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Conte B, Boni L, Bisagni G, Durando A, Sanna G, Gori S, Garrone O, Tamberi S, De Placido S, Schettini F, Pazzola A, Ponzone R, Montemurro F, Lunardi G, Notaro R, De Angioletti M, Turletti A, Mansutti M, Puglisi F, Frassoldati A, Porpiglia M, Fabi A, Generali D, Scognamiglio G, Rossi M, Brasó-Maristany F, Prat A, Cardinali B, Piccioli P, Serra M, Lastraioli S, Bighin C, Poggio F, Lambertini M, Del Mastro L. SNP of Aromatase Predict Long-term Survival and Aromatase Inhibitor Toxicity in Patients with Early Breast Cancer: A Biomarker Analysis of the GIM4 and GIM5 Trials. Clin Cancer Res 2023; 29:5217-5226. [PMID: 37888299 PMCID: PMC10722129 DOI: 10.1158/1078-0432.ccr-23-1568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/12/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE In estrogen receptor-positive (ER+) breast cancer, single-nucleotide polymorphisms (SNP) in the aromatase gene might affect aromatase inhibitors (AI) metabolism and efficacy. Here, we assessed the impact of SNP on prognosis and toxicity of patients receiving adjuvant letrozole. EXPERIMENTAL DESIGN We enrolled 886 postmenopausal patients in the study. They were treated with letrozole for 2 to 5 years after taking tamoxifen for 2 to 6 years, continuing until they completed 5 to 10 years of therapy. Germline DNA was genotyped for SNP rs4646, rs10046, rs749292, and rs727479. Log-rank test and Cox model were used for disease-free survival (DFS) and overall survival (OS). Cumulative incidence (CI) of breast cancer metastasis was assessed through competing risk analysis, with contralateral breast cancer, second malignancies and non-breast cancer death as competing events. CI of skeletal and cardiovascular events were assessed using DFS events as competing events. Subdistribution HR (sHR) with 95% confidence intervals were calculated through Fine-Gray method. RESULTS No SNP was associated with DFS. Variants rs10046 [sHR 2.03, (1.04-2.94)], rs749292 [sHR 2.11, (1.12-3.94)], and rs727479 [sHR 2.62, (1.17-5.83)] were associated with breast cancer metastasis. Three groups were identified on the basis of the number of these variants (0, 1, >1). Variant-based groups were associated with breast cancer metastasis (10-year CI 2.5%, 7.6%, 10.7%, P = 0.035) and OS (10-year estimates 96.5%, 93.0%, 89.6%, P = 0.030). Co-occurrence of rs10046 and rs749292 was negatively associated with 10-year CI of skeletal events (3.2% vs. 10%, P = 0.033). A similar association emerged between rs727479 and cardiovascular events (0.3% vs. 2.1%, P = 0.026). CONCLUSIONS SNP of aromatase gene predict risk of metastasis and AI-related toxicity in ER+ early breast cancer, opening an opportunity for better treatment individualization.
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Affiliation(s)
- Benedetta Conte
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Luca Boni
- S.C. Epidemiologia Clinica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Giancarlo Bisagni
- Azienda unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Durando
- Breast Unit Ospedale S Anna, Citta' della Salute e della Scienza di Torino, Torino, Italy
| | - Giovanni Sanna
- Azienda Ospedaliera Universitaria – Sassari, Sassari, Italy
| | - Stefania Gori
- UOC Oncologia Medica, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Ornella Garrone
- Breast Unit, AO S. Croce e Carle Ospedale di insegnamento, Cuneo, Italy
- Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Milano
| | | | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Francesco Schettini
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Spain
| | | | - Riccardo Ponzone
- Candiolo Cancer Institute, FPO-IRCCS, Gynecologic Oncology and Multidisciplinary Outpatient Oncology Clinic, Candiolo, Italy
| | - Filippo Montemurro
- Candiolo Cancer Institute, FPO-IRCCS, Gynecologic Oncology and Multidisciplinary Outpatient Oncology Clinic, Candiolo, Italy
| | - Gianluigi Lunardi
- Laboratorio Analisi Chimico-Cliniche, IRCCS-Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | | | - Maria De Angioletti
- Core Research Laboratory-ISPRO, Firenze, Italy
- National Research Council (CNR) - ICCOM, Firenze, Italy
| | | | - Mauro Mansutti
- Department of Oncology, ASUFC Santa Maria della Misericordia, Udine, Italy
| | - Fabio Puglisi
- Department of Medicine, University of Udine, Udine, Italy
- Depatment of Medical Oncology, Centro di Riferimento Oncologico di Aviano IRCCS, Aviano, Italy
| | - Antonio Frassoldati
- Department of Morphology, Surgery and Experimental medicine, Clinical Oncology, St. Anna University Hospital, Ferrara, Italy
| | - Mauro Porpiglia
- Breast Unit Ospedale S. Anna, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Alessandra Fabi
- Medical Oncology, IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | - Daniele Generali
- Medical Oncology, Azienda Istituti Ospitalieri di Cremona, Cremona, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Maura Rossi
- SOC Oncologia, ASO SS.Antonio e Biagio, Alessandria, Italy
| | - Fara Brasó-Maristany
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Aleix Prat
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
- Reveal Genomics, Barcelona, Spain
- Institute of Oncology (IOB)-Hospital Quirónsalud, Barcelona, Spain
| | - Barbara Cardinali
- Medical Oncology Department, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Patrizia Piccioli
- Medical Oncology Department, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Martina Serra
- Laboratory of Clinical and Experimental Immunology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Sonia Lastraioli
- Molecular Diagnostic Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Claudia Bighin
- Medical Oncology Department 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesca Poggio
- Medical Oncology Department 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Lambertini
- Medical Oncology Department, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Lucia Del Mastro
- Medical Oncology Department, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
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2
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Di Maio M, Bighin C, Schettini F, Ruelle T, Marandino L, Fabi A, De Angelis C, Giuliano M, De Placido P, De Laurentiis M, Riccardi F, Picotto C, Puglisi F, Del Mastro L, Arpino G. Evolving treatments and outcomes in HER2-Positive metastatic breast cancer: Data from the GIM14/BIOMETA study. Breast 2023; 72:103583. [PMID: 37783133 PMCID: PMC10551556 DOI: 10.1016/j.breast.2023.103583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Treatment for HER2-positive (+) metastatic breast cancer has improved in the last decade. We analyzed treatment changes over time and their impact on patients outcomes in a real-world dataset. METHODS Data from 637 HER2+ patients with metastatic breast cancer enrolled in the multicenter Italian GIM14/BIOMETA study were retrieved. Progression-free survival (PFS) over time was evaluated according to the type of anti-HER2 therapy, disease onset (de novo vs. relapsing), metastatic site, and year of treatment (2000-2013 vs. 2014-2020). RESULTS Median follow-up was 64.4 months. Overall, for first-line therapies, mPFS was 16.5 vs 19.5 months for patients treated in 2000-2013 vs 2014-2020 (HR: 0.78, 95% CI:0.65-0.94, P = 0.008). mPFS improved over time in all patients except for those with brain metastasis. Interestingly mPFS was 17.4 vs13.4 months (HR, 1.49; 95% CI, 1.13-1.98, P = 0.005) in 2000-2013 and 24.4 vs 20.9 months (HR 1.04; 95% CI 0.78-1.40 p = 0.77) in 2014-2020 in pts without vs with liver metastases. For second line therapies, the overall median PFS was 9.6 months (95% CI, 8.31-10.97) and did not change over time. CONCLUSION Median first-line PFS improved since 2014, mainly due to the introduction of pertuzumab. The outcome of patients with liver metastases appears to have improved in recent years. Patients with brain metastases had the worst PFS, which also did not improve over time.
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Affiliation(s)
- Massimo Di Maio
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | - Claudia Bighin
- Department of Medical Oncology, U.O. Oncologia Medica 2, Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Schettini
- Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Tommaso Ruelle
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Laura Marandino
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandra Fabi
- Precision Medicine in Senology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Carmine De Angelis
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Mario Giuliano
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Pietro De Placido
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Michelino De Laurentiis
- Department of Breast and Thoracic Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | | | - Caterina Picotto
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | - Fabio Puglisi
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy; Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Lucia Del Mastro
- Department of Medical Oncology, U.O. Oncologia Medica 2, Ospedale Policlinico San Martino, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Grazia Arpino
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy.
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Gori S, Fabi A, Angiolini C, Turazza M, Salvini P, Ferretti G, Cretella E, Gianni L, Bighin C, Toss A, Zamagni C, Vici P, De Rossi C, Russo A, Bisagni G, Frassoldati A, Borgato L, Cariello A, Cappelletti C, Bordonaro R, Cinieri S, Modena A, Valerio M, Alvisi MF, De Simone I, Galli F, Rulli E, Santoni A, Nicolis F. Neoadjuvant Systemic Therapy in Early Breast Cancer: Results of a Prospective Observational Multicenter BRIDE Study. Cancers (Basel) 2023; 15:4852. [PMID: 37835546 PMCID: PMC10572070 DOI: 10.3390/cancers15194852] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
To evaluate the rate of early breast cancer (EBC) patients treated with neoadjuvant systemic therapy (NAT) in Italy, criteria of patient selection and types of therapies delivered, an analysis of 1276 patients with stage I-II-III was conducted out of 1633 patients enrolled in the multicenter prospective observational BRIDE study. A total of 177 patients (13.9%) were treated with NAT and 1099 (85.9%) with surgery; in multivariate analysis, menopausal status, cT, cN, grade, HER2-positive and Triple negative (TN) subgroups were significantly associated with the decision to administer NAT. The type of NAT delivered was influenced by EBC subtype. NAT was administered to 53.2% of HER2+/HR-negative, 27.9% of HER2+/HR+, 7.1% of HER2-negative/HR+ and 30.3% of TN EBC patients. The pCR rates were similar to the ones reported in the literature: 74.2% in HER2+/HR-negative, 52.3% in HER2+/HR+, 17.2% in HER2-negative/HR+ and 37.9% in TN. In clinical practice, patient and tumor characteristics influenced oncologists in the decision to administer NAT in EBC and in the choice of the type of systemic therapy, according to ESMO and AIOM Guidelines. Currently, it is recommended always to evaluate the use of NAT in EBC, mainly in HER2+ and TN patients, considering that pCR is associated with significantly better survival of the patient and that effective therapies are now available for residual disease.
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Affiliation(s)
- Stefania Gori
- Medical Oncology Unit, IRCCS Sacro Cuore Don Calabria, 37024 Negrar di Valpolicella, Italy
| | - Alessandra Fabi
- Precision Medicine Unit in Senology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Catia Angiolini
- Breast Unit and Multidisciplinary Oncology Group, Department of Breast Oncology, AOU Careggi, 50134 Florence, Italy;
| | - Monica Turazza
- Medical Oncology Unit, IRCCS Sacro Cuore Don Calabria, 37024 Negrar di Valpolicella, Italy
| | - Piermario Salvini
- Oncology, Humanitas Gavazzeni, 24125 Bergamo, Italy;
- Oncological Medicine—Policlinico Ponte S Pietro di Istituti Ospedalieri Bergamaschi, 24036 Ponte San Pietro, Italy
| | - Gianluigi Ferretti
- Division of Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | | | | | | | - Angela Toss
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, 41125 Modena, Italy
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Claudio Zamagni
- Medical Oncology of Senology and Gynecology, IRCCS AOU Bologna, Policlinico Sant’Orsola, 40138 Bologna, Italy
| | - Patrizia Vici
- UOSD Sperimentazioni Fase IV, IRCCS Istituto Nazionale Tumori Regina Elena, 00144 Rome, Italy
| | - Costanza De Rossi
- Oncology—Ospedale dell’Angelo Azienda ULSS 3 Serenissima, 30174 Venice, Italy;
| | - Antonio Russo
- Medical Oncology, AOU Policlinico P. Giaccone, 90127 Palermo, Italy
| | - Giancarlo Bisagni
- Medical Oncology, Comprehensive Cancer Centre, AUSL-IRCCS di Reggio Emilia, 22100 Reggio Emilia, Italy;
| | | | - Lucia Borgato
- Department of Oncology, San Bortolo General Hospital, Azienda ULSS8 Berica, 36100 Vicenza, Italy
| | - Anna Cariello
- Medical Oncology, AUSL Ravenna, 48100 Ravenna, Italy;
| | | | | | - Saverio Cinieri
- Medical Oncology, Antonio Perrino Hospital, 72100 Brindisi, Italy
| | - Alessandra Modena
- Medical Oncology Unit, IRCCS Sacro Cuore Don Calabria, 37024 Negrar di Valpolicella, Italy
| | - Matteo Valerio
- Medical Oncology Unit, IRCCS Sacro Cuore Don Calabria, 37024 Negrar di Valpolicella, Italy
| | - Maria Francesca Alvisi
- Laboratory of Methodology for Clinical Research, Department of Clinical Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy (I.D.S.); (E.R.)
| | - Irene De Simone
- Laboratory of Methodology for Clinical Research, Department of Clinical Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy (I.D.S.); (E.R.)
| | - Francesca Galli
- Laboratory of Methodology for Clinical Research, Department of Clinical Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy (I.D.S.); (E.R.)
| | - Eliana Rulli
- Laboratory of Methodology for Clinical Research, Department of Clinical Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy (I.D.S.); (E.R.)
| | - Anna Santoni
- Laboratory of Methodology for Clinical Research, Department of Clinical Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy (I.D.S.); (E.R.)
| | - Fabrizio Nicolis
- Medical Direction, IRCCS Sacro Cuore Don Calabria, 37024 Negrar di Valpolicella, Italy
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Gianni C, Palleschi M, Scarpi E, Merloni F, Blondeaux E, Puglisi F, Collovà E, Pugliese P, Cognetti F, Giannubilo I, Ruelle T, Bighin C, Mastro LD, De Giorgi U. Abstract P2-11-19: Inflammatory indexes as prognostic biomarkers in advanced triple negative breast cancer patients. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p2-11-19] [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: 03/06/2023]
Abstract
Abstract
Background The identification of treatment selection biomarkers for advanced triple negative breast cancer (aTNBC) patients remains an unmet need. The immune system is known to be involved in the microenvironment of triple negative breast cancer (TNBC). Immune ratios like the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the monocyte-lymphocyte ratio (MLR) and the systemic immune-inflammation index (SII) may reflect the immune system functional status in these patients and the involvement of circulating immune cells in cancer progression. In particular MLR showed to predict overall survival (OS) in aTNBC and to contribute to migration of circulating tumor cells [1]. Methods A retrospective-prospective, observational multicenter study from the GIM-14 experience was performed to investigate the association between inflammatory indexes (NLR, MLR, PLR and SII), as measured at baseline and at progression, and clinical and survival aspects in patients with aTNBC in first line setting. The optimal cutoff values between low and high expression of inflammatory indexes were established on the basis of cut-off values determined in a previously conducted study in order to validate them[1], and was used to predict progression-free survival (PFS) and OS. Time-to-event variables (PFS; OS) were calculated using Kaplan-Meier method, while Cox regression model was used to estimate HRs and their 95% CI. Results 105 consecutive patients with a diagnosis of aTNBC were fully evaluated for the final analysis. The median age at diagnosis was 55 years (33-86). Of them, 80 patients received a neo/adjuvant treatment after diagnosis. At first progression the majority of patients (n= 97) received chemotherapy, while only 8 patients were treated with chemo-immunotherapy due to the programmed death ligand 1 (PD-L1) expression in the immunohistochemical analyses. At a median follow-up of 54 months, median PFS in the whole patients population was 13 months (95% CI 9,4-16,5), while median OS was 17.3 OS (95% CI 13-22,2). All high inflammation based scores evaluated at diagnosis of metastatic disease were significantly associated with lower PFS, in particular high NLR (≥3) and high MLR (≥0.34) (p = 0.0006 and p = 0.011, respectively). Similarly, all high indexes appeared significantly associated with a lower OS, especially NLR (>3), SII (≥836) and MLR (≥0.34) (p < 0.0001, p = 0.0005, p=001 respectively). In particular also NLR and SII evaluated at disease progression after first line treatment were significantly associated with a worse OS (p=0.0006 and p=0.001 respectively). In multivariable analysis for predictors of overall survival, the number of metastatic sites, NLR, SII and MLR remained significant (p< 0.0001, p=0.006, p=0.005 respectively). Conclusions NLR, SII and MLR are predictors of OS in aTNBC. Although our results need validation with larger studies, we suggest that inflammatory ratios could be used as feasible biomarkers of prognosis and treatment efficacy in aTNBC. Further research about HER-2 low categorized patients will be updated and presented at the final meeting. 1. De Giorgi U, Mego M, Scarpi E, Giordano A, Giuliano M, Valero V, Alvarez RH, Ueno NT, Cristofanilli M, Reuben JM. Association between circulating tumor cells and peripheral blood monocytes in metastatic breast cancer. Ther Adv Med Oncol. 2019 Aug 14;11:1758835919866065. doi: 10.1177/1758835919866065. PMID: 31452692; PMCID: PMC6696837.
Citation Format: Caterina Gianni, Michela Palleschi, Emanuela Scarpi, Filippo Merloni, Eva Blondeaux, Fabio Puglisi, Elena Collovà, Palma Pugliese, Francesco Cognetti, Irene Giannubilo, Tommaso Ruelle, Claudia Bighin, Lucia Del Mastro, Ugo De Giorgi. Inflammatory indexes as prognostic biomarkers in advanced triple negative breast cancer patients [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-11-19.
