer Epigenetics and Biology Program (PEBC), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona 08908, Spain
| | - Manel Esteller
- Cancer Epigenetics and Biology Program (PEBC), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona 08908, Spain.,Department of Physiological Sciences II, School of Medicine, University of Barcelona, Barcelona 08007, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona 08010, Spain
| | | | - Gaelle Bougeard
- Genetics Department, Rouen University Hospital, Rouen 76000, France
| | - Tierry Frebourg
- Genetics Department, Rouen University Hospital, Rouen 76000, France
| | - Miguel Urioste
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Madrid 28029, Spain.,Familial Cancer Clinical Unit, Spanish National Cancer Research Center (CNIO), Madrid 28029, Spain
| | - Maria A Blasco
- Telomeres and Telomerase Group, Spanish National Cancer Research Center (CNIO), Madrid 28029, Spain
| | - Javier Benítez
- Human Genetics Group, Spanish National Cancer Research Center (CNIO), Melchor Fernandez Almagro 3, Madrid 28029, Spain.,Center for Biomedical Network Research on Rare Diseases (CIBERER), Madrid 28029, Spain
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López-Tarruella S, Escudero MJ, Martín M, Jara C, Guerrero Á, Lluch A, Santaballa A, Martínez del Prado P, Lao J, Alba E, Fernández A, Andrés R, Llombart A, Batista N, Porras I, López-Vega JM, Adrover E, Calvo L, Pollán M, Carrasco E. Abstract P2-13-17: Impact on survival of primary tumor resection in women with de novo metastatic breast cancer. The GEICAM Alamo I-III breast cancer registry (1990-2001). Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p2-13-17] [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
Introduction: Retrospective data from institutional series and population-based databases have suggested a potential benefit of the primary tumor (PT) surgery in de novo metastatic breast cancer (MBC) patients (pts). Recently reported prospective data from 2 randomized trials and a multicenter registry questioned the real role of the local approach in the modern individualized systemic treatment era. Methods: The ALAMO (A) is a retrospective analysis of pts diagnosed with BC between 1990 and 2001 across 56 GEICAM hospitals in Spain. Patterns of BC presentation (tumor and host characteristics), treatment and survival were recorded in 3 cohorts, AI (1990-93, 4529 pts, closed by 2000), AII (1994-97, 10453 pts, closed by 2003) and AIII (1998-2001, 10675 pts, closed by 2007). MBC pts at first diagnosis excluding those without complete information about their PT surgery were included. Descriptive, Kaplan-Meier and Cox regression analyses were carried out. Results: 5.5% (N=1415) of the ALAMO database pts were initially diagnosed with MBC, 1331 fulfilled the present analysis criteria (327 from AI, 619 from AII and 385 from AIII). Median age was 63.1 years (range: 21.6-96.0), 51.8% had single-organ metastasis, and their distribution according to the predominant site of disease was skin/soft tissue (16.2%), bone (33.7%), and visceral (48.4%). Surgery of the PT was done in 44.5% (N=592) of pts (512 with radical procedures, 46 with palliative procedures and 34 unknown); besides, 427 pts underwent axillary dissection. Initial local treatment was the choice for 380 pts (358 surgery and 22 radiotherapy), 722 received initial systemic therapy (480 chemotherapy, 214 endocrine treatment and 28 both), 29 received best supportive care and for 200 pts the treatment sequence could not be established. Pts in the surgery (S) group were younger (19.5% vs 11.8% were <44 years-old in the S vs non-S group respectively), with oligometastatic disease (61.9% vs 43.9% with single-organ involvement in the S vs non-S group respectively) and with different sites of disease (40.2% vs 54.3% with visceral and 39% vs 29.8% with bone metastasis in the S vs non-S group respectively). With a median follow-up of 1.9 years, the 5-yr overall survival (OS) was 25.4% in the entire de novo MBC population, with a median OS of 3.3 yrs in the S-group vs 1.9 yrs in the non-S-group (HR 1.69, p<0.0001). Subgroup analyses showed a benefit of PT surgery in OS regardless the number of metastasis and site of disease, but didn't show this benefit analyzing pts according to BC subtypes. The multi-adjusted HR for surgery was 1.38 (p=0.037). The multivariate Cox regression analysis model included the site of disease (p=0.028), the histopathologic grade (p=0.019) and the hormone receptor status (p=0.007). Discussion: The Alamo data line up with previously reported population-based registries, which highlight the better survival outcome of de novo MBC pts undergoing PT surgery. However, the consideration of the biological heterogeneity of BC has changed the landscape of systemic treatment. Only well designed randomized controlled trials will have the power to discriminate between a consistent bias and a real biologic effect of the PT surgery.
Citation Format: Sara López-Tarruella, María José Escudero, Miguel Martín, Carlos Jara, Ángel Guerrero, Ana Lluch, Ana Santaballa, Purificación Martínez del Prado, Juan Lao, Emilio Alba, Antonio Fernández, Raquel Andrés, Antonio Llombart, Norberto Batista, Ignacio Porras, José Manuel López-Vega, Encarna Adrover, Lourdes Calvo, Marina Pollán, Eva Carrasco. Impact on survival of primary tumor resection in women with de novo metastatic breast cancer. The GEICAM Alamo I-III breast cancer registry (1990-2001) [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-13-17.
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Alés-Martínez JE, Ruiz A, Chacón JI, Lluch Hernández A, Ramos M, Córdoba O, Aguirre E, Barnadas A, Jara C, González S, Plazaola A, Florián J, Andrés R, Sánchez Rovira P, Frau A. Preventive treatments for breast cancer: recent developments. Clin Transl Oncol 2014; 17:257-63. [PMID: 25445174 PMCID: PMC4357652 DOI: 10.1007/s12094-014-1250-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 10/17/2014] [Indexed: 11/15/2022]
Abstract
Breast cancer is a burden for western societies, and an increasing one in emerging economies, because of its high incidence and enormous psychological, social, sanitary and economic costs. However, breast cancer is a preventable disease in a significant proportion. Recent developments in the armamentarium of effective drugs for breast cancer prevention (namely exemestane and anastrozole), the new recommendation from the National Institute for Health and Care Excellence to use preventative drugs in women at high risk as well as updated Guidelines from the US Preventive Services Task Force and the American Society of Clinical Oncology should give renewed momentum to the pharmacological prevention of breast cancer. In this article we review recent major developments in the field and examine their ongoing repercussion for breast cancer prevention. As a practical example, the potential impact of preventive measures in Spain is evaluated and a course of practical actions is delineated.
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Affiliation(s)
- J E Alés-Martínez
- Hospital Nuestra Señora de Sonsoles, GEICAM Spanish Breast Cancer Group, Ávila, Spain,
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Casado JL, Bañon S, Andrés R, Perez-Elías MJ, Moreno A, Moreno S. Prevalence of causes of secondary osteoporosis and contribution to lower bone mineral density in HIV-infected patients. Osteoporos Int 2014; 25:1071-9. [PMID: 24057480 DOI: 10.1007/s00198-013-2506-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 09/05/2013] [Indexed: 01/23/2023]
Abstract
SUMMARY Eighty-one percent of human immunodeficiency virus (HIV)-infected patients had one or more of seven evaluated causes of secondary osteoporosis, and this rate increases with age. The type and number of causes were associated with a lower bone mineral density (BMD), and with an increased rate of osteopenia/osteoporosis, regardless of age and body mass index. INTRODUCTION The objective of this study was to determine whether factors of secondary osteoporosis were associated with lower BMD in HIV. METHODS This was a cross-sectional study of 285 HIV-infected patients (25 % females) evaluating the impact of seven different factors of reduced BMD: hyperthyroidism, diabetes, chronic viral hepatitis, chronic kidney disease (CKD), hypovitaminosis D, secondary hyperparathyroidism, and hypogonadism. Dual-energy X-ray absorptiometry scan of the femoral neck was obtained at the clinical visit. RESULTS Mean age was 45.7 years; osteopenia and osteoporosis were diagnosed in 38 and 6 %, respectively. Overall, 230 patients (81 %) had secondary factors; 107 (38 %) had only 1 cause, 94 (33 %) had 2, and 28 (10 %) had 3 or more, predominantly vitamin D deficiency in 61 %, hepatitis C virus coinfection in 45 %, and secondary hyperparathyroidism in 27 %. The number of secondary factors was closely related to a lower BMD, which is statistically significant for patients having ≥2 causes (0.77 vs 0.73 g/cm(2), p = 0.02). The rate of osteopenia ranged from 36 % without any cause to 57 % with three or more, osteoporosis from 0 to 19 %, and Z-score <-2 SD from 0 to 27 %, respectively. In a multivariate linear regression, adjusting by age, body mass index, and HIV-related factors, the number of secondary factors was independently associated with a lower BMD (ß coefficient -0.134; p = 0.02), mainly due to patients with hepatitis C virus (HCV) coinfection, secondary hyperparathyroidism, and CKD. CONCLUSIONS A high prevalence of secondary causes of osteoporosis is observed in HIV-infected patients, and its type and cumulative number determine a lower BMD, after adjusting by age and body mass index.
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Affiliation(s)
- J L Casado
- Department of Infectious Diseases, Ramon y Cajal Hospital, Cra. de Colmenar, Km 9.1, 28034, Madrid, Spain,
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Andrés R, Pajares I, Balmaña J, Llort G, Ramón y Cajal T, Chirivella I, Aguirre E, Robles L, Lastra E, Pérez-Segura P, Bosch N, Yagüe C, Lerma E, Godino J, Miramar MD, Moros M, Astier P, Saez B, Vidal MJ, Arcusa A, Ramón y Cajal S, Calvo MT, Tres A. Association of BRCA1 germline mutations in young onset triple-negative breast cancer (TNBC). Clin Transl Oncol 2013; 16:280-4. [DOI: 10.1007/s12094-013-1070-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 06/16/2013] [Indexed: 11/24/2022]
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Martín M, Ruiz A, Ruiz Borrego M, Barnadas A, González S, Calvo L, Margelí Vila M, Antón A, Rodríguez-Lescure A, Seguí-Palmer MA, Muñoz-Mateu M, Dorca Ribugent J, López-Vega JM, Jara C, Espinosa E, Mendiola Fernández C, Andrés R, Ribelles N, Plazaola A, Sánchez-Rovira P, Salvador Bofill J, Crespo C, Carabantes FJ, Servitja S, Chacón JI, Rodríguez CA, Hernando B, Álvarez I, Carrasco E, Lluch A. Fluorouracil, doxorubicin, and cyclophosphamide (FAC) versus FAC followed by weekly paclitaxel as adjuvant therapy for high-risk, node-negative breast cancer: results from the GEICAM/2003-02 study. J Clin Oncol 2013; 31:2593-9. [PMID: 23733779 DOI: 10.1200/jco.2012.46.9841] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Adding taxanes to anthracycline-based adjuvant therapy improves survival outcomes of patients with node-positive breast cancer (BC). Currently, however, most patients with BC are node negative at diagnosis. The only pure node-negative study (Spanish Breast Cancer Research Group 9805) reported so far showed a docetaxel benefit but significant toxicity. Here we tested the efficacy and safety of weekly paclitaxel (wP) in node-negative patients, which is yet to be established. PATIENTS AND METHODS Patients with BC having T1-T3/N0 tumors and at least one high-risk factor for recurrence (according to St. Gallen 1998 criteria) were eligible. After primary surgery, 1,925 patients were randomly assigned to receive fluorouracil, doxorubicin, and cyclophosphamide (FAC) × 6 or FAC × 4 followed by wP × 8 (FAC-wP). The primary end point was disease-free survival (DFS) after a median follow-up of 5 years. Secondary end points included toxicity and overall survival. RESULTS After a median follow-up of 63.3 months, 93% and 90.3% of patients receiving FAC-wP or FAC regimens, respectively, remained disease free (hazard ratio [HR], 0.73; 95% CI, 0.54 to 0.99; log-rank P = .04). Thirty-one patients receiving FAC-wP versus 40 patients receiving FAC died (one and seven from cardiovascular diseases, respectively; HR, 0.79; 95% CI, 0.49 to 1.26; log-rank P = .31). The most relevant grade 3 and 4 adverse events in the FAC-wP versus the FAC arm were febrile neutropenia (2.7% v 3.6%), fatigue (7.9% v 3.4%), and sensory neuropathy (5.5% v 0%). CONCLUSION For patients with high-risk node-negative BC, the adjuvant FAC-wP regimen was associated with a small but significant improvement in DFS compared with FAC therapy, in addition to manageable toxicity, especially regarding long-term cardiac effects.
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Affiliation(s)
- Miguel Martín
- Instituto de Investigación Sanitaria Gregorio Marañon, Universidad Complutense, Dr. Esquerdo 46, Madrid 28009, Spain.
