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Pancreatic Neoplasms: HELP
Articles by Paula Jimenez-Fonseca
Based on 13 articles published since 2009
(Why 13 articles?)
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Between 2009 and 2019, P. Jiménez-Fonseca wrote the following 13 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Guideline Consensus document on the progression and treatment response criteria in gastroenteropancreatic neuroendocrine tumors. 2018

Merino-Casabiel, X / Aller, J / Arbizu, J / García-Figueiras, R / González, C / Grande, E / Jiménez-Fonseca, P / Sevilla, M I / Capdevila, J. ·Radiology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain. · Endocrinology Department, Hospital Universitario Puerta de Hierro de Majadahonda, Madrid, Spain. · Nuclear Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain. · Radiology Department, Complexo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain. · Radiology Department, Hospital Universitario Puerta de Hierro de Majadahonda, Madrid, Spain. · Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain. · Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain. · Medical Oncology Department, Investigación Clínica y Traslacional en Cáncer, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Hospital Universitario Regional y Virgen de la Victoria de Málaga, Malaga, Spain. · Medical Oncology Department and Gastrointestinal and Endocrine Tumor Unit, Hospital Universitario Vall d'Hebron, Vall d'Hebron Institute of Oncology (VHIO), Pg Vall d'Hebron, 119-129, 08035, Barcelona, Spain. jacapdevila@vhebron.net. ·Clin Transl Oncol · Pubmed #29766455.

ABSTRACT: PURPOSE: Gastroenteropancreatic neuroendocrine tumors are a heterogeneous group of low incidence neoplasms characterized by a low proliferative activity and slow growth. Their response to targeted therapies is heterogeneous and often does not lead to tumor shrinkage. Thus, evaluation of the therapeutic response should differ from other kind of tumors. METHODS: To answer relevant questions about which techniques are best in the assessment of progression or treatment response a RAND/UCLA-based consensus process was implemented. Relevant clinical questions were listed followed by a systematic search of the literature. The expert panel answered all questions with recommendations, combining available evidence and expert opinion. Recommendations were validated through a questionnaire and a participatory meeting. RESULTS: Expert recommendations regarding imaging tools for tumor assessment and evaluation of progression were agreed upon. Available imaging techniques were reviewed and recommendations for best patient monitoring practice and the best way to evaluate treatment response were formulated.

2 Guideline SEOM clinical guidelines for the diagnosis and treatment of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) 2014. 2014

Garcia-Carbonero, R / JImenez-Fonseca, P / Teulé, A / Barriuso, J / Sevilla, I / Anonymous2520805. ·Medical Oncology Department, Hospital Universitario Virgen del Rocio, Instituto de Biomedicina de Sevilla (IBIS) (Universidad de Sevilla, CSIC, HUVR), Center affiliated to the Red Temática de Investigación Cooperativa en Cancer (RTICC), Instituto Carlos III, Spanish Ministry of Science and Innovation, Av. Manuel Siurot, s/n, 41013, Seville, Spain, rgcarbonero@gmail.com. ·Clin Transl Oncol · Pubmed #25183048.

ABSTRACT: GEP-NENs are a challenging family of tumors of growing incidence and varied clinical management and behavior. Diagnostic techniques have substantially improved over the past decades and significant advances have been achieved in the understanding of the molecular pathways governing tumor initiation and progression. This has already translated into relevant advances in the clinic. This guideline aims to provide practical recommendations for the diagnosis and treatment of GEP-NENs. Diagnostic workup, histological and staging classifications, and the different available therapeutic approaches, including surgery, liver-directed ablative therapies, peptide receptor radionuclide therapy, and systemic hormonal, cytotoxic or targeted therapy, are briefly discussed in this manuscript. Clinical presentation (performance status, comorbidities, tumor-derived symptoms and hormone syndrome in functioning tumors), histological features [tumor differentiation, proliferation rate (Ki-67), and expression of somatostatin receptors], disease localization and extent, and resectability of primary and metastatic disease, are all key issues that shall be taken into consideration to appropriately tailor therapeutic strategies and surveillance of these patients.

