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Wekking D, Porcu M, Pellegrino B, Lai E, Mura G, Denaro N, Saba L, Musolino A, Scartozzi M, Solinas C. Multidisciplinary clinical guidelines in proactive monitoring, early diagnosis, and effective management of trastuzumab deruxtecan (T-DXd)-induced interstitial lung disease (ILD) in breast cancer patients. ESMO Open 2023; 8:102043. [PMID: 37951130 PMCID: PMC10679891 DOI: 10.1016/j.esmoop.2023.102043] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 06/05/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 11/13/2023] Open
Abstract
Trastuzumab deruxtecan (T-DXd), a human epidermal growth factor receptor 2 (HER2)-directed antibody-drug conjugate (ADC), has altered the treatment landscape in breast cancer (BC), irrespective of the HR-receptor status. The use of the agent is increasing, despite the finding that exposure to T-DXd increases the risk of interstitial lung disease (ILD), particularly in BC patients. Although T-DXd-related ILD can be potentially severe and life-threatening, most low-grade cases can be treated safely using a multidisciplinary approach comprising early and accurate diagnosis, effective management, close monitoring, and the prompt administration of steroids. Additionally, increasing patients' education on ILD symptoms ensures close attention and enables prompt reporting, enhancing patient outcomes. It is recommended that predictive biomarkers are assessed in patients with risk factors for developing ILD. Currently, diagnostic criteria comprise newly identified pulmonary opacities, the relation of symptom onset to medication initiation, and the exclusion of other causes of ILD. The general condition of patients is weakened during the management of ILD (BC progression and corticosteroid treatment). Consequently, BC chemotherapy might be attenuated. This highlights the importance of preventing (high-grade) ILD, especially since its use is expanded. Identifying high-risk patients, diagnosing, and customizing treatment is, however, challenging and additional information on patient selection is often not fully clarified. In this paper, we provide updated multidisciplinary clinical guidance for patient selection, proactive monitoring, early diagnosis, and effectively management of T-DXd-induced ILD in HER2-positive BC patients. We describe the risk factors for developing ILD, patients' characteristics of ILD, and the histopathological and radiographic characteristics of ILD, including real-world clinical practice reports. These recommendations provide a structured step-by-step approach for managing each suspected BC-related ILD grade.
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Affiliation(s)
- D Wekking
- Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | - M Porcu
- Radiology Department, AOU Cagliari, Cagliari University, Policlinico di Monserrato, Monserrato (CA)
| | - B Pellegrino
- Department of Medicine and Surgery, University of Parma, Parma; Medical Oncology and Breast Unit, University Hospital of Parma, Parma; Gruppo Oncologico Italiano di Ricerca Clinica(GOIRC), Parma
| | - E Lai
- Medical Oncology, AOU Cagliari, Policlinico di Monserrato, Monserrato
| | - G Mura
- Anatomical Pathology, Valdes Laboratory, Cagliari
| | - N Denaro
- IRCCS Fondazone Ca' Granda Policlinico Milano, SC Oncologia, Milan, Italy
| | - L Saba
- Radiology Department, AOU Cagliari, Cagliari University, Policlinico di Monserrato, Monserrato (CA)
| | - A Musolino
- Department of Medicine and Surgery, University of Parma, Parma; Medical Oncology and Breast Unit, University Hospital of Parma, Parma; Gruppo Oncologico Italiano di Ricerca Clinica(GOIRC), Parma
| | - M Scartozzi
- Medical Oncology, AOU Cagliari, Policlinico di Monserrato, Monserrato
| | - C Solinas
- Medical Oncology, AOU Cagliari, Policlinico di Monserrato, Monserrato
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Trevisan B, Pepe FF, Vallini I, Montagna E, Amoroso D, Berardi R, Butera A, Cagossi K, Cavanna L, Ciccarese M, Cinieri S, Cretella E, De Conciliis E, Febbraro A, Ferraù F, Ferzi A, Baldelli A, Fontana A, Gambaro AR, Garrone O, Gebbia V, Generali D, Gianni L, Giovanardi F, Grassadonia A, Leonardi V, Sarti S, Musolino A, Nicolini M, Putzu C, Riccardi F, Santini D, Sarobba MG, Schintu MG, Scognamiglio G, Spadaro P, Taverniti C, Toniolo D, Tralongo P, Turletti A, Valenza R, Valerio MR, Vici P, Clivio L, Torri V, Cazzaniga ME. Final results of the real-life observational VICTOR-6 study on metronomic chemotherapy in elderly metastatic breast cancer (MBC) patients. Sci Rep 2023; 13:12255. [PMID: 37507480 PMCID: PMC10382472 DOI: 10.1038/s41598-023-39386-x] [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] [Received: 04/06/2023] [Accepted: 07/25/2023] [Indexed: 07/30/2023] Open
Abstract
Nowadays, treatment of metastatic breast cancer (MBC) has been enriched with novel therapeutical strategies. Metronomic chemotherapy (mCHT) is a continuous and frequent administration of chemotherapy at a lower dose and so whit less toxicity. Thus, this strategy could be attractive for elderly MBC patients. Aim of this analysis is to provide insights into mCHT's activity in a real-life setting of elderly MBC patients. Data of patients ≥ 75 years old included in VICTOR-6 study were analyzed. VICTOR-6 is a multicentre, Italian, retrospective study, which collected data on mCHT in MBC patients treated between 2011 and 2016. A total of 112 patients were included. At the beginning of mCHT, median age was 81 years (75-98) and in 33% of the patients mCHT was the first line choice. Overall Response Rate (ORR) and Disease Control Rate (DCR) were 27.9% and 79.3%, respectively. Median PFS ranged between 7.6 and 9.1 months, OS between 14.1 and 18.5 months. The most relevant toxicity was the hematological one (24.1%); severe toxicity (grade 3-4) ranged from 0.9% for skin toxicity up to 8% for hematologic one. This is a large study about mCHT in elderly MBC patients, providing insights to be further investigated in this subgroup of frail patients.
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Affiliation(s)
- B Trevisan
- Azienda Ospedaliera San Gerardo, Monza, Italy
| | - F F Pepe
- Azienda Ospedaliera San Gerardo, Monza, Italy
| | - I Vallini
- Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - E Montagna
- European Institute of Oncology, Milan, Italy
| | | | - R Berardi
- Azienda Ospedaliera Universitaria Ospedali Riuniti, Torrette, Italy
| | - A Butera
- Nuovo Ospedale San Giovanni Di Dio, Florence, Italy
| | | | - L Cavanna
- Azienda Ospedaliera Piacenza, Piacenza, Italy
| | | | - S Cinieri
- Ospedale A. Perrino, Brindisi, Italy
| | | | | | - A Febbraro
- Ospedale S. Cuore di Gesù Fatebenefratelli, Benevento, Italy
| | - F Ferraù
- Ospedale San Vincenzo, Taormina, Italy
| | - A Ferzi
- Azienda Ospedaliera Ospedale Civile Di Legnano, Magenta, Italy
| | | | - A Fontana
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - O Garrone
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - V Gebbia
- Ospedale La Maddalena, Palermo, Italy
| | - D Generali
- Istituti Ospitalieri Cremona, Cremona, Italy
| | | | | | | | | | - S Sarti
- IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | | | | | - C Putzu
- Azienda Ospedaliera-Universitaria, Sassari, Italy
| | - F Riccardi
- Ospedale Antonio Cardarelli, Naples, Italy
| | - D Santini
- Università Campus Bio-Medico, RomE, Italy
| | | | | | | | - P Spadaro
- Casa di Cura Villa Salus-Messina, Messina, Italy
| | | | | | | | | | | | - M R Valerio
- A.O.U. Policlinico Paolo Giaccone, Palermo, Italy
| | - P Vici
- INT Regina Elena, Rome, Italy
| | - L Clivio
- IRCCS Mario Negri Institute of Pharmacological Research, Milan, Italy
| | - V Torri
- IRCCS Mario Negri Institute of Pharmacological Research, Milan, Italy
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3
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Cortesi L, Venturelli M, Cortesi G, Caggia F, Toss A, Barbieri E, De Giorgi U, Guarneri V, Musolino A, De Matteis E, Zambelli A, Bisagni G, Dominici M. A phase II study of pembrolizumab plus carboplatin in BRCA-related metastatic breast cancer (PEMBRACA). ESMO Open 2023; 8:101207. [PMID: 37028000 PMCID: PMC10163155 DOI: 10.1016/j.esmoop.2023.101207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND BRCA1/2-related metastatic breast cancers (mBC) are sensitive to DNA-damage agents and show high tumor-infiltrated lymphocytes. We hypothesized that the association between pembrolizumab and carboplatin could be active in BRCA-related mBC. PATIENTS AND METHODS In this phase II Simon's design multicenter single-arm study, BRCA1/2-related mBC patients received carboplatin at area under the curve 6 every 3 weeks for six courses associated with 200 mg pembrolizumab every 3 weeks until disease progression or unacceptable toxicity. The primary aim at first stage was overall response rate (ORR) ≥70%. Disease control rate (DCR), time to progression (TTP), duration of response (DOR), and overall survival (OS) were the secondary aims. RESULTS Among 22 patients enrolled at the first stage, 5 BRCA1 and 17 BRCA2, 16 (76%) were luminal tumors and 6 (24%) triple-negative BC (TNBC). In 21 patients, ORR and DCR were 43% and 76% (47% and 87% in luminal, 33% and 50% in TNBC), respectively. TTP was 7.1 months, DOR was 6.3 months, and median OS was not reached. Grade ≥3 adverse events (AEs) or serious AEs occurred in 5/22 patients (22.7%). Since the primary aim was not met, the study was terminated at the first stage. CONCLUSIONS Although the primary aim was not reached, data on efficacy and safety of pembrolizumab plus carboplatin in first-line visceral disease BRCA-related luminal mBC were provided and they need to be further investigated.
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Affiliation(s)
- L Cortesi
- Department of Oncology and Haematology, University Hospital Modena, Modena.
| | - M Venturelli
- Department of Oncology and Haematology, University Hospital Modena, Modena
| | - G Cortesi
- Department of Oncology and Haematology, University Hospital Modena, Modena
| | - F Caggia
- Department of Oncology and Haematology, University Hospital Modena, Modena
| | - A Toss
- Department of Oncology and Haematology, University Hospital Modena, Modena
| | - E Barbieri
- Department of Oncology and Haematology, University Hospital Modena, Modena
| | - U De Giorgi
- Department of Medical Oncology, "Dino Amadori Scientific Institute of Romagna for the Study of Cancer", Meldola
| | - V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova; Division of Oncology, Istituto Oncologico Veneto IRCCS, Padova
| | - A Musolino
- Department of Medicine and Surgery, University of Parma, Parma; Medical Oncology, Breast Unit and Cancer Genetics Service, University Hospital of Parma, Parma
| | | | - A Zambelli
- Papa Giovanni XXIII Cancer Center Hospital, Bergamo
| | - G Bisagni
- Oncology Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Dominici
- Department of Oncology and Haematology, University Hospital Modena, Modena
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Banzola S, Corsaro A, Capitani S, Vesco S, Dodi L, Serra O, Piazza N, Onesti S, Salvati MA, Musolino A. Breast cancer screening adhesion among migrants: a matter of communication strategy? Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.174] [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: 11/12/2022] Open
Abstract
Abstract
Background
Migrants’ engagement to cancer screening programs is a relevant issue for universalistic health systems. To increase breast cancer screening coverage among migrant women, a public-private partnership involving a multidisciplinary team of Primary Care, Public Health, Hospital and private social workers has been built up in a district in Italy. The team worked in two steps, planning health promotion (HP) meetings addressing women in refugees’ reception programs and a web-based workshop involving intercultural mediators (IMs) and community health promoters.
Objectives
The workshop, involving 10 professionals among IMs and community health promoters, realized in 3 online meetings during March ‘22, aimed at identifying communication tools to enable migrants’ participation to breast cancer screening and increasing health literacy (HL) and cultural competence (CC) among the team. A participatory approach, supported by learning methods, such as storytelling and role-play, has been adopted to identify the major barriers to access to screening and public health messages. Participants worked on critical words and concepts, highlighted during HP meetings, accounting for HL, literacy, language skills, communication techniques and different perspectives about health and prevention.
Results
Several barriers, such as lack of knowledge on preventive initiatives and different approaches to health, decrease the perception of cancer risk. Others, like family and work duties, influence the adhesion. Fear or shame about the exam and linguistic issues are further hampering factors. Participants pointed out text, audio and video messages, in Italian and native plain language, as useful tools to explain the screening procedure and give relevant and practical information supported by simple and clear illustrations to diffuse via WhatsApp.
Conclusions
The intervention enabled the team to improve HL and CC defining suitable communication strategies for cancer screening programs.
Key messages
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Affiliation(s)
- S Banzola
- Migrant Health Unit, Spazio Salute Immigrati, Local Health Unit , Parma, Italy
| | - A Corsaro
- Public Health Department, Local Health Unit , Parma, Italy
| | - S Capitani
- Press and Communication Office, University Hospital , Parma, Italy
| | - S Vesco
- Social Health Unit, Center for Immigration Asylum and Cooperation, CIAC Onlus , Parma, Italy
| | - L Dodi
- Healthcare Management Direction, Local Health Unit , Parma, Italy
| | - O Serra
- Breast Unit, University Hospital and Local Health Unit , Parma, Italy
| | - N Piazza
- Breast Unit, University Hospital and Local Health Unit , Parma, Italy
| | - S Onesti
- Breast Unit, University Hospital and Local Health Unit , Parma, Italy
| | - MA Salvati
- Cervical Screening Center, UOC Salute Donna, Local Health Unit , Parma, Italy
| | - A Musolino
- Breast Unit, University Hospital and Local Health Unit , Parma, Italy
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5
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Capoluongo ED, Pellegrino B, Arenare L, Califano D, Scambia G, Beltrame L, Serra V, Scaglione GL, Spina A, Cecere SC, De Cecio R, Normanno N, Colombo N, Lorusso D, Russo D, Nardelli C, D'Incalci M, Llop-Guevara A, Pisano C, Baldassarre G, Mezzanzanica D, Artioli G, Setaro M, Tasca G, Roma C, Campanini N, Cinieri S, Sergi A, Musolino A, Perrone F, Chiodini P, Marchini S, Pignata S. Alternative academic approaches for testing homologous recombination deficiency in ovarian cancer in the MITO16A/MaNGO-OV2 trial. ESMO Open 2022; 7:100585. [PMID: 36156447 PMCID: PMC9512829 DOI: 10.1016/j.esmoop.2022.100585] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/28/2022] [Accepted: 08/16/2022] [Indexed: 11/26/2022] Open
Abstract
Background The detection of homologous recombination deficiency (HRD) can identify patients who are more responsive to platinum and poly ADP ribose polymerase inhibitors (PARPi). MyChoice CDx (Myriad) is the most used HRD test in ovarian cancer (OC). However, some limitations of commercial tests exist, because of the high rate of inconclusive results, costs, and the impossibility of evaluating functional resistance mechanisms. Patients and methods Two academic genomic tests and a functional assay, the RAD51 foci, were evaluated to detect HRD. One hundred patients with high-grade OC enrolled in the MITO16A/MaNGO-OV2 trial and treated with first-line therapy with carboplatin, paclitaxel, and bevacizumab were analyzed. Results The failure rate of the two genomic assays was 2%. The sensitivity in detecting HRD when compared with Myriad was 98.1% and 90.6%, respectively. The agreement rate with Myriad was 0.92 and 0.87, with a Cohen’s κ coefficient corresponding to 0.84 and 0.74, respectively. For the RAD51 foci assay, the failure rate was 30%. When the test was successful, discordant results for deficient and proficient tumors were observed, and additional HRD patients were identified compared to Myriad; sensitivity was 82.9%, agreement rate was 0.65, and Cohen’s κ coefficient was 0.18. The HRD detected by genomic assays and residual tumor at primary surgery and stage was correlated with progression-free survival at multivariate analysis. Conclusions Results suggest the feasibility of academic tests for assessing HRD status that show robust concordance with Myriad and correlation with clinical outcome. The contribution of the functional information related to the RAD51 foci test to the genomic data needs further investigation. Deficiency in homologous recombination repair of DNA generates genomic instability and permanent genomic changes. HRD status is fundamental for identifying OC patients suitable for platinum and PARPi treatment. HRD testing is considered a topic with urgent need for improvement, going beyond those available commercially. Within this study, two academic genomic tests and a functional assay, the RAD51 foci, were evaluated to detect HRD. Our tests compare favorably with the reference Myriad assay and correlate with the outcome of high-grade OC patients.
