10 research outputs found

    The Scarface Score: Deciphering Response to DNA Damage Agents in High-Grade Serous Ovarian Cancer—A GEICO Study

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    Genomic instability; Machine learningInestabilidad genómica; Aprendizaje automáticoInestabilitat genòmica; Aprenentatge automàticGenomic Instability (GI) is a transversal phenomenon shared by several tumor types that provide both prognostic and predictive information. In the context of high-grade serous ovarian cancer (HGSOC), response to DNA-damaging agents such as platinum-based and poly(ADP-ribose) polymerase inhibitors (PARPi) has been closely linked to deficiencies in the DNA repair machinery by homologous recombination repair (HRR) and GI. In this study, we have developed the Scarface score, an integrative algorithm based on genomic and transcriptomic data obtained from the NGS analysis of a prospective GEICO cohort of 190 formalin-fixed paraffin-embedded (FFPE) tumor samples from patients diagnosed with HGSOC with a median follow up of 31.03 months (5.87–159.27 months). In the first step, three single-source models, including the SNP-based model (accuracy = 0.8077), analyzing 8 SNPs distributed along the genome; the GI-based model (accuracy = 0.9038) interrogating 28 parameters of GI; and the HTG-based model (accuracy = 0.8077), evaluating the expression of 7 genes related with tumor biology; were proved to predict response. Then, an ensemble model called the Scarface score was found to predict response to DNA-damaging agents with an accuracy of 0.9615 and a kappa index of 0.9128 (p < 0.0001). The Scarface Score approaches the routine establishment of GI in the clinical setting, enabling its incorporation as a predictive and prognostic tool in the management of HGSOC.This research was partially funded by GVA Grants “Subvencions per a la realització de projectes d’i+d+i desenvolupats per grups d’investigació emergents (GV/2020/158)” and “Ayudas para la contratación de personal investigador en formación de carácter predoctoral” (ACIF/2016/008) and “Beca de investigación traslacional Andrés Poveda 2020” from GEICO group. This study was awarded the Prize “Antonio Llombart Rodriguez-FINCIVO 2020” from the Royal Academy of Medicine of the Valencian Community

    Phase 2 Trial (POLA Study) of Lurbinectedin plus Olaparib in Patients with Advanced Solid Tumors: Results of Efficacy, Tolerability, and the Translational Study

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    Endometrial cancer; Genomic instability; OlaparibCáncer endometrial; Inestabilidad genómica; OlaparibCàncer d'endometri; Inestabilitat genòmica; OlaparibWe hypothesized that the combination of olaparib and lurbinectedin maximizes DNA damage, thus increasing its efficacy. The POLA phase 1 trial established the recommended phase 2 dose of lurbinectedin as being 1.5 mg (day 1) and that of olaparib as being 250 mg/12 h (days 1–5) for a 21-day cycle. In phase 2, we explore the efficacy of the combination in terms of clinical response and its correlation with mutations in the HRR genes and the genomic instability (GI) parameters. Results: A total of 73 patients with high-grade ovarian (n = 46), endometrial (n = 26), and triple-negative breast cancer (n = 1) were treated with lurbinectedin and olaparib. Most patients (62%) received ≥3 lines of prior therapy. The overall response rate (ORR) and disease control rate (DCR) were 9.6% and 72.6%, respectively. The median progression-free survival (PFS) was 4.54 months (95% CI 3.0–5.2). Twelve (16.4%) patients were considered long-term responders (LTR), with a median PFS of 13.3 months. No clinical benefit was observed for cases with HRR gene mutation. In ovarian LTRs, although a direct association with GI and a total loss of heterozygosity (LOH) events was observed, the association did not reach statistical significance (p = 0.055). Globally, the total number of LOHs might be associated with the ORR (p =0.074). The most common grade 3–4 toxicities were anemia and thrombocytopenia, in 6 (8.2%) and 3 (4.1%) patients, respectively. Conclusion: The POLA study provides evidence that the administration of lurbinectedin and olaparib is feasible and tolerable, with a DCR of 72.6%. Different GI parameters showed associations with better responses.This trial was sponsored by AstraZeneca and PharmaMar, including supply of the drugs used in this study

