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Vitali A, Felici A, Lees AM, Giacinti G, Maresca C, Bernabucci U, Gaughan JB, Nardone A, Lacetera N. Heat load increases the risk of clinical mastitis in dairy cattle. J Dairy Sci 2020; 103:8378-8387. [PMID: 32564950 DOI: 10.3168/jds.2019-17748] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 04/11/2020] [Indexed: 11/19/2022]
Abstract
The study was aimed at assessing heat load-related risk of clinical mastitis (CM) in dairy cows. Records of CM for the years 2014 and 2015 were obtained from a large conventional dairy farm milking about 1,200 Holstein cows in central Italy. A case of CM was defined by the presence of clinical signs and veterinary confirmation. Quarter milk samples were collected and bacteriological investigated for each CM. Etiological agents were identified and classified as environmental or contagious pathogens. Hourly weather data from the nearest weather station were used to calculate heat load index (HLI). Upper and lower thresholds of HLI, at which the animal accumulates or dissipates heat, were settled and used to measure heat load balance through the accumulated heat load (AHL) model. Zero and positive values of AHL indicate periods of thermo-neutral and heat accumulation, respectively. Each case of CM was associated with HLI-AHL values recorded 5 d before the event. The risk of CM was evaluated using a case-crossover design. A conditional logistic regression model was used to calculate the odds ratio and 95% confidence intervals of CM recorded in thermo-neutral (AHL = 0) or heat load (AHL > 0) days, pooled or stratified for pathogen type (environmental or contagious). Classes of AHL as low (<6.5), medium (6.6-34.9), and high (>35) were included in the model. Other variables included in the model were milk yield as liters (<20, 20-30, and >30), days in milk (<60, 60-150, and >150), and parity (1, 2-3, and >3). A total of 1,086 CM cases were identified from 677 cows. Escherichia coli, Streptococcus spp., and Streptococcus uberis were the environmental pathogens isolated with the highest frequency; Staphylococcus aureus prevailed within contagious species. The analysis of pooled data indicated a significant effect of heat load on the occurrence of CM in the contagious pathogen stratum. Higher milk yield, middle and late stage of lactation, and older parity increased the risk of CM under heat load conditions. However, the association between pathogen type and these factors was not clear because the model provided significant odds ratios within all pathogen categories. The present study provided the first evidence of an association between HLI and CM in dairy cattle and suggested the ability of the AHL model to assess the risk of mastitis associated with heat load.
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Affiliation(s)
- A Vitali
- Dipartimento Scienze Agrarie e Forestali, Università della Tuscia, 01100 Viterbo, Italy.
| | - A Felici
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, 06126 Perugia, Italy
| | - A M Lees
- School of Agriculture and Food Sciences, The University of Queensland, Gatton, QLD 4343, Australia; School of Environmental and Rural Science, Animal Science, University of New England Australia, Armidale, NSW, Australia, 2350
| | - G Giacinti
- Istituto Zooprofilattico Sperimentale del Lazio e Toscana, 00178 Roma, Italy
| | - C Maresca
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, 06126 Perugia, Italy
| | - U Bernabucci
- Dipartimento Scienze Agrarie e Forestali, Università della Tuscia, 01100 Viterbo, Italy
| | - J B Gaughan
- School of Agriculture and Food Sciences, The University of Queensland, Gatton, QLD 4343, Australia
| | - A Nardone
- Dipartimento Scienze Agrarie e Forestali, Università della Tuscia, 01100 Viterbo, Italy
| | - N Lacetera
- Dipartimento Scienze Agrarie e Forestali, Università della Tuscia, 01100 Viterbo, Italy
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Bracarda S, Bamias A, Casper J, Negrier S, Sella A, Staehler M, Tarazi J, Felici A, Rosbrook B, Jardinaud-Lopez M, Escudier B. Is Axitinib Still a Valid Option for mRCC in the Second-Line Setting? Prognostic Factor Analyses From the AXIS Trial. Clin Genitourin Cancer 2019; 17:e689-e703. [PMID: 31072748 DOI: 10.1016/j.clgc.2019.03.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/18/2019] [Accepted: 03/24/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Axitinib resulted in significantly longer progression-free survival (PFS) versus sorafenib in patients with metastatic renal-cell carcinoma (mRCC) previously treated with sunitinib in the AXIS trial. We report post hoc analyses evaluating patient subgroups that may benefit more from axitinib in this setting. PATIENTS AND METHODS AXIS was an open-label randomized phase 3 trial (NCT00678392) in mRCC patients with disease that failed to respond to one prior systemic therapy. Univariate and multivariate analyses evaluated potential prognostic factors for improved PFS and overall survival (OS) after sunitinib. PFS and OS of axitinib versus sorafenib were assessed within subgroups identified according to these factors. RESULTS Of 723 patients, 389 received first-line sunitinib; 194 and 195 were randomized to second-line axitinib and sorafenib, respectively. Identified prognostic factors were: nonbulky disease (sum of the longest diameter < 98 mm), favorable/intermediate risk disease (Memorial Sloan Kettering Cancer Center or International Metastatic Renal Cell Carcinoma Database Consortium criteria), and no bone or liver metastases. In patients with all of these prognostic factors (n = 86), significantly longer PFS was observed for axitinib versus sorafenib (hazard ratio = 0.476; 95% confidence interval, 0.263-0.863; 2-sided P = .0126). OS (hazard ratio = 0.902; 95% confidence interval, 0.457-1.780; 2-sided P = .7661) was similar between treatments. Across subgroups, PFS was generally longer in patients treated with axitinib versus sorafenib, and OS was generally similar between the two treatments. CONCLUSION In patients with mRCC, axitinib remains a suitable second-line treatment option across multiple subgroups. A relevant reduction in the risk of a PFS event was observed for axitinib compared to sorafenib in selected subgroups of patients.
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Affiliation(s)
- Sergio Bracarda
- Department of Oncology, Azienda Ospedaliera Santa Maria, Terni, Italy.
| | | | | | - Sylvie Negrier
- Service d'Oncologie Medicale, Centre Leon Berard, University of Lyon, Lyon, France
| | - Avishay Sella
- Department of Oncology, Shamir (Assaf Harofeh) Medical Center, Sackler School of Medicine, Zerifin, Israel
| | - Michael Staehler
- Urology Department, University Hospital of Munich, Munich, Germany
| | | | | | | | | | - Bernard Escudier
- Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
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Bertasa M, Bandini F, Felici A, Lanfranchi MR, Negrotti R, Riminesi C, Scalarone D, Sansonetti A. Soluble Salts Extraction with Different Thickeners: Monitoring of the Effects on Plaster. ACTA ACUST UNITED AC 2018. [DOI: 10.1088/1757-899x/364/1/012076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Buonomo O, Felici A, Granai AV, Piccirillo R, De Liguori Carino N, Guadagni F, Mariotti S, Orlandi A, Tipaldi G, Cipriani C, Chimenti S, Cervelli V, Casciani CU, Roselli M. Sentinel Lymphadenectomy in Cutaneous Melanoma. Tumori 2018; 88:S49-51. [PMID: 12369552 DOI: 10.1177/030089160208800343] [Citation(s) in RCA: 4] [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: 11/17/2022]
Abstract
Aims and Background In the last ten years validation of the sentinel lymph node (SLN) concept has led to modification of the surgical approach for patients with intermediate-risk cutaneous melanoma. Methods and Study Design Forty-eight patients affected by cutaneous melanoma with a Breslow thickness between 0.65 and 4 mm were enrolled in the study. Approximately 2 mCi of radiotracer and 1 mL of vital blue dye were injected in each patient around the site of the primary lesion. Lymphoscintigraphy was performed until the lymphatic basin and the respective SLN were localized. The whole surgical procedure consisted of enlargement of the surgical margins followed by localization and excision of the SLN(s) by using both radiotracer and vital dye. Whenever the SLN proved to be histologically positive for metastasis, complete regional lymphadenectomy was performed. Results Within 15 minutes of radiotracer administration the lymphatic basin was localized in all 48 patients by lymphoscintigraphy. Vital dye and radiotracer successfully allowed SLN localization and excision in 46 of 48 patients (97%); in one case the SLN was detected by radiotracer alone. The SLN proved to be metastatic in six (13%) of 46 evaluable patients; interestingly, in three of them the presence of metastatic cells was revealed only by immunohistochemistry. All patients with tumor-positive SLNs had primary lesions with a Breslow thickness = 2 mm. Conclusions Sentinel lymphadenectomy is able to identify lymph node involvement in patients with cutaneous melanoma with a Breslow thickness >1 mm, thus avoiding the risks associated with radical regional lymphadenectomy. Lymphoscintigraphy proved to be an important tool to obtain correct preoperative localization of the drainage basin, especially for melanomas located on the face and trunk.
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Affiliation(s)
- O Buonomo
- Department of Surgery, University of Rome Tor Vergata, Italy.
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Mariotti S, Buonomo O, Guadagni F, Spila A, Schiaroli S, Cipriani C, Simonetti G, Felici A, Granal AV, Bellotti A, Cabassi A, Casciani CU, Roselli M. Minimal Sentinel Node Procedure for Staging Early Breast Cancer. Tumori 2018; 88:S45-7. [PMID: 12365388 DOI: 10.1177/030089160208800340] [Citation(s) in RCA: 2] [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: 11/15/2022]
Abstract
Aims and Background Sentinel lymph node dissection (SLND) has recently been evaluated as a new staging technique for early breast cancer. To minimize the extent of surgery, the feasibility of eradicating primary breast lesions and the relative sentinel lymph nodes (SLN) under regional anesthesia was evaluated in this study. Methods and Study Design A selected population of 76 patients with suspected operable breast cancer and no clinically palpable lymph nodes was enrolled in the study. Intra- and perilesional administration of a radiotracer was performed. Lymphoscintigraphy was carried out to confirm the drainage pathway and locate the SLN. The following day, after inducing a nervous block induction of the ipsilateral intercostal nerves, we performed the surgical procedure with the help of a hand-held gamma-detecting probe. In case the primary lesion was diagnosed as invasive carcinoma by frozen section, the SLN and the remaining axillary lymph nodes (non-SLNs) were removed. The status of SLN and non-SLNs was compared. Results The primary breast lesion was located and excised in all cases (identification rate: 100%). Lymphoscintigraphy positively identified SLNs in 40/45 (89%) patients; in five patients no lymphatic drainage was detected. In 38 cases an average of 1.5 SLNs and 14 non-SLNs per patient were removed and pathologically analyzed; the remaining two patients showed SLNs in the internal mammary chain, which were not excised. Twenty-nine percent of the patients showed metastatic disease in the lymph nodes examined. Of all patients with affected nodes, 55% had cancer cells only in the SLN. No false negatives (skip metastases) were found. No immediate or long-term anesthesia-related complications (eg pleural lesions, intravascular injection) were observed. Conclusions Our data confirm the feasibility of single radiotracer administration for both occult lesion and SLN localization as well as the usefulness of SLND in staging early breast cancer. Regional anesthesia resulted in easy management and good patient compliance. This time-saving procedure allowed the completion of the whole surgical plan, reducing the recovery time without modifying the effectiveness of surgery.
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Affiliation(s)
- S Mariotti
- Division of Medical Oncology, University of Rome Tor Vergata, Italy
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Buonomo O, Granai AV, Felici A, Piccirillo R, De Liguori Carino N, Guadagni F, Polzoni M, Mariotti S, Cipriani C, Simonetti G, Cossu E, Schiaroli S, Altomare V, Cabassi A, Pernazza E, Casciani CU, Roselli M. Day-surgical Management of Ductal Carcinoma in Situ (Dcis) of the Breast Using Wide Local Excision with Sentinel Node Biopsy. Tumori 2018; 88:S48-9. [PMID: 12365390 DOI: 10.1177/030089160208800342] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- O Buonomo
- Department of Surgery, University of Tor Vergata, Rome, Italy.
