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Cabibbo G, Daniele B, Borzio M, Casadei-Gardini A, Cillo U, Colli A, Conforti M, Dadduzio V, Dionisi F, Farinati F, Gardini I, Giannini EG, Golfieri R, Guido M, Mega A, Cinquini M, Piscaglia F, Rimassa L, Romanini L, Pecorelli A, Sacco R, Scorsetti M, Viganò L, Vitale A, Trevisani F. Multidisciplinary treatment of hepatocellular carcinoma in 2023: Italian practice Treatment Guidelines of the Italian Association for the Study of the Liver (AISF), Italian Association of Medical Oncology (AIOM), Italian Association of Hepato-Bilio-Pancreatic Surgery (AICEP), Italian Association of Hospital Gastroenterologists (AIGO), Italian Association of Radiology and Clinical Oncology (AIRO), Italian Society of Pathological Anatomy and Diagnostic Cytology (SIAPeC-IAP), Italian Society of Surgery (SIC), Italian Society of Gastroenterology (SIGE), Italian Society of Medical and Interventional Radiology (SIRM), Italian Organ Transplant Society (SITO), and Association of Patients with Hepatitis and Liver Disease (EpaC) - Part II - Non-surgical treatments. Dig Liver Dis 2024; 56:394-405. [PMID: 38052656 DOI: 10.1016/j.dld.2023.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/13/2023] [Accepted: 10/30/2023] [Indexed: 12/07/2023]
Abstract
Worldwide, hepatocellular carcinoma (HCC) is the third most common cause of cancer-related death. The remarkable improvements in treating HCC achieved in the last years have increased the complexity of its management. Following the need to have updated guidelines on the multidisciplinary treatment management of HCC, the Italian Scientific Societies involved in the management of this cancer have promoted the drafting of a new dedicated document. This document was drawn up according to the GRADE methodology needed to produce guidelines based on evidence. Here is presented the second part of guidelines, focused on the multidisciplinary tumor board of experts and non-surgical treatments of HCC.
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Affiliation(s)
- Giuseppe Cabibbo
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties PROMISE, University of Palermo, Gastroenterology Unit, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone", Palermo, Italy.
| | - Bruno Daniele
- Oncology Unit, Ospedale del Mare, ASL Napoli 1 Centro, Napoli, Italy
| | - Mauro Borzio
- Centro Diagnostico Italiano (CDI), Milano, Italy
| | - Andrea Casadei-Gardini
- Department of Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute Hospital, Milan, Italy
| | - Umberto Cillo
- General Surgery 2-Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Padua University Hospital, 35128 Padua, Italy
| | - Agostino Colli
- Dipartimento di Medicina Trasfusionale ed Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Vincenzo Dadduzio
- Medical Oncology Unit, "Mons. A.R.Dimiccoli" Hospital, Barletta, ASL BT, Italy
| | - Francesco Dionisi
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute - Rome, Italy
| | - Fabio Farinati
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy; Gastroenterology Unit, Azienda Ospedale-Università di Padova, 35128 Padova, Italy
| | - Ivan Gardini
- EpaC Onlus, Italian Liver Patient Association, Turin, Italy
| | - Edoardo Giovanni Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Rita Golfieri
- Alma Mater Studiorum" Bologna University, Bologna, Italy; Radiology Unit Madre Fortunata Toniolo Private Hospital, coordinator of Radiology centers Medipass Bologna, Bologna, Italy
| | - Maria Guido
- Department of Medicine, University of Padova, Padova - Italy
| | - Andrea Mega
- Department of Gastronterology, Regional Hospital Bolzano, Italy
| | - Michela Cinquini
- Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Milano, Italy
| | - Fabio Piscaglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy; Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Laura Romanini
- Radiology Unit, Ospedale di Cremona, ASST Cremona, Cremona, Italy
| | - Anna Pecorelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Rodolfo Sacco
- Gastroenterology and Endoscopy Unit, Department of Surgical and Medical Sciences, University of Foggia, 71100 Foggia, Italy
| | - Marta Scorsetti
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Luca Viganò
- Hepatobiliary Unit, Department of Minimally Invasive General & Oncologic Surgery, Humanitas Gavazzeni University Hospital, Viale M. Gavazzeni 21, 24125 Bergamo, Italy; Department of Biomedical Sciences, Humanitas University, Viale Rita Levi Montalcini 4, 20090 Milan, Italy
| | - Alessandro Vitale
- General Surgery 2-Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Padua University Hospital, 35128 Padua, Italy
| | - Franco Trevisani
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
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Ottaiano A, Santorsola M, Diana A, Belli A, Lentini Graziano ML, Orefice J, Patrone R, Di Mauro A, Scognamiglio G, Tatangelo F, De Bellis M, Piccirillo M, Fiore F, Stilo S, Tarotto L, Correra M, Di Lorenzo S, Capuozzo M, Avallone A, Silvestro L, Bianco A, Granata V, Federico P, Montesarchio V, Daniele B, Izzo F, Nasti G. Treatments, prognostic factors, and genetic heterogeneity in advanced cholangiocarcinoma: A multicenter real-world study. Cancer Med 2024; 13:e6892. [PMID: 38457226 PMCID: PMC10923031 DOI: 10.1002/cam4.6892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/14/2023] [Accepted: 12/16/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND AND AIMS Cholangiocarcinoma (CCA), a rare and aggressive hepatobiliary malignancy, presents significant clinical management challenges. Despite rising incidence and evolving treatment options, prognosis remains poor, motivating the exploration of real-world data for enhanced understanding and patient care. METHODS This multicenter study analyzed data from 120 metastatic CCA patients at three institutions from 2016 to 2023. Kaplan-Meier curves assessed overall survival (OS), while univariate and multivariate analyses evaluated links between clinical variables (age, gender, tumor site, metastatic burden, ECOG performance status, response to first-line chemotherapy) and OS. Genetic profiling was conducted selectively. RESULTS Enrolled patients had a median age of 68.5 years, with intrahepatic tumors predominant in 79 cases (65.8%). Among 85 patients treated with first-line chemotherapy, cisplatin and gemcitabine (41.1%) was the most common regimen. Notably, one-third received no systemic treatment. After a median 14-month follow-up, 81 CCA-related deaths occurred, with a median survival of 13.1 months. Two clinical variables independently predicted survival: response to first-line chemotherapy (disease control vs. no disease control; HR: 0.27; 95% CI: 0.14-0.50; p < 0.0001) and metastatic involvement (>1 site vs. 1 site; HR: 1.99; 95% CI: 1.04-3.80; p = 0.0366). The three most common genetic alterations involved the ARID1A, tp53, and CDKN2A genes. CONCLUSIONS Advanced CCA displays aggressive clinical behavior, emphasizing the need for treatments beyond chemotherapy. Genetic diversity supports potential personalized therapies. Collaborative research and deeper CCA biology understanding are crucial to enhance patient outcomes in this challenging malignancy.
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Affiliation(s)
| | | | - Anna Diana
- Medical Oncology UnitOspedale del MareNapoliItaly
| | - Andrea Belli
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”NapoliItaly
| | | | | | - Renato Patrone
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”NapoliItaly
| | | | | | | | - Mario De Bellis
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”NapoliItaly
| | - Mauro Piccirillo
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”NapoliItaly
| | - Francesco Fiore
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”NapoliItaly
| | - Salvatore Stilo
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”NapoliItaly
| | - Luca Tarotto
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”NapoliItaly
| | - Marco Correra
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”NapoliItaly
| | | | | | - Antonio Avallone
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”NapoliItaly
| | | | - Antonella Bianco
- Medical Oncology UnitAORN Ospedali dei Colli‐Monaldi‐Cotugno‐CTONapoliItaly
| | - Vincenza Granata
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”NapoliItaly
| | | | | | | | - Francesco Izzo
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”NapoliItaly
| | - Guglielmo Nasti
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”NapoliItaly
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Cabibbo G, Daniele B, Borzio M, Casadei-Gardini A, Cillo U, Colli A, Conforti M, Dadduzio V, Dionisi F, Farinati F, Gardini I, Giannini EG, Golfieri R, Guido M, Mega A, Minozzi S, Piscaglia F, Rimassa L, Romanini L, Pecorelli A, Sacco R, Scorsetti M, Viganò L, Vitale A, Trevisani F. Multidisciplinary Treatment of Hepatocellular Carcinoma in 2023: Italian practice Treatment Guidelines of the Italian Association for the Study of the Liver (AISF), Italian Association of Medical Oncology (AIOM), Italian Association of Hepato-Bilio-Pancreatic Surgery (AICEP), Italian Association of Hospital Gastroenterologists (AIGO), Italian Association of Radiology and Clinical Oncology (AIRO), Italian Society of Pathological Anatomy and Diagnostic Cytology (SIAPeC-IAP), Italian Society of Surgery (SIC), Italian Society of Gastroenterology (SIGE), Italian Society of Medical and Interventional Radiology (SIRM), Italian Organ Transplant Society (SITO), and Association of Patients with Hepatitis and Liver Disease (EpaC) - Part I - Surgical treatments. Dig Liver Dis 2024; 56:223-234. [PMID: 38030455 DOI: 10.1016/j.dld.2023.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/07/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Abstract
Worldwide, hepatocellular carcinoma (HCC) is the third most common cause of cancer-related death. The remarkable improvements in treating HCC achieved in the last years have increased the complexity of HCC management. Following the need to have updated guidelines on the multidisciplinary treatment management of HCC, the Italian Scientific Societies involved in the management of this cancer have promoted the drafting of a new dedicated document. This document was drawn up according to the GRADE methodology needed to produce guidelines based on evidence. Here is presented the first part of guidelines, focused on the multidisciplinary tumor board of experts and surgical treatments of HCC.
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Affiliation(s)
- Giuseppe Cabibbo
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties PROMISE, University of Palermo, Italy; Gastroenterology Unit, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone", Palermo, Italy.
| | - Bruno Daniele
- Oncology Unit, Ospedale del Mare, ASL Napoli 1 Centro, Napoli, Italy
| | - Mauro Borzio
- Centro Diagnostico Italiano (CDI), Milano, Italy
| | - Andrea Casadei-Gardini
- Department of Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute Hospital, Milan, Italy
| | - Umberto Cillo
- General Surgery 2-Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Padua University Hospital, 35128 Padua, Italy
| | - Agostino Colli
- Dipartimento di Medicina Trasfusionale ed Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Vincenzo Dadduzio
- Medical Oncology Unit, "Mons. A.R.Dimiccoli" Hospital, Barletta, ASL BT, Italy
| | - Francesco Dionisi
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute - Rome, Italy
| | - Fabio Farinati
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy; Gastroenterology Unit, Azienda Ospedale-Università di Padova, 35128 Padova, Italy
| | - Ivan Gardini
- EpaC Onlus, Italian Liver Patient Association, Turin, Italy
| | - Edoardo Giovanni Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Rita Golfieri
- Alma Mater Studiorum" Bologna University, Bologna, Italy; Radiology Unit Madre Fortunata Toniolo Private Hospital, coordinator of Radiology centers Medipass Bologna, Bologna, Italy
| | - Maria Guido
- Department of Medicine, University of Padova, Padova- Italy
| | - Andrea Mega
- Department of Gastronterology, Regional Hospital Bolzano, Italy
| | - Silvia Minozzi
- Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Milano, Italy
| | - Fabio Piscaglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy; Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Laura Romanini
- Radiology Unit, Ospedale di Cremona, ASST Cremona, Cremona, Italy
| | - Anna Pecorelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Rodolfo Sacco
- Gastroenterology and Endoscopy Unit, Department of Surgical and Medical Sciences, University of Foggia, 71100 Foggia, Italy
| | - Marta Scorsetti
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Luca Viganò
- Hepatobiliary Unit, Department of Minimally Invasive General & Oncologic Surgery, Humanitas Gavazzeni University Hospital, Viale M. Gavazzeni 21, 24125 Bergamo, Italy; Department of Biomedical Sciences, Humanitas University, Viale Rita Levi Montalcini 4, 20090 Milan, Italy
| | - Alessandro Vitale
- General Surgery 2-Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Padua University Hospital, 35128 Padua, Italy
| | - Franco Trevisani
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
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4
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Merle P, Kudo M, Edeline J, Bouattour M, Cheng AL, Chan SL, Yau T, Garrido M, Knox J, Daniele B, Breder V, Lim HY, Ogasawara S, Cattan S, Chao Y, Siegel AB, Martinez-Forero I, Wei Z, Liu CC, Finn RS. Pembrolizumab as Second-Line Therapy for Advanced Hepatocellular Carcinoma: Longer Term Follow-Up from the Phase 3 KEYNOTE-240 Trial. Liver Cancer 2023; 12:309-320. [PMID: 37901200 PMCID: PMC10601873 DOI: 10.1159/000529636] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/06/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction KEYNOTE-240 showed a favorable benefit/risk profile for pembrolizumab versus placebo in patients with sorafenib-treated advanced hepatocellular carcinoma (HCC); however, prespecified statistical significance criteria for overall survival (OS) and progression-free survival (PFS) superiority were not met at the final analysis. Outcomes based on an additional 18 months of follow-up are reported. Methods Adults with sorafenib-treated advanced HCC were randomized 2:1 to pembrolizumab 200 mg intravenously every 3 weeks or placebo. Dual primary endpoints were OS and PFS assessed per RECIST v1.1 by blinded independent central review (BICR). Secondary endpoints included objective response rate (ORR), assessed per RECIST v1.1 by BICR, and safety. Results 413 patients were randomized (pembrolizumab, n = 278; placebo, n = 135). As of July 13, 2020, median (range) time from randomization to data cutoff was 39.6 (31.7-48.8) months for pembrolizumab and 39.8 (31.7-47.8) months for placebo. Estimated OS rates (95% CI) were 17.7% (13.4-22.5%) for pembrolizumab and 11.7% (6.8-17.9%) for placebo at 36 months. The estimated PFS rate (95% CI) for pembrolizumab was 8.9% (5.3-13.6%) and 0% for placebo at 36 months. ORR (95% CI) was 18.3% (14.0-23.4%) for pembrolizumab and 4.4% (1.6-9.4%) for placebo. Immune-mediated hepatitis events did not increase with follow-up. No viral hepatitis flare events were reported. Conclusion With extended follow-up, pembrolizumab continued to maintain improvement in OS and PFS and was associated with a consistent adverse event profile compared with placebo in patients with sorafenib-treated advanced HCC. Although KEYNOTE-240 did not meet prespecified statistical significance criteria at the final analysis, these results together with the antitumor activity of second-line pembrolizumab observed in KEYNOTE-224 and the statistically significant and clinically meaningful OS and PFS benefits of second-line pembrolizumab in patients from Asia observed in KEYNOTE-394 reinforce the clinical activity of pembrolizumab in previously treated patients with advanced HCC.
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Affiliation(s)
- Philippe Merle
- Department of Hepatology and Gastroenterology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France, and Centre de Recherche en Cancerologie de Lyon, Lyon, France
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Julien Edeline
- INSERM, University Rennes, Department of Medical Oncology, CLCC Eugène Marquis, COSS (Chemistry Oncogenesis Stress Signaling) – UMR_S 1242, Rennes, France
| | - Mohamed Bouattour
- Department of Liver Cancer Unit, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France
| | - Ann-Lii Cheng
- Department of Medical Oncology, National Taiwan University Cancer Center and National Taiwan University Hospital, Taipei, Taiwan
| | - Stephen L. Chan
- Department of Clinical Oncology, Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas Yau
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Marcelo Garrido
- Department of Medical Oncology, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Jennifer Knox
- Department of Medical Oncology, UHN Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Bruno Daniele
- Department of Oncology, Ospedale del Mare, Naples, Italy
| | - Valeriy Breder
- Department of Chemotherapy, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russian Federation
| | - Ho Yeong Lim
- Department of Hematology and Oncology, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Sadahisa Ogasawara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Stéphane Cattan
- Department of Medical Oncology and Gastroenterology, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Yee Chao
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Abby B. Siegel
- Department of Medical Oncology, Merck & Co., Inc., Rahway, NJ, USA
| | | | - Ziwen Wei
- Biostatistics and Research Decision Sciences, Merck & Co., Inc., Rahway, NJ, USA
| | - Chih-Chin Liu
- Biostatistics and Research Decision Sciences, Merck & Co., Inc., Rahway, NJ, USA
| | - Richard S. Finn
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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5
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Rimini M, Fornaro L, Lonardi S, Niger M, Lavacchi D, Pressiani T, Lucchetti J, Giordano G, Pretta A, Tamburini E, Pirrone C, Rapposelli IG, Diana A, Martinelli E, Garajová I, Simionato F, Schirripa M, Formica V, Vivaldi C, Caliman E, Rizzato MD, Zanuso V, Nichetti F, Angotti L, Landriscina M, Scartozzi M, Ramundo M, Pastorino A, Daniele B, Cornara N, Persano M, Gusmaroli E, Cerantola R, Salani F, Ratti F, Aldrighetti L, Cascinu S, Rimassa L, Antonuzzo L, Casadei-Gardini A. Durvalumab plus gemcitabine and cisplatin in advanced biliary tract cancer: An early exploratory analysis of real-world data. Liver Int 2023; 43:1803-1812. [PMID: 37452505 DOI: 10.1111/liv.15641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/15/2023] [Accepted: 05/27/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The TOPAZ-1 phase III trial reported a survival benefit with the anti-programmed death cell ligand 1 (anti-PD-L1) durvalumab in combination with gemcitabine and cisplatin in patients with advanced biliary tract cancer. The present study investigated the efficacy and safety of this new standard treatment in a real-world setting. METHODS The analysed population included patients with unresectable, locally advanced or metastatic adenocarcinoma of the biliary tract treated with durvalumab in combination with gemcitabine and cisplatin at 17 Italian centres. The primary endpoint of the study was progression-free survival (PFS), whereas secondary endpoints included overall survival (OS), overall response rate (ORR) and safety. Unadjusted and adjusted hazard ratios (HRs) by baseline characteristics were calculated using the Cox proportional hazards model. RESULTS From February 2022 to November 2022, 145 patients were enrolled. After a median follow-up of 8.5 months (95% CI: 7.9-13.6), the median PFS was 8.9 months (95% CI: 7.4-11.7). Median OS was 12.9 months (95% CI: 10.9-12.9). The investigator-assessed confirmed ORR was 34.5%, and the disease control rate was 87.6%. Any grade adverse events (AEs) occurred in 137 patients (94.5%). Grades 3-4 AEs occurred in 51 patients (35.2%). The rate of immune-mediated AEs (imAEs) was 22.7%. Grades 3-4 imAEs occurred in 2.1% of the patients. In univariate analysis, non-viral aetiology, ECOG PS >0 and NLR ≥3 correlated with shorter PFS. CONCLUSION The results reported in this first real-world analysis mostly confirmed the results achieved in the TOPAZ-1 trial in terms of PFS, ORR and safety.
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Affiliation(s)
- Margherita Rimini
- Medical Oncology Department, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Department of Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Sara Lonardi
- Medical Oncology 3, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Monica Niger
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniele Lavacchi
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
| | - Jessica Lucchetti
- Division of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Guido Giordano
- Unit of Medical Oncology and Biomolecular Therapy, Policlinico Riuniti, Foggia, Italy
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Andrea Pretta
- Medical Oncology, University and University Hospital, Cagliari, Italy
| | - Emiliano Tamburini
- Department of Oncology and Palliative Care, Cardinale G Panico, Tricase City Hospital, Tricase, Italy
| | - Chiara Pirrone
- Medical Oncology Unit 1, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Ilario Giovanni Rapposelli
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Anna Diana
- Medical Oncology Unit, Ospedale del Mare, Napoli, Italy
| | - Erika Martinelli
- Medical Oncology Unit, Department of Precision Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Ingrid Garajová
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Francesca Simionato
- Department of Oncology, San Bortolo General Hospital, Azienda ULSS8 Berica, Vicenza, Italy
| | - Marta Schirripa
- Medical Oncology Unit, Department of Oncology and Hematology, Belcolle Hospital, Viterbo, Italy
| | - Vincenzo Formica
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Caterina Vivaldi
- Medical Oncology, University Hospital of Pisa, Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Enrico Caliman
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Mario Domenico Rizzato
- Medical Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Valentina Zanuso
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Federico Nichetti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Computational Oncology, Molecular Precision Oncology Program, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lorenzo Angotti
- Division of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Matteo Landriscina
- Unit of Medical Oncology and Biomolecular Therapy, Policlinico Riuniti, Foggia, Italy
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Mario Scartozzi
- Medical Oncology, University and University Hospital, Cagliari, Italy
| | - Matteo Ramundo
- Department of Oncology and Palliative Care, Cardinale G Panico, Tricase City Hospital, Tricase, Italy
| | | | - Bruno Daniele
- Medical Oncology Unit, Ospedale del Mare, Napoli, Italy
| | - Noemi Cornara
- Medical Oncology Department, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Department of Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | - Mara Persano
- Oncology Unit, San Martino Hospital, Oristano, Italy
| | - Eleonora Gusmaroli
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Riccardo Cerantola
- Medical Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Francesca Salani
- Medical Oncology, University Hospital of Pisa, Pisa, Italy
- Institute of Interdisciplinary Research "Health Science", Scuola Superiore Sant'Anna, Pisa, Italy
| | - Francesca Ratti
- Hepatobiliary Surgery Division, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Cascinu
- Medical Oncology Department, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Department of Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Casadei-Gardini
- Medical Oncology Department, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Department of Oncology, Vita-Salute San Raffaele University, Milan, Italy
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6
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Normanno N, De Luca A, Abate RE, Morabito A, Milella M, Tabbò F, Curigliano G, Masini C, Marchetti P, Pruneri G, Guarneri V, Frassineti GL, Fasola G, Adamo V, Daniele B, Berardi R, Feroce F, Maiello E, Pinto C. Current practice of genomic profiling of patients with advanced solid tumours in Italy: the Italian Register of Actionable Mutations (RATIONAL) study. Eur J Cancer 2023; 187:174-184. [PMID: 37167765 DOI: 10.1016/j.ejca.2023.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 02/16/2023] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND The Italian Register of Actionable Mutations (RATIONAL) is a multicentric, observational study collecting next-generation sequencing (NGS)-based tumour profiling data of patients with advanced solid tumours. METHODS The study enrols patients who had available an NGS-based tumour profiling (Pathway-A) or undergo comprehensive genomic profiling (CGP) with FoundationOne CDx assays within the trial (Pathway-B). The primary endpoint was the rate of actionable mutations identified. RESULTS Sequencing data were available for 738 patients in Pathway-A (218) and -B (520). In Pathway-A, 154/218 (70.6%) tests were performed using NGS panels ≤52 genes, and genomic alterations (GAs) were found in 164/218 (75.2%) patients. In Pathway-B, CGP revealed GAs in 512/520 (98.5%) patients. Levels I/II/III actionable GAs according to the European Society of Medical Oncology Scale for Clinical Actionability of molecular Targets (ESCAT) were identified in 254/554 (45.8%) patients with non-small-cell lung cancer, cholangiocarcinoma, colorectal, gastric, pancreatic and breast cancer. The rate of patients with level I GAs was similar in Pathways A and B (69 versus 102). CGP in Pathway-B revealed a higher number of patients with level II/III GAs (99 versus 20) and potentially germline pathogenic/likely pathogenic variants (58 versus 15) as compared with standard testing in Pathway-A. In patients with cancer of unknown primary, CGP detected OncoKB levels 3B/4 GAs in 31/58 (53.4%) cases. Overall, 67/573 (11.7%) of patients received targeted therapy based on genomic testing. CONCLUSION The Italian Register of Actionable Mutations represents the first overview of genomic profiling in Italian current clinical practice and highlights the utility of CGP for identifying therapeutic targets in selected cancer patients.