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Maroto JP, del Muro XG, Mellado B, Perez-Gracia JL, Andrés R, Cruz J, Gallardo E, Domenech M, Arranz JA, Meana JA. Phase II trial of sequential subcutaneous interleukin-2 plus interferon alpha followed by sorafenib in renal cell carcinoma (RCC). Clin Transl Oncol 2013; 15:698-704. [PMID: 23359179 DOI: 10.1007/s12094-012-0991-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 12/14/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Immunotherapy (IL-2 and INF-α) was the treatment of choice for advanced renal cell carcinoma (RCC) until antiangiogenic therapy with tyrosin kinase inhibitors was developed in the early 2000s. This clinical trial explored the efficacy and toxicity of sequential treatment of IL-2 plus INF-α followed by sorafenib. METHODS Eligibility criteria included measurable, non-resectable, histologically confirmed predominantly clear cell RCC, no prior systemic treatment, and ECOG PS 0-2. The treatment regimen was a 6-week cycle of subcutaneous IL-2 at 9 × 10(6) IU on days 1-6 of weeks 1, 2, 4 and 5 plus s.c. INF-α at 6 × 10(6) IU on days 1, 3 and 5 of weeks 1-6. Responders received 6 additional weeks of this regimen. All patients received oral sorafenib (400 mg bid) after immunotherapy until disease progression. The primary endpoint was progression-free survival. RESULTS Forty-one patients were enrolled, median age 57 years. ECOG was 0/1 in 17/20 patients, 35 patients had prior nephrectomy and 18 patients pure clear cell cancer. Median PFS was 7.4 months (95 % CI 6.5-13.1) and OS was 16.6 months (95 % CI not reached). In 36 patients evaluable for response, ORR was 44.4 % and control rate was 94.4 %. Most adverse events (AEs) were Grade 1 or 2 toxicities (84.7 %). During immunotherapy the most common AEs were pyrexia (82.9 %), asthenia (56.1 %) and anorexia (46.3 %), whereas during sorafenib were diarrhoea (48.8 %) and hand-foot syndrome (46.3 %). CONCLUSIONS A sequential regimen of IL-2 and INF-α followed by sorafenib showed effectiveness and manageable toxicity in patients with advanced RCC.
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Affiliation(s)
- J P Maroto
- Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08025, Barcelona, Spain.
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Tanic M, Yanowsky K, Rodriguez-Antona C, Andrés R, Márquez-Rodas I, Osorio A, Benitez J, Martinez-Delgado B. Deregulated miRNAs in hereditary breast cancer revealed a role for miR-30c in regulating KRAS oncogene. PLoS One 2012; 7:e38847. [PMID: 22701724 PMCID: PMC3372467 DOI: 10.1371/journal.pone.0038847] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 05/11/2012] [Indexed: 12/20/2022] Open
Abstract
Aberrant miRNA expression has been previously established in breast cancer and has clinical relevance. However, no studies so far have defined miRNAs deregulated in hereditary breast tumors. In this study we investigated the role of miRNAs in hereditary breast tumors comparing with normal breast tissue. Global miRNA expression profiling using Exiqon microarrays was performed on 22 hereditary breast tumors and 15 non-tumoral breast tissues. We identified 19 miRNAs differentially expressed, most of them down-regulated in tumors. An important proportion of deregulated miRNAs in hereditary tumors were previously identified commonly deregulated in sporadic breast tumors. Under-expression of these miRNAs was validated by qRT-PCR in additional 18 sporadic breast tumors and their normal breast tissue counterparts. Pathway enrichment analysis revealed that deregulated miRNAs collectively targeted a number of genes belonging to signaling pathways such as MAPK, ErbB, mTOR, and those regulating cell motility or adhesion. In silico prediction detected KRAS oncogene as target of several deregulated miRNAs. In particular, we experimentally validated KRAS as a miR-30c target. Luciferase assays confirmed that miR-30c binds the 3′UTR of KRAS transcripts and expression of pre-miR-30c down-regulated KRAS mRNA and protein. Furthermore, miR-30c overexpression inhibited proliferation of breast cancer cells. Our results identify miRNAs associated to hereditary breast cancer, as well as miRNAs commonly miss-expressed in hereditary and sporadic tumors, suggesting common underlying mechanisms of tumor progression. In addition, we provide evidence that KRAS is a target of miR-30c, and that this miRNA suppresses breast cancer cell growth potentially through inhibition of KRAS signaling.
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Affiliation(s)
- Miljana Tanic
- Human Genetics Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Kira Yanowsky
- Human Genetics Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | | | - Raquel Andrés
- Medical Oncology Service, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Ana Osorio
- Human Genetics Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Javier Benitez
- Human Genetics Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Beatriz Martinez-Delgado
- Human Genetics Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
- * E-mail:
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Fernandez de Orueta L, Andrés R, Elías T, Pintado V. [Vertebral aspergillosis in a cirrhotic patient: an uncommon cause of spondylitis]. Enferm Infecc Microbiol Clin 2012; 30:219-20. [PMID: 22365181 DOI: 10.1016/j.eimc.2011.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 11/08/2011] [Accepted: 11/09/2011] [Indexed: 11/16/2022]
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Antoniou AC, Kuchenbaecker KB, Soucy P, Beesley J, Chen X, McGuffog L, Lee A, Barrowdale D, Healey S, Sinilnikova OM, Caligo MA, Loman N, Harbst K, Lindblom A, Arver B, Rosenquist R, Karlsson P, Nathanson K, Domchek S, Rebbeck T, Jakubowska A, Lubinski J, Jaworska K, Durda K, Złowowcka-Perłowska E, Osorio A, Durán M, Andrés R, Benítez J, Hamann U, Hogervorst FB, van Os TA, Verhoef S, Meijers-Heijboer HEJ, Wijnen J, Gómez Garcia EB, Ligtenberg MJ, Kriege M, Collée JM, Ausems MGEM, Oosterwijk JC, Peock S, Frost D, Ellis SD, Platte R, Fineberg E, Evans DG, Lalloo F, Jacobs C, Eeles R, Adlard J, Davidson R, Cole T, Cook J, Paterson J, Douglas F, Brewer C, Hodgson S, Morrison PJ, Walker L, Rogers MT, Donaldson A, Dorkins H, Godwin AK, Bove B, Stoppa-Lyonnet D, Houdayer C, Buecher B, de Pauw A, Mazoyer S, Calender A, Léoné M, Bressac- de Paillerets B, Caron O, Sobol H, Frenay M, Prieur F, Ferrer SF, Mortemousque I, Buys S, Daly M, Miron A, Terry MB, Hopper JL, John EM, Southey M, Goldgar D, Singer CF, Fink-Retter A, Tea MK, Kaulich DG, Hansen TVO, Nielsen FC, Barkardottir RB, Gaudet M, Kirchhoff T, Joseph V, Dutra-Clarke A, Offit K, Piedmonte M, Kirk J, Cohn D, Hurteau J, Byron J, Fiorica J, Toland AE, Montagna M, Oliani C, Imyanitov E, Isaacs C, Tihomirova L, Blanco I, Lazaro C, Teulé A, Valle JD, Gayther SA, Odunsi K, Gross J, Karlan BY, Olah E, Teo SH, Ganz PA, Beattie MS, Dorfling CM, van Rensburg EJ, Diez O, Kwong A, Schmutzler RK, Wappenschmidt B, Engel C, Meindl A, Ditsch N, Arnold N, Heidemann S, Niederacher D, Preisler-Adams S, Gadzicki D, Varon-Mateeva R, Deissler H, Gehrig A, Sutter C, Kast K, Fiebig B, Schäfer D, Caldes T, de la Hoya M, Nevanlinna H, Muranen TA, Lespérance B, Spurdle AB, Neuhausen SL, Ding YC, Wang X, Fredericksen Z, Pankratz VS, Lindor NM, Peterlongo P, Manoukian S, Peissel B, Zaffaroni D, Bonanni B, Bernard L, Dolcetti R, Papi L, Ottini L, Radice P, Greene MH, Loud JT, Andrulis IL, Ozcelik H, Mulligan AM, Glendon G, Thomassen M, Gerdes AM, Jensen UB, Skytte AB, Kruse TA, Chenevix-Trench G, Couch FJ, Simard J, Easton DF. Common variants at 12p11, 12q24, 9p21, 9q31.2 and in ZNF365 are associated with breast cancer risk for BRCA1 and/or BRCA2 mutation carriers. Breast Cancer Res 2012; 14:R33. [PMID: 22348646 PMCID: PMC3496151 DOI: 10.1186/bcr3121] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 11/15/2011] [Accepted: 02/20/2012] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Several common alleles have been shown to be associated with breast and/or ovarian cancer risk for BRCA1 and BRCA2 mutation carriers. Recent genome-wide association studies of breast cancer have identified eight additional breast cancer susceptibility loci: rs1011970 (9p21, CDKN2A/B), rs10995190 (ZNF365), rs704010 (ZMIZ1), rs2380205 (10p15), rs614367 (11q13), rs1292011 (12q24), rs10771399 (12p11 near PTHLH) and rs865686 (9q31.2). METHODS To evaluate whether these single nucleotide polymorphisms (SNPs) are associated with breast cancer risk for BRCA1 and BRCA2 carriers, we genotyped these SNPs in 12,599 BRCA1 and 7,132 BRCA2 mutation carriers and analysed the associations with breast cancer risk within a retrospective likelihood framework. RESULTS Only SNP rs10771399 near PTHLH was associated with breast cancer risk for BRCA1 mutation carriers (per-allele hazard ratio (HR) = 0.87, 95% CI: 0.81 to 0.94, P-trend = 3 × 10-4). The association was restricted to mutations proven or predicted to lead to absence of protein expression (HR = 0.82, 95% CI: 0.74 to 0.90, P-trend = 3.1 × 10-5, P-difference = 0.03). Four SNPs were associated with the risk of breast cancer for BRCA2 mutation carriers: rs10995190, P-trend = 0.015; rs1011970, P-trend = 0.048; rs865686, 2df-P = 0.007; rs1292011 2df-P = 0.03. rs10771399 (PTHLH) was predominantly associated with estrogen receptor (ER)-negative breast cancer for BRCA1 mutation carriers (HR = 0.81, 95% CI: 0.74 to 0.90, P-trend = 4 × 10-5) and there was marginal evidence of association with ER-negative breast cancer for BRCA2 mutation carriers (HR = 0.78, 95% CI: 0.62 to 1.00, P-trend = 0.049). CONCLUSIONS The present findings, in combination with previously identified modifiers of risk, will ultimately lead to more accurate risk prediction and an improved understanding of the disease etiology in BRCA1 and BRCA2 mutation carriers.
