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Massari F, Mollica V, Fiala O, De Giorgi U, Kucharz J, Vitale MG, Molina-Cerrillo J, Facchini G, Seront E, Lenci E, Bourlon MT, Carrozza F, Pichler R, Lolli C, Myint ZW, Kanesvaran R, Torniai M, Rescigno P, Gomez de Liaño A, Zakopoulou R, Buti S, Porta C, Grande E, Santoni M. Papillary Renal Cell Carcinoma: Outcomes for Patients Receiving First-line Immune-based Combinations or Tyrosine Kinase Inhibitors from the ARON-1 Study. Eur Urol Oncol 2024:S2588-9311(24)00088-9. [PMID: 38575409 DOI: 10.1016/j.euo.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/13/2024] [Accepted: 03/22/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND AND OBJECTIVE Papillary renal cell carcinoma (pRCC) is the most frequent histological subtype of non-clear cell RCC (nccRCC). Owing to the heterogeneity of nccRCC, patients are often excluded from large phase 3 trials focused on clear cell RCC, so treatment options for nccRCC remain limited. Our aim was to investigate the efficacy of first-line treatment with tyrosine kinase inhibitors (TKIs) or immuno-oncology (IO)-based combinations in patients with pRCC. METHODS We performed a multicenter retrospective analysis of real-world data collected for patients with advanced pRCC treated in 40 centers in 12 countries as part of the ARON-1 project (NCT05287464). The primary endpoints were overall survival (OS), progression-free survival (PFS), the overall response rate (ORR), and time to second progression (PFS2). OS, PFS, and PFS2 were estimated using the Kaplan-Meier method and results were compared between the treatment groups using a log-rank test. Univariate and multivariable analyses were carried out using Cox proportional-hazard models. KEY FINDINGS AND LIMITATIONS We included 200 patients with metastatic pRCC, of whom 73 were treated with IO-based combinations and 127 with TKIs. Median OS was 22.5 mo in the TKI group 28.8 mo in the IO group (p = 0.081). Median PFS was 6.4 mo in the TKI group and 17.4 mo in the IO group (p < 0.001). The ORR was higher in the IO group than in the TKI group (41% vs 27%; p = 0.037). CONCLUSIONS AND CLINICAL IMPLICATIONS Our results show that IO-based combinations have superior efficacy outcomes to TKIs for first-line treatment of metastatic pRCC. PATIENT SUMMARY The ARON-1 project collects clinical data for patients with kidney cancer treated in multiple centers worldwide to assess outcomes in the real-world setting. We analyzed data for patients with metastatic kidney cancer of a specific subtype to evaluate the efficacy of different first-line treatments. Patients treated with immune-based combinations had better outcomes than patients treated with tyrosine kinase inhibitors.
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Affiliation(s)
- Francesco Massari
- Department of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Veronica Mollica
- Department of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Ondrej Fiala
- Department of Oncology and Radiotherapeutics, Faculty of Medicine and University Hospital Pilsen, Charles University, Pilsen, Czechia; Biomedical Center, Faculty of Medicine, Charles University, Pilsen, Czechia
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Jakub Kucharz
- Department of Uro-oncology, Maria Sklodowska-Curie National Research Institute of Oncology Warsaw, Poland
| | - Maria Giuseppa Vitale
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | | | - Gaetano Facchini
- Medical Oncology Unit, SM delle Grazie Hospital, Pozzuoli, Italy
| | - Emmanuel Seront
- Department of Medical Oncology, Centre Hospitalier de Jolimont, Haine Saint Paul, Belgium
| | - Edoardo Lenci
- UOC Oncologia, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Maria T Bourlon
- Hematology and Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Francesco Carrozza
- Oncology Unit, Santa Maria delle Croci Hospital, Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy
| | - Renate Pichler
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Cristian Lolli
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Zin W Myint
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | | | | | - Pasquale Rescigno
- Translational and Clinical Research Institute, Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | | | - Roubini Zakopoulou
- 2nd Department of Propedeutic Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital Parma, Parma, Italy
| | - Camillo Porta
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, Bari, Italy; Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, Bari, Italy
| | - Enrique Grande
- Department of Medical Oncology, MD Anderson Cancer Center Madrid, Madrid, Spain
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Pistelli M, Natalucci V, Scortichini L, Agostinelli V, Lenci E, Crocetti S, Merloni F, Bastianelli L, Taus M, Fumelli D, Giulietti G, Cola C, Capecci M, Serrani R, Ceravolo MG, Ricci M, Nicolai A, Barbieri E, Nicolai G, Ballatore Z, Savini A, Berardi R. The Impact of Lifestyle Interventions in High-Risk Early Breast Cancer Patients: A Modeling Approach from a Single Institution Experience. Cancers (Basel) 2021; 13:cancers13215539. [PMID: 34771702 PMCID: PMC8583345 DOI: 10.3390/cancers13215539] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 11/16/2022] Open
Abstract
A healthy lifestyle plays a strategic role in the prevention of BC. The aim of our prospective study is to evaluate the effects of a lifestyle interventions program based on special exercise and nutrition education on weight, psycho-physical well-being, blood lipid and hormonal profile among BC patients who underwent primary surgery. From January 2014 to March 2017, a multidisciplinary group of oncologists, dieticians, physiatrists and an exercise specialist evaluated 98 adult BC female patients at baseline and at different time points. The patients had at least one of the following risk factors: BMI ≥ 25 kg/m2, high testosterone levels, high serum insulin levels or diagnosis of MS. Statistically significant differences are shown in terms of BMI variation with the lifestyle interventions program, as well as in waist circumference and blood glucose, insulin and testosterone levels. Moreover, a statistically significant difference was reported in variations of total Hospital Anxiety and Depression Scale (HADS) score, in the anxiety HADS score and improvement in joint pain. Our results suggested that promoting a healthy lifestyle in clinical practice reduces risk factors involved in BC recurrence and ensures psycho-physical well-being.
