1
|
Pelizzari G, Bertoli E, Buriolla S, Vitale MG, Basile D, Palmero L, Zara D, Iacono D, Andrea F, Pascoletti G, Bolzonello S, Garutti M, Fasola G, Puglisi F, Minisini AM. Estimating survival in patients with melanoma brain metastases: prognostic value of lactate dehydrogenase. Melanoma Res 2023; 33:398-405. [PMID: 37402350 DOI: 10.1097/cmr.0000000000000907] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Patients with melanoma brain metastases (MBM) have poor prognosis, albeit advances in locoregional and systemic treatments. The melanoma-specific Graded Prognostic Assessment (GPA) effectively stratifies survival for patients with MBM. Nevertheless, lactate dehydrogenase (LDH), a well known prognostic factor for patients with melanoma, is not represented in the GPA scores and might add prognostic information for patients with MBM. In this study, 150 consecutive patients with MBM were retrospectively analyzed with the aim of evaluating independent prognostic factors for MBM patients, including LDH. Furthermore, we implemented a disease-specific prognostic score and estimated survival according to treatment modalities. On the basis of multivariable Cox regression analyses, six prognostic factors (age, BRAF status, number of MBM, number of extracranial metastatic sites, performance status, and LDH level) resulted statistically significant in terms of survival and were combined in a prognostic score to stratify patients in distinct prognostic groups ( P < 0.0001). Among treatment modalities, a multimodal approach with stereotactic radiosurgery or neurosurgery associated with systemic therapy showed the best outcome (median overall survival: 12.32 months, 95% confidence interval, 7.92-25.30). This is the first study to demonstrate that LDH has independent prognostic value for patients with MBM and might be used to improve prognostic stratification, albeit external validation is mandatory. Survival of patients with MBM is affected by both disease-specific risk factors and treatment modalities, with locoregional treatments associated with better outcomes.
Collapse
Affiliation(s)
- Giacomo Pelizzari
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC)
| | - Elisa Bertoli
- Department of Medicine (DAME), University of Udine, Udine
- Department of Medical Oncology, CRO Aviano National Cancer Institute IRCSS, Aviano
| | - Silvia Buriolla
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC)
- Department of Medicine (DAME), University of Udine, Udine
| | - Maria Grazia Vitale
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli
| | - Debora Basile
- Department of Medical Oncology, San Giovanni di Dio Hospital, Crotone, Italy
| | - Lorenza Palmero
- Department of Medicine (DAME), University of Udine, Udine
- Department of Medical Oncology, CRO Aviano National Cancer Institute IRCSS, Aviano
| | - Diego Zara
- Department of Medicine (DAME), University of Udine, Udine
- Department of Medical Oncology, CRO Aviano National Cancer Institute IRCSS, Aviano
| | - Donatella Iacono
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC)
| | - Freschi Andrea
- Department of Medical Oncology, CRO Aviano National Cancer Institute IRCSS, Aviano
| | - Gaetano Pascoletti
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC)
| | - Silvia Bolzonello
- Department of Medical Oncology, CRO Aviano National Cancer Institute IRCSS, Aviano
| | - Mattia Garutti
- Department of Medical Oncology, CRO Aviano National Cancer Institute IRCSS, Aviano
| | - Gianpiero Fasola
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC)
| | - Fabio Puglisi
- Department of Medicine (DAME), University of Udine, Udine
- Department of Medical Oncology, CRO Aviano National Cancer Institute IRCSS, Aviano
| | | |
Collapse
|
2
|
de Scordilli M, Michelotti A, Zara D, Palmero L, Alberti M, Noto C, Totaro F, Foltran L, Guardascione M, Iacono D, Ongaro E, Fasola G, Puglisi F. Preoperative treatments in borderline resectable and locally advanced pancreatic cancer: current evidence and new perspectives. Crit Rev Oncol Hematol 2023; 186:104013. [PMID: 37116817 DOI: 10.1016/j.critrevonc.2023.104013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 04/10/2023] [Accepted: 04/24/2023] [Indexed: 04/30/2023] Open
Abstract
Surgery is the only curative treatment for non-metastatic pancreatic adenocarcinoma, but less than 20% of patients present a resectable disease at diagnosis. Treatment strategies and disease definition for borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) vary in the different cancer centres. Preoperative chemotherapy (CT) is the standard of care for both BRPC and LAPC patients, however literature data are still controversial concerning the type, dose and duration of the different CT regimens, as well as regarding the integration of radiotherapy (RT) or chemoradiation (CRT) in the therapeutic algorithm. In this unsettled debate, we aimed at focusing on the therapeutic regimens currently in use and relative literature data, to report international trials comparing the available therapeutic options or explore the introduction of new pharmacological agents, and to analyse possible new scenarios in microenvironment evaluation before and after neoadjuvant therapies or in patients' selection at a molecular level.
Collapse
Affiliation(s)
- Marco de Scordilli
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy.
| | - Anna Michelotti
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; Department of Oncology, ASUFC University Hospital of Udine, 33100 Udine, Italy.
| | - Diego Zara
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy.
| | - Lorenza Palmero
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy.
| | - Martina Alberti
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; Department of Oncology, ASUFC University Hospital of Udine, 33100 Udine, Italy.
| | - Claudia Noto
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy.
| | - Fabiana Totaro
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy.
| | - Luisa Foltran
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy.
| | - Michela Guardascione
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy.
| | - Donatella Iacono
- Department of Oncology, ASUFC University Hospital of Udine, 33100 Udine, Italy.
| | - Elena Ongaro
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy.
| | - Gianpiero Fasola
- Department of Oncology, ASUFC University Hospital of Udine, 33100 Udine, Italy.
| | - Fabio Puglisi
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy.
| |
Collapse
|
3
|
DI Cola I, DI Muzio C, Conforti A, Iacono D, Pantano I, Rozza G, Rossi S, De Stefano L, Vitale A, Caso F, Costa L, Prete M, Navarini L, Sensini F, Iagnocco A, Atzeni F, Guggino G, Perosa F, Cantarini L, Frediani B, Bugatti S, Montecucco C, Ciccia F, Giacomelli R, Cipriani P, Ruscitti P. POS1337 ADULT-ONSET STILL’S DISEASE WITH ELDERLY ONSET, RESULTS FROM A MULTICENTRE STUDY AND ASSESSMENT OF AGE INFLUENCE ON CLINICAL FEATURES AND DISEASE OUTCOMES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1642] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundAging is a physiological, multidimensional, and irreversible process, occurring in humans over time. Interestingly, multiple lines of evidence have recently suggested that some diseases, generally affecting young adults, are nowadays described in the elderly, although possibly associated with different symptoms or complications. In this context, a possible occurrence of adult onset Still’s disease (AOSD) in elderly has been suggested. This is a rare inflammatory disorder of unknown origin usually observed in young adults [1-3].ObjectivesIn this study, we aimed at describing the clinical characteristics, life-threatening complications occurrence, and mortality of AOSD patients with an elderly onset. The manifestations of these patients were also compared with those with a younger onset. Furthermore, the predictive role of age was evaluated on clinical features and disease outcomes. Finally, in these patients, an assessment of associated comorbidities was also performed.MethodsA retrospective assessment of prospectively followed patients, from January 2001 to April 2021, was provided to analyse clinical features, life-threatening complications occurrence, and mortality in AOSD patients with onset in elderly. AOSD patients, who were included in multicentre Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale (GIRRCS) cohort, were evaluated.ResultsOut of 221 assessed patients, 37 (16.7%) had an onset of the disease aged over than 60 years. When compared with younger patients, these were characterised by a higher prevalence of pericarditis (p=0.008), comorbidities (p<0.0001), and mortality (p=0.023).Additionally, our analysis showed that pleuritis and pericarditis positively correlated with age (coefficient=0.227, p=0.001; coefficient=0.213, p=0.001, respectively). Furthermore, the occurrence of parenchymal lung disease was significantly related with age (coefficient=0.168, p=0.012). The presence of comorbidities positively correlated with age (coefficient=0.443, p<0.0001). Moreover, age was negatively related to the polycyclic pattern (coefficient=-0.209, p=0.002). A correlation between mortality and age was also retrieved (coefficient=0.158, p=0.019).Age predicted the presence of serositis in both univariate (HR: 1.02, 95%CI: 1.01-1.03, p=0.007) and multivariate analyses (HR: 1.02, 95%CI: 1.01-1.04, p=0.007). Age was also a significant predictor of parenchymal lung disease in both univariate (HR: 1.03, 95%CI: 1.01-1.05, p=0.017) and multivariate analyses (HR: 1.03, 95%CI: 1.00-1.05, p=0.048). No significant results were observed assessing the predictive role of age on occurrence of macrophage activation syndrome. Furthermore, age resulted to be a negative predictor of polycyclic pattern only in univariate analysis (HR: 0.99, 95%CI: 0.97-1.00, p=0.048). Finally, age significantly predicted the mortality in both univariate (HR: 1.03, 95%CI: 1.00-1.06, p=0.034) and multivariate analyses (HR: 1.05, 95%CI: 1.01-1.08, p=0.012).ConclusionClinical features of AOSD patients with elderly onset were described in our multicentre cohort. Although the main clinical characteristics were similar comparing older and younger patients, patients aged over 60 years at disease onset were characterised by an increased prevalence of serositis, comorbidities, mostly cardiometabolic, and a higher mortality rate. Age predicted the presence of parenchymal lung disease and mortality, and it could be considered a further negative prognostic factor in AOSD.References[1]Mollaeian A, Chen J, et al. BMC Rheumatol. 2021;5(1):12.[2]Maruyama A, et al. Mod Rheumatol. 2021;31(4):862-868.[3]Suzuki E, et al. Tohoku J Exp Med. 2021;255(3):195-202.Disclosure of InterestsNone declared
