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Proto C, Manglaviti S, Lo Russo G, Musca M, Galli G, Imbimbo M, Perrino M, Cordua N, Rulli E, Ballatore Z, Maso AD, Chella A, Sbrana A, Prelaj A, Ferrara R, Occhipinti M, Brambilla M, De Toma A, Mazzeo L, Beninato T, Signorelli D, Massa G, Greco FG, Calareso G, Miliziano D, Di Mauro RM, Mella G, Lucarelli A, Paggio A, Galli F, Torri V, de Braud FGM, Pasello G, Petrini I, Berardi R, Ganzinelli M, Garassino M, Zucali P. STYLE (NCT03449173) a phase II Trial of Sunitinib in patients with type B3 Thymoma or Thymic Carcinoma in second and further lines. J Thorac Oncol 2023:S1556-0864(23)00513-0. [PMID: 37094664 DOI: 10.1016/j.jtho.2023.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/22/2023] [Accepted: 04/14/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Thymic malignancies are rare tumors with few therapeutic options. The STYLE trial was aimed to evaluate activity and safety of sunitinib in advanced/recurrent type B3 thymoma (T) and thymic carcinoma (TC). METHODS In this multicenter Simon 2 stages phase II trial, patients with pretreated T/TC were enrolled in two cohorts and assessed separately. Sunitinib was administered 50mg daily for 4-weeks, followed by a 2-week rest period (schedule 4/2), until disease progression or unacceptable toxicity. The primary endpoint was objectives response rate (ORR). Progression free survival (PFS), overall survival (OS), disease control rate (DCR) and safety were secondary endpoints. RESULTS From 03/2017 to 01/2022, 12 T and 32 TC patients were enrolled. At stage 1 ORR was 0% (90%CI 0.0-22.1) in T and 16.7% (90%CI 3.1-43.8) in TC, so T cohort was closed. At stage 2, the primary endpoint was met for TC with ORR of 21.7% (90%CI 9.0%-40.4%). In the ITT analysis DCR was 91.7% (95%CI 61.5%-99.8%) in Ts and 89.3% (95%CI 71.8%-97.7%) in TCs. mPFS was 7.7 months (95%CI 2.4-45.5) in Ts, 8.8 (95%CI 5.3-11.1) in TCs; mOS was 47.9 months (95%CI 4.5-not reached) in Ts, and 27.8 (95%CI 13.2-53.2) in TCs. Adverse events (AEs) occurred in 91.7% T and 93.5% TCs. Grade ≥3 treatment-related AEs were reported in 25.0% T and 51.6% TC. CONCLUSIONS This trial confirms the activity of sunitinib in TC patients, supporting its use as second line treatment.
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Affiliation(s)
- C Proto
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
| | - S Manglaviti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - G Lo Russo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M Musca
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - G Galli
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M Imbimbo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy; Department of Oncology, Lausanne University Hospital (CHUV), 1011, Lausanne, Switzerland
| | - M Perrino
- Department of Oncology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - N Cordua
- Department of Oncology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - E Rulli
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Z Ballatore
- Clinical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - A Dal Maso
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - A Chella
- Pneumology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Sbrana
- Pneumology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - A Prelaj
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - R Ferrara
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M Occhipinti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M Brambilla
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - A De Toma
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - L Mazzeo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - T Beninato
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - D Signorelli
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy; Niguarda Cancer Center-Grande Ospedale Metropolitano Niguarda-Milan, Italy
| | - G Massa
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - F G Greco
- Department of Interventional Radiology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - G Calareso
- Department of Interventional Radiology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - D Miliziano
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - R M Di Mauro
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - G Mella
- Department of Oncology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - A Lucarelli
- Clinical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - A Paggio
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - F Galli
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - V Torri
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - F G M de Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - G Pasello
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy
| | - I Petrini
- Medical Oncology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - R Berardi
- Clinical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - M Ganzinelli
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M Garassino
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy; Thoracic Oncology Program, Department of Medicine, Section of Hematology/Oncology, The University of Chicago, Chicago, IL, USA
| | - P Zucali
- Department of Oncology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Canova S, Ceresoli G, Grosso F, Zucali P, Gelsomino F, Pasello G, Mencoboni M, Rulli E, Galli F, De Simone I, Carlucci L, De Angelis A, Belletti M, Bonomi M, D’Aveni A, Perrino M, Bono F, Cortinovis D, Canova S, Colonese F, Abbate M, Sala L, Sala E, Perez Gila M, Bono F, Pagni F, Ceresoli G, D’Aveni A, Bonomi M, Grosso F, De Angelis A, Ugo F, Belletti M, Zucali P, Perrino M, De Vincenzo F, Santoro A, Gelsomino F, Ardizzoni A, Pasello G, Frega S, Mencoboni M, Carlucci L, De Simone I, D’Incalci M, Galli F, Poli D, Rulli E, Torri V. Final results of DIADEM, a phase II study to investigate the efficacy and safety of durvalumab in advanced pretreated malignant pleural mesothelioma. ESMO Open 2022; 7:100644. [PMID: 36463732 PMCID: PMC9808442 DOI: 10.1016/j.esmoop.2022.100644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/15/2022] [Accepted: 10/26/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) is a cancer with a high mortality rate and few therapeutic options. After platinum-pemetrexed combination, no further promising drug seems to be effective. Immune checkpoint inhibitors may have some activity in pretreated patients and no data are available in this population about durvalumab. MATERIALS AND METHODS DIADEM was a multicenter, open-label, single-arm, phase II trial aimed at evaluating the efficacy and safety of durvalumab. Patients with locally advanced/metastatic MPM who progressed after platinum-pemetrexed chemotherapy were enrolled to receive durvalumab (1500 mg, intravenously Q4W) for 12 months or until evidence of disease progression or unacceptable toxicity. The primary endpoint was the proportion of patients alive and free from progression at 16 weeks (PFS16wks) calculated from treatment initiation. Secondary endpoints were progression-free survival, overall survival, overall response rate, and safety. RESULTS Sixty-nine patients with a median age of 69 years (range 44-82 years) were enrolled; 62 patients (89.9%) had epithelioid histotype. As first-line treatment, all patients received platinum derivatives-pemetrexed combination (60.9% with carboplatin and 39.1% with cisplatin). As of March 2021, the median follow-up was 9.2 months (interquartile range 5.2-11.1 months). Six patients (8.7%) completed the 12-month treatment; 60 patients discontinued, of whom 42 for progressive disease, and 4 died. Seventeen patients (28.3%; 95% confidence interval 17.5% to 41.4%) were alive or free from progression at 16 weeks. Eleven patients (18.6%) had a grade 3 or 4 treatment-related adverse event (AE), and one (1.4%) had a grade ≥3 immune-related, treatment-related AE. There was one drug-related death. CONCLUSION Durvalumab alone in pretreated non-selected MPM did not reach a meaningful clinical activity, showing any new major safety issue signals.
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Affiliation(s)
- S. Canova
- ASST H S Gerardo, SC Medical Oncology, Monza
| | - G.L. Ceresoli
- Humanitas Gavazzeni, Bergamo,Department of Oncology, Saronno Hospital, ASST Valle Olona, Saronno (VA)
| | - F. Grosso
- Mesothelioma Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria
| | - P.A. Zucali
- Department of Oncology, IRCCS Humanitas Research Hospital, Rozzano,Department of Biomedical Sciences, Humanitas University, Rozzano
| | - F. Gelsomino
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - G. Pasello
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova,Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova
| | | | - E. Rulli
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - F. Galli
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - I. De Simone
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - L. Carlucci
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - A. De Angelis
- Mesothelioma Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria
| | - M. Belletti
- Mesothelioma Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria
| | - M. Bonomi
- Humanitas Gavazzeni, Bergamo,Department of Oncology, ASST Cremona, Cremona, Italy
| | - A. D’Aveni
- Humanitas Gavazzeni, Bergamo,Department of Oncology, Saronno Hospital, ASST Valle Olona, Saronno (VA)
| | - M. Perrino
- Department of Oncology, IRCCS Humanitas Research Hospital, Rozzano
| | - F. Bono
- ASST H S Gerardo, SC Medical Oncology, Monza
| | - D.L. Cortinovis
- ASST H S Gerardo, SC Medical Oncology, Monza,Correspondence to: Dr Diego Luigi Cortinovis, ASST-Monza San Gerardo Hospital, SC Medical Oncology, Monza, Via Pergolesi 33 20900 Monza, Italy. Tel: +39-0392339575; Fax: +39-0392332284
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Lo Russo G, Sgambelluri F, Prelaj A, Galli F, Manglaviti S, Bottiglieri A, Di Mauro R, Ferrara R, Galli G, Signorelli D, De Toma A, Occhipinti M, Brambilla M, Rulli E, Triulzi T, Torelli T, Agnelli L, Brich S, Martinetti A, Dumitrascu A, Torri V, Pruneri G, Fabbri A, de Braud F, Anichini A, Proto C, Ganzinelli M, Mortarini R, Garassino M. PEOPLE (NCT03447678), a first-line phase II pembrolizumab trial, in negative and low PD-L1 advanced NSCLC: clinical outcomes and association with circulating immune biomarkers. ESMO Open 2022; 7:100645. [PMID: 36455507 PMCID: PMC9808469 DOI: 10.1016/j.esmoop.2022.100645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 09/25/2022] [Accepted: 10/26/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The PEOPLE trial aimed to identify new immune biomarkers in negative and low programmed death-ligand 1 (PD-L1) (0%-49%) advanced non-small-cell lung cancer (aNSCLC) patients treated with first-line pembrolizumab. Here we report the main outcomes and the circulating immune biomarkers analysis. PATIENTS AND METHODS The primary endpoint of this phase II trial was the identification of immune biomarkers associated with progression-free survival (PFS). Overall survival (OS), objective response rate (ORR), disease control rate (DCR), duration of response (DoR) and safety were secondary endpoints. Absolute cell counts for 36 subsets belonging to innate and adaptive immunity were determined by multiparametric flow cytometry in peripheral blood at baseline and at first radiologic evaluation. An orthoblique principal components-based clustering approach and multivariable Cox regression model adjusted for clinical variables were used to analyze immune variables and their correlation with clinical endpoints. RESULTS From May 2018 to October 2020, 65 patients were enrolled. After a median follow-up of 26.4 months, the median PFS was 2.9 months [95% confidence interval (CI) 1.8-5.6 months] and median OS was 12.1 months (95% CI 8.7-17.1 months). The ORR was 21.5%, DCR was 47.7% and median DoR was 14.5 months (95% CI 6.4-24.9 months). Drug-related grade 3-4 adverse events were 9.2%. Higher T cell and natural killer (NK) cell count at baseline and at the first radiologic evaluation were associated with improved PFS, DCR and OS. On the contrary, higher myeloid cell count at baseline or at the first radiologic evaluation was significantly associated with worse OS and DCR. CONCLUSIONS Circulating immune biomarkers can contribute to predict outcomes in negative and low PD-L1 aNSCLC patients treated with first-line single-agent pembrolizumab.
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Affiliation(s)
- G. Lo Russo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy,Correspondence to: Dr Giuseppe Lo Russo Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, via Giacomo Venezian 1, 20133 Milan, Italy. Tel: +39-0223903829
| | - F. Sgambelluri
- Department of Research, Human Tumors Immunobiology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - A. Prelaj
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy,Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - F. Galli
- Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - S. Manglaviti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - A. Bottiglieri
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - R.M. Di Mauro
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - R. Ferrara
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - G. Galli
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy,Medical Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - D. Signorelli
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy,Medical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - A. De Toma
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M. Occhipinti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M. Brambilla
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - E. Rulli
- Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - T. Triulzi
- Molecular Targeting Unit, Department of Research, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - T. Torelli
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - L. Agnelli
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - S. Brich
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A. Martinetti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - A.D. Dumitrascu
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - V. Torri
- Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - G. Pruneri
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - A. Fabbri
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - F. de Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - A. Anichini
- Department of Research, Human Tumors Immunobiology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - C. Proto
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M. Ganzinelli
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - R. Mortarini
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M.C. Garassino
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy,Department of Medicine, University of Chicago Comprehensive Cancer Center, University of Chicago, Chicago, USA
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Mandalà M, Rutkowski P, Galli F, Patuzzo R, De Giorgi V, Rulli E, Gianatti A, Valeri B, Merelli B, Szumera-Ciećkiewicz A, Massi D, Maurichi A, Teterycz P, Santinami M. Acral lentiginous melanoma histotype predicts outcome in clinical stage I-II melanoma patients: an International multicenter study. ESMO Open 2022; 7:100469. [PMID: 35421840 PMCID: PMC9271470 DOI: 10.1016/j.esmoop.2022.100469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 03/03/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In the American Joint Committee on Cancer (AJCC) classification, acral lentiginous melanoma (ALM) histotype ALM is not included as an independent prognostic factor; in small series its negative prognostic impact on disease-free survival (DFS) and overall survival (OS) has been linked to the greater Breslow thickness (BT). PATIENTS AND METHODS The study was carried out at four referral melanoma centers (three Italian and one Polish). Clinical consecutive patients with stage I-II melanoma, who were diagnosed, treated, and followed up between January 1998 and March 2018 in annotated specific databases were included. RESULTS Overall, 6734 were evaluable, 4349 with superficial spreading melanoma (SSM), 2132 with nodular melanoma (NM), and 253 with ALM. At univariable analysis, a statistically significant worse DFS [hazard ratio (HR) 2.72, 95% confidence interval (CI) 2.24-3.30; P < 0.001] and OS (HR 2.67, 95% CI 2.15-3.32; P < 0.001) were found in patients with ALM compared with SSM. Similarly, the NM histotype was associated with a worse prognosis compared with the SSM histotype (DFS: HR 2.29, 95% CI 2.08-2.52; P < 0.001 and OS: HR 2.21, 95% CI 1.99-2.46; P < 0.001). At multivariable analysis, after adjusting for age, sex, BT, ulceration, and the sentinel lymph node status, a statistically significant worse DFS [adjusted HR (aHR; ALM versus SSM) 1.25, 95% CI 1.02-1.52; P = 0.028] was confirmed for patients with ALM. For patients with NM, instead, no impact of histology was found in terms of DFS [aHR (NM versus SSM) 1.04, 95% CI 0.93-1.15; P = 0.513] and OS [aHR (NM versus SSM) 0.96, 95% CI 0.86-1.08; P = 0.548]. CONCLUSIONS ALM is associated with a worse long-term DFS. Our results could have important clinical implications for patients' stratification in future clinical trials and the incorporation of ALM histotype in the new AJCC classification as an independent prognostic factor.
