Publications by authors named "Macarulla T"

Background: Prognostic factors for ambulatory oncology patients have been described, including Eastern Cooperative Oncology Group (ECOG), tumor stage and malnutrition. However, there is no firm evidence on which variables best predict mortality in hospitalized patients receiving active systemic treatment. Our main goal was to develop a predictive model for 90-day mortality upon admission.

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  • Biliary tract cancers (BTCs) have an immune system that doesn't respond well to standard PD-1/PD-L1 inhibitors, but adding bevacizumab to chemotherapy may enhance immune responses.
  • A phase II study involving 162 patients evaluated the effects of adding bevacizumab to atezolizumab and standard chemotherapy (cisplatin and gemcitabine), focusing on progression-free survival (PFS) as the main outcome.
  • Results showed that the PFS was slightly better for patients receiving bevacizumab (8.3 months) compared to placebo (7.9 months), but overall survival (OS) was similar in both groups, indicating a modest benefit in PFS without an impact on OS. *
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Background: Poly (ADP-ribose) polymerase 1 and 2 (PARP1/2) inhibitors (PARPi) are targeted therapies approved for homologous recombination repair (HRR)-deficient breast, ovarian, pancreatic, and prostate cancers. Since inhibition of PARP1 is sufficient to cause synthetic lethality in tumors with homologous recombination deficiency (HRD), PARP1 selective inhibitors such as saruparib (AZD5305) are being developed. It is expected that selective PARP1 inhibition leads to a safer profile that facilitates its combination with other DNA damage repair inhibitors.

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What Is This Summary About?: Researchers wanted to study whether the research drug zanidatamab could help people with a type of cancer called biliary tract cancer. In some people, biliary tract cancer cells make extra copies of a gene called HER2 (also called ERBB2). This is known as being HER2-amplified.

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  • The study explores the use of a CD73 inhibitor (oleclumab) combined with durvalumab and chemotherapy in treating pancreatic ductal adenocarcinoma (PDAC), targeting immune surveillance evasion.
  • Conducted across multiple centers, the trial included patients with metastatic PDAC in two cohorts, assessing safety and response rates with various treatment combinations for the chemotherapy regimens.
  • While safety results were acceptable, the trial did not achieve its main goal of demonstrating significant treatment efficacy, although some patients with high CD73 levels showed improved outcomes.
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  • FGFR2 fusions, found in 10-15% of intrahepatic cholangiocarcinoma (iCCA) patients, may benefit from FGFR inhibitors, and this study evaluated detecting these fusions in plasma samples.
  • In a study of 18 iCCA patients with known FGFR2 fusions, 88.9% tested positive for the fusion in plasma, suggesting that lower levels of circulating tumor DNA (ctDNA) correlate with better clinical outcomes.
  • The research indicates that monitoring plasma biomarkers can not only predict treatment success but also detect disease progression earlier than traditional imaging methods, aiding in better clinical management for iCCA patients.
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Biliary tract cancers (BTC) are a heterogeneous group of cancers that continue to present a particularly poor prognosis. BTC treatment is rapidly evolving yet facing many challenges to improve patient outcomes and maximize benefit from treatment. Only a minority of patients are diagnosed with early-stage disease and are suitable for curative resection.

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  • Current treatments for metastatic pancreatic ductal adenocarcinoma yield very low survival rates, prompting research into new therapies like mitazalimab combined with a modified chemotherapy regimen called mFOLFIRINOX.
  • The OPTIMIZE-1 study enrolled 70 patients across 14 hospitals in Belgium, France, and Spain to evaluate the safety and effectiveness of this combination therapy, focusing on determining the optimal dose of mitazalimab as well as measuring tumor response.
  • The trial successfully determined 900 μg/kg of mitazalimab as the recommended dose for the next phase and gathered data on the initial outcomes for the patients treated within the study timeframe from September 2021 to March 2023.
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Intrahepatic cholangiocarcinoma (ICC) is an aggressive bile duct malignancy that frequently exhibits isocitrate dehydrogenase () mutations. Mutant IDH (IDHm) ICC is dependent on SRC kinase for growth and survival and is hypersensitive to inhibition by dasatinib, but the molecular mechanism underlying this sensitivity is unclear. We found that dasatinib reduced p70 S6 kinase (S6K) and ribosomal protein S6 (S6), leading to substantial reductions in cell size and de novo protein synthesis.

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Cholangiocarcinoma (CCA) poses a substantial clinical hurdle as it is often detected at advanced metastatic stages with limited therapeutic options. To enhance our understanding of advanced CCA, it is imperative to establish preclinical models that faithfully recapitulate the disease's characteristics. Patient-derived xenograft (PDX) models have emerged as a valuable approach in cancer research, offering an avenue to reproduce and study the genomic, histologic, and molecular features of the original human tumors.

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The efficacy and safety of olaratumab plus nabpaclitaxel and gemcitabine in treatment-naïve participants with metastatic pancreatic ductal adenocarcinoma was evaluated. An initial phase 1b dose-escalation trial was conducted to determine the olaratumab dose for the phase 2 trial, a randomized, double-blind, placebo-controlled trial to compare overall survival (OS) in the olaratumab arm vs. placebo arms.

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Background & Aims: Accumulating data has shown the rising incidence and poor prognosis of early-onset gastrointestinal cancers, but few data exist on biliary tract cancers (BTC). We aimed to analyse the clinico-pathological, molecular, therapeutic characteristics and prognosis of patients with early onset BTC (EOBTC, age ≤50 years at diagnosis), versus olders.

