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1.
Clin Colorectal Cancer ; 22(2): 222-230, 2023 06.
Article in English | MEDLINE | ID: mdl-36944559

ABSTRACT

BACKGROUND: The bCTC count is a well-established prognostic biomarker in mCRC, as well as in other tumor types. The aim of this analysis was to evaluate the prognostic/predictive role of the bCTC count (≥3 vs. <3) in previously untreated mCRC. PATIENTS AND METHODS: The study involved 589 untreated mCRC patients included in the intention-to-treat population of 2 randomized clinical trials (phase III VISNU-1 [NCT01640405] and phase II VISNU-2 [NCT01640444] studies). RESULTS: Of the 589 patients, 349 (59.2%) had bCTC≥3 and 240 (40.7%) had bCTC<3. Multivariate analysis showed that the bCTC count is an independent prognostic factor for overall survival (OS) (HR 0.59, 95% CI 0.48-0.72; P = 0.000) and potential for progression-free survival (PFS) (P = 0.0549). Median OS was 32.9 and 19.5 months in patients with bCTC<3 and bCTC≥3 (P <0.001), respectively. This effect was also observed comparing OS in RASwt patients from both studies. Other prognostic factors were: ECOG-PS, primary tumor site, number of metastatic sites and surgery of the primary tumor. Median OS was lower for patients treated with anti-VEGF versus anti-EGFR (22.3 vs. 33.3 months, P <0.0001) while there were no significant differences in PFS according to the targeted treatment received. CONCLUSION: This post-hoc analysis of 2 randomized studies confirms the poor prognosis of patients with bCTC≥3 but this is not associated with other adverse independent prognostic factors such as RAS/BRAF mutations.


Subject(s)
Colonic Neoplasms , Colorectal Neoplasms , Neoplastic Cells, Circulating , Rectal Neoplasms , Humans , Colorectal Neoplasms/drug therapy , Colorectal Neoplasms/genetics , Randomized Controlled Trials as Topic , Prognosis , Colonic Neoplasms/drug therapy , Rectal Neoplasms/drug therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Clinical Trials, Phase II as Topic
2.
Clin Transl Oncol ; 22(2): 236-244, 2020 Feb.
Article in English | MEDLINE | ID: mdl-31989475

ABSTRACT

Gastric cancer (GC) is the fifth most common cancer worldwide with a varied geographic distribution and an aggressive behavior. In Spain, it represents the sixth cause of cancer death. In Western countries, the incidence is decreasing slightly, with an increase in gastroesophageal junction adenocarcinoma (GEJA), a different entity that we separate specifically in the guideline. Molecular biology advances have been done recently, but do not yet lead to the choice in treatment approach except in advanced disease with overexpression of HER2. Endoscopic resection in very early stage, perioperative chemotherapy in locally advanced tumors and preliminary immune therapy resulting in advanced disease are the main treatment innovations in the GC/GEJA treatment. We describe the different evidences and recommendations following the statements of the American College of Physicians.


Subject(s)
Adenocarcinoma/diagnosis , Adenocarcinoma/therapy , Clinical Trials as Topic/standards , Esophagogastric Junction/pathology , Practice Guidelines as Topic/standards , Stomach Neoplasms/diagnosis , Stomach Neoplasms/therapy , Humans , Medical Oncology , Societies, Medical
3.
Clin Transl Oncol ; 19(12): 1423-1429, 2017 Dec.
Article in English | MEDLINE | ID: mdl-28623515

ABSTRACT

The treatment of choice of metastatic PADC is systemic chemotherapy. In the last decade, there have been significant advances in this area. New combination poli-chemotherapy schemes have shown a significant increase in overall survival and progression-free survival without impairing quality of life. In addition, the value of second-line chemotherapy treatment has consolidated and a new concept called "therapeutic sequencing" has also emerged. The aim of this article is to review the different therapeutic options in metastatic PDAC based on patient's characteristics.


Subject(s)
Adenocarcinoma/drug therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Pancreatic Ductal/drug therapy , Pancreatic Neoplasms/drug therapy , Quality of Life , Adenocarcinoma/secondary , Carcinoma, Pancreatic Ductal/secondary , Humans , Pancreatic Neoplasms/pathology , Prognosis , Pancreatic Neoplasms
4.
Clin Transl Oncol ; 19(6): 667-681, 2017 Jun.
Article in English | MEDLINE | ID: mdl-27995549

ABSTRACT

The management of patients with pancreatic cancer has advanced over the last few years. We convey a multidisciplinary group of experts in an attempt to stablish practical guidelines for the diagnoses, staging and management of these patients. This paper summarizes the main conclusions of the working group. Patients with suspected pancreatic ductal adenocarcinoma should be rapidly evaluated and referred to high-volume centers. Multidisciplinary supervision is critical for proper diagnoses, staging and to frame a treatment plan. Surgical resection together with chemotherapy offers the highest chance for cure in early stage disease. Patients with advanced disease should be classified in treatment groups to guide systemic treatment. New chemotherapeutic regimens have resulted in improved survival. Symptomatic management is critical in this disease. Enrollment in a clinical trial is, in general, recommended.