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Affiliation(s)
- Antonis C Antoniou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge CB1 8RN, UK
| | - Karoline B Kuchenbaecker
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge CB1 8RN, UK
| | - Penny Soucy
- Cancer Genomics Laboratory, Centre Hospitalier Universitaire de Québec, 2705 Laurier Boulevard, T3-57, Quebec City, QC Canada
| | - Jonathan Beesley
- Genetics and Population Health Division, Queensland Institute of Medical Research, 300 Herston Rd, Herston, Brisbane, QLD 4006, Australia
| | - Xiaoqing Chen
- Genetics and Population Health Division, Queensland Institute of Medical Research, 300 Herston Rd, Herston, Brisbane, QLD 4006, Australia
| | - Lesley McGuffog
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge CB1 8RN, UK
| | - Andrew Lee
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge CB1 8RN, UK
| | - Daniel Barrowdale
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge CB1 8RN, UK
| | - Sue Healey
- Genetics and Population Health Division, Queensland Institute of Medical Research, 300 Herston Rd, Herston, Brisbane, QLD 4006, Australia
| | - Olga M Sinilnikova
- Unité Mixte de Génétique Constitutionnelle des Cancers Fréquents, Centre Hospitalier Universitaire de Lyon/Centre Léon Bérard, 28 rue Laënnec, Lyon 69373, France and INSERM U1052, CNRS UMR5286, Université Lyon 1, Cancer Research Center of Lyon, 28 rue Laënnec, Lyon 69373, France
| | - Maria A Caligo
- Section of Genetic Oncology, Dept. of Laboratory Medicine, University and University Hospital of Pisa, Via Roma 57, 56125 Pisa, Italy
| | - Niklas Loman
- Department of Oncology, Lund University Hospital, Lund, Sweden
| | - Katja Harbst
- Department of Oncology, Lund University Hospital, Lund, Sweden
| | - Annika Lindblom
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Brita Arver
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Richard Rosenquist
- Department of Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
| | - Per Karlsson
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kate Nathanson
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Susan Domchek
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Tim Rebbeck
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Anna Jakubowska
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Jan Lubinski
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Jaworska
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Durda
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin and Postgraduate School of Molecular Medicine, Warsaw Medical University, Warsaw, Poland
| | | | - Ana Osorio
- Human Genetics Group, Human Cancer Genetics Programme, Spanish National Cancer Research Centre, Madrid, Spain and Spanish Network on Rare Diseases (CIBERER)
| | - Mercedes Durán
- Institute of Biology and Molecular Genetics. Universidad de Valladolid (IBGM-UVA), Valladolid, Spain
| | - Raquel Andrés
- Oncology unit. Hospital clinico Universitario "Lozano Blesa", Zaragoza, Spain
| | - Javier Benítez
- Human Genetics Group and Genotyping Unit, Human Cancer Genetics Programme, Spanish National Cancer Research Centre, Madrid, Spain and Spanish Network on Rare Diseases (CIBERER)
| | - Ute Hamann
- Molecular Genetics of Breast Cancer, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
| | - Frans B Hogervorst
- Family Cancer Clinic, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Theo A van Os
- Department of Clinical Genetics, Academic Meical Center, Amsterdam, The Netherlands
| | - Senno Verhoef
- Department of Clinical Genetics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Juul Wijnen
- Department of Clinical Genetics and GROM, School for Oncology and Developmental Biology, MUMC, Maastricht, The Netherlands
| | - Encarna B Gómez Garcia
- Department of Clinical Genetics and GROM, School for Oncology and Developmental Biology, MUMC, Maastricht, The Netherlands
| | - Marjolijn J Ligtenberg
- Department of Human Genetics, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Mieke Kriege
- Department of Clinical Genetics, Family Cancer Clinic, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J Margriet Collée
- Department of Clinical Genetics, Family Cancer Clinic, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Margreet GEM Ausems
- Department of Medical Genetics, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Jan C Oosterwijk
- Department of Genetics, University Medical Center, Groningen University, Groningen, The Netherlands
| | - Susan Peock
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge CB1 8RN, UK
| | - Debra Frost
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge CB1 8RN, UK
| | - Steve D Ellis
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge CB1 8RN, UK
| | - Radka Platte
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge CB1 8RN, UK
| | - Elena Fineberg
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge CB1 8RN, UK
| | - D Gareth Evans
- Genetic Medicine, Manchester Academic Health Sciences Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Fiona Lalloo
- Genetic Medicine, Manchester Academic Health Sciences Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Chris Jacobs
- Clinical Genetics, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Ros Eeles
- Oncogenetics Team, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, UK
| | | | - Rosemarie Davidson
- Ferguson-Smith Centre for Clinical Genetics, Yorkhill Hospitals, Glasgow, UK
| | - Trevor Cole
- West Midlands Regional Genetics Service, Birmingham Women's Hospital Healthcare NHS Trust, Edgbaston, Birmingham, UK
| | - Jackie Cook
- Sheffield Clinical Genetics Service, Sheffield Children's Hospital, Sheffield, UK
| | - Joan Paterson
- Department of Clinical Genetics, East Anglian Regional Genetics Service, Addenbrookes Hospital, Cambridge, UK
| | - Fiona Douglas
- Institute of Genetic Medicine, Centre for Life, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Carole Brewer
- Department of Clinical Genetics, Royal Devon & Exeter Hospital, Exeter, UK
| | - Shirley Hodgson
- Medical Genetics Unit, St George's, University of London, UK
| | - Patrick J Morrison
- Northern Ireland Regional Genetics Centre, Belfast Health and Social Care Trust, and Department of Medical Genetics, Queens University Belfast, Belfast UK
| | - Lisa Walker
- Oxford Regional Genetics Service, Churchill Hospital, Oxford, UK
| | - Mark T Rogers
- All Wales Medical Genetics Services, University Hospital of Wales, Cardiff, UK
| | - Alan Donaldson
- Clinical Genetics Department, St Michael's Hospital, Bristol, UK
| | - Huw Dorkins
- North West Thames Regional Genetics Service, Kennedy-Galton Centre, Harrow, UK
| | - Andrew K Godwin
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Betsy Bove
- Clinical Molecular Genetics Laboratory, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Dominique Stoppa-Lyonnet
- Service de Génétique Oncologique, Institut Curie, Paris, France, Unité INSERM U830, Institut Curie, Paris, France, Université Paris Descartes, Faculté de Médecine, Paris, France
| | - Claude Houdayer
- Service de Génétique Oncologique, Institut Curie, Paris, France and Université Paris Descartes, Faculté de Pharmacie, Paris, France
| | - Bruno Buecher
- Service de Génétique Oncologique, Institut Curie, 26 rue d'Ulm, Paris, France
| | - Antoine de Pauw
- Service de Génétique Oncologique, Institut Curie, Paris, France
| | - Sylvie Mazoyer
- INSERM U1052, CNRS UMR5286, Université Lyon 1, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Alain Calender
- Unité Mixte de Génétique Constitutionnelle des Cancers Fréquents, Hospices Civils de Lyon/Centre Léon Bérard, Lyon, France
| | - Mélanie Léoné
- Unité Mixte de Génétique Constitutionnelle des Cancers Fréquents, Hospices Civils de Lyon/Centre Léon Bérard, Lyon, France
| | - Brigitte Bressac- de Paillerets
- Service de Génétique, Institut de Cancérologie Gustave Roussy, Villejuif, France and INSERM U946, Fondation Jean Dausset, Paris, France
| | - Olivier Caron
- Consultation de Génétique, Département de Médecine, Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - Hagay Sobol
- Département Oncologie génétique, Prévention et Dépistage, INSERM CIC-P9502, Institut Paoli-Calmettes/Université d'Aix-Marseille II, Marseille, France
| | | | - Fabienne Prieur
- Service de Génétique Clinique Chromosomique et Moléculaire, Centre Hospitalier Universitaire de St Etienne, St Etienne, France
| | - Sandra Fert Ferrer
- Laboratoire de Génétique Chromosomique, Hôtel Dieu Centre Hospitalier, BP 1125 Chambéry, France
| | | | - Saundra Buys
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112, USA
| | - Mary Daly
- Division of Population Science, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA
| | - Alexander Miron
- Department of Cancer Biology, Dana-Farber Cancer Institute, and Department of Surgery, Harvard Medical School, 27 Drydock Avenue, Boston, MA 02210, USA
| | - Mary Beth Terry
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - John L Hopper
- Centre for Molecular, Environmental, Genetic and Analytic (MEGA) Epidemiology, Melbourne School of Population Health, Level 1, 723 Swanston Street, The University of Melbourne, VIC 3010, Australia
| | - Esther M John
- Department of Epidemiology, Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA 94538, USA
| | - Melissa Southey
- Genetic Epidemiology Laboratory, Department of Pathology, University of Melbourne, Australia
| | - David Goldgar
- Department of Dermatology, University of Utah School of Medicine, 30 North 1900 East, SOM 4B454, Salt Lake City, UT 84132, USA
| | - Christian F Singer
- Dept of OB/GYN and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Anneliese Fink-Retter
- Dept of OB/GYN and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Muy-Kheng Tea
- Dept of OB/GYN and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | | | - Thomas VO Hansen
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Finn C Nielsen
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rosa B Barkardottir
- Department of Pathology, Landspitali - University Hospital, Reykjavik Iceland and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Mia Gaudet
- Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA
| | - Tomas Kirchhoff
- Department of Environmental Medicine, NYU Cancer Institute, New York University School of Medicine, New York, NY, USA
| | - Vijai Joseph
- Clinical Cancer Genetics Laboratory, Memorial Sloane Kettering Cancer Center, New York, NY, USA
| | - Ana Dutra-Clarke
- Clinical Cancer Genetics Laboratory, Memorial Sloane Kettering Cancer Center, New York, NY, USA
| | - Kenneth Offit
- Clinical Cancer Genetics Laboratory, Memorial Sloane Kettering Cancer Center, New York, NY, USA
| | - Marion Piedmonte
- Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Judy Kirk
- Australia New Zealand (ANZGOG), Westmead Hospital, Sydney, Australia
| | - David Cohn
- Ohio State University, Columbus Cancer Council, Columbus, OH, USA
| | - Jean Hurteau
- Evanston CCOP - NorthShore University Health System; University of Chicago, Chicago, IL, USA
| | - John Byron
- Southern Pines Women's Health Center, P.C., University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James Fiorica
- Sarasota Memorial Healthcare, Tufts Medical Center, Sarasota, Florida, USA
| | - Amanda E Toland
- Department of Molecular Virology, Immunology and Medical Genetics and Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
| | - Marco Montagna
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
| | | | - Evgeny Imyanitov
- Laboratory of Molecular Oncology, N.N. Petrov Institute of Oncology, St.-Petersburg, Russia
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, USA
| | | | - Ignacio Blanco
- Genetic Counselling Unit, Hereditary Cancer Program, IDIBELL-Catalan Institute of Oncology, Barcelona, Spain
| | - Conxi Lazaro
- Molecular Diagnostic Unit, Hereditary Cancer Program, IDIBELL-Catalan Institute of Oncology, Barcelona, Spain
| | - Alex Teulé
- Genetic Counselling Unit, Hereditary Cancer Program, IDIBELL-Catalan Institute of Oncology, Barcelona, Spain
| | - J Del Valle
- Molecular Diagnostic Unit, Hereditary Cancer Program, IDIBELL-Catalan Institute of Oncology, Barcelona, Spain
| | - Simon A Gayther
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kunle Odunsi
- Department of Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Jenny Gross
- Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Beth Y Karlan
- Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Edith Olah
- Department of Molecular Genetics, National Institute of Oncology, Budapest, Hungary
| | - Soo-Hwang Teo
- Cancer Research Initiatives Foundation, Sime Darby Medical Centre, Malaysia and University Malaya Cancer Research Institute, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Patricia A Ganz
- Jonsson Comprehensive Cancer Center at UCLA, Los Angeles, CA, USA
| | - Mary S Beattie
- UCSF Cancer Risk Program, University of California, San Francisco, CA; UCSF Departments of Medicine, Epidemiology, and Biostatistics, Sand Francisco, CA, USA
| | - Cecelia M Dorfling
- Cancer Genetics Laboratory, Department of Genetics, University of Pretoria, South Africa
| | | | - Orland Diez
- Oncogenetics Laboratory. Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital. Barcelona, Spain
| | - Ava Kwong
- The Hong Kong Hereditary Breast Cancer Family Registry; The Universtiy of Hong Kong; Cancer Genetics Center, Hong Kong Sanatorium and Hospital, Hong Kong
| | - Rita K Schmutzler
- Centre of Familial Breast and Ovarian Cancer, Department of Gynaecology and Obstetrics and Centre for Integrated Oncology (CIO), University hospital of Cologne, Cologne, Germany
| | - Barbara Wappenschmidt
- Centre of Familial Breast and Ovarian Cancer, Department of Gynaecology and Obstetrics and Centre for Integrated Oncology (CIO), University hospital of Cologne, Cologne, Germany
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Alfons Meindl
- Department of Gynaecology and Obstetrics, Division of Tumour Genetics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Nina Ditsch
- Department of Gynaecology and Obstetrics, Ludwig-Maximilian University Munich, Munich, Germany
| | - Norbert Arnold
- Department of Gynaecology and Obstetrics, University Hospital of Schleswig-Holstein, Campus Kiel, Christian-Albrechts University Kiel, Kiel, Germany
| | - Simone Heidemann
- Institute of Human Genetics, University Hospital of Schleswig-Holstein, Campus Kiel, Christian-Albrechts University Kiel, Kiel, Germany
| | - Dieter Niederacher
- Department of Gynaecology and Obstetrics, University Hospital Düsseldorf, Heinrich-Heine University, Düsseldorf, Germany
| | | | - Dorothea Gadzicki
- Institute of Cell and Molecular Pathology, Hannover Medical School, Hannover, Germany
| | | | - Helmut Deissler
- Department of Gynaecology and Obstetrics, University Hospital Ulm, Germany
| | - Andrea Gehrig
- Centre of Familial Breast and Ovarian Cancer, Department of Medical Genetics, Institute of Human Genetics, University Würzburg, Würzburg, Germany
| | - Christian Sutter
- Institute of Human Genetics, Department of Human Genetics, University Hospital Heidelberg, Germany