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Affiliation(s)
- Nicola Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italy.
| | - Antonella De Luca
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italy
| | - Riziero Esposito Abate
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italy
| | - Alessandro Morabito
- Thoracic Department, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italy
| | - Michele Milella
- U.O.C. Oncology, Azienda Ospedaliera Universitaria Integrata, University and Hospital Trust of Verona, Verona, Italy
| | - Fabrizio Tabbò
- Department of Oncology, Università degli Studi di Torino, AOU San Luigi, Orbassano, Italy
| | - Giuseppe Curigliano
- Department of Oncology and Hemato-Oncology, University of Milano, Milano, Italy; Division of Early Drug Development, European Institute of Oncology IRCCS, Milano, Italy
| | - Cristina Masini
- Medical Oncology, Comprehensive Cancer Centre IRCCS - AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Marchetti
- Istituto Dermopatico dell'Immacolata (IDI-IRCCS), Roma, Italy
| | - Giancarlo Pruneri
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Oncology 2, Istituto Oncologico Veneto (IOV) IRCCS, Padova, Italy
| | - Giovanni L Frassineti
- Department of Medical Oncology-IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Gianpiero Fasola
- Department of Medical Oncology, University Hospital of Udine, Udine, Italy
| | - Vincenzo Adamo
- Scientific Direction Oncology Department, Papardo Hospital, Messina, Italy
| | | | | | - Florinda Feroce
- Surgical Pathology Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italy
| | - Evaristo Maiello
- Oncology Unit, Fondazione Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Carmine Pinto
- Medical Oncology, Comprehensive Cancer Centre IRCCS - AUSL Reggio Emilia, Reggio Emilia, Italy
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7
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Fasola G, Barducci MC, Pelizzari G, Grossi F, Pinto C, Daniele B, Giordano M, Ortega C, Silva RR, Tozzi VD, Cavanna L, Aprile G. Implementation of Precision Oncology in Clinical Practice: Results of a National Survey for Health Care Professionals. Oncologist 2023:7059092. [PMID: 36848261 DOI: 10.1093/oncolo/oyad020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/10/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Two main aspects lead the implementation of precision oncology into clinical practice: the adoption of extended genome sequencing technologies and the institution of the Molecular Tumor Boards (MTBs). CIPOMO (Italian Association of Heads of Oncology Department) promoted a national survey across top health care professionals to gain an understanding of the current state of precision oncology in Italy. METHODS Nineteen questions were sent via the SurveyMonkey platform to 169 heads of oncology departments. Their answers were collected in February 2022. RESULTS Overall, 129 directors participated; 113 sets of answers were analyzed. Nineteen regions out of 21 participated as a representative sample of the Italian health care system. The use of next-generation sequencing (NGS) is unevenly distributed; informed consent and clinical reports are managed differently, as the integration of medical, biologic, and informatics domains in a patient-centered workflow is inconsistent. A heterogeneous MTB environment emerged. A total of 33.6% of the responding professionals did not have access to MTBs while 76% of those who have did not refer cases. CONCLUSIONS NGS technologies and MTBs are not homogeneously implemented in Italy. This fact potentially jeopardizes equal access chances to innovative therapies for patients. This survey was carried out as part of an organizational research project, pursuing a bottom-up approach to identify the needs and possible solutions to optimize the process. These results could be a starting point for clinicians, scientific societies, and health care institutions to outline the best practices and offer shared recommendations for precision oncology implementation in current clinical practice.
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Affiliation(s)
- Gianpiero Fasola
- Department of Oncology, Santa Maria della Misericordia University Hospital, ASUFC, Udine, Italy.,Collegio Italiano dei Primari Oncologi Medici Ospedalieri (CIPOMO), Genova, Italy
| | - Maria C Barducci
- Department of Oncology, Santa Maria della Misericordia University Hospital, ASUFC, Udine, Italy
| | - Giacomo Pelizzari
- Department of Oncology, Santa Maria della Misericordia University Hospital, ASUFC, Udine, Italy
| | - Francesco Grossi
- Department of Medicine and Surgery, University of Insubria, ASST dei Sette Laghi, Varese, Italy
| | - Carmine Pinto
- Department of Medical Oncology, Comprehensive Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Bruno Daniele
- Collegio Italiano dei Primari Oncologi Medici Ospedalieri (CIPOMO), Genova, Italy.,Department of Oncology, Ospedale del Mare, ASL Napoli 1 Centro, Napoli, Italy
| | - Monica Giordano
- Collegio Italiano dei Primari Oncologi Medici Ospedalieri (CIPOMO), Genova, Italy.,Department of Oncology, Ospedale Sant'Anna, ASST-Lariana, Como, Italy
| | - Cinzia Ortega
- Collegio Italiano dei Primari Oncologi Medici Ospedalieri (CIPOMO), Genova, Italy.,Department of Oncology, Ospedale San Lazzaro, Azienda sanitaria locale CN2, Alba, Italy
| | - Rosa Rita Silva
- Collegio Italiano dei Primari Oncologi Medici Ospedalieri (CIPOMO), Genova, Italy.,Department of Oncology, ASUR Marche, Area Vasta 2, Fabriano, Italy
| | - Valeria D Tozzi
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan, Italy
| | - Luigi Cavanna
- Collegio Italiano dei Primari Oncologi Medici Ospedalieri (CIPOMO), Genova, Italy.,Department of Oncology and Hematology, Piacenza General Hospital, AUSL Piacenza, Piacenza, Italy
| | - Giuseppe Aprile
- Collegio Italiano dei Primari Oncologi Medici Ospedalieri (CIPOMO), Genova, Italy.,Department of Clinical Oncology, San Bortolo Hospital of Vicenza, Azienda ULSS8 Berica, Vicenza, Italy
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8
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Carotenuto P, Salati M, Barbato A, Piscopo F, Evangelista L, Gambardella G, Sarnataro S, Petrillo A, Daniele B, Pisapia P, Iaccarino A, Salatiello M, Spallanzani A, Gelsomino F, Malapelle U, Iuliano A, Troncone G, Reggiani Bonetti L, Dominici M, Franco B. Integrated analysis of genomic and transcriptomic profiles to examine CD73/NT5E as a driver of drug-resistance and immunosuppression in biliary cancer (BTC). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.606] [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: 01/26/2023] Open
Abstract
606 Background: Despite the improved outcome achieved by the addition of the anti-PD-L1 durvalumab to standard chemotherapy, the vast majority of BTC do not benefit from chemo-immunotherapy. Immunosuppressive microenvironment is a dominant feature of BTC, involved in tumour progression and drug resistance. Here, we investigated the biological role and treatment implications of the adenosine-producing enzyme CD73 in a clinically-annotated cohort of BTC. CD73, an ecto-5’-nucleotidase (NT5E), creates an immunosuppressive tumour-promoting microenvironment by converting ATP to adenosine. Methods: Immunohistochemistry for CD73, CD4/CD8 and FOXP3 as well as whole-exome and transcriptomic sequencing were performed on resected specimens of 80 BTC (Illumina Platform). Spatial Transcriptomics was performed by using Visium Spatial Gene Expression-10x Genomics). Silencing of CD73 was obtained by transient transfection od CD73-siRNA, while genetic Knock-out by using CRISPR-Cas system technology in two BTC cell lines. Tumor growth was assessed in 2D and in 3D cell culture by using MTS assay and spheroid growth analysis before and after treatment with selected drugs. Statistical and Survival, correlation analyses were performed. Results: High CD73 expression (CD73high) was associated with older age (>70 years, p=0.01), gallbladder subsite (p=0.03), and nodal involvement (p=0.04). CD73high tumours were significantly enriched in infiltrating FOXP3+ T lymphocytes (p<0.001). CD73high status was independent predictor of poorer prognosis at the multivariate analysis (p=0,03) together with ECOG PS ≥2 (p=0,001) and the pathological stage (p=0,025) and was associated with a remarkably shorter RFS in patients treated with adjuvant chemotherapy (p=0,011). At the transcriptomic level, CD73high tumours were significantly enriched in upregulated EMT, TNF-alfa/NFKB, hypoxia and G2/M checkpoint signaling pathways and p53, BMI1, MEL18, EGFR and K-RAS genes. In in vitro models, siRNA-mediated depletion and CRISPR-CAS9 gene KO of CD73 sensitized both BTC 2D and 3D culture to cisplatin/gemcitabine treatment. The pharmacological inhibition of CD73 by AMCP improved the sensitivity of BTC cell lines to cisplatin/gemcitabine treatment. Finally, Spatially resolved transcriptomics of CD73high revealed a critical role of CD73 in tumor immunity and therapeutic response. Conclusions: We showed that CD73high BTC display aggressive biological features, poorer prognosis and resistance to standard chemotherapy. The therapeutic targeting of this adenosinergic ectonucleotidase by clinically-available compounds has the potential to enhance the efficacy of conventional treatment in BTC.
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Affiliation(s)
- Pietro Carotenuto
- Department of Translational Medical Science, University of Naples, Federico II, Naples, Italy
| | - Massimiliano Salati
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Anna Barbato
- Genomic Medicine, TIGEM-Telethon Institute of Genetics and Medicine, Pozzuoli, Italy
| | - Fabiola Piscopo
- TIGEM, Telethon Institute of Genetics and Medicine, Naples, Italy
| | | | - Gennaro Gambardella
- Genomic Medicine, TIGEM-Telethon Institute of Genetics and Medicine, Pozzuoli, Italy
| | - Sergio Sarnataro
- TIGEM, Telethon Institute of Genetics and Medicine, Naples, Italy
| | | | - Bruno Daniele
- Medical Oncology Unit, Ospedale del Mare, Naples, Italy
| | - Pasquale Pisapia
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Antonino Iaccarino
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Maria Salatiello
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | | | - Fabio Gelsomino
- Department of Oncology and Haematology, Division of Oncology, University Hospital of Modena, Modena, Italy, Modena, Italy
| | - Umberto Malapelle
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Antonella Iuliano
- Department of Mathematics, Informatics and Economy (DIMIE), University of Basilicata, Potenza, Italy
| | - Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | | | - Massimo Dominici
- Department of Oncology, University of Modena and Reggio Emilia, Italy, Modena, Italy
| | - Brunella Franco
- TIGEM, Telethon Institute of Genetics and Medicine, Naples, Italy
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9
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Kudo M, Finn RS, Qin S, Han KH, Ikeda K, Cheng AL, Vogel A, Tovoli F, Ueshima K, Aikata H, López CL, Pracht M, Meng Z, Daniele B, Park JW, Palmer D, Tamai T, Saito K, Dutcus CE, Lencioni R. Overall survival and objective response in advanced unresectable hepatocellular carcinoma: A subanalysis of the REFLECT study. J Hepatol 2023; 78:133-141. [PMID: 36341767 DOI: 10.1016/j.jhep.2022.09.006] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/26/2022] [Accepted: 09/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND & AIMS Validated surrogate endpoints for overall survival (OS) are important for expediting the clinical study and drug-development processes. Herein, we aimed to validate objective response as an independent predictor of OS in individuals with unresectable hepatocellular carcinoma (HCC) receiving systemic anti-angiogenic therapy. METHODS We investigated the association between objective response (investigator-assessed mRECIST, independent radiologic review [IRR] mRECIST and RECIST v1.1) and OS in REFLECT, a phase III study of lenvatinib vs. sorafenib. We conducted landmark analyses (Simon-Makuch) of OS by objective response at 2, 4, and 6 months after randomization. RESULTS Median OS was 21.6 months (95% CI 18.6-24.5) for responders (investigator-assessed mRECIST) vs. 11.9 months (95% CI 10.7-12.8) for non-responders (hazard ratio [HR] 0.61; 95% CI 0.49-0.76; p <0.001). Objective response by IRR per mRECIST and RECIST v1.1 supported the association with OS (HR 0.61; 95% CI 0.51-0.72; p <0.001 and HR 0.50; 95% CI 0.39-0.65; p <0.001, respectively). OS was significantly prolonged for responders vs. non-responders (investigator-assessed mRECIST) at the 2-month (HR 0.61; 95% CI 0.49-0.76; p <0.001), 4-month (HR 0.63; 95% CI 0.51-0.80; p <0.001), and 6-month (HR 0.68; 95% CI 0.54-0.86; p <0.001) landmarks. Results were similar when assessed by IRR, with both mRECIST and RECIST v1.1. An exploratory multivariate Cox regression analysis identified objective response by investigator-assessed mRECIST (HR 0.55; 95% CI 0.44-0.68; p <0.0001) and IRR-assessed RECIST v1.1 (HR 0.49; 95% CI, 0.38-0.64; p <0.0001) as independent predictors of OS in individuals with unresectable HCC. CONCLUSIONS Objective response was an independent predictor of OS in individuals with unresectable HCC in REFLECT; additional studies are needed to confirm surrogacy. Participants achieving a complete or partial response by mRECIST or RECIST v1.1 had significantly longer survival vs. those with stable/progressive/non-evaluable disease. GOV NUMBER NCT01761266. IMPACT AND IMPLICATIONS This analysis of data taken from a completed clinical trial (REFLECT) looked for any link between objective response and overall survival time in individuals with unresectable HCC receiving anti-angiogenic treatments. Significantly longer median overall survival was found for responders (21.6 months) vs. non-responders (11.9 months). Overall survival was also significantly longer for responders vs. non-responders (based on objective response status at 2, 4, and 6 months) in the landmark analysis. Our results indicate that objective response is an independent predictor of overall survival in this setting, confirming its validity as a rapid marker of efficacy that can be applied in phase II trials; however, further validation is required to determine is validity for other systemic treatments (e.g. immunotherapies), or as a surrogate of overall survival.
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Affiliation(s)
- Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
| | - Richard S Finn
- Department of Gastroenterology and Hepatology, Geffen School of Medicine, UCLA Medical Center, Santa Monica, CA, USA
| | - Shukui Qin
- Director of Chinese PLA Cancer Center, Nanjing Bayi Hospital, Nanjing, Jiangsu, China
| | - Kwang-Hyub Han
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kenji Ikeda
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Ann-Lii Cheng
- Oncology, Internal and General Medicine, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Taiwan
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Francesco Tovoli
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Kazuomi Ueshima
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Hiroshi Aikata
- Department of Medicine and Molecular Science, Hiroshima University Hospital, Hiroshima, Japan
| | - Carlos López López
- Department of Medical Oncology, Marqués de Valdecilla University Hospital, IDIVAL, Santander, Spain
| | - Marc Pracht
- Department of Medical Oncology, Comprehensive Cancer Center Eugène Marquis, Rennes, France
| | - Zhiqiang Meng
- Department of Integrative Oncology, Fudan University, Shanghai Cancer Center, Shanghai, China
| | - Bruno Daniele
- Department of Oncology, Azienda Ospedaliera G. Rummo, Benevento, Italy and Ospedale del Mare, Naples, Italy
| | - Joong-Won Park
- Department of Internal Medicine, National Cancer Center Korea, Goyang-si, Republic of Korea
| | - Daniel Palmer
- Department of Medical Oncology, The Clatterbridge Cancer Centre, Birkenhead, England, UK
| | | | - Kenichi Saito
- Biostatistics and Clinical Research, Eisai Inc., Nutley, NJ, USA
| | - Corina E Dutcus
- Biostatistics and Clinical Research, Eisai Inc., Nutley, NJ, USA
| | - Riccardo Lencioni
- Department of Radiology, Miami Cancer Institute, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Radiology, University of Pisa School of Medicine, Pisa, Italy
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10
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Fasola G, Barducci M, Pelizzari G, Aprile G, Grossi F, Pinto C, Daniele B, Giordano M, Ortega C, Silva R, Tozzi V, Cavanna L. 1337P Implementation of precision oncology in clinical practice: A nationwide survey in Italy. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1469] [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: 11/26/2022] Open
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11
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Edeline J, Finn R, Bouattour M, Cheng AL, Chan S, Yau T, Garrido M, Knox J, Daniele B, Breder V, Lim H, Ogasawara S, Odeleye-Ajakaye A, Martinez-Forero I, Siegel A, Merle P. 713P Pembrolizumab (Pembro) vs placebo (Pbo) as second-line treatment for sorafenib-treated advanced hepatocellular carcinoma (aHCC): 4.5-year follow-up from KEYNOTE-240. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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12
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Parisi A, Giampieri R, Mammarella A, Felicetti C, Salvatore L, Bensi M, Maratta MG, Strippoli A, Filippi R, Satolli MA, Petrillo A, Daniele B, De Tursi M, Di Marino P, Giordano G, Landriscina M, Vitale P, Zurlo IV, Dell’Aquila E, Tomao S, Depetris I, Di Pietro FR, Zoratto F, Ciardiello D, Pensieri MV, Garrone O, Galassi B, Ferri C, Berardi R, Ghidini M. Primary versus secondary antiemetic prophylaxis with NK1 receptor antagonists in patients affected by gastrointestinal malignancies and treated with a doublet or triplet combination regimen including oxaliplatin and/or irinotecan plus fluoropyrimidines: A propensity score matched analysis. Front Oncol 2022; 12:935826. [PMID: 36033477 PMCID: PMC9413268 DOI: 10.3389/fonc.2022.935826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/28/2022] [Indexed: 11/18/2022] Open
Abstract
Aim The aim of the current study is to investigate the impact of primary compared to secondary chemotherapy-induced nausea and vomiting (CINV) prophylaxis with NK1 receptor antagonists (NK1-RA) in patients affected by gastrointestinal malignancies and treated with oxaliplatin- and/or irinotecan-based doublet or triplet regimens. Study design and methods Clinical data of patients affected by gastrointestinal malignancies, treated with an oxaliplatin and/or irinotecan-based doublet or triplet regimen as neo/adjuvant or advanced-line treatment, and who received NK1-RA as primary (from the first cycle of treatment) or secondary (after the onset of CINV with a previous regimen with 5HT3-RA and dexamethasone) prophylaxis for CINV, were retrospectively collected in an observational study involving 16 Italian centers. A propensity score matching was performed by taking into account the following stratification factors: sex (male vs. female), age (< vs. ≥70 years old), overweight (body mass index, BMI < vs. ≥25), underweight (BMI < vs. ≥19), disease spread (early vs. advanced/metastatic), tumor type (esophagogastric cancer vs. the rest, hepatobiliary tumor vs. the rest, colorectal cancer vs. the rest), type of NK1-RA used as primary/secondary prophylaxis (netupitant-palonosetron vs. fosaprepitant/aprepitant), concomitant use of opioids (yes vs. no), concomitant use of antidepressant/antipsychotic drugs (yes vs. no), Eastern Cooperative Oncology Group (ECOG) performance status at the start of NK1-RA treatment (0 vs. 1–2), and intensity of chemotherapy regimen (doublet vs. triplet). Results Among 409 patients included from January 2015 to January 2022 and eligible for analysis, 284 (69%) and 125 (31%) were treated with NK1-RA as primary and secondary antiemetic prophylaxis, respectively. After matching, primary NK1-RA use was not associated with higher rates of protection from emesis regardless the emesis phase (acute phase, p = 0.34; delayed phase, p = 0.14; overall phase, p = 0.80). On the other hand, a lower rate of relevant nausea (p = 0.02) and need for rescue antiemetic therapy (p = 0.000007) in the overall phase was found in primary NK1-RA users. Furthermore, a higher rate of both complete antiemetic response (p = 0.00001) and complete antiemetic protection (p = 0.00007) in the overall phase was more frequently observed in primary NK1-RA users. Finally, chemotherapy delays (p = 0.000009) and chemotherapy dose reductions (p = 0.0000006) were less frequently observed in primary NK1-RA users. Conclusion In patients affected by gastrointestinal malignancies, a primary CINV prophylaxis with NK1-RA, 5HT3-RA, and dexamethasone might be appropriate, particularly in those situations at higher risk of emesis and in which it is important to avoid dose delays and/or dose reductions, keeping a proper dose intensity of chemotherapy drugs.
