What tumors do we treat?

Adult malignant tumors originating in the brain or spinal cord.

These tumors may harbor genetic aberrations such as BRAF v600E mutations, NTRK fusions. They are different to brain metastases, which originate from other tumors that emerge from different organs (such as metastases from lung carcinoma, melanoma, renal carcinoma, breast carcinoma, etc.). 

Diffuse adult gliomas: these are tumors that can have varying degrees of aggressiveness.

• Follicular carcinoma or papillary thyroid carcinoma: they represent the most common thyroid tumors and may harbor RET gene translocations or fusions, BRAF mutations, among the most relevant genetic alterations and for which there are effective targeted therapies.
• Other types include medullary thyroid carcinoma and anaplastic thyroid carcinoma.

Malignant tumors (usually squamous cell carcinoma) emerging from the ootorhinolaryngology and maxillofacial area.

They are subdivided into:

• Oral cavity and lip carcinoma: includes carcinoma of the tongue, carcinoma of the base of the tongue, carcinoma of the oral mucosa and retromolar trigone, carcinoma of the gums, carcinoma of the palate and carcinoma of the uvula, and carcinoma of the tonsil (palatine tonsil).
• Oropharyngeal carcinoma: These are tumors that can harbor human papillomavirus (HPV-positive) or not (HPV-negative) and include tonsillar fossa carcinoma and carcinoma of the soft palate.
• Nasopharyngeal carcinoma: carcinomas that develop in the area bounded by the rim of the nostril, the posterior wall of the oropharynx, the sphenoid body, and the soft palate.
• Hypopharynx carcinoma: include carcinoma of the pyriform sinus, carcinoma of the arytenoids, carcinoma of the posterior pharyngeal wall.
• Laryngeal carcinoma (glottic and supraglottic): include carcinoma of the glottis (vocal cords), and carcinoma of the epiglottis and subglottis.
• Carcinoma of the ethmoid sinuses and maxillary sinuses: include carcinoma of the nasal vestibule, nasal cavity, and paranasal sinuses.
• Salivary gland carcinoma: major salivary gland carcinoma (parotid, submandibular, and sublingual) and minor salivary gland carcinoma.

Malignant tumors that originate from the superficial layer of the skin (epidermis).

• Cutaneous (non-uveal) melanoma. Usually tumors harboring BRAF (v600E), NRAS, PIK3CA, or PTEN gene mutations, which often respond positively to antiPD-1 and antiCTLA-4 immunotherapy.
• Squamous cell carcinoma of the skin and basal cell skin carcinoma: they represent the majority of malignant skin tumors and those with the best prognosis. Basal cell skin carcinoma emerges from the basal layer of the epidermis and encompasses several subtypes (nodular, superficial, sclerosing, cystic, linear, and micronodular basal cell skin carcinoma); in advanced cases of basal cell skin carcinoma, treatment with antiPD-1 immunotherapy offers good clinical results.
• Squamous cell carcinoma of the skin originates in most cases from actinic keratosis and includes includes subtypes such as keratoacanthoma, basal cell skin carcinoma and squamous cell carcinoma in situ (Bowen’s disease).
• Less frequent: Merkell carcinoma. It represents a rare and aggressive type of skin tumor, originating from cells present in the neural crest. In advanced cases, treatment with antiPD-1 immunotherapy offers good clinical results.

Primary malignant tumors of the lung, thymus, or pleura.

• Non-small cell lung carcinoma (NSCLC). It represents the most common subtype of lung carcinoma, accounting for approximately 85% of all cases. NSCLC tumors are subdivided into two major subtypes: squamous NSCLC or non-squamous NSCLC (including adenocarcinoma, large cell NSCLC). They are tumors that harbor a great genetic variability, with the presence of somatic mutations and the option of highly effective targeted therapies for genes such as KRAS (KRAS G12C for example), EGFR (EGFR deletion of exon 19 or EGFR exon 21), “skipping” of exon 14 of MET (METex14 skipping), rearrangements (fusions) of genes such as ALK, ROS1, RET, BRAF mutations or fusions (BRAF v600E for example) among others. The use of immunotherapy with antiPD1, antiPD-L1 or antiCTLA-4 can offer good clinical results.
• Lung microcytic carcinoma (small cell): These account for the remaining 15% of lung tumors. They are aggressive tumors and are highly sensitive to combined platinum-based chemotherapy and antiPD-L1 immunotherapy.
• Thymic tumors: They account for approximately 20% of tumors that emerge within the limits of the mediastinum (anterior mediastinum), and may include subtypes such as thymomas, carcinomas of the thymus, carcinoid tumors of the thymus, or germ cell tumors.
• Pleural mesothelioma. Tumors that emerge from the pleura (parietal or visceral), closely related to exposure to asbestos. They can be classified as epithelioid pleural mesothelioma or sarcomatoid pleural mesothelioma. Combination therapy with antiPD-1 and anti-CTLA4 immunotherapy has been shown to be beneficial for advanced cases of mesothelioma.

