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Garattini SK, Valent F, Minisini AM, Riosa C, Favaretti C, Regattin L, Fasola G. Analysis of workload generated in the two years following first consultation by each new cancer patient: studying the past to plan the future of cancer care. BMC Health Serv Res 2022; 22:1184. [PMID: 36131286 PMCID: PMC9494889 DOI: 10.1186/s12913-022-08573-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 09/14/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Prevalence of cancer patients is dramatically increasing. We aimed at quantifying the oncology workload generated by each new cancer patient in the two years following first consultation. Methods In this record-based retrospective study, we retrieved data of all newly diagnosed patients treated at the Oncology Department of Udine Academic Hospital between 01.01.2012 and 31.12.2017. We calculated mean number and standard deviation of the activity type generated by each new cancer patient during the following 2 years. Results Seven thousand four hundred fifty-two cancer patients generated a total of 85,338 clinical episodes. The two-years mean number of oncology episodes generated was 11.31 (i.e., for every 1,000 new cancer patients, 11,310 oncology activities are generated overall in the following two-year lapse). Patients with advanced disease generated the highest workload (24.3; SD 18.8) with a statistically significant difference compared to adjuvant and follow-up patients (p < 0.001). The workload generated in the period 0–6 and 0–12 months was significantly higher than in the following months (p < 0.001) and it was also higher for patients initially designated to treatment (p < 0.001). Conclusion This is the first study reporting on the mean oncology workload generated during the 2 years following first consultation. Workload is the highest for patient with advanced disease, especially in the first months and in patients in active treatment. A detailed analysis of workloads in oncology is feasible and could be crucial for planning a sustainable framework for cancer care in the next future.
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Affiliation(s)
- S K Garattini
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, Udine, UD, 33100, Italy.
| | - F Valent
- Institute of Hygiene and Clinical Epidemiology, Academic Hospital of Udine ASUFC, 33100, Udine, UD, Italy
| | - A M Minisini
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, Udine, UD, 33100, Italy
| | - C Riosa
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, Udine, UD, 33100, Italy
| | - C Favaretti
- Center for Leadership in Medicine, Catholic University of Sacred Heart, 000168, Rome, RO, Italy
| | - L Regattin
- Medical Director, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, Udine, UD, 33100, Italy
| | - G Fasola
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, Udine, UD, 33100, Italy
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Regan MM, Walley BA, Fleming GF, Francis PA, Colleoni MA, Láng I, Gómez HL, Tondini CA, Burstein HJ, Goetz MP, Ciruelos EM, Stearns V, Bonnefoi HR, Martino S, Geyer CE, Chini C, Minisini AM, Spazzapan S, Ruhstaller T, Winer EP, Ruepp B, Loi S, Coates AS, Goldhirsch A, Gelber RD, Pagani O. Abstract GS2-05: Randomized comparison of adjuvant aromatase inhibitor exemestane (E) plus ovarian function suppression (OFS) vs tamoxifen (T) plus OFS in premenopausal women with hormone receptor-positive (HR+) early breast cancer (BC): update of the combined TEXT and SOFT trials. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-gs2-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background The updated combined SOFT+TEXT analysis, after 9 years median follow-up (MFU), revealed that adjuvant E+OFS vs T+OFS significantly improved disease-free survival (DFS) and distant recurrence-free interval (DRFI) but not overall survival (OS) in premenopausal women with HR+ early BC (Francis et al NEJM 2018). Given the high rate of OS in both arms and the long-term risk of relapse in HR+ BC, continued follow-up is key to assessing treatment benefit. We report a planned update analysis including OS with database lock of May 2021, after 13 years MFU.. Methods TEXT and SOFT enrolled premenopausal women with HR+ early BC from November 2003 to April 2011 (2660 in TEXT, 3047 in SOFT intention-to-treat (ITT) populations). TEXT randomized women within 12 weeks of surgery to 5 years E+OFS vs T+OFS; chemotherapy (CT) was optional and concurrent with OFS. SOFT randomized women to 5 years E+OFS vs T+OFS vs T alone, within 12 weeks of surgery if no CT planned, or within 8 months of completing (neo)adjuvant CT. Both trials were stratified by CT use. For the combined analysis of E+OFS vs T+OFS, the primary endpoint was DFS defined as invasive local, regional, distant recurrence, contralateral BC, second malignancy, death. Secondary endpoints included invasive breast cancer-free interval (BCFI), DRFI and OS.. Results: At database lock there were 953 DFS events and 473 deaths among 4690 pts assigned to T+OFS or E+OFS. In the ITT population, DFS, BCFI and DRFI outcomes for pts assigned E+OFS (n=2346) continued to be significantly improved over T+OFS (n=2344). 12-yr DFS was 80.5% vs. 75.9% (4.6% absolute improvement; HR 0.79 95% CI 0.70-0.90), 12-yr BCFI was improved by 4.1% and 12-yr DRFI by 1.8%. At 12 years OS was excellent in both groups, 90.1% in pts assigned E+OFS vs 89.1% in pts assigned T+OFS (HR 0.93; 95% CI, 0.78-1.11). There was heterogeneity of relative treatment effect according to HER2 status. When enrollment commenced, anti-HER2 adjuvant therapy was not standard; 53% of 583 pts with HER2+ tumors received HER2-targeted therapy. Below are Kaplan-Meier 12-yr estimates for patients with HER2 negative tumors by trial and chemotherapy stratum and for those with high-grade tumours, as an example of high-risk feature (Table). There is an emerging OS benefit for E+OFS vs T+OFS in pts with HER2 negative tumors who received chemotherapy in both trials.In pts with HER2-negative tumors, clinically-relevant outcome benefits were also seen in other high-risk subgroups: 12-yr DFS and OS were improved by 7.4% and 2.7%, respectively, in pts with pN1a disease, and by 10.6% and 4.5%, respectively, in those with tumors >2cm.
Conclusions After 13 years MFU, adjuvant E+OFS, as compared with T+OFS, shows a sustained reduction in the risk of recurrence, more consistent in HER2 negative patients and in those with high-risk disease features, e.g., indication for adjuvant chemotherapy and G3 tumors. Oncologists may use this information to discuss potential benefits of E+OFS with individual patients. Follow-up continues for 5 additional years.
Chemotherapy HER2-negativeSOFTT+OFS (n=424)E+OFS (n=411)Absolute difference12-yr DFS67.4%74.1%6.7%12-yr OS81.1%84.4%3.3%TEXTT+OFS (n=656)E+OFS (n=661)Absolute difference12-yr DFS71.0%78.4%7.4%12-yr OS83.5%86.8%3.3%No chemotherapy HER2-negativeSOFTT+OFS (n=445)E+OFS (n=447)Absolute difference12-yr DFS82.9%88.2%5.3%12-yr OS96.1%96.9%0.9%TEXTT+OFS (n=499)E+OFS (n=492)Absolute difference12-yr DFS80.2%86.7%6.5%12-yr OS95.9%96.2%0.2%G3 HER2-negativeT+OFS (n=423)E+OFS (n=405)Absolute difference12-yr DFS62.7%73.0%10.3%12-yr OS78.1%83.6%5.5%
Citation Format: Meredith M Regan, Barbara A Walley, Gini F Fleming, Prudence A Francis, Marco A Colleoni, István Láng, Henry L Gómez, Carlo A Tondini, Harold J Burstein, Matthew P Goetz, Eva M Ciruelos, Vered Stearns, Hervé R Bonnefoi, Silvana Martino, Charles E Geyer, Jr, Claudio Chini, Alessandro M Minisini, Simon Spazzapan, Thomas Ruhstaller, Eric P Winer, Barbara Ruepp, Sherene Loi, Alan S Coates, Aron Goldhirsch, Richard D Gelber, Olivia Pagani. Randomized comparison of adjuvant aromatase inhibitor exemestane (E) plus ovarian function suppression (OFS) vs tamoxifen (T) plus OFS in premenopausal women with hormone receptor-positive (HR+) early breast cancer (BC): update of the combined TEXT and SOFT trials [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr GS2-05.