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Affiliation(s)
- Alessandro Parisi
- Clinica Oncologica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti-Ancona, Ancona, Italy
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
- *Correspondence: Alessandro Parisi,
| | - Riccardo Giampieri
- Clinica Oncologica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti-Ancona, Ancona, Italy
| | - Alex Mammarella
- Clinica Oncologica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti-Ancona, Ancona, Italy
| | - Cristiano Felicetti
- Clinica Oncologica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti-Ancona, Ancona, Italy
| | - Lisa Salvatore
- Università Cattolica del Sacro Cuore, Rome, Italy
- Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Maria Bensi
- Università Cattolica del Sacro Cuore, Rome, Italy
- Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Maria Grazia Maratta
- Università Cattolica del Sacro Cuore, Rome, Italy
- Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Antonia Strippoli
- Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Roberto Filippi
- Department of Oncology, University of Turin, Torino, Italy
- S.C Oncologia Medica 1, Centro Oncologico Ematologico Subalpino (COES), Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Maria Antonietta Satolli
- Department of Oncology, University of Turin, Torino, Italy
- S.C Oncologia Medica 1, Centro Oncologico Ematologico Subalpino (COES), Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Bruno Daniele
- Medical Oncology Unit, Ospedale del Mare, Naples, Italy
| | - Michele De Tursi
- Department of Medical, Oral and Biotechnological Sciences and Center for Advance Studies and Technology (CAST), G. D’Annunzio University, Chieti, Italy
- Clinical Oncology Unit, S.S. Annunziata Hospital, Chieti, Italy
| | - Pietro Di Marino
- Department of Medical, Oral and Biotechnological Sciences and Center for Advance Studies and Technology (CAST), G. D’Annunzio University, Chieti, Italy
- Clinical Oncology Unit, S.S. Annunziata Hospital, Chieti, Italy
| | - Guido Giordano
- Medical Oncology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Matteo Landriscina
- Medical Oncology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | | | | | - Silverio Tomao
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Medical Oncology Unit A, Policlinico Umberto I, ‘Sapienza’ University of Rome, Rome, Italy
| | - Ilaria Depetris
- Medical Oncology, ASL TO4, Ospedale Civile di Ivrea, Turin, Italy
| | | | | | - Davide Ciardiello
- Oncology Unit, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
- Oncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | | | - Ornella Garrone
- Medical Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Barbara Galassi
- Medical Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Rossana Berardi
- Clinica Oncologica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti-Ancona, Ancona, Italy
| | - Michele Ghidini
- Medical Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
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13
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Pisapia P, Iaccarino A, De Luca C, Acanfora G, Bellevicine C, Bianco R, Daniele B, Ciampi L, De Felice M, Fabozzi T, Formisano L, Giordano P, Gridelli C, Ianniello GP, Libroia A, Maione P, Nacchio M, Pagni F, Palmieri G, Pepe F, Russo G, Salatiello M, Santaniello A, Scamarcio R, Seminati D, Troia M, Troncone G, Vigliar E, Malapelle U. Evaluation of the Molecular Landscape in PD-L1 Positive Metastatic NSCLC: Data from Campania, Italy. Int J Mol Sci 2022; 23:ijms23158541. [PMID: 35955681 PMCID: PMC9369105 DOI: 10.3390/ijms23158541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Immune-checkpoint inhibitors (ICIs) have increased and improved the treatment options for patients with non-oncogene-addicted advanced stage non-small cell lung cancer (NSCLC). However, the role of ICIs in oncogene-addicted advanced stage NSCLC patients is still debated. In this study, in an attempt to fill in the informational gap on the effect of ICIs on other driver mutations, we set out to provide a molecular landscape of clinically relevant oncogenic drivers in programmed death-ligand 1 (PD-L1) positive NSCLC patients. Methods: We retrospectively reviewed data on 167 advanced stage NSCLC PD-L1 positive patients (≥1%) who were referred to our clinic for molecular evaluation of five driver oncogenes, namely, EGFR, KRAS, BRAF, ALK and ROS1. Results: Interestingly, n = 93 (55.7%) patients showed at least one genomic alteration within the tested genes. Furthermore, analyzing a subset of patients with PD-L1 tumor proportion score (TPS) ≥ 50% and concomitant gene alterations (n = 8), we found that n = 3 (37.5%) of these patients feature clinical benefit with ICIs administration, despite the presence of a concomitant KRAS gene alteration. Conclusions: In this study, we provide a molecular landscape of clinically relevant biomarkers in NSCLC PD-L1 positive patients, along with data evidencing the clinical benefit of ICIs in patient NSCLC PD-L1 positive alterations.
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Affiliation(s)
- Pasquale Pisapia
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Antonino Iaccarino
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Caterina De Luca
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Gennaro Acanfora
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Claudio Bellevicine
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Roberto Bianco
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Bruno Daniele
- Oncology Unit, Ospedale del Mare, 80147 Naples, Italy
| | - Luisa Ciampi
- Department of Pathology, Ente Ecclesiastico Ospedale Generale Regionale F. Miulli, 70021 Acquaviva delle Fonti, Italy
| | - Marco De Felice
- Department of Oncology, A.O.R.N. Sant'Anna e San Sebastiano, 81100 Caserta, Italy
| | | | - Luigi Formisano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | | | - Cesare Gridelli
- Division of Medical Oncology, "S.G. Moscati" Hospital, 83100 Avellino, Italy
| | | | - Annamaria Libroia
- Oncology Unit, "Andrea Tortora" Hospital, ASL Salerno, 84016 Pagani, Italy
| | - Paolo Maione
- Division of Medical Oncology, "S.G. Moscati" Hospital, 83100 Avellino, Italy
| | - Mariantonia Nacchio
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, University of Milano-Bicocca, 20900 Monza, Italy
| | - Giovanna Palmieri
- Department of Pathology, Ente Ecclesiastico Ospedale Generale Regionale F. Miulli, 70021 Acquaviva delle Fonti, Italy
| | - Francesco Pepe
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Gianluca Russo
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Maria Salatiello
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Antonio Santaniello
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Rachele Scamarcio
- Department of Pathology, Ente Ecclesiastico Ospedale Generale Regionale F. Miulli, 70021 Acquaviva delle Fonti, Italy
| | - Davide Seminati
- Department of Medicine and Surgery, Pathology, University of Milano-Bicocca, 20900 Monza, Italy
| | - Michele Troia
- Department of Pathology, Ente Ecclesiastico Ospedale Generale Regionale F. Miulli, 70021 Acquaviva delle Fonti, Italy
| | - Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Elena Vigliar
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Umberto Malapelle
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
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14
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Luca CD, Pepe F, Pisapia P, Iaccarino A, Righi L, Listì A, Russo G, Campione S, Pagni F, Nacchio M, Conticelli F, Russo M, Fabozzi T, Vigliar E, Bellevicine C, Rocco D, Laudati S, Iannaci G, Daniele B, Gridelli C, Cortinovis DL, Novello S, Molina-Vila MA, Rosell R, Troncone G, Malapelle U. RNA-based next generation sequencing in non-small-cell lung cancer in a routine setting: an experience from an Italian referral center. Per Med 2022; 19:395-401. [PMID: 35801400 DOI: 10.2217/pme-2022-0020] [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] [Indexed: 11/21/2022]
Abstract
Aim: ALK, ROS1, NTRK and RET gene fusions and MET exon 14 skipping alterations represent novel predictive biomarkers for advanced non-small-cell lung cancer (NSCLC). Therefore, testing patients for these genetic variants is crucial for choosing the best selective treatment. Over the last couple of decades, next generation sequencing (NGS) platforms have emerged as an extremely useful tool for detecting these variants. Materials & methods: In the present study, we report our NGS molecular records produced during a year of diagnostic activity. Results: Overall, our in-house developed NGS workflow successfully analyzed n = 116/131 (88.5%) NSCLC samples. Of these, eight (6.8%) and five (4.3%) out of 116 patients harbored ALK and RET gene rearrangements, respectively: one case harbored ROS1 gene fusion (0.7%). Conclusion: Our results highlight that an RNA-based NGS analysis can reliably detect gene fusion alterations, thereby playing a pivotal role in the management of NSCLC patients.
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Affiliation(s)
- Caterina De Luca
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Francesco Pepe
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Pasquale Pisapia
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Antonino Iaccarino
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Luisella Righi
- Department of Oncology, University of Turin, San Luigi Hospital, Regione Gonzole 1, Orbassano, Turin, 10043, Italy
| | - Angela Listì
- Department of Oncology, University of Turin, San Luigi Hospital, Regione Gonzole 1, Orbassano, Turin, 10043, Italy
| | - Gianluca Russo
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Severo Campione
- Department of Advanced Technology, Pathology Unit, Cardarelli Hospital, Naples, Italy
| | - Fabio Pagni
- Department of Pathology, University of Milan-Bicocca (UNIMIB), Monza, Italy
| | - Mariantonia Nacchio
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Floriana Conticelli
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Maria Russo
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | | | - Elena Vigliar
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Claudio Bellevicine
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Danilo Rocco
- Department of Pulmonary Oncology, AORN dei Colli Monaldi, Naples, Italy
| | | | | | | | - Cesare Gridelli
- Division of Medical Oncology, 'S.G. Moscati' Hospital, Avellino, Italy
| | | | - Silvia Novello
- Department of Oncology, University of Turin, San Luigi Hospital, Regione Gonzole 1, Orbassano, Turin, 10043, Italy
| | | | - Rafael Rosell
- Laboratory of Oncology, Pangaea Biotech, Quiron Dexeus University Hospital, Barcelona, Spain.,Instituto Oncológico Dr. Rosell, Quiron-Dexeus University Hospital, Barcelona, Spain.,Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain.,Germans Trias i Pujol, Health Sciences Institute & Hospital, Badalona, Spain
| | - Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Umberto Malapelle
- Department of Public Health, University of Naples Federico II, Naples, Italy
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15
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Verset G, Borbath I, Karwal M, Verslype C, Van Vlierberghe H, Kardosh A, Zagonel V, Stal P, Sarker D, Palmer DH, Vogel A, Edeline J, Cattan S, Kudo M, Cheng AL, Ogasawara S, Daniele B, Chan SL, Knox JJ, Qin S, Siegel AB, Chisamore M, Hatogai K, Wang A, Finn RS, Zhu AX. Pembrolizumab Monotherapy for Previously Untreated Advanced Hepatocellular Carcinoma: Data from the Open-Label, Phase II KEYNOTE-224 Trial. Clin Cancer Res 2022; 28:2547-2554. [PMID: 35421228 PMCID: PMC9784157 DOI: 10.1158/1078-0432.ccr-21-3807] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/27/2022] [Accepted: 04/11/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE KEYNOTE-224 cohort 1 demonstrated that pembrolizumab was efficacious and tolerable in patients with advanced hepatocellular carcinoma (HCC) previously treated with sorafenib. We report results from KEYNOTE-224 (NCT02702414) cohort 2, which enrolled patients with advanced HCC and no prior systemic therapy. PATIENTS AND METHODS KEYNOTE-224 was an open-label, multicountry phase II trial. Eligible patients in cohort 2 had advanced HCC not amenable or refractory to locoregional therapy and not previously treated with systemic therapy. Patients received pembrolizumab 200 mg intravenously every 3 weeks for ≤2 years. Primary endpoint was objective response rate (ORR) by central imaging review per RECIST v1.1. Secondary endpoints included duration of response (DOR), disease control rate (DCR), time to progression (TTP), progression-free survival (PFS), overall survival (OS), and safety/tolerability. RESULTS Between September 4, 2018, and February 20, 2019, 51 patients were allocated in cohort 2. The median time from the first dose to data cutoff (January 19, 2021) was 27 months (range, 23-29). ORR was 16% [95% confidence interval (CI), 7-29] and was similar across key subgroups. Median DOR was 16 months (range, 3-24+), and DCR was 57%. The median PFS was 4 months (95% CI, 2-8), and median TTP was 4 months (95% CI, 3-9). Median OS was 17 months (95% CI, 8-23). Grade ≥3 treatment-related adverse events occurred in 16% of patients. CONCLUSIONS In patients with advanced HCC with no prior systemic therapy, pembrolizumab provided durable antitumor activity, promising OS, and had a safety profile consistent with previous observations. These findings support further evaluation of pembrolizumab-based regimens for HCC.
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Affiliation(s)
- Gontran Verset
- Gastrointestinal Oncology Unit, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Ivan Borbath
- Cliniques Universitaires Saint-Luc and Université Catholique de Louvain, Brussels, Belgium
| | | | - Chris Verslype
- Digestive Oncology, Department of Oncology, University Hospital Leuven, Belgium
| | | | - Adel Kardosh
- Oregon Health & Science University, Knight Cancer Institute, Portland, Oregon
| | - Vittorina Zagonel
- Oncology Unit 1, Istituto Oncologico Veneto, IOV, IRCCS, Padua, Italy
| | - Per Stal
- Karolinska Institutet, Stockholm, Sweden
| | - Debashis Sarker
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Daniel H. Palmer
- Cancer Research UK Liverpool Experimental Cancer Medicine Centre, University of Liverpool, Liverpool, United Kingdom
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology, and Endocrinology, Medizinische Hochschule, Hannover, Germany
| | - Julien Edeline
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Stephane Cattan
- Department of Medical Oncology and Gastroenterology, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Ann-Lii Cheng
- Department of Medical Oncology, National Taiwan University Cancer Center, and Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Sadahisa Ogasawara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | - Stephen L. Chan
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jennifer J. Knox
- Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Shukui Qin
- Cancer Centre of Jinling Hospital, Nanjing University of Chinese Medicine, Nanjing, China
| | | | | | | | - Anran Wang
- Merck & Co., Inc., Kenilworth, New Jersey
| | - Richard S. Finn
- Department of Medicine, University of California, Los Angeles, California.,Corresponding Author: Richard S. Finn, Department of Medicine, University of California, Los Angeles, 2020 Santa Monica Boulevard Suite 580, Santa Monica, CA 90404. E-mail:
| | - Andrew X. Zhu
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Jiahui International Cancer Center, Jiahui Health, Shanghai, China
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16
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Carlino F, Diana A, Piccolo A, Ventriglia A, Bruno V, De Santo I, Letizia O, De Vita F, Daniele B, Ciardiello F, Orditura M. Immune-Based Therapy in Triple-Negative Breast Cancer: From Molecular Biology to Clinical Practice. Cancers (Basel) 2022; 14:cancers14092102. [PMID: 35565233 PMCID: PMC9103968 DOI: 10.3390/cancers14092102] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 12/19/2022] Open
Abstract
Triple-negative breast cancer (TNBC) has been considered for many years an orphan disease in terms of therapeutic options, with conventional chemotherapy (CT) still representing the mainstay of treatment in the majority of patients. Although breast cancer (BC) has been historically considered a "cold tumor", exciting progress in the genomic field leading to the characterization of the molecular portrait and the immune profile of TNBC has opened the door to novel therapeutic strategies, including Immune Checkpoint Inhibitors (ICIs), Poly ADP-Ribose Polymerase (PARP) inhibitors and Antibody Drug Conjugates (ADCs). In particular, compared to standard CT, the immune-based approach has been demonstrated to improve progression-free survival (PFS) and overall survival (OS) in metastatic PD-L1-positive TNBC and the pathological complete response rate in the early setting, regardless of PD-L1 expression. To date, PD-L1 has been widely used as a predictor of the response to ICIs; however, many patients do not benefit from the addition of immunotherapy. Therefore, PD-L1 is not a reliable predictive biomarker of the response, and its accuracy remains controversial due to the lack of a consensus about the assay, the antibody, and the scoring system to adopt, as well as the spatial and temporal heterogeneity of the PD-L1 status. In the precision medicine era, there is an urgent need to identify more sensitive biomarkers in the BC immune oncology field other than just PD-L1 expression. Through the characterization of the tumor microenvironment (TME), the analysis of peripheral blood and the evaluation of immune gene signatures, novel potential biomarkers have been explored, such as the Tumor Mutational Burden (TMB), Microsatellite Instability/Mismatch Repair Deficiency (MSI/dMMR) status, genomic and epigenomic alterations and tumor-infiltrating lymphocytes (TILs). This review aims to summarize the recent knowledge on BC immunograms and on the biomarkers proposed to support ICI-based therapy in TNBC, as well as to provide an overview of the potential strategies to enhance the immune response in order to overcome the mechanisms of resistance.
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Affiliation(s)
- Francesca Carlino
- Department of Precision Medicine, Division of Medical Oncology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (A.P.); (A.V.); (V.B.); (F.D.V.); (F.C.); (M.O.)
- Medical Oncology Unit, Ospedale Ave Gratia Plena, San Felice a Cancello, 81027 Caserta, Italy; (I.D.S.); (O.L.)
- Correspondence: ; Tel.: +39-349-5152216
| | - Anna Diana
- Medical Oncology Unit, Ospedale del Mare, 80147 Naples, Italy; (A.D.); (B.D.)
| | - Antonio Piccolo
- Department of Precision Medicine, Division of Medical Oncology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (A.P.); (A.V.); (V.B.); (F.D.V.); (F.C.); (M.O.)
| | - Anna Ventriglia
- Department of Precision Medicine, Division of Medical Oncology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (A.P.); (A.V.); (V.B.); (F.D.V.); (F.C.); (M.O.)
| | - Vincenzo Bruno
- Department of Precision Medicine, Division of Medical Oncology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (A.P.); (A.V.); (V.B.); (F.D.V.); (F.C.); (M.O.)
| | - Irene De Santo
- Medical Oncology Unit, Ospedale Ave Gratia Plena, San Felice a Cancello, 81027 Caserta, Italy; (I.D.S.); (O.L.)
| | - Ortensio Letizia
- Medical Oncology Unit, Ospedale Ave Gratia Plena, San Felice a Cancello, 81027 Caserta, Italy; (I.D.S.); (O.L.)
| | - Ferdinando De Vita
- Department of Precision Medicine, Division of Medical Oncology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (A.P.); (A.V.); (V.B.); (F.D.V.); (F.C.); (M.O.)
| | - Bruno Daniele
- Medical Oncology Unit, Ospedale del Mare, 80147 Naples, Italy; (A.D.); (B.D.)
| | - Fortunato Ciardiello
- Department of Precision Medicine, Division of Medical Oncology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (A.P.); (A.V.); (V.B.); (F.D.V.); (F.C.); (M.O.)
| | - Michele Orditura
- Department of Precision Medicine, Division of Medical Oncology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (A.P.); (A.V.); (V.B.); (F.D.V.); (F.C.); (M.O.)
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17
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Diana A, Carlino F, Buono G, Antoniol G, Famiglietti V, De Angelis C, Carrano S, Piccolo A, De Vita F, Ciardiello F, Daniele B, Arpino G, Orditura M. Prognostic Relevance of Progesterone Receptor Levels in Early Luminal-Like HER2 Negative Breast Cancer Subtypes: A Retrospective Analysis. Front Oncol 2022; 12:813462. [PMID: 35419293 PMCID: PMC8996175 DOI: 10.3389/fonc.2022.813462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction In luminal-like early breast cancer (BC), the lack of Progesterone Receptor (PR) expression generally correlates with more aggressive behavior but the clinical validity of low PR levels remains a debated issue. Methods The main aim of this retrospective analysis was to assess the survival outcome (Breast cancer specific survival, BCSS) in a cohort of 687 luminal-like HER2 negative early BC patients treated at our Institutions from January 2000 to December 2018, using a sub-classification of tumors in subgroup 1 (PR high/Ki67 low), subgroup 2 (PR high/Ki67 high), subgroup 3 (PR low/Ki67 low), subgroup 4 (PR low/Ki67 high) according to PR and Ki67 values. Results At a median follow-up of 7 years, BCSS rates were 96.3%, 89%, 86.8% and 85% in the subgroup 1, 2, 3, 4 respectively. Overall, a statistically significant difference in BCSS rates was observed among the 4 subgroups (p=0.0036). On univariate analysis, post-menopause, older age (≥ 50 years), low PR and high Ki67 expression, poorly differentiated grade and size ≥ 2 cm as well as luminal B-like tumors (subgroups 2, 3, 4) were significantly associated with a worse BCSS. Multivariate analysis identified grade, size and subgroup classification of BC as independent prognostic markers of poorer outcome. In particular, subgroups 4, 3 and 2 displayed a significantly higher risk of BC-related death (HR=4.11; p=0.008; HR=3.43; p=0-007; HR=2.57; p=0.020, respectively) when compared to subgroup 1. Conclusions Our results support the usefulness of PR and Ki67 levels as prognostic markers, corroborating their crucial role in the decision-making process of patients with luminal-like HER2 negative early BC. Clinical application of these parameters should be assessed prospectively.