Collapse
|
4
|
Fasano S, Pantano I, Mauro D, Capocotta D, Iacono D, Gaggiano E, Pasquale MD, Rozza G, DI Vico C, Ruggiero A, Tirri E, Ciccia F. POS1210 PREVALENCE OF COVID-19 AMONG PATIENTS WITH RHEUMATIC DISEASES: AN OBSERVATIONAL SURVEY DURING THE TWO WAVES IN ITALY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2297] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The new coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) is a source of concern for the management of patients suffering from rheumatic and musculoskeletal diseases (RMDs) treated with immunomodulatory therapies (1).Objectives:We aimed to analyze the prevalence of SARS-CoV-2 infection in patients with RMDs living in Italy.Methods:During the first wave (March-May 2020) and during the second wave (October-December 2020) of COVID-19, we conducted a survey to investigate the incidence of SARS-CoV-2 infection in patients with RMDs followed at the Rheumatology Unit of the University of Campania, Italy. The demographic data, medication use, the frequency of respiratory symptoms and the incidence of COVID-19 confirmed by nasopharyngeal swab were collected with questionnaires administered by phone. The prevalence of COVID-19 of our cohort was compared to that of the general population (2).Results:During the first wave, we collected data from 900 patients with RMDs (Table 1): 320 patients with rheumatoid arthritis (RA), 295 patients with spondyloarthropathies (SpA), 283 patients with systemic lupus erythematosus (SLE), 2 patients with vasculitis. 546 (60%) were treated with bDMARD/tsDMARDs. Overall, a total of 11/900 (1%) cases were tested for COVID-19 due to compatible symptoms. 2 (0.2%) adult patients treated with bDMARDs were registered as swab test positive by PCR for COVID-19. 2 patients without confirmed COVID-19 developed pneumonia that required admission to hospital. No deaths occurred among the patients with confirmed COVID-19.During the second wave, data were collected from 470 patients who accepted to take part of the study (Table 1). 49 presented with symptoms that were compatible with COVID-19. 139 patients were tested whereas 30 patients (6%) had a swab confirmation of SARS-CoV-2 infection. Among them, 16 (53%) were treated with bDMARDs and a patient was treated with tofacitinib. we found no increase in COVID-19 prevalence in patients treated with bDMARD/tsDMARDs (p>0.05). A patient with SLE developed pneumonia that required admission to hospital and died.Lacking distinct prevalence data between first and second waves, we found no differences in total COVID-19 prevalence between general population living in Campania (215.752/5.802.000; 3.7%) and patients with RMDs (32/900; 3.5%). However, we had a significant increase in COVID-19 prevalence in our cohort during the second wave compared to the first. Nevertheless, no increase in mortality or hospitalization was recorded, confirming the safety of immunomodulatory therapies in patients with RMDs.Conclusion:In this cohort of patients with RMDs in a geographical region with a high prevalence of COVID-19, the risk of SARS-CoV-2 infection does not appear different from that observed in the general population.References:[1]Wang L., Wang Y., Ye D. Int J Antimicrob Agents. 2020:105948.[2]http://www.protezionecivile.gov.it/ (accessed 28.01.21)Table 1.Demographics and clinical characteristics of 900 patients with rheumatic diseases during the COVID-19 Pandemic.First waveSecond waveWomen, n 660 (73 %) 366(77%)Age, years, median (range)56 (54-57)53 (51-55)Rheumatoid Arthritis320 (35.5%)143 (30%)Spondyloarthritis295 (32%)110 (23%)Systemic Lupus Erythematosus283 (31%)217 (46 %)Vasculitis2 (0.2%)1 (0.2%)Prior ILD56 (6%)22 (4.6%)Smokers220 (24%)118 (25%)Hydroxychloroquine215 (23%)155 (32%)Steroids337 (37%)194 (41%)Prednisone equivalent dose, median (range)5 (0-75)5 (0-50)bDMARD/tsDMARDs546 (60%)247 (52%)csDMARDS387 (43%)185 (39%)Angiotensin-converting enzyme (ACE) inhibitors178 (19.8%)101 (21%)Angiotensin II receptor blockers(ARBs)153 (17%)61 (13%)Fever64 (7%)30 (6.3%)Cough83 (9%)36 (7%)Shortness of breath34 (3%)15 (3%)Sore throat32 (3%)11 (2.3%)Rhinorrhoea36 (3%)11 (2.3%)Headache5 (0.5%)2 (0.4%)Anosmia10 (1%)24 (5%)Myalgia2 (0.2%)1 (0.2%)Gastrointestinal symptoms24 (2.6%)3 (0.6%)Pneumonia2 (0.2%)2 (0.4%)Admission to hospital2 (0.2%)9 (1.9%)Swab confirmation of SARS-CoV-2 infection230Disclosure of Interests:None declared.
Collapse
|
5
|
Rovesti G, Leone F, Brandi G, Cesario S, Scartozzi M, Niger M, Yoo C, Filippi R, Casagrande M, Silvestris N, Santini D, Faloppi L, Palloni A, Aglietta M, Bernardini L, Cho H, Lai E, Fenocchio E, Pircher C, Iacono D, De Lorenzo S, Sperti E, Massa V, De Braud F, Jeong JH, Aprile G, Burgio V, Cascinu S, Casadei-Gardini A. A Novel Prognostic Tool in Western and Eastern Biliary Tract Cancer Patients Treated in First-line Setting: the ECSIPOT Index. J Gastrointest Cancer 2021; 53:528-536. [PMID: 34033000 DOI: 10.1007/s12029-021-00649-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIM The need to estimate prognosis of advanced BTC (aBTC) patients treated with first-line chemotherapy is compelling. The aim of the study is to evaluate the ECSIPOT (psECogSIiPnigOT) index, influenced by PECS (PsECogSii) index, prognostic nutritional index (PNI), and GOT. METHODS This international study was conducted on a training cohort of 126 patients and in three validation cohorts, both European and Korean. ECSIPOT index formula: (PECS:0 = 1 point; PECS:1 = 1.4 points; PECS:2 = 3.2 points) + (PNI > 36.7 = 1 point; PNI < 36.7 = 2 points) + (GOT < 100 = 1 point; GOT > 100 = 2 points). Event-time distributions were estimated using the Kaplan-Meier method, and survival curves were compared using the log-rank test. RESULTS In the training cohort, mOS was 12.9, 6.3, and 2.8 months for patients with ECSIPOT-0, ECSIPOT-1, and ECSIPOT-2, respectively (ECSIPOT-0: HR 1; ECSIPOT-1: HR 2.11; ECSIPOT-2: HR 4.93; p < 0.0001). In the first validation cohort, mOS was 11.5, 7.3, and 3.3 months for ECSIPOT-0, ECSIPOT-1, and ECSIPOT-2, respectively (ECSIPOT-0: HR 1; ECSIPOT-1: HR 1.74; ECSIPOT-2: HR 3.41; p < 0.0001). In the second validation cohort, mOS was 25.2, 12.5, and 3.0 months for ECSIPOT-0, ECSIPOT-1, and ECSIPOT-2, respectively (ECSIPOT-0: HR = 1; ECSIPOT-1: HR 2.33; ECSIPOT-2: HR 8.46; p < 0.0001). In the third validation cohort, mOS was 11.8, 8.1, and 4.6 months for ECSIPOT-0, ECSIPOT-1, and ECSIPOT-2, respectively (ECSIPOT-0: HR = 1; ECSIPOT-1: HR 1.47; ECSIPOT-2: HR 3.17; p < 0.0001). Multivariate analysis in all cohorts confirmed the ECSIPOT index as an independent prognostic factor for OS. CONCLUSION The easy assessment and good risk-stratification performance make the ECSIPOT index a promising tool to comprehensively estimate the prognosis of aBTC patients.
Collapse
Affiliation(s)
- Giulia Rovesti
- Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, Modena, Italy
| | - Francesco Leone
- Division of Medical Oncology, Nuovo Ospedale Degli Infermi, Ponderano, BI, Italy
| | - Giovanni Brandi
- Oncology Unit, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Silvia Cesario
- Medical Oncology Unit, Pisa University Hospital, Pisa, Italy
| | - Mario Scartozzi
- Medical Oncology, University Hospital of Cagliari, Cagliari, Italy
| | - Monica Niger
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Changhoon Yoo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Roberto Filippi
- Department of Oncology, Centro Oncologico Ematologico Subalpino, Azienda Universitaria Ospedaliera Città della Salute e Della Scienza di Torino, Torino, Italy
| | - Mariaelena Casagrande
- Medical Oncology Unit, Azienda Ospedaliero Universitaria, Santa Maria della Misericordia, Udine, Italy
| | - Nicola Silvestris
- Medical Oncology Department, IRCCS IstitutoTumori "Giovanni Paolo II", Bari, Italy.,Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Daniele Santini
- Medical Oncology Department, Campus Biomedico University, Roma, Italy
| | - Luca Faloppi
- Oncology Unit, Macerata Hospital, Macerata, Italy
| | - Andrea Palloni
- Oncology Unit, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Massimo Aglietta
- Department of Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | | | - Hyungwoo Cho
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eleonora Lai
- Medical Oncology, University Hospital of Cagliari, Cagliari, Italy
| | - Elisabetta Fenocchio
- Multidisciplinary Outpatient Oncology Clinic, Candiolo Cancer Institure FPO-IRCCS, Candiolo, TO, Italy
| | - Chiara Pircher
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Donatella Iacono
- Medical Oncology Unit, Azienda Ospedaliero Universitaria, Santa Maria della Misericordia, Udine, Italy
| | - Stefania De Lorenzo
- Oncology Unit, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Elisa Sperti
- Medical Oncology Unit, Ordine Mauriziano Hospital, Torino, Italy
| | - Valentina Massa
- Medical Oncology Unit, Pisa University Hospital, Pisa, Italy
| | - Filippo De Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Jae Ho Jeong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Giuseppe Aprile
- Department of Clinical Oncology, ULSS8 Berica, Vicenza, Italy
| | - Valentina Burgio
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Unit of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Cascinu
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Unit of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Casadei-Gardini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy. .,Unit of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Department of Medical Oncology, Università Vita- Salute, San Raffaele Hospital IRCCS, Via Olgettina 58, Milan, Italy.