3 Review Optimizing Somatostatin Analog Use in Well or Moderately Differentiated Gastroenteropancreatic Neuroendocrine Tumors. 2017

Carmona-Bayonas, Alberto / Jiménez-Fonseca, Paula / Custodio, Ana / Grande, Enrique / Capdevila, Jaume / López, Carlos / Teule, Alex / Garcia-Carbonero, Rocío / Anonymous24040919. ·Department of Hematology and Medical Oncology, Morales Meseguer University Hospital, Calle Marqués de los Vélez, s/n, CP 30008, Murcia, Spain. alberto.carmonabayonas@gmail.com. · Department of Medical Oncology, Central Asturias University Hospital, Oviedo, Spain. · Department of Medical Oncology, La Paz University Hospital, Madrid, Spain. · Department of Medical Oncology, Ramón y Cajal University Hospital, Madrid, Spain. · Department of Medical Oncology, Vall D'Hebrón University Hospital, Vall D'Hebrón Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, center affiliated with the Red Temática de Investigación Cooperativa en Cáncer (RTICC), Instituto Carlos III, Spanish Ministry of Science and Innovation, Barcelona, Spain. · Department of Medical Oncology, Marqués de Valdecilla University Hospital, Santander, Spain. · Department of Medical Oncology, Institut Català d'Oncologia, L'Hospitalet de Llobregat, center affiliated with the Red Temática de Investigación Cooperativa en Cáncer (RTICC), Instituto Carlos III, Spanish Ministry of Science and Innovation, Barcelona, Spain. · Department of Medical Oncology, Doce de Octubre University Hospital, center affiliated with the Red Temática de Investigación Cooperativa en Cáncer (RTICC), Instituto Carlos III, Spanish Ministry of Science and Innovation, Madrid, Spain. ·Curr Oncol Rep · Pubmed #28920153.

ABSTRACT: BACKGROUND: Somatostatin analogues, aiming to control tumor secretion or growth, constitute the most attractive therapeutic option for patients with well-differentiated gastroenteropancreatic neuroendocrine tumors (GEP-NETs). The objective of this article is to provide a comprehensive review of the current state-of-the-art knowledge gaps and potential opportunities for future development and optimization of this therapeutic modality. METHOD: A contextualized systematic review with a narrative component was conducted using PubMed, The Cochrane Library, EMBASE, and Google Scholar. Titles were screened, and non-English, duplicate, or irrelevant entries were excluded. Selection criteria for articles included the following: publication in English between 1995 and 2016, patients with GEP-NETs, analysis of efficacy, safety, practical management considerations, predictive factors, and/or strategies for overcoming resistance, concerning somatostatin analogs. RESULTS: Ninety-seven studies out of 2771 screened publications met the inclusion criteria (16 randomized clinical trials, 27 phase II trials, 3 phase I trials, 3 subgroup analyses of clinical trials, 1 open-label extension of a randomized trial, 1 phase IV trial, 32 observational studies, and 14 basic research articles). The nature and scope of literature was diverse with most articles dedicated to drug efficacy or indications of use (n = 49), pharmacological issues (n = 8), assessment or predictors of response (n = 4), practical management (n = 11), combination therapy or other means to overcome resistance (n = 19), receptors and signaling pathways (n = 3), and subgroup analyses (n = 3). CONCLUSION: In this appraisal, we have found some practical aspects that can help to the optimization of somatostatin analog (SSA) therapy in patients with well-differentiated GEP-NETs. We have also identified areas of uncertainty in an effort to guide clinical research in the coming years.

4 Review Supportive care in pancreatic ductal adenocarcinoma. 2017

Laquente, B / Calsina-Berna, A / Carmona-Bayonas, A / Jiménez-Fonseca, P / Peiró, I / Carrato, A. ·Department Medical Oncology, Instituto Catalán de Oncología, L'Hospitalet de Llobregat, Av. Gran Vía 199-203, 0898, Barcelona, Spain. blaquente@iconcologia.net. · Department Palliative Care, Hospital Germans Trias I Pujol, Instituto Catalán de Oncología, Badalona, Spain. · Department Medical Oncology and Hematology, Hospital Universitario Morales Meseguer, Murcia, Spain. · Department Medical Oncology, Hospital Universitario Central de Asturias, Oviedo, Spain. · Clinical Nutrition Unit, Instituto Catalán de Oncología, L'Hospitalet de Llobregat, Barcelona, Spain. · Department Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain. ·Clin Transl Oncol · Pubmed #28612201.