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Affiliation(s)
- Anna Diana
- Division of Medical Oncology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.,Medical Oncology Unit, Ospedale del Mare, Naples, Italy
| | - Francesca Carlino
- Division of Medical Oncology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.,Medical Oncology Unit, Ospedale Ave Gratia Plena, San Felice a Cancello, Caserta, Italy
| | - Giuseppe Buono
- Department of Breast and Thoracic Oncology, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Fondazione G. Pascale", Naples, Italy
| | | | - Vincenzo Famiglietti
- Division of Medical Oncology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Carmine De Angelis
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples "Federico II", Naples, Italy
| | - Simone Carrano
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples "Federico II", Naples, Italy
| | - Antonio Piccolo
- Division of Medical Oncology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Fortunato Ciardiello
- Division of Medical Oncology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Bruno Daniele
- Medical Oncology Unit, Ospedale del Mare, Naples, Italy
| | - Grazia Arpino
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples "Federico II", Naples, Italy
| | - Michele Orditura
- Division of Medical Oncology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
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Vogel A, Cervantes A, Chau I, Daniele B, Llovet JM, Meyer T, Nault JC, Neumann U, Ricke J, Sangro B, Schirmacher P, Verslype C, Zech CJ, Arnold D, Martinelli E. Corrigendum to "Hepatocellular carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up": [Annals of Oncology 29 suppl. 4 (2018) v238-iv255]. Ann Oncol 2022; 33:666. [PMID: 35365377 DOI: 10.1016/j.annonc.2022.03.009] [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: 11/28/2022] Open
Affiliation(s)
- A Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover, Germany
| | - A Cervantes
- Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - I Chau
- Department of Medicine, Royal Marsden Hospital, Surrey, UK
| | - B Daniele
- Dipartimento di Oncologia, A. O. G. Rummo, Benevento, Italy
| | - J M Llovet
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, Mount Sinai Liver Cancer Program, New York, USA; Barcelona-Clínic Liver Cancer Group (BCLC), Unitat d'Hepatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - T Meyer
- Oncology, Royal Free Hospital, London, UK; UCL Cancer Institute, University College London, London, UK
| | - J-C Nault
- Service d'hépatologie, Hôpital Jean Verdier, Bondy, France
| | - U Neumann
- Klinik für Allgemein- und Viszeralchirurgie, Medizinische Fakultät der RWTH Aachen, Germany
| | - J Ricke
- Klinik und Poliklinik für Radiologie, Ludwig-Maximilians-Universität München, Munich, Germany
| | - B Sangro
- Liver Unit, Clinica Universidad de Navarra-IDISNA and CIBEREHD, Pamplona, Spain
| | - P Schirmacher
- Institute of Pathology, University Hospital, Heidelberg, Germany
| | - C Verslype
- Campus Gasthuisberg, UZ Leuven, Leuven, Belgium
| | - C J Zech
- Klinik für Radiologie und Nuklearmedizin Universität Basel, Basel, Switzerland
| | - D Arnold
- Department Oncology, Section Hematology and Palliative Care AK Altona, Asklepios Tumorzentrum Hamburg, Hamburg, Germany
| | - E Martinelli
- Faculty of Medicine, Università della Campania L. Vanvitelli Naples, Caserta, Italy
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19
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Kudo M, Finn RS, Edeline J, Cattan S, Ogasawara S, Palmer DH, Verslype C, Zagonel V, Fartoux L, Vogel A, Sarker D, Verset G, Chan SL, Knox J, Daniele B, Yau T, Gurary EB, Siegel AB, Wang A, Cheng AL, Zhu AX. Updated efficacy and safety of KEYNOTE-224: a phase II study of pembrolizumab in patients with advanced hepatocellular carcinoma previously treated with sorafenib. Eur J Cancer 2022; 167:1-12. [PMID: 35364421 DOI: 10.1016/j.ejca.2022.02.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Pembrolizumab, a PD-1 inhibitor, demonstrated anti-tumour activity and tolerability in patients treated with sorafenib and with advanced hepatocellular carcinoma in KEYNOTE-224. Longer-term efficacy and safety after ∼2.5 years of additional follow-up are reported. PATIENTS AND METHODS Adults with confirmed hepatocellular carcinoma who experienced progression after or intolerance to sorafenib treatment received pembrolizumab 200 mg every 3 weeks for ≤35 cycles or until confirmed progression, unacceptable toxicity, withdrawal of consent or investigator decision. The primary end-point was objective response rate assessed by blinded independent central review per Response Evaluation Criteria in Solid Tumours v1.1. The secondary end-points included duration of response, disease control rate, time to progression, progression-free survival, overall survival and adverse events. RESULTS Efficacy and safety were assessed in 104 patients. The median time from first dose to data cutoff was 45.1 months (range, 41.3-49.3). Objective response rate was 18.3% (95% CI: 11.4-27.1), and median duration of response was 21.0 months (range, 3.1 to 39.5+). Disease control rate was 61.5%, and median time to progression was 4.8 months (95% CI: 3.9-7.0). Median progression-free survival was 4.9 months (95% CI: 3.5-6.7) and median overall survival was 13.2 months (95% CI: 9.7-15.3). Of 104 patients, 76 (73.1%) patients reported treatment-related adverse events; most were low grade in severity (grade 3-4, n = 26 [25.0%]; grade 5, n = 1 [1.0%]). Immune-mediated hepatitis occurred in 3 patients (all grade 3). No viral-induced hepatitis flares occurred. CONCLUSIONS After ∼2.5 years of additional follow-up, pembrolizumab continued to provide durable anti-tumour activity and no new safety concerns were identified. CLINICALTRIALS GOV IDENTIFIER NCT02702414.
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Affiliation(s)
- Masatoshi Kudo
- Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, Japan.
| | - Richard S Finn
- University of California, 10833 Le Conte Avenue, Los Angeles, CA, USA.
| | - Julien Edeline
- Centre Eugene Marquis, Avenue de la Bataille Flandres-Dunkerque, Rennes, France.
| | | | - Sadahisa Ogasawara
- Chiba University Graduate School of Medicine, Inohana Campus 1-8-1, Inohana, Chuo-ku, Chiba, Japan.
| | - Daniel H Palmer
- CR UK Liverpool Experimental Cancer Medicine Centre, 5 Pembroke Place, Liverpool, UK; Clatterbridge Cancer Centre, Liverpool, UK.
| | - Chris Verslype
- University Hospitals Leuven, Herestraat 49, Leuven, Belgium.
| | - Vittorina Zagonel
- Istituto Oncologico Veneto IOV-IRCCS, Via Gattamelata, 64, Padua, Italy.
| | - Laetitia Fartoux
- The Hospital Group Saint Joseph, 47-83 Boulevard de l'Hôpital, Paris, France.
| | - Arndt Vogel
- Medizinische Hochschule, Carl-Neuberg-Strasse 1, Hannover, Germany.
| | | | - Gontran Verset
- Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, Brussels, Belgium.
| | - Stephen L Chan
- State Key Laboratory of Oncology in South China, The Chinese University of Hong Kong, Shatin, LG, LKS Specialist Clinic (North Wing), Hong Kong, China.
| | - Jennifer Knox
- Princess Margaret Cancer Centre and University of Toronto, 610 University Avenue, Toronto, Ontario, Canada.
| | | | - Thomas Yau
- University of Hong Kong, Queen Mary Hospital, Hong Kong, 102 Pok Fu Lam Rd, Hong Kong, China.
| | - Ellen B Gurary
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, USA.
| | - Abby B Siegel
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, USA.
| | - Anran Wang
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, USA.
| | - Ann-Lii Cheng
- National Taiwan University Cancer Center, No. 57, Lane 155, Keelung 3rd Road, Taipei, Taiwan.
| | - Andrew X Zhu
- Massachusetts General Hospital Cancer Center and Harvard Medical School, 55 Fruit Street, Boston, MA, USA; Jiahui International Cancer Center, Jiahui Health, Shanghai, China.
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Tovoli F, Garajová I, Gelsomino F, Iavarone M, Federico P, Salati M, Corianò M, Caputo F, De Lorenzo S, Granito A, Renzulli M, Daniele B, Piscaglia F. Pattern of progression of intrahepatic cholangiocarcinoma: Implications for second-line clinical trials. Liver Int 2022; 42:458-467. [PMID: 34826193 PMCID: PMC9300150 DOI: 10.1111/liv.15117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/13/2021] [Accepted: 11/23/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Intrahepatic cholangiocarcinoma (iCCA) is the second most frequent liver cancer. The overall survival of iCCA and other biliary tract cancers (BTC) remains poor. Recently, the ABC-06 trial reported the superiority of FOLFOX vs clinical observation as a second-line treatment. Still, the survival benefit was less than expected. We hypothesized that the pattern of progression of iCCA can drive post-progression survival (PPS), similar to hepatocellular carcinoma. METHODS Multicentre retrospective evaluation of consecutive iCCA patients who progressed after frontline systemic treatment with gemcitabine as monotherapy or in combination with platinum. Radiological assessment of progression was evaluated according to RECIST 1.1. The progression pattern was divided according to the presence/absence of new extrahepatic lesions (NEH). RESULTS We included 206 patients from 5 centres. The median OS was 14.1 months and its independent predictors (hazard ratio [HR], 95% confidence interval [CI]) were previous surgery 0.699 [0.509-0.961], performance status >2.445 [1.788-3.344], permanent first-line discontinuation 16.072 [5.102-50.633], registration of ascites 2.226 [1.448-3.420] or bilirubin >3 mg/dl 3.004 [1.935-4.664] during the follow-up, and disease progression 2.523 [1.261-5.050]. The appearance of NEH independently predicted OS 2.18 [1.55-3.06] in patients with radiological progression. Amongst 138 patients eligible for second-line treatment, PPS was 16.8 and 5.9 months in cases without and with NEH, respectively (P = .001). Progression owing to NEH lesions was an independent predictor of PPS 1.873 [1.333-2.662], together with performance status, time to progression to the frontline treatment, bilirubin >3 mg/dl and ascites. CONCLUSIONS PPS of iCCA is influenced by progression pattern, with important implications for second-line trial design and analysis.
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Affiliation(s)
- Francesco Tovoli
- Division of Internal Medicine, Hepatobiliary and Immunoallergic DiseasesIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | | | - Fabio Gelsomino
- Department of Oncology and HematologyUniversity Hospital of ModenaModenaItaly
| | - Massimo Iavarone
- Foundation IRCCS Ca' Granda Ospedale Maggiore PoliclinicoDivision of Gastroenterology and HepatologyMilanItaly
| | | | - Massimiliano Salati
- Department of Oncology and HematologyUniversity Hospital of ModenaModenaItaly
| | | | - Francesco Caputo
- Department of Oncology and HematologyUniversity Hospital of ModenaModenaItaly
| | | | - Alessandro Granito
- Division of Internal Medicine, Hepatobiliary and Immunoallergic DiseasesIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
- Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
| | - Matteo Renzulli
- Department of RadiologyIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | | | - Fabio Piscaglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic DiseasesIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
- Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
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21
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Kelly D, Fernández-Ortega P, Arjona ET, Daniele B. The role of nursing in the management of patients with renal and hepatic cancers: A systematic literature review. Eur J Oncol Nurs 2021; 55:102043. [PMID: 34655916 DOI: 10.1016/j.ejon.2021.102043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE This systematic literature review identified publications evaluating the role and benefits of nurse-led care in the management of patients with a diagnosis of renal cell carcinoma (RCC) or hepatocellular carcinoma (HCC). METHODS The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Structured searches of the PubMed database and the EMCare nursing and allied health database were conducted (August 11, 2021). Eligible publications were English-language, full-text, peer-reviewed journal articles featuring HCC and/or RCC populations, interventions involving nurses, any/no comparators, and reporting any related healthcare outcomes. Data on study design and size, patient characteristics and impact of nursing care were extracted. RESULTS Fifty-six relevant articles were identified (43 on HCC; 10 on RCC; 3 on HCC and RCC). The literature described the role and impact of oncology nurses across a variety of care functions, including in health promotion and screening, care coordination, holistic oversight, symptom and adverse event monitoring and management, and emotional support. Twenty-nine empirical studies/case reports were identified demonstrating benefit of nurse-led interventions in HCC/liver cancer (n = 28) and RCC (n = 1). Benefits were achieved through: improved patient participation in screening programs; reduced time to diagnosis; improved treatment adherence, reduced treatment complications, dose reductions and outpatient visits, and potential cost savings. CONCLUSIONS The oncology nurse plays a multifaceted role in the care of patients with HCC and RCC, but more evidence from nurse-led interventions is required to guide optimal multidisciplinary care of patients with these conditions.
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Affiliation(s)
- Daniel Kelly
- School of Healthcare Sciences, Cardiff University, Cardiff, Wales, UK.
| | - Paz Fernández-Ortega
- Department of Nursing Research, Catalan Institute of Oncology, Hospital Duran i Reynals, Barcelona, Spain
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22
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Vogel A, Merle P, Verslype C, Finn RS, Zhu AX, Cheng AL, Chan SL, Yau T, Ryoo BY, Knox J, Daniele B, Qin S, Wei Z, Miteva Y, Malhotra U, Siegel AB, Kudo M. ALBI score and outcomes in patients with hepatocellular carcinoma: post hoc analysis of the randomized controlled trial KEYNOTE-240. Ther Adv Med Oncol 2021; 13:17588359211039928. [PMID: 34616489 PMCID: PMC8488519 DOI: 10.1177/17588359211039928] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/29/2021] [Indexed: 12/30/2022] Open
Abstract
Aims: This post hoc analysis evaluated albumin/bilirubin (ALBI) score, an objective measure of liver function, in patients receiving pembrolizumab plus best supportive care (BSC) compared with placebo plus BSC in the KEYNOTE-240 study. Methods: Patients with confirmed hepatocellular carcinoma (HCC) and progression after/intolerance to sorafenib, Child–Pugh class A liver function, and Eastern Cooperative Oncology Group performance status of 0–1 were randomly assigned 2:1 to pembrolizumab 200 mg or placebo intravenously every 3 weeks plus BSC for ⩽35 cycles or until confirmed progression/unacceptable toxicity. Outcomes were assessed by ALBI grade. Results: Of 413 patients, at baseline 116 had an ALBI grade 1 score (pembrolizumab, n = 74; placebo, n = 42) and 279 had an ALBI grade 2 score (n = 193; n = 86). Change from baseline in ALBI score to the end of treatment was similar in both arms [difference in least squares mean, −0.039; 95% confidence interval (CI): −0.169 to 0.091]. Time to ALBI grade increase was similar in both arms [median for pembrolizumab versus placebo: 7.8 versus 6.9 months; hazard ratio (HR) = 0.863 (95% CI: 0.625–1.192)]. Regardless of baseline ALBI grade, a trend toward improved overall survival was observed with pembrolizumab [grade 1: HR = 0.725 (95% CI: 0.454–1.158); grade 2: HR = 0.827 (95% CI: 0.612–1.119)]. Conclusion: Pembrolizumab did not adversely impact liver function compared with placebo in patients with HCC, as measured by changes in ALBI scores. A trend toward improved overall survival was observed with pembrolizumab in both ALBI grade groups. ClinicalTrials.gov identifier: NCT02702401.
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Affiliation(s)
- Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neubergstrasse 1, Hannover, 30625, Germany
| | - Philippe Merle
- Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Chris Verslype
- Katholieke Universiteit Leuven and University Hospitals Leuven and Leuven Cancer Institute, Leuven, Belgium
| | - Richard S Finn
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Andrew X Zhu
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Ann-Lii Cheng
- National Taiwan University Hospital and National Taiwan University Cancer Center, Zhongzheng District, Taipei
| | - Stephen Lam Chan
- State Key Laboratory of Translational Oncology, Department of Clinical Oncology, Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong
| | - Thomas Yau
- The University at Hong Kong, People's Republic of China, Hong Kong
| | - Baek-Yeol Ryoo
- Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, South Korea
| | - Jennifer Knox
- McCain Center for Pancreatic Cancer, University of Toronto, Toronto, ON, Canada
| | | | - Shukui Qin
- Cancer Center of People's Liberation Army, Jinling Hospital, Nanjing, China
| | - Ziwen Wei
- Merck & Co., Inc., Kenilworth, NJ, USA
| | | | | | | | - Masatoshi Kudo
- Faculty of Medicine, Kindai University, Osaka-Sayama, Osaka, Japan
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23
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Kudo M, Finn RS, Morimoto M, Rau KM, Ikeda M, Yen CJ, Galle PR, Llovet JM, Daniele B, Lim HY, McIlwain DW, Yoshikawa R, Nakamura K, Liang K, Wang C, Abada P, Widau RC, Zhu AX. Ramucirumab for Patients with Intermediate-Stage Hepatocellular Carcinoma and Elevated Alpha-Fetoprotein: Pooled Results from Two Phase 3 Studies (REACH and REACH-2). Liver Cancer 2021; 10:451-460. [PMID: 34721507 PMCID: PMC8527922 DOI: 10.1159/000516605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/19/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Intermediate-stage hepatocellular carcinoma (HCC), as defined by Barcelona Clinic Liver Cancer (BCLC) stage B, is heterogeneous in terms of liver function and tumor burden. REACH and REACH-2 investigated ramucirumab in patients with HCC after prior sorafenib, with REACH-2 enrolling only patients with baseline α-fetoprotein (AFP) ≥400 ng/mL. An exploratory analysis of outcomes by BCLC stage was performed. METHODS A pooled meta-analysis of independent patient data (stratified by study) from REACH (AFP ≥ 400 ng/mL) and REACH-2 was performed. All patients had Child-Pugh A, Eastern Cooperative Oncology Group performance status 0-1, prior sorafenib treatment, and either HCC BCLC stage B (refractory/not amenable to locoregional therapy) or BCLC stage C. Patients were randomized to ramucirumab 8 mg/kg or placebo every 2 weeks. Median overall survival (OS) and progression-free survival were estimated by the Kaplan-Meier method. Treatment effects in BCLC stage B and C were evaluated by Cox proportional-hazards model; prognosis of BCLC staging for OS was evaluated by multivariate Cox proportional-hazards model. Tumor responses were evaluated according to Response Evaluation in Solid Tumors v1.1. Liver function was assessed with albumin-bilirubin score. RESULTS Baseline characteristics were generally balanced between treatment arms in each BCLC stage. BCLC staging trended as an independent prognostic factor for OS (B vs. C; hazard ratio [HR] 0.756 [95% CI 0.546-1.046]). Consistent treatment benefit was observed for ramucirumab versus placebo across BCLC stages. Median OS for ramucirumab versus placebo was 13.7 versus 8.2 months; HR (95%): 0.43 (0.23-0.83) and 7.7 versus 4.8 months; HR (95%): 0.72 (0.59-0.89) for BCLC stage B and C, respectively. Adverse events (AEs) were consistent with observations from both studies; hypertension was the most frequent grade ≥3 AE. Liver function was preserved throughout the study and similar between treatment arms in both BCLC stages. CONCLUSIONS Ramucirumab provided a better survival benefit irrespective of BCLC stage and was well tolerated without compromising liver function during treatment.
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Affiliation(s)
- Masatoshi Kudo
- Departments of Gastroenterology and Hepatology, Kindai University, Osaka, Japan
| | - Richard S. Finn
- Geffen School of Medicine, University of California, Los Angeles, California, USA
| | | | - Kun-Ming Rau
- Chang Gung Memorial Hospital − Kaohsiung Branch, Kaohsiung City, Taiwan
- Hematology-Oncology Department, E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Masafumi Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Chia-Jui Yen
- Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Peter R. Galle
- Department of Internal Medicine, Mainz University Medical Center, Mainz, Germany
| | - Josep M. Llovet
- Mount Sinai Liver Cancer Program, Department of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Liver Cancer Translational Research Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | | | - Ho Yeong Lim
- Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | | | | | | | - Kun Liang
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | - Paolo Abada
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | - Andrew X. Zhu
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
- Jiahui International Cancer Center, Jiahui Health, Shanghai, China
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Pappalardo A, Giunta EF, Tirino G, Pompella L, Federico P, Daniele B, De Vita F, Petrillo A. Adjuvant Treatment in Pancreatic Cancer: Shaping the Future of the Curative Setting. Front Oncol 2021; 11:695627. [PMID: 34485130 PMCID: PMC8415474 DOI: 10.3389/fonc.2021.695627] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/16/2021] [Indexed: 12/19/2022] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is a lethal disease even in the early stages, despite progresses in surgical and pharmacological treatment in recent years. High potential for metastases is the main cause of therapeutic failure in localized disease, highlighting the current limited knowledge of underlying pathological processes. However, nowadays research is focusing on the search for personalized approaches also in the adjuvant setting for PDAC, by implementing the use of biomarkers and investigating new therapeutic targets. In this context, the aim of this narrative review is to summarize the current treatment scenario and new potential therapeutic approaches in early stage PDAC, from both a preclinical and clinical point of view. Additionally, the review examines the role of target therapies in localized PDAC and the influence of neoadjuvant treatments on survival outcomes.
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Affiliation(s)
- Annalisa Pappalardo
- Medical Oncology Unit, Ospedale del Mare, Naples, Italy
- Division of Medical Oncology, Department of Precision Medicine, School of Medicine, University of study of Campania “L. Vanvitelli”, Naples, Italy
| | - Emilio Francesco Giunta
- Medical Oncology Unit, Ospedale del Mare, Naples, Italy
- Division of Medical Oncology, Department of Precision Medicine, School of Medicine, University of study of Campania “L. Vanvitelli”, Naples, Italy
| | - Giuseppe Tirino
- Division of Medical Oncology, Department of Precision Medicine, School of Medicine, University of study of Campania “L. Vanvitelli”, Naples, Italy
| | - Luca Pompella
- Division of Medical Oncology, Department of Precision Medicine, School of Medicine, University of study of Campania “L. Vanvitelli”, Naples, Italy
| | | | - Bruno Daniele
- Medical Oncology Unit, Ospedale del Mare, Naples, Italy
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Precision Medicine, School of Medicine, University of study of Campania “L. Vanvitelli”, Naples, Italy
| | - Angelica Petrillo
- Medical Oncology Unit, Ospedale del Mare, Naples, Italy
- Division of Medical Oncology, Department of Precision Medicine, School of Medicine, University of study of Campania “L. Vanvitelli”, Naples, Italy
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25
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Ryoo BY, Palmer DH, Park SR, Rimassa L, Daniele B, Steinberg J, López B, Lim HY. Efficacy and Safety Results from a Phase 2, Randomized, Double-Blind Study of Enzalutamide Versus Placebo in Advanced Hepatocellular Carcinoma. Clin Drug Investig 2021; 41:795-808. [PMID: 34351608 DOI: 10.1007/s40261-021-01063-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related mortality worldwide. Despite recent advances, more effective therapeutic options for patients with advanced HCC are still required. The aim of this Phase 2, multicenter, multinational, randomized, double-blind, placebo-controlled study (NCT02528643) was to investigate the potential benefit of enzalutamide in the treatment of patients with advanced HCC. METHODS Patients aged ≥ 18 years diagnosed with advanced HCC (Barcelona Clinic Liver Cancer stage B or C and Child-Pugh class A at screening who had progressed on, or were intolerant to, sorafenib or other anti-vascular endothelial growth factor therapies) were randomized 2:1 to receive either enzalutamide 160 mg daily or placebo. The primary endpoint was overall survival (OS); secondary endpoints included progression-free survival (PFS) and safety. RESULTS In total, 165 patients were randomized to enzalutamide (n = 110) or placebo (n = 55). The hazard ratio (HR) (95% confidence interval [CI]) for OS was 1.15 (0.774-1.696) and median OS was 7.8 months and 7.7 months for enzalutamide and placebo, respectively. The HR (95% CI) for PFS was 1.04 (0.732-1.474) and median PFS was 2.2 months and 1.9 months for enzalutamide and placebo, respectively. The overall frequency of treatment-emergent adverse events (TEAEs) was broadly similar between the groups: 105 (98.1%) enzalutamide patients experienced ≥1 TEAEs compared with 49 (89.1%) placebo patients. CONCLUSIONS The results of this study indicate that enzalutamide does not provide a benefit in patients with advanced HCC. No unexpected safety findings were observed in the trial. CLINICALTRIALS. GOV IDENTIFIER NCT02528643.