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Affiliation(s)
- Meredith M Regan
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Barbara A Walley
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Gini F Fleming
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Prudence A Francis
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Marco A Colleoni
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - István Láng
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Henry L Gómez
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Carlo A Tondini
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Harold J Burstein
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Matthew P Goetz
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Eva M Ciruelos
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Vered Stearns
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Hervé R Bonnefoi
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Silvana Martino
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Charles E Geyer
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Claudio Chini
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Alessandro M Minisini
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Simon Spazzapan
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Thomas Ruhstaller
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Eric P Winer
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Barbara Ruepp
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Sherene Loi
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Alan S Coates
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Aron Goldhirsch
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Richard D Gelber
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Olivia Pagani
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
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3
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Johansson H, Spadola G, Tosti G, Mandalà M, Minisini AM, Queirolo P, Aristarco V, Baldini F, Cocorocchio E, Albertazzi E, Zichichi L, Cinieri S, Jemos C, Mazzarol G, Gnagnarella P, Macis D, Tedeschi I, Salè EO, Stucci LS, Bonanni B, Testori A, Pennacchioli E, Ferrucci PF, Gandini S. Vitamin D Supplementation and Disease-Free Survival in Stage II Melanoma: A Randomized Placebo Controlled Trial. Nutrients 2021; 13:nu13061931. [PMID: 34199802 PMCID: PMC8226808 DOI: 10.3390/nu13061931] [Citation(s) in RCA: 15] [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: 05/05/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 12/29/2022] Open
Abstract
Patients with newly resected stage II melanoma (n = 104) were randomized to receive adjuvant vitamin D3 (100,000 IU every 50 days) or placebo for 3 years to investigate vitamin D3 protective effects on developing a recurrent disease. Median age at diagnosis was 50 years, and 43% of the patients were female. Median serum 25-hydroxy vitamin D (25OHD) level at baseline was 18 ng/mL, interquartile range (IQ) was 13–24 ng/mL, and 80% of the patients had insufficient vitamin D levels. We observed pronounced increases in 25OHD levels after 4 months in the active arm (median 32.9 ng/mL; IQ range 25.9–38.4) against placebo (median 19.05 ng/mL; IQ range 13.0–25.9), constantly rising during treatment. Remarkably, patients with low Breslow score (<3 mm) had a double increase in 25OHD levels from baseline, whereas patients with Breslow score ≥3 mm had a significantly lower increase over time. After 12 months, subjects with low 25OHD levels and Breslow score ≥3 mm had shorter disease-free survival (p = 0.02) compared to those with Breslow score <3 mm and/or high levels of 25OHD. Adjusting for age and treatment arm, the hazard ratio for relapse was 4.81 (95% CI: 1.44–16.09, p = 0.011). Despite the evidence of a role of 25OHD in melanoma prognosis, larger trials with vitamin D supplementation involving subjects with melanoma are needed.
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Affiliation(s)
- Harriet Johansson
- Division of Cancer Prevention and Genetics, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (V.A.); (D.M.); (B.B.)
- Correspondence: ; Tel.: +39-0294372654
| | - Giuseppe Spadola
- Divisione di Chirurgia del Melanoma, IRCCS Fondazione Istituto Nazionale per lo Studio e la Cura dei Tumori, 20133 Milan, Italy;
| | - Giulio Tosti
- Division of Surgery for Melanoma, Sarcoma, and Rare Tumors, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.T.); (F.B.); (I.T.); (E.P.)
| | - Mario Mandalà
- Unit of Medical Oncology, Department of Oncology and Haematology, Papa Giovanni XXIII Cancer Center Hospital, 24127 Bergamo, Italy;
| | - Alessandro M. Minisini
- Department of Oncology, Azienda Sanitaria Universitaria del Friuli Centrale, 33100 Udine, Italy;
| | - Paola Queirolo
- Department of Medical Oncology, IRCCS Ospedale Policlinico San Martino—IST-Istituto Nazionale per la Ricerca sul Cancro, 16132 Genoa, Italy;
| | - Valentina Aristarco
- Division of Cancer Prevention and Genetics, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (V.A.); (D.M.); (B.B.)
| | - Federica Baldini
- Division of Surgery for Melanoma, Sarcoma, and Rare Tumors, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.T.); (F.B.); (I.T.); (E.P.)
| | - Emilia Cocorocchio
- Division of Medical Oncology for Melanoma, Sarcoma and Rare Tumors, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Elena Albertazzi
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | | | - Saverio Cinieri
- Medical Oncology & Breast Unit, Department of Oncology, “Antonio Perrino” Hospital, 72100 Brindisi, Italy;
| | - Costantino Jemos
- Division of Pharmacy, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (C.J.); (E.O.S.)
| | - Giovanni Mazzarol
- Division of Pathology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Patrizia Gnagnarella
- Division of Epidemiology and Biostatistics, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Debora Macis
- Division of Cancer Prevention and Genetics, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (V.A.); (D.M.); (B.B.)
| | - Ines Tedeschi
- Division of Surgery for Melanoma, Sarcoma, and Rare Tumors, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.T.); (F.B.); (I.T.); (E.P.)
| | - Emanuela Omodeo Salè
- Division of Pharmacy, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (C.J.); (E.O.S.)
| | - Luigia Stefania Stucci
- Section of Medical Oncology, Department of Biomedical Sciences and Clinical Oncology (DIMO), University of Bari ‘Aldo Moro’, 70124 Bari, Italy;
| | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (V.A.); (D.M.); (B.B.)
| | - Alessandro Testori
- EORTC Melanoma Group, 1200 Brussel, Belgium;
- Skin Oncology Division, Image Rigenerative Clinic, 20121 Milan, Italy
| | - Elisabetta Pennacchioli
- Division of Surgery for Melanoma, Sarcoma, and Rare Tumors, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.T.); (F.B.); (I.T.); (E.P.)
| | - Pier Francesco Ferrucci
- Biotherapy of Tumors Unit, IEO, Department of Experimental Oncology, European Institute of Oncology, IRCCS, 20141 Milan, Italy;
| | - Sara Gandini
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy;
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4
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Galardi F, De Luca F, Biagioni C, Migliaccio I, Curigliano G, Minisini AM, Bonechi M, Moretti E, Risi E, McCartney A, Benelli M, Romagnoli D, Cappadona S, Gabellini S, Guarducci C, Conti V, Biganzoli L, Di Leo A, Malorni L. Circulating tumor cells and palbociclib treatment in patients with ER-positive, HER2-negative advanced breast cancer: results from a translational sub-study of the TREnd trial. Breast Cancer Res 2021; 23:38. [PMID: 33761970 PMCID: PMC7992319 DOI: 10.1186/s13058-021-01415-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/08/2021] [Indexed: 12/24/2022] Open
Abstract
Background Circulating tumor cells (CTCs) are prognostic in patients with advanced breast cancer (ABC). However, no data exist about their use in patients treated with palbociclib. We analyzed the prognostic role of CTC counts in patients enrolled in the cTREnd study, a pre-planned translational sub-study of TREnd (NCT02549430), that randomized patients with ABC to palbociclib alone or palbociclib plus the endocrine therapy received in the prior line of treatment. Moreover, we evaluated RB1 gene expression on CTCs and explored its prognostic role within the cTREnd subpopulation. Methods Forty-six patients with ER-positive, HER2-negative ABC were analyzed. Blood samples were collected before starting palbociclib treatment (timepoint T0), after the first cycle of treatment (timepoint T1), and at disease progression (timepoint T2). CTCs were isolated and counted by CellSearch® System using the CellSearch™Epithelial Cell kit. Progression-free survival (PFS), clinical benefit (CB) during study treatment, and time to treatment failure (TTF) after study treatment were correlated with CTC counts. Samples with ≥ 5 CTCs were sorted by DEPArray system® (DA). RB1 and GAPDH gene expression levels were measured by ddPCR. Results All 46 patients were suitable for CTCs analysis. CTC count at T0 did not show significant prognostic value in terms of PFS and CB. Patients with at least one detectable CTC at T1 (n = 26) had a worse PFS than those with 0 CTCs (n = 16) (p = 0.02). At T1, patients with an increase of at least three CTCs showed reduced PFS compared to those with no increase (mPFS = 3 versus 9 months, (p = 0.004). Finally, patients with ≥ 5 CTCs at T2 (n = 6/23) who received chemotherapy as post-study treatment had a shorter TTF (p = 0.02). Gene expression data for RB1 were obtained from 19 patients. CTCs showed heterogeneous RB1 expression. Patients with detectable expression of RB1 at any timepoint showed better, but not statistically significant, outcomes than those with undetectable levels. Conclusions CTC count seems to be a promising modality in monitoring palbociclib response. Moreover, CTC count at the time of progression could predict clinical outcome post-palbociclib. RB1 expression analysis on CTCs is feasible and may provide additional prognostic information. Results should be interpreted with caution given the small studied sample size. Supplementary Information The online version contains supplementary material available at 10.1186/s13058-021-01415-w.
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Affiliation(s)
- Francesca Galardi
- "Sandro Pitigliani" Translational Research Unit, Hospital of Prato, Prato, Italy
| | - Francesca De Luca
- "Sandro Pitigliani" Translational Research Unit, Hospital of Prato, Prato, Italy
| | | | - Ilenia Migliaccio
- "Sandro Pitigliani" Translational Research Unit, Hospital of Prato, Prato, Italy
| | - Giuseppe Curigliano
- Division of Early Drug Development, Istituto Europeo di Oncologia, IRCCS, Milan, Italy.,Department of Haematology and Haemato-Oncology, University of Milan, Milan, Italy
| | - Alessandro M Minisini
- Department of Oncology, Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Martina Bonechi
- "Sandro Pitigliani" Translational Research Unit, Hospital of Prato, Prato, Italy
| | - Erica Moretti
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Emanuela Risi
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Amelia McCartney
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy.,School of Clinical Sciences, Monash University, Melbourne, Australia
| | | | | | - Silvia Cappadona
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Stefano Gabellini
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Cristina Guarducci
- "Sandro Pitigliani" Translational Research Unit, Hospital of Prato, Prato, Italy.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - Valerio Conti
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Laura Biganzoli
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Angelo Di Leo
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Luca Malorni
- "Sandro Pitigliani" Translational Research Unit, Hospital of Prato, Prato, Italy. .,"Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy.