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Affiliation(s)
- Caterina Gianni
- 1Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”
| | - Michela Palleschi
- 2Department of Medical Oncology, IRCCS- Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Emanuela Scarpi
- 3Biostatistics and Clinical Trials Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST);Dino Amadori, Via P.Maroncelli 40, 47014 Meldola, Italy
| | - Filippo Merloni
- 4Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”
| | | | - Fabio Puglisi
- 6Department of Medical Oncology, CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy
| | - Elena Collovà
- 7Oncology Unit Cancer Center Department ASST Ovest MIlanese
| | | | - Francesco Cognetti
- 9Division of Medical Oncology 1, Regina Elena National Cancer Institute, Rome, Italy
| | - Irene Giannubilo
- 10Department of Medical Oncology 2, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Tommaso Ruelle
- 11Department of Medical Oncology 2, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | | | | | - Ugo De Giorgi
- 14Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”
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5
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Cucciniello L, Blondeaux E, Bighin C, Gasparro S, Russo S, Dri A, Pugliese P, Fontana A, Naso G, Ferzi A, Riccardi F, Sini V, Boni L, Fabi A, Montemurro F, De Laurentiis M, Arpino G, Mastro LD, Gerratana L, Puglisi F. Abstract P1-11-04: Assessing the clinico-pathological characteristics of HER2 positive metastatic breast cancer patients experiencing radiologic complete response in a nationwide cohort. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p1-11-04] [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: 03/06/2023]
Abstract
Abstract
Background: Up to 6% of patients (pts) with HER2 positive (pos) metastatic breast cancer (MBC) experience a radiologic complete response (rCR) to a first line of therapy, but these results mostly derive from dated and/or limited cohorts. Aim of this study was to define the clinico-pathological characteristics of HER2 positive (pos) MBC pts experiencing a rCR. Methods: Pts were selected from the database of the GIM14 study (NCT02284581) and classified according to the best radiologic response obtained to the first line chemotherapy (CT) and upon time-to-treatment-failure (TTF). rCR was defined as complete response (CR) with a TTF > 3 months. The association across variables was tested through logistic regression and their prognostic impact in terms of overall survival (OS) was estimated using the Kaplan-Meier method and compared using the log-rank test. Results: Of the 3,423 pts included in the GIM14 study, 814 had HER2 pos MBC. After exclusion of pts treated with first line endocrine therapy and/or with TTF < 3 months, 656 pts were included in the present analysis, of which 96 (14.6%) experienced a rCR. Instead, the best response was a partial response for 295 pts (45.0%), stable disease for 221 pts (33.7%), and progression for 44 pts (6.7%). Most pts (59.8%) presented de novo MBC; 379 pts (57.8%) had visceral metastases (mets), 609 pts (92.8%) did not have central nervous system (CNS) involvement and 318 pts (48.5%) had only 1 site of distant mets. Also, 445 pts (67.9%) had hormone receptor (HR) pos disease, a HER2 3+ score at immunohistochemistry (IHC) was present in 59.8% of cases versus 40.2% with HER2 2+ at IHC and in situ hybridization (ISH) + disease. Taxanes were the main CT backbone (489 pts, 74.5%), 341 pts (52.0%) had received a Trastuzumab-Pertuzumab doublet. At multivariable analysis, higher odds of experiencing a rCR were reported for presence of non-visceral mets (OR 1.87, 95%CI 1.10-3.17), low number of metastatic sites (OR 2.42, 95%CI 0.80-7.33 for 1 site only) and HER2 3+ score at IHC (OR 1.80, 95%CI 1.09-2.98). Disease-free interval (DFI) was associated to rCR at univariable but not at multivariable analysis. HR status, CT backbone and type of anti-HER2 regimen were not associated with rCR neither at univariable nor at multivariable analysis. Median follow-up was 76.2 months. Amongst pts with TTF>12 months, those with rCR had a significantly higher OS compared to those not experiencing a rCR (median OS 133 and 90 months, respectively; p=0.0191). OS rates in pts with TTF ≥ 12 months were 97.8% at 2-year follow-up and 59.4% at 5-year follow-up. Instead, in pts with TTF ≥ 60 months, OS rates were 76.7% at 10-year follow-up. Amongst the 96 pts experiencing a CR, 38 had a rCR with TTF between 12 and 60 months, while 22 pts had a rCR with a TTF ≥ 60 months. The remaining pts had a CR with a TTF < 12 months. Pts with HR negative (neg) disease were found to be more likely to experience a rCR with a with TTF between 12 and 60 months, whilst pts with HR pos disease had a higher probability to experience a rCR with a TTF ≥ 60 months (p=0.0074). Pts with HER2 3+ score at IHC had a higher probability to achieve a rCR with a TTF ≥ 12 months compared to pts with HER2 2+ score at IHC and ISH + (p=0.0216). Age at diagnosis, menopausal status, DFI, number and site of mets, CT backbone and anti-HER2 therapy did not influence the duration of the rCR obtained. Conclusions: This study characterized a real-world cohort of HER2 positive MBC patients experiencing radiologic complete response to a first line treatment. Based on these results a clinical trial focused on liquid biopsy-based minimal residual disease is being designed. Novel anti-HER2 agents are gaining momentum as ever increasingly effective treatments and future de-escalation strategies after complete response will represent a growing need.
Citation Format: Linda Cucciniello, Eva Blondeaux, Claudia Bighin, Simona Gasparro, Stefania Russo, Arianna Dri, Palma Pugliese, Andrea Fontana, Giuseppe Naso, Antonella Ferzi, Ferdinando Riccardi, Valentina Sini, Luca Boni, Alessandra Fabi, Filippo Montemurro, Michelino De Laurentiis, Grazia Arpino, Lucia Del Mastro, Lorenzo Gerratana, Fabio Puglisi. Assessing the clinico-pathological characteristics of HER2 positive metastatic breast cancer patients experiencing radiologic complete response in a nationwide cohort [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-11-04.
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Affiliation(s)
- Linda Cucciniello
- 1Unit of Medical Oncology and Cancer Prevention, Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano
| | | | | | | | - Stefania Russo
- 5Department of Medical Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC) Udine, Italy
| | - Arianna Dri
- 6Santa Maria della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine
| | | | | | | | | | | | - Valentina Sini
- 12Centro Oncologico S. Spirito-Nuovo Regina Margherita, ASL Roma 1, Rome
| | - Luca Boni
- 13IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Alessandra Fabi
- 14Precision Medicine in Breast Cancer, Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome, Rome,, Italy
| | | | | | | | | | - Lorenzo Gerratana
- 19Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano
| | - Fabio Puglisi
- 20Department of Medicine (DAME), University of Udine, Udine, Italy and Department of Medical Oncology - CRO Aviano, National Cancer Institute, IRCCS, Friuli-Venezia Giulia, Italy
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Conte B, Montemurro F, Levaggi A, Blondeaux E, Molinelli C, Cardinali B, Poggio F, Buzzatti G, Bighin C, Lambertini M, Del Mastro L. Anthracycline, taxane, and trastuzumab-based neoadjuvant chemotherapy in HER2-positive early breast cancer: phase II trial. Tumori 2023; 109:71-78. [PMID: 34989265 DOI: 10.1177/03008916211067568] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Neoadjuvant chemotherapy has become the preferred treatment in HER2-positive early breast cancer. Several trials investigated the neoadjuvant efficacy of dual HER2 blockade with anthracycline-free chemotherapy, whereas few data are available on single-agent trastuzumab and anthracycline-based regimens, which represent the standard of care in the adjuvant setting. This phase II, single-arm trial assessed anthracycline-based chemotherapy and trastuzumab as neoadjuvant treatment for high-risk HER2-positive breast cancer. METHODS Forty-three patients with stage II-III HER2-positive breast cancer were treated with 4 courses of neoadjuvant 5-fluorouracil 600 mg/m2, epirubicin 90 mg/m2, cyclophosphamide 600 mg/m2 (FEC ×4) every 21 days, followed by 12 courses of weekly paclitaxel 80 mg/m2 and trastuzumab 2 mg/Kg IV (loading dose 4 mg/kg). RESULTS Pathologic complete response (pCR) was observed in 22 (51%) of 43 patients. After a median follow-up of 6 years, the 5-year disease-free survival and overall survival were 85.8% (95% confidence interval 75.9%-97%) and 89.6% (80.4%-99.8%), respectively. A temporary decrease in left ventricular ejection fraction was observed in two patients. No cardiac death or congestive heart failure occurred. One patient died due to febrile neutropenia. CONCLUSIONS FEC ×4 followed by paclitaxel and trastuzumab was associated with high pCR rates and favorable long-term outcomes. However, this regimen was associated with relevant hematologic toxicity.
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Affiliation(s)
- Benedetta Conte
- Department of Medical Oncology, Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Filippo Montemurro
- Multidisciplinary Outpatient Oncology Clinic, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Alessia Levaggi
- Department of Medical Oncology, Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Eva Blondeaux
- Department of Medical Oncology, Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Molinelli
- Department of Medical Oncology, Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Barbara Cardinali
- Department of Medical Oncology, Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesca Poggio
- Department of Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genova, U.O. Oncologia Medica 2, Genova, Italy
| | - Giulia Buzzatti
- Department of Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genova, U.O. Oncologia Medica 2, Genova, Italy
| | - Claudia Bighin
- Department of Medical Oncology, Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy.,Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy.,Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Del Mastro L, Poggio F, Blondeaux E, De Placido S, Giuliano M, Forestieri V, De Laurentiis M, Gravina A, Bisagni G, Rimanti A, Turletti A, Nisticò C, Vaccaro A, Cognetti F, Fabi A, Gasparro S, Garrone O, Alicicco MG, Urracci Y, Mansutti M, Poletti P, Correale P, Bighin C, Puglisi F, Montemurro F, Colantuoni G, Lambertini M, Boni L, Venturini M, Abate A, Pastorino S, Canavese G, Vecchio C, Guenzi M, Lambertini M, Levaggi A, Giraudi S, Accortanzo V, Floris C, Aitini E, Fornari G, Miraglia S, Buonfanti G, Cherchi M, Petrelli F, Vaccaro A, Magnolfi E, Contu A, Labianca R, Parisi A, Basurto C, Cappuzzo F, Merlano M, Russo S, Mansutti M, Poletto E, Nardi M, Grasso D, Fontana A, Isa L, Comandè M, Cavanna L, Iacobelli S, Milani S, Mustacchi G, Venturini S, Scinto A, Sarobba M, Pugliese P, Bernardo A, Pavese I, Coccaro M, Massidda B, Ionta M, Nuzzo A, Laudadio L, Chiantera V, Dottori R, Barduagni M, Castiglione F, Ciardiello F, Tinessa V, Ficorella A, Moscetti L, Vallini I, Giardina G, Silva R, Montedoro M, Seles E, Morano F, Cruciani G, Adamo V, Pancotti A, Palmisani V, Ruggeri A, Cammilluzzi E, Carrozza F, D'Aprile M, Brunetti M, Gallotti P, Chiesa E, Testore F, D'Arco A, Ferro A, Jirillo A, Pezzoli M, Scambia G, Iacono C, Masullo P, Tomasello G, Gandini G, Zoboli A, Bottero C, Cazzaniga M, Genua G, Palazzo S, D'Amico M, Perrone D. Fluorouracil and dose-dense adjuvant chemotherapy in patients with early-stage breast cancer (GIM2): end-of-study results from a randomised, phase 3 trial. Lancet Oncol 2022; 23:1571-1582. [DOI: 10.1016/s1470-2045(22)00632-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/11/2022]
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Cucciniello L, Blondeaux E, Bighin C, Gasparro M, Russo S, Dri A, Pugliese P, Fontana A, Naso G, Ferzi A, Riccardi F, Sini V, Fabi A, Montemurro F, De Laurentiis M, Arpino G, Del Mastro L, Gerratana L, Puglisi F. 270P Defining clinico-pathological characteristics of HER2 positive metastatic breast cancer (MBC) patients experiencing radiologic complete response (rCR) in a nationwide real-world cohort. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Del Mastro L, Poggio F, Blondeaux E, de Placido S, Giuliano M, De Laurentiis M, Bisagni G, Cantore M, Turletti A, Nisticò C, Urracci Y, Garrone O, Bighin C, Mansutti M, Montemurro F, Colantuoni G, Lambertini M, Boni L. 134O Dose-dense adjuvant chemotherapy in early-stage breast cancer patients: End-of-study results from a randomised, phase III trial of the Gruppo Italiano Mammella (GIM). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Paleari L, Malini V, Paoli G, Scillieri S, Bighin C, Blobel B, Giacomini M. EU-Funded Telemedicine Projects – Assessment of, and Lessons Learned From, in the Light of the SARS-CoV-2 Pandemic. Front Med (Lausanne) 2022; 9:849998. [PMID: 35572981 PMCID: PMC9098161 DOI: 10.3389/fmed.2022.849998] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/21/2022] [Indexed: 11/24/2022] Open
Abstract
The SARS-CoV-2 health emergency has demonstrated the need for developing structured telemedicine systems to protect citizens from the spread of the virus. Thereby, their importance and the necessity to tailor their diffusion at large scale for providing services both at a distance and in time has been shown. For these reasons, the European Union advocates the digital transition of health systems for the next 5 years. The main aim of this work is to revisit the telemedicine research projects financed by European Community during the period 2000-2020 with particular respect to the results derived from their application. The analysis showed that some integration of tele-care and tele-health could be obtained with tele-monitoring systems and the implementation of Electronic Personal Record (EPR). Furthermore, telemedicine allows enhancing health care in critical environments, to protect health and life of the most vulnerable patients, and to encourage cross-border dialogue. The criteria of “from distance” and “timely delivered” are granted, but the effectiveness of the overall offered services highly depends on the availability and the quality of the input data. Unfortunately, this remains a relevant problem in the SARS-CoV-2 pandemic.
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Affiliation(s)
- Laura Paleari
- Research, Innovation and HTA Unit, A.Li.Sa.- Liguria Health Authority, Genoa, Italy
| | - Virginia Malini
- Department of Informatics, Bioengineering, Robotics and System Engineering, Genoa University, Genoa, Italy
| | - Gabriella Paoli
- Research, Innovation and HTA Unit, A.Li.Sa.- Liguria Health Authority, Genoa, Italy
| | - Stefano Scillieri
- Department of Informatics, Bioengineering, Robotics and System Engineering, Genoa University, Genoa, Italy
| | - Claudia Bighin
- Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Bernd Blobel
- Medical Faculty, University of Regensburg, Regensburg, Germany
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering, Genoa University, Genoa, Italy
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11
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Conte B, Molinelli C, Bisagni G, Durando A, Sanna G, Gori S, Garrone O, Tamberi S, De Placido S, Schettini F, Pazzola A, Ponzone R, Montemurro F, Lunardi G, Notaro R, Turletti A, Bighin C, Poggio F, Buzzatti G, Lambertini M, Boni L, Del Mastro L. Abstract P3-09-03: Single nucletotide polymorphisms of aromatase gene ( CYP19A1) and toxicity of adjuvant aromatase inhibitors: A translational, prospective study. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p3-09-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Extending adjuvant endocrine treatment (ET) with aromatase inhibitors (AI) to 7-10 years decreases the risk of relapse in hormone receptor-positive (HR+) breast cancer (BC). However, such benefit comes at the price of higher incidence of skeletal and cardiovascular (CV) events. Biomarkers predicting such toxicities might help clinicians in tailoring adjuvant ET to patient’s needs. We conducted a prospective study to assess whether SNPs in the gene encoding for the aromatase enzyme (CYP19A1) affect the risk of skeletal and CV events in HR+ early BC patients enrolled in the GIM4 trial. Methods: The GIM4 trial randomized HR+ BC postmenopausal patients who had been already treated with 2-3 years of adjuvant tamoxifen to either 3-2 years or 5 years of adjuvant letrozole. Four SNPs of CYP19A1 were evaluated: rs10046, rs4646, rs479292 and rs727479. SNPs were genotyped through PCR on DNA obtained from patients’ peripheral blood samples. Skeletal and CV events were assessed from randomization in the GIM4 trial to last follow-up, disease recurrence or death. Skeletal events were defined as the onset of osteoporosis or bone fractures. CV events were defined as the onset of thrombosis, embolism, stroke, myocardial infarction, hearth failure, or arrythmia. Univariate and multivariate logistic regressions were performed to evaluate the association between SNPs and skeletal and CV events. Bonferroni correction for multiplicity was used for univariate SNPs association tests, with a corrected alpha of 0.012. Only associations with an alpha level <0.012 were considered significant and included in multivariate models.Multivariate models’ covariates included: treatment arm (5 vs 3-2 years letrozole), (neo)adjuvant chemotherapy, previous hormone replacement therapy, age, BMI, previous biphosphonates, hypercholesterolemia and hypertension at baseline. SNPs were tested for Hardy–Weinberg equilibrium (HWE) and linkage disequilibrium (LD). Interaction between SNPs of interest and treatment arm was also investigated. Results: Of 2,056 patients enrolled in the GIM4 trial, 647 entered this translational study. All SNPs were in HWE. The CT and TT variants of rs10046 were less associated to skeletal events compared to variant CC, suggesting a dominant effect of the minor T allele (odds ratio [OR]: 0.47,. 95% confidence interval [CI]: 0.28-0.79, p=0.005). The association was independent from the other covariates (adjusted OR [aOR]: 0.43, p=0.002). Patients with rs10046-TT had no significant differences in the odd of skeletal events according to treatment arm. Conversely, in patients with rs10046-CC, skeletal events were more likely with 5-year letrozole (interaction p=0.043). Compared to rs10046-CC, rs10046-TT/CT was also less associated with CV events at both univariate (OR: 0.46 95% CI: 0.27-077, p=0.003) and multivariate analysis (aOR: 0.41, p<0.001).The rs727479—GG variant was associated with more CV events compared to the GT and TT variants (OR: 2.30, 95%CI: 1.27-4.15, p=0.009), suggesting a recessive effect of the minor G allele. The association remained significant at multivariate analysis (aOR: 2.30, p=0.010). No significant interaction was observed among treatment arms, rs10046 or rs272479 variants (interaction p=0.070 and 0.061). Rs10046-CC and rs727479-GG variants were in high LD (D’=0.92, haplotype-CG frequency: 39%). Hence, the association between genotype rs10046-CC/rs727479-GG and CV events was investigated. The association was significant at the multivariate analysis (aOR: 2.79, p=0.002). With such genotype, the odd of CV events was significantly increased with the 5-year letrozole (interaction p=0.046). Conclusions: SNPs of CYP19A1 could be useful biomarkers of long-term toxicity in HR+ BC patients who are candidates for adjuvant AI.