Methods: We analysed patients diagnosed with intrahepatic cholangiocarcinoma, extrahepatic cholangiocarcinoma, and gallbladder adenocarcinoma between 1 January 2003 and 30 June 2021.

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  • In advanced biliary tract cancer (BTC), there is a need for effective second-line treatments due to the disease's molecular diversity; a new target has been identified that appears in about 5-8% of cases.* -
  • An analysis of ongoing trials tested brigimadlin, a potent oral drug targeting MDM2-p53, alone and in combination with other therapies on 12 BTC patients, leading to significant responses.* -
  • The results showed that brigimadlin had a good safety profile and resulted in anti-tumor activity, especially in patients with the specific genetic amplification, necessitating further research.*
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Neuregulin 1 () fusions are oncogenic drivers that have been detected in non-small-cell lung cancer (NSCLC), pancreatic ductal adenocarcinoma (PDAC) and other solid tumors. fusions are rare, occurring in less than 1% of solid tumors. Patients with fusion positive (NRG1+) cancer have limited therapeutic options.

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In the context of pancreatic cancer, surgical intervention is typically recommended for localized tumours, whereas chemotherapy is the preferred approach in the advanced and/or metastatic setting. However, pancreatic cancer is closely linked to ageing, with an average diagnosis at 72 years. Paradoxically, despite its increased occurrence among older individuals, this population is often underrepresented in clinical studies, complicating the decision-making process.

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BACKGROUND: Sequential nab-paclitaxel plus gemcitabine followed by modified FOLFOX-6 (oxaliplatin, leucovorin, and 5-fluorouracil) (nab-P/Gem-mFOLFOX) showed a good safety and clinical profile in metastatic pancreatic ductal adenocarcinoma (mPDAC) in the phase I SEQUENCE trial. METHODS: The safety and efficacy of sequential nab-P/Gem-mFOLFOX was compared with standard nab-paclitaxel plus gemcitabine (nab-P/Gem) as first-line treatment in a multi-institutional, randomized, open-label, phase II trial in patients with untreated mPDAC. We randomly assigned patients in a 1:1 ratio to receive nab-P/Gem on days 1, 8, and 15 followed by mFOLFOX on day 29 of a 6-week cycle (experimental group) or nab-P/Gem on days 1, 8, and 15 of a 4-week cycle (control group).

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: The use of imaging, in general, and during follow-up after resection of pancreatic cancer, is increasing. Consequently, the number of asymptomatic patients diagnosed with metastatic pancreatic cancer (mPDAC) is increasing. In these patients, palliative systemic therapy is the only tumor-directed treatment option; hence, it is often immediately initiated.

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Chemotherapy resistance in biliary tract cancer (BTC) presents a major clinical hurdle. Ren et al. developed and characterized an extensive collection of BTC patient-derived organoid (PDO) models, enabling advanced investigation of chemotherapy response prediction.

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Background: The incidence of early-onset pancreatic cancer (EOPC) has risen dramatically in recent years. We aimed to characterise the clinical and genomic features of EOPC and evaluate their therapeutic implications.

Methods: We performed a comparative, single-centre, retrospective analysis of clinical, germline, and genomic features in EOPC (≤50 years) patients and compared them with a control group of average-onset pancreatic cancer patients (AOPC, ≥70 years).

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Background: Periarterial divestment is a surgical technique to approach borderline resectable (BR) or locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC) with arterial involvement. There are no reports in the literature regarding the role of endoscopic ultrasound and elastography (EUS-EG) in exploring the integrity of Inoue's level III and its correlation with the periarterial divestment technique feasibility. Our research is aimed at exploring the role of EUS-EG in this scenario.

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Background: Real-world data on treatment patterns/outcomes for metastatic pancreatic cancer (mPAC) are limited. This study aims to assess real-world treatment patterns, survival outcomes, and prognostic/predictive factors in patients with mPAC.

Methods: Retrospective, observational, chart-review involving medical oncologists and gastroenterologists from five European countries.

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Background: Pancreatic ductal adenocarcinoma remains one of the most lethal malignancies, with few treatment options. NAPOLI 3 aimed to compare the efficacy and safety of NALIRIFOX versus nab-paclitaxel and gemcitabine as first-line therapy for metastatic pancreatic ductal adenocarcinoma (mPDAC).

Methods: NAPOLI 3 was a randomised, open-label, phase 3 study conducted at 187 community and academic sites in 18 countries worldwide across Europe, North America, South America, Asia, and Australia.

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Background: Immunotherapy is effective, but current biomarkers for patient selection have proven modest sensitivity. Here, we developed VIGex, an optimized gene signature based on the expression level of 12 genes involved in immune response with RNA sequencing.

Methods: We implemented VIGex using the nCounter platform (Nanostring) on a large clinical cohort encompassing 909 tumor samples across 45 tumor types.

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Background: It has been hypothesised that manipulation during surgery releases tumoral components into circulation. We investigate the effect of surgery on plasma-borne DNA biomarkers and the oncological outcomes in resectable pancreatic ductal adenocarcinoma (PDAC). We also compare non-touch isolation techniques (NTIT) with standard techniques.

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Article Synopsis
  • - PBRM1 mutations, affecting around 8.1% of biliary tract cancers (BTCs), are more common in intrahepatic BTCs and are associated with higher rates of additional mutations in chromatin-remodeling and DNA damage repair genes.
  • - Despite the presence of PBRM1 mutations, overall survival rates for patients with these mutations do not significantly differ from those without.
  • - In laboratory tests, the use of PARP and ATR inhibitors showed potential effectiveness against BTCs with PBRM1 loss of function, suggesting a new avenue for treatment in patients with these mutations.
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