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Monti M, Prochowski Iamurri A, Bianchini D, Gallio C, Esposito L, Montanari D, Ruscelli S, Molinari C, Foca F, Passardi A, Vittimberga G, Morgagni P, Frassineti GL. Association between Pre-Treatment Biological Indicators and Compliance to Neoadjuvant/Perioperative Chemotherapy in Operable Gastric Cancer. Nutrients 2023; 15:3604. [PMID: 37630794 PMCID: PMC10458231 DOI: 10.3390/nu15163604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND AND AIMS Perioperative treatment is currently the gold standard approach in Europe for locally advanced gastric cancer (GC). Unfortunately, the phenomenon of patients dropping out of treatment has been frequently observed. The primary aims of this study were to verify if routine blood parameters, inflammatory response markers, sarcopenia, and the depletion of adipose tissues were associated with compliance to neoadjuvant/perioperative chemotherapy. METHODS AND STUDY DESIGN Blood samples were considered before the first and second cycles of chemotherapy. Sarcopenia and adipose indices were calculated with a CT scan before starting chemotherapy and before surgery. Odds ratios (OR) from univariable and multivariable models were calculated with a 95% confidence interval (95% CI). RESULTS A total of 84 patients with locally advanced GC were identified between September 2010 and January 2021. Forty-four patients (52.4%) did not complete the treatment according to the number of cycles planned/performed. Eight patients (9.5%) decided to suspend chemotherapy, seven patients (8.3%) discontinued because of clinical decisions, fourteen patients (16.7%) discontinued because of toxicity and fifteen patients (17.9%) discontinued for miscellaneous causes. Seventy-nine (94%) out of eighty-four patients underwent gastrectomy, with four patients having surgical complications, which led to a suspension of treatment. Sarcopenia was present in 38 patients (50.7%) before chemotherapy began, while it was present in 47 patients (60%) at the CT scan before the gastrectomy. At the univariable analysis, patients with basal platelet to lymphocyte ratio (PLR) ≥ 152 (p = 0.017) and a second value of PLR ≥ 131 (p = 0.007) were more frequently associated with an interruption of chemotherapy. Patients with increased PLR (p = 0.034) compared to the cut-off were associated with an interruption of chemotherapy, while patients with increased monocytes between the first and second cycles were associated with a lower risk of treatment interruption (p = 0.006); patients who underwent 5-fluorouracil plus cisplatin or oxaliplatin had a higher risk of interruption (p = 0.016) compared to patients who underwent a 5-fluorouracil plus leucovorin, oxaliplatin and docetaxel (FLOT) regimen. The multivariable analysis showed a higher risk of interruption for patients who had higher values of PLR compared to the identified cut-off both at pretreatment and second-cycle evaluation (OR: 5.03; 95% CI: 1.34-18.89; p = 0.017) as well as for patients who had a lower PLR than the identified cut-off at pretreatment evaluation and had a higher PLR value than the cut-off at the second cycle (OR: 4.64; 95% CI: 1.02-21.02; p = 0.047). Becker regression was neither affected by a decrease of sarcopenia ≥ 5% (p = 0.867) nor by incomplete compliance with chemotherapy (p = 0.281). CONCLUSIONS Changes in PLR values which tend to increase more than the cut-off seem to be an immediate indicator of incomplete compliance with neoadjuvant/perioperative treatment. Fat loss and sarcopenia do not appear to be related to compliance. More information is needed to reduce the causes of interruption.
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Affiliation(s)
- Manlio Monti
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Andrea Prochowski Iamurri
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - David Bianchini
- Medical Physics Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Chiara Gallio
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Luca Esposito
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Daniela Montanari
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Silvia Ruscelli
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Chiara Molinari
- Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Flavia Foca
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Alessandro Passardi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Giovanni Vittimberga
- General and Oncologic Surgery, “Morgagni-Pierantoni” Hospital, 47121 Forlì, Italy
| | - Paolo Morgagni
- General and Oncologic Surgery, “Morgagni-Pierantoni” Hospital, 47121 Forlì, Italy
| | - Giovanni Luca Frassineti
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
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Fenton M, Bianchini D, Brulinski P. Avelumab/Axitinib versus Ipilimumab/Nivolumab: a Kent Oncology Centre Real-world Experience of First-line Combination Treatment for Metastatic Renal Cell Carcinoma. Clin Oncol (R Coll Radiol) 2023. [DOI: 10.1016/j.clon.2022.11.027] [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: 01/13/2023]
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Galante J, Adeleke S, Wong M, Choy A, Lees K, Edwards A, Raman R, Thomas C, Taylor H, Pang J, Ramadan A, Bianchini D, Clarke A, Naji M, Ellul G, Brulinski P. Use of Novel Imaging for Patient Selection for Stereotactic Ablative Radiotherapy (SABR) in Oligometastatic Prostate Cancer (PCa): Does the PET Tracer Make a Difference? Clin Oncol (R Coll Radiol) 2022. [DOI: 10.1016/j.clon.2021.11.032] [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]
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Di Iorio V, Boschi S, Sarnelli A, Cuni C, Bianchini D, Monti M, Gorgoni G, Paganelli G, Matteucci F, Masini C. [ 18F]F-PSMA-1007 Radiolabelling without an On-Site Cyclotron: A Quality Issue. Pharmaceuticals (Basel) 2021; 14:ph14070599. [PMID: 34206461 PMCID: PMC8308622 DOI: 10.3390/ph14070599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 12/20/2022] Open
Abstract
Radiopharmaceuticals targeting the prostate-specific membrane antigen (PSMA) has become the gold standard for PET imaging of prostate cancer. [68Ga]Ga-PSMA-11 has been the forerunner but a [18F]F-PSMA ligand has been developed because of the intrinsic advantages of Fluorine-18. Fluorine-18 labelled compounds are usually prepared in centers with an on-site cyclotron. Since our center has not an on-site cyclotron, we decided to verify the feasibility of producing the experimental 18F-labelled radiopharmaceutical [18F]F-PSMA-1007 with [18F]F- from different external suppliers. A quality agreement has been signed with two different suppliers, and a well-established and correctly implemented quality assurance protocol has been followed. The [18F]F- was produced with cyclotrons, on Nb target, but with different beam energy and current. Extensive validation of the [18F]F-PSMA-1007 synthesis process has been performed. The aim of this paper was the description of all the quality documentation which allowed the submission and approval of the Investigational Medicinal Product Dossier (IMPD) to the Competent Authority, addressing the quality problems due to different external suppliers. The result indicates that no significant differences have been found between the [18F]F- from the two suppliers in terms of radionuclidic and radiochemical purity and [18F]F- impacted neither the radiochemical yield of the labelling reaction nor the quality control parameters of the IMP [18F]F-PSMA-1007. These results prove how a correct quality assurance system can overcome some Regulatory Authorities issue that may represent an obstacle to the clinical use of F-18-labelled radiopharmaceuticals without an on-site cyclotron.
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Affiliation(s)
- Valentina Di Iorio
- IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori” IRST, 47014 Meldola, Italy; (A.S.); (C.C.); (D.B.); (M.M.); (G.P.); (F.M.); (C.M.)
- Correspondence: ; Tel.: +39-0543-739930
| | - Stefano Boschi
- Department for Life Quality Studies, University of Bologna, 47921Rimini, Italy;
| | - Anna Sarnelli
- IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori” IRST, 47014 Meldola, Italy; (A.S.); (C.C.); (D.B.); (M.M.); (G.P.); (F.M.); (C.M.)
| | - Cristina Cuni
- IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori” IRST, 47014 Meldola, Italy; (A.S.); (C.C.); (D.B.); (M.M.); (G.P.); (F.M.); (C.M.)
| | - David Bianchini
- IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori” IRST, 47014 Meldola, Italy; (A.S.); (C.C.); (D.B.); (M.M.); (G.P.); (F.M.); (C.M.)
| | - Manuela Monti
- IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori” IRST, 47014 Meldola, Italy; (A.S.); (C.C.); (D.B.); (M.M.); (G.P.); (F.M.); (C.M.)
| | - Giancarlo Gorgoni
- Radiopharmacy & Cyclotron Department, IRCCS Ospedale Sacro Cuore-Don Calabria, 37024 Negrar di Valpolicella, Italy;
| | - Giovanni Paganelli
- IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori” IRST, 47014 Meldola, Italy; (A.S.); (C.C.); (D.B.); (M.M.); (G.P.); (F.M.); (C.M.)
| | - Federica Matteucci
- IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori” IRST, 47014 Meldola, Italy; (A.S.); (C.C.); (D.B.); (M.M.); (G.P.); (F.M.); (C.M.)
| | - Carla Masini
- IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori” IRST, 47014 Meldola, Italy; (A.S.); (C.C.); (D.B.); (M.M.); (G.P.); (F.M.); (C.M.)