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Mazzone P, Corneli S, Di Paolo A, Maresca C, Felici A, Biagetti M, Ciullo M, Sebastiani C, Pezzotti G, Leo S, Ricchi M, Arrigoni N. Survival of Mycobacterium avium subsp. paratuberculosis in the intermediate and final digestion products of biogas plants. J Appl Microbiol 2018; 125:36-44. [PMID: 29573309 DOI: 10.1111/jam.13762] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/02/2018] [Accepted: 03/12/2018] [Indexed: 01/13/2023]
Abstract
AIMS To evaluate the survival of Mycobacterium avium subsp. paratuberculosis (MAP) during anaerobic digestion (AD), we studied two different biogas plants loaded with manure and slurry from paratuberculosis-infected dairy herds. METHODS AND RESULTS Both plants were operating under mesophilic conditions, the first with a single digester and the second with a double digester. Mycobacterium avium subsp. paratuberculosis detection was performed by sampling each stage of the process, specifically the prefermenter, fermenter, liquid digestate and solid digestate stages, for 11 months. In both plants, MAP was isolated from the prefermenter stage. Only the final products, the solid and liquid digestates, of the one-stage plant showed viable MAP, while no viable MAP was detected in the digestates of the two-stage plant. CONCLUSIONS Mycobacterium avium subsp. paratuberculosis showed a significant decrease during subsequent steps of the AD process, particularly in the two-stage plant. We suggest that the second digester maintained the digestate under anaerobic conditions for a longer period of time, thus reducing MAP survival and MAP load under the culture detection limit. SIGNIFICANCE AND IMPACT OF THE STUDY Our data are unable to exclude the presence of MAP in the final products of the biogas plants, particularly those products from the single digester; therefore, the use of digestates as fertilizers is a real concern related to the possible environmental contamination with MAP.
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Affiliation(s)
- P Mazzone
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, Perugia, Italy
| | - S Corneli
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, Perugia, Italy
| | - A Di Paolo
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, Perugia, Italy
| | - C Maresca
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, Perugia, Italy
| | - A Felici
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, Perugia, Italy
| | - M Biagetti
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, Perugia, Italy
| | - M Ciullo
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, Perugia, Italy
| | - C Sebastiani
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, Perugia, Italy
| | - G Pezzotti
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, Perugia, Italy
| | - S Leo
- Centro di Referenza Nazionale per la Paratubercolosi, Istituto Zooprofilattico Sperimentale della Lombardia ed Emilia Romagna, Piacenza, Italy
| | - M Ricchi
- Centro di Referenza Nazionale per la Paratubercolosi, Istituto Zooprofilattico Sperimentale della Lombardia ed Emilia Romagna, Piacenza, Italy
| | - N Arrigoni
- Centro di Referenza Nazionale per la Paratubercolosi, Istituto Zooprofilattico Sperimentale della Lombardia ed Emilia Romagna, Piacenza, Italy
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Bracarda S, Bamias A, Casper J, Negrier S, Sella A, Staehler MD, Tarazi JC, Felici A, Rosbrook B, Jardinaud-Lopez M, Escudier B. Optimizing axitinib treatment selection following first-line sunitinib in metastatic renal cell carcinoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
589 Background: The treatment landscape for metastatic renal cell carcinoma (mRCC) is continuously evolving, with several new first-line (1L) and second-line (2L) treatment options. In the AXIS trial, axitinib resulted in significantly longer progression-free survival (PFS) vs sorafenib in the 2L treatment of mRCC. In these post-hoc exploratory analyses of AXIS, possible key drivers for successful 2L treatment with axitinib after sunitinib were evaluated. Methods: AXIS was an open-label, randomized, phase III trial (NCT00678392) in patients (pts) with mRCC who failed 1 prior systemic therapy. Univariate and multivariate analyses evaluated potential predictive factors for improved PFS (investigator-assessed) and overall survival (OS) with axitinib. PFS (independent review), OS and objective response rate (ORR) for axitinib vs sorafenib according to these predictive factors were assessed. Results: In all, 389 pts received 1L sunitinib: 194 and 195 pts received 2L axitinib and sorafenib, respectively. Based on multivariate analyses of PFS and OS, predictive factors favoring 2L axitinib treatment were identified as: non-bulky disease (sum of the longest diameter < 98 mm), favorable/intermediate (Fav/Int) risk (Memorial Sloan Kettering Cancer Center or International Metastatic Renal Cell Carcinoma Database Consortium criteria), no bone and no liver metastases. Thus, pts were grouped according to these factors. In pts with favorable risk factors (n = 86), a significantly longer median (95% confidence interval [CI]) PFS was observed in axitinib (n = 39; 13.9 [7.8–17.7] mo) vs sorafenib pts (n = 47; 4.7 [3.5–6.7] mo; hazard ratio [HR] 0.476 [95% CI 0.263–0.863]; P= 0.0126). Median (95% CI) OS (32.4 [23.8–not evaluable] mo vs 35.0 [23.9–35.0] mo; HR 0.902 [95% CI 0.457–1.780]; P= 0.7661) and ORR (both 12.8%) were similar between the 2 groups. More pts had stable disease ≥20 weeks with axitinib (38.5%) vs sorafenib (21.3%). Conclusions: In the continuously changing treatment landscape for mRCC, axitinib remains a suitable 2L treatment option, particularly in pts with non-bulky disease, Fav/Int risk and no bone nor liver metastases, characterized by an impressive PFS. Clinical trial information: NCT00678392.
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Affiliation(s)
| | | | | | | | | | - Michael D. Staehler
- University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany
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Bassanelli M, Felici A, Milella M, Giannarelli D, Giacinti S, Gentile G, Carlini P, Cognetti F, Roberto M, Poti G, Macrini S, Aschelter AM, Simmaco M, Marchetti P. ABCB1, CYP3A5*3, and CYP3A4*1B SNPs and risk of toxicity with sunitinib treatment for mRCC. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.485] [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
485 Background: Currently there are no biomarkers to predict either toxicity or activity of targeted therapy in mRCC. The aim of this study was to correlate single nucleotide polymorphisms (SNPs) of genes encoding for efflux transporters and metabolizing enzymes with sunitinib toxicity in metastatic renal cell carcinoma (mRCC) patients (pts). Methods: We conducted an observational, retrospective analysis of 60 Caucasian pts who received sunitinib for mRCC from 2 Italian institutions. Correlation between adverse events (AE, according to CTCAE v.4.0) and 4 polymorphisms in 3 genes (ABCB1 [1236C>T, 3435C>T], CYP3A5*3 6986A>G, CYP3A4*1B-392A>G) was analyzed. SNPs were detected in blood samples using pyrosequencing technique. Association between SNPs and toxicities was evaluated using the Chi Square test. Results: 60pts (median age: 61 years; male: 63.3%) with mRCC (clear cell: 85%, other histologies: 15%) were treated with sunitinib (83.3% as first-line). The most common AE (any-grade) reported were: hypertension (85%), asthenia (83.3%), hypothyroidism (65%), anemia (61.6%), nausea/vomiting (60%), stomatitis (58.3%), diarrhoea (48.3%), neutropenia (48.3%), thrombocytopenia (46.7%), leukopenia (46.7%), hypertriglyceridemia (45%), hyperglycaemia (38.4%), hypercholesterolemia (35%), and hand-foot syndrome (35%). Treatment was discontinued and sunitinib dose was reduced due to AE in 28.3% and 61.7% of pts, respectively. The G/A-variant in CYP3A5*3 was associated with thrombocytopenia (any grade, p=0.03); homozygous C/C alleles in ABCB1 1236C>T significantly correlated with leukopenia (any grade, p=0.01), while the C/C genotype in ABCB1 3435C>T was associated with hypertension (grade≥3, p=0.05); hypertriglyceridemia showed a trend towards increased prevalence in the presence of the C allele (grade≥3, p=0.08). Conclusions: Polymorphisms in ABCB1 and CYP3A5*3 are predictive of toxicity, as hypertension, leukopenia, and thrombocytopenia in pts with mRCC treated with sunitinib. This analysis could support the selection of the more appropriate drug to the individual patient.
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Affiliation(s)
| | | | | | | | - Silvana Giacinti
- Department of Clinical and Molecolar Medicine, Sapienza University of Rome, Rome, Italy
| | - Giovanna Gentile
- NESMOS Department, Sapienza University of Rome, Advanced Molecular Diagnostic, IDI-IRCCS, Rome, Italy
| | | | | | - Michela Roberto
- Sapienza University of Rome - Ospedale Sant'Andrea, Rome, Italy
| | - Giulia Poti
- Sapienza University of Rome - Ospedale Sant'Andrea, Rome, Italy
| | - Serena Macrini
- Sapienza University of Rome - Ospedale Sant'Andrea, Rome, Italy
| | | | - Maurizio Simmaco
- NESMOS Department, Sapienza University of Rome, Advanced Molecular Diagnostic, IDI-IRCCS, Rome, Italy
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Bracarda S, Caserta C, Galli L, Carlini P, Pastina I, Sisani M, Scali S, Hamzaj A, Derosa L, Felici A, Rossi M, Altavilla A, Chioni A, De Angelis V. Docetaxel rechallenge in metastatic castration-resistant prostate cancer: any place in the modern treatment scenario? An intention to treat evaluation. Future Oncol 2015; 11:3083-90. [PMID: 26437324 DOI: 10.2217/fon.15.217] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND We evaluated the possible advantages of a docetaxel (DCT) rechallenge strategy in metastatic castration-resistant prostate cancer (mCRPC) patients, also given the possible earlier positioning of this treatment option in the modern scenario. PATIENTS & METHODS All mCRPC patients planned for DCT chemotherapy rechallenge in our institutions were evaluated. RESULTS Of 128 patients, 98 achieved disease control on the initial DCT round. After a treatment holiday of 8.3 months, the 98 responsive patients underwent a second DCT round, with 56 cases achieving again disease control. After a 5.7-month off-treatment period, 32 of these cases underwent a third DCT round, and 16 responded. Lastly, after a further 4.2-month treatment holiday, eight patients underwent a fourth DCT round and two responded. Median time to definitive disease progression for the whole population was 16.4 months. CONCLUSIONS Rechallenge with DCT may be considered a suitable treatment option for mCRPC patients recurring after a successful DCT chemotherapy. The interest in this strategy may be increased because of the showed efficacy of early DCT chemotherapy in patients with bulky disease (CHAARTED study) and the potential lower efficacy of the new hormonal agents abiraterone acetate and enzalutamide when used in a immediate sequencing.
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Affiliation(s)
- Sergio Bracarda
- Medical Oncology, Ospedale San Donato, Azienda USL8, Istituto Toscano Tumori (ITT), Arezzo, Italy
| | - Claudia Caserta
- Medical Oncology, Ospedale S Maria, Terni, Italy.,Medical Oncology, Ospedale della Gruccia, Azienda USL8, Istituto Toscano Tumori (ITT), Arezzo, Italy
| | - Luca Galli
- Medical Oncology, Azienda Ospedaliera Universitaria di Perugia, Perugia, Italy
| | - Paolo Carlini
- Medical Oncology, Azienda Ospedaliero Universitaria Pisana, Istituto Toscano Tumori (ITT), Pisa, Italy
| | | | - Michele Sisani
- Medical Oncology, Ospedale San Donato, Azienda USL8, Istituto Toscano Tumori (ITT), Arezzo, Italy
| | - Simona Scali
- Medical Oncology, Ospedale Misericordia, Istituto Toscano Tumori (ITT), Grosseto, Italy
| | - Alketa Hamzaj
- Medical Oncology, Ospedale San Donato, Azienda USL8, Istituto Toscano Tumori (ITT), Arezzo, Italy.,Medical Oncology, Ospedale della Gruccia, Azienda USL8, Istituto Toscano Tumori (ITT), Arezzo, Italy
| | - Lisa Derosa
- Medical Oncology, Azienda Ospedaliera Universitaria di Perugia, Perugia, Italy
| | - Alessandra Felici
- Medical Oncology, Azienda Ospedaliero Universitaria Pisana, Istituto Toscano Tumori (ITT), Pisa, Italy
| | - Marta Rossi
- Medical Oncology, Ospedale della Gruccia, Azienda USL8, Istituto Toscano Tumori (ITT), Arezzo, Italy
| | - Amelia Altavilla
- Medical Oncology, Ospedale San Donato, Azienda USL8, Istituto Toscano Tumori (ITT), Arezzo, Italy
| | | | - Verena De Angelis
- Medical Oncology, Ospedale della Gruccia, Azienda USL8, Istituto Toscano Tumori (ITT), Arezzo, Italy
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Iacovelli R, Santini D, Rizzo M, Felici A, Santoni M, Verzoni E, Masini C, Massari F, Calvani N, Mosca A, Procopio G. Bone metastases affect prognosis but not effectiveness of third-line targeted therapies in patients with metastatic renal cell carcinoma. Can Urol Assoc J 2015; 9:263-7. [PMID: 26316911 PMCID: PMC4537338 DOI: 10.5489/cuaj.2377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Treatment of metastatic renal cell carcinoma (mRCC) has improved with the use of targeted therapies, but bone metastases continue to be negative prognostic factor. METHODS Patients with mRCC treated with everolimus (EV) or sorafenib (SO) after two previous lines of targeted therapies were included in the analysis. Overall survival (OS) and progression-free survival (PFS) were assessed based on the presence of bone metastases and type of therapy; they were also adjusted based on prognostic criteria. RESULTS Of the 233 patients with mRCC, 76 had bone metastases. Of the 233 patients, EV and SO were administered in 143 and 90 patients, respectively. Median OS was 10.4 months in patients with BMs and 17.4 months in patients without bone metastases (p = 0.002). EV decreased the risk of death by 18% compared to SO (adjusted hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.74-0.91; p < 0.001), with comparable effects in patients with or without bone metastases. In the same manner, EV decreased the risk of progression by 12% compared to SO (adjusted HR 0.88, 95% CI 0.82-0.96; p = 0.002), but this difference was not significant in patients without bone metastases. The major limitations of the study are its retrospective nature, the heterogeneity of the methods to detect bone metastases, and the lack of data about patients treated with bisphosphonates. CONCLUSIONS The relative benefit of targeted therapies in mRCC is not affected by the presence of bone metastases, but patients without bone metastases have longer response to therapy and overall survival.