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Affiliation(s)
- M Mandalà
- Department of Medicine and Surgery, University of Perugia, Unit of Medical Oncology, Perugia, Italy.
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - F Galli
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - R Patuzzo
- Melanoma and Sarcoma Unit, Department of Surgery, IRCCS Fondazione Istituto Nazionale dei Tumori, Milan, Italy
| | - V De Giorgi
- Department of Dermatology, University of Florence, Firenze, Italy
| | - E Rulli
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - A Gianatti
- Unit of Pathology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - B Valeri
- Department of Pathology and Laboratory Medicine, IRCCS Fondazione Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - B Merelli
- Unit of Medical Oncology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - A Szumera-Ciećkiewicz
- Department of Pathology and Laboratory Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland; Diagnostic Hematology Department, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - D Massi
- Section of Pathology, Department of Health Sciences, University of Florence, Firenze, Italy
| | - A Maurichi
- Melanoma and Sarcoma Unit, Department of Surgery, IRCCS Fondazione Istituto Nazionale dei Tumori, Milan, Italy
| | - P Teterycz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - M Santinami
- Melanoma and Sarcoma Unit, Department of Surgery, IRCCS Fondazione Istituto Nazionale dei Tumori, Milan, Italy
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Bertero E, Robusto F, Rulli E, D‘Ettore A, Staszewsky L, Maack C, Lepore V, Latini R, Ameri P. P148 CANCER INCIDENCE AND MORTALITY ACCORDING TO PRE–EXISTING HEART FAILURE IN A COMMUNITY–BASED COHORT. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.143] [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: 11/14/2022]
Abstract
Abstract
Background
Studies assessing whether heart failure (HF) is associated with an excess risk of cancer and cancer–related mortality yielded conflicting results. Here, we assessed the incidence and mortality of cancer according to the presence of HF in a community–based cohort.
Methods
By reviewing the health care records of the Puglia region in Italy, we first selected the individuals ≥50–year–old, with no history of cancer within 3 years before the baseline evaluation and ≥5 years of follow–up, during the period from January 1st, 2005 to December 31st, 2013. Next, we matched 1:1 104,020 subjects with HF at baseline and 104,020 controls based on age, sex, Drug–Derived Complexity Index, and follow–up duration. Cancer incidence and mortality were analyzed by Kaplan–Meier method and Cox regression models. Fine and Grey’s regression model was also used to compare cancer–specific mortality while taking into account the competing risk of non–cancer death.
Results
Overall, the mean age of the study population was 76±10 years and the mean follow–up was 5.7 years. The incidence rate of cancer in HF patients and controls was 21.36 (95%CI, 20.98–21.74) and 12.42 (95%CI, 12.14–12.72) per 1000 person/years, respectively, corresponding to a 76% higher risk of incident cancer in HF patients (HR, 1.76; 95%CI, 1.71–1.81). HF patients also died from cancer more frequently than controls (HR 4.11; 95%CI, 3.86–4.38; Figure 1). This excess mortality was highest when age was <70 years (HR 7.54, 95%CI 6.33–8.98), and declined in subjects aged 70–79 years (HR 3.80, 95%CI 3.44–4.19) and ≥80 years (HR 3.10, 95%CI 2.81–3.43). The association of HF with cancer mortality was confirmed in the competing risk analysis (subdistribution HR 3.48, 95%CI 3.27–3.72), as well as the interaction with age: <70 years of age: SHR 6.65, 95%CI 5.60–7.94; 70–80 years: SHR 3.14, 95%CI 2.84–3.48; and ≥80 years: SHR 2.81, 95%CI 2.55–3.10. The HF–related risk applied to the majority of cancer types. Interestingly, among HF patients a high consumption of loop diuretic (≥80 mg/d of furosemide equivalents for ≥30 days in the year before the index date) was associated with a higher mortality for cancer (HR 1.35, 95%CI 1.19–1.53 vs. ≤37.5 mg/d).
Conclusions
The analysis of this large community–based sample suggests that HF does portend an increased risk of cancer and cancer–related mortality, which is blunted, yet remains substantial, with increasing age and competing risk of dying from other causes.
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Affiliation(s)
- E Bertero
- DEPARTMENT OF INTERNAL MEDICINE, UNIVERSITY OF GENOVA, GENOVA, ITALY, GENOVA; ISTITUTO DI RICERCHE FARMACOLOGICHE MARIO NEGRI IRCCS, MILANO, ITALY, MILANO; OMPREHENSIVE HEART FAILURE CENTER (CHFC), UNIVERSITY CLINIC WÜRZBURG, 97078, WÜRZBURG, GERMANY, WÜRZBURG, GERMANY; OSPEDALE POLICLINICO SAN MARTINO, GENOVA
| | - F Robusto
- DEPARTMENT OF INTERNAL MEDICINE, UNIVERSITY OF GENOVA, GENOVA, ITALY, GENOVA; ISTITUTO DI RICERCHE FARMACOLOGICHE MARIO NEGRI IRCCS, MILANO, ITALY, MILANO; OMPREHENSIVE HEART FAILURE CENTER (CHFC), UNIVERSITY CLINIC WÜRZBURG, 97078, WÜRZBURG, GERMANY, WÜRZBURG, GERMANY; OSPEDALE POLICLINICO SAN MARTINO, GENOVA
| | - E Rulli
- DEPARTMENT OF INTERNAL MEDICINE, UNIVERSITY OF GENOVA, GENOVA, ITALY, GENOVA; ISTITUTO DI RICERCHE FARMACOLOGICHE MARIO NEGRI IRCCS, MILANO, ITALY, MILANO; OMPREHENSIVE HEART FAILURE CENTER (CHFC), UNIVERSITY CLINIC WÜRZBURG, 97078, WÜRZBURG, GERMANY, WÜRZBURG, GERMANY; OSPEDALE POLICLINICO SAN MARTINO, GENOVA
| | - A D‘Ettore
- DEPARTMENT OF INTERNAL MEDICINE, UNIVERSITY OF GENOVA, GENOVA, ITALY, GENOVA; ISTITUTO DI RICERCHE FARMACOLOGICHE MARIO NEGRI IRCCS, MILANO, ITALY, MILANO; OMPREHENSIVE HEART FAILURE CENTER (CHFC), UNIVERSITY CLINIC WÜRZBURG, 97078, WÜRZBURG, GERMANY, WÜRZBURG, GERMANY; OSPEDALE POLICLINICO SAN MARTINO, GENOVA
| | - L Staszewsky
- DEPARTMENT OF INTERNAL MEDICINE, UNIVERSITY OF GENOVA, GENOVA, ITALY, GENOVA; ISTITUTO DI RICERCHE FARMACOLOGICHE MARIO NEGRI IRCCS, MILANO, ITALY, MILANO; OMPREHENSIVE HEART FAILURE CENTER (CHFC), UNIVERSITY CLINIC WÜRZBURG, 97078, WÜRZBURG, GERMANY, WÜRZBURG, GERMANY; OSPEDALE POLICLINICO SAN MARTINO, GENOVA
| | - C Maack
- DEPARTMENT OF INTERNAL MEDICINE, UNIVERSITY OF GENOVA, GENOVA, ITALY, GENOVA; ISTITUTO DI RICERCHE FARMACOLOGICHE MARIO NEGRI IRCCS, MILANO, ITALY, MILANO; OMPREHENSIVE HEART FAILURE CENTER (CHFC), UNIVERSITY CLINIC WÜRZBURG, 97078, WÜRZBURG, GERMANY, WÜRZBURG, GERMANY; OSPEDALE POLICLINICO SAN MARTINO, GENOVA
| | - V Lepore
- DEPARTMENT OF INTERNAL MEDICINE, UNIVERSITY OF GENOVA, GENOVA, ITALY, GENOVA; ISTITUTO DI RICERCHE FARMACOLOGICHE MARIO NEGRI IRCCS, MILANO, ITALY, MILANO; OMPREHENSIVE HEART FAILURE CENTER (CHFC), UNIVERSITY CLINIC WÜRZBURG, 97078, WÜRZBURG, GERMANY, WÜRZBURG, GERMANY; OSPEDALE POLICLINICO SAN MARTINO, GENOVA
| | - R Latini
- DEPARTMENT OF INTERNAL MEDICINE, UNIVERSITY OF GENOVA, GENOVA, ITALY, GENOVA; ISTITUTO DI RICERCHE FARMACOLOGICHE MARIO NEGRI IRCCS, MILANO, ITALY, MILANO; OMPREHENSIVE HEART FAILURE CENTER (CHFC), UNIVERSITY CLINIC WÜRZBURG, 97078, WÜRZBURG, GERMANY, WÜRZBURG, GERMANY; OSPEDALE POLICLINICO SAN MARTINO, GENOVA
| | - P Ameri
- DEPARTMENT OF INTERNAL MEDICINE, UNIVERSITY OF GENOVA, GENOVA, ITALY, GENOVA; ISTITUTO DI RICERCHE FARMACOLOGICHE MARIO NEGRI IRCCS, MILANO, ITALY, MILANO; OMPREHENSIVE HEART FAILURE CENTER (CHFC), UNIVERSITY CLINIC WÜRZBURG, 97078, WÜRZBURG, GERMANY, WÜRZBURG, GERMANY; OSPEDALE POLICLINICO SAN MARTINO, GENOVA
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6
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Guffanti F, Alvisi MF, Anastasia A, Ricci F, Chiappa M, Llop-Guevara A, Serra V, Fruscio R, Degasperi A, Nik-Zainal S, Bani MR, Lupia M, Giavazzi R, Rulli E, Damia G. Basal expression of RAD51 foci predicts olaparib response in patient-derived ovarian cancer xenografts. Br J Cancer 2022; 126:120-128. [PMID: 34732853 PMCID: PMC8727677 DOI: 10.1038/s41416-021-01609-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/07/2021] [Accepted: 10/21/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The search for biomarkers to evaluate ovarian cancer (OC) homologous recombination (HR) function and predict the response to therapy is an urgent clinical need to improve the selection of patients who could benefit from platinum- and olaparib (poly-ADP ribose polymerase inhibitors, PARPi)-based therapies. METHODS We used a large collection of OC patient-derived xenografts (PDXs) (n = 47) and evaluated their HR status based on BRCA1/2 mutations, BRCA1 promoter methylation and the HRDetect score. RAD51 foci were quantified in formalin-fixed, paraffin-embedded untreated tumour specimens by immunofluorescence and the messenger RNA expression of 21 DNA repair genes by real-time PCR. RESULTS Tumour HR deficiency predicted both platinum and olaparib responses. The basal level of RAD51 foci evaluated in geminin-positive/replicating cells strongly inversely correlated with olaparib response (p = 0.011); in particular, the lower the foci score, the greater the sensitivity to olaparib, while low RAD51 foci score seems to associate with platinum activity. CONCLUSIONS The basal RAD51 foci score is a candidate predictive biomarker of olaparib response in OC patients as it can be easily translatable in a clinical setting. Moreover, the findings corroborate the importance of OC-PDXs as a reliable tool to identify and validate biomarkers of response to therapy.
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Affiliation(s)
- F. Guffanti
- grid.4527.40000000106678902Laboratory of Molecular Pharmacology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - M F Alvisi
- grid.4527.40000000106678902Laboratory of Methodology for Clinical Research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - A. Anastasia
- grid.4527.40000000106678902Laboratory of Cancer Metastasis Therapeutics, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - F. Ricci
- grid.4527.40000000106678902Laboratory of Molecular Pharmacology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - M. Chiappa
- grid.4527.40000000106678902Laboratory of Molecular Pharmacology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - A. Llop-Guevara
- grid.411083.f0000 0001 0675 8654Experimental Therapeutics Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - V. Serra
- grid.411083.f0000 0001 0675 8654Experimental Therapeutics Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - R. Fruscio
- grid.7563.70000 0001 2174 1754Clinic of Obstetrics and Gynecology, Department of Medicine and Surgery, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy
| | - A. Degasperi
- grid.5335.00000000121885934MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Box 197, Cambridge Biomedical Campus, Cambridge, CB2 0XZ UK ,grid.120073.70000 0004 0622 5016Academic Laboratory of Medical Genetics, Lv 6 Addenbrooke’s Treatment Centre, Addenbrooke’s Hospital, Box 238, Cambridge, CB2 0QQ UK
| | - S. Nik-Zainal
- grid.5335.00000000121885934MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Box 197, Cambridge Biomedical Campus, Cambridge, CB2 0XZ UK ,grid.120073.70000 0004 0622 5016Academic Laboratory of Medical Genetics, Lv 6 Addenbrooke’s Treatment Centre, Addenbrooke’s Hospital, Box 238, Cambridge, CB2 0QQ UK
| | - M R Bani
- grid.4527.40000000106678902Laboratory of Cancer Metastasis Therapeutics, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - M. Lupia
- grid.15667.330000 0004 1757 0843Unit of Gynecological Oncology Research, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - R. Giavazzi
- grid.4527.40000000106678902Laboratory of Cancer Metastasis Therapeutics, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - E. Rulli
- grid.4527.40000000106678902Laboratory of Methodology for Clinical Research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - G. Damia
- grid.4527.40000000106678902Laboratory of Molecular Pharmacology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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7
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Bertero E, Robusto F, Rulli E, D'Ettorre A, Staszewsky L, Maack C, Lepore V, Latini R, Ameri P. Cancer incidence and mortality according to pre-existing heart failure in a community-based cohort. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0996] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Studies assessing whether heart failure (HF) is associated with an excess risk of cancer and cancer-related mortality yielded conflicting results. Here, we assessed the incidence and mortality of cancer according to the presence of HF in a community-based cohort.