Citation Format: Benedetta Conte, Chiara Molinelli, Giancarlo Bisagni, Antonio Durando, Giovanni Sanna, Stefania Gori, Ornella Garrone, Stefano Tamberi, Sabino De Placido, Francesco Schettini, Antonio Pazzola, Riccardo Ponzone, Filippo Montemurro, Gianluigi Lunardi, Rosario Notaro, Anna Turletti, Claudia Bighin, Francesca Poggio, Giulia Buzzatti, Matteo Lambertini, Luca Boni, Lucia Del Mastro. Single nucletotide polymorphisms of aromatase gene (CYP19A1) and toxicity of adjuvant aromatase inhibitors: A translational, prospective study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-09-03.
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Affiliation(s)
- Benedetta Conte
- U.O. Oncologia Medica 2, Medical Oncology Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Molinelli
- U.O. Oncologia Medica 2, Medical Oncology Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Giancarlo Bisagni
- Azienda unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Durando
- Breast Unit Ospedale S Anna, Citta' della Salute e della Scienza di Torino, Torino, Italy
| | - Giovanni Sanna
- Azienda Ospedaliera Universitaria – Sassari, Sassari, Italy
| | - Stefania Gori
- UOC Oncologia Medica, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Ornella Garrone
- Breast Unit, AO S. Croce e Carle Ospedale di insegnamento, Cuneo, Italy
| | | | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Francesco Schettini
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcellona, Spain
| | | | - Riccardo Ponzone
- Candiolo Cancer Institute, FPO-IRCCS, Gynecologic Oncology and Multidisciplinary Outpatient Oncology Clinic, Candiolo (TO), Italy
| | - Filippo Montemurro
- Candiolo Cancer Institute, FPO-IRCCS, Gynecologic Oncology and Multidisciplinary Outpatient Oncology Clinic, Candiolo (TO), Italy
| | - Gianluigi Lunardi
- Laboratorio Analisi Chimico-Cliniche, IRCCS-Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Rosario Notaro
- Core Research Laboratory-Istituto Toscano Tumori, Azienda Universitaria-Ospedaliera Careggi, Firenze, Italy
| | | | - Claudia Bighin
- U.O. Oncologia Medica 2, Medical Oncology Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesca Poggio
- U.O. Oncologia Medica 2, Medical Oncology Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Giulia Buzzatti
- U.O. Oncologia Medica 2, Medical Oncology Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Lambertini
- U.O.C. Clinica di Oncologia Medica, Medical Oncology Department, IRCCS Ospedale Policlinico San Martino and Università di Genova, Dipartimento di Medicina Interna e Specialità Mediche (Di.M.I.), Genova, Italy
| | - Luca Boni
- S.C. Epidemiologia Clinica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Lucia Del Mastro
- S.S.D. Breast Unit, IRCCS Ospedale Policlinico San Martino and Università di Genova, Dipartimento di Medicina Interna e Specialità Mediche (Di.M.I.), Genova, Italy
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Lambertini M, Boni L, Michelotti A, Magnolfi E, Cogoni AA, Mosconi AM, Giordano M, Garrone O, Arpino G, Poggio F, Cinacchi P, Bighin C, Fregatti P, Pronzato P, Blondeaux E, Del Mastro L. Long-Term Outcomes with Pharmacological Ovarian Suppression during Chemotherapy in Premenopausal Early Breast Cancer Patients. J Natl Cancer Inst 2021; 114:400-408. [PMID: 34850043 DOI: 10.1093/jnci/djab213] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/26/2021] [Accepted: 09/27/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although use of gonadotropin-releasing hormone agonist (GnRHa) during chemotherapy is an established strategy to protect ovarian function in premenopausal breast cancer patients, no long-term safety data are available raising some concerns in women with hormone receptor-positive disease. There are controversial data on its fertility preservation potential. METHODS The PROMISE-GIM6 is a multicenter, randomized, open-label, phase III superiority trial conducted at 16 Italian centers from October 2003 to January 2008. Eligible patients were randomized to (neo)adjuvant chemotherapy alone (control arm) or combined with the GnRHa triptorelin (GnRHa arm). Primary planned endpoint was incidence of chemotherapy-induced premature ovarian insufficiency (POI). Post-hoc endpoints were disease-free survival (DFS), overall survival (OS), and post-treatment pregnancies. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. RESULTS Of 281 randomized patients, 80.4% had hormone receptor-positive breast cancer. Median follow-up was 12.4 years (interquartile range = 11.3-13.2 years). No differences in 12-year DFS (65.7% [95% CI = 57.0% to 73.1%] in GnRHa arm vs. 69.2% [95% CI = 60.3% to 76.5%] in control arm; HR = 1.16, 95% CI = 0.76 to 1.77) nor in 12-year OS (81.2% [95% CI = 73.6% to 86.8%] in GnRHa arm vs. 81.3% [95% CI = 73.1% to 87.2%] in control arm; HR = 1.17, 95% CI = 0.67 to 2.03) were observed. In patients with hormone receptor-positive disease, the HR was 1.02 (95% CI = 0.63 to 1.63) for DFS and 1.12 (95% CI = 0.59 to 2.11) for OS. In the GnRHa and control arms, 9 and 4 patients had a post-treatment pregnancy, respectively (HR = 2.14, 95% CI = 0.66 to 6.92). CONCLUSIONS Final analysis of the PROMISE-GIM6 trial provides reassuring results on the safety of GnRHa use during chemotherapy as a strategy to preserve ovarian function in premenopausal patients with early breast cancer, including those with hormone receptor-positive disease.
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Affiliation(s)
- Matteo Lambertini
- Department of Medical Oncology, Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Luca Boni
- Clinical Trial Center, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Andrea Michelotti
- UO Oncologia Medica I, Ospedale S. Chiara, Dipartimento di oncologia, dei trapianti e delle nuove tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | | | - Anna Maria Mosconi
- S.C. Oncologia Medica, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | | | - Ornella Garrone
- Dipartimento di Oncologia, Ospedale di Insegnamento S. Croce e Carle, Cuneo, Italy
| | - Grazia Arpino
- Department of Medical Oncology, Università di Napoli Federico II, Napoli, Italy
| | - Francesca Poggio
- Department of Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genova, U.O. Oncologia Medica 2, Italy
| | - Paola Cinacchi
- UO Oncologia Medica I, Ospedale S. Chiara, Dipartimento di oncologia, dei trapianti e delle nuove tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Claudia Bighin
- Department of Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genova, U.O. Oncologia Medica 2, Italy
| | - Piero Fregatti
- Department of Surgery, U.O.C. Clinica di Chirurgia Senologica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Integrated Diagnostic Surgical Sciences, School of Medicine, University of Genova, Genova, Italy
| | - Paolo Pronzato
- Department of Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genova, U.O. Oncologia Medica 2, Italy
| | - Eva Blondeaux
- Department of Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genova, U.O. Oncologia Medica 2, Italy
| | - Lucia Del Mastro
- Department of Medical Oncology, Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
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13
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Blondeaux E, Boni L, Ruelle T, Di Lauro V, Molinelli C, Piezzo M, Fratini B, Poggio F, Pugliese P, Ferzi A, Buzzatti G, Russo S, Garrone O, Gasparro S, D'Alonzo A, De Laurentiis M, Fabi A, Arpino G, Bighin C, Del Mastro L. 307P Overall survival in metastatic breast cancer patients according to different follow up strategies for early breast cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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14
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Cerbone L, Blondeaux E, Boni L, Ruelle T, Russo S, Bonotto M, Targato G, De Laurentiis M, Piezzo M, Arpino G, Pugliese P, Fabi A, D'Alonzo A, Giannubilo I, Conte B, Mulinelli C, Lambertini M, Bighin C, Del Mastro L. 261P Survival outcomes of triple-negative breast cancer (TNBC) patients in the pre-immunotherapy age: An analysis of Gruppo Italiano Mammella (GIM) 14 BIOMETA study with a focus on biological subtypes. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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15
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Puglisi F, Gerratana L, Lambertini M, Ceppi M, Boni L, Montemurro F, Russo S, Bighin C, De Laurentiis M, Giuliano M, Bisagni G, Durando A, Turletti A, Garrone O, Ardizzoni A, Gamucci T, Colantuoni G, Gravina A, De Placido S, Cognetti F, Del Mastro L. Composite risk and benefit from adjuvant dose-dense chemotherapy in hormone receptor-positive breast cancer. NPJ Breast Cancer 2021; 7:82. [PMID: 34183674 PMCID: PMC8238951 DOI: 10.1038/s41523-021-00286-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 05/27/2021] [Indexed: 11/09/2022] Open
Abstract
The GIM2 phase III trial demonstrated the benefit of dose-dense chemotherapy in node-positive early breast cancer (eBC). To better define the dose-dense effect in the hormone receptor-positive subgroup, we evaluated its benefit through a composite measure of recurrence risk. We conducted an ancillary analysis of the GIM2 trial evaluating the absolute treatment effect through a composite measure of recurrence risk (CPRS) in patients with hormone receptor-positive HER2-negative eBC. CPRS was estimated through Cox proportional hazards models applied to the different clinicopathological features. The treatment effect was compared to the values of CPRS by using the Sub-population Treatment Effect Pattern Plot (STEPP) process. The Disease-Free Survival (DFS)-oriented STEPP analysis showed distinct patterns of relative treatment effect with respect to CPRS. Overall, 5-year DFS differed across CPRS quartiles ranging from 95.2 to 66.4%. Each CPRS quartile was characterized by a different patients' composition, especially for age, lymph node involvement, tumor size, estrogen and progesterone receptor expression, and Ki-67. A number needed to treat of 154 and 6 was associated with the lowest and the highest CPRS quartile, respectively. Dose-dense adjuvant chemotherapy showed a consistent benefit in node-positive eBC patients with hormone receptor-positive HER2-negative disease, but its effect varied according to CPRS.
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Affiliation(s)
- Fabio Puglisi
- Department of Medicine (DAME), University of Udine, Udine, Italy.
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano (PN), Italy.
| | - Lorenzo Gerratana
- Department of Medicine (DAME), University of Udine, Udine, Italy
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano (PN), Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genova, Italy
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Marcello Ceppi
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Luca Boni
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Filippo Montemurro
- Day Hospital Oncologico Multidisciplinare, Istituto di Candiolo, FPO-IRCCS, Candiolo, Italy
| | - Stefania Russo
- Department of Oncology, ASU FC University Hospital, Udine, Italy
| | - Claudia Bighin
- Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Michelino De Laurentiis
- Department of Breast Oncology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Mario Giuliano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | - Antonio Durando
- Breast Unit Ospedale S Anna, Citta' della Salute e della Scienza di Torino, Torino, Italy
| | | | - Ornella Garrone
- Breast Unit, Department of Medical Oncology AO S. Croce e Carle Ospedale di Insegnamento, Cuneo, Italy
| | | | - Teresa Gamucci
- Department of Medical Oncology, Sandro Pertini Hospital and S. Eugenio Hospital, ASL Roma2, Roma, Italy
| | | | - Adriano Gravina
- Clinical Trial Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Francesco Cognetti
- Department of Medical Oncology, Istituto Regina Elena per lo Studio e la Cura dei Tumori, Roma, Italy
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genova, Italy
- UO Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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16
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Blondeaux E, Massarotti C, Fontana V, Poggio F, Arecco L, Fregatti P, Bighin C, Giannubilo I, Ruelle T, Razeti MG, Boni L, Anserini P, Del Mastro L, Lambertini M. The PREgnancy and FERtility (PREFER) Study Investigating the Need for Ovarian Function and/or Fertility Preservation Strategies in Premenopausal Women With Early Breast Cancer. Front Oncol 2021; 11:690320. [PMID: 34150661 PMCID: PMC8210666 DOI: 10.3389/fonc.2021.690320] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 04/26/2021] [Indexed: 12/11/2022] Open
Abstract
Background Offering ovarian function and/or fertility preservation strategies in premenopausal women with newly diagnosed breast cancer candidates to undergo chemotherapy is standard of care. However, few data are available on uptake and main reasons for refusing these options. Methods The PREFER study (NCT02895165) is an observational, prospective study enrolling premenopausal women with early breast cancer, aged between 18 and 45 years, candidates to receive (neo)adjuvant chemotherapy. Primary objective is to collect information on acceptance rates and reasons for refusal of the proposed strategies for ovarian function and/or fertility preservation available in Italy. Results At the study coordinating center, 223 patients were recruited between November 2012 and December 2020. Median age was 38 years (range 24 – 45 years) with 159 patients (71.3%) diagnosed at ≤40 years. Temporary ovarian suppression with gonadotropin-releasing hormone agonists (GnRHa) was accepted by 58 out of 64 (90.6%) patients aged 41-45 years and by 151 out of 159 (95.0%) of those aged ≤40 years. Among patients aged ≤40 years, 57 (35.8%) accepted to access the fertility unit to receive a complete oncofertility counseling and 29 (18.2%) accepted to undergo a cryopreservation technique. Main reasons for refusal were fear of delaying the initiation of antineoplastic treatments and contraindications to the procedure or lack of interest in future childbearing. Patients with hormone-receptor positive breast cancer had a tendency for a higher acceptance rates of ovarian function and/or fertility preservation strategies than those with hormone-receptor negative disease. Conclusions More than 90% of premenopausal women with early breast cancer, and particularly those with hormone receptor-positive disease, were concerned about the potential risk of chemotherapy-induced premature ovarian insufficiency and/or infertility and accepted GnRHa administration. Less than 1 out of 5 women aged ≤40 years accepted to undergo cryopreservation strategies.
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Affiliation(s)
- Eva Blondeaux
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy.,Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Claudia Massarotti
- Physiopathology of Human Reproduction Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Valeria Fontana
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesca Poggio
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Luca Arecco
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Piero Fregatti
- U.O.C. Clinica di Chirurgia Senologica, Department of Surgery, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Claudia Bighin
- U.O.C. Oncologia Medica 2, Department of Medical Oncology, Ospedale Policlinico San Martino, Genova, Italy
| | - Irene Giannubilo
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Tommaso Ruelle
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Maria Grazia Razeti
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Luca Boni
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Paola Anserini
- Physiopathology of Human Reproduction Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy.,Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy.,Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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17
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Lambertini M, Boni L, Michelotti A, Magnolfi E, Cogoni AA, Mosconi AM, Giordano M, Garrone O, Arpino G, Poggio F, Cinacchi P, Bighin C, Fregatti P, Pronzato P, Blondeaux E, Del Mastro L. Final analysis of the PROMISE-GIM6 phase III trial assessing GnRH agonist use during chemotherapy as a strategy to preserve ovarian function in premenopausal patients with early breast cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
516 Background: Current guidelines recommend GnRH agonist (GnRHa) use during chemotherapy (CT) as a strategy to reduce the risk of premature ovarian insufficiency (POI) in premenopausal patients with early breast cancer (EBC). However, no long-term safety data are available raising some concerns on concurrent use of GnRHa during CT in patients with hormone receptor-positive disease. In addition, there is no evidence on the protective role of this strategy in patients with germline BRCA mutations ( mBRCA). Here, we report the final analysis of the PROMISE-GIM6 phase III randomized study, the largest trial addressing the role of GnRHa use during CT in premenopausal EBC patients (Del Mastro et al, JAMA 2011 & Lambertini et al, JAMA 2015). Methods: From October 2003 to January 2008, 281 premenopausal patients aged 18 to 45 years with stage I-III EBC candidates for (neo)adjuvant CT were randomized to receive CT alone or combined with the GnRHa triptorelin. Primary endpoint was incidence of CT-induced POI (defined as amenorrhea and post-menopausal FSH/estradiol levels 1 year following CT). This final analysis reports on post-treatment pregnancies, disease-free survival (DFS) and overall survival (OS). An exploratory descriptive analysis in mBRCA patients is also reported. (ClinicalTrial.gov: NCT00311636) Results: Of the 281 randomized patients (CT+GnRHa arm = 148; CT alone arm = 133), 80% had hormone receptor-positive disease. At the time of this final analysis, 38 (13.5%) patients were lost to follow-up. Median follow-up was 12.4 years (IQR: 11.3-13.2 years). In the CT+GnRHa and CT alone arms, respectively, 9 (10-year cumulative incidence of pregnancy 6.5%, 95% CI 3.5%-12.3%) and 4 (10-year cumulative incidence of pregnancy 3.2%, 95% CI 1.2%-8.3%) patients had a post-treatment pregnancy (HR 2.14, 95% CI 0.66-6.92). No differences in 10-year DFS (72.4% in CT+GnRHa arm vs. 71.2% in CT alone arm: HR 1.16, 95% CI 0.76-1.77) nor in 10-year OS (82.0% in CT+GnRHa arm vs. 85.9% in CT alone arm: HR 1.17, 95% CI 0.67-2.03) were observed. There was no interaction between treatment effect and hormone receptor status. In patients with hormone receptor-positive disease, HR was 1.02 (95% CI 0.63-1.63) for DFS and 1.12 (95% CI 0.59-2.11) for OS. Out of 43 patients tested for BRCA, overall incidence of POI, irrespective of treatment arm, was 20% in mBRCA patients (n = 10) and 12% in patients without mBRCA (n = 33). In mBRCA patients, incidence of POI was 0% and 33% in the CT+GnRHa and CT alone arms, respectively. One post-treatment pregnancy was described in a patient with mBRCA1 in the CT alone arm. Conclusions: The final analysis of the PROMISE-GIM6 trial at a median follow-up of 12.4 years provides reassuring evidence on the safety of GnRHa use during CT as a strategy to preserve ovarian function in premenopausal patients with hormone receptor-positive EBC. Clinical trial information: NCT00311636.
