251 Airforce General Hospital

Athens, Greece

251 Airforce General Hospital

Athens, Greece

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Economopoulou P.,National and Kapodistrian University of Athens | Kotsakis A.,University of Crete | Kapiris I.,251 Airforce General Hospital | Kentepozidis N.,251 Airforce General Hospital
Cancer Management and Research | Year: 2015

Recognition and management of treatment-related cardiovascular toxicity, defined as either an acute cardiac event or a chronic condition, has been tightly integrated into routine cancer care and has become an important component in treatment selection. Several chemotherapeutic agents, such as anthracyclines, are traditionally characterized as cardiotoxic, but cardiovascular adverse events are also associated with commonly used molecular targeted therapies. In the past decade, bevacizumab, a monoclonal humanized antibody against vascular endothelial growth factor, has been introduced in the treatment of a variety of metastatic malignancies. Despite its efficacy, bevacizumab has been associated with significant risk of cardiovascular complications, such as hypertension, cardiac ischemia, and congestive heart failure. This review will focus on the cardiovascular toxicity of bevacizumab, providing the latest evidence on the incidence, clinical spectrum, risk factors, and responsible mechanisms. © 2015 Economopoulou et al.


Mountzios G.,251 Airforce General Hospital | Mountzios G.,National and Kapodistrian University of Athens | Soultati A.,251 Airforce General Hospital | Pectasides D.,National and Kapodistrian University of Athens | And 3 more authors.
Cancer Treatment Reviews | Year: 2013

Despite the available prevention and early detection strategies, advanced squamous-cell carcinoma of the uterine cervix remains a major concern for public health. Systemic treatment with cisplatin, either in combination with external beam irradiation for locally advanced disease, or as monotherapy for recurrent/metastatic disease has been the cornerstone of treatment for more than two decades. Cisplatin has been also combined with a number of agents including paclitaxel, topotecan, gemcitabine, vinorelbine and ifosfamide, leading to encouraging response rates and increases in progression-free survival in a series of randomized phase III trials. Platinum-based triplets have been also tested, albeit at the cost of substantial toxicity. More recently, combinations with molecular agents targeting critical pathways in cervical malignant transformation are being assessed in clinical trials. In the current review, we discuss all recent advances in the systemic treatment of metastatic cervical cancer with emphasis on the results of large randomized phase III trials. Concerns regarding treatment-related toxicity in the context of co-morbidities and the need for potent predictive biomarkers for individualized treatment are also addressed. © 2012 Elsevier Ltd.


Sanoudou D.,National and Kapodistrian University of Athens | Mountzios G.,251 Airforce General Hospital | Arvanitis D.A.,Biomedical Research Foundation of the Academy of Athens | Pectasides D.,National and Kapodistrian University of Athens
Pharmacogenomics Journal | Year: 2012

The advent of microarrays over the past decade has transformed the way genome-wide studies are designed and conducted, leading to an unprecedented speed of acquisition and amount of new knowledge. Microarray data have led to the identification of molecular subclasses of solid tumors characterized by distinct oncogenic pathways, as well as the development of multigene prognostic or predictive models equivalent or superior to those of established clinical parameters. In the field of molecular-targeted therapy for cancer, in particular, the application of array-based methodologies has enabled the identification of molecular targets with 'key' roles in neoplastic transformation or tumor progression and the subsequent development of targeted agents, which are most likely to be active in the specific molecular setting. Herein, we present a summary of the main applications of whole-genome expression microarrays in the field of molecular-targeted therapies for solid tumors and we discuss their potential in the clinical setting. An emphasis is given on deciphering the molecular mechanisms of drug action, identifying novel therapeutic targets and suitable agents to target them with, and discovering molecular markers/signatures that predict response to therapy or optimal drug dose for each patient.


Mavroudis D.,University of Crete | Saloustros E.,General Hospital of Heraklion Venizelio | Malamos N.,Elena Venizelou Hospital | Kakolyris S.,University General Hospital of Alexandroupolis | And 5 more authors.
Annals of Oncology | Year: 2015