| |
Collapse
|
6
|
Andreotti V, Cinausero M, Garattini S, Bortot L, Palmero L, Valent F, Riosa C, Iacono D, Casagrande M, Rihawi K, Macerelli M, Minisini A, Fasola G. 48P Impact of 12 months of immunotherapy for metastatic cancer patients on oncology workload. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.535] [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: 11/30/2022] Open
|
7
|
Andreotti V, Cinausero M, Garattini SK, Bortot L, Palmero L, Valent F, Riosa C, Iacono D, Casagrande M, Rihawi K, Macerelli M, Minisini AM, Fasola G. Impact of 12 months of immunotherapy for metastatic cancer patients on oncology workload. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.29_suppl.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
279 Background: In the last years, the introduction of immune checkpoint inhibitors (ICI) in clinical practice translated into major changes in oncology workload. We conducted a study aimed to estimate the shift in workload generated, within 1 year of first consultation, by any new metastatic cancer patient receiving ICI at the Oncology Department of the Academic Hospital of Udine, Italy. Methods: We collected from our electronic accountability system data all new cases of metastatic cancer between 01.01.2017 and 31.12.2018, leading to at least a second clinical episode (treatment sessions, unplanned presentations, hospitalizations, re-evaluations, follow-up, and inpatient oncology advices) during the following year. Patients (pts) were divided into those receiving ICI (anti-CTLA4/PD1/PDL1) versus pts receiving other treatments. Mean number per patient and standard deviation were calculated for clinical episodes, and the mean numbers in each group were compared using Student’s t-test (significance p<0.05). Follow-up continued until 31.12.2019. Results: 969 pts were included: 115 were treated with ICI, 854 received other treatments. In the first group a greater number of treatment sessions, re-evaluations and unplanned presentations was generated, with a statistically significant increased workload. On the other hand, pts receiving other treatments generated a greater workload in terms of follow-up. In detail, data are reported in Table. Conclusions: ICI have transformed the oncology landscape, leading to longer lasting treatment period with emerging toxicities. Estimating the workload generated by ICI is crucial for the implementation of more sustainable systems and for planning clinical activities. Mean number of clinical episodes in the first year of treatment with ICI for metastatic disease. Mean number per patient is represented by mean value and standard deviation (SD). Total number of clinical episodes is shown (N=). Data are reported for ICI versus other treatments group. [Table: see text]
Collapse
Affiliation(s)
- Victoria Andreotti
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Marika Cinausero
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | | | - Lucia Bortot
- Department of Medicine (DAME), University of Udine; Dipartimento di Oncologia Medica, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Udine, Italy
| | | | - Francesca Valent
- Institute of Hygiene and Clinical Epidemiology,University Hospital of Udine, Udine, Italy
| | - Chiara Riosa
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Donatella Iacono
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | | | - Karim Rihawi
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | | | | | - Gianpiero Fasola
- Department of Oncology, University Hospital of Udine, Udine, Italy
| |
Collapse
|
8
|
Iacono D, Vitale MG, Basile D, Pelizzari G, Cinausero M, Poletto E, Pascoletti G, Minisini AM. Immunotherapy for older patients with melanoma: From darkness to light? Pigment Cell Melanoma Res 2020; 34:550-563. [PMID: 32745351 DOI: 10.1111/pcmr.12917] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/10/2020] [Accepted: 07/28/2020] [Indexed: 01/12/2023]
Abstract
Approximately 40% of malignant melanomas are diagnosed in patients older than 65 years. Elderly patients with melanoma present clinicopathological features related to a more aggressive biology, and they are often diagnosed with advanced stage of disease. Interestingly, in older patients the immune system can be altered with changes both in the innate system and in the adaptive immune system with the acquisition of a pro-inflammatory and immune suppressive phenotype. Immunotherapy with immune checkpoint inhibitors has reshaped the treatment strategies and prognosis of patients with melanoma, and particularly, older age should not be considered a contraindication for immunotherapy. However, data regarding efficacy and safety of immunotherapy in elderly population are still limited because frail older patients are generally excluded from clinical trials. Recently, real-world data have shed light on similar efficacy and safety of immunotherapy in older population compared with younger counterpart. The aim of the present review was to summarize the available knowledge on the underlying immune system in older patients with a diagnosis of melanoma and the immunotherapeutic approaches in this population.
Collapse
Affiliation(s)
- Donatella Iacono
- Department of Oncology, Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Maria Grazia Vitale
- Department of Oncology, Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy.,Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Debora Basile
- Department of Medicine (DAME), University of Udine, Udine, Italy.,Department of Medical Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Giacomo Pelizzari
- Department of Medicine (DAME), University of Udine, Udine, Italy.,Department of Medical Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Marika Cinausero
- Department of Oncology, Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Elena Poletto
- Department of Oncology, Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Gaetano Pascoletti
- Department of Oncology, Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | | |
Collapse
|
9
|
Pantano I, Iacono D, Favalli EG, Scalise G, Costa L, Caso F, Guggino G, Scarpa R, Ciccia F. SAT0435 SECUKINUMAB EFFICACY In PsA PATIENTS IS DEPENDENT ON PATIENTS’ BODY MASS INDEX. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Psoriatic arthritis (PsA) is a chronic inflammatory arthritis burdened by a series of metabolic comorbidities. Among them, obesity is very common in PsA, with a prevalence of 27%, as confirmed by a recent Spanish work (1). Obesity in PsA has been associated with higher disease activity and a worse effectiveness of biologic treatment in PsA. This has been certainly proven for anti-TNF-α as demonstrated by different studies reporting, in obese patients, a reduced treatment response and adherence. In particular, results coming from DAN-BIO and ICE-BIO registries, (2) point out that obesity is a risk factor for anti-TNF withdrawal due to poor response. Although a recent multi-centric, retrospective study in Spain has shown that obese subjects with psoriasis have a poor therapeutic response to secukinumab, (3) no data are currently available for secukinumab in PsA obese patients.Objectives:Our studies focused on the relationship between BMI and clinical response to secukinumab in PsA.Methods:We, retrospectively, analysed clinical data of 100 patients with PsA (57% female, median age 53 (49.2-55 years)) satisfying CASPAR criteria (4) for PsA, afferent to our clinic, who were treated with secukinumab. Patients were divided into 2 groups based on BMI (BMI<25 normal weight and BMI≥25 overweight/obese).Results:In the normal weight group 75% were female, median age was 50.5 (41-54.6), median BMI was 22 (20.2-23.3) and median DAPSA was 19.19 (15.6-24.2). The features of the overweight/obese patients were similar to the normal weight group (48% were female, median age 54 (50-59), median BMI 29 (27.4-30.1) and median DAPSA 21.2 (19-24.4)). Clinical response to therapy, evaluated as the achievement of low disease activity or remission according to DAPSA, was recorded 6 months after starting treatment. After 6 months of treatment, the variation of the DAPSA was inversely related to BMI: overweight/obese patients had in fact a better response to secukinumab compared to normal weight patients. By using a correlation coefficient (SPSS), to analyze the degree of association between BMI and DAPSA, we observed that BMI and DAPSA are inversely related in our PsA patients (p=0.05). Interestingly, analysis of serum levels of IL-17 in 20 obese patients compared to 20 non-obese patients, showed significantly higher serum levels of IL-17 in the former (Figure 1), indicating IL-17 as a key cytokine driving inflammation in PsA obese patients.Conclusion:These are the first data about clinical response to secukinumab in obese PsA patients. Our results support the relevance of IL-17 in driving systemic inflammation in obese PsA patients, also providing evidence that obese patients may have a better response to secukinumab compared to non-obese patients. Interestingly, this effect was notReferences:[1]Rubén Queiro, Lorenzo A, Tejón P et al. Obesity in psoriatic arthritis. Comparative prevalence and associated factors. Medicine 2019 Jul;98(28):e16400[2]Pil Højgaard, Glintborg B, Kristensen LE et al. The influence of obesity on response to tumour necrosis factor-a inhibitors in psoriatic arthritis:results from the DANBIO and ICEBIO registries. Rheumatology (Oxford). 2016 Dec;55(12):2191-2199[3]Jaime Notario, Deza G, Vilarrasa E et al. Treatment of patients with plaque psoriasis with secukinumab in a real-life setting: a 52-weeks, multicenter, retrospective study in Spain. Journ of Derm Treat 2019 Aug;30(5):424-429[4]Taylor W, Gladman D, Helliwell P et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006 Aug;54(8):2665-73.[5]Lluís Puig. Cardiometabolic Comorbidities in Psoriasis and Psoriatic Arthritis. Int J Mol Sci. 2017 Dec 25;19(1).Disclosure of Interests:Ilenia Pantano: None declared, DANIELA IACONO Speakers bureau: PFIZER, BRISTOL MAYERS SQUIBB, SANOFI, ENNIO GIULIO FAVALLI: None declared, GIUSEPPE SCALISE: None declared, Luisa Costa: None declared, Francesco Caso: None declared, Giuliana Guggino Grant/research support from: Pfizer, Celgene, Speakers bureau: Celgene, Sandoz, Pfizer, Raffaele Scarpa: None declared, francesco ciccia Grant/research support from: pfizer, novartis, roche, Consultant of: pfizer, novartis, lilly, abbvie, Speakers bureau: pfizer, novartis, lilly, abbvie
Collapse
|
10
|
Iacono D, Pantano I, Birra D, Scalise G, Coscia MA, Messiniti V, Loi G, Merchionda A, Moscato P, Ciccia F. AB0315 RETENTION RATE OF ABATACEPT MONOTHERAPY IN AN ITALIAN MULTICENTRIC RHEUMATOID ARTHRITIS COHORT. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5780] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:EULAR recommendations focus the importance of Methotrexate (MTX) therapy as a key element in the treatment of patients with Rheumatoid Arthritis (RA), alone as first line therapy and in combination with biological Disease Modifying Anti-rheumatic Drug (bDMARDs). Abatacept (CTLA4-Ig) in Europe is approved for the treatment of moderate to severe active RA in combination with MTX. Several patients, however, discontinue MTX for intolerance, side effects or contraindications, and real-life data demonstrate how, even in patients receiving therapy with MTX, compliance could be suboptimal. The only data on the use of abatacept in monotherapy come from the ORA-Registry, where a worse performance is observed in monotherapy patients.Objectives:To evaluate a multicenter cohort of RA patients treated with Abatacept in patients underwent combined MTX therapy vs monotherapy.Methods:We retrospectively evaluated RA patients, referring to 2 Italian rheumatology centers, treated with Abatacept monotherapy or in combination with MTX. We compared both persistence in therapy and the rate of remission/low disease activity according to Clinical Disease Activity Index (CDAI) between the 2 groups.Results:We enrolled 147 patients, out of them 66 patients were on monotherapy with Abatacept due to intolerance or controindications and 81 in therapy with Abatacept plus MTX. The two cohorts appeared homogeneous in age, gender, disease duration and baseline activity indexes, with the only difference being higher baseline Physician Global assessment (PhGA) values in monotherapy patients. During the follow-up (median duration 24±14 months), the retention rate of Abatacept treatment was 71.2% in MTX patients (median duration 27–15.6 months) and 62.1% in monotherapy patients (median duration 25.2–17.5; p=ns). No differences between the two groups in terms of retention rate, low-disease activity and CDAI remission (log rank p=ns), Breslow p=ns) were detected.Conclusion:In patients with RA with intolerance or contraindication to MTX use, Abatacept monotherapy could be an efficient and safe option even in the long term follow-up.References:[1]Abatacept monotherapy compared with abatacept plus disease-modifying anti-rheumatic drugs in rheumatoid arthritis patients: data from the ORA registry.Truchetet ME et al. Arthritis Res Ther. 2016 Mar 30;18:72.Disclosure of Interests:DANIELA IACONO Speakers bureau: PFIZER, BRISTOL MAYERS SQUIBB, SANOFI, Ilenia Pantano: None declared, domenico birra: None declared, GIUSEPPE SCALISE: None declared, Melania Alessia Coscia: None declared, VALENTINA MESSINITI: None declared, Gabriella Loi: None declared, Anna Merchionda: None declared, Paolo Moscato: None declared, francesco ciccia Grant/research support from: pfizer, novartis, roche, Consultant of: pfizer, novartis, lilly, abbvie, Speakers bureau: pfizer, novartis, lilly, abbvie
Collapse
|
11
|
Iacono D, Vitale MG, Cortiula F, Macerelli M, Cinausero M, Minisini AM, Valent F, Tullio A, Palmero L, Targato G, Zara D, Fasola G. Management of immune-related adverse events: A single-center retrospective analysis in a real-world scenario. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e15163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15163 Background: Immune checkpoint inhibitors (ICI), anti CTLA-4 and anti PD-1/PD-L1 agents, have demonstrated an improvement in survival outcome in several malignancies. Therapy with ICI is characterized by immune-related adverse events (irAEs) as a result of exuberant immune system activation. Despite good tolerance for ICI, the potentially severe and life-threatening irAEs underscore the importance of investigating optimal management strategies. Methods: A retrospective series of 130 consecutive patients (pts) treated with ICI from Jan 2012 to Dec 2017 was analyzed. Adverse events with a potential immunological etiology were defined as irAEs and graded according to CTCAE v.4.0. The aim of the study was to evaluate irAEs management in an academic hospital center. Results: Pts with a diagnosis of NSCLC n = 64 (49%), melanoma n = 55 (42%), kidney n = 9 (7%) and others n = 2 (2%) were investigated. Baseline ECOG PS was ≤ 1 in 96% of the pts. ICI represented first line treatment for 27% pts, second line for 57% and third or further line for the remaining 16%. 18% were treated with ipilimumab and 82% with anti PD-1/PD-L1 agents (nivolumab 60%, pembrolizumab 21%, atezolizumab 1%). Overall, 50 (38% of pts) developed an irAE.42% of irAEs were grade 1, 38% grade 2, 14% grade 3 and 6% grade 4. The most frequent irAEs were endocrinopathies in 17 pts (34%), followed by cutaneous toxicity in 9 pts (18%) and colitis and diarrhea in 7 pts (14%). A total of 373 unscheduled accesses were observed, 89 (24%) of them were due to irAEs: 78 were unplanned consultations in the oncology department and 11 in the emergency department. irAEs led to hospitalization in 14 pts for 118 days, cumulatively. Grade ≥ 2 colitis was the most frequent irAE associated with hospitalization, it occurred in 4 pts (29%). Colitis and diarrhea required the longest hospitalization (range 4-31 days). 48% (24 pts) required immunosuppressive treatment. Systemic steroids were the most common immunosuppressive agents used. Only one patient received infliximab as second line immunosuppressive treatment after steroid failure. Totally, irAEs required 67 specialist consultancies and additional diagnostic examinations. 15 pts required ICI discontinuation because of irAEs. Conclusions: In our center prevalence and severity of irAEs were similar to literature data. Considered the complexity of irAEs management, multidisciplinary approach and a trained hospital network plays a key role for a more efficient diagnostic and treatment work-up in pts who received ICI therapy and experienced irAEs.