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Kolinsky MP, Rescigno P, Bianchini D, Zafeiriou Z, Mehra N, Mateo J, Michalarea V, Riisnaes R, Crespo M, Figueiredo I, Miranda S, Nava Rodrigues D, Flohr P, Tunariu N, Banerji U, Ruddle R, Sharp A, Welti J, Lambros M, Carreira S, Raynaud FI, Swales KE, Plymate S, Luo J, Tovey H, Porta N, Slade R, Leonard L, Hall E, de Bono JS. A phase I dose-escalation study of enzalutamide in combination with the AKT inhibitor AZD5363 (capivasertib) in patients with metastatic castration-resistant prostate cancer. Ann Oncol 2020; 31:619-625. [PMID: 32205016 PMCID: PMC7217345 DOI: 10.1016/j.annonc.2020.01.074] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 01/16/2020] [Accepted: 01/29/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Activation of the PI3K/AKT/mTOR pathway through loss of phosphatase and tensin homolog (PTEN) occurs in approximately 50% of patients with metastatic castration-resistant prostate cancer (mCRPC). Recent evidence suggests that combined inhibition of the androgen receptor (AR) and AKT may be beneficial in mCRPC with PTEN loss. PATIENTS AND METHODS mCRPC patients who previously failed abiraterone and/or enzalutamide, received escalating doses of AZD5363 (capivasertib) starting at 320 mg twice daily (b.i.d.) given 4 days on and 3 days off, in combination with enzalutamide 160 mg daily. The co-primary endpoints were safety/tolerability and determining the maximum tolerated dose and recommended phase II dose; pharmacokinetics, antitumour activity, and exploratory biomarker analysis were also evaluated. RESULTS Sixteen patients were enrolled, 15 received study treatment and 13 were assessable for dose-limiting toxicities (DLTs). Patients were treated at 320, 400, and 480 mg b.i.d. dose levels of capivasertib. The recommended phase II dose identified for capivasertib was 400 mg b.i.d. with 1/6 patients experiencing a DLT (maculopapular rash) at this level. The most common grade ≥3 adverse events were hyperglycemia (26.7%) and rash (20%). Concomitant administration of enzalutamide significantly decreased plasma exposure of capivasertib, though this did not appear to impact pharmacodynamics. Three patients met the criteria for response (defined as prostate-specific antigen decline ≥50%, circulating tumour cell conversion, and/or radiological response). Responses were seen in patients with PTEN loss or activating mutations in AKT, low or absent AR-V7 expression, as well as those with an increase in phosphorylated extracellular signal-regulated kinase (pERK) in post-exposure samples. CONCLUSIONS The combination of capivasertib and enzalutamide is tolerable and has antitumour activity, with all responding patients harbouring aberrations in the PI3K/AKT/mTOR pathway. CLINICAL TRIAL NUMBER NCT02525068.
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Affiliation(s)
- M P Kolinsky
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK; Cross Cancer Institute, Edmonton, Canada
| | - P Rescigno
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK; Department of Clinical Medicine and Surgery, Department of Translational Medical Sciences, AOU Federico II, Naples, Italy
| | - D Bianchini
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - Z Zafeiriou
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - N Mehra
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - J Mateo
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - V Michalarea
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - R Riisnaes
- The Institute of Cancer Research, London, UK
| | - M Crespo
- The Institute of Cancer Research, London, UK
| | | | - S Miranda
- The Institute of Cancer Research, London, UK
| | | | - P Flohr
- The Institute of Cancer Research, London, UK
| | - N Tunariu
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - U Banerji
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - R Ruddle
- The Institute of Cancer Research, London, UK
| | - A Sharp
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - J Welti
- The Institute of Cancer Research, London, UK
| | - M Lambros
- The Institute of Cancer Research, London, UK
| | - S Carreira
- The Institute of Cancer Research, London, UK
| | - F I Raynaud
- The Institute of Cancer Research, London, UK
| | - K E Swales
- The Institute of Cancer Research, London, UK
| | - S Plymate
- University of Washington School of Medicine, Seattle, USA
| | - J Luo
- Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, USA
| | - H Tovey
- The Institute of Cancer Research, London, UK
| | - N Porta
- The Institute of Cancer Research, London, UK
| | - R Slade
- The Institute of Cancer Research, London, UK
| | - L Leonard
- The Institute of Cancer Research, London, UK
| | - E Hall
- The Institute of Cancer Research, London, UK
| | - J S de Bono
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK.
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Marzano AV, Genovese G, Casazza G, Moltrasio C, Dapavo P, Micali G, Sirna R, Gisondi P, Patrizi A, Dini V, Bianchini D, Bianchi L, Fania L, Prignano F, Offidani A, Atzori L, Bettoli V, Cannavò SP, Venturini M, Bongiorno MR, Costanzo A, Fabbrocini G, Peris K. Evidence for a 'window of opportunity' in hidradenitis suppurativa treated with adalimumab: a retrospective, real-life multicentre cohort study. Br J Dermatol 2020; 184:133-140. [PMID: 32119111 DOI: 10.1111/bjd.18983] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND The anti-tumour necrosis factor (TNF)-α adalimumab is the only licenced biologic for moderate-to-severe hidradenitis suppurativa (HS). No predictors of response have been identified so far. OBJECTIVES To identify clinical parameters predicting response to adalimumab and confirm its efficacy/safety. METHODS The data of 389 patients with HS treated with adalimumab in 21 Italian centres were reviewed. Sex, age at onset/diagnosis/baseline, body mass index, smoking, phenotype, previous treatments, concomitant antibiotics and 'therapeutic delay', defined as the time from HS onset to adalimumab initiation, were assessed. Response to adalimumab and its impact on quality of life (QoL) were evaluated using the Hidradenitis Suppurativa Clinical Response (HiSCR) and the Dermatology Life Quality Index (DLQI) or the Visual Analogue Scale for pain (VAS pain), respectively. Logistic regression analysis was performed. RESULTS The therapeutic delay correlated to lack of response to adalimumab at week 16 [odds ratio (OR) 1·92 for therapeutic delay > 10 years; 95% confidence interval (CI) 1·28-2·89; P = 0·0016). HiSCR was achieved in 43·7% and 53·9% patients at week 16 and 52, respectively. Significant reductions in both DLQI and VAS pain were found between week 16 vs. baseline (P < 0·0001 for both) and week 52 vs. baseline (P < 0·0001 for both). Previous immunosuppressants inversely correlated to HiSCR at week 52 (OR = 1·74, 95% CI 1·04-2·91, P = 0·0342). CONCLUSIONS Inverse correlation between therapeutic delay and clinical response was found, supporting early adalimumab use and providing evidence for a 'window of opportunity' in HS treatment. Adalimumab efficacy and safety were confirmed, along with patients' QoL improvement. Immunosuppressants could negatively influence the response to adalimumab inducing a switch to non-TNF-α-driven pathways.
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Affiliation(s)
- A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - G Genovese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - G Casazza
- Dipartimento di Scienze Biomediche e Cliniche 'L. Sacco', Università degli Studi di Milano, Milan, Italy
| | - C Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - P Dapavo
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - G Micali
- Dermatology Clinic, University of Catania, Catania, Italy
| | - R Sirna
- Dermatology Unit, Department of Surgery, Misericordia Hospital, Grosseto, Italy
| | - P Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - A Patrizi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - V Dini
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - D Bianchini
- Dermatologic Clinic, Department of Internal Medicine and Medical Specialties, 'La Sapienza' University, Rome, Italy
| | - L Bianchi
- Department of Dermatology, University of Rome 'Tor Vergata', Rome, Italy
| | - L Fania
- First Dermatology Clinic and Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
| | - F Prignano
- Department Health Science Section of Dermatology, University of Florence, Florence, Italy
| | - A Offidani
- Dermatological Clinic Department of Clinical and Molecular Sciences, Polytechnic University of the Marche Region, Ancona, Italy
| | - L Atzori
- Unit of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - V Bettoli
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - S P Cannavò
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy
| | - M Venturini
- Department of Dermatology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - M R Bongiorno
- Section of Dermatology, Department of Health Promotion, Maternal-Infant, Internal Medicine and Specialization, University of Palermo, Palermo, Italy
| | - A Costanzo
- Dermatology Unit, IRCCS Humanitas Clinical and Research Center, Rozzano (Milan), Italy
| | - G Fabbrocini
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - K Peris
- Institute of Dermatology, Università Cattolica - Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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Corazza I, Rossi P, Bianchini D, Lombi A, Sapignoli S, Zanzi M. Radiological aspects of CO 2peripheral DSA: Preliminary analysis on the dedicated protocols. Indian J Radiol Imaging 2020; 30:372-375. [PMID: 33273772 PMCID: PMC7694728 DOI: 10.4103/ijri.ijri_247_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 08/12/2020] [Accepted: 08/18/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives: Thanks to its lack of allergic reactions and renal toxicity, CO2 represents an alternative to iodine as a contrast medium for peripheral subtraction angiography. Since CO2 has a lower and negative contrast than iodine, postprocessing DSA and stacking are mandatory. So, it seems that higher doses than traditional iodine angiography are required. We addressed the dosimetric aspects of CO2 angiography for two different commercial DSA-apparatus. Materials and Methods: Two different radiological suites were analyzed by recreating the same setup on all the apparatuses: we used a PMMA slabs phantom with a MPD Barracuda dosimeter on its side to collect all radiological parameters. Results: Results show that the irradiation parameters were left completely unchanged between the traditional and CO2 angiographic programs. Conclusions: This leads to thinking that these CO2 protocols do not operate on the X-ray emission, but only differ on image manipulation. The possibility of improvements by changing radiological parameters are still not explored and really promising.
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Lorente D, Olmos D, Mateo J, Dolling D, Bianchini D, Seed G, Flohr P, Crespo M, Figueiredo I, Miranda S, Scher HI, Terstappen LWMM, de Bono JS. Circulating tumour cell increase as a biomarker of disease progression in metastatic castration-resistant prostate cancer patients with low baseline CTC counts. Ann Oncol 2019; 29:1554-1560. [PMID: 29741566 DOI: 10.1093/annonc/mdy172] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background The development of treatment response and surrogate biomarkers for advanced prostate cancer care is an unmet clinical need. Patients with baseline circulating tumour cell (BLCTCs) counts <5/7.5 mL represent a good prognosis subgroup but are non-evaluable for response assessment (decrease in CTCs). The aim of the study is to determine the value of any increase in CTCs (CTC progression) as an indicator of progression in prostate cancer patients with low pre-treatment CTCs (<5). Patients and methods We carried out a post hoc analysis of patients with BLCTCs < 5 treated in the COU-AA-301 (abiraterone or placebo + prednisone) and IMMC-38 (chemotherapy) trials. The association of CTC progression (increase in CTCs at 4, 8 or 12 weeks) with overall survival (OS) was evaluated in multi-variable Cox regression models. Performance of survival models with and without CTC progression was evaluated by calculating ROC curve area under the curves (AUCs) and weighted c-indices. Results Overall, 511 patients with CTCs < 5 (421 in COU-AA-301 and 90 in IMMC-38) were selected; 212 (41.7%) had CTC progression at 4, 8 or 12 weeks after treatment initiation. CTC progression was associated with significantly worse OS [27.1 versus 15.1 m; hazard ratio (HR) 3.4 (95% confidence interval [CI] 2.5-4.5; P < 0.001)], independent of baseline CTCs and established clinical variables. Adding CTC progression to the OS model significantly improved ROC AUC (0.77 versus 0.66; P < 0.001). Models including CTC progression had superior ROC AUC (0.77 versus 0.69; P < 0.001) and weighted c-index [0.750 versus 0.705; delta c-index: 0.045 (95% CI 0.019-0.071)] values than those including CTC conversion (increase to CTCs ≥ 5). In COU-AA-301, the impact of CTC progression was independent of treatment arm. Conclusions Increasing CTCs during the first 12 weeks of treatment are independently associated with worse OS from advanced prostate cancer in patients with baseline CTCs < 5 treated with abiraterone or chemotherapy and improve models with established prognostic variables. These findings must be prospectively validated.
