REGIS OTAVIANO FRANCA BEZERRA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/44 - Laboratório de Ressonância Magnética em Neurorradiologia, Hospital das Clínicas, Faculdade de Medicina
LIM/44 - Laboratório de Ressonância Magnética em Neurorradiologia, Hospital das Clínicas, Faculdade de Medicina
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- Real-world evidence on first-line treatment for metastatic renal cell carcinoma with non-clear cell and sarcomatoid histologies: are sunitinib and pazopanib interchangeable?(2019) BONADIO, Renata Colombo; VELHO, Pedro Isaacsson; MARTA, Guilherme Nader; NARDA, Mirella; SOUZA, Manoel Carlos La; MUNIZ, David Q. B.; BEZERRA, Regis O. F.; BISPO, Raisa K. A.; FARAJ, Sheila F.; BASTOS, Diogo A.; DZIK, CarlosIntroduction: Non-clear cell renal cell carcinoma (nccRCC) and sarcomatoid renal cell carcinoma (sRCC) are underrepresented in clinical trials. Treatment approaches are frequently extrapolated from data of clear cell renal cell carcinoma, in which pazopanib is non-inferior to sunitinib. We aim to compare the effectiveness of first-line sunitinib and pazopanib for nccRCC and sRCC. Methods: We evaluated a retrospective cohort of patients with metastatic nccRCC and sRCC treated with first-line sunitinib or pazopanib at an academic cancer centre. Overall survival (OS), progression-free survival (PFS) and response rate were measured. Kaplan-Meier and log-rank analyses were used for time-to-event data. Cox regression was used for prognostic factors. Results: Fifty-three patients were included; 16 (30.1%) treated with sunitinib and 37 (69.9%) with pazopanib. Forty-six (86.8%) patients had nccRCC and 7 (13.2%) had sRCC. The majority had intermediate or poor International Metastatic Renal-Cell Carcinoma Database Consortium risk (93%). Median PFS was 6.6 months with sunitinib and 4.9 months with pazopanib (HR 1.75; P = 0.078). Treatment with pazopanib was associated with inferior OS in comparison with sunitinib (median OS: 30.4 months versus 8.7 months; HR 2.71, 95% CI 1.31-5.58, P = 0.007). These results were confirmed in subgroup analysis of patients with papillary, chromophobe and MiT family translocation histologies (median OS: 38.7 months versus 14.7 months; HR 3.16, 95% CI 1.20-8.29, P = 0.019). Unclassified and sarcomatoid histologies had inferior OS (median: 6.9 and 1.1 months, respectively) regardless of the treatment used. Conclusion: In this patient cohort, pazopanib was associated with inferior OS in comparison with sunitinib for metastatic nccRCC. Larger trials are ideally warranted to confirm these results.
- Whole-Body Magnetic Resonance Imaging in the Oncology Setting: An Overview and Update on Recent Advances(2019) BEZERRA, Regis Otaviano Franca; RECCHIMUZZI, Debora Zachello; MOTA, Micaela Maciel dos Santos; GARCIA, Marcio Ricardo Taveira; MENEZES, Marcos Roberto de; MAZO, Paulo Eduardo; CERRI, Giovanni GuidoWhole-body magnetic resonance imaging is becoming an important tool in oncology as a nonirradiating imaging technique since recent technological advances allowed the incorporation of high-quality imaging in an adequate time. Moreover, the noninjection of radioisotope/intravenous contrast, low cost compared with traditional nuclear medicine techniques, and fast acquisition times are another distinct feature. Thus, the purpose of this article is to review the whole-body magnetic resonance imaging protocol and its main applications in the oncology setting.
