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Rossini D, Boccaccino A, Sbrana A, Daniel F, Borelli B, Raimondi A, Santini D, Conca V, Tomasello G, Caponnetto S, Marmorino F, Zaniboni A, Buonadonna A, Masi G, Lonardi S, Pietrantonio F, Falcone A, Antonuzzo A, Cremolini C. Clinical impact of neutropenia and febrile neutropenia in metastatic colorectal cancer patients treated with FOLFOXIRI/bevacizumab: a pooled analysis of TRIBE and TRIBE2 studies by GONO. ESMO Open 2021; 6:100293. [PMID: 34689001 PMCID: PMC8551530 DOI: 10.1016/j.esmoop.2021.100293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/30/2021] [Accepted: 10/05/2021] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND TRIBE and TRIBE-2 studies demonstrated higher benefit from FOLFOXIRI (fluorouracil, leucovorin, oxaliplatin, and irinotecan)/bevacizumab compared with FOLFIRI (fluorouracil, leucovorin, and irinotecan) or FOLFOX/bevacizumab as an upfront option for metastatic colorectal cancer patients, with more toxicities. We focused on the incidence and longitudinal dynamics of neutropenia and febrile neutropenia (FN) in the two studies, to evaluate their clinical relevance, the magnitude of impact of FOLFOXIRI/bevacizumab, and the role of risk factors in predicting their occurrence. METHODS The overall incidence of grade 3-4 (G3-4) neutropenia and FN, the time to their onset, the use of granulocyte colony-stimulating factor, and the association with risk factors were evaluated in the overall population and according to treatment arm. FN episodes were assessed by Multinational Association for Supportive Care in Cancer (MASCC) score. RESULTS Among 1155 patients, 568 (49%) received FOLFOXIRI/bevacizumab. Overall, 410 (35%) experienced G3-4 neutropenia and 70 (6%) FN, 21 (2%) at high risk. FOLFOXIRI/bevacizumab was associated with higher incidence of neutropenia (51% versus 21%, P < 0.001), FN (8% versus 4%, P = 0.02), and high-risk FN [18 (3%) versus 3 (1%), P = 0.015]. No related deaths were observed. The first episode of G3-4 neutropenia and FN occurred mainly in the first 2 months in both arms. Longitudinal analysis showed different patterns of evolution over cycles between the arms (P < 0.001) G3-4 neutropenia being more frequent in the first cycles with FOLFOXIRI/bevacizumab. Older patients (P = 0.01) and females (P < 0.001) had a significantly higher risk of G3-4 neutropenia. No significant interaction effect between arm and analysed risk factors in terms of risk of G3-4 neutropenia or FN was observed. The incidence of FN among older females receiving FOLFOXIRI/bevacizumab was 12%. Neither G3-4 neutropenia nor FN impaired efficacy in terms of overall response rate, progression-free survival, and overall survival. CONCLUSIONS FOLFOXIRI/bevacizumab has a higher risk of G3-4 neutropenia and FN than doublets/bevacizumab. FN occurred in <10% of patients, mostly as low-risk episodes. A closer monitoring during the first 2 months is recommended; prophylactic use of granulocyte colony-stimulating factor may be considered for older females.
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Affiliation(s)
- D Rossini
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - A Boccaccino
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - A Sbrana
- Service of Pneumo-Oncology, Unit of Pneumology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - F Daniel
- Oncology Unit 1, Department of Oncology IOV - IRCCS, Padua, Italy
| | - B Borelli
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - A Raimondi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - D Santini
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - V Conca
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - G Tomasello
- UOC Oncologia Medica, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - S Caponnetto
- Policlinico Umberto I, Oncologia B, Department of Radiological, Oncological and Pathological Sciences, La Sapienza University, Rome, Italy
| | - F Marmorino
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - A Zaniboni
- Medical Oncology Unit, Poliambulanza Foundation, Brescia, Italy
| | - A Buonadonna
- Department of Medical Oncology, Centro Riferimento Oncologico (CRO) IRCCS, Aviano, Italy
| | - G Masi
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - S Lonardi
- Oncology Unit 3, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - F Pietrantonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Falcone
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - A Antonuzzo
- Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy; Unit of Medical Oncology 1, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - C Cremolini
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy.
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Nuzzo A, Manacorda S, Paolieri F, Sbrana A, Bazzurri S, Sammarco E, Bloise F, Ferrari M, Manfredi F, Mercinelli C, Bonato A, Massaro G, Salfi A, Galli L, Antonuzzo A, Cosio S, Gadducci A. 750P Safety and efficacy of platinum desensitization treatment in patients with ovarian cancer and platinum hypersensitivity. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Antonuzzo A, Bossi P, Cortinovis D. Elapsed time for an unresolved adverse event: systemic anticancer therapy-induced neurotoxicity calls for action. Ann Oncol 2020; 31:1289-1290. [DOI: 10.1016/j.annonc.2020.08.2103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022] Open
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Sbrana A, Paolieri F, Bloise F, Nuzzo A, Manacorda S, Sammarco E, Manfredi F, Mercinelli C, Gadducci G, Giannini N, Antonuzzo A, Paiar F, Falcone A, Pasqualetti F, Galli L. 1711P SARS-CoV-2 infection in prostate cancer patients: Data from a high-incidence area in Italy. Ann Oncol 2020. [PMCID: PMC7506440 DOI: 10.1016/j.annonc.2020.08.1775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Sbrana A, Paolieri F, Sammarco E, Bloise F, Zucchelli G, Massa V, Lorenzini G, Borelli B, Boccaccino A, Catanese S, Pecora I, Galli L, Fontana A, Falcone A, Antonuzzo A. Clinical benefit from late lines of therapy offered to patients treated in a tertiary referral centre. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz265.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rossini D, Sbrana A, Bergamo F, Manai C, Santini D, Ghidini M, Antoniotti C, Moretto R, Marmorino F, Urbano F, Ronzoni M, Noventa S, Randon G, Carlomagno C, Latiano T, Cordio S, Granetto C, Cremolini C, Falcone A, Antonuzzo A. Clinical impact of neutropenia and febrile neutropenia in metastatic colorectal cancer patients treated with FOLFOXIRI/bevacizumab: a pooled analysis of TRIBE and TRIBE2 studies. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz156.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bossi P, Antonuzzo A, Cherny NI, Rosengarten O, Pernot S, Trippa F, Schuler U, Snegovoy A, Jordan K, Ripamonti CI. Diarrhoea in adult cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol 2018; 29:iv126-iv142. [PMID: 29931177 DOI: 10.1093/annonc/mdy145] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- P Bossi
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
| | - A Antonuzzo
- U.O. Oncologia Medica 1, Polo Oncologico Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - N I Cherny
- Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - O Rosengarten
- Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - S Pernot
- Department of Hepato-Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - F Trippa
- Radiation Oncology Centre, "S. Maria" Hospital, Terni, Italy
| | - U Schuler
- Department of Internal Medicine I, Palliative Care Centre, University Hospital Carl Gustav Carus, Dresden, Germany
| | - A Snegovoy
- N.N. Blokhin Russian Cancer Research Center, Moscow, Russia
| | - K Jordan
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - C I Ripamonti
