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Pasello G, Lorenzi M, Scattolin D, Del Conte A, Cecere F, Pavan A, Macerelli M, Polo V, Pilotto S, Santarpia M, Cumerlato E, Da Ros V, Targato G, Bortolami A, Bonanno L, Ferro A, Dal Maso A, Frega S, Guarneri V. Osimertinib in Patients With Treatment-Naive EGFR-Mutant Non-small Cell Lung Cancer: Overall Survival, Post-progression Management and Budget Impact Analysis in Real-World. Oncologist 2024:oyae043. [PMID: 38520745 DOI: 10.1093/oncolo/oyae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/05/2024] [Indexed: 03/25/2024] Open
Abstract
INTRODUCTION The observational multicenter prospective FLOWER study (NCT04965701) confirmed effectiveness and safety of osimertinib in the real-world (RW) management of untreated EGFR-mutant advanced non-small cell lung cancer (aNSCLC) patients. METHODS Herein, we report updated survival data, post-progression management, cost/effectiveness and budget impact (BI) of osimertinib compared with a RW population receiving gefitinib or erlotinib. RESULTS Overall, 189 Caucasian patients receiving first-line osimertinib were included. After a follow-up of 20.7 months, 74(39.2%) patients discontinued osimertinib, median time-to-treatment discontinuation (mTTD) was 27.9 months, overall survival 36.8 months. At progression, tissue biopsy was performed in 29 (56.9%), liquid biopsy in 15 (29.4%) and both in 7 (13.7%) cases. The most frequent resistant mechanism was MET amplification (N = 14, 29.8%). At data cutoff, 13 (6.9%) patients were continuing osimertinib beyond progression; 52 (67.5%) received second-line treatment; no further treatments were administered in 25 (32.5%) cases. Thirty-three (63.4%) patients received chemotherapy, 12(23.1%) TKIs combination. Cost-effectiveness analysis showed a total cost per patient based on RW mTTD of 98,957.34€, 21,726.28€ and 19,637.83€ for osimertinib, erlotinib and gefitinib, respectively. The incremental cost-effectiveness ratio (ICER)/month for osimertinib was 359,806.0€/life-year-gained (LYG) and 197,789.77€/LYG compared to erlotinib and gefitinib. For osimertinib, the BI-gap between RW-TTD and theoretical-TTD was 16,501.0€ per patient. CONCLUSIONS This updated analysis confirms the effectiveness of osimertinib in RW. Although the ICER of osimertinib seems not cost-effective, additional costs for the management of disease progression to old generation TKIs were not considered in this study. The BI-gap suggests RW mTTD as a more reliable measure for expense estimation.
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Affiliation(s)
- Giulia Pasello
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
| | - Martina Lorenzi
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
| | - Daniela Scattolin
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
| | - Alessandro Del Conte
- Medical Oncology and Immunorelated Tumors, National Cancer Institute Centro di Riferimento Oncologico (CRO) - IRCCS, Aviano (PN), Italy
| | - Fabiana Cecere
- Oncology 1, Regina Elena National Cancer Institute - IRCCS, Roma, Italy
| | - Alberto Pavan
- Medical Oncology Department, Azienda Unità Locale Socio Sanitaria (AULSS 3) Serenissima, Mestre-Venezia, Italy
| | - Marianna Macerelli
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Valentina Polo
- Oncology Unit, AULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy
| | - Sara Pilotto
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Verone, Italy
| | | | - Enrico Cumerlato
- Medical Oncology, AULSS 6 Euganea, South Padua Hospital, Monselice (PD), Italy
| | - Valentina Da Ros
- Medical Oncology and Immunorelated Tumors, National Cancer Institute Centro di Riferimento Oncologico (CRO) - IRCCS, Aviano (PN), Italy
| | - Giada Targato
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Alberto Bortolami
- Veneto Oncology Network, Istituto Oncologico Veneto, I.R.C.C.S., Padua, Italy
| | - Laura Bonanno
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
| | - Alessandra Ferro
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
| | - Alessandro Dal Maso
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
| | - Stefano Frega
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
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De Carlo E, Bertoli E, Schiappacassi M, Stanzione B, Del Conte A, Doliana R, Spina M, Bearz A. Case report: First evidence of impressive efficacy of modulated dose selpercatinib in a young Caucasian with ANK3-RET fusion-positive NSCLC. Front Oncol 2024; 14:1307458. [PMID: 38420011 PMCID: PMC10900756 DOI: 10.3389/fonc.2024.1307458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/18/2024] [Indexed: 03/02/2024] Open
Abstract
Over the past decade, molecular characterization has led to change the management of advanced non-small cell lung cancer (NSCLC) harboring driver mutations. Rearranged during transfection (RET) gene fusions, occurring in 1% to 2% of NSCLC, have emerged as an oncogenic druggable target. Systemic targeted therapies with highly selective RET inhibitors (RETi), selpercatinib and pralsetinib, represent a recent clinical breakthrough. While the development of RETi has improved survival, with their increasing use, it is crucial to be aware of the risks of rare but serious adverse events (AEs). A particular challenge for clinicians in applying targeted therapies is not only diagnosing but also interpreting rare mutations. Herein, we report a case of a 43-year-old Caucasian advanced NSCLC patient diagnosed with a rare RET gene fusion, ANK3::RET, identified with Next Generation Sequencing (NGS). Selpercatinib has been initiated at the recommended initial dose after one incomplete chemotherapy cycle due to a severe infusion reaction, but it subsequently required a dose adjustment following grade 3 (G3) AEs. During treatment, we used a particular selpercatinib dosage (160 mg in the morning and 80 mg in the evening) with good tolerance and without compromising effectiveness. Our finding broadens the range of RET fusion types in not-Asian NSCLC. To the best of our knowledge, our case demonstrates, for the first time, a clinical and radiological response to frontline highly selective RETi selpercatinib, expanding the spectrum of potential oncogenic RET fusion partners in newly diagnosed NSCLC patients. Furthermore, to our knowledge, this is the first case describing a RET fusion-positive (RET+) NSCLC patient treated with a modified selpercatinib dosage outside the drug data sheet and demonstrating a safe and effective use.
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Affiliation(s)
- Elisa De Carlo
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Elisa Bertoli
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Monica Schiappacassi
- Molecular Oncology Unit, Oncologia Molecolare e dei Modelli Preclinici di Progressione Tumorale (OMMPPT) Department of Translational Research, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Brigida Stanzione
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Alessandro Del Conte
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Roberto Doliana
- Molecular Oncology Unit, Oncologia Molecolare e dei Modelli Preclinici di Progressione Tumorale (OMMPPT) Department of Translational Research, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Michele Spina
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Alessandra Bearz
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
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Stanzione B, Del Conte A, Bertoli E, De Carlo E, Revelant A, Spina M, Bearz A. Therapeutical Options in ROS1-Rearranged Advanced Non Small Cell Lung Cancer. Int J Mol Sci 2023; 24:11495. [PMID: 37511255 PMCID: PMC10380455 DOI: 10.3390/ijms241411495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
ROS proto-oncogene 1 (ROS1) rearrangements occur in 0.9-2.6% of patients with non small cell lung cancer (NSCLC), conferring sensitivity to treatment with specific tyrosine-kinase inhibitors (TKI). Crizotinib, a first-generation TKI, was the first target-therapy approved for the first-line treatment of ROS1-positive NSCLC. Recently, entrectinib, a multitarget inhibitor with an anti-ROS1 activity 40 times more potent than crizotinib and better activity on the central nervous system (CNS), received approval for treatment-naive patients. After a median time-to-progression of 5.5-20 months, resistance mechanisms can occur, leading to tumor progression. Therefore, newer generation TKI with greater potency and brain penetration have been developed and are currently under investigation. This review summarizes the current knowledge on clinicopathological characteristics of ROS1-positive NSCLC and its therapeutic options.
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Affiliation(s)
- Brigida Stanzione
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Alessandro Del Conte
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Elisa Bertoli
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Elisa De Carlo
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Alberto Revelant
- Department of Radiotherapy, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Michele Spina
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Alessandra Bearz
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
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Bertoli E, De Carlo E, Basile D, Zara D, Stanzione B, Schiappacassi M, Del Conte A, Spina M, Bearz A. Liquid Biopsy in NSCLC: An Investigation with Multiple Clinical Implications. Int J Mol Sci 2023; 24:10803. [PMID: 37445976 DOI: 10.3390/ijms241310803] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/21/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Tissue biopsy is essential for NSCLC diagnosis and treatment management. Over the past decades, liquid biopsy has proven to be a powerful tool in clinical oncology, isolating tumor-derived entities from the blood. Liquid biopsy permits several advantages over tissue biopsy: it is non-invasive, and it should provide a better view of tumor heterogeneity, gene alterations, and clonal evolution. Consequentially, liquid biopsy has gained attention as a cancer biomarker tool, with growing clinical applications in NSCLC. In the era of precision medicine based on molecular typing, non-invasive genotyping methods became increasingly important due to the great number of oncogene drivers and the small tissue specimen often available. In our work, we comprehensively reviewed established and emerging applications of liquid biopsy in NSCLC. We made an excursus on laboratory analysis methods and the applications of liquid biopsy either in early or metastatic NSCLC disease settings. We deeply reviewed current data and future perspectives regarding screening, minimal residual disease, micrometastasis detection, and their implication in adjuvant and neoadjuvant therapy management. Moreover, we reviewed liquid biopsy diagnostic utility in the absence of tissue biopsy and its role in monitoring treatment response and emerging resistance in metastatic NSCLC treated with target therapy and immuno-therapy.
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Affiliation(s)
- Elisa Bertoli
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Elisa De Carlo
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Debora Basile
- Department of Medical Oncology, San Giovanni Di Dio Hospital, 88900 Crotone, Italy
| | - Diego Zara
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Brigida Stanzione
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Monica Schiappacassi
- Molecular Oncology Unit, (OMMPPT) Department of Translational Research, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Alessandro Del Conte
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Michele Spina
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Alessandra Bearz
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
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De Carlo E, Bertoli E, Chimienti E, Del Conte A, Bearz A. Chylous Ascites as a Possible Rare Side Effect of Selpercatinib in RET-Positive NSCLC. J Thorac Oncol 2023; 18:e11-e13. [PMID: 36682840 DOI: 10.1016/j.jtho.2022.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/03/2022] [Indexed: 01/21/2023]
Affiliation(s)
- Elisa De Carlo
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy.
| | - Elisa Bertoli
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy; Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Emanuela Chimienti
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Alessandro Del Conte
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Alessandra Bearz
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
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Lorenzi M, Ferro A, Cecere F, Scattolin D, Del Conte A, Follador A, Pilotto S, Polo V, Santarpia M, Chiari R, Pavan A, Dal Maso A, Da Ros V, Targato G, Vari S, Indraccolo S, Calabrese F, Frega S, Bonanno L, Conte PF, Guarneri V, Pasello G. First-Line Osimertinib in Patients with EGFR-Mutant Advanced Non-Small Cell Lung Cancer: Outcome and Safety in the Real World: FLOWER Study. Oncologist 2022; 27:87-e115. [PMID: 35641222 PMCID: PMC9714585 DOI: 10.1002/onco.13951] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/17/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Osimertinib became the standard treatment for patients with untreated EGFR-mutant advanced non-small cell lung cancer (aNSCLC) following results reported in the phase III randomized FLAURA trial. Because of strict exclusion criteria, patient populations included in pivotal trials are only partially representative of real-world patients. METHODS We designed an observational, prospective, multicenter study enrolling patients with EGFR-mutant aNSCLC receiving first-line osimertinib to evaluate effectiveness, safety, and progression patterns in the real-world. RESULTS At data cutoff, 126 White patients from nine oncology centers were included. At diagnosis, 16 patients (12.7%) had a performance status (PS) ≥2 and 38 (30.2%) had brain metastases. Overall response rate (ORR) was 73%, disease control rate (DCR) 96.0%. After a median follow-up of 12.3 months, median time to treatment discontinuation (mTTD) was 25.3 months, median progression-free-survival (mPFS) was 18.9 months and median overall survival (mOS) was not reached (NR). One hundred and ten patients (87%) experienced adverse events (AEs), 42 (33%) of grade 3-4, with venous thromboembolism (VTE) as the most common (n = 10, 7.9%). No difference in rates of VTE was reported according to age, PS, comorbidity, and tumor load. We observed longer mTTD in patients without symptoms (NR vs. 18.8 months) and with fewer than three metastatic sites at diagnosis (NR vs. 21.4 months). Patients without brain metastases experienced longer mPFS (NR vs. 13.3 months). No difference in survival outcome was observed according to age, comorbidity, and type of EGFR mutation. Isolated progression and progression in fewer than three sites were associated with longer time to treatment discontinuation (TTD). CONCLUSION Osimertinib confirmed effectiveness and safety in the real world, although thromboembolism was more frequent than previously reported.
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Affiliation(s)
- Martina Lorenzi
- Department of Surgery, Oncology, and Gastroenterology, University of
Padova, Padova, Italy
- Division of Medical Oncology 2, Veneto Institute of Oncology -
IRCCS, Padova, Italy
| | - Alessandra Ferro
- Department of Surgery, Oncology, and Gastroenterology, University of
Padova, Padova, Italy
- Division of Medical Oncology 2, Veneto Institute of Oncology -
IRCCS, Padova, Italy
| | - Fabiana Cecere
- Oncology 1, Regina Elena National Cancer Institute – IRCCS,
Padova, Italy
| | - Daniela Scattolin
- Department of Surgery, Oncology, and Gastroenterology, University of
Padova, Padova, Italy
| | - Alessandro Del Conte
- Medical Oncology and Immunorelated Tumors, National Cancer Institute Centro di
Riferimento Oncologico (CRO) – IRCCS, Aviano (PN),
Italy
| | - Alessandro Follador
- Department of Medical Oncology, Azienda Sanitaria Universitaria Integrata of
Udine, Santa Maria della Misericordia Hospital,
Udine, Italy
| | - Sara Pilotto
- Oncology Department, Azienda Ospedaliera Universitaria Integrata di
Verona, Verona, Italy
| | - Valentina Polo
- Oncology Unit, Azienda Unità Locale Socio Sanitaria (AULSS 2) Marca Trevigiana,
Ca’ Foncello Hospital, Treviso, Italy
| | - Mariacarmela Santarpia
- Medical Oncology, Azienda Ospedaliera Policlinico Universitario “G.