Collapse
Affiliation(s)
- Donatella Iacono
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | | | - Francesco Cortiula
- Azienda Sanitaria Universitaria Integrata di Udine, Dipartimento di Oncologia, Udine, Italy
| | | | - Marika Cinausero
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | | | - Francesca Valent
- Institute of Hygiene and Clinical Epidemiology,University Hospital of Udine, Udine, Italy
| | - Annarita Tullio
- Institute of Hygiene and clinical Epidemiology, University Hospital of Udine, Udine, Italy
| | | | - Giada Targato
- Department of Oncology, University Hospital of Udine - Santa Maria della Misericordia, Udine, Italy
| | - Diego Zara
- University Hospital of Udine, Department of Oncology, Udine, Italy
| | - Gianpiero Fasola
- Department of Oncology, University Hospital of Udine - Santa Maria della Misericordia, Udine, Italy
| |
Collapse
|
12
|
Cinausero M, Garattini SK, Minisini AM, Valent F, Riosa C, Iacono D, Macerelli M, Andreotti V, Giavarra M, Vitale MG, Fasola G. Incremental oncology workload generated by immunotherapy in the first-year of treatment. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e14143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14143 Background: The rapid development of immunotherapy (IO) has transformed the cancer therapy landscape with growing impact on oncology workload. Given the few data on this topic, we conducted a study to estimate the shift in workload generated by any new metastatic cancer patient treated with IO and referred to the Oncology Department of the Academic Academic Cancer Center of Udine, Italy, within the 12 months of first consultation. Methods: We collected from our “Data Warehouse” electronic accountability system all new diagnosis of metastatic cancer between 01.01.2017 and 31.12.2018, resulting in a first consultation and leading to a second clinical episode during the following year, in order to assess the oncology workload. The population was divided into patients that received IO (anti-CTLA-4/PD-1/PDL1) versus patients treated with “other treatments”. Mean number per patient and standard deviation were calculated for clinical episodes (first consultations, treatment sessions, unplanned presentations, hospitalizations, re-evaluations, follow-up and inpatient oncology advices). The total number of patients treated and the number of episodes were recorded. Mean numbers of episodes in the IO group and “other treatments” group were compared using Student’s t-test (significance p < 0.005). Follow-up data was collected up to 31.12.2019. Results: A total number of 969 patients were considered (854 “other treatments” group and 115 IO group), resulting in a total of 12407 clinical episodes over the period of 12 months (first consultations excluded). Compared to “other treatments” group, patients in the IO group generated a greater workload in terms of treatment sessions (9.59 vs 6.83 per patient, p < 0.0001), re-evaluations (2.55 vs 1.88, p = 0.0002), and unplanned presentations (2.19 vs 1.51, p = 0.08). On the other hand, follow-up visits workload was greater for “other treatments” group (0.83 vs 0.63, p = 0.0002). No differences were found regarding hospitalizations and inpatient oncology advices. Further analysis will be presented. Conclusions: IO represents a new frontier in oncology landscape, leading to outcome’s improvement and longer lasting treatment periods. The estimate of oncology workload generated by new diagnosis of metastatic cancer requiring IO, is crucial for implementing more sustainable systems and for planning clinical activities.
Collapse
Affiliation(s)
- Marika Cinausero
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | | | | | - Francesca Valent
- Institute of Hygiene and Clinical Epidemiology,University Hospital of Udine, Udine, Italy
| | - Chiara Riosa
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Donatella Iacono
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | | | - Victoria Andreotti
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Marco Giavarra
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Maria Grazia Vitale
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Gianpiero Fasola
- Department of Oncology, University Hospital of Udine, Udine, Italy
| |
Collapse
|
13
|
Basile D, Garattini SK, Corvaja C, Montico M, Cortiula F, Pelizzari G, Gerratana L, Audisio M, Lisanti C, Fanotto V, Ongaro E, Iacono D, Cardellino GG, Foltran L, Pella N, Buonadonna A, Aprile G, Di Maio M, Fasola G, Puglisi F. The MIMIC Study: Prognostic Role and Cutoff Definition of Monocyte-to-Lymphocyte Ratio and Lactate Dehydrogenase Levels in Metastatic Colorectal Cancer. Oncologist 2020; 25:661-668. [PMID: 32202020 DOI: 10.1634/theoncologist.2019-0780] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/05/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Monocyte-to-lymphocyte ratio (MLR) and lactate dehydrogenase (LDH) levels are circulating biomarkers that provide information about tumor-related inflammation and immune suppression. This study aimed to evaluate the prognostic role of MLR and LDH in metastatic colorectal cancer (mCRC). MATERIAL AND METHODS This multicentric study analyzed a consecutive cohort of 528 patients with mCRC treated in 2009-2017. The whole population was randomly divided in training and validation cohort. The first was used to identify a threshold for MLR and to create the prognostic model with MLR and MLR-LDH combined (group 1: MLR-LDH low; group 2: MLR or LDH high; group 3: MLR-LDH high). The second cohort was used to validate the model. RESULTS At the median follow-up of 55 months, median overall survival (OS) was 22 months. By multivariate analysis, high MLR >0.49 (hazard ratio [HR], 2.37; 95% confidence interval [C.I.], 1.39-4.04), high LDH (HR, 1.73; 95% C.I., 1.03-2.90) in the first model, group 2 (HR, 2.74; 95% C.I.; 1.62-4.66), and group 3 (HR, 3.73; 95% C.I., 1.94-7.18) in the combined model, had a worse prognosis in terms of OS. These data were confirmed both in the validation set and then in the whole cohort. CONCLUSION MLR and LDH are circulating cost-effective biomarkers, readily available in clinical practice, that can be useful for predicting the prognosis of patients with mCRC. IMPLICATIONS FOR PRACTICE High monocyte-to-lymphocyte ratio (MLR) and lactate dehydrogenase (LDH) levels could be a sign of a tumor's recruitment of suppressive and inflammatory cells worsening prognosis of different types of cancer, including colorectal cancer (CRC). Currently, no data are available for metastatic CRC regarding a cutoff definition for MLR or the prognostic impact of MLR and MLR-LDH combined. The present study showed in the training cohort and confirmed in the validation and whole cohort that MLR is a reliable and independent laboratory biomarker, which is easy to use, to predict clinical outcomes in patients with mCRC. Moreover, MLR and composite MLR-LDH could potentially result in an incremental improvement in the prognostic value of these biomarkers, being used as stratification tools for patients with mCRC.