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Affiliation(s)
- E D Capoluongo
- Department of Molecular Medicine and Medical Biotechnology, Università degli Studi di Napoli Federico II, Naples; Azienda Ospedaliera per L'Emergenza, Cannizzaro, Catania
| | - B Pellegrino
- Department of Medicine and Surgery, University of Parma, Parma; Medical Oncology and Breast Unit, University Hospital of Parma, Parma; Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma
| | - L Arenare
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples
| | - D Califano
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS - Fondazione G. Pascale, Naples
| | - G Scambia
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome; Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome
| | - L Beltrame
- Molecular Pharmacology laboratory., Group of Cancer Pharmacology IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - V Serra
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - G L Scaglione
- Advanced Biotechnology, Università Federico II-CEINGE, Naples; IDI-IRCSS, Rome
| | - A Spina
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS - Fondazione G. Pascale, Naples
| | - S C Cecere
- Uro-Gynecologic Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples
| | - R De Cecio
- Pathology Unit, Istituto Nazionale Tumori 'Fondazione Giovanni Pascale', IRCCS, Napoli
| | - N Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori 'Fondazione Giovanni Pascale', IRCCS, Napoli
| | - N Colombo
- University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan
| | - D Lorusso
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome; Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome
| | - D Russo
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS - Fondazione G. Pascale, Naples
| | - C Nardelli
- Department of Molecular Medicine and Medical Biotechnology, Università degli Studi di Napoli Federico II, Naples; Advanced Biotechnology, Università Federico II-CEINGE, Naples
| | - M D'Incalci
- Molecular Pharmacology laboratory., Group of Cancer Pharmacology IRCCS Humanitas Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan
| | | | - C Pisano
- Uro-Gynecologic Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples
| | - G Baldassarre
- Molecular Oncology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, National Cancer Institute, Aviano
| | - D Mezzanzanica
- Molecular Therapies Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - G Artioli
- Oncologia Medica, ULSS2 Marca Trevigiana, Treviso
| | - M Setaro
- Advanced Biotechnology, Università Federico II-CEINGE, Naples
| | - G Tasca
- Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padova
| | - C Roma
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori 'Fondazione Giovanni Pascale', IRCCS, Napoli
| | - N Campanini
- Unit of Pathological Anatomy, Department of Medicine and Surgery, University Hospital of Parma, Parma
| | - S Cinieri
- Oncologia Medica, Ospedale Senatore Antonio Perrino, Brindisi
| | - A Sergi
- Molecular Pharmacology laboratory., Group of Cancer Pharmacology IRCCS Humanitas Research Hospital, Rozzano, Italy; Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan
| | - A Musolino
- Department of Medicine and Surgery, University of Parma, Parma; Medical Oncology and Breast Unit, University Hospital of Parma, Parma; Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma
| | - F Perrone
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples
| | - P Chiodini
- Department of Mental Health and Public Medicine, Section of Statistics, Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
| | - S Marchini
- Molecular Pharmacology laboratory., Group of Cancer Pharmacology IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - S Pignata
- Uro-Gynecologic Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples.
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Pellegrino B, Llop-Guevara A, Solinas C, Campanini N, Tommasi C, Michiara M, Boggiani D, Sikokis A, Frassoldati A, Casarini C, Cretella E, Zoppoli G, Lambertini M, Dieci M, Cortesi L, Silini E, Balmaña J, Willard-Gallo K, Serra V, Musolino A. 146P HRD/TIL-low high-risk breast cancer is characterized by good prognosis (the RADIMMUNE trial). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Buonsenso D, De Rose C, Ferro V, Morello R, Musolino A, Valentini P. Lung ultrasound to detect cardiopulmonary interactions in acutely ill children. Pediatr Pulmonol 2022; 57:483-497. [PMID: 34761881 DOI: 10.1002/ppul.25755] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/28/2021] [Accepted: 10/28/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE AND DESIGN Our prospective observational study is the first study that evaluates the lung ultrasound (LUS) findings of cardiopulmonary interactions in acutely ill children with elevated pro-brain natriuretic peptide (BNP) levels, with the aim of establishing the specific LUS pattern in this category of patients without primary lung diseases. METHODOLOGY We prospectively analyzed epidemiological, clinical, laboratory, instrumental, and lung ultrasound parameters in acutely ill children aged 1 month to 18 years admitted to the Department of Pediatrics between March 2020 to August 2020. Among the acutely ill patients evaluated, only patients with pro-BNP > 300 pg/ml and who underwent LUS before the start of any treatment were included. They were stratified into three subcategories based on the diagnosis (A) cardiac disease, (B) systemic inflammatory disease/sepsis without functional and/or organic alterations of the myocardium, and (C) systemic inflammatory disease/sepsis and cardiac disease, and were classified into two groups based on the level of pro-BNP. We also enrolled patients belonging to two other categories (patients with primary infectious lung disease and completely healthy patients) analyzing their epidemiological, clinical, laboratory, instrumental parameters, and lung ultrasound findings and comparing them with those of acutely ill children. RESULTS AND CONCLUSION We found that LUS findings in these acutely ill children are different from the ultrasound pattern of other categories of children and in particular (1) children with acute lower respiratory tract infections and (2) healthy infants. The finding in a child of a sonographic interstitial syndrome with multiple, bright, long, separate, and nonconfluent B-lines/long vertical artifacts deriving from a normal and regular pleural line, in the absence of subpleural consolidations, is strongly predictive of cardiogenic pulmonary edema or pulmonary congestion in the course of systemic inflammatory disease/sepsis.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy.,Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Valentina Ferro
- Department of Pediatric Emergency Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Annamaria Musolino
- Department of Pediatric Emergency Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
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8
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Moscetti L, Sperduti I, Frassoldati A, Musolino A, Nasso C, Toss A, Omarini C, Dominici M, Piacentini F. Quality of life of therapies for hormone receptor positive advanced/metastatic breast cancer: Regulatory aspects and clinical impact in Europe. Breast 2021; 59:232-238. [PMID: 34304064 PMCID: PMC8327134 DOI: 10.1016/j.breast.2021.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 11/22/2022] Open
Abstract
In recent years, the number of trials incorporating health-related quality of life (HRQoL) data has increased. The impact of HRQoL on regulatory decision making in the European context and on clinical practice is not well established. We conducted an analysis of the role of QoL data extracted from the clinical trials of the drugs approved for hormone receptor positive/HER2-negative advanced/metastatic breast cancer (mBC). The results from the HRQoL were collected and a meta-analysis was performed to evaluate the impact of experimental drugs compared to standard treatments. The results showed a non-detrimental effect in HRQoL from the new treatments. As regards the approval process, from an examination of the European Medicine Agency (EMA) documents, HRQoL was reported nonextensively and contained and discussed in the European assessment reports (EPARs) for eleven trials in the approval process and cited in three cases in the EPARs and summary of medicinal product characteristics (SmPC). An effort should be made by all the stakeholders to increase the visibility of the HRQoL results in order to allow increased consideration in the approval process to make QoL data more easily and visibly available for the clinician and the patients. The evaluation should be reflected in the SmPC in order to increase the amount of information provided to the physician.
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Affiliation(s)
- L Moscetti
- Department of Oncology-Hematology, University Hospital of Modena, Modena, Italy; Gruppo Oncologico Italiano per la Ricerca Clinica (GOIRC), Italy.
| | - I Sperduti
- Department of Bio-Statistics, RCCS Regina Elena National Cancer Institute, Italy
| | - A Frassoldati
- Department of Oncology, Ospedale Sant'Anna di Cona, Ferrara, Italy; Gruppo Oncologico Italiano per la Ricerca Clinica (GOIRC), Italy
| | - A Musolino
- Medical Oncology and Breast Unit, University Hospital of Parma, Department of Medicine and Surgery, University of Parma, Parma, Italy; Gruppo Oncologico Italiano per la Ricerca Clinica (GOIRC), Italy
| | - C Nasso
- Department of Oncology-Hematology, University Hospital of Modena, Modena, Italy; Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena, Italy
| | - A Toss
- Department of Oncology-Hematology, University Hospital of Modena, Modena, Italy; Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena, Italy
| | - C Omarini
- Department of Oncology-Hematology, University Hospital of Modena, Modena, Italy; Gruppo Oncologico Italiano per la Ricerca Clinica (GOIRC), Italy
| | - M Dominici
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena, Italy
| | - F Piacentini
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena, Italy; Gruppo Oncologico Italiano per la Ricerca Clinica (GOIRC), Italy
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9
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Cazzaniga ME, Vallini I, Montagna E, Amoroso D, Berardi R, Butera A, Cagossi K, Cavanna L, Ciccarese M, Cinieri S, Cretella E, De Conciliis E, Febbraro A, Ferraù F, Ferzi A, Baldelli A, Fontana A, Gambaro AR, Garrone O, Gebbia V, Generali D, Gianni L, Giovanardi F, Grassadonia A, Leonardi V, Marchetti P, Sarti S, Musolino A, Nicolini M, Putzu C, Riccardi F, Santini D, Saracchini S, Sarobba MG, Schintu MG, Scognamiglio G, Spadaro P, Taverniti C, Toniolo D, Tralongo P, Turletti A, Valenza R, Valerio MR, Vici P, Di Mauro P, Cogliati V, Capici S, Clivio L, Torri V. Metronomic chemotherapy (mCHT) in metastatic triple-negative breast cancer (TNBC) patients: results of the VICTOR-6 study. Breast Cancer Res Treat 2021; 190:415-424. [PMID: 34546500 PMCID: PMC8558172 DOI: 10.1007/s10549-021-06375-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
Purpose Triple-negative breast cancer (TNBC) represents a subtype of breast cancer which lacks the expression of oestrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER2): TNBC accounts for approximately 20% of newly diagnosed breast cancers and is associated with younger age at diagnosis, greater recurrence risk and shorter survival time. Therapeutic options are very scarce. Aim of the present analysis is to provide further insights into the clinical activity of metronomic chemotherapy (mCHT), in a real-life setting. Methods We used data included in the VICTOR-6 study for the present analysis. VICTOR-6 is an Italian multicentre retrospective cohort study, which collected data of metastatic breast cancer (MBC) patients who have received mCHT between 2011 and 2016. Amongst the 584 patients included in the study, 97 were triple negative. In 40.2% of the TNBC patients, mCHT was the first chemotherapy treatment, whereas 32.9% had received 2 or more lines of treatment for the metastatic disease. 45.4% out of 97 TNBC patients received a vinorelbine (VRL)-based regimen, which resulted in the most used type of mCHT, followed by cyclophosphamide (CTX)-based regimens (30.9%) and capecitabine (CAPE)-based combinations (22.7%). Results Overall response rate (ORR) and disease control rate (DCR) were 17.5% and 64.9%, respectively. Median progression free survival (PFS) and overall survival (OS) were 6.0 months (95% CI: 4.9–7.2) and 12.1 months (95% CI: 9.6–16.7). Median PFS was 6.9 months for CAPE-based regimens (95% CI: 5.0–18.4), 6.1 months (95% CI: 4.0–8.9) for CTX-based and 5.3 months (95% CI: 4.1–9.5) for VRL-based ones. Median OS was 18.2 months (95% CI: 9.1-NE) for CAPE-based regimens and 11.8 months for VRL- (95% CI: 9.3–16.7 and CTX-based ones (95%CI: 8.7–52.8). Tumour response, PFS and OS decreased proportionally in later lines. Conclusion This analysis represents the largest series of TNBC patients treated with mCHT in a real-life setting and provides further insights into the advantages of using this strategy even in this poor prognosis subpopulation.
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Affiliation(s)
- M E Cazzaniga
- Phase 1 Research Centre and Oncology Unit, Department of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Via Pergolesi 33, 20900, Monza, MB, Italy.
- Oncology Unit, ASST Monza, Monza, MB, Italy.