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Affiliation(s)
- Matteo Lambertini
- U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Department of Internal Medicine and Medical Specialties (DiMI), University of Genova, Genoa, Italy
| | - Luca Boni
- Unità Operativa Epidemiologia Clinica IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | | | | | | | | | - Grazia Arpino
- Department of Clinical Medicine and Surgery, Oncology Division, University Federico II, Naples, Italy
| | | | | | - Claudia Bighin
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy
| | - Piero Fregatti
- Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genova, Genoa, Italy
| | - Paolo Pronzato
- Medical Oncology 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Lucia Del Mastro
- IRCCS Ospedale Policlinico San Martino, University of Genova, Genoa, Italy
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18
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Schettini F, Conte B, Buono G, De Placido P, Parola S, Griguolo G, Fabi A, Bighin C, Riccardi F, Cianniello D, De Laurentiis M, Puglisi F, Pelizzari G, Bonotto M, Russo S, Frassoldati A, Pazzola A, Montemurro F, Lambertini M, Guarneri V, Cognetti F, Locci M, Generali D, Conte P, De Placido S, Giuliano M, Arpino G, Del Mastro L. T-DM1 versus pertuzumab, trastuzumab and a taxane as first-line therapy of early-relapsed HER2-positive metastatic breast cancer: an Italian multicenter observational study. ESMO Open 2021; 6:100099. [PMID: 33819752 PMCID: PMC8047485 DOI: 10.1016/j.esmoop.2021.100099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/06/2021] [Accepted: 02/27/2021] [Indexed: 02/06/2023] Open
Abstract
Background The current standard first-line treatment of human epidermal growth factor receptor 2 (HER2)-positive (+) metastatic breast cancer is the combination of pertuzumab, trastuzumab and a taxane (P + T + taxane), while standard second-line is ado-trastuzumab-emtansine (T-DM1). The registration trial of pertuzumab, however, did not include early-relapsing patients, defined as patients experiencing tumor relapse ≤12 months from the end of (neo)adjuvant anti-HER2 therapy. Conversely, the pivotal trial of T-DM1 included some patients relapsing ≤6 months after the end of (neo)adjuvant trastuzumab. Thus, a proportion of early-relapsing patients are currently eligible to receive T-DM1 as first-line treatment. Nevertheless, no direct comparison exists between the two regimens in this clinical setting. Patients and methods We retrospectively compared T-DM1 versus P + T + taxane as first-line treatment in two cohorts of early-relapsing patients in an Italian ‘real-world’ setting, involving 14 public health care institutions. The primary endpoint was progression-free survival. Secondary endpoints included patients' characterization, overall survival and post-progression survival. Univariate and multivariate analyses were carried out. All tests were two-sided and a P ≤ 0.05 was considered statistically significant. Results Among 1252 screened patients, 75 met the inclusion criteria. Forty-four (58.7%) received P + T + taxane and 31 (41.3%) received T-DM1. The two cohorts showed similar characteristics of aggressiveness and no significant differences in treatment history. T-DM1, compared with P + T + taxane was associated with worse progression-free survival (adjusted hazard ratio: 2.26, 95% confidence interval: 1.13-4.52, P = 0.021) and overall survival (adjusted hazard ratio: 3.95, 95% confidence interval: 1.38-11.32, P = 0.010), irrespective of previous (neo)adjuvant treatment, age, hormone receptors status, time-to-relapse (≤6 months or within 6-12 months) and presence of visceral/brain metastases. No differences were observed in post-progression survival (P = 0.095). Conclusions Our study suggests superiority for P + T + taxane over T-DM1 as up-front treatment of early-relapsing HER2+ metastatic breast cancer, which merits further assessment in larger and prospective trials. This is the first study comparing pertuzumab + trastuzumab + taxane (P + T + taxane) with T-DM1 in early-relapsing HER2+ MBC. The majority of early-relapsing HER2+ MBC have high-grade, node-positive, large primary tumors. First-line T-DM1 compared with P + T + taxane is associated with worse progression-free survival. First-line T-DM1 compared with P + T + taxane is associated with worse overall survival. Post-progression survival does not differ between the two treatments cohorts.
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Affiliation(s)
- F Schettini
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy; Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain.
| | - B Conte
- SOLTI Breast Cancer Research Group, Barcelona, Spain; Medical Oncology Unit 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - G Buono
- Oncology Unit, San Rocco Hospital, Sessa Aurunca, Italy
| | - P De Placido
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - S Parola
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - G Griguolo
- Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - A Fabi
- Division of Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - C Bighin
- Medical Oncology Unit 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - F Riccardi
- Medical Oncology, 'A. Cardarelli' Hospital, Naples, Italy
| | - D Cianniello
- National Cancer Institute Fondazione 'G. Pascale', Naples, Italy
| | - M De Laurentiis
- National Cancer Institute Fondazione 'G. Pascale', Naples, Italy
| | - F Puglisi
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Clinical Oncology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - G Pelizzari
- Department of Clinical Oncology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - M Bonotto
- Department of Oncology, ASUFC University Hospital, Udine, Italy
| | - S Russo
- Department of Oncology, ASUFC University Hospital, Udine, Italy
| | - A Frassoldati
- Oncology Unit, University Hospital St. Anna, Ferrara, Italy
| | - A Pazzola
- Division of Medical Oncology, AOU Sassari, Sassari, Italy
| | - F Montemurro
- Depertment of Medical Oncology, Candiolo Cancer Institute, Candiolo, Italy
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy; Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - V Guarneri
- Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - F Cognetti
- Department of Clinic and Molecular Medicine, 'La Sapienza' University of Rome, Rome, Italy
| | - M Locci
- Department of Neuroscience, Reproductive Medicine, Odontostomatology, University of Naples 'Federico II', Naples, Italy
| | - D Generali
- Breast Cancer Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy; Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - P Conte
- Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - S De Placido
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - M Giuliano
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - G Arpino
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - L Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy; U.O.S.D. Breast Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Blondeaux E, Massarotti C, Fontana V, Poggio F, Arecco L, Fregatti P, Bighin C, Giannubilo I, Ruelle T, Razeti MG, Boni L, Anserini P, Del Mastro L, Lambertini M. The PREgnancy and FERtility (PREFER) Study Investigating the Need for Ovarian Function and/or Fertility Preservation Strategies in Premenopausal Women With Early Breast Cancer. Front Oncol 2021. [PMID: 34150661 DOI: 10.3389/fonc.2021.690320/full] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Offering ovarian function and/or fertility preservation strategies in premenopausal women with newly diagnosed breast cancer candidates to undergo chemotherapy is standard of care. However, few data are available on uptake and main reasons for refusing these options. METHODS The PREFER study (NCT02895165) is an observational, prospective study enrolling premenopausal women with early breast cancer, aged between 18 and 45 years, candidates to receive (neo)adjuvant chemotherapy. Primary objective is to collect information on acceptance rates and reasons for refusal of the proposed strategies for ovarian function and/or fertility preservation available in Italy. RESULTS At the study coordinating center, 223 patients were recruited between November 2012 and December 2020. Median age was 38 years (range 24 - 45 years) with 159 patients (71.3%) diagnosed at ≤40 years. Temporary ovarian suppression with gonadotropin-releasing hormone agonists (GnRHa) was accepted by 58 out of 64 (90.6%) patients aged 41-45 years and by 151 out of 159 (95.0%) of those aged ≤40 years. Among patients aged ≤40 years, 57 (35.8%) accepted to access the fertility unit to receive a complete oncofertility counseling and 29 (18.2%) accepted to undergo a cryopreservation technique. Main reasons for refusal were fear of delaying the initiation of antineoplastic treatments and contraindications to the procedure or lack of interest in future childbearing. Patients with hormone-receptor positive breast cancer had a tendency for a higher acceptance rates of ovarian function and/or fertility preservation strategies than those with hormone-receptor negative disease. CONCLUSIONS More than 90% of premenopausal women with early breast cancer, and particularly those with hormone receptor-positive disease, were concerned about the potential risk of chemotherapy-induced premature ovarian insufficiency and/or infertility and accepted GnRHa administration. Less than 1 out of 5 women aged ≤40 years accepted to undergo cryopreservation strategies.
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Affiliation(s)
- Eva Blondeaux
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Claudia Massarotti
- Physiopathology of Human Reproduction Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Valeria Fontana
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesca Poggio
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Luca Arecco
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Piero Fregatti
- U.O.C. Clinica di Chirurgia Senologica, Department of Surgery, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Claudia Bighin
- U.O.C. Oncologia Medica 2, Department of Medical Oncology, Ospedale Policlinico San Martino, Genova, Italy
| | - Irene Giannubilo
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Tommaso Ruelle
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Maria Grazia Razeti
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Luca Boni
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Paola Anserini
- Physiopathology of Human Reproduction Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Molinelli C, Del Mastro L, Giraudi S, Ballestrero A, Carli F, Poggio F, D'Alonzo A, Dellepiane C, Buzzatti G, Blondeaux E, Conte B, Pastorino S, Gallo M, Lambertini M, Bighin C. 226P Impact of BMI on outcome and cardiac safety in HER2-positive breast cancer patients treated with adjuvant trastuzumab: Results of a monocentric observational study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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21
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Blondeaux E, Ferreira AR, Poggio F, Puglisi F, Bighin C, Sottotetti F, Montemurro F, Poletto E, Lai A, Sini V, Minuti G, Mura S, Fontana A, Fregatti P, Cardinali B, Lambertini M, Del Mastro L. Clinical outcomes of patients with breast cancer relapsing after (neo)adjuvant trastuzumab and receiving trastuzumab rechallenge or lapatinib-based therapy: a multicentre retrospective cohort study. ESMO Open 2020; 5:S2059-7029(20)32642-9. [PMID: 32817059 PMCID: PMC7437709 DOI: 10.1136/esmoopen-2020-000719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/09/2020] [Accepted: 04/29/2020] [Indexed: 11/24/2022] Open
Abstract
Background In the prepertuzumab era, we evaluated the clinical outcomes of patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer who underwent first-line trastuzumab-based or lapatinib-based therapy according to prior exposure to (neo)adjuvant trastuzumab. Materials and methods In this multicentre retrospective cohort study conducted in 14 Italian centres of the Gruppo Italiano Mammella, consecutive patients undergoing first-line trastuzumab or lapatinib-based therapy were included. Analyses were performed according to the type of first-line therapy for metastatic disease (trastuzumab or lapatinib). Dichotomous clinical outcomes were analysed using logistic regression and time-to-event outcomes using Cox proportional hazard models controlling for relevant demographic, clinicopathological and therapy characteristics. Results Out of 450 patients included in the study, 416 (92%) received trastuzumab and 34 (7.5%) lapatinib. As compared with the trastuzumab cohort, more patients in the lapatinib cohort had a trastuzumab-free interval <1 month (37% vs 13.9%; p=0.017) and brain metastasis as first site of relapse (38.2% vs 9.4%; p<0.001). Among the 128 patients who relapsed after prior (neo)adjuvant trastuzumab, 101 (78.9%) received first-line trastuzumab and 27 (21.1%) first-line lapatinib. The following outcomes were observed with first-line lapatinib or trastuzumab, respectively: overall response rate 45.5% vs 61.3% (p=0.184), clinical benefit rate 68.2% vs 72.5% (p=0.691), median progression-free survival (PFS) 11.4 vs 12.0 months (p=0.814) and median overall survival (OS) 34.7 vs 48.2 months (p=0.722). In patients with brain metastasis as first site of relapse, median PFS was 12.2 vs 9.9 months (p=0.093) and median OS 33.7 vs 28.5 months (p=0.280), respectively. Conclusions In patients with HER2-positive breast cancer relapsing after prior (neo)adjuvant trastuzumab, first-line treatment with trastuzumab or lapatinib was not associated with a significant difference in the clinical outcomes. A non-significant trend favouring the use of lapatinib was observed in patients with brain metastasis as the first site of relapse.
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Affiliation(s)
- Eva Blondeaux
- U.O.S.D. Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Arlindo R Ferreira
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - Francesca Poggio
- U.O.S.D. Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Fabio Puglisi
- Department of Medical Oncology, IRCCS Centro di Riferimento Oncologico, Aviano, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | - Claudia Bighin
- U.O.S.D. Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Federico Sottotetti
- Unità Dipartimentale di Oncologia Medica, Fondazione Salvatore Maugeri IRCCS, Pavia, Italy
| | - Filippo Montemurro
- Day Hospital Oncologico Multidisciplinare, Istituto di Candiolo FPO-IRCCS, Candiolo, Italy
| | - Elena Poletto
- Department of Oncology, University of Udine, Udine, Italy
| | - Antonella Lai
- Oncologia Medica, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy.,Department of Oncology, Mater Olbia Hospital, Olbia, Italy
| | - Valentina Sini
- U.O. Centro Oncologico S. Spirito-Nuovo Regina Margherita, ASL Roma 1, Rome, Italy
| | - Gabriele Minuti
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy
| | - Silvia Mura
- U.O.C. Medical Oncology, Ospedale Civile Santissima Annunziata, Sassari, Italy
| | - Andrea Fontana
- Polo Oncologico, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Piero Fregatti
- Department of Surgical Oncology, U.O. Chirurgia Senologica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Barbara Cardinali
- U.O.S.D. Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Lambertini
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, Università degli Studi di Genova, Genova, Italy
| | - Lucia Del Mastro
- U.O.S.D. Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy .,Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, Università degli Studi di Genova, Genova, Italy
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22
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Conte B, Bruzzone M, Lambertini M, Poggio F, Bighin C, Blondeaux E, De Laurentiis M, Valle E, Cognetti F, Nisticò C, De Placido S, Garrone O, Gamucci T, Montemurro F, Puglisi F, Cardinali B, Fregatti P, Miglietta L, Boccardo F, Ceppi M, Del Mastro L. Effect of dose-dense adjuvant chemotherapy in hormone receptor positive/HER2-negative early breast cancer patients according to immunohistochemically defined luminal subtype: an exploratory analysis of the GIM2 trial. Eur J Cancer 2020; 136:43-51. [PMID: 32634760 DOI: 10.1016/j.ejca.2020.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Luminal A-like and luminal B-like subtypes have different sensitivity to (neo)adjuvant chemotherapy, but their role in predicting dose-dense (DD) efficacy in the high-risk setting is unknown. In this exploratory analysis of the Gruppo Italiano Mammella 2 (GIM2) trial, we investigated DD efficacy according to luminal-like subtypes. METHODS Patients with node-positive early breast cancer were randomised to receive either DD or standard-interval (SI) anthracycline-based chemotherapy followed by paclitaxel. In our analysis, luminal A-like cohort was identified as having a Ki67 < 20% and a progesterone receptor (PgR) ≥ 20%; luminal B-like cohort as having a Ki67 ≥ 20% and/or a PgR < 20%. RESULTS Out of 2003 patients enrolled in the GIM2 trial, 412 had luminal A-like and 638 luminal B-like breast cancer. After a median follow-up of 7.9 years, disease-free survival (DFS) was 80.8% (95% confidence interval [CI] 76.4-84.5) and 70.5% (66.5-74.2) in luminal A-like and luminal B-like cohorts; overall survival (OS) was 91.6% (88.2-94.1) and 85.1% (81.7-87.9), respectively. We found no significant interaction between treatment and luminal subtype (interaction p = 0.603 and 0.535 for DFS and OS, respectively). When DD efficacy was investigated separately in each cohort, luminal-B like cohort appeared to benefit more from the DD schedule both in terms of DFS (unadjusted hazard ratio [HR] 0.72 [95% CI 0.54-0.96]) and OS (unadjusted HR 0.61 [95% CI 0.40-0.94]), compared with the luminal A-like cohort (unadjusted HR for DFS 0.89 [95% CI 0.59-1.33]; unadjusted HR for OS 0.83 [95% CI 0.45-1.54]). CONCLUSIONS No significant interaction between luminal-like subtype and treatment was observed. Patients in the luminal B-like cohort seemed to benefit more from DD schedule.