- Oncology-Supportive Care in Cancer Unit, Department Onco-Haematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Falcone A, Pfanner E, Brunetti I, Allegrini G, Lencioni M, Galli C, Masi G, Danesi R, Antonuzzo A, Del Tacca M, Conte PF. Suramin in Combination with 5-Fluorouracil (5-FU) and Leucovorin (LV) in Metastatic Colorectal Cancer Patients Resistant to 5-FU+LV-Based Chemotherapy. Tumori 2018; 84:666-8. [PMID: 10080673 DOI: 10.1177/030089169808400610] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS AND BACKGROUND Suramin has been shown to be of interest as a potential new anticancer agent because of its capacity to inhibit the binding of several growth factors to their receptors and to inhibit the growth of cancer cells in vitro. Since multi-autocrine loops involving growth factors which are antagonized by suramin have been demonstrated in colorectal cancer, we previously evaluated the activity of suramin in patients with advanced colorectal cancer. Interestingly, in this study three patients who had received 5-FU+LV after suramin, although heavily pretreated with fluoropyrimidines, obtained an objective response. This observation was intriguing as it might have been that suramin had changed the biology of the tumor, making it sensitive to 5-FU+LV. We therefore conducted the present study to investigate the possibility that suramin might overcome the resistance to 5-FU+LV. METHODS AND STUDY DESIGN Only colorectal cancer patients with metastatic and progressive disease during 5-FU+LV-based chemotherapy were eligible for this study. Suramin was administered for eight weeks at doses determined by means of a computer-assisted dosing algorithm that used Bayesian pharmacokinetics to maintain suramin plasma concentrations of 200-250 microg/ml. 5-FU was administered weekly at a dosis of 450 mg/m2 halfway through a two-hour infusion of I-LV 250 mg/m2 starting one week after the initiation of suramin for a maximum of 26 weeks. RESULTS Treatment was relatively well tolerated, but no objective responses were observed after the accrual of 13 patients in the first stage of the trial. Consequently, the trial was interrupted according to the initial two-stage sampling design. CONCLUSIONS The present study does not support the hypothesis that suramin might overcome resistance to 5-FU+LV and its use in colorectal cancer is not recommended.
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Affiliation(s)
- A Falcone
- U.O. Oncologia Medica, Dipartimento di Oncologia, Ospedale S. Chiara, Pisa, Italy
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Carnio S, Galetta D, Scotti V, Cortinovis D, Antonuzzo A, Pisconti S, Rossi A, Martelli O, Cecere F, Lunghi A, Del Conte A, Montagna E, Topulli J, Pelizzoni D, Rapetti S, Gianetta M, Pacchiana M, Pegoraro V, Cataldo N, Bria E, Novello S. The close link between anxiety and cluster symptoms in lung cancer patients during first-line chemotherapy: further data from a dedicated WALCE (Women Against Lung Cancer in Europe) survey. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx426.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Marconcini R, Marra E, De Rosa F, Stucci L, Orgiano L, Ribero S, Bloise F, Antonuzzo A, Falcone A. Patterns of progression in metastatic melanoma patients treated with Braf and Mek inhibitors: an Italian Melanoma Intergroup (IMI) study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx377.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Marconcini R, Faviana P, Campani D, Galli L, Antonuzzo A, Orlandini C, Falcone A, Ricci S. Enhancer of zest homolog 2 (EZH2) expression in well and moderately differentiated pancreatic neuroendocrine tumor (pNET). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw369.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Marconcini R, Ricci S, Galli L, Antonuzzo A, Orlandini C, Vasile E, Falcone A. Progressing G1-G2 neuroendocrine tumors (WD NET) in treatment with capecitabine (Cp) plus somatostatin analog (SSA): a single center experience. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw369.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vasile E, Musettini G, Sbrana A, Farnesi A, Brunetti I, Galli L, Biasco E, Falcone A, Ricci S, Antonuzzo A. Antiemetic prophylaxis (AP) in our clinical practice: are we doing it right? Ann Oncol 2016. [DOI: 10.1093/annonc/mdw390.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bossi P, Botta L, Bironzo P, Sonetto C, Musettini G, Sbrana A, Di Giannantonio V, Locati L, Di Maio M, Antonuzzo A. Systematic review of adverse events reporting in clinical trials leading to approval of targeted therapy and immunotherapy. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw366.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Antonuzzo A, Vasile E, Sbrana A, Lucchesi M, Galli L, Brunetti IM, Musettini G, Farnesi A, Biasco E, Virgili N, Falcone A, Ricci S. Impact of a supportive care service for cancer outpatients: management and reduction of hospitalizations. Preliminary results of an integrated model of care. Support Care Cancer 2016; 25:209-212. [DOI: 10.1007/s00520-016-3403-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/29/2016] [Indexed: 10/21/2022]
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Antonuzzo A, Bossi P, Botta L, Bironzo P, Sonetto C, Musettini G, Sbrana A, Di Giannantonio V, Locati L, Di Maio M. Systematic review of adverse events reporting in clinical trials leading to approval of targeted therapy and immunotherapy. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw345.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Roila F, Spina F, Ripamonti C, Fumi G, Antonuzzo A, Cavanna L, Gori S, Mirabile A, Fabi A, Marzano N, Graiff C, De Sanctis V, Serpentini S, Bocci C, Pino M, Clienti G, Verusio C, Lutrino S, Fatigoni S, Ballatori E. Incidence, characteristics and treatment of fatigue in oncological cancer patients (pts) in italy: a cross-section study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw345.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Vasile E, Sbrana A, Musettini G, Farnesi A, Brunetti I, Biasco E, Galli L, Falcone A, Ricci S, Antonuzzo A. Antiemetic prophylaxis (AP) in our clinical practice: are we doing it right? Ann Oncol 2016. [DOI: 10.1093/annonc/mdw345.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Marconcini R, Faviana P, Campani D, Galli L, Antonuzzo A, Falcone A, Ricci S. Enhancer of zeste homolog 2 (EZH2) expression in G1 -G2 Pancreatic Neuroendocrine Tumor (pNET). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw333.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Carnio S, Galetta D, Scotti V, Cortinovis D, Antonuzzo A, Pisconti S, Rossi A, Martelli O, Cecere F, Bria E, Del Conte A, Pegoraro V, Montagna E, Topulli J, Pelizzoni D, Rapetti S, Gianetta M, Novello S. Chemotherapy-induced nausea and vomiting (CINV) in patients with stage III/IV lung cancer during the first-line treatment: assessment by physician, nurse and patient. Preliminary results from an Italian multicenter survey. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw332.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ricci S, Marconcini R, Galli L, Antonuzzo A, Vasile E, Falcone A. G1-G2 Neuroendocrine Tumors (WD NET) in treatment with Capecitabine (Cp) plus somatostatin analog (SSA). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw345.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Farnesi A, Mazzarri S, Boni G, Galli L, Cianci C, Borso' E, Marconcini R, Biasco E, Derosa L, Sbrana A, Antonuzzo A, Ricci S, Volterrani D, Falcone A. Feasibility and efficacy of 223Ra-dichloride (223Ra) to treat bone metastases in patients (pts) with castration resistant prostate cancer (mCRPC). Ann Oncol 2015. [DOI: 10.1093/annonc/mdv341.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Marconcini R, Ricci S, Galli L, Antonuzzo A, Farnesi A, Derosa L, Biasco E, Falcone A. Metastatic well or moderately differentiated Neuroendocrine tumors (WDNET) treated with sequences of different Somatostatin Analogs (SSA) - Lanreotide LAR (La), Octreotide LAR (Oc): a single center experience. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv348.