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Affiliation(s)
- Mirco Pistelli
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
- Correspondence: (M.P.); (R.B.); Tel.: +39-071-5964265 (M.P.); Fax: +39-071-5965053 (M.P.)
| | - Valentina Natalucci
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy; (V.N.); (E.B.)
| | - Laura Scortichini
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
| | - Veronica Agostinelli
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
| | - Edoardo Lenci
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
| | - Sonia Crocetti
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
| | - Filippo Merloni
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
| | - Lucia Bastianelli
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
| | - Marina Taus
- Dietology and Clinical Nutrition, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (M.T.); (D.F.); (G.G.); (C.C.); (A.N.)
| | - Daniele Fumelli
- Dietology and Clinical Nutrition, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (M.T.); (D.F.); (G.G.); (C.C.); (A.N.)
| | - Gloria Giulietti
- Dietology and Clinical Nutrition, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (M.T.); (D.F.); (G.G.); (C.C.); (A.N.)
| | - Claudia Cola
- Dietology and Clinical Nutrition, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (M.T.); (D.F.); (G.G.); (C.C.); (A.N.)
| | - Marianna Capecci
- Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (M.C.); (M.G.C.)
| | - Roberta Serrani
- Division of Rehabilitation Medicine, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (R.S.); (M.R.)
| | - Maria Gabriella Ceravolo
- Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (M.C.); (M.G.C.)
| | - Maurizio Ricci
- Division of Rehabilitation Medicine, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (R.S.); (M.R.)
| | - Albano Nicolai
- Dietology and Clinical Nutrition, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (M.T.); (D.F.); (G.G.); (C.C.); (A.N.)
| | - Elena Barbieri
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy; (V.N.); (E.B.)
| | - Giulia Nicolai
- Department of Medical Emergency, AOU Ospedali Riuniti Marche Nord, 61121 Pesaro, Italy;
| | - Zelmira Ballatore
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
| | - Agnese Savini
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
| | - Rossana Berardi
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
- Correspondence: (M.P.); (R.B.); Tel.: +39-071-5964265 (M.P.); Fax: +39-071-5965053 (M.P.)
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Maccaroni E, Giampieri R, Lenci E, Scortichini L, Bianchi F, Belvederesi L, Brugiati C, Pagliaretta S, Ambrosini E, Berardi R. BRCA mutations and gastrointestinal cancers: When to expect the unexpected? World J Clin Oncol 2021; 12:565-580. [PMID: 34367929 PMCID: PMC8317649 DOI: 10.5306/wjco.v12.i7.565] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/17/2021] [Accepted: 06/18/2021] [Indexed: 02/06/2023] Open
Abstract
BRCA1/2 pathogenic variants are widely known as major risk factors mainly for breast and ovarian cancer, while their role in gastrointestinal (GI) malignancies such as colorectal cancer (CRC), gastric cancer and oesophageal cancer (OeC) is still not well established. The main objective of this review is to summarise the available evidence on this matter. The studies included in the review were selected from PubMed/GoogleScholar/ScienceDirect databases to identify published articles where BRCA1/2 pathogenic variants were assessed either as a risk factor or a prognostic/predictive factor in these malignancies. Our review suggests that BRCA1/2 might have a role as a risk factor for colorectal, gastric and OeC, albeit with differences among these diseases: In particular BRCA1 seems to be much more frequently mutated in CRC whereas BRCA2 appears to be much more closely associated with gastric and OeC. Early-onset cancer seems to be also associated with BRCA1/2 mutations and a few studies suggest a positive prognostic role of these mutations. The assessment of a potentially predictive role of these mutations is hampered by the fact that most patients with these diseases have been treated with platinum compounds, where it is expected that a higher probability of response should be seen. A few clinical trials focused on poly (ADP-ribose) polymerase inhibitors use in GI cancers are currently ongoing.
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Affiliation(s)
- Elena Maccaroni
- Department of Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona 60126, Italy
| | - Riccardo Giampieri
- Department of Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona 60126, Italy
| | - Edoardo Lenci
- Department of Oncology, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Laura Scortichini
- Department of Oncology, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Francesca Bianchi
- Molecular and Clinical Science Department, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Laura Belvederesi
- Molecular and Clinical Science Department, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Cristiana Brugiati
- Molecular and Clinical Science Department, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Silvia Pagliaretta
- Molecular and Clinical Science Department, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Elisa Ambrosini
- Molecular and Clinical Science Department, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Rossana Berardi
- Department of Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona 60126, Italy
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4
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Giampieri R, Liguori C, Crocetti S, Pecci F, Bittoni A, Lenci E, Cantini L, Giulia M, Lanese A, Pinterpe G, Giglio E, Copparoni C, Lupi A, Meletani T, De Simoni E, Berardi R. P-131 External validation of prognostic ALAN score in patients with inoperable bile duct cancer treated with second-line chemotherapy. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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5
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Pecci F, Cantini L, Bittoni A, Lenci E, Lupi A, Crocetti S, Giglio E, Giampieri R, Berardi R. Beyond Microsatellite Instability: Evolving Strategies Integrating Immunotherapy for Microsatellite Stable Colorectal Cancer. Curr Treat Options Oncol 2021; 22:69. [PMID: 34110510 PMCID: PMC8192371 DOI: 10.1007/s11864-021-00870-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 12/19/2022]
Abstract
OPINION STATEMENT Advanced colorectal cancer (CRC) is a heterogeneous disease, characterized by several subtypes with distinctive genetic and epigenetic patterns. During the last years, immune checkpoint inhibitors (ICIs) have revamped the standard of care of several tumors such as non-small cell lung cancer and melanoma, highlighting the role of immune cells in tumor microenvironment (TME) and their impact on cancer progression and treatment efficacy. An "immunoscore," based on the percentage of two lymphocyte populations both at tumor core and invasive margin, has been shown to improve prediction of treatment outcome when added to UICC-TNM classification. To date, pembrolizumab, an anti-programmed death protein 1 (PD1) inhibitor, has gained approval as first-line therapy for mismatch-repair-deficient (dMMR) and microsatellite instability-high (MSI-H) advanced CRC. On the other hand, no reports of efficacy have been presented in mismatch-repair-proficient (pMMR) and microsatellite instability-low (MSI-L) or microsatellite stable (MSS) CRC. This group includes roughly 95% of all advanced CRC, and standard chemotherapy, in addition to anti-EGFR or anti-angiogenesis drugs, still represents first treatment choice. Hopefully, deeper understanding of CRC immune landscape and of the impact of specific genetic and epigenetic alterations on tumor immunogenicity might lead to the development of new drug combination strategies to overcome ICIs resistance in pMMR CRC, thus paving the way for immunotherapy even in this subgroup.