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Affiliation(s)
- Benedetta Conte
- Medical Oncology Unit 2, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute, Carrer de Rosselló, 149, 08036, Barcelona, Spain
| | - Marco Bruzzone
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - Matteo Lambertini
- Medical Oncology Department, UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 1632, Genoa, GE, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Viale Benedetto XV, 10, 16132, Genoa, GE, Italy
| | - Francesca Poggio
- Medical Oncology Unit 2, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - Claudia Bighin
- Medical Oncology Unit 2, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - Eva Blondeaux
- Medical Oncology Unit 2, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - Michelino De Laurentiis
- Breast Unit, Istituto Nazionale Tumori-Fondazione "G. Pascale", Via Mariano Semmola, 53, 80131, Naples, NA, Italy
| | - Enrichetta Valle
- Department of Medical Oncology, Ospedale Businco, Via Edward Jenner, 1, 09121, Cagliari, CA, Italy
| | - Francesco Cognetti
- Department of Clinical and Molecolar Medicine, La Sapienza University, Viale Regina Elena, 324, 00161, Rome, RM, Italy
| | - Cecilia Nisticò
- Department of Medical Oncology 1, Istituto Nazionale Tumori "Regina Elena", Via Elio Chianesi, 53, 00128, Rome, RM, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, NA, Italy
| | - Ornella Garrone
- Breast Unit, Department of Oncology, Azienda Ospedaliera Santa Croce e Carle, Via Michele Coppino, 26, 12100, Cuneo, CN, Italy
| | - Teresa Gamucci
- Department of Medical Oncology, Ospedale Sandro Pertini, Via dei Monti Tiburtini, 385/389, 00157, Rome, RM, Italy; Department of Medical Oncology, Ospedale SS Trinità, Località San Marciano, 03039, Sora, FR, Italy
| | - Filippo Montemurro
- Multidisciplinary Oncology Outpatient Clinic, Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale, 142, 10060, Turin, TO, Italy
| | - Fabio Puglisi
- Department of Medicine, University of Udine, Piazzale Massimiliano Kolbe, 4, 33100, Udine, Italy; Department of Medical Oncology, IRCCS Centro di Riferimento Oncologico Aviano - National Cancer Institute, Via Franco Gallini, 2, 33081, Aviano, PN, Italy
| | - Barbara Cardinali
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - Piero Fregatti
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genova, Viale Benedetto XV, 6, 1612, Genoa, GE, Italy; Department of Surgery, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 1632, Genoa, GE, Italy
| | - Loredana Miglietta
- Medical Oncology Unit 2, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - Francesco Boccardo
- Medical Oncology Department, UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 1632, Genoa, GE, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Viale Benedetto XV, 10, 16132, Genoa, GE, Italy
| | - Marcello Ceppi
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Viale Benedetto XV, 10, 16132, Genoa, GE, Italy; Breast Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy.
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23
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Lambertini M, Poggio F, Bruzzone M, Conte B, Bighin C, de Azambuja E, Giuliano M, De Laurentiis M, Cognetti F, Fabi A, Bisagni G, Durando A, Turletti A, Urracci Y, Garrone O, Puglisi F, Montemurro F, Ceppi M, Del Mastro L. Dose-dense adjuvant chemotherapy in HER2-positive early breast cancer patients before and after the introduction of trastuzumab: Exploratory analysis of the GIM2 trial. Int J Cancer 2019; 147:160-169. [PMID: 31724170 DOI: 10.1002/ijc.32789] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 06/13/2019] [Revised: 10/30/2019] [Accepted: 11/04/2019] [Indexed: 12/20/2022]
Abstract
Dose-dense adjuvant chemotherapy is standard of care in high-risk early breast cancer patients. However, its role in HER2-positive patients is still uncertain. In this exploratory analysis of the GIM2 trial, we investigated the efficacy of dose-dense chemotherapy in HER2-positive breast cancer patients with or without exposure to trastuzumab. In the GIM2 trial, node-positive early breast cancer patients were randomized to receive four cycles of (fluorouracil)epirubicin/cyclophosphamide followed by four cycles of paclitaxel administered every 2 (dose-dense) or 3 (standard-interval) weeks. After approval of adjuvant trastuzumab, protocol was amended in April 2006 to allow use of trastuzumab for 1 year after chemotherapy completion in HER2-positive patients. The efficacy of dose-dense chemotherapy in terms of disease-free survival (DFS) and overall survival (OS) was assessed according to HER2 status and trastuzumab use. Out of 2,003 breast cancer patients, HER2 status was negative/unknown in 1,551 patients; among the 452 patients with HER2-positive breast cancer, chemotherapy alone or followed by trastuzumab was given to 320 and 132 patients, respectively. Median follow-up was 8.1 years. No significant interaction between HER2 status, trastuzumab use and chemotherapy treatment was observed for both DFS (p = 0.698) and OS (p = 0.708). Nevertheless, there was no apparent benefit in the HER2-positive group treated with trastuzumab (DFS: HR, 0.99; 95% CI 0.52-1.89; OS: HR, 0.95; 95% CI 0.37-2.41). Although dose-dense chemotherapy was associated with a significant survival improvement in high-risk breast cancer patients, its benefit appeared to be smaller (if any) in patients with HER2-positive disease who received adjuvant trastuzumab.
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Affiliation(s)
- Matteo Lambertini
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
| | - Francesca Poggio
- Department of Medical Oncology, Breast Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marco Bruzzone
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Benedetta Conte
- Department of Medical Oncology, Breast Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Claudia Bighin
- Department of Medical Oncology, Breast Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Evandro de Azambuja
- Department of Medical Oncology, Institut Jules Bordet and l'Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - Mario Giuliano
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | | | - Francesco Cognetti
- La Sapienza University, Rome, Italy.,Department of Medical Oncology 1, Istituto Nazionale Tumori Regina Elena, Rome, Italy
| | - Alessandra Fabi
- La Sapienza University, Rome, Italy.,Department of Medical Oncology 1, Istituto Nazionale Tumori Regina Elena, Rome, Italy
| | - Giancarlo Bisagni
- Department of Medical Oncology, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Durando
- Breast Unit, Azienda Ospedaliera Universitaria Città della Salute e delle Scienze, Torino, Italy
| | - Anna Turletti
- Medical Oncology, Martini Hospital, ASL Città' di Torino, Italy
| | - Ylenia Urracci
- Department of Medical Oncology, Hospital Businco, Cagliari, Italy
| | - Ornella Garrone
- Breast Unit, Medical Oncology, Azienda Ospedaliera S. Croce e Carle, Ospedale di Insegnamento, Cuneo, Italy
| | - Fabio Puglisi
- Unit of Medical Oncology and Cancer Prevention, IRCCS Centro di Riferimento Oncologico Aviano-National Cancer Institute, Aviano (Udine), Italy.,Medical Oncology, Department of Medicine, University of Udine, Udine, Italy
| | - Filippo Montemurro
- Day Hospital Oncologico Multidisciplinare, Istituto di Candiolo, FPO-IRCCS, Candiolo, Torino, Italy
| | - Marcello Ceppi
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy.,Department of Medical Oncology, Breast Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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24
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Conte B, Fabi A, Poggio F, Blondeaux E, Dellepiane C, D’alonzo A, Buono G, Arpino G, Magri V, Naso G, Presti D, Mura S, Fontana A, Cognetti F, Molinelli C, Pastorino S, Bighin C, Miglietta L, Boccardo F, Lambertini M, Del Mastro L. T-DM1 EFFICACY AND ACTIVITY IN HER2-POSITIVE METASTATIC BREAST CANCER PATIENTS PROGRESSING AFTER FRONTLINE TAXANE PLUS PERTUZUMAB AND TRASTUZUMAB: AN ITALIAN MULTICENTER OBSERVATIONAL STUDY OF THE GRUPPO ITALIANO MAMMELLA (GIM) STUDY GROUP. Breast 2019. [DOI: 10.1016/s0960-9776(19)30674-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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25
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Poggio F, Lambertini M, Bighin C, Conte B, Blondeaux E, D'Alonzo A, Dellepiane C, Buzzatti G, Molinelli C, Boccardo F, Del Mastro L. Potential Mechanisms of Ovarian Protection with Gonadotropin-Releasing Hormone Agonist in Breast Cancer Patients: A Review. Clin Med Insights Reprod Health 2019; 13:1179558119864584. [PMID: 31391786 PMCID: PMC6669835 DOI: 10.1177/1179558119864584] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 06/25/2019] [Indexed: 01/22/2023]
Abstract
The use of chemotherapy in premenopausal cancer patients may lead to chemotherapy-induced premature ovarian failure. Pharmacological temporary ovarian suppression obtained with the gonadotropin-releasing hormone agonist (GnRHa) administered concomitantly with chemotherapy has been investigated as a technique capable to reduce the gonadotoxicity, reducing the risk of developing premature menopause. In recent years, important evidence has become available on the efficacy and safety of this strategy that should now be considered a standard option for ovarian function preservation in premenopausal breast cancer patients. However, in women interested in fertility preservation, this is not an alternative to cryopreservation strategies, which remains the first option to be proposed. The purpose of this review is to summarize the mechanisms of GnRHa in the preservation of fertility in premenopausal cancer patient candidates to receive chemotherapy, highlighting the areas of doubt that require further investigation.
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Affiliation(s)
| | - Matteo Lambertini
- Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS San Martino Hospital, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
| | - Claudia Bighin
- UO Breast Unit, IRCCS San Martino Hospital, IST, Genova, Italy
| | - Benedetta Conte
- UO Breast Unit, IRCCS San Martino Hospital, IST, Genova, Italy
| | - Eva Blondeaux
- UO Breast Unit, IRCCS San Martino Hospital, IST, Genova, Italy
| | | | | | - Giulia Buzzatti
- UO Breast Unit, IRCCS San Martino Hospital, IST, Genova, Italy
| | | | - Francesco Boccardo
- Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS San Martino Hospital, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
| | - Lucia Del Mastro
- UO Breast Unit, IRCCS San Martino Hospital, IST, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
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26
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Del Mastro L, Mansutti M, Bisagni G, Ponzone R, Durando A, Amaducci L, Fabi A, Frassoldati A, Michelotti A, Pazzola A, Valle E, Sanna G, Gori S, De Placido S, Garrone O, Donadio M, Bruzzi P, Bighin C, Lambertini M, Poggio F. Benefit from letrozole as extended adjuvant therapy after sequential endocrine therapy: A randomized, phase III study of Gruppo Italiano Mammella (GIM). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.504] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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
504 Background: The effect of extended adjuvant endocrine therapy (ET) with aromatase inhibitors (AI) after sequential ET with tamoxifen (Tam) followed by AI for 5 years is still controversial. We conduct a clinical trial to assess different durations of ET of letrozole after tam. Methods: The GIM4 LEAD (Gruppo Italiano Mammella 4- Letrozole adjuvant therapy duration study, ClinicalTrials.gov:NCT01064635 ) was a prospective, randomized, Italian multicentric trial. Post-menopausal patients (pts) with hormone receptor positive early breast cancer free of recurrence after 2-3 years of adjuvant tam, were randomized in a 1:1 ratio to receive 3-2 years (short arm, S) or 5 years (long arm, L) of letrozole. The primary study end point was disease-free survival (DFS). Results: Between August 2005 and May 2010, 2056 pts were randomly assigned to receive 3-2 years (n=1030) or 5 years (n=1026) of letrozole. Main patients characteristics in the S and L arms were, respectively: median age 60 vs 61 years, node negative 56 vs 56%, (neo)adjuvant chemotherapy 53.4 vs 54.1%. The median follow-up was 10 years (IQR range: 8.6-11.4). The 8-year DFS was 80% (95% CI:77.3-82.7) and 85% (95% CI:82.9-87.6) in the S and L arm, respectively (hazard ratio, HR 0.82; 95% CI:0.68-0.98; p=0.031). This effect did not change in a multivariate Cox model that included nodal status, grading and age. No evidence of interaction between random assignment and nodal status, age and grading was observed. Among 1960 pts evaluable for toxicity, osteoporosis was diagnosed in 47 (4.8%) in S arm and 81 (8.3%) pts in L arm (chi-square=9.88; p=0.002). Bone fractures occurred in 5 (0.5%) and 9 (0.9%) pts in S and L arm, respectively ( p=0.29, Fisher exact test). Conclusions: After 2-3 years of adjuvant tam, extended treatment with 5 years of letrozole resulted in significant improvement in DFS compared to the standard duration of 2-3 years of letrozole. Clinical trial information: NCT01064635.
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Affiliation(s)
- Lucia Del Mastro
- Ospedale Policlinico San Martino-Oncologia Medica, Genova, Italy
| | - Mauro Mansutti
- Department of Oncology-ASUI Udine University Hospital, Udine, Italy
| | - Giancarlo Bisagni
- Oncologia Medica Azienda USL/IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Antonio Durando
- Breast Unit, Città della Salute e della Scienza, ASO S. Anna, Torino, Italy
| | - Laura Amaducci
- Ospedale Faenza, Dipartimento Oncologico Area Vasta Romagna, Faenza, Italy
| | - Alessandra Fabi
- Division of Medical Oncology, “Regina Elena” National Cancer Institute, Rome, Italy
| | | | | | - Antonio Pazzola
- Medical Oncology - Ospedale Civile SS. Annunziata, Sassari, Italy
| | - Enrichetta Valle
- Oncologia Medica, Ospedale Oncologico “A. Businco”-AO Brotzu, Cagliari, Italy
| | - Giovanni Sanna
- Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy
| | - Stefania Gori
- Oncology Unit, Ospedale Sacro Cuore-don Calabria, Negrar, Italy
| | - Sabino De Placido
- Oncology Unit, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Ornella Garrone
- Breast Unit Medical Oncology S. Croce and Carle Teaching Hospital, Cuneo, Italy
| | - Michela Donadio
- Oncology Department Aou Città Della Salute e Della Scienza, Torino, Italy
| | - Paolo Bruzzi
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Claudia Bighin
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy
| | - Matteo Lambertini
- Policlinico San Martino Hospital - University of Genova, Genova, Italy
| | - Francesca Poggio
- Ospedale Policlinico San Martino- Oncologia medica, Genova, Italy
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Blondeaux E, Cantore M, Michelotti A, Conte B, Benasso M, Bighin C, Lambertini M, Poggio F, Del Mastro L. Dose-dense adjuvant chemotherapy in early breast cancer: 15–year results of the phase III Mammella InterGruppo (MIG)-1 study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gray R, Bradley R, Braybrooke J, Liu Z, Peto R, Davies L, Dodwell D, McGale P, Pan H, Taylor C, Barlow W, Bliss J, Bruzzi P, Cameron D, Fountzilas G, Loibl S, Mackey J, Martin M, Del Mastro L, Möbus V, Nekljudova V, De Placido S, Swain S, Untch M, Pritchard KI, Bergh J, Norton L, Boddington C, Burrett J, Clarke M, Davies C, Duane F, Evans V, Gettins L, Godwin J, Hills R, James S, Liu H, MacKinnon E, Mannu G, McHugh T, Morris P, Read S, Wang Y, Wang Z, Fasching P, Harbeck N, Piedbois P, Gnant M, Steger G, Di Leo A, Dolci S, Francis P, Larsimont D, Nogaret JM, Philippson C, Piccart M, Linn S, Peer P, Tjan-Heijnen V, Vliek S, Mackey J, Slamon D, Bartlett J, Bramwell VH, Chen B, Chia S, Gelmon K, Goss P, Levine M, Parulekar W, Pater J, Rakovitch E, Shepherd L, Tu D, Whelan T, Berry D, Broadwater G, Cirrincione C, Muss H, Weiss R, Shan Y, Shao YF, Wang X, Xu B, Zhao DB, Bartelink H, Bijker N, Bogaerts J, Cardoso F, Cufer T, Julien JP, Poortmans P, Rutgers E, van de Velde C, Carrasco E, Segui MA, Blohmer JU, Costa S, Gerber B, Jackisch C, von Minckwitz G, Giuliano M, De Laurentiis M, Bamia C, Koliou GA, Mavroudis D, A'Hern R, Ellis P, Kilburn L, Morden J, Yarnold J, Sadoon M, Tulusan AH, Anderson S, Bass G, Costantino J, Dignam J, Fisher B, Geyer C, Mamounas EP, Paik S, Redmond C, Wickerham DL, Venturini M, Bighin C, Pastorino S, Pronzato P, Sertoli MR, Foukakis T, Albain K, Arriagada R, Bergsten Nordström E, Boccardo F, Brain E, Carey L, Coates A, Coleman R, Correa C, Cuzick J, Davidson N, Dowsett M, Ewertz M, Forbes J, Gelber R, Goldhirsch A, Goodwin P, Hayes D, Hill C, Ingle J, Jagsi R, Janni W, Mukai H, Ohashi Y, Pierce L, Raina V, Ravdin P, Rea D, Regan M, Robertson J, Sparano J, Tutt A, Viale G, Wilcken N, Wolmark N, Wood W, Zambetti M. Increasing the dose intensity of chemotherapy by more frequent administration or sequential scheduling: a patient-level meta-analysis of 37 298 women with early breast cancer in 26 randomised trials. Lancet 2019; 393:1440-1452. [PMID: 30739743 PMCID: PMC6451189 DOI: 10.1016/s0140-6736(18)33137-4] [Citation(s) in RCA: 202] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/11/2018] [Accepted: 11/29/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Increasing the dose intensity of cytotoxic therapy by shortening the intervals between cycles, or by giving individual drugs sequentially at full dose rather than in lower-dose concurrent treatment schedules, might enhance efficacy. METHODS To clarify the relative benefits and risks of dose-intense and standard-schedule chemotherapy in early breast cancer, we did an individual patient-level meta-analysis of trials comparing 2-weekly versus standard 3-weekly schedules, and of trials comparing sequential versus concurrent administration of anthracycline and taxane chemotherapy. The primary outcomes were recurrence and breast cancer mortality. Standard intention-to-treat log-rank analyses, stratified by age, nodal status, and trial, yielded dose-intense versus standard-schedule first-event rate ratios (RRs). FINDINGS Individual patient data were provided for 26 of 33 relevant trials identified, comprising 37 298 (93%) of 40 070 women randomised. Most women were aged younger than 70 years and had node-positive disease. Total cytotoxic drug usage was broadly comparable in the two treatment arms; colony-stimulating factor was generally used in the more dose-intense arm. Combining data from all 26 trials, fewer breast cancer recurrences were seen with dose-intense than with standard-schedule chemotherapy (10-year recurrence risk 28·0% vs 31·4%; RR 0·86, 95% CI 0·82-0·89; p<0·0001). 10-year breast cancer mortality was similarly reduced (18·9% vs 21·3%; RR 0·87, 95% CI 0·83-0·92; p<0·0001), as was all-cause mortality (22·1% vs 24·8%; RR 0·87, 95% CI 0·83-0·91; p<0·0001). Death without recurrence was, if anything, lower with dose-intense than with standard-schedule chemotherapy (10-year risk 4·1% vs 4·6%; RR 0·88, 95% CI 0·78-0·99; p=0·034). Recurrence reductions were similar in the seven trials (n=10 004) that compared 2-weekly chemotherapy with the same chemotherapy given 3-weekly (10-year risk 24·0% vs 28·3%; RR 0·83, 95% CI 0·76-0·91; p<0·0001), in the six trials (n=11 028) of sequential versus concurrent anthracycline plus taxane chemotherapy (28·1% vs 31·3%; RR 0·87, 95% CI 0·80-0·94; p=0·0006), and in the six trials (n=6532) testing both shorter intervals and sequential administration (30·4% vs 35·0%; RR 0·82, 95% CI 0·74-0·90; p<0·0001). The proportional reductions in recurrence with dose-intense chemotherapy were similar and highly significant (p<0·0001) in oestrogen receptor (ER)-positive and ER-negative disease and did not differ significantly by other patient or tumour characteristics. INTERPRETATION Increasing the dose intensity of adjuvant chemotherapy by shortening the interval between treatment cycles, or by giving individual drugs sequentially rather than giving the same drugs concurrently, moderately reduces the 10-year risk of recurrence and death from breast cancer without increasing mortality from other causes. FUNDING Cancer Research UK, Medical Research Council.