Collapse
Affiliation(s)
- Debora Basile
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Silvio Ken Garattini
- Department of Medicine, University of Udine, Udine, Italy
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, Italy
| | - Carla Corvaja
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Marcella Montico
- Scientific Directorate, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Francesco Cortiula
- Department of Medicine, University of Udine, Udine, Italy
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, Italy
| | - Giacomo Pelizzari
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Lorenzo Gerratana
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Marco Audisio
- Department of Oncology, University of Turin at Umberto I "Ordine Mauriziano" Hospital, Turin, Italy
| | - Camilla Lisanti
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Valentina Fanotto
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Elena Ongaro
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Donatella Iacono
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, Italy
| | | | - Luisa Foltran
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Nicoletta Pella
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, Italy
| | - Angela Buonadonna
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin at Umberto I "Ordine Mauriziano" Hospital, Turin, Italy
| | - Gianpiero Fasola
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, Italy
| | - Fabio Puglisi
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| |
Collapse
|
14
|
Pelizzari G, Bertoli E, Vitale M, Buriolla S, Palmero L, Bartoletti M, Zara D, Basile D, Iacono D, Pascoletti G, Cinausero M, Poletto E, Bolzonello S, Freschi A, Puglisi F, Fasola G, Minisini A. A multivariate model to define prognostic groups among patients with melanoma brain metastases: A 10-year retrospective cohort study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz255.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
15
|
Vitale M, Basile D, Bertoli E, Giavarra M, Pelizzari G, Palmero L, Zara D, Targato G, Pascoletti G, Cinausero M, Poletto E, Iacono D, Puglisi F, Fasola G, Minisini A. Impact of sarcopenia in patients with metastatic melanoma treated with immunotherapy. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz255.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
16
|
Lisanti C, Basile D, Garattini S, Parnofiello A, Corvaja C, Cortiula F, Pelizzari G, Cattaneo M, Andreotti V, Bertoli E, Ongaro E, Iacono D, Foltran L, Casagrande M, Miolo G, Cardellino G, Fasola G, Pella N, Buonadonna A, Puglisi F. The SAFFO study: Sex-related prognostic role and cut-oFf deFinition of monocyte-to-lymphocyte ratio (MLR) in metastatic colOrectal cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
17
|
Garattini S, Bonotto M, Basile D, Porcu L, Ongaro E, Gerratana L, Cortiula F, Pelizzari G, Parnofiello A, bertoli E, Corvaja C, Lisanti C, Casagrande M, Iacono D, Cardellino G, Buonadonna A, Aprile G, Pella N, Puglisi F, Fasola G. Drug holidays and overall survival in patients treated for metastatic colorectal cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
18
|
Vogrig A, Gigli GL, Segatti S, Corazza E, Marini A, Bernardini A, Valent F, Fabris M, Curcio F, Brigo F, Iacono D, Passadore P, Rana M, Honnorat J, Valente M. Epidemiology of paraneoplastic neurological syndromes: a population-based study. J Neurol 2019; 267:26-35. [PMID: 31552550 DOI: 10.1007/s00415-019-09544-1] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The epidemiology of paraneoplastic neurological syndromes (PNS) remains to be defined. We present here the first population-based incidence study and report the clinical spectrum and antibody profile of PNS in a large area in Northeastern Italy. METHODS We performed a 9-year (2009-2017) population-based epidemiological study of PNS in the provinces of Udine, Pordenone and Gorizia, in the Friuli-Venezia Giulia region (983,190 people as of January 1, 2017). PNS diagnosis and subgroups were defined by the 2004 diagnostic criteria. Age- and sex-adjusted incidence rates were calculated. RESULTS We identified 89 patients with a diagnosis of definite PNS. Median age was 68 years (range 26-90), 52% were female. The incidence of PNS was 0.89/100,000 person-years. PNS incidence rates increased over time from 0.62/100,000 person-years (2009-2011), 0.81/100,000 person-years (2012-2014) to 1.22/100,000 person-years (2015-2017). The prevalence of PNS was 4.37 per 100,000. Most common PNS were limbic encephalitis (31%), cerebellar degeneration (28%) and encephalomyelitis (20%). Among antibody (Ab)-positive cases, most frequent specificities included: Yo (30%), Hu (26%), and Ma2 (22%), while the most frequent associated tumors were lung (17%) and breast cancer (16%), followed by lymphoma (12%). PNS developed in 1 in every 334 cancers in our region. Statistically significant associations were observed between cancer type and Ab-specificity (P < 0.001), and between neurological syndrome and Ab-specificity (P < 0.001). CONCLUSIONS This first population-based study found an incidence of PNS that approximates 1/100,000 person-years and a prevalence of 4/100,000. Moreover, the incidence of PNS is increasing over time, probably due to increased awareness and improved detection techniques.
Collapse
Affiliation(s)
- Alberto Vogrig
- Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, Piazzale Santa Maria della Misericordia, 15, 33010, Udine, Italy. .,French Reference Center of Paraneoplastic Neurological Syndrome, Hospices Civils de Lyon, Hôpital Neurologique, Lyon, France. .,SynatAc Team, NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Lyon, France. .,University Claude Bernard Lyon 1, Université de Lyon, Lyon, France.
| | - Gian Luigi Gigli
- Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, Piazzale Santa Maria della Misericordia, 15, 33010, Udine, Italy.,Department of Medicine (DAME), University of Udine Medical School, Udine, Italy.,Department of Mathematics, Informatics and Physics (DMIF), University of Udine, Udine, Italy
| | - Samantha Segatti
- Department of Medicine (DAME), University of Udine Medical School, Udine, Italy
| | - Elisa Corazza
- Department of Medicine (DAME), University of Udine Medical School, Udine, Italy
| | - Alessandro Marini
- Department of Medicine (DAME), University of Udine Medical School, Udine, Italy
| | - Andrea Bernardini
- Department of Medicine (DAME), University of Udine Medical School, Udine, Italy
| | - Francesca Valent
- Institute of Hygiene and Clinical Epidemiology, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Martina Fabris
- Department of Laboratory Medicine, Institute of Clinical Pathology, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Francesco Curcio
- Department of Medicine (DAME), University of Udine Medical School, Udine, Italy.,Department of Laboratory Medicine, Institute of Clinical Pathology, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Francesco Brigo
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Department of Neurology, Hospital Franz Tappeiner, Merano, Italy
| | - Donatella Iacono
- Department of Oncology, Santa Maria della Misericordia University Hospital, Udine, Italy
| | | | - Michele Rana
- Neurology Unit, Hospital of Gorizia, Gorizia, Italy
| | - Jérôme Honnorat
- French Reference Center of Paraneoplastic Neurological Syndrome, Hospices Civils de Lyon, Hôpital Neurologique, Lyon, France.,SynatAc Team, NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Lyon, France.,University Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Mariarosaria Valente
- Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, Piazzale Santa Maria della Misericordia, 15, 33010, Udine, Italy.,Department of Medicine (DAME), University of Udine Medical School, Udine, Italy
| |
Collapse
|
19
|
Cortellini A, Leonetti A, Catino A, Pizzutillo P, Ricciuti B, De Giglio A, Chiari R, Bordi P, Santini D, Giusti R, De Tursi M, Brocco D, Zoratto F, Rastelli F, Citarella F, Russano M, Filetti M, Marchetti P, Berardi R, Torniai M, Cortinovis D, Sala E, Maggioni C, Follador A, Macerelli M, Nigro O, Tuzi A, Iacono D, Migliorino MR, Banna G, Porzio G, Cannita K, Ferrara MG, Bria E, Galetta D, Ficorella C, Tiseo M. Osimertinib beyond disease progression in T790M EGFR-positive NSCLC patients: a multicenter study of clinicians’ attitudes. Clin Transl Oncol 2019; 22:844-851. [DOI: 10.1007/s12094-019-02193-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 07/25/2019] [Indexed: 01/10/2023]
|
20
|
Basile D, Parnofiello A, Vitale MG, Cortiula F, Gerratana L, Fanotto V, Lisanti C, Pelizzari G, Ongaro E, Bartoletti M, Garattini SK, Andreotti VJ, Bacco A, Iacono D, Bonotto M, Casagrande M, Ermacora P, Puglisi F, Pella N, Fasola G, Aprile G, Cardellino GG. The IMPACT study: early loss of skeletal muscle mass in advanced pancreatic cancer patients. J Cachexia Sarcopenia Muscle 2019; 10:368-377. [PMID: 30719874 PMCID: PMC6463465 DOI: 10.1002/jcsm.12368] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/03/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pancreatic cancer (PC) patients have multiple risk factors for sarcopenia and loss of skeletal muscle mass (LSMM), which may cause greater treatment toxicities, reduced response to cancer therapy, prolonged hospitalization, impaired quality of life, and worse prognosis. METHODS This is a retrospective study on advanced PC patients treated at the Department of Oncology of Udine, Italy, from January 2012 to November 2017. Among 162 patients who received chemotherapy, 94 consecutive patients with an available computed tomography (CT) scan were retrospectively analyzed. The primary objective of our study was to explore if an early LSMM ≥ 10% (measured at first radiological evaluation and compared with baseline) and/or baseline sarcopenia may impact prognosis. Baseline sarcopenia was defined according to Prado's criteria. Skeletal muscle area was measured as cross-sectional areas (cm2 ) using CT scan data through the Picture archiving and communication system (PACS) image system. RESULTS In the whole cohort, 48% of patients were ≤70 years old, and 50% had metastatic disease. At baseline, 73% of patients had sarcopenia, and 16% presented a visceral fat area ≥ 44 cm2 /m2 . Overall, 21% experienced an early LSMM ≥ 10%. Approximately 33% of sarcopenic patients at baseline and ~35% of patients with early LSMM ≥ 10% had a body mass index > 25 kg/m2 . Of note, 71% of patients were evaluated by a nutritionist, and 56% received a dietary supplementation (oral and/or parenteral). After a median follow-up of 30.44 months, median overall survival (OS) was 11.28 months, whereas median progression-free survival (PFS) was 5.72 months. By multivariate analysis, early LSMM ≥ 10% was significantly associated with worse OS [hazard ratio (HR): 2.16; 95% confidence interval (CI) 1.23-3.78; P = 0.007] and PFS (HR: 2.31; 95% CI 1.30-4.09; P = 0.004). Moreover, an exploratory analysis showed that inflammatory indexes, such as neutrophil-lymphocyte ratio variation, impact early LSMM ≥ 10% (odds ratio 1.31, 95% CI 1.06-1.61, P = 0.010). CONCLUSIONS Early LSMM ≥ 10% has a negative prognostic role in advanced PC patients. Further prospective investigations are needed to confirm these preliminary data.
Collapse
Affiliation(s)
- Debora Basile
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Annamaria Parnofiello
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Maria Grazia Vitale
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Francesco Cortiula
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Lorenzo Gerratana
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Valentina Fanotto
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Camilla Lisanti
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Giacomo Pelizzari
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Elena Ongaro
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Michele Bartoletti
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Silvio Ken Garattini
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Victoria Josephine Andreotti
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Anna Bacco
- Department of Endocrinology, University Hospital of Udine, Udine, UD, Italy
| | - Donatella Iacono
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Marta Bonotto
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | | | - Paola Ermacora
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Fabio Puglisi
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, PN, Italy
| | - Nicoletta Pella
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Gianpiero Fasola
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, ULSS8 Berica, East District, Vicenza, VI, Italy
| | | |
Collapse
|
21
|
Fornaro L, Vivaldi C, Parnofiello A, Ugolini C, Aprile G, De Maglio G, Pecora I, Iacono D, Crivelli F, Catanese S, Cardellino GG, Lencioni M, Vasile E, Salani F, Clerico M, Calvetti L, Falcone A, Fasola G, Fontanini G, Montagnani F. Validated clinico-pathologic nomogram in the prediction of HER2 status in gastro-oesophageal cancer. Br J Cancer 2019; 120:522-526. [PMID: 30745584 PMCID: PMC6461920 DOI: 10.1038/s41416-019-0399-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 07/09/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 12/28/2022] Open
Abstract
Background HER2 is the only validated predictive biomarker in gastro-oesophageal carcinoma (GOC). However, several factors, such as heterogeneity in protein expression, shortage of evaluable tumour tissue and need for quick target assessment, underline the usefulness of a pre-screening tool in order to anticipate HER2 status. Methods Data from 723 consecutive GOC analysed for HER2 at four Italian Institutions were collected. HER2 positivity was defined as 3+ by immunohistochemistry (IHC) or 2+ with gene amplification by in situ hybridisation (ISH). A multivariate logistic regression model was built using data from 413 cases, whereas 310 patients served as validation cohort. C-index, visual inspection of the calibration plot, Brier score and Spiegelhalter z-test were used to assess the performance of the nomogram. Results HER2 positive rate was 17.4%. Four variables were retained after adjustment in the final model: grading, Lauren’s histotype, pathologic material analysed (surgical specimen/biopsy) and site of tissue collection (primary tumour/metastases). Visual inspection of the calibration plot revealed a very good overlap between predicted and observed probabilities, with a Brier score of 0.101 and a non-significant Spiegelhalter z-test (P = 0.319). C-index resulted in 0.827 (95%CI 0.741–0.913). Conclusion A simple nomogram based on always-available pathologic information accurately predicts the probability of HER2 positivity in GOC.
