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Crispo A, Rivieccio G, Cataldo L, Coluccia S, Luongo A, Coppola E, Grimaldi M, Montagnese C, Nocerino F, Celentano E, Saviano R, Bastone A, Baglio G, De Angelis C, Ciardiello F, Avallone A, Cassata A, Costanzo R, Morabito A, Maione P, Gridelli C, Cigolari S, Borrelli A, De Placido S, Schiavone F, Bianchi AAM, Pignata S, Aquino A, Bonito C, Buonerba C, Caccavallo F, Carlomagno C, Cavaliere M, Centonze S, Damiano S, De Divitiis C, De Nardo R, Del Deo Vito A, D'Errico D, Esposito G, Esposito L, Famiglietti V, Formisano L, Formisano L, Franzese E, Gaeta V, Gragnano E, Grimaldi R, Iovane G, Lauria R, Migliore G, Mirto M, Napoletano A, Napoli D, Vitale P, Pepe S, Rambaldo MP, Renato M, Rescigno M, Rossi E, Santabarbara G, Stanzione C. New approach to implement cancer patient care: The valutazione percorso rete oncologica campana (ValPeROC)‐experience from an Italian oncology network. Eur J Cancer Care (Engl) 2022; 31:e13736. [PMID: 37039607 DOI: 10.1111/ecc.13736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The primary goal of the Campania Oncology Network (ROC) was to reduce cancer delay and care fragmentation through the establishment of cancer-specific multidisciplinary oncologic groups (GOMs) and diagnostic and therapeutic assistance paths (PDTAs). METHODS Five cancer centres of the ROC, with their own cancer specific GOM, were selected. In our analysis, we have focused on four neoplasms: lung, colon, ovarian and prostate cancers. The median time for pre-GOM and GOM Times was calculated for each tumour site. Univariate and multivariate logistic regressions were performed to individuate risk factors for pre-GOM and GOM Time. RESULTS Significant differences were observed for prostate cancer compared to other patients either for pre-GOM or GOM Times. Significant risks were found for ovarian and prostate cancers in pre-GOM time and for prostate cancer in GOM-Time. CONCLUSIONS This experience will produce knowledge and data to guide decision-making and to manage more effectively the challenges of fighting cancer in Campania region. The Valutazione Percorso Rete Oncologica Campana (ValPeROC) study evaluates, for the first time, the ROC activity, through the analysis of key performance indices. Pre-GOM and GOM Time represent the quality of the entire regional health system and are useful to define models, which can evaluate the performance of the ROC over time.
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Affiliation(s)
- Anna Crispo
- Epidemiology and Biostatistics Unit Istituto Nazionale Tumori IRCCS 'Fondazione G. Pascale', Naples, Italy Naples Italy
| | - Giorgia Rivieccio
- Department of Managerial Studies and Quantitative Methods University of Naples Parthenope Faculty of Economics Naples Italy
| | - Luca Cataldo
- Department of Managerial Studies and Quantitative Methods University of Naples Parthenope Faculty of Economics Naples Italy
| | - Sergio Coluccia
- Epidemiology and Biostatistics Unit Istituto Nazionale Tumori IRCCS 'Fondazione G. Pascale', Naples, Italy Naples Italy
| | - Assunta Luongo
- Epidemiology and Biostatistics Unit Istituto Nazionale Tumori IRCCS 'Fondazione G. Pascale', Naples, Italy Naples Italy
| | - Elisabetta Coppola
- Department of Urology and Gynecology Istituto Nazionale Tumori IRCCS ‘Fondazione G. Pascale’ Naples Italy
| | - Maria Grimaldi
- Epidemiology and Biostatistics Unit Istituto Nazionale Tumori IRCCS 'Fondazione G. Pascale', Naples, Italy Naples Italy
| | - Concetta Montagnese
- Epidemiology and Biostatistics Unit Istituto Nazionale Tumori IRCCS 'Fondazione G. Pascale', Naples, Italy Naples Italy
| | - Flavia Nocerino
- Epidemiology and Biostatistics Unit Istituto Nazionale Tumori IRCCS 'Fondazione G. Pascale', Naples, Italy Naples Italy
| | - Egidio Celentano
- Epidemiology and Biostatistics Unit Istituto Nazionale Tumori IRCCS 'Fondazione G. Pascale', Naples, Italy Naples Italy
| | - Rocco Saviano
- National Cancer Institute IRCCS Pascale Foundation Naples Italy
| | - Anna Bastone
- Department of Managerial Studies and Quantitative Methods University of Naples Parthenope Faculty of Economics Naples Italy
| | - Giovanni Baglio
- AGENAS ‐ Italian National Agency for Regional Healthcare Services Rome Italy
| | - Carmine De Angelis
- Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - Fortunato Ciardiello
- Oncologia Medica, Dipartimento di Medicina di Precisione Università degli Studi della Campania ‘L. Vanvitelli’ Naples Italy
| | - Antonio Avallone
- Experimental Clinical Abdominal Oncology Unit Istituto Nazionale Tumori 'Fondazione G. Pascale', Naples, Italy Naples Italy
| | - Antonino Cassata
- Medical Oncology Unit Istituto Nazionale Tumori 'Fondazione G. Pascale', Naples, Italy Naples Italy
| | - Raffaele Costanzo
- Thoracic Department Istituto Nazionale Tumori 'Fondazione G. Pascale', Naples, Italy Naples Italy
| | - Alessandro Morabito
- Thoracic Department Istituto Nazionale Tumori 'Fondazione G. Pascale', Naples, Italy Naples Italy
| | - Paolo Maione
- Division of Medical Oncology S.G. Moscati Hospital Avellino Italy
| | - Cesare Gridelli
- Division of Medical Oncology S.G. Moscati Hospital Avellino Italy
| | - Silvio Cigolari
- Hospital Health Direction Azienda Ospedaliera Universitaria ‘San Giovanni di Dio e Ruggi d'Aragona’ Salerno Italy
| | - Anna Borrelli
- Hospital Health Direction Azienda Ospedaliera Universitaria ‘San Giovanni di Dio e Ruggi d'Aragona’ Salerno Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - Francesco Schiavone
- Department of Managerial Studies and Quantitative Methods University of Naples Parthenope Faculty of Economics Naples Italy
| | - Attilio A. M. Bianchi
- Directorate‐General for Management Istituto Nazionale Tumori 'Fondazione G. Pascale', Naples, Italy Naples Italy
| | - Sandro Pignata
- Department of Urology and Gynecology Istituto Nazionale Tumori IRCCS ‘Fondazione G. Pascale’ Naples Italy
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Cuomo A, Mercurio V, Varricchi G, Galdiero MR, Rossi FW, Carannante A, Arpino G, Formisano L, Bianco R, Carlomagno C, De Angelis C, Giuliano M, Matano E, Picardi M, Salvatore D, De Vita F, Martinelli E, Della Corte CM, Morgillo F, Orditura M, Napolitano S, Troiani T, Tocchetti CG. Impact of a cardio-oncology unit on prevention of cardiovascular events in cancer patients. ESC Heart Fail 2022; 9:1666-1676. [PMID: 35362255 PMCID: PMC9065840 DOI: 10.1002/ehf2.13879] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/11/2022] [Accepted: 02/25/2022] [Indexed: 12/29/2022] Open
Abstract
Aims As the world population grows older, the co‐existence of cancer and cardiovascular comorbidities becomes more common, complicating management of these patients. Here, we describe the impact of a large Cardio‐Oncology unit in Southern Italy, characterizing different types of patients and discussing challenges in therapeutic management of cardiovascular complications. Methods and results We enrolled 231 consecutive patients referred to our Cardio‐Oncology unit from January 2015 to February 2020. Three different types were identified, according to their chemotherapeutic statuses at first visit. Type 1 included patients naïve for oncological treatments, Type 2 patients already being treated with oncological treatments, and Type 3 patients who had already completed cancer treatments. Type 2 patients presented the highest incidence of cardiovascular events (46.2% vs. 12.3% in Type 1 and 17.9% in Type 3) and withdrawals from oncological treatments (5.1% vs. none in Type 1) during the observation period. Type 2 patients presented significantly worse 48 month‐survival (32.1% vs. 16.7% in Type 1 and 17.9% in Type 3), and this was more evident when in the three groups we focused on patients with uncontrolled cardiovascular risk factors or overt cardiovascular disease at the first cardiologic assessment. Nevertheless, these patients showed the greatest benefit from our cardiovascular assessments, as witnessed by a small, but significant improvement in ejection fraction during follow‐up (Type 2b: from 50 [20; 67] to 55 [35; 65]; P = 0.04). Conclusions Patients who start oncological protocols without an accurate baseline cardiovascular evaluation are at major risk of developing cardiac complications due to antineoplastic treatments.
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Affiliation(s)
- Alessandra Cuomo
- Cardio-Oncology Unit, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Valentina Mercurio
- Cardio-Oncology Unit, Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy
| | - Gilda Varricchi
- Internal Medicine and Clinical Immunology Unit, Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), Federico II University, Naples, Italy.,WAO Center of Excellence, Naples, Italy.,Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council, Naples, Italy
| | - Maria Rosaria Galdiero
- Internal Medicine and Clinical Immunology Unit, Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), Federico II University, Naples, Italy.,WAO Center of Excellence, Naples, Italy
| | - Francesca Wanda Rossi
- Internal Medicine and Clinical Immunology Unit, Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), Federico II University, Naples, Italy.,WAO Center of Excellence, Naples, Italy
| | - Antonio Carannante
- Cardio-Oncology Unit, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Grazia Arpino
- Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Luigi Formisano
- Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Roberto Bianco
- Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Chiara Carlomagno
- Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Carmine De Angelis
- Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Mario Giuliano
- Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Elide Matano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Marco Picardi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | - Ferdinando De Vita
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Erika Martinelli
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | | | - Floriana Morgillo
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Michele Orditura
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Stefania Napolitano
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Teresa Troiani
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Carlo G Tocchetti
- Cardio-Oncology Unit, Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), Federico II University, Naples, Italy.,WAO Center of Excellence, Naples, Italy.,Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
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Dell'Aquila E, Rossini D, Galletti A, Stellato M, Boccaccino A, Conca V, Germani MM, Bergamo F, Daniel F, Spagnoletti A, Provenzano L, Tomasello G, Zaniboni A, Buonadonna A, Fanchini L, Cupini S, Carlomagno C, Caponnetto S, Rapisardi S, Santini D. PROGNOSTIC AND PREDICTIVE ROLE OF BODY MASS INDEX (BMI) IN METASTATIC COLORECTAL CANCER (mCRC): A POOLED ANALISYS OF TRIBE AND TRIBE-2 STUDIES BY GONO. Clin Colorectal Cancer 2022; 21:220-228. [DOI: 10.1016/j.clcc.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/21/2022] [Accepted: 02/13/2022] [Indexed: 01/18/2023]
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Avallone A, Piccirillo MC, Nasti G, Rosati G, Carlomagno C, Di Gennaro E, Romano C, Tatangelo F, Granata V, Cassata A, Silvestro L, De Stefano A, Aloj L, Vicario V, Nappi A, Leone A, Bilancia D, Arenare L, Petrillo A, Lastoria S, Gallo C, Botti G, Delrio P, Izzo F, Perrone F, Budillon A. Effect of Bevacizumab in Combination With Standard Oxaliplatin-Based Regimens in Patients With Metastatic Colorectal Cancer: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2118475. [PMID: 34309665 PMCID: PMC8314140 DOI: 10.1001/jamanetworkopen.2021.18475] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Although bevacizumab is a standard of care in combination treatments for metastatic colorectal cancer (mCRC), its clinical benefit has been limited. OBJECTIVE To determine whether sequential scheduling of bevacizumab administration in combination with chemotherapy improves treatment efficacy in patients with mCRC, in keeping with the tumor vascular normalization hypothesis. DESIGN, SETTING, AND PARTICIPANTS This open-label, randomized clinical phase 3 trial was conducted from May 8, 2012, to December 9, 2015, at 3 Italian centers. Patients aged 18 to 75 years with unresectable, previously untreated, or single line-treated mCRC were recruited. Follow-up was completed December 31, 2019, and data were analyzed from February 26 to July 24, 2020. INTERVENTIONS Patients received 12 biweekly cycles of standard oxaliplatin-based regimens (modified FOLFOX-6 [levo-folinic acid, fluorouracil, and oxaliplatin]/modified CAPOX [capecitabine and oxaliplatin]) plus bevacizumab administered either on the same day as chemotherapy (standard arm) or 4 days before chemotherapy (experimental arm). MAIN OUTCOMES AND MEASURES The primary end point was the objective response rate (ORR) measured with Response Evaluation Criteria in Solid Tumors, version 1.1. Secondary end points included progression-free survival, overall survival, safety, and quality of life (QOL). RESULTS Overall, 230 patients (136 men [59.1%]; median age, 62.3 [interquartile range, 53.3-67.6] years) were randomly assigned to the standard arm (n = 115) or the experimental arm (n = 115). The median duration of follow-up was 68.3 (95% CI, 61.0-70.0) months. No difference in ORR (57.4% [95% CI, 47.8%-66.6%] in the standard arm and 56.5% [95% CI, 47.0-65.7] in the experimental arm; P = .89) or progression-free survival (10.5 [95% CI, 9.1-12.3] months in the standard arm and 11.7 [95% CI, 9.9-12.9] months in the experimental arm; P = .15) was observed. However, the median overall survival was 29.8 (95% CI, 22.5-41.1) months in the experimental arm compared with 24.1 (95% CI, 18.6-29.8) months in the standard arm (adjusted hazard ratio, 0.73; 95% CI, 0.54-0.99; P = .04). Moreover, the experimental arm was associated with a significant reduction in the rate of severe diarrhea (6 [5.3%] vs 19 [16.5%]; P = .006) and nausea (2 [1.8%] vs 8 [7.0%]; P = .05) and improved physical functioning (mean [SD] change from baseline, 0.65 [1.96] vs -7.41 [2.95] at 24 weeks; P = .02), and constipation scores (mean [SD] change from baseline, -17.2 [3.73] vs -0.62 [4.44]; P = .003). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, sequential administration of bevacizumab plus chemotherapy did not improve ORR, the primary end point. However, the overall survival advantage, fewer adverse effects, and better health-related QOL associated with sequential bevacizumab administration might provide the basis for exploring antiangiogenic combination treatments with innovative perspectives. TRIAL REGISTRATION EudraCT Identifier: 2011-004997-27; ClinicalTrials.gov Identifier: NCT01718873.