Methods
By reviewing the health care records of the Puglia region in Italy, we first selected individuals ≥50-year-old, with no history of cancer within 3 years before the baseline evaluation and ≥5 years of follow-up, during the period from January 1st, 2005 to December 31st, 2013. Next, we matched 1:1 104,020 subjects with HF at baseline and 104,020 controls based on age, sex, Charlson Comorbidity Index, Drug-Derived Complexity Index, and follow-up duration. Cancer incidence and mortality were analyzed by Kaplan-Meier method and Cox regression models. Fine and Grey's regression model was also used to compare cancer-specific mortality while taking into account the competing risk of non-cancer death.
Results
Overall, the mean age of the study population was 76±10 years and the mean follow-up was 5.7 years. The incidence rate of cancer in HF patients and controls was 21.36 (95% CI, 20.98–21.74) and 12.42 (95% CI, 12.14–12.72) per 1000 person/years, respectively, corresponding to a 76% higher risk of incident cancer in HF patients (HR, 1.76; 95% CI, 1.71–1.81). HF patients also died from cancer more frequently than controls (HR 4.11; 95% CI, 3.86–4.38; Figure 1). This excess mortality was highest when age was <70 years (HR 7.54, 95% CI 6.33–8.98), and declined in subjects aged 70–79 years (HR 3.80, 95% CI 3.44–4.19) and ≥80 years (HR 3.10, 95% CI 2.81–3.43). The association of HF with cancer mortality was confirmed in the competing risk analysis (HR 3.48, 95% CI 3.27–3.72), as well as the interaction with age: <70 years of age: HR 6.65, 95% CI 5.60–7.94; 70–80 years: HR 3.14, 95% CI 2.84–3.48; and ≥80 years: HR 2.81, 95% CI 2.55–3.10.
The HF-related risk applied to the majority of cancer types, with the exception of neoplasm of the male reproductive system. Interestingly, among HF patients a high consumption of loop diuretic (>37.5 mg/d of furosemide) was associated with a higher mortality for cancer (HR 1.34, 95% CI 1.26–1.42 vs. ≤37.5 mg/d).
Conclusions
The analysis of this large community-based sample suggests that HF does portend an increased risk of cancer and cancer-related mortality, which is blunted, yet remains substantial, with increasing age and competing risk of dying from other causes. The risk of cancer may be heightened when HF is poorly compensated.
Funding Acknowledgement
Type of funding sources: None. Figure 1. Cancer mortality in HF patient
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Affiliation(s)
- E Bertero
- San Martino Hospital, Department of Internal Medicine, Genova, Italy
| | - F Robusto
- The Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - E Rulli
- The Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - A D'Ettorre
- The Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - L Staszewsky
- The Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - C Maack
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - V Lepore
- The Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - R Latini
- The Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - P Ameri
- San Martino Hospital, Department of Internal Medicine, Genova, Italy
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8
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Ganzinelli M, Linardou H, Alvisi MF, Caiola E, Lo Russo G, Cecere FL, Bettini AC, Psyrri A, Milella M, Rulli E, Fabbri A, De Maglie M, Romanelli P, Murray S, Broggini M, Marabese M, Garassino MC. Single-arm, open label prospective trial to assess prediction of the role of ERCC1/XPF complex in the response of advanced NSCLC patients to platinum-based chemotherapy. ESMO Open 2021; 6:100034. [PMID: 33422766 PMCID: PMC7809372 DOI: 10.1016/j.esmoop.2020.100034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/24/2020] [Accepted: 12/06/2020] [Indexed: 11/05/2022] Open
Abstract
Background Platinum-based therapy, combined or not with immune checkpoint inhibitors, represents a front-line choice for patients with non-small-cell lung cancer (NSCLC). Despite the improved outcomes in the last years for this malignancy, only a sub-group of patients have long-term benefit. Excision repair cross-complementation group 1 (ERCC1) has been considered a potential biomarker to predict the outcome of platinum-based chemotherapy in NSCLC. However, the ERCC1 gene is transcribed in four splice variants where the isoform 202 was described as the only one active and able to complex Xeroderma pigmentosum group F-complementing protein (XPF). Here, we prospectively investigated if the active form of ERCC1, as assessed by the ERCC1/XPF complex (ERCC1/XPF), could predict the sensitivity to platinum compounds. Patients and methods Prospectively enrolled, patients with advanced NSCLC treated with a first-line regimen containing platinum were centrally evaluated for ERCC1/XPF by a proximity ligation assay. Overall survival (OS), progression-free survival (PFS) and objective response rate (ORR) were analyzed. Results The absence of the ERCC1/XPF in the tumor suggested a trend of worst outcomes in terms of both OS [hazard ratio (HR) 1.41, 95% confidence interval (CI) 0.67-2.94, P = 0.373] and PFS (HR 1.61, 95% CI 0.88-3.03, P = 0.123). ORR was marginally influenced in ERCC1/XPF-negative and -positive groups [odds ratio (stable disease + progressive disease versus complete response + partial response) 0.87, 95% CI 0.25-3.07, P = 0.832]. Conclusion The lack of ERCC1/XPF complex in NSCLC tumor cells might delineate a group of patients with poor outcomes when treated with platinum compounds. ERCC1/XPF absence might well identify patients for whom a different therapeutic approach could be necessary. This is the first study investigating the ERCC1/XPF complex as a platinum-based therapy response biomarker in NSCLC. The lack of ERCC1/XPF complex might delineate a group of patients with poor outcomes when treated with platinum compounds. ERCC1/XPF absence might identify tumors for whom a different therapeutic approach than platinum compounds could be necessary.
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Affiliation(s)
- M Ganzinelli
- Unit of Thoracic Oncology, Medical Oncology Department 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - H Linardou
- 4th Oncology Department, Metropolitan Hospital, Athens, Greece
| | - M F Alvisi
- Laboratory of Methodology for Clinical Research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - E Caiola
- Laboratory of Molecular Pharmacology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - G Lo Russo
- Unit of Thoracic Oncology, Medical Oncology Department 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - F L Cecere
- Division of Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - A C Bettini
- UO Oncologia Medica, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - A Psyrri
- Section of Oncology, Department of Internal Medicine, Attikon Hospital, National Kapodistrian University of Athens, Athens, Greece
| | - M Milella
- Department of Medicine, Section of Medical Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - E Rulli
- Laboratory of Methodology for Clinical Research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - A Fabbri
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M De Maglie
- Mouse and Animal Pathology Lab, Fondazione Filarete, Milan, Italy; Department of Veterinary Medicine, University of Milan, Milan, Italy
| | - P Romanelli
- Mouse and Animal Pathology Lab, Fondazione Filarete, Milan, Italy; Department of Veterinary Medicine, University of Milan, Milan, Italy
| | - S Murray
- Biomarker Solutions Ltd, London, UK
| | - M Broggini
- Laboratory of Molecular Pharmacology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - M Marabese
- Laboratory of Molecular Pharmacology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - M C Garassino
- Unit of Thoracic Oncology, Medical Oncology Department 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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9
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Petrelli F, Rulli E, Labianca R, Lonardi S, Rosati G, Dotti K, Ronzoni M, Pella N, Pusceddu V, Banzi M, Zampino MG, Yasmina M, Marchetti P, Cantore M, Zaniboni A, Rimassa L, Ciuffreda L, Ferrari D, Zagonel V, Maiello E, Sobrero A. Overall survival with 3 or 6 months of adjuvant chemotherapy in Italian TOSCA phase 3 randomised trial. Ann Oncol 2020; 32:66-76. [PMID: 33098997 DOI: 10.1016/j.annonc.2020.10.477] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Oxaliplatin-based adjuvant chemotherapy is the standard treatment of high-risk colon cancer (CC). A shorter duration (3 months) can achieve a similar outcome [in terms of relapse-free survival (RFS)] to a longer duration. This study reports the overall survival (OS) analysis of the three or six colon adjuvant (TOSCA) phase III study. It assessed different adjuvant chemotherapy durations in patients with resected high-risk stage II and stage III CC. MATERIAL AND METHODS TOSCA was an open-label, phase III, multicentre, non-inferiority trial conducted in 130 Italian centres. Patients were randomly assigned, in a 1 : 1 ratio, to receive 3 months of standard doses of FOLFOX/CAPOX, or 6 months of FOLFOX/CAPOX. Patients with histologically confirmed high-risk stage II and III CC were included, with RFS being the primary end point. OS was a secondary end point. RESULTS From June 2007 to March 2013, 3759 patients were accrued. At a median follow-up of 7 years, the hazard ratio (HR) for RFS of the 3-month versus 6-month arms was 1.13; 95% confidence interval (CI) 0.99-1.29, P for non-inferiority = 0.380, P for superiority = 0.068, crossing the non-inferiority limit of 1.20. This result did not allow us to reject the null hypothesis of the inferiority of the 3-month arm. The HR for OS of the 3-month versus 6-month arms was 1.09 (95% CI 0.93-1.26, P for superiority = 0.288). At the last follow-up analysis, the absolute OS difference between arms was <1%. CONCLUSIONS The present analysis of the TOSCA trial does not indicate any significant difference in OS between the treatment groups. The extra benefit provided by the longer treatment should be balanced against the extra toxicity of more prolonged therapy. The trial is registered with ClinicalTrials.gov, registration number: NCT0064660.
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Affiliation(s)
- F Petrelli
- Medical Oncology Unit, Treviglio, Caravaggio Hospital, Treviglio, Bergamo, Italy.
| | - E Rulli
- Laboratory of Methodology for Clinical Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - R Labianca
- Cancer Center ASST Papa Giovanni XXIII, Bergamo, Italy
| | - S Lonardi
- Medical Oncology Unit 1, Istituto Oncologico Veneto - IRCCS, Padua, Italy
| | - G Rosati
- Medical Oncology Unit, Ospedale San Carlo, Potenza, Italy
| | - K Dotti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - M Ronzoni
- Medical Oncology Unit, Ospedale San Raffaele - IRCCS, Milan, Italy
| | - N Pella
- Medical Oncology Unit, Azienda Ospedaliero Universitaria Santa Maria della Misericordia, Udine, Italy
| | - V Pusceddu
- Medical Oncology, University Hospital and University of Cagliari, Cagliari, Italy
| | - M Banzi
- Medical Oncology Unit, AUSL-IRCCS, Reggio Emilia, Italy
| | - M G Zampino
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumours, IRCCS, Milan, Italy
| | - M Yasmina
- Medical Oncology Unit, Rovigo Hospital, Rovigo, Italy
| | - P Marchetti
- Medical Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome and IDI-IRCCS, Rome, Italy
| | - M Cantore
- Medical Oncology Unit, ASST Mantova, Mantua, Italy
| | - A Zaniboni
- Medical Oncology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - L Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, Rozzano (MI); Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - L Ciuffreda
- Medical Oncology Unit, Azienda Ospedaliero Universitaria San Giovanni Battista, Molinette, Turin, Italy
| | - D Ferrari
- Medical Oncology Unit, Azienda Ospedaliera San Paolo, Milan, Italy
| | - V Zagonel
- Medical Oncology Unit 1, Istituto Oncologico Veneto - IRCCS, Padua, Italy
| | - E Maiello
- Medical Oncology Unit, Hospital Casa Sollievo della Sofferenza-IRCCS, San Giovanni Rotondo, Italy
| | - A Sobrero
- Medical Oncology Unit, IRCCS San Martino-IST, Genoa, Italy
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Colombo N, Gadducci A, Sehouli J, Biagioli E, Nyvang GB, Riniker S, Montes A, Ottevanger N, Zeimet A, Vergote I, Funari G, Baldoni A, Tognon G, De Censi A, Galaz CC, Chekerov R, Maenpaa J, Rulli E, Fossati R, Poveda A. LBA30 INOVATYON study: Randomized phase III international study comparing trabectedin/PLD followed by platinum at progression vs carboplatin/PLD in patients with recurrent ovarian cancer progressing within 6-12 months after last platinum line. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2260] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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11
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Colombo N, Nicoletto M, Benedetti Panici P, Tognon G, Bologna A, Lissoni A, DeCensi A, Tomao F, Fossati R, Tettamanzi F, Rulli E, Galli F, De Luca M, Alvisi M, Mancari R, Ratti M, Baldoni A, Torri V, Biagioli E. BAROCCO: A randomized phase II study of weekly paclitaxel vs cediranib-olaparib combination given with continuous or intermittent schedule in patients with recurrent platinum resistant ovarian cancer (PROC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.055] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mandala M, Legramandi L, Salvati L, Rulli E. The impact of targeted therapies and immunotherapy in melanoma brain metastases: A systematic review and meta-analysis. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz255.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Colombo N, Nicoletto O, Benedetti Panici P, Tognon G, Lissoni A, Bologna A, Tomao F, Fossati R, Tettamanzi F, Rulli E, Galli F, Alvisi M, Torri V, Biagioli E. BAROCCO: A randomized phase II study of weekly paclitaxel vs cediranib-olaparib with continuous schedule vs cediranib-olaparib with intermittent schedule in advanced platinum resistant ovarian cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy285.209] [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
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Ghi MG, Paccagnella A, Ferrari D, Foa P, Alterio D, Codecà C, Nolè F, Verri E, Orecchia R, Morelli F, Parisi S, Mastromauro C, Mione CA, Rossetto C, Polsinelli M, Koussis H, Loreggian L, Bonetti A, Campostrini F, Azzarello G, D'Ambrosio C, Bertoni F, Casanova C, Emiliani E, Guaraldi M, Bunkheila F, Bidoli P, Niespolo RM, Gava A, Massa E, Frattegiani A, Valduga F, Pieri G, Cipani T, Da Corte D, Chiappa F, Rulli E. Induction TPF followed by concomitant treatment versus concomitant treatment alone in locally advanced head and neck cancer. A phase II-III trial. Ann Oncol 2018; 28:2206-2212. [PMID: 28911070 DOI: 10.1093/annonc/mdx299] [Citation(s) in RCA: 101] [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] [Indexed: 11/12/2022] Open
Abstract
Background Platinum-based chemoradiation (CCRT) is the standard treatment for Locally Advanced Head and Neck Squamous-Cell Carcinoma (LAHNSCC). Cetuximab/RT (CET/RT) is an alternative treatment option to CCRT. The efficacy of induction chemotherapy (IC) followed by chemoradiation compared to chemoradiation alone has not been demonstrated in randomized clinical trials. The goals of this phase II-III trial were to assess: (i) the overall survival (OS) of IC versus no-induction (no-IC) and (ii) the Grade 3-4 in-field mucosal toxicity of CCRT versus CET/RT. The present paper focuses on the analysis of efficacy. Materials and methods Patients with LAHNSCC were randomized to receive concomitant treatment alone [CCRT (Arm A1) or CET/RT (Arm A2)], or three cycles of induction docetaxel/cisplatin/5 fluorouracil (TPF) followed by CCRT (Arm B1) or followed by CET/RT (Arm B2). The superiority hypothesis of OS comparison of IC versus no-IC (Arms B1 + B2 versus A1 + A2) required 204 deaths to detect an absolute 3-year OS difference of 12% (HR 0.675, with 80% power at two-sided 5% significance level). Results 414 out of 421 patients were finally analyzed: 206 in the IC and 208 in the no-IC arm. Six patients were excluded because of major violation and one because of metastatic disease at diagnosis. With a median follow-up of 44.8 months, OS was significantly higher in the IC arm (HR 0.74; 95% CI 0.56-0.97; P = 0.031). Complete Responses (P = 0.0028), Progression Free Survival (P = 0.013) and the Loco-regional Control (P = 0.036) were also significantly higher in the IC arm. Compliance to concomitant treatments was not affected by induction TPF. Conclusions IC followed by concomitant treatment improved the outcome of patients with LAHNSCC without compromising compliance to the concomitant treatments. The degree of the benefit of IC could be different according to the type of the subsequent concomitant strategy. Clinical Trial Number NCT01086826, www.clinicaltrials.gov.