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5
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Guida M, Bartolomeo N, Quaglino P, Madonna G, Pigozzo J, Di Giacomo AM, Minisini AM, Tucci M, Spagnolo F, Occelli M, Ridolfi L, Queirolo P, De Risi I, Quaresmini D, Gambale E, Chiaron Sileni V, Ascierto PA, Stigliano L, Strippoli S. No Impact of NRAS Mutation on Features of Primary and Metastatic Melanoma or on Outcomes of Checkpoint Inhibitor Immunotherapy: An Italian Melanoma Intergroup (IMI) Study. Cancers (Basel) 2021; 13:cancers13030475. [PMID: 33530579 PMCID: PMC7865301 DOI: 10.3390/cancers13030475] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/08/2021] [Accepted: 01/21/2021] [Indexed: 12/17/2022] Open
Abstract
AIMS It is debated whether the NRAS-mutant melanoma is more aggressive than NRAS wildtype. It is equally controversial whether NRAS-mutant metastatic melanoma (MM) is more responsive to checkpoint inhibitor immunotherapy (CII). 331 patients treated with CII as first-line were retrospectively recruited: 162 NRAS-mutant/BRAF wild-type (mut/wt) and 169 wt/wt. We compared the two cohorts regarding the characteristics of primary and metastatic disease, disease-free interval (DFI) and outcome to CII. No substantial differences were observed between the two groups at melanoma onset, except for a more frequent ulceration in the wt/wt group (p = 0.03). Also, the DFI was very similar in the two cohorts. In advanced disease, we only found lung and brain progression more frequent in the wt/wt group. Regarding the outcomes to CII, no significant differences were reported in overall response rate (ORR), disease control rate (DCR), progression free survival (PFS) or overall survival (OS) (42% versus 37%, 60% versus 59%, 12 (95% CI, 7-18) versus 9 months (95% CI, 6-16) and 32 (95% CI, 23-49) versus 27 months (95% CI, 16-35), respectively). Irrespectively of mutational status, a longer OS was significantly associated with normal LDH, <3 metastatic sites, lower white blood cell and platelet count, lower neutrophil-to-lymphocyte (N/L) ratio. Our data do not show increased aggressiveness and higher responsiveness to CII in NRAS-mutant MM.
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Affiliation(s)
- Michele Guida
- Rare Tumors and Melanoma Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (I.D.R.); (D.Q.); (S.S.)
- Correspondence: ; Tel.: +39-080-555-5138
| | - Nicola Bartolomeo
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70124 Bari, Italy;
| | - Pietro Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, 10126 Turin, Italy; (P.Q.); (L.S.)
| | - Gabriele Madonna
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, 80131 Napoli, Italy; (G.M.); (P.A.A.)
| | - Jacopo Pigozzo
- Melanoma Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 31033 Padova, Italy; (J.P.); (V.C.S.)
| | - Anna M. Di Giacomo
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, 53100 Siena, Italy; (A.M.D.G.); (E.G.)
| | | | - Marco Tucci
- Medical Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, University of Bari Aldo Moro, 70124 Bari, Italy;
| | - Francesco Spagnolo
- Skin Cancer Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
| | - Marcella Occelli
- Azienda Ospedaliera Santa Croce e Carle di Cuneo SC Oncologia, 12100 Cuneo, Italy;
| | - Laura Ridolfi
- Department of Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy;
| | - Paola Queirolo
- Division of Melanoma Sarcoma and Rare Tumors, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Ivana De Risi
- Rare Tumors and Melanoma Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (I.D.R.); (D.Q.); (S.S.)
| | - Davide Quaresmini
- Rare Tumors and Melanoma Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (I.D.R.); (D.Q.); (S.S.)
| | - Elisabetta Gambale
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, 53100 Siena, Italy; (A.M.D.G.); (E.G.)
| | - Vanna Chiaron Sileni
- Melanoma Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 31033 Padova, Italy; (J.P.); (V.C.S.)
| | - Paolo A. Ascierto
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, 80131 Napoli, Italy; (G.M.); (P.A.A.)
| | - Lucia Stigliano
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, 10126 Turin, Italy; (P.Q.); (L.S.)
| | - Sabino Strippoli
- Rare Tumors and Melanoma Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (I.D.R.); (D.Q.); (S.S.)
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Pelizzari G, Bertoli E, Giavarra M, Corvaja C, Gerratana L, Basile D, Bartoletti M, Lisanti C, Bortot L, Buriolla S, Garutti M, Avoledo D, Bonotto M, Da Ros L, Bolzonello S, Mansutti M, Nardo PD, Fasola G, Spazzapan S, Minisini AM, Puglisi F. Abstract P5-14-08: Predictors of relative dose intensity and early dose reduction in patients with metastatic breast cancer treated with palbociclib and endocrine therapy. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p5-14-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The combination of endocrine therapy with the cyclin-dependent kinases 4/6 inhibitor palbociclib was proven to be effective for the treatment of hormone receptor (HR)-positive/HER2-negative metastatic breast cancer (MBC). Although generally well tolerated, treatment delays and dose reductions are frequently observed with palbociclib, mainly due to severe neutropenia. Predictors of palbociclib-related toxicities are still unknown, as well as the clinical relevance of its relative dose intensity (RDI). Henceforth, this study aimed to identify baseline clinicopathological features associated with a RDI <75% and early dose reduction (within the first 3 months of treatment). Secondarily, we explored the impact of RDI <75% and early dose reduction on progression-free survival.
Methods: We reviewed data of 150 consecutive patients with HR-positive/HER2-negative MBC patients treated with palbociclib at two Italian cancer centers from 2017 to 2019. Eligible patients must have received at least 3 cycles of treatment. Those who experienced early suspension due to unacceptable toxicities were still eligible. RDI was calculated as the ratio of actual dose intensity (cumulative administered dose/treatment duration) and planned dose intensity (cumulative planned dose/planned treatment duration). The association of both RDI <75% and early dose reduction with baseline clinicopathological features was assessed using multivariate logistic regression. The following variables were investigated as predictors of dose reduction: de novo vs. recurrent MBC, prior chemotherapy, treatment line, associated endocrine therapy, performance status (PS), weight, renal clearance, hemoglobin level, absolute white blood cell (WBC) count, absolute neutrophils count and absolute platelet count. A ROC analysis was performed to identify the best cut-off for baseline weight in predicting a RDI <75%, while continuous laboratory variables were dichotomized according to clinically relevant cut-offs.
Results: Overall, 142 patients were deemed eligible. Of these patients, 98 (69.0%) were treated with palbociclib plus fulvestrant, 44 (31.0%) with palbociclib plus aromatase inhibitors, and 73 (51.4%) in the first-line setting. The median number of administered palbociclib cycles was 8 (range: 1-24) and 61 patients (43.0%) required at least a first-level dose reduction (29 within 3 months). Furthermore, the median time to first dose reduction was 3.22 months, with neutropenia being responsible for 85.24% of first-level dose reductions. In the whole cohort, median RDI was 90.5% (95.1% for patients without dose reduction and 80% for those who had received a dose reduction). Notably, 28 patients (19.7%) experienced a RDI <75%. Through multivariate logistic regression, baseline weight ≤66 kg (OR 3.01, 95% CI: 1.08-8.35, p=0.03) and WBC ≤4.5 × 109/L (OR 3.15, 95% CI: 1.08-9.12, p=0.03) were independently associated with a RDI <75%. Moreover, baseline weight ≤66 kg was also significantly correlated with early dose reduction (OR 2.77, 95% CI: 1.09-7.01, p=0.03). After a median follow-up of 11.76 months, median PFS was 13.99 months. When exploring potential prognostic factors, neither a RDI <75% (HR 1.01, 95% CI: 0.52-1.95, p=0.97) nor a dose reduction within the first 3 months (HR 1.39, 95% CI: 0.67-2.91, p=0.31) did significantly impact PFS.
Conclusions: In our analysis, baseline weight and WBC were statistically associated with a RDI <75% in patients with MBC treated with palbociclib. Furthermore, baseline weight was also able to predict an early dose reduction in the study population. Lastly, early dose reduction and RDI <75% did not impact PFS. Although the small sample size and the limited follow-up, our results warrant further investigation in specifically designed trials.
Citation Format: Giacomo Pelizzari, Elisa Bertoli, Marco Giavarra, Carla Corvaja, Lorenzo Gerratana, Debora Basile, Michele Bartoletti, Camilla Lisanti, Lucia Bortot, Silvia Buriolla, Mattia Garutti, Debora Avoledo, Marta Bonotto, Lucia Da Ros, Silvia Bolzonello, Mauro Mansutti, Paola Di Nardo, Gianpiero Fasola, Simon Spazzapan, Alessandro M Minisini, Fabio Puglisi. Predictors of relative dose intensity and early dose reduction in patients with metastatic breast cancer treated with palbociclib and endocrine therapy [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-14-08.