ABSTRACT: Pancreatic ductal adenocarcinoma (PDAC) is one of the cancers with poorest prognosis and represents the third leading cause of cancer-related deaths in Western countries. Despite advances in diagnostic procedures and treatment, diagnosis is made in most cases when the disease is locally advanced or metastatic. Supportive care aims to improve symptoms, reduce hospital admission rates, and preserve quality of life. Proper symptomatic management is critical to allow administration of chemotherapy and radiotherapy. Symptomatic management should be accomplished in a multidisciplinary fashion. Its primary aims include relief of biliary or duodenal obstruction, prevention and/or treatment of thromboembolic disease, and control cancer-related pain. Nutritional support and optimal replacement therapy in patients with endocrine and/or exocrine insufficiency, is mandatory. This manuscript highlights the most significant problems faced when caring for patients with advanced PDAC and provides an evidence-based approach to symptomatic management.

5 Review Translational research in neuroendocrine tumors: pitfalls and opportunities. 2017

Capdevila, J / Casanovas, O / Salazar, R / Castellano, D / Segura, A / Fuster, P / Aller, J / García-Carbonero, R / Jimenez-Fonseca, P / Grande, E / Castaño, J P. ·Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron, Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain. · ProCURE Research Program, Instituto Catalán de Oncología - IDIBELL, Barcelona, Spain. · Oncology Department, Catalan Institute of Oncology-IDIBELL, Universitat de Barcelona, Barcelona, Spain. · Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain. · Oncology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain. · Oncology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain. · Department of Endocrinology, Puerta de Hierro University Hospital, Madrid, Spain. · Medical Oncology Department, Hospital Universitario Doce de Octubre, Center affiliated to the Red Tematica de Investigacion Cooperativa en Cancer (RTICC), Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, Madrid, Spain. · Department of Medical Oncology, Central Asturias University Hospital, Oviedo, Spain. · Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain. · Maimónides Institute of Biomedical Research at Córdoba (IMIBIC); Reina Sofía University Hospital; Department of Cell Biology, Physiology and Immunology, University of Córdoba; CIBER Fisiopatología de la Obesidad y Nutrición, Córdoba, Spain. ·Oncogene · Pubmed #27641330.

ABSTRACT: Interest in research on neuroendocrine tumors (NETs) has grown in the past 10 years, coinciding with improvements in our understanding of the molecular pathogenesis of NETs. In addition, NETs have become one of the most exciting settings for drug development. Two targeted agents for the management of advanced pancreatic NETs have been approved, but the development of targeted agents for NETs is limited by problems with both patient selection and demonstration of activity. In this review, we analyze these limitations and discuss ways to increase the predictive value of preclinical models for target discovery and drug development. The role of translational research and 'omics' methodologies is emphasized, with the final aim of developing personalized medicine. Because NETs usually grow slowly and metastatic tumors are found at easily accessible locations, and owing to improvements in techniques for liquid biopsies, NETs provide a unique opportunity to obtain tumor samples at all stages of the evolution of the disease and to adapt treatment to changes in tumor biology. Combining clinical and translational research is essential to achieve progress in the NET field. Slow growth and genetic stability limit and challenge both the availability and further development of preclinical models of NETs, one of the most crucial unmet research needs in the field. Finally, we suggest some useful approaches for improving clinical drug development for NETs: moving from classical RECIST-based response end points to survival parameters; searching for different criteria to define response rates (for example, antiangiogenic effects and metabolic responses); implementing randomized phase II studies to avoid single-arm phase II studies that produce limited data on drug efficacy; and using predictive biomarkers for patient selection.

6 Review Imaging approaches to assess the therapeutic response of gastroenteropancreatic neuroendocrine tumors (GEP-NETs): current perspectives and future trends of an exciting field in development. 2015