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Affiliation(s)
- M G Ghi
- Medical Oncology Department, Ospedale dell'Angelo, Venezia
| | - A Paccagnella
- Medical Oncology Department, Ospedale dell'Angelo, Venezia
| | - D Ferrari
- Medical Oncology Unit, Ospedale San Paolo, Milano
| | - P Foa
- Medical Oncology Unit, Ospedale San Paolo, Milano
| | | | - C Codecà
- Medical Oncology Unit, Ospedale San Paolo, Milano
| | - F Nolè
- Unit of Urogenital and Head and Neck Oncology, Istituto Europeo di Oncologia, Milano
| | - E Verri
- Unit of Urogenital and Head and Neck Oncology, Istituto Europeo di Oncologia, Milano
| | | | | | - S Parisi
- U.O.C. Radiation Oncology, IRCCS Casa Sollievo della Sofferenza, San Giovanni, Rotondo
| | - C Mastromauro
- Medical Oncology Department, Ospedale dell'Angelo, Venezia
| | - C A Mione
- Radiotherapy Department, Ospedale SS Giovanni e Paolo, Venezia
| | | | - M Polsinelli
- S.O.C. Radiation Oncology, Azienda Ospedaliero-Universitaria S.Maria della Misericordia, Udine
| | - H Koussis
- Medical Oncology Department 2, Istituto Oncologico Veneto- IRCCS, Padova
| | - L Loreggian
- Radiotherapy Department, Istituto Oncologico Veneto - IRCCS, Padova
| | - A Bonetti
- Medical Oncology Department, Ospedale Mater Salutis, Legnago
| | - F Campostrini
- Radiotherapy Department, Ospedale Mater Salutis, Legnago
| | - G Azzarello
- Oncology Unit, Department of Internal Medical Sciences, Mirano
| | | | - F Bertoni
- Radiotherapy Department, Azienda Ospedaliero Universitaria, Modena
| | | | - E Emiliani
- Radiotherapy Department, Azienda USL, Ravenna
| | - M Guaraldi
- Medical Oncology Department, Policlinico Sant'Orsola-Malpighi, Bologna
| | - F Bunkheila
- Radiotherapy Department, Policlinico Sant'Orsola-Malpighi, Bologna
| | - P Bidoli
- Medical Oncology Department, Ospedale San Gerardo, Monza
| | - R M Niespolo
- Radiotherapy Department, Ospedale San Gerardo, Monza, Ospedale San Gerardo, Monza
| | - A Gava
- Radiotherapy Department, Ospedale Ca' Foncello, Treviso
| | - E Massa
- Department of Medical Science, Università degli Studi di Cagliari, Cagliari
| | - A Frattegiani
- Radiation Oncology Department, Ospedale S. Maria della Misericordia, Perugia
| | - F Valduga
- Medical Oncology Department, Ospedale S. Chiara, Trento
| | - G Pieri
- Medical Oncology Department, AO Triestina, Trieste
| | - T Cipani
- Niguarda Cancer Center, Ospedale Niguarda Cà Granda, Milano
| | - D Da Corte
- Oncology Department, Ospedale S. Martino, Belluno
| | - F Chiappa
- Laboratory of Clinical Research, Istituto di Ricerche Farmacologiche "Mario Negri," Milano, Italy
| | - E Rulli
- Laboratory of Clinical Research, Istituto di Ricerche Farmacologiche "Mario Negri," Milano, Italy
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Lonardi S, Sobrero A, Rosati G, Di Bartolomeo M, Ronzoni M, Aprile G, Massida B, Scartozzi M, Banzi M, Zampino MG, Pasini F, Marchetti P, Cantore M, Zaniboni A, Rimassa L, Ciuffreda L, Ferrari D, Barni S, Zagonel V, Maiello E, Rulli E, Labianca R. Phase III trial comparing 3-6 months of adjuvant FOLFOX4/XELOX in stage II-III colon cancer: safety and compliance in the TOSCA trial. Ann Oncol 2017; 28:3110. [PMID: 28327986 DOI: 10.1093/annonc/mdx021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tessari A, Palmieri D, Pawlikowski M, Parbhoo K, Foray C, Fassan M, La Perle K, Rulli E, Fabbri A, Ganzinelli M, Embrione V, Broggini M, Amann J, Carbone D, Garassino M, Croce C, Coppola V. P2.02-065 RanBP9 is a Novel Prognostic and Predictive Biomarker for NSCLC and Affects Cellular Response to Cisplatin and PARP Inhibitors. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ruzzo A, Galli F, Galli F, Rulli E, Lonardi S, Zagonel V, Ronzoni M, Ionta M, Pella N, Mucciarini C, Labianca R, Veltri E, Sozzi P, Barni S, Nicolini M, Biondi E, Bramati A, Turci D, Buscaglia M, Magnani M, Graziano F. Germline variants and clinical outcomes of high-risk stage II and stage III colon cancer patients treated with oxaliplatin and fluoropyrimidines adjuvant chemotherapy: a pharmacogenetic ancillary study to TOSCA trial. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx422.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Zaniboni A, Lonardi S, Labianca R, Di Bartolomeo M, Rosati G, Ronzoni M, Pella N, Banzi M, Zampino M, Pasini F, Marchetti P, Rimassa L, Maiello E, Bidoli P, Cinieri S, Barni S, Ciuffreda L, Beretta G, Frontini L, Rulli E, Sobrero A. FOLFOX4/XELOX in stage II–III colon cancer: early survival data of the Italian Three Or Six Colon Adjuvant (TOSCA) trial. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Labianca R, Lonardi S, Rosati G, Di Bartolomeo M, Ronzoni M, Pella N, Scartozzi M, Banzi M, Zampino M, Pasini F, Marchetti P, Cantore M, Zaniboni A, Rimassa L, Ciuffreda L, Barni S, Zagonel V, Maiello E, Rulli E, Sobrero A. FOLFOX4/XELOX in stage II–III colon cancer: Efficacy and safety results of the Italian Three Or Six Colon Adjuvant (TOSCA) trial. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ganzinelli M, Broggini M, Sozzi G, Moro M, Marabese M, Caiola E, Busico A, Bria E, Rulli E, Garassino M. Correlation between clinical outcomes of patients treated within the tailor trial and next-generation sequencing (NGS) results: Analysis of genes associated to KRAS mutations. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cazzaniga ME, Cortesi L, Ferzi A, Scaltriti L, Cicchiello F, Ciccarese M, Della Torre S, Villa F, Giordano M, Verusio C, Nicolini M, Gambaro AR, Zanlorenzi L, Biraghi E, Legramandi L, Rulli E. Metronomic chemotherapy with oral vinorelbine (mVNR) and capecitabine (mCAPE) in advanced HER2-negative breast cancer patients: is it a way to optimize disease control? Final results of the VICTOR-2 study. Breast Cancer Res Treat 2016; 160:501-509. [PMID: 27752847 PMCID: PMC5090011 DOI: 10.1007/s10549-016-4009-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 10/03/2016] [Indexed: 11/29/2022]
Abstract
Purpose The VICTOR-1 study demonstrated that the all-oral metronomic combination of vinorelbine and capecitabine is highly active and well tolerated in hormone receptor-positive/HER2-negative patients. The VICTOR-2 study was designed to confirm these results. Methods Patients received mVNR 40 mg three times a week and mCAPE 500 mg three times a day, continuously. The primary endpoint was the clinical benefit rate (CBR); secondary endpoints were toxicity, objective response rate (ORR), and progression-free survival (PFS). Results Eighty patients were evaluable for the primary efficacy analysis. Median age was 65.3 years; most patients had HR-positive tumors (65 %). The CBR was 45.7 % (95 % CI 28.8–63.4) and 51.1 % (95 % CI 35.8–66.3) in first- and ≥ second-line therapy, respectively. The ORR was 35.5 % in first-line (95 % CI 19.2–54.6) and 25.6 % in ≥second-line (95 % CI 13.5–41.2). The median duration of response was 11.3 and 6.4 months and PFS rates at 1 year were 24.3 and 22.2 %, respectively. In triple-negative breast cancer patients (N = 28, 35 %) a lower, but clinically relevant CBR (35.7, 95 % CI 18.6–55.9) was observed. The main toxicities per cycle were non-febrile neutropenia (1.1 %), hand-foot syndrome (1.0 %), nausea and vomiting (1.0 %), leucopenia (0.8 %), fatigue (0.7 %), and diarrhea (0.4 %). Conclusion The VICTOR-2 study confirms the clinical activity of mVNR and mCAPE in HER2-negative breast cancer patients, suggesting that the easy schedule of administration, which requires monthly blood tests and limits patients’ dependence on hospitals, and the low cost of the drugs are valuable elements, even for countries with limited access to innovative or expensive drugs.
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Affiliation(s)
- M E Cazzaniga
- Oncology Unit, ASST Monza, Via Pergolesi, 33 20900, Monza, MB, Italy.
| | - L Cortesi
- Haematology and Oncology Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - A Ferzi
- Oncology Unit, ASST Ovest Milanese, Ospedale di Legnano, Legnano, Italy
| | - L Scaltriti
- Oncology Day Hospital Unit, Ospedale Civile di Guastalla, Guastalla, Italy
| | - F Cicchiello
- Oncology Unit, ASST Monza, Via Pergolesi, 33 20900, Monza, MB, Italy
| | - M Ciccarese
- Oncology Unit, Ospedale Vito Fazzi, Lecce, Italy
| | - S Della Torre
- Oncology Unit, ASST Rhodense-Presidio di Garbagnate Milanese e Presidio di Rho, Garbagnate, Italy
| | - F Villa
- Oncology Unit, ASST, Lecco, Italy
| | - M Giordano
- Oncology Unit, ASST Lariana, Como, Italy
| | - C Verusio
- Oncology Unit, ASST della Valle Olona, Saronno, Italy
| | - M Nicolini
- Oncology Day Hospital Unit, Azienda USL Romagna, Cattolica, Italy
| | - A R Gambaro
- Oncology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - L Zanlorenzi
- Oncology Unit, ASST della Valle Olona, Busto Arsizio, Italy
| | - E Biraghi
- Oncology Unit, ASST Melegnano e Martesana, Gorgonzola, Italy
| | - L Legramandi
- Methodology for Clinical Research Laboratory, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - E Rulli
- Methodology for Clinical Research Laboratory, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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Graziano F, Ruzzo A, Rulli E, Galli F, Galli F, Menghi M, Viti D, Giacomini E, Lonardi S, Ronzoni M, Massidda B, Pella N, Mucciarini C, Labianca R, Veltri E, Sozzi P, Barni S, Sobrero A, Frontini L, Magnani M. Dihydropyrimidine dehydrogenase (DPYD) gene polymorphisms profiling in colon cancer patients treated with adjuvant chemotherapy in the randomized phase III TOSCA trial. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw331.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Legramandi L, Rulli E, Stupia S, Roberto A, Corli O. Efficacy and safety of oral Prolonged-Release Oxycodone/Naloxone in opioid-naïve cancer patients: results from GREAT study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw344.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lonardi S, Sobrero A, Rosati G, Di Bartolomeo M, Ronzoni M, Aprile G, Massida B, Scartozzi M, Banzi M, Zampino MG, Pasini F, Marchetti P, Cantore M, Zaniboni A, Rimassa L, Ciuffreda L, Ferrari D, Barni S, Zagonel V, Maiello E, Rulli E, Labianca R. Phase III trial comparing 3-6 months of adjuvant FOLFOX4/XELOX in stage II-III colon cancer: safety and compliance in the TOSCA trial. Ann Oncol 2016; 27:2074-2081. [PMID: 27573560 DOI: 10.1093/annonc/mdw404] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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: 04/27/2016] [Accepted: 08/15/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Six months of oxaliplatin-based adjuvant chemotherapy is standard of care for radically resected stage III colon cancer and an accepted option for high-risk stage II. A shorter duration of therapy, if equally efficacious, would be advantageous for patients and Health-Care Systems. PATIENTS AND METHODS TOSCA ['Randomized trial investigating the role of FOLFOX-4 or XELOX (3 versus 6 months) regimen duration and bevacizumab as adjuvant therapy for patients with stage II/III colon cancer] is an open-label, phase III, multicenter, noninferiority trial randomizing patients with high-risk stage II or stage III radically resected colon cancer to receive 3 months (arm 3 m) versus 6 months (arm 6 m) of FOLFOX4/XELOX. Primary end-point was relapse-free survival. We present here safety and compliance data. RESULTS From June 2007 to March 2013, 3759 patients were accrued from 130 Italian sites, 64% receiving FOLFOX4 and 36% XELOX in either arm. Treatment completion rate without any modification was 35% versus 12% and with delays or dose reduction 52% versus 44% in arm 3 and 6 m. Treatment was permanently discontinued in 8% (arm 3 m) and 33% (arm 6 m). In arm 6 m, 50% of patients discontinuing treatment did so after completing 80% of planned program. Grade 3+ toxicities were higher in arm 6 m than that in 3 m. Grade 2+ neuropathy was 31.2% versus 8.8% (P < 0.0001) while grade 3+ was 8.4 versus 1.3 (P < 0.0001), in arm 3 and 6 m. Seven deaths within 30 days from last treatment administration in arm 6 m and three deaths in arm 3 m were observed (0.3% versus 0.1%, P = 0.34). CONCLUSIONS TOSCA is the first trial comparing 3 versus 6 months of adjuvant chemotherapy completing accrual within the international initiative of treatment duration evaluation (International Duration Evaluation of Adjuvant, IDEA). High compliance to treatment in control arm will allow a correct assessment of potential differences between the two treatment durations. CLINICALTRIALSGOV REGISTRATION NUMBER NCT00646607.