Collapse
Affiliation(s)
- Lorenzo Fornaro
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
| | - Caterina Vivaldi
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Annamaria Parnofiello
- Department of Oncology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Clara Ugolini
- Department of Laboratory Medicine, Section of Pathology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, East District, Vicenza, AULSS8, Italy
| | - Giovanna De Maglio
- Department of Pathology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Irene Pecora
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Donatella Iacono
- Department of Oncology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Francesca Crivelli
- Department of Oncology, Azienda Sanitaria Locale di Biella, Ponderano (BI), Italy
| | - Silvia Catanese
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Monica Lencioni
- Unit of Medical Oncology 1, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Enrico Vasile
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Francesca Salani
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Mario Clerico
- Department of Oncology, Azienda Sanitaria Locale di Biella, Ponderano (BI), Italy
| | - Lorenzo Calvetti
- Department of Oncology, San Bortolo General Hospital, East District, Vicenza, AULSS8, Italy
| | - Alfredo Falcone
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Gianpiero Fasola
- Department of Oncology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Gabriella Fontanini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Francesco Montagnani
- Department of Oncology, Azienda Sanitaria Locale di Biella, Ponderano (BI), Italy
| |
Collapse
|
22
|
Garattini S, Bonotto M, Porcu L, Ongaro E, Basile D, Cortiula F, Pelizzari G, Cattaneo M, Parnofiello A, Andreotti V, Corvaja C, Cardellino G, Ermacora P, Casagrande M, Iacono D, Pella N, Buonadonna A, Minisini A, Puglisi F, Fasola G. Determinants of oncologist’s choice in offering drug holidays during first line therapy for patients with metastatic colorectal cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
23
|
Iacono D, Vitale M, Cortiula F, Cinausero M, Tullio A, Valent F, Macerelli M, Follador A, Vogrig A, Minisini A, Puglisi F, Fasola G. Serum markers as predictors of immune checkpoint inhibitors (ICI) related adverse events in a real-world scenario. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy288.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
24
|
Basile D, Garattini S, Pelizzari G, Cortiula F, Gerratana L, Cattaneo M, Corvaja C, Parnofiello A, Andreotti V, Bertoli E, Lisanti C, Iacono D, Casagrande M, Cardellino G, Miolo G, Pella N, Aprile G, Buonadonna A, Fasola G, Puglisi F. Monocyte-to-lymphocyte ratio in metastatic colorectal cancer: Prognostic role evaluation and cut-off definition. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
25
|
Lisanti C, Basile D, Garattini S, Pelizzari G, Parnofiello A, Cortiula F, Ongaro E, Cattaneo M, Corvaja C, Andreotti V, Bartoletti M, Casagrande M, Iacono D, Bonotto M, Ermacora P, Pella N, Buonadonna A, Puglisi F, Fasola G, Miolo G. The SENECA study: Prognostic role of serum biomarkers in elderly metastatic colorectal cancer patients. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
26
|
Basile D, Bacco A, Parnofiello A, Vitale M, Cortiula F, Garattini S, Gerratana L, Andreotti V, Lisanti C, Bartoletti M, Bonotto M, Fanotto V, Cattaneo M, Iacono D, Ermacora P, Puglisi F, Aprile G, Pella N, Cardellino G, Fasola G. Early loss of skeletal muscle mass as prognostic factor in metastatic pancreatic cancer patients. Nutrition 2018. [DOI: 10.1016/j.nut.2018.03.039] [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]
|
27
|
Basile D, Pelizzari G, Vitale MG, Lisanti C, Cinausero M, Iacono D, Puglisi F. Atezolizumab for the treatment of breast cancer. Expert Opin Biol Ther 2018; 18:595-603. [DOI: 10.1080/14712598.2018.1469619] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Debora Basile
- School of Medical Oncology, Department of Medicine, University of Udine, Udine, Italy
| | - Giacomo Pelizzari
- School of Medical Oncology, Department of Medicine, University of Udine, Udine, Italy
| | - Maria Grazia Vitale
- School of Medical Oncology, Department of Medicine, University of Udine, Udine, Italy
| | - Camilla Lisanti
- School of Medical Oncology, Department of Medicine, University of Udine, Udine, Italy
| | - Marika Cinausero
- School of Medical Oncology, Department of Medicine, University of Udine, Udine, Italy
| | - Donatella Iacono
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Fabio Puglisi
- School of Medical Oncology, Department of Medicine, University of Udine, Udine, Italy
- Department of Clinical Oncology, IRCCS CRO Aviano National Cancer Institute, Aviano (PN), Italy
| |
Collapse
|
28
|
De Angelis C, Di Maio M, Crispo A, Giuliano M, Schettini F, Bonotto M, Gerratana L, Iacono D, Cinausero M, Riccardi F, Ciancia G, De Laurentiis M, Puglisi F, De Placido S, Arpino G. Luminal-like HER2-negative stage IA breast cancer: a multicenter retrospective study on long-term outcome with propensity score analysis. Oncotarget 2017; 8:112816-112824. [PMID: 29348868 PMCID: PMC5762553 DOI: 10.18632/oncotarget.22643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 10/28/2017] [Indexed: 11/25/2022] Open
Abstract
The benefit of adding chemotherapy (CT) to adjuvant hormone therapy (HT) in stage IA luminal-like HER2-negative breast cancer (BC) is unclear. We retrospectively evaluated predictive factors and clinical outcome of 1,222 patients from 4 oncologic centers. Three hundred and eighty patients received CT and HT (CT-cohort) and 842 received HT alone (HT-cohort). Disease-free survival (DFS) and overall survival (OS) were evaluated with univariate and multivariate analyses. We also applied the propensity score methodology. Compared with the HT-cohort, patients in the CT-cohort were more likely to be younger, have larger tumors of a higher histological grade that were Ki67-positive, and lower estrogen and progesterone receptor expression. At univariate analysis, a higher histological grade and Ki67 were significantly associated to a lower DFS. At multivariable analysis, only histological grade was predictive of DFS. The CT-cohort had a worse outcome than the HT-cohort in terms of DFS and OS, but differences disappeared when matched according to propensity score. In summary, patients with stage IA luminal-like BC had an excellent prognosis, however relapse and mortality were higher in the CT-cohort than in the HT-cohort. Longer use of adjuvant HT or other therapeutic strategies may be needed to improve outcome.
Collapse
Affiliation(s)
- Carmine De Angelis
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Massimo Di Maio
- Oncology Department, University of Turin, 10043 Orbassano, Italy
| | - Anna Crispo
- Epidemiology Department, 'Fondazione G. Pascale' Istituto Nazionale Tumori, 80131 Naples, Italy
| | - Mario Giuliano
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, Texas 77030, USA.,Clinical Medicine and Surgery Department, University of Naples Federico II, 80131 Naples, Italy
| | - Francesco Schettini
- Clinical Medicine and Surgery Department, University of Naples Federico II, 80131 Naples, Italy
| | - Marta Bonotto
- Department of Medical and Biological Sciences, University of Udine, 33100 Udine, Italy
| | - Lorenzo Gerratana
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Donatella Iacono
- Department of Medical and Biological Sciences, University of Udine, 33100 Udine, Italy
| | - Marika Cinausero
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Ferdinando Riccardi
- Medical Oncology Unit, Azienda Ospedaliera di Rilievo Nazionale A. Cardarelli, 80131 Naples, Italy
| | - Giuseppe Ciancia
- Advanced Biomedical Sciences Department, University of Naples Federico II, 80131 Naples, Italy
| | | | - Fabio Puglisi
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy.,Department of Clinical Oncology, CRO Aviano National Cancer Institute, 33081 Aviano, Italy
| | - Sabino De Placido
- Clinical Medicine and Surgery Department, University of Naples Federico II, 80131 Naples, Italy
| | - Grazia Arpino
- Clinical Medicine and Surgery Department, University of Naples Federico II, 80131 Naples, Italy
| |
Collapse
|
29
|
Basile D, Cinausero M, Iacono D, Pelizzari G, Bonotto M, Vitale MG, Gerratana L, Puglisi F. Androgen receptor in estrogen receptor positive breast cancer: Beyond expression. Cancer Treat Rev 2017; 61:15-22. [PMID: 29078133 DOI: 10.1016/j.ctrv.2017.09.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 09/22/2017] [Accepted: 09/23/2017] [Indexed: 01/22/2023]
Abstract
In recent years, new therapeutic approaches have reshaped the overall strategy of breast cancer (BC) treatment and have markedly improved patient survival. This is, in part, due to novel therapies for estrogen receptor (ER)-positive BC. Unfortunately, many patients present de novo resistance to these therapies or develop an acquired resistance over time. Therefore, research is now focused on discovering new molecular targets to overcome these resistances. Interestingly, preclinical and clinical studies have shown a critical role for the cross-talk between androgen receptor (AR) and ER in luminal-like BC. AR is expressed in >60% of BC and in up to 90% of ERα-positive tumors. Multiple studies suggest that AR is associated with a favorable prognosis. However, AR overexpression and, in particular, the high AR:ER ratio, seem to be involved in resistance to hormonal treatment. In this setting, a group of BCs could benefit from AR-inhibitors; nevertheless, some ER-positive BC patients do not seem to benefit from this strategy. Therefore, it is crucial to identify biomarkers that would enable the selection of patients who might benefit from combination treatment with ER and AR inhibitors.