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Affiliation(s)
- Baek-Yeol Ryoo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Daniel H Palmer
- Liverpool CR UK/NIHR Experimental Cancer Medicine Centre, and The Clatterbridge Cancer Centre, Liverpool, UK
| | - Sook Ryun Park
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Bruno Daniele
- Department of Oncology, G. Rummo Hospital, Benevento, Italy
- Oncology Unit, Ospedale del Mare, Naples, Italy
| | | | - Beatriz López
- Data Science, Astellas Pharma Inc., Leiden, The Netherlands
- Quantitative Sciences, Janssen R&D, Janssen Pharmaceutical Companies of Johnson & Johnson, Leiden, The Netherlands
| | - Ho Yeong Lim
- Division of Hematology-OncologyDepartment of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Vogel A, Frenette C, Sung M, Daniele B, Baron A, Chan SL, Blanc JF, Tamai T, Ren M, Lim HJ, Palmer DH, Takami Y, Kudo M. Baseline Liver Function and Subsequent Outcomes in the Phase 3 REFLECT Study of Patients with Unresectable Hepatocellular Carcinoma. Liver Cancer 2021; 10:510-521. [PMID: 34721512 PMCID: PMC8527908 DOI: 10.1159/000516490] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/13/2021] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Baseline liver function among patients starting treatment for unresectable hepatocellular carcinoma (uHCC) impacts survival and could impact efficacy outcomes and safety profiles of treatments. This post hoc analysis of the phase 3 REFLECT study examined the efficacy and safety outcomes for lenvatinib and for sorafenib in patients with uHCC, assessed by Child-Pugh score (CPS) and albumin-bilirubin (ALBI) grade. METHODS Efficacy and safety were assessed in patient cohorts from REFLECT according to study entry baseline ALBI grade and CPS. RESULTS Lenvatinib treatment generally provided survival benefits in all groups. Median overall survival (OS) among patients with an ALBI grade of 1 was consistently higher than among patients with an ALBI grade of 2 for both the lenvatinib and sorafenib arms (lenvatinib: 17.4 vs. 8.6 months; sorafenib: 14.6 vs. 7.7 months, respectively). Median OS among patients with a CPS of 5 was consistently higher than among patients with a CPS of 6 (lenvatinib: 15.3 vs. 9.4 months; sorafenib: 14.2 vs. 7.9 months, respectively). Progression-free survival and objective response rates for these ALBI grades and CPS demonstrated similar patterns. Among patients who received lenvatinib and experienced a treatment-related treatment-emergent adverse event leading to withdrawal, 6.6% had an ALBI grade of 1, while 13.3% had an ALBI grade of 2, and 7.9% had a CPS of 5, while 12.1% had a CPS of 6. CONCLUSIONS Better liver function at baseline, as measured by ALBI grade or CPS, may be prognostic for better survival outcomes in patients with uHCC undergoing treatment with lenvatinib or sorafenib.
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Affiliation(s)
- Arndt Vogel
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany,*Arndt Vogel,
| | - Catherine Frenette
- Department of Transplantation Hepatology, Scripps MD Anderson Cancer Center, La Jolla, California, USA
| | - Max Sung
- Department of Hematology-Oncology, Tisch Cancer Institute at Mount Sinai, New York, New York, USA
| | - Bruno Daniele
- Department of Oncology, Ospedale del Mare, Napoli, Italy
| | - Ari Baron
- Department of Clinical Oncology, Pacific Hematology Oncology Associates, San Francisco, California, USA
| | - Stephen L. Chan
- Department of Clinical Oncology, The State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China
| | - Jean Frédéric Blanc
- Department of Clinical Research and Innovation, University Hospital of Bordeaux, Bordeaux, France
| | | | - Min Ren
- Eisai Inc., Biostatistics, Oncology Business Group, Woodcliff Lake, New Jersey, USA
| | - Howard J. Lim
- Department of Medicine, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Daniel H. Palmer
- Department of Medical Oncology, Liverpool Experimental Cancer Medicine Centre, University of Liverpool, Liverpool, United Kingdom
| | - Yuko Takami
- Department of Hepato-Biliary-Pancreatic Surgery, National Hospital Organization Kyushu Medical Center, Clinical Research Institute, Fukuoka, Japan
| | - Masatoshi Kudo
- Department of Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
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Ottaviano M, Giunta EF, Rescigno P, Pereira Mestre R, Marandino L, Tortora M, Riccio V, Parola S, Casula M, Paliogiannis P, Cossu A, Vogl UM, Bosso D, Rosanova M, Mazzola B, Daniele B, Palmieri G, Palmieri G. The Enigmatic Role of TP53 in Germ Cell Tumours: Are We Missing Something? Int J Mol Sci 2021; 22:7160. [PMID: 34281219 PMCID: PMC8267694 DOI: 10.3390/ijms22137160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 12/24/2022] Open
Abstract
The cure rate of germ cell tumours (GCTs) has significantly increased from the late 1970s since the introduction of cisplatin-based therapy, which to date remains the milestone for GCTs treatment. The exquisite cisplatin sensitivity has been mainly explained by the over-expression in GCTs of wild-type TP53 protein and the lack of TP53 somatic mutations; however, several other mechanisms seem to be involved, many of which remain still elusive. The findings about the role of TP53 in platinum-sensitivity and resistance, as well as the reported evidence of second cancers (SCs) in GCT patients treated only with surgery, suggesting a spectrum of cancer predisposing syndromes, highlight the need for a deepened understanding of the role of TP53 in GCTs. In the following report we explore the complex role of TP53 in GCTs cisplatin-sensitivity and resistance mechanisms, passing through several recent genomic studies, as well as its role in GCT patients with SCs, going through our experience of Center of reference for both GCTs and cancer predisposing syndromes.
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Affiliation(s)
- Margaret Ottaviano
- Oncology Unit, Ospedale del Mare, 80147 Naples, Italy; (D.B.); (M.R.); (B.D.)
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, 80131 Naples, Italy; (M.T.); (G.P.)
- IOSI (Oncology Institute of Southern Switzerland), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (R.P.M.); (L.M.); (U.M.V.)
| | - Emilio Francesco Giunta
- Oncology Unit, Department of Precision Medicine, Università Degli Studi Della Campania Luigi Vanvitelli, 80131 Naples, Italy;
| | - Pasquale Rescigno
- Interdisciplinary Group for Translational Research and Clinical Trials, Urological Cancers (GIRT-Uro), Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10160 Turin, Italy;
| | - Ricardo Pereira Mestre
- IOSI (Oncology Institute of Southern Switzerland), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (R.P.M.); (L.M.); (U.M.V.)
| | - Laura Marandino
- IOSI (Oncology Institute of Southern Switzerland), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (R.P.M.); (L.M.); (U.M.V.)
| | - Marianna Tortora
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, 80131 Naples, Italy; (M.T.); (G.P.)
| | - Vittorio Riccio
- Department of Clinical Medicine and Surgery, Università degli studi di Napoli Federico II, 80131 Naples, Italy; (V.R.); (S.P.)
| | - Sara Parola
- Department of Clinical Medicine and Surgery, Università degli studi di Napoli Federico II, 80131 Naples, Italy; (V.R.); (S.P.)
| | - Milena Casula
- Institute of Genetics and Biomedical Research (IRGB), National Research Council (CNR), 07100 Sassari, Italy; (M.C.); (G.P.)
| | - Panagiotis Paliogiannis
- Departments of Biomedical Sciences and Medical, Surgical, Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (P.P.); (A.C.)
| | - Antonio Cossu
- Departments of Biomedical Sciences and Medical, Surgical, Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (P.P.); (A.C.)
| | - Ursula Maria Vogl
- IOSI (Oncology Institute of Southern Switzerland), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (R.P.M.); (L.M.); (U.M.V.)
| | - Davide Bosso
- Oncology Unit, Ospedale del Mare, 80147 Naples, Italy; (D.B.); (M.R.); (B.D.)
| | - Mario Rosanova
- Oncology Unit, Ospedale del Mare, 80147 Naples, Italy; (D.B.); (M.R.); (B.D.)
| | - Brunello Mazzola
- Department of Urology, Ente Ospedaliero Cantonale (EOC), 6600 Locarno, Switzerland;
| | - Bruno Daniele
- Oncology Unit, Ospedale del Mare, 80147 Naples, Italy; (D.B.); (M.R.); (B.D.)
| | - Giuseppe Palmieri
- Institute of Genetics and Biomedical Research (IRGB), National Research Council (CNR), 07100 Sassari, Italy; (M.C.); (G.P.)
- Departments of Biomedical Sciences and Medical, Surgical, Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (P.P.); (A.C.)
| | - Giovannella Palmieri
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, 80131 Naples, Italy; (M.T.); (G.P.)
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Tovoli F, Dadduzio V, De Lorenzo S, Rimassa L, Masi G, Iavarone M, Marra F, Garajova I, Brizzi MP, Daniele B, Trevisani F, Messina C, Di Clemente F, Pini S, Cabibbo G, Granito A, Rizzato MD, Zagonel V, Brandi G, Pressiani T, Federico P, Vivaldi C, Bergna I, Campani C, Piscaglia F. Real-Life Clinical Data of Cabozantinib for Unresectable Hepatocellular Carcinoma. Liver Cancer 2021; 10:370-379. [PMID: 34414124 PMCID: PMC8339460 DOI: 10.1159/000515551] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 11/19/2020] [Accepted: 02/27/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Cabozantinib has been approved by the European Medicine Agency (EMA) for hepatocellular carcinoma (HCC) previously treated with sorafenib. Cabozantinib is also being tested in combination with immune checkpoint inhibitors in the frontline setting. Real-life clinical data of cabozantinib for HCC are still lacking. Moreover, the prognostic factors for HCC treated with cabozantinib have not been investigated. METHODS We evaluated clinical data and outcome of HCC patients who received cabozantinib in the legal context of named patient use in Italy. RESULTS Ninety-six patients from 15 centres received cabozantinib. All patients had preserved liver function (Child-Pugh A), mostly with an advanced HCC (77.1%) in a third-line setting (75.0%). The prevalence of performance status (PS) > 0, macrovascular invasion (MVI), extrahepatic spread, and alpha-fetoprotein (AFP) >400 ng/mL was 50.0, 30.2, 67.7, and 44.8%, respectively. Median overall survival (OS) and progression-free survival were 12.1 (95% confidence interval 9.4-14.8) and 5.1 (3.3-6.9) months, respectively. Most common treatment-related adverse events (AEs) were fatigue (67.7%), diarrhoea (54.2%), anorexia (45.8%), HFSR (43.8%), weight loss (24.0%), and hypertension (24.0%). Most common treatment-related Grade 3-4 AEs were fatigue (6.3%), HFSR (6.3%), and increased aminotransferases (6.3%). MVI, ECOG-PS > 0, and AFP >400 ng/mL predicted a worse OS. Discontinuation for intolerance and no new extrahepatic lesions at the progression were associated with better outcomes. CONCLUSIONS In a real-life Western scenario (mostly in a third-line setting), cabozantinib efficacy and safety data were comparable with those reported in its registration trial. Data regarding the prognostic factors might help in patient selection and design of clinical trials.
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Affiliation(s)
- Francesco Tovoli
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Vincenzo Dadduzio
- Medical Oncology Unit 1, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Stefania De Lorenzo
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Gianluca Masi
- Department of Medical Oncology, Pisa University Hospital, Pisa, Italy
| | - Massimo Iavarone
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Marra
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Ingrid Garajova
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Maria Pia Brizzi
- Medical Oncology Unit, A.O.U. S. Luigi Gonzaga, Orbassano, Italy
| | | | - Franco Trevisani
- Semeiotica Medica, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Francesco Di Clemente
- Unità Operativa Semplice Dipartimentale (UOSD) “Oncologia medica” del Valdarno, Montevarchi, Italy
- *Francesco Tovoli,
| | - Sara Pini
- Division of Oncology, AUSL Romagna, Rimini, Italy
| | - Giuseppe Cabibbo
- Section of Gastroenterology & Hepatology, Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
| | - Alessandro Granito
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Mario Domenico Rizzato
- Medical Oncology Unit 1, Istituto Oncologico Veneto, IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Vittorina Zagonel
- Medical Oncology Unit 1, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Giovanni Brandi
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Caterina Vivaldi
- Department of Medical Oncology, Pisa University Hospital, Pisa, Italy
| | - Irene Bergna
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Campani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Fabio Piscaglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Zhu AX, Cattan S, Merle P, Daniele B, Chan SL, Yau T, Bouattour M, Lim HY, Chao Y, Knox JJ, Ogasawara S, Garrido M, Cheng AL, Edeline J, Finn RS, Siegel AB, Rahman A, Liu CC, Kudo M. Landmark analysis of overall survival (OS) by objective response (OR) in previously treated patients (pts) with advanced hepatocellular carcinoma (aHCC): Post hoc analysis of the randomized, phase 3 KEYNOTE-240 study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e16122] [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
e16122 Background: Studies have shown that OR is prognostic of OS in pts with HCC. KEYNOTE-224 (NCT02702414) evaluated pembrolizumab (pembro; anti–PD-1) in sorafenib (sora)-treated pts with aHCC and showed an ORR of 17% that was durable in responders receiving pembro, ultimately leading to FDA approval. In KEYNOTE-224, a landmark analysis showed that OR in pembro-treated pts was prognostic of longer OS. The KEYNOTE-240 (NCT02702401) study evaluated pembro + best supportive care (BSC) vs placebo (pbo) + BSC in sora-treated pts with aHCC. Although clinical benefit was observed in KEYNOTE-240 with pembro vs pbo, prespecified statistical significance criteria for OS and PFS were not met. This post hoc analysis of KEYNOTE-240 was performed to determine whether OR at landmark is prognostic of longer survival after landmark time. Methods: Eligible pts were aged ≥18 y, had confirmed aHCC, and experienced progression during or after sora treatment or intolerance to sora. Landmark analyses of OS according to OR at 6, 12, and 18 wk after randomization were performed on the pembro arm to evaluate the association between survival after the landmark with response achieved before the landmark. OR was assessed by blinded independent central review per RECIST v1.1. Responders at each landmark were defined as pts with any response assessment of CR or PR before the landmark date; all other pts were defined as nonresponders. HR and 95% CI for survival after the landmark were calculated from the Cox proportional hazards model using Efron method of tie handling, with responder status as a single covariate. Analysis was performed on the ITT population. Results: As of Jan 2, 2019, median time from randomization to data cutoff was 21.2 mo (range 13.4-30.4) for pembro. In the pembro arm, 51 pts (18.3%) had a best OR of CR or PR and 6 pts (4.4%) in the pbo arm had a best OR of PR (no CR) (excluded from landmark analyses). OS after landmark time was longer for responders than nonresponders at the wk 6, 12, and 18 time points (Table). The HR for OS after landmark time for responders vs nonresponders was 0.37 (95% CI 0.18-0.75), 0.39 (95% CI 0.23-0.66), and 0.37 (95% CI 0.21-0.63) at wk 6, 12, and 18, respectively. Conclusions: This post hoc analysis showed that pts with sora-treated aHCC who achieved OR by landmark time with pembro have longer OS after the landmark time, confirming the prognostic association between OR with pembro and OS observed in KEYNOTE-224. Clinical trial information: NCT02702401. [Table: see text]
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Affiliation(s)
- Andrew X. Zhu
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Stéphane Cattan
- Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Philippe Merle
- Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | | | - Stephen Lam Chan
- Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas Yau
- The University of Hong Kong, Hong Kong, China
| | - Mohamed Bouattour
- Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France
| | - Ho Yeong Lim
- Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Yee Chao
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jennifer J. Knox
- UHN Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | | | - Ann-Lii Cheng
- National Taiwan University Cancer Center and National Taiwan University Hospital, Taipei, Taiwan
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30
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Finn RS, Edeline J, Bouattour M, Cheng AL, Chan SL, Yau T, Garrido M, Knox JJ, Daniele B, Zhu AX, Breder VV, Lim HY, Ogasawara S, Siegel AB, Rahman A, Wei Z, Merle P. Pembrolizumab (pembro) versus placebo (pbo) in patients (pts) with advanced hepatocellular carcinoma (aHCC) previously treated with sorafenib: Updated data from the randomized, phase 3 KEYNOTE-240 study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.4072] [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
4072 Background: KEYNOTE-240 (NCT02702401) examined the antiPD-1 antibody pembro and showed improvement in OS and PFS vs pbo in pts with aHCC previously treated with sorafenib. The study did not meet prespecified statistical significance criteria for OS and PFS. Median OS (final analysis) was 13.9 mo for pembro vs 10.6 mo for pbo (HR 0.781; 95% CI 0.611-0.998). At the first interim analysis when testing for PFS and ORR was prespecified, median PFS was 3.0 mo for pembro vs 2.8 mo for pbo (HR 0.775; 95% CI 0.609-0.987) and ORR was 16.9% (CR, n = 3) for pembro and 2.2% (CR, n = 0) for pbo. AEs were consistent with the known safety profile of pembro. Longer term data from KEYNOTE-240 after ̃1.5 y of additional follow-up are reported. Methods: Adults with confirmed aHCC for whom sorafenib therapy failed (progression or intolerance) were randomly assigned 2:1 to receive pembro 200 mg IV Q3W + best supportive care (BSC) or pbo + BSC for ≤35 cycles or until confirmed progression/unacceptable toxicity, pt withdrawal of consent, or investigator decision to withdraw pt. Dual primary end points were OS and PFS, assessed by blinded independent central review (BICR) per RECIST v1.1. Secondary end points included ORR, DOR, DCR, TTP (all assessed by BICR per RECIST v1.1), and safety. Results: Of 413 pts, 278 were randomized to receive pembro; 135, to pbo.As of July 13, 2020, median time (range) from randomization to data cutoff was 39.6 mo (31.7-48.8) for pembro and 39.8 mo (31.7-47.8) for pbo. Median OS (95% CI) was 13.9 mo (11.6-16.0) for pembro and 10.6 mo (8.3-13.5) for pbo (HR 0.771; 95% CI 0.617-0.964). Estimated OS rates at 24 and 36 mo for pembro and pbo were 28.8% and 20.4% and 17.7% and 11.7%, respectively. Median PFS (95% CI) was 3.3 mo (2.8-4.1) for pembro and 2.8 mo (1.6-3.0) for pbo (HR 0.703; 95% CI 0.559-0.885). Estimated PFS rate at 24 mo was 11.8% for pembro and 4.8% for pbo. ORR (95% CI) was 18.3% (14.0-23.4) for pembro and 4.4% (1.6-9.4) for pbo. Median time to response (95% CI) was 2.7 mo (1.2-16.9) for pembro and 2.9 mo (1.1-6.9) for pbo. Median DOR (range) was 13.9 mo (1.5+ to 41.9+) for pembro and 15.2 mo (2.8-21.9) for pbo; 53.7% of responders in the pembro arm and 50.0% of responders in the pbo arm had DOR ≥12 mo. DCR was 61.9% for pembro and 53.3% for pbo. Best overall responses were 10 CR, 41 PR, 121 SD, and 85 PD for pembro and 0 CR, 6 PR, 66 SD, and 54 PD for pbo. Median TTP (95% CI) was 4.0 mo (2.8-5.3) for pembro and 2.8 mo (1.6-3.0) for pbo. No new or unexpected AEs occurred. The frequency of sponsor-assessed immune-mediated hepatitis events did not increase with additional follow-up. There continued to be no HBV or HCV viral flare events. Conclusions: In previously treated pts with aHCC, improvement in OS and PFS was maintained over time with pembro vs pbo, and the safety profile remained consistent. These data support the benefit:risk profile of pembro. Clinical trial information: NCT02702401.
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Affiliation(s)
| | | | - Mohamed Bouattour
- Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France
| | - Ann-Lii Cheng
- National Taiwan University Cancer Center and National Taiwan University Hospital, Taipei, Taiwan
| | - Stephen Lam Chan
- Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas Yau
- The University of Hong Kong, Hong Kong, China
| | | | - Jennifer J. Knox
- UHN Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | - Andrew X. Zhu
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | | | - Ho Yeong Lim
- Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | | | | | | | | | - Philippe Merle
- Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
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31
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Ottaviano M, De Placido P, Pietroluongo E, Tortora M, Picozzi F, Mucci B, Riccio V, Formisano P, Daniele B, De Placido S, Giuliano M, Palmieri G. Pneumonitis in patients with thymoma and Good's syndrome. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e20595] [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
e20595 Background: The association between thymoma (T) and immunological dysregulations is well acknowledged. Good’s syndrome (GS), which occurs in approximately 6% to 11% of T patients, is characterized by hypogammaglobulinemia, few or absent B-cells (CD19+), CD4 T cells lymphopenia, abnormal CD4/CD8 T ratio and impaired T cell mitogenic response. Patients with GS have increased susceptibility to bacterial, opportunistic and viral infections related to both humoral and cell-mediated immunodeficiency. The recent Sars-Cov-2 pandemic drew attention to the clinical condition of fatal viral pneumonitis and cytokines storm. Here we reported our monocentric experience of pneumonitis in patients with T and GS before the Sars-Cov-2 pandemic. Methods: We conducted a retrospective analysis of T patients with associated GS referred to the Rare Tumours Reference Center of University Federico II of Naples over a 10-year period (from 2009 to 2019). All the patients with radiological and/or clinical pneumonitis diagnosis were evaluated for this report. Immunological features, histopathological diagnosis and clinical outcome were registered. Results: A total of 41 patients with T and GS were identified, including 17 patients with local disease (stage I-II according to Masaoka-Koga) and 24 with advanced disease (stage III-IV). The majority (56.3%) had B2 T diagnosis. Radiological and/or clinical pneumonitis diagnosis was assessed in 23 cases (56%). Viral pneumonitis was detected in 8 patients: 3 patients with H1N1 infection, 3 patients with CMV infection, 2 patients with EBV infection. Bacterial pneumonitis was diagnosed in 9 patients (3 patients with K. pneumoniae, 4 patients with S. aureus, 2 patients with H. influenza). Opportunistic pneumonitis was found in 2 patients with Aspergillosis infection. In 2 cases no pathogenic agent was identified. The immunophenotyping, assessed in 4 patients with viral pneumonitis, displayed very low/undetectable levels of B cells, with median % value of CD3+T cells and NKT of respectively 9.8% and 0.4% of the total leukocytes. The median % of Treg was 4.7%. CD4+/CD8+ ratio was variable, ranging from 1,2 to 0,6. Interestingly the number of B cells was extremely low, independent of CD4+/CD8+ ratio. Blood levels of cytokines, chemokines and growth factors revealed elevated IL-4, Eotaxin, CCL2 / MCP-1 and CCL5 / RANTES ad strong reduction of IL-10. PDGF-BB levels were also elevated. 15 patients required admission to intensive care Six patients died for fatal pneumonitis. Conclusions: The management of T patients with GS is extremely challenging. Clear diagnostic algorithms do not yet exist and immune-profiling and quantitative immunoglobulins should be considered a part of diagnostic search in these patients. The coexistence of cancer, infections and immunosuppression may trigger life-threatening conditions, such as fatal pneumonitis, which often require intensive care and multidisciplinary approach.