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ricci S, Marconcini R, Galli L, Antonuzzo A, Farnesi A, Derosa L, Biasco E, Falcone A. Predictive factors of efficacy of Somatostatine Analogs (SSA) in Gastroenteropancreatic Neuroendocrine Tumors (GEP-NET). Ann Oncol 2015. [DOI: 10.1093/annonc/mdv348.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Marconcini R, Ricci S, Galli L, Antonuzzo A, Vasile E, Pancrazi F, Farnesi A, Derosa L, Biasco E, Falcone A. 2311 Evaluation of predictive factors of efficacy of Somatostatin Analogs (SSA) in Gastroenteropancreatic Neuroendocrine Tumors (GEP-NET): a single centre experience. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31227-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Marconcini R, Ricci S, Antonuzzo A, Galli L, Vasile E, Farnesi A, Derosa L, Biasco E, Falcone A. 2249 Comparison of Everolimus (EV) plus somatostatin analog (SSA) administered before or after chemotherapy (CT) or PRRT in advanced G1-G2 Neuroendocrine Tumor (NET) progressed after SSA: analysis of different sequences in single center experience. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31165-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Marconcini R, Petrini I, Galli L, Vasile E, Antonuzzo A, Farnesi A, Derosa L, Bracco E, Viglialoro R, Falcone A, Ricci S. Octreotide Lar Suitable Treatment for G1-G2 Thoracic Neuroendocrine Tumors (T-Net): Single Center Experience. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu345.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Marconcini R, Ricci S, Vasile E, Galli L, Antonuzzo A, Derosa L, Farnesi A, Biasco E, Bracco E, Vaglialoro R, Sbrana A, Falcone A. Efficacy of Somatostatin Analogs (Ssa) in Gastroenteropancreatic Neuroendocrine Tumors (Gep-Net) According to Ki67 Index: a Single Centre Experience. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu345.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Marconcini R, Di Paolo A, Polillo M, Galli L, Antonuzzo A, Farnesi A, Sbrana A, Biasco E, Derosa L, Ricci S, Falcone A. Therapeutic Drug Monitoring of Imatinib in Gist Patients. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu354.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Spada F, Fazio N, Marconcini R, Antonuzzo A, Ricci S, Fontana A, Luppi G, Antonuzzo L, Di Costanzo F, Nobili E, Radice D, Galdy S, Sonzogni M, Pisa E, Barberis M. Real-World Study on Oxaliplatin-Based Chemotherapy in Patients with Advanced Neuroendocrine Neoplasms : Clinical Outcomes and Preliminary Correlation with Biological Factors. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu345.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Vasile E, Masi G, Fornaro L, Cupini S, Loupakis F, Bursi S, Petrini I, Di Donato S, Brunetti IM, Ricci S, Antonuzzo A, Chiara S, Amoroso D, Andreuccetti M, Falcone A. A multicenter phase II study of the combination of oxaliplatin, irinotecan and capecitabine in the first-line treatment of metastatic colorectal cancer. Br J Cancer 2009; 100:1720-4. [PMID: 19436300 PMCID: PMC2695688 DOI: 10.1038/sj.bjc.6605075] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The triple drug combination consisting of irinotecan, oxaliplatin and 5-fluorouracil (FOLFOXIRI) has demonstrated higher activity and efficacy compared to the doublet FOLFIRI. 5-Fluorouracil could be substituted in FOLFOXIRI regimen by capecitabine, an oral fluoropyrimidine with similar efficacy. Recently, a dose-finding trial has demonstrated the feasibility of the combination of irinotecan, oxaliplatin and capecitabine (XELOXIRI) and established their recommended doses. The aim of this study was to evaluate the activity of XELOXIRI. A total of 36 patients with unresectable metastatic colorectal cancer received irinotecan 165 mg m−2 and oxaliplatin 85 mg m−2 on day 1 plus capecitabine 2000 mg m−2 per day orally in two doses from day 1 to day 7, every 2 weeks. Grade 3–4 toxicities were infrequent, expect for neutropenia and diarrhoea, which were each observed in 30% of patients. Two complete and twenty-two partial responses were obtained, corresponding to an overall response rate of 67% (95% CI 51.4–82%). After a median follow-up of 17.7 months, the median progression-free and overall survival were 10.1 and 17.9 months, respectively. The substitution of 5-fluorouracil with capecitabine, in combination with irinotecan and oxaliplatin, is feasible and does not impair the activity of the regimen. However, the XELOXIRI combination is associated with a high incidence of diarrhoea and, therefore, should be considered as a not preferable alternative to FOLFOXIRI.
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Affiliation(s)
- E Vasile
- UO Oncologia Medica, Azienda USL 6, Istituto Toscano Tumori, Viale Alfieri 36, Livorno 57100, Italy.
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Fornaro L, Masi G, Bursi S, Loupakis F, Vasile E, Antonuzzo A, Chiara S, Pfanner E, Di Paolo A, Bocci G, Del Tacca M, Falcone A. A dose finding and pharmacokinetic study of capecitabine in combination with oxaliplatin and irinotecan in metastatic colorectal cancer. Cancer Chemother Pharmacol 2008; 63:965-9. [DOI: 10.1007/s00280-008-0840-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Accepted: 09/12/2008] [Indexed: 12/27/2022]
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Vasile E, Tibaldi C, Antonuzzo A, Di Marsico R, Tartarelli G, Fabbri A, Lo Dico M, Mazzoni E, Andreuccetti M, Falcone A. First-line chemotherapy with planned sequential administration of gemcitabine (G) followed by docetaxel (D) in elderly advanced non-small-cell lung cancer (NSCLC) patients: A multicenter phase II study. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.19092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Fontana A, Bocci G, D’Arcangelo M, Galli L, Galli C, Bursi S, Landi L, Antonuzzo A, Del Tacca M, Falcone A. Docetaxel (D) plus prednisone (P) in combination with metronomic cyclophosphamide (CTX) and celecoxib (C) as first line chemotherapy in metastatic hormone refractory prostate cancer (HRPC): Phase II clinical trial with pharmacodynamic evaluation. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.16084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Tibaldi C, Vasile E, Antonuzzo A, Di Marsico R, Fabbri A, Innocenti F, Tartarelli G, Amoroso D, Andreuccetti M, Lo Dico M, Falcone A. First line chemotherapy with planned sequential administration of gemcitabine followed by docetaxel in elderly advanced non-small-cell lung cancer patients: a multicenter phase II study. Br J Cancer 2008; 98:558-63. [PMID: 18212755 PMCID: PMC2243160 DOI: 10.1038/sj.bjc.6604187] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This multicenter phase II study evaluated, in chemonaive patients with stage IIIB–IV NSCLC, age ⩾70 and with a performance status 0–2, the activity, efficacy and tolerability of planned sequential administration of gemcitabine 1200 mg m−2 on days 1 and 8 every 3 weeks for three courses followed by three cycles of docetaxel 37.5 mg m−2 on days 1 and 8 every 3 weeks, provided there was no evidence of disease progression. A total of 56 patients entered the study. According to intention-to-treat analysis, the objective response rate was 16.0% (95% CI 7.6–28.3%); 23 patients (41.0%) had stable disease and 24 patients (43%) had progressive disease. Five patients who had a stable disease after three courses of gemcitabine obtained a conversion to partial response by docetaxel. Median time to progression was 4.8 months (95% CI 3.6–6.0 months) and median duration of survival was 8.0 months (95% CI 5.6–10.5 months). The 1-year survival rate was 34%. No grade 4 haematological toxicity was observed and grade 3 neutropenia and thrombocytopenia were reported in 5.4 and 3.6% of the patients, respectively. Grade 3/4 mucositis and grade 3 diarrhoea, both occurred in 3.6% of the patients and grade 3 asthenia was observed in 9% of patients. One patient reported a grade 4 skin toxicity. No treatment-related deaths occurred. Sequential gemcitabine and docetaxel is a well-tolerated and effective regimen in elderly advanced NSCLC patients.