Collapse
Affiliation(s)
- Debora Basile
- Department of Oncology, University Hospital of Udine, Italy; School of Medical Oncology, Department of Medicine, University of Udine, Italy
| | - Marika Cinausero
- Department of Oncology, University Hospital of Udine, Italy; School of Medical Oncology, Department of Medicine, University of Udine, Italy
| | - Donatella Iacono
- Department of Oncology, University Hospital of Udine, Italy; School of Medical Oncology, Department of Medicine, University of Udine, Italy
| | - Giacomo Pelizzari
- Department of Oncology, University Hospital of Udine, Italy; School of Medical Oncology, Department of Medicine, University of Udine, Italy
| | - Marta Bonotto
- Department of Oncology, University Hospital of Udine, Italy; School of Medical Oncology, Department of Medicine, University of Udine, Italy
| | - Maria Grazia Vitale
- Department of Oncology, University Hospital of Udine, Italy; School of Medical Oncology, Department of Medicine, University of Udine, Italy
| | - Lorenzo Gerratana
- Department of Oncology, University Hospital of Udine, Italy; School of Medical Oncology, Department of Medicine, University of Udine, Italy.
| | - Fabio Puglisi
- School of Medical Oncology, Department of Medicine, University of Udine, Italy; Department of Clinical Oncology, CRO Aviano National Cancer Institute, Aviano (PN), Italy
| |
Collapse
|
30
|
Ongaro E, De Maglio G, Gerratana L, Bonotto M, Garattini S, Basile D, Cattaneo M, Andreotti V, Cortiula F, Parnofiello A, Fanotto V, Pizzolitto S, Cardellino G, Casagrande M, Ermacora P, Giovannoni M, Iacono D, Puglisi F, Aprile G, Pella N, Fasola G. Mutational status and metastatic patteRn in a cohort Of ADvanced colorectal cancer patients: the ROAD study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx422.023] [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
|
31
|
De Maglio G, Ongaro E, Pella N, Ciani S, Cernic S, Giovannoni M, Ermacora P, Cardellino G, Iacono D, Aprile G, Pizzolitto S, Fasola G. How can molecular heterogeneity impact on treatment choice in advanced colorectal cancer? Ann Oncol 2017. [DOI: 10.1093/annonc/mdx422.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
32
|
Iacono D, Basile D, Gerratana L, Vitale M, Pelizzari G, Cinausero M, Poletto E, Puglisi F, Fasola G, Minisini A. Prognostic role of disease extent and lymphocyte-monocyte ratio in advanced melanoma. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx428.001] [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
|
33
|
Vitale M, Bonotto M, Gerratana L, Basile D, Bartoletti M, Pelizzari G, Fanotto V, Lisanti C, Bozza C, Cinausero M, Iacono D, Poletto E, Barban S, Mansutti I, Minisini A, Russo S, Andreetta C, Mansutti M, Fasola G, Puglisi F. Strategy of monitoring metastatic breast cancer (M-MBC) in clinical practice: more or less intensive? Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
34
|
Verna L, Di Pietro F, Iacono D, Peris F, Mazzotta M, Giusti R, Marchetti P, Porzio G. Incidence of alcoholism among cancer patients undergoing active treatment. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx434.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
35
|
Bozza C, Gerratana L, Basile D, De Carlo E, Cortiula F, Pella N, Vitale M, Bartoletti M, Russo S, Bonotto M, Cinausero M, Fanotto V, Pelizzari G, Minisini A, Andreetta C, Mansutti M, Iacono D, Sottile R, Fasola G, Puglisi F. Final results from CAMEO-PRO study: complementary and alternative medicine in oncology. physicians inform oncological patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx436.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
36
|
Basile D, Parnofiello A, Vitale M, Cortiula F, Garattini S, Gerratana L, Andreotti V, Ongaro E, Lisanti C, Bartoletti M, Bonotto M, Fanotto V, Cattaneo M, Iacono D, Bacco A, Ermacora P, Puglisi F, Aprile G, Pella N, Cardellino G, Fasola G. Early loss of skeletal muscle mass (LSMM) as prognostic factor in metastatic pancreatic cancer (PC) patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx425.017] [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
|
37
|
Cortiula F, Basile D, Gerratana L, Bonotto M, Ongaro E, Garattini S, Fanotto V, Cattaneo M, Andreotti V, Parnofiello A, Cocconi R, Pecori D, Cardellino G, Casagrande M, Ermacora P, Giovannoni M, Iacono D, Puglisi F, Aprile G, Pella N, Fasola G. Blood stream infection in cancer patients—device management and epidemiology: the BSIDE study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx436.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
38
|
Cinausero M, Gerratana L, De Carlo E, Iacono D, Bonotto M, Fanotto V, Buoro V, Basile D, Vitale MG, Rihawi K, Fasola G, Puglisi F. Determinants of Last-line Treatment in Metastatic Breast Cancer. Clin Breast Cancer 2017; 18:205-213. [PMID: 28781022 DOI: 10.1016/j.clbc.2017.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/03/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND In metastatic breast cancer (MBC) patients, the identification of factors helping clinicians in the choice between active therapy versus best supportive care is needed clinically. The aim of the present study was to identify the clinicopathologic factors that could improve the prognostic valuation of MBC patients and clinical decision-making at the end of life. PATIENTS AND METHODS The present study analyzed data from a retrospective series of 522 MBC patients treated at the oncology department (University Hospital of Udine) from January 2004 to June 2014. The association between clinicopathologic features and death within 30 or 90 days since last-line treatment prescription was explored. Differences between lightly (≤ 3 lines) and heavily (> 3 lines) pretreated patients and the factors affecting treatment choice were investigated. RESULTS The event "death" occurred in 410 patients. The median last-line survival was 100 days. The median number of therapeutic lines was 3. On multivariate analysis, worse Eastern Cooperative Oncology Group performance status was significantly associated with death within 90 and 30 days since last-line treatment prescription. Among the heavily pretreated patients, liver function impairment and evaluation by a breast cancer specialist were significantly associated with a greater and lower risk of death within 30 days, respectively. Among the lightly pretreated patients with luminal disease, age < 70 years, luminal B-like disease, and number of previous lines were associated with a greater chance of receiving chemotherapy. CONCLUSION In the present study, the Eastern Cooperative Oncology Group performance status was the most robust independent factor driving the last-line therapeutic choice for MBC patients. In addition, the molecular subtype and oncologist subspecialization also influenced the decision-making process.
Collapse
Affiliation(s)
- Marika Cinausero
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Lorenzo Gerratana
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Elisa De Carlo
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Donatella Iacono
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Marta Bonotto
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Valentina Fanotto
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Vanessa Buoro
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Debora Basile
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Maria Grazia Vitale
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Karim Rihawi
- Division of Oncology, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Gianpiero Fasola
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Fabio Puglisi
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Clinical Oncology, CRO Aviano National Cancer Institute, Aviano, Italy.
| |
Collapse
|
39
|
Bozza C, Gerratana L, Basile D, Vitale MG, Bartoletti M, Agostinetto E, Russo S, Bonotto M, Cinausero M, Fanotto V, Pelizzari G, Lisanti C, Minisini AM, Andreetta C, Mansutti M, Poletto E, Iacono D, Sottile R, Fasola G, Puglisi F. Preliminary results from CAMEO-PRO study: Complementary and alternative medicine in oncology—Physicians inform oncological patients. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e21632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21632 Background: It is estimated that about half of cancer patients (pts) use at least one form of (CAM) Complementary and Alternative Medicine in their life but there is a strong reticence of pts in talking about CAM with their oncologist. Aim of this study is to inform pts about CAM. Methods:From April to December 2016, the observational pilot trial “CAMEO-PRO” prospectively enrolled 200 cancer pts that were invited to attend a tutorial about CAM at the Department of Oncology, University Hospital of Udine (Italy). Before and after the seminar, pts were asked to fill a questionnaire reporting their knowledge and opinion about CAM . Results:Median age was 61 years, 141 (72%) women and 53 (28%) men. At study entry, 139 (72%) pts declared they have never been interested in this topic before; 22 pts (12%) revealed the use of a type of alternative therapy and 53 (31%) revealed the use of complementary therapy. Overall, 111 (55.5%) pts participated to the tutorial. Table 1 shows the percentage of response and the opinion’s change about CAM before and after the tutorial. Conclusions:Informative seminars seem to have an impact on patients’ perceptions and opinions about CAM. [Table: see text]
Collapse
Affiliation(s)
- Claudia Bozza
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Lorenzo Gerratana
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Debora Basile
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Maria Grazia Vitale
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Michele Bartoletti
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Elisa Agostinetto
- Department of Medicine, University of Udine - Humanitas Cancer Center, Milan, Italy
| | - Stefania Russo
- Department of Oncology, University Hospital Udine, Udine, Italy
| | - Marta Bonotto
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Marika Cinausero
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Valentina Fanotto
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Giacomo Pelizzari
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Camilla Lisanti
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | | | | | - Mauro Mansutti
- Department of Oncology, University Hospital Udine, Udine, Italy
| | - Elena Poletto
- Department of Oncology, University Hospital Udine, Udine, Italy
| | | | - Roberta Sottile
- Department of Oncology, University Hospital Udine, Udine, Italy
| | | | - Fabio Puglisi
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| |
Collapse
|
40
|
Bonotto M, Gerratana L, Bettini A, Cinausero M, Basile D, Pelizzari G, Vitale MG, Bozza C, Lisanti C, Fanotto V, Bartoletti M, Andreetta C, Russo S, Poletto E, Iacono D, Mansutti M, Minisini AM, Fasola G, Puglisi F. Determinants of adjuvant chemotherapy use in small luminal-like breast cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e12010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e12010 Background: The use of adjuvant chemotherapy (CT) in small luminal-like breast cancer (BC) is still heavily debated. International guidelines identify endocrine therapy as the backbone of adjuvant treatment for these patients (pts), while the addition of CT should be limited to high risk cases. The aim of this study was to evaluate the association between patient- or disease-related factors with the prescription of adjuvant CT. Methods: This retrospective study reviewed data from 559 consecutive pts with pT1 ( < 2 cm) luminal-like BC treated between 2004 and 2015 at the Department of Oncology of Udine (Italy). No restrictions were applied regarding lymph node status. The cut-off point of 1% was used to define ER and/or PgR positivity. Factors influencing the prescription of CT were investigated through uni- and multivariate logistic regression with odds ratio (OR) calculation. Prognosis was explored through Cox regression. Results: About thirty percent (173/559) of pts received adjuvant CT. By multivariate analysis, lymph node involvement was highly associated with CT prescription (OR 16.94, 95% CI 7.86-36.50, P < 0.001 for pN1; OR 3.92, 95% CI 1.45-10.58, P = 0.007 for pNmi). Tumor size drove towards the use of CT among pts with pT1c tumors (OR 12.87, 95% CI 1.49-110.88, P = 0.020) but not in pts with pT1b BC (OR 2.38, 95% CI 0.26-21.38, P = 0.437). In addition, a higher CT use was observed in pts with luminal B-like disease (OR 3.79, 95% CI 2.16-6.65, P < 0.001) or in presence of a Ki67 > 14% (OR 1.05, 95% CI 1.03-1.07, P < 0.001). On the contrary, pts with age > 60 years had a very low chance of receiving adjuvant CT (OR 0.09, 95% CI 0.04-0.20, P < 0.001). Notably, the use of CT was not associated with Disease Free Survival or Overall Survival (HR 1.3, 95% CI 0.77-2.17, P = 0.320; HR 1.05, 95% CI 0.56-2, P = 0.866; respectively). Conclusions: Nodal status, tumor size, disease sub-type, Ki67 expression and age are determinants of adjuvant CT prescription in pts with small luminal-like BC. Prospective studies are needed to identify which pts could safely avoid CT without influencing prognosis.