    Use of tocilizumab in kidney transplant recipients with COVID-1

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    Acute respiratory distress syndrome associated with coronavirus infection is related to a cytokine storm with large interleukin-6 (IL-6) release. The IL-6-receptor blocker tocilizumab may control the aberrant host immune response in patients with coronavirus disease 2019 (COVID-19) . In this pandemic, kidney transplant (KT) recipients are a high-risk population for severe infection and showed poor outcomes. We present a multicenter cohort study of 80 KT patients with severe COVID-19 treated with tocilizumab during hospital admission. High mortality rate was identified (32.5%), related with older age (hazard ratio [HR] 3.12 for those older than 60 years, P = .039). IL-6 and other inflammatory markers, including lactic acid dehydrogenase, ferritin, and D-dimer increased early after tocilizumab administration and their values were higher in nonsurvivors. Instead, C-reactive protein (CRP) levels decreased after tocilizumab, and this decrease positively correlated with survival (mean 12.3 mg/L in survivors vs. 33 mg/L in nonsurvivors). Each mg/L of CRP soon after tocilizumab increased the risk of death by 1% (HR 1.01 [confidence interval 1.004-1.024], P = .003). Although patients who died presented with worse respiratory situation at admission, this was not significantly different at tocilizumab administration and did not have an impact on outcome in the multivariate analysis. Tocilizumab may be effective in controlling cytokine storm in COVID-19 but randomized trials are needed

    Producción de materiales híbridos bioreabsorbibles para regeneración ósea

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    [EN] We have developed a microporous hybrid membrane that combines polylactic acid, chitosan nanoparticles and bioactive glass, PLLA / CHT / BG-NPs, designed to provide support in bone regeneration with tissue engineering techniques. The material was produced in three steps. On one hand, the membrane of PLLA was obtained by a method of freeze extraction. The process of freeze extraction produces a polymeric membrane with interconnected pores and with a pore size in the range of micrometers. The porosity depends on the concentration of PLLA solution in dioxane. In this work, membranes produced from solutions with 10% by weight of PLLA was used. The nanoparticles, which are useful for delivery of ions from the bioactive glass from the pores of the scaffold, are synthesized by a sol-gel reaction. Visualization by FESEM of the bioactive glass nanoparticles and CHT-NPs film demonstrates that the nanoparticles have suitable characteristics of shape and size, obtaining spherical nanoparticles with diameters between 180-320 nm. The BG-NPs were dispersed in a 1% chitosan solution and loaded by vacuum into the porous membrane of PLLA, forming the hybrid. The resulting dispersion of nanoparticles of chitosan-bioactive glass creates an evenly distributed coating over the entire surface of the pores of the membrane of PLLA. The in vitro bioactivity of the hybrid scaffold and the different samples (PLLA and chitosan films) were separately investigated by incubation in simulated body fluid (SBF). The FESEM (field emission scanning electron microscopy) and EDX (Energy Dispersive X-ray Spectroscopy) instruments were employed to test the variation of the samples’ surfaces during incubation in SBF, as well as used to visualized the different structures formed on the surface of the samples. In that way, it was determined if the there was a layer of hydroxyapatite on the surface of the different materials, confirming their bioactivity.[ES] Se ha desarrollado una membrana hibrida microporosa que combina ácido poliláctico, quitosano y nanopartículas de vidrio bioactivo, PLLA/CHT/BG-NPs, destinada a servir de soporte en regeneración ósea con técnicas de ingeniería tisular. El material fue producido en tres pasos. Por una parte, la membrana de PLLA se obtuvo mediante un procedimiento de extracción de disolvente en frío o “freeze extraction”. El proceso de “freeze extraction” produce una membrana polimérica con poros interconectados y con un tamaño de poro del orden de micrometros. La porosidad depende de la concentración PLLA en la disolución en dioxano. En este trabajo se utilizan membranas producidas a partir de soluciones con un 10% en peso de PLLA. Las nanopartículas, las cuales son útiles para la liberación de iones del vidrio bioactivo desde los poros del scaffold, son sintetizadas mediante una reacción de sol-gel. La visualización mediante FESEM de las nanopartículas de vidrio bioactivo y del film de CHT-NPs, demuestra que las nanopartículas tienen las características adecuadas de forma y tamaño, obteniéndose nanopartículas esféricas con diámetros comprendido entre 180-320 nm. Las BG-NPs se dispersaron en una solución al 1% de quitosano y se introdujeron mediante vacio en la membrana porosa de PLLA, formando el híbrido. La dispersión formada por nanopartículas de vidrio bioactivo en quitosano crea un recubrimiento homogéneamente distribuido sobre toda la superficie de los poros de la membrana de PLLA. La bioactividad in vitro del scaffold hibrido, así como de las diferentes muestras (PLLA y films de quitosano) por separado fue investigada mediante incubación en fluido corporal simulado (SBF). Los instrumentos FESEM (field emission scanning electron microscopy) y EDX (Energy Dispersive X-ray Spectroscopy) fueron empleados para comprobar la variación de las superficies de las muestras durante la incubación en SBF, así como para visualizar las diferentes estructuras previas al ensayo de bioactividad. Así, se determinó si se había producido la capa de hidroxiapatita sobre la superficie de los distintos materiales, confirmando la bioactividad de los mismos.López Reig, R. (2014). Producción de materiales híbridos bioreabsorbibles para regeneración ósea. http://hdl.handle.net/10251/39775.Archivo delegad