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Affiliation(s)
- D Lorente
- Medical Oncology Service, Hospital La Fe, Valencia, Spain; Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, Surrey
| | - D Olmos
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - J Mateo
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, Surrey; Prostate Cancer Translational Research Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - D Dolling
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, Surrey
| | - D Bianchini
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, Surrey
| | - G Seed
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, Surrey
| | - P Flohr
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, Surrey
| | - M Crespo
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, Surrey
| | - I Figueiredo
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, Surrey
| | - S Miranda
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, Surrey
| | - H I Scher
- Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, USA
| | - L W M M Terstappen
- MIRA Research Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - J S de Bono
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, Surrey.
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Mejorada RL, Lorente D, Castro E, Bianchini D, Nombela P, Sandhu S, Laorden NR, Cendón Y, Sharp A, Casado EA, Pacheco M, Rescigno P, LLácer C, Saez M, Rivera L, Vitrone F, Moreno C, Mateo J, de Bono J, Hidalgo DO. Circulating tumour cells (CTC) count and prostate-specific antigen (PSA) response measures in metastatic castration-resistant prostate cancer (mCRPC) patients (pts) treated with docetaxel (Doc). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz248.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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10
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Matteucci F, Solinas L, Turri V, Donati C, D'errico V, Moretti A, Bianchini D, Paganelli G, Gallegati D, Altini M. IntegoTM infusion system: cost effectiveness analysis focusing on dosimetry, sterility and management. Q J Nucl Med Mol Imaging 2019; 63:183-190. [PMID: 27387379 DOI: 10.23736/s1824-4785.16.02866-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Healthcare providers across Europe are facing an ever-growing demand in clinical PET referrals. Currently, it is estimated that the administration of the PET tracer accounts for approximately 40% of the unitary PET procedure reimbursement (uPETr). Although the cost of PET/CT is highly dependent on the radiopharmaceutical cost itself, little is known about the economic impact of the utilized administration method and the repercussions on staff radiation exposure. Our objective was to evaluate the cost-effectiveness of automatic injection/fractionation system Intego™ (Bayer HealthCare, MEDRAD Europe, Netherlands) for istaff radiation exposure reduction and to validate its use with 18F-choline (FCH). METHODS In order to validate Intego™ use with FCH we analyzed sterility, radioactivity fractionation accuracy and radiation protection for staff. We analyzed Intego™ impact on examination costs and its impact on organization efficiency. A cost-effectiveness analysis (CEA) was estimated as the incremental cost to reduce staff radiationexposure. RESULTS According to our data, Intego™ ensures both sterility and accuracy of FCH doses' activity, reducing, at the same time, the exposure to radiation either whole body and at the extremities (94% and 75% respectively for the technicians and complete reduction for physicians). Intego™'s variable unit costs are higher than the SA (respectively 1.8% and 0.4% of PET reimbursement), while staff costs are significantly higher with SA (respectively 0.27% and 1.57% of unitary PET reimbursement [uPETr]). In our simulation, based on a 2,450 PET yearly output, the differential costs were slightly higher by using Intego™™ (+ 14%). The incremental cost-effectiveness ratio (ICER) was equal to 1.1, i.e. the healthcare provider pays an additional cost of 0.38% of uPETr to obtain a significant reduction of staff radiation exposure (-4.5 µS). CONCLUSIONS Intego™, for its favorable results in terms of cost effectiveness, could be a useful tool in a nuclear medicine department, limiting the staff radiation exposure.
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Affiliation(s)
- Federica Matteucci
- Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Forlì-Cesena, Italy -
| | - Laura Solinas
- Planning and Control Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Forlì-Cesena, Italy
| | - Valentina Turri
- Health Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Forlì-Cesena, Italy
| | - Caterina Donati
- Pharmacy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Forlì-Cesena, Italy
| | - Vincenzo D'errico
- Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Forlì-Cesena, Italy
| | - Andrea Moretti
- Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Forlì-Cesena, Italy
| | - David Bianchini
- Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Forlì-Cesena, Italy
| | - Giovanni Paganelli
- Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Forlì-Cesena, Italy
| | - Davide Gallegati
- Planning and Control Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Forlì-Cesena, Italy
| | - Mattia Altini
- Health Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Forlì-Cesena, Italy
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11
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Mezzenga E, Ravaglia V, D’Errico V, Bianchini D, Menghi E, Belli M, Mazzotti G, Savini A, Feliciani G, Sarnelli A. 194. Retrospective analysis of daily Tomotherapy output check performed by means of statistical process control: A helpful way for preventive maintenance interventions? Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.205] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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12
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Savini A, Bianchini D, Belli M, Mezzenga E, Feliciani G, Ravaglia V, Falaschi D, Barone D, Cenni P, Sarnelli A. 232. Implementation of an edited-PRESS sequence for the detection of the 2-Hydroxyglutarate metabolite. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.243] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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13
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Sarnelli A, Mezzenga E, D’Errico V, Bianchini D, Negrini M. 344. Application of Monte Carlo techniques to the calibration of airborne radioactivity monitoring systems. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.353] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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14
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Feliciani G, Bellia S, Bianchini D, Mazzotti G, Ravaglia V, Menghi E, Del Duca M, Kelson I, Keisari Y, Popovtzer A, Monti M, Turri V, Romeo A, Stanganelli I, Ibrahim T, Sarnelli A. Diffusing Alpha-Emitters Radiation Therapy: Template Based TPS for Brachytherapy of Squamous Cell Skin Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1396] [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: 10/28/2022]
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15
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Arrico L, Migliorini R, Bianchini D, Salducci M, Collini S, Malagola R. Ocular motility alterations in orbital fractures: pre-post evaluation in maxillofacial surgical treatment. G Chir 2018; 39:363-367. [PMID: 30563599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE The study aims to investigate the ability of maxillofacial surgery to reduce strabismus and improve ocular clinical symptomatology in patients with fracture of the medial or lateral floor of the orbit, or both, and to evaluate such abilities relative to the temporal distance between trauma and surgery. PATIENTS AND METHODS 25 patients with traumatic diplopia were evaluated by CT, Goldman manual field of view, Hess-Lancaster test, eye examination and orthoptic examination, before and after surgery. RESULTS We observed: a statistically significant reduction of the deviation angle, both from close and long distance (P = 0.0054 and P = 0.0051 respectively) with a 38% reduction of the deviation from short distance and 54% from afar; a regression of diplopia in 20% of the surgically treated cases (CL from 0 to 39%), significant at the Mc Nemar test; a negative correlation with the time elapsed between the onset of the fracture and maxillofacial surgery (R = -0.26), even if the analysis did not show a statistical significance of the data (P = 0.2). However, it is evident that the maximum improvement is observed only in cases operated within 5 months of the trauma, while the failures (worsening or persistence of diplopia) were observed only in the cases operated later. CONCLUSION We can state that the intervention reduces strabismus and improves ocular symptomatology, as it statistically significantly reduces cases of diplopia; furthermore, it would seem preferable to intervene early, especially when damage to a muscular structure is suspected, even if the data do not allow definitive conclusions in this regard.
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16
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Colella M, Strada L, Bianchini D, Ajmar G, Del Sette M. Stroke or Stramonium? A novel stroke mimic. Neurol Sci 2018; 40:631-632. [PMID: 30341480 DOI: 10.1007/s10072-018-3609-6] [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] [Received: 07/09/2018] [Accepted: 10/15/2018] [Indexed: 10/28/2022]
Affiliation(s)
- M Colella
- Neurology Unit, Ente Ospedaliero Ospedali Galliera, Genoa, Italy.,IRCCS Neurolesi Bonino-Pulejo-Ospedale Piemonte, Messina, Italy
| | - L Strada
- Neurology Unit, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - D Bianchini
- Neurology Unit, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - G Ajmar
- Neurology Unit, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - M Del Sette
- Neurology Unit, Ente Ospedaliero Ospedali Galliera, Genoa, Italy.