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Affiliation(s)
- Antonio Avallone
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori–Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G. Pascale, Napoli, Italy
| | - Maria C. Piccirillo
- Clinical Trials Unit, Istituto Nazionale Tumori–IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Guglielmo Nasti
- Innovative Therapy for Abdominal Metastases, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Gerardo Rosati
- Medical Oncology Unit, S. Carlo Hospital, Potenza, Italy
| | - Chiara Carlomagno
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Elena Di Gennaro
- Experimental Pharmacology Unit, Istituto Nazionale Tumori–IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Carmela Romano
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori–Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G. Pascale, Napoli, Italy
| | - Fabiana Tatangelo
- Pathology Unit, Istituto Nazionale Tumori–IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Vincenza Granata
- Radiology Unit, Istituto Nazionale Tumori–IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Antonino Cassata
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori–Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G. Pascale, Napoli, Italy
| | - Lucrezia Silvestro
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori–Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G. Pascale, Napoli, Italy
| | - Alfonso De Stefano
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori–Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G. Pascale, Napoli, Italy
| | - Luigi Aloj
- Nuclear Medicine Unit, Istituto Nazionale Tumori–IRCCS, Fondazione G. Pascale, Napoli, Italy
- currently affiliated with Department of Radiology, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Valeria Vicario
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori–Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G. Pascale, Napoli, Italy
| | - Anna Nappi
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori–Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G. Pascale, Napoli, Italy
| | - Alessandra Leone
- Experimental Pharmacology Unit, Istituto Nazionale Tumori–IRCCS, Fondazione G. Pascale, Napoli, Italy
| | | | - Laura Arenare
- Clinical Trials Unit, Istituto Nazionale Tumori–IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Antonella Petrillo
- Radiology Unit, Istituto Nazionale Tumori–IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Secondo Lastoria
- Nuclear Medicine Unit, Istituto Nazionale Tumori–IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Ciro Gallo
- Università della Campania Luigi Vanvitelli, Napoli, Italy
| | - Gerardo Botti
- Pathology Unit, Istituto Nazionale Tumori–IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Paolo Delrio
- Colorectal Oncological Surgery, Istituto Nazionale Tumori–IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Francesco Izzo
- Colorectal Oncological Surgery, Istituto Nazionale Tumori–IRCCS, Fondazione G. Pascale, Napoli, Italy
- Hepatobiliary Surgery Unit, Istituto Nazionale Tumori–IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Franco Perrone
- Clinical Trials Unit, Istituto Nazionale Tumori–IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Alfredo Budillon
- Experimental Pharmacology Unit, Istituto Nazionale Tumori–IRCCS, Fondazione G. Pascale, Napoli, Italy
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5
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Maddalena C, Ponsiglione A, Camera L, Santarpia L, Pasanisi F, Bruzzese D, Panico C, Fiore G, Camardella S, Caramia T, Farinaro A, De Placido S, Carlomagno C. Prognostic role of sarcopenia in metastatic colorectal cancer patients during first-line chemotherapy: A retrospective study. World J Clin Oncol 2021; 12:355-366. [PMID: 34131567 PMCID: PMC8173330 DOI: 10.5306/wjco.v12.i5.355] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/31/2021] [Accepted: 03/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sarcopenia is a condition characterized by decreased skeletal muscle mass due to physiological ageing or to a concomitant disease such as neoplasia. In cancer patients, a low lean body mass is suggested to be a negative prognostic factor for survival and for the development of dose-limiting chemotherapy toxicities irrespective of disease stage.
AIM To evaluate the prognostic role of sarcopenia in patients with metastatic colorectal cancer (mCRC) undergoing first-line chemotherapy.
METHODS Our retrospective analysis included 56 mCRC patients who received first-line chemotherapy from 2014 to 2017 at the Medical Oncology Unit of our hospital. Computerized scans were performed before starting chemotherapy and at the first disease reassessment. Sarcopenia was assessed using the skeletal mass index = muscle area in cm2/(height in m2) calculated at the L3 vertebra. Overall survival and objective response rate were evaluated. Toxicities were analyzed during the first four cycles of therapy and graded according to Common Terminology Criteria for Adverse Events version 4.0. A loss of skeletal muscle mass ≥ 5% was considered indicative of deterioration in muscle condition.
RESULTS Median age was 67 years and 35.7% of patients were ≥ 70 years old. Fourteen patients (25%) were sarcopenic at baseline computed tomography (CT) scan (7/33 men; 7/23 women); 5/14 sarcopenic patients were ≥ 70 years old. Median follow-up was 26.8 mo (3.8-66.8 mo) and median overall survival was 27.2 mo (95%CI: 23.3-37.3). Sarcopenia was not correlated to overall survival (P = 0.362), to higher toxicities reported during the first 4 cycles of chemotherapy (P = 1.0) or to response to treatment (P = 0.221). At the first disease reassessment, a skeletal muscle loss (SML) ≥ 5% was found in 17 patients (30.3%) 3 of whom were already sarcopenic at baseline CT scan, while 7 patients became sarcopenic. SML was not correlated to overall survival (P = 0.961). No statistically significant correlation was found between baseline sarcopenia and age (P = 1.0), body mass index (P = 0.728), stage at diagnosis (P = 0.355) or neutrophil/lymphocyte ratio (P = 0.751).
CONCLUSION Neither baseline sarcopenia nor SML affected survival. In addition, baseline sarcopenia was not related to worse treatment toxicity. However, these results must be interpreted with caution due to the limited sample size.
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Affiliation(s)
- Chiara Maddalena
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples 80131, Italy
| | - Luigi Camera
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples 80131, Italy
| | - Lidia Santarpia
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Fabrizio Pasanisi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Dario Bruzzese
- Department of Public Health, University of Naples Federico II, Naples 80131, Italy
| | - Camilla Panico
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples 80131, Italy
| | - Giovanni Fiore
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Simona Camardella
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Tolomeo Caramia
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Alessia Farinaro
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Chiara Carlomagno
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
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6
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Carlomagno C, Bertazioli D, Gualerzi A, Picciolini S, Banfi PI, Lax A, Messina E, Navarro J, Bianchi L, Caronni A, Marenco F, Monteleone S, Arienti C, Bedoni M. COVID-19 salivary Raman fingerprint: innovative approach for the detection of current and past SARS-CoV-2 infections. Sci Rep 2021; 11:4943. [PMID: 33654146 PMCID: PMC7925543 DOI: 10.1038/s41598-021-84565-3] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [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: 11/30/2020] [Accepted: 02/15/2021] [Indexed: 12/20/2022] Open
Abstract
The pandemic of COVID-19 is continuously spreading, becoming a worldwide emergency. Early and fast identification of subjects with a current or past infection must be achieved to slow down the epidemiological widening. Here we report a Raman-based approach for the analysis of saliva, able to significantly discriminate the signal of patients with a current infection by COVID-19 from healthy subjects and/or subjects with a past infection. Our results demonstrated the differences in saliva biochemical composition of the three experimental groups, with modifications grouped in specific attributable spectral regions. The Raman-based classification model was able to discriminate the signal collected from COVID-19 patients with accuracy, precision, sensitivity and specificity of more than 95%. In order to translate this discrimination from the signal-level to the patient-level, we developed a Deep Learning model obtaining accuracy in the range 89-92%. These findings have implications for the creation of a potential Raman-based diagnostic tool, using saliva as minimal invasive and highly informative biofluid, demonstrating the efficacy of the classification model.
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Affiliation(s)
- C Carlomagno
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Capecelatro 66, 20148, Milan, Italy.
| | - D Bertazioli
- Università di Milano-Bicocca, Viale Sarca 366, 20126, Milan, Italy
| | - A Gualerzi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Capecelatro 66, 20148, Milan, Italy
| | - S Picciolini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Capecelatro 66, 20148, Milan, Italy
| | - P I Banfi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Capecelatro 66, 20148, Milan, Italy
| | - A Lax
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Capecelatro 66, 20148, Milan, Italy
| | - E Messina
- Università di Milano-Bicocca, Viale Sarca 366, 20126, Milan, Italy
| | - J Navarro
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Capecelatro 66, 20148, Milan, Italy
| | - L Bianchi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Capecelatro 66, 20148, Milan, Italy
| | - A Caronni
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Capecelatro 66, 20148, Milan, Italy
| | - F Marenco
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Capecelatro 66, 20148, Milan, Italy
| | - S Monteleone
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Capecelatro 66, 20148, Milan, Italy
| | - C Arienti
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Capecelatro 66, 20148, Milan, Italy
| | - M Bedoni
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Capecelatro 66, 20148, Milan, Italy.
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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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Maddalena C, Ponsiglione A, Camera L, Santarpia L, Pasanisi F, Bruzzese D, Panico C, Fiore G, Camardella S, Caramia T, Farinaro A, Placido SD, Carlomagno C. P-272 Sarcopenia in metastatic colorectal cancer patients during first-line chemotherapy. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Buccafusca G, Cappuccio F, Cordio S, Mare M, Bruera G, Colombo A, Formica V, Montesarchio V, Tonini G, Leo S, Antonuzzo L, Gemma D, Biglietto M, Giuseppina B, Carlomagno C, Tralongo P. P-66 Treatment with FOLFIRI-aflibercept in an elderly population (over 75 and octogenarians) with metastatic colorectal cancer after failure of an oxaliplatin-based regimen: Experience in a real-life population. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.148] [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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Cremolini C, Antoniotti C, Rossini D, Lonardi S, Loupakis F, Pietrantonio F, Bordonaro R, Latiano TP, Tamburini E, Santini D, Passardi A, Marmorino F, Grande R, Aprile G, Zaniboni A, Murgioni S, Granetto C, Buonadonna A, Moretto R, Corallo S, Cordio S, Antonuzzo L, Tomasello G, Masi G, Ronzoni M, Di Donato S, Carlomagno C, Clavarezza M, Ritorto G, Mambrini A, Roselli M, Cupini S, Mammoliti S, Fenocchio E, Corgna E, Zagonel V, Fontanini G, Ugolini C, Boni L, Falcone A, Falcone A, Lonardi S, De Braud FGM, Bordonaro R, Maiello E, Tamburini E, Santini D, Frassineti GL, Gamucci T, Aprile G, Zaniboni A, Granetto C, Buonadonna A, Di Costanzo F, Tomasello G, Gianni L, Di Donato S, Carlomagno C, Clavarezza M, Racca P, Mambrini A, Roselli M, Allegrini G, Sobrero A, Aglietta M, Corgna E, Cortesi E, Corsi DC, Ballestrero A, Bonetti A, Di Clemente F, Ruggeri E, Ciardiello F, Benasso M, Vitello S, Cinieri S, Mosconi S, Silvestris N, Frassoldati A, Cupini S, Bertolini A, Tortora G, Bengala C, Ferrari D, Ardizzoia A, Milandri C, Chiara S, Romano G, Miraglia S, Scaltriti L, Pucci F, Blasi L, Brugnatelli S, Fioretto L, Ribecco AS, Longarini R, Frisinghelli M, Banzi M. Upfront FOLFOXIRI plus bevacizumab and reintroduction after progression versus mFOLFOX6 plus bevacizumab followed by FOLFIRI plus bevacizumab in the treatment of patients with metastatic colorectal cancer (TRIBE2): a multicentre, open-label, phase 3, randomised, controlled trial. Lancet Oncol 2020; 21:497-507. [DOI: 10.1016/s1470-2045(19)30862-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 01/07/2023]
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11
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Rosati G, Addeo R, Aprile G, Avallone A, Bilancia D, Brugnatelli S, Buccafusca G, Carlomagno C, Cordio S, Delfanti S, Dell'Aquila E, Di Bisceglie M, Di Donato S, Di Stasi A, Germano D, Giuliani F, Granetto C, Latiano TP, Leo S, Tralongo P, Stroppolo ME, Venturini F, Bianco S. Italian survey on cetuximab-based therapy of elderly patients with metastatic colorectal cancer. Cancer Chemother Pharmacol 2019; 84:1089-1096. [PMID: 31493178 DOI: 10.1007/s00280-019-03943-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 05/14/2019] [Accepted: 08/24/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE There is no consensus on the use of cetuximab in elderly patients with metastatic colorectal cancer. To this end, a survey was carried in 17 Italian oncology centers. METHODS The centers answered a 29-item questionnaire structured as follows: (i) demographic characteristics; (ii) medical history; (iii) assessment of RAS/BRAF mutations and DPD/UGT polymorphism before treatment; (iv) treatment schemes and side effects; (v) geriatric assessment and customization of treatment. RESULTS One-third of patients are over 80 years old. The RAS/BRAF mutational status is not primarily evaluated by 17.6% of the centers, while DPD and UGT polymorphism is not evaluated by 82.4% and 76.5% of the centers. The most common therapeutic scheme is cetuximab/FOLFIRI and diarrhea is the main cause of suspension/reduction of treatment. The 70% of centers use systemic tetracyclines for skin toxicity. The 23.5% of the centers do not carry out any geriatric evaluation before the start of the therapy and those who perform it prefer the G8 (70.6%) and VES-13 (29.4%) scales. CONCLUSIONS Greater efforts should be made to improve the evaluation of the patient both about mutational and genetic procedures with geriatric evaluation. As for cetuximab in elderly patients, randomized studies are needed to provide guidance to physicians.