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Affiliation(s)
- S Lonardi
- Medical Oncology Unit 1, Istituto Oncologico Veneto-IRCCS, Padova
| | - A Sobrero
- Medical Oncology Unit, IRCCS San Martino-IST, Genova
| | - G Rosati
- Medical Oncology Unit, Ospedale San Carlo, Potenza
| | - M Di Bartolomeo
- Medical Oncology Unit, Fondazione Istituto Nazionale Tumori-IRCCS, Milano
| | - M Ronzoni
- Medical Oncology Unit, Ospedale San Raffaele-IRCCS, Milano
| | - G Aprile
- Medical Oncology Unit, Azienda Ospedaliero Universitaria Santa Maria della Misericordia, Udine
| | | | - M Scartozzi
- Medical Oncology, University Hospital and University of Cagliari, Cagliari
| | - M Banzi
- Medical Oncology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia
| | - M G Zampino
- Gastrointestinal Medical Oncology Unit and Neuroendocrine Tumors, Istituto Europeo di Oncologia-IRCCS, Milano
| | - F Pasini
- Medical Oncology Unit, Ospedale Santa Maria della Misericordia, Rovigo
| | - P Marchetti
- Medical Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome and IDI-IRCCS, Roma
| | - M Cantore
- Medical Oncology Unit, Civico Hospital Carrara (MS)
| | - A Zaniboni
- Medical Oncology Unit, Fondazione Poliambulanza, Brescia
| | - L Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano (MI)
| | - L Ciuffreda
- Medical Oncology Unit, Azienda Ospedaliero Universitaria San Giovanni Battista, Molinette, Torino
| | - D Ferrari
- Medical Oncology Unit, Azienda Ospedaliera San Paolo, Milano
| | - S Barni
- Medical Oncology, ASST Bergamo Ovest, Ospedale di Treviglio, Bergamo
| | - V Zagonel
- Medical Oncology Unit 1, Istituto Oncologico Veneto-IRCCS, Padova
| | - E Maiello
- Medical Oncology Unit, Ospedale Casa Sollievo della Sofferenza-IRCCS, San Giovanni Rotondo
| | - E Rulli
- Laboratory of Clinical Research Methodology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milano
| | - R Labianca
- Medical Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
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Graziano F, Ruzzo A, Giacomini E, Ricciardi T, Aprile G, Loupakis F, Lorenzini P, Ongaro E, Zoratto F, Catalano V, Sarti D, Rulli E, Cremolini C, De Nictolis M, De Maglio G, Falcone A, Fiorentini G, Magnani M. Glycolysis gene expression analysis and selective metabolic advantage in the clinical progression of colorectal cancer. Pharmacogenomics J 2016; 17:258-264. [DOI: 10.1038/tpj.2016.13] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 01/26/2016] [Accepted: 01/27/2016] [Indexed: 01/16/2023]
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Graziano F, Rulli E, Biagioli E, Catalano V. Number needed to treat for pricing costly anticancer drugs: the example of regorafenib in metastatic colorectal cancer. Ann Oncol 2016; 27:747-8. [PMID: 26787235 DOI: 10.1093/annonc/mdw024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F Graziano
- Department of Onco-Hematology, Azienda Ospedaliera 'Ospedali Riuniti Marche Nord', Pesaro
| | - E Rulli
- Clinical Research Laboratory, IRCCS Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - E Biagioli
- Clinical Research Laboratory, IRCCS Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - V Catalano
- Department of Onco-Hematology, Azienda Ospedaliera 'Ospedali Riuniti Marche Nord', Pesaro
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Cascinu S, Lonardi S, Rosati G, Nasti G, Zaniboni A, Romiti A, Aglietta M, Bilancia D, Iaffaioli V, Zagonel V, Giordano M, Corsi D, Ferraù F, Labianca R, Berardi R, Rulli E, Floriani I. 2006 A phase III multicenter trial comparing two different sequences of second/third line therapy (cetuximab/irinotecan followed by FOLFOX versus FOLFOX followed by cetuximab/irinotecan) in metastatic K-RAS wt colorectal cancer (mCC) patients, refractory to FOLFIRI/Bevacizumab). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(15)30040-x] [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: 10/23/2022]
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Rulli E, Marabese M, Torri V, Farina G, Veronese S, Bettini A, Longo F, Moscetti L, Ganzinelli M, Lauricella C, Copreni E, Labianca R, Martelli O, Marsoni S, Broggini M, Garassino MC. Value of KRAS as prognostic or predictive marker in NSCLC: results from the TAILOR trial. Ann Oncol 2015. [PMID: 26209642 DOI: 10.1093/annonc/mdv318] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The prognostic and predictive role of KRAS mutations in advanced nonsmall-cell lung cancer (NSCLC) is still unclear. TAILOR prospectively assessed the prognostic and predictive value of KRAS mutations in NSCLC patients treated with erlotinib or docetaxel in second line. PATIENTS AND METHODS NSCLC patients from 52 Italian hospitals were genotyped for KRAS and EGFR mutational status in two independent laboratories. Wild-type EGFR patients (N = 218) received first-line platinum-based chemotherapy and were randomly allocated at progression to erlotinib or docetaxel. Overall survival (OS) according to KRAS mutational status was the primary end point. RESULTS KRAS mutations were present in 23% of TAILOR randomized cases. The presence of a KRAS mutation did not adversely affect progression-free (PFS) or overall (OS) survival [hazard ratio (HR) PFS = 1.01, 95% confidence interval (CI) 0.71-1.41, P = 0.977; OS = 1.24, 95% CI 0.87-1.77, P = 0.233], nor influenced treatment outcome (test for interaction: OS P = 0.965; PFS P = 0.417). Patients randomized to docetaxel treatment experienced longer survival independently from the KRAS mutational status of their tumors (HR: mutated KRAS 0.81, 95% CI 0.45-1.47; wild-type KRAS 0.79, 95% CI 0.57-1.10). CONCLUSION In TAILOR, KRAS was neither prognostic nor predictive of benefit for either docetaxel or erlotinib. Docetaxel remains superior independently from KRAS status for second-line treatment in EGFR wild-type advanced NSCLC patients. CLINICAL TRIAL REGISTRATION NCT00637910.
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Affiliation(s)
- E Rulli
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan
| | - M Marabese
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan
| | - V Torri
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan
| | - G Farina
- Department of Medical Oncology, Fatebenefratelli e Oftalmico Hospital, Milan
| | - S Veronese
- Department of Pathology, Niguarda Cancer Center, Ospedale Niguarda Cà Granda, Milan
| | - A Bettini
- Department of Medical Oncology, Papa Giovanni XXIII Hospital, Bergamo
| | - F Longo
- Department of Medical Oncology, Università La Sapienza, Policlinico Umberto I, Rome
| | - L Moscetti
- Department of Medical Oncology, Ospedale Belcolle, Viterbo
| | - M Ganzinelli
- Thoracic Oncology Unit, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - C Lauricella
- Department of Pathology, Niguarda Cancer Center, Ospedale Niguarda Cà Granda, Milan
| | - E Copreni
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan
| | - R Labianca
- Department of Medical Oncology, Papa Giovanni XXIII Hospital, Bergamo
| | - O Martelli
- Department of Medical Oncology, Ospedale San Giovanni e Addolorata, Rome
| | - S Marsoni
- Clinical Trials Coordination Unit, Istituto di Candiolo-FPO, IRCCS, Candiolo, Italy
| | - M Broggini
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan
| | - M C Garassino
- Thoracic Oncology Unit, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
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D'Onofrio M, Biagioli E, Gerardi C, Canestrini S, Rulli E, Crosara S, De Robertis R, Floriani I. Diagnostic performance of contrast-enhanced ultrasound (CEUS) and contrast-enhanced endoscopic ultrasound (ECEUS) for the differentiation of pancreatic lesions: a systematic review and meta-analysis. Ultraschall Med 2014; 35:515-521. [PMID: 25226455 DOI: 10.1055/s-0034-1385068] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To evaluate CEUS for the diagnosis of pancreatic diseases and its application in the clinical routine with a focus on the value of CEUS in ductal pancreatic carcinoma and its use for the differentiation of neoplastic and non-neoplastic lesions. MATERIALS AND METHODS All prospective and retrospective studies published in any language by March 6, 2014 were included based on the following criteria: use of contrast-enhanced ultrasound (CEUS) and contrast-enhanced endoscopic ultrasound (ECEUS) as the imaging methods, use of histology as the reference method and availability of a complete translation. Two authors analyzed the titles and abstracts of the search results to identify all relevant publications. Two independent readers then analyzed the full articles to identify those meeting the inclusion criteria. Details regarding study design, patient characteristics, interventions, and results were then independently extracted by two radiologists and one reviewer with methodological expertise. Sensitivity, specificity and diagnostic odds ratio (DOR) were used to obtain overall estimates. RESULTS 1293 articles were initially identified. 27 studies met the inclusion criteria. CEUS was the index test in 23 studies while ECEUS was the index test in 4 studies. The primary study objective was met by 20 studies with respect to ductal adenocarcinoma. CEUS sensitivity was evaluated in all studies. The pooled estimate of CEUS sensitivity for the diagnosis of ductal adenocarcinoma was 0.89 (95 % CI, 0.85 - 0.92). 15 out of 20 studies examined CEUS specificity. The average specificity was 0.84 (95 % CI, 0.77 - 0.89). The pooled estimate for DOR was 61.12 (95 % CI, 34.81 - 107.32). With regard to the secondary study objective, the pooled sensitivity and specificity were 0.95 (95 % CI, 0.93 - 0.96) from 14 studies and 0.72 (95 % CI, 0.58 - 0.83) from 13 studies, respectively. The pooled DOR was 57.63 (95 % CI, 33.62 - 98.78). CONCLUSION The sensitivity, specificity, and DOR results show the high value of CEUS for the characterization and differentiation of ductal adenocarinomas from other pancreatic diseases and for cystic pancreatic lesions. For this reason and due to their noninvasive nature, CEUS and ECEUS should be used as the first methods for characterizing neoplastic pancreatic lesions, especially since these are often incidental findings. The methods improve the quality of ultrasound diagnostics and result in faster diagnosis and better disease management.
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Affiliation(s)
| | - E Biagioli
- Department of Oncology, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - C Gerardi
- Department of Oncology, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - S Canestrini
- Department of Radiology, G.B. Rossi University Hospital, Verona, Italy
| | - E Rulli
- Department of Oncology, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - S Crosara
- Department of Radiology, G.B. Rossi University Hospital, Verona, Italy
| | - R De Robertis
- Department of Radiology, G.B. Rossi University Hospital, Verona, Italy
| | - I Floriani
- Department of Oncology, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
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Massi D, Brusa D, Merelli B, Ciano M, Audrito V, Serra S, Buonincontri R, Baroni G, Nassini R, Minocci D, Cattaneo L, Tamborini E, Carobbio A, Rulli E, Deaglio S, Mandalà M. PD-L1 marks a subset of melanomas with a shorter overall survival and distinct genetic and morphological characteristics. Ann Oncol 2014; 25:2433-2442. [PMID: 25223485 DOI: 10.1093/annonc/mdu452] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Programmed cell death ligand 1 (PD-L1) is a cell surface molecule that plays a critical role in suppressing immune responses, mainly through binding of the PD-1 receptor on T lymphocytes. PD-L1 may be expressed by metastatic melanoma (MM). However, its clinical and biological significance remains unclear. Here, we investigated whether expression of PD-L1 in MM identifies a biologically more aggressive form of the disease, carrying prognostic relevance. PATIENTS AND METHODS PD-L1 expression was analyzed by immunohistochemistry using two different antibodies in primary tumors and paired metastases from 81 melanoma patients treated at a single institution. Protein expression levels were correlated with PD-L1 mRNA, BRAF mutational status and clinical outcome. PD-L1(+) and PD-L1(-) subsets of the A375 cell line were stabilized in vitro and compared using gene expression profiling and functional assays. Results were confirmed using xenograft models. RESULTS PD-L1 membrane positivity was detected in 30/81 (37%) of patients. By multivariate analysis, Breslow thickness and PD-L1 membrane positivity were independent risk factors for melanoma-specific death {PD-L1 5% cutoff [hazard ratio (HR) 3.92, confidence interval (CI) 95% 1.61-9.55 P < 0.003], PD-L1 as continuous variable (HR 1.03, 95% CI 1.02-1.04 P < 0.002)}. PD-L1 expression defined a subset of the BRAF-mutated A375 cell line characterized by a highly invasive phenotype and by enhanced ability to grow in xenograft models. CONCLUSIONS PD-L1 is an independent prognostic marker in melanoma. If confirmed, our clinical and experimental data suggest that PD-L1(+) melanomas should be considered a disease subset with distinct genetic and morpho-phenotypic features, leading to enhanced aggressiveness and invasiveness.