| | - I Vallini
- Medical Oncology, ASST Sette Laghi Ospedale Di Circolo E Fondazione Macchi, Varese, VA, Italy
| | - E Montagna
- Medical Senology Division, IEO, Milan, Italy
| | - D Amoroso
- Medical Oncology, Ospedale Versilia, ATNO, Lido Di Camaiore, LU, Italy
| | - R Berardi
- Medical Oncology, Università Politecnica Delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - A Butera
- Medical Oncology, Ospedale San Giovanni Di Dio, Agrigento, Italy
| | - K Cagossi
- Medical Oncology, Ospedale Ramazzini, Carpi, Italy
| | - L Cavanna
- Medical Oncology, Azienda Ospedaliera Piacenza, Piacenza, Italy
| | - M Ciccarese
- Medical Oncology, Ospedale Vito Fazzi, Lecce, Italy
| | - S Cinieri
- Medical Oncology, ASL Brindisi, Brindisi, Italy
| | - E Cretella
- Medical Oncology, Ospedale Bolzano, Bolzano, Italy
| | | | - A Febbraro
- Medical Oncology, Ospedale S. Cuore di Gesù Fatebenefratelli, Benevento, Italy
| | - F Ferraù
- Medical Oncology, Osp Taormina, Taormina, Italy
| | - A Ferzi
- Medical Oncology, A.S.S.T. Ovest Milanese Legnano, Legnano, Italy
| | - A Baldelli
- Medical Oncology, Ospedale San Salvatore, Pesaro, Italy
| | - A Fontana
- Medical Oncology 2, Az. Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - A R Gambaro
- Medical Oncology, ASST Fatebenefratelli Sacco, Milano, Italy
| | - O Garrone
- Breast Unit Medical Oncology, A.O. S. Croce e Carle, Cuneo, Italy
| | - V Gebbia
- Medical Oncology, Ospedale La Maddalena, Palermo, Italy
| | - D Generali
- Medical Oncology, Istituti Ospitalieri Cremona, Cremona, Italy
| | - L Gianni
- Medical Oncology, Azienda USL Romagna, U.O. di Oncologia Rimini, Cattolica, Italy
| | - F Giovanardi
- AUSL IRCCS Reggio Emilia Provincial Oncology Unit, Reggio Emilia, Italy
| | - A Grassadonia
- Medical Oncology, P.O. SS Annunziata -ASL2 Lanciano-Vasto, Chieti, Italy
| | - V Leonardi
- Medical Oncology, Ospedale Civico, Palermo, Italy
| | - P Marchetti
- Medical Oncology, A.O. Sant'Andrea, Roma, Italy
| | - S Sarti
- IRCCS Istituto Romagnolo per lo studio dei Tumori (IRST) "Dino Amadori", 47014, Meldola, Italy
| | - A Musolino
- Department of Medicine and Surgery, Medical Oncology and Breast Unit, University of Parma and University Hospital of Parma, Parma, Italy
| | - M Nicolini
- Medical Oncology, Azienda USL Romagna, U.O. di Oncologia Rimini, Cattolica, Italy
| | - C Putzu
- Medical Oncology, A. Ospedaliera-Universitaria, Sassari, Italy
| | - F Riccardi
- Medical Oncology, A. Ospedaliera Antonio Cardarelli, Napoli, Italy
| | - D Santini
- Medical Oncology, Università Campus Bio-Medico, Roma, Italy
| | - S Saracchini
- Medical Oncology, Az. Osp. Santa Maria degli Angeli, Pordenone, Italy
| | - M G Sarobba
- Medical Oncology, Ospedale San Francesco, Nuoro, Italy
| | - M G Schintu
- Medical Oncology, Osp Giovanni Paolo II, Olbia, Italy
| | | | - P Spadaro
- Medical Oncology, Casa di Cura Villa Salus-Messina, Messina, Italy
| | - C Taverniti
- Medical Oncology, A.O.U. Città della Salute e della Scienza, Osp. Molinette, Torino, Italy
| | - D Toniolo
- Medical Oncology, ASST Rhodense, Ospedale di Circolo Rho, Rho, Italy
| | - P Tralongo
- Medical Oncology, Osp. Umberto I, Siracusa, Italy
| | - A Turletti
- Medical Oncology, P.O. Martini, Torino, Italy
| | - R Valenza
- Medical Oncology, P.O. Vittorio Emanuele, Gela, Italy
| | - M R Valerio
- Department of Discipline Chirurgiche, Oncologiche e Stomatologiche (DICHIRONS), Medical Oncology, A.O.U. Policlinico Paolo Giaccone, Palermo, Italy
| | - P Vici
- Phase IV trials, IRCCS, INT Regina Elena, Rome, Italy
| | - P Di Mauro
- Oncology Unit, ASST Monza, Monza, MB, Italy
| | - V Cogliati
- Phase 1 Research Centre and Oncology Unit, Department of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - S Capici
- Phase 1 Research Centre and Oncology Unit, Department of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - L Clivio
- Oncology Department, IRCCS Mario Negri Institute, Milan, Italy
| | - V Torri
- Oncology Department, IRCCS Mario Negri Institute, Milan, Italy
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10
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Musolino A, Pellegrino B, Isella L, Tommasi C, Pucci F, Leonetti A, Rapacchi E, Leonardi F, Bizzoco S, Affanni P, Veronesi L, Sgargi P, Maglietta G, Michiara M. 1587P SARS-CoV-2 infection risk and COVID-19 prevalence in cancer patients during the first wave of COVID-19 pandemic in a Northern Italy’s virus epicenter area. Ann Oncol 2021. [PMCID: PMC8454340 DOI: 10.1016/j.annonc.2021.08.1580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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11
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Dieci M, Griguolo G, Bisagni G, Musolino A, Spazzapan S, Moretti G, Schiavi F, Pinato C, Vernaci G, Giarratano T, Urso L, Tosi A, Magni G, Lo Mele M, De Salvo G, Rosato A, Guarneri V, Conte P. 129P Integration of gene expression and tumor-infiltrating lymphocytes (TILs) to predict pCR after neoadjuvant chemotherapy and nivolumab for patients with luminal B-like breast cancer in the phase II GIADA trial. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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12
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Raucci U, Boni A, Foligno S, Valfrè L, Bagolan P, Schingo PS, Della Vecchia N, Reale A, Villani A, Musolino A. Late congenital diaphragmatic hernia: is a significant challenge? A case series and review from literature. Minerva Pediatr (Torino) 2021:S2724-5276.21.06329-1. [PMID: 34152116 DOI: 10.23736/s2724-5276.21.06329-1] [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: 11/08/2022]
Abstract
BACKGROUND Late-presenting congenital diaphragmatic hernia (L-CDH) diagnosis is a challenge for its clinical various presentation. In literature radiologic misdiagnosis is up to 62%. The aim of this study is analyze clinical findings about our cases series in a particular setting of Pediatric Emergency Department (PED) and review of literature. METHODS We retrospectively analyzed the medical records of children older than 1 month, operated for L-CDH from November 2009 to December 2019 presented to PED, with a total of 20 children (5 Morgagni and 15 Bochdaleck). RESULTS The median age at diagnosis was 1,48 years. 50% patients had a history of previouses symtptoms with a mean duration of 243,75 days. In 30 % of cases associated anomalies were presented, mainly cardiovascular. 25% of patients had undergone to chest X-ray in past history with misdiagnosis of pneumonia, microganulia and broncovascular thickening. Misdiagnosis are manly among left sided Bochdaleck hernia. Respiratory distress alone or associated with vomiting is commonest acute symptom refered to PED. Respiratory symptoms were more common in younger children, while gastrointestinal ones in older children (not statistically differences p=0,8769). Post-operative recurrence were frequent only in cases of right sided CDH and comparing with left ones, there is a difference statistically significant (p=0.0476). CONCLUSIONS L-CDH should be suspected in cases of unexplained acute respiratory distress and vomiting, particulary when children are affected to associate cardiovascular malformation. In cases of patients with long previouses symptoms and various accesses to PED is important to emphasize history of respiratory distress, dysphagia and failure to thrive and should be considered a chest X-ray.
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Affiliation(s)
- Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy -
| | - Alessandra Boni
- Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Silvia Foligno
- University Hospital Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Tor Vergata University, Rome, Italy
| | - Laura Valfrè
- Department of Medical and Surgical Neonatology, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Piero Bagolan
- Department of Medical and Surgical Neonatology, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Paolo S Schingo
- Departments of Radiology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Antonino Reale
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Annamaria Musolino
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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13
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Mattioli V, Crocetti E, Dal Maso L, Buzzoni C, Franceschi S, Serraino D, Vaccarella S, Ferretti S, Busco S, Fedeli U, Varvarà M, Falcini F, Zorzi M, Carrozzi G, Mazzucco W, Gasparotti C, Iacovacci S, Toffolutti F, Cavallo R, Stracci F, Russo AG, Caldarella A, Rosso S, Musolino A, Mangone L, Casella C, Fusco M, Tagliabue G, Piras D, Tumino R, Guarda L, Dinaro YM, Piffer S, Pinna P, Mazzoleni G, Fanetti AC. RISK OF HEMOLYMPHOPOIETIC NEOPLASM BEFORE AND AFTER THYROID CANCER. A POPULATION‐BASED STUDY IN ITALY, 1998‐2012. Hematol Oncol 2021. [DOI: 10.1002/hon.104_2881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | | | | | | | - S. Vaccarella
- International Agency for Research on Cancer Section of Cancer Surveillance Lyon France
| | - S. Ferretti
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori" Meldola, Italy‐Azienda Usl della Romagna, Romagna Cancer Registry Forlì Italy
| | - S. Busco
- ASL Latina Cancer Registry of Latina Province Latina Italy
| | - U. Fedeli
- Azienda Zero Epidemiological Department Padua Italy
| | - M. Varvarà
- Università degli Studi di Catania Registro Tumori Integrato Catania‐Messina‐Siracusa‐Enna Catania Italy
| | - F. Falcini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS Romagna Cancer Registry Meldola Italy
| | - M. Zorzi
- Veneto Region Veneto Tumor Registry Padua Italy
| | - G. Carrozzi
- Modena Cancer Registry AUSL Modena Public Health Department Modena Italy
| | - W. Mazzucco
- Palermo and Province Cancer Registry Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone" University of Palermo Clinical Epidemiology Unit with Cancer Registry Palermo Italy
| | - C. Gasparotti
- Brescia Health Protection Agency Epidemiology Unit Brescia Cancer Registry Brescia Italy
| | - S. Iacovacci
- ASL Latina Cancer Registry of Latina Province Latina Italy
| | | | - R. Cavallo
- ASL Salerno Cancer Registry Salerno Italy
| | - F. Stracci
- University of Perugia Public Health Section ‐ Dept. of Medicine and Surgery Perugia Italy
| | - A. G. Russo
- Agency for Health Protection of Milan Cancer Registry of Milan Epidemiology Unit Milan Italy
| | - A. Caldarella
- Institute for Cancer Research Prevention and Clinical Network (ISPRO) Tuscany Cancer Registry Clinical Epidemiology Unit Florence Italy
| | - S. Rosso
- Azienda Ospedaliera‐Universitaria Città della Salute e della Scienza di Torino Piedmont Cancer Registry Torino Italy
| | - A. Musolino
- Azienda Ospedaliera Universitaria di Parma Parma Cancer Registry Oncology Unit Parma Italy
| | - L. Mangone
- AUSL ASMN‐IRCCS Azienda USL di Reggio Emilia Reggio Emilia Cancer Registry Epidemiology Unit Reggio Emilia Italy
| | - C. Casella
- IRCCS Ospedale Policlinico San Martino Liguria Cancer Registry Clinical Epidemiology Genova Italy
| | - M. Fusco
- ASL Napoli 3 Sud Cancer Registry Napoli Italy
| | - G. Tagliabue
- Fondazione IRCCS Istituto Nazionale dei Tumori Lombardy Cancer Registry Varese Province Cancer Registry Unit Department of Research Milan Italy
| | - D. Piras
- Azienda Regionale per la Tutela della Salute North Sardinia Cancer Registry Sassari Italy
| | - R. Tumino
- Provincial Health Authority (ASP 7) Cancer Registry and Histopathology Department Ragusa Italy
| | - L. Guarda
- Agenzia di Tutela della Salute (ATS) della Val Padana Mantova Cancer Registry Epidemilogy Unit Mantova Italy
| | - Y. M. Dinaro
- Siracusa Cancer Registry Health Unit of Siracusa Siracusa Italy
| | - S. Piffer
- Trento Province Cancer Registry Unit of Clinical Epidemiology Trento Italy
| | - P. Pinna
- ASSL Nuoro/ATS Sardegna Nuoro Cancer Registry RT Nuoro Nuoro Italy
| | | | - A. C. Fanetti
- Health Protection Agency Sondrio Cancer Registry Sondrio Italy
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14
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Pellegrino B, Cavanna L, Boggiani D, Zamagni C, Frassoldati A, Schirone A, Caldara A, Rocca A, Gori S, Piacentini F, Berardi R, Brandes AA, Foglietta J, Villa F, Todeschini R, Tognetto M, Naldi N, Bortesi B, Montemurro F, Ardizzoni A, Boni L, Musolino A. Phase II study of eribulin in combination with gemcitabine for the treatment of patients with locally advanced or metastatic triple negative breast cancer (ERIGE trial). Clinical and pharmacogenetic results on behalf of the Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC). ESMO Open 2020; 6:100019. [PMID: 33399082 PMCID: PMC7808100 DOI: 10.1016/j.esmoop.2020.100019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/07/2020] [Accepted: 11/17/2020] [Indexed: 12/21/2022] Open
Abstract
Background The combination of a microtubule inhibitor (eribulin) with a nucleoside analog (gemcitabine) may synergistically induce tumor cell death, particularly in triple negative breast cancer (TNBC) characterized by high cell proliferation, aggressive behavior, and chemo-resistance. Patients and methods This is an open-label, multicenter phase II study evaluating the combination of eribulin (0.88 mg/m2) plus gemcitabine (1000 mg/m2) on days 1 and 8 of a 21-day cycle as either first- or second-line treatment of locally advanced or metastatic TNBC. The primary endpoint was the objective response for evaluable patients. A prospective, molecular correlative study was carried out to assess the role of germinal BRCA pathogenic variants and single nucleotide polymorphisms (SNPs) in predicting efficacy and toxicity of the combination regimen. Results From July 2013 to September 2016, 83 evaluable patients were enrolled. They received a median number of six cycles of treatment. An overall response rate (ORR) of 37.3% (31 patients) was observed, with a complete response rate of 2.4% and a partial response rate of 34.9%; the clinical benefit rate was 48.8%. With a median follow-up of 28.8 months, the median response duration was 6.6 months, the median progression-free survival (PFS) was 5.1 months, and the median overall survival (OS) was 14.5 months. The most common grade 3-4 adverse events were aminotransferase elevation (in 25% of the patients) and neutropenia (in 23.8%). Women with BRCA1/2 pathogenic variants were associated with worse ORR, PFS, and OS than BRCA1/2 wild-type carriers. CYP3A4 and FGD4 SNPs were associated with increased risk of liver toxicity. Three different SNPs in CDA∗2, RRM1, and CYP2C8 genes were significantly associated with poorer OS. Conclusions The combination of eribulin and gemcitabine showed promising activity and a moderate toxicity profile in metastatic TNBC. BRCA status and pharmacogenetics tests may help identify patients with high probability of response with negligible toxicity. EudraCT number 2012-003505-10. Eribulin plus gemcitabine showed a remarkable best ORR of 37.3% and a clinical benefit rate of 48.8%. The most common grade 3/4 toxicities were liver toxicity and neutropenia without febrile neutropenia. The study regimen partially lost its efficacy in patients harboring BRCA1/2 pathogenic variants. SNPs in CYP3A4 and FGD4 genes were associated with increased risk of liver toxicity. Three different SNPs in CDA∗2, RRM1, and CYP2C8 genes were significantly associated with poorer OS.
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Affiliation(s)
- B Pellegrino
- Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy; Italian Oncology Group for Clinical Research (GOIRC), Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - L Cavanna
- Hospital of Piacenza, Piacenza, Italy
| | - D Boggiani
- Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy; Italian Oncology Group for Clinical Research (GOIRC), Parma, Italy
| | - C Zamagni
- SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - A Frassoldati
- Italian Oncology Group for Clinical Research (GOIRC), Parma, Italy; Medical Oncology Unit, University Hospital of Ferrara, Ferrara, Italy
| | - A Schirone
- Medical Oncology Unit, University Hospital of Ferrara, Ferrara, Italy
| | - A Caldara
- Medical Oncology Unit, Ospedale Santa Chiara, Trento, Italy
| | - A Rocca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | - S Gori
- Sacro Cuore-Don Calabria Hospital, Negrar (VR), Italy
| | - F Piacentini
- Medical Oncology Unit, University Hospital of Modena, Modena, Italy
| | - R Berardi
- Ancona University Hospital, Ancona, Italy
| | - A A Brandes
- Department of Medical Oncology, Azienda USL, Bologna, Italy
| | | | - F Villa
- Hospital of Lecco, Lecco, Italy
| | - R Todeschini
- Italian Oncology Group for Clinical Research (GOIRC), Parma, Italy
| | - M Tognetto
- Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - N Naldi
- Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy
| | - B Bortesi
- Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy
| | - F Montemurro
- Multidisciplinary Oncology Outpatient Clinic, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - A Ardizzoni
- Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - L Boni
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - A Musolino
- Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy; Italian Oncology Group for Clinical Research (GOIRC), Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy.
