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Sponghini AP, Rondonotti D, Platini F, Cena T, Ferrante D, Stratica F, Gatti A, Magnani C, Gennari A. A Simon's two-stage design trial evaluating the potential role of a kind of honey in preventing chemotherapy-hematopoietic toxicities. J Tradit Complement Med 2021; 11:466-469. [PMID: 34522641 PMCID: PMC8427476 DOI: 10.1016/j.jtcme.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 12/03/2022] Open
Abstract
Background and aim Hematopoietic toxicities are a serious consequence of myelosuppressive CT that may result in dose reductions, delays or even discontinuation of CT, which, in turn, may compromise patient outcomes. Concerns about tolerability and costs of CSFs are still ongoing, therefore the potential use of supportive therapeutics agents are still of interest. Experimental procedure We performed a monocentric, phase II study using Simon's two-stage design. The primary endpoint was the evaluation of the potential clinical benefit of a special kind of honey (Life-Mel Honey) administered prophylactically to reduce the incidence of hematopoietic toxicities following chemotherapy. We have enrolled patients undergoing adjuvant or first-line chemotherapy. Results and conclusion From November 2013 to May 2014 (First stage) and from November 2014 to April 2016 (Second stage), 39 patients were enrolled at our Institution. The majority of patients was male (24/39, 61.5%), medium age was 60.4 years (range 34–77 years). The median follow up was 74.5 days (SD +/- 28.5). Overall, the majority of patients could underwent their chemoterapy with a regular schedule (25/39, 64.1%), while 9/39 patients (23.1%) need to delay chemotherapy due to hematological adverse events of various grade. Ten/39 patients (25.6%) had a grade 1 neutrophils count decreased, 56.4% a grade 1 platelets count decrease and 64.1% a grade 1 hemoglobin decrease. Therefore, Life-Mel Honey showed an interesting profile to reduce hematological toxicities. The proportion of responses is sufficiently high to recommend this honey to go to a next step in the clinical trial phase.
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Affiliation(s)
- Andrea Pietro Sponghini
- Division of Oncology, University Hospital “Maggiore Della Carità”, 28100, Novara, Italy
- Corresponding author. Division of Oncology, University Hospital “Maggiore della Carità”, Novara, Italy.
| | - David Rondonotti
- Division of Oncology, University Hospital “Maggiore Della Carità”, 28100, Novara, Italy
| | - Francesca Platini
- Division of Oncology, University Hospital “Maggiore Della Carità”, 28100, Novara, Italy
| | - Tiziana Cena
- Department of Translational Medicine, Unit of Medical Statistics, University of Eastern Piedmont and Cancer Epidemiology, CPO Piemonte, Novara, Italy
| | - Daniela Ferrante
- Department of Translational Medicine, Unit of Medical Statistics, University of Eastern Piedmont and Cancer Epidemiology, CPO Piemonte, Novara, Italy
| | - Florian Stratica
- Division of Oncology, University Hospital “Maggiore Della Carità”, 28100, Novara, Italy
| | - Alice Gatti
- Division of Oncology, University Hospital “Maggiore Della Carità”, 28100, Novara, Italy
| | - Corrado Magnani
- Department of Translational Medicine, Unit of Medical Statistics, University of Eastern Piedmont and Cancer Epidemiology, CPO Piemonte, Novara, Italy
| | - Alessandra Gennari
- Division of Oncology, University Hospital “Maggiore Della Carità”, 28100, Novara, Italy
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Era VD, Garzaro M, Borello G, Pisani C, Masini L, Sponghini AP, Rondonotti D, Krengli M, Valletti PA. P-182 Multi-step treatment of advanced Sinonasal Mucosal Melanoma: combination of surgery, radiation and immunotherapy. Oral Oncol 2021. [DOI: 10.1016/s1368-8375(21)00467-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pisani C, Krengli M, Era VD, Garzaro M, Borello G, Sponghini AP, Rondonotti D, Valletti PA. P-73 Multidisciplinary management of recurrent nasopharyngeal carcinoma after chemo-radiotherapy protocol. Oral Oncol 2021. [DOI: 10.1016/s1368-8375(21)00360-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Resteghini C, Castelnuovo P, Nicolai P, Orlandi E, Bossi P, Vischioni B, Schreiber A, Iacovelli NA, Battaglia P, Mattavelli D, Facchinetti N, Gambazza S, Calareso G, Ravanelli M, Facco C, Tartaro T, Sponghini AP, Pagella F, Mariani L, Licitra LF. The SINTART 1 study: A phase II trial of induction chemotherapy (IC), surgery, photon-, proton-and carbon ion-based radiotherapy (RT) integration in locally advanced operable sinonasal epithelial tumors patients (pts). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.6066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6066 Background: Sinonasal epithelial tumors are rare diseases with several histotypes and poor prognosis. Multimodal approach including surgery is widely used, although no standard therapy has been established in prospective trials. This study assessed activity and safety of an innovative integration of multimodality treatment - IC, surgery and RT - modulated by histology, molecular profile and response to IC. Methods: Pts with untreated, operable squamous cell carcinoma (SCC), p53 wild type intestinal type adenocarcinoma (ITAC), sinonasal undifferentiated and neuroendocrine carcinoma (SNUC, SNEC) were enrolled in a single-arm, phase II, multicenter clinical trial from 2014 to 2018. Pts was treated with up to 5 IC cycles, whose regimen was selected according to histotype, followed either by curative radio-chemotherapy (CRT) (pts with ≥80% reduction of initial tumor volume (TV)) or surgery and adjuvant (C)RT. Photon and/or proton/carbon ion-based RT was employed according to disease site and stage. Primary endpoint was 5 years PFS, secondary endpoints were OS, IC ORR per RECIST 1.1 and safety. Results: Out of 39 enrolled pts, 35 pts were evaluable for primary endpoint. Two pts were only considered for safety analyses because definitive diagnosis on surgical specimen did not meet the study entry criteria; other two pts were screening failure due to inoperable disease. Five-year PFS was 38% (95% CI, 21 – 69), with a median PFS of 26 months. Five-year OS was 46% (95% CI, 28 – 75), with a median OS of 36 months. Responses to IC are reported in table. Globally, 15 pts avoided surgery. Overall treatment safety was in line with multimodality intensive head and neck cancer treatments (5% of pts with G3-4 adverse event during IC). One sudden cardiac death was recorded. At a median follow up of 27 months, 5 G3-4 RT related late adverse events have been recorded (1 G3 neurotoxicity, 2 G3 hearing impairment, 2 G3 xerostomia). Three-year PFS - OS for pts achieving PR/CR vs SD/PD to IC were 49.8% - 56.7% vs 43.2% - 53%, respectively. Conclusions: Treatment of advanced SNC with histology-driven IC followed by locoregional therapy tailored to response to IC was safe and showed survival rate similar to surgery containing case series. In the first prospective study, a surgery sparing multimodal approach proved feasible and effective in IC responsive pts. Clinical trial information: NCT02099175. [Table: see text]
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Affiliation(s)
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology, University of Insubria and ASST Sette Laghi, Varese, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-"Azienda Ospedaliera di Padova", Padua, Italy
| | - Ester Orlandi
- Radiotherapists Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Paolo Bossi
- Head and Neck Cancer Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Barbara Vischioni
- Radiotherapists Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia-"ASST Spedali Civili di Brescia", Brescia, Italy
| | | | - Paolo Battaglia
- Department of Otorhinolaryngology, University of Insubria and ASST Sette Laghi., Varese, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia-"ASST Spedali Civili di Brescia", Brescia, Italy
| | - Nadia Facchinetti
- Radiotherapists Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Simone Gambazza
- Laboratory of Medical Statistics and Biometry, 'Giulio A. Maccacaro', Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giuseppina Calareso
- Radiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Ravanelli
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia-"ASST Spedali Civili di Brescia", Brescia, Italy