| | - Karin Kast
- Department of Gynaecology and Obstetrics, University Hospital Carl Gustav Carus, Technical University. Dresden, Germany
| | - Britta Fiebig
- Institute of Human Genetics, University Regensburg, Regensbirg. Germany
| | - Dieter Schäfer
- Institute of Human Genetics, University Hospital Frankfurt a.M., Germany Molecular Oncology Laboratory, Hospital Clinico San Carlos, Madrid, Spain
| | - Trinidad Caldes
- Molecular Oncology Laboratory, Hospital Clinico San Carlos, Martin Lagos s/n, Madrid, Spain
| | - Miguel de la Hoya
- Molecular Oncology Laboratory, Hospital Clinico San Carlos, Martin Lagos s/n, Madrid, Spain
| | - Heli Nevanlinna
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Biomedicum Helsinki, P.O. BOX 700, 00029 HUS, Helsinki, Finland
| | - Taru A Muranen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Biomedicum Helsinki, P.O. BOX 700, 00029 HUS, Helsinki, Finland
| | - Bernard Lespérance
- Faculty of Medicine - Medicine and Medical Specialties, Université de Montréal Hemato-oncology service, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Blvd West Montreal, QC, Canada
| | - Amanda B Spurdle
- Genetics and Population Health Division, Queensland Institute of Medical Research, 300 Herston Rd, Herston, Brisbane, QLD 4006, Australia
| | - Susan L Neuhausen
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
| | - Yuan C Ding
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
| | - Xianshu Wang
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Noralane M Lindor
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Paolo Peterlongo
- Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Preventive and Predicted Medicine, Fondazione IRCCS Istituto Nazionale Tumouri (INT), Milan, Italy and IFOM, Fondazione Istituto FIRC di Oncologia Molecolare, Milan, Italy
| | - Siranoush Manoukian
- Unit of Medical Genetics, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale Tumouri (INT), Milan, Italy
| | - Bernard Peissel
- Unit of Medical Genetics, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale Tumouri (INT), Milan, Italy
| | - Daniela Zaffaroni
- Unit of Medical Genetics, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale Tumouri (INT), Milan, Italy
| | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, Istituto Europeo di Oncologia (IEO), Milan Italy
| | - Loris Bernard
- Department of Experimental Oncology, Istituto Europeo di Oncologia, Milan, Italy and Consortium for Genomics Technology (Cogentech), Milan, Italy
| | - Riccardo Dolcetti
- Cancer Bioimmunotherapy Unit, Centro di Riferimento Oncologico, IRCCS, Aviano (PN), Italy
| | - Laura Papi
- Medical Genetics Unit, Department of Clinical Physiopathology, University of Florence, Firenze, Italy
| | - Laura Ottini
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Paolo Radice
- Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Preventive and Predicted Medicine, Fondazione IRCCS Istituto Nazionale Tumouri (INT), Milan, Italy and IFOM, Fondazione Istituto FIRC di Oncologia Molecolare, Milan, Italy
| | - Mark H Greene
- Clinical Genetics Branch, DCEG, NCI; Room EPS 7032, Rockville, MD 20852, USA
| | - Jennifer T Loud
- Clinical Genetics Branch, DCEG, NCI; Room EPS 7032, Rockville, MD 20852, USA
| | - Irene L Andrulis
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, ON; Cancer Care Ontario, Departments of Molecular Genetics and Laboratory Medicine and Pathobiology, University of Toronto, ON, Canada
| | - Hilmi Ozcelik
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, ON; Department of Laboratory Medicine and Pathobiology, University of Toronto, ON, Canada
| | - Anna Marie Mulligan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine, and the Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Gord Glendon
- Ontario Cancer Genetics Network: Cancer Care Ontario, Toronto, ON, Canada
| | - Mads Thomassen
- Department of Clinical Genetics, Odense University Hospital, Denmark
| | - Anne-Marie Gerdes
- Department of Clincial Genetics, Rigshospital and Copenhagen University, Denmark
| | - Uffe B Jensen
- Department of Clinical Genetics, Skejby Hospital, Aarhus, Denmark
| | | | - Torben A Kruse
- Department of Clinical Genetics, Odense University Hospital, Denmark
| | - Georgia Chenevix-Trench
- Genetics and Population Health Division, Queensland Institute of Medical Research, 300 Herston Rd, Herston, Brisbane, QLD 4006, Australia
| | - Fergus J Couch
- Department of Laboratory Medicine and Pathology, and Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jacques Simard
- Cancer Genomics Laboratory, Centre Hospitalier Universitaire de Québec, 2705 Laurier Boulevard, T3-57, Quebec City and Canada Research Chair in Oncogenetics, Department of Molecular Medicine, Faculty of Medicine, Laval University, QC, Canada
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge CB1 8RN, UK
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Maxwell CA, Benítez J, Gómez-Baldó L, Osorio A, Bonifaci N, Fernández-Ramires R, Costes SV, Guinó E, Chen H, Evans GJR, Mohan P, Català I, Petit A, Aguilar H, Villanueva A, Aytes A, Serra-Musach J, Rennert G, Lejbkowicz F, Peterlongo P, Manoukian S, Peissel B, Ripamonti CB, Bonanni B, Viel A, Allavena A, Bernard L, Radice P, Friedman E, Kaufman B, Laitman Y, Dubrovsky M, Milgrom R, Jakubowska A, Cybulski C, Gorski B, Jaworska K, Durda K, Sukiennicki G, Lubiński J, Shugart YY, Domchek SM, Letrero R, Weber BL, Hogervorst FBL, Rookus MA, Collee JM, Devilee P, Ligtenberg MJ, van der Luijt RB, Aalfs CM, Waisfisz Q, Wijnen J, van Roozendaal CEP, Easton DF, Peock S, Cook M, Oliver C, Frost D, Harrington P, Evans DG, Lalloo F, Eeles R, Izatt L, Chu C, Eccles D, Douglas F, Brewer C, Nevanlinna H, Heikkinen T, Couch FJ, Lindor NM, Wang X, Godwin AK, Caligo MA, Lombardi G, Loman N, Karlsson P, Ehrencrona H, von Wachenfeldt A, Bjork Barkardottir R, Hamann U, Rashid MU, Lasa A, Caldés T, Andrés R, Schmitt M, Assmann V, Stevens K, Offit K, Curado J, Tilgner H, Guigó R, Aiza G, Brunet J, Castellsagué J, Martrat G, Urruticoechea A, Blanco I, Tihomirova L, Goldgar DE, Buys S, John EM, Miron A, Southey M, Daly MB, Schmutzler RK, Wappenschmidt B, Meindl A, Arnold N, Deissler H, Varon-Mateeva R, Sutter C, Niederacher D, Imyamitov E, Sinilnikova OM, Stoppa-Lyonne D, Mazoyer S, Verny-Pierre C, Castera L, de Pauw A, Bignon YJ, Uhrhammer N, Peyrat JP, Vennin P, Fert Ferrer S, Collonge-Rame MA, Mortemousque I, Spurdle AB, Beesley J, Chen X, Healey S, Barcellos-Hoff MH, Vidal M, Gruber SB, Lázaro C, Capellá G, McGuffog L, Nathanson KL, Antoniou AC, Chenevix-Trench G, Fleisch MC, Moreno V, Pujana MA. Interplay between BRCA1 and RHAMM regulates epithelial apicobasal polarization and may influence risk of breast cancer. PLoS Biol 2011; 9:e1001199. [PMID: 22110403 PMCID: PMC3217025 DOI: 10.1371/journal.pbio.1001199] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [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: 06/08/2011] [Accepted: 10/10/2011] [Indexed: 12/24/2022] Open
Abstract
Differentiated mammary epithelium shows apicobasal polarity, and loss of tissue organization is an early hallmark of breast carcinogenesis. In BRCA1 mutation carriers, accumulation of stem and progenitor cells in normal breast tissue and increased risk of developing tumors of basal-like type suggest that BRCA1 regulates stem/progenitor cell proliferation and differentiation. However, the function of BRCA1 in this process and its link to carcinogenesis remain unknown. Here we depict a molecular mechanism involving BRCA1 and RHAMM that regulates apicobasal polarity and, when perturbed, may increase risk of breast cancer. Starting from complementary genetic analyses across families and populations, we identified common genetic variation at the low-penetrance susceptibility HMMR locus (encoding for RHAMM) that modifies breast cancer risk among BRCA1, but probably not BRCA2, mutation carriers: n = 7,584, weighted hazard ratio ((w)HR) = 1.09 (95% CI 1.02-1.16), p(trend) = 0.017; and n = 3,965, (w)HR = 1.04 (95% CI 0.94-1.16), p(trend) = 0.43; respectively. Subsequently, studies of MCF10A apicobasal polarization revealed a central role for BRCA1 and RHAMM, together with AURKA and TPX2, in essential reorganization of microtubules. Mechanistically, reorganization is facilitated by BRCA1 and impaired by AURKA, which is regulated by negative feedback involving RHAMM and TPX2. Taken together, our data provide fundamental insight into apicobasal polarization through BRCA1 function, which may explain the expanded cell subsets and characteristic tumor type accompanying BRCA1 mutation, while also linking this process to sporadic breast cancer through perturbation of HMMR/RHAMM.
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Affiliation(s)
- Christopher A. Maxwell
- Translational Research Laboratory, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Catalonia, Spain
| | - Javier Benítez
- Human Cancer Genetics Programme, Spanish National Cancer Research Centre, Madrid, Spain
- Biomedical Research Centre Network for Rare Diseases, Spain
| | - Laia Gómez-Baldó
- Translational Research Laboratory, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Catalonia, Spain
- Biomedical Research Centre Network for Epidemiology and Public Health, Spain
| | - Ana Osorio
- Human Cancer Genetics Programme, Spanish National Cancer Research Centre, Madrid, Spain
- Biomedical Research Centre Network for Rare Diseases, Spain
| | - Núria Bonifaci
- Translational Research Laboratory, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Catalonia, Spain
- Biomedical Research Centre Network for Epidemiology and Public Health, Spain
- Biomarkers and Susceptibility Unit, Catalan Institute of Oncology, IDIBELL, L'Hospitalet, Catalonia, Spain
| | - Ricardo Fernández-Ramires
- Human Cancer Genetics Programme, Spanish National Cancer Research Centre, Madrid, Spain
- Biomedical Research Centre Network for Rare Diseases, Spain
| | - Sylvain V. Costes
- Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, California, United States of America
| | - Elisabet Guinó
- Biomedical Research Centre Network for Epidemiology and Public Health, Spain
- Biomarkers and Susceptibility Unit, Catalan Institute of Oncology, IDIBELL, L'Hospitalet, Catalonia, Spain
| | - Helen Chen
- Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Gareth J. R. Evans
- Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Pooja Mohan
- Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Isabel Català
- Department of Pathology, University Hospital of Bellvitge, IDIBELL, L'Hospitalet, Catalonia, Spain
| | - Anna Petit
- Department of Pathology, University Hospital of Bellvitge, IDIBELL, L'Hospitalet, Catalonia, Spain
| | - Helena Aguilar
- Translational Research Laboratory, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Catalonia, Spain
| | - Alberto Villanueva
- Translational Research Laboratory, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Catalonia, Spain
| | - Alvaro Aytes
- Translational Research Laboratory, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Catalonia, Spain
| | - Jordi Serra-Musach
- Translational Research Laboratory, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Catalonia, Spain
- Biomarkers and Susceptibility Unit, Catalan Institute of Oncology, IDIBELL, L'Hospitalet, Catalonia, Spain
| | - Gad Rennert
- CHS National Cancer Control Center, Department of Community Medicine and Epidemiology, Carmel Medical Center and B. Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Flavio Lejbkowicz
- CHS National Cancer Control Center, Department of Community Medicine and Epidemiology, Carmel Medical Center and B. Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Paolo Peterlongo
- Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale Tumori, and IFOM Fondazione Istituto FIRC di Oncologia Molecolare, Milan, Italy
| | - Siranoush Manoukian
- Unit of Medical Genetics, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Bernard Peissel
- Unit of Medical Genetics, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Carla B. Ripamonti
- Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale Tumori, and IFOM Fondazione Istituto FIRC di Oncologia Molecolare, Milan, Italy
- Unit of Medical Genetics, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, Istituto Europeo di Oncologia, Milan, Italy
| | - Alessandra Viel
- Division of Experimental Oncology 1, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - Anna Allavena
- Department of Genetics, Biology and Biochemistry, University of Turin, Turin, Italy
| | - Loris Bernard
- Department of Experimental Oncology, Istituto Europeo di Oncologia, and Consortium for Genomics Technology (Cogentech), Milan, Italy
| | - Paolo Radice
- Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale Tumori, and IFOM Fondazione Istituto FIRC di Oncologia Molecolare, Milan, Italy
| | - Eitan Friedman
- The Susanne Levy Gertner Oncogenetics Unit, Institute of Human Genetics, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Bella Kaufman
- The Susanne Levy Gertner Oncogenetics Unit, Institute of Human Genetics, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Yael Laitman
- The Susanne Levy Gertner Oncogenetics Unit, Institute of Human Genetics, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Maya Dubrovsky
- The Susanne Levy Gertner Oncogenetics Unit, Institute of Human Genetics, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Roni Milgrom
- The Susanne Levy Gertner Oncogenetics Unit, Institute of Human Genetics, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Anna Jakubowska
- International Hereditary Cancer Centre, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Cezary Cybulski
- International Hereditary Cancer Centre, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Bohdan Gorski
- International Hereditary Cancer Centre, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Jaworska
- International Hereditary Cancer Centre, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Durda
- International Hereditary Cancer Centre, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Grzegorz Sukiennicki
- International Hereditary Cancer Centre, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Jan Lubiński
- International Hereditary Cancer Centre, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Yin Yao Shugart
- Unit of Statistical Genetics, Division of Intramural Research Program, National Institute of Mental Health, National Institute of Health, Bethesda, Maryland, United States of America
| | - Susan M. Domchek
- Abramson Cancer Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Richard Letrero
- Abramson Cancer Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Barbara L. Weber
- Abramson Cancer Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Frans B. L. Hogervorst
- Family Cancer Clinic, Department of Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Matti A. Rookus
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - J. Margriet Collee
- Department of Clinical Genetics, Rotterdam Family Cancer Clinic, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Peter Devilee
- Department of Genetic Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Rob B. van der Luijt