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Affiliation(s)
- Federica Pecci
- Clinical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti, Via Conca 71, 60126 Ancona, Italy
| | - Luca Cantini
- Clinical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti, Via Conca 71, 60126 Ancona, Italy
| | - Alessandro Bittoni
- Clinical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti, Via Conca 71, 60126 Ancona, Italy
| | - Edoardo Lenci
- Clinical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti, Via Conca 71, 60126 Ancona, Italy
| | - Alessio Lupi
- Clinical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti, Via Conca 71, 60126 Ancona, Italy
| | - Sonia Crocetti
- Clinical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti, Via Conca 71, 60126 Ancona, Italy
| | - Enrica Giglio
- Clinical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti, Via Conca 71, 60126 Ancona, Italy
| | - Riccardo Giampieri
- Clinical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti, Via Conca 71, 60126 Ancona, Italy
| | - Rossana Berardi
- Clinical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti, Via Conca 71, 60126 Ancona, Italy
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Maccaroni E, Lenci E, Agostinelli V, Cognigni V, Giampieri R, Mazzanti P, Di Pietro Paolo M, Bianchi F, Brugiati C, Belvederesi L, Pagliaretta S, Mandolesi A, Scarpelli M, Murrone A, Morgese F, Ballatore Z, Berardi R. Lynch syndrome-associated lung cancer: pitfalls of an immunotherapy-based treatment strategy in an unusual tumor type. Exploration of Targeted Anti-tumor Therapy 2021; 2:240-248. [PMID: 36046437 PMCID: PMC9400785 DOI: 10.37349/etat.2021.00044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/18/2021] [Indexed: 11/19/2022] Open
Abstract
Lynch syndrome is a hereditary cancer predisposition syndrome caused by germline alterations in mismatch repair (MMR) genes leading to increased risk of colon cancer as well as other cancer types. Non-small cell lung cancer (NSCLC) is not among typical Lynch syndrome-associated tumors: pembrolizumab, an immune checkpoint inhibitor, is actually approved for the treatment of NSCLC patients and represents a promising treatment option for patients with advanced metastatic MMR-deficient cancer, regardless of tumor origin. This case report describes the clinical presentation and management of a 74-year-old female with a history of rectal adenocarcinoma and ovarian cancer, who has a documented frameshift pathogenic variant in the exon 8 of MSH6 gene and an intronic variant in the BRCA2 gene (classified as a variant of uncertain significance), affected by NSCLC with brain metastases. Despite these premises, the patient was treated with pembrolizumab and she did not benefit from this kind of treatment.
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Affiliation(s)
- Elena Maccaroni
- Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti Umberto I G M Lancisi G Salesi, 60126 Ancona, Italy
| | - Edoardo Lenci
- Medical Oncology Unit, Università Politecnica delle Marche, 60126 Ancona, Italy
| | | | - Valeria Cognigni
- Medical Oncology Unit, Università Politecnica delle Marche, 60126 Ancona, Italy
| | - Riccardo Giampieri
- Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti Umberto I G M Lancisi G Salesi, 60126 Ancona, Italy 2Medical Oncology Unit, Università Politecnica delle Marche, 60126 Ancona, Italy
| | - Paola Mazzanti
- Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti Umberto I G M Lancisi G Salesi, 60126 Ancona, Italy
| | - Marzia Di Pietro Paolo
- Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti Umberto I G M Lancisi G Salesi, 60126 Ancona, Italy
| | - Francesca Bianchi
- Medical Oncology Unit, Università Politecnica delle Marche, 60126 Ancona, Italy
| | - Cristiana Brugiati
- Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti Umberto I G M Lancisi G Salesi, 60126 Ancona, Italy
| | - Laura Belvederesi
- Medical Oncology Unit, Università Politecnica delle Marche, 60126 Ancona, Italy
| | - Silvia Pagliaretta
- Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti Umberto I G M Lancisi G Salesi, 60126 Ancona, Italy
| | - Alessandra Mandolesi
- SOD Anatomia Patologica, Azienda Ospedaliero Universitaria Ospedali Riuniti Università Politecnica delle Marche, 60126 Ancona, Italy
| | - Marina Scarpelli
- SOD Anatomia Patologica, Azienda Ospedaliero Universitaria Ospedali Riuniti Università Politecnica delle Marche, 60126 Ancona, Italy
| | - Alberto Murrone
- Medical Oncology Unit, Università Politecnica delle Marche, 60126 Ancona, Italy
| | - Francesca Morgese
- Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti Umberto I G M Lancisi G Salesi, 60126 Ancona, Italy
| | - Zelmira Ballatore
- Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti Umberto I G M Lancisi G Salesi, 60126 Ancona, Italy
| | - Rossana Berardi
- Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti Umberto I G M Lancisi G Salesi, 60126 Ancona, Italy 2Medical Oncology Unit, Università Politecnica delle Marche, 60126 Ancona, Italy
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7
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Lenci E, Marcantognini G, Cognigni V, Lupi A, Rinaldi S, Cantini L, Fiordoliva I, Carloni AL, Rocchi M, Zuccatosta L, Gasparini S, Berardi R. Tumor burden as possible biomarker of outcome in advanced NSCLC patients treated with immunotherapy: a single center, retrospective, real-world analysis. Exploration of Targeted Anti-tumor Therapy 2021; 2:227-239. [PMID: 36046436 PMCID: PMC9400786 DOI: 10.37349/etat.2021.00043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/19/2021] [Indexed: 11/19/2022] Open
Abstract