Garcia-Carbonero, Rocio / Garcia-Figueiras, Roberto / Carmona-Bayonas, Alberto / Sevilla, Isabel / Teule, Alex / Quindos, Maria / Grande, Enrique / Capdevila, Jaume / Aller, Javier / Arbizu, Javier / Jimenez-Fonseca, Paula / Anonymous5380844. ·Medical Oncology Department, Hospital Universitario Doce de Octubre, Center affiliated to the Red Tematica de Investigacion Cooperativa en Cancer (RTICC), Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, Av. Cordoba km 5.4, 28041, Madrid, Spain. rgcarbonero@gmail.com. · Radiology Department, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain. · Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain. · Medical Oncology Department, Hospital Universitario Virgen de la Victoria y Hospital Regional Universitario, Málaga, Spain. · Medical Oncology Department, Instituto Catalán de Oncología (ICO), Center affiliated to the Red Tematica de Investigacion Cooperativa en Cancer (RTICC), Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, Seville, Spain. · Medical Oncology Department, Complejo Hospitalario Universitario, A Coruña, Spain. · Medical Oncology Department, Hospital Ramon y Cajal, Madrid, Spain. · Medical Oncology Department, Hospital Vall d'Hebron, Center affiliated to the Red Tematica de Investigacion Cooperativa en Cancer (RTICC), Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, Barcelona, Spain. · Endocrinology Department, Hospital Puerta de Hierro, Madrid, Spain. · Nuclear Medicine Department, Clinica Universidad de Navarra, Navarra, Spain. · Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain. ·Cancer Metastasis Rev · Pubmed #26433592.

ABSTRACT: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are a family of neoplasms with a complex spectrum of clinical behavior. Although generally more indolent than carcinomas, once they progress beyond surgical resectability, they are essentially incurable. Systemic treatment options have substantially expanded in recent years for the management of advanced disease. Imaging plays a major role in new drug development, as it is the main tool used to objectively evaluate response to novel agents. However, current standard response criteria have proven suboptimal for the assessment of the antiproliferative effect of many targeted agents, particularly in the context of slow-growing tumors such as well-differentiated NETs. The aims of this article are to discuss the advantages and limitations of conventional radiological techniques and standard response assessment criteria and to review novel imaging modalities in development as well as alternative cancer- and therapy-specific criteria to assess drug efficacy in the field of GEP-NETs.

7 Review Health-related quality of life in well-differentiated metastatic gastroenteropancreatic neuroendocrine tumors. 2015

Jiménez-Fonseca, P / Carmona-Bayonas, A / Martín-Pérez, E / Crespo, G / Serrano, R / Llanos, M / Villabona, C / García-Carbonero, R / Aller, J / Capdevila, J / Grande, E / Anonymous5620838. ·Department of Medical Oncology, Central Asturias University Hospital, C/ Avenida de Roma sn, Oviedo, 33011, Asturias, Spain. palucaji@hotmail.com. · Department of Hematology and Medical Oncology, Morales Meseguer University Hospital, Murcia, Spain. · Department of General Surgery, La Princesa University Hospital, Madrid, Spain. · Department of Medical Oncology, Burgos University Hospital, Burgos, Spain. · Department of Medical Oncology, Reina Sofia University Hospital, Córdoba, Spain. · Department of Medical Oncology, Canarias University Hospital, Tenerife, Spain. · Department of Endocrinology, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain. · Department of Medical Oncology, Virgen del Rocio University Hospital, Instituto de Biomedicina de Sevilla (IBIS) [Universidad de Sevilla, CSIC, HUVR], Center affiliated with the Red Temática de Investigación Cooperativa en Cancer (RTICC), Instituto Carlos III, Spanish Ministry of Science and Innovation, Sevilla, Spain. · Department of Endocrinology, Puerta de Hierro University Hospital, Madrid, Spain. · Department of Medical Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Center affiliated with the Red Temática de Investigación Cooperativa en Cancer (RTICC), Instituto Carlos III, Spanish Ministry of Science and Innovation, Barcelona, Spain. · Department of Medical Oncology, Ramon y Cajal University Hospital, Madrid, Spain. ·Cancer Metastasis Rev · Pubmed #26245646.

