- Email: [email protected]
Residual cancer burden as a prognostic factor in a large series of neoadjuvant chemotherapy. Subgroup analysis per molecular surrogated subtypes
abstracts 241P
Residual cancer burden as a prognostic factor in a large series of neoadjuvant chemotherapy. Subgroup analysis per molecular surrogated subtypes
Background: Neoadjuvant chemotherapy offers the possibility to test chemo sensitivity in vivo. pCR is a good surrogate of survival. Other measures of pathological response include de residual cancer burden (RCB). The aim of our study is to assess prognostic factors of survival including RCB. Methods: 488 breast cancer (BC) patients treated with NATC based on anthracyclines and taxanes with trastuzumab in HER-2 positive between 2009 and 2016 at a single Institution. Chi-square test was run for the univariate analyses and a cox-regression was performed regarding prognostic factors. Survival was calculated with KaplanMeier survival plots since the start of NATC to the first documented disease recurrence (DDFS) or overall survival (OS) by using IBM SPSS version 23. Results: Mean age was 51.13 (24-84). After a follow up of 63 (4-129) months there have been 14 (2.9%) local recurrences; 55 (11.3%) distant recurrences and 56 deaths (11.4%), 50 due to BC progression (10.2%). In the univariate analyses those factors related to distant recurrence were histology ductal vs lobular: 14.2 vs 35.7%, p: 0.032; molecular subtype: luminal A (15.2%) vs luminal B (14.2%) vs luminal B Her2 (11.8%) vs HER2 enriched (7.7%) vs triple negative (TN) (22.8%), p: 0.042; TstageT0 (0%), T1(12.5%), T2(12.3%), T3 (18.8%) and T4 (23.9%), p: 0.006; N stage N0 (9.6); N1 (12.8), N2 (17.5) and N3(27.3%), p ¼ 0.063;pTstage pT0 (8.5%), pTis (9.7) pT1aþb(7.5%)pT1c(20.3 %), pT2(21.8%), pT3 (29.2%) and pT4 (100%), p ¼ 0.000; pN stage pN0 (8.2); pN1mic (0%), pN1 (16.8), pN2 (32.2) and pN3(42.3%), p ¼ 0.000 and the RCB 0 (3.2%) vs I (7.1%) vs II (16.5%) vs III (23.4%), p: 0.0001. The estimated 5y DDFS was for RCB0: 100%; RCBI: 98%; RCBII: 85% and RCBIII: 68%. The HR for RCB was 1.4 (95%IC, 1.2-1.6), per subgroups the log rank was for luminal A: 3.4, p: 0.330; for luminal B: 10.6, p: 0.03; for luminal B Her2: 7.9, p: 0.04; for Her2 enriched: 25, p: 0.000 and for TN 16, p: 0.003. Conclusions: In our large series the RCB is reproducible as a surrogate of survival special in those chemo sensitive tumors such as Her2 and triple negative ones. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
242P
Clinical validation of CanAssist breast in a Spanish cohort
M. Bakre Research and Development, OncoStem Diagnostics Pvt Ltd, Bangalore, Karnatala, India Background: CanAssist-Breast (CAB) is a prognostic test for predicting risk of distant recurrence within five years in hormone receptor positive early stage breast cancer patients. It is unique in that the test uses immunohistochemistry coupled with a support vector machine learning based algorithm to predict risk score and category (High or Low). It has been developed and validated on a mix of Asian and Caucasian patients. The test has been clinically validated in over 1000 retrospective patient samples. In this study, we present for the first time data on the performance of CAB in a single center study from Spain (Vall D’Hebron Institute of Oncology, Barcelona). Methods: Post-surgical FFPE tumor blocks along with patient demographics and clinical follow up data up to a mınimum of five years were obtained from the hospital. CAB was performed on the tumor samples at the CAP and ISO 15189 accredited OncoStem reference laboratory in India. Distant Metastasis Free Survival (DMFS) and Hazard Ratio were used were computed using survival analysis. MedCalc software (Version 18.10.2) was used for all statistical analysis. The negative predictive value (NPV) was computed for establish the accuracy of prediction in the low risk group. Results: Sixty-two percent of this cohort had stage II disease. Sixty-nine percent and 61% had node negative and Grade 2 disease respectively. The median at onset was 61 years. The DMFS in the low risk category was 98% and 85% for the high risk (P ¼ 0.0032). The Hazard Ratio was 7.04 (95% CI: 1.93-25.73). The NPV was calculated to be 98%. To exclude any confounding effect of chemotherapy, survival analysis was done in the chemotherapy naı¨ve sub-group. In the chemotherapy naı¨ve sub-group, the DMFS for the low risk group was 100% and 85% for the high risk (P ¼ 0.02). These are results of the interim analysis of the study at half way mark and complete study data will be presented at the time ESMO meeting.