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Affiliation(s)
- Margaret Ottaviano
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Pietro De Placido
- Department of Clinical Medicine and Surgery, Oncology Division, University Federico II, Napoli, Italy
| | - Erica Pietroluongo
- Department of Clinical Medicine and Surgery, Oncology Division, University Federico II, Naples, Italy
| | - Marianna Tortora
- CRCTR Rare Tumors Reference Center of Campania Region, AOU Federico II, Naples, Italy
| | - Fernanda Picozzi
- Oncology Unit, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Brigitta Mucci
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Vittorio Riccio
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Pietro Formisano
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Bruno Daniele
- Medical Oncology Unit, Ospedale del Mare, Naples, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Mario Giuliano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Giovannella Palmieri
- CRCTR Rare Tumors Reference Center of Campania Region, AOU Federico II, Naples, Italy
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Trojan J, Mollon P, Daniele B, Marteau F, Martín L, Li Y, Xu Q, Piscaglia F, Zaucha R, Sarker D, Lim HY, Venerito M. Comparative Efficacy of Cabozantinib and Ramucirumab After Sorafenib for Patients with Hepatocellular Carcinoma and Alpha-fetoprotein ≥ 400 ng/mL: A Matching-Adjusted Indirect Comparison. Adv Ther 2021; 38:2472-2490. [PMID: 33822328 PMCID: PMC8107171 DOI: 10.1007/s12325-021-01700-2] [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: 12/21/2020] [Accepted: 03/06/2021] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Cabozantinib and ramucirumab are approved for the treatment of adults with hepatocellular carcinoma (HCC) following prior sorafenib treatment; ramucirumab is restricted to use in patients with serum alpha-fetoprotein (AFP) ≥ 400 ng/mL. This matching-adjusted indirect comparison evaluated the efficacy and safety of both drugs after sorafenib in patients with HCC and AFP ≥ 400 ng/mL. METHODS Individual patient data (IPD) from the CELESTIAL trial (cabozantinib) and population-level data from the REACH-2 trial (ramucirumab) were used. To align with REACH-2, the CELESTIAL population was limited to patients who received first-line sorafenib only and had baseline serum AFP ≥ 400 ng/mL. The IPD from CELESTIAL were weighted to balance the distribution of 11 effect-modifying baseline characteristics with those of REACH-2. Overall survival (OS; primary endpoint) and progression-free survival (PFS) were compared for the CELESTIAL (matching-adjusted) and REACH-2 populations using weighted Kaplan-Meier (KM) curves and parametric (OS, Weibull; PFS, log-logistic) modeling. Rates of treatment-related adverse events (TRAEs) and TRAE-related discontinuations were also compared. RESULTS After matching and weighting, baseline characteristics were balanced between populations (REACH-2, N = 292; CELESTIAL, effective sample size = 105). Weighted KM estimates for OS (median [95% CI]) were not significantly different between cabozantinib and ramucirumab (10.6 [9.5-17.3] months versus 8.7 [7.3-10.8] months; p = 0.104), but PFS was significantly longer for cabozantinib than for ramucirumab (5.5 [4.6-7.4] months versus 2.8 [2.7-4.1] months; p = 0.016). Parametric modeling results were consistent with the weighted KM analysis. Rates of some grade 3 or 4 TRAEs were lower with ramucirumab than with cabozantinib; however, TRAE-related discontinuation rates were similar (p = 0.271). CONCLUSION In this MAIC, cabozantinib significantly prolonged median PFS compared with ramucirumab after prior sorafenib treatment in patients with HCC and AFP ≥ 400 ng/mL; rates of some grade 3 or 4 TRAEs were lower with ramucirumab than cabozantinib but related discontinuation rates were not significantly different between treatments. TRIAL REGISTRATION Clinical trials.gov identifiers: CELESTIAL trial (NCT01908426) and REACH-2 trial (NCT02435433). These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Jörg Trojan
- Gastrointestinal Oncology Unit, Medical Clinic 1, Goethe University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | | | | | | | | | | | | | - Fabio Piscaglia
- Department of Digestive Disease and Internal Medicine, University of Bologna, Bologna, Italy
| | - Renata Zaucha
- Department of Oncology, Medical University of Gdańsk, Gdańsk, Poland
| | - Debashis Sarker
- Comprehensive Cancer Centre, King's College London, London, UK
| | - Ho Yeong Lim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Marino Venerito
- Department of Gastroenterology, Otto von Guericke University Hospital, Magdeburg, Germany
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Diana A, Carlino F, Giunta EF, Franzese E, Guerrera LP, Di Lauro V, Ciardiello F, Daniele B, Orditura M. Cancer Treatment-Induced Bone Loss (CTIBL): State of the Art and Proper Management in Breast Cancer Patients on Endocrine Therapy. Curr Treat Options Oncol 2021; 22:45. [PMID: 33864145 PMCID: PMC8052225 DOI: 10.1007/s11864-021-00835-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2021] [Indexed: 02/06/2023]
Abstract
OPINION STATEMENT About 70-80% of early breast cancer (BC) patients receive adjuvant endocrine therapy (ET) for at least 5 years. ET includes in the majority of cases the use of aromatase inhibitors, as upfront or switch strategy, that lead to impaired bone health. Given the high incidence and also the high prevalence of BC, cancer treatment-induced bone loss (CTIBL) represents the most common long-term adverse event experimented by patients with hormone receptor positive tumours. CTIBL is responsible for osteoporosis occurrence and, as a consequence, fragility fractures that may negatively affect quality of life and survival expectancy. As recommended by main international guidelines, BC women on aromatase inhibitors should be carefully assessed for their fracture risk at baseline and periodically reassessed during adjuvant ET in order to early detect significant worsening in terms of bone health. Antiresorptive agents, together with adequate intake of calcium and vitamin D, should be administered in BC patients during all course of ET, especially in those at high risk of osteoporotic fractures, as calculated by tools available for clinicians. Bisphosphonates, such as zoledronate or pamidronate, and anti-RANKL antibody, denosumab, are the two classes of antiresorptive drugs used in clinical practice with similar efficacy in preventing bone loss induced by aromatase inhibitor therapy. The choice between them, in the absence of direct comparison, should be based on patients' preference and compliance; the different safety profile is mainly related to the route of administration, although both types of drugs are manageable with due care, since most of the adverse events are predictable and preventable. Despite advances in management of CTIBL, several issues such as the optimal time of starting antiresorptive agents and the duration of treatment remain unanswered. Future clinical trials as well as increased awareness of bone health are needed to improve prevention, assessment and treatment of CTIBL in these long-term survivor patients.
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Affiliation(s)
- Anna Diana
- Medical Oncology, Department of Precision Medicine, School of Medicine, "Luigi Vanvitelli" University of Campania, 80131, Naples, Italy.
- Medical Oncology Unit, Ospedale del Mare, 80147, Naples, Italy.
| | - Francesca Carlino
- Medical Oncology, Department of Precision Medicine, School of Medicine, "Luigi Vanvitelli" University of Campania, 80131, Naples, Italy
| | - Emilio Francesco Giunta
- Medical Oncology, Department of Precision Medicine, School of Medicine, "Luigi Vanvitelli" University of Campania, 80131, Naples, Italy
| | - Elisena Franzese
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Pascale, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy
| | - Luigi Pio Guerrera
- Medical Oncology, Department of Precision Medicine, School of Medicine, "Luigi Vanvitelli" University of Campania, 80131, Naples, Italy
| | - Vincenzo Di Lauro
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Pascale, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy
| | - Fortunato Ciardiello
- Medical Oncology, Department of Precision Medicine, School of Medicine, "Luigi Vanvitelli" University of Campania, 80131, Naples, Italy
| | - Bruno Daniele
- Medical Oncology Unit, Ospedale del Mare, 80147, Naples, Italy
| | - Michele Orditura
- Medical Oncology, Department of Precision Medicine, School of Medicine, "Luigi Vanvitelli" University of Campania, 80131, Naples, Italy
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Zhu AX, Finn RS, Kang YK, Yen CJ, Galle PR, Llovet JM, Assenat E, Brandi G, Motomura K, Ohno I, Daniele B, Vogel A, Yamashita T, Hsu CH, Gerken G, Bilbruck J, Hsu Y, Liang K, Widau RC, Wang C, Abada P, Kudo M. Serum alpha-fetoprotein and clinical outcomes in patients with advanced hepatocellular carcinoma treated with ramucirumab. Br J Cancer 2021; 124:1388-1397. [PMID: 33531690 PMCID: PMC8039038 DOI: 10.1038/s41416-021-01260-w] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [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: 07/31/2020] [Revised: 12/11/2020] [Accepted: 01/07/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Post hoc analyses assessed the prognostic and predictive value of baseline alpha-fetoprotein (AFP), as well as clinical outcomes by AFP response or progression, during treatment in two placebo-controlled trials (REACH, REACH-2). METHODS Serum AFP was measured at baseline and every three cycles. The prognostic and predictive value of baseline AFP was assessed by Cox regression models and Subpopulation Treatment Effect Pattern Plot method. Associations between AFP (≥ 20% increase) and radiographic progression and efficacy were assessed. RESULTS Baseline AFP was confirmed as a continuous (REACH, REACH-2; p < 0.0001) and dichotomous (≥400 vs. <400 ng/ml; REACH, p < 0.01) prognostic factor, and was predictive for ramucirumab survival benefit in REACH (p = 0.0042 continuous; p < 0.0001 dichotomous). Time to AFP (hazard ratio [HR] 0.513; p < 0.0001) and radiographic (HR 0.549; p < 0.0001) progression favoured ramucirumab. Association between AFP and radiographic progression was shown for up to 6 (odds ratio [OR] 5.1; p < 0.0001) and 6-12 weeks (OR 1.8; p = 0.0065). AFP response was higher with ramucirumab vs. placebo (p < 0.0001). Survival was longer in patients with an AFP response than patients without (13.6 vs. 5.6 months, HR 0.451; 95% confidence interval, 0.354-0.574; p < 0.0001). CONCLUSIONS AFP is an important prognostic factor and a predictive biomarker for ramucirumab survival benefit. AFP ≥ 400 ng/ml is an appropriate selection criterion for ramucirumab. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, REACH (NCT01140347) and REACH-2 (NCT02435433).
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Affiliation(s)
- Andrew X Zhu
- Massachusetts General Hospital Cancer Center, Boston, MA, USA.
- Jiahui International Cancer Center, Jiahui Health, Shanghai, China.
| | - Richard S Finn
- Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Yoon-Koo Kang
- Asan Medical Center, University of Ulsan, Seoul, South Korea
| | - Chia-Jui Yen
- National Cheng Kung University Hospital, Tainan, Taiwan
| | | | - Josep M Llovet
- Liver Cancer Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institut d'Investigations Biomèdiques August Pi i Sunyer, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Eric Assenat
- Department of Medical Oncology, CHU de Montpellier, Montpellier, France
| | | | | | - Izumi Ohno
- National Cancer Center Hospital East-Hepatobiliary and Pancreatic Oncology, Kashiwa, Japan
| | - Bruno Daniele
- Azienda Ospedaliera Gaetano Rummo, Benevento, Italy
- Ospedale del Mare, Napoli, Italy
| | - Arndt Vogel
- Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Chih-Hung Hsu
- National Taiwan University Hospital, Taipei, Taiwan, ROC
| | | | | | - Yanzhi Hsu
- Eli Lilly and Company, New York, NY, USA
| | - Kun Liang
- Eli Lilly and Company, Branchburg, NJ, USA
| | | | | | - Paolo Abada
- Eli Lilly and Company, Indianapolis, IN, USA
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Ottaviano M, Giunta EF, Tortora M, Curvietto M, Attademo L, Bosso D, Cardalesi C, Rosanova M, De Placido P, Pietroluongo E, Riccio V, Mucci B, Parola S, Vitale MG, Palmieri G, Daniele B, Simeone E. BRAF Gene and Melanoma: Back to the Future. Int J Mol Sci 2021; 22:ijms22073474. [PMID: 33801689 PMCID: PMC8037827 DOI: 10.3390/ijms22073474] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 12/13/2022] Open
Abstract
As widely acknowledged, 40-50% of all melanoma patients harbour an activating BRAF mutation (mostly BRAF V600E). The identification of the RAS-RAF-MEK-ERK (MAP kinase) signalling pathway and its targeting has represented a valuable milestone for the advanced and, more recently, for the completely resected stage III and IV melanoma therapy management. However, despite progress in BRAF-mutant melanoma treatment, the two different approaches approved so far for metastatic disease, immunotherapy and BRAF+MEK inhibitors, allow a 5-year survival of no more than 60%, and most patients relapse during treatment due to acquired mechanisms of resistance. Deep insight into BRAF gene biology is fundamental to describe the acquired resistance mechanisms (primary and secondary) and to understand the molecular pathways that are now being investigated in preclinical and clinical studies with the aim of improving outcomes in BRAF-mutant patients.
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Affiliation(s)
- Margaret Ottaviano
- Department of Clinical Medicine and Surgery, Università Degli Studi di Napoli “Federico II”, 80131 Naples, Italy; (P.D.P.); (E.P.); (V.R.); (B.M.); (S.P.)
- Oncology Unit, Ospedale del Mare, 80147 Naples, Italy; (L.A.); (D.B.); (C.C.); (M.R.); (B.D.)
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, 80131 Naples, Italy; (M.T.); (G.P.)
- Correspondence:
| | - Emilio Francesco Giunta
- Department of Precision Medicine, Università Degli Studi della Campania Luigi Vanvitelli, 80131 Naples, Italy;
| | - Marianna Tortora
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, 80131 Naples, Italy; (M.T.); (G.P.)
| | - Marcello Curvietto
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, 80131 Naples, Italy; (M.C.); (M.G.V.); (E.S.)
| | - Laura Attademo
- Oncology Unit, Ospedale del Mare, 80147 Naples, Italy; (L.A.); (D.B.); (C.C.); (M.R.); (B.D.)
| | - Davide Bosso
- Oncology Unit, Ospedale del Mare, 80147 Naples, Italy; (L.A.); (D.B.); (C.C.); (M.R.); (B.D.)
| | - Cinzia Cardalesi
- Oncology Unit, Ospedale del Mare, 80147 Naples, Italy; (L.A.); (D.B.); (C.C.); (M.R.); (B.D.)
| | - Mario Rosanova
- Oncology Unit, Ospedale del Mare, 80147 Naples, Italy; (L.A.); (D.B.); (C.C.); (M.R.); (B.D.)
| | - Pietro De Placido
- Department of Clinical Medicine and Surgery, Università Degli Studi di Napoli “Federico II”, 80131 Naples, Italy; (P.D.P.); (E.P.); (V.R.); (B.M.); (S.P.)
| | - Erica Pietroluongo
- Department of Clinical Medicine and Surgery, Università Degli Studi di Napoli “Federico II”, 80131 Naples, Italy; (P.D.P.); (E.P.); (V.R.); (B.M.); (S.P.)
| | - Vittorio Riccio
- Department of Clinical Medicine and Surgery, Università Degli Studi di Napoli “Federico II”, 80131 Naples, Italy; (P.D.P.); (E.P.); (V.R.); (B.M.); (S.P.)
| | - Brigitta Mucci
- Department of Clinical Medicine and Surgery, Università Degli Studi di Napoli “Federico II”, 80131 Naples, Italy; (P.D.P.); (E.P.); (V.R.); (B.M.); (S.P.)
| | - Sara Parola
- Department of Clinical Medicine and Surgery, Università Degli Studi di Napoli “Federico II”, 80131 Naples, Italy; (P.D.P.); (E.P.); (V.R.); (B.M.); (S.P.)
| | - Maria Grazia Vitale
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, 80131 Naples, Italy; (M.C.); (M.G.V.); (E.S.)
| | - Giovannella Palmieri
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, 80131 Naples, Italy; (M.T.); (G.P.)
| | - Bruno Daniele
- Oncology Unit, Ospedale del Mare, 80147 Naples, Italy; (L.A.); (D.B.); (C.C.); (M.R.); (B.D.)
| | - Ester Simeone
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, 80131 Naples, Italy; (M.C.); (M.G.V.); (E.S.)
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Federico P, Giunta EF, Pappalardo A, Tufo A, Marte G, Attademo L, Fabbrocini A, Petrillo A, Daniele B. How to Treat Hepatocellular Carcinoma in Elderly Patients. Pharmaceuticals (Basel) 2021; 14:233. [PMID: 33800217 PMCID: PMC8001824 DOI: 10.3390/ph14030233] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 02/08/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the primary tumour of the liver with the greatest incidence, particularly in the elderly. Additionally, improvements in the treatments for chronic liver diseases have increased the number of elderly patients who might be affected by HCC. Little evidence exists regarding HCC in old patients, and the elderly are still underrepresented and undertreated in clinical trials. In fact, this population represents a complex subgroup of patients who are hard to manage, especially due to the presence of multiple comorbidities. Therefore, the choice of treatment is mainly decided by the physician in the clinical practice, who often tend not to treat elderly patients in order to avoid the possibility of adverse events, which may alter their unstable equilibrium. In this context, the clarification of the optimal treatment strategy for elderly patients affected by HCC has become an urgent necessity. The aim of this review is to provide an overview of the available data regarding the treatment of HCC in elderly patients, starting from the definition of "elderly" and the geriatric assessment and scales. We explain the possible treatment choices according to the Barcelona Clinic Liver Cancer (BCLC) scale and their feasibility in the elderly population.
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Affiliation(s)
- Piera Federico
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
| | - Emilio Francesco Giunta
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
- Department of Precision Medicine, School of Medicine, University of Study of Campania “L. Vanvitelli”, 80131 Napoli, Italy
| | - Annalisa Pappalardo
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
- Department of Precision Medicine, School of Medicine, University of Study of Campania “L. Vanvitelli”, 80131 Napoli, Italy
| | - Andrea Tufo
- Surgical Unit, Ospedale del Mare, 80147 Napoli, Italy; (A.T.); (G.M.)
| | - Gianpaolo Marte
- Surgical Unit, Ospedale del Mare, 80147 Napoli, Italy; (A.T.); (G.M.)
| | - Laura Attademo
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
| | - Antonietta Fabbrocini
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
| | - Angelica Petrillo
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
- Department of Precision Medicine, School of Medicine, University of Study of Campania “L. Vanvitelli”, 80131 Napoli, Italy
| | - Bruno Daniele
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
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Ottaviano M, Giuliano M, Tortora M, La Civita E, Liotti A, Longo M, Bruzzese D, Cennamo M, Riccio V, De Placido P, Picozzi F, Parola S, Daniele B, Botti G, Formisano P, Beguinot F, De Placido S, Terracciano D, Palmieri G. MA06.10 A New Horizon of Liquid Biopsy in Thymic Epithelial Tumors: The Potential Utility of Circulating Cell-Free DNA. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.180] [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: 11/28/2022]
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Ottaviano M, Giuliano M, Tortora M, La Civita E, Liotti A, Longo M, Bruzzese D, Cennamo M, Riccio V, De Placido P, Picozzi F, Parola S, Daniele B, Botti G, Formisano P, Beguinot F, De Placido S, Terracciano D, Palmieri G. A New Horizon of Liquid Biopsy in Thymic Epithelial Tumors: The Potential Utility of Circulating Cell-Free DNA. Front Oncol 2021; 10:602153. [PMID: 33634024 PMCID: PMC7902074 DOI: 10.3389/fonc.2020.602153] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/02/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Thymic epithelial tumors (TETs) are rare thoracic malignancies, commonly divided into two different histopathological entities, thymoma (T) and thymic carcinoma (TC). To date, there are no specific biomarkers for monitoring the biological course of these rare tumors. We carried out a single center study aiming at the detection of circulating cell-free DNA (ccfDNA) and the correlation of its levels with metastatic dissemination and histological subtype in patients with TETs. METHODS From July 2018 to January 2020, 5-ml blood samples from 26 patients with advanced TET (aTET) (11 patients with TC and 15 patients with T) and from six patients with completely resected TET (cr-TET), were prospectively obtained before the initiation of systemic therapy. Blood samples from 10 healthy donors were used as control. The QIAamp MinElute ccfDNA Kits was used for ccfDNA isolation from plasma; real-time PCR was used for cfDNA quantification. RESULTS We found significantly higher ccfDNA amount in patients with T and TC compared to controls, with median ccfDNA level of 3.3 ng/µl, 11.4 ng/µl and 25.6 ng/µl, for healthy donors, T and TC patients, respectively (p<0.001). No significant difference was found between cr-TET and controls (p = 0.175). ccfDNA concentrations were higher in metastatic (M1a and M1b) compared to non-metastatic (M0) TETs (25.6 ng/µl versus 7.2 ng/µl; p= 0.037). No significant correlation was found either between ccfDNA and disease stage, according to both the Masaoka-Koga (p= 0.854) and the TNM 8th edition staging systems (p = 0.66), or between ccfDNA levels and overall tumor burden, estimated according RECIST 1.1 criteria (r = 0.07, p = 0.725). CONCLUSIONS To the best of our knowledge, this is the first study that prospectively explores detection and quantification of ccfDNA in TETs. Higher baseline cfDNA levels have been observed in both advanced T and TC comparing to the control group.