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Affiliation(s)
- Roberto Iacovelli
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Daniele Santini
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Mimma Rizzo
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Alessandra Felici
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Matteo Santoni
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Elena Verzoni
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Cristina Masini
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Francesco Massari
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Nicola Calvani
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Alessandra Mosca
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Procopio
- Fondazione IRCCS Istituto Nazionale Tumori, Division of Medical Oncology, Rome, Italy
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Vitali A, Felici A, Esposito S, Bernabucci U, Bertocchi L, Maresca C, Nardone A, Lacetera N. The effect of heat waves on dairy cow mortality. J Dairy Sci 2015; 98:4572-9. [DOI: 10.3168/jds.2015-9331] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 03/26/2015] [Indexed: 11/19/2022]
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Maresca C, Costarelli S, Dettori A, Felici A, Iscaro C, Feliziani F. Enzootic bovine leukosis: Report of eradication and surveillance measures in Italy over an 8-year period (2005–2012). Prev Vet Med 2015; 119:222-6. [DOI: 10.1016/j.prevetmed.2015.02.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 02/24/2015] [Accepted: 02/25/2015] [Indexed: 11/24/2022]
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Pantano F, Santoni M, Procopio G, Rizzo M, Iacovelli R, Porta C, Conti A, Lugini A, Milella M, Galli L, Ortega C, Guida FM, Silletta M, Schinzari G, Verzoni E, Modica D, Crucitti P, Rauco A, Felici A, Ballatore V, Cascinu S, Tonini G, Carteni G, Russo A, Santini D. The changes of lipid metabolism in advanced renal cell carcinoma patients treated with everolimus: a new pharmacodynamic marker? PLoS One 2015; 10:e0120427. [PMID: 25885920 PMCID: PMC4401714 DOI: 10.1371/journal.pone.0120427] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 01/22/2015] [Indexed: 12/30/2022] Open
Abstract
Background Everolimus is a mammalian target of rapamycin (mTOR) inhibitor approved for the treatment of metastatic renal cell carcinoma (mRCC). We aimed to assess the association between the baseline values and treatmentrelated modifications of total serum cholesterol (C), triglycerides (T), body mass index (BMI), fasting blood glucose level (FBG) and blood pressure (BP) levels and the outcome of patients treated with everolimus for mRCC. Methods 177 patients were included in this retrospective analysis. Time to progression (TTP), clinical benefit (CB) and overall survival (OS) were evaluated. Results Basal BMI was significantly higher in patients who experienced a CB (p=0,0145). C,T and C+T raises were significantly associated with baseline BMI (p=0.0412, 0.0283 and 0.0001). Median TTP was significantly longer in patients with T raise compared to patients without T (10 vs 6, p=0.030), C (8 vs 5, p=0.042) and C+T raise (10.9 vs 5.0, p=0.003). At the multivariate analysis, only C+T increase was associated with improved TTP (p=0.005). T raise (21.0 vs 14.0, p=0.002) and C+T increase (21.0 vs 14.0, p=0.006) were correlated with improved OS but were not significant at multivariate analysis. Conclusion C+T raise is an early predictor for everolimus efficacy for patients with mRCC.
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Affiliation(s)
- Francesco Pantano
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Matteo Santoni
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Piazza Roma, 22,60121 Ancona, Italy
| | - Giuseppe Procopio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milan, Italy
| | - Mimma Rizzo
- Department of Medical Oncology, Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Roberto Iacovelli
- Department of Oncology, Oncology Unit B, Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185 Rome, Italy
| | - Camillo Porta
- Department of Medical Oncology, I.R.C.C.S. San Matteo University Hospital Foundation, Viale Camillo Golgi, 19, 27100 Pavia, Italy
| | - Alessandro Conti
- Department of Clinical and Specialist Sciences, Urology, Università Politecnica delle Marche, Piazza Roma, 22, 60121, Ancona, Italy
| | - Antonio Lugini
- Department of Medical Oncology, San Camillo De Lellis Hospital, Via John Fitzgerald Kennedy, 17, 02100 Rieti, Italy
| | - Michele Milella
- Department of Medical Oncology, Medical Oncology A, Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00128 Rome, Italy
| | - Luca Galli
- Department of Medical Oncology, Azienda Ospedaliera Universitaria Pisana, Via Roma, 67, 56126 Pisa, Italy
| | - Cinzia Ortega
- Department of Medical Oncology, Institute for Cancer Research & Treatment (IRCC), Strada Provinciale, 142, 10060 Candiolo, Torino, Italy
| | - Francesco Maria Guida
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Marianna Silletta
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Giovanni Schinzari
- Department of Medical Oncology, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168 Rome, Italy
| | - Elena Verzoni
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milan, Italy
| | - Daniela Modica
- Department of Oncology, Oncology Unit B, Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185 Rome, Italy
| | - Pierfilippo Crucitti
- Department of Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Annamaria Rauco
- Department of Medical Oncology, San Camillo De Lellis Hospital, Via John Fitzgerald Kennedy, 17, 02100 Rieti, Italy
| | - Alessandra Felici
- Department of Medical Oncology, Medical Oncology A, Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00128 Rome, Italy
| | - Valentina Ballatore
- Department of Medical Oncology, Institute for Cancer Research & Treatment (IRCC), Strada Provinciale, 142, 10060 Candiolo, Torino, Italy
| | - Stefano Cascinu
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Piazza Roma, 22,60121 Ancona, Italy
| | - Giuseppe Tonini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Giacomo Carteni
- Department of Medical Oncology, Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Antonio Russo
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy
- * E-mail:
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Santoni M, Conti A, Procopio G, Porta C, Ibrahim T, Barni S, Guida FM, Fontana A, Berruti A, Berardi R, Massari F, Vincenzi B, Ortega C, Ottaviani D, Carteni G, Lanzetta G, De Lisi D, Silvestris N, Satolli MA, Collovà E, Russo A, Badalamenti G, Luzi Fedeli S, Tanca FM, Adamo V, Maiello E, Sabbatini R, Felici A, Cinieri S, Montironi R, Bracarda S, Tonini G, Cascinu S, Santini D. Bone metastases in patients with metastatic renal cell carcinoma: are they always associated with poor prognosis? J Exp Clin Cancer Res 2015; 34:10. [PMID: 25651794 PMCID: PMC4328067 DOI: 10.1186/s13046-015-0122-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 01/03/2015] [Indexed: 01/21/2023]
Abstract
Purpose Aim of this study was to investigate for the presence of existing prognostic factors in patients with bone metastases (BMs) from RCC since bone represents an unfavorable site of metastasis for renal cell carcinoma (mRCC). Materials and methods Data of patients with BMs from RCC were retrospectively collected. Age, sex, ECOG-Performance Status (PS), MSKCC group, tumor histology, presence of concomitant metastases to other sites, time from nephrectomy to bone metastases (TTBM, classified into three groups: <1 year, between 1 and 5 years and >5 years) and time from BMs to skeletal-related event (SRE) were included in the Cox analysis to investigate their prognostic relevance. Results 470 patients were enrolled in this analysis. In 19 patients (4%),bone was the only metastatic site; 277 patients had concomitant metastases in other sites. Median time to BMs was 16 months (range 0 − 44y) with Median OS of 17 months. Number of metastatic sites (including bone, p = 0.01), concomitant metastases, high Fuhrman grade (p < 0.001) and non-clear cell histology (p = 0.013) were significantly associated with poor prognosis. Patients with TTBM >5 years had longer OS (22 months) compared to patients with TTBM <1 year (13 months) or between 1 and 5 years (19 months) from nephrectomy (p < 0.001), no difference was found between these two last groups (p = 0.18). At multivariate analysis, ECOG-PS, MSKCC group and concomitant lung or lymph node metastases were independent predictors of OS in patients with BMs. Conclusions Our study suggest that age, ECOG-PS, histology, MSKCC score, TTBM and the presence of concomitant metastases should be considered in order to optimize the management of RCC patients with BMs.
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Affiliation(s)
- Matteo Santoni
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle, Marche, Ancona, Italy.
| | - Alessandro Conti
- Department of Clinical and Specialist Sciences, Urology, Università Politecnica delle Marche, Ancona, Italy.
| | - Giuseppe Procopio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Camillo Porta
- Division of Medical Oncology, I.R.C.C.S. San Matteo University Hospital Foundation, Pavia, Italy.
| | - Toni Ibrahim
- Osteoncology and Rare Tumors Center, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, FC, Italy.
| | - Sandro Barni
- Medical Oncology Department, Azienda Ospedaliera Treviglio-Caravaggio, Treviglio, Italy.
| | | | - Andrea Fontana
- Unit of Medical Oncology 2, Istituto Toscano Tumori, Azienda-Ospedaliero-Universitaria Pisana, Pisa, Italy.
| | - Alfredo Berruti
- Dipartimento di Specialità Medico-Chirurgiche, Medical Oncology, Scienze Radiologiche e Sanità Pubblica, Università degli Studi di Brescia, Azienda Ospedaliera Spedali Civili, Brescia, Italy.
| | - Rossana Berardi
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle, Marche, Ancona, Italy.
| | - Francesco Massari
- Department of Medical Oncology, "G.B. Rossi" Academic Hospital, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy.
| | - Bruno Vincenzi
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy.
| | - Cinzia Ortega
- Department of Medical Oncology, Institute for Cancer Research & Treatment (IRCC), Candiolo, Torino, Italy.
| | - Davide Ottaviani
- Department of Medical Oncology, Presidio Sanitario Gradenigo, Turin, Italy.
| | - Giacomo Carteni
- Department of Medical Oncology, Cardarelli Hospital, Naples, Italy.
| | - Gaetano Lanzetta
- Department of Neurological Sciences, Neuromed Institute, IRCSS, Pozzilli, IS, Italy. .,Istituto Neurotraumatologico Italiano, Unità Funzionale di Oncologia, Grottaferrata, Italy.
| | - Delia De Lisi
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy.
| | - Nicola Silvestris
- Medical Oncology Unit, National Cancer Research Centre "Giovanni Paolo II", Bari, Italy.
| | - Maria Antonietta Satolli
- Department of Oncology, University of Turin, Medical Oncology 1, AOU Città della Salute e della Scienza, Turin, Italy.
| | - Elena Collovà
- Division of Medical Oncology, Hospital of Legnano, Milan, Italy.
| | - Antonio Russo
- Department of Surgery and Oncology, Section of Medical Oncology, University of Palermo, Palermo, Italy.
| | - Giuseppe Badalamenti
- Department of Surgery and Oncology, Section of Medical Oncology, University of Palermo, Palermo, Italy.
| | - Stefano Luzi Fedeli
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Presidio San Salvatore, Pesaro, Italy.
| | | | - Vincenzo Adamo
- Department of Human Pathology, Medical Oncology Unit AOOR Papardo-Piemonte, University of Messina, Messina, Italy.
| | - Evaristo Maiello
- Oncology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy.
| | - Roberto Sabbatini
- Dipartimento Integrato di Oncologia ed Ematologia, Medical Oncology Division, Università degli Studi di Modena e Reggio Emilia, Modena, Italy.
| | - Alessandra Felici
- Department of Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy.
| | - Saverio Cinieri
- Medical Oncology Department & Breast Unit - Hospital of Brindisi and Medical Oncology Department - European Institute of Oncology, Milan, Italy.