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17
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Rescigno P, Rediti M, Dolling D, Rodrigues D, Bianchini D, Riisnaes R, Messina C, Barrero M, Petremolo A, Sharp A, Sumanasuriya S, Seed G, Figueiredo I, Miranda S, Goodall J, Mateo J, Chandler R, Yuan W, Carreira S, de Bono J. PI3K/AKT pathway deleterious mutations in lethal prostate cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy284.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Feliciani G, Bellia SR, Bianchini D, Mazzotti G, Ravaglia V, Keisari Y, Popovtzer A, Kelson I, Monti M, Duca MD, Turri V, Stanganelli I, Romeo A, Ibrahim T, Sarnelli A. [OA089] Diffusing Alpha-emitters Radiation Therapy (DaRT): template based treatment planning technique for brachytherapy of squamous cell skin cancer. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.06.161] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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19
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Colella M, Stilo C, Cocchella A, Bianchini D, Pilotto A, Del Sette P, Musolino R. Cerebral vasoreactivity and intima-media thickness in Down syndrome: A case-control study. J Neurol Sci 2018; 385:57-63. [PMID: 29406914 DOI: 10.1016/j.jns.2017.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 06/04/2017] [Revised: 10/23/2017] [Accepted: 11/14/2017] [Indexed: 01/12/2023]
Abstract
Subjects with Down Syndrome (DS) have high prevalence of cerebral vascular amyloidosis, cognitive decline and dementia. In Alzheimer Disease, impaired vasoreactivity has been reported as the results of vascular amyloid deposition. Aim of our study was to verify presence of impaired cerebral vasoreactivity and to study carotid intima media-thickness (IMT) by carotid and transcranial ultrasound. We studied 25 DS and compared them with 25 age- and sex-matched normal controls. Vasomotor reactivity was evaluated by means of breath-holding index (BHI) test. There was no difference in IMT, both considering the two side separately (left: 0.70±0.10 vs 0.69±0.12mm, p=0.6) (right: 0.67±0.13 vs 0.68±0.10mm, p=0.5), and considering the sum of both sides (1.38±0.22 vs 1.38±0.23mm, p=1). There was a significant difference in peak systolic velocities (PSV) (139.75±27.67 vs. 123.89±25.73cm/s, p=0.04) and in pulsatility index (PI) (0.95±0.14 vs. 0.86±0.12, p=0.02). BHI was significantly lower in DS than in controls (1.15±0.38 vs 1.88±0.72, p<0.001). In conclusion, subjects with DS have increased PSV and PI, and show a reduction of BHI, expression of impaired vasomotor reserve, possibly due to micro-vascular impairment. Larger study with longitudinal design is needed to verify our data.
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Affiliation(s)
- M Colella
- Department of Neurology, University of Messina, Italy; E.O. Ospedali Galliera, Genova, Italy.
| | - C Stilo
- Department of Neurology, University of Messina, Italy; E.O. Ospedali Galliera, Genova, Italy
| | | | | | - A Pilotto
- E.O. Ospedali Galliera, Genova, Italy
| | - P Del Sette
- Department of Psychology, University of Genova, Italy
| | - R Musolino
- Department of Neurology, University of Messina, Italy
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20
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De Massimi B, Bianchini D, Sarnelli A, D’Errico V, Marcocci F, Mezzenga E, Mostacci D. Air contamination measurements for the evaluation of internal dose to workers in nuclear medicine departments. Radiat Phys Chem Oxf Engl 1993 2017. [DOI: 10.1016/j.radphyschem.2017.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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21
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Jayaram A, Nowakowska K, Mateo J, Hernandez T, Kumar S, Fulton B, Nava Rodrigues D, Riisnaes R, Zukiwski A, Proniuk S, Bexon A, Bisaha J, Bianchini D, Zafeiriou Z, Lopez R, Tunariu N, Pacey S, Jones R, de Bono JS, Attard G. Phase 1-2 study of progesterone receptor (PR) inhibition with extended-release (ER) onapristone (ONA) alone or in combination with abiraterone (AA) in patients (pts) with castration-resistant prostate cancer (CRPC) incorporating plasma DNA analysis to define androgen receptor (AR) status. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx513.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Mezzenga E, D’Errico V, D’Arienzo M, Strigari L, Panagiota K, Matteucci F, Severi S, Paganelli G, Fenwick A, Bianchini D, Marcocci F, Sarnelli A. Quantitative accuracy of 177Lu SPECT imaging for molecular radiotherapy. PLoS One 2017; 12:e0182888. [PMID: 28806773 PMCID: PMC5564164 DOI: 10.1371/journal.pone.0182888] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 07/26/2017] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study is to investigate the optimal reference geometry for gamma camera calibration. Yet another question of interest was to assess the influence of the number of 3D Ordered Subsets Expectation Maximization (3D-OSEM) updates on activity quantification for SPECT imaging with 177Lu. The accuracy of 177Lu activity quantification was assessed both in small and in large objects. Two different reference geometries, namely a cylindrical homogeneous phantom and a Jaszczak 16 ml sphere surrounded by cold water, were used to determine the gamma camera calibration factor of a commercial SPECT/CT system. Moreover, the noise level and the concentration recovery coefficient were evaluated as a function of the number of 3D-OSEM updates by using the SPECT/CT images of the reference geometry phantoms and those of a cold Jaszczak phantom with three hot spheres (16ml, 8ml and 4ml), respectively. The optimal choice of the number of 3D-OSEM updates was based on a compromise between the noise level achievable in the reconstructed SPECT images and the concentration recovery coefficients. The quantitative accuracy achievable was finally validated on a test phantom, where a spherical insert composed of two concentric spheres was used to simulate a lesion in a warm background. Our data confirm and extend previous observations. Using the calibration factor obtained with the cylindrical homogeneous phantom and the Jaszczak 16 ml sphere, the recovered activity in the test phantom was underestimated by -16.4% and -24.8%, respectively. Our work has led us to conclude that gamma camera calibration performed with large homogeneous phantom outperforms calibration executed with the Jaszczak 16ml sphere. Furthermore, the results obtained support the assumption that approximately 50 OSEM updates represent a good trade-off to reach convergence in small volumes, meanwhile minimizing the noise level.
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Affiliation(s)
- Emilio Mezzenga
- Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la
Cura dei Tumori (IRST) IRCCS, Meldola, Italy
- * E-mail:
| | - Vincenzo D’Errico
- Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la
Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Marco D’Arienzo
- National Institute of Ionizing Radiation Metrology, ENEA CR Casaccia,
Rome, Italy
| | - Lidia Strigari
- Laboratory of Medical Physics and Expert Systems, Regina Elena National
Cancer Institute, Rome, Italy
| | - Koutla Panagiota
- Department of Physics, Aristotle University of Thessaloniki,
Thessaloniki, Greece
| | - Federica Matteucci
- Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la
Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Stefano Severi
- Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la
Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Giovanni Paganelli
- Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la
Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Andrew Fenwick
- National Physical Laboratory, Hampton Road, Teddington, United
Kingdom
| | - David Bianchini
- Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la
Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Francesco Marcocci
- Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la
Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Anna Sarnelli
- Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la
Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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23
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Massard C, Mateo J, Loriot Y, Pezaro C, Albiges L, Mehra N, Varga A, Bianchini D, Ryan CJ, Petrylak DP, Attard G, Shen L, Fizazi K, de Bono J. Phase I/II trial of cabazitaxel plus abiraterone in patients with metastatic castration-resistant prostate cancer (mCRPC) progressing after docetaxel and abiraterone. Ann Oncol 2017; 28:90-95. [PMID: 28039155 PMCID: PMC5378222 DOI: 10.1093/annonc/mdw441] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background Abiraterone and cabazitaxel improve survival in patients with metastatic castration-resistant prostate cancer (mCRPC). We conducted an open-label phase I/II trial of cabazitaxel plus abiraterone to assess the antitumor activity and tolerability in patients with progressive mCRPC after docetaxel (phase I), and after docetaxel and abiraterone (phase II) (NCT01511536). Patients and methods The primary objectives were to determine the maximum tolerated dose (MTD) and dose-limiting toxicities (DLTs) of cabazitaxel plus abiraterone (phase I), and the prostate-specific antigen (PSA) response defined as a ≥ 50% decrease confirmed ≥3 weeks later with this combination (phase II). Results Ten patients were enrolled in the phase I component; nine were evaluable. No DLTs were identified. The MTD was established as the approved doses for both drugs (cabazitaxel 25 mg/m2 every 3 weeks and abiraterone 1000 mg once daily). Daily abiraterone treatment did not impact on cabazitaxel clearance. Twenty-seven patients received cabazitaxel plus abiraterone plus prednisone (5 mg twice daily) in phase II. The median number of cycles administered (cabazitaxel) was seven (range: 1-28). Grade 3-4 treatment-emergent adverse events included asthenia (in 5 patients; 14%), neutropenia (in 5 patients; 14%) and diarrhea (in 3 patients; 8%). Nine patients (24%) required dose reductions of cabazitaxel. Of 26 evaluable patients, 12 achieved a PSA response [46%; 95% confidence interval (CI): 26.6-66.6%]. Median PSA-progression-free survival was 6.9 months (95% CI: 4.1-10.3 months). Of 14 patients with measurable disease at baseline, 3 (21%) achieved a partial response per response evaluation criteria in solid tumors. Conclusions The combination of cabazitaxel and abiraterone has a manageable safety profile and shows antitumor activity in patients previously treated with docetaxel and abiraterone.