    Once-Weekly Hypofractionated Radiotherapy for Breast Cancer in Elderly Patients: Efficacy and Tolerance in 486 Patients

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    PURPOSE: Radiation therapy is a key treatment of breast cancer. Elderly patients with associated diseases that modify their performance status do not tolerate long periods of daily irradiation. The objective of this study is to analyze the results of weekly hypofractionated treatment in these patients. MATERIAL AND METHODS: Between 1992 and 2016, we included 486 elderly patients presenting concomitant pathology or sociofamilial problems in which it was not feasible to propose conventional treatment. They were treated with conservative surgery or mastectomy and then adjuvant hypofractionated irradiation, administering 5 Gy or 6.25 Gy in 6 fractions, once a week (total dose 30-37.5 Gy) over 6 weeks. RESULTS: Breast cancer overall survival according to the Kaplan-Meier method at 5 years was 74.2% ± 2.3%; breast cancer disease-free survival was 90% ± 1.6%; local relapse-free survival was 96.5% ± 1% showing that patients die more from other causes and not from their neoplasia. Acute dermatitis was mild (75.6% of the patients grades I-III) and 30.6% had moderate chronic fibrosis. CONCLUSIONS: the once-weekly hypofractionated radiotherapy is a feasible and convenient option for elderly patients with breast cancer. It is a safe treatment modality with similar survival and local control results compared to standard fractionation, while the side effects are acceptable

    Once-Weekly Hypofractionated Radiotherapy for Breast Cancer in Elderly Patients: Efficacy and Tolerance in 486 Patients

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    PURPOSE: Radiation therapy is a key treatment of breast cancer. Elderly patients with associated diseases that modify their performance status do not tolerate long periods of daily irradiation. The objective of this study is to analyze the results of weekly hypofractionated treatment in these patients. MATERIAL AND METHODS: Between 1992 and 2016, we included 486 elderly patients presenting concomitant pathology or sociofamilial problems in which it was not feasible to propose conventional treatment. They were treated with conservative surgery or mastectomy and then adjuvant hypofractionated irradiation, administering 5 Gy or 6.25 Gy in 6 fractions, once a week (total dose 30-37.5 Gy) over 6 weeks. RESULTS: Breast cancer overall survival according to the Kaplan-Meier method at 5 years was 74.2% ± 2.3%; breast cancer disease-free survival was 90% ± 1.6%; local relapse-free survival was 96.5% ± 1% showing that patients die more from other causes and not from their neoplasia. Acute dermatitis was mild (75.6% of the patients grades I-III) and 30.6% had moderate chronic fibrosis. CONCLUSIONS: the once-weekly hypofractionated radiotherapy is a feasible and convenient option for elderly patients with breast cancer. It is a safe treatment modality with similar survival and local control results compared to standard fractionation, while the side effects are acceptable
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