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Affiliation(s)
- D Massi
- Department of Surgery and Translational Medicine, Division of Pathological Anatomy, University of Florence
| | - D Brusa
- Human Genetics Foundation (HuGeF), Turin
| | - B Merelli
- Unit of Medical Oncology, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo
| | - M Ciano
- Human Genetics Foundation (HuGeF), Turin
| | - V Audrito
- Human Genetics Foundation (HuGeF), Turin; Department of Medical Sciences, University of Turin, Turin
| | - S Serra
- Human Genetics Foundation (HuGeF), Turin; Department of Medical Sciences, University of Turin, Turin
| | - R Buonincontri
- Human Genetics Foundation (HuGeF), Turin; Department of Medical Sciences, University of Turin, Turin
| | - G Baroni
- Department of Surgery and Translational Medicine, Division of Pathological Anatomy, University of Florence
| | - R Nassini
- Unit of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Firenze
| | - D Minocci
- Unit of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Firenze
| | - L Cattaneo
- Division of Pathological Anatomy, Papa Giovanni XXIII Hospital, Bergamo
| | - E Tamborini
- Department of Pathology, Experimental Molecular Pathology, National Cancer Institute, Milan
| | - A Carobbio
- Research Foundation, Papa Giovanni XXIII Hospital, Bergamo
| | - E Rulli
- Department of Oncology, Clinical Research Laboratory, Mario Negri Institute IRCCS, Milan, Italy
| | - S Deaglio
- Human Genetics Foundation (HuGeF), Turin; Department of Medical Sciences, University of Turin, Turin
| | - M Mandalà
- Unit of Medical Oncology, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo.
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Graziano F, Ruzzo A, Galli F, Giacomini E, Floriani I, Galli F, Rulli E, Lonardi S, Ronzoni M, Massidda B, Zagonel V, Pella N, Mucciarini C, Labianca R, Veltri E, Sozzi P, Barni S, Ricci V, Sobrero A, Magnani M. Pharmacogenetic Profiling for Toxicity of Oxaliplatin and Fluoropyrimidines. Final Report from an Ancillary Protocol to the Tosca (Three or Six Colon Adjuvant) Trial. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu333.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Floriani I, D'Onofrio M, Rulli E, Chen MH, Li R, Musicco L. Performance of imaging modalities in the diagnosis of hepatocellular carcinoma: a systematic review and meta-analysis. Ultraschall Med 2013; 34:454-462. [PMID: 23238800 DOI: 10.1055/s-0032-1330358] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE The recent guidelines published in 2011 suggest the use of only one imaging method for the final imaging diagnosis of hepatocellular carcinoma. To evaluate the methods in the context of the available literature evidence, this systematic review aimed at assessing the relative performance of different imaging techniques currently used in clinical practice. MATERIALS AND METHODS MEDLINE and EMBASE were searched from January 1996 to June 2011, with no language limitation. Eligible trials had to be conducted in patients with suspicion or diagnosis of hepatocellular carcinoma; compare at least two of the following imaging modalities: magnetic resonance imaging, computed tomography, ultrasound; have pathological findings as a reference standard. An analysis also including non-comparative studies was performed as a validation of the main comparison results. RESULTS Of 5,144 screened papers, 16 studies fulfilled the eligibility criteria for the comparative analysis and 65 were eligible for the non-comparative analysis. The overall sensitivity and specificity derived by the pooled analysis were 0.78 and 0.77 for computed tomography, 0.84 and 0.84 for magnetic resonance imaging and 0.86 and 0.77 for ultrasound, respectively. In the pair-wise comparisons, ultrasound showed a statistically better specificity than magnetic resonance imaging (0.86 vs. 0.78; p = 0.014) and a statistically better sensitivity than computed tomography (0.88 vs. 0.78; p = 0.030). CONCLUSION The present systematic review did not show an obvious superiority of one imaging method. Since their accuracy is not completely overlapping, the possibility of reaching better performance by combining methods should be considered in future prospective trials.
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Affiliation(s)
- I Floriani
- Oncology department, Istituto di Ricerche Farmacologiche "Mario Negri"
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Marabese M, Rulli E, Bettini A, Farina G, Longo F, Moscetti L, Pavese I, Lauricella C, Broggini M, Garassino M. 1143 POSTER KRAS Mutational Status Strongly Impact Progression Free Survival of Patients Treated With Platinum Based Chemotherapy in NSCLC -Final Results of a Multicenter Prospective Study. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)70786-9] [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: 10/17/2022]
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Canestrari E, Ruzzo A, Vincenzi B, Galluccio N, Perrone G, Andreoni F, Lorenzini P, Rulli E, d'Emidio S, Catalano V, Loupakis F, Bisonni R, Floriani I, De Nictolis M, Santini D, Salvatore L, Tonini G, Falcone A, Magnani M, Graziano F. Let-7a microRNA levels in KRAS-mutated colorectal carcinomas determine survival differences in patients treated with anti-EGFR. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3635] [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: 11/20/2022] Open
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Garassino MC, Marabese M, Rusconi P, Rulli E, Martelli O, Farina G, Scanni A, Broggini M. Different types of K-Ras mutations could affect drug sensitivity and tumour behaviour in non-small-cell lung cancer. Ann Oncol 2011; 22:235-237. [PMID: 21169473 DOI: 10.1093/annonc/mdq680] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M C Garassino
- Division of Medical Oncology, Fatebenefratelli and Oftalmico Hospital.
| | | | - P Rusconi
- Laboratory of Molecular Pharmacology
| | - E Rulli
- Laboratory of Clinical Trial, Department of Oncology, "Mario Negri" Institute, Milan
| | - O Martelli
- Division of Medical Oncology, San Giovanni Hospital, Rome
| | - G Farina
- Division of Medical Oncology, Fatebenefratelli and Oftalmico Hospital
| | - A Scanni
- General Direction, "Luigi Sacco" Hospital, Milan, Italy
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Pronzato P, Mustacchi G, De Matteis A, Di Costanzo F, Rulli E, Floriani I, Cazzaniga ME. Biological characteristics and medical treatment of breast cancer in young women-a featured population: results from the NORA study. Int J Breast Cancer 2010; 2011:534256. [PMID: 22332011 PMCID: PMC3275934 DOI: 10.4061/2011/534256] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 08/16/2010] [Indexed: 11/20/2022] Open
Abstract
Background. The present paper described the biological characteristics and clinical behavior of young women in the cohort NORA study Patients and Methods. From 2000–2002, patients (N > 3500) were enrolled at 77 Italian hospitals. Women aged ≤50 years (N = 1013) were stratified into age groups (≤35, 36–40, 41–45, and 46–50 years). The relationship between age and patient characteristics, cancer presentation, and treatment was analyzed. Results. Younger women more frequently had tumors with ER/PgR-negative(χ2 = 7.07; P = .008), HER2 amplification (χ2 = 5.76; P = .01), and high (≥10%) Ki67 labelling index (χ2 = 9.53; P = .002). Positive nodal status, large tumors, and elevated Ki67 all associated with the choice for chemotherapy followed by endocrine therapy in hormone receptor-positive patients (P < .0001). At univariate analysis, ER-ve status, chemotherapy and age resulted as the only statistically significant variables (HR = 2.02, P = .004, and >40 versus ≤40, P < .0001, resp.). At multivariate analysis, after adjustment for significant clinical and pathological factors, age remains a significant prognostic variable (HR = 0.93, P = .0021). Conclusion. This cohort study suggests that age per sè is an important prognostic factor. The restricted role of early diagnosis and the aggressive behavior of cancer in this population make necessary the application of targeted medical strategies crucial.
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Affiliation(s)
- P Pronzato
- Oncologia Medica, IST, Genova 16010, Italy
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Cremolini C, Loupakis F, Perrone G, Ruzzo A, Rulli E, Bencardino K, Vincenzi B, Salvatore L, Graziano F, Falcone A. 6113 BRAF V600E mutation and Amphiregulin (AR) immunohistochemical expression in the prediction of benefit from cetuximab plus irinotecan in KRAS wild-type metastatic colorectal cancer (mCRC) patients. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71208-x] [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: 11/16/2022] Open
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Loupakis F, Ruzzo A, Cremolini C, Vincenzi B, Salvatore L, Santini D, Masi G, Stasi I, Canestrari E, Rulli E, Floriani I, Bencardino K, Galluccio N, Catalano V, Tonini G, Magnani M, Fontanini G, Basolo F, Falcone A, Graziano F. KRAS codon 61, 146 and BRAF mutations predict resistance to cetuximab plus irinotecan in KRAS codon 12 and 13 wild-type metastatic colorectal cancer. Br J Cancer 2009; 101:715-21. [PMID: 19603018 PMCID: PMC2736831 DOI: 10.1038/sj.bjc.6605177] [Citation(s) in RCA: 434] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: KRAS codons 12 and 13 mutations predict resistance to anti-EGFR monoclonal antibodies (moAbs) in metastatic colorectal cancer. Also, BRAF V600E mutation has been associated with resistance. Additional KRAS mutations are described in CRC. Methods: We investigated the role of KRAS codons 61 and 146 and BRAF V600E mutations in predicting resistance to cetuximab plus irinotecan in a cohort of KRAS codons 12 and 13 wild-type patients. Results: Among 87 KRAS codons 12 and 13 wild-type patients, KRAS codons 61 and 146 were mutated in 7 and 1 case, respectively. None of mutated patients responded vs 22 of 68 wild type (P=0.096). Eleven patients were not evaluable. KRAS mutations were associated with shorter progression-free survival (PFS, HR: 0.46, P=0.028). None of 13 BRAF-mutated patients responded vs 24 of 74 BRAF wild type (P=0.016). BRAF mutation was associated with a trend towards shorter PFS (HR: 0.59, P=0.073). In the subgroup of BRAF wild-type patients, KRAS codons 61/146 mutations determined a lower response rate (0 vs 37%, P=0.047) and worse PFS (HR: 0.45, P=0.023). Patients bearing KRAS or BRAF mutations had poorer response rate (0 vs 37%, P=0.0005) and PFS (HR: 0.51, P=0.006) compared with KRAS and BRAF wild-type patients. Conclusion: Assessing KRAS codons 61/146 and BRAF V600E mutations might help optimising the selection of the candidate patients to receive anti-EGFR moAbs.
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Affiliation(s)
- F Loupakis
- Unit of Medical Oncology 2, Azienda-Ospedaliero Universitaria Pisana, Istituto Toscano Tumori and Department of Oncology, Transplantes and New Technologies in Medicine, University of Pisa, Via Roma 67 - 56126 Pisa, Italy
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Lissoni AA, Colombo N, Pellegrino A, Parma G, Zola P, Katsaros D, Chiari S, Buda A, Landoni F, Peiretti M, Dell'anna T, Fruscio R, Signorelli M, Grassi R, Floriani I, Fossati R, Torri V, Rulli E. A phase II, randomized trial of neo-adjuvant chemotherapy comparing a three-drug combination of paclitaxel, ifosfamide, and cisplatin (TIP) versus paclitaxel and cisplatin (TP) followed by radical surgery in patients with locally advanced squamous cell cervical carcinoma: the Snap-02 Italian Collaborative Study. Ann Oncol 2009; 20:660-5. [PMID: 19181826 DOI: 10.1093/annonc/mdn690] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The efficacy and tolerability of the regimen containing paclitaxel and cisplatin (TP) in the neo-adjuvant treatment of locally advanced squamous cell cervical cancer are unknown. The TIP regimen (TP plus ifosfamide) showed high efficacy but high toxicity and it is used as an internal control. PATIENTS AND METHODS In all, 154 patients were randomized to TP (paclitaxel 175 mg/m(2) + cisplatin 75 mg/m(2); n = 80) or TIP (TP + ifosfamide 5 g/m(2); n = 74), three cycles, followed by radical surgery. Pathological response to chemotherapy was classified as optimal [no residual tumor (complete response) or residual disease with < or = 3 mm stromal invasion (PR1)] or suboptimal response. RESULTS Patient characteristics (TP/TIP): stage IB2 (56%/64%), IIA (18%/14%), IIB (20%/19%), III-IVA (5%/4%) and median age (42 years/45 years). The optimal response rate in the TP group was 25%, 95% confidence interval (CI) = 16% to 37% and 43%, 95% CI = 31% to 55% in the TIP group. Grades 3-4 leukopenia (6%/53%) and neutropenia (26%/76%) were significantly more frequent on TIP. CONCLUSION TP performance was below expectation since the lower 95% confidence limit of the optimal response rate failed to reach the prespecified minimum requirement of efficacy, i.e. 22%. The TIP regimen confirmed its activity but was associated with higher haematological toxicity than TP.