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Dieci M, Guarneri V, Bisagni G, Tosi A, Musolino A, Spazzapan S, Moretti G, Vernaci G, Giarratano T, Lo Mele M, Rosato A, De Salvo G, Conte P. 162MO Neoadjuvant chemotherapy and immunotherapy in Luminal B BC: Results of the phase II GIADA trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.284] [Citation(s) in RCA: 7] [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: 11/26/2022] Open
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Dieci MV, Conte P, Bisagni G, Brandes AA, Frassoldati A, Cavanna L, Musolino A, Giotta F, Rimanti A, Garrone O, Bertone E, Cagossi K, Sarti S, Ferro A, Piacentini F, Maiorana A, Orvieto E, Sanders M, Miglietta F, Balduzzi S, D'Amico R, Guarneri V. Association of tumor-infiltrating lymphocytes with distant disease-free survival in the ShortHER randomized adjuvant trial for patients with early HER2+ breast cancer. Ann Oncol 2020; 30:418-423. [PMID: 30657852 PMCID: PMC6442655 DOI: 10.1093/annonc/mdz007] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [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: 12/18/2022] Open
Abstract
BACKGROUND There is the need to identify new prognostic markers to refine risk stratification for HER2-positive early breast cancer patients. The aim of this study was to evaluate the association of tumor-infiltrating lymphocytes (TILs) with distant disease-free survival (DDFS) in patients with HER2-positive early breast cancer enrolled in the ShortHER adjuvant trial which compared 9 weeks versus 1-year trastuzumab in addition to chemotherapy, and to test the interaction between TILs and treatment arm. PATIENTS AND METHODS Stromal TILs were assessed for 866 cases on centralized hematoxylin and eosin-stained tumor slides. The association of TILs as 10% increments with DDFS was assessed with Cox models. Kaplan-Meier curves were estimated for patients with TILs ≥20% and TILs <20%. Median follow-up was 6.1 years. RESULTS Median TILs was 5% (Q1-Q3 1%-15%). Increased TILs were independently associated with better DDFS in multivariable model [hazard ratio (HR) 0.73, 95% confidence interval (CI) 0.59-0.89, P = 0.006, for each 10% TILs increment]. Five years DDFS rates were 91.1% for patients with TILs <20% and 95.7% for patients with TILs ≥20% (P = 0.025). The association between 10% TILs increments and DDFS was significant for patients randomized to 9 weeks of trastuzumab (HR 0.60, 95% CI 0.41-0.88) but not for patients treated with 1 year of trastuzumab (HR 0.89, 95% CI 0.71-1.12; test for interaction P = 0.088). For patients with TILs <20%, the HR for the comparison between the short versus the long arm was 1.75 (95% CI 1.09-2.80, P=0.021); whereas, for patients with TILs ≥20% the HR for the comparison of short versus long arm was 0.23 (95% CI 0.05-1.09, P = 0.064), resulting in a significant interaction (P = 0.015). CONCLUSIONS TILs are an independent prognostic factor for HER2-positive early breast cancer patients treated with adjuvant chemotherapy and trastuzumab and may refine the ability to identify patients at low risk of relapse eligible for de-escalated adjuvant therapy.
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Affiliation(s)
- M V Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova; Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova
| | - P Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova; Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova.
| | - G Bisagni
- Oncology Unit, Department of Oncology and Advanced Technologies, Azienda USL-IRCCS, Reggio Emilia
| | - A A Brandes
- Medical Oncology, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna
| | - A Frassoldati
- Clinical Oncology, Department of Morphology, Surgery and Experimental Medicine, S Anna University Hospital, Ferrara
| | - L Cavanna
- Department of Oncology-Hematology, G. da Saliceto Hospital, Piacenza
| | - A Musolino
- Medical Oncology Unit, University Hospital of Parma, Piacenza
| | - F Giotta
- Division of Medical Oncology, IRCCS, Istituto Tumori "Giovanni Paolo II", Bari
| | - A Rimanti
- Medical Oncology, Azienda Ospedaliera di Mantova, Mantova
| | - O Garrone
- Medical Oncology, A.O. S. Croce and Carle Teaching Hospital, Cuneo
| | - E Bertone
- Medical Oncology, S. Anna Hospital, Torino
| | - K Cagossi
- Breast Unit Ausl Modena, Ramazzini Hospital, Carpi
| | - S Sarti
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola
| | - A Ferro
- Rete Clinica Senologica - Oncologia Medica S. Chiara, Trento
| | - F Piacentini
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena; Azienda Ospedaliero-Universitaria di Modena, Modena
| | - A Maiorana
- Department of Diagnostic, Clinical Medicine and Public Health, University Hospital of Modena, Modena
| | - E Orvieto
- Pathology Unit, Ulss 5 Polesana, Rovigo, Italy
| | - M Sanders
- Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, USA
| | - F Miglietta
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova
| | - S Balduzzi
- Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Italy
| | - R D'Amico
- Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Italy
| | - V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova; Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova
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Pellegrino B, Musolino A, Llop-Guevara A, Serra V, De Silva P, Hlavata Z, Sangiolo D, Willard-Gallo K, Solinas C. Homologous Recombination Repair Deficiency and the Immune Response in Breast Cancer: A Literature Review. Transl Oncol 2020; 13:410-422. [PMID: 31901781 PMCID: PMC6948367 DOI: 10.1016/j.tranon.2019.10.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/16/2019] [Indexed: 12/11/2022] Open
Abstract
The success of cancer immunotherapy with immune checkpoint blockade (ICB) has demonstrated the importance of targeting a preexisting immune response in a broad spectrum of tumors. This is particularly novel and relevant for less immunogenic tumors, such as breast cancer (BC), where the efficacy of ICB was more evident in the triple-negative (TNBC) subtype, in earlier stages, and in association with chemotherapy. Tumors harboring homologous recombination DNA repair (HRR) deficiency (HRD) are supposed to have a higher number of mutations, hence a higher tumor mutational burden, which could potentially make them more sensitive to immunotherapy. However, the mechanisms involved in ICB sensitivity and patient selection are still yet to be defined in BC: whether the innate system could play a role and how the adaptive immunity could be linked with HRR pathways are the two key points of debate that we will discuss in this article. The aim of this review was to close the loop between what was found in clinical trial results so far, go back to laboratory theory and preclinical results and point out what needs to be clarified from now on.
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Affiliation(s)
- B Pellegrino
- Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy.
| | - A Musolino
- Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy
| | - A Llop-Guevara
- Experimental Therapeutics Group, Vall D'Hebron Institute of Oncology, Barcelona, Spain
| | - V Serra
- Experimental Therapeutics Group, Vall D'Hebron Institute of Oncology, Barcelona, Spain
| | - P De Silva
- Molecular Immunology Unit, Institut Jules Bordet and Universitè Libre de Bruxelles, Bruxelles, Belgium
| | - Z Hlavata
- Medical Oncology Department, CHR Mons-Hainaut, Mons, Belgium
| | - D Sangiolo
- Department of Oncology, University of Torino, Torino, Italy; Candiolo Cancer Institute FPO-IRCCS, Candiolo, Torino, Italy
| | - K Willard-Gallo
- Molecular Immunology Unit, Institut Jules Bordet and Universitè Libre de Bruxelles, Bruxelles, Belgium
| | - C Solinas
- Molecular Immunology Unit, Institut Jules Bordet and Universitè Libre de Bruxelles, Bruxelles, Belgium; Regional Hospital of Valle D'Aosta, Aosta, Italy.
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18
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Conte P, Frassoldati A, Bisagni G, Brandes AA, Donadio M, Garrone O, Piacentini F, Cavanna L, Giotta F, Aieta M, Gebbia V, Molino A, Musolino A, Ferro A, Maltoni R, Danese S, Zamagni C, Rimanti A, Cagossi K, Russo A, Pronzato P, Giovanardi F, Moretti G, Lombardo L, Schirone A, Beano A, Amaducci L, Bajardi EA, Vicini R, Balduzzi S, D'Amico R, Guarneri V. Nine weeks versus 1 year adjuvant trastuzumab in combination with chemotherapy: final results of the phase III randomized Short-HER study‡. Ann Oncol 2019; 29:2328-2333. [PMID: 30219886 DOI: 10.1093/annonc/mdy414] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Chemotherapy plus 1-year trastuzumab is the standard adjuvant treatment of HER2-positive breast cancer. The efficacy of less extended trastuzumab exposure is under investigation. The short-HER study was aimed to assess the non-inferiority of 9 weeks versus 1 year of adjuvant trastuzumab combined with chemotherapy. Patients and methods HER2-positive breast cancer patients with node-positive or, if node negative, with at least one risk factor (pT>2 cm, G3, lympho-vascular invasion, Ki-67 > 20%, age ≤35 years, or hormone receptor negativity) were randomly assigned to receive sequential anthracycline-taxane combinations plus 1-year trastuzumab (arm A, long) or plus 9 weeks trastuzumab (arm B, short). This study was designed as a non-inferiority trial with disease-free survival (DFS) as primary end point. A DFS hazard ratio (HR) <1.29 was chosen as the non-inferiority margin. Analyses according to the frequentist and Bayesian approach were planned. Secondary end points included 2-year failure rate and cardiac safety. Results A total of 1254 patients from 82 centers were randomized (arm A, long: n = 627; arm B, short: n = 626). Five-year DFS is 88% in the long and 85% in the short arm. The HR is 1.13 (90% CI 0.89-1.42), with the upper limit of the CI crossing the non-inferiority margin. According to the Bayesian analysis, the probability that the short arm is non-inferior to the long one is 80%. The 5-year overall survival (OS) is 95.2% in the long and 95.0% in the short arm (HR 1.07, 90% CI 0.74-1.56). Cardiac events are significantly lower in the short arm (risk-ratio 0.33, 95% CI 0.22-0.50, P < 0.0001). Conclusions This study failed to show the non-inferiority of a shorter trastuzumab administration. One-year trastuzumab remains the standard. However, a 9-week administration decreases the risk of severe cardiac toxicity and can be an option for patients with cardiac events during treatment and for those with a low risk of relapse. Trial Registration EUDRACT number: 2007-004326-25; NCI ClinicalTrials.gov number: NCT00629278.
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Affiliation(s)
- P Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto (IOV), IRCCS, Padova, Italy.
| | - A Frassoldati
- Clinical Oncology, Department of Morphology, Surgery and Experimental Medicine, S Anna University Hospital, Ferrara, Italy
| | - G Bisagni
- Department of Oncology and Advanced Technologies, Oncology Unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - A A Brandes
- Medical Oncology, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - M Donadio
- Department of Medical Oncology 1, Città della Salute e della Scienza Hospital, Turin, Italy
| | - O Garrone
- Medical Oncology, A.O. S. Croce and Carle Teaching Hospital, Cuneo, Italy
| | - F Piacentini
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena, Italy; Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - L Cavanna
- Department of Oncology-Hematology, G. da Saliceto Hospital, Piacenza, Italy
| | - F Giotta
- Division of Medical Oncology, IRCCS, Giovanni Paolo II Hospital, Bari, Italy
| | - M Aieta
- Division of Medical Oncology, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero Vulture (PZ), Italy
| | - V Gebbia
- Medical Oncology, Casa di Cura La Maddalena, University of Palermo, Palermo, Italy
| | - A Molino
- Oncology Unit, Verona University Hospital, Verona, Italy
| | - A Musolino
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - A Ferro
- Medical Oncology, Santa Chiara Hospital, Trento, Italy
| | - R Maltoni
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS, Meldola, Italy
| | - S Danese
- Department of Gynecology and Obstetrics, Ospedale S. Anna, Turin, Italy
| | - C Zamagni
- Policlinico S.Orsola-Malpighi, SSD Oncologia Medica Addarii, Bologna, Italy
| | - A Rimanti
- Medical Oncology, Azienda Ospedaliera Carlo Poma, Mantova, Italy
| | - K Cagossi
- Division of Medical Oncology, "B.Ramazzini" Hospital, Carpi, Italy
| | - A Russo
- Section of Medical Oncology, Department of Surgical and Oncological Sciences, University of Palermo, Palermo, Italy
| | - P Pronzato
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy
| | - F Giovanardi
- Department of Oncology and Advanced Technologies, Oncology Unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - G Moretti
- Department of Oncology and Advanced Technologies, Oncology Unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - L Lombardo
- Medical Oncology, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - A Schirone
- Clinical Oncology, Department of Morphology, Surgery and Experimental Medicine, S Anna University Hospital, Ferrara, Italy
| | - A Beano
- Department of Medical Oncology 1, Città della Salute e della Scienza Hospital, Turin, Italy
| | - L Amaducci
- Medical Oncology Unit, Ospedale degli Infermi Faenza, Faenza, Italy
| | - E A Bajardi
- Medical Oncology, Casa di Cura La Maddalena, University of Palermo, Palermo, Italy
| | - R Vicini
- Department of Diagnostic and Clinical Medicine and Public Health, Statistics Unit, University Hospital of Modena and Reggio Emilia, Modena, Italy
| | - S Balduzzi
- Department of Diagnostic and Clinical Medicine and Public Health, Statistics Unit, University Hospital of Modena and Reggio Emilia, Modena, Italy
| | - R D'Amico
- Azienda Ospedaliero-Universitaria di Modena, Modena, Italy; Department of Diagnostic and Clinical Medicine and Public Health, Statistics Unit, University Hospital of Modena and Reggio Emilia, Modena, Italy
| | - V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto (IOV), IRCCS, Padova, Italy
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19
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Pellegrino B, Llop-Guevara A, Pedretti F, Cruz C, Castroviejo M, Cedro-Tanda A, Fasani R, Mateo F, Musolino A, Pujana M, Nuciforo P, Gros A, Balmana J, O’Connor M, Serra Elizalde V. PARP inhibition increases immune infiltration in homologous recombination repair (HRR)-deficient tumors. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Cazzaniga ME, Pinotti G, Montagna E, Amoroso D, Berardi R, Butera A, Cagossi K, Cavanna L, Ciccarese M, Cinieri S, Cretella E, De Conciliis E, Febbraro A, Ferraù F, Ferzi A, Fiorentini G, Fontana A, Gambaro AR, Garrone O, Gebbia V, Generali D, Gianni L, Giovanardi F, Grassadonia A, Leonardi V, Marchetti P, Melegari E, Musolino A, Nicolini M, Putzu C, Riccardi F, Santini D, Saracchini S, Sarobba MG, Schintu MG, Scognamiglio G, Spadaro P, Taverniti C, Toniolo D, Tralongo P, Turletti A, Valenza R, Valerio MR, Vici P, Clivio L, Torri V. Metronomic chemotherapy for advanced breast cancer patients in the real world practice: Final results of the VICTOR-6 study. Breast 2019; 48:7-16. [PMID: 31470257 DOI: 10.1016/j.breast.2019.07.006] [Citation(s) in RCA: 30] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/24/2019] [Accepted: 07/29/2019] [Indexed: 12/21/2022] Open
Abstract
Metronomic chemotherapy (mCHT) refers to the minimum biologically effective dose of a chemotherapy agent given as a continuous dosing regimen, with no prolonged drug-free breaks, that leads to antitumor activity. Aim of the present study is to describe the use of mCHT in a retrospective cohort of metastatic breast cancer (MBC) patients in order to collect data regarding the different types and regimens of drugs employed, their efficacy and safety. Between January 2011 and December 2016, data of 584 metastatic breast cancer patients treated with mCHT were collected. The use of VRL-based regimens increased during the time of observation (2011: 16.8% - 2016: 29.8%), as well as CTX-based ones (2011: 17.1% - 2016: 25.6%), whereas CAPE-based and MTX-based regimens remained stable. In the 1st-line setting, the highest ORR and DCR were observed for VRL-based regimens (single agent: 44% and 88%; combination: 36.7% and 82.4%, respectively). Assuming VRL-single agent as the referee treatment (median PFS: 7.2 months, 95% CI: 5.3-10.3), the longest median PFS were observed in VRL-combination regimens (9.5, 95%CI 88.8-11.3, HR = 0.72) and in CAPE-single agent (10.7, 95%CI 8.3-15.8, HR = 0.70). The VICTOR-6 study provides new data coming from the real-life setting, by adding new information regarding the use of mCHT as an option of treatment for MBC patients.