v80 | Breast Cancer, Early Stage
Conclusions: CAB performs well in stratifying risk of recurrence in this Spanish cohort with the data matching performance shown earlier with the mix of Asian and Caucasian patients. In the absence of any inter-mediate risk category in CAB, it offers a cost effective alternative to existing prognostic tests providing definitive results to plan treatment of early stage breast cancer patients. Legal entity responsible for the study: Manjiri M. Bakre. Funding: Has not received any funding. Disclosure: M. Bakre: Leadership role, Full / Part-time employment, Officer / Board of Directors, CEO and Founder: OncoStem Diagnostics Pvt Limted.
243P
Meta-analysis on association of pathological complete response with long-term survival outcomes in triple-negative breast cancer
P.A. Fasching1, M. Huang2, J. Corte´s3, J. Zhao4, J. O’Shaughnessy5, P. Hu2, A. Haiderali6, V. Karantza7, G. Aktan8, A. Briggs9, S. Ramsey10, C.Z. Qi11, J. Xie12, C. Gu12, K. Qian12, M. Yuan11, E.Q. Wu11 1 Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany, 2Economic and Data Sciences, Merck & Co Inc, North Wales, PA, USA, 3 Oncology Department, IOB Institute of Oncology, Quironsalud Group, Madrid & Barcelona & Vall dHebron Intitute of Oncology (VHIO), Barcelona, Madrid, Spain, 4 Biostatistics and Research Decision Sciences, Merck & Co Inc, North Wales, PA, USA, 5 Medical Oncology, Texas Oncology - Baylor Sammons Cancer Center, Dallas, TX, USA, 6 Center for Observation and Real-World Evidence, MSD-Merck Sharp & Dohme, Kenilworth, NJ, USA, 7Department of Oncology, Merck & Co., Inc., Kenilworth, NJ, USA, 8 Department of Oncology, Merck Sharp & Dohme Corp. USA, Whitehouse Station, PA, USA, 9Health Economics & Health Technology Assessment, University of Glasgow, Glasgow, UK, 10Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA, 11Healthcare economics and outcomes research, Analysis Group Inc., Boston, MA, USA, 12Healthcare Economics and Outcomes Research, Analysis Group Inc., Los Angeles, CA, USA Background: Neoadjuvant studies in breast cancer (BC) patients have well-demonstrated that attaining pathological complete response (pCR) is associated with improved event-free survival (EFS) and overall survival (OS); and the association is strong in triple negative BC (TNBC) subtype. This study aimed to comprehensively evaluate the association of pCR and survival outcomes in TNBC by incorporating most recent studies; and to explore the impact of different study settings, thresholds of hormone receptor positivity defining TNBC and adjuvant chemotherapy usage on this association. Methods: A literature search of neoadjuvant studies in TNBC was conducted up to October 2018. Clinical trials (CTs), real-world evidence (RWE) studies and meta-analyses (MA) with EFS/OS reported by pCR outcome were included. Main analyses were restricted to pCR definition of absence of tumor in the breast and axillary nodes, which is aligned with FDA guidance. Hazard ratios (HRs) evaluating the association between pCR and EFS/OS were derived from meta-analyses using fixed-effect and randomeffects models. To further quantify the association, meta-analyses were conducted to synthesize the published survival curves by pCR outcome. A random-effects frailty model was utilized to account for between-study variation. Results: Four randomized CTs, 2 single-arm CTs, 18 RWE studies and 1 MA for a total of 4,330 patients with TNBC were included in this study. Achieving pCR was strongly associated with improved survival outcomes (HR of EFS: 0.26, 95% CI: 0.22-0.30; and HR of OS: 0.20, 95% CI: 0.16-0.25). HR results were similar across study settings of CTs, RWE and MA. TNBC definition and adjuvant chemotherapy use did not have significant impact on HR results. The meta-analyses showed numerically longer survival in studies that reported adjuvant chemotherapy usage compared with those