Collapse
Affiliation(s)
- Marta Bonotto
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Lorenzo Gerratana
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | | | - Marika Cinausero
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Debora Basile
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Giacomo Pelizzari
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Maria Grazia Vitale
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Claudia Bozza
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Camilla Lisanti
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Valentina Fanotto
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Michele Bartoletti
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | | | - Stefania Russo
- Department of Oncology, University Hospital Udine, Udine, Italy
| | - Elena Poletto
- Department of Oncology, University Hospital Udine, Udine, Italy
| | | | - Mauro Mansutti
- Department of Oncology, University Hospital Udine, Udine, Italy
| | | | | | - Fabio Puglisi
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| |
Collapse
|
41
|
Bonotto M, Garattini SK, Basile D, Ongaro E, Fanotto V, Cattaneo M, Cortiula F, Iacono D, Cardellino GG, Pella N, Fasola G, Antonuzzo L, Silvestris N, Aprile G. Immunotherapy for gastric cancers: emerging role and future perspectives. Expert Rev Clin Pharmacol 2017; 10:609-619. [PMID: 28349740 DOI: 10.1080/17512433.2017.1313113] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The broad use of immunotherapy is revolutionizing the treatment paradigms of many solid tumors. Although chemotherapy remains the treatment backbone for advanced gastric cancer, improvements in its molecular characterization and progresses in understanding its underpinning biology have supported clinical development of novel immunotherapies. However, the results of recent trials testing these new agents raise the question on how to identify the patients that could greatly benefit. Areas covered: This article summarizes the current understanding on the biology and the mechanisms underlying different clinical features of gastric cancers. Particularly, after a comprehensive literature search, we speculate whether specific molecular subsets of patients could derive more benefit from immunotherapy. Expert commentary: Most cancers may evade the immune response, which is normally regulated by a delicate balance between activating and inhibitory signals. For example, both CTLA-4 and PD-1, once linked to PD-L1/2, may inhibit T-cell signaling. The use of agent to harness the power of the immune system appears to be the ultimate frontier in gastric cancer treatment. While anti-CTLA-4 antibodies are minimally active, there is growing evidence for the efficacy of PD1/-L1 inhibitors. The search of predictive factors for immunotherapy will provide key hints towards the optimal use of these agents.
Collapse
Affiliation(s)
- Marta Bonotto
- a Department Oncology , University Hospital of Udine , Udine , Italy.,b Department of Medical Area , University of Udine , Udine , Italy
| | - Silvio Ken Garattini
- a Department Oncology , University Hospital of Udine , Udine , Italy.,b Department of Medical Area , University of Udine , Udine , Italy
| | - Debora Basile
- a Department Oncology , University Hospital of Udine , Udine , Italy.,b Department of Medical Area , University of Udine , Udine , Italy
| | - Elena Ongaro
- a Department Oncology , University Hospital of Udine , Udine , Italy.,b Department of Medical Area , University of Udine , Udine , Italy
| | - Valentina Fanotto
- a Department Oncology , University Hospital of Udine , Udine , Italy.,b Department of Medical Area , University of Udine , Udine , Italy
| | - Monica Cattaneo
- a Department Oncology , University Hospital of Udine , Udine , Italy.,b Department of Medical Area , University of Udine , Udine , Italy
| | - Francesco Cortiula
- a Department Oncology , University Hospital of Udine , Udine , Italy.,b Department of Medical Area , University of Udine , Udine , Italy
| | - Donatella Iacono
- a Department Oncology , University Hospital of Udine , Udine , Italy
| | | | - Nicoletta Pella
- a Department Oncology , University Hospital of Udine , Udine , Italy
| | - Gianpiero Fasola
- a Department Oncology , University Hospital of Udine , Udine , Italy
| | | | - Nicola Silvestris
- d Medical Oncology Unit , National Cancer Institute IRCCS "Giovanni Paolo II" , Bari , Italy
| | - Giuseppe Aprile
- a Department Oncology , University Hospital of Udine , Udine , Italy.,e Department of Oncology , General Hospital San Bortolo, ULSS8 Berica , Vicenza , Italy
| |
Collapse
|
42
|
Mazzotta M, Iacono D, Lauro S, Giusti R, Marchetti P. Toxicity profile of afatinib in advanced EGFR mutated NSCLC treatment: a real world single-center experience. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw332.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
43
|
Giusti R, Verna L, Iacono D, Ficorella C, Porzio G. Knowledge, attitudes and associated behaviors of young Italian medical oncologists in management of cancer pain: Preliminary data of a National survey. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw344.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
44
|
Cinausero M, Gerratana L, Bonotto M, Iacono D, Bozza C, Basile D, Pelizzari G, Vitale M, Fontanella C, Fanotto V, Andreetta C, Minisini A, Moroso S, Poletto E, Russo S, Mansutti M, Fasola G, Puglisi F. Last-line treatment of luminal metastatic breast cancer: which factors influence the therapeutic choice? Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
45
|
Ongaro E, Bonotto M, Gerratana L, Casagrande M, Ferrari L, Iacono D, Garattini S, Fanotto V, Basile D, Cattaneo M, Rihawi K, Giovannoni M, Pella N, Ermacora P, Cardellino G, Aprile G, Fasola G. May mutational status influence the metastatic pattern of colorectal cancer patients? Ann Oncol 2016. [DOI: 10.1093/annonc/mdw335.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
46
|
Ferrari L, Gerratana L, Jove M, Bonotto M, Cinausero M, Iacono D, Fontanella C, Bozza C, Fanotto V, Basile D, Pelizzari G, Vitale M, Minisini A, Mansutti M, Russo S, Andreetta C, Fasola G, Puglisi F, Twelves C. Treatment strategies in patients with Metastatic Breast Cancer: real-world practice in the United Kingdom (UK) and Italy. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
47
|
Iacono D, Cuomo G, D'Abrosca V, Pantano I, Valentini G. SAT0057 Low Mortality Rate in A Cohort of Rheumatoid Arthritis Patients from South Italy. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4611] [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: 11/04/2022]
|
48
|
Ruscitti P, Cipriani P, Ciccia F, Masedu F, Iacono D, Liakouli V, Guggino G, Carubbi F, Berardicurti O, Di Benedetto P, Valenti M, Triolo G, Valentini G, Giacomelli R. FRI0504 Prognostic Factors of Adult Onset Still's Disease: Analysis of 100 Cases in 3 Tertiary Referral Centers. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3955] [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: 11/03/2022]
|
49
|
Pietrantonio F, Cremolini C, Rimassa L, Lonardi S, Mennitto A, Morano F, Iacono D, Berenato R, Caporale M, Niger M, Marmorino F, Bozzarelli S, Bergamo F, Rossini D, Baretti M, Battaglin F, Bonotto M, Loupakis F, de Braud F, Miceli R. O-013 A new nomogram for estimating 12-weeks survival in patients (pts) with chemorefractory metastatic colorectal cancer (mCRC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw198.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
50
|
Fontanella C, Fanotto V, Gerratana L, Bonotto M, Cinausero M, Bozza C, Iacono D, Russo S, Andreetta C, Minisini AM, Moroso S, Mansutti M, Fasola G, Puglisi F. Abstract P2-08-06: Usefulness of the pre-treatment neutrophil-to-lymphocyte ratio in predicting first-line progression free-survival in triple-negative breast cancer patients. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-08-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The neutrophil-to-lymphocyte ratio (NLR) is an independent predictor of poor prognosis inunselected breast cancer patients with NLR >3.3. Moreover, pre-treatment NLR has been associated with disease-free and overal survival (OS) in patients with early triple-negative breast cancer (TNBC). We aimed to determine whether the NLR is predictive of progression-free survival (PFS) in metastatic TNBC.
Methods: We reviewed the records of 48 TNBC patients who received at least one administration of first-line (1°L) chemotherapy for advanced disease from October 2004 to April 2014. The NLR (absolute neutrophil count/absolute lymphocyte count) was calculated from the full blood count routinely performed immediately before the initiation of first-line treatment. The association between categorical variables was calculated by X2 test. PFS (from start of 1°L treatment to disease progression or death) and OS (from start of 1°L treatment to death) were estimated using Kaplan Meier method. Multivariable Cox regression was used to determine the independent prognostic significances of the NLR (co-variables stage at diagnosis, histology, and tumor grade).
Results: NLR was not associated with stage at diagnosis (p=0.214), histology (p=0.597), or tumor grade (p=0.775). After a median follow-up of 10.9 months (range 1.3-54.9), 88.6% of TNBC patients with NLR≤3.3 versus 0.0% of patients with NLR>3.3 had a 1°L PFS>3 months (p<0.001). Similarly, 62.9% of TNBC patients with NLR≤3.3 versus 30.8% of patients with NLR>3.3 had an OS>10 months (p=0.047). Metastatic TNBC patients with NLR≤3.3 had a longer median 1°L PFS (5.2 months) and median OS (13.5 months) compared with patients with NLR>3.3 (1°L PFS 2.1 months, p<0.001; OS 7.7 months, p=0.018). In multivariable analysis, NLR>3.3 is associated with a shorter PFS (hazard ratio [HR] 22.4; 95% confidence interval [CI] 6.7-75.1, p<0.001) and higher risk of death (HR 3.2, 95%CI 1.4-7.4, p=0.005).
Conclusion: Our study showed that pre-treatment NLR is associated with 1°L PFS and OS in patients with metastatic TNBC. However, further investigation in larger series of metastatic TNBC is warranted.
Citation Format: Fontanella C, Fanotto V, Gerratana L, Bonotto M, Cinausero M, Bozza C, Iacono D, Russo S, Andreetta C, Minisini AM, Moroso S, Mansutti M, Fasola G, Puglisi F. Usefulness of the pre-treatment neutrophil-to-lymphocyte ratio in predicting first-line progression free-survival in triple-negative breast cancer patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-08-06.
Collapse
Affiliation(s)
| | - V Fanotto
- University Hospital of Udine, Udine, Italy
| | | | - M Bonotto
- University Hospital of Udine, Udine, Italy
| | | | - C Bozza
- University Hospital of Udine, Udine, Italy
| | - D Iacono
- University Hospital of Udine, Udine, Italy
| | - S Russo
- University Hospital of Udine, Udine, Italy
| | | | | | - S Moroso
- University Hospital of Udine, Udine, Italy
| | - M Mansutti
- University Hospital of Udine, Udine, Italy
| | - G Fasola
- University Hospital of Udine, Udine, Italy
| | - F Puglisi
- University Hospital of Udine, Udine, Italy
| |
Collapse
|