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Affiliation(s)
- Gerardo Rosati
- U.O. Oncologia Medica, Azienda Ospedaliera S. Carlo, Potenza, Italy.
| | - Raffaele Addeo
- U.O. Oncologia Medica, Ospedale "San Giovanni di Dio", ASL NA 2 NORD, Frattamaggiore, Italy
| | - Giuseppe Aprile
- Dipartimento di Oncologia Clinica, Ospedale San Bortolo, AULSS8, Vicenza, Italy
| | - Antonio Avallone
- Unità Oncologia Clinica Sperimentale Addome, Dipartimento Assistenziale e di Ricerca dei Percorsi Oncologici del Distretto Addominale, INT Fondazione 'G. Pascale', Naples, Italy
| | | | - Silvia Brugnatelli
- S.C. Oncologia Medica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Chiara Carlomagno
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II, Naples, Italy
| | - Stefano Cordio
- S.C. Oncologia Medica, Ospedale Garibaldi, Catania, Italy
| | - Sara Delfanti
- S.C. Oncologia Medica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | | | | | | | | | | | - Tiziana Pia Latiano
- Dipartimento di Oncologia Medica, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy
| | | | - Paolo Tralongo
- U.O. Oncologia Medica, Ospedale Umberto I - RAO, Siracusa, Italy
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Rossini D, Sbrana A, Bergamo F, Manai C, Santini D, Ghidini M, Antoniotti C, Moretto R, Marmorino F, Urbano F, Ronzoni M, Noventa S, Randon G, Carlomagno C, Latiano T, Cordio S, Granetto C, Cremolini C, Falcone A, Antonuzzo A. Clinical impact of neutropenia and febrile neutropenia in metastatic colorectal cancer patients treated with FOLFOXIRI/bevacizumab: a pooled analysis of TRIBE and TRIBE2 studies. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz156.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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13
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Rossini D, Sbrana A, Bergamo F, Manai C, Santini D, Ghidini M, Antoniotti C, Moretto R, Marmorino F, Urbano F, Ronzoni M, Noventa S, Randon G, Carlomagno C, Latiano TP, Cordio SS, Granetto C, Cremolini C, Falcone A, Antonuzzo A. Clinical impact of neutropenia and febrile neutropenia in mCRC pts treated with FOLFOXIRI/bevacizumab (bev): A pooled analysis of TRIBE and TRIBE2 studies. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11591] [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
11591 Background: FOLFOXIRI/bev is a valid option as first-line therapy for unresectable mCRC. TRIBE and TRIBE2 trials reported better activity and efficacy of the triplet/bev when compared with doublets/bev at the price of a higher incidence of chemo-related toxicities, including neutropenia (N). Here we aim at providing a detailed description of this adverse event, including the occurrence of febrile neutropenia (FN) and the use of granulocyte-colony stimulating factors (G-CSFs), in order to estimate the clinical relevance of N during FOLFOXIRI/bev. Methods: Safety data of 1175 pts enrolled in the TRIBE and TRIBE2 studies were reviewed. The incidence of N, the incidence and severity of FN, and the use of G-CSF in the triplet/bev and in the doublets/bev arms were compared using the Chi-square or the Fisher exact test as appropriate. Results: Out of 1175 pts included in the final analysis, 586 (49.8%) were treated with FOLFOXIRI/bev. Five pts (0.8%) in the doublets/bev arms and 29 (4.9%) in the triplet/bev arms received a primary prophylaxis with G-CSF. Among other pts, 118 (20.2%) in the doublets/bev arms and 276 (49.9%) in the triplet/bev arms experienced ≥ G3 N (p < 0.001). FN occurred in 25 (4.3%) and 41 (7.4%) cases respectively (p=0.041). Out of 78 FN episodes, 4 (13.3%) out of 30 in the doublets/bev arms and 13 out of 48 (27.1%) in the triplet/bev arms were associated with a poor MASCC score (<21) (p=0.17). G-CSF was used in 1069 (10.8%) cycles, 270 (5.3%) in doublets/bev and 799 (16.6%) in triplet/bev arms. In both arms, the majority of N and FN episodes were observed in the first two months (318 ≥ G3 N episodes out of 675 (47.1%), and 54 FN episodes out of 78 (69.2%)). Conclusions: FOLFOXIRI/bev was associated with a higher risk of N and FN than doublets/bev. However, the risk of FN was lower than 10%, thus not requiring a systematic use of primary G-CSF prophylaxis. The majority of FN episodes was associated with a good MASCC score, thus having a limited clinical impact. The vast majority of FN episodes occurred in the first two months of treatment, suggesting a closer monitoring of this adverse event during the first courses of therapy.
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Affiliation(s)
- Daniele Rossini
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Andrea Sbrana
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Francesca Bergamo
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Chiara Manai
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico - University of Rome, Rome, Italy
| | | | - Carlotta Antoniotti
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Roberto Moretto
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Federica Marmorino
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Federica Urbano
- Department of Radiological Science, Oncology and Patology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Monica Ronzoni
- Department of Oncology, Istituto Scientifico San Raffaele IRCSS, Milan, Italy
| | - Silvia Noventa
- Medical Oncology Unit, Casa di Cura Poliambulanza, Brescia, Italy
| | - Giovanni Randon
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Carlomagno
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Tiziana Pia Latiano
- Oncology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy
| | | | - Cristina Granetto
- Oncologia Medica, Azienda Sanitaria Ospedaliera Santa Croce e Carle, Cuneo, Italy
| | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Alfredo Falcone
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Andrea Antonuzzo
- Unit of Medical Oncology 1, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
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Avallone A, Nasti G, Rosati G, Carlomagno C, Romano C, Bilancia D, De Stefano A, Silvestro L, Ottaiano A, Cassata A, Bianco F, Izzo F, Delrio P, De Gennaro E, Casaretti R, Tafuto S, Albino V, Pace U, Lastoria S, Gallo C, Budillon A, Piccirillo M. Survival analysis of a multicentre, randomized phase 3 study on the optimization of the combination of bevacizumab with FOLFOX/OXXEL in patients with metastatic colorectal cancer (mCRC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Avallone A, Nasti G, Rosati G, Carlomagno C, Silvestro L, Cassata A, Romano C, Granata V, De Stefano A, Tafuto S, Bianco F, Vicario V, Bilancia D, Lastoria S, Petrillo A, Izzo F, Gallo C, Delrio P, Budillon A, Piccirillo MC. Update survival analysis from a multicenter, randomized phase 3 study on the optimization of the combination of bevacizumab with FOLFOX/OXXEL in patients with metastatic colorectal cancer (mCRC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.3562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Guglielmo Nasti
- Istituto Nazionale Tumori Fondazione G.Pascale, Naples, Italy
| | - Gerardo Rosati
- Medical Oncology Unit, S. Carlo Hospital, Potenza, Italy
| | - Chiara Carlomagno
- Department of Molecular and Clinical Endocrinology and Oncology, University of Naples Federico II, Naples, Italy
| | | | | | - Carmen Romano
- Istituto Nazionale Tumori Fondazione G.Pascale, Naples, Italy
| | | | | | | | - Franco Bianco
- Istituto Nazionale Tumori Fondazione G.Pascale, Naples, Italy
| | - Valeria Vicario
- Istituto Nazionale Tumori Fondazione G.Pascale, Naples, Italy
| | | | | | | | - Francesco Izzo
- Istituto Nazionale Tumori Fondazione G.Pascale, Naples, Italy
| | - Ciro Gallo
- Università degli Studi Luigi Vanvitelli, Napoli, Italy
| | - Paolo Delrio
- Istituto Nazionale Tumori Fondazione G.Pascale, Naples, Italy
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Perrone F, De Placido S, Carlomagno C, Nuzzo F, Ruggiero A, De Laurentiis M, Gridelli C, Pagliarulo C, Bianco AR. Chemotherapy with Mitomycin C and Vinblastine in Pretreated Metastatic Breast Cancer. Tumori 2018; 79:254-7. [PMID: 8249178 DOI: 10.1177/030089169307900405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims In February 1986 we began a study to test the activity of mitomycin C (12 mg/m2) plus vinblastine (6 mg/m2) on day 1 of a 28-day cycle (MV) as second or third-line chemotherapy for metastatic breast cancer patients. Methods As of February 1988 the study was stopped after 26 patients had been enrolled. The median age of the patients was 54 years (range 35-78); all patients were progressive from chemotherapy; 15 (57.7 %) patients were treated as second and 11 (42.3 %) as third line; 19 (73.1 %) patients had received anthracyclines as first (13 patients) or second-line (6 patients) chemotherapy; 18 (69.2 %) patients had visceral Involvement; 7 (26.9 %) had one metastatic site, 11 (42.3 %) two sites, 6 (23.1 %) three sites and 2 (7.7 %) four sites. Results Overall, 86 cycles were administered, with a median number of 3 cycles per patient. Toxicity was mild; hematologic side effects required discontinuation of treatment in 3 cases. Vomiting occurred in 3 (11.5 %) patients, nausea in 5 (19.2 %). Moderate neurologic toxicity was recorded in 6 (23 %) patients. No complete and 3 partial responses were observed. The objective response rate was 11.5 % (exact 95 % confidence interval, 2.4-30.1). Responses occurred independently of disease-free interval, dominant metastatic site, response to previous chemotherapy, previous anthracycline and line of treatment; all responses were recorded in patients under 50 years of age. Kaplan-Meier estimated median time to progression and overall survival were 13 and 40 weeks, respectively. Conclusion The MV regimen was well tolerated but showed little activity in pretreated metastatic breast cancer.
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Affiliation(s)
- F Perrone
- Division of Medical Oncology, University of Naples, Federico II Medical School, Italy
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de Placido S, Nuzzo F, Perrone F, Carlomagno C, Noviello A, Delrio P, di Palma E, Pini MT, Cerato PL, Bianco C. The First Breast Cancer Screening Program in Southern Italy: Preliminary Results from Three Municipalities of the Naples Province. Tumori 2018; 81:7-12. [PMID: 7754547 DOI: 10.1177/030089169508100103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and Background It has been demonstrated that breast cancer screening induces a 30% reduction of specific mortality. In May 1990, we started a pilot screening program to assess the feasibility of carrying out such a program in Campania (southern Italy). Herein we report the results of the first round of the program from three municipalities (Giugliano, Mugnano and Qualiano) that lie within the local health district no. 23, close to the city of Naples. Methods Women between the ages of 50 and 69 years were sent a personalized letter inviting them to attend the screening test; those not responding were sent a second invitation. The screening test consisted of clinical examination followed by two-view mammography. Second–level diagnostic tools were sonography, fine needle aspiration (manual, echo-guided and stereotaxic) and surgical biopsy. Results Out of 5,732 women invited for the first round, 1,813 (31.6%) attended the screening. Attendance rate was higher among younger women. Ninety-one women were positive at the screening test and underwent further examination (recall rate, 5.0%). Among them, 19 had surgical biopsy (biopsy rate, 1.0%) that led to breast cancer diagnosis in 11 cases. The benign/malignant biopsy rate was 0.73. Detection rate was 6.07 × 1,000 screened women and varied among age categories, increasing within the 60–69 subgroup; detection rate/expected incidence ratio in the overall group was 4.5 and also increased within the older age category. Seven out of 11 cancers were at UICC stage 0-I. Among 327 self-referring women, 38 were positive (recall rate, 11.6%), and 14 underwent biopsy (biopsy rate, 4.3%), which showed cancer in 7 cases (benign/malignant biopsy rate, 1.0). In addition, 2 inflammatory cancers were diagnosed without surgical biopsy. Thus 9 cancer cases were detected in this group. Self-referring women differed from responding women in that they had a higher frequency of symptoms or familiar history of cancer, and a higher educational level and awareness of preventive medicine. Clinical examination added no diagnostic advantage in the responding group but did not significantly worsen the recall rate. In the self-referring group, one case of inflammatory cancer was missed by mammography and diagnosed by clinical examination. Conclusion The early results (recall rate = 5%, detection rate/expected incidence ratio = 4.5, benign/malignant biopsy rate = 0.73, advanced cancers = 36.4%) are encouraging and indicate the validity of the program. Strategies to improve attendance rate are planned.
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Affiliation(s)
- S de Placido
- Cattedra di Oncologia Medica, Facoltà di Medicina e Chirurgia, Università di Napoli Federico II, Italy
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18
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Attademo L, De Falco S, Rosanova M, Esposito M, Mazio F, Foschini F, Santaniello A, Fiore G, Matano E, Manganelli F, Carlomagno C. A case report of limbic encephalitis in a metastatic colon cancer patient during first-line bevacizumab-combined chemotherapy. Medicine (Baltimore) 2018; 97:e0011. [PMID: 29489644 PMCID: PMC5851735 DOI: 10.1097/md.0000000000010011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Paraneoplastic limbic encephalitis (PLE) is one of the most common causes of neurologic paraneoplastic syndromes, with unclear pathogenesis. While several reports published in the last decades showed the occurrence of PLE in a variety of cancers, only a few cases have been associated with colon cancer. PATIENT CONCERNS In February 2017, a 54-year-old man with clinical history of radically resected colon cancer started first line chemotherapy with FOLFOXIRI plus bevacizumab, after radiological diagnosis of multiple liver and bone metastases. During the third cycle of treatment, the patient developed psychomotor agitation and hallucinations followed by severe consciousness level reduction and cognitive impairment. DIAGNOSES Magnetic resonance imaging showed hyperintense signals in both hippocampal areas, insula and right cingulate gyrus on fluid attenuated inversion recovery, diffusion weighted imaging, and T2-weighted images, highly suggestive of limbic encephalitis. Other causes (brain metastases, toxicity of chemotherapeutic agents, and infections) were excluded. INTERVENTIONS Empirical immunosuppressive treatment (high-dose immunoglobulins and corticosteroids) was administered and chemotherapy was resumed. OUTCOMES A slowly progressive improvement in neurological condition has been observed, even though radiological signs of limbic encephalitis are still evident. LESSONS The present case highlights the complex diagnostic process of PLE, and the lack of a standard treatment. Moreover, the absence of correlation between PLE and tumor progression or tumor burden, and the opportunity of treating underlying neoplasm is discussed.