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Affiliation(s)
- C Massard
- Department of Drug Development, Gustave Roussy Cancer Campus, University of Paris Sud, Villejuif, France.,Department of Medical Oncology, Gustave Roussy Cancer Campus, University of Paris Sud, Villejuif, France
| | - J Mateo
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Y Loriot
- Department of Medical Oncology, Gustave Roussy Cancer Campus, University of Paris Sud, Villejuif, France
| | - C Pezaro
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - L Albiges
- Department of Medical Oncology, Gustave Roussy Cancer Campus, University of Paris Sud, Villejuif, France
| | - N Mehra
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - A Varga
- Department of Drug Development, Gustave Roussy Cancer Campus, University of Paris Sud, Villejuif, France
| | - D Bianchini
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - C J Ryan
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, USA
| | - D P Petrylak
- Comprehensive Cancer Center Yale School of Medicine, New Haven
| | - G Attard
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - L Shen
- Sanofi Genzyme, Cambridge, USA
| | - K Fizazi
- Department of Medical Oncology, Gustave Roussy Cancer Campus, University of Paris Sud, Villejuif, France
| | - J de Bono
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
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24
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Bellomo G, Marcocci F, Bianchini D, Mezzenga E, D’Errico V, Menghi E, Zannoli R, Sarnelli A. MR Spectroscopy in Prostate Cancer: New Algorithms to Optimize Metabolite Quantification. PLoS One 2016; 11:e0165730. [PMID: 27832096 PMCID: PMC5104319 DOI: 10.1371/journal.pone.0165730] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 10/17/2016] [Indexed: 11/18/2022] Open
Abstract
Prostate cancer (PCa) is the most common non-cutaneous cancer in male subjects and the second leading cause of cancer-related death in developed countries. The necessity of a non-invasive technique for the diagnosis of PCa in early stage has grown through years. Proton magnetic resonance spectroscopy (1H-MRS) and proton magnetic resonance spectroscopy imaging (1H-MRSI) are advanced magnetic resonance techniques that can mark the presence of metabolites such as citrate, choline, creatine and polyamines in a selected voxel, or in an array of voxels (in MRSI) inside prostatic tissue. Abundance or lack of these metabolites can discriminate between pathological and healthy tissue. Although the use of magnetic resonance spectroscopy (MRS) is well established in brain and liver with dedicated software for spectral analysis, quantification of metabolites in prostate can be very difficult to achieve, due to poor signal to noise ratio and strong J-coupling of the citrate. The aim of this work is to develop a software prototype for automatic quantification of citrate, choline and creatine in prostate. Its core is an original fitting routine that makes use of a fixed step gradient descent minimization algorithm (FSGD) and MRS simulations developed with the GAMMA libraries in C++. The accurate simulation of the citrate spin systems allows to predict the correct J-modulation under different NMR sequences and under different coupling parameters. The accuracy of the quantifications was tested on measurements performed on a Philips Ingenia 3T scanner using homemade phantoms. Some acquisitions in healthy volunteers have been also carried out to test the software performance in vivo.
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Affiliation(s)
- Giovanni Bellomo
- Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | - Francesco Marcocci
- Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
- * E-mail:
| | - David Bianchini
- Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | - Emilio Mezzenga
- Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | - Vincenzo D’Errico
- Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | - Enrico Menghi
- Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | - Romano Zannoli
- Experimental, Diagnostic and Specialty Medicine Department DIMES, University of Bologna, Bologna, Italy
| | - Anna Sarnelli
- Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
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Mehra N, Seed G, Lambros M, Sharp A, Fontes MS, Crespo M, Sumanasuriya S, Yuan W, Boysen G, Riisnaes R, Calcinotto A, Carreira S, Goodall J, Zafeiriou Z, Bianchini D, Morilla A, Morilla R, Alimonti A, de Bono J. Myeloid-derived suppressor cells (MDSCs) in metastatic castration-resistant prostate cancer (CRPC) patients (PTS). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw372.41] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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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Feliciani G, Peron C, La Rocca A, Scuppa MF, Malavolta A, Bianchini D, Corazza I, Zannoli R. Cold pressor test using strain-gauge plethysmography. Adv Physiol Educ 2016; 40:410-417. [PMID: 27503902 DOI: 10.1152/advan.00096.2015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/06/2016] [Indexed: 06/06/2023]
Abstract
This laboratory activity is designed to teach students how to measure forearm muscle blood flow (FBF) to describe the mechanisms of peripheral blood flow thermal regulation in healthy subjects. The cold pressor test (CPT) is the clinical procedure used in the experiment to induce arterial vasoconstriction. Strain-gauge plethysmography is applied on the patient's forearm to noninvasive monitor vasoconstriction effects on local blood perfusion and physiological parameters such as blood pressure (BP) and heart rate (HR). Patients with an altered peripheral vascular resistance (e.g., in hypertension) have different responses to the CPT from healthy subjects. To date, experimental evidence remains unexplained, as we do not know if the BP and HR increase is caused by a decrease in flow rate or an increase in peripheral vascular resistance during the test. To clarify this situation, we have to quantify the parameter we assume is being conditioned by the regulatory physiological intervention, i.e., peripheral vascular resistance. Peripheral vascular resistance quantification can be calculated as the ratio between muscle flow and mean arterial pressure. Students will learn how to apply the instrumental procedure to collect and analyze data before, during, and after the CPT and to describe the physiological responses of the peripheral vascular system to external stressors. They will also learn how to distinguish healthy from pathological responses on the basis of how sympathetic nervous system reactions influence the biomechanics of peripheral vessels.
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Affiliation(s)
- Giacomo Feliciani
- Postgraduate School in Medical Physics, University of Bologna, Bologna, Italy;
| | | | | | | | | | - David Bianchini
- Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS-IRST, Meldola, Italy
| | - Ivan Corazza
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy; and
| | - Romano Zannoli
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy; and
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Pioli G, Lauretani F, Pellicciotti F, Pignedoli P, Bendini C, Davoli ML, Martini E, Zagatti A, Giordano A, Nardelli A, Zurlo A, Bianchini D, Sabetta E, Ferrari A, Tedeschi C, Lunardelli ML. Modifiable and non-modifiable risk factors affecting walking recovery after hip fracture. Osteoporos Int 2016; 27:2009-16. [PMID: 26792647 DOI: 10.1007/s00198-016-3485-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 01/05/2016] [Indexed: 10/22/2022]
Abstract
UNLABELLED Modifiable and non-modifiable predictors of mobility recovery were analyzed on a sample of 774 hip fracture patients according to pre-fracture abilities. Overall predictors were mostly non-modifiable factors related to frailty of patients with the exception of 25-hydroxyvitamin D concentration which significantly affected walking recovery, especially in patients with higher pre-fracture performance. INTRODUCTION This study aims to investigate mobility changes after hip fracture with the aim of identifying modifiable and non-modifiable predictors of mobility recovery according to different pre-fracture abilities. METHODS This is a prospective inception cohort study of consecutive older patients, admitted with a fragility hip fracture in three Hospitals of Emilia Romagna (Italy). A sample of 774 patients alive at the sixth month was divided into three groups according to pre-fracture ambulation ability (group 1: mobile outdoors; group 2: mobile indoors; and group 3: mobile with help). The relationship between baseline characteristics of patients and the odds of walking recovery was analyzed using multivariate regression analysis. RESULTS Mortality differed significantly among the three groups and was the highest in patients needing help to walk. Among the survivors, only 50.3 % of patients recovered walking ability. In a multivariate analysis, independent risk factors were different among the three groups. In group 1, older age, comorbidities, the use of walking devices before fracture, and low albumin level acted as negative factors while male gender, a pre-fracture high functional status, and higher 25-hydroxyvitamin D levels increased the probability of full recovery. In group 2, only pre-fracture functional status and 25-hydroxyvitamin D concentration were related to the recovery of walking ability. Pre-fracture functional status was also the only significant predictor for patients in group 3. CONCLUSIONS Several baseline characteristics of patients are related to the likelihood of recovering walking ability after hip fracture. The 25-hydroxyvitamin D level seems to be the only relevant modifiable factor even if the effectiveness of its supplementation has yet to be demonstrated.
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Affiliation(s)
- G Pioli
- Geriatric Unit, Department of Neuromotor Physiology, ASMN-IRCCS, Via Risorgimento 70, 42100, Reggio Emilia, Italy.
| | - F Lauretani
- Geriatric Unit, Geriatric-Rehabilitation Department, University Hospital of Parma, Parma, Italy
| | - F Pellicciotti
- Geriatric Unit, Department of Neuromotor Physiology, ASMN-IRCCS, Via Risorgimento 70, 42100, Reggio Emilia, Italy
| | - P Pignedoli
- Orthopaedic Unit, Department of Neuromotor Physiology, ASMN-IRCCS, Reggio Emilia, Italy
| | - C Bendini
- Geriatric Unit, Department of Neuromotor Physiology, ASMN-IRCCS, Via Risorgimento 70, 42100, Reggio Emilia, Italy
| | - M L Davoli
- Geriatric Unit, Department of Neuromotor Physiology, ASMN-IRCCS, Via Risorgimento 70, 42100, Reggio Emilia, Italy
| | - E Martini
- Orthogeriatric Unit, Department of Internal Medicine, Aging and Nephrology, University Hospital Policlinico S.Orsola Malpighi, Bologna, Italy
| | - A Zagatti
- Orthogeriatric Unit, S. Anna Hospital, Ferrara, Italy
| | - A Giordano
- Geriatric Unit, Geriatric-Rehabilitation Department, University Hospital of Parma, Parma, Italy
| | - A Nardelli
- Geriatric Unit, Geriatric-Rehabilitation Department, University Hospital of Parma, Parma, Italy
| | - A Zurlo
- Orthogeriatric Unit, S. Anna Hospital, Ferrara, Italy
| | - D Bianchini
- Physical and Rehabilitation Medicine Unit, Department of Neuromotor Physiology, ASMN-IRCCS, Reggio Emilia, Italy
| | - E Sabetta
- Orthopaedic Unit, Department of Neuromotor Physiology, ASMN-IRCCS, Reggio Emilia, Italy
| | - A Ferrari
- Geriatric Unit, Department of Neuromotor Physiology, ASMN-IRCCS, Via Risorgimento 70, 42100, Reggio Emilia, Italy
| | - C Tedeschi
- Physical and Rehabilitation Medicine Unit, Department of Neuromotor Physiology, ASMN-IRCCS, Reggio Emilia, Italy
| | - M L Lunardelli
- Orthogeriatric Unit, Department of Internal Medicine, Aging and Nephrology, University Hospital Policlinico S.Orsola Malpighi, Bologna, Italy
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Mezzenga E, D’Errico V, Sarnelli A, Strigari L, Menghi E, Marcocci F, Bianchini D, Benassi M. Preliminary Retrospective Analysis of Daily Tomotherapy Output Constancy Checks Using Statistical Process Control. PLoS One 2016; 11:e0147936. [PMID: 26848962 PMCID: PMC4746057 DOI: 10.1371/journal.pone.0147936] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 01/11/2016] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study was to retrospectively evaluate the results from a Helical TomoTherapy Hi-Art treatment system relating to quality controls based on daily static and dynamic output checks using statistical process control methods. Individual value X-charts, exponentially weighted moving average charts, and process capability and acceptability indices were used to monitor the treatment system performance. Daily output values measured from January 2014 to January 2015 were considered. The results obtained showed that, although the process was in control, there was an out-of-control situation in the principal maintenance intervention for the treatment system. In particular, process capability indices showed a decreasing percentage of points in control which was, however, acceptable according to AAPM TG148 guidelines. Our findings underline the importance of restricting the acceptable range of daily output checks and suggest a future line of investigation for a detailed process control of daily output checks for the Helical TomoTherapy Hi-Art treatment system.