which did not, irrespective of attainment of pCR. Conclusions: This study confirms the strong association between pCR and survival outcomes in TNBC based on evidence synthesis from both clinical and real-world settings. In addition, this study suggests potential survival benefit of subsequent adjuvant therapy for TNBC patients who received neoadjuvant therapy. Legal entity responsible for the study: Merck & Co., Inc. Funding: Merck & Co., Inc. Disclosure: P.A. Fasching: Advisory / Consultancy: Merck & Co., Inc. M. Huang: Full / Part-time employment: Merck & Co., Inc. J. Corte´s: Advisory / Consultancy: Merck & Co., Inc. J. Zhao: Full / Part-time employment: Merck & Co., Inc. J. O’Shaughnessy: Advisory / Consultancy: Merck & Co., Inc. P. Hu: Full / Part-time employment: Merck & Co., Inc. A. Haiderali: Full / Part-time employment: Merck & CO., Inc. V. Karantza: Full / Part-time employment: Merck & Co., Inc. G. Aktan: Full / Parttime employment: Merck & Co., Inc. A. Briggs: Advisory / Consultancy: Merck & Co., Inc. S. Ramsey: Advisory / Consultancy: Merck & Co., Inc. C.Z. Qi: Advisory / Consultancy, Employee of Analysis Group, Inc., which has received consulting fees from Merck & Co., Inc.: Merck & Co., Inc. J. Xie: Advisory / Consultancy, Employee of Analysis Group, Inc., which has received consulting fees from Merck & Co., Inc.: Merck & Co., Inc. C. Gu: Advisory / Consultancy, Employee of Analysis Group, Inc., which has received consulting fees from Merck & Co., Inc.: Merck & Co., Inc. K. Qian: Advisory / Consultancy, Employee of Analysis Group, Inc., which has received consulting fees from Merck & Co., Inc.: Merck & Co., Inc. M. Yuan: Advisory / Consultancy, Employee of Analysis Group, Inc., which has received consulting fees from Merck & Co., Inc.: Merck & Co., Inc. E.Q. Wu: Advisory / Consultancy, Employee of Analysis Group, Inc., which has received consulting fees from Merck & Co., Inc.: Merck & Co., Inc.
Volume 30 | Supplement 5 | October 2019
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz240.065/5576253 by guest on 25 October 2019
os2, A.C. Vethencourt Casado3, S. Vazquez4, C. Falo1, S. Fernandez2, E. Garrig A. Stradella1, S. Recalde1, M.J. Pla2, M. Campos2, A. Guma5, R. Ortega5, A. Petit6, T. Soler7, J. Perez8, E. Fernandez2, M.S. Bergamino1, S. Pernas Simon9, M.J. Gil10, J. Ponce2, A. Garcia Tejedor2 1 Medical Oncology, ICO - Institut Catal a d’Oncologia l’Hospitalet (Hospital Duran i Reynals), Hospitalet De Llobregat, Barcelona Spain, 2Gynaecology, Hospital Universitari Bellvitge, Hospitalet De Llobregat, Barcelona, Spain, 3Medical Oncology, Institut Catala de Oncologia, Barcelona, Spain, 4Department of Medical Oncology, Catalan Institute of Oncology (ICO), Hospital Duran i Reynals, ONCOBELL, IDIBELL, L’Hospitalet Barcelona, Spain, 5Radiology, Hospital Universitari Bellvitge, Hospitalet De Llobregat, Spain, 6 Pathology, Hospital Universitari Bellvitge, Hospitalet De Llobregat, Barcelona, Spain, 7 Pathology, Hospital de Bellvitge, Hospitalet De Llobregat, Barcelona, Spain, 8 Department Assaigs Clinics, ICO - Institut Catala d’Oncologia Hospital Duran i Reynals, L’Hospitalet Barcelona, Spain, 9Medical Oncology, Bellvitge Biomedical Research a Institute (IDIBELL), Hospitalet De Llobregat, Spain, 10Medical Oncology, Institut Catal d’Oncologia Hospital Duran i Reynals, Barcelona, Spain
Annals of Oncology
Residual cancer burden as a prognostic factor in a large series of neoadjuvant chemotherapy. Subgroup analysis per molecular surrogated subtypes