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Sarocchi M, Arboscello E, Ghigliotti G, Murialdo R, Bighin C, Gualandi F, Sicbaldi V, Balbi M, Brunelli C, Spallarossa P. Ivabradine in Cancer Treatment-Related Left Ventricular Dysfunction. Chemotherapy 2019; 63:315-320. [PMID: 30840967 DOI: 10.1159/000495576] [Citation(s) in RCA: 4] [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: 08/24/2018] [Accepted: 11/19/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients developing cancer treatment-related left ventricular dysfunction (CTrLVD) require a prompt therapy. Hypotension, dizziness, and fatigue often limit the use of angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), and β-blockers (BB) in cancer patients who may already be afflicted by these symptoms. Ivabradine is a heart rate-lowering drug that does not cause hypotension and may be used in heart failure with reduced left ventricular ejection fraction (LVEF). OBJECTIVE The aim of this paper was to investigate the role of ivabradine to treat CTrLVD. METHODS A retrospective analysis in a cohort of 30 patients with CTrLVD (LVEF < 50%) receiving ivabradine on top of the maximal tolerated dose of ACEi/ARB and BB was performed. We evaluated cardiovascular treatment, oncologic treatment, LVEF, functional class (New York Heart Association [NYHA]), and fatigue during the study period. RESULTS Ivabradine was initially started at the dose of 2.5 mg/b.i.d. in most patients and then carefully titrated. Hypotension (70%) and fatigue (77%) were the main causes limiting the treatment with ACEi/ARB and BB. After a mean follow-up of 6.5 months, LVEF increased from 45.1% (SD = 6.4) to 53.2% (SD = 3.9; p < 0.001). When patients were analyzed according to the type of cancer therapy, no difference in LVEF changes across the groups was found. NYHA class ameliorated in 11 patients, while fatigue improved in 8 patients. No serious cardiovascular side effects were reported. CONCLUSIONS The ability to improve symptoms and LVEF in unfit cancer patients makes ivabradine a reasonable pharmacological tool for treating CTrLVD.
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Affiliation(s)
- Matteo Sarocchi
- Cardiovascular Disease Unit, San Martino Policlinic Hospital, Genoa, Italy.,Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | - Giorgio Ghigliotti
- Cardiovascular Disease Unit, San Martino Policlinic Hospital, Genoa, Italy.,Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Roberto Murialdo
- Internal Medicine Unit, San Martino Policlinic Hospital, Genoa, Italy
| | - Claudia Bighin
- Medical Oncology Unit, San Martino Policlinic Hospital, Genoa, Italy
| | | | - Vera Sicbaldi
- Internal Medicine Unit, San Martino Policlinic Hospital, Genoa, Italy
| | - Manrico Balbi
- Cardiovascular Disease Unit, San Martino Policlinic Hospital, Genoa, Italy.,Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Claudio Brunelli
- Cardiovascular Disease Unit, San Martino Policlinic Hospital, Genoa, Italy.,Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Paolo Spallarossa
- Cardiovascular Disease Unit, San Martino Policlinic Hospital, Genoa, Italy,
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Poggio F, Lambertini M, Bighin C, Conte B, Blondeaux E, D'Alonzo A, Dellepiane C, Boccardo F, Del Mastro L. Management of young women with early breast cancer. ESMO Open 2018; 3:e000458. [PMID: 30559981 PMCID: PMC6267460 DOI: 10.1136/esmoopen-2018-000458] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 10/18/2018] [Indexed: 12/31/2022] Open
Abstract
Breast cancer is still the most frequent cancer diagnosed in women aged ≤40 years and the primary cause of death in this age group. The management of these patients needs a dedicated approach involving a multidisciplinary team that takes into account their treatment and survivorship issues. The present review aims to provide a perspective on the many challenges associated with treatment of young women with early breast cancer. We will focus on the standard (neo)adjuvant treatment, highlighting the paucity of age-specific results about the available genomic signatures, the groundbreaking landscape of adjuvant endocrine therapy and the relevant issue of the fertility preservation.
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Affiliation(s)
- Francesca Poggio
- Department of Medical Oncology, UO Oncologia Medica 2, Policlinico San Martino-IST, Genova, Italy
| | - Matteo Lambertini
- Department of Medical Oncology, Institut Jules Bordet and Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Claudia Bighin
- Department of Medical Oncology, UO Oncologia Medica 2, Policlinico San Martino-IST, Genova, Italy
| | - Benedetta Conte
- Department of Medical Oncology, UO Oncologia Medica 2, Policlinico San Martino-IST, Genova, Italy
| | - Eva Blondeaux
- Department of Medical Oncology, UO Oncologia Medica 2, Policlinico San Martino-IST, Genova, Italy
| | - Alessia D'Alonzo
- Department of Medical Oncology, UO Oncologia Medica 2, Policlinico San Martino-IST, Genova, Italy
| | - Chiara Dellepiane
- Department of Medical Oncology, UO Oncologia Medica 2, Policlinico San Martino-IST, Genova, Italy
| | - Francesco Boccardo
- Department of Medical Oncology, Clinica di Oncologia Medica, Policlinico San Martino-IST, Genova, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
| | - Lucia Del Mastro
- Department of Medical Oncology, UO Oncologia Medica 2, Policlinico San Martino-IST, Genova, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy.
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Conte B, Fabi A, Poggio F, Blondeaux E, Dellepiane C, D'Alonzo A, Staiano A, Buono G, Arpino G, Magri V, Naso G, Presti D, Mura S, Fontana A, Cognetti F, Molinelli C, Pastorino S, Bighin C, Lambertini M, Del Mastro L. Effectiveness of trastuzumab emtansine (TDM1) in patients with HER2-positive advanced breast cancer (ABC) progressing after taxane plus pertuzumab plus trastuzumab. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy272.316] [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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Lambertini M, Fontana V, Massarotti C, Poggio F, Dellepiane C, Iacono G, Abate A, Miglietta L, Ferreccio C, Pescio MC, Conte B, Blondeaux E, Bighin C, D'Alonzo A, Vaglica M, Zanardi E, Boccardo F, Ballestrero A, Anserini P, Del Mastro L. Prospective study to optimize care and improve knowledge on ovarian function and/or fertility preservation in young breast cancer patients: Results of the pilot phase of the PREgnancy and FERtility (PREFER) study. Breast 2018; 41:51-56. [DOI: 10.1016/j.breast.2018.06.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/29/2018] [Accepted: 06/21/2018] [Indexed: 12/22/2022] Open
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D'Alonzo A, Bighin C, Puglisi F, DeLaurentiis M, Fontana A, Pugliese P, Arpino G, Poggio F, Vaglica M, Dellepiane C, Blondeaux E, Conte B, Cognetti F, Garrone O, Pastorino S, Ceppi M, Del Mastro L. Trends in the choice of first line treatment for hormone - responsive (HR+), human epidermal growth factor receptor - 2 negative (HER2-) metastatic breast cancer (MBC) patients (pts): Results of a multicentric Italian observational study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e13053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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)
- Alessia D'Alonzo
- Ospedale Policlinico San Martino- Oncologia medica, Genova, Italy
| | - Claudia Bighin
- Ospedale Policlinico San Martino- Oncologia medica, Genova, Italy
| | - Fabio Puglisi
- SOC Oncologia B - Oncologia Medica e Prevenzione Oncologica, Aviano, Italy
| | | | | | | | | | - Francesca Poggio
- Ospedale Policlinico San Martino- Oncologia medica, Genova, Italy
| | - Marina Vaglica
- Ospedale Policlinico San Martino- Oncologia medica, Genova, Italy
| | | | | | - Benedetta Conte
- Department of Medical Oncology, Oncologia Medica 2, Ospedale Policlinico San Martino, Genova, Italy
| | | | - Ornella Garrone
- Medical Oncology, S. Croce and Carle Teaching Hospital, Cuneo, Italy
| | - Simona Pastorino
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy
| | - Marcello Ceppi
- Unit of Clinical Epidemiology, Ospedale Policlinico San Martino, Genova, Italy
| | - Lucia Del Mastro
- Ospedale Policlinico San Martino- Oncologia medica, Genova, Italy
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34
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De Placido S, Gallo C, De Laurentiis M, Bisagni G, Arpino G, Sarobba MG, Riccardi F, Russo A, Del Mastro L, Cogoni AA, Cognetti F, Gori S, Foglietta J, Frassoldati A, Amoroso D, Laudadio L, Moscetti L, Montemurro F, Verusio C, Bernardo A, Lorusso V, Gravina A, Moretti G, Lauria R, Lai A, Mocerino C, Rizzo S, Nuzzo F, Carlini P, Perrone F, Agostara B, Aieta M, Alabiso O, Alicicco MG, Amadori D, Amaducci L, Amiconi G, Antuzzi G, Ardine M, Ardizzoia A, Aversa C, Badalamenti G, Barni S, Basurto C, Berardi R, Bergamasco C, Bidoli P, Bighin C, Biondi E, Bisagni G, Boni C, Borgonovo K, Botta M, Bravi S, Bruzzi P, Buono G, Butera A, Caldara A, Candeloro G, Cappelletti C, Cardalesi C, Carfora E, Cariello A, Carrozza F, Cartenì G, Caruso M, Casadei V, Casanova C, Castori L, Cavanna L, Cavazzini G, Cazzaniga M, Chilelli M, Chiodini P, Chiorrini S, Ciardiello F, Ciccarese M, Cinieri S, Clerico M, Coccaro M, Comande M, Corbo C, Cortino G, Cusenza S, Daniele G, D'arco AM, D'auria G, Dazzi C, De Angelis C, de Braud F, De Feo G, De Matteis A, De Tursi M, Di Blasio A, di Lucca G, Di Lullo L, Di Rella F, Di Renzo G, Di Stefano P, Di Stefano A, Diana A, Donati S, Fabbri A, Fabi A, Faedi M, Farina G, Farris A, Febbraro A, Fedele P, Federico P, Ferraù F, Ferretti G, Ferro A, Floriani I, Forcignanò R, Forciniti S, Forestieri V, Fornari G, Frisinghelli M, Fusco V, Gallizzi G, Galvano A, Gambardella A, Gambi A, Gebbia V, Gervasi E, Ghilardi M, Giacobino A, Giardina G, Giotta F, Giraudi S, Giuliano M, Grassadonia A, Grasso D, Grosso F, Guizzaro L, Incoronato P, Incorvaia L, Iodice G, La Verde N, Labonia V, Landi G, Latorre A, Leonardi V, Levaggi A, Limite G, Lina Bascialla L, Livi L, Maiello E, Mandelli D, Marcon I, Menon D, Montedoro M, Moraca L, Moretti A, Morritti MG, Morselli P, Mura A, Mura S, Musacchio M, Muzio A, Natale D, Natoli C, Nigro C, Nisticò C, Nuzzo A, Orditura M, Orlando L, Pacilio C, Palumbo G, Palumbo R, Pasini F, Paterno E, Pazzola A, Pelliccioni S, Pensabene M, Perroni D, Pesenti Gritti A, Petrelli F, Piccirillo MC, Pinotti G, Pogliani C, Poli D, Prader S, Recchia F, Rizzi D, Romano C, Rossello R, Rossini C, Salvucci G, Sanna V, Santini A, Saracchini S, Savastano C, Scambia G, Schettini F, Schiavone P, Schirone A, Seles E, Signoriello S, Signoriello G, Silva RR, Silvestri A, Simeon V, Spagnoletti I, Tamberi S, Teragni C, Thalmann V, Thomas R, Thomas G, Tienghi A, Tinari N, Tinessa V, Tomei F, Tonini G, Torri V, Traficante D, Tudini M, Turazza M, Vignoli R, Vitale MG, Zacchia A, Zagarese P, Zanni A, Zavallone L, Zavettieri M, Zoboli A. Adjuvant anastrozole versus exemestane versus letrozole, upfront or after 2 years of tamoxifen, in endocrine-sensitive breast cancer (FATA-GIM3): a randomised, phase 3 trial. Lancet Oncol 2018; 19:474-485. [PMID: 29482983 DOI: 10.1016/s1470-2045(18)30116-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Uncertainty exists about the optimal schedule of adjuvant treatment of breast cancer with aromatase inhibitors and, to our knowledge, no trial has directly compared the three aromatase inhibitors anastrozole, exemestane, and letrozole. We investigated the schedule and type of aromatase inhibitors to be used as adjuvant treatment for hormone receptor-positive early breast cancer. METHODS FATA-GIM3 is a multicentre, open-label, randomised, phase 3 trial of six different treatments in postmenopausal women with hormone receptor-positive early breast cancer. Eligible patients had histologically confirmed invasive hormone receptor-positive breast cancer that had been completely removed by surgery, any pathological tumour size, and axillary nodal status. Key exclusion criteria were hormone replacement therapy, recurrent or metastatic disease, previous treatment with tamoxifen, and another malignancy in the previous 10 years. Patients were randomly assigned in an equal ratio to one of six treatment groups: oral anastrozole (1 mg per day), exemestane (25 mg per day), or letrozole (2·5 mg per day) tablets upfront for 5 years (upfront strategy) or oral tamoxifen (20 mg per day) for 2 years followed by oral administration of one of the three aromatase inhibitors for 3 years (switch strategy). Randomisation was done by a computerised minimisation procedure stratified for oestrogen receptor, progesterone receptor, and HER2 status; previous chemotherapy; and pathological nodal status. Neither the patients nor the physicians were masked to treatment allocation. The primary endpoint was disease-free survival. The minimum cutoff to declare superiority of the upfront strategy over the switch strategy was assumed to be a 2% difference in disease-free survival at 5 years. Primary efficacy analyses were done by intention to treat; safety analyses included all patients for whom at least one safety case report form had been completed. Follow-up is ongoing. This trial is registered with the European Clinical Trials Database, number 2006-004018-42, and ClinicalTrials.gov, number NCT00541086. FINDINGS Between March 9, 2007, and July 31, 2012, 3697 patients were enrolled into the study. After a median follow-up of 60 months (IQR 46-72), 401 disease-free survival events were reported, including 211 (11%) of 1850 patients allocated to the switch strategy and 190 (10%) of 1847 patients allocated to upfront treatment. 5-year disease-free survival was 88·5% (95% CI 86·7-90·0) with the switch strategy and 89·8% (88·2-91·2) with upfront treatment (hazard ratio 0·89, 95% CI 0·73-1·08; p=0·23). 5-year disease-free survival was 90·0% (95% CI 87·9-91·7) with anastrozole (124 events), 88·0% (85·8-89·9) with exemestane (148 events), and 89·4% (87·3 to 91·1) with letrozole (129 events; p=0·24). No unexpected serious adverse reactions or treatment-related deaths occurred. Musculoskeletal side-effects were the most frequent grade 3-4 events, reported in 130 (7%) of 1761 patients who received the switch strategy and 128 (7%) of 1766 patients who received upfront treatment. Grade 1 musculoskeletal events were more frequent with the upfront schedule than with the switch schedule (924 [52%] of 1766 patients vs 745 [42%] of 1761 patients). All other grade 3-4 adverse events occurred in less than 2% of patients in either group. INTERPRETATION 5 years of treatment with aromatase inhibitors was not superior to 2 years of tamoxifen followed by 3 years of aromatase inhibitors. None of the three aromatase inhibitors was superior to the others in terms of efficacy. Therefore, patient preference, tolerability, and financial constraints should be considered when deciding the optimal treatment approach in this setting. FUNDING Italian Drug Agency.