Malignant tumors that emerge from different areas of the mammary glands.

• Ductal carcinoma in situ. These are tumors that originate in the mammary gland but do not invade the tissues of the mammary gland.
• Invasive carcinoma of the breast. Lobular carcinoma of the breast (10-15% of invasive breast carcinomas) and invasive ductal carcinoma (IDC) representing 70-80% of invasive breast carcinomas are classified. CDI is further subdivided into Luminal A, Luminal B, triple-negative breast carcinoma, and HER2 amplified subtypes. The therapies administered depend on the stage and subtype of CDI (include hormonal therapies, anti-HER2 antibodies, selective CDK4/CDK6 inhibitors, chemotherapy, anti-PD1 immunotherapy). There are other, rarer subtypes of invasive breast carcinoma (10% of invasive carcinomas: tubular carcinoma of the breast, papillary carcinoma, mucinous carcinoma of the breast or Phyllodes tumor).

Malignant tumors originating from the cervical esophagus to the gastroesophageal junction.

• Squamous cell carcinoma: The most common type of esophageal carcinoma. They present more frequently in the upper two thirds of the esophagus. The combination of chemotherapy and antiPD-1 immunotherapy has been found to be effective in these types of tumors.
• Esophageal adenocarcinoma: These tumors usually emerge from the distal third of the esophagus secondary to premalignant conditions (Barrett’s esophagus) and may harbor HER2 amplifications in a group of patients, and in these cases anti-HER2 therapies can be applied. The combination of chemotherapy and antiPD-1 immunotherapy has been found to be effective in these types of tumors.

Malignant stomach tumors that may include cardia, fundus, body, gastric antrum, or pylorus.

These tumors may harbor genetic alterations such as HER2 amplification, alteration of DNA repair proteins (MLH1, MSH2, MSH6 or PMS2, alteration called microsatellite instability or “MSI”, among others. In a small group of patients with a genetic predisposition to familial gastric-intestinal cancer, the presence of germline mutations of the CDH1 gene can be detected. In this type of tumor, the efficacy of the combination of chemotherapy and antiPD-1 immunotherapy has also been demonstrated.

Malignant tumors that originate from different areas of the hepatic and pancreatic system, as well as the intra- and extrahepatic bile ducts.

• Pancreatic carcinomas: Pancreatic adenocarcinoma is the most common subtype of pancreatic cancer, although other types of pancreatic tumors (pancreatic carcinoid tumors, pancreatic neuroendocrine carcinomas) are also found. Most of these tumors harbor mutations of the KRAS genes, as well as the TP53 and SMAD4 genes, and in some cases NTRK gene fusions can be detected. Likewise, the presence of germline mutations of the BRCA1/2, PALB2, CDKN2B, ATM gene has been demonstrated.
• Gallbladder carcinomas: The most frequent type of cancer of the bile ducts, which can be detected as a casual finding in cholecystectomy surgery. Somatic mutations have been studied and detected in genes such as ARID1A, ARID2, ATM, HER2, KRAS, PIK3CA, TERT, and TP53, among others.
• Intra- or extrahepatic olangiocarcinomas: Rare and aggressive tumors. In the case of intrahepatic cholangiocarcinomas, FGFR2 gene fusions can be detected with targeted therapy options.
• Hepatocarcinoma. Hepatocellular carcinoma is the most frequent primary liver tumor, it emerges in association with risk factors, in particular previous infections by hepatitis B or C virus (HBV, HCV) and cirrhosis (by HBV, HCV, by chronic alcoholism). Anti-PD-L1 immunotherapy has been shown to be effective in advanced stages of hepatocarcinoma.

Malignant tumors of the renal system and urinary tract.