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Affiliation(s)
- C Tibaldi
- Division of Oncology, Department of Oncology, UO Oncologia Medica, Presidio Ospedaliero, Azienda USL-6 of Livorno Viale Alfieri 36, Livorno 57100, Italy.
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Galli L, Fontana A, Galli C, Landi L, Fontana E, Antonuzzo A, Andreuccetti M, Aitini E, Barbieri R, Di Marsico R, Falcone A. Phase II study of sequential chemotherapy with docetaxel-estramustine followed by mitoxantrone-prednisone in patients with advanced hormone-refractory prostate cancer. Br J Cancer 2007; 97:1613-7. [PMID: 18026196 PMCID: PMC2360275 DOI: 10.1038/sj.bjc.6604090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Sequential chemotherapy may improve treatment efficacy avoiding the additive toxicity associated with concomitant polichemotherapy in hormone-refractory prostate cancer (HRPC). Forty patients received docetaxel 30 mg m−2 intravenous (i.v.), weekly, plus estramustine 280 mg twice daily for 12 weeks. After 2 weeks rest, patients with a decline or stable PSA were treated with mitoxantrone 12 mg m−2 i.v. every 3 weeks plus prednisone 5 mg twice daily for 12 cycles. Forty patients were assessable for toxicity after docetaxel/estramustine. Main toxicities were grade 3–4 AST/ALT or bilirubin increase in seven patients (17.5%) and deep venous thrombosis (DVT) in four patients (10%). Twenty-seven patients received mitoxantrone/prednisone. Main toxicities included DVT in one patient (3.7%) and congestive heart failure in two patients (7%). Thirty-nine patients were assessable for PSA response. Twenty-nine patients (72.5%; 95% CI 63–82%) obtained a ⩾50% PSA decline with 15 patients (37.5%; 95% CI 20–50%) that demonstrated a ⩾90% decrease. Median progression-free and overall survival were respectively 7.0 (95% CI 5.8–8.2 months) and 19.2 months (95% CI 13.9–24.3 months). In conclusion, although this regimen demonstrated a favourable toxicity profile, sequential administration of mitoxantrone is not able to improve docetaxel activity in patients with HRPC.
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Affiliation(s)
- L Galli
- Division of Medical Oncology, Azienda USL 6 of Livorno, Livorno 57100, Italy
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Tibaldi C, Vasile E, Lo Dico M, Antonuzzo A, Di Marsico R, Tartarelli G, Fabbri A, Mazzoni E, Andreuccetti M, Falcone A. 1307 POSTER First-line chemotherapy with sequential administration of gemcitabine followed by docetaxel in elderly advanced non-small-cell lung cancer (NSCLC) patients: a multicenter phase II study. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70733-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Bursi S, Masi G, Loupakis F, Antonuzzo A, Chiara S, Pfanner E, Petrini I, Barletta M, Baldi G, Falcone A. 3063 POSTER Capecitabine (C), in combination with irinotecan (I) and oxaliplatin (O) (XELOXIRI) as first-line treatment of metastatic colorectal cancer (MCRC): results of a pilot study by the Gruppo Oncologico Nord-Ovest (G.O.N.O.). EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70991-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Loupakis F, Masi G, Bursi S, Picone V, Mentuccia L, Granetto C, Fea E, Murr R, Antonuzzo A, Falcone A. Phase II study of sequential chemotherapy with cisplatin (P) in combination with infusional 5FU/LV (PFL) followed by irinotecan (Ir) + 5FU/LV (IrFL) followed by docetaxel (T) + 5FU/LV (TFL) in patients (pts) with metastatic gastric carcinoma (MGC) by the Gruppo Oncologio Nord-Ovest (GONO). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.15059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
15059 Background: 5FU in combination with P can be considered a standard treatment for MGC. Ir and T are active agents with not complete cross-resistance with P and 5FU. The combination of Ir or T with P and 5FU is feasible but with substantial toxicities. A different way to include Ir and T in the first-line treatment of MGC is to use them sequentially to a P and 5FU containing regimen. Methods: we conducted a phase II study of first-line sequential chemotherapy in MGC pts with measurable disease (RECIST criteria). Treatment consisted of: 3 cycles of PFL (biweekly P 50 mg/sqm d1, LV 200 mg/sqm d1 and 5FU 3200 mg/sqm 48-h c.i. starting on d1) followed by 3 cycles of IrFL (biweekly Ir 180 mg/sqm d1 and 5FU/LV) followed by 3 cycles of TFL (biweekly T 50 mg/sqm d1 and 5FU/LV). Evaluation of disease was performed every 3 cycles. Results: 46 pts have been enrolled. Pts characteristics are: median age = 60 years (37–75), M/F = 36/10, sites of disease (single/multiple) 9/37, ECOG PS 0/1 = 27/19. Treatment was well tolerated. Grade 3–4 non-haematological toxicities were: diarrhea in 2,5% pts with PFL; diarrhea and asthenia in 2,5% and stomatitis in 5% pts with IrFL; stomatitis in 5,7% pts with TFL. Grade 3/4 neutropenia was observed in 14% pts with PFL, 15% with IrFL and 22,9% pts with TFL. Nor febrile neutropenia neither toxic deaths have occurred. Two pts had not evaluable disease and 6 are still receiving treatment. We observed 1 CR and 8 PR with PFL (RR 24%) among the 38 evaluable pts. IrFL improved responses in 10 pts while 4 pts progressed and TFL further improved responses in 6 pts while 5 pts progressed. Response rate at the end of the planned 9 cycles was 40% (4 CR, 11 PR; 95% CI 25–58%). At a median follow-up of 15.5 mos median TTP is 6.8 mos and median OS is 13.5 mos. Conclusions: this sequential treatment is feasible with a very favourable safety profile and produces encouraging results in terms of activity and efficacy in a population of unselected MGC patients. Final data will be presented at the meeting. Partially supported by A.R.C.O. Foundation. No significant financial relationships to disclose.