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Affiliation(s)
- Giacomo Pelizzari
- 1Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Elisa Bertoli
- 2Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Oncology, ASUIUD University Hospital of Udine, Udine, Italy
| | - Marco Giavarra
- 2Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Oncology, ASUIUD University Hospital of Udine, Udine, Italy
| | - Carla Corvaja
- 1Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Lorenzo Gerratana
- 1Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Debora Basile
- 1Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Michele Bartoletti
- 1Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Camilla Lisanti
- 1Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Lucia Bortot
- 1Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Silvia Buriolla
- 1Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Mattia Garutti
- 3Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Roma, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Debora Avoledo
- 4Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Marta Bonotto
- 5Department of Oncology, ASUIUD University Hospital of Udine, Udine, Italy
| | - Lucia Da Ros
- 6Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Silvia Bolzonello
- 6Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Mauro Mansutti
- 5Department of Oncology, ASUIUD University Hospital of Udine, Udine, Italy
| | - Paola Di Nardo
- 6Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Gianpiero Fasola
- 5Department of Oncology, ASUIUD University Hospital of Udine, Udine, Italy
| | - Simon Spazzapan
- 6Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | | | - Fabio Puglisi
- 1Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
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7
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Malorni L, Curigliano G, Minisini AM, Cinieri S, Tondini CA, D'Hollander K, Arpino G, Bernardo A, Martignetti A, Criscitiello C, Puglisi F, Pestrin M, Sanna G, Moretti E, Risi E, Biagioni C, McCartney A, Boni L, Buyse M, Migliaccio I, Biganzoli L, Di Leo A. Palbociclib as single agent or in combination with the endocrine therapy received before disease progression for estrogen receptor-positive, HER2-negative metastatic breast cancer: TREnd trial. Ann Oncol 2019; 29:1748-1754. [PMID: 29893790 DOI: 10.1093/annonc/mdy214] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background The activity of palbociclib as a single agent in advanced breast cancer has not been extensively studied, with the only available clinical data limited to heavily pretreated patients. Preclinical data suggests palbociclib may partially reverse endocrine resistance, though this hypothesis has not been evaluated in previous clinical studies. This phase II, open-label, multicenter study examined the activity of palbociclib monotherapy, as well as palbociclib given in combination with the same endocrine therapy (ET) that was received prior to disease progression, in postmenopausal women with moderately pretreated, estrogen receptor-positive, HER2 negative advanced breast cancer. Patients and methods Eligible women with advanced disease which had progressed on one or two prior ETs were randomized 1 : 1 to receive either palbociclib alone, or palbociclib in combination with the ET as previously received. Primary end point was clinical benefit rate (CBR); secondary end points included progression-free survival (PFS). Results Between October 2012 and July 2016, a total of 115 patients were randomized. The CBR was 54% [95% confidence interval (CI): 41.5-63.7] for combination therapy, and 60% (95% CI: 47.8-72.9) for monotherapy. Median PFS was 10.8 months (95% CI: 5.6-12.7) for combination therapy, and 6.5 months (95% CI: 5.4-8.5) for monotherapy [hazard ratio (HR) 0.69; 95% CI: 0.4-1.1, exploratory P-value = 0.12]. Exploratory analyses revealed the PFS advantage for combination therapy was seen in the subgroup of patients who received prior ET for >6 months (HR 0.53; 95% CI: 0.3-0.9, exploratory P-value = 0.02), but not in those who received prior ET for ≤6 months. Conclusion Palbociclib has clinical activity as a single agent in women with moderately pretreated, oestrogen receptor-positive, HER2-negative advanced breast cancer. Palbociclib may have potential to reverse endocrine resistance in patients with a history of previous durable response to ET. Clinical trial information NCT02549430.
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Affiliation(s)
- L Malorni
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy.
| | - G Curigliano
- Division of Early Drug Development, Department of Haematology and Haemato-Oncology, Istituto Europeo di Oncologia, University of Milan, Milan, Italy
| | - A M Minisini
- Department of Oncology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - S Cinieri
- Medical Oncology Department, ASL Brindisi, Brindisi, Italy
| | - C A Tondini
- Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - K D'Hollander
- International Drug Development Institute, Louvain-La-Neuve, Belgium
| | - G Arpino
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples
| | - A Bernardo
- Medical Oncology Department, ICS Maugeri IRCCS, Pavia, Italy
| | - A Martignetti
- Oncology Department, Azienda USL Toscana Sud Est, Hospital Alta Val D'Elsa, Poggibonsi Siena, Italy
| | - C Criscitiello
- Division of Early Drug Development, Istituto Europeo di Oncologia, Milan, Italy
| | - F Puglisi
- Medical Oncology and Cancer Prevention Unit, IRCCS, CRO National Cancer Institute, Aviano; Department of Medicine, University of Udine, Udine, Italy
| | - M Pestrin
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - G Sanna
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - E Moretti
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - E Risi
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - C Biagioni
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - A McCartney
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - L Boni
- Clinical Trial Coordinating Center, AOU Careggi, Istituto Toscano Tumori, Florence, Italy
| | - M Buyse
- International Drug Development Institute, San Francisco, USA
| | - I Migliaccio
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - L Biganzoli
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - A Di Leo
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
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8
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Malorni L, Biagioni C, Luca FD, Bonechi M, Curigliano G, Minisini AM, Moretti E, Bergqvist M, Mattsson K, Risi E, Migliaccio I, Vitale S, Gabellini S, McCartney A, Santo ID, Galardi F, Boccalini G, Benelli M, Rossi L, Biganzoli L, Leo AD. Abstract 4416: Plasma thymidine kinase activity in patients with luminal metastatic breast cancer treated with Palbociclib within the phase II TREnd trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-4416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The CDK4/6 inhibitor palbociclib (P) is approved for the treatment of luminal metastatic breast cancer (MBC) in combination with endocrine therapy (ET). It leads to reduced phosphorylation of the Rb protein resulting in a decrease in E2F activity and eventual cell cycle arrest. Thymidine kinase 1 is a well-known cancer proliferation marker downstream of the E2F pathway, whose activity can be measured in plasma samples as readout of tumor proliferation. Circulating thymidine kinase activity (TKa) is a prognostic marker in MBC patients (pts) treated with ET, both when measured at baseline and during treatment. TKa has been previously shown to decrease in pts treated with neoadjuvant P+ET for 15 days, which was attributed as pharmacodynamic change on P treatment. The predictive value of TKa changes during treatment with P, as well as the dynamics of TKa changes on P-containing treatments are not yet comprehensively defined. Here we investigate the role of plasma TKa measured at different timepoints in a cohort from the TREnd study (NCT02549430).
Methods: TREnd was a randomized phase II trial that allocated 115 pts with moderately pre-treated luminal MBC to receive single-agent P or P plus the same ET agent that was received in the prior line of therapy. Plasma samples were collected at baseline (T0; n=45), at day 1 of cycle 2 (T1; n=45) and at disease progression (T2; n= 36) from 46 consenting pts. TKa was measured with DiviTum®, a refined ELISA-based assay. Patients were dichotomized as high/low at T0 based on an optimal cut-off (260 Du/L) determined by maximally selected rank statistics, and on the median value at T2 (250 Du/L). Dynamic changes between T0 and T1 were deemed meaningful if >10% of T1 or T0, whichever was greatest. Clinical outcome was estimated using the Kaplan-Meier method.
Results: Median TKa (mTKa) at T0 was 73 Du/L (range 20-4302). As expected, P-containing treatment reduced mTKa levels at T1 (37 Du/L, range 20-4504). Conversely, at disease progression, TKa increased compared to T0 (mTKa at T2, 250 Du/L, range 20-3653). Median time to progression (mTTP) in pts with low TKa at T0 (n= 33) was 8.5 months, compared to 5.6 months in pts with high TKa (n= 12). Interestingly, pts with an increase in TKa at T1 (n=9) had a mTTP of only 3.1 months compared to pts with stable/reduced TKa (N=35), who showed a mTTP of 9 months. Considering the potential significance of TKa measured at disease progression, pts with high levels at T2 (n=18) had a worse outcome on subsequent post-study treatment (both chemotherapy and ET) compared to those with lower levels (n=18) (mTTP at T2, 2.9 vs 8.9 months, respectively).
Conclusions: These data suggest for the first time that TKa may be a useful prognostic biomarker for non-invasive monitoring of MBC in the context of treatment with P. These results warrant further investigation in larger sample sets.