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Affiliation(s)
- M E Cazzaniga
- Research Unit Phase I Trials, ASST Monza, Monza, Italy; Oncology Unit, ASST Monza, Italy.
| | - G Pinotti
- Medical Oncology, ASST Sette Laghi "Ospedale di Circolo e Fondazione Macchi, Varese, VA, Italy
| | - E Montagna
- Medical Senology Division, IEO, Milan, Italy
| | - D Amoroso
- Medical Oncology, Ospedale Della Versilia, Lido di Camaiore, IT, Italy
| | - R Berardi
- Medical Oncology, A. Ospedaliero-universitaria Ospedali Riuniti, Ancona, IT, Italy
| | - A Butera
- Medical Oncology, Ospedale San Giovanni di Dio, Agrigento, IT, Italy
| | - K Cagossi
- Medical Oncology, Ospedale Ramazzini, Carpi, IT, Italy
| | - L Cavanna
- Medical Oncology, Azienda Ospedaliera Piacenza, Piacenza, IT, Italy
| | - M Ciccarese
- Medical Oncology, Ospedale Vito Fazzi, Lecce, IT, Italy
| | - S Cinieri
- Medical Oncology, ASL Brindisi, Brindisi, Italy
| | - E Cretella
- Medical Oncology, Ospedale Bolzano, IT, Italy
| | | | - A Febbraro
- Medical Oncology, Ospedale S. Cuore di Gesù Fatebenefratelli, Benevento, Italy
| | - F Ferraù
- Medical Oncology, Osp Taormina, Taormina, IT, Italy
| | - A Ferzi
- Medical Oncology, A.S.S.T. Ovest Milanese, Legnano, IT, Italy
| | - G Fiorentini
- Medical Oncology, Ospedale San Salvatore, Pesaro, Italy
| | - A Fontana
- Medical Oncology, Az. Ospedaliero-Universitaria, Pisana, IT, Italy
| | - A R Gambaro
- Medical Oncology, ASST Fatebenefratelli, Sacco, IT, Italy
| | - O Garrone
- Medical Oncology, A.O. S. Croce e Carle, Cuneo, Italy
| | - V Gebbia
- Medical Oncology, Ospedale La Maddalena, Palermo, IT, Italy
| | - D Generali
- Medical Oncology, Istituti Ospitalieri Cremona, Cremona, IT, Italy
| | - L Gianni
- Medical Oncology, Azienda USL Romagna, U.O. di Oncologia Rimini, Cattolica, IT, Italy
| | - F Giovanardi
- Medical Oncology, Ospedale Civile, Guastalla, IT, Italy
| | - A Grassadonia
- Medical Oncology, P.O. SS Annunziata -ASL2 Lanciano-Vasto, Chieti, IT, Italy
| | - V Leonardi
- Medical Oncology, Ospedale Civico, Palermo, IT, Italy
| | - P Marchetti
- Medical Oncology, A.O. Sant'Andrea, Roma, IT, Italy
| | - E Melegari
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - A Musolino
- Medical Oncology, Azienda Ospedaliero-Universitaria di Parma, IT, Italy
| | - M Nicolini
- Medical Oncology, Azienda USL Romagna, U.O. di Oncologia Rimini, Cattolica, IT, Italy
| | - C Putzu
- Medical Oncology, A. Ospedaliera-Universitaria, Sassari, IT, Italy
| | - F Riccardi
- Medical Oncology, A. Ospedaliera Antonio Cardarelli, Napoli, IT, Italy
| | - D Santini
- Medical Oncology Università Campus Bio-Medico, Roma, IT, Italy
| | - S Saracchini
- Medical Oncology, Az. Osp. Santa Maria Degli Angeli, Pordenone, IT, Italy
| | - M G Sarobba
- Medical Oncology, Ospedale San Francesco, Nuoro, IT, Italy
| | - M G Schintu
- Medical Oncology, Osp Giovanni Paolo II, Olbia, IT, Italy
| | | | - P Spadaro
- Medical Oncology, Casa di Cura Villa Salus, Messina, IT, Italy
| | - C Taverniti
- Medical Oncology, A.O.U. Città Della Salute e Della Scienza, Osp. Molinette, Torino, IT, Italy
| | - D Toniolo
- Medical Oncology, ASST Rhodense 3 Ospedale di Circolo Rho, IT, Italy
| | - P Tralongo
- Medical Oncology, Osp. Umberto I, Siracusa, IT, Italy
| | - A Turletti
- Medical Oncology, P.O. Martini, Torino, IT, Italy
| | - R Valenza
- Medical Oncology, P.O. Vittorio Emanuele, Gela, IT, Italy
| | - M R Valerio
- Medical Oncology, A.O.U. Policlinico Paolo Giaccone, Palermo, IT, Italy
| | - P Vici
- Medical Oncology, B, INT Regina Elena, Roma, IT, Italy
| | - L Clivio
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Italy
| | - V Torri
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Italy
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Musolino A, Cavanna L, Boggiani D, Zamagni C, Frassoldati A, Caldara A, Rocca A, Gori S, Piacentini F, Berardi R, Brandes AA, Foglietta J, Villa F, Pellegrino B, Todeschini R, Tognetto M, Naldi N, Bortesi B, Boni L, Montemurro F, Ardizzoni A. Abstract P1-14-05: Phase II study of eribulin in combination with gemcitabine for the treatment of patients with locally advanced or metastatic triple negative breast cancer (ERIGE Trial). Clinical and pharmacogenetic results on behalf of the Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-14-05] [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: There are no well-established chemotherapy regimens for metastatic triple negative breast cancer. The combination of a microtubule inhibitor (eribulin) with a nucleoside analog (gemcitabine) may synergistically induce tumor cell death, especially in tumors like triple negative breast cancers (TNBC) characterized by high cell proliferation, aggressive tumor behavior, and chemo-resistance.
Materials and Methods:This is an open-label, national multicenter phase II study evaluating the combination of eribulin (0.88 mg/m2) plus gemcitabine (1000 mg/m2) on day 1 and 8, q21 as either first- or second-line treatment of locally advanced or metastatic TNBC.The primary endpoint was the objective response rate (ORR) for evaluable patients (pts). The study was designed according to the Simon's two stage optimal design. We chose the lower activity (p0) of 0.20 and target activity level (p1) of 0.35. A prospective, molecular correlative study has been being carried out on germinal DNA of study population to assess the role of BRCA mutations and single nucleotide polymorphisms (SNPs) in predicting efficacy and toxicity of the combination regimen.
Results: From July 2013 to September 2016, 83 evaluable pts (37 in the first stage, 46 in the second one) were enrolled. They received a median number of 6 cycles of treatment (range 1-24). The ORR (CR+PR) was 37.35% (90% CI: 28.47-46.93) and the clinical benefit rate (CR+PR+SD ≥ 24wks) was 48.78% (90% CI: 39.24%-58.39%). The most common grade 3-4 adverse events (> 10% of patients) were neutropenia and liver toxicity. With a median follow-up of 28.8 months, the median progression-free survival (PFS) and overall survival (OS) were 5.1 months (95% CI: 4.2-7.0) and 14.7 months (95% CI: 10.2-20.0), respectively. BRCA1/2 deleterious mutations were observed in 15 (22%) out of 68 genotyped pts. Women with BRCA1/2 mutations were associated with worse ORR, PFS and OS than those with BRCA1/2 wild-type. A panel of SNPs in genes of study drug metabolism pathways was evaluated. Among these, CYP3A4 392A >G and FGD4 2044236G>A SNPs were associated with greater liver toxicity by logistic regression analysis. Furthermore, CDA*2 79A>C, RRM1 2455 A>G, and CYP2C8 416G>A SNPs were associated with poorer overall survival by Cox proportional hazards model.
Conclusions:The combination of eribulin and gemcitabine shows promising activity and a moderate toxicity profile in metastatic TNBC. BRCA status and pharmacogenetics tests may help identify pts with high probability of response with negligible toxicity.
Citation Format: Musolino A, Cavanna L, Boggiani D, Zamagni C, Frassoldati A, Caldara A, Rocca A, Gori S, Piacentini F, Berardi R, Brandes AA, Foglietta J, Villa F, Pellegrino B, Todeschini R, Tognetto M, Naldi N, Bortesi B, Boni L, Montemurro F, Ardizzoni A. Phase II study of eribulin in combination with gemcitabine for the treatment of patients with locally advanced or metastatic triple negative breast cancer (ERIGE Trial). Clinical and pharmacogenetic results on behalf of the Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-14-05.
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Affiliation(s)
- A Musolino
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - L Cavanna
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - D Boggiani
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - C Zamagni
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - A Frassoldati
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - A Caldara
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - A Rocca
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - S Gori
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - F Piacentini
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - R Berardi
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - AA Brandes
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - J Foglietta
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - F Villa
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - B Pellegrino
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - R Todeschini
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - M Tognetto
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - N Naldi
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - B Bortesi
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - L Boni
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - F Montemurro
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - A Ardizzoni
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
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Affiliation(s)
- Danilo Buonsenso
- Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Department of Pediatric Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Annamaria Musolino
- Department of Pediatric Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Conte P, Guarneri V, Bisagni G, Piacentini F, Brandes A, Cavanna L, Giotta F, Aieta M, Gebbia V, Frassoldati A, Musolino A, Garrone O, Taverniti C, Rimanti A, Sarti S, Rubino D, Bologna A, Vicini R, Balduzzi S, D'Amico R. 9 weeks versus 1 year adjuvant trastuzumab for HER2+ early breast cancer: Subgroup analysis of the ShortHER trial allows to identify patients for whom a shorter trastuzumab administration may have a favourable risk/benefit ratio. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dieci M, Conte P, Bisagni G, Brandes A, Frassoldati A, Cavanna L, Musolino A, Giotta F, Rimanti A, Garrone O, Bertone E, Cagossi K, Sarti S, Ferro A, Omarini C, Maiorana A, Orvieto E, Sanders M, D'Amico R, Guarneri V. Tumor-infiltrating lymphocytes (TILs) as an independent prognostic factor for early HER2+ breast cancer patients treated with adjuvant chemotherapy and trastuzumab in the randomized shortHER trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy270.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Musolino A, Gori S, Cavanna L, Graiff C, Frassoldati A, Bria E, Bisagni G, Zambelli A, Partesotti G, Brandes A, Bonetti A, Moscetti L, Zamagni C, Rocca A, Generali D, Montemurro F, Gianni L, Tognetto M, Maglietta G, Todeschini R. Abstract OT1-03-03: Phase II, open label, randomized, biomarker study of immune-mediated mechanism of action of neoadjuvant subcutaneous trastuzumab in patients with operable or locally advanced/Inflammatory HER2-positive breast cancer. ImmunHER trial on behalf of the Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot1-03-03] [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: Tumor-infiltrating lymphocytes (TILs) have been reported to be associated with increased therapeutic efficacy of trastuzumab in the (neo)adjuvant setting for HER2-positive breast cancer (BC). Subcutaneous (SC) trastuzumab has been observed to act at different immunologic levels than IV trastuzumab. Therefore, by modifying the modality of administration of trastuzumab, it could be possible to interfere with different pathways of the immune system and exert a favorable immunomodulation in HER2-positive BC.
Trial design: In this non-comparative, phase II, neoadjuvant, randomized study, patients will be treated with FEC chemotherapy (fluorouracil 500 mg/m2; epirubicin 75 mg/m2; cyclophosphamide 500 mg/m2) q21 for 3 cycles. Then, they will be randomly assigned in a 1:1 ratio to receive: docetaxel (75 mg/m2) plus pertuzumab (840 mg loading dose, then 420 mg) plus IV trastuzumab (8 mg/kg loading dose, then 6 mg/kg) q21 for 4 cycles (Group A) or, docetaxel plus pertuzumab plus SC trastuzumab (fixed dose of 600 mg) q21 for 4 cycles (Group B). After surgery, study patients will receive trastuzumab q21 x 14 cycles using the same formulation (SC or IV) of the preoperative phase.
Eligibility criteria: Patients must have previously untreated, T2-4d primary HER2-positive BC with no metastatic disease. Other inclusion criteria are: age 18 or older; ECOG performance status 0-1; availability of tumor tissue from diagnostic biopsy; normal left ventricular ejection fraction; normal organ and marrow function.
Specific aims: The main objective of this trial is to evaluate variations of host immune response parameters to either trastuzumab SC or trastuzumab IV given in combination with pertuzumab and chemotherapy as neoadjuvant treatment of patients with HER2-positive BC. Tumor samples obtained at diagnosis and at definitive surgery will be centrally analyzed for TILs. Blood samples will be also collected during study treatment for tumor-specific lymphocyte cell activity (TLA) analysis. Feasibility, efficacy, safety and health-related quality of life will be also evaluated.
Statistical methods: The primary endpoint is post-surgery pathologic TIL rate on residual disease. The threshold for classifying subjects with high TILs, or not, is defined as equal to 15%, according to the median TIL rate observed in primary HER2-positive tumors. Because this is a phase II study with 2 non-comparative arms, Simon's optimal 2-stage design will be used for each of the 2 study groups. For each arm we assume: p1 = 0.4, expected rate of subjects with high TILs on residual disease, p0 = 0.1, lowest limit of the subject rate (alpha= 0.05; beta= 0.20).
Present accrual and target accrual: A total of 60 patients (first stage: 16 patients) will be enrolled from multiple institutions. From November 29, 2016 to June 11, 2017, 34 patients have been recruited.
Contact information:Dr. Antonino Musolino, MD, MSc, PhD; Medical Oncology Unit, University Hospital of Parma; Tel: +390521702316; Fax: +390521995448; e-mail: amusolino@ao.pr.it. Clinical Trials.gov: NCT03144947.
Citation Format: Musolino A, Gori S, Cavanna L, Graiff C, Frassoldati A, Bria E, Bisagni G, Zambelli A, Partesotti G, Brandes A, Bonetti A, Moscetti L, Zamagni C, Rocca A, Generali D, Montemurro F, Gianni L, Tognetto M, Maglietta G, Todeschini R. Phase II, open label, randomized, biomarker study of immune-mediated mechanism of action of neoadjuvant subcutaneous trastuzumab in patients with operable or locally advanced/Inflammatory HER2-positive breast cancer. ImmunHER trial on behalf of the Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC) [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 OT1-03-03.
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Affiliation(s)
- A Musolino
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - S Gori
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - L Cavanna
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - C Graiff
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - A Frassoldati
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - E Bria
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - G Bisagni
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - A Zambelli
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - G Partesotti
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - A Brandes
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - A Bonetti
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - L Moscetti
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - C Zamagni
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - A Rocca
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - D Generali
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - F Montemurro
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - L Gianni
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - M Tognetto
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - G Maglietta
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
| | - R Todeschini
- University Hospital of Parma, Parma, Italy; Ospedale Sacro Cuore – Don Calabria – Negrar (VR), Negrar (VR), Italy; G. da Saliceto Hospital, Piacenza, Italy; Ospedale di Bolzano, Bolzano, Italy; University Hospital of Ferrara, Ferrara, Italy; University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Azienda Ospedaliera S.Maria Nuova/IRCCS of Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Ospedale di Sassuolo, Modena, Italy; Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy; Azienda ULSS21 Legnago (VR), Legnago (VR), Italy; Hematology and Respiratory Diseases, University Hospital of Modena, Modena, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Investigative Clinical Oncology, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy; Azienda USL di Rimini, Rimini, I
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Guarneri V, Dieci MV, Bisagni G, Brandes AA, Frassoldati A, Cavanna L, Musolino A, Giotta F, Cavazzini G, Garrone O, Bertone E, Cagossi K, Nanni O, Ferro A, Donadio M, Aieta M, Zamagni C, Piacentini F, Maiorana A, Ragazzi M, Cucchi MC, Querzoli P, Orsi N, Curtarello M, Urso L, Amadori A, Orvieto E, Vicini R, Balduzzi S, D'Amico R, Conte P. Abstract P1-13-02: Withdrawn. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-13-02] [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
This abstract was withdrawn by the authors.