ABSTRACT: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are rare neoplasms capable of producing hormones. The development of new treatments has improved progression-free survival, albeit with increased toxicity. Health-related quality of life (HRQoL) has become an important endpoint in clinical research to evaluate patients' well-being in such a contradictory scenario. In this review, we examine key reported outcomes across clinical studies exploring HRQoL in patients with GEP-NETs. We have conducted a review of the literature using PubMed, The Cochrane Library, EMBASE, and Google Scholar. Selection criteria for articles were (1) publication in English between 1995 and 2014, (2) patients with GEP-NET, and (3) analysis of HRQoL, including mental health and psychological symptoms. Forty-nine studies met the inclusion criteria (31 clinical trials, 14 observational studies, and 4 developments of NET-specific HRQoL instruments). The scope and nature of the literature was diverse with 27 instruments used to measure aspects of HRQoL. EORTC QLQ-C30 was the most frequently used, in 38 of the 49 studies. Standardized measures revealed that in spite of generally good HRQoL, GEP-NET patients have specific psychological and physical complaints. The clinical benefit of somatostatin analogs and sunitinib has been clearly supported by HRQoL assessment. Improvement in HRQoL scores or symptom relief over time was also reported in 14 trials of peptide receptor radionuclide therapy, however the absence of randomized studies obviate definitive conclusions. We have also identified several unanswered questions that should be addressed in further research concerning chemotherapy, everolimus, surgery, local ablative therapies, and chemoembolization. Future research should incorporate GEP-NET-specific HRQoL instruments into phase III trials. This review may help both clinicians and researchers to select the most appropriate tools to assess changes in HRQoL in this population.

8 Review Incidence, patterns of care and prognostic factors for outcome of gastroenteropancreatic neuroendocrine tumors (GEP-NETs): results from the National Cancer Registry of Spain (RGETNE). 2010

Garcia-Carbonero, R / Capdevila, J / Crespo-Herrero, G / Díaz-Pérez, J A / Martínez Del Prado, M P / Alonso Orduña, V / Sevilla-García, I / Villabona-Artero, C / Beguiristain-Gómez, A / Llanos-Muñoz, M / Marazuela, M / Alvarez-Escola, C / Castellano, D / Vilar, E / Jiménez-Fonseca, P / Teulé, A / Sastre-Valera, J / Benavent-Viñuelas, M / Monleon, A / Salazar, R. ·Department of Medical Oncology, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Sevilla. rgcarbonero@hotmail.com ·Ann Oncol · Pubmed #20139156.

ABSTRACT: BACKGROUND: Neuroendocrine tumors (NETs) are an unusual family of neoplasms with a wide and complex spectrum of clinical behavior. Here, we present the first report of a National Cancer Registry of gastroenteropancreatic neuroendocrine tumors from a Southern European country. PATIENTS AND METHODS: Data was provided online at www.retegep.net by participating centers and assessed for internal consistency by external independent reviewers. RESULTS: The study cohort comprised 907 tumors. The most common tumor types were carcinoids (55%), pancreatic nonfunctional tumors (20%), metastatic NETs of unknown primary (9%), insulinomas (8%) and gastrinomas (4%). Forty-four percent presented with distant disease at diagnosis, most often those from small intestine (65%), colon (48%), rectum (40%) and pancreas (38%), being most unusual in appendix primaries (1.3%). Stage at diagnosis varied significantly according to sex, localization of primary tumor, tumor type and grade. Overall 5-year survival was 75.4% (95% confidence interval 71.3% to 79.5%) and was significantly greater in women, younger patients and patients with hormonal syndrome and early stage or lower grade tumors. Prognosis also differed according to tumor type and primary tumor site. However, stage and Ki-67 index were the only independent predictors for survival. CONCLUSION: This national database reveals relevant information regarding epidemiology, current clinical practices and prognosis of NETs in Spain, providing valuable insights that may contribute to understand regional disparities in the incidence, patterns of care and survival of this heterogeneous disease across different continents and countries.

9 Article SEOM clinical guidelines for the diagnosis and treatment of gastroenteropancreatic and bronchial neuroendocrine neoplasms (NENs) (2018). 2019

González-Flores, E / Serrano, R / Sevilla, I / Viúdez, A / Barriuso, J / Benavent, M / Capdevila, J / Jimenez-Fonseca, P / López, C / Garcia-Carbonero, R. ·Department of Medical Oncology, Hospital Universitario Virgen de las Nieves, Granada, Spain. · Department of Medical Oncology, Hospital Reina Sofía, Córdoba, IMIBIC, CIBERONC, Córdoba, Spain. · Department of Medical Oncology, Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain. · Department of Medical Oncology, Complejo Hospitalario de Navarra (CHN), OncobionaTras Unit, Navarrabiomed, IdiSNA, Pamplona, Spain. · Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK. · Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK. · Department of Medical Oncology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina, Seville, Spain. · Department of Medical Oncology, Vall Hebron University Hospital, Vall Hebron Institute of Oncology (VIHO), Barcelona, Spain. · Department of Medical Oncology, Hospital Universitario Central de Asturias, Oviedo, Spain. · Department of Medical Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Spain. · Department of Medical Oncology, Hospital Universitario 12 de Octubre, IIS imas12, UCM, CNIO, CIBERONC, Av. de Córdoba, s/n, 28041, Madrid, Spain. rgcarbonero@gmail.com. ·Clin Transl Oncol · Pubmed #30535553.