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy.
| | - Sergio Bracarda
- Department of Oncology, USL-8, Ospedale San Donato, Arezzo, Italy.
| | - Giuseppe Tonini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy.
| | - Stefano Cascinu
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle, Marche, Ancona, Italy.
| | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy.
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Santini D, Santoni M, Conti A, Procopio G, Porta C, Ibrahim T, Barni S, Fontana A, Berruti A, Vincenzi B, Ortega C, Carteni G, Fedeli S, Adamo V, Maiello E, Sabbatini R, Felici A, Tonini G, Bracarda S, Cascinu S. Bone Metastases from Rcc are not Always Associated with a Poor Prognosis. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu337.21] [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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Felici A, Santini D, De Giorgi U, Iacobelli S, Facchini G, Santoni M, Verzoni E, Derosa L, Di Lorenzo G, Ardito R, Badalamenti G, Marchetti P, Cortesi E, Cengarle R, Fedeli S, Adamo V, Maroto P, Guida F, Sperduti I, Milella M. Treatment and Outcome(S) of a Large Cohort of Poor Risk Metastatic Renal Cell Carcinoma (Prrcc) Patients (Pts). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu337.29] [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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Guida F, Santoni M, De Giorgi U, De Tursi M, Procopio G, Pignata S, Galli L, Di Lorenzo G, Badalamenti G, Felici A, Marchetti P, Iacovelli R, Longo F, Maruzzo M, Massari F, Suarez C, Aieta M, Cascinu S, Milella M, Santini D. Poor Risk Metastatic Renal Cell Carcinoma (Mrcc) Patients are not a Homogeneous Group: a New Stratificating Model in the Era of Targeted Therapy. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu337.30] [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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Procopio G, Derosa L, Gernone A, Morelli F, Sava T, Zustovich F, De Giorgi U, Ferrari V, Sabbatini R, Gasparro D, Felici A, Burattini L, Calvani N, Lo Re G, Banna G, Pia Brizzi M, Rizzo M, Ciuffreda L, Iacovelli R, Ferraù F, Taibi E, Bracarda S, Porta C, Galligioni E, Contu A. Sorafenib as first- or second-line therapy in patients with metastatic renal cell carcinoma in a community setting. Future Oncol 2014; 10:1741-50. [DOI: 10.2217/fon.14.48] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Aim: The Italian Retrospective Analysis of Sorafenib as First or Second Target Therapy study assessed the efficacy and safety of sorafenib in metastatic renal cell carcinoma patients treated in the community. Patients & methods: Patients receiving first- or second-line single-agent sorafenib between January 2008 and December 2010 were eligible. Retrospective data collection started in 2012 and covers at least 1-year follow-up. The primary end point was overall survival (OS). Results: Median OS was 17.2 months (95% CI: 15.5–19.6): 19.9 months (95% CI: 15.9–25.3) in patients treated with first-line sorafenib and 16.3 months (95% CI: 13.1–18.2) with second-line sorafenib. Overall median (95% CI) progression-free survival was 5.9 months (95% CI: 4.9–6.7): 6.6 (95% CI: 4.9–9.3) and 5.3 months (95% CI: 4.3–6.0) in first- and second-line patients, respectively. Conclusion: The efficacy and safety of sorafenib in routine community practice was generally good, especially in relation to OS in patients treated in the second line, where results were similar to those seen in recent prospective clinical trials.
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Affiliation(s)
- Giuseppe Procopio
- S.C. Oncologia Medica 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133 Milano, Italy
| | - Lisa Derosa
- U.O. Oncologia Medica 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Via Roma 67, 56100 Pisa, Italy
| | - Angela Gernone
- U.O. Oncologia Medica Universitaria, Azienda Ospedaliera Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Franco Morelli
- U.O.C. Oncologia, Casa Sollievo della Sofferenza, Viale Cappucini 1, 71013 San Giovanni Rotondo (FG), Italy
| | - Teodoro Sava
- Oncologia Medica d.O., Azienda Ospedaliera Universitaria Integrata Verona, Borgo Trento, P.le Stefani 1, 37126 Verona, Italy
| | - Fable Zustovich
- Oncologia Medica 1, Istituto Oncologico Veneto – IRCCS, Via Gattamelata 64, 35127 Padova, Italy
| | - Ugo De Giorgi
- IRCCS Istituto Scientifico Romagnolo, per lo Studio e la Cura dei Tumori (I.R.S.T.), Via Piero Maroncelli 40, 47014 Meldola (FC), Italy
| | - Vittorio Ferrari
- U.O. Oncologia Medica, Spedali Civili Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Roberto Sabbatini
- Medical Oncology Division, Azienda Ospedaliero Universitaria, Policlinico di Modena, 41125 Modena, Italy
| | - Donatello Gasparro
- Azienda Ospedaliero-Universitaria di Parma, Dipartimento Onco-Ematogico, Oncologia Medica, Via Gramsci 14, 40126 Parma, Italy
| | - Alessandra Felici
- Division of Medical Oncology A, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Luciano Burattini
- Oncologia Clinica, Ospedali Riuniti, Via Conca 71, 60100 Ancona, Italy
| | - Nicola Calvani
- Medical Oncology Division & Breast Unit, Sen. Antonio Perrino Hospital, S.S. 7, 72100 Brindisi, Italy
| | - Giovanni Lo Re
- Divisine di Oncologia, Azienda Ospedaliera Santa Maria degli Angeli, Via Montereale 24, 33170 Pordenone, Italy
| | - Giuseppe Banna
- Division of Medical Oncology, Cannizzaro Hospital, Via Messina 829, 95126, Catania, Italy
| | - Maria Pia Brizzi
- Department of Oncology, Medical Oncology, A.O.U. San Luigi, Regione Gonzole 10, 10043, Orbassano (TO), Italy
| | - Mimma Rizzo
- A.O.R.N. “A. Cardarelli”, U.O.S.C. Oncologia, Via A. Cardarelli 9, 80131 Napoli, Italy
| | - Libero Ciuffreda
- Direttore S.C. Oncologia Medica 1, Dipartimento Oncologia ed Ematologia, A.O.Citta’ della Salute e della Scienza – Ospedale Molinette, C.so Bramante 88, 10126 Torino, Italy
| | - Roberto Iacovelli
- Oncology Unit B, Department of Radiology, Oncology & Human-Pathology, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Francesco Ferraù
- Medical Oncology Unit, “S.Vincenzo” Hospital, C.da Sirina, 98039 Taormina, Italy
| | - Eleonora Taibi
- Humanitas Centro Catanese di Oncologia S.p.A, Via V. E. Da Bormida 64, 95126 Catania (CT), Italy
| | - Sergio Bracarda
- Dipartimento Oncologico UOC, Ospedale S. Donato USL 8Toscana, Via Pietro Nenni 20, 52100 Arezzo, Italy
| | - Camillo Porta
- Medical Oncology, IRCCS San Matteo, University Hospital Foundation, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Enzo Galligioni
- Dipartimento di Oncologia, Azienda Provinciale per i Servizi Sanitari, Trento, Ospedale S.Chiara, 38122 Trento, Italy
| | - Antonio Contu
- SC di Oncologia Medica, ASL n°1, Via De Nicola 14, 07100 Sassari, Italy
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Felici A, Santini D, De Giorgi U, De Tursi M, Facchini G, Santoni M, Verzoni E, Derosa L, di Lorenzo G, Badalamenti G, Marchetti P, Cortesi E, Maruzzo M, Massari F, Longo F, Noto L, Carles J, Guida FM, Sperduti I, Milella M. Treatment and outcome(s) of a large cohort of Italian patients (pts) with poor-risk metastatic renal cell carcinoma (prRCC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e15568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Alessandra Felici
- Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Ugo De Giorgi
- IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy
| | - Michele De Tursi
- Department of Oncology and Neurosciences, Consorzio Interuniversitario Nazionale per la Bio-Oncologia, University G. d'Annunzio, Chieti, Italy
| | | | - Matteo Santoni
- Medical Oncology, Polytechnic University of the Marche Region, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I-GM Lancisi and G Salesi, Ancona, Italy
| | - Elena Verzoni
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lisa Derosa
- Division of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | | | - Giuseppe Badalamenti
- Department of Oncology, Medical Oncology Division, University of Palermo, Palermo, Italy
| | | | - Enrico Cortesi
- Dipartimento di Oncologia Medica, Università di Roma La Sapienza, Rome, Italy
| | - Marco Maruzzo
- Medical Oncology 1, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Francesco Massari
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Flavia Longo
- Medical Oncology Department Policlinico Umberto I La Sapienza, Rome, Italy
| | - Laura Noto
- Unit of Medical Oncology, A.O. Papardo; Department of Human Pathology, University of Messina, Messina, Italy
| | - Joan Carles
- Hospital Universitari Vall d´Hebron, Barcelona, Spain
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Santini D, Santoni M, De Giorgi U, Iacobelli S, Procopio G, Facchini G, Galli L, di Lorenzo G, Badalamenti G, Guida FM, Felici A, Marchetti P, Iacovelli R, Basso U, Adamo V, Longo F, Massari F, Carles J, Tonini G, Milella M. A proposed new model for prognostic stratification of poor-risk patients with metastatic renal cell carcinoma (mRCC) in the era of targeted therapy. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e15588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Matteo Santoni
- Medical Oncology, Polytechnic University of the Marche Region, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I-GM Lancisi and G Salesi, Ancona, Italy
| | - Ugo De Giorgi
- IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy
| | | | - Giuseppe Procopio
- Oncology Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Luca Galli
- Division of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | | | - Giuseppe Badalamenti
- Department of Oncology, Medical Oncology Division, University of Palermo, Palermo, Italy
| | | | - Alessandra Felici
- Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | | | - Roberto Iacovelli
- Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomo-Patologiche, Sapienza Università di Roma, Roma, Italy
| | - Umberto Basso
- Medical Oncology 1, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Vincenzo Adamo
- AOOR Papardo Piemonte & University of Messina, Messina, Italy
| | - Flavia Longo
- Medical Oncology Department Policlinico Umberto I La Sapienza, Rome, Italy
| | - Francesco Massari
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Joan Carles
- Hospital Universitari Vall d´Hebron, Barcelona, Spain
| | - Giuseppe Tonini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
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Maines F, Pilotto S, Milella M, Massari F, Vaccaro V, Felici A, Bria E, Tortora G. “Targeting” renal cell carcinoma patients with “targeted” agents: Are we there yet? World J Clin Urol 2014; 3:9-19. [DOI: 10.5410/wjcu.v3.i1.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 12/07/2013] [Accepted: 02/18/2014] [Indexed: 02/06/2023] Open
Abstract
The rapid approval of several novel agents, targeting the vascular endothelial growth factor or mammalian target of rapamycin pathways (sunitinib, pazopanib, sorafenib, axitinib, bevacizumab, everolimus, temsirolimus) has given to metastatic renal cell carcinoma (mRCC) patients and their treating physicians many new and effective therapeutic options. The treatment paradigm for these patients is rapidly evolving, with future studies needed to define the optimal sequencing of these new agents. Despite progresses, no validated biomarkers able to predict clinical outcome or useful to guide patient selection for treatment are currently available. Recent studies have suggested that some biomarkers, including cytokines, circulating proangiogenic factors, markers of hypoxia or targets of signaling pathways are potentially promising prognostic or predictive factors in mRCC. We present an overview of the most recent developments in identifying biomarkers for targeted therapies in advanced RCC.