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Affiliation(s)
- F. Loupakis
- Azienda USL 6, Livorno, Italy; Università La Sapienza, Roma, Italy; Ospedale S. Croce e Carle, Cuneo, Italy; Ospedale S. Chiara, Pisa, Italy; Azienda USL 6, Piombino, Italy; Università degli Studi, Pisa, Italy
| | - G. Masi
- Azienda USL 6, Livorno, Italy; Università La Sapienza, Roma, Italy; Ospedale S. Croce e Carle, Cuneo, Italy; Ospedale S. Chiara, Pisa, Italy; Azienda USL 6, Piombino, Italy; Università degli Studi, Pisa, Italy
| | - S. Bursi
- Azienda USL 6, Livorno, Italy; Università La Sapienza, Roma, Italy; Ospedale S. Croce e Carle, Cuneo, Italy; Ospedale S. Chiara, Pisa, Italy; Azienda USL 6, Piombino, Italy; Università degli Studi, Pisa, Italy
| | - V. Picone
- Azienda USL 6, Livorno, Italy; Università La Sapienza, Roma, Italy; Ospedale S. Croce e Carle, Cuneo, Italy; Ospedale S. Chiara, Pisa, Italy; Azienda USL 6, Piombino, Italy; Università degli Studi, Pisa, Italy
| | - L. Mentuccia
- Azienda USL 6, Livorno, Italy; Università La Sapienza, Roma, Italy; Ospedale S. Croce e Carle, Cuneo, Italy; Ospedale S. Chiara, Pisa, Italy; Azienda USL 6, Piombino, Italy; Università degli Studi, Pisa, Italy
| | - C. Granetto
- Azienda USL 6, Livorno, Italy; Università La Sapienza, Roma, Italy; Ospedale S. Croce e Carle, Cuneo, Italy; Ospedale S. Chiara, Pisa, Italy; Azienda USL 6, Piombino, Italy; Università degli Studi, Pisa, Italy
| | - E. Fea
- Azienda USL 6, Livorno, Italy; Università La Sapienza, Roma, Italy; Ospedale S. Croce e Carle, Cuneo, Italy; Ospedale S. Chiara, Pisa, Italy; Azienda USL 6, Piombino, Italy; Università degli Studi, Pisa, Italy
| | - R. Murr
- Azienda USL 6, Livorno, Italy; Università La Sapienza, Roma, Italy; Ospedale S. Croce e Carle, Cuneo, Italy; Ospedale S. Chiara, Pisa, Italy; Azienda USL 6, Piombino, Italy; Università degli Studi, Pisa, Italy
| | - A. Antonuzzo
- Azienda USL 6, Livorno, Italy; Università La Sapienza, Roma, Italy; Ospedale S. Croce e Carle, Cuneo, Italy; Ospedale S. Chiara, Pisa, Italy; Azienda USL 6, Piombino, Italy; Università degli Studi, Pisa, Italy
| | - A. Falcone
- Azienda USL 6, Livorno, Italy; Università La Sapienza, Roma, Italy; Ospedale S. Croce e Carle, Cuneo, Italy; Ospedale S. Chiara, Pisa, Italy; Azienda USL 6, Piombino, Italy; Università degli Studi, Pisa, Italy
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Masi G, Bursi S, Loupakis F, Barletta M, Baldi G, Antonuzzo A, Sonaglio C, Pfanner E, Petrini I, Falcone A. The combination of capecitabine (C), irinotecan (I) and oxaliplatin (O) (XELOXIRI) as first line treatment of metastatic colorectal cancer (MCRC): Preliminary results of a pilot study by the Gruppo Oncologico Nord-Ovest (G.O.N.O.). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4096 Background: FOLFOXIRI demonstrated manageable toxicities and improved activity and efficacy compared to FOLFIRI in MCRC in a phase III trial by the G.O.N.O. group. Oral C has demonstrated similar efficacy to 5-FU and might substitute 5-FU in the FOLFOXIRI regimen. Methods: The G.O.N.O. started a pilot study to evaluate the combination of escalating doses of C with fixed doses of I, O (XELOXIRI) in metastatic and not resectable CRC patients (pts). The objectives of the study are the definition of the recommended dose (RD) of C in combination with I and O, safety and activity of the combination and analysis of plasma pharmacokinetics. The planned treatment in the first 3 patients was: I 165 mg/sqm over 1-h on day 1, O 85 mg/sqm over 2-h on day 1 and C 2,500 mg/sqm/die from day 1 to 7, repeated every 2 weeks. C dose was increased to 3,000 mg/sqm/die or decreased to 2,000 mg/sqm/die in subsequent groups of 3 to 6 pts on the basis of the observed dose limiting toxicities (DLT). Results: Up today 33 patients have been enrolled. Main patients characteristic are: sex (M/F) = 22/11, PS (0/1/2) = 28/4/1, age (median/range) = 65/42–76, sites of disease (single/multiple) = 18/15. The DLT was G3–4 diarrhea that was observed in 2 out 6 patients receiving C at 2500 mg/sqm, in 2 out 3 patients receiving C at 3,000 mg/sqm and in 1 out 6 patients receiving C at 2,000 mg/sqm. This last dose was defined the RD. Among the 23 patients treated at the RD main G3–4 toxicities were: diarrhea 17%, neutropenia 26%, thrombocytopenia 9%, neurotoxicity 4%. One toxic death for diarrhea and sepsis occurred. Up today 21 out of the 23 patients (2 patients too early) treated at the RD are assessable for response (ITT analysis) and 15 RP, 3 SD and 3 treatment failures have been observed with a response rate of 71% (95% CI: 48–89%). At a median follow-up of 10.3 months median PFS is 9.0+ months and median OS isn’t yet reached. Conclusions: XELOXIRI is a feasible regimen with diarrhea being the DLT. The recommended dose of C is 2,000 mg/sqm. At the RD toxicity is manageable and preliminary results in terms of activity are promising. Partially supported by Fondazione ARCO. No significant financial relationships to disclose.