Aim: The role of tumor burden (TB) for patients with non-small cell lung cancer (NSCLC) receiving immunotherapy is still unknown. The aim of this analysis was to analyze the prognostic value of TB in a real-world sample of advanced NSCLC patients. Methods: Sixty-five consecutive patients with advanced NSCLC treated with immunotherapy as first or second line therapy were retrospectively analyzed between August 2015 and February 2018. TB was recorded at baseline considering sites and number of metastases, thoracic vs. extrathoracic disease, measurable disease (MD) vs. not-MD (NMD) and evaluating dimensional aspects as maximum lesion diameter (cut-off = 6.3 cm), sum of the 5 major lesions diameters (cut-off = 14.3 cm), and number of sites of metastases (cut-off > 4). All cut-offs were calculated by receiver operating characteristic curves. Median overall survival (OS) was estimated using Kaplan-Meier method. A Cox regression model was carried out for univariate and multivariate analyses. Results: Median age was 70 years and most patients (86.2%) had a good performance status (PS-Eastern Cooperative Oncology Group < 2). No significant difference in OS was noted between subgroups of patients according to TB. Bone metastases (BM) had a negative prognostic impact [median OS (mOS), 13.8 vs. 70.0 months, P = 0.0009; median progression free survival in the second line (mPFS2) 2.97 vs. 8.63 months; P = 0.0037]. Patients with NMD had a poorer prognosis (mOS, 15.9 months vs. not reached, P < 0.0001; mPFS2 3.8 vs. 12.2 months; P = 0.0199). Patients with disease limited to the thorax had a better prognosis compared to patients with involvement of extrathoracic sites (mOS, 70 vs. 17.3 months; P = 0.0136). Having more than 4 metastatic sites resulted as a negative prognostic factor (mOS, 15.9 vs. 25.2 months; P = 0.0106). At multivariate analysis, BM, NMD, extrathoracic disease and number of sites of metastases > 4 were negative prognostic factors (P < 0.0001). Conclusions: This study underlines the negative prognostic impact of specific metastatic sites, presence of NMD and extrathoracic disease in advanced NSCLC patients treated with immunotherapy. However, TB does not appear to affect the outcome of these patients.
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Affiliation(s)
- Edoardo Lenci
- Clinical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, 60126 Ancona, Italy
| | - Giulia Marcantognini
- Clinical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, 60126 Ancona, Italy
| | - Valeria Cognigni
- Clinical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, 60126 Ancona, Italy
| | - Alessio Lupi
- Clinical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, 60126 Ancona, Italy
| | - Silvia Rinaldi
- Clinical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, 60126 Ancona, Italy
| | - Luca Cantini
- Clinical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, 60126 Ancona, Italy
| | - Ilaria Fiordoliva
- Clinical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, 60126 Ancona, Italy
| | - Anna Lisa Carloni
- Clinical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, 60126 Ancona, Italy
| | - Marco Rocchi
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Lina Zuccatosta
- Operative Unit of Pneumology, Ospedali Riuniti University Hospital, 60126 Ancona, Italy
| | - Stefano Gasparini
- Operative Unit of Pneumology, Ospedali Riuniti University Hospital, 60126 Ancona, Italy
| | - Rossana Berardi
- Clinical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, 60126 Ancona, Italy
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Lenci E, Cantini L, Pecci F, Cognigni V, Agostinelli V, Mentrasti G, Lupi A, Ranallo N, Paoloni F, Rinaldi S, Nicolardi L, Caglio A, Aerts S, Cortellini A, Ficorella C, Chiari R, Di Maio M, Dingemans AMC, Aerts JGJV, Berardi R. The Gustave Roussy Immune (GRIm)-Score Variation Is an Early-on-Treatment Biomarker of Outcome in Advanced Non-Small Cell Lung Cancer (NSCLC) Patients Treated with First-Line Pembrolizumab. J Clin Med 2021; 10:jcm10051005. [PMID: 33801320 PMCID: PMC7958321 DOI: 10.3390/jcm10051005] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 12/15/2022] Open
Abstract
Background: The Gustave Roussy Immune (GRIm)-Score takes into account neutrophil-to-lymphocyte ratio (NLR), serum albumin concentration and lactate dehydrogenase (LDH) and its prognostic value has been investigated in patients treated with immune check-point inhibitors (ICIs). To further assess the prognostic and predictive value of baseline GRIm-Score (GRImT0) in advanced non-small cell lung cancer (aNSCLC) patients, we separately investigated two cohorts of patients treated with first-line pembrolizumab or chemotherapy. We also investigated whether GRIm-Score at 45 days since treatment initiation (GRImT1) and GRIm-Score difference between the two timepoints may better predict clinical outcomes (GRImΔ = GRImT0 − GRImT1). Methods: We retrospectively evaluated 222 aNSCLC patients: 135 treated with pembrolizumab and 87 treated with chemotherapy as the first-line regimen. NLR, serum albumin and LDH concentrations were assessed at T0 and at T1. According to the GRIm-Score, patients were assigned 1 point if they had NLR > 6, LDH > upper limit normal or albumin < 3.5 g/dL. Patients with a GRIm-Score < 2 were considered as having a low Score. Results: In both cohorts, no difference in terms of overall survival (OS) between patients with low and high GRImT0 was found. Otherwise, median OS and progression free survival (PFS) of the low GRImT1 group were significantly longer than those of the high GRImT1 group in pembrolizumab-treated patients, but not in the CHT cohort (pembrolizumab cohort: low vs. high; median OS not reached vs. 9.2 months, p = 0.004; median PFS 10.8 vs. 2.3 months, p = 0.002). Patients receiving pembrolizumab with stable/positive GRImΔ had better OS (median OS not reached vs. 12.0 months, p < 0.001), PFS (median PFS 20.6 vs. 2.6 months, p < 0.001) and objective response rate (58.2% vs. 7.6%, p = 0.003) compared to patients with negative GRImΔ. Conclusion: Our data shown that GRImT1 and GRImΔ are more reliable peripheral blood biomarkers of outcome compared to GRImT0 in aNSCLC patients treated with pembrolizumab and might represent useful biomarkers to drive clinical decisions in this setting.