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Santoni M, De Tursi M, Felici A, Lo Re G, Ricotta R, Ruggeri EM, Sabbatini R, Santini D, Vaccaro V, Milella M. Management of metastatic renal cell carcinoma patients with poor-risk features: current status and future perspectives. Expert Rev Anticancer Ther 2014; 13:697-709. [PMID: 23773104 DOI: 10.1586/era.13.52] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
With seven agents approved for renal cell carcinoma within the past few years, there has undoubtedly been progress in treating this disease. However, patients with poor-risk features remain a challenging and difficult-to-treat population, with the mTOR inhibitor, temsirolimus, the only agent approved in the first-line setting. Phase III trial data are still lacking VEGF-pathway inhibitors in patients with poor prognostic features. Poor-risk patients need to be considered as a heterogeneous population. Further understanding of biomarkers can lead to a better selection of patients who may benefit the most from treatment and improvements in prognosis. The presence of poor Karnofsky scores and liver or CNS disease may affect the outcome of these patients much more than other identified factors. This consideration may provide the rationale to further stratify poor-risk patients further subgroups destined to receive either cure or palliation.
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Affiliation(s)
- Matteo Santoni
- Clinica di Oncologia Medica, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
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Felici A, Bria E, Tortora G, Cognetti F, Milella M. Sequential therapy in metastatic clear cell renal carcinoma: TKI–TKI vs TKI–mTOR. Expert Rev Anticancer Ther 2014; 12:1545-57. [DOI: 10.1586/era.12.149] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Cardillo I, Spugnini EP, Galluzzo P, Contestabile M, Dell’Anna ML, Picardo M, Crispi S, Calogero RA, Piccolo MT, Arigoni M, Cantarella D, Boccellino M, Quagliuolo L, Ferretti G, Carlini P, Felici A, Boccardo F, Cognetti F, Baldi A. Functional and pharmacodynamic evaluation of metronomic cyclophosphamide and docetaxel regimen in castration-resistant prostate cancer. Future Oncol 2013; 9:1375-88. [DOI: 10.2217/fon.13.99] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Aim: The aim of our study was to investigate the association of docetaxel and metronomic cyclophosphamide (CYC) in castration-resistant prostate cancer (CRPC). Materials & methods: CRPC xenografts were established with PC3 cells. Mice were treated with a combination of CYC (50 mg/kg/day) and docetaxel (10–30 mg/kg/week) or with docetaxel alone. Docetaxel plasma levels were analyzed in patients receiving the drug alone or combined with CYC. Results: Metronomic CYC is an effective adjuvant in blocking tumor growth in vivo, with comparable efficacy and less toxic effects compared with docetaxel treatment. CYC acts by downregulating cell proliferation and inducing apoptosis thorough upregulation of p21 and inhibition of angiogenesis. Finally, CYC increases docetaxel plasma levels in patients. Conclusion: Metronomic CYC exerts anti-tumoral effects in an in vivo model of prostate cancer and in patients with CRPC, and also increases the bioavailability of docetaxel. These results explain the favorable toxicity and activity profiles observed in patients treated with this regimen.
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Affiliation(s)
- Irene Cardillo
- SAFU Department, Regina Elena National Cancer Institute, Via E. Chianesi 53, 00144 Rome, Italy
| | - Enrico P Spugnini
- SAFU Department, Regina Elena National Cancer Institute, Via E. Chianesi 53, 00144 Rome, Italy
| | - Paola Galluzzo
- SAFU Department, Regina Elena National Cancer Institute, Via E. Chianesi 53, 00144 Rome, Italy
| | - Michela Contestabile
- SAFU Department, Regina Elena National Cancer Institute, Via E. Chianesi 53, 00144 Rome, Italy
| | - Maria Lucia Dell’Anna
- Laboratory of Cutaneous Physiopathology & CIRM, Dermatologic San Gallicano Institute, Rome, Italy
| | - Mauro Picardo
- Laboratory of Cutaneous Physiopathology & CIRM, Dermatologic San Gallicano Institute, Rome, Italy
| | - Stefania Crispi
- Gene Expression & Human Molecular Genetics Laboratory, Institute of Genetics & Biophysics, CNR, Naples, Italy
| | - Raffaele A Calogero
- Bioinformatics & Genomics Unit, Molecular Biotechnology Center, University of Turin, Turin, Italy
| | - Maria Teresa Piccolo
- Gene Expression & Human Molecular Genetics Laboratory, Institute of Genetics & Biophysics, CNR, Naples, Italy
| | - Maddalena Arigoni
- Bioinformatics & Genomics Unit, Molecular Biotechnology Center, University of Turin, Turin, Italy
| | | | - Mariarosaria Boccellino
- Department of Biochemistry, Biophysics & General Pathology, Second University of Naples, Naples, Italy
| | - Lucio Quagliuolo
- Department of Biochemistry, Biophysics & General Pathology, Second University of Naples, Naples, Italy
| | - Gianluigi Ferretti
- Division of Medical Oncology A, Regina Elena National Cancer Institute, Via E. Chianesi 53, 00144 Rome, Italy
| | - Paolo Carlini
- Division of Medical Oncology A, Regina Elena National Cancer Institute, Via E. Chianesi 53, 00144 Rome, Italy
| | - Alessandra Felici
- Division of Medical Oncology A, Regina Elena National Cancer Institute, Via E. Chianesi 53, 00144 Rome, Italy
| | | | - Francesco Cognetti
- Division of Medical Oncology A, Regina Elena National Cancer Institute, Via E. Chianesi 53, 00144 Rome, Italy
| | - Alfonso Baldi
- Department of Environmental, Biological & Pharmaceutical Sciences & Technologies, Second University of Naples, Naples, Italy
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Derosa L, Gernone A, Morelli F, Sava T, Zustovich F, Rossi L, Ferrari VD, Sabbatini R, Gasparro D, Felici A, Cascinu S, Calvani N, Lo Re G, Rizzo M, Iacovelli R, Bracarda S, Porta C, Galligioni E, Cogoni AA, Procopio G. Retrospective analysis of sorafenib as first or second target therapy in mRCC patients in Italian centers: An update. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e15524] [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
e15524 Background: With several agents available for the treatment of metastatic renal cell carcinoma (mRCC) a better understanding of their use in daily clinical practice is fundamental in the decision-making process. Methods: The REtrospective analysis of Sorafenib (So) as 1st or 2nd targET therapy (RESET) in mRCC was a retrospective, observational field study that assessed the use and safety of So in clinical practice in Italian centers. Treatments were determined by physicians per local prescribing guidelines. Patients (pts) treated with So single agent as 1st or 2nd target therapy (TT) for mRCC between 1st Jan 2008 and 31st Dec 2010 were eligible for inclusion. Endpoints included safety, overall survival (OS), progression-free survival, response rate and treatment duration. Subgroup analyses included age, ECOG performance status, prior therapy, number of metastases and line of TT with So. Results: From Feb to Jul 2012, 358 pts from 37 Italian centers were enrolled. The most common ≥ grade 3 drug-related adverse events were hand-foot skin reaction (6.7%), rash (2.2%), hypertension, fatigue and diarrhea (1.7% each). In the overall population, median OS was 17.2 months (mos) (95% CI 15.4 – 19.6 mos) and median PFS was 5.9 mos (95% CI 4.9-6.7 mos). Median duration of treatment with So was 5.03 mos. Disease control (complete response + partial response + stable disease) was observed in 198(56%) pts. In pts receiving So as first or as second TT median OS was 19.9 mos (95% CI 15.9-25.3 mos) and 16.3 mos (95% CI 13.0-18.2 mos) respectively. In the subgroup of pts treated with So 1st TT followed by sunitinib (Su) 2nd TT (44 pts) and Su 1st TT followed by So 2nd TT (173 pts), median OS was 30.4 mos (95% CI 22.0-34.8 mos) and 16.6 mos (95% CI 13.1-18.2 mos) respectively. There were 269(76%) pts that received a total of 2 lines of therapy for mRCC, 133(38%) pts 3 lines and 43(12%) pts 4 lines of therapy. Conclusions: The efficacy and safety profile of So in the setting of Italian community-based daily clinical practice was similar to data reported in prospective clinical trials. The efficacy of So was observed in both the subgroups of pts receiving So as either the first or second TT for mRCC, with intriguing OS data in first line.
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Affiliation(s)
- Lisa Derosa
- Division of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Angela Gernone
- Azienda Ospedaliera Universitaria Consorziale Policlinico, Bari, Italy
| | - Franco Morelli
- Oncology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Teodoro Sava
- Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Fable Zustovich
- Medical Oncology 1, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Lorena Rossi
- IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | | | - Roberto Sabbatini
- Azienda Ospedaliero Universitaria, Policlinico di Modena, Modena, Italy
| | | | - Alessandra Felici
- Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Stefano Cascinu
- Clinica di Oncologia Medica, A.O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
| | | | - Giovanni Lo Re
- Santa Maria Degli Angeli General Hospital, Pordenone, Italy
| | - Mimma Rizzo
- Azienda Ospedaliero di Rilievo Nazionale A. Cardarelli, Naples, Italy
| | - Roberto Iacovelli
- Department of Radiology Oncology and Human Pathology, Oncology Unit, Sapienza University of Rome, Rome, Italy
| | - Sergio Bracarda
- Department of Oncology, USL-8, Ospedale San Donato, Arezzo, Italy
| | - Camillo Porta
- IRCCS San Matteo University Hospital Foundation, Pavia, Italy
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Verzoni E, Iacovelli R, Rizzo M, Felici A, Cascinu S, Di Lorenzo G, Cerbone L, Ortega C, Masini C, Giganti MO, Lorusso V, Messina C, Atzori F, De Vincenzo F, Sacco C, Boccardo F, Valduga F, Massari F, Tassi R, Procopio G. Progression-free survival (PFS) and overall survival (OS) in patients receiving three targeted therapies (TTs) for metastatic renal cell carcinoma (mRCC). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.6_suppl.431] [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
431 Background: In recent years, TTs have improved the prognosis of mRCC patients (pts). Despite a non-negligible number of pts received 3 TTs in clinical practice, no TTs have been evaluated as third-line. Aim of this study is to investigate the clinical outcome in pts who received 3 TTs. Methods: Pts with clear-cell mRCC who received 3 TTs were included. A questionnaire was sent to main Italian centers involved in the treatment of mRCC. Demographic data, history of RCC, type and length of first-, second- and third-line were collected; MSKCC risk class was calculated before starting the first-line. Sequences were evaluated by class (TKI-TKI-mTOR vs. TKI-mTOR-TKI) or by drug (Su-So-Ev vs. Su-Ev-So). Median PFS, OS and Time to Strategy Failure (TTSF: from start of first- to end of thrid-line) were estimated with the Kaplan-Meyer method with 95% CI and curves were compared with log-rank test. Cox model was used to explore predictors of TTSF and OS. The study had the ethical approval. Results: 2,065 pts were screened and 281 pts (13%) were treated with 3 TTs. No differences were found between TKI-TKI-mTOR and TKI-mTOR-TKI groups. The TTSF was 36.5 (30.5–42.6) mos vs. 29.3 (23.6–34.9) mos (p=0.059), and the OS was 50.7 (40.6–60.8) vs. 37.8 (34.2–41.5) mos (p=0.004), for TKI-TKI-mTOR and and TKI-mTOR-TKI, respectively. TTSF for Su-So-Ev was 32.1 vs. 30.4 mos for Su-Ev-So (p=0.006). The median OS was not reached in the group treated with Su-So-Ev compared to 35.6 (95%CI, 31.6–39.6) mos in the group treated with Su-Ev-So (p<0.001). The univariate and multivariable Cox analyses for TTSF and OS showed that the only predictive factor is the primary resistance to 1st line (HR: 3.15, 95%CI, 1.98-4.99; p<0.001). The Prognostic factors are the initial MSKCC group (HR: 2.07, 95% CI, 1.41 -3.05; p<0.001), the sequence of therapy (HR: 2.59, 95% CI, 1.59-4.22; p<0.001) and the primary resistance to first line (HR: 2.20, 95% CI, 1.16-4.11; p<0.001). Conclusions: We report as the sequential treatment with two antiangiogenic inhibitors followed by an mTOR inhibitor could increase survival and the control disease in metastatic renal cell carcinoma.