Citation Format: Luca Malorni, Chiara Biagioni, Francesca De Luca, Martina Bonechi, Giuseppe Curigliano, Alessandro M. Minisini, Erica Moretti, Mattias Bergqvist, Karin Mattsson, Emanuela Risi, Ilenia Migliaccio, Stefania Vitale, Stefano Gabellini, Amelia McCartney, Irene De Santo, Francesca Galardi, Giulia Boccalini, Matteo Benelli, Lorenzo Rossi, Laura Biganzoli, Angelo Di Leo. Plasma thymidine kinase activity in patients with luminal metastatic breast cancer treated with Palbociclib within the phase II TREnd trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4416.
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Affiliation(s)
- Luca Malorni
- 1“Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | | | - Francesca De Luca
- 3“Sandro Pitigliani” Translational Research Unit, Hospital of Prato, Prato, Italy
| | - Martina Bonechi
- 3“Sandro Pitigliani” Translational Research Unit, Hospital of Prato, Prato, Italy
| | - Giuseppe Curigliano
- 4Division of Early Drug Development, Department of Haematology and Haemato-Oncology, Istituto Europeo di Oncologia, University of Milan, Milan, Italy
| | - Alessandro M. Minisini
- 5Department of Oncology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Erica Moretti
- 1“Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | | | | | - Emanuela Risi
- 1“Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Ilenia Migliaccio
- 3“Sandro Pitigliani” Translational Research Unit, Hospital of Prato, Prato, Italy
| | - Stefania Vitale
- 7Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Stefano Gabellini
- 1“Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Amelia McCartney
- 1“Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Irene De Santo
- 8Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Francesca Galardi
- 3“Sandro Pitigliani” Translational Research Unit, Hospital of Prato, Prato, Italy
| | - Giulia Boccalini
- 3“Sandro Pitigliani” Translational Research Unit, Hospital of Prato, Prato, Italy
| | | | - Lorenzo Rossi
- 1“Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Laura Biganzoli
- 1“Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Angelo Di Leo
- 1“Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
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9
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Rossi L, Biagioni C, McCartney A, Migliaccio I, Curigliano G, Sanna G, Moretti E, Minisini AM, Cinieri S, Tondini C, Arpino G, Bernardo A, Martignetti A, Risi E, Pestrin M, Boni L, Benelli M, Biganzoli L, Di Leo A, Malorni L. Clinical outcomes after palbociclib with or without endocrine therapy in postmenopausal women with hormone receptor positive and HER2-negative metastatic breast cancer enrolled in the TREnd trial. Breast Cancer Res 2019; 21:71. [PMID: 31142370 PMCID: PMC6542028 DOI: 10.1186/s13058-019-1149-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Currently, there is limited data regarding the effectiveness of standard subsequent line therapies such as endocrine therapy, chemotherapy, or targeted agents after progression on CDK4/6 inhibitor-based regimens. This paper describes time-to-treatment failure beyond progression on palbociclib or palbociclib+endocrine therapy in patients enrolled in the phase II, multicenter TREnd trial. Our results indicate that there is limited benefit from post-palbociclib treatment, regardless of the type of therapy received. A small population of long responders were identified who demonstrated ongoing benefit from a subsequent line of endocrine therapy after progression to palbociclib-based regimens. A translational research program is ongoing on this population of outliers.
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Affiliation(s)
- Lorenzo Rossi
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy.,Institute of Oncology of Southern Switzerland (IOSI), Bellinzona, Switzerland.,Breast Unit of Southern Switzerland (CSSI), Lugano, Switzerland
| | | | - Amelia McCartney
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Ilenia Migliaccio
- "Sandro Pitigliani" Translational Research Unit, Hospital of Prato, Prato, Italy
| | - Giuseppe Curigliano
- Division of Early Drug Development, Department of Haematology and Haemato-Oncology, Istituto Europeo di Oncologia, IRCCS, Milano and University of Milano, Milan, Italy
| | - Giuseppina Sanna
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Erica Moretti
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Alessandro M Minisini
- Department of Oncology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | | | | | - Grazia Arpino
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | - Angelo Martignetti
- Oncology Department, Azienda USL Toscana Sud Est, Hospital Alta Val D'Elsa, Poggibonsi, Siena, Italy
| | - Emanuela Risi
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Marta Pestrin
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Luca Boni
- Clinical Trial Coordinating Center, AOU Careggi, Istituto Toscano Tumori, Florence, Italy
| | - Matteo Benelli
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy.,Bioinformatics Unit, Hospital of Prato, Prato, Italy
| | - Laura Biganzoli
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Angelo Di Leo
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Luca Malorni
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy. .,"Sandro Pitigliani" Translational Research Unit, Hospital of Prato, Prato, Italy.
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10
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Biganzoli L, Berardi R, Pedersini R, Minisini AM, Caremoli ER, Spazzapan S, Lima JS, Baldari D, Orlando L, Magnolfi E, Pistelli M, Brunello A, Zafarana E, Bernardo A, Leo S, Colleoni M, Donati S, De Placido S, Parolin V, Vitale S, Di Leo A, Puglisi F, Boni L, Cinieri S. Abstract P6-14-01: The effect trial: A randomized phase II trial evaluating two different doses of weekly (W) NAB-paclitaxel (NP) as first-line chemotherapy in older breast cancer (BC) patients (pts). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-14-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: W taxanes (T) are commonly used in the treatment of older BC pts, with neurotoxicity (NTX) and fatigue being dose-limiting toxicities with a possible negative impact on function. No prospective data exists on the safety and efficacy of W NP in this population. NP might be of particular value in older pts, due to no need for premedication with steroids and shorter time to recovery from neurotoxicity than conventional T, resulting in a reduced risk of exacerbation of comorbidities such as hypertension and diabetes, and possibly of functional decline (FD). Methods: Pts aged ≥ 65 years (y) with Her-2 negative or Her-2 positive (+), but contraindicated to anti-Her-2 therapy, advanced BC were randomized to receive NP as first-line chemotherapy at either 100 (Arm A) or 125 mg/m2 (Arm B), days 1, 8, 15 q 28. The primary end-point was event-free survival (EFS). An event was either disease progression (PD), death, or FD - defined as a decrease of at least 1 point from baseline values of activities of daily living (ADL) or instrumental ADL (IADL), deemed by the investigator as treatment-related and confirmed at the subsequent cycle. Secondary endpoints included progression-free survival (PFS), response rate (RR) in pts with measurable disease, and incidence of adverse events (AEs). Results: From January 2013 to September 2016, 160 pts were randomized in 15 Italian centres; all but 2 who never started NP were eligible for final analysis. Pts median age was 72y (range 65-84) in Arm A and 73y (range 65-88) in Arm B. Median ECOG performance status was 0 (range 0-2). Baseline IADL impairment was reported in 20 pts (25%) in both arms. >80% pts had ER+ tumors; 2 pts had HER2+ disease. Visceral disease was present in 71% (Arm A) and 70% (Arm B) of pts. Prior exposure to T in the neo/adjuvant setting was 14% (Arm A) and 13% (Arm B). Median number of delivered cycles of NP was 6 (range 1-28 in Arm A, and 1-22 in Arm B), with 3 pts still on treatment. Dose reductions were similarly reported (72% of pts Arm A, 78% of pts Arm B). At a median follow-up of 21 months (mos) (Interquartile range 14-28.4) 140 events were observed. Arm A/Arm B: PD n=53(67%)/n=52(66%); FD n=13(15%)/n=14(18%), death n=3(4%)n=5(6%). Outcomes data are reported in the following table:
Outcomes Arm AArm BMedian EFS, mos (90% CI)6.2 (5.5-8.4)6.4 (5.8-7.7)Median PFS, mos (95% CI)8.3 (5.9-10.5)8.8 (7.4-10.3)RR (95% CI)37% (25-50)42% (30-54)
Fatigue (Arm A: grade (G)2 29%, G3 11%; Arm B: G2 46%, G3 5%) and NTX (Arm A: G2 15%, G3 4%; Arm B: G2 28%, G3 8%) were the most frequently reported AEs. No G4 AEs were reported with the exception of neutropenia (1 pt in arm A) and leucopenia (3 pts in Arm A, 1 pt in arm B). 1 G5 (sepsis) was recorded in Arm B. NTX was reported as the reason for treatment discontinuation in 21 pts (13%) of whom 16 (21%) in arm B. Conclusion: Looking at classical study endpoints (PFS, RR), both doses of NP are active in older pts. However, 17% of pts had to stop treatment due to FD, assessed according to predefined criteria. Due to similar efficacy and reduced NTX, W NP 100 is the suggested dose to be used in older pts with advanced BC.
Citation Format: Biganzoli L, Berardi R, Pedersini R, Minisini AM, Caremoli ER, Spazzapan S, Lima JS, Baldari D, Orlando L, Magnolfi E, Pistelli M, Brunello A, Zafarana E, Bernardo A, Leo S, Colleoni M, Donati S, De Placido S, Parolin V, Vitale S, Di Leo A, Puglisi F, Boni L, Cinieri S. The effect trial: A randomized phase II trial evaluating two different doses of weekly (W) NAB-paclitaxel (NP) as first-line chemotherapy in older breast cancer (BC) patients (pts) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-14-01.