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Affiliation(s)
| | | | | | - Marcello Esposito
- Department of Neurosciences, Reproductive Sciences and Odontostomatology
| | - Federica Mazio
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | | | | | | | - Fiore Manganelli
- Department of Neurosciences, Reproductive Sciences and Odontostomatology
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19
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Guacci A, Cordella A, Rocco T, Giurato G, Nassa G, Rizzo F, Carlomagno C, Pepe S, Tarallo R, Weisz A. Identification of a novel truncating mutation in PALB2 gene by a multigene sequencing panel for mutational screening of breast cancer risk-associated and related genes. J Clin Lab Anal 2018; 32:e22418. [PMID: 29484706 DOI: 10.1002/jcla.22418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 12/29/2017] [Accepted: 02/04/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Breast cancer (BC) is the most common neoplasm in women, with 5%-10% patients showing a familial predisposition, where germline mutations in BRCA1/BRCA2 genes are found in -20% of cases. Next-generation sequencing (NGS) is among the best available options for genetic screening, providing several benefits that include enhanced sensitivity and unbiased mutation detection. PALB2 (partner and localizer of BRCA2) is a cancer predisposing gene recently described that encodes a protein partner of BRCA2 involved in DNA double-strand break repair and cell cycle control. The DNA damage response represents a key cellular event, targeted by innovative anticancer therapies, including those based on poly (ADP-ribose) polymerase (PARP) inhibitors targeting PARP1 and PARP2 enzymes, activated by DNA damage and involved in single-strand break and base excision repair. METHODS Genomic DNA was isolated from 34 patient samples and four BC cell lines, as controls, and 27 breast cancer predisposing genes belonging to the BRCA1/BRCA2 and PARP pathways were sequenced by NGS. RESULTS The panel described here allowed identification of several sequence variations in most investigated genes, among which we found a novel truncating mutation in PALB2. CONCLUSIONS The NGS-based strategy designed here for molecular analysis of a customized panel of BC predisposing and related genes was found to perform effectively, providing a comprehensive exploration of all genomic sequences of the investigated genes. It is thus useful for BC molecular diagnosis, in particular for familiar cases where alterations in routinely investigated genes, such as BRCAs, result to be absent.
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Affiliation(s)
- Anna Guacci
- Genomix4Life srl, Department of Medicine, Surgery and Dentistry, 'Scuola Medica Salernitana', University of Salerno, Baronissi, Italy
| | - Angela Cordella
- Genomix4Life srl, Department of Medicine, Surgery and Dentistry, 'Scuola Medica Salernitana', University of Salerno, Baronissi, Italy
| | - Teresa Rocco
- Genomix4Life srl, Department of Medicine, Surgery and Dentistry, 'Scuola Medica Salernitana', University of Salerno, Baronissi, Italy
| | - Giorgio Giurato
- Genomix4Life srl, Department of Medicine, Surgery and Dentistry, 'Scuola Medica Salernitana', University of Salerno, Baronissi, Italy.,Laboratory of Molecular Medicine and Genomics, Department of Medicine, Surgery and Dentistry, 'Scuola Medica Salernitana', University of Salerno, Baronissi, Italy
| | - Giovanni Nassa
- Laboratory of Molecular Medicine and Genomics, Department of Medicine, Surgery and Dentistry, 'Scuola Medica Salernitana', University of Salerno, Baronissi, Italy.,Medical Genomics Program, 'SS. Giovanni di Dio e Ruggi d'Aragona' Hospital, University of Salerno, Salerno, Italy
| | - Francesca Rizzo
- Laboratory of Molecular Medicine and Genomics, Department of Medicine, Surgery and Dentistry, 'Scuola Medica Salernitana', University of Salerno, Baronissi, Italy.,Medical Genomics Program, 'SS. Giovanni di Dio e Ruggi d'Aragona' Hospital, University of Salerno, Salerno, Italy
| | - Chiara Carlomagno
- Department of Clinical Medicine and Surgery, University of Napoli 'Federico II', Napoli, Italy
| | - Stefano Pepe
- Division of Oncology, 'SS. Giovanni di Dio e Ruggi d'Aragona' Hospital, University of Salerno, Salerno, Italy
| | - Roberta Tarallo
- Laboratory of Molecular Medicine and Genomics, Department of Medicine, Surgery and Dentistry, 'Scuola Medica Salernitana', University of Salerno, Baronissi, Italy.,Medical Genomics Program, 'SS. Giovanni di Dio e Ruggi d'Aragona' Hospital, University of Salerno, Salerno, Italy
| | - Alessandro Weisz
- Laboratory of Molecular Medicine and Genomics, Department of Medicine, Surgery and Dentistry, 'Scuola Medica Salernitana', University of Salerno, Baronissi, Italy.,Medical Genomics Program, 'SS. Giovanni di Dio e Ruggi d'Aragona' Hospital, University of Salerno, Salerno, Italy
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20
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Nunziato M, Starnone F, Lombardo B, Pensabene M, Condello C, Verdesca F, Carlomagno C, De Placido S, Pastore L, Salvatore F, D'Argenio V. Fast Detection of a BRCA2 Large Genomic Duplication by Next Generation Sequencing as a Single Procedure: A Case Report. Int J Mol Sci 2017; 18:ijms18112487. [PMID: 29165356 PMCID: PMC5713453 DOI: 10.3390/ijms18112487] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 09/28/2017] [Revised: 11/06/2017] [Accepted: 11/18/2017] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to verify the reliability of a next generation sequencing (NGS)-based method as a strategy to detect all possible BRCA mutations, including large genomic rearrangements. Genomic DNA was obtained from a peripheral blood sample provided by a patient from Southern Italy with early onset breast cancer and a family history of diverse cancers. BRCA molecular analysis was performed by NGS, and sequence data were analyzed using two software packages. Comparative genomic hybridization (CGH) array was used as confirmatory method. A novel large duplication, involving exons 4-26, of BRCA2 was directly detected in the patient by NGS workflow including quantitative analysis of copy number variants. The duplication observed was also found by CGH array, thus confirming its extent. Large genomic rearrangements can affect the BRCA1/2 genes, and thus contribute to germline predisposition to familial breast and ovarian cancers. The frequency of these mutations could be underestimated because of technical limitations of several routinely used molecular analysis, while their evaluation should be included also in these molecular testing. The NGS-based strategy described herein is an effective procedure to screen for all kinds of BRCA mutations.
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Affiliation(s)
- Marcella Nunziato
- CEINGE-Biotecnologie Avanzate, via Gaetano Salvatore 486, 80145 Naples, Italy.
- Department of Movement Sciences and Wellness (DiSMEB), University of Naples Parthenope, via Medina 40, 80133 Naples, Italy.
| | - Flavio Starnone
- CEINGE-Biotecnologie Avanzate, via Gaetano Salvatore 486, 80145 Naples, Italy.
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples "Federico II", via Sergio Pansini 5, 80131 Naples, Italy.
| | - Barbara Lombardo
- CEINGE-Biotecnologie Avanzate, via Gaetano Salvatore 486, 80145 Naples, Italy.
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples "Federico II", via Sergio Pansini 5, 80131 Naples, Italy.
| | - Matilde Pensabene
- Oncology Division, Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy.
| | - Caterina Condello
- Oncology Division, Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy.
| | - Francesco Verdesca
- CEINGE-Biotecnologie Avanzate, via Gaetano Salvatore 486, 80145 Naples, Italy.
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples "Federico II", via Sergio Pansini 5, 80131 Naples, Italy.
| | - Chiara Carlomagno
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy.
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy.
| | - Lucio Pastore
- CEINGE-Biotecnologie Avanzate, via Gaetano Salvatore 486, 80145 Naples, Italy.
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples "Federico II", via Sergio Pansini 5, 80131 Naples, Italy.
| | - Francesco Salvatore
- CEINGE-Biotecnologie Avanzate, via Gaetano Salvatore 486, 80145 Naples, Italy.
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples "Federico II", via Sergio Pansini 5, 80131 Naples, Italy.
- IRCCS-Fondazione SDN, via Emanuele Gianturco 113, 80143 Naples, Italy.
| | - Valeria D'Argenio
- CEINGE-Biotecnologie Avanzate, via Gaetano Salvatore 486, 80145 Naples, Italy.
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples "Federico II", via Sergio Pansini 5, 80131 Naples, Italy.
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21
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Rosanova M, De Falco S, Attademo L, Fiore G, De Stefano A, Maddalena C, De Placido S, Carlomagno C. Multiple treatment lines and prognosis for metastatic colorectal (mCRC) patients (pts). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx422.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Avallone A, Nasti G, Rosati G, Carlomagno C, Romano C, Bilancia D, De Stefano A, Ottaiano A, Cassata A, Silvestro L, Tafuto S, Bianco F, Delrio P, Izzo F, Di Gennaro E, Lastoria S, Gallo C, Perrone F, Budillon A, Piccirillo M. A multicentre, randomized phase 3 study on the optimization of the combination of bevacizumab with mFOLFOX/OXXEL in patients with metastatic colorectal cancer (mCRC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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23
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Formica V, Casaretti R, Comella G, Carlomagno C, Maiorino L, Greco E, Russo A, Sanna G, Barzelloni Maria L, Massidda B, Serci C, Defraia S, Palmieri G, Ionta Maria T. The panitumumab with FOLFOX4 in metastatic gastric or gastroesophageal junction adenocarcinoma (mGA) - VEGA trial. Efficacy and safety outcomes of a phase II S.I.C.O.G. study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx261.095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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24
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Cella CA, Di Minno G, Carlomagno C, Arcopinto M, Cerbone AM, Matano E, Tufano A, Lordick F, De Simone B, Muehlberg KS, Bruzzese D, Attademo L, Arturo C, Sodano M, Moretto R, La Fata E, De Placido S. Preventing Venous Thromboembolism in Ambulatory Cancer Patients: The ONKOTEV Study. Oncologist 2017; 22:601-608. [PMID: 28424324 DOI: 10.1634/theoncologist.2016-0246] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 12/20/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The efficacy of risk model scores to predict venous thromboembolism (VTE) in ambulatory cancer patients is under investigation, aiming to stratify on an individual risk basis the subset of the cancer population that could mostly benefit from primary thromboprophylaxis. MATERIALS AND METHODS We prospectively assessed 843 patients with active cancers, collecting clinical and laboratory data. We screened all the patients with a duplex ultrasound (B-mode imaging and Doppler waveform analysis) of the upper and lower limbs to evaluate the right incidence of VTE (both asymptomatic and symptomatic). The efficacy of the existing Khorana risk model in preventing VTE was also explored in our population. Several risk factors associated with VTE were analyzed, leading to the construction of a risk model. The Fine and Gray model was used to account for death as a competing risk in the derivation of the new model. RESULTS The risk factors significantly associated with VTE at univariate analysis and further confirmed in the multivariate analysis, after bootstrap validation, were the presence of metastatic disease, the compression of vascular/lymphatic structures by tumor, a history of previous VTE, and a Khorana score >2. Time-dependent receiving operating characteristic (ROC) curve analysis showed a significant improvement in the area under the curve of the new score over the Khorana model at 3 months (71.9% vs. 57.9%, p = .001), 6 months (75.4% vs. 58.6%, p < .001), and 12 months (69.8% vs. 58.3%, p = .014). CONCLUSION ONKOTEV score steps into history of cancer-related-VTE as a promising tool to drive the decision about primary prophylaxis in cancer outpatients. The validation represents the goal of the prospective ONKOTEV-2 study, endorsed and approved by the European Organization for Research and Treatment of Cancer Young Investigators Program. The Oncologist 2017;22:601-608 IMPLICATIONS FOR PRACTICE: Preventing venous thromboembolism in cancer outpatients with a risk model score will drive physicians' decision of starting thromboprophylaxis in high-risk patients.
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Affiliation(s)
- Chiara Alessandra Cella
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
- University Cancer Center Leipzig (UCCL), University Medicine, Leipzig, Germany
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Chiara Carlomagno
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Michele Arcopinto
- Heart Surgery Department, IRCCS Policlinico San Donato Milanese, Milan, Italy
| | - Anna Maria Cerbone
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Elide Matano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Florian Lordick
- University Cancer Center Leipzig (UCCL), University Medicine, Leipzig, Germany
| | - Biagio De Simone
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | - Dario Bruzzese
- Department of Public Health, Federico II University, Naples, Italy
| | - Laura Attademo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Claudia Arturo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Marta Sodano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Roberto Moretto
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Ersilia La Fata
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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25
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Pensabene M, Condello C, Carlomagno C, De Placido S, Liccardo R, Duraturo F. Two novel sequence variants in MSH2 gene in a patient who underwent cancer genetic counseling for a very early-onset epithelial ovarian cancer. Hered Cancer Clin Pract 2016; 14:18. [PMID: 27602174 PMCID: PMC5011803 DOI: 10.1186/s13053-016-0054-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 06/20/2016] [Indexed: 12/02/2022] Open
Abstract
Background Early-onset or hereditary ovarian cancer is mostly associated with BRCA1 or BRCA2 mutations. Mismatch repair genes sequence alteration frequently cause colorectal cancer, and, in less extent, other tumors, such as ovarian cancer. Subjects with personal and/or family history suggestive for hereditary cancer should be addressed to cancer genetic counseling, aimed to the identification, definition and management of hereditary cancer syndrome, by a multidisciplinary approach. Case presentation A woman with a very early onset epithelial ovarian cancer underwent to cancer genetic counseling and genetic testing. Pedigree analysis suggested a clinical diagnosis of Lynch II syndrome, according to the Amsterdam criteria. The MMRpro model showed a cumulative risk of mutation of 50.3 %, thus, genetic testing was offered to the patient. Two germ-line mutations have been identified in exon 11 of MSH2 gene: c.1706A > T (p.Glu569Val) and c.1711G > T (p.Glu571*). Both DNA alterations were novel mutations not yet described in literature. The first is a missense mutation that is to be considered an unclassified variant; the second is nonsense mutation that created a premature stop codon resulting in a truncated not functioning protein. Both genetic alterations were found in the patients’ father DNA. Conclusions The present report finds out two unpublished sequence alterations in exon 11 of the MSH2 gene, one on which can be considered causative of Lynch phenotype. Moreover, it stresses the importance of the multidisciplinary onco-genetic counselling in order to correctly frame the hereditary syndrome, suggest the right genetic test, and offer the most appropriate management of the cancer risk for the patients and her family members.