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Affiliation(s)
- Elena Verzoni
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Iacovelli
- Department of Radiology Oncology and Human Pathology, Oncology Unit, Sapienza University of Rome, Rome, Italy
| | | | - Alessandra Felici
- Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Stefano Cascinu
- Department of Medical Oncology, Polytechnic University of the Marche Region, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I-GM Lancisi and G Salesi, Ancona, Italy, Ancona, Italy
| | | | | | - Cinzia Ortega
- Institute for Cancer Research and Treatment, Turin, Italy
| | - Cristina Masini
- A.O. Univ. Policl. di Modena Univ. Studi Modena e R. Emilia, Modena, Italy
| | | | - Vito Lorusso
- Oncologic Institute, Vito Fazzi Hospital, Lecce, Italy
| | | | | | | | | | | | | | | | - Renato Tassi
- Oncologia Medica 2, Università degli Studi di Firenze, Firenze, Italy
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Procopio G, Derosa L, Gernone A, Morelli F, Sava T, Zagonel V, De Giorgi U, Ferrari VD, Masini C, Gasparro D, Felici A, Berardi R, Calvani N, Lo Re G, Lipari H, Brizzi MP, Sisani M, Porta C, Galligioni E, Contu AS. Retrospective analysis of sorafenib as first- or second-line targeted therapy in patients with mRCC: Three-year Italian experience. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.6_suppl.415] [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
415 Background: The Retrospective analysis of Sorafenib (So) as the first- or second- target therapy (RESET) study in metastatic renal cell carcinoma (mRCC) patients assessed the use and safety of sorafenib under daily-life treatment conditions in a community-based patient population in Italian centers. Methods: RESET was a retrospective, observational, non-interventional field study in mRCC patients. Treatment decisions were determined by each physician according to local prescribing guidelines and clinical practice. Patients for whom a decision to treat with sorafenib single agent as first- or second- target therapy (TT) for mRCC has been made, were eligible for inclusion. Patients that started So treatment between January 1, 2008 and December 31, 2010 were included. Data collection started retrospectively in 2012, in order to have a period of observation of at least 1 year up to 31st Dec 2011. Endpoints included safety, overall survival (OS), progression-free survival (PFS), response rate (RR), and treatment duration. Subgroup analyses included age, Eastern Cooperative Oncology Group performance status, prior therapy, number of metastases, and line of TT with So. Results: From February to Jululy 2012, 358 pts from 37 Italian centers were enrolled. The most common ≥ grade 3 drug-related adverse events were hand-foot skin reaction (6.3%), rash (2.3%), hypertension, fatigue, and diarrhea (1.7% each). In the overall population, median OS was 17.2 months (mos) (95% CI 15.5 – 19.6 mos) and median PFS was 5.9 mos (95% CI 5.0-6.8 mos). Median duration of treatment with So was 5.09 mos. Complete response was observed in 3 (0.8%) pts, partial response in 53(15.0%) pts and stable disease in 139(39.4%) pts. In pts receiving So as first- or second- TT, median OS was 19.9 mos (95% CI 15.4-25.3 mos) and 16.6 mos (95% CI 13.1-18.4 mos) respectively, and median PFS was 6.6 mos (95% CI 4.9-9.3 mos) and 5.3 mos (95% CI 4.4-6.2 mos) respectively. Conclusions: The efficacy and safety of So under routine clinical practice conditions in the setting of community-based practice in Italy were similar to that reported in prospective clinical trials. The efficacy of So was observed in the subgroup of pts receiving So as either the first or second TT for mRCC.
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Affiliation(s)
| | - Lisa Derosa
- Division of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | | | - Franco Morelli
- Medical Oncology, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Vittorina Zagonel
- Oncologia Medica 1, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | | | | | - Cristina Masini
- Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | | | - Alessandra Felici
- Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Rossana Berardi
- Clinica di Oncologia Medica, A.O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
| | - Nicola Calvani
- Medical Oncology and Breast Unit, Antonio Perrino Hospital, Brindisi, Italy
| | - Giovanni Lo Re
- Santa Maria Degli Angeli General Hospital, Pordenone, Italy
| | - Helga Lipari
- Division of Medical Oncology, Cannizzaro Hospital, Catania, Italy
| | - Maria Pia Brizzi
- Oncology - Azienda Ospedaliero-Universitaria San Luigi Gonzaga, Orbassano, Italy
| | | | - Camillo Porta
- Oncologia Medica, Fondazione IRCCS Policlinico Universitario San Matteo, Pavia, Italy
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Milella M, Di Lorenzo G, Felici A, Aieta M, Re GL, Boni C, Aitini E, Villa E, De Placido S, Cognetti F. Medical Optimization of Torisel® (MOTOR): A Phase II Trial of Temsirolimus as Second-Line Treatment for Advanced RCC by the Italian Kidney Cancer Group (GIR). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33418-9] [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] Open
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Milella M, Massari F, La Russa F, Maines F, Felici A, Vaccaro V, Porta C, Bracarda S, Cognetti F, Giannarelli D, Tortora G, Bria E. PFS to predict long-term OS after first-line treatment for advanced renal cell carcinoma (aRCC): Correlation and power analysis of randomized trials (RCT). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.4541] [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
4541 Background: Targeted agents (TA) have become standard 1st line aRCC treatment based on evidence of PFS advantage. Retrospective series indicatePFS as a reliable intermediate end-point in this setting; however, correlation, surrogacy testing, and validation are required. Methods: RCT evaluating the efficacy of TA as 1st line treatment for aRCC were eligible. PFS/OS Response/Disease Control rates (ORR, DCR) and HR were extracted from papers/updated presentations. Correlations between 6-, 9-, and 12-mo PFS and OS rates according to parametric (Pearson’s r) and non-parametric (Spearman’s Rho and Kendall’s Tau) coefficients (with 95% CI) were analyzed to avoid lead-time biases. Regression analysis (parametric R2) and a power-analysis-model to determine patients’ sample necessary to detect 3%, 5% and 10% OS gain were developed. Results: Six RCT (4096 pts) were gathered. The best overall correlation between PFS and OS at concurrent timepoints was found at 9 mos. With regard to overall rates, 3- and 6-mo PFS significantly correlated with 9-mo OS, as shown in the table below. Pearson’s coefficients for the correlation between 3-mo PFS and 6- and 12-mo OS were 0.70 (p=0.01) and 0.67 (p=0.01); the correlation between 6-mo PFS and 12-mo OS was also significant (Pearson 0.74, p=0.005; Spearman 0.83, p=0.005; Tau 0.71, p=0.001). The regression equation was: Y=0.391861 + 0.4914X [R2 0.44, p(slope)=0.01]; based on this model, the demonstration of a 3-mo PFS absolute difference of 6%, 10% and 21% (corresponding to a 9-mo OS benefit of 3%, 5% and 10%) would require 2043, 696 and 155 patients, respectively. A significant correlation was also found between DCR and OS. Conclusions: Early PFS is an acceptable intermediate end-point for OS in the context of 1st line TA for aRCC. Individual patient data analysis to verify Prentice criteria would be required for definitive confirmation. [Table: see text]
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Affiliation(s)
| | | | | | | | - Alessandra Felici
- Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | | | - Camillo Porta
- Oncologia Medica, Fondazione IRCCS Policlinico Universitario San Matteo, Pavia, Italy
| | - Sergio Bracarda
- Department of Oncology, USL-8, Ospedale San Donato, Arezzo, Italy
| | | | | | | | - Emilio Bria
- Medical Oncology, University of Verona, Verona, Italy
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Milella M, Felici A, Lorenzo GD, Aieta M, Ardito R, Boni C, Rondini E, Aitini E, Villa E, Re GL, Algeri R, Foa P, Amoroso D, Moscetti L, Gallucci M, Giannarelli D, Placido SD, Cognetti F. Abstract LB-226: mTOR inhibition by Temsirolimus as second-line treatment for advanced RCC: The Medical optimization of Torisel® (MoTOR) phase II trial by the Italian Kidney Cancer Group (GIR). Cancer Res 2012. [DOI: 10.1158/1538-7445.am2012-lb-226] [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: 11/16/2022]
Abstract
Abstract
Background: The mammalian target of rapamycin (mTOR) kinase is an essential regulator of growth and response to hypoxic and metabolic stress and a well-established therapeutic target in renal cell carcinoma (RCC). The mTOR inhibitor Temsirolimus (CCI-779, Torisel®) is the first-line treatment of choice for RCC patients with poor-risk features. Preclinical and clinical evidence indicates that mTOR inhibitors may be effective in controlling RCC growth, even after resistance to agents targeting the VEGF/VEGFR axis ensues. Thus we designed a multicenter phase II trial to assess the activity and safety of Temsirolimus as II-line treatment for advanced RCC patients (pts). Methodology: This was an open-label, multicenter, phase II trial of Temsirolimus (25 mg/wk i.v.), administered to advanced RCC pts with documented progression after I-line treatment. Primary endpoint was PFS rate at 6 mos. Tumor response was assessed every 8 wks. Considering a 6-mo PFS rate of 20% unacceptable (p0=20%) and a 6-mo PFS rate of 40% (p1=40%) of interest, a minimum targeted accrual of 47 pts in the sunitinib-pretreated group was to be pursued in order to reach 90% power at a significance level of 5%. Pts who underwent any other I-line treatment were allowed on study until the target accrual in the sunitinib-pretreated group was met. Results: From May 2009 to January 2012, 76 pts were enrolled (median age: 67 yrs, range: 36-86; M/F: 58/18; ECOG PS 0/1/2: 51/19/6); I-line therapy included sunitinib (60 pts), bevacizumab (8), sorafenib (3), cytokines (2), or other (3). With 18/57 evaluable patients free from progression at 6 mos in the sunitinib-pretreated group the primary endpoint was met. Median PFS was 4.0 mos (95% CI: 2.7-5.3) and 4.6 mos (95% CI: 2.8-6.5) in the overall (n=71) and sunitinib-pretreated (n=57) populations, respectively; OS in the same groups was 13.7 mos (95% CI: 9.1-18.3) and 14.6 mos (95% CI: 8.9-20.3), respectively. Six out of 71 pts (8%) had PR and 33/71 (46%) had SD as their best response. Toxicity (n=68) was mild with G3 anemia, neutropenia and thrombocytopenia in 2, 1, and 1 pts, respectively; G3 hyperglycemia and G3 hypertriglyceridemia in 2 and 7 pts, respectively; G4 hypercholesterolemia in 2 pts; G3 stomatitis in 5 pts; G3 asthenia in 3 pts; G3-4 pulmonary toxicity in 2 pts; G3 diarrhea in 2 pts; G3 cutaneous rash in 1 pt. Only 1 hypersensitivity reaction occurred during Temsirolimus infusion. Treatment compliance was good, with <10% of weekly administrations omitted and 15/67 (22%) pts requiring dose reductions (to 20 mg/wk and 15 mg/wk in 11 and 4 pts, respectively). Mean number of weekly administrations received was 15. Conclusions. Temsirolimus is an active and well-tolerated II-line treatment for advanced RCC, particularly in sunitinib-pretreated pts, and may constitute a suitable therapeutic option in this setting.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr LB-226. doi:1538-7445.AM2012-LB-226
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Affiliation(s)
| | | | | | - Michele Aieta
- 3Ospedale Oncologico Regionale, Rionero in Vulture, Italy
| | | | - Corrado Boni
- 4Arcispedale S.Maria Nuova, Reggio Emilia, Italy
| | | | | | - Eugenio Villa
- 6Istituto Scientifico S.Raffaele - IRCCS, Milan, Italy
| | - Giovanni Lo Re
- 7Azienda Ospedaliera Santa Maria degli Angeli, Pordenone, Italy
| | | | - Paolo Foa
- 9Azienda Ospedaliera S. Paolo, Polo Universitario, Milan, Italy
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Cognetti F, Ruggeri EM, Felici A, Gallucci M, Muto G, Pollera CF, Massidda B, Rubagotti A, Giannarelli D, Boccardo F. Adjuvant chemotherapy with cisplatin and gemcitabine versus chemotherapy at relapse in patients with muscle-invasive bladder cancer submitted to radical cystectomy: an Italian, multicenter, randomized phase III trial. Ann Oncol 2012; 23:695-700. [PMID: 21859900 DOI: 10.1093/annonc/mdr354] [Citation(s) in RCA: 158] [Impact Index Per Article: 13.2] [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: 11/14/2022] Open
Abstract
BACKGROUND The purpose of the study was to evaluate the benefit of adjuvant chemotherapy (AC) versus surgery alone in patients with muscle-invasive bladder cancer (MIBC). PATIENTS AND METHODS One hundred and ninety-four patients with pT2G3, pT3-4, N0-2 transitional cell bladder carcinoma were randomly allocated to control (92 patients) or to four courses of AC (102 patients). These latter patients were further randomly assigned to receive gemcitabine 1000 mg/m(2) days 1, 8 and 15 and cisplatin 70 mg/m(2) day 2 or gemcitabine as above plus cisplatin 70 mg/m(2) day 15, every 28 days. RESULTS At a median follow-up of 35 months, the 5-year overall survival (OS) was 48.5%, with no difference between the two arms [P = 0.24, hazard ratio (HR) 1.29, 95% confidence interval (CI) 0.84-1.99]. Mortality hazard was significantly correlated with Nodes (N) and Tumor (T) stage. The control and AC arms had comparable disease-free survival (42.3% and 37.2%, respectively; P = 0.70, HR 1.08, 95% CI 0.73-1.59). Only 62% of patients received the planned cycles. A significant higher incidence of thrombocytopenia was observed in patients receiving cisplatin on day 2 (P = 0.006). A similar global quality of life was observed in the two arms. CONCLUSION The study was underpowered to demonstrate that AC with cisplatin and gemcitabine improves OS and disease-free survival in patients with MIBC.