Martino,”Messina, Italy
| | - Rita Chiari
- Medical Oncology, AULSS 6 Euganea, South Padua Hospital,
Monselice (PD), Italy
| | - Alberto Pavan
- Medical Oncology, AULSS 6 Euganea, South Padua Hospital,
Monselice (PD), Italy
| | - Alessandro Dal Maso
- Department of Surgery, Oncology, and Gastroenterology, University of
Padova, Padova, Italy
- Division of Medical Oncology 2, Veneto Institute of Oncology -
IRCCS, Padova, Italy
| | - Valentina Da Ros
- Medical Oncology and Immunorelated Tumors, National Cancer Institute Centro di
Riferimento Oncologico (CRO) – IRCCS, Aviano (PN),
Italy
| | - Giada Targato
- Department of Medical Oncology, Azienda Sanitaria Universitaria Integrata of
Udine, Santa Maria della Misericordia Hospital,
Udine, Italy
| | - Sabrina Vari
- Oncology 1, Regina Elena National Cancer Institute - IRCCS,
Rome, Italy
| | - Stefano Indraccolo
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV –
IRCCS, Padua, Italy
| | - Fiorella Calabrese
- Cardiovascular Pathology Unit, Department of Cardio-Thoracic and Vascular
Sciences, University of Padova, Padova, Italy
| | - Stefano Frega
- Division of Medical Oncology 2, Veneto Institute of Oncology -
IRCCS, Padova, Italy
| | - Laura Bonanno
- Division of Medical Oncology 2, Veneto Institute of Oncology -
IRCCS, Padova, Italy
| | - Pier Franco Conte
- Department of Surgery, Oncology, and Gastroenterology, University of
Padova, Padova, Italy
- Division of Medical Oncology 2, Veneto Institute of Oncology -
IRCCS, Padova, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology, and Gastroenterology, University of
Padova, Padova, Italy
- Division of Medical Oncology 2, Veneto Institute of Oncology -
IRCCS, Padova, Italy
| | - Giulia Pasello
- Department of Surgery, Oncology, and Gastroenterology, University of
Padova, Padova, Italy
- Division of Medical Oncology 2, Veneto Institute of Oncology -
IRCCS, Padova, Italy
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DE Carlo E, Schiappacassi M, Pelizzari G, Baresic T, Del Conte A, Stanzione B, DA Ros V, Doliana R, Baldassarre G, Bearz A. Acquired EGFR C797G Mutation Detected by Liquid Biopsy as Resistance Mechanism After Treatment With Osimertinib: A Case Report. In Vivo 2021; 35:2941-2945. [PMID: 34410991 DOI: 10.21873/invivo.12586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/22/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Osimertinib is a third-generation EGFR-tyrosine kinase inhibitor approved for the treatment of T790M-positive non-small-cell lung cancer. More recently, osimertinib demonstrated improved disease control compared to other EGFR-TKIs. Multiple mechanisms of resistance have been described in T790M-positive patients who experienced treatment failure with osimertinib. CASE REPORT We report the case of a 78-year-old non-smoker woman with stage IV EGFR L858R-positive lung adenocarcinoma presented with T790M mutation after five years of treatment with gefitinib. The patient was started on osimertinib, but after two and a half years of treatment experienced disease progression. The analyses of circulating tumor DNA using next-generation sequencing showed, together with the pre-existing T790M and exon 21 L858R, the presence of the EGFR C797G resistance mutation. CONCLUSION Our case report revealed a rare EGFR-dependent acquired resistance mutation to osimertinib in circulating tumor DNA. Liquid biopsy appears to be a promising resource to understand the biology of osimertinib resistance by clonal evolution monitoring and the identification of novel resistance mechanisms.
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Affiliation(s)
- Elisa DE Carlo
- Clinical Oncology Department - Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy;
| | - Monica Schiappacassi
- Molecular Oncology Department - Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Giacomo Pelizzari
- Oncology Department, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Tania Baresic
- Nuclear Medicine Department - Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Alessandro Del Conte
- Clinical Oncology Department - Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Brigida Stanzione
- Clinical Oncology Department - Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Valentina DA Ros
- Clinical Oncology Department - Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Roberto Doliana
- Molecular Oncology Department - Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Gustavo Baldassarre
- Molecular Oncology Department - Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Alessandra Bearz
- Clinical Oncology Department - Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
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De Carlo E, Stanzione B, Del Conte A, Revelant A, Bearz A. Brigatinib as a treatment of ALK-positive non-small cell lung cancer. Expert Review of Precision Medicine and Drug Development 2021. [DOI: 10.1080/23808993.2021.1954907] [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: 10/20/2022]
Affiliation(s)
- Elisa De Carlo
- Clinical Oncology Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Brigida Stanzione
- Clinical Oncology Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Alessandro Del Conte
- Clinical Oncology Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Alberto Revelant
- Division of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Alessandra Bearz
- Clinical Oncology Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
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Dal Maso A, Lorenzi M, Ferro A, Pilotto S, Cecere F, Follador A, Polo V, Del Conte A, Sartori G, Giavarra M, Scattolin D, Indraccolo S, Frega S, De Maglio G, Menis J, Bonanno L, Calabrese F, Guarneri V, Conte P, Pasello G. Real-world data on treatment outcomes in EGFR-mutant non-small-cell lung cancer patients receiving osimertinib in second or further lines. Future Oncol 2021; 17:2513-2527. [PMID: 33988036 DOI: 10.2217/fon-2021-0356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Aims: This study describes real-world outcomes of pretreated EGFR T790M-positive (T790M+) advanced non-small-cell lung cancer patients progressing after first- or second-generation tyrosine kinase inhibitors and receiving osimertinib, compared with T790M-negative (T790M-) patients. We have also described progression patterns and treatment sequences. Patients & methods: This is a retrospective multicenter Italian observational study including consecutive Caucasian patients referred between 2014 and 2018. Results: 167 patients were included. Median progression-free survival was 9.8 months (95% CI: 8.3-13.3) for T790M+ and 6.0 months (95% CI: 4.9-7.2) for T790M- patients, respectively. Median overall survival was 20.7 months (95% CI: 18.9-28.4) for T790M+ and 10.6 months (95% CI: 8.6-23.6) for T790M- patients, respectively. The T790M mutation correlated with absence of new sites of disease. After progression, most T790M+ patients continued osimertinib, whereas most T790M- patients received a different treatment line. Conclusion: Better outcomes were shown in patients receiving osimertinib. A more limited progression pattern for T790M+ was suggested.
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Affiliation(s)
- Alessandro Dal Maso
- Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy.,Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova, 35128, Italy
| | - Martina Lorenzi
- Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy.,Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova, 35128, Italy
| | - Alessandra Ferro
- Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy.,Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova, 35128, Italy
| | - Sara Pilotto
- Medical Oncology, University of Verona, AOUI Verona, Verona, 37126, Italy
| | - Fabiana Cecere
- Oncology 1, Regina Elena National Cancer Institute IRCCS Rome, Rome, 00144, Italy
| | - Alessandro Follador
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale, Udine Hospital, Udine, 33100, Italy
| | - Valentina Polo
- Oncology Unit, AULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, 31100, Italy
| | - Alessandro Del Conte
- Medical Oncology & Immunorelated Tumors, Centro di Riferimento Oncologico (CRO) - IRCCS, Aviano (PN), 33081, Italy
| | - Giulia Sartori
- Medical Oncology, University of Verona, AOUI Verona, Verona, 37126, Italy
| | - Marco Giavarra
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale, Udine Hospital, Udine, 33100, Italy
| | - Daniela Scattolin
- Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova, 35128, Italy
| | - Stefano Indraccolo
- Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova, 35128, Italy.,Immunology & Molecular Oncology Unit, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy
| | - Stefano Frega
- Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy
| | - Giovanna De Maglio
- Department of Pathology, Azienda Sanitaria Universitaria Friuli Centrale, Udine Hospital, Udine, 33100, Italy
| | - Jessica Menis
- Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy.,Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova, 35128, Italy
| | - Laura Bonanno
- Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy
| | - Fiorella Calabrese
- Pathology Unit, Department of Cardio-Thoracic & Vascular Sciences, University of Padova, Padova, 35128, Italy
| | - Valentina Guarneri
- Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy.,Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova, 35128, Italy
| | - PierFranco Conte
- Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy.,Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova, 35128, Italy
| | - Giulia Pasello
- Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy.,Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova, 35128, Italy
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10
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Basso SMM, Del Conte A, Zuccon U, Sulfaro SC, Fanti G, Maffeis F, Ubiali P, Ermani M, Lumachi F. Diagnostic Accuracy of Pleural Fluid Cytology, Carcinoembryonic Antigen and C-Reactive Protein Together in Patients With Pulmonary Metastases and Malignant Pleural Effusion. Anticancer Res 2020; 40:5877-5881. [PMID: 32988918 DOI: 10.21873/anticanres.14607] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/18/2020] [Revised: 08/02/2020] [Accepted: 08/03/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Pleural effusion (PE) has a heterogeneous aetiology, and differential diagnosis between benign and malignant disease may require invasive procedures in up to 60% of cases. The sensitivity of pleural cytology is limited, and several strategies have been tested to reduce the need of invasive diagnostic approaches. The aim of this study was to evaluate the usefulness of pleural fluid cytology, compared to, and combined with, carcinoembryonic antigen (CEA), C reactive protein (CRP), and lactate dehydrogenase (LDH) assay of pleural fluid (PF) in patients with a history of cancer, exudative non-purulent PE, and suspicion of malignant PE on imaging studies. PATIENTS AND METHODS The medical records of 40 patients with pulmonary metastases and malignant PE, and 57 controls with benign exudative PE were reviewed. All the patients underwent pleural cytology and CEA, CRP, and LDH assay before VATS-guided biopsy. RESULTS The sensitivity and specificity were 55.0% and 98.2% (cytology), 35.0% and 98.2% (CEA), 92.5% and 71.9% (CRP), 70.0% and 54.4% (LDH). The multivariate analysis excluded LDH, and the final AUC (cytology+CEA+CRP) was 0.894. CONCLUSION In all patients with a history of cancer and PE of uncertain origin, the combination of PF cytology plus pleural CEA and CRP assay together should be suggested to recognize malignant plural effusion (MPE), minimising the use of unnecessary invasive investigations.
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Affiliation(s)
- Stefano M M Basso
- Department of Surgery, General Surgery, S. Maria degli Angeli Hospital, Pordenone, Italy
| | - Alessandro Del Conte
- Medical Oncology and Immune-Related Tumors, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Pordenone, Italy
| | - Umberto Zuccon
- Department of Medicine, Pneumology, S. Maria degli Angeli Hospital, Pordenone, Italy
| | - Sandro C Sulfaro
- Department of Laboratory Medicine, Pathology and Histopathology Section, S. Maria degli Angeli Hospital, Pordenone, Italy
| | - Giovanni Fanti
- Department of Surgery, General Surgery, S. Maria degli Angeli Hospital, Pordenone, Italy
| | - Federica Maffeis
- Department of Surgery, General Surgery, S. Maria degli Angeli Hospital, Pordenone, Italy
| | - Paolo Ubiali
- Department of Surgery, General Surgery, S. Maria degli Angeli Hospital, Pordenone, Italy
| | - Mario Ermani
- Department of Neurosciences, Statistic and Informatics Unit, University of Padua, School of Medicine, Padua, Italy
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11
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Cortiula F, Pasello G, Follador A, Nardo G, Polo V, Scquizzato E, Conte AD, Miorin M, Giovanis P, D’Urso A, Girlando S, Settanni G, Picece V, Veccia A, Corvaja C, Indraccolo S, De Maglio G. A Multi-Center, Real-Life Experience on Liquid Biopsy Practice for EGFR Testing in Non-Small Cell Lung Cancer (NSCLC) Patients. Diagnostics (Basel) 2020; 10:diagnostics10100765. [PMID: 32998450 PMCID: PMC7601690 DOI: 10.3390/diagnostics10100765] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 02/07/2023] Open
Abstract
Background: circulating tumor DNA (ctDNA) is a source of tumor genetic material for EGFR testing in NSCLC. Real-word data about liquid biopsy (LB) clinical practice are lacking. The aim of the study was to describe the LB practice for EGFR detection in North Eastern Italy. Methods: we conducted a multi-regional survey on ctDNA testing practices in lung cancer patients. Results: Median time from blood collection to plasma separation was 50 min (20–120 min), median time from plasma extraction to ctDNA analysis was 24 h (30 min–5 days) and median turnaround time was 24 h (6 h–5 days). Four hundred and seventy five patients and 654 samples were tested. One hundred and ninety-two patients were tested at diagnosis, with 16% EGFR mutation rate. Among the 283 patients tested at disease progression, 35% were T790M+. Main differences in LB results between 2017 and 2018 were the number of LBs performed for each patient at disease progression (2.88 vs. 1.2, respectively) and the percentage of T790M+ patients (61% vs. 26%).
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Affiliation(s)
- Francesco Cortiula
- Dipartimento di Oncologia, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (A.F.); (C.C.)
- Dipartimento di Medicina (DAME), Università degli Studi di Udine, 33100 Udine, Italy
- Correspondence: (F.C.); (S.I.)
| | - Giulia Pasello
- Oncologia Medica 2, Istituto Oncologico Veneto IOV IRCCS, 35128 Padova, Italy;
| | - Alessandro Follador
- Dipartimento di Oncologia, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (A.F.); (C.C.)
| | - Giorgia Nardo
- U.O.C. Immunologia e Diagnostica Molecolare Oncologica, Istituto Oncologico Veneto IOV IRCCS, 35128 Padova, Italy;
| | - Valentina Polo
- Dipartimento di Oncologia, AULSS 2 Marca Trevigiana, Ospedale Ca’ Foncello, 31100 Treviso, Italy;
| | - Elisa Scquizzato
- Dipartimento interaziendale di Anatomia Patologica, ULSS 2 Marca Trevigiana, 31100 Treviso, Italy;
| | - Alessandro Del Conte
- S.O.C. Oncologia Medica e dei Tumori Immunocorrelati, Centro di Riferimento Oncologico (CRO) IRCCS, 33081 Aviano, Italy;
| | - Marta Miorin
- SSD Genetica medica, Azienda Sanitaria Friuli Occidentale, Presidio Ospedaliero di Pordenone, 33170 Pordenone, Italy;
| | - Petros Giovanis
- U.O.C. Oncologia, ULSS1 Dolomiti, Presidio Ospedaliero di Feltre, 32032 Feltre, Italy;
| | - Alessandra D’Urso
- U.O.C. Anatomia Patologica, ULSS1 Dolomiti, Presidio Ospedaliero di Feltre, 32032 Feltre, Italy;
| | - Salvator Girlando
- U.O. Anatomia Patologica, Ospedale Santa Chiara, 38122 Trento, Italy;
| | - Giulio Settanni
- Servizio di Anatomia-Istologia Patologica, IRCCS Ospedale Sacro Cuore Don Calabria, 37024 Negrar, Italy;
| | - Vincenzo Picece
- Dipartimento di Oncologia Medica, IRCCS Ospedale Sacro Cuore Don Calabria, 37024 Negrar, Italy;
| | - Antonello Veccia
- U.O. Oncologia Medica, Ospedale Santa Chiara, 38122 Trento, Italy;
| | - Carla Corvaja
- Dipartimento di Oncologia, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (A.F.); (C.C.)