Background: Neoadjuvant chemotherapy offers the possibility to test chemo sensitivity in vivo. pCR is a good surrogate of survival. Other measures of pathological response include de residual cancer burden (RCB). The aim of our study is to assess prognostic factors of survival including RCB. Methods: 488 breast cancer (BC) patients treated with NATC based on anthracyclines and taxanes with trastuzumab in HER-2 positive between 2009 and 2016 at a single Institution. Chi-square test was run for the univariate analyses and a cox-regression was performed regarding prognostic factors. Survival was calculated with KaplanMeier survival plots since the start of NATC to the first documented disease recurrence (DDFS) or overall survival (OS) by using IBM SPSS version 23. Results: Mean age was 51.13 (24-84). After a follow up of 63 (4-129) months there have been 14 (2.9%) local recurrences; 55 (11.3%) distant recurrences and 56 deaths (11.4%), 50 due to BC progression (10.2%). In the univariate analyses those factors related to distant recurrence were histology ductal vs lobular: 14.2 vs 35.7%, p: 0.032; molecular subtype: luminal A (15.2%) vs luminal B (14.2%) vs luminal B Her2 (11.8%) vs HER2 enriched (7.7%) vs triple negative (TN) (22.8%), p: 0.042; TstageT0 (0%), T1(12.5%), T2(12.3%), T3 (18.8%) and T4 (23.9%), p: 0.006; N stage N0 (9.6); N1 (12.8), N2 (17.5) and N3(27.3%), p ¼ 0.063;pTstage pT0 (8.5%), pTis (9.7) pT1aþb(7.5%)pT1c(20.3 %), pT2(21.8%), pT3 (29.2%) and pT4 (100%), p ¼ 0.000; pN stage pN0 (8.2); pN1mic (0%), pN1 (16.8), pN2 (32.2) and pN3(42.3%), p ¼ 0.000 and the RCB 0 (3.2%) vs I (7.1%) vs II (16.5%) vs III (23.4%), p: 0.0001. The estimated 5y DDFS was for RCB0: 100%; RCBI: 98%; RCBII: 85% and RCBIII: 68%. The HR for RCB was 1.4 (95%IC, 1.2-1.6), per subgroups the log rank was for luminal A: 3.4, p: 0.330; for luminal B: 10.6, p: 0.03; for luminal B Her2: 7.9, p: 0.04; for Her2 enriched: 25, p: 0.000 and for TN 16, p: 0.003. Conclusions: In our large series the RCB is reproducible as a surrogate of survival special in those chemo sensitive tumors such as Her2 and triple negative ones. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
242P
Clinical validation of CanAssist breast in a Spanish cohort
M. Bakre Research and Development, OncoStem Diagnostics Pvt Ltd, Bangalore, Karnatala, India Background: CanAssist-Breast (CAB) is a prognostic test for predicting risk of distant recurrence within five years in hormone receptor positive early stage breast cancer patients. It is unique in that the test uses immunohistochemistry coupled with a support vector machine learning based algorithm to predict risk score and category (High or Low). It has been developed and validated on a mix of Asian and Caucasian patients. The test has been clinically validated in over 1000 retrospective patient samples. In this study, we present for the first time data on the performance of CAB in a single center study from Spain (Vall D’Hebron Institute of Oncology, Barcelona). Methods: Post-surgical FFPE tumor blocks along with patient demographics and clinical follow up data up to a mınimum of five years were obtained from the hospital. CAB was performed on the tumor samples at the CAP and ISO 15189 accredited OncoStem reference laboratory in India. Distant Metastasis Free Survival (DMFS) and Hazard Ratio were used were computed using survival analysis. MedCalc software (Version 18.10.2) was used for all statistical analysis. The negative predictive value (NPV) was computed for establish the accuracy of prediction in the low risk group. Results: Sixty-two percent of this cohort had stage II disease. Sixty-nine percent and 61% had node negative and Grade 2 disease respectively. The median at onset was 61 years. The DMFS in the low risk category was 98% and 85% for the high risk (P ¼ 0.0032). The Hazard Ratio was 7.04 (95% CI: 1.93-25.73). The NPV was calculated to be 98%. To exclude any confounding effect of chemotherapy, survival analysis was done in the chemotherapy naı¨ve sub-group. In the chemotherapy naı¨ve sub-group, the DMFS for the low risk group was 100% and 85% for the high risk (P ¼ 0.02). These are results of the interim analysis of the study at half way mark and complete study data will be presented at the time ESMO meeting.
