Fernández-Montes, A. (Ana)

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2016 - 20172

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    Nomogram-based prediction of survival in patients with advanced oesophagogastric adenocarcinoma receiving first-line chemotherapy: a multicenter prospective study in the era of trastuzumab
    (2017) Jiménez-Fonseca, P. (Paula); López, C. (Carolina); Azkarate, A. (Aitor); Custodio, A. (Ana); Mangas, M. (Monserrat); Viudez, A. (Antonio); Echavarría, I. (Isabel); Sanchez-Bayona, R. (Rodrigo); Buxó, E. (Elvira); Hernández, R. (Raquel); Longo, F.; Pericay, C. (Carles); Carmona-Bayonas, A. (Alberto); Ramchandani, A. (Avinash); Lacalle, A. (Alejandra); Fernández-Montes, A. (Ana); Macías-Declara, I. (Ismael); García-García, T. (Teresa); Sánchez-Lorenzo, M. L. (María Luisa); Cano, J. M. (Juana María); Rodríguez-Palomo, A. (Alberto); Álvarez-Manceñido, F. (Felipe); Visa, L. (Laura); Limón, M. L. (María-Luisa)
    Background: To develop and validate a nomogram and web-based calculator to predict overall survival (OS) in Caucasian-advanced oesophagogastric adenocarcinoma (AOA) patients undergoing first-line combination chemotherapy. Methods: Nine hundred twenty-four AOA patients treated at 28 Spanish teaching hospitals from January 2008 to September 2014 were used as derivation cohort. The result of an adjusted-Cox proportional hazards regression was represented as a nomogram and web-based calculator. The model was validated in 502 prospectively recruited patients treated between October 2014 and December 2016. Harrell's c-index was used to evaluate discrimination. Results: The nomogram includes seven predictors associated with OS: HER2-positive tumours treated with trastuzumab, Eastern Cooperative Oncology Group performance status, number of metastatic sites, bone metastases, ascites, histological grade, and neutrophil-to-lymphocyte ratio. Median OS was 5.8 (95% confidence interval (CI), 4.5–6.6), 9.4 (95% CI, 8.5–10.6), and 14 months (95% CI, 11.8–16) for high-, intermediate-, and low-risk groups, respectively (P<0.001), in the derivation set and 4.6 (95% CI, 3.3–8.1), 12.7 (95% CI, 11.3–14.3), and 18.3 months (95% CI, 14.6–24.2) for high-, intermediate-, and low-risk groups, respectively (P<0.001), in the validation set. The nomogram is well-calibrated and reveals acceptable discriminatory capacity, with optimism-corrected c-indices of 0.618 (95% CI, 0.591–0.631) and 0.673 (95% CI, 0.636–0.709) in derivation and validation groups, respectively. The AGAMENON nomogram outperformed the Royal Marsden Hospital (c-index=0.583; P=0.00046) and Japan Clinical Oncology Group prognostic indices (c-index=0.611; P=0.03351). Conclusions: We developed and validated a straightforward model to predict survival in Caucasian AOA patients initiating first-line polychemotherapy. This model can contribute to inform clinical decision-making and optimise clinical trial design.
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    On the Effect of Triplet or Doublet Chemotherapy in Advanced Gastric Cancer: Results From a National Cancer Registry
    (2016) Jiménez-Fonseca, P. (Paula); Azkarate, A. (Aitor); Díaz-Serrano, A. (Asunción); Rivera, F. (Fernando); Custodio, A. (Ana); Mangas, M. (Monserrat); Garrido, M. (Marcelo); Echavarría, I. (Isabel); Asensio-Martínez, E. (Elisa); Carmona-Bayonas, A. (Alberto); Ramchandani, A. (Avinash); Buxó, L. (Laura); Lacalle, A. (Alejandra); Fernández-Montes, A. (Ana); García-García, T. (Teresa); Sánchez-Lorenzo, M. L. (María Luisa); Cano, J. M. (Juana María); Álvarez-Manceñido, F. (Felipe); Lorenzo-Barreto, J. E. (José Enrique); Visa, L. (Laura); Ferrer-Cardona, M. (Marta)
    Background: There is currently no consensus regarding first-line chemotherapy for patients with advanced gastric cancer (AGC) who are ineligible to receive trastuzumab. The objective of this study was to evaluate the efficacy and tolerance of triplets versus doublets by analyzing a national gastric cancer registry. Patients and Method: Patients with AGC treated with polychemotherapy without associating trastuzumab were included from 2008 through 2016. The effect of triplets versus doublets was compared using 3 methods: Cox proportional hazards regression, propensity score matching (PSM), and coarsened exact matching (CEM). Results: A total of 970 patients were recruited (doublets: n=569; triplets: n=401). In the multivariate Cox model, the use of triplets was associated with better overall survival (OS), with a hazard ratio (HR) of 0.84 (95% CI, 0.72–0.98; P=.035). After PSM, the sample contained 340 pairs. A significant increase in OS, 11.14 months (95% CI, 9.60–12.68) versus 9.60 months (95% CI, 8.44–10.75), was seen in favor of triplets (HR, 0.77; 95% CI, 0.65–0.92; stratified log-rank test, P=.004). The effect appeared to be comparable for anthracycline-based (HR, 0.78; 95% CI, 0.64–0.94) or docetaxel-based triplets (HR, 0.78; 95% CI, 0.60–1.009). The trend was similar after applying the CEM algorithm, with an HR of 0.78 (95% CI, 0.63–0.97; P=.03). Triplet therapy was viable and relative dose intensities exceeded 85%, except for cisplatin in DCX (docetaxel, cisplatin, capecitabine). Triplets had more severe toxicity overall, especially hematologic, hepatic, and mucosal adverse events. Conclusions: With the limitations of a retrospective study that examines a heterogeneous set of chemotherapy regimens, we found that triplets are feasible in daily practice and are associated with a discreet benefit in efficacy at the expense of a moderate increase in toxicity.