- Department of Clinical Molecular Genetics, Utrecht University Medical Center, Utrecht, the Netherlands
| | - Cora M. Aalfs
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, the Netherlands
| | - Quinten Waisfisz
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, the Netherlands
| | - Juul Wijnen
- Center for Human and Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | | | - HEBON
- Hereditary Breast and Ovarian Cancer Group, the Netherlands
| | - EMBRACE
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Douglas F. Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Susan Peock
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Margaret Cook
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Clare Oliver
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Debra Frost
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | | | - D. Gareth Evans
- Genetic Medicine, Manchester Academic Health Sciences Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Fiona Lalloo
- Genetic Medicine, Manchester Academic Health Sciences Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Rosalind Eeles
- The Oncogenetics Team, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Surrey, United Kingdom
| | - Louise Izatt
- Clinical Genetics, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Carol Chu
- Yorkshire Regional Genetics Service, St. James's Hospital, Leeds, United Kingdom
| | - Diana Eccles
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, United Kingdom
| | - Fiona Douglas
- Institute of Human Genetics, Centre for Life, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom
| | - Carole Brewer
- Department of Clinical Genetics, Royal Devon & Exeter Hospital, Exeter, United Kingdom
| | - Heli Nevanlinna
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
| | - Tuomas Heikkinen
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
| | - Fergus J. Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Noralane M. Lindor
- Department of Medical Genetics, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Xianshu Wang
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Andrew K. Godwin
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States of America
| | - Maria A. Caligo
- Section of Genetic Oncology, Department of Oncology, University of Pisa, and Department of Laboratory Medicine, University Hospital of Pisa, Pisa, Italy
| | - Grazia Lombardi
- Section of Genetic Oncology, Department of Oncology, University of Pisa, and Department of Laboratory Medicine, University Hospital of Pisa, Pisa, Italy
| | - Niklas Loman
- Department of Oncology, Lund University Hospital, Lund, Sweden
| | - Per Karlsson
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hans Ehrencrona
- Department of Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
| | | | - SWE-BRCA
- Swedish Breast Cancer Study, Sweden
| | | | - Ute Hamann
- Molecular Genetics of Breast Cancer, Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Muhammad U. Rashid
- Molecular Genetics of Breast Cancer, Deutsches Krebsforschungszentrum, Heidelberg, Germany, and Department of Basic Sciences, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Adriana Lasa
- Genetic Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Trinidad Caldés
- Molecular Oncology Laboratory, Hospital Clínico San Carlos, Madrid, Spain
| | - Raquel Andrés
- Medical Oncology Division, Hospital Clínico de Zaragoza, Zaragoza, Spain
| | - Michael Schmitt
- Department of Internal Medicine III, University of Rostock, Rostock, Germany
| | - Volker Assmann
- Center for Experimental Medicine, Institute of Tumor Biology, University Hospital Hamburg–Eppendorf, Hamburg, Germany
| | - Kristen Stevens
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Kenneth Offit
- Clinical Genetics Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - João Curado
- Bioinformatics and Genomics Group, Centre for Genomic Regulation (CRG), Biomedical Research Park of Barcelona (PRBB), Barcelona, Catalonia, Spain
| | - Hagen Tilgner
- Bioinformatics and Genomics Group, Centre for Genomic Regulation (CRG), Biomedical Research Park of Barcelona (PRBB), Barcelona, Catalonia, Spain
| | - Roderic Guigó
- Bioinformatics and Genomics Group, Centre for Genomic Regulation (CRG), Biomedical Research Park of Barcelona (PRBB), Barcelona, Catalonia, Spain
| | - Gemma Aiza
- Translational Research Laboratory, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Catalonia, Spain
| | - Joan Brunet
- Genetic Counseling and Hereditary Cancer Programme, Catalan Institute of Oncology, IDIBELL and Girona Biomedical Research Institute (IdIBGi), Catalonia, Spain
| | - Joan Castellsagué
- Genetic Counseling and Hereditary Cancer Programme, Catalan Institute of Oncology, IDIBELL and Girona Biomedical Research Institute (IdIBGi), Catalonia, Spain
| | - Griselda Martrat
- Translational Research Laboratory, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Catalonia, Spain
| | - Ander Urruticoechea
- Translational Research Laboratory, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Catalonia, Spain
| | - Ignacio Blanco
- Genetic Counseling and Hereditary Cancer Programme, Catalan Institute of Oncology, IDIBELL and Girona Biomedical Research Institute (IdIBGi), Catalonia, Spain
| | | | - David E. Goldgar
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Saundra Buys
- Department of Internal Medicine, Huntsman Cancer Institute, Salt Lake City, Utah, United States of America
| | - Esther M. John
- Cancer Prevention Institute of California, Fremont, California, United States of America
| | - Alexander Miron
- Department of Cancer Biology, Dana-Farber Cancer Institute, and Department of Surgery, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Melissa Southey
- Centre for Molecular, Environmental, Genetic and Analytic (MEGA) Epidemiology, Melbourne School of Population Health, The University of Melbourne, Victoria, Australia
| | - Mary B. Daly
- Division of Population Science, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States of America
| | - BCFR
- Breast Cancer Family Registry, United States of America
| | - Rita K. Schmutzler
- Center for Familial Breast and Ovarian Cancer and Center of Integrated Oncology, University of Cologne, Cologne, Germany
| | - Barbara Wappenschmidt
- Center for Familial Breast and Ovarian Cancer and Center of Integrated Oncology, University of Cologne, Cologne, Germany
| | - Alfons Meindl
- Department of Obstetrics and Gynaecology, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Norbert Arnold
- Division of Oncology, Department of Gynaecology and Obstetrics, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Helmut Deissler
- Department of Obstetrics and Gynecology, Ulm University, Ulm, Germany
| | | | - Christian Sutter
- Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
| | - Dieter Niederacher
- Division of Molecular Genetics, Department of Gynaecology and Obstetrics, Clinical Center University of Düsseldorf, Düsseldorf, Germany
| | - Evgeny Imyamitov
- N. N. Petrov Institute of Oncology, Saint-Petersburg, Russian Federation
| | - Olga M. Sinilnikova
- Unité Mixte de Génétique Constitutionnelle des Cancers Fréquents, Centre Hospitalier Universitaire de Lyon, Centre Léon Bérard, Lyon, France
- Equipe labellisée LIGUE 2008, UMR5201 CNRS, Centre Léon Bérard, Université de Lyon, Lyon, France
| | - Dominique Stoppa-Lyonne
- INSERM U509, Service de Génétique Oncologique, Institut Curie, Université Paris-Descartes, Paris, France
| | - Sylvie Mazoyer
- Equipe labellisée LIGUE 2008, UMR5201 CNRS, Centre Léon Bérard, Université de Lyon, Lyon, France
| | - Carole Verny-Pierre
- Equipe labellisée LIGUE 2008, UMR5201 CNRS, Centre Léon Bérard, Université de Lyon, Lyon, France
| | - Laurent Castera
- INSERM U509, Service de Génétique Oncologique, Institut Curie, Université Paris-Descartes, Paris, France
| | - Antoine de Pauw
- INSERM U509, Service de Génétique Oncologique, Institut Curie, Université Paris-Descartes, Paris, France
| | - Yves-Jean Bignon
- Département d'Oncogénétique, Centre Jean Perrin, Université de Clermont-Ferrand, Clermont-Ferrand, France
| | - Nancy Uhrhammer
- Département d'Oncogénétique, Centre Jean Perrin, Université de Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean-Philippe Peyrat
- Laboratoire d'Oncologie Moléculaire Humaine, Centre Oscar Lambret, Lille, France
| | - Philippe Vennin
- Consultation d'Oncogénétique, Centre Oscar Lambret, Lille, France
| | - Sandra Fert Ferrer
- Laboratoire de Génétique Chromosomique, Hôtel Dieu Centre Hospitalier, Chambéry, France
| | - Marie-Agnès Collonge-Rame
- Service de Génétique-Histologie-Biologie du Développement et de la Reproduction, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | | | - GEMO Study Collaborators
- GEMO Study (Genetics Network “Groupe Génétique et Cancer”), Fédération Nationale des Centres de Lutte Contre le Cancer, France
| | | | | | - Xiaoqing Chen
- Queensland Institute of Medical Research, Brisbane, Australia
| | - Sue Healey
- Queensland Institute of Medical Research, Brisbane, Australia
| | - kConFab
- The Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer, Peter MacCallum Cancer Institute, East Melbourne, Australia
| | - Mary Helen Barcellos-Hoff
- Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, California, United States of America
| | - Marc Vidal
- Center for Cancer Systems Biology (CCSB) and Department of Cancer Biology, Dana-Farber Cancer Institute, and Department of Genetics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Stephen B. Gruber
- Department of Internal Medicine, Epidemiology, Human Genetics, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Conxi Lázaro
- Genetic Counseling and Hereditary Cancer Programme, Catalan Institute of Oncology, IDIBELL and Girona Biomedical Research Institute (IdIBGi), Catalonia, Spain
| | - Gabriel Capellá
- Genetic Counseling and Hereditary Cancer Programme, Catalan Institute of Oncology, IDIBELL and Girona Biomedical Research Institute (IdIBGi), Catalonia, Spain
| | - Lesley McGuffog
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Katherine L. Nathanson
- Abramson Cancer Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Antonis C. Antoniou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | | | - Markus C. Fleisch
- Department of Obstetrics and Gynaecologie, Heinrich-Heine-University, Duesseldorf, Germany
| | - Víctor Moreno
- Biomedical Research Centre Network for Epidemiology and Public Health, Spain
- Biomarkers and Susceptibility Unit, Catalan Institute of Oncology, IDIBELL, L'Hospitalet, Catalonia, Spain
| | - Miguel Angel Pujana
- Translational Research Laboratory, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Catalonia, Spain
- Biomedical Research Centre Network for Epidemiology and Public Health, Spain
- Biomarkers and Susceptibility Unit, Catalan Institute of Oncology, IDIBELL, L'Hospitalet, Catalonia, Spain
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Antoniou AC, Kartsonaki C, Sinilnikova OM, Soucy P, McGuffog L, Healey S, Lee A, Peterlongo P, Manoukian S, Peissel B, Zaffaroni D, Cattaneo E, Barile M, Pensotti V, Pasini B, Dolcetti R, Giannini G, Putignano AL, Varesco L, Radice P, Mai PL, Greene MH, Andrulis IL, Glendon G, Ozcelik H, Thomassen M, Gerdes AM, Kruse TA, Birk Jensen U, Crüger DG, Caligo MA, Laitman Y, Milgrom R, Kaufman B, Paluch-Shimon S, Friedman E, Loman N, Harbst K, Lindblom A, Arver B, Ehrencrona H, Melin B, Nathanson KL, Domchek SM, Rebbeck T, Jakubowska A, Lubinski J, Gronwald J, Huzarski T, Byrski T, Cybulski C, Gorski B, Osorio A, Ramón y Cajal T, Fostira F, Andrés R, Benitez J, Hamann U, Hogervorst FB, Rookus MA, Hooning MJ, Nelen MR, van der Luijt RB, van Os TAM, van Asperen CJ, Devilee P, Meijers-Heijboer HEJ, Gómez Garcia EB, Peock S, Cook M, Frost D, Platte R, Leyland J, Evans DG, Lalloo F, Eeles R, Izatt L, Adlard J, Davidson R, Eccles D, Ong KR, Cook J, Douglas F, Paterson J, Kennedy MJ, Miedzybrodzka Z, Godwin A, Stoppa-Lyonnet D, Buecher B, Belotti M, Tirapo C, Mazoyer S, Barjhoux L, Lasset C, Leroux D, Faivre L, Bronner M, Prieur F, Nogues C, Rouleau E, Pujol P, Coupier I, Frénay M, Hopper JL, Daly MB, Terry MB, John EM, Buys SS, Yassin Y, Miron A, Goldgar D, Singer CF, Tea MK, Pfeiler G, Dressler AC, Hansen TVO, Jønson L, Ejlertsen B, Barkardottir RB, Kirchhoff T, Offit K, Piedmonte M, Rodriguez G, Small L, Boggess J, Blank S, Basil J, Azodi M, Toland AE, Montagna M, Tognazzo S, Agata S, Imyanitov E, Janavicius R, Lazaro C, Blanco I, Pharoah PDP, Sucheston L, Karlan BY, Walsh CS, Olah E, Bozsik A, Teo SH, Seldon JL, Beattie MS, van Rensburg EJ, Sluiter MD, Diez O, Schmutzler RK, Wappenschmidt B, Engel C, Meindl A, Ruehl I, Varon-Mateeva R, Kast K, Deissler H, Niederacher D, Arnold N, Gadzicki D, Schönbuchner I, Caldes T, de la Hoya M, Nevanlinna H, Aittomäki K, Dumont M, Chiquette J, Tischkowitz M, Chen X, Beesley J, Spurdle AB, Neuhausen SL, Chun Ding Y, Fredericksen Z, Wang X, Pankratz VS, Couch F, Simard J, Easton DF, Chenevix-Trench G. Common alleles at 6q25.1 and 1p11.2 are associated with breast cancer risk for BRCA1 and BRCA2 mutation carriers. Hum Mol Genet 2011; 20:3304-21. [PMID: 21593217 PMCID: PMC3652640 DOI: 10.1093/hmg/ddr226] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 05/09/2011] [Accepted: 05/16/2011] [Indexed: 11/15/2022] Open
Abstract
Two single nucleotide polymorphisms (SNPs) at 6q25.1, near the ESR1 gene, have been implicated in the susceptibility to breast cancer for Asian (rs2046210) and European women (rs9397435). A genome-wide association study in Europeans identified two further breast cancer susceptibility variants: rs11249433 at 1p11.2 and rs999737 in RAD51L1 at 14q24.1. Although previously identified breast cancer susceptibility variants have been shown to be associated with breast cancer risk for BRCA1 and BRCA2 mutation carriers, the involvement of these SNPs to breast cancer susceptibility in mutation carriers is currently unknown. To address this, we genotyped these SNPs in BRCA1 and BRCA2 mutation carriers from 42 studies from the Consortium of Investigators of Modifiers of BRCA1/2. In the analysis of 14 123 BRCA1 and 8053 BRCA2 mutation carriers of European ancestry, the 6q25.1 SNPs (r(2) = 0.14) were independently associated with the risk of breast cancer for BRCA1 mutation carriers [hazard ratio (HR) = 1.17, 95% confidence interval (CI): 1.11-1.23, P-trend = 4.5 × 10(-9) for rs2046210; HR = 1.28, 95% CI: 1.18-1.40, P-trend = 1.3 × 10(-8) for rs9397435], but only rs9397435 was associated with the risk for BRCA2 carriers (HR = 1.14, 95% CI: 1.01-1.28, P-trend = 0.031). SNP rs11249433 (1p11.2) was associated with the risk of breast cancer for BRCA2 mutation carriers (HR = 1.09, 95% CI: 1.02-1.17, P-trend = 0.015), but was not associated with breast cancer risk for BRCA1 mutation carriers (HR = 0.97, 95% CI: 0.92-1.02, P-trend = 0.20). SNP rs999737 (RAD51L1) was not associated with breast cancer risk for either BRCA1 or BRCA2 mutation carriers (P-trend = 0.27 and 0.30, respectively). The identification of SNPs at 6q25.1 associated with breast cancer risk for BRCA1 mutation carriers will lead to a better understanding of the biology of tumour development in these women.