v80 | Breast Cancer, Early Stage
Conclusions: CAB performs well in stratifying risk of recurrence in this Spanish cohort with the data matching performance shown earlier with the mix of Asian and Caucasian patients. In the absence of any inter-mediate risk category in CAB, it offers a cost effective alternative to existing prognostic tests providing definitive results to plan treatment of early stage breast cancer patients. Legal entity responsible for the study: Manjiri M. Bakre. Funding: Has not received any funding. Disclosure: M. Bakre: Leadership role, Full / Part-time employment, Officer / Board of Directors, CEO and Founder: OncoStem Diagnostics Pvt Limted.
243P
Meta-analysis on association of pathological complete response with long-term survival outcomes in triple-negative breast cancer
P.A. Fasching1, M. Huang2, J. Corte´s3, J. Zhao4, J. O’Shaughnessy5, P. Hu2, A. Haiderali6, V. Karantza7, G. Aktan8, A. Briggs9, S. Ramsey10, C.Z. Qi11, J. Xie12, C. Gu12, K. Qian12, M. Yuan11, E.Q. Wu11 1 Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany, 2Economic and Data Sciences, Merck & Co Inc, North Wales, PA, USA, 3 Oncology Department, IOB Institute of Oncology, Quironsalud Group, Madrid & Barcelona & Vall dHebron Intitute of Oncology (VHIO), Barcelona, Madrid, Spain, 4 Biostatistics and Research Decision Sciences, Merck & Co Inc, North Wales, PA, USA, 5 Medical Oncology, Texas Oncology - Baylor Sammons Cancer Center, Dallas, TX, USA, 6 Center for Observation and Real-World Evidence, MSD-Merck Sharp & Dohme, Kenilworth, NJ, USA, 7Department of Oncology, Merck & Co., Inc., Kenilworth, NJ, USA, 8 Department of Oncology, Merck Sharp & Dohme Corp. USA, Whitehouse Station, PA, USA, 9Health Economics & Health Technology Assessment, University of Glasgow, Glasgow, UK, 10Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA, 11Healthcare economics and outcomes research, Analysis Group Inc., Boston, MA, USA, 12Healthcare Economics and Outcomes Research, Analysis Group Inc., Los Angeles, CA, USA Background: Neoadjuvant studies in breast cancer (BC) patients have well-demonstrated that attaining pathological complete response (pCR) is associated with improved event-free survival (EFS) and overall survival (OS); and the association is strong in triple negative BC (TNBC) subtype. This study aimed to comprehensively evaluate the association of pCR and survival outcomes in TNBC by incorporating most recent studies; and to explore the impact of different study settings, thresholds of hormone receptor positivity defining TNBC and adjuvant chemotherapy usage on this association. Methods: A literature search of neoadjuvant studies in TNBC was conducted up to October 2018. Clinical trials (CTs), real-world evidence (RWE) studies and meta-analyses (MA) with EFS/OS reported by pCR outcome were included. Main analyses were restricted to pCR definition of absence of tumor in the breast and axillary nodes, which is aligned with FDA guidance. Hazard ratios (HRs) evaluating the association between pCR and EFS/OS were derived from meta-analyses using fixed-effect and randomeffects models. To further quantify the association, meta-analyses were conducted to synthesize the published survival curves by pCR outcome. A random-effects frailty model was utilized to account for between-study variation. Results: Four randomized CTs, 2 single-arm CTs, 18 RWE studies and 1 MA for a total of 4,330 patients with TNBC were included in this study. Achieving pCR was strongly associated with improved survival outcomes (HR of EFS: 0.26, 95% CI: 0.22-0.30; and HR of OS: 0.20, 95% CI: 0.16-0.25). HR results were