• Renal carcinoma. Tumors originating from the kidneys, can show a positive response to immunotherapy with antiPD-1 and antiCTLA-4, as well as antiangiogenic therapies.
• Urinary bladder and urinary tract carcinoma: These are tumors that emerge from the inner surface of the urinary bladder and urinary tracts such as the renal pelvis and ureter. The presence of TP53, PIK3CA, FGFR3 gene mutations, or MDM2 amplifications is commonly observed. The presence of genetic aberrations of the FGFR gene (fusions) has been shown to be a predictor of response to targeted therapies with oral drugs such as erdaftitinib. In advanced cases, treatment with antiPD-1 or antiPD-L1 immunotherapy offers good clinical results.
• Prostate carcinoma: One of the most frequent tumors among the male population. In advanced stages, patients receive androgen deprivation hormone therapy with LHRH analogs. There are various treatments for patients who are resistant to hormonal therapies (including enzalutamide, abiraterone, chemotherapy, radium-223, sipuleucel-T, with PARP inhibitors in patients with germline BRCA1/2 gene mutations, among others). In cases of patients with alterations in DNA repair proteins (MLH1, MSH2, MSH6 or PMS2, an alteration called microsatellite instability or “MSI”), anti-PD1 therapy can be effective.
• Penile carcinoma: Rare tumors. The most common type is squamous cell cancer. It is related to human papilloma virus (HPV) infection. Mutations in the TP53, NOTCH1, PIK3CA or CDKN2A genes have been described in squamous cell cancer of the penis. They may present alteration of DNA repair proteins (MLH1, MSH2, MSH6 or PMS2, alteration called microsatellite instability or “MSI”) and in these cases antiPD-1 immunotherapy has proven to be effective.

Malignant tumors originating in the female reproductive system.

• Endometrial carcinoma (endometrioid, mucinous): These are tumors that are related to prolonged exposure to estrogens, polycystic ovary syndrome, obesity, family history of endometrial or breast cancer, among others. These tumors usually harbor mutations in the TP53, NF1, BRCA1, BRCA2, RB1 or CDK12 genes, they may also present alterations in DNA repair proteins (MLH1, MSH2, MSH6 or PMS2, an alteration called microsatellite instability or “MSI” or M: YES”). In cases of advanced endometrial cancer, antiPD-1 immunotherapy has proven to be effective.
• Ovarian carcinoma (clear cell, serous, mucinous, carcinosarcoma): These tumors can occur in patients with a family history of endometrial or breast cancer. The presence of germinal mutations in genes such as BRCA1, BRCA2, CHEK2, BRIP1, PALB2, or alteration of DNA repair proteins (MLH1, MSH2, MSH6 or PMS2, alteration called microsatellite instability or “MSI” have been identified. ”). In advanced stages of the disease, therapy with PARP inhibitors has shown efficacy in patients with ovarian carcinoma.
• Fallopian tube carcinoma: This type of tumor shares many features with ovarian cancer and is usually treated in the same way. The fallopian tubes are considered to be the areas where many cases of ovarian carcinomas or peritoneal carcinomas emerge.
• Cervical carcinoma (squamous or adenocarcinoma): closely related to human papilloma virus (HPV) infection in most cases and also related to the patient’s sex life. Mutations have been detected in the PIK3CA, PTEN, and KRAS genes, among others. Currently, treatments in advanced stages include chemotherapy, bevacizumab, immunotherapy with antiPD-1 or tisotumab-vedotin.

Malignant tumors that originate from different points of the upper and lower digestive tract.

• Adenocarcinoma of the cecal appendix (cecum), ascending colon, transverse colon, descending colon or sigma and rectum: They represent the most common type of lower digestive cancer. They may harbor RAS gene mutations (KRAS, NRAS), TP53, BRAF v600E or present alteration of DNA repair proteins (MLH1, MSH2, MSH6 or PMS2, alteration called microsatellite instability or “MSI”), among the most common genetic aberrations.
• Anal canal carcinomas: They represent 1-2% of tumors of the lower gastrointestinal tract.
• Small intestine adenocarcinoma: Usually located in the duodenum or jejunum. They are rare.
• Peritoneal mesothelioma or primary peritoneal carcinoma: A tumor that originates in the peritoneum.
• GIST (gastrointestinal stromal tumors): Rare tumors usually located in the small intestine.