- Dipartimento di Medicina (DAME), Università degli Studi di Udine, 33100 Udine, Italy
| | - Stefano Indraccolo
- U.O.C. Immunologia e Diagnostica Molecolare Oncologica, Istituto Oncologico Veneto IOV IRCCS, 35128 Padova, Italy;
- Correspondence: (F.C.); (S.I.)
| | - Giovanna De Maglio
- SOC Anatomia Patologica, Azienda Sanitaria UniversitariaFriuli Centrale, 33100 Udine, Italy;
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12
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Mariniello A, Ghisoni E, Righi L, Catino A, Chiari R, Del Conte A, Barbieri F, Cecere F, Gelibter A, Giajlevra M, Parra HS, Zichi C, DI Maio M, Valabrega G, Novello S. Women With Synchronous or Metachronous Lung and Ovarian Cancer: A Multi-Institutional Report. In Vivo 2020; 33:2021-2026. [PMID: 31662533 DOI: 10.21873/invivo.11699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/15/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND/AIM Double diagnosis of lung cancer (LC) and ovarian cancer (OC) is rare. Here, we describe patients with synchronous/metachronous LC and OC to identify common clinical and pathological patterns. PATIENTS AND METHODS Clinical, pathological and molecular data of patients diagnosed and treated at 30 European Institutions from 2008 to 2018 were retrieved and analysed. Whenever tissue was available, centralized pathology revision was performed. RESULTS A total of 19 cases were found; one was excluded at pathology revision. Most LCs were adenocarcinomas (15/18) and most OCs were high-grade serous (15/18) carcinomas. Of the 9 patients analysed, 7 carried oncogene-addicted LC (4 EGFR, 1 B-RAF and 2 ALK) and five out of 7 carried BRCA mutations. One patient with a germline-BRCA1 mutation received olaparib, resulting in a durable response of both malignancies. Median overall survival was 33 months. CONCLUSION In our series, most synchronous/metachronous LCs and OCs showed genetic alterations. Further analyses with wide NGS panel could shed light on the biological mechanisms driving their occurrence.
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Affiliation(s)
- Annapaola Mariniello
- Department of Oncology, University of Torino at San Luigi University Hospital, Orbassano, Italy
| | - Eleonora Ghisoni
- Department of Oncology, University of Torino, Turin, Italy.,Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Luisella Righi
- Department of Oncology, University of Torino at San Luigi University Hospital, Orbassano, Italy
| | - Annamaria Catino
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Rita Chiari
- Department of Medical Oncology, University of Perugia at Santa Maria della Misericordia Hospital, Perugia, Italy
| | | | - Fausto Barbieri
- Department of Oncology and Hematology, University-Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Fabiana Cecere
- Careggi University Hospital, Medical Oncology Unit, Department of Oncology, Florence, Italy
| | - Alain Gelibter
- Sapienza University of Rome at Policlinico Umberto I, Oncology Unit, Rome, Italy
| | - Matteo Giajlevra
- CHU Grenoble Alpes, Clinique Universitaire de Pneumologie, Pôle Thorax et Vaisseaux, Grenoble, France
| | | | - Clizia Zichi
- Department of Oncology, University of Torino at San Luigi University Hospital, Orbassano, Italy
| | - Massimo DI Maio
- Department of Oncology, University of Torino at Mauriziano Umberto I Hospital, Turin, Italy
| | - Giorgio Valabrega
- Department of Oncology, University of Torino, Turin, Italy .,Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Silvia Novello
- Department of Oncology, University of Torino at San Luigi University Hospital, Orbassano, Italy
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13
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Basso SMM, Lumachi F, Del Conte A, Sulfaro S, Maffeis F, Ubiali P. Diagnosis of Malignant Pleural Effusion Using CT Scan and Pleural-Fluid Cytology Together. A Preliminary Case-Control Study. Anticancer Res 2020; 40:1135-1139. [PMID: 32014965 DOI: 10.21873/anticanres.14054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 12/31/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The purposes of this study were to evaluate the usefulness of chest computed tomographic (CT) scan plus pleural fluid cytology (PFC) together in patients with malignant pleural effusion (PE), and to compare the results of these diagnostic tools in patients with malignant PE due to non-small-cell lung cancer and pulmonary metastases from other malignancies. PATIENTS AND METHODS The medical records of 185 patients with PE, who underwent chest CT, PFC and video-assisted thoracoscopy (VATS) thoracentesis followed by VATS-guided biopsy for diagnostic purpose, were reviewed. At the final diagnosis, 123 (66.5%) patients had malignant PE (cases), and 62 (33.5%) had benign PE (controls). RESULTS Overall, the sensitivity, specificity, and accuracy of CT and PFC were 65.0% vs. 67.5% 98.4% vs. 98.4%, and 76.2% vs. 77.8%, respectively. The combination of CT plus PFC significantly improved sensitivity (86.2%, p=0.003) and accuracy (90.8%, p=0.02). CONCLUSION CT and PFC used together may lead to approximately 100% specificity and >90% sensitivity in distinguishing between benign and malignant PE.
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Affiliation(s)
| | | | | | - Sandro Sulfaro
- Pathology, S. Maria degli Angeli Hospital, Pordenone, Italy
| | - Federica Maffeis
- General Surgery, S. Maria degli Angeli Hospital, Pordenone, Italy
| | - Paolo Ubiali
- General Surgery, S. Maria degli Angeli Hospital, Pordenone, Italy
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14
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Reale ML, Chiari R, Tiseo M, Vitiello F, Barbieri F, Cortinovis D, Ceresoli GL, Finocchiaro G, Romano GD, Piovano PL, Del Conte A, Borra G, Verderame F, Scotti V, Nonnis D, Galetta D, Sergi C, Migliorino MR, Tonini G, Cecere F, Berardi R, Pino MS, Martelli O, Gelibter A, Carta A, Vattemi E, Pagano M, Zullo A, Ferrari S, Rossi A, Novello S. Be-TeaM: An Italian real-world observational study on second-line therapy for EGFR-mutated NSCLC patients. Lung Cancer 2019; 140:71-79. [PMID: 31884129 DOI: 10.1016/j.lungcan.2019.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 09/16/2019] [Revised: 11/21/2019] [Accepted: 12/13/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Molecular diagnostics and care of non-small cell lung cancer (NSCLC) are continuously evolving. Few data document the current strategies to manage advanced NSCLC patients beyond progression in clinical practice. PATIENTS AND METHODS Be-TeaM is an Italian multi-center observational study conducted on consecutive EGFR-mutated stage IV NSCLC patients, progressed during/after a first-line EGFR-TKI. It consists of a retrospective phase, from first-line EGFR-TKI therapy start until study entry (i.e. beginning of the diagnostic process), and a prospective phase, until treatment choice or for 3 months if no therapy was prescribed. Primary objective was to describe the diagnostic and therapeutic approaches adopted after progression in a real-world setting. RESULTS Of 308 patients enrolled in 63 centers from July 2017 to June 2018, 289 were included in the analysis. In first line, 53.3 % received gefitinib, 32.5 % afatinib and 14.2 % erlotinib. The testing rate (i.e. rate of all patients undergone any biopsy -liquid and/or tissue- for the T790 M detection) was 90.7 %, with liquid biopsy being the most frequently executed. Of 262 biopsied patients, 64.5 % underwent only 1 liquid biopsy, 10.7 % only 1 tissue biopsy and 18.3 % >1 biopsy, both liquid and solid in 85.4 %. The T790M positivity rate was 45.3 %; of 166 patients undergone only a liquid biopsy and tested for the mutation, 39.8 % were T790M+ and 60.2 % T790M-/undetermined. By the observation end, 87.9 % patients had a post-progression treatment chosen, osimertinib being the most frequent among the T790M+. CONCLUSION Be-TeaM provides the first snapshot of current practices for the management of NSCLC patients beyond progression in Italy; in clinical practice, assessing the T790M status is not always feasible.
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Affiliation(s)
- Maria Lucia Reale
- Department of Oncology, University of Turin, AOU San Luigi Gonzaga, Regione Gonzole, 10, 10043, Orbassano, TO, Italy.
| | - Rita Chiari
- UOC Oncology, Ospedali Riuniti Padova Sud-AULSS6 Euganea, Via Albere, 30, Monselice, PD, Italy(1).
| | - Marcello Tiseo
- Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, Azienda Ospedaliero-Universitaria, Viale Antonio Gramsci, 14, 43126, Parma, Italy.
| | - Fabiana Vitiello
- U.O.S.D. DH Pneumoncologico A.O. dei Colli - Monaldi, Via Leonardo Bianchi, 80131, Napoli, Italy.
| | - Fausto Barbieri
- Dipartimento Oncologia ed Ematologia, AOU Policlinico, Largo del Pozzo, 71, 41125, Modena, Italy.
| | - Diego Cortinovis
- UO Oncologia Medica, ASST Ospedale San Gerardo, Via G. B. Pergolesi, 33, 20900, Monza, MB, Italy.
| | - Giovanni Luca Ceresoli
- Unità di Oncologia Toracica e Urologica, Humanitas Gavazzeni, Via Mauro Gavazzeni, 21, 24125, Bergamo, Italy.
| | - Giovanna Finocchiaro
- U.O Oncologia Medica ed Ematologia, Humanitas Cancer Center, Istituto Clinico Humanitas-IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy.
| | | | - Pier Luigi Piovano
- SC Oncologia, ASO SS Antonio e Biagio e C Arrigo, Via Venezia, 16, 15121, Alessandria, Italy.
| | - Alessandro Del Conte
- S.C. Oncologia Medica e dei Tumori Immunocorrelati (OMTI), Centro di Riferimento Oncologico (CRO) - IRCCS, Via Franco Gallini, 2, 33081, Aviano, PN, Italy.
| | - Gloria Borra
- Dipartimento Medico Specialistico ed Oncologico, AOU Maggiore della Carità, corso Mazzini 18, Novara, Italy.
| | - Francesco Verderame
- U.O Oncologia Medica, AO Riuniti Villa Sofia - Cervello, Via Trabucco 180, 90146, Palermo, Italy.
| | - Vieri Scotti
- Unità di Radioterapia Oncologica - Dipartimento di Oncologia, Azienda Ospedaliero-universitaria Careggi, Largo G. Alessandro Brambilla, 3, 50134, Florence, Italy.
| | - Daniela Nonnis
- Oncologia Medica, ASST Spedali Civili, Piazzale Spedali Civili, 1, 25123, Brescia, Italy.
| | - Domenico Galetta
- SSD Oncologia Medica Patologia Toracica IRCCS Oncologico Giovanni Paolo II, Viale Orazio Flacco, 65, 70124, Bari, Italy.
| | - Concetta Sergi
- U.O.C Oncologia Medica, AO di rilievo Nazionale, ARNAS Garibaldi-Nesima, Via Palermo, 636, Catania, Italy.
| | - Maria Rita Migliorino
- U.O.C Pneumologia Oncologica, AO S. Camillo Forlanini, Circonvallazione Gianicolense, 87, 00152, Roma, Italy.
| | - Giuseppe Tonini
- Dipartimento di Oncologia, Università Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Roma, Italy.
| | - Fabiana Cecere
- U.O. Oncologia Medica, Istituto Tumori Regina Elena, Via Elio Chianesi, 53, 00128, Roma, Italy.
| | - Rossana Berardi
- SOD Clinica Oncologica, AOU Ospedali Riuniti, Via Conca, 71, 60126, Ancona, Italy.
| | - Maria Simona Pino
- U.O. Oncologia Medica, Ospedale S. Maria Annunziata, Via Antella, 58, 50012, Ponte a Niccheri, Bagno a Ripoli, FI, Italy.
| | - Olga Martelli
- U.O Oncologia Medica, Azienda Ospedaliera S Giovanni-Addolorata, Via dell'Amba Aradam 8, 00184, Roma, Italy.
| | - Alain Gelibter
- U.O Oncologia Medica, Policlinico Umberto I, Via del Policlinico 155, Roma, Italy.
| | - Annamaria Carta
- U.O Oncologia Medica, Ospedale A. Businco, Via Edward Jenner, 1, 09121, Cagliari, Italy.
| | - Emanuela Vattemi
- U.O Oncologia Medica, Ospedale Regionale, Via Lorenz Böhler, 5, 39100, Bolzano, Italy.
| | - Maria Pagano
- Azienda Unità Sanitaria Locale-IRCCS, Via Giovanni Amendola, 2, 42122, Reggio Emilia, Italy.
| | | | - Silvia Ferrari
- AstraZeneca S.p.A., Via Ludovico il Moro, 6/C, 20080, Basiglio, MI, Italy.
| | - Antonio Rossi
- Oncology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini, 1, 71013, San Giovanni Rotondo, FG, Italy.
| | - Silvia Novello
- Department of Oncology, University of Turin, AOU San Luigi Gonzaga, Regione Gonzole, 10, 10043, Orbassano, TO, Italy.
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15
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Dal Maso A, Lorenzi M, Roca E, Pilotto S, Macerelli M, Polo V, Cecere FL, Del Conte A, Nardo G, Buoro V, Scattolin D, Monteverdi S, Urso L, Zulato E, Frega S, Bonanno L, Indraccolo S, Calabrese F, Conte P, Pasello G. Clinical Features and Progression Pattern of Acquired T790M-positive Compared With T790M-negative EGFR Mutant Non-small-cell Lung Cancer: Catching Tumor and Clinical Heterogeneity Over Time Through Liquid Biopsy. Clin Lung Cancer 2019; 21:1-14.e3. [PMID: 31601525 DOI: 10.1016/j.cllc.2019.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 05/02/2019] [Revised: 06/18/2019] [Accepted: 07/26/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Clinical-pathologic predictors of acquired T790M epidermal growth factor receptor (EGFR) mutation in Caucasian patients with non-small-cell lung cancer (NSCLC) progressing after first-/second-generation tyrosine kinase inhibitors (TKIs) is an open field for research. Similarly, the best time point for T790M detection by liquid or tissue biopsy after disease progression is currently matter of debate. PATIENTS AND METHODS This is an observational study at 7 Italian centers enrolling patients with EGFR-mutant NSCLC progressing after first-/second-generation EGFR TKIs, between 2014 and 2018, aiming at comparing baseline clinical-pathologic features and progression patterns in acquired T790M-positive compared with T790M-negative cases. RESULTS A total of 235 patients received first-line treatment with gefitinib (N = 126; 53%), erlotinib (N = 51; 22%), or afatinib (N = 58; 25%). In 120 (51%) cases, T790M was detected in liquid biopsy, tissue biopsy, or both. Age younger than 65 years (P = .037), the presence of common mutations (P = .004), and better response to first-line TKI (P = .023) were correlated with T790M positivity. T790M detection was associated with higher number of new progressing sites (P = .04), liver progression (P = .002), and a lower frequency of lung metastases (P = .027). When serial liquid biopsies were performed (N = 15), an oligoprogressive disease was correlated with a negative test outcome, whereas systemic progression was observed at the time of T790M positivity. CONCLUSION This study on a Caucasian population showed that age, type of EGFR mutation at diagnosis, response to first-line treatment, and peculiar progression pattern are associated with T790M status. Serial liquid biopsy might be useful for treatment selection, especially when tissue rebiopsy is not feasible.