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Affiliation(s)
- F Cognetti
- Department of Medical Oncology, Regina Elena Cancer Institute, Rome.
| | - E M Ruggeri
- Division of Medical Oncology, Belcolle Hospital, Viterbo
| | - A Felici
- Department of Medical Oncology, Regina Elena Cancer Institute, Rome
| | - M Gallucci
- Department of Urology, Regina Elena Cancer Institute, Rome
| | - G Muto
- Department of Urology, San Giovanni Bosco Hospital, Torino
| | - C F Pollera
- Division of Medical Oncology, Belcolle Hospital, Viterbo
| | - B Massidda
- Department of Medical Oncology, Policlinico Universitario, Cagliari
| | - A Rubagotti
- Departments of Medical Oncology and of Oncology, Biology and Genetics (Biostatistics Unit), National Cancer Research Institute and University, Genova; Departments of Medical Oncology and of Oncology, Biology and Genetics, National Cancer Research Institute and University, Genova
| | - D Giannarelli
- Department of Biostatistics, Regina Elena Cancer Institute, Rome, Italy
| | - F Boccardo
- Departments of Medical Oncology and of Oncology, Biology and Genetics, National Cancer Research Institute and University, Genova
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Abstract
Prostate cancer (PC) is the leading cause of cancer and the second leading cause of cancer-death among men in the Western world. About 10-20% of men with PC present with metastatic disease at diagnosis, while 20-30% of patients diagnosed with localized disease will eventually develop metastases. Although most respond to initial androgen-deprivation therapy (ADT), progression to castration-resistant PC (CRPC) is universal. In 2004 the docetaxel/prednisone regimen was approved for the management of patients with metastatic CRPC, becoming the standard first-line therapy. Recent advances have now led to an unprecedented number of new drug approvals within the past years, providing many new treatment options for patients with metastatic CRPC. Four new drugs have received U.S. Food and Drug Administration (FDA)-approval in 2010 and 2011: sipuleucel-T, an immunotherapeutic agent; cabazitaxel, a novel microtubule inhibitor; abiraterone acetate, a new androgen biosynthesis inhibitor; and denosumab, a bone-targeting agent. The data supporting the approval of each of these agents are described in this review, as are current approaches in the treatment of metastatic CRPC and ongoing clinical trials of novel treatments and strategies.
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Affiliation(s)
- A. Felici
- Department of Medical Oncology, Regina Elena National Cancer InstituteRome, Italy
| | - M. S. Pino
- Medical Oncology Unit, Department of Oncology, Azienda Sanitaria FirenzeFlorence, Italy
| | - Paolo Carlini
- Department of Medical Oncology, Regina Elena National Cancer InstituteRome, Italy
- *Correspondence: Paolo Carlini, Department of Medical Oncology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy. e-mail:
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Abstract
In the past ten years we have made exceptional progresses in the understanding of RCC biology, particularly by recognizing the crucial pathogenetic role of activation of the HIF/VEGF and mTOR pathways. This has resulted in the successful clinical development of anti-angiogenic and mTOR-targeted drugs, which have profoundly impacted on the natural history of the disease and have improved the duration and quality of RCC patient lives. However, further improvements are still greatly needed: 1) even in patients who obtain striking clinical responses early in the course of treatment, disease will ultimately escape control and progress to a treatment-resistant state, leading to therapeutic failure; 2) prolonged disease control usually requires 'continuous' treatment, even across different treatment lines, making the impact of chronic, low-grade, toxicities on quality of life greater and precluding, for most patients, the possibility of experiencing 'drug-free holidays'; 3) although we have successfully identified classes of drugs (or molecular mechanisms of action) that are effective in a substantial proportion of patients, we still fall short of molecular predictive factors that identify individual patients who will (or will not) benefit from a specific intervention and still proceed on a trial-and-error basis, far from a truly 'personalized' therapeutic approach; 4) finally (and perhaps most importantly), even in the best case scenario, currently available treatments inevitably fail to definitively 'cure' metastatic RCC patients. In this review we briefly summarize recent developments in the understanding of the molecular pathogenesis of RCC, the development of resistance/escape mechanisms, the rationale for sequencing agents with different mechanisms of action, and the importance of host-related factors. Unraveling the complex mechanisms by which RCC shapes host microenvironment and immune response and therapeutic treatments, in turn, shape both cancer cell biology and tumor-host interactions may hold the key to future advances in such a complex and challenging disease.
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Affiliation(s)
- Michele Milella
- Division of Medical Oncology A, Regina Elena national Cancer Institute, Rome Italy
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Felici A, Naso G, Di Segni S, Vici P, Antenucci A, Angelini F, Pizzuti L, Mandoj C, D'Auria G, Fabi A, Tata A, Cognetti F, Papaldo P. Fulvestrant administered in two different schedules: Pharmacokinetics, biological markers, and activity. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e11026] [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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Piazza A, Canossi A, Buonomo O, Rocco M, Beato T, Torlone N, Felici A, Cortini C, Casciani C, Adorno D. HLA class I residue mismatch and renal graft outcome. Transpl Int 2011. [DOI: 10.1111/j.1432-2277.2000.tb02079.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fabi A, Felici A, Metro G, Mirri A, Bria E, Telera S, Moscetti L, Russillo M, Lanzetta G, Mansueto G, Pace A, Maschio M, Vidiri A, Sperduti I, Cognetti F, Carapella CM. Brain metastases from solid tumors: disease outcome according to type of treatment and therapeutic resources of the treating center. J Exp Clin Cancer Res 2011; 30:10. [PMID: 21244695 PMCID: PMC3033846 DOI: 10.1186/1756-9966-30-10] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Accepted: 01/18/2011] [Indexed: 01/08/2023]
Abstract
Background To evaluate the therapeutic strategies commonly employed in the clinic for the management of brain metastases (BMs) and to correlate disease outcome with type of treatment and therapeutic resources available at the treating center. Methods Four Cancer centres participated to the survey. Data were collected through a questionnaire filled in by one physician for each centre. Results Clinical data regarding 290 cancer patients with BMs from solid tumors were collected. Median age was 59 and 59% of patients had ≤ 3 brain metastases. A local approach (surgery and stereotactic radiosurgery) was adopted in 31% of patients. The local approach demonstrated to be superior in terms of survival compared to the regional/systemic approach (whole brain radiotherapy and chemotherapy, p = <.0001 for survival at 2 years). In the multivariate analysis local treatment was an independent prognostic factor for survival. When patients were divided into 2 groups whether they were treated in centers where local approaches were available or not (group A vs group B respectively, 58% of patients with ≤ 3 BMs in both cohorts), more patients in group A received local strategies although no difference in time to brain progression at 1 year was observed between the two groups of patients. Conclusions In clinical practice, local strategies should be integrated in the management of brain metastases. Proper selection of patients who are candidate to local treatments is of crucial importance.
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Affiliation(s)
- Alessandra Fabi
- Department of Medical Oncology, Regina Elena National Cancer Institute, Rome - Italy.
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Di Lorenzo G, Buonerba C, Federico P, Rescigno P, Milella M, Ortega C, Aieta M, D'Aniello C, Longo N, Felici A, Ruggeri EM, Palmieri G, Imbimbo C, Aglietta M, De Placido S, Mirone V. Third-line sorafenib after sequential therapy with sunitinib and mTOR inhibitors in metastatic renal cell carcinoma. Eur Urol 2010; 58:906-11. [PMID: 20884115 DOI: 10.1016/j.eururo.2010.09.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 09/06/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sunitinib and everolimus have been approved for first- and second-line treatment, respectively, in metastatic renal cell carcinoma (mRCC). The role of sorafenib, which is approved for second-line treatment after cytokines failure, is presently to be defined. OBJECTIVE To determine whether third-line sorafenib after sequential use of sunitinib and mammalian target of rapamycin inhibitors (everolimus or temsirolimus) is feasible and effective. DESIGN, SETTING, AND PARTICIPANTS One hundred fifty medical records of patients with mRCC treated with first-line sunitinib between January 2006 and January 2010 were reviewed at four participating centers. Data regarding patients treated with the sequence sunitinib-everolimus or temsirolimus-sorafenib were extracted. Central analysis of radiographic images was performed using RECIST criteria to determine progression-free survival (PFS) and overall response rate (oRR) to sorafenib treatment. MEASUREMENTS PFS and oRR to sorafenib were the primary end points. Secondary outcomes were safety and overall survival (OS). RESULTS AND LIMITATIONS Thirty-four patients were eligible for the study. A median PFS of 4 mo (range: 3-6 mo) and a median OS of 7 mo since sorafenib treatment (range: 6-10 mo) were reported. Of the patients, 23.5% showed response to sorafenib, with an overall disease control rate (complete responses plus partial responses plus stable disease) of 44%. Selection bias, data incompleteness, and absence of study design are inevitable limitations of the study, although central review can strengthen the quality of presented data. CONCLUSIONS Third-line sorafenib appears to be active and well tolerated in mRCC after first-line sunitinib and second-line everolimus or temsirolimus, with no patients interrupting sorafenib because of toxicity or lack of compliance. Prospective, placebo-controlled trials are completely lacking and are required in this setting.
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Affiliation(s)
- Giuseppe Di Lorenzo
- Dipartimento di Endocrinologia ed Oncologia Clinica e Molecolare, Università Federico II, Napoli, Italy.