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Affiliation(s)
- Matilde Pensabene
- Department of Clinical Medicine - Clinical Unit of Oncology, University Hospital Federico II, Naples, Italy
| | - Caterina Condello
- Department of Clinical Medicine - Clinical Unit of Oncology, University Hospital Federico II, Naples, Italy
| | - Chiara Carlomagno
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Raffaella Liccardo
- Department of Molecular Medicine and Medical Biotechnology, University Federico II, Naples, Italy
| | - Francesca Duraturo
- Department of Molecular Medicine and Medical Biotechnology, University Federico II, Naples, Italy
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26
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Rossini D, Casagrande M, Moretto R, Loupakis F, Cremolini C, Masi G, Borelli B, Lonardi S, Zagonel V, Aprile G, Ricci V, Grande R, Tomasello G, Ronzoni M, Allegrini G, Tonini G, Mancini M, Zaniboni A, Chiara S, Carlomagno C, Falcone A. Safety and efficacy of FOLFOXIRI with or without targeted agents as first-line treatment of selected elderly metastatic colorectal cancer patients: a pooled analysis of GONO studies. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw335.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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27
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Casagrande M, Moretto R, Loupakis F, Cremolini C, Masi G, Borelli B, Lonardi S, Marsico Valentina A, Salvatore L, Rossini D, Ferrari L, Ricci V, Grande R, Tomasello G, Ronzoni M, Allegrini G, Tonini G, Mancini M, Zaniboni A, Chiara S, Carlomagno C, Falcone A. PD-009 Safety and efficacy of FOLFOXIRI with or without targeted agents as first-line treatment of selected elderly metastatic colorectal cancer patients: a pooled analysis of GONO studies. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw200.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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28
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Casagrande M, Moretto R, Loupakis F, Cremolini C, Masi G, Borelli B, Lonardi S, Marsico VA, Ferrari L, Ricci V, Grande R, Tomasello G, Ronzoni M, Allegrini G, Tonini G, Mancini ML, Zaniboni A, Chiara S, Carlomagno C, Falcone A. Safety and efficacy of FOLFOXIRI with or without targeted agents as first-line treatment of selected elderly metastatic colorectal cancer patients: A pooled analysis of GONO studies. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e15054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Roberto Moretto
- Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | | | - Chiara Cremolini
- Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Gianluca Masi
- Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Beatrice Borelli
- Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | | | - Valentina Angela Marsico
- Dipartimento di Oncologia Clinica e Sperimentale, UOC Oncologia Medica I, Istituto Oncologico Veneto-IRCCS, Padova, Italy
| | - Laura Ferrari
- Department of Oncology, University Hospital, Udine, Italy, Udine, Italy
| | | | | | | | - Monica Ronzoni
- Oncologia Medica - Ospedale San Raffaele, Milano, Milano, Italy
| | - Giacomo Allegrini
- Dipartimento Oncologico U.O. Oncologia Medica Azienda Toscana Nord Ovest, Pontedera, Italy
| | | | | | | | | | - Chiara Carlomagno
- Department of Molecular and Clinical Endocrinology and Oncology, University of Naples Federico II, Naples, Italy
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29
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Avallone A, Piccirillo MC, Aloj L, Nasti G, Delrio P, Izzo F, Di Gennaro E, Tatangelo F, Granata V, Cavalcanti E, Maiolino P, Bianco F, Aprea P, De Bellis M, Pecori B, Rosati G, Carlomagno C, Bertolini A, Gallo C, Romano C, Leone A, Caracò C, de Lutio di Castelguidone E, Daniele G, Catalano O, Botti G, Petrillo A, Romano GM, Iaffaioli VR, Lastoria S, Perrone F, Budillon A. A randomized phase 3 study on the optimization of the combination of bevacizumab with FOLFOX/OXXEL in the treatment of patients with metastatic colorectal cancer-OBELICS (Optimization of BEvacizumab scheduLIng within Chemotherapy Scheme). BMC Cancer 2016; 16:69. [PMID: 26857924 PMCID: PMC4746902 DOI: 10.1186/s12885-016-2102-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 11/07/2015] [Accepted: 01/29/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Despite the improvements in diagnosis and treatment, colorectal cancer (CRC) is the second cause of cancer deaths in both sexes. Therefore, research in this field remains of great interest. The approval of bevacizumab, a humanized anti-vascular endothelial growth factor (VEGF) monoclonal antibody, in combination with a fluoropyrimidine-based chemotherapy in the treatment of metastatic CRC has changed the oncology practice in this disease. However, the efficacy of bevacizumab-based treatment, has thus far been rather modest. Efforts are ongoing to understand the better way to combine bevacizumab and chemotherapy, and to identify valid predictive biomarkers of benefit to avoid unnecessary and costly therapy to nonresponder patients. The BRANCH study in high-risk locally advanced rectal cancer patients showed that varying bevacizumab schedule may impact on the feasibility and efficacy of chemo-radiotherapy. METHODS/DESIGN OBELICS is a multicentre, open-label, randomised phase 3 trial comparing in mCRC patients two treatment arms (1:1): standard concomitant administration of bevacizumab with chemotherapy (mFOLFOX/OXXEL regimen) vs experimental sequential bevacizumab given 4 days before chemotherapy, as first or second treatment line. Primary end point is the objective response rate (ORR) measured according to RECIST criteria. A sample size of 230 patients was calculated allowing reliable assessment in all plausible first-second line case-mix conditions, with a 80% statistical power and 2-sided alpha error of 0.05. Secondary endpoints are progression free-survival (PFS), overall survival (OS), toxicity and quality of life. The evaluation of the potential predictive role of several circulating biomarkers (circulating endothelial cells and progenitors, VEGF and VEGF-R SNPs, cytokines, microRNAs, free circulating DNA) as well as the value of the early [(18)F]-Fluorodeoxyglucose positron emission tomography (FDG-PET) response, are the objectives of the traslational project. DISCUSSION Overall this study could optimize bevacizumab scheduling in combination with chemotherapy in mCRC patients. Moreover, correlative studies could improve the knowledge of the mechanisms by which bevacizumab enhance chemotherapy effect and could identify early predictors of response. EudraCT Number: 2011-004997-27 TRIAL REGISTRATION: ClinicalTrials.gove number, NCT01718873.
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Affiliation(s)
- Antonio Avallone
- Multidisciplinary Treatment Unit, Gastrointestinal Medical Oncology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Napoli, Italy. .,Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Napoli, Italy.
| | | | - Luigi Aloj
- Nuclear Medicine Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Napoli, Italy.
| | - Guglielmo Nasti
- Gastrointestinal Medical Oncology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Napoli, Italy.
| | - Paolo Delrio
- Colorectal Surgery Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Napoli, Italy.
| | - Francesco Izzo
- Hepatobiliary Surgery Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Napoli, Italy.
| | - Elena Di Gennaro
- Experimental Pharmacology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Napoli, Italy.
| | - Fabiana Tatangelo
- Pathology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Napoli, Italy.
| | - Vincenza Granata
- Radiology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Napoli, Italy.
| | - Ernesta Cavalcanti
- Laboratory Medicine Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Napoli, Italy.
| | - Piera Maiolino
- Pharmacy Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Napoli, Italy.
| | - Francesco Bianco
- Gastrointestinal Surgery Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Napoli, Italy.
| | - Pasquale Aprea
- Vascular Access Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Napoli, Italy.
| | - Mario De Bellis
- Endoscopy Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Napoli, Italy.
| | - Biagio Pecori
- Radiotherapy Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Napoli, Italy.
| | - Gerardo Rosati
- Medical Oncology Unit, San Carlo Hospital, Potenza, Italy.
| | - Chiara Carlomagno
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.
| | | | - Ciro Gallo
- Medical Statistics Unit, Second University, Naples, Italy.
| | - Carmela Romano
- Gastrointestinal Medical Oncology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Napoli, Italy.
| | - Alessandra Leone
- Experimental Pharmacology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Napoli, Italy.
| | - Corradina Caracò
- Nuclear Medicine Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Napoli, Italy.
| | | | - Gennaro Daniele
- Clinical Trials Unit, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Napoli, Italy.
| | - Orlando Catalano
- Radiology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Napoli, Italy.
| | - Gerardo Botti
- Pathology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Napoli, Italy.
| | - Antonella Petrillo
- Radiology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Napoli, Italy.
| | - Giovanni M Romano
- Gastrointestinal Surgery Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Napoli, Italy.
| | - Vincenzo R Iaffaioli
- Gastrointestinal Medical Oncology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Napoli, Italy.
| | - Secondo Lastoria
- Nuclear Medicine Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Napoli, Italy.
| | - Francesco Perrone
- Clinical Trials Unit, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Napoli, Italy.
| | - Alfredo Budillon
- Experimental Pharmacology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Napoli, Italy.
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Malapelle U, Pisapia P, Sgariglia R, Vigliar E, Biglietto M, Carlomagno C, Giuffrè G, Bellevicine C, Troncone G. Less frequently mutated genes in colorectal cancer: evidences from next-generation sequencing of 653 routine cases. J Clin Pathol 2016; 69:767-71. [PMID: 26797410 PMCID: PMC5036215 DOI: 10.1136/jclinpath-2015-203403] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 12/29/2015] [Indexed: 12/20/2022]
Abstract
AIMS The incidence of RAS/RAF/PI3KA and TP53 gene mutations in colorectal cancer (CRC) is well established. Less information, however, is available on other components of the CRC genomic landscape, which are potential CRC prognostic/predictive markers. METHODS Following a previous validation study, ion-semiconductor next-generation sequencing (NGS) was employed to process 653 routine CRC samples by a multiplex PCR targeting 91 hotspot regions in 22 CRC significant genes. RESULTS A total of 796 somatic mutations in 499 (76.4%) tumours were detected. Besides RAS/RAF/PI3KA and TP53, other 12 genes showed at least one mutation including FBXW7 (6%), PTEN (2.8%), SMAD4 (2.1%), EGFR (1.2%), CTNNB1 (1.1%), AKT1 (0.9%), STK11 (0.8%), ERBB2 (0.6%), ERBB4 (0.6%), ALK (0.2%), MAP2K1 (0.2%) and NOTCH1 (0.2%). CONCLUSIONS In a routine diagnostic setting, NGS had the potential to generate robust and comprehensive genetic information also including less frequently mutated genes potentially relevant for prognostic assessments or for actionable treatments.
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Affiliation(s)
- Umberto Malapelle
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Pasquale Pisapia
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Roberta Sgariglia
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Elena Vigliar
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | | | - Chiara Carlomagno
- Department of Surgical and Clinical Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe Giuffrè
- Department of "Patologia Umana dell'Adulto e dell'età evolutiva, G.Barresi", University of Messina, Messina, Italy
| | - Claudio Bellevicine
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, Naples, Italy
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Falcone A, Cremolini C, Antoniotti C, Lonardi S, Ronzoni M, Zaniboni A, Tonini G, Salvatore L, Masi G, Mezi S, Tomasello G, Carlomagno C, Allegrini G, Chiara S, D'Amico M, Granetto C, Lupi C, Sensi E, Fontanini G, Boni L, Loupakis F. FOLFOXIRI plus bevacizumab versus FOLFIRI plus bevacizumab as initial treatment for metastatic colorectal cancer (TRIBE study): updated survival results and final molecular subgroups analyses. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv335.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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32
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Casaretti R, Comella P, Carlomagno C, Maiorino L, Greco E, Russo A, Sanna G, Barzelloni M, Massidda B, Formica V, Serci C, Defraia S, Palmieri G, Ionta M. A Single Arm Clinical Trial to Assess the Efficacy and Safety of Panitumumab (Vectibix®) in combination with FOLFOX4 Chemotherapy as 1st line treatment in Subjects with Metastatic Gastric or Gastroesophageal Junction adenocarcinoma (VEGA trial). A multicenter Phase II SICOG trial 0802. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv344.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cremolini C, Loupakis F, Antoniotti C, Lupi C, Sensi E, Lonardi S, Mezi S, Tomasello G, Ronzoni M, Zaniboni A, Tonini G, Carlomagno C, Allegrini G, Chiara S, D'Amico M, Granetto C, Cazzaniga M, Boni L, Fontanini G, Falcone A. FOLFOXIRI plus bevacizumab versus FOLFIRI plus bevacizumab as first-line treatment of patients with metastatic colorectal cancer: updated overall survival and molecular subgroup analyses of the open-label, phase 3 TRIBE study. Lancet Oncol 2015; 16:1306-15. [PMID: 26338525 DOI: 10.1016/s1470-2045(15)00122-9] [Citation(s) in RCA: 700] [Impact Index Per Article: 77.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 06/22/2015] [Accepted: 06/24/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND In the TRIBE study, FOLFOXIRI (fluorouracil, leucovorin, oxaliplatin, and irinotecan) plus bevacizumab significantly improved progression-free survival of patients with metastatic colorectal cancer compared with FOLFIRI (fluorouracil, leucovorin, and irinotecan) plus bevacizumab. In this updated analysis, we aimed to provide mature results for overall survival-a secondary endpoint-and report treatment efficacy in RAS and BRAF molecular subgroups. METHODS TRIBE was an open-label, multicentre, phase 3 randomised study of patients (aged 18-70 years with Eastern Cooperative Oncology Group [ECOG] performance status of 2 or less and aged 71-75 years with an ECOG performance status of 0) with unresectable metastatic colorectal cancer who were recruited from 34 Italian oncology units. Patients were randomly assigned (1:1) via a web-based procedure to receive FOLFIRI plus bevacizumab or FOLFOXIRI plus bevacizumab. Bevacizumab was given as a 5 mg/kg intravenous dose. FOLFIRI consisted of a 180 mg/m(2) intravenous infusion of irinotecan for 60 min followed by a 200 mg/m(2) intravenous infusion of leucovorin for 120 min, a 400 mg/m(2) intravenous bolus of fluorouracil, and a 2400 mg/m(2) continuous infusion of fluorouracil for 46 h. FOLFOXIRI consisted of a 165 mg/m(2) intravenous infusion of irinotecan for 60 min, followed by an 85 mg/m(2) intravenous infusion of oxaliplatin given concurrently with 200 mg/m(2) leucovorin for 120 min, followed by a 3200 mg/m(2) continuous infusion of fluorouracil for 48 h. Tissue samples for RAS and BRAF mutational status analyses were centrally collected. In this updated analysis, we assessed the secondary endpoint of overall survival in the main cohort and treatment efficacy in RAS and BRAF molecular subgroups. All analyses were by intention to treat. TRIBE was concluded on Nov 30, 2014. The trial is registered with ClinicalTrials.gov, number NCT00719797. FINDINGS Between July 17, 2008, and May 31, 2011, 508 patients were randomly assigned. At a median follow-up of 48·1 months (IQR 41·7-55·6), median overall survival was 29·8 months (95% CI 26·0-34·3) in the FOLFOXIRI plus bevacizumab group compared with 25·8 months (22·5-29·1) in the FOLFIRI plus bevacizumab group (hazard ratio [HR] 0·80, 95% CI 0·65-0·98; p=0·03). Median overall survival was 37·1 months (95% CI 29·7-42·7) in the RAS and BRAF wild-type subgroup compared with 25·6 months (22·4-28·6) in the RAS-mutation-positive subgroup (HR 1·49, 95% CI 1·11-1·99) and 13·4 months (8·2-24·1) in the BRAF-mutation-positive subgroup (HR 2·79, 95% CI 1·75-4·46; likelihood-ratio test p<0·0001). Treatment effect was not significantly different across molecular subgroups (pinteraction=0·52). INTERPRETATION FOLFOXIRI plus bevacizumab is a feasible treatment option for those patients who meet the inclusion criteria of the present study, irrespective of baseline clinical characteristics and RAS or BRAF mutational status.