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Affiliation(s)
- Alessandro Dal Maso
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Martina Lorenzi
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Elisa Roca
- Department of Medical Oncology, ASST - Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Sara Pilotto
- Department of Medical Oncology, University of Verona, AOUI Verona, Verona, Italy
| | - Marianna Macerelli
- Department of Medical Oncology - ASUIUD Santa Maria della Misericordia, Udine, Italy
| | - Valentina Polo
- Oncology Unit, AULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy
| | - Fabiana Letizia Cecere
- Department of Oncology 1, Regina Elena National Cancer Institute IRCCS Rome, Rome, Italy
| | - Alessandro Del Conte
- Department of Medical Oncology and Immunorelated Tumors, Centro di Riferimento Oncologico (CRO) - IRCCS, Aviano (PN), Italy
| | - Giorgia Nardo
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Vanessa Buoro
- Department of Medical Oncology - ASUIUD Santa Maria della Misericordia, Udine, Italy
| | - Daniela Scattolin
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Sara Monteverdi
- Department of Medical Oncology, University of Verona, AOUI Verona, Verona, Italy
| | - Loredana Urso
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Elisabetta Zulato
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Stefano Frega
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Laura Bonanno
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Stefano Indraccolo
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Fiorella Calabrese
- Pathology Unit, Department of Cardio-Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - PierFranco Conte
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Giulia Pasello
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy.
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Re GL, Conte AD, Re FL, Doretto P, Ubiali P, Brosolo P, Sulfaro S, Marus W. Cyclophosphamide, Fluorouracil and subcutaneous Interleukin-2 in the treatment of advanced GIST: A Case Report. Surg Case Rep 2019. [DOI: 10.31487/j.scr.2019.03.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A male 68 years hold patient was admitted to surgical ward for hemorrhagic shock. After CT scan detection of 6x5 cm neoformation of first jejunal loop, he was submitted to segmental resection and pathological diagnosis was gastrointestinal stromal tumor. The patient was defined as high-risk according to Takahashi criteria, but refused Imatinib adjuvant therapy. After 15 months of disease-free interval, he developed bilobar liver metastases. After treatment with Imatinib 400 mg he reported G3 hepatotoxicity resolved with temporary suspension, he continue low dose with stable disease. After liver progression, he resumed Imatinib full dose with disease stabilization for 9 months. After liver progression, second line Sunitinib 37,5 mg/day was started for four months with stable disease. After further liver and lymph node mediastinal progression he was treated for four months with Regorafenib with disease stabilization. Patient developed slow but inexorable progression of liver disease with severe abdominal pain resistant to opioid and was treated with authorized compassionate program comprising Cyclophosphamide 300 mg/sqm and Fluorouracil 500 mg/sqm on day 1 intravenously followed by Interleukin-2 4.5 MUI subcutaneously on days 3–6 and 17–20 every four weeks. After three cycles the patients obtained a relevant subjective improvement with partial response on mediastinal lymph node and liver stabilization. A substantial increase on neutrophil, lymphocytes, monocytes, platelets, T regulator cells count, and a decrease on platelets/lymphocytes, CD8/T regulator cells ratio, CD8, NK count and C-reactive protein value were observed after treatment compared to basal value. The toxicity was mild represented by fever G1, flue-like-syndrome G1 during the treatment. After four cycle of chemo-immunotherapy, the patient demonstrated progression of disease and died five months after treatment. Noteworthy is the temporal disease control with significant symptomatic improvement achieved for the first time with this chemo-immunotherapeutic combination in a patient with very advanced pretreated GIST.
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17
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Pasello G, Dal Maso A, Lorenzi M, Roca E, Pilotto S, Macerelli M, Polo V, Del Conte A, Nardo G, Buoro V, Scattolin D, Monteverdi S, Urso L, Zulato E, Frega S, Bonanno L, Indraccolo S, Calabrese F, Conte P. Clinical features and progression pattern of T790M+ compared with T790M-EGFR mutant NSCLC. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e20612] [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
e20612 Background: Acquired T790M EGFR mutation (mut) is not predictable by any clinical-pathological feature. The best time point for T790M mut detection by liquid or tissue biopsy is currently undefined. Methods: This is an observational study at 6 Italian Centers enrolling EGFR mutant NSCLC patients (pts) progressing after first/second generation EGFR TKI, between 2014 and 2018. The primary endpoint of the study was to compare clinical features in acquired T790M+ compared with T790M- cases. The secondary endpoint was to assess different progression (PD) patterns between the two groups. We also explored the PD pattern at the time of cfDNA negativity and subsequent positivity, in a subgroup of pts receiving serial liquid biopsies. Statistical analysis was performed by the Chi-square test to correlate clinical features with T790M status, and by the Kaplan-Meier estimator to evaluate median progression free (mPFS) and overall survival (mOS). Multiple logistic regression and log-rank tests were applied. Results: 219 pts were included. Median follow-up since diagnosis was 25 months. First line treatment was gefitinib (N = 119, 54%), erlotinib (N = 48, 22%) or afatinib (N = 52, 24%). In 108 (49%) cases a T790M acquired mut was detected in liquid (70), tissue (31) biopsy or both (7). Age younger than 65 years ( p= 0.05) and presence of sensitizing exon 19 deletion ( p= 0.04) were correlated with T790M mut; this association was confirmed at multivariate analysis ( p= 0.010 and p= 0.006, respectively). At the time of PD, new PD sites ( p= 0.005) and liver PD ( p< 0.001) were more commonly observed in T790M+ group; at multivariate analysis statistical significance was confirmed ( p= 0.01 and p= 0.008, respectively). Longer mOS was observed in T790M+ cases at univariate (53 versus 22 months, p < 0.0001) and multivariate analysis. In 13 pts undergoing serial liquid biopsies, an oligoprogressive disease was correlated with a negative test outcome, while PS/symptoms worsening, higher number of new lesions and PD sites were observed at the time of T790M positivity, although without statistical significance. Conclusions: This is the first caucasian series showing different clinical features and progression patterns of T790M+ versus T790M- EGFR mutant NSCLC.
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Affiliation(s)
| | | | | | - Elisa Roca
- Oncology Department, Spedali Civili Hospital, Brescia, Italy
| | - Sara Pilotto
- University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | | | | | - Giorgia Nardo
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Vanessa Buoro
- Department of Medicine (DAME) - University of Udine, Udine, Italy, Udine, Italy
| | | | | | - Loredana Urso
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Elisabetta Zulato
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - Stefano Frega
- Medical Oncology 2, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | | | - Stefano Indraccolo
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Fiorella Calabrese
- Department of CardioThoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Pierfranco Conte
- University of Padova and Istituto Oncologico Veneto, Padova, Italy
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Platania M, Pasini F, Porcu L, Boeri M, Verderame F, Modena Y, Del Conte A, Nichetti F, Garassino MC, Martinetti A, Sottotetti E, Cavanna L, Vattemi E, Pozzessere D, Bertolini A, Irtelli L, Verri C, Sozzi G, Proto C, Pastorino U, Torri V, Fraccon AP, Spinnato F, Signorelli D, Lo Russo G, Tuzi A, Gallucci R, Cinieri S, Mencoboni M, Antonelli P, Giacomelli L, de Braud F. Oral maintenance metronomic vinorelbine versus best supportive care in advanced non-small-cell lung cancer after platinum-based chemotherapy: The MA.NI.LA. multicenter, randomized, controlled, phase II trial. Lung Cancer 2019; 132:17-23. [PMID: 31097088 DOI: 10.1016/j.lungcan.2019.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 12/17/2018] [Revised: 03/25/2019] [Accepted: 04/01/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Oral vinorelbine administered at the maximum tolerated dose has already showed activity and a good safety profile in advanced non-small-cell lung cancer (NSCLC). The MA.NI.LA study was a phase II, multicenter, randomized, controlled trial that aimed to assess the effects of a 'switched maintenance' regimen with oral metronomic vinorelbine (OMV) in patients with NSCLC who had not progressed after first-line platinum-based chemotherapy. PATIENTS AND METHODS Patients were randomly assigned in a 1:1 ratio to either OMV (50 mg three-times weekly) as maintenance treatment or best supportive care (BSC). The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), objective disease control rate (DCR, CR + PR + SD), safety and quality of life. RESULTS In total, 61 and 59 patients were assigned to OMV and BSC, respectively. At a median follow-up of 23.9 (IQR 10.2-38.2) months, patients treated with OMV reported a significantly lower progression rate compared to patient in the BSC arm (89% [54/61] vs 96% [56/58]; HR 0.73; 90% CI 0.53-0.999, p = 0.049). Median PFS for patients treated with vinorelbine was 4.3 months (95% CI 2.8-5.6) vs 2.8 months (95% CI 1.9-4.5) for patients receiving BSC. This benefit was specifically evident in patients aged ≥70 years, in current smokers, and in those who reported disease stabilization as best response to induction chemotherapy. OS and response rate and quality of life were similar in the two arms. Drop-out rate for major toxicity with OMV was unexpectedly high (25%, 14/61) mainly due to grade 3-4 neutropenia (11%, 7/61). Conclusions In patients with unselected NSCLC achieving disease control after platinum-based chemotherapy switch maintenance therapy with OMV prolonged PFS compared to BSC; however, the optimal dose of OMV requires further investigation.
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Affiliation(s)
- Marco Platania
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133, Milan, Italy.
| | - Felice Pasini
- Medical Oncology Unit, Pederzoli Hospital, Peschiera del Garda, Verona, Italy.
| | - Luca Porcu
- Laboratory of Methodology for Clinical Research, Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - Mattia Boeri
- Unit of Tumor Genomics, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133, Milan, Italy.
| | - Francesco Verderame
- Department of Hematology and Oncology, Hospital Vincenzo Cervello, Palermo, Italy.
| | - Yasmina Modena
- Oncology Departmente, Santa Maria della Misericordia Hospital, Rovigo, Italy.
| | | | - Federico Nichetti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133, Milan, Italy.
| | - Marina Chiara Garassino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133, Milan, Italy.
| | - Antonia Martinetti
- Laboratory Department - National Cancer Institute of Milan - Fondazione IRCCS Istituto Nazionale Tumori, 20133, Milan, Italy.
| | - Elisa Sottotetti
- Laboratory Department - National Cancer Institute of Milan - Fondazione IRCCS Istituto Nazionale Tumori, 20133, Milan, Italy.
| | - Luigi Cavanna
- Department of Hematology and Oncology, Medical Oncology Unit, Piacenza Hospital, Piacenza, Italy.
| | | | - Daniele Pozzessere
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy.
| | | | - Luciana Irtelli
- Medical Oncology Unit, SS Annunziata Hospital, Chieti, Italy.
| | - Carla Verri
- Unit of Tumor Genomics, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133, Milan, Italy.
| | - Gabriella Sozzi
- Unit of Tumor Genomics, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133, Milan, Italy.
| | - Claudia Proto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133, Milan, Italy.
| | - Ugo Pastorino
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133, Milan, Italy.
| | - Valter Torri
- Laboratory of Methodology for Clinical Research, Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - Anna Paola Fraccon
- Medical Oncology Unit, Pederzoli Hospital, Peschiera del Garda, Verona, Italy.
| | - Francesca Spinnato
- Department of Hematology and Oncology, Hospital Vincenzo Cervello, Palermo, Italy.
| | - Diego Signorelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133, Milan, Italy.
| | - Giuseppe Lo Russo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133, Milan, Italy.
| | | | - Rosaria Gallucci
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133, Milan, Italy.
| | | | - Manlio Mencoboni
- Medical Oncology, ASL 3 Genovese, Ospedale Villa Scassi, Genoa, Italy.
| | - Paola Antonelli
- ASST Valle Olona, Busto Arsizio Hospital, Busto Arsizio, Italy.
| | - Luca Giacomelli
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
| | - Filippo de Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, 20133, Milan, Italy.
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Tamburrini M, Gothi D, Barbetta C, Del Conte A, Sulfaro S, Zuccon U. Esophageal ultrasound with ultrasound bronchoscope (EUS-B) guided left adrenal biopsy: Case report with review of literature. Respir Med Case Rep 2018; 26:154-156. [PMID: 30603608 PMCID: PMC6310773 DOI: 10.1016/j.rmcr.2018.12.012] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/18/2018] [Accepted: 12/18/2018] [Indexed: 11/25/2022] Open
Abstract
A 45-year old man, chronic smoker with a pancoast tumor due to squamous cell carcinoma has been described. The initial diagnosis of lung carcinoma was based on a scant tissue so the exact cell typing was not possible. The initial treatment consisted of platinum based chemotherapy and radiotherapy. He developed a left adrenal lesion on treatment. There was a possibility of metachronous primary. Also, a large tissue sample was required for tumor markers. The lung mass was difficult to access and was static on treatment. A left adrenal biopsy was considered to be more appropriate. A novel approach for left adrenal lesion with esophageal ultrasound using ultrasound bronchoscope (EUS-B) was successfully performed. This article is aimed at describing the use of EUS-B for transdiaphragmatic structures.