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Affiliation(s)
- Antonis C Antoniou
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, UK.
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Llombart-Cussac A, Ruiz A, Antón A, Barnadas A, Antolín S, Alés-Martínez JE, Alvarez I, Andrés R, García Saenz JA, Lao J, Carrasco E, Cámara C, Casas I, Martín M. Exemestane versus anastrozole as front-line endocrine therapy in postmenopausal patients with hormone receptor-positive, advanced breast cancer: final results from the Spanish Breast Cancer Group 2001-03 phase 2 randomized trial. Cancer 2011; 118:241-7. [PMID: 21717449 DOI: 10.1002/cncr.26299] [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: 12/23/2010] [Revised: 04/15/2011] [Accepted: 04/25/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND Several aromatase inhibitor studies have reported variations in the inhibitory potency of these agents that could lead to differences in clinical outcomes. In the current study, the authors formally evaluated the activity of anastrozole and exemestane in postmenopausal women with hormone-responsive, advanced breast cancer. METHODS Postmenopausal women who had measurable disease according to Response Evaluation Criteria in Solid Tumors and had not received previous endocrine therapy for advanced breast cancer were randomized to receive either oral exemestane 25 mg daily or oral anastrozole 1 mg daily until they had disease progression. The primary endpoint was the objective response rate (ORR), and secondary endpoints included the clinical benefit rate (CBR), time to progression (TTP), overall survival, and safety. Crossover to the other aromatase inhibitor was permitted at the time of disease progression; ORR, CBR, and TTP after second-line treatment also were explored. RESULTS In total, 103 patients were enrolled. The median patient age was 71.6 years, 52.4% of patients had visceral disease, and 75.8% of patients had ≥ 2 disease sites. Half of the patients had received previous tamoxifen, and 60% had received previous chemotherapy. The efficacy observed in the exemestane and anastrozole groups was an ORR of 36.2% and 46%, respectively; a CBR of 59.6% and 68%, respectively, and a TTP of 6.1 months and 12.1 months, respectively. At progression, 28 patients crossed over to the other aromatase inhibitor, including 16 patients who switched to exemestane (CBR, 43.7%; TTP, 4.4 months) and 12 patients who switched to anastrozole (CBR, 8.3%; TTP, 2 months). Both drugs were generally well tolerated, and no study drug-related serious adverse events were reported. CONCLUSIONS In this phase 2 randomized trial, no significant differences in clinical activity were observed in favor of exemestane to justify a superiority phase 3 trial design in the first-line setting.
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Affiliation(s)
- Antonio Llombart-Cussac
- Medical Oncology Service, Biomedical Research Institute, Arnau de Vilanova University Hospital, Lleida, Spain.
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Ciruelos EM, Cortés J, Cortés-Funes H, Mayordomo JI, Bermejo B, Ojeda B, García E, Rodríguez CA, Muñoz M, Gómez P, Manso L, Andrés R, Lluch A, Saura C, Mendiola C, Baselga J. Gemcitabine and capecitabine in previously anthracycline-treated metastatic breast cancer: a multicenter phase II study (SOLTI 0301 trial). Ann Oncol 2009; 21:1442-1447. [PMID: 19940004 DOI: 10.1093/annonc/mdp536] [Citation(s) in RCA: 8] [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: 11/14/2022] Open
Abstract
BACKGROUND On the basis of clinical activity of capecitabine and gemcitabine for metastatic breast cancer, we carried out a multicenter phase II clinical trial on the combination of these two agents in advanced anthracycline-pretreated breast cancer patients. Main objectives were to assess its efficacy and safety profile. PATIENTS AND METHODS Seventy-six anthracycline-pretreated breast cancer patients were evaluated and were stratified according to previous treatment of advanced disease (group-1: not previously treated and group-2: previously treated). Study treatment consisted of gemcitabine 1000 mg/m(2), i.v., as 30 min-infusion, days 1 and 8 every 21 days, plus oral capecitabine 830 mg/m(2) b.i.d., days 1-14 every 21 days. RESULTS Overall response rate was 61% for group-1, 48.5% for group-2 and 55.2% for the whole population. Clinical benefit rate was 73% for group-1, 80% for patients in group-2 and 76% for all patients. Median time to progression was 13.0 months for group-1, 8.2 months for group-2 and 11.1 months for the whole population. Most frequent grade 3-4 observed toxic effects per patient were neutropenia (60%), asymptomatic liver toxicity (13.5%), asthenia (14%) and hand-foot syndrome (16%). Only one patient presented febrile neutropenia. No treatment-related deaths occurred. CONCLUSION Combination of gemcitabine and capecitabine is an active and safe regimen in anthracycline-pretreated breast cancer patients.
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Affiliation(s)
- E M Ciruelos
- Medical Oncology Department, University Hospital 12 de Octubre, Madrid.
| | - J Cortés
- Medical Oncology Division, Hospital Vall d'Hebron, Barcelona
| | - H Cortés-Funes
- Medical Oncology Department, University Hospital 12 de Octubre, Madrid
| | - J I Mayordomo
- Medical Oncology Division, Hospital Clínico de Zaragoza, Zaragoza
| | - B Bermejo
- Medical Oncology Division, Hospital Clínico de Valencia, Valencia
| | - B Ojeda
- Medical Oncology Division, Hospital de Sant Pau, Barcelona
| | - E García
- Medical Oncology Division, Hospital Morales Meseguer, Murcia
| | - C A Rodríguez
- Medical Oncology Division, Hospital Clínico de Salamanca, Salamanca
| | - M Muñoz
- Medical Oncology Division, Hospital Clínico de Barcelona, Barcelona, Spain
| | - P Gómez
- Medical Oncology Division, Hospital Vall d'Hebron, Barcelona
| | - L Manso
- Medical Oncology Department, University Hospital 12 de Octubre, Madrid
| | - R Andrés
- Medical Oncology Division, Hospital Clínico de Zaragoza, Zaragoza
| | - A Lluch
- Medical Oncology Division, Hospital Clínico de Valencia, Valencia
| | - C Saura
- Medical Oncology Division, Hospital Vall d'Hebron, Barcelona
| | - C Mendiola
- Medical Oncology Department, University Hospital 12 de Octubre, Madrid
| | - J Baselga
- Medical Oncology Division, Hospital Vall d'Hebron, Barcelona
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Maurel J, López-Pousa A, de las Peñas R, Fra J, Martín J, Cruz J, Casado A, Poveda A, Martínez-Trufero J, Balañá C, Gómez MA, Cubedo R, Gallego O, Rubio-Viqueira B, Rubió J, Andrés R, Sevilla I, de la Cruz JJ, del Muro XG, Buesa JM. Efficacy of Sequential High-Dose Doxorubicin and Ifosfamide Compared With Standard-Dose Doxorubicin in Patients With Advanced Soft Tissue Sarcoma: An Open-Label Randomized Phase II Study of the Spanish Group for Research on Sarcomas. J Clin Oncol 2009; 27:1893-8. [PMID: 19273704 DOI: 10.1200/jco.2008.19.2930] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To assess the progression-free survival (PFS) and antitumor response to standard-dose doxorubicin compared with sequential dose-dense doxorubicin and ifosfamide in first-line treatment of advanced soft tissue sarcoma. Patients and Methods Patients with measurable advanced soft tissue sarcoma, Eastern Cooperative Oncology Group (ECOG) performance status (PS) < 2, between the ages 18 and 65 years, and with adequate bone marrow, liver, and renal function were entered in the study. The stratifications were: ECOG PS (0 v 1), location of metastases, and potentially resectable disease. Patients were randomly assigned to either doxorubicin 75 mg/m2 given as a bolus injection every 3 weeks for 6 cycles (arm A) or doxorubicin at 30 mg/m2 per day for 3 consecutive days once every 2 weeks for 3 cycles followed by ifosfamide at 12.5 g/m2 delivered by continuous infusion over 5 days once every 3 weeks for 3 cycles with filgastrim or pegfilgastrim support (arm B). Results Between December 2003 and September 2007, 132 patients were entered onto the study. Febrile neutropenia, asthenia, and mucositis were more frequent in the arm B. The interim preplanned analysis for futility allowed the premature closure. Objective responses were observed in 23.4% of assessable patients in arm A and 24.1% in arm B. PFS was 26 weeks in the arm A and 24 weeks in arm B (P = .88). Overall survival did not differ between the two therapeutic arms (P = .14). Conclusion Single-agent doxorubicin remains the standard treatment in fit patients with advanced soft tissue sarcoma.