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Affiliation(s)
- Sabino De Placido
- Dipartimento di Clinica Medica e Chirurgia, Università Federico II, Naples, Italy
| | - Ciro Gallo
- Statistica Medica, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Michelino De Laurentiis
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Pascale, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy
| | - Giancarlo Bisagni
- Dipartimento di Oncologia, Arcispedale S Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Grazia Arpino
- Dipartimento di Clinica Medica e Chirurgia, Università Federico II, Naples, Italy
| | | | | | - Antonio Russo
- Dipartimento di Scienze Chirurgiche, Oncologiche e Stomatologiche, Sezione di Oncologia Medica, Università di Palermo, Palermo, Italy
| | - Lucia Del Mastro
- Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova-Oncologia Medica, Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Francesco Cognetti
- Divisione Oncologia Medica 1, Istituto Nazionale Tumori Regina Elena, Rome, Italy
| | - Stefania Gori
- Oncologia Medica, Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | | | | | - Domenico Amoroso
- Oncologia Medica, Ospedale della Versilia, Lido di Camaiore (LU), Istituto Toscano Tumori, Florence, Italy
| | | | - Luca Moscetti
- Dipartimento di Oncologia Medica, Ospedale Belcolle, Viterbo, Italy
| | - Filippo Montemurro
- Divisione di Oncologia Clinica Investigativa dell'Istituto di Candiolo-IRCCS, Candiolo, Italy
| | | | | | - Vito Lorusso
- Polo Oncologico, Ospedale Vito Fazzi, Lecce, Italy
| | - Adriano Gravina
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Pascale, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy
| | - Gabriella Moretti
- Dipartimento di Oncologia, Arcispedale S Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Rossella Lauria
- Dipartimento di Clinica Medica e Chirurgia, Università Federico II, Naples, Italy
| | - Antonella Lai
- Oncologia Medica, Azienda Ospedaliera Universitaria, Sassari, Italy
| | | | - Sergio Rizzo
- Dipartimento di Scienze Chirurgiche, Oncologiche e Stomatologiche, Sezione di Oncologia Medica, Università di Palermo, Palermo, Italy
| | - Francesco Nuzzo
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Pascale, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy
| | - Paolo Carlini
- Divisione Oncologia Medica 1, Istituto Nazionale Tumori Regina Elena, Rome, Italy
| | - Francesco Perrone
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Pascale, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy.
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D' Alonzo A, Bighin C, Puglisi F, Gerratana L, De Laurentis M, Fontana A, Pugliese P, Ferzi A, Montemurro F, Arpino G, Poggio F, Vaglica M, Dellepiane C, Blondeaux E, Benedetta C, Cognetti F, Garrone O, Turletti A, Pastorino S, Del Mastro L. Trends in the choice of first line treatment for hormone - responsive (HR+), human epidermal growth factor receptor - 2 negative (HER2-) metastatic breast cancer (MBC) patients (pts): results of a multicentric Italian observational study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424] [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: 11/12/2022] Open
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Dellepiane C, Lambertini M, Fontana V, Poggio F, Blondeaux E, Conte B, D'Alonzo A, Vaglica M, Bighin C, Iacono G, Abate A, Pastorino S, Pescio M, Anserini P, Del Mastro L. The Pregnancy and Fertility (PREFER) study: a prospective cohort study on fertility-preserving (FP) strategies in young early breast cancer (EBC) patients (pts). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.005] [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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Dellepiane C, Lambertini M, Fontana V, Poggio F, Blondeaux E, Conte B, D'Alonzo A, Vaglica M, Bighin C, Iacono G, Abate A, Pastorino S, Pescio M, Anserini P, Del Mastro L. The pregnancy and fertility (PREFER) study: A prospective cohort study on fertility-preserving (FP) strategies in young early breast cancer (EBC) patients (pts). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.055] [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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Lambertini M, Anserini P, Fontana V, Poggio F, Iacono G, Abate A, Levaggi A, Miglietta L, Bighin C, Giraudi S, D'Alonzo A, Blondeaux E, Buffi D, Campone F, Merlo DF, Del Mastro L. The PREgnancy and FERtility (PREFER) study: an Italian multicenter prospective cohort study on fertility preservation and pregnancy issues in young breast cancer patients. BMC Cancer 2017; 17:346. [PMID: 28526012 PMCID: PMC5437418 DOI: 10.1186/s12885-017-3348-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 05/12/2017] [Indexed: 12/30/2022] Open
Abstract
Background Fertility and pregnancy issues are of key importance for young breast cancer patients. Despite several advances in the field, there are still multiple unmet needs and barriers in discussing and dealing with these concerns. To address the significant challenges related to fertility and pregnancy issues, the PREgnancy and FERtility (PREFER) study was developed as a national comprehensive program aiming to optimize care and improve knowledge around these topics. Methods The PREFER study is a prospective cohort study conducted across several Italian institution affiliated with the Gruppo Italiano Mammella (GIM) group evaluating patterns of care and clinical outcomes of young breast cancer patients dealing with fertility and pregnancy issues. It is composed of two distinctive studies: PREFER-FERTILITY and PREFER-PREGNANCY. The PREFER-FERTILITY study is enrolling premenopausal patients aged 18–45 years, diagnosed with non-metastatic breast cancer, who are candidates to (neo)adjuvant chemotherapy and not previously exposed to anticancer therapies. The primary objective is to obtain and centralize data about patients’ preferences and choices towards the available fertility preserving procedures. The success and safety of these strategies and the hormonal changes during chemotherapy and study follow-up are secondary objectives. The PREFER-PREGNANCY study is enrolling survivors achieving a pregnancy after prior history of breast cancer and patients diagnosed with pregnancy-associated breast cancer (PABC). The primary objectives are to obtain and centralize data about the management and clinical outcomes of these women. Patients’ survival outcomes, and the fetal, obstetrical and paediatric care of their children are secondary objectives. For both studies, the initial planned recruitment period is 5 years and patients will remain in active follow-up for up to 15 years. The PREFER-FERTILITY study was first activated in November 2012, and the PREFER-PREGNANCY study in May 2013. Discussion The PREFER study is expected to support and improve oncofertility counseling in Italy, to explore the real need of fertility preserving procedures, and to acquire prospectively more robust data on the efficacy and safety of the available strategies for fertility preservation, on the management of breast cancer survivors achieving a pregnancy and of women with PABC (including the possible short- and long-term complications in their children). Trial registration number ClinicalTrials.gov identifier: NCT02895165 (Retrospectively registered in August 2016).
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Affiliation(s)
- Matteo Lambertini
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Largo Rosanna Benzi, 10, 16132, Genova, Italy.,Breast Cancer Translational Research Laboratory, Department of Medicine, Institut Jules Bordet, and l'Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Paola Anserini
- Physiopathology of Human Reproduction Unit, IRCCS AOU San Martino-IST, Genova, Italy
| | - Valeria Fontana
- Department of Epidemiology, Biostatistics and Clinical Trials - IRCCS AOU San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Francesca Poggio
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy
| | - Giuseppina Iacono
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Largo Rosanna Benzi, 10, 16132, Genova, Italy
| | - Annalisa Abate
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Largo Rosanna Benzi, 10, 16132, Genova, Italy
| | - Alessia Levaggi
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Largo Rosanna Benzi, 10, 16132, Genova, Italy
| | - Loredana Miglietta
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy
| | - Claudia Bighin
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy
| | - Sara Giraudi
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Largo Rosanna Benzi, 10, 16132, Genova, Italy
| | - Alessia D'Alonzo
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Largo Rosanna Benzi, 10, 16132, Genova, Italy
| | - Eva Blondeaux
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy
| | - Davide Buffi
- Department of "Alta intensità di Cura e Percorso Nascita", U.O.C. Ostetricia e Ginecologia, UOSD Centro di Medicina Fetale e Perinatale, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Francesco Campone
- Department of "Alta intensità di Cura e Percorso Nascita", U.O.C. Patologia e Terapia Intensiva Neonatale-Assistenza Neonatale, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Domenico F Merlo
- Department of Epidemiology, Biostatistics and Clinical Trials - IRCCS AOU San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Lucia Del Mastro
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Largo Rosanna Benzi, 10, 16132, Genova, Italy.
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Generali D, Montemurro F, Bordonaro R, Mafodda A, Romito S, Michelotti A, Piovano P, Ionta MT, Bighin C, Sartori D, Frassoldati A, Cazzaniga ME, Riccardi F, Testore F, Vici P, Barone CA, Schirone A, Piacentini F, Nolè F, Molino A, Latini L, Simoncini EL, Roila F, Cognetti F, Nuzzo F, Foglietta J, Minisini AM, Goffredo F, Portera G, Ascione G, Mariani G. Everolimus Plus Exemestane in Advanced Breast Cancer: Safety Results of the BALLET Study on Patients Previously Treated Without and with Chemotherapy in the Metastatic Setting. Oncologist 2017; 22:648-654. [PMID: 28432226 DOI: 10.1634/theoncologist.2016-0461] [Citation(s) in RCA: 9] [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] [Received: 11/23/2016] [Accepted: 01/10/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The BALLET study was an open-label, multicenter, expanded access study designed to allow treatment with everolimus plus exemestane in postmenopausal women with hormone receptor-positive metastatic breast cancer progressed following prior endocrine therapy. A post hoc analysis to evaluate if previous chemotherapy in the metastatic setting affects the safety profile of the combination regimen of everolimus and exemestane was conducted on the Italian subset, as it represented the major part of the patients enrolled (54%). PATIENTS AND METHODS One thousand one hundred and fifty-one Italian patients were included in the present post hoc analysis, which focused on two sets of patients: patients who never received chemotherapy in the metastatic setting (36.1%) and patients who received at least one chemotherapy treatment in the metastatic setting (63.9%). RESULTS One thousand one hundred and sixteen patients (97.0%) prematurely discontinued the study drug, and the main reasons reported were disease progression (39.1%), local reimbursement of everolimus (31.1%), and adverse events (AEs) (16.1%). The median duration of study treatment exposure was 139.5 days for exemestane and 135.0 days for everolimus. At least one AE was experienced by 92.5% of patients. The incidence of everolimus-related AEs was higher (83.9%) when compared with those that occurred with exemestane (29.1%), and the most commonly reported everolimus-related AE was stomatitis (51.3%). However, no significant difference in terms of safety related to the combination occurred between patients without and with chemotherapy in the metastatic setting. CONCLUSION Real-life data of the Italian patients BALLET-related cohort were an adequate setting to state that previous chemotherapy did not affect the safety profile of the combination regimen of everolimus and exemestane. IMPLICATIONS FOR PRACTICE With the advent of new targeted agents for advanced or metastatic breast cancer, multiple lines of therapy may be possible, and components of the combined regimens can overlap from one line to another. Thus, it is important to assess even the potential of cumulative and additive toxic effects among the drugs. Previous chemotherapy did not affect the safety profile of the combination regimen of everolimus and exemestane. The continuous monitoring of the safety signals of this drug combination from general clinical practice is important, in particular for stomatitis.
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Affiliation(s)
- Daniele Generali
- Breast Cancer Unit and Molecular Therapy Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Filippo Montemurro
- Divisione di Oncologia Clinica Investigativa dell'Istituto di Candiolo-IRCCS, Candiolo, Italy
| | | | - Antonino Mafodda
- Divisione Oncologia Medica, A.O. Bianchi Melarino Morelli, Reggio Calabria, Italy
| | - Sante Romito
- Reparto di Oncologia Medica, Ospedali Riuniti di Foggia, Foggia, Italy
| | | | - Pierluigi Piovano
- Divisione Oncologia Medica, Presidio Santi Antonio e Biagio, Alessandria, Italy
| | | | - Claudia Bighin
- Reparto Oncologia Medica A, Istituto Nazionale Ricerca sul Cancro, Genova, Italy
| | - Donata Sartori
- Divisione Oncologia Ematologia, Presidio Ospedaliero di Mirano, Venezia, Italy
| | | | | | | | - Franco Testore
- Day Hospital Oncologia, Ospedale Cardinale Guglielmo Massaia, Asti, Italy
| | - Patrizia Vici
- Divisione Oncologia Medica B, IRE IRCCS Regina Elena, Roma, Italy
| | | | - Alessio Schirone
- Day Hospital Oncoematologia, IRST Istituto Scientifico Romagnolo, Meldola, Italy
| | - Federico Piacentini
- Division of Medical Oncology Department of Medical and Surgical Sciences for Children & Adults University Hospital of Modena, Modena, Italy
| | - Franco Nolè
- Divisione Oncologia Medica Urogenitale, Istituto Europeo di Oncologia, Milano, Italy
| | | | - Luciano Latini
- Day Hospital Oncologia, Ospedale di Macerata, Macerata, Italy
| | | | - Fausto Roila
- Divisione Oncologia Medica, Ospedale Civile Santa Maria, Terni
| | | | - Francesco Nuzzo
- U.O.C. Oncologia Medica Senologica, Istituto Nazionale Tumori Fondazione Pascale, Napoli, Italy
| | - Jennifer Foglietta
- U.O. Oncologia Medica, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | | | | | | | | | - Gabriella Mariani
- Divisione Oncologia Medica 1, IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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Poggio F, Ceppi M, Lambertini M, Bruzzi P, Ugolini D, Bighin C, Levaggi A, Giraudi S, D'Alonzo A, Vaglica M, Blondeaux E, Sertoli MR, Pronzato P, Del Mastro L. Concurrent versus sequential adjuvant chemo-endocrine therapy in hormone-receptor positive early stage breast cancer patients: a systematic review and meta-analysis. Breast 2017; 33:104-108. [PMID: 28360014 DOI: 10.1016/j.breast.2017.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 03/22/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although in clinical practice adjuvant chemotherapy (CT) and endocrine therapy (ET) are administered sequentially in patients with hormone-receptor positive breast cancer, the optimal timing, i.e. concurrent or sequential administration, of these treatments has been scarcely investigated. To better clarify this issue we conducted a systematic review and meta-analysis of randomized studies comparing these two modalities of administrations in terms of disease-free survival (DFS) and overall survival (OS). METHODS Relevant studies were identified by searching PubMed, Web of Knowledge and the proceedings of the major conferences with no date restriction up to March 2016. The summary risk estimates (pooled hazard ratio [HR] and 95% confidence intervals [CI]) for DFS and OS were calculated using random effect models (DerSimonian and Laird method). RESULTS A total of three randomized studies were eligible including 2021 breast cancer patients. Overall, 755 DFS events were observed, 365 in the sequential arm and 390 in the concomitant arm, with a pooled HR of 0.95 (95% CI = 0.76 to 1.18, P = 0.643). No association between timing of treatment and OS was observed (HR = 0.95; 95% CI = 0.80 to 1.12, P = 0.529). CONCLUSION Our pooled analysis showed no association between the timing of administration of adjuvant CT and ET and DFS and OS in breast cancer patients candidates for both adjuvant treatments. Because of the small number of published trials, the lack of data on the timing with modern adjuvant treatments, i.e. taxane-containing CT and aromatase inhibitors, this topic remain still controversial and requires further studies to be clarified.
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Affiliation(s)
- F Poggio
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino - IST, Genova, Italy
| | - M Ceppi
- Unit of Clinical Epidemiology, IRCCS AOU San Martino-IST, Genova, Italy
| | - M Lambertini
- BrEAST Data Centre, Department of Medicine, Institut Jules Bordet, and l'Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - P Bruzzi
- Unit of Clinical Epidemiology, IRCCS AOU San Martino-IST, Genova, Italy
| | - D Ugolini
- Department of Internal Medicine, University of Genoa, Unit of Clinical Epidemiology, IRCCS AOU San Martino-IST, Genova, Italy
| | - C Bighin
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino - IST, Genova, Italy
| | - A Levaggi
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino - IST, Genova, Italy
| | - S Giraudi
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino - IST, Genova, Italy
| | - A D'Alonzo
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino - IST, Genova, Italy
| | - M Vaglica
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino - IST, Genova, Italy
| | - E Blondeaux
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino - IST, Genova, Italy
| | - M R Sertoli
- Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS AOU San Martino - IST, Genova, Italy
| | - P Pronzato
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino - IST, Genova, Italy
| | - L Del Mastro
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino - IST, Genova, Italy.