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Affiliation(s)
- L Biganzoli
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - R Berardi
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - R Pedersini
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - AM Minisini
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - ER Caremoli
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - S Spazzapan
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - JS Lima
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - D Baldari
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - L Orlando
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - E Magnolfi
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - M Pistelli
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - A Brunello
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - E Zafarana
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - A Bernardo
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - S Leo
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - M Colleoni
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - S Donati
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - S De Placido
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - V Parolin
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - S Vitale
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - A Di Leo
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - F Puglisi
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - L Boni
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - S Cinieri
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
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Fontanella C, Fanotto V, Gerratana L, Bonotto M, Cinausero M, Bozza C, Iacono D, Russo S, Andreetta C, Minisini AM, Moroso S, Mansutti M, Fasola G, Puglisi F. Abstract P2-08-06: Usefulness of the pre-treatment neutrophil-to-lymphocyte ratio in predicting first-line progression free-survival in triple-negative breast cancer patients. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-08-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The neutrophil-to-lymphocyte ratio (NLR) is an independent predictor of poor prognosis inunselected breast cancer patients with NLR >3.3. Moreover, pre-treatment NLR has been associated with disease-free and overal survival (OS) in patients with early triple-negative breast cancer (TNBC). We aimed to determine whether the NLR is predictive of progression-free survival (PFS) in metastatic TNBC.
Methods: We reviewed the records of 48 TNBC patients who received at least one administration of first-line (1°L) chemotherapy for advanced disease from October 2004 to April 2014. The NLR (absolute neutrophil count/absolute lymphocyte count) was calculated from the full blood count routinely performed immediately before the initiation of first-line treatment. The association between categorical variables was calculated by X2 test. PFS (from start of 1°L treatment to disease progression or death) and OS (from start of 1°L treatment to death) were estimated using Kaplan Meier method. Multivariable Cox regression was used to determine the independent prognostic significances of the NLR (co-variables stage at diagnosis, histology, and tumor grade).
Results: NLR was not associated with stage at diagnosis (p=0.214), histology (p=0.597), or tumor grade (p=0.775). After a median follow-up of 10.9 months (range 1.3-54.9), 88.6% of TNBC patients with NLR≤3.3 versus 0.0% of patients with NLR>3.3 had a 1°L PFS>3 months (p<0.001). Similarly, 62.9% of TNBC patients with NLR≤3.3 versus 30.8% of patients with NLR>3.3 had an OS>10 months (p=0.047). Metastatic TNBC patients with NLR≤3.3 had a longer median 1°L PFS (5.2 months) and median OS (13.5 months) compared with patients with NLR>3.3 (1°L PFS 2.1 months, p<0.001; OS 7.7 months, p=0.018). In multivariable analysis, NLR>3.3 is associated with a shorter PFS (hazard ratio [HR] 22.4; 95% confidence interval [CI] 6.7-75.1, p<0.001) and higher risk of death (HR 3.2, 95%CI 1.4-7.4, p=0.005).
Conclusion: Our study showed that pre-treatment NLR is associated with 1°L PFS and OS in patients with metastatic TNBC. However, further investigation in larger series of metastatic TNBC is warranted.
Citation Format: Fontanella C, Fanotto V, Gerratana L, Bonotto M, Cinausero M, Bozza C, Iacono D, Russo S, Andreetta C, Minisini AM, Moroso S, Mansutti M, Fasola G, Puglisi F. Usefulness of the pre-treatment neutrophil-to-lymphocyte ratio in predicting first-line progression free-survival in triple-negative breast cancer patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-08-06.
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Affiliation(s)
| | - V Fanotto
- University Hospital of Udine, Udine, Italy
| | | | - M Bonotto
- University Hospital of Udine, Udine, Italy
| | | | - C Bozza
- University Hospital of Udine, Udine, Italy
| | - D Iacono
- University Hospital of Udine, Udine, Italy
| | - S Russo
- University Hospital of Udine, Udine, Italy
| | | | | | - S Moroso
- University Hospital of Udine, Udine, Italy
| | - M Mansutti
- University Hospital of Udine, Udine, Italy
| | - G Fasola
- University Hospital of Udine, Udine, Italy
| | - F Puglisi
- University Hospital of Udine, Udine, Italy
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12
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Bonotto M, Gerratana L, Poletto E, Driol P, Giangreco M, Russo S, Minisini AM, Andreetta C, Mansutti M, Pisa FE, Fasola G, Puglisi F. Measures of outcome in metastatic breast cancer: insights from a real-world scenario. Oncologist 2014; 19:608-15. [PMID: 24794159 PMCID: PMC4041678 DOI: 10.1634/theoncologist.2014-0002] [Citation(s) in RCA: 177] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 04/03/2014] [Indexed: 11/17/2022] Open
Abstract
No gold standard treatment exists for metastatic breast cancer (MBC). Clinical decision making is based on knowledge of prognostic and predictive factors that are extrapolated from clinical trials and, sometimes, are not reliably transferable to a real-world scenario. Moreover, misalignment between endpoints used in drug development and measures of outcome in clinical practice has been noted. The roles of overall survival (OS) and progression-free survival (PFS) as primary endpoints in the context of clinical trials are the subjects of lively debate. Information about these parameters in routine clinical practice is potentially useful to design new studies and/or to interpret the results of clinical research. This study analyzed the impact of patient and tumor characteristics on the major measures of outcome across different lines of treatment in a cohort of 472 patients treated for MBC. OS, PFS, and postprogression survival (PPS) were analyzed. The study showed how biological and clinical characteristics may have different prognostic value across different lines of therapy for MBC. After first-line treatment, the median PPS of luminal A, luminal B, and human epidermal growth factor receptor 2 (HER2)-positive groups was longer than 12 months. The choice of OS as a primary endpoint for clinical trials could not be appropriate with these subtypes. In contrast, OS could be an appropriate endpoint when PPS is expected to be low (e.g., triple-negative subtype after the first line; other subtypes after the third line). The potential implications of these findings are clinical and methodological.
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Affiliation(s)
- Marta Bonotto
- Department of Oncology and Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy; General Hospital, Gorizia, Italy
| | - Lorenzo Gerratana
- Department of Oncology and Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy; General Hospital, Gorizia, Italy
| | - Elena Poletto
- Department of Oncology and Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy; General Hospital, Gorizia, Italy
| | - Pamela Driol
- Department of Oncology and Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy; General Hospital, Gorizia, Italy
| | - Manuela Giangreco
- Department of Oncology and Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy; General Hospital, Gorizia, Italy
| | - Stefania Russo
- Department of Oncology and Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy; General Hospital, Gorizia, Italy
| | - Alessandro M Minisini
- Department of Oncology and Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy; General Hospital, Gorizia, Italy
| | - Claudia Andreetta
- Department of Oncology and Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy; General Hospital, Gorizia, Italy
| | - Mauro Mansutti
- Department of Oncology and Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy; General Hospital, Gorizia, Italy
| | - Federica E Pisa
- Department of Oncology and Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy; General Hospital, Gorizia, Italy
| | - Gianpiero Fasola
- Department of Oncology and Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy; General Hospital, Gorizia, Italy
| | - Fabio Puglisi
- Department of Oncology and Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy; General Hospital, Gorizia, Italy
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Minisini AM, Andreetta C, Fasola G, Puglisi F. Pegylated liposomal doxorubicin in elderly patients with metastatic breast cancer. Expert Rev Anticancer Ther 2014; 8:331-42. [DOI: 10.1586/14737140.8.3.331] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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14
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Minisini AM, Moroso S, Gerratana L, Giangreco M, Iacono D, Poletto E, Guardascione M, Fontanella C, Fasola G, Puglisi F. Risk factors and survival outcomes in patients with brain metastases from breast cancer. Clin Exp Metastasis 2013; 30:951-6. [PMID: 23775210 DOI: 10.1007/s10585-013-9594-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 06/03/2013] [Indexed: 10/26/2022]
Abstract
Development of central nervous system (CNS) metastases in breast cancer (BC) is associated with poor prognosis. The incidence of CNS metastases in metastatic BC is reported to be about 10-16 %, but different subtypes of BC are associated with different risk of developing CNS metastases. We retrospectively analysed the risk of CNS metastases and the outcome in a cohort of 473 patients with metastatic BC. CNS metastases were diagnosed in 15.6 % of patients and median survival from diagnosis of CNS metastases was 7.53 (25th-75th 2.8-18.9) months. The risk of developing CNS metastases was higher in patients with grade 3, hormone receptor negative, HER2-positive, high Ki-67 BC. When compared to luminal A subtype, only HER2-positive BC was associated with increased risk of CNS metastases. Survival from diagnosis of CNS metastases was longer in patients with HER2-positive BC, while it was shorter in patients that did not receive any locoregional treatment, or with extra-CNS disease, or with more than 3 CNS lesions.