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Affiliation(s)
- Margaret Ottaviano
- Department of Clinical Medicine and Surgery, Università degli Studi di Napoli “Federico II”, Naples, Italy
- CRCTR Rare Tumors Coordinating Center of Campania Region, Naples, Italy
- Oncology Unit, Ospedale del Mare, Naples, Italy
| | - Mario Giuliano
- Department of Clinical Medicine and Surgery, Università degli Studi di Napoli “Federico II”, Naples, Italy
- CRCTR Rare Tumors Coordinating Center of Campania Region, Naples, Italy
| | - Marianna Tortora
- CRCTR Rare Tumors Coordinating Center of Campania Region, Naples, Italy
- Department of Translational Medical Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Evelina La Civita
- Department of Translational Medical Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Antonietta Liotti
- Department of Translational Medical Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Michele Longo
- Department of Translational Medical Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Dario Bruzzese
- Department of Public Health, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Michele Cennamo
- Department of Translational Medical Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Vittorio Riccio
- Department of Clinical Medicine and Surgery, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Pietro De Placido
- Department of Clinical Medicine and Surgery, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Fernanda Picozzi
- Department of Clinical Medicine and Surgery, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Sara Parola
- Department of Clinical Medicine and Surgery, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | | | - Gerardo Botti
- CRCTR Rare Tumors Coordinating Center of Campania Region, Naples, Italy
- Pathology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - Pietro Formisano
- Department of Translational Medical Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Francesco Beguinot
- Department of Translational Medical Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, Università degli Studi di Napoli “Federico II”, Naples, Italy
- CRCTR Rare Tumors Coordinating Center of Campania Region, Naples, Italy
| | - Daniela Terracciano
- Department of Translational Medical Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
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Merle P, Edeline J, Bouattour M, Cheng AL, Chan SL, Yau T, Garrido M, Knox JJ, Daniele B, Zhu AX, Breder VV, Lim HY, Ogasawara S, Siegel AB, Rahman A, Wei Z, Finn RS. Pembrolizumab (pembro) vs placebo (pbo) in patients (pts) with advanced hepatocellular carcinoma (aHCC) previously treated with sorafenib: Updated data from the randomized, phase III KEYNOTE-240 study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.268] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
268 Background: KEYNOTE-240 (NCT02702401) examined the anti-PD-1 antibody pembro and demonstrated improvement in OS and PFS vs pbo in pts with aHCC previously treated with sorafenib. However, the study did not meet prespecified statistical significance criteria for OS and PFS. Median OS (final analysis) was 13.9 mo for pembro vs 10.6 mo for pbo (HR 0.781; 95% CI 0.611-0.998). At the first interim analysis when PFS and ORR were prespecified to be tested, median PFS was 3.0 mo for pembro vs 2.8 mo for pbo (HR 0.775; 95% CI 0.609-0.987) and ORR was 16.9% (CR, n = 3) for pembro and 2.2% (CR, n = 0) for pbo. AEs were consistent with the known safety profile of pembro. Longer-term data from KEYNOTE-240 after ~1.5 years of additional follow-up are reported. Methods: Adults with confirmed aHCC who experienced failure (progression or intolerance) to sorafenib therapy were randomized 2:1 to pembro 200 mg IV Q3W + best supportive care (BSC) or pbo + BSC for ≤35 cycles or until confirmed progression/unacceptable toxicity, pt withdrawal of consent, or investigator decision. Dual primary end points were OS and PFS, assessed by blinded independent central review (BICR) per RECIST v1.1. Secondary end points included ORR, DOR, DCR, TTP (all assessed by BICR per RECIST v1.1), and safety. Results: Of 413 pts, 278 were randomized to pembro and 135 to pbo. As of July 13, 2020, median time from randomization to data cutoff was 39.6 mo (range 31.7-48.8) for pembro and 39.8 mo (31.7-47.8) for pbo. Median OS was 13.9 mo (95% CI 11.6-16.0) for pembro and 10.6 mo (8.3-13.5) for pbo (HR 0.771; 95% CI 0.617-0.964). Estimated OS rates at 24 and 36 mo for pembro and pbo were 28.8% and 20.4% and 17.7% and 11.7%, respectively. Median PFS was 3.3 mo (95% CI 2.8-4.1) for pembro and 2.8 mo (1.6-3.0) for pbo (HR 0.703; 95% CI 0.559-0.885). Estimated PFS rate at 24 mo was 11.8% for pembro and 4.8% for pbo. ORR was 18.3% (95% CI 14.0-23.4) for pembro and 4.4% (1.6-9.4) for pbo. Median time to response was 2.7 mo (95% CI 1.2-16.9) for pembro and 2.9 mo (1.1-6.9) for pbo. Median DOR was 13.9 mo (range 1.5+ to 41.9+) for pembro and 15.2 mo (2.8-21.9) for pbo; 45.1% of responders in pembro arm and 33.3% of responders in pbo arm had DOR ≥12 mo. DCR was 61.9% for pembro and 53.3% for pbo. Best overall responses were 10 CR, 41 PR, 121 SD, and 85 PD for pembro and 0 CR, 6 PR, 66 SD, and 54 PD for pbo. The median TTP was 4.0 mo (95% CI 2.8-5.3) for pembro and 2.8 mo (1.6-3.0) for pbo. No new or unexpected AEs occurred. The frequency of sponsor-assessed immune-mediated hepatitis events did not increase with additional follow-up. There continued to be no HBV or HCV viral flare events. Conclusions: In previously treated pts with aHCC, improvement in OS and PFS was maintained over time with pembro vs pbo, and the safety profile remained consistent over time. These data support the benefit:risk profile of pembro. Clinical trial information: NCT02702401.
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Affiliation(s)
- Philippe Merle
- Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | | | - Mohamed Bouattour
- Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France
| | - Ann-Lii Cheng
- National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Taiwan
| | - Stephen Lam Chan
- Sir YK Pao Center for Cancer, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas Yau
- The University of Hong Kong, Hong Kong, China
| | | | - Jennifer J. Knox
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | - Andrew X. Zhu
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | | | - Ho Yeong Lim
- Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
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Edeline J, Cattan S, Merle P, Daniele B, Chan SL, Yau T, Bouattour M, Lim HY, Chao Y, Knox JJ, Ogasawara S, Garrido M, Cheng AL, Zhu AX, Finn RS, Siegel AB, Rahman A, Liu CC, Kudo M. Landmark analysis of overall survival (OS) by objective response (OR) in previously treated patients (pts) with advanced hepatocellular carcinoma (aHCC): Post-hoc analysis of the randomized, phase III KEYNOTE-240 study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.318] [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
318 Background: Studies have shown that OR is prognostic of OS in pts with HCC. KEYNOTE (KN)-224 (NCT02702414) evaluated pembrolizumab (pembro; anti-PD-1) in sorafenib (sora)-treated pts with aHCC and demonstrated an OR rate of 17% that was durable in responders receiving pembro, ultimately leading to its FDA approval. In KN-224, a landmark analysis showed that OR in pembro-treated pts was prognostic of longer OS. The KN-240 (NCT02702401) study evaluated pembro + best supportive care (BSC) vs placebo (pbo) + BSC in sora-treated pts with aHCC. Although clinical benefit was observed in KN-240 with pembro vs pbo, prespecified statistical significance criteria for OS and PFS were not met. This post hoc analysis of KN-240 was performed to determine whether OR at landmark is prognostic of longer survival after landmark time. Methods: Eligible pts were aged ≥18 y, had confirmed aHCC, and experienced progression during or after sora treatment or intolerance to sora. Landmark analyses of OS according to OR at 6, 12, and 18 wk after randomization were performed on the pembro arm to examine the association between survival after the landmark with response achieved prior to the landmark. OR was assessed by blinded independent central review per RECIST v1.1. Responders at each landmark were defined as pts with any response assessment of CR or PR before the landmark date; all other pts were defined as nonresponders. HRs and 95% CIs for survival after the landmark were calculated from the Cox proportional model with Efron’s method of tie handling with responder status as a single covariate. Analyses were performed in the ITT population. Results: As of Jan 2, 2019, the median time from randomization to data cutoff was 21.2 months (range 13.4-30.4) for pembro. There were 51 pts (18.3%) with a BOR of CR or PR in the pembro arm and 6 pts (4.4%) with a BOR of PR (no CR) in the pbo arm (excluded from landmark analyses). OS after landmark time was longer for responders compared with nonresponders at the wk 6, 12, and 18 time points (Table). The HR for OS after landmark time for responders versus nonresponders were 0.37 (95% CI 0.18-0.75), 0.39 (95% CI 0.23-0.66), and 0.37 (95% CI 0.21-0.63) at wk 6, 12, and 18, respectively. Conclusions: This post hoc analysis demonstrates that pts with sora-treated aHCC who achieve OR by landmark time with pembro have longer OS after the landmark time, confirming the prognostic association between OR with pembro and OS observed in KN-224. Clinical trial information: NCT02702401. [Table: see text]
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Affiliation(s)
| | - Stéphane Cattan
- Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Philippe Merle
- Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | | | - Stephen Lam Chan
- Sir YK Pao Center for Cancer, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas Yau
- The University of Hong Kong, Hong Kong, China
| | - Mohamed Bouattour
- Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France
| | - Ho Yeong Lim
- Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Yee Chao
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jennifer J. Knox
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | | | - Ann-Lii Cheng
- National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Taiwan
| | - Andrew X. Zhu
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
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Ascierto PA, Butterfield LH, Campbell K, Daniele B, Dougan M, Emens LA, Formenti S, Janku F, Khleif SN, Kirchhoff T, Morabito A, Najjar Y, Nathan P, Odunsi K, Patnaik A, Paulos CM, Reinfeld BI, Skinner HD, Timmerman J, Puzanov I. Perspectives in immunotherapy: meeting report from the "Immunotherapy Bridge" (December 4th-5th, 2019, Naples, Italy). J Transl Med 2021; 19:13. [PMID: 33407605 PMCID: PMC7789268 DOI: 10.1186/s12967-020-02627-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 11/20/2020] [Indexed: 12/30/2022] Open
Abstract
Over the last few years, numerous clinical trials and real-world experience have provided a large amount of evidence demonstrating the potential for long-term survival with immunotherapy agents across various malignancies, beginning with melanoma and extending to other tumours. The clinical success of immune checkpoint blockade has encouraged increasing development of other immunotherapies. It has been estimated that there are over 3000 immuno-oncology trials ongoing, targeting hundreds of disease and immune pathways. Evolving topics on cancer immunotherapy, including the state of the art of immunotherapy across various malignancies, were the focus of discussions at the Immunotherapy Bridge meeting (4-5 December, 2019, Naples, Italy), and are summarised in this report.
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Affiliation(s)
- Paolo A Ascierto
- Cancer Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Cancer Immunotherapy and Innovative Therapy, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Via Mariano Semmola, 80131, Naples, Italy.
| | - Lisa H Butterfield
- PICI Research & Development, Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | - Katie Campbell
- PICI Research & Development, Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | | | - Michael Dougan
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Leisha A Emens
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Silvia Formenti
- Sandra and Edward Meyer Cancer Center, Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Filip Janku
- Division of Cancer Medicine, Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Samir N Khleif
- The Loop Immuno-Oncology Research Laboratory, Lombardi Cancer Center, Georgetown University, Washington, DC, USA
| | - Tomas Kirchhoff
- Perlmutter Cancer Center, New York University School of Medicine, New York, NY, USA
| | - Alessandro Morabito
- Thoracic Medical Oncology, National Cancer Institute, IRCCS-Fondazione G. Pascale, Naples, Italy
| | - Yana Najjar
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Kunle Odunsi
- Center for Immunotherapy and Department of Gynecologic Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Akash Patnaik
- Section of Hematology and Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | | | - Heath D Skinner
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - John Timmerman
- University of California, Los Angeles, Los Angeles, CA, USA
| | - Igor Puzanov
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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El Bairi K, Trapani D, Petrillo A, Le Page C, Zbakh H, Daniele B, Belbaraka R, Curigliano G, Afqir S. Repurposing anticancer drugs for the management of COVID-19. Eur J Cancer 2020; 141:40-61. [PMID: 33125946 PMCID: PMC7508523 DOI: 10.1016/j.ejca.2020.09.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 02/05/2023]
Abstract
Since its outbreak in the last December, coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 has rapidly spread worldwide at a pandemic proportion and thus is regarded as a global public health emergency. The existing therapeutic options for COVID-19 beyond the intensive supportive care are limited, with an undefined or modest efficacy reported so far. Drug repurposing represents an enthusiastic mechanism to use approved drugs outside the scope of their original indication and accelerate the discovery of new therapeutic options. With the emergence of COVID-19, drug repurposing has been largely applied for early clinical testing. In this review, we discuss some repurposed anticancer drugs for the treatment of COVID-19, which are under investigation in clinical trials or proposed for the clinical testing.
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Affiliation(s)
- Khalid El Bairi
- Department of Medical Oncology, Mohammed VI University Hospital, Oujda, Morocco.
| | | | - Angelica Petrillo
- Medical Oncology Unit, Ospedale del Mare, Naples, Italy; University of Study of Campania "L.Vanvitelli", Naples, Italy
| | - Cécile Le Page
- Research Institute of McGill University Health Center (RI-MUHC), Montréal, QC, Canada
| | - Hanaa Zbakh
- Center of Marine Sciences, University of Algarve, Ed. 7, Campus of Gambelas, 8005-139, Faro, Portugal
| | - Bruno Daniele
- Medical Oncology Unit, Ospedale del Mare, Naples, Italy
| | - Rhizlane Belbaraka
- Department of Medical Oncology, "Bioscience et Santé" Research Laboratory, Faculty of Medicine, Cadi Ayad University, Marrakesh, Morocco
| | - Giuseppe Curigliano
- European Institute of Oncology, IRCCS, Milan, Italy; University of Milan, Department of Oncology and Hematology, Milan, Italy
| | - Said Afqir
- Department of Medical Oncology, Mohammed VI University Hospital, Oujda, Morocco
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Ryoo BY, Merle P, Kulkarni AS, Cheng AL, Bouattour M, Lim HY, Breder V, Edeline J, Chao Y, Ogasawara S, Yau T, Garrido M, Chan SL, Daniele B, Norquist JM, Chen E, Siegel AB, Zhu AX, Finn RS, Kudo M. Health-related quality-of-life impact of pembrolizumab versus best supportive care in previously systemically treated patients with advanced hepatocellular carcinoma: KEYNOTE-240. Cancer 2020; 127:865-874. [PMID: 33231873 DOI: 10.1002/cncr.33317] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Health-related quality of life (HRQoL) is an important outcome measure and prognostic indicator in hepatocellular carcinoma (HCC). KEYNOTE-240 (NCT02702401) assessed the efficacy and safety of pembrolizumab plus best supportive care (BSC) versus placebo plus BSC in patients with HCC who previously received sorafenib. This study presents the results of a prespecified exploratory analysis of patient-reported outcomes. METHODS Patients completed the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) and its HCC supplement (EORTC QLQ-HCC18) electronically at baseline; at weeks 2, 3, 4, 6, 9, 12, and 18; and then every 9 weeks until 1 year or end of treatment, and at the 30-day safety follow-up visit. RESULTS The HRQoL population included 271 and 127 patients randomly assigned to pembrolizumab and placebo, respectively. From baseline to week 12, changes in both scores were similar between pembrolizumab and placebo; global health status/QoL scores were stable. The proportions of patients who improved, remained stable, or deteriorated across all functional domain and symptom scores were generally similar between pembrolizumab and placebo. Time to deterioration was similar between the 2 arms based on the prespecified analysis of EORTC QLQ-HCC18 domains of abdominal swelling, fatigue, and pain. CONCLUSION Pembrolizumab preserved HRQoL during treatment for advanced HCC. Combined with efficacy and safety results from KEYNOTE-240, these findings support a positive benefit/risk profile for pembrolizumab in a second-line treatment setting for patients with HCC who previously received sorafenib.
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Affiliation(s)
- Baek-Yeol Ryoo
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Philippe Merle
- Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Ann-Lii Cheng
- National Taiwan University Cancer Center, Taipei City, Taiwan
| | - Mohamed Bouattour
- Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Ho Yeong Lim
- Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Valeriy Breder
- N. N. Blokhin National Medical Research Center of Oncology, Moscow, Russia
| | | | - Yee Chao
- Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Sadahisa Ogasawara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Thomas Yau
- The University at Hong Kong, Hong Kong, People's Republic of China
| | | | - Stephen L Chan
- State Key Laboratory of Translational Oncology, Department of Clinical Oncology, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | | | | | - Erluo Chen
- Merck & Co., Inc., Kenilworth, New Jersey
| | | | - Andrew X Zhu
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts.,Jiahui International Cancer Center, Jiahui Health, Shanghai, China
| | - Richard S Finn
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
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Ottaviano M, Curvietto M, Rescigno P, Tortora M, Palmieri G, Giannarelli D, Aieta M, Assalone P, Attademo L, Avallone A, Bloise F, Bosso D, Borzillo V, Buono G, Calderoni G, Caputo F, Cartenì G, Cavallero D, Cavo A, Ciardiello F, Conca R, Conteduca V, De Falco S, De Felice M, De Laurentiis M, De Placido P, De Placido S, De Santo I, De Stefano A, Della Corte CM, Di Franco R, Di Lauro V, Fabbrocini A, Federico P, Festino L, Giordano P, Giuliano M, Gridelli C, Grimaldi AM, Lia M, Marretta AL, Massa V, Mennitto A, Merler S, Merz V, Messina C, Messina M, Milano M, Minisini AM, Montesarchio V, Morabito A, Morgillo F, Mucci B, Nappi L, Napolitano F, Paciolla I, Pagliuca M, Palmieri G, Parola S, Pepe S, Petrillo A, Piantedosi F, Piccin L, Picozzi F, Pietroluongo E, Pignata S, Prati V, Riccio V, Rosanova M, Rossi A, Russo A, Salati M, Santabarbara G, Sbrana A, Simeone E, Silvestri A, Spada M, Tarantino P, Taveggia P, Tomei F, Vincenzo T, Trapani D, Trojanello C, Vanella V, Vari S, Ventriglia J, Vitale MG, Vitiello F, Vivaldi C, von Arx C, Zacchi F, Zampiva I, Zivi A, Daniele B, Ascierto PA. Impact of COVID-19 outbreak on cancer immunotherapy in Italy: a survey of young oncologists. J Immunother Cancer 2020; 8:jitc-2020-001154. [PMID: 33060148 PMCID: PMC7565202 DOI: 10.1136/jitc-2020-001154] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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] [Accepted: 08/08/2020] [Indexed: 01/20/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has overwhelmed the health systems worldwide. Data regarding the impact of COVID-19 on cancer patients (CPs) undergoing or candidate for immune checkpoint inhibitors (ICIs) are lacking. We depicted the practice and adaptations in the management of patients with solid tumors eligible or receiving ICIs during the COVID-19 pandemic, with a special focus on Campania region. Methods This survey (25 questions), promoted by the young section of SCITO (Società Campana di ImmunoTerapia Oncologica) Group, was circulated among Italian young oncologists practicing in regions variously affected by the pandemic: high (group 1), medium (group 2) and low (group 3) prevalence of SARS-CoV-2–positive patients. For Campania region, the physician responders were split into those working in cancer centers (CC), university hospitals (UH) and general hospitals (GH). Percentages of agreement, among High (H) versus Medium (M) and versus Low (L) group for Italy and among CC, UH and GH for Campania region, were compared by using Fisher’s exact tests for dichotomous answers and χ2 test for trends relative to the questions with 3 or more options. Results This is the first Italian study to investigate the COVID-19 impact on cancer immunotherapy, unique in its type and very clear in the results. The COVID-19 pandemic seemed not to affect the standard practice in the prescription and delivery of ICIs in Italy. Telemedicine was widely used. There was high consensus to interrupt immunotherapy in SARS-CoV-2–positive patients and to adopt ICIs with longer schedule interval. The majority of the responders tended not to delay the start of ICIs; there were no changes in supportive treatments, but some of the physicians opted for delaying surgeries (if part of patients’ planned treatment approach). The results from responders in Campania did not differ significantly from the national ones. Conclusion Our study highlights the efforts of Italian oncologists to maintain high standards of care for CPs treated with ICIs, regardless the regional prevalence of COVID-19, suggesting the adoption of similar solutions. Research on patients treated with ICIs and experiencing COVID-19 will clarify the safety profile to continue the treatments, thus informing on the most appropriate clinical conducts.