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Affiliation(s)
- Joan Maurel
- From the Medical Oncology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas; Hospital Clínic Barcelona, University of Barcelona; Hospital Sant Pau, Barcelona; Hospital Provincial Castellón; Hospital Central Asturias; Hospital Universitario Canarias; Hospital Son Dureta, Mallorca; Hospital Clínico Madrid; Instituto Valenciano de Oncologia; Hospital Miguel Servet, Zaragoza; Hospital Germans Trias i Pujol,
| | - Antonio López-Pousa
- From the Medical Oncology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas; Hospital Clínic Barcelona, University of Barcelona; Hospital Sant Pau, Barcelona; Hospital Provincial Castellón; Hospital Central Asturias; Hospital Universitario Canarias; Hospital Son Dureta, Mallorca; Hospital Clínico Madrid; Instituto Valenciano de Oncologia; Hospital Miguel Servet, Zaragoza; Hospital Germans Trias i Pujol,
| | - Ramón de las Peñas
- From the Medical Oncology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas; Hospital Clínic Barcelona, University of Barcelona; Hospital Sant Pau, Barcelona; Hospital Provincial Castellón; Hospital Central Asturias; Hospital Universitario Canarias; Hospital Son Dureta, Mallorca; Hospital Clínico Madrid; Instituto Valenciano de Oncologia; Hospital Miguel Servet, Zaragoza; Hospital Germans Trias i Pujol,
| | - Joaquín Fra
- From the Medical Oncology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas; Hospital Clínic Barcelona, University of Barcelona; Hospital Sant Pau, Barcelona; Hospital Provincial Castellón; Hospital Central Asturias; Hospital Universitario Canarias; Hospital Son Dureta, Mallorca; Hospital Clínico Madrid; Instituto Valenciano de Oncologia; Hospital Miguel Servet, Zaragoza; Hospital Germans Trias i Pujol,
| | - Javier Martín
- From the Medical Oncology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas; Hospital Clínic Barcelona, University of Barcelona; Hospital Sant Pau, Barcelona; Hospital Provincial Castellón; Hospital Central Asturias; Hospital Universitario Canarias; Hospital Son Dureta, Mallorca; Hospital Clínico Madrid; Instituto Valenciano de Oncologia; Hospital Miguel Servet, Zaragoza; Hospital Germans Trias i Pujol,
| | - Josefina Cruz
- From the Medical Oncology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas; Hospital Clínic Barcelona, University of Barcelona; Hospital Sant Pau, Barcelona; Hospital Provincial Castellón; Hospital Central Asturias; Hospital Universitario Canarias; Hospital Son Dureta, Mallorca; Hospital Clínico Madrid; Instituto Valenciano de Oncologia; Hospital Miguel Servet, Zaragoza; Hospital Germans Trias i Pujol,
| | - Antonio Casado
- From the Medical Oncology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas; Hospital Clínic Barcelona, University of Barcelona; Hospital Sant Pau, Barcelona; Hospital Provincial Castellón; Hospital Central Asturias; Hospital Universitario Canarias; Hospital Son Dureta, Mallorca; Hospital Clínico Madrid; Instituto Valenciano de Oncologia; Hospital Miguel Servet, Zaragoza; Hospital Germans Trias i Pujol,
| | - Andrés Poveda
- From the Medical Oncology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas; Hospital Clínic Barcelona, University of Barcelona; Hospital Sant Pau, Barcelona; Hospital Provincial Castellón; Hospital Central Asturias; Hospital Universitario Canarias; Hospital Son Dureta, Mallorca; Hospital Clínico Madrid; Instituto Valenciano de Oncologia; Hospital Miguel Servet, Zaragoza; Hospital Germans Trias i Pujol,
| | - Javier Martínez-Trufero
- From the Medical Oncology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas; Hospital Clínic Barcelona, University of Barcelona; Hospital Sant Pau, Barcelona; Hospital Provincial Castellón; Hospital Central Asturias; Hospital Universitario Canarias; Hospital Son Dureta, Mallorca; Hospital Clínico Madrid; Instituto Valenciano de Oncologia; Hospital Miguel Servet, Zaragoza; Hospital Germans Trias i Pujol,
| | - Carmen Balañá
- From the Medical Oncology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas; Hospital Clínic Barcelona, University of Barcelona; Hospital Sant Pau, Barcelona; Hospital Provincial Castellón; Hospital Central Asturias; Hospital Universitario Canarias; Hospital Son Dureta, Mallorca; Hospital Clínico Madrid; Instituto Valenciano de Oncologia; Hospital Miguel Servet, Zaragoza; Hospital Germans Trias i Pujol,
| | - María Auxiliadora Gómez
- From the Medical Oncology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas; Hospital Clínic Barcelona, University of Barcelona; Hospital Sant Pau, Barcelona; Hospital Provincial Castellón; Hospital Central Asturias; Hospital Universitario Canarias; Hospital Son Dureta, Mallorca; Hospital Clínico Madrid; Instituto Valenciano de Oncologia; Hospital Miguel Servet, Zaragoza; Hospital Germans Trias i Pujol,
| | - Ricardo Cubedo
- From the Medical Oncology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas; Hospital Clínic Barcelona, University of Barcelona; Hospital Sant Pau, Barcelona; Hospital Provincial Castellón; Hospital Central Asturias; Hospital Universitario Canarias; Hospital Son Dureta, Mallorca; Hospital Clínico Madrid; Instituto Valenciano de Oncologia; Hospital Miguel Servet, Zaragoza; Hospital Germans Trias i Pujol,
| | - Oscar Gallego
- From the Medical Oncology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas; Hospital Clínic Barcelona, University of Barcelona; Hospital Sant Pau, Barcelona; Hospital Provincial Castellón; Hospital Central Asturias; Hospital Universitario Canarias; Hospital Son Dureta, Mallorca; Hospital Clínico Madrid; Instituto Valenciano de Oncologia; Hospital Miguel Servet, Zaragoza; Hospital Germans Trias i Pujol,
| | - Belen Rubio-Viqueira
- From the Medical Oncology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas; Hospital Clínic Barcelona, University of Barcelona; Hospital Sant Pau, Barcelona; Hospital Provincial Castellón; Hospital Central Asturias; Hospital Universitario Canarias; Hospital Son Dureta, Mallorca; Hospital Clínico Madrid; Instituto Valenciano de Oncologia; Hospital Miguel Servet, Zaragoza; Hospital Germans Trias i Pujol,
| | - Jordi Rubió
- From the Medical Oncology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas; Hospital Clínic Barcelona, University of Barcelona; Hospital Sant Pau, Barcelona; Hospital Provincial Castellón; Hospital Central Asturias; Hospital Universitario Canarias; Hospital Son Dureta, Mallorca; Hospital Clínico Madrid; Instituto Valenciano de Oncologia; Hospital Miguel Servet, Zaragoza; Hospital Germans Trias i Pujol,
| | - Raquel Andrés
- From the Medical Oncology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas; Hospital Clínic Barcelona, University of Barcelona; Hospital Sant Pau, Barcelona; Hospital Provincial Castellón; Hospital Central Asturias; Hospital Universitario Canarias; Hospital Son Dureta, Mallorca; Hospital Clínico Madrid; Instituto Valenciano de Oncologia; Hospital Miguel Servet, Zaragoza; Hospital Germans Trias i Pujol,
| | - Isabel Sevilla
- From the Medical Oncology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas; Hospital Clínic Barcelona, University of Barcelona; Hospital Sant Pau, Barcelona; Hospital Provincial Castellón; Hospital Central Asturias; Hospital Universitario Canarias; Hospital Son Dureta, Mallorca; Hospital Clínico Madrid; Instituto Valenciano de Oncologia; Hospital Miguel Servet, Zaragoza; Hospital Germans Trias i Pujol,
| | - Juan Jose de la Cruz
- From the Medical Oncology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas; Hospital Clínic Barcelona, University of Barcelona; Hospital Sant Pau, Barcelona; Hospital Provincial Castellón; Hospital Central Asturias; Hospital Universitario Canarias; Hospital Son Dureta, Mallorca; Hospital Clínico Madrid; Instituto Valenciano de Oncologia; Hospital Miguel Servet, Zaragoza; Hospital Germans Trias i Pujol,
| | - Xavier García del Muro
- From the Medical Oncology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas; Hospital Clínic Barcelona, University of Barcelona; Hospital Sant Pau, Barcelona; Hospital Provincial Castellón; Hospital Central Asturias; Hospital Universitario Canarias; Hospital Son Dureta, Mallorca; Hospital Clínico Madrid; Instituto Valenciano de Oncologia; Hospital Miguel Servet, Zaragoza; Hospital Germans Trias i Pujol,
| | - Jose María Buesa
- From the Medical Oncology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas; Hospital Clínic Barcelona, University of Barcelona; Hospital Sant Pau, Barcelona; Hospital Provincial Castellón; Hospital Central Asturias; Hospital Universitario Canarias; Hospital Son Dureta, Mallorca; Hospital Clínico Madrid; Instituto Valenciano de Oncologia; Hospital Miguel Servet, Zaragoza; Hospital Germans Trias i Pujol,
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Repiso A, Andrés R, Climent F, Ureña JM. Expression Patterns in Mouse Embryos of Neuroleukin/Glucose-6-Phosphate Isomerase and Autocrine Motility Factor Receptor. Anat Histol Embryol 2008; 37:380-2. [DOI: 10.1111/j.1439-0264.2008.00865.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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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García AG, Esteban E, Girón CG, Maroto P, Andrés R, Canelas A, Caballido J, Carles J, Espinosa E, Lacave AJ. Observational study in patients with pulmonary metastases of renal cell carcinoma receiving inhaled recombinant interleukin-2 (rIL-2). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.4603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4603 Background: Patients with metastatic renal cell carcinoma have a poor prognosis, including those with pulmonary metastases (PMRCC). The objective of this study was to obtain efficacy and safety data on inhaled rIL-2 used in clinical practice in PMRCC patients. Methods: Data provided from 107 PMRCC patients from 48 centres in Spain and 6 in Portugal, treated with inhaled rIL-2 between 2000 and 2005 were evaluated. Data were analyzed by ITT, considering a valuable patient when receiving the first dose of inhaled rIL-2. The treatment schedule was: 3 cycles of 36 MIU rIL-2 per day for 5 days/week for 12 weeks (with one week treatment free between cycles) in Spain and for 3 weeks (out of each 4 weeks) for 12 weeks in Portugal. Efficacy was assessed by best response following each treatment cycle and overall (WHO criteria). The Kaplan-Meier method was used to estimate progression free survival (PFS) and overall survival (OS) that were measured from the time of administration of the first dose of inhaled rIL-2 until progression or death. Safety data were analysed using descriptive statistics, with toxicities expressed as number of weeks in which each toxicity was reported by cycle and by grade. Results: After 1902 treatment weeks administered (median 17.8), the overall objective response rate (complete and partial response,) was 12.2% (95% CI: 6.0–18.4) and a stable disease rate of 22.45% (95% CI: 14.5–30.3). Median PFS and OS were 3.72 (95% CI: 2.86–4.57) and 18.5 (12.69– 23.61) months, respectively. Non-haematological toxicities were the most notable adverse events observed, especially in terms of cough (20.4% of weeks) and fatigue (4.4%) being grade 1 or 2 in severity and reversible by removing the treatment in all cases. Conclusions: This study provides data of efficacy and mild toxicity of inhaled rIL-2. On the basis of these findings inhaled rIL-2 might be considered as an alternative to its systemic administration to treat patients with PMRCC. No significant financial relationships to disclose.
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Affiliation(s)
- A. G. García
- Hospital Reina Sofía, Córdoba, Spain; Hospital Central de Asturias, Oviedo, Spain; Hospital General Yagüe, Burgos, Spain; Hospital Santa Cruz y San Pablo, Barcelona, Spain; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Hospital San Bernardo, Setubal, Portugal; Clínica Puerta de Hierro, Madrid, Spain; Hospital del Mar, Barcelona, Spain; Hospital Universitario La Paz, Madrid, Spain
| | - E. Esteban
- Hospital Reina Sofía, Córdoba, Spain; Hospital Central de Asturias, Oviedo, Spain; Hospital General Yagüe, Burgos, Spain; Hospital Santa Cruz y San Pablo, Barcelona, Spain; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Hospital San Bernardo, Setubal, Portugal; Clínica Puerta de Hierro, Madrid, Spain; Hospital del Mar, Barcelona, Spain; Hospital Universitario La Paz, Madrid, Spain
| | - C. G. Girón
- Hospital Reina Sofía, Córdoba, Spain; Hospital Central de Asturias, Oviedo, Spain; Hospital General Yagüe, Burgos, Spain; Hospital Santa Cruz y San Pablo, Barcelona, Spain; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Hospital San Bernardo, Setubal, Portugal; Clínica Puerta de Hierro, Madrid, Spain; Hospital del Mar, Barcelona, Spain; Hospital Universitario La Paz, Madrid, Spain
| | - P. Maroto
- Hospital Reina Sofía, Córdoba, Spain; Hospital Central de Asturias, Oviedo, Spain; Hospital General Yagüe, Burgos, Spain; Hospital Santa Cruz y San Pablo, Barcelona, Spain; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Hospital San Bernardo, Setubal, Portugal; Clínica Puerta de Hierro, Madrid, Spain; Hospital del Mar, Barcelona, Spain; Hospital Universitario La Paz, Madrid, Spain
| | - R. Andrés
- Hospital Reina Sofía, Córdoba, Spain; Hospital Central de Asturias, Oviedo, Spain; Hospital General Yagüe, Burgos, Spain; Hospital Santa Cruz y San Pablo, Barcelona, Spain; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Hospital San Bernardo, Setubal, Portugal; Clínica Puerta de Hierro, Madrid, Spain; Hospital del Mar, Barcelona, Spain; Hospital Universitario La Paz, Madrid, Spain
| | - A. Canelas
- Hospital Reina Sofía, Córdoba, Spain; Hospital Central de Asturias, Oviedo, Spain; Hospital General Yagüe, Burgos, Spain; Hospital Santa Cruz y San Pablo, Barcelona, Spain; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Hospital San Bernardo, Setubal, Portugal; Clínica Puerta de Hierro, Madrid, Spain; Hospital del Mar, Barcelona, Spain; Hospital Universitario La Paz, Madrid, Spain
| | - J. Caballido
- Hospital Reina Sofía, Córdoba, Spain; Hospital Central de Asturias, Oviedo, Spain; Hospital General Yagüe, Burgos, Spain; Hospital Santa Cruz y San Pablo, Barcelona, Spain; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Hospital San Bernardo, Setubal, Portugal; Clínica Puerta de Hierro, Madrid, Spain; Hospital del Mar, Barcelona, Spain; Hospital Universitario La Paz, Madrid, Spain
| | - J. Carles
- Hospital Reina Sofía, Córdoba, Spain; Hospital Central de Asturias, Oviedo, Spain; Hospital General Yagüe, Burgos, Spain; Hospital Santa Cruz y San Pablo, Barcelona, Spain; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Hospital San Bernardo, Setubal, Portugal; Clínica Puerta de Hierro, Madrid, Spain; Hospital del Mar, Barcelona, Spain; Hospital Universitario La Paz, Madrid, Spain
| | - E. Espinosa
- Hospital Reina Sofía, Córdoba, Spain; Hospital Central de Asturias, Oviedo, Spain; Hospital General Yagüe, Burgos, Spain; Hospital Santa Cruz y San Pablo, Barcelona, Spain; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Hospital San Bernardo, Setubal, Portugal; Clínica Puerta de Hierro, Madrid, Spain; Hospital del Mar, Barcelona, Spain; Hospital Universitario La Paz, Madrid, Spain
| | - A. J. Lacave
- Hospital Reina Sofía, Córdoba, Spain; Hospital Central de Asturias, Oviedo, Spain; Hospital General Yagüe, Burgos, Spain; Hospital Santa Cruz y San Pablo, Barcelona, Spain; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Hospital San Bernardo, Setubal, Portugal; Clínica Puerta de Hierro, Madrid, Spain; Hospital del Mar, Barcelona, Spain; Hospital Universitario La Paz, Madrid, Spain
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Modolell A, Mayordomo MD JI, Garcia-Bueno JM, Machengs I, Alvarez I, Centelles M, Palombo H, Burillo M, Yubero A, Murillo L, Andrés R. Multicenter phase II study of liposomal doxorubicin (M) and docetaxel (T) as neoadjuvant treatment in patients with stage II - III breast cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.10662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10662 Background: T and M is a very active chemotherapy regimen for breast cancer. M has been shown to be as effective as doxorubicin at same doses while reducing the cardiotoxicity and causing less myelosuppression. This study was designed to evaluate clinical and pathological response rate (RR) and toxicity after induction chemotherapy in patient with breast cancer. Methods: Patients with histological confirmation of breast cancer (stage II-III and inflammatory), age > 18 years, left ventricular eject fraction > 45% and adequate bone marrow, renal and hepatic function were included in the study. Prior systemic therapy or radiotherapy and surgery for breast cancer were not allowed. Treatment: T (75 mg/m2) iv and M (75 mg/m2) iv, every 21 days during 4 cycles, followed by surgery. Results: To date 59 patients have been enrolled; 50 were included in this interim analysis, with a median age of 52 years old (28–76), ECOG PS 0, 88.0%; ECOG PS 1, 12.0%; breast location: right, 52.0%; peri-postmenopausal status, 44.9%. Positive hormonal receptor status was 63.3%. Histology was ductal carcinoma in 84.0%. Patients received a total of 188 cycles (median 4, range 2–4). Median relative dose intensity was 99% for T and for M. Efficacy: Nine patients were non-evaluable (7 on treatment, 1 consent withdrawal and 1 lost of follow-up). Of 41 evaluable patients, 5 achieved complete response (CR) (12.2%), 26 partial response (PR)(63.4%), 9 stable disease (SD) (22.0%) and 1 progressive disease (PD) (2.4%), resulting in a clinical response rate (RR) of 75.6% (95% CI: 62.5–88.7%). Surgery was performed in 40 patients: six (15.0%) of them had pathological (p) CR, 25 (62.5%) pPR, 9 (22.5%) pSD resulting in a pathological RR of 77.5% (95% CI: 64.6–90.4%). Median of time to progression and overall survival has not been achieved yet. Hematological toxicities grades III/IV per patient were neutropenia (14%), thrombocytopenia (4%), leukopenia (2%), anemia (2%) and febrile neutropenia (12%). Non-hematological grade III/IV toxicities per patient were asthenia (6%), nausea / vomiting (4%) and infection (4%). Conclusions: T and M every 21 days during 4 cycles as induction chemotherapy in stage II and III breast cancer is an active and well tolerated treatment. No significant financial relationships to disclose.