ABSTRACT: NENs are a heterogeneous family of tumors of challenging diagnosis and clinical management. Their incidence and prevalence continue to rise across all sites, stages and grades. Although improved diagnostic techniques have led to earlier detection and stage migration, the improved prognosis documented over time for advanced gastrointestinal and pancreatic neuroendocrine tumors also reflect improvements in therapy. The aim of this guideline is to update practical recommendations for the diagnosis and treatment of gastroenteropancreatic and lung NENs. Diagnostic procedures, histological classification and therapeutic options are briefly discussed, including surgery, liver-directed therapy, peptide receptor radionuclide therapy, and systemic hormonal, cytotoxic or targeted therapy, and treatment algorithms are provided.

10 Article Prognostic factors for survival with nab-paclitaxel plus gemcitabine in metastatic pancreatic cancer in real-life practice: the ANICE-PaC study. 2018

Fernández, Ana / Salgado, Mercedes / García, Adelaida / Buxò, Elvira / Vera, Ruth / Adeva, Jorge / Jiménez-Fonseca, Paula / Quintero, Guillermo / Llorca, Cristina / Cañabate, Mamen / López, Luis Jesús / Muñoz, Andrés / Ramírez, Patricia / González, Paula / López, Carlos / Reboredo, Margarita / Gallardo, Elena / Sanchez-Cánovas, Manuel / Gallego, Javier / Guillén, Carmen / Ruiz-Miravet, Nuria / Navarro-Pérez, Víctor / De la Cámara, Juan / Alés-Díaz, Inmaculada / Pazo-Cid, Roberto Antonio / Carmona-Bayonas, Alberto. ·Complejo Hospitalario Universitario Ourense, Calle Ramon Puga Noguerol, 54, 32005, Ourense, Spain. ana.fernandez.montes@sergas.es. · Complejo Universitario Ourense, Ourense, Spain. · Institut Català d'Oncologia (ICO) Hospital Dr. Trueta, Girona, Spain. · Hospital Clínic de Barcelona, Barcelona, Spain. · Complejo Hospitalario de Navarra, Navarra, Spain. · Hospital 12 de Octubre, Madrid, Spain. · Hospital Universitario Central de Asturias, Asturias, Spain. · Hospital Lucus Agustí, Lugo, Spain. · Hospital de Elda, Alicante, Spain. · Hospital Público Lluis Alcanyis de Xátiva, Xátiva, Spain. · Hospital Virgen de la Salud, Toledo, Spain. · Hospital Gregorio Marañón, Madrid, Spain. · Hospital Puerta del Mar, Cadiz, Spain. · Hospital Universitario de Vigo, Vigo, Spain. · Hospital Marqués de Valdecilla, Santander, Spain. · Hospital A Coruña Teresa Herrera, A Coruña, Spain. · Hospital de Pontevedra, Pontevedra, Spain. · Hospital Morales Meseguer, Murcia, Spain. · Hospital de Elche, Elche, Spain. · Hospital Ramón y Cajal, Madrid, Spain. · Hospital Provincial Castellón, Castellón de la Plana, Spain. · Complejo Hospitalario de Jaén, Jaén, Spain. · Hospital del Ferrol, Ferrol, Spain. · Hospital Regional Universitario, Málaga, Spain. · Hospital Miguel Servet, Zaragoza, Spain. ·BMC Cancer · Pubmed #30497432.