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Affiliation(s)
- Chiara Cremolini
- Department of Oncology, University Hospital of Pisa, Pisa, Italy; Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Fotios Loupakis
- Department of Oncology, University Hospital of Pisa, Pisa, Italy; Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Carlotta Antoniotti
- Department of Oncology, University Hospital of Pisa, Pisa, Italy; Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Cristiana Lupi
- Department of Surgical Pathology, Medical, Molecular, and Critical Area, University of Pisa, Pisa, Italy
| | - Elisa Sensi
- Department of Surgical Pathology, Medical, Molecular, and Critical Area, University of Pisa, Pisa, Italy
| | - Sara Lonardi
- Medical Oncology 1, Oncology Institute IRCCS Veneto, Padua, Italy
| | - Silvia Mezi
- Day Hospital of Oncology, Policlinico Umberto I, Rome, Italy
| | - Gianluca Tomasello
- Division of Medicine and Medical Oncology, Hospital of Cremona, Cremona, Italy
| | - Monica Ronzoni
- Department of Oncology, Hospital San Raffaele IRCSS, Milan, Italy
| | - Alberto Zaniboni
- Department of Medical Oncology, Poliambulanza Foundation, Brescia, Italy
| | | | - Chiara Carlomagno
- Department of Clinical Medicine and Surgery, University Hospital Federico II, Naples, Italy
| | | | - Silvana Chiara
- Medical Oncology 2, IRCCS University Hospital San Martino, Genoa, Italy
| | - Mauro D'Amico
- Unit of Medical Oncology, Galliera Hospital, Genoa, Italy
| | - Cristina Granetto
- Unit of Medical Oncology, Medical Centre Hospital Santa Croce and Carle, Cuneo, Italy
| | | | - Luca Boni
- Clinical Trials Coordinating Center, Toscano Cancer Institute, University Hospital Careggi, Florence, Italy
| | - Gabriella Fontanini
- Department of Surgical Pathology, Medical, Molecular, and Critical Area, University of Pisa, Pisa, Italy
| | - Alfredo Falcone
- Department of Oncology, University Hospital of Pisa, Pisa, Italy; Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy.
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Malapelle U, De Stefano A, Carlomagno C, Bellevicine C, Troncone G. Next-generation sequencing in the genomic profiling of synchronous colonic carcinomas: comment on Li et al (2015). J Clin Pathol 2015; 68:946-7. [PMID: 26139632 DOI: 10.1136/jclinpath-2015-203205] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 06/18/2015] [Indexed: 11/04/2022]
Affiliation(s)
- Umberto Malapelle
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Alfonso De Stefano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Chiara Carlomagno
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Claudio Bellevicine
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, Naples, Italy
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Cremolini C, Loupakis F, Antoniotti C, Lonardi S, Ronzoni M, Zaniboni A, Tonini G, Masi G, Chiara S, Carlomagno C, Salvatore L, Banzi M, Negri F, Marcucci L, Schirripa M, Barone C, Fontanini G, Borrelli N, Giordano M, Macerola E, Boni L, Falcone A. O-006 FOLFOXIRI plus bevacizumab versus FOLFIRI plus bevacizumab as initial treatment for metastatic colorectal cancer (TRIBE study): updated survival results and final molecular subgroups analyses. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv235.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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36
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Loupakis F, Cremolini C, Antoniotti C, Lonardi S, Ronzoni M, Zaniboni A, Tonini G, Salvatore L, Chiara S, Carlomagno C, Banzi C, Negri F, Marcucci L, Barone C, Fontanini G, Borrelli N, Giordano M, Macerola E, Boni L, Falcone A. FOLFOXIRI plus bevacizumab versus FOLFIRI plus bevacizumab as initial treatment for metastatic colorectal cancer (TRIBE study): Updated survival results and final molecular subgroups analyses. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.3510] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Fotios Loupakis
- U.O. Oncologia Medica 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Chiara Cremolini
- Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Carlotta Antoniotti
- U.O. Oncologia Medica 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Sara Lonardi
- Medical Oncology Unit, IRCCS Istituto Oncologico Veneto, Padua, Italy
| | - Monica Ronzoni
- Dipartimento di Oncologia Medica, Istituto Scientifico San Raffaele, Milano, Italy
| | - Alberto Zaniboni
- Department of Medical Oncology, Casa di Cura Poliambulanza, Brescia, Italy
| | - Giuseppe Tonini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Lisa Salvatore
- U.O. Oncologia Medica 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Chiara Carlomagno
- Department of Molecular and Clinical Endocrinology and Oncology, University of Naples Federico II, Naples, Italy
| | - Chiara Banzi
- Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | | | | | - Carlo Barone
- Policlinico Universitario A. Gemelli, U.O.C. Oncologia Medica, Rome, Italy
| | | | | | | | | | - Luca Boni
- Clinical Trial Coordinating Center, AOU Careggi, Istituto Toscano Tumori, Firenze, Italy
| | - Alfredo Falcone
- Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
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Cacciola NA, Calabrese C, Malapelle U, Pellino G, De Stefano A, Sepe R, Sgariglia R, Quintavalle C, Federico A, Bianco A, Uchimura Bastos A, Milone M, Bellevicine C, Milone F, Carlomagno C, Selvaggi F, Troncone G, Fusco A, Pallante P. UbcH10 expression can predict prognosis and sensitivity to the antineoplastic treatment for colorectal cancer patients. Mol Carcinog 2015; 55:793-807. [PMID: 25917796 DOI: 10.1002/mc.22322] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 09/01/2014] [Revised: 03/10/2015] [Accepted: 03/16/2015] [Indexed: 01/13/2023]
Abstract
Colorectal cancer (CRC) is one of the most frequent and deadly malignancies worldwide. Despite the progresses made in diagnosis and treatment, the identification of tumor markers is still a strong clinical need, because current treatments are efficacious only in a subgroup of patients. UbcH10 represents a potential candidate biomarker, whose expression levels could be employed to predict response or resistance to chemotherapy or targeted agents. UbcH10 mRNA and protein expression levels have been evaluated in a large group of CRC patients and correlated with clinico-pathological characteristics, including KRAS mutations. Moreover, the endogenous levels of UbcH10 and its role on cell growth have been evaluated in CRC cells. Finally, to investigate the impact of UbcH10 protein expression on the response to irinotecan, its active metabolite SN-38 and cetuximab treatment, UbcH10 silencing experiments were carried-out on two colon carcinoma cell lines, Caco-2, and DLD1. Overexpression of UbcH10 mRNA and protein was observed in the vast majority of patients analyzed. UbcH10 suppression decreased CRC cell growth rate (at least in part through deregulation of Cyclin B and ERK1) and sensitized them to pharmacological treatments with irinotecan, SN-38 and cetuximab (at least in part through a down-regulation of AKT). Taken together, these findings indicate that UbcH10 expression regulates CRC growth and could play an important role in the personalization of the therapy of CRC patients.
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Affiliation(s)
- Nunzio Antonio Cacciola
- Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), Department of Molecular Medicine and Medical Biotechnology (DMMBM), University of Naples "Federico II", Via S. Pansini 5, Naples, Italy
| | - Chiara Calabrese
- Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), Department of Molecular Medicine and Medical Biotechnology (DMMBM), University of Naples "Federico II", Via S. Pansini 5, Naples, Italy
| | - Umberto Malapelle
- Department of Public Health, University of Naples "Federico II", Via S. Pansini 5, Naples, Italy
| | - Gianluca Pellino
- Unit of General Surgery, Second University of Naples, Piazza Miraglia 2, Naples, Italy
| | - Alfonso De Stefano
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S. Pansini 5, Naples, Italy
| | - Romina Sepe
- Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), Department of Molecular Medicine and Medical Biotechnology (DMMBM), University of Naples "Federico II", Via S. Pansini 5, Naples, Italy
| | - Roberta Sgariglia
- Department of Public Health, University of Naples "Federico II", Via S. Pansini 5, Naples, Italy
| | - Cristina Quintavalle
- Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), Department of Molecular Medicine and Medical Biotechnology (DMMBM), University of Naples "Federico II", Via S. Pansini 5, Naples, Italy.,Institute of Pathology, Molecular Pathology Division, University of Basel, Schonbeinstrasse 40, Basel, Switzerland
| | - Antonella Federico
- Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), Department of Molecular Medicine and Medical Biotechnology (DMMBM), University of Naples "Federico II", Via S. Pansini 5, Naples, Italy
| | - Antonio Bianco
- Department of Public Health, University of Naples "Federico II", Via S. Pansini 5, Naples, Italy
| | - André Uchimura Bastos
- Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), Department of Molecular Medicine and Medical Biotechnology (DMMBM), University of Naples "Federico II", Via S. Pansini 5, Naples, Italy.,Genetic Bases of Thyroid Tumors Laboratory, Division of Genetics, Department of Morphology and Genetics, Federal University of São Paulo, São Paulo, Brazil
| | - Marco Milone
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini 5, Naples, Italy
| | - Claudio Bellevicine
- Department of Public Health, University of Naples "Federico II", Via S. Pansini 5, Naples, Italy
| | - Francesco Milone
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini 5, Naples, Italy
| | - Chiara Carlomagno
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S. Pansini 5, Naples, Italy
| | - Francesco Selvaggi
- Unit of General Surgery, Second University of Naples, Piazza Miraglia 2, Naples, Italy
| | - Giancarlo Troncone
- Department of Public Health, University of Naples "Federico II", Via S. Pansini 5, Naples, Italy
| | - Alfredo Fusco
- Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), Department of Molecular Medicine and Medical Biotechnology (DMMBM), University of Naples "Federico II", Via S. Pansini 5, Naples, Italy.,National Cancer Institute-INCA, Rua André Cavalcanti, 37-Centro, CEP 20231-050, Rio de Janeiro, Brazil
| | - Pierlorenzo Pallante
- Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), Department of Molecular Medicine and Medical Biotechnology (DMMBM), University of Naples "Federico II", Via S. Pansini 5, Naples, Italy
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Malapelle U, Sgariglia R, De Stefano A, Bellevicine C, Vigliar E, de Biase D, Sepe R, Pallante P, Carlomagno C, Tallini G, Troncone G. KRAS mutant allele-specific imbalance (MASI) assessment in routine samples of patients with metastatic colorectal cancer. J Clin Pathol 2015; 68:265-9. [PMID: 25609577 DOI: 10.1136/jclinpath-2014-202761] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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] [Indexed: 02/05/2023]
Abstract
AIMS Patients with colorectal cancer harbouring KRAS mutations do not respond to antiepidermal growth factor receptor (anti-EGFR) therapy. Community screening for KRAS mutation selects patients for treatment. When a KRAS mutation is identified by direct sequencing, mutant and wild type alleles are seen on the sequencing electropherograms. KRAS mutant allele-specific imbalance (MASI) occurs when the mutant allele peak is higher than the wild type one. The aims of this study were to verify the rate and tissue distribution of KRAS MASI as well as its clinical relevance. METHODS A total of 437 sequencing electropherograms showing KRAS exon 2 mutation was reviewed and in 30 cases next generation sequencing (NGS) was also carried out. Five primary tumours were extensively laser capture microdissected to investigated KRAS MASI tissue spatial distribution. KRAS MASI influence on the overall survival was evaluated in 58 patients. In vitro response to anti-EGFR therapy in relation to different G13D KRAS MASI status was also evaluated. RESULTS On the overall, KRAS MASI occurred in 58/436 cases (12.8%), being more frequently associated with G13D mutation (p=0.05) and having a heterogeneous tissue distribution. KRAS MASI detection by Sanger Sequencing and NGS showed 94% (28/30) concordance. The longer overall survival of KRAS MASI negative patients did not reach statistical significance (p=0.08). In cell line model G13D KRAS MASI conferred resistance to cetuximab treatment. CONCLUSIONS KRAS MASI is a significant event in colorectal cancer, specifically associated with G13D mutation, and featuring a heterogeneous spatial distribution, that may have a role to predict the response to EGFR inhibitors. The foreseen implementation of NGS in community KRAS testing may help to define KRAS MASI prognostic and predictive significance.