Background: Adjuvant trastuzumab in combination with chemotherapy improves survival of women with HER2-positive early breast cancer. In this study, we compared 12 versus 6 months of adjuvant trastuzumab. Patients and methods: Axillary node-positive or high-risk node-negative women with HER2-positive early breast cancer were randomized to receive 12 or 6 months of adjuvant trastuzumab concurrently with dose-dense, granulocyte colony-stimulating factor (G-CSF)-supported docetaxel (75 mg/m2 every 14 days for four cycles). All patients received upfront dose-dense, G-CSF-supported FEC (5-fluorouracil 700 mg/m2, epirubicin 75 mg/m2, cyclophosphamide 700 mg/m2 every 14 days for four cycles). Randomization was carried out before commence of chemotherapy. The primary end point was the 3-year disease-free survival (DFS). Results: A total of 481 patients were randomized to receive 12 months (n = 241) or 6 months (n = 240) of adjuvant trastuzumab. Chemotherapy was completed in 99% and 98% of patients, while trastuzumab therapy in 100% and 96% of patients in the 12- and 6-month groups, respectively. After 47 and 51 months of median follow-up, there were 17 (7.1%) and 28 (11.7%) disease relapses in the 12- and 6-month groups (P = 0.08). The 3-year DFS was 95.7% versus 93.3% in favor of the 12-month treatment group (hazard ratio = 1.57; 95% confidence interval 0.86-2.10; P = 0.137). There was no difference in terms of overall survival and cardiac toxicity between the two groups. Conclusions: Our study failed to show noninferiority for the 6-month arm. The results further support the current standard of care that is administration of adjuvant trastuzumab for 12 months. © The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.


Koutsoukos K.,National and Kapodistrian University of Athens | Mountzios G.,251 Airforce General Hospital
Future Oncology | Year: 2016

Advanced squamous non-small-cell lung carcinoma (SqCC) has traditionally been considered the 'neglected sibling' compared with lung adenocarcinoma due to lack of effective targeted treatment options. Currently, limited progress has been made in the systemic treatment of advanced disease and combination chemotherapy remains the gold standard. However, the recent completion of the molecular characterization of SqCC revealed an interestingly complex genomic profile, comprising various genetic alterations that can potentially function as molecular targets for the development of novel targeted agents. Recent encouraging results of the use of immune checkpoint inhibitors in several neoplasms has emerged as a promising novel treatment option for advanced SqCC. Future personalized studies, enrolling SqCC patients according to specific driving mutations are underway. © 2016 Future Medicine Ltd.


Linardou H.,Metropolitan Hospital | Briasoulis E.,University of Ioannina | Dahabreh I.J.,Institute for Clinical Research and Health Policy Studies | Mountzios G.,251 Airforce General Hospital | And 5 more authors.
Cancer Treatment Reviews | Year: 2011

The KRAS oncogene has been extensively studied for more than three decades, however, it is only recently that it attained a central role in the clinical decision-making process for the practicing oncologist. Recently, based on retrospective analyses of large randomized clinical trials, the use of anti-epidermal growth factor (EGFR) monoclonal antibodies, cetuximab and panitumumab, was restricted to patients with metastatic colorectal cancer that carry the " wild-type" KRAS genotype. Challenges remain in the laboratory implementation of KRAS mutational testing and the clinical application of the test for treatment planning. This review attempts to offer a global view of KRAS biology, its functional role in cell signaling, mechanisms of resistance to anti-EGFR agents and its predictive potential in metastatic colorectal cancer. We also survey the growing list of candidate biomarkers that may shortly supplement KRAS in routine clinical patient stratification. Finally, we discuss practical aspects of KRAS testing that may be useful for those involved in mutational screening in their centers. This general overview of KRAS for clinical oncology practice aims to assist in data interpretation and offer insight into potential pitfalls of mutational testing. KRAS is a prime example of how translational research can fulfill the promises of personalized medicine for tailoring treatment to match the underlying tumor biology. © 2010 Elsevier Ltd.


Mountzios G.,251 Airforce General Hospital | Soultati A.,251 Airforce General Hospital | Syrigos K.,National and Kapodistrian University of Athens
Head and Neck Oncology | Year: 2013

Squamous-cell carcinoma of the head and neck (SCCHN) represents the sixth most common malignancy and accounts for approximately 6% of new cancer cases annually worldwide. Although the majority of cases occur between the fifth and sixth decades of life, their onset in patients older than 60 years is not rare and up to one fourth of SCCHN cases are diagnosed in patients older that 70 years. As the elderly population with SCCHN is constantly growing and as elderly cancer patients are severely under-represented in clinical trials, there is a clear need to address the particular aspects of this specific patient group, especially in the context of novel multidisciplinary cancer approaches. The frailty of elderly patients with SCCHN is further exacerbated by the high incidence of smoking and alcohol abuse and the presence of substantial cardiovascular, respiratory or metabolic comorbidities that may hamper optimal therapeutic strategies. Herein, we review current and emerging treatment approaches, including improved surgical techniques attempting to improve radicality of excision while preserving functionality, the incorporation of sophisticated techniques in radiotherapy and the implementation of novel chemotherapeutic regimens and molecular targeted agents in an effort to reduce toxicity without compromising efficacy. We also discuss the particular characteristics that render this patient population a unique entity and we emphasize on the need for a multidisciplinary approach in order to optimize therapeutic outcome while preserving quality of life in this frail subgroup of SCCHN patients.