ABSTRACT: BACKGROUND: Treatment with nab-paclitaxel plus gemcitabine increases survival in patients with metastatic pancreatic cancer. However, the assessment of treatment efficacy and safety in non-selected patients in a real-life setting may provide useful information to support decision-making processes in routine practice. METHODS: Retrospective, multicenter study including patients with metastatic pancreatic cancer, who started first-line treatment with nab-paclitaxel plus gemcitabine between December 2013 and June 2015 according to routine clinical practice. In addition to describing the treatment pattern, overall survival (OS) and progression-free survival (PFS) were assessed for the total sample and the exploratory subgroups based on the treatment and patients' clinical characteristics. RESULTS: All 210 eligible patients had a median age of 65.0 years (range 37-81). Metastatic pancreatic adenocarcinoma was recurrent in 46 (21.9%) patients and de novo in 164 (78.1%); 38 (18%) patients had a biliary stent. At baseline, 33 (18.1%) patients had an ECOG performance status ≥2. Patients received a median of four cycles of treatment (range 1-21), with a median duration of 3.5 months; 137 (65.2%) patients had a dose reduction of nab-paclitaxel and/or gemcitabine during treatment, and 33 (17.2%) discontinued treatment due to toxicity. Relative dose intensity (RDI) for nab-paclitaxel, gemcitabine, and the combined treatment was 66.7%. Median OS was 7.2 months (95% CI 6.0-8.5), and median PFS was 5.0 months (95% CI 4.3-5.9); 50 patients achieved either a partial or complete response (ORR 24.6%). OS was influenced by baseline ECOG PS, NLR and CA 19.9, but not by age ≥ 70 years and/or the presence of hepatobiliary stent or RDI < 85%. All included variables, computed as dichotomous, showed a significant contribution to the Cox regression model to build a nomogram for predicting survival in these patients: baseline ECOG 0-1 vs. 2-3 (p = 0.030), baseline NLR > 3 vs. ≤ 3 (p = 0.043), and baseline CA 19.9 > 37 U/mL vs. ≤37 U/mL (p = 0.004). CONCLUSIONS: Nab-Paclitaxel plus gemcitabine remain effective in a real-life setting, despite the high burden of dose reductions and poorer performance of these patients. A nomogram to predict survival using baseline ECOG performance status, NLR and CA 19.9 is proposed.

11 Article Applying Reflective Multicriteria Decision Analysis (MCDA) to Patient-Clinician Shared Decision-Making on the Management of Gastroenteropancreatic Neuroendocrine Tumors (GEP-NET) in the Spanish Context. 2018

Wagner, Monika / Samaha, Dima / Cuervo, Jesus / Patel, Harshila / Martinez, Marta / O'Neil, William M / Jimenez-Fonseca, Paula. ·Analytica Laser, Montreal, Canada. m.wagner@analytica-laser.com. · Analytica Laser, London, UK. · Analytica Laser, Madrid, Spain. · Analytica Laser, Montreal, Canada. · Department of Medical Oncology, Hospital Universitario Central de Asturias, Oviedo, Spain. ·Adv Ther · Pubmed #29987525.

ABSTRACT: INTRODUCTION: Unresectable, well-differentiated nonfunctioning gastroenteropancreatic neuroendocrine tumors (GEP-NETs) can be monitored (watchful waiting, WW) or treated with systemic therapy such as somatostatin analogues (SSAs) to delay progression. We applied a reflective multicriteria decision analysis (MCDA) shared-decision framework (previously developed for the USA) to explore what matters to Spanish patients and clinicians considering GEP-NET treatment options. METHODS: The EVIDEM-derived framework was updated and adapted to the Spanish context. During a Chatham House session, five patients and six physicians assigned criteria weights using hierarchical point allocation and direct rating scale (alternative analysis). Informed by synthesized evidence embedded in the framework, participants scored how each criterion favored SSA treatment (reference case lanreotide) or WW and shared insights and knowledge. Weights and scores were combined into value contributions (norm. weight × score/5), which were added across criteria to derive the relative benefit-risk balance (RBRB, scale - 1 to + 1). Exploratory comparisons to US study findings were performed. RESULTS: Focusing on intervention outcomes (effectiveness, patient-reported, and safety), the mean RBRB favored treatment over WW (+ 0.32 ± 0.24), with the largest contributions from progression-free survival (+ 0.11 ± SD 0.07), fatal adverse events (+ 0.06 ± SD 0.08), and impact on HRQoL (+ 0.04 ± SD 0.04). Consideration of modulating criteria (type of benefit, need, costs, evidence, and feasibility) increased the RBRB to + 0.50 ± 0.14, with type of therapeutic benefit (+ 0.10 ± SD 0.08) and quality of evidence (+ 0.08 ± SD 0.06) contributing most towards treatment. Alternative weighting yielded similar results. Results were broadly comparable to those derived from the US study. CONCLUSION: The multicriteria framework helped Spanish patients and clinicians identify and express what matters to them. The approach is transferable across decision-making contexts. FUNDING: IPSEN Pharma.