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Affiliation(s)
- Mario Tamburrini
- Department of Pulmonary Medicine, Santa Maria degli Angeli di Pordenone, Italy
| | - Dipti Gothi
- Department of Pulmonary Medicine, ESI-PGIMSR, Delhi, India
| | - Carlo Barbetta
- Department of Pulmonary Medicine, Santa Maria degli Angeli di Pordenone, Italy
| | | | - Sandro Sulfaro
- Department of Pathology, Santa Maria degli Angeli di Pordenone, Italy
| | - Umberto Zuccon
- Department of Pulmonary Medicine, Santa Maria degli Angeli di Pordenone, Italy
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20
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Grossi F, Crinò L, Logroscino A, Canova S, Delmonte A, Melotti B, Proto C, Gelibter A, Cappuzzo F, Turci D, Gamucci T, Antonelli P, Marchetti P, Santoro A, Giusti S, Di Costanzo F, Giustini L, Del Conte A, Livi L, Giannarelli D, de Marinis F. Use of nivolumab in elderly patients with advanced squamous non-small-cell lung cancer: results from the Italian cohort of an expanded access programme. Eur J Cancer 2018; 100:126-134. [PMID: 30014881 DOI: 10.1016/j.ejca.2018.05.015] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [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: 02/11/2018] [Revised: 05/06/2018] [Accepted: 05/21/2018] [Indexed: 02/03/2023]
Abstract
AIM This analysis evaluated the efficacy and safety of nivolumab, an immune checkpoint inhibitor, in elderly patients with stage IIIB or IV squamous non-small-cell lung cancer (NSCLC) enrolled in the expanded access programme (EAP) in Italy. METHODS Nivolumab was available on physician request. Safety data included adverse events (AEs). Efficacy data included investigator-assessed tumour response, progression date and survival information. Results were analysed for patients aged <65, 65-<75 and ≥75 years and for the overall population. RESULTS A total of 371 patients with squamous NSCLC were enrolled at 96 centres between April 2015 and September 2015; 34% (n = 126), 47% (n = 175) and 19% (n = 70) were aged <65, 65-<75 and ≥75 years, respectively. Efficacy was similar among patients aged <65, 65-<75 and ≥75 years and the overall population (objective response rates: 18%, 18%, 19% and 18%, respectively; disease control rates: 49%, 47%, 43% and 47%, respectively). Median overall survival was reduced in patients aged ≥75 years (5.8 months) versus patients aged <65; years (8.6 months), patients aged 65-<75 years (8.0 months) and the overall population (7.9 months). The incidence of grade 3-4 treatment-related AEs was low in patients aged 65, 65-<75 and ≥75 years and the overall population (3%, 9%, 3%, 6%, respectively). Discontinuation rates due to treatment-related AEs were low irrespective of age (4-5%). CONCLUSIONS These EAP results suggest that elderly patients with advanced squamous NSCLC benefit from nivolumab, with tolerability similar to that in the overall population.
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Affiliation(s)
| | - Lucio Crinò
- Istituto Scientifico Romagnolo per Lo Studio e La Cura Dei Tumori (IRST), Meldola, Italy
| | - Antonio Logroscino
- Clinical Cancer Center IRCCS Istituto Tumori "Giovanni Paolo II" Bari, Italy
| | - Stefania Canova
- Department of Oncology, ASST Monza, Presidio San Gerardo, Monza, Italy
| | - Angelo Delmonte
- Istituto Scientifico Romagnolo per Lo Studio e La Cura Dei Tumori (IRST), IRCCS, Meldola, Italy
| | | | | | - Alain Gelibter
- Università Degli Studi di ROMA "La Sapienza", Rome, Italy
| | | | - Daniele Turci
- AUSL Della Romagna Presidi Ospedalieri di Ravenna, Faenza, Italy
| | - Teresa Gamucci
- ASL Frosinone - Presidio Ospedaliero SS Trinità, Sora, Italy
| | - Paola Antonelli
- ASST Valle Olona, Presidio Ospedaliero di Busto Arsizio, Busto Arsizio, Italy
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Lo Re G, Lo Re F, Doretto P, Del Conte A, Amadio M, Cozzi C, Casarotto MM, Maruzzi D, Marus W, Ubiali P, Sandri P. Cyclophosphamide with or without fluorouracil followed by subcutaneous or intravenous interleukin-2 use in solid tumors: A feasibility off-label experience. Cytokine 2018; 113:50-60. [PMID: 29958796 DOI: 10.1016/j.cyto.2018.06.005] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 05/13/2018] [Accepted: 06/05/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Immune tolerance seems to correlate with disease progression and T regulatory cells (Tregs) and myeloid-derived suppressor cells play a relevant role in immunosuppression. Cyclophosphamide (Cyt) and Fluorouracil (FU) seem to reduce these cell populations. METHODS AND OBJECTIVE Establishing safety, feasibility, activity and impact on the immune system (neutrophil/lymphocyte [N/L], platelet/L [Plt/L], monocyte [M] and lymphocyte subpopulation (CD3, CD4, CD8, CD16, HLADR/CD3, Tregs, cells count), CD8/Treg and C-reactive protein (CRP). TREATMENT 1) Cyt 300 mg/sqm ± FU 500 mg/sqm day (d) 1 and interleukin 2 (IL-2) 18 MUI/sqm intravenous (I.V.) d 4-6, 18-20 or 2) Cyt 300 mg/sqm + FU 500 mg/sqm day d 1, IL-2 4.5 MUI subcutaneous (S.C.) d 3-6, 17-20. The cycle was repeated every four weeks for 2 cycles. Stable or responding patients (pts) continued therapy for 3 cycles. RESULTS From February 2014 to December 2016, 13/14 pre-treated pts (mean 3 lines) with solid tumors were enrolled. Male/Female: 1/1. The median age and Eastern Cooperative Oncology Group Performance Status (ECOG PS) was 68 years and 1 respectively. Mean 2 cycles of therapy were administered. G3-4 toxicities presented as diarrhea and bleeding anemia in 2 pts and proteinuria and erhytroderma in 1pt, respectively. Regarding the hematological profile, a more reduction in Plt, less decrease of Plt/Ly, and less increase of Treg with I.V. than S.C. IL-2 administration was observed. However a transient decrease of Treg on day 7 of first cycle in the I.V. IL-2 was reported. RESPONSE PR 3 (23%), SD 3 (23%), PD 7 (54%). The response duration was 2+ and 3 months in 2 HCC and 18+ months in the pancreatic cancer (PC). Pathological CR was reported in one HCC treated with I.V. IL-2. The median progression-free-survival (PFS) and overall survival (OS) were 1 and 7 months. CONCLUSION Cyt-FU-IL-2 can be considered safe, feasible and moderately active in heavily pre-treated pts. Plt, Plt/Ly, CD8/Treg and a transient Tregs reduction were observed without significative difference on survival.
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Affiliation(s)
| | | | - Paolo Doretto
- Clinical Patholgy, AAS5 Pordenonese, Pordenone, Italy.
| | | | - Maria Amadio
- Medical Direction, AAS5 Pordenonese, Pordenone, Italy.
| | | | | | | | - Wally Marus
- Pathology Unit, AAS5 Pordenonese, Pordenone, Italy.
| | - Paolo Ubiali
- Surgery Unit, AAS5 Pordenonese, Pordenone, Italy.
| | - Paolo Sandri
- CRO Pordenone-S. Vito Oncology, Pordenone, Italy.
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22
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Platania M, Nichetti F, Porcu L, Pasini F, Boeri M, Modena Y, Del Conte A, Martinetti A, Sottotetti E, Pozzessere D, Vattemi E, Verderame F, Cavanna L, Fraccon AP, Formisano B, Gallucci R, Lo Russo G, Torri V, De Braud FG. A randomized phase II trial of maintenance oral metronomic vinorelbine versus close observation in advanced non-small cell lung cancer (NSCLC) following platinum-based chemotherapy: MA.NI.LA. trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e21101] [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)
- Marco Platania
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Luca Porcu
- IRCCS Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Felice Pasini
- Medical Oncology, Casa di Cura Pederzoli, Peschiera del Garda, Peschiera Del Garda (VR), Italy
| | - Mattia Boeri
- Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | | | | | | | | | | | - Luigi Cavanna
- Oncology-Hematology Department, Hospital of Piacenza, Piacenza, Italy
| | | | | | | | | | - Valter Torri
- IRCCS Istituto Di Ricerche Farmacologiche Mario Negri, Milan, Italy
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Fiorentini G, Del Conte A, De Simone M, Guadagni S, Mambrini A, D'Alessandro M, Aliberti C, Rossi G, Cantore M. Complete Response of Colorectal Liver Metastases after Intra-Arterial Chemotherapy. Tumori 2018; 94:489-92. [DOI: 10.1177/030089160809400408] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and Background We demonstrated that colorectal liver metastases considered in complete response after intra-arterial floxuridine-based chemotherapy had recurred in situ. Methods and Study Design One hundred and six colorectal liver metastases disappeared after intra-arterial chemotherapy. Persistent macroscopic disease was observed at surgery at the site of 52 of 106 liver metastases, even though computerized tomography scan and ultrasound showed a complete response. The sites of 35 initial liver metastases that were not visible at surgery were resected. Pathologic examination of these sites, considered in complete response, showed viable cancer cells in 22 of 35 cases. Results After 1 year of follow-up, 33 of 106 liver metastases considered in complete response had recurred in situ. After 2 years of follow-up, persistent macroscopic or microscopic residual disease or recurrence was observed in 86 (81%) of the 106 liver metastases. Conclusions Nevertheless, 19% of the patients had a long-lasting response. This means that floxuridine given as intra-arterial hepatic chemotherapy can still be considered an interesting option of cure in the treatment of colorectal liver metastases. When feasible, the site of the lesion that disappeared after intra-arterial chemotherapy should be resected at surgery. The best palliative cure of liver metastases should be the combination of local-regional strategies like intra-arterial chemotherapy, surgery or radiofrequency ablation with the systemic approach.
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Affiliation(s)
| | | | - Michele De Simone
- Department of Surgical Oncology, San Giuseppe Hospital, Empoli (Florence)
| | | | | | | | | | - Giuseppe Rossi
- Interventional Radiology Unit, Istituto Ortopedico Rizzoli, Bologna, Italy
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Trovo M, Furlan C, Polesel J, Fiorica F, Arcangeli S, Giaj-Levra N, Alongi F, Del Conte A, Militello L, Muraro E, Martorelli D, Spazzapan S, Berretta M. Radical radiation therapy for oligometastatic breast cancer: Results of a prospective phase II trial. Radiother Oncol 2018; 126:177-180. [DOI: 10.1016/j.radonc.2017.08.032] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/14/2017] [Accepted: 08/20/2017] [Indexed: 12/15/2022]
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Finocchiaro CY, Rota A, Barbieri V, Bettini A, Bianco R, Borra G, Buffoni L, Bulotta A, Carta A, Cortinovis D, Costanzo R, Cusmai A, Danesi R, D’Argento E, Del Conte A, Franchina T, Gilli M, Gregorc V, Irtelli L, Landi L, Malorgio F, Mancuso G, Martelli O, Mazzanti P, Melotti B, Migliorino MR, Minotti V, Montrone M, Morabito A, Roca E, Romano G, Rossi A, Savio G, Tiseo M, Boscardini I, Piccolo L, Pilotto S, Malapelle U. Listening understanding and acting (lung): focus on communicational issue in thoracic oncology. Transl Cancer Res 2018; 8:S16-S22. [PMID: 35117061 PMCID: PMC8798889 DOI: 10.21037/tcr.2018.12.32] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 12/21/2018] [Indexed: 12/03/2022]
Abstract
Background In the field of oncological assistance, nowadays we have to deal with a complex scenario where patients got used to obtain a huge amount of information through internet or social media and to apply them in performing their health-related decisions. This landscape requires that clinicians become able to handle therapeutical approaches and adequate skills in communication tools to satisfy the current needs. Our project aimed to build a communication model based on clinical oncologists’ real experiences in order to find a simple way to share with patients all the innovative therapeutical opportunities today available in lung cancer. The final goal is to design a flexible and personalized model adaptable to clinician’s personal characteristics and to the specific patient he is facing. We applied both traditional educational tools and innovative techniques in order to make the results effective and applicable to support peer learning. Methods The first step consisted in a Board synthesized the definition of the diagnostic process, the identification of treatment strategies and any potential communication barrier clinicians may face dealing with patients. The second step consisted in teamwork including a theoretical part and a training part. In the third step we produce five training videos and video interviews regarding communication praxis and a “Small communication manual”. The last step consisted in the publication of the produced material on website and its diffusion through the social media. Results In medicine, the universal application of a single model of communication does not represent the optimal solution. By contrary, the availability of simple and practical suggestions to improve the communicative style could allow clinicians to abandon stereotyped formulas identically repurposed to all patients. The “from bottom to top” training, starting from real-life to take advantage of the clinician’s experience, give the clinicians the possibility to meditate about their own communicative style and to train in the context of a protected environment. Applying these rules, we design an effective communication model, based on healthcare humanization, which could represent a fundamental support for the patient in order to be gently driven by the clinician to the most appropriate therapeutical choice, balancing efficacy and quality of life. The relational training may improve the quality of clinician-patient communication and could be widespread to other clinicians through the media. Conclusions Considering the innovative therapeutical options available, particularly for lung cancer patients, and the increasing access of health-related information through internet or social media the clinician-patient communication has become crucial to support the achievement of the most appropriate therapeutical choice for the patient, facing the intricate illness experience. Building a shareable and easy-to-apply communication model represents a challenge aimed to help clinicians and including technology not as a threat, but as a positive tool.