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Affiliation(s)
- V Guarneri
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - MV Dieci
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - G Bisagni
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - AA Brandes
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - A Frassoldati
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - L Cavanna
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - A Musolino
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - F Giotta
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - G Cavazzini
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - O Garrone
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - E Bertone
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - K Cagossi
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - O Nanni
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - A Ferro
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - M Donadio
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - M Aieta
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - C Zamagni
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - F Piacentini
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - A Maiorana
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - M Ragazzi
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - MC Cucchi
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - P Querzoli
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - N Orsi
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - M Curtarello
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - L Urso
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - A Amadori
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - E Orvieto
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - R Vicini
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - S Balduzzi
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - R D'Amico
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - P Conte
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
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Musolino A, Falcini F, Sikokis A, Boggiani D, Rimanti A, Pellegrino B, Silini EM, Campanini N, Barbieri E, Zamagni C, Degli Esposti R, Cortesi L, Bisagni G, Cavanna L, Frassoldati A, Sgargi P, Michiara M. Prognostic impact of interval breast cancer detection in women with pT1a N0M0 breast cancer with HER2-positive status: Results from a multicentre population-based cancer registry study. Eur J Cancer 2017; 88:10-20. [PMID: 29175735 DOI: 10.1016/j.ejca.2017.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 10/18/2017] [Accepted: 10/22/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although human epidermal growth factor receptor 2 (HER2) overexpression is associated with poor prognosis, patients (pts) with pT1a N0M0 breast cancers (BCs) have an excellent outcome across all subtypes. Interval cancers (ICs) have poorer survival than screen-detected (SD) tumours, and an association has been reported between ICs and HER2 overexpression. We aimed to determine, in a general population of pT1a N0M0 BCs with known screening status, whether HER2-positive ICs have a poorer outcome than HER2-positive SD cancers. METHODS We evaluated all incident pT1a N0M0 BCs (n = 874) collected in the Emilia-Romagna region (Italy) from 2003 to 2009 and diagnosed in women aged 50-69. Pts unexposed to screening, with unknown HER2 status and/or treated with adjuvant trastuzumab were excluded from analysis. RESULTS Sixty-one percent of the BCs were SD, whereas 19% were ICs. BCs with high histologic grade, hormone receptor-negative or HER2-positive status (odds ratio=1.7; 95% confidence interval [CI]: 1.1-2.7) were more likely ICs. Median follow-up was 115 months. The 10-year invasive disease-free survival (iDFS) for HER2-positive ICs was lower than that for HER2-positive SD cancers: 75.0% (95% CI: 55.5%-94.5%) versus 93.8% (95% CI: 86.5%-100%). An interaction between ICs and HER2-positive status was found for poorer iDFS after adjusting for prognostic variables (HR = 5.3; 95% CI: 1.6-16.7). CONCLUSIONS IC detection may identify pts with HER2-positive pT1a N0M0 tumours in whom the rate of recurrence justifies consideration for conventional, anti-HER2, adjuvant treatment.
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Affiliation(s)
- A Musolino
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy.
| | - F Falcini
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Forlì, Italy; Azienda USL Della Romagna, Forlì, Italy
| | - A Sikokis
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy
| | - D Boggiani
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy
| | - A Rimanti
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy
| | - B Pellegrino
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy
| | - E M Silini
- Section of Anatomy and Pathology, University Hospital of Parma, Italy
| | - N Campanini
- Section of Anatomy and Pathology, University Hospital of Parma, Italy
| | - E Barbieri
- SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - C Zamagni
- SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - R Degli Esposti
- Medical Oncology Unit, Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy
| | - L Cortesi
- Department of Oncology, Hematology and Respiratory Diseases, University Hospital of Modena, Italy
| | - G Bisagni
- Department of Oncology and Advanced Technologies, Oncology Unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - L Cavanna
- Department of Oncology-Hematology, G. da Saliceto Hospital, Piacenza, Italy
| | - A Frassoldati
- Division of Medical Oncology, University Hospital of Ferrara, Italy
| | - P Sgargi
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy
| | - M Michiara
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy
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Conte P, Conte P, Bisagni G, Frassoldati A, Brandes A, Cavanna L, Giotta F, Aieta M, Gebbia V, Musolino A, Garrone O, Donadio M, Cavazzini G, Turletti A, Zamagni C, Danese S, Ferro A, Piacentini F, Balduzzi S, D'Amico R, Guarneri V. Final analysis of the phase III multicentric Italian study Short-HER: 9 weeks vs 1 year adjuvant trastuzumab for HER2+ early breast cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx421.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cazzaniga ME, Airoldi M, Arcangeli V, Artale S, Atzori F, Ballerio A, Bianchi GV, Blasi L, Campidoglio S, Ciccarese M, Cursano MC, Piezzo M, Fabi A, Ferrari L, Ferzi A, Ficorella C, Frassoldati A, Fumagalli A, Garrone O, Gebbia V, Generali D, La Verde N, Maur M, Michelotti A, Moretti G, Musolino A, Palumbo R, Pistelli M, Porpiglia M, Sartori D, Scavelli C, Schirone A, Turletti A, Valerio MR, Vici P, Zambelli A, Clivio L, Torri V. Efficacy and safety of Everolimus and Exemestane in hormone-receptor positive (HR+) human-epidermal-growth-factor negative (HER2-) advanced breast cancer patients: New insights beyond clinical trials. The EVA study. Breast 2017; 35:115-121. [PMID: 28711793 DOI: 10.1016/j.breast.2017.06.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/12/2017] [Accepted: 06/29/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The BOLERO-2 trial reported efficacy and safety of Everolimus (EVE) and Exemestane (EXE) combination in HR+ advanced breast cancer (ABC) patients. The BALLET trial further evaluated the safety of EVE-EXE in HR+ ABC patients, without reporting efficacy data. Aim of the EVA real-life study was to collect data of efficacy and safety of EVE-EXE combination in the clinical setting, as well as exploring efficacy according to EVE Dose-Intensity (DI) and to previous treatment with Fulvestrant. PATIENTS AND METHODS This study aimed to describe the outcome of ABC pts treated with EVE-EXE combination in terms of median duration of EVE treatment and ORR in a real-life setting. RESULTS From July 2013 to December 2015, the EVA study enrolled 404 pts. Median age was 61 years (33-83). Main metastatic sites were: bone (69.1%), soft tissue (34.7%) and viscera (33.2%). Median number of previous treatments was 2 (1-7). 43.3% of the pts had received Fulvestrant. Median exposure to EVE was 31.0 weeks (15.4-58.3) in the whole population. No difference was observed in terms of EVE exposure duration according to DI (p for trend = 0.27) or type of previous treatments (p = 0.33). ORR and Disease Control Rate (DCR) were observed in 31.6% and 60.7% of the patients, respectively, with the lowest ORRs confined in CHT pre-treated patients or in those who received the lowest DI of EVE. Grade 3-4 adverse events (AEs) were reported in 37.9% of the patients. Main AEs were: stomatitis (11.2%), non-infectious pneumonitis - NIP (3.8%), anaemia (3.8%) and fatigue (3.2%). CONCLUSIONS The EVA study provided new insights in the use of EVE-EVE combination in HR+ ABC pts many years after the publication of the pivotal trial. The combination is safe and the best response could be obtained in patients receiving the full dose of EVE and/or after hormone-therapy as Fulvestrant in ABC.
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Affiliation(s)
- M E Cazzaniga
- Research Unit Phase I Trials, ASST Monza, Monza, Italy; Oncology Unit, ASST Monza, Monza, Italy.
| | - M Airoldi
- Oncology Unit 2 - Città della Salute e della Scienza di Torino, Torino, Italy
| | - V Arcangeli
- Oncology Unit Rimini Azienda USL Romagna, Rimini, Italy
| | - S Artale
- Oncology Department, Ospedale di Gallarate ASST Valle Olona, Gallarate, Italy
| | - F Atzori
- Oncology Unit, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - A Ballerio
- Oncology Unit, ASST della Valle Olona - Presidio Ospedaliero di Saronno, Saronno, Italy
| | - G V Bianchi
- Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - L Blasi
- Oncology Unit, ARNAS Civico Palermo, Palermo, Italy
| | - S Campidoglio
- Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
| | - M Ciccarese
- Oncology Unit, Ospedale "Vito Fazzi" di Lecce, Lecce, Italy
| | - M C Cursano
- Oncology Unit, Università Campus Bio-Medico, Roma, Italy
| | - M Piezzo
- National Cancer Institute "Fondazione Giovanni Pascale", Napoli, Italy
| | - A Fabi
- Oncology Unit 1, Istituto Regina Elena - IFO, Roma, Italy
| | - L Ferrari
- Oncology Unit, ASL di Frosinone Osp. "SS. Trinità", Italy
| | - A Ferzi
- Oncology Unit, ASST OVEST Milanese - Presidio di Legnano, Legnano, Italy
| | - C Ficorella
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche (DISCAB) - Università Degli Studi Dell'Aquila, L'Aquila, Italy
| | - A Frassoldati
- Oncology Unit, Az Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - A Fumagalli
- Oncology Unit, Ospedale Moriggia Pelascini, Gravedona, Italy
| | - O Garrone
- Oncology Unit, A.O. S. Croce e Carle Ospedale di Insegnamento, Cuneo, Italy
| | - V Gebbia
- Oncology Unit, Osp. La Maddalena, Palermo, Italy
| | | | - N La Verde
- Oncology Unit, ASST Fatebenefratelli Sacco, Milano, Italy
| | - M Maur
- Oncology and Haematology Department, A.O.U Policlinico di Modena, Modena, Italy
| | - A Michelotti
- Oncology Unit I, Ospedale S. Chiara, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - G Moretti
- Oncology Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - A Musolino
- Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - R Palumbo
- Oncology Unit, IRCCS ICS Maugeri, Pavia, Italy
| | - M Pistelli
- Oncology Unit, AOU Ospedali Riuniti Umberto I-G.M. Lancisi-G. Salesi, Ancona, Italy
| | - M Porpiglia
- Oncology Unit, Presidio Ospedaliero S. Anna, Torino, Italy
| | - D Sartori
- Oncology Unit, AULSS 3, Mirano, Italy
| | - C Scavelli
- Oncology Unit, Ospedale "S. Cuore di Gesù", Gallipoli, Italy
| | - A Schirone
- Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - A Turletti
- Oncology Unit, Ospedale Martini della ASL "Città di Torino", Torino, Italy
| | - M R Valerio
- Oncology Department, Policlinico di Palermo Paolo Giaccone, Palermo, Italy
| | - P Vici
- Oncology Unit, Istituto Nazionale Tumori Regina Elena - IFO, Roma, Italy
| | - A Zambelli
- Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - L Clivio
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - V Torri
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
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Musolino A, Sikokis A, Boggiani D, Rimanti A, Pellegrino B, Silini E, Campanini N, Barbieri E, Cortesi L, Panebianco M, Porzio R, Frassoldati A, Sgargi P, Falcini F, Michiara M. Prognostic impact of interval breast cancer detection in women with pT1aN0M0 breast cancer with HER2-positive status: results from a multicenter population-based cancer registry study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw364.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Boggiani D, Sikokis A, Rimanti A, Pellegrino B, Silini E, Campanini N, Barbieri E, Cortesi L, Panebianco M, Porzio R, Frassoldati A, Sgargi P, Falcini F, Michiara M, Musolino A. Prognostic Impact of Interval Breast Cancer Detection in Women with pT1aN0M0 Breast Cancer with HER2-positive Status: Results from a Multicenter Population-based Cancer Registry Study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Musolino A, Naldi N, Dieci MV, Zanoni D, Rimanti A, Boggiani D, Sgargi P, Generali DG, Piacentini F, Ambroggi M, Cagossi K, Gianni L, Sarti S, Bisagni G, Ardizzoni A, Conte PF, Guarneri V. Immunoglobulin G fragment C receptor polymorphisms and efficacy of preoperative chemotherapy plus trastuzumab and lapatinib in HER2-positive breast cancer. Pharmacogenomics J 2016; 16:472-7. [PMID: 27378608 DOI: 10.1038/tpj.2016.51] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/04/2016] [Accepted: 05/06/2016] [Indexed: 11/09/2022]
Abstract
Lapatinib enhances antibody-dependent cell-mediated cytotoxicity (ADCC) activity of trastuzumab. FcγR polymorphisms have been associated with both ADCC and clinical activity of trastuzumab in HER2+ breast cancer (BC) patients (pts). We analyzed FcγRIIa-H131R and FcγRIIIa-V158F polymorphisms in the CHER-LOB trial population of HER2+ BCs treated with preoperative chemotherapy plus trastuzumab (arm A), lapatinib (arm B) or both (arm C). Genotyping was successfully performed in 73/121 (60%) pts. A significant improvement in pathological complete response (pCR) rate was observed for the combination arm C, but only in FcγRIIIa V allele carriers (C vs A, 67 vs 27%, P=0.043; C vs B, 67 vs 22%, P=0.012). An independent interaction between arm C and FcγRIIIa V allele was found for pCR (odds ratio=9.4; 95% confidence interval, 2.3-39.6; P=0.003). No significant associations were observed between pCR and FcγRIIa polymorphism, and between pre-treatment tumor-infiltrating lymphocytes and FcγR polymorphisms. Our study provides evidence for a FcγRIIIa V allele-restricted pCR benefit from neoadjuvant trastuzumab plus lapatinib in HER2+ BC.
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Affiliation(s)
- A Musolino
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - N Naldi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - M V Dieci
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - D Zanoni
- Department of Oncology, Guastalla Hospital, Guastalla, Italy
| | - A Rimanti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - D Boggiani
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - P Sgargi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - D G Generali
- U.O. Multidisciplinare di Patologia Mammaria, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy
| | - F Piacentini
- Medical Oncology Unit, Modena University Hospital, Modena, Italy
| | - M Ambroggi
- Medical Oncology Unit, Hospital of Piacenza, Piacenza, Italy
| | - K Cagossi
- Medical Oncology Unit, Ramazzini Hospital, Carpi, Italy
| | - L Gianni
- Medical Oncology Unit, Ospedale Infermi, Rimini, Italy
| | - S Sarti
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - G Bisagni
- Medical Oncology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - A Ardizzoni
- Division of Oncology, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - P F Conte
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - V Guarneri
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
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Musolino A, Michiara M, Boggiani D, Sikokis A, Rimanti A, Pellegrino B, Silini EM, Campanini N, Barbieri E, Sgargi P, Falcini F, Pinto C. Abstract P1-07-23: Prognostic impact of HER2 overexpression/amplification in women with pT1a N0 M0 breast cancer with known screening status: Results from a multicenter population-based cancer registry study. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-07-23] [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
Introduction: Outcomes for women with pT1aN0M0 breast cancers (BC) may vary by biologic subtype. A higher proportion of HER2-positive BCs diagnosed in the interval between scheduled screening rounds has been proposed to account for the more aggressive behaviour of interval cancers (IC) compared with screen-detected (SD) tumors. No data are available on the prognostic role of HER2-positive status in a general population of pT1aN0M0 breast tumors with known screening status.