| | - Carla Facco
- Department of Pathology, University of Insubria and ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | | | | | - Fabio Pagella
- ENT Department, I.R.C.C.S. Policlinico San Matteo-University of Pavia, Pavia, Italy
| | - Luigi Mariani
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lisa F. Licitra
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milan, Milan, Italy
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Biello F, Audisio M, Genestroni S, Borra G, D'Avanzo F, Lacidogna G, Sponghini AP, Rondonotti D, Forti L, Vignani F, Barone Adesi F, Di Maio M, Sica A, Gennari A. Host metabolic factors and prognosis in patients treated with immune checkpoint inhibitors for advanced malignancies. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e14162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14162 Background: It is well established that an altered host metabolism has an impact on cancer outcome, possibly mediated by several mechanisms, including hyperglicaemia, hyperinsulinemia and presence of chronic inflammation. The aim of our analysis was to evaluate the correlation between host metabolism and clinical outcome in patients with advanced melanoma, kidney and non-small cell lung cancer (NSCLC), treated with immune checkpoint inhibitors (anti-CTLA4, anti PD1 and anti PDL1). Methods: The relationship between presence of type 2 diabetes mellitus (DMII) at baseline and outcome was assessed in 187 patients treated with immune checkpoint inhibitors in two cancer centers. Progression Free Survival (PFS) and Overall Survival (OS) were calculated by Kaplan-Meier estimation; multivariate Cox analysis was performed according to age, gender, BMI (normal < 25 kg/m2, overweight 25-30 kg/m2, obese > 30 kg/m2), type of cancer and line of treatment. Results: One-hundred-sixty-eight patients were available for our analysis. Twenty-eight patients (17%) were diabetic at baseline. Median age was 65 (range 25-80); 83 patients were males (49%); 82 (48%) had advanced melanoma, 83 (49%) NSCLC and 3 (3%) kidney cancer. One-hundred-two (60%) patients had BMI < 25, 51 (30%) were overweight and 16 (10%) were obese. The first line of treatment was immunotherapy in 83 (49%) patients. By univariable analysis median PFS was 4.2 months in non diabetics vs 6.4 in diabetics patients (HR 0.95; 95%CI 0.58-1.58); median OS was 6.17 and 9.1 months, respectively (HR 1.00; 95%CI 0.58-1.75). At multivariable analysis, taking into account DMII, BMI, sex, age, line of treatment and type of cancer, we found that BMI ≤25 was associated with a two fold increase in risk of progression (PD) or death (p = 0.005), whereas patients who received immunotherapy as second or subsequent line had a two fold increase in risk of PD or death (p = 0.003). Conclusions: The results of our analysis show that in patients with advanced cancer treated with immune checkpoint inhibitors, the presence of DMII does not adversely affect the clinical outcome. Conversely, lower BMI was associated with a significantly worse PFS and OS, independently from type of cancer, age and gender. As expected, patients who received immunotherapy in later lines of treatment had a significantly shorter survival.
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Affiliation(s)
- Federica Biello
- Division of Medical Oncology, Maggiore Hospital, Novara, Italy, Novara, Italy
| | - Marco Audisio
- Medical Oncology, Mauriziano Hospital; Department of Oncology, University of Turin, Turin, Italy
| | - Silvia Genestroni
- Division of Medical Oncology, Maggiore Hospital, Novara, Italy, Novara, Italy
| | - Gloria Borra
- Division of Medical Oncology, Maggiore Hospital, Novara, Italy, Novara, Italy
| | - Francesca D'Avanzo
- Division of Medical Oncology, Maggiore Hospital, Novara, Italy, Novara, Italy
| | - Gaetano Lacidogna
- Medical Oncology, Mauriziano Hospital; Department of Oncology, University of Turin, Turin, Italy
| | | | - David Rondonotti
- Division of Medical Oncology, Maggiore Hospital, Novara, Italy, Novara, Italy
| | - Laura Forti
- Division of Medical Oncology, Maggiore Hospital, Novara, Italy, Novara, Italy