PubMed | 251 Airforce General Hospital and National and Kapodistrian University of Athens
Type: Journal Article | Journal: Future oncology (London, England) | Year: 2016

Advanced squamous non-small-cell lung carcinoma (SqCC) has traditionally been considered the neglected sibling compared with lung adenocarcinoma due to lack of effective targeted treatment options. Currently, limited progress has been made in the systemic treatment of advanced disease and combination chemotherapy remains the gold standard. However, the recent completion of the molecular characterization of SqCC revealed an interestingly complex genomic profile, comprising various genetic alterations that can potentially function as molecular targets for the development of novel targeted agents. Recent encouraging results of the use of immune checkpoint inhibitors in several neoplasms has emerged as a promising novel treatment option for advanced SqCC. Future personalized studies, enrolling SqCC patients according to specific driving mutations are underway.


Bakogeorgos M.,251 Airforce General Hospital | Mountzios G.,251 Airforce General Hospital | Kotsantis G.,251 Airforce General Hospital | Economopoulou P.,251 Airforce General Hospital | And 2 more authors.
Journal of B.U.ON. | Year: 2013

Purpose: To evaluate whether elderly patients with metastatic colorectal cancer (mCRC) receive chemotherapy of suboptimal intensity and duration, mainly due to fears of poor compliance and/or excessive toxicity. Methods: We carried out a retrospective analysis in a series of 94 mCRC patients. Using the cut-off of 70 years, we compared elderly patients with their younger counterparts in terms of treatment delivery [type, dose intensity (DI), relative dose intensity (RDI), duration], chemotherapy toxicity and efficacy [objective response rate (ORR), overall survival (OS) and progression-free survival (PFS)]. Results: Complete data were available for 72 patients (76.6%) among which 38 (52.8%) were elderly. As compared to the younger, elderly patients were more likely to receive single-agent chemotherapy (13.1 vs 0%, p<0.001). The mean number of chemotherapy cycles was 6.2 for the elderly and 8.3 for the non-elderly patients who received either the FOLFOX or FOLFIRI regimen (p=0.142) and 5.1 vs 5.0 for those who received either the XELOX or XELIRI regimen, respectively (p=0.831). In oxaliplatin-containing regimens, elderly patients received 42.8% of the planned dose, as compared to 78.4% for the younger ones (p=0.012). DI for oxaliplatin was higher in non-elderly than in the elderly (46.66 mg/ m 2/week vs 32.47 mg/m2/week, p=0.008). No difference was observed in the rate of severe (grade III-IV) toxicities. ORR, PFS and OS were similar between the two groups. Conclusion: Despite the inferior type and intensity of chemotherapy, elderly patients derived equivalent benefit to their younger counterparts. These data further support the use of optimal chemotherapy in elderly patients with mCRC.


Mountzios G.,251 Airforce General Hospital
World Journal of Clinical Oncology | Year: 2015

Head and neck cancer (HNC) represents the sixth most common malignancy and accounts for approximately 6% of new cancer cases annually worldwide. As life expectancy constantly increases, the onset of HNC in patients older than 65 years of age at diagnosis is not rare and up to one fourth of cases occurs in patients older that 70 years at age. Because elderly cancer patients are severely under-represented in clinical trials, there is a clear need to address the particular aspects of this specific patient group, especially in the context of novel multidisciplinary therapeutic approaches. The frailty of elderly patients with HNC is attributed to the high incidence of smoking and alcohol abuse in this malignancy and the presence of substantial cardiovascular, respiratory or metabolic comorbidities. In the current work, I provide an overview of current and emerging treatment approaches, in elderly patients with HNC. In particular, I discuss modern surgical approaches that improve radical excision rates while preserving functionality, the incorporation of modern radiotherapeutic techniques and the introduction of novel chemotherapeutic combinations and molecular targeted agents in an effort to reduce toxicity without compromising efficacy. Finally, there is an urgent need to increase accrual and active participation of elderly patients with HNC in clinical trials, including biomarker evaluation in biopsy specimens towards an individualized therapeutic approach. © 2015 Baishideng Publishing Group Inc. All rights reserved.

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