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Affiliation(s)
- Emilio Mezzenga
- Medical Physics Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
- * E-mail:
| | - Vincenzo D’Errico
- Medical Physics Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | - Anna Sarnelli
- Medical Physics Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | - Lidia Strigari
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome, Italy
| | - Enrico Menghi
- Medical Physics Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | - Francesco Marcocci
- Medical Physics Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | - David Bianchini
- Medical Physics Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | - Marcello Benassi
- Medical Physics Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
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D'Errico V, Sarnelli A, Bianchini D, Menghi E, Mezzenga E, Marcocci F, Strigari L, Benassi M. Exploiting the machine log files for VMAT and IMRT treatment verification. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.01.062] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Rescigno P, Lorente D, Bianchini D, Kolinsky M, Zafeiriou Z, Ferraldeschi R, Mateo J, Recine F, Jayaram A, Nava Rodrigues D, Riisnaes R, Miranda S, Figueiredo I, Crespo M, Mehra N, Perez-Lopez R, Tunariu N, Reid A, Attard G, De Bono J. 2558 Impact of PTEN protein loss on response to docetaxel and overall survival (OS) in metastatic castration resistant prostate cancer (mCRPC) patients. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31377-6] [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: 11/28/2022]
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Zannoli R, Bianchini D, Corazza I. A medical instrumentation laboratory dedicated to cardiovascular nurse training. Nurse Educ Today 2015; 35:e26-e30. [PMID: 26004438 DOI: 10.1016/j.nedt.2015.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 05/01/2015] [Indexed: 06/04/2023]
Affiliation(s)
- Romano Zannoli
- Experimental, Diagnostic and Specialty Medicine Department, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - David Bianchini
- Experimental, Diagnostic and Specialty Medicine Department, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Ivan Corazza
- Experimental, Diagnostic and Specialty Medicine Department, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.
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Lorente D, Ravi P, Mehra N, Gillman A, Omlin A, Pezaro C, Miranda M, Mateo J, Rescigno P, Kolinsky M, Porta N, Jayaram A, Bianchini D, Hall E, Ijzerman M, De Bono J. 2579 Evaluation of clinical decision-making and the use of circulating tumor cells (CTCs) by physicians treating castration-resistant prostate cancer (CRPC). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31398-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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33
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Crespo M, van Dalum G, Ferraldeschi R, Zafeiriou Z, Sideris S, Lorente D, Bianchini D, Rodrigues DN, Riisnaes R, Miranda S, Figueiredo I, Flohr P, Nowakowska K, de Bono JS, Terstappen LWMM, Attard G. Androgen receptor expression in circulating tumour cells from castration-resistant prostate cancer patients treated with novel endocrine agents. Br J Cancer 2015; 112:1166-74. [PMID: 25719830 PMCID: PMC4385957 DOI: 10.1038/bjc.2015.63] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 01/19/2015] [Accepted: 01/27/2015] [Indexed: 01/15/2023] Open
Abstract
Background: Abiraterone and enzalutamide are novel endocrine treatments that abrogate androgen receptor (AR) signalling in castration-resistant prostate cancer (CRPC). Here, we developed a circulating tumour cells (CTCs)-based assay to evaluate AR expression in real-time in CRPC and investigated nuclear AR expression in CTCs in patients treated with enzalutamide and abiraterone. Methods: CTCs were captured and characterised using the CellSearch system. An automated algorithm to identify CTCs and quantify AR expression was employed. The primary aim was to evaluate the association between CTC AR expression and prior treatment with abiraterone or enzalutamide. Results: AR expression in CTCs was evaluated in 94 samples from 48 metastatic CRPC patients. We observed large intra-patient heterogeneity of AR expression in CTCs. Prior exposure to abiraterone or enzalutamide was not associated with a change in CTCs AR expression (median intensity and distribution of AR-positive classes). In support of this, we also confirmed maintained nuclear AR expression in tissue samples collected after progression on abiraterone. AR staining also identified additional AR-positive CD45-negative circulating cells that were CK-negative/weak and therefore missed using standard protocols. The number of these events correlated with traditional CTCs and was associated with worse outcome on univariate analysis. Conclusions: We developed a non-invasive method to monitor AR nuclear expression in CTCs. Our studies confirm nuclear AR expression in CRPC patients progressing on novel endocrine treatments. Owing to the significant heterogeneity of AR expression in CTCs, studies in larger cohorts of patients are required to identify associations with outcome.
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Affiliation(s)
- M Crespo
- Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK
| | - G van Dalum
- Department of Medical Cell BioPhysics, MIRA Institute, University of Twente, 7522ND, Enschede, The Netherlands
| | - R Ferraldeschi
- 1] Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK [2] Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, SM2 5NG, UK
| | - Z Zafeiriou
- 1] Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK [2] Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, SM2 5NG, UK
| | - S Sideris
- 1] Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK [2] Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, SM2 5NG, UK
| | - D Lorente
- 1] Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK [2] Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, SM2 5NG, UK
| | - D Bianchini
- 1] Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK [2] Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, SM2 5NG, UK
| | - D N Rodrigues
- Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK
| | - R Riisnaes
- Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK
| | - S Miranda
- Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK
| | - I Figueiredo
- Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK
| | - P Flohr
- Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK
| | - K Nowakowska
- Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK
| | - J S de Bono
- 1] Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK [2] Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, SM2 5NG, UK
| | - L W M M Terstappen
- Department of Medical Cell BioPhysics, MIRA Institute, University of Twente, 7522ND, Enschede, The Netherlands
| | - G Attard
- 1] Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK [2] Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, SM2 5NG, UK
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Lorente D, Mateo J, Templeton AJ, Zafeiriou Z, Bianchini D, Ferraldeschi R, Bahl A, Shen L, Su Z, Sartor O, de Bono JS. Baseline neutrophil-lymphocyte ratio (NLR) is associated with survival and response to treatment with second-line chemotherapy for advanced prostate cancer independent of baseline steroid use. Ann Oncol 2014; 26:750-755. [PMID: 25538172 DOI: 10.1093/annonc/mdu587] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The neutrophil-lymphocyte ratio (NLR), proposed as an indicator of cancer-related inflammation, has known prognostic value in prostate cancer. We examine its association with survival (OS) and response in patients treated with second-line chemotherapy. METHODS We analysed patients with metastatic castration-resistant prostate cancer (mCRPC) treated in the TROPIC trial, evaluating cabazitaxel versus mitoxantrone. Cox regression models were used to investigate the association of baseline NLR (BLNLR) with OS and the significance of a change in NLR count with treatment. Logistic regression models were used to determine the association of BLNLR counts with prostate specific antigen (PSA) and RECIST responses. The optimal NLR cut-off was established based on the concordance index of different values. RESULTS Data from 755, 654 and 405 patients was available for OS, PSA and RECIST response analysis respectively. Median OS was 14.0 months [95% confidence interval (CI) 13.2-14.8]. Median NLR was 2.9 (IQR: 1.9-5.1). BLNLR was associated with survival (HR 1.5, 95% CI 1.1-2.1, P = 0.011) in multivariable analysis (MVA) independently of variables included in the Halabi nomogram, treatment arm and corticosteroid use. The optimal cut-off for a dichotomous NLR was selected at 3.0 based on its higher c-index related to survival. BLNLR ≥3.0 was associated with lower PSA response (40.1% versus 59.9%; P < 0.001) and RECIST response (7.7% versus 15.6%, P = 0.022) in MVA. Conversion from high (≥3) to low (<3) NLR was associated with improved survival (HR 0.66; 95% CI 0.51-0.85; P = 0.001) and higher PSA response rates (66.4% versus 33.6%; P = 0.000). Use of corticosteroids at baseline did not modify the association between NLR and survival. CONCLUSIONS NLR is a valid prognostic biomarker in CRPC and is associated with survival, PSA and RECIST responses in patients treated with second-line chemotherapy. Changes in NLR counts with treatment may indicate benefit. NLR prognostic value is independent of prior use of corticosteroids. CLINICALTRIALSGOV NCT00417079.
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Affiliation(s)
- D Lorente
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton (Surrey), UK
| | - J Mateo
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton (Surrey), UK
| | - A J Templeton
- Department of Medical Oncology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Z Zafeiriou
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton (Surrey), UK
| | - D Bianchini
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton (Surrey), UK
| | - R Ferraldeschi
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton (Surrey), UK
| | - A Bahl
- Department of Clinical Oncology, Bristol Haematology and Oncology Centre, Bristol, UK
| | - L Shen
- Oncology, Sanofi Oncology, Cambridge
| | - Z Su
- Oncology, Sanofi Oncology, Cambridge
| | - O Sartor
- Department of Medicine: Section of Hematology & Medical Oncology and Department of Urology, Tulane University, New Orleans, USA
| | - J S de Bono
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton (Surrey), UK.