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Affiliation(s)
- Margaret Ottaviano
- Oncology Unit, Ospedale del Mare, Napoli, Campania, Italy.,Department of Clinical Medicine and Surgery, Università degli Studi di Napoli Federico II and CRCTR Coordinating Rare Tumors Reference Center of Campania Region, AOU Federico II, Napoli, Italy
| | - Marcello Curvietto
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Pasquale Rescigno
- Clinical Studies, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Marianna Tortora
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, AOU Federico II, Napoli, Campania, Italy
| | - Giovannella Palmieri
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, AOU Federico II, Napoli, Campania, Italy
| | - Diana Giannarelli
- Biostatistics Unit, IRCCS Regina Elena National Cancer Institute, Roma, Lazio, Italy
| | - Michele Aieta
- Medical Oncology Unit, Department of Onco-Hematology, IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Basilicata, Italy
| | - Pasquale Assalone
- Oncology Unit, Ospedale Ferdinando Veneziale, Isernia, Molise, Italy
| | - Laura Attademo
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Antonio Avallone
- Abdominal Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | | | | | - Valentina Borzillo
- Department of Radioterapia, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Giuseppe Buono
- Oncology Unit, San Rocco Hospital, Sessa Aurunca, Campania, Italy
| | | | - Francesca Caputo
- U.O.C. Oncologia, Azienda Ospedaliera dei Colli, Monaldi Hospital, Napoli, Campania, Italy
| | - Giacomo Cartenì
- Department of Medical Oncology, AORN "A. Cardarelli", Napoli, Campania, Italy
| | | | - Alessia Cavo
- Oncology Unit, Villa Scassi Hospital, Genova, Italy
| | - Fortunato Ciardiello
- Oncology, Department of Precision Medicine, Università della Campania "L. Vanvitelli", Napoli, Campania, Italy
| | - Raffaele Conca
- Medical Oncology Unit, Department of Onco-Hematology, IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Basilicata, Italy
| | - Vincenza Conteduca
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Emilia-Romagna, Italy
| | - Stefano De Falco
- Oncology Unit, Sant'Ottone Frangipane Hospital, Avellino, Campania, Italy
| | - Marco De Felice
- Oncology, Department of Precision Medicine, Università della Campania "L. Vanvitelli", Napoli, Campania, Italy.,Oncology Unit, Sant'Anna e San Sebastiano, Caserta, Campania, Italy
| | | | - Pietro De Placido
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Sabino De Placido
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, AOU Federico II, Napoli, Campania, Italy.,Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Irene De Santo
- Oncology Unit, Gemelli Molise s.p.a, Campobasso, Molise, Italy
| | - Alfonso De Stefano
- Abdominal Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Carminia Maria Della Corte
- Oncology, Department of Precision Medicine, Università della Campania "L. Vanvitelli", Napoli, Campania, Italy
| | - Rossella Di Franco
- Department of Radioterapia, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Vincenzo Di Lauro
- Breast Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy.,Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | | | | | - Lucia Festino
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | | | - Mario Giuliano
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, AOU Federico II, Napoli, Campania, Italy.,Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Cesare Gridelli
- Division of Medical Oncology, "San Giuseppe Moscati" Hospital, Avellino, Campania, Italy
| | - Antonio Maria Grimaldi
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Michela Lia
- Oncology Unit, SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Piemonte, Italy
| | - Antonella Lucia Marretta
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Valentina Massa
- Medical Oncology Unit, University of Pisa, Pisa, Toscana, Italy
| | - Alessia Mennitto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Sara Merler
- Department of Oncology, University of Verona, Verona, Veneto, Italy
| | - Valeria Merz
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Trentino Alto Adige, Italy
| | - Carlo Messina
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Trentino Alto Adige, Italy
| | - Marco Messina
- UOC Oncologia Medica, Ospedali Riuniti Villa Sofia Cervello, Palermo, Sicilia, Italy
| | - Monica Milano
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Alessandro Marco Minisini
- Department of Oncology, Azienda Sanitaria Universitaria Integrata del Friuli Centrale, Udine, Friuli Venezia Giulia, Italy
| | - Vincenzo Montesarchio
- U.O.C. Oncologia, Azienda Ospedaliera dei Colli, Monaldi Hospital, Napoli, Campania, Italy
| | - Alessandro Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Floriana Morgillo
- Oncology, Department of Precision Medicine, Università della Campania "L. Vanvitelli", Napoli, Campania, Italy
| | - Brigitta Mucci
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Lucia Nappi
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada and British Columbia Cancer Agency-Vancouver Center-Department of Medicine, Division of Medical Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fabiana Napolitano
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Immacolata Paciolla
- Oncology Unit, Ospedale Sacro Cuore di Gesù Fatebenefratelli, Benevento, Campania, Italy
| | - Martina Pagliuca
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Giuseppe Palmieri
- Institute of Research on Genetics and Biomedicine (IRGB), National Research Council (CNR), Sassari, Sardegna, Italy
| | - Sara Parola
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Stefano Pepe
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Oncology Unit, University of Salerno, Baronissi, Campania, Italy
| | - Angelica Petrillo
- Oncology Unit, Ospedale del Mare, Napoli, Italy.,Oncology, Department of Precision Medicine, Università della Campania "L. Vanvitelli", Napoli, Campania, Italy
| | - Francovito Piantedosi
- U.O.C. Pneumologia Oncologica, Azienda Ospedaliera dei Colli, Monaldi Hospital, Naples, Campania, Italy
| | - Luisa Piccin
- Veneto Institute of Oncology IOV-IRCCS, Padova, Veneto, Italy
| | - Fernanda Picozzi
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Erica Pietroluongo
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | | | - Vittorio Riccio
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | | | - Alice Rossi
- Department of Oncology, University of Verona, Verona, Veneto, Italy
| | - Anna Russo
- Medical Oncology Unit, Fondazione IRCCS Giovanni Paolo II, Bari, Puglia, Italy
| | - Massimiliano Salati
- Medical Oncology Unit, University Hospital Modena, Modena, Emilia Romagna, Italy
| | - Giuseppe Santabarbara
- Division of Medical Oncology, "San Giuseppe Moscati" Hospital, Avellino, Campania, Italy
| | - Andrea Sbrana
- Medical Oncology Unit, University of Pisa, Pisa, Toscana, Italy
| | - Ester Simeone
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | | | - Massimiliano Spada
- Oncology Unit, Fondazione Istituto San Raffaele G Giglio di Cefalu, Cefalu, Sicilia, Italy
| | - Paolo Tarantino
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Milano, Lombardia, Italy
| | | | - Federica Tomei
- Oncology Unit, Ospedale Ferdinando Veneziale, Isernia, Molise, Italy
| | - Tortora Vincenzo
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy.,Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Oncology Unit, University of Salerno, Baronissi, Campania, Italy
| | - Dario Trapani
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Milano, Lombardia, Italy
| | - Claudia Trojanello
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Vito Vanella
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Sabrina Vari
- Medical Oncology 1 Unit, IRCCS Regina Elena National Cancer Institute, Rome, Lazio, Italy
| | - Jole Ventriglia
- Oncology Division, ASL San Felice a Cancello, Caserta, Campania, Italy
| | - Maria Grazia Vitale
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy.,Department of Oncology, Azienda Sanitaria Universitaria Integrata del Friuli Centrale, Udine, Friuli Venezia Giulia, Italy
| | - Fabiana Vitiello
- U.O.C. Pneumologia Oncologica, Azienda Ospedaliera dei Colli, Monaldi Hospital, Naples, Campania, Italy
| | | | - Claudia von Arx
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Francesca Zacchi
- Oncology Unit, Università degli Studi di Verona, sede Borgo Roma, Verona, Veneto, Italy
| | - Ilaria Zampiva
- Oncology Unit, Università degli Studi di Verona, sede Borgo Roma, Verona, Veneto, Italy
| | - Andrea Zivi
- Department of Surgery and Cancer, Imperial College, London, UK.,Medical Oncology Department, AOUI di Verona, Verona, Veneto, Italy
| | | | - Paolo Antonio Ascierto
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
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Federico P, Petrillo A, Giordano P, Bosso D, Fabbrocini A, Ottaviano M, Rosanova M, Silvestri A, Tufo A, Cozzolino A, Daniele B. Immune Checkpoint Inhibitors in Hepatocellular Carcinoma: Current Status and Novel Perspectives. Cancers (Basel) 2020; 12:E3025. [PMID: 33080958 PMCID: PMC7603151 DOI: 10.3390/cancers12103025] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) represent a promising treatment for many kinds of cancers, including hepatocellular carcinoma (HCC). The rationale for using ICIs in HCC is based on the immunogenic background of hepatitis and cirrhosis and on the observation of high programmed death-ligand 1 (PD-L1) expression and tumor-infiltrating lymphocytes in this cancer. Promising data from phase I/II studies in advanced HCC, showing durable objective response rates (~20% in first- and second-line settings) and good safety profile, have led to phase III studies with ICIs as single agents or in combination therapy, both in first and second line setting. While the activity of immunotherapy agents as single agents seems to be limited to an "ill-defined" small subset of patients, the combination of the anti PD-L1 atezolizumab and anti-vascular endothelial growth factor bevacizumab revealed a benefit in the outcomes when compared to sorafenib in the first line. In addition, the activity and efficacy of the combinations between anti-PD-1/anti-PD-L1 antibody and other ICIs, tyrosine kinase inhibitors, or surgical and locoregional therapies, has also been investigated in clinical trials. In this review, we provide an overview of the role of ICIs in the management of HCC with a critical evaluation of the current status and future directions.
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Affiliation(s)
- Piera Federico
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (A.P.); (P.G.); (D.B.); (A.F.); (M.O.); (M.R.); (A.S.); (B.D.)
| | - Angelica Petrillo
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (A.P.); (P.G.); (D.B.); (A.F.); (M.O.); (M.R.); (A.S.); (B.D.)
- Division of Medical Oncology, Department of Precision Medicine, School of Medicine, University of Study of Campania “L. Vanvitelli”, 80131 Napoli, Italy
| | - Pasqualina Giordano
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (A.P.); (P.G.); (D.B.); (A.F.); (M.O.); (M.R.); (A.S.); (B.D.)
| | - Davide Bosso
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (A.P.); (P.G.); (D.B.); (A.F.); (M.O.); (M.R.); (A.S.); (B.D.)
| | - Antonietta Fabbrocini
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (A.P.); (P.G.); (D.B.); (A.F.); (M.O.); (M.R.); (A.S.); (B.D.)
| | - Margaret Ottaviano
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (A.P.); (P.G.); (D.B.); (A.F.); (M.O.); (M.R.); (A.S.); (B.D.)
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy
| | - Mario Rosanova
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (A.P.); (P.G.); (D.B.); (A.F.); (M.O.); (M.R.); (A.S.); (B.D.)
| | - Antonia Silvestri
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (A.P.); (P.G.); (D.B.); (A.F.); (M.O.); (M.R.); (A.S.); (B.D.)
| | - Andrea Tufo
- Surgical Unit, Ospedale del Mare, 80147 Napoli, Italy;
| | | | - Bruno Daniele
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (A.P.); (P.G.); (D.B.); (A.F.); (M.O.); (M.R.); (A.S.); (B.D.)
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Palmieri G, Giuliano M, Tortora M, Formisano P, Malfitano A, D'Esposito V, Botti G, Marretta A, Margherita V, Di Lauro V, Daniele B, De Placido S, Verde A, Ottaviano M. 1904P Clinical implications of distinct immunoprofiles in patients with thymic epithelial tumours and autoimmunity. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1447] [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: 11/26/2022] Open
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Ottaviano M, Giuliano M, Tortora M, Picozzi F, Mucci B, Parola S, Riccio V, Pietroluongo E, De Placido P, Vaia A, D'Esposito V, Malfitano A, Di Somma S, Campione S, Staibano S, Botti G, Formisano P, Daniele B, De Placido S, Palmieri G. 1901P Immunomodulatory role of multi-agent therapy in thymic epithelial tumours and severe immunological dysregulation. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1444] [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: 10/23/2022] Open
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Kudo M, Galle PR, Llovet JM, Finn RS, Vogel A, Motomura K, Assenat E, Merle P, Brandi G, Daniele B, Okusaka T, Tomášek J, Borg C, Dadduzio V, Morimoto M, Pracht M, Jen MH, Drove Ubreva N, Widau RC, Shinozaki K, Yoshikawa R, Zhu AX. Ramucirumab in elderly patients with hepatocellular carcinoma and elevated alpha-fetoprotein after sorafenib in REACH and REACH-2. Liver Int 2020; 40:2008-2020. [PMID: 32279446 DOI: 10.1111/liv.14462] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Limited data on treatment of elderly patients with hepatocellular carcinoma (HCC) increase the unmet need. REACH and REACH-2 were global phase III studies of ramucirumab in patients with HCC after prior sorafenib, where patients with alpha-fetoprotein (AFP) ≥400 ng/mL showed an overall ssurvival (OS) benefit for ramucirumab. These post-hoc analyses examined efficacy and safety of ramucirumab in patients with HCC and baseline AFP ≥ 400 ng/mL by three prespecified age subgroups (<65, ≥65 to <75 and ≥75 years). METHODS Individual patient data were pooled from REACH (baseline AFP ≥400 ng/mL) and REACH-2. Kaplan-Meier and Cox proportional hazards regression methods (stratified by study) assessed OS, progression-free survival (PFS), time to progression (TTP) and patient-reported outcomes (Functional Hepatobiliary System Index-8 [FHSI-8] score). RESULTS A total of 542 patients (<65 years: n = 302; ≥65 to <75 years: n = 160; ≥75 years: n = 80) showed similar baseline characteristics between ramucirumab and placebo. Older subgroups had higher hepatitis C and steatohepatitis incidences, and lower AFP levels, than the <65 years subgroup. Ramucirumab prolonged OS in patients <65 years (hazard ratio [HR], 0.753; 95% CI 0.581-0.975), ≥65 to <75 years (0.602; 0.419-0.866) and ≥75 years (0.709; 0.420-1.199), PFS and TTP irrespective of age. Ramucirumab showed similar overall safety profiles across subgroups, with a consistent median relative dose intensity ≥97.8%. A trend towards a delay in symptom deterioration in FHSI-8 with ramucirumab was observed in all subgroups. CONCLUSIONS In this post-hoc analysis, ramucirumab showed a survival benefit across age subgroups with a tolerable safety profile, supporting its use in advanced HCC with elevated AFP, irrespective of age, including ≥75 years.
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Affiliation(s)
- Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Peter R Galle
- Department of Internal Medicine, Mainz University Medical Center, Mainz, Germany
| | - Josep M Llovet
- Translational Research in Hepatic Oncology Group, Liver Unit, IDIBAPS, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
- Mount Sinai Liver Cancer Program, Division of Liver Diseases, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Richard S Finn
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Arndt Vogel
- Department of Hepatology, Gastroenterology and Endocrinology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Kenta Motomura
- Department of Hepatology, Aso Iizuka Hospital, Fukuoka, Japan
| | - Eric Assenat
- Department of Medical Oncology, CHU de Montpellier, Montpellier, France
| | - Philippe Merle
- Hepatology and Gastroenterology Unit, Croix-Rousse Hospital, Northern Lyon Hospital Group, Lyon, France
| | - Giovanni Brandi
- Department of Experimental, Diagnostic and Speciality Medicicne, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Bruno Daniele
- Department of Oncology, Azienda Ospedaliera Gaetano Rummo, Benevento, Italy
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Jiří Tomášek
- Department of Complex Oncology Care, Masaryk Memorial Cancer Institute, Masaryk University, Brno, Czech Republic
| | - Christophe Borg
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Vincenzo Dadduzio
- Department of Clinical and Experimental Oncology, Medical Oncology Unit-1, Veneto Institute of Oncology (IOV) - IRCCS, Padua, Italy
| | - Manabu Morimoto
- Department of Hepatobiliary and Pancreatic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Marc Pracht
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Min-Hua Jen
- Global Statistical Sciences, Eli Lilly and Company, Surrey, UK
| | | | - Ryan C Widau
- Oncology, Eli Lilly and Company, Indianapolis, IN, USA
| | - Kenta Shinozaki
- Medicines Development Unit Japan, Eli Lilly Japan K.K, Kobe, Japan
| | | | - Andrew X Zhu
- Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
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Piccirillo MC, Avallone A, Carlomagno C, Maiello E, Rosati G, Alabiso O, Nasti G, De Placido S, Latiano TP, Bilancia D, Ottaiano A, De Stefano A, Romano C, Silvestro L, Nappi A, Cassata A, Giordano P, Iaffaioli RV, Normanno N, Perrone F, Daniele B. Multicenter Single-Arm, Two-Stage Phase 2 Study of Panitumumab in Patients With Cetuximab-Refractory Metastatic Colorectal Cancer: The PACER Trial. Clin Colorectal Cancer 2020; 19:270-276. [PMID: 32631788 DOI: 10.1016/j.clcc.2020.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 01/23/2020] [Accepted: 05/22/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess whether panitumumab is active in patients with cetuximab-refractory metastatic colorectal cancer (mCRC). PATIENTS AND METHODS Eligible patients had pretreated RAS (renin-angiotensin system) wild-type mCRC that progressed after cetuximab treatment, after having shown either objective response or stable disease. A minimax two-stage design was applied, with progression-free rate at 2 months as the primary end point. At least 12 of 28 and 21 of 41 successes at the first and second stage, respectively, were required for a positive result. Panitumumab 6 mg/kg was provided every 2 weeks, until progression or unacceptable toxicity. RESULTS Overall, 52 patients with KRAS (Kirsten rat sarcoma viral oncogene) wild-type disease were enrolled, but 11 were found to have mutated disease after all-RAS retesting. Among 41 eligible patients, median time since diagnosis was 38 months, and 71% experienced an objective response to previous cetuximab. First stage was passed with 12 of 28 patients alive without progression at 2 months. At the second stage, 17 of 41 patients were alive without progression at 2 months. At a median follow-up of 21.8 months, 35 patients experienced disease progression, and 26 died. Median progression-free survival was 2.1 months (95% confidence interval, 1.8-3.6) and median overall survival 6.8 months (95% confidence interval, 4.6-16.6). Most of the patients experienced no adverse reactions; 25% of patients had grade 3 rash. CONCLUSION According to our study design, panitumumab was not effective in patients with cetuximab-refractory RAS wild-type mCRC.
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Affiliation(s)
- Maria Carmela Piccirillo
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Antonio Avallone
- Oncologia Clinica Sperimentale Addome, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Chiara Carlomagno
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II, Napoli, Italy
| | - Evaristo Maiello
- Oncologia Medica, IRCCS, Casa Sollievo Sofferenza, S. Giovanni Rotondo (FG), Italy
| | | | | | - Guglielmo Nasti
- Oncologia Clinica Sperimentale Addome, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Sabino De Placido
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II, Napoli, Italy
| | - Tizana Pia Latiano
- Oncologia Medica, IRCCS, Casa Sollievo Sofferenza, S. Giovanni Rotondo (FG), Italy
| | | | - Alessandro Ottaiano
- Oncologia Clinica Sperimentale Addome, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Alfonso De Stefano
- Oncologia Clinica Sperimentale Addome, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Carmela Romano
- Oncologia Clinica Sperimentale Addome, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Lucrezia Silvestro
- Oncologia Clinica Sperimentale Addome, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Anna Nappi
- Oncologia Clinica Sperimentale Addome, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Antonino Cassata
- Oncologia Clinica Sperimentale Addome, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | | | - Rosario Vincenzo Iaffaioli
- Oncologia Clinica Sperimentale Addome, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Nicola Normanno
- Biologia Cellulare e Bioterapie, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Francesco Perrone
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
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50
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Kelley RK, Mollon P, Blanc JF, Daniele B, Yau T, Cheng AL, Valcheva V, Marteau F, Guerra I, Abou-Alfa GK. Comparative Efficacy of Cabozantinib and Regorafenib for Advanced Hepatocellular Carcinoma. Adv Ther 2020; 37:2678-2695. [PMID: 32424805 PMCID: PMC7467441 DOI: 10.1007/s12325-020-01378-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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: 04/29/2020] [Indexed: 12/21/2022]
Abstract
Background No trials have compared cabozantinib and regorafenib for the second-line treatment of advanced hepatocellular carcinoma (HCC). Objectives Conduct a matching-adjusted indirect comparison (MAIC) of the efficacy and safety of second-line cabozantinib and regorafenib in patients with advanced HCC and disease progression after prior sorafenib. Methods The CELESTIAL and RESORCE trials were used for indirect comparison of second-line cabozantinib and regorafenib in advanced HCC. Population-level data were available for RESORCE, individual patient data (IPD) for CELESTIAL. To align with RESORCE, the CELESTIAL population was limited to patients who received first-line sorafenib only. To minimize potential effect-modifying population differences, the CELESTIAL IPD were weighted to balance the distribution of clinically relevant baseline characteristics with those of RESORCE. Overall survival (OS) and progression-free survival (PFS) were evaluated for the matching-adjusted second-line CELESTIAL population and compared with those for RESORCE using weighted Kaplan-Meier curves and parametric modeling. Rates of grade 3/4 treatment-emergent adverse events (TEAEs) affecting > 5% of patients in any study arm were compared. Results In the matching-adjusted second-line populations (CELESTIAL, effective sample size = 266; RESORCE, n = 573), median (95% confidence interval) OS was similar for cabozantinib and regorafenib (11.4 [8.9–17.0] versus 10.6 [9.1–12.1] months; p = 0.3474, log-rank test). Median PFS was longer for cabozantinib than regorafenib (5.6 [4.9–7.3] versus 3.1 [2.8–4.2] months; p = 0.0005, log-rank test). There was a trend for lower rates of some grade 3/4 TEAEs with regorafenib than with cabozantinib, which may reflect the exclusion of sorafenib-intolerant patients from RESORCE but not from CELESTIAL, a difference that the MAIC methods could not remove. Only diarrhea rates were statistically significantly lower for regorafenib (p ≤ 0.001). Conclusions Cabozantinib may achieve similar OS and prolonged PFS compared with regorafenib in patients with progressive advanced HCC after prior sorafenib. Electronic Supplementary Material The online version of this article (10.1007/s12325-020-01378-y) contains supplementary material, which is available to authorized users. Cabozantinib and regorafenib are treatments approved for some patients with advanced hepatocellular carcinoma (HCC), a type of liver cancer, after disease progression despite prior sorafenib treatment. Cabozantinib, regorafenib and sorafenib are tyrosine kinase inhibitors (TKIs), meaning that they slow cancer progression by targeting specific ways that tumors grow. Cabozantinib and regorafenib offer benefits to patients compared with placebo (i.e., no treatment) for those who have progressed despite sorafenib treatment. No clinical studies have compared cabozantinib and regorafenib directly. This study compared the efficacy and safety of cabozantinib and regorafenib using data from trials of each drug versus placebo: CELESTIAL for cabozantinib and RESORCE for regorafenib. These two trials were similar—both involved patients with progressive advanced HCC who had received previous cancer treatment. There were some important differences, but these were minimized using statistical methods (matching and adjustments/“weighting”) allowing outcomes to be meaningfully compared. One difference that could not be removed by the statistical methods was that patients who were intolerant to prior sorafenib were excluded from RESORCE but were eligible for the CELESTIAL trial. In the otherwise matched populations, treatment with cabozantinib was associated with similar overall survival and significantly longer progression-free survival than regorafenib. Rates of diarrhea were significantly lower for regorafenib than cabozantinib, suggesting that regorafenib may be better tolerated, but this may reflect the exclusion of sorafenib-intolerant patients from RESORCE. These findings cannot replace a head-to-head study, but may help in guiding decision-making between cabozantinib and regorafenib in patients with progressive advanced HCC after soraftenib treatment.
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Affiliation(s)
- Robin K Kelley
- UCSF, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA.
| | | | | | - Bruno Daniele
- Azienda Ospedaliera G Rummo, Benevento, Italy
- Ospedale del Mare, Naples, Italy
| | - Thomas Yau
- University of Hong Kong, Pokfulam, Hong Kong
| | - Ann-Lii Cheng
- National Taiwan University Cancer Center, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
| | | | | | | | - Ghassan K Abou-Alfa
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Medical College at Cornell University, New York, NY, USA
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