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Affiliation(s)
- A A Lissoni
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, S Gerardo Hospital, Monza, Italy
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Graziano F, Ruzzo A, Canestrari E, Loupakis F, Santini D, Rulli E, Humar B, Galluccio N, Bisonni R, Floriani I, Maltese P, Falcone A, Tonini G, Catalano V, Fontana A, Giustini L, Masi G, Vincenzi B, Alessandroni P, Magnani M. Variations in the interleukin-1 receptor antagonist gene impact on survival of patients with advanced colorectal cancer. Pharmacogenomics J 2008; 9:78-84. [DOI: 10.1038/tpj.2008.16] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Cazzaniga M, Pronzato P, Mustacchi G, De Matteis A, Di Costanzo F, Rulli E, Floriani I. The anthracyclines and the clinical practice: do all breast cancer patients benefit? Results from the NORA study. Ann Oncol 2008; 19:1811-2. [DOI: 10.1093/annonc/mdn547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Porcu L, Poli D, Torri V, Rulli E, Di Tullio MC, Cinquini M, Bajetta E, Labianca R, Di Costanzo F, Nitti D, Floriani I. Impact of recent legislative bills regarding clinical research on Italian ethics committee activity. J Med Ethics 2008; 34:747-750. [PMID: 18827108 DOI: 10.1136/jme.2007.022178] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIMS AND BACKGROUND The present work assessed the impact of two decrees on ethics committees in Italy, aimed at bringing the national laws on the conduct of clinical trials into line with the rest of the EC, and regulating and facilitating not-for-profit research. MATERIAL AND METHODS Prospectively collected data from an Italian multicentre study were examined with respect to the ethics review process. Administrative and time elements of the review process were audited. Main outcome measures were time between the application submission and the ethics committee definitive opinion, type and number of application submission forms, number of ethics committees that refused fee exemption, and time between the ethics committee approval and the administrative authorisation. RESULTS A total of 134 local research ethics committees (LRECs) were approached. Application submission procedures and application forms varied greatly; paper submission was mandatory. The median time from submission to approval was 72 days. Only two LRECs refused the fee exemption. The median time from LREC approval to administrative agreement was 50 days and only 9.6% of local authorities came to a verbal agreement with the sponsor. CONCLUSIONS Italian LRECs are still not sufficiently efficient in complying with the Directive 2001/20/EC requirement (60 days). Better coordination of LRECs work is needed although the optimal level of coordination between them is still not known. In the meantime, national guidelines are needed concerning the application of Directive 2001/20/EC. The behaviour of Italian LRECs towards not-for-profit research was excellent although only the fee exemption was requested.
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Affiliation(s)
- L Porcu
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
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Ludovini V, Gori S, Colozza M, Pistola L, Rulli E, Floriani I, Pacifico E, Tofanetti FR, Sidoni A, Basurto C, Rulli A, Crinò L. Evaluation of serum HER2 extracellular domain in early breast cancer patients: correlation with clinicopathological parameters and survival. Ann Oncol 2008; 19:883-90. [PMID: 18187484 DOI: 10.1093/annonc/mdm585] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We explored the correlation between serum human epidermal growth factor receptor-2 (HER2) extracellular domain (ECD) and tissue HER2 status, their relationship with clinicopathological parameters and their impact on disease-free survival (DFS) and overall survival in early breast cancer patients. PATIENTS AND METHODS This prospective trial included patients with stage I-III breast cancer. Serum HER2 ECD levels were measured by two enzyme-linked immunosorbent assays before surgical treatment. Tissue HER2 status was analyzed by immunohistochemistry (IHC) in all tumors; FISH assay was utilized in HER2 2+ tumors by IHC. RESULTS From May 2000 to July 2005, 256 consecutive stage I-III breast cancer patients were included in this study. High serum HER2 ECD levels (>or=15 ng/ml) were reported in 23 patients (9.0%) and HER2-positive status in tumor tissue was observed in 42 patients (16.4%) with a concordance of 87.1%. High HER2 ECD levels were significantly associated with high histological grade (P = 0.003), stage III (P = 0.008), lymph node involvement (P = 0.035) and negativity of both estrogen (P = 0.016) and progesterone (P = 0.007) receptors. At multivariate analysis, high serum HER2 ECD levels were a significant independent prognostic factor of worse DFS (P = 0.009). CONCLUSIONS A statistically significant association was observed between high serum HER2 ECD levels and worse DFS in early breast cancer patients.
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Affiliation(s)
- V Ludovini
- Medical Oncology Division, Azienda Ospedaliera of Perugia, Perugia, Italy.
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Cazzaniga ME, Mustacchi G, Pronzato P, Di Costanzo F, De Matteis A, Ravaioli A, Gamucci T, Brugia M, Bari M, Rulli E. Pathological characteristics and clinical outcome in triple-negative breast cancer (BC) patients (PTS): Results from the NORA study. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.11014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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
11014 Background: Different studies have recently focused the attention on the so-called triple-negative pts, defined as ER-/PR- /HER2-. Although triple-negative tumours have been reported to be more aggressive, there are limited long-term data evaluating outcome as a function of this classification. Methods: NORA is an observational study aimed at investigating treatment modalities and clinical outcome of 3515 patients (pts) with early breast cancer (EBC) treated in 77 Oncological Centres in Italy from to 2000 to 2003, whose overall results have been already published. We now compare pathological characteristics and clinical outcome of pts for whom ER and PR andHER2 tests are negative with remaining pts (OTH). Results: 123 (4.1%) of 2968 evaluable pts resulted triple-negative. Out of these 123, 76 pts (61.7% vs 63.2% of OTH) were treated with conservative surgery (CS). Pathological T stage was T1 in55.3% pts (OTH: 59.6%), 47.9% were pN+ (OTH: 45.3%), 63.2 had G3 tumours (OTH: 34.1%). Chemotherapy alone was administered in 89.4% pts, mainly anthracycline-based (54.1%). At a median follow up of 27 months, all triple-negative pts were alive, 11 (8.9%) with relapse. No difference has been observed between two groups both in DFS (HR=0.74; 95%CI: 0.39–1.40; p=0.35) and OS (HR not estimated, p=0.99). Conclusions: Our results suggest that triple-negative pts have pathological characteristics similar to what observed in the other pts, receive CS in the same percentage of the cases, but have a 3-fold increase of undifferentiated tumours. On the contrary to what observed by other Authors, our data show that triple- negative pts do not have worse prognosis. Longer follow up is required to confirm these data. No significant financial relationships to disclose.
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Affiliation(s)
- M. E. Cazzaniga
- Treviglio Hospital, Treviglio, Italy; University of Trieste, Trieste, Italy; Isituto Tumori, Genova, Italy; Ospedale Careggi, Firenze, Italy; Istituto Pascale, Napoli, Italy; Ospedale degli Infermi, Rimini, Italy; Ospedale Civile Umberto I, Frosinone, Italy; Az Osp S Maria, Terni, Italy; Osp Calvi, Noale, Italy; Istituto Mario Negri, Milano, Italy
| | - G. Mustacchi
- Treviglio Hospital, Treviglio, Italy; University of Trieste, Trieste, Italy; Isituto Tumori, Genova, Italy; Ospedale Careggi, Firenze, Italy; Istituto Pascale, Napoli, Italy; Ospedale degli Infermi, Rimini, Italy; Ospedale Civile Umberto I, Frosinone, Italy; Az Osp S Maria, Terni, Italy; Osp Calvi, Noale, Italy; Istituto Mario Negri, Milano, Italy
| | - P. Pronzato
- Treviglio Hospital, Treviglio, Italy; University of Trieste, Trieste, Italy; Isituto Tumori, Genova, Italy; Ospedale Careggi, Firenze, Italy; Istituto Pascale, Napoli, Italy; Ospedale degli Infermi, Rimini, Italy; Ospedale Civile Umberto I, Frosinone, Italy; Az Osp S Maria, Terni, Italy; Osp Calvi, Noale, Italy; Istituto Mario Negri, Milano, Italy
| | - F. Di Costanzo
- Treviglio Hospital, Treviglio, Italy; University of Trieste, Trieste, Italy; Isituto Tumori, Genova, Italy; Ospedale Careggi, Firenze, Italy; Istituto Pascale, Napoli, Italy; Ospedale degli Infermi, Rimini, Italy; Ospedale Civile Umberto I, Frosinone, Italy; Az Osp S Maria, Terni, Italy; Osp Calvi, Noale, Italy; Istituto Mario Negri, Milano, Italy
| | - A. De Matteis
- Treviglio Hospital, Treviglio, Italy; University of Trieste, Trieste, Italy; Isituto Tumori, Genova, Italy; Ospedale Careggi, Firenze, Italy; Istituto Pascale, Napoli, Italy; Ospedale degli Infermi, Rimini, Italy; Ospedale Civile Umberto I, Frosinone, Italy; Az Osp S Maria, Terni, Italy; Osp Calvi, Noale, Italy; Istituto Mario Negri, Milano, Italy
| | - A. Ravaioli
- Treviglio Hospital, Treviglio, Italy; University of Trieste, Trieste, Italy; Isituto Tumori, Genova, Italy; Ospedale Careggi, Firenze, Italy; Istituto Pascale, Napoli, Italy; Ospedale degli Infermi, Rimini, Italy; Ospedale Civile Umberto I, Frosinone, Italy; Az Osp S Maria, Terni, Italy; Osp Calvi, Noale, Italy; Istituto Mario Negri, Milano, Italy
| | - T. Gamucci
- Treviglio Hospital, Treviglio, Italy; University of Trieste, Trieste, Italy; Isituto Tumori, Genova, Italy; Ospedale Careggi, Firenze, Italy; Istituto Pascale, Napoli, Italy; Ospedale degli Infermi, Rimini, Italy; Ospedale Civile Umberto I, Frosinone, Italy; Az Osp S Maria, Terni, Italy; Osp Calvi, Noale, Italy; Istituto Mario Negri, Milano, Italy
| | - M. Brugia
- Treviglio Hospital, Treviglio, Italy; University of Trieste, Trieste, Italy; Isituto Tumori, Genova, Italy; Ospedale Careggi, Firenze, Italy; Istituto Pascale, Napoli, Italy; Ospedale degli Infermi, Rimini, Italy; Ospedale Civile Umberto I, Frosinone, Italy; Az Osp S Maria, Terni, Italy; Osp Calvi, Noale, Italy; Istituto Mario Negri, Milano, Italy
| | - M. Bari
- Treviglio Hospital, Treviglio, Italy; University of Trieste, Trieste, Italy; Isituto Tumori, Genova, Italy; Ospedale Careggi, Firenze, Italy; Istituto Pascale, Napoli, Italy; Ospedale degli Infermi, Rimini, Italy; Ospedale Civile Umberto I, Frosinone, Italy; Az Osp S Maria, Terni, Italy; Osp Calvi, Noale, Italy; Istituto Mario Negri, Milano, Italy
| | - E. Rulli
- Treviglio Hospital, Treviglio, Italy; University of Trieste, Trieste, Italy; Isituto Tumori, Genova, Italy; Ospedale Careggi, Firenze, Italy; Istituto Pascale, Napoli, Italy; Ospedale degli Infermi, Rimini, Italy; Ospedale Civile Umberto I, Frosinone, Italy; Az Osp S Maria, Terni, Italy; Osp Calvi, Noale, Italy; Istituto Mario Negri, Milano, Italy
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Cazzaniga M, Di Costanzo F, Mustacchi G, Pronzato P, De Matteis A, Tabiadon D, Botta M, Pisconti S, Danese S, Rulli E. 314 POSTER Young (≤45) and old (≥65) early breast cancer (EBC) patients (pts): two different populations for surgeons? Results from the NORA study. Eur J Surg Oncol 2006. [DOI: 10.1016/s0748-7983(06)70749-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ludovini V, Gori S, Mosconi A, Pistola L, Rulli E, Rulli A, Anastasi P, Pacifico E, Sidoni A, Tofanetti FR, Colozza M. Evaluation of HER-2 in serum and tissue: correlation with clinical-pathological parameters and outcome in early stage breast cancer (BC) patients (pts). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.20066] [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
20066 Background: HER2 is amplified and/or overexpressed in approximately 20–30% of invasive BC and is associated with poor prognosis. It is also a predictive marker of response to trastuzumab. The extracellular domain of the HER2 protein (sHER2) is frequently cleaved and released into the circulation where it can be detected by ELISA in up to 45% of advanced BC. We evaluated HER2 expression in paired serum and tissue samples of operable BC pts to analyze 1) the correlation between sHER2 and HER2 tumor status 2) their relationship with clinical-pathological parameters and 3) their impact on the outcome. Methods: 188 consecutive stage I-III BC pts were included in this study from May 2000 to July 2005. sHER2 was measured by ELISA (manual Kit “Oncogene Science Diagnostics” and automated version “ADVIA Centaur”) before the local treatment. Tumor tissue was analyzed by IHC with CB11 antibody and scored with Dako Hercept-test. HER2 amplification was determined using the Ventana FISH assay in patients with 2+ by IHC. Chi-squared test was used to evaluate the association between HER2 and patients’ clinical-pathological features. Survival outcomes were analyzed using Cox’s model. Results: Median age was 56.6 years; 122 pts received adjuvant chemotherapy, 54 endocrine therapy and 83 both. Forty-three pts (23%) had HER2 overexpression/amplification in tumor tissue and 25 pts (13%) had sHER2 levels ≥15 ng/ml (cut-off level) with a concordance of 85%. Both high sHER2 levels and HER2 tumor expression were associated with high histological grade (p = .02 and p < .0001 respectively) and negativity of ER (p = .0035 and p < .0001) and PgR (p = .0056 and p =. 002). At a median follow-up of 2.4 years we observed 8 deaths and 19 relapses. At univariate analysis high sHER2 levels (evaluated as continuous variable) were significantly correlated with shorter DFS (p = 0.0002) even if at multivariate analysis high sHER2 levels, after adjustment for stage and ER status, were associated with a shorter DFS with borderline significance (p = 0.06). Conclusion: Our preliminary data indicate that the evaluation of sHER2 at diagnosis defines a small subgroup of early BC pts with a poor prognosis even if it needs to be confirmed in a longer follow up. No significant financial relationships to disclose.