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Affiliation(s)
- Edoardo Lenci
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
| | - Luca Cantini
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
- Department of Pulmonary Medicine, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.A.); (A.-M.C.D.); (J.G.J.V.A.)
- Erasmus MC Cancer Institute, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Federica Pecci
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
| | - Valeria Cognigni
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
| | - Veronica Agostinelli
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
| | - Giulia Mentrasti
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
| | - Alessio Lupi
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
| | - Nicoletta Ranallo
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
| | - Francesco Paoloni
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
| | - Silvia Rinaldi
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
| | - Linda Nicolardi
- Medical Oncology, Ospedali Riuniti Padova Sud, 35043 Monselice, Italy; (L.N.); (R.C.)
| | - Andrea Caglio
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, 10128 Torino, Italy; (A.C.); (M.D.M.)
| | - Sophie Aerts
- Department of Pulmonary Medicine, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.A.); (A.-M.C.D.); (J.G.J.V.A.)
- Erasmus MC Cancer Institute, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Alessio Cortellini
- Medical Oncology, St Salvatore Hospital, 67100 L’Aquila, Italy; (A.C.); (C.F.)
- Department of Biotechnology and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Corrado Ficorella
- Medical Oncology, St Salvatore Hospital, 67100 L’Aquila, Italy; (A.C.); (C.F.)
- Department of Biotechnology and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Rita Chiari
- Medical Oncology, Ospedali Riuniti Padova Sud, 35043 Monselice, Italy; (L.N.); (R.C.)
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, 10128 Torino, Italy; (A.C.); (M.D.M.)
| | - Anne-Marie C. Dingemans
- Department of Pulmonary Medicine, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.A.); (A.-M.C.D.); (J.G.J.V.A.)
- Erasmus MC Cancer Institute, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Joachim G. J. V. Aerts
- Department of Pulmonary Medicine, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.A.); (A.-M.C.D.); (J.G.J.V.A.)
- Erasmus MC Cancer Institute, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Rossana Berardi
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
- Correspondence: ; Tel.: +39-071-596-4169
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Lenci E, Cantini L, Rinaldi S, Pecci F, Cognigni V, Agostinelli V, Mentrasti G, Ranallo N, Lupi A, Paoloni F, Cortellini A, Ficorella C, Chiari R, Di Maio M, Aerts J, Dingemans A, Nicolardi L, Caglio A, Aerts S, Berardi R. FP12.06 GRIm-Score Variations Predict Outcome in Metastatic NSCLC Patients Treated with First-Line Pembrolizumab. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.132] [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: 10/21/2022]
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Bittoni A, Pecci F, Mentrasti G, Crocetti S, Lupi A, Lanese A, Pellei C, Ciotti C, Cantini L, Giampieri R, Lenci E, Giglio E, Bini F, Copparoni C, Meletani T, Baleani MG, Berardi R. Systemic immune-inflammation index: a prognostic tiebreaker among all in advanced pancreatic cancer. Ann Transl Med 2021; 9:251. [PMID: 33708878 PMCID: PMC7940927 DOI: 10.21037/atm-20-3499] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Pancreatic ductal adenocarcinoma (PDAC) detains a dismal prognosis and has a limited number of prognostic factors. Inflammation has been demonstrated to play a key role both in PDAC initiation and progression and several inflammation-based prognostic scores have been investigated in a wide range of malignancies. We compared the most analyzed inflammation-based prognostic scores in order to establish their potential impact on prediction of the outcome in advanced PDAC patients. Methods A total of 234 advanced PDAC patients undergoing first-line chemotherapy in our institute were retrospectively analyzed. Baseline clinicopathological and pre-treatment laboratory data were collected. Survival was estimated using Kaplan-Meier method and survival differences were evaluated using the log-rank test. Level of statistical significance P was set at 0.05. Only those variables that proved to be associated with statistically significant differences in outcome were compared in multivariate analysis using multiple Cox regression, as to identify their independent role and their relative power against each other. Results In the whole cohort, median overall survival (OS) was 8.7 months (95% CI: 7.8–9.4 months), median progression-free survival (PFS) was 3.8 months (95% CI: 3.1–4.2 months). At univariate analysis high systemic immune-inflammation index (SII) was related to shorter OS [hazard ratio (HR) =2.04, 95% CI: 1.59–4.19, P=0.0001] and PFS (HR =1.52, 95% CI: 1.11–2.20, P=0.01). This was maintained at multivariate analysis both for OS (HR =2.11, 95% CI: 1.29–3.46, P=0.003) and PFS (HR =1.64, 95% CI: 1.14–2.37, P=0.008), whereas other inflammation-based scores lost their independent role. Elevated SII (≥1,200) was associated with low albumin levels (P=0.03) and with elevated lactate dehydrogenase (LDH) (P=0.01). Conclusions Elevated SII represents an independent negative prognostic factor above all others for both OS and PFS in advanced PDAC patients treated with first-line chemotherapy, thus confirming a pivotal role of systemic inflammation on PDAC progression and on patient outcome.