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Generali D, Bordonaro R, Febbraro A, Madoffa A, Romito S, Michelotti A, Savastano C, Mariani G, Tondini C, Piovano P, Iona MT, Bighin C, Roviello G, Ascione G, Goffredo F, Sartori D, Frassoldati A, Simoncini E. Abstract P4-22-17: Safety of the combination of everolimus plus exemestane in the Italian cohort of patients enrolled in the expanded access “BALLET” study. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-22-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:The expanded access “BALLET” study has been designed toevaluate the safety of EVE plus EXE combination in hormone receptor-positive (HR+), human epidermal growth factor-receptor-2-negative (HER2-) metastatic Breast Cancer (mBC). The Italian population was predominantly enrolled in trial.
Patients and methods: Patients has been included according to the inclusion and exclusion criteria provided previously in the BALLET study. The aim of our analysis was the safety everolimus and exemestane analysed in two sets of population: a subpopulation including only patients who never received chemotherapy in metastatic setting (416 patients – 36.1% of the safety population) and a subpopulation including only patients who received at least one chemotherapy in metastatic setting, whatever the line of treatment (735 patients – 63.9%).
Results:One thousand two hundred seventy nine (1279) Italian female patients were screened, 1153 (90.1% of the screened set) out of these were included in the analysis and 1151 (90.0% of the screened set) were included in the safety population. 1116 (97.0% of the safety population) prematurely discontinued the study drug and the main reasons reported were disease progression (39.1%), local reimbursement of everolimus (31.1%) and adverse event(s) (16.1%). The mean duration of study treatment exposure was 158.3±106.79 days (median 139.5) for exemestane and 153.9±108.48 days (median 135.0) for everolimus with a treatment compliance (higher than 90%) of 94.4% and 58.6% and (lower than 60%) of 0.1% and 15.1% for exemestane and everolimus, respectively. 92.5% of patients of the safety population (91.1% and . 93.3% patients without and with chemotherapy respectively) experienced at least one adverse event: gastrointestinal disorders” (67.3% vs. 64.6% in without and with chemo group); general disorders (48.6% vs. 48.3%); metabolism and nutrition disorders (35.6% vs. 37.4%) and skin and subcutaneous tissue disorders (32.2% vs. 27.5%). The incidence of everolimus related adverse events was higher (83.9%) when compared to those which occurred with exemestane. The most commonly reported adverse event was stomatitis (51.3% of patients) with 22.5% Grade 1; 18.2% Grade 2; 10.5% Grade 3; 0.2% Grade 4. The 49.7% of the patients experienced at least one stomatitis related to everolimus. No relevant difference was observed between the two groups of patients without and with chemo in metastatic setting.
Conclusions: The administration of chemotherapy before starting EVE plus EXE combination did not affect the safety profile of EXE/EVE in the treatment of mBC. The stomatitis is the most frequent and relevant adverse event to be clinically focused on.
Citation Format: Generali D, Bordonaro R, Febbraro A, Madoffa A, Romito S, Michelotti A, Savastano C, Mariani G, Tondini C, Piovano P, Iona MT, Bighin C, Roviello G, Ascione G, Goffredo F, Sartori D, Frassoldati A, Simoncini E. Safety of the combination of everolimus plus exemestane in the Italian cohort of patients enrolled in the expanded access “BALLET” study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-22-17.
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Lambertini M, Ceppi M, Cognetti F, Cavazzini G, De Laurentiis M, De Placido S, Michelotti A, Bisagni G, Durando A, Valle E, Scotto T, De Censi A, Turletti A, Benasso M, Barni S, Montemurro F, Puglisi F, Levaggi A, Giraudi S, Bighin C, Bruzzi P, Del Mastro L. Dose-dense adjuvant chemotherapy in premenopausal breast cancer patients: A pooled analysis of the MIG1 and GIM2 phase III studies. Eur J Cancer 2016; 71:34-42. [PMID: 27951450 DOI: 10.1016/j.ejca.2016.10.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 08/29/2016] [Revised: 10/11/2016] [Accepted: 10/29/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND No evidence exists to recommend a specific chemotherapy regimen in young breast cancer patients. We performed a pooled analysis of two randomised clinical trials to evaluate the efficacy of adjuvant dose-dense chemotherapy in premenopausal breast cancer patients and its impact on the risk of treatment-induced amenorrhoea. PATIENTS AND METHODS In the MIG1 study, node-positive or high-risk node-negative patients were randomised to 6 cycles of fluorouracil/epirubicin/cyclophosphamide every 2 (dose-dense) or 3 (standard-interval) weeks. In the GIM2 study, node-positive patients were randomised to 4 cycles of dose-dense or standard-interval EC or FEC followed by 4 cycles of dose-dense or standard-interval paclitaxel. Using individual patient data, the hazard ratio (HR) for overall survival by means of a Cox proportional hazards model and the odds ratio for treatment-induced amenorrhoea through a logistic regression model were calculated for each study. A meta-analysis of the two studies was performed using the random effect model to compute the parameter estimates. RESULTS A total of 1,549 patients were included. Dose-dense chemotherapy was associated with a significant improved overall survival as compared to standard-interval chemotherapy (HR, 0.71; 95% confidence intervals [CI], 0.54-0.95; p = 0.021). The pooled HRs were 0.78 (95% CI, 0.54-1.12) and 0.65 (95% CI, 0.40-1.06) for patients with hormone receptor-positive and -negative tumours, respectively (interaction p = 0.330). No increased risk of treatment-induced amenorrhoea was observed with dose-dense chemotherapy (odds ratio, 1.00; 95% CI, 0.80-1.25; p = 0.989). CONCLUSION Dose-dense adjuvant chemotherapy may be considered the preferred treatment option in high-risk premenopausal breast cancer patients.
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Affiliation(s)
- Matteo Lambertini
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy; Department of Medicine, BrEAST Data Centre, Institut Jules Bordet and l'Université Libre de Bruxelles (U.L.B.), Brussels, Belgium.
| | - Marcello Ceppi
- Epidemiology Unit, IRCCS AOU San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
| | - Francesco Cognetti
- Department of Medical Oncology, Istituto Regina Elena per lo Studio e la Cura dei Tumori, Roma, Italy.
| | | | - Michele De Laurentiis
- Medical Oncology, Istituto Nazionale Tumori-IRCCS Fondazione Pascale, Napoli, Italy.
| | - Sabino De Placido
- Medical Oncology, Azienda Ospedaliera Universitaria Federico II, Napoli, Italy.
| | - Andrea Michelotti
- UO Oncologia Medica I, Ospedale S. Chiara, Dipartimento di oncologia, dei trapianti e delle nuove tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
| | - Giancarlo Bisagni
- Medical Oncology, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
| | - Antonio Durando
- Breast Unit, Azienda Ospedaliera Universitaria Città della Salute e delle Scienze, Torino, Italy.
| | - Enrichetta Valle
- Medical Oncology, ASL8-Ospedale Oncologico A. Businco, Cagliari, Italy.
| | | | - Andrea De Censi
- S.C. Oncologia Medica, Medical Oncology Unit, E.O. Ospedali Galliera, Genova, Italy.
| | | | - Marco Benasso
- Medical Oncology, Ospedale San Paolo, Savona, Italy.
| | - Sandro Barni
- Medical Oncology, Azienda Ospedaliera, Caravaggio, Treviglio, Bergamo, Italy.
| | - Filippo Montemurro
- Investigative Clinical Oncology, Fondazione del Piemonte per l'Oncologia/Candiolo Cancer Center (IRCCS), Candiolo, Torino, Italy.
| | - Fabio Puglisi
- Department of Oncology, Azienda Ospedaliera di Udine, Udine, Italy.
| | - Alessia Levaggi
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
| | - Sara Giraudi
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
| | - Claudia Bighin
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
| | - Paolo Bruzzi
- Epidemiology Unit, IRCCS AOU San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
| | - Lucia Del Mastro
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
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Poggio F, Ceppi M, Lambertini M, Bruzzi P, Ugolini D, Bighin C, Levaggi A, Giraudi S, D'alonzo A, Vaglica M, Blondeaux E, Conte B, Sertoli M, Pronzato P. Concurrent versus sequential adjuvant chemo-endocrine therapy in early stage hormone receptor-positive breast cancer patients: a systematic review and meta-analysis. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.12] [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: 11/15/2022] Open
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Giraudi S, Cavazzini M, Michelotti A, De Censi A, Testore F, Benasso M, Sertoli M, Bighin C, Pastorino S, Levaggi A, D'Alonzo A, Lambertini M, Poggio F, Blondeaux E, Conte B, Pronzato P, Del Mastro L. Dose-dence adjuvant chemotherapy in early breast cancer: the results of 15 years of follow-up. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.08] [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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Blondeaux E, Lambertini M, Ceppi M, Cognetti F, Cavazzini G, De Laurentiis M, De Placido S, Michelotti A, Bisagni G, Durando A, Valle E, Scotto T, De Censi A, Turletti A, Benasso M, Barni S, Montemurro F, Puglisi F, Bighin C, Bruzzi P, Del Mastro L. Dose-dense adjuvant chemotherapy, treatment-induced amenorrhea and overall survival in premenopausal breast cancer patients: a pooled analysis of the MIG1 and GIM2 phase 3 studies. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.01] [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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Conte B, Varesco L, Iacono G, Poggio F, Blondeaux E, Levaggi A, D'Alonzo A, Bighin C, Giraudi S, Vaglica M, Pronzato P, Del Mastro L. TP53 germline mutation testing in early onset breast cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.40] [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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Levaggi A, Poggio F, Lambertini M, D'Alonzo A, Giraudi S, Bighin C, Blondeaux E, Pastorino S, Abate A, Iacono G, Vaglica M, Conte B, Pronzato P, Del Mastro L. Neoadjuvant therapy with FEC followed by weekly paclitaxel and concurrent trastuzumab in Her2 positive non operable breast cancer: a phase II study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.37] [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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Fontanella C, Del Mastro L, De Placido S, De Laurentiis M, Boni C, Giovanna C, Durando A, Turletti A, Turletti A, Nisticò C, Valle E, Garrone O, Montemurro F, Barni S, Ardizzoni A, Gamucci T, Colantuoni G, Bighin C, Cognetti F, Puglisi F. The STAR score predicts prognosis in Luminal-like breast cancer patients independently from dose-dense adjuvant chemotherapy. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.17] [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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Fontanella C, Lederer B, Del Mastro L, Denkert C, De Placido S, Hanusch C, Cognetti F, Huober JB, De Laurentiis M, Jackisch C, Bisagni G, Kummel S, Garrone O, Schneeweiss A, Montemurro F, Untch M, Bighin C, Von Minckwitz G, Loibl S, Puglisi F. Development and validation of a new prognostic score on 4,646 patients with luminal-like breast cancer (BC) enrolled in 7 randomized prospective trials. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.529] [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)
| | | | - Lucia Del Mastro
- Department of Medical Oncology, U.O Sviluppo Terapie Innovative, IRCCS AOU IST-S.Martino, Genova, Italy
| | - Carsten Denkert
- Charité Berlin, Institute of Pathology and German Cancer Consortium (DKTK), Berlin, Germany
| | | | | | | | | | | | | | - Giancarlo Bisagni
- Medical Oncology Unit, IRCCS-Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | | | - Ornella Garrone
- Medical Oncology, S. Croce & Carle Teaching Hospital, Cuneo, Italy
| | | | - Filippo Montemurro
- Istituto di Candiolo, Fondazione del Piemonte per l'Oncologia, IRCCS, Candiolo, Italy
| | | | - Claudia Bighin
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy
| | | | | | - Fabio Puglisi
- Department of Oncology, University Hospital of Udine, Udine, Italy
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Lambertini M, Boni L, Michelotti A, Gamucci T, Scotto T, Gori S, Giordano M, Garrone O, Levaggi A, Poggio F, Giraudi S, Bighin C, Vecchio C, Sertoli MR, Pronzato P, Del Mastro L. Ovarian Suppression With Triptorelin During Adjuvant Breast Cancer Chemotherapy and Long-term Ovarian Function, Pregnancies, and Disease-Free Survival: A Randomized Clinical Trial. JAMA 2015; 314:2632-40. [PMID: 26720025 DOI: 10.1001/jama.2015.17291] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [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: 12/30/2022]
Abstract
IMPORTANCE Whether the administration of luteinizing hormone-releasing hormone analogues (LHRHa) during chemotherapy is a reliable strategy to preserve ovarian function is controversial owing to both the lack of data on long-term ovarian function and pregnancies and the safety concerns about the potential negative interactions between endocrine therapy and chemotherapy. OBJECTIVE To evaluate long-term results of LHRHa-induced ovarian suppression during breast cancer chemotherapy. DESIGN, SETTING, AND PARTICIPANTS Parallel, randomized, open-label, phase 3 superiority trial conducted at 16 Italian sites. Between October 2003 and January 2008, 281 premenopausal women with stage I to III hormone receptor-positive or hormone receptor-negative breast cancer were enrolled. Last annual follow-up was June 3, 2014. INTERVENTIONS Patients were randomized to receive adjuvant or neoadjuvant chemotherapy alone (control group) or chemotherapy plus triptorelin (LHRHa group). MAIN OUTCOMES AND MEASURES The primary planned end point was incidence of chemotherapy-induced early menopause. Post hoc end points were long-term ovarian function (evaluated by yearly assessment of menstrual activity and defined as resumed by the occurrence of at least 1 menstrual cycle), pregnancies, and disease-free survival (DFS). RESULTS A total of 281 women (median age, 39 [range, 24-45] years) were randomized. Median follow-up was 7.3 years (interquartile range, 6.3-8.2 years). The 5-year cumulative incidence estimate of menstrual resumption was 72.6% (95% CI, 65.7%-80.3%) among the 148 patients in the LHRHa group and 64.0% (95% CI, 56.2%-72.8%) among the 133 patients in the control group (hazard ratio [HR], 1.28 [95% CI, 0.98-1.68]; P = .07; age-adjusted HR, 1.48 [95% CI, 1.12-1.95]; P = .006). Eight pregnancies (5-year cumulative incidence estimate of pregnancy, 2.1% [95% CI, 0.7%-6.3%]) occurred in the LHRHa group and 3 (5-year cumulative incidence estimate of pregnancy, 1.6% [95% CI, 0.4%-6.2%]) in the control group (HR, 2.56 [95% CI, 0.68-9.60]; P = .14; age-adjusted HR, 2.40 [95% CI, 0.62-9.22]; P = .20). Five-year DFS was 80.5% (95% CI, 73.1%-86.1%) in the LHRHa group and 83.7% (95% CI, 76.1%-89.1%) in the control group (LHRHa vs control: HR, 1.17 [95% CI, 0.72-1.92]; P = .52). CONCLUSIONS AND RELEVANCE Among premenopausal women with either hormone receptor-positive or hormone receptor-negative breast cancer, concurrent administration of triptorelin and chemotherapy, compared with chemotherapy alone, was associated with higher long-term probability of ovarian function recovery, without a statistically significant difference in pregnancy rate. There was no statistically significant difference in DFS for women assigned to triptorelin and those assigned to chemotherapy alone, although study power was limited. TRIAL REGISTRATION clinicaltrials.gov Identifier:NCT00311636.
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Affiliation(s)
- Matteo Lambertini
- Department of Medical Oncology, U.O. Oncologia Medica A, IRCCS AOU San Martino-IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Luca Boni
- Centro Coordinamento Sperimentazioni Cliniche, AOU Careggi and Istituto Toscano Tumori, Firenze, Italy
| | - Andrea Michelotti
- U. O. Oncologia Medica I, Ospedale S. Chiara, Dipartimento di oncologia, dei trapianti e delle nuove tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | | | - Stefania Gori
- S. C. Oncologia Medica, Ospedale Santa Maria della Misericordia, Perugia, Italy7U. O. C. Oncologia Medica, Ospedale Sacro Cuore-Don Calabria, Negrar-Verona, Italy
| | - Monica Giordano
- S. C. di Oncologia, Azienda Ospedaliera S. Anna, Como, Italy
| | - Ornella Garrone
- Dipartimento di Oncologia, Ospedale di Insegnamento S. Croce e Carle, Cuneo, Italy
| | - Alessia Levaggi
- Department of Medical Oncology, U. O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Francesca Poggio
- Department of Medical Oncology, U.O. Oncologia Medica A, IRCCS AOU San Martino-IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Sara Giraudi
- Department of Medical Oncology, U. O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Claudia Bighin
- Department of Medical Oncology, U.O. Oncologia Medica A, IRCCS AOU San Martino-IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Carlo Vecchio
- Department of Surgical Oncology, Chirurgia Senologica U1E, IRCCS AOU San Martino-IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Mario Roberto Sertoli
- Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS AOU San Martino-IST, Istituto Nazionale per la Ricerca sul Cancro, Genova
| | - Paolo Pronzato
- Department of Medical Oncology, U.O. Oncologia Medica A, IRCCS AOU San Martino-IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Lucia Del Mastro
- Department of Medical Oncology, U. O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
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