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Affiliation(s)
- Umberto Malapelle
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Roberta Sgariglia
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Alfonso De Stefano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoles, Italy
| | - Claudio Bellevicine
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Elena Vigliar
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Dario de Biase
- Department of Medicine (DIMES)-Anatomic Pathology Unit, Bellaria Hospital, University of Bologna, Bologna, Italy
| | - Romina Sepe
- CNR/IEOS, Institute of Experimental Endocrinology and Oncology, National Research Council, Naples, Italy Department of Molecular Medicine and Medical Biotechnology (DMMBM), University of Naples Federico II, Naples, Italy
| | - Pierlorenzo Pallante
- CNR/IEOS, Institute of Experimental Endocrinology and Oncology, National Research Council, Naples, Italy Department of Molecular Medicine and Medical Biotechnology (DMMBM), University of Naples Federico II, Naples, Italy
| | - Chiara Carlomagno
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoles, Italy
| | - Giovanni Tallini
- Department of Medicine (DIMES)-Anatomic Pathology Unit, Bellaria Hospital, University of Bologna, Bologna, Italy
| | - Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, Naples, Italy
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Stefano AD, Moretto R, Cella CA, Romano FJ, Raimondo L, Fiore G, Pietro FD, Pepe S, Placido SD, Carlomagno C. Bevacizumab maintenance in metastatic colorectal cancer: How long? World J Clin Cases 2014; 2:717-723. [PMID: 25405197 PMCID: PMC4233413 DOI: 10.12998/wjcc.v2.i11.717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 07/30/2014] [Accepted: 09/10/2014] [Indexed: 02/05/2023] Open
Abstract
The management of patients with non-progressive metastatic colorectal cancer after six months of treatment has not yet been codified. The most relevant concerns are the effectiveness of maintenance vs discontinuation, and the tolerability of prolonged treatment. Here we report the case of a 72-year-old man affected by colorectal cancer with lung metastases who achieved a complete response after receiving capecitabine, oxaliplatin and bevacizumab for six months, and bevacizumab alone for six months. Bevacizumab was continued as maintenance regimen for more than three years. It was discontinued because of an arthroplasty. Fifty-eight months after beginning first-line treatment, the patient remains free from relapse. Adverse effects were minimal and easily controlled.
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Loupakis F, Cremolini C, Masi G, Lonardi S, Zagonel V, Salvatore L, Cortesi E, Tomasello G, Ronzoni M, Spadi R, Zaniboni A, Tonini G, Buonadonna A, Amoroso D, Chiara S, Carlomagno C, Boni C, Allegrini G, Boni L, Falcone A. Initial therapy with FOLFOXIRI and bevacizumab for metastatic colorectal cancer. N Engl J Med 2014; 371:1609-18. [PMID: 25337750 DOI: 10.1056/nejmoa1403108] [Citation(s) in RCA: 712] [Impact Index Per Article: 71.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND A fluoropyrimidine plus irinotecan or oxaliplatin, combined with bevacizumab (a monoclonal antibody against vascular endothelial growth factor), is standard first-line treatment for metastatic colorectal cancer. Before the introduction of bevacizumab, chemotherapy with fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) showed superior efficacy as compared with fluorouracil, leucovorin, and irinotecan (FOLFIRI). In a phase 2 study, FOLFOXIRI plus bevacizumab showed promising activity and an acceptable rate of adverse effects. METHODS We randomly assigned 508 patients with untreated metastatic colorectal cancer to receive either FOLFIRI plus bevacizumab (control group) or FOLFOXIRI plus bevacizumab (experimental group). Up to 12 cycles of treatment were administered, followed by fluorouracil plus bevacizumab until disease progression. The primary end point was progression-free survival. RESULTS The median progression-free survival was 12.1 months in the experimental group, as compared with 9.7 months in the control group (hazard ratio for progression, 0.75; 95% confidence interval [CI], 0.62 to 0.90; P=0.003). The objective response rate was 65% in the experimental group and 53% in the control group (P=0.006). Overall survival was longer, but not significantly so, in the experimental group (31.0 vs. 25.8 months; hazard ratio for death, 0.79; 95% CI, 0.63 to 1.00; P=0.054). The incidences of grade 3 or 4 neurotoxicity, stomatitis, diarrhea, and neutropenia were significantly higher in the experimental group. CONCLUSIONS FOLFOXIRI plus bevacizumab, as compared with FOLFIRI plus bevacizumab, improved the outcome in patients with metastatic colorectal cancer and increased the incidence of some adverse events. (Funded by the Gruppo Oncologico Nord Ovest and others; ClinicalTrials.gov number, NCT00719797.).
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Affiliation(s)
- Fotios Loupakis
- From Azienda Ospedaliero-Universitaria Pisana and Università di Pisa, Pisa (F.L., C. Cremolini, G.M., L.S., A.F.), Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua (S.L., V.Z.), Sapienza Università di Roma (E.C.) and Università Campus Biomedico (G. Tonini), Rome, Azienda Istituti Ospitalieri, Cremona (G. Tomasello), Ospedale San Raffaele, IRCCS, Milan (M.R.), Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Turin (R.S.), Fondazione Poliambulanza, Brescia (A.Z.), Centro di Riferimento Oncologico, IRCCS, Aviano (A.B.), Ospedale Versilia, Lido di Camaiore (D.A.), Ospedale San Martino, IRCCS, Genoa (S.C.), Azienda Ospedaliera Universitaria Federico II, Naples (C. Carlomagno), Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia (C.B.), Ospedale Felice Lotti, Pontedera (G.A.), and Azienda Ospedaliero-Universitaria Careggi and Istituto Toscano Tumori, Florence (L.B.) - all in Italy
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Sabbatino F, Fusciello C, Somma D, Pacelli R, Poudel R, Pepin D, Leonardi A, Carlomagno C, Della Vittoria Scarpati G, Ferrone S, Pepe S. Effect of p53 activity on the sensitivity of human glioblastoma cells to PARP-1 inhibitor in combination with topoisomerase I inhibitor or radiation. Cytometry A 2014; 85:953-61. [PMID: 25182801 DOI: 10.1002/cyto.a.22563] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 08/09/2014] [Accepted: 08/13/2014] [Indexed: 01/19/2023]
Abstract
Poly (ADP-Ribose) polymerase-1 (PARP-1) is involved in the DNA repairing system by sensing and signaling the presence of DNA damage. Inhibition of PARP-1 is tested in combination with DNA damaging agents such as topoisomerase I inhibitors or ionizing radiations (RT) for the treatment of glioblastoma (GBM). Disruption of p53, widely prevalent in GBMs, plays a major role in DNA repairing system. The current study investigates whether p53 activity has an effect on the sensitivity of human GBM cells to PARP-1 inhibitors in combination with topoisomerase I inhibitor topotecan (TPT) and/or RT. Human GBM cell lines carrying a different functional status of p53 were treated with PARP-1 inhibitor NU1025, in combination with TPT and/or RT. Cytotoxic effects were examined by analyzing the antiproliferative activity, the cell cycle perturbations, and the DNA damage induced by combined treatments. PARP inhibition enhanced the antiproliferative activity, the cell cycle perturbations and the DNA damage induced by both TPT or RT in GBM cells. These effects were influenced by the p53 activity: cells carrying an active p53 were more sensitive to the combination of PARP inhibitor and RT, while cells carrying an inactive p53 displayed a higher sensitivity to the combination of PARP inhibitor and TPT. Our study suggests that p53 activity influences the differential sensitivity of GBM cells to combined treatments of TPT, RT, and PARP inhibitors. © 2014 International Society for Advancement of Cytometry.
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Affiliation(s)
- Francesco Sabbatino
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via Sergio Pansini 5, Naples, Italy, 80131; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, 02114
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Antoniotti C, Cremolini C, Loupakis F, Lonardi S, Boni C, Carlomagno C, Salvatore L, Masi G, Negri F, Barone C, Zoratto F, Ricci V, Bonetti A, D'Argenio F, Leo S, Chiara S, Dell'Aquila E, Fontanini G, Boni L, Falcone A. Folfoxiri Plus Bevacizumab (Bev) As First-Line Treatment of Ras Wild-Type (Wt) Metastatic Colorectal Cancer (Mcrc) Patients (Pts). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu333.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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De Stefano A, Carlomagno C. Beyond KRAS: Predictive factors of the efficacy of anti-EGFR monoclonal antibodies in the treatment of metastatic colorectal cancer. World J Gastroenterol 2014; 20:9732-43. [PMID: 25110411 PMCID: PMC4123362 DOI: 10.3748/wjg.v20.i29.9732] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 02/13/2014] [Accepted: 03/12/2014] [Indexed: 02/06/2023] Open
Abstract
Systematic analysis of the epidermal growth factor receptor (EGFR) pathway revealed that biomarkers could be used to predict the response to and outcome of anti-EGFR therapies in patients affected by metastatic colorectal cancer. We have conducted a review on the most recent findings and advances on this topic. To this aim, we searched the PubMed database for articles devoted to predictive and prognostic biomarkers for patients administered cetuximab- and panitumumab-based therapies. Here we review the state of the art and the controversies about the molecular factors known to be predictors of the efficacy of anti-EGFR therapy, namely, KRAS, BRAF, NRAS, PI3KCA and PTEN, and we discuss their prognostic value in colorectal cancer patients.
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Bajetta E, Floriani I, Di Bartolomeo M, Labianca R, Falcone A, Di Costanzo F, Comella G, Amadori D, Pinto C, Carlomagno C, Nitti D, Daniele B, Mini E, Poli D, Santoro A, Mosconi S, Casaretti R, Boni C, Pinotti G, Bidoli P, Landi L, Rosati G, Ravaioli A, Cantore M, Di Fabio F, Aitini E, Marchet A. Randomized trial on adjuvant treatment with FOLFIRI followed by docetaxel and cisplatin versus 5-fluorouracil and folinic acid for radically resected gastric cancer. Ann Oncol 2014; 25:1373-1378. [PMID: 24728035 DOI: 10.1093/annonc/mdu146] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [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] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Some trial have demonstrated a benefit of adjuvant fluoropirimidine with or without platinum compounds compared with surgery alone. ITACA-S study was designed to evaluate whether a sequential treatment of FOLFIRI [irinotecan plus 5-fluorouracil/folinic acid (5-FU/LV)] followed by docetaxel plus cisplatin improves disease-free survival in comparison with 5-FU/LV in patients with radically resected gastric cancer. PATIENTS AND METHODS Patients with resectable adenocarcinoma of the stomach or gastroesophageal junction were randomly assigned to either FOLFIRI (irinotecan 180 mg/m(2) day 1, LV 100 mg/m(2) as 2 h infusion and 5-FU 400 mg/m(2) as bolus, days 1 and 2 followed by 600 mg/m(2)/day as 22 h continuous infusion, q14 for four cycles) followed by docetaxel 75 mg/m(2) day 1, cisplatin 75 mg/m(2) day 1, q21 for three cycles (sequential arm) or De Gramont regimen (5-FU/LV arm). RESULTS From February 2005 to August 2009, 1106 patients were enrolled, and 1100 included in the analysis: 562 in the sequential arm and 538 in the 5-FU/LV arm. With a median follow-up of 57.4 months, 581 patients recurred or died (297 sequential arm and 284 5-FU/LV arm), and 483 died (243 and 240, respectively). No statistically significant difference was detected for both disease-free [hazard ratio (HR) 1.00; 95% confidence interval (CI): 0.85-1.17; P = 0.974] and overall survival (OS) (HR 0.98; 95% CI: 0.82-1.18; P = 0.865). Five-year disease-free and OS rates were 44.6% and 44.6%, 51.0% and 50.6% in the sequential and 5-FU/LV arm, respectively. CONCLUSIONS A more intensive regimen failed to show any benefit in disease-free and OS versus monotherapy. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01640782.