- Tumor Growth Rate as a Validated Early Radiological Biomarker Able to Reflect Treatment-Induced Changes in Neuroendocrine Tumors: The GREPONET-2 Study(2019) LAMARCA, Angela; RONOT, Maxime; MOALLA, Salma; CRONA, Joakim; OPALINSKA, Marta; LOPEZ, Carlos Lopez; PEZZUTTI, Daniela; NAJRAN, Pavan; CARVHALO, Luciana; BEZERRA, Regis Otaviano Franca; BORG, Philip; VIOLI, Naik Vietti; TRUEBA, Hector Vidal; MESTIER, Louis de; SCAEFER, Niklaus; BAUDIN, Eric; SUNDIN, Anders; COSTA, Frederico; PAVEL, Marianne; DROMAIN, ClarissePurpose: Tumor growth rate (TGR) represents the percentage change in tumor volume per month (%/m). Previous results from the GREPONET study showed that TGR measured after 3 months (TGR(3m)) of starting systemic treatment (ST) or watch and wait (WW) was an early biomarker predicting progression-free survival (PFS) in neuroendocrine tumors (NET). Experimental Design: Patients from 7 centers with advanced grade (G) 1/2 NETs from the pancreas (P)/small bowel (SB) initiating ST/WW were eligible. Computed tomography (CT)/MRI performed at prebaseline, baseline, and 3 (perpendicular to 1) months of study entry were retrospectively reviewed. Aim-1: explore treatment-induced changes in TGR (Delta TGR(3m-BL); paired T test), and Aim-2: validate TGR(3m) (<0.8%/m vs. >= 0.8%/m) as an early biomarker in an independent cohort (Kaplan-Meier/Cox regression). Results: Of 785 patients screened, 127 were eligible. Mean (SD) TGR(0) and TGR(3m) were 5.4%/m (14.9) and -1.4%/m (11.8), respectively. Mean (SD) Delta TGR(3m-BL) paired-difference was -6.8%/m (19.3; P < 0.001). Most marked Delta TGR(3m-BL) [mean (SD)] were identified with targeted therapies [-11.3%/m (4.7); P = 0.0237] and chemotherapy [-7.9%/m (3.4); P = 0.0261]. Multivariable analysis confirmed the absence of previous treatment (OR = 4.65; 95% CI, 1.31-16.52; P = 0.018) and low TGR(3m) (continuous variable; OR 1.09; 95% CI, 1.01-1.19; P = 0.042) to be independent predictors of radiologic objective response. When the multivariable survival analysis for PFS (Cox regression) was adjusted to grade (P = 0.004) and stage (P = 0.017), TGR(3m) >= 0.8 (vs. <0.8) maintained its significance as a prognostic factor (P < 0.001), whereas TGR(0) and Delta TGR(3m-BL) did not. TGR(3m) >= 0.8%/m was confirmed as an independent prognostic factor for PFS [external validation; Aim-2; multivariable HR 2.21 (95% CI, 1.21-3.70; P = 0.003)]. Conclusions: TGR has a role as a biomarker for monitoring response to therapy for early identification of treatment-induced changes and for early prediction of PFS and radiologic objective response.
- Value of Tumor Growth Rate (TGR) as an Early Biomarker Predictor of Patients' Outcome in Neuroendocrine Tumors (NET)-The GREPONET Study(2019) LAMARCA, Angela; CRONA, Joakim; RONOT, Maxime; OPALINSKA, Marta; LOPEZ, Carlos Lopez; PEZZUTTI, Daniela; NAJRAN, Pavan; CARVHALO, Luciana; BEZERRA, Regis Otaviano Franca; BORG, Philip; VIOLI, Naik Vietti; TRUEBA, Hector Vidal; MESTIER, Louis de; SCHAEFER, Niklaus; SUNDIN, Anders; COSTA, Frederico; PAVEL, Marianne; DROMAIN, ClarisseIntroduction Tumor growth rate (TGR; percent size change per month [%/m]) is postulated to be an early radiological biomarker to overcome limitations of RECIST. This study aimed to assess the impact of TGR in neuroendocrine tumors (NETs) and potential clinical and therapeutic applications. Materials and Methods Patients (pts) with advanced grade (G) 1/2 NETs from the pancreas or small bowel initiating systemic treatment (ST) or watch and wait (WW) were eligible. Baseline and follow-up scans were retrospectively reviewed to calculate TGR at pretreatment (TGR(0)), first follow-up (TGR(first)), and 3(+/- 1) months of study entry (TGR(3m)). Results Out of 905 pts screened, 222 were eligible. Best TGR(first) (222 pts) cutoff was 0.8 (area under the curve, 0.74). When applied to TGR(3m) (103 pts), pts with TGR(3m) <0.8 (66.9%) versus TGR(3m) >= 0.8 (33.1%) had longer median progression-free survival (PFS; 26.3 m; 95% confidence interval [CI] 19.5-32.4 vs. 9.3 m; 95% CI, 6.1-22.9) and lower progression rate at 12 months (7.3% vs. 56.8%; p = .001). WW (vs. ST) and TGR(3m) >= 0.8 (hazard ratio [HR], 3.75; 95% CI, 2.21-6.34; p < .001) were retained as factors associated with a shorter PFS in multivariable Cox regression. TGR(3m) (HR, 3.62; 95% CI, 1.97-6.64; p < .001) was also an independent factor related to shorter PFS when analysis was limited to pts with stable disease (81 pts). Out of the 60 pts with TGR(0) data available, 60% of pts had TGR(0) < 4%/month. TGR(0) >= 4 %/month (HR, 2.22; 95% CI, 1.15-4.31; p = .018) was also an independent factor related to shorter PFS. Conclusion TGR is an early radiological biomarker able to predict PFS and to identify patients with advanced NETs who may require closer radiological follow-up. Implications for Practice Tumor growth rate at 3 months (TGR(3m)) is an early radiological biomarker able to predict progression-free survival and to identify patients with advanced neuroendocrine tumors who may require closer radiological follow-up. It is feasible to calculate TGR(3m) in clinical practice and it could be a useful tool for guiding patient management. This biomarker could also be implemented in future clinical trials to assess response to therapy.
bookPart Radiologia oncológica - Medicina Interna(2019) CARNEIRO, Hugo Costa; BEZERRA, Regis O. F.; BADRA, Márcio Ricardo Taveira