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Affiliation(s)
- G. Masi
- Az. Usl 6, Livorno, Italy; Az. Usl 6, Piombino, Italy; IST, Genova, Italy; Ospedale S.Chiara, Pisa, Italy; Università degli Studi, Pisa, Italy
| | - S. Bursi
- Az. Usl 6, Livorno, Italy; Az. Usl 6, Piombino, Italy; IST, Genova, Italy; Ospedale S.Chiara, Pisa, Italy; Università degli Studi, Pisa, Italy
| | - F. Loupakis
- Az. Usl 6, Livorno, Italy; Az. Usl 6, Piombino, Italy; IST, Genova, Italy; Ospedale S.Chiara, Pisa, Italy; Università degli Studi, Pisa, Italy
| | - M. Barletta
- Az. Usl 6, Livorno, Italy; Az. Usl 6, Piombino, Italy; IST, Genova, Italy; Ospedale S.Chiara, Pisa, Italy; Università degli Studi, Pisa, Italy
| | - G. Baldi
- Az. Usl 6, Livorno, Italy; Az. Usl 6, Piombino, Italy; IST, Genova, Italy; Ospedale S.Chiara, Pisa, Italy; Università degli Studi, Pisa, Italy
| | - A. Antonuzzo
- Az. Usl 6, Livorno, Italy; Az. Usl 6, Piombino, Italy; IST, Genova, Italy; Ospedale S.Chiara, Pisa, Italy; Università degli Studi, Pisa, Italy
| | - C. Sonaglio
- Az. Usl 6, Livorno, Italy; Az. Usl 6, Piombino, Italy; IST, Genova, Italy; Ospedale S.Chiara, Pisa, Italy; Università degli Studi, Pisa, Italy
| | - E. Pfanner
- Az. Usl 6, Livorno, Italy; Az. Usl 6, Piombino, Italy; IST, Genova, Italy; Ospedale S.Chiara, Pisa, Italy; Università degli Studi, Pisa, Italy
| | - I. Petrini
- Az. Usl 6, Livorno, Italy; Az. Usl 6, Piombino, Italy; IST, Genova, Italy; Ospedale S.Chiara, Pisa, Italy; Università degli Studi, Pisa, Italy
| | - A. Falcone
- Az. Usl 6, Livorno, Italy; Az. Usl 6, Piombino, Italy; IST, Genova, Italy; Ospedale S.Chiara, Pisa, Italy; Università degli Studi, Pisa, Italy
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Abstract
Patients treated with platinum compounds are subject to hypersensitivity reactions. Our study has highlighted the reactions related to oxaliplatin (OHP) infusion. One hundred and twenty-four patients affected by advanced colorectal cancer were treated with different schedules containing OHP, at the Institute of Haematology and Medical Oncology 'L. and A. Seragnoli' of Bologna and at the Medical Oncology Division of Livorno Hospital. Seventeen patients (13%) showed hypersensitivity reactions after a few minutes from the start of the OHP infusion. Usually, these reactions were seen after 2-17 exposures to OHP (Mean+/-s.e.: 9.4+/-1.07). No patient experienced allergic reactions at his/her first OHP infusion. Eight patients developed a mild reaction consisting of flushing and swelling of the face and hands, itching, sweating and lachrymation. The remaining nine patients showed a moderate-severe reaction with dyspnoea, wheezing, laryngospasm, psycho-motor agitation, tachycardia, precordial pain, diffuse erythema, itching and sweating. Six patients out of 17 were re-exposed to the drug with premedication of steroids and all except one developed the hypersensitivity reaction again. The cumulative dose, the time of exposure to OHP and the clinical features are variable and unpredictable. The risk of developing hypersensitivity reactions in patients treated with a short infusion of OHP cannot be underestimated.
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Affiliation(s)
- G Brandi
- Institute of Haematology and Medical Oncology 'L.& A. Seragnoli', University of Bologna, Policlinico Sant'Orsola, Via Massarenti 9, 40138 Bologna, Italy.
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Novello S, Galli L, Antonuzzo A, Crinó L, Pozzi E, Selvaggi G, Ricci S, Marrocolo F, Darwish S, Sorbolini S, Tonato M, Scagliotti GV. Phase II study of high-dose paclitaxel and carboplatin in previously untreated, unresectable non-small cell lung cancer. Lung Cancer 2001; 34:261-9. [PMID: 11679185 DOI: 10.1016/s0169-5002(01)00238-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION This phase II study was designed to assess the activity and tolerability of the carboplatin-paclitaxel combination, given without routine growth factor support to previously untreated patients with stage IIIB and IV non-small cell lung cancer. PATIENTS AND METHODS Sixty patients (15 stage IIIb and 45 stage IV) received paclitaxel 225 mg/ml on day 1, followed by carboplatin AUC 6 mg/ml per minute (Calvert formula) every 3 weeks. Paclitaxel was administered as a 3-h intravenous infusion followed by carboplatin over 30 min, on completion of paclitaxel administration. RESULTS The combination showed a good safety profile with Grade 4 neutropenia occurring in 31% of patients without any serious infectious episodes requiring hospitalization. Moderate to severe anemia and thrombocytopenia seldom occurred. Sensorimotor peripheral neuropathy (Grade 2-3) and myalgia (Grade 3-4) were documented in 34 and 20% of the patients, respectively. Among 59 evaluable patients, there was one complete response and 26 partial responses for an overall response rate of 46% (95% C.I.: 34-59%). With a minimum follow-up duration of 16.5 months, the median overall survival time is 52 weeks and the 1-year survival rate is 50%. Median duration of response is 20 weeks (range: 4-52) and progression-free survival is 22 weeks (range: 5-77). CONCLUSION In advanced NSCLC, the combination carboplatin-paclitaxel at doses of AUC 6 mg/ml per minute and 225 mg/ml every 3 weeks, is both active and relatively well-tolerated.
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Affiliation(s)
- S Novello
- Department of Clinical and Biological Sciences, University of Torino, Azienda Ospedaliera S. Luigi, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
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Ricci S, Antonuzzo A, Galli L, Tibaldi C, Bertuccelli M, Lopes Pegna A, Petruzzelli S, Bonifazi V, Orlandini C, Franco Conte P. A randomized study comparing two different schedules of administration of cisplatin in combination with gemcitabine in advanced nonsmall cell lung carcinoma. Cancer 2000; 89:1714-9. [PMID: 11042565 DOI: 10.1002/1097-0142(20001015)89:8<1714::aid-cncr10>3.0.co;2-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This randomized trial was designed to investigate the feasibility, toxicity, and activity of two different schedules of gemcitabine plus cisplatin in previously untreated patients with advanced (International Union Against Cancer (UICC) Stage IIIB-IV) nonsmall cell lung carcinoma (NSCLC). METHODS From February 1997 to September 1998, 82 patients with advanced NSCLC were entered onto the study and were randomized to gemcitabine 1000 mg/m(2) on Days 1, 8, and 15 plus cisplatin 80 mg/m(2) on Day 2 (arm A) or Day 15 (arm B) every 28 days. RESULTS All the patients were assessable for toxicity (arm A/arm B: 151/177 cycles; median, 4 of 5 cycles per patient), and the following Grade 3-4 toxicities were reported (percentage of cycles in arm A vs. arm B): anemia, 7.9% and 2.3% (P < 0.05); leukopenia, 6.0% and 6.7%; thrombocytopenia, 15.0% and 1.6% (P < 0.01); no World Health Organization (WHO) Grade 3-4 nonhematologic toxicities were observed. These side effects led to gemcitabine dose reductions in 35.1% of courses in arm A and 22.0% of courses in arm B (P < 0.05) and to gemcitabine omissions in 28.5% of courses in arm A versus 7.3% of courses in arm B (P < 0.01). Dose intensities (DIs) of gemcitabine were 607.5 mg/m(2)/week in arm A and 711.6 mg/m(2)/week in arm B (P < 0.01); DIs of cisplatin were 18. 1 mg/m(2)/week in arm A and 18.8 mg/m(2)/week in arm B. The total delivered doses of gemcitabine were 9315.5 mg/m(2) in arm A and 12, 631.0 mg/m(2) in arm B (P < 0.01); the total delivered doses of cisplatin were 277.1 mg/m(2) in arm A and 333.0 mg/m(2) in arm B (P < 0.01). Response rates according to intention to treat were 40.4% (95% confidence interval [CI], 25.5-55.3) in arm A and 45% (95% CI, 29.5-60.5) in arm B. The overall median duration of response was 7.4 months; the median time to disease progression was 6 months (95% CI, 3-9) in arm A and 9 months (95% CI, 4-14) in arm B (P < 0.02); the median overall survival was 10 months (95% CI, 7.0-12.5) in arm A and 17 months (95% CI, 13.0-21.6) in arm B (P < 0.01); the 1-year survival rates were 34% and 63%, respectively. CONCLUSIONS Our data show that arm B (cisplatin on Day 15) is less toxic than arm A (cisplatin on Day 2) and allows the administration of significantly higher total doses and dose intensities of chemotherapy. No significant differences in response rates were observed between the two schedules; patients on arm B experienced a significantly more prolonged progression free and overall survival; however, the study was not powered to detect differences in these outcomes.