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Affiliation(s)
- E Bajetta
- Istituto di Oncologia, Policlinico di Monza, Monza
| | - I Floriani
- Laboratory of Clinical Research, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milano.
| | - M Di Bartolomeo
- Struttura Complessa di Medicina Oncologica 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
| | - R Labianca
- Unità di Oncologia Medica, Ospedale Papa Giovanni XXIII, Bergamo
| | - A Falcone
- Dipartimento di Ricerca Traslazionale, Università di Pisa, Istituto Toscano Tumori, Pisa
| | - F Di Costanzo
- S.C. Oncologia Medica, Azienda Ospedaliero-Universitaria Careggi, Firenze
| | - G Comella
- Oncologia Medica A, Fondazione Pascale, Istituto Nazionale dei Tumori, Napoli
| | - D Amadori
- I.R.C.C.S. Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola
| | - C Pinto
- U.O. di Oncologia Medica, Policlinico S.Orsola Malpighi, Bologna
| | - C Carlomagno
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II, Napoli
| | - D Nitti
- Clinica Chiurgica 1, Dipartimento di Scienze Chirurgiche Oncologiche e Gastroenterologiche, Padova
| | - B Daniele
- Dipartimento di Oncologia, A.O.G. Rummo, Benevento
| | - E Mini
- Dipartimento di Scienze Della Salute, Sezione di Farmacologia Clinica e Oncologia, Università degli Studi di Firenze, Firenze
| | - D Poli
- Laboratory of Clinical Research, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milano
| | - A Santoro
- U.O. Oncologia e Ematologia, Humanitas Cancer Center, Istituto Clinico Humanitas-I.R.C.C.S., Rozzano
| | - S Mosconi
- Unità di Oncologia Medica, Ospedale Papa Giovanni XXIII, Bergamo
| | - R Casaretti
- S.C. di Oncologia Medica Addominale, dell'Istituto Tumori di Napoli, Napoli
| | - C Boni
- Oncologia, Arcispedale Santa Maria Nuova-I.R.C.C.S., Reggio Emilia, Reggio Emilia
| | - G Pinotti
- Divisione di Oncologia Medica, A.O. Ospedale di Circolo, Varese
| | - P Bidoli
- S.C. Oncologia Medica, A.O.S. Gerardo, Monza
| | - L Landi
- U.O. Oncologia Medica, Azienda USL6 di Livorno, Istituto Toscano Tumori, Livorno
| | - G Rosati
- Unità Oncologia Medica, Ospedale S. Carlo, Potenza
| | - A Ravaioli
- U.O. di Oncologia, Ospedale Infermi Rimini, Ospedale Cervesi, Azienda USL di Rimini, Rimini, Cattolica
| | - M Cantore
- Oncologia Medica, USL 1, Massa Carrara
| | - F Di Fabio
- U.O. di Oncologia Medica, Policlinico S.Orsola Malpighi, Bologna
| | - E Aitini
- Ospedale Carlo Poma, Mantova, Italy
| | - A Marchet
- Clinica Chiurgica 1, Dipartimento di Scienze Chirurgiche Oncologiche e Gastroenterologiche, Padova
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De Stefano A, Moretto R, Bucci L, Pepe S, Romano FJ, Cella AC, Attademo L, Rosanova M, De Falco S, Fiore G, Raimondo L, De Placido S, Carlomagno C. Adjuvant treatment for locally advanced rectal cancer patients after preoperative chemoradiotherapy: when, and for whom? Clin Colorectal Cancer 2014; 13:185-91. [PMID: 25080847 DOI: 10.1016/j.clcc.2014.05.004] [Citation(s) in RCA: 20] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 05/19/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND The standard treatment for patients with locally advanced rectal cancer (clinical tumor, node, metastases [TNM] stage II or III) is radiotherapy before surgery (with or without concomitant fluoropyrimidine-based chemotherapy) followed by surgery. The role of adjuvant chemotherapy in this setting of patients is controversial in terms of the overall benefit on survival, the subgroup of patients who might not need it, and the best regimen (combination regimens vs. fluoropyrimidine alone). PATIENTS AND METHODS Based on the retrospective analysis of the clinical outcome of all patients with locally advanced rectal adenocarcinoma treated at our institute during the past 9 years, we comment on prognostic factors for local and distant metastases of patients who received neoadjuvant treatment followed by surgery, and the scientific evidence that can help to decide the adjuvant chemotherapy. RESULTS We conclude that pathological TNM stage after neoadjuvant chemoradiation (ypTNM) stage after surgery significantly affects disease-free and overall survival. In particular, patients with pathologically positive lymph nodes (ypN+) after surgery have a high probability of developing distant metastases. CONCLUSION ypN+ patients are candidate for intensified adjuvant chemotherapy.
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Affiliation(s)
- Alfonso De Stefano
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Roberto Moretto
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Luigi Bucci
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Stefano Pepe
- Department of Medicine, University of Salerno, Baronissi, Italy
| | | | | | - Laura Attademo
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Mario Rosanova
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Stefano De Falco
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Giovanni Fiore
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Lucia Raimondo
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Chiara Carlomagno
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.
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Cella CA, Arcopinto M, Lordick F, Carlomagno C, Matano E, Muehlberg K, Bruzzese D, Moretto R, Attademo L, Raimondo L, Schloegl H, De Stefano A, Knoedler M, Stocker G, Gabrecht M, De Placido S. Risk factors for cancer-related venous thromboembolism in ambulatory patients. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e20625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Michele Arcopinto
- Department of Translational Medical Science Federico II University, Naples, Italy
| | - Florian Lordick
- Universitätsklinikum Leipzig, Universitäres Krebszentrum (UCCL), Leipzig, Germany
| | - Chiara Carlomagno
- Department of Molecular and Clinical Endocrinology and Oncology, University of Naples Federico II, Naples, Italy
| | - Elide Matano
- Department of Clinical Oncology and Endocrinology and Rare Tumors Reference Center Campania Region, University Federico II, Naples, Italy
| | | | | | | | | | | | | | - Alfonso De Stefano
- Department of Molecular and Clinical Endocrinology and Oncology, University of Naples Federico II, Naples, Italy
| | - Maren Knoedler
- Comprehensive Cancer Center, University Leipzig, Leipzig, Germany
| | | | | | - Sabino De Placido
- Medical Oncology, Endocrinology and Oncology Department, University Federico II of Napoli, Naples, Italy
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Della Vittoria Scarpati G, Fusciello C, Perri F, Sabbatino F, Ferrone S, Carlomagno C, Pepe S. Ipilimumab in the treatment of metastatic melanoma: management of adverse events. Onco Targets Ther 2014; 7:203-9. [PMID: 24570590 PMCID: PMC3933725 DOI: 10.2147/ott.s57335] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Recently, "ipilimumab," an anti-cytotoxic T-lymphocyte antigen-4 (CTLA-4) monoclonal antibody, has been demonstrated to improve overall survival in metastatic melanoma. "CTLA-4" is an immune-checkpoint molecule that downregulates pathways of T-cell activation. Ipilimumab, by targeting CTLA-4, is able to remove the CTLA-4 inhibitory signal, allowing the immune system to react to cancer cells. Due to its immune-based mechanism of action, ipilimumab causes the inhibition of CTLA-4-mediated immunomodulatory effects, the enhancement of antitumor specific immune response mediated by the weakening of self-tolerance mechanisms while exacerbating the development of autoimmune diseases and immune-related adverse events, including dermatitis, hepatitis, enterocolitis, hypophysitis, and uveitis.
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Affiliation(s)
- Giuseppina Della Vittoria Scarpati
- Department of Medicine, University of Salerno, Salerno, Italy ; Division of Oncology, "San Giovanni di Dio e Ruggi d'Aragona" Hospital, Salerno, Italy
| | - Celeste Fusciello
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Francesco Perri
- Head and Neck Medical Oncology Unit, National Tumor Institute, Naples, Italy
| | - Francesco Sabbatino
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Soldano Ferrone
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Chiara Carlomagno
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Stefano Pepe
- Department of Medicine, University of Salerno, Salerno, Italy ; Division of Oncology, "San Giovanni di Dio e Ruggi d'Aragona" Hospital, Salerno, Italy
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Cremolini C, Loupakis F, Lonardi S, Trenta P, Antoniotti C, Masi G, Tomasello G, Ronzoni M, Ciuffreda L, Zaniboni A, Carlomagno C, Boni C, Negri F, Barone C, Vitello S, Giuntini N, Bonetti A, D'Amico M, Boni L, Falcone A. Early tumor shrinkage (ETS) and deepness of response (DoR) to predict progression-free, postprogression, and overall survival: Results from the phase III TRIBE trial. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.3_suppl.521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
521 Background: The TRIBE trial demonstrated that first-line FOLFOXIRI plus bevacizumab (bev) improves PFS, response rate (RECIST), and OS in comparison to FOLFIRI plus bev (ASCO Annual Meeting 2013). Recent experiences evidenced that both ETS and DoR may implement the assessment of response and correlate with survival in metastatic colorectal cancer (mCRC). Methods: ETS was defined as the relative change in the sum of longest diameters of RECIST target lesions at week 8 compared to baseline. A 20% decrease was adopted as cut-off value to discriminate early responders and non-responders. DoR was defined as the relative change in the sum of longest diameters of RECIST target lesions at the nadir in the absence of new lesions or progression of non-target lesions compared to baseline. The median value was used as cut-off. Results: Out of 508 randomized patients, 443 and 484 patients were evaluable for ETS and DoR, respectively. Early responders achieved longer PFS (median PFS: 12.7 vs 10.0 mos, HR: 0.66 [0.52-0.79], p<0.0001), post-progression survival (median PPS: 17.1 vs 10.7 mos, HR: 0.64 [0.47-0.81], p=0.0005) and OS (median OS: 35.8 vs 22.4 mos, HR: 0.54 [0.39-0.67], p<0.0001). Patients achieving a DoR higher than the median reported longer PFS (median PFS: 13.1 vs 9.3 mos, HR: 0.61 [0.49-0.73], p<0.0001), PPS (median PPS: 18.4 vs 10.5 mos, HR: 0.58 [0.44-0.73], p<0.0001) and OS (median OS: 36.8 vs 21.3 mos, HR: 0.47 [0.35-0.58], p<0.0001). A significant correlation of DoR as a continuous variable with PFS (HR: 0.983 [0.979-0.986], p<0.0001), PPS (HR: 0.987 [0.984-0.991], p<0.0001) and OS (HR: 0.979 [0.975-0.983], p<0.0001) was observed. No differences across arms were reported. Conclusions: ETS and DoR predict PFS, PPS and OS. These findings support the hypothesis that the adoption of active upfront regimens, able to induce a rapid and deep tumor shrinkage, may positively affect the subsequent disease history, thus translating into an advantage in survival. Clinical trial information: NCT00719797.
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Affiliation(s)
- Chiara Cremolini
- U.O. Oncologia Medica 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Fotios Loupakis
- U.O. Oncologia Medica 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Sara Lonardi
- Oncologia Medica 1, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | | | - Carlotta Antoniotti
- U.O. Oncologia Medica 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Gianluca Masi
- U.O. Oncologia Medica 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | | | - Monica Ronzoni
- Dipartimento di Oncologia Medica, Istituto Scientifico San Raffaele, Milano, Italy
| | | | | | - Chiara Carlomagno
- Department of Molecular and Clinical Endocrinology and Oncology, University of Naples Federico II, Naples, Italy
| | - Corrado Boni
- Division of Oncology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Francesca Negri
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | | | | | - Andrea Bonetti
- Department of Oncology, Mater Salutis Hospital-AULSS 21 della Regione Veneto, Legnago, Italy
| | | | - Luca Boni
- Clinical Trial Coordinating Center, AOU Careggi, Istituto Toscano Tumori (ITT), Firenze, Italy
| | - Alfredo Falcone
- U.O. Oncologia Medica 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
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D'Alterio C, Avallone A, Tatangelo F, Delrio P, Pecori B, Cella L, Pelella A, D'Armiento FP, Carlomagno C, Bianco F, Silvestro L, Pacelli R, Napolitano M, Iaffaioli RV, Scala S. A prognostic model comprising pT stage, N status, and the chemokine receptors CXCR4 and CXCR7 powerfully predicts outcome in neoadjuvant resistant rectal cancer patients. Int J Cancer 2014; 135:379-90. [PMID: 24375277 DOI: 10.1002/ijc.28689] [Citation(s) in RCA: 28] [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: 08/13/2013] [Revised: 12/03/2013] [Accepted: 12/12/2013] [Indexed: 01/15/2023]
Abstract
Despite the optimization of the local treatment of advanced rectal cancer (LARC), combination of preoperative chemoradiotherapy (CRT) and surgery, approximately one third of patients will develop distant metastases. Since the chemokine receptor CXCR4 has been implicated in metastasis development and prognosis in colorectal cancer, the role of the entire axis CXCR4-CXCL12-CXCR7 was evaluated to identify high relapse risk rectal cancer patients. Tumor specimens of 68 LARC patients undergoing surgery after neoadjuvant-CRT were evaluated for CXCR4, CXCR7, and CXCL12 expression through immunohistochemistry. Multivariable prognostic model was developed using classical prognostic factors along with chemokine receptor expression profiles. High CXCR4 correlated with a shorter relapse-free survival (RFS) (p = 0.0006) and cancer specific survival (CSS) (p = 0.0004). Concomitant high CXCR4-negative/low CXCR7 or high CXCR4-negative/low CXCL12 significantly impaired RFS (p = 0.0003 and p = 0.0043) and CSS (p = 0.0485 and p = 0.0026). High CXCR4/N+ identified the worst prognostic category for RFS (p < 0.0001) and CSS (p = 0.0003). The optimal multivariable predictive model for RFS was a five-variable model consisting of gender, pT stage, N status, CXCR4, and CXCR7 (AUC = 0.92, 95% CI = 0.77-0.98). The model is informative and supportive for adjuvant treatment and identifies CXCR4 as a new therapeutic target in rectal cancer.
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Affiliation(s)
- Crescenzo D'Alterio
- Department of Oncological Immunology, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale"-IRCCS-ITALIA, via M. Semmola, 80131, Naples, Italy
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Scarpati GDV, Fusciello C, Sabbatino F, Ferrone S, Caponigro F, Perri F, Carlomagno C, Pepe S. Multidisciplinary approach to patient with malignant melanoma. Anticancer Agents Med Chem 2014; 13:887-900. [PMID: 23272971 DOI: 10.2174/18715206113139990079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 10/22/2012] [Accepted: 11/29/2012] [Indexed: 11/22/2022]
Abstract
The incidence of melanoma is rapidly increasing worldwide and the prognosis of patients with metastatic disease is still poor, with a median survival of 8-9 months and a 3-year overall survival (OS) rate less than 15% [1,2]. A complete surgical excision is the main treatment for primary cutaneous melanoma [3], but controversies about the extension of excision margins still remain [4]. Sentinel lymph node biopsy (SLNB) provides important prognostic and staging data by the identification of regional node-negative patients who would not benefit from a complete nodal dissection. However, there is no consensus in the definition of melanoma thickness to enforce the execution of the SLNB [5]. To date, Interferon-α (IFN-α)is the only approved adjuvant treatment after surgical excision of high-risk melanoma, but its indication remains still controversial [2,6].
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