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Affiliation(s)
| | | | - Vito Barbieri
- UO Oncologia Medica, AOU “Mater Domini”, Germaneto, Catanzaro, Italy
| | - Anna Bettini
- ASST Papa Giovanni XXIII, UO Oncologia, Bergamo, Italy
| | | | - Gloria Borra
- AOU Maggiore della Carità di Novara, Novara, Italy
| | - Lucio Buffoni
- AOU San Luigi Orbassano, Oncologia Medica, Torino, Italy
| | - Alessandra Bulotta
- Dipartimento di Oncologia Medica, IRCCS Ospedale Scientifico San Raffaele, Milano, Italy
| | - Annamaria Carta
- AOB Cagliari, UO Oncologia Medica, Ospedale Businco, Cagliari, Italy
| | - Diego Cortinovis
- Struttura Semplice Lung Unit, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Raffaele Costanzo
- UO Complessa di Oncologia medica Toraco-Polmonare, Istituto Nazionale Tumori, Napoli, Italy
| | | | - Romano Danesi
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy
| | - Ettore D’Argento
- UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Alessandro Del Conte
- IRCCS, Centro di Riferimento Oncologico, SOC Oncologia Medica e dei Tumori Immunocorrelati, Aviano (PN), Italy
| | - Tindara Franchina
- Dipartimento di Patologia Umana “G.Barresi”, Università degli studi di Messina, Messina, Italy
| | - Marina Gilli
- AORN dei Colli, UOSD DH PNL Oncologico, Napoli, Italy
| | - Vanesa Gregorc
- Dipartimento di Oncologia Medica, IRCCS Ospedale Scientifico San Raffaele, Milano, Italy
| | - Luciana Irtelli
- Clinica Oncologica, ASL Lanciano Vasto Chieti, Chieti, Italy
| | - Lorenza Landi
- Unità Operativa di Oncologia ed Ematologia, AUSL Romagna, Ravenna, Italy
| | | | | | - Olga Martelli
- AO Complesso Ospedaliero San Giovanni-Addolorata, Roma, Italy
| | - Paola Mazzanti
- UO Clinica Oncologica, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Barbara Melotti
- Oncologia Medica, Azienda Ospedaliera S.Orsola-Malpighi, Bologna, Italy
| | - Maria Rita Migliorino
- UOSD di Pneumologia Oncologica Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy
| | - Vincenzo Minotti
- Divisione Struttura Complessa Oncologia Medica, Ospedale S. Maria della Misericordia Perugia, Perugia, Italy
| | - Michele Montrone
- SSD Oncologia Medica per la Patologia Toracica, IRCCS Istituto Tumori “Giovanni Paolo II” di Bari, Bari, Italy
| | - Alessandro Morabito
- Struttura Complessa Oncologia Medica Toraco-Polmonare, Divisione di Oncologia Medica, Istituto Nazionale Tumori Fondazione Pascale, Napoli, Italy
| | - Elisa Roca
- Oncologia Medica, Spedali Civili di Brescia, Brescia, Italy
| | | | - Antonio Rossi
- Divisione di Oncologia Medica, Fondazione IRCCS Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Foggia, Italy
| | | | - Marcello Tiseo
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Parma, Italy
| | - Ivano Boscardini
- Docente di tecniche di comunicazione, CREMS Centro di Ricerca in Economia e Management in Sanità e nel Sociale, Università Cattaneo LIUC, Castellanza, VA, Italy
| | | | - Sara Pilotto
- Università degli Studi di Verona, UO Oncologia Medica, AOUI Verona, Verona, Italy
| | - Umberto Malapelle
- Anatomia Patologica, Dip.to di Sanità Pubblica, Università degli Studi di Napoli Federico II, Naples, Italy
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Muraro E, Furlan C, Avanzo M, Martorelli D, Comaro E, Rizzo A, Fae' DA, Berretta M, Militello L, Del Conte A, Spazzapan S, Dolcetti R, Trovo' M. Local High-Dose Radiotherapy Induces Systemic Immunomodulating Effects of Potential Therapeutic Relevance in Oligometastatic Breast Cancer. Front Immunol 2017; 8:1476. [PMID: 29163540 PMCID: PMC5681493 DOI: 10.3389/fimmu.2017.01476] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 10/20/2017] [Indexed: 12/15/2022] Open
Abstract
Local irradiation of cancer through radiotherapy can induce spontaneous regression of non-directly irradiated lesions, suggesting the involvement of systemic antitumor immune responses. In oligometastatic breast cancer (BC) patients, the use of stereotactic body radiotherapy (SBRT) favors the local control of treated lesions and may contribute to break local tolerance and release tumor-associated antigens (TAAs), improving host antitumor immunity. We performed a detailed immunomonitoring of BC patients undergoing SBRT to verify its ability to “switch on” the anti-tumor immunity both systemically, in peripheral blood, and locally, employing in vitro BC models. Twenty-one BC patients with ≤6 metastases were treated with 3 daily doses of 10 Gy with SBRT. Blood samples for immune profiling were collected before and after treatment. One month after treatment a third of patients displayed the boosting or even the de novo appearance of polyfunctional CD4+ and CD8+ T cell responses against known BC TAAs (survivin, mammaglobin-A, HER2), through intracellular staining in flow cytometry. Half of patients showed increased numbers of activated natural killer (NK) cells, measured with multispectral flow cytometry, immediately after the first dose of SBRT. Interestingly, high levels of activated NK cells at diagnosis correlated with a longer progression-free survival. BC in vitro models, treated with the same SBRT modality, showed enhanced expression of MHC class-I and class-II, major histocompatibility complex class I-related chain A/B, and Fas molecules, and increased release of pro-inflammatory cytokines, such as IL-1β and TNF-α. Consistently, we noticed enhanced production of perforin by CD4+ T cells when patients’ lymphocytes were cultured in the presence of irradiated BC cell line, compared to untreated targets. Besides immunogenic effects, SBRT also enhanced the percentages of circulating regulatory T cells, and increased indoleamine 2,3 dioxygenase and PD-L1 expression in BC in vitro models. These results suggest that SBRT may boost host antitumor immune responses also in an advanced disease setting such as oligometastatic BC, by inducing immunomodulating effects both locally and systemically. However, the concomitant induction of immunosuppressive pathways suggests that a combination with immunotherapy could further enhance the in situ vaccination ability of radiotherapy, possibly further improving the curative potential of SBRT in this subset of patients.
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Affiliation(s)
- Elena Muraro
- Immunopathology and Biomarker Unit, Department of Translational Research, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Carlo Furlan
- Department of Radiation Oncology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Michele Avanzo
- Division of Medical Physics, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Debora Martorelli
- Immunopathology and Biomarker Unit, Department of Translational Research, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Elisa Comaro
- Immunopathology and Biomarker Unit, Department of Translational Research, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Aurora Rizzo
- Immunopathology and Biomarker Unit, Department of Translational Research, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Damiana A Fae'
- Immunopathology and Biomarker Unit, Department of Translational Research, CRO Aviano National Cancer Institute, Aviano, Italy
| | | | - Loredana Militello
- Department of Medical Oncology, CRO Aviano National Cancer Institute, Aviano, Italy
| | | | - Simon Spazzapan
- Department of Medical Oncology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Riccardo Dolcetti
- Immunopathology and Biomarker Unit, Department of Translational Research, CRO Aviano National Cancer Institute, Aviano, Italy.,Translational Research Institute, University of Queensland Diamantina Institute, Brisbane, QLD, Australia
| | - Marco Trovo'
- Department of Radiation Oncology, Azienda Sanitaria Universitaria Integrata of Udine, Udine, Italy
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Mencoboni M, Filiberti RA, Taveggia P, Del Corso L, Del Conte A, Covesnon MG, Puccetti C, Donati S, Auriati L, Amoroso D, Camerini A. Safety of First-line Chemotherapy with Metronomic Single-agent Oral Vinorelbine in Elderly Patients with NSCLC. Anticancer Res 2017; 37:3189-3194. [PMID: 28551663 DOI: 10.21873/anticanres.11679] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 03/28/2017] [Revised: 04/13/2017] [Accepted: 04/19/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The optimal therapeutic use of metronomic vinorelbine has not yet been defined. We aimed to assess the safety of metronomic oral vinorelbine in first-line treatment of elderly patients with advanced lung cancer who were unfit for polychemotherapy. Progression-free survival, response rate and overall survival were secondary end-points. PATIENTS AND METHODS Seventy-six patients received 50 mg of oral vinorelbine three times per week, until disease progression, patient refusal or unacceptable toxicity. Patients were evaluated for response and toxicity after one cycle of chemotherapy. The treatment was considered feasible with a grade 3/4 toxicity rate lower than 20%. RESULTS Clinical benefit was observed in 50% of patients. Median overall survival was 8.0 months. Grade 1/2 toxicity was observed in 53 patients (69.7%), grade 3 toxicity in eight patients (10.5%). One patient had grade 4 diarrhea. CONCLUSION Metronomic oral vinorelbine is safe in elderly patients, allowing for long-term disease stabilization with optimal patient compliance.
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Affiliation(s)
| | - Rosa Angela Filiberti
- Clinical Epidemiology, IRCCS AOU San Martino-IST-National Cancer Research Institute, Genoa, Italy
| | | | | | | | | | - Cheti Puccetti
- Medical Oncology, Versilia Hospital, Lido di Camaiore, Italy
| | - Sara Donati
- Medical Oncology, Versilia Hospital, Lido di Camaiore, Italy
| | | | | | - Andrea Camerini
- Medical Oncology, Versilia Hospital, Lido di Camaiore, Italy
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Pacchiana MV, Capelletto E, Carnio S, Gridelli C, Rossi A, Galetta D, Montagna ES, Bordi P, Ceribelli A, Cortinovis D, Scotti V, Martelli O, Valmadre G, Del Conte A, Miccianza A, Morena R, Rosetti F, Di Maio M, Ostacoli L, Novello S. Patients' Attitudes and Physicians' Perceptions Toward Maintenance Therapy for Advanced Non–Small-cell Lung Cancer: A Multicenter Italian Survey. Clin Lung Cancer 2017; 18:381-387. [DOI: 10.1016/j.cllc.2016.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 10/17/2016] [Accepted: 10/18/2016] [Indexed: 12/01/2022]
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Lo Re G, Lo Re F, Doretto P, Del Conte A, Amadio M, Cozzi C, Adamo V, Maruzzi D, Ubiali P, Sandri P. Cyclophosphamide with (+)/without (-) fluorouracil followed by subcutaneous or intravenous interleukin-2 in solid tumors: An off-label experience. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e14621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14621 Background: primary and acquired resistance cause treatment failure to several agents. Recently it is emerging the role of immune surveillance in the control of tumor progression. The immune tolerance correlates with disease progression and FOXP3+ regulatory T cells (Tregs) and myeloid-derived suppressor cells (MDSC) play a relevant role in immunosuppression. Cyclophosphamide (C) and Fluorouracil (FU) seems to reduce these cell populations. Methods: Objective: safety, feasibility, pain control, activity and impact on immune system (Neutrophil/Lymphocyte (N/L), Platelet/L (P/L), Tregs %, Monocytes (M)(103/μL) count.Treatment: 1) C 300 mg/sqm +/- FU 500 mg/sqm day (d) 1, Interleukin-2 (IL-2) 18 MUI/sqm intravenous continuous infusion (i.v.c.i) d 3-5, 17-19 q 29 or 2) C 300 mg/sqm + FU 500 mg/sqm day d 1, IL-2 4.5 MUI subcutaneous (s.c) d 3-6, 17-20 q 29 for 2 cycles. Stable or responding patients (pts) continue therapy for three cycles. Results: from February 2014 to December 2016, 13/14 pts were treated. M/F:1/1. Median age was 68 years and median PS 1 (range 0-2). The primary tumor was bladder, liver, pancreas, neuroendocrine carcinoma and ovary in 2, melanoma, prostate, GIST and breast in 1 pt respectively. Sites of metastases were: lung in 4, liver in 9, lymph’nodes in 9, bone in 5 and spleen in 1 pt respectively. Previous therapy: 1- 2 in 6, ≥ 3 in 8. Six and 7 pts performed treatment 1, 2 respectively. Median number of cycles administered was 2 (range 1-3). Median basal and post-treatment N/L, P/L, M and Treg values were 2, 130, 0.49, 2,9% and 2, 94, 0.55, 10.5%. Pain improvement was obtained on 7/8 pts. The toxicity was manageable as for i.v.c.i as for s.c administration. In addition to universal capillary like syndrome, G3-4 toxicities were diarrhea, bleeding, anemia in 2, proteinuria in 1 pt respectively. Response: 3 PR (2 HCC, 1 pancreas), 2 SD, 4 PD, 5 unevaluable. The duration of response was 2+ and 3 months in 2 HCC pts and 8+ months in pancreatic pt. The crude median PFS and OS was 1 (range1-8+) and 2+ (range 1-18) months Conclusions: C- FU- IL-2 can be considered safe, feasible and meanly active in heavy pretreated pts. Except P/L, no reduction on Tregs, M counts and N/L was observed.
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Affiliation(s)
| | - Francesco Lo Re
- Clinical and Experimental Pharmacology CRO IRCCS, Aviano, Italy
| | - Paolo Doretto
- Clinical Pathology AAS5 Pordenonese, Pordenone, Italy
| | | | | | | | - Valter Adamo
- Obstetrics and Gynecology AAS5 Pordenonese, Pordenone, Italy
| | | | | | - Paolo Sandri
- Oncology Unit Pordenone CRO Aviano, Pordenone, Italy
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Bonanno L, De Paoli A, Zulato E, Esposito G, Calabrese F, Favaretto A, Santo A, Conte AD, Chilosi M, Oniga F, Sozzi G, Moro M, Ciccarese F, Nardo G, Bertorelle R, Candiotto C, De Salvo GL, Amadori A, Conte P, Indraccolo S. LKB1 Expression Correlates with Increased Survival in Patients with Advanced Non–Small Cell Lung Cancer Treated with Chemotherapy and Bevacizumab. Clin Cancer Res 2017; 23:3316-3324. [DOI: 10.1158/1078-0432.ccr-16-2410] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/22/2016] [Accepted: 12/31/2016] [Indexed: 11/16/2022]
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Lumachi F, Ubiali P, Del Conte A, Mazza F, Basso S. P1.06-025 Analysis of Risk Factors for Development of Skeletal-Related Events in Women with Bone Metastases from NSCLC and Breast Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.889] [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: 11/24/2022]
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Lumachi F, Ubiali P, Del Conte A, D'Aurizio F, Tozzoli R, Basso S. P2.01-003 Serum VEGF, MMP-7 and CYFRA 21-1 as Predictive Markers of Lung Metastases from Colorectal Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Carnio S, Galetta D, Scotti V, Cortinovis DL, Antonuzzo A, Pisconti S, Rossi A, Martelli O, Lunghi A, Pilotto S, Del Conte A, Pegoraro V, Montagna ES, Topulli J, Pelizzoni D, Rapetti SG, Gianetta M, Pacchiana MV, Novello S. P2.03a-017 Chemotherapy-Induced Nausea and Vomiting (CINV) in Italian Lung Cancer Patients: Assessment by Physician, Nurse and Patient. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lumachi F, Ubiali P, Tozzoli R, Del Conte A, Basso S. P2.04-054 Pleural CEA and C-Reactive Protein in Patients with Lung Metastases and Malignant Pleural Effusion. A Prospective Case-Control Study. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1434] [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: 11/25/2022]
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Cappuzzo F, Morabito A, Normanno N, Bidoli P, Del Conte A, Giannetta L, Montanino A, Mazzoni F, Buosi R, Burgio MA, Cerea G, Chiari R, Cortinovis D, Finocchiaro G, Foltran L, Migliorino MR, Tiseo M, Ferrari S, De Marinis F. Efficacy and safety of rechallenge treatment with gefitinib in patients with advanced non-small cell lung cancer. Lung Cancer 2016; 99:31-7. [PMID: 27565910 DOI: 10.1016/j.lungcan.2016.06.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 03/16/2016] [Revised: 06/06/2016] [Accepted: 06/11/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Although patients with advanced non-small cell lung cancer (NSCLC) and an activating epidermal growth factor receptor (EGFR) mutation benefit from the use of EGFR-tyrosine kinase inhibitors (TKI), most of them progress within 12 months from treatment start due to acquired resistance. In clinical practice, many physicians frequently offer these patients retreatment with EGFR-TKIs after a chemotherapy break, based on small or retrospective studies. MATERIALS AND METHODS A phase II trial was conducted in patients with stage III/IV NSCLC, to assess the efficacy, safety and impact on quality of life (QoL) and disease-related symptoms of gefitinib rechallenge. Eligible patients had initially responded to first-line gefitinib and progressed after second-line chemotherapy. RESULTS Of 61 enrolled patients, 73.8% were female, 100% had EGFR-mutated adenocarcinoma and 67.2% were never-smokers. Thirty-two (52.5%) patients obtained a clinical benefit, with 3 (4.9%) achieving a partial response and 29 (47.5%) having stable disease. Median progression-free survival was 2.8 months, overall survival 10.2 months and duration of gefitinib treatment 3.6 months. The most common all grade-adverse events were diarrhea (27.6%), nausea and/or vomiting (20.3%), rash (14.7%) and dyspnea (10.3%); no new toxicities were apparent. CONCLUSION Findings from this study indicate that gefitinib rechallenge offers modest benefit and may be taken into consideration only for patients for whom no other treatment option exists.