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Affiliation(s)
- A M Minisini
- Department of Oncology, University Hospital of Udine, Piazzale S.M. Misericordia, 33100, Udine, Italy
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15
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Pestrin M, Bessi S, Puglisi F, Minisini AM, Masci G, Battelli N, Ravaioli A, Gianni L, Di Marsico R, Tondini C, Gori S, Coombes CR, Stebbing J, Biganzoli L, Buyse M, Di Leo A. Final results of a multicenter phase II clinical trial evaluating the activity of single-agent lapatinib in patients with HER2-negative metastatic breast cancer and HER2-positive circulating tumor cells. A proof-of-concept study. Breast Cancer Res Treat 2012; 134:283-9. [PMID: 22476856 DOI: 10.1007/s10549-012-2045-1] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 03/18/2012] [Indexed: 12/28/2022]
Abstract
This multicenter phase II trial was designed to evaluate the activity of lapatinib in metastatic breast cancer patients with HER2-negative primary tumors and HER2-positive circulating tumor cells (CTCs). In this study MBC patients with HER2-negative primary tumors and HER2-positive CTCs previously treated with at least a first-line therapy for metastatic disease received lapatinib 1500 mg/day. The CellSearch System® was used for CTCs isolation and bio-characterization. HER2 status was assessed on CTCs by immunofluorescence. A case was defined as CTCs positive if ≥2 CTC/7.5 ml of blood were isolated and HER2-positive if ≥50% of CTCs were HER2-positive. 139 HER2-negative patients were screened, 96 patients were positive for CTCs (mean number of CTCs: 85; median number of CTCs: 19; range 2-1637). Seven of the 96 patients (7%) had ≥50% HER2-positive CTCs and were eligible for treatment with lapatinib. No objective tumor responses occurred in this population. In one patient, disease stabilization lasting 254 days (8.5 months) was observed. From the findings of this study, we concluded that a subset of patients with a HER2-negative primary tumor presents HER2-positive CTCs during disease progression, although the HER2 shift rate seems to be lower than previously reported. Despite the lack of objective response, the durable disease stabilization observed in one patient cannot rule out the hypothesis that lapatinib may have some activity in this patient population. However, considering that only 1/139 screened patients may potentially have derived benefit from this approach, future trials designed according to the presented strategy cannot be recommended.
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MESH Headings
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Lobular/drug therapy
- Carcinoma, Lobular/metabolism
- Carcinoma, Lobular/secondary
- Female
- Humans
- Lapatinib
- Middle Aged
- Neoplastic Cells, Circulating/metabolism
- Quinazolines/pharmacology
- Quinazolines/therapeutic use
- Receptor, ErbB-2/metabolism
- Treatment Outcome
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Affiliation(s)
- Marta Pestrin
- Medical Oncology Unit, Hospital of Prato, Prato, Italy
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Andreetta C, Minisini AM, Miscoria M, Puglisi F. First-line chemotherapy with or without biologic agents for metastatic breast cancer. Crit Rev Oncol Hematol 2010; 76:99-111. [DOI: 10.1016/j.critrevonc.2010.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Revised: 12/26/2009] [Accepted: 01/07/2010] [Indexed: 12/20/2022] Open
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Minisini AM, Pauletto G, Andreetta C, Bergonzi P, Fasola G. Anticancer drugs and central nervous system: Clinical issues for patients and physicians. Cancer Lett 2008; 267:1-9. [DOI: 10.1016/j.canlet.2008.02.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Revised: 02/21/2008] [Accepted: 02/22/2008] [Indexed: 11/16/2022]
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Puglisi F, Cardellino GG, Crivellari D, Di Loreto C, Magri MD, Minisini AM, Mansutti M, Andreetta C, Russo S, Lombardi D, Perin T, Damante G, Veronesi A. Thymidine phosphorylase expression is associated with time to progression in patients receiving low-dose, docetaxel-modulated capecitabine for metastatic breast cancer. Ann Oncol 2008; 19:1541-6. [PMID: 18441329 DOI: 10.1093/annonc/mdn165] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Preclinical data have indicated a synergistic interaction between docetaxel and capecitabine by means of taxane-induced up-regulation of thymidine phosphorylase (TP). On the basis of such premises, we conducted a phase II trial to determine the activity and tolerability of weekly docetaxel plus capecitabine in patients with metastatic breast cancer (MBC). Furthermore, we explored the relationship between TP tumor expression and benefit from this regimen. PATIENTS AND METHODS Patients received docetaxel 36 mg/m(2) i.v. on days 1, 8, and 15 and capecitabine orally 625 mg/m(2) b.i.d. from days 8 to 21. Cycles were repeated every 4 weeks. In the correlative study, we evaluated the TP expression by immunohistochemistry and the TP messenger RNA expression by real-time RT-PCR in the primary tumor. RESULTS Forty-seven women were enrolled. In the intention-to-treat analysis, objective responses were achieved in 24 patients (51%). Fourteen additional patients (30%) had stable disease. The median time to progression (TTP) was 6 months (range 1-44 months). Median survival was 17 months (range 1-48 months). Overall, the treatment was well tolerated. The most common clinical adverse events (all grades) were alopecia (55%), nail changes (53%), fatigue/asthenia (51%), nausea/vomiting (51%), neutropenia (49%), and neuropathy (49%). A significantly higher TTP was observed in patients with TP-positive tumors (log-rank test, P = 0.009). Interestingly, a subgroup analysis confirmed this TTP benefit in patients with TP-positive tumors obtaining a tumor response (log-rank test, P = 0.03), whereas the statistical significance was lost in nonresponders (log-rank test, P = 0.3). CONCLUSIONS This study indicates that a regimen with low doses of capecitabine plus weekly docetaxel is active against MBC. The correlative analysis provides preliminary evidence that TP expression may be a predictive marker for therapeutic benefit.
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Affiliation(s)
- F Puglisi
- Department of Clinical Oncology, University Hospital of Udine, Piazzale S.M. Misericordia, 33100 Udine, Italy.
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Minisini AM, De Faccio S, Ermacora P, Andreetta C, Fantinel R, Balestrieri M, Piga A, Puglisi F. Cognitive functions and elderly cancer patients receiving anticancer treatment: a prospective study. Crit Rev Oncol Hematol 2008; 67:71-9. [PMID: 18394917 DOI: 10.1016/j.critrevonc.2008.02.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Revised: 11/29/2007] [Accepted: 02/15/2008] [Indexed: 10/22/2022] Open
Abstract
It has been reported that anticancer treatment may cause cognitive impairment. Elderly patients in particular could be at increased risk for treatment-related cognitive deterioration. A consecutive series of cancer out-patients >or=65 years old were prospectively assessed by means of a neuropsychological test Cambridge Cognitive Examination (CAMCOG) test at baseline, and after 3 and 6 months from study entry. Patients were categorized in three groups (group 1, no anticancer treatment; group 2, receiving chemotherapy; group 3, receiving endocrine therapy). Comprehensive geriatric assessment was performed at the three time points evaluation. Sixty-one patients were enrolled (32, 16 and 13, in groups 1, 2, and 3, respectively). At baseline, cognitive function was directly correlated to Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scores and was associated with higher educational level and absence of depression. Overall, cognitive function did not worsen across time in each group. However, more patients in the CT group showed worsening in memory skills, and more patients in the ET and CT group experienced reduction in the attention score.
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Affiliation(s)
- Alessandro M Minisini
- Department of Oncology, University Hospital of Udine, Ple SM della Misercordia, 33100 Udine, Italy.
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Minisini AM, Pauletto G, Bergonzi P, Fasola G. Paraneoplastic neurological syndromes and breast cancer. Regression of paraneoplastic neurological sensorimotor neuropathy in a patient with metastatic breast cancer treated with capecitabine: a case study and mini-review of the literature. Breast Cancer Res Treat 2006; 105:133-8. [PMID: 17123150 DOI: 10.1007/s10549-006-9444-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2006] [Accepted: 10/25/2006] [Indexed: 11/24/2022]
Abstract
Paraneoplastic neurological syndromes are a rare complication of breast cancer. Nevertheless, they may be clinically relevant leading to neurological impairment. Clinicians should be aware that these neurological disorders could even precede the diagnosis of breast cancer. Here we present the case of a female patient with advanced breast cancer who developed paraneoplastic sensorimotor neuropathy. Treatment with capecitabine lead to clinical amelioration. A review of the literature on the paraneoplastic neurological syndromes in breast cancer is also included.
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Affiliation(s)
- Alessandro M Minisini
- Department of Medical Oncology, University and S.M. Misericordia Hospital, P.le S.M. della Misericordia, 33100 Udine, Italy.