| | - Francesca Vignani
- Medical Oncology, Mauriziano Hospital; Department of Oncology, University of Turin, Turin, Italy
| | - Francesco Barone Adesi
- Department of Pharmaceutical Sciences, East Piedmont University, Novara, Italy, Novara, Italy
| | - Massimo Di Maio
- Medical Oncology, Mauriziano Hospital; Department of Oncology, University of Turin, Torino, Italy
| | - Antonio Sica
- Lab of Immuno-Oncology,CAAD, Center fo Autoimmune and Allergic Disease, East Piedmont University, Novara, Italy, Novara, Italy
| | - Alessandra Gennari
- Department of Translational Medicine, East Piedmont University, Novara, Italy, Novara, Italy
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Negru ME, Sponghini AP, Rondonotti D, Platini F, Giavarra M, Forti L, Lombardi M, Masini L, Boldorini R, Galetto A. Primary Ewing's sarcoma of the sinonasal tract, eroding the ethmoid and sphenoid sinus with intracranial extension: A rare case report. Mol Clin Oncol 2015; 3:807-810. [PMID: 26171185 DOI: 10.3892/mco.2015.548] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 03/05/2015] [Indexed: 11/06/2022] Open
Abstract
Ewing's sarcoma (ES) is an aggressive tumour that may present with skeletal and extraskeletal forms. The extraskeletal form is rarely encountered in the head and neck region and is extremely rare in the sinonasal tract. This is the case report of a ES of the ethmoid sinus with intracranial and orbital extension in a 33-year-old male patient who presented with anosmia, epistaxis, reduction of visual acuity in the left eye and headache. On otorhinolaryngological clinical examination and biopsy via flexible endoscope, the lesion was misdiagnosed as ethmoid sinus carcinoma. The subsequent magnetic resonance imaging (MRI) of the brain revealed a large mass (6×7 cm) eroding the ethmoid and sphenoid sinuses, extending beyond the orbits and occupying the anterior cranial fossa with a maximum extension of ~5 cm. The patient underwent surgical resection and the microscopic examination of the specimen established the diagnosis of ES (immunohistochemically positive for CD99, neuron-specific enolase, CD56, synaptophysin, pancytokeratin, low-molecular weight cytokeratins and vimentin. The periodic acid Schiff stain exhibited strong intracytoplasmic block positivity and fluorescence in situ hybridization revealed a t(22;11) translocation. First-line chemotherapy was administered for 3 cycles; however, on restaging MRI, local disease progression was diagnosed. The patient received radiotherapy and second-line chemotherapy for 6 cycles. At 15 months after the diagnosis, the patient remains recurrence-free and maintains a good functional status and quality of life.
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Affiliation(s)
- Maria Emanuela Negru
- Medical Oncology Unit, School of Medicine, University Hospital Maggiore della Carità, I-28100 Novara, Italy
| | - Andrea Pietro Sponghini
- Medical Oncology Unit, School of Medicine, University Hospital Maggiore della Carità, I-28100 Novara, Italy
| | - David Rondonotti
- Medical Oncology Unit, School of Medicine, University Hospital Maggiore della Carità, I-28100 Novara, Italy
| | - Francesca Platini
- Medical Oncology Unit, School of Medicine, University Hospital Maggiore della Carità, I-28100 Novara, Italy
| | - Marco Giavarra
- Medical Oncology Unit, School of Medicine, University Hospital Maggiore della Carità, I-28100 Novara, Italy
| | - Laura Forti
- Medical Oncology Unit, School of Medicine, University Hospital Maggiore della Carità, I-28100 Novara, Italy
| | - Mariangela Lombardi
- Radiodiagnostic and Interventional Radiology Institute, School of Medicine, University Hospital Maggiore della Carità, I-28100 Novara, Italy
| | - Laura Masini
- Department of Radiotherapy, School of Medicine, University Hospital Maggiore della Carità, I-28100 Novara, Italy
| | - Renzo Boldorini
- Department of Health Sciences, School of Medicine, University Hospital Maggiore della Carità, I-28100 Novara, Italy
| | - Alessandra Galetto
- Medical Oncology Unit, School of Medicine, University Hospital Maggiore della Carità, I-28100 Novara, Italy
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