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Affiliation(s)
- A. Modolell
- Instituto Oncologico Corachan, Barcelona, Spain; Hospital Clinico Universitario, Zaragoza, Spain; Policlinica Miramar, Palma de Mallorca, Spain; Hospital Sagrat Cor, Barcelona, Spain; Hospital San Jorge, Huesca, Spain; Clinica del Remedio, Barcelona, Spain; Hospital Obispo Polanco, Teruel, Spain; Hospital Reina Sofia, Tudela, Spain
| | - J. I. Mayordomo MD
- Instituto Oncologico Corachan, Barcelona, Spain; Hospital Clinico Universitario, Zaragoza, Spain; Policlinica Miramar, Palma de Mallorca, Spain; Hospital Sagrat Cor, Barcelona, Spain; Hospital San Jorge, Huesca, Spain; Clinica del Remedio, Barcelona, Spain; Hospital Obispo Polanco, Teruel, Spain; Hospital Reina Sofia, Tudela, Spain
| | - J. M. Garcia-Bueno
- Instituto Oncologico Corachan, Barcelona, Spain; Hospital Clinico Universitario, Zaragoza, Spain; Policlinica Miramar, Palma de Mallorca, Spain; Hospital Sagrat Cor, Barcelona, Spain; Hospital San Jorge, Huesca, Spain; Clinica del Remedio, Barcelona, Spain; Hospital Obispo Polanco, Teruel, Spain; Hospital Reina Sofia, Tudela, Spain
| | - I. Machengs
- Instituto Oncologico Corachan, Barcelona, Spain; Hospital Clinico Universitario, Zaragoza, Spain; Policlinica Miramar, Palma de Mallorca, Spain; Hospital Sagrat Cor, Barcelona, Spain; Hospital San Jorge, Huesca, Spain; Clinica del Remedio, Barcelona, Spain; Hospital Obispo Polanco, Teruel, Spain; Hospital Reina Sofia, Tudela, Spain
| | - I. Alvarez
- Instituto Oncologico Corachan, Barcelona, Spain; Hospital Clinico Universitario, Zaragoza, Spain; Policlinica Miramar, Palma de Mallorca, Spain; Hospital Sagrat Cor, Barcelona, Spain; Hospital San Jorge, Huesca, Spain; Clinica del Remedio, Barcelona, Spain; Hospital Obispo Polanco, Teruel, Spain; Hospital Reina Sofia, Tudela, Spain
| | - M. Centelles
- Instituto Oncologico Corachan, Barcelona, Spain; Hospital Clinico Universitario, Zaragoza, Spain; Policlinica Miramar, Palma de Mallorca, Spain; Hospital Sagrat Cor, Barcelona, Spain; Hospital San Jorge, Huesca, Spain; Clinica del Remedio, Barcelona, Spain; Hospital Obispo Polanco, Teruel, Spain; Hospital Reina Sofia, Tudela, Spain
| | - H. Palombo
- Instituto Oncologico Corachan, Barcelona, Spain; Hospital Clinico Universitario, Zaragoza, Spain; Policlinica Miramar, Palma de Mallorca, Spain; Hospital Sagrat Cor, Barcelona, Spain; Hospital San Jorge, Huesca, Spain; Clinica del Remedio, Barcelona, Spain; Hospital Obispo Polanco, Teruel, Spain; Hospital Reina Sofia, Tudela, Spain
| | - M. Burillo
- Instituto Oncologico Corachan, Barcelona, Spain; Hospital Clinico Universitario, Zaragoza, Spain; Policlinica Miramar, Palma de Mallorca, Spain; Hospital Sagrat Cor, Barcelona, Spain; Hospital San Jorge, Huesca, Spain; Clinica del Remedio, Barcelona, Spain; Hospital Obispo Polanco, Teruel, Spain; Hospital Reina Sofia, Tudela, Spain
| | - A. Yubero
- Instituto Oncologico Corachan, Barcelona, Spain; Hospital Clinico Universitario, Zaragoza, Spain; Policlinica Miramar, Palma de Mallorca, Spain; Hospital Sagrat Cor, Barcelona, Spain; Hospital San Jorge, Huesca, Spain; Clinica del Remedio, Barcelona, Spain; Hospital Obispo Polanco, Teruel, Spain; Hospital Reina Sofia, Tudela, Spain
| | - L. Murillo
- Instituto Oncologico Corachan, Barcelona, Spain; Hospital Clinico Universitario, Zaragoza, Spain; Policlinica Miramar, Palma de Mallorca, Spain; Hospital Sagrat Cor, Barcelona, Spain; Hospital San Jorge, Huesca, Spain; Clinica del Remedio, Barcelona, Spain; Hospital Obispo Polanco, Teruel, Spain; Hospital Reina Sofia, Tudela, Spain
| | - R. Andrés
- Instituto Oncologico Corachan, Barcelona, Spain; Hospital Clinico Universitario, Zaragoza, Spain; Policlinica Miramar, Palma de Mallorca, Spain; Hospital Sagrat Cor, Barcelona, Spain; Hospital San Jorge, Huesca, Spain; Clinica del Remedio, Barcelona, Spain; Hospital Obispo Polanco, Teruel, Spain; Hospital Reina Sofia, Tudela, Spain
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Millastre E, Ruiz-Echarri Sr. M, Ortega M, Mayordomo JI, Lastra R, Prats E, Lambea J, Aguirre E, Razola P, Andrés R, Tres A, Banzo J. Axillary lymphadenectomy can be safely avoided in patients with breast cancer and negative sentinel lymph node biopsy. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.10787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10787 Background: Patients with breast cancer in which sentinel lymph node biopsy is histologically negative for tumor cells, have a low probability of having involvement of additional regional lymph nodes. Lymph node dissection may be avoided in these cases. Methods: Ninety-six consecutive patients with invasive breast cancer and tumour size less than 2 centimeters by mammography, had lymphoscintigraphy with colloidal 99Tc and radioisotope-guided sentinel lymph node biopsy in the University Hospital of Zaragoza from 1999 to 2005.Pathological assessment included serial sections of the sentinel lymph node with immunohistochemistry for cytokeratins in selected cases. Results: Sentinel lymph node biopsy was negative in 57 patients. There were 56 females and 1 male. Median age was 57 years (range 24–87). Median pathological tumor size was 15 mm (range 5–31). Location of the sentinel lymph node was axillary in 47patients, internal mammary in 0 patients, and both in 10 patients. Median number of resected lymph nodes was 2 (range 1–4). With median follow-up of 33 months, no local or systemic relapses have occurred. Conclusions: Avoidance of regional lymph node dissection is safe in patients with breast cancer and histologically negative sentinel lymph node biopsy. No significant financial relationships to disclose.
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Affiliation(s)
- E. Millastre
- Hospital Clínico Universitario de Zaragoza, Zaragoza, Spain
| | | | - M. Ortega
- Hospital Clínico Universitario de Zaragoza, Zaragoza, Spain
| | | | - R. Lastra
- Hospital Clínico Universitario de Zaragoza, Zaragoza, Spain
| | - E. Prats
- Hospital Clínico Universitario de Zaragoza, Zaragoza, Spain
| | - J. Lambea
- Hospital Clínico Universitario de Zaragoza, Zaragoza, Spain
| | - E. Aguirre
- Hospital Clínico Universitario de Zaragoza, Zaragoza, Spain
| | - P. Razola
- Hospital Clínico Universitario de Zaragoza, Zaragoza, Spain
| | - R. Andrés
- Hospital Clínico Universitario de Zaragoza, Zaragoza, Spain
| | - A. Tres
- Hospital Clínico Universitario de Zaragoza, Zaragoza, Spain
| | - J. Banzo
- Hospital Clínico Universitario de Zaragoza, Zaragoza, Spain
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Sahagún Pareja J, Castillo FJ, Andrés R, Capilla S, Mayordomo JI, Pitart C, Tres A. [Surveillance of commensal flora evolution and infections in neutropenic cancer patients submitted to chemoprophylaxis]. Rev Esp Quimioter 2005; 18:32-8. [PMID: 15915230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The evolution of the flora and its resistance to different antimicrobials in neutropenic patients submitted to high-dose chemotherapy with autologous blood stem-cell transplantation, and the relation of these findings to the etiology of the infections the patients developed was studied in order to evaluate the suitability of the chemoprophylaxis and the empirical antibiotic therapy used. Forty-one patients were analyzed in a period of 28 months. The chemoprophylaxis used was levofloxacin, fluconazole and acyclovir. The empirical sequential treatment was an initial administration of cefepime, followed by teicoplanin and amikacin. Cultures were done of nasal and pharyngeal smears, Hickman catheter and stools, 1 day before chemoprophylaxis started and then on days 5 and 9. In the case of fever, three sets of blood cultures and urine cultures were done and samples from areas related to the clinical condition were analyzed. Levofloxacin induced the selection of resistant strains or species in the flora and in the infectious agents. Fluconazole also selected resistant species in the flora. Seventeen infections were documented in eleven patients, produced by Gram-positive bacteria in thirteen cases (81.25%) and by Gram-negative bacteria in three (18.75%). The coagulase negative staphylococci and Enterococcus faecalis were the most frequent agents of infection. We identified on nine occasions the same microorganism in the flora and in the pathological product; this suggests its endogenous origin and supports the use of prospective cultures of the flora, monitoring the sensibility of the microorganisms isolated to the antimicrobials used in chemoprophylaxis and empirical treatment.
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Affiliation(s)
- J Sahagún Pareja
- Servicios de Microbiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza.
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Güemes A, Sousa R, Navarro A, Val-Carreres P, Moros M, Sainz JM, Mayordomo JI, Andrés R, Polo E, Álvarez I, Lozano R. Aspectos técnicos y resultados de la mastectomía profiláctica en pacientes con elevado riesgo de cáncer de mama. Cir Esp 2004. [DOI: 10.1016/s0009-739x(04)78940-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: 10/27/2022]
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50
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Andrés R, Saenz A, Mayordomo JI, Zaballos P, Isla D, Escudero P, Alvarez I, Polo E, Lara R, Tres A. Case 4. Hypertrophic osteoarthropathy associated with pulmonary metastasis of uterine leiomyosarcoma. J Clin Oncol 2003; 21:3540-1. [PMID: 12972534 DOI: 10.1200/jco.2003.11.080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Raquel Andrés
- Division of Medical Oncology, University Hospital, Zaragoza, Spain
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