Subject(s)
Carcinoma, Pancreatic Ductal/diagnosis , Carcinoma, Pancreatic Ductal/therapy , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/therapy , Follow-Up Studies , Humans , Practice Guidelines as Topic , Spain
5.
Clin Transl Oncol ; 16(10): 921-6, 2014 Oct.
Article in English | MEDLINE | ID: mdl-24788817

ABSTRACT

PURPOSE: An association between neuroendocrine tumors (NETs) and second primary malignancies (SPMs) has been reported. We have examined the incidence and etiology of SPMs in patients with NETs included in the Neuroendocrine Tumor Association of Andalusia (ATNEA) Registry. METHODS: Data on 111 patients were collected. Sex, age, NET site, chromogranin A levels, neuropeptide secretion and disease stage were compared between NETs with and without SPMs. RESULTS: SPMs were present in 21 patients (18.9 %): five colorectal tumors, four non-small-cell lung cancers, three gastric cancers, two tumors in the small intestine, one hepatocarcinoma, two ovarian tumors, one breast adenocarcinoma, one hypernephroma, one bladder cancer, and one neuroblastoma. SPMs were present in 18 % of patients with a gastrointestinal NET and 22 % of those with a non-gastrointestinal NET. SPMs were found in 23 % of patients with elevated levels of serum chromogranin A, compared to 17 % of patients with normal levels, and in 22 % of patients with functional tumors, compared to 11 % of those with non-functional tumors. Finally, SPMs were observed in 24 % of patients with a local or locoregional tumor but in only 13 % of those with a metastatic tumor. No other differences between patients with and without SPMs were observed. CONCLUSIONS: The percentage of patients with SPMs in the ATNEA Registry is similar to those reported in other series. In our registry, patients with functional NETs and local/locoregional tumors have higher probability of SPMs. The low number of patients, selection bias and other etiologic factors of SPMs may have influenced our results.


Subject(s)
Chromogranin A/blood , Gastrointestinal Neoplasms/epidemiology , Neoplasms, Second Primary/epidemiology , Neuroendocrine Tumors/epidemiology , Registries , Adolescent , Adult , Aged , Breast Neoplasms/epidemiology , Carcinoma, Ductal, Breast/epidemiology , Carcinoma, Hepatocellular/epidemiology , Carcinoma, Non-Small-Cell Lung/epidemiology , Carcinoma, Renal Cell/epidemiology , Colorectal Neoplasms/epidemiology , Female , Gastrointestinal Neoplasms/blood , Humans , Kidney Neoplasms/epidemiology , Liver Neoplasms/epidemiology , Male , Middle Aged , Neuroblastoma/epidemiology , Neuroendocrine Tumors/blood , Ovarian Neoplasms/epidemiology , Spain , Stomach Neoplasms/epidemiology , Young Adult
7.
Gen Diagn Pathol ; 143(5-6): 317-20, 1998 Apr.
Article in English | MEDLINE | ID: mdl-9653914

ABSTRACT

We report on a 65-year-old white woman who was hospitalized because of symptoms of an acute adrenocortical insufficiency. A CT scan revealed the presence of a large mass in the left kidney that infiltrated the adrenal gland. Fine needle aspiration cytology of the mass under imaging control failed to achieve a correct diagnosis, and nephrectomy was undertaken with a preoperative diagnosis of renal cell carcinoma. However, the frozen section reveals a neoplasm of large lymphoid cells with a diffuse growth pattern. Immunohistochemistry confirms the B-cell nature of the neoplasm (CD20+). The final diagnosis was non-Hodgkin B-cell high grade centroblastic lymphoma (KIEL classification). Postoperative studies failed to show lymph node or bone marrow infiltration by neoplastic cells. We found reports on only 60 malignant lymphomas, considered to be primary to the kidney. They usually affect middle-aged people, can be diagnosed with imaging techniques, and seem to show a better prognosis than other types of lymphoma.


Subject(s)
Adrenal Gland Neoplasms/secondary , Kidney Neoplasms/pathology , Lymphoma, B-Cell/pathology , Lymphoma, Non-Hodgkin/pathology , Aged , Female , Humans
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