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Affiliation(s)
- Alessandro Bittoni
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Federica Pecci
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Giulia Mentrasti
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Sonia Crocetti
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Alessio Lupi
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Andrea Lanese
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Chiara Pellei
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Chiara Ciotti
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Luca Cantini
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Riccardo Giampieri
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Edoardo Lenci
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Enrica Giglio
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Federica Bini
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Cecilia Copparoni
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Tania Meletani
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Maria Giuditta Baleani
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Rossana Berardi
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
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Cantini L, Pecci F, Merloni F, Lanese A, Lenci E, Paoloni F, Aerts JG, Berardi R. Old but gold: the role of drug combinations in improving response to immune check-point inhibitors in thoracic malignancies beyond NSCLC. Exploration of Targeted Anti-tumor Therapy 2021; 2:1-25. [PMID: 36046087 PMCID: PMC9400728 DOI: 10.37349/etat.2021.00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/08/2020] [Indexed: 12/02/2022] Open
Abstract
The introduction of immune checkpoint inhibitors (ICIs) in non-oncogene addicted non-small cell lung cancer (NSCLC) has revolutionized the treatment scenario and led to a meaningful improvement in patient prognosis. Disappointingly, the success of ICI therapy in NSCLC has not been fully replicated in other thoracic malignancies as small cell lung cancer (SCLC), malignant pleural mesothelioma (MPM), and thymic epithelial tumors (TETs), due to the peculiar biological features of these disease and to the difficulties in the conduction of well-designed, biomarker-driven clinical trials. Therefore, combination strategies of ICIs plus conventional therapies (either chemotherapy, alternative ICIs or targeted agents) have been implemented. Although first approvals of ICI therapy have been recently granted in SCLC and MPM (in combination with chemotherapy and different ICIs), results remain somewhat modest and limited to a small proportion of patients. This work reviews the trial results of ICI therapy in mesothelioma, SCLC, and TETs and discusses the potential of combining ICIs with old drugs.
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Affiliation(s)
- Luca Cantini
- Clinical Oncology, Università Politecnica delle Marche, A.O.U. Ospedali Riuniti, 60126 Ancona, Italy
| | - Federica Pecci
- Clinical Oncology, Università Politecnica delle Marche, A.O.U. Ospedali Riuniti, 60126 Ancona, Italy
| | - Filippo Merloni
- Clinical Oncology, Università Politecnica delle Marche, A.O.U. Ospedali Riuniti, 60126 Ancona, Italy
| | - Andrea Lanese
- Clinical Oncology, Università Politecnica delle Marche, A.O.U. Ospedali Riuniti, 60126 Ancona, Italy
| | - Edoardo Lenci
- Clinical Oncology, Università Politecnica delle Marche, A.O.U. Ospedali Riuniti, 60126 Ancona, Italy
| | - Francesco Paoloni
- Clinical Oncology, Università Politecnica delle Marche, A.O.U. Ospedali Riuniti, 60126 Ancona, Italy
| | - Joachim G.J.V. Aerts
- Department of Pulmonary Medicine, Erasmus MC, 3015 CE Rotterdam, The Netherlands 3Erasmus MC Cancer Institute, Erasmus MC, 3015 CE Rotterdam, The Netherlands
| | - Rossana Berardi
- Clinical Oncology, Università Politecnica delle Marche, A.O.U. Ospedali Riuniti, 60126 Ancona, Italy
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Giampieri R, Cantini L, Giglio E, Bittoni A, Lanese A, Crocetti S, Pecci F, Copparoni C, Meletani T, Lenci E, Lupi A, Baleani MG, Berardi R. Impact of Polypharmacy for Chronic Ailments in Colon Cancer Patients: A Review Focused on Drug Repurposing. Cancers (Basel) 2020; 12:cancers12102724. [PMID: 32977434 PMCID: PMC7598185 DOI: 10.3390/cancers12102724] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 01/10/2023] Open
Abstract
Colorectal cancer is characterized by high incidence worldwide. Despite increased awareness and early diagnosis thanks to screening programmes, mortality remains high, particularly for patients with metastatic involvement. Immune checkpoint inhibitors or poly (ADP-ribose) polymerase (PARP)-inhibitors have met with disappointing results when used in this setting, opposed to other malignancies. New drugs with different mechanisms of action are needed in this disease. Drug repurposing might offer new therapeutic options, as patients with metastatic colorectal cancer often share risk factors for other chronic diseases and thus frequently are on incidental therapy with these drugs. The aim of this review is to summarise the published results of the activity of drugs used to treat chronic medications in patients affected by colorectal cancer. We focused on antihypertensive drugs, Non-Steroid Anti-inflammatory Drugs (NSAIDs), metformin, antidepressants, statins and antibacterial antibiotics. Our review shows that there are promising results with beta blockers, statins and metformin, whereas data concerning antidepressants and antibacterial antibiotics seem to show a potentially harmful effect. It is hoped that further prospective trials that take into account the role of these drugs as anticancer medications are conducted.