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Affiliation(s)
- S Ricci
- U.O. Oncologia Medica, Ospedale S. Chiara Hospital, Pisa, Italy
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Ricci S, Antonuzzo A, Galli L, Ferdeghini M, Bodei L, Orlandini C, Conte PF. Octreotide acetate long-acting release in patients with metastatic neuroendocrine tumors pretreated with lanreotide. Ann Oncol 2000; 11:1127-30. [PMID: 11061606 DOI: 10.1023/a:1008383132024] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In the present study we investigated the efficacy and tolerability of i.m. octreotide acetate (octreotide LAR) in patients with metastatic neuroendocrine tumors (NETs) previously treated and failed on i.m. lanreotide. PATIENTS AND METHODS Fifteen patients (8 females, 7 males, median age 67 years, range 28-81 years) with metastatic NETs (8 endocrine pancreatic tumors, 7 midgut carcinoids) were enrolled in the study. All patients were in progressive disease (objective: 11 patients, symptomatic: 10 patients, biochemical: 11 patients) after treatment with slow release lanreotide, 30 mg every 14 days for a median time of 8 months (range 3-19 months). All patients had measurable disease; 12 patients had elevated serum and/or urine markers and 11 were symptomatic. Octreotide scintigraphy was positive in 13 of 15 patients. Octreotide LAR was administered as i.m. injection at the dose of 20 mg every four weeks until disease progression. RESULTS An objective partial response (PR) was documented in one patient (7%), no change (NC) in six (40%), and progressive disease (PD) in eight patients (53%). The PR was observed in one patient with non-functioning endocrine pancreatic tumor with progressive liver and lymph node metastases after 16 months of i.m. lanreotide therapy. The median duration of disease stabilization was 7.5 months (range 6-12+ months). The overall biochemical response rate was 41%, including CRs (33%) and PRs (8%); biochemical responses were observed in carcinoids as well as in endocrine pancreatic tumors; the median duration of response was 5 months for CRs and 7.5 months for PRs. The overall symptomatic response rate was 82%. The median duration of response for diarrhoea, abdominal pain, or both was 6.5 months (range 3-12+ months). Improvement in performance status (PS) was obtained in 5 of 11 patients with PS of 1 at study entry. Median duration of octreotide LAR treatment was seven months (range 3-12+ months). No serious adverse events were reported; mild side effects were reported in 26% of patients. CONCLUSIONS Octreotide LAR 20 mg shows significant efficacy in terms of objective response rate (PR + SD), biochemical and symptomatic control in patients with metastatic NETs of the GEP system pretreated and progressing on slow release lanreotide.
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Affiliation(s)
- S Ricci
- Department of Ontology, S. Chiara Hospital and University, Pisa, Italy
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Ricci S, Antonuzzo A, Galli L, Orlandini C, Ferdeghini M, Boni G, Roncella M, Mosca F, Conte PF. Long-acting depot lanreotide in the treatment of patients with advanced neuroendocrine tumors. Am J Clin Oncol 2000; 23:412-5. [PMID: 10955874 DOI: 10.1097/00000421-200008000-00020] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Long-acting depot forms of somatostatin analogs administered by intramuscular injections are now available for the treatment of neuroendocrine tumors (NETs). In the present study, we investigated the efficacy and tolerability of a slow-release form of lanreotide in patients with advanced NETs. From July 1996 to January 1999, 25 patients with advanced NETs (12 carcinoids, 13 endocrine pancreatic tumors) were enrolled in the study. Thirteen patients were pretreated with subcutaneous octreotide, chemotherapy, or hepatic metastasis alcoholization. All the patients had measurable disease. Seventeen patients were symptomatic and 20 patients had elevated serum and/or urine markers. Octreotide scintigraphy was positive in 23 of 25 patients. Lanreotide was administered as intramuscular injections at the dose of 30 mg every 2 weeks until there was objective, biochemical, or symptomatic tumor progression. Objective partial responses (PRs) were documented in 2 patients (8%), whereas 10 patients (40%) had tumor stabilization. The PRs were observed in patients with midgut carcinoids, of whom one was pretreated with subcutaneous octreotide. The response duration was 21+ and 24+ months in responding patients; the median duration of disease stabilization was 8.5 months (range, 4-21+). The overall biochemical response rate was 42%, including 2 complete responses (CRs) (10.5%) and 6 PRs (31.5%); all biochemical responses were observed mostly in patients with carcinoid tumors; the duration of response was 18+ and 30+ months for CRs; the median duration of biochemical response was 7 months (range, 4-18+) for PRs. The overall symptomatic response rate was 70% with a median duration of 7.5, 18, and 18+ months for diarrhea, abdominal pain, and flushing, respectively. Median duration of lanreotide treatment was 10 months (range, 2-30+). No significant side effects were reported. Depot lanreotide 30 mg shows significant efficacy in terms of objective response rate and in biochemical and symptomatic control, in pretreated patients as well as nonpretreated patients with advanced NETs. Tolerability is good, with good patient compliance.