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Papaldo P, Metro G, Felici A, Russillo M, Pellegrini D, Fabi A, Ferretti G, Introna M, Cognetti F. Individualized administration of capecitabine plus lapatinib in heavily pretreated HER2+ metastatic breast cancer patients: A single-center experience. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.1108] [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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Ferretti G, Fabi A, Felici A, Papaldo P. Improved prognosis by trastuzumab of women with HER2-positive breast cancer compared with those with HER2-negative disease. J Clin Oncol 2010; 28:e337; author reply e338-9. [PMID: 20479395 DOI: 10.1200/jco.2010.28.2525] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Affiliation(s)
- Gianluigi Ferretti
- Division of Medical Oncology A, Regina Elena Cancer Institute, Rome, Italy
| | - Alessandra Felici
- Division of Medical Oncology A, Regina Elena Cancer Institute, Rome, Italy
| | - Francesco Cognetti
- Division of Medical Oncology A, Regina Elena Cancer Institute, Rome, Italy
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Di Cosimo S, Ferretti G, Fazio N, Silvestris N, Carlini P, Alimonti A, Gelibter A, Felici A, Papaldo P, Cognetti F. Docetaxel in advanced gastric cancer--review of the main clinical trials. Acta Oncol 2009; 42:693-700. [PMID: 14690154 DOI: 10.1080/02841860310011014] [Citation(s) in RCA: 13] [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: 12/15/2022]
Abstract
The aim was to investigate the activity of docetaxel in advanced gastric cancer either as single agent or in combination with other drugs. A systematic review was carried out using the databases of Medline, Embase and CancerLit. Results from ASCO and ESMO meetings during 2002 were also included. Eight phase II trials focused on docetaxel as a single agent. Considering collectively the 262 evaluable patients enrolled in these studies, the mean response rate (RR) was 19% (CI 95% 14-24%). Docetaxel was well tolerated with a dose-limiting myelosuppression (grade 3-4 neutropenia in 36-95% of cases). Adding fluorouracil, an RR ranging from 22% to 86% was registered, due to differences in populations studied (young vs elderly) and modalities of drug administration (continuous vs. bolus infusion). RRs for docetaxel-cisplatin combination were 56%, 37% and 36% in three phase II trials and 35% in a phase III trial. The addition of both cisplatin and fluorouracil to docetaxel did not increase toxicity. Randomized trials comparing docetaxel-cisplatin-fluorouracil with ciplatin-fluorouoracil or epirubicin-cisplatin-fluorouracil, the most commonly used regimens, are ongoing. The future results of the above phase III studies could indicate docetaxel as a key drug to improve treatment of patients with advanced gastric cancer.
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Affiliation(s)
- Serena Di Cosimo
- Division of Medical Oncology A, Regina Elena Cancer Institute, Rome, Italy
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Fabi A, Vidiri A, Ferretti G, Felici A, Papaldo P, Carlini P, Mirri A, Nuzzo C, Cognetti F. Dramatic Regression of Multiple Brain Metastases from Breast Cancer with Capecitabine: Another Arrow at the Bow? Cancer Invest 2009; 24:466-8. [PMID: 16777702 DOI: 10.1080/07357900600705805] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Several chemotherapic agents, which are active against breast cancer, penetrate poorly into the central nervous system. Despite its limited brain penetration, 5-fluorouracil has been a component of effective regimens for brain metastases. Capecitabine is a recently developed oral prodrug that is converted into 5-fluorouracil by sequential enzymatic steps. Thymidine phosphorylase (TP) is the final enzyme responsible for Capecitabine activation. Studies have demonstrated that high intratumoral levels of TP and low levels of its catabolite dihydropyrimidine-dehydrogenase are correlated with the capecitabine response. The penetration of Capecitabine across the brain-blood barrier remains unknown; we report the case of and discuss a breast cancer patient who had an interesting response of brain metastases with Capecitabine in monochemotherapy before brain irradiation.
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Felici A, Di Segni S, Milella M, Colantonio S, Sperduti I, Nuvoli B, Contestabile M, Sacconi A, Zaratti M, Citro G, Cognetti F. Pharmacokinetics of gemcitabine at fixed-dose rate infusion in patients with normal and impaired hepatic function. Clin Pharmacokinet 2009; 48:131-41. [PMID: 19271785 DOI: 10.2165/00003088-200948020-00005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Gemcitabine (2,2-difluorodeoxycytidine [dFdC]) can be administered in a standard 30-minute infusion or in a fixed-dose-rate (FDR) infusion to maximize the rate of accumulation of triphosphate, its major intracellular metabolite. The standard 30-minute infusion requires dose adjustment in patients with organ dysfunction, especially in patients with elevated baseline serum bilirubin levels. On the other hand, the FDR infusion is burdened by increased haematological toxicity. The primary aim of this study was to evaluate the pharmacokinetics of dFdC and its metabolite difluorodeoxyuridine (dFdU) in patients with normal and impaired hepatic function. PATIENTS AND METHODS In this prospective study, patients with pancreatic or biliary tract carcinoma and normal or impaired hepatic function tests were considered eligible for recruitment. Patients were recruited according to the following criteria: (i) serum bilirubin <1.6 mg/dL and AST and ALT <2 times the upper the limit of normal (ULN) [cohort I]; and (ii) serum bilirubin >1.6 mg/dL and/or AST/ALT >2 times the ULN (cohort II). An FDR infusion of gemcitabine 1000 mg/m2 was administered on days 1, 8 and 15 every 4 weeks. The pharmacokinetic analysis of gemcitabine and dFdU was performed with high-performance liquid chromatography-tandem mass spectrometry assay in cycles 1 and 2. RESULTS Thirteen patients were enrolled, four in cohort I and nine in cohort II. All patients were assessable for toxicity and pharmacokinetic analysis. The grade and rate of toxicities were similar in both groups, and patients with elevation of bilirubin and/or transaminases did not require dose reduction of gemcitabine. Pharmacokinetic analysis revealed a reduction of the experimental area under the plasma concentration-time curve for gemcitabine and dFdU in patients with hepatic dysfunction when compared with patients with normal hepatic function. All other pharmacokinetic parameters were similar in the two cohorts. No statistical difference was demonstrated for all parameters evaluated between cycle 1 and cycle 2 in the two groups. CONCLUSION Gemcitabine 1000 mg/m2 can be administered as an FDR infusion in patients with altered hepatic function without causing additional toxicity compared with patients with normal hepatic function.
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Affiliation(s)
- Alessandra Felici
- Laboratory of Pharmacokinetics, Regina Elena Cancer Institute, Rome, Italy.
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Felici A, Russillo M, Di Segni S, Fabi A, Ferretti G, Carlini P, Contestabile M, Nuvoli B, Sperduti I, Cognetti F, Papaldo P. Dose-escalating study of continuative low dose of oral vinorelbine in patients with advanced breast cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.1128] [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
1128 Background: Low and continuative dose of antineoplastic drugs has been shown to have an antiangiogenic activity. The rapid absorption and relatively short half-life of the oral formulation of vinorelbine are favorable pharmacokinetic characteristics to test a continuative low-dose schedule. Methods: Patients with measurable metastatic breast cancer were treated with escalating dose of oral vinorelbine from 50 mg/m2 per week to 90 mg/m2 per week until progressive disease or unacceptable toxicity. These patients were administered one third of the total weekly dose 3 times per week, every other day. A pharmacokinetic analysis was planned at the first 3 weeks of drug assumption. Results: Of twenty-two patients included in the study, 3 were treated at 50 mg/m2/w (level 1), 5 at 60 mg/m2/w (level 2), 3 at 70 mg/m2/w (level 3), 8 at 80 mg/m2/w (level 4), and 3 at 90 mg/m2/w (level 5); we are still enrolling patients at this level. The median age was 59 years (range 23–75). The median number of prior lines of chemotherapy and hormonal therapy was 2 (range 0–4 for CT and 0–5 for OT). Fifteen of 22 patients had visceral metastasis. No dose-limiting toxicities have been observed until now. The main toxicities were: asymptomatic neutropenia grade 4 in two patients (1 in level 4 and 1 in level 5), asthenia grade 3 in 7 patients (1 at level 1, 2 at level 2, 1 at level 3, 3 at level 4), neurotoxicity grade 3 in two patients (one at level 2 and one at level 4). One patient experienced an intestinal sub-occlusion and hospitalization was required with no permanent side effects. One patient had a partial response, five a stable disease, fourteen progressed and two are not evaluated yet. At 1 year, five of the twenty evaluable patients are died by disease. Samples of twenty patients were collected for pharmacokinetic analysis that will be presented at the meeting. Conclusions: The continuative split 3 times per week oral vinorelbine is feasible, and at 90 mg/m2/w we have not reached yet the maximum tolerated dose. No significant financial relationships to disclose.
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Affiliation(s)
- A. Felici
- Regina Elena National Cancer Institute, Rome, Italy
| | - M. Russillo
- Regina Elena National Cancer Institute, Rome, Italy
| | - S. Di Segni
- Regina Elena National Cancer Institute, Rome, Italy
| | - A. Fabi
- Regina Elena National Cancer Institute, Rome, Italy
| | - G. Ferretti
- Regina Elena National Cancer Institute, Rome, Italy
| | - P. Carlini
- Regina Elena National Cancer Institute, Rome, Italy
| | | | - B. Nuvoli
- Regina Elena National Cancer Institute, Rome, Italy
| | - I. Sperduti
- Regina Elena National Cancer Institute, Rome, Italy
| | - F. Cognetti
- Regina Elena National Cancer Institute, Rome, Italy
| | - P. Papaldo
- Regina Elena National Cancer Institute, Rome, Italy
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Cuppone F, Bria E, Carlini P, Milella M, Felici A, Sperduti I, Nisticò C, Terzoli E, Cognetti F, Giannarelli D. Taxanes as primary chemotherapy for early breast cancer. Cancer 2008; 113:238-46. [DOI: 10.1002/cncr.23544] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Cognetti F, Ruggeri EM, Felici A, Gallucci M, Muto G, Pollera CF, Massidda B, Rubagotti A, Giannarelli D, Boccardo F. Adjuvant chemotherapy (AC) with cisplatin + gemcitabine (CG) versus chemotherapy (CT) at relapse (CR) in patients (pts) with muscle-invasive bladder cancer (MIBC) submitted to radical cystectomy (RC). An Italian multicenter randomised phase III trial. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.5023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [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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Papaldo P, Russillo M, Ferretti G, Giannarelli D, Carlini P, Metro G, Felici A, Toglia G, Graziano V, Cognetti F. Trastuzumab-related cardiotoxicity in setting outside clinical trials: A mono-institutional experience. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.22116] [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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Metro G, Fabi A, Russillo M, Papaldo P, De Laurentiis M, Ferretti G, Pellegrini D, Nuzzo C, Graziano V, Vici P, Introna M, Felici A, Cognetti F, Carlini P. Taxanes and gemcitabine doublets in the management of HER-2 negative metastatic breast cancer: towards optimization of association and schedule. Anticancer Res 2008; 28:1245-1258. [PMID: 18505062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The management of human epidermal receptor-2 (HER-2) negative metastatic breast cancer (MBC) is usually problematic, since no standard therapy exists in this setting. For some patients, combination chemotherapy represents a valuable approach, although its use is often limited by the risks of increased toxicity as well as impairments in quality of life (QoL) that often outweigh the marginal efficacy benefit. Against this background, the use of taxanes, either paclitaxel or docetaxel, in combination with gemcitabine as first-line treatment of HER-2 negative MBC is supported by the evidence of the single-agent activity of these drugs, beneficial pharmacological interactions, different mechanisms of action and largely non superimposable toxicity profiles. A number of phase II studies have explored the activity of a taxane plus gemcitabine in both chemonaïve and pretreated MBC patients, all showing remarkably high response rates and exceptional tolerability. In randomized phase III trials, the paclitaxel and gemcitabine combination showed significant improvements in objective responses, time to progression and overall survival, as compared to paclitaxel monotherapy, whereas the docetaxel and gemcitabine doublet demonstrated equal efficacy and better tolerability, as compared to docetaxel plus capecitabine. In addition to standard threeweekly dosing regimens, alternative schedules of administration of taxanes and gemcitabine doublets (weekly, twoweekly) might deserve further investigation due to their potential usefulness in reducing pharmacological toxicity while maintaining or increasing dose-intensity and clinical efficacy. Furthermore, uncertainty exists on which taxane should be preferred in combination with gemcitabine, since no head-to-head comparison between paclitaxel-gemcitabine and docetaxel-gemcitabine has been performed so far. Ongoing trials will address these issues and future investigations will also include the evaluation of bevacizumab, the monoclonal antibody targeted against vascular endothelial growth factor (VEGF), in combination with taxanes and gemcitabine doublets.
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Affiliation(s)
- Giulio Metro
- Division of Medical Oncology A, Regina Elena National Cancer Institute, Rome, Italy
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