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Affiliation(s)
- V. Ludovini
- Medical Oncology Azienda Ospedaliera, Perugia, Italy; Istituto Mario Negri, Milano, Italy; Breast Unit Azienda Ospedaliera, Perugia, Italy; Laboratorio Analisi Azienda Ospedaliera, Perugia, Italy; Pathology Department Azienda Ospedaliera, Perugia, Italy
| | - S. Gori
- Medical Oncology Azienda Ospedaliera, Perugia, Italy; Istituto Mario Negri, Milano, Italy; Breast Unit Azienda Ospedaliera, Perugia, Italy; Laboratorio Analisi Azienda Ospedaliera, Perugia, Italy; Pathology Department Azienda Ospedaliera, Perugia, Italy
| | - A. Mosconi
- Medical Oncology Azienda Ospedaliera, Perugia, Italy; Istituto Mario Negri, Milano, Italy; Breast Unit Azienda Ospedaliera, Perugia, Italy; Laboratorio Analisi Azienda Ospedaliera, Perugia, Italy; Pathology Department Azienda Ospedaliera, Perugia, Italy
| | - L. Pistola
- Medical Oncology Azienda Ospedaliera, Perugia, Italy; Istituto Mario Negri, Milano, Italy; Breast Unit Azienda Ospedaliera, Perugia, Italy; Laboratorio Analisi Azienda Ospedaliera, Perugia, Italy; Pathology Department Azienda Ospedaliera, Perugia, Italy
| | - E. Rulli
- Medical Oncology Azienda Ospedaliera, Perugia, Italy; Istituto Mario Negri, Milano, Italy; Breast Unit Azienda Ospedaliera, Perugia, Italy; Laboratorio Analisi Azienda Ospedaliera, Perugia, Italy; Pathology Department Azienda Ospedaliera, Perugia, Italy
| | - A. Rulli
- Medical Oncology Azienda Ospedaliera, Perugia, Italy; Istituto Mario Negri, Milano, Italy; Breast Unit Azienda Ospedaliera, Perugia, Italy; Laboratorio Analisi Azienda Ospedaliera, Perugia, Italy; Pathology Department Azienda Ospedaliera, Perugia, Italy
| | - P. Anastasi
- Medical Oncology Azienda Ospedaliera, Perugia, Italy; Istituto Mario Negri, Milano, Italy; Breast Unit Azienda Ospedaliera, Perugia, Italy; Laboratorio Analisi Azienda Ospedaliera, Perugia, Italy; Pathology Department Azienda Ospedaliera, Perugia, Italy
| | - E. Pacifico
- Medical Oncology Azienda Ospedaliera, Perugia, Italy; Istituto Mario Negri, Milano, Italy; Breast Unit Azienda Ospedaliera, Perugia, Italy; Laboratorio Analisi Azienda Ospedaliera, Perugia, Italy; Pathology Department Azienda Ospedaliera, Perugia, Italy
| | - A. Sidoni
- Medical Oncology Azienda Ospedaliera, Perugia, Italy; Istituto Mario Negri, Milano, Italy; Breast Unit Azienda Ospedaliera, Perugia, Italy; Laboratorio Analisi Azienda Ospedaliera, Perugia, Italy; Pathology Department Azienda Ospedaliera, Perugia, Italy
| | - F. R. Tofanetti
- Medical Oncology Azienda Ospedaliera, Perugia, Italy; Istituto Mario Negri, Milano, Italy; Breast Unit Azienda Ospedaliera, Perugia, Italy; Laboratorio Analisi Azienda Ospedaliera, Perugia, Italy; Pathology Department Azienda Ospedaliera, Perugia, Italy
| | - M. Colozza
- Medical Oncology Azienda Ospedaliera, Perugia, Italy; Istituto Mario Negri, Milano, Italy; Breast Unit Azienda Ospedaliera, Perugia, Italy; Laboratorio Analisi Azienda Ospedaliera, Perugia, Italy; Pathology Department Azienda Ospedaliera, Perugia, Italy
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Pronzato P, Cazzaniga ME, Mustacchi G, De Matteis A, Di Costanzo F, Verusio C, Marzano N, Rulli E, Floriani I. Factors influencing the switch from Tamoxifen (TAM) to Aromatase Inhibitors (AIs) as adjuvant therapy in early breast cancer (EBC) patients (pts). Results from the NORA study. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.10633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
10633 Background: Results from recent trials indicate that AIs as adjuvant treatment, either as up-front therapy or sequencing after TAM, can improve the clinical outcome of EBC pts. It is therefore important to assess the prevalence of the AI use in adjuvant setting and the reasons associated to the choice of this treatment. PATIENTS AND Methods: The NORA trial is an observational study, aimed at investigating adjuvant treatment modalities, that consecutively enrolled 3515 EBC pts, according to the following criteria: 10 pts each year starting from 2000 (retrospective cohort) and 20 pts starting from the beginning of 2003 or the date of ethical approval, if subsequent (prospective cohort). Using data from NORA, we focused on the subgroup of pts who switched from TAM to AIs in order to determine which factors are more likely to be associated with the probability of switching. Multivariate analysis was conducted using the Cox’s regression model. Results: Out of 2075 pts who started TAM, 329 (15.9%) switched to AIs. They had a median age of 63.1 yrs, 147 (45.9%) were N+, 190 (57.8%) received chemotherapy, 179 (54.6%) were T1, 248 (77.5%) were ER+/PgR+. Switch from TAM to AIs was influenced by N+ status, previous chemotherapy and age, whereas no effect was observed for T size or HR status. Previous chemotherapy increases the probability of switching by 27% (95% CI -4% to +70%, p = 0.10), each age decade increase by 35% (95% CI +21% to +52%, p < 0.0001), N+ status by 16% (95% CI +1% to 34%, p = 0.03). Conclusion: As expected, high risk N+ pts have higher probabilities to be switched in comparison to other groups, probably due to the encouraging results of AIs trials. In previously treated or older age pts, TAM side effects could have determined the switch. No significant financial relationships to disclose.
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Affiliation(s)
- P. Pronzato
- La Spezia Hospital, La Spezia, Italy; Treviglio Hospital, Treviglio, Italy; University of Trieste, Trieste, Italy; Pascale Institute, Naples, Italy; Careggi Hospital, Firenze, Italy; Saronno Hospital, Saronno, Italy; S Paolo Hospital, Bari, Italy; Mario Negri Institute, Milan, Italy
| | - M. E. Cazzaniga
- La Spezia Hospital, La Spezia, Italy; Treviglio Hospital, Treviglio, Italy; University of Trieste, Trieste, Italy; Pascale Institute, Naples, Italy; Careggi Hospital, Firenze, Italy; Saronno Hospital, Saronno, Italy; S Paolo Hospital, Bari, Italy; Mario Negri Institute, Milan, Italy
| | - G. Mustacchi
- La Spezia Hospital, La Spezia, Italy; Treviglio Hospital, Treviglio, Italy; University of Trieste, Trieste, Italy; Pascale Institute, Naples, Italy; Careggi Hospital, Firenze, Italy; Saronno Hospital, Saronno, Italy; S Paolo Hospital, Bari, Italy; Mario Negri Institute, Milan, Italy
| | - A. De Matteis
- La Spezia Hospital, La Spezia, Italy; Treviglio Hospital, Treviglio, Italy; University of Trieste, Trieste, Italy; Pascale Institute, Naples, Italy; Careggi Hospital, Firenze, Italy; Saronno Hospital, Saronno, Italy; S Paolo Hospital, Bari, Italy; Mario Negri Institute, Milan, Italy
| | - F. Di Costanzo
- La Spezia Hospital, La Spezia, Italy; Treviglio Hospital, Treviglio, Italy; University of Trieste, Trieste, Italy; Pascale Institute, Naples, Italy; Careggi Hospital, Firenze, Italy; Saronno Hospital, Saronno, Italy; S Paolo Hospital, Bari, Italy; Mario Negri Institute, Milan, Italy
| | - C. Verusio
- La Spezia Hospital, La Spezia, Italy; Treviglio Hospital, Treviglio, Italy; University of Trieste, Trieste, Italy; Pascale Institute, Naples, Italy; Careggi Hospital, Firenze, Italy; Saronno Hospital, Saronno, Italy; S Paolo Hospital, Bari, Italy; Mario Negri Institute, Milan, Italy
| | - N. Marzano
- La Spezia Hospital, La Spezia, Italy; Treviglio Hospital, Treviglio, Italy; University of Trieste, Trieste, Italy; Pascale Institute, Naples, Italy; Careggi Hospital, Firenze, Italy; Saronno Hospital, Saronno, Italy; S Paolo Hospital, Bari, Italy; Mario Negri Institute, Milan, Italy
| | - E. Rulli
- La Spezia Hospital, La Spezia, Italy; Treviglio Hospital, Treviglio, Italy; University of Trieste, Trieste, Italy; Pascale Institute, Naples, Italy; Careggi Hospital, Firenze, Italy; Saronno Hospital, Saronno, Italy; S Paolo Hospital, Bari, Italy; Mario Negri Institute, Milan, Italy
| | - I. Floriani
- La Spezia Hospital, La Spezia, Italy; Treviglio Hospital, Treviglio, Italy; University of Trieste, Trieste, Italy; Pascale Institute, Naples, Italy; Careggi Hospital, Firenze, Italy; Saronno Hospital, Saronno, Italy; S Paolo Hospital, Bari, Italy; Mario Negri Institute, Milan, Italy
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Darwish S, Ludovini V, Pistola L, Piattoni S, Di Carlo L, Rulli E, Ferraldeschi M, Tofanetti F, Sheibel M, Tonato M. O-112 Microsatellite alterations and P53 mutations in tumor and plasma DNA of resected non small cell lung cancer (NSCLC) patients. (A study of the Perugia Multidisciplinary team for thoracic tumors). Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80246-6] [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: 12/01/2022]
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Fossati R, Buda A, Rulli E, Landoni F, Lissoni A, Colombo N, Zola P, Katsaros D, Grassi R, Mangioni C. Randomized trial of neoadjuvant chemotherapy followed by radical surgery in locally advanced squamous cell cervical carcinoma (LASCCC). Comparison of paclitaxel, cisplatin (TP), versus paclitaxel, ifosfamide, cisplatin (TIP): The SNAP-02 Italian collaborative study. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.5026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- R. Fossati
- Mario Negri Inst, Milan, Italy; Univ of Milano-Bicocca, Monza, Italy; European Institute of Oncology, Milan, Italy; Mauriziano Hosp, Turin, Italy; Univ of Turin, Turin, Italy; Treviglio Hosp, Treviglio, Italy
| | - A. Buda
- Mario Negri Inst, Milan, Italy; Univ of Milano-Bicocca, Monza, Italy; European Institute of Oncology, Milan, Italy; Mauriziano Hosp, Turin, Italy; Univ of Turin, Turin, Italy; Treviglio Hosp, Treviglio, Italy
| | - E. Rulli
- Mario Negri Inst, Milan, Italy; Univ of Milano-Bicocca, Monza, Italy; European Institute of Oncology, Milan, Italy; Mauriziano Hosp, Turin, Italy; Univ of Turin, Turin, Italy; Treviglio Hosp, Treviglio, Italy
| | - F. Landoni
- Mario Negri Inst, Milan, Italy; Univ of Milano-Bicocca, Monza, Italy; European Institute of Oncology, Milan, Italy; Mauriziano Hosp, Turin, Italy; Univ of Turin, Turin, Italy; Treviglio Hosp, Treviglio, Italy
| | - A. Lissoni
- Mario Negri Inst, Milan, Italy; Univ of Milano-Bicocca, Monza, Italy; European Institute of Oncology, Milan, Italy; Mauriziano Hosp, Turin, Italy; Univ of Turin, Turin, Italy; Treviglio Hosp, Treviglio, Italy
| | - N. Colombo
- Mario Negri Inst, Milan, Italy; Univ of Milano-Bicocca, Monza, Italy; European Institute of Oncology, Milan, Italy; Mauriziano Hosp, Turin, Italy; Univ of Turin, Turin, Italy; Treviglio Hosp, Treviglio, Italy
| | - P. Zola
- Mario Negri Inst, Milan, Italy; Univ of Milano-Bicocca, Monza, Italy; European Institute of Oncology, Milan, Italy; Mauriziano Hosp, Turin, Italy; Univ of Turin, Turin, Italy; Treviglio Hosp, Treviglio, Italy
| | - D. Katsaros
- Mario Negri Inst, Milan, Italy; Univ of Milano-Bicocca, Monza, Italy; European Institute of Oncology, Milan, Italy; Mauriziano Hosp, Turin, Italy; Univ of Turin, Turin, Italy; Treviglio Hosp, Treviglio, Italy
| | - R. Grassi
- Mario Negri Inst, Milan, Italy; Univ of Milano-Bicocca, Monza, Italy; European Institute of Oncology, Milan, Italy; Mauriziano Hosp, Turin, Italy; Univ of Turin, Turin, Italy; Treviglio Hosp, Treviglio, Italy
| | - C. Mangioni
- Mario Negri Inst, Milan, Italy; Univ of Milano-Bicocca, Monza, Italy; European Institute of Oncology, Milan, Italy; Mauriziano Hosp, Turin, Italy; Univ of Turin, Turin, Italy; Treviglio Hosp, Treviglio, Italy
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Di Silvestre M, Greggi T, Rulli E, Paderni S, Palumbi P, Parisini P. Lumbar disc herniation in the elderly patient. Chir Organi Mov 2001; 86:223-30. [PMID: 12025186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
It was the purpose of this study to clinically follow-up 78 patients affected with lumbar disc herniation, aged from 60 to 81 years (mean 66 years), hospitalized in several wards at the Rizzoli Orthopaedic Hospital between 1987 and 1996, for surgical treatment. A minimum of 24 months after surgery (maximum 61 months), sciatic pain (present in all of the patients prior to surgery) had regressed in 90% of the patients and was reported to occur only occasionally in 10%. Low back lumbar pain was still present in 21%. Results concerning recovery of motor deficit (30%), deficit in reflexes (31%), and sensory deficit (24%) were good. Better results were obtained when the surgical findings were sequestered hernia and expulsed hernia, with excellent results observed in 70% and 60%, respectively (based on the Smiley-Webster scale), as compared to contained hernia, the results for which were excellent in 54% of patients. Complications were observed in 9 cases (11%); 5 of the cases (6%) after a period of time ranging from 20 to 45 days postsurgery required further surgery because of an error in level in 3 and a residual nerve root compression in 2.
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Affiliation(s)
- M Di Silvestre
- Chirurgia del Rachide, Istituto Ortopedico Rizzoli, Bologna
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