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Baleani M, Bittoni A, Prete MD, Lanese A, Meletani T, Giglio E, Cantini L, Crocetti S, Copparoni C, Lupi A, Lenci E, Bini F, Giulia M, Pecci F, Bisonni R, Alessandroni P, Graziano F, Berardi R, Giampieri R. P-75 Retrospective comparison between FLOT perioperative chemotherapy vs surgery followed by adjuvant chemotherapy: Results from a multicenter analysis. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.157] [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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Bittoni A, Pecci F, Giulia M, Pellei C, Zizzi A, Mandolesi A, Piva F, Murrone A, Cantini L, Lanese A, Giglio E, Meletani T, Baleani M, Crocetti S, Lenci E, Copparoni C, Lupi A, Giampieri R, Berardi R. P-117 Prognostic role of plasmatic exosomal and tissue caveolin-1 in metastatic pancreatic cancer patients. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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15
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Giampieri R, Zizzi A, Bittoni A, Pecci F, Giglio E, Giulia M, Lupi A, Mandolesi A, Copparoni C, Crocetti S, Bini F, Lanese A, Lenci E, Cantini L, Baleani M, Meletani T, Berardi R. P-27 Retrospective observational analysis of p53 mutational status as a prognostic factor in TAS-102 treated metastatic colorectal cancer patients. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Cantini L, Merloni F, Rinaldi S, Lenci E, Marcantognini G, Meletani T, Fiordoliva I, Morgese F, Torniai M, Ricci G, Giampieri R, Berardi R. Electrolyte disorders in advanced non-small cell lung cancer patients treated with immune check-point inhibitors: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2020; 151:102974. [PMID: 32416348 DOI: 10.1016/j.critrevonc.2020.102974] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 03/20/2020] [Accepted: 04/23/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Aim of this meta-analysis was to determine the relative risk (RR) of electrolyte disorders (EDs) in advanced non-small cell lung cancer (aNSCLC) patients treated with immune check-point inhibitors (ICIs). METHODS We searched for phase II/III randomized controlled trials (RCTs) comparing ICIs (alone or combined with chemotherapy) with standard chemotherapy in aNSCLC. Summary incidence and RR were calculated. RESULTS Six RCTs with data on all-grade hyponatremia were identified (n = 3257). The incidence was 8.7 % in the study group and 4.9 % in the control group (RR 1.78, 95 %CI 1.12-2.80). Looking at all-grade hypokalemia, 7 RCTs were included (n = 4119). Incidence was 10.4 % in ICIs-treated patients and 5.9 % in the control arms (RR 1.62, 95 % CI 1.30-2.02). CONCLUSIONS Treatment with ICIs in aNSCLC is associated with a significant increased risk of hyponatremia and hypokalemia compared to chemotherapy. Monitoring of electrolyte levels should be emphasized in this setting.
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Affiliation(s)
- Luca Cantini
- Clinical Oncology, Polytechnic University of Marche, AOU Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Filippo Merloni
- Clinical Oncology, Polytechnic University of Marche, AOU Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Silvia Rinaldi
- Clinical Oncology, Polytechnic University of Marche, AOU Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Edoardo Lenci
- Clinical Oncology, Polytechnic University of Marche, AOU Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Giulia Marcantognini
- Clinical Oncology, Polytechnic University of Marche, AOU Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Tania Meletani
- Clinical Oncology, Polytechnic University of Marche, AOU Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Ilaria Fiordoliva
- Clinical Oncology, Polytechnic University of Marche, AOU Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Francesca Morgese
- Clinical Oncology, Polytechnic University of Marche, AOU Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Mariangela Torniai
- Clinical Oncology, Polytechnic University of Marche, AOU Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Giulia Ricci
- Clinical Oncology, Polytechnic University of Marche, AOU Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Riccardo Giampieri
- Clinical Oncology, Polytechnic University of Marche, AOU Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Rossana Berardi
- Clinical Oncology, Polytechnic University of Marche, AOU Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy.
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Pierucci F, Frati A, Squecco R, Lenci E, Vicenti C, Slavik J, Francini F, Machala M, Meacci E. Non-dioxin-like organic toxicant PCB153 modulates sphingolipid metabolism in liver progenitor cells: its role in Cx43-formed gap junction impairment. Arch Toxicol 2016; 91:749-760. [PMID: 27318803 DOI: 10.1007/s00204-016-1750-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 06/08/2016] [Indexed: 12/13/2022]
Abstract
The non-dioxin-like environmental toxicant 2,2',4,4',5,5'-hexachlorobiphenyl (PCB153), member of a group of persistent organic pollutants wide-spread throughout the environment, reduces gap junction intercellular communication (GJIC), an event possibly associated with tumor promotion. Since very few studies have investigated the signaling effectors and mode(s) of action of PCB153, and it is known that the gap junction (GJ) protein Cx43 can be regulated by the bioactive sphingolipid (SL) sphingosine 1-phosphate (S1P), this in vitro study mainly addresses whether SL metabolism is affected by PCB153 in rat liver epithelial WB-F344 cells. PCB153 treatment obtained significant changes in the S1P/ceramide (Cer) ratio, known to be crucial in determining cell fate. In particular, an increase in S1P at 30 min and a decrease of the bioactive lipid at 3 h were observed, whereas Cer level increased at 1 h and 24 h. Notably, a time-dependent modulation of sphingosine kinase (SphK), the enzyme responsible for S1P synthesis, and of its regulators, ERK1/2 and protein phosphatase PP2A, supports the involvement of these signaling effectors in PCB153 toxicity. Electrophysiological analyses, furthermore, indicated that the lipophilic environmental toxicant significantly reduced GJ biophysical properties, affecting both voltage-dependent (such as those formed by Cx43 and/or Cx32) and voltage-independent channels, thereby demonstrating that PCB153 may act differently on GJs formed by distinct Cx isoforms. SphK down-regulation alone induced GJIC impairment, and, when combined with PCB153, the acute effect on GJ suppression was additive. Moreover, after enzyme-specific gene silencing, the SphK1 isoform appears to be responsible for down-regulating Cx43 expression, while being the target of PCB153 at short-term exposure. In conclusion, we provide the first evidence of novel effectors in PCB153 toxic action in rat liver stem-like cells, leading us to consider SLs as potential markers for preventing GJIC deregulation and, thus, the tumorigenic action elicited by this environmental toxicant.