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Affiliation(s)
- S Ricci
- Department of Oncology, S. Chiara Hospital and University, Pisa, Italy
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Restivo DA, Giuffrida S, Rapisarda G, Antonuzzo A, Saponara R, Reggio A, Trovato Salinaro A, Raffaele R, Domina E, Trovato A, Condorelli DF, Pennisi G. Central motor conduction to lower limb after transcranial magnetic stimulation in spinocerebellar ataxia type 2 (SCA2). Clin Neurophysiol 2000; 111:630-5. [PMID: 10727914 DOI: 10.1016/s1388-2457(99)00305-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate central motor conduction to lower limbs in spinocerebellar ataxia type 2 (SCA2). METHODS Transcranial magnetic stimulation was performed to study the corticospinal tracts of 18 patients with SCA2. RESULTS Central motor conduction time (CMCT) to lower limbs and thresholds were abnormal in 8 patients (44%); CMCT and thresholds were significantly correlated with disease duration and disability. CONCLUSIONS Corticospinal tract involvement is more frequent than previously reported in SCA2. Prolonged CMCT and increased threshold should not be used to differentiate between various type of autosomal dominant cerebellar ataxia. Similar to that reported in Friedreich's ataxia, we suggest that examining central motor conduction to the lower limbs may assist in evaluating the progressive steps of neurodegeneration in SCA2.
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Affiliation(s)
- D A Restivo
- Istituto di Scienze Neurologiche, Università di Catania, Viale A. Doria 6, 95125, Catania, Italy
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Ricci S, Antonuzzo A, Galli L, Tibaldi C, Bertuccelli M, Lopes Pegna A, Petruzzelli S, Algeri R, Bonifazi V, Fioretto ML, Orlandini C, Conte PF. Gemcitabine monotherapy in elderly patients with advanced non-small cell lung cancer: a multicenter phase II study. Lung Cancer 2000; 27:75-80. [PMID: 10688490 DOI: 10.1016/s0169-5002(99)00098-7] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND This trial investigated the activity and toxicity of gemcitabine in previously untreated elderly (> 70 years) patients with advanced (stage IIIB-IV) non-small cell lung cancer (NSCLC). PATIENTS AND METHODS From January 1997 to July 1998, 46 patients with advanced NSCLC aged over 70 years with a performance status of 0-2 were entered into the study. Gemcitabine 1000 mg/m2 was administered as a 30-min infusion once a week for 3 weeks followed by a week of rest; cycles were repeated every 4 weeks. RESULTS Forty-four patients were evaluable for response. One complete response and nine partial responses were observed, for an overall response rate of 22.2% (95% C.I.: 11.3-37.5). The median time to disease progression was 5.1 months (95% C.I.: 3.5-6.7), the median duration of response was 6.3 months, and the median overall survival time 6.75 months (95% C.I.: 5.3-8.2). All patients were evaluable for toxicity (184 cycles, median = 3 cycles/patient) and no grade 4 hematologic toxicities were reported. WHO grade 3 leukopenia, neutropenia and anemia occurred in 3.3, 0.5 and 1.1% of cycles, respectively. Grade 3 skin rash occurred in 4.3% of patients. These side effects led to treatment discontinuation in two patients. CONCLUSION Our data show that gemcitabine is active and well tolerated in patients aged over 70 years with advanced NSCLC.
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Affiliation(s)
- S Ricci
- Department of Oncology, S. Chiara Hospital and University, Pisa, Italy
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Ardizzoni A, Antonelli G, Ricci S, Frasci G, Rinaldi M, Boni L, Galletti P, Pennucci MC, Antonuzzo A, Gravina A, Galli L, Comella G, Conte PF, Salvati F, Rosso R. Ambamustine in the second-line treatment of patients with small-cell lung cancer: a phase II Fonicap study. Am J Clin Oncol 2000; 23:22-5. [PMID: 10683068 DOI: 10.1097/00000421-200002000-00005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite a high probability of response to first-line chemotherapy, most patients with small-cell lung cancer (SCLC) will eventually have progression of their disease because of the development of resistant disease. Second-line testing of new drugs is an accepted research strategy in SCLC. In this context, the Italian Lung Cancer Task Force (FONICAP) has tested a new synthetic bifunctional alkylating agent, Ambamustine, with preliminary evidence of activity in other solid tumors. Patients with measurable SCLC, progressive after one first-line chemotherapy regimen (either "sensitive" or "refractory"), were eligible for the study. Ambamustine was administered at the dose of 2 mg/kg as a 1-hour intravenous infusion on day 1 every 21 days. The dose was to be increased to 3 mg/kg if no grade IV toxicity and complete hematologic recovery had occurred by day 22. Sample size was calculated according to a two-stage optimal Simon's design. Seventeen patients were entered into the study. Twelve patients were refractory to prior chemotherapy; 12 had extensive disease; the median age was 64 years (range: 46-75 years) and the median performance status was 1. Among 13 patients who received more than one cycle, 9 patients could increase Ambamustine dose from 2 to 3 mg/kg. No objective response was observed: one patient obtained a 50% regression of the primary tumor with contemporary disease progression in the liver and was qualified as having progressive disease. The treatment was well tolerated: grade IV leukopenia occurred in only 1 patient; grade III anemia occurred in 17.6%, grade III leukopenia in 11.8%, and grade III thrombocytopenia in 23.5%. Nonhematologic toxicity was minimal. Ambamustine, at the dose and schedule used in this study, is well tolerated in pretreated patients with SCLC but has no significant antitumor activity in this unfavorable group of patients.
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Affiliation(s)
- A Ardizzoni
- Department of Medical Oncology, Istituto Nazionale Ricerca Cancro Genoa, Italy
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Falcone A, Allegrini G, Antonuzzo A, Brunetti I, Pfanner E, Lencioni M, Masi G, Danesi R, Del Tacca M, Conte P. Infusions of fluorouracil and leucovorin: effects of the timing and semi-intermittency of drug delivery. Oncology 1999; 57:195-201. [PMID: 10545787 DOI: 10.1159/000012031] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Preclinical and clinical studies have demonstrated that the circadian modulation of 5-FU delivery may reduce toxicities and improve antitumor activity. However, the relative importance of the timing of 5-FU delivery has not been clinically addressed. The aims of this study were to determine the toxicities, the maximum tolerable doses and the activity of a regimen with 5-fluorouracil (5-FU) and leucovorin (LV) administered as a 14-day continuous infusion according to a flat or three different chronomodulated rhythms in patients with metastatic gastrointestinal carcinomas. A total of 113 patients entered the study and their characteristics were comparable among the four groups. Toxicities included mainly stomatitis and diarrhea, and a reduced toxicity was observed in all the three chronogroups that allowed the delivery of higher dose intensities. Response rates were not significantly different among the four groups. These results suggest that a reduction in 5-FU+LV toxicity and an increase in 5-FU dose intensity can be obtained by a nonsinusoidally circadian modulated infusion. However, the reduction in toxicity observed seems to be dependent mainly on the quasi-intermittency and not on the timing of 5-FU+LV delivery.
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Affiliation(s)
- A Falcone
- UO Oncologia Medica, Ospedale S. Chiara, Pisa, Italia.
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Gini S, Guarguaglini E, Gambini L, Buonamini I, Fonti G, Benanti F, Bengala C, Galli L, Antonuzzo A, Conte P. Venous central line management and complications in patients treated with high-dose chemotherapy and circulating hemopoietic progenitor support (PBPC). Eur J Cancer 1999. [DOI: 10.1016/s0959-8049(99)80557-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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