similar across study settings of CTs, RWE and MA. TNBC definition and adjuvant chemotherapy use did not have significant impact on HR results. The meta-analyses showed numerically longer survival in studies that reported adjuvant chemotherapy usage compared with those which did not, irrespective of attainment of pCR. Conclusions: This study confirms the strong association between pCR and survival outcomes in TNBC based on evidence synthesis from both clinical and real-world settings. In addition, this study suggests potential survival benefit of subsequent adjuvant therapy for TNBC patients who received neoadjuvant therapy. Legal entity responsible for the study: Merck & Co., Inc. Funding: Merck & Co., Inc. Disclosure: P.A. Fasching: Advisory / Consultancy: Merck & Co., Inc. M. Huang: Full / Part-time employment: Merck & Co., Inc. J. Corte´s: Advisory / Consultancy: Merck & Co., Inc. J. Zhao: Full / Part-time employment: Merck & Co., Inc. J. O’Shaughnessy: Advisory / Consultancy: Merck & Co., Inc. P. Hu: Full / Part-time employment: Merck & Co., Inc. A. Haiderali: Full / Part-time employment: Merck & CO., Inc. V. Karantza: Full / Part-time employment: Merck & Co., Inc. G. Aktan: Full / Parttime employment: Merck & Co., Inc. A. Briggs: Advisory / Consultancy: Merck & Co., Inc. S. Ramsey: Advisory / Consultancy: Merck & Co., Inc. C.Z. Qi: Advisory / Consultancy, Employee of Analysis Group, Inc., which has received consulting fees from Merck & Co., Inc.: Merck & Co., Inc. J. Xie: Advisory / Consultancy, Employee of Analysis Group, Inc., which has received consulting fees from Merck & Co., Inc.: Merck & Co., Inc. C. Gu: Advisory / Consultancy, Employee of Analysis Group, Inc., which has received consulting fees from Merck & Co., Inc.: Merck & Co., Inc. K. Qian: Advisory / Consultancy, Employee of Analysis Group, Inc., which has received consulting fees from Merck & Co., Inc.: Merck & Co., Inc. M. Yuan: Advisory / Consultancy, Employee of Analysis Group, Inc., which has received consulting fees from Merck & Co., Inc.: Merck & Co., Inc. E.Q. Wu: Advisory / Consultancy, Employee of Analysis Group, Inc., which has received consulting fees from Merck & Co., Inc.: Merck & Co., Inc.
Volume 30 | Supplement 5 | October 2019
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz240.065/5576253 by guest on 25 October 2019
os2, A.C. Vethencourt Casado3, S. Vazquez4, C. Falo1, S. Fernandez2, E. Garrig A. Stradella1, S. Recalde1, M.J. Pla2, M. Campos2, A. Guma5, R. Ortega5, A. Petit6, T. Soler7, J. Perez8, E. Fernandez2, M.S. Bergamino1, S. Pernas Simon9, M.J. Gil10, J. Ponce2, A. Garcia Tejedor2 1 Medical Oncology, ICO - Institut Catal a d’Oncologia l’Hospitalet (Hospital Duran i Reynals), Hospitalet De Llobregat, Barcelona Spain, 2Gynaecology, Hospital Universitari Bellvitge, Hospitalet De Llobregat, Barcelona, Spain, 3Medical Oncology, Institut Catala de Oncologia, Barcelona, Spain, 4Department of Medical Oncology, Catalan Institute of Oncology (ICO), Hospital Duran i Reynals, ONCOBELL, IDIBELL, L’Hospitalet Barcelona, Spain, 5Radiology, Hospital Universitari Bellvitge, Hospitalet De Llobregat, Spain, 6 Pathology, Hospital Universitari Bellvitge, Hospitalet De Llobregat, Barcelona, Spain, 7 Pathology, Hospital de Bellvitge, Hospitalet De Llobregat, Barcelona, Spain, 8 Department Assaigs Clinics, ICO - Institut Catala d’Oncologia Hospital Duran i Reynals, L’Hospitalet Barcelona, Spain, 9Medical Oncology, Bellvitge Biomedical Research a Institute (IDIBELL), Hospitalet De Llobregat, Spain, 10Medical Oncology, Institut Catal d’Oncologia Hospital Duran i Reynals, Barcelona, Spain
Annals of Oncology