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Corazza I, Bianchini D, Urbinati S, Zannoli R. REHAL®, a telemedicine platform for home cardiac rehabilitation. Minerva Cardioangiol 2014; 62:399-405. [PMID: 25069785] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM The new REHAL® platform manages home-based cardiac rehabilitation programs without most of the drawbacks of an earlier E-Remedy EC proposal. The proposal is based on the awareness that safe home rehabilitation is only possible in the post-hospital phase when the patient no longer needs direct control by medical staff and has become accustomed to the technological set-up. METHODS The platform is composed of a web-based database and client software (Ergomonitor), which allows health staff to manage the sessions without a real-time connection and legal liability. Ergomonitor permits the complete management of a bike (training session settings, web transmission and data recording) by a serial connection to a PC. Patients own their data and may approve the access of health personnel to evaluate the results and introduce longitudinal ambulatory information together with updated physical activity protocols. The health service does not bear the cost of the technological set-up. Ergomonitor acquires and records heart rate, loads, pedalling speed and other parameters of interest (i.e., arterial pressure) and forwards data to a remote database. Health personnel can modify time by time the scheduled exercise settings, analyse the results of each session and compare session by session. RESULTS The platform is actually used in hospital, gymnasium and home context. More than 1000 subjects have been enrolled in the protocol, with a very good appreciation. CONCLUSION The first experience of REHAL® (six months, more than 1000 enrolled patients) highlights the positive aspects of the solution: the patients are very satisfied with the continuity of the rehabilitation programme and the clinicians are very satisfied they can follow their patient population longitudinally and with a personalized protocol.
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Affiliation(s)
- I Corazza
- Experimental, Diagnostic and Specialty Medicine Department DIMES, University of Bologna, Bologna, Italy -
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Zafeiriou Z, Ferraldeschi R, Omlin A, Pezaro C, Mukherji D, Lorente D, Altavilla A, Sideris S, Rescigno P, Mateo J, Bianchini D, Smith A, Lopez RP, Mehra N, Ravi P, Grist E, Tunariu N, Attard G, de Bono J. Sequencing of Docetaxel (D) and Abiraterone Acetate (Aa) for Metastatic Castration-Resistant Prostate Cancer (Mcrpc). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu336.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Corazza I, Bianchini D, Marcelli E, Cercenelli L, Zannoli R. Passive aortic counterpulsation: Biomechanical rationale and bench validation. J Biomech 2014; 47:1618-25. [DOI: 10.1016/j.jbiomech.2014.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 01/08/2014] [Accepted: 03/01/2014] [Indexed: 11/26/2022]
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Messiou C, Collins DJ, Morgan VA, Bianchini D, de Bono JS, de Souza NM. Use of apparent diffusion coefficient as a response biomarker in bone: effect of developing sclerosis on quantified values. Skeletal Radiol 2014; 43:205-8. [PMID: 24271011 DOI: 10.1007/s00256-013-1768-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 10/09/2013] [Accepted: 10/21/2013] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To investigate the effect of sclerosis on apparent diffusion coefficient measurements in bone metastases from prostate cancer undergoing treatment. MATERIALS AND METHODS Sixteen patients underwent CT scans and MRI at baseline and 12 weeks following commencement of chemotherapy. For each patient, up to five bone metastases were selected. Hounsfield units were measured on CT and apparent diffusion coefficient (ADC) was measured on diffusion weighted MRI at both time points. Correlations between changes in apparent diffusion coefficient and Hounsfield units were investigated. RESULTS Corresponding pre- and post-treatment apparent diffusion coefficient and Hounsfield units were available on 60 lesions from 16 patients. Overall, there was no significant correlation between changes in apparent diffusion coefficient with Hounsfield units. However, where changes in Hounsfield units increased by more than 50 %, there was a trend for an associated ADC rise. CONCLUSIONS Increasing sclerosis of bone metastases on treatment does not significantly impede diffusion.
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Affiliation(s)
- C Messiou
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK,
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Pezaro C, Omlin A, Lorente D, Rodrigues DN, Ferraldeschi R, Bianchini D, Mukherji D, Riisnaes R, Altavilla A, Crespo M, Tunariu N, de Bono J, Attard G. Visceral disease in castration-resistant prostate cancer. Eur Urol 2014; 65:270-273. [PMID: 24295792 PMCID: PMC4881819 DOI: 10.1016/j.eururo.2013.10.055] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [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: 09/23/2013] [Accepted: 10/31/2013] [Indexed: 11/29/2022]
Abstract
Metastatic involvement of the viscera in men with advanced castration-resistant prostate cancer (CRPC) has been poorly characterised to date. In 359 CRPC patients treated between June 2003 and December 2011, the frequency of radiologically detected visceral metastases before death was 32%. Of the 92 patients with computed tomography performed within 3 mo of death, 49% had visceral metastases. Visceral metastases most commonly involved the liver (20%) and lung (13%). Median survival from diagnosis of visceral disease was 7.1 mo (95% confidence interval, 5.9-8.3). Survival was affected by the degree of bone involvement at detection of visceral disease, varying from 6.1 mo in men with more than six bone metastases to 18.2 mo in men with no bone metastases (p=0.001). Heterogeneity was noted in clinical phenotypes and prostate-specific antigen trends at development of visceral metastases. Visceral metastases are now more commonly detected in men with CRPC, likely due to the introduction of novel survival-prolonging treatments.
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Affiliation(s)
- C Pezaro
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - A Omlin
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - D Lorente
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - D Nava Rodrigues
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - R Ferraldeschi
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - D Bianchini
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - D Mukherji
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - R Riisnaes
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - A Altavilla
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - M Crespo
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - N Tunariu
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - J de Bono
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - G Attard
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
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Bianchini D, Lorente D, Rodriguez-Vida A, Omlin A, Pezaro C, Ferraldeschi R, Zivi A, Attard G, Chowdhury S, de Bono JS. Antitumour activity of enzalutamide (MDV3100) in patients with metastatic castration-resistant prostate cancer (CRPC) pre-treated with docetaxel and abiraterone. Eur J Cancer 2013; 50:78-84. [PMID: 24074764 DOI: 10.1016/j.ejca.2013.08.020] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [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: 05/08/2013] [Revised: 07/23/2013] [Accepted: 08/22/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The new generation anti-androgen enzalutamide and the potent CYP17 inhibitor abiraterone have both demonstrated survival benefits in patients with metastatic castration-resistant prostate cancer (CRPC) progressing after docetaxel. Preliminary data on the antitumour activity of abiraterone after enzalutamide have suggested limited activity. The antitumour activity and safety of enzalutamide after abiraterone in metastatic CRPC patients is still unknown. PATIENTS AND METHODS We retrospectively identified patients treated with docetaxel and abiraterone prior to enzalutamide to investigate the activity and safety of enzalutamide in a more advanced setting. Prostate specific antigen (PSA), radiological and clinical assessments were analysed. RESULTS 39 patients with metastatic CRPC were identified for this analysis (median age 70years, range: 54-85years). Overall 16 patients (41%) had a confirmed PSA decline of at least 30%. Confirmed PSA declines of ⩾50% and ⩾90% were achieved in 5/39 (12.8%) and 1/39 (2.5%) respectively. Of the 15 patients who responded to abiraterone, two (13.3%) also had a confirmed ⩾50% PSA decline on subsequent enzalutamide. Among the 22 abiraterone-refractory patients, two (9%) achieved a confirmed ⩾50% PSA decline on enzalutamide. CONCLUSION Our preliminary case series data suggest limited activity of enzalutamide in the post-docetaxel and post-abiraterone patient population.
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Affiliation(s)
- D Bianchini
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - D Lorente
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - A Rodriguez-Vida
- Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London, UK
| | - A Omlin
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - C Pezaro
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - R Ferraldeschi
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - A Zivi
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - G Attard
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - S Chowdhury
- Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London, UK
| | - J S de Bono
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK.
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Omlin A, Pezaro CJ, Zaidi S, Lorente D, Mukherji D, Bianchini D, Ferraldeschi R, Sandhu S, Dearnaley D, Parker C, Van As N, de Bono JS, Attard G. Antitumour activity of abiraterone and diethylstilboestrol when administered sequentially to men with castration-resistant prostate cancer. Br J Cancer 2013; 109:1079-84. [PMID: 23928659 PMCID: PMC3778298 DOI: 10.1038/bjc.2013.446] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 07/05/2013] [Accepted: 07/10/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Abiraterone is a standard treatment for men with castration-resistant prostate cancer (CRPC). We evaluated the antitumour activity of abiraterone following the synthetic oestrogen diethylstilboestrol (DES). METHODS Castration-resistant prostate cancer patients treated with abiraterone were identified. Demographics, response variables and survival data were recorded. RESULTS Two-hundred and seventy-four patients received abiraterone, 114 (41.6%) after DES. Pre-chemotherapy abiraterone resulted in ≥50% PSA declines in 35/41 (85.4%) DES-naïve and 20/27 (74.1%) DES-treated patients. Post-docetaxel abiraterone resulted in ≥50% PSA declines in 40/113 (35.4%) DES-naïve and 23/81 (28.4%) DES-treated patients. Time to PSA progression was similar regardless of prior DES. CONCLUSION Abiraterone has important antitumour activity in men with CRPC even after DES exposure.
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Affiliation(s)
- A Omlin
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
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Pezaro C, Mukherji D, Tunariu N, Cassidy AM, Omlin A, Bianchini D, Seed G, Reid AHM, Olmos D, de Bono JS, Attard G. Sarcopenia and change in body composition following maximal androgen suppression with abiraterone in men with castration-resistant prostate cancer. Br J Cancer 2013; 109:325-31. [PMID: 23807167 PMCID: PMC3721397 DOI: 10.1038/bjc.2013.340] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 06/04/2013] [Accepted: 06/09/2013] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Standard medical castration reduces muscle mass. We sought to characterize body composition changes in men undergoing maximal androgen suppression with and without exogenous gluocorticoids. METHODS Cross-sectional areas of total fat, visceral fat and muscle were measured on serial CT scans in a post-hoc analysis of patients treated in Phase I/II trials with abiraterone followed by abiraterone and dexamethasone 0.5 mg daily. Linear mixed regression models were used to account for variations in time-on-treatment and baseline body mass index (BMI). RESULTS Fifty-five patients received a median of 7.5 months abiraterone followed by 5.4 months abiraterone and dexamethasone. Muscle loss was observed on single-agent abiraterone (maximal in patients with baseline BMI >30, -4.3%), but no further loss was observed after addition of dexamethasone. Loss of visceral fat was also observed on single-agent abiraterone, (baseline BMI >30 patients -19.6%). In contrast, addition of dexamethasone led to an increase in central visceral and total fat and BMI in all the patients. INTERPRETATION Maximal androgen suppression was associated with loss of muscle and visceral fat. Addition of low dose dexamethasone resulted in significant increases in visceral and total fat. These changes could have important quality-of-life implications for men treated with abiraterone.