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Affiliation(s)
- Federico Cappuzzo
- Medical Oncology Department, Istituto Toscano Tumori, Ospedale Civile, Viale Alfieri 36, 57100 Livorno, Italy.
| | - Alessandro Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori "Fondazione G Pascale"-IRCCS, Via Semmola, 80131 Naples, Italy.
| | - Nicola Normanno
- Cell Biology & Biotherapy Unit, Istituto Nazionale Tumori "Fondazione G Pascale"-IRCCS, Via Semmola, 80131 Naples, Italy.
| | - Paolo Bidoli
- Department of Oncology, San Gerardo Hospital, Monza, Via Pergolesi 33, 20900 Monza, Italy.
| | - Alessandro Del Conte
- Medical Oncology, Azienda per l'Assistenza Sanitaria No. 5 (AAS5) - Friuli Occidentale - Presidio Ospedaliero di Pordenone, Via Montereale 24, 33170 Pordenone, Italy.
| | - Laura Giannetta
- Oncologia Falck, Division of Medical Oncology, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
| | - Agnese Montanino
- Thoracic Medical Oncology, Istituto Nazionale Tumori "Fondazione G Pascale"-IRCCS, Via Semmola, 80131 Naples, Italy.
| | - Francesca Mazzoni
- Medical Oncology, University Hospital Careggi, L. go Brambilla 3, 50134 Florence, Italy.
| | - Roberta Buosi
- Division of Oncology, Department of Translational Medicine, University of Eastern Piedmont "Amedeo Avogadro", 28100 Novara, Italy.
| | - Marco Angelo Burgio
- Department of Medical Oncology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy.
| | - Giulio Cerea
- Oncologia Falck, Division of Medical Oncology, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
| | - Rita Chiari
- Department of Medical Oncology, "Santa Maria della Misericordia" Hospital, Azienda Ospedaliera di Perugia, 06132 Perugia, Italy.
| | - Diego Cortinovis
- Department of Oncology, San Gerardo Hospital, Monza, Via Pergolesi 33, 20900 Monza, Italy.
| | - Giovanna Finocchiaro
- Department of Medical Oncology, Istituto Clinico Humanitas IRCCS, Via Manzoni 56, 20089 Rozzano, Milan, Italy.
| | - Luisa Foltran
- Medical Oncology, Azienda per l'Assistenza Sanitaria No. 5 (AAS5) - Friuli Occidentale - Presidio Ospedaliero di Pordenone, Via Montereale 24, 33170 Pordenone, Italy.
| | - Maria Rita Migliorino
- Department of Thoracic Oncology, 1st Pulmonary Oncological Unit, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy.
| | - Marcello Tiseo
- Division of Medical Oncology, University Hospital of Parma, Via Gramsci, 14, 43126 Parma, Italy.
| | - Silvia Ferrari
- AstraZeneca, Palazzo Ferraris, Via Ludovico il Moro 6/C, 20080 Basiglio, Milan, Italy.
| | - Filippo De Marinis
- Thoracic Oncology Division, Istituto Europeo di Oncologia (IEO), Via Ripamonti 435, 20141 Milan, Italy, Italy; Formerly Department of Thoracic Oncology, 1st Pulmonary Oncological Unit, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy.
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Csõszi T, Goldman JW, Szilasi M, Von Pawel J, Novello S, Carter CA, Ciuleanu TE, Del Conte A, Chatta G, Schenker M, Robert F, Orlov S, Zajda K, De Marinis F, Bennett CL, Kroll S, Pearce TE, Belani C. Randomized, double-blind, placebo-controlled trial of evofosfamide (Evo) and pemetrexed (Pem) in advanced non-squamous non-small cell lung cancer (n-s NSCLC). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.9075] [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)
- Tibor Csõszi
- Jász-Nagykun Szolnok Megyei Hetényi Géza Kórház-Rendelointézet, Szolnok, Hungary
| | | | - Maria Szilasi
- University of Debrecen Medical and Health Science Center, Debrecen 4032, Hungary
| | | | - Silvia Novello
- Azienda Ospedaliero-Universitaria S. Luigi Gonzaga, Orbassano, Italy
| | | | | | | | | | | | - Francisco Robert
- The University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Sergey Orlov
- Department of Thoracic Oncology, St. Petersburg State Medical University, St. Petersburg, Russia
| | - Katarzyna Zajda
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | | | | | - Stew Kroll
- Threshold Pharmaceuticals, Inc., South San Francisco, CA
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Lumachi F, Chiara GB, Tozzoli R, Del Conte A, Basso SMM. Factors Affecting Survival in Patients with Lung Metastases from Colorectal Cancer. A Short Meta-analysis. Anticancer Res 2016; 36:13-19. [PMID: 26722023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Liver and pulmonary metastases (PMs) are relatively common in patients with colorectal cancer. The majority of metastases are suitable for surgical resection, and the effectiveness of metastasectomy is usually assessed based on overall survival (OS). Metastasectomy provides a mean 5-year OS rate of approximately 50%, but the results are better in patients with liver metastases compared to those with PMs. Unfortunately, the presence of bilateral or multiple PMs represents a relative contraindication to surgical metastasectomy. Unresectable PMs can be safely treated with percutaneous radiofrequency ablation or radiotherapy, but the reported results vary widely. Several clinical prognostic factors affecting OS after metastasectomy have been reported, such as number of PMs, hilar or mediastinal lymph node involvement, disease-free interval, age and gender, resection margins, size of the metastases, neoadjuvant chemotherapy administration, and histological type of the primary cancer. The accurate evaluation of all clinical prognostic factors, circulating and immunohistochemical markers, and the study of gene mutational status will lead to a more accurate selection of patients scheduled to metastasectomy, with the aim of improving outcome.
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Affiliation(s)
- Franco Lumachi
- Department of Surgery Oncology and Gastroenterology, University of Padua, School of Medicine, Padova, Italy
| | - Giordano B Chiara
- Department of Surgery, Surgery 1, S. Maria degli Angeli Hospital, Pordenone, Italy
| | - Renato Tozzoli
- Department of Laboratory Medicine, Clinical Pathology Laboratory, S. Maria degli Angeli Hospital, Pordenone, Italy
| | | | - Stefano M M Basso
- Department of Surgery, Surgery 1, S. Maria degli Angeli Hospital, Pordenone, Italy
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Cazzaniga ME, Camerini A, Addeo R, Nolè F, Munzone E, Collovà E, Del Conte A, Mencoboni M, Papaldo P, Pasini F, Saracchini S, Bocci G. Metronomic oral vinorelbine in advanced breast cancer and non-small-cell lung cancer: current status and future development. Future Oncol 2015; 12:373-87. [PMID: 26584409 DOI: 10.2217/fon.15.306] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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: 12/17/2022] Open
Abstract
Metronomic chemotherapy (mCT), a frequent administration of low-dose chemotherapy, allows prolonged treatment duration and minimizes the toxicity of standard-dose chemotherapy. mCT has multiple actions against cancer cells including inhibition of angiogenesis and modulation of the immune system. A number of studies lend support to the clinical efficacy of mCT in advanced breast cancer and non-small-cell lung cancer. However, further evidence is necessary to describe the optimal use of mCT and to identify suitable patients. Oral vinorelbine has emerged as a promising metronomic treatment in patients with metastatic breast cancer and non-small-cell lung cancer and is the only orally available microtubule-targeting agent. This paper reviews current evidence on metronomic oral vinorelbine, discusses its management and defines a suitable patient profile on the basis of a workshop of Italian experts.
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Affiliation(s)
- Marina E Cazzaniga
- Department of Oncology, AO San Gerardo, via Pergolesi 33, 20052 Monza (MB), Italy
| | - Andrea Camerini
- Department of Medical Oncology, Versilia Hospital & Istituto Toscano Tumori, 55041 Lido di Camaiore (LU), Italy
| | - Raffaele Addeo
- Oncology Unit, San Giovanni di Dio Hospital, 80027 Frattamaggiore (NA), Italy
| | - Franco Nolè
- Division of Urogenital & Head & Neck Cancer, European Institute of Oncology, 20141 Milan, Italy
| | - Elisabetta Munzone
- Division of Medical Senology, European Institute of Oncology, 20141 Milan, Italy
| | - Elena Collovà
- Oncology Unit, AO Ospedale Civile di Legnano, Legnano, 20025 Legnano (MI), Italy
| | - Alessandro Del Conte
- Department of Medical Oncology, Azienda per l'Assistenza Sanitaria No. 5 - Friuli Occidentale, Presidio Ospedaliero di Pordenone, 33170 Pordenone, Italy
| | - Manlio Mencoboni
- Oncology Unit, Villa Scassi Hospital, ASL3-Genovese, 16149 Genoa, Italy
| | - Paola Papaldo
- Department of Medical Oncology, Istituto Nazionale Tumori Regina Elena, 00144 Rome, Italy
| | - Felice Pasini
- Department of Medical Oncology, Rovigo Hospital, ULSS18, 45100 Rovigo, Italy
| | - Silvana Saracchini
- Department of Medical Oncology, Azienda per l'Assistenza Sanitaria No. 5 - Friuli Occidentale, Presidio Ospedaliero di Pordenone, 33170 Pordenone, Italy
| | - Guido Bocci
- Department of Clinical & Experimental Medicine, Division of Pharmacology, University of Pisa, 56126 Pisa, Italy
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Minatel E, Trovo M, Bearz A, Di Maso M, Baresic T, Drigo A, Barresi L, Furlan C, Del Conte A, Bruschi G, Fontana P, Pagan V, Franchin G. Radical Radiation Therapy After Lung-Sparing Surgery for Malignant Pleural Mesothelioma: Survival, Pattern of Failure, and Prognostic Factors. Int J Radiat Oncol Biol Phys 2015; 93:606-13. [PMID: 26281826 DOI: 10.1016/j.ijrobp.2015.06.029] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 06/10/2015] [Accepted: 06/16/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To prospectively assess the survival, patterns of failure, and prognostic factors in a large cohort of patients with malignant pleural mesothelioma who had undergone a novel trimodal therapeutic approach, including lung-sparing surgery, chemotherapy, and subsequent treatment with high doses of intensity modulated radiation therapy (IMRT) to the whole hemithorax. METHODS AND MATERIALS The analysis was conducted on the data from 69 patients. Of the 69 patients, 35 underwent extended pleurectomy/decortication (P/D), with resection of the entire pleura, along with portions of the pericardium and diaphragm and 34, partial pleurectomy, defined as partial removal of parietal or visceral pleura for diagnostic purposes, leaving gross tumor behind in all cases. All patients received cisplatin/pemetrexed chemotherapy. Postoperative IMRT was delivered to the entire hemithorax, excluding the intact lung. The IMRT dose was 50 Gy in 25 fractions. Any fluorodeoxyglucose-avid areas or regions of particular concern for residual disease were given a simultaneous boost to 60 Gy. RESULTS The median follow-up duration was 19 months. No difference was seen in overall survival and locoregional control between the extended P/D group and the partial pleurectomy group. The 2-year overall survival was 65% and 58% in the extended P/D and partial pleurectomy groups, respectively (P=.94). Locoregional control at 2 years was 65% and 64% in the extended P/D and partial pleurectomy groups, respectively (P=.75). The predominant pattern of failure was distant: 19 patients (27.5%) developed distant metastases as the first site of relapse. Gross residual disease after surgery was significantly associated with overall survival (hazard ratio 3.45). One fatal pneumonitis was reported; 14 cases (20%) of grade 2 to 3 pneumonitis were documented. CONCLUSIONS Radical IMRT after lung-sparing surgery and chemotherapy for malignant pleural mesothelioma leads to promising survival results and acceptable toxicity rates. The similarity of survival between patients treated with extended P/D or partial pleurectomy observed in our study is intriguing.
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Affiliation(s)
- Emilio Minatel
- Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Aviano, Italy
| | - Marco Trovo
- Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Aviano, Italy.
| | - Alessandra Bearz
- Department of Medical Oncology, Centro di Riferimento Oncologico of Aviano, Aviano, Italy
| | - Matteo Di Maso
- Unit of Epidemiology and Biostatistics, Centro di Riferimento Oncologico of Aviano, Aviano, Italy
| | - Tania Baresic
- Department of Nuclear Medicine, Centro di Riferimento Oncologico of Aviano, Aviano, Italy
| | - Annalisa Drigo
- Department of Medical Physics, Centro di Riferimento Oncologico of Aviano, Aviano, Italy
| | - Loredana Barresi
- Department of Medical Physics, Centro di Riferimento Oncologico of Aviano, Aviano, Italy
| | - Carlo Furlan
- Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Aviano, Italy
| | | | - Gioia Bruschi
- Department of Pneumology, Pordenone General Hospital, Pordenone, Italy
| | - Paolo Fontana
- Department of Thoracic Surgery, Mestre General Hospital, Mestre, Italy
| | - Vittore Pagan
- Department of Surgery, Centro di Riferimento Oncologico of Aviano, Aviano, Italy
| | - Giovanni Franchin
- Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Aviano, Italy
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Lumachi F, Mazza F, Del Conte A, Lo Re G, Ermani M, Chiara GB, Basso SMM. Short-term Survival of Patients with Lung Metastases from Colorectal and Non-colorectal Cancer Who Underwent Pulmonary Metastasectomy. Anticancer Res 2015; 35:3563-3566. [PMID: 26026126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The lung is a common site of metastases, whose prevalence varies as a function of the primary tumor site, which is usually colorectal cancer (CRC), breast carcinoma, or genitourinary cancers, such as ovary, urinary bladder and renal cell carcinomas. The aim of the present study was to analyze whether the site of primitive tumor affects overall survival (OS) of patients with lung metastases (LMs) who underwent pulmonary metastasectomy. The data of 41 patients with surgically treated CRC (Group A=22 patients) and non-colorectal carcinomas (Group B=19 patients), who developed matachronous LMs and underwent pulmonary metastasectomy with curative intent, were analyzed. The origin of non-colorectal LMs was genitourinary cancer in nine and breast cancer in 10 patients. Overall, there were 22 men and 19 women, with a median age of 65 years (range=31-80); 18 patients had a solitary metastatic tumor, while 23 had two or more LMs. Twenty-nine patients underwent wedge resection, through thoracotomy or video-assisted thoracic surgery, while 12 underwent pulmonary lobectomy. Seventy-five LMs were resected with a 5-tear OS of 48.8%. No difference was found between elderly (≥65 year-old) and younger patients (p=0.26), and between those with solitary or multiple LMs (p=0.62) in terms of survival rate. The female patients had a worse OS (31.6% vs. 63.6%; odds ratio (OR)=3.79, 95% confidence interval (CI)=1.03-13.91, p=0.003) compared to males, independent of the origin of primary cancer. There was no difference in the cumulative survival rates (OR=1.65, 95%CI=0.48-5.69, p=0.42) between Groups and the log-rank test (p=0.75) was not significant. In conclusion, the main pathological characteristics of metastatic lesions and advanced age do not appear to be associated with a poor prognosis in patients with LMs, while the female gender is a negative prognostic factor. Thus, the primary tumor site should not be considered a major criterion in selecting patients for pulmonary metastasectomy.