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Fornasarig M, Minisini AM, Viel A, Quaia M, Canzonieri V, Veronesi A. Twelve years of endoscopic surveillance in a family carrying biallelic Y165C MYH defect: report of a case. Dis Colon Rectum 2006; 49:272-5. [PMID: 16416081 DOI: 10.1007/s10350-005-0257-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE We report the case of two siblings, clinically andendoscopically followed for 12 years, who displayed anattenuated adenomatous polyposis coli phenotype. METHODS On workup for rectal bleeding with colonoscopy, we found multiple adenomas mainly right-sided in a 21-year-old female and the same colonic phenotype was observed in her 27-year-old brother. We made a clinical diagnosis of attenuated adenomatous polyposis coli and performed APC gene testing. Because they had refused the proposed ileorectal anastomosis surgical option, we planned a periodic, endoscopic follow-up. RESULTS Gene testing did not confirm the clinical suspicion of attenuated adenomatous polyposis coli. Actually, we did not find anypathogenic mutation in APC gene and we recently identified a biallelic Y125C MYH defect. During the endoscopic follow-up, a progressive reduction of adenomas was seen. CONCLUSIONS New insight colorectal cancer genetics have allowed definition of a new class of polyposis that applies to some patients with attenuated adenomatous polyposis coli phenotype as in the siblings we have described. To prevent colorectal cancer without recurring to surgery, colonoscopic polypectomy may be a suitable tool in controlling MYH polyposis.
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Affiliation(s)
- Mara Fornasarig
- Gastroenterology Unit, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy.
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Puglisi F, Follador A, Minisini AM, Cardellino GG, Russo S, Andreetta C, Di Terlizzi S, Piga A. Baseline staging tests after a new diagnosis of breast cancer: further evidence of their limited indications. Ann Oncol 2005; 16:263-6. [PMID: 15668281 DOI: 10.1093/annonc/mdi063] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Bone scanning (BS), liver ultrasonography (LUS) and chest radiography (CXR) are commonly used in patients with newly diagnosed breast cancer as part of baseline staging. However, in the absence of symptomatic disease, the usefulness of this routine diagnostic work-up is not evidence-based. METHODS We selected the study sample from 516 consecutive patients with newly diagnosed invasive breast cancer. For each diagnostic test (BS, LUS, CXR), we analyzed the prevalence defined as the number of patients with diagnosis of metastatic disease after an imaging technique divided by the total number of patients tested. In addition, sensitivity and specificity were calculated. Initial suspicion was confirmed by other independent tests (bone X-ray, computerized tomography scan, magnetic resonance imaging) in order to identify "true" positive diagnoses. RESULTS At baseline, BS was carried out in 412 patients, LUS in 412 patients and CXR in 428 patients. Thirty-three patients were correctly diagnosed by the initial staging investigations as having metastatic disease (true positive cases). BS detected skeletal metastases in 6.31% of patients, LUS detected liver metastases in 0.72% of patients and CXR detected lung metastases in 0.93% of patients. Before imaging tests, all patients with either LUS or CXR evidence of metastases were previously classified as having stage III disease. On the other hand, only 26.9% of bone metastases were detected in patients with stage III. Accordingly, the detection rate in stage III patients was 14%, 5.6% and 7.2%, respectively for BS, LUS and CXR. CONCLUSIONS These findings indicate that a complete diagnostic work-up to detect metastases is unnecessary in the majority of patients with newly diagnosed breast cancer, whereas it may be indicated for specific patient categories such as those with stage III disease.
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Affiliation(s)
- F Puglisi
- Breast Unit and Clinical Oncology, University of Udine, Piazzale SM Misericordia, 33100 Udine, Italy.
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Minisini AM, Di Loreto C, Mansutti M, Artico D, Pizzolitto S, Piga A, Puglisi F. Topoisomerase IIalpha and APE/ref-1 are associated with pathologic response to primary anthracycline-based chemotherapy for breast cancer. Cancer Lett 2004; 224:133-9. [PMID: 15911109 DOI: 10.1016/j.canlet.2004.11.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2004] [Revised: 10/30/2004] [Accepted: 11/01/2004] [Indexed: 11/15/2022]
Abstract
The aim of this study was to evaluate the role of several biological and histological markers (topoisomerase IIalpha, MIB-1, E2F, apoptotic index, APE/ref-1, p53, Her-2/neu, estrogen and porgesterone receptors, and histological grading) as predictors of pathologic response after anthracycline-based chemotherapy for breast cancer. A series of 50 consecutive breast cancer patients receiving anthracycline-based primary chemotherapy were retrospectively studied. Biological markers were assessed by immunohistochemistry (and by TUNEL assay for apoptotic index) in pre-treatment core biopsies and post-treatment surgical samples. The expression of topoisomerase IIalpha, E2F, MIB-1, estrogen and progesterone receptors decreased, while APE/ref-1 staining increased after treatment. Higher topoisomerase IIalpha (P=0.007) and lower APE/ref-1 (P=0.04) expression were associated with better pathologic response.
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Affiliation(s)
- Alessandro M Minisini
- Medical Oncology Department, University of Udine and S. Maria della Misericordia Hospital, P.le SM della Misericordia, I-33100 Udine, Italy.
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Minisini AM, Tosti A, Sobrero AF, Mansutti M, Piraccini BM, Sacco C, Puglisi F. Taxane-induced nail changes: incidence, clinical presentation and outcome. Ann Oncol 2003; 14:333-7. [PMID: 12562663 DOI: 10.1093/annonc/mdg050] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The clinical characteristics of nail changes in seven patients receiving taxane-containing chemotherapy are described. They include nail pigmentation, subungual hematoma, Beau's lines and onycholysis and subungual suppuration. The incidence of such changes (ranging from 0% to 44%) is reviewed from a Medline search of the literature.
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Affiliation(s)
- A M Minisini
- Clinical Oncology, University of Udine, Udine, Italy
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Puglisi F, Aprile G, Minisini AM, Barbone F, Cataldi P, Tell G, Kelley MR, Damante G, Beltrami CA, Di Loreto C. Prognostic significance of Ape1/ref-1 subcellular localization in non-small cell lung carcinomas. Anticancer Res 2001; 21:4041-9. [PMID: 11911289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
PURPOSE To evaluate the prognostic value of the DNA repair/redox-protein Ape1/ref-1 in a retrospective series of consecutive non-small cell lung carcinomas (NSCLC). PATIENTS AND METHODS Sections from 91 radically resected NSCLC were analyzed for immunohistochemical expression of Ape1/ref-1. For each case 1,000 tumor cells were evaluated to detect nuclear and cytoplasmic reactivity scored as a percentage of positive cells. With respect to sub-cellular localization and percentage of immunoreactive cells, each tumor was classified as "cytoplasmic" or "non cytoplasmic". The survival rate according to Ape1/ref-1 sub-cellular localization was calculated. RESULTS The main pattern of Ape1/ref-1 expression was nuclear. No significant difference was observed in Ape1/ref-1 pattern according to histotype (squamous vs adenocarcinoma). Among adenocarcinomas, a cytoplasmic expression of Ape1/ref-1 was significantly associated with poor survival rate in univariate (p=0.01) and multivariate (p=0.07) analyses. In addition, a cytoplasmic expression of the DNA repair protein was also predictive of worse prognosis (log-rank test, p=0.02) in cases with lymph node involvement, regardless of histotype. CONCLUSION The results suggest a potential role of Ape1/ref-1 sub-cellular localization as a prognostic indicator in patients with NSCLC. In particular, cytoplasmic localization of the protein seems to confer a poor outcome in subgroups of patients with nodal involvement or adenocarcinoma histotype.
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Belvedere O, Feruglio C, Malangone W, Bonora ML, Minisini AM, Spizzo R, Donini A, Sala P, De Anna D, Hilbert DM, Degrassi A. Increased blood volume and CD34(+)CD38(-) progenitor cell recovery using a novel umbilical cord blood collection system. Stem Cells 2000; 18:245-51. [PMID: 10924090 DOI: 10.1634/stemcells.18-4-245] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A major problem with the use of umbilical cord/placental blood (UCB) is the limited blood volume that can be collected from a single donor. In this study, we evaluated a novel system for the collection of UCB and analyzed the kinetics of output of hematopoietic stem cells in the collected blood. Sequential UCB fractions were collected from 48 placentas by gravity following common procedures. When UCB flow was ended, collection was continued using the device. Nucleated cell (NC) density in each fraction was evaluated and the expression of CD34, CD38 and other hematopoietic markers was assessed by flow cytometry. The total collected volume was 60.9 +/- 26.2 ml (mean +/- SD, range 17-141.5). The device yield (volume collected using the device/total volume) was 26.5 +/- 15.1%. No significant difference was observed in NC count in sequential fractions. A significant increase in CD34(+) cell content in sequential fractions and a 2.07 +/- 1.18-fold increase in the percentage of CD34(+) cells in the last versus first fraction were observed. Furthermore, within the CD34(+) population, the percentage of CD38(-) pluripotent stem cells in the first fraction was 3.24 +/- 1.39, while in the last fraction it raised to 34.43 +/- 22.62. Thus, at the end of a collection performed following current procedures, further blood rich in the most primitive progenitor cells can be recovered. Therefore, the optimization and standardization of collection procedures are required to obtain maximal recovery from each placenta and increase the percentage of UCB units suitable for clinical use.
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Affiliation(s)
- O Belvedere
- Consorzio FENICE, Department of Experimental and Clinical Pathology and Medicine, Medical Oncology, S.M. Misericordia Hospital, Udine, Italy
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