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Affiliation(s)
- C Pezaro
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - D Mukherji
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - N Tunariu
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - A M Cassidy
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - A Omlin
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - D Bianchini
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - G Seed
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - A H M Reid
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - D Olmos
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - J S de Bono
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - G Attard
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
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Loriot Y, Bianchini D, Ileana E, Sandhu S, Patrikidou A, Pezaro C, Albiges L, Attard G, Fizazi K, De Bono JS, Massard C. Antitumour activity of abiraterone acetate against metastatic castration-resistant prostate cancer progressing after docetaxel and enzalutamide (MDV3100). Ann Oncol 2013; 24:1807-1812. [PMID: 23576708 DOI: 10.1093/annonc/mdt136] [Citation(s) in RCA: 275] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Androgen receptor (AR) signalling remains critically important in metastatic castration-resistant prostate cancer (mCRPC) as confirmed by recent phase III trials, showing a survival advantage for abiraterone acetate and enzalutamide (MDV3100). The antitumour activity of abiraterone and prednisolone in patients pre-treated with enzalutamide is as yet unknown. PATIENTS AND METHODS We investigated the antitumour activity of abiraterone and prednisolone in patients with mCRPC who had progressed following treatment with docetaxel (Taxotere) and enzalutamide. Clinical data were retrospectively analysed for prostate-specific antigen (PSA) and RECIST responses, clinical benefit and survival. RESULTS Thirty-eight patients were included in the analysis. The median age was 71 years (range 52-84); metastatic sites included bone disease in 37 patients (97%), lymph nodes in 15 patients (39%) and visceral disease in 10 patients (26%). Abiraterone was well tolerated. Three patients (8%) attained a PSA response, defined as ≥50% decline in PSA confirmed after ≥4 weeks, while seven patients (18%) had a ≥30% PSA decline. The median progression-free survival (PFS) was 2.7 months (95% CI 2.3-4.1). Of the 12 patients assessable radiologically, only 1 (8%) attained a confirmed partial response. CONCLUSION Abiraterone and prednisolone have modest antitumour activities in patients with mCRPC pretreated with docetaxel and enzalutamide.
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Affiliation(s)
- Y Loriot
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris-Sud, INSERM 981, Villejuif, France.
| | - D Bianchini
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - E Ileana
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris-Sud, INSERM 981, Villejuif, France
| | - S Sandhu
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - A Patrikidou
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris-Sud, INSERM 981, Villejuif, France
| | - C Pezaro
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - L Albiges
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris-Sud, INSERM 981, Villejuif, France
| | - G Attard
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - K Fizazi
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris-Sud, INSERM 981, Villejuif, France
| | - J S De Bono
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - C Massard
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris-Sud, INSERM 981, Villejuif, France
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Grieco T, Faina V, Milana M, Dies L, Bianchini D, Calvieri S. Allergic diseases and climate changes: our experience and an update. Clin Ter 2013; 164:e17-e21. [PMID: 23455746 DOI: 10.7417/ct.2013.1515] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIMS Recent research has shown that there are many effects of climate change on aeroallergens and thus allergic diseases in humans. It is not easy to evaluate the impact of climate change and air pollution on the prevalence of allergic diseases. The present study is devoted to decipher the possible relationships between climatic changes and allergic diseases, and in particular with atopic dermatitis (AD). MATERIALS AND METHODS To evaluate the aeroallergens effects on AD, we submitted to an allergological study protocol 59 children patients with AD to study the interaction between aeroallergens-atopy patch test (APT) and skin prick test (SPT). The same tests were performed on to the same patients after 24 months to assess the time trend. RESULTS We found a high prevalence of house dust mites and grasses pollen APT positivity in AD's and in respiratory patients and we also found an increase in positive results in the same patients after 24 months. However, we observed a variation in the control group, in which in earlier tests all patients had negative results but after 24 months we found some positivity. CONCLUSION We found a correlation between APT and SPT in AD and we observed a concordance between APT results and the atopy score index, underlying the triggering role of these aereoallergens in the atopic patient's skin reactivity.
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Affiliation(s)
- T Grieco
- Department of Dermatology, University Sapienza, Rome, Italy.
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Mezynski J, Pezaro C, Bianchini D, Zivi A, Sandhu S, Thompson E, Hunt J, Sheridan E, Baikady B, Sarvadikar A, Maier G, Reid AHM, Mulick Cassidy A, Olmos D, Attard G, de Bono J. Antitumour activity of docetaxel following treatment with the CYP17A1 inhibitor abiraterone: clinical evidence for cross-resistance? Ann Oncol 2012; 23:2943-2947. [PMID: 22771826 DOI: 10.1093/annonc/mds119] [Citation(s) in RCA: 210] [Impact Index Per Article: 17.5] [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] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Abiraterone and docetaxel are both approved treatments for men with metastatic castration-resistant prostate cancer (mCRPC). Abiraterone pre-docetaxel is currently undergoing evaluation in a phase III study. In vitro studies indicate that taxanes may act by disrupting androgen receptor signalling. We hypothesised that prior abiraterone exposure would adversely impact docetaxel efficacy. PATIENTS AND METHODS We retrospectively evaluated activity of docetaxel in mCRPC patients previously treated with abiraterone, using Prostate Cancer Working Group and radiological criteria. RESULTS Of the 54 patients treated with abiraterone, 35 subsequently received docetaxel. Docetaxel resulted in a prostate-specific antigen (PSA) decline of ≥50% in nine patients [26%, 95% confidence interval (CI) 13% to 43%], with a median time to PSA progression of 4.6 months (95% CI 4.2% to 5.9%). PSA declines ≥30% were achieved by 13 patients (37%, 95% CI 22% to 55%). The median overall survival was 12.5 months (95% CI 10.6-19.4). All patients who failed to achieve a PSA fall on abiraterone and were deemed abiraterone-refractory were also docetaxel-refractory (N = 8). In the 24 patients with radiologically evaluable disease, partial responses were reported in four patients (11%), none of whom were abiraterone-refractory. CONCLUSION The activity of docetaxel post-abiraterone appears lower than anticipated and no responses to docetaxel were observed in abiraterone-refractory patients.
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Affiliation(s)
- J Mezynski
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - C Pezaro
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - D Bianchini
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - A Zivi
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - S Sandhu
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - E Thompson
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - J Hunt
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - E Sheridan
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - B Baikady
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - A Sarvadikar
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - G Maier
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - A H M Reid
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - A Mulick Cassidy
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - D Olmos
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - G Attard
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK.
| | - J de Bono
- Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
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Bianchini D, Loriot Y, Ileana E, Sandhu S, Pezaro C, Albiges L, Attard G, Fizazi K, de Bono J, Massard C. Abiraterone in Patients with Metastatic Castration-Resistant Prostate Cancer Progressing after Docetaxel and MDV3100: A Multicentre Study. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33483-9] [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: 11/30/2022] Open
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Abstract
Treatment options for patients with advanced prostate cancer (PCa) remain limited. Improved understanding of the underlying molecular drivers of PCa pathogenesis, progression and resistance development has provided the fundamental basis for rational targeted drug design. Key findings in recent years include the identification of ETS gene rearrangements, the dissection of PCa molecular heterogeneity and the discovery that castration-resistant prostate cancer (CRPC) remains androgen driven despite the androgen-depleted milieu, thus making androgen receptor (AR) signaling a continued focus of molecularly targeted treatments. AR ligand-independent activation of tyrosine kinase prosurvival signaling cascades and angiogenesis have also been implicated in disease progression. A multitude of new molecularly targeted agents that abrogate AR signaling, inhibit the mitogenic and prosurvival signal transduction pathways, perturb the tumor-bone microenvironment, impair tumor vasculature, facilitate immune modulation and induce apoptosis are in clinical development and are highly likely to change the current treatment paradigm. It is clear that the success of these molecular targeted therapies hinges in part on optimal patient selection based on the molecular disease profile and an improved understanding of the mechanistic basis of acquired resistance. This review outlines the current clinical development of molecular targeted treatments in CRPC, with particular emphasis on agents that are in the later stages of clinical development, and details the challenges and future direction of developing these antitumor agents.
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Affiliation(s)
- D Bianchini
- The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, UK
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Olmos D, Clark J, Brewer D, Barwell L, Attard G, Reid AH, Sandhu SK, Zivi A, Bianchini D, Babu Oomen N, Thompson E, Molife LR, Kaye SB, Parker C, Cooper C, Jones RJ, De Bono JS. An evaluation of blood mRNA expression array signatures derived from unsupervised analyses in the identification of prostate cancers with poor outcome. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4577] [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: 11/20/2022] Open
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Mezynski J, Attard G, Zivi A, Bianchini D, Sandhu S, Cassidy AM, Thompson E, Reid A, Baikady B, de Bono J. 31 Evaluating the antitumour activity of docetaxel following treatment with abiraterone acetate and steroids: Evidence for cross-resistance. Crit Rev Oncol Hematol 2011. [DOI: 10.1016/s1040-8428(11)70050-6] [Citation(s) in RCA: 2] [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: 11/16/2022] Open
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Bianchini D, Zivi A, Attard G, Mezynski J, Cassidy A, Sandhu S, Hunt J, Sheridan L, Thompson E, de Bono J. 30 Weight change analysis in advanced castration resistant prostate cancer (CRPC) patients treated with Abiraterone Acetate (AA) single agent and in combination with steroids. Crit Rev Oncol Hematol 2011. [DOI: 10.1016/s1040-8428(11)70049-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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