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Affiliation(s)
- Franco Lumachi
- Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, School of Medicine, Padua, Italy
| | - Francesco Mazza
- Pneumology, S. Maria degli Angeli Hospital, Pordenone, Italy
| | | | - Giovanni Lo Re
- Pneumology, S. Maria degli Angeli Hospital, Pordenone, Italy
| | - Mario Ermani
- Department of Neurosciences, University of Padua, School of Medicine, Padua, Italy
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Amoroso D, DelCorso L, Bergaglio M, Bruzzone A, Puccetti C, Camerini A, Filiberti R, Del Conte A, Brianti A, Mencoboni M. Phase II, multicentre, open label, non randomized trial on safety of first line chemotherapy with oral metronomic vinorelbine in the elderly subgroup of NSCLC patients. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e19015] [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)
| | | | | | | | - Cheti Puccetti
- U.O. Oncologia Medica, Ospedale Versilia, Az. USL12, Lucca, Lido di Camaiore, Italy
| | - Andrea Camerini
- U.O. Oncologia Medica, Ospedale Versilia, Az. USL12, Lucca, Lido di Camaiore, Italy
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Foltran L, Bertola M, Del Conte A, Lo Re G, Bestetti A, Sandri P, Saracchini S. Everolimus plus exemestane for hormone resistant metastatic breast cancer (MBC): A single institutional experience. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e11576] [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)
- Luisa Foltran
- Department of Oncology, General Hospital, Pordenone, Italy
| | - Manuela Bertola
- Department of Oncology, General Hospital "S. Maria degli Angeli", Pordenone, Italy
| | | | - Giovanni Lo Re
- Santa Maria Degli Angeli General Hospital, Pordenone, Italy
| | | | - Paolo Sandri
- Department of Oncology, General Hospital "S. Maria degli Angeli", Pordenone, Italy
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43
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Lo Re G, Santeufemia DA, Ius A, Del Conte A, Foltran L, Fadda GM, Basso SM, Marus W, Chiara GB, Stuto A, Tosolini G, Sulfaro S, Spaziante R, Nicolosi G, Boz G, Mancinelli P, Tumolo S, Bidoli E, Cozzi C. Offlabel nab-paclitaxel: Gemcitabine chemotherapy in advanced pancreatic cancer—A monoinstitutional experience. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e15239] [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)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gianni Boz
- Centro di Riferimento Oncologico Aviano, Aviano, Italy
| | | | | | - Ettore Bidoli
- Centro di Riferimento Oncologico Aviano, Aviano, Italy
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Saracchini S, Foltran L, Bassini A, Sulfaro S, Lorenzon M, Micheli E, Favero A, Marus W, Del Conte A, Gusso G, Manente S, Tumolo S. Neoadjuvant chemotherapy with nonpegylated liposome-encapsulated doxorubicin (NPLD) plus cyclophosphamide followed by trastuzumab plus nabpaclitaxel for HER2-positive breast cancer (BC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
| | - Luisa Foltran
- Department of Oncology, General Hospital, Pordenone, Italy
| | - Anna Bassini
- Radiology Department, Hospital, Pordenone, Italy
| | | | | | | | | | - Wally Marus
- Santa Maria degli Angeli GH, Pordenone, Italy
| | | | | | | | - Salvatore Tumolo
- Medical Oncology Department, S. Maria degli Angeli Hospital, Pordenone, Italy
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Trovo M, Minatel E, Durofil E, Polesel J, Avanzo M, Baresic T, Bearz A, Del Conte A, Franchin G, Gobitti C, Rumeileh IA, Trovo MG. Stereotactic Body Radiation Therapy for Re-irradiation of Persistent or Recurrent Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2014; 88:1114-9. [DOI: 10.1016/j.ijrobp.2014.01.012] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 01/04/2014] [Accepted: 01/08/2014] [Indexed: 11/26/2022]
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Del Conte A, Minatel E, Schinella D, Baresic T, Basso SMM, Lumachi F. Complete metabolic remission with Gefitinib in a hemodialysis patient with bone metastases from non-small cell lung cancer. Anticancer Res 2014; 34:319-322. [PMID: 24403481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Gefitinib is highly active in patients with advanced or metastatic non-small cell lung cancer (NSCLC) harboring activating mutation of the epidermal growth factor receptor (EGFR) gene. The feasibility and the degree of response to treatment with gefitinib in patients with chronic renal failure (CRF) undergoing hemodialysis has not yet been fully described in literature. We describe the case of a 70-year-old man with CRF undergoing hemodialysis three times-a-week who developed vertebral and rib bone metastasis three years after lobectomy. The bone biopsy confirmed the pulmonary origin and pyrosequencing analysis revealed deletion in E746-E750 of exon 19. We started daily administration of 250 mg gefitinib with no changes in the hemodialysis schedule. Gefitinib was well-tolerated without any adverse event. After three months, the (18)F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG PET/CT) showed complete metabolic remission of bone lesions. The patient is still under treatment and maintains response (30 months to date). To our knowledge, this is the first description of complete metabolic remission in this type of patient. In conclusion, gefitinib has been safely administered to a patient with NSCLC with EGFR-activating mutation undergoing chronic hemodialysis and its use has achieved an excellent and prolonged response on bone metastases.
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Affiliation(s)
- Alessandro Del Conte
- Medical Oncology, S. Maria degli Angeli Hospital, via Montereale 24, 33170 Pordenone, Italy.
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Bearz A, Minatel E, Rumeileh IA, Borsatti E, Talamini R, Franchin G, Gobitti C, Del Conte A, Trovò M, Baresic T. Concurrent chemoradiotherapy with tomotherapy in locally advanced Non-Small Cell Lung Cancer: a phase I, docetaxel dose-escalation study, with hypofractionated radiation regimen. BMC Cancer 2013; 13:513. [PMID: 24176164 PMCID: PMC4228391 DOI: 10.1186/1471-2407-13-513] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 05/31/2013] [Accepted: 10/27/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Concurrent chemo-radiotherapy is demonstrately superior to sequential chemo-radiotherapy in the treatment of advanced Non-Small-Cell Lung Cancer not suitable for surgery. Docetaxel is considered to enhance the cytotoxic effect of radiotherapy on the tumour cells. Tomotherapy (HT) is a novel radiotherapeutic technique, which allows the delivery of Image Guided-IMRT (IG-IMRT), with a highly conformal radiation dose distribution.The goal of the study was to estimate tolerability of Docetaxel concurrent with IMRT and to find the maximum tolerated dose of weekly Docetaxel concurrent with IMRT delivered with HT Tomotherapy after induction chemotherapy with Cisplatin and Docetaxel in patients affected with stage III Non-Small Cell Lung Cancer. METHODS We designed a phase I, dose-finding study to determine the dose of weekly Docetaxel concurrent with Tomotherapy after induction chemotherapy, in patients affected by Non-Small Cell Lung Cancer with Stage III disease, not suitable for surgery. RESULTS Concurrent weekly Docetaxel and Tomotherapy are feasible; we did not reach a maximum tolerated dose, because no life-threatening toxicity was observed, stopping the accrual at a level of weekly docetaxel 38 mg/m2, a greater dose than in previous assessments, from both phase-I studies with weekly docetaxel alone and with Docetaxel concomitant with standard radiotherapy. CONCLUSIONS Concurrent weekly Docetaxel and Tomotherapy are feasible, and even with Docetaxel at 38 mg/m2/week we did not observe any limiting toxicity. For those patients who completed the combined chemo-radio treatment, median progression-free survival (PFS) was 20 months and median overall survival (OS) was 24 months.
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Affiliation(s)
- Alessandra Bearz
- Medical Oncology Department, National Cancer Institute of Aviano (PN), Aviano (PN), Italy
| | - Emilio Minatel
- Radiation Oncology Department, National Cancer Institute of Aviano (PN), Aviano (PN), Italy
| | - Imad Abu Rumeileh
- Radiation Oncology Department, National Cancer Institute of Aviano (PN), Aviano (PN), Italy
| | - Eugenio Borsatti
- Nuclear Medicine Department, National Cancer Institute of Aviano (PN), Aviano (PN), Italy
| | - Renato Talamini
- Division of Epidemiology and Biostatistics, National Cancer Institute of Aviano (PN), Aviano (PN), Italy
| | - Giovanni Franchin
- Radiation Oncology Department, National Cancer Institute of Aviano (PN), Aviano (PN), Italy
| | - Carlo Gobitti
- Radiation Oncology Department, National Cancer Institute of Aviano (PN), Aviano (PN), Italy
| | | | - Marco Trovò
- Radiation Oncology Department, National Cancer Institute of Aviano (PN), Aviano (PN), Italy
| | - Tanja Baresic
- Nuclear Medicine Department, National Cancer Institute of Aviano (PN), Aviano (PN), Italy
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48
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Lumachi F, Santeufemia DA, Del Conte A, Mazza F, Tozzoli R, Chiara GB, Basso SMM. Carboxy-terminal telopeptide (CTX) and amino-terminal propeptide (PINP) of type I collagen as markers of bone metastases in patients with non-small cell lung cancer. Anticancer Res 2013; 33:2593-2596. [PMID: 23749913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The early diagnosis of non-small cell lung carcinoma (NSCLC) is difficult, and 30-40% of patients with NSCLC develop bone metastases (BMs) during the course of their disease. Because the delayed demonstration of skeletal involvement may seriously affect survival, there is a need for early diagnosis of BMs. Unfortunately, the sensitivity of common serum tumor markers is low and they are used mainly for monitoring the efficacy of therapy and detection of recurrence. The aim of this study was to evaluate the utility of a panel of serum biomarkers in patients with NSCLC and BMs. Sixteen patients (11 males, 5 females; median age=64 years, range 54-68 years) with NSCLC and BMs (cases), and 18 age- and stage-matched patients without BMs (controls) underwent measurement of serum carboxy-terminal telopeptide of type I collagen (CTX), tartrate-resistant acid phosphatase isoform type 5b (TRAP5b) and amino-terminal propeptide of type I collagen (PINP), carcinoembryonic antigen (CEA) and fragments of cytokeratin 19 (CYFRA 21-1. CTX (443.7 ± 945.1 vs. 402.7 ± 28.4 pg/ml, p=0.003) and PINP (75.9 ± 11.4 vs. 64.1 ± 7.5 μg/l, p=0.001) were significantly higher in patients with BMs, while the mean value of the other markers did not differ (p=NS) between cases and controls. The sensitivity, specificity and accuracy were 73.3%, 86.7% and 79.4% for CTX; 55.5%, 62.5% and 58.8% for CEA; 65.0%, 78.6% and 70.6% for CYFRA; 30.4%, 76.2% and 67.6% for TRAP5b; and 72.2%, 81.2% and 76.5% for PINP, respectively. The area under the receiver operating characteristic curve (AUC) for CTX was 0.68. In conclusion, CTX and PINP measurement can be useful in monitoring patients with NSCLC during follow-up, with the aim of detecting BMs early.
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Affiliation(s)
- Franco Lumachi
- Department of Surgery, Oncology and Gastroenterology, School of Medicine, University of Padua, Padova, Italy.
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Lumachi F, Marino F, Mazza F, Del Conte A, Chiara G, Basso S. Ct-Guided Fine-Needle Aspiration Cytology and Cdx2 Immunostaining of Pulmonary Nodules in Patients with Colorectal Cancer. Preliminary Study. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt203.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Saracchini S, Foltran L, Sulfaro S, Tuccia F, Del Conte A, Bertola M, Bassini A, Micheli E, Manente S, Gusso G, Baresic T, Tumolo S. Liposome-encapsulated doxorubicin plus cyclophosphamide followed by trastuzumab plus docetaxel as neoadjuvant therapy for HER2-positive breast cancer (BC): A multicenter single-arm phase II study. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.641] [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
641 Background: Trastuzumab combined to sequential chemotherapy with taxanes and anthracyclines as primary treatment achieved high rates of pathologic complete response (pCR) in HER2 positive BC. Liposome-encapsulated doxorubicin (DLNP) shown equal efficacy but minor cardiotoxicity compared to doxorubicin. This phase II study aimed to evaluate the activity and safety of trastuzumab associated with chemotherapy for early or locally advanced HER2 positive BC. Methods: Primary objective of the study was pCR defined as the absence of residual invasive cancer both in the breast and regional nodes. Preoperative treatment included DLNP (60 mg/mq iv) plus cyclophosphamide (600 mg/mq iv) every 3 weeks for 4 cycles followed by docetaxel (35 mg/mq iv) plus trastuzumab (4 mg/mq loading dose iv, then 2 mg/mq iv) weekly for 16 weeks. Patients (pts) were scheduled to receive adjuvant trastuzumab (8 mg/mq loading dose, then 6 mg/mq iv) every 3 weeks for 12 cycles and radiation and hormonal therapy according to guidelines. Results: From December 2005 to September 2011, 43 pts were treated at 3 centers in Italy. 39 out of 43 pts were evaluable for the purpose of the study. Median age was 53 years (range: 31-78). The majority of pts had cT2 (63%), grade 3 (93%), N+ (77%) ER positive (56%) and MIB-1 ≥20% (77%). pCR was reported in 19 (49%) of 39 pts. The histological regression score (Von Minckwitz G, J Clin Oncol 2012) is shown in the Table. A significant correlation between MIB-1 ≥20% at baseline and pCR was observed (p=0.018). Pts with pCR had a time to response (29.4 weeks, 95% CI 28-31) lower than pts without pCR (32.9 weeks, 95% CI 27-39). No cardiac toxicity or discontinuation of trastuzumab was reported. After a median follow-up of 30 months only 2 pts relapsed, both with pCR. Conclusions: This study confirms the high activity of trastuzumab combined with chemotherapy based on anthracyclines and taxanes as primary treatment for HER2 positive BC. DLNP is an active and safe option to minimize cardiotoxicity. [Table: see text]
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Affiliation(s)
| | | | | | - Fausto Tuccia
- Ospedale Civile S. Martino, Belluno, Italy, Belluno, Italy
| | | | | | - Anna Bassini
- "S. Maria degli Angeli" Hospital, Pordenone, Italy
| | | | | | | | | | - Salvatore Tumolo
- Medical Oncology Department, S. Maria degli Angeli Hospital, Pordenone, Italy
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