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Affiliation(s)
- F Pierucci
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Research Unit of Molecular and Applied Biology, University of Florence, Viale GB Morgagni 50, 50134, Florence, Italy
| | - A Frati
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Research Unit of Molecular and Applied Biology, University of Florence, Viale GB Morgagni 50, 50134, Florence, Italy
| | - R Squecco
- Department of Experimental and Clinical Medicine, Section of Physiological Sciences, University of Florence, Viale GB Morgagni 63, 50134, Florence, Italy
| | - E Lenci
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Research Unit of Molecular and Applied Biology, University of Florence, Viale GB Morgagni 50, 50134, Florence, Italy
| | - C Vicenti
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Research Unit of Molecular and Applied Biology, University of Florence, Viale GB Morgagni 50, 50134, Florence, Italy
| | - J Slavik
- Veterinary Research Institute, Hudcova 70, 62100, Brno, Czech Republic
| | - F Francini
- Department of Experimental and Clinical Medicine, Section of Physiological Sciences, University of Florence, Viale GB Morgagni 63, 50134, Florence, Italy
| | - M Machala
- Veterinary Research Institute, Hudcova 70, 62100, Brno, Czech Republic
| | - E Meacci
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Research Unit of Molecular and Applied Biology, University of Florence, Viale GB Morgagni 50, 50134, Florence, Italy.
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Abstract
Carbohydrates are attractive building blocks for diversity-oriented synthesis due to their stereochemical diversity and high density of polar functional groups.
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Affiliation(s)
- E. Lenci
- Department of Chemistry “Ugo Schiff”
- University of Florence
- Sesto Fiorentino
- Italy
| | - G. Menchi
- Department of Chemistry “Ugo Schiff”
- University of Florence
- Sesto Fiorentino
- Italy
| | - A. Trabocchi
- Department of Chemistry “Ugo Schiff”
- University of Florence
- Sesto Fiorentino
- Italy
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Quintaliani G, Lenci E, Ferrara G, Gentile G. [From evidence to practice: a difficult but not impossible itinerary]. G Ital Nefrol 2007; 24 Suppl 38:49-54. [PMID: 17922448] [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: 05/25/2023]
Abstract
In recent years, evidence-based medicine (EBM) has acquired its own dignity and cultural identity, and increasing importance. EBM helps doctors understand that the uncertainties of medicine must be analyzed quantitatively in order to rationalize and systematize the information gathered from clinical observation; on the other hand, it provides them with suitable instruments to estimate the performance of diagnostic tests and the efficacy of drugs. One of the main merits of EBM has been the progressive spread of randomized controlled trials as the gold standard for evaluating the effectiveness of treatments. EBM's primary objectives can be summarized by the following points: 1) To transform the physicians' need for information into questions that may be answered (ie, formulate the questions); 2) To find in an as efficient way as possible the best evidence to answer these questions; 3) To critically evaluate the evidence obtained (ie, assign a weight to it) in order to determine its validity (ie, its approximation to the truth) and its usefulness (ie, its concrete clinical applicability); 4) To introduce into clinical practice the conclusions drawn from the results; 5) To estimate individual physicians' performance (ie, one's own conduct and efficiency). EBM's advantages are not only that physicians have acquired a method to search for the right evidence and to apply diagnostic and therapeutic procedures, but, more importantly, that it has provided them with the only tool for true quality improvement, namely the critical appraisal of their own work. Unfortunately, the latter is too often based on a different type of EBM: Evidence-Based Medicine.
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Affiliation(s)
- G Quintaliani
- SC Nefrologia e Dialisi, Ospedale SM Misericordia, Perugia, Italy.
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Quintaliani G, Gori F, Lenci E, Benci L, Fioroni S. [Nurses' professional responsibility]. G Ital Nefrol 2005; 22 Suppl 31:S94-100. [PMID: 15786411] [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: 05/02/2023]
Abstract
As managed care relevance is growing, several old issues related to personal institutional responsibility are increasing among practitioners. Therefore, as a professional figure a nurse bases his/her job on a mix of personal knowledge and skills along with training, and he/she is responsible for giving advice in line with professional care standards. In addition, he/she is in charge of the treatment pattern agreed with the patient. However, nursing is a much more complex job, which leads professional figures facing the controversial issue of combining institutional responsibility and nursing professional tasks and duties daily. As far as nursing institutional responsibility is concerned, different view points or approaches can be applied to investigate it. The most common one is the legal approach, yet this is not the most appropriate one. Therefore, our professional background is mainly based on a management prospective rather than a legal one; dealing with the issue legally would lead, essentially, to a summary of laws and regulations without any kind of argumentative discussion. Consequently, this study aimed to analyze nurses' institutional responsibility by approaching the issue from an innovative human resources management prospective; therefore, defining the gap between nursing institutional responsibility and its tasks.
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Affiliation(s)
- G Quintaliani
- Struttura Complessa di Nefrologia e Dialisi della Azienda Ospedale di Perugia - Italy
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Lenci E, Perko V, Falaschi C. [Clinico-radiological observations and biological studies in patients with pulmonary tuberculosis treated with prothionamide]. G Pneumol 1970; 14:249-63. [PMID: 5526261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Lenci E, Croce G, Falcone G. [Treatment of chronic pleural empyema with gentamicin]. G Ital Chemioter 1969; 16:171-7. [PMID: 5404094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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