12 Article Guidelines for biomarker testing in gastroenteropancreatic neuroendocrine neoplasms: a national consensus of the Spanish Society of Pathology and the Spanish Society of Medical Oncology. 2014

García-Carbonero, R / Vilardell, F / Jiménez-Fonseca, P / González-Campora, R / González, E / Cuatrecasas, M / Capdevila, J / Aranda, I / Barriuso, J / Matías-Guiu, X / Anonymous4350760 / Anonymous4360760. ·Medical Oncology Department, Virgen del Rocío University Hospital, Biomedicine Institute of Sevilla (IBIS) [University of Sevilla, CSIC, HUVR], Avenida Manuel Siurot, S/N, 41013, Seville, Spain, rgcarbonero@gmail.com. ·Clin Transl Oncol · Pubmed #23749327.

ABSTRACT: The annual incidence of neuroendocrine tumours in the Caucasian population ranges from 2.5 to 5 new cases per 100,000 inhabitants. Gastroenteropancreatic neuroendocrine tumours is a family of neoplasms widely variable in terms of anatomical location, hormone composition, clinical syndromes they cause and in their biological behaviour. This high complexity and clinical heterogeneity, together with the known difficulty of predicting their behaviour from their pathological features, are reflected in the many classifications that have been developed over the years in this field. This article reviews the main tissue and clinical biomarkers and makes recommendations for their use in medical practice. This document represents a consensus reached jointly by the Spanish Society of Medical Oncology (SEOM) and the Spanish Society of Pathology (SEAP).

13 Article Prognostic factors and long-term outcome of pancreatic neuroendocrine neoplasms: Ki-67 index shows a greater impact on survival than disease stage. The large experience of the Spanish National Tumor Registry (RGETNE). 2013

Martin-Perez, Elena / Capdevila, Jaume / Castellano, Daniel / Jimenez-Fonseca, Paula / Salazar, Ramon / Beguiristain-Gomez, Adolfo / Alonso-Orduña, Vicente / Martinez Del Prado, Purificacion / Villabona-Artero, Carles / Diaz-Perez, Jose A / Monleon, Antonio / Marazuela, Monica / Pachon, Vanessa / Sastre-Valera, Javier / Sevilla, Isabel / Castaño, Angel / Garcia-Carbonero, Rocio. ·Department of Surgery, University Hospital La Princesa, Madrid, Spain. ·Neuroendocrinology · Pubmed #23988576.

ABSTRACT: INTRODUCTION: Pancreatic neuroendocrine neoplasms (PNENs) are uncommon neoplasms with a wide spectrum of clinical behavior. The objective of this study was to assess in a large cohort of patients the relative impact of prognostic factors on survival. METHODS: From June 2001 through October 2010, 1,271 patients were prospectively registered online (www.getne.org) at the Spanish National Cancer Registry for Gastroenteropancreatic Neuroendocrine Tumors (RGETNE) by participating centers. Clinical and histopathological features were assessed as potential prognostic factors by uni- and multivariate analyses. RESULTS: Of 483 PNENs, 171 (35%) were functional (F) and 312 (65%) non-functional (NF). NF-PNENs were associated with a higher incidence of histological features denoting more aggressive disease, such as poor tumor differentiation, Ki-67 >20%, or vascular invasion (NF- vs. F-PNENs, respectively, p < 0.05). Nevertheless, functionality was not a significant predictor of survival (p = 0.19). Stage at diagnosis, Ki-67 index, tumor differentiation and surgical resection of the primary tumor were all significant prognostic factors in univariate analysis. However, Ki-67 (>20 vs. ≤2%) (hazard ratio (HR) 2.21, p = 0.01) and surgical resection (yes vs. no) (HR 0.92, p = 0.001) were the only independent predictors of survival in multivariate analysis. Among patients who underwent surgery, high Ki-67 index (HR 10.37, p = 0.02) and poor differentiation (HR 8.16, p = 0.03) were the only independent predictors of clinical outcome. CONCLUSION: Ki-67 index and tumor differentiation are key prognostic factors influencing survival of patients with PNENs and, in contrast to what it is observed for other solid malignancies, they seem to have a greater impact on survival than the extent of disease. This should be borne in mind by physicians in order to appropriately tailor therapeutic strategies and surveillance of these patients.