Methods: All incident pT1aN0M0 BCs (n=874), systematically collected by the Cancer Registries of Emilia Romagna Region (northern Italy) and diagnosed in women aged 50-69 from 2003 to 2009 were evaluated. Screening status was ascertained by reference to the Emilia Romagna Breast Cancer Screening Program (ERBSP) database. Patients unexposed to screening, with HER2 unknown primary tumor and/or who received adjuvant chemotherapy or trastuzumab were excluded from analysis.
Results: Twenty percent of patients had HER2-positive tumors. Fifty-three percent of the entire study population were SD cancers, while 18% were ICs. Tumors with high histologic grade, high proliferative rate, negative estrogen receptor status, or HER2-positive status were more likely to be diagnosed in the interval between screening. At a median follow-up of 84 months, the 5-year invasive disease-free survival (IDFS) rates were 89% and 95% in patients with HER2-positive and HER2-negative tumors, respectively (P = 0.025). Notably, HER2-positive ICs showed poorer IDFS than HER2-positive SD tumors (84% vs. 95%, respectively; P = 0.04). No difference in IDFS rates were observed between HER2-positive SD cancers and HER2-negative SD cancers. Multivariable analysis of candidate prognostic factors for IDFS will be reported.
Conclusions: In a general population of pT1aN0M0 early BCs with known screening status, IC detection may identify patients with HER2-positive pT1aN0M0 tumors in whom the rate of recurrence justifies consideration for systemic, anti-HER2, adjuvant therapy.
Citation Format: Musolino A, Michiara M, Boggiani D, Sikokis A, Rimanti A, Pellegrino B, Silini EM, Campanini N, Barbieri E, Sgargi P, Falcini F, Pinto C. Prognostic impact of HER2 overexpression/amplification in women with pT1a N0 M0 breast cancer with known screening status: Results from a multicenter population-based cancer registry study. [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 P1-07-23.
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Affiliation(s)
- A Musolino
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Parma, Italy; Section of Anatomy and Pathology, University Hospital of Parma, Parma, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna, Italy; Romagna Tumor Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy
| | - M Michiara
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Parma, Italy; Section of Anatomy and Pathology, University Hospital of Parma, Parma, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna, Italy; Romagna Tumor Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy
| | - D Boggiani
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Parma, Italy; Section of Anatomy and Pathology, University Hospital of Parma, Parma, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna, Italy; Romagna Tumor Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy
| | - A Sikokis
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Parma, Italy; Section of Anatomy and Pathology, University Hospital of Parma, Parma, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna, Italy; Romagna Tumor Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy
| | - A Rimanti
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Parma, Italy; Section of Anatomy and Pathology, University Hospital of Parma, Parma, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna, Italy; Romagna Tumor Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy
| | - B Pellegrino
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Parma, Italy; Section of Anatomy and Pathology, University Hospital of Parma, Parma, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna, Italy; Romagna Tumor Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy
| | - EM Silini
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Parma, Italy; Section of Anatomy and Pathology, University Hospital of Parma, Parma, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna, Italy; Romagna Tumor Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy
| | - N Campanini
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Parma, Italy; Section of Anatomy and Pathology, University Hospital of Parma, Parma, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna, Italy; Romagna Tumor Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy
| | - E Barbieri
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Parma, Italy; Section of Anatomy and Pathology, University Hospital of Parma, Parma, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna, Italy; Romagna Tumor Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy
| | - P Sgargi
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Parma, Italy; Section of Anatomy and Pathology, University Hospital of Parma, Parma, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna, Italy; Romagna Tumor Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy
| | - F Falcini
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Parma, Italy; Section of Anatomy and Pathology, University Hospital of Parma, Parma, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna, Italy; Romagna Tumor Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy
| | - C Pinto
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Parma, Italy; Section of Anatomy and Pathology, University Hospital of Parma, Parma, Italy; SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna, Italy; Romagna Tumor Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy
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Barni S, Fontanella C, Del Mastro L, Livraghi L, Morritti M, Pizzuti L, Michelotti A, Lutrino E, Ciccarese M, Musolino A, Quercia S, Garrone O, Pellegrino A, Pistelli M, Martella F, Iezzi L, Mentuccia L, Latorre A, D'Onofrio L, Porcu L. 1849 Italian observational study of Eribulin Mesylate in patients with advanced breast cancer: ESEMPiO study. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30799-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Musolino A, Bella M, Michiara M, Zanelli P, Naldi N, Bortesi B, Sgargi P, Camisa R, Neri T, Ardizzoni A. Brca Status, Molecular Profile and Clinical Variables in Primary Bilateral Breast Cancers: A Population-Based Cancer Registry Study. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33079-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Guarneri V, Frassoldati A, Bottini A, Generali DG, Cagossi K, Artioli F, Bisagni G, Boni C, Ravaioli A, Amadori D, Musolino A, Cavanna L, Untch M, Orlando L, Giardina G, Piacentini F, Tagliafico E, Bagnalasta M, D'Amico R, Conte PF. Final results of a phase II randomized trial of neoadjuvant anthracycline-taxane chemotherapy plus lapatinib, trastuzumab, or both in HER2-positive breast cancer (CHER-LOB trial). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.507] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Musolino A, Michiara M, Conti GM, Boggiani D, Bozzani F, Zatelli M, Sgargi P, Ardizzoni A. Abstract P2-04-01: HER2 Status as Predictor of Mammographic Screening Detection: Comparison of Interval-and Screen-Detected Breast Cancers. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p2-04-01] [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: To determine whether markers of poor prognosis are associated with risk of breast cancer diagnosis in the interval between screening examinations, we estimated the effect of the mode of detection on distribution of breast cancer molecular subtypes using population cancer registry data.
Material and Methods: Subjects (n = 641) comprised all breast cancers systematically collected by the Cancer Registry of Parma Province and diagnosed in women aged 50-69, from 2004 to 2007. These included 370 screen-detected and 271 symptomatic breast cancers (63 women with interval cancers and 208 who had not attended screening). We used logistic regression to determine whether interval cancers were associated with selected clinical and biologic characteristics. We also estimated the relative risk of cause-specific fatality and disease-free survival (DFS) by each resulting predictive factor (screen-detected compared to either symptomatic or interval cancers).
Results: Interval-detected cancers occurred more in younger women and were of more advanced tumor stage than screen-detected cancers. In unconditional logistic regression models adjusted for age and tumor stage, tumors with high histologic grade (odds ratio[OR] = 2.2; 95% CI =1.0-5.4), high proliferation rate (OR =2.7; 95% CI =1.5-4.8), or positive HER2 status (OR =2.6; 95% CI =1.3-5.1) were more likely to surface in the interval between screening examinations. After adjusting for various potential biases, women with screen-detected breast cancer had a substantial survival advantage over those with symptomatic breast cancer. In a multivariate model, positive HER2 status independently predicted poor DFS when the mode of cancer detection was included as covariate in addition to age, histologic grade, proliferation rate, and tumor stage. Conclusions: This is the first population-based cancer registry study demonstrating that HER2-positive tumors account for a substantial proportion of mammographic screening failure to detect breast cancer. Our data indicate that molecular subtype distribution of screen-detected breast cancer differs from that of interval cancers and accounts in part for the better outcome of screen-detected cancer.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-04-01.
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Affiliation(s)
- A Musolino
- Medical Oncology Unit and Tumor Registry of Parma Province, University Hospital of Parma, Italy; Mammographic Screening, USL Parma, Parma, Italy
| | - M Michiara
- Medical Oncology Unit and Tumor Registry of Parma Province, University Hospital of Parma, Italy; Mammographic Screening, USL Parma, Parma, Italy
| | - GM Conti
- Medical Oncology Unit and Tumor Registry of Parma Province, University Hospital of Parma, Italy; Mammographic Screening, USL Parma, Parma, Italy
| | - D Boggiani
- Medical Oncology Unit and Tumor Registry of Parma Province, University Hospital of Parma, Italy; Mammographic Screening, USL Parma, Parma, Italy
| | - F Bozzani
- Medical Oncology Unit and Tumor Registry of Parma Province, University Hospital of Parma, Italy; Mammographic Screening, USL Parma, Parma, Italy
| | - M Zatelli
- Medical Oncology Unit and Tumor Registry of Parma Province, University Hospital of Parma, Italy; Mammographic Screening, USL Parma, Parma, Italy
| | - P Sgargi
- Medical Oncology Unit and Tumor Registry of Parma Province, University Hospital of Parma, Italy; Mammographic Screening, USL Parma, Parma, Italy
| | - A. Ardizzoni
- Medical Oncology Unit and Tumor Registry of Parma Province, University Hospital of Parma, Italy; Mammographic Screening, USL Parma, Parma, Italy
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Musolino A, Bisagni G, De Matteis A, Nuzzo F, Ardizzoni A, Crinò L, Gamucci T, Passalacqua R, Gnoni R, Boni C. Abstract P2-17-01: Phase II Study of Bevacizumab in Combination with Docetaxel and Capecitabine for the First-Line Treatment of Patients with Locally Recurrent or Metastatic Breast Cancer. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p2-17-01] [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: Docetaxel (T; Taxotere) with capecitabine (X) is active against metastatic breast cancer (MBC); bevacizumab (B) has demonstrated efficacy with taxanes in the first-line setting. This study was conducted to assess the efficacy and safety of TX-B in patients (pts) with MBC. Patients and methods: In this single-arm, multicenter phase II study, pts received first-line bevacizumab 15 mg/kg and docetaxel 60 mg/m2 on day 1, plus capecitabine 900 mg/m2 twice per day on days 1-14 every 21 days. The treatment was administrated for 3 cycles and in case of objective response or stable disease at that time, pts were treated with 3 additional cycles. More courses of chemotherapy were administered at Investigator's discretion. Bevacizumab was continued until progressive disease, patient refusal, or unacceptable toxicity. Primary end point was progression-free survival (PFS) and secondary end points were tumor response rate (RR), overall survival (OS), and toxicity.
Results: We report data from the first 30 pts enrolled. Median age was 54 (37-72). Eight (27%) pts had triple-negative disease, while 18 (60%) were hormone-receptor positive. HER2 status was recognized as negative in 25 (84%) pts. TX-B was administered for a median of seven cycles. Five complete and 13 partial responses were observed (overall RR 60%). Median response duration was 12 months. Median OS and PFS were 26 and 11 months, respectively. Grade 3/4 adverse events included tromboembolism (10%), neutropenia (23%), hand-foot syndrome (13%), stomatitis (10%). The median TX doses administered per cycle were 60 mg/m2 and 660 mg/m2, respectively. Ten (33%) pts required dose reductions of docetaxel, while capecitabine dose was reduced in 15 (50%) pts. Results of all the 80 assessable pts entered in the study will be presented at the meeting.
Conclusion: TX-B demonstrated significant activity with an acceptable toxicity profile. Maintenance therapy with B is possible for a long period of stable tumor disease.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-17-01.
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Affiliation(s)
- A Musolino
- University Hospital of Parma, Italy; Arcispedale S. Maria Nuova, Reggio Emilia, Italy; Istituto Nazionale Tumori-Fondazione G. Pascale, Napoli, Italy; Ospedale S. Maria della Misericordia, Perugia, Italy; Ospedale Santissima Trinità, Frosinone, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Italian Oncology Group for Clinical Research (GOIRC), Italy
| | - G Bisagni
- University Hospital of Parma, Italy; Arcispedale S. Maria Nuova, Reggio Emilia, Italy; Istituto Nazionale Tumori-Fondazione G. Pascale, Napoli, Italy; Ospedale S. Maria della Misericordia, Perugia, Italy; Ospedale Santissima Trinità, Frosinone, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Italian Oncology Group for Clinical Research (GOIRC), Italy
| | - A De Matteis
- University Hospital of Parma, Italy; Arcispedale S. Maria Nuova, Reggio Emilia, Italy; Istituto Nazionale Tumori-Fondazione G. Pascale, Napoli, Italy; Ospedale S. Maria della Misericordia, Perugia, Italy; Ospedale Santissima Trinità, Frosinone, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Italian Oncology Group for Clinical Research (GOIRC), Italy
| | - F Nuzzo
- University Hospital of Parma, Italy; Arcispedale S. Maria Nuova, Reggio Emilia, Italy; Istituto Nazionale Tumori-Fondazione G. Pascale, Napoli, Italy; Ospedale S. Maria della Misericordia, Perugia, Italy; Ospedale Santissima Trinità, Frosinone, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Italian Oncology Group for Clinical Research (GOIRC), Italy
| | - A Ardizzoni
- University Hospital of Parma, Italy; Arcispedale S. Maria Nuova, Reggio Emilia, Italy; Istituto Nazionale Tumori-Fondazione G. Pascale, Napoli, Italy; Ospedale S. Maria della Misericordia, Perugia, Italy; Ospedale Santissima Trinità, Frosinone, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Italian Oncology Group for Clinical Research (GOIRC), Italy
| | - L Crinò
- University Hospital of Parma, Italy; Arcispedale S. Maria Nuova, Reggio Emilia, Italy; Istituto Nazionale Tumori-Fondazione G. Pascale, Napoli, Italy; Ospedale S. Maria della Misericordia, Perugia, Italy; Ospedale Santissima Trinità, Frosinone, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Italian Oncology Group for Clinical Research (GOIRC), Italy
| | - T Gamucci
- University Hospital of Parma, Italy; Arcispedale S. Maria Nuova, Reggio Emilia, Italy; Istituto Nazionale Tumori-Fondazione G. Pascale, Napoli, Italy; Ospedale S. Maria della Misericordia, Perugia, Italy; Ospedale Santissima Trinità, Frosinone, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Italian Oncology Group for Clinical Research (GOIRC), Italy
| | - R Passalacqua
- University Hospital of Parma, Italy; Arcispedale S. Maria Nuova, Reggio Emilia, Italy; Istituto Nazionale Tumori-Fondazione G. Pascale, Napoli, Italy; Ospedale S. Maria della Misericordia, Perugia, Italy; Ospedale Santissima Trinità, Frosinone, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Italian Oncology Group for Clinical Research (GOIRC), Italy
| | - R Gnoni
- University Hospital of Parma, Italy; Arcispedale S. Maria Nuova, Reggio Emilia, Italy; Istituto Nazionale Tumori-Fondazione G. Pascale, Napoli, Italy; Ospedale S. Maria della Misericordia, Perugia, Italy; Ospedale Santissima Trinità, Frosinone, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Italian Oncology Group for Clinical Research (GOIRC), Italy
| | - C. Boni
- University Hospital of Parma, Italy; Arcispedale S. Maria Nuova, Reggio Emilia, Italy; Istituto Nazionale Tumori-Fondazione G. Pascale, Napoli, Italy; Ospedale S. Maria della Misericordia, Perugia, Italy; Ospedale Santissima Trinità, Frosinone, Italy; Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Italian Oncology Group for Clinical Research (GOIRC), Italy
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Guarneri V, Frassoldati A, Gebbia V, Bisagni G, Cavanna L, Donadio M, Lelli G, Musolino A, Colucci G, Banna GL, Degli Esposti R, Ferro A, Grasso F, Zamagni C, Amadori D, Aieta M, Molino A, Garrone O, Aitini E, Fornari G, Cascinu S, Rossi G, D'Amico R, Conte PF. Abstract P5-12-05: 9 Weeks vs 1 Year Adjuvant Trastuzumab in Combination with Chemotherapy: Preliminary Cardiac Safety Data of the Phase III Multicentric Italian Study Short-HER. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p5-12-05] [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
Introduction: Several large randomized trials have shown the superiority of combining trastuzumab with chemotherapy versus chemotherapy alone as adjuvant treatment for HER2+ breast cancer patients. We are running a large phase III trial comparing two different trastuzumab durations (Short-HER study). We are reporting the preliminary cardiac safety data.
Methods: The Short-HER study is a phase III, multicentric, Italian trial where 2500 HER2+ breast cancer patients will be randomized to: Arm A (Long) 4 courses of anthracycline based chemotherapy (AC or EC) followed by 4 courses of docetaxel in combination with trastuzumab, followed by 14 additional courses of 3-weekly trastuzumab; or Arm B (Short) 3 courses of 3-weekly docetaxel in combination with weekly trastuzumab followed by FEC x3. this is a non-inferiority trial with DFS and OS as primary end points, and 2-yr failure rate and incidence of cardiac events as secondary end points. Left ventricular ejection fraction (LVEF) is measured at baseline, at the end of each sequence of chemotherapy in both arms, and after 9 and 12 months since randomization thereafter. A cardiac event (CE) was defined as the occurrence of any of the followings: 1) LVEF decrease of more than 15 percentage points from baseline ; 2) LVEF decrease of more than 10 percentage points with absolute value below 50%; 3) symptomatic cardiac failure; 4) other cardiac side effects of grade 2 or more.
Results: 510 patients from 69 Italian centers have been randomized so far, 251 in arm A (long) and 259 in Arm B (Short). 146 patients enrolled in arm A and 150 patients enrolled in arm B have received at least 3 months of therapy, and are eligible for the present analysis. In arm A (long), 20 patients (13.7%) experienced a CE: 12 patients experienced a LVEF decline of > 15 percentage points (5 patients with LVEF below 50%, one patient with concomitant atrial fibrillation); 3 patients had a LVEF decline of >10 percentage points with an absolute value below 50%. One patient had symptomatic cardiac failure. Two patients developed Grade 2 hypertension. Two patients developed Grade 2 arrhythmia.
In arm B (short), 11 patients (7.3%) experienced a CE: 7 patients had a LVEF decline of > 15 percentage points; one patient had a LVEF decline of > 10 percentage points with an absolute value below 50%. Three patients developed Grade 2 arrhythmia
Conclusions: This is a non-inferiority study designed on the assumption that a shorter treatment duration is associated with a significantly lower incidence of cardiac events. With 9 clinically relevant CEs (symptomatic cardiac failure or LVEF below 50%) in arm A (Long) and 1 in arm B (Short), these preliminary data support the assumption, and recruitment is ongoing.
Supported by Agenzia Italiana del FArmaco (AIFA).
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-12-05.
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Affiliation(s)
- V Guarneri
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - A Frassoldati
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - V Gebbia
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - G Bisagni
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - L Cavanna
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - M Donadio
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - G Lelli
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - A Musolino
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - G Colucci
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - GL Banna
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - R Degli Esposti
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - A Ferro
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - F Grasso
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - C Zamagni
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - D Amadori
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - M Aieta
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - A Molino
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - O Garrone
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - E Aitini
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - G Fornari
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - S Cascinu
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - G Rossi
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - R D'Amico
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - PF. Conte
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
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Musolino A, Ciccolallo L, Panebianco M, Fontana E, Zanoni D, De Lisi V, Ardizzoni A. 5187 Multifactorial CNS relapse susceptibility in HER-2-positive breast cancer patients: first results from a population-based registry study. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71079-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Musolino A, Ciccolallo L, Panebianco M, Fontana E, Zanoni D, De Lisi V, Sgargi P, Ceci G, Ardizzoni A. Multifactorial CNS relapse susceptibility in HER2-positive breast cancer patients: First results from a population-based registry study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.1117] [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
1117 Background: A series of retrospective studies have reported a higher incidence of central nervous system (CNS) metastases in HER-2-positive (HER-2+) metastatic breast cancer. Trastuzumab, which does not cross the blood-brain barrier, has been associated with this increased risk. Methods: The aim of this study was to evaluate incidence, survival, and risk factors of CNS metastases in the incident breast cancer population systematically collected by the Tumor Registry of Parma Province over the 4-year period, 2004–2007. Study endpoints were: any distant metastasis as first event; CNS metastasis as first event; CNS metastasis at any time. Associations between CNS metastases and HER-2 status in the entire population and between trastuzumab and CNS metastases in HER-2+ patients (pts) were estimated. A multivariate analysis was performed to test the effect of covariates. Results: We evaluated the total resident population (n = 1500) of breast cancer pts diagnosed during the period 2004–2007 in Parma Province. Two-hundred and twenty-five pts (15%) were HER-2+ (IHC 3+/FISH amplified). Of these, 100 pts were treated with adjuvant trastuzumab-based therapy. At a median follow-up of 36 months from the diagnosis, the incidence of CNS relapse was 3% (1.3% as first recurrence). The median time to death from the diagnosis of CNS metastases was 25 months. Among the HER-2+ pts, there was a significant association between trastuzumab and subsequent CNS metastases (p = 0.02). However, in multivariate analysis, HER-2 status regardless of trastuzumab therapy was found to be the only independent predictive factor for CNS metastases (either as first or as subsequent recurrences; p < 0.01). Conclusions: This is the first population-based registry study analyzing CNS metastases in breast cancer in relation to tumor biological features, systemic treatment, and clinical outcome. Based on our results, HER-2 status independently distinguishes pts with a higher risk of CNS metastases. It is however presumable that, in some cases, improvements in systemic control and overall survival associated with trastuzumab-based therapy lead to an “unmasking” of CNS relapse that would otherwise have remained clinically silent prior to a patient's death. No significant financial relationships to disclose.
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Affiliation(s)
- A. Musolino
- University Hospital of Parma, Medical Oncology, Parma, Italy; Regione Emilia-Romagna, Tumor Registry of Parma, Parma, Italy; Regione Emilia-Romagna, Tumor Registry of Parma, Parma, Italy
| | - L. Ciccolallo
- University Hospital of Parma, Medical Oncology, Parma, Italy; Regione Emilia-Romagna, Tumor Registry of Parma, Parma, Italy; Regione Emilia-Romagna, Tumor Registry of Parma, Parma, Italy
| | - M. Panebianco
- University Hospital of Parma, Medical Oncology, Parma, Italy; Regione Emilia-Romagna, Tumor Registry of Parma, Parma, Italy; Regione Emilia-Romagna, Tumor Registry of Parma, Parma, Italy
| | - E. Fontana
- University Hospital of Parma, Medical Oncology, Parma, Italy; Regione Emilia-Romagna, Tumor Registry of Parma, Parma, Italy; Regione Emilia-Romagna, Tumor Registry of Parma, Parma, Italy
| | - D. Zanoni
- University Hospital of Parma, Medical Oncology, Parma, Italy; Regione Emilia-Romagna, Tumor Registry of Parma, Parma, Italy; Regione Emilia-Romagna, Tumor Registry of Parma, Parma, Italy
| | - V. De Lisi
- University Hospital of Parma, Medical Oncology, Parma, Italy; Regione Emilia-Romagna, Tumor Registry of Parma, Parma, Italy; Regione Emilia-Romagna, Tumor Registry of Parma, Parma, Italy
| | - P. Sgargi
- University Hospital of Parma, Medical Oncology, Parma, Italy; Regione Emilia-Romagna, Tumor Registry of Parma, Parma, Italy; Regione Emilia-Romagna, Tumor Registry of Parma, Parma, Italy
| | - G. Ceci
- University Hospital of Parma, Medical Oncology, Parma, Italy; Regione Emilia-Romagna, Tumor Registry of Parma, Parma, Italy; Regione Emilia-Romagna, Tumor Registry of Parma, Parma, Italy
| | - A. Ardizzoni
- University Hospital of Parma, Medical Oncology, Parma, Italy; Regione Emilia-Romagna, Tumor Registry of Parma, Parma, Italy; Regione Emilia-Romagna, Tumor Registry of Parma, Parma, Italy
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Vasini G, Bacchini G, Franciosi V, Ghidini C, Musolino A, Camisa R, Meschi T, Borghi L, Ardizzoni A. 1134 POSTER Survival prediction of terminally ill cancer patients by clinical and laboratory parameters: usefullness role of simple prognostic indicators. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70653-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Musolino A, Guazzi A, Lazzaretti M, Pezzuolo D, Calzetti C, Degli Antoni A, Ardizzoni A. Intracranial hematopoiesis in a patient with aids-related central nervous system lymphoma and severe pancytopenia. Haematologica 2007; 92:e59-61. [PMID: 17562595 DOI: 10.3324/haematol.11419] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The case here reported reflects the difficulty in diagnosing meningeal extramedullary hematopoiesis (EMH), which clinically appeared concomitantly with primary cerebral lymphoma and occurred in a patient with HIV infection and severe pancytopenia. Pancytopenia secondary to HIV infection could be hypothesized as a predisposing factor for the ectopic development of hematopoietic tissue outside the bone marrow. Although rare, intracranial EMH should always be considered in the differential diagnosis of headache and other endocranial hypertension symptoms in patients with chronic bone marrow dysfunction.
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Affiliation(s)
- A Musolino
- Medical Oncology Unit, University Hospital of Parma, Parma Italy.
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Musolino A, Naldi N, Bortesi B, Capelletti M, Pezzuolo D, Missale G, Laccabue D, Camisa R, Franciosi V, Ardizzoni A. Immunoglobulin G fragment C receptor polymorphisms and response to trastuzumab-based treatment in patients with HER-2/neu-positive metastatic breast cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.13090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
13090 Background: A potential mechanism of action of the humanized anti-HER-2/neu monoclonal antibody Trastuzumab involves antibody-dependent cellular cytotoxicity (ADCC) with the activation of immune effector cells via their immunoglobulin G fragment C receptors (FcγRs). Trastuzumab has been shown to engage both activation (FcγRIIIa; FcγRIIa) and inhibitory (FcγRIIb) antibody receptors on myeloid cells and several FcγR polymorphisms have been identified that may affect the antibody-dependent cytotoxicity of natural killer cells and macrophages. Methods: Forty consecutive HER-2/neu-positive (FISH+) metastatic breast cancer patients receiving a trastuzumab-based treatment (combined with paclitaxel for the majority) were examined for the FcγRIIIa 158 valine (V)/phenylalanine (F), FcγRIIa 131 histidine (H)/arginine (R), and FcγRIIb 232 isoleucine (I)/threonine (T) polymorphisms. A PCR-RFLP based assay using genomic DNA was performed for FcγRIIIa and FcγRIIa genotyping, while PCR-SSCP methods using complementary DNA were utilized for FcγRIIb. Patients’ peripheral blood mononuclear cells were drawn before treatment initiation and their trastuzumab-mediated killing function was measured by 51Cr release using a HER-2/neu-expressing human breast cancer cell line as a target. The results were then correlated with clinical outcome of these patients. Results: Median age was 60 years (range 26–83 years). Thirty-six (90%) patients received a trastuzumab-based treatment as first-line therapy. The overall clinical benefit rate (CR+PR+SD) was 65% (95% Confidence Interval: 62–71%), including 8 (20%) complete and 11 (27.5%) partial responses. Median survival was 22.3 mo with a median PFS of 7 mo. Trastuzumab-based treatment was well tolerated and no changes in cardiac function were observed. Conclusions: This study evaluates for the first time the potential role of FcγR polymorphisms in predicting response to trastuzumab-based treatment. Results according to this study purpose will be presented at the meeting. No significant financial relationships to disclose.
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Affiliation(s)
| | - N. Naldi
- University Hospital, Parma, Italy
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Musolino A, Bella MA, Michiara M, Zanelli P, Naldi N, Bortesi B, Capelletti M, Bandini N, Camisa R, Franciosi V. BRCA1 status, molecular markers, clinical variables in breast cancer patients with high probability of having an inherited genetic mutation. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.9648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A. Musolino
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy
| | - M. A. Bella
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy
| | - M. Michiara
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy
| | - P. Zanelli
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy
| | - N. Naldi
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy
| | - B. Bortesi
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy
| | - M. Capelletti
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy
| | - N. Bandini
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy
| | - R. Camisa
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy
| | - V. Franciosi
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy
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Michiara M, Bella MA, Naldi N, Musolino A, Zanelli P, Bortesi B, Capelletti M, De Lisi V, Sgargi P, Franciosi V. Male breast cancer in Parma Province: Descriptive epidemiology, molecular markers and clinical variables. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.9655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. Michiara
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy; Parma Cancer Registry, Parma, Italy
| | - M. A. Bella
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy; Parma Cancer Registry, Parma, Italy
| | - N. Naldi
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy; Parma Cancer Registry, Parma, Italy
| | - A. Musolino
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy; Parma Cancer Registry, Parma, Italy
| | - P. Zanelli
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy; Parma Cancer Registry, Parma, Italy
| | - B. Bortesi
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy; Parma Cancer Registry, Parma, Italy
| | - M. Capelletti
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy; Parma Cancer Registry, Parma, Italy
| | - V. De Lisi
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy; Parma Cancer Registry, Parma, Italy
| | - P. Sgargi
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy; Parma Cancer Registry, Parma, Italy
| | - V. Franciosi
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy; Parma Cancer Registry, Parma, Italy
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48
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Bella MA, Michiara M, Musolino A, Naldi N, Zanelli P, Bortesi B, Capelletti M, Bandini N, Franciosi V. Different expression of BRCA1 status and clinical variables in a sample of Italian women with early onset breast cancer (EOBC). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.9670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. A. Bella
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy
| | - M. Michiara
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy
| | - A. Musolino
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy
| | - N. Naldi
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy
| | - P. Zanelli
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy
| | - B. Bortesi
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy
| | - M. Capelletti
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy
| | - N. Bandini
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy
| | - V. Franciosi
- Medical Oncology Unit, University Hospital, Parma, Italy; Medical Genetic Service, University Hospital, Parma, Italy
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49
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Negri F, Musolino A, Norman AR, Ladas G, Pastorino U, Chong G, Cunningham D. The development of a preoperative chemotherapy strategy for patients selected to undergo pulmonary metastasectomy from colorectal cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- F. Negri
- Royal Marsden Hospital, London, United Kingdom; Royal Brompton Hospital, London, United Kingdom
| | - A. Musolino
- Royal Marsden Hospital, London, United Kingdom; Royal Brompton Hospital, London, United Kingdom
| | - A. R. Norman
- Royal Marsden Hospital, London, United Kingdom; Royal Brompton Hospital, London, United Kingdom
| | - G. Ladas
- Royal Marsden Hospital, London, United Kingdom; Royal Brompton Hospital, London, United Kingdom
| | - U. Pastorino
- Royal Marsden Hospital, London, United Kingdom; Royal Brompton Hospital, London, United Kingdom
| | - G. Chong
- Royal Marsden Hospital, London, United Kingdom; Royal Brompton Hospital, London, United Kingdom
| | - D. Cunningham
- Royal Marsden Hospital, London, United Kingdom; Royal Brompton Hospital, London, United Kingdom
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50
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Musolino A, Bella M, Michiara M, Zanelli P, Naldi N, Bortesi B, Capelletti M, Cengarle R, Bandini N, Camisa R. P2 BRCA-1 status, molecular markers, and clinical variables in breast cancer patients with high probability of having an inherited, cancer-predisposing genetic mutation. EJC Suppl 2004. [